Medical and Sanitary Service of the Civil Air Fleet of the USSR during the Great Patriotic War.

Semenova Elena Nikolaevna PhD in History Postgraduate student, Department of Russian History, Altai State University 656049, Russia, Altaiskii krai, g. Barnaul, pr. Lenina, 61 lapimoh@yandex.ru Other publications by this author

Semenov Mikhail Aleksandrovich PhD in History Researcher, Institute of History SB RAS 630058, Russia, Novosibirsk region, Novosibirsk, Nikolaeva str., 8 pihterek@yandex.ru

The rapid development of air communication in the Soviet period led to a significant increase in people using this type of transport, as well as to an increase in the number of employees of the civil air fleet (GVF) of the USSR. The role of air transport in providing communications is difficult to overestimate. However, in addition to the transportation of people and goods, the emergence of a new type of transport caused the development of various kinds of support services and institutions, without the existence of which the functioning of air lines would be extremely complicated. One of these services was the medical and sanitary service, designed to ensure the preservation of the health of passengers and employees of the Civil Air Fleet. The study of the development of this service, its activities, allows us to form a comprehensive picture of the history of the development of civil aviation, the contribution of the departmental health of the GVF to the preservation of life and health of citizens of the Soviet Union in difficult wartime.

The history of civil aviation of the Soviet Union during the war is difficult to attribute to the number of well-studied topics. First of all, it is worth noting the collection of articles, memoirs and documents prepared under the editorship of B.P. Bugaev^[1]. In addition, a large place of civil aviation activity during the war years was given in a number of generalizing works ^[2,3] and separate articles ^[4,5,6,7]. However, in the available literature, the history of the medical and sanitary network of the GVF, unfortunately, has not found its reflection.

The purpose of this work is to analyze the development and activities of the network of medical and sanitary management of the Civil Air Fleet during the Great Patriotic War.

The main source for writing this article was archival documents extracted from the Russian State Archive of Economics (RGAE). Most of the information is taken from the "Annual Statistical Reports" - documents compiled by the medical and sanitary department of the GVF for subsequent sending to the Central Statistical Office. The reports contained information on the condition, staffing, and various aspects of the activities of medical institutions, which allows us to reconstruct the diverse work carried out by medical and sanitary institutions of the GVF during the Great Patriotic War.

On October 29, 1930, the All-Union Association of the GVF was formed under the Council of Labor and Defense of the USSR, at the same time the medical and sanitary service of the Civil Air Fleet appeared, which was under the direct supervision of the medical and sanitary department of the GVF. On February 25, 1932, the UGVF was transformed into the Main Directorate of the GVF (GUGVF) under the SNK of the USSR, which was entrusted with the management of all civil aviation activities.

In the USSR in 1939 there were 153 airports on air lines, the total volume of passenger traffic on air lines of Union significance was 248 thousand people. By the beginning of 1941, 42685 people worked in the civil air fleet system, including 3927 flight–lifting personnel ^{[7, pp. 70, 72.]}.

At the same time, by the beginning of the war, medical support for the work of the GVF was quite modest. In 1941, the medical care of the GVF was provided by only one hospital with 46 beds, 4 outpatient clinics and 4 nurseries for children of employees of the GVF ^{[8, L. 2, 3, 5.]}. However, already in 1942, the medical network of the GVF's Lechsanupra grew to 2 hospitals with 134 beds, 7 polyclinics and outpatient clinics and 6 nurseries ^{[9, l. 11, 12, 14.]}. In 1943, growth continued: the number of hospitals increased to 10, beds in them to 156, outpatient outpatient care was already provided by 4 outpatient clinics and 5 polyclinics, 7 nurseries functioned ^{[10, l. 1ob.-2, 3ob.-4, 6.]}. In 1944, the number of hospitals remained the same (10 institutions), and the number of beds in them even decreased slightly – to 141 beds on average per year. On the other hand, outpatient care has sharply increased: all outpatient clinics have been transformed into polyclinics, as part of one of them, a children's consultation has begun to operate. At the same time, and in general, the number of outpatient clinics has grown, numbering 11 polyclinics by the end of 1944. The number of nurseries remained unchanged, numbering 7 institutions ^{[11, l. 13ob.-14, 15ob.-16, 18.]}. In 1945, the number of hospitals decreased to 7 institutions with 110 beds. Some polyclinics were reorganized back into outpatient clinics. As a result, the outpatient network consisted of 4 polyclinics and 9 outpatient clinics in 1945, the number of independent women's and children's consultations increased to 2. Due to the increase in the number of children, the number of nurseries has increased to 9 ^{[12, L. 1ob., 7, 8ob.-9, 11.]}.

In addition to the above, medical assistance to employees and passengers of the Civil Air Fleet was provided by other, smaller institutions: medical units of airports and squadrons, health centers. In 1941, there were 39 such institutions, replaced by medical personnel and 60 – replaced by paramedics. In 1942 there were 73 medical and 63 paramedic health centers and medical units of airports. In 1943 – 66 medical and 57 paramedics. In 1944 – 65 medical and 51 paramedic stations. In 1945 – 71 and 60, respectively ^{[8, l. 4.; 9, l. 13.; 10, l. 5.; 11, l. 17.; 12, l. 10.]}.

As we can see, during the war, the number of medical inpatient institutions increased by 700% in terms of the number of institutions and by 239% in terms of the number of beds in them. The number of outpatient clinics has increased by 325%. If in 1942-1943 the concept of increasing the number of medical inpatient institutions prevailed, then by the end of the war it was abandoned and moved to a gradual reduction in the number of hospitals. At the same time, the number of outpatient clinics continued to grow continuously.

During the war years, the number of medical health centers increased by 182%. At the same time, the number of paramedic health posts, despite the multidirectional dynamics in 1942-1944, eventually remained at the level of 1941 by the end of the war.

In general, the war years became a time of dynamic development of the medical network of the Civil Air Fleet, as well as a time of searching for optimal forms of its development. It is particularly worth noting 1942 as the time of an attempt to dramatically strengthen all types of medical care for employees and passengers of the GVF due to the development of relatively large medical institutions. In the future, taking into account the peculiarities of air transport, the relatively short time that passengers spent in flight, this concept has been adjusted: interest in the creation of medical inpatient facilities is weakening, the main emphasis is on providing highly qualified outpatient care within the walls of polyclinics, outpatient clinics, medical health centers and medical units of airports.

The staffing of the medical and sanitary service of the GVF during the war also underwent major changes, see table 1.

Table 1

Staffing of medical institutions of the GVF

Compiled by: ^{[8, l. 2, 3, 7-8.; 9, l. 10, 12, 17-18.; 10, l. 1ob.-2, 3ob.-4, 10ob.-12.; 11, l. 13ob.-14., 15ob.-16., 22ob.-24.; 12, L. 1ob., 7, 8ob-9, 19ob.-21.]}.

From the data given in the table, it can be seen that during the war the total number of medical workers of the GVF increased significantly: by 170% in full–time medical positions, by 157% in employed, by 200% in the number of individual doctors for 1941-1945. According to the average medical staff, the growth over the same period amounted to 149% for full-time positions, 223% for employed and 260% for the number of individuals.  At the same time, to a large extent, the average medical staff was not recruited full-time. So, in 1942, there were 380 employees for 306 employed by the average medical staff of the rate, a similar situation was in 1945 when 554 average medical workers occupied 480 rates. This anomaly can be explained by the need to staff part-time positions in health centers and outpatient clinics, which led to an excess of the number of employees over the number of rates. It is characteristic that with this abundance of secondary medical personnel, there were still unoccupied full-time positions, which can be explained by the inability to staff the existing redundant personnel scattered throughout the country medical units of airfields, health centers, etc.

The active development of large inpatient and outpatient clinics has caused a rapid growth of their personnel, exceeding the average for the GVF. Thus, the number of occupied medical positions in medical inpatient institutions of the GVF increased by 210% in 1941-1945, in outpatient clinics - by 254%. The number of occupied positions of secondary medical personnel increased by 277% and 261%, respectively.

The dynamics of the staffing capacity of medical institutions is interesting. Thus, the capacity of outpatient clinics fell during the war, from 12.25 occupied medical rates per 1 outpatient clinic in 1941, to 9.58 occupied rates in 1945. At the same time, the number of nursing staff employed in them increased sharply from 9.63 employed rates per 1 outpatient clinic in 1941 to 21.29 rates in 1942, and then in 1943 also fell sharply to 7.33 employed rates. In the future, sluggish growth continued up to 7.73 employed rates per 1 institution in 1945. Thus, with the exception of an attempt to increase medical care in outpatient clinics at the expense of secondary medical personnel in 1942, it can be said that the outpatient clinics of the GVF during the war years became less powerful, the development of the medical network outstripped the possibilities of their staffing.

In many ways, the reverse process took place with the medical and inpatient institutions of the GVF. After a natural decline in the capacity of institutions in 1942 caused by the fact that in 1941 the GVF had only one central hospital and new medical inpatient institutions had to be less powerful by definition, in 1943-1945 there was a constant increase in the number of doctors and average medical workers per 1 hospital. So, in 1943, for 1 medical inpatient institution of the GVF, there were 1.1 employed doctor's rate and 3.9 average medical staff rates, in 1944 – 1.2 and 4.1 rates, and in 1945 – 1.5 and 4.36 rates, respectively.

The scale of the assistance provided is evidenced by the following data: in 1941, 698 patients who spent a total of 13028 days in the hospital were admitted to the medical inpatient institutions of the GVF; in 1942 - 1002 patients who were treated for 21429 days; in 1943 – 2882 patients and 47714 bed days; in 1944 – 3351 patients and 44,000 bed days; in 1945 – 2,152 patients and 39,800 bed days ^{[8, l. 2.; 9, l. 11.; 10, l. 1ob.-2.; 11, l. 13ob.-14.; 12, l. 1ob., 7.]}. As we see, the number of patients increased rapidly, amounting to 1944. 480% of the level of 1941, but in 1945 it decreased slightly.

The intensity of the use of the bed fund is evidenced by such an indicator as the number of days of bed operation per year. For medical inpatient institutions of the GVF, it was: in 1941 - 283.2 days; in 1942 – 159.9 days; in 1943 – 305.9 days; in 1944 – 312.1 days; in 1945 – 361.8 days of bed work per year ^{[8, l. 2.; 9, l. 11.; 10, l. 1ob.-2.; 11, l. 13ob.-14.; 12, l. 1ob., 7.]}. As can be seen, the active expansion of the network of medical inpatient institutions in 1942 led to a sharp decrease in this indicator. The hospital beds were empty half the time. Obviously, it was this fact that predetermined the refusal to further expand the medical and stationary network of the GVF. However, the rapid growth in the number of patients in 1943-1944, as well as the reduction of the bed stock in 1945, led to a sharp intensification of the use of the hospital network. Considering that 300 days of bed operation per year was considered the norm for healthcare institutions, it should be noted that in 1943-1944 the intensity of use of the bed fund was quite high, and after the reduction in the number of beds in 1945, the medical hospital network of the GVF literally suffocated from the load - the bed, on average, remained unoccupied for only 3 years of the day.

It is possible to get an idea of the number of patients admitted by outpatient clinics only for 1943 - 1945. In 1943, 234.7 thousand people visited all outpatient clinics of the GVF (of which 51.4 thousand people took outpatient clinics and 183.3 thousand people – polyclinics)^{[10, l. 3ob.-4.]}. In 1944, the total number of visits was 330.0 thousand people. Due to the reorganization of the outpatient network, only polyclinics remained in it at that time. and the number of visits to polyclinics was also equal to 330.0 thousand people ^{[11, l. 15ob.-16.]}. In 1945, the total number of visits to outpatient clinics amounted to 315.2 thousand people (of which 116.8 thousand people took outpatient clinics, and 198.4 thousand people - polyclinics) ^{[12, l. 8ob.-9.]}. As we can see, the short–lived reorganization of all outpatient clinics into polyclinics in 1944 allowed to significantly increase the scale to provide assistance to people and, in general, to maintain the level achieved in 1945.

The structure of patients who visited outpatient clinics of the GVF looks for 1943-1945 as follows, see Table 2:

Table 2

The number of visits to outpatient clinics by specialty

Compiled by: 10, L. 4.; 11, L. 16.; 12, L. 9.

As can be seen from the table, the main share of outpatient care provided had a therapeutic profile. Specialized care expanded significantly in 1944, reflecting the increased number of polyclinics. At the same time, in 1945, with the transformation of some polyclinics back into outpatient clinics, not all areas of specialized care decreased. If the number of eye and ENT care decreased, the number of gynecological and surgical care continued to increase.

The structure of patients admitted to medical inpatient institutions was different. The specialization of the bed fund and the number of patients are presented in Table 3.

Table 3

Specialization of the bed fund of medical inpatient institutions of the GVF and the number of patients of the corresponding profile in 1941-1945.

Compiled by: 8, L. 2ob.; 9, L. 11ob.; 10, L. 3.; 11, L. 15.; 12, L. 8.

As you can see, the specialization of the bed fund of medical inpatient institutions of the GVF was minimal. In 1941, 1942 and 1944 it did not go beyond the division of patients into surgical, therapeutic and others, and in 1943 and 1945 it was basically absent. Of course, the organization of highly specialized assistance on such a basis is impossible. In fact, the hospitals of the Air Fleet had to provide minimal medical care to passengers and employees of the GVF in the most urgent cases. In all other situations, the resources of the medical system of the People's Commissariat of Health were used. It should be recognized that this approach is correct. Since, given the territorial dispersion of airports, the amount of resources needed to create a highly specialized medical network was huge, and the benefits of this approach are not great, because the number of passengers requiring such assistance was relatively small.

Separately, it is worth dwelling on such an indicator characterizing the quality of medical work as lethality. In 1943, 34 people died in medical inpatient institutions of the GVF, the mortality rate was 1.18%. In 1944, 26 people died, the mortality rate was 0.78%. In 1945, 20 people died, the mortality rate was 0.93% [Calculated by: 10, l. 3.; 11, l. 15.; 12, l. 8.]. As we can see, the mortality rate was quite low, while it tended to decrease. The quality of medical work is also evidenced by the data of postmortem autopsies of corpses. It is worth noting that almost all the deceased were opened in the GVF system. So in 1943, of the 34 deceased, an autopsy was performed on 30, and in 1945, an autopsy was performed on all the deceased. At the same time, the number of discrepancies with the diagnosis revealed as a result of the autopsy in 1943 was 2 cases (or 6.67% of the number of autopsies performed), and in 1945 – 1 case (3.85% of the number of autopsies) ^{[10, l. 8.; 12, l. 17.]}. These indicators were significantly lower, than at the institutions of the People's Commissariat of Health.

It is worth noting that such successes are associated not only with the specifics of the contingent of patients, the dedicated work of doctors and all medical personnel, but also with the good equipment of the institutions of the GVF with medical equipment. So, in 1941, there were 4 active X–rays in the institutions of the GVF, in 1942 – 5, in 1943 – 3, in 1944 – 3, in 1945 - 6 ^{[8, l. 6ob.; 9, l. 15ob.; 10, l. 7ob.; 11, l. 19ob.;12, l. 12ob.]}, which, given the modest medical network of the GVF, can be considered quite high indicators. The medical institutions of the GVF conducted quite active laboratory and diagnostic work. So in 1943, the clinical laboratories of the medical institutions of the GVF performed more than 50,5 thousand general clinical, 804 serological and 718 bacteriological analyses. In 1945 – 48 thousand general clinical, 1463 serological and 2172 bacteriological analyses ^{[10, l. 19ob.; 12, l. 12ob.]}. Physiotherapy offices released in 1943 more than 44 thousand procedures, in 1944 – 51.4 thousand procedures, and in 1945 – 45.5 thousand procedures ^{[10, l. 7ob.; 11, L. 19ob.;12, L. 12ob.]}.

Active work was carried out by medical and paramedic health centers and medical units of the GVF. In 1943, 214.6 thousand medical and 125.3 paramedic appointments were carried out in them; in 1944 – 268 thousand and 161.6 thousand receptions; in 1945 – 309.9 thousand and 158.1 receptions, respectively ^{[10, l. 5.; 11, l. 17.; 12, l. 10.]}.

A few words should be said about the medical care provided by women's and children's consultations formed as part of polyclinics. In 1944, 3053 children were admitted by doctors, 2795 by the average medical staff. At the same time, 1,375 children were visited by doctors during the year, 4015 by the average medical staff. In 1945, the service also began for women. During the year, 1209 women and 975 children were admitted by doctors, 447 children by the average medical staff. 364 women and 746 children were visited at home by doctors, 1132 children by average medical staff ^{[11, l. 18ob.-19.; 12, l. 11ob.-12.]}.

The service of children's nurseries has grown during the war years. If in 1941 there were 266 children in the nursery, in 1942 – 439 babies, in 1943 – 417, in 1944 – 395 and in 1945 - 485 children ^{[8, l. 5.; 9, l. 14.; 10, l. 6.; 11, l. 18.;12, L. 11.]}.

It is particularly worth considering visits by medical staff to patients at home. In 1941, doctors of polyclinics and outpatient clinics made 7279 visits to patients at home, and the average medical staff – 1694 ^{[8, l. 4.]}. In 1942, the number of home care provided increased significantly, amounting to 23729 medical visits and 10126 made by the average medical staff of polyclinics and outpatient clinics ^{[9, l. 13.]} It is worth noting that according to the reports for 1941-1942, home care was provided from outpatient clinics of all types only by doctors of polyclinics and outpatient clinics. In the future, this situation has changed dramatically, due to the expansion of the range of institutions that provide statistical data on this type of work. In 1943, the doctors of polyclinics and outpatient clinics made 18,825 visits to patients, the average medical staff – 8062, in general, the doctors of outpatient clinics had absolutely 57346 visits to patients, and the average medical staff - 9981 ^{[10, L. 5.]}. The number of home visits of employees of polyclinics and outpatient clinics began to decline, but, due to the activities of medical personnel of outpatient clinics that are not part of polyclinics and outpatient clinics, the growth of this type of care was still recorded. In 1944, the number of home visits amounted to 17,788 visits by doctors and 9,604 by the average medical staff of polyclinics and outpatient clinics, and in total by doctors of outpatient clinics – 35,251 visits at home, by the average medical staff - 16,225 ^{[10, l. 17.]}. As we can see, some growth occurred only in the category of visits by the average medical staff. In 1945, the decline in visits became universal: 15466 visits were made by doctors of polyclinics and outpatient clinics, 6096 by secondary medical personnel. The number of visits by doctors of outpatient clinics of all types decreased to 21382, by the average medical staff - to 8268 visits ^{[12, l. 10.]}.

Sanitary and anti-epidemic work has also received some development. In 1943, an attempt was even made to open two small sanitary and anti-epidemic institutions ^{[10, l. 9.]}. However, this idea was quickly abandoned. At the same time, the GVF had a certain number of de-chambers for the sanitary treatment of things of passengers and employees of the GVF. In 1942, there were 21 dezokamera in Lechsanupra GVF, in 1943 – 26, in 1944 – 38, in 1945 – 35 ^{[9, l. 15ob.; 10, l. 9ob.; 11, l. 21ob.; 12, l. 18ob.]}. Thus, their number grew in during almost the entire war.

Thus, during the war years there was a serious development of the medical system of the Civil Air Fleet, which was essentially in its infancy before the war. The design of its structure was accompanied by the struggle of various ideas, sometimes the medical network began to copy the development of the civil health network, creating an extensive network of hospitals, sometimes it went to risky experiments, such as the transformation of all outpatient clinics into polyclinics. Nevertheless, by the end of the war, the concept of providing basic medical care in urgent cases was established through medical inpatient facilities, health centers and medical units of airports, and the concentration of assistance, primarily to the personnel of the GVF, in a system of sufficiently powerful outpatient clinics.