30 Chapter 1
and on the size of their membership. Workers in individual enterprises who
wished to spend their annual leave at a rest home could then apply through
their factory committees for one of the available spaces. The factory’s labor
protection commission and medical staff provided documents for review by
the local (city or region) allocation commission, and successful applicants
would receive a putevka for an all-expenses-paid vacation to a particular rest
home. (If the review turned up more serious medical problems, the applicant
would in theory be directed to a health resort instead.)^49
Allocation by medical need alone did not optimally utilize the health sys-
tem. Perhaps the Soviet population was healthier than offi cials had realized,
but heads of health spa institutions reported over and over that their tuber-
culosis sanatoria could not be fi lled with tuberculosis patients alone, that
sometimes only half of their so-called patients needed any real treatment.
Many patients arrived with putevki but without any medical certifi cation
whatsoever. A 1934 study in Kislovodsk suggested that fewer than 50 percent
of patients in sanatoria there required medical treatment. Patients arrived at
tuberculosis sanatoria for forty-fi ve-day cures completely aware of their good
health, while known tuberculosis patients were denied access. At Evpatoria
in Crimea, 10 percent of patients had no medical reason to be there: “Many
receive putevki as a prize, and instead of sending them to a rest home, they
send them to us,” taking spaces away from patients who genuinely needed
treatment.^50
From the point of view of the trade unions and Soviet labor offi cials, health
resorts as “repair shops for workers” should give priority in their treatment
and rest regimes to workers and particularly to industrial workers. This view-
point clashed with that of public health specialists, who would continue
to favor access rationed by medical need, not occupation.^51 Offi cially, the
trade unions prevailed. In 1923 the Central Trade Union Council directed
that 80 percent of sanatorium places should be reserved for workers, an ar-
bitrarily large fi gure that gestured both to workers’ status in the new regime
and to their frail physical constitutions. In 1926 “workers” consisted of 6.5
percent of the entire income-earning Soviet population, “industrial work-
ers” 2.7 percent. Even in the late 1930s, workers represented less than one-
third of the economically active population.^52 Putevki for workers only were
distinguished by special colors and could cost 50 percent less than putevki
available to the general public. In addition, most or all of the cost would be- Beloborodov, “Printsipy,”in Doma otdykha 1920–23 , 49–51.
- GARF, f. 9493, op. 1, d. 8, ll. 34, 74–75, 96, 160 (quote); d. 24, l. 9; GARF, f. 9228, op.
1, d. 24, l. 54; GARF, f. 5528, op. 4, d.132, ll. 237–38. - Sally Ewing, “The Science and Politics of Soviet Insurance Medicine,” in Solomon
and Hutchinson, Health and Society in Revolutionary Russia , 69–96. - Vsesoiuznaia perepis' naseleniia 17 dekabria 1926 goda. Kratkie svodki (Moscow,
1927–29), vol. 34, table 1, 2–3; Vsesoiuznaia perepis' naseleniia 1937 g. Kratkie itogi (Mos-
cow, 1991), 116, 121; Vsesoiuznaia perepis' naseleniia 1939 goda. Osnovnye itogi (Moscow,
1992).