SANATORIUM (late lat. sanatorium from armor. sanare to treat, cure) — treatment and prevention facility for treatment of patients with preferential natural medical physical factors (climate, mineral waters, etc.) in combination with physical therapy, physiotherapy exercises and clinical nutrition, at observance of the certain mode providing full treatment and rest of patients.
Pages will be organized both in resorts, and out of them, in residential suburbs, in areas with favorable landscape and a dignity. - a gigabyte. conditions (local S.).
In the USSR permits in S. are provided generally free of charge or on favorable terms, with a considerable discount (at the expense of means of the state social insurance), and permits in children's and antitubercular S. — is only free at the expense of the state budget. Free permits at the expense of the state budget are provided also to disabled people of the Great Patriotic War and disabled people of nek-ry other categories.
the First institution of sanatorium type, a cut was called an institution for recovering, was founded in France in 1640. In the second half of 19 century the so-called forest shelters for rest intended generally for TB patients appeared in Germany and England. In Russia the first establishment of sanatorium type where the gigiyenodiyetichesky method of treatment was combined with drink of koumiss and the maximum stay in the open air, was organized in 1858 in the neighborhood of Samara (nowadays Kuibyshev) by N. V. Postnikov. Before Great October socialist revolution there were only 60 sanatoria on 3000 beds and several kumysolechebnitsa belonging to individuals. All of them intended for prosperous segments of the population. During World War I several S. was open for sick and wounded soldiers.
After Great October socialist revolution of S. became available to broad masses of workers. The decree about nationalization of resorts signed by V. I. Lenin in 1919 defined the main directions and perspectives of development a dignity. - hens. affairs in the country (see. Resorts ); the network C. began to extend both due to construction of new buildings, and at the expense of adaptation of the palaces and estates which were earlier belonging to the propertied classes. As a result by 1939 it increased by 30 times, and number of sanatorium beds — by 80 times; at the same time beds of year-round functioning made more than 50% of all bed fund C. During the Great Patriotic War in S.'s most evakogospital, and also resort hospital were developed. After war, along with recovery of the destroyed sanatorium buildings, construction new, expansion and improvement of the operating Pages continued. For further improvement a dignity. - hens. service in 1960 all S. were transferred to labor unions (except the children's and antitubercular, remained under the authority of the Ministries of Health federal republics). There are also S. constructed by collective farms or associations of collective farms (intercollective-farm S.). Irrespective of departmental subordination of S. coordination of their activities for questions of use natural to lay down. factors and organization dignity. - hens. the mode it is assigned to Central office on management of resorts of labor unions that allowed to create instructions for use, uniform for all country, a dignity. - hens. institutions.
Sanatorium network. As show data of TsSU of the USSR (tab. 1), the number C. from 1939 for 1982 increased on 514. The quantity of beds in them during this time increased by 327 thousand. In 1950 in sanatoria 1654 thousand people, and in 1982 — 5501 thousand persons were treated.
«The main directions of economic and social development of the USSR for 1981 — 1985 and for the period till 1990» provided further development of network C., especially in the nonchernozem zone RSFSR, Siberia and in the Far East, by hl. obr. on the basis of local mineral sources and the field to lay down. dirt. The wide program in this area is defined by the resolution of the Central Committee of the CPSU, Council of ministers of the USSR and the All-Union Central Council of Trade Unions «About measures for further improvement of sanatorium treatment and rest of workers and development of network of health resorts of labor unions» (1982).
Depending on age composition of the serviced patients distinguish S. for adults, children, teenagers, for treatment of parents with children. Besides, there are S. for pregnant women. Treat institutions of sanatorium type also sanatorium dispensary (see) and sanatorium specialized summer camp (see).
In total S. have specialization (a medical profile), i.e. are intended for treatment of patients with certain diseases. Specific weight of S. of this or that profile in total quantity of specialized S. depends on need of the population for the specialized sanatorium help, edges is defined proceeding from the general incidence of N of its structure. S.'s specialization in resorts depends from natural to lay down. factors of the resort and medical indications established for it. Extra resort S.' specialization is defined depending on local requirements and conditions. Send the patients consisting under dispensary observation or patients after treatment in a hospital to local S. and also when the trip to the remote resorts, especially with contrast klimatogeografichesky conditions, can worsen the course of a disease (see. Klimatopatologiya , Sanatorium selection ).
There are specialized S. for treatment of patients with diseases of bodies of blood circulation, digestion, disbolism, diseases of a nervous system, musculoskeletal system, a respiratory organs of not tubercular character, a female genital, skin, kidneys and urinary tract. There are also S. and departments in them narrower profile: for treatment of patients with bronchial asthma, glaucoma, a diabetes mellitus, patients with effects of injuries and diseases of a spinal cord, obliterating diseases of peripheral vessels of extremities, and also nek-ry prof. diseases (a silicosis, a vibration disease, etc.). As in the general structure of incidence of the population of a disease of bodies of blood circulation and digestion are the most widespread, for treatment of such patients more than 50% of all places in the Village are allocated. S.'s specialization for TB patients is defined by a form and localization of tubercular process.
Pages can be one-profile (for patients with homogeneous diseases) and multi-profile — with two and more specialized departments. Depending on a medical profile C. are provided with necessary shots of doctors - spetsia - sheets, the corresponding medical and diagnostic offices and laboratories. The important area of work on development of sanatorium network is enlargement and expansion all-resort medical diagnostiche-skoy bases (all-resort offices of functional diagnosis, balneofizioterapevtichesky associations, ingalyatoriyev, etc.).
Data on distribution on the main medical profiles C. of the labor unions intended for adults are provided in tab. 2.
In a number of resorts basic S. of various medical profiles are created, tasks to-rykh include improvement of diagnostic methods and treatment, generalization and distribution of the best practices, development and implementation practice of a sanatorium therapy new to lay down. the techniques developed by research in-ta of balneology and physical therapy, and also other medical in-ta. Basic S. perform scientific and methodical management of the scientific and practical work which is carried out to S. and will organize professional development a dignity. - hens. workers, that defines these S.' role as methodical centers for other specialized S. of the corresponding medical profile in this resort or group of resorts.
Features of a sanatorium therapy and the mode
the Sanatorium therapy is one of stages of complex treatment of the patient and therefore shall be successive, i.e. coordinated both with previous, and with the subsequent treatment. For definition of indications to a dignity. - hens. treatment and implementation of close connection between the previous polyclinic or stationary and sanatorium therapy needs careful pilot survey of the patient for establishment of the diagnosis, a stage and severity of the basic and associated diseases. The relevant data should be documented precisely (see. Sanatorium selection), sanitation of the centers of a local infection shall be carried out. For establishment of efficiency and for determination of results of a sanatorium therapy the accounting of its short-term and long-term results is obligatory.
Idiosyncrasy of a sanatorium therapy is its preventive orientation. For this purpose it is appointed during initial dysfunctions of bodies and systems — at a so-called donozologichesky stage (or stages of a pre-disease) to prevent development of the beginning disease and to increase protective forces of an organism (see. Prevention primary ). At hron. diseases this treatment is appointed for prevention of aggravations and a recurrence to prevent or slow down progressing of a disease. An important role is played by treatment in S. at a stage rehabilitations (see) after a serious illness for more bystry and full return of the patient to work p socially active life. So, the patients who had a myocardial infarction to-rye as step-by-step treatment passed an aftercare (after stay in a hospital) in local S., recover working capacity in shorter terms, than the patients treated only in a hospital. Since 1981 in sanatoria of labor unions for the patients who had a myocardial infarction annually allocate 50 thousand permits, to-rye are provided free of charge, at the expense of the budget of the state social insurance; the sick-list is issued for all term of treatment in these S. sick. The network of the local cardiological S. equipped with the necessary equipment, including and for chambers of an intensive care extends.
Feature of a sanatorium therapy is its complex character: natural physical factors apply in combination with pre-created, i.e. received artificially (electro-, phototherapy and other types of physical therapy), LFK dosed by a physical activity, clinical dietary nutrition and only at indications — with drug treatment. Such approach allows to carry out impact on various links developing patol. process, i.e. is pathogenetic. Efficiency of treatment in S. in many respects is defined by the fact that the patient changes the situation which quite often caused or supporting his disease is exempted from labor and household loadings, observes the certain mode promoting a normal current fiziol. processes, i.e. it appears in the sparing conditions adequate to the protective forces of an organism weakened owing to a disease. Along with treatment the large role is played by rationally organized rest, the maximum stay in the open air, a klimatolecheniye; recreational value has also a surrounding beautiful landscape, communication with the nature. The recreational role of natural factors is promoted by care of purity of air, the soil and reservoirs around S.'s arrangement (see. Zones of sanitary protection, resorts ). The situation of comfort and cosiness in S.'s rooms, the attentive relation of personnel, the thought-over cultural and educational actions have considerable value, i.e. all that distracts the patient from thoughts of a disease and creates a positive emotional background.
The sanatorium therapy is directed generally to recovery of normal reactivity of an organism, strengthening of functional activity of a number of bodies and systems, and including immune system, increase in protective forces of an organism. Thus, influence of physical factors has nonspecific character. At the same time the use of a number of physical factors adequate on character and a dosage to this or that pathogenetic link of a disease, maybe specific. E.g., specific impact is made by use of sulphidic bathtubs of a certain concentration and temperature for patients with a pseudorheumatism since hydrogen sulfide, joining in fabric metabolism, increases activity of oxidizing processes in circumarticular and cartilaginous fabrics, improves trophic processes in them, promoting recovery of their structural elements; influencing simiatoadrenalovy system, these procedures promote suppression of the autoimmune processes which are the cornerstone of this disease.
An important condition of a successful sanatorium therapy is observance of the all-sanatorium and individual regime including rules of conduct of the patient and providing a rational combination of treatment and rest. The mode is divided on sparing and training. However this division is in many respects conditional; rest needs to be alternated to loadings. Loads of the mechanisms of thermal control connected with stay in the open air and with klimatoprotsedura, reception of balneofizio-therapeutic procedures, etc. concern to them bigger or smaller intensity (depending on a functional condition of an organism of the patient).
An important component of a sanatorium regime is the dosed physical activity, including. physiotherapy exercises (see) and terrainkur (see), the hypokinesias helping to fight against effects, as one of risk factors of emergence of a number of diseases, first of all coronary heart disease. In process of recovery of normal reactivity of an organism of loading gradually increase. In unity of the sparing and training loadings which are closely coordinated among themselves the essence of the all-sanatorium and individual modes also consists. The sanatorium regime includes also careful hardening (see).
Takes a certain place in a complex of a sanatorium therapy psychotherapy (see); use of psychotherapeutic methods raises an emotional tone of patients, removes in some cases psychopathic reactions, promotes creation of a favorable background for increase to lay down. effect of influence of natural and preformirovanny physical factors, promotes potentiation of their action and action applied in the shown cases of drug treatment.
Though character of a sanatorium therapy is complex, it is not necessary to overload the patient with procedures. Unlike a hospital the leading value in to lay down. process in S. belongs natural to lay down. to factors. Drug treatment is applied in sanatorium practice only in necessary cases, mostly at an aftercare of patients in local S. and, as a rule, in so-called maintenance doses.
Duration of treatment in S.'s most for adults makes 24 days; in S. for treatment of patients with diseases of skin and glaucoma — 26 days, for treatment of patients with nek-ry occupational diseases — 30 and 45 days, with effects of diseases and injuries of a spinal cord — 45 days, with inflammatory diseases of kidneys (in summertime) — 48 days. Duration of treatment of TB patients is established individually depending on a form and weight of a course of process. (Duration of treatment in children's S. — see below, undressed Children's sanatoria.)
Time of stay of the patient in S. is conditionally divided into 3 periods: adaptations, making several days and intended for accustoming of the patient to sanatorium and climatic conditions, the main (longest), in Krom the full course of treatment, and final is conducted.
Regular standards and the main requirements to a design of sanatoria
Regular standards of medical staff of S. are established by the Ministry of Health of the USSR and the All-Union Central Council of Trade Unions taking into account its medical specialization. Led by. there is a chief physician, to-ry is responsible for all medical and administrative activity of establishment. The manager of department directs to lay down. - the prof. work of the division and, being a highly skilled specialist doctor, is the main consultant for this medical discipline.
Large S.' construction is the most rational (on 500 — 1000 beds), their operation is most effective as in them the high level of medical service (concentration of highly qualified specialists and creation of the equipped medical and diagnostic base) can be more stoutly provided.
In the USSR there was a type of building of the territory of sanatorium one building or their complex including separate functional links: sleeping cases, the medical case, the electrical power unit, the room for holding cultural events, economic office buildings. There are several options of configuration of the specified base units: centralized (at the same time all links are located in one building); block (various links are in the separate cases connected among themselves by the covered transitions); stage (separate links are located in the different, not connected among themselves buildings). Feature of architecture of S. is the interrelation with the surrounding nature, its «description» in a landscape, creation or use around S. of extensive forest-park arrays.
In all regions of the Soviet Union sanatorium institutions function, sunbeds, drinking galleries and other constructions enter a complex to-rykh along with medical and sleeping cases (tsvetn. fig.).
The children's sanatorium
Children's sanatorium is intended for complex treatment of sick children, prevention of a number of a serious illness, the prevention of their transition to long, chronic forms. Children's S.' specialization is established taking into account features of diseases at children's age. Along with basic groups of specialized S., similar S. for treatment of adults, there are S. for treatment of children with effects of poliomyelitis, for the children who had dysentery, etc. The institutions of new type which appeared in recent years — S. for parents with children and specialized sanatorium pioneer the camp of year-round action — are intended for treatment of children with not serious illness, hl. obr. with functional disturbances of a pla the residual phenomena after the postponed diseases; for the children having rheumatism in an inactive phase, an adenoid disease, nek-ry diseases of a respiratory organs of not tubercular character, functional diseases of a nervous system with an asthenic syndrome, convalescents after a number of diseases and the weakened children. In children's S. the USSR M3 systems located out of resorts accept children aged from 1 year up to 14 years inclusive, in S. in resorts — from 5 to 14 years inclusive. Children with dysfunctions of a musculoskeletal system, including with cerebral paralyzes, are sent to S. by the USSR M3 systems located in resorts from 3 to 14 years, to a dignity. - hens. institutions of system of labor unions — from 4 to 14 years, and system of education — from 7 to 14 years. For parents with children send children aged from 4 up to 14 years to sanatoria. Duration of treatment in children's S. of a health system depends on a medical profile of sanatorium and the nature of diseases; in S. intended for treatment of children with a serious illness it makes not less than 45 days; duration of treatment in S. for parents with children 24 days. Terms of treatment in children's antitubercular S. are established individually, depending on a form and a stage of process. In specialized sanatorium summer camps of year-round action terms of treatment in summer months — to 45, and during academic year — 65 days. The issue of need of extension of terms of treatment for child care sanatorium facilities is resolved by the special medical commission.
Treatment and a sanatorium regime in child care sanatorium facilities are based taking into account anatomo-fiziol. features of an organism of the child, character and klpn. courses of a disease, a season of year, climatic conditions of the area also have especially individual character. The mode shall provide sufficient duration day p a night dream, rational alternation of a physical activity, lay down. - the prof. p teaching and educational actions (during academic year children continue study not to lag behind the school program), the maximum stay on air.
Time of stay in child care sanatorium facility is divided into three periods: adaptation, the main and final. The first, «introduction», the period is taken away on accustoming to new klimatogeografichesky conditions, sanatorium orders and the mode, children's collective. The child is younger and it is heavier than disturbance from a number of bodies and systems and also what more expressed contrast between climatic conditions of the resort, on Krom there is S., and conditions of the permanent residence of the child, the this period is longer. At this time conduct examination of the child, a morning hygienic pshnastika, a careful klimatolecheniye by the sparing technique. The main period, the longest, is intended for complex medical actions (balneo-, gryaze-, fizio-and klimatoprotsedur). The final period serves for fixing of results of treatment, hl. obr. by means of a climatotherapy and LFK.
Special attention in children's S. is paid to a good and balanced diet: it has to be 10 — 15% higher age fiziol. norms since during a sanatorium therapy on the growing organism additional loading falls and the increased amount of energy is spent. Besides, at a row patol. states, napr, chronic pneumonia, the need for energy even more increases; losses of protein with a phlegm, decrease in comprehensibility of food owing to intoxication can lead at the same time to a proteinaceous and vitamin deficiency that reduces protective forces of an organism and causes a delay of physical development. Against the background of the broken trophicity and an oppressed immunoreactivity there are recurrent respiratory diseases leading, in turn, to an aggravation of the basic patol more often. process. In this regard it is necessary to include the increased amount of protein, vitamins in a diet of such children (food greens, fruit and vegetables). Occupations of LFK are also appointed individually, depending on the nature of a disease and a condition of the child, his physical fitness, gradual increase of an exercise stress is obligatory. The hardening (see) shall be careful, but daily and persistent. It is necessary to consider that reactions of an organism of the child or the teenager on balneo-and mud cure can differ from reactions of adult patients considerably. Mineral bathtubs of all types shall be weaker concentration, and temperature of dirt is lower than the procedures appointed by the adult patient (see. Bathtubs , Mud cure ). All physiotherapeutic procedures are also appointed by the sparing technique, they shall not be load. Considering that in the climatic resort the organism of the child is under the influence of natural to lay down. factors, especially in summertime, when biol. activity of solar radiation is highest, during this season it is necessary to limit prescription of any physiotherapeutic procedures. It is important to construct a daily routine so that the child or the teenager was not overloaded to lay down. procedures and studies. The overload can arise not only at the expense of an irrational combination to lay down. procedures with studies, but also owing to heavier and intense, than at the adult, functional and social adaptation of the child to new klimatogeografichesky conditions and conditions of new collective. At the same time functions of century of N of page can be broken, went. - kish. a path, endocrine system and also to arise psychoemotional tension.
At the direction of the child to the resort with contrast klimatogeografichesky conditions it is necessary to consider that patol. reactions are possible not only during adaptation, but also in the period of a readaptation (upon return from S.) and they proceed more sharply, than at adults.
In sanatorium child care facilities as well as for adults, drug treatment is applied only in necessary cases.
Military sanatorium — the treatment and prevention facility intended for sanatorium treatment of the military personnel and members of their families, workers and employees of SA and Navy (see. Medical profilaktacheskoye providing Armed Forces ).
The first military sanatoria began to be created in Russia in the second half of the 19th century in the form of sanitarnolechebny stations. In 1922 orders of Revolutionary Military Council and Narkomzdra-va of RSFSR No. 2208 from 9/24/1922 and No. 2452 of 30.10. 1922 states of military and resort stations in the Caucasus and in the Crimea are put into operation. In 1928 the first military and resort station in Sochi for treatment of the highest command structure of RKKA was created. In July, 1931 they were renamed into sanatoria of RKKA.
Military sanatoria are subdivided into sanatoria of the central subordination and sanatoria of different types of Armed Forces and military districts (fleet). The general management of military sanatoria is performed of the Master military-medical control of the Ministry of Defence of the USSR.
For improvement of methods of sanatorium treatment and achievement of high performance of treatment military sanatoria taking into account their geographic location, existence of natural medical factors of resorts are specialized for treatment of patients with diseases of bodies of blood circulation (in Moscow area, Kislovodsk, Zvenigorod, etc.), breath (in the Crimea, Vinnytsia, etc.), digestion and a metabolism (in Yessentuki, Borjomi, Feodosiya, Truskavets, etc.), a musculoskeletal system (in Saky, Yevpatoria, Pyatigorsk, Sochi, Tsqaltubo, etc.), skin and hypodermic cellulose (in Pyatigorsk, Sochi, etc.) - Besides, there are special klimatoterapevtichesky sanatoria (or departments) intended for preventive treatment and rest of the military personnel which work is connected with systematic influence of adverse factors and with special conditions of military work. The term of treatment in sanatoria of 24 — 26 days, in department for spinal patients of Saksky sanatorium — 60 days, in tubercular — 60 days and more.
Selection needing for treatment military sanatoria is made by the sanatorium and selection commissions at military units, institutions or in garrisons.
All military sanatoria have well equipped klinikobiokhimichesky, x-ray departments (offices) and departments of functional diagnosis that allows to conduct necessary additional researches, to exercise medical control in the course of sanatorium treatment and to estimate its efficiency.
See also Treatment-and-prophylactic help .
Table 1. GROWTH of NUMBER of SANATORIA AND BEDS IN THEM from 1939 to 1982. And IN COMPARISON WITH 1913.
Table 2. SPECIALIZATION of BED FUND of SANATORIA of LABOR UNIONS FOR ADULTS (by data for 1982)
Bibliography: Vasilyev A. A. The organization of treatment-and-prophylactic work in sanatorium institutions of labor unions, Kiev, 1964; M. G. Sparrows, Naumov A. M. and With at-to about I P. S N. Indications for the direction in sanatorium of the Ministry of Defence of the USSR of patients with diseases of internals and the principles of a resort therapy, JI., 1976; Goldfayl L. G. and Poltoranov V. V. The quick reference guide in the direction of patients to resorts and in local sanatoria, M., 1974; Kozlov I. I., V. I. Lenin and development of sanatorium matter in the USSR, M., 1982; Experience of basic sanatoria of labor unions, M., 1969; Poltoranov V. V. Sanatorium treatment and rest in the USSR, M., 1971; it, resort therapy of chronic diseases of the digestive system, M., 1979, bibliogr.; Poltoranov V. V. imazur M. M. Sanatorium treatment and its efficiency. M, 1969; Chazov E. I. The general principles of rehabilitation of patients with a myocardial infarction, in book: Rehabilitation and definition of working ability of patients with chronic coronary insufficiency, under the editorship of L. Fogelson, page 5, M., 1970.
V. V. Poltoranov, V. F. Nazarov.