HEALTH 1921-1945, PART 3

The year is 1934. On 19 May the political power is taken by the military league "Zveno". Head of Directorate of Public Health is appointed Dr. Georgi Ivanov /?/. However, the burden of loose operational leadership has a timely effect on institutional settings. The government is under pressure and legislation, given that all political parties are banned and National Assembly is disrupted, have to deal with co-ops which, in fact, represent the outrageous ordinary masses from the street. Even IMRO had to put an end to its activity and leader Ivan Michailov /1896-1990/ fled away from the country in exile. The picture comes to a rest at the eve of WWII when in December 1939 an election campaign for the XXV^th Ordinary National Assembly is held.

Let us examine what's going on with health care. On 22 March 1935 is issued provisional draft for "Law for Compulsory Medical Practice in the Village" or LCMPV. Despite that the number of physicians in the period is increased and there is an evidence for "physicians plethora", meanwhile, in the countryside health is far removed from the population and the individual. The hard mode of life and work in the bulgarian village, their backwardness and timidness, repulses the young practitioners to stay in the ambulatory. In an editorial from 1940 in the "Annales …" we read: "Most of the jobs offers in the village will remain chronically vacant, because the super-pretentious doctor can not get hold there and due to lack of elementary conditions for subsistence - board and lodging".

That is quite different in the city. A greater number from the young medical practitioners are still graduates from abroad, while Medical Faculty in Sofia takes a narrow margin. Those bachelors, naturally, apply the forms and methods of treatment which they have learned in the institutes of their education. For the first time this create a "tower of Babel", a confounding of terminology, classifications, etc. Further, specialization and post-graduate education is necessary with respect to private clientele and that is organized in two manners: First, the medical doctor is sent abroad - with a stipend - to a western establishment, which issues a document that the specialist has served for "such and such" period and received a title; Second, there is a practical training available in a bulgarian clinic - without reimbursement - which leads to a certificate for a specialty. Both lines were a matter of debate from the Bulgarian Medical Union. Dr. Robev from the council of BMU remarks: "It is a high time that the Directorate of Public Health stop sending proteges and other partisans… which is a violation of deontological norms and downright laws". Finally, the raising in medico-sanitary hierarchy is organized on the basis of a competition with a maturity exam, commissioned by the Supreme Medical Council. The candidates for a managing post are rated and graded on a percentile scale and the most successful ones are reported to the Council. Usually, the administration of the procedure is supported by high taxes but the benefactor, while every effort was made to prevent the corruption, still remained dim.

We will be back on the professional item of medical life but let us now take a look on the demographic situation in the country. A concentration of main demographic indicators is presented on Table 1:

 Table 1: Crude birth rates, crude death rates and natural increase for the period 1921-44 /per 1000 population/.

We see from the data that total mortality show a tendency for decline, while it is associated with parallel slow down of the numbers for natality and their product limit. Here are some data on a comparative scale for natural increase per 1000 /N.B. The information is for the period before WWI/: Bulgaria /1910-12/ is 19.7; Russia /1912-13/ is 18.4; Serbia /1909-12/ is 14.5; … Spain /1908-13/ is 9.3; Belgium /190-12/ is 7.7; France /1908-13/ is 6.9. Evidently, demographic revolution in Western Europe is some 20-30 years ahead. Or maybe, some experts lament, the existing bureaucratic system in Bulgaria prevent regular registration and/or intensive-extensive mix give misclassification of rates. However, this is a misnomer in the whole civilized world!

Now let us dwell on some international issues concerning health policy of the "League of Nations" /LN/ and "Rockefeller's Foundation" /RF/. The small scope of our study does not allow to give a more detailed picture on those organizations. Suffice to say, from a special committee report presided by Prof. Hecht & Co. entitled: "Raport sur son voyage d'etude dans certin pays d'Europeen. Geneva: Health Section of the Secretariat of the League of Nations, 1924" we see that a project is undertaken for Bulgaria. With the management of "Rockefeller's Foundation", in the period 1931-34, an imposing building for public health activities is mastered in Sofia, Bulgaria. Architect is Dr. K. Koev and the design is the biggest on the Balkan Peninsula, a huge six store building which stays on the "Regentska Street" some 100 meters away from the Mausoleum of Vassil Levsky. It is there that the Directorate of Public Health with Supreme Medical Council transfer its quarters under the name "Institutes for Public Health". It is pity that the archives of the "Institutes …" were ravaged after the World War. I, personally, got some information from a notebook belonging to two members of the "Teetotaler's Association in Bulgaria", namely Dr. Haritton Neykov and Dr. Dimmo Burilkov. Suggestions for further research on the topic are welcomed.

/to be continued/.