It remains to look at some Communist countries other than those on the eastern fringe of Europe, among which there is tantalizing evidence of VD control surpassing that of the rest of the world. We saw before that the U.S.S.R. seems to have had some success in control of syphilis, but less with gonorrhea; that Cuba, for which our information is meager but we are in a position to snatch at straws is reputed to have done well with gonorrhea but not with syphilis; and that China may have been so successful in controlling both diseases that Dr. Ma, who is given credit for the job, can now devote his energies to the control of other diseases.

Let us look first at the U.S.S.R., and begin with its health services, which have been well studied by Western experts and have been described in the United States over a period of many years in several books and in frequent articles.

In the Soviet Union today, medical care is widely available and free. Soviet citizens have as much access to medical care as Swedes do, although there are hints as well that Soviet medical techniques are not always quite so sophisticated. The U.S.S.R. makes wide use of partly trained or paramedical personnel ("feldshers") working under the supervision of physicians; these act, with local variations, as midwives, sanitarians, and pharmacists.

The U.S.S.R. has evidently taken strenuous measures to control VD, from its early years. Both Dr. Victor Heiser and Dr. Thomas Farran, in his Shadow on the Land (1937) were much impressed with early efforts to control VD in the Soviet Union. Heiser, who was there in 1929, spoke of the use of radio to reach illiterate persons in farthest Siberia, and of the handling of VD simply as infectious disease in great contrast to our "ostrich like" attitude. Parran mentions that syphilis had been "pandemic" in many parts of the country before the Revolution, and that gonorrhea had become widespread with the return of the soldiers after World War I. Intensive anti VD efforts were begun in 1922 after the hard early years, with widespread Wassermann tests and treatment by flying squadrons of doctors and assistants, spreading to the farthest reaches of the country. In the cities, he says, treatment was non-compulsive during that period;

“the Russian with syphilis is treated with a delicacy and with a due regard for his sensibilities which is almost British [!]. If a patient is examined and found to be infected, permission is asked to examine his whole household. The effort is also made to trace all sources of infection; but the permissive attitude is emphasized in spite of the fact that in 1927, at about the same time as in Germany, a law was passed making treatment for syphilis compulsory. There is no cost for treatment. There is no penalty, social or economic, attached to the disease. The almost complete liquidation of the commercial prostitute has helped the problem greatly.” (see VD CONTROL MUST EMPHASIZE MORALS MORE THAN MICROBES PART III)