Health Service (common)

Categories / Medicine. Public Health
HEALTH SERVICE, PUBLIC. The first stationary medical institutions in St. Petersburg were military hospitals for the army and the navy (opened in 1715 and 1717). In 1775-1828, city hospitals and alms-houses were under the control of the Board of Social Charity, later they were transferred to the control of the Council of Trustees for the Department of Institutions of the Empress Maria Fedorovna. In 1868, the Commission for finding measures for the organisation of civilian hospitals in St. Petersburg was established but the project proposed by the Commission was declined. According to the City Instructions of 1870, control of the public health service was given to the City Duma. In 1878 the Commission of Public Health was created by the decree of the City Duma. As a result of its activity the city alms-house for 2,500 beds with a children’s orphanage and also six hospitals (Kalinkinskaya, Obukhovskaya, St. Mary Magdalene's, Petropavlovskaya, Alexandrovskaya and of St. Nicholas the Miracle Worker) with a total of 9,889 beds (2,934 regular beds) were transferred under the control of the city government. On the initiative of S.P. Botkin in 1882 the institute of Duma doctors was set up and a network of ambulances was created in St. Petersburg for the first time in Russia. To oversee the Health Service, the City Hospital and Sanitary Commissions were set up, which were housed in the building of the City Duma (38 Nevsky Prospect). All the city hospitals, drugstores and city alms-houses were under the control of the former Commission; the latter commission controlled disinfection plants, Isolation Houses with sanitary transport, Smallpox Vaccinating Institute, maternity hospitals, an orphanage for prematurely born children, city cemeteries, the Veterinary and Sanitary Bureau, ambulance stations, smithy for ambulance horses. The Commission also oversaw the work of sanitary inspectors and Duma doctors, specialists attached to ambulances, obstetricians, doctors controlling the night houses, doctors on night duty and veterinary doctors. St. Petersburg had 278 medical institutions, maternity hospitals and ambulances in 1910, out of which 49 were under the control of the city government (including 12 hospitals with 10,980 beds), 11 were under supervision of the Department of Institutions of the Empress Maria, eight were controlled by the Military Department, one was controlled by the Naval Department, ten by the Russian Red Cross, four by educational and scientific institutions, ten by the district local government, 19 were independent, 22 were charitable, and 144 institutions were private. The total number of beds in all the hospitals exceeded 20,000. Scientific research work in public health was carried out at the chairs of the Medical Surgical Academy (Military Medical Academy) from 1798, of the Women’s Medical Institute (1897), the Psycho-Neurological Institute (the faculty of medicine, 1911), and of the Elnensky Institute for Advanced Training of Doctors (1885). The first scientific research medical centre was the Emperor's Institute of Experimental Medicine, opened in 1890. In 1911 the Commission for the Preparation for the Hospital and Sanitary Reorganisation of the Capital was formed, which developed a plan for extending the existing hospitals and building new hospitals; it suggested the creation of a special institution - the Commission of Public Health with four departments (sanitary, veterinary-sanitary, medical, and sanitary-statistical) and the introduction of the territorial principle of organisation, with the division of St. Petersburg into 22 sanitary districts. The Commission strove for equal rights and for free medical care for all citizens. The First World War 1914-18 and events of 1917 disrupted the completion of these measures, but some of the suggestions were achieved under the Soviet government. In 1918 a single institution for governing was created - the Commissariat of Public Health of the Union of Communes for the Northern District. Scientific commissions and councils for developing measures against epidemics, measures for fighting social diseases, the protection of motherhood and infancy were attached to it. In 1919 obligatory smallpox vaccination was introduced to St. Petersburg for the first time in Russia, first aid stations were reopened, medical stations were created to provide for home calls at night. In the 1920s a number of hospitals were reconstructed. By 1933 the health system consisted of 21 epidemiological stations and 20 hygienic and bacteriological laboratories. By 1927 six scientific research institutes were created (Radiology Institute, 1918; Tuberculosis Institute, 1922; Bacteriological Institute, 1923; the Institute of Professional Diseases, 1924; the Institute for Protection of Motherhood and Infancy, 1925; Oncology Institute, 1926) and Chemical Pharmaceutical Institute were set up. In the years of the Great Patriotic War of 1941-45 the majority of hospitals and research institutes operated as military hospitals. Despite the cold weather, lack of water and absence of power supply, the medical service of the city prevented the outbreak of epidemics. The plan of development of a public health system in the first years after the war included eliminating the consequences of the war, restoration of damaged medical institutions and adding new medical institutions to their network. During that period hospitals were joined with ambulance and clinical institutions, and the health service was reorganised. In 1978 the first in the country central dispatching station for first aid with an automatic control system was created. Later old hospitals were reconstructed and new specialised and general hospitals, maternity hospitals and polyclinics were opened. For the purpose of widening medical and diagnostic possibilities, consulting, diagnostic and specialised centres were organised (eye polyclinics, medical genetics centres, neurological clinics, burn treatment centres, pancreatological, toxicological, rheumatological clinics, the St. Petersburg branch of the Eye Microsurgery Centre, etc.). The main group of medical institutions is comprised of institutions of the system of the Committee of Public Health of the Administration of St. Petersburg (1 Malaya Sadovaya Street). Part of them is directly controlled by the committee (mainly hospitals), other institutions are under the jurisdiction of district administrations (polyclinics, dispensaries etc.). The second part is comprised of federal institutions of the Ministry of Health (МH) of the Russian Federation, located on the territory of the city (including universities and scientific research institutes). The third group consists of medical institutions in the Leningrad Region located on the territory of the city. All the three groups are included in the system of the Ministry of Health of the Russian Federation. Besides this, there are medical prophylactic centres and scientific research institutions under the jurisdiction of the Russian Academy of Sciences, of the Ministry of Defence and non-governmental medical institutions in St. Petersburg. The largest centres for training medical professionals in St. Petersburg include the Medical University, the Medical Academy, the Paediatric Medical Academy, the Chemical Pharmaceutical Academy, The Medical Academy of Postgraduate Education, and the Military Medical Academy. Over 30 Institutes in the sphere of medical biology carry out scientific research, a number of them have clinical hospitals. The institutes render scientific, methodical and consultative help for practical health. In 1988 the Northwestern Department of the Russian Academy of Medical Sciences coordinating research work in academic and specialised scientific research institutes and educational centres was created in St. Petersburg. In 1997 the Concept for the Development of Public Health in St. Petersburg to 2004 was adopted, which determined priorities, stages of development and 68 concrete programmes, but the financial crisis of 1998 impaired their implementation. Correction of these plans was reflected in "Main Trends of Development of Health Care in St. Petersburg Up Through 2004". 12 medical, social and legislative programmes were adopted concerning the development and perfection of the psychiatrical service in St. Petersburg and its material base; on the development of extra medical help before hospitalisation, on the prevention of tuberculosis, substance abuse, diabetes and its complications, the Anti-HIV/ AIDS programme etc. In 2000 the types of diseases among adults consists of diseases involving blood circulation, the respiratory system, the nervous system and sensory organs, and injuries and poisoning. The death rate exceeds the birth rate by 2.4 times. In 1995-2000 the number of diseases registered at medical prophylactic institutions increased to 1.2 million. There is an increase in illness among all age groups. Primary illnesses which are growing include tuberculosis, and venereal diseases, the number of diseases related to substance abuse has also grown, and the incidence oncological diseases is higher in St. Petersburg than in the rest of Russia. By the end of 2000 medical help was rendered by 106 hospitals and 274 ambulance clinical institutions by the Ministry of Health of the Russian Federation, out of which 78 and 214 respectively are under the jurisdiction of the Committee of Public Health. Over 31,100 doctors and over 42,100 mid-line medical professionals are working for the Ministry of Health of the Russian Federation, including over 20,800 and over 35,400 for the Committee of Public Health respectively. The number of doctors has increased by about 10,000 and the number of mid-line medical personnel has dropped (in 1996-2000 by 3500 people) and consequently leaves their numbers at 43,900 and 33,500. In 1990-2000 because of the elimination of hospitals with unsatisfactory conditions the number of beds supported by the Ministry of Health has dropped by 14,500, while the Committee of Public Health lost some 13,000 beds. The Ministry of Health still supports over 43,900 and the Commission of Public Health over 33,500 beds respectively. The number of day hospitals in ambulance clinical institutions (77 in 2000) and the number of departments of day presence in hospitals (16 in 2000) have increased. Over 10,000 operations are carried out in 16 centres of ambulance surgery annually, which were earlier made only in hospitals. The solution to problems of public health is complicated by the disproportion between the volume of free of charge medical help proclaimed by the state and its financing. It is especially revealed in the privileged provision with medications. Low salary and reduction of prestige of medical professions result in flow-out of personnel. Reformation of the ambulance clinical system includes the transition to a general practice programme. In 2001 there were some 19 departments of general medical practice (established in 1997-9), serving over 150,000 people. Departments of extra medical help are attached to large multi-field hospitals, substations of urgent medical help are being transferred to the territory of hospitals. There are several small hospitals for very specific and expensive kinds of medical treatment (such as cardiac surgery and neurosurgery clinics). Hospitals and nursing departments, hospices with mobile medical teams have been arranged. A special group of hospitals deals with treatment of long-term illnesses (mental disorders, substance abuse, skin and venereal diseases). Construction of the city oncological hospital (2003) in the town of Pesochny, the clinic of the Scientific Research Institute of Cardiology, the surgical clinic of Pokrovskaya Hospital, two adult clinics and one children’s clinic in the new districts of the city is underway. A number of hospitals are being reconstructed.

References: Врачебные и санитарные учреждения гор. С.-Петербурга. СПб., 1910; Реорганизация врачебно-санитарного дела в Петрограде. Пг., 1916; Хромов Б. М., Свешников А. В. Здравоохранение Ленинграда: Крат. ист. очерк. Л., 1969; Гладких П. Ф. Здравоохранение блокированного Ленинграда, 1941-1944 гг. 2-е изд., перераб. и доп. Л., 1985; Павлов Ю. В., Красильников И. А. Здравоохранение Санкт-Петербурга в годы реформ: (Стат. обзор). СПб., 1999; Основные направления развития здравоохранения Санкт-Петербурга до 2004 года. СПб., 2001; Состояние здоровья населения и деятельность здравоохранения Санкт-Петербурга / И. А. Красильников и др. // Мир медицины. 2001. № 3/4. С. 9-12.

T. I. Grekova. Botkin Sergey Petrovich
Maria Fedorovna, Empress
Malaya Sadovaya St./Saint Petersburg, city, house 1
Nevsky prospect/Saint Petersburg, city, house 38
Врачебные и санитарные учреждения гор. С.-Петербурга. СПб., 1910
Реорганизация врачебно-санитарного дела в Петрограде. Пг., 1916
Павлов Ю. В., Красильников И. А. Здравоохранение Санкт-Петербурга в годы реформ: (Стат. обзор). СПб., 1999
Основные направления развития здравоохранения Санкт-Петербурга до 2004 года. СПб., 2001
Состояние здоровья населения и деятельность здравоохранения Санкт-Петербурга / И. А. Красильников и др. // Мир медицины, 2001
Гладких П. Ф. Здравоохранение блокированного Ленинграда, 1941-1944 гг. 2-е изд., перераб. и доп. Л., 1985
Хромов Б. М., Свешников А. В. Здравоохранение Ленинграда: Крат. ист. очерк. Л., 1969 City Duma
Obukhovskaya Hospital
Botkin Memorial Hospital For Infectious Diseases
Army Medical Academy
Bekhterev Psycho-neurological Research Institute, The St. Petersburg
Union of Communes of the Northern Region
Pavlov Medical University
Paediatric Medical Academy
Medical Academy of Postgraduate Education
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