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The organization of mental health services and structure of mental disorders of the military personnel of the Red Army in days of the Great Patriotic War


UDC 616.89 (091)


V.K. Shamrey, G.P. Kostiuk, A.G. Chudinovsky, A.G. Sinenchenko

Army medical college of S.M. Kirov, St. Petersburg

To studying clinical aspects of fighting mental pathology, the organization of mental health services to staff, sizes and structures of sanitary losses of a psychiatric profile the special place in numerous works of domestic and foreign authors was always allocated. However on this problem and now there is no uniform frame of reference. On the one hand, in the last decades the number of armed conflicts and local wars sharply increased, with another - the structure of sanitary losses towards increase in frustration of boundary level (significantly changed at considerable reduction of reactive psychoses) that caused need of introduction of amendments both in the organization of rendering mental health services, and in training of military psychiatrists. At the same time, the organization of mental health services is defined not only by structure of sanitary losses, but also the nature of fighting, the involved medical forces and means (especially, in the advanced area) and also the political goals of armed conflict which are directly reflected in a moral and psychological condition of staff of belligerent parties. The successful solution of a problem of creation of conceptual model of the organization of mental health services in local wars and armed conflicts is impossible without analysis of experience of its rendering in wars of the 20th century, first of all in the Great Patriotic War.

Results of a research

For the first time in world practice domestic psychiatrists organized the structured mental health services to the military personnel of warring army during the Russo-Japanese war (1904-1905) [32]. The main attention, at the same time, was paid not so much to improvement of the stationary help in mental health facilities of the back of the country, how many assistance

the insane to soldiers directly around fighting. Fighting during this period was considered as a special pathogenic factor, combining mental and physical traumatization that fixed a concept in the subsequent "contused" and allowed to prove need of creation of the staff of neuropsychiatrists for field army. Thus, the basic organizational principle keeping the relevance and now was formulated

>- approach of mental health services to the advanced area [2, 5, 32].

At the same time, the experience of the organization of mental health services to the military personnel of warring army in the subsequent wars got in the years of the Russo-Japanese war including during the Great Patriotic War, it was not used, generally because by the beginning of the Great Patriotic War in the Red Army the acute shortage of military psychiatrists was noted and also there were no specialized medical psychoneurological institutions. In many respects it was caused by the "special" relation to military psychiatry during the pre-war period when the mental health service in army was almost liquidated by the orders Narkomzdrava as on submissions of the political guide of that time "mental diseases in army collective during an era of great transformations should not be", respectively, and prospects "in treatment mentally sick and their preservation for military service" did not seem [24]. It is not accidental that existence of mental violations among the military personnel was in every possible way leveled, or they were considered as colorable behavior, issues of disciplinary and even criminal liability of "neurotics military personnel" were quite often discussed. The similar relation also became the reason for the developed personnel situation when training of military psychiatrists actually stopped. Scientific research in the field of a military psikhiat-

riya were also considered not as relevant and, in fact, were curtailed. Nevertheless, in 1934 there was a collective work of staff of "Psychoses and Psychoneurosises of War" department (under the editorship of V.P. Osipov) which by the time of the Great Patriotic War was almost only management of this sort. Then, already at its beginning (1941), the new cathedral work "Issues of Psychiatric Practice of Wartime" which played the main role in training of psychiatrists in the years of war [14, 15] was as a matter of priority released.

All above extremely negatively affected already the initial stage of war. So, for example, on the Western front (subsequently divided into the 1st, 2nd and 3rd Belarusian fronts) there were only two psychiatrists (A.M. Svyadoshch and A.A. Portnov), and in the 1st Ukrainian - one (V.E. Makarov) who at the same time was also the chief neuropathologist of the front. They and army psychiatrists undertook the main weight of organizational and methodical work in troops. In these conditions the works of department of psychiatry of Army medical college focused on army doctors were of particular importance: "Issues of psychiatric practice of wartime" (1941), "Bases of recognition of psychoses and psychotic states in practice of the medical officer" (1943) and others [14, 16]. Summing up the results of an initial stage of war, Nikolay Nikolaevich Timofeev (the chief psychiatrist of the Red Army in days of the Great Patriotic War), allocated the following main problems [28]: at an acute shortage of military psychiatrists, many of them (as from among personnel, and called from a stock) were not used in the specialty; an overwhelming part of patients of a psychiatric profile were evacuated to the deep back, many of which on the state could be treated in army or, as a last resort, in the front area; the considerable category of these patients after passing through a number of stages of evacuation came on treatment to all-surgical and all-therapeutic hospital in which there were no specially organized mental health services. Owing to lack of such help the patients hronizirovatsya and late in hospitals much more necessary time; for the same reasons the result of treatment (up to 45% of the military personnel were struck off the military register, up to 30% - it was transferred to not service with troops) were negative.

Thus, the main lack of an initial stage of war was the lack of necessary quantity of shots and specialized psychiatric departments. It led to the fact that practical mental health services in the operating parts were limited generally evacuation of patients from army and front areas in rear hospital of the country. In this regard, the fastest shtatno-orga-

became the major task

nizatsionny formation of psychiatric (psychoneurological) divisions with their maximum approach to the advanced area. Thanks to vigorous activity of staff of department of psychiatry of Army medical college (V.P. Osipov, S.P. Ronchevsky, V.A. Gorovoy-Shal-tan, V.A. Makarov, M.Sh. Glekel), as a matter of priority the scientific-theoretical base of psychiatry of wartime also developed.

Psychiatrists and neuropathologists from the first days of war took active part in work of hospitals of the front and the back; the neurologic ("nevropsikhiatrichesky") offices of military hospitals specialized hospital for "contused" were hastily created. In some cases, psychiatric (psychoneurological) departments were developed in sorting and evacuation hospitals (since 1943) and also on the basis of others medical and not medical (for example, on the island of Valaam in the monastery the psychiatric department on 100 beds was open) medical institutions [3, 11]. At the same time, from a division and mental health services are lower, as a rule, it did not appear. Only in one of parts of the Leningrad front the army doctor having pre-war psychiatric preparation initiatively developed "a hospital for contused" which results of work "exceeded all expectations" - the military personnel in 10-14 days came back to a system [31]. An exception was also the First Baltic front where in each medical and sanitary battalion the doctors responsible for medical sorting, treatment "contused" and "neurotics" were allocated. However the taken measures nevertheless did not solve the main problem

>- rendering full mental health services in the advanced area.

In general, for the first months of the Great Patriotic War in rear medical institutions about 70% of victims of a psychiatric profile were evacuated, which, as a rule, appeared in various all-surgical and therapeutic hospitals without adequate mental health services that, on the one hand, led to an overload of stages of medical evacuation and complicated assistance to wounded, on the other hand, led to an invalidization of patients with mental disorders. So by data I.V. Rebelsky, about 50% of the military personnel with mental disorders were recognized further as unusable to military service and struck off the military register [23].

The most considerable category of victims of a psychiatric profile was made, at the same time, so-called "contused", including the most diverse contingents of patients: "transferred a kommotion, a contusion, emotsiogenny shock, reaction of fear, a reactive state; dekom-pensirovanny psychopaths, neurotics, etc.". It should be noted that the term "contusion" was on

that period wide, generalizing and, it is rather not so much clinical how many the organizational concept applied only in the Red Army. The variety of clinical manifestations at "contused" caused essential diagnostic difficulties in army doctors and fair doubts in expediency of use of this term at experts. So, in particular, the famous military neuropathologists M.I. Astvatsatu-rov and S.I. Karchikyan spoke undesirability of his use as "the deprived accurate kliniko-anatomic contents" [17]. Also some military psychiatrists (S.P. Ronchevsky) held the similar opinion, ironically calling such patients "embarrassed" [22]. At the same time, use of this diagnostic category had nevertheless some justification as defined the direction of evacuation and volume of medical care at early stages of its rendering. It is possible that at more detailed differentiation of these frustration the military personnel with various manifestations of "a fighting stress" (panic, hysterical reactions, etc.) could appear easily in the sphere of attention of not medical bodies. Masking mental disorders, various by the nature, a uniform medical and organizational concept ("contusion"), domestic military psychiatrists showed the highest humanity (saving considerable number of persons with "a fighting stress" from possible repressive measures) and provided, at the same time, functioning of a landmark system of rendering mental health services needing. So, in particular, N.N. Timofeev specified that the persons who transferred separate types of "contusions" (in modern understanding - short-term reactions of a fighting stress), subsequently, in the vast majority, came back to a system, making the most efficient contingent [29].

Development of the structured system of rendering mental health services in the Red Army belongs to the beginning of 1942, due to the need of the decision health service of the main task of war - return of perhaps bigger number of wounded and patients. During this period the problem of shortage of the draft contingent for the front especially became aggravated. Same year the position of the chief psychiatrist of the Red Army was entered (N.N. Timofeev) under the leadership of whom became consistently (army, the front, the back of the country) to be organized institutions of a psychoneurological profile. In health service of fronts, since 1942, began to be formed specialized hospital for "contused". The psychoneurological offices created later in army hospitals for lightly wounded, being the brought most closer to the front line, assumed the main flow of such patients, having become (according to V.E. Makaro-va) "the filter for patients with nervous and loonies -

chesky diseases in the army area" [14]. At the same time it should be noted that the nature of the organization of mental health services significantly differed not only during the different periods of the Great Patriotic War, but also on various fronts, depending on specifics of the battlefield, an operational situation, presence of personnel, etc. The system of rendering mental health services was not stiffened, unified for all fronts, and for the entire period of war it dynamically changed, proceeding from the current opportunities and the need for it, including - the gained experience. For an illustration of this situation it is possible to give an example Western and the First Baltic fronts.

On the Western front for the first time arose hospital for "contused", subject to treatment on the place. To the middle of 1943 in all armies freelance army psychiatrists appeared. Army therapeutic field mobile hospital were considered, at the same time, as "... sortirovochnodiagnostichesky institutions, not only for therapeutic, but also for nervous patients" (there were special chambers on 20-30 of beds for patients of a psychiatric profile). In army and front hospitals for treatment of lightly wounded psychoneurological offices were created, and expansion of the "nervous office" which is "the main army hospital" for treatment of persons with boundary mental states [23] was provided in the army therapeutic evakogospital. Took the central place specialized "nevro-psychiatric evakogospital" the first echelon of the front (with terms of treatment of 30-60 days), being kind of the finishing link of network of the medical institutions providing medical care for mentally sick. The psychiatrists who are a part of the voyennovrachebny commissions of front evacuation centers exercised, in addition, control of medical work in subordinated medical institutions.

On the First Baltic front to the second half of 1942 the organization of the psychoneurological help was carried out irregularly (usually mentally patients were located in therapeutic offices of army hospitals where neuropathologists or therapists were engaged in their treatment). In the subsequent when for the general leadership in psychoneurological work there were assignees, the acting as the front neuropathologist and the psychiatrist, in hospital base of the front "three sorts of psychoneurological hospitals" appeared: "nevro-psychiatric" office at front hospital for treatment lightly wounded, front psychoneurological hospital (on 600 beds) in the system of front evacuation point and the second psychoneurological hospital (on 600 beds) in the system of local evacuation Paragraph [12].

Thus, in troops of the Red Army the profiling of "nevro-psychiatric" institutions of army and front hospital bases was noted that affected not only the general system of the organization of mental health services, but also reliability of accounting of mental diseases among the military personnel. In many respects it was caused by already mentioned earlier staff shortage of an initial stage of war which consequences were felt up to its termination. So, when studying data on structure of mental disorders at the military personnel of the Red Army in days of the Great Patriotic War, often you face lack of full data even about their general prevalence among staff on fronts, types of military forces and types of forces. A variety of wording of diagnoses in different medical institutions is not less indicative. There is their far incomplete list, applied to only psychogenic frustration: "exogenous reaction", "reactive state", "reactive psychosis", "реактоз", "reactive neurasthenia", "neurotic reaction", "iste-ronevrasteniye", "istero-trauma", "reactive neurosis", "functional neurosis", "personone-vroz", "ambitimoidny neurosis", "istero-ambi-timoidny neurosis", "isteropatiya", "traumatic neurasthenia", "traumatic psikhasteniya", "neurotic psychogenic reactive states" and some other. The mixed diagnoses attract attention: "traumatic hysteria" and others, allowing to interpret randomly genesis of painful states (psychogenic or traumatic) [10].

The data submitted in available reporting medical literature are extremely separate and, as a rule, affect only separate military formations, the short temporary periods (as a rule, conducting combat operations), sometimes are limited only to the analysis trudopoter and stay terms on a hospital bed of the military personnel and so on. It is enough to tell that in the main generalizing multivolume work "Experience of the Soviet medicine in the Great Patriotic War of 1941-1945 ",

published in 1949, mental disorders were included in the section "Nervous Diseases (Features of Emergence, Current, Prevention and Treatment During the War)" in which chapter 1 is devoted to a problem of neurosises, the separate symptomatic and organic mental disorders arising at neurologic and some somatic diseases are mentioned in other heads. As for "mental diseases" to which, along with schizophrenia and manic-depressive psychosis, were carried as well reactive psychoses, they were included in the "Other Diseases of Nervous System" group and separately in detail were not analyzed (tab. 1).

By comparison of frequency of cases in separate forms of "nervous diseases" in the attitude towards all quantity "nervnobolny" in army (without traumatic damages of nervous system) the fact that "neurosises" in relation to all "neurologic incidence" made nevertheless the considerable group (26.6%) following on number diseases of peripheral nervous system attracts attention. To it it is necessary to add still the combined group of so-called "vegetative neurosises" which made 4.8%. Hysteria (11.9%) most often occurred among neurosises, is slightly more rare - a neurasthenia (7.8%) and is even more rare - others "sharp reactive neurosises" (6.2%). Psikhasteniya, at the same time, was observed exclusively seldom (0.5%). In the group of neurosises, their separate forms were distributed as follows: hysteria - 45.1%, a neurasthenia of-29.6%, others "sharp reactive neurosises" of-23.4% and a psikhasteniye - 1.9%. Special category as it was already noted, made "contused" with prevalence in a clinical picture of a surdomutiz-m (37%), a mutizm (2%), deafness (2.2%), "with attacks" (19%), "with trembling of the head and extremities" (3%) [6]. As for actually mental diseases, their number was much less. They made only 4.3% of all of "nervous and mental diseases" [8], slightly less than a half of them (44.8%) were made by patients with manic-depressive psychosis, schizophrenia and mental retardation. Specific weight of other groups was insignificant. So, psychoses of an infectious etiology made only 5.8% of all mental diseases, a toxic etiology - 4.0%, traumatic genesis - 3.7%. Also the number of the psychoses which developed because of dystrophy or avitaminosis (1.7%) was insignificant, psychoses of an involutional or vascular etiology (1.1%) were even more rare. Reactive psychoses made 3.2% of all mental diseases in army [8].

As it was specified [8, 13] earlier, "neurosises of wartime" were generally presented by hysteria (45.1%). At the same time, the ratio of various forms of neurotic frustration is essential

Table 1

Structure of neurologic incidence of the military personnel of the Red Army (1941-1945)

of the Form of nervous diseases * Frequency of occurrence, %

Diseases of peripheral nervous system 50.0

Neurosises 26.6

Infectious diseases of nervous system 3.4

Diseases of vascular origin 1.6

Other diseases of nervous system 18.4


Note: *-author's terminology is hereinafter used.

Table 2

Distribution of neurosises on age groups (%) of the military personnel of the Red Army (1941-1945)

Neurosis forms Age

Up to 20 years 20-29 years 30-39 years 40-49 years 50 years are also more senior Than all

Neurasthenia 5.0 40.6 40.5 13.2 0.7 100.0

Psikhasteniya 2.9 70.6 17.7 8.8 - 100.0

Hysteria 14.1 46.9 26.8 11.5 0.7 100.0

Reactive neurosises 7.7 41.3 32.7 17.8 0.5 100.0

differed in different age groups (tab. 2), distinctly prevailing at persons of young age (20-29 years).

Thus, in the official medical reporting the mental disorders, as a rule, were considered within "incidence of nervous system" and, respectively, were analyzed by doctors-neuropathologists. At the same time, according to the psychiatrists who were taking part in the organization of mental health services in days of the Great Patriotic War the military personnel with psychological diseases, including "contused", made 3-4% of the total number of sanitary fighting losses of the Red Army. At the same time, and these data also carry very separate (owing to staff deficit) and contradictory (as in the terminological, and quantitative relation) character. In many respects it was caused by the fact that these data had no system character and, as a rule, reflected various conditions of their professional activity (the advanced area, a hospital link, the back; profile of hospital; war period, etc.).

So, for example, A.M. Svyadoshch, analyzing data on the military personnel with psychogenic diseases (including victims of a mine and explosive trauma), hospitalized in "nevro-psychiatric" offices, established that in 1942 their number made 8.6% of all which arrived, in

1943 year - 13.8%, in 1944 - 10.5%. At the same time, the sharp psychogenic diseases observed

at stages of regimental and divisional points of medical care and "nevro-psychiatric" office of army hospital during the period about 1943-1945, according to its data were distributed as follows: shock psychoses (stupor, a twilight state, the fugue) - 4.7%, hysterical psychoses (twilight states, a hysterical stupor) of-4.5%, psychogenic reactions (pseudo-dementia, a psev-dokatatonichesky stupor, a fastsination, paranoid reactions, elementary excitement) - 3.85%, shock neurosises - 8.0%, hysterical reactions of-78%. In general, patients with reactive psychoses according to it made 13.05% of number of all patients [25].

I.V. Pavlovsky, on the basis of data of front "nevro-psychiatric" hospital for 3 years of war, specified that in 1942 in structure of patients of a psychoneurological profile on reactive psychoses 10.9%, were the share of acute psychogenic reactions (hysterical, twilight states, fugues, a psychogenic stupor, sharp paranoid)

>- 24.1%, in 1943 - 5.6% and 16.7% respectively, and in 1944-1945 - 7.4% and 10.2% respectively [18].

According to N.I. Bondarev's data received when studying clinical material of two Army medical colleges, reactive psychoses and states (from 1939 for 1942) were distributed as follows: shock emotsiogen-ny reactions - 18.3%, psychogenic disorders of consciousness - 16.6%, reactive depression - 36.6%, reactive paranoid - 3.3%, a hypochondriac syndrome - 2.5%, hysterical reactive states - 20.8%, explosive reactions against the background of insignificant mental injuries - 1.6% [4].

Data of "nevro-psychiatric" institutions of army, the front and operational beds of some psychiatric hospitals are not less contradictory. So, according to sanitary management of the Western front (tab. 3) for the first years of war in structure of mental incidence on all institutions of the army area reactive psychoses and "psychoneurosises" (46.7%) and also the psychoses and mental violations caused by a brain injury (18.3%), then prevailed

Table 3

Structure of sick nevro-psychiatric hospitals of the Western front (1941-1943)

Nature of mental disorders Type of hospitals

Army area Front area Psychiatric hospitals

Reactive psychoses and psychoneurosises 46.7 42.3 30.4

Mental disorders of traumatic genesis 18.3 16.1 14.9

Exogenous psychoses 3.5 4.3 5.4

Epilepsy 15.1 13.7 12.9

Psychopathia 3.7 4.1 4.6

Endogenous psychoses 3.1 4.6 16.2

Other mental diseases 9.6 14.9 15.6

Total 100 100 100

as "other" mental disorders were noted much less often [23].

From data of civil psychiatric hospitals data of hospital of P.P. Kashchenko are of interest, (1941-1943) which reflected a condition of mental incidence in the armies of the Western front (which came very close to Moscow) according to which patients with psychogenic diseases made 30.4% to the total number of the insane, including neurotic (asthenic, hypochondriac) and reactive (psychogenic paranoid) conditions of-19.8%, hysteria and hysterical reactions (pseudo-dementia, a stupor, attacks, a surdomutizm) - 10.6% are fuller than others. Of traumatic psychoses and other mental violations of traumatic genesis 14.9%, on a psychopathia - 4.6%, were the share of exogenous psychoses - 5.4%, of endogenous states - 16.2% [27].

The attempt of the generalized analysis of the data given above allows to make the following conclusion: all psychotic forms of psychogenic diseases (including so-called "reactions of emotsiogenny shock") made in "nevro-psychiatric" offices of army medical institutions 10-12% to number of hospitalized; in "nevro-psychiatric" hospitals of the front of 12-15% to the total number of patients with psychogenic diseases; in "operational offices" of psychiatric hospitals - 12-15% to the total number of the insane [10].

Characterizing mental incidence on the fleet, it should be noted that, despite exclusively "the fighting tension of staff" of connections of the ships, sea aircraft and coastal parts of Navy in the Great Patriotic War, the number of mental diseases on the fleet was rather small. So, the number of the servicemen with mental disorders on the Northern Fleet was: in 1941-6 people, in 1942 - 29, in 1943 - 39, and in

1944 year - 54 willows 1945 - 32 persons; on the Baltic Fleet: in 1941 - 87 people, in 1942 - 93, in 1943 - 109, and in 1944 - 122 and in
1945 year - 101 persons. At the same time in structure psi-

hichesky incidence of the military personnel of the Baltic Fleet (tab. 4) who was on operational beds of the Leningrad psychiatric hospitals mental violations of traumatic genesis prevailed [9].

It is necessary to specify at the same time that generally rendering mental health services in Navy both during the pre-war period, and in the years of war was carried out on operational beds of psychiatric hospitals of civil health care. In close interaction of Navy with parts of the Red Army the evacuation of mentally sick was also quite often made also in army "nevro-psychiatric" offices.

It should be noted that besides the above-stated frustration, psychiatrists studied value of another, specific to wartime, mental pathology: intoksikatsionno-wound mental disorders [26], psychoses at fire osteomiyelita [20, 30] and fire sepsis [7], all-somatic diseases and ekstratserebralny wounds [27] and also at traumatic exhaustion and other septic diseases [1]. Despite the small number, the known novelty represented the psychoses arising after poisoning with tetraethyllead [21]. At last, traditionally described earlier as "very widespread", alcoholic psychoses made it is insignificant the small size (less than 1%) in structure of the general mental incidence in the years of war [19].

The analysis of average duration of treatment "nervously and mental patients" in various years of war revealed a distinct tendency to its gradual reduction. So, for example, if the average duration of treatment within the first year of war for all nervously and mentally sick was 42.6 days, then within the second year - 41.9 days, the third year - 39.3 days, the fourth year - 37.9 days. At the same time the majority "nervnobolny" (74.0%) finished treatment in evakogospitalyakh and on more front lines (than in an initial stage of war) stages [8].

Table 4

Sanitary losses of a psychiatric profile of staff of the Baltic Fleet (1941-1945)

Nature of a mental disorder Number of patients, abs.

1941 1942 1943 1944 1945 All

Mental violations of reactive genesis 19 20 23 10 10 82

Mental violations at brain injuries 6 10 19 37 38 110

Exogenous psychoses 17 20 22 15 12 86

Epilepsy 4 9 7 8 5 33

Psychopathia and mental retardation 15 12 21 15 15 78

Endogenous psychoses 22 21 16 29 18 106

Other mental diseases 4 1 1 8 3 17

Only 87 93 109 122 101 512

Thus, synthesis of experience of the organization of mental health services in the Great Patriotic War showed that its basic doctrinal provisions were formulated by domestic psychiatrists even during the Russo-Japanese war, however properly were not used that demanded reforming of the developed pre-war system, with creation of the relevant organizational and regular structures as close as possible to an army stage, and allocation of mental health services in the independent system of medical and evacuation actions.

All "organizational costs" of an initial stage of war found the reflection as reporting materials on prevalence, structure and dynamics of mental disorders, generally eyes of military neuropathologists. It is necessary to recognize, however, as the materials prepared by the psychiatrists who were taking part in rendering mental health services to the military personnel of the Red Army in days of the Great Patriotic War because of staff shortage, absence uniform siste-

we views of fighting mental disorders and organizational dissociation also did not differ in terminological unity and completeness. At the same time, even the data which are available at our disposal, despite all specified shortcomings, are of considerable scientific and practical interest. In general, experience on studying mental disorders in the conditions of the Great Patriotic War allowed to formulate and solve a number of the major theoretical, kliniko-methodological and organizational problems of military psychiatry, including questions of military-medical and sudebnopsikhiatrichesky examinations. The analysis of the available statistical data on structure of sanitary losses of a psychiatric profile confirms prevalence among mental disorders at the military personnel of the Red Army of the traumatic psychoses and other mental violations which arose in connection with an injury of a brain, reactive "psychogenic" psychoses and "psychoneurosises" along with which a specific place was held by the mental disorders caused by wound process, somatic diseases.


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V.K. Shamrey, G.P. Kostiuk, A.G. Chudinovsky, A.G. Sinenchenko

On the basis of studying archive materials and references new supplied are obtained and the available information on the organization of mental health services and structure of sanitary losses of a psychiatric profile among the military personnel of the Red Army in days of the Great Patriotic War is generalized. The staging of rendering mental health services is shown

to the military personnel who was involved in fighting during the different periods of war. Are specified it is reduced

Salo Albert
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