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УДК 61(091))([476-11+476-15])"1921/1939"
KAPLIYEV ALEXEY A., PhD in Hist. Sc., Associate Professor Institute of History of the National Academy of Sciences of Belarus, Minsk, Republic of Belarus
Received 30 March 2024
MEDICAL PERSONNEL IN THE BSSR AND WESTERN BELARUS DURING THE INTERWAR PERIOD1
The article describes the features of the medical staff provision for the healthcare of both BSSR and Western Belarus in the interwar period. It was shown that the main factor in the superiority of the Soviet healthcare system in the BSSR over the Polish one in Western Belarus was an increase in recruitment and graduation in medical institutes and technical schools, while in Western Belarus the training of medical personnel did not satisfy the needs of the population.
Keywords: healthcare, medicine, doctors, paramedics, BSSR, Western Belarus.
А.А. КАПЛИЕВ, канд. ист. наук, доцент Институт истории НАН Беларуси, г. Минск, Республика Беларусь
МЕДИЦИНСКИЙ ПЕРСОНАЛ В БССР И ЗАПАДНОЙ БЕЛАРУСИ В МЕЖВОЕННЫЙ ПЕРИОД
В статье описываются особенности обеспечения медицинскими кадрами здравоохранения БССР и Западной Беларуси в межвоенный период. Было показано, что ключевым фактором превосходства советской системы здравоохранения в БССР над польской в Западной Беларуси стала модернизация системы высшего и среднего медицинского образования, в то время как в Западной Беларуси подготовка медицинского персонала не соответствовала потребностям населения.
Ключевые слова: здравоохранение, медицина, врачи, фельдшеры, БССР, Западная Беларусь.
1 Статья публикуется в авторской редакции.
Introduction. A comparison of the state of development of Soviet and Western Belarus in the interwar period is gaining relevance either in public discussion or on the pages of the mass media. However, given the significant differences in the socio-political, economic and cultural life of the parts of Belarus divided by the Riga Treaty of 1921, it is difficult to find an objective marker that would clearly reflect the advantages and disadvantages of a particular development model. One of these indisputable markers is the level of healthcare development, which in the interwar period had universal growth criteria - primarily the number of qualified medical personnel. In the interwar soviet historiography, only a few articles on this topic were written by F. Shultz and A. Lipmanova, later medical personnel was studied by E. Shish-ko, but in Soviet Belarus only [1; 2; 3]. Studying the medical personnel of Western Belarus in soviet historiography was hindered due to the lack of access to original sources, so this question began to be analyzed in 1990-2000s by N. Chilmonchik and M. Mirski [4]. The last qualified works on the topic were conducted by M. Abramenko and E. Tishchenko [5; 6]. In Polish interwar historiography, the problem was reviewed briefly only. This article characterizes the movement of medical personnel both in the BSSR and Western Belarus in the interwar period. The study is based on the analysis of statistical data and archival records management of the studied period.
The main part. Before the outbreak of World War I, the territory of Belarus was considered one of the least regions of the Russian Empire by medical development. The late creation of zemstvos and, accordingly, «the zemstvo medicine» the absence of higher medical education predetermined the weak development of
medical institutions and, accordingly, the low attractiveness of the region for the practice of doctors who studied at Russian universities and abroad. So, in 1913, there were only 1,091 doctors in 5 Belarusian provinces of the Northwestern Edge (1.5 per 10,000 people) (Table 1) [7, p. 1-2; 8, p. 86].
As a result of recalculation of the data in Table 1 per population, it should be stated, that in the lands that in the interwar period made up the territory of the BSSR, by 1914 there were less than 0.85 doctors per 10,000 people, and the conditional future Western Belarus had an average of 1.19 doctors, respectively thus the Western Belarusian lands had 1/3 more personnel potential in the medical field.
However, during World War I, this situation was aggravated by military destruction, the German occupation, and the mobilization of a significant part of qualified medical personnel into the army, as well as large-scale epidemics of typhus, cholera, and «Spanish flu». These factors were catalyzed during the Polish-Soviet War of 1919-1921. That's why the demobilization of the local physicians became one of the main goals of civil health authorities. As a result of the activities of the People's Commissariat for Healthcare (PCH) of the BSSR 47 doctors, 98 dentists, 283 paramedics, and 65 pharmacists were demobilized and placed at the disposal of healthcare institutions in 1921. It should be added that 142 more doctors, 264 dentists, 598 paramedics, and 138 pharmacists continued to be registered in the Red Army [9, p. 226].
In the first post-war years, the BSSR and Western Belarus were in an approximately equal position in providing doctors, due to the influence of similar negative factors that suspended the process of increasing the number of doctors:
Province Physicians Feldshers (Paramedics) Midwives
Vilna 262 404 262
Vitebsk 183 313 171
Grodno 217 303 174
Minsk 253 333 220
Mogilev 176 502 288
TOTAL 1091 1855 1115
Table 1. - Medical personnel in the North-Western region of the Russian Empire in 1913 [7, p. 1-2; 8, p. 86]
the consequences of warfare, high mortality of medical staff during epidemics, migration of doctors (from the BSSR to the RSFSR, and from Western Belarus to Poland and other European countries).
In the first post-war years, the BSSR and Western Belarus were in an approximately equal position in providing doctors, due to the influence of similar negative factors that suspended the process of increasing the number of doctors: the consequences of warfare, high mortality of medical staff during epidemics, migration of doctors (from the BSSR to the RSFSR, and from Western Belarus to Poland and other European countries). In addition, the BSSR and Western Belarus in the 1920s. They had only one medical training center each - the Medical faculty of Belarusian State University (BSU) and the Medical Faculty of University named by Stefan Ba-tory (USB) in Vilnius, respectively, which carried out approximately equal sets of applicants during the 1920s (Table 2) [10, p. 79-81].
However, in the second half of the 1920s, the calculations made by influential Polish health officials showed that the number of doctors whom USB produced was too high for the small population of the «eastern borderlands». It was believed that in 1928-1934 there would be a
«hyperproduction» of doctors, which led to the conclusion that it was necessary to reduce recruitment. In particular, according to A. Teszyn-ski's calculations, the optimal number of doctors in Poland was 1 doctor per 3,500 inhabitants, which made it necessary to recruit 500 students only for the first courses of all 5 Polish medical faculties annually. When recruiting doctors to 5 medical faculties, they were to be distributed in the following proportion: Warsaw University -40%, Krakow and Lvov - 20% each, Poznan -14%, Vilna - 6 % [12, p. 79-81]. So, starting from the mid-1920s, the BSSR began to outpace Western Belarus in terms of the number of doctors in absolute numbers: in 1925, there were 917 doctors in the BSSR, while in Western Belarus there were only 758 (Table 3) [13, p. 53; 14, p. 136-138].
By 1928, 1,381 doctors (2.77 per 10,000) had already been registered in the BSSR, and in Western Belarus - only 1,090 (2.64 per 10,000). Despite the difference in absolute figures, in recalculation per 10,000 people it could be seen, that there was parity in providing medical personnel in the BSSR and Western Belarus: in the mid-1920s - 2.05 and 1.9, in the late 1920s -2.77 and 2.71, respectively (table 3).
Table 2. - Enrollment of students at the medical faculties of the BSU and the USB in 1925-1927 [11, p. 52-54; 12, p. 80]
Year BSU USB
1925 134 113
1926 95 110
1927 114 127
Total 343 350
Table 3. - The number of doctors in the BSSR and Western Belarus in 1921-1937 [2, p. 122; 13, p. 53; 14, p. 136-138; 15, p 28 rev.; 16, p 44-44 rev.; 17]
Year BSS] R Western Belarus
Total Per 10.000 Total Per 10.000
1921 203 1,24 762 1,9
1923 285 1,84 812 2,03
1925 917 2,05 758 1,9
1927 1296 2,6 983 2,46
1928 1381 2,77 1083 2,71
1930 1566 3,14 1090 2,73
1935 1778 3,38 1416 2,45
1937 2267 4,31 1470 2,87
A significant role in the formation of such a situation was also played by the reductions of a medical network of BSSR in the early 1920s (as a part of New Economic Policy), which especially affected the Vitebsk and Gomel provinces, which worsened the overall statistics on the number of doctors in the BSSR after the provinces returned to its composition [13, p 53; 18, p. 320-323].
In the 1930s, in the BSSR, PCH was eager to expand the medical network, due to industrialization and collectivization, which required an appropriate number of qualified personnel. That caused the expansion of existing medical faculties into independent institutes, as a result of which the medical faculty of BSU was transformed into the Minsk State Medical Institute, and later a second medical university was established in Vitebsk in 1934 [1, p. 78-79]. As a result of the expansion, already in the early 1930s, the number of first-year students accepted sharply increased to 400 people with two annual enrollments. When in 1930 only 198 people were enrolled in the medical faculty, by 1934 the enrollment had increased to 500. Later in the middle 1930s, it was envisaged to progressively increase the enrollment of students by 100 people per year, bringing the number of first-year students from 500 in 1934 to 800 in 1937 (Table 4) [19, p. 659].
The main goal of the reform was to increase the number of doctors by reducing their training time. Measures were taken to reduce the total period of training for doctors from five to four years. Even the new Vitebsk Medical Institute began its work in the experimental hospital-university format, which combined training with
practice and trained more than 800 doctors from 1935 to 1941 [1, p. 78-79].
Because of the reform, in the second half of the 1930s, there was a sharp increase in the number of doctors trained at the Minsk Medical Institute: in 1931-1936, the university graduated only 642 doctors, then in 1936-1940 - 1997 already. Thus, in 1938 alone, 476 doctors were trained, most of whom were assigned to work in rural areas [21, p. 29].
At the same time, there were no measures to intensify training in Western Belarus, since Polish health officials believed that «Kresy» should not have a large number of doctors. Thus, despite the growth in the population of Western Belarus, the number of students of the Medical Faculty of the USB increased by 60 students only in 1930-1938 (Table 5) [12, p. 79-81].
In 1939, 756 students were enrolled in the faculty, and the average number of students in 1919-1939 was 579. Due to the small number of teachers and reduced funding during the economic crisis, the average enrollment was about 120 students per year. As a result, from 1924 to 1938 only 1,048 people received medical degrees. At the same time, the medical faculty of BSU trained 1008 doctors only in 1925-1931 [3, p. 57; 5, p. 385].
As a result, the number of doctors in Western Belarus increased by 500 people from 1927 to 1937, while in the BSSR - by more than 1,000 (table 3). In 1931 there were 1,750 doctors in BSSR, which per 10,000 people gave an indicator of 3.3 doctors, and in the eastern voivode-ships of Poland, there were only 1,082 (2 per 10,000). By 1938, there were 2,267 doctors in the BSSR (4.31 per 10,000), while in Western Belarus - only 1,368 (2.67 per 10,000).
University 1932 1937 1938
Minsk 1142 2459 2737
Vitebsk - 749 1006
Total 1142 3208 3743
Table 5. - Number of students of the Medical Faculty of USB 1930-1938 [12, p. 79-81]
Year 1930 1931 1932 1933 1934 1935 1936 1937 1938
Students 653 677 713 706 707 703 704 705 736
Table 4. - The number of students in medical institutes of the BSSR in 1932, 1937 and 1938 [20, p. 102]
It should be noted, that the indicator of the provision of doctors to the population in the Polesie and Novogrudok voivodeships remained the lowest in Poland (in 1938 in the Novogrudok voivodeship - 1.8, and Polesie - 1.7 per 10,000 (Fig. 1) [13, p. 21; 18, p. 320-323].
The gap in the provision of doctors was aggravated by an even greater disparity in the provision of mid-level medical staff. In conditions of the insufficiency of doctors in rural regions, the basic medical care for peasants was delivered mostly by paramedics [2, p. 122]. However, due to the consequences of war, by 1921 Soviet Belarus had 304 paramedics, 113 dentists, and 92 midwives only [23, p. 253 rev.]. One of the main problems of the 1920s in both Soviet and Western Belarus was the illegal practice of so-called «company paramedics» - former military corpsmen, that continued to heal the civilians in peacetime, which was restricted. But in the BSSR the PCH organized special 1.5-year refresher schools for retraining «company para-medics» by upgrading their skills to the level of qualified paramedics, which simultaneously solved illegal practice problems and increased the number of paramedics who had long medical experience during wartime. Only in 1923 did 48 «company paramedics» become full-skilled paramedics, and by 1926 the lack of paramedics to the required number in rural areas in the BSSR was 23 people. A similar policy was applied to «mercy sisters» who, through courses, had to upgrade their level of training to the qualification of nurses. As a result, the shortage of mid-level medical staff in BSSR was significantly lower than doctors [24, p. 28].
According to Polish medical thought, the paramedics were the unpromising type of medical personnel, that should be replaced by doc-
tors, therefore there were no centers for paramedics training in Western Belarus. In fact, Mid-level medical was outnumbered even by a few doctors [4, p. 46].
That's why, unlike the BSSR in the Western Belarus «company paramedics» continued to heal peasants, but illegally. In 1925, 56 people were engaged in illegal paramedic practice in Novogrudok district alone, 47 in Baranovichi, and 105 in Nesvizh [25, p. 45]. However, even the qualified paramedics faced difficulties with confirmation of their diplomas by Polish law -by 1925, in Novogrudok voivodeship, only 17.4% of paramedics received the right to practice medicine. Due to the lack of doctors, the necessity of paramedic personnel for Western Belarus was much more acute in comparison with the saturated medical personnel of the Polish lands proper. The mid-level medical personnel played the most significant role in rural areas of Western Belarus, where 71.4% of local paramedics and 45.2% of midwives worked in 1926 [6, p 359].
Nevertheless, in rural areas, paramedics remained the only alternative to the scarce doctors, providing all possible medical care and fulfilling the competence of doctors. So, in the Maly Lyaskovichi of the Pruzhany district, the local paramedic N. Kot was called a «doctor»: he allocated one of the rooms of his house as a medical office for admission, and made some medicines, ointments, etc. necessary for treatment with his own hands.
As a result, not only residents of Small and Large Lyaskovichi but also the population of other nearby villages, turned to the «doctor» who became famous in the district [26, p. 284285].
Figure 1. - The number of doctors in the regions of the BSSR and Western Belarus in 1937 [22, p 48]
Like in higher education, in the 1930s in the BSSR, there was an increase in mid-level medical personnel training: a wide network of30 medical colleges was deployed, which largely provided the necessary cadres of secondary medical personnel, especially paramedics, most of whom worked in rural areas, where they replaced doctors (Table 6) [2, p. 124; 27, p. 2-3].
As a result, in contrast with Western Belarus in BSSR the mid-level medical personnel more than 3 times outnumbered the doctors (Fig. 2).
In Western Belarus, due to a weak increase in medical personnel, paramedics also continued to play a key role in medical care for the rural population, however, the absence of an organized system of training secondary medical personnel in the eastern voivodeships of Poland led to a decrease in the number of paramedics and a corresponding deterioration in medical care for the most vulnerable categories of the population. As a result, the disparity in the provision of doctors for Western Belarus was aggravated by the gradual «extinction» of the paramedic profession. In 1930 in Polesie voivodeship, only 80 paramedics were registered. The peculiarity of the distribution of paramedics across the territory remained the predominance on the periphery, in rural areas, which radically distinguished them from doctors. So, 12 paramedics were registered in Brest, and in the Brest region - 20, in Pinsk - 6, in Pinsk region - 9. In 1931, there were only 107 paramedics in the Vilnius voi-
vodeship, of which 25 worked in Vilnius and 82 in the provinces. However, the lack of training of paramedics led to a gradual natural decrease in their number. For example, until 1935, only 64 paramedics remained in the Polesie voivode-ship (Table 3). In the Novogrudok voivodeship in 1936, there were only 54 paramedics [28, p.
7].
The same situation prevailed in nursing. That was caused by the educational policy of Polish authorities, which hadn't organized even the regular training of nurses. The training of nurses was carried out mainly in Warsaw, where most nursing schools were concentrated, where a small number of applicants were recruited from the province according to quotas. The only way to increase the amount of personnel in Western Belarus was through short-term courses, which were created by the Polish Red Cross. However, these courses were not regular, and the level of their preparation remained insignificant. So, in 1930, the Polesie district of the Polish Red Cross trained only 42 nurses, and in 1937-1938 it organized two training courses, which 77 people attended [29, p. 69]. Thus, unlike the BSSR, where the average medical staff exceeded the number of doctors in quantitative terms, the reverse process took place in Western Belarus, when the average medical staff was quantitatively inferior to doctors (Table 6) [10, p. 179; 28, p.
7].
Table 6. - The number of paramedics in the BSSR in 1925-1937 [2, p. 21; 13, p. 21]
Year 1925 1928 1932 1933 1934 1935 1936 1937
Paramedics 630 790 1285 1252 1229 1266 1616 2258
10000
8000 6000 4000 2000 0
7739
1893 917
1925
2764 1381
3156 1566
5171 1750
TÍ0
5057
1694
5897
1711 370
1778 57
1928 1930
Doctors ■
1932 1933 1934 1935
Dentists Mid-level personnels
2092 620
1936
Figure 2. - The growth of the number of medical personnel in the BSSR in 1925-1936 [13, p. 53]
Conclusion. Thus, the main factor in the superiority of the Soviet healthcare system in the BSSR over the Polish one in Western Belarus was an increase in the recruitment and graduation of medical institutes and technical schools, while in Western Belarus doctors were graduated only by the Medical faculty of Stefan Batory University, and significant training centers for secondary medical personnel were absent. The turning point in the development of medical education in the BSSR was the rejection of the model of a classical university with an attached medical faculty in favor of the allocation of separate medical institutes in Minsk and Vitebsk. As a result, by the end of the 1930s, the BSSR managed to achieve a quantitative increase in the training of doctors, while in Western Belarus, the recruitment of applicants and the training of doctors did not satisfy the needs of the population. This situation in Western Belarus was complicated by the actual lack of a system for training mid-level medical personnel, who could not replace the few doctors in the medical care of the rural population.
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Статья поступила 30 марта 2024 г.
