Hospital

Hospital (шпиталь; shpytal). Institution at which sick people are given medical and surgical treatment. The earliest hospitals developed out of hostels for pilgrims and travelers to Jerusalem that provided care for their sick guests during frequent epidemics. There were hospitals in Ukraine by the end of the 10th century. Under Prince Volodymyr the Great, free shelters, attached to monasteries and churches, for orphans, the homeless, the aged, and the sick were built. These were supported by a tithe. Metropolitan Yefrem founded several hospitals in Pereiaslav and other towns at the end of the 11th century. In the 15th–17th centuries some hospitals were maintained by the brotherhoods.

From 1775 hospitals in Russian-ruled Ukraine came under the control of social welfare departments, managed by local administrators elected by the gentry. Small hospitals for serfs were sometimes maintained on the estates of large landowners. In this period hospitals were charitable shelters rather than treatment facilities and they were few in number. The first hospital in the modern sense of the term was a 50-bed hospital for infectious diseases established in Kyiv in 1787, and the first hospital for somatic illnesses was established in 1803. During and after the Russo-Turkish War of 1787–91, a teaching hospital for training physicians operated in Yelysavethrad from 1788 to 1793. In this period hospitals appeared in Kremenchuk (1800), Poltava (1804), Cherkasy (1822), and a number of other towns. Gradually the local shelters were also converted into true hospitals.

With the introduction of zemstvo medicine the number of hospitals and hospital beds throughout the Russian Empire increased rapidly after 1864. Legislation introduced in 1866 required factory owners to provide hospital facilities for employees. In 1915 in Russian-ruled Ukraine, there were 617 gubernia and county hospitals, 21 municipal hospitals, 202 factory hospitals, 47 Jewish hospitals, 4 church-run hospitals, 26 hospitals run by volunteers, 4 run by the Red Cross, 66 private hospitals, 17 university hospitals, 16 hospitals run by the railroads, 68 prison hospitals, and 58 run by various other institutions and organizations. There were also 22 institutions for the mentally ill.

In Galicia and Bukovyna, which were under Austrian rule, hospitals were overseen until 1918 by the provincial authorities. In the 1920s and 1930s hospitals (including state, self-governing, community, and private hospitals) in Polish-ruled territories of Ukraine came under the jurisdiction of the voivodeship government.

In the Ukrainian SSR the typical hospital after 1947 consisted of an inpatient and an outpatient department. Hospitals were classified as general or specialized (infectious diseases, tubercular, psychiatric, gynecological, oncological, etc), some of which were attached to institutions of higher education or scientific research institutes. General hospitals in the Ukrainian SSR were officially classified in categories based on the range of services they offered and their administrative subordination. These categories included republic and oblast hospitals (offering the most comprehensive range of medical services), town and urban district hospitals, raion center hospitals, and rural district hospitals. In 1971, for the entire USSR, the average number of beds per hospital for each category was 613, 166, 156, and 31 respectively. Most hospitals in the Ukrainian SSR were controlled by the republic’s Ministry of Health, but some were under the jurisdiction of the USSR Ministry of Defense and such ministries as the Ministry of Transport, which retained considerable autonomy in providing health care to its employees.

The development of the hospital network in the Ukrainian SSR is summarized in the accompanying table. In general, the eastern oblasts were best supplied with hospital beds. According to 1985 figures, Kirovohrad oblast had 143 beds per 10,000 inhabitants, the city of Kyiv 138.9, Voroshylovhrad oblast 138.9, Donetsk oblast 135.9, and Dnipropetrovsk oblast 133.7. The worst-supplied oblasts were in the south and west: Transcarpathia oblast (114.9), Rivne oblast (119.4), Lviv oblast (120.4), Odesa oblast (123.2), Ivano-Frankivsk oblast (120.3), Zhytomyr oblast (123.6), Kherson oblast (124.8), Chernivtsi oblast (124.4), and Ternopil oblast (125.0). The low figure of 115.0 beds per 10,000 inhabitants for Kyiv oblast (excluding the city of Kyiv) was explained by the practice of transporting patients from various parts of the oblast to Kyiv for treatment. In 1985, the Ukrainian SSR, on the average, had 130 beds per 10,000 inhabitants, the RSFSR 126, and the USSR 120.8.

In 1960 over 20 percent of hospital beds were occupied by medical patients, 13 percent by surgical patients, and 10 percent by mental patients. Less than 10 percent of the beds were used by the following groups of patients: pregnant women and women in childbirth, women with gynecological disorders, children, and people with infectious diseases.

Despite the increases in the number of hospitals in the Ukrainian SSR in the 1970s and 1980s, especially in rural areas (by the mid-1970s almost every raion had a hospital with some 250–300 beds), there were shortcomings in the system. Many hospitals were severely overcrowded—in fact, increases in the number of beds were often a result of simply placing more beds in existing facilities—and overall sanitary conditions were often primitive, with clean bedding and sterilized or disposable equipment being in short supply. In addition, claims that health care was equally accessible to everyone in society were somewhat unfounded. The best hospitals in the USSR were in Moscow, and high Communist Party officials and employees of certain agencies (eg, the KGB and the Academy of Sciences) had access to special, and undoubtedly superior, hospital services.

BIBLIOGRAPHY
Materialy do istoriï rozvytku okhorony zdorov’ia na Ukraïni (Kyiv 1957)
Organizatsiia zdravokhraneniia v SSSR, 2 vols (Moscow 1958)
Ryan, M. The Organization of Soviet Medical Care (Oxford and London 1978)
Verkhrats'kyi, S. Istoriia medytsyny, 3rd edn (Kyiv 1983)

Toma Lapychak

[This article originally appeared in the Encyclopedia of Ukraine, vol. 2 (1988).]