GENERAL ARTICLES

A Surgeon Looks at Russia

Heroic women, medical science the equal or better of ours, soaring morale . „ ■ Such are this Canadian’s impressions of the U.S.S.R.

DR. WILDER G. PENFIELB December 15 1943
GENERAL ARTICLES

A Surgeon Looks at Russia

Heroic women, medical science the equal or better of ours, soaring morale . „ ■ Such are this Canadian’s impressions of the U.S.S.R.

DR. WILDER G. PENFIELB December 15 1943

A Surgeon Looks at Russia

Heroic women, medical science the equal or better of ours, soaring morale . „ ■ Such are this Canadian’s impressions of the U.S.S.R.

DR. WILDER G. PENFIELB

Director of the Montreal Neurological Institute

ON THE afternoon of July 2, seven surgeons disemplaned at a Moscow airport. Our mission had nothing to do with politics; our hosts were total strangers; the visit was without precedent. Consequently I, for one, felt some trepidation. To make matters worse, we had to get out of a Liberator bomber in front of the receiving line. To do this you must climb down backward until you reach the ground in a sitting position, as though you had just been laid by a giant goose. You then crawl under its body on all fours and, finally, having developed an acute inferiority feeling, you rear yourself before the welcoming delegation. They looked quite impressive but gave us a friendly welcome.

Our mission* was partly representative of Allied military medical services and partly of medical research councils. Perhaps a word of explanation of the Canadian participation may be in order.

The function of the Medical Committees of the National Research Council of Canada in wartime is to promote medical research, to collect medical information, and to get it into the hands of those who need it in the armed forces of Canada and her Allies. This work was initiated largely by Sir Frederick Banting. He died while flying the Atlantic to carry such information to England. His work has been ably continued by Professor J. B. Collip, Montreal; Professor Duncan Graham, Toronto, and others.

It fell to my lot to represent these committees on this British-American-Canadian -Surgical Mission. We were the first nonpolitical group to be invited to enter the Soviet Union in recent years.

We gathered for the start in London, and during the

^The members of the mission were Surgeon Rear-Admiral Gordon Gordon-Tayior, consulting surgeon to the Royal Navy; Colonel Elliott Cutler, chief consultant in surgery, E.T.Ó., U.S.A.; E. Rock Carling, Medical Research Council, London; Lieut.-Col. Loyal Davis, Committee on Medical Research, O.S.R.D., and National Research Council, Washington; MajorGeneral D. C. Monro, consulting surgeon to the British Army; Reginald W. Watson-Jones, civil consultant in Orthopaedic Surgery to the Royal Air Force; Professor Wilder Penfield, National Research Council of Canada.

period of waiting I made use of the time to look up all the Soviet medical literature that had entered the largest medical library in that city. I was referred to the basement and there, climbing to the top of a ladder, I found on a single dusty shelf the complete set of medical journals that had entered England from the Union of Soviet Socialist Republics daring the war. It was a little like looking for water from the garden faucet during a Canadian winter. The latest date was 1940. The channel of information was obviously frozen, but actually the pipe never was adequate to supply the need for knowledge of medical science from that vast country, and the situation is the same on this side of the Atlantic.

Finally, one afternoon at the end of June, we left Paddington Station and at midnight, on a starlit airdrome, we climbed up into the dark body of a giant airplane. There followed three days when the world, like a revolving globe, seemed to be turning slowly beneath us. On the final day, hundreds of miles of Russian farm land slipped beneath us—huge fields spread out like green carpets of unbelievable size and evenness, with plow furrows a mile in length. Before the war, half of the Soviet consumption of gasoline is said to have gone to the farm tractors. There were haystacks and grain caulks laid out in mathematical rows, communal farm villages, with houses and truck gardens neat and orderly along a country road. This made an extraordinary contrast to the countryside of Iraq and Persia, which we had seen on the previous day, dotted with round yellow threshing floors where oxen with slow feet were treading out the grain as in Biblical times.

Great Courtesy

W "E PASSED over the forests which surrounded Moscow and roared down at an airport. As we walked off the field English larks were singing in the sky above us, but when I spoke of it to one of our hosts I learned that they were Russian larks. I suppose anyone in the diplomatic service would have called them Anglo-Soviet larks to begin with.

During our stay in Soviet Russia we were treated

with great courtesy. Three weeks were not enough to make an exhaustive analysis, but long enough to select critical samples. We learned a good deal and gave such information as we had. We certainly made friends.

During this war advances in medicine have been few in number but important. None has been overlooked in the U. S. S. R. Take the use of sulphonamides; they have not as many forms of tins drug as we have but they use them even more enthusiastically.

' Take the plaster treatment of wounds and of fractures, the provision of blood and blood substitutes for haemorrhage and shock, the development of surgical specialists, the evacuation of wounded by air, all these they have developed independently and as best suits their particular need.

People have asked me whether Russia is ahead of us or behind us in medicine. This cannot be answered in one word. I suppose it is the competitive spirit learned in sport that leads us to want to know how the score stands.

Russia does not lead the world in surgery; neither can it be said that she is behind the procession. They do some things better than we. These are apt to be in the field of organization. Their methods of blood collecting and the preparation of, blood derivatives and the distribution of these preparations may well be considered the best in the world. The organization and co-ordination of their hospitals for the wounded is excellent.

The general principles of treatment of the wounded which they have adopted are very like our own. They are behind us in certain aspects of surgery, particularly in the refinements of technique. These refinements they might have learned had their leading surgeons travelled from clinic to clinic during their formative years, as many of ours have. Nevertheless Russia is abreast of the times in the field of medicine, and, looking into the future, the excellent organization of her system of medical education and her lavish support of research institutes promise a leadership that will make us look to our laurels.

During the last 20 years medical education in Russia has developed rapidly. There were 13 medical faculties before the revolution; whereas in the five years before the war, 72 medical institutes had turned out about 21,000 doctors yearly.

' The training of medical men may be of interest. A boy or girl on leaving secondary school takes examina-

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lions for university and is accepted on the basis of that examination as a medical student. Before the war these were 50% women. At the present time 85% are women because of the number of men at the front. They accelerated their curriculum during the first year of the war, but at the end of the year decided to return to the slower method. (Some of us believe we might well follow suit.)

It takes a student five years to go through medical school, during which time he is supported by the State if his work is good. If not, he may continue if he receives support from his parents. During this process he acts as a nurse for a time, and is also apprenticed to a practicing physician in an outlying district. Otherwise his training resembles ours. However, halfway through his medical course he chooses between therapeutics—the treatment of disease—and public health, with particular reference to the medical problems of factory workers.

No Private Practice

A medical student is qualified as a, physician on the basis of competitive examination and may then he sent, theoretically, to a post anywhere in the Soviet Union. However, we were told that the preference of the graduate is taken into consideration. There seems to be no private practice. If a physician wishes to proceed to the higher doctorate of medicine, lie must put in a minimum of six additional years of work as aspirant in either a university laboratory or in a clinic, and only those who have won their doctorate are eligible to apply for vacant university chairs.

We were much interested in the large new Lenin Library for general purposes. There are 250 branch libraries in the Moscow area, situated in parks, factories, and library buildings. Particularly well elaborated are the children’s libraries, of which there are 70 in this district, all receiving their supply of books from the Lenin Library. Moscow is not more than three or four times larger than Montreal.

On our way to the front line hospitals we travelled in five small cars-—the Russian counterpart of the Ford, made in Gorki. One car followed us as a spare. Our road began as a splendid highway. At each crossroads our credentials were examined or we were waved on by the guard on duty, usually a fair-haired soldier girl, with a rifle slung over her back, who saluted smartly but did not fail to scan the occupants with searching eyes.

We passed through heavy forests of pine and birch, filled with wild flowers, all very much like a Canadian wood, for the climate of Moscow, winter and summer, resembles that of Montreal. Even the wood smells were familiar— including aroma from a skunk. We passed ruined tanks along the roadside and ihe trenches and dugouts of the German line, which had been evacuated three months before, already fast disappearing in the growth of grass.

Peasants had trekked back and new houses were being built here and there, someiimes on the ruins of the old ones -—small, warm log houses with thatched roofs, the cracks between the logs well battened. Some crops were already growing and women, children and a few oEd men were working in the fields, driving horses harnessed with a characteristic wooden arch over the withers.

The road soon degenerated to a slippery dirt surface. Periodically the cortege stopped so we could walk and stretch, after which we were recalled each time by a shout from Colonel Banaytis, one of our guides—“pakoniam.” This cry is used to call the Cossack cavalry to horse, and was invariably followed by good-natured laughter from our Russian friends.

We passed through the City of Vyazma, once containing 60,000 people, and now completely converted to rubble, except for occasional chimneys supported in their lonely place by the large stoves with which Russian houses are ordinarily heated. Finally we stopped and were told that we had reached a 200-bed tented hospital. Its concealment, however, was so complete that although it was not more than 30 feet from us we could detect its presence only by the sound of an accordion issuing from the wood. During the first year of the war the enemy did not respect the Red Cross with which hospitals were marked, so camouflage has been pressed into use.

We soon found ourselves in a mess tent, round in shape and covered with heavy wool felt. This tent, which is warm and serviceable, is called a yurt. It has been presented to mobile hospitals of this type in large numbers by the Mongolian Republic—a source of lend-lease supply that I had not suspected.

We were invited to tea, which we had come to recognize as a formidable affair. The ceremony was inaugurated by the commanding officer, a stocky, grey-haired man of 50, who pledged outhealth by downing a tumbler of vodka. This physiological experiment we decided not to repeat, as we preferred to remember his hospital.

Dinner of Many Courses

At 10 o’clock we arrived at a sorting and evacuation hospital, which is the most forward of Russian hospitals. We sat down, with a large number of medical officers, to a dinner of many courses. For three hours there was a constant cabaret show, all put on by members of the staff, male and female. There was accordion music, singing, Russian dances and, most, surprising

of all, some very sophisticated dances. The fancy dress was assorted, to say the least, but there was an occasional silk dress, high heels and silk stockings, all of which were worn to good advantage.

One of our waitresses stopped her work several times and danced beautifully. While serving us her face had been expressionless—a characteristic one noted in others—but when she began to dance her face flushed and her eyes sparkled. There were toasts and more toasts, to the Red Soldier, to success in arms, to each other, to things which are above nationalism, such as medicine, science, understanding and friendship.

Next morning our hosts were back, with friendly grins, to take us to breakfast and show us their work. This hospital could accommodate from 2,000 to 4,000 wounded. When the Germans retreated from the area three months before, this unit moved in with a staff of 700. The site was then eight kilometres from the front. They built the huts themselves, cutting down trees for building material and digging them into the ground for protection from bombing. For camouflage they used sod, trees and netting. As a source of power, an old wood-burning threshing machine was used.

These were surgeons of great experience in handling war casualties. One of them, a woman, slender and quiet, with the rank of major, wore three wound stripes. She had operated on 1,000 gunshot wounds of the chest and 400 of the abdomen during this war.

Aside from medical and surgical information and their excellent organization, perhaps the thing that made the deepest impression on us at the front was the role of the Russian woman. Nurses who had received a three-year training in the profession of nursing were bearing their share of work in the construction of the unfinished huts. They were quiet, seemingly stolid, with hands in the dirt or hammering, planing or sawing. And yet some of these women had danced the night before and presented quite a different appearance.

Behind the front, women, sometimes tall and gaunt, but usually stocky and sturdy, were working in the fields, trudging the roads or getting a lift in a passing military truck. In ruined Vyazma they cleared the rubble and labored to construct temporary hovels until their men could return to help them regain their own.

The streets of Moscow look very much like the streets of other western capitals. My first impression, however, was that men, women and children seemed to be hurrying somewhere. Soon I realized that this was habitual, and later when I went to visit Chungking I found that the Russian habit of diligent haste resembled that of the common people of China.

Streetcars, three in a row, are usually crowded. People hang on the outside and others pursue them to catch on the back. On a Sunday morning the appearance of the streets below my hotel window had altered somewhat. Many people were now carrying garden tools and lunches, apparently going, with their children, to spend the day on allotments outside the city.

Opera, concert and ballet are crowded every night and the performances are good. The ballet, 40 companies of which are said to be playing at the present time throughout the Soviet Union, is superlative.

Volley ball, with six on a side, is the most popular outdoor sport in the Soviet Union, and one morning, outside a hospital in the forest, the members of our surgical delegation found themselves playing against a group of Soviet surgeons who were our guides for the morning. I regret to report, however, that despite the star performance on our side by our young lady interpreter, we lost ignominiously!

No Malnutrition

We were on the lookout for evidence of malnutrition, but we saw none. The allowance of food for the worker is greater than for the nonworker. To mention a few items, we were told that a worker is allowed one and three quarter pounds of bread a day and four and four tenth pounds of meat or fish a week. A nonworker and a child receives eight tenths of a pound of bread a day and one and three tenth pounds of meat or fish a week. On the other band, if a school child is able to put in three hours of work a day it receives the ration of a worker. Thus a family may balance its food budget, and the method serves to mobilize the maximum number of workers. The prices of these articles on the ration card, including food and clothes, are fixed.

In Moscow we lived in the National Hotel, opposite the Kremlin, and we were quite free to come and go as we liked. Red Square, flanked on one side by the Kremlin’s 50-foot wall of red stone, in front of which stands a row of dark pines, is as impressive as one had expected, but the gloomy sepulchre of Lenin is closed during the war.

Another building capped by bulbous Byzantine spires, which fronts on the Square, is also closed. One evening while walking by it with Mr. Carling, a companion on this adventure, I was filled with curiosity about a sign which we could see on one of the doors. We lifted a broken lock off the gate of the building’s enclosure and approached the building. I had spent the month in London studying the Russian language but ended by learning little more than its strange alphabet, and the sign was much too much for either of us. So I pulled out my notebook and carefully copied down the letters of the notice.

We had heard nothing, but, suddenly, on turning my head, I realized a soldier was looking over my shoulder at the notebook. A chill ran down my spine. He was dressed in a curious blue uniform. For a moment we three stood still and I held the book for his inspection. Then I made a rather silly remark to him in English but he did not reply or make any move. He did look a little surprised, perhaps. Finally Carling and I agreed we had better go. The soldier followed closely and locked the gate without a word. We hurried back to the hotel, with no one in pursuit, and looked up someone who could read the words in the notebook. They were “Entrance to Museum.”

Our contacts with Soviet surgeons consisted of a series of visits arranged in advance for us by the Commissariat of Public Health. It is true that there were no free, informal calls. This was partly due to our need of an interpreter. But it was also because at present Soviet citizens do not seem to feel free to initiate contacts with foreigners, spontaneously, for fear of official criticism. Once a visit had been arranged, however, we found their

doctors eager to make friends, to show us hospitality, and to demonstrate their methods and results.

The reluctance of Soviet authorities to allow unrestricted entrance of other nationals to their country is widely recognized and frequently commented upon. This, I would suggest, is to be explained quite simply on the basis that they have been building up an internal structure—economic, political, educational and social. As long as they have felt that this rapid and so far successful evolution was likely to progress more smoothly without visits from their friends, they have continued to maintain barriers to travel.

Aloofness May Disappear

My personal experience would lead me to believe that this attitude toward foreigners is not prompted in any way by fear nor by enmity toward outsiders, as some seem to suggest, but by private consideration of what is best for their own people. This attitude, which seems justified under present conditions, may well disappear as soon as it is obvious to them that the development of the various departments of life within the Soviet Union will not be disturbed by such outside contacts. Certainly in the field of surgery they appear to be completely ready for discussion, comparison and also cooperation.

We were interested to observe that the words “Commissariat of Public Health” appear on the entrance to that building in both Russian and English. Thé Commissar, Georgii Andreyevich Miterev, is a man of 42 years, blond, energetic and forceful. Having been an active surgeon, he showed a broad grasp of the general principles of medicine in regard to public health, and particularly in regard to the Army.

Lieut.-General Smirnov is in charge of the Army Medical Service at the front and is directly responsible to Marshal Stalin. He is only 38 years old. Until the age of 24 he was a worker. His rise, nine years after graduation, to the highest position in the Army Medical Service must have been meteoric, to say the least. But the top-ranking surgeon in the Navy, Major General Andreev, is said to be only 35.

Smirnov’s associates say that he has a genius for organization and leader^

ship and that he is capable of working 20 hours a day. He is an alert young giant, of good appearance in the standard dress uniform. ’Personally, he is a most likeable fellow. When I quoted a French-Canadian poem to him about “Ma Pipe et ma Femme,” he replied with a Cossack song on the same subject.

Lieut.-General Burdenko, aged 62, Chief Surgeon of the Red Army, is a fiery, energetic, stocky little man, whose chest is covered with stars and decorations and who seems to have the complete loyalty of his subordinates in spite of the fact that he has become deaf. Colonel Yudin is tall, cadaverous, intense, a brilliant technician, and a man of great enthusiasms, who is probably not excelled technically in any country as an abdominal surgeon or extremity surgeon. Like his master, Burdenko, he is capable of enormous labor day after day and night after night, in spite of ill-health.

Adversity seems to have brought out the tough fibre of this people. Casualties have reached staggering figures and hospital admissions approach 6,000,000—70% of whom are said to have been returned to the fighting line. They have faced defeat and repeated evacuation, privation and bereavement, yet the casual observer might think them stolid or apathetic. Let me cite an example to show this is not so. During one of our luncheons, a distinguished physician, who had that morning conducted us on rounds, rose to his feet with the rest to drink a toast, which had been proposed by one of our members, to the Red Soldier. When he sat down he suddenly leaned across the table and spoke in French, “The Red Soldier!” he said. “You don’t know what that means to us. My son was killed two days ago and today he is 21 years old.” For only an instant his face was contorted, but this was followed immediately by a composure that resembled indifference. No one of us who heard him could reply.

It is not their way to voice threats. Grim determination to drive out the invader expresses itself in action. Psychoneurosis, or shell shock, is really rare in Russia, for they have an enormous supply of its specific antidote. The antidote is high morale and an enthusiasm generated in adversity. It was not necessary to import this by lend-lease. Napoleon learned about this and Hitler is learning.