From Big Medical Encyclopedia

HOSPITAL FOR LIGHTLY WOUNDED (GLR; lat. hospitalis is hospitable, hospitable) — the field medical institution intended for rendering specialized medical aid and treatment lightly wounded and easily sick within field army. For the first time GLR were created in Red Army at the beginning of the Great Patriotic War.

Attempts to concentrate lightly wounded and sick for treatment within field army took place already in wars of the second half of 18 century. So, in 1769 during the Russian-Turkish war (1768 — 1774) in Kremenchuk the infirmary on 150 places for treatment of «all wounded and patients who according to the note doctor's give hope to fast recovery» was organized. Situation for temporary military hospitals at field army (1812) provided treatment «the most easily wounded» till a final outcome in mobile hospitals of the 1st line, and lightly wounded with terms of treatment to 40 days — in «osoblivy houses for recovering» at mobile hospitals of the 2nd line. In 1836 P, C. was developed by Chetyrkin the provision on «weak-willed teams» which were formed at the hospitals developed around fighting during the Crimean war (1853 — 1856), and during the Russian-Turkish war (1877 — 1878), in addition to «weak-willed teams» at hospitals, in Nikolaev and Sevastopol were created «sanitary the camp» for recovering on 1500 places everyone. «Weak-willed teams» independent, and also at hospitals and reserve battalions were created also during the Russian-Japanese war of 1904 — 1905.

In World War I in connection with exhaustion of mobilization resources of male population the problem of replenishment of armies due to return lightly wounded became especially acute. Therefore serious attempts to detain these contingents for treatment within armies and fronts were made. So, in June, 1916 the commander of the Southwest front A. And. Brusilov prohibited evacuation lightly wounded to the back of the country. Receivers in armies (more than on 22 thousand places) and in the front were open for their concentration (almost on 30 thousand places). In total by January, 1917 as a part of the Southwest front for lightly wounded there were 51 419 places. However these actions proceeding only from the aspiration to detain lightly wounded within field army for the subsequent bystreyshy return them in a system did not raise the questions of medical sorting, evacuation to destination, and also the organizations of specialized treatment of these contingents, and they as «lungs» were transferred, in essence, to care of paramedical staff.

In World War I due to the lack of the accurate organization of treatment lightly wounded among them there was very high disability and, as a result of it, mass dismissal from army. At the same time at timely specialized treatment they could recover the health in short terms and return to a system. Especially there are a lot of soldiers and officers left army in connection with wounds of a brush and fingers.

During the Soviet-Finnish conflict (1939 — 1940) there were attempts to treat lightly wounded in hospital base of army. For this purpose as a part of the army hospital collector of the 8th army developed ahead of hospital base one divisional hospital, and in hospital base (in Petrozavodsk) — evacuation hospital was allocated. Taking into account this experience and experience of the previous wars the Head military and sanitary department of Red Army in 1940 developed offers on introduction of the regular GLR intended for specialized treatment lightly wounded and easily sick. However it was succeeded to realize them only at the beginning of the Great Patriotic War. In August, 1941 on the Western front on the basis of field mobile hospitals and evacuation receiving stations the first were created «gospitali-camp» for lightly wounded on 1000 places everyone. Relying on experience of these institutions, in the subsequent were organized special hospital for treatment lightly wounded in which specialized complex treatment with use of surgical interventions, medicamentous methods was provided, to lay down. physical cultures, physical therapy and work therapy in combination with classes in combat and political training. Barracks accommodation of wounded (in dugouts, tents, villages) on plank beds, in own clothes, etc. was allowed at the same time.

In December, 1941 the state of GLR was approved, and in January, 1942 the order of the chief of the Head military and sanitary department of Red Army entered «The provision on GLR» and «Instructions on the organization of treatment lightly wounded and easily sick». During 1942 in armies were created army hospital of lightly wounded (AGLR), and in fronts — front (FGLR), instructions on medical sorting and evacuation to destination so-called lightly wounded in field public health service» in which character and localization of the wounds belonging to the category of lungs, conditions of an operational (tactical) situation under which the corresponding categories of lightly wounded it is necessary to treat in MSB, AGLR, FGLR, PPG taking into account the terms of treatment established for these field to lay down were defined are developed «. institutions, Thus, for the first year of the Great Patriotic War in Red Army the harmonious system of treatment lightly wounded was finally issued, a cut their treatment with terms of recovery to 5 days was provided in PMP, up to 10 days — in MSB, up to 30 days — in AGLR, up to 60 days — in FGLR. This situation extended also to patients.

Evacuation lightly wounded and sick was to destination carried out since MSB or HPPG of the 1st line (see. Evacuation medical ).

Wounded with gutter, through and nonperforating bullet and missile wounds of soft tissues without internal injury, bones, joints, sinews, nervous trunks and large vessels went to AGLR; with damages and the isolated fractures of trailer phalanxes of fingers, one of bones of a shank without the shift of fragments and without injury of sinews and nerves; with traumatic amputation of phalanxes III, IV and V fingers.

Wounded with more extensive damages of soft tissues without injury of bones, joints, nervous trunks and large vessels, and also with the buttonhole, subperiostal fire fractures which are not followed by the shift of fragments with the isolated changes of one of bones of a forearm, fibula and not connected with defect of soft tissues and deformation of an extremity went to FGLR; with limited burns and freezing injuries of fingers of the III degree. Wounded and patients who after treatment admitted unusable to military service were not subject to the direction in GLR.

From among patients persons whose disease did not demand difficult special inspection and a long bed rest, capable to self-service, implementation of the barracks schedule and participation in classes in combat and political training went to GLR. In these hospital also convalescents from other hospitals were translated hospital bases (see).

During the Great Patriotic War finally there was a regular and organizational structure of GLR. The main regular divisions of hospital are priyemnosortirovochny, 3 surgical and therapeutic departments. Besides, departments of physiotherapy exercises, physical therapy, dental, laboratory, a drugstore, divisions of service and material security are its part. For reception, placements and treatments of wounded and patients are developed the relevant functional divisions of hospital.

In a reception sorting room rooms for temporary accommodation of wounded and patients, the sanitary inspection room, the central operating room and the central dressing room where surgical interventions are carried out are equipped. From a reception sorting room wounded and patients according to purpose go to other divisions of hospital. Besides, as a part of priyemnosortirovochny department are developed the insulator for accommodation of persons, suspicious on existence of an infectious disease, and evacuation chamber where it is temporary, before transfer in the relevant hospital, place the wounded and patients who are not subject to treatment in GLR.

In the 1st surgical department offices of LFK and physical therapy, and also chamber for wounded are developed operational, preoperative. The wounded with injuries and burns needing the hospital mode and surgeries go to this department. In process of improvement of the state of health they from this department are transferred to others, by the wounds of department corresponding to character. the 2nd and 3rd surgical departments are developed according to one scheme and incorporate the operating room, a dressing room, chambers for postoperative wounded, an office of LFK and physical therapy, the room of barracks type for accommodation of wounded. In the 2nd department wounded with injuries of top and bottom extremities, a trunk and other areas of a body, go to the 3rd — with a burn injury. In the 4th, therapeutic department hospital chambers for persons in need in a short-term bed rest, out-patient clinic, procedural, rooms for barracks accommodation of patients and the insulator are developed. For occupations on fighting and physical. to preparation educational classes and military-training fields, the sports town, for work therapy — different workshops are equipped (shoe, sewing, joiner's, etc.).

The correct organization of work of GLR with performing complex treatment in combination with classes in combat training in days of the Great Patriotic War was provided with intra hospital sorting of wounded and patients; specialization of medical departments and concentration in them the homogeneous list of wounded and patients on localization of wound and the period of treatment.

Process of treatment of wounded and patients in GLR was conditionally divided into 3 periods taking into account a condition of a wound, function of the damaged body and the general condition of the wounded. Existence at wounded of a fresh wound or wound with young granulations, sharply bounded function of the damaged body, the general breakdown, subfebrile temperature in this connection self-service is complicated is characteristic of the first period; for the second — existence of healthy granulations with the beginning epithelization of a wound, the restriction of function connected with local changes in area of a wound, improvement of the general state, standard temperature, a possibility of self-service; for the third — the coming to the end epithelization or a wound repair under a scab, the volume of movements substantially recovered and their restriction connected only with existence of hems, residual contractures; an insufficient animal force at a top general condition. Similarly on the periods also patients were distributed.

Wounded in the 2nd and 3rd departments usually combined in companies taking into account localization of wound, companies were subdivided into platoons and departments. The wounded needing in to lay down. actions of the first period of treatment, the wounded corresponding to the second period — in the second, third — in the third platoon were enlisted in the first platoon. In process of a wound repair and recovery of function of the struck body wounded consistently were transferred from the first platoon to the second, then to the third. Political, front, physical. and tactical preparation with an exit to military-training towns was also in the field planned in strict dependence on the period of treatment and was under control of doctors. The stated principles of division of wounded into the homogeneous groups on localization of wound and to the period of treatment demanding approximately identical medical manipulations, homogeneous procedures on to lay down. to physical culture and physical therapy, and also same work therapy, fighting and physical. preparation, allowed to use extremely economically and rationally forces and means of hospital, much more to increase capacity.

In complex treatment of wounded in GLR the leading place belonged to surgical methods of treatment, to lay down. to physical culture and a hardening in combination with physiotherapeutic procedures. Surgical methods of treatment included, in particular, primary (early or late) the surgical treatment of wounds and actions promoting their healing (the seams which are pulling together bandages, an immobilization, etc.), fight against complications (cuts, opening of zatek, removal of the foreign bodys preventing healing), treatment of osteomyelites of bones of a brush and fingers, and also the plastic surgeries accelerating closing of skin defects.

From physiotherapeutic methods thermal and balneological procedures, including phototherapy and sukhovozdushny bathtubs, torfo-and a paraffin therapy, climatic factors were widely used; from the physiotherapeutic equipment — generally quartz and sollyuks. Methods to lay down. physical cultures, in particular to lay down. the gymnastics, mechanotherapy including hl. obr. exercises with components of active movements, were applied at wounded in early terms (from the 3-5th day after wound); classes were given by preferential group method. The main attention was paid to a training of all extremity and development of functions of the damaged segment. In the same purposes were used morning a gigabyte. gymnastics and hardening. On classes in physical and tactical training wounded improved military and applied skills, trained in force, dexterity, endurance, coordination of movements.

Work therapy included various forms of participation of wounded in the labor processes connected with self-service, performance of economic works and works in workshops on production of objects of care of wounded, repair of sanitary and economic property. In the course of work therapy results of treatment were fixed, adaptation of an organism to conditions of front life was provided. In therapeutic department also complex treatment was applied and depending on the period of a disease were widely used physical therapy, to lay down. physical culture and work therapy in combination with combat training.

The system of treatment accepted in Red Army in days of the Great Patriotic War lightly wounded and easily sick completely was repaid: continuously throughout war disability among these contingents considerably decreased and their specific weight among returned in a system increased. So, on Western (the 3rd Belarusian) the front among the wounded treated in GLR returned in a system made in the first year of war 29,3%, and on the fourth — 58,9%; respectively patients of 15,8 and 25%. At the same time coming on replenishment to troops from GLR favourably differed in the tempering, existence of fighting experience, a vtyanutost in marching combat conditions of life.

The organization of treatment existing in Red Army during the Great Patriotic War lightly wounded and easily sick did not undergo essential changes and in post-war time. At the same time in war using the opponent of weapons of mass destruction the organization of treatment of lightly wounded and easily sick shall be under construction taking into account emergence of new types of a fighting injury, the changed characters, the sizes and structure a dignity. losses, and also the new ways of treatment allowing to expand indications for treatment of wounded and patients in GLR.

See also Hospital military .

Bibliography: Vishnevsky A. A. and Schreiber M. I. Field surgery, M., 1975; Kapilevich Ya. B. Organization of treatment lightly wounded, Voyen. - medical zhurn., To «5, page 64, 1970; Maples E. M. Gospital for lightly wounded during offensive combats, in book: Voyen. medical on Leningr, the front, page 43, M., 1946; M and and z and N and to G. L. Not hardware physical therapy in hospitals for lightly wounded, M., 1944; Naumov V. A. and Klyuchnikov G. A. Physiotherapy exercises in hospitals for lightly wounded, Riga, 1945; Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 14, page 88, M., 1952, t. 18, page 69, M., 1950; Smirnov E. I. Problems of military medicine, M., 1944.

I. P. Leads, A. I. Komarov, G. E. Komshalyuk, D. G. Kucherenko.