Semashko Nikolai Alexandrovich: contribution to medicine. On

SEMASHKO NIKOLAY ALEXANDROVICH

(8/20. 09. 1874, the village of Livenskoye, Eletsk district, now Zadonsk district - 05.18. 1949, Moscow), party and statesman, one of the organizers of Soviet healthcare, academician of the Academy of Medical Sciences of the USSR (1944) and the Academy of Pedagogical Sciences of the RSFSR (1945 ). Born into the family of a teacher, his ancestors on his father’s side were Polish nobles, participants in the national liberation movement, his mother was G. V. Plekhanov’s sister. In 1883 he was admitted to the Yelets gymnasium. In his senior year, he organized with a group of high school students (including S. M. Maslov, the future Socialist Revolutionary and Minister of Agriculture of the 3rd coalition Provisional Government of 1917) a group to study banned Marxist literature. For his brilliant studies, Semashko was allowed to graduate from high school, but without a gold medal.

In 1891 he entered the medical faculty of Moscow University and quickly became an active participant in the student social movement, joining its medical wing. In 1893 he was elected to the illegal Moscow “Council of Student Associations” and soon became one of its leaders. In 1895 he met V.I. Lenin on one of his visits to Moscow. In December 1895, he was arrested for organizing a student demonstration and, after a three-month prison sentence, was exiled to Yelets for three years under public police supervision. Here Semashko founded a Marxist circle, and also, under the legal cover of a Sunday school, launched Social Democratic propaganda among railway workers.

After the end of the expulsion, he entered Kazan University to complete his medical education. In 1899-1901, together with A.I. Rykov, he conducted revolutionary work in Kazan. After graduating from the university in 1901, he worked as a local doctor in the Oryol and Samara provinces, and from 1904 - in Nizhny Novgorod. Here Semashko became one of the leaders of the city committee of the RSDLP. During the revolutionary events of 1905, he was among the organizers of the uprising of Sormovo workers. After serving nine months in prison and being released for health reasons (exacerbation of tuberculosis), he immediately emigrated to Switzerland. In August 1907, Semashko was a delegate to the Stuttgart Congress of the 2nd International from the Geneva Bolshevik organization. In January 1908 he was arrested by the Swiss police on charges of assisting in the armed expropriation of the Tiflis bank. After liberation, he moved with the Bolshevik foreign center to Paris, where until 1910 he was secretary of the foreign bureau of the Central Committee of the RSDLP. He was a delegate to the 6th (Prague) All-Russian Conference of the RSDLP (1912), where he made a report on state insurance of workers. In 1913 he participated in the social democratic movement in Serbia and Bulgaria; at the beginning of World War I he was interned. In September 1917 he returned to Russia. Participated in the preparation of the October uprising in Moscow, organized medical assistance to the rebels.

After the October Revolution, Semashko was the head of the medical and sanitary department of the Moscow City Council, then from 1918-1930. - - First People's Commissar of Health of the RSFSR. In October 1924, Semashko came to Yelets and got acquainted with the organization of medical care in the city and region. In January 1931, Semashko visited Yelets again and assisted in the construction of a new city hospital (now the hospital bears his name) and a children's hospital. In 1922-1949. Semashko is a professor, head of the department of social hygiene of the medical faculty of Moscow University (since 1930 - 1st Moscow Medical Institute). In 1930-1936. - member of the Presidium of the All-Russian Central Executive Committee, chairman of the children's commission, which supervised treatment and preventive work in children's health institutions and fought against homelessness. In 1945-1949 was director of the Institute of School Hygiene of the Academy of Medical Sciences of the RSFSR and at the same time (1947-1949) of the Institute of Health Organization and History of Medicine of the Academy of Medical Sciences of the USSR. Initiator of the creation of the Central Medical Library (1918) and the House of Scientists (1922) in Moscow. In 1927-1936 - editor-in-chief of the Great Medical Encyclopedia.

Prishvin and Semashko studied at the Yeletsk boys' gymnasium. Under the influence of Semashko, Prishvin became interested in Marxism already in his high school years. The story of their high school friendship will find artistic expression in the autobiographical novel “Kashcheev’s Chain.” In the novel, Efim Nesgovorov (N. Semashko) will introduce Kurymushka to forbidden literature.

“Tell you what, brother,” said Nesgovorov, “you understood physics right away, try to defeat Buckle, take it and read it, I’ll bring it to you tomorrow, just don’t show it to anyone, and this is considered a forbidden book in our country.”

For-pre-schen-noy!

Well, what's wrong with that... you should already know this: there is a whole underground life.

Pod-pol-na-ya! (2, 86).

Nesgovorov-Semashko opened a “completely new world” to Kurymushka-Prishvin.

M. Vvedenskaya, sister of A. M. Konoplyantsev, the writer’s friend in Yelets, one of the first graduates of the Bestuzhev courses, a doctor, recalls how they, her brother, Prishvin, Semashko, Maslov and other gymnasium students in Yelets, read Marx, for which they were expelled from the gymnasium Semashko, but they soon returned: “At the final exams, everything was done in order not to give him medals: so, the law of God forced him to answer in Greek, and he answered. He wrote a brilliant essay, and they gave him a “high five” for his behavior, but still didn’t give him a medal” (Vvedenskaya M. M. Eletsky friends // Personal file of Mikhail Mikhailovich Prishvin. St. Petersburg: Rostock, 2005. P. 27).

Prishvin often repeated that Semashko was his “first friend”: “... People’s Commissar Semashko was my classmate, my first friend (and to this day he helps out of every trouble, almost anything - to him, a very good person, honest to the last detail) (Prishvin M Diaries 1920-1922. M., 1995. P. 275).

However, in his assessments of the human qualities of Nikolai Semashko, Prishvin, like his autobiographical hero Alpatov, is not always consistent. The orthodox Marxist Nesgovorov even tried to fit Raphael’s “Madonna of Sixine” into the chain of causes and consequences of the monistic view of history: “...Why are you dressed up, sitting among the bourgeoisie and looking at the Madonna like an owl?

Alpatov tensed up to fight and replied:

Admit it, Efim, you also came to look at the Madonna, and in your own way you looked at her with great curiosity... You, too, like everyone else, are drawn to the Madonna.

“I’m drawn,” Yefim answered, “I’ll now try to tell you what I promised: I’m drawn to hide somewhere under one of the sofas on which the Madonna’s contemplators are sitting, wait for the bell to ring and lie there until the watchmen leave, and then cut out the Madonna and destroy it.

Alpatov lowered his eyes and, pale, said quietly:

I could kill for this.

Efim began to look closely at Alpatov and asked:

Can you?

“I can stand up for my own things,” replied Alpatov (2, 309).

Disillusioned with Marxism, Prishvin takes a different path, the path of spiritual growth, a path that excludes any violence, physical or moral: “Semashko: my path is common with God’s creature, but your path is different: you have all suppressed within yourself the possible, perhaps, love for a woman, love for the motherland, and the desire for art and science, and the inclination of every free person to think about the life of the world (philosophy) in order to take the human path, that is, to put his will for happiness ahead of his personal existence others (“until this happens, I give up life”). My question is: isn’t it time to free all Russian creatures from the obligation to share the path with you? The creature wants to be the creature.

The October days are mysterious for us, and we are not their judges yet, but the veil has fallen in the present: this is the name of the state life of thieves and robbers (M. M. Prishvin. Diaries 1920-1922. M., 1995. P. 108).

But if “you close your eyes to his policy and approach him (Semashko. - N.B.) from the human side,” then Semashko as a person appears to Prishvin as the ideal of moral purity: “...purity of nature (morality, humanity). Uneasiness to deal with conscience. Secret romanticism. Refusal of personal life" (M. Prishvin. Diaries 1918-1919. M., 1994. P. 89). But such a path for Prishvin is “a path to crucifixion, suffering,” and he, as a person and a writer, needs the joy, depth and unpredictability of life’s creativity, which Semashko cannot see because of his “political myopia.”

“The movement of the spirit,” mental maturation, “the slow accumulation of love in words” underlie the creative fate of the writer who abandoned Marxist dogmatics. On January 26, 1941, he wrote in his diary: “And so in 1906 (an error in the manuscript - the book was published in 1907 - Composition.), when my first book... “In the Land of Unfrightened Birds” was published in an excellent edition, I was told in the greatest secret that N.A. Semashko had secretly arrived from emigration and was inviting me on a date. It was difficult for me to go to the business man of the revolution, because even in my new business I was not yet firm and could not prove in any way my right to be a freedman of the revolution. Everything went well while we were in public, but when our hostess left both of her favorite friends to spend the night in the same room, both of them became awkward. Before going to bed we had this conversation:

What are you doing now?

And it's all?

Of course, I gave up agronomy: I can’t combine it.

And satisfies?

Yes, I want to write about what I love: my first book is dedicated to my homeland.

Now we don’t need to love our homeland, but hate it.

I don’t like our Yelets homeland either.

You have always had a tendency to think in a philistine way, am I talking about Yelets?

No, I’m not a philistine, I’m only inclined to think in images: my homeland is not in Yelets, but in the land of unafraid birds. I believe that such a homeland of mine exists, and I love it selflessly. What about the revolution? Revolution is not love, but action. My love also includes revolution, since it is a movement of the spirit. If I had been able to participate in the revolution, like Rudin, I would not have given up such a moment and, perhaps, would have died long ago at Krasnaya Presnya. But to do it slowly, to organize, to wait, to accumulate the power of hatred in myself, to pray to an unknown god for vengeance, I cannot do this, I am incapable.

What are you capable of?

To the same slow accumulation of love in the word. This is also not easy, perhaps even more difficult, but I am more capable of it. I can do this..." (Memoirs of Mikhail Prishvin. St. Petersburg; M., 1991. P. 24).

Lit.:

Blinkin S. A. N. A. Semashko. M., 1978.

Prishvin M. M. Diaries. 1918-1919. M.: Moscow worker, 1994.

Prishvin M. M. Diaries. 1920-1922. M.: Moscow worker, 1995.

I. Introduction……………………………………………………………………………….3

II. Main part

o Life and work before the October Revolution……………………………4

o Creation of the People's Commissariat of Health……………………………6

o Measures to combat epidemics…………………………………………8

o Work in the People's Commissariat of Health after the Civil War……………………………...10

o N.A. Semashko and the reform of rural healthcare………………….11

o Pedagogical activity of N.A. Semashko………………………………….12

o Other activities of N.A. Semashko……………………………………………………13

III. Conclusion…………………………………………………………………………………14

IV. List of sources and literature……………………………………………………………..15

Introduction

This work is dedicated to the personality of Nikolai Aleksandrovich Semashko, an outstanding health care organizer, the first People's Commissar of Health, theorist and creator of the unique Soviet health care system.

Although widely known during the Soviet era, nowadays his name and his achievements are becoming less and less known. Information about his life is mostly contained only in specialized literature. However, in my opinion, it deserves more attention. He did a tremendous amount of work to create a fundamentally new Soviet healthcare system that had no analogues in the world at that time. It must be remembered that Soviet medicine was created in extremely difficult conditions of the collapse of all old social institutions, the Civil War, an acute shortage of personnel and institutions, and numerous epidemics. Nevertheless, such a system was created and launched. You can criticize it and consider it erroneous, but one thing is indisputable - this system has functioned for more than 70 years, reaching serious heights in improving the health of the population and providing it with qualified and affordable medical care. Moreover, the modern Russian healthcare system was created on the basis of the Soviet one, having inherited numerous treatment and preventive institutions, educational institutions and research institutes.

This work tells about the main events of N.A.’s life. Semashko, about his activities before the October Revolution, work as head of the People's Commissariat of Health and editor-in-chief of the Great Medical Encyclopedia, teaching work. The main goal of my work is to show his most basic achievements, which were of great importance for the development of medicine in Russia and the USSR in the 20th century.

Life and work before the October Revolution

N.A. Semashko was born on September 20, 1874 in the village of Livensky, Oryol province. His mother was the sister of the famous Marxist G.V. Plekhanov.

Childhood of N.A. Semashko passed in the village with his aunt. Having entered the gymnasium, he was actively engaged in self-education. In particular, in the last grade, he and his friends organized an illegal club for self-development and reading prohibited books. In this circle the works of V.G. Belinsky, N.A. Dobrolyubov, D.I. Pisarev, N.G. Chernyshevsky were studied. But the activities of the circle were exposed. N.A. Semashko should have been expelled, but the pedagogical council, taking into account his excellent academic performance, decided to leave him in the gymnasium, although depriving him of a gold medal.

In 1891, N.A. Semashko entered the medical faculty of Moscow University. At that time, illegal literature and conspiracy circles were distributed among students, and liberal-minded professors (A.I. Chuprov, I.M. Sechenov, K.A. Timiryazev, etc.) gave lectures at the university. While studying at Moscow University, N.A. Semashko became acquainted with the works of G.V. Plekhanov and V.I. Lenin (in 1894).

He studied with outstanding professors of that time, the creators of advanced medical schools of world significance, such as physiologist I.M. Sechenov, hygienist F.F. Erisman, pediatrician N.F. Filatov, therapist G.A. Zakharyin, surgeon N.V. Sklifosovsky, psychiatrist S.S. Korsakov and others. “We, doctors,” recalls N.A. Semashko, “loved them very much and showed our affection for them in every possible way.”

In December 1895 N.A. Semashko was arrested for preparing a mass demonstration of students and workers. He spent three months in solitary confinement in a prison at the Prechistensky police station. In prison, he actively studied political economy, economic geography, literature, French, not forgetting about medicine. After his release, N.A. Semashko was exiled to Yelets for three years, under open political supervision. He was also expelled from the university and prohibited from entering higher education institutions.

In 1898, after serving his term of deportation, N.A. Semashko tried to reinstate himself at Moscow University, but was refused. Then he decided to move to Kazan to complete his education, where he was nevertheless enrolled in the 4th year of the medical faculty of Kazan University, which then shone with outstanding names in medical terms, such as Professor E.V. Adamyuk, Professor L.O. Darkshevich ( neuropathologist), Professor V.I. Razumovsky (surgeon) and many others.

In February 1901, in response to the suppression of protests by students at St. Petersburg University, a mass student demonstration took place in Kazan. After its acceleration N.A. Semashko was arrested and spent about a month in prison. However, the accusation of writing a revolutionary proclamation was not proven. He was prohibited from living in all university cities in Russia for a year. This deprived him of the opportunity to pass the state exam and become a doctor.

But he firmly decided to complete his medical education at all costs. Having settled outside the city, he continued to study. The professors, who noted his extraordinary abilities, begged the police chief not to arrest him if he appeared at the university to take exams. In the evenings, having pasted on a beard and mustache, wearing blue glasses, N.A. Semashko came to the university and took exams. In 1901, he passed the state examination to become a doctor with honors.

While studying at the university, he was invited to work in the clinic or in the department after graduation. However, this became impossible due to “political unreliability.” However, Professor M.Ya. Kapustin gave N.A. Semashko a letter of recommendation to M.M. Gran, head of the Provincial Sanitary Bureau in Samara, with a request to give N.A. Semashko position of doctor-epidemiologist. In Samara, after a month of improvement in bacteriology, he was sent to fight epidemics in the village of Orlov-Gai, and then to the village of Novaya Aleksandrovka, where cases of plague were registered. According to the order of the anti-plague commission, the village should have been burned. With the permission of the authorities, N.A. Semashko went to the site to find out the causes of the disease. After the necessary laboratory tests, he came to the conclusion that it was not the plague, but a cutaneous form of Anthrax, and immediately began treating patients and preventing it. Soon all cases of the disease were eliminated. Thus, from the very first steps of his independent activity, N.A. Semashko proved himself to be an outstanding organizer and talented physician.

Having worked in Buzuluk, then in the Saratov province, N.A. Semashko got a job as head of a rural medical district with a small hospital in the Mtsensk district of the Oryol province. He worked in this place for three years. He not only treated the sick, but also gave lectures to peasants about common diseases, paying special attention to the sanitary, hygienic and socio-economic prerequisites for their occurrence.

In December 1905, he was one of the leaders of the workers' uprising of Nizhny Novgorod and Sormovo. During the uprising, he led the work of sanitary detachments that provided medical assistance to the rebels.

After the suppression of the uprising, N.A. Semashko was arrested and imprisoned in Nizhny Novgorod prison, where he fell ill with tuberculosis. Only after nine months of imprisonment was he, at the request of his relatives and comrades, released on bail. Knowing that he was facing hard labor, the Nizhny Novgorod party organization decided to transport him abroad.

After long wanderings, he reached Switzerland. Life as an emigrant was by no means easy. ON THE. Semashko recalls: “Again, less frequent lunches, again sausage, as an ideal, again more black bread. No earnings, no lessons. After some time, I received a small amount of money from my aunt. Literary income turned up: one rich Armenian decided to publish the social democratic magazine “Rainbow”... ...But only a few issues of the magazine were published (two or three), the funds dried up, the magazine closed... ...So I lived from bread to water.”

In 1913, N.A. Semashko left for the Balkans and until February 1917 he lived, working as a doctor, in Serbia, then in Bulgaria.

In September 1917, having returned from emigration to Moscow, N.A. Semashko, together with other doctors (M.F. Vladimirsky, V.A. Obukh, Z.P. Solovyov, etc.) was engaged in political activities. From the Bolshevik Party he was elected chairman of the Pyatnitskaya Council of Moscow. In this post, he was actively involved in organizing the city economy that had suffered during the war, organizing healthcare and public education.

Creation of the People's Commissariat of Health

In the Russian Empire, healthcare was dispersed among various departments and charitable organizations, and in cities it was represented mainly by private practitioners. For the entire population (159 million people in 1913), there were 28 thousand doctors, that is, an average of two doctors per 10 thousand population, with most doctors practicing in large cities in the European part of the country. There were about 208 thousand beds in hospitals (1.3 beds per 1000 inhabitants). More than a third of cities had no hospitals at all.

In terms of sanitary conditions, the Russian Empire was the most unfavorable country in Europe. Epidemics of typhus and relapsing fever, cholera, plague, smallpox, malaria, syphilis and tuberculosis were frequent occurrences. Preventative medicine was practically non-existent.

Every year, 2 million children died from disease. The average life expectancy was 32 years.

In such conditions, radical measures were required to solve this most important problem. It was necessary to unite all forms of departmental medicine under a single state center.

In the first days of the establishment of Soviet power, a Medical and Sanitary Department was created under the Petrograd Council of Workers' and Soldiers' Deputies. The department was tasked with reorganizing the entire medical and sanitary sector in the country and involving all doctors who sympathized with the new government in this matter. To solve these problems, Medical and Sanitary Departments (under all local Councils) and Medical Colleges (under some people's commissariats) were created locally.

ON THE. Semashko continued to work in Moscow during this period. In October 1917, the Council of District Dumas was created. ON THE. Semashko was elected a member and headed the medical and hygienic department, which was faced with the task of managing healthcare in Moscow. In this post N.A. Semashko carried out active work, especially paying attention to the concentration of forces and resources of the medical service, public and free services to the population, and carrying out sanitary measures aimed at preventing the spread of epidemics in Moscow.

In May 1918, N.A. Semashko was appointed head of the medical and sanitary department of the Moscow Council. Under his leadership, hospital bed capacity expanded, new outpatient clinics were opened, emergency medical care was created, the supply of medicines was improved, and emergency measures were taken to prevent the spread of infectious diseases.

In March 1918, N.A. Semashko became a member of the Council of Medical Colleges, the highest medical body. On May 15, 1918, the first issue of the official printed organ of the Council of Medical Colleges under the Council of People's Commissars of the RSFSR, “Izvestia of Soviet Medicine,” was published. The main task of the Council of Medical Colleges remained to unite efforts in the field of health care throughout the country. In this regard, preparations were underway for the All-Russian Congress of representatives of medical and sanitary departments, which was to resolve the issue of forming the People's Commissariat of Health of the RSFSR.

On June 16-19, 1918, the All-Russian Congress of the Medical and Sanitary Departments of the Soviets took place in Moscow. N.A. Semashko made a report at the congress “On the organization of Soviet medicine locally,” in which he outlined the principles and foundations of the organization of the future of Soviet healthcare.

The main provisions of N.A. Semashko’s report are as follows:

1. “The urgent organizational task of Soviet local medicine is to eliminate the previous interdepartmental framework and unify it.
2. Curative medicine should be built on the sequence of principles: a) universal accessibility and b) free.
3. There is an immediate need to improve the quality of medical care (special appointments, special outpatient clinics, special hospitals). It is necessary to categorically fight against the trend of independent paramedics, which is now noticeable in some provincial areas.
4. The next medical and sanitary tasks of Soviet medicine, in addition to general and ordinary ones, are the fight against social diseases (tuberculosis, sexually transmitted diseases), the fight against infant mortality, etc.
5. Only Soviet sanitation is capable of combating radically and effectively the housing needs of the poorest population.
6. In view of the insufficiently conscious attitude of the masses of the population, especially in the provinces, to health issues, it is necessary to immediately develop the widest possible sanitary and educational activities (conversations, lectures, exhibitions, etc.).
7. The forms of participation of the population in health care activities and the forms of their initiative in this regard must be radically changed: it is necessary to involve workers’ organizations in the cities and the rural poor in the villages in the current activities.”

In addition to N.A. Semashko’s report, the congress featured reports “Tasks and organization of the People’s Commissariat of Health” (Z.P. Solovyov and V.M. Bonch-Bruevich), “On the organization of the fight against epidemics in the conditions of the Soviet Republic (A.N. Sysin), “On insurance medicine” (I.V. Rusakov and G.V. Lindov).

After discussing the reports, the congress decided: “Based on the unity of state power underlying the structure of the Soviet republic, it should be recognized as necessary to create a single central body - the Commissariat of Health, in charge of all medical and sanitary matters.” The first All-Russian congress of medical and sanitary departments played an outstanding role in the history of Soviet healthcare. He laid the foundation for the implementation of its basic principles.

On June 26, 1918, the Council of Medical Colleges sent a memorandum and a draft decree on the creation of the People's Commissariat of Health (Narkomzdrav) of the RSFSR to the Council of People's Commissars. On July 9, 1918, they were published in Izvestia of the All-Russian Central Executive Committee for wide circulation.

Thus, for the first time in the world, a supreme government body was created that united under its jurisdiction all branches of health care in the country. N.A. was appointed the first People's Commissar of Health of the RSFSR. Semashko. He led it for 11 years - until 1930.

Anti-epidemic measures

Separately, we should talk about the activities carried out by the People's Commissariat of Health under the leadership of N.A. Semashko to combat epidemics. One of the main reasons for the massive spread of infectious diseases was the severe sanitary and epidemic state of the country, the low level of general and sanitary culture of the population. The situation was further complicated by the Civil War and foreign intervention, as numerous infectious diseases were rife in the opposing armies. Thus, among the 60 thousand soldiers who went over to the side of the Red Army after the defeat of Kolchak and Dutov, 80% were infected with typhus.

To illustrate the true state of affairs, we can cite the report of the head of the sanitary unit: “... before leaving Orsk, which is occupied by us, the whites took out all the medical personnel, property, medicines and dressings, leaving up to 2,500 patients with nothing. The appearance of the hospitals is terrible: there is absolutely no linen, beds, dishes or other property. The patients lie on straw and bare boards, on bunks and on the floor. The infection spreads to the entire garrison and the city. More than 90% of patients have typhus and relapsing fever... the mortality rate is enormous... There are masses of corpses everywhere in the city...” According to N.A. Semashko, he received such reports almost every week.

The situation was further complicated by the fact that, due to the economic devastation in the country, there was an acute shortage of the most necessary things - linen, soap, disinfectants, equipment for disinfection chambers, baths, etc.

Already in the first days of the work of the People's Commissariat of Health, a sanitary and epidemiological department was formed within its structure. A.N. was appointed its leader. Sysin.

Sanitary and epidemiological subdepartments were created locally. In October 1918, the People's Commissariat of Health convened a meeting of representatives of health departments and sanitary doctors. ON THE. Semashko opened the meeting. The meeting approved the scheme for combating typhus adopted by the People's Commissariat of Health.

On August 18, 1918, the Central Commission for the Control of Epidemic Diseases was created. On October 19, based on the materials of the work of this commission, a circular was drawn up and sent out with a plan to combat the epidemic. The plan provided for the deployment of hospital beds, the construction and equipment of baths, laundries, disinfection points, the organization of morbidity records, sanitary educational work, etc.

At the same time, the Soviet government also paid great attention to the fight against typhus. At the 7th All-Russian Congress of Soviets, V.I. Lenin said: “Comrades, all attention to this issue. Either the lice will defeat socialism, or socialism will defeat the lice!”

On a weekly basis, the People's Commissariat of Health provided the Council of People's Commissars with information on the activities of the Central Commission for the Fight against Contagious Diseases signed by N.A. Semashko.

On October 5, 1918, at a meeting of the Council of People's Commissars, N.A. Semashko made a report on the Spanish disease. After its discussion, the Council of People's Commissars granted the right to the People's Commissariat of Health to spend anti-cholera loans to combat other epidemics and to carry out measures to improve sewerage and water supply.

On January 28, 1919, based on the report of N.A. Semashko, the decree of the Council of People's Commissars “On measures against typhus” was adopted.

The People's Commissariat of Health also did a lot of work to combat the cholera epidemic. In a number of areas, emergency commissions to combat cholera were created. In cities and towns, at railway stations, river and sea terminals, anti-epidemic measures were urgently carried out. An additional network of hospitals was deployed, all medical institutions were provided with equipment, food and medicine, and patients were provided with dietary nutrition. Strict quarantines were introduced at the ports. As a result of the measures taken, already in 1922 it was possible to achieve a real reduction in the incidence, and in 1923 it was practically eliminated.

In the report to the 9th All-Russian Congress of Soviets on the activities of the People's Commissariat of Health of the RSFSR for 1921, N.A. Semashko said that “at present there is no shortage of vaccination material; this made it possible to vaccinate almost everyone in the Red Army against cholera and typhoid this year.”

Health education was of no small importance in preventing the spread of infectious diseases. On the initiative of N.A. Semashko, the Department of Health Education was created. On his instructions, a number of popular brochures (“Typhus and the fight against it”, “Typhus, its treatment and measures to combat its spread”) and posters on the fight against typhus and relapsing fever were created. In the course of this work, N.A. Semashko was the initiator of the research and implementation of new, more acute, visual and diverse forms of sanitary agitation and propaganda. These include sanitary rallies, sanitary courts, plays, dramatizations, and the organization of traveling exhibitions on sanitary education. So-called “weeks” were held: “trash control week”, “sanitation week”. The purpose of such “weeks” was to familiarize the broad masses of the population with issues of health care, Soviet medicine and to attract them to conscious and active participation in the protection of health. Short speeches by N.A. Semashko about Soviet medicine, the fight against typhus, etc. were recorded on gramophone records.

Work in the People's Commissariat of Health after the Civil War

After the end of the Civil War and the transition to the New Economic Policy, the main attention of the People's Commissariat of Health was paid to the restoration and deployment of new medical institutions, to carrying out broad preventive measures to improve the health of work and life. N.A. plays a huge role in organizing and conducting such events. Semashko. On his initiative, measures were taken to organize tuberculosis and venereal dispensaries, which actively carried out not only therapeutic, but also preventive work. ON THE. Semashko was the initiator of the creation of a network of dispensaries to combat occupational diseases. On his instructions, dispensary examinations began to be carried out for groups of workers in hazardous production. These groups were taken into special registration and subjected to periodic comprehensive examinations in order to timely detect diseases.

Under the leadership of N.A. Semashko, instructions were developed for organizing workplaces and providing them with the necessary hygiene supplies, for the proper arrangement of housing, public baths, laundries, and hairdressers. It was also pointed out the need to monitor the condition of courtyards and take measures for the sanitary improvement of villages, streets, gardens, and parks.

N.A. Semashko traveled a lot around the country to inspect hospitals and outpatient clinics, clinics and research institutes. He often made presentations at work meetings and among the intelligentsia.

In 1925, the report of the People's Commissariat of Health N.A. Semashko reported on significant successes of Soviet medicine. Thus, mortality decreased from 27.9 people per 1000 population (in 1913) to 22.7. The mortality rate of children under one year of age has decreased from an average of 27.6% in 1913 to 13.7%. The incidence of mass infections has sharply declined. There was rapid growth of medical facilities, especially in cities. The network of specialized treatment and preventive institutions has increased - anti-tuberculosis and venereal disease dispensaries, as well as institutions for the protection of motherhood and infancy. At the same time, N.A. Semashko noted the lag in rural healthcare and the need to take measures to improve it.

From May 3 to May 9, 1927, the 6th All-Russian Congress of Health Departments was held in Moscow. This congress was a kind of final congress, which summarized the experience of Soviet medicine and summed up what the health authorities had done over 10 years. ON THE. Semashko made a report at this congress “The state of health care and its tasks.”

Here are just some of the achievements.

• Morbidity and mortality from infectious diseases decreased by 20%.
• The number of hospital beds has increased by 40% compared to 1913
• The number of medical outpatient facilities increased from 5,597 in 191 to 13,204.
• The number of antenatal clinics was 2151 compared to 9 in 1913.

N.A. Semashko’s fruitful work as People’s Commissar of Health continued until 1930. In 1930, he moved to the Presidium of the All-Russian Central Executive Committee and headed the work of the Children's Commission.

N.A. Semashko and the reform of rural healthcare

ON THE. Semashko paid great attention to rural healthcare throughout his life. He wrote about 70 works devoted to this issue.

Working as a zemstvo doctor, N.A. Semashko acquired rich medical experience. He had to treat patients in an outpatient clinic, at home, work in a hospital, operate, and assist during childbirth. As he later wrote, working on a rural plot allowed him to “comprehend medical work in all its depth and diversity” and gave him “medical training” for life.

Subsequently, he repeatedly returned to the topic of rural medicine in his works. Of interest is his description of the introduction of the precinct system and the reasons for its low efficiency: “In zemstvo times, the gentlemen of the situation - zemstvos (the overwhelming majority were nobles) planted plots, guided not by a plan for serving the rural population, but by considerations of a secondary nature: proximity to the estate of an influential landowner, the presence of free (usually unsuitable for farming) land, etc.” The experience of working in such a site will later help him in the post of People's Commissar of Health during the reorganization of rural medical districts. An important place in his works on rural health care is occupied by the thesis about the need for widespread promotion of healthier living conditions and health education of the population.

ON THE. Semashko viewed rural health issues as a large and important socio-political task. He repeatedly emphasized that the tasks of improving the health of the peasantry are dictated by both the political and economic interests of the country, as well as its sanitary interests, since “without improving the health of the peasantry, there can be no talk of the sanitary well-being of the country.”

While at the post of People's Commissar of Health, he paid close attention to the shortcomings in the medical care of collective and state farms. He persistently demanded that qualified medical care be brought closer to workers of collective and state farms, a study of the working and living conditions of the rural population, the nature and causes of morbidity and injury, as well as the implementation of measures to improve the health of work and life. In his works, he dwelt in detail on the content and methods of work of a rural medical station, highlighting preventive work. So, for example, in the article “The most important quality indicators of a hospital in a village” N.A. Semashko examined the reasons for the underutilization of rural beds, which, in his opinion, lay in the lack of organization and clarity of the activities of health authorities and rural medical workers, and the low quality of work of many rural medical districts.

In December 1925, the All-Union Congress of Rural District Doctors took place. ON THE. Semashko delivered a report on the tasks of organizing medicine in rural areas, in which he drew attention to the need to improve the situation of local medical personnel, improve the supply of medical equipment and medicines, and provide rural doctors with vehicles.

Since 1936, edited by N.A. Semashko began publishing the magazine “Healthy Village”. Its pages contained materials that outlined issues of improving the health of the village, gave practical advice on rural improvement, the protection of motherhood and infancy, physical education, etc. The magazine contributed to the dissemination of medical knowledge in rural areas.

Pedagogical activity of N.A. Semashko

30 years of his life N.A. Semashko devoted himself to teaching. For 27 years he headed the Department of Social Hygiene (later the Department of Health Organization) of the 1st Moscow Medical Institute. In all questionnaires, when asked about his main profession, he invariably answered – teacher.

ON THE. Semashko took a direct part in the life of the higher medical school. He attended absolutely all meetings, congresses, conferences, and participated in the development of curricula and programs. His extensive experience in managing the health care system provided him with considerable assistance in this matter. In turn, teaching allowed him to better understand the daily needs of medicine and medical education.

In 1920 N.A. Semashko took part in the 1st All-Russian Congress on Medical Education. At the congress, a thesis was put forward about the need for a radical reorganization of the medical education system, reworking programs and teaching methods “with special attention to identifying the vocation and abilities of students.” In his report at the congress N.A. Semashko also spoke about the need for a synthesis of work and science, serious natural science and social training of future doctors.

According to N.A. Semashko, the methodology of higher medical education had to be rebuilt taking into account two important areas - the connection between teaching and life, everyday medical practice and the independence of students in the learning process. He wrote about excessive teaching supervision, high specialization of teaching in individual departments, limited within the scientific work of the department, often to the detriment of general outpatient education. “As a result of this,” he wrote, “a young doctor who has graduated from a medical university, who has memorized well what the teacher explains to him, is at a loss if he has to find himself in a situation that is unusual for him.” He insisted on teaching students to think independently in any field, both theoretical and clinical. Moreover, in the article “Let’s turn to practice,” he proposed sending teachers to practical work for a certain period of time.

ON THE. Semashko was actively involved in organizing state tests. While attaching great importance to them in improving the quality of education, he did not forget about their shortcomings. As he wrote, the main task of state tests for the title of doctor is to check how prepared the student who has completed the course is for independent medical practice. The main mistake of examiners is that they do not understand this and test knowledge in a way that is more typical for tests.

The main theses of Semashko the teacher about the basic principles of a doctor can be found in one of his works: “Firstly, study, study and study again... Secondly, conscientiously treat your duties, especially towards the sick... And, finally, thirdly, both the clinician and the sanitary doctor need to be social doctors.”

Other activities of N.A. Semashko

In 1944, with the participation of N.A. Semashko, the Academy of Medical Sciences of the USSR was created - a higher scientific and medical institution that united leading research institutes. By decision of the government, he became one of the first academicians, after which he was elected to the Presidium of the USSR Academy of Medical Sciences. He participated in the development of the structure of the academy and the most important areas of its activities.

In 1945, on the initiative of N.A. Semashko created a Commission to study the sanitary consequences of the war. At five conferences he organized, the most prominent clinicians, hygienists and health care organizers discussed issues of post-war reconstruction of the country and the fight against the medical consequences of the war. The proceedings of these conferences formed the basis for post-war Soviet health care plans.

In 1945 N.A. Semashko was elected a full member of the Academy of Pedagogical Sciences of the RSFSR. From 1945 to 1949, he headed the work of the Institute of School Hygiene, participating in the development of issues of work and rest for schoolchildren, and sanitary standards for children's institutions.

In 1947 N.A. Semashko headed the work of the Institute of Healthcare Organization and History of Medicine.

He often had to represent Soviet science abroad. Speaking at various international conferences, he spoke about the achievements of Soviet medicine and the basic principles of Soviet healthcare. So, in 1925, he gave a report on Soviet healthcare at the medical faculty of the University of Paris, then with a report to the Hygienic Commission of the League of Nations in Geneva on the topic “Healthcare in the RSFSR.” In his foreign trips, he sought to establish connections with the medicine of Western countries, invited foreign scientists to visit our country, and was the initiator of foreign scientific trips for Soviet doctors.

Until the end of his life, despite his serious illness, he continued to work. A few days before his death, he was interested in the work of the institutes he led.

Conclusion

Merits of N.A. Semashko's views on medicine are very great. He was the very person who managed to organize the world’s first coherent public health care system on the vast territory of the USSR. Largely thanks to his work, healthcare has reached a qualitatively new level, which has made it possible to increase the level of public health many times over. I believe that the name N.A. Semashko has the right to be included in the golden fund of Russian medicine.

List of used literature

1. Mirsky M.B. Chief Doctor of the Republic: N.A. Semashko. M.: Politizdat, 1964.
2. Mirsky M.B. Medicine of Russia 10th – 20th centuries: essays on history. M.: ROSSPEN, 2005.
3. Semashko N.A. Selected works. M.: Medgiz, 1954.
4. Semashko N.A. Essays on the theory of organization of Soviet healthcare: the fundamental foundations of Soviet healthcare. M.: Publishing house of the Academy of Medical Sciences of the RSFSR, 1947.
5. Sorokina T.S. History of medicine: a textbook for students of higher medical educational institutions. M.: Publishing center "Academy", 2004.
6. B.D. Petrov, B.M. Potulov. ON THE. Semashko: abstract. M.: Medicine. 1974.

Russian doctor, statesman, first People's Commissar of Health of the RSFSR, academician of the USSR Academy of Medical Sciences (1944) and the Academy of Pedagogical Sciences of the RSFSR (1945).

Main scientific works

“Fundamentals of Soviet Medicine” (1920); "The Science of Public Health" (1921); “Essays on the theory of organization of Soviet health care” (1947).

Contribution to the development of medicine

He was the first People's Commissar of Health of Russia (1918-1930).

Since 1901 - zemstvo doctor in the Oryol province. In 1905 he was arrested for participation in the revolution and served a prison sentence.

Since 1918, he was in charge of the medical and sanitary department of the Moscow Council of Workers' and Soldiers' Deputies.

Since 1921, he headed the Department of Social Hygiene, created on his initiative, at the Faculty of Medicine of Moscow University.

He laid the theoretical and organizational foundations of Soviet healthcare (health protection of the proletariat; organizational unity of Soviet healthcare; unity of medical, preventive and sanitary work; participation of the population in the construction of healthcare). He led the restructuring of the system of higher medical education in Russia.

Initiator of the creation of the Institute of Healthcare Organization and History of Medicine (now bearing his name).

Actively worked in the field of school hygiene. In 1945-1949 was the director of the Institute of School Hygiene of the USSR Academy of Pedagogical Sciences.

He was the first chairman of the Supreme Council for Physical Culture and Sports. Initiator of the creation of the Institute of Physical Culture named after. P.F. Lesgaft in Leningrad and the Institute of Physical Culture named after. V.I. Lenin in Moscow.

An active participant in the All-Union Hygiene Society, chairman of its board in 1940-1949.

Initiator of the first edition of the Great Medical Encyclopedia, its editor-in-chief (1927-1936).

12. Initiator of the opening of the Central Medical Library (1918) and the House of Scientists in Moscow.

Soloviev Zinoviy Petrovich

Soviet doctor, statesman, one of the organizers and theorists of Soviet healthcare.

Main scientific works

“Preventive tasks of medical medicine” (1926); "Issues of military medicine").

Contribution to the development of medicine

Participated in the development of the healthcare management structure in Soviet Russia. Theorist and organizer of the Soviet healthcare system.

Deputy People's Commissar of Health of the RSFSR (1918), Chairman of the Executive Committee of the Red Cross of the RSFSR (1919), Head of the Main Military Sanitary Directorate of the Red Army (1920-1928).

Organized and headed the second department of social hygiene in the country at the 2nd Moscow State University (1923).

He developed the idea of ​​unity of therapeutic and preventive measures. In preventive medicine, he pointed out the importance of studying the working and living conditions of the patient, determining methods of organized influence aimed at improving the health of this environment.

Investigating the nature and ways of spreading social diseases, he proposed identifying groups of workers (or entire enterprises) in dire need of medical and preventive care.

One of the organizers of the fight against epidemics of typhus and relapsing fever in the Red Army. Supporter of the introduction of preventive measures into the practice of military health institutions. One of the organizers of Soviet military medicine.

Initiator of the creation of the All-Union Children's Health Camp Artek (1925).

SEMASHKO Nikolai Alexandrovich, owl. desk and state activist, doctor, one of the organizers of the healthcare system in the USSR, academician. Academy of Medical Sciences of the USSR (1944) and APN of the RSFSR (1945). From the nobles. Nephew of G. V. Plekhanov. Studied to become a medical student. Faculty of Moscow University (1893–96, expelled for participating in anti-government demonstrations), graduated from medical school. Faculty of Kazan University (1901). An epidemiologist in the Samara, Orenburg, Saratov, and Oryol provinces (1901–05; he was regularly fired for political unreliability and was arrested). Member Nizhny Novgorod Committee of the RSDLP (1904–05), Bolshevik, one of the organizers of the strike at the Sormovsky plant in 1905. Since 1906 in exile in Switzerland and France. Delegate to the 7th Congress International 2nd(1907, Stuttgart). Member Central Committee of the RSDLP and its Foreign Bureau (1910–11). With the beginning Balkan Wars 1912–13 went to Serbia at the invitation of the International. Red Cross Foundation, Ch. doctor at the hospital in Paracin. Interned in the 1st World War during the occupation of Serbia by the Bulgarians. troops (1915), received permission from the Bulgarian Ministry of Health to engage in medical work. practice. After Feb. Revolution of 1917 returned to Russia. Prev. Pyatnitskaya district government of Moscow (since September 1917). Head Medical and sanitary department Moscow. Council of Workers' and Soldiers' Deputies (1918). First People's Commissar of Health of the RSFSR (11.7.1918–25.1.1930); On his initiative, departments were formed within the People's Commissariat - sanitary-epidemiological and health education. At the same time, in 1922–49, head. Department of Social Hygiene of the 1st Moscow State University (since 1930 1st Moscow Medical Institute). Prev. Supreme Council for Physical Affairs culture and sports (1923–26). Prev. Children's Commission under the Presidium of the All-Russian Central Executive Committee (1930–36). Ch. editor of the Great Medical Encyclopedia (1st ed., 1928–36). Participated in the creation of the USSR Academy of Medical Sciences (1944), member. its presidium, director of the Institute of School Hygiene (since 1945), Institute of Health Organization and History of Medicine (since 1947; now the National Research Institute of Public Health named after N. A. Semashko) of the USSR Academy of Medical Sciences.

He viewed the disease as a consequence of unfavorable social conditions and an unhealthy lifestyle. He declared that the ultimate goal of the state’s sanitary policy was to combat the “housing needs of the poorest population.” Author of drafts of the most important decrees of the Council of People's Commissars in the field of health care (“On measures against typhus” dated January 28, 1919, “On compulsory smallpox vaccination” dated April 10, 1919, “On the use of Crimea for the treatment of workers” dated December 21, 1920, etc.). Initiator of the creation of a network of children's and women's consultations, tuberculosis and venereal disease. dispensaries, dispensaries for the fight against prof. diseases. Organizer of the unified state healthcare system, based on the principles (developed by progressive doctors of the late 19th century) of universal access to medical care. services, priority attention to childhood and motherhood, unity of prevention and treatment, elimination of the social basis of diseases. Awarded the Order of Lenin (1944).

Many were named in honor of S. therapeutic and prophylactic institutions, streets in cities across the country.

The theorist and organizer of Soviet healthcare, the first people's commissar of healthcare of Soviet Russia, revolutionary and teacher Nikolai Aleksandrovich Semashko was associated with Samara for several months of his life (Fig. 1).

He was born on September 20, 1874 in the village of Livenskoye, Yeletsk district, Oryol province. In 1891, after graduating from the Yeletsk men's gymnasium, Nikolai entered Moscow University at the Faculty of Medicine. At the university he became involved in illegal political activities and was a member of conspiracy circles. Despite his political activities, he worked hard and hard. He studied with outstanding professors of that time, the creators of advanced medical schools of world importance - such as the physiologist I.M. Sechenov, hygienist F.F. Erisman, surgeon N.V. Sklifosovsky and others.

In December 1895 he was arrested for preparing a mass demonstration of students and workers. After spending three months in prison, Semashko was expelled from Moscow University without the right of reinstatement and deported to Yelets under public police supervision. In 1898, after unsuccessful attempts to re-enter Moscow or Kiev universities, Semashko went to Kazan, where he was nevertheless enrolled in the fourth year of the medical faculty of Kazan University.

However, even here, active activity in illegal circles and participation in strikes for a long time did not give him the opportunity to fully study. Nevertheless, in 1901 Nikolai Aleksandrovich Semashko passed the state exam to become a doctor with honors. But due to his political unreliability, he could not be left to work in Kazan. Therefore, Semashko, having received a letter of recommendation, went to get a job in Samara.

Here, in the Provincial Sanitary Bureau, he accepted the position of epidemiologist, and after a month of improvement in bacteriology, he was sent to fight epidemics in the village of Orlovo-Gai, and then to the village of Novaya Aleksandrovka. Cases of plague were then registered in these settlements, and therefore the anti-plague commission ordered to burn these villages. Then, with the permission of N.A.’s superiors. Semashko went to the site to find out the causes of the disease.

After the necessary laboratory tests, he came to the conclusion that in the villages people were not suffering from the plague, but from a cutaneous form of anthrax. The doctor immediately began treating the patients and preventing infection. Soon all cases of the disease were eliminated, and villages were saved from destruction. Thus, from the very first steps of his independent activity, N.A. Semashko proved himself to be an outstanding organizer and talented physician.

However, only a couple of months passed, and Semashko was dismissed from service with a ban on living in the Samara province. This happened by order of the governor, who could dismiss a politically unreliable person without explanation within the first three months of service. N.A. Semashko wrote about this then: “I had to weigh anchor again and set sail on the brown sea of ​​life.”

He traveled around the Orenburg, Saratov and Oryol provinces. Here he not only treated the sick, but also gave lectures to peasants about infectious diseases and methods of their prevention. In 1904, Semashko moved to Nizhny Novgorod, where he received the position of zemstvo sanitary doctor. In addition to his medical work, he was also involved in political activities, which is why Semashko was arrested again in 1905, and after a nine-month imprisonment, with great difficulty, he managed to go abroad, where he lived until the February Revolution.

In September 1917, having returned from emigration to Moscow, N.A. Semashko, together with some doctors (M.F. Vladimirsky, V.A. Obukh, Z.P. Solovyov and others) actively became involved in big politics. Soon he was elected chairman of the Pyatnitskaya Council of Moscow from the Bolshevik Party. In this post, he was actively involved in organizing the city economy that had suffered during the war, organizing healthcare and public education.

In May 1918, N.A. Semashko was appointed head of the medical and sanitary department of the Moscow Council. Under his leadership, hospital bed capacity expanded, new outpatient clinics were opened, an emergency medical service was created, the supply of medicines was improved, and emergency measures were taken to prevent the spread of infectious diseases.

By decree of July 11, 1918, a supreme state body was created in Soviet Russia, uniting under its jurisdiction all branches of health care in the country. ON THE. Semashko was appointed the first People's Commissar of Health of the RSFSR. He headed the People's Commissariat for 11 years - until 1930.

After the end of the civil war and the country's transition to a new economic policy, the main attention of the People's Commissariat of Health was paid to the restoration and deployment of new medical institutions, to carrying out broad preventive measures, and to improving the health of work and life. ON THE. Semashko plays a huge role in organizing and conducting such events. On his initiative, measures were taken to organize tuberculosis and venereal dispensaries, which actively carried out not only therapeutic, but also preventive work. ON THE. Semashko also initiated the creation of a network of dispensaries to combat occupational diseases. On his instructions, dispensary examinations of groups of workers in hazardous industries began to be carried out. Such groups were placed on special records, and workers were subjected to periodic comprehensive examinations in order to timely detect diseases. To improve medical care, it was planned to organize a wide network of sanatoriums and rest homes.

Among the merits of Nikolai Aleksandrovich Semashko in the post of People's Commissar of Health can be noted a decrease in morbidity and mortality from infectious diseases by 20 percent, an increase in the number of hospital beds by 40 percent, an increase in medical outpatient facilities and antenatal clinics several times. Statistics compare all these figures with 1913, the year of economic growth of the Russian Empire.

In 1930 N.A. Semashko moved to the Presidium of the All-Russian Central Executive Committee, where he headed the work of the Children's Commission. After that, for more than ten years he was involved in the creation of the Great Medical Encyclopedia, being its editor-in-chief. From 1928 to 1936, 35 volumes of BME were published, containing about 8.5 thousand author sheets, 80,000 terms related to almost 100 medical and related disciplines.

ON THE. Semashko devoted more than 30 years of his life to teaching. For 27 years he headed the Department of Social Hygiene (later the Department of Health Organization) of the First Moscow Medical Institute. The main theses of Semashko the teacher about the basic principles of a doctor can be found in one of his works: “Firstly, study, study and study again... Secondly, conscientiously treat your duties, especially towards the sick... And, finally, thirdly, both the clinician and the sanitary doctor need to be social doctors” (Fig. 2).

In 1944, with the participation of N.A. Semashko, the Academy of Medical Sciences of the USSR was created - a higher scientific and medical institution that united leading research institutes. He was also the initiator of the organization of the State Scientific Institute of Public Health, the creator of the Department of Social Hygiene at Moscow University.

Until the end of his life, despite his serious illness, he continued to work. On May 18, 1949, Nikolai Alexandrovich Semashko died in Moscow.

Currently, many medical institutions in Russia bear his name. In Samara this is city clinical hospital No. 2 (Fig. 3-5).

Anastasia Silina

Bibliography

Twenty-five years of Soviet healthcare. Collection ed. G.A. Mitereva. M., State Publishing House of Medical Literature, 1944. - 296 pp., table.