World War for its bloodshed and duration surpassed all the wars of the XIX century combined. This led to a sharp increase in combat losses. Unfortunately, we still have a rich experience of that war, which has been studied very little in contrast to the countries of Western Europe and the USA. Archival materials are almost completely lost. But Russian military medicine entered the twentieth century, having serious achievements.
By the beginning of the new century, a decentralized multi-departmental health care system was formed in Russia. Along with public health, they were engaged in local and city governments, private and public organizations, and charitable institutions. There were factory, military, maritime, insurance, prison and other forms of medical care.
In 1908 – 1915, the position of Chairman of the Medical Council was held by Honorary Life-Surgeon, an outstanding obstetrician-gynecologist, Academician of the Imperial Military Medical Academy (IVMA) Georgiy Ermolaevich Rein. He proposed to establish in Russia the General Directorate of Health. The Rhine project met with resistance from the Pirogov Society and many figures of rural medicine. However, thanks to the patronage of Nicholas II, Rhine secured a decision on the allocation of the health care system to 1916 since September.
The State Duma insisted on the cancellation of the decision of the emperor, and in February 1917, the academician, withdrew his bill. Nevertheless, from September 1916, de facto, George Rein was the first and only Minister of Health in pre-revolutionary Russia. As is known, the Bolsheviks six months after the October Revolution began the construction of Soviet health care also with the establishment of the appropriate People's Commissariat.
During the first year of the war, only the officer losses of the Russian army amounted to 60 thousand people, as a result of this time, almost no one left 40 thousand of pre-war cadres. In September, the rare front-line regiments of 1915 (three thousand soldiers each) had more 12 officers. In anticipation of the great losses and the most difficult tasks assigned by the war to the medical service, a decision is made to establish a single governing body. 3 (16) September 1914, order No. 568 for the military department creates the Office of the Supreme Chief of the Sanitary and Evacuation Unit headed by a member of the State Council, Adjutant General Prince Alexander Petrovich of Oldenburg, endowed with the broadest rights and powers. The order stated: “The supreme chief of the sanitary and evacuation unit is the highest chief of all organs, organizations, societies and persons of the sanitary and evacuation service both in the theater of operations and in the inner region of the empire ... His special character unites all kinds of sanitary and evacuation activities in the state . His duties concerning this activity are carried out by all officials and all people without exception as the highest ... ”
Such powers of the Prince of Oldenburg, subject to their full implementation, ensured the absolute unity of military medicine management, which was an unprecedented phenomenon. While in the theater of military operations, Alexander Petrovich submitted to the Supreme Commander, and outside the theater of operations, directly to the emperor. 20 of September (3 of October) 1914 of the year by order of the Supreme Commander No. 59 at the army headquarters formed sanitary departments, the heads of which were directly subordinate to the head of the army, and the specialty - the head of the sanitary part of the army of the front.
Having entered into the execution of their duties, the supreme commander of Russian military medicine personally familiarized himself with the formulation of the case locally, having made a detour of the front, the rear area and the largest centers of the internal region located along the evacuation routes. The Prince of Oldenburg reported to the king in his report 3 (16) of September 1915: “The impression from the first detours was unfavorable. With a very complex organization, the business was hampered mainly by the lack of proper unity among the commanding officers ... Excessive multitask, which was actually reduced to a beginninglessness, formalism and a tendency to interdepartmental and personal friction prevented the establishment of proper interaction. ” In this regard, the prince decided, first of all, to achieve coordinated actions of his department, the Russian Red Cross Society and the new public organizations that emerged during the war - the All-Russian Zemstvo Union and the All-Russian Union of Cities.
Not being a doctor, the Prince of Oldenburg relied on his closest consultants, among whom were surgeons Roman Romanovich Vreden, Nikolai Aleksandrovich Veliyaminov, Sergey Petrovich Fedorov, and other prominent figures in Russian medicine in solving fundamental issues. In the office of the supreme chief of the sanitary and evacuation unit there was a medical department, which included experienced medical doctors. According to Velyaminov, the prince always extremely quickly responded to his advice on various issues of medical support for the troops. He listened attentively to the opinion of specialists, summarizing their recommendations in the form of orders.
The underestimation of the scale of the war and combat losses led to the fact that in the first year there was an acute shortage of a bed network to accommodate a huge flow of wounded and sick evacuated from the front. K 1 (14) November 1915-th capacity of this network has expanded. By the end of the war, the number of beds in medical institutions exceeded one million and was quite sufficient. The average bed turnover is 70 days.
The military medical unit's bed net made up only 43,2 percent of the total capacity, while 56,8 percent accounted for the Red Cross and other public organizations. The distribution of beds between the theater of operations and the interior of the country was not entirely rational. Two thirds were deployed in the rear, and only one third were on the fronts, which predetermined the “evacuation by all means” system that prevailed throughout the war.
The main stages of the medical evacuation of the wounded and sick were:
- the forward dressing station deployed by means of the regimental infirmary in the rear of the regiment - first aid to the injured, surgical operations for life, feeding the wounded and sick;
the main dressing station deployed by the division dressing unit behind the dressing points as close as possible to them but outside the scope of fire (its removal, like the advanced dressing squad, was not regulated, but usually the forward units were deployed 1,5 – 5 kilometers from the front line, and the main ones - in 3 – 6 kilometers from advanced dressing stations) - the provision of emergency surgical and general medical care, temporary accommodation and care of the wounded before sending them to the next stage. Sort the wounded into four categories:
returned to the system, following to the rear on foot, evacuated to medical institutions and non-transportable. According to Nikolai Nilovich Burdenko, the percentage of operability of the wounded here ranged from 1 to 7. Vladimir Andreevich Oppel and a number of other front-line surgeons insisted on a greater expansion of the surgical operations of the main dressing stations. In their opinion, the percentage of operability here could be raised to 20 while reinforcing divisional dressing points due to advanced detachments of the Red Cross and other public organizations. In practice, this was rarely achieved;
-Lazards of the division, two of which were deployed in the rear for the wounded and sick, who did not need long-term treatment, according to the decision of the division doctor and the commander - treatment giving hope for recovery, surgical and general medical care of hospital character. Most often they were used to treat lightly wounded and sick;
-Head evacuation point, deployed at the main railway station by order of the head of the sanitary unit of the front armies (later the right to move them was given to the heads of the sanitary departments of the army headquarters); medical institutions of the rear area, the direction of infectious patients on the instructions of the head of the sanitary part of the army.
Circumstances forced the formation of additional stages of medical evacuation:
- dressing and nutritional centers, organized in winter and with a significant length of escape routes, most often with the help of forces and means of public organizations;
Army receivers deployed at railway stations and at sites of unpaved evacuation routes and “improvised” by means of military medical and public medical institutions in cases where the wounded and sick were evacuated from military units to several railway stations that could not be provided with head evacuation points.
This general scheme of organizing the treatment and evacuation of the wounded and sick in different armies and fronts under different conditions of combat and rear environment changed and was not fully maintained, as a rule.
First aid was provided by a company medical assistant. The search for the wounded and their removal from the battlefield, first aid, and delivery to the dressing stations were assigned to regimental and divisional porters, the number of which in the states was quite sufficient. In each regiment (16 mouth) there were 128 (eight in a company), in four shelves - 512, in the dressing unit of the division - 200 people. Thus, the division had 712 porters, excluding the artillery brigade, where there were six, and two orderlies in each battery. Despite this, the timely and complete removal of the wounded was not always ensured, especially in heavy fighting, under adverse terrain conditions and bad weather conditions. In such cases, the removal of the wounded was often delayed for several days. Great losses among the porters were made up for with difficulty.
For the evacuation of the wounded and sick infantry divisions, the state relied on 146 gigs (in the infantry regiment - 16). During the war, the number of full-time equestrian sanitation vehicles was increased to 218, which made it possible to improve the transportation of people who were injured on unpaved escape routes. By the beginning of the war, the auto ambulance consisted of only two cars, but by July 1917, there were 58 military troop units on the fronts, in which 1154 ambulances were listed. In addition, the fronts served 40 auto-sanitary units of public organizations with 497 machines. The pack transport was not prescribed by the mobilization plan and its formation began only in 1915, when it was urgently necessary to ensure the evacuation of the wounded and sick in the mountains of the Caucasus and the Carpathians. Created 24 baggage sanitary transport (in January 1917-th 12 of them were in the formative stage).
The evacuation of the wounded and sick has reached an unusually large size (full information about this is missing). From August 1914 to December 1916 alone, over five million sick and wounded officers and soldiers were delivered from the front to the rear medical-evacuation facilities, which amounted to almost 117 thousand people per month. Of the arrivals, two and a half million people (43,7 percent) were dispatched to inland areas, not counting those who left by direct transit trains. In the hospitals of the rear areas there were more than three million people before the final cure. Mortality among soldiers here was 2,4 percent in patients and 2,6 percent in wounded; mortality among sick officers - 1,6 percent, among the wounded - 2,1 percent. About 44 percent returned from among sick soldiers, 46,5 percent from injured, about 68 percent from injured officers, 54 percent from injured.
By February 1917, apart from the Caucasus, 195 field mobile and 411 reserve hospitals of the military medical department, 76 field hospitals, 215 advanced units and insignia, 242 equestrian transport and 157 disinfection units ROKK and other societies of equestrian transport and XNUMX disinfection units ROKK and other societies of equestrian sanitary facilities and XNUMX disinfection units ROKK and other societies of equestrian sanitary facilities and XNUMX disinfection units ROKK and other societies of equestrian sanitary vehicles and XNUMX disinfection units ROKK and other social organizations In the inner area, medical-evacuation work was carried out by distribution and district points.
To ensure the railway evacuation, the mobilization plan envisaged the formation of 100 military-sanitary trains. In fact, during the mobilization period, only 46 was formed; by 12 (25) of September 1914, there were 57 military trains and 17 sanitary trains of public organizations. However, at the beginning of the 1915 train there were more than 300, and in December 1916 operated around 400.
To send infectious patients, special sanitary trains were allocated, which unloaded infectious patients into infectious hospitals deployed in large cities of the front and inner regions, with a total capacity of 12 thousand beds. ROKK was engaged in evacuation of the mentally ill, their transportation was carried out in specially equipped cars. There were departments for mental patients in military hospitals and medical institutions of public organizations. Often, the mentally ill, who arrived from the front, were sent to civilian psychiatric hospitals.
On 15 (28) of September 1917 of the year, there were the following number of staffed places for the wounded and sick: about 14,000 62 thousand in the compound’s hospitals, more than 145,000 in the army area, over 10,000,000 248 in the inner area, thousand, total - about 427 thousand, not counting the seats in convalescent teams. If we take the number of active army at this time for 883 million people, then the number of full-time beds will be quite sufficient, because the annual losses of the active army by the wounded did not exceed 6,5 million people.
New challenges and key achievements
In 1917, the Chief Field Medical Inspector of the Russian Army, Nikolai Aleksandrovich Veliyaminov, wrote instructions on how to organize assistance to the wounded at the front. On the experience of the war, Vladimir Andreevich Oppel developed a doctrine on the staged treatment of the wounded and sick in the war, which became the starting point in the creation of Boris Konstantinovich Leonardov and Efim Ivanovich Smirnov of the staged treatment system with evacuation according to its intended purpose.
Oppel defined the three main tasks of the medical service during the war: returning the maximum possible number of injured to the shortest possible time, maximizing disability and maintaining working capacity, and preserving the life of the largest number of injured. Vladimir Oppel formulated the essence of the staged treatment as follows: “A wounded person receives such a surgical allowance when and where and when such a need is found; the wounded man is evacuated to such a distance from the battle line that is most beneficial for his health. ”
The concept of Oppel Efim Smirnov considered lifeless in a war. “In the Opplean definition of staged treatment,” wrote Smirnov, “there is surgery and competent surgery, there is a wounded person, but there is not a word about war, about the combat situation, and this is the main thing.” This disadvantage of the Oppel study was subsequently corrected, but its essence is the close combination of evacuation with treatment, their fusion into an inseparable process formed the basis of the modern system of medical-evacuation support for the troops.
The First World War put forward a number of fundamentally new tasks for military medicine in connection with the emergence of new weapons of warfare - chemical warfare agents, aviation и tanks. On May 18 (31), 1915, Germans applied phosgene for the first time in separate sections of the North-Western and Western Fronts. More than 65 thousand people suffered from toxic gases (among them was the writer Mikhail Zoshchenko). Of the victims, more than six thousand people died in the military district. For the 12 largest gas attacks, the total mortality rate of the victims reached about 20 percent. The initial means of protection against toxic gases were bonfires that lifted them up, pieces of cloth moistened with water and applied to the nose and mouth. The production of protective dressings impregnated with hyposulfite was quickly adjusted. In June 1915, the Prince of Oldenburg reported: "Only about eight million dressings have already been sent to the army."
The position of the medical staff of the army during the first gas attacks was truly desperate. Doctors, medical assistants and orderlies did not know first aid measures and had no means of protection. The removal of victims from the battlefield during the gas attack, their rescue seemed almost impossible. Any attempts led to the death of nurses.
The production of more advanced remedies went slowly. The industrial committee selected a filtering gas mask based on the use of activated carbon from several samples. The first batches of these gas masks went to supply the officers and non-commissioned officers, then the soldiers also received them. Subsequently, the poisoned were taken away from the battlefield by divisional porters to special shelters, and medical assistance was provided to them at regimental and main dressing stations, in divisions' hospitals and hospitals. When evacuating the victims, they usually changed their clothes and underwear.
The sanitary and epidemic state of the Russian army during the war years, thanks to a fairly rational organization of anti-epidemic measures, was relatively good. From August 1914 to September 1917, the army has been diagnosed with typhoid fever, dysentery, cholera, typhus, relapsing fever, and smallpox. None of the acute infectious diseases has become threatening. Russia in this war did not know major epidemics of infectious diseases, either in the army or among the population. Of the non-communicable diseases, scurvy was the most common. During the war years with this diagnosis, more than 300 thousands of people were hospitalized.
Accurate information about the military sanitary losses of the Russian army during the First World War is not due to the contradictory reporting data during the spontaneous mobilization of the army and the Civil War. On the day of mobilization, the total number of the Russian army was about one and a half million people. Total until February 1917, mobilized about 15 million people. The current army on 1 (13) of September 1917 was determined by 6 million 372 thousand people, moreover, in public organizations serving the army, 2 million 678 thousand were listed.
The main achievements of the Russian military medicine during the First World War can be considered:
-creation of mobile surgical teams, groups and other types of mobile reserves;
-increase surgical activity at the main dressing stations;
-the emergence of specialized medical care (eye detachments, departments and hospitals for maxillofacial injuries, medical institutions for light wounded);
- rapid development in the existing army of automobile ambulance transport;
-generation and development of the army level of medical service with receivers on the railway and in the nodes of unpaved escape routes;
-creation of a well-equipped railway sanitary transport;
- introduction of compulsory vaccinations against typhoid and cholera, as well as a traveling disinfection chamber and laboratory equipment at the fronts;
-creation of an extensive network of isolation and observational points on the railway and water evacuation routes;
-the formation of infectious hospitals - barriers in the ways of communication from the spread of the epidemic;
- organization of bathing and laundry services for troops on the fronts (during the positional period of the war);
- the creation and development of means of protection against chemical warfare agents;
-the creation of mobile stocks of medical equipment in divisions and corps;
-relatively widespread use of x-ray installations in the field;
-developing teachings on the staged treatment of the wounded and sick in war conditions.
Unfortunately, the views on the First World War in the Soviet period have changed significantly. From domestic and just it has become imperialistic. For decades, everything was done to destroy the memory of her in the national consciousness. Meanwhile, more than a quarter of the casualties of the murdered Kaiser Germany were received in battles with the Russian army.