ABSTRACT
The final substantive chapter explores developments in the Leningrad health service from 1928, the start of Stalin's ‘Revolution from above’ (rapid industrialisation and forced collectivisation and the implementation of health planning) through to the Winter War with Finland and the siege of Leningrad, 1939–41. We analyse the aims and priorities of the Stalinist regime, namely to catch and overtake the West, and Leningrad's contribution to this process. The chapter assesses the impact all this had on the city – population growth, the influx of workers, shortages of housing, food etc. – and the financial and political constraints on health service development. As Stalin's policies started to have an adverse effect, there was growing political opposition to his leadership as well as social order issues between 1930–34. At the same time, the medical situation deteriorated as social diseases (VD, TB, abortion, alcoholism) increased and infectious diseases and famine occurred. Stalin's very ambitious five-year plans put the health service under extreme pressure, and when they were unable to meet his unrealistic targets, this put the health of the collective in danger. Doctors and other medical personnel at first were criticised (1928–34) and after 1934, and Kirov's death, they were purged (imprisoned, exiled or killed). At the height of the Great Terror, in 1937–38, the Leningrad medical profession was rounded up and executed. The old tsarist medical profession that previously cooperated with their Soviet colleagues were now replaced by the Party faithful. Although it appears that they were targeted for class reasons and seen as class enemies and ‘former people’, this chapter advances a new interpretation arguing that the real reason was the medical disorder prevailing from 1936 onwards. This situation was caused by Stalin's policies, his failure to prioritise health care and social disorder prevailing which caused population movement to and from the Leningrad, thereby spreading disease. However, the medical profession in the city (deemed to be a terrorist centre full of Trotsky's supporters and Oppositionists) was held responsible and became a victim before and during the purges. The chapter concludes that although Lenin and the early Soviet state sought to protect the health of the collective, and cooperated with the bourgeois medical profession to achieve this goal, Stalin's rise in the 1920s and his ascent to power after 1928, actually put workers' and peasants' health in increasing danger. This chapter shows that the hope of participants in the October Revolution and the Russian civil War for improved health conditions and care had still not been met by 1941 as war broke out with Nazi Germany and the siege of Leningrad followed. Responsibility for this lies squarely with Stalin and his followers not former zemstvo members of the medical profession at least in Leningrad's case.
