Hospital

HOSPITAL (from the Latin *hostis*), a medical institution, primarily in the armed forces. In a number of European countries and the USA, the term 'hospital' is also used in some cases for civilian medical institutions, using it as a synonym for 'hospital' (see). In the USSR, hospitals are exclusively military medical institutions. The history of the military hospital as a form of organization of medical aid in the armed forces basically repeats the line of development of military sanitary affairs (see). The interest of a class state in its armed forces as an instrument of class domination and aggression made the army one of the first groups of the population with respect to which the state embarked on the path of organized public health. In the system of measures for the protection of the health of the armed forces, the first (and in most cases for a long period the only) form of medical-sanitary service was medical aid in the form of hospitalization. Among the intermediate systems of hospitalization, reflecting various stages of the development of military-sanitary affairs, the first, most close to the hospital form of medical aid were field hospitals (valetudinaria), for example in the troops of Tiberius (Rome, 1st century AD). This sufficiently primitive type of military-medical institution was preserved in various variations throughout many centuries at all stages of the evolution of military-sanitary affairs. Only the 16th century, in connection with the organization of standing armies, gave impetus to the transformation of field hospitals into a more perfect form of medical aid: such an organizational form, under conditions of weak provision of troops with medical personnel and low qualification of doctors, could only be a hospital. However, recognition and spread of the hospital were very slow: the hospitals created in the 16th century in Spain remained a lonely and unattainable model for a number of countries for a long time. In France, hospitals appeared in the 17th century, little differing in the nature of aid from military medical institutions; in Germany in the 18th century; in Russia also in the 18th century, under Peter I. The first 'hofspital' was established in Moscow in 1706-07 (at present - the 1st Moscow Communist Military Hospital). During the reign of Peter I, 10 hospitals were opened, and by the end of the 18th century there were over 30 of them in Russia. As the oldest form of medical service for the armed forces, the military hospital accumulated a large number of diverse forms of organization and activity, a significant part of which have been preserved to the present time. For this reason, the content and scope of the term 'military hospital' have an insufficiently definite character; by this term in different armies is covered a conglomerate of far from homogeneous concepts. To the type of permanent hospitals belong military-medical institutions not organizationally connected with the troops and serving not individual military units, but whole areas of troop deployment; this gives grounds to name them permanent hospitals as opposed to military medical institutions. The last group of medical institutions, extremely diverse in organizational and functional terms, is classified differently and is called local, garrison, or regimental field hospitals. This last type of military-medical institution is the basic one in most modern armies, as it has a number of advantages: it brings stationary medical aid closer to the military unit and represents the most inexpensive form of this aid. However, the limitation of its functional possibilities makes the existence of permanent military hospitals inevitable, which in this case acquire the significance of regional centers for consultation and qualified medical aid. In the first years of the construction of the Red Army, permanent hospitals were almost the only organizational form of therapeutic aid in the Red Army. However, the development of therapeutic activity on preventive bases called for the strengthening and improvement of military medical institutions, which, under the condition of ensuring them with sufficiently qualified medical personnel, represent the most favorable conditions for introducing preventive principles into medical affairs, as they organically unite the functions of medical and sanitary service of the military collective in the hands of one apparatus of the military sanitary service. For this reason, permanent hospitals in the RKKA acquire the significance of regional centers of therapeutic and preventive aid, which cannot be carried out by the forces and means of military medical institutions due to the lesser medical qualification of their medical personnel and the limitation of medical equipment. By its internal structure, military hospitals in the RKKA have a mixed character, since the desire to limit as much as possible in peacetime the evacuation of patients reduces the radius of the area of each hospital and thereby its size, and on the other hand, the character of indications for referral to a hospital presents to it requirements for all types of specialized aid. Military hospitals in the RKKA have the following tasks: 1. Provision of medical aid to military personnel requiring stationary care in an environment ensuring continuous connection with the RKKA. 2. Establishment of the causes and conditions of occurrence and development of various diseases among military personnel, especially those connected with military labor and life, for the conduct of corresponding sanitary-preventive measures in the troops. 3. Sanitary enlightenment and education of hygienic skills among military personnel undergoing treatment. 4. Scientific-practical development of methods and means of treatment in order to improve the organization of medical affairs in the RKKA. 5. Medical examination and certification of military personnel and those called up into the ranks of the RKKA by decision of medical and reception commissions to determine the degree of fitness for military service, need for treatment, and for other reasons. 6. Preparation and improvement of the personnel of military-sanitary service for specialized practical work in the RKKA. Such an understanding of the functions of a military hospital is answered by its structure. A military hospital in the RKKA, besides the hospital ward including departments for different specialties, must have a polyclinic department with reception for all specialties presented in the hospital, a dental office, and in some hospitals also a dental laboratory, a medical commission (general for certification regarding disability and invalidity, and special, for example, resort-selection) and in a number of cases sanatorium departments, which are developed both on the territory of the hospital (relying in this case on its physiotherapy cabinets) and on local resorts. As an auxiliary apparatus, a military hospital has a clinic-diagnostic laboratory, cabinets for special investigations (X-ray, patho-anatomical, etc.). The task of preparing the personnel of the sanitary service of a military hospital is fulfilled in the order of organization of courses for sanitary instructors and disinfectors. Deviation from the general type of military hospital in the RKKA represent military-resort stations, which are institutions of narrow specialization - for providing sanatorium-resort aid. Depending on the number of beds and the volume of functions, military hospitals are divided in the RKKA into 5 classes: to the 1st class belong military hospitals with a number of beds from 50 to 75; to the 2nd - from 100 to 200; to the 3rd - from 250 to 300, but due to special tasks maintained according to individual staffs; to the 4th class - military hospitals with a number of beds from 350 to 700 and to the 5th - with 1,200 beds. One of the military hospitals in each military district performs the functions of the district hospital. Planning the network of military hospitals, establishing for each of them the area of service, determining the volume of function and the size of activity, and thereby the class of hospital, is built on the account of the number of contingents of military personnel of each district, the magnitude of morbidity and sickness of these contingents, the capacity of military medical institutions and the qualification of the medical aid provided by them. The degree of actual provision of the RKKA with hospital aid is evidenced by the following data. On 100 patients received stationary treatment: Medical institutions 1913 Hospital 1927 Hospital 25.8 34.3 37.2 2.7 44.9 17.2 35.2 2.6 Reception wards of military units Civilian medical institutions ... The growth of work of auxiliary hospital institutions of diagnostic and therapeutic significance is characterized by a very high tempo in recent years. On 1,000 personnel of the army was performed: Years X-ray procedures Laboratory investigations Physiotherapy procedures 91.9 120.1 141.3 559.0 636.9 731.2 521.4 1 543.2 556.4 Growing in terms of the qualification of its personnel and having received a solid material base, the military hospital in recent years was able to embark on the path of building its work on preventive principles. Investing in this task the same understanding of its content, which is characteristic of civilian therapeutic-preventive institutions, the military hospital was forced, due to the specific conditions of organization of the army, to create its own system and methods of work in this direction. Schematically presented, this system has 2 variants. The first, when the treatment of the patient occurs and ends in a military medical institution. In this case, individual diagnosis and treatment, study of the conditions of labor and life of the patient and the whole collective to which the patient belongs, measures for their health improvement - all this is carried out by the apparatus of the military sanitary service. A military hospital performs the task of qualified consultation in establishing individual diagnosis and treatment, methodological guidance and participation of qualified forces in conducting research work, assistance in forming the conclusions of the analysis into concrete measures.

Roles change in the second variant, when the patient's treatment occurs in permanent military hospitals. In this case, all the functions listed above are performed by the military hospital, which recruits the military sanitary service as an apparatus for studying the conditions of labor and life and for their improvement. For the correct diagnosis and treatment of the patient directed to a medical institution, the latter must have a brief medical history, a presumed diagnosis, know the circumstances under which the disease occurred, and its first manifestations. In order for the military unit to be able to conduct the necessary observation after the patient's return from the medical institution, to establish the correct labor regime, and in some cases even subsequent treatment, it is necessary to know not only the diagnosis of the transferred disease, but also its nature, severity, complications, treatment performed, and changes remaining after the disease. This task of mutual information between the military unit and the medical institution is carried out in the form of a sanitary certificate. Thus understood, the preventive orientation of hospital work could not fail to include in the sphere of its attention the conditions of the patient's stay in a hospital. The introduction of preventive principles into medical practice, alongside other forms of influence on the patient, implies targeted treatment built from the angle of strengthening those sides of the organism which prove to be most vulnerable under certain conditions of labor and life. The system of such targeted treatment, striving to ensure the most stable results and to prevent the further development of the disease, requires the use of all conditions of the patient's stay in the medical institution as therapeutic factors. Among these conditions, nutrition occupies one of the first places. The hygienic norms for the placement of patients in a hospital basically do not differ from the general civil ones (see Volnitsa). However, the organization of a military hospital has some features reflecting the nature of its activity. The opening of military hospitals or their dissolution is carried out by the order of the commander of the Military Administration of the Red Army (VSU RKKA), the staffs are developed by the VSU RKKA together with the Main Administration of the Red Army and are approved by the People's Commissar for Military and Naval Affairs of the USSR and the People's Commissar of Health of the RSFSR; financing of military hospitals occurs mainly according to the budget of the VSU RKKA and in some respects according to the budget of the People's Commissar for Military and Naval Affairs, supply of all types of property is carried out through the Military Sanitary Administration (VSU) of the corresponding district, on the territory of which the military hospital is located. The provision of a military hospital with housing and communal services is carried out by local bodies of the military department, the direct management of the military hospital is entrusted to the VSU of the district, to which the chief physician standing at the head of the hospital is directly subordinate. In wartime, hospitals are formed for the purpose of providing aid to the sick and wounded: field mobile and evacuation hospitals. Field mobile hospitals possess standard sanitary transport means for transporting the sick and wounded, as well as means for transporting, in case of necessity, the property due to them along dirt roads. Evacuation hospitals differ from field mobile hospitals mainly in that they cannot move by their own means; consequently, evacuation hospitals are located, as a rule, near railway lines. On the other hand, evacuation hospitals differ from permanent military hospitals in that the latter exist also in peacetime and their movements can be carried out in wartime, as a rule, only in the event of the abandonment of the area during the developing offensive of the enemy.