Medical Instruments and Equipment

MEDICAL INSTRUMENTS AND EQUIPMENT. Medical instruments and equipment include all kinds of devices used in medical practice. From a manufacturing standpoint, the following groups are distinguished: 1) metallic surgical instruments, including syringes; 2) surgical and general medical instruments with rubber parts; 3) laboratory devices; 4) utensils and patient care items (glass, porcelain, earthenware, enameled tin); 5) medical thermometers; 6) rubber devices; 7) equipment, operating room furniture, and sterilization apparatus; 8) disinfection devices and apparatus; 9) mechanotherapy equipment; 10) electromedical apparatus; 11) X-ray apparatus, tubes, and accessories; 12) dental instruments and devices; 13) spectacle optics. The USSR's demand for medical instruments and equipment (at contemporary wholesale prices) was: in 1913—12 million rubles, in 1926/27—16 million rubles, in 1929/30—27.5 million rubles, in 1933—approx. 60 million rubles. Before the October Revolution, medical instruments and equipment were imported into Russia almost entirely from abroad. The Military Medical Procurement Plant in Petersburg produced medical instruments for a total sum of only 187,000 rubles (1913). A significant portion of the instruments was received by this plant from abroad, and it merely stamped its own trademark on them. Among other enterprises producing medical devices in Russia before 1914, Schwabe's factories (operating room furniture and autoclaves) and Tryndin's in Moscow (laboratory devices, part of which went to medical laboratories) deserve mention, as well as the electromedical device workshop organized in Leningrad by the German firm Reiniger. In addition to these enterprises, which numbered a total of no more than 250–300 workers, there were only semi-craft-scale workshops engaged in instrument repair. Patient care items made of rubber, glass, and earthenware were manufactured by enterprises of the respective industrial sectors—the Triangle plant (Petersburg), Provodnik (Riga), the Maltsev plants, and others. There are no exact data on the volume of imports of medical devices and equipment into Russia, because customs statistics did not account for them separately. In the period 1910–14, medical instruments and equipment were imported for approximately up to 6 million rubles, of which dental materials and equipment accounted for 2.5 million rubles per year. Up to 80% of imported medical instruments were brought in from Germany. On the initiative of the Army Sanitary Administration and the All-Russian Zemstvo Union in 1915, the production of surgical instruments with mass application in field surgery was established in the metalworking industry regions—in Nizhny Novgorod Governorate (Pavlovo, Vorsma)—both in small factories that previously manufactured cutlery and by the efforts of handicraft artels and individual artisans. In 1916, the output of surgical instruments in Russia amounted to up to 1 million pieces of various instruments worth 700,000 rubles. For the production of disinfection devices and operating room furniture, the Presnya Sanitary Engineering Plant in Moscow was organized by the Main Committee of the All-Russian Zemstvo Union. The value of medical device and equipment stocks nationalized after the revolution amounted to about 5 million rubles at pre-war prices. Replenishment of medical instruments occurred partly at the expense of these stocks and partly through the surviving production of artisans in the Pavlovo region. Medical institutions were supplied with instruments from these stocks through apportionment. In 1923, production was restored at the Plant for Medical Procurement; following this, the production of surgical instruments resumed at the factories of the Pavlovo region, united under the Pavlovo Regional Metal Industry Management (Prump). The former Schwabe plant, which became part of the newly organized Precision Mechanics Trust, resumed the production of operating room furniture and autoclaves. The growth of medical instrument production in the USSR and the decrease in imports are illustrated by the following table: Years | Domestic production | Import | Total consumption (thousand rubles at internal wholesale prices) | Percentage domestic / import. Among the most important items whose production has been established in the USSR, one can note: general surgical instruments (all), eye, ear, nose and throat, and obstetrical-gynecological (majority), medical thermometers, Record syringes and needles for them, urethroscopes, dental chairs, dental engines, extraction forceps, electric thermostats and centrifuges, spectacle lenses, electromedical devices (light baths, diathermy and d'arsonvalization apparatus, switchboards and universal apparatus replacing them, etc.), X-ray apparatus, tubes and other accessories, quartz lamps. Supply of medical instruments occurred until 1930 centrally through the joint-stock company Gosmedtorgprom (see), and locally through local pharmacy administrations. From February 1, 1930, in connection with the reorganization of the industrial management system, the supply of all types of medical and laboratory instruments and devices was consolidated in the trust Goslaborsnabzheniye, and from the end of 1931 it passed under the jurisdiction of the Russian Pharmaceutical Association (RAPO). Goslaborsnabzheniye, reorganized into the All-Union Trust of Precision Industry (VOTI), retained only production functions regarding precision devices. In terms of medical instruments, one of the VOTI plants retained only the production of thermometers, syringes, and electromedical devices, realized in the general order through RAPO. The state and prospects of domestic production for individual most important types of medical devices and equipment are as follows. 1. Surgical instruments. Main manufacturing enterprises: a) the Krasnogvardeyets plant in Leningrad and the Lenin and Gorky plants in Pavlovo and Vorsma, which are part of the "Medical Instruments" trust; b) industrial cooperative associations, of which the largest is the "Krasny Oktyabr" artel in Vorsma, Gorky Krai. Of general surgical instruments, domestic production in the USSR manufactures 167 items out of 233 adopted by the Standardization Commission under the People's Commissariat of Health, such as: scissors, curettes, scalpels, saws, chisels, tweezers, clamps, sponge forceps, curettes, forceps, trocars, hooks, probes, scraping spoons, metal spatulas, etc. Less developed in the USSR is the production of specialized instruments for ear, throat and nose, gynecology, urology, and ophthalmology. Injection syringes and syringe needles are produced at the Krasnogvardeyets plant. In 1930, the production of surgical needles was started at the plant of the Gosshveymashina trust. In value, domestic production of surgical instruments in 1932 exceeded 1916 production by 13.5 times (9.5 million rubles against 700 thousand rubles). 2. Medical thermometers until 1928 were imported exclusively from abroad. Domestic production was hindered by the lack of established production of thermometric glass in the USSR and the lack of skilled craftsmen. Production, started in 1927 at the Rukhimovich factory in Moscow on the scale of a small workshop with two dozen workers, expanded and grew into an independent factory. 3. General medical devices (for percussion, auscultation, examination of the oral cavity and stomach, infusion, vaccination, and transfusion). Domestic production of these items is currently concentrated in workshops that are part of industrial cooperation. In this group, the gap between demand and production is insignificant, and imports have been reduced to zero. 4. Patient care items, operating room furniture, and sterilization apparatus. This group includes items supplied by the rubber industry, silicate industry (glass, porcelain, earthenware), metallurgical industry (enameled mugs, metal hot water bottles, operating room furniture, autoclaves, sterilizers), leather industry (bandages). Demand for items of this group in 1933 was about 18 million rubles and was 99% satisfied by domestic production. Foreign imports are limited to rubber stockings, "Ideal" bandages, certain orthopedic accessories, hearing aids, and novelties in the field of hospital technology. 5. Spectacle lenses. Domestic production is concentrated in 3 enterprises: Optical Plant No. 19, the plant of the Optical-Mechanical Association in Leningrad, and the spectacle factory in Vitebsk. In 1932, all these enterprises expanded the production of spectacle optics to a scale that fully covers the demand of the USSR. 6. Disinfection devices and apparatus. Disinfection chambers, Flugge, Zarevich, Zauisaylov apparatus, and hydropumps are produced at a number of state plants and industrial cooperative enterprises. Disinfection chambers of the Sachs, Krupitsa, "Universal", paraformalin, and other types are manufactured at the following plants: Penza Mechanical, Rudzutak in Moscow, in Zhukovka (Western Oblast), and in Gorlovka (Ukrainian SSR). Demand for them is fully met by domestic production; imports of disinfection equipment have been halted since 1925. 7. Laboratory devices. Devices and apparatus used for medical-diagnostic and sanitary-bacteriological research number over two thousand items.

Their production is dispersed among a number of plants of the factory, semi-factory, and kustar type, the most important of which are under the jurisdiction of Soyuzlabreaktiv. Achievements of recent years include the production of analytical balances, electric thermostats and centrifuges, colorimeters, microscopes with a magnification of 600x, and potentiometers. The production of complex optical instruments in the USSR is still absent (microscopes with a magnification of 1,000x and higher, polarimeters, refractometers, blood cell counting chambers, as well as microtomes and precise measuring instruments for physiological, psychotechnical, and similar studies). The sale of laboratory instruments is carried out through the All-Union Association Soyuzlabreaktiv. 8. X-ray apparatus, electromedical and other physiatric devices. For these groups, the demand for 1933 amounted to about 25 million rubles. Their production is dispersed in the following enterprises: a) 2 plants of VESO: Burevestnik (Leningrad) and the X-Ray Plant (Moscow); b) the factory of medical instruments in Moscow of VOTI; c) the Svetlana plant of VESO in Leningrad (X-ray tubes); d) the workshops of the State Traumatological Institute of the People's Commissariat of Health of the RSFSR in Leningrad (devices for mechanotherapy); the Electrokombinat in Moscow (quartz burners), and e) Metkopromsoyuz (hydrotherapy clinics). Among the domestically produced instruments of this group, one can note X-ray apparatus and stands for diagnostic and therapeutic purposes (in 1932, the production of apparatus was carried out — about 1,000 units were manufactured, which fully covered the demand for them); X-ray tubes of all types (except for especially powerful ones), quartz lamps (Bach, Kromayer, and Jesionek types), Sollux and Spectrosol lamps, light baths, devices for d'Arsonvalization, distribution boards, devices for endoscopy and caustics, diathermy devices, pendulum apparatus for mechanotherapy according to the Michaud-Caro system, hydrotherapy clinics (consoles, showers, etc.). 9. Dental equipment. The production of dental engines and all small instruments, including burs, has been established in the USSR. Regarding artificial teeth (which can only conditionally be classified as medical instruments and equipment), factory production was deployed after successful experiments at the Lomonosov Porcelain Factory (Leningrad). The production of teeth made of stainless metal at the Mosshtamp plants (Moscow) and Stalkan (Sverdlovsk) has received great development in recent years. See also Dental prostheses, artificial teeth. The highest percentage increase in demand occurred during the first five-year plan in the following types of medical devices: 1) disinfection equipment; at the same time, the fulfillment of the government decree on the sanitary service of the population, which establishes the norms for disinfection installations, was taken into account; 2) regarding X-ray and electromedical apparatus, which is associated with the expansion of X-ray assistance and physical methods of treatment; 3) regarding laboratory property, taking into account the upcoming significant expansion of both the network of special sanitary-bacteriological laboratories and the increase in the use of laboratory research in routine hospital and outpatient practice. On average, the growth in consumption for all types of medical instruments and devices amounted to 150% in 1933 compared to 1928/29. In monetary terms, the consumption at constant prices (as of October 1, 1927) of medical devices and equipment throughout the USSR for the first five-year plan amounted to a sum of 190 million rubles (rounded), of which the share of imports (at the same prices) accounted for no more than 9 million rubles (4.6%); the rest was provided by domestic production, which by the end of the five-year plan compared to the pre-war period amounted to 15 : 1. Standardization. The multi-thousand nomenclature (over 18,000 items according to the 1912 catalog of the Schwabe firm) of medical instruments and equipment is not caused by actual necessity. Among this nomenclature, a great deal has lost its significance in medical practice; much is the result of the desire of individual firms to single out the instrument they manufacture with some detail, often completely insignificant from the point of view of actual expediency. In December 1926, a standardization commission was organized under the People's Commissariat of Health of the RSFSR. As a result of the commission's work, the following simplification of the nomenclature was achieved: Number of items according to the Schwabe 1912 catalog / According to lists approved by the commission / Received reductions (in %) for groups of instruments: General medical instruments: 2,069 / 169 / 92%. General surgical instruments and special furniture: 1,510 / 195 / 87%. Anthropometric: 117 / 42 / 64%. Odontological and stomatological: 2,155 / 345 / 84%. Obstetrical and gynecological: 914 / 612 / 33%. Otorhinolaryngological: 1,309 / 118 / 91%. Pharmacy inventory: 125 / 79 / 37%. Special surgical (laparotomy, bone operations, operations in the anal region, in the chest cavity and lungs): 345 / 80 / 77%. Care items: 2,069 / 248 / 88%. Total: 10,729 / 1,886 / 82%. In the future, in the field of standardization of medical instruments and equipment, the following tasks stand: a) the establishment of standard requirements for the material from which each instrument is made; b) the development of a standard for testing medical instruments and equipment; c) the improvement of existing and the creation of new types of instruments and devices based on the latest achievements of medicine and technology. On the basis of standard lists, the People's Commissariat of Health of the RSFSR approved in September 1931 exemplary catalogs and norms of instruments and equipment items for various types of medical institutions, for guidance in drawing up estimates and projects of hospital construction. These norms were published by Medgiz (1932). The most important current legislative acts and circulars of the People's Commissariat of Health of the RSFSR concerning the supply of medical devices and equipment: On the verification of medical thermometers, Decree of the All-Russian Central Executive Committee and the Council of People's Commissars of the RSFSR of April 20, 1923, Izvestia of the Central Executive Committee of the USSR and the All-Russian Central Executive Committee, no. 208, September 15, 1923; On the mandatory verification of thermometers, Circular of the People's Commissariat of Health no. 41, Bulletin of the People's Commissariat of Health, 1924, no. 4; On the enactment of the regulation on measures and weights, Decree of the Central Executive Committee and the Council of People's Commissars of the USSR of June 6, 1924, Izvestia of the Central Executive Committee of the USSR and the All-Russian Central Executive Committee, no. 130, June 10, 1924; On the procedure for ordering medical property from abroad, Circular of the People's Commissariat of Health no. 9, Bulletin of the People's Commissariat of Health, 1925, no. 2; Norms of equipment for sanitary-bacteriological laboratories, Circular of the People's Commissariat of Health no. 251/33, ibid., 1927, no. 21; Norms of laboratory equipment for hospital institutions, Circular no. 207/64, Voprosy zdravookhraneniya, 1928, no. 15; On the selection and dispensing of optical glasses for spectacles and pince-nez, Circular of the People's Commissariat of Health no. B-37/61, ibid., no. 23; Medical and sanitary-economic supply, norms and tables for peacetime for hospitals and outpatient clinics, approved by the People's Commissariat of Health on September 24, 1931, Medgiz, Moscow-Leningrad, 1932; On the replacement of thermometers with a scale different from the centigrade scale, Circular of the People's Commissariat of Health no. 240, Voprosy zdravookhraneniya, 1928, no. 17; On the supply of surgical instruments, Circular of the People's Commissariat of Health no. B-181, ibid., 1929, no. 21, supplement; Instructions for the care of surgical instruments made of stainless steel, Circular of the People's Commissariat of Health no. 2, ibid., 1929, no. 38, supplement; Exemplary annual depreciation norms for general surgical instruments and operating furniture, Circular of the People's Commissariat of Health no. 13, ibid., 1929, no. 40, supplement.