ABSTRACT
This chapter analyses the aftermath of the civil war and what happened to Soviet medicine in Petrograd (up to 1924, renamed Leningrad after 1924) in the 1920s. By the end of the Civil War in 1920, medical facilities in Petrograd were at an all-time low and worker discontent was widespread. The New Economic policy (NEP) aimed at dealing with the crisis situation. The health service remained in state ownership, but in order for the proletariat to retain its faith in the leadership, some relaxation took place giving rise to a limited private medical sector. Many of the socialist principles devised during War Communism were watered down or abandoned altogether. Following victory in the civil war, there were calls to put the health service on a firmer socialist footing. The transition to the market under the NEP from March 1921, led to the introduction of fees, budget cuts in 1922 and more cuts during the 1926 regime of the economy. Although population recovery took place, and the local health service still emphasised the importance of insurance medicine given the city and regions industrial importance, it was faced by new challenges posed by social diseases (TB, VD) and abortion and infant mortality. As the city's population increased, its housing and health care system came under pressure and overcrowding spread disease. This situation was partly offset by an initial improvement in diet in early NEP but as the food situation declined in late NEP, the kulaks (rich peasants) were blamed for the food shortages; and the once useful tsarist medical profession was now blamed for falling health conditions. At the same time, the local authorities resisted central attempts to cut public health funding as Petrograd health service wished to prioritise the industrial working class. By 1926–27 a hardening of attitudes towards bourgeois specialists of the Leningrad medical profession took place. Hardliners in the Leningrad Party were growing anxious about the key role which the former zemstvo specialists were playing in public health affairs under NEP. The move from persuasion to coercion was, therefore, not very far off. The chapter concludes by arguing that budget cuts and a changing political atmosphere meant that the city and regions doctors and other personnel were badly-equipped to meet the planned shift in economic and political strategy as a result of Stalin's victory in the power struggle for leadership of the USSR following Lenin's death in January 1924.
