The main items of expenditures are shown in the table following. Nearly one-half of the expenditure is for salaries and traveling expenses of the medical staff, and the bulk of the other half for medical and surgical supplies and the cost of keeping the patients in the railroad hospitals or in other hospitals: EXPENDITURES OF RAILROADS FOR MEDICAL AID TO EMPLOYEES AND MEMBERS OF THEIR FAMILIES, 1901 TO 1907. [Source: Ministerstvo Putei Soobshchenia. Otdiel zheleznykh dorog. Otchot o vrachebno-sanitarnom sostoïanii zheleznykh dorog, 1902-1907.] Medical Year. traveling etc. Rent, Keeping Keeping in rail in other hos expenses. expendi- Total.(4) tures. pitals. a For most of the years the totals are slightly different from the sum of the items; the figures are given as shown in the original reports. The extent to which the employees utilize these medical facilities is shown in the next table. There were 229.6 cases for each 100 employees in 1901 and 279 per each 100 employees in 1907, an increase of 21.5 per cent in six years. The members of the families do not apply for medical aid as frequently, but here, too, the increase was from 107.5 per 100 in 1901 to 130.9 in 1907, or 21.8 per cent. As the number of members of families exceeds that of employees by nearly 150 per cent, the actual treatment given to them was greater than to the employees, notwithstanding the very much higher sickness rate of the former. Altogether nearly 5,000,000 cases of illness are being treated by the railroads' medical staff. NUMBER OF EMPLOYEES OF RAILROADS AND MEMBERS OF THEIR FAMILIES TREATED BY THE RAILROAD MEDICAL STAFF, 1901 TO 1907. [Source: Ministerstvo Putei Soobshchenia. Otdiel zheleznykh dorog. Otchot o vrachebno-sanitarnom sostoïanii zheleznykh dorog, 1902-1907.] PROPOSED REFORMS. The foregoing statistical data show that in manufactures, mining, and railroads the employers expended in 1907 nearly $12,000,000 in. furnishing medical aid to some 2,750,000 employees and their families; but nevertheless the system is not considered satisfactory. The shortcomings of the system of medical aid to workers in private establishments, as established by the temporary rules of 1866 and the later fragmentary legislation, were disclosed in the report of the factory inspector above quoted, and since the beginning of the present century a plan for a comprehensive law has been under preparation in the Ministry of Finance. A draft of this plan was made public in 1903, and referred for criticism to the Ministries of Justice, Agriculture, Interior, and Ways of Communication. A later draft embodying the changes suggested by these ministries was made public in 1905. The proposal at that time seemed very near becoming a law, but action on it was postponed for the consideration of the newly established Duma, in connection with the intended complete revision of the entire labor legislation. The plan was again under discussion in connection with the problem of labor insurance in the spring of 1908, but no action has as yet been taken. This proposed law establishes the principle that workmen employed in factories, mills, mines, and metallurgical establishments privately owned must be furnished medical aid at the expense of the employer. The earlier draft included the private railroad shops, but it was pointed out by the minister of ways of communication that all railroad employees had been provided for, under more favorable conditions, since 1893. This medical aid may include first aid to the injured or those suddenly taken ill, medical advice, medicine, dressings and similar appliances in ambulatory cases, medical attendance in confinements, full hospital treatment and subsistence in cases requiring confinement in bed, or in exceptional cases, treatment, medicines, etc., but without subsistence, when the patient prefers to remain at home, with the permission of the attending physician. When the nature of sickness is such as to cause disability to work, such medical aid must be given until recovery, but not longer than three months, though in exceptional cases this limit may be extended to six months. In these cases the duration of treatment does not depend upon the employment contract. In cases which do not cause disability the employer is required to furnish treatment only up to the expiration of the employment contract. To meet the requirements of this plan, the employer may establish and support hospitals and dispensaries independently or in conjunction with other employers of labor, and in such cases the medical institutions of the factory must satisfy in every particular the stand ard requirements to be published by the medical council of the Ministry of Interior, or he may enter into agreement with municipal authorities or the zemstvo to furnish this aid in their medical institutions for compensation. It was the intention of the legislative plan to encourage such agreements, and it provided, therefore, that when the employer desired to enter into such an agreement public institutions could not decline to accept it. For such services the employer could be required to pay the municipality or zemstvo annual compensation for the current cost, as well as a lump sum for the organization of the necessary hospital facilities, the rates of compensation to be fixed by the municipality or zemstvo under approval of the civil authorities and the factory and mining commissions. Appeals against the decisions of the latter are permitted to the ministers of finance and interior, and penalties are provided for failure to carry out the demands of the law. This legislative proposal has evidently abandoned the specific demands of the old temporary law of 1866 as to the number of beds, and left the elaboration of all practical details to administrative regulations. The destructive tendency of this new proposal is its effort to transfer the organization of medical aid from the factory to the local civil authorities, while recognizing the duty of the employer to meet the financial burden. This was the result of the many disclosures, official as well as private, that the organization of medical aid in factory hospitals and dispensaries was not entirely satisfactory. In an official report on this matter, published in 1905, it is frankly admitted that the law of 1866 "forces upon the employer a function utterly foreign to him, which in the very nature of things can not be satisfactorily fulfilled." It was recognized at the same time that there were a few highly satisfactory factory hospitals, and these should not be absolutely prohibited. The choice between an independent hospital and an agreement with existing hospitals is left with the employer; but a high standard is established for private hospitals which would require such a high cost that in the majority of cases an agreement would be considerably cheaper, and the local hospital authorities are not permitted to decline to enter into such agreement. Finally the argument is brought forth that such agreements are preferable for the treatment of the employee's family, since by no principle can the employer be required to furnish hospital facilities for the benefit of the workmen's families, while if the local authorities will extend their hospital facilities in accordance with agreements with factory owners room will be found for the workmen's families as well. In view of the preparation of this draft of a special law for regulating conditions of medical aid to employees of the manufacturing, metallurgical, and mining industries the draft of a general labor insurance law of 1905 did not contain, in its chapter on sickness insurance, any reference to medical aid. When subsequently the proposal of a labor insurance law was broken up into its component parts and a special bill prepared for each branch of labor insurance, the matter of medical assistance was combined with that of sick benefits into one bill. Nevertheless the essential features of the proposal remained the same as in the drafts of 1903 and 1905. In the draft of December, 1906, presented to the Duma in June, 1908, the obligation of furnishing medical aid and that of furnishing sick benefits are still kept separately, because of the conviction that the workmen's sick benefit associations to be established in the factories and mines would not have any experience with the work of furnishing medical aid and could not be expected to cope with this important problem successfully. The burden of the cost of medical aid is left upon the employer. It is provided, however, that the employer may transfer this duty to the sickbenefit fund by mutual agreement, in addition to the option of making similar agreements with other employers or public hospitals in the vicinity. Where no such agreement exists, the wage-worker obtains the right to receive treatment in the hospitals of the municipal or zemstvo authorities, and the actual cost must be borne by the employer. The elaboration of the regulations and the entire administration of the law is to be placed in the hands of the labor insurance council, the establishment of which is contemplated in the general scheme of labor insurance. FINANCIAL ASSISTANCE DURING SICKNESS. Much less has been accomplished for financial relief during illness of workmen than for medical aid. If the sickness requires hospital treatment, subsistence is given to the patient free, in compliance with a decision of the Ministry of Finance. By the law of 1886 subsistence was a part of the hospital treatment and the employer could not charge for it. The conditions of life of the majority of the Russian factory workers are such that serious cases requiring confinement in bed can not be satisfactorily treated at home. Only two-fifths of the factory workers had factory hospitals at their disposal. Where only dispensary treatment is furnished, and in all cases not requiring hospital treatment, no subsistence is granted; besides, in case of hospital treatment the family of the patient is without income. The only general legislation which endeavors to meet this situation is that referring to "fine funds." FINE FUNDS. The imposition of fines and penalties upon employees is a feature .of Russian industry. Before the adoption of the law of 1886 regulating the relations between employers and employees, fines in some establishments furnished considerable returns to the employers. This abuse was remedied by law, which regulated the imposition of fines and provided that the proceeds be used for the relief of the workmen only. This and all other provisions of the law of 1886 were extended in 1892 to the mines and metallurgical establish ments. According to this law the manager of the industrial establishment may by his own authority impose fines for only three reasons: (1) For faulty work, (2) for absence without excuse, (3) for "disturbance of the peace and order," such as tardiness, carelessness with machinery or with fire, lack of cleanliness, fights, quarrels, disobedience, drunkenness, gambling, or any conduct contrary to the factory rules. The fines must be imposed according to a definite scale approved by the factory inspector. The actual amount of fines imposed must not exceed one-third of the wages due at pay day, but when the sum of fines imposed would exceed that limit the manager may dismiss the employee. Against these fines the employee has no appeal, but if the factory inspector during his visit of inspection discovers cases of illegal fining, he must hold the manager responsible for it. The amount of fines collected in each establishment constitutes a special fund, which may be used only for the benefit of the employees with a special approval of the factory inspector in each case, and in conformity with the regulations to be published by the minister of finance in regard to the purpose and methods of such relief. According to these regulations promulgated by the minister of finance on December 4 (16), 1890, subsidies from these funds may be granted for the following purposes only: Permanent or temporary disability due to sickness; pregnancy, if work has been discontinued two weeks before childbirth; funeral expenses; sudden loss of employee's property through fire or other causes. The fund is administered by the employer, but all sums over 100 rubles ($51.50) must be deposited with the state savings bank, and the accounts of this fund are subject to the control of the factory inspectors. The factory commission may, upon its own judgment, grant the employers the right to grant subsidies not to exceed 15 rubles ($7.73) each, but this permission is subject to recall when the subsidies are granted extravagantly or not in conformity with the laws and regulations. On the other hand, the factory inspectors may grant such subsidy when the manufacturer unjustly refuses it to a needy workman; but the manufacturer may enter a complaint with the local factory commission against such acts of the inspector. In comparatively few factories are fines levied. While the data do not go back of 1900, even for the eight years 1900 to 1907 the number of establishments in which the collection of fines is authorized has declined, and also the number of factories in which fines |