Italy

ITALY. Area: 310,120 km² (according to 1921 data). Before the imperialist war: 286,610 km². Present population: 38,710,576 people, of which 19,089,535 are men and 19,621,041 are women. Population density according to the 1921 census was 133.8 people for the permanent population and 129.6 people per 1 km² for the present population. Demography. The population in Italy is increasing rapidly. According to the census, there were 35,845,048 inhabitants in 1912, 38,710,576 in 1921, and 39,943,528 in 1926. The birth rate over the last 45 years (in absolute figures) is as follows: Table 1, Years, Number of live births, Men, Women, 545,714, 570,787, 661,670, 581,834, 577,700, 560,225, 515,380, 539,786, 631,404, 652,151, 649,744, 534,362, 1,059, 1,057, 1,057, 1,054, 1,051, 1,048. The birth rate and mortality rate in Italy are gradually decreasing, and the decline in the birth rate has recently begun to seriously worry the government. Data for the last 27 years are given in Table 2 (per 1,000 inhabitants): Table 2. Years, Birth rate, Mortality rate, Natural increase, 33.0, 23.77, 9.23, 32.38, 18.15, 14.23, 31.84, 18.75, 13.09, 30.07, 17.71, 12.47, 27.79, 16.79, 11.00, 26.40, 15.50, 10.90. The government is striving to increase the birth rate by adopting measures prohibiting propaganda aimed at limiting the birth rate, strengthening penalties for abortion, etc., and also by restricting emigration. But due to the rapid population growth, emigration from Italy is very large, although over the last few years, in view of the restrictive measures taken by the government, it has fallen sharply. In 1927, there were 9,674,367 people registered as emigrants outside of Italy. Accurate data on the distribution of emigration by country are available for 9,168,457 emigrants. The latter were distributed by various countries as follows: Table 3. Parts of the world, Abs. numbers, In %, Oceania and Australia, 7,674,583, 1,267,841, 27,567, 9,674, 83.71, 13.83, 2.06, 0.30, 0.10, Total. . . In America, the main mass of Italian emigration was distributed as follows: Table 4. United States, Brazil, Argentina, 3,706,116, 1,839,579, 1,707,000, Canada, Uruguay, Chile, 200,000, 65,000, 23,000. The rest are scattered across other countries of America. In Europe, Italian emigrants were distributed mainly as follows: Table 5. France, Austria, (75.91%), Belgium, Switzerland, Yugoslavia, (10.72%), Romania, England, Luxembourg, Germany, Monaco. Health care organization. The central health administration is part of the Ministry of the Interior. Local organizations are subordinate in the province to the prefect, subprefect, and "podesta". At the head of the Central Health Administration is a director. Attached to it is a scientific-consultative body - the Superior Council of Health (Consiglio Superiore di Sanita), which is entrusted with the duty of proposing sanitary-hygienic measures and monitoring their implementation. It consists of 34 members, 12 of whom are ex officio (director of health, etc.), and the rest are appointed by the king for a term of three years. The central administration has 5 sections. 1. General section: prepares sanitary-preventive bills and appoints personnel. 2. Administrative section: control over the medical profession, appointment of sanitary officials, doctors, midwives, veterinarians, sanitary inspection (supervision of local hygiene bureaus, laboratories, etc.), supervision of pharmacies, inspection of professions that are harmful in a sanitary sense, issuance of instructions on hygiene, receipt and consideration of complaints and conflicts in the field of implementing sanitary measures; this same section issues loans for work on the implementation of preventive measures. 3. Section of general hygiene: prevention of infectious and tropical diseases, control over sera and vaccines, publication of a weekly and annual report on infectious diseases and a monthly bulletin on the same for abroad. 4. Section for the fight against tuberculosis and cancer. 5. Veterinary section. At the head of each section is an appointed director. Communal health care is the basis of the entire health care organization. At its head in each province is a provincial doctor. In addition, there are sanitary officials. Doctors and officials are appointed by the prefect and are considered to be in the state service, although they are paid from the local budget. In every commune with a population of over 20,000, there is a communal department of hygiene, while for other communes, sanitary inspection is mandatory. In 1926, there were a total of 183 sanitary inspectors in Italy. In Italy, sanitary legislation has developed strongly in recent years and has achieved significant results, but the entire health care system is built on the principles of charity. Since the time of the fascist dictatorship, the state has striven to direct health care matters more and more, without, however, violating the interests of the big bourgeoisie. Therefore, while general health care is organized not badly, labor protection is very weakly developed. Fight against infectious diseases. Registration of infectious diseases is mandatory. The incidence of them is progressively decreasing, having reached a minimum in 1927. Mortality from them fell from 5.7 per 1,000 inhabitants in 1887 to 2.1 in 1925. Below are the absolute figures for mortality from infectious diseases over the last 40 years. Table 6. Diseases, Average figures for 1887-89, 1925. Anthrax, Rabies. These figures will become even more indicative if one takes into account the population growth over the last 40 years. Relative indicators of mortality from some infectious diseases in 1923 per 1 million inhabitants are as follows: Table 7. Tuberculosis, Typhoid fever, Diphtheria, Scarlet fever, Pellagra, 73, 62, 0.4. Pellagra is widespread in the south and in northern Italy, where the consumption of corn is high. Cases of pellagra are decreasing sharply, and in parallel with this, the number of psychoses on the basis of pellagra is decreasing. In 1881, there were 104,037 cases of pellagra, and in 1926, only 1,466. Vaccination against smallpox is mandatory by the law of 31/III 1892 and the decree of 30/XII 1923. Individual cases of smallpox are of an imported nature (from Africa). A large outbreak occurred during the imperialist war. Typhoid fever is very widespread; in recent years it has been stationary, but in 1926 a strong epidemic was observed. By circular of 28/VII 1926, a number of measures to combat it were prescribed. By decree of 2/XII 1926, mandatory vaccination against typhoid fever was introduced for some categories of the population and a number of sanitary measures were introduced. To combat rabies, which is still quite widespread, there are 17 Pasteur stations. Leprosy is rare, brought in by re-emigrants from South America. In 1926, there were only 350 leprosy patients. The law of 11/II 1926 establishes measures to combat it. There are 2 leprosariums and wards for lepers in some hospitals. Trachoma is very widespread, especially in the south and on the islands, in particular among workers in tobacco factories. Registration of cases is mandatory. In 1927, there were 208 anti-trachoma dispensaries (in 1924 only 156) and many special consultations. Malaria is one of the most widespread diseases in Italy in view of the large number of swampy areas and rice plantations. The state has long been waging an energetic fight against it by draining swamps, which has yielded good results; a state monopoly on quinine has been introduced, mandatory registration of malaria patients, free distribution of quinine to the needy, and free treatment for those in need. Income from the sale of quinine goes into a special fund for the fight against malaria. Malaria is most widespread in Sardinia (in 1918, 212 deaths per 100,000 inhabitants), and least of all in Lombardy (3 deaths per 100,000). Mortality from malaria over the last 40 years is as follows: Table 8. Years, Number of deaths, Mortality per 1 million inhabitants, 1887, 27,990, 21,930, 20,900, 18,750, 16,560, 377, 62.3, 52.1, 43.5, 1919. During the years of the imperialist war, there was an increase in mortality from malaria due to the weakening of the fight against it. The number of people who fell ill with malaria was 177,946 in 1902, 323,312 in 1905, and 234,656 in 1922. By 1927, 1,226,949 hectares of swampy areas had been drained, 568,196 hectares were in the process of being drained, and it was planned to drain 589,858 hectares. The state has purchased quinine plantations on the island of Java and is conducting experiments with the cultivation of the cinchona tree in the African colony of Eritrea. Legislation to combat malaria is extensive. There are numerous courses on malariology for doctors and for the population. In 1927, a Higher School of Malariology was founded in Rome. There are laboratories in cities and on transport. In Nettuno, there is a special institute of malariology. Extensive propaganda is being conducted among the population. Fight against cancer. The government has recently paid special attention to it, and cancer diseases are being widely studied. 2.5 million lire were allocated for the fight against cancer in 1927. Mortality from various tumors in 1926 was 22,548. Fight against social diseases. Tuberculosis. Cases of pulmonary tuberculosis are significant and have a tendency to increase. Mortality in 1926 was: men - 27,188 and women - 30,691, total - 57,879.

In the field of the fight against tuberculosis, besides various sanitary-preventive measures, there are 2 main laws: 1) the law of June 23, 1927, on the mandatory organization in all provinces of 'consortiums' for the fight against tuberculosis, and 2) the law of October 27, 1927, on mandatory insurance against tuberculosis. Insurance extends to those insured against disability and old age and to sailors, members of the maritime insurance fund. Its purpose is the hospitalization of insured patients and their families and an allowance for family patients depending on the contribution (4-6 lire per day). In 1927, there were in total: Table 9. Dispensaries... Institutions for Preventoriums... surgical tuberculosis... Sanatoriums... Special Departments for hospitals... for tubercular patients... Forest schools for sick children. It is assumed that in 2-3 years the total number of those insured against tuberculosis will amount to about 20 million for all of Italy. State subsidies for the fight against tuberculosis amounted to a total of 31 million lire from 1917 to 1927. In addition, loans were issued to communes and public organizations in the amount of 23,674,000 lire. A number of large public organizations are conducting the fight against tuberculosis and propaganda among the population. -Venereal diseases. Treatment of venereal diseases is provided free of charge. According to the law of March 25, 1923, in every city with a population of over 30,000 there must be a venereal dispensary. The state provides subsidies for the establishment of dispensaries. In 1926, there were 187 venereal dispensaries in Italy (in 1924, only 139) and 145 special clinics. In ports, there are 16 state dispensaries for the free treatment of sailors (based on the International Convention of 1924). For the supervision of prostitution and brothels, there were 150 doctors in 1927. Medical personnel according to data for 1927 were distributed as follows: Table 10. Medical personnel, Absolute number, Per 10,000 inhabitants. Medical doctors... Pharmacists... Midwives... Pharmacies (private)... 7.51 0.17 3.13 4.03 2.50. Medical care for the population is provided by doctors and hospitals. For both, medical care is paid. But for the indigent, who can present a certificate of poverty from the commune, medical care is provided free of charge by a special category of doctors, the so-called medici condotti—doctors for the poor. Each such doctor has his own medical district, called a condotta sanitaria. The number of doctors depends on the number of inhabitants in the district. These doctors are paid from the local budget. Wealthy patients who, for some reason, do not wish to use the services of a private practitioner can also resort to the services of medici condotti, paying them according to a special rate, depending on the financial situation of the patient. The determination of financial status and payment for treatment depends on local authorities. -Hospital care. In principle, in Italy, all hospitals are paid, but for indigent patients who cannot pay themselves, the commune pays. Starting from the Middle Ages, hospitals in Italy were concentrated in the hands of Catholic church organizations, to which philanthropic institutions joined in the 19th century, and later municipal and private ones. Hospital care in Italy has either a semi-philanthropic or private character. Hospital institutions can be divided into 3 types: 1) state, which include only university clinics equated to hospitals, 2) communal, and 3) charitable-religious. The latter are the most numerous, fully autonomous, and managed on the basis of their own internal statutes. These institutions possess their own property and sometimes even large estates. In 1928, there were up to 1,500 hospitals in Italy, possessing property worth over 2 billion lire and an annual income of about 90 million lire. According to the decree of 1923, hospitals are obliged to admit and treat all patients of a given commune within the limits of their available funds. Excess expenses are paid by the commune. In case of a lack of funds in the commune, the state can come to the rescue. Recently, by a special decree, small municipal hospitals were transferred to the disposal of university clinics. -Psychiatric care. In recent years, the number of psychiatric patients has been growing rapidly, especially in the most industrial provinces—Piedmont, Liguria, Venice, Tuscany; the growth is weakest in the least cultured and agricultural provinces—Apulia (Puglie), Calabria, and Sicily. The number of alcoholic psychoses is growing especially. Psychoses on the basis of pellagra, on the contrary, are decreasing in connection with the decrease in the incidence of this disease. The following table shows the growth of the total number of the mentally ill. Table 11. Years, Number of patients, Incidence per 1,000 inhabitants. 1874... 0.5, 1880... 0.6, 0.7, 0.9, 1.3, 1.5, 1.5, 1.6. For psychiatric patients, there are many free outpatient clinics; in total, over 30 institutions. In addition, there is the National Organization for Assistance to War-Disabled Mentally Abnormal Persons (Opera Nazionale per l'Assistenza agli orfani di guerra anormali psichici). There are also the Italian League of Mental Hygiene and a number of leagues for the fight against alcoholism. In 1923, alcoholism caused 18 deaths per 1 million inhabitants, in 1924—24 deaths, and in 1925—32. -Resorts. In 1928, 332 mineral springs were exploited in Italy. Almost all of them belong to the state, but are leased by it to private societies, which exploit them on a private-ownership basis. The main resorts—Montecatini and Salsomaggiore—belong to joint-stock companies and are widely advertised everywhere. For the working people, they are open only insofar as they can pay for their own treatment. Supervision of food products. There are a number of special legislative measures and regulations. In the first place is the supervision of milk, the production of which in Italy is very significant and is developing rapidly. Regulation concerns the construction and maintenance of barns, supervision of personnel, care and supervision of livestock, supervision of milk, milking of cows, and the sale of milk. -Supervision of narcotic substances. The decree of September 9, 1922, establishes strict control over the import, export, production, and trade of narcotic substances. All patented remedies must be mandatorily registered. The number of these remedies is growing every year. As of January 1, 1928, there were 8,083 of them. -Finally, it is necessary to note the extensive sanitary legislation in the fields of construction, housing, etc. Sanitary education is developed quite widely, conducted by the state, semi-state institutions, and various societies. In the field of protection of motherhood and childhood, propaganda through brochures, lectures, etc., is conducted by the National Society for the Protection of Motherhood. The League for the Fight against Tuberculosis, the League of Mental Hygiene, and the Red Cross also widely conduct propaganda of hygiene. Fascist organizations like 'Balilla' and 'Avanguardisti' also engage in the propaganda of hygiene. For the propaganda of hygiene among workers, there is a special society 'Dopolavoro,' the purpose of which is to entertain workers in their free time. This is done, of course, to strengthen the fascist spirit and to distract the proletariat from the revolutionary struggle. Protection of motherhood and childhood. Infant mortality in Italy is still very high, but is decreasing every year. It amounted to for children under one year of age: Table 12. 1906... 16.1%, 1910... 14.0%, 1915... 14.7%, 1920... 12.7%, 1925... 11.9%. The basic law in this area was issued on December 10, 1925, and the basic rules were approved by the decree of April 15, 1926. The National Organization was founded—Opera Nazionale per la Protezione della Maternità e dell'Infanzia. Its goal is to organize supervision of the physical and moral upbringing of children and assistance to mothers. It is maintained by private funds and government subsidies. So far, very little has actually been done. Legally, a woman is completely without rights; protection of female labor does not exist. Maternity insurance is conditional and negligible. School hygiene. Theoretically, medical supervision should exist in all schools, but in fact, it is carried out only in cities. This matter is best organized in Genoa, Naples, and Florence. By Royal Decree of May 24, 1925, a consultative commission was established on issues of school and pedagogical hygiene and for the coordination of the activities of the sanitary administration with the school administration on issues of school hygiene and camps. Physical education of school youth is also handled by the fascist society Opera Nazionale di Balilla. In 1929, this society had up to 700,000 members, and in addition, there were 500,000 'avanguardisti' (avanguardisti). Children aged 10-14 are accepted into the Balilla society, and 14-18 year olds into the 'avanguardisti'. Besides physical education, these societies strengthen fascist ideas in children and prepare them for service in the fascist militia, which accepts them from the age of 18. Labor protection is very poorly developed. The working day is not limited. Protection of child labor is in its infancy. The rules of April 14, 1927, establish hygiene requirements in industrial, agricultural, and commercial enterprises and concern the volume and maintenance of premises, temperature in them, water supply, etc. The decrees of July 12, 1912, and February 26, 1927, establish a list of hazardous occupations. Insurance of workers against accidents is not mandatory. The employer is only obliged to provide first aid to the injured worker and pay a certain sum for material damage (usually in the amount of 20 times the wage).

There is a National Accident Insurance Fund, but by no means all workers are insured in it. It has organized medical assistance for the insured in the form of medical consultations, special hospitals, dispensaries, permanent doctors, and consulting physicians. In total, it has 25 medical consultations and 123 dispensaries, of which 104 belong to the fund, and the rest to other organizations. It has at its disposal 6 hospitals and beds in the necessary quantity without limitation in all other hospitals. In addition, the fund owns 11 sanitary institutes in various places. The fund also engages in the professional retraining of workers and the provision of prostheses to them. By decrees of November 29, 1925, and March 4, 1926, health insurance funds were founded at the expense of contributions from entrepreneurs and workers. Healthcare in transport and ports. Railways. There are a total of 170,000 employees. A well-organized medical structure with a central bureau in Rome and 20 regional bureaus. In 1927, there were 50 permanent medical inspectors and 1,600 attending physicians. At major stations, in depots, in workshops, etc., there are first-aid posts (64), which are at the same time dispensaries. Everywhere there are sanitary stretchers (11,000), in many places mobile beds (270), sanitary carriages, boxes with a set of medicines and instruments (7,500). Maritime transport. Italy is a predominantly maritime country, with a coastline of over 8,000 km. Sanitary measures among sailors are very numerous, but they stem not so much from the intention to protect the labor of sailors as to improve the situation of passengers. Special strict examinations according to a large program have been established for ship doctors. In ports, there is a special sanitary administration that monitors their sanitary condition and the protection of borders, disinfection, and deratization of ships (mainly hydrogen cyanide gas is used). This kind of administration exists in 70 coastal cities. Medical education. In Italy, there are 15 state universities and 2 private ones. The medical faculty course lasts 6 years. There are a number of special institutes and schools for various specialties. Special advanced training courses for sanitary doctors are organized in many universities. The healthcare budget consists of separate credits from different ministries and from the local budget. Comparative figures of the budget for healthcare in 1914/15 and 1926/27 (in Italian lire) are as follows: Table 15. Institutions: 1914/15, 1926/27. Ministry of Internal Affairs: 9,060,720. Provincial administration: 594,720 and 23,749,800. Municipal administration: 693,013,784. Provincial anti-tuberculosis organizations: 41,561,945. Credits for healthcare by ministries (public works, navy, military, aeronautics, national economy, and communications): 140,472,250. Total: 175,489,785 and 1,026,088,060. Thus, the growth of the healthcare budget was most reflected in the budget of the provinces, which grew 40 times since 1914/15, while the growth of other credits is somewhat fictitious, corresponding to the fall in the exchange rate of the Italian lira.

A. Rubakin.