Medical Education

MEDICAL EDUCATION I. History of medical education. The first reliable information on medical education dates back to the most ancient historical monuments of Eastern culture. In Mesopotamia, the Code of Hammurabi (about 2250 BC) already dealt with medical issues. Healing was practiced by the physicians of the temples of the healing gods Ea and Marduk, but at the same time, medical schools founded and maintained at state expense also existed. The best of these were considered to be the schools in Uruk and Borsippa. Surgery was a distinct specialty, and how thoroughly a surgeon had to prepare for his profession is evident from § 218 of the Code of Hammurabi, which punished the cutting off of a physician's hand for an unsuccessful operation the consequence of which was the death of the patient or the loss of an eye during cataract removal. In ancient Egypt, 3,000 years before our era, the teaching of medicine was initially also conducted in temples, where priests engaged in healing recorded traditions, instructions, recipes, etc.; from these records books were compiled according to which medicine was taught, and since patients also flocked here, there was an opportunity to demonstrate to students the application of theoretical knowledge in practice. Subsequently, medical schools were founded in Memphis, Thebes, and Sais, which enjoyed great fame. In these schools, physicians of three specialties were trained: internal medicine, surgery, and the art of incantation, which also pertained to medicine. In ancient India, there was a separate class of physicians who received the right to practice from the state authority. Multi-year preparation for the profession was required: along with the study of medical books that existed in the 5th century BC, students learned the technique of handling the knife on plants (water lilies, fruits) and on animal carcasses. They learned probing on wood eaten away by worms. In China, the history of medicine traces its origin to the 28th or 29th century BC. Textbooks of medicine already existed at that time. Due to the propensity for filigree work in details characteristic of old Chinese culture, medical education bore the same traits: for example, a Chinese physician had to know up to 200 different characteristics of the pulse, which was examined in various parts of the body with weak, medium, and strong pressure on the arteries. To obtain the title of physician, it was required to pass an examination, which was regulated by law. The same applies to Japan, which was entirely under the influence of Chinese culture. In Japan, medical schools existed with a 7-year course in the department of internal medicine and shorter courses in other medical specialties. Students received the title of physician after a final examination in the presence of a representative of state authority. In ancient Greece, medicine was initially concentrated in the temples of Asclepius, whose priests specialized in medicine. But alongside this, there was also free medical practice outside of connection with cult and state, transmitted mostly by inheritance from father to son as a craft. Medical education was a private matter. The state neither regulated it in any way nor assisted it in any way. But since the demand for physicians who rapidly accumulated wealth, especially in the Age of Pericles, was great, teaching the medical art was a lucrative business. And therefore, purely artisanal training began to rapidly push back the framework of family tradition. At the same time, the general flourishing of education elevated medicine in the person of Hippocrates (460–370 BC) from a craft to the rank of science. The guild of physicians sought to protect itself from the competition of new elements, especially from unfair competition. One of the means for this, in the absence of any legislative regulation, was raising their profession to the highest possible level with regard to education and professional ethics. From young people who wished to devote themselves to the practice of medicine, physicians demanded the taking of an oath. In this oath, which has come down to us in the writings of Hippocrates, a promise is given not to reveal the secrets of science to outsiders, to conscientiously use one's knowledge for the good of the patient, not to abuse his trust, to treat teachers with respect, and to pass on all one's knowledge completely to one's students. Teaching usually took place with a single teacher, but traveling for the purpose of studying with prominent physicians in other cities and countries was also customary. Since patients were received not at home, but mostly in special premises—infirmaries (jatreia), where there were also a small number of stationary beds, or in Asclepieia (public hospitals), where a team of physicians worked—teaching was of an illustrative character. Thus arose the medical school on Kos, from which Hippocrates came, and the competing school in Cnidus. It should be noted that these were not only medical educational institutions, but simultaneously research institutions as well. Teaching in these schools took place in the Asclepieia, i.e., at the patient's bedside. That theoretical teaching was also set at a high level simultaneously is evidenced by the writings of Hippocrates and the very fact of two trends in medicine that received their names from the names of the schools—the Coan and Cnidian schools. On the other hand, theoretical medical questions were also touched upon by all the philosophical systems of that time, acquaintance with which was mandatory for every educated Greek. Theory even prevailed over practice, and Celsus correctly considered it to be Hippocrates' merit that he, being a contemporary of such major philosophers of antiquity as Socrates and Plato, primus disciplinam hunc a studio sapientiae se-separavit. In the 3rd century BC, Greek medical education made significant progress after the founding of the famous library and Museum in Alexandria. The Museum was the name of an institution in which scientists and students received free maintenance at the expense of the state. Right there were also lecture halls where lectures on all branches of knowledge were read. Medicine was taught here by the largest physicians of that time, in particular Herophilus and Erasistratus. They were the first to introduce the study of anatomy on corpses and the study of physiology as the basis of the medical art. In ancient Rome during the republican period, medicine as a science did not exist at all. Pliny wrote that the Romans got along without physicians for 600 years. In the imperial era, after the conquest of Greece, Greek physicians began to emigrate to Rome, where they were at first met with hostility, but later won recognition both in the wealthy classes of society and on the part of state authority. It was by decree of Antoninus Pius that the most prominent emigrant physicians were granted the rights of Roman citizenship. Emperor Septimius Severus regulated this right by requiring approval on the part of municipalities to obtain it, but since the latter were not competent in assessing medical knowledge, Alexander Severus took the next step: he opened lecture halls in Rome for reading lectures on medicine, the lecturers received maintenance from state funds, and students were given scholarships. The approval of physicians by municipalities began to be carried out after an examination in the college of archiatrs—physicians in the service of city communities or the state. The most famous physician of that time, Galen, noted that the state-regulated procedure for obtaining the title of physician and state-organized medical education have a great advantage over the system of free apprenticeship. After the fall of Rome, Byzantium remained the custodian of Greek science. Through Byzantine scholars, especially through the Nestorians expelled from Constantinople, Greek science passed to the Arabs. Arab culture contributed a great deal to medical education. In Baghdad, Damascus, Cairo, and other large cities, large hospitals were built by the caliphs, and the training of physicians was organized right there. Greek medical treatises were translated into Arabic, and their own literature grew rapidly. How great it was can be seen from the fact that for eye diseases alone, 18 Arabic treatises have come down to us. General manuals on medicine were also written. Some of them, through Spain after its conquest by the Saracens, and from there through Salerno (see below), penetrated into Western Europe, were translated into Latin, and formed the basis of Western European university courses in medicine. In the first place among these textbooks must be named the Canon of Medicine by Avicenna (980–1036 AD). In the medical education of the Arabs, in accordance with the general magical character of their worldview, pharmacy and pharmacology were placed in first place, whereas anatomy took a step backward compared to what we saw in Alexandria. The Early Middle Ages in Western Europe regarding medical education reflect the general character of that epoch: he who did not fight fled from war, and one could flee from it perhaps only behind EDUCATION

636 monastery walls. Medicine also fled there in the form of fragments of knowledge that remained from the time of Galen. Charlemagne issued a decree in 805 on the mandatory teaching of medicine in schools existing at cathedrals and large monasteries. Since hospitals were also under the jurisdiction of the clergy, for some time medical education was entirely under the control of the clergy. However, one cannot speak of medical education here, but rather only of training in the provision of first aid and the care of the wounded and the sick. Medical education acquired a secular character again only in the 10th century at the medical school in Salerno (Italy). In this city, the medical school was founded by a corporation of local doctors, but soon gained wide fame, and students from all countries began to flock there. The prosperity of the school was promoted by its basic principle of combining theoretical education with practical training: docti istius professionis artifices (learned masters of their profession)—such must doctors be, according to the Salerno school. Taking into account the deep darkness of the Middle Ages, this principle, laid at the foundation of education, cannot be appreciated highly enough. Much time was devoted to theoretical education: 5 years were allotted to reading lectures. Practical training was organized worse. It consisted of the fact that senior students accompanied their lecturers in city hospitals, since the school did not have its own clinics. Anatomy was taught from drawings or on pig carcasses. The dissection of the dead encountered the prejudices of that time. Only in 1238 did Emperor Frederick II issue a decree according to which in Salerno once every 5 years a corpse had to be dissected in the presence of all doctors. Lectures were read in Latin and literally in the literal sense of the word, i.e., the works of Hippocrates, Galen, or Arab authors, translated into Latin, were read. The docents of the Salerno school also compiled their own universal textbook of medicine under the title De aegritudinum curatione. Frederick II granted the school the monopoly right to issue medical diplomas after a corresponding examination of those seeking this title. In the 12th century, the school in Montpellier began to compete with the Salerno school. The time of its foundation is unknown. In 1180, the right to study was granted to Jews and Saracens in this school. In 1220, the statute of the school was drawn up. The school was subordinated to the bishop, and a chancellor was placed at its head. Academic degrees were introduced: bachelor for those who passed mid-course exams, licentiate upon completion of the course, which gave the right to medical practice, and the degree of master for persons invited to the corporation of teachers of the school. Obtaining academic degrees was conditional upon passing exams. Teaching was conducted in Latin, generally according to the same system as in Salerno. In the 12th century, the first 5 universities of Western Europe were founded (Paris, Bologna, Oxford, Montpellier, Valencia), in the 13th century another 10 opened, in the 14th century—12, in the 15th century—13. As the very name shows (universitas litterarum), universities had the purpose of providing general education, and medicine was originally taught in them as part of physics (hence the English name for a doctor that has survived to this day—physician), while physics in turn—as part of philosophy. Therefore, initially in universities, it was a common occurrence to teach all of medicine by one professor or several professors reading parallel courses. Hence the phenomenon widespread in the Middle Ages—the transfer of students from one university to another in order to listen to different professors. Some Italian universities (Bologna, Padua) were a secular school organized on democratic principles, where both the rector and professors were elected by students and paid at their expense. But in the majority, universities bore a clerical character, being subordinate to the church (Paris, Oxford, Cambridge), or were founded and maintained by the state. At the head of the university stood the chancellor; the collegium of professors represented a closed corporation. The course was 4 or 5 years long. Admission to the university required the completion of a general school (monastic, church, or municipal). The course was interrupted after 3 years by an examination for the bachelor's degree, after which students were admitted to practical exercises as assistants to their professors, not in university clinics, of which there were none, but in city hospitals, for which special permission was required. The textbooks were predominantly the above-mentioned works of recognized authorities. Lectures consisted of reading these textbooks. The professor could only comment on what was read or illustrate it with examples from his own practice. Universities were only educational, not research institutions until the Renaissance. With such a system of teaching, medicine went down the same path of scholasticism on which all medieval science reached a dead end. Anatomy was taught according to Galen and from drawings. Only starting from the Renaissance does a new stream of living thought break into universities. The dissection of corpses began to be practiced from the beginning of the 14th century (in Italy), and the material for dissections was an extreme rarity. By the end of the 16th century, dissection in the presence of students had been introduced in all universities. The famous 16th-century anatomist Vesalius (Vesalius), who studied at the University of Paris, wrote in his autobiography: "Except for the muscles of the abdomen, shamefully mangled, no one showed me a single muscle, a single bone, not to mention the system of arteries, veins, and nerves." Only after Vesalius did the dissection of corpses become ubiquitous, professors rose from their armchairs, took the scalpel in their own hands, and students crowded in a tight bunch around them, as we see in the paintings of Rembrandt and other masters of the Flemish school. No less instructive is the fate of surgery. Surgery in the precise sense of the word was a craft (Greek cheir—hand, ergon—work) and was not taught in universities. Doctors were not surgeons, they disdained this business, and all surgery was in the hands of barbers and militaryfeldshers who studied nowhere. For the first time, surgery found access to higher education in France thanks to the fistula of Louis XIV, from which he was cured by his surgeon Mareschal. As a reward for this, he was granted the right to open a surgical academy, to which the Paris medical faculty responded with a street demonstration: professors in corpore led by the dean in their gowns, accompanied by students and guards, went out into the street and headed to the house of Mareschal, where the students smashed the windows. Only in the 18th century were departments of surgery established in all universities. In Germany, surgery began to be lectured in Göttingen in 1766. Obstetrics also remained outside university walls for a long time. Childbirth assistance in the Middle Ages was provided by midwives who did not have medical education; a doctor, if invited, was called only in extremis and by no means for manipulations, but only for advice to the same midwife or prescribing an internal medicine. The first obstetrical school (for women only) was opened in Paris in 1720. In the coming decades, it was followed by schools in Strasbourg, Vienna, Berlin, Rome, and then in other cities. University clinics began to open only in the 18th century. In France, clinical classes were introduced from 1780, in England the first university clinic opened in 1741, in Vienna—in 1745, in Germany, in Göttingen—in 1784. Laboratory classes entered the teaching practice of medical faculties only in the 19th century. It is interesting to note that the French Revolution saw the medical faculties as a medieval institution, which in many ways had its grounds. With its characteristic radicalism, the Convention in 1793 simply closed all medical faculties and the royal medical society. Instead of medical faculties, schools of health (ecoles de santé) were established, which were exclusively occupied with the urgent training of surgeons for the army (officier de santé). Medical faculties were restored under Napoleon's consulate in 1803.

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Rosanoff. II. Medical Education Abroad. The growth of productive forces and the profound economic shifts that characterize the 19th century in connection with the development of industrial capitalism, along with major achievements in natural science and directly in medicine associated with the general growth of technology, could not fail to influence the organization of medical education. The requirements placed upon the training of a physician increased significantly, new subjects were included in the curriculum, and a general striving toward the elimination of the so-called "second-class physicians" was observed everywhere. The abundance of accumulated scientific material made differentiation into separate branches inevitable: a whole series of disciplines, both theoretical and clinical, stood out into independent departments. The second half of the 19th century was marked by the work of Virchow (on the role of cell vital activity in the healthy and diseased organism), Pasteur and Koch (etiology and prophylaxis of infectious diseases); the experiment acquired paramount importance, and the laboratory method became an integral part of medical educational institutions. The immense achievements of technology affected teaching methods, which underwent significant shifts. In individual countries, in connection with their economic and political situation and their cultural level, the development of medical education followed a distinctive path. In the first half of the 19th century, the leading role belonged to France. Medical education here bore a clearly expressed practical bias. The training of physicians was concentrated in medical schools that grew up on the basis of hospitals, the rich material of which created favorable conditions for practical training. Here, the so-called hospital system of medical education developed. Teaching was conducted mainly at the bedside. Practical exercises were supplemented by lectures. The student, working in the hospital from the first year, initially participated in the care of patients, underwent elementary diagnostics, and so on, and subsequently was drawn into more responsible work. Thus, through practical techniques, the training of a general practitioner was achieved. Theoretical disciplines were allotted an insignificant place: of them, anatomy alone remained a compulsory subject for a long time. This training system did not undergo any substantial changes even with the conversion of some medical schools into faculties. The hospital continued to occupy a central place in teaching. The first three medical faculties were created under Napoleon in 1808 in Paris, Montpellier, and Strasbourg. In the second half of the 19th century, medical schools were reorganized into faculties in Nancy (1872), Lyon (1876), Bordeaux (1878), Lille, and Algiers (1909); the last three were medical and pharmaceutical. In addition, a medical and pharmaceutical faculty was opened in Toulouse in 1890. At the present time, universities have departments in all theoretical disciplines, and many of them have laboratories for practical exercises and research purposes. However, little attention is paid to laboratory work. The faculties do not have special clinics; certain large hospitals serve for teaching purposes. Clinical disciplines are introduced from the first year of study. Theoretical subjects are studied concurrently with the clinic. The natural method is thus practiced—the student approaches the patient without prior acquaintance with the structure and functions of the healthy organism and studies the healthy and diseased organism simultaneously. The remaining medical schools in France are subdivided into 2 types: in the former, the student can complete the entire course of study; to obtain a diploma, one must pass the corresponding examinations at the faculty. There are 4 such schools: in Clermont-Ferrand, Marseille (scheduled for conversion into a faculty), Nantes, and Rennes. At medical schools of the second type, only the first three years can be completed; the student receives the completion of their education elsewhere. Due to the small number of students in these institutions, practical and clinical exercises are conducted more successfully here. There are 12 such schools. In France, earlier than in other countries, the state itself took the training and the right to practice of a physician under its direct supervision. In 1803, compulsory examinations were introduced; in 1824, all medical schools and faculties became subordinate to the newly created Ministry of Education. Medical schools and faculties in France have pedagogical activity as their main purpose. Research work is not mandatory for them and finds a place here only as a rare exception. The greatest achievements of this century, of which France is proud, bypassed the medical schools. This situation is sustained by the bureaucratic selection of the teaching staff (it is carried out by ministerial appointment), meager appropriations for pedagogical and research purposes, etc. The budget for medical education, which was already small, suffered further cuts after the war. Teaching activity, unpermeated by research pursuits, stagnated in established forms. In Germany, medical education took a completely different direction than in France. At the beginning of the 19th century, German medicine was under the influence of the idealistic philosophical currents dominant there, mainly Schelling's natural philosophy. In the endeavor to resolve questions about the essence of life and pathological phenomena on the basis of natural philosophical constructs, German scientists departed from the methods of observation and experiment; they lost themselves in theorizing and speculative reasoning just as was observed in medieval scholasticism. Teaching was distinguished by abstraction and detachment from practice; it retained this character for quite a long time. A striking example is the well-known case of Helmholtz, who, when defending his dissertation on "Surgery of Tumors" in 1842, not only had never operated on tumors himself, but had never even seen them. The revolution of 1848 and the rapid industrial development of Germany in the second half of the 19th century, especially after the Franco-Prussian War, widely opened the path for research thought and experiment. Simultaneously, significant shifts occurred in the organization of medical education. German universities did not stand aloof from the scientific movement, but on the contrary, became the center of research work. University professors were not only teachers but also major researchers who created scientific schools around themselves. Such a close connection between teaching and research was one of the most positive aspects of the German higher medical school. The prosperity of research work within the walls of medical faculties contributed to the emergence of laboratories and institutes within them. Thus, in 1824, a physiological laboratory was created in Breslau (Purkinje), and the following year a chemical laboratory in Giessen (Liebig). With Virchow's move to Berlin, a pathological institute was opened there (1856). Following the model of the latter, pathological laboratories arose at other German universities as well. Subsequently, a number of other theoretical subjects were singled out into independent departments provided with appropriate laboratories, and many became compulsory: in 1856—physiology, in 1869—pathological anatomy, etc. The biological cycle, including natural disciplines and sciences studying the healthy organism, obligatorily preceded the clinic in German universities. The student proceeded to the latter only after passing the semi-course examination (physicum). The clinics, being university institutions, served primarily for teaching and study purposes. As with the theoretical departments, a wide field was provided here for scientific work and for the comprehensive study of the patient on the basis of the achievements of theoretical disciplines. Clinics also gradually acquired richly equipped laboratories and special consulting rooms. The selection of patients was subordinated to the requirements of teaching, which made it possible to conduct it in a definite system. The student was not bound to the clinic by permanent work in it. While in France the student went through the clinic by directly participating "in production," in Germany they dealt with the patient only in an educational setting (curation, auscultation and percussion courses, "Touschier-Kurs", etc.). The prevailing method of teaching even for clinical disciplines was the lecture method; practical exercises and demonstrations merely illustrated what was communicated in lectures. The order of completing the curriculum within each of the main cycles (preclinical and clinical) in German universities was not strictly established: the student had great freedom in choosing lectures and the opportunity to concentrate attention on subjects of most interest to them, which not infrequently went to the detriment of other lectures and practical exercises. In the first half of the 19th century, there still existed two classes of physicians in Germany: 1) physicians with a full university education, who received the right to practice in all branches of medicine, and 2) second-class physicians (Wundärzte in Prussia, Landärzte in Bavaria, etc.) who received education in medico-surgical educational institutions. Since 1852, the second class of physicians was abolished, and uniform training at universities was introduced. The title of physician was granted only upon graduation from the university and passing the corresponding examinations.

By the time of the World War, German medicine reached its zenith; almost all German universities had independent, well-equipped laboratories provided with equipment for anatomy, physiology, pharmacology, pathology, hygiene with bacteriology, and separate clinics with departments for internal diseases, surgery, children's diseases, obstetrics and gynecology, psychiatry, dermatology, and otolaryngology. In Germany in 1932, there were 25 medical faculties: in Berlin, Bonn, Breslau, Frankfurt, Göttingen, Greifswald, Halle, Kiel, Cologne, Königsberg, Marburg, Münster, Düsseldorf (medical academy), Braunsberg (academy), Erlangen, Munich, Würzburg, Leipzig, Tübingen, Heidelberg, Freiburg, Jena, Giessen, Hamburg, and Rostock. Over the last 3 years since the fascist dictatorship, German universities have degraded sharply and lost their former leading significance. The sergeant-major policy in higher education, the spirit of obscurantism and racism, which entailed the expulsion and emigration of leading clinicians (such as, for example, Lichtwitz, Zondek, Tangl, Klemperer, Goldstein, Mayer-Gross, Kronfeld, and many others), led to a sharp decline in scientific work in the universities. The remaining scientists, having quickly adapted to the service of National Socialism, develop anti-scientific theories of racism (Rüdin and others). This is vividly reflected in the decline of printed production, filled predominantly with racial research; this reduction in printed publications is welcomed by fascist officials as an achievement of the regime of the Third Empire. Medical higher education institutions in Switzerland, Austria, Italy, the Northwestern states, and Poland approach the type of the former German school. In England, the matter of medical education in the 19th century was left to private initiative and was weakly regulated by state authority. At the beginning of the 19th century, individual training under a practicing physician or in a hospital with subsequent passing of exams to obtain the right to practice was still widely accepted. Later on, medical schools, which were organized at hospitals by groups of physicians who united for teaching purposes, acquired great popularity. The training system here was built according to the principle of French schools: teaching did not go beyond the hospital ward and the morgue. The few compulsory theoretical subjects, such as anatomy, pathology, and psychology, were also taught by hospital physicians. A number of universities had medical faculties, but training there suffered from being overly theoretical, and in order to acquire practical knowledge, one had to additionally study in hospitals. This significantly lengthened the term of education, was expensive, and therefore universities were not popular: the bulk of physicians received their education in medical schools. In the second half of the 19th century, the British government created a special organization, the "General Council of Medical Education and Registration of the United Kingdom," to direct and unify the business of medical education and medical practice in the country, to encourage science, etc. Its activity had a beneficial effect on the reorganization of medical education. By the end of the past century, major shifts are observed here in this matter. Many medical schools merge with universities and acquire laboratories. Relatively small groups of students, a large number of teachers, and an abundance of material make it possible to conduct training here on practical principles and to accustom students to independence. Among the universities, the following must be mentioned: the universities in the cities of Oxford, Cambridge, London, Birmingham, Durham, Leeds, Liverpool, Bristol, Sheffield, Edinburgh (Scotland), and Dublin (Ireland). In addition, England has a significant number of medical schools. In London alone, there are 12 of them. In the USA, the development of medical education followed a special path. The rapidly growing population, dispersed over a large territory, and the rapid capitalist development of the country made colossal demands for physicians. In accordance with the features of the economic development of the USA with the predominance of private economic initiative and enterprise, the training of physicians became the business of private individuals and organizations. Groups of practicing physicians, calling themselves "faculties," undertook the teaching of medicine, imparting to undereducated students the empirical knowledge that they themselves possessed. Practical training remained insufficient, and teaching retained a predominantly didactic character. Private medical schools turned out to be profitable "enterprises" and began to develop rapidly in many American cities. About 400 of them were created in total, but many disappeared just as quickly as they grew. In 1880, there were about 100 of them; in 1904, 166. Great influence in the sense of improving the business of medical education in the USA was exerted by the Johns Hopkins school (Baltimore), built in the 1990s by a group of young scientists who received their education in Germany, France, and England and who wished to use for their school all the best that they found in these countries. In 1907, supervision over medical schools was introduced on the part of the major medical association, the American Medical Association. It conducted a comprehensive survey, as a result of which about 50% of the schools were closed as not corresponding to their purpose. At the present time, about 80 schools remain in the USA; in terms of the organization of training, they are divided into sharply differing groups. The curriculum in American medical schools is built almost everywhere according to the logical type: the study of the normal organism precedes the clinics. In all schools, a course system is applied, and this is carried out here with extreme pedantry. Students study subjects in an established order and at the same time perform established tasks, and pass exams at scheduled times. But in some of the best schools, departures are made: students are given the opportunity within the framework of a four-year course to participate in the research work of the entire higher education institution or to conduct their own scientific work, and free hours are allocated for studies in subjects of particular interest to the student. Clinical training is conducted in hospitals. In 1925, medical schools had at their disposal: 316 hospitals with 135,548 beds (16.9% of all beds in the country). Thus, there are 429 beds per hospital. This indicates that the largest hospitals serve for this purpose. In a number of schools, the organization of the clinical cycle continues to be unsatisfactory to this day. Not infrequently, a single school has to use several hospitals, the management is in the hands of hospital physicians occupied with their practical work, which causes teaching to suffer greatly. Little attention is paid to the laboratory, etc. Control on the part of the school is often absent. Matters are better in schools where teaching is conducted in specific hospitals appropriately adapted for pedagogical purposes. In such hospitals, the student gets the opportunity to work at the patient's bedside, to study the patient comprehensively using laboratory methods; here he is provided with pedagogical guidance. A special place in the USA is occupied by a small group of schools built according to the type of the Johns Hopkins school. In terms of the rich equipment of clinics and laboratories, progressive teaching methods, and the provision of qualified pedagogical force, they can compete with the best schools in Europe. The indicated conditions are favorable for developing research work and linking the latter with the main task of the schools—teaching. In Japan, higher medical education developed only from the second half of the past century, with the first Japanese studying in Western Europe. With the return of these pioneers to their homeland, a new public health organization and higher medical schools begin to be built in Japan. Now in Japan, alongside Tibetan and Chinese physicians who still survive, there are up to 5,000 certified physicians. Japan currently has 14 higher medical higher education institutions: 4 of them are under the jurisdiction of local prefectures—at the universities of Tokyo, Okayama, Taichu, Kyoto, and Kyushu—and 5 are under the jurisdiction of the Ministry of Education. Ministerial schools are equated in rights with medical faculties at universities. Upon defending a dissertation, those who graduate from them receive the academic degree of Doctor of Medicine. The curriculum applied here is very close to the German one. In China, alongside the old Chinese medical school (see China), a school of the Western European type has been introduced since 1881. The first was opened by Mackenzie in Tianjin; six years later came the opening of the second school in Hong Kong. Sun Yat-sen received his education in this school. Subsequently, schools open one after another with the help of missions. These schools are largely connected with missionary hospitals. After the Boxer Rebellion of 1900, a whole network of such higher medical schools opens (in Mukden, Hankou, Nanjing, Shanghai, Canton, Beiping, and others). Of all these schools, the college in Beijing (Peking Union Medical College) stands out particularly: it was opened in 1900 and in 1915 passed into the management of the Rockefeller Foundation. The German-Chinese Higher Medical School Tongji in Shanghai enjoys a certain popularity. After the war, it was transformed into a Chinese state university while retaining its former direction. Over the past 10–11 years, the influence of Chinese authorities in the organization of medical education has been growing. In 1925, out of the 25 higher medical schools existing in China, only 11 remained under the management of foreigners.

The contrast between well-equipped foreign schools and schools funded by Chinese is very great. Civil war and lack of funds do not allow medical education in China to be brought to the proper level; the best universities remain the Rockefeller Peking Union Medical School in Beiping, the English University Medical School in Hong Kong, and the Japanese medical school in Mukden. Only here does it seem possible to provide training in preclinical and clinical disciplines. Upon graduating from the Beijing College, students are given the opportunity to improve their skills in America at Rockefeller's expense. There is no unity in teaching methods in Chinese schools. Schools funded by Americans or Englishmen lean towards the clinical type and use a course system. The duration of study in them is 4-5 years. The academic year is equal to 8¹/₂ months. Actual medical education is preceded by 1-2 years of study in colleges in chemistry, physics, and mathematics. In German schools, a subject-based system is implemented, with a 5-year period of study and 1 year of internship to obtain the title of a practicing physician. The Japanese school in China approximates the German type. Foreign schools, divorced from the conditions of Chinese life, are one of the outposts of imperialist policy and levers of the colonial enslavement of China. The difference in the systems of higher medical schools is rooted in the paths of the historical development of medical education in different countries, its connection with universities and medical corporations, the varying degree of state regulation of the right to medical practice, teaching activity, and the educational process itself, and the state of medical science and public health organization. All this, in turn, is determined by the features of the economic and political development of each of these countries. In France, where the Great Revolution and the Napoleonic era created a centralized bourgeois state and which went further than other bourgeois states along the path of liquidating elements of the feudal economy and society, the medical school is subordinated to the greatest extent to the practical interests of the state, and state guidance of medical education is most direct, down to the detailed regulation of the educational process. In Germany, with its "Prussian" path of development, combining the rapid rates of economic growth of the country, which entered the path of capitalist development later than others, with an "unfinished" bourgeois revolution and strong survivals of pre-capitalist relations and classes, the traditions of medieval universities with their corporate spirit and academic freedom, now very closely grown into the system of the fascist state, proved to be most resilient. The American system reflects "freedom" of a different kind; it expresses most of all the spirit of private economy, the weakness of state patronage and regulation of the country, where the direct dictatorship of banks and monopoly capital operates most openly and directly, and where the traditions of a feudal-aristocratic society are absent. Finally, in the oldest capitalist country—England—which has still not reduced medical education to a clear unity, we can see the layering of whole historical epochs in the system of higher medical schools, which presses upon higher medical education and prevents it from moving forward, just as the historical past of England in general, which determined the backwardness of a whole series of its economic and organizational forms, lies as a burden on its economic development and prevents it from reconstructing at the necessary rates to match the young imperialist countries overtaking the once all-powerful "mistress of the seas." In recent years, a major movement for the reorganization of medical education has been noted almost everywhere: it can be characterized as the approximation of the two systems to each other. In Germany, the reform is moving towards an increase in practical exercises at the expense of theoretical ones, the expansion of the clinical disciplines program, the modification of the natural sciences program (biology, chemistry, physics) in accordance with the requirements of medicine, the strengthening of control (examinations), etc. The laws of 1924 and 1928 are drawn up in this spirit. In England and America, on the contrary, the range of theoretical subjects is expanding and deepening, in connection with which laboratory work is widely developing; fundamental changes are being introduced into teaching methods. To raise the initiative of students and develop their critical approach, conferences, seminar classes, etc., are being introduced. Privat-docent courses are acquiring wide development. As in Germany, in England and America there is a striving to establish a unified program for the entire country. France is the most conservative: here the reform has manifested itself only in the reduction of the time spent on morphological disciplines, some regrouping of subjects, and the strengthening of examinations (the law of 1927). If the difference in systems is determined mainly by the features of the historical development of individual countries, then the latest development of medical science, the strengthening of its natural-science and theoretical medical basis, the development of the state health care system and medical assistance in forms and frameworks characteristic of capitalist society, give rise to a certain tendency towards unity in the system of medical education, making its way very slowly, contradictorily, encountering great resistance from conservatism, routine, and traditions, and receiving the fastest implementation in cases where it coincides with the class interests and tasks of the bourgeoisie and the fascist state during the period of the crisis of capitalism and the fascisation of political power. One can point to the most important guidelines and tendencies, to one degree or another common to all capitalist countries in the field of higher medical schools. 1) The increasing differentiation of medical sciences and specialization in the field of medical practice should not be introduced inside medical faculties. The task of the higher medical school is to train a general physician who has mastered the theoretical and practical foundations of medical sciences to such an extent that he can subsequently either specialize after graduating from the higher medical school or remain a universal general physician. This type of physician, called in France médecin de base, differs both from the narrow specialist deprived of a general medical basis and from the practitioner whose qualification is based mainly on an empirical foundation. 2) The existing periods of study are everywhere recognized as insufficient. If we take into account that in some countries (USA, France, etc.) admission to the medical faculty is preceded by preliminary natural-science training, and on the other hand, there is (Germany) or is being introduced (France) a mandatory practical internship after graduating from the university, then the duration of study necessary to obtain a medical qualification is recognized as being no less than 6 years with a tendency to its further increase. 3) Recognition of the importance of establishing a closer connection between the preclinical and clinical periods of study. On the one hand, it is pointed out that it is necessary to teach natural-science disciplines, as well as anatomy and physiology, based on the needs of the future clinic, and to introduce the student to a living person—healthy or sick—as early as possible; on the other hand, a second concentration of physiology teaching is created in the clinical period (England). 4) More and more attention is paid to the teaching of physiology, which is beginning to dispute anatomy's significance as the leading discipline in the preclinical period. The teaching of anatomy itself is changing in the direction of moving away from the dead morphological scheme and teaching from the point of view of the relationship between the organ's form and its function. 5) Recognition of the necessity to introduce the teaching of public hygiene and preventive medicine at medical faculties as elements necessary to prepare the physician for service in state public health organs. This tendency is manifested in the introduction of special courses and disciplines during the study period or practical internship, practical work and visits to sanitary institutions, dairy farms, etc. (some universities in the USA and Canada), in paying attention to early diagnosis in clinical teaching, and in involving medical students in periodic examinations of students (Nancy, Strasbourg). All these measures in practice are of a partial nature and do not go beyond the framework of those practical requirements that can be placed on a physician working in the field of insurance, municipal, or state medicine in a capitalist country. All sorts of proposals predominate over their practical implementation. It goes without saying that the problem of prophylaxis both in medical education and in the health care system cannot be posed in its full breadth under the conditions of capitalism. 6) It is pointed out that it is necessary to conduct teaching not only on clinical material, but also on outpatient, policlinic, and dispensary material. 7) It is pointed out that it is necessary to strengthen the selection of students upon admission to medical faculties, and to tighten examination requirements during the course of study and upon its completion. The question of the preparation of those entering the medical faculty is essential. It is universally recognized that for the successful passage of medical disciplines, the student must be well acquainted with the natural sciences—physics, chemistry, and biology.

In some countries (USA, Canada, France, and others), the aforementioned cycle of subjects is taken in special preparatory courses. In France, a year is officially set aside for passing physics, chemistry, and biology; in reality, the requirements are so substantial that a student has to spend up to two and even three years. Without completing the natural sciences and passing the corresponding examinations in France, admission to a medical school is impossible. In America, colleges with a 2-year term of study serve preparation purposes. In England, admission to a medical school requires passing examinations in physics and chemistry (Premedical Examination). If a student is accepted without passing these examinations, they take them first. In Germany, with its subject-based system, no special preparation is required. Only the completion of secondary school is mandatory. The above-mentioned biological subjects are included in the medical school curriculum. They are taught jointly with students of other faculties, due to which they are too general and the requirements of medicine are not taken into account. In a number of universities, subjects of a general educational character are included in the first cycle: for example, philosophy in Denmark, logic in Poland, foreign languages in the USA, and so on. Theoretical subjects fall into two groups: 1) those studying the healthy organism (anatomy, histology, embryology, comparative anatomy, and physiology) and 2) those studying the diseased organism (pathological anatomy, general pathology, bacteriology, and pharmacology). Under a strict block system, the latter group serves as a transition to the clinic. Among clinical disciplines, internal diseases and surgery are the main ones. In addition to completing the main course in internal diseases, many universities provide additional special courses (on infectious diseases, tuberculosis, tropical diseases, and so on) and practical exercises, namely: percussion and auscultation in Germany, clinical pathology in England, laboratory diagnostic methods, and so on. The entire clinical cycle occupies on average 40-50% of the total study time; according to the plan of the American commission, 50%, and the German, 40%. The organization of clinical training in Sweden deserves special mention. For a certain time, the student is occupied with completing a single clinic: 8 months in therapy, 6 months in surgery, and 2-3 months in each of the other disciplines. Thorough study of patients during the internship in internal diseases inevitably requires returning to physiology, pathology, and bacteriology, while the study of surgery and obstetrics renews the student's contact with the internal clinic. The Swedish school is recognized by many as the best in terms of training outcomes. Its drawback is that the student's time is used uneconomically and is stretched over too long a period. Disciplines of the preventive cycle occupy one of the very last places in all countries. Teaching of this cycle is conducted in one of the final semesters for a very limited number of hours. In Boston, only 0.6% of study time is allotted to it, in Warsaw 1.6%, in Bologna 2%, and in Toronto 2¹/₂%. In Germany, its scope is expanded to up to 4%; in addition to general hygiene, it includes social hygiene, public health, epidemiology, and the like. In America and England, interest in public health and preventive medicine is also increasing. The head of the department of health in the USA, Vaughan, says on this occasion: "For the ultimate success of public health, we must prepare every general practitioner to be a representative of public health." But this is still far from being implemented. It deserves to be noted that in many US universities, physical culture has been introduced as a mandatory subject. The same is done in Germany, where there are special schools for these activities (Inst. f. Leibesübungen). With the goal of producing a universal general practitioner, each country provides special classes to deepen practical knowledge. In France, in addition to mandatory internships beginning in the third year, a student can work in hospitals as an extern or intern. This institution was introduced in France back in 1839. A definite number of positions are allotted for these roles in respective hospitals (approximately 30-60 positions for externs and 10-30 for interns), so only a limited number of students can obtain them. These positions are paid: in 1925, an extern received 1,200-1,500 francs per month, and an intern 2,300-3,200 francs. For an extern, prior completion of at least 4 semesters of the main curriculum is required; for an intern, 6 semesters and passing a corresponding examination. One can compete for an intern position after completing at least 1 year of externship. The term for full completion of an externship is 3 years, and an internship is 4 years. Externships and internships provide solid practical training, and quite a few researchers emerge from them. In America, the institution of internship and residency exists. Interns undergo training in hospitals, working for 2-3 months in each specialty. The internship lasts at least one year, which is considered the fifth, concluding practical year, but is often stretched to a year and a half or two years. It enjoys great popularity, and the number of interns is growing from year to year. Thus, in 1923 there were 3,119 of them, in 1925—3,825, and in 1927—4,952 people. Residency is a more responsible form of training, and only those hospitals that have proven themselves in training interns are allowed to have residents. In 1927, 1,699 residents worked in US hospitals. In Germany, Belgium, Switzerland, and Denmark, students have the opportunity to intern in hospitals and clinics during vacation time; but this depends on the student's own desire. A mandatory year of practice upon graduation from the medical faculty is required for them, but given the student's weak training during the main course, this is insufficient. The Germans themselves criticize their system and believe that under the current state of affairs, they fail to immediately obtain doctors upon graduation who are sufficiently prepared for practical work. In Sweden, students thoroughly acquaint themselves with practical work already during the course. In addition, internships in villages during student years are practiced there. Terms of study at medical faculties: 4 years—USA, 5 years—France, the majority of universities in England, Czechoslovakia; 5¹/₂ years—Germany, Switzerland, and Poland; 6 years—Austria, some universities in England, Canada, Belgium, Spain, Italy; 7 years—Sweden, Denmark, the Netherlands, and Norway. These terms do not include either the time of practical internship or the time for preliminary preparation. In reality, the actual average duration is longer than the official terms indicated above. The academic year is divided on the continent (with the exception of Poland) into two semesters, and in England, the USA, and Poland into trimesters. Regarding the number of hours for the entire medical education, a great variety is observed in individual countries: according to the 1927 German plan, 4,446 hours are established; the American commission established a standard term of 4,000 hours. However, there are universities with a much smaller number of hours, such as Wisconsin—2,933 hours, Johns Hopkins—3,544 hours, with annual fluctuations from 750 to 1,100 hours. The weekly workload by semesters is very diverse; it fluctuates within 30-48 hours and more. Knowledge verification is carried out everywhere through examinations, and they are used not only at graduation but also in the process of completing the course. In most countries, a line is drawn between the pre-clinical and clinical cycles. Transition to clinics is possible only after passing examinations in the subjects of the first cycle. In England, such examinations are the first professional examination, in Germany the Physikum, in France testing proceeds by courses, and in the USA control of completed material is more strict and mechanical than in Germany and England, where it boils down to a series of comprehensive examinations. There are countries where, in addition to oral examinations, written ones are also provided (France, Denmark, and others). In England and France, examinations are conducted by external professors; special commissions are created to avoid any bias on the part of the instructor. In Switzerland and other countries, this matter is in the hands of the instructors themselves; here examinations are administered throughout the entire year. Final examinations, the so-called state examinations, are given great importance everywhere, but not all countries provide the same scope of subjects and a unified system of verification. Certain achievements in the sense of introducing a uniform examination program exist in Great Britain due to the activities of the General Medical Council. In America until 1922, examinations were taken before the medical boards of the given state (Board of Medical Examination). A diploma issued in one state was not recognized in others. In 1922, on private initiative, a semi-official body was created—the National Board of Medical Examination of the United States—where mid-course, state, and post-internship year examinations are used. The diploma issued by this body is already recognized by 37 states.

Thus, in the USA, there is a trend to introduce examinations that would be recognized throughout the state. In some countries (Germany, Switzerland, France), in addition to state examinations, there is also the defense of a thesis (dissertation), which confers the title of Doctor of Medicine. In England, Italy, and America, there are examinations to obtain the title of specialist. Examination fees are quite significant everywhere. In England, they cost a total of 500 to 1,000 rubles, in Germany, together with the doctoral work, up to 500 rubles, and so on. In the USA, the number of students in 1926 was 18,840, which is an average of 230 per faculty; women accounted for about 5% of the total number of students; Negroes for 3% (in the USA, Negroes make up 12% of the entire population). They are concentrated in a very small number of universities; 55 universities do not accept Negroes at all. Tuition fees are rising from year to year: in 1910 the average fee was 118 dollars, in 1915 - 145 dollars, in 1920 - 177 dollars, in 1925 - 236 dollars, in 1926 - 274 dollars. The number of schools with tuition fees over 300 dollars increased from 1920 to 1926 from 4.7% to 34.2%. Scholarships for the needy were issued in 1926 to 543 students, i.e., 2.8% of the total enrollment. Mutual aid funds are poorly developed and exist at only 5 medical faculties. These data indicate that education is accessible only to the wealthy class. The number of medical students in France in 1925 was 13,116 people, which includes 1,500 pharmacists. The general crisis of capitalism and the world economic crisis have found their reflection in the organization of medical education in capitalist countries. The main motif under which the problem of higher medical education in the West is considered is the overproduction of doctors. There is no shortage of statements by professors and figures of higher medical schools pointing to the overcrowding of the medical profession and the dangers that new graduates of doctors bring with them in connection with this, due to the increased influx of students into medical faculties after the World War. In reality, this overcrowding is of course not absolute, but is connected with the decrease in the public's recourse to private medical practice due to a severe material situation and the reduction of the network of state and communal medical institutions. Even in the USA, where there is one doctor per 789 inhabitants, 90% of newly graduated doctors settle in cities with a population of over 50,000. "The most affluent rural residents have no doctor other than a hygienist who has obtained the right to practice." In London, there are only 6,000 doctors serving the insured. Burnet points out that "in five years in Germany we will have several thousand doctors deprived of any hope for a normal career. Insurance funds and communal institutions, from which demands for personnel have recently come, have staffed their cadres, and these demands will decrease even independently of the influence of the economic crisis." This was said even before Hitler's coup. In the first issue of D. m. W. for 1934, in an editorial titled "The Doctor and Science," L. v. Krehl writes: "There is too much worry and haste in the professional activity of the modern doctor. He faces economic worries that every sensible person must acknowledge. They depend primarily on the excessive number of doctors. With horror we look into the future: not because there are already too many of them now, but even more because almost countless masses are pressing forward, i.e., are being trained in higher education and then will also want to have work. What will happen to them under the limited possibilities of development and expansion of our people?" The desire to reduce the number of medical students so as not to increase the overproduction of doctors in capitalist countries is intertwined with the desire of the ruling classes to create from the student body one of the social bases of the fascist dictatorship, making access to higher educational institutions difficult for the proletariat and the petty bourgeoisie. The fascization of higher education in such countries as Poland, Italy, and Germany is moving forward rapidly. The nationalist ideology of fascism is aimed at depriving foreigners of the right to medical practice (Germany, Austria, and very recently France) and expelling Jews and "non-Aryans" from higher education (Germany). A number of countries are introducing restrictions on the admission of students to medical faculties. In Hungary, since 1920, 350 people have been admitted annually to the first year of all four medical faculties. In France, an examination with written tests has been introduced, failure in which entails expulsion. In the USA, it is proposed to select medical students through "vocational guidance tests." In early 1933, the Minister of Public Education in Prussia authorized universities to limit the number of those admitted to faculties. The desire to make higher medical education accessible only to the wealthier classes is also expressed in the desire to make classical education necessary for admission to the medical faculty. In France, the issue has been raised of the compulsory requirement for a future doctor to have the examination for the degree of Bachelor of Classical Sciences along with Latin and Greek. When consulted, the medical corporation spoke out in the majority in favor of the compulsory nature of these sciences; among the medical teaching staff, this reform is demanded especially by clinical professors. The desire to expand the number of years of study at medical faculties is also dictated to a large extent by these same considerations. S. Dubrovinsky. III. History of Medical Education in Pre-Revolutionary Russia. The study of medicine in Russia until the 18th century had a handicraft character. Those wishing to devote themselves to medical activity entered as apprentices to foreign doctors, who were obliged to sign an agreement that they would "teach the apprentices who are given for study with great diligence, concealing nothing." Upon completion of studies, apprentices were usually sent to the troops for practice, and they received the title of healer (lekar) only after several years of service in the troops with the rank of healer's assistant. Until the 17th century, doctors in Russia were imported from abroad, mainly for the tsar, his family, and the most important boyars, and only from the time of Alexei Mikhailovich were Russians also sent abroad to study medical sciences. The first Russian doctor to receive the degree of Doctor of Medicine from the University of Padua in 1692 was Pyotr Vasilyevich Posnikov. Although already under Ivan the Terrible and Alexei Mikhailovich foreign doctors living in Russia had Russian apprentices, there was no medical school where medical sciences were systematically taught. With the establishment of a standing army in Russia, the need for doctors arose, since foreign doctors imported from abroad were very expensive for the state. Moreover, there was a very great shortage of doctors in the troops, and the sick and wounded often remained without any treatment and medical aid. In 1654, the first medical school was founded in Moscow, to which 30 strelets children were appointed, but it soon closed; and only under Peter I, when the first medical schools arose, were the necessary conditions finally created for the proper development of medicine in Russia. The first medical school in Russia was founded on the initiative of the Dutch doctor Nicholas Bidloo. In 1705, Bidloo proposed to Peter I to found a hospital and a school attached to it for training doctors from Russian citizens. This idea was approved by Peter, who by a decree of May 26, 1706, ordered the construction in Moscow across the Yauza River opposite the German Quarter of a "hofpital for the treatment of ailing people." The Moscow "hofpital for pharmaceutical science" was the first medical school in Russia, since the teaching of medicine was organized in it, and the day this hospital was founded—May 26, 1706—is essentially the birthday of Russian medicine. An anatomical theater was built at the hospital, and by order of Peter I it was commanded "to recruit from foreigners and from Russians of all ranks 50 people for pharmaceutical science," who were handed over to the disposal of the chief doctor of the hospital, Dr. Nicholas Bidloo, for training in medical sciences. Initially, the students were recruited predominantly from foreigners, but since the latter were few, Bidloo obtained permission to take students for training in medical sciences from those studying in spiritual Slavic-Greek-Latin schools. Teaching in the first medical school in Russia in its structure resembled the teaching of medicine in Western European universities. Students were divided into apprentices, sub-healers, and healers; an apprentice, having spent a certain number of years in the school and passed an examination, received the title of sub-healer and a salary increase, after which his studies continued until the sub-healer acquired sufficient knowledge and experience for independent practice. Often sub-healers were sent for medical practice in the troops. Besides apprentices and sub-healers, the student body also included so-called "volunteers" who did not receive a salary. There was no exact term of study. Studies lasted from 5 to 7 and even 11 years. There were no medical textbooks and books other than the anatomy brought by Bidloo from Holland, and instead of textbooks, students used so-called "lektions," i.e., lectures written down from the words of the teachers, which were memorized and which passed from one generation to another.

Only from the 1740s did translations of foreign textbooks begin to appear in Russian. Writing paper, imported from abroad and expensive, was issued to students in very limited quantities; goose feathers and flattened-shot sticks were used for writing. The school taught anatomy, surgery "with instruction in making bandages," pharmaceutical science, drawing, and Latin. Although the theoretical study of anatomy was supplemented by autopsies of corpses of "mean people" delivered to the hospital, upon the opening of the hospital there was not a single skeleton in it, and the study of anatomy took place mainly from drawings. The teaching of the "creation of bandages," i.e., desmurgy, was conducted both on humans and on phantoms. The performance of operations was preceded by a discussion of the given disease and the establishment of surgical indications for the operation. Surgical operations were performed both on living people lying in the hospital and on corpses in the anatomical theater in the form of rehearsals "for the reinforcement of students." Among operations, skull-boring, i.e., trepanation of the skull, was particularly frequent. The study of pharmaceutical science, which consisted of a combination of botany and pharmacognosy with pharmacy and partly with pharmacology, took place in "apothecary gardens," where students acquainted themselves with medicinal herbs, and in addition, excursions were made outside the city to gather medicinal plants. Medicinal prescriptions, distinguished by their complexity, had to be recorded and memorized by students. The teaching plan also included rounds of the hospital wards, with doctors conducting examinations and questioning of the patients lying in the hospital in the presence of students. All orders of the doctors were carried out by students and junior doctors, who had to perform minor operations themselves, be present during visits by doctors to patients, take on duties, and perform all paramedic duties. All medical disciplines were dictated from a book or notebook and carefully recorded by students. All teaching was conducted in Latin. Bidloo spent much effort and time on the preparation of future doctors, striving to ensure that those graduating from the medical school were "skillfully made." In 1712 Bidloo, reporting to Peter on the course of studies in the hospital, wrote that "the students not only have knowledge of one or another disease which befalls the body and pertains to the rank of surgeon, but also a general art concerning all those diseases from the head even to the feet with true and customary instruction on how to treat them." In 1713 the first, and in 1718 the second, graduation of doctors who finished Bidloo's school took place. With the death of Bidloo, which followed on March 23, 1735, the medical school created by him had to experience a difficult time for several years, since Doctor De-Teilhe, appointed in Bidloo's place, took little interest in the organization of teaching at the school, treated the students cruelly, and did nothing for the further improvement of pedagogical work. The situation of the school improved with the appointment of the former President of the Academy of Sciences, Lavrenty Blumentrost, as head of the hospital. Under Blumentrost, teaching in the hospital expanded and improved; the teaching of internal diseases and forensic medicine was introduced; the first medical textbooks appeared; for the teaching of the Latin language, a "studiosus, obliged to occupy himself with the students every day for two hours in the Latin language, as well as in spelling and orthography with all diligence" was invited; and so-called "tortures," i.e., systematic examinations, were introduced, in the instructions for which it was proposed "to put questions loudly, briefly, and clearly, and whose answer shall be faulty, to correct affectionately, so as not to lead youth into the greatest confusion." The teaching of internal diseases was divided into several sections: de morbis capitis, pleuritide, diarrhoea, dysenteria et de febribus. Clinical teaching took the form of doctors' rounds of patients together with students, and the students, fulfilling the role of paramedics, played the same role of curators that students play in modern university clinics. Thanks to Blumentrost, the first Russian medical school grew stronger and could honorably compete with the newly born hospital schools opened in 1733 in Petersburg at the land and naval hospitals and at the hospital in Kronstadt. While in Moscow the majority of students were recruited from Russians and teaching was conducted in Latin, in Petersburg the majority of students were foreigners and teaching in the Petersburg hospitals was conducted in German. Teaching in the hospital schools of the mid-18th century was set up far from satisfactorily, which happened, according to Chistovich, "not because capable teachers could not be found—teachers sometimes appeared from native Russians who had received a thorough education abroad—but as soon as they showed a desire to expand teaching, they were immediately removed from the department and sometimes ruined by all kinds of iniquities. The fact is that foreign administrators of medical affairs in Russia were convinced and tried to convince whom it concerned that Russians are incapable and should not receive a full medical education." Throughout the entire first half of the 18th century, teaching in medical schools was not up to standard, and I. Z. Kondoidi, who headed the medical administration during the reign of Elizabeth, had to carry out a fundamental reform of all medical education, raise the quality of teaching, and raise the moral level of students in medical schools. Striving to ensure that the teaching of medicine in Russian schools did not lag behind foreign schools, Kondoidi decided to send doctors who had received their education in Russia abroad for the improvement of their knowledge, and from 1761 the systematic sending of young Russian doctors to foreign universities was established. Under Kondoidi, a seven-year term was established, a proper examination system was introduced, the beginning of the clinical study of patients was laid, medical histories for the first time began to be compiled during the study of patients, and for the first time physiology, women's and children's diseases, and obstetrics entered the teaching program, for which students were sent to special doctors of the "midwifery business" to listen to lectures and learn obstetric operations. By the decree of June 4, 1754, the seven-year course of study in medical sciences was to proceed as follows: "In the first year, to listen to anatomy and pharmacy and learn to draw from a drawing master. In the second year, the same as in the first year. In the third year, to listen to anatomy, pharmacy, and physiology and become established in the drawing business. Upon the completion of three years, those who at the examination show considerable success in anatomy, pharmacy, and drawing, and moreover recommend themselves by virtuous behavior in life, shall be made junior doctors. In the fourth year, to listen to physiology and pathology, and when free, to go to listen to anatomy and pharmacy. In the fifth year, to listen to physiology, pathology, special praxim medico-chirurgicam, and cursum opertionum chirurgicarum, while making bandages and applying them to a dummy. In the sixth year, all the same as in the fifth year. In the seventh year, it is proper especially to study clinical practice and gather observations, and for that diligently to attend to patients in the wards, to note all occurring attacks and changes in diseases, also the effect of medicines and diet and other things, and for future use to record everything. To be always at every dressing of important external diseases and to present at the performed anatomical examinations of dead bodies sent from various places to find the cause of death and at such anatomical examinations of those who died from diseases in hospitals, and to listen to the doctor's and operator's reasoning occurring thereupon about the cause of death and to record it for one's future enlightenment. And furthermore, changing by turn, to be monthly at the hospital pharmacy for the compounding and dispensing of all kinds of medicines, so that by that method and in that art they might obtain practice, and for that time, while they are at the pharmacy according to the above-described, they are not to be employed in other business, unless some especially important operation is to be performed, and there is no business in the pharmacy, in which case to watch such a performed operation they must by all means be present. And so that they may fulfill all this, in the seventh year they are to listen to only one collegium of special praxis medico-chirurgicam and cursum of surgical operations with bandages, and to other lectures they shall not go." Kondoidi showed great care regarding the supply of teaching aids to students, ordering textbooks by Vesalius, Boerhaave, Van Swieten, Heister, and medical journals for medical schools from abroad; first of all, the "Journal des savants" was received from Holland, and from Germany the "Commentaria de rebus in scientia naturali et medicina gestis." In addition, in 1754 Kondoidi submitted a proposal to the Senate on the establishment of a public medical library. Under Elizabeth, the need for doctors already increased so much that at the university founded in Moscow in 1755, the first medical faculty in Russia was opened. According to the initial project, only chemistry, natural history, and anatomy in connection with medical practice were supposed to be taught at the medical faculty. From 1765.

Johann Friedrich Erasmus from Strasbourg opened a course in anatomy, surgery, and the "midwifery art," and in 1765–66 the teaching of "theoretical medicine" began, the first professor of which was S. G. Zyslin, who presented this science according to "Ludwig" in the following sequence: "firstly, the physiology of the healthy human body with the semiotics and dietetics belonging to it, then pathology with its semiotics, and finally, general therapy." Thus, in the first period of teaching at the medical faculty, clinical teaching did not exist. Only at the end of the 18th century, in 1797, was a clinical ward for 10 people opened at the Moscow Military Hospital, intended for teaching purposes and equipped with all the supplies necessary for teaching. Teaching at the medical faculty of Moscow University at the beginning of its foundation was far from being at the proper level, sciences were still poorly differentiated, the scopes of courses were small, and the medical faculty was represented only by a small group of professors. Even the teaching of the main subject—anatomy—was very superficial, and in his speech "De molestis studiis anatomici, deliciisque maximaque illius utilitate longe superandis" (1765), published in Russian under the title "On the annoyances of anatomical study, surpassed immeasurably by the amusement and the great utility thereof," Erasmus complains that anatomists are accused of impiety, the study of anatomy is equated to a slaughterer's craft, for months corpses are not provided by the police, and he fails to arrange disputes between students because lectures are almost unvisited by students. Medical education at Moscow University in the first century of its existence bore a purely theoretical character. During the study of anatomy, exercises on corpses were not performed, operations on living people were done very rarely, lectures were read according to notes compiled in most cases ten or fifteen years ago, and even in the 1920s of the 19th century some professors still lectured from 1750 guidebooks, and for medical examinations only the ability to write a description of some operation in Latin was required. Among the teachers in the middle of the 18th century, K. I. Shchepin stands out in particular; he lectured at the Moscow General Hospital on a course consisting of anatomy, physiology, botany, surgery, and pharmacology, abandoned "dictations"—that is, dictating phrases to students to be memorized by rote—and demanded from students an understanding and intelligent assimilation of medical sciences. P. I. Podgoretsky also stood up warmly for the cessation of teaching in the Latin language and the reading of lectures in the Russian language, thanks to which the teaching of medicine in the Russian language first acquired the force of law in 1764 with the simultaneous abandonment of teaching in the German language. Medical education during the time of Catherine II was in a rather deplorable state: hospitals and infirmaries were destroyed and not repaired, and no attention was paid to the establishment of new medical institutions and the development of educational medical institutions. The Petersburg, Kronstadt, and even Moscow military hospitals, which served simultaneously as medical schools, came to an utterly ruinous state by the end of Catherine II's reign. At the very end of Catherine II's reign, in 1795, the study terms in hospital schools were firmly regulated, the departments were staffed with professors in accordance with the special training of each of them, adjuncts were established at each department to help the professors, and an elective principle was established when appointing to teaching positions. Among the individual professorships were established the positions of professors of mathematics and physics, chemistry and botany, anatomy and physiology, materia medica, pathology and therapy, surgery, obstetrics, and drawing. The full course of study was set at five years, of which the first three years were intended for school instruction alone, and the last two for practical work in hospitals or clinics. In the first year of their education, students were to study mathematics, physics, chemistry, botany, anatomy, and physiology; in the second year, repeating physics, chemistry, botany, anatomy, and physiology, to study materia medica, the skill of writing prescriptions, pathology, and therapy; in the third year, continuing the study of pathology, therapy, and botany, to study surgery and practice the dissection of corpses; the fourth and fifth years of study were devoted to practical work in hospitals and clinics. Annually upon completion of study, students underwent examinations in the presence of members of the board. At the very end of the 18th century, already under Paul, a new attitude toward medical education begins in Russia. In 1797, rules were drawn up for the teaching of medical sciences by professors, and in these rules professors were instructed not only to conduct teaching properly, but also to treat students solicitously, "winning their affection by affectionate behavior, and, in case of their fault, by no means using abusive expressions." In 1799, two medico-surgical academies were established: one in Moscow—the Moscow Medico-Surgical Academy, which arose instead of the medico-surgical school at the Lefortovo Military Hospital, and the other in Petersburg instead of the Petersburg Medico-Surgical School. Half a million rubles was allocated for the establishment of the medico-surgical academy in Moscow, a very large sum for that time, "for the construction in Moscow at the main hospital of a stone building with houses belonging thereto for medical ranks and for the medical school." The Moscow Medico-Surgical Academy existed until 1804, upon its closure all students being transferred to the Petersburg Medico-Surgical Academy. On December 18, 1799, construction began on the building of the medico-surgical academy with lecture theaters, and in the summer of 1800, students of the St. Petersburg Medico-Surgical Academy began studying in the newly built academy building. The Kronstadt and Elizavetgrad medico-surgical schools were abolished; likewise, in 1802, the Petersburg Kalinkin Surgical School, or the Imperial Kalinkin Medico-Surgical Institute, opened during the reign of Catherine II specially for Germans, merged with the Petersburg Medico-Surgical Academy. It should be noted that medical education in Russia at the end of the 18th century owed its great development and successes in large part to State Treasurer and Chief Director of the Medical College Alexey Ivanovich Vasiliev. The numerous transformations and improvements of medical schools that arose in Russia in the final years of the 18th century, the reorganization of hospital and sanitary affairs, the creation of medico-surgical academies, and the improvement of the delivery of teaching at medical faculties were carried out under his influence. Clinical teaching emerged as an independent subject only at the beginning of the 19th century. Thus, according to the 1804 charter, the following departments were established at the medical faculty: 1. Anatomy, physiology, and forensic medicine. 2. Pathology, therapy, and clinic. 3. Medical materia, pharmacy, and medical literature. 4. Obstetrics. 5. Veterinary medicine. At the beginning of the 19th century, medical education in Russia was significantly expanded and deepened by the introduction of new subjects. The medico-surgical schools in Moscow and Petersburg, transformed into academies in 1799, received new charters modeled after the charters of higher medical schools abroad. New universities with medical faculties were opened in Kazan and Kharkov, and medical faculties began to function again in the universities of Dorpat and Vilna. A sad period in the history of medical education in Russia in the first half of the 19th century was the time of the last years of the reign of Alexander I, when teaching at the medical faculties was placed in a very difficult position, which was especially vividly revealed at the medical faculty of Kazan University, teaching at which was almost completely destroyed in 1819 by the university's trustee Magnitsky. The best professors were removed, teaching bore either an abstract-theoretical character or was reduced to pure empiricism. The teaching of anatomy took place without exercises on corpses, and professors of anatomy taught the doctrine of muscles by "attaching handkerchiefs to the ends of bones." A number of subjects were completely abolished; for example, geology was abolished "as a science in its current systems of volcanists and neptunists, completely contrary to Holy Scripture." The professor of physics was obliged, when presenting his course, to constantly point "to the divine wisdom and the limitations of our senses and instruments for knowing the wonders constantly surrounding us." The professor of natural history had to constantly point out that "the natural kingdom is only a faint imprint of the highest order to which people are predestined after death." Reproaches against science and praises of magic, cabalism, and the new orders were frequently heard from the departments. Regarding teaching, Magnitsky gave the professors a number of instructions, in which, among other things, it was pointed out that it was the professors' duty to observe without fail that the lessons of religion and obedience were actually carried out, that students constantly saw around them examples of the strictest subordination on the part of teachers and supervisors, and that the slightest violation thereof was always punished, regardless of the rank of the persons.

So that the spirit of free-thinking could neither openly nor covertly weaken the teachings of the Church, the professor must have reliable information about the spirit of the instructors, frequently attend lectures, examine students' notebooks, etc. Regarding the teaching of medical sciences, Magnitsky's instruction states that "professors must take every possible measure to avert that blinding to which many of the most distinguished physicians have been subjected out of astonishment at the excellence of the organs and laws of our living body, falling into ruinous materialism precisely from what the creator's supreme wisdom reveals. Students must be instilled with the notion that Holy Scripture inseparably links the healing art with piety, that a free-thinking physician will never go beyond the limits of human knowledge, that the healing art without the spirit of Christian love and mercy is a craft in itself, especially when pursued solely for gain—a craft as low as medicine is great and venerable when turned to the benefit of humanity and illumined by the higher light." In what spirit the teaching of medical sciences was conducted during Magnitsky's time can be judged from the work of Kazan University Professor Arngoldt, entitled "A Brief Discourse, Based on the Word of God, on the Essence of Life in General and of Human Life in Particular, on Health and Its Preservation, on Diseases and Their Curing," which indicates that "every body represents a definite and incarnate word of God. Diseases are divided by him according to the kind of sins: against God, neighbor, or oneself. Spiritual remedies are recommended predominantly for treatment." "In teaching medical sciences," says Kazan University Rector Fuchs in his report, "I tried in every way to reject those harmful effects of the ungodly philosophy of Schelling to which certain foolish physicians were subjected in the writings on the physiology of the human body, so that our pupils would not become infected with harmful thoughts and fall into ruinous materialism. On the contrary, in all medical teachings the main subject was to show young physicians that the art of healing without the spirit of Christian love and mercy cannot have a blessing and remains unsuccessful at the bedside of the sick." In the syllabus of lectures on anatomy and physiology compiled by Fuchs, it says: "The purpose of anatomy is to find in the structure of the human body the supreme wisdom of the creator who created man in his own image and likeness. Our body is the temple of the soul and therefore it is necessary to know it. Given the close connection of body and soul, one must carefully guard against falling into horrible materialism, like certain foolish physicians. Since we, after the fall of our forefather, became exposed to manifold diseases, God through the science of anatomy gave us a means not only to alleviate but also to eradicate diseases." The views on medicine that were propagated from the professorial chairs in the first quarter of the 19th century are well represented in the work of Moscow University Professor Mudrov, "Discourse on the Method of Teaching and Learning Practical Medicine." In this work Mudrov says that healing consists not in treating the disease, not in treating the causes, but in treating the patient himself, for which it is necessary to conduct an examination of the sick person. The healing powers of the organism itself are of great importance for successful treatment. The means that are brought into play by the organism for self-cure are secretions, critical evacuations, and inflammations. The cause of nature's self-cure, however, is the sympathy of parts, antagonism, and instinct. Among the causes producing various diseases, Mudrov includes hunger, drunkenness, gluttony, idleness, mental and physical exertion, catching cold, as well as "subcelestial influences, solstices, changes of the moon, evaporations on land and on waters." In classifying diseases, Mudrov distinguishes "four natures of acute diseases (inflammatory, catarrhal, gastric, and nervous) and eight chronic ones (weak, convulsive, rheumatic, scorbutic, scrofulous, venereal, indurated, and periodic)." Teaching in the 18th century and early 19th century was of a purely demonstrative character, and the patients located in the clinics served to demonstrate the main symptoms of the disease to students and to indicate the therapy applied for various ailments. In 1835, clinical teaching was expanded, and under the new charter, a department of clinical medicine was established with a division into a) special pathology and therapy and b) clinic in the hospital. The charter of 1863 separated special pathology and therapy from the clinic into a special department of "Special Pathology and Therapy" and under it a) systematic clinical presentation of the doctrine of nerves and mental diseases and b) systematic and clinical presentation of the doctrine of skin rashes. In St. Petersburg in the 18th century, medical education was provided by the Imperial Medico-Surgical Institute, in which teaching was conducted exclusively in the German language. In 1799, the St. Petersburg Medico-Surgical Academy was founded, in which lectures began in 1800. From 1805, the teaching of medical sciences was significantly expanded by the introduction of practical clinical studies in therapy, surgery, and obstetrics, and from 1806 special clinics were established. In 1840, the 2nd Land-Forces Military Hospital was attached to the academy as a clinic, thanks to which a very significant contingent of patients was provided for student practice. The curriculum of teaching at the Medico-Surgical Academy in the first years of the 19th century consisted of "preparatory" and medical sciences. Preparatory sciences included: 1) Latin language, 2) German language, 3) mathematics, 4) logic, 5) physics, 6) chemistry, 7) natural history. Medical sciences included: 1) anatomy, 2) physiology and hygiene, 3) general pathology, 4) special pathology, 5) general therapy, 6) materia medica, 7) prescription writing, 8) theoretical and practical pharmacy, 9) theoretical and practical surgery, 10) theoretical and practical obstetrics, 11) ophthalmology, 12) special therapy (clinical medicine), 13) forensic medicine, 14) medical police, 15) military medicine, 16) theoretical and practical veterinary science. The history of medicine was divided into sections, which were lectured on by each representative in the form of a historical outline of the respective science. The academic course of the academy lasted for four years, and only in 1835 was a fifth year of study added. Such a teaching curriculum existed until 1830, when under the new charter 12 departments were approved for the following subjects: natural history, physics and chemistry, physiological and pathological anatomy, pharmacology with prescription writing and general therapy, department of therapy, general and special surgery, clinic of external diseases combined with "ophthalmological" clinic, department of internal diseases clinic, obstetrics with the study of women's and children's diseases and obstetrical clinic, forensic medicine, medical police, hygiene, history and literature of medicine. Teaching took place in approximately the same scope in other higher medical educational institutions as well. In the "Announcement on the Lecturing in the Imperial Moscow Medico-Surgical Academy for the 1838/39 Academic Year," preserved in the library of Moscow State University, one can see the sequence in which teaching took place. In the first year, the following were taught: Law of God, anatomy, physiology, fundamentals of mathematics and physics, medical encyclopedia and methodology, botany, zoology and mineralogy, Latin literature, German literature, and drawing. In the second year: anatomy, physiology and general pathology, inorganic and organic chemistry, pharmacy with pharmacology, botany, and German language. In the third year: pharmacology with toxicology, general therapy with prescription writing, special pathology and therapy, general and special surgery, and pathological anatomy. In the fourth year, students listened to special pathology and therapy, therapeutic clinic with the study of mental diseases and pathological semiotics, general and special surgery, and obstetrics with women's and children's diseases. The fifth year of study was devoted to forensic medicine with medical police and hygiene, history and literature of medicine with the exposition of medical authors, epizootic diseases with a general review of veterinary pharmacology and therapy, and surgical clinic with ophthalmology. At the medical faculty of the University of Yuryev (Dorpat), besides the above-listed subjects, the polyclinic of internal diseases, founded in 1804, acquired great pedagogical significance, occupying for more than a century of its existence one of the most prominent places among the clinical institutions of Yuryev University. In 1858, the "Institute for the Advanced Training of Physicians" was founded at the St. Petersburg Medico-Surgical Academy; it sent physicians retained at the institute for advanced training in medicine abroad, and it provided Russia with a number of scientific workers who contributed to the prosperity of the medical sciences in Russia. In 1881, the St. Petersburg Medico-Surgical Academy was transformed into the Military Medical Academy with the special purpose of training physicians for the military and naval departments. The first two courses, in which general and natural sciences were taught, were closed; the third, fourth, and fifth courses were renamed junior, middle, and senior courses, and only medical faculty students who had moved to the third course or graduated from the natural sciences department at the physico-mathematical faculty began to be accepted as listeners. From 1885, two junior courses were re-opened at the academy.

Beginning in the 1870s, clinical teaching began to pursue broader goals, striving for a comprehensive examination of the patient, for which it became necessary for patients to be under the constant supervision of teachers and students, as a result of which extensive clinics with a large number of beds began to emerge. The establishment of independent surgical and therapeutic clinics took place only in the middle of the 19th century, and separate obstetrical clinics arose even later, since until the 1830s obstetrics was ordinarily taught by the professor of surgery. The formation of other specialized clinics—eye, ear, nose, and throat, skin and syphilis, and others—began only in the 1860s and 1870s. The medical faculty of Moscow University, the oldest in Russia, and the Military Medical Academy in Leningrad, throughout their many years of existence, produced a number of prominent clinicians and major scientists for medical science, creators of a number of scientific schools that had a tremendous influence on the development of clinical thought and medical science in Russia and undoubtedly contributed to the advancement of medicine of worldwide significance. Being in the 18th and early 19th centuries almost the sole nurseries of medical knowledge and medical thought in Russia, the medical faculty of Moscow University and the Military Medical Academy enriched medicine with a number of important scientific works and studies and put forward a number of famous clinicians, founders of new medical schools (N. I. Pirogov, S. P. Botkin, G. A. Zakharin, A. A. Ostroumov, A. Ya. Kozhevnikov, V. F. Snegirev, S. S. Korsakov, A. I. Pospelov, and others). At the end of the 19th and in the 20th centuries, obtaining the title of physician required completing 10 semesters at the medical faculty over a 5-year period of study and passing the so-called state examinations before a special Medical Examining Commission. The state examinations included the following subjects: descriptive anatomy, histology, pathological anatomy, operative surgery with topographical anatomy including desmurgy and the study of dislocations and fractures, physiology, medical chemistry, general pathology, pharmacology with prescription writing and the study of mineral waters, pharmacy with pharmacognosy, special pathology and therapy of internal diseases, therapeutic clinic, the study of children's diseases, the study of skin and venereal diseases, the study of nervous and mental diseases, clinic of children's diseases, surgical pathology, surgical clinic, ophthalmology, clinic of women's diseases, obstetrics with the study of women's diseases, hygiene with medical police, forensic medicine with toxicology, and the study of epizootics with veterinary police. Upon receiving the medical diploma, it was required to sign a "faculty oath" of the following content: "Accepting with profound gratitude the rights of a physician granted to me by science and comprehending all the importance of the duties placed upon me by this title, I promise throughout my entire life not to tarnish in any way the honor of the estate into which I now enter. I promise at all times to assist to the best of my understanding those suffering who resort to my aid; to sacredly guard the family secrets entrusted to me and not to use to evil the trust placed in me. I promise to continue to study medical science and to contribute with all my powers to its prosperity, communicating to the scientific world everything that I discover. I promise not to engage in the preparation and sale of secret remedies. I promise to be fair to my fellow physicians and not to insult their persons; however, should the benefit of the patient require it, to speak the truth directly and without partiality. In important cases, I promise to resort to the advice of physicians more knowledgeable and experienced than myself; when I myself am called to a consultation, I will conscientiously do justice to their merits and efforts."

D. Rossiysky. IV. Higher Medical Education in the USSR. Growth of the network of medical higher education institutions and main stages in the development of higher medical schools. In 1917, before the October Revolution, on the territory currently occupied by the USSR, there were the following 13 higher medical educational institutions listed on the state budget: the Military Medical Academy, the Petrograd Medical Institute (until 1917 the Women's Medical Institute), the Psychoneurological Institute, medical faculties at the universities of: Don (Rostov-on-Don, transferred in 1915 from Warsaw), Kazan, Kiev, Moscow, Odessa, Perm, Saratov, Tomsk, Kharkov, and the Moscow Higher Women's Courses. In Dnepropetrovsk, a medical institute was organized during the World War. In addition, there were medical faculties at the Higher Women's Courses in Kiev and women's medical courses in Kharkov and Odessa. The shortage of physicians that soon became apparent after the October Revolution, both for serving the needs of the Red Army and the civilian population, sharply raised the issue of expanding the network of higher medical schools. The October Revolution widely opened access to higher education for numerous cadres of youth who, for political, social, and national reasons, could not obtain higher education under tsarism. The revolution also provided the opportunity to take up teaching positions in higher education institutions for qualified scientific and medical forces whom the suffocating regime of tsarist universities did not allow on the threshold of higher school. The network of higher medical schools began to expand rapidly. Until 1922, 16 higher medical schools were newly deployed in the cities of: Voronezh (transferred from Yuryev in 1918), Nizhny Novgorod (1918), Simferopol (1918), Smolensk (1920), Tiflis (1918), Moscow (Moscow Higher Medical School, 1919), Minsk (1919), Samara (1919), Yaroslavl (1919), Irkutsk (1919), Baku (Azerbaijan University, 1920), Astrakhan (1920), Krasnodar (Kuban Medical Institute, 1920), Sverdlovsk (then Ekaterinburg, 1920), Tashkent (1920), Omsk (1920), Erivan (1922). The medical faculties of the Kharkov, Kiev, and Odessa universities were merged in 1920 with women's medical institutes and named medical academies; since 1921 they were renamed medical institutes. Some of the newly opened medical institutes were low-powered and lacked the necessary teaching staff and equipment. The growth of the urban and rural medical network was provided by physicians demobilized from the ranks of the Red Army, as well as by graduates of medical institutes. In the upper years of medical higher education institutions, by 1924/25, a large number of students from the expanded admissions of 1920-21 were already studying. All this, along with the accumulation, predominantly in large cities, of a large number of 'unemployed' physicians who did not want to go to the countryside and the periphery, created the impression that the existing number of medical higher education institutions and students in them corresponded to the demand for physicians over the coming years. The People's Commissariat of the Workers' and Peasants' Inspection of the RSFSR raised the issue in 1924 of reducing the network of higher medical schools. Medical faculties were closed in Sverdlovsk (1924), Yaroslavl (1924), Simferopol (1925), Samara (1927), and Nizhny Novgorod (1929); the Higher Medical School in Moscow merged with the medical faculty of the 2nd Moscow University (1924). Already a few years later, in connection with the rapid growth of socialist construction and the cultural demands of the population, an extreme shortage of medical personnel was revealed and the issue of the necessity of expanding the network of higher medical schools arose. From the beginning of the 1929/30 academic year, the medical faculty in Nizhny Novgorod was reopened; from the first half of the 1930/31 academic year, medical institutes were opened in Ivanovo-Voznesensk, Samara, Khabarovsk; from the second half, institutes opened in Alma-Ata, Samarkand, Sverdlovsk, Simferopol, and Stalino. During 1932 and 1933, medical institutes were opened in Arkhangelsk, Ufa, Makhachkala, Izhevsk, and Ashkhabad. In 1935, institutes were opened in Novosibirsk, Stalingrad, Kursk, Vitebsk, Vinnitsa, as well as the 1st Pediatric Medical Institute in Leningrad, the 3rd Moscow, and the 3rd Leningrad Medical Institutes. In the Ukrainian SSR, the Kharkov Institute, transformed from a mother and child welfare school, and the psychoneurological institute in Kharkov on the basis of the Psychoneurological Academy were organized. In addition, a number of hospital-medical higher education institutions, or as they are called, production medical institutes, arose in the RSFSR, BSSR, and Ukrainian SSR, directly on the basis of medical institutions; some of these medical higher education institutions-hospitals were transformed in 1935 into medical institutes. The October Revolution created a state healthcare organization, which was tasked with the primary service of the working people and above all the industrial proletariat, bringing qualified medical assistance closer to the population, carrying out broad health-improving measures, preventing morbidity among working people, and combating social diseases. The new tasks of healthcare in turn set new tasks for the higher medical school. However, the higher medical school was far from soon restructured. The Civil War and the typhus epidemic demanded from the medical school the satisfaction of significant requirements for physicians. In the first years after the October Revolution, the center of attention of the higher medical school was the satisfaction of the requirements of healthcare organs and the Red Army with a sufficient number of physicians. This period is characterized by a fierce class struggle within the walls of higher medical schools. The proletarization of higher education carried out by Soviet power, class selection upon admission of students, the organization of workers' faculties, new methods of teaching, reorganization of the higher school management system—all this met with stubborn resistance from the reactionary part of the professoriate and teaching staff. The end of the Civil War, the breaking of the blockade ring, and victory on the anti-epidemic front made it possible to focus attention on the front of economic and cultural construction. The higher medical school, relying on the cadres of proletarian students, in the first years predominantly on that party stratum which came to the higher school directly from the fronts of the Civil War, and on the progressive part of the professoriate and teachers, began to carry out its restructuring in accordance with the tasks of Soviet medicine and the class tasks of the Soviet higher school. The People's Commissariat of Education gave the first guidelines for the profile of the physician that the higher medical school should train. The higher medical school during this period was built with a focus on the generalist physician, wherein not only specialization in individual branches of therapeutic medicine and sanitation, but even differentiation between the medical physician and the sanitary physician was postponed to the period of medical practice after graduation from the higher education institution. Only in Ukraine was some differentiation transferred into the higher medical school in the form of so-called 'inclinations' in the upper year. The launched socialist offensive along the entire front posed to the higher medical school the issue of training new cadres of proletarian physicians capable of becoming active participants in the socialist restructuring of the entire healthcare business. The growth of sanitary requirements of the population, the development of therapeutic business on the basis of high-quality service, the growing role of broad health-improving measures, the socialist reconstruction of cities and the creation of new socialist cities, the broad coverage of the population with public catering, the development of preventive work based on the collective farm mass in the socialist sector of the countryside, bringing qualified therapeutic assistance closer to the collective farm population—all this required not only a large quantitative growth of medical personnel, but also a decisive restructuring of the system of higher medical education. This restructuring was carried out in 1930 on the basis of directives of the November (1929) plenum of the Central Committee of the All-Union Communist Party (Bolsheviks). The higher medical school was transferred from the People's Commissariat of Education to the jurisdiction of the People's Commissariat of Health. At the same time, a change in all its educational-programmatic and methodological work was carried out. The most important link in carrying out this reorganization was the introduction of specialization within the walls of the higher medical school. However, in the practical implementation of this reorganization, a whole series of infatuations and errors took place, the most important of which were the reduction of the study period in medical higher education institutions to 3½ and 4½ years, early specialization at the expense of the general theoretical and general medical basis, an excessive number of hours of production practice and the introduction of production practice in junior years, a sharp reduction in the number of lecture hours, the weakening of individual control of student knowledge, etc. The material base of the higher medical school did not keep pace with the rapid growth of student contingents. The leadership of the medical education business by the people's commissariats of health of the union republics was insufficient. All this served as the reason for that unsatisfactory state of the higher medical school by the beginning of the 2nd five-year plan, which received its sharp and completely correct assessment in the speech of comrade Stalin at the 17th Congress of the All-Union Communist Party (Bolsheviks). Stalin said: 'I have in mind the inadmissible phenomenon that pedagogical and medical faculties are generally in a state of neglect with us. This is a big shortcoming bordering on a violation of the interests of the state. This shortcoming must be ended, and the sooner this is done, the better.' The leader's instructions on bringing medical institutes out of neglect served as a combat program for the restructuring of medical institutes.

The tasks of developing the higher medical school in the second five-year plan and raising the quality of work of the higher medical school are set forth in the decree of the Central Executive Committee of the USSR of September 3, 1934, "On the Training of Physicians." Finally, very recently (June 1936), a decree of the Council of People's Commissars of the USSR and the Central Committee of the All-Union Communist Party (Bolsheviks) "On the Work of Higher Educational Institutions and the Management of the Higher School" was published, which is of paramount importance for the further improvement of the work of higher educational institutions (for details see below). Reorganization of higher medical education. The first steps in the reorganization of the higher medical school after the October Revolution were taken in 1919 in Leningrad, where a commission was established under the department of educational institutions and educational establishments of the People's Commissariat of Education to elaborate the issue of reforming higher medical education. The main decisions of the commission boiled down to setting a six-year period of study, with the sixth year planned in the form of practical training in the main clinical disciplines, to reducing lectures and moving to demonstrative and practical teaching in all disciplines, to expanding familiarity with social medicine, sanitary statistics, epidemiology, occupational and school hygiene, issues of labor restoration, and physiotherapy. In August 1920, the First All-Russian Congress on Medical Education was held in Moscow. The draft of the new curriculum adopted by the congress differed significantly from the draft developed by the commission in 1919. According to this plan, the six-year period of study was divided into three stages: a preparatory physical-chemical-biological stage lasting 3 trimesters (2 years), a general medical stage lasting 7 trimesters, and a practical specialized stage lasting 5 trimesters. At the third stage, teaching was conducted in several special cycles: therapeutic, surgical, gynecological, sanitary, and others. In each cycle, in addition to the main disciplines, related and auxiliary ones were included. The congress recognized it as timely to completely abolish the system of examinations; verification of knowledge was to be carried out through collective educational sessions. The congress pointed out the necessity of introducing into the curricula of the higher medical school social sciences, social hygiene, eugenics, psychology, anthropology, medical expertise, school and military sanitation, occupational diseases, infectious diseases, physiotherapy, diseases of the ear, throat, and nose, physical chemistry, and elements of higher mathematics. However, the decisions of the congress did not receive further development. From the beginning of the 1922/23 academic year, certain changes were made to the curricula of the higher medical school: the teaching of social hygiene (in Moscow since 1920), diseases of the ear, throat, nose, and physiotherapy were introduced, while the teaching of pharmacy with pharmacognosy and mineralogy was excluded. Only in 1924, on the assignment of the State Academic Council, the Department of Medical Education of Glavprofobr developed regulations on the reform of higher medical education. The basic principles of restructuring were adopted by the State Academic Council in 1924 and formed the basis for constructing a new curriculum. This plan was discussed at the All-Russian Methodological Conference on Higher Medical Education convened in April 1925 and approved by the State Academic Council. According to the new curriculum, the period of study remained five years, with the academic year lengthened to 36 weeks (instead of 28–30); the number of lecture hours was significantly reduced and the number of hours for practical classes was increased: under the old curriculum, the number of lecture hours was 2¹/₂ times higher than the number of practical hours, whereas under the new plan, the number of lecture hours was two times less than the number of practical hours. Regarding the disciplines studied, a number of additions and changes were made to the new curriculum. Newly introduced were: dialectical materialism, Leninism, occupational hygiene, hygiene of upbringing, infectious diseases, physical and colloidal chemistry, military sciences, and foreign languages. Zoology and botany were excluded and general biology was introduced; the scope of morphological disciplines—anatomy and histology—was reduced; obstetrics and gynecology were combined into a single department, medical diagnostics and special pathology and therapy were merged into a single discipline—propedeutics of internal diseases, the department of surgical pathology with desmurgy was renamed the department of propedeutics of surgical diseases, the department of general pathology into the department of pathological physiology, bacteriology into microbiology, and general hygiene into experimental hygiene. Examination verification of knowledge was retained. Final examinations were established in 12 subjects: 8 clinical, pathological anatomy, pathological physiology, experimental hygiene, and social hygiene. The All-Russian Methodological Conference paid special attention to the issue of connecting the higher medical school with production. According to the resolution adopted by the conference, the connection of the higher medical school with production should enter the curriculum as an integral part of medical education; "all hospital, therapeutic-prophylactic, and sanitary institutions of public health bodies at the location of the higher medical school must be used as educational and auxiliary institutions, forming, together with the clinics and educational-auxiliary institutions of the higher medical school itself, a single network serving the practical tasks of protecting the health of the population." The conference also dwelt on the issue of linking the scientific work of the higher medical school with the tasks of public health: "The higher medical school must become a research headquarters for all public health work of a given region." The resolutions of the All-Russian Methodological Conference of 1925 were of great importance in the development of higher medical education in the USSR, since the curriculum adopted by it, unlike previous drafts that were largely of a study-cabinet character, was based on a number of years of practical experience of the Soviet higher medical school, met the requirements of Soviet public health at that stage, and, being the first completed and generalized curriculum, served as the basis upon which the further reorganization of higher medical education was built. The conference did not raise the issue of practical production training, as a result of which a major flaw remained in the system of higher medical education regarding the training of physicians—namely, the detachment of the higher medical school from the rural medical precinct. The maximum portion of those graduating from the higher medical school were immediately upon graduation sent to work in rural medical precincts, meanwhile the physicians leaving the walls of the higher medical school overwhelmingly did not know what a rural precinct was like, and did not know the labor and living conditions of the rural population among whom they were to work. The demands of the precinct were little taken into account by the higher medical school, there was no linkage of it with the precinct, and there was no living connection with production, on the basis of which the entire higher medical school should have been built. To correct this gap, a compulsory 2-month summer internship at a precinct was established starting in 1926 for students moving from the 4th to the 5th year, and from 1928 a second such internship was introduced for students moving from the 3rd to the 4th year. In the Ukrainian SSR in 1922, a sixth year of practical internship in one of the following groups was introduced for those completing the five-year period of study in the higher medical school: a) therapeutic medicine, b) protection of motherhood and infancy with two subgroups—maternal and infant welfare and pedagogical, c) sanitation and hygiene, d) bacteriology. Upon completion of the internship, everyone who completed the internship had to defend an independent work before a commission appointed by the Medical Institute, after which a medical diploma was issued. Starting from the 1923/24 academic year, curricula underwent significant revision: specialization in certain fields (tracks) was introduced. Four tracks were established: surgical, therapeutic, protection of motherhood and infancy, and sanitary-prophylactic. Specialization by tracks began from the 5th year of study, and the sixth year was spent in the manner of an internship on the principles indicated above. The tracks were abolished in 1928. Other union republics, when constructing the curricula of their higher medical schools, oriented themselves toward the guidelines in the RSFSR. The next most important stage in the reorganization of the system of higher medical education in all union republics was 1930, following the 16th Party Congress. "The period before the 16th Congress is a period of the general offensive of socialism along the entire front" (Stalin). The "general offensive of socialism" implied an offensive on the cultural sector of the front as well, in particular on such a sector of it as the training of personnel. "The problem of personnel has turned into our most vital problem" (Stalin). To resolve this problem, the higher school, including the medical school, had to be radically restructured.

This reorganization was carried out in accordance with the directives of the July 1928 Plenum of the Central Committee of the All-Union Communist Party (Bolsheviks) and especially the November 1929 Plenum of the Central Committee, as well as a number of government resolutions, aiming at specialization, turning higher education "face to production," and decisively renewing teaching methods and systems by introducing continuous production practice and active teaching methods. The reorganization of higher medical schools in accordance with the resolution of the Council of People's Commissars of the RSFSR of June 19, 1930, was carried out on the following principles: The target orientation of medical higher educational institutions became the training of physicians with a completed specialty in individual branches of health care, in accordance with which medical higher educational institutions are divided into faculties: a) therapeutic and prophylactic, b) sanitary and prophylactic, and c) faculty of mother, infant, and child care. The therapeutic and prophylactic faculty trains physicians in the specialties of therapy, surgery, dentistry; the sanitary and prophylactic faculty trains both general sanitary physicians and physicians in the specialties of epidemiology, housing and municipal, food, and sanitary-industrial; the faculty of mother, infant, and child care trains physicians in two sections: mother and infant care and child care. The periods of study were established as follows: for the specialties of therapy, surgery, mother, infant, and child care, 4 years; for the training of general sanitary physicians, 4 years; for narrow-specialty sanitary physicians and dentists, 3¹/₂ years. For those graduating in the specialties of therapy, surgery, and mother, infant, and child care, it is mandatory to undergo a year of practical medical training in medical institutions under the supervision of qualified medical personnel, after which graduates in the indicated specialties receive the right to independent medical practice. The reorganization of medical higher educational institutions was also carried out in other union republics. In the Ukrainian Soviet Socialist Republic, medical institutes, along with the indicated three faculties, had a fourth—dental. The reorganization of higher medical education in other union republics is carried out by creating two faculties—therapeutic-prophylactic and sanitary-prophylactic—with periods of study of 4¹/₂ years for the first and 4 years for the second, without subsequent mandatory practical internship. To this time belongs the resolution of the All-Russian Central Executive Committee of June 30, 1930, "On the transfer of clinics of medical higher educational institutions and faculties to the jurisdiction of local public health organs." Prior to that, some medical higher educational institutions relied entirely on independent clinics, others partially, and the clinics of still others were entirely housed in medical institutions of public health organs. Only some medical higher educational institutions of the RSFSR had independent clinics. In 1932–1933, significant changes were made to the new curricula*. Periods of study were increased again. At the therapeutic-prophylactic faculty, the mother and child care faculty, and the medical-physical culture faculty, the period of study was set at 5 years instead of 4; at the sanitary-hygienic faculty, 4 and 4¹/₂ years instead of 3 and 3¹/₂ years. Periods of study at evening faculties were increased from 3 to 4 years. Instead of the profiles of micro- and macro-pediatrician, a single profile of pediatrician was left; instead of two profiles—health station physician and industrial sanitation physician—a single profile of industrial sanitation physician was left; instead of general sanitary physician and epidemiologist, a single profile of sanitary physician-epidemiologist was left. The teaching of general scientific, general medical, and special disciplines was sharply increased. In 1934, additional changes were introduced into curricula and syllabi, expressed in an increase in the number of hours allocated to clinical and partially to theoretical disciplines, as seen in Table 1 (p. 669). At present, in connection with the resolution of the Council of People's Commissars of the USSR and the Central Committee of the All-Union Communist Party (Bolsheviks) of June 23, 1936, "On the work of higher educational institutions and the management of higher education," curricula are being revised anew on the basis of this resolution. Table 1. Disciplines | Number of hours allocated according to the 1932 plan | 1938 plan. Theoretical disciplines... 3,000 | ... General education disciplines... 1,748 | ... Production practice... 3,400 | ... Credit sessions and state exams... 2,300 | 600 390. The stormy growth of socialist construction during the first five-year plan was accompanied by a significant increase in the number of higher medical educational institutions and the student body, alongside a further growth in the proletarian composition of the student body. The number of medical higher educational institutions in the USSR grew from 25 units in 1928 to 55 units on January 1, 1936, and the number of students from 26.1 thousand people to 63 thousand people. The number of scientific teaching personnel also grew significantly, but nevertheless, the state of higher medical education lagged significantly behind the needs of the working masses and Soviet health care both quantitatively and qualitatively. The resolution of the Central Executive Committee of the USSR on the training of physicians dated September 3, 1934, stemming directly from the instructions of the leader of the peoples, comrade Stalin, on pulling medical institutes out of their backward state, noted that the work of training physicians as a result of weak leadership from the People's Commissariats of Health of the union republics was unsatisfactory: the general direction of teaching in the higher medical school and the profiles of specialists trained by it did not fully correspond to the actual demand for physicians from the city and the countryside. Due attention was not paid to the training of practicing physicians. The number of students admitted to sanitary-prophylactic faculties and faculties of mother and infant care was disproportionately large and higher than the specific weight of the need for these specialists in relation to the total number of physicians. Therapeutic-prophylactic faculties were overloaded with disciplines that had no direct bearing on clinical medicine. By virtue of this overload, as well as early and fractional specialization within the walls of medical higher educational institutions, the higher medical school, even after the transition to the five-year course, did not provide the proper volume of teaching of general medical disciplines forming the basis of medical knowledge and practical activity of future physicians. Proper attention was not paid to scientific work within medical higher educational institutions, which could not but affect the decline in the qualitative level of teaching work: medical higher educational institutions limited themselves exclusively to pedagogical work, which was reflected both in the cutting of appropriations for scientific work in medical higher educational institutions and in the insufficient equipment of higher educational institution scientific departments. The transfer of clinics of medical higher educational institutions to the jurisdiction of city health departments led to the fact that the clinics were brought down to the level of city hospitals, and their equipment became significantly worn out. The provision of students in medical higher educational institutions with textbooks was extremely unsatisfactory and quantitatively insufficient. For a number of years, highly valuable and classical manuals by Russian and foreign authors were not published. Despite the significant growth in the student body, capital investments in new construction and major repairs of higher educational institutions were insignificant. During the division of universities in the RSFSR, the material base of a number of medical institutes (Rostov, Tomsk, Saratov, Irkutsk) narrowed even further, since the buildings in which teaching of theoretical disciplines (physics, chemistry, etc.) was conducted passed to the pedagogical institutes of the People's Commissariat of Education. All this led to extreme overcrowding of medical higher educational institutions and congestion in student dormitories. Along with this, defects in the teaching methods themselves have not been eradicated. Despite the enormous responsibility resting on the practicing physician, the system of examinations and credits was not set up in such a way as to guarantee the necessary quality of physicians graduating from medical higher educational institutions. The resolution of the Central Executive Committee of the USSR of September 3, 1934, established enrollment quotas in higher medical educational institutions, the division of institutes into faculties, and the main ways to ensure an increase in the quality of physicians graduating from medical higher educational institutions. In all medical institutes of the USSR, therapeutic faculties were established for the training of practicing physicians with subdivision in the 5th year into therapeutic, surgical, and obstetrical-gynecological cycles. Faculties for the training of pediatricians were organized in 14 higher medical educational institutions: in the 1st Leningrad, 2nd Moscow, Voronezh, Kazan, Rostov, Saratov, Kharkov, Kiev, Odessa, Tomsk, Omsk, Ivanovo, Tiflis, and Tashkent institutes. Sanitary-hygienic faculties for the training of sanitary physicians, bacteriologists, epidemiologists, and food sanitation physicians are organized in 10 higher medical educational institutions: in the 2nd Leningrad, 1st Moscow, Rostov, Kazan, Voronezh, Tomsk, Baku, Kharkov, Kiev, and Odessa. The beginning of specialization in them is carried out only in the 5th year. A 5-year period of study is established in all the enumerated faculties. 75% of the student body in higher medical educational institutions as a whole across the Union is established for faculties of practicing physicians, 15% for faculties of pediatricians, and 10% for sanitary-hygienic physicians. The training of physicians through correspondence courses is prohibited.

It was deemed expedient to train practicing physicians and middle medical personnel without separation from production. Curricula and syllabi were revised based on the necessity: a) to strengthen the teaching of special medical disciplines as well as Latin by reducing general disciplines and eliminating excessive multi-subject load; b) to ensure sufficient military-sanitary training; c) to establish general theoretical training in the first five semesters across all faculties; d) to ensure general clinical training in the faculties of pediatric physicians to such an extent that physicians graduating from this faculty could perform the work of a general medical practitioner. For all students graduating from higher educational institutions, compulsory state examinations were established, conducted by special state examination commissions appointed by the People's Commissariats of Health of the union republics. In order to improve clinical teaching, from January 1, 1935, the clinics of the following higher medical educational institutions were taken onto the state budget and transferred to the full jurisdiction of medical institutes: the 1st Moscow, 1st Leningrad, Kazan, Saratov, Rostov, Tomsk, Perm, Irkutsk, Kharkov, Kiev, and Odessa institutes. Starting September 1, 1934, additional remuneration was established for all teaching personnel of the clinics for the scientific and therapeutic work they performed, in accordance with the rates for qualified specialists of city hospitals. Special remuneration was also established for senior and junior research staff of theoretical departments. By the same decree, student stipends were increased, as well as expenditures for research work and other needs of medical institutes. Additional allocations were released from the reserve fund of the Council of People's Commissars of the USSR in the amount of 5 million 740 thousand rubles. By a decree of the Council of People's Commissars of the USSR dated November 10, 1934, significant funds for linen were allocated to the clinics of medical institutes, and funds for paper to medical institutes for printing scientific works. Thus, already during 1934, significant steps were taken towards improving the material position of medical higher educational institutions. In 1935–1936, there was a further significant growth in allocations for medical higher educational institutions. The growth of capital investments across the USSR for the training of medical personnel increased from year to year. Thus, in 1933, 5 million rubles were allocated for these purposes, in 1934—17 million rubles, in 1935—52 million rubles, and in 1936—141 million rubles. The oldest medical institutes of the Union (the 1st Moscow Medical Institute, the 2nd Moscow Medical Institute, the 1st Leningrad, Kiev, Kharkov, and others) are being newly equipped and reconstructed through the addition of floors to clinical and theoretical buildings, the construction of new buildings, and the installation of new equipment representing the latest achievement of medical science and technology. New medical complexes are being built in Tbilisi (Tiflis), Baku, and other cities, and new academic buildings in Alma-Ata, Ivanovo, Arkhangelsk, etc. Management of higher medical schooling. By 1917, out of 13 higher medical educational institutions of the RSFSR, only the Military Medical Academy, the Petrograd Medical Institute, and the Psychoneurological Institute were independent medical educational institutions; the rest were incorporated as faculties within universities. The further deployment of higher medical schooling proceeded both along the lines of creating medical institutes and along the lines of organizing medical faculties. Until 1930, all medical higher educational institutions were under the jurisdiction of the People's Commissariats of Education of the respective union republics, excluding the Military Medical Academy, which for a short time (1919) was under the jurisdiction of the People's Commissariat of Education when it was renamed the Petrograd Medical Academy, after which it was transferred to the jurisdiction of the Main Military-Sanitary Administration. From 1920, a special department for the management of higher and secondary medical education was created within the Main Administration for Professional and Technical Education (Glavprofobr). Over the period from 1920 to 1922, the People's Commissariat of Health also had a relation to the management of medical higher educational institutions through so-called military commissars (military commissars). According to a decree of the Council of Labor and Defense in May 1920, medical higher educational institutions were to produce an early graduation of doctors. To monitor the implementation of this decree, the position of military commissar was established at each medical higher educational institution, appointed by the People's Commissariat of Health in agreement with the People's Commissariat of Education. At the end of 1920, militarization was extended to all years of study of medical higher educational institutions; military commissars became members of the presidiums of the boards of higher educational institutions with the right of a decisive vote on all issues of the life of the higher educational institution. All official documents of the medical higher educational institution were signed by the military commissar and the dean. The work of the military commissars was directed by a special Directorate of the People's Commissariat of Health, headed by the chief of military commissars. The institution of military commissars was called into life during the period of war communism by the task of strengthening Soviet leadership in higher educational institutions. In the absence of a significant stratum of communists among the student body and teaching staff and the hostility at that time of a significant portion of the professoriate towards the Soviet power, the institution of military commissars played a large positive role in the restructuring of the administration of higher educational institutions and the organization of the educational and economic life of medical higher educational institutions during this period. Military commissars at medical higher educational institutions also existed in Ukraine. The institution of military commissars in the RSFSR was abolished at the end of 1922, after which the participation of the People's Commissariat of Health in the management of medical higher educational institutions temporarily ended. The first basic regulation on the management of higher educational institutions of the RSFSR was approved by the Council of People's Commissars of the USSR on July 3, 1922, partially amended in July 1925 and January 1928. A radical change in the management system of higher educational institutions was carried out in 1930. According to the regulation that existed until 1930, the management of all scientific-educational and administrative-economic aspects of university life was carried out by the board under the general supervision and control of Glavprofobr. Direct management of the life of the medical faculty was entrusted to the dean's office. A major role in the life of higher educational institutions was played by subject commissions, which included all teachers of the respective disciplines and student representatives in a number equal to half the number of teachers. The conditions of the socialist reconstruction of the national economy demanded a radical reorganization of higher educational institutions, including medical ones, on the basis of their organizational and operational connection with the corresponding economic agencies while retaining methodological guidance for the People's Commissariat of Education. In accordance with these guidelines, the People's Commissariat of Education developed a new regulation on the management of higher educational institutions. According to this regulation, the management of a medical higher educational institution is carried out by the director. The director exercises leadership and management of the scientific-educational and administrative-economic work of the higher educational institution on the principles of one-man management and bears personal responsibility for the state of the higher educational institution entrusted to his management. To carry out the functions assigned to him, the director can organize temporarily and permanently operating meetings and commissions. Attached to the director are assistant directors directly subordinate to him for academic affairs, for administrative, financial, and economic affairs, and in the largest higher educational institutions, also for student affairs. At the head of each faculty stands the dean of the faculty, directly subordinate to the deputy director for academic affairs. When a faculty is divided into departments, the latter are headed by department heads appointed by the director, directly subordinate to the dean of the respective faculty. Educational-methodological commissions are established under the faculties' deans, as well as under the department heads, the resolutions of which come into force upon their approval by the dean of the faculty. An essential role is played by the institute councils, which include all professors of the higher educational institution. By a decree of the Central Executive Committee and the Council of People's Commissars of the USSR dated July 23, 1930, a reorganization of all higher educational institutions was carried out on the basis of a decisive rapprochement between theoretical training and production practice and specialization according to the industrial branch principle. Medical institutes and faculties, in accordance with the specified decree, were subject to transfer to the People's Commissariats of Health of the union republics. This transfer took place in July–August 1930, with medical faculties being separated into independent institutes. Under the People's Commissariat of Health of the RSFSR, the Ukrainian SSR, and a number of other union people's commissariats of health, the management of higher medical education is carried out through a special Directorate of Higher Medical Education. By a decree of the Central Executive Committee and the Council of People's Commissars of the USSR dated May 21, 1936, the All-Union Committee for Higher School Affairs under the Council of People's Commissars of the USSR was created, which is entrusted with the management of all higher educational institutions except military ones and those under the jurisdiction of the All-Union Committee for Arts Affairs. The All-Union Committee for Higher School Affairs is entrusted with: the approval of curricula and syllabi, the review of estimates for the maintenance of higher educational institutions, the approval of directors and teachers in the academic ranks of professors and docents, the establishment of admission quotas, and the review of the distribution plan for graduates of higher educational institutions. By a decree of the Council of People's Commissars of the USSR and the Central Committee of the All-Union Communist Party (Bolsheviks) dated June 23, 1936, it was established that people's commissars and heads of departments bear full personal responsibility for the state and work of higher educational institutions, with the administrations of higher educational institutions being subordinate directly to them. The latter decree establishes the rights and obligations of the directors of higher educational institutions as bearing full responsibility before the state for all management of the higher educational institution, for the organization of the educational process and research work, for the admission and training of students and their cultural and domestic services, for the selection, correct utilization, and training of scientific-pedagogical personnel in departments, etc.

Proceeding from the necessity of training highly qualified specialists in higher educational institutions who stand at the level of modern science, and in the interests of raising the authority of directors, the same decree established that only persons with a completed higher education and experience in scientific and pedagogical work may be directors of higher education institutions, and also determined the procedure for the appointment and dismissal of directors, which are carried out by the All-Union Committee on Higher Technical Education under the Council of People's Commissars of the USSR upon the presentation of the People's Commissars. The right to impose administrative penalties on directors of higher education institutions is granted only to the People's Commissar. The same decree determined the procedure for the approval and dismissal of deputy directors for scientific and academic affairs, deans of faculties, heads of departments, docents, and assistants. Teaching methods and academic regime. In the field of teaching methods, the Soviet higher medical school, like higher education in general, went through a whole series of quests and infatuations before finding that form which best corresponds to the tasks of higher medical education and the organization of academic life in higher education in the USSR. Teaching methods in the higher medical school are based on a combination of the collective organization of academic life (group) with the individual work of the student and individual control over academic performance; on the active assimilation by the student of the material being studied on the basis of independent study; on the connection between academic and practical work. In recent years, the seminar method has occupied a significant place in the higher medical school. The seminar method was practiced in various forms: a simple conversation between the teacher and the student group on a certain topic; a system of reports by individual students on a preliminary assignment given by the teacher to certain students or chosen by the teacher directly at the seminar with subsequent discussion of this report by the entire group; independent work of the group under the consultation of the teacher (laboratory method). In the practical application of the seminar method, a whole series of errors was permitted, especially before the decree of the Central Executive Committee of the USSR of October 19, 1932, "On Academic Curricula and Regime in Higher Education Institutions and Technicums," which pointed out the necessity of decisively eliminating all shortcomings by shifting the center of gravity to the individual work and individual responsibility of the student. The decree of the Council of People's Commissars of the USSR and the Central Committee of the All-Union Communist Party (Bolsheviks) of June 23, 1936, "On the Work of Higher Educational Institutions and on the Management of Higher Education," noted the most serious shortcomings in the teaching methodology and academic regime of higher education institutions and established a firm order for the organization of academic time and academic work. The decree notes that "the state of personnel training in higher education still remains unsatisfactory." The most serious shortcomings in the work of higher education institutions include: the multi-subject nature of curricula, excessive fragmentation and multiplicity of profiles, the presence in the organization of academic work of the so-called "brigade-laboratory" method of teaching, when group classes with insufficiently qualified teachers substitute for lectures, the lack of guidance for practical training, which should be an organic part of the entire educational process, the lack of stable textbooks and study guides, poor provision of higher education institutions with scientific and pedagogical personnel, laboratories, offices, etc. The decree indicates that "the Stakhanovite movement revealed a sharp lag of scientific and academic work in higher education institutions behind practice. From this stems the necessity of revising outdated programs, textbooks, reference books, encyclopedias, and technical manuals." To streamline the educational process, this decree establishes unified dates for the beginning and end of classes in higher education institutions from September 1 to June 30 with breaks for winter holidays from January 24 to February 6 and summer holidays from July 1 to August 31, and also establishes a fixed number of school days and hours per six-day week: for the 1st and 2nd years, no more than 30 hours; for the 3rd and 4th years, no more than 24 hours; and for the 5th year, no more than 18 hours. This makes it possible to allocate one free day in the six-day week (in addition to the day off) for students of the 3rd and 4th years for independent studies. All classes must be organized according to a fixed class schedule approved for the entire academic year and providing for the continuity of the educational process throughout the entire day. As a rule, the number of disciplines studied in a semester should not exceed six, and those studied daily should not exceed three. The previously practiced group classes for working through lecture material are liquidated, and the following forms of academic work with teachers are established: a) lectures given by professors and docents, b) practical exercises in clinics and laboratories conducted under the guidance of professors, docents, and assistants, and c) practical training. The center of attention is concentrated on the independent work of students. The activity of student scientific societies and scientific circles has been widely expanded. They are the center where a significant mass of students satisfies their special scientific interests, having the opportunity to begin research work. These circles contribute to the identification of future scientific personnel. By the decree of the Council of People's Commissars of the USSR and the Central Committee of the All-Union Communist Party (Bolsheviks) of June 23, 1936, the existing practice of current accounting of student academic performance is abolished, and the passing of examinations in lecture courses and credits in practical exercises after the course has been fully listened to is established as the sole criterion of academic performance. The right to administer examinations is granted only to professors and docents. In all higher educational institutions, a unified matriculation book is introduced, into which all compulsory subjects are entered, as well as records of passing credits and examinations. University students who have completed the full course of study pass state examinations (and in technical universities, diploma projects) in special state examination commissions appointed by the People's Commissar. The decree established a single period for passing state examinations from June 1 to June 30 and from October 1 to October 31. Two degrees of diplomas are established for those graduating from higher education institutions: a diploma of the first degree for those who graduated with "excellent" grades in ³/₄ of all subjects and "satisfactory" in all other subjects and who passed state examinations or defended diploma projects with an "excellent" grade, and a diploma of the second degree for all others. Persons who have received a diploma of the first degree enjoy a preferential right to fill vacant positions in work according to their specialty and in research institutions, as well as the right to be enrolled in graduate school (aspirantura) and to be included among candidates for scientific business trips. Practical training. Being an important link of the higher school reorganized on the basis of the decisions of the November Plenum of the Central Committee of the All-Union Communist Party (Bolsheviks) (1929), practical training has the purpose of ensuring the training of new personnel of specialists who, standing at the height of the latest achievements of science, "would be strong not only theoretically, but also in their practical experience, in their ties with production" (Stalin). A student sent to undergo continuous practical training in one or another institution of the health care system receives a workplace for the duration of the practice, performing the functions assigned to that workplace. However, over the past years, a number of excesses were permitted in the conduct of practical training, which led partly to the unproductive expenditure of time; for example, in the junior years, when students, not yet possessing medical knowledge, worked as orderlies, according to the plan of the 1931/32 academic year, continuous practical training occupied 2,688 hours, i.e., 47% of the entire study time. In 1933, the number of hours of practical training was reduced to 1,020, and the types of practice of the first two years, which had no connection with theoretical disciplines, were eliminated. According to the 1935 curriculum, 360 hours are allocated for practical training in the 4th and 5th years. Table 2. Movement of the number of students in 1934 (results for the USSR).* Number of medical universities that gave information... Number of students in them as of January 1, 1934... 48,376 Accepted for 1934... 20,006 Including in the 1st year... 18,980 Transferred from other educational institutions... 5,283 Departed without completing the full course... 7,619 Including the percentage of those transferred to other educational institutions... 20.0 Completed the course during the year... 3,015 | 63,031 Composition of students. In the struggle to win over the higher school, to create its own proletarian intelligentsia, it was naturally of paramount importance to staff higher educational institutions (including medical ones) with a worker-peasant composition. Already the first decrees of the Council... Table 3. Students by republics, krais, and oblasts as of October 1, 1935. Republics, krais, oblasts I. RSFSR... Northern Krai... Leningrad Oblast... Kalinin Oblast... Western Oblast... Moscow Oblast... Ivanovo-Industrial Oblast... Gorki Krai... Kirov Krai... Tatar ASSR... Kuibyshev Krai...

Saratov Krai (excluding the Volga German ASSR).............. Stalingrad Krai ......... Voronezh Oblast......... Kursk Oblast........... Azov-Black Sea Krai...... Dagestan ASSR..... . . . Crimean ASSR........... Bashkir ASSR.......... Sverdlovsk Oblast ......... Kazakh ASSR........... Omsk Oblast............ West Siberian Krai ....... East Siberian Krai (excluding Buryat-Mongolian ASSR)............ Far Eastern Krai........ II. Ukrainian SSR................... III. Belarusian SSR................... IV. Transcaucasian SFSR.................. Azerbaijani SSR........ Georgian SSR.............. Armenian SSR............ V. Uzbek SSR ............. VI. Turkmen SSR............ Number 79,934 50,418 9,055 1,415 9,497 1,451 1,307 607 2,133 1,596 2,092 1,102 1,959 3,717 601 1,103 3,632 707 1,850 2,463 19,790 2,674 6,511 2,309 2,732 1,124 of the Soviet government regarding admissions to higher education institutions indicated the priority of admitting those recommended by proletarian organizations. In accordance with the directives of the government * This and all subsequent tables are taken from the handbook of the Central Directorate of National Economic Accounting of the USSR State Planning Commission 'Cultural Construction of the USSR, 1935'. and the party, the percentage of workers and peasants among students in higher education institutions increased year by year, although in medical higher education institutions the social and party composition was weaker than in industrial-technical, agricultural, and socio-economic higher education institutions. Students are distributed by year of study in 1935 as follows: 1st year - 26,640, 2nd year - 15,790, 3rd year - 15,386, 4th year - 12,739, 5th year - 9,379, total - 79,934. The character of the social composition of students in the pre-revolutionary higher school is illustrated by the following data: at Moscow University in 1915 there were 11,184 students, of whom hereditary nobles numbered 946, sons of personal nobles and officials - 2,981, of the clergy - 1,042, sons of honorary citizens and merchants - 1,872, sons of petty bourgeois and guild artisans - 2,334, Cossacks - 95, peasants - 1,402, foreigners - 103, others - 409. In the interests of providing higher education institutions, including medical ones, with the maximum worker composition, the Council of People's Commissars of the USSR decreed, starting from the 1930/31 academic year, to reorganize existing rabfak departments according to educational branches into independent rabfaks attached to the corresponding higher education institutions. As of October 1, 1935, there were 78 rabfaks under the jurisdiction of the People's Commissariat of Health with a student population of 29,920. Table 4. Composition of students by sex, social origin, and party affiliation at the beginning of 1934 and 1935 in the USSR (in % of the total number of students). Composition Women in the total number of students ............. Workers in the total number of students ............. Members and candidate members of the All-Union Communist Party (Bolsheviks) . . Members and candidate members of the All-Union Leninist Young Communist League .

1935: 71.3, 37.1, 5.1, 25.3. For the national composition of students in medical higher education institutions, see Table 5. Admissions and graduations. The total number of medical students in the 1917/18 academic year was approximately equal to the pre-war number of students. For example, at Moscow University, the number of medical students in the 1913/14 academic year was 2,298; in 1917/18, it was 2,367; and it changed little in the following 1918/19 academic year, standing at 2,487. A decree issued by the Council of People's Commissars in the second half of 1918, which permitted admission to higher educational institutions of 'persons who had reached the age of 16, without presenting a diploma, certificate, or testimonies from a secondary or any other school,' caused a large influx of applicants into higher educational institutions (vuzes), particularly into higher medical schools. While the total number of students at the 1st Moscow State University was 8,682 in 1917/18, the number of students in the 1919/20 academic year rose to 26,921, of whom about 10,000 were medical students; at the Petrograd Medical Institute, the number of students rose from 2,065 in the 1917/18 academic year to 3,635 in the 1919/20 academic year. The shortage of premises and teachers, and a weak material base, made it impossible for higher education institutions to cope with the task of teaching such a number of students. From the 1920/21 academic year, the number of newly admitted students fell, and there was attrition among those previously admitted. In 1924, the total number of medical students across the entire USSR was 32,150, of which 24,714 were in the RSFSR; the latter figure decreased to 21,616 in the 1925/26 academic year, and to 18,865 in the 1926/27 academic year. The dynamics of the student bodies of medical higher education institutions are represented by the following figures. Number of students as of January 1 (in thousands): 1930—26.1; 1931—27.6; 1932—32.1; 1933—46.4; 1934—48.1. Student admissions in the USSR by years of the first five-year plan were (in thousands): 1928—5.2; 1929—5.9; 1930—8.4; 1931—14.4; 1932—25.2; 1933—13.3; 1932 as a percentage of 1928—484.6. Student admissions in thousands in 1934 were 18.18, and in 1935—25.18. The total number of students studying in medical higher education institutions as of January 1, 1936, was 74,800. Table 6. Admissions and graduations in medical higher education institutions for 1934 and 1935. Number of higher educational institutions and number of students as of January 1, 1934: number of educational institutions that submitted information—64, number of students (in thousands)—47.8, admission (in thousands)—18.7, graduation (in thousands)—2.3. As of January 1, 1935: 61.8, 25.6, 7.4. As of January 1, 1936: 75.4. The number of graduated physicians across all higher medical schools was 1,276 in 1913, and 1,531 in 1917. The number of graduating physicians began to rise from 1922, when 2,197 physicians graduated in the RSFSR, reaching a maximum of 5,529 in 1925. Subsequently, a decline began to 4,163 in 1928, 2,883 in 1929, and 2,700 in 1930. Further on, the graduation of physicians in the RSFSR was: 1931—5,478, 1932—2,265, 1933—2,678, 1934—1,650, 1935—5,247, 1936—4,734 (plan). The graduation of physicians by medical higher education institutions of the USSR is distributed as follows: 1928—6,200, 1929—4,000, 1930—4,400, 1931—6,500, 1932—4,100, 1933—4,300, 1934—2,468, 1935—7,444, 1936—8,750 persons (plan). The decree of the Council of People's Commissars of the USSR and the Central Committee of the All-Union Communist Party (Bolsheviks) dated June 23, 1936, 'On the work of higher educational institutions and on the leadership of higher education,' notes a number of serious shortcomings in the organization of admissions to higher education institutions: there are no unified, firmly established admission conditions, entrance examinations in higher education institutions are in most cases insufficiently organized, directors of higher education institutions often delegate the conduct of admissions to secondary personnel, etc. One of the most serious shortcomings in the organization of admissions noted by the latest decree is the lack of control over the general educational preparation of those admitted: in pursuit of fulfilling their plans, higher education institutions admitted poorly prepared, and sometimes even semi-literate and random people into their walls, which entailed significant attrition of those admitted and did not make it possible to raise teaching in higher education to the appropriate level. The social shifts that occurred in the country and the tremendous growth of culture, marking the great Stalinist era, made it possible to abolish the previously existing social restrictions for those entering higher education institutions. By the decree of the Council of People's Commissars of the USSR and the Central Committee of the All-Union Communist Party (Bolsheviks) of June 23, 1936, the following procedure for admission to all higher educational institutions, including medical ones, was established: a) All citizens of the Soviet Union of both sexes, aged 17 to 35, holding a certificate of completion of a full secondary school course, enjoy the right of admission to higher educational institutions and free tuition therein. b) The sole criterion for admission to a higher education institution is competition. All applicants to higher educational institutions are subject to entrance examinations in the Russian language, grammar, literature, political literacy, mathematics, physics, and chemistry. Applicants to agricultural, economic, construction, architectural, and art higher educational institutions are subject to additional tests. Starting in 1937, a test for applicants in one of the foreign languages (English, German, or French) is also introduced. c) Persons who have graduated from secondary school and have 'excellent' marks in core subjects, and 'good' marks in drawing, drafting, singing, music, and physical culture, are admitted to higher education without entrance examinations. d) In connection with the abolition of social restrictions, applicants to higher education institutions are required to present only the originals of the following documents: a certificate and a passport, presented in person. Persons liable for military service present a certificate regarding their attitude to military service. e) Unified admission deadlines have been established for all higher educational institutions of the USSR: submission of applications from June 20 to August 1, entrance tests from August 1 to 20, and enrollment as students from August 21 to 25. Admission outside these deadlines is prohibited to higher educational institutions. By the same decree, all people's commissariats were instructed to issue appropriate guidebooks on higher educational institutions and established the procedure for transfer from one higher educational institution to another, according to which transfer to similar educational institutions is permitted only before the start of the academic year, and to dissimilar ones only for students of the first two years, with the permission of the directors of both higher education institutions. These admission conditions are being implemented as early as 1936. Student provision. The material provision of the student body, which played a tremendous role in the proletarianization of higher education during the construction of a classless socialist society, ensures the realization of the right to education for working people proclaimed by the draft of the new constitution of the USSR. The draft constitution of the USSR states: 'Citizens of the USSR have the right to education.'

"This right is ensured by universal compulsory primary education, free education including higher education, a system of state stipends for the vast majority of students in higher education..." (Article 121). The amount of the stipend depends on the student's academic progress and financial need. In the upper years, the amount of the stipend increases. In 1931, the average stipend in medical institutes of the RSFSR was 57 rubles with coverage of 63% of all students, in 1933 it was 65 rubles with coverage of 75% of students, in 1934 it was 102 rubles with coverage of 78% of students, and in 1935 it was 176 rubles with coverage of 90% of students. For especially high-achieving students, the stipend was increased in 1935 to 201 rubles 50 kopecks. The average annual stipend was 915 rubles in 1934 and 1,362 rubles in 1935. In addition to stipends, students are provided with furnished dormitories for a very nominal fee. Across 30 medical higher educational institutions of the USSR, there were student dormitories with a living space of 93,213 m² for 21,759 people, which amounts to 4.3 m² per person. Dining halls were organized at the institutes for student meals. The cost of maintaining one student grows from year to year: in 1931, maintaining one student cost 1,029 rubles, in 1932—1,070 rubles, in 1933—1,447 rubles, in 1934—2,819 rubles, and in 1935—2,610 rubles. When calculating all expenses associated with student training, this cost increased in 1935 to 3,248 rubles. Teaching staff. Three main teaching positions are established in the higher educational institutions of the USSR: professor, docent, assistant. The number of professors in higher educational institutions is determined by the number of departments in the main disciplines. The main duties of a professor are: managing the work of the department, conducting general classes on the most important sections of the course, conducting introductory and concluding classes for the given course, as well as conducting group educational classes requiring particularly qualified guidance, independent research work, supervising the work of graduate students (aspirants) and residents, supervising the professional development of the teachers of the given department, and general management of educational and auxiliary institutions attached to the department. The main duties of a docent: conducting auxiliary courses that do not have a department; fulfilling, within the limits of the courses entrusted to them, the same duties assigned to a professor; conducting independent and special courses within the department; conducting practical classes; research work; acting for the professor during his absence. The main duties of an assistant (prosector): direct conduct of group classes; supervision, under the guidance of a professor or docent, of continuous practical production training; assisting the professor or docent in supervising the work of graduate students, promoted specialists, and residents; research work in their specialty. In clinics, there is an institution of residents, who are the closest assistants to the assistants in their work. The procedure for filling teaching positions is stipulated by the decree of the Council of People's Commissars of the USSR and the Central Committee of the All-Union Communist Party (Bolsheviks) dated June 23, 1936. Department heads are selected by competition and approved, upon the recommendation of the director of the higher educational institution, by the All-Union Committee for Higher School Affairs. The right to participate in the competition for department head is granted to persons holding the title of professor or the academic degree of Doctor of Sciences. Department docents are selected by competition and approved by the head of the administration of higher educational institutions of the People's Commissariat. The right to participate in库 the competition for a vacant docent position is granted to persons holding the title of docent or the degree of Candidate of Sciences. Department staff—assistants, research workers, laboratory assistants—are nominated personally by the professor-head of the department in agreement with the dean of the faculty and approved by the director of the higher educational institution. Along with the courses included in the normal curriculum, there are also optional (elective) courses in higher educational institutions. The lecturing of such courses may be entrusted both to members of the teaching staff of the higher educational institution and to persons not belonging to the teaching staff but possessing sufficient scientific training. Persons approved to teach optional courses are called privatdocents and are entered into the lists of scientific workers of the higher educational institution. The list of approved courses is reviewed at the end of the academic year to authorize the further teaching of the course or to terminate it. Across 35 medical institutes, there were: 1,117 professors, 969 docents, 3,702 assistants, and a total of 5,788 teachers. Graduate study (Aspirantura). The graduate study institute, established in 1925, was tasked with resolving the problem of training scientific workers and teachers for higher educational institutions and research institutes in accordance with the tasks of socialist construction. In the 1925/26 academic year, 1,279 graduate students were enrolled across all branches of education, in 1926/27—522, in 1927/28—582, in 1928/29—561, in 1929/30—974; for the same years in the medical education branch, 291, 71, 117, 118, and 123 graduate students were enrolled, totaling 720, which makes up 18.3% of the total number enrolled. The intake of 1925/26 yielded only 17.3% workers and peasants, and 11% party and Komsomol members. In 1928/29, graduate admissions already yielded 30% workers and peasants, and in 1929/30—63.4%; the party and Komsomol composition also increased significantly, rising in the 1928/29 intake to 34%, and in the 1929/30 intake to 43.7%. The composition of medical graduate students improved correspondingly: in 1926/27, the worker-peasant share was 23%, and the party-Komsomol share was 25%; in 1929/30, the corresponding figures rose to 54% and 55%. The autumn intake of 1930/31 in Moscow yielded 323 (64%) workers and peasants among the enrolled graduate students, 258 (51.2%) members of the All-Union Communist Party (Bolsheviks), and 69 (13.6%) members of the All-Union Leninist Young Communist League (Komsomol); according to data from six regions, the same autumn intake of 1,088 graduate students yielded 50.4% members of the All-Union Communist Party (Bolsheviks) and 17.2% members of the Komsomol among them. Of the medical graduate students enrolled in all years through the People's Commissariat of Education, their actual headcount as of April 1, 1930, was 358; as of March 1, 1931, there were 454 graduate student positions allocated to medical higher educational institutions. Starting in 1926, a graduate study institute was also established under the People's Commissariat of Health of the RSFSR for the purpose of training scientific workers for the institutes of public health agencies. Until 1930, the admission of graduate students for the institutes of the People's Commissariat of Health was limited to 40 graduate students per year. As of March 1, 1931, there were 310 graduate students registered in the scientific institutes of the People's Commissariat of Health of the RSFSR, and 392 in medical higher educational institutions. Their party and social composition is indicated in Table 8 (in %):

In 1935, 366 graduate students were admitted to the medical institutes of the RSFSR. As of January 1, 1936, 670 graduate students (292 men and 378 women) were studying in the medical and advanced training institutes of the RSFSR. Physicians under the age of 40 may be enrolled as graduate students, provided they have at least 3 years of medical practice experience; preference in enrollment is given to physicians with peripheral medical practice experience. Physicians who have just graduated from higher educational institutions may be enrolled as graduate students with special permission from the People's Commissariat of Health. According to the decree of the Council of People's Commissars of the RSFSR of June 19, 1930, all medical graduate training was transferred to the jurisdiction of the People's Commissariat of Health. In 1936, clinical graduate training was abolished, leaving only graduate training in theoretical departments. In clinics, the training of teachers and scientific workers is conducted through the residency institute. Budget of medical higher educational institutions. The budget of higher medical education is growing annually. The following funds were allocated for all medical education in the RSFSR: in 1934—89,193 thousand rubles, in 1935—222,000 thousand rubles, and in 1936—320,000 thousand rubles. At the same time, the budget of the clinics that are part of the medical institutes is also growing: in 1928/29, 3,720 thousand rubles were allocated for the maintenance of 9 clinics belonging to medical institutes (excluding the maintenance of medical personnel), whereas in 1935, 22 million rubles were allocated for these same clinics. The budget of higher medical education of the RSFSR consists of the following elements (in million rubles) (see Table 10). The budget of medical higher educational institutions for 1935 in the RSFSR is indicated in Table 11.

Table 10. Expenditures (in million rubles)

graduate students .......... Other types of material provision Total for material provision....... Other current expenses.......... Current expenses per 1 student based on the average annual enrollment: For all items.............. Ditto without scholarships........... B. Capital investments Total capital investments........ . . Including: New construction and additions..... Equipment . ............ Major repairs............ Of the total amount of expenses, covered at the expense of funds: Union, republican, and local budget............ Other sources.......... Total 37 515 45 309 36 505 147 932.0 114 392.0 34 223.3 6 037.9 12 571.3 4 222.2 48 166.6 1 628.1 4 953.2 54 767.9 2 563.4 2 618 1 256 33 590.0 26 305.0 1 160.0 6 125.0 147 983.0 Capital investments in medical education in the RSFSR: 1931 - 7.2 million rubles, 1932 - 14.7 million rubles, 1935 - 36.7 million rubles. Total capital investments in medical education in the USSR for 1936 - 141,550,000 rubles.

V. Bronner, A. Zhuk. V. Postgraduate medical training. Postgraduate medical training is one of the forms of medical education, a very broad concept encompassing the replenishment of a physician's knowledge at all stages of theoretical and practical work; this includes both self-improvement of the physician through the study of corresponding medical literature and the retraining of physicians who for some reason did not receive sufficient medical education in higher education (e.g., wartime physicians), the upgrading of a physician's qualifications, specialization in a particular branch of medicine, and finally the preparation of a physician for leadership and teaching work. Postgraduate medical training is of immense importance in supplying the country with qualified personnel, and its organization is currently one of the major tasks of public health. Despite this completely indisputable proposition, postgraduate medical training as a task of state public health is practically implemented only in the USSR, remaining to this day in all capitalist countries a private matter for the physician or, at best, of individual organizations. History of postgraduate medical training. Already in one of the Hindu medical books it is said: «Verily, medicine cannot be learned, and he cannot be considered a physician who does not study it anew every day,» and thus already in deep antiquity physicians clearly realized that the constant forward movement of medical science requires constant improvement from the physician. This improvement, from ancient times and almost until our era, was carried out, apart from the study of medical literature, by visiting famous physicians and medical schools of one's own or other countries. The greatest physicians of all times (Hippocrates, Paracelsus) replenished their knowledge by frequent travels to distant countries famous for their physicians. The first medical school was founded in Memphis—the birthplace of ancient Egyptian philosophy—then in Croton, in Lower Italy—the birthplace of Pythagoras—and finally on the islands of the Asia Minor coast, where the Asclepiads in Cnidus and Cos founded famous ancient Greek medical schools; in the 3rd century, such a school for physicians was the Alexandrian; in the 12th century, the school in Salerno (Southern Italy) and in the 13th and 14th centuries in Montpellier; later in Bologna, Padua, and Paris, medical centers were formed that attracted physicians of all countries and exerted a tremendous influence both on the postgraduate training of physicians and on the development of medicine, for example in Holland, Switzerland, and England. In the 19th century, the medical centers that attracted physicians for postgraduate training were at first Paris and Vienna, and later Germany, thanks to the enormous progress of its medical faculties, especially in Berlin and Munich, became the country where physicians from all over the world flocked to replenish their knowledge. After the war of 1914–1918, America became such a country. However, in all these medical centers, postgraduate medical training never constituted any separate organization; it was carried out by the same higher medical school where teaching of medicine to students took place. Every physician interested in this or that branch of medical knowledge sought opportunities, besides attending student lectures, to work in a clinic, laboratory, or museum under the guidance of authorities who had gained worldwide fame in this field or their assistants, and ultimately, until the early 20th century, the matter of postgraduate medical training remained everywhere a private matter of both the physician himself and his supervisor. In the 20th century, postgraduate medical training in Western Europe and in the USSR proceeded along two completely different paths. Postgraduate medical training in Western Europe. Having taken shape historically from the individual desire of each physician to replenish his knowledge, raise his qualifications, or acquire special knowledge, postgraduate medical training in Western Europe and America is nowhere a subject of state concern. Physicians of a given country or other states seeking postgraduate training, personally or at best on behalf of individual institutions (universities, scientific institutes), after preliminary correspondence, are directed to this or that representative of a medical discipline and study the question of interest to them for a certain time under his personal guidance. Setting out on such a scientific business trip, the physician is essentially not bound even to this or that institution and works according to a plan developed for himself ad hoc, and his success depends entirely on the supervisor's personal attitude toward him. In some cases, this guidance is completely free of charge as part of the traditional scientific connection of individual institutions operating in a given field (laboratories, clinics); in others, the remuneration of the professor and his assistants was conditioned by a personal agreement with the physician, which sometimes bore the character of a commercial transaction, which is why, especially in certain specialties, it was often accessible only to affluent physicians. This circumstance and the unhealthy competition that arose on this soil in connection with the significantly increased influx of physicians for postgraduate training, who flocked at one time especially to Germany in connection with the development of transport routes, economic and trade relations of Central Europe with other distant states, put forward precisely in Germany the question of regulating the matter of postgraduate medical training, and since state institutions did not deal with this matter at all, the organization of postgraduate training arose by way of private initiative. Thus, in a number of individual cities in Germany at the very end of the 1890s, local committees for the postgraduate training of physicians arose from among professors and teachers of medicine, and in Munich for the first time in 1902, courses for the postgraduate training of physicians were announced (Moritz). To this same time belong a number of attempts to create such courses in other university centers of Germany as well. Already in 1901, the Central Committee for the Cause of Postgraduate Medical Training in Prussia (Zentralkomitee für das ärztliche Fortbildung in Preußen) was organized in Berlin, uniting 34 local committees. Similar committees unite the work of postgraduate medical training in Bavaria, Saxony—where as early as 1816 a special Surgical-Medical Academy for the Postgraduate Training of Physicians existed in Dresden—in Württemberg, where as early as 1832 a medical society organized periodic scientific reports, in Thuringia (courses in Jena in 1883), in Hamburg, and other cities. Thus, even at present, Germany still does not have an organization uniting the work of postgraduate medical training in the entire country, despite the fact that Germany precisely for more than 50 years was one of the main countries attracting physicians of the entire world for postgraduate training. The work of postgraduate medical training is even less organized in other European countries. But even 25 years after the founding of the Central Committee for Postgraduate Medical Training in Germany, this work cannot be considered satisfactorily established. Postgraduate courses pass a relatively small number of physicians, mostly foreigners, since they are primarily fee-based and require significant material and professional sacrifices from physician-listeners. Scientific business trips at the expense of the state and institutions are granted only to military and individual communal physicians. How weakly the interest of the ruling circles in the postgraduate training of physicians and its Central Committee in Prussia is expressed is evident from the mere fact that out of 31 thousand German marks making up the annual budget of this organization, the Ministry of Public Welfare allocates a mere 8 thousand to the committee, while the rest is made up of deductions contributed by listeners and teachers. Germany has no special institutes for the postgraduate training of physicians. Attempts to organize such institutes where there are no universities, but there are sufficient scientific forces and a powerful clinical base, ended in failure; in Cologne, a university grew out of such an institution; the Medical Academy founded for this purpose in Düsseldorf became a higher medical school for students who had already completed the first 4 semesters and has in its charter only the task of training specialists and organizing courses for general practitioners. Thus, in Germany, in the absence of a special institution for postgraduate medical training, this work is carried out by a whole series of organizations not united by definite plans and tasks. Thus, in Berlin alone, postgraduate medical training is practically carried out by the teaching staff of the medical faculty, the special House of Medical Postgraduate Training (Das Kaiserin-Friedrich-Haus für ärztliche Fortbildung), which organizes periodic courses for physicians, and finally by a special association of teachers (Dozentenverein)—a powerful organization of the best medical forces of Berlin, having permanent courses for physicians during the academic semester and arranging 4-week courses in all specialties during the vacation time. In addition to all these more or less permanent and organized courses in university cities in Germany, there is also a very large number of special courses in individual institutes, large hospitals, health resorts, etc. These include, for example, courses on tropical diseases at the special institute in Hamburg, courses on tuberculosis, physiotherapy, radiology, and a whole series of individual special issues and disciplines.

All courses are paid for by the listeners in various amounts from 20 to 100 German marks per course, and individual courses with a very limited number of listeners are paid for especially highly. Thus, the listener's expenses for paying for their advanced training depend entirely on the number of courses they have signed up for and on the practical work they consider it necessary to carry out for themselves. Short-term vacation courses (Ferienkurse), lasting 5-10 days, are reduced to cycles of lectures, paid for at 75 to 100 German marks per cycle. The lack of special institutions for advanced training and of teaching plans united by a specific goal makes it impossible to coordinate the numerous and very diverse courses with one another. The methodology of teaching physicians remained completely undeveloped in Germany, despite the fact that many thousands of physicians passed through these courses and that each of them individually undoubtedly received a significant improvement in their qualifications. There is also no record of the teachers' experience, detailed course programs, or reports that could serve as a basis for creating a curriculum for the advanced training of physicians. Over recent years of the fascist regime, Germany gradually lost its significance as a former center for the advanced training of physicians. The expulsion of the best professors and the intrusive preaching of obscurantist racial theories repelled the vast masses of physicians who had previously flocked to Germany to improve their qualifications. In general, courses for the advanced training of physicians in Germany reflect the state of this matter in other countries of Europe and America as a matter whose task is to satisfy the private interests of the individual physician and which is in no way connected with the planned development of public health in the country. Advanced training of physicians in pre-revolutionary Russia. The advanced training of physicians in our country followed completely different paths. Here, two periods must be sharply distinguished: before and after the October Revolution. It must not be forgotten that only 70 years ago, upon returning from a foreign scientific business trip, Zakharyin and Botkin laid the foundation for the scientific approach to clinical medicine in Russia. At the end of the 19th century and especially in the first years of the 20th century, right up to the beginning of the imperialist war, a significant number of Russian physicians received their scientific qualifications and especially special knowledge abroad, either through scientific missions by universities or by way of personal, private initiative. Individual physicians, just as in other countries, went in a completely private capacity to university laboratories and clinics and received a significant increase in knowledge there, especially frequently engaging in scientific work on specific topics (dissertation works). To the credit of Russians, it must be said that cases of paying scientific supervisors for teaching physicians were completely unknown in Russia. In contrast to German and French ones, Russian medical faculties never took an active part in organizing the advanced training of physicians. Instead, it was precisely in Russia, in Petersburg, that a special institution for the advanced training of physicians was organized. Conceived back in 1870 by Professor E. Eikhvald, who suggested that Grand Duchess Elena Pavlovna transform the Maximilian Medical Clinic and the Cross of Exaltation Community into an institution for the advanced training of physicians, the Clinical Institute was opened only on May 21, 1885, and was built partly with state and partly with charitable funds, receiving the name of the «Imperial Clinical Institute of Grand Duchess Elena Pavlovna». The Clinical Institute was met very skeptically by authoritative scientists in medical circles of that time and was created with no small amount of friction thanks to the special energy of the professors, with E. E. Eikhvald at their head. Even in the report dedicated to the 25th anniversary of this institute's activity, notes glimmer that bear witness to the necessity even then of having weighty proof of «the reasonableness of the organization of educational activity in the institute and its viability». During the first 25 years of its existence, the Clinical Institute passed through a total of 7,786 listeners, and if in 1885/86 the number of Zemsky physicians made up 8.7% of all listeners, by the 1909/10 academic year already up to 48.6% of them had passed through it. The institute had two semesters a year, passing 200-250 physicians per semester. During the imperialist and civil wars, the educational activity of the institute ceased altogether. The institute's budget in 1886 was 74,016 rubles, in 1909 it reached 193,105 rubles, with the greater part of it consisting of state subsidies. Despite its modest funds and its semi-charitable and patronizing character, the Clinical Institute played a definite role in the advanced training of physicians, and the increase in the number of Zemsky physicians sent to the institute on scholarships best testified to the usefulness of the courses organized by the institute. A number of Zemstvos applied to the Ministry of Public Education with a request to open similar courses at universities, but these petitions remained unfulfilled. Despite all its enormous work on the advanced training of physicians, the Clinical Institute named after Elena Pavlovna—created by a whole constellation of major and brilliant scientists and their assistants—nevertheless left no traces of methodological work on teaching physicians or curricula, and the numerous printed reports of the institute contain only a listing of an extremely large number of courses and practical exercises for physicians.

R. Luria. Advanced training of physicians in the USSR. The advanced training of physicians in the USSR, whose task is to equip the physician with the latest achievements of medical science and technology, raising his qualifications in the interests of the best medical and sanitary service for the working people and maximum assistance to successful socialist construction, is currently carried out on the following principles: it is organized by the state according to a definite plan at the expense of budget funds; those sent on assignment to courses are provided with a stipend and a dormitory and retain their received salary at their places of service for the entire duration of the assignment. The upgrading of physicians' qualifications is carried out in various ways: by attachment to various medical and sanitary institutions and research institutes for definite periods, through the institute of interns, externs, postgraduate students, and through specially organized courses of specialization and advanced training. By advanced training of physicians is meant the raising of qualifications of physicians who already have a definite specialty, while by specialization is meant the training of physicians who do not have a sharply defined specialty, or the training of specialist physicians in any additional or related specialty. Courses of specialization and advanced training are conducted in those centers where there are medical institutes, in clinics, and in other cities at large medical and sanitary institutions provided with qualified specialists and the necessary equipment for educational purposes. Such courses locally are organized at the expense of special allocations for this purpose by the People's Commissariat of Health and allocations from the local budget. Local medical and sanitary institutions are of particularly important significance for the specialization of physicians; in them, under the constant systematic guidance of qualified specialists, the possibility of practical training of specialists is achieved. Even a number of district and precinct hospitals, where qualified specialists and the necessary equipment are available, are also used for the specialization of physicians by attaching physicians for a definite period for training. In the future, the role of local medical institutions must be further increased in connection with the impending expansion of the work of physician specialization and the concentration in the largest institutes for advanced training predominantly of the advanced training of physicians, leaving in them specialization only in separate narrow medical specialties for which there is an insufficient number of strong bases on the periphery, for example, in urology, radiology, physiotherapy, otolaryngology, etc., and in separate sections of the corresponding disciplines, e.g., in neurosurgery, traumatology, orthopedics, etc., as well as specialization in sanitary and hygienic disciplines—communal, nutritional, industrial, school hygiene and sanitation, microbiology, malariology, etc. Institutes for advanced training of physicians. In the work of raising the qualifications of physicians, institutes for advanced training of physicians play a major role, of which there are currently 4 in the RSFSR: in Moscow—the Central Institute for Advanced Training, in Leningrad, in Kazan, in Novosibirsk; in the Ukrainian SSR—also 4: in Kharkov, in Kiev, Odessa, and Dnepropetrovsk; in the Belorussian SSR—in Minsk; in the Uzbek SSR—in Tashkent; in the Georgian SSR—in Tbilisi (Tiflis). The Moscow Central Institute for Advanced Training of Physicians, organized in 1931, conducted from 1931 to January 1, 1936: through 3-5-month courses—9,900 physicians, practical workplaces—1,107, courses without work interruption in Moscow—2,652, field courses in Moscow Oblast—2,111, decadal courses—1,721, total—17,857 physicians. The Leningrad Institute for Advanced Training of Physicians, organized in 1885, conducted over 30 years, from 1886 to 1917, through advanced training courses 9,903, and over the last 10 years from 1924 to 1934—19,196 physicians. For 1930 it passed 1,803 persons, for 1931—1,895 persons, for 1932—2,184 persons, for 1933—2,324 persons, for 1934—2,491 persons, and in addition through short-term courses—decadal courses for 1933–1934—844 persons. The Central Institute for Advanced Training in Moscow consists of 5 faculties uniting about 60 departments: therapeutic faculty, surgical, pediatric, sanitary-hygienic, and the faculty of sanitary defense. All institutes for advanced training of physicians conduct extensive research work in their departments, have postgraduate students and interns. Institutes for advanced training have the right to confer academic degrees in all clinical and sanitary-hygienic disciplines. All institutes for advanced training have departments in all clinical and sanitary disciplines and a whole series of theoretical departments, e.g., in pathological anatomy, in pathological physiology, biochemistry, etc., and unlike medical institutes, institutes for advanced training also establish departments in separate special branches of medicine and its narrow sections, such as (in Moscow) in endocrinology, radiology, urology, physiotherapy, dietetics, emergency surgery, traumatology and orthopedics, surgical tuberculosis, maxillofacial surgery, oncology, neurosurgery, balneology, occupational diseases, etc. Even basic clinics, such as therapeutic and surgical, can be differentiated in institutes for advanced training of physicians, e.g., clinic of gastrointestinal tract diseases, clinic of cardiovascular system diseases, etc. Institutes for advanced training have their own clinics as well (e.g., Kazan—400 beds, Leningrad—300, etc.) and utilize the largest and best-equipped municipal medical institutions in which they deploy their clinics. In view of the fact that institutes for advanced training of physicians require a large number of beds, even with their own clinics they are forced to deploy a number of departments in municipal hospitals. In this case, on the basis of a special agreement, the heads of departments are simultaneously for the most part also the heads of the corresponding hospital departments in which the departments they head are located. Department heads are granted the right to allocate a certain percentage of the established number of beds for teaching needs. In hospital departments serving as research and educational bases for institutes for advanced training, a clinical regime is usually established. Institutes for advanced training utilize for training physicians in sanitary and hygienic disciplines—communal, industrial, nutritional, and school hygiene, epidemiology, and microbiology—corresponding sanitary institutions and research institutes; in Moscow, for example, the Erisman Institute of Communal Hygiene and Sanitation, the Institute of Nutrition, the Mechnikov Institute of Microbiology are bases of the Central Institute for Advanced Training, upon which the corresponding departments are deployed and teaching is conducted. Likewise, research institutes in clinical disciplines serve as the same research and educational bases for institutes for advanced training of physicians, such as the State Institute of Physiotherapy, the Institute of Endocrinology, the State Central Institute for the Protection of Motherhood and Infancy, the Sklifosovsky Institute in Moscow, the Ott Institute of Obstetrics and Gynecology and the Institute for the Protection of Motherhood and Infancy in Leningrad, etc. In the institutes for advanced training of physicians, work is currently underway on the advanced training and specialization of physicians, with the Moscow Central Institute for Advanced Training, the Leningrad and the Kharkov All-Ukrainian institutes devoting primary attention to the advanced training of the physician, while specialization is carried out in narrow and scarce specialties. Advanced training and specialization are carried out for the most part according to the so-called cycle system in the form of courses in a definite specialty—therapists, surgeons, ophthalmologists, obstetrician-gynecologists, etc., of varying duration, mostly 2–4 months for advanced training and 4–6 months for specialization, with 4–6-month specialization courses providing only basic information, the most important practical skills, and the ability to navigate the main problems in the given specialty—initial specialization, which should be followed by further study of the given specialty in the order of work on-site in the corresponding medical and sanitary institutions. Advanced training pursues the task of introducing the specialist physician to the latest achievements in the given field of medical science, acquainting him not only with all that is new in the theory of the given question, but also with new methods of diagnostics, therapy, and for the sanitary physician—with the latest methodology of sanitary and hygienic research in the given field of sanitation and hygiene. The curriculum of advanced training courses is usually constructed in such a way that it provides mostly selected chapters on the given specialty (Moscow Institute), or if it is given in the form of a systematic course (Leningrad Institute), the latter is also presented taking into account the degree of preparedness of the trainees, their special inquiries, and paying special attention to the latest achievements in separate areas of medical science and to separate selected chapters.

On advanced training courses, unlike specialization courses, more time is devoted to the theoretical lecture part, about 40-50% of the number of hours, and to the practical part—60-50% of the total study time, since these courses are attended by physicians who usually already have considerable practical training and need not only to familiarize themselves with new diagnostic and therapeutic methods (and sanitary physicians—with the newest methods of sanitary and hygienic research), but also with the theoretical exposition of the basic problems and topical issues of the given discipline. In order to satisfy the individual requests and interests of the arriving physicians, in addition to the subjects mandatory under the curriculum, a number of elective subjects are provided, for which lectures are given and practical classes are conducted for those wishing to attend elective courses. Advanced training of district physicians. Throughout the entire system of upgrading the qualifications of physicians in the USSR, special attention is focused on the specialization and advanced training of rural district physicians. Advanced training courses for district physicians are designed for physicians who have spent at least 3 years in district work, and the curriculum of these courses is structured so as to provide the dispatched physicians with the opportunity to study a specific branch of medicine, taking into account the specific requirements of district work and, at the same time, to familiarize themselves with a number of issues in related specialties and those in which they have to provide medical assistance due to local conditions. At the present time, both in the RSFSR and in the Ukrainian SSR, all curricula and programs of specialization and advanced training courses are being unified with regard to the duration of the courses, the composition of the basic and related, allied disciplines and theoretical subjects taught on the courses (pathological physiology, pathological anatomy, biochemistry, etc.), the ratio of lecture hours to practical classes, and the nature of the latter (supervision of patients, laboratory work, conferences-colloquiums, practical work of sanitary physician-trainees under the guidance of the respective district sanitary physicians at the locations of the courses: at factory enterprises—on industrial sanitation, at food enterprises—on food hygiene, at communal enterprises—on communal hygiene, etc.). Unified curricula also provide for the inclusion of subjects related to the sanitary defense of the country. The duration of the school day is set at 6 hours in order to give physicians the opportunity to attend elective courses and work through the necessary material at home. The verification of assimilation and knowledge is carried out during the course upon the completion of individual sections and upon the completion of the entire course. Those who complete the course are issued a certificate with a note on the auditing of the courses and the practical work completed, along with an assessment of academic performance. Production meetings, usually organized at each cycle with the participation of teachers, discuss all issues of a programmatic and methodological nature, the order of classes, the degree of implementation of the curriculum, necessary changes in the curriculum in accordance with the requests of the trainees, etc. Consultation bureaus exist under the institutes for the advanced training of physicians, providing practical assistance to peripheral physicians in resolving questions and doubts arising in connection with their practical and scientific activities. Upon completion of the courses, the physician can maintain contact with the institute through the consultation bureau for their further advanced training. In addition to courses for group training of trainees, advanced training institutes organize training through individual assignment for various periods to their departments in the order of so-called "workplaces" for those physicians who wish to improve their qualifications in some branch of medicine outside the general cycle in the given specialty. The curriculum for "workplaces" and the schedule of classes are drawn up for each physician separately, in accordance with the requests and interests of the physician. Assignment to "workplaces" is made by health departments or other commissariats and organizations under whose jurisdiction the physicians are. Institutions and organizations not belonging to the system of health care bodies cover the expenses associated with the training of the physicians sent by them and with their material and living services. The recruitment of courses is carried out in such a way that the People's Commissariats of Health approve the corresponding course plans for all advanced training institutes, both central and peripheral, and the corresponding distribution of vacancies in the courses is carried out among all the People's Commissariats of Health of the autonomous republics and regional health departments in agreement with them. In accordance with the distribution, the advanced training institutes send out travel certificates to the localities, which serve as a document for enrollment in the courses. Assignment to advanced training courses with leave from production is carried out on the basis of a special resolution of the Council of People's Commissars of the Union Republics: in the RSFSR—on the basis of the resolution of the Council of People's Commissars of the RSFSR on scientific assignments of physicians dated March 26, 1927 (Bull. NKZ RSFSR, No. 8, 1927), which provides for the issuance of stipends to those assigned, the retention of an apartment with public utilities for the assigned person and their family for the entire duration of the assignment and the salary actually received by them at their place of work, the coverage of travel expenses to the courses and back, and the obligation for the physician to serve for 1 year for an assignment lasting no more than 6 months and two years for an assignment of more than 6 months. According to the instructions of the People's Commissariat of Health, the People's Commissariat of Labor, and the All-Union Central Council of Trade Unions dated March 26, 1927 (Bull. NKZ RSFSR, No. 11, 1927), district physicians are sent as a first priority to stipend positions in state institutes for the advanced training of physicians. According to the resolution of the Central Executive Committee of the USSR dated September 3, 1934, on the training of physicians (Izvestia TsIK SSSR dated September 4, 1934, No. 208), rural physicians and physicians in remote areas are mandatory granted assignments once every three years to courses at advanced training institutes with the provision of a stipend, a dormitory, and the retention of the salary for the position held. According to § 4 of this resolution, the specialization of physicians in individual branches of medicine (obstetrics, gynecology, eye diseases, diseases of the ear, throat, and nose, etc.), as well as the advanced training of working physicians, must be carried out through serving an internship as interns or residents in the clinics of advanced training institutes and in medical institutions in accordance with lists approved by the People's Commissariat of Health of the union republics, and, moreover, through "the completion by urban physicians of practical courses in a specialty without leaving production at advanced training institutes, medical institutes, and large hospitals." These courses function in Moscow, where they are organized by the Central Institute for Advanced Training, as well as in Leningrad, Kazan, and other centers—on the basis of advanced training institutes, medical institutes, and other corresponding medical and sanitary institutions. The curricula of these courses are structured in such a way that classes for physicians working in the morning hours are conducted in the evening, and for those working in the evenings, classes are organized in the mornings, usually 2-3 times per 6-day week, with the duration of classes averaging 3 hours each. These courses, having enormous significance for upgrading the qualifications of urban physicians, have developed to such an extent that, for example, the Moscow Institute for Advanced Training passes over 1,000 physicians of the city of Moscow per year through various courses without leaving production, using for this not only its permanent clinical and sanitary bases, but also a number of auxiliary bases on which corresponding departments are established. Special curricula and programs are drawn up for urban courses without leaving production. In recent years, 3 more types of advanced training for physicians have developed—short-term courses, traveling courses, and the correspondence form of advanced training. Short-term courses are organized in the form of 10-24-day courses with leave from production on various selected topics and on narrow issues of medical theory and practice. These courses are intended for qualified specialists, teachers of medical higher educational institutions, scientific and practical workers of medical and sanitary institutions and research institutes who wish to familiarize themselves with the newest achievements in the field of medicine of interest to them. Such thematic courses are conducted with enormous success by the Moscow and Leningrad Institutes for Advanced Training of Physicians, with the involvement in these courses of prominent scientists and major specialist professors from other centers of the USSR. Unlike the short-term courses widely practiced abroad, mostly in individual clinics and hospitals, organized by professors and docents for a special fee paid by the listeners, thematic courses in the USSR are organized according to a definite plan for the corresponding categories of physicians, predominantly in the form of a complex of issues related to the given specialty. Separate decadal courses are also held on the fundamental problems of theoretical medicine—in Moscow, Leningrad, Kharkov, and Kiev. Conference-courses organized by a number of scientific institutes closely adjoin these courses in their character.

Scientific conferences, congresses, meetings of medical societies at which scientific papers are presented, and the entire scientific medical press play a major role in raising the qualifications of physicians. In district centers where qualified physicians are available, 1- to 2-day scientific conferences are also convened for the physicians of the district, to which specialists from large urban and regional centers of nearby locations come with scientific papers. In the system of advanced training for physicians over the past few years, a new form has begun to develop: visiting courses. These courses are built mainly on a cycle system. Professors and assistant professors usually go out once a month for 2 days, and since several professors and assistant professors participate in these courses, each has to go out once a month. These courses are also conducted according to a fixed curriculum and a special program. Part of the classes is conducted by local qualified specialists under the general guidance of the corresponding department. In recent years, the correspondence system of advanced training for physicians has begun to develop. At the present time, it is organized on the basis of combining correspondence education with "resident" sessions in certain specialties: in therapy, tuberculosis, infectious diseases with epidemiology and disinfection, in obstetrics for rural physicians, in diseases of early childhood, in industrial sanitation, and in food sanitation. The duration of correspondence education is 8-10 months; business trips for the "resident" course-sessions following correspondence preparation at institutes for advanced training of physicians or medical institutes or corresponding research institutes are given for a period of 1 to 1¹/₂ months, during which main attention is paid to practical classes (study of research methodology, acquisition of practical skills, etc.). The correspondence part of the course is completed according to certain manuals published specifically for this purpose and according to manuals with appropriate methodological instructions for working through the special tasks and works given to correspondence students, which are reviewed by departments and specially invited instructors. All management of the matter of correspondence advanced training of physicians for the RSFSR is concentrated in the Moscow Central Institute for Advanced Training of Physicians, which relies in its work on a number of departments, clinics, scientific institutes in Moscow and on the periphery, where such "resident" sessions are held. Correspondence physicians are provided with systematic consultation on all questions that arise for them. A large role in raising the qualifications of peripheral physicians is played by lectures broadcast on the radio from centers where there are medical institutes and research institutes on various topics that are particularly relevant for physicians of the districts, on pre-established days and hours. Particular note should be made of the work on raising the qualifications of healthcare organizers, chief physicians of hospitals, sanatoriums, and the like. This work is also carried out in institutes for advanced training and in regional and oblast centers. In the matter of advanced training of physicians in the USSR, there are significant achievements. The successes of socialist construction and the enormous growth of public healthcare ensure a further powerful growth in the matter of advanced training of physicians for the benefit of the broad working masses. D. Gorphin. VI. Secondary Medical Education. The first secondary medical workers who arrived in Russia were Englishmen who arrived to serve at the court of Ivan the Terrible in 1581 with Dr. Jacobi, sent by the English Queen Elizabeth. In 1682, the first attempt at school training of physician's apprentices was made. The first schools for training physicians were opened in Russia under Peter I simultaneously with the opening of hospitals and the reform of the entire medical business in Russia. In the schools, along with the training of physicians, they began to train junior physicians (1740), recruiting soldier's children who could read and write, so that they would "practice in supervising patients" and learn the junior physician's art, after which they were sent to the army by regiments and companies; essentially speaking, these were company feldshers. They were paid very poorly, only 6 rubles a year with rations and a daily jigger of vodka and a mug of beer. Their training was simple and short-lived. In 1780, the physician schools were reorganized into three higher medical schools following the type of Western European schools. After the removal of the training of physicians from the hospitals, the training of junior physicians continued in the hospitals until 1829, when by order of the Public Charity, a regulation was issued on schools for the education of feldshers, which began to be established at large hospitals. The schools were recruited from the children of townspeople, orphans, and children of free professions, as well as people belonging to landowners with payment for them by the landowner. Out of the number of pupils of the school, 20 people were maintained at the expense of the Boards of Public Charity (as it were, treasury scholarship holders), while the rest lived at their own expense and were even charged tuition fees. Persons not younger than 12 and not older than 16 years of age were admitted to the school. The full course of study was established at 4 years and was divided into 2 classes. Upon completion of the course, final examinations were established in the presence of a member of the Board of Public Charity, and graduates, depending on their success, were awarded the title of junior or senior feldsher. Pupils who studied at state expense were sent by the Board of Public Charity to any place as needed for 6 years, peasant children who studied at the expense of the landowner entered his disposal, and the rest were free in choosing their place of work. There were only 5 such schools by 1861, and their graduation in 1861 was equal to 215 people. The junior physician schools at military hospitals, which trained personnel for the needs of the army, at the beginning of the 19th century were also renamed military feldsher schools. In them, the four-year training period was strictly fixed, and the course program almost coincided with the civil school, with the exception of surgery, on which an emphasis was placed. Along with the school training of military and civil feldshers at that time, craft training in the feldsher art in the order of individual apprenticeship with individual doctors was widespread both in the army and in the civil department. Such persons were then subjected to an examination at the Medical Boards and received a certificate for the title of feldsher, and those who were not subjected to such an examination and practiced were called company feldshers, but no statutory enactment was issued about them. This situation with the training of feldshers remained until the Zemsky reform of 1864. After the reform of 1864 and the creation of Zemsky institutions, the matter of public health passed to the latter, including the training of secondary and lower medical personnel to serve the needs of medical institutions. From the former owners (Boards of Public Charity), the Zemstvos received only 5 feldsher schools with a poor organization of educational work in them. The feldsher schools under the Boards of Public Charity had the character of general educational institutions and to a small extent were a vocational school, for they were recruited by persons who could read and write in their native language, at the age of 12 to 14 years, with a 4-year training period; of these 4 years, a lot of time was spent on general education subjects. The introduction of the traveling feldsher system, and then the transition to the creation of stationary medical posts with feldshers as assistants and independent feldsher posts caused a great need for feldshers. A number of Zemstvos came to the need to create feldsher schools with a shorter training period; thus, schools with a 2-year training period were created, and all training was reduced mainly to practical familiarization of students with medical business with low general educational and special training, and the age limit was raised from 14 to 16 years. A number of other Zemsky institutions held another point of view and insisted on a longer training period and more solid general educational (preliminary) and special training. Therefore, the charters of feldsher schools presented by a number of Zemstvos differed in great diversity both in training periods and programs, and in the general educational and age qualifications required upon admission to the school. From 1867 to 1876, 19 Zemsky feldsher schools were created. The lack of uniformity in the system of training feldshers led to a whole series of inconveniences in the use of feldshers in different Zemstvos, and this forced the government in 1872, in order to introduce uniformity in the charters and programs of Zemsky feldsher schools, as well as to determine the minimum requirements for persons wishing to obtain the title of feldsher, to issue a normal school charter introducing uniformity in the feldsher training system. During the 25 years of existence of Zemsky feldsher schools under the charter of 1872, their number increased to 32.

Along with the Zemstvo paramedic schools, there existed military paramedic schools with a four-year course of study, continuing the history of the sub-medical assistant schools, and by the latter period, paramedic schools of the Russian Red Cross Society began to appear, of which there were two, paramedic courses at the Kostroma Epiphany Monastery and a paramedic institution in St. Petersburg, while the Odessa community of the Red Cross was granted the right to additionally train its sisters, conferring upon them the title of sister-paramedic. Besides the Zemstvo paramedic schools, the paramedic schools of the military and naval departments, and the above-listed schools of the Russian Red Cross Society, towards the end of this period private paramedic schools began to emerge, organized and maintained at the expense of individual medical societies and private individuals. The period of study in private schools was three years, and the teaching curriculum basically corresponded to the program of the Zemstvo schools. In general, the total number of all paramedic schools by the end of the 19th century reached 50. However, among the ministerial (maintained on the budget of the Ministry of Internal Affairs and in non-Zemstvo provinces) and Zemstvo schools, there was no complete uniformity, and a number of schools of an advanced type existed. Over time, it turned out that the charter of 1872 was unsatisfactory and did not guarantee qualified training for upcoming activities. A number of Zemstvos and schools petitioned to change the curriculum in the direction of expanding special subjects and changing admission requirements towards raising the general educational qualification. All these petitions prompted the Ministry of Internal Affairs in 1897 to issue a new normal charter for Zemstvo paramedic schools and new teaching programs. Due to its conservatism, the Ministry of Internal Affairs did not meet the petitions of the Zemstvos and schools halfway: the innovations were insignificant, the term of study was set at four years, the age requirement was left the same—14–18 years, and the general educational requirement was set at the volume of a two-year public school; by virtue of these circumstances, all general educational subjects were retained and special subjects were slightly expanded thanks to the introduction of the 4th year of study. Along with the organization of paramedic schools for men, paramedic schools for women and mixed schools for men and women began to appear. The first paramedic school for women in Russia is the department for training female paramedics, organized in 1854 at the St. Petersburg Foundling Home, which in 1872 was transformed into a school for female paramedics. In 1895, a women's midwifery-paramedic school was opened in Tobolsk, and in 1902, a similar school in Saratov under the sanitary society. By the beginning of the 20th century, midwifery-paramedic schools began to develop widely, being transformed from midwifery and paramedic schools and setting as their goal the training of a female paramedic-midwife over a four-year period of study. The Tobolsk paramedic-midwifery school, which arose in 1895, should be considered the first paramedic-midwifery school, while the bulk of paramedic-midwifery schools arose after 1903. The type of worker known as the female paramedic-midwife was recognized by the Zemstvo as more suitable than the separate existence of a male paramedic and a midwife, which is explained exclusively by economic considerations: it was more profitable for the Zemstvo, instead of two workers—a paramedic and a midwife—to have a single worker who would combine in their person the work of a paramedic and a midwife. In 1913, there were 24 civil department paramedic schools, of which 12 were for men, 7 for women, and 5 for persons of both sexes. There were 44 paramedic-midwifery schools, of which 17 were for persons of both sexes, and the rest for women. Of the total number of paramedic and paramedic-midwifery schools, 31 were maintained at the expense of provincial Zemstvos, 9 at the expense of Zemstvo levies (in non-Zemstvo provinces and Siberia), 19 at the expense of private individuals and societies, 5 at the expense of cities, 3 at the expense of the Red Cross, and 1 at the expense of the Ministry of Public Education. In 1913, 588 people graduated from paramedic schools and 1,449 people from paramedic-midwifery schools. In 1915, there were 80 paramedic and paramedic-midwifery schools, of which 23 were governmental (these are schools in non-Zemstvo provinces and financed by the Ministry of Internal Affairs, the Ministry of Public Education, and other government institutions), 36 Zemstvo and municipal, 6 of various organizations including the Red Cross, and 15 private. The number of students in the 80 schools reached up to 9.5 thousand people. Along with school-based training for paramedics, there existed a system of external studies or, as it was called, extramural education for paramedics. The procedure for external examinations for the paramedic title was established by a circular of the Ministry of Internal Affairs on March 15, 1907. Along with military school-trained paramedics, another category of paramedics was trained in the troops, the so-called company, battery, and squadron paramedics. School-trained paramedics could not satisfy the needs of the army, and in the event of war these needs grew in connection with the growth of the army and the growth of losses in paramedics, therefore both in peacetime and wartime, company paramedics were trained at military hospitals and infirmaries according to a program reduced compared to the paramedic school, with a term of study from 2 years down to 0.5 years, and in wartime these terms were shortened even further. Upon leaving the army, company paramedics spread out to all corners of Russia and often either replaced school-trained paramedics at district stations and in Zemstvo hospitals or engaged in private practice among the poorest population and peasantry, who were unable to obtain qualified medical care. It is impossible to indicate even approximately the number of company paramedic courses: the courses arose as needed and ceased to exist; during the last war of 1914–1918, a huge number of such company paramedics were trained. At the initiative of paramedic organizations, the first congress on the reform of paramedic and midwifery education was convened from January 2 to 6, 1911. The second congress on paramedic and midwifery education took place in Moscow on January 2, 1914, and was occupied with drafting regulations on paramedics and female paramedics, their professional rights and duties, and the procedure for acquiring the paramedic title. This work, performed by the congress, formed the basis of the work of the commission for the revision of medical and sanitary legislation, but the regulations presented on behalf of the commission diverged in many ways from what was adopted by the congress. The third congress on paramedic education took place on October 22–25, 1918; it examined the future destinies of paramedic education, with the congress speaking out in favor of preserving the institution of paramedics and, in connection with this, their school training. The first trained midwife in Russia appeared in 1712 from Germany, arriving with the wife of Peter I's son Alexei. The second midwife was Captain Engelbrecht, Dutch by origin, who by all accounts received her training in her homeland and practiced in Moscow in the 1730s and 1740s. In 1740, she was recommended by Dr. Blumentrost to the court of Elizabeth Petrovna. The third trained midwife in Russia was the Dutchwoman Adriana von der Schaar, who served Catherine II. After Condoidi's unsuccessful attempt to organize schools for training midwives in 1754, the schools began their work 3 years later. In the Moscow school, lectures were read at the apartment of Dr. Erasmus twice a week. In St. Petersburg, Lindeman was appointed as doctor of "midwifery affairs," along with physician-accoucheur von Medlen. Teaching was provided with study aids and textbooks, instruments were ordered from abroad, and the supply of cadavers was arranged. In the same year in Moscow and St. Petersburg, state-appointed midwives were designated, 2 per year, who engaged mostly in carrying out the orders of judicial authorities (assisting women giving birth in prisons, examining rape victims, etc.). From 1757, examinations for midwives were conducted year after year, and in Moscow alone by 1770 up to 28 midwives had been examined, and from that time until 1800—46 midwives, all of whom underwent theoretical training first under Professor Erasmus, and after him under Professors Mass, Ilya Rutsky, Grigory Timchenko, Alexander Shumlyansky, who was succeeded by Wilhelm Richter. In total, from 1757 to 1806, 94 midwives were trained in Moscow. Approximately the same (if not greater) number of midwives was trained in St. Petersburg. In the St. Petersburg school during this period of time (from 1757 to 1806), those who taught included Maksimovich-Ambodik, who did a great deal to improve teaching in the school, having introduced practical exercises on a phantom for the first time. To him belongs the first introduction of obstetric forceps into practice. Despite the formal designation of midwifery schools, the training of midwives was actually conducted on a craft-type training model, bearing no resemblance to school training.

The system of individual artisanal apprenticeship very soon ceased to satisfy the demands of contemporary life, because, aside from insufficient theoretical preparation, it did not allow for the graduation of midwives in large numbers, while the need for them was growing, especially after the decree of 1797 on the establishment of one official midwife position in provincial and uyezd towns, which required (according to the number of towns) 378 midwives, whereas by that time no more than 200 people had been trained in Moscow and Petersburg. In 1785, a midwifery institute was organized at the Foundling Home, in which the school training of midwives was initiated. In 1801, a midwifery institute was also created in Moscow, the first director of which was Wilhelm Richter. However, alongside the training of midwives in midwifery institutes, the system of examinations at the Medical Chancery still remained for anyone who wanted to obtain the title of midwife and the right to practice, and even the midwifery institutes themselves were deprived of the ability to independently issue diplomas and sent their trainees to the Medical Chancery, where they were examined and only after that issued a diploma. Such an order was preserved until 1870, and after the abolition of the Medical Chancery, the right to issue diplomas in Petersburg was granted to the Military Medical Academy, and in Moscow to Moscow University. The recruitment of midwifery institutes was conducted from the wards of the Foundling Home. The study period was set at three years, and in its character, the institute was a closed educational institution. Only from the moment of the organization of the midwifery institutes in Moscow and Petersburg can one consider the beginning of the school training of midwives (obstetricians) in Russia. By the time of the Zemsky reform (1864), there were only 6 midwifery schools in Russia training midwives with a two-year study period. Shortly before the Zemsky reform, in 1858, certain changes took place in the study periods in the midwifery institutes (midwifery schools) in the direction of reducing them from 3 to 2 years under the previous recruitment conditions. The necessity of serving the countryside with qualified midwives led to the organization in 1895 in Tobolsk of a midwifery-feldsher school. In 1900, a statute of the State Council was issued on the procedure for acquiring the title of midwife. This statute established two types of educational institutions for training midwives: a maternity educational institution, training 1st-category midwives over the course of 2 years, and midwifery schools, training 2nd-category midwives. The statute stipulated that 2nd-category midwives could not be appointed to established and supernumerary positions in governmental and public institutions. Thereby, 2nd-category midwives could work independently and serve the poorer part of the population. The statute also established external studies for the course of both educational institutions. In development of the statute, the Ministry of Internal Affairs issued a circular on 10 August 1901 concerning the rules of admission to maternity educational institutions and midwifery schools, the curricula of these educational institutions, and the rules on external studies. According to the admission rules, the admission of female persons aged 18 to 40 years was established for maternity educational institutions and midwifery schools. Those entering maternity educational institutions were required to have a general educational standard in the volume of 4 classes of women's gymnasiums, and those entering midwifery schools, literacy (the ability to read and write in Russian). Upon completion of the course in the educational institutions, examinations in all completed subjects, as well as practical examinations, were established for the award of the title, at which students of both educational institutions were required: a) knowledge of methods of obstetric examination and care of women in labor, postpartum women, and newborns, b) the ability to perform obstetric operations permitted by the law, tested on phantoms; in addition, for students of maternity educational institutions—15 independent deliveries, and for students of midwifery schools—10 independent deliveries. Persons wishing to obtain the title of 1st- and 2nd-category midwife were subjected to examinations at the respective educational institutions according to the school curricula; in the first case, 20 independent deliveries and a four-class education were required, in the second—5 independent deliveries and literacy. In a word, external studies presented no great labor, and this made it possible, alongside school training, to obtain a large number of midwives, especially 2nd-category ones, by extracurricular means. Maternity educational institutions and midwifery schools continued to exist according to the previous, highly unsatisfactory curricula until the October Revolution, as before training 1st- and 2nd-category midwives, with the latter fully deserving to be called an obstetric surrogate. In 1913, there were 28 maternity educational institutions and 28 midwifery schools, of which 27 were maintained at the expense of private individuals and societies, 6 at the expense of the Department of Empress Maria, 3 at the expense of provincial zemstvos, 2 at the expense of zemstvo levies, 12 at the expense of towns, and 4 at the expense of the Ministry of Public Education. In all educational institutions in 1913, 2,123 people graduated from the course. The cost of maintenance per year was determined at 630,000 rubles. Maternity educational institutions and midwifery schools were listed all the time in the group of lower educational institutions. This situation changed only after the revolution, when the entire curriculum of obstetric schools, their target setting, and the entire structure of obstetric education changed radically. Sisters of Charity. In Russia, for the first time in 1844, the Holy Trinity Community was established in Petersburg, staffed by nuns and setting itself the goal of preparing sisters of charity for the care of the sick, and this organization pursued more missionary goals—for preaching the "word of God" to the sick, rather than qualified care for the sick. In 1854, upon the proposal of Pirogov, a military community was created in Petersburg, the so-called Cross of Exaltation Community, which over a short period of time conducted a training course for sisters numbering 120 people, headed by Pirogov, and sent a detachment to the front. The Russian Red Cross Society, which arose in 1857 to train nursing personnel in its institutions and detachments, as well as for other hospitals, created a whole network of sisterly communities where sisters of charity were trained. A year-and-a-half study period was established for the sisters with theoretical and practical bedside teaching. By 1881, 11 Red Cross sister communities had been organized (the Aleksandrovsk Community in Petersburg, the Elizabeth Community in Warsaw, the Mariinsky in Kiev, the Kasperovsky in Odessa, etc.). The second strong impetus that gave growth to the sister communities was the famine in 1891–1892, and therefore by 1895, 65 communities had arisen with 61 hospitals attached to them. By the nature of their organization and their entire way of life, the communities bore all the features of monasteries. The schools of sisters of charity existing under the communities had a two-year, and in individual cases a year-and-a-half, study period, including theoretical and practical training in the care of the sick and wounded. The number of sisters of charity trained by the communities grew from year to year, and if in 1888 they numbered 593 people, then in 1890 there were 1,782 people, in 1896—2,812 people, and by 1914 they numbered more than 10,000 people. By virtue of the special ideological and organizational structure of the communities, their schools trained not a professional worker, as in any other vocational-technical school, but some sort of monastic personnel, all the work of which was built on humility and charity, rather than on theoretical training. Zemstvo medical figures were far from the work of the communities, were not interested in it, and did not introduce a living stream, and so these monastic orders continued to exist right up to the revolution. In the last years before the war, the appearance of the sister changed somewhat in the direction of approaching her from a nun to vocational-technical personnel, but basically the idea in the system of training sisters remained monastic. In the years of the imperialist war (1914–1918), the number of sisters grew many times over thanks to the functioning of all sorts of short-term courses that graduated sisters sometimes after six weeks of training. After the October Revolution, the management of the matter of secondary medical education passed to the People's Commissariat of Health created in 1918, which had to do a great deal of work on the radical overhaul of the entire system of secondary medical education. The period of the Civil War and War Communism is characterized by the organization of a whole series of short-term courses in the system of the departments of the People's Commissariat of Health, as well as along the lines of the Military Sanitary Administration, the task of which was to serve the needs of the Red Army, the fight against epidemics, as well as those new tasks of Soviet medicine, such as the protection of motherhood and infancy, and health education, which had inherited no secondary cadres from the old regime. Such were the courses of the so-called red sisters, sisters for the protection of motherhood and childhood, disinfectors, and others.

Simultaneously with this, the question was raised concerning the radical reorganization of the system of secondary medical education, the future fate of medical assistant (feldsher) and medical assistant-obstetrician schools, the reorganization of schools for nurses, and the training of a new type of workers. Feldsher schools in the RSFSR were gradually phased out and by approximately 1924 they ceased to exist. In the Ukrainian SSR they were liquidated as early as 1921. Along with the liquidation of feldsher schools, a network of three-year courses was organized across the RSFSR to retrain company feldshers into school feldshers. The bulk of school feldshers were also granted the opportunity, through an accelerated completion of the medical faculty course (3-4 years), to acquire a new medical qualification and provide the working people with qualified therapeutic assistance. In Moscow, the 3rd Moscow University was created specifically for this purpose, enabling not a few hundred school feldshers to obtain a physician's qualification. The training of midwives up to 1920 was conducted according to the pre-revolutionary method; obstetrical educational institutions preparing 2nd-grade midwives continued to exist as before. In 1920, in connection with the growth of mother and infant protection, the question arose of reorganizing the schools for training 1st- and 2nd-grade midwives into uniform obstetrical schools. The reorganization manifested in the establishment of a uniform obstetrical school with a 2¹/₂-year term of study, training midwives both for work in their specialty and for work in the field of mother and infant protection. The curriculum was newly reconstructed; first and foremost, the reorganization affected the midwifery institute in Moscow, where a new obstetrical school was created under the new institute, following the example of which obstetrical schools began to be established throughout the RSFSR. A distinctive feature of the new curriculum was that special subjects (obstetrics, gynecology) found sufficient reflection in it; biological subjects and subjects of the mother and infant protection cycle (diseases of newborns, care of newborns, milk science and milk kitchen, mother and infant protection) were included in a significantly greater quantity than in the pre-revolutionary school. The work on reorganizing the training system for nurses, taking into account the needs of the Red Army, was conducted at a faster pace than regarding the training of other types of medical personnel. At the beginning of 1919, the medical department of the Russian Society of the Red Cross (RORKK) published the regulations on nursing schools, as well as the curriculum and syllabi approved by the People's Commissariat of Health and RORKK. On February 19, 1919, the training of sisters of charity remained a task of the Russian Society of the Red Cross. The task of the post-revolutionary school includes "preparing a bedside nursing staff that is skilled, conscientious, and correctly understands its role in the life of a medical institution." The regulations emphasize the necessity of a purely practical method of teaching: "the center of gravity in training nurses in a properly established school must lie in practical bedside exercises with patients." From this, a conclusion is drawn about the necessity of the student's constant presence in the hospital throughout their entire working day. However, theoretical studies are not thrown overboard, and the necessity of theoretical teaching is stated so that the student conscientiously performs patient care. The period of study is set at 2¹/₂-3 years. In determining this period, it was assumed that students who have completed four semesters of theoretical and practical studies are already prepared for the activities of sisters of charity, but in order to be prepared for work as a nurse in special medical and therapeutic-prophylactic institutions (physiotherapy rooms, sanatoriums, dispensaries, etc.), an additional year of training is required. Along with the training of midwives and nurses, the training of nurses for mother and infant protection was initiated. The first courses bore more of a public character than a therapeutic one, since the graduates faced major work in propagating the ideas of mother and infant protection. For these purposes, the courses were accelerated (9 months) and recruited from factory working women. The subsequent courses were already 11-month courses, and three courses were one-year, then 1¹/₂-year courses, and from 1922 two-year courses, which continued to exist until 1926. In 1920, alongside the Moscow courses, a number of courses arose in other places, primarily in industrial cities. In 1920, the People's Commissariat of Health and the People's Commissariat of Education convened the first All-Russian Conference on Higher and Secondary Medical Education. This conference did not adopt a concrete system of secondary medical education, and the reorganization of secondary medical schools continued after it through partial reforms of individual types of schools without mutual coordination. In 1922, in connection with the organization of the Main Administration of Vocational and Technical Education (Glavprofobr) under the People's Commissariat of Education, secondary medical education passed from the People's Commissariat of Health to the People's Commissariat of Education. On October 25-30, 1922, Glavprofobr of the RSFSR convened the first All-Russian Conference on Secondary Medical Education, which was of great importance in the reorganization of secondary medical schools and, in particular, decided the fate of feldsher education. The conference confirmed the measure already implemented by this time to liquidate feldsher schools and defined the main types of secondary medical workers and the character of the schools for their training. It recognized the admissibility of narrow specialization of secondary medical personnel within the walls of medical schools. By 1925, the following secondary medical schools were established: 1) feldsher-obstetrical schools with a four-year term of study, recruiting persons who completed a four-year school, existing mainly according to pre-revolutionary curricula and syllabi. The revision of curricula and syllabi was not undertaken due to the liquidation of the schools, which became fewer and fewer year by year; by 1925 there were about 10 of them throughout the RSFSR. 2) Obstetrical schools with a 2¹/₂-year term of study, recruited on the basis of a seven-year school. 3) Schools for training patient-care nurses (sisters of charity), later renamed nursing courses with a a two-year term of study and on the basis of a four-year school. 4) Schools for training mother and infant protection nurses with a two-year term of study and recruitment on the basis of a four-year school were also designated as courses and assigned to the system of lower vocational-technical (thereby lower medical) education. 5) Courses for training sanitary physician assistants, which had emerged by this time in one or two cities of the RSFSR, were liquidated. 6) Courses for retraining company feldshers into school feldshers existed with a three-year term of study according to a curriculum that basically did not differ from the curriculum of former four-year feldsher schools, with the inclusion of some subjects reflecting modernity (political literacy, social hygiene). As for the question of training social assistance nurses, GPF (State Scientific Pedagogical Institute / Glavprofobr) took measures to organize a special Prophylactic Technical School in Moscow jointly with Mosprofobr and to organize special departments for training social assistance nurses at one of the Leningrad medical technical schools. In January 1926, the second All-Russian Conference on Secondary Medical Education took place in Moscow. In accordance with the conference decisions and in close contact with the People's Commissariat of Health, the board of GPF on October 13, 1926, resolved to unify the types of secondary medical schools, recognizing that the required type of secondary medical educational institution should be a medical technical school for training all categories of secondary medical personnel, and it should be structured along the lines of polytechnical schools with appropriate specializations. By this decision, a unified type of educational institution was created for training secondary medical personnel, and the secondary medical school was thereby reorganized on the basis of the general system of vocational and technical education. All existing medical schools and courses, both state-budgeted and locally budgeted, were renamed starting from the 1927/28 academic year into medical technical schools with corresponding changes in curricula and syllabi. Recruitment to all medical technical schools was to proceed on the basis of the seven- and nine-year school, the age limit was uniform for all educational institutions—not younger than 17 years, and the terms of study for all categories of secondary medical personnel were set at 2¹/₂-3 years. Furthermore, the terms of study, taking into account their insufficiency, were increased: for midwives instead of 2¹/₂-3 years, for nurses of all categories instead of 2-2¹/₂ years, for feldsher-obstetrical training - 4 years, and for company feldsher retraining courses the old 3 years were retained. The regulations on technical schools, approved by the Council of People's Commissars of the RSFSR following the decision of the Board of the People's Commissariat of Education on November 26, 1927, regarding the reorganization of secondary medical education on the polytechnic principle, were immediately implemented. Thus, all medical technical schools and medical schools that previously existed separately were merged in all cities into a single medical polytechnic school with a number of departments attached to it. The regulations on technical schools provided for the recruitment of the medical polytechnic school with persons who had graduated from the seven-year school.

On the basis of the polytechnic, a number of new departments were deployed in medical technicums, preparing narrow specialists. Both in Moscow and in Leningrad, up to 7 different departments were organized in individual technicums, among which there are departments for training secondary medical personnel for physiotherapy institutions, for X-ray rooms, secondary laboratory personnel, disinfectants, surgical and therapeutic nursing personnel, psychiatric personnel to work in psychiatric hospitals, nervous departments of somatic hospitals and institutions of neuropsychiatric prophylaxis (neuropsychiatric dispensary), resort and sanatorium personnel, sisters of social assistance, etc. By 1927-28 there were 5 types of secondary medical educational institutions: a) Medical polytechnic technicum with a number of departments: obstetrics, mother and infant welfare, care department and a number of narrowly specialized departments with a study period from 2 1/2 to 3 years (depending on the nature of the department). This type was the main one. b) Feldsher-obstetric technicums, finishing the last graduations and being phased out in connection with the liquidation of this type of educational institutions with a four-year study period, c) Prophylactic medical technicums with a number of departments in them with a study period of three years, d) Three-year courses for the retraining of company feldshers into school ones, also gradually being phased out. e) Evening medical technicum, organized for training secondary medical personnel from nannies in three main departments—obstetrics, mother and infant welfare, and medical care—with a three-year study period. The latter type of educational institutions appeared in 1927 in Moscow and began to grow in a number of cities. Its structure and work routine were the same as in other medical technicums. For two years, only evening classes are conducted, and in the 3rd year, students are exempted from work in medical institutions while retaining their salary and study during the day. In 1928 and 1929, the 3rd and 4th All-Russian Conferences on Secondary Medical Education took place. The 3rd conference discussed and consolidated the principles of the reorganization of medical education on a polytechnic principle, and also worked out programs for the first and second semesters for all departments of the medical technicum; the 4th conference worked out programs for the third and fourth semesters of the three main departments of the medical technicum and a number of measures for the socio-political education of students of medical technicums. During the 1929/30 academic year, the curricula of all medical technicums were restructured along the lines of reducing theoretical training and introducing continuous practical training. The study periods were set at 2 1/2 years for midwives and 2 years for nursing, mother and infant welfare, and social-prophylactic personnel. In 1930, all medical technicums were transferred from the jurisdiction of the People's Commissariat of Education to the jurisdiction of the People's Commissariat of Health and its local bodies. By the personal initiative of Comrade Stalin in 1935, a radical reorganization of secondary medical education was carried out. The feldsher was put forward as the leading figure, whose role in the countryside in connection with the shortage of medical personnel for the near future is still very great. The decree of the Council of People's Commissars of the USSR "On the training of secondary medical, dental and pharmaceutical personnel" issued on September 8, 1936, is of great importance for improving secondary medical education. Instead of the former medical technicums, the following were created: a) feldsher schools with a 3-year study period, b) obstetric schools with a 2-year study period, c) schools of medical nurses with a 2-year study period for training medical nurses, d) schools of nursery nurses with a 2-year study period, e) courses for medical laboratory assistants with a 1-year study period. Medical technicums as of January 1, 1934—see Table 14. As of January 1, 1935, the number of medical technicums in the USSR was brought to 253 with the number of students at 65 thousand, and as of October 1, 1935, there were 264 secondary medical educational institutions with the number of students at 84,185 people. Admission in 1935 was 41.6 thousand, and graduation was 12.8 thousand. Results of admission and graduation in medical technicums of the USSR for 1928–36. Admission (in thousand people): 1928—8.0; 1929—9.6; 1930—18.2; 1931—22.1; 1932—41.3 (1932 in % to 1928—516.3); 1933—31.4; 1934—32.55; 1935—38.808; 1936—43.85 (plan). Graduation (in thousand people): 1928—4.8; 1929—4.9; 1930—9.3; 1931—10.5; 1932—12.6 (1932 in % to 1928—262.5); graduation of medical technicums (excluding nurses): 1933—14.2; 1934—10.8; 1935—12.842; 1936—19.62 (plan). Table 12. Composition of students of medical technicums as of January 1, 1935, and admitted to technicums in the autumn of 1935 by nationalities. Nationalities: Students as of January 1, 1935, Admitted as of October 1, 1935. Adyghes¹ .......... Armenians ............ Bashkirs........... Belarusians ........... Buryats ............ Mountain nationalities of Dagestan Georgians............. Jews.............. Ingush............ Kabardino-Balkars ..... Kazakhs............. Kalmyks............ Karakalpaks ......... Komi .............. Karels and Finns....... Latvians............ Mari........... Moldovans........... Mordvinians............. Germans............. Oyrot-Altaians........ Ossetians............. Poles ............. Russians............. Tajiks............. Tatars............. Turkmen............ Turks.............. Udmurts............. Uzbeks.............. Ukrainians............ Chechens............. Chuvash............. Khakasses............. Others²............. Total........ 1,833 1,762 3,271 16 34,021 1,200 1,246 228 16 246 3,300 2,932 64 214 11 323 1,160 51 665 220 20 211 10 489 38,817 ¹ Circassians are shown together with Adyghes. ² Yakuts are included among others. By the decree of the Council of People's Commissars of the USSR dated September 8, 1936, the following admission quota to schools and courses was established for the autumn of 1937 (for the USSR as a whole): a) to feldsher schools—44,700 people; b) to obstetric schools—13,300 people; c) to schools of medical nursery nurses—95,000; d) to courses for medical laboratory assistants—5,200 people. The composition of students in medical technicums of the USSR by sex, social status, party affiliation, and nationality is given in Tables 12 and 13. Students of medical technicums are recruited from youth not younger than 17 years old who have graduated from a seven-year school. Material and financial situation of medical technicums. The budget of technicums is growing from year to year. In 1925/26, each technicum (state-budgeted) on average had a budget of 20,000 rubles, of which salaries accounted for 78%, stipends for 6%, and the rest for educational and maintenance expenses. The cost of one student was 167 rubles per year. In the 1926/27 academic year, the cost of a technicum on average increased to 23,000 rubles, of which salaries accounted for 72%, stipends for 10%. The cost of one student per year was 239 rubles. In the 1927/28 academic year, the budget of a technicum was already equal to 30,000 rubles: salaries—60%, stipends—17%, and for educational expenses—15%. The cost of one student per year became 279 rubles. In 1928/29, the financing system of technicums changed dramatically in connection with the organization of oblasts and krais, to whose budgets the technicums were transferred. From this, their financial situation significantly improved. Expenditures on educational equipment increased, and the expenditure per student reached more than 300 rubles. In 1929/30, the absolute majority of medical technicums were transferred to the budget of oblasts, and the budget of individual most powerful technicums in Moscow and Leningrad exceeded 300,000 rubles per year (for example, the Moscow Prophylactic Medical Technicum, the S. Perovskaya Medical Technicum, etc.). In 1930/31, all medical technicums were transferred by the People's Commissariat of Health to the budget of krai and oblast health departments. Table. Number of medical technicums and students by republics as of January 1, 1934. Turkmen SSR...... Tajik SSR ...... Trans-Caucasian Railroad of the People's Commissariat of Railways . . Total for the USSR . . 252, 66.8. Lower Medical Education.

Training of junior medical support personnel (orderlies, nurses' aides) is carried out in special courses organized at medical institutions. Persons with a 5-grade education are accepted into these courses.

N. Propper.