Medical Personnel

MEDICAL PERSONNEL, medical workers serving medical-sanitary institutions. Higher M.P. — physicians, dentists; Middle M.P. — nurses, feldshers, feldsher-midwives, midwives, dental technicians, X-ray technicians, laboratory and prosectorium preparators, masseurs, masseuses, disinfectors, smallpox vaccinators, pharmacists; Junior M.P. — orderlies, sanitary workers, nannies, wet nurses for mother and child homes (for numbers, see Medsantrud). The administrative-economic group of M.P. includes farm managers, caretakers, storekeepers, porters, stokers, yard workers, kitchen staff of medical-sanitary institutions, etc. The basic rights and duties of M.P. are regulated by the corresponding legislation. Unlike the pre-revolutionary period, when medical workers represented separate class-professional groups, whose activity was interpreted as a private-law function in accordance with the entire bourgeois-landlord system of that time, M.P. in the USSR, called upon to be an active participant in socialist construction, is one of the detachments of the proletarian army of labor, performing responsible public tasks for the protection of the health of the working population, and thus for the strengthening of the labor resources of the proletarian state. Instead of the old pre-revolutionary nomenclature of medical titles (physician, district doctor, midwife, sister of mercy), new medical titles have now been established in the USSR (physician, midwife, nurse, etc.). The decree of the All-Russian Central Executive Committee and the Council of People's Commissars of the RSFSR of 1924 "On professional work and the rights of medical personnel" (Collection of Enactments and Orders of the Workers' and Peasants' Government, Art. 892, 1924, No. 88) defines the rights and duties of M.P. of different categories, and the right to medical and pharmaceutical work is granted only to persons having a duly certified medical title. In pre-revolutionary legislation, although Article 220 of the Medical Charter existed, which granted the right to medical practice only to persons having a diploma of graduation from a corresponding medical educational institution, the prohibition derived from this article against engaging in practice by persons not having the corresponding medical title was effectively annulled by Article 226 of the Medical Charter, which stated that "persons who, out of philanthropy, gratuitously help patients with their advice and known means of treatment are not subject to punishment for illegal medical practice." Further clarifications by the Senate and the Special Conference under the State Council effectively legalized the provision of medical aid by persons having no special knowledge certified by corresponding certificates or diplomas of medical educational institutions. Medical activity of M.P. in the USSR is regulated by special instructions issued by the People's Commissariats of Health of the union republics. Medical and pharmaceutical workers, upon entering service, are obliged to present to the administration of the institution documents regarding the special education they have received. Hiring the indicated workers without their presentation of documents regarding education is punishable by criminal law. By the decree of the Council of People's Commissars of the USSR of April 10, 1936, from July 1, 1936, mandatory personal registration was introduced by local health departments for physicians, pharmacists, feldshers, nurses with secondary medical education, and midwives working in institutions and enterprises of all departments and organizations of the USSR and union republics. Registration of medical personnel is performed upon their arrival at a permanent place of residence, upon departure to another place, and upon changing the place of work within the limits of a district or city. Medical personnel of the Workers' and Peasants' Red Army and the border and internal security of the NKVD of the USSR are not subject to registration (Official Collection of the People's Commissariat of Health of the RSFSR, No. 9, 1936). Medical workers wishing to engage in private practice are obliged to register at the corresponding health department (decree of the All-Russian Central Executive Committee and the Council of People's Commissars of the RSFSR of January 10, 1930, Voprosy Zdravookhraneniya, official section, No. 6, 1930). Documents confirming the presence of a medical title are certificates of graduation from a corresponding medical educational institution or copies of certificates certified in the established order, service records or labor records with an indication of the medical title, place and time of its receipt, and copies of service or labor records certified in the established order. For persons who received the title of physician before 1916, confirmation of the presence of the title is also a mention of the given medical worker in the Russian Medical List, published by the Administration of the Chief Medical Inspector until 1916. The presence of the title of preparator is established by special references from laboratories and institutes at which the corresponding persons acquired their technical skills. In the absence of the indicated documents or their dubiousness, a definite term is given for their presentation; upon their non-presentation within the indicated term, medical workers belonging to the category of persons who received higher or secondary medical education are subjected to a verification test according to an established program within established terms: physicians and dentists — at medical higher educational institutions, middle M.P. — at corresponding departments of medical technical schools, and pharmacists — at pharmaceutical technical schools or chemical-pharmaceutical faculties of medical higher educational institutions. If a medical worker registered at a health department has discovered clearly insufficient knowledge in their practical activity, then the health department has the right to subject them to undergoing a practical internship with a duration of up to 1 year for physicians and up to 6 months for other M.P., and further medical professional work is permitted to them only upon the presence of a satisfactory reference from the institution at which the internship was undergone. Medical workers who have not worked in their medical profession for over 5 years and who wish to receive a registration certificate for the right to medical work are also subject to undergoing a practical internship at corresponding medical-sanitary institutions, clinics, medical higher educational institutions, well-organized large hospitals, dental outpatient clinics, and pharmacies. The term of the practical internship is determined by the health department for each given case depending on the duration of previous medical work and the duration of the break: for physicians — from 1 to 6 months, and for other medical workers — from 1 to 3 months, and this term can also be shortened if the medical worker, before the expiration of the established term, discovers sufficient preparation for practical activity. This term can be extended by the health department in case of necessity, however, not exceeding 9 months for a physician and 4 1/2 months for other categories of medical workers. If a medical worker who has lost a document certifying their right to a medical title has a break in work, then to receive the right to medical work, they must undergo a verification test after undergoing a practical internship (Instruction of the People's Commissariat of Health and the People's Commissariat of Education of August 3, 1928, Voprosy Zdravookhraneniya, 1928, No. 16). Physicians and dentists undergo testing at medical higher educational institutions; feldshers, pharmacists, midwives, and nurses — at corresponding secondary medical educational institutions. These educational institutions issue a corresponding certificate of the verification test. Nurses who have a practical internship of at least 3 years out of the last 6 years and who have discovered sufficient knowledge during their work, in case of their loss of the document regarding the title, are not subjected to a verification test, but on the basis of data regarding previous work receive from the health department a certificate for the right to further medical work (Voprosy Zdravookhraneniya, official section, 1929, No. 47). In all indicated cases of medical workers undergoing a practical internship at a specific medical-sanitary institution, the latter is obliged to issue to the medical worker, upon the expiration of the term appointed by the health department, in case of their established preparation for practical activity, a corresponding certificate signed by the head of the institution. On the basis of this certificate, further medical work is permitted by the health department. Military (company, squadron) feldshers who have not engaged in their profession continuously for 3 years or more are deprived of the right to medical work, even if they have a document certifying the presence of the title of military feldsher. Those same military feldshers who have engaged in their profession for at least 4 years during the last 6 years and who are in service or registered at the labor exchange, in case of their loss of documents regarding the title, are not subjected to a verification test, but on the basis of the certificates of previous service they possess, have the right to receive from the local health department permission for further work (instruction of the People's Commissariat of Health, People's Commissariat of Education, and the Central Committee of Medsantrud, No. 225/mv of August 3, 1928). In general, persons having the title of military feldsher (company, squadron, battery) can be granted the right to medical work in medical-sanitary institutions under the supervision of a physician only in exceptional cases with the permission of the health department and on the condition that the military feldsher has worked continuously for the last 3 years in civilian medical institutions (decree of the All-Russian Central Executive Committee and the Council of People's Commissars of December 1, 1924, Collection of Enactments, 1924, No. 8).

Medical assistants of the Workers' and Peasants' Red Army who have graduated from the school of military medical assistants at the Military Medical Academy may, upon discharge from military service, be accepted into all civilian medical-sanitary institutions for positions of intermediate medical personnel (feldschers) (Circular of the People's Commissariat of Health, No. 157/mv dated April 23, 1930, Na fronte zdravookhraneniya [On the Healthcare Front], official section, 1930, No. 16). The specified practical experience is paid, with the amount of payment equal to half the salary for the corresponding position in the given medical-sanitary institution for the following categories of medical workers: persons who worked for hire not in their main profession, and persons who previously worked for hire but ceased work for valid reasons (Instruction of the People's Commissariat of Labor of the RSFSR dated September 10, 1929, No. 101, Voprosy zdravookhraneniya [Healthcare Issues], 1929, No. 27). Medical workers, within the limits of their specialty and competence and the rights granted to them, may issue appropriate certificates regarding health status, disease, injuries, and treatment; these certificates must contain an indication of the time and place of issuance and the purpose for which they were issued. These certificates are signed with an indication of the rank and the seal of the medical worker who issued the certificate; in the absence of a seal, the signature is certified by the appropriate institution. Physicians may issue certificates not only regarding health status and treatment but also birth and death certificates. Feldschers are granted the right to issue, under their signature, certificates regarding the disease of persons treated by them, regarding preventive inoculations and vaccinations performed, and regarding death in cases not requiring forensic medical autopsies. Dentists have the right to issue certificates regarding treatment performed and the health status of patients treated by them. Midwives have the right to issue birth certificates for children delivered by them only in the absence of a physician (Resolution of the All-Russian Central Executive Committee and the Council of People's Commissars of the RSFSR dated December 1, 1924, Collection of Statutes, Art. 892, 1924, No. 88). These certificates are issued upon the request of health authorities, administrative, judicial, and investigative authorities, and at the request of interested private individuals (certificates for submission to state institutions regarding birth, death, disease, smallpox vaccination, etc.). The procedure and conditions for the issuance of certificates by medical workers are determined by a special instruction (People's Commissariat of Health and People's Commissariat of Justice of the RSFSR, 1925; Bulletin of the People's Commissariat of Health, 1925, No. 21). Payment for certificates via stamp duty is made on the basis of the Charter on Stamp Duty. Certificates regarding public health protection and regarding birth and death for submission to civil registry offices are not subject to stamp duty. Prescriptions written by medical workers must contain an indication of their medical rank. To avoid abuses through advertising, medical workers are permitted to indicate in announcements on signs only their rank and specialty, surname, first name and patronymic, and time and place of reception. Duties of Medical Personnel. Every medical worker engaged in practical medical activity is charged with the duty to provide medical assistance in case of necessity. These duties are determined by a special instruction of the People's Commissariat of Health, the People's Commissariat of Internal Affairs, the People's Commissariat of Labor, and the All-Union Central Council of Trade Unions dated March 2, 1926 (Bulletin of the People's Commissariat of Health, 1926, No. 5). In particular, physicians working in rural medical institutions are required to travel to provide home care within their district in cases requiring immediate assistance, when the patient cannot be transported to a medical institution without danger to life or obvious harm to health (see Physician). Depending on the case, a physician may dispatch a member of the intermediate medical personnel to provide home care. Refusal to provide medical assistance is punishable by law (see below). Medical workers are required to notify the nearest health department within 24 hours of every case of acute infectious diseases that comes to them for treatment [plague, cholera, typhoid fever, dysentery, typhus, relapsing fever, smallpox, scarlet fever, diphtheria, leprosy, anthrax, glanders, influenza (during an epidemic), and epidemic encephalitis] and of every case of death from these diseases; moreover, mandatory notification may be extended by local health departments, if necessary, to other infectious diseases (Resolution of the People's Commissariat of Health of the RSFSR dated August 7, 1918; Izvestiya Narkomzdrava [News of the People's Commissariat of Health], No. 7-8, 1918; also in Izvestiya VTsIK, August 18, 1918, No. 177). Medical workers are also required to notify about occupational poisonings and diseases no later than a week after the patient seeks their help (Resolution of the People's Commissariat of Health and the People's Commissariat of Labor of the RSFSR dated March 1, 1924, No. 95/346; Bulletin of the People's Commissariat of Health, 1924, No. 10; Circular of the People's Commissariat of Health of the RSFSR dated June 23, 1924, No. 129, Bulletin of the People's Commissariat of Health, 1924, No. 12). A medical worker is required to send an immediate notification or report by telegraph or telephone if several cases of poisoning have occurred (more than three) or if emergency measures are required. A detailed instruction on the procedure for mandatory urgent notification of occupational poisonings and occupational diseases is given in the circular of the People's Commissariat of Health of the RSFSR dated May 21, 1928, No. 143/31. Sending notifications is mandatory for a medical worker in all cases of poisoning, murder, infliction of grievous bodily harm, or suicide that have occurred in their practice. There are special instructions regarding the procedure and forms for the aforementioned notifications (Circular of the People's Commissariat of Health of the RSFSR dated July 8, 1925, Bulletin of the People's Commissariat of Health, 1925, No. 14). A special instruction (Circular of the People's Commissariat of Health of the RSFSR dated February 8, 1925, No. 134) establishes in detail the duties of medical workers regarding the maintenance of a complete and accurate record of all cases of bodily injury. The activities of different categories of medical personnel are regulated by special statutes and instructions, such as, for example, the instruction on the rights and duties of district medical personnel (Instruction of the People's Commissariat of Health, People's Commissariat of Justice, People's Commissariat of Labor, and the All-Union Central Council of Trade Unions dated February 11, 1926; Bulletin of the People's Commissariat of Health, 1926, No. 5). The rights and duties of medical personnel performing sanitary functions are regulated by a whole series of government orders. For the rights and duties of sanitary physicians as bodies of inquiry, the rights and duties of state sanitary inspectors, and instructions on the procedure for exercising the rights and duties of sanitary inspectors and sanitary physicians, see Sanitary Physician, Sanitary Organization. A number of instructions define the duties and rights of other categories of medical workers, e.g., the instruction of the People's Commissariat of Health and the People's Commissariat of Education to physicians on the protection of children's health (Bulletin of the People's Commissariat of Health, 1923, No. 21); the statute of the People's Commissariat of Health on the work of a child health protection physician in preschool institutions (Healthcare Issues, 1929, No. 28); the statute of the People's Commissariat of Health on the rights and duties of a physician for the protection of the health of adolescents dated December 3, 1932, No. 104; the same regarding physicians working in water transport dated November 25, 1932, No. 394 (supplement to the journal Na fronte zdravookhraneniya, official section, December 10, 1932, No. 33-34); the statute of the People's Commissariat of Health on the instructor for the protection of motherhood and infancy (Bulletin of the People's Commissariat of Health, 1925, No. 21), etc. The rights and duties of forensic medical experts are defined particularly in detail. According to the statute of the People's Commissariat of Health and the People's Commissariat of Justice on forensic medical experts dated December 16, 1921 (Bulletin of the People's Commissariat of Health, 1922, No. 1), forensic medical experts are officials obligated to perform forensic medical examinations according to existing rules (examination of living persons and examination of corpses in the presence of judicial-investigative authorities or militia bodies and 2 witnesses) with the compilation of an act in the appropriate form. Special rules exist for forensic medical examinations of corpses (Circular of the People's Commissariat of Health and the People's Commissariat of Justice of the RSFSR dated January 7, 1929, No. 6-70/mv), for the compilation of a conclusion on the severity of injuries (Circular of the People's Commissariat of Health and the People's Commissariat of Justice dated January 27, 1927), on the examination of dead bodies in case of sudden death (Circular of the People's Commissariat of Health dated December 19, 1918), and on the form of preliminary inquiry in these cases (statutes of the People's Commissariat of Health, the People's Commissariat of Internal Affairs, and the People's Commissariat of Justice dated July 29, 1919). For the RSFSR, the duties of forensic medical experts are established by a special statute (Healthcare Issues, 1929, No. 33). For forensic medical experts serving the rural population, the same benefits regarding periodic salary increases, scientific business trips, and vacations are established as for a sanitary physician (see) (Resolution of the Council of People's Commissars of the RSFSR dated June 15, 1928, Collection of Statutes, Art. 492, 1928, No. 68). There are a number of statutes regulating individual aspects of the activity of medical personnel, such as, for example, the statute on various categories of pharmacy personnel (Healthcare Issues, 1929, No. 42); the statute on emergency and urgent aid and on operations permitted to be performed outside medical institutions (Circular of the People's Commissariat of Health of the RSFSR dated October 20, 1925, No. 207, Bulletin of the People's Commissariat of Health, 1925, No. 20); the list of preventive and therapeutic sera and vaccines permitted for use by feldschers (Circular of the People's Commissariat of Health of the RSFSR dated May 16, 1925, No. 1051); the list of the simplest surgical operations permitted to be performed by feldschers (Instruction of the People's Commissariat of Health of the RSFSR dated January 12, 1926); on the rights of midwives to medical work (Circular of the People's Commissariat of Health dated January 2, 1924, No. 2); on the rights of obstetricians (Circular of the People's Commissariat of Health and the People's Commissariat of Education dated January 2, 1929, No. 4); on the rights of dentists to professional work (Circular of the People's Commissariat of Health and the People's Commissariat of Education dated January 9, 1924, No. 5); on the rights of dental technicians (Circular of the People's Commissariat of Health dated January 2, 1927, No. 6); on the rights of massage therapists (Circular of the People's Commissariat of Health dated August 12, 1926, No. 127). Among them, intermediate medical personnel work under the guidance of physicians, carrying out their instructions as assistants, and as a rule, do not have the right to independent medical work.

In the absence of physicians or in the event of their shortage, feldshers may manage medical posts and outpatient clinics, provided they have at least 3 years of work experience in a state or public medical institution of an inpatient or outpatient type. By feldshers, in this context, are meant medical workers who have completed a course at a standard-type feldsher school or a feldsher-midwifery technical school, or who have passed the corresponding examination at a feldsher or former medical administration and possess the appropriate certificates (for details on the rights and duties of feldshers, see Feldsher). Regarding the rights, duties, and nature of the medical work of other categories of medical workers, see the corresponding articles. The rights and duties of Medical Personnel in medical-sanitary institutions are regulated by internal regulations and special provisions on the duties of each category of medical worker, drawn up in accordance with the Labor Code. There are model internal regulations (circular of the People's Commissariat of Health of the RSFSR and the Central Committee of the Medical and Sanitary Workers' Union dated 10/VIII 1924, No. 186); regulations on the district sanitary physician (Vopr. zdrav., official section, 1929, No. 46 dated 15/XI 1929), on the chief physician, head of a department, resident physician, physician on duty, on the business manager, senior nurse of a hospital department, senior operating room nurse, on the chief accountant of a hospital (Hospital Affairs, collection of orders of the People's Commissariat of Health of the RSFSR, Biomedgiz, 1935); instructions of the People's Commissariat of Health of the RSFSR dated 16/V 1933, 23/VI 1933, published in Na fronte zdrav., official section, No. 15, dated 15/VII 1933, on the intern physician, intermediate Medical Personnel for patient care, on the ward nurse, on the rights and duties of administrative and economic personnel—issued by the People's Commissariat of Health of the RSFSR and the Central Committee of the Medical and Sanitary Workers' Union in the form of separate circulars (dated 22/VI 1927 and 23/IX 1927). The procedure for the hiring and dismissal of medical workers is regulated by special instructions of the People's Commissariats of Health of the union republics and trade unions in accordance with generally established provisions on the procedure and conditions for the hiring, distribution, and dismissal of labor and specialists.

Workload standards for Medical Personnel are established by special orders of the People's Commissariats of Health of the union republics in agreement with the Central Committee of the Medical and Sanitary Workers' Union. Workload standards for Medical Personnel in the RSFSR [Circular No. 44/mv dated 15/XII 1929 (see Vopr. zdr., official section, People's Commissariat of Health of the RSFSR 1929, No. 46)]. Medical Institution Number of patients per 1 physician General hospital: * therapeutic department - nervous » . . . infectious »

Surgical department... gynecological, eye and ear... Maternity homes and maternity wards... Children's bone sanatorium... Venereal disease hospital... Pulmonary sanatorium for adults... Children's pulmonary sanatorium... Venereological dispensary... Day sanatorium for children... Day sanatorium for adults... Night sanatorium... TB dispensary... Sanatorium for patients who are not severely ill and do not require bed rest... [Staffing norms follow]. Note: Auxiliary departments (physiotherapy), as well as the operating room and dressing room are serviced by special personnel; with an increase in the number of wards beyond 2-3 wards with 40-50 beds (standard departments), the staff also increases; in each hospital department with 40-50 beds, 1 housekeeper is provided. For servicing operating rooms and children's wards in maternity departments, special personnel are required. For pulmonary hospitals and sanatoriums for the severely ill, the same workload norms apply as in therapeutic departments. By the decree of the Board of the People's Commissariat of Health of the RSFSR dated 25/XI 1933 (see Narkomzdrav, official section, 1933, No. 15 dated 15/VII 1933), as a draft, it is indicated for a therapeutic department: 1 doctor per 45 beds, 1 nurse per 10 beds, and 1 junior staff member per 5 beds, with the department conventionally taken as 40 beds; for a surgical department: 1 doctor per 30-35 beds, for other personnel the same norms as for a therapeutic department; for an eye department: 1 doctor per 30 beds, 1 nurse per 10, and 1 junior staff member per 7 beds; in addition to this, for each department, 1 head nurse per department, 2 bath attendants, and 2 cleaners are provided. For the children's department, also as a draft, the following norms are given: 1 doctor per 25-35 beds, intermediate personnel—1 person per 5 beds; for the maternity department, also as a draft, the norm is given: for a doctor—1 doctor per 30 beds, 1 nurse per 4 beds, and 1 junior staff member per 2.5 beds. In addition to this, the following are provided for the children's department: a head nurse, an instructor, 2 cleaners; in the maternity department, round-the-clock duty of a doctor, nurse, and nanny is established. The average norms indicated in the table for an infectious department are differentiated by the aforementioned decree of the Board of the People's Commissariat of Health as follows: for a quarantine department: 1 doctor per 30 beds, 1 nurse per 3 beds, and 1 junior staff member per 2.5 beds; for a sorting department—1 doctor per 35 beds, for the rest of the medical personnel the same norms as in the quarantine one; for a general department—1 doctor per 45 beds, 1 nurse per 5 beds, and 1 junior medical personnel member per 4.5 beds. For the X-ray department, the following service norms are established: 1 brigade consisting of 1 doctor, 1 nurse, and 1 nanny per 18 patients, based on the calculation of producing 25 procedure-units, with lung fluoroscopy taken as the unit of measurement: lungs—1 unit, stomach—2, intestines—3; the calculation of 18 patients is made as follows: 13 pulmonary—18 units, 3 gastric—5 units, 2 intestinal—6 units, total 25 procedure-units. A brigade consisting of a doctor and a laboratory photographer produces 5 images per hour, 20 during a working day; the combined workload of X-ray workers (imaging, fluoroscopy) is established by calculating procedure units and the number of imaged patients. Special norms are established for radiotherapy. Regarding infants, adult norms are accepted with a 25% reduction for fluoroscopy and 50% for imaging. For psychiatric hospitals and departments, the following norms are established: [Table data]. Norms for dentists: In a conservative dentistry office, 16 patients per appointment (with an assistant). In an operative dentistry office, 20 patients per appointment (with 1 assistant, 1 orderly per shift, and 1 nurse per 2 chairs). In a conservative dentistry office, 12 patients per appointment. In an operative dentistry office, 15 patients per appointment without an assistant. Workload norm for a masseur: 16-18 units per working day, counting as a unit the massage of one limb, back, or abdomen. Norm for laboratory technicians: The duration of performing a clinical urine analysis is 20 minutes. Counting a clinical urine analysis as a unit of workload, the following number of units is accepted for other analyses: clinical blood analysis—3, sputum—1, blood for malaria—1, blood for relapsing fever—1, urine and mucus for gonococci—1.5, feces for helminth eggs—1.5, films for diphtheria—1.5, general feces—2, Widal reaction—2, feces for cholera—3, feces for typhoid, paratyphoid, dysentery—4, gastric juice—2. The time for performing analyses in laboratories of medium capacity and with average equipment increases by 15-20% (urine analysis—up to 24 minutes) and in small laboratories—by 25-30% (up to 27 minutes). The duration of the Wassermann reaction (with parallel setting of 2 precipitation reactions) in groups, simultaneously at least 20 analyses—20 minutes (in large laboratories) or 2,600 analyses per year. Regarding laboratories, it is more convenient to establish workload norms not daily, but annually, accepting them for laboratories of different capacities in the following form: [Table data]. Consultation for children: 1 doctor per 5-6 children per hour; for intermediate personnel: a) visiting nurse—1 per 5-6 home visits per day. In consultations for women: 1 doctor per 5-6 women per hour; intermediate personnel: a) visiting midwife per 5-6 visits per day. In an infant home: doctors—1 doctor per up to 40 infants; intermediate personnel—1 nurse per 10 infants during the day shift and per 15 during the night. In children's homes: 1 doctor per 40-60 children; intermediate personnel: 1 nurse per 10 children during the day shift and 20 children during the night. Additional staff of instructors is necessary. In children's nurseries: 1 doctor per up to 60 children (without home visits); intermediate personnel—1 nurse per 12 children (additionally 1 nurse for instruction). In mother and child homes: 1 doctor per 40-60 beds; intermediate personnel—1 nurse per 12 beds during the day and 30 beds during the night shift. In children's rooms at maternity homes: 1 doctor per 40-50 beds; intermediate personnel—1 nurse per 12 children during the day and 20 children during the night shift. In children's preventive outpatient clinics-dispensaries: 1 doctor per 20 children during 4 hours of outpatient reception (1:5), the remaining 2 hours are devoted to processing material. Nurses, as in the outpatient clinic, on general grounds. In stationary institutions for child health protection. Doctors: a) in institutions for physically weak children (forest school-sanatorium, etc.)—1 doctor per 50 children; b) in psychoneurological institutions—1 doctor per 25-30 children. Norms of outpatient reception for doctors (in 1 hour)—see Outpatient Clinic. Norms for a doctor's home assistance: per 1 doctor—8-9 visits in a 6-hour working day. The working time of medical personnel is established by a special decree of the People's Commissariat of Labor of the USSR (dated 10/I 1931, No. 8), on the basis of which, from 1/III 1931, a new regulation on working time in medical-sanatorium and veterinary institutions was introduced. Medical, veterinary, and dental doctors, with the exception of doctors with a reduced (up to 5 and up to 4 hours) working day or an irregular working day, as well as scientific workers of research institutions, work 6.5 hours a day.

Doctors have a reduced working day: 1) in sanatoriums, hospitals, and hospital wards for patients with open forms of tuberculosis and for bedridden tuberculosis patients—6 hours; 2) in hospitals, hospital wards, and barracks for infectious patients—6 hours; 3) in psychiatric institutions and hospitals, provided they are directly attending to patients—6 hours; 4) in correctional houses, places of detention, police receiving stations, and sobering-up stations—6 hours; 5) in outpatient clinics, polyclinics, dispensaries, and child consultation centers, provided they work exclusively on outpatient reception—5 1/2 hours; 6) in medical expert bureaus and medical control commissions—4 hours; 7) in anatomical institutes and offices, provided they work exclusively in dissection rooms—4 hours; 8) in X-ray institutes and offices, provided they spend their entire time within the sphere of X-rays—4 hours; 9) in radio-institutes, offices, and laboratories, in cases where the work involves spending the entire working time within the sphere of influence of radium—4 hours. An irregular working day is held by: medical personnel 1) heads of groups of institutions and institutions (including hospitals), their deputies and assistants, department heads, chief physicians, directors, etc.; 2) heads of districts; 3) sanitary physicians and sanitary inspectors; 4) epidemic physicians; and 5) forensic medical experts. Dentists have a working day: prosthodontists—5 1/2 hours; those working on electric dental drills—5 1/2 hours; those working on foot-operated dental drills—5 hours. Dental technicians have an 8-hour working day. Intermediate medical personnel [medical assistants, feldshers, feldsher-midwives, midwives, male and female nurses, smallpox vaccinators, laboratory assistants, preparators, and masseurs(masseuses)] work 6 1/2 hours; an 8-hour working day is established for intermediate medical personnel working in sanatoriums and rest homes, hospitals for chronic patients, homes for the disabled and almshouses, milk kitchens, and first-aid stations, except for those serving enterprises (at first-aid stations serving enterprises, the duration of the working day is 6 1/2 hours). A 7-hour working day is held by intermediate medical personnel of nurseries (regardless of where the nursery is located). A 6-hour working day is held by intermediate medical personnel: 1) of sanatoriums, hospitals, and hospital wards for patients with open forms of tuberculosis and for bedridden tuberculosis patients; 2) of hospitals, hospital wards, and barracks for infectious patients; 3) of psychiatric institutions and hospitals, provided they are directly attending to patients; 4) of correctional houses, places of detention, police receiving stations, and sobering-up stations. A 4-hour working day is held by intermediate medical personnel: 1) of anatomical institutes and offices, provided they work exclusively in dissection rooms; 2) of X-ray institutes and offices, provided they spend their entire working time within the sphere of influence of X-rays; 3) of radio-institutes and offices in cases where the work involves spending the entire working time within the sphere of influence of radium. Medical assistants, provided they work independently exclusively on outpatient reception, work 5 1/2 hours. Junior medical personnel work 8 hours. For junior personnel of psychiatric institutions directly attending to patients, of dissection rooms with constant work in them, bath attendants (mud and sulfur baths), and institutions for patients with open forms of tuberculosis and infectious wards, a 6-hour working day is established. For junior medical personnel of Matsesta hydrogen sulfide baths (bath attendant-nannies)—a 5-hour working day; for those in X-ray institutes and offices, provided they spend their entire working time within the sphere of influence of X-rays, and in radio-institutes and offices in cases where the work involves spending the entire working time within the sphere of influence of radium—a 4-hour working day. Disinfectors, disinstructors, disinfection orderlies, and deratizers—7 hours. Administrative/support staff, with the exception of the aforementioned administrative persons, work 8 hours. A reduced working day is held by: laundry workers in mud-treatment facilities—7 hours; physical culture and crafts instructors—6 1/2 hours; evacuators and telephone operators at ambulance stations—6 1/2 hours; housekeepers, cleaners, dishwashers, and matrons of sanatoriums, hospitals, and wards for patients with open forms of tuberculosis and other bedridden tuberculosis patients—6 hours; packers and workers in pharmacy warehouses engaged exclusively in bottling acids, formalin, and ammonia—6 hours; workers in anatomical institutes and offices, provided they work exclusively in dissection rooms—6 hours. Heads of administration, their assistants, caretakers, and workers whose working time is divided into parts of indefinite duration (e.g., chauffeurs, coachmen, etc.) have an irregular working day. Office staff of medical-sanitary institutions work 8 hours, cashiers in institutions—6 1/2 hours, other cashiers (including pharmacies)—8 hours. Pedagogical staff of medical-educational institutions—educators—4 hours. For minors, the working day cannot exceed 6 hours. The recording of working time for medical personnel is conducted on a daily basis by the administration of the institutions according to the relevant instructions on the forms of accounting and control of working time, with this accounting being based on a monthly norm of 184 hours for those using an 8-hour working day, 144 hours for a 6-hour working day, 120 hours for a 5-hour working day, and 96 hours for a 4-hour working day. For medical personnel whose work consists of home visits, a monthly work norm is established (number of visits, number of deliveries performed, etc.), taking into account the duration of the normal working day for the given group of medical workers, the time spent waiting for a call, traveling, and the actual visit to the patient. Nighttime work (from 10 o'clock in the evening until 6 o'clock in the morning) is accounted for such that, if it is possible to sleep, 1 hour is counted as 1/2, and if it is impossible to sleep, 1 hour is counted for workers with a 6-hour working day as 6/6 of an hour, and for workers with an 8-hour working day as 8/8 of an hour. The distribution of working time and duty shifts is established by internal regulations. Continuous work is permitted for no more than 12 hours with mandatory subsequent rest of at least 12 hours. The duration of a regular periodic continuous duty shift is permitted for no more than 24 hours, with the worker being provided with free daily rations during this duty. Overtime work is permitted for medical personnel in cases, limits, and order established by the Labor Code, and with monthly accounting of working time, work in excess of the monthly norm of working time is considered overtime and is paid at one and a half times the rate for the first 48 hours, and at double the rate for over 48 hours. The use of overtime work is permitted only with the permission of the labor inspector and with the consent of the Medsantrud trade union in each individual case. The Regulation on the Performance of Overtime Work in Medical-Sanitary and Veterinary-Sanitary Institutions (Decree of the All-Russian Central Executive Committee and the Council of People's Commissars of the RSFSR of 11/VII 1924, Code of Laws, Art. 594, 1924, No. 60, and Bulletin of the People's Commissariat of Health, 1924, No. 13) permits the temporary use of overtime work in medical-sanitary and veterinary-sanitary institutions in emergency urgent cases, provided that the total amount of overtime work for a medical worker cannot be more than 50 hours per month and 120 hours per year. This limit may be increased to 75 hours per month and 600 hours per year only for medical personnel of sanatorium-resort institutions during the season, for workers of nurseries and milk kitchens that do not operate around the clock, for on-duty medical personnel in medical-sanitary, veterinary-sanitary institutions and institutions for the protection of motherhood, infancy, and childhood, and for workers in production processes that do not allow for interruption (laboratory assistants, preparators, attendants, etc.); in institutes, laboratories, and anti-epidemic and epizootic stations. The use of overtime work is permitted in each individual case only with the permission of the labor inspector and with the prior consent of the trade union. Benefits and privileges for medical personnel. All benefits granted to engineering and technical workers apply to doctors [Decree of the Council of People's Commissars of the USSR and the Central Committee of the All-Union Communist Party (Bolsheviks) of 14/III 1935, published in Izvestia of the Central Executive Committee of the USSR on 5/III 1935]. Medical workers in state service who are specially assigned or work permanently on combating infectious diseases (cholera, typhus, scarlet fever, leprosy, anthrax, glanders, and malaria) in areas particularly affected by epidemics, in the event of loss of ability to work in connection with this work, as well as the families of medical workers who died as a result of infection with the specified diseases, receive state pension provision (according to the decree of the Council of People's Commissars of the USSR of 31/III 1926, Izvestia of the Central Executive Committee of the USSR and the All-Russian Central Executive Committee of 20/IV 1926, No. 90) in the established amounts. According to the instruction of the People's Commissariat of Social Security, the People's Commissariat of Labor, the People's Commissariat of Finance, and the All-Union Central Council of Trade Unions (Bulletin of the People's Commissariat of Health, 1926, No. 15), the effect of this decree applies only to persons whose disability or death occurred after the publication of the decree. By the decree of the Council of People's Commissars, the rules of the People's Commissariat of Labor of the USSR of 3/I 1924, established for the provision of disabled workers whose permanent disability resulted from an industrial injury, are also extended to members of the families of workers and employees who died from injuries (Code of Laws, 1924, No. 21, Art. 211).

Persons working on plague are provided for in accordance with the decree of the Council of People's Commissars of the RSFSR of 21/II 1924 regarding benefits for Medical Personnel dispatched to fight the plague. The families of persons dispatched to the plague are equated in terms of benefits to the families of those called up for service by military mobilization, and in the event of death or loss of ability to work in connection with plague infection, medical workers and their families are granted pensions on a par with persons having exceptional services to the Republic (Collection of Laws, Art. 198, 1923, No. 15). Medical and veterinary workers: doctors, veterinary doctors, dentists, feldschers, veterinary feldschers, feldscher-midwives, and medical nurses who have graduated from medical technical schools (normal courses) and normal schools for Red Cross nurses, acquire the right to pension provision for length of service if they have served in medical positions in rural areas and workers' settlements for no less than 25 years, including no less than 5 years under Soviet power, with pre-revolutionary medical work also being counted toward the length of service. Breaks caused by service in a city are not counted toward the 25-year length of service, but they do not interrupt the continuity of the length of service. Pension provision for medical and veterinary workers in rural areas and workers' settlements is carried out on the basis of the decree of the Central Executive Committee and the Council of People's Commissars of the USSR of 25/IX 1929, Collection of Laws 1929, No. 63, Art. 582. When calculating length of service, 1 year of service in remote areas, starting from 1/X 1927, for medical workers sent from non-remote areas, is equated to 1 year 8 months and 1 year 3 months, depending on the zone corresponding to the remote area (decree of the Central Executive Committee and the Council of People's Commissars of the USSR on benefits for workers in remote areas, Collection of Laws, Art. 276, 1927, No. 25). This benefit is also extended to medical workers working in remote areas among the nomadic population. Length of service must be documented by appropriate certificates. Length of service includes service in the Red Army, time spent in elected Soviet and trade union positions, time served for political activity in pre-revolutionary years, and the time during which a medical worker was removed from work before the October Revolution for revolutionary activity; also taken into account is the time during which a medical worker was unemployed or temporarily disabled. Pensions for length of service are paid to the pensioners themselves for life, regardless of their state of ability to work and property status; these pensions are granted in accordance with Art. 18 of the Regulations on Pensions and Benefits for Social Insurance, approved by the Central Executive Committee and the Council of People's Commissars of the USSR on 13/III 1930, Collection of Laws 1930, No. 11, Art. 132. In the event of the death of a person entitled to a pension, the right to a pension is enjoyed by persons who were dependent on them and do not have sufficient means of subsistence: for minor children, brothers, and sisters, the pension is paid until they reach 16 years of age, and for those studying in educational institutions—until 18 years of age; for disabled children, brothers, and sisters (disability groups I, II, and III)—until the restoration of ability to work; for disabled parents and a spouse, or those who have reached 60 years of age for men and 55 years of age for women, the pension is given for life; the spouse receives 1/2 of the full pension, each of the other family members—1/3 of the full pension, however, on the condition that the total sum for the entire family does not exceed the full pension amount: To parents and a spouse, even if able-bodied, but occupied with the care of children, brothers, and sisters of the deceased who have not reached 8 years of age, the pension is paid until the child reaches 8 years of age. The indicated medical workers receive a pension for length of service in the amount of half of the average monthly wage for 12 months of employment in medical positions prior to the granting of the pension. The pension cannot be greater than the maximum amount of a disability pension for general causes granted to workers (Decree of the Central Executive Committee and the Council of People's Commissars of the USSR of 17/I 1932, Collection of Laws 1932, No. 5, Art. 31). Pensioner doctors who remain in their jobs receive a pension in the amount of half of their earnings. The granting of a pension for length of service is carried out by insurance funds. The resolution of the insurance fund on the granting of a pension is approved by the presidium of the corresponding executive committee. The indicated rules on pension provision (put into effect from 1/X 1929) do not extend to persons who ceased medical work in rural areas and workers' settlements before 1/X 1929 (for details, see the instruction of the People's Commissariat of Labor of the USSR of 3/XI 1929, No. 349, on the procedure for applying the decree of the Central Executive Committee and the Council of People's Commissars of the USSR of 25/IX 1929 "on pension provision for medical and veterinary workers in rural areas and workers' settlements for length of service"; Questions of Health Care, official section, 1930, No. 1, and 1929, No. 44). For more details, see the decree of the Central Executive Committee and the Council of People's Commissars of the USSR of 23/IV 1931 on amending the legislation on pension provision for education workers, medical and veterinary workers (Collection of Laws 1931, No. 26) and the decree of the People's Commissariat of Labor of the USSR of 23/I 1932 (Izvestiya of the People's Commissariat of Labor of the USSR, 1932, No. 5-6). Medical Personnel dispatched for temporary work to fight cholera, typhus, relapsing fever, scarlet fever, leprosy, anthrax, glanders, malaria (in areas particularly affected by malaria), retains their salary at their place of service and is provided with a daily allowance in the amount of 1/10 of their salary; when dispatched to fight other diseases—in the amount of 1/15 of their salary. Qualified medical personnel (doctors, dentists, feldschers, midwives, pharmacists, and nurses) working in rural areas are granted by law a whole series of benefits and advantages for service in the countryside of no less than 3 years under Soviet power, including preferential right to occupy positions in cities (see Doctor). For the decree of the Council of People's Commissars of the RSFSR of 2/XII 1925 regarding the improvement of the material and living conditions of medical workers in rural areas, see Collection of Laws, Art. 625, 1925, No. 90, and the instruction of the People's Commissariat of Health and the People's Commissariat of Education of the RSFSR on benefits for children of district medical personnel of 24/III 1926, Bulletin of the People's Commissariat of Health, 1926, No. 6. These benefits also extend to qualified Medical Personnel working in a district hospital or district outpatient clinic located on the territory of an urban-type settlement (former district town, factory-plant or industrial settlement, etc.), if only a district with a peasant population is assigned to the indicated medical institutions for service with inpatient, outpatient, and itinerant care. These benefits are also enjoyed by sanitary doctors serving the rural population. Qualified medical and veterinary workers residing in rural areas and workers' settlements must be provided with free apartments with heating and lighting; they are also given regular leave with a duration of 1 month. Every 3 years, doctors in rural areas are granted a scientific assignment or an assignment to advanced training courses with the provision of a stipend, dormitory, and the retention of their salary, apartment, and utility services for the duration of the assignment (decree of the Central Executive Committee of the USSR on the training of doctors of 3/IX 1934, item 4, § c, published in Izvestiya of the Central Executive Committee of the USSR of 4/IX 1934, No. 208). For medical workers and their families who have left for work in a rural area or workers' settlement, living space at their former place of residence is retained for 6 months from the day of departure; in the event that the family remains in this place, the living space is retained for them for the entire duration of the medical worker's work in the rural area or workers' settlement (decree of the All-Russian Central Executive Committee and the Council of People's Commissars of the RSFSR of 10/VI 1930, On the Health Care Front, official section, 1930, No. 29; also in Izvestiya of the Central Executive Committee of the USSR, 1930, No. 230). A number of special benefits and advantages are granted to sanitary doctors in all union republics. Thus, sanitary doctors are granted scientific assignments for a period of no less than 3 months no less frequently than every 5 years of service in the position of a sanitary doctor. Sanitary doctors constantly serving the rural population and workers' settlements are provided with free apartments with heating and lighting. Sanitary doctors are given annual monthly leave (decree of the All-Russian Central Executive Committee and the Council of People's Commissars of the RSFSR on improving the situation of sanitary doctors, Questions of Health Care, official section, 1930, No. 6, and 1929, No. 40). -For Medical Personnel serving the mentally ill (doctors, feldschers, supervisors, nurses, orderlies, and attendants), salary increases have been established (see below). By the decree of the Council of People's Commissars of the RSFSR of 8/V 1929 (Questions of Health Care, 1929, No. 27), the People's Commissariat of Health and the State Planning Committee were proposed to provide for the housing of workers of psychiatric institutions located outside of cities, and the strengthening of service by nurseries and kindergartens for the children of these workers.

Certain categories of medical personnel have the right to an additional two-week leave due to the hazardous nature of their work: doctors, physician's assistants, nurses, orderlies, and caregivers working during epidemics of typhus, cholera, plague, glanders, dysentery, smallpox; all medical staff and orderlies, nannies, wardens, and guards of psychiatric medical institutions; veterinarians, physician's assistants, and attendants working on epidemic control; disinfectors and disinsectors in permanent employment; doctors, intermediate and junior medical personnel of tuberculosis wards where severe bedridden patients are treated; pharmacy warehouse workers and packers engaged exclusively in bottling acids, formalin, and ammonia; medical, nursing, and auxiliary staff in leprosariums; workers directly engaged full-time in X-ray rooms who have worked continuously for 5 1/2 months receive an annual six-week leave divided into 2 parts, each 3 weeks in duration. Dual employment. In view of the shortage of medical and sanitary personnel, dual employment of doctors and intermediate medical personnel in the same institution is permitted; remuneration for dual employment is paid for the actual number of hours worked at the ordinary rate, based on the basic salary rate of the employee in dual employment, regardless of where the specified dual employment takes place—whether at the place of the primary job or in another institution; payment for the extension of working hours for doctors and intermediate medical personnel caused by temporary reasons (substitution due to illness, granting of leave, business trips, etc.) is made as for overtime in the general order. It is forbidden to pay for dual employment as for overtime work. For junior personnel, dual employment is not permitted, and payment for overtime is made as for overtime work (Decree of the People's Commissariat of Labor of the USSR dated 19/I 1932, No. 7; published in the Bulletin of the People's Commissariat of Labor of the USSR dated 25/III 1932, No. 8-9). Salaries for medical workers were established by the decree of the Council of People's Commissars of the USSR and the Central Committee of the All-Union Communist Party (Bolsheviks) dated 4/III 1935 'On increasing the salaries of medical workers and on increasing appropriations for healthcare in 1935' (Izvestiya of the Central Executive Committee of the USSR dated 5/III 1935) in the form of official salary rates, the amounts of which are determined not only by the position held, but also by the nature of the institution, the volume of its work, the length of service of the given medical worker, and the degree of their qualifications (possession of an academic degree is equated to over 10 years of service). When establishing the size of rates depending on length of service, 3 gradations of service were established—up to 5 years, from 5 to 10 years, and over 10 years. For chief physicians of hospitals, rates are established depending on the size of the institution headed, determined by the number of beds, from 400 to 750 rubles per month, and for doctors managing rural hospitals, depending on length of service, from 360 to 510 rubles, and for rural outpatient clinics—300-450 rubles; doctors managing outpatient-polyclinic institutions receive 350-600 rubles, depending on the size of the institution, determined by the number of visits per year; doctors managing departments of a hospital or polyclinic, heads of laboratories in a city or workers' settlement—375-550 rubles depending on length of service; doctors of medical-preventive institutions—300-400 rubles in cities and workers' settlements and 275-360 in rural areas. District state sanitary inspectors, sanitary and school-sanitary doctors, bacteriologist doctors—from 300 rubles to 400 rubles depending on length of service; regional and city state sanitary inspectors, authorized representatives of the state sanitary inspection—350-550 rubles; dentists who have graduated from dental schools—225-350 rubles; dentists with completed higher specialized education are equated to medical doctors. Pharmacists with higher medical education receive, depending on length of service, 300-400 rubles (pharmacy managers) and 225-300 rubles (prescription clerk and controller). Physician's assistants managing an independent medical station receive 200-300 rubles per month depending on length of service; other physician's assistants 180-225 rubles in cities and workers' settlements and 160-200 rubles in rural areas. Nurses with completed secondary medical education—150-200 rubles per month in cities and workers' settlements and 135-175 rubles in rural areas; intermediate medical personnel without completed secondary medical education 100-140 rubles in cities and workers' settlements and 90-120 rubles in rural areas; senior operating nurses, senior nurses of clinics with completed secondary education from 200 to 300 rubles; senior nurses in a department, dentists, dental technicians with completed secondary education—from 180 to 250 rubles in cities and workers' settlements and 160-200 rubles in rural areas. Sanitary physician's assistants (assistants to sanitary doctors), managers of disinfection stations, detachments, sanitary checkpoints, disinfection instructors, laboratory assistants with completed secondary education—180-225 rubles depending on length of service. Nurses without completed secondary medical education who have over 15 years of continuous service are equated in salary rates to nurses with completed secondary medical education with 10 years of service. Pharmacists with secondary pharmaceutical education, depending on length of service, position held, and place of work (city, village), receive from 135 to 275 rubles per month. For junior medical personnel, the following service gradations were established for calculating salaries—up to 3 years, from 3 to 10 years or up to 3 years on the condition of completing special courses, and over 10 years or over 3 years on the condition of completing special courses. Orderlies and ward attendants of hospitals, maternity homes, and sanatoriums—80-110 rubles per month in cities and workers' settlements and 60-85 rubles in rural areas; junior personnel of outpatient and polyclinic institutions—70-90 rubles in cities and workers' settlements and 55-75 rubles in rural areas; orderlies of mud-bath clinics—50-120 rubles per month. Rates for medical workers of railway and water transport are equated to the rates of the corresponding groups of medical workers in cities. All previously existing periodic salary increases for length of service were canceled by the aforementioned decree of the Council of People's Commissars of the USSR and the Central Committee of the All-Union Communist Party (Bolsheviks) dated 4/III 1935, with the exception of periodic salary increases established by the decree of the Central Executive Committee and the Council of People's Commissars of the USSR dated 12/VIII 1930 (Collection of Laws of the USSR, 1930, No. 41, Art. 427) for persons working in remote areas of the 1st zone, as well as for workers of anti-plague institutions. For certain categories of medical workers, bonuses were established depending on the hazardous and dangerous nature of the work; thus, for doctors, intermediate and junior medical personnel of psychiatric and infectious disease hospitals and wards and X-ray rooms, as well as for medical workers engaged in serum-vaccine production, bonuses to the corresponding salary rates were established in the amount of 15%, and for those working in disturbed wards of psychiatric hospitals and in leprosariums—in the amount of 30%. In addition, for the specified workers, a reduced length of service was established, giving the right to a salary increase; for personnel of psychiatric infectious disease hospitals and wards and X-ray rooms instead of 5 years—3 years, and instead of 10 years—7 years; for personnel of disturbed wards of psychiatric hospitals and leprosariums instead of 5 years—2 years, and instead of 10 years—4 years. Rates were also increased for medical personnel working in remote areas. Thus, salary rates were increased by 20% for the Far Eastern regions, the Transbaikal part of the East Siberian Territory, and the aimaks of the Buryat-Mongolian ASSR listed in the decree of the Council of People's Commissars and the Central Committee of the All-Union Communist Party (Bolsheviks) dated 5/II 1934 (Collection of Laws 1934, No. 9, Art. 54), the Yakut ASSR, the Kara-Kalpak ASSR, the Kirghiz ASSR, the Karsakpay, Dossor, Balkhash districts and Karaganda of the Kazakh ASSR, the Turkmen SSR, and the Khorezm district of the Uzbek SSR. Salary rates were increased by 10% for the Uzbek SSR (except Tashkent), the Tajik SSR, and the Kalmyk Autonomous Oblast. For doctors and other medical workers working in the Far North of the USSR, salary rates are increased by 50%. Doctors and dentists practicing at home have the right to an additional room or additional Personnel.

Additional space in excess of the existing general norm in the absence of a separate room (Decree of the All-Russian Central Executive Committee and the Council of People's Commissars of February 28, 1930; Izvestiya of the Central Executive Committee of the USSR and the All-Russian Central Executive Committee, 1930, No. 116-117). Regarding apartment rent, medical doctors, veterinarians, and dental technicians belong to the category of persons of the so-called liberal professions, paying for the premises they occupy at the rates of employees, even if they have side earnings; if these persons own a medical institution, they are equated in terms of apartment rent to entrepreneurs (see the instruction of the People's Commissariat of Internal Affairs of August 21, 1924, No. 359, Bulletin of the People's Commissariat of Internal Affairs of September 27, 1924). Doctors, dentists, dental technicians, midwives, and masseuses engaged in private practice are exempt from the trade tax (Decree of the People's Commissariat of Finance of the USSR of July 23, 1925, No. 108, Bulletin of the People's Commissariat of Health, 1925, No. 17). Additional space is paid for by privately practicing doctors and dentists at an increased rate, according to the legislation on apartment rent. Similar to the mentioned decrees regulating the rights and duties of medical personnel in the RSFSR, instructions have also been issued in other union republics through the relevant People's Commissariats of Health, which do not differ significantly from those mentioned, as they are based on the general labor legislation of the USSR. - Special clothing. Regarding special clothing and protective equipment for medical and pharmaceutical workers, special norms for the issuance of corresponding types of special clothing and wear periods have been established. For example, for outpatient and hospital doctors, a light fabric gown is issued for 1 year; for doctors working in operating rooms, for 6 months; and in sanitary-epidemiological detachments, for 3 months, etc.; for hospital and outpatient paramedics and nurses, light fabric gowns for 8 months, in operating rooms for 6 months, in infectious wards for 4 months, etc. For details, see the norms of special clothing for medical and pharmaceutical workers approved by the People's Commissariat of Labor of the USSR on July 23, 1931 (Izvestiya of the People's Commissariat of Labor of July 30, 1931, No. 21). Responsibility of medical workers. For the violation of duties imposed on medical personnel in the course of performing their medical work, responsibility is established by law. Medical workers are held liable in cases of engaging in such medical practice for which they do not have the right (Criminal Code, Art. 157, in the 1926 edition), in the case of failure to provide assistance to a patient without a valid reason; the guilt is aggravated if the refusal of medical assistance could have dangerous consequences for the patient (Criminal Code, Art. 157), in cases of an expert's evasion from appearing upon the summons of an inquiry body, investigative or judicial body (Art. 92), giving knowingly false testimony (Art. 95), and in the case of performing an abortion in the absence of specific medical indications, in unsanitary conditions; in cases of receiving payment for medical assistance which the medical worker was supposed to provide free of charge as a matter of official (not professional) duty, even outside of working hours. Refusal of medical assistance in cases where its provision was not part of the medical worker's official duties does not constitute an official crime and may be prosecuted under Art. 165 of the Criminal Code. According to the clarifications of the People's Commissariat of Justice, "receiving in any form remuneration from private individuals for providing medical assistance when they apply to Soviet and public medical institutions is completely unacceptable" and is punishable as the receipt of a bribe by an official. If medical workers serving in Soviet and public service received remuneration for providing medical assistance outside of working hours, they cannot be prosecuted under Art. 114 of the Criminal Code as having committed criminally punishable acts, unless the specified receipt of remuneration was accompanied by extortion, threats, or did not occur during epidemics or a significant spread of a particular disease, the fight against which was a priority at that time. Insulting medical personnel by words or actions while they are performing their official duties, both administrative and professional, is punishable under Articles 88 and 10 of the Criminal Code, i.e., insulting medical workers by words or actions is equated to a public insult of individual representatives of authority while they are performing their duties, and a case under Art. 88 can be initiated not only by the injured medical worker but also by the health department, trade union organization, prosecutor's office, etc., and is not subject to termination. Those guilty of insulting medical workers are punished by imprisonment for a term of not less than 6 months (circular of the People's Commissariat of Justice and the Supreme Court of the RSFSR of August 19, 1926, No. 113, Bulletin of the People's Commissariat of Health, 1926, No. 15). D. Gorfin. Occupational hazards of medical workers. I. Main factors causing labor hazards in various detailed professions of medical work. 1) The danger of infection with contagious (epidemic) diseases exists for all groups of medical workers who come into contact with patients and their excretions, but it is especially great for personnel working in institutions for contagious patients and directly in contact with patients, as well as for treating, sanitary, prosector, and laboratory personnel during epidemics. The danger of infection with epizootics (glanders, anthrax, etc.) exists for veterinary personnel. Among contagious non-epidemic diseases, the danger of tuberculosis infection is especially great for tuberculosis workers (see below). Infection with syphilis during work threatens obstetric personnel more than other groups of medical workers. Infection with purulent infection, often with a fatal outcome, threatens surgeons, prosectors, and veterinary workers as a result of injuries during operations, autopsies, or injuries from animals. Cutaneous purulent diseases (furuncles, pyodermas) are characteristic of veterinary personnel; cutaneous tuberculosis of the fingers for pathologists (post-mortem tubercles); infection with leprosy for medical personnel of leprosariums. 2) A large expenditure of neuropsychic energy is characteristic of the most responsible groups of medical workers—medical and veterinary doctors, and to a lesser extent, for nursing staff. Among the latter, the work of personnel in psychiatric institutions is the most difficult. 3) Unfavorable sanitary-hygienic conditions exist in a number of medical professions: a) unfavorable meteorological factor—for all traveling medical and veterinary personnel, veterinary workers of slaughterhouses, railways, for sanitary workers, especially those working in conditions of exposure to industrial hazards (sanitary inspectors, doctors of industrial hygiene, etc.), for workers of mud baths (combination of high temperature, high humidity, and poor ventilation), hydrotherapy clinics, light therapy rooms, and often operating rooms; b) workers in pharmacies, and mainly pharmaceutical warehouses with mass weighing of material, and dental technicians are exposed to dust; c) poisonous and irritating substances have an effect through inhalation and ingestion, on the one hand, and absorption from the skin of the hands on the other; the first danger is especially pronounced for disinfectors (work with hydrogen cyanide, Cyclon B, formaldehyde, sulfur dioxide). A significant content of formaldehyde in the air is noted in prosectoriums, especially in preparation rooms. Although the concentration of some substances in the air of disinfected rooms is undoubtedly lethal, the insignificant time of the disinfector's stay in the corresponding room and some precautions used by them protect the disinfector from intoxication. Disinfectors and pathological-anatomical workers work with substances that irritate the skin of the hands, mucous membranes of the respiratory tract, and eyes (formalin, carbolic acid). The intoxication of disinfectors with mercury when working with corrosive sublimate must be considered an undoubted fact (mercury was found in the urine). Mercury intoxication also occurs in personnel rubbing mercury into the skin of syphilitics if this is done without rubber gloves. Whether mercury intoxication occurs in dentists (as a result of using amalgams) has not yet been finally decided. There are indications of irritation of the skin of the hands in them by novocaine solutions used for local anesthesia. There is no convincing data on the intoxication of pharmacy workers by inhaled substances. There is reason to think about the toxic effect of narcotic substances on persons systematically administering anesthesia. 4) The harmful effect of X-rays and radium causes characteristic occupational diseases in radiologists (for more details, see X-ray therapy). 5) Physical labor is expressed in the work of junior and auxiliary medical personnel. The severity of physical labor for nursing staff in psychiatric institutions reaches a very high degree. The same must be assumed for personnel caring for severe chronic patients. The work of masseuses and attendants of anatomical theaters is heavy physical labor. 6) Eye strain occurs in persons working for a long time with a microscope. Work in light therapy rooms has a harmful effect on the organ of vision. 7) The danger of occupational injuries is especially great for workers serving psychiatric (see below) and prison institutions, and for veterinary workers. II. Morbidity, mortality, and disability of medical, veterinary, and pharmaceutical workers have features characterizing the influence of occupational hazards on the health of workers.

At the present time, sufficient data has accumulated on the morbidity of medical workers, both on the basis of outpatient visits and insurance fund materials, and especially from mass and special examinations. According to social insurance statistics for 1925, the number of cases of disease per 100 insured medical workers per year for all diseases was: men—39.68, women—72.38 (excluding childbirth), and for both sexes—61; moreover, infectious diseases stand in first place in terms of frequency, followed by diseases of the digestive organs, influenza, and pulmonary tuberculosis; the average duration of one illness associated with loss of ability to work is 18.1 days, i.e., higher for medical workers than for many other labor groups, which can be seen from the following table: Average duration of one illness by sex. Branches of work. Both sexes. Extractive industry. Garment industry... Polygraphic industry—18.7, 11.6, 11.7, 12.1, 13.4, 13.5, 13.6, 18.0, 12.2, 11.5, 12.1, 11.8, 12.7, 11.6, 18.1, 11.6, 11.7, 12.1, 12.3, 13.5, 13.0. Some Western European data are interesting. Doctors show a higher mortality rate from circulatory disorders, nervous and infectious diseases (Koelsch). According to Koelsch's data, nurses have a high mortality rate from tuberculosis at the age of 20–40, which he explains partly by the fact that many who are hereditarily burdened enter the community, as well as girls from rural areas who are not accustomed to the hard labor of a nurse in enclosed spaces. Intense labor and a long working day cause high morbidity among medical personnel abroad. Streiter, in his book (1924), cites many examples of various violations of the established 10-hour working day, reaching up to 72–74 hours per week, with night shifts coinciding with days of daytime work. Added to this is a lack of exercise in the fresh air. Epstein calls the nursing medical personnel of Germany the "stepchildren of public health." According to Epstein's data, for disabled Red Cross nurses, disability occurred mostly due to disorders of the circulatory organs, and in rare cases due to tuberculosis. Heart diseases and circulatory disorders in the lower extremities due to long periods of standing on one's feet are frequently encountered among nurses. The spread of tuberculosis among medical personnel causes particular concern. According to data from a survey conducted by the Health Administration in Germany in 1906–1911 (Hamel), a connection between tuberculosis morbidity and profession was established for medical personnel in half of all cases of tuberculosis diseases among medical personnel in general hospitals, in 1/3 of cases in university clinics, and in 6/7 of all cases in special tuberculosis institutions. Regarding doctors, Hamel cites an indication that out of 250 doctors who worked in internal wards, only 2 fell ill with tuberculosis, whereas out of 243 doctors who worked in special tuberculosis wards, 14 died. III. Occupational safety of medical workers. Sanitary-hygienic and sanitary-technical measures. Projects for the construction and equipment of medical-sanitary institutions do not sufficiently provide for the occupational safety of medical workers. Such projects have been developed (regarding construction and partly equipment) by the Central Scientific-Consultative Bureau under the Central Committee of the Medical and Sanitary Workers' Union regarding hospitals for highly contagious and tuberculosis patients, medical-sanitary laboratories, pathological-anatomical institutions, operating rooms, light therapy offices, mud therapy clinics, and partly psychiatric institutions, but they have not yet been introduced by legislation. Regarding X-ray institutions, there is a decree of the People's Commissariat of Labor dated 9/IX 1922, providing for their special design and equipment with protective devices. Special types of protective clothing have been established for some groups of medical workers: radiologists—for protection against the harmful effects of rays, workers in operating rooms, prosectoriums, those working with plague, etc. Labor rationalization occupies an insignificant place in the system of occupational safety for medical workers. Here one can note only the proposal for special pharmacy furniture, developed by the rationalization bureau of the Moscow Pharmacy Administration, implemented in a number of pharmacies and replacing work in a standing position with a sitting one; proposals to work while sitting, made for dentists, and others. Works devoted to psychotechnics in medical labor (psychiatric personnel, laboratory assistants) are also appearing, but these works have not yet received practical significance.