The paper presents the results of a study of the public health system of cities and towns on the western section of the Baikal-Amur Mainline (BAM) during the all-union Komsomol shock construction projects. The local network of RSFSR medical institutions, which was developing at a painstakingly slow pace, was initially intended to shoulder all the burden of providing medical service. Departmental health care, coordinated by the BAM Medical and Sanitary Service under the Ministry of Railways of the USSR, was organised to allow the swift delivery of medical care to construction workers.