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hospitalan institution where the sick, wounded, infirm or incapacitated are nursed and given medical treatment. Originating in medieval places of refuge, such as hostels and hospices run by charitable and nursing orders of nuns, for the poor, the sick and social outcasts, the hospital emerged as a specialized institution during the period of INDUSTRIALIZATION when the control and classification of social problems resulted in the differentiation of the hospital from the asylum and the workhouse.
Historians of medicine see the hospital as a key institution in the theoretical and social development of the PROFESSION. During the 19th century, medical practices were changing because of advancements in knowledge of anatomy and pathology. The status of medical doctors was being altered by changes in training and by medical registration which created a professional monopoly over healing. Teaching hospitals were the source of scientific training, research, specialization, practical techniques and a professional subculture. These hospitals admitted patients less on the basis of clinical need than on clinical interest, and they also created a new client group for the medical profession – their social equals and inferiors instead of the aristocrats who had hitherto employed doctors as part of their domestic retinue. The hospital was a vital institution also in the evolution of nursing as a profession, since it was in this setting that the Nightingale Reforms were put into practice: recruitment on the basis of ‘vocation’, training undertaken as part of the work process, the hygiene ideal, the practice of ‘nursing the ward’, and the social order of the hospital (which can be seen as paralleling the English bourgeois family of the time).
a medical institution for inpatient treatment; in the USSR and other socialist countries, a government treatment-prophylactic institution that provides the population with free, qualified, specialized medical care.
In the USSR many hospitals are combined with polyclinics into one medical staff providing inpatient and outpatient care and carry out prophylactic and antiepidemic measures. Hospitals are divided according to their territorial location and the scope and character of their activity; there are republic, oblast (krai), city, and clinical (at medical and scientific research institutes) urban hospitals and district, raion (zonal), and central raion rural hospitals. There are general hospitals—that is, hospitals with departments for treating various diseases—and specialized hospitals (gynecological, psychiatric, infectious, and so on), designated for the treatment of specific diseases. From 1917 to 1967 the scope of hospital care in the USSR increased almost 13 times. (See Table 1.)
A hospital is headed by a chief physician; a department, by a director chosen from among the best-qualified specialists. A three-level system of serving patients (physician, ward nurse, and nurse’s aide) is practiced in the hospital, as is the preferable two-level system (physician and ward nurse). Large hospitals (republic and oblast hospitals) conduct systematic work in the specialization and improvement of the qualifications of physicians working in raion and district hospitals. Hospital administration, work procedures, regimen, admission and discharge of patients, and other matters are regulated by norms, statutes, and instructions published by the Ministry of Public Health of the USSR.
The resolution of the Central Committee of the CPSU and the USSR Council of Ministers (August 1968) “On Measures for the Further Improvement of Public Health and the Development of Medical Science in the Country,” and the resolution of the Supreme Soviet of the USSR (June 1968), “On the State of Medical Care and on Measures for the Improvement of Public Health in the USSR,” defined the need for increasing effectiveness in the use of investment capital in building public-health institutions and of building only large hospitals (in the cities, hospitals with 300–1,000 beds; in rural regions, hospitals with 200 beds or more), which can provide high-quality diagnosis and treatment through the use of modern technical medical equipment. Hospitals are built on the pavilion, or decentralized, system. (The hospital consists of several separate buildings, each of which has its own function.) Hospitals are also built on the centralized, or blocked, system. (The hospital is located in one building or in several that are united into a whole.) Finally, hospitals are constructed according to the mixed system most common in the USSR. (Alongside the main building in which the principal medical departments for noninfectious diseases are located, separate buildings are erected for certain treatments and other departmental functions.)
The hospital structure contains a diagnostic treatment division (admissions department, specialized departments, wards, laboratories, pathology department, and pharmacy) and an administrative-maintenance division (kitchen, laundry, office, garage, and so on).
In the USSR hospitals are usually built according to a standard plan in which the inpatient areas, consisting of two sections of wards, patient lounges, and service areas, are located along a vertical, thus assuring clear intercommunication.
|Table 1. Development of the hospital network in the USSR as of January 1|
|Hospitals (exclusive of military hospitals)||5,300||13,793||18,253||24,428||26,400|
|Number of beds|
|Per thousand inhabitants||1.3||4.1||5.5||6.5||9.6|
In capitalist countries there are three principal types of hospital establishments: the small and medium-sized inpatient division with a diagnostic division and an outpatient division; the large medical center (university clinic) with a diagnostic division, physical therapy rooms, a polyclinic, and teaching areas; and so-called health centers, with a diagnostic division (laboratories, offices, and so on). Polyclinics are usually part of a hospital.
Hospitals in capitalist countries are principally privately owned commercial institutions that charge high rates for treatment and inpatient care. New hospital construction is done according to individual plans that provide space for new types of apparatus and equipment. Preference is given to the building of single-block hospital structures (hospital structures in one framework) having 300–600 beds. Hospital construction practice in foreign countries uses both a two-sided scheme for the ward sections with two parallel corridors and a noncorridor system.
Along with private hospitals, inexpensive hospitals belonging to municipal, religious, and philanthropic organizations are built.
Many hospitals were designed by major architects, and their monumental buildings play an important role in the architectural ensemble of the city—for example, the Santa Maria Nuova in Florence (15th century), Santo-Spirito in Rome (1480’s), Ospedale Maggiore in Milan (15th—17th centuries), the hospital in Chelsea, London (17th century; architect, C. Wren), the buildings of the first city hospital of Moscow(1796–1801;architect, M. F. Kazakov;and 1828–32; architect, O. I. Bove), the N. V. Sklifosovskii First Aid Institute in Moscow (1794–1807; architects, E. S. Nazarov, Dzh. Kvarengi, and others), and many contemporary hospitals in the Soviet Union and abroad.
REFERENCESFreidlin, S. Ia. Organizatsiia raboty statsionara gorodskoi bol’-nitsy. Leningrad, 1960.
Kurashov, S. V. Bol’nichnaia pomoshch’ na novom etape. Moscow, 1963.
Barkman, E. M. Lechebno-profilakticheskoe obsluzhivanie bol’nykh v gorodskikh bol’nitsakh. Moscow, 1965.
Kumpan, P. V. Tipy i struktura gorodskikh bol’nits. Moscow, 1958.
E. M. BARKMAN
a medical treatment facility, intended in the USSR for the in-patient treatment of military servicemen (in a number of European countries and in the USA certain civilian medical institutions are also called hospitals). Military hospitals were first established in the I6th century in Spain; in Russia, Prussia, and Great Britain they were established in the 18th century.
Hospitals may be either permanent (that is, they exist in both peacetime and war) or temporary (established during war only). In the Soviet armed forces permanent hospitals are classified according to function as garrison hospitals, district hospitals, hospitals under the jurisdiction of individual branches of the armed services (for example, air force or navy), or hospitals under central jurisdiction. The oldest hospital in Russia, the Main Military Hospital (now named for N. N. Burdenko), founded in Moscow in 1707, is under central jurisdiction. Hospitals that offer preparation, specialization, and advanced training for physicians are called clinical hospitals (for example, the S. M. Kirov Clinical Military Hospital of the Military Medical Academy). District hospitals are also treatment, scientific and clinical, and training centers that provide medical service for a military district; they provide treatment for patients with the most complex and serious diseases and serve as centers for the advanced medical training of district personnel. Garrison hospitals provide medical service for military units of the one or more garrisons attached to the given hospital. Temporary hospitals are subdivided into mobile field hospitals of various types (surgical, therapeutic, infectious, and hospitals for the superficially wounded) and evacuation hospitals. Mobile field hospitals are intended for the immediate care of the troops; they have regular vehicular transport, tents, and the necessary equipment for setting up operations in areas outside of population centers. These hospitals are designed for mass admissions of the battle-wounded and sick; they provide medical treatment according to their type and place in the system of provisions for the treatment and evacuation of troops.
A. S. GEORGIEVSKII
What does it mean when you dream about a hospital?
The hospital is a place to heal and get back to health and back into the flow of life. The hospital also suggests the need to pay attention to one’s health.