В статье рассматривается эволюция требований, предъявляемых к проектам медицинских учреждений, в частности военных госпиталей с 1731 года до настоящего времени. Автор рассматривает эволюцию отдельных требований (месторасположение, конструктив, вентиляция и пр.) и развитие всего процесса проектирования. В работе собраны материалы из различных источников (архивные материалы, свод законов Российской империи, СНиП и СанПиНы).
Ключевые слова: военные госпитали, нормативы, требования, история
In the 11th century in Kievan Rus' was published the first order that regulated construction processes. This document represented by itself the first Russian Code of obligatory construction requirements. Much later, in 1737 during Peter the Great reign in Russia the Construction Code «A position of architectural expedition» was issued. Regulating rules of construction practice and theoretical canons, an order of preliminary consideration and the approval of projects built at the expense of the state budget and so on were included in this Code. Duties of «the engineer and the military architect» included the decision not only technical, but also economical and construction tasks which in some cases are indissoluble.
The first instructions concerning the structure of medical institutions, their states, and salary of medical staff were represented in the decree of the Senate of April 5, 1722, «Regulations about management of the Admiralty and shipyard» and «Regulations about hospitals». Originally these documents were related only to fleet staff, but in connection with formation of the mining industry in the Urals they began to be use as practical guidance and in this branch too.
With development of the weapon and combat methods, increasing of number of soldiers in army, has appeared the new type of medical facility — field infirmaries, they were created for providing first aid as close as it possible to the place of the fights. For place of location of the hospital is given the following explanation: "… in summertime, when a regiment in soldier's tents and when circumstances are permitted, infirmaries could be set in the wooden sheds, and in winter time in winter-apartments… or in the detached houses or in the village …" (Full collection of laws of the Russian Empire,1830).
In 1764 (in the law No. 12.017 of the Code of laws of the Russian Empire) expenses of construction of hospitals are shifted to local government (Full collection of laws of the Russian Empire, 1830).In 1789 was published a new provision about construction of hospitals, in it a number of requirements to health facility construction has been fully described and consisted from 11 points. Analyzing these requirements, we can find their echoes in modern construction norms.
The first paragraph of the provision says: «For creation of the hospital elect position on the sublime place, not surrounded by marsh places, far from housing living zone …to North side of it» (State Archive of Sverdlovsk region, case № 2779). Today we can name it the first requirement to placement of the hospital building in the city. Still there is a tendency of placement of health facilities on suburbs for reduction of risk of their destruction in case of carrying combat operations. On the other hand this requirement is expedient to isolate patients, and in dangerous cases not to allow developing of infection disease.
The second paragraph of the provision speaks about dependence from clear water: «Try as much as possible to place hospital near flowing clear and healthy water» (State Archive of Sverdlovsk region, case No 2779). This phrase is a prototype of the modern requirement to water supply. Place of location is described: "… the North side has to be protected by a grove…", it is a requirement to a landscape. The grove also is suitable place for walk for patients and natural protection against noise, thereby providing full-fledged rest of patients. Also an architect should provide “… the place for a kitchen garden nearby the hospital building»(State Archive of Sverdlovsk region, case No 2779).
«The building for a hospital has to be elongated, the facades to the East and the West turned» — the requirement for insolation and orientation according to cardinal directions. Oblong shape assumes the corridor scheme of the plan which prevails in hospitals of that time.
«It’s arrangement has to be such that the air flow was free, and therefore … the yard should not be blocked» — the requirement to aeration and ventilation. Meeting these requirements, the architect could prevent spread of an infection from one patient to others in the airborne way (State Archive of Sverdlovsk region, case No 2779).
In order to avoid spread of infectious diseases subdivision is provided: «for external; feverish and fevers of obsessed; venereal; phthisis; recovering. For a female is necessary to organize the small extension». It is especially noted that «The ward for infectious diseases shouldn't have any connection with other wards… especially the linen, a bed, ware… all that can only give a chance for spread of an illness» (State Archive of Sverdlovsk region, case No 2779). Such care is guarantee of suppression of spread of an infection.
According to the standard in the hospital has to be «banya and the bathroom and both of them should be divided into two parts from which one to serve only the patients with an infectious illness». The first health requirement which will become a prototype of a modern sanitary code.
Among the main rooms are named: «Kitchen, a bakery, a dry cellar, a freeze box, a hangar, room for storage of edibles and another for any various ware, the storeroom for linen for beds» (State Archive of Sverdlovsk region, case No 2779).
For regulating of civil engineering processes in 1811–1812 were developed Fixed Registers. These documents contained consumption norms of labor, vehicles and materials. In 1828 was published the law (No. 1889) about constants hospitals and it included the first classification of military hospitals on classes and their bed quantity.
Chapter 1 of this law is devoted to division of military hospitals into 6 classes according to the number of normal and emergency places: "… in 1 class — 100 normal and 50 emergency places, to 2 class 250 normal and 50 emergency, to 3 class 500 normal and 100 emergency, in 4 class 1000 normal and 200 emergency, in the 5 class 1500 normal and 300 emergency, in 6 class 2000 normal and 500 emergency». (over these norms, for reception and treatment of sick officers it is necessary to have special wards in hospital).
Next year, new law No 3010 was issued, in this law was given classification and bed quantity for field infirmaries: "… in infantry regiments consisted from 3 battallions, in everyone for 84 people … In cavalry, in everyone for 42 people …" (Full collection of laws of the Russian Empire, 1830).
In 1837 The Ministry of Internal Affairs of the Russian Federation has issued new document — «The Construction Order». It contained some quantitative standards obligatory to application in design. «Fixed registers» was repeatedly revised for the purpose of his specification, and mainly, decreasing of norms. In 1869 it has been approved by the government and has captured all questions of construction production. Introduction of new equipment, improvement of quality and depreciation of construction was the purpose of this document. It was considered as the united legislative document.
In 1851 was published addition to the law No.24781 «About organizing of hospital buildings» where detailed rules for economic, medical, pharmaceutical, and reporting parts of management of medical institutions of civil department were considered. These rules in many aspects repeat the rules of 1789 described in this article earlier.
By the first point it was instructed that the place for the hospital should be verified with the appointment made in the approved city map and an architect should be guided by the rules accepted in general for medical facilities: "… the place chosen for construction of the hospital building has to be a little sublime, plain, not closed by mountains and the woods, remote from lakes, big ponds, bogs and extensive sand; not close to slaughters and factories or plants … not in the middle of the city, but as it is possible not in a long distance from him; … such place where there would be a fresh air and close healthy flowing water …" (Full collection of laws of the Russian Empire, 1830).Comparing to requirements of 1789, we can notice a difference — the requirements to clean air and coordination of placement with local government were added.
The stone (in requirements of 1789 there was no instruction about materials) becomes the main material for construction of hospitals: "… has to build buildings for hospitals preferably stone with iron roofs; in case of shortage to make construction from a tree, on the stone base, with an iron or tile roof» (Full collection of laws of the Russian Empire, 1830).
In chapter two «About organizing of hospital buildings» it is said about placing of the main building of hospital in the yard in order to avoid dust and noise from passing and passersby and if it was possible to plant the yard with bushes and trees, especially if at hospital there was no garden.
To the main rooms of hospital in the new law were added:
‒ accident ward, rooms for a drugstore
‒ restroom for hospital staff
‒ room for the storage of clothes and other things belonging to patients
‒ room for storage of bodies of the dead
‒ rooms for a residence of public servants
‒ sheds for crew, stables,canopies for fire tools
It is important to note that so far to rooms the concrete areas weren't specified.
As it was in provision of 1789, we also could find requirement on which it is necessary to provide zoning for patients with internal diseases, for patients with external diseases, for patients with infectious diseases, for psora patients, for stink patients.
For the first time in requirements of 1851 mentioned necessity of the organization (or proximity) of the churches: «In the big hospital facility having a sufficient area, should be organized the church in hall or in the special ward…".
Also the concrete height of ward is specified in law No 24890: «height of wards has to be more than 5 and ½ arshina (about 4 meters) from a floor», according to cardinal directions: "… it is possible to arrange windows to the southeast, except south cities where they should be turned to the northwest». Orridors as to the new law have to be arranged warm, width 3 ½ to 4 arshin (2,5 from 2,8 m), with the stone arches and doors with glasses in hospital wards. (Full collection of laws of the Russian Empire, 1882). The drugstore has to consist actually from three parts: prescription, drugs and kitchens. There has to be a room for the pharmacy manager connected with a drugstore and servants. At a drugstore should be placed one cellar and one freeze box for storage of the drugs.
In an accident ward have to be «one or two beds, a bathroom, a table, a chair, and a case with the necessary quantity of linen, footwear, and a case for some medicines and surgical tools».
In 1912 was issued law No 56405 about new classification of constant military hospitals and their division into departments (Full collection of laws of the Russian Empire, 1914).
The hospital in the medical relation is divided now according to the major medical specialties into 5 main hospital departments — therapeutic, surgical, eye, venereal and highly infectious.
Air temperature according «to Reaumur's thermometer have to be 14 degrees in wards and the dining room in which ordinary there are sick patients, in corridors — 12 degrees, and in other parts of the building — to correspond to their appointment» (Full collection of laws of the Russian Empire, 1914).
In the twenties of the last century were done several attempts to adapt «Fixed registers» for new conditions, and then was carried out its radical revision. In 1927–1930 was published new document «The code of industrial construction standards”. Building Code has appeared in 1954–1956.
In Building Code issue from 1954 we can find the following innovations (Building Code, 1954),
‒ was established fire resistance of building depending on number of stores and appointment;
‒ was described the engineering system (a central heating, hot water supply, ventilation system);
‒ were described requirements to the area;
‒ was defined the limit quantity of beds in wards;
‒ was described the organization of pathoanatomical department;
‒ was described the organization of a sanitary entrance for staff;
‒ was specified orientation of rooms according to cardinal directions;
‒ were set parameters of illumination and frequency rate of air exchange;
‒ were described conditions of elevators arrange.
In 1970 was published new Building Code «Hospitals and policlinics. Requirements to design» where were introduced the concept of sanitary gaps between wards. In 1978 was published new document «Treatment and preventive establishments».In the eighties of the last century the new type of medical facility- — mobile hospital appears in Russia. Thanks to convenience the new type quickly gains popularity and further several main types develop.
In 2003 was published the Building Code No 188.8.131.525–03 «Medical facilities. Hygienic requirements to placement, the arrangement, the equipment and operation of hospitals, maternity hospitals and other medical hospitals». B 2010 were approved Sanitary Norm and Requirements No 184.108.40.20630–10 «Sanitary and epidemiologic requirements to the organizations where is carrying out medical activity».
In 2010 was approved Building Code No 31–06–2009 «Public buildings and constructions» (instead of Building Code No 2.08.02–89 *) on the basis of which design of medical institutions has to be carried out (Building Code, 2009).
In 2014 the new normative document Building Code 158.13330.2014 «Buildings and rooms for health care facilities. Design rules” was approved.
During studying of key stages in the history of development of norms for design of hospitals authors have found out that design of the first public medical facilities has arisen for the military purposes, for service of army. Initial obligatory requirements to design and construction of hospitals were limited to only eleven points and left a scope for works of architects. Today the first requirements evolved in the relevant standards, Building Code, Sanitary Norms, to the first standards were added hundreds of requirements, restrictions and recommendations received during 300 years' operating experience that have to be observed at design of medical facility.
- Building Code (1954), ‘Norms and Regulations of construction design’, Moscow, Russia.
- Building Code (2009), № 31–06–2009 «Public buildings and constructions» (instead of 2.08.02–89)
- Full collection of laws of the Russian Empire (1830). First edition (1649–1825), Available at http://www.nlr.ru/e-res/law_r/search.php, accessed 23 May 2016.
- Full collection of laws of the Russian Empire (1882), Second edition (1825–1881) Available at http://www.nlr.ru/e-res/law_r/search.php, accessed 23 May 2016.
- Full collection of laws of the Russian Empire. Third edition (1914) (1882–1913), Available at http://www.nlr.ru/e-res/law_r/search.php, accessed 23 May 2016.
- State archive of Sverdlovsk region. SASR. Fund 24, 1T 2, case № 2779. “Case of drugstores and hospitals”.
- СНиП II Нормы строительного проектирования. –М: Государственное издательство литературы по строительству и архитектуре, 1954 (не действует).
- СНиП 31–06–2009 «Общественные здания и сооружения» (взамен СНиП 2.08.02–89*)
- Полное собрание законов Российской Империи. Второе собрание (1825–1881). 1882, [Электронный ресурс]. — Режим доступа:http://www.nlr.ru/e-res/law_r/search.php, свободный. — Загл. с экрана. — Яз.рус.
- Полное собрание законов Российской Империи. Первое собрание (1649–1825). 1830, [Электронный ресурс]. — Режим доступа: http://www.nlr.ru/e-res/law_r/search.php, свободный. — Загл. с экрана. — Яз.рус.
- Полное собрание законов Российской Империи. Третье собрание (1882–1913). 1914, [Электронный ресурс]. — Режим доступа:http://www.nlr.ru/e-res/law_r/search.php, свободный. — Загл. с экрана. — Яз.рус
- Государственный архив Свердловской области. ГАСО. Ф24, 1Т2, 2779. Дело об аптеках и госпиталях.