HEALTH 1921-1945, PART 2

During the period 1921-1945, medicine and health care in Bulgaria develop on a background of complicated national and international political relations, which determine both the tendency and structure of specific socio-medical institutes. As a whole, there is somewhat of a decline from the side of medical and health policy in the country. Progressive bulgarian scholars, like Prof. Assen Zlatarov and Ilya Yanulov, make observations in their works that the very question of deteriorated health indicators of the general population is a reflection of poor labor conditions, i.e. that works as a scissors on life style of the people. Thus, a bread which have a mean price in year 1923: - 5.63 lv /index 100/, costs respectively in year 1924: - 7.04 lv /index 125/ and in year 1927; - 8.30 lv /index 147/. One kilo of butter, respectively, in year 1923: - 34.93 lv /index 100/ and in year 1927: - 37.79 lv /index 105/. Meanwhile, the mean daily wage of a worker is 63.08 lv /index 100/ in year 1923 and is 61.62 lv /index 97/ in year 1927, given that the laborer has, on average, ten days that he is gainfully employed.

On the mainstream, the sharp turn in politics after 9 June 1923 does not reflect on organizations and levels of health care maintenance /?/ in the country. It is true, that head of Directorate of Public Health - Dr. Veliko Georgiev /1872-1924/ quits his position, on grounds that "he would not cooperate with authority uzurping the government". This is not surprising, while he was one of the leaders in premier's Alexandre Stamboliisky "equipe medicalle" to reform the country and the health care, aprtially, on a commune principles. Dr. Georgiev, together with other communist-agrarian reformers like Dr. Yotov, Dr. PopSavov, Dr. Daskalov, Dr. Kaishev, etc. perished in the political turmoil after June 1923 - some died or other emigrated abroad. The post Head of Directorate Public Health is succeeded by progressive Dr. Petar Tzonchev /1867-1947/ from Gabrovo.

The bourgeois political development in Bulgaria, which is in a nutshell radical and democratic, confounds a series of occasional formations playing role in the governing of the country. One such organization is the Bulgarian Medical Union /BMU/, founded in 1903. As a matter of fact, more information on BMU activities can be find in the journal of the organizaton "Annales De L'Union Des Medecins Bulgares", issued volumes I-XXXVIII. In it's nearly 45th years, the BMU had 26 assemblies but on the XXVI Assembly, held on 23, 24, 25 December 1945, the union came abruptly to an end. It took another 45 years that BMU had its revival under new auspices. Now, it is not our aim to dwell on the history of BMU but to show its role on the political community in the country and in particular, what scientific and technologic support it gave to medicine in Bulgaria. Our main thesis is that BMU played an important role in the historical development and was always on the right hand side to support the decisions of the main ruling medical body - the Supreme Medical Council at the Ministry of Interior and Public Health.

Thus, it hailed the constitutional "Law of State Defense" or LSD received on 4 January 1924. The BMU approved the sanctions taken against those members of the medical community which boycott the change of policy after June 1923, according art.15 of the LSD. Dr. Ivanov of BMU says: "That means LSD has an inverse power in relationship with the discharges of union members, having in mind that those people have ever had communist convictions". However, the union took in mind the arguments of Dr. Racho Angelov, a social-democrat and council of BMU. The latter resigned from his post but the assembly of BMU, obviously realizing that this is an act of reproachment from an independent member towards the sway of terror and violence in the country, gave him a tribute. Ahead of events Dr. Angelov was right - LSD was abolished on 16 October 1944.

To assume multicollinearity of views it is worth rendering the fact that medico-sanitary insurance represent the "Achilles heel" of health care during that period. Here comes the "Public Health Law" or PHL from 9 March 1929. The PHL aims at centralization of top medical leadership and further specialization and systematization of medical organs. The law transfers all expenditures on local health services to burden the budget of communities and municipalities. The PHL is acknowledged in a moment when the country economy is in a business recession and tax paying from the masses is scarce. Art.18 from PHL says: "Taxes can not be lower than the actual expenditures for the diseased" and accordingly "Expenses for the poor are untowardly met by the communities". This gives some good opportunities for flowering of private stationary and ambulatory cabinets. Art.192 from PHL says: "Every registered physician has the authority to open a hospital or sanatorium having in mind that he is not under conviction, disciplinary or criminal, connected with his medical service or is pending". The ethical issues connected with this file are not under consideration. The PHL gives access for profitable investment of capitals coming from shareholders and stockholders. This requirements are liberal but still they are looking for compromise between a public and a private mix.

Next moment in health issues of the period is combat with social evils, namely with tuberculosis, alcoholism, prostitution, etc. The socialhygienic elements are based on wade hygienic councils under the operational leadership of the Directorate of Public Health and with the strategic goal of liquidating and eradicating so called "social pathology". This approach was not a new one, while before the WWI there were agitated debates between the two fractions of BMU: Dr. Orahovatz's and Dr. Russev's supporters. On a new scale those fractions were classified by some modern socialhygiene narrators from the 70th and 80th decades as "bolshevik" and "reactionary" but we do not wish to devaluate what was written some 30-40 years ago.

Whatever, on the continuously deteriorating status of the masses we can judge from the reports of the head of the Directorate of Public Health, mimeograph from year 1931: "I would propose to decrease the taxes for delivering health care while prices of goods from first necessity mark a decline those in health establishments are still high". At that time the prices are: - for ambulatory exam is 20 lv; - for one day stationary treatment is 40-80 lv; - for one day sanatorial treatment is 75-120 lv, etc. In the field of infectious disease prevention: - for desinfection of one kilogram stuff is 5 lv; - for hygienic douche is 5 lv, etc.

/to be continued/.