CHAPTER 3. PARQUET FLOORS
“I’ve heard, I’ve heard a lot about your scientific successes,” the new General Secretary repeated several times, shaking the Chief’s hand.
– I read an article about your clinic in the latest issue of my favorite magazine. Now I believe that you can help me,” the Kremlin Pulmonary continued, although without much confidence in his voice.
After all, he remembered his predecessor - KaGeBist, and his end was sudden, coming unexpectedly for everyone. And then he was one of his personal consultants and assured of good prospects for another couple of years of rule...
“So my hopes didn’t come true,” another thought came to Lung Man’s head. “But on the other hand, he suffered from kidney problems, and it is unlikely that a personal consultant therapist could help him. But I’m a completely different matter - with my lungs, all the cards are in his hands. He is the first specialist in the country - a therapist and pulmonologist! Only forty-four years old, and already at the Academy of Sciences!”
From this thought, the face of the Kremlin Pulmonary Man brightened, and he once again remembered how the unexpected death of the KaGeBist turned out to be to his advantage: in confusion and confusion from the pestilence that fell from above on the members of the party leadership, the Politburo in a hurry did not find another candidate to rule the country.
“Now he (meaning the Chief) will make every effort to justify the high trust placed in him,” the new head of the USSR reasoned mentally, “and will not, like the KaGeBist last time, deny that the kidneys are not his profile... He invented so many things for asthmatics... The central press won’t print just anything”...
Well, the Chief, standing at attention in front of him, tried to find an acceptable answer that would allow him to get a time delay, now thinking with regret about his popularity:
“And why did I agree to this interview? And the article is worthless, and, in general, there is no benefit from it. The country must know its heroes,” he recalled with irritation the words of the deputy editor who had placed his daughter in graduate school in his department.
“And how much later I had to fend off letters from sick workers! Now think about how best to disown this article!”
But I thought one thing, and said another - life-saving phrases nevertheless came to my tongue:
– We will definitely help you! We will use not only our own, but all the latest foreign methods. We don't have everything yet. Of course, if I had my own institute (here he showed deep regret on his face), not only my own, but all the world’s achievements would be introduced into healthcare! But what can you do on the basis of an ordinary Moscow city hospital?
“In the future, this can be solved,” his new ward smiled patronizingly at the Chief. – Based on the results of your work, we will make the necessary decision in the government. I think for now, implement everything that you consider necessary here, in the Kremlin Directorate. If you can treat me, we’ll consider your proposal for the institute...
Leaving the reception room of the Kremlin Pulmonary Hospital, the Chief mentally imagined himself as the director of the future Institute of Pulmonology in Moscow, hoping that he would last at least a couple more years under his care. Yes, and Pulmonary hoped for this, naively believing that the most outstanding doctors in the Kremlin Directorate used him. But looking ahead, let’s say: I hoped in vain. It’s not without reason that there was a saying among graduates of Moscow medical universities: “In the Kremlin clinic, the floors are parquet, and the doctors use questionnaires.” But the “correct” questionnaire, as it often turns out, is not a guarantee of correct treatment...
By the way, the Chief himself was a typical “doctor with a profile”: he spent almost his entire residency in the department laboratory, conducting biochemical research. And as he ran into his wards on rounds, he was not thinking at all about treating asthmatics, but about defending his future dissertation ahead of schedule. In the same way - ahead of schedule - he jumped from assistant to professor - head of the department, and then to corresponding member. That is why he, in a hurry, had no time to comprehend the science of medicine. It happened that on my monthly rounds I got into trouble, but at the same time I always got out of it very skillfully. Once, deep in thought, he began to listen to the patient through his thick hospital pajamas, not noticing that he had not yet undressed. And when he noticed, he was not embarrassed, but announced with a patronizing smile, pointing to his stethoscope: this is a new model - you can hear everything even through clothes. Well, those around me in the ward just gaped in surprise. Nothing can be said here: the Chief was always able to turn everything upside down so successfully that he earned the nickname “diplomat” in his circle. But here I, the reader, got a little distracted. So let's get back to the story about the Kremlin Pulmonary Man...
The next day, with the appearance of the Chief in the Kremlin Directorate, a rush began: dozens of faxes were sent to all corners of the world - from Switzerland and Germany to Japan and Australia. These requests were sent to medical and pharmaceutical companies, leading scientists - immunologists, pharmacists, biochemists and others with one goal: to obtain the latest information about the latest treatment methods, the most effective drugs and medical equipment in order to purchase everything necessary for the speedy treatment of the Kremlin Lung. On behalf of the USSR government, the most authoritative scientists were invited to Moscow for consultation. We sent out invitations and began to wait for responses...
We didn’t have to wait particularly long: who would refuse a paid trip to this mysterious country - Russia, where bears roam Red Square in winter, and people eat exclusively pancakes with caviar and wash it all down with vodka. And companies producing medicines and medical equipment promptly sent catalogs and price lists. A couple of months later, everything was agreed upon and purchased, and a representative council met in Moscow in the personal apartments of the Secretary General in the Kremlin Directorate. And how it went and how it ended, the Doctor was told by his colleague in graduate school -.
Since today is the anniversary of the collapse of the USSR and the Soviet system, let's remember Soviet medicine, supposedly “good” and supposedly “free”.
In the Western world, a former Soviet man, like a horse, is recognized by his teeth. If you see a person of Eastern European appearance on the streets of London, Paris or New York, they immediately look at the mouth to clarify the diagnosis. There, in the mouths of former Soviets, there is always a mess going on. Stamp of traditional medicine. Even the Poles, Czechs and Bulgarians, that is, comrades who have gone a little further from socialism than us, have neater mouths.
In Latin rima oris. Or "mouth gap".
This is what Soviet dentists called our mouths. “Open your mouth!” - a man in a white coat barked imperiously, seating a man with a face white with fear under the drilling machine...
Yesterday I saw a campaign banner by the roadside from the leader of one of our few parliamentary parties: “Let’s bring back decent free healthcare!” Probably, before we had decent medicine, but today it is no good. Oh, I wish this leader could go to a Soviet clinic for at least an hour. Better dental.
Any exploitation of false longing for non-existent Soviet happiness must be punished with at least a ruble, because playing on Soviet mythology results in infantilization of the population. It ceases to really perceive the world and its responsibility for it, preferring to escape from reality into the languid past.
People who believe that there was good free medicine in the USSR are twice mistaken, because it was not free and it was not good either.
The income level of Soviet citizens lagged behind almost all countries except Africa, India, China and Latin American juntas. For free medicine, free education and free apartments, Soviet people paid at least 2/3 of their real earnings. In the early 1970s, each Soviet person had less than 65 rubles of net income, which even in the Party Central Committee was considered to be living below the poverty line. This is how 3/4 of the country's population lived. And 40% did not even reach the subsistence level.
In Soviet times, people were fleeced by the state brazenly, hypocritically, and cruelly. And for all those modest benefits that the state called free, they paid in full. And then they paid above the norm.
In 1965, ten tablets of chloramphenicol cost 64 kopecks, while their production, according to the State Planning Committee, cost the state only 18 kopecks. The famous Soviet “head remedy” based on analgin, banned in Europe, and even more dangerous pyramidon and caffeine, cost 45 kopecks in pharmacies, and 8 kopecks were spent on its production. It was called “Troychatka”.
Imagine that today a blister of antediluvian citramone would cost more than 100 rubles. What was truly affordable in the Brezhnev pharmacy were iodine and brilliant green - 4 kopecks.
These simple remedies, plus cough lozenges, cough tablets, penicillin and the bronchodilator solutan - these are, perhaps, all the medicines that an ordinary Soviet citizen knew. In the 1970s, they were joined by noshpa and Indian festal, but they were sold through connections or at exorbitant prices. In large cities, a recipe could be used to prepare sulfur powder, calendula tincture or anti-acne lotion. In small cities there were interruptions even with the pyramidon.
Remember the satirical miniature by Kartsev and Ilchenko “Warehouse”.
Pyramidon and analgin were already known then for their severe side effects. Noshpa outside the socialist camp was considered a placebo with long-term side effects, including on the intrauterine development of the child. Festal is today called a pseudo-medicine.
The entire Soviet Union used brilliant green to disinfect scratches, while in the rest of the world it was used to dry the edges of wounds. Soviet drug addicts made “vint” from solutan.
Contrary to the memories of patriots, even these meager medicines were not free in Soviet times. All pharmacies in the USSR were divided into outpatient, that is, self-supporting, and hospital. In the first, medicines were sold for money. Pensioners at the pharmacy were entitled to only one benefit - out-of-turn service. Disabled people and war veterans, disabled people of the first two groups and children under one year old received medicines free of charge. Group III disabled people and children from one to three years old were given a discount. Beneficiaries formed their own queue.
Diabetics bought their own insulin. And seriously ill patients also bought pain relief. Both were chronically unavailable in pharmacies; injections were often obtained only at a doctor’s appointment. The luckiest ones, with connections and money, injected insulin at home from reusable syringes. They were boiled. As a rule, there was one syringe per family, and they took care of it. By the way, life for diabetics in the Soviet country was very bad: insulin was homemade and could not cope with a carbohydrate diet. The country lived on potatoes, pasta and bread. Only two products were produced for diabetics - sorbitol and buckwheat. Both were not given out free of charge, but were sold at market prices. And according to recipes.
Buckwheat - according to the recipe! Did you know?
In the Soviet Union, it was necessary to live young and healthy, because any disease brought a person to the sidelines. The words “cancer”, “stroke”, cerebral palsy in Russia are still synonymous with death or lifelong misfortune, because they were not treated in the USSR, people died quietly, secretly, children with cerebral palsy were hidden.
This is because there were no effective medicines freely available outside of Moscow, and in Moscow they were rare and expensive. Soviet people died not only from strokes, but also from diseases that are ridiculous by today's standards: bronchitis, pancreatitis, asthma, from inflammation of the plenum, from a simple cut on the hand or an abscess.
There were no good antibiotics available for public sale, which is why a huge share of child mortality was due to respiratory diseases. There were no drugs like pancreatin. Asthmatics were injected with hormones in the hospital, during a planned hospitalization, the person could not relieve the asthma attack himself. The chief engineer of the housing office from Mamin’s film “Fountain” used an inhaler for asthmatics - a miracle unprecedented even in the late Soviet Union.
People watched the film and understood that this wonderful romantic was an ordinary thief, because the inhaler, and even with a prescription, was not given to thieves.
Any more or less serious illness resulted in huge expenses, even if the person was admitted to a hospital: medicines in the hospital, like other shortages, were obtained through connections. It happened that tests were done through acquaintances and procedures were carried out for bribes. Clinics often had no reagents, no laboratory equipment, and no dressing material. What was available was distributed corruptly, taken home by staff.
They carried everything: droppers for crafts, bandages for reserve, alcohol for vodka, tweezers, lancets, clamps for the kitchen. A person who ended up in a Soviet hospital without money or acquaintances could simply lie under a glucose drip for 20 days, since there was often nothing in hospitals. Almost everyone had to lie like this, because people with a salary of up to 135 rubles, that is, at least 4/5 of the population, did not have access to the illegal drug market.
However, even the medicines distributed through connections hardly treated anyone, because they were Soviet medicines. Truly effective Western drugs penetrated illegally - mainly through traveling diplomats, athletes, and trade mission workers. And they were a drop in the ocean. We produced almost nothing. In a closed country, science was also closed. The technical, medical, and natural science intelligentsia did not know foreign languages, and the damned bourgeoisie did not translate their publications into Russian. Contrary to proud myths, the Soviet pharmaceutical industry did not make any breakthrough discoveries.
Today, about 5 thousand effective original drugs are known in the world of evidence-based medicine. Of these, less than twenty were discovered by Soviet pharmacology.
The KGB had a powerful pharmaceutical intelligence service - security officers from all over the world brought other people's developments to the Union.
Against the backdrop of a total shortage of pharmaceuticals, the Soviet people were treated with whatever was necessary. Nowadays it is common to remember salt rooms in schools, wet salt mats in kindergartens, morning exercises before classes. This is all very good, of course. But apart from salt treatments and massage mats, there was virtually nothing in the country.
Visiting doctors was free, but what kind of doctors did they see in regular hospitals and clinics? They also did not know languages. They were taught by teachers who themselves learned in isolation from world science. Therefore, various obscurantist medical practices flourished in the Union. Especially in the field of physical therapy.
UHF, polarized light, electrophoresis, UV, electrosleep, cups, leeches and mustard plasters were perhaps the only weapons of the Soviet doctor.
They fought against all diseases - from the consequences of perinatal hypoxia and pathologies of placental development to ischemia and osteoporosis.
A sick Soviet worker came under double pressure. On the one hand, helpless medicine awaited him, which took a month and a half to treat ear inflammation or mastitis. On the other hand, sick leave was lying in wait for the poor fellow. The country had standard periods for being on sick leave. After a heart attack and ischemia, 20 days of rest were given. For all illnesses, sick leave had to be extended every three days; it was forbidden to stay on sick leave for more than 10 days without a medical commission.
For colds and acute respiratory viral infections without a fever, sick leave was not required - they went to work snotty. It was impossible to stay at home with a sick child for more than seven calendar days - sick leave was closed, even if the child had whooping cough. For two years, being on sick leave for more than a week was collectively not encouraged; everyone knew this and took time off at their own expense.
Sick leave was paid in full only to people with extensive experience - over eight years. In Soviet times, people got sick with their own money. But dues to the trade union were required to be paid - 1% of the salary, including vacation pay. The teacher paid 12–14 rubles a year to the trade fund. And I was sick 2.5 working days a year. And once every ten years I went on a trip to a sanatorium. That is, the Soviet people paid for their medical care themselves.
Things were a little better in departmental hospitals - valuable workers were taken care of, so bosses went on sick leave several times a year. But another problem was lurking in the special institutions - they received scarce Western equipment and Western medicines. For this reason, good hospitals were extremely corrupt, jobs were grain-based and distributed among their own. And where there is a lot of cronyism, there is no place for qualifications. And they stole more in special hospitals than in district ones.
I personally know the family of a former judge of the Supreme Court and the family of one of the first secretaries of the regional committee of a non-poor region. Both were afraid to be treated in departmental clinics.
What can we say about ordinary outpatient clinics and hospitals? These establishments were scary. Chambers for 12 people and one toilet for two departments are the standard design of the clinic. In maternity hospitals there were ten people in a ward. There were five to ten chairs in the maternity room.
Soviet obstetrics and pediatrics are the main enemies of Soviet citizens. All pediatrics in the first year of a child’s life was aimed at separating the baby from the mother as early as possible so that she could enter production as quickly as possible. Therefore, until the 1960s, a woman did not have the right to babysit for more than three months. Then she was given first six months, then a year, but unpaid leave.
Until 1982, a woman could stay at home with her child in the first year of life only at her own expense.
At the same time, all obstetrics in the USSR was organized so that a woman would go on maternity leave as late as possible. For this purpose, antenatal clinics specifically reduced the duration of pregnancy and issued a certificate stating that it was time to go on maternity leave at 39 weeks. Women gave birth without having time to convey this certificate to their accounting department.
However, obstetrics and pediatrics were not the most terrible areas of Soviet medicine - otolaryngology and dentistry were more terrible. ENT doctors performed almost all operations without anesthesia: puncture of the nasal sinuses, removal of tonsils, tonsils, adenoids, puncture of the eardrum, cleaning of the middle ear - all at best with novocaine, that is, live.
And in the USSR, teeth were treated using pre-war machines, cement fillings were placed, the nerve was removed with arsenic, and the pain was anesthetized with the same novocaine. People were afraid of this kind of dentistry. Any effective anesthesia, foreign fillings or good prosthetics cost more than a worker’s monthly salary and appeared only in large cities; there was a queue for them for years to come. War veterans and disabled people, and labor veterans received preferential places in the queue. A woman under 60 did not have the opportunity to get teeth inserted without a huge bribe - she could not get through the beneficiaries.
People who yearn for free medicine today simply do not remember the millions of toothless mouths. And in Soviet times they didn’t suffer from anything serious.
Surprisingly, both ultra-liberal and ultra-conservative our citizens today equally criticize modern medicine for the fact that it does not live up to Soviet medicine. And thank God, I’ll tell you that it doesn’t live up to it!
Almost all diseases without exception are now treated in Russia without crazy queues and bribes. Yes, our medicine is not of a Western level. Yes, not everything is free. Yes, not everyone is treated with everything. But the situation is not as bad as some nostalgic alarmists imagine. At least parents today don't have to sell their wedding rings to pay the nurse for injections.
Maybe that’s why hospitals these days are so far from ideal that they are constantly compared not with American or European clinics, but with Soviet institutions, where people were 12 people in a room and where medicines were literally more expensive than gold?
Soviet healthcare cannot stand any comparison with modern healthcare. Moreover, if only because over the course of several decades, medicine and medical practice throughout the world have made a breakthrough. And in our country too. By denying the superiority of post-Soviet healthcare, people, in addition to common sense, are denying progress. Because even if the USSR was a super-open power, its medicine would still seem backward to us. Just because of progress.
Memories of good Soviet medicine are of the same romantic order as longing for Brezhnev's ice cream. Most of those who today still have the strength to discuss the advantages of socialist health care were young in the USSR, for this reason they were happy and, by the way, very healthy. They simply did not have time to encounter the system. And, to be honest, they have nothing to compare Russian medicine with. But for those who really want to compare, I advise you to risk pulling out a tooth without anesthesia. I have never heard of such bold experimenters in the 21st century.
The series of stories about great doctors continues Hematologist Nikita Shklovsky-Kordi:
Why were global programs to harvest bone marrow in case of nuclear war closed?
— So, Nikita Efimovich, 1972, a protocol for the treatment of Donald Pinkel’s childhood leukemia appeared. How was this implemented in the USSR?
— The leading Soviet hematologist Andrei Ivanovich Vorobyov at that time, as they said, “played the box” - he had to work in the clinic of the Third Directorate. It was a very closed clinic (hence “box”) - such offers were difficult to refuse in Soviet times. Although he said that his parents were imprisoned and he could not be a party member, he did not wriggle out. (In 1936, A.I. Vorobyov’s father was shot, and his mother was sentenced to ten years in the camps. The “Institute of Biophysics” with a departmental closed hospital with 200 beds was under the jurisdiction of the Third Main Directorate of the Ministry of Health - the Atomic Ministry - "Sredmash" - and was specially engaged in rehabilitation of workers “suffered from the radiation factor” - Note auto).
But, on the other hand, there were much more opportunities to conduct serious therapy there.
Before Vorobyov, it was believed at the Institute of Biophysics that acute radiation sickness was, first of all, a disease of the nervous system.
Andrei Ivanovich fundamentally changed these ideas and created a system of biological dosimetry: an algorithm that allows one to retrospectively reconstruct the radiation dose based on the clinical signs of the disease. It was practically impossible to measure this dose using physical methods. An accident is always a mess: people go where they shouldn’t and don’t take a dosimeter with them. And the dosimeters were designed for small doses; during accidents they went off scale.
At A.I. Vorobyova had a brilliant colleague - Dr. Marina Davydovna Brilliant. She looked after the patients very carefully and, every day, when she did a blood test for them, she recorded the results on a temperature sheet. All doctors in the world are taught to keep such a list, but few do it.
M.D. Diamond and A.I. Vorobyov discovered that in acute radiation sickness, the leukocyte curve—the change in the number of peripheral blood leukocytes over time—reflects the dose of total radiation that the patient received on the bone marrow. Observing victims of many radiation accidents of that time allowed them to learn to determine the emergency radiation dose with an accuracy of several tens of rads and formulate this in the form of instructions.
During Chernobyl, Andrei Ivanovich’s student discharged fifteen thousand people from hospitals in Ukraine in one day - because he could estimate the upper limit of the radiation dose they received, from which it directly followed that they would not need medical care.
On the other hand, it became clear who could not be cured - with a total dose of more than six hundred rads, the bone marrow was not restored, and the success of bone marrow transplantation in case of emergency radiation was excluded.
This was also proven by A.I. Vorobyov and his colleagues and closed the Soviet and world programs for the procurement of bone marrow in case of nuclear war.
— As I understand it, when Chernobyl happened, all of Academician Vorobyov’s research was very useful?
- And how! Andrei Ivanovich gave a lecture on acute radiation sickness to all hematology cadets at his department at the Institute for Advanced Medical Studies. I first heard it at medical school, and while already working for him, I sat at this lecture in April 1986 - just before the accident. And someone chuckled:
- Why do we say we need this?
Vorobyov answered very decisively:
“Tomorrow some station will collapse, you will all be on the front line and will treat these patients.”
And so it happened.
Chernobyl nuclear power plant, after the explosion and before conservation. Photo: ria.ru
And then Vorobiev became the main person responsible for the clinical part of Chernobyl. Two hundred people were treated in the sixth hospital, and no serious mistakes were made there, except that they were not given a blood test on the May holidays. And international experts R. Gale and Tarasaki were allowed there due to the fact that Vorobyov was not afraid of openness.
Andrei Ivanovich Vorobyov is a hero not only of saving the lives of victims, but also a champion of understanding the Chernobyl experience.
— And in peacetime, these studies were continued - as a treatment for leukemia, and not for acute radiation sickness?
— Yes, Academician Vorobiev very soon created a program for the treatment of lymphogranulomatosis with chemotherapy and radiation at the same time. It was an absolutely innovative program, ahead of its time, but as a complication, ten percent of patients developed acute myeloid leukemia. Then this program was stopped and then came to us from abroad with a modification - chemistry and radiation were postponed by a month. This gave brilliant results.
The first thing Vorobyov did when he became director of the Central Institute of Blood Transfusion was resuscitation for oncological and, in particular, hematological patients. There, chemotherapy began with artificial ventilation and hemodialysis.
This is how the “medicine of the future” was formed, capable of taking on a number of important functions of the human body and helping to endure the toxic load of chemotherapy. The institute began to be called the “Center for Hematology and Intensive Care” - during perestroika, it was sometimes possible to change the names in accordance with the meaning.
As a result, Vorobiev achieved that lymphogranulomatosis began to be cured in 90% of cases, and some types of lymphosarcoma - in 80%.
This happened due to the fact that he took full responsibility for clinical trials, without waiting for endless approval procedures.
“All because Vorobyov managed to explain to his superiors”
— I understand that this later came in handy during Chernobyl. But what does this have to do with children?
— Vorobiev remained the most experienced specialist in radiation sickness - then there were fewer accidents, and he came to Sredmash just at the moment when our nuclear industry was transferred from the hands of the scientific creators to the hands of operating engineers.
There were many accidents then and, accordingly, many sick people. We learned from them.
But still, these were random patients. And here Andrei Ivanovich managed to explain to his superiors that the model of radiation sickness is acute leukemia and get permission to admit children with acute leukemia to his closed clinic.
When the Total Therapy program appeared, Vorobiev, in the same year, slightly changing the protocol to suit his real capabilities, treated several dozen children. The protocol included the need to destroy leukemia cells that had “settled” in the membranes of the brain and spinal cord. Pinkel had radiation for this.
But, since Vorobyov did not have a suitable irradiator for the head and spine, he prevented neuroleukemia not with x-rays, but with chemotherapy - he injected three cytostatics into the cerebrospinal fluid at once. By the way, a few years later the Americans modified the protocol in the same way.
And a miracle happened that pediatric hematologists could not believe in - 50% of cases of complete cure for acute lymphoblastic leukemia in children - just as it was said in Pinkel’s publication.
Despite the fact that Vorobyov was publicly accused of being subject to the “corrupt influence of the West,” at least ten of these first cured people live in Russia today.
We are friends with one of them, a film director and restaurateur, and she invites us to celebrate the holiday of her life, it is known who gave it to her. And the holiday has been going on for more than forty years.
Great doctors may have different methods
— Pinkel was a democratic doctor who insisted on the patient’s duty to know his diagnosis. And Vorobiev? What's even better?
— Yes, and in his clinic, for example, there was a special documentation regime, when the patient’s card was placed in a folder on the door of the room and was available to him and his family. This was a great step, and very few in world medicine have reached this point today.
Our last conversation about Pinkel was illustrated by the website Miloserdie.ru with a photograph of the pompous entrance to St. Jude with a huge statue. This is a picture of today's regression: the first St. Jude building was surprisingly modest and proportionate to small patients.
But the laboratories there were spacious - in contrast to what I saw in the USA when I got there in 1989 - luxurious hospital lobbies and closets of research departments.
In St. Jude Original, Pinkel took an epochal step comparable to Pinel, who removed the chains from psychiatric patients. Pinkel put the medical history in the hands of the patient and his parents - so that there would be no conflict between the doctor and his patient. secret.
Andrei Ivanovich Vorobyov is a completely different person - he is a paternalistic doctor. He told his patients this: “We know what is wrong with you, and we will do everything that is necessary.” And the patient, when he hears this, does not argue, because
Every sick person - both small and large - wants to have parents. If you have such happiness - a doctor who is your father and mother - it is a rare patient who will refuse this.
- Nikita Efimovich, but in the current conditions, when an oncology patient must receive a quota, wait for a place in the federal center and get there when he is transferred from region to region, he should know his diagnosis and the list of procedures that he needs.
- Undoubtedly. And Andrei Ivanovich is one of those people who understands this well. Of the people I know, the one best prepared for remote treatment was eighty-seven-year-old Doctor Vorobiev. He is ready to consult patients by phone, Skype - whatever you like. He has one goal - to help the patient, and if new means can be used for this, he uses it.
Today A.I. Vorobiev says that the patient must become much more active and take many things into his own hands - first of all - collecting and storing medical records, ensuring continuity treatment.
Without this, everything is in vain, just like thinking without memory falls apart. The literacy of patients has increased and at the same time the organizational capabilities of the doctor have decreased. That is, today the patient must be responsible for collecting and storing medical information.
Another thing is that Vorobyov always says: “You cannot take away a person’s last hope.” Not because he ever took it away, but there are people who do it, and not without pleasure. In Harrison's textbook, the Bible of American medicine, there is, for example, the following statement:
“A misanthrope may be a good diagnostician, but he will never be a good doctor.”
There is also a psychological defense: a person does not hear what he does not want to hear. All current “informed consent” does not take into account what exactly the person heard and accepted. Formally, you informed him, but you don’t know what he learned from it. It seems to me that the highest success of “informed consent” - mutual understanding between doctor and patients, were the words of the parents of Pinkel’s young patients: “We know that our children will die. But do your best to understand how to treat other children.” This is where the healing took place. These are not random words in the Universe!
The point is not to tell a person that he is dying. Personally, I tell patients who ask me about death directly:
“You know, today you are sick, but I seem to be healthy. But tomorrow is tomorrow for both of us.”
So we discuss what we know about the diagnosis and what we will do.
In the West, a person is also not informed about a diagnosis in such a way that he has nowhere to run. Because a catastrophe for a person is a lack of meaning.
And a constructive path is a search for the meaning of today’s life, with any diagnosis, and people who are looking for this meaning with you.
The main advantage and main disadvantage of a doctor
Doctor Fedor Petrovich Gaaz. Image from lecourrierderussie.com
In world practice, medical research has begun to slow itself down. They are overgrown with a huge bureaucracy, commissions and committees, which believe that good can only be compared with very good, and risky cannot be compared. This dulls the role of the doctor-researcher - after all, Dr. Haass said: “ Hurry up to do good".
Vorobiev openly believes that he is doing an “experiment” with each patient: he treats each one as if it were the first time, because all patients are complex. But patients become complex only when the doctor works with them only after the requirements for making a diagnosis have been met. Then, when treatment is prescribed, the doctor follows the protocol, but with each patient, within the framework of the protocol, he looks for what can be done better.
Vorobyov is the genius of the council. He takes his own opinion into account last, and even treats the “breaths” of someone else’s thoughts with great attention and is ready to hear it, even if this requires a change in the entire concept of treatment.
Vorobiev considers the main quality necessary for a doctor to be focus on the patient. And the most dangerous flaw a doctor can have is stubbornness.
So try to please him!
Medicine “for the nose” - a relapse of the Middle Ages
"Hippocrates: Medicine Becomes Science" by Tom Robert, ser. 20th century. Image from casosgalenos.com
— You said that ideally a medical history is written as an essay, and the patient participates in its creation. But this results in a huge amount of information that is impossible to analyze in the current flow conditions.
— The history of the disease, as it was formed at the end of the 19th century, is an example of a successful approach to describing a complex object. As they say in mathematics, “decision making with insufficient and unreliable information.” And here you cannot follow the symptom.
Our pharmacies are experiencing a relapse of the Middle Ages: medicines “for the nose”, “for the eyes” and “for the back” are the complete opposite of science.
The scientific approach is different: you listen to the patient’s complaints, ask about how he lived and was ill, and then examine him according to a plan that is the same throughout the world: the respiratory system, the digestive system, the endocrine system, etc., and only after that you put forward a hypothesis about the diagnosis and see how to check it: order additional tests.
A good doctor always follows a systemic examination algorithm, the problem is that now they have become worse at recording their findings and conclusions, and this is the main creative result of a doctor’s work!
Alas, medical history is being replaced by reporting forms.
The amount of information that laboratory and instrumental tests provide in modern medical history is enormous. But they are scattered and can only be integrated by a person - a doctor. The task of information systems is to help find connections and present information to the doctor in a convenient form. The temperature sheets kept by M.D. Brilliant are the simplest example of such a system - and how it worked!
As A.I. says Vorobyov: “the most terrible condition in medicine is the lack of diagnosis.”
“AiF”: - Evgeniy Ivanovich, in the USSR the rulers promoted domestic medicine, therefore, when Brezhnev had a heart attack, he ordered the construction of a Cardiac Center. This is true?
Evgeny Chazov:- Not really. Brezhnev had a heart attack in his youth, when he worked in Moldova as secretary of the Republican Central Committee. In the mid-1970s, my colleagues and I often visited him at his dacha in Zarechye - he then had health problems. The visits took place in the morning and ended with a tea party, which was organized by Brezhnev’s wife. One day he remembered that he had suffered a heart attack. They began to discuss modern methods of treatment, and the conversation turned to health problems in general. I told him about our proposal to create a special cardiology service - already at that time, mortality from cardiovascular diseases occupied one of the first places. After listening carefully, he was surprised that the Ministry of Health could not resolve this issue. And within a week, these proposals with Brezhnev’s visa were discussed at all levels of government. And the fact that none of the Soviet leaders ever went abroad for treatment is indeed true. On the one hand, they probably didn’t want foreigners to find out about their state of health. On the other hand, they believed that we already had everything: a high level of medicine, outstanding specialists recognized throughout the world. Moreover, there was even a certain ban on inviting foreign specialists to the country. Of the 19 leaders of various countries whom I treated, only three - Brezhnev, Andropov, Chernenko (I’m not counting Khrushchev) - were Soviet. And the rest are leaders of foreign states.
What the press didn’t write about me then... For example, that I supposedly killed Brezhnev, Andropov and Chernenko so that Gorbachev would come to power. But in medicine, decisions on the most complex cases are made collectively. So, many academicians took part in the treatment of those whom I “killed”. And at a meeting of the Academy of Medical Sciences, I showed that very article and said: “Dear colleagues, 12 academicians sitting here, it turns out, are criminals, murderers. That's what Pravda said. Everyone started talking. The president of the academy wrote a letter to the newspaper: “Are you creating a new “doctors’ business”?” And Pravda, I note, published this letter along with an apology.
Are overseas doctors in fashion?
“AiF”: - But starting with Boris Yeltsin, our leaders prefer to be treated by foreign specialists. It was you who invited the American heart surgeon Michael DeBakey to see him?
E.Ch.:- Andropov was the first. When, at the end of his life, he had serious health problems, he asked for a consultation with the participation of foreign specialists. We invited Professor Rubin from New York General Hospital, a world-renowned kidney specialist. And he confirmed all our diagnoses and the correctness of treatment. And Yeltsin had surgery with us. By the way, Chernomyrdin also performed operations in Russia. I actually asked my friend DeBakey to come to Yeltsin. Yeltsin liked him. But Yeltsin’s entourage was not satisfied with his verdict and decided to invite German specialists for consultation. When they saw Michael and me, they became nervous. In Germany, I am an honorary member of two universities, everyone knows me there, and suddenly they were sent to supervise me and our outstanding cardiac surgeon and academician Renat Akchurin, with whom we were supposed to operate. The Germans sat silently throughout the entire operation, literally pressed against the wall. As soon as we left the operating room, Michael immediately began applauding himself. He really performed the operation brilliantly. The heart didn’t even have to be artificially restarted - it repaired itself and “started up.” And the first of our people whom DeBakey operated on was the great mathematician Mstislav Keldysh. Then I turned to DeBakey as the author of the treatment method that was required for such a diagnosis as Keldysh’s. But that is another story.
P.S. How is medicine today different from what it was half a century ago? How was Marshal Zhukov saved? Read about this and much more in the continuation of the interview with Academician E. Chazov in the following issues.
Material prepared by: Yulia Borta, Savely Kashnitsky, Dmitry Skurzhansky, Vitaly Tseplyaev, Lydia Yudina
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“Medical and Sanitary Administration of the Kremlin.” This is the title of a new book by Kremlin historians, which for the first time, based on declassified archival documents, tells about the once famous “Lechsanupra”, about how Soviet leaders were treated. (Authors - Sergey Devyatov, Valentin Zhilyaev, Olga Kaykova and others, edited by the director of the Federal Security Service of Russia Evgeny Murov.) Today - on the day of Lenin's death - we are turning over exactly those pages that are dedicated to Vladimir Ilyich...
“Temperature and pulse are normal”
In March 1918, the Soviet government moved from Petrograd to Moscow, and the central authorities of the RSFSR were located in the Kremlin. And immediately the acute question arose - how to organize medical care for the state leadership and Kremlin residents? At that time, about three thousand people permanently lived in the Kremlin. But there was not even a first-aid post - only one dentist's office.
August-1918. Russia is in the midst of a civil war, plus unprecedented activity of the internal opposition.
On August 30, Socialist-Revolutionary Fani Kaplan shot at Lenin. After being wounded, Vladimir Ilyich was brought first to the Kremlin, then to the Botkin Hospital for surgery. And the leader was recuperating in Gorki.
“Politically reliable” medical luminaries were involved in the treatment of the Council of People’s Commissars. Among them is Professor V.M. Mints, doctors V.N. Rozanov, B.S. Weisbrod, N.N. Mamonov, A.N. Vinokurov, M.I. Baranov. It was they, together with the manager of the Council of People's Commissars of the RSFSR V.D. Bonch-Bruevich signed official bulletins about the leader’s health.
In total, from August 30 to September 12, 1918, 37 of them were released. (The book contains the originals of these documents for the first time.) In one of them, dated September 3, 1918, at midnight, it is recorded: “V.I. Lenin’s health is satisfactory. Temperature 38.2. Pulse – 110; breathing - 24".
Bulletin No. 37, at 8 p.m. on September 18, 1918, reported: “The temperature is normal. The pulse is good... Vladimir Ilyich is allowed to do business.” And Lenin immediately added a note: “Based on this bulletin and my good health, my humble request not to bother the doctors with calls and questions... V. Ulyanov (Lenin).”
“You can already walk around in the Kremlin without covering your nose”
Even the state of the office of the leader of the world proletariat, not to mention the entire building of the workers' and peasants' government, did not stand up to criticism. “In the office of Comrade. Lenin, we read in the conclusion of the sanitary special commission, there is a lot of dust on the cabinets, stoves and palm leaves in the office, and in the corners near the ceiling there is a cobweb... In the corridor there is a broken iron cabinet with ashes, dust, bones from under meat..."
The situation was complicated by the fact that at the end of 1918 - beginning of 1919, an epidemic of typhus swept the entire country. The Kremlin has created a sanitary inspection station “for new arrivals.” (It was located in front of the entrance to the Kremlin, at the Trinity Tower.) Everyone, without exception, who tried to enter the territory had to be examined by a doctor, then subjected to mandatory “disinfection procedures.” For this purpose, a “sanitary area” was created in the Kremlin.
And the “Sanitary Rules for Kremlin Residents” were signed by Lenin himself. This formidable circular ordered “to maintain personal cleanliness in the premises” and obliged all new visitors to the Kremlin to “wash in the bathhouse and hand over their personal belongings to a disinfector.” Ignoring these rules threatened with immediate eviction from the Kremlin and trial “for causing public harm”1.
According to Bonch-Bruevich’s recollections, Lenin once told him: “You know, I see the results of the work of the sanitary and medical organization. Already in the Kremlin you can walk without holding your nose where before it was completely impossible to walk.”
BY THE WAY
...Plus a typhus hospital
As of December 17, 1920, the Kremlin Sanitary Department included a disinfection bureau, a bathhouse, a laundry, and an isolation checkpoint. The Kremlin also had its own typhus hospital - it was located on Bolshaya Polyanka. In February-May 1920 alone, 214 people were admitted to it with a total of 4,479 sick days used. Of the 214 patients, 12 died.
...And Ilyich did not like domestic resorts
If unknown “comrades” could go to domestic resorts, only a very limited circle of senior officials of the party and state apparatus were sent for treatment abroad (there was no talk of vacation there at all).
The treatment and recreation of statesmen abroad, as well as the invitation of foreign specialists to Soviet Russia, required significant foreign exchange expenses. Therefore, a special currency fund of the Central Committee was created, which was administered by the executive bodies of the Central Committee of the RCP - the All-Union Communist Party (Bolsheviks) - the Politburo, the Organizing Bureau and the Secretariat.
In 1921–1924, foreign medical specialists were repeatedly invited to Moscow regarding V.I.’s illness. Lenin. After all, Ilyich was very critical of the recommendations of domestic doctors. He was also skeptical about the restoration capabilities of domestic resorts. Therefore, Lenin recommended exclusively foreign medicine to his close friends and party comrades. In 1921 he wrote to A.M. Gorky:
“Alexey Maksimovich! ...I'm so tired that I can't do anything. And you have hemoptysis, and you don’t eat! This is, by all means, unconscionable and irrational. In Europe, in a good sanatorium, you will receive treatment and do three times more work. Hey, hey. But we have no treatment, no business - just vanity. Wasteful fuss. Go away, get better. Don't be stubborn, please. Your Lenin."
It was Lenin who raised the question at the Politburo “On the release of money to Gorky for treatment abroad.”
“I need the lifestyle of a sick person”
In the spring days of 1922, German doctors, having examined Lenin, recommended him to take a long rest in the “mountain air.” Vladimir Ilyich even wrote an application for leave, which he, at the suggestion of the Secretary of the Central Committee V.M. Molotov was granted on February 22, and then extended by decisions of the Politburo of the Central Committee. Lenin was planning to go on vacation to the Caucasus in May-June 1922, was looking for a suitable vacation spot and corresponded on this issue, including with his comrade-in-arms G.K. Ordzhonikidze.
“(April 9, 1922) Comrade Sergo! ...I need to live separately. The patient’s lifestyle... Either separate houses, or only such a large house in which absolute separation is possible... There should be no visits. I read the “Companion to the Caucasus”... I see that I don’t need either a map or detailed descriptions in books (which I asked you for). For the whole point is to inspect suitable houses, and neither a map nor a book will give you this. Send a smart, business-like person for an inspection (if you don’t have time before 7/V, it’s better to postpone it for a week) and send me a choice: such and such houses; miles from the railway; miles along the highway; height; raininess. If repairs are needed, we will agree by telegraph (“repairs will take so many weeks”). Don’t forget the Black Sea coast and the foothills of the North Caucasus. It’s not fun at all to be beyond Tiflis: it’s far away. Your Lenin."
But the second letter is dated April 17, 1922... “T. Sergo. I am sending you a few more small information. They were reported to me by a doctor who was there himself and deserves complete trust: Abastuman (resort in Georgia - Ed.) is completely unsuitable, because it looks like a “coffin”, a narrow hollow; not suitable for nervous people; there are no walks, other than to climb, and Nadezhda Konstantinovna cannot climb. Borzhom is very suitable, because there are walks on level ground, and this is necessary for Nadezhda Konstantinovna. In addition, Borjom is a suitable altitude, but Abastuman is an excessive altitude, more than 1000 meters. It is forbidden. Our doctor especially warns against an early trip, as it will be cold and rainy until mid-June. On this last point, I am not so afraid if the house does not leak and is heated, because under these conditions the cold and rain are not terrible. Shake your hand. Your Lenin."
But Lenin never went to the Caucasus - “due to complications of the disease.”
THERE WAS A CASE
Predsovnarkom heated... a fake fireplace
In the early 1920s, statesmen were also treated in rest homes and sanatoriums, which were created on the basis of palaces, country estates and estates. Lenin did not like palaces, so they found him a not very luxurious, but comfortable and well-preserved mansion of the former Moscow mayor Rainbot in Gorki. But even there the situation was unusual for Lenin and Nadezhda Krupskaya. After all, the spouses are used to living in modest apartments and cheap boarding houses abroad. They settled in the smallest room of the estate. Nadezhda Konstantinovna recalled that next to her there was a large room in which “there were two fireplaces. We are used to fireplaces in London, where in most apartments this is the only heating.
“Light the fireplace,” asked Ilyich. They brought firewood, looked for pipes, but there were none. Well, the guards thought, fireplaces must not have chimneys. Flooded. But the fireplaces, it turned out, were for decoration, not for heating. The attic caught fire, they began to flood it with water, the ceiling collapsed..."
The Soviet leadership passed through the Medical Commission
In the early 1920s, the young Soviet government began to think about organizing medical care and recreation for statesmen, because many of them were pretty “battered” by the civil war, went through prisons and exile. Famous German doctors were invited to Moscow, they held consultations together with Moscow specialists. At the beginning of 1923, a Medical Council was created under the Central Committee of the RCP, which monitored the health of “party comrades.” A little later, the Medical Commission of the Central Committee of the RCP (b) appeared (since 1926 - the Medical Commission of the People's Commissariat of Health). She organized treatment for leadership in the USSR and abroad. The commission issued cash benefits and helped “party members” who were temporarily unable to work. In 1923-1924. More than 3,000 people passed through it. The patients suffered mainly from nervous diseases and tuberculosis.
Holiday homes for children or members of the Politburo?
If no one except Lenin laid claim to the Gorki estate, then street children also relied on rest homes for less eminent “comrades”. In 1921, doctors recommended that A.I., who was seriously ill, Rykov, member of the Politburo of the Central Committee of the RCP(b), Deputy Chairman of the Council of People's Commissars of the RSFSR, after treatment, to spend a vacation in the Moscow region. They decided to place the statesman at the Lipki state farm (the palace of the former estate of A. Ruppert). At the same time, the People's Commissariat for Education planned to establish a children's educational institution for street children on this estate. In May 1921, “representatives of the People's Commissariat for Education came ... to the Lipki state farm to move colonies of children into the main building of the state farm, but ... “The Central Committee of the Party decided to provide Lipki to Comrade Rykov...” More than a hundred street children who came from Petrograd were temporarily placed in in the homes of the residents of the village of Lipki, as well as in the state farm stables and cowshed.
A similar incident occurred at this time in another place. In April 1921, Secretary of the Central Committee of the RCP(b) E.M. Yaroslavsky sent the following note to the Presidium of the All-Russian Central Executive Committee: “The dachas allocated for the children of emigrants in Tarasovka have been taken away from them for the Council of People’s Commissars.”
As for “Lipok”, they were left for the children for two years, and in the summer of 1923 another place was found for them. “After renovation, the estate again became a holiday home (state dacha), but this time for the Council of People's Commissars of the USSR, where A.I. spent his country vacation. Rykov. Later, in the mid-30s of the twentieth century, this object became known as the Lipki state dacha near Moscow, which I.V. occasionally visited. Stalin."
Not treatment, but torture!
The Soviet government thought not only about the health of statesmen, but also tried to take care of the well-being of ordinary Soviet workers. For the preservation and development of domestic resorts in the early 20s. two million rubles were allocated. The leadership and the entire working population of the RSFSR and other autonomous Soviet republics went to the resorts of the Caucasian Mineral Waters. True, in the first years after the civil war there, “the most bleak, to say the least, picture emerges of the state of treatment of patients, among whom were a significant number of workers from various localities of Soviet Russia.”
In general, patients often came on vacation when their vacation period had already expired: for a month or even two they “hanged out” on the road. The “lucky” ones who managed to get to the resort on time received very dubious treatment. After all, “part of the medical staff was recruited with such economic calculations: for example, the doctors themselves were many sick, were being treated and at the same time had to treat others. Of course, as a result, almost no medical care existed.” Of course, you could find a good doctor for money, but not everyone could afford it.
In addition, “the patients did not finish eating, they were nervous, watching when food for personal consumption was prepared from their own products in the kitchen, the quality was much better than what they ate. Throughout almost the summer, the patients ate semolina porridge with water, which, according to the patients, was simply “sick of them.” ... In some sanatoriums, food was prepared together with worms, in dirty dishes, which resulted in poisoning of sanatorium patients... At the resorts, vacationers fled in droves from the “health resorts.” The reason for this treatment was that among the administration there were many people from bourgeois-White Guard circles. They paid main attention to personal interests.
In June 1922, Chairman of the Union of Metalworkers of Russia S.P. Medvedev wrote to the Central Committee of the RCP (b) I.S. To Stalin: “Two days ago I returned to Moscow from the Caucasian Mineral Waters region...
First of all: there is not yet a single sanatorium there, internally equipped and furnished so as to provide those undergoing treatment with real sanatorium peace and healing, in order to completely relieve the sick from everyday household problems and shortages... Lack of bed linen... Lack of evening lighting due to lack of light bulbs. Lack of such simple items as a glass, tea saucer, spoon, plate, knife, fork, etc. ...How great the need for these items is is shown by a note in the local newspaper with an appeal to everyone traveling to the Caucasian Mineralnye Vody - “Comrades, take all this from home.”
Favorite resorts of the USSR top leadership
In 1923, conditions for recreation and treatment improved at the resorts of the Caucasian Mineralnye Vody, and famous party leaders went there: G.E. Zinoviev, N.I. Bukharin. They were joined by I.V. Stalin, K.E. Voroshilov, M.V. Frunze. High-ranking officials hunted and took mud baths.
In 1924, the number of applications from senior government and party leaders for recreation and treatment at the resorts of the Caucasian Mineral Waters increased greatly. Naturally, there was a different attitude towards the famous “comrades”. For medical care of the All-Russian Central Executive Committee holiday homes in the Caucasian Mineralnye Vody, a special doctor was allocated, paid at the expense of the All-Russian Central Executive Committee. According to his recipes for vacationers, “responsible comrade. (including more than 20 people, such as Krupskaya, Zinoviev, Bukharin, etc.) are dispensed with medicines from the pharmacies of the resort administration.” Medicines for patients of the All-Russian Central Executive Committee rest homes were free.
In subsequent years, the resorts of the Caucasian Mineral Waters enjoyed particular success among the highest state and political leadership of the Soviet Union.
True, unrest with the organization of recreation and treatment still continued during the 20s. “The sanatorium staff were selected by group institutions with almost no participation from the sanatorium managers. In the matter of hiring employees, the dominant principle was to hire “your own person”... The result is a lack of qualified workers, adhesions in the work of the staff.” In addition, “sanatoriums lived without income and expense estimates. They were advanced according to actual need from group departments. Consequently, the chief doctors had almost no money on hand.”
“It is better to be killed by the will of the “Almighty...”
The lack of qualified medical personnel at Soviet resorts forced eminent patients to seek help from German doctors. In 1928 G.K. Ordzhonikidze, chairman of the Central Control Commission of the All-Union Communist Party (Bolsheviks) and the People's Commissariat of the RKI of the USSR in Kislovodsk, treated the kidneys, but doctors could not make an accurate diagnosis. People's Commissar for Military and Naval Affairs K.E. Voroshilov wrote to Ordzhonikidze: “I learned that they didn’t find anything on you, and that you were returning soon. Both made me very happy. Today I received a letter from you in which you confirm the initial information about the absence of tuberculosis indicators. For some reason I am convinced that you don’t have any tuberculosis. Before, I didn’t trust our doctors even a penny, but now, after experiments with you and a host of other comrades, I finally decided for myself - it’s better to be killed by the will of the “Almighty” than to use learned healers. I do not admit for a minute that the Germans could not detect bacilli (meaning the Koch bacilli, the presence of which indicates kidney tuberculosis. - Ed.), if they are present in the body, obviously they were not there, and the Germans, out of decency (support the authority of colleagues) dig, search and... earn money from the whole business. Well, to hell with them, let them earn money, as long as everything turns out well.”
Soviet doctors are good, but Germans are better
Member of the Politburo of the All-Union Communist Party of Bolsheviks L.D. was also skeptical about the capabilities of domestic medicine. Trotsky. In 1924, he and his wife went to the Black Sea coast of the Caucasus to Sukhum.
But rest and treatment did not help. Lev Davydovich was constantly unwell and had a fever.
The distrust in the capabilities of domestic doctors was similar to that of L.D. Trotsky, and some of the leaders of the Soviet state of that time. Lev Davydovich recalled the Kremlin doctor L.G. Levin: “He treated Lenin, Stalin and all members of the government. I knew this calm and conscientious man well. Like any authoritative doctor, he established intimate, almost patronizing, relationships with high-profile patients. He knows well what the spines of the gentlemen “leaders” look like and how their authoritarian kidneys function. Levin had free access to any dignitary.” And, nevertheless, the Kremlin doctor L.G. Levin and other Moscow doctors could not establish the cause of L.D.’s prolonged fever and poor health. Trotsky. To avoid taking responsibility, they insisted on his traveling abroad. And Lev Davydovich in the spring of 1926 went to Germany for treatment, but even after this trip he did not feel better.
Domestic medicine helped Stalin
Despite criticism of domestic doctors by some eminent patients, Soviet doctors were still able to help. For example, Stalin’s health improved at domestic resorts. In the second half of the 20s, he spent his holidays mainly on the Black Sea coast of the Caucasus - in the Sochi-Matsesta region. Stalin complained of pain in the muscles of his arms and legs. Soviet doctors did not find any pathological changes in him and recommended a course of Matsesta baths. In August 1925, Stalin wrote to Molotov from Sochi: “I am recovering. Matsesta waters (near Sochi) are good against sclerosis, nerve damage, heart enlargement, sciatica, gout, rheumatism. I would send my wife here.”
The next year, Stalin again took Matsesta baths, but under closer medical supervision. Doctor of Medical Sciences Ivan Aleksandrovich Valedinsky (later the scientific director of the clinical sanatorium "Barvikha") advised him to take procedures in a special way: lie “under a sheet and blanket without clothes for 15–20 minutes, which contributed to a rush of blood to the skin, to the muscles of the limbs, and this rush gave rise to a feeling of warmth in the arms and legs.”
With this method of taking baths, the effectiveness of the treatment was higher, and they were also easier to tolerate.
At the end of the course of treatment, Joseph Vissarionovich arranged a Saturday lunch for the doctors and treated them to cognac so much that doctor Valedinsky was at home only the next day, Sunday.
If Stalin was pleased with the treatment in Sochi, the Secretary General of the Central Committee did not like the improvement of the resort. The main disadvantage was the lack of centralized water supply and sewerage. As at the resorts of the Caucasian Mineral Waters, ordinary vacationers were fed disgustingly, there was a lack of bedding, and there was no medical care or medicine. The same thing was observed at the resorts of the southern coast of Crimea.
Stalin played bowls in Crimea
During their stay in Crimea, the top leaders of the USSR rested and received treatment at the All-Russian Central Executive Committee "Mukhalatka" rest house. In September 1925, K.E. Voroshilov wrote about his holiday in “Mukhalatka”:
“...We are resting as proletarians who have achieved real rest should. Me and Shkiryatich (Shkiryatov M.F., member of the Central Control Committee of the All-Union Communist Party of Bolsheviks. - Note. KP) spend 4-5 hours hanging out on the sea, breathing in all our pores the beautiful sea air. The weather has always been favorable to us, and we are blissful. They don’t feel bad, etc. etc. and especially Koba. He rested thoroughly and was always cheerful and joyful. Among other things, Koba learned to play bowls and billiards. He really likes both.”
We express our gratitude to the Administration of the President of Russia. State Archive of the Russian Federation, Russian State Archive of Socio-Political History for the materials provided and assistance in preparing the publication.