Feldsher

FELDSHER (feldsheritsa), a medical worker with completed secondary medical education (3-year feldsher school). The training of secondary medical personnel in Russia dates back to the 1840s due to the increased demand for this category of medical workers from the army. The institute of medical apprentices was introduced, who received individual training, mainly from foreign physicians who came to Russia. Upon completion of individual training, medical apprentices were sent to work in regiments. The contingent of medical apprentices was formed mainly from artillerymen, marksmen, and so-called "volunteers". In 1706, the first school for physicians was organized for 50 people; training in the physician school lasted 7 years. To accelerate the training of medical workers, in 1740, so-called subphysicians began to be trained from soldier children who could read and write. The training of subphysicians continued almost until the middle of the 19th century, when for the first time schools for training feldshers were organized by the Public Welfare Department at major hospitals. Persons aged 12 to 16 were admitted to these schools. Most students in these schools were charged tuition. The period of study in feldsher schools was set at four years, and persons studying for free on scholarships from the Public Welfare Department (mainly orphans) were sent to work in remote areas of the country for 6 years, while peasant children who studied at the expense of landowners were transferred to their disposal. In addition to training in feldsher schools, feldshers were also trained individually through apprenticeship (craft training with physicians), followed by examinations at medical administrations. The Zemstvo reform of 1864 found 5 poorly organized feldsher schools, where the attention of students was focused to a significant extent on general education subjects rather than specialized subjects. The creation by the zemstvo of mobile feldsher assistance, as well as medical posts served by feldshers, required strengthening the training of feldshers. By the end of the 19th century, 32 feldsher schools had been created. The government normal charter (1872) provided for a minimal general education level of students and their weak specialized training. In 1897, the Ministry of Internal Affairs issued a new normal charter for feldsher schools, but even in it, innovations were extremely limited due to the conservatism and stagnation of the government. The new charter introduced four-year training in feldsher schools and established the admission of persons with general education training equivalent to a two-year folk school. - The first female feldsher school, preparing feldsheritsas, was opened in 1872 from a department for training feldsheritas of the St. Petersburg Educational Home. At the beginning of the 20th century, the first feldsher-midwife schools were opened, as the training of a feldshera-midwife was economically more advantageous for the zemstvo, which sent one worker (feldshera-midwife) to a district instead of two workers (feldsher and midwife). The training of feldshera-midwife was completely insufficient: in the curricula, a large number of subjects predominated that had nothing to do with obstetrics, and only 6 hours annually were allocated to obstetrics and women's diseases in the 3rd and 4th years, and 1½ hours annually to the study of diseases of newborns. In the prerevolutionary years, all activities of F. by law had to take place under the control and guidance of a physician, and independent practice was prohibited. Pharmacies did not have the right to dispense medicine according to prescriptions of F. Only in 1910 were the rights and obligations of feldshers formalized. They were to provide assistance for acutely occurring diseases where there was no physician, but with the obligation to inform the nearest physician at the first opportunity; they had the right to take necessary measures independently upon the appearance of epidemic diseases (cholera, scarlet fever, smallpox, typhus and diphtheria) with mandatory notification of the nearest physician and receiving instructions from him; to perform minor surgical operations, apply bandages for fractures, perform vaccination and provide independent assistance in cases of poisoning and strangulation. In 1913, there were 29,986 persons F. and feldsheritsas in Russia (compared to 25,433 civilian physicians). There were 24,058 F., 5,928 feldsheritsas, and 5,111 independent feldsher posts (for details on feldsher posts, see Healthcare, zemstvo medicine). The number of independent feldsher posts exceeded the number of medical posts in all non-zemstvo provinces, except Kiev and Astrakhan, and in the vast majority of zemstvo provinces, because, not to mention the shortage of physicians, the organization of feldsher posts cost the zemstvo significantly less than the organization of medical districts. Throughout Russia in 1910, there were 3,800 medical districts and 4,600 feldsher posts. Of all patients registered in 1910, 34.1% were treated by F. According to zemstvo reports, in many provinces more than 50% of patients were treated by F.; 30-35% of patients in medical outpatient clinics were treated by F. Of all outpatients registered in 1910, only about 64% were treated by physicians. The salary of F. was extremely low, mostly 25-30 rubles per month; working conditions were exceptionally heavy: 8-12 hours of work per day, in some provinces 12-16 hours; vacations as a rule existed only in 66.5% of zemstvo provinces, in 9% of zemstvos there were no vacations at all; vacations for illness were given with retention of salary, but the work of those who left mostly fell on those remaining at work. Duty shifts lasted more than 24 hours and no rest was provided afterward. The legal status of F. was very difficult and humiliating. In legislation, the rights and obligations of F. were not precisely regulated: on the one hand, F. was required under penalty of punishment to provide medical assistance, but on the other hand, medical practice was prohibited to them. To protect their interests, F. began to unite from the 1880s into various unions. After the October Revolution, F. continued to play a fairly significant role in providing medical assistance to the population, because the significant growth in the training of medical personnel still lagged behind the colossal cultural growth and increasing needs of the country. The proportion of independent feldsher posts, although reduced in number, still remained quite large, and many unfilled medical districts were staffed by F. After the revolution, the training of feldshers (lekpoms, pomvrachey, pom-sanvrachey) was concentrated in special departments of medical technical schools with a 3-year period of study. The Regulations on Technical Schools, approved by the Collegium of Narkompros in 1927, provided for the reorganization of secondary medical education on a polytechnical principle. As a result of this reorganization, by 1928 there were five types of secondary medical educational institutions where, along with other secondary medical personnel, feldshers were also trained (medical polytechnicums, preventive medical technical schools, 3-year courses for reclassification of regimental F. into school and evening medical technical schools). In 1930, in connection with the reorganization of specialized education on a sectoral principle, all medical technical schools were transferred to the jurisdiction of the people's commissariats of health of the union republics. However, in the established system of training F., there were a number of serious shortcomings. Preparing assistants to physicians (lekpoms, pom-sanvrachey), medical technical schools did not prepare them for independent work. The enormous growth of our socialist industry and especially socialist agriculture, care for the health of the country's population required a significantly larger number of feldshers capable of working independently than were prepared by the people's commissariats of health of the union republics. In 1935, medical technical schools were reorganized by the people's commissariats of health into independent feldsher and feldsher-midwife schools with a 3-year period of study, the curricula and programs of feldsher schools were changed to strengthen the training and education of practical skills of students with preparation for independent therapeutic and preventive work, mainly in rural areas (see Medical education). Along with this, the people's commissariats of health developed detailed rights and obligations of feldshers. Rights and obligations of F. The title of F. (-itsa) can only be held by persons who have completed a course in a normal feldsher school or corresponding departments of former feldsher-midwife technical schools and have received appropriate certificates. The title of F. is also conferred on persons who have practical experience and have passed the established examination by the People's Commissariat of Health at feldsher schools, as well as on persons who previously passed the examination for the title of feldsher at former medical administrations. F. wishing to work in their specialty must apply to the health department for a registration certificate, issued upon presentation of documents about their education. In the absence of such documents, F. are subject to a verification examination at feldsher schools; F. are admitted to the examination upon presentation of a certificate from institutions about their work as feldshers at present or about their previous medical-sanitary service, provided that the break in work until the moment of registration does not exceed 3 years.

If the break was more than 5 years, then in addition to the verification examination, the feldsher who has lost the document confirming medical qualification must complete a practical internship for 1 year at a well-organized provincial, city, or large district hospital. The feldsher who has not practiced their profession for 5 years or more but has a document confirming their qualification must complete a practical internship for 6 months in the aforementioned, well-organized hospital. A practical internship of less than 6 months is also established for those feldshers who have shown insufficient knowledge and were therefore deprived of the right to professional work after completing the practical internship. The feldsher must submit to the health department a review from the head of the hospital where the internship was conducted, regarding how the internship was carried out. According to the instruction of the People's Commissariat of Health of the RSFSR of July 1, 1935, the scope of the feldsher's independent activities includes: a) providing necessary assistance for acute, dangerous diseases in places where there is no physician; as soon as possible, he must inform the nearest district physician of this; b) independently taking measures to prevent the spread of epidemic and contagious diseases, such as cholera, scarlet fever, smallpox, measles, typhus, etc., with immediate notification of the district sanitary physician to receive instructions from him; c) performing minor surgical operations (applying bandages and sutures for wounds, setting dislocations, extracting teeth, stopping bleeding, removing foreign bodies, opening abscesses and performing other operations that do not require general anesthesia), performing intubation of the larynx and providing surgical assistance in obstetrics within the scope of operations permitted to be performed by midwives, conducting all types of preventive and therapeutic vaccinations; d) independently applying all measures in case of acute poisoning, drowning, in cases of apparent death, etc. Along with the ability to provide general medical assistance, the feldsher must have knowledge and necessary skills in providing obstetric and gynecological assistance to the population. According to the same instruction of the People's Commissariat of Health of the RSFSR of July 1, 1935, a feldsher who has worked for a year at a hospital has the right, in the absence of a physician, to manage small hospitals (up to 10 beds) and reception rooms, reporting on their work every ten days to the district physician. The feldsher is granted the right: a) to prescribe prescriptions, including potent substances, within pharmacopoeial doses; b) to manage hospital pharmacies where a pharmacist is not provided for by the staff; c) to use in their practice therapeutic and preventive serums permitted by the People's Commissariat of Health; d) to issue certificates: about vaccinations, about death resulting from a disease that does not require a forensic autopsy, about the illness of the person treated; the feldsher has the right to issue a sick leave certificate (medical certificate) in agreement with the social security fund. In forensic medical examination, feldshers must be guided by the 'Regulations on Forensic Expertise of Feldshers'. The feldsher is liable to the court on general grounds for improper treatment that caused harm to the patient.