subject to factory inspection, are omitted. But as far as the data go they show 1,834 fatal and 210,333 nonfatal accidents, giving a total of 212,167 accidents for 2,927,965 employees, or a rate of 72.46 per thousand.

TOTAL NUMBER OF EMPLOYEES AND OF RECORDED ACCIDENTS AND ACCIDENT RATE PER 1,000, 1906.

The field of "sickness insurance," which includes all forms of provision for workmen in case of sickness, may be divided into (1) medical care of the diseased, and (2) financial assistance to him and those dependent upon him for support during the time of inability to work, resulting from such sickness. Whenever such sickness follows. an industrial accident the various compensation acts, described in the preceding sections, meet this condition by requiring the employer to furnish both the cost of medical help and the allowances to the injured and his family. As far as sick benefits are concerned, the law requiring that fines collected in establishments shall be used for that purpose is the only general legislation on the subject. In addition, some provision for the sick may be found in isolated branches of industry: In government mining, and in metallurgical, and a few other industrial establishments. Establishment sick benefit associations are found mainly in the mining industry of the western Provinces, such as Poland and the Baltic region; and industrial sick benefit associations are found in the larger industrial centers. Information in regard to these private local funds is very meager.

The need of a better system of provision for the sick is strongly felt in Russia, and a system of obligatory sick insurance through establishment benefit associations forms a part of the general plan of compulsory workmen's insurance, discussed both in the governmental schemes and by society at large since 1905. A bill to that effect has been introduced into the Third Duma in conjunction with the bill for a new accident-insurance law.

MEDICAL AID.

HISTORY.

To understand the development of Russian legislation in regard to medical assistance to workmen employed in factories it is necessary to point out that, in theory, medical aid is considered a proper governmental function, to be supplied in cities by the municipal government, and in the rural districts by the so-called "zemstvos"-organs of local self-government. In provinces where zemstvos have not been organized the duty of furnishing medical aid to the rural population devolves upon the governmental authorities. In practice only a very few municipalities have met this duty, and in those provinces which have as yet no zemstvos the organization of medical aid is purely formal and perfunctory. On the other hand, the zemstvos have, since their organization in the early sixties, always looked upon the organization of medical aid as one of their most important functions. The combined budgets of these zemstvos amount to many millions of dollars, and about one-fourth of the total expenditures is being devoted to medical aid in rural communities. There are many free hospitals and dispensaries in each county (uyezd) where a zemstvo exists, and the Russian peasant may be said to be fairly well provided with free medical assistance.

LAW OF 1866. The law which imposed upon the factory owners the duty of furnishing medical aid to their factory employees dates from the year 1866. It owes its origin to the beginning of an epidemic of Asiatic cholera in Moscow. The governor of Moscow, considering the large factories with their insanitary conditions and large number of workers a possible means of spreading the cholera epidemic, in a report to the minister of interior suggested that the owners of large factories be required to establish hospitals and employ physicians in connection with their industrial establishments. As a result of this suggestion a decision of the committee of ministers was approved by the Emperor August 26 (Sept. 7), 1866, ordering as a temporary measure that "there be established in connection with each factory employing 1,000 workers a hospital with ten beds, and at each factory employing more than 1,000 workers 15 beds or more, and at each factory employing less than 1,000 workers 5 beds or more, at the rate of one for each 100 workers." Though the order was declared to be a temporary measure no time limit was mentioned, and the law is still in force.

The indefinite language of this law and the absence of any punitive measures for noncompliance with its demands or any organ of inspection and control, except the police authorities, left the entire problem in a very unsatisfactory condition. The language of the order showed that the intention existed at that time to follow it up with a systematic

law regulating the question of medical aid to factory employees, for the minister of interior was ordered to present a plan for such legislation to the Imperial Council. In 1867, and again in 1874 in connection with a proposal of a law for regulation of conditions of employment, these legislative propositions were discussed, but without success, as the Imperial Council judged the law of 1866 to be sufficient and refused to go any further in this matter. The effect of this law was far from uniform; its execution depended mainly upon the zeal and energy of the provincial governors. In some factories good hospitals were established; in others the beds were left without medical attendance, and in a great many localities the law was entirely disregarded. In many factories the costs of these medical establishments were charged to the workmen.

LAW OF 1886.-This latter abuse was checked by the law of June 3 (15), 1886, regulating the conditions of employment and the relations between employers and employees, which among other things prohibited the deducting of the cost of medical aid from the wages of the workmen (Code, Vol. XI, 2, Industrial Code, sec. 102). On the other hand, it established serious limitations to the extent of medical aid to the workmen required of the employers, by laying down the rules that the employer could discharge any workman at two weeks' notice and immediately in case of a contagious disease. Evidently a dismissed employee had no claim to medical aid from the employer after the termination of the employment.

The law of June 3 (15), 1886, established municipal factory commissions for St. Petersburg, Moscow, Odessa, and Warsaw, and provincial commissions for the separate Provinces, and these commissions were intrusted among other things with the administrative regulations of the problem of medical aid to factory employees.

EXTENSION OF THE LAW TO MINING AND METALLURGY.-By a decree of March 9 (21), 1892, the provisions of the law of 1886 were extended to apply to the mining and metallurgical industries and were embodied in the Mining Code. Local mining commissions were established with functions parallel to those of the factory commissions, including the regulation of medical assistance to the employees A law requiring proprietors of mining and metallurgical establishments to establish hospital facilities for treatment of sick employees had been on the Russian statute books for sixty years before similar provisions were made for factory industries, namely, in the general mining law of July 13 (25), 1806, for the mining industry was developed much earlier than manufactures. The greater danger to health and life from work in the mines was evident, and many of these establishments were owned from the beginning of Russian industry by the State or Crown, which was more inclined to take care of its employees.

According to this law, both the State and private mining and metallurgical establishments employing 200 persons or more were required to have a hospital and one or more resident physicians; but in the case of privately owned mines the law remained a dead letter until 1892. Finally both the local factory commissions and the local mining commissions were united into factory and mining commissions by the act of June 7 (19), 1899, which also established a central factory and mining commission and put it in control of the local commissions, for the purpose of unifying this work. The central commission is required to formulate general principles for the administration of the law of 1866, but the actual administration is still in the hands of the local commissions and exercised through the factory and mine inspectors. Provincial commissions were established in 64 provinces; in 35 of these such regulations were established, and in the remaining 29, mostly nonindustrial provinces, practically nothing was added to the ambiguous language of the law of 1866.

While the establishment of factory hospitals was mandatory according to the exact language of the law of 1866, it was nevertheless evident that for small industrial establishments with 100 or even less employees the organization of such a private hospital would either be a great hardship, possibly not demanded in view of the existence of good hospitals in the immediate vicinity, or would become a pure formality without any substantial benefit to the employees. Nor was it clear whether the law applied to factories with less than 100 workmen, whether 5 beds was the minimum number for a factory hospital, and what the requirements were in regard to medical attendance. In answer to inquiries from the Moscow provincial factory commission it was explained in 1887 that conditions had changed considerably during the preceding two decades, and that the growth of the activity of zemstvos and municipalities in supplying hospital facilities has made the organization of special factory hospitals unnecessary in many cases, and that as a substitute for the required hospitals factory owners may in certain cases be required to enter into agreements with zemstvos and other bodies for the supply of hospital and other medical facilities to their employees.

REGULATIONS OF MOSCOW.

As an example of the regulations established by the provincial factory commissions, those in force since February 1 (13) 1897, in the province of Moscow, outside of the city of Moscow, may be briefly mentioned. Factories employing 500 or more workmen are required to have a factory hospital with one bed for each 100 workmen, a resident physician and a "feldsher" (a medical assistant of a somewhat higher grade than a trained nurse). When the number

of workmen exceeds 3,000 two physicians must be employed, one of whom shall reside at the factory. Factories employing from 17 to 500 workmen may be freed from this obligation if they make arrangements with the zemstvo hospital or any other hospital, or several factories may combine for establishing a common hospital. In exceptional cases such arrangement may be permitted to factories having more than 500 workmen. When the factory hospital has less than 5 beds the physician need not reside at the factory, but must live not more than 7 versts (4.7 miles) from it, and must visit it at least three times a week, while the hospital must have a resident "feldsher.' When the factory has no hospital of its own, and the distance to the hospital with which such arrangements have been made is more than 3 versts (2 miles), the factory must have an emergency room with all necessary appliances for first aid to sick or injured, and, if the number of workmen exceeds 200, also a "feldsher." Artisans' shops employing no more than 16 workmen are not subject to any of these requirements. In factories employing more than 500 workmen the hospital is required to consist of three divisions-a general ward, a contagious ward with facilities for isolation when necessary, and a dispensary for outside patients. Where both men and women are employed there must be separate rooms for each sex in both the general ward and the contagious ward. The rooms must contain a minimum air capacity of 3 cubic sazhens (1,029 cubic feet) per each bed; there must also be warm privies. In factories employing from 200 to 500 workmen the hospital must contain at least four rooms-two wards, an examination room, and a waiting room for outside patients. In factories employing less than 200 workmen at least two rooms are required, one for the beds and one for the outdoor patients. Where 200 or more women are employed, a special maternity room must be provided and also the services of a resident trained midwife; where less than 200 women are employed, such room and the services of a midwife must be furnished by the employer when necessary. Information must be furnished the factory commission in regard to the exact measures taken for compliance with these regulations.

REGULATIONS OF OTHER LOCALITIES.

The above regulations of the Moscow commission have been quoted as a type. Considerable variations of greater or less importance are found in other districts. Quite uniformly establishments with no more than 16 workmen are excepted, while the regulations quoted require that hospital facilities, either in factory hospitals or other hospitals by arrangement, shall be furnished by all factories above that size; others except factories with less than 100 and in some cases