Poland

Poland. The Polish Republic as an independent state was formed in November 1918 as a result of the world war and revolution from territories that had been part of Russia (260,000 km²), Austria-Hungary (84,000 km²) and Germany (46,000 km²). Thus, modern Poland occupies an area of 390,000 km². According to the census in December 1931, the population of Poland equals 31,928,000 inhabitants. The population density per 1 km² is 70 people. The urban population constituted 25.8% of the total population. Demography. Poland is a country with high birth rate and high mortality rate. In recent years, a certain decrease in birth rate has been noted with almost stable mortality rate. Infant mortality (under 1 year) in 1927 was for cities with population above 25,000 inhabitants 14.4, below 25,000 inhabitants-12.1, for rural areas-15.4, and for the country as a whole-15.1 per 100 births. See Table 1. Natural population movement in Poland for 1922-1929 (per 1000 inhabitants). Years Birth rate Mortality rate Natural increase 35.5 20.0 15.5 36.0 17.5 18.5 39.2 35.0 18.2 16.8 35.7 16.9 18.8 33.6 18.1 15.5 32.1 17.6 14.5 32.6 16.7 15.9 32.3 17.0 15.3 On infant mortality in the two largest cities of Poland: in Warsaw (as of 1/1 1930-1,109,478 inhabitants) and Lodz (as of 1/1 1930-506,980 inhabitants) the following table gives an idea: Table 2. Mortality of children under 1 year (per 100 births). Years Warsaw Lodz 1924................ 16.07 15.18 1925................ 14.36 11.91 1926................ 12.90 12.40 1927................ 11.80 19.17 1928................ 16.48 17.54 1929................ 18.69 18.73 1930................ 17.10 16.80 Attention is drawn to the high infant mortality in the capital of Poland-Warsaw and especially in Lodz, the largest industrial center of the country, significantly exceeding that of almost all major European cities. Infectious disease incidence. The incidence of the most important infectious diseases is visible from Table 3.-Typhus fever remains at a high level, especially in the eastern (26.5 cases per 100,000 inhabitants in 1928) and southern voivodeships (13.1 per 100,000 inhabitants in the same year).-Typhoid fever does not show a tendency to decrease, remaining at a high level all years. In cities with more than 100,000 inhabitants, typhoid fever gave in 1928 9.2 cases per 100,000 inhabitants, in cities with less than 100,000 inhabitants-8.8, in other populated areas-4.6. The highest incidence was recorded in Warsaw (12.8), Vilnius (11.0) and Lodz (9.8). Table 3. Incidence of infectious diseases in 1927-1929 (absolute numbers). Disease name 1927 G. Smallpox...........

..... Anthrax..... 5 011 2 950 36 300 8 640 34 041 9 638 489 66 646 62 1928. 1929 ; 14 080 15 429 1 1 784 2 759 2 401 28 898 20 909 10 460 37 063 25 481 9 082 Since 1919, compulsory smallpox vaccination has been introduced. In 1929, 1,954,300 people were vaccinated against smallpox, of which 991,800 people were vaccinated (with a positive result of 94.8%) and 962,500 people were revaccinated (with a positive result of 79.4%). Hospitalization for acute infectious diseases is extremely insufficient; in total, Poland has 5,877 infectious disease beds, or 0.22 per 1,000 inhabitants.-Tuberculosis. A law on the mandatory registration of confirmed cases of tbc has existed since 1919; however, registration is carried out very poorly, as evidenced by the sharp discrepancy between the number of registered cases of tbc and the number of deaths from tbc: in 1928, 21,212 cases of tbc were registered and 9,837 cases of death from tbc. Mortality from all forms of tbc in the 7 largest cities of Poland is presented in Table 4. Despite a decrease in recent years, it still remains high compared to most European cities. The fight against tbc is conducted by the National Society for the Fight against tbc, organized in 1925, working in conjunction with insurance funds. In 1929, the society had 155 local branches. Tub. consultations and dispensaries were functioning in 1929, 269, tuberk. beds in general hospitals-2 575, sanatoriums (1930)- 61 with 4,381 beds. These institutions, maintained by municipalities and charitable societies, receive subsidies from insurance funds and from the state.-Venereal diseases are very widespread in Poland, especially in the southern voivodeships (Krakow, Stanislawow). In the most affected settlements, the incidence of syphilis reached 8% in 1926. There is no mandatory registration of venereal diseases. Despite the widespread prevalence of venereal diseases, the network of specialized anti-venereal institutions is very small. In 1928, there were 30 dispensaries, half of which are in the Krakow and Stanislawow voivodeships. Warsaw has only one dispensary. Beds for hospitalization of patients totaled 2,698 in 1928. One of the main factors for the high incidence of venereal diseases is the widespread prevalence of regulated prostitution.-Trachoma is widespread in Poland, especially in the eastern and southeastern voivodeships. Table 5. Incidence of trachoma 1922-1929 (absolute numbers). Years Number of patients Years Number of patients 2 737 4 061 2 954 4 751 7 144 13 182 13 941 14 028 3t>7 ms Examination of orphanages in 1928 revealed 6.1% of patients with trachoma. The 1928 law on the fight against trachoma provides for mandatory registration of trachomatous patients, compulsory treatment, and the organization of specialized trachomatous institutions. In 1928, there were 195 trachoma consultations and 11 institutions with 1,824 beds for trachomatous children. Alcoholism. According to the 1922 law, communes have the right to prohibit the sale of alcoholic beverages (with an alcohol content above 2.5%) based on a decision adopted by a majority vote of citizens. In 10 years of this law's existence, out of a total of 12,504 communes, only 222 (1.8%) have implemented a ban on the sale of alcohol. In 1929, there were 20,712 retail outlets for alcoholic beverages, or one outlet per 1,468 inhabitants. In addition, there were (1930) 24,442 retail outlets for beer, wine, and mead, i.e., one outlet per 1,250 inhabitants. Since 1924, a state monopoly on the sale of alcoholic beverages has been introduced. State expenditures for the fight against alcoholism in 1929/30 amounted to only 335,000 zlotys compared to 546,975 zlotys in 1928/29. Protection of motherhood and infancy, which is under the jurisdiction of the Ministry of Labor and Social Welfare, is in its infancy. Despite the existence since 1924 of a law on the labor of women and adolescents, which provides for the opening of nurseries for children under 1 year in all enterprises with more than 100 women, nurseries were first opened only in 1927 (in Warsaw). In 1928, there were 218 points for the protection of motherhood and infancy, serving 43,000 children. Maternity care is extremely insufficient: one bed per 1,372 births per year. The total number of midwives is 7,327 (1930), a significant portion of whom are concentrated in large cities. In rural areas, maternity care is still provided by midwives. As a result of such poor organization of maternity care, mortality from postpartum diseases is very significant even in large cities, ranging from 3.3 in Lviv to 6.6 in Krakow per 1,000 births.-School hygiene is under the jurisdiction of the Ministry of Education. Secondary schools are covered by school-sanitary supervision satisfactorily, while primary schools are served extremely poorly: out of 26,470 primary schools, only 1,292 schools (4.8%) had school-sanitary supervision (1926), and of the 426 doctors serving these schools, only 83 were in rural areas. Organization of healthcare. The Ministry of Health, established in 1919, was abolished in 1923 for economic reasons, and in its place, a department of public hygiene was created at the Ministry of Internal Affairs, which is divided into the following six departments: 1) organizational, 2) public hygiene, 3) fight against infectious diseases, 4) hospitals and resorts, 5) pharmaceutical, 6) statistics and information. Protection of motherhood and childhood, medical care for the disabled, industrial hygiene, and social insurance are under the jurisdiction of the Ministry of Labor and Social Welfare; school hygiene-the Ministry of Education, physical education-the Ministry of Public Works, medical care in places of detention-the Ministry of Justice, in the army-the Ministry of War, on railroads-the Ministry of Railways. Thus, the healthcare system in Poland is scattered among seven ministries. At the Department of Public Hygiene of the Ministry of Internal Affairs, there is a consultative body-the Health Council, which includes representatives of all the above-mentioned ministries, medical faculties, the veterinary department of the Ministry of Agriculture, medical chambers, medical societies, and municipalities.-In each of the 16 voivodeships into which the country is divided, there are health directorships headed by a director, under whom a Health Council functions, built similarly to the central Health Council. In each of the 272 counties into which the voivodeships are divided, there is a government medical inspector-physician, who performs administrative medical functions; under him functions a county Health Council, which includes representatives of departments, self-governments, and medical societies. At city magistrates, there are health departments headed by one of the councilors, in charge of city hospitals, dispensaries, emergency medical services, and city sanitary supervision; protection of motherhood and childhood (nurseries, milk kitchens), school sanitation, and medical care for the chronically ill and unemployed are handled by other departments of the magistrate.-Hospital care is only to a small extent in the hands of the state. Out of a total of 64,493 beds on January 1, 1930, 6,855 belonged to the state, 35,512 to self-governments, 19,335 to various societies, and 2,791 to private individuals. On average, there were 2.1 beds per 1,000 inhabitants, with 5.7 in the western voivodeships and 0.9 in the eastern ones.-Pharmacies are mainly in private hands. Out of a total of 2,031 pharmacies, 84 belong to hospital funds. Hospital funds. In Poland, there is compulsory insurance in case of illness. On 1/1 1930, there were 243 funds with 2,264,909 insured persons and 2,522,283 family members. Due to the economic crisis in Poland, the number of insured is decreasing. The funds of hospital funds consist of contributions from employers and workers. Hospital funds pay benefits for temporary disability, provide free medical care, and supply medicines. Recently, the assistance provided by hospital funds has been sharply reduced: the number of dispensaries is decreasing, and payment for 50% of the cost of medicines has been shifted to the insured themselves. The sanitary organization, which is under the jurisdiction of self-governments, is very weak. There are only 30 sanitary specialists (1928), almost all in cities.-Control over food products is carried out by five state institutes for the research of food products and 17 laboratories under the jurisdiction of city self-governments. In recent years, with financial assistance from the Rockefeller Foundation, so-called "health centers" have begun to emerge, combining all types of sanitary-preventive work; in 1930, there were only 151 such centers. Their composition is quite diverse; most of them have tuberculosis and trachoma departments, about half have venereological, mother and child protection, and school hygiene departments.

In a number of cities where there are health centers, sanitary bureaus are included in their composition (in 27 cities). Medical personnel. In 1928, there were 9,422 physicians (3.1 per 10,000 inhabitants); the overwhelming majority of them—8,429 physicians—were concentrated in cities (12.5 per 10,000 inhabitants) and 981 in rural areas (0.4 per 10,000 inhabitants); dentists—3,183, paramedics—2,330, and pharmacists—4,263 (1930). Medical education. In Poland there are 5 medical faculties at the Warsaw, Kraków, Lviv, Vilnius, and Poznań universities with a total number of students in 1929/30—3,757. The course of study is 5 years; after completion, a practical internship for one year is mandatory. Pharmacists receive their education at four pharmaceutical faculties of universities; the number of students—859 (1929/30). For the training of midwives, there are 5 schools with a 2-year course, and for the training of nurses, also 5 schools. For the improvement and training of physician-administrators (county physicians) at the State Hygiene Institute in Warsaw, there is a hygiene school that organizes special courses annually. The health budget consists of sums spent according to the budgets of various ministries and self-governments. In 1928/29, expenditures for health care in the state budget amounted to 45,334,790 zlotys with a total state budget of 2,528,247,000 zlotys. By individual ministries, the expenditure for health care is distributed as follows: Ministry of the Interior (fighting against tbc, venereal diseases, infectious diseases, hospitals, medical assistance to officials, maintenance of the State Hygiene Institute)—11,714,941 zlotys, Ministry of Education (school hygiene, physical education, etc.)—10,347,849 zlotys, Ministry of Labor and Social Welfare (protection of motherhood and infancy, etc.)—7,200,000 zlotys, Ministry of Railways (medical assistance to railway workers and disinfection of carriages)—16,072,000 zlotys. Self-governments of 47 cities with a population of more than 20,000 spent on health care 47,975,000 zlotys, or 12.5 zlotys per capita (1926). Expenditures of sick funds for medical assistance in 1928 amounted to 130,653,600 zlotys.