Switzerland

SWITZERLAND. Area 41,295 km². Population in 1932: 4,095,000. Population density: 94.1 per 1 km². Switzerland is a country with low birth rate and low mortality rate, with the birth rate falling faster than the mortality rate, and the natural population growth slowing each year (Table 1). Table 1. Population movement in Switzerland (per 100,000 population). Natural Years Birth rate Mortality rate increase 19.4 11.8 7.6 13.9 12.6 1.3 18.5 12.2 6.3 18.3 11.8 6.5 17.5 12.4 5.1 17.4 12.0 5.4 17.1 12.5 4.6 16.7 12.2 4.5 In large cities, such as Geneva, mortality exceeds birth rate. Sanitary organization. Each of the 25 Swiss cantons is completely independent and has its own sanitary organization and sanitary legislation, but since 1890, by constitutional provision, a federal sanitary bureau was established, whose activities and powers gradually expanded. Thus, the country has two sanitary legislations: cantonal and federal. The federal bureau, belonging to the department (ministry) of internal affairs, has the right to take measures against infectious diseases, as well as diseases most common and dangerous to humans and animals, to observe medical practice, and to represent Switzerland in international sanitary organizations. In addition, this bureau is an official intermediary between cantonal organizations, collects material on healthcare, keeps disease statistics, monitors the enforcement of laws on the sale of narcotics, etc. The federal government has the right to issue laws applicable to the entire federation regarding child labor in factories, working hours for adults, and protection of labor in hazardous or harmful enterprises. Supervision of laws on worker insurance, industrial labor, and epizootics lies with the department (federal) of national economy. Thus, the Federal Health Bureau serves as a link between local sanitary organizations. In addition to cantonal sanitary authorities, most large cities have their own sanitary organizations, independent of cantonal ones. In some cantons, there are district physicians, appointed by the cantonal government and serving as local sanitary authorities. Almost every canton has a cantonal hospital where the poor are treated and hospitalized at the expense of the commune. Infectious diseases. By federal decree of August 23, 1927, the main infectious diseases are subject to mandatory registration in all cantons. In most cantons, by local laws, other infectious diseases not listed in the federal list are also registered. Except for influenza, infectious diseases are widespread. Only diphtheria has somewhat increased in recent years (in 1926: 4.8 cases per 10,000 inhabitants, in 1927: 8, in 1930: 11.2). Since 1929, the Federal Council has paid cantons 33% of the expenses for diphtheria vaccination, but this vaccination is widely implemented only in Geneva (3,523 children vaccinated in 1929). Compulsory smallpox vaccination was rejected in 1880 and currently exists only in 7 cantons. In 1920-21, there was a serious outbreak of smallpox. Since 1922, no cases of smallpox have been observed. Hospital affairs. Most hospitals are maintained at the expense of cantons, but patients pay for maintenance. The poor are treated free of charge or at the expense of communes everywhere, with admission rules for the poor being almost the same everywhere. Thus, in Zurich, patients whose income does not exceed 3,500 francs per year pay 3 francs per day in the hospital, often charitable organizations or the cantonal Poor Bureau pay for them. As income increases, so does the hospital fee. According to 1928 data (almost unchanged since then), the number of hospitals is as follows (Table 2): Table 2. Medical institutions in Switzerland in 1928. Type of institutions General hospitals......... Psychiatric hospitals . . . Nervous (epileptics and alcoholics) .......... Asylums for the mentally retarded Children's hospitals........ Hospitals for the disabled...... Hospitals for infectious diseases..... Gynecological and obstetric hospitals . . . Eye hospitals........ Asylums for the incurable . Total . Number Number of beds 18,590 18,807 1,007 1,642 4,431 48,585 Beds per 1,000 inhabitants 45.5 4.1 2.4 0.5 4.0 2.4 0.9 11.1 97.9 Social diseases. Tuberculosis. Mortality rates from tuberculosis in Switzerland are relatively high, as they include all foreigners coming for treatment in Switzerland and dying here. The decrease in mortality from tuberculosis in recent years is partly due to the reduced influx of foreign patients into Swiss sanatoriums due to the economic crisis, high cost of living in Switzerland, and the development of tuberculosis institutions in neighboring countries. In 1891, mortality from tuberculosis (all forms) was 29.3 per 10,000 inhabitants, in 1905: 27.4, in 1930: 12.6. Since 1922, the federal government has subsidized the fight against tuberculosis (in 1930, it allocated 1,900,000 francs). The fight against tuberculosis is conducted on the basis of the law of June 13, 1928. Registration of infectious forms of tuberculosis is mandatory, as is the patient's notification of change of address and disinfection of the premises after departure. But the main fight is conducted on private and public funds by anti-tuberculosis leagues, which in 1919 united into a federation. In 1930, there were the following institutions for the treatment of tuberculosis: Table 3. Name of institutions Number Number of beds in them Patients treated Dispensers...... Children's sanatoriums for the sick...... Hospitals for tbc...... Departments for tbc in general hospitals: Preventoria: for children ....... Summer colonies for children 31 5 65 10 5 18 3 246 240 1,849 457 241 11/4 15 398 }^; 6,071 \ 846 | t; 5,338 !: 534 1,640 ({ 3,534 28,890 £ In 1930, the first sanatorium-factory was opened in Leysen, where patients, even those bedridden, work on special machines. Expenses of cantons, communes, and private organizations for the fight against tuberculosis in 1930 amounted to 18,491,301 francs. In each rural school district, there should be a school physician-inspector—at the rate of one per 3,000 children for detecting tuberculosis in children and teachers. Sick teachers receive leave: for treatment and 80% of salary during illness. Venereal diseases are increasing every year. Mortality from syphilis in absolute numbers was 664 for the period 1881-90, 1,214 for 1891-1900, 1,715 for 1901-10, and 1,784 for 1911-1920. In 1930, there were 8 central consultations for venereal diseases, through which 1,625 syphilis patients and 2,514 gonorrhea patients passed. In the same year, there were 109 other institutions for syphilitics, which admitted 649 syphilitics and 1,263 gonorrhea patients. Prostitution is officially prohibited, but in large cities the number of prostitutes is relatively large. The poor in cities are treated free of charge, but the bulk of patients are treated by private practitioners. According to Dr. Jeger, in 1923, 4 residents per 1,000 in Switzerland were treated for venereal diseases (in Geneva even 5.2).-Goiter is very common in almost all cantons, but mainly in high mountainous areas. In Switzerland, salt is a state monopoly; iodine salts are necessarily added to it to combat goiter.-Cancer. In terms of cancer morbidity, particularly stomach cancer, Switzerland occupies one of the first places in Europe. Mortality from cancer in recent years (1927-30) averages about 15 per year per 10,000 inhabitants without a tendency to decrease. The fight is conducted only by university clinics. Protection of motherhood and childhood. Infant mortality in Switzerland is very low and is falling quite rapidly, parallel to the decrease in birth rate (Table 4). Table 4. Infant mortality in Switzerland Years Mortality per 100 births _g 1 Mortality per 100 births 1925 1926 1927 1928 5.8 5.7 5.7 5.4 1929 1930 1931 1932 5.2 5.1 4.9 5.1 Legislative protection of motherhood, childhood, and women's labor is very poorly developed, varying in different cantons. The number of illegitimate children increased from 37.1 per 1,000 in 1922 to 44.3 in 1930. Mortality among them is twice as high as among those born in wedlock. In 1929, there were 115 consultations for children and "milk drops," in 1930: 6 consultations for pregnant women, which admitted 4,662 women. In 1928, there were 236 nurseries, almost exclusively private, and 16 dispensaries for mother and child (4,079 people passed through). Medical personnel. Switzerland has 7 medical faculties. The number of medical personnel in 1930 was expressed in such figures (Table 5): Table 5. Medical personnel Total Per 10,000 inhabitants 3,407 1,175 2,828 8.4 2.9 1.8 6.9 A significant number of physicians served the numerous foreign tourists, whose number decreased significantly after the 1914 war and during the 1929-1934 crisis. The material position of physicians has deteriorated greatly since then. Labor protection. Legislation varies in different cantons. Everywhere, the working day for workers and employees is set at 48 hours per week with mandatory Sunday rest. In most cantons, there is a labor inspection to monitor compliance with labor legislation and hygiene rules in enterprises. Accident insurance is mandatory for most industries. By the law of 1911, each canton can independently introduce health insurance. A federal law on social insurance was rejected by referendum due to the voting of peasants in peasant cantons.

In 4 cantons (Basel, St. Gallen, Appenzell, and Zug), only the poor are insured against disease. The federal government subsidizes these insurance funds at a rate of from 3.5 to 5.5 francs per year per insured person. In 8 cantons there is compulsory insurance against disease. In three cantons there is compulsory insurance of schoolchildren against disease. In the case of schoolchildren insurance, the contribution is made by the parents (law of 1928) at 12 francs per year per child with a discount for each subsequent child. Mutual societies for insurance against disease are widely developed. Thus, in 1932, there were in all of Switzerland 1,153 insurance funds with 1,717,334 members. Their budget in 1931 amounted to 76,162,220 francs, of which 71% were membership contributions, 12.6% state subsidies, 3.7% subsidies from the cantons, and 1.8% subsidies from employers. The number of members of insurance funds increased from 334.9 per 1,000 inhabitants in 1927 to 402.3 in 1929. The law of July 13, 1911, established compulsory insurance against accidents in professional and non-professional work. Until 1932, the state subsidy for this insurance was 25%, in 1933 this subsidy was reduced to 20%. Compulsory insurance against old age and death, voted by parliament, was rejected by referendum at the end of 1931.