Collectivization of Agriculture and Healthcare

COLLECTIVIZATION OF AGRICULTURE AND HEALTHCARE. K. s. h. means the process of transition from small individual peasant farming to large-scale social production. The problem of socialization of peasant production is one of the most important, decisive problems of the proletarian revolution. The economic significance of this problem is determined by the fact that it is connected with the decisive increase in labor productivity in agriculture through the reconstruction of its technical and economic base, the broad development of food and raw material bases in accordance with the pace of industrialization. The main point, however, is that the path of collectivization of agriculture is the path of socialist reconstruction of the countryside.--The indicators of the technical and economic backwardness of our national economy, inherited from capitalism, can be served by the following data: ⁴/₅ of the working population is engaged in agriculture in the USSR; industrial labor is 5 times more productive than agricultural labor; in America labor is more productive than in the USSR: in agriculture-2 times, in industry-3-3.5 times. In connection with this, the per capita national income in the USA is 8-10 times higher than in the USSR. "Labor productivity--in the final count," "COLLECTIVIZATION OF AGRICULTURAL", "is the most important, the main thing for the victory of the new social system" (Lenin, Volume XVI, p. 254). A radical increase in labor productivity in agriculture presupposes the reconstruction of its technical base on the basis of applying modern achievements of agronomic science and technology, the maximum growth of energy armament of agriculture. In 1928-1929, the energy armament of living labor, or energy consumption in kilowatt-hours per 1 worker, was in the USSR: in censused industry 2,420, in agriculture only 324. But small-scale peasant farming allows the use of modern agrotechnical achievements only in very limited dimensions, because precisely small-scale land ownership hinders the acquisition of complex machines and their profitable operation, the transition to multi-field crop rotation, etc. A regular seeder saves at least 45 kg of grain per 1 ha; with full load it can give an extra 7-9 tons of bread per year, i.e. pay for itself in a year. It can sow 65-75 ha per year. An individual farmer with a small farm cannot use the benefits of a seeder at all. The same is true with the binder, which harvests from 65 to 85 ha of grain in summer. In a small peasant farm, its load will be negligible.--In the Shevchenko state farm (Ukraine), the productivity of one tractor averages 220 ha per season, and when serving small farms, the tractor load ranges from 60 to 80 ha. The yield in 1927 was in centners: in peasant farms of the RSFSR-8.1; in the Tamovsky state farm trust-14.4; in the Shevchenko complex of Sugar Trust-22.2.--According to the data of the RKI inspection in 1927, the yield of rye in the Pskov district was in farms with gross output up to 200 rubles-5 centners, in farms with output from 800 to 1,000 rubles-8.4 centners, over 1,400 rubles-12.4 centners; the yield of wheat in the Dnepropetrovsk district in farms with gross output up to 200 rubles-2.8 centners; from 800 to 1,000 rubles-5.6, and over 1,400 rubles-7.2 centners. All this clearly illustrates the advantages of large-scale farming over small-scale farming in the field of agriculture. "The strength of large-scale farming, whether it is landlord, kulak or kolkhoz,-consists in the fact that it, this large-scale farm, has the opportunity to use machines, use the achievements of science, apply fertilizers, increase labor productivity and thereby give the largest amount of commodity bread" [Stalin, November Plenum of the CC VKP(b), 1929]. The existence of an enlarged farm is possible on two fundamentally different bases: capitalist and socialist. The path of capitalist development of the countryside "is the path of creating in the coming years a powerful layer of kulaks, who would concentrate in their hands the main mass of means of production, products, etc., turning the overwhelming majority of farms into manure for themselves"... "The progress of the countryside along the capitalist path is not only unacceptable for the proletariat; it is at the same time an unimaginably painful, unbearably heavy and therefore unacceptable path for the peasant masses themselves" [Ya. A. Yakovlev, Introduction to the book "On the Question of the Socialist Reorganization of Agriculture" (Materials of the research of the NK RKI USSR, 1927, XI)]. The proletarian state, naturally, chooses the path of socialist transformation, "reorganization" of peasant farming; this is the path of using the advantages of large-scale farming on the basis of cooperation of the main production processes of the mass of small and smallest peasant farms-creation of kolkhozes. Indications of the policy that the proletariat in power should pursue in relation to small-scale peasant farming are found already in Engels. "We will not think of forcibly expropriating the peasants (with or without compensation-this is indifferent), as we are forced to do with large landowners. Our task in relation to the small peasants consists primarily in transferring their private production and private property to cooperative, but not forcibly, but by means of example and offering social help for this purpose." This path was also put forward by Lenin even before the conquest of power by the proletariat in July 1917. "We cannot hide from the peasants, let alone from the proletarians and semi-proletarians in the village, that small-scale farming, while maintaining commodity economy and capitalism, is unable to free humanity from the poverty of the masses, that we must think about the transition to large-scale farming on a social account and take it up immediately, involving the masses and learning from the masses practically expedient measures of such a transition." Lenin pointed out that as long as the country remains small-peasant, capitalism has "a more solid economic base than communism", because small-scale farming "inevitably and necessarily constantly gives birth to this capitalism." "To undermine it (small-scale farming), there is one means-to transfer the country's economy, including agriculture, to a new technical base, to the technical base of modern large-scale production." As early as 1918, Lenin set this task at the congress of zemotdels, kombeds and communes: "To live as before, as we lived before the war, is impossible, and such a waste of human forces and labor, as is associated with small individual peasant farming, cannot continue further. Labor productivity would rise two or three times, human labor for agriculture and human economy would be saved two or three times, if from this fragmented economy there was a transition to social economy... It becomes clearer and clearer before us the entire gigantic size of what we must do to restore the economy, in order to forever free the peasants from their old position of neglect, oppression and darkness; it becomes clearer and clearer that the way out is really solid and bringing the mass of peasants closer to cultural life, really putting them in a position equal to other citizens-431", "COLLECTIVIZATION OF AGRICULTURE AND HEALTHCARE"

432 mi,-this exit is only the public cultivation of land, and to this public cultivation of land the Soviet power is now systematically striving through gradual measures». While fighting against capitalist elements, decisively displacing them from all sectors of the economy, and finally liquidating them, the Party and Soviet power are simultaneously carrying out the policy of 'remaking' small commodity production on the basis of implementing a rapid pace of industrialization and electrification. In the decree on socialist land settlement (Collection of Government Laws, 1919, No. 4) Lenin wrote: 'For the final elimination of all exploitation of man by man, for the organization of agriculture on socialist foundations, with the application of all the achievements of technology, for the education of the working masses in the spirit of socialism, as well as for the unification of the proletariat and the rural poor in their struggle against capital, it is necessary to transition from individual forms of land use to collective ones. Large Soviet farms, communes, and public cultivation of land are the best means for achieving this goal'. Thus, the path forward to socialism is the path of cooperativization of the mass of small and smallest peasant farms. The course toward collectivization cannot be opposed to Lenin's cooperative plan: K. is the most important component of this plan. Cooperation ensures, under the conditions of the Soviet system, the transition of the mass of small farms to large-scale production on the basis of organizing collective forms of agricultural production.-The reconstruction period, which has extraordinarily accelerated the pace of industrial development, opened up enormous possibilities for the technical re-equipment of agriculture, and created the necessary prerequisites for solving the task of restructuring small peasant farming on collective principles, providing it with the base of modern machine technology. The XV Congress of the All-Union Communist Party (Bolsheviks) (December 1927) notes a new stage in the area of productive cooperativization in the countryside. 'It is necessary to set as a primary task, on the basis of further cooperativization of the peasantry, the gradual transition of scattered peasant farms to the rails of large-scale production (collective cultivation of land on the basis of intensification and mechanization of agriculture), while fully supporting and encouraging the growth of shoots of socialized agricultural labor. In the present period, the task of uniting and transforming small individual farms into large collectives must be set as the main task of the Party in the countryside'. The November (1928) Plenum of the Central Committee of the All-Union Communist Party (Bolsheviks) adopts a number of decisions specifying this task, proceeding from the fact that 'at the present time, the possibility of the working class exerting its revolutionary influence on both the technology of agricultural production and the reconstruction of economic relations in the countryside in the direction of their socialization has grown enormously'. On the basis of the successful development of the collective sector, the XVI Party Conference (April 1929) recognizes the need for 'full support for the initiative to transition entire villages and rural areas to collective forms of labor, using for this purpose the mass contracting of sowing of seed varieties in continuous arrays, using machine-tractor stations and columns, the importance of which becomes in the present period the most important factor, while at the same time taking all measures to overcome kulak resistance and to gradually create on this basis large collective farms'. The five-year plan for national economic and cultural construction, approved by the V All-Union Congress of Soviets (1929), projected the following growth rates for the collective sector of the countryside: the sown area in collective farms was planned to be increased from 1.4 million hectares in 1928 to 20 million hectares in 1933/34, with which by the end of the five-year period about 19 million people were to be covered by collective farms. Together with state farms, the socialized sector should cover a total of up to 20 million people, or up to 5 million peasant households. By the end of the five-year period, it was planned to mechanize 50% of the sown area of collective farms, providing collective farms with 120,000 tractors. Collective farms and state farms should as a result give 43% of the total amount of commercial grain, which approximately corresponds to the share that the 10% prosperous upper stratum of the countryside occupied in the commodity output of grain at the beginning of the five-year period.-The course of implementation of the five-year plan for collectivization of the countryside showed already in the first year and especially at the beginning of the second year of the five-year period that the possibilities for the development of the collective sector in the countryside were not sufficiently taken into account, that reality far surpassed all plan designs in this area.-This huge spontaneous rush into collective farms by the millions of poor and middle peasant masses is a fact of world-historical significance and testifies that the main mass of the peasantry has been convinced of the advantages of large-scale farming over small-scale farming and that it has decided for itself the question of the path along which it will go further. Of the two paths - capitalist and socialist - the poor and middle peasant masses have chosen the latter. The features of the collective farm movement at the present time are as follows. 1. The peasantry is going into collective farms not in separate groups, but in entire villages, districts, regions, provinces, and territories. 2. The collective farm movement is developing along the path of ever-increasing enlargement. In connection with the above-mentioned advantages of large-scale farming over small-scale farming (possibilities for large-scale farming to more effectively use tractors, agricultural machines, mineral fertilizers, all the latest resources of agrotechnical and zootechnical science, as well as human resources, and consequently to achieve a higher level of labor productivity, and on this basis - a higher income per capita, etc.), the formation of giant collective farms with sown areas of many tens of thousands of hectares is taking place. Entire districts, regions are transitioning to complete collectivization, 433

COLLECTIVIZATION OF AGRICULTURE AND HEALTHCARE

434 excluding kulak farms. 3. The kolkhoz movement is accompanied by the growth of socialization of the means of production. In the construction of large kolkhozes, inter-village machine-tractor stations play a particularly important role. Tractor stations, numbering several tens and hundreds of tractors, cultivate an area of 25-50 thousand hectares of land. The significance of these stations is as follows: 1) the stations eliminate boundaries and make it possible to introduce a multi-field crop rotation on a large land plot; 2) the crop yield increases due to tractor cultivation; 3) cultivation costs are reduced (by at least 20 rubles per hectare); 4) peasants are convinced by experience of the advantages of large-scale mechanized collective farms over scattered individual farms. Tractor stations thus become the most important factor in collectivization; 'by creating broad opportunities for the use of the advantages of modern technology in peasant farms, machine-tractor stations must become the center of continuous collectivization' [November Plenum of the CC VKP(b), 1929]. In the last year of the five-year plan, it is planned to increase the number of tractor stations to 1,000 with coverage of 40 million hectares of sown area. Machine-tractor stations are becoming the energy bases of areas of continuous collectivization, centers of ever-increasing concentration of the economic, administrative, and socio-political life of the area. - As K. grows and the energy base of kolkhozes strengthens, the industrialization of agriculture takes place, i.e., the growth of production for the primary processing of agricultural products (starch-glucose, potato processing, distilling, dairy, cheese-making and other industries). In recent months, large agro-industrial complexes and kolkhoz-state farm associations have begun to develop. A growing trend towards the economic specialization of kolkhozes should be noted. Thus, in addition to grain kolkhozes, the number of livestock, dairy-flax, cotton, garden-vegetable and other types of kolkhozes is growing. - The further growth in the number of kolkhozes and state farms in the above-mentioned direction will make it possible to solve the food and raw materials problems, as well as significantly increase labor productivity, on this basis the profitability of the kolkhoz, and consequently the well-being of the peasant masses covered by the collective sector. The main form of kolkhoz construction at the present time is the agricultural artel. The primary form of collectivization - the partnership for joint land cultivation (TOZ), in which the means of production remain in individual use - is already a stage that has been passed. The agricultural commune, in which not only production but also consumption is socialized, cannot at the present stage of kolkhoz construction be recognized as the main, predominant form of K., since the number of communes in the total mass of collectivized farms is still very small; the necessary conditions have not yet matured, the main poor and middle peasant masses have not yet been brought through experience to the solution of this task. The model charter of the agricultural artel approved by the government provides a solid basis for the predominant form of kolkhoz construction at this stage. The charter provides for the socialization of the main means of production having industrial-commercial significance, leaving in individual use those means of production which yield products for personal consumption of kolkhoz members. Thus, with the complete socialization of all land, working and commodity-productive livestock, agricultural implements, seed reserves, etc., the following remain in individual use: household gardens, orchards and other household lands, residential premises of artel members, small implements for work on household lands, one cow, domestic poultry, etc. Having established approximately the charter of the agricultural artel, the Party and government declared a decisive struggle against distortions of the Party's correct line from both those who want to restrain the growth of kolkhozes (right opportunism) and those who want to jump over the experience of the masses ('leftist excesses') and in practice retreat from the principle of voluntariness in the formation of kolkhozes, from the principle of taking into account the diversity of conditions in individual regions of the USSR in relation to kolkhoz construction, and also to skip the unfinished form of the kolkhoz movement. The powerful movement of the poor and middle peasant masses towards collective forms of farming brings a fundamental shift in the socio-class relations in the countryside. The creation of areas of continuous K. means 'the beginning of that great process which leads to the overcoming of the poor and middle peasantry as a class, leads to the elimination of the opposition between city and countryside, leads to the establishment of a classless society' (editorial of the journal 'Bolshevik', 1930, No. 2). With the process of eliminating individual peasant farms, the uprooting of the roots of capitalism in the city and countryside is connected. Hence the frenzied resistance which capitalist elements offer to kolkhoz construction. The transition to continuous K. changes the policy of the proletarian state in the countryside. At the first stage of the NEP, when the material and technical base for the socialist reconstruction of agriculture had not yet been created, the task was to, while stimulating the development of poor and middle peasant farming, at the same time limit the development of large capitalist elements in the countryside, expel and overcome individual detachments of the kulaks. The growth of the kolkhoz and state farm sector reduces the role of the kulak as a grain producer to insignificant proportions. The production of state farms and kolkhozes surpasses the production of kulak farms. The proletarian state is therefore now able, in areas of continuous collectivization, to move from the policy of limiting the kulak to the policy of liquidating the kulaks as a class.

COLLECTIVIZATION OF AGRICULTURE AND HEALTHCARE

The transition to the policy of eliminating the kulaks as a class cannot be considered in isolation from the process of collectivization. On the contrary, it is a direct result of collectivization, a constituent element of it. "The main method for carrying out the elimination of the kulaks as a class is the method of collectivization" (Stalin). By waging a decisive struggle against the kulaks, the party and Soviet power unite the poor and middle peasant strata of the village around the tasks of collectivization, organize batrak (laborer)-poor peasant groups in the simplest production associations and primary collectives. Tasks of healthcare in the countryside in connection with collectivization. If the sanitary conditions of labor and everyday life in cities and workers' settlements are still at a very low level, this applies even more so to the countryside, whose extreme backwardness, economic, cultural, and sanitary, is conditioned by centuries of dominance of the landlord-capitalist system. This low sanitary level of the countryside, inherited from the past, finds expression in high morbidity, especially in the high incidence of infectious and socio-domestic diseases (syphilis, trachoma, scabies, etc.) and in high general and child mortality. The high morbidity and mortality of the rural population are maintained by the following, mainly, socio-hygienic factors: extremely unsatisfactory housing conditions, an unsatisfactory diet from the point of view of sanitary-hygienic requirements, difficult labor conditions in small, technically backward peasant farms, the absence of elementary measures in the field of municipal improvement (the unsatisfactory state of water supply in a significant, if not predominant, number of populated places, soil pollution, the insignificance, or even absence, of green plantings, etc.), the low cultural level and, in connection with this, the absence of elementary sanitary-hygienic skills, and an extremely insufficient quantity and unsatisfactory quality of medical-sanitary assistance. It goes without saying that the negative sanitary factors act to a greater degree on the batrak and poor peasant strata of the village, which have a lower material and cultural level of existence, more difficult labor and living conditions compared to the middle peasant masses, not to mention the well-to-do kulak upper stratum of the village. In the years of the revolution, factors that favorably influenced the process of improving the health of the countryside have intensified: the improvement in the well-being of the main poor and middle peasant masses as a result of the entire policy of Soviet power, improvement in nutrition, growth of the cultural level of the countryside, development of the medical network. But still, the previous stage of development of the countryside could not ensure a serious shift in its sanitary condition. The extreme sanitary backwardness of the countryside is rooted in the conditions of small individual peasant farming, technically and culturally backward with extremely low labor productivity, in conditions that do not provide sufficient accumulation, and therefore, opportunities for raising the small peasant to a higher level of material and cultural existence, overcoming poverty, kulak bondage, neglect, and "the idiocy of rural life" (in Marx's expression). The process of collectivization, the technical and social reconstruction of agriculture, is a factor of the greatest socio-hygienic importance. It creates the necessary material prerequisites for eliminating the century-old sanitary neglect of the countryside and for the genuine, fundamental improvement of the health of the broadest peasant masses. The creation of large-scale collectivized farms ensures full mechanization of agricultural production processes, a huge increase in energy equipment, and consequently, the productivity of agricultural labor, and on this basis, a rapid rise in the material level of the peasant. According to data from the Central Statistical Administration of the RSFSR for 1928, the crop yield in collective farms exceeded that in peasant farms by 19% to 63%. The gross income per capita in communes was 322 rubles, in agricultural artels-246 rubles, in partnerships-143 rubles, in individual farms-75 rubles, i.e., the gross income per capita in collective farms was 2 to 4 times higher than in individual farms. The net income per capita in collective farms was 115 rubles, in individual farms-50 rubles, i.e., almost 2 times less. If we take into account the existing real prospects: 1) full mechanization within the next five-year period of all agricultural production processes through the use of tractors, combines and other agricultural machines and the widespread use of electric power; 2) replacement of horse-drawn transport with automotive; 3) the enormous development of chemical production, and consequently, the widest use of chemical mineral fertilizers in agriculture; 4) transition to a multi-field crop rotation, the widespread development of technical crops; 5) the development of enterprises for the primary processing of agricultural products, agro-industrial complexes, etc., then the extraordinary possibilities for the growth of labor productivity and the resulting income in a collectivized farm in the near future become completely obvious. Furthermore, a huge factor in improving the health of the countryside is the rise in its cultural level. In 1930/31, the completion of the task of eliminating illiteracy among the adult population is planned, the implementation of universal primary education for all children of 8 years of age in cities, workers' settlements, state farms and collective farms throughout the RSFSR. By the end of the five-year period, the realistic prospect is to cover the rural population of children aged 8-11 with primary schools. The resolution of the task of the socialist reorganization of agriculture will require the coverage of millions of peasant masses with a network of courses, conferences, correspondence courses, and a whole system of other cultural and educational measures for raising the general cultural and agrotechnical level of these masses. The development of printing, cinema, and radio projected by the five-year plan will serve as a powerful stimulus for raising the cultural level of the countryside. The need for new qualified personnel in all sectors of the national economy and cultural construction will attract significant masses of rural youth to higher technical schools, universities, technical schools, vocational schools, factory schools, collective farm schools, etc. to acquire certain qualifications. This growth in the cultural level of the countryside will contribute to the rapid assimilation of basic sanitary-hygienic knowledge and skills, an increase in the attention of the masses to questions of protecting their health, and the prevention and treatment of diseases.

On the basis of the economic upturn, the process of restructuring life on new principles must begin (and has already begun). The process will basically consist of the following. In the first place, it will proceed along the line of creating nurseries, children's hearths, children's playgrounds, etc., with the aim of more productive use of the labor of collective farm women and the protection of the health of the rising generation, the organization of public catering (initially for the duration of field work), the development of bathhouse and laundry services, etc. In the future, scattered small villages with their backward cultural and sanitary way of life will be eliminated, giving way to new large settlements, agro-towns, which will naturally be built around the main energy base of the collective farm-the machine-tractor station. At the location of this station, repair workshops, garages, facilities for storing the harvest, auxiliary industrial enterprises, housing for agronomists, tractor drivers, drivers, mechanics, etc., will be built. Here, in this economic center, the administrative and cultural life of the district will gradually concentrate: the apparatus of Soviet power and higher type schools (collective farm faculties, peasant universities, agricultural technical schools and various kinds of courses) and other cultural and educational institutions, specialized medical assistance, etc. As collective farm economy strengthens, as automobile transport, telephone communication, etc., develop, facilitating continuous economic ties between the center of a large collective farm and its periphery, located tens of kilometers away from it (the center), the preservation of old villages will be economically inexpedient, and conversely, it will become advantageous to create a new large settlement providing better living conditions and cultural services for the members of the collective farm. In the new collective farm settlements, or agro-towns, housing will better meet sanitary-hygienic requirements, and there will be the basic elements of municipal improvement. All this will undoubtedly be a huge health-improving factor. On the basis of collectivization, the phenomenon of so-called agrarian overpopulation will be overcome: the expansion of sown area, the development of labor-intensive crops, the industrialization of agriculture, the settlement of vacant lands, the enormous need for personnel, etc., along with the implementation of high rates of industrial and other construction in cities, will lead to the utilization of the currently surplus labor force in agriculture. The expansion of the sown area, the increase in crop yields, the rise in animal husbandry will ensure broad prospects for a fundamental resolution.

438 solutions to the problem of nutrition of the rural population both in terms of quantity and composition of food. The enormous growth of the raw material base gives industry the possibility in the following years to provide the rural population with necessary fabrics, footwear, etc. K. further opens up the greatest possibilities for using cooperative labor, creative initiative, and self-activity of the peasant masses in carrying out measures to improve their working and living conditions. K., by raising the material well-being of the millions of rural masses, thereby strengthens the financial base of the proletarian state, and consequently the possibilities for it to resolve the main tasks of improving rural health. These are the most important material prerequisites that ensure, under conditions of K., the elimination of the sanitary backwardness of the countryside and the improvement of the broad masses of its population. There are no exact data on the state of medical care for the collective sector of the countryside at the present time. The available scattered materials from individual districts of the RSFSR indicate that medical care for state farms and collective farms differs in no way from that for the individual sector. How the individual sector is served, or rather, the countryside as a whole, is seen from the following figures: in 1927/28, there were on average 19,000 people per 1 medical district (from 3.8 thousand to 43.8 thousand); per 1 hospital district - 30.6 thousand, and per 1,000 rural population - 0.5 beds (in cities per 1,000 people - 6 beds). Up to 1,000 volosts had no hospitals on their territory, and 600 - even medical districts. Per 1 rural resident, there were in rural institutions: 0.12 bed-days and 1.2 outpatient visits. Along with 4.7 thousand medical districts, there were 3.4 thousand separate feldsher points. The specialized medical care provided to the rural population, as well as the sanitary service for the latter, is extremely negligible. The CC VKP(b), on the report of the People's Commissariat of Health of the RSFSR and Ukrainian SSR on 'medical care for workers and peasants', decided: 'Given the acute insufficiency of medical care in the village, especially in serving the poor and laborer masses, the CC proposes to the People's Commissariats of Health of the union republics to outline a plan for the systematic expansion of the rural medical network. The development of work in the countryside should be linked to the collective farm and state farm construction, which covers the broad masses of laborers, poor peasants, and middle peasants.' Some turning point in the medical care of the collective sector begins only in 1929/30. The five-year plan for medical care of the countryside is drawn up, based on the following guidelines. In the collective sector, workers of state farms are provided for first of all and according to higher norms, and then collective farmers. And among the collective farms themselves, taking into account the possible insufficiency of resources in the first one or two years, priority attention should be given to those collective farms that have reached a particularly high level of mechanization or have a special economic specialization (livestock breeding, flax growing, cotton growing, etc. 4S9

COLLECTIVIZATION OF AGRICULTURE AND HEALTHCARE', '440 or in which auxiliary industrial enterprises (agricultural industrialization) have developed, as well as those collective farms located in areas particularly unfavorable in sanitary terms (endemic plague, constant foci of malaria, typhus and abdominal typhus, etc.).--The previous medical district (ambulatory or hospital), a legacy of the zemstvo era, is completely unsuitable under new conditions when it is necessary to carry out broad health measures and provide specialized medical and sanitary-preventive care. The medical district should be replaced by a complex of medical institutions of the unified dispensary type. The new medical base should be built at the location of the energy base of the collective farm - machine-tractor station - and should consist of a hospital with not less than 50 beds, including departments of general, surgical, infectious, and maternity wards; an outpatient clinic with receptions in therapy and surgery, a dental office, a consultation with receptions for children and women; permanent nurseries, a pharmacy, a laboratory, disinfection chambers, a children's playground, transport (horse-drawn, and later - automobile). In areas particularly affected by tuberculosis, syphilis, and trachoma, special outpatient receptions for these diseases, as well as a corresponding number of special beds in hospitals, are allocated. During field work, near working brigades, first aid points and mobile children's nurseries function. On the periphery of large state farms and collective farms, particularly remote from the main base (more than 15-20 km), as well as in small state farms and collective farms, medical-outpatient points with several evacuation-type beds and obstetrical points are organized. These points work as branches of the central dispensary and under its leadership. Initially, only in the largest collective farms, and then in all collective farms, health protection points for children and adolescents are created. In constructing the new medical network, it is necessary to take into account the need for it to serve primarily the workers of state farms, laborers, workers engaged in forest and peat extraction located nearby, etc.--In areas of complete collectivization where there are industrial enterprises, it is advisable to build one hospital with a number of beds that can serve both industrial workers and collective farmers. Given the relatively small number of permanent workers even in large state farms, it is advisable to build one medical base to serve both state farm workers and collective farmers, without creating a parallel network without special need. From the spring of 1930, health authorities begin to increasingly practice sending medical brigades from cities to state farms and collective farms to serve the latter during the sowing and harvesting campaigns. This will continue until the collective sector is provided with a stationary network. When considering the reasons that determined the structure of the new medical network, it is necessary to first note the extremely increased demand, especially from the population of the socialized sector, for specialized medical care. The general practitioner will soon become unnecessary in the countryside, as is now the case in cities, with the exception of backward districts. In connection with the mechanization of agricultural production, the widespread use of tractors, complex machines, etc., there may be an increase, especially in the first years, in the number of accidents, and consequently an increase in the need for surgical help. Hence the need for the broad development of a network of first aid points, providing state farms and collective farms with surgical beds and surgeons. It is also necessary to pay attention to the fight against occupational diseases in agricultural production, using for this purpose the help and guidance from institutes and other institutions for the fight against occupational diseases. In the coming years, there will be a great demand from the population of the collective sector of the countryside for sanatorium care. Taking this into account, it is necessary to widely develop local resorts, especially balneological and mud resorts, which can become a significant factor in the overall system of rural healthcare. The rapid growth rate is ensured by institutions for the protection of motherhood and infancy, given the huge role these institutions play in liberating the life of collective farm women, fully utilizing their labor, improving the health of the child population, and due to the widest possibilities of involving the collective farm population itself, especially women's masses, in the work of developing these institutions.

As for obstetrical care, at present it covers no more than 12% of all births. It is necessary to strive to cover by the end of the five-year period (1933) 50% or more of all births in collective farms with obstetrical care, including not less than 25% through inpatient care. A sanitary task of paramount importance is the implementation of broad anti-epidemic measures. In the countryside, including its collective sector, there are numerous scattered epidemic foci, the elimination of which must be included in the program of the coming years. The implementation of anti-epidemic measures should be carried out through timely and as complete as possible hospitalization of infectious patients, disinfection (disinsection), development of bath and laundry facilities, smallpox vaccination and other mass preventive vaccinations; improvement of water supply, swamp drainage, etc. In the fight against typhus, the goal is set to eliminate foci by the end of the five-year period not only in cities and workers' settlements, but also throughout the entire collective sector of the countryside. Intensified measures will be required in the fight against typhus, first of all in the Western, Leningrad, Central Chernozem, Moscow, and Ural regions, where there are a number of endemic foci. The prospect of eliminating smallpox diseases no later than 1932 is quite realistic with universal smallpox vaccination in affected areas. A decisive reduction must be achieved in the fight against malaria and typhus. It is necessary to carry out extensive meliorative- 441

In the collectivization of agriculture, measures should be taken to sanitize areas affected by malaria, expand the network of malaria stations and detachments, and strengthen the supply of quinine and other necessities. When developing the medical network in the collective sector, special attention should be paid to areas unfavorable from a sanitary-epidemiological standpoint. To eliminate epidemics, it is necessary to widely deploy the construction of infectious disease barracks to ensure the maximum possible isolation of the sick, equip all rural hospitals with disinfection facilities, and organize sanitary service to the village based on the norm of 1 sanitary physician for 30-40 thousand collectivized population. In the area of sanitary service to the collective sector, as in the provision of medical assistance, there will be growing demands for differentiated assistance and specialization. In addition to so-called general sanitary physicians, epidemiologists, communal-housing, and food sanitary physicians will be required in the near future. The sanitary organization faces the tasks of actively participating in the selection of sites for state farms and new settlements; in the construction of new settlements and housing (planning, development of standards and types, sanitary supervision of construction, etc.); in the implementation of communal improvements (water supply, sanitation, green spaces, bathhouse-laundry services); in the organization of proper nutrition, etc. The sanitary organization must become (as well as the rest of the medical personnel) the initiator, pioneer, and propagandist of the idea of reorganizing daily life on the basis of collectivization, and an active organizer of the new collective way of life. It is necessary to develop types of new housing that satisfy sanitary-hygienic requirements and are oriented towards the maximum collectivization of daily life. Although under the conditions of the artel form of collective farm construction the type of collectivized housing may not predominate, the number of communes is nonetheless growing now. A well-organized house-commune will play a stimulating role in abandoning individual forms of life and transitioning to a collective way of life. The sanitary organization must actively participate in implementing the following directive from the VII All-Russian Congress of Health Departments: 'In state farms and collective farms, along with building the network of medical institutions provided for in the plans and organizing broad health measures to combat epidemics, during the current summer, first-aid medical posts, nurseries, and bathhouses must be organized in each large state farm and collective farm.' At the present time, the question of organizing nutrition in the state farm, especially during field work, is of great importance. This involves a number of issues: establishing proper nutrition regimens and food composition, storage, preparation, and distribution of food, etc. The entire nutrition system should be based on public dining. The tasks of sanitary service to the collective sector of the village are becoming increasingly complex. The tasks no longer amount to mere 'supervision' but to active participation in building a new way of life, actively helping the masses to master a new sanitary culture, and introducing the masses to the basics of personal and public hygiene and prevention. Solving the task of sanitizing the collectivizing village is impossible with the forces of the medical organization alone. It is necessary to mobilize the forces, energy, initiative, and self-activity of the millions of collective farm members around this task, as is done in resolving other major economic and political tasks. The task of the health authorities and the entire medical collective is to arouse the activity of the masses and lead them in the struggle for a new, healthy way of life and labor. In each state farm and collective farm, cells of mass self-activity in the field of healthcare should be organized: sanitary commissions, KOTIBs at unified dispensaries, etc. It is also necessary to widely use the cells and detachments of the ROKK, Komsomol, and other organizations existing in the village, and to more broadly involve women's organizations in this work. Methods of socialist competition and shock work should become the basis for the work of health authorities and the entire medical network in sanitizing the collective sector. Along with patronage of state farms and collective farms by urban medical collectives, it is also necessary to widely practice the latter's patronage of the medical institutions serving them; periodic holding of production meetings at medical institutions with the participation of collective farm members, periodic reporting by medical institutions at meetings of state farm workers and collective farm members, inspection of the activities of medical institutions by brigades of state farm workers and collective farm members, etc. The resolution of all the aforementioned tasks in the area of sanitizing the collective sector of the village depends to a large extent on the question of personnel. For the coming years, huge numbers of both medical and middle-level medical personnel will be needed: tens of thousands of physicians and middle-level staff. The personnel problem is a problem not only of quantitative but also of qualitative order. Instead of the so-called district physician, the general practitioner, there is a need for physicians-therapists, surgeons, physicians for the protection of motherhood and childhood, eye doctors, venereologists, sanitary physicians, dentists, etc. In accordance with these new demands from the countryside, the system of medical education is being reorganized on the basis of medical universities graduating physicians with completed specialization, by all means increasing the pace of training physicians both by maximizing admission quotas and by introducing a continuous academic year, reducing training periods, etc. But all these measures will still not fully satisfy the need for medical personnel in the near years. Therefore, it will be necessary to practice sending medical brigades from the city to state farms and collective farms during field work, minimize the performance of administrative and economic functions by physicians and middle-level medical personnel in rural medical institutions (these functions can be entrusted to people promoted from among the collective farm members themselves); use the labor of collective farm women who have passed through short-term courses to serve in nurseries and other children's institutions, etc. Full provision of medical institutions with transport, especially automobiles, will significantly increase the productivity of the physician and the entire medical institution. Rationalization in the placement of the network, full utilization of the network, and rational organization of labor based on the maximum use of medical personnel for their direct purpose, etc., will make it possible to compensate for the shortage of medical personnel. In addition to the question of personnel, the question of the financial base for healthcare is of decisive importance in the task of sanitizing the village. Until now, rural medicine has been financed from the local budget. No matter how much local budget appropriations for healthcare may grow in the future, they will still not be able to ensure the necessary pace of building a new network and maintaining it. The problem arises of creating a financial base for healthcare in the countryside adapted to the new tasks. Collectivization itself creates this financial base by increasing the accumulations of the peasantry in much larger amounts compared to individual farming. The task is to mobilize part of these accumulations for the purpose of improving the health of the collective farm masses. The introduction of social insurance in collective farms with corresponding percentage deductions to the medical assistance fund can provide very significant sums that will ensure much faster implementation of health measures than before. Along with this, it is necessary to use the resolutions of the Council of People's Commissars of the USSR of November 26, 1929, and January 12, 1930, on financing the construction of new hospitals in state farms from the budgets of agricultural associations (Grain Trust, Sovkhozcenter, etc.). The cultural funds of both consumer and agricultural cooperatives should be widely used. The creation of a special fund to assist in the construction of cultural and everyday institutions in large collective farms makes it possible to significantly intensify the deployment of medical posts, nurseries, and other cultural and everyday institutions. A great resource is the personal labor and monetary contribution of the collective farm population itself, which in new hospital construction can cover 25-30% of the construction cost, and in the development of the nursery network—even up to 75-100% of all expenses. But while mobilizing all possible means from the collective farms and agricultural associations themselves, it is necessary at the same time to significantly increase the role of the local budget in financing healthcare in the collective sector of the village, and also to involve the state budget in this work through the implementation of measures to combat epidemics, financing of hospital construction, etc.