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EALTH ANDS, SANITA..TI ent Contains inf ormat on of f ectin the meani of the sspio a Act, 50 U.S.C., r laatLon tif its contents in any manner to an pproved For Release 2003/05/14 : the national de erase 4 'the the Unite i$ t ri 31 and ?32, ais`amend - t guns fission or 'the un-~~ authoriz sori is- prohibited y jaw. CIA-RDP79-01144A000200010011 DOCUMEN Mil. jJ/ D CLA~SWIE~1 CLA$ GN SEA CO. ti EDITORIAL FILE aum i tin o.a,~ - Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 LIST OF EFFECTIVE PAGES, CHAPTER XI CHANGE IN SUBJECT MATTER EFFECT Cover Page . . . . . . . . . . . . . . . . . Original List of Effective Pages and Table of Contents, Chapter XI (inside front cover) . . . . . . . . . Original Text and Figures . . . . . . . . . . . . . . . Original Figures (inserts, reverse sides blank) . . . . . . . . Original Text and Figures . . . . . . . . . . . . . . . Original Text (reverse blank) . . . . . . . . . . . . . . Original Imprint (inside back cover, reverse blank) . . . . . . Original TABLE OF CONTENTS PAGE NUMBERS unnumbered unnumbered pp. XI-1 to XI-18 Figures XI-6 to XI-8 pp. XI-19 to XI-32 p. XI-33 unnumbered Note: This chapter is based upon material available in Washington, D. C., on 1 July 1946. Page 110. INTRODUCTION . . . . . . . . . . XI- 1 111. ENVIRONMENT . . . . . . . . . . XI - 1 A. Water . . . . . . . . . . . . . XI - 2 B. Waste disposal . . . . . . . . . . XI - 2 C. Animals . . . . . . . . . . . . XI - 3 (1) Vectors of disease . . . . . . . XI - 3 (2) Dangerous animals . . . . . . . XI - 5 (3) Pests . . . . . . . . . . . XI - 5 D. Plants . . . . . . . . . . . . . XI - 5 E. Food . . . . . . . . . . . . . XI - 5 (1) General . . . . . . . . . . . XI - 5 (2) Collective feeding . . . . . . . XI - 6 (3) Food sanitation . . . . . . . . XI - 6 112. PUBLIC HEALTH AND MEDICAL FACILITIES . . . . . . . XI - 7 A. Public health organization . . . . . XI - 7 (1) Republic . . . . . . . . . . XI - 7 (2) Oblast (territory) and kray (region) . XI - 8 (3) Rayon (rural districts and city boroughs) . . . . . . . . XI - 8 (4) Village . . . . . . . . . . . XI - 8 (5) Commissariats of Transportation and Defense . . . . . . . . XI - 8 B. Hospitals and medical institutions . . . XI - 8 (1) Hospital facilities . . . . . . . XI - 8 (2) Medical institutions . . . . . . XI - 10 C. Medical personnel . . . . . . . . XI - 13 (1) Professional medical personnel . . . XI - 13 (2) Subprofessional medical personnel . XI - 14 D. Rest and recreation facilities . . . . . XI - 15 (1) Health resorts . . . . . . . . XI - 15 (2) Red Corners, clubhouses, and parks . XI - 15 E. Social service agencies . . . . . . . XI - 15 (1) General . . . . . . . . . . . XI - 15 (2) Social insurance . . . . . . XI - 16 (3) Care for mother and child . . . . XI - 16 (4) Red Cross and Red Crescent . . . . XI - 16 113. DISEASES XI - 16 A. Diseases of military importance . . . . XI - 16 (1) Malaria . . . . . . . . . . XI - 16 (2) Sandfly fever (pappataci fever) XI - 18 (3) Rickettsial diseases . . . . . . XI - 19 Page (4) Dysentery and diarrheas . . . . . XI - 20 (5) Frostbite . . . . . . . . . . XI - 21 (6) Venereal diseases . . . . . . . XI - 21 B. Diseases of potential military importance. XI - 21 (1) Endemic diseases . . . . . . . XI - 21 (2) Diseases which may be introduced XI - 23 C. Diseases of minor military importance XI - 23 (1) Typhoid fever . . . . . . . . XI - 23 (2) Scarlet fever . . . . . . . . . XI - 23 (3) Diphtheria . . . . . . . . . XI - 23 (4) Measles . . . . . . . . . . . XI - 23 D. Diseases common among the civil population . . . . . . . . . XI - 23 (1) Tuberculosis . . . . . . . . . XI - 23 (2) Helminthiasis . . . . . . . . XI - 24 (3) Influenza . . . . . . . . . . XI - 24 E. Miscellaneous diseases . . . . . . . XI - 25 (1) Tularemia . . . . . . . . . . XI - 25 (2) Leprosy . . . . . . . . . . . XI - 25 (3) Trachoma . . . . . . . . . . XI - 25 (4) Smallpox . . . . . . . . . . XI - 25 (5) Rabies . . . . . . . . . . . XI - 25 (6) Anthrax . . . . . . . . . . . XI - 25 115. RECOMMENDATIONS . . . . . . . . XI - 27 A. Water . . . . . . . . . . . . XI - 27 B. Waste disposal . . . . . . . . . XI - 27 C. Food sanitation . . . . . . . . . XI - 27 D. Venereal disease control . . . . . . XI - 27 E. Prevention of frostbite . . . . . . . XI - 27 F. Control of mosquito-borne diseases . . XI - 27 G. Control of flies . . . . . . . . . . XI - 28 H. Sandfly control . . . . . . . . . XI - 28 I. Control of louse-borne diseases (typhus and relapsing fever) . . . XI - 28 J. Control of tick-borne disease . . . . . XI - 28 K. Control of flea-borne diseases . . . . XI - 28 L. Cholera control . . . . . . . . . XI - 28 116. PRINCIPAL SOURCES . . . . . . . . XI - 28 A. Evaluation . . . . . . . . . . . XI - 28 B. List of references . . . . . . . . . XI - 28 C - J. Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Chapter XI HEALTH AND SANITATION Prepared by the Medical Intelligence Branch, Office of the Surgeon General, War Department. 110. INTRODUCTION This chapter deals with environmental conditions which affect health, including water, sewerage, animals, plants, and food, and with public health administration, medical. facilities, and diseases. The area covered is the European part of the U.S.S.R., extending from the Barents Sea and. Beloye More (White Sea) to the Black and Caspian Seas, and from the Ural Mountains and Ural river to a line which would connect the Frisches Haff with the estuary of the Danube (river). This territory includes the entire European U.S.S.R. and contains the following political units: The European part of the R.S.F.R., the Ukrainian S.S.R., the White Russian S.S.R., the Karelo-Finnish S.S.R., the Moldavian S.S.R., the Estonian S.S.R., the Latvian S.S.R., and the Lithuanian S.S.R. Water and sewerage systems, although present, are neither modern nor sufficient in number. The quantity of water available is abundant, because of the large rivers, numerous springs, and adequate rains and snow. Euro- pean U.S.S.R. has some of the most fertile regions of the world, the Ukrainian S.S.R. being an example; and the supply of food in normal times is adequate. The canned food industry is in its infancy, but is growing rapidly and steadily. Malaria-transmitting mosquitoes and sandflies are pres- ent in great numbers. The louse population is consider- able, and there are innumerable pests, such as cockroaches, bedbugs, ants, and beetles. In the southeastern part of European U.S.S.R. the rodents and domestic animals con- stitute a reservoir for plague. This disease is transmitted by fleas, which abound in that region. The ticks in Euro- pean U.S.S.R. are incriminated in the transmission of en- cephalitis. Dangerous animals include poisonous fishes and snakes, bears, wolves, foxes, and rabid dogs and cats. Medical and public health services are almost entirely state controlled and supervised. The Soviet Union in 1941 had 130,348 physicians, 661,431 hospital beds for general medicine and surgery, 73,992 beds for psychiatric patients, and 141,873 maternity beds. The Narkomzdrav, or Ministry for Public Health, controls all the medical activities in the country. The most important diseases of the Union are tubercu- losis, malaria, and dysentery. Louse-borne typhus is still present, although much better controlled than ever before. The venereal disease rate has been considerably reduced in the last 25 years. There are still some small foci of Page XI-1 trachoma, plague, and leprosy, particularly in the south- eastern and central-eastern parts of European U.S.S.R. In general, the Soviet Union has exerted strenuous efforts toward the solution of its health and sanitation problems and has attained some measure of success. The medical facilities of the country are still in the process of rapid growth. 111, ENVIRONMENT Despite the vast extent of the Soviet Union, climatic conditions in large parts of the country have much in common. The situation is different near the Black Sea, across the Caspian Sea, and in the Far East, where winters are longer and precipitation lower than in the rest of the U.S.S.R. Occasional frosts which extend into the summer or come early in the fall, lack of adequate spring rainfall or ground moisture from melting snow, and drying winds foster crop uncertainties. Only a few areas in the west and in the higher moun- tains receive more than 20 inches of rainfall. If it were not for the low summer temperatures and limited evapora- tion, very little of the entire country would be suitable for agriculture. Changes of latitude and altitude are not always accom- panied by corresponding climatic variations. For exam- ple, the yearly average temperature in Moskva (Moscow) is 3 ? F. lower than in Leningrad, which is 400 miles to the north, and winters in the delta of the Volga are colder than in the Gulf of Finland where the north wind brings warmer weather. Stations on the Azovskoye More (Sea of Azov) have the same January average as the northern coast of Kol'skiy Poluostrov (Kola Peninsula). Winter is the predominant season. The frost-free pe- riod is only 90 to 120 days in the northern half of European U.S.S.R. In the central European area and the Ukraine, only 120 to 180 days of each year are frost-free. Snow- fall is not heavy but, since thaws are rare in winter, snow accumulates and may be blown into formidable drifts. In the European part of the Union, except for the Ukraine, the snow persists for 100 to 200 days. Summers are warm almost everywhere, with July iso- therms extending east and west. Alon,g the Arctic Coast long hours of sunshine raise the day and night monthly average temperature to 50?F. From Arkhangel'sk to Kiyev (Kiev), July temperatures are 60?F. to 68?F.; in the steppes they reach 75?F. Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Page XI-2 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 JANIS 40 A. Water The first water-supply systems were built in Moskva (Moscow) and Pushkin during the eighteenth century. The amount of water supplied by all systems in Russia during the eighteenth and nineteenth centuries was gross- ly inadequate and expensive to the consumer. Important changes did not take place until 1920. In 1924 and 1926 the numbers of water-supply systems in operation were 278 and 325, respectively. The numbers of town inhabitants benefiting from municipal water- supply systems during these same years were 12.5 millions and 14.9 millions, respectively. Thus, the number of townspeople benefiting from municipal water-supply sys- tems increased by 16 percent. On the other hand, the quantity of supplied water increased by 2', only, since the entire Russian water supply per 24 hours was 714,000 cubic meters (approximately 188,500,000 gallons) in 1926 as compared to 700,000 cubic meters (184,800,000 gallons) in 1924. The average water consumption of the individual as the result of urbanization seems, therefore, to have been reduced. It was 55.2 liters (14.57 gallons) per 24 hours in 1924, and 51.3 liters (13.54 gallons) in 1926. The low capacity of water production during this period in the U.S.S.R. can be judged by comparison with Chicago's water supply. The daily output of water in the entire U.S.S.R. was 714,000 cubic meters (188,500,000 gallons) in 1926, while for Chicago it was 3,200,000 cubic meters (844,800,000 gallons) per 24 hours in the same year. The safeness of the drinking water in those years, particularly river water, can be questioned seriously. The typhoid epidemic of 1926 was caused by the poor water system of the city of Rostov-na-Donu (Rostov-on-Don). For that reason a decree was issued which established a special body in charge of "z:nes of sanitary protection." By establishing zoning regulations for protection of reservoirs, this body had jurisdiction over the sanitary control of municipal water-supply systems and the sources from which those systems were fed. For about 12 years before World War II municipal water supplies had been developing rather rapidly in volume and in potability. By the end of 1938, according to Soviet figures, 411 cities had central water systems with approximately 14,000 kilometers (8,700 miles) of water mains. This indicates that the majority of Russian cities had central water supplies, as the number of cities in the U.S.S.R. with. populations exceeding 50,000, according to the census of January 1939, was only 174. The third Five- Year Plan proposed to increase the daily water supply to 5.25 million cubic meters (1,386 million gallons) by 1942. Moreover, two years before the war (1939) legal stand- ards were finally set for the minimum requisites of water for drinking and household purposes. During the war, expansion of water supply and main- tenance of existing water systems continued in the un- occupied cities, except in a few areas. In Moskva (Mos- cow), for example, 54 kilometers (33.5 miles) of water mains were laid during 1942 and 1943. No breakdowns in main supply during 1941-1943 were reported. In the towns of the Volga, which had to absorb many refugees and evac- uees, water delivery doubled during the war. On the whole, no serious threat to health was traced to the func- tioning of water systems in the unoccupied U.S.S.R. during the war period. The following cities are among those which received new water systems in the past 15 or 20 years: Bronnitsy, Gor'kiy (Gorki), Ivanovo, Krasnodar, Mozhaysk, and Murmansk. The following cities, among others, had/their water-supply systems improved: Buk- hara, Lenilftgrad, Moskva (Moscow), Rostov, Stavropol', and Stalinrad. The very few rural water-supply systems always were poor. 'Villages obtain their water almost exclusively from wells, the majority of which are of wooden construction and of inferior design. The Russian Government has initiated an ambitious program of water improvement in rural areas. Thus, the building of concrete wells has been encouraged, particularly around Moskva (Moscow) and Pskov. During the second Five-Year Plan, 318 new rural water mains, 99 of which are in the Crimea alone, were under construction. A great improvement in rural water supply may be anticipated in the near future, even if temporarily interrupted by the war. In the entire U.S.S.R. in 1936 water was obtained from various sources in the following proportions: rivers 35.2'( springs 20.7', ; subsoil water (wells) 10.5 artesian water 13.3' ; subsoil spring water 6.7', artesian-spring water 4.7'> ; the remaining 8.9': from combined sources. These percentages are not constant but change continuously; nevertheless, rivers continue to be predominant as sources of water supply in the Soviet Union. The European U.S.S.R. is abundantly equipped with such natural sources of water supply. B. Waste disposal The first sewerage system in the U.S.S.R. was built in Odessa in 1862; sewerage systems for the cities of Kiyev (Kiev), Moskva (Moscow), Rostov, and Khar'kov followed in the years 1894, 1898, 1906, and 1914, respectively. As late as the year 1930 there were only about 42 cities equipped with sewerage systems, which represented an almost insignificant, number compared to the number of Russian cities without them. The number of buildings served by the canalization sys- tem in 1928 was very small. Thus, in Moskva (Moscow) 9,612 out of 29,449 dwelling units were connected with the sewerage system; in Gor'kiy (Gorki), the number was 641 out of 9,199; in Rostov-na-Donu (Rostov-on-Don) 2,014 out of 16,170; in Sevastopol' 706 out of 5,749; in Kiyev (Kiev) 4,582 out of 17,209; and in Khar'kov 1,648 out of 21,418. The control and planning of major canalization projects is partly in the hands of the NKVD (Department of In- terior) and partly under the supervision of the Narkomz- dray. Minor projects are planned and controlled by the individual city or town councils. Rural communities do not have any sewerage systems at all. and waste disposal methods there are still extremely primitive. The sanitary position of Soviet cities on the eve of World War II apparently had a background of inadequate devel- opment followed in 1925 by large-scale expansion, includ- ing improvements in standards and regulations. In spite of its extension, sanitation lagged behind growing urban needs. By the end of 1938, approximately 107 cities had sewer- age systems with about 5,000 kilometers (3,100 miles) of sewage mains. The most striking increase was in the number of cities equipped. Between 1928 and 1938 their number had more than doubled, but it should be noted that the total of 107 reported for 1938 represented only three-fifths of the number of cities with a population of more than 50,000. An example of the increasing official attention paid to sanitation was shown in 1937 at the All-Union Conference which recommended municipally controlled disposal of sewage. At about the same time sanitary facilities were unified within the administrative system of some cities where the same department became responsible for rub- bish collections, removal of wastes, general sanitation of the city, street cleaning and washing, snow removal, and Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 10 ime, HEALTH AND SANITATION cemetery maintenance, as well as the preparation and pub- lication of technical instructions and studies in these fields. During World War II insanitary conditions were rather prevalent, although, with the favorable turn of the war, serious efforts were reported to have been made to improve unsatisfactory conditions all over the Soviet Union. There are no data available on either the destruction or recon- struction of the sanitation systems in the Soviet Union. C. Animals (1) Vectors of disease (a) Mosquitoes.-Mosquitoes are numerous in Euro- pean U.S.S.R. Positive identifications recorded for the region include 9 species of Anopheles, 27 of Aedes, 7 of Culex, and 11 of other genera. Many of the 54 species are numerous enough to become serious pests in some localities, but the only important vectors of disease in European U.S.S.R. are five species of Anopheles respon- sible for the spread of malaria. The breeding and other habits of these species are described below. The larvae of A. maculipennis maculipennis are present, particularly in fresh sunlit water, but also in other types of standing water. The larvae avoid thick horizontal vegetation such as Lemna and prefer thin and vertical vegetation such as Ranunculus, Myriophyllum, and Cera- tophyllum. The adult mosquito is mainly active after sunset and before sunrise. The species appears in April and is most abundant from August to September. The females start hibernation at the end of September. The larvae of A. labranchiae atroparvus are found in brackish water, coastal marshes, the fresh water of rice fields, and upland streams. The adults enter houses in large numbers. They bite animals but prefer human blood. This species is an important vector of malaria. The larvae of A. messeae thrive in cool, standing bodies of fresh water, and in large inland river valleys, lakes, and marshes. Adults prefer the blood of animals to that of human beings. Hibernation occurs in barns and houses. The species is believed to be an important vector of malaria. A. sacharovi, because of its anthropophilic tendency, is an important vector. It feeds on man and domestic ani- mals, and breeds in coastal marshes, even if strongly brackish, or in inland marshes which are open to sunlight in midsummer. Adults enter human habitations and bite man freely at ni,ght. A. hyrcanus hyrcanus is considered to be a minor vector of malaria in European U.S.S.R. The larvae of this species are found not only in marshes and rice fields but also in ponds and other collections which are exposed to the sun. Adults are especially active at sunset and sunrise. In the malarious regions of European U.S.S.R. (Ukraine, Lower Volga region, Crimea, Moldavia) it has been estab- lished that there are definite characteristic seasonal fluc- tuations, sometimes considerable, among the various spe- cies of Anopheles. Two distinct maxima are noticeable for A. labranchiae atroparvus, one in April and May, and a greater one around September. The species is considered a "warm" type of Anopheles which cannot withstand the cool nights of springtime. The autumnal increase is coincident with the disappearance of A. messeae, which commence to hibernate around this time of the year. In summertime in the vicinity of Odessa A. labranchiae atro-? parvus slightly outnumbers A. messeae. The seasonal quantitative changes of the different types of Anopheles can be studied by the typical "fli,ght curves." These can be: 1) a pure type of flight curve representing flights of A. messeae only; 2) a, pure type of flight curve Original Page XI-3 representing flights of A. labranchiae atroparvus only; and 3) a mixed type of curve due to flights of both A. messeae and A. labranchiae atroparvus. The A. messeae type of flight curve is characterized as low in May with the peak in June and July. The curve de- scends in August and reaches its lowest point around the last half of September, when A. messeae retires for hiber- nation. The flight curve of A. labranchiae atroparvus has two peaks, one in July and a second one in September. The September peak often is higher. In the third curve which represents the flights of mixed populations of Anopheles, there is no autumnal (Sep- tember) rise because in mixed populations atroparvus is less abundant. In Nikolayev (Nikolaev) for example, dur- ing 1937 A. messeae outnumbered A. labranchiae atro- parvus about two to one. The morbidity rate of malaria noted in different regions shows a definite peak in the second and third quarter of the year. This corresponds also to the flight curve of Anopheles which always starts to rise in April to reach its peak between June and September and falls to its low in the last and first months of the year. (b) Flies.-Flies are extremely common in the Soviet Union and represent a serious health problem. Their numbers can at times increase to myriads, and reports from German occupation forces in White Russia stated that "it was impossible to avoid flies and that flies would creep into the mouths of soldiers, or cover completely their faces, food, etc." Sandflies (family Psychodidae) are vectors of sandfly fever and certain flies like Sarcophaga carnaris and species belonging to the families of Oes- tridae and Gasterophilidae cause different forms of myia- sis. Some 39 species distributed among 15 genera in 9 fami- lies have been recorded for the U.S.S.R. Calliphoridae: Calliphora erythrocephala Do. vomitoria Lucilia caesar Gasterophilidae (gadflies) : Gasterophilus intestinalis Do. veterinus Do. pecorum Hypodermatidae (gadflies) : Hypoderma bovis Do. lineata Muscidae (common flies) : Entire European U.S.S.R. do. do. Entire U.S.S.R. do. do. Entire U.S.S.R. do. Stomoxys calcitrans Musca domestica Fannia canicularis Oestridae (gadflies) : Rhinoestrus purpureus Piophilidae: Piophila casei Psychodidae (sandflies): Entire European U.S.S.R. do. do. Phlebotomus chinensis Crimea Do. major do. Do. minutus do, Do. papatasii do. Do. perfilievi do. Do. sergenti do. Do. sergenti var. do. alexandri Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Page XI-4 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 JANIS 40 FAMILY AND SPECIES GEOGRAPHIC DISTRIBUTION tContinued) Sarcophagidae: sarcophaga carnaria Do. haemorrhoidalis Wohifahrtia magnifica Entire European U.S.S.R. do. Southern European U.S.S.R. Tabanus tarandinus Do. fulvicornis Do. tropicus Do. ?nontanus Do. solstitialis Do. bovines Do. bromius Do. peculiaris Do. erberi Chrysops caecutiens Tayga, northern regions Tayga and forests do. do. Forests and steppes do. do. Around rivers in half-deserts do. Entire European U.S.S.R. except deserts do. Do. quadratus Entire European U.S.S.R. except deserts Do. nigripes Tayga Chz/rsorona pluvialis Entire European U.S.S.R. except deserts Do. crassicorois Tayga and forests Do. italica Forests and steppe forests (c) Lice.--The usual lice that infest man are found in the U.S.S.R. They always have claimed a prominent place in the history of Russian wars, revolutions, postwar periods, migrations, etc., which were associated with crowded living conditions and poor sanitation. The species found are: Pediculus humanus capitis, Pediculus humanus corporis, and Phthirus pubis. The most im- portant diseases spread by lice are typhus fever, relapsing fever, and trench fever. (d) Fleas.-Approximately 35 species of fleas have been identified in European U.S.S.R. Of these, Xenop- sylla cheopis and species of Ceratophyllus, Ctenophthal- mus, Ctenopsyllus, and Meropsylla are important as vec- U. S. S. R. DISTRIBUTION OF TICKS Northern limits of distribution of the genera: Ixodes Hoemophysolis DBrmocenlor Rhipioepho/us 5. Booph/lus 6. Hyolommo FIGURE XI - 1. Geographical distribution of ticks. Northern limits of the genera represented in the U.S.S.R. Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 tors of plague and typhus. However, flea-borne typhus is rare in European U.S.S.R. (e) Other insects.-Cockroaches, bedbugs, and ants may serve as mechanical vectors of disease. Cockroaches and ants transfer organisms by crawling over filth and food indiscriminately. While the ability of the bedbug to transmit disease is debatable, the ingestion or crushing upon the skin of infected bedbugs may give rise to infec- tion in man. The more numerous species of cockroaches include Blatta orientalis, Blatella germanica, and Peri- planeta americana. The bedbug, Cimex lectularius, is found throughout the U.S.S.R. Ants are a very considerable nuisance to man and ani- mal. The following types are found in the territory of the European U.S.S.R.: Monomorium pharaonis, Tetra- morium caespitum, as well as Iridomyrmex humilis and others. Monomorium pharaonis, imported to Europe from tropical climates, is mainly found inside dwellings, par- ticularly in bakeries, restaurants, hotels, and laboratories. Sometimes these ants become particularly destructive to the deep foundation of a dwelling and increase their popu- lation to such an extent that the dwelling becomes unin- habitable. Monomorium latinode can harbor the live cholera bacillus for eight hours, and Monomorium de- structor, which devours rats that died from plague, spread this disease while the ant itself remains immune to it. (f) Ticks and mites.--The importance of ticks as vectors of disease in European U.S.S.R. is manifested in the transmission of tick-borne encephalitis. Ixodes per- sulcatus, whose larvae also may be infected with enceph- alitis virus, is the main vector; Dermacentor sylvarum, Haemaphysalis concinna, and Haemaphysalis japonica are less important. These species are found in thick un- cultivated forests. They attack man, cattle, horses, sheep, pigs, dogs, and wild rodents. The geographical distri- bution of ticks in the U.S.S.R. is shown in FIGURE XI-1. Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 HEALTH AND SANITATION The itch mite, Sarcoptes scabiei, and the follicle mite, Demodex folliculorum, are common throughout the Euro- pean U.S.S.R. The importance of mites as vectors of rickettsial infection has not been established in this area. Russian authors consider it as almost nonexistent. (g) Mollusks.-Snails, clams, and other mollusks are present in the European part of Soviet Russia. The Rus- sian literature does not indicate that they are important as hosts for flukes or other parasites. (h) Rodents.-The rodents are the most important group of mammals associated with spread of disease, par- ticularly plague and certain forms of typhus. This ap- plies especially to the southeastern part of European U.S.S.R., but also to the rest of the Soviet Union. Mice, rats, jerboas, marmots, rabbits, polecats, and weasels are some of the most common rodents of the area. The genus Citellus is represented by three species, namely Citellus citellus, Citellus suslicus, and Citellus pygmaeus. Mar- mota bobak is also present. The family Gerbillidae is represented by two species, Pallasiomys erythrourus and Meriones tamaricinus. Mus musculus, Lagurus lagurus, Microtus socialis, and Microtus arvalis have periodic mass migrations which sometimes do not reach human habitations but terminate in the steppes of southeastern U.S.S.R.; nevertheless, they represent an abundant reservoir of plague. (2) Dangerous animals The dangerous animals of European U.S.S.R. include two species of venomous snakes, certain fishes, and wild animals. (a) Reptiles.-The only poisonous serpents of Euro- pean U.S.S.R. are two small vipers, true vipers or members of the family Viperidae. Both are members of the same genus, Vipera. There are no pit vipers. The common viper or adder, Vipera berus, seldom grows longer than twenty-four inches. The color is variable, ranging through gray, olive, and brown, sometimes to reddish. The color pattern may be uniform or dotted with small spots. A bold, zigzag pattern of dark hue usually extends the length of the back, thus distinguishing it from the harmless snakes. This species has an X-shaped mark at the back of the head, like a St. Andrew's cross. Another viper, V. renardi, is particularly characteristic of the southern parts of the European U.S.S.R. The bite of these vipers is not always fatal; the venom is reported to be hemotoxic. (b) Dangerous and poisonous fishes.-The fishes which are found off the shores of the various seas and lakes of European U.S.S.R. are dangerous only in their ability to injure by cutting or puncturing. The Trachinus vipera (weaver) is frequently present in the Baltic Sea. The Black Sea contains the following species: Dasyatis pastinaca (sting ray), Scorpaena porcus (scorpion fish), and Trachinus draco (weaver). Some of the river fishes may prove deadly upon ingestion because they contain an alkloid. The Dnepr (Dnieper), Volga, and Kuban' rivers contain species of Barbus and Schitzothorax (minnows) which may be poisonous. From 50'% to 100`% of the perch, bass, burbot (eelpout), pike and pike-perch in the estuary of the Neva are in- fected with Diphyllobothrium Tatum. (c) Mammals.-The usual domestic animals, such as horses, cattle, dogs, cats, donkeys, and camels, can all become quite important as sources of infections. This applies particularly to the Volga valley and the steppe regions of southeastern European U.S.S.R. where most of these animals may become a source of infection for plague. Page XI-5 There are still many rabid dogs, cats, and wolves in the country, and about 70,000 people are bitten every year. The European wolf, Canis lupus, is found in the north, and the bear, Ursus arctos, in the tayga region. The fox is also encountered in the northern regions. (3) Pests Some of the insects mentioned previously, such as ants, bedbugs, and cockroaches, may become pests when suffi- ciently numerous. Other pests include blackflies, cock- chafers and other beetles, spiders, and scorpions. (a) Blackflies.-Blackflies appear in great numbers and become an almost unbearable nuisance, particularly in the southern parts of the U.S.S.R. Among the species found, two particularly are ubiquitous; namely, Simulium vittatum and Simulium reptans. When they become very numerous, these species are often so annoying that the working capacity of the people is reduced. (b) Beetles.-Altogether 28 species of beetles, distrib- uted among 9 families, have been identified in European U.S.S.R. These families are: Anobiidae, Cleridae, Curcu- lionidae, Dermestidae, Histeridae, Ptinidae, Scarabaeidae (cockchafers), Silphidae, and Tenebrionidae. Some of these Coleoptera are pests only because they damage food, clothes, and furniture. Others are inter- mediate hosts for certain types of worms, particularly nematodes. Many are agricultural pests. (c) Spiders.-Spiders are universally present. Latro- dectus tredecimguttatus (a species of Black Widow) is frequently found on the beaches of the Azovskoye More (Sea of Azov), Caspian Sea, Black Sea and in the Ukraine south of Khar'kov. This spider is most active in summer, especially in thinly inhabited regions where there is abun- dant grass vegetation. Hay used as a spread on which to sleep often contains spiders. Severe local and general symptoms result from the bite of this species, but a fatal result has never been reported. Another spider found in southern European U.S.S.R is the Trochosa singoriensis, often called the South Russian Tarantula. (d) Scorpions.-Buthus cupeus is found in the area of Astrakhan' and in the Volga Valley. Euscorpius italicus lives along the shores of the Black Sea, and Euscorpius tauricus populates the Crimea, particularly the area a- round Sevastopol'. The sting of these scorpions, though painful, is said not to be fatal. D. Plants Scant information has been found concerning poisonous plants in European U.S.S.R. The darnel, Lolium temu- lentum (family, Gramineae), is subject to infection of its inflorescence by the fungus ergot, the ingestion of which by man or animal may be fatal. Any of the pollen-pro- ducing trees and grasses may be sources of allergic re- actions in susceptible individuals. E. Food (1) General In the U.S.S.R., the supplying of food is a public service. The state feels responsible for the production and dis- tribution of food to individuals according to their needs. An attempt is made to provide the entire population with a rational diet designed to conform to physiological needs and hygienic standards. The health authorities play an important part in the solution of the food problem. The food situation has always been a very serious matter in the U.S.S.R. Famines occurred about once in every 10 years, and serious crop failures about once in every 5 years. Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Page XI-6 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 JANIS 40 In the nineteenth century alone, famines occurred in the years 1822, 1833, 1840, 1873, 1880, 1883, 1891, 1892, .1898, and 1899. The disturbance created by civil war, foreign intervention, and boycott, after the Russian Revolution, resulted in the disastrous famine of 1920 to 1922 which cost the country numberless human lives and created end- less suffering. The famine caused mass migration in a search for food and contributed to the spreading of epi- demics. The Soviet Government decided to solve the problem of food and famine by collectivization and mechanization of agriculture. This proved to be a failure at the end of the first Five-Year Plan, and in 1932 the U.S.S.R. ex- perienced a disastrous famine again. The failure was caused by lack of cooperation on the part of the "kuiaks" (rich peasants), who openly sabotaged the government's plan. However, in 1933 all forces were mobilized to rem- edy the kulak situation, and since then the U.S.S.R. has been having record crops and no major food problems except those resulting from war and drought. Bread is one of the most important foodstuffs of the Russian. The government reduced the export of grain, so as to make more bread available for the population. In addition, in peacetime, the government attempts to keep a reserve equal to a full year's supply for emergencies such as war or crop failure. Mechanized bakeries were instituted. The Commissariat of Food Industry controlled about 170 mechanized bakeries in 1936, exclusive of local establishments. In 1937, 78' of all bread consumed in the Union was produced mechanically. The whole process is under strict medical supervision, and laboratories are attached to the bread factories to test ingredients. The workers are subject to medical control each day as a matter of routine. Meat is rather scarce in the Soviet Union. A great deal of livestock was lost during the years when the farms be- came collectivized. The number of sheep and goats was particularly low; pigs were more numerous. This was the situation in 1937. The war undoubtedly has created more critical conditions as a result of retreat and "scorched earth" policy. The meat consumption of the population in 1937 was higher than in preceding years. There are about 40 meat- packing plants (government controlled) in European U.S.S.R., the largest of which is the "Meat Combinat" in Moskva (Moscow) where 1,250 head of cattle, 3,500 pigs, and 1,500 sheep are slaughtered daily, producing a total of 500 tons of meat daily. Forty-three veterinarians are responsible for the quality of the products of this factory. Fishing is another extremely important branch of the Soviet food industry. Both seas and rivers are very rich in fish. However, the chief center of fishing is not in the European, but in the far eastern part of the Union. Fish- eries, like farms, are collectivized. Fish is sold to the population fresh, frozen, dried, salted, and canned. Previous to the Soviet regime canning was an unknown industry in Russia.. In 1936 the U.S.S.R. produced about 600 million cans of meat, vegetables, fruit, tomatoes, and milk, and about 225 million cans of fish. Fresh mill: is being delivered to dairies in the larger cities, where it is analyzed and tested by chemists and physicians. About, 75;, of it is delivered in pasteurized form. The ice cream industry is small; total Russian ice cream production in 1936 was 15,000 tons. The ice cream production is under strict medical supervision. Butter production is divided among mechanized factories and homes. Complete figures can not be reported be- cause no information on the home-made butter output is available. In the production of beet sugar the Soviet Union ranked first in the world before World War II, and the output was of such magnitude that, sugar could be exported in in- creasing quantities. Fruits and vegetables are scarce in the cities because of transportation difficulties; they are abundant in rural regions. Citrus fruits are very scarce throughout the U.S.S.R. Potatoes, cabbage, cucumbers, melons, and strawberries are abundant. Tea still must be imported, but in increasingly smaller quantities. Coffee is imported, but is not a popular beverage. (2) Collective feeding Collective feeding is a widespread practice in the Soviet Union since it is considered the best method of providing a correct diet for the people. It is believed to contribute to the welfare of workers as well as to the increase of their productivity. Every large working place, factory, office, or school has its dining hall. Collective meals are the rule in state farms and are becoming increasingly popular on collective farms. The direction and supervision of collective feeding is in the hands of Narpit (Nardonoe Pitanie: People's Nutrition). It consists of representa- tives of various government departments involved, such as Agriculture, Food, Internal Trade, and Public Health. In 1931 collective feeding embraced 42.8 of all industrial workers, 251( of office employees, and 801,( of university students. The scientific foundation for collective feeding is promul- gated by the Central Institute for Nutrition. Its program is the study of nutrition of man in health and illness. It has departments of physiology and biology, food hygiene, cooking, diabetic-therapeutic nutrition, nutrition of moth- ers and infants, education and training of technical staffs, and economics. It not only has laboratories, but also an infirmary with 120 beds. The nutritional standards worked out by the Institute are outlined in TABLE XI-1. Carbo- Total hydrates calories Workmen and residents of cities: 1-3 years 52 54 200 1,530 4-7 years 72 57 300 2,060 8-13 years 83 52 380 2,380 14-18 years 118 60 536 3,250 Adults 120 108 525 3,644 Maximum for very heavy work Rural districts: Average adults 115 96 592 3,800 Workmen in over- heated premises 130-150 In rural districts more carbohydrate and less protein are given than in cities. Twenty percent of the protein, according to the Institute, should be animal protein. Vitamins ordinarily should not be added to the food. However, in the northern districts where the diet is de- ficient, it may become necessary to add them. Lenin- grad has two factories producing vitamin A and vitamin C. (3) Food sanitation The supervision of sanitary conditions in large restau- rants and kitchens attached to factories is very strict. Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 HEALTH AND SANITATION Page XI-7 The same applies to bakeries and canneries. Workers must bathe and wash thoroughly before starting their daily work. The bathing facilities (showers and baths) are attached to the food plant or restaurant. This ideal condition of sanitation is found, however, only in large industrial centers and large cities. 112. PUBLIC HEALTH AND MEDICAL FACILITIES A. Public health organization (1) Republic The public health organization of each republic is headed by the Narkomzdrav (NKZ) (People's Commis- sariat for Public Health), divided into a number of depart- STRUCTURE OF PUBLIC HEALTH ORGANIZATION OF THE U.S.S.R. Sovietsky Narodnyy Kommissariat U.S.S.R. (Sovnarkom) (Council of the People's Commissars of the U.S.S.R.) Narodnyy Kommissariat Zdravookhraneniya (Narkomzdrav) (People's Commissars of Public Health of an SSR or an ASSR) ments (FIGURES XI-2 and XI-3). The Narkomzdrav con- trols all health work in the republic-preventive, diag- nostic, and curative. It also controls medical education, medical research, and medical industries. The adminis- trative organization is as follows : 1) People's Commissar of Public Health 2) Two vice-commissars of public health 3) Collegium, consisting of: Commissar Vice-commissars, each one of which acts as chief sanitary inspector for his oblast or kray President of medical workers' union Head, bureau of finance, commissariat for public health Peasant delegate Planning commission, to work out details of Collegium's policies and plans 4) Scientific medical council Oblastnoy Otdel Zdravookhraneniya (Dept. of public health of an Oblast) Kraevoy Otdel Zdravookhraneniya (Dept. of public health of a kray) Gorodskoy Otdel Zdravookhraneniya (Gorzdravotdel) (City dept. of public health) Rayonnyy Otdel Zdravookhraneniya (Rayzdravotdel) (Rural district and city borough depts.of public health) Legend ? ? ADVISORY FUNCTION ..~~~ DIRECT CONTROL FIGURE XI - 2. Structure of Public Health Organization, U.S.S.R. Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Page XI-8 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 JANIS 40 STRUCTURE OF COMMISSARIAT OF PUBLIC HEALTH OF THE U.S.S.R. Administration and Management of The People's Commissars for Public Health Chief Inspector for Sanitation Education Inspector for Controls and Complaints Sanitation; water, sewage, living conditions, etc. Conscriplion and Mobilization (Secret) Dept. of Construction (Finances) Dept. for Planning and Finances Dept. for Medical and Sanitation Statistics Dept. of Cadres b'IGURE XI - 3. Structure of Commissariat of Public Health, U.S.S.R. Chief Inspector for Obstetrics and Gynecology --A Dept. of Administrative and Economic Problems Teaching of personal hygiene. Development of physical culture. Appointment of trustees for insane persons. The selosoviet has the following functions in relation to social insurance. (2) Oblast (territory) and kray (region) Each oblast and kray has its own narkomsdrav in charge of its own department of health. The Department carries out policies and plans laid down by the narkomz- drav, controls health departments of cities (gorzdravotdel), and controls health departments of rural districts (rayz- dravotdel). (3) Rayon (rural districts and city boroughs) Each rayon has a department of health (rayzdravotdel) subject to the respective oblast or kray department of health (FIGURE XI-4) . The rayon department of health controls medical institutions within the limits of the rayon. The administration includes a rayon inspector of public health, and, in cities, one sanitary inspector to every 25,000 inhabitants, under the jurisdiction of chief sanitary inspector for the oblast or kray. (4) Village Village health matters are administered by the selo- soviet (village soviet), which has the following functions in relation to public health. Supervision of all hospitals in selosoviet budget. Organization of sanitation inspection. Control of venereal diseases. Keep register of insured persons. Disburse benefits. Form associations (artels) of invalids. Place war veteran invalids in groups for collective farming. Appoint trustees for deaf, dumb, and blind. (5) Commissariats of Transportation and Defense The Commissariats of Transportation and of Defense have subsidiary health administrations independent of the Commissariat for Public Health. The Commissariat of Defense provides health and medical service for the army, and navy. B. Hospitals and medical institutions (1) Hospital facilities Hospital facilities were inadequate in Tsarist Russia. Though considerably improved, hospital facilities in the Administration of Pediatric Services Government Sanitary Control and Inspection Administration of Offices engaged in epidemic control polyclinics in towns and villages Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 HEALTH AND SANITATION Page XI-9 SAMPLE OF ORGANIZATION OF RURAL MEDICAL DISTRICT OUTSIDE OF REGIONAL CENTER Selskiy Soviet (Village Soviet) Feldshersko-Akusherskie Punkty (Feldsher and midwife aid stations) Dizinfektor (Sanitation Officer) Sanfeldsher (Asst. Sanitation Officer) Hospital and ambulatory, internal medicine, surgery, infectious diseases, obstetrics, laboratory X-ray. Rayonnyy Otdel Zelravookhraneniya (Rayzelravotdel) (Rural District Dept. of Public Health) Chief of rural medical district in a village Oblastnoy Aptekoupravlenie (Pharmaceutical Administration for Oblast) Office of consultation for women and children Dairy kitchen Sanitary activities in school, village, etc. Legend DIRECT INTERDEPENDENCE SUPERVISION AND CONTROL FIGURE XI - 4. Rural Medical District. Sample of organization outside of regional center. U.S.S.R. are poor by American standards even today. Cer- tain diseases and services have received special consider- ation because they were completely neglected in pre- Soviet Russia. The number of beds has been increased more rapidly for tuberculosis, venereal diseases, and ob- stetrics than for other specialties. (a) Hospital beds.-The total bed capacity of hos- pitals exclusive of sanatoria and health resorts was 185,374 in Tsarist Russia (1913). This number was increased in 1941 to 877,296 (according to another source, to 710,000). The Five-Year Plan which was started in 1945, provides for a further increase to 985,000 beds by 1950. Of the 877,296 hospital beds accounted for in 1941, 491,543 served cities and 169,888 were located in rural communities; 73,992 beds were set aside for psychiatric cases and 141,873 beds were located in maternity hos- pitals. These numbers do not include the beds of the various sanatoria, permanent and seasonable nurseries, dispensaries, and emergency agencies. Of the 491,543 beds in cities of the U.S.S.R. in 1941, the R.S.F.S.R. had 320,283 beds, the Ukrainian S.S.R. 88,759, the White Russian S.S.R. 15,731, the Karelo-Finnish S.S.R. 1,775, and the Moldavian S.S.R. 861. The greatest relative increases in bed capacity took place in the White Russian S.S.R. and Moldavian S.S.R. (TABLE XI-2). The Original number of hospital beds in the U.S.S.R. per 1,000 popula- tion in cities rose from 3.9 in 1913 to 8.2 in 1941. The ratio in the R.S.F.S.R. was 8.2, in the Ukrainian S.S.R. 7.5, in the White Russian S.S.R. 10.9, in the Karelo-Finnish S.S.R. 9.1, and in the Moldavian S.S.R. 11.5 per 1,000 popu- lation in 1941 (TABLE XI-2). The Caucasian republics are not mentioned individually; they are included in the numbers referring to the U.S.S.R. The numbers referring to the R.S.F.S.R. include Siberian republics also. Of the 169,888 beds in rural hospitals in the Soviet Union in 1941 approximately 114,094 were located in the R.S.F.S.R., 30,726 in the Ukrainian S.S.R., 3,069 in the White Russian S.S.R., 1,144 in the Karelo-Finnish S.S.R., and 277 in the Moldavian S.S.R. In 1913 the number of hospital beds in rural localities was small, but by 1941 it had shown some increase (TABLE XI-2). The most impressive developments again are seen in the southern European constituent republics. In rural localities the number of beds per 1,000 population was 0.44 in 1913 and rose to 1.47 by 1941 for the entire territory of the U.S.S.R. The individual republics in 1941 ranked in the following order with respect to beds per 1,000 population : The Kare- lo-Finnish S.S.R. with 2.69, the R.S.F.S.R. with 1.58, the Ukrainian S.S.R. with 1.51, the White Russian S.S.R. with 0.73, and the Moldavian S.S.R. with 0.48 (TABLE XI-2). Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Page XI-10 U.S.S.R. and Constituent Republics Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 JANIS 40 in cities 1913 1928 1932 1938 1941 R.S.F.R. 65,467 115,792 176,697 Ukrainian S.S.R. 19,556 21,122 42,289 White Russian Karelo-Finnish S.S.R. 305 559 1,097 Moldavian S.S.R. 64 86 147 Remaining Beds per 1,000 293,925 320,283 8.2 82,963 88,759 7.5 1,576 1,775 9.1 786 861 1.1.5 U.S.S.R. 93,223 158,514 256,158 450,694 491,543 8.2 R.S.F.S.R. 38,653 42,859 84,007 104,452 Ukrainian S.S.R. 8,668 11,269 20,524 27,720 White Russian S.S.R. Karelo-Finnish 114,094 1.58 30,726 1.51 1,144 2.69 277 0.48 S.S.R. 132 241 380 Moldavian S.S.R. 156 162 195 Remaining republics U.S.S.R 49,087 59,230 116,075 153,129 169,888 1.47 A certain percentage of beds in the hospitals is devoted to certain specialties. As shown in TABLE XI--3, obstetrics and pediatrics have gained. in importance, a fact which reflects the increasing attention being paid to care for mother and child. On the other hand, the number of beds devoted to dermosyphilopathy had decreased very con- siderably, which would correspond to the Russian claim that the venereal disease rate has been lowered as com- pared with prior years. PERCENTAGE OF CITY HOSPITAL BEDS DEVOTED TO CERTAIN SPECIALTIES, 1928 TO 1941 S P E C I A L T I E S i hD .0 i O. I ~ on I i R3 d n ? . 11 N Q1 ~ .y Ld 0 I 0 Republics I Year I 0 0 0 A a z j 0 0 0 R.S.F.S.R. 1928 20.2 19.4 5.4 6.5 6.6 3.3 4.1 2.9 1.7 29.9 1941 16.2 16.4 15.1 5.6 2.2 17.4 1.8 2.5 1.2 21.6 Ukrainian 1928 17.6 21.4 8.3 7.4 4.3 5.6 3.2 4.0 1.4 26.8 S.S.R. 1941 14.1 17.8 14.4 7.1 2.8 13.2 1.8 2.3 1.7 24.8 White Russian 1928 18.9 24.9 6.6 6.5 7.2 2.2 0.6 7.4 3.2 22.5 S.S.R. 1941 15.0 13.6 16.0 4.9 2.1 9.4 1.2 3.9 1.7 32.2 (b) Rural medical centers.-The number of rural medical centers in the U.S.S.R. was 13,512 in 1941. With- in the U.S.S.R., the R.S.F.S.R. had 7,963, the Ukrainian S.S.R. 2,445, the White Russian S.S.R. 539, the Karelo- Finnish S.S.R. 116, and the Moldavian S.S.R. 28 (TABLE XI-4). (c) Technical equipment.-The technical equipment of the hospitals in the U.S.S.R. must be regarded as poor. Information on such equipment for rural hospitals, pre- sumably inferior to that of urban hospitals, is not avail- U.S.S.R. and constituent republics U.S.S.R. total R.S F.S.R. Ukrainian S.S.R. White Russian S.S.R. Karelo-Finnish S.S.R. Moldavian S.S.R. Year 4,367 7,531 9,883 11,594 13,512 3,069 4,940 5,442 6,992 7,963 1,007 1,751 2,641 2,148 2,445 131 188 314 467 539 - - - Included in R.S.F.S.R. - - - 116 - - - Included in R.S.F.S.R. - - - 28 able. In the cities of the entire Soviet Union. in 1941 it was reported that 25.5'j,, of all the hospitals had physio- therapy equipment, 36.2';' had X-ray equipment, and 41.9 had laboratory equipment. The figures for the con- stituent republics in European Russia are given in TABLE XI-5. CITY HOSPITALS WITH PHYSIOTHERAPY, X-RAY, AND LABORATORY EQUIPMENT, 1941 U.S.S.R. and Percentage of total number of hospitals constituent With With With republics physiotherapy X-ray laboratories U.S.S.R. 25.5 36.2 41.9 R.S.F.S.R. 27.5 38.2 40.1 Ukrainian S.S.R. 27.8 36.3 48.2 White Russian S.S.R. 20.9 36.6 '77.6 Karelo-Finish S.S.R. 45.5 63.6 36.4 Moldavian S.S.R. 57.2 71.4 71.4 (d) Health propaganda.-Health propaganda was virtually unknown in Tsarist Russia and the number of outpatient clinics for medical consultation was small. By emphasizing health propaganda and free medical ad- vice to the population, outpatient, clinics have increased very considerably in number. The absolute number of clinics is still inadequate, but the tendency is to further develop these facilities. (TABLE XI-6) U.S.S.R. and constituent republics U.S.S.R. 1,230 5,673 7,340 12,645 13,461 R.S.F.S.R. 893 3,307 3,988 7,543 8,160 Ukrainian S.S.R. 187 1,276 1,712 2,554 2,600 White Russian S.S.R. 24 276 337 487 476 Karelo-Finnish S.S.R. 3 35 31 44 65 Moldavian S.S.R. .. 10 13 34 30 (2) Medical institutions (a) The Academy of Medical Sciences.-The Academy of Medical Sciences comprises 60 of the most outstanding medical scientists of all branches of medical science, all of whom were confirmed in 1945 by the Narkomzdrav as Academicians. The nature of the activities of this body are not yet known. (b) Research institutions and medical schools.-The research institutions and medical. schools in the U.S.S.R. in 1941 numbered 223 separate institutes whose medical research was carried on under the authority of Narkomz- drav and whose personnel amounted to 19,500 scientific workers. The institutes operate 'with the advice of 16 or 17 committees of the Medical Research Council (Uchonyy Meditsinskiy Soviet), which is a body of outstanding Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 HEALTH AND SANITATION scientists selected by Narkomzdrav. The council examines their research plans, personnel and equipment needs, and budget, after which its decisions are transmitted to the Narkomzdrav where final decisions are made. There are four kinds of institutes under the Narkomz- drav: Central Institutes, Special Institutes, the All-Union Institute of Experimental Medicine (VIEM), and Medical Institutes (Medical Schools) . 1. CENTRAL INSTITUTES.-Central Institutes are en- gaged chiefly in clinical work. There are 12 of them and all conduct research in their own fields; tuberculosis, skin and venereal diseases, microbiology and epidemiology, on- cology, neurosurgery, endocrinology, otolaryngology, ophthalmology, plague, malaria and tropical diseases, obstetrics and gynecology, and pediatrics. A branch of each Central Institute must be established in each re- public of the U.S.S.R., budgeted and coordinated through the Narkomzdrav of the republic, but directed by their respective parental institutes. Vaccines, sera, and other biologic products are manufactured in the Central Insti- tute of Microbiology and Epidemiology. 2. SPECIAL INSTITUTES.-Matters such as trauma- tology, prosthesis, orthopedics, industrial hygiene, and sanitation education are dealt with by Special Institutes. These organizations do not have branches in the republics and usually are limited to a single laboratory. Each Narkomzdrav has its own Special Institutes which are directly under its jurisdiction and are not connected with the national institutes. 3. ALL-UNION INSTITUTE OF EXPERIMENTAL MEDICINE (VIEM).--This organization does most of the fundamental medical research. The Moscow branch has 13 departments; the Leningrad branch, 6 departments; and at Sukhumi in the Caucasus there is a monkey station. The depart- ments of the Moscow branch are: General physiology, physiology of the nervous system, physiology of the special Page XI-11 organs, biochemistry, organic chemistry, morphology, general experimental biology, biophysics, general pathol- ogy, virus diseases, microbiology, brucellosis, and tula- remia. There are small physiology laboratories which work on problems in electrophysics, vitamins, endocrines, and ferments. Two hospitals are attached to VIEM in Moskva (Moscow), one for surgery and the other for neu- rosurgery. The departments of the Leningrad branch are : Physiology, special physiology, chemistry of microbes, microciology, morphology, and general pathology. The VIEM personnel numbers about 2,000, of whom 500 are scientific workers including 85 professors. The VIEM publishes a monthly journal, the Arkhiv Biologi- cheskikh Nauk (Arch. Biol. Sciences), as well as brochures and collected works. 4. MEDICAL INSTITUTES.-In 1941 there were 72 medi- cal institutes. known as Medvuz (Meditsinskie vishie Uchebhie Zavedeniya), of which 51 were general medical schools and 21 were stomatologic institutes and pharma- cologic institutes. In addition there is a Medico-Military Institute in Moskva (Moscow), which gives a complete medical course. This school is under the direction of military authorities. Each republic has at least one gen- eral medical school. The total enrollment of students in the general medical schools in 1941 was approximately 106,000, the largest enrollments being in Moskva (Mos- cow), Leningrad, Kiyev (Kiev), and Khar'kov. The total enrollment in 1939 in the Institutes of Stomatology and of Pharmacology was about 14,000. Each department of a medical institute is required to conduct scientific work as well as to teach students. Tlp institutes are directly under the jurisdiction of the re- public Narkomzdrav, and their research programs are examined and supported by the respective local narkomz- drav. The 46 medical institutes located in European U.S.S.R. are listed in TABLE XI-7. TABLE XI-7 MEDICAL INSTITUTES IN EUROPEAN U.S.S.R., 1935 Republic or Oblast Town Specialty taught Rostovskaya Oblast' Rostov-na-Donu Meditsinskiy Institut All specialties (Medical school) Voronezhskaya Oblast' Voronezh Meditsinskiy Institut do. (Medical school) Gor'kovskaya Oblast' Gor'kiy Meditsinskiy Institut do. (Medical school) Smolenskaya Oblast' Smolensk Meditsinskiy Institut Therapy, general medicine (Medical school) Ivanovskaya Oblast' Ivanov Meditsinskiy Institut Therapy, prophylaxis, (Medical school) pediatrics, general medicine Kuybyshevskaya Oblast' Kuybyshev Meditsinskiy Institut Therapy, general medicine (Medical school) Kurskaya Oblast' Kursk Meditsinskiy Institut Therapy, general medicine (Medical school) Leningradskaya Oblast' Leningrad Pervyy Meditsinskiy All specialties Institut (1st medical school) Do. do. Vtoroy Meditsinskiy General medicine, therapy, Institut (2nd Medical prophylaxis, hygiene school) Do. do. Tretiy Meditsinskiy Therapy, general medicine (3rd medical school) Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Page Xl-12 JANIS 40 TABLE XI-7 (Continued) Republic or oblast Town Name of institute or school Specialty taught Leningradskaya Oblast' Leningrad (Continued) (Continued) Do. do. Pediatricheskiy Pediatrics Institut (Pediatrics school) Do. do. Medvuz pri bolnitse Hospital and school Mechnikova (Medical school attached to Mechnikov Hospital) Do. do. Stomatologicheskiy Stomatology Institut (School for stomatology) Moskovskaya Oblast' Moskva Pervyy Meditsinskiy All specialties Institut (1st Medical school) Do. do. Vtoroy Meditsinskiy General medicine, therapy, Institut (2nd medical pediatrics school) Do. do. Medvuz pri Krasno Hospital and school Sovetskoy Bolnitse (Medical school attached to hospital) Do. do. Medvuz pri Bolnitse Hospital and school Babukhina Do. do. Farm. Fakulbet Pharmacology (Pharmacological faculty) Do. do. Stomatologicheskiy Stomatology Institut (Stomatological institute) Saratovskaya Oblast' Saratov Meditsinskiy Institut General medicine, hygiene, (Medical school) therapy, pediatrics Arkhangel'skaya Oblast' Arkhangel'sk Meditsinskiy Institut Therapy, prophylaxis (Medical school) Astrakhanskaya Oblast' Astrakhan' Meditsinskiy Institut Therapy, prophylaxis (Medical school) Stalingradskaya Oblast' Stalingrad Meditsinskiy Institut Therapy, general medicine (Medical school) Tatarskaya A.S.S.R. Kazan' Meditsinskiy Institut Therapy, general medicine (Medical school) Bashkirskaya A.S.S.R. Ufa Meditsinskiy Institut Therapy, general medicine (Medical school) Krymskaya Oblast' Simferopol' Meditsinskiy Institut Therapy, general medicine (Medical school) Udmurtskaya A.S.S.R. Izhevsk Meditsinskiy Institut Therapy, general medicine (Medical school) Ukrainian S.S.R. Vinnitsa Meditsinskiy Institut Therapy and pharmacology Vinnitskaya Oblast' (Medical school) Dnepropetrovskaya Dnepropetrovsk Meditsinskiy Institut Therapy and prophylaxis Oblast' (Medical school) Do. do. Farmatsevticjeskiy Pharmacology Institut (Pharmaco- logical school) Stalinskaya Oblast' Stalino Meditsinskiy Institut Therapy and general (Medical school) medicine o Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 HEALTH AND SANITATION Page XI-13 TABLE XI - 7 (Continued) Republic or oblast Town Kiyevskaya Oblast' Kiyev Do. do. Do. do. Do. do. Odesskaya Oblast' Odessa Khar'kovskaya Oblast' Khar'kov Do. Poltava White Russian S.S.R. Minsk Name of institute or school Specialty taught Meditsinskiy Institut All specialties (Medical school) Farmatsevticheskiy Institut (Pharmacology school) Stomatologicheskiy Institut (Stomatology school) Pharmacology Stomatology Proizvodstvennyy Therapy, prophylaxis, Meditsinskiy Institut general medicine (School for industrial medicine) Meditsinskiy Institut Therapy, prophylaxis, (Medical school) hygiene, pediatrics Mediko-Analiticheskiy Laboratory work and Institut (School for sanitation research medical analysis) Proizvodstvennyy Medit- Therapy, prophylaxis sinskiy Institut (School for industrial medicine) Meditsinskiy Institut Therapy, prophylaxis, (Medical school) pediatrics, hygiene Farmatsevticheskiy Pharmacology Institut (Pharmacology school) Stomatologicheskiy Institut (Stomatology school) Psikho-Nevrologicheskiy Institut (School for neuropsychiatry) Stomatology Neuropsychiatry Proizvodstvennyy Therapy, prophylaxis Meditsinskiy Institut (School for industrial medicine) Proizvodstvenny Therapy, prophylaxis Meditsinskiy Institut (School for industrial medicine) Meditsinskiy Institut Therapy, prophylaxis (Medical school) Meditsinskiy Institut Therapy, prophylaxis (Medical school) In addition to medical schools there are "postgraduate institutes" for physicians, and they are entirely separate from the medical schools. Specialists in clinical subjects and research workers are trained in the medical schools or in the many research institutes of the Soviet Union. Of the scientists and teachers working in the medical and research institutes, 87% have been medically trained and the remainder were biologists, chemists, economists, and engineers. Sixty percent of the workers at these insti- tutes were women. Original C. Medical personnel (1) Professional medical personnel (a) General.-The physicians (general practitioners and specialists), dentists, and veterinarians who have been educated in institutions of university standard, constitute the higher medical personnel. (b) Preparation for medical practice.-In 1930 during the first Five-Year Plan, the modern period of medical education began in Soviet Russia. Emphasis on medical education was deemed essential and radical changes were Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Page XI-14 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 JANIS 40 made in its administration and curriculum. Medical schools were placed under the jurisdiction of the Com- missariat of Public Health (Narkomzdrav). The medical course was shortened to four years. The subjects were reduced in number and were coordinated, duplication was eliminated, recitations and lectures were restricted, and use of Latin terms discontinued. Moreover, the usual subjects of medicine were curtailed while hygiene and preventive medicine were alloted additional time. Social sciences, economics, physical culture, and military train- ing occupied almost 40%v of the time. Students worked in groups and carried out collective tasks. Examinations again were abolished. Since specialists were desired in all institutions, three faculties of medicine were estab- lished : general medicine and prophylaxis, hygiene and sanitation, and pediatrics including maternity and child protection. The results achieved from the curriculum were not satisfactory. By 1935 the medical course was again lengthened to five years. Lectures and recitations were increased, group projects were reduced, Latin was resumed for medical terms, and individual examinations were reintroduced. At the same time, the number of instructors and the amount of medical equipment were increased. With the beginning of 1945 the course of study in all medical universities was advanced to cover six years. The new curriculum was to pay particular attention to anat- omy, physiology, and biochemistry. Intensified instruc- tion was to be given in clinics for internal diseases, in- fectious diseases, surgery, pediatrics, and obstetrics and gynecology. Radiology, urology, and physiotherapy was to be taught only in basic surgical and therapeutic clinics. (c) Physicians.-In 1913 there were 19,785 physicians in Russia; in 1941 the number was 130,348. Despite severe losses medical education continued without interruption throughout the war. During the first 18 months 32,000 graduates took their places in the ranks of military and civilian medicine of the Soviet Union. No information on the territorial distribution of physicians in European U.S.S.R. is available. For medical students and doctors, three. types of prac- tice are to be introduced : 1) practice as a feldsher (doc- tor's assistant) after termination of the third year of study; 2) practice preliminary to becoming a doctor, after four years of study; 3) practice as a doctor, after five years of study. Every physician in the U.S.S.R. is required to take three to six months of postgraduate instruction every three years. (d) Dentists.--The dentists, like the. physicians, are under the jurisdiction of the Narkomzdrav. Since 1918 the dental profession has been subdivided into two groups : 1) stomatologists, and 2) dentists (zubnoy vrach). The stomatologists are fully trained doctors who have special- ized in dentistry and stomatology. The dentists receive their training in dentistry only and do not study in medical schools. The number of dentists in European U.S.S.R. reported by the Soviet authorities in 1937 was 10,508, or 881yc of the total number of dentists in the entire territory of the Soviet Union. In that year it was planned by 1942 to in- crease the total number for the entire Union from 13,000 to 32,000. Whether this goal was reached cannot be determined from available literature. (e) Veterinarians.-The department of veterinary affairs in the Soviet Union is part of the NKZ or Narkom- zem (People's Commissariat of Agriculture). Each con- stituent republic has its own individual NKZ and thus its own attached department of veterinary affairs which has the task of managing, administering, and supervising all veterinary activities of that particular republic. Each kray, oblast, and rayon has also its own individual veteri- nary department. Among other activities the veterinar- ians take care of slaughterhouses and meat inspections as well as the inspection of industries engaged in process- ing animal products. No recent data are available on the present veterinary manpower in European U.S.S.R. The veterinary feldsher has the same position in the veterinary profession as the regular feldsher in the medical profession. (2) Subprofessional medical personnel (a) General.-Apart from the professional personnel there are other medical workers comprising the "middle medical classifications," apparently so-called because they receive their training in middle schools (preparatory or high schools). Middle, or subprofessional, medical work- ers consist of the following categories: Feldsher, midwife, medical nurse, child nurse, laboratory technician, dental technician, and pharmacist. (b) Feldshers.-The position of the feldsher and the feldsheritsa is a peculiarly Russian institution. The word "feldsher" is of German origin and literally means "field barber." Before the nineteenth century all European arm- ies had surgeons who had not been trained in universities but had received their preparation through apprentice- ship and special courses. On account of its size and the general lack of trained physicians and surgeons, however, the Russian Army still makes use of the feldsher. He prac- tices not only in the arm; but among civilians. The special functions of the feldshers always have been to assist physicians, carry out their instructions, practice minor surgery, vaccinate, and assist in fighting epidemics. Because of the lack of physicians, some rural medical stations are headed by feldshers. The number of aid stations headed by feldshers and midwives in 1941 is shown in TABLE XI-8. NUMBER OF AID STATIONS HEADED BY FELDSHERS AND MIDWIVES, 1941 o Ca a) U.S.S.R. and o 3 0 o cu o o constituent c a Cd -1-1 U)C -E! ig Ca o republics W ca W fl m H D H U.S.S.R. 19,683 8,885 5,117 4,577 170 980 39,412 R.S.F.S.R. 11,552 6,218 2,534 3,564 90 183 24,141 Ukrainian S.S.R. 4,759 998 1,744 18 13 14 7,546 White Russian S.S.R. 48 901 55 179 1,183 Karelo-Finnish S.S.R. 116 83 11 210 Moldavian S.S.R. 52 5 10 67 In 1937 the number of subprofessional medical personnel trained in feldsher schools was 44,770; in schools of mid- wifery, 13,300; in schools of nursing (medical and child), 95,000; and in courses for laboratory technicians, 5,200. These figures apply to the whole of the Soviet Union: No information covering European U.S.S.R. alone is available. In 1941 there were in the Soviet Union 985 subprofessional schools which graduated 85,000 students per year. The majority of the 460,000 middle medical workers in were women. 1941 (c) Nurses.-The exact number of nurses in European U.S.S.R. is not known from available sources, but it is known that there is a great shortage, probably because factories, offices, and social services absorb a large number of the women workers. Medical nurses and children's nurses are now being trained in two-year courses. Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 HEALTH AND SANITATION (d) Dental technicians.-Although trained for tech- nical work only, dental technicians perform some clinical work because of the shortage of fully qualified dentists. Some technicians have acquired considerable skill in clinical dentistry and help to relieve the dental manpower shortage. The number of these workers in European U.S.S.R. is not known. (e) Midwives.-The midwife is an essential factor in obstetrical practice in the Soviet Union. The large num- ber of midwives which existed prior to the era of trained obstetricians is steadily decreasing, but in rural localities the midwife is still the only practitioner available. No information as to the number of midwives in European U.S.S.R. has been found. (f) Laboratory technicians and pharmacists.-These workers in the Soviet Union occupy a position comparable to that in other countries. D. Rest and recreation facilities (1) Health resorts The U.S.S.R. has only a few elegant resorts, but is rather rich in localities which provide good conditions for differ- ent types of therapy. The broad area extending from the Arctic Ocean to the Black Sea and to the Pacific Ocean contains innumerable varieties of mineral springs, beaches, mountain resorts, and other resorts where climatic treat- ment, balneotherapy, and radioactive mud baths are available. Of the 1,400 mineral springs spread over the entire continent of Europe, 534 are within the territory of European U.S.S.R.; many other such springs are situated in the Asiatic part of the Soviet Union. Although the most numerous health resorts of the entire Union are in the Caucasus, the most important in the European part of the U.S.S.R. are the Crimean resorts. The latter are located mainly along the southern beaches of the Crimean peninsula, and are operated all the year round. The numbers of health resorts in different parts of the U.S.S.R. are shown in TABLE XI-9. Next in impor- tance are the resorts near Odessa, such as the towns of Kuyal'nik, Proletarskoye Zdorov'je, and Kholodnaya Bal- ka, known for their therapeutic muds. Farther to the north are Slavyansk near Khar'kov, Osipenko and Yeysk on the Sea of Azov, and El'ton and Tinaki in the lower Volga region. An extensive strip of health resorts is represented by the Black Sea coast of the Caucasus, ex- tending as far south as Batumi (Batum), and including the towns of Sochi, Gagry, Sukhumi, and Krasnaya Poly- ana. These places are considered to be equal in their climatic advantages and other features to Nice and the rest of the French and Italian Riviera. Sanatorium care is available in the health resorts for patients who need it, but ambulatory patients live in hotels, villas, and country homes attached to the sanatoria. Polyclinics have specialists on their staffs, including bal- neologists and special physiotherapists who are well trained for the particular type of work carried on in the health resort where the clinic is located. There are several research institutes which occupy themselves with the exploration of the different thera- peutic factors of any type of health resort; they are under the general direction of the "Tsentral'nyy Institut Kurar- bologii" (Central Institute for Balneology), located in Moskva (Moscow). The institutes in Yalta and Krasno- dar concentrate on research connected with health resorts for tuberculosis. The "Sechenovskiy Institut" in Sevas- topol, does research in physiotherapy among other things. These institutes also train doctors for practice in health resorts. Original Page XI-15 The purely scientific activities of such institutions are under the jurisdiction of the Narkomzdrav, which also controls those specialities which are secondarily connected with health resort activities, such as geology, chemistry, biology, climatology, engineering, and construction. The official paper of these health resort institutions is the "Kurortuoe Delo". YEAR-ROUND HEALTH RESORTS FOR ADULTS AND CHILDREN, 1935 Health Resorts Health Resorts for Adults for Children Tubercu- Tuber- Ne uropsy- losis All other culosis c hiatry All other sana- toria resorts sana- toria s ana- toria resorts U.S.S.R. Number of resorts 113 439 127 32 306 Number of beds 13,471 80,715 R.S.F.S.R. 9,311 1,838 34,260 Number of resorts 92 297 89 24 172 Number of beds 10,195 56,775 Ukrainian S.S.R. 6,480 1,459 18,299 Number of resorts 12 81 27 4 73 Number of beds 1,853 15,867 1,781 244 8,531 White Russian S.S.R. Number of resorts 2 2 1 4 Number of beds 411 150 200 285 (2) Red Corners, clubhouses, and parks The U.S.S.R. was the first country to organize a program of rest and recreation on a large scale as part of the general public-health program of the nation. Every working place, small as it may be, has its "Red Corner", or social center; larger enterprises have their own clubhouses built with money earned by the factory. These clubs have rooms for dining, rest, study, and games; a dance hall, library, cinema, and theatre. The workers' clubs are organized by trade-unions and are exceedingly active. There are also many rest and recreation opportunities outside of the working places, including one-day rest homes and parks. All cities take pride in having good "Parks of Culture and Rest," the prototype of which is the "Maxim Gorki Park" in Moskva (Moscow). These parks are centers of recreation and entertainment, and have become institutions of great hygienic significance. In addition, physical culture and sports have become highly popular. It has been estimated that about 25,000,- 000 people take some active part in sports in the U.S.S.R. Some of the factories begin their day's work with physical exercises, and gymnastic periods of three to five minutes are held during working hours. The trade-unions, in ad- dition, have clubs outside the factories and mills, such as yacht, rowing, and football clubs where the workers of various plants meet. Corrective physical exercises are utilized in the factories to counteract the effects of certain occupations, and to increase the productiveness of labor. E. Social service agencies (1) General Social service activities in the U.S.S.R. are largely state- controlled and state-supported except for the Red Cross and Red Crescent organizations. Governmental social service is a part of the national medical service program and includes such features as social insurance and care for mother and child. The health of the individual is con- sidered just as much the responsibility of the government as the health of the nation as a whole. The state-financed Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Page XI-16 JANIS 40 health system has several characteristic features, as fol- lows: Medical service is free to all; the prevention of di- seases is its principal goal; all health activities are directed by central bodies (People's Commissariats of Health) ; and promotion of health is being planned on a large scale. (2) Social insurance About 30% of the population of the Soviet Union con- sists of wage-earners. Their health service is financed primarily through social insurance which is administered by the trade-unions. Social insurance in the Soviet Union includes : 1) Medical care, 2) benefits in case of temporary disabilities, 3) additional benefits to families having children beyond a certain number and for funerals. 4) unemployment benefits, 5) invalid pensions, 6) old-age pensions, and 7) pensions to families in case of death of the breadwinner. Social insurance extends its benefits not only to the insured workers but to their dependents as well. In case of temporary disability the insured person is paid full wages from the first day, the allocation amounting to the average of the wages paid during the last three months. In case of permanent disability, whatever its cause may be, the insured worker or employee is entitled to a pension. Pensions range from 40 to 100%, of former wages ac- cording to the degree of disability and its cause. Further- more, pensions are paid to family members who have lost their main source of support. All insured persons are entitled to old-age pensions of 50 to 60% of the last year's wages upon reaching the age of 60 (women 55), or 50 if they were employed in unhealthy or underground work. They must, however, have worked for not less than 25 years (20 years for women). While social insurance is administered by the trade-un- ions, the medical services given to the insured workers and their families is controlled by the Commissariats of Health. They are responsible for providing such services, and they receive the financial means required from the social insurance funds. The health work for the agricultural population is financed by the so-called "indivisible funds" which the kolkhozs (collective farms) have in their budget. These funds constitute between 10'%% and 20%/% of each kolkhoz' earnings, a part of which is used for acquiring and im- proving equipment, and part of which is used for building nurseries and dispensaries, and for health work at large. Since these funds are not sufficient for a full health pro- gram, they must be supplemented by mutual aid funds and state medical service through a network of health stations financed primarily from public funds. (3) Care for mother and child The special health problems and needs of women and children are the concern of a number of specialized insti- tutions. Health centers usually have Women's Consulta- tion Bureaus attached to them, to which women can apply for advice and treatment. Before World War II almost all ? the children born to city women were delivered in maternity hospitals, but the country districts were not so well equipped. There were special polyclinics, dis- pensaries, and hospitals provided for children, and in many cases children's consultation bureaus were attached to health centers. It was the duty of these bodies to supervise the health of the child from the day of its birth, to, see that the necessary vaccinations and inoculations were administered, and that medical aid was given either at home or in the hospital when required. Nurseries and kindergartens cared for the preschool child in town and country, while a special team of school doctors as well as the general network of health centers looked after the school child, and special group treatment was arranged for delicate children. Regular medical examinations and special health care were prescribed for adolescents, and their health was further protected by labor legislation controlling their hours of work and vacations. Research centers such as the Central Scientific Research Institute for the Protection of Motherhood and Infancy study all problems connected with health of women and children, and establish norms and set standards to be observed in their health and care. There are no statistics at present available on the care of children in European U.S.S.R. alone. The statistics for the whole of the Soviet Union give an inaccurate pic- ture if used as an indication since the European part is far in advance of the rest of Russia. The war had a very detrimental effect on the health of Russian children, particularly in the front areas and in German-occupied territories. Insufficient food, prolonged cold, bad living conditions, and the psychological shocks inflicted by bombardment all took their toll, and most of the children treated in children's hospitals and polyclinics were found to be suffering from alimentary dystrophia, avitaminosis, and similar diseases. Children subjected to the German occupation also suffered grave mental dis- abilities. Institutional facilities for children, including nurseries, were criticized in Soviet papers for lack of man- power and general equipment. The noticeable effects of war conditions on the health of children may prove a handicap to the Soviet efforts for postwar reconstruc- tion. (4) Red Cross and Red Crescent The Russian Red Cross, called in Moslem regions the Red Crescent, was organized in 1867. It is a philanthropic society that follows the pattern of the Red Cross societies in other countries. The Soviet Red Cross is a member of the International Red Cross and has representatives in Geneva and New York. A delegate of the International Red Cross has an office in Moskva (Moscow). In 1934 the Red Cross and Red Crescent of the U.S.S.R. were admitted to the League of Red Cross Societies. Activities of the Red Cross and Red Crescent include nursing sick and wounded soldiers and aiding prisoners of war. During the famine period 1921 to 1922 they organ- ized large-scale relief operations in the Volga region and fed 130,000 people daily. They work in close cooperation with authorities, and supplement and integrate the gov- ernment medical services. Their membership in the Soviet Union grew from 75,000 in 1926 to over 5,000,000 in 1934. In addition to the activities mentioned above, the Red Cross occupies itself with health education, teaching of first-aid measures, and training of nurses and health instructors. In 1935 the Red Cross established 48,282 stations, mostly in villages, where they performed sani- tation work. No statistics are available for the activities, personnel, and equipment controlled by the Red Cross and Red Crescent societies in European U.S.S.R. 113. DISEASES A. Diseases of military importance (1) Malaria (a) Distribution.-The U.S.S.R. contains a large ma- larious area which extends from the Asiatic steppes to the plains around the Caspian Sea; from Astrakhan' along the banks of the Volga River on the one side to the Cau- casian valleys on the other. It reaches the northern Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 HEALTH AND SANITATION 400 1900 1902 1904 1906 1908 1910 1912 1914 1916 1918 1920 1922 1924 1926 1928 1930 1932 1934 1936 FIGURE XI - 5. Malaria in the U.S.S.R. Incidence per 10,000 inhabitants, 1900-1936. shores of the Black Sea and extends along the banks of the Dnepr (Dnieper) and Dnestr (Dniester) rivers into the Ukraine and Volhynia, continuing along the Danube River to the Balkans. The Ukrainian swamps offer favorable breeding sites for mosquitoes. The overflowing of the big rivers in spring creates new swamps each year and plays an important part in increasing the incidence of malaria to epidemic proportions. The important malaria vectors in European U.S.S.R. are discussed in Topic 111, C, (1), (a). Before the revolution, malaria was the predominant communicable disease with a morbidity rate of 215 per 10,000 population. In the six years (1918 to 1923) follow- ing the revolution, the U.S.S.R. had a severe outbreak of malaria (1923). The greatest number of cases occurred from April to August, with the maximum in June. The officially reported morbidity rate for malaria in 1923 was 474 per 10,000 population (FIGURE XI-5), an estimate which appears to be too low. The total number of malaria patients in the entire U.S.S.R. in 1923 was 12,500,000, of whom some 62,000 died. The morbidity rates per 10,000 population for various regions of European U.S.S.R. in the 1923 outbreaks were reported as follows: Lower Volga Original Page XI-1'7 ARIA MAL IN THE U.S.S.R. 1900-1936 INCIDENCE PER 10,000 INHABITANTS A L MMN 1,548.8, Don 921.9, Central Volga 812.0, Ukrainian S.S.R. 232.2, Northern Provinces 184.6, Moskva (Moscow) 178.0, Crimea 84.3, White Russian S.S.R. '22.4, and Sea Regions (Baltic) 9.4. In the 1923 epidemic all three common types of malaria were found, but falciparum infection, which in nonepi- demic years is almost completely absent, was variously estimated to account for 50 to 90% of all cases. The case fatality rate varied from 0.5 to 0.8%. The greatest number of falciparum cases occurred in August; the peak for vivax infections was noted in May and June. Following 1923 malaria cases became less numerous and the morbidity rate per 10,000 population for the following six years showed a steady decline as follows: 446.5 for 1924, 229.4 for 1925, 164.4 for 1926, 130.7 for 1927, 92.5 for 1928, and 58.0 for 1929. (b) Endemicity.-The morbidity rate and predomi- nant type of malaria differ from year to year in various geographical regions of the U.S.S.R. The disease is en- demic in the Ukraine, the Crimea, and the Lower Volga region. In these regions the falciparum type of infection usually predominates. Troop movements and traffic be- tween the various provinces promote the transfer of an- Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Page XI-18 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 JANIS 40 opheles mosquitoes and (alciparum carriers from one re- gion to another. It is by these means that the falciparum type of malaria is transplanted to the northern provinces of the U.S.S.R. The extent of the disease is shown in appended maps (FIGURES XI-6 to XI-8, inclusive). In most of European U.S.S.R. malaria is hypoendemic, though in some localities such as Odessa and Dneprope- trovsk, it sometimes may become endemic. Occasionally there occurs an extensive outbreak which, however, never assumes the proportions which normally might be expected in endemic or hyperendemic regions. In European U.S.- S.R. the vivax type of malaria predominates. The intro- duction of the falciparum type of malaria by carriers from other regions such as the Caucasus may result in small epidemics which are limited in the number of cases and the area involved. An example of this type of localized epidemic is reported from Poltava where 52 cases of falci- parum infection in 1936 and 32 cases in 1937 were reported. The number of cases decreased each year, and by 1943 no falciparum cases were reported. The Ukrainian S.S.R. has the highest malaria morbidity rate among the European Soviet Republics. The average annual number of malaria cases from 1900 to 1914 was 231.6 per 10,000 population in nine Ukrainian districts as compared with 181.0 per 10,000 population in the re- mainder of European U.S.S.R. The average number of cases according to districts in the same years appear in the accompanying tabulation: Number per Number per 10,000 10,000 District population District population Yekaterinoslav 438.2 Tavrichanskiy 361.0 (Dnepropetrovsk) * Kherson 198.2 Khar'kov 392.7 Kiyev (Kiev) 81.8 Poltava 383.6 Podol 68.9 Chernigov 361.4 Volhynia (Volynskaya 42.3 Oblast') * *Present name The malaria epidemic which occurred in the southern European and Caucasian provinces and republics of the Soviet Union during 1923 was ascribed to: a) an unprece- dented movement of population masses brought about by the Russian civil war; b) particularly hot summers in 1921 and 1922 which favored the numerical increase of anophe- line mosquitoes; c) increase of mosquito breeding places created by war destruction of houses and cultivated fields; d) the wholesale slaughtering of domestic animals upon which certain species of Anopheles fed; e) scarcity of quinine during the blockade during and after the civil war; and f) the reduction of natural resistance to disease by famine. An epidemic of malaria which occurred in 1935 followed a period of famine during which there was mass slaughter- ing of livestock, and the people's resistence to disease was at a low ebb. Since 1935 the malaria morbidity rate again has steadily diminished. An investigation by the Ger- mans during their military occupation revealed only one carrier among 850 persons examined in a zone which was considered to be malarious. (c) Malaria control.-A systematic campaign of ma- laria control was instituted in 1920 with the establishment of a Central Institute for Tropical Diseases. The struc- ture of the malaria control organization in the U.S.S.R. is shown in FIGURE XI-9. Cooperating in the malaria control campaign is the Commissariat of Agriculture and Trans- portation. The campaign includes oiling or draining swamps, examining inhabitants in infected areas, and dis- tributing quinine. A perceptible lowering of malaria mor- bidity became apparent only after 1936. Malaria stations have been built in malarious districts. Each station is equipped with a laboratory, dispensary, hospital, entomological department, and propaganda mu- seum. The staff of a malaria station consists of a malari- ologist who is a physician, an assistant malariologist, and a subordinate staff which varies according to the size of the station. Airplane dusting with Paris green is utilized. Most of the malaria stations remain closed during the winter. The numbers of sanitary and epidemiological institutions, including malaria stations, are listed in TABLE XI-10. NUMBER OF SANITARY AND EPIDEMIOLOGICAL INSTITUTIONS, 1941 Cd rd v x'60 U.S.S.R. and Gd 0 0 0 0 O d s constituent O v] a U v~ U . 0 p 1 republics c d 0 4, Cd ~a 4 o 4a a .tt 0 Pi Q W C10 60 iu m C] ~ A'cd c d U.S.S.R. 1,760 181 2,107 1,405 1,086 1,859 R.S.F.S.R. 746 69 905 726 579 602 Ukrainian S.S.R. 677 101 551 450 150 180 White Russian S.S.R. 36 Karelo-Finnish S.S.R. 6 23 7 Moldavian S.S.R. 8 1 7 3 Much of the antimalarial work was disrupted because of the war. In 1943 there were indications of an increase in the incidence of malaria in the U.S.S.R. The areas specifically mentioned in published reports include the Tatar A.S.S.R., and the oblasts of Voronezh, Kuybyshev, Rostov, and Stalingrad. The Ukrainian S.S.R. has re- corded a tenfold increase over the incidence reported for 1940; .in the Lisichansk rayon, for example, about 3,500 of its 4,000 inhabitants were stricken with malaria, and in the village of Sirotino 250 of the 400 inhabitants were afflicted with the disease. Efforts are being made to re- establish malaria-control measures wherever they are needed. (2) Sandfly fever (pappataci fever) This is a virus disease spread by a species of sandfly belonging to the genus Phlebotomus. In European U.S.- S.R. sandfly fever is encountered only in the Crimea where it is sometimes called "summer grippe". The disease has a tendency to break out suddenly, in- volving numerous persons simultaneously. It has an in- cubation period of three to nine days and a short prodromal period. During convalescence the patients remain greatly weakened for a long time. An extensive outbreak occurred among the troops of the Red Army stationed in the Crimea in 1922. Sandfly fever was first found in Sevastopol'; later many cases were found in Bakhchisaray, Yalta, and other points of the southern coast of the Crimean penin- sula. The disease occurs predominantly in the beginning of the summer, and again around the first of August, coin- cident with the appearance of two different generations of sandflies in the course of the current year. It was es- tablished in 1932 that cases of pappataci fever were noted soon after the first sandflies appeared; it is therefore assumed that the virus hibernates in the larvae of the sandflies. The diagnosis of sandfly fever is very difficult and small isolated outbreaks are often mistaken for influenza. No figures on the incidence of the disease during recent years Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011 URE XI-6 MALARIA MORBIDITY, 1902-1911 JANIS 40 40? 50? 60? 70? pa 0 60 Ad Barents Sea BARENTS SEA ARCTIC v OCEAN .'.,? t 1 I ~ x'60? so? 1 : ,. d ... No Ih p ea U? 5. S. R. ~? f S ea AREA OF MAP ,: . G ~' . ?? BELOYE ,. . 1' . C ?i I .MORE.: ,. ~r' el k s.e - 1 O b' ? Arkhangelsk e ms,., /' - ~? . O' . ~ ~ .10 1 7 R.d ~ o . BOUNDARIES,1937 `??.~ Arabrarl '. r -.~. f?, yoJ J1 the do' I Sea 4< 10 , 60' Pet ozavodsk ;/..?:''^' "`~ zero GULF OF FINLAND l kho~ f . a I , S ankt ;.: )Peterburg. ? p. ! Vologda egrad)(` 0 Q V atka Perm 0Novgorod (Kirov (Molotov) Pskov r = k.. .ij fjKoskroma ~.. r ..: .~ '-? ? Tver' Yaroslavl :: '^v .. < (Kali i r' . . ' , - V..L + :: n .- 1.??1+ \, n)O ~. J ?f ... r ) . Mir- Kaz an': -71, ITV II i f Vitebsk 11oskua garodrl -~ .f~oy U a ~/' O 0 7- (GOT'kly) * l ~ ` ti : / [ -- f t , . Smolensk ?-., - --- - -- ------ - - ---------------- k Kal4gaa' Ryazan ti, ?lUSim J'yanavsk f ~ --- ------- _, /. Mlns - --- Mogilev Tula ~' , ~- ~ `' - -- enzap 61 33aCY1$fa Orenburg I \. \e r J P (IS ~ (Chkafov) b h , ys ev uy ., J 1 {~ bte a l . . 1 J ;Tambov 1 Walk a 1!111 r6 1 f ~1:;?== IIII LI , ,f -------------------- hernI U I v , i.: 2Y - ~- 50? 111 11111 ,+ k(JRII kl 1 Z ? I II ~ V 1 1 - ; I Q1A I1v II - - . II 1 lit / +N tall' I I, Zhitomir / i , ~ t+ = 50? h I ~ ::_ W O Oit IIII , , I li_I ti Kryev:.,I III I'II II ~ ~'+?~ - t III y j I! 'C {` III I~I 1 1 I1~1 11~II ~"+r I 1 I 311 Kamenets:? 'idhrtkov'~ O ~ Podol skiy+. 1 0 IIII! j.II . ( .... rn tI 111'1111 ill Yekatennoslav,~ 1 I - Y+ I ~ I 1 I I 1 1 1 111 T II 4 till 1 ; ` p ) tie? 1 Iii. a ~ I I 1 11~ ([) nep 1 111 III Hi 1 H I 1 11I vs::,k) 1 of ? ll ? ~P `I'I '' r lit '111 I' 1 I'I . ' 1i IV'PVdd erkassk' , Astrakhan l ?'?? " ':.AZOVSKOYE a .: - ....: MORE ' - . . .. ? ... RUMANIA - -.- Siimferop I e a enno arti0 Krasnodar) Stavropol j D "Ube s Novoro siysk . ' v.. . BULGARIA =. . : ? ? ' Vfad)Kavkazr r B L A C K S E A (Dzauslztkau Temir-Khan?Shura B ( uyna s ) Kutaisi ~.... Tiflis0 / Batumi ~., (Tbilisi) CASPIAN vetpol 40? W T U R K E Y ( Bakl~ " `Kars f FrivariKir OV = SEA b ad) ?, Yerevan)ji? '" ??..~: . FROM: BOL'SHAYA MEDITSINSKAYA ENTSIKLOPEDIYA, 1936 Vol. 16 IRAN 30? 40? 50? EUROPEAN RUSSIA MALARIA MORBIDITY Number of patients per 10,000 persons; yearly average r77777779 1 111 ~'~II 1902-1911 1.50 50100 100-200 200400 400600 600-1000 1000 or more 200 400 BOUNDARIES, 1911 MILES 2 4 ---?-? International -??-??-?? Guberniya KILOMETERS Names in parentheses are current usage. curiFiDFNTIAI Approved For Release 2003/05/14: CIA-RDP79-01144A000200 IGURE XI-7 WAIMORBIDITY, , 1924 JANIS 40 i"v'J,~Cherepovetsn l ~.: i` ..: ljli iiil i !,;I;, i~iu'IIIiy~r~ I i skO O ..i Novgorod f r. ~' _ fsr c:? O Tula 0Orel 4?..r?. EUROPEAN U.S.S.R. MALARIA MORBIDITY 1924 0 Ryaza O Molotov BOUNDARIES, 1924 -.-International _- Uniorepublic -...-Autonomous republic, oblast' kray,etc. Names in parentheses era currant usage. O Sta ingrad Kazan' Astrakhan Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 FIGURE XI-8 MALARIA MORBIDITY AND CONTROL STATIONS, 1929 JANIS 40 20' 30" 40' 50' 60' GULF OF:FINLATJD ? a _ .F; ? ESTONIA o?? , ~? SJkh ; ?1 ., ? r f ?''r"?~ - ' ~ LATVIA / ? 21. ? ? ... `? ! / `? f...~ \ ~ ?\ (- \ _ l ?22. , ? `.1 ~' ~- ?~ '' 1 ~ '? ? LITHUANIA .,~.~ ? 14. ;' ' . J ? ~; 20 . ? . ? ^"~~ i ' _; . r . . ~ ... .._ . 1B. i ' 2. f ~ ' _ r ? ? ,~ r~ " fir; j ... 041. 013 Vol a' ,,~? ~ ? " : ? ._ . /. t... .~-? ~. ?: 15. 16. y []3. ?5+~. /: .' 19. .. ' ?J?? 3. C ~? 0 06. ? '~.. j ?24 ~ ' ~;^ j ~ ?~ ?9 ; ; 910 ~ ' _, r?.. ~., ., ~-.:. y j 11 J . . . 30 t.. ?? ' ?s.: '1 ?12. j ?? ?. . , POLAND : 027. 29. ' ? 33. ? 31. 28 ?,~ i+.:r..~?.. 026. ` /~..~ ' J? ..4 ' ` 034. ?32 .~? ...,,,~.. ..L~ / :. '` ... ` ~?'?1 ?t 25 ?~ . / ? 37. 35 43. '1? . / r '. r: ?'~ 44 '? U - ? ? 50` ~?? , _ . ,J .. ..?R ~ : `. ?36. 41.... (040. / L./wt"'.... /~.? 54 /f~ ? : ~7 ? ??.? ?45 ~ *% ~ . ~ ?42 II (~ ? ? ? . 55. 38 .. .J' .I w/ 9 3 . ? ly ?46.x/ ? 9 '~ ' . P urr? ?58: ~....... > . ; ~. ~1. 5 6 , 57. ? / V. '?% 48. 60 ` .. .0 ' ?61 ?j 67. 3 ? ? 68. 0?646 . ? 62)074 / 9. 70 5 9 69 ,.~ tir ' ~. 4. 71? V ; .,?\ 072 ?fi Don 76 RUMANIA- 51 77, ZOVSK0YE MORE ?78. J'?1..., ' ? ' 2 . 53. r~ ? ? ? ~ :J... a ' ae. 73. 79. ?80. ? .~ ? . ... ? 82. ? 81. 089 . ' ? 83. ? '86. ? 9o ~? ?? `?' . (l 85. 87 . ?91. 0 B L A C K S E A 92 094. ` ? 93. ? 98 10. 101 . ' . to ~ 0 .. 09-1' i99\ .0 105. 95 0 . 98 0 ? 0106 . ? 107. / 0110. 'V 116 ? 0 ' . , ? 109. ?114. 112 103. ; ?111. (]0 ~ ? . 40' .. . 113. 117. ?.128. .. . '^?^ .,r'.T '??~ 132. 29. ~(i 118. ?;126. 130 ? 0 . 031. T U R K E Y ?127 1' 40' . 137 ? 119.: ! 120 ? 121. ? 135. F ?. ` 122.' 'Y ??.~' 133. ? 8OL'SHAYA MEDITSINSKAYA ENTSIKLOPEDIYA 1936 V.L 16 x 134 FROM ? ' 1 . , . : ~ 123 136..-,. ? 124 \ / 12 ' 5 ?? ~ ` ? , 30" 40' 50" EUROPEAN U.S.S.R. MALARIA MORBIDITY AND CONTROL STATIONS 1929 BOUNDARIES Number of patients per 10,000 persons; yearly average: ? Malaria Control Station -.- International (1937) Tropical institute - - Union republic (1929) _ Sanitary and d Bacteriological Autonomous republic, Oblast; 1-50 50100 100-200 200-400 400600 6001000 1000 or more institute kray,etc. (1929) INDEX 1. LENINGRAD 21. MOLOTOV 41. SARATOV 61. STAROBEL'SK 81. KRASNODAR 101. MAKHACHKALA 121. YEREVAN 2. KAASSOM INSTITUTE 22. SVERDLOVSK 42. ENGEL'S 62. VOROSHILOVGRAD 82. NOVOROSSIYSK 102. BUYNAKSK 122. KAMARLU 3. MOSKVA 23. CHELYABINSK 43. VOLSK 63. ARTEMOVSK 83. GELENDZHIK 103. DERBENT 123. ARARAT 4. BOLSHEVO 24. UFA 44. PUGACHEV 64. KONSTANTINOVKA 84. GORYACHIY KLYUCH 104. SUKHUMI 124. NAKHICHEVAN' 5. N0GINSK 25. CHKALOV 45. DERGACHI 65. STALING 85. TUAPSE 105. OCHEMCHIRI 125. MEGRI 6. KUDI NOVO 26. BUZULUK 46. NOVOUZENSK 66. MARIUPOL' 86. MAYKOP 106. GALI 126. KAZAKH 7. OREKHOVO-ZUEVO 27. BUGURUSLAN 47. URAL'SK 67. DNEPROPETROVSK 87. SOCHI 107. ZUGDIDI 127. KIROVFBAD 8. SHATURA 28. KUYBYSHEV 48. KAMYSHIN 68. KRIVOY ROG 88. KROPOTKIN 108. POTI 128. ALIABAD 9. MIKHNEVO 29, SYZRAN' 49. STALINGRAD 69. NIKOLAYEV 89. ARMAVIR 109. MIKHA TSKHAKAYA 129. NUKHA 10 RYAZAN' 30. UL'YANOVSK 50. YENOTAYEVSK 70. TIRASPOL' 90. LABINSKAYA 110. KUTAISI 130. AGDASH 11. TULA 31. PENZA 51. KRASNYY YAR 71. ODESSA 91. GEORGIYEVSK 111. MAKHARADZE 131. GEOKCHAY 12. SKOPIN 32. TAMBOV 52. ASTRAKHAN' 72. KHERSON 92. PYATIGORSK 112. KOBULETI 132. KUBA 13. VLADIMIR 33. RANENBURG 53. LI MAN 73. YALTA 93. NAL'CHIK 113. BATUMI 133: KALAGAIN 14. IVANOVO 34. LIPETSK 54. KIYEV 74. KAMENSK-SHAKHTINSKIY 94. MOZDOK 114. GOBI 134. DZHEBRAIL 15. KOZINO 35. RAMON' 55. SUMY 75. ROSTOV.NA-DONU 95. ARDON 115. TBILISI 135. ABDUL'YAN 16. GOR'KIY 36. VORONEZH 56. MOGILEV-PODOL'SKIY 76. NOVOCHERKASSK 96. DZAUDZHIKAU 116. TELAVI 136. SAL'YANY 17. CHEBOKSARY 37. KUR5K 57. KREMENCHUG 77. YEYSK 97. KOSTA-KHETAGUROVO 117. KARAYAZY 137. BAKU 18. YOSHKAR-OLA 38. OSTROGOZHSK 58. POLTAVA 78. LENINGRADSKAYA 98. ORDZHONIKIDZEVSKAYA 118. IDZHEVAN 19. KAZAN' 39. PAVLOVSK 59. KHAR'KOV 79. ANAPA 99. GROZNYY 119. LILIZHAN 20. IZHEVSK 40. BALASHOV 60. IZYUM 80. SLAVYANSKAYA 100. KHASAVYURT 120. ECHMIAOZIN 0 200 400 MILES 00 2y IN KILOMETERS Cartography 10454 December Approved For Release 2003/05/14: CIA-RDP79-01144A000'2tJTM. 0tYOI I"-70n oraphed na[he Reproducti on Branch Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 HEALTH AND SANITATION STRUCTURE OF ORGANIZATION FOR MALARIA CONTROL IN U.S.S.R. Narodnyy Kom m issariat Zdravookhraneniya U.S.S.R. (People's Commissars of Public Health of the U.S.S.R. Tsentrazlriyy Institut Malyarii i Meditsinskoy Parazitologii (Central Institute of Malaria and Medical Parasitology) Narkomzdravy Soyuznkh Respublik (People's Commissars of Public Health of the individual republics) Respublikanskiy Institut Malyarii i Meditsinskoy Parazitologii (Institute of Malaria and Medical Parasitology of an individual republic) Oblastnoy, Kraevoy Otdel Zdravookhraneniya (Oblast and kray depts, of public health) Oblastnaya, Kraevaya, Malyariynaya Stantsiya (Oblast and kray malaria stations) Gorodskoy (Rayonnyy) Otdel Zdravookhraneniya (City and rayon depts. of public health) Legend ADMINISTRATION 'I NTERDEPENDENCE SUPERVISION OF METHODS AND ORGANIZATION Malyariynyy Otryad (Malaria squad) Page XI-19 Gorodskaya (Rayonnaya) Malyariynaya Stantsiya (City and rayon malaria stations) Khinizatory i Bonifacto (Personnel for quinine administration and malaria field work) are available. However, in Sevastopol' there were 200 to 250 cases of sandfly fever during July and August of 1932. (3) Rickettsial diseases (a) Typhus.-Famine, overcrowded living conditions, and migration of troops and civilians favor the appearance of louse-borne typhus epidemics. Conditions produced by civil war, such as dislocation of populations, helped spread the disease, and the U.S.S.R. experienced one of the great- est typhus epidemics known in history during 1919 to 1922. Although the figures are admittedly incomplete, some 20 million persons were estimated to have contracted the disease in those years. The morbidity rate in 1920 was said to be over 260 per 10,000 population. A graphic Original Malyariynyy Otryad (Malaria squad) representation of typhus incidence in Russia from 1900 to 1936 is shown in FIGURE XI-10. Since 1925 the morbidity rate for typhus has remained at a relatively low level for the U.S.S.R. as a whole, al- though some localities have had numerous cases at times; there were said to be 1,000 cases in the hospitals of Kuy- byshev in March 1942, for example. ? A League of Nations report noted that in 1942 typhus was "markedly on the increase" in the endemic countries of eastern Europe, and it is probable that European U.S.S.R. shared this general trend because the sanitary and living conditions in such cities as Kazan', Leningrad, Moscow, and Penza had noticeably deteriorated. Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Page XI-20 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 JANIS 40 TYPHUS IN THE U.S.S.R. 1900-1936 INCIDENCE PER 10,000 INHABITANTS 1900 1902 1904 1906 1908 1910 1912 1914 1916 1918 1920 1922 1924 1926 1928 1930 1932 1934 1936 FIGURE XI - 10. Typhus in the U.S.S.R. Incidence per 10,000 inhabitants, 1900-1936. In all the epidemics mentioned above, the highest inci- dence of typhus occurred during the winter months. Flea-borne (endemic or murine) typhus is a rare disease in the Soviet Union and particularly in European U.S.S.R. Only occasional cases have been reported, although many infected rats have been found in the larger cities. Tick- borne and mite-borne typhus are not reported from Euro- pean U.S.S.R. (b) Trench fever (Volhynian fever).-In World War I, enormous numbers of cases of a febrile disease appeared among troops on the German front in Poland and Vol- hynia. Because the disease attacked front-line troops al- most exclusively it was spoken of as trench fever or Vol- hynian fever. A characteristic of the disease is pain in bones and joints not accompanied by signs of inflamma- tion. Fever curves are very irregular, sometimes show- ing a sharp rise every five days (hence another name, "Five-day fever") and in other cases developing a typhoid- like pattern. Another characteristic is the frequency of relapses, which may come on after weeks or months. The disease has been shown to be caused by an organism of the Rickettsia group, which is transmitted chiefly by the body louse, Pediculus humanus corporis. The organism is introduced by the bite of the louse or by rubbing louse feces into the skin when scratching. Prevention of trench fever, like the prevention of typhus, depends upon delousing. (4) Dysentery and diarrheas (a) Dysentery.-Bacillary dysentery is endemic and large numbers of cases are seen annually, but the amebic form occurs only sporadically in European U.S.S.R. The following remarks refer to bacillary dysentery only. The types of organisms reported from the U.S.S.R. include the Flexner, Hiss (y) , Shiga, Strong, and Stutzer-Schmitz strains. The disease assumes epidemic proportions from time to time in various localities. The Ukrainian S.S.R. has con- tinuously maintained a morbidity rate higher than that in the rest of the Soviet Union. The morbidity rates for the Ukraine from 1903 to 1917 ranged between 34.0 and 47.7 per 10,000 population. The case incidence in the U.S.S.R. was highest in 1913 and 1920, but no adequate figures are available for recent years. The number of cases was said to be high in 1940 and 1941 and the disease assumed epidemic proportions in the winter and spring of 1941 to 1942. Seasonal incidence in European U.S.S.R. Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Wmlyllmm HEALTH AND SANITATION is, greatest from June to September; in the Ukrainian S.S.R. the season extends into October. Mortality rates for bacillary dysentery fluctuate within rather wide limits, but no reliable figures have been found to indicate case fatality rates. A large proportion of the deaths are reported to occur among young children and adults beyond the age of 50 years. (b) Diarrheas.-Various forms of diarrhea and enter- itis are commonly reported from all parts of the Soviet Union. In some instances this classification may errone- ously include cases of the more serious enteric diseases. There have been reports of acute gastro-enteritis caused by Staphylococcus aureus carried by dairy products such as cheese, ice cream, custard, and pastries. The incidence of mild diarrhea is great, and is aggravated by poor water systems. Infections caused by Salmonella breslau or S. suipestifer also have been recorded. (5) Frostbite The effects of frostbite on the human and animal organ- ism have been under extensive investigation in the Soviet Union since 1934. The investigations, experimental as well as clinical, were intensified during the Russo-Finnish war and during the fall, winter, and spring of the first year of the Russo-German war. The entire research was cen- tralized under the People's Commissariat for Public Health, and the work has been carried on systematically through- out the war. Studies on the effect of cold on the human organism demonstrate that adequate, warm clothing which does not interfere with circulation protects the wearer against frostbite. Footwear that is properly fitted and kept dry, and a diet high in fats and carbohydrates, were found to be essential. Various ointments used by infantrymen during severe frosts did not prove efficacious. (6) Venereal diseases No adequate data are available concerning the. preva- lence of venereal diseases in the U.S.S.R. as a whole, nor in European U.S.S.R., at the present time. It is believed that all five venereal diseases are present in sufficient numbers to constitute a threat to the health of personnel operating in the country despite the facts that prostitu- tion is no longer officially sanctioned and that the Soviet Union has greatly increased the number of institutions for treatment and control of venereal diseases. Such statistics as are available refer only to cities in some in- stances, only to rural areas in other cases, and occasionally deal with venereal diseases in an all-inclusive manner without separate reference to the individual diseases. The number of cases reported includes only those patients who have sought treatment and have been officially registered. The number of registered syphilis and gonorrhea pa- tients per 10,000 population in the U.S.S.R. was reported for various years as follows: Syphilis 74.7 42.8 32.2 29.5 24.7 Gonorrhea 40.0 31.0 25.7 24.3 20.5 No similar figures are available for the other venereal di- seases. It is stated that in 1936, the morbidity rate per 10,000 population in cities was 18.6 for syphilis and that the incidence of gonorrhea in 18 of the large cities of the U.S.S.R. in 1940 was 25.3% lower than the 1936 figure (which is not revealed). The morbidity rate in 1913 for chancroid in cities was 51.4 cases per 10,000 population. The incidence for only two cities is reported for 1931 when Moskva (Moscow) had 2.6 and Leningrad 1.8 registered cases per 10,000 population. In 1941 it was officially re- ported that only isolated cases of chancroid were found in the entire U.S.S.R. The number of registered cases of venereal disease in the whole of Russia averaged 180.4 per 10,000 population in 1913. The figures for Moskva (Moscow) alone were stated to be 388.7 in 1914 and 75.1 in 1934, both per 10,000 popu- lation. No comparable data are available for recent years. The Soviet Union officially does not sanction prostitu- tion and has provided a program for the reeducation of prostitutes. The reduction of the number of infections acquired from prostitutes is exemplified by statistics con- cerning such infections in Moskva (Moscow), shown in TABLE XI-11. Page XI-21 NUMBER OF PATIENTS TREATED IN ANTIVENEREAL DISPENSARIES IN MOSKVA (MOSCOW), 1914 TO 1934 Average number per 10,000 population Patients infected Total by prostitutes Percentage of patients infected by prostitutes as compared with 1914 1914 388.7 221.0 56.9 100.0 1925 190.0 60.0 31.6 27.1 1927 132.0 35.0 26.5 15.8 1934 75.1 9.0 12.0 4.1 The number of institutes doing antivenereal work is reported variously. Such institutions include the Cen- tral Institute for Skin and Venereal Diseases (established in Moskva (Moscow) in 1919) ; venereal disease clinics established by the various Constituent Republics, by the Provinces, and by regions; dispensaries established by districts; and aid stations. Apparently all of these units are included in the term "venerealogic institutions." In 1941 there were 2,605 venerealogic institutions under the supervision of the Narkomzdrav of the R.S.F.S.R. alone. The increase in the number of dispensaries and aid sta- tions in European Russia from 1913 to 1941 is shown in. TABLE XI-12. NUMBER OF VENEREAL-DISEASE DISPENSARIES AND AID- STATIONS, 1913 TO 1941 U.S.S.R. and constituent republics 1913 1928 1932 1938 1941 U.S.S.R. 12 800 683 1,351 1,498; R.S.F.S.R. 11 509 412 728 828 Ukrainian S.S.R. 1 205 146 282 295 White Russian S.S.R. 14 15 40 38 Karelo-Finnish S.S.R. 1 4 5 Moldavian S.S.R. 3 1 5 61 The functions of the venerealogic institutions include the registry, examination, and treatment of patients. Hos- pitalization is compulsory for patients found to have com- municable forms of syphilis. Periodic examinations are conducted in schools, dormitories, and institutions, and antivenereal propaganda is disseminated by radio, cinema, newspapers, posters, and other means. B. Diseases of potential military importance (1) Endemic diseases (a) Relapsing fever.-All parts of the U.S.S.R. have experienced epidemics of louse-borne relapsing fever at one time or another, but the morbidity rate has been highest in Leningrad, Moskva (Moscow), and the Ukrain- ian S.S.R. The disease appears to reach its highest level Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Page XI-22 JANIS 40 in the winter and early spring months. The morbidity rate, which normally is between 1 and 2 per 10,000 popu- lation, has been as high as 117 per 10,000 population dur- ing some epidemics (1922). The mortality rate per 10,000 population, was 5.8 in Leningrad, 4.9 in Moskva (Moscow), and 6.8 in Odessa, during the last great epidemic of 1919 to 1922. No recent information is available concerning the oc- currence of relapsing fever in the U.S.S.R. The availa- bility of salvarsan in sufficient quantity to treat such cases as do occur has reduced the threat of epidemic spread of the disease. (b) Tick-borne encephalitis.-Encephalitis is indige- nous to the forest regions of the Far East, Siberia, and parts of European U.S.S.R., including the Urals, Karelia, West Ukraine, and White Russia. Its seasonal incidence begins in April, increases to epidemic proportions in May, and reaches its height in June. Only sporadic cases occur between August and May. The greatest incidence and mortality occur in new settlements situated in virgin forests. The disease is contracted through the bite of in- fected ticks that live in the forest. The most important tick vector is said to be Ixodes persulcatus, the larvae of which also may be infected with the encephalitis virus. Other less important vectors are mentioned in Topic 111, C, (1), (f) The virus of tickborne or spring-summer encephalitis may be harbored by birds and animals, including certain rodents, goats, and sheep, all of which serve as reservoirs of infection for the ticks which transmit the disease to man. The eradication of rodents and ticks has proved effective in controlling spring-summer encephalitis. Pre- vention of the disease by means of a formolized vaccine prepared from the brains of infected animals has been reported in the Russian literature. The fatality rate among patients who have contracted spring-summer encephalitis ranges from 20% to 30%. The disease appears to be less severe in European U.S.S.R. than in eastern Siberia. Patients who survive the disease may have residual paralysis and atrophy of the cervical mus- cles and those of the shoulder girdle. (c) Asiatic cholera.-The U.S.S.R. has experienced many great epidemic outbreaks of cholera, the last of which occurred in 1921 to 1922, the number of cases then reaching 173,398. According to Russian reports, the dis- ease has been under control since 1930. No cases have been reported after 1926. The epidemic of 1921 to 1922 was centered in the area of European U.S.S.R. embracing Voronezh, Kursk, Tambov, and the Lower Volga region. The seasonal incidence is usually highest from June through August but in the regions just mentioned cases were reported in the winters of 1919 and 1920. In those epidemic years when famine occurred fatality rates averaged about 50%. Even though water and sewerage systems have been improved since the last cholera outbreak, sanitation con- ditions are far from perfect, and cholera still must be considered a potential danger in the Soviet Union. (d) Plague.-This disease occurs in the southeastern territories of the U.S.S.R. and in Zabaykal'ye (Transbai- kalia).; it is endemic in the Astrakhan' region where cli- matic conditions are favorable and great numbers of carriers are present among the local fauna. The number of cases reported for the years 1924 to 1927 inclusive were, respectively, 266, 257, 179, and 118 for all of U.S.S.R., and these were distributed over the following areas: Volga delta, Astrakhan' region, and Turkestan in 1924; Volga and Don valleys in 1925; northern banks of the Caspian Sea, northern Caucasus, Stalingrad area, Astrakhan' area, and the Ural valley in 1926; and the Ural valley in 1927. The location is not stated for 1928 to 1930 inclusive. In the southeastern parts of European U.S.S.R., plague appears in the summer and fall when mice, rats, squirrels, and other rodents are abundant, and the flea population has greatly increased. The squirrel, Citellus citellus, is most numerous from March to July while the yellow sand- mouse, Pallasiomys meridianus, is most abundant during the fall months. The rodents and fleas found in the U.S.S.R. are referred to in Topic 111, C, (1), (d) and (h), respectively. Various German investigators have re- ported the rodents which serve as intermediate hosts of plague in the Don and North Caucasus regions together with the more important species of fleas involved in the transmission of plague. The list from German sources is summarized in TABLE XI-13. RODENTS AND FLEAS INCRIMINATED IN THE DISSEMINATION OF PLAGUE IN THE DON AND NORTH CAUCASUS REGIONS* Families Subfamilies Dipodidae Alactaga elater do. jaculus Meropsylla spp.; Ophthalmopsylla volgensis Dipus sagitta Scirtopoda telum Leporidae* Lepus europaeus Muridae Rattus norvegicus do. rattus Cricetinae Cricetulus migratorius Cricetus cricetus Gerbillinae Meriones tamaricinus Pallasiomys meridianust Microtinae Ellobius talpinus Lagurus lagurus Microtus arvalis do. socialis Murinae Mus musculus Ceratophyllus fasciatus Xenopsylla cheopis Ctenophthalmus spp. Ctenophthalmus spp. Xenopsylla mycerini Ceratophyllus laeviceps Ceratophyllus consimilis Ceratophyllus spp.; Ctenophthalmus spp. Ceratophyllus mokrzeckyi; Ctenopsyllus segnis Citellus pygmaeust i Ceratophyllus tesquorum; Neopsylla setosa Compiled from German sources. Regarded by many as belonging to the Order Lagomorpha. -i Secondary plague reservoir. i t Primary plague reservoir. The Institute of Microbiology and Epidemiology in the city of Saratov reports that livestock as well as wild ani- mals may become infected with plague. Domestic animals such as the cat and the dog may acquire the disease by direct contact from rodents they have caught; camels and donkeys become infected through ingestion of hay or other fodder contaminated with feces of rodent carriers. A source of infection for man is said to be the Kirghizean wheat, Argyrophyllum arenarium, which becomes con- taminated with the feces of infected rodents. Workers in the wheat fields may acquire plague by inhalation of dust from such contaminated wheat. Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 HEALTH AND SANITATION (2) Diseases which may be introduced Filariasis and kala-azar are endemic in the Caucasus, and Japanese B-encephalitis occurs in the Siberian Re- publics. The movement of troops and the migration of people from one part of the Soviet Union to another easily may introduce such diseases into European U.S.S.R. The introduction of falciparum malaria has been dis- cussed in Topic 113, A, (1). C. Diseases of minor military importance (1) Typhoid fever No data are available to show the incidence or prevalence of typhoid fever in recent years. Following the revolution of 1917, the morbidity rate increased considerably, reach- ing about 34 per 10,000 population in 1920, but official re- ports indicate a decreasing incidence after 1924. Fatality rates have always been higher in the smaller communities, probably because of inadequate medical care. Typhoid immunization is now practiced extensively throughout the U.S.S.R. and is compulsory for certain groups of work- ers living in camps. New water and sewerage systems have been built, and food inspection has been introduced. Despite these measures, typhoid fever remains an endemic disease in the Soviet Union and still represents a serious sanitation problem. (2) Scarlet fever The incidence of scarlet fever has fluctuated within wide limits in the U.S.S.R. for many years. In the period from 1920 to 1939, distinct peaks of increased incidence were noted in 1926, 1930, and 1936 with a maximum of 41 cases per 10,000 population in 1930. A study of the seasonal in- cidence of scarlet fever in the central zone of the R.S.F.S.R. during the period 1931 to 1937 showed that 36.2% of the cases occurred in the autumn (September to November inclusive), 27.4% in the winter (December to February inclusive), 21.3%, in the spring (March to May, inclusive), and 15.1% in the summer (June to August inclusive). School children make up the majority of cases occurring in the autumn. Fatality rates appear to be highest in winter and spring, and lowest in autumn. Mortality is highest in infants under the age of one year, and next in the age group of one to five years. Some attempts to control the disease have been made in cities where mass immunizations have been carried out. Immunization of children is carried out by institutions for the protection of infancy and childhood and by the increasing number of nurseries. (3) Diphtheria The incidence of diphtheria has been below 10 per 10,000 population in the U.S.S.R. for many years. The last no- ticeable increase in incidence of diphtheria was noted in 1931 to 1932. A study of the seasonal incidence of diph- theria in the central zone of the R.S.F.S.R. during the period 1931 to 1937 showed that 34.5% of cases occurred in the autumn, 28.4% in winter, 22.3% in spring, and 14.81/c in summer. Among children below three years of age, diphtheria is more common in winter than in spring; in the age group of three to four years, the winter and fall incidences are about even; in the age group of five to seven, the autumn incidence shows a marked increase (31.1%, of reported cases) ; and the age group of eight to fourteen has the highest morbidity in the autumn (43.5%, of reported cases). Fatality rates appear to be highest in winter and spring, and lowest in autumn. Mortality is highest in infants under the age of one year and next highest in the age group of one to five years. Immunization against diphtheria is compulsory throughout the U.S.S.R. However, the incidence of the Original Page XI-23 disease increased in 1942, and remained at a high level in 1943. Inadequate immunization and late hospitali- zation have been blamed for this state of affairs. In ad- dition, the quality of diphtheria vaccine was said to be poor during World War II. (4) Measles No comprehensive data are available, but it is said that the morbidity and mortality rates for measles had notice- ably increased during World War II. The incidence re- ported for the U.S.S.R. reached about 66 per 10,000 popu- lation in 1930, then declined sharply but in 1936 was on the increase again. D. Diseases common among the civil population (1) Tuberculosis Tuberculosis long has occupied a leading place as a cause of death in Russia. The number of registered cases has increased annually, probably as a result of improved methods of diagnosis and increasing efforts to discover cases. The incidence of tuberculosis in the country as a whole from 1900 to 1929 is recorded in TABLE XI-14. TABLE XI - 14 TUBERCULOSIS IN SOVIET RUSSIA, 1911 TO 1929 No. of cases Cases per 10,000 pop. No. of cases Cases per 10,000 pop. 1911 676,602 47.3 289,462 18.0 1912 775,123 53.0 309,960 18.9 1913 824,817 55.3 315,728 19.4 1914 775,904 51.6 1915 to 1920 - No informatio n available. 1921 to 1925 - Registration i ncomplete. 1926 940,893 65.4 307,059 21.4 1927 1,326,204 90.1 458,460 31.2 1928 1,361,268 90.5 457,120 30.4 1929 1,385,905 90.3 491,969 32.1 It is stated on questionable authority that in 1913 the death rate per 10,000 population for pulmonary tuber- culosis alone in Moskva (Moscow) was 22.6; in St. Peters- burg (now Leningrad), 28.6; in Saratov, 29.9; and in Yaro- slavl', 30.9. Mortality rates for tuberculosis (all forms) have been recorded for the city of Moskva (Moscow) from 1911 to 1931, and for purposes of comparison, similar rates for Berlin, London, and New York are included in TABLE XI-15. TABLE XI-15 TUBERCULOSIS MORTALITY RATES PER 10,000 POPULATION IN SELECTED CITIES, 1911 TO 1931 1911 19.9 17.7 26.9 21.0 1912 19.3 17.1 28.1 20.1 1913 18.4 16.5 26.6 19.9 1914 19.4 17.7 24.9 20.0 1915 20.7 18.9 23.6 19.6 1916 22.2 17.4 24.4 18.2 1917 32.3 18.9 23.2 18.8 1918 32.0 19.1 20.2 18.4 1919 27.3 13.9 28.5 15.2 1920 17.6 12.8 39.7 12.5 1921 15.0 12.8 24.5 10.2 1922 16.6 12.8 26.1 9.7 1923 18.4 11.6 18.0 9.3 1924 14.9 11.6 16.8 9.0 1925 12.4 11.2 16.0 8.6 1926 10.7 10.3 14.8 8.5 1927 10.7 10.5 15.7 7.8 1928 10.1 10.4 15.5 7.9 1929 11.5 10.3 15.6 7.5 1930 9.1 9.9 15.2 7.3 1931 9.1 10.2 14.6 6.9 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Page XI-24 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 JANIS 40 In 1918 a Central Tuberculosis Institute was established in Moskva (Moscow) by the Commissariat of Public Health of the U.S.S.R. The Institute has an experimental de- partment devoted to research in the pathological anatomy, physiology, microbiology, and epidemiology of tuberculosis. It has a clinical department for the study of pulmonary tuberculosis, bone tuberculosis, and tuberculosis of chil- dren. In 1937 the Institute controlled five sanatoria, of which three were for children and two for adults. The constituent republics have established Central Tuberculosis Institutes in Kharkov, Minsk, Tbilisi (Tiflis), Samarkand, and Alma-Ata, and regional institutes have been organized in Moskva (Moscow), Ivanovo, Kazan', Sverdlovsk, and in many other places. All the tubercu- losis institutes give postgraduate courses to physicians and train about 500 specialists a year. Dispensaries and sanatoria employ about 27,000 physicians, all of whom have had some specialized training. The basic unit in the campaign against tuberculosis is the dispensary, of which there are two types. About half of the dispensaries are independent organizations (TABLE XI-16) ; the other half are operated in connection with health centers. No dispensary has fewer than 10 to 25 physicians. There is generally one dispensary for every district of 150,000 to 350,000 inhabitants; Moskva (Mos- cow) has 20 dispensaries. Rural regions have or will have a dispensary for each rayon. NUMBER OF INDEPENDENT TUBERCULOSIS DISPENSARIES AND AID STATIONS, 1913 TO 1941 U.S.S.R. and constituent republics U.S.S.R. 43 498 498 925 1,048 R.S.F.S.R. 36 286 '281 587 669 Ukrainian S.S.R. 5 161 151 287 238 White Russian S.S.R. 2 15 16 22 29 Karelo-Finnish S.S.R. 1 1 2 4 Moldavian S.S.R. 1 4 5 The dispensary keeps an individual record of all patients in the area under its jurisdiction. The patient is under obligation to follow the instructions of the dispensary doctor. If he refuses to accept the treatment prescribed, he is denied a certificate entitling him to sick benefits during his illness. The dispensary registers patients, ar- ranges for treatment, and keeps patients and contacts under observation. The district nurse calls regularly on those patients who are living at home, educates families in hygienic measures which will safeguard others from the disease, and sends contacts to the dispensary for X-ray examination. In the whole Russian empire in 1914, there were only 43 tuberculosis dispensaries and 18 sanatoria with 307 free beds. In the area of the R.S.F.S.R. where there were only four tuberculosis dispensaries in 1914, the number had increased to 84 by 1924 and to 500 by 1936. In 1936 the total number of such dispensaries in the Soviet Union was 750. They were equipped with X-ray and labora- tories, and generally had their own clinical facilities. Where such facilities were lacking, the dispensaries had at their disposal observation wards, clinics, hospitals, re- search institutes, or sanatoria, which were bound to ac- cept any patients recommended by the dispensaries. Existing sanatoria have an inadequate number of beds for open tuberculosis cases. In 1936, there were about 35,000 beds in the R.S.F.S.R. and some 6,000 such beds in the Ukrainian S.S.R. Special institutions called lupo- soria have been established for the treatment of cutaneous tuberculosis. There were three luposoria in 1934; one with 170 beds in Leningrad, one with 120 beds in Moskva (Moscow), and one with 30 beds in Sverdlovsk. A labor colony where patients may find employment is attached to the Moskva (Moscow) institution. The antituberculosis campaign was somewhat disrupted by the war which broke out in 1941, but by 1944 the rising incidence of the disease was once more reduced to the 1941 level. Early in 1943 hospital accommodations for tubercu- losis cases were increased, and patients were granted extra rations. Workers with a history of tuberculosis were not required to work night shifts or to engage in trades that might be harmful to health. In some cases, their working day was shortened without reduction of wages and, when necessary, they were given care in so-called night sana- toria established by various factories. (2) Helminthiasis Intestinal worm infections are common throughout the Soviet Union, but no adequate studies have been made by Russian or other scientists to establish an adequate picture of the prevalence of the different varieties of helminth in- fections. It is stated that nearly 100% of the population of the central part of European U.S.S.R. are infected with Enterobius vermicularis and that about 80% of the people have Ascaris lumbricoides infection. Other nematodes found in central European U.S.S.R. include Trichostrongy- lus instabilis, T. orientalis, T. probolurus, and T. vitrinus. Tapeworms are much more common in the northern regions of the country. An examination of children in Moskva (Moscow) in 1936 showed 3% to be infected with Hymenolepis nana. The pork tapeworm, Taenia solium, is not as prevalent as the beef tapeworm, Taenia saginata. Infection with Echinococcus granulosus appears to be en- demic in the Baltic areas from which occasional cases of Necator americanus infection are reported. Fasciola hepatica infections are rather frequently found in the region of Ivanovo. Dicrocoelium lanceatum infections are reported from the Donbass region, Ivanovo, Moskva (Mos- cow), Penza, Sverdlovsk, and Kalinin. In the northern part of European U.S.S.R., infections with Enterobius vermicularis and Diphyllobothrium latum have been commonly reported among the populations of Arkhangel'sk, Leningrad, and the Karelo-Finnish S.S.R. Examination of fishes from the Neva (river) showed Di- phyllobothrium latum in 50 to 82% of the bass, perch, and ruffs examined; in 50 %c to 91 % of the burbot, eelpout, and lings; and in 100% of pickerel and pike examined. Helminth infections in the White Russian S.S.R. appear to parallel the figures reported for the central part of European S.S.R. with the addition of Trichinella infec- tions. Cases of loiasis have been reported from Astra- khan', Zaporozh'ye, Khar'kov, Krasnodar, and from some localities of the Asiatic republics. (3) Influenza Influenza is an endemic disease throughout the entire territory of the Soviet Union. European U.S.S.R., like the rest of Europe, experienced a particularly severe epi- demic during the years following World War I. The morbidity rate in "normal" years seldom is lower than 200 per 10,000 population, and was 400 to 500 per 10,000 population in 1929 to 1930. In absolute numbers, 3,500,000 to 5,000,000 cases of influenza per year are not unusual. Although the highest incidence of influenza in southern regions as a rule occurs in February and March, the northern regions may have a maximum number of cases in January, and maintain a high morbidity rate even as late as April. Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 HEALTH AND SANITATION E. Miscellaneous diseases (1) Tularemia The spread of tularemia from Asia into Europe has taken place within the past 20 years. The first epidemic of tularemia in the U.S.S.R. occurred in 1926 when numer- ous epidemic outbreaks, mainly in regions along the Dnepr (Dnieper), Don, Kuban', Ural, and Volga rivers were re- corded. The incidence of tularemia in 1941 in the south- eastern part of European U.S.S.R. was greater than ever has been observed in Europe or North America (TABLE XI-17). In the 1926 outbreak the water rat (Arvicola amphibius) was considered the main reservoir of infection, but by 1940 it was established that the field mouse (Microtus arvalis) and the house mouse (Mus musculus) were pre- dominant as carriers of the disease. Because of lack of storage space in 1941, crops were only partially harvested, and those which were left in the fields furnished favorable conditions for the increase of the number of rodents. The southeastern part of European U.S.S.R. offers con- ditions favorable to the maintenance of a large rodent population and may become a permanent focus of tula- remia infection. 1935 Between Cherkassy and Kanev .. Water rats 1935-36 Cherkassy and vicinity 100 Water rats 1941 Bobruysk, Gomel', and Sumy Field mice 1941-42 Khar'kov, Kursk, and Shchigry Field mice 1942 Right bank of Dnepr (Dnieper) around Kirovograd 100 Water rats Water rats, rabbits field and house mice 1941-42 Rostov-na-Donu and vicinity 37,000 Field and house mice 1938 1940-41 Aleksandrovskiy Entire Kuban' Valley 34,206 Field mice, rats, cats, hares, squirrels 1926 1928 1934 1938-41 1942-43 Bolshoy, Churki, and Mogol Villages on Oka (river) Stalingrad Orel Orel 200 800 .. 5,000 .. Water rats Water rats Squirrels Field mice Field mice Original Page XI-25 (2) Leprosy In 1939, according to official Russian sources, there were some 3,000 cases of leprosy in the entire territory of the U.S.S.R., of which about 1,000 were in Turkestan, 700 in the Caucasus area, and 600 in the Estuary region of the Volga. Astrakhan' is one of the important foci of the dis- ease. In 1923 it was estimated that there were between 250 and 500 lepers in the Astrakhan' area; in 1926 the estimate ranged from 500 to 600. About 30 cases were reported from Saratov in 1926 and some cases from a few of the villages around Stalingrad. Second to the lower Volga valley in the incidence of leprosy is the Kuban' valley where the disease is known as "Krymka," probably because it was thought to have been introduced from the Crimea. The number of lepers in the Kuban' area in 1901 was 187, and in 1926, 175; the greatest number reported in 1913 was 289. Most of the lepers were found among the rural population. Sporadic cases of leprosy have been reported from the Crimea, Odessa, the Don valley, and the Caucasian Re- publics. There are no official statistics concerning the number of lepers in the Baltic Republics. In 1936 Russian sources estimated that there were 226 lepers in Estonia, 210 in Latvia, and 21 in Lithuania. Institutions for the care of lepers have been established in Astrakhan', Leningrad, Moskva (Moscow), and the Ukrainian S.S.R. (3) Trachoma The officially reported number of trachoma cases in the whole of Russia in 1913, admittedly based on incomplete registrations, was 1,029,333. Of this number 885,789 were registered in European Russia. In some areas such as that which now makes up the Chuvash A.S.S.R. and the Tatar A.S.S.R., it was said that nearly 25% of the popula- tion were trachomatous. The number of cases reported for the U.S.S.R. in 1927 was 846,750. The reduction in the number of cases, as compared with 1913, was most noticeable in those regions where the disease formerly was particularly prevalent; namely, the Chuvash A.S.S.R., Mari A.S.S.R., and Udmurt A.S.S.R., and surrounding areas. (4) Smallpox The formerly large number of smallpox cases reported annually has dwindled to a negligible figure since the ad- vent of compulsory vaccination in the U.S.S.R. No data are available for recent years, but in 1938 the total number of cases in the whole of the U.S.S.R. was officially reported as 223. The smallpox incidence per 10,000 population reached a maximum of 14 in 1919, but has since declined steadily except for an outbreak in 1932. (5) Rabies There are still many rabid dogs, cats, and wolves in the country, and about 70,000 people are bitten every year. There are several Pasteur Institutes in the U.S.S.R.; the three most important are in Moskva (Moscow), Lenin- grad, and Rostov-na-Donu (Rostov-on-Don). (6) Anthrax Anthrax still occurs in cattle breeding regions. The morbidity rate for this disease is about 1 per 10,000 popu- lation. In rural regions the greatest number of infections are observed during the summer months. In 1938, the entire U.S.S.R. had 2,558 cases of anthrax, of which 385 were reported from the Ukrainian S.S.R., and 16 from White Russian S.S.R. Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Page XI-26 JANIS 40 114. THE BALTIC REPUBLICS The Estonian S.S.R., Latvian S.S.R., and Lithuanian S.S.R. comprise the Baltic Republics. Available data con- cerning these territories are incomplete and inconclusive. Official reports made to the League of Nations during the few years these countries were independent States con- stitute the major source of information for this discussion. Late in 1939 these territories were occupied first by the U.S.S.R., then by the Germans; and finally by the Russians who incorporated them into the Soviet Union. No infor mation concerning medical and sanitary conditions in the Baltic Republics has been reported by Russian sources. Such information as has been found concerning the Karelo-Finnish S.S.R. has already been cited. The only available data referable to the Estonian S.S.R. deal with the number of cases of certain diseases in 1929; these are summarized in TABLE XI-18. INFECTIOUS DISEASES REPORTED IN THE ESTONIAN S.S.R., 1929 4 . o a;?o ~ C 1 d (U x P Typhoid fever 471 4.22 37 7.9 Paratyphoid fever 202 1.81 19 9.4 Measles 3,705 33.21 48 13.1 Scarlet fever 2,179 19.53 (?) Diphtheria 405 3.63 (?) Influenza 1,425 12.77 (?) Dysentery 11. 0.10 3 27.3 Leprosy 19 0.17 4 21.0 Erysipelas 44 (?) 0.39 (?) (?) Encephalitis lethargica 1 0.01 (?) Epidemic meningitis 22 0.20 (?) Tuberculosis, respiratory 1,532 13.73 (?) Tuberculosis, meninges & CNS 2 0.02 (?) Syphilis 1,118 10.02 8 0.7 Soft chancre 95 0.85 (?) Gonococcus infection 3,660 32.81 (?) Data referring to the Latvian S.S.R. include a report of the number of doctors and dentists registered in 1938, and the. hospitals and diseases reported for 1929. Of the 1,566 physicians reported in 1938, there were 1,092 males and 474 women. The distribution of physicians and den- tists in the Latvian S.S.R. shows a large concentration in Riga and a few other cities, with the remainder scattered among smaller towns and rural areas (TABLE XI-19). DISTRIBUTION OF DOCTORS AND DENTISTS IN THE LATVIAN S.S.R., 1938 No. I % No. I % Riga 830 53.0 489 60.4 Liepaja 86 5.5 33 4.1 Daugavplis 64 4.1 35 4.3 Jelgava 45 2.9 24 2.9 Small towns and rural areas 541 34.5 229 28.3 The Latvian S.S.R. in 1929 had 65 general hospitals with nearly 5,000 beds, a ratio of 26.25 beds.per 10,000 popu- lation. Next in bed capacity were 6 lunatic asylums with 2,334 beds, a ratio of 12.28 beds per 10,000 population. Specialized hospitals, sanatoria, and convalescent homes comprise the remaining institutions, all of which are listed in TABLE XI-20. HOSPITALS AND OTHER MEDICAL INSTITUTIONS IN THE LATVIAN S.S.R., 1929 Institutions Beds Type No. No. Ratio per 10,000 pop. General hospitals 65 4,988 26.25 Surgical hospitals 13 324 1.71 Gynecological hospitals 11 162 0.85 Maternity hospitals 3 11 0.06 Children's hospitals 1 465 2.45 Hospitals for contagious diseases 3 70 0.39 Leper hospitals 2 220 1.16 Venereal diseases hospitals 1 120 0.62 Hospital for nervous diseases 1 30 0.16 Lunatic asylums 6 2,334 12.28 Eye hospitals 2 21 0.11 Tuberculosis hospitals 1 150 0.79 Sanatoria for pulmonary tuberculosis 10 408 2.15 Sanatoria for bone tuberculosis 2 151 0.79 Sanatoria for internal diseases 3 58 0.31 Sanatoria for respiratory and nervous diseases. Sanatoria for children with pulmonary tuberculosis Sanatoria for children with bone tuberculosis 1 60 0.32 Sanatoria for debilitated children 1 27 0.14 Institutes for hydrotherapy and dietetics 3 90 0.50 Convalescent homes 7 307 1.62 The number of cases (and deaths) of certain infectious diseases in 1929 as reported to the League of Nations for Latvian S.S.R. are recorded in TABLE XI-21. INFECTIOUS DISEASES REPORTED IN THE LATVIAN S.S.R., 1929 Typhoid fever Typhus Malaria Measles Scarlet fever Whooping cough Diphtheria Influenza Dysentery Leprosy Erysipelas Poliomyelitis Encephalitis lethargica Epidemic meningitis Anthrax Tuberculosis, respiratory Tuberculosis, miliary Tuberculosis, bone Tuberculosis, other Syphilis Soft chancre Gonococcus infection Morb per idity rate 10,000 pop. Fa tality rate 619 4.84 94 15.2 25 0.13 3 12.0 5 0.03 0 0 302 1.59 8 2.6 942 4.96 11 1.2 245 1.29 12 4.9 277 1.46 26 9.4 1,797 9.46 6 0.3 22 0.12 1 4.5 276 1.45 28 10.1 276 1.45 27 9.8 134 0.71 21 15.7 9 0.05 6 66.7 85 0.45 36 42.4 2 0.01 0 0 4,495 23.66 379 8.4 36 0.19 8 22.2 768 4.04 15 1.9 564 2.97 42 7.5 1,192 6.27 17 1.4 160 0.84 0 0 1,566 8.24 0 0 The Lithuanian S.S.R. is essentially an agricultural country. The 1923 census showed that 76.7% of the in- habitants live in the rural areas and engage in agricul- tural activities. The 1938 population estimate was Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 HEALTH AND SANITATION 2,549,668. In 1929 there were 22 rural health centers under the jurisdiction of the Department of Labor and Social Insurance (supervised by the Ministry of the In- terior) conducted by the Union of Maternity and Child Welfare Organizations. The hospitals and other medical institutions in the Lithuanian S.S.R. in 1929 are listed in TABLE XI-22. HOSPITALS AND OTHER MEDICAL INSTITUTIONS IN THE LITHUANIAN S.S.R., 1929 Ra 10,0 tio per 00 pop. General hospitals 41 1,889 8.19 Mental hospitals 2 500 2.46 Children's hospitals 2 80 0.32 Hospitals for contagious diseases 1 50 0.21 Tuberculosis hospitals 2 72 0.31 Homes for lepers 1 20 0.08 Gynecological and obstetrical hospitals 8 172 0.74 Maternity hospitals 2 17 0.07 Eye hospitals 2 45 0.18 Total 61 2,915 In 1938 some 210 health stations were opened, each serving an average of 10,000 inhabitants. Patients afflicted with venereal diseases were given free treatment. The number of cases of certain infectious diseases as reported in 1929 to the League of Nations is listed in TABLE XI-23. duce safe water, but it should not be considered safe until a thorough sanitary engineering survey has shown that the system is properly located and constructed, and that proper operating practices, including adequate analytical control, are in effect. B. Waste disposal Except in larger cities and a few towns, sewage-dis- posal systems may be considered inadequate or nonexist- ent. Hence, suitable plans must be made for local waste disposal wherever troops may be stationed outside those cities with sewerage systems. Careful waste disposal is of essential importance in view of the prevalence of enteric infections. C. Food sanitation Because of the prevalence of flies and the high incidence of enteric infections, special care must be exercised in the storage, handling, and preparation of food in military in- stallations. Artificial ice, if used to chill drinks or food, should not be used in such a way as to contaminate the food or drinks, or their containers. Personnel should be cautioned as to the risk of eating in other than approved establishments. Native employees of the military forces should be examined periodically for evidence of intestinal infections. Recommendations given for the control of flies (Subtopic G below) are especially important for the protection of food from contamination. D. Venereal disease control Venereal diseases are sufficiently prevalent to warrant control measures. Adequate supplies of prophylactic ma- terials will be needed, and easily accessible prophylactic stations should be established. Comprehensive educa- tional programs and adequate recreational facilities are important. To a great extent the success of control meas- ures will depend upon the accessibility and efficiency of prophylactic stations and on the availability of prophy- lactic devices. Page XI-27 INFECTIOUS DISEASES REPORTED IN THE LITHUANIAN S.S.R., 1929 Typhoid fever Typhus Relapsing fever Smallpox Measles Scarlet fever Whooping cough Diphtheria Influenza Dysentery Leprosy Erysipelas Epidemic meningitis Rabies Tuberculosis, all forms Syphilis Soft chancre Gonococcus infection M r 10 orbidity ate per ,000 pop. Fatality rate 1,013 4.37 28 2.8 420 1.81 35 8.3 1 0 0 1 0 0 749 3.23 4 0.5 1,094 4.72 16 1.5 1,015 4.37 6 0.6 555 2.39 26 4.7 5,883 23.39 19 0.3 79 0.34 15 19.0 2 0 0 414 1.74 1 0.2 51 0.22 11 21.6 1 1 100.0 1,051 4.53 31 2.9 1,749 7.54 0 0 48 0.26 0 0 1,637 7.66 0 0 115. RECOMMENDATIONS The following recommendations are for personnel oper- ating in European U.S.S.R. and are intended to supplement the general sanitary precautions ordinarily in force in all areas. A. Water All water supplies should be considered unsafe as found. Some municipal systems may be properly equipped to pro- E. Prevention of frostbite The winters are extremely severe in most of European U.S.S.R. Suitable precautions must be taken to avoid frostbite whenever troops are exposed to temperatures below 20? F. Proper clothing includes long underwear, shoes roomy enough to allow the wearing of two pairs of wool socks, windproof jackets, and warm clothing. Frost- bite of the uncovered parts of the face cannot always be avoided. Frequent warming of the face by covering with the hand is necessary. The wearing of a mask has some disadvantages. It protects the face but often becomes frozen after saturation with vapor from the expired air. Tight shoes, straps, or leggings, or even too many socks or wrappings may reduce circulation and cause the toes or feet to be frozen. Ski-trooper's trousers with knitted cuffs protect against the wind and prevent snow from sifting into the boot. Stamping and moving the toes inside the boots improve the circulation and help prevent frostbite. F. Control of mosquito-borne diseases Mosquito control is of paramount importance in Euro- pean U.S.S.R. from April through October. Control meas- ures should include : 1) : Elimination of mosquito breeding. 2) Location of camp sites preferably one or two miles from important breeding places and human habitations so as to be beyond the effective flight range of mosquitoes. Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Page XI-28 JANIS 40 3) Screening of military buildings and use of mosquito sprays where needed. As soon as possible after arrival in a new area, all habitations for troops should be treated with DDT residual spray. Entrance vestibules with a screened door at each end. (mosquito lock) will prove invaluable in excluding mosquitoes from buildings. 4) Liberal use of insect repellents. 5) Wearing of protective clothing such as long-sleeved shirts, trousers, and high shoes after sundown in mosquito- infested areas. Head nets and mosquito gloves hould be worn, when feasible, by personnel especially exposed to mosquitoes. 6) Use of bed nets issued as individual equipment. 7) Provision of a supply of antimalarial drugs sufficient for 100% suppressive treatment to be used at the discretion of the surgeon. G. Control of flies Because of the prevalence of enteric diseases, fly con- trol is imperative during the summer months. Thorough screening of buildings, mess halls, kitchens, and latrines is necessary. In addition, all garbage should be deposited within covered containers and disposed of by burial or incineration. The use of DDT residual spray should con- stitute an essential part of all fly-control programs. In mess halls and kitchens, it is advisable to apply the residual spray thoroughly to the walls, window and door screens, ceilings, crossbeams, light wires, light cords, and similar places where flies rest or where fly specks are seen. All food, cooking equipment, eating utensils, and tabletops must be covered before spraying is begun. All breeding places and their immediate surroundings, where the newly emerged adult flies may alight, should be treated with DDT. H. Sandfly control Sandflies are known to exist in the Crimea, and the possibility that sandfly fever may occur must not be over- looked. The disease may cause a high ineffective rate in military personnel. The sandflies are too small to be restrained by ordinary mosquito-netting. Recommended measures to control sandflies include: 1) An insect repellent issued by the quartermaster is effec- tive in protecting from bites of sandflies. It should be ap- plied to exposed parts of the body. One application is effective for three or four hours. 2) Spraying of the walls of tents or dwellings with DDT residual spray furnishes effective protection. 3) Metal screening also may be sprayed or painted with DDT. Sandflies which attempt to pass through the mesh will be killed. 4) Care should be taken to choose a camp site on high, dry ground with good ventilation. 5) The ground surrounding the camp site should be cleaned of rubbish. Crevices in buildings or in the ground may serve as breeding spots and should be filled, smoothed, or treated with DDT. 6) Use of bed nets of special sandfly mesh. 1. Control of louse-borne diseases (typhus and relaps- ing fever) Enforcement of the utmost personal cleanliness possible under the circumstances is essential. Ample facilities for bathing and laundering are urgently necessary. Complete equipment for delousing clothing, bedding, and other gar- ments, and facilities for disinfestation of personnel should be provided. Delousing powder to be dusted into the clothing should be available. Typhus immunization is essential. Adequate stocks of vaccine for stimulating doses should be maintained. J. Control of tick-borne disease Spring-summer encephalitis is acquired from ticks in forested areas. Control measures include the use of an insect repellent, wearing of protective clothing, rodent control, and the burning of grass around encampments. K. Control of flea-borne diseases Rodents and fleas are prevalent in European U.S.S.R. Plague is endemic in southeastern European U.S.S.R. and occurs in epidemic outbreaks from time to time. All build- ings should be of ratproof construction so far as possible, and rat-control programs should be enforced in all camps. Native public buildings, habitations, and ware- houses should be considered as harboring rats and other vermin. Such,buildings should be sanitized before use for living quarters or offices. Adequate stocks of plague vaccine should be available for use as a control measure in the event of a plague outbreak. L. Cholera control Cholera has been endemic in the Soviet Union. Be- cause of the ease with which it could appear in epidemic form as a result of break-down in the usual sanitation procedures, preventive measures are indicated. All medi- cal officers should be alert to detect the disease and, if it occurs among either military or civilian personnel, stimu- lating doses of vaccine should be administered to all troops. Strict attention to water and food sanitation, to disposal of excreta, and to control of flies (Topic 115, A, B, C, and G) will be essential to reduce the risk of spread. 116. PRINCIPAL SOURCES A. Evaluation Officially reported Russian statistics have been used to a considerable extent although their reliability is not always clear. Russian medical statistics under the Soviet regime frequently compare morbidity and mortality figures with those of the Tsarist regime and such comparisons usually glorify the achievements of the present govern- mental system. The recording of cases and deaths due to the various diseases is not universally practiced and offi- cially reported statistics are correspondingly incomplete. It is not known how much of the failure to present com- prehensive statistics may be based on a desire to credit local health organizations with effective disease-control measures. If bias exists in official reports, it is no less evident in many reports from non-Russian sources which often are either so laudatory or so derogatory in tone as to cause one to suspect their reliability. Only a limited amount of original Russian source ma- terial is available in the United States and almost no perti- nent medical reports written since the onset of World War II have been found. Free use has been made of infor- mation obtained in interviews with persons who have lived or visited in the U.S.S.R. B. List of references 1. Akhundov, A. I. and Trofimov, G. K. OB ISPOLZOVANII OTKHODA NEFTEPERERABOTKI "ZELENOE MASLO" PROTIV LICHINOK MALYARIYNYKH KOMAROV (Use of the petroleum by-product called "green oil" for mos- quito larvae control). Medits. Parazitol. i Parazitarn. Bolezni, vol. 13, No. 1, pp. 53-56. Moscow. 1944. PRIMENENIE OTKHODA NEFTEPERERABOTKI "ZELENOE MASLO" PROTIV OKRYLENNYKH KOMAROV (Employment of the petroleum by-product "green oil" for adult mosquito control). Medits. Parazitol. i Parazitarn. Bolezni, vol. 13, No. 1, pp. 56-57. Moscow. 1944. Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 HEALTH AND SANITATION 3. Aksenov, E. E. PROFILAKTIKA PISHCHEVYKH OTRAVLENIY (Prophylaxis of food poisonings). "Medgiz," 109 pp. Moscow. 1940. 4. Almazova, V. V. FENOLOGIYA "ANOPHELES MACULIPENNIS" MEIG. V MOSKOV- SKOY OBLASTI (Phenology of Anopheles maculipennis Meig. in the Oblast of Moscow). Medits. Parazitol. i Parazitarn. Bolezni, vol. 13, No. 4, pp. 26-37. Moscow. 1944. 5. Ansheles, I. M. EPIDEMIOLOGICHESKAYA KHARAKTERISTIKA LENINGRADA ZA GOD OTECHESTVENNOY VOYNY (Epidemiological character- istics of Leningrad during one year of the "Patriotic War"). Zhurn. Mikrobiol., Epidemiol., i ImmunobioL, Nos. 7-8, pp. 79-92. Moscow. 1943. 6. Babskiy, E. B., Kochergin, I. G., Parin, V. V. DOSTIZHENIYA SOVETSKOY MEDITSINY V GODY OTECHESTVEN- NOY VOYNY (Accomplishments of Soviet medicine dur- ing the years of the "Patriotic War"). "Medgiz," 179 pp. Moscow. 1944. 7. Baranskiy, N. N. EKONOMICHESKAYA GEOGRAFIA (Economic geography). "Uchpedgiz," 372 pp. Moscow. 1937. 8. Barinskiy, F. G. and Dodonova, O. N. DETSKIE INFEKTSII I BORBA S NIMI V SSSR V GODY VELIKOY OTECHESTVENNOY VOYNY (Childhood infections and their control in the U.S.S.R. during the "Great Patriotic War"). Zhurn. Mikrobiol., Epidemiol., i Immunobiol., Nos. 1-2, pp. 3-8. Moscow. 1945. 9. Barovskiy, V. V. ZHUKI SEMEYSTVA LYCIDAE (COLEOPTERA) (Beetles of the family Lycidae (Coleoptera)). Izd. Akad. Nauk., 27 pp. Moscow-Leningrad. 1931. 10. Beklemishev, W. N. O SRAVNITEL'NOM IZUCHENII ZHIZNENYKH KROVOSOSUSHCHIKH CHLENISTONOGIKH (Comparative study of life histories of bloodsucking arthropods). Medits. Parazitol. i Para- zitarn. Bolezni, vol. 11, No. 3, pp. 39-44. Moscow. 1942. 11. Ben, E. E. TUBERKULEZNAYA SMERTNOST v LENINGRADE ZA 50 LET (Tu- berculosis mortality in Leningrad during 50 years). Leningr. Tuberk. Inst., 71 pp. Leningrad. 1934. 12. Berlin, A. L. KRATKOE RUKOVODSTVO PO BORBE S CHUMOY (Short guide for plague control). "Medgiz," 76 pp. Moscow. 1944. 13. Bilmanis, A. BALTIC STATES IN POST-WAR EUROPE. Press Bureau of Latvian Legation, Washington. 1943. 14. Biryukov, V. I. ZARAZHENOST PARAZITOM MALYARII PODVIDA "ANOPHELES MACULIPENNIS MESSEAE" (To. what extent is Anopheles maculipennis messeae infected with malaria para- sites?). Vrachebnoe Delo, No. 5, pp. 261-264. Moscow. 1945. 15. Blakhov, A. A. and Kuptsova, A. D. TRANSPORTOVKA MALAYARYYNYKH KOMAROV PARAKHODAMI (Transportation of malaria mosquitoes by. vessels). Medits. Parazitol. i Parazitarn. Bolezni, vol. 9, pp. 508-510. Moscow. 1940. 16. BOLSHAYA MEDITSINSKAYA ENTSIKLOPEDIYA (Large Medical Encyclopedia), vol. 4, pp. 159-214 (1928); vol. 16, pp. 578-694 (1931) ; vol. 31, pp. 467-670 (1935) ; vol. 32, pp. 182-236 (1935). Moscow, Soviet Encyclopedia Publish- ing House. 1928-1935. 17. Bush, W. A. BOTANIKO-GEOGRAFICHESKIY OCHERK EVROPEYSKOY CHASTI SSSR (Botanical and geographical outline of the Euro- pean part of the U.S.S.R.) Izd. Akad. Nauk., 192 pp. Moscow-Leningrad. 1935. 18. Cazeneuve. TT. J. ORGANISATION OF THE PUBLIC HEALTH SERVICES IN LATVIA. League of Nations Health Organisation. 71 pp. Geneva. 1925. 19. Chinaev, P. P. MATERIYALY K METODIKE KOLICHISTVENNOGO UCHETA LICHI- NOK ANOPHELES (Materials for a method of counting of Anopheles larvae). Medits. Parazitol. i Parazitarn. 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War Department, were used in preparing this chapter. Original Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Published by THE JOINT INTELLIGENCE STUDY PUBLISHING BOARD Intelligence Division, War Department General Staff Office of Naval Intelligence Office of Assistant Chief of Air Staff-2, Air Intelligence Division Office of the Chief of Engineers Special Assistant to the Secretary of State for Research and Intelligence WASHINGTON, D. C. Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7 Approved For Release 2003/05/14: CIA-RDP79-01144A000220501YFlF T PRINTING OFFICE 1350--S-1947