Congresses and Conferences

E. S. Benyaminson (Moscow)

Conference of the People’s Commissars of Health of the Union Republics

From July 27 to August 1, 1939, a conference of the people’s commissars of health of the Union republics was held at the People’s Commissariat of Health of the USSR. Reports on the principal issues in health care were presented, and a number of important decisions were adopted.

The conference resolved to ensure that beds were occupied for an average of at least 330 days in 1939 and 340 days in 1940, with 75% of the beds in clinics and clinical hospitals to be assigned at the direction of local health authorities.

The conference paid particular attention to the hospitalization of patients with infectious diseases, directing the people’s commissariats of health of the Union republics to allocate the necessary number of beds in existing hospitals and to ensure completion of the infectious-disease bed capacity included in the 1939 construction plan.

It was deemed necessary to take decisive steps to improve trauma care, above all by improving the technical equipment available for surgical beds and the qualifications of physicians and nurses.

In outpatient and polyclinic care, it was decided to reorganize all work on a district basis and to make the polyclinic district physician responsible for carrying out anti-epidemic measures, including the hospitalization of patients with infectious diseases and the ordering of terminal and ongoing disinfection.

With regard to medical care for children, the conference outlined a number of organizational, preventive, and anti-epidemic measures to prevent infections acquired in outpatient facilities. It emphasized the need to organize screening stations and isolation rooms properly; provide home care for children with fever and those who had been in contact with patients with infectious diseases; ensure separate consultations for sick and healthy children; and achieve full and timely hospitalization of patients with scarlet fever, diphtheria, and severe forms of measles.

To prevent hospital-acquired infections, isolation rooms and wards with airlocks or separate isolation compartments must be established in children’s hospitals and admission departments.

The conference gave exceptional attention to combating tuberculosis among children, especially those of an early age. It decided to increase the number of tuberculosis sanatoriums and further expand production of the Calmette vaccine.

The conference emphasized the decisive role of the rural medical district—the outpost of public health—and stressed the need to strengthen its treatment, preventive, and anti-epidemic activities further. In particular, the following decisions were adopted:

a) By the end of 1939, fully staff rural medical districts with physicians;

b) Ensure maximum use of district laboratories;

c) Equip districts with disinfection equipment in accordance with the 1939 plan and carry out the necessary repairs to disused disinfection chambers and shower facilities;

d) Add a disinfector, a vaccinator, a visiting nurse, a sanitary feldsher, and a laboratory technician at the rural hospital to the staff of each rural medical district and, in malarial areas, a drainage and land-reclamation worker and two quinine administration instructors.

In the fight against communicable diseases, decisions were adopted with the aim of further reducing infectious disease and completely eliminating a number of infections. The conference outlined the following principal measures:

a) Direct the people’s commissariats of health of the Union republics and the territorial and regional health departments to draw up a unified comprehensive state anti-epidemic plan for 1940 covering individual infections;

b) Ensure that higher authorities are promptly notified of in-

…infectious diseases in accordance with the health-care reporting schedule;

(c) conduct thorough investigations of infection foci and of the causes of outbreaks of infectious diseases, and take decisive measures to eliminate them and prevent new outbreaks;

(d) establish independent antiepidemic departments in those territorial and regional health departments where this has not yet been done.

With regard to combating particular infectious diseases, the meeting resolved:

For diphtheria, to fulfill the annual plan for diphtheria immunization in full (vaccination and revaccination), taking steps to supply vaccination sites with vaccine, and to raise with the Councils of People’s Commissars of the Union republics the question of issuing a decree requiring children entering the first grade of primary school to present certificates of diphtheria vaccination.

For smallpox vaccination, to vaccinate 100 percent of children in their first year of life and all those who remained unvaccinated in 1938, using the medical staff of local health districts and medical and sanitary institutions for this purpose.

For the elimination of typhus foci, to take decisive steps to ensure early diagnosis of cases, full hospitalization, and effective preventive measures.

In the field of gastrointestinal diseases (typhoid fever and dysentery), to ensure hospitalization of all patients during the autumn and winter and actively combat bacillus carriage, requiring health authorities to carry out tests for bacillus carriage without exception and in full, at the expense of the health-care budget.

To carry out measles seroprophylaxis promptly and fully, and for this purpose to establish a reserve stock of measles antiserum at consultation centers, nurseries, infant homes, children’s hospitals, and district polyclinics.

To combat malaria and helminth infections, to require the medical staff of the general health-care network to provide systematic antirelapse treatment for malaria patients; and to entrust the people’s commissariats of health of the Union republics with drafting a decree requiring economic organizations, municipal authorities, and collective farms to carry out the necessary environmental health and hydraulic-engineering works.

To organize helminthology stations at polyclinics and outpatient clinics in areas where helminth infections are widespread.

In the field of disinfection, to fulfill in full the plan for training intermediate and higher-level personnel (disinfectors, disinfection instructors, and disinfection physicians), repair all idle disinfection equipment, and bring all disinfection chambers to full readiness, organizing an appropriate number of repair and installation teams for this purpose. To ensure completion of the construction of disinfection facilities in accordance with the 1939 capital construction list.

To ensure full implementation of the 1939 production plan for bacteriological preparations, and to provide in the 1940 plan for an expansion of their production sufficient to meet the entire demand.

Following the report by Professor T. Ya. Tkachev, Chief State Sanitary Inspector of the People’s Commissariat of Health of the USSR, the following decisions were adopted:

1. To require the Chief State Sanitary Inspectorate to draft regulations on state sanitary inspection, ensuring that state sanitary oversight is exercised regardless of the departmental affiliation of the facility or institution subject to inspection.

2. To improve the training of sanitary personnel by strengthening the material and operational resources of sanitary-hygiene faculties, and to require the people’s commissariats of health of the Union republics and the territorial and regional health departments to designate sanitary-hygiene laboratories, disinfection stations, and selected urban districts and industrial facilities as practical training and instructional bases for these faculties, where students could undertake practical work.

3. Recognizing the need to provide transport for employees of state sanitary inspectorates and antiepidemic institutions, to provide in the 1940 plan for the allocation of 400 passenger cars and 100 bicycles to city and interdistrict sanitary-epidemiological stations, and 11 passenger cars, 11 seagoing launches, and 6 river launches to maritime sanitary-quarantine stations. To assign 12 sanitary aircraft to the state sanitary inspectorates of the Union republics and the Chief State Sanitary Inspectorate.

4. On retaining sanitary inspectors and strengthening the sanitary organization as a whole, the meeting resolved:

(a) to confirm to the people’s commissars of the Union republics that sanitary inspectors may be appointed and dismissed only with the knowledge of the higher sanitary authority;

(b) to provide in the 1940 plan for the establishment of 350 district sanitary stations, both through new construction and, principally, on the basis of existing sanitary and antiepidemic institutions;

c) Require the people’s commissariats of health of the Union republics to improve their work on industrial sanitation, first and foremost at enterprises of the defense industry;

d) Ensure the organization of systematic oversight by the sanitary inspection authorities and all medical personnel of sanitary conditions in milk kitchens and institutions supplying milk to children;

e) In connection with the extensive work being carried out to consolidate scattered farmsteads into settlements, require the state sanitary inspectorates of the people’s commissariats of health of the Union republics and the regional and territorial health departments to supervise the selection of settlement sites and the implementation there of the necessary anti-epidemic and antimalarial measures;

f) Request that the People’s Commissariat of Health of the USSR petition the Council of People’s Commissars of the USSR to raise the salaries of sanitary physicians to at least one and a half times those of treating physicians, while retaining the additional allowance for epidemic-control work during the suppression of outbreaks of infectious diseases.

With regard to the sanitary protection of the borders, a number of exceptionally important decisions were adopted to ensure further improvement of sanitary conditions in border districts and the successful implementation there of preventive and anti-epidemic measures.

In the field of food-poisoning prevention, the conference resolved to intensify investigations into the causes of food poisoning; to require the All-Union State Sanitary Inspectorate and the state sanitary inspectorates of the Union republics to draw up planned targets for 1940 for sanitary improvements at individual enterprises in the food industry, public catering, and the retail network; and to propose that the All-Union State Sanitary Inspectorate develop, within ten days, new instructions for investigating and recording food-poisoning cases.

With regard to the sanitary protection of water supply systems and water sources, the following decisions were adopted in accordance with the law of May 17, 1937:

a) Require the people’s commissariats of health of the Union republics, by September 15, 1939, to draw up a specific plan of measures, broken down by region, for establishing sanitary protection zones around water sources, and to complete this work in full in 1940, securing approval of the designated zones through the councils of people’s commissars of the Union and autonomous republics and the territorial and regional executive committees;

b) Prohibit newly constructed water supply systems from being put into operation without the simultaneous establishment of strict sanitary protection zones;

c) By November 15, 1939, draw up a list of enterprises and institutions under Union, republic, and local jurisdiction that must construct sewerage and wastewater treatment facilities during 1940–1942;

d) Require the All-Union State Sanitary Inspectorate and the state sanitary inspectorates of the Union republics to take more decisive action to hold violators of the law of May 17, 1937, accountable.

Noting the inadequate work of the people’s commissariats of health of the Union republics in health education, the conference resolved to give special attention to organizing and strengthening health education activities in medical and preventive institutions; intensifying work with health-care activists; expanding sanitary and technical training among workers in the leading branches of industry, with a decision making such training mandatory to be adopted through the councils of people’s commissars of the Union republics; improving health-related defense work; and providing effective assistance in this field to the organizations of the Union of Red Cross and Red Crescent Societies.

To ensure the further development of health education, the people’s commissariats of health of the Union republics were required to expand the network of health education centers and secure additional paper allocations for health education literature, paying particular attention to the publication of materials in national languages.

The staffing problem was subjected to comprehensive discussion. Specific decisions were adopted to ensure proper staffing of the network of medical, sanitary, and epidemiological institutions; improve admissions to higher educational institutions, particularly to faculties of sanitation and hygiene; and staff those faculties with qualified teaching personnel.

The conference devoted exceptional attention to preparing and drawing up the health-care plan for 1940. It resolved to strengthen local statistical services, particularly at the district level, and to establish sanitary statistics bureaus under the people’s commissariats of health of the Union republics and the territorial and regional health departments. Recognizing the immense importance of studying morbidity among the population and causes of death, the conference deemed it necessary to require the people’s commissars of health of the Union and autonomous republics, as well as the heads of territorial and regional health departments, to direct personally the work of ensuring accurate and comprehensive recording of morbidity and causes of death, and to use these materials in their operational work, especially when carrying out anti-epidemic measures.

The conference resolved to recognize the following as the principal objectives for 1940:

a) A further, decisive reduction in childhood morbidity and mortality;

b) Expansion of the network of nurseries in towns and rural areas;

(c) A broad expansion of sanitary and anti-epidemic measures and further strengthening of sanitary defense;

(d) Expansion and improvement of medical care in rural areas, primarily through further strengthening of the rural medical district;

(e) Comprehensive strengthening of existing sanitary and epidemiological stations and further establishment of new stations in all regions and cities on the basis of existing sanitary and anti-epidemic institutions.

In conclusion, the conference adopted a resolution on labor discipline and work record books. This resolution is intended to ensure full and unwavering implementation at the local level of the decree of the Council of People’s Commissars of the USSR, the Central Committee of the All-Union Communist Party (Bolsheviks), and the All-Union Central Council of Trade Unions of December 25, 1938.

All People’s Commissariats of Health of the Union republics were instructed to hold meetings of republican and regional activists locally to consider the conference’s resolutions, with particular attention to combating childhood diseases and mortality and preventing infectious diseases. These meetings should include staff of the health departments of railway and water transport and workers of the Union of Red Cross and Red Crescent Societies.

It was deemed advisable to convene meetings of the People’s Commissars of Health annually in the second half of July.