Naval Sanitary Affairs

Naval Sanitary Affairs in the Soviet Navy encompasses the healthcare system in naval forces and the practical implementation of measures aimed at improving the sanitary condition of ships and protecting the health of naval personnel. The history and organization of Naval Sanitary Affairs. The first Russian warship was built in 1670, but the systematic development of Russian warship construction began a quarter century later. The sanitary service was poorly developed during the first hundred years and was subordinate to the medical chancellery, later the medical college. In 1802, the Ministry of Naval Forces was established, which was renamed in 1815 as the Ministry of the Navy. The latter included the medical department of the naval administration, whose director headed the naval sanitary service. In 1861, the medical department was reorganized into the administration of the medical service of the fleet, headed by the fleet staff doctor, and from 1886 by the chief medical inspector of the fleet; in 1911, the administration and the position of head of the sanitary service of the fleet were renamed: administration of the sanitary service of the fleet and chief sanitary inspector of the fleet. In 1858-1859, scientific societies of naval physicians arose in naval ports, which greatly contributed to the development of issues of naval hygiene, and in 1861 the journal "Medical Supplements to the Naval Collection" was founded, renamed in 1911 to the journal "Naval Doctor," the publication of which ceased in 1919. Physicians entering service in the navy did not undergo any preparatory course, but became familiar with the specifics of naval service in practice under the guidance of senior ship physicians and by participating in the work of the aforementioned scientific societies and reading specialized literature. For the training of middle medical personnel, there were schools of naval paramedics in Kronstadt and Nikolaev; the training of junior sanitary personnel was conducted at naval hospitals. Naval hospitals, the first of which was the St. Petersburg hospital, founded in the early 18th century, were established in all significant naval ports. In some foreign port cities, in France (in the city of Villefranche), and later in Greece (in the city of Piraeus) and Japan (in the city of Nagasaki), naval infirmaries were established to provide hospitalized ship's crews with more familiar conditions ashore. In 1914, a sanatorium for military sailors suffering from tuberculosis was opened near the city of Yalta. On large ships of the Russian fleet, earlier than in other fleets, separate premises were already allocated during construction, specifically designated for setting up a first aid dressing station and appropriately equipped. The design scheme for such a station, developed by naval physician R. I. Glovetsky, and a number of devices invented by him for equipping such a station are still used on warships. During wartime, floating naval hospitals-hospital ships-were organized. After the October Revolution, the administration of the sanitary service of the fleet became part of the People's Commissariat of Health of the RSFSR (1920), in 1922 it was reorganized into the naval sanitary department of the Main Military Sanitary Administration; since 1924, there has been no special body for managing the sanitary service of the Soviet Navy, and it is carried out in the general order by the Military Sanitary Administration of the Workers' and Peasants' Red Army, which since 1929 has been part of the People's Commissariat for Military Affairs. Locally, in individual fleets, the naval sanitary service is headed by the chiefs of the military sanitary administrations of the naval forces of the given sea. The chiefs of the military sanitary administrations of naval forces of the seas, in the general order of service and operationally, are directly subordinate to the revolutionary military council of the naval forces of the given sea, and in the area of special service-to the chief of the military sanitary administration of the Workers' and Peasants' Red Army. They manage the healthcare service of the given fleet and resolve all issues of military sanitary affairs arising on ships and in shore units. The sanitary service on ships of each fleet is under the general guidance and supervision of the fleet physician of the headquarters of the naval forces of the sea. Fleet physicians monitor the sanitary condition of ships and their crews, ensure that ships are staffed with everything necessary in the medical-sanitary part, and that the sanitary service personnel are fully prepared to perform their duties in peacetime and wartime; they check the correctness of the organization and implementation of the military sanitary service on ships and maintain the established reporting. The healthcare service on ship formations is managed by fleet physicians of the headquarters of the given formation; on individual ships, there are senior and junior ship physicians. The senior ship physician is the assistant to the commander of the ship in everything related to the military sanitary service and is responsible for the sanitary well-being of the ship, which is achieved 1) by the extensive development of preventive measures against diseases, carried out by promoting sanitary knowledge and developing hygiene skills among all ship personnel, by observing hygiene and sanitation rules by all Red Fleet sailors, strengthening their physical development and health through appropriate sanitary-hygienic measures towards the personnel and the ship itself; 2) by timely and proper medical care for the sick and wounded. The senior ship physician is subordinate to junior ship physicians, pharmacy assistants, sanitary sergeants and orderlies, as well as combat medics and stretcher-bearers appointed during wartime. In their activities, senior ship physicians are guided by the "Rules of Healthcare Service on Ships of the Soviet Navy" (Appendix III to the Regulations of Ship Service of the Soviet Navy) and the relevant articles of the Regulations of Ship Service of the Soviet Navy. The Rules of Healthcare Service on Ships contain instructions 1) on the procedure for implementing measures to protect health and ensure sanitary well-being of the personnel; 2) on the procedure for providing medical care to the sick and wounded; 3) on the training of medical and sanitary personnel; 4) on the provision of the healthcare service with special property; 5) on the maintenance of military sanitary reporting and statistics; 6) on combat sanitary service. The work of the ship physician specified in paragraph 1 specifically consists in careful observation of the health condition of all persons of the ship service, thorough examination of all newly arriving or returning from leave, business trip or from a medical institution, monitoring the correct application of physical education methods, frequent checking of the health condition of persons involved in food preparation, as well as persons with weakened health, and the application of necessary preventive measures-in the administration of preventive vaccinations, in taking preventive measures against venereal diseases, disinfection and deratization, etc.; the physician is also responsible for careful control of food products arriving on the ship and stored on it, for the preparation and distribution of food, for maintaining cleanliness of all ship premises, especially galleys (kitchens) and bakeries; monitoring the reception and storage of drinking water, the condition, cleaning and disinfection of drinking water tanks, the chlorination of drinking water, the proper condition of air in living quarters, its temperature, humidity and proper ventilation, the proper lighting of living and working quarters, the observance of personal cleanliness by Red Fleet sailors, the correspondence of their clothing to the season and weather, the taking of measures to ensure safety in labor during various work, the proper disposal of waste and proper maintenance of toilets (closets), garbage chutes and cleaning items; in addition, the physician should strive to implement all necessary measures to improve the sanitary condition of the ship both during stays in ports of the USSR and during voyages and when entering foreign ports. The supply of ships in the medical part is carried out according to special schedules and catalogs that provide for the special conditions of shipboard life and voyages. On large ships, the provision of ship infirmaries, pharmacies, medical aid stations, dental offices, laboratories for chemical-bacteriological and sanitary-hygienic analyses, X-ray rooms and disinfection chambers is provided. For the ship infirmary, a space on the middle deck is allocated, ventilated and having natural lighting (side portholes). On battleships, there are two infirmaries-one on each side. The number of infirmary beds usually corresponds to two percent of the ship's crew. Beds-iron with wire mesh-are arranged in two tiers; the infirmary has a dining table, stools, bedside cabinets, a cupboard for tableware and linen; next to the infirmary there are compartments for a bath and a toilet. In addition to the general infirmary, on the largest ships there is an isolation infirmary for 1-2 beds with a bath and toilet. For steam-formaldehyde disinfection of this infirmary and its equipment, a nozzle is installed in the bulkhead, to which a steam pipe and a hose from a bottle with formaldehyde are connected. On small displacement ships, a separate room for the infirmary is usually not allocated, but only a bed allocated in the command compartment and a cupboard for medical property next to it.

In the ship's sickbay are placed patients requiring short-term treatment, and during voyages also those requiring hospital treatment, who are sent there after the ship returns to port. For storing medicines and other medical supplies, a cabin on the ship is designated as the ship's dispensary; its usual equipment is a medicine cabinet, table, sink with hot and cold water piped in, and a small cabinet for medical supplies. In the upper part of the medicine cabinet are shelves with holders for bottles, and in the lower part are drawers for dressing material and other medical supplies. On large ships there is correspondingly equipped medical aid station, intended for providing medical aid to the wounded in battle (main dressing station). During battle, 1-2 additional stations are set up. In peacetime, the medical aid station, according to its equipment, is used for surgical treatment of outpatient and sickbay patients. The medical aid station is arranged in a protected and accessible part of the ship; it is equipped with artificial ventilation and strong lighting; its equipment is a washbasin with hot and cold water piped in, an operating table, cabinets for surgical instruments and dressing material, a steam sterilizer for dressing material, and a steam-electric sterilizer for instruments. For providing first aid to the wounded in battle in isolated compartments of the ship, special boxes with ready-made wound and burn dressings, splints, tourniquets, and other items are installed there (first aid posts). In compartments of the ship with a small number of people, the boxes are replaced by first aid bags. The coastal parts of the fleet, coastal defense units, naval educational institutions, etc., in terms of the organization of health service, differ little from other land military units (see Military Sanitary Affairs). The naval sanitary service is staffed on the same general basis as the entire sanitary service of the Workers' and Peasants' Red Army. Doctors called up for compulsory military service on preferential terms, while serving in the naval forces, acquire through self-study and under the guidance of their sanitary commanders the theoretical and practical knowledge necessary for independent work in their specialty on ships and in coastal units of the fleet, and in the summer they undergo practical sea voyages. Doctors attached from the naval forces to the Military Medical Academy for advanced training take a short additional course in naval hygiene and naval sanitary tactics. Sanitary sergeants, corresponding to sanitary instructors of the land forces, are trained by teaching in naval hospitals according to a special program for 10 months from the most suitable orderlies who have completed the first year of compulsory military service in naval units. Red Fleet orderlies-sanitarians are trained according to the general program for orderlies of the Red Army for 4 months; those intended for ship service undergo additional practical training on ships during voyages. All personnel of the Red Fleet receive basic information on hygiene and sanitation: the commanding staff during training in naval educational institutions, and the rank and file throughout the entire period of compulsory military service according to special programs in the form of school classes, as well as in the form of extracurricular sanitary-educational work. Naval sanitary service in foreign fleets. In imperialist states possessing military fleets, the sanitary service in the fleet is managed by corresponding departments or bureaus that are part of the naval ministry, and in those states where there is no separate naval ministry, it is part of the naval department of the war ministry. Thus, in the English fleet there is a sanitary department (one of nine), headed by the chief sanitary officer of the fleet (Surgeon general) and subordinate to the Second Sea Lord. In 1928, there were 387 doctors and 56 dentists in the English fleet. Doctors of the English fleet receive special additional training, and when promoted in service, they undergo corresponding examinations. The junior sanitary staff is recruited from those entering the fleet with an obligation to remain in service for 12 years; the age of recruits ranges from 18 to 25 and even up to 30 years. Those intended for sanitary service undergo an initial training course at naval hospitals; successful examination gives the title of sanitary attendant. Promotion to the rank of senior sanitary attendant requires 3-6 years of service and passing an examination on a somewhat expanded program (elementary anatomy, care for patients and the wounded, reporting, etc.). Promotion to the rank of junior non-commissioned officer requires three years of practical experience in the position of senior sanitary attendant. With excellent knowledge of his craft, a junior sanitary non-commissioned officer is promoted after 3-6 years of service in this rank to senior sanitary non-commissioned officers. The sanitary department publishes a journal: "Journal of the Royal Naval Medical Service" (4 issues per year). In the North American fleet, within the naval department (ministry), there is a sanitary bureau (Bureau of Medicine and Surgery), headed by a Surgeon general, appointed for 4 years by the president with the consent of the Senate from among naval doctors. The bureau consists of departments: a) inspection, b) hospitals, c) personnel, d) instruction and publication, e) physical training and medical reporting, f) preventive medicine, g) financial. For additional training of doctors and for training dentists (of whom there were 180 in the fleet in 1928 according to establishment), pharmacists, nurses, and orderlies, special naval schools have been established. There are a number of naval hospitals. At naval stations, medical departments have been established. The journal "United States Naval Medical Bulletin" is published (4 issues per year). In France, in the naval ministry, there is a central sanitary administration (Direction centrale du service de sante), headed by a directeur central; in addition, there is also directly subordinate to the naval minister an inspecteur general du service de sante de la Marine, who is the chairman of the higher health council of the fleet. In naval districts, sanitary service administrations of the district are formed; the head of the administration presides over the health council and the bureau of naval hygiene of the district. In 1922, the total number of naval doctors in France was 323. The sanitary administration publishes the journal "Archives de medecine et pharmacie navales" (4 issues per year). In Italy, within the naval ministry, there is one sanitary department out of 4 inspectorates, headed by a "direttore della sanita militare maritima." The journal "Annali di medicina navale e coloniale" is published (6 issues per year). In Germany, the health service of the fleet is managed by the sanitary department of the naval administration, which together with the troop administration forms part of the Ministry of Defense. In Poland, the sanitary administration of the fleet is part of the naval department of the war ministry. In the fleets of some states, for example, the English and North American, there are hospital ships for serving squadrons on long voyages. In wartime, the number of hospital ships can be significantly increased. The Second International Convention on Naval Warfare, concluded in The Hague in 1907, defines the conditions ensuring the safety of hospital ships from military actions and their neutrality. This convention has been recognized by the Council of People's Commissars of the USSR as having force for the USSR. In peacetime conditions, the protection of seaports from the importation of infectious diseases by ships arriving from ports unfavorable with respect to these diseases is of great importance. This applies primarily and mainly to merchant ships, which carry passengers and various cargoes and which are not always provided with qualified sanitary service personnel. Instructions on corresponding measures are set forth in the "Temporary Regulations on the Sanitary Protection of the Sea Borders of the USSR" (Collection of Laws and Decrees of the Workers' and Peasants' Government of the Union of Soviet Socialist Republics, No. 69, 1926; see also No. 4, 1928). Morbidity in the fleet. Due to the significant improvement of hygienic conditions on ships, the morbidity of the ship's personnel has decreased, especially with respect to nutritional and infectious diseases. The great overcrowding on warships, the abundance of bulky and heavy machinery, narrow winding passages, steep ladders, and the minimal use of wood for covering metal parts and for making furnishings lead to a significant number of injuries "from external causes." In most cases, these are minor injuries, but among outpatient diseases, they occupy first place, accounting for up to 20% of all visits for outpatient medical care. The morbidity of diseases requiring hospitalization varies in different fleets in terms of the number of diseases per 1,000 personnel per year, but is similar in the relative importance of individual groups of diseases. Among them, colds and gastrointestinal diseases occupy a prominent place. The predominant cause of the former is the sharp temperature difference between the internal ship compartments and the outside air in cold weather.

The filling of a ship with propulsion mechanisms (steam boilers, turbines) and auxiliary steam mechanisms, to which a powerful steam pipeline is laid throughout the ship, causes high air temperature not only in the ship's compartments where these mechanisms are located, but also in adjacent service and living quarters. Coming out of such hot compartments onto the deck or upper deck exposes one to the effect of piercing cold air; therefore, muscular rheumatism and diseases of the upper respiratory tract are the predominant illnesses of ship specialists serving in the main and auxiliary machinery compartments. Stokers are particularly affected by cold-related illnesses, being subjected to the combined effect of radiant heat and the vortex of cold air supplied by ventilators to the boiler furnaces. Cold-related illnesses of the crew serving the upper deck of the ship and its superstructures are caused by maritime meteorological conditions (piercing wind, rain, spray of seawater). In connection with these causal factors, the fight against cold-related illnesses is carried out in the direction of 1) possible reduction of the high air temperature in the ship's internal compartments by means of artificial ventilation and 2) correspondence of clothing to service conditions. Sanitary control over ship ventilation and supervision of the correspondence of clothing lie within the duties of the ship's doctor. Mass gastrointestinal diseases, mostly of a dyspeptic nature, are common on ships in summer and when sailing in southern latitudes; the cause is excessive drinking of water, the presence of salts of seawater in drinking water when desalination plants are malfunctioning or not working properly, accidental contamination of water in drinking water tanks, microbial contamination of food, most often salads and other cold dishes. Thorough sanitary observation of drinking water and the drinking regimen of the crew, sanitary control over food preparation fully guarantee the prevention of mass gastrointestinal diseases. In all naval fleets, venereal diseases (including syphilis) occur significantly more often than in the corresponding land forces. The greatest incidence of these diseases in recent years has been in the North American fleet. Thus, in 1928, with a strength of 116,047 personnel in the US fleet, there were 14,403 venereal diseases, which amounts to 124.01 per mille, of which 71.98 were gonorrhea, 29.44 were chancroid, and 22.59 were syphilis. These figures have remained stable over several years. At the same time, in the Soviet Navy, there is a steady tendency to decrease venereal diseases. If in 1907 there were 179 diseases per mille, then in 1923 there were 95, and in 1927 there were 85. The constant improvement of offensive and defensive means of the ship, the increase in the number and caliber of guns, and consequently the capacity of ammunition magazines, the increase in power of the propulsion mechanisms, and along with them the fuel reserves, are at the expense of the living comforts of the ship's personnel: the volume of living and service compartments is reduced to a minimum, the air temperature rises to the limit, and for living quarters it is necessary to find space in the deep parts of the ship, devoid of natural light and natural ventilation. The technique of improving the combat qualities of the ship must be accompanied by the technique of protecting the living force. Therefore, when building ships, very serious hygienic requirements are imposed regarding the equipment of artificial ventilation, heating, water supply, etc. For details, see Ship Hygiene. From this it is clear what importance preventive sanitary-technical supervision has for the fleet during the construction of ships. Since 1930, this has been ensured by the inclusion in the composition of the scientific-technical committee of the Military Sanitary Administration of the Red Army of a naval doctor of appropriate qualifications, who at the same time acts as a representative of the Military Sanitary Administration (MSA) of the Red Army both in the scientific-technical committee of the naval forces administration and in the commissions for supervising the construction of ships and for their acceptance. At present, the list of ship devices and systems has been specified, the consideration and approval of whose designs, implementation during construction, and test trials must be carried out with the mandatory participation of a representative of the MSA of the Red Army. Through systematic measures and the general improvement of ship conditions, a number of diseases that formerly were a scourge of all fleets have completely lost their significance for the ship's personnel. Thus, scurvy is now generally not encountered on warships, whereas in the middle of the 19th century, during a voyage, 229 people out of a ship's crew of 450 (the Spanish frigate 'La Blanca') were observed to have scurvy, and the mortality among scurvy patients was 19%. Typhoid fever, which still caused great damage to ship crews at the beginning of the 20th century, now occurs only as isolated cases. In 1912, compulsory anti-typhoid vaccinations were introduced in the US fleet, as a result of which the number of cases was reduced to isolated cases. In the Red Fleet, compulsory anti-typhoid vaccinations were introduced in 1922; the results of this measure proved to be quite favorable.

Figure 1. Stretcher type Stille.

Combat Sanitary Service. During wartime, the naval sanitary service must use all available means and methods to assist the naval forces in fulfilling their mission. In particular, during a naval battle on ships, 'the first concern of the medical personnel... should be the possible rapid return to their combat stations of those wounded who are able to continue service' ('Rules of Health Service on Ships of the Soviet Navy', Art. 139). The organization and preparation of the sanitary service in peacetime must provide for this duty, as well as providing medical assistance to all wounded, burned, and victims of chemical warfare agents who need it. On ships, the basic rule is the placement of medical personnel in the safest and at the same time most accessible places where pre-arranged or temporary medical aid posts are set up in advance. Stocks of dressing materials, medicines, and surgical instruments must be distributed in several places on the ship to avoid their destruction by a single hit from an artillery shell or an explosion. Due to the specific conditions of the ship, it is necessary that all ship personnel be trained in applying primary dressings, as well as in methods of stopping bleeding, and in armored turrets, near other artillery guns, in hard-to-reach parts of the ship, etc., there should be some stocks of dressing materials (first aid posts). The wounded arrive at medical aid posts mainly during breaks in the battle and after its completion, but some of the injured arrive during the battle. Naval battles, occurring between ships usually

Figure 2. Vertical lifting of a wounded person on a ship.

at considerable distances from each other, differ in terms of losses in personnel from battles occurring on land, where bullet wounds, which are generally absent on ships, play a major role. The total loss for the fleet during wartime is taken as 20% of the personnel. On individual ships that survived after a battle, the number of losses can reach 40 percent or more, but losses among the wounded are taken on average as equal to 15-16% of the personnel. Naval battles in general are not prolonged, so the wounded appear in large numbers within sometimes a very short time, for example, in the first half hour of battle. The largest number of losses occurs from drowning. In the largest naval battle, Jutland (in 1916), the British lost 6,014 men killed and drowned, of whom 5,553 drowned (some of the drowned were wounded or killed on sunk warships); the number of wounded established was 534 people, including 370 wounded by shell fragments and 160 burned. In the German fleet, 2,545 men were killed (or drowned)

Fig. 3. Transportation of the wounded on a ship. During the Russo-Japanese war, out of 494 wounded persons. If we exclude the sunken ships, the total number of killed was to the total number of wounded as 10 to 9. The heavily and lightly wounded are distributed approximately equally. The wounds are characterized by their extent and multiplicity; as a rule, they bleed slightly. Although chemical weapons were not used in naval warfare, cases of poisoning by nitrogen oxides and carbon monoxide, which develop during the combustion of explosives, were observed. During a battle, only initial assistance can be provided, stopping bleeding and performing only urgent surgical operations, calming pain and taking other measures against shock. After the battle, it is necessary to evacuate the wounded to a hospital ship or to a shore hospital at the first opportunity, and if this is not possible, to treat the wounded until the earliest opportunity to remove them from the ship. The organization of such treatment on a ship damaged in battle is greatly complicated by the lack of suitable premises, necessary materials, and insufficient medical personnel. For transporting the wounded on the ship and for extracting them from deep and generally inaccessible parts of the ship, special types of stretchers are used, which vary in different fleets; none of the existing types of stretchers fully satisfies the needs on different ships, and often a large ship simultaneously has stretchers of two or three (in the French fleet) types. In the Soviet Navy, Stille-type stretchers are used (Figs. 1-3), in the English fleet - Neil-Robertson, in the North American fleet - Stokes, in the French fleet - Offre and Geseneck, in the Japanese fleet - Totsuka. Maritime sanitary service for merchant marine shipping - see Waterways, Medical supervision, Medical supervision stations and posts, Quarantine, Conventions, Pilgrims, Port, Ship hygiene.