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HISTORY OF THE ENT SPECIALIST FOR WARS

Otolaryngology as an independent surgical specialty was formed in Russia by the end of the 19th century. Prior to this, general practitioners provided medical assistance to the wounded in the active ENT army. By the beginning of the Russo-Japanese War, the first ENT departments in some military hospitals had already been organized in the Russian army; scheduled training of military and civilian ENT specialists had begun. However, the insufficient level of development of the economy, the healthcare system, and medical science did not allow satisfactorily organizing otolaryngological support for the troops by the beginning of World War I. In Russia there were only five ENT clinics, about 300 ENT specialists (with varying degrees of surgical training), only in two higher educational institutions of the country (Military Medical Academy and Moscow Higher Women's Courses) ENT specialty was included in the program for training doctors.

The official military medical documents and instructions did not provide for specialized ENT assistance to the wounded and sick in the army. I must say that some front evacuation hospitals have already been profiled as otolaryngological, but in most cases there were not enough doctors to equip their ENT. The main part of otolaryngologists worked in medical institutions of the rear. The largest centers for the specialized treatment of ENT for the wounded and sick were Moscow and Petrograd. In Moscow, by 1915, about 1,000 beds were deployed and filled with ENT by the injured. During the 2.5 years of the First World War, approximately 14 thousand wounded, shell-shocked and sick people passed through the ENT department of hospitals in Russia. Of these, 50.0-55.0% were returned to service.

After the civil war, along with other medical disciplines, otolaryngology was further developed. In 1922 she became a compulsory subject of teaching at medical schools. In 1937, there were already 2,000 ENT doctors in the country, 51 ENT departments, 4 research institutes, and more than 4,000 stationary ENT beds.

The experience gained by military otolaryngologists was systematized and summarized in the monograph of Professor V.I. Voyachek "Selected Issues of Military Otolaryngology" (1934), which was the first systematized work in the world in this area. The supply of medical equipment to the army is improving. So, in equipping regimental medical points (PMP) and medical facilities of hospital bases, sets of ENT tools are introduced.

The experience of the hostilities of the Soviet-Finnish war, military conflicts near Lake Hasan and on the Khalkhin-Gol River showed that wounds to the head most often turned out to be combined. In this regard, the question arose about the creation in the GBA and GBF of specialized hospitals and reinforcement groups (consisting of a neurosurgeon, dentist, ophthalmologist and otolaryngologist) to work together to provide medical care to such wounded. However, during this period, there was an opinion among military surgeons that ENT assistance at the stages of evacuation is not mandatory. Therefore, no groups were introduced into the ORMU ENT department, and the inclusion of special ENT instruments sets in surgical equipment sets for medical evacuation stages was considered inappropriate (1940).

Consequently, before the Great Patriotic War there was no complete system of organizing medical care for ENTs for the affected and sick, provided with special staff and medical services at the stages of medical evacuation. This system was improved during the war as follows. Until the end of 1942, specialists, as a rule, were absent in medical institutions of the army and front of the ENT. Most of those affected for specialized treatment were evacuated to hospitals in the rear of the country. Since injuries of ENT organs were mainly of a combined nature, injured with damage to ENT organs at the stages of medical evacuation were treated by dentists, ophthalmologists, and neurosurgeons. These specialists, due to insufficient training in the field of ENT surgery, could not provide ENT to the wounded with full specialized assistance. This situation often led to defects in surgical work, required repeated operations, affected the quality and extended the treatment of ENT of the wounded, and increased dismissal from the army. Therefore, life itself dictated the need to strengthen otorhinolaryngological care in the army.

In March 1942, the post of chief otolaryngologist of the Soviet Army was introduced. They became professor G. G. Kulikovsky. Then the posts of contingent army, and since 1944, front-line chief ENT specialists, were introduced. K.L. Khilov, M.I. Svetlakov, V.G. successfully worked at these responsible posts. Ermolaev, A.R. Khapamirov, S. M. Gordienko and others. The medical staff of the sorting and evacuation hospitals, army and front-line hospitals for lightly wounded includes the posts of otorhinolaryngologists. Intensive training of ENT specialists is underway, and ENT doctors are being transferred from administrative to medical posts.
Military medical institutions are equipped with sets of ENT instruments. The direct organization of medical care and treatment for otolaryngological wounded and sick was carried out in the following order.

In the military district (PMF, DMP, first-line KhPG) medical care for ENT injuries was provided by general practitioners mainly for health reasons. This assistance included tracheotomy, stopping bleeding, fighting shock and swallowing disorders.

In the army district, specialized medical assistance was provided to the ENT for the affected and sick for up to 30 days. The treatment was carried out in the hospital for the wounded in the head, hospitals for the slightly wounded (GLR), in which the necessary ENT forces and equipment were concentrated.

ENT patients affected with an estimated treatment period of up to 60 days. were sent to the EG for the wounded in the head, neuropsychiatric hospitals, FGLR.

ENTs of affected and patients requiring complex surgical interventions and long-term treatment (over 60 days) were evacuated to medical facilities in the rear of the country (ENT department of evacuation hospitals, ENT department of medical institutes, ENT department of large rear military hospitals and hospitals). The correct ways and forms of organizing specialized care for affected ENT patients led to a significant improvement in treatment indicators during the Great Patriotic War compared with the period of the First World War. Last war 87.5% of the ENT of the wounded, 91.0% of the ENT of the shell-shocked, 94.5% of the ENT of the patients were returned to service.

At the same time, the experience of the Great Patriotic War showed an extremely great dependence of specific forms of organizing medical and evacuation measures on the combat, rear and medical situation, which was repeatedly emphasized during the war in directives and service letters of the Main Directorate of the Red Army. They said that the amount of work and the choice of method of surgical intervention and treatment are determined mainly by the situation at the front, the number of incoming wounded and sick, their condition, the number of doctors, especially surgeons, at this stage, the availability of vehicles, field medical institutions and medical equipment , season and weather conditions.

With all its advantages, the system of staged treatment with evacuation for the designated period of the Great Patriotic War was not without some drawbacks. These include the need to re-provide surgical assistance to the wounded, due to the impossibility of conducting comprehensive surgical interventions at the military stages of medical evacuation and surgical field mobile first-line hospitals. At that time, there were also no means that delayed the development of infection in the wound, the modern use of which allows delayed surgical treatment in specialized medical institutions.

The second most significant drawback of the medical evacuation system was the multistage nature of the evacuation of the wounded (patients) and the provision of medical care. Most of the wounded and sick at that time passed sequentially not only all military stages of medical evacuation (PMP, DMP, or first-line KhPG), but also a number of echelons of hospital bases of the army and the front, performing approximately the same amount of specialized medical care. Such a multi-stage process was caused not only by the impossibility of comprehensive simultaneous surgical care, but also by the existing evacuation procedure. The main means of transporting the wounded and sick in the front lines of the country was rail. At the same time, there were different types of it (military sanitary bombs, temporary and permanent military sanitary trains) operating on different sections of the railroads, which inevitably led to a consecutive transshipment of evacuated from one type of railway transport to another and to the need to deploy in places of this overload appropriate echelons of army or front hospital bases. The medical service during the Great Patriotic War had a limited number of ambulance aircraft, which excluded the possibility of organizing the evacuation of seriously wounded, in which they directly entered the echelons of hospital bases located at a great distance from the front line, bypassing the echelons preceding them. The multi-stage evacuation negatively affected the results of the treatment process, increasing the duration of treatment and contributing to worsening outcomes. This, in particular, is evidenced by the data of a statistical analysis of the dependence of treatment periods on the number of stages of medical evacuation completed by the wounded. So, with injuries of the upper extremities with damage to the hand with an increase in the number of stages of medical evacuation from three to seven, the treatment period was extended by almost 49 days, and with injuries of the lower extremities by more than 58 days. All this required further improvement of the system of staged treatment of the wounded and sick.
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HISTORY OF THE ENT SPECIALIST FOR WARS

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