Netherlands

Netherlands, with an area of 32,600 sq. km, has a population of 7,461,493 (as of 1926). The country is distinguished by high indicators of sanitary well-being. Its birth rate in 1927 was 23.1 per 1,000 population, and the mortality rate was 10.3. Between the years 1910-1914 and 1927, the birth rate decreased by 5.1 (per 1,000), i.e., by 18.1%, while the mortality rate decreased by 2.7, i.e., by 20.8%. The population growth in 1927 was 12.8 per 1,000 (compared to 15.2 in 1910-1914). The healthcare apparatus is under the jurisdiction of the Ministry of Labor, Trade, and Industry. At the head of healthcare stands the Chief Director of Public Health, who performs his functions of state control over healthcare affairs through Chief Inspectors who oversee individual branches of healthcare. There are six of them: 1) infectious diseases, supervision of the activities of medical personnel and treatment institutions; 2) hygiene of water, air, and soil, foodstuffs, pharmaceutical affairs, and control of opium importation; 3) housing affairs; 4) supervision of meat; 5) protection of childhood and the fight against tuberculosis; and 6) the fight against alcoholism. Each of these Chief Inspectors has several assistants who conduct state control in certain parts of the state. As a consultative body to the Chief Director, there is a Hygienic Council consisting of 70 members, some of whom serve by position (the Chief Inspectors) and some of whom are appointed by the Minister from persons competent in various branches of healthcare. The Council has the right of initiative and the right of direct communication with the Minister of Labor. As auxiliary institutions subordinate to the Chief Director, there is a central laboratory with bacteriological, chemical, and veterinary departments, as well as a serological institute. Local consultative and partly initiative bodies for healthcare are the local hygienic commissions, which each commune with a population of over 18,000 people is required to have; smaller ones must unite in a common commission. The commissions consist of persons nominated by the municipalities and approved by the governor. Municipal councils are required to submit all hygiene questions for preliminary discussion to the commission, but the right of decisive vote remains with the municipal council. The sanitary condition of the country is very high. All communes with a population of over 10,000 inhabitants and 30% of the remaining communes have water supply systems. Of the 7 million population, 4,600,000 use piped water. Group water supply systems are widely applied; for example, Noord Holland serves 104 communes, Nord-Ouest-Brabant serves 80 communes, etc. The water supply affair is regulated by the 'State Water Supply Bureau,' which is attached to the Ministry of Labor, Trade, and Industry. It approves plans for hydraulic works, distributes state subsidies, and develops scientific questions. Attached to it is a central commission on water supply, consisting of lawyers, agronomists, hygienists, technicians, and deputies. The state gives subsidies and loans to municipalities and associations for the development of plans, etc. Sewage disposal is the weakest aspect of the Netherlands' economy. Technical difficulties in installing sewage systems (a significant part of the country lies below sea level) and the abundance of channels lead to frequent use of the latter for discharging waste. Biological purification is generally not applied. Solid waste is used to raise the level of low-lying areas. The housing question, somewhat complicated during the war, is beginning to lose some of its acuteness thanks to state loans and subsidies and a series of laws (law of 1926 against rising land prices, laws of 1916, 1918, 1919, and 1920). In 1926, 51,289 dwellings were built, designed to meet the housing needs of workers and employees (habitations populaires). Since 1927, the number of new dwellings has even exceeded the normal growth of need for them. 84.1% of these dwellings were built by private individuals, 9.7% by building associations, 6.1% by communes, and 0.2% by the state and provincial councils. Municipalities have a housing inspection, but it is outside the jurisdiction of healthcare, connected with it only through hygienic councils. The sanitary supervision of food is carried out a) by meat inspection for meat and b) by food inspection for other food products. Meat supervision is a matter for municipalities, which are required to have mandatory sanitary regulations. The state law only sets a minimum of general requirements. Supervision of slaughterhouses is carried out by the meat inspection (in the person of a veterinarian under the jurisdiction of the health department). The food inspection in each of the 21 districts consists of a chief chemist (or chemical engineer), a pharmacist, a veterinarian, two assistant chemists, and 20-24 inspectors. The latter are without special education and are usually recruited from persons practically familiar with product quality. The inspection has a well-equipped laboratory at its disposal. Veterinary physicians supervise dairy farms and the quality of milk sold. In large cities, a bureau for milk control has been introduced (under the law of 1926). Standardization of main products and beverages has been carried out by law. The fight against epidemics is carried out by municipalities. Mandatory notification is required for cholera, plague, typhoid and typhus, scarlet fever, and diphtheria. By royal decree, any other disease can be included in this list for a period of 1 year. Isolation is mandatory only for lodging houses, shelters, and public dormitories, but the administration has the right, in case of intensification of ordinary epidemics, to declare isolation mandatory not only for the sick but also for bacillus carriers; expenses are paid equally by the state and the commune. The provincial council has the right to oblige a commune to have an infectious disease hospital, and in case of a commune's weakness, to propose that it unite with other communes for this purpose. There are over 3,500 infectious disease beds in the Netherlands (1:2,000 population). Disinfection can also be declared mandatory by the administration. The state subsidizes municipalities in the amount of 1/6 of the cost of disinfection stations and expenses for training disinfection personnel. Compulsory smallpox vaccination is not required until school age, and revaccination is only required upon entry into military service. The number of unvaccinated persons is 7.2%, and those with 'invalid' vaccination (over 10 years old) is 71.3%. The morbidity of infectious diseases is low. Thus, in 1926 there were: 1 case of typhus, 13 cases of smallpox (in the previous three years there were no cases), 97 cases of dysentery, 1,221 cases of typhoid fever, 14,659 cases of scarlet fever, 3,629 cases of diphtheria, 93 cases of meningitis, 49 cases of poliomyelitis, 85 cases of lethargic encephalitis. The fight against tuberculosis in the Netherlands is a matter of private and public initiative, mainly in the hands of the Dutch Society for the Fight against Tuberculosis, which unites 21 provincial branches and about 575 local societies (of which many provide generally home treatment care and in particular conduct the fight against tuberculosis). These societies had 14 regional, 53 district, and 40 local dispensaries in 1926. There are 2,480 beds in 26 sanatoriums. Mortality from all forms of tuberculosis is 9.63 per 10,000 population (in 1926). The state subsidizes tuberculosis societies (652,256 guilders in 1925). There is no special anti-tuberculosis legislation. The fight against venereal diseases is the concern of the Dutch Society for the Fight against Venereal Diseases, which has a network of dispensaries. Large municipalities have free polyclinics for skin and venereal diseases, and there are clinics for venereal diseases in four universities. Houses of tolerance have been closed since 1911, and there is no regulation of prostitution. Notification of illness is not mandatory. The fight against child prostitution is carried out by the so-called 'child police' (a philanthropic organization, however, which has the right to initiate before the court the question of removing children from 'negligent and vicious' parents). The Netherlands has joined the Brussels International Convention of 1925 and undertakes to provide free assistance to foreign sailors suffering from venereal diseases. Protection of motherhood and childhood is also a matter of private societies and individuals, sometimes municipalities. In 1925, there were 48 child consultation centers in 38 points serving 19,738 children (of which 10,000 in Amsterdam and Rotterdam). In most provinces, there are 'child hygiene commissions' with nursing sisters for home patronage of infants and their mothers, and in the center, there is a central commission for assistance to parturients, which aims mainly to improve the training of midwives and nursing sisters with midwifery experience. Medical assistance is provided by physicians in only 40% of births, while in 60% it is provided by midwives who have completed a 3-year course of study in midwifery schools. School health organizations exist only in large cities (in Amsterdam - 13 physicians and 26 sisters supervising 200 schools). The mortality rate of children under 1 year is 6.1 per 100 born. Protection of labor, being in the same Ministry of Labor, Trade, and Industry, has its own special apparatus: the Chief Director of the Labor Department and 11 Chief Inspectors (for districts), 1 consulting physician in the center and 5 physicians for work on the periphery. The latter carry out preventive and current industrial sanitary supervision. Since 1922, an eight-hour working day has been introduced, factory labor for children under 13 and 14 years has been prohibited, and a number of restrictions have been introduced for the labor of adolescents under 17 and 18 years and for women (certain categories of labor).

Accident insurance is mandatory, paid for by enterprise owners who make contributions to the state insurance fund, from which benefits for general treatment (outpatient and inpatient) and for special types of medical assistance are paid.-Insurance against illness is on a voluntary basis, but since the overwhelming majority of workers are members of trade unions, whose collective agreements provide for mandatory insurance, it covers the majority of all workers. The costs of insurance are borne equally by workers and entrepreneurs. The administration of insurance bodies consists of workers and entrepreneurs on a parity basis.-Medical assistance is organized partly by municipalities, partly by various charitable societies and clerical organizations. Medical assistance in villages is organized by communities that invite a doctor on certain conditions, which vary in different communities. In 1925, there were a total of 20,160 beds and 2,780 temporary ones; of these, 20,733 were in general hospitals, 927 in children's hospitals, 202 in eye hospitals, and 1,078 in clinics. Of the total number of beds, only 638 belonged to the state, 8,700 to municipalities, and the remaining 13,602 to private individuals and various national organizations. On average, there are 2.7 beds per 1,000 population. The number of physicians is 4,177, dentists 625, midwives 965, pharmacists 632, and assistant pharmacists 2,046.