In this much anticipated monograph, Susan Grant examines Soviet nursing from its tsarist origins through the fall of the Soviet Union. Using primary sources, Grant argues that, while at first ignored, Soviet nurses’ work experience bore the brunt of change and crises, making them significant contributors to Soviet culture. Western nursing influenced the development of its Soviet counterpart, which followed a similar, but not identical path. Progressing chronologically, through nine chapters, the author builds this thesis, most tellingly in Ch. 8, which deals with psychiatry.
Ch. 1 begins with an examination of tsarist nursing. The Russian physician N. I. Pirogov (1810–1881) predicted that Russian nursing would conform neither to western standards nor to the Orthodox Church. The first Sister of Nursing community was chartered in 1848. A lack of centralization allowed such groups to spread as the Red Cross constructed an infrastructure. Noblewomen dominated, but women of all social classes served from the Crimean War (1853–56) through World War I. Even before the Soviets, nurses embraced science and secularism. During the Russian Civil War, which Ch. 2 details, seven million citizens perished as the Soviets embraced War Communism (1918–21) (35). Social stressors and local pressures inhibited the formation of nursing guidelines, as did conflicting understandings of how a proletarian state should operate. Absorbed by the Commissariat of Heath, the Sister groups exploited regional pressures to retain agency.
Grant examines the evolution of Soviet nursing through the New Economic Policy (NEP, 1921–28) in Ch. 3. The Soviets moved away from communism and accepted international aid to battle famine. The author emphasizes training and the role of international healthcare in building the Soviet nursing profession amid chaos and shortages. Western organizations helped build women's outpatient clinics, maternal and women's homes, and a training school. In Iosif Stalin's First Five Year Plan (1928–33), the Soviets no longer accepted western assistance. Using trade union literature in Ch. 4, Grant details how the state blurred the lines between “middle medical workers,” nurses, feldshers, and physicians during the Five-Year Plan. Assaults on medical workers rose even as nursing training highlighted compassionate care.
As shown in Ch. 5, the Soviets pursued equality of the sexes and retained thoughtful and considerate care as goals throughout the Stalin era. The 1936 Constitution that promised all citizens well-being was at best marginally successful. The author does not fully endorse Nicholas Timasheff's idea of a “Great Retreat” from socialism (97). Providing patient care, preparing sanitary defenses, and toting rifles, nurses overcame stereotypes through the 1920s and 1930s. Impediments sabotaged improved care, but militarization in preparation for World War II, covered in Ch. 6, emphasized patriotism, service, and expertise, affording nurses greater opportunities.
Ch. 7 addresses World War II and postwar reconstruction. An emphasis on cultured care buffered mass fear during Stalin's campaigns against the intelligentsia, the Jews, and the west. Medical wards provided an environment for nurses to engage patients in conversation as compassionate nursing co-existed with political coercion. Psychologically scarred nurses simply pushed forward. In Ch. 8, Grant illustrates how these stressors peaked, affecting middle medical workers. As psychiatry competed for relevance with maternal care and epidemiology in the 1930s, mental care in Soviet hospitals was “particularly deplorable.” The state undertook initiatives to improve working conditions. Female medical workers particularly bore trauma. Male colleagues used female medical workers’ knowledge while seeking to limit it. Nurses worked in shock treatment, insulin therapy, and patient restraint. Grant presents the latter issue in Foucauldian terms. Theoretically loaded, this chapter is sure to spark discussion.
The ninth and final chapter supports Vera Dunham's scholarship on the middle classes (217). Nurses, and the Russian people lost confidence in a vision that excluded them. The Chernobyl meltdown and other calamities sealed the final fate of Soviet socialism.
Susan Grant has authored a compelling narrative of Soviet nursing and public health. With western assistance and an indomitable mindset, Soviet nurses forged career paths that typified the Soviet experience, affording them a significant place within the larger framework of public health and society. The book is appropriate for two-and four-year colleges, medical departments, colleges of public health, specialists in gender, the social sciences, the humanities, and most adult readers.
