Induration

INDURATION (from Latin indurare - to make hard), hardening, a term used to denote an increase in the density of tissues of very different character. In some cases of I., the basis is merely a loss of parenchyma, which is the soft component of the organ, whereby the more dense consistency of the connective tissue stroma begins to predominate; in other cases, I. is associated with proliferation of interstitial connective tissue in the organ. Often, I. is based on a simultaneous or sequential loss of parenchyma and proliferation of connective tissue. I. occurs in atrophies; here it is initially associated only with loss of parenchyma, but later proliferation of interstitial connective tissue is added. Venous I. (induratio venosa, s. cyanotica) is the hardening observed with prolonged blood stasis in organs (liver, spleen, kidneys), is partly associated with tension of the vascular system from blood engorgement, and partly (later) with proliferation of connective tissue. I. in the lungs develops with the deposition of non-native materials in them, for example, hemosiderin (brown I. of the lung), dust materials (induratio anthracotica, chalicotica, siderotica, etc.). Phenomena of I. are very often observed in chronic inflammations, as well as in tuberculosis, syphilis, actinomycosis, stomach ulcers, with the organization of extensive exudate masses (in the pleura, peritoneum); some of these are sometimes called indurative inflammation. I. can also be observed in acutely developing processes (for example, ulcus induratum, indurative phlegmon of the neck), when edema and infiltration of tissues are accompanied by a significant increase in their turgor. INDUSTRIALIZATION AND HEALTHCARE. I. in the general sense of the word means providing the base of large-scale machine production for the country's economy. The powerful growth of large-scale machine production is a characteristic feature of the economic development of advanced capitalist countries. In capitalist countries, the growth of I. means the growth and strengthening of capitalist relations (but along with this also the growth of capitalist contradictions and forces antagonistic to the capitalist system); under the conditions of the USSR, I. is the path to the socialist transformation of the entire national economy. 'Large-scale machine industry and its transfer to agriculture is the only economic base, the base of socialism, the only base for the successful struggle for the liberation of humanity from the yoke of capital'... 'As long as we live in a small peasant country, capitalism in Russia has a more solid economic base than communism. This must be remembered. Everyone who has carefully observed the life of the village in comparison with the life of the city knows that we have not uprooted the roots of capitalism and have not undermined the foundation (basis) of the internal enemy. The latter is based on small-scale farming, and to undermine it, there is one means - to transfer the country's economy, including agriculture, to a new technical base of modern large-scale production' (Lenin). I. creates the necessary prerequisites for the socialist transformation of small-scale peasant farming, namely: it ensures 1) correct relations between the proletariat and the broad peasant masses, under which the advantages of the socialist economic system over the capitalist one become obvious to the peasant masses, 2) the transfer of agriculture to a higher energy base, to the base of applying the latest achievements of machine technology and agricultural science. The question of the path of development of small-scale peasant farming is decisive in the struggle between socialist and capitalist elements (both inside and outside the USSR). Two paths are possible: capitalist and socialist. In a state of proletarian dictatorship, the path of socialist development of small-scale peasant farming is ensured on the basis of I. of the entire national economy and collectivization of peasant farming (see Collectivization of agriculture and healthcare). To fully resolve the task of uprooting the roots of capitalism, of transferring the national economy to the path of socialist development, it is possible only under the condition of the maximum development of production of the means of production. 'To conduct economic construction from such a point of view that the USSR, a country importing machines and equipment, would become a country producing machines and equipment, so that the USSR, in the conditions of capitalist encirclement, could by no means become an economic appendage of the world capitalist economy, but would represent an independent economic unit building along socialist lines and, thanks to its economic growth, able to serve as a powerful means for revolutionizing the workers of all countries and the oppressed peoples of colonies and semi-colonies. It is necessary to especially emphasize the importance of I., especially the development of production of the means of production, also from the point of view of strengthening the defense capacity of the USSR' [XIV Congress of the CPSU(b) - 1925]. The XV Congress decided 'to continue at an unslackening pace the policy of socialist I., which has already yielded its first positive results'. The November plenum of the CPSU(b) Central Committee in 1928 again confirmed that 'the main task of the party, its general line, is the line of further industrialization of the country'. At this plenum, the question of the pace of I. was raised with all sharpness. The maximum acceleration of the pace of I. is dictated by external and internal conditions. 'Bearing in mind the need to catch up and surpass technically and economically the capitalist countries, the CC plenum indicates that the solution of these tasks is possible only with a tense pace of development of industry and I. of the country in general and the maximum mobilization of the party, workers and peasant masses'. 'The proletariat will be able to carry out the revolutionary impact on agriculture only with a rapid pace of development of industry and further strengthening of the leading and transforming role of socialist industry. In this respect, heavy industry and production of the means of production are the main key to the socialist transformation of the entire national economy, including agriculture' [November plenum of the CPSU(b) CC 1928]. The immediate prospects for the industrial development of the USSR are basically given in the five-year plan for the national economy, approved by the XVI Party Conference and the V Congress of Soviets. The basis for the plan of industrialization, in accordance with the above, was based on the following fundamental principles. 1. Powerful growth of electrification as the modern technical basis of large-scale machine production, and under Soviet conditions - also the technical basis of socialism. 2. Forced growth of production of the means of production, in particular metallurgy and machine building. 3. Intensive development of those branches of industry that ensure the technical rise of agriculture (tractor building, agricultural machinery, chemical fertilizers, etc.). 4. The most tense pace of I. in order to implement the slogan 'catch up and surpass the advanced capitalist countries technically and economically', as well as in order to most quickly uproot the roots of capitalism within the country. 5. A firm course on improving the quality indicators of industrial work (reduction of cost, increase in labor productivity, etc.) on the basis of the rationalization being carried out and the development of the activity and initiative of the masses, in order to mobilize the internal resources of industry for the needs of I. 6. Intensive attention to the problem of qualified personnel and to ensuring the improvement of the material and cultural level of the working class. The course on increasing the specific weight of heavy industry in the system of industrial production finds its expression in the growth indicators of capital investments and products of heavy industry (Group 'A'). Of the 16.4 billion rubles planned for the five-year plan for investment in industrial fixed capital - 13.5 billion falls on heavy industry. With the growth of light industry (Group 'B') products by 2.5 times, the products of the metal industry are planned to grow by 3 times, fuel extraction by 2.5 times, basic chemistry by 5 times, production of building materials by 3.6 times. But even these rates will be significantly exceeded. The grandiose production program, outlined on the basis of the construction of new super-powerful plants of ferrous metallurgy and the reconstruction of existing metallurgical plants, ensures an increase in pig iron products to 12-13 million tons by the end of the five-year period instead of 3.3 million tons in 1927/28. For coal, extraction of 75 million tons is planned for 1932/33; for oil, due to the giant growth of automobile and tractor building, according to the latest version - 40 million tons. In one of the most backward branches - in the field of automobile building - a revolutionary shift is planned. Instead of 16,000 automobiles in 1927/28, 150,000 were planned for 1932/33 according to the five-year plan, and according to the later version - 500,000 automobiles. The full production capacity of the Nizhny Novgorod automobile plant will be 280,000 machines. During the five-year period, electricity production will increase from 5.1 billion to 22 billion kW per hour, with the specific weight of regional stations with high-voltage energy transmission rising from 30% to 50% in capacity.

As a result, electrification, which in 1927/28 amounted to about 1,500 kilowatt-hours per worker in industry, will rise by the end of the five-year period to 4,400 kW/h, and power equipment, i.e., the equipment of the worker with mechanical engines, from 3,000 to 5,700 kW/h. In state farms, the increase in power equipment is projected per worker from 475 to 1,350 kW/h, and in collective farms from 175 to 390 kW/h. Taking into account the enormous increase in the growth rates of agricultural machine and tractor construction, there is no doubt that these rates will be exceeded in the direction of a significant increase. Labor productivity is planned to increase by 2.1 times during the five-year period; actually, judging by the rate set for 1929/30 and taking into account all the factors acting in the direction of its maximum increase, it can be assumed that it will actually increase by 3 times by the end of the five-year period. Unprecedented in history growth rates are planned in the field of industry serving agriculture. According to the five-year plan, it was planned to increase the value of agricultural machinery produced from 153 million rubles in 1927/28 to 610 million rubles by the end of the five-year period, and according to the revised version to 1,100 million rubles, which will make it possible to have as many machines per hectare of sown area as there are currently in America. According to more recent plans, the 5 tractor plants planned for construction will produce about 210,000 tractors per year by the end of the five-year period, which will provide the country with mechanical traction power exceeding the power of the entire horse force-24 million working horses, since even before the end of the second five-year period, 1-1¼ million tractors with a traction power of 25-30 million horsepower will be working in the fields of the USSR. The sown area, roughly twice the current one, will be entirely cultivated by tractors in the second five-year period. This means a complete technical revolution in the working and living conditions in the countryside, which will complete in rough draft the process of socialization in 2-3 years. As a result of the enormous growth rates of socialization, significant intensification of agriculture and expansion of the sown area, it will be possible to a large extent to alleviate the agrarian overpopulation of the countryside. In connection with the alleviation of agrarian overpopulation and on the basis of the enormous growth of industry, urban unemployment will be reduced to a minimum by the end of the five-year period. In the second five-year period, the available labor resources of the country will be used more plannedly and fully. During the five-year period, the proletariat is planned to increase by 4.4 million people, or by 38.9%, including the industrial group of the proletariat by 50% (these data were projected before the introduction of continuous work). Socialist I. ensures unprecedented in the history of capitalist countries rates of accumulation. The largest increase in the per capita level of national income took place in the USA for 1880-90, namely-4.5% per year; for 1900-13-not more than 1.2%; in Prussia for 1896-1913-0.2% per year; in England from 1895 to 1913 there was no increase; the five-year plan sets the rate of growth of national income for the USSR at no less than 10-12%. Actually, even this optimal design will be surpassed thanks to those social levers of enormous importance that have been set in motion at the beginning of the five-year period to accelerate the general pace of socialist construction (socialist competition, continuous working week, rationalization, etc.). In the first 2 years of the five-year period, national income according to plan should have grown by 29.6%, but the actual growth will be 35.3%. This high rate of growth of national income, rooted in the advantages of the Soviet economic system over the capitalist system, ensures under the conditions of the dictatorship of the proletariat more accelerated rates of expanded reproduction of the national economy on the path to socialism and is the basis for a powerful rise in the material well-being of the working masses and the implementation of the cultural revolution. 'The growth of I. means in our conditions at the same time the growth of the socialist sector in the entire national economy' (Control figures of the national economy of the USSR for 1929/30). In the first 2 years of the five-year period, the increase in the socialized sector exceeds the entire increase in national income. In 1928/29, with an increase in national income of 3.1 billion rubles, the increase in the socialized sector amounts to 3.2 billion rubles, which is also explained by the reduction of the private sector; in 1929/30, an increase in national income of 5.8 billion rubles is planned, and in the socialized sector-6 billion rubles. The share of income of the socialized sector in the total amount of income will rise as a result from 44.9% in 1928/29 to 51.4% in 1929/30, with the income of the proletariat from 33.2% to 33.5%, including workers from 15.7% to 16.2%; peasants united in collective farms from 0.6% to 1.5%. The growth of the workers' budget is planned by the end of the five-year period nominally by 47%, and actually-by 71%. Already by the end of the current five-year period, the Soviet worker in Moscow in terms of living standards will catch up and surpass the London worker, and in the next five-year period he will be able to compare with and surpass the American worker. In housing construction, both urban and rural, about 15 billion rubles will be invested during the current five-year period. With the general growth of the housing norm per capita in the USSR by 10.5%, this norm for workers of planned industry will rise by 30.4%. The plan projects a significant improvement in nutrition by the end of the five-year period. However, it has already become clear that the fulfillment of the plan for the first year of the five-year period, the huge previously unaccounted for reserves, such as: the transfer of industry to a continuous production year, the enormously increased activity of the working class, which found its expression in socialist competition, the movement of shock workers, the growth of worker invention, etc., ensure the possibility of a more accelerated pace of development of socialist I. already from 1929/30 compared to the pace projected in the optimal version of the five-year plan. The revision of the five-year plan in 1929 in its most important sections has already confirmed the full feasibility of implementing the five-year plan in basically 4-3½ years. The increase in gross output of censused industry was planned according to the plan for the five-year period by 279% compared to 1927/28, including an increase in heavy industry (Group 'A') by 331%, and light industry (Group 'B') by 244%. But already for 1929/30, the control figures of the USSR State Plan project a sharp jump, an increase that far exceeds the prospects for this year set by the five-year plan. Thus, the increase in gross output of industry (in 1926/27 prices) is projected by the control figures at 32.1%, including for Group 'A' at 45.1%, for Group 'B' at 21.9%, while the increase in gross output according to the optimal version of the five-year plan was set at 21.5%. Such rates of economic growth are not even known in the most advanced capitalist countries. In the USA, the annual increase in gross industrial output was 8.2% in 1890-95, 5.2% in 1895-1900, 2.6% in 1900-05, 3.6% in 1905-10. In tsarist Russia, this increase was 10.7% in 1895-1905, 8.1% in 1905-13. The above-mentioned rate of growth of industrial production in the USSR in the coming years of the five-year period will increase further due to the further expansion of capital investments and the commissioning of new construction projects. 'Already in 10 years, provided the country develops peacefully, we will be able to significantly surpass the current level of development of US industry (in terms of production volume), and in terms of technology we will be able to catch up and reach the level of the USA, if we do not overtake this country, because in a short period we will create a completely new basic industrial capital according to the latest word of world science and technology' (Sabsovich). The planned by the end of the five-year period transfer of all industry to a seven-hour working day is a measure of enormous socio-hygienic importance. By the end of the five-year period, it will be possible to raise the question of further reducing the working day, i.e., to begin the transition to a six-hour working day. The social insurance budget will more than double by the end of the five-year period and will exceed 2 billion rubles. Among the most important measures in this area, old-age insurance should be noted, which will be a factor in rejuvenating the working composition of industry. During the five-year period, expenses for labor protection are planned in the amount of about 320 million rubles. In close connection with the tasks of I. are the prospects outlined in the field of cultural construction. In the current five-year period, such capital tasks in the field of raising mass culture as the elimination of adult illiteracy and the implementation of universal primary education will be resolved. A major shift is planned in the training of qualified workers and specialists for all sectors of the national economy. I. under Soviet power creates the material prerequisites for a new approach to the tasks of improving the health of the working masses.

The reconstruction of industrial and agricultural production on a higher energy base, on the basis of electrification; the rapid growth of the socialist sector in all branches of the national economy, the enormous growth of national income, which in turn ensures a powerful rise in the material and cultural level of the working class and the working masses of the countryside—all these are factors of primary importance from the point of view of resolving the problems of improving the health of the social collective. The growth of sanitary culture in the USSR, physical culture of the masses in the broad sense of the word, improvement of working and living conditions—are factors of enormous economy of live labor and material resources of the country and also contribute to the successful resolution of the tasks of Induration. The working class is the base, the source of the dictatorship of the proletariat, the producer of material 'benefits' and cultural values, the builder of socialist society. Therefore, the growth of Induration in the USSR means the growth of socialism, the rise in the material and cultural level of the masses. The modern stage of technical and social reconstruction poses before healthcare as an organic part of the national economic plan a number of problems related to the building of socialist society. The previous stage in the development of Soviet medicine, corresponding to the so-called restoration period in the sphere of the national economy, did not ensure the elimination of the disproportion or discrepancy between the low level of sanitary culture in the country, the anti-hygienic conditions of labor and living of the masses, particularly the working class, inherited by Soviet power from the landlord-capitalist system, and the needs of socialist construction, the demands of the masses, which have grown enormously in the post-October period. During the period of Induration, the lag of the healthcare sector from the general level of economic development and the cultural growth of the working class and the working masses of the countryside is felt extremely acutely. The planned formulation of healthcare tasks, i.e., their formulation in accordance with the general tasks and the pace of the country's socialist development, is thus the path to eliminating sanitary backwardness and the actual improvement of working and living conditions for the broad working masses. Socialist Induration is taking place in an atmosphere of intensified class struggle, the desperate resistance of capitalist elements who do not wish to surrender their positions. A clear class proletarian policy acquires dominant significance in all spheres of economic and cultural construction, including in the sphere of healthcare. The correct class approach to the problem of healthcare under conditions of Induration dictates placing the tasks of improving the health of the working class, its main industrial groups, as well as the population covered by the socialized sector of agriculture (see Collectivization of agriculture and healthcare) in the forefront. The problem of medical care for the insured requires a differentiated approach. The differences established by Soviet legislation regarding medical care for insured and uninsured population groups continue to exist; at the same time, the insured population itself cannot be treated as a homogeneous group and uniform standards of care established for the entire mass of the insured. The task is to, in accordance with the interests of Induration, reorganize medical care for the insured on the basis of higher coefficients or norms of care for the core industrial groups, paying special attention to the extremely unfavorable sanitary conditions and significantly lagging in terms of medical network provision industrial districts. The question of medical care for industrial workers is not only a quantitative question, i.e., the question of higher norms of medical-sanitary care for them compared to other groups of the insured. Medical care for industrial workers must be posed and resolved as a problem of improving the main industrial districts—cities and workers' settlements, i.e., as a problem of implementing in them a complex of health measures covering broadly communal improvement, residential construction, rational organization of nutrition, measures for physical culture, the struggle with social-living anomalies (alcoholism, prostitution, homelessness), protection of labor, protection of motherhood and childhood, etc. In other words, it is a matter of the real implementation of one of the most important principles of Soviet medicine—the complete reorganization of the entire healthcare system (first of all in the main working districts) on the principles of broad prevention. Already in this five-year plan, and even more so in the next one, it is practically possible to set the task of a fundamental improvement of working districts on the basis of reconstructing working and living conditions. On the basis of the giant growth of accumulations associated with the building of socialism, the process of breaking up the old way of life, both in the city and in the countryside, and building a new way of life on socialist principles will begin at a rapid pace. And this means a decisive step forward in the fundamental resolution of healthcare problems: For the coming years, it is also insufficient to pose the problem of healthcare, as well as of cultural-living services in general, for working districts in general, without specifying this problem. Otherwise must the problem and the tasks of healthcare be posed in newly created cities and workers' settlements, and differently in existing industrial centers. The construction of new cities near newly built giant plants (Magnitogorsk, new cities near Stalingrad, Taganrog, in the Donbas, etc.) has already begun. With the further growth of industrialization, this construction of new cities will take on even broader dimensions. Taking into account the real prospects of building socialism in the shortest historical period, it is completely natural that one cannot continue to build cities on the basis of preserving the bourgeois-individualist way of life, the existing forms of cultural-living services for the masses. The problem of the new city is already facing us as the problem of the socialist city. New cities will be built on the principles of socialization of nutrition, upbringing, all functions of cultural-living services for the population and provision with modern facilities of communal improvement. In connection with the reconstruction of the way of life on socialist principles in new cities, a number of problems arise, in the resolution of which healthcare agencies must take an active part. These problems include: the size of the city, the choice of location for it, the type and character of it (industrial, agrarian, or agro-industrial), the territorial location of the city in relation to industrial enterprises, the type of residential, public, school and hospital buildings, the forms and methods of the most rational organization of nutrition for the population, the most suitable forms of upbringing of the child and growing generation, the rules and principles, forms and methods of cultural-living services and communal improvement, etc. All these are questions in the resolution of which, along with the working public, politicians, economists, architects, teachers, and physicians will also have to participate. The task of healthcare agencies in this is—to ensure the choice of such methods and forms of collectivization of the way of life that would correspond to the interests and tasks of improving the health of the population. Particularly topical is the question of developing a system of healthcare organization applicable to the conditions of the socialist city. Some general provisions in this area can already be outlined now. All the population of the socialist city must be under dispensary care, and the main organizational form of providing therapeutic and preventive assistance will be an organization of the type of a unified dispensary, relying on a health complex, such as, for example, a communal house. This means that the system of patronage of various diseases, physical methods of treatment along with the preventive use of sun, air and water, the orientation towards the complete elimination of infectious diseases, reduction to a minimum of infant mortality up to 1 year and mortality from tuberculosis, elimination of social anomalies (alcoholism, prostitution, homelessness), broad neuro- and psychoprophylaxis, reduction to an inevitable minimum of occupational diseases and injuries will develop. Along with the problem of healthcare in new socialist-type cities, significant tasks stand before healthcare agencies in the matter of improving existing cities and workers' settlements. The reconstruction of old plants on the basis of electrification, the use of automatic machines, mechanization of transport, accounting for all requirements of labor hygiene and technical safety, the growth of the general culture and technical qualification of the working class—all this opens up enormous prospects in the matter of improving working conditions. The complete transition of industry to a seven-hour working day is also a factor of a positive order from the point of view of protecting the health of workers. By the end of the five-year plan, the average normal working day will be reduced from 7.71 hours in 1927/28 to 6.86 hours, i.e., by 11%. Furthermore, a significant role in the field of labor improvement will be played by the joint broad work of healthcare agencies, labor protection agencies and trade unions in the prevention and struggle with occupational diseases and injuries.

This work must be carried out along the lines of developing professional selection, measures for labor hygiene and safety, ensuring enterprises with qualified first aid, and "etc." One of the most important tasks in the effort to improve the health of industrial cities and worker settlements is the elimination or at least the reduction to a minimum of epidemic diseases. In relation to parasitic typhus and smallpox, the prospect of their elimination in the coming years in industrial cities and worker settlements is quite realistic, provided systematic combat against these diseases. A significant reduction can also be achieved in relation to malaria. A serious task stands in the fight against typhoid fever and childhood infections. In the area of combating typhoid fever, the task primarily and mainly hinges on the decisive improvement of water supply and sanitation, for which it is necessary to implement in the coming years the construction of water mains and sewers in the main industrial cities and worker settlements. The lack of effective measures for the mass prevention of childhood infections and the fight against them, as well as housing overcrowding, do not allow for a policy aimed at eliminating these diseases in the coming years. The task for now is to use possible measures to maximize the reduction of childhood infections: mass preventive vaccinations, and above all, the extensive development of a network of infectious disease beds, especially for childhood infections; at the same time, one should strive for as complete hospitalization of the sick as possible. The fight against epidemics in industrial areas inevitably entails measures in this regard for the rural areas adjacent to these areas, as well as for the areas supplying the industrial areas with labor. The implementation of the broad program of worker housing construction outlined in the five-year plan poses for the health authorities the tasks of 1) active participation in the development of the most rational types of housing from a sanitary-hygienic point of view, at the same time taking into account the tasks of collectivization of daily life; 2) sanitary evaluation of specific housing construction plans; 3) proper organization of current housing and sanitary supervision, using to the maximum the initiative of the population in observing sanitary rules for the maintenance of housing. Also brought to the forefront is the most active participation of health authorities in the rationalization of the nutrition of the working population, especially in the organization of public catering, in the service of the powerful food bases being created near worker centers in the form of livestock and fruit-vegetable state farms and collective farms and dairy farms; in the mechanization of baking; in the development of warehousing and refrigeration; in the broad coverage of the working population by public catering enterprises (factory kitchens, large mechanized canteens), etc. The activity of health authorities should develop along the lines of: a) developing nutritional standards for different population groups, taking into account sex, age, and profession; b) organizing sanitary-food supervision in the most important areas of production and procurement of basic food products (meat, fish, dairy products, etc.), as well as over places where food products are sold; c) organizing dietary departments for patients with gastrointestinal diseases; d) participation in the development of all issues related to the development of public catering and ensuring proper sanitary supervision over public catering enterprises. In connection with the noted tasks for the sanitary improvement of the country, especially of worker areas, the question of raising the activity of sanitary organizations to the proper level acquires exceptional importance. The current state of sanitary organization, characterized by extreme insufficiency of personnel, insufficient specialization, and the inadequacy of methods of work to the new conditions, is in sharp contradiction with the tasks posed in the reconstruction period in the field of improving working and living conditions. The industrialization of the country dictates the necessity to ensure sanitary service of all worker areas at higher standards, to develop a broad system of measures for the training of sanitary doctors and auxiliary sanitary personnel, to raise the competence of sanitary organizations, and, what is especially important, to fundamentally reorganize their methods of work: from individual sanitary supervision to the organization of mass measures, to the development of initiative and self-activity around the tasks of improving working and living conditions. Among the problems of most important significance should be included the problem of the protection of motherhood and infancy and the protection of the health of children and adolescents. In the field of the protection of motherhood and infancy, the following tasks can be set as quite realistic. 1. To cover by the end of the current five-year period all children up to 1 year of age in cities and worker settlements with a network of child consultation centers, which will ensure a further significant reduction in child mortality; in the next five-year period, it will be possible to cover all children up to 3 years of age with consultation centers. In new cities built on the principles of complete collectivization of upbringing, where therefore children in the first years of life will be kept in children's institutions (regardless of where they are located - in a communal house or in a separate building), the need for consultation centers disappears. 2. In the conditions of industrialization, the nursery problem acquires special significance. The current broad development of nurseries attached to large buildings, the growth of permanent nurseries in the rapidly developing collective sector of agriculture, and the significant allocations by economic organs (industry, collective farm center, cooperatives, etc.) for this purpose will make it possible to significantly exceed the indicated plan, and consequently the coefficient of provision of women workers with nurseries. 3. The broad development of pregnancy hygiene by covering all pregnant women in cities and worker settlements by the end of the five-year period with women's consultation centers. Ensuring all parturients with hospital bed care. In the field of the protection of childhood and adolescent health, tasks arise in connection with the significant growth of contingents in schools of all types and levels. Main attention should be focused on the improvement of mass schools, the working and living conditions of adolescent workers, and on the coverage in particular of all children and adolescents with physical education. In the existing industrial centers, the pace of coverage of the working population with the system of dispensarization (see) should be significantly intensified. Large tasks stand before the health authorities in adapting the activities of medical-sanitary institutions to production conditions (seven-hour working day, shift work, continuous working week). The implementation of the above-mentioned measures in production is associated with a significant increase in the size of the labor force and changes in working hours, which should find corresponding expression in an increase in the amount of medical care: the number of outpatient visits, home care visits, hospital beds, etc., as well as in coordinating the working hours of medical-sanitary institutions with the working hours of enterprises. Special attention is drawn to the problem of the quality of medical care. Soviet medicine has always held the course of maximum improvement of the quality of medical care, but in the conditions of industrialization, when the cultural demands of the working masses are unusually increasing, questions of the quality of medical, as well as cultural-domestic service in general, acquire exceptional importance. The problem of quality includes a number of questions. These include questions of the rational organization of the network and its types, the high specialization and qualification of medical personnel of all categories, the application of achievements in hospital and sanitary technology, etc. As in all areas of the national economy and cultural construction, so in the field of health, the problem of personnel must become the center of attention (see Medical education). 14 sh The enormous tasks standing in the reconstruction period in the field of protecting the health of the population require a fundamental revision of the policy of financing health care. That lag in the growth rate of the cultural sector from the national economy, which is repeatedly noted in the decisions of government bodies, applies to health care to an even greater extent. The slogan "the protection of the health of the working people is the business of the working people themselves," one of the most important principles of Soviet health care, acquires at this stage of socialist construction unusually rich possibilities for practical implementation. The problem of the self-activity of the masses must and should be resolved in the field of health care in the light of the grandiose achievements and prospects that the creative activity of the masses reveals on all fronts of socialist construction. It is possible to maximize the acceleration of the growth rate of health care only on the basis of attracting the creative enthusiasm, initiative, and self-activity of the working class and the rural working masses to the tasks of improving the conditions of their labor and daily life. Water supply, sanitation, housing, nutrition, enterprise, school, physical education, cultural-domestic institutions - these are the channels along which the self-activity of the masses must be directed.

Health and labor committees (commissions for improving labor and living conditions) at medical and preventive institutions, health sections at soviets, sanitary commissions and representatives in housing, commissions for labor protection at enterprises and institutions, cells and sanitary squads of the ROKK (Russian Red Cross Society) - such are the forms of organization of mass self-activity in the field of healthcare. Before the healthcare organs stands a great task - to transform into organizers of the masses, to become organs that create a new sanitary culture, healthy labor and living conditions with the masses and at the head of the masses. The current stage in the construction of healthcare is characterized by the transition from random, unsystematic measures based on empirical determination of needs to the planned implementation of comprehensive health measures based on the scientific study of the socio-hygienic condition of each locality. This determines the role and tasks of scientific research institutes in the field of healthcare. The scientific-practical base, synthesizing all work in the study of the social health of the population and the development of measures that must be implemented in each separate district, should be the regional (provincial) socio-hygienic institute, which is methodologically guided by the Central State Socio-hygienic Institute. (I. of agriculture - see Collectivization of agriculture and healthcare.)