MEDICINE IN RUSSIA
[To the Editor of THE SPECTATOR.] SIR; I would not venture for a moment to cast any doubt on the good faith of your correspondent, Mr. H. H. Charnock, who, as a member of a family with large interests in Russian industry before the Revolution, should be well acquainted with the health conditions of Russian workers in those days. It is a little disconcerting to find, however, that on the subject of the " medical assistance " rendered to the peasantry by the zemstvos, a publication issued with the support of the Tsarist Government—The Russian Year Book for 1913— should say (after a mass of figures with which I will not burden your readers) : " The state of public health in the provinces is due not only to the bad sanitation and un- hygienic conditions, but also to the absence of medical aid. Even in governments where zemstvos exist, a large number of the population is left without medical aid " (p. 676).
The death-rate figures among the peasantry in 1913 were 27 per 1,000, while the infant death-rate (250- per 1,000 over the whole country) rose in some country districts to 600. Mr. Charnoek's experience in the " excellent " country hospitals, unfortunately, did not help these Russian infants very much. Turning to the factories, it would be interesting to hear from Mr. Charnoek under what Tsarist law " every industrial concern employing above 500 workpeople had to have its own hospital." Under the Insurance Law of June, 1912, factories employing over 200 had to form a " sick club," to which the employer contributed under 1 per cent. of the total wages bill, and the employees just over 1 per cent. But each sick club had " to make arrangements with the existing private or Government hospitals regarding the treatment of its members and the rate of remuneration." (Russian Year Book, p. 695.) While many of the larger factories, we learn from the same source, provided " well-equipped hospitals " (p. 691), in the remaining factories covered by the measure, by the summer of 1917, the total number of factory " ambulatoria " opened by the sick clubs throughout Russia did not exceed 15. The measure itself, however, did not in any case extend to factories employing four-fifths of the entire working class.
Mr. Charnock, one suspects, does not distinguish sufficiently between the letter of laws forced out of Tsardom by revolu- tionary strikes and crude reality. Only this can explain his innocent references to the regulations being " very strictly controlled by the factory inspectors." The total staff of the factory inspectorate numbered some 250 persons (of whom over a quarter had no investigating powers whatever). These were scattered, according to the authority quoted already (p. 683) over 231 districts, in which there were 16,600 factories in 1911, employing 2,051,000 workmen. It may readily be imagined how " strictly " controlled the factories were. In any case, the Year Book itself reveals (p. 684) that in 1911, out of 18,840 violations of the law noted by the inspectors, the latter- " censured" those responsible in. 17,801 cases, and drew up protocols (i.e., took the matter up with the legal authorities) in only 1,059 cases. In 1913, out of 13,814 breaches of the law noted, protocols were drawn up in 4 per cent, of the cases, and in 1914 in 41 per cent. It is hardly necessary to remind Mr. Charnock, who knows the old Russia so well, of the amazing tenderness of the district courts for the manufacturer in that small percentage of cases which reached them. Most of the more- honest factory inspectors realized perfectly well that their real function, as one of them wrote in: his memoirs, was that of Government agents for the maintenance of order" (Gvozdev : Recollections of a Factory Inspector, 1911).—I am, Sir, &c., Friends of the Soviet Union,
ANDREW ROTHSTEIN.
33 Ormond Yard, Great Ormond Street, .W.C.1.
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