Sanitary Supervision

SANITARY SUPERVISION, one of the basic forms of practical activity of sanitary authorities. Maintaining a certain sanitary level of life for various population groups and its gradual improvement, on the one hand, and protection from harmful factors, on the other hand, require constant and uninterrupted observation by the relevant sanitary authorities. The sanitary level of life of the population depends not only on the general culture and general cultural skills and habits of a person, but also on the implementation of a series of measures of a public mass character, which do not depend on the will and strength of each individual individual. At the same time, the necessary effect in maintaining and improving the sanitary level also depends on the universality and simultaneity of the implementation of the corresponding S. n., carried out uniformly and according to general sanitary norms. Thus, sanitary supervision is primarily the main task of those practical sanitary workers who are part of sanitary authorities, and then it is also an additional function of many other workers in the medical field (treating physicians, health posts, etc.) and general administrative personnel (police, heads of households, dormitory commanders, teaching staff). S. n. usually divides according to its tasks into two main types: a) preventive S. n. and b) current S. n. In the system of population and populated areas' sanitary service, both types of S n. occupy an important place, mutually complementing each other. Under preventive S. n. is meant the mandatory, based on certain legal requirements, participation of sanitary authorities in the consideration, evaluation and approval of projects and operation of all more or less large construction and improvement facilities. Under current S. i. is meant the usual daily control over the sanitary condition of the same facilities during their operation period, i.e. S n. over the maintenance in order and cleanliness of these structures, enterprises and installations in accordance with the requirements of hygiene and sanitary rules, as well as over certain groups of the population. This understanding of the two main types of S. n., preventive and current, has been established by the practice of sanitary authorities; the terminology of these types of S. n. is also reflected in the republican laws "On Sanitary Authorities" (in the RSFSR, the decree of the Council of People's Commissars of 8/X 1927). The said decree of the Council of People's Commissars of the RSFSR in paragraph 1 formulates the tasks and forms of S i. as follows: paragraph 1. "For the purpose of carrying out everywhere measures to protect the life and health of workers and to prevent and eliminate sanitary disorganization of populated areas, as well as to organize the fight against contagious social and professional diseases, to establish mandatory permanent preventive and current S n.". In the same provisions on the sanitary authorities of the RSFSR republic-in one of its subsequent articles (Article 18)-there is also a more or less general list of the objects themselves subject to current and preventive S. n.: paragraph 18. "Current and preventive sanitary supervision by sanitary authorities, indicated in Art. 5 of these provisions, is subject to: a) all sources of water supply and water structures with their purification installations (water pipes, filters, wells, irrigation and drainage structures, etc.); b) structures, installations and measures for collecting, removing and neutralizing sewage and waste (irrigation fields, biological filters, incinerators, sewer carts, crematoria, cemeteries, etc.); c) structures and measures for the improvement of populated areas (planning, building, paving, tree planting, etc.); d) dwellings, dormitories, places of temporary stay and overnight accommodation, places of public use and mass gathering of people (hotels, inns, theaters, cinemas, etc.) and places of sanitary service to the population (baths, laundries, hairdressers, etc.); e) places of manufacture, storage, consumption and sale of food products and beverages (markets, bazaars, warehouses, refrigerators, bakeries, restaurants, canteens, shops, stalls) and other institutions and establishments of public catering (food industry and trade); f) places of special purpose (places of detention, barracks, etc.) by agreement with the authorities in charge of these institutions, buildings or places; g) health-resort and sanatorium institutions, sanatoriums, rest homes, resorts, etc.; h) educational institutions (children's homes, schools, factory apprentice schools, higher educational institutions, libraries, clubs, etc.); i) factories, plants and other industrial enterprises both from the point of view of general improvement and prevention of their adverse effect on the surrounding population, in particular their pollution of air, water and soil, and from the point of view of studying professional diseases and the influence of work and environment on the health of workers, in order to find the best measures to combat professional morbidity".-In the new draft Sanitary Code, now being developed by the People's Commissariat of Health of the RSFSR (1932-33), this article has been expanded and additional objects subject to S. n. have been introduced, namely: "a) machine-tractor stations, state farms and other enterprises of the socialist sector of agriculture; b) piers, stations, aerodromes, passenger, service and duty premises of transport, transport workshops and depots, rolling stock..., as well as buildings, adaptations and structures in the right-of-way; c) places of production and supply of the population with items of personal hygiene, household and wide consumption". In addition to all the above-mentioned objects, this same form of sanitary work is also established in relation to: a) human contingents which, by the nature of their activities, conditions of their work or level of their sanitary condition, require the adoption of special sanitary measures and are subject to corresponding sanitary control; b) individual measures where, in the course of their implementation, control by sanitary authorities over the order of their execution and verification of results is also necessary. To the objects of S. i. from the field of human contingents belong: a) professional and other groups of workers in the process of their productive labor (sanitary supervision in the field of labor protection); b) the same selective groups where it is necessary to conduct additional preliminary or current examinations of these groups of workers due to the special harmfulness of production or the dangers of the latter for consumers (periodic examinations of workers in the food industry, selection upon admission to certain productions, etc.); c) moving masses of population (resettlers, emigrants, refugees, pilgrims, conscription groups); d) separate contingents of the population in special living conditions (prisoners, etc.).-To the objects of S. n. from the field of individual measures should be attributed various mass spectacles and entertainments (competitions, sports games, tourism), other mass one-time gatherings of people (congresses, rallies, demonstrations, subbotniks), as well as gatherings of people in connection with trade (fairs, bazaars, etc.). Finally, sanitary supervision organized urgently on a large scale in times of natural disasters, when its functions acquire special importance (floods, earthquakes, etc.), should also be included here. Preventive S. n. received special development from the moment permanent sanitary organizations were established in various countries for the purpose of deeper sanitary impact on the improvement of living conditions and environment of the population. For these purposes, preventive S. n. is closely linked with certain sanitary legislation, which establishes the obligation for all relevant economic, communal and departmental organizations to submit for preliminary consideration and approval (or giving of an opinion) to sanitary authorities all without exception construction and improvement projects (see the list of objects given above). The procedure for carrying out preventive S. n. is divided into several stages, namely: a) selection and allocation of a site for the planned structures and buildings, taking into account sanitary requirements, b) participation in the development of sanitary assignments for this construction based on the sanitary norms and requirements presented, c) consideration or participation in the consideration of the relevant construction projects and giving an opinion or approval of them, d) participation in the acceptance of structures and construction for the purpose of checking the fulfillment of the sanitary requirements previously presented, e) determining the possibility of commissioning or settlement (dwelling) and carrying this out taking into account sanitary indicators. In carrying out all these forms of preventive S. n., sanitary authorities proceed either from the sanitary norms established by law in each given field (norms of water consumption, norms of living space, norms of composition of food products, norms of sanitary-technical equipment, etc.) or-in the absence of legally established norms-from the general hygienic norms proposed by hygiene. In the USSR, a certain part of hygienic requirements is now formalized in the form of sanitary norms, which usually constitute an important part of the so-called Sanitary Code (see.

Sanitary legislation, as well as in the form of 'Uniform Standard Norms' issued by the Standardization Committee at STO. - In relation to individual types of construction, the law usually establishes a certain practice of preventive supervision, for example, sanitary rules for the construction of residential buildings (of 20/VII.1929, see 'Questions of Public Health' of 7/VIII.1929, No. 29), where a number of housing and sanitary norms are given, which the S. n. must follow when considering housing construction projects; such are the 'Instructions for sanitary authorities on accepting newly built and majorly repaired buildings' (of 17/X, see 'Questions of Public Health' of 1/XI.1929, No. 40); such are the 'Sanitary rules on the settlement of worker housing' (adopted by the People's Commissariat of Health, NKVD of the RSFSR and VTsSPS of 5/X, see 'Doctor-Sanitary Legislation of the RSFSR', issue II, p. 64). Practice and law usually establish that cases of disagreement between sanitary authorities and economic authorities when considering construction and other matters are submitted for final decision to higher authorities, up to central ones. Casuistic cases that require scientific confirmation or consultation are usually resolved by the corresponding scientific-consultative bodies of the People's Commissariat of Health (medical scientific councils) or in the scientific-technical councils of departments, with the participation of representatives of the People's Commissariat of Health. For the systematic implementation of preventive S. n., health authorities must also take mandatory part in the consideration of long-term construction plans (planning authorities). In carrying out current S. n., the following moments are important: a) the broad coverage of all objects subject to this S. n., b) the systematicity and periodicity of carrying out this S. n., c) the implementation of unified sanitary and sanitary-technical requirements in S. n. (based on mandatory sanitary regulations or other sanitary laws), d) the accounting and registration of all S. n. acts (recording in books, written presentation of requirements, setting deadlines for fulfillment), e) control over the fulfillment of requirements and f) holding responsible for non-fulfillment of the latter. The organization of current S. n. therefore puts on the agenda the planning of work of sanitary authorities. It is necessary in specific plans of work for each given territory (sanitary area, enterprise, school, etc.) to list the objects of current sanitary supervision and establish the procedure and timing of its conduct, giving first place to the most responsible objects in sanitary terms (e.g., in the housing sector - dormitories, worker barracks, in the food sector - canteens, factory kitchens, in the epidemic sector - sanitary checkpoints, etc.). Furthermore, it is necessary to take all measures to develop and promptly publish local mandatory sanitary regulations, widely disseminated among the population for its information, and corresponding instruction of the population and persons responsible for the sanitary condition of individual objects. It is also necessary to establish certain forms of recording individual sanitary inspections in the course of current S. n. (journal at the enterprise, sanitary books, special forms, etc.). A number of local sanitary authorities in the USSR publish such one-time record books locally, with a brief introduction to them on the question of the essence of S. n. and with references to the corresponding articles of sanitary legislation. Requirements presented by sanitary authorities in the course of current S. n. should not be unfounded and of a general nature; they should be specific, fixing certain deficiencies identified by inspection and indicating methods of correction and deadlines for fulfillment. In addition, they should be presented to specific individuals who are responsible for non-fulfillment of the requirements. The establishment of control over this fulfillment is extremely important; in its absence, S. n. turns into unnecessary paper correspondence. In addition to this planned current S. n., there is also unplanned current supervision in the practice of sanitary authorities, caused by various life requirements, departmental requests, complaints from individuals, and finally conducted at one time and on the initiative of the sanitary authorities themselves. The significance of this form of S. n. is also great, but it should not replace planned S. n. All types of S. n. should find their reflection in the reports of sanitary authorities and involve broader masses of the population in the work of health improvement. Various forms of S. n. often require very significant qualifications of sanitary authorities. This is especially necessary to keep in mind in relation to preventive S. n., where consideration of projects for often very complex industrial or municipal construction raises a number of difficult sanitary-technical questions. The same applies, for example, to the field of food sanitary affairs, where a number of questions of food hygiene have not yet been sufficiently worked out scientifically. Therefore, in practice, special types of S. n. are created, in accordance with the qualification of the workers themselves. Such are: housing and municipal S. n., food S. n., industrial sanitary supervision, S. n. on transport routes, in the field of child protection (school S. n.). In the corresponding instructions for sanitary doctors of these specialties, the forms of the corresponding S. n. are usually indicated (see Food Legislation, Housing and Sanitary Supervision, Protection of the Health of Children and Adolescents, etc.). A special place in the conduct of S. n. is occupied by the so-called sanitary surveys. In the practice of preventive S. n., and to some extent of current S. n., these surveys are usually the initial stage of all work. In preventive S. n., sanitary surveys are the main obligatory part of the work when choosing a site for construction, when planning populated areas, when determining water supply sources; the same should be done when carrying out S. n. in relation to individual population groups (survey of sanitary working conditions, survey of sanitary transport conditions, etc.). For a whole range of objects, health authorities have developed special programs for such sanitary surveys: such is, for example, the program for the sanitary study of cities when developing their planning projects (circular of the People's Commissariat of Health of the RSFSR of 3/XII 1927, see 'Doctor-Sanitary Legislation', issue II, p. 71), such are programs for the study and survey of water supply sources, sanitary survey of individual industries and trades, etc. In relation to individual objects, special sanitary survey maps are compiled (courtyards, dwellings, homesteads, trading enterprises, canteens, kitchens, wells, schools, etc.). The use of homogeneous sanitary maps, questionnaires and programs is of great importance for the subsequent processing of these materials (statistical summaries). On the basis of these sanitary surveys, not only preventive and current S. n. are carried out, but also individual monographs on the sanitary condition of one or another object are compiled. In the practice of S. n., these works have their significance as historical and as starting material for a number of conclusions and comparisons. In the past of Russian sanitary practice, such sanitary descriptions existed in relation to a number of territories and enterprises of old Russia. Such are the medical-topographical descriptions of individual provinces and cities (works of 1860-70s); zemstvo sanitary-statistical surveys (e.g., works on the sanitary condition of factories and mills of the Moscow Province, conducted with the participation of Prof. Erisman, Pogozhev, Dementiev, etc. in the 1880s); further, sanitary surveys of the middle and lower Volga and some populated points of the Urals (works of Prof. Khlopin in the 1900s), etc. Such are also the numerous sanitary surveys carried out after the revolution - industrial enterprises of Moscow (Moscow Health Department), surveys of rural housing in Ukraine (Marzeev), etc. S. n. of all the above-mentioned types is carried out primarily by sanitary authorities, i.e., sanitary doctors and sanitary inspection. The most qualified types of S. n. (especially preventive S. n.) must be carried out exclusively by doctors. For other types of S. n., in particular for current S. n., persons of other personnel can and should be involved in this work. These are 1) assistants to sanitary doctors and public sanitary inspectors; 2) doctors of health centers; 3) bodies of the militia. The forms of participation of this personnel in S. n. are established by special instructions. The simplest types of S. n., especially carried out in the order of sanitary minimum, of course can be entrusted to non-medical personnel on condition of their preliminary instruction. To such simplest types of S. n. (current S. n. over the condition of apartments, courtyards, streets, workshops) are thus attracted building commanders, heads of institutions and other administrative personnel responsible in these areas. Finally, in addition to all this, public forces and corresponding sanitary self-activity should also be used - health cells, sanitary commissions, house deputies, organizations of the ROCC. The procedure for carrying out S. n. by these bodies should be instructed by sanitary doctors, and the scope of this work most closely merges with the corresponding requirements for carrying out the sanitary minimum (see Sanitary Minimum). A special form of S. n. is also sanitary-technical supervision and veterinary-sanitary supervision.

Sanitary-technical supervision is understood as control of a predominantly technical nature over the activity and operation of sanitary-technical facilities (water supply, sewerage, treatment plants, etc.). The same form of supervision also includes supervision of a similar nature over the construction and operation of housing, in particular sanitary-technical supervision over the operation of sanitary-technical appliances in housing (heating, ventilation, lighting, etc.). Sanitary-technical supervision bases its requirements both on accepted sanitary standards and on technical requirements, and implements them through the corresponding qualified sanitary-technical personnel (engineers, technicians). The requirements of sanitary-technical supervision are usually stated in the necessary technical instructions and rules, and in relation to construction - in the Building Code. The activities of sanitary-technical supervision must be coordinated, when necessary, with the activities of sanitary supervision organs. Veterinary sanitary supervision is carried out by veterinary personnel and is mainly concerned with the inspection of meat products and live animals (see Meat). The correct and as complete as possible implementation of sanitary supervision of all kinds can naturally be realized only if there is not only sufficient and qualified personnel and corresponding legislation, but also certain socio-economic conditions and the organization of the economic system of the given country. The tasks and forms of sanitary supervision often come into sharp conflict with the narrow interests of both individuals and classes that are not interested in the implementation of sanitary supervision requirements or are hostile to it. Capitalist forms of economy and private ownership of the means of production (enterprises, facilities) are therefore obstacles to the implementation of the most essential requirements of sanitary supervision. In bourgeois countries, sanitary supervision consequently remains for the most part within the framework of current sanitary supervision, which in individual cases is carried out very carefully and correctly, but does not solve the main tasks of sanitary improvement, which is closely linked to preventive sanitary supervision. The latter, however, cannot be fully implemented under the conditions of capitalist countries. Therefore, in a number of Western European countries, there is still a lack and inadequacy of various types of sanitary supervision, especially in the fields of industrial and housing sanitary supervision. At the same time, it is clear that under Soviet conditions, the organization of sanitary supervision can be carried out most rationally, and this places particularly responsible tasks on the health authorities in the USSR in this direction. This responsibility, moreover, due to the same features of the Soviet system, also falls on all economic and other organs and on the broad public.

A. Sysoyev. Industrial sanitary supervision, the totality of measures carried out by authorized and specially trained competent sanitary authorities, aimed at protecting the labor and health of persons working at industrial enterprises, and the health of the population surrounding the enterprise. Measures for industrial sanitary supervision cover the following aspects: a) preventive supervision over industrial construction; b) periodic inspection of industrial enterprises with the aim of monitoring compliance with legislative norms. Since here the object of industrial sanitary supervision is primarily the enterprise building or, generally speaking, the production site, and since work here is carried out jointly by doctors (sanitary inspectors) and engineers (technical inspectors), the measures related to these aspects of the matter are usually combined under the name of sanitary-technical supervision over industrial enterprises. All other measures included in the scope of industrial sanitary supervision, covering mainly the person and health of the worker himself and the surrounding population, and carried out mostly independently by sanitary doctors of various designations, are usually combined under the name of proper industrial sanitary supervision. Only in the USSR, where industrial sanitary legislation completely and fully protects the interests of workers in enterprises and the surrounding population, the scope and content of preventive industrial sanitary supervision is the most complete and consistent from a class point of view. The content of preventive industrial sanitary supervision we present mainly according to the 'Instructions of the Sanitary Inspection of the NKT of the USSR' and the corresponding sanitary rules of the NKZdr., where these functions are outlined in the following formulations: 1) participation in the inspection of the area and giving opinions on the allocation of sites for industrial construction, as well as establishing distances between industrial enterprises and residential areas of populated places from the point of view of the health of the surrounding population; 2) participation in the consideration of projects for newly constructed, reconstructed or major repaired industrial buildings and structures, as well as projects for various sanitary-technical installations at enterprises (ventilation installations, facilities for wastewater treatment, etc.) and, if necessary, making corresponding changes and additions to them from the standpoint of protecting the labor of employed workers and the health of the surrounding population; 3) supervision to ensure that buildings, alterations or major repairs, as well as the implementation of various sanitary-technical installations, are carried out according to projects that have received the approval of labor protection and sanitary supervision authorities; 4) participation in commissions for inspecting industrial structures before their commissioning, with the aim of determining the conformity of these structures to approved projects and current legislative norms; 5) supervision to ensure that no enterprise is opened, put into operation or moved to another premises without the approval of labor inspection authorities in the prescribed manner; 6) visiting enterprises planned to be opened and giving opinions on their compliance with established sanitary norms. (For details on the norms and requirements of Soviet legislation regarding the territory of industrial enterprises, its planning, and the production buildings located on this territory, see Industrial Sanitation.) In most capitalist countries, sanitary-technical supervision over industrial enterprises is carried out by special persons, so-called sanitary labor inspectors, who together with technical labor inspectors constitute the labor inspection (see Labor). Sanitary inspectors are appointed from doctors who have specialized in the field of labor hygiene in general and industrial sanitation in particular, and in different countries they have various rights within the functions outlined above. The sanitary inspection as a special organization with specific competence was first organized in England (in 1898) and since then has gradually been organized in a number of European countries, namely in Austria, England, Belgium, Bulgaria, Hungary, Germany (Bavaria, Baden, Württemberg, Prussia and Saxony), Italy, Lithuania, Netherlands, Norway, Poland, Portugal, Romania, USSR, Finland and Sweden, and in non-European countries in Australia, Brazil, Canada, Mexico, Peru, USA (Illinois, Ohio, Oregon, New York and Pennsylvania), South Africa and Japan. In all other countries, the functions outlined for sanitary-technical or industrial sanitary supervision are carried out by general sanitary authorities. In the USSR, the functions of industrial sanitary supervision are divided between the bodies of the VTsSPS, to which the functions of the NKT of Labor were transferred, and the NKZdr. According to the latest resolution of the Council of People's Commissars of the USSR of July 4, 1932, 'the sanitary inspection supervises the implementation of all resolutions concerning the working conditions of workers employed in production, in everything related to the production process, and the health authorities (industrial sanitary doctors, health center doctors, sanitary doctors) supervise the general sanitary condition on the territory of the enterprise and all domestic institutions located on the enterprise, in particular the implementation of all rules for the sanitary maintenance of the enterprise insofar as it concerns the protection of the health of the surrounding population.' [According to the resolution of the Council of People's Commissars of the USSR and VTsSPS of June 23, 1933, the Labor Inspection (legal, technical and sanitary) was transferred to the jurisdiction of the VTsSPS, but until special resolutions are issued, it is guided in its work by the provisions and instructions issued by the NKT of the USSR and the union republics.] When inspecting enterprises, the sanitary inspector, as well as the industrial sanitary doctor and health center doctor, has the right to demand from the administration of enterprises, institutions and economies necessary explanations and information and the presentation of relevant documents, books and information, as well as explanations about the details of production processes, the names and composition of items and substances used in this process, even if this constituted a production secret. The sanitary inspector has the right to demand cooperation from administrative personnel in carrying out his duties. The sanitary inspector visits enterprises both individually and together with a technical inspector, depending on the tasks set by the inspection. During individual inspections of enterprises (institutions, economies), the sanitary inspector draws up an inspection report of a standard form, in which the sanitary defects found are noted and requirements for their elimination are entered with indication of deadlines for fulfilling these requirements. During joint visits with a technical inspector, the inspection report is drawn up jointly, with the sanitary inspector noting in it the defects found and the requirements presented in his specialty. Requirements involving significant costs for individual state economic organizations, the sanitary inspector presents, if possible, after prior coordination with the administration on the scope of proposed measures, the order and timing of their implementation, for which he is provided with the right to convene meetings with representatives of the administration and the factory committee of the given enterprise and other interested and knowledgeable persons. When determining the scope of requirements and the timing of their implementation, the sanitary inspector must proceed from the possibility of their implementation by individual enterprises both from an economic and technical point of view; in this case, the requirements should be distributed in order, according to the degree of importance of individual measures. In case of detection by the sanitary inspector or industrial sanitary doctor of any violations of legislative norms or non-fulfillment of his legal requirements, the sanitary inspector has the right to bring the guilty to judicial responsibility, as well as to subject the guilty persons to a fine in an administrative manner.

M. Rafes.