frequent in the next higher and lower classes. Dispensaries predominated in the factories employing less than 500 workmen. Altogether 900,000 workmen, or over 50 per cent, in 1907 had hospital facilities at their disposal, either in an independent factory hospital or by agreement with some other hospital, as against 580,000, or 40 per cent, in 1897, while dispensary treatment only (including emergency wards) was provided for 584,000, or 32 per cent, in 1907, as against 397,000, or 27 per cent, in 1897. It must be added that usually, when hospital or dispensary facilities are available at the hospital, the members of the workmen's families are given the privilege of free medical treatment on equal terms with the employees themselves. In 1897 the number of persons granted this privilege was 189,401, and of these about one-half belonged to factories with over 100 workmen. Similar data for 1907 are not available. The two tables following show, by size of establishment, the number and per cent of factories and of employees provided with the various means of medical assistance: NUMBER AND PER CENT OF FACTORIES SUBJECT TO INSPECTION PROVIDING MEDICAL AID, BY FORM OF AID AND SIZE OF ESTABLISHMENT, 1907. [Source: Viestnik Finansov, 1910, No. 5.] NUMBER AND PER CENT OF EMPLOYEES IN FACTORIES SUBJECT TO INSPECTION PROVIDED WITH MEDICAL AID, BY FORM OF AID AND SIZE OF ESTABLISHMENT, COST OF MEDICAL AID.-In the official reports from which these data are taken, the cost of medical assistance is also given. The cost is quite considerable and is increasing. It increased from $2,048,069 in 1897 to $4,874,052 in 1907, or more than doubled in ten years, the per capita cost increasing from $2.01 to $3.19. This per capita cost is fairly uniform for establishments of different size, but this uniformity is brought about by the smaller establishments substituting less satisfactory and consequently cheaper forms of medical assistance, namely, emergency wards and dispensaries for hospitals. The difference in the per capita cost for different forms of medical assistance is much greater. Arrangements with Red Cross hospitals showed an average cost of $3.81 per capita, in factory hospitals the average cost was $3.58, in emergency wards $2.70, and in dispensaries $2.95, while arrangements with zemstvos and municipalities were cheaper. The total and per capita cost of medical aid to the factories subject to inspection are shown by form of aid and by size of establishment in the table following: TOTAL AND PER CAPITA COST OF PROVIDING MEDICAL AID TO EMPLOYEES OF MEDICAL AID IN MINING AND METALLURGICAL INDUSTRIES. The situation is somewhat more favorable in the mining and the metallurgical industries, both as regards legislation and the actual practice. Originally the Government controlled a large share of these industries and it took better care of its employees. On the other hand, the isolated position of the mining and metallurgical establishments, together with the greater frequency of accidents and diseases, makes the necessity of systematic medical aid more pressing. By the Mining Code of 1806 each government mining or metallurgical establishment with over 200 workers was required to have a hospital and a physician, and another article of the same code required private establishments to comply with the same requirements as regards medical assistance. The temporary law of 1866 did not apply specifically to mining and metallurgy, but the law of June 3, 1886, conferred upon the factory commissions, among other functions, the right to issue regulations concerning the care of the health and life of the workmen, and by the extension of this law to the mining and metallurgical establishments on March 9, 1892, the same rights were given to the mining commissions established in the principal mining regions. In conformance with this law, the mining commissions passed regulations concerning the organizations of medical aid on the following dates: (1) The central mining commission (the northern, northwestern, Volga, and Moscow mining territories) on April 9, 1893. (2) The Ural mining commission on July 31, 1896, and amended August 9, 1897. (3) The western mining commission on April 6, 1896. (4) The south Russia mining commission on May 18, 1893. (6) Caucasus mining commission on March 12, 1897, amended July 17, 1897. (7) Western Siberia mining commission on December 15, 1900. (8) Eastern Siberia mining commission on May 3, 1899. While the special mining commissions in European Russia were abolished by the law of June 7, 1899, the regulations remained in force. There are considerable differences between the regulations of different mining commissions, but those adopted by the Ural commission may be taken as a type; both because the Ural mining territory claims nearly 150,000 out of a total of 480,000 persons employed in mining, or nearly one-third, and also because the regulations of the central commission, with 30,000 employees under its jurisdiction, of the western commission, with 42,000 employees, and of the Caucasus commission, with 43,000, are very similar to those of the Ural commission. Thus these rules apply to about 265,000 workers, or over 55 per cent of those employed in mining. These regulations of the Ural commission are as follows: All private mining and metallurgical establishments are required to furnish medical aid to their employees free of charge according to the following conditions: Establishments employing less than 100 workers and located within the distance of 15 to 25 versts (10 to 17 miles) from a hospital may furnish only an emergency room without permanent beds. The establishment employing from 100 to 400 workers must have a permanent hospital ward with not less than one bed for each 100 workers, and a permanent "feldsher" (medical assistant), and must call a physician whenever necessary. Establishments employing over 400 workers must have a hospital with a private pharmacy, not less than one bed for each 100 workers employed, a permanent physician, and the necessary number of "feldshers." While no such hospital facilities are required of the smaller establishments, they must make arrangements with hospitals in the vicinity for such sick employees as require hospital treatment. Owners of establishments located near each other may enter into agreements for the establishment of common hospitals. Each mining and metallurgical establishment must be provided with the necessary medical and surgical appliances for giving first aid to persons injured or suddenly taken ill, and also with conveyances for transportation of such patients to the nearest hospitals. In addition the very large establishments, employing over 1,000 persons, must organize a permanent emergency service for first aid to the injured and sick. New hospital buildings must be erected with due regard to the demands of hygiene. They must be located in a dry place at some distance from dwellings and such shop buildings as would unfavorably influence the course of treatment, and be provided with good drinking water. The hospitals must be well lighted, ventilated, and heated. The wards must contain at least 5 cubic sazhen (1,715 cubic feet) of air space, 1 square sazhen (49 square feet) of floor space, and one-sixth square sazhen (over 8 square feet) of window space, per bed. The ceiling must be at least 14 feet high. Each hospital must be provided with a reception ward, a bathroom, an operating room, a morgue, rooms for the "feldshers" and servants, a kitchen, a laundry, a bath house, and similar accessories. The dispensary must be separate from the hospital wards. All toilet rooms must be heated, have proper ventilation, and be in the same building with the hospital. Every hospital must be provided with a special room for contagious diseases, permitting perfect isolation when necessary. This contagious ward must have its own bathroom and toilet facilities. There must also be a special room for preparation and distribution of drugs, and a room for disinfection of clothing and dressings. STATISTICS FOR 1904.-A special investigation of the conditions obtaining under these regulations was made through the mining inspectors in 1904. The main results of this investigation are shown in the following summary statement, where data for European and Asiatic Russia are shown separately: SUMMARY OF MEDICAL AID IN THE MINING AND METALLURGICAL ESTABLISHMENTS, 1904. [Source: Tigranov, G. Th, i Gussiatnikov. Vrachebnaya pomoshch rabochim na gornykh zavordakh, 1907.] |