Health Protection of Children and Adolescents

HEALTH PROTECTION OF CHILDREN AND ADOLESCENTS The methods and organization of work in Health Protection of Children and Adolescents (OZDiP) are determined by the general system of healthcare and education in the USSR. History of OZDiP. In the prerevolutionary period, the first weak beginnings of state measures appeared in direct connection with the growth of the workers' movement in 1905, in the form of the so-called "Medical-Sanitary Department of Educational Institutions" created in that year at the Ministry of People's Education. Before this, the secondary school, faithfully preserving the "traditions" of the lamentable memory of D. Tolstoy, who had created in the system of pure classicism an "antidote" to the growing revolutionary movement of the era of Alexander II, did not even have those more than modest measures that emerged after 1905. However, systems for improving the health of children and youth did not exist, and subsequently there were only separate, disparate measures, the class character of which is best seen in the example that the object of school hygiene was only the secondary school. Basically, this work was reduced to the most elementary sanitary supervision (participation in the construction of schools and in their equipment). In some places, attempts were made to teach a course in hygiene, but not on a mandatory basis. School sanitary physicians, who specifically worked and dedicated themselves to this activity, could be counted on one's fingers and only in secondary schools. The mass school, both in rural areas and in cities (rural, elementary and urban schools), was not served at all. The overwhelming majority of physicians serving the school carried on this work as an additional activity to their main medical specialty. OZDiP in the USSR is the child of the October Revolution. In its initial period, soon after the transfer of state power to the organs of the dictatorship of the proletariat—the Soviets, the current department of OZDiP of the People's Commissariat of Health (NKZdr.) was organized as a school hygiene department at the People's Commissariat of Education (Narkompros). The beginning of the organization of the department dates back to November 1917, i.e., the school hygiene department was structured in the system of Narkompros from the moment of its organization. The organization of this work was entrusted to V. M. Bonch-Bruyevich with a small group of workers who showed much initiative and energy in organizing OZDiP. The work of the school hygiene department of Narkompros, compared with similar work before the October Revolution, unfolded on completely new principles. The principle of involving broad strata of the proletariat both in the organization of this matter and in direct practical work is laid at the foundation of this work. A school sanitary council was organized at the school hygiene department. The latter includes representatives of proletarian organizations, parents, and representatives of scientific institutions. The task of the council was to guide the activities of local school sanitary councils, as well as to organize institutions designed to implement the entire set of scientific and practical measures in the field of OZDiP. In 1918 (October 18), the school sanitary council of Narkompros was transferred to NKZdr., where it exists as an independent department, later renamed the department for the protection of the health of children and adolescents, which serves as an expression of the fundamental change in the entire content of the work and its expansion from the questions of school hygiene toward the improvement of the entire children's collective and the children's environment. The initial work of the school sanitary department of NKZdr. unfolded in the direction of deepening the work of the school sanitary physician in terms of a broader coverage of all the factors affecting the child, and first of all, factors conditioned by the social environment and the influences of the pedagogical process. The work of the integral school sanitary physician, which was based mainly on data from undifferentiated examination of the child, to a large extent without taking into account all the complexity and structure of his behavior, is increasingly differentiated as specialized polyclinical and clinical-type institutions grow. The main types of these institutions become the children's preventive outpatient clinic (DPA), school-nervous sanatorium. The task of school physicians, having materials from DPA, included establishing on the basis of examination data the state of health, physical development, and behavior of children, taking into account all factors of the social environment and the necessary complex of health-improving, pedagogical, and educational influences. Under the new requirements, in turn, posed by the reorganizing school, the functions of the school physician also changed. The latter gradually transformed into a physician of OZDiP, relying in his work on the data of medical-pedological research of children and adolescents. The historical continuity of work in OZDiP and school sanitary supervision often serves as a basis for their identification. Meanwhile, they are fundamentally and essentially different from each other. Work in OZDiP is built on a pedological basis and proceeds in close organic connection with the pedagogical process. The starting point for the construction of all work in OZDiP is not normative hygiene requirements, but the accounting of the dynamics of the growth and development of the child in his active interaction with the real environment surrounding him. The content of work in OZDiP is a system of organized social-preventive measures (social-hygienic and socio-pedagogical) for the improvement of the child and adolescent and the children's collective on the basis of analysis of their behavior in the conditions of everyday life and labor. Thus, work in OZDiP, being in essence not only sanitary-hygienic, but also medical-pedological work, also differs from the hygiene of upbringing. The latter has as its main task "participation in the organization of the external environment of the child as an educating factor, ensuring its hygienic completeness." The work of OZDiP has as its task, in addition to this, the rational organization of the regime and load of children and the entire pedagogical process as a whole through active participation in it, for the purpose of educating a healthy and complete in social-class terms generation. The hygienic design of the external environment is considered in the work of OZDiP as an essential part of the entire pedagogical process as a whole, and not as an independent task isolated from the school. The content of medical-pedological work—work in OZDiP—is determined to a large extent by the nature of the construction of the pedagogical process and the peculiarities of various types of institutions of social education and vocational-technical education. At present, in connection with the introduction of universal education and the polytechnization of the mass school, work in OZDiP will be determined to a large extent by these factors. The polytechnization of the mass school, essentially changing the entire character of pedagogical work in the school, connecting the latter with production and making labor the main backbone of the entire educational-educational work, naturally must change both the methods and the content of work in OZDiP. The labor of children in school and in production should become not only a method of cognition, but also a method of education and health improvement. According to the resolution of the Central Committee of the All-Union Communist Party (Bolsheviks) of September 5, 1931, on primary and secondary schools—"the connection of education with productive labor must be carried out on such a basis that all socially-productive labor of students is subordinated to the educational and educational goals of the school"; all the more the role and significance of the physician of OZDiP in the rationalization of this labor, the organization of the correct regime and load of children, and the improvement of mass children's institutions are increased. Thanks to the above-mentioned resolution of the Central Committee of the All-Union Communist Party (Bolsheviks), the issues of improving the mass school, the regime and load of the schoolchild became the center of attention not only of physicians of OZDi and educators, but of the entire Soviet public. A direct and concrete implementation of the resolution of the Central Committee of the All-Union Communist Party (Bolsheviks) is the "Temporary Regulations on School Sanitary Inspection", issued by NKZdr. on December 15, 1931, the resolution of the Council of People's Commissars of the RSFSR of November 15, 1932, "On the Internal Routine of the School", and the publication by NKZdr. and NKP of the RSFSR of the "standard routine" of school classes and the norms of load for schoolchildren by all types of educational-production and public work. The Regulation on School San. Inspection imposes on physicians of OZDiP the duties of school sanitary inspectors as state inspectors having the right of state control and supervision over the sanitary condition of children's institutions, bringing persons guilty of non-compliance with sanitary requirements to responsibility in court and imposing various penalties. The Regulation on School Sanitary Inspection determines the specific content of the sanitary-hygienic work of the physician of OZDiP in mass children's institutions. The resolutions of the Council of People's Commissars, NKP and NKZdr. of the RSFSR of November 15, 1932 give precise normative indicators for individual types of activities of the schoolchild both in school and outside it, as well as regulate his public work and ensure the schoolchild a normal and healthy rest. The resolutions of the Council of People's Commissars of the RSFSR, NKZdr. and NKP were warmly supported by the Central Committee of the Komsomol, which by a special resolution of February 17, 1932 proposed to all local organizations of the Komsomol to take upon themselves direct control, supervision and responsibility for the correct and timely implementation of the said resolutions.

Thus, the work of the physician for the Health Protection of Children and Adolescents (OZDiP) in the polytechnic school received powerful support from all Soviet society, and first and foremost from the Komsomol. The aforementioned resolutions represent a turning point in the work of the OZDiP physician, requiring his direct and active participation in the work of the mass school, both in terms of its improvement through the simplest, available, and widespread measures (sanitary minimum), and in the rationalization of the regimen and workload of children. This gives a decisive rebuff to both the leftist deviations of the 'ura-pedologists,' who dissolved sanitary-hygienic work in pedology, and the 'pure hygienists,' who noticed nothing in the mass school except sanitary-hygienic defects, passing over questions of polytechnicism, regimen, and workload, etc. - Simultaneously with the concrete plan of actions outlined in the resolution of the Central Committee of the All-Union Communist Party (Bolsheviks) on primary and secondary schools and the resolution of the Council of People's Commissars, People's Commissariat of Education, and People's Commissariat of Health of the RSFSR of 15/11 1932, the Central Committee of the Komsomol adopted a resolution of 4/XII 1931 on the service to working adolescents. This resolution outlines a series of concrete measures that should become a plan of action for the OZDiP physician in serving the working adolescent, both in terms of protecting and improving the labor conditions of the working adolescent, and in carrying out mass health measures to improve his living conditions. All the aforementioned resolutions define a decisive turn in the work on OZDiP towards the maximum approximation of this work to the direct needs of children's institutions and active participation in social construction on the basis of fulfilling the six historical conditions of Comrade Stalin. Thus, the work on OZDiP consists of the following main sections: 1) sanitary-prophylactic, 2) cultural-hygienic (sanitary-educational), 3) physical education and mass health measures, 4) pedological substantiation of the pedagogical process, and 5) organizational-public. The sanitary-prophylactic section of the OZDiP work consists: 1) in systematic sanitary supervision over the condition of the premises of children's institutions and their equipment, the adjacent area and auxiliary premises, and in the practical implementation of necessary sanitary-hygienic measures; 2) in mass preventive examination of children and adolescents for the isolation of patients with various contagious diseases (trachoma, scabies, ringworm, etc.); 3) in a general hygienic examination of children to identify the most hygienically neglected children - dirty, lousy, poorly washed, etc. - for the purpose of carrying out hygienic measures; 4) in carrying out mass preventive measures to combat contagious diseases (vaccination against smallpox, diphtheria, scarlet fever, etc., as well as disinfection and disinfestation); 5) in establishing the terms of isolation and quarantine, as well as in the temporary closure of children's institutions in connection with various infectious diseases; 6) in the organization and systematic supervision of the proper organization of children's nutrition in children's institutions. Particularly relevant in connection with universal education are hot breakfasts in the mass school. In institutions of the boarding type (children's homes), hostels-communes of working youth and kindergartens, questions of nutrition, both in quantitative and qualitative aspects, require special supervision from physicians. The cultural-hygienic section of the OZDiP work includes 1) systematic conversations with children on questions of personal and social hygiene and the organization of special hygiene circles among children; 2) the organization of children's activity to participate in the supervision and practical implementation of all sanitary-hygienic measures in the children's institution and outside it, as well as among individual children, in the children's collective and in daily life; the most common form of organizing children's activity is the children's sanitary commission; the latter is usually created for the school as a whole with representation from each group; in addition, children's sanitary commissions can be created in individual groups; 3) systematic sanitary-educational work among parents through conversations, lectures, and consultations (individual and collective) on questions of hygiene of upbringing and pedology, as well as the organization of special circles from parents on questions of upbringing and health improvement of the child; 4) systematic pedological-educational work among educators through the organization of special pedological circles, reports, lectures, conversations, and constant pedological consultation; 5) systematic conversations with the technical staff of children's institutions on questions of sanitation and hygiene, cleaning of premises and basic questions of age-related features of children; 6) teaching hygiene - general and professional - in children's institutions. Supervision of the correct physical education of children and adolescents and the organization of mass health measures are one of the essential tasks of the OZDiP work. The basis for the correct physical education of children and adolescents is the regimen of work and rest, organized in accordance with the features of a given children's institution and a given children's collective. In connection with the polytechnization of the mass school and the attraction of children and adolescents to active participation in social construction and in productive labor, the content of the OZDiP work in relation to the physical education of children and adolescents consists of 1) dosing of labor in terms of workload and duration in time in connection with the individual psycho-physiological features of children and adolescents; 2) establishing the correct distribution and alternation of work and rest during the working day, decade, month, etc.; 3) correction of harmful labor factors and influences through both special physical exercises and general measures for physical education; 4) systematic medical supervision of the physical development of children and the state of their health through periodic, not less than once a year, medical examinations and anthropometric measurements; 5) systematic medical supervision of the correct organization and conduct of physical exercises among children and adolescents, both in special lessons in physical exercises and during club hours and out-of-school time; this medical supervision either is limited to only accounting for the most accessible reactions of the body to one or another physical exercise (pulse rate, respiration, subjective complaints and sensations) or is conducted on the basis of experimental physiological research (biochemical, functional research of the activity of the cardiovascular system, energy balance, psychological data, etc.); 6) organization and systematic supervision of the organization of physical education in mass health institutions for children and adolescents. Among the mass health institutions are first and foremost children's playgrounds. The next institution of a mass health nature is the summer colony. Similar to summer colonies for children, camps for pioneers are organized (see Camp, pioneer camps). - Along with the organization of mass health institutions, an organic component of the OZDiP work is the conduct of mass health measures within the children's institution. It is also very important to supervise the regular presence of children in the fresh air. In this regard, special importance is given to children going out during breaks between lessons to the schoolyard or playground. In preschool institutions, children's walks constitute an obligatory part of the daily regimen. Walks have not only a health-improving value but also a pedagogical one. In school institutions, children's walks are usually conducted in the form of excursions into the bosom of nature (forest, field, etc.), into the city to get acquainted with individual sights, and to production. In the spring-summer period, schools also conduct walks of a purely health-improving character, especially for younger children. The next substantial section of the OZDiP work - the medical-pedological substantiation of the pedagogical process - is based on two main points: medical-pedagogical examination of children and adolescents and medical-pedological analysis of the pedagogical process. Pedological examination is a dynamic examination of the personality of the child and his behavior in active interaction with the environment. The pedological examination conducted by OZDiP physicians is fundamentally different from the examinations conducted by school-sanitary physicians in the pre-revolutionary period. The latter concerned mainly the state of health and physical development of children without taking into account their specific behavior in the conditions of a specific environment and without taking into account the specific requirements of the pedagogical process. The state of the 'body' of the child was examined mainly, not the integral psycho-physical personality. The examination in its practical conclusions was not connected with pedological and medical practice for the improvement of the school and had predominantly a purely biological character. Meanwhile, the medical-pedological examination, along with the biological features of the child, also concerns his psychological qualities, socio-domestic features, and traits of behavior in their dynamic development and constant interaction. The integral pedological examination and study of the child does not, however, exclude the simultaneous special examination and study of individual aspects of the child's development.

Thus, physicians of the Health Protection Department for Children and Adolescents (OZDiP) and the Department of Physical Education (DPA) have conducted and continue to conduct extensive practical and research work on the study of the physical development of the child and the peculiarities of this development depending on climatic, national-racial, domestic, industrial, and other conditions. Data on physical development, which were previously often considered in isolation from other data on the socio-biological development of the child, are now regarded only as an organic component of all data on the child's development and are interpreted relative to and depending on specific requirements (labor, physical education, etc.). Therefore, the examination of physical development takes place not so much in special anthropometric offices as in offices for medical supervision of physical education or in medical-pedological offices. Pedological examination is conducted comprehensively and consists of the following main points: 1) examination of the socio-domestic, cultural, and industrial conditions of the environment of the child and adolescent; 2) examination of the physical development and health status of children and adolescents; 3) examination of psychological development (intellect and giftedness, range of ideas, thinking, etc.); 4) pedological characterization of behavior and success. All data from the examination form the basis of the so-called collective diagnosis. The collective diagnosis is a medical-pedological analysis and synthesis of all examination data in their holistic understanding as applied to the actual behavior of the child and adolescent. In the collective diagnosis, the physician of the children's polyclinic who participated in the examination, the physician of the OZDiP serving this children's institution, and the teacher of the group where the child or adolescent studies participate. On the basis of the collective diagnosis, both medical-prophylactic measures and measures of pedagogical influence are outlined in relation to individual children and the children's collective as a whole. Measures of pedagogical influence represent a sum of deliberately organized pedagogical measures aimed at correcting various shortcomings in the behavior of the child and the children's collective. The basic principle of organizing various measures of pedagogical influence in the Soviet school is the re-education of the child and adolescent through the organized influence of the children's collective in the interests of socialist construction. No measures of physical influence and punishment in any form are permitted in Soviet children's institutions and are strictly prosecuted by law. It should be noted that in a number of bourgeois countries of Western Europe (Germany, France, etc.) and America, corporal punishment of children remains to this day one of the measures of pedagogical influence that is fundamentally justified. On the basis of pedological examination, the OZDiP physician together with the teacher conducts the formation of school groups and the grouping of individual children and adolescents in children's institutions. When forming school groups, special attention is paid to the organization of relatively homogeneous groups in terms of their educational and productive success and performance, as well as social activity. Individual children and adolescents who cannot work in the conditions of a normal regular school group, such as: mentally retarded, mentally abnormal, overage children, are separated into special children's institutions for these children. Such institutions are auxiliary schools, psycho-neurological schools-sanatoriums, forest schools, and schools for overage children. Auxiliary schools are part of the system of people's education authorities and are intended for children with mild mental retardation. Auxiliary schools differ from ordinary schools in their method of work and the volume of educational-program material. All educational and educational work in auxiliary schools is built on the basis of the active labor method adapted to the primitive-concrete thinking of the mentally retarded child. The volume of educational-program material in an auxiliary school is approximately equal to the course of the first stage and is designed for 5 years of study. Children with severe mental retardation (profoundly feeble-minded, idiots, profoundly demented epileptics, etc.) are placed in special psycho-neurological schools-sanatoriums. The latter are institutions of the boarding type, serving for the care of chronically ill children. These institutions are usually organized at regional or provincial psychiatric hospitals. For children with nervous-psychic abnormalities without mental retardation (psychopaths and neurotics), there are special psycho-neurological schools-sanatoriums and psycho-neurological clinics. These schools represent a type of therapeutic-pedagogical institution where, along with special psychiatric measures, therapeutic-pedagogical measures are also carried out. These institutions have particular importance for children with mild psychopathic and neurotic conditions identified and aggravated by unfavorable conditions of personality development. Psycho-neurological schools-sanatoriums aim at the psychological health improvement of children psychopaths and neurotics, correction of shortcomings in their behavior, bringing them to a state that would allow them to be educated and brought up in ordinary children's institutions. In accordance with these tasks, psycho-neurological schools-sanatoriums have their own special sanatorium-type regime, a special organization of educational and educational work, designed for the boarding stay of children. At present, such schools exist in almost all major industrial cities of the USSR with a total number of beds up to 2,500. All psycho-neurological schools-sanatoriums are part of the system of institutions of the OZDiP of the People's Commissariat of Health. Overage children, exceeding the maximum age established for the school group according to their knowledge and preparation, are separated into separate groups or special schools for overage children. Children usually become overage due to a number of unfavorable domestic conditions that do not allow them to enter school in a timely manner. Overage children are separated into special groups or schools mainly because special teaching methods are required for them, which cannot be implemented in the conditions of normal groups. In addition, keeping overage children in regular groups hinders the work of the latter. Schools for overage children are under the jurisdiction of the people's education authorities. The introduction of universal primary education should completely eliminate the existence of overage children. Data from pedological examination enable the OZDiP physician and teacher to organize work on vocational guidance in school. Until recently, all vocational guidance work was carried out exclusively in the form of so-called vocational selection in special offices and vocational selection laboratories. This work had the character of a one-time examination of the adolescent who had completed school, with the aim of selecting him for a particular production or FZU school. At present, in connection with the elimination of unemployment and universal education, instead of one-time vocational selection, vocational guidance work in the mass school is gradually being introduced. In connection with the polytechnization of the mass school, vocational guidance work in the school acquires very great importance. Vocational guidance in the mass school has as its task, on the basis of long-term and systematic observation and study of the child and corresponding active educational influence on him, to prepare the most qualified personnel for socialist construction. Vocational guidance work in the mass school is conducted on the basis of data from the pedological examination of the school student (see above), as well as additional data on the examination of his behavior, and thus consists in general of: 1) study of the socio-domestic, industrial, and cultural environment of the child; 2) study of the pedagogical process both in its academic and industrial-labor aspects; 3) study of the psycho-physical peculiarities of children and adolescents in their dynamic development; 4) study of the orientation and interests of children and adolescents and their abilities and inclinations; 5) differentiated accounting of the success of children and pedagogical characterization of their behavior; 6) formation and grouping of school groups on pedagogical principles (differentiated groups and schools); 7) systematic work on vocational information of children and adolescents regarding the main industrial professions by introducing this material into the general educational-program material; 8) vocational guidance conclusion in relation to all adolescents graduating from the mass school to vocational-technical schools, on the basis of analysis and synthesis of all materials from long-term and systematic study and observation. Work on vocational guidance in school is an organic component of the pedological work of the physician-pedologist in the mass school and is closely connected with his work on the pedological analysis of the pedagogical process. The latter basically aims to evaluate the methods and content of pedagogical work from the point of view of their correspondence to the psycho-physiological peculiarities of children.

The questions of pedological substantiation of the pedagogical process and its rationalization are exceptionally important, as their best resolution ensures all work on the active health improvement of childhood and enhances its educational and productive success. The organizational and public aspect of the work of the Department for the Protection of Children's Health (DiP). The multifaceted work on the Protection of Children's and Adolescents' Health (OZDiP) can be properly carried out only if it is built on a broad public base. Involvement in active work on OZDiP by party and Soviet public figures, especially pioneers and Komsomol members, is an essential prerequisite for conducting broad preventive measures in the field of OZDiP. The most common form of public participation in the work of OZDiP is the creation of Commissions for the Improvement of Labor and Living Conditions (KOTiB) at the DiP or OZDiP. Among public organizations, the Children's Commission under the Central Executive Committees (CIK) of the union republics in the fight against homelessness and neglect, the 'Friend of Children' Society (ODD), and the republican Red Cross and Red Crescent Society provide special assistance to the work of OZDiP, both materially and in terms of active and direct help in the work. The Red Cross Society of Russia (ROKK) has a special organization for conducting health improvement measures among children, primarily pioneers, called the 'health service for young pioneers' (YP). The latter conducts all its work in close connection with the OZDiP organization, providing it with direct practical assistance, mainly in developing mass and special health improvement measures and institutions for YP. In 1931, the budget of the ROKK for the 'health service for YP' (organization of health resorts and sanatorium camps, summer playgrounds, etc.) amounted to 2.5 million rubles. The ROKK health service also organizes periodic expeditions to serve the child population of national minorities in remote areas of the USSR. Along with organizing adult public figures around the work of OZDiP, no less an urgent task is the involvement of pioneers and Komsomol in this work. Pioneers and Komsomol, representing the most active and conscious part of childhood and youth, are the best conductors of the tasks of OZDiP to the masses of children and adult populations. Many representatives of Komsomol are currently leaders in the work of OZDiP, many actively work in various commissions and councils for the promotion of OZDiP. Pioneer outposts and detachments in schools play a major role in raising the hygienic level of school premises and instilling hygienic skills in children. The large, highly active mass of children and adolescents from Komsomol and pioneers, who carry a significant social burden along with their educational work, naturally requires special attention from OZDiP. In addition to the systematic care of all organized childhood and adolescent populations, they also have the duty of conducting health improvement work among pioneers and Komsomol. The main goal of this work is the rationalization of the regime and work and rest (in school, pioneer detachment, club, etc.) and its active health improvement. All the above sections of work on OZDiP differ somewhat in their content and methods depending on the type of children's institution served - kindergarten, children's home, factory and plant seven-year school (FZS), factory and plant apprenticeship school (FZU), school of apprenticeship for mass professions (SHUMP), etc. Thus, in the FZU school, where adolescents are directly connected with work in production, one of the current tasks of work on OZDiP is participation in the correct distribution of adolescents to individual detailed professions and workshops, improvement of working conditions, fight against injuries and occupational hazards, vocational counseling and professional selection (see), etc. All this work is carried out by medical-pedological offices in FZU schools, which are a branch of the unified dispensary. The OZDiP doctor working in FZU schools is part of the healthcare point at the enterprise. In preschool institutions (kindergartens, playgrounds, etc.), main attention should be paid to the correct organization of physical education, daily routine, mass health improvement measures, etc. In this connection, the practical work on OZDiP is usually differentiated among individual workers according to different types of children's institutions (preschool work, school work and work with adolescents). The content of the work on OZDiP also determines the nature of its structure, which is currently presented as follows. All practical work on OZDiP is carried out by special OZDiP doctors. Among them there is a large contingent of doctors who have completed special medical-pedological courses. Currently, with the reorganization of medical education, special faculties for the protection of motherhood and childhood have been organized, which prepare specialist doctors for OZDiP (pediatricians and pedologists). All work of OZDiP doctors in the area is united around the district DiP (or the gradually replacing it children's department of the dispensary association of the given district). The latter is the leading methodological center for OZDiP work in the district. The DiP (or children's department of the dispensary association) has a number of offices in various specialties: pediatric (therapeutic), psycho-neurological, eye, skin, for diseases of the ear, throat and nose, dental, etc., as well as separate offices for medical control of physical development (anthropometric), medical-pedological and office for vocational counseling and selection. Some DiP, in addition to the mentioned offices, also have special offices for pedological consultation and patronage and a sanitary-hygienic office. The DiP has a staff of nurses for examining the 'living conditions of children and adolescents and carrying out pedological patronage. All work on the dispensarization of children and adolescents and their medical-pedological examination is carried out by the DiP together with OZDiP doctors. The DiP organizes regular conferences of OZDiP doctors, conducts work to improve their qualifications, organizes circles for parents on issues of child upbringing and health improvement, circles for improving the hygienic qualifications of teachers, conducts work with pioneer leaders and the Komsomol active to acquaint them with issues of hygiene and pedology, etc. Thus, the DiP (or children's department of the dispensary association) is the central headquarters for all OZDiP work in the district. Currently, with the organization of the entire healthcare system in the system of dispensary associations, children's departments are organized at the latter, which should take on all the functions of the DiP. All treatment, health improvement and mass preventive measures in relation to children and adolescents of the district, as well as all medical-pedological work, are concentrated in the general system of the dispensary association through its children's departments. At the DiP (or children's departments of the dispensary association), health improvement grounds for children and adolescents, day and night sanatoriums and diet kitchens, which work under their direct leadership and supervision, are organized. All other special institutions for OZDiP also work in close connection, such as: psycho-neurological sanatorium, children's bone tuberculosis sanatorium, forest schools (see), sanatorium camps for working adolescents, etc. In rural areas, in collective farms and state farms, there are OZDiP points, which are small cells of the DiP and perform in a limited way the main functions of the latter. Usually, an OZDiP point consists of one OZDiP doctor and a nurse-examiner. The OZDiP point unites all OZDiP work in the given area and is its methodological and organizational center. In all its work, the OZDiP point is closely connected with the district DiP and is under its methodological guidance. Currently, the network of OZDiP points in collective farms and state farms is still very insufficient and weak. Often, collective farms and state farms are served by workers of the district by periodic visits of the latter to collective farms and state farms for a certain period. In most rural areas, OZDiP work is currently carried out by area doctors. Recently, a number of institutions and OZDiP doctors in regional and city centers have been conducting systematic work on OZDiP in collective farms, state farms and MTS (machine-tractor stations) as part of patronage. All district DiP and OZDiP points are united and work under the methodological guidance of regional or district DiP or OZDiP institutes. The latter are the regional methodological center for all OZDiP work in the region or territory. In some regions or territories, instead of regional DiP, there are OZDiP institutes, which, along with scientific-practical work on methodological guidance of work in the field of OZDiP in the region and territory (functions of the regional DiP), also carry out scientific research work applicable to the peculiarities and needs of the given territory. Scientific research work on OZDiP has been developing since the first days of the organization of OZDiP and continues intensively to the present time, expanding and deepening more and more.

Along with the in-depth study of the material environment, the main issues of scientific research in the field of Health Protection of Children and Adolescents (HPDA) are the problem of child development, age-related psycho-physical characteristics, questions of child behavior, and the influence of individual factors of organized and unorganized environmental impact on this behavior, the problem of child labor, questions of daily routine, hygiene of premises of children's institutions, their equipment, inventory, teaching aids, books, etc., school construction, psycho-physical characteristics of 'difficult' children, sick children, disabled children, etc. All scientific research work aims to substantiate and scientifically formulate the methodology, techniques, and practice of work of the HPDA physician in all its sections. - The structure of HPDA institutes at the present time is generally uniform and has the main departments: 1) morphological-physiological, 2) sanitary-hygienic, 3) medical-pedological, 4) psycho-neurological, 5) social-hygienic and organization of HPDA. Regional and territorial departments of child protection (DPA) and institutes are at the same time the methodological base for operational work on HPDA of regional and regional health authorities. At present, in the RSFSR there are the following institutes for HPDA: the Central Institute for HPDA named after the tenth anniversary of the October Revolution in Moscow, the HPDA Institute in Leningrad, the North Caucasus HPDA Institute in Rostov, the West Siberian HPDA Institute in Novosibirsk, and the HPDA Institute in Nizhny Novgorod; in Ukraine there are HPDA institutes in Kharkov, Kiev, and Odessa. All operational work on HPDA is carried out through health authorities that have in their staff special sectors or departments for HPDA or special HPDA instructors. In Ukraine, work on HPDA in the health department apparatus is united in a single sector of Okhmatdet. According to materials of the five-year plan of the People's Commissariat of Health of the RSFSR, the network of institutions for HPDA is planned as follows: tuberculosis sanatoriums, etc.), as well as representatives of the Komsomol working in the field of HPDA, and representatives of workers' and public organizations. In total, during the existence of the HPDA organization since October 1917, 8 congresses and conferences have been held. The last conference was held in Moscow in March 1931. HPDA in the West. Analyzing measures in the field of HPDA in bourgeois countries of Western Europe and America, we encounter extreme diversity of forms and methods of work not only on an international scale, but also in each individual country. What is for us an indisputable, characteristic feature of practice in building in any field (e.g., planning work), is absent in capitalist countries. Familiarization with international reports of the hygiene commission of the League of Nations in the part of materials covering the state of HPDA abroad leads to the conviction that even in the organization that, among other branches of sanitary-preventive work and measures in the field of HPDA, there is not even an attempt at planning. Table 1. Network of institutions 1927/28. 1928/29. 1929/30. 1931. 1932. 1933. Auxiliary beds (day and night beds for physically anomalous children Sanatorium colony for working teenagers . . . The table shows significant growth of the HPDA network compared to the existing one. The latter follows from the need for adequate service of huge contingents of children involved in mass school in connection with universal education, as well as the large number of adolescents entering into productive labor in connection with the industrialization of the country and the need to prepare large contingents of qualified workers. According to the data of the People's Commissariat of Education, the contingents of organized childhood are expressed in the following table: Contingents of service 1930/31. 1931/32. 1932/33. In the city Preschoolers.......... 1,200,000 2,653,050 300,000 1,820,000 7,063,360 274,000 1,850,000 2,873,420 500,000 4,150,000 7,865,800 672,000 250,000 2,200,000 3,106,320 1,000,000 5,800,000 8,800,000 1,050,000 1,095,000 Schools of I and II degree ..... In rural areas Preschoolers .......... Schools of collective farm youth . . Evening schools of collective farm youth. Thus, the planned large growth of the HPDA network is still far from sufficient and will require its further intensive development. - All work on HPDA is periodically subject to public review and accounting at special conferences and congresses on HPDA. The mentioned conferences and congresses are convened from among practical workers in HPDA (pediatricians, this work. For example, in the USA, one of the most advanced capitalist countries, or in Germany, almost everywhere work in the field of HPDA is carried out independently by individual states or municipalities, with weak attempts by central organizations to introduce unity into forms, content, and methods of work. The second feature of HPDA abroad, sharply differing from our practice, is the bourgeois-class nature of all measures in the field of HPDA. Service to schools and other children's institutions abroad in terms of the nature of work varies depending on the type of institutions. Institutions serving children of the aristocracy and bourgeoisie have excellent equipment, beautiful buildings built according to all the rules of sanitation and hygiene, with special grounds and premises for gymnastic and sports exercises, and all these institutions are provided with assistance and support from physicians of various specialties. Despite the presence of extensive legislative acts on the protection of child labor, despite the extensive network of institutions for the protection of the mental and physical health of children, all this taken together does not protect children from the destructive influence of the capitalist system. Mass unemployment, a sharp decrease in wages, inflation, rising prices for essential products - all this primarily affects the children of the proletariat and leads to high morbidity and mortality. As a form of self-defense, bourgeois science has developed and widely uses the concept that children inherit inadequate biological properties from their parents; hence their mental and physical ill-being. At the same time, the thought of the responsibility of the bourgeois capitalist system and the socially unfavorable environment is consciously discarded. One of the distinctive features in HPDA work in bourgeois countries is the philanthropic nature of many measures. Most pronounced in this respect is the work on HPDA in the USA. If in the USSR the entire system of measures for HPDA is an independent section of the work of the People's Commissariat of Health, then in the USA this branch of work is scattered among various departments and moreover differently in different states. Measures for HPDA can be found in the departments of labor authorities, health authorities, education authorities, internal affairs authorities, etc. In the absence of a single organization guiding all measures in the field of HPDA, in the USA there is an organ of ideological guidance for all work on the protection of childhood, namely - the Federal Bureau for the Protection of Childhood (Department of Labor). The Bureau consists of six departments, including the department of child hygiene (besides the department for the protection of motherhood and infancy). The main tasks of the department of child hygiene and health protection are as follows: studying the influence of working and living conditions, studying the health of children, as well as studying their physical condition and nutrition, studying child mortality, accidents and diseases of children. The department concentrates data on methods of work and 'must find the best ways and means so that the child is strong and healthy'. It is obliged to report the results of its research to parents, teachers, and all organizations concerned with children. The department of labor protection of the same bureau also sets itself a number of tasks closely related to work on the protection of children's health (studies the labor of minors, the influence of labor on the psycho-physical development of children, develops legislation on child labor, on the admission of students to various educational institutions and to production depending on their mental and physical development). There are quite a few states where work on HPDA is in its initial stage. Special departments for HPDA exist in 46 states. The most common institutions working in the field of HPDA in the USA are the following: children's polyclinics, remedial schools for physically and mentally anomalous children, schools for so-called defective children, school doctors, social help sisters. A large amount of work is carried out in a social-hygienic aspect in institutions serving homeless children. So-called bureaus of investigation are widely spread in the USA, in the work of which, as a rule, a somatic physician, a psychiatrist, and an investigator at home ('social worker') participate. - Along with the extensive network of institutions for HPDA, it is necessary to note as one of the contradictions of the capitalist system - the widespread use of corporal punishment applied as a system, which, however, is also characteristic of other bourgeois countries. Legislation on the protection of childhood, which in general is of great interest due to the thoroughness of its development, deserves no less attention.

Care for the protection of children's health and their recreation, as well as the protection of child labor, are included in legislation as main sections. In particular, it is punishable to leave children without medical care, to keep them in filth, to sell alcoholic beverages to children, to treat children with tobacco and cigarettes, to employ them in industries harmful to health; it is forbidden for children and adolescents under 18 years of age to participate in fighting, boxing, fist fights, etc. Despite the presence of well-developed legislation, it is rare to find such vicious exploitation of children as in the USA. Armies of bootblacks, newspaper vendors, and workers in various industries are staffed with children starting from 7-8 years of age. England. Work in the field of children's health protection is carried out by the Ministry of Education in coordination with the Ministry of Health. All work, allocated to a special school-medical sector, is divided into districts, the number of which is 318 (rural and urban districts). The main sections of work in the field of health protection of children and adolescents (HPChA) in England are as follows: 1) medical inspection (examination and sanitary supervision) and treatment of schoolchildren, 2) organization of breakfasts in schools, 3) conducting physical education activities, 4) care for the "evening" recreation of students (in our country "club" days, organization of students' leisure time), 5) service for preschool children (from 2 to 5 years old ecoles maternelles) and 6) work along the line of so-called "special" schools (schools for physically and mentally deficient children). All work in each autonomous district is directed by a special school doctor. He is often also a sanitary doctor (which, in the opinion of the author of the report, is not useless, as it helps to establish a connection between health authorities and education authorities). It should be noted that in the USSR, such a "connection" has long been abandoned, since each area of work requires special competence; moreover: work in the field of HPChA in the USSR is so differentiated that it requires training of doctors in special faculties, and the work itself, depending on the age of the children served and the type of pedagogical and therapeutic-pedagogical institutions, is carried out by special doctors (doctors serving preschool institutions, seven-year schools, FZU, neuropsychiatrists, physical culture doctors). The school doctor, directing the work in his district, directs the work of specialists and nurses. All work is mainly of a preventive nature. Instructions are given regarding heating, ventilation, physical and mental health of children, sanitary-hygienic education, etc. School authorities ensure regular supervision of all children in primary and secondary schools. Students during their time at school are examined at least three times: upon entering school, upon reaching the age of eight, and upon reaching the age of twelve. In addition, children can be examined at any time based on applications from parents, students, teachers, and school nurses. The school nurse systematically monitors the children, especially those requiring special observation, and ensures compliance with the doctor's prescriptions. If parents cannot care for children, the school provides necessary assistance in this regard. As a result of examinations, a number of therapeutic and preventive measures are carried out. Children with disorders of vision, hearing, speech, with lesions of the tonsils and teeth, etc., are identified. Treatment is carried out in special institutions called "school clinics", the number of which is 1,500. Where there are no school clinics, treatment is carried out in general hospitals and medical institutions on the basis of special agreements concluded by health and education authorities. Annually, more than half of the children attending primary school undergo regular medical examination. The total number of children examined in 1927 was 2,686,000 (out of 4,967,000 attending school). Children who only undergo regular examination account for about 20%, those receiving special treatment for special indications - 30%. This does not include children receiving dental care and special "preventive care" due to "dirtiness". Two-thirds of the examined children need dental care. The dental personnel engaged exclusively in oral sanitation numbers 280 full-time and 1,860 part-time. In addition to dentists, there are dental surgeons. Of these, 238 work full-time and 386 part-time. There are 2,796 school nurses. Of these, 1,252 sisters are engaged only in this work (mentioning part-time work, the author of the English report emphasizes that all part-timers are engaged only in public medicine, not in curative medicine). As in the USA, work in English schools is also carried out by charitable organizations. Often school nurses are helped by district nurses serving charitable organizations. Special attention is paid to the complete service of visual impairments, nasopharynx (adenoids, hypertrophy of the tonsils, etc.). But still there are many areas where this work is not carried out. Dental care by no means covers all contingents of children. All the data presented characterize the work in the field of HPChA in primary school. Similar work carried out by education authorities in the second stage or in advanced type schools is limited only to medical examination. Treatment is optional. Basically, service of these schools is carried out by doctors of the first stage. The organization of "hot breakfasts" is within the competence of school doctors. Breakfasts should be given free of charge to those in need. In other cases, parents must reimburse the cost of breakfasts. The number of breakfasts issued in 1927 amounted to 10,000,000. The cost of a breakfast is 3 pence. By the number of breakfasts issued, one can often judge the social upheavals in the country. For example, during the famous coal strike of 1926-27, the number of breakfasts issued increased to 70,000,000. Physical education, conducted in primary schools according to the Swedish system, is entrusted to teachers under the medical control of school doctors. In the second stage, physical education is conducted by specialists (in girls' schools by female specialists). From the review presented, it is clear that the English bourgeoisie spends significant funds on the cause of HPChA, but just as in the USA we encounter ruthless exploitation of children here. Unemployment in England, sharply exacerbated class struggle, primarily affect children. Hungary. In the work on HPChA in Hungarian schools, school doctors, specialist doctors, and school nurses participate. Specialist doctors are also distributed by districts. A school nurse works with each of them. School doctors carry out only sanitary-preventive work and as a rule do not engage in treatment (only in exceptional cases). The doctor's task is to monitor the health of children in school and their physical and social well-being. The doctor creates a card for all children in school. At repeat examinations, special attention is paid to children who need it. School doctors report on their work in special monthly and annual reports. They work and participate in conferences with teachers, speak among parents and students. School nurses help doctors in examining children, visiting homes, and compiling individual cards. Dental care for schoolchildren is carried out by a special dental group. In 1926, school doctors conducted 54,738 primary examinations with completion of an individual card (total number of students in Budapest 79,800), 20,723 home visits; 10,817 children were sent to summer colonies. Sanitary-educational work is carried out in schools. Poland. The work of HPChA in Poland is concentrated in the Ministry of National Education. Medical-sanitary service of primary schools is funded from local budgets. The same work in second-stage schools is financed from the state budget. Regular service of primary schools is carried out in 168 points (according to the 1924 report). In Warsaw, one doctor serves 2,500 children. Rural primary schools are visited by so-called hygiene functionaries (inspectors). The table below gives an idea of the quantitative coverage of schools with HPChA measures. Table 3. Total number of schools [including private] Number with medical service absolute % 128,267 Schools

375 I 72,8 ! 782 I 546 1 69,8 47ft The system of measures for Health Protection of Children and Adolescents also includes schools for children with reduced intellect (for 200 beds), 13 schools for backward children (for 2,000 children), 4 schools for the blind (200 people), 15 schools for the deaf-mute (850 people), 2 schools in the open air (Warsaw, Zakopane). Finland. Measures in the field of Health Protection in Finland are included in the system of the Ministry of Social Welfare, where they are allocated as a separate division of work. All measures for Health Protection of Children and Adolescents in Belgium are concentrated in the Ministry of National Education, in Greece - in the Ministry of Cults and National Education. The Ministry has organized medical-sanitary service for schools in all large cities. Hygiene has been introduced as a compulsory subject in secondary schools. As a detail characteristic of Greece, it should be noted that all teachers undergo a compulsory medical examination before beginning their teaching duties. In Lithuania, work on Health Protection is concentrated in the Ministry of National Education in the form of the so-called school-sanitary service. Schools of an advanced type are served by 97 school doctors. In Turkey, within the Ministry of National Education, a directorate of school hygiene has been allocated. Regular sanitary supervision is conducted, hygiene teaching has been introduced, and medical examination of students is carried out. In Czechoslovakia, the Ministry of Education, through a special service, has provided medical service to primary schools, organized 514 institutions for youth assistance (colonies, polyclinics), 315 orphanages, 20 shelters for the deaf-mute, 15 for the blind, 4 for epileptics, and 21 for the mentally retarded. In Yugoslavia, the Ministry of Cults, through a school-hygienic service, has provided schools with medical service, which includes not only examination and treatment, but also lectures on hygiene. The number of school polyclinics is very limited. Polyclinics are organized by the Ministry of Health. By 1926, a total of 52 had been created. All work of the school-hygienic service is carried out in the following areas: 1) systematic examination of students; 2) treatment of sick students in hospitals by specialist doctors; 3) sending weakened students to colonies, etc.; 4) assistance to those in need of food and clothing; 5) carrying out disinfection and, if necessary, prescribing showers; 6) consultations and conferences with parents, teachers, and children; 7) cooperation with private societies serving childhood; 8) creation of school kitchens, summer colonies, schools in the open air, school baths.--Health Protection of Children and Adolescents in Italy and Germany-see Germany, Italy.