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RUSSIA IN RECONSTRUCTION.
1255
SPECIAL ARTICLES of beds were reserved for abortion cases. far as I could judge, the question of an operation for abortion was treated precisely as the BY L. HADEN GUEST, M.C., M.R.C.S. ENG. question of any other operation might be. No special considerations and no special formalities entered into the decision one way or the other. 1 did not indeed 111. *-POPULATION AND BIRTH CONTROL. refusal to operate, but only of inability hear of THE birth-rate in Russia is still very high ; in because any of lack of accommodation. 1926 it was about 47 per 1000, but has declined At the hospital I visited about ten abortion operasince that date. The death-rate, 30 per 1000, has tions were performed daily, the operation taking five also declined, and the propaganda of hygienic ways ten minutes. I witnessed one operation on a to of living and the establishment of a service of rural who was under an anaesthetic ; the operaprimipara medicine will undoubtedly reduce it still more. Infant done by a woman doctor, occupied just over mortality was formerly very high, but it has been tion, minutes. The method was simple. The drawing five greatly reduced in the main urban centres, especially down of the cervix to the vaginal entrance, dilatation in Moscow and Leningrad. and scraping with a series of dilators, by Hegars The 1897 census of Russia (the first taken) showed curettes. In cases of multipart an anaesthetic is a population of over 129 millions, which included not used as a rule, unless the patient is very nervous. Finland and the Baltic provinces,since separated Patients are kept three days in hospital. Cases of from Russia at the 1917 Revolution. In 1926 the abortion are operated upon, on request, up to three population of the area remaining inside the Soviet months. - boundary was estimated at nearly 147 millions, and I was informed that the results were almost it is now calculated at about 160 millions. With satisfactory. In a series of 40,000 cases, uniformly improving sanitation, limitation of infectious over ten years, there had been only two deaths, spread epidemics, and reduction of infantile mortality, it and this included 20,000 cases operated on in the is clear that a continuation of the growth of Russia’s homes and to hospital because of complibrought population at the same rate would very soon give cations. There was a post-operative rise of temperaher an overwhelming numerical superiority over any other European country. But the same factors which ture in 0’11 per cent. of cases, and there were 10 to 12 check the growth of population in other countries cases of perforation a year. I inquired specially as serve the same end in Russia. With increasing to whether there were any nervous or psychological industrialisation and improvement in the standard after-effects, and I was assured, by several members of life as compared with pre-war conditions, the of the staff of the hospital, that there were none population is already showing a tendency to decline. observable. The operation is not performed free of cost, but But the factor of artificial birth control is likely to a a Russia as have than elsewhere, charge is made of 25 roubles to include stay in greater effect in This sum the propaganda of birth control is actively pursued hospital, operation, and all expenses. a week’s wages of an ordinary worker, about rather than merely permitted or even tacitlyrepresents I rather more in the case of some unskilled women encouraged. In all hospitals dealing with the treatment of workers, and much less in the case of the highly women’s diseases or maternity, instruction is given skilled. The reason why operations are performed in methods of birth control, and the methods adopted in the home, where they are usually done by a " friend " or by a midwife and are illegal, is partly are substantially the same as those in use in Western for The used most economy, the home fee charged being about appliance Europe.is* the contraceptive 5 roubles ; and partly because of the difficulty of Graciella pessary, invented by Dr. widely Petersen, of Munich. It is not only in the towns of securing admission to a hospital. I heard of a comMoscow and Leningrad that this information is plaint by a woman who said : " Oh, yes, abortions are available, but in all the towns and at all the centres legal, only the child is about 12 years old before of rural medicine established during recent years in you can get admission to a clinic." The operations the agricultural districts. Apart from actual cities for abortion take place not only in Moscow and the medical services are particularly well organised Leningrad and the larger cities, but in the mining in the mining areas. In the Donetz basin, for example, areas-many operations are performed in the Donetz coalfield-and in the centres of rural medicine birth control information is freely available. established for groups of villages in the agricultural
portion
RUSSIA IN RECONSTRUCTION.
And,
so
I
LEGALISED ABORTION
areas.
-
It may be accepted, therefore, that the practice The most interesting feature of birth control methods in Russia is the legalisation of abortion of legal abortion is widespread and likely to increase when performed by duly qualified medical men or in the future. And it will certainly have a big effect women. This legalisation has been discussed else- on the rate of population increase. One or two where, in Saxony for example, but Russia is the only doctors with whom I discussed the question said country to have introduced the practice as a normal that the birth-rate was already less than before method of restricting births. In Russia at the the war, and that it must be expected to show signs present time any woman who is pregnant and desires shortly of a definite decrease. In the ordinary way to havethe pregnancy terminated may have an this could not be expected to take place among the 80 per cent. of the Russian population who are abortion operation carried out by a doctor. development in Russia is not proMy information on methods was gained at a large peasants. But the in ordinary way. Over one-half of the ceeding women’s hospital, where general gynaecological and Russia have already thrown in their of peasants cases dealt a were and where with, maternity prolot with collectivisation and joined the Collective * Farms. And by the end of 1933 the Soviet Parts I. and II. have appeared in preceding issues.
1256 Government anticipates the whole of the peasants will be collectivised. This means the substitution of large scale, machine worked, and scientific agriculture on giant farms, as against the Russian peasant cultivation on farms of an average of 9 acres. With this rapid change, which is accepted by the peasants, now that agricultural machinery and tractors can be supplied, because it improves their position and standard of life, go other changes. There are changes in housing, in the provision of reading rooms and clubs for adults, creches and play-places for children, the new service of rural medicine, already referred to, the extension of elementary and adult
tional, but
that the increase of abortion between 1921 and is typical of a general Russian tendency thereislittle doubt. It would therefore appear probable that the exten-
1927
sion of birth control information all over the Soviet Union and the spread of the practice of abortion in hospital to the agricultural areas will have the result of decreasing the very high birth-rate, and may
education, and, in fact, a revolutionary reorientation of life. With these changes also there goes a change in the position of women, who have the opportunity i for economic equality and who more and more accept it. Under these conditions it is the fact that a larger and larger proportion of women every year avail themselves of birth control in practice by the use contraceptive appliances, and of abortion in case I, of need.
of
THE SITUATION IN MOSCOW.
whole I did not obtain,I but I was able to secure figures of birth-rate abortion-rate in Moscow for the years of 1909 to I showing proportion of natural births (stippled) and1927, which are quoted in the Problem of Abortion,Chart abortions (black) per 1000 of the population of Moscow in A. in Moscow. to Guince, published by According the years 1909-14 and 1921-27. this authority the figures are as follows :I I have constructed a Chart from the figures inz, Columns 6 and 7, which shows at a glance the totalmake the population stationary in a few years time. In any case it is important for Russia to understand pregnancies and their results over the two series of from what section of the population her increase is. years. now From the statistics available
Figures for the country as
a
and I
coming.
population
would appear that the greatest increases of populaI Births and Abortions at -Jloscott7, 1909-14 and 1921-27’ ! it are in the peasant areas, and the greatest decreasestion I the towns and among the industrial workers. But present-day Russia the progress of industrialisation its so rapid, and the increase of the population of the between town and towns so great, thatis the contrast country populations becoming less marked. Furthermore, the collectivisation of peasant holdings and. the formation of giant collective farms, creates a kind of industrialisation of the countryside so that the factors affecting the future growth of population in Russia are largely incalculable. What is certain is that birth control and abortion are spreading all over the Soviet Union, and are bound to result in a decrease of the birth-rate. But it is equally certain that the improvement of hygienic conditions and standard of life of the people is also spreading all over Russia. The net result in the immediate future is therefore likely to be a considerable increase of total population. But beyond that it is not possible to go without further detailed information.
in
in
s
i
abortionsI
Figures in parentheses in Column 3 indicate illegal outside hospitals of which authorities got information.
Apart-
In interpreting the figures it is necessary to note that Moscow is now very much over-crowded. ment space is measured not in rooms but in square yards of floor space, for not only has an increased population to be housed but accommodation has to be found for all the governmental, trade union, co5perative, and political offices. It is also necessary to remember that Moscow is one of the chief centres of Communist influence, and a great medical where treatment can be more easily obtained thanI elsewhere. The Moscow figures are inevitably
centre excep-i
EXTENSION OF HUDDERSFIELD INFIRMARY.-The centenary of this hospital is to be marked by the erection_ of a new block and, should means permit, by the reconstruction and extension of the existing main building. The scheme, in its entirety, will cost 275,000. The new block will include a fully equipped accident ward, a new out-patients’ department, with a dispensary, a waiting hall to hold 300 persons, and a cafe for those who have to wait. for special treatment. There will also be a self-contained unit for ear, nose, and throat cases, two consulting rooms, a dental department, and a unit of 12 cots for tonsils and adenoids operations. New pathological and radiological departments and a massage or orthopaedic clinic are also proposed. The proposal for the remodelling of the existingpremises includes the conversion of the present outpatient and casualty department into a general ward, ancL the conversion of a large house into wards for paying:
patients.
SPECIAL ARTICLES of beds were reserved for abortion cases. far as I could judge, the question of an operation for abortion was treated precisely as the BY L. HADEN GUEST, M.C., M.R.C.S. ENG. question of any other operation might be. No special considerations and no special formalities entered into the decision one way or the other. 1 did not indeed 111. *-POPULATION AND BIRTH CONTROL. refusal to operate, but only of inability hear of THE birth-rate in Russia is still very high ; in because any of lack of accommodation. 1926 it was about 47 per 1000, but has declined At the hospital I visited about ten abortion operasince that date. The death-rate, 30 per 1000, has tions were performed daily, the operation taking five also declined, and the propaganda of hygienic ways ten minutes. I witnessed one operation on a to of living and the establishment of a service of rural who was under an anaesthetic ; the operaprimipara medicine will undoubtedly reduce it still more. Infant done by a woman doctor, occupied just over mortality was formerly very high, but it has been tion, minutes. The method was simple. The drawing five greatly reduced in the main urban centres, especially down of the cervix to the vaginal entrance, dilatation in Moscow and Leningrad. and scraping with a series of dilators, by Hegars The 1897 census of Russia (the first taken) showed curettes. In cases of multipart an anaesthetic is a population of over 129 millions, which included not used as a rule, unless the patient is very nervous. Finland and the Baltic provinces,since separated Patients are kept three days in hospital. Cases of from Russia at the 1917 Revolution. In 1926 the abortion are operated upon, on request, up to three population of the area remaining inside the Soviet months. - boundary was estimated at nearly 147 millions, and I was informed that the results were almost it is now calculated at about 160 millions. With satisfactory. In a series of 40,000 cases, uniformly improving sanitation, limitation of infectious over ten years, there had been only two deaths, spread epidemics, and reduction of infantile mortality, it and this included 20,000 cases operated on in the is clear that a continuation of the growth of Russia’s homes and to hospital because of complibrought population at the same rate would very soon give cations. There was a post-operative rise of temperaher an overwhelming numerical superiority over any other European country. But the same factors which ture in 0’11 per cent. of cases, and there were 10 to 12 check the growth of population in other countries cases of perforation a year. I inquired specially as serve the same end in Russia. With increasing to whether there were any nervous or psychological industrialisation and improvement in the standard after-effects, and I was assured, by several members of life as compared with pre-war conditions, the of the staff of the hospital, that there were none population is already showing a tendency to decline. observable. The operation is not performed free of cost, but But the factor of artificial birth control is likely to a a Russia as have than elsewhere, charge is made of 25 roubles to include stay in greater effect in This sum the propaganda of birth control is actively pursued hospital, operation, and all expenses. a week’s wages of an ordinary worker, about rather than merely permitted or even tacitlyrepresents I rather more in the case of some unskilled women encouraged. In all hospitals dealing with the treatment of workers, and much less in the case of the highly women’s diseases or maternity, instruction is given skilled. The reason why operations are performed in methods of birth control, and the methods adopted in the home, where they are usually done by a " friend " or by a midwife and are illegal, is partly are substantially the same as those in use in Western for The used most economy, the home fee charged being about appliance Europe.is* the contraceptive 5 roubles ; and partly because of the difficulty of Graciella pessary, invented by Dr. widely Petersen, of Munich. It is not only in the towns of securing admission to a hospital. I heard of a comMoscow and Leningrad that this information is plaint by a woman who said : " Oh, yes, abortions are available, but in all the towns and at all the centres legal, only the child is about 12 years old before of rural medicine established during recent years in you can get admission to a clinic." The operations the agricultural districts. Apart from actual cities for abortion take place not only in Moscow and the medical services are particularly well organised Leningrad and the larger cities, but in the mining in the mining areas. In the Donetz basin, for example, areas-many operations are performed in the Donetz coalfield-and in the centres of rural medicine birth control information is freely available. established for groups of villages in the agricultural
portion
RUSSIA IN RECONSTRUCTION.
And,
so
I
LEGALISED ABORTION
areas.
-
It may be accepted, therefore, that the practice The most interesting feature of birth control methods in Russia is the legalisation of abortion of legal abortion is widespread and likely to increase when performed by duly qualified medical men or in the future. And it will certainly have a big effect women. This legalisation has been discussed else- on the rate of population increase. One or two where, in Saxony for example, but Russia is the only doctors with whom I discussed the question said country to have introduced the practice as a normal that the birth-rate was already less than before method of restricting births. In Russia at the the war, and that it must be expected to show signs present time any woman who is pregnant and desires shortly of a definite decrease. In the ordinary way to havethe pregnancy terminated may have an this could not be expected to take place among the 80 per cent. of the Russian population who are abortion operation carried out by a doctor. development in Russia is not proMy information on methods was gained at a large peasants. But the in ordinary way. Over one-half of the ceeding women’s hospital, where general gynaecological and Russia have already thrown in their of peasants cases dealt a were and where with, maternity prolot with collectivisation and joined the Collective * Farms. And by the end of 1933 the Soviet Parts I. and II. have appeared in preceding issues.
1256 Government anticipates the whole of the peasants will be collectivised. This means the substitution of large scale, machine worked, and scientific agriculture on giant farms, as against the Russian peasant cultivation on farms of an average of 9 acres. With this rapid change, which is accepted by the peasants, now that agricultural machinery and tractors can be supplied, because it improves their position and standard of life, go other changes. There are changes in housing, in the provision of reading rooms and clubs for adults, creches and play-places for children, the new service of rural medicine, already referred to, the extension of elementary and adult
tional, but
that the increase of abortion between 1921 and is typical of a general Russian tendency thereislittle doubt. It would therefore appear probable that the exten-
1927
sion of birth control information all over the Soviet Union and the spread of the practice of abortion in hospital to the agricultural areas will have the result of decreasing the very high birth-rate, and may
education, and, in fact, a revolutionary reorientation of life. With these changes also there goes a change in the position of women, who have the opportunity i for economic equality and who more and more accept it. Under these conditions it is the fact that a larger and larger proportion of women every year avail themselves of birth control in practice by the use contraceptive appliances, and of abortion in case I, of need.
of
THE SITUATION IN MOSCOW.
whole I did not obtain,I but I was able to secure figures of birth-rate abortion-rate in Moscow for the years of 1909 to I showing proportion of natural births (stippled) and1927, which are quoted in the Problem of Abortion,Chart abortions (black) per 1000 of the population of Moscow in A. in Moscow. to Guince, published by According the years 1909-14 and 1921-27. this authority the figures are as follows :I I have constructed a Chart from the figures inz, Columns 6 and 7, which shows at a glance the totalmake the population stationary in a few years time. In any case it is important for Russia to understand pregnancies and their results over the two series of from what section of the population her increase is. years. now From the statistics available
Figures for the country as
a
and I
coming.
population
would appear that the greatest increases of populaI Births and Abortions at -Jloscott7, 1909-14 and 1921-27’ ! it are in the peasant areas, and the greatest decreasestion I the towns and among the industrial workers. But present-day Russia the progress of industrialisation its so rapid, and the increase of the population of the between town and towns so great, thatis the contrast country populations becoming less marked. Furthermore, the collectivisation of peasant holdings and. the formation of giant collective farms, creates a kind of industrialisation of the countryside so that the factors affecting the future growth of population in Russia are largely incalculable. What is certain is that birth control and abortion are spreading all over the Soviet Union, and are bound to result in a decrease of the birth-rate. But it is equally certain that the improvement of hygienic conditions and standard of life of the people is also spreading all over Russia. The net result in the immediate future is therefore likely to be a considerable increase of total population. But beyond that it is not possible to go without further detailed information.
in
in
s
i
abortionsI
Figures in parentheses in Column 3 indicate illegal outside hospitals of which authorities got information.
Apart-
In interpreting the figures it is necessary to note that Moscow is now very much over-crowded. ment space is measured not in rooms but in square yards of floor space, for not only has an increased population to be housed but accommodation has to be found for all the governmental, trade union, co5perative, and political offices. It is also necessary to remember that Moscow is one of the chief centres of Communist influence, and a great medical where treatment can be more easily obtained thanI elsewhere. The Moscow figures are inevitably
centre excep-i
EXTENSION OF HUDDERSFIELD INFIRMARY.-The centenary of this hospital is to be marked by the erection_ of a new block and, should means permit, by the reconstruction and extension of the existing main building. The scheme, in its entirety, will cost 275,000. The new block will include a fully equipped accident ward, a new out-patients’ department, with a dispensary, a waiting hall to hold 300 persons, and a cafe for those who have to wait. for special treatment. There will also be a self-contained unit for ear, nose, and throat cases, two consulting rooms, a dental department, and a unit of 12 cots for tonsils and adenoids operations. New pathological and radiological departments and a massage or orthopaedic clinic are also proposed. The proposal for the remodelling of the existingpremises includes the conversion of the present outpatient and casualty department into a general ward, ancL the conversion of a large house into wards for paying:
patients.