SANITARY WORK IN EASTERN RUMELIA

The Organic Statutes of Eastern Rumelia /1879-1885/ pay little attention to sanitary work. It has the same features as that during the Provisional Russian Government and is under the control of the Directorate of Internal Affairs. First leader, jurist Gavril Krastevich, is in a difficult position for he is in front of a dilemma to choose between two opposite sanitary variants. According the Russian model health care is totally state powered including ambulatory, hospital, sanitary-epidemiological activities under Supreme Medical Council constituency. The Turkish sanitary organization on the contrary during the Tanzimat period functions in a western manner: all hospital and ambulatory care are excluded from state competency and are under charge of charitable organizations and private practitioners. Thus from the necessity to choose in november 1879 G. Krastevich puts forward at the Regional Assembly a proposal for a Sanitary Law and Statute on the sanitary part. So from the sanitary regulations voted in June 1880 a mixed system of health care is introduced in Rumelia – the state takes care of epidemiological control and ambulatory care while hospital facilities are under private initiative. The higher institution is the Sanitary Council consisting of a minister, three physicians, pharmacist and veterinarian. The governor of Eastern Rumelia A. Bogoridi appoints Dr. Stoian Chomakov for a minister. The Council also includes a balanced staff from professionals with only one foreigner – K. Sostrojonek.

For a six year period in Rumelia the Council resolute sixteen normative documents. Problem legislation decrees the statute of general practice physicians, vaccinations, veterinary control, dead burials, pharmaceutical statute etc. Aside from legislature the Sanitary Council elaborates certain materials like statistics for sickness, hospitalized, diseased; instructions to regional physicians; raports to the Director of Internal Affairs; communications to the press etc. An analysis of appointed medicals in the region reveals 28 district and 6 sector regulars – all of them graduates from France, Roumania, Russia, Turkey which attests a very high standard. As a national proportion we see 25 Bulgarians, 4 Greek, 3 Russian and 2 Armenian physicians. Approximately 20% from the doctors had to change their working place from two to three times. However, unfavorable working conditions are compensated with comparatively high salaries – 1700-1800 grosh; which is half as much the compensation of the sanitary chief. Compared to the police force dismissals are seldom not so much for political reasons as for lack of professional qualifications. Accusations against state physicians are unequivocal: refuse medical help to the peasants, restrain from inspection tours, lack of authority to impose hygienic norms, do not control feldshers work, show ethnic preferences etc. In such information against the Sanitary Council acts according a procedure determined from Director Krastevich /from 1884 superseded by Nachov/ - an inquiry commission is created which report leads to disciplinary sanction or denial with facts in the press. Despite considerable decentralization of sanitary work prevailing statements contain good reference for hygienic, ambulatory and small surgical activities.

Few words concerning pharmaceutical services reveal serious burden for the government: overwhelming are old habits of the population used to receive medical goods without prescription from unqualified sellers. The Pharmaceutical Statute from february 1879 regulates strict control from the state, rules for preparing, preservation and allotment of drugs, conditions for establishing a pharmacy, structure and function of pharmacy etc. The Rumelian pharmacy network consists of 28 mobile units of Ist type /remuneration from the state/ and 12 mobile units of IInd type /private owners/. Greater difficulties are presented by stationary pharmacies – lack of appropriate rooms, professional standing of personal, communication with hospital base – all in all 17 such pharmacies are established. Main depot for medical goods is Pharmaceutical Store in Sofia and a branch in Plovdiv exists headed by member of Sanitary Council chemist K. Sostrojonek /from 1884 A. Naidenovich/.

Hygienic matters in Eastern Rumelia are identical to them in the Principality Bulgaria: main current of diseases are caused by terrible dwelling conditions /houses are built directly on the soil terrain, no windows or apertures, people and cattle live together/; so this way of life mediates vermin, filth, superstition. Nutrition is unhealthy – uncooked, hard to digest food, rotting food, spring water. Settlements have hardly canalization and sewerage; mud, compost, marshes everywhere; no regular cemetery land etc. What can do the Sanitary Council in the case is, traditionally: health education, distribution of free medication, regulation of whorehouses, vaccination. In case of resistance to vaccination fines are imposed also those are not admitted to school and in the army. The picture of epidemics in Rumelia reveals more significantly some variola epidemics in Plovdiv in 1882, scarlet fever epidemics in Karlovo in 1883, epidemics from syphilis, epidemics from egyptian cholera in 1883. Quarantine function well; desinfection of people and animals is compulsory; people are relieved from anxiety etc.

While ambulatory and epidemiological activity is a priority of the state hospital care depends on private initiative. The provisional Russian government, namely General Skobelev and Prince Shachovsky propose to bulgarian intelligence to take care by commissioning a semi-Red Cross association. Under the leadership of the Bulgarian Exarchate on 23 May 1879 an association “St. Pantaleimon” is created. Its statute copies a Russian style – salvation work with no regard to ethnic or religious affiliations, education of health personal, cooperation to vaccinations, establishment of hospitals with drug stores. Presiding the association is head of the Sanitary Council Dr. Chomakov. The board of trustees includes eminent figures, medical doctors Vulcovich, Stambolski, Hakanov as well as deputies and members of regional comities. Funding for the association depends on charities from private persons and on reliefs from the district authorities. Main discrepancies in hospital administration appears to be the conflict for appropriation of possessions left by the Russian army namely the military lasers. However, from 1879 there are hospital functioning in Plovdiv, Burgass, Yambol; from 1880 – in T. Pazarghik; from 1881 – in Sliven, Kazanluk; from 1882 – in N. Zagora; from 1883 – in Chirpan, St. Zagora etc. The income of “St. Pantaleimon” association is distributed proportionally to the hospitals by size, nevertheless, funding is inadequate. The problems are the same as in the Principality Bulgaria: unsuitable buildings; lack of basic appliances i.e. beds, instruments, apparatus; insufficient personal etc. The statistics from the Sanitary Council shows that most of the hospitals have 10-15 beds with approximate rate of 135 patients per bed per year. Obviously that low attendance of hospitals is due to distrust of the system, poor hospital environment, inadequate medical qualification, high mortality rate in hospitals versus home therapy etc. Finally, there is information that as early as 1879 a measure to convert mentally ill from the monasteries is introduced – the first madhouse is assylumed to Plovdivs hospital. As a conclusion to the review of sanitary work in Eastern Rumelia there is evidence that despite considerable decentralization effect of state health care is stable with many achievements of modern medicine gained.