Isolation-Transit Points

ISOLATION-TRANSIT POINTS, a special type of medical-sanitary institution, which are established at certain (mostly junction) points of railway and waterways of communication to combat the spread of infectious diseases among moving masses of population, and in their fully developed form carry out the following tasks: 1) medical-sanitary inspection of moving organized groups of population, 2) temporary isolation of contagious and suspicious patients identified from these groups, 3) their evacuation to treatment institutions, 4) sanitation processing of the moving population groups themselves, and 5) washing and disinfection of their linen and clothing, as well as the cars in which these masses are transported. For the proper fulfillment of the indicated tasks, I.-p. p. must have the following institutions and installations with corresponding equipment and inventory: a) a reception room and outpatient clinic with a pharmacy (the outpatient clinic has very great importance for detecting suspicious patients); b) an isolation ward with the possibility of separately housing different types of infection before sending patients to treatment institutions; c) premises for observation of persons suspicious of contagious diseases or those in quarantine; d) a transit-type bathhouse with a barber shop; e) a laundry; f) disinfection installations and apparatuses; and g) transportation for transporting patients and various household needs. The indicated range of tasks of I.-p. p. and the normal type of their design and equipment emerged only gradually in the process of their development, which can be divided into 3 periods, sharply differing in the volume and character of the activities of I.-p. p.: 1) from 1914 to 1918, 2) from 1919 to 1923, and 3) from 1924 to the present time (1929). I.-p. p. first appeared as temporary institutions during the war, when by order of the supreme head of the sanitary and evacuation department on November 9, 1914, they were organized by the Ministry of Communications (which at that time had an independent medical service) on the main evacuation routes for the wounded and prisoners of war from the theater of military operations and conducted inspection only of passing echelons with wounded and prisoners, identifying from them contagious patients, who were transferred for treatment to corresponding medical institutions. When under the influence of the large wave of refugees in the country the foci of cholera and typhus were scattered, and on the other hand the movement of other organized groups of population intensified, then the same supreme head of the sanitary and evacuation department in March 1916 issued the "Rules of the Sanitary Service of Railway Isolation-Transit Points," according to which medical inspection was also extended to military trains, trains with workers, with refugees, and in individual cases even to passenger trains. Despite the fact that in these rules all details of the design and equipment of the I.-p. p. themselves were regulated and the order of their operation was established, the actual design and equipment of I.-p. p. was extremely varied, and their work did not have a regular character. The number of all I.-p. p. by the end of 1918 did not exceed 40, most points were not separated as independent units from the composition of permanent railway medical districts, of which they were a part, and all of them were constantly overloaded with work in servicing infectious patients among the permanent railway population. Therefore, already after the revolution, at the end of 1919, for the purpose of combating typhus epidemics throughout the country and especially in the Red Army, it was decided to create a planned network of quarantine and I.-p. points, in order to organize with their help complete and systematic supervision of military echelons throughout their formation and movement route. Along with the restoration of some railway I.-p. p. of the Department of Communications of the People's Commissariat of Health (to which, since the formation of the People's Commissariat of Health, all medical-sanitary institutions of the former Ministry of Communications were transferred), the functions of I.-p. p. were entrusted to special medical-nutrition points of the department of the People's Commissariat of Health for providing medical-sanitary assistance to evacuated sick and wounded soldiers, prisoners of war and refugees (thus was named the former department of medical-nutrition points of the Zemstvo and City Unions), as well as to medical-nutrition and observation-provision points of the Central Prisoner-of-War Bureau and the Central Evacuation Bureau that replaced it. During 1919-20, all these institutions, by orders of the Revolutionary Military Council of the Republic, organized a network of I.-p. p., designed in such a way that each military echelon during its journey was examined once a day at one of the I.-p. points and once every 5-7 days underwent complete sanitation processing at a larger I.-p. p. (washing in the bathhouse, changing linen and disinfection of clothing). This entire network covered by the end of 1920 172 I.-p. p. on railway paths, including 42 I.-p. p. organized by the Department of Communications, 71 by the Department of Medical-Nutrition Points of the People's Commissariat of Health, and 59 I.-p. p. organized by the Central Evacuation Bureau; in addition, 78 I.-p. p. were established on waterways, including 37 by the Department of Communications of the People's Commissariat of Health, 23 by the Department of Medical-Nutrition Points of the People's Commissariat of Health, and 18 by the Central Evacuation Bureau. Although all these I.-p. p. were under the jurisdiction of different organizations, they were all constructed according to the same types, worked according to a single plan, single instructions, under the control of the Main Military-Sanitary Administration and under the general leadership of the Extraordinary Military-Sanitary Commission at the Revolutionary Military Council of the Republic; types, staffs and instructions were approved for all I.-p. p. and published by corresponding orders of the Revolutionary Military Council of the Republic, since they served primarily Red Army soldiers and received from the organs of the military department all types of provisions and fuel. Since nevertheless this work through the medium of various organizations did not always perform with sufficient speed and clarity all the assignments of the military-sanitary department, in October 1920 in the most responsible and large (in volume of military movement) railway junctions (Moscow, Kharkov, Poltava, Darnitsa, Bataysk, Smolensk, Polotsk, Gomel, Chelyabinsk, Syzran and Perm) I.-p. p. belonging to different organizations were transferred directly to the military-sanitary department; the latter strengthened them with material and personal means and, under the name "charter I.-p. p.", turned them into powerful sanitary filters, through which all without exception military echelons and detachments and trains with contingents of prisoners of war, refugees, workers passed, and all organized groups of the moving population underwent complete sanitation processing at these charter I.-p. p. The model for the organization of powerful charter I.-p. p. served the railway station I.-p. p., or, as they were called, sanitary-transit points of the city of Moscow, which were organized on an emergency basis in the summer of 1920 by decree of the Council of People's Commissars of May 13, 1920, for the purpose of combating the spread of epidemic infectious diseases in Moscow by passengers arriving there from long-distance travel. According to this decree of the Council of People's Commissars, sanitary-transit points were organized on 7 railway stations of the city of Moscow with powerful transit bathhouses specially built for them (with a capacity from 3,000 to 8,000 people per day), special disinfection chambers heated by hot flue gases from locomotives, reception rooms, waiting rooms, tea rooms, dining rooms and isolation departments for temporary stay of contagious patients removed from trains. Regarding the equipment of railway station sanitary points, one can judge by the accompanying drawing (see pp. 213-214). All I.-p. p., according to the power of their equipment, were divided into 5 types (see table on pp. 217-218). Since the development of epidemics and the movement of different groups of population increased in 1921, the number of I.-p. p. increased this year. There was a gradual gathering of I.-p. points of various departments into sections of I.-p. p. of the Department of Communications of the People's Commissariat of Health, and due to the transfer to this section of I.-p. p. of the military-sanitary department and the aforementioned sanitary-transit points of the city of Moscow, the number of all I.-p. p. in this one section reached 186. A large amount of work fell to their share in servicing all demobilized from the army, in isolating cholera patients, as well as in servicing the starving and resettlers on all paths of communication. One can judge the scale of the work of I.-p. p. at this time from the fact that in 1921 in 574 days of work of I.-p. p. on 7 sanitary-transit points of the city

In Moscow, 411,547 people (including 211,468 Red Army soldiers and 28,423 isolation houses) underwent complete sanitary processing. The size and equipment of I.-t.p. institutions. Types of I.-t.p. Bath with a throughput capacity of Laundry with a throughput capacity of Disinfection chamber per day per day Fourth type 25-50 beds 200-100 people 80-160 kg of bedding Heating or Third type 50-100 400-600 160-240 sulfur Heating or Second type 100-150 600-800 240-320 sulfur Formaldehyde vapor First type 150-200 Transit point for 500-1,000 people with a barber shop 400-800 kg of bedding Steam or formaldehyde vapor Lettered I.-t.p. 200-300 Transit point for 5,000-7,000 people 1,600-2,000 kg of bedding Steam or formaldehyde vapor with a barber shop for prisoners and refugees), and on other I.-t.p. in 9 months, 14,523 Red Army echelons, 24,098 passenger trains, and 977 steamships were inspected; in addition to Red Army soldiers, 85,928 refugees and prisoners of war, 86,626 workers and resettlers, and 4,282 railway and water transport workers passed through I.-t.p. From the million-strong moving mass, 607,960 Red Army soldiers and passengers were washed in baths at I.-t.p., and 23,220 Red Army soldiers and 18,922 passengers were identified as sick, while 10,330 Red Army soldiers and 12,188 passengers were suspected of having infections. At I.-t.p., in 9 months of 1921, 360,193 outpatients, 45,906 infectious inpatients, and 40,362 other inpatients were admitted, who spent a total of 371,308 hospital days; in addition, over 320,000 kg of bedding was washed and over 160,000 kg of clothing and bedding and 36,503 railway cars were disinfected. In 1921, the management of I.-t.p. on all communication routes was centralized in a special I.-t.p. subsection, which was part of the Department of Communication Routes of the People's Commissariat of Health. In 1922, I.-t.p. played a major role in the fight against epidemics among hungry refugees, and starting from 1923, with the end of the civil war and the spontaneous movement of masses of people and the sharp decline in epidemics throughout the country, the number of I.-t.p. began to decrease sharply; from 1924, the organization of an independent I.-t.p. subsection in the center and corresponding sections in the localities also disappeared. From that time until the present (1929), there are 22 I.-t.p. on railway routes in Vyazma, Smolensk, Syzran, Tula, Voronezh, Liski, Samara, Saratov, Chelyabinsk, Krasnoyarsk, Vladivostok, and other border and internal stations of railways along the main routes for the formation and movement of resettlers to Siberia and the Far East and workers to the regions beyond the Volga and to Central Asia, and in addition, a small number of auxiliary detachments at intermediate stations in places of long-term stops of resettler masses and in the locations of People's Commissariat of Agriculture resettler points. -Thus, arising at the beginning of the imperialist war as temporary scattered auxiliary institutions for medical-sanitary service of military masses, the wounded, and prisoners of war, I.-t.p. during the civil war with its massive epidemics and colossal movements of military and civilian populations reached their maximum development and developed into a centralized network of I.-t.p. with centralized autonomous management. With the end of the civil war and the transition to peaceful construction, they turned into a permanent auxiliary part of the sanitary-epidemiological organization on communication routes, which, together with other parts of the medical-sanitary apparatus, serves the moving organized groups of the population and thereby protects both them and the entire country from the spread of infectious diseases.