Short History of Bulgarian Medicine1

Part I ~ Ancient and Medieval Evidences for medicine on the Bulgarian Lands 1. Introduction 2. Thracian medicine 3. Slavic medicine 4. Proto-Bulgarian medicine 5. Bulgarian medicine in the Middle Ages 6. Bulgarian medicine under Ottoman rule (14th-19 th century) 7. Medicine during the Bulgarian National Revival (1796-1877) Part II ~ Famous Bulgarian medical man during the Revival Period 1. Dr. Petar Beron 1800-1871 2. Dr. Ivan Seliminsky 1799-1867 3. Dr. Nicola Piccolo 1792-1865 4. Dr. Atanas Bogoridi 1788-1826 5. Dr. Marko Pavlov 1786-1864 6. Dr. Ivan Bogorov 1820-1892 7. Dr. Vasil Beron 1824-1909 8. Dr. Stoyan Chomakov 1819-1893 9. Dr. Christo Stambolsky 1843-1932 10. Dr. Georgi Vulkovich 1833-1893 11. Mr. Sava Dobroplodni 1820-1894 12. Mr. Zahary Knyazeski 1810-1877 13. Dr. Dimitar Mollov 1845-1914

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14. Dr. Kirko Kirkovich 1840-1877 15. Dr. Atanas Granitski 1825-1879 16. Dr. Zachari Strumski 1820-1869 17. Dr. Georgi Atanasovich 1821-1892 18. Dr. Petar Protich 1822-1881 19. Dr. Nacho Planinski 1847-1895 20. Dr. Dimitar Nachev 1850-1903 Part III ~ Modern Period of Bulgarian medical science 1. Organization of medical services during the provisional Russian administration 2. Medical services during coup d'etat of the Russian generals 3. Sanitary work in Eastern Rumelia 4. Sanitary Law from 1888 5. Advancement of health care in administration of the Liberal Party /1903-1920/ 6. Health 1921-1945 7. Health 1921-1945, part 2 8. Health 1921-1945, part 3 9. Health 1921-1945, part 4 10. Health 1921-1945, part 5 11. Health since 1945: Transition period 12. Health since 1945: Transition period, part 2 13. Health since 1945: Transition period, part 3 14. Health since 1945: Transition period, part 4 15. Health since 1945: Institutionalization period 16. Health since 1945: Institutionalization period, part 2 17. Health since 1945: Institutionalization period, part 3 18. Health since 1945: Institutionalization period, part 4 19. Health since 1945: Institutionalization period, part 5 20. Health since 1945: Institutionalization period, part 6

Part IV ~ Health Care in Bulgaria from 1989 up-to-date /financing and delivery through a transition period/ 1. New Laws Regulate the Problems of Organization, Management and Financing 2. The Crisis in Bulgarian Public Health Services 3. Paid Medical Care — with Preperence and at One’s Choice and Will 4. National Health Insurance Fund – 1 5. National Health Insurance Fund – 2 6. National Health Insurance Fund – 3

Paleolithic and Neolithic man in the Balkans appears to have had a good knowledge and awareness of health matters. They inhabited the lands between the lower reaches of the Danube.C. R (editor). were one of the most ancient of peoples and can be traced as far back as the Bronze Age. . who belonged to the Indo-European ethno-linguistic community. The distinctive nature of Tracian civilization and craftsmanship was firmly established by the second millennium BC. Introduction The Balkan Peninsula’s highly distinctive traditions of medicine and public healthcare have always been linked: the region’s relatively high standard of living and cultural life dating back several thousand years BC. Miniature models of ancient dwellings found near me town of Rouse show. revealed the world’s oldest horde of gold (dating back to 4600-4200 BC) . 1973). Figure 1: Objects of pure gold discovered in the Varna necropolis.. The excavation of the Varna Necropolis from 1972 /Picture 1/. In: Pötzsch.the work of exceptionally skilful preThracian craftsmen and reflecting a high standard of social and economic development (Venedikov et al. Thracian culture flourished particularly strongly between the 6th and the 4th century BC in the state of Odrysae. Slavs and Proto-Bulgarians. TO 1878/ ~ AN OUTLINE From: Zlatka Dimitrova. Ancient Bulgarian medicine was shaped primarily by the practices of the three tribal communities who formed the basis of the Bulgarian nation: the Thracians. Varna. Basel: Editiones Roche. the existence of waste pits (the first evidence we have of sanitation in neolithic times). The Pharmacy ~ Windows on History. as well as entire regions of Asia Minor. for instance. Historical Museum. Thracian medicine The Thracians. 1996.PART I: ANCIENT AND MEDIEVAL EVIDENCES FOR MEDICINE ON THE BULGARIAN LAND /FROM 100 000 B. The Heirs of Orpheus: Bulgarian Medicine and Pharmacy over the Centuries. the Aegean and the River Strouma. whose rulers built citadels and towns. the Sea of Marmora. the Black Sea.

Fillicis maris). goddesses and demi-gods constituted the Thracian pantheon. on a fifty-hectare site not far from the present-day city of Kazanlak. Heros the healer was depicted as a hunter slaying a wild boar. possessing the power to bring happiness not only to people on earth but also to those in the afterlife. Gods. Celts and Scythians. which symbolized disease and all things fatal to man. would gather the people together in the town squares and teach them rules of hygiene which these would then have to repeat in chorus. His followers believed him to be omnipotent. 1985). in their capacity as physicians. Thracian nobles were free from intestinal worms because. besides knowing how to treat these parasites with male fern roots (Rh. Seuthopolis had a water-supply and sewage network. Seuthopolis. they had such high levels of personal hygiene (Miteva. which survived until the 2nd century BC. . Seuthes III. The priests. Extant votive tablets refer to him as ‘the great and benevolent Heros’ and ‘the patron saint of mining’. the ruler of the state of Odrysae. Figure 2: Sculpture portraying the Thracian horseman. the Thracians had the technical knowledge to build the public sanitation facilities typical of the period. The sewers ran outside the city walls where the sewage was deposited in the River Toundja. Heros (the Thracian Horseman) was the Thracian god most commonly cited as being the god of life. Found at Glava Panega Thracian civilization owes its distinctive nature to the great structural diversity of its society and beliefs and to its relations with the four major civilizations of the time: the Persians.minted coins and constructed palaces and monumental burial mounds. and wastewater was drained from the houses through clay pipes which were connected up to the central sewage system. which encircled the city on three sides. The Thracians were renowned for their progressive views on hygiene. The Celtic and Roman invasions of the 4th to the 1st century BC and the devastating epidemics of plague and other infectious diseases which periodically swept through the country (such as the pandemic plague of the 5th century BC or those of the 1st and 2nd centuries AD) led to a general decline in Thracian civilization. built his capital. death. As excavations at Seuthopolis show. According to some authors. hunting and fertility /Picture 2/. At the end of the 4th century BC. Heros the horseman ‘protected’ people from sickness and evil. Greeks. Freshwater was drawn from wells. all of whom had some bearing on the nation’s health.

The Thracian healer Orpheus, who most probably lived during the 6th century BC, was another popular figure. Said to be descended from the tribe of the Cicones, there is disagreement among historians whether he was a real historical figure or simply a myth. He was celebrated as a great singer, musician, tsar, god, physician, pharmacist and philosopher. On vases, coins and sundials from the Classical and Hellenistic period, he is often depicted playing a lyre, surrounded by Thracians or wild animals tamed by the magical powers of his music. It was Orpheus who first suggested using music as a healing aid. He employed a variety of techniques involving music, songs and fables, and left a legacy of tablets inscribed with remedies for numerous illnesses. Figure 3: Orpheus making music, surrounded by Thracians wearing coloured hooded capes and leather hats. Red-figured Attic crater, second half of 5th century BC. Antiquities Collection, State Museums, Berlin. Orpheus was famous for his herbal remedies. He was associated in particular with Heberlia Rhodopensis, ‘Orpheus’ flower’ or silivraka, perhaps mainly because it was found in the Rhodopes Mountains from which he is said to have originated. This plant is anabiotic, meaning that dried samples can be preserved for up to eighteen months and then brought back to life by being planted in the right environment. In most European countries, Orpheus is considered to be the patron saint of pharmacy (Dimitrova, 1990). Orpheus was the founder of the philosophy later named after him, Orphism /Picture 3/. He was considered responsible for the Thracian and Ancient Greek theories of the origin of the universe and the origins of man. His philosophy was linked to the belief that the soul is immortal, and promoted a simple lifestyle close to nature. His acts of healing are reported in the writings of many ancient authors. According to Pausanias, ‘Orpheus surpassed everybody and possessed great powers since he was able to discover the secrets of the gods and produce remedies for illnesses which preserved one from their wrath’ (Vasilev, 1975). Orpheus’ contemporary, the physician, priest and demi-god Zalmoxis, was an important figure in Thracian spiritual life. Before being endowed with divine powers, he had been the leader and priest of the Thracian Geti tribe who inhabited both banks of the Danube delta. Herodotus (5th century BC), the earliest writer to mention Zalmoxis, relates the story of Zalmoxis’ resurrection, when he returns from the afterlife to teach the Thracians about the immortality of the soul. This clearly identifies him as a follower of Orpheus. We can also deduce something of Zalmoxis’ beliefs from the following extract from the Charmides dialogue of Plato (427—347 BC): ‘Well, that’s how matters stand,

Charmides. They use recitation. I discovered this from a Thracian physician during manoeuvres, who was taught by Zalmoxis, and who, presumably, believes in the immortality of the soul. This Thracian said that the Greeks had a right to talk about what I’ve just told you. He also said that their king, Zalmoxis, himself a god, maintains that, just as one would not cure the eyes without curing the body, one should not cure the body without curing the soul. Apparently the reason why the Greeks have so much difficulty treating so many illnesses is that they do not treat the body as a whole. They fail to recognize that the health of one part of the body depends on the health of the other parts. The soul, he continued, is the font from which all the good and evil present in the body, and in the person as a whole, flow. The head performs a similar function for the eyes. So it is of paramount importance that we treat the soul first, in order that the head and the other parts of the body should be healthy. The way to treat the soul, my dear, is by recitation, by reciting good advice. The soul learns wisdom from this advice. Once the soul has accepted this wisdom, it is easy to treat the head and the remainder of the body.’ Zalmoxis is shown here as the founder of a school of thought that embraces both man and nature. Its very essence was the Orphic concept of the afterlife and the belief that body and soul formed an integral whole as did all of man’s individual functions. It is clear from the Charmides dialogue that the Thracian followers of Zalmoxis were critical of the Greeks, who did not accept the idea of the body as a unified whole in which ‘the health of one part depends on the health of the other parts’. Later on, Hippocrates (460—377 BC), the Father of Medicine, was to see nature as a united and indivisible whole, and man as a harmonious unity of physical and spiritual functions. Herbal remedies were common in Thracian medicine. Theophrastus of Eresus (3rd century BC) notes that the Thracians used wormwood (Artemisia absinthium), hellebore (Veratrum album), bindweed (Convolvulus arvensis), elder (Sambucus nigra) to stop bleeding, wild thyme (Thymus serpillum) and other herbal remedies. In his treatise entitled De Materia Medica, the Roman physician Pedanius Dioscorides (1st century AD) refers to the use of greater celandine (Chelidonium majus), male fern (Dryopteris filixmas), colt’s foot (Tussilago farfara), blackberry (Rubus fructicosus), creeping tormentil (Potentillla erecta) and other medicinal plants by the Thracians. The Thracians also used remedies containing calamine (zinc oxide), alum and other mineral extracts. The remedies of Dioscorides were used widely by Galen (129—200 AD) and even by Avicenna (979—1037 AD) and other medieval physicians. Yoghurt was used by the Thracians to treat burns, scalds and other wounds, and later came to be known as the ‘Thracian elixir’. It was used by the women of the tribe of the Cicones for cosmetic purposes.

Figure 4: Votive tablet depicting the gods of medicine, first half of 3rd century. National Archeological Museum, Sofia. Under Roman rule, interest in the cult of Aesculapius grew significantly in Thracian civilization. Aesculapius was the god of medicine and, in typical Thracian fashion, was usually depicted as a horseman with the face of a young man and a head of curly hair. At Glava Panega, we also find Aesculapius portrayed in typical Greek fashion /Picture 4/. He has a mantle thrown over him and is holding an egg in his hand with a snake entwined around his staff. On his left, his daughter Hygieia is depicted as a symbol of the sick person’s soul being nourished with health-giving juices, and on his right is Telesphorus, the god of children’s health. The origin of the cult of Aesculapius is disputed. Those who claim it is of Thracian origin point to the fact that Aesculapius is often depicted with Bendida, the Thracian goddess of hunting. In addition, his name and that of his daughter Panacea are Thracian, and his cult enjoyed exceptional popularity in areas considered to be Thracian. Most of the sanctuaries dedicated to him have been found in areas of present-day Bulgaria which were formerly populated by the Thracians. Those who attribute a Greek origin to the cult point out that there is no written or epigraphic evidence on any statue or relief which directly or indirectly refers to the Thracian origins of Aesculapius or Panacea. The numerous sanctuaries which appeared at the beginning of the 1st century AD bear witness to the widespread popularity of the Aesculapius cult. They were situated near the mineral springs of all the larger towns and villages and served as public health centres. The earliest reference to mineral water being used in the treatment of skin complaints is found in Herodotus’ description of the military manoeuvres of Darius I in Thracian lands during the 5th century BC. The use of mineral waters and other natural forms of therapy from Thracian times such as herbal remedies, music therapy and ‘good advice’ is as much a feature of Bulgarian medicine today as it was in the past. Votive tablets dedicated to Aesculapius were donated by people who had been cured by such treatment. One such tablet was found during excavations at the village of Batkoun in the Pazardjik region (the original and a copy are now on display in Plovdiv’s Archeological Museum and Pharmacy Museum respectively). One of the largest tablets of its kind from that period depicts Aesculapius and Hygieia with the Thracian horseman, testifying to the link between Thracian, Greek and Roman mythology /Picture 5/.

But by 46 BC. for instance) sprang up amongst the Greeks very early on. Certain religious cults of Thracian origin (the cult of Bacchus. During excavations at Bansko in 1970. Hygieia and the Thracian horseman found at Batkun. At excavations near the village of Lyublen. twenty mineral-based tablets of varying colour. the Greeks had established small towns and colonies on the Black Sea coast. Odessos (Varna). The original is in the Archeological Museum at Plovdiv and a copy is on display in the Pharmacy Museum. but also by the sick from the shores of the Aegean. Greece and Rome is of great historical interest. Plovdiv.A frieze of the health-bearing Thracian deities was discovered during excavations at Plovdiv in 1921. the god of children’s health. including Aesculapius. They built new towns and improved the sanitation of the old ones. silver and silverplated bronze dosage spoons and a silver-plated set of six surgical instruments with elaborately worked silver handles. The frieze is one of the most important finds from Thrace during the Roman period (the first half of the 3rd century AD) It depicts eight figures. and Telesphorus. Advances in almost all branches of medicine were achieved during the first four centuries AD. his daughters Hygieia and Panacea. Appolonia Pontica (Sozopol). This cult had a great impact on the way ancient civilization developed and on Ionian philosophical thinking in particular. which were used not only by the Imperial families. 1974). The cult of Orpheus was the ideology which the poverty-stricken peasants and slaves of the 6th century BC embraced. Asia Minor and Egypt. This physician had probably been a priest from the nearby sanctuary of the Thracian horseman. Pharmacy Museum. e. Mesembria (Nesebur). there is no doubt that Greek and Roman medical and pharmaceutical practice had an important impact on those lands that were later to become known as Bulgaria.g. who introduced high standards of sanitation. Figure 5: Relief depicting Aesculapius. shape and size (up to 11 mm) and a boot which had probably contained fragrant oils (Apostolov et al. In return. As far back as the 7th century BC. The Thracians participated in the birth of Greek civilization and their influence was strongly felt in early Greek history. Anchialos (Pomorie). . The relationship which existed between Ancient Thrace. They constructed baths and reservoirs near the mineral springs. a large number of surgical instruments were discovered in the grave of a physician from the Roman period. a medicine box with a bronze spoon. The grave also contained two bronze vessels. the burial tomb of an eminent Thracian physician of the Roman period yielded such finds as medicine bottles. the god of medicine. Dionysopolis (Balchik) and Bizone (Kavarna). the Balkan Peninsula was under the complete control of the Romans..

When this disintegrated. it only really got under way in the third and fourth centuries after the Celtic and Hun invasions. but slowly the belief in one supreme god. Slavic medicine Though migration of the Slavs began in the 2nd century AD. The beautiful Pirin mountain is named after this god and is considered to have been his main sanctuary. lived in the Caucasian Mountains. the Proto-Bulgarians were drawn into the Hun tribal union. This is considered to be the starting point of the Bulgarian state /Picture 6/. The unsuccessful attempts of the Byzantine Emperor Constantine IV Pogonatus (652-685) to quell the incursions by Asparukh’s ProtoBulgarians forced him to make peace with them in 681 and officially recognize Bulgar control of the area. sycamore and pine. Thessaly and Epirus. During the period known as the great migration of peoples. They coated the tips of their arrows with hellebore (Veratrum album). willow. the Onogurs. and ivy to cure vomiting. some treatments involved the use of plant remedies such as birch. the god of lightning. Proto-Bulgarian medicine The Proto-Bulgarians belong to the Turkic linguistic and ethnic community. the chieftain Khan Koubrat formed the Proto-Bulgarian tribal confederation on what is now southern Russia and was called Great Bulgaria by Byzantine writers. from the fourth century onwards. they established themselves on the lands between the Danube and the Dniester rivers.After the fall of the Roman Empire (378 AD). the confederation was invaded by the Khazars and then broke up. they migrated towards Europe in the second century and. From the mid-sixth century on. Nevertheless. who moved West to the Danube delta. began to gain ground. Slavic religion was polytheistic. Incursions by the southern Slavonic group into Byzantium began at the end of the fifth century when they attacked the provinces south of the Danube and reached the Peloponnese peninsula. lime. Perun. Originally from Central Asia. Perceptions of health and sickness in the medicine of these Slavic peoples contained elements of magic. Asparukh (641-700). . At the end of the sixth century. they settled permanently in these regions and mixed with the local Thracian population. used hemp and poppy for anesthetics. these lands which were later to constitute Bulgaria became part of Byzantium. one of Koubrat’s sons. became ruler of one of the Proto-Bulgarian tribes. After Koubrat’s death in 651.

The healing power of these stones is due to their content of iron and alum. testifying to the Proto-Bulgarians’ high standards of public and personal hygiene. stones and other objects in esteem. . shells) were gradually replaced by a more sophisticated technique which involved grinding and scorching the cranial bone. This practice was known as moxa. up to the end of the last century and possibly even later. Of particular interest in Proto-Bulgarian medicine are the (real and symbolic) trepanations which were performed (Boev. fat or other such substance. we must bear in mind that stone worship was also prevalent amongst certain Turkic tribes.. The Proto-Bulgarians believed in just one god. believing them to have magical powers. were used in Bulgarian folk medicine to treat the frail and the bewitched. This short extract clearly shows that the Proto-Bulgarians bathed frequently and that they could not accept the Greek priests’ recommendation not to bathe on Wednesdays or Fridays.Figure 6: Relief depicting a victorious Bulgarian soldier on the medallion of an 11th century gold ewer from the treasure of Nagi St. In times of war. mixed with water or wine. . Madara and Preslav and in the palace of Khan Omourtag (died 831). the actual questions have been lost). Miklosh in Rumania. Pope Nicholas I’s sixth answer states. Tangra (from the Turkic word tangri meaning sky). crushed red stones (Argilla rubra). they also held water. were found at Pliska. From the time of the first Bulgarian state. Vienna. antlers. the book containing the answers of Pope Nicholas I (800-867) to the 118 questions set by Boris I in 862 has been preserved (unfortunately. ‘. However. 1964). with air-heating and complex sewage and drainage systems. The ground was also doused with water after sacrificial ceremonies had taken place. which have antiinflammatory properties. When examining papal answer 62. regarding the cult worship of a certain healing stone. The Proto-Bulgarians believed in the prophylactic and purgative power of water and erected buildings to accommodate baths. You mention later that the Greeks say you must not bathe on Wednesdays and Fridays’. Open-air pools and baths. and was performed using wool dipped in hot tallow. The rough-and-ready implements used in trepanation (flints. where the soldiers were sprinkled with water before going into battle. baths made out of leather were set up in special military bathing tents. Historical Museum. Interestingly enough.

which could be construed as herbal . his knowledge of medicine was wide-ranging. He was the first to translate the concept of pharmaceuticals into Bulgarian. Though John the Exarch did not think of himself as a physician. Shestodnev (The Six’ Days of Creation) (John Exarch. the Great (863-927).Many of the healing practices of the Proto-Bulgarians were assimilated into the folk medicine of the Slav. the first translation of the Bible into French did not appear until the 13th century and ecclesiastical writings in English only in the 15th century. a privilege not granted to any other European language. Knyaz Boris I. knowledge of the natural sciences and medicine in Bulgaria was comparable with that in Byzantium. referring to ‘root phenomena’. By way of comparison. The Bulgarian language was also used along with Greek. which already drew upon a wide variety of Thracian and Slav medical practices. where theology and science were taught in Bulgarian /Picture 7/.Bulgarian state. with help from disciples of St Cyril and St Methodius and from St Naum and St Clement. Clement of Ohrid. the 9th and 10th century scholastic writings of the Germans. 1981). French and Italians were purely religious in nature. was the first medieval Bulgarian textbook on the natural sciences and contains interesting descriptions of the human body /Picture 8/. Cyril and Methodius Nation Library. established the universities of Preslav and Ohrid. At the end of the 9th and the beginning of the 10th century. The natural-history and medical writings of Bulgarian scholars such as John the Exarch. a great scholar from the Golden Age of Bulgarian literature. Sofia. was one of the most influential people in medieval literature and natural science. Hebrew and Latin in the churches of the time. it was not written in any of these languages. In comparison. Figure 7: Synodicon issued by King Boris I. Though medical texts of the time were usually in Latin. His second work. Chernorizets the Hrabur circulated throughout all the Slavonic countries. Bulgarian medicine in the Middle Ages The Middle Ages represent the period from the creation of the first Bulgarian state in 681 to its subjugation under the Ottoman yoke in 1396. The adoption of Christianity in 865 and the spread of the Slavonic alphabet in the 9th and 10th centuries allowed Bulgaria to establish its authority as one of the most culturally advanced states. John the Exarch (who lived some time during the 8th and 9th centuries). Hebrew or Greek. written especially for Tsar Simeon I. Kievan Russia and Western Europe.

the most renowned medical centre of the day was that established by Clement of Ohrid (840-916) at the monaster. After Bulgaria’s conversion to Christianity in 865. ‘Nothing which is created exists in vain. or through diet or psychotherapy. in Ohrid. such as dipping people into cold water or locking them in the monastery cellars..). were excellent herbalists and psychotherapists. In the second half of the 9th century. fruit. National Museum of History. ‘Pomegranates are sour and almonds bitter. Bogomil writings and practices of the time give us an .’ John the Exarch also had a thorough grasp of the methods used to modify the active ingredients present in medicinal plants. Figure 8: Cover page of the Shestodnev of John the Exarch. These plants can also be of benefit to us.’ (John Exarch. particularly mental illness. 13th century manuscript. healing with consecrated food (bread. These highly humane heretics. he developed a philosophical theory of the origin of life. its poison does not harm them. poisoning. etc. 1981). wine. septic wounds and nosebleeds with herbs or honey. Using medicinal plants as examples.. herbal remedies. To make them sweet. a farmer car pierce the tree trunk at the roots and drive in a tarred pine wedge. Hellebore relieves long-drawn-out suffering. sermons and confession. Others use hemlock to control and quell their passions and desires. because of their body structure. Ivan Rilski (880—946) of the Rila Monastery became widely known for his treatment of various illnesses. Moscow. healing by the use of holy relics. In the early 10th century. Quails feed off hellebore but their organism is such that they are not harmed by its poison. stress or shock therapy. treatment with water from sacred springs. which did not charge for its services. ecclesiastical and monastic medicine evolved on the basis of the following therapeutic practices: oral stimulation through the use of prayers.remedies. written in the 10th or 11th century It contains instructions on how to cure such conditions as eye and skin complaints... who shook the foundations of the feudal system in Europe. music therapy. Hospitals were later established at the Bachkovski. It was here that the eminent medieval physician and Bogomil leader Vasilii Vrach (1028-1111) received his medical training. Troyanski and Bitolski monasteries. stomach-ache. One exceptionally valuable source of medical information is the Bogomil tract entitled Zeleinik. A plant is either there to feed the cattle or it is there to alleviate our lives and help cure the sick. Opium soothes and alleviates strong pain. Crickets eat hemlock but. The distinctive nature of medieval Bulgarian medicine was strengthened by the emergence of the Bogomils (a dualist religious sect) during the reign of Tsar Peter (died 970).

wrote.’ (English Travel Notes. while others were killed. 1970). From 1396 onwards. excessive taxes and frequent wars were all determining factors in the poor standard of hygiene existing amongst the people. The close link existing between historical and medical developments was severed when Bulgaria came under Turkish domination. our route took us through hilly and forested localities. Bulgarian medicine under Ottoman rule (14th-19th century) The Ottoman invaders established a feudal system of government by spahi (Turkish warriors) and curtailed the intellectual and spiritual development of the Bulgarian people. Acording to a French diplomat. his knowledge of theology.possibly including Hodja Bulgar (died 964). ‘The area around Silistra is covered in freshly dug graves. philosophy and medicine and his eloquence and progressive ideas made him a threat to the Byzantine authorities. ‘From Varna to Rouschouk. Squalid living conditions. and one’s imagination conjures up a picture of death itself. Persecution forced several Bogomil activists . malaria and plague. We passed the occasional squalid and solitary hut whose inhabitants nevertheless. 1981). looked quite healthy and strong. the economic. baths and ointments (Ivanov.. spiritual and intellectual life of the Bulgarian people that had evolved over centuries was ruthlessly suppressed. France and other countries. The travel reports of Europeans who visited Bulgaria during the period known as the ‘Turkish yoke’ are a valuable source of information regarding Bulgarian medicine. 1987).insight into the use of different types of therapy such as infusions. Some educated Bulgarians adapted to the Turkish way of life. who came to be known throughout Afghanistan and Northern India . They often present a picture of a depopulated country. The Emperor Alexius I Comnenus (1048-1118) waged a successful campaign against the Bogomils aimed at liquidating its leader. especially in Northern Italy and Southern France. Through the Bogomil movement and doctrine. philosophical and social thought.to seek sanctuary in the East. Vasilii Vrach was burnt at the stake in Constantinople in 1111. suppression of the rights of the rayah (non-Muslim subjects). or driven to exile in Italy. on the eastern shore of the Danube. There were devastating epidemics of smallpox. Bogomilism came to be widely accepted throughout the Balkan Peninsula and its influence was strongly felt in Western Europe. They look empty and mournful. The wide popularity enjoyed by Vasilii Vrach. . Bulgaria undoubtedly made a significant contribution to the development of medieval religious. He had become the driving force and intellectual leader of the Bogomil Movement after the death of Father Bogomil in the early 12th century. surrounded by dead bodies and dying people with the poisons of the infectious plague spewing out of their repulsive mouths’ (French Travel Notes. A doctor at the British Military Mission in the Ottoman Empire..

Pierre Belon. Here. they used herbal remedies made from the medicinal plants which flourished in such abundance in Bulgaria. Egypt and Syria are Jewish. doctor and traveler. No traveler can survive long in Turkey. This is due to the fact that the country has no public sanitation system. introducing Western medical ideas and Arab and Jewish medicine into the Balkans and Bulgaria.No Bulgarian physicians or pharmacists were trained during this period of political and social oppression.’ (French Travel Notes. The pharmacists and chemists selling medicines in the Turkish towns are also Jewish.. Another traveler produced a list of medicines Europeans needed to carry with them when in Bulgaria ‘Wine vinegar to stop vomiting. Jewish doctors driven out of Spain in 1492 and Portuguese Jews expelled from Portugal in 1496 came to Turkey.. a relatively large town. as elsewhere... quinine sulphate for fever. 1981). elder for high temperatures. mallow as an emollient. cantharides beetles for blisters. When a doctor writes a prescription. and the healthcare situation amongst the Bulgarian population was correspondingly deplorable. elderly Armenian who was taken to see the doctor in Dobrich. During our travels. More often than not... The rayah were cared for mostly by folk healers who preserved and fostered the popular traditions of medicine. camphor or opodeldoc for massaging rheumatic pains. 1975).. lime blossom and camomile. ‘The doctor prescribed him medicines but the interpreter could not explain the prescription to the old man and the town had no pharmacist to whom he could go for help. without falling ill.. we were constantly having to resort to our medical supplies. however. gentian for the stomach. or they die. that even there had been a pharmacist. he sends it to the pharmacist to get the medicine he wants /Picture 9/.. 1981). On our last trip.. Yosip Boshkovich recounts the tale of a sick. rhubarb because of its laxative and fortifying properties.. Figure 9: The Hippocrates Pharmacy on Maxim-Gorki Street in Plovdiv. the only alternative for the sick seems to be that they either get better and live a while longer. About the area around the town of Shoumen. large numbers of people from .’ (Boshkovich. We were told. we came across so many people who were ill with fever that we had to replenish our stocks of quinine and other medicines’ (French Travel Notes.. he would not have been capable of understanding the prescription. ‘Most of the doctors practicing in Turkey... mercuric chloride (a strong purgative) . wrote extensively about the medicines and different types of medicinal plants found in Turkey. laxative salts. Pharmacists as we know them do not exist. The French naturalist. one traveller wrote: ‘Every year.

including Greeks. ahtari (druggists) and spitseri (unqualified pharmacists who had learnt their trade from a doctor who owned a pharmacy). we met a Dalmatian doctor. Contemporary publications reveal that the ahtarnitsi sold raw medicinal ingredients. herbs. Dr Petrovich. Armenians.and mineral-based healing potions and other items. . The ahtarnitsa of the Hippocrates Pharmacy Museum has many healthcare items of the period on display.Hadrianople (Edirne) come to this area to gather the seeds and seedlings they need for their medicines’ (English Travel Notes.’ Evliya Chelebi. ‘An amount equivalent to the size of two chick-peas. tea. who had settled and married in Melnik. It was found in the River Moushtanlii. Jews. among others. Italians. French. vitually no healthcare or sanitation existed in Bulgaria. 1972). cups. surgical instruments. According to the Turkish traveler Evliya Chelebi. thus making this prototype chemist’s shop sound very much like a general store. Bulgarian alum was very beneficial. animal. the word ahtarnitsa is defined as a place which sold herbal remedies. In the dictionary compiled by Naiden Gerov (1823-1900). 1981). Turks. came to Bulgaria. He was a practicing physician but was also involved in the sale of leeches and cotton-wool. Austrians. is sufficient to stop even the most acute diarrhea immediately. ‘In Iskoub. djerahi (surgeons). however. taken on an empty stomach. Unfortunately. qualified doctors of all nationalities. However. poorly paid. alum causes heart complaints. Medicine during the Bulgarian National Revival (1796—1877) During the period known as the National Revival. sugar. They were. During the first four centuries of Ottoman rule. bileri (Greek healers). amongst them hekimi (selfproclaimed doctors). coffee. Germans. taken in excess. 1987). Russians and Serbians. pre-prepared medicines. plates and other items. mentions that Bulgaria’s numerous mineral springs were used in the treatment of certain illnesses (Chelebi. Ahtarnitsi still existed in Bulgaria after Turkish rule ended. The only medical assistance the Bulgarian population received was from folk healers and monks. The lack of doctors in 19th century Bulgaria prompted the emergence of a variety of self-proclaimed physicians. paint. circumstances in Turkey forced him to do this so that he would be able to leave his children some sort of inheritance’ (French Travel Notes.

The first medical school in the Balkan Peninsula was established in Athens in 1829. Pavlov’s surgery was supplied with medicines by the local pharmacy. Graduates from the pharmaceutical faculty of Tsarigrad medical school were referred to as spitseri (spicers). not including those attached to the Turkish military hospitals. the Sultan’s Council of Physicians issued a decree stating that the title spitseri could only be used by suitably qualified persons. In 1865. All unqualified spitseri who wished to continue practicing had to pass the necessary examinations. in the town of Veliko Tarnovo. Different filters were used depending on the purity of the drug.Bulgarian doctors were first mentioned in the early 19th century. . Marko Pavlov (17841864) was the first trained Bulgarian doctor He qualified in Paris in 1811 and opened the first doctor’s surgery in Bulgaria in 1823. that of Dr Rashko Petrov. The first spitseriya in Bulgaria was opened by Mavrodiya Kourtev in Sliven in the 1820s. The first such pharmacy was opened in 1876 in Rouse. These were copied over and over again and handed down from generation to generation. By the time Bulgaria had been liberated. Even towards the end of the 19th century the services of the folk healers Hadji Evtimii (1800-1880). Figure 10: Instruments used at the Hippocrates Pharmacy for making medicines. Over twenty manuscripts of collections of remedies have survived for scholars to study. one of them. alongside the private pharmacies run by doctors and spitseri. which was used for herbal infusions. now houses the Hippocrates Pharmacy Museum in Plovdiv /Picture 10/. there were 32 in all. The second group of pharmacies were run by pharmacists who had qualified abroad. Folk medicine continued to play a very important role in the lives of the vast majority of the population. the abbot of Glyuzhenski Monastery. Pharmacies gradually spread throughout the country. and their number gradually increased. The first pharmacies were run by qualified doctors. and only these people could run a spitseriya. and Father Matei Preobrazhenski (1825-1875) were still much sought after. Public pharmacies whose main purpose was to supply the poor with free medicines also began to appear. Dr Pavlov’s surgery is now a working museum which sells medicines to the public. The oldest exhibit on display is an earthenware filter made in Manchester in 1830.

Elena of Savoy. he successfully used a solution extracted from the roots of deadly nightshade (Atropa belladonna) in the treatment of Parkinson’s disease. democratic ideas of popular Russian medicine. Public health services were established and the first municipal hospitals and private and public pharmacies opened. Figure 11: Workshop of the Hippocrates Pharmacy. Dr Ivan Bogorov. Dr Nikola Pikolo and Dr Vasil Beron) who not only contributed to literature but were also involved in the struggle for an independent Church. Spas lvanov. Dr Kiro Popov. Ivan Raev is still remembered with respect and his treatment is accepted throughout the world. The folk healer Ivan Raev (1876-1938) achieved wide international acclaim. and fighting for their liberation.also involved in revolutionary activities /Picture 11/. During the National Revival period. In 1922. There seems to have been a very fine divide between the humane act of caring for the health of the people. Bulgaria’s first group of doctors were also eminent writers (Dr Petar Beron. Vasil Petleshev and others were hanged by the Turks for their part in the April Uprising. . pharmacists and spitseri were . Though new and more effective drugs are now available for the treatment of Parkinson’s disease. As the 19th century progressed. moreover. The Russo-Turkish War of Liberation (1877-1878) put an end to almost five hundred years of Ottoman rule and left Bulgarian medicine with a great deal of catching up to do. was later turned into an educational institute bearing his name. where Raev’s drug was clinically tested. Subsequent healthcare developments in the liberated Bulgaria of the late 19th century were influenced not only by the country’s own revolutionary and democratic traditions but also by the progressive. Dr Vasil Sokolski.Many of Bulgaria’s first healers and pharmacists were also actively involved in the struggle to liberate the people from spiritual and political oppression.besides being writers . The clinic set up in Rome by the Italian queen. Dr Ivan Seliminski. The second group of Bulgarian doctors. The first sanitation laws were passed in an attempt to combat epidemics and establish sanitary control and quarantine. In the background. This treatment was later accepted by the medical establishment and is referred to as the Cura Bulgara. healthcare in the Ottoman-dominated lands gradually improved. the herb mill for grinding medicinal plants.

1970. Vasilev V: Ancient Thracian Medicine. 5. p 104. Bulgarian Academy of Sciences. 1970. vols 9-10. Kitanov C: The Bulgarian Treatment of Parkinsonism. Venedikov I. Sofia: 1974. 12. 7. 13. 14. pp 387-388. Veliko Tarnovo. pp 155-156. 185. vol 5. 248. English Travel Notes in the Balkans (14th Century to 1930). 1973. pp 106. Gerasimov T: Thracian Art. Sofia: Naouka i Izkoustvo. vol 7. Sofia: Naouka i Izkoustvo. pp 16-18. Atanasova S: A Study of the Composition of Medicines found in Roman Tomb near Bansko. 16. Sofia: Otechestven Front. 1. 3. Ivanov I: Bogomil Books and Legends. 8. Dernschwam H: The Diary of Hans Dernschwam on his Journey to Tsarigrad during 1553-1555. 187. 6. Bulgarian Academy of Sciences.References Note: Most of the following publications are Bulgarian originals. p 407. 11. pp 24. II National Congress on the History of Medicine. 2. p 23 Sofia: Priroda i Znanie Magazine. p 92 (Russian original). Sofia: Meditsina i Fizkoultura. Sofia: Meditsina i Fizkoultura. . Sofia: Naouka i Izkoustvo. Chelebi E: Travel Notes. 1972. 28-29. 482. 1987. Sofia: Bulgarski Houdozhnik. Sofia: Meditsina i Fizkoultura. 1981. Dimitrova Z: Introduction to the Subject. Boev P: Symbolic Trepanation in Bulgaria. The titles are translated here for information purposes. Apostolov M. 48. pp 55-56. Sofia: Otechestven Front. 10. 1981. French Travel Notes in the Balkans (l5th-l8th Century) vol 4. p 57. 15. Sofia: Naouka i Izkoustvo. Rogev B: The Astronomical Basis of the Proto-Bulgarian System of Chronology. John the Exarch: Shestodnev Sofia: Naouka i Izkoustvo. 1986. 1982. 341. 1974. 1964. 1975 4. 1975. 337. 644. 1990. Boshkovich R: Diary of a Journey. 271-272. Plato: Charmides (Ancient Greek original). Aesculapius (Russian original). 1-4 November 1985. 287. 253. Sofia: Naouka i Izkoustvo. 9. News Bulletin. Miteva N: Thracian Beliefs and their Connection with Medicine.

Dr. Nacho Planinski 1847-1895 20. Dr. Kirko Kirkovich 1840-1877 15. Georgi Vulkovich 1833-1893 11. Dimitar Mollov 1845-1914 14. Ivan Bogorov 1820-1892 7. Dr. Christo Stambolsky 1843-1932 10. Petar Protich 1822-1881 19. Nicola Piccolo 1792-1865 4. Dr. Dr. Petar Beron 1800-1871 2. Dr. Atanas Granitski 1825-1879 16. Atanas Bogoridi 1788-1826 5. Dr. Dr. Stoyan Chomakov 1819-1893 9. Mr. Dr. Dr. Dr. Mr. Zahary Knyazeski 1810-1877 13. Dr.PART II: LIST OF BULGARIAN MEDICAL MAN 1. Vasil Beron 1824-1909 8. Zachari Strumski 1820-1869 17. Dr. Dr. Dr. Dr. Dimitar Nachev 1850-1903 . Georgi Atanasovich 1821-1892 18. Marko Pavlov 1786-1864 6. Sava Dobroplodni 1820-1894 12. Dr. Ivan Seliminsky 1799-1867 3. Dr.

On the session of the Royal Academy of Science in London. in a rich family of handcrafts and merchants. his doctoral dissertation and the “Fish Primer”. Sir John Lee presents his work “On the system of atmospherology” and gives tribute to Beron’s activity. Beron enrolls as a student in Heidelberg University where he proceeds philosophy until two years later when he transfers to Munich to study medicine. There are certain facts. After fifteen years he makes a fortune and goes to Paris where he lives as a renter. a famous for his time pedagogist and encyclopedist. held on the 20 June 1850. has influenced a lot for the formation of Beron as scientist and philosopher. His encyclopedism is remarkable. In Kotel he receives his primary education at the cell school of Stoiko Vladislavov and Raino Popovich. BERON Petar Beron is born at 1800 in the town Kotel. In 1853 Dr. His scope is to entail all the human knowledge by that time and to make a naturphilosophical evaluation by creating a new “Panepisteme”.NATURPHILOSOPHY SYSTEM OF DR. In 1955 he publishes in German language his “Slavic philosophy” where an . The latter. where he compiles “The Fish Primer”. Dr. In 1825 P. Further he goes to Bucharest where he enters the school of Greek educator Konstantin Vardalach. Beron is invited by the Association of Natural Sciences in Athens where he reads an article “Earth before the Deluge”. because he participated in a “Greek plot”. and goes to Brashov. On the 9 July 1831 after successfully defending a doctoral dissertation Beron is promoted Doctor in Medicine. another Rumanian town. This book is fundamental for the Reformation in Bulgaria and an achievement for the young scholar. Here he starts a real scientific career. In 1824 he is compelled to leave Bucharest. one atlas. Beron was appreciated by his contemporary scientific community. P. “a miniature of Nuremberg”. Beron spoke nine languages and wrote about 30 volumes not regarding two dictionaries. Dissertation is in Latin and concerns a methodology of obstetrics and gynecology. which come to show that Dr. The young physician works in Bucharest and Kraiova but after several years of general practice he quits his job and starts merchandise.

a doctor remain in his heart a bulgarian and belonged to the Slavdom. So. existed many examples of early secular literature. the multivolume "Panepisteme" could stand hand in hand with Humboldt's "Cosmos". In 1858 is printed in French language “Origins of physical and natural sciences and of metaphysical and moral sciences”. The later high development of the Russian Empire and other eastern nationalities. It is not so. bulgarians keep a good tradition for this man. it is necessary to abridge all that stuff.outline of his Panepisteme is featured. how are we going to proceed with a critique on P. These are the principal ends of his theoretical and logical views. First. will be our man. However Beron sincerely believed in the independence of his philosophy Panepisteme. was preceded by the Golden Bulgarian Age. The maps in the atlas were designed by the famous bulgarian painter Nicolaus Pavlovich. This statement could not be disproved . But. Second. We put an emphasis on this because in Medieval Bulgaria .but. He has seriously and systematically studied western philosophy and culture. his literary heritage comprise more than 10 000 pages. it is still that we don't have this major opus in Bulgarian. Addendum: If we make an inquiry. about. He could have been another Alexander von Humboldt for the Slav Nations . looking here and there in the process of gathering materials for this review. to replace materialism and idealism with a third line in philosophy. Beron has spent certainly 25 years of his life in Paris and other European cities. No more comments./. Until the end of his life on 21 March 1871 he is devoted to this interesting and creative task. Even. While. there are several good monographs reviewing his outlooks . there. because.certainly. This. He witnessed the endeavors of classical positivism.that. his heart was sent back to a newly liberated Bulgaria. Dr. Today. But the height of his scientific endeavors is the “Panepisteme”. Next two years are devoted to a huge cosmographical atlas with text. that. consistently. of his "Fish Primer" allegedly. bulgarians are worldwide known as a nation not producing celebrities. One thing is sure. in 1978. the most infamous bulgarian . to be berried in his native town Kotel. because.First and Second Bulgarian Kingdoms .not only. The literature on that famous Renaissance man is vast. It is so. Petar Beron as a bulgarian. We wanted to make this extension on Petar Beron for several reasons. in seven volumes. We have been trying to view the question from many angles. if there are . Otherwise. remains in the shadows of the Byzantium Literature /Vth to XVth cc. The only scholar whom he accepts as authority is Aristotle. because. this embalmed heart could still be found in his House Museum in town. we turn on page after page of the life and works of a rare genius. however. the first bulgarian secular textbook /in modern times and in new bulgarian script !/. because. most obviously in his contemporary Auguste Comte. no one in Europe during the end of the XIXc. regarded Dr. which is published in French starting 1961. Beron's philosophy.there.

As time goes on and an open access to a "corpus habeum" will be available on that author for free access.but. Until then our project will keep in touch for any fresh assets on the topic! See for further details * . we believe that an interested reader will excuse our efforts. we don't have an idea on such works and don't have a necessary access. if there are living ancestors of the scholar . Thirdly.but. fortunately. In such case.other major works on that scholar in languages other than bulgarian . there is no evidence for such an archive existing and not yet.

The bulgarian colony there includes many compatriots and young Seliminsky aquainted with way of life. His inborn name is Yordan Georgiev Christov. As all bulgarian youths studying in Greek schools he changed his name to hide his origin. In 1825 Ivan Seliminsky returns in native city of Sliven. Thus in august 1814 Seliminsky departs for Jerusalem as a pilgrim. The Odrin peace agreement in 1829 and the retreat of Russian troops from Bulgaria makes the population from Northeastern parts of the country to flee away in Russia afraid . physics. mainly the men who took part in the insurrection. Members are common people from the class of “non-nobility. the torlaks”. His father was cattle merchant but was massacred by a turk one year after his son was born. IVAN SELIMINSKY Ivan Seliminsky is born on 24 december 1799 in Sliven.PHILOSOPHICAL AND SOCIOECONOMIC OUTLOOK OF DR. Ivan Seliminsky studied in Kidonia till the Greek uprising in 1821. At meetings of bulgarian colony Seliminsky explains that freedom of Bulgaria needs a national fraternity to unite all fighters and to apply in practice the act of liberty. Thus Seliminsky is chosen a leader of the emmigrees. socioeconomic and intellectual progress in western nations partakes actively with the life of the bulgarian settlement. In 1824 we see him in Brashov /Romania/. The turks started mass massacre of infidels. The objective conditions and spiritual freedom еxite the bulgarians in exile towards liberty of ideas and actions to improve the fate of their motherland. In 1812 his whole family perished from plague. geography and bulgarian language are studied. but also woman and children which were sold as slaves. Seliminsky organizes also the first bulgarian school where mathematics. On his return he stays in the city of Kidonia /Minor Asia/ where he enters the local high school sponsored for five years by Kazanluk merchant Christo hadji Petrov. There he finds a Secret Society. Seliminsky succeeded to escape and next three years /1821-1823/ enrolls as soldier and officer with the Greek army and takes part in many battles.

As an emigree in Romania Seliminsky reads Yury Venelin’s work “Ancient and contemporary bulgarians” where deeds of the ancestors are narrated. also the influence of the naturalists is great – Lamark. As a student in Kidonia and later in Athens Seliminsky studies the Greek philosophers – Socrates. Addendum: Let me say few words about the literary heritage of that man. Montesquieu. Dr.from the revenge of the turks. the epoch where Ivan Seliminsky lives and works is time of enlightenment and self-consciousness of the bulgarian people. So far. immaturity and hesitance of bulgarian bourgeoisie and poor scientific and ideological atmosphere are all reflected in the outlook of Dr. In his brochure “The national fraternity in Sliven and the great migration in 1830” Seliminsky outlines correctly the social stratification in bulgarian society. Seliminsky. A major influence over his views is brought by the French reformators and materialists from the XVIII century – Rousseau. Great influence has his acquaintance with the cultural advancement of western countries. In 1853 he leaves work to actively join the bulgarian volunteer battalion with which he serves in the Crimean war as battalion physician. the common people or “torlaks”. Condorcet etc. Those papers are written in greek language during 1855-57 and in a state of depression after the failure of the Crimean War. In his memoirs. The “greeks” are a caste totally favored by the greek clergy and turkish rulers and they play a role absolutely reactionary against the liberation of the country. The promoted doctor returns to Braila where he spent several years working as district physician. i. The moral and national character of the land is preserved pure among the natives of the population. Humboldt etc."Historical Recall". The most important part of his works are the memoirs . This book creates an urge to study history after 500 years of lethargy. He depicts the class of nobility. Democritus and cites them in his works.. Now from 1840 until 1844 Ivan Seliminsky studies medicine at Athens University. The overall public and historical backwardness. After graduating he transfers to Sienna in Italy where he specializes in the fields and receives the title Doctor in Medicine and Surgery. There he is honorably gifted and receives two silver medals from the Russian government. those bulgarians who call themselves “greeks” and on the other hand the class of non-nobility. Seliminsky narrates the fate of the bulgarian . Dr.e. with some intermissions. It is for them that the young bulgarian bourgeoisie is interested for national and political freedom. Aristotle. This is a time when industry and trade prosper in Bulgaria – the national bourgeoisie becomes the embodiment of the idea for democratic reform and for liberation of the masses. Helvetius. The leader of the refugees is Seliminsky. Plato. Ivan Seliminsky forms his naturalistic and social views amidst a community of economic progress in the first half of XIX century. The end of the war finds him in Bolgrad where he works as a district physician. to his death in 1867. He stays some time in Galatz then works as a teacher in Greek language at Bucharest and other places.

The memoirs are written in a lively manner. formally. blasphemy. "Religion. e. Greece. etc. "Origin of the religions". Aprilov.. Bolgrad /Bessarabia/ and other places. Social and Moral Laws". unfortunately. philosophical sciences. etc. southern Moldova and parts of Ukraine/. so far. Later. they were published in the form of XIV volumes in the period 1904-1931 . "Politics of Russia and the European Concert against Turkey with its enslaved nationalities" (1859). when. G. two books with materials from Dr. I. in the "Natural Development of the Man" (1843). he reflects on the idea of the human mind and the development of the brain according the natural and social conditions. So. with collaboration from Athens University. The rest of the work on the topic remains. Dr. somehow. Numerous are the secondary sources about Seliminsky. a bulgarian revival movement developed with differed social factors evolving in the enslaved bulgarian land. A. "Bulgarians and the Church Question" (1862). On the Bulgarian side remains his legacy. See for further details * . would appear to be appropriate for the format of this project. If an archive is available with his descendants. I. equalizingly. Some other essays are written with a popular inclination and in the natural. If something exist on the Greek side. handwritten testament carried on by his compatriots in Bessarabia /nowadays. Seliminsky write a number of studies on the topic of religion. has been available in its original form . in bulgarian language. During the period 1843-64.mainly. Priesthood and Church Problems". We engage in presenting to the reader and in a digestible form. with good historical accuracy and are a real relic of its time. i. e. Dr. mainly. we don't know them. e. P. in the Greek language. We could recommend 2-3 major monographs. This handwritten materials were transported. For instance. i. Zolotovich. "Main Economic. contain wealth of information collected from first hand witnesses in Sliven. journals and other printed matter. Another field of his works are the essays .. letters to and from V. Still important is the epistolary heritage. etc. we are not aware. to Bulgaria and donated to the Ministry of Education. Seliminsky's literary work comprised about 1000 written materials . Ivanov. Pazheva. "Bulgarians Attitude towards the Neighboring Christian Nations" (1856). "On the clergy and its origin". which. what. i.people after falling under Turkish bondage and by the middle of the XIX c.viz. let us recapitulate. allegedly. books.papers with a direct thematic narrative. Chilev and E. Seliminsky appeared. sacrilege and marriage. Still in the 70s of the past century. Nothing. His correspondence with different bulgarian activists from the revival period highlighted many a forgotten details.edited by P. Beron. "On Matrimony". ethical.

In an appeal to the American people for help in their struggle we see Piccolo's signature in a row with greek revolutionaries. Next we see him as a medicine graduate from Padua /Italy/ and in 1817 as a lecturer at the university of the Chios Isles. appoints him as inspector general of schools and hospitals /1929/. invites him for a track in philosophy at the University of Corfu Isles. He has definitive role in the formation of modern Greek literary history. among others. creates quarantine checkpoints on Danube’s harbors and engages in political activities. a helenophil and philologist. Piccolo never mastered the bulgarian language. It is a serious fact. Now in 1820 Piccolo immigrates to Paris where he meets Dr. Meanwhile the young scholar continues his work in literature and medicine.the Greek revolutionary organization for freedom of turkish yoke. He establishes modern tuition scheme. Piccolo resides in Paris. In 1823 Lord Guilford. Piccolo and Dr. He completes his secondary education in Bucharest with the school of Vardalach who becomes his intellectual father. He partakes in many political debates and campaigns. Corais. There he becomes active member of bulgarian emigrant community. A. Beron work out a special petition which demands autonomy of Bulgaria together with the other Balkan nations. At his new post in Bucharest Piccolo excels as talented administrator. Lissani & Co. After the liberation of Greece and the Odrins peace treaty Count Pavel Kisselov. that common truth at that times was the thesis of the Slavic origin of the greek people. Here studying medicine he also becomes a member of “Philiki eteria”. In 1811 Nicola takes the post of a teacher in French languages at Vardalach’s school. an eminent greek naturalist and philosopher. Dr. russian governor of the Danubian Principalities. and joins his group. As a man of letters Nicola Piccolo was a follower of a Cartesian philosophy. He is also one of the eminent figures of bulgarian national revival. Further he organizes sanitary affairs and hospitals. In 1839 Dr. rationalist and eclecticist. It is with Piccolo's intercession to Prince Stephan Begird that the idea of an autonomous principality of Bulgarians is created in Dobruja. substitutes Greek language for Rumanian and introduces studies of natural sciences. He also was an atheist which is evident from the fact that only 1500 golden francs from his testament were dedicated to the church. There Piccolo teaches till 1827 and among other activities translates in greek Decartes “Discourse on the method”. Nevertheless. NICOLA SAVA PICCOLO N. S. Among others “Demosten and Kalauria” had the greatest success. Piccolo is born in Veliko Turnovo from both parents bulgarians. a cholera epidemia hinders the project. On the next year Piccolo together with a group of greek rebels transfers to Odessa where G. however.THE HUMANITARIAN DR. During piece conference in Paris after the Crimean war. . had a small theater and there three of his plays are performed.

however. abstract vital force. In a while Bogoridi departs for Valachia. where he works for some time general practice but afterwards he moves to Vienna and still later to Paris with the intention to specialize in hospitals. a village in Turnovo region. water is a prime mechanism for existence of life and plants and animals are confined in a repeated metamorphosis of water. On this occasion his close friend Teoklit Farmanidis writes an obituary. Bogoridi is from a famous bulgarian renaissance family . He was an active contributor to the journal “Logios Hermes”. Further we see an acknowledgement for his work in the words of Bulgarian penman Grigor Purlichev when the latter polemizes with Greek professor Orfanidis in 1860.e. Germany to continue his studies. Greece. Moschopulos writes accordingly: We have to mark down that Atanas Bogoridi was one of the greatest bulgarian scholars and patriots from the beginning of XIX century. We see that the process of digestion is examined in details with good knowledge of the anatomy of abdomen and intestines. Bogoridi reveals 55 pages written in German alphabet. Another Greek scholar. the city of Yash. Then he tries to explain mechanism of digestion with chemical. He was born in Kotel about 1788 but settled in Arbanasi. . A closer look at the dissertation of A. mechanical and thermal factors. ATANAS TZONKOV BOGORIDI AND FIRST BULGARIAN DISSERTATION IN MEDICINE A. One way or another his discussion rests on mechanistic not idealistic concepts and correspond to the matter of science of the day. Next year the monograph is printed by Frans Ernst & Publishers. however. on 1 Mart 1826 Bogoridi dies after short illness in the prime of his life. with notes on his life and activities. In 1816 after a successful promotion he graduates with a doctoral dissertation “On the problems of digestion in human stomach”. At the same time he becomes active member of greek revolutionary movement “Philiki Eteria” and consequently the city council authorities expelled him from town and Bogoridi departs for Wьrzburg. enzymes/ he entails in different speculations on material substratum rather than some supreme. published in Vienna. not knowing its constituents /i. In 1811 he departs for Vienna to study medicine. namely: Bulgarian Atanas Bogoridi was the energetic apostle of “Eteria” during his stay in Vienna.DR. He further makes guesses on the role of saliva in mouth and comparing with gastro-intestinal juices makes a difference. He was always exposed to the danger of being arrested by the Austrian police. Bogoridi graduated the Greek academy in Bucharest in the class of Lambroso Votiadi. Being a talented student afterwards he was appointed a professorship in classical languages in the same school. published in the official organ of “Philiki Eteria” at the city of Navlion. physiological processes are poorly described and he uses naturphilosophical speculations… The author considers water a common nutritional substance as is evident from empirical evidence that plants subside on water and animals subside directly or indirectly on plants – ergo. Meanwhile he regularly contributes to scholarly journals. Unfortunately.grandson of Sophroni Vrazanski and brother of Stephan Bogoridi. Tz.

we can say that a short life did not give opportunity to this talented Bulgarian scholar and man of the revival period to fully manifest his versatile abilities. .Finally.

Pavlov goes with him to a new destination. all of them from the Military Medical School in Tzarigrad. The family of Dr. It was a time of revolution and turmoil when Napoleons army conquered the world. We know from a checkpoint in the university archives that a student with such name figured in the register at the end of XVIII c. The data are arranged in a museum collection.FIRST BULGARIAN MEDICAL DOCTOR Marko Pavlov is born in the town of Sveshti. Dr. Pavlov acquired in the Greek school at Turnovo. Pavlov continues his education in France. Charalampi Markov /1831-1881/ works as city physician in the town of Razgrad. Duc d'Elchingen /1769-1815/. eminent figure from bulgarian enlightenment. Next. He remains orphan as a kid so an Italian wheat merchant take care of him. Afterwards. This is scarcely what we know about life and work of M. we can conclude that Dr. Dr. At that time it is said that the town had not a qualified medical doctor. this was a reward for good medical practice on his retirement from the Turkish army. but it is a fact that he was honored to be a private physician to the Pasha of Philibe. M. Marko Pavlov had three sons . district Tetovo. Pavlov. A revision in 1981 shows this to be the apothecary documentation . with a private drug store functioning about 1856. He opens a drug store and stays with his family in Turnovo. a primary tuition M. Young doctor Pavlov enlisted a volunteer in the medical brigade.Markidis /1835-1903/ graduates . Firstly. Finally. one graduated pharmacy. M. When the Pasha leaves the town Dr. Obviously.D. Georgi Markov .two of them graduated medicine. Here are two more facts which are worth discussing when we speak about Dr. Further. Pavlov was adjunct physician to Marechal Ney. He is said to be first M. He travels there to Tunisia and Marocco. in the University of Monpelie where he enrolls to the medical faculty.DR. Pavlov. 1807-1808. Pavlov establishes back in Bulgaria. Bogomil Vachev. 1785-1786. a scientific researcher in pharmacy. Prince de la Moskowa. We don’t know exactly when Dr. they reside in the city of Turnovo where Marko Pavlov spent his youth. because we don’t see his name later than year 1808. Dr. After the defeat of the French army Pavlov migrates to the Ionic islands where we see him now as member of Greek rebellion from 1821-1822. he moved to live with his Italian benefactor in Venice where he graduated secondary studies. Marko Pavlov transfers to an ordinance with the turks and is at medical service with the military. Tzarigrad and Yemen. Pavel Markov /1824-1880/ is military physician in the Turkish army and works in Badgered. a. The cause of Greek independence pending. Dr. finds in the municipal archives of Suchindol /district Veliko Turnovo/ a literature fund in French from the past century.so called "vasaria" or "lekarnia". Marko Pavlov received his Medical Diploma a. Dr. Pavlov dies on 18 January 1864. MARKO PAVLOV . people look for help at folk healers. According to one of Napoleons niece Dr. yet.

pharmacy and inherits his fathers apothecary until 1886 when its sold to Panayot Slavkov. No one of the three sons claim to have heirs. .

1872. In Odessa he meets with other bright bulgarians of the time. One way or another. At 18 years he goes to Tzarigrad to study in the Magnus Schola at Kuru Cheshma. The second one is "My trip round the Stara Planina" by Panayot Hitov . We will not dwell on his activities in the field. In Plovdiv he establishes a private practice and parallel with that he becomes member of the City Municipal Council for three years.THE VERSATILE BOOKMAN DR. Chintulov. however. In Romania it is supposed that he is involved with the activities of the "Dobrodetelna Druzhina" movement. for which he is persecuted from the government.he makes a great roundtrip in the country and in 1868 he publishes a travel diary "My trip round the Bulgarskite Mesta. His birthday. a very challenging task for the time. 1868". while still studying chemistry. is a. Somewhere about 1873. A. Dec 1820 to Jan 1821. BOGOROV Ivan Bogorov is born in the town of Karlovo. Now. Dr. Five years he spent there and in 1858 we see the newly qualified physician back in Tzarigrad. Michailovski. Later he corresponds to a friend that while studying in Paris he contributed regularly to different medical journals with articles. the young scholar is tempted to continue his education so he travels to Leipzig in 1845. since those materials were anonymous their origin could not be traced. Bogorov has a new attire. This time he goes to Russia to specialize in commodity circulation. in 1847 we see him back in Tzarigrad where he participates in the issues of "Tzarigradski vestnik" and from there he moves to Romania where he stays until 1853. Bukarest: RaduleskuPrint. N. after not being able to find a job in Tzarigrad as a physician but editing instead another newspaper "Bulgarski knizhitzi". Gerov. With some saved money. At the eve of the Crimean War /1853-1856/. Bogorov supports himself by editing a newspaper "Bulgarian Eagle" in the period 1846-1847. to the name of Duc Armand Jean du Plessis de Richelieu /1852-1642/ .founder of the French Academy of Sciences. No sooner than 1865 his restless spirit dashes him on another trial . . Bogorov is sponsored by maecenas Christo Georgiev to study medicine in Paris. D. maybe as early as 1869. His primary education he received with the famous revival elinist Paino Popovich at his hometown. viz. In his early fifties Dr. Bogorov decides to return to his hometown Plovdiv. according to the transfer from the Julian to the Gregorian calendar. Bogorov is author of two monographs and numerous articles in politeconomy. he resides back in Tzarigrad and becomes co-editor of financial column /"listak"/ in the politeconomical journal "The Turkije". only suffice to say. For the purposes of his medical practice Bogorov is endowed with a haberdashery /"achtarnitza"/. namely for the Greek patriarchate as was the option for many bulgarian youth. Bogorov stays there until 1841 when he moves to Odessa at the French Gymnasium. for which he supplied from Paris. I. N. There.

the first being a work from Atanas Granitski twenty years earlier. that it was written by a selfstyled charlatan who advocated more on industry than on health matters. In 1877 when the Rusko-Tursko War is waged. The list of his works in philology is enormous. again. On how to prevent our health. After the liberation Bogorov remains somewhat in neglect. more than 200 titles. Bogorov is appointed interpreter in Svishtov. Vienna: Yanko KovachevPrint. on 20 October 1892 he dies from apoplexy in Alexanders hospital in Sofia. The book has a short introduction /"obazhdane"/ and three principal parts: 1. 2. Thusfar. 3. an alternative response from publicist Luben Karavelov who admitted.In the course of the Serbian-Turkish conflict we see Dr. 1875". etc. in a sense. also. however. he is made honorary member of Bulgarian Academy of Sciences. During that period he writes his famous treatise "The Village Physician. The book received. . as a military physician at station "Javor". On how to beware our animal from illness and to take care when it is sick. The book received a fair response from the medical community. Dr. Bogorov engaged. Still. at the age of 72. the old tycoon remains faithful to his lifetime obligation as a "purist" of Bulgarian language. no matter the fact that it was an attempt to introduce a unified medical terminology. This was second in a row. On how to make a diagnosis and give a proper medication.

Beron is mobilized at the Russian Military Hospital in Bucharest.to continue his education in a university. excels in nationality activities by means of public oration. By the end of the war we see the young patriot dispatched to Turnovo. on the pathology.MYSTIC-IDEALIST PHILOSOPHY OF DR. however. other non-governmental positions as a physician. On 4 December 1864 Dr. One way or another. He is engaged in natural history. Petar Beron. He is famous for propagation of the ideas of brothers Cyril and Metodius. Keffalov and P. show that he has not been totally impartial towards the revolutionary struggle of his people. V. There he studies two years and transfers to Odessa's Richelieu Lyceum and graduates with honors in 1846. Most notably he is president of the . diagnosis and prognosis of "tetanus" or lock-jaw. in Bolgrad. as well as. Beron is back in his native country and is welcomed with respect. This is evidenced by few reports from the Austrian council from Russe to the Turkish authorities. This is. Here Dr. He has been city physician. After completing courses in Greek and French languages young Vasil enrolls in Tzarigrad's Patriarchal School at Kurucheshme. pedagogic and sanitary control. Next. again. but luckily being a favorite and mentored again by Dr. educator and secularist. He is elected member of Parliament and takes different administrative-political duties in the Office. Twenty two years old Beron is supposed to continue his father as a merchant. Now. Beron is appointed Principal to the local community school. inclusive. Unfortunately. In ideological light Beron stand on progressist and evolutionist position. His primary education he received at birth-place while in 1839 he departs for Krayova /Romania/ to join his uncle. a case study on healing properties of "indian hemp" or Cannabis Sativa from Family Moraceae. There he had the opportunity to attend lectures from such famous medical celebrities as Josef Skoda /1805-1881/ and Karl Rokitanky /1804-1878/. Bulgaria. Beron was back in the capital city Turnova before the Liberation Day. Kissimov.the latter already on a profitable practice in Paris . having received solid education Dr. Some historians say that Dr. Romania. Petar Beron . Beron is acclaimed as a leader. BERON Vasil Beron is born in Kotel in the year 1824 from a family of rich cattle breeder. famous figure from Bulgarian Enlightenment. both contain as their principal component narcotic resins. Vasil Beron moves to Vienna to strengthen his clinical experience. highly improbable as is evidenced by the memoirs of revivalists M. he goes to Wurzburg and in the year 1852 graduates with a doctoral dissertation "Uber den Startkrampf und den Indishen Hanf als Heilmittel Gegen Denselben". His maiden name is Jellalsky and he is sisterly son of Dr. however. Note: the dried leaves is called "marijuana" and the dried flowers is called "hashish". his work was hampered by the outbreak of the Crimean War. Dr. viz. Having troubles with the Turks makes him flee to Bessarabia. creators of the slavic alphabet. Vasil enrolls as a student in medicine at Munich. Some facts. but also chairman of church's and teacher's community. The patriot.

Panayotov Printers. Somer Printers. This is evidence that the bulgarian nation has the potential to be abreast with those who are ahead in progress and peace. receiver of medal "For Civic Valor".Archaeological Society in Turnovo /1884/. Beron dies on 24 September 1909 in Sofia. . H. that we can rank the Beron family as exceptional. Vasil Beron's versatile heritage reveal a rare genius. etc. Vasil Beron makes a worthy contribution to the development of bulgarian scentific thought in the period of the Enlightenment and the first decades after the Liberation in 1878 and in the beginning of the modern Bulgarian State. 1886". It is far more precious that all his works are written in a bulgarian language. His most famous works are: "Logic. Viewpoints on Dr. but here we see a lineage that continues to give a series of professors even up to our own day. 1870". 3 rd degree /1902/. Vienna: L. Dr. Bolgrad: Central School Printers. Beron's philosophical concepts are unequivocal. Petar Beron. It is hand in hand with the creative work of his uncle Dr. by directly offering the wisdom of a worlds treasure he makes an advancement in literary aspect as well. Superlative aside. Thus. "Archeological and Historical Reports. Turnovo: P. associate /1870/ and full /1884/ member of the Bulgarian Literary Society which is the forerunner of the Bulgarian Academy of Sciences. 1861". People does not choose their ancestors. "Natural history. author of the encyclopedic "Panepisteme". a source for studying V.

His stay in Paris has an utmost importance for formation of his political sympathies and antipathies. Salcho Chomakov. in 1832 Chomakov is sent to study at Andros Island School in Cyclades Archipelagos. Dr. The major waves of revolution occurring in the first half of the 19th century had its repercussions in 1848.LEADER FOR SECULAR FREEDOM Born in the year 1819. His school is banned in 1839 from the Greek authorities. Thusfar.DR. This is homeplace of greek revivalist Teophil Cairo /1784-1853/. The Polish cause was led from emigration by Prince Adam Czartorysky /1770-1861/: fighting the Russian subjugation of the Poles from September 1831. After receiving his primary education in Plovdiv. His linkage is from two of the most wealthy and influential families in the town: Chomakov's and Chalukov's . His elderly brother. Here he get his medical diploma and in year 1846 is transferred to Paris for a two year specialization in surgery. STOYAN CHOMAKOV . His next step is to study medicine.teaching blaspheme and theosophy. Stoyan Chomakov is influenced by him and later applies his studies in solution for the Bulgarian Church Question.e.both authorized tax dealers on cattle trade /"beglikjii" and "dgelepjii"/. from Koprivtiza in Orta Dag region. However. At that time in the early 50s he was the first medical doctor in the region and his work gained him the . had connections with the Sultan's court and it is owing to him that young Stoyan got reference for a job in Tzarigrad during the 60's and 70's. After graduating his secondary education in Athens in 1838 young Stoyan is sent to Pizza and Florence in Italy. Stoyan Chomakov is back in Plovdiv as a municipal physician. The latter is famous admirer of French Rationalism and becomes founder and propagator of a heresy . Although not of Polish identity Dr. Aegean Sea. Mikhail Chaikovsky and others/ and thisway is connected with the life and deeds of another great bulgarian Patriarch Neophit Bosveli /1785-1848/. Chomakov was close to Prince Adam and his circle /i. Bosveli is a titan from the Bulgarian Revival and Church Independence War with the Greek Fanariote but we will refer to the question later.

resolved with firm measures. Chomakov. Dr. Further publications are two articles on cholera in the newspaper "Vreme". He was so busy with his job that he couldn't go back to Plovdiv to attend his sick wife which subsequently died. The firman provided for equality between the christian and muslim subjects of the realm. He had to hold a reception for many foreign ministers and ambassadors which required a staff for the residency. France and Piedmont won the Crimean War and by the Treaty of Paris in 1856 the Ottoman Empire was considered a European State. also got ill and died. however. Last but not least is his political activity. Four years later during the April Uprising Dr.Fuad Pasha . Chomakov performed three operations in Plovdiv which were debated even from the medical circles in Tzarigrad. Chomakov had firmly quitted medical practice so this could not have brought him any income.and signed by Sultan Abdul Mejid. in two consecutive issues from August 1865. that he would leave his gainful medical practice and would stay for 17 years in the capital to become one of the first professional politicians of modern Bulgaria. In 1861 Dr.Mustafa Reshid Pasha . money which were sent from the diocese were not enough to support himself and on his account a half from his expenses came out from his own pocket. Chomakov is turkofill and join the most "reactionary" circles in Tzarigrad. calumniated the bulgarians for unrest against the Ottoman Government. we speak of him on the First National Exarchate Assembly on 16 February 1872 and the choice of Exarch Antim I /1816-1888/.73 grosh make a gold coin/. In the midst of that political turmoil Dr. The subject matter of his activities as a public figure is versatile. the latter being pro-rusofill and the right hand of Russian . but in reality it led to clashes between muslims and non-muslims which soon became an international issue. No more materials on medical themes are printed by Dr. Chomakov is chosen for representative of Plovdiv Diocese in Tzarigrad. Karakonovsky left the town. by the way. He opened a pharmacy which was later administrated by his brother Salcho. He had to arrange a big and well maintained house as was required by the Exarchate. One way or another. Chomakov arrived in Tzarigrad with his two daughters. Turkey and her allies England.B. his figure was often counterposed to another eminent bulgarian politician Count Gavril Krustevich. I see from the register at that time . Salcho. Stoyan Chomakov on a level hand.image of a skillful operator. Meanwhile. But let us take a look at the geopolitical map of the region from that time. mainly secular. Same year the Reform Firman /"Tanzimat"/ was drawn up by the minister of foreign affairs . He donated 3000 grosh to the pedagogy school of Daskal Nayden Gerov in 1958 /N. The topic of his work were "Ligatura Oesophagus". a private secretary and also governant for his daughters. When. he is author of three books and numerous etudes on political and secular history. Panoff in the journal "Bulgarski Knigitsi" from October 1861. in the face of his protest versus the greek bishop Chrisante who. The same operation was reported as a case-study by Dr. His brother. Dr. On his way to the new job he never presumed that this is a turning point in his life. for instance. and which the minister of internal affairs . Even in 1865 some people from the bulgarian community protested against him on refusing to take care on cholera patients when practicing physician Dr. This and many other of his behavior makes it difficult to characterize Dr. it is truly his radical position and he is qualified as "red".

Not that it is the cheapest way. We are a non-profit organization. in 1887. All in all. The new times are hard to live for the old political lion. Pantaleimon Charitable Society". After the Unification of Bulgaria he is people's deputy in Vth and VIth Common National Assembly. who. grand-granddaughter of Dr. Museum House of Dr. An attempt to be a "gubernks" physician failed in 1978. Chomakov. Alexander".20 August 1887. By far. See for further details * . who often made visits to Plovdiv with Dr. Full member of the Bulgarian Literary Society. whatever. for sure it is the steadiest! Our master list contains many a valuable collectibles. the most touchy problem is that of the archives. Awarded medal "St. While. but. first degree in 1888. Premier Stambolov and Prince Ferdinant sent him on his last journey. being detached from university curriculum and funding.Attache Count Ignatieff. we started this project that many obstacles could hamper our work. Chomakov attend the funeral in Sofia but on his way back he get ill. in two volumes. viz. More stuff can be written on his Tzarigrad period but this is item of other story. Chomakov. From bulgarian side collaborator is. so we seek secondary access to materials . Chomakov. Then he was chosen as a delegate in the National assembly of Eastern Rumelia. Nine days later he dies in piece. This being. Chomakov. Dr. Meanwhile Dr. Chomakov is back to Plovdiv . he went to Tzarigrad with 400 000 grosh in his pocket and on his way back he carried two truckloads of inventory and 60 golden lira from the Exarchate cashier for travel expenses. when. we present the latest document for this important revival activist and legalist for church freedom. Chomakov participated in charity activities and become president of "St. Also.Chomakova from Italy. This is a collective effort from the descendants of the doctor. Sonya Petrova . his daughter Maria Chomakova was appointed a court lady. Addendum: We knew. proudly. later Bulgarian Academy of Science. Minister of education from 28 June .published and republished.capital of liberated Eastern Rumelia. in his own words. In 1878 Dr. scattered around the world pay their tribute. With respect to the legacy of Dr. Work and Descendants". From their side collaborator is. he becomes one of the favorites in the court of Prince Ferdinant. "Dr Stoyan Tchomakoff ~ Life. in Plovdiv. On 14 October 1893 the body of Prince Alexander Batemberg is buried on bulgarian soil.

Even before graduation he works hard on the elaboration of anatomic terminology in turkic-arabic language and simultaneously reads lectures in the bulgarian community center on topics such as anthropology. stambuli"/. Subsequently. He is immediately entangled in the fight for autonomous bulgarian church led by nationalist émigré. Whatever the chronology of that revolutionary events. physiology and hygiene. we see young Stambolsky as one of the initiators of the "Easter Day Liturgy" on 3 April 1860. On that day Bishop Illarion Makariopolski /1812-1875/ denunciates the dependence of the Bulgarian church from the influence of the Greek Patriarchate. There he studied for ten years and in 1868 graduated with a medical degree and In the middle of the XIX century Tzarigrad was the most important city in the Ottoman Empire. Christo .DR. stambollu" /that is. Thus. As a medical student Christo demonstrates keen interest in anatomy. Further. His parents were orthodox christians Tanyo and Dafina Stambolsky. Christo Stambolsky gets there amidst a whirl of empirial struggle. Here is where the family name comes from. It is said that he traveled for 18 days to the capital of Stambuli and when he was back his fellow-citizens greeted him with the words "Hosh geldin. At that time a popular allusion was that national church liberation should anticipate a much more political freedom of bulgarians. In year 1858 he enrolled in the highly prestigious Military Medical Academy in Tzarigrad. Dr. he is also ordained the post of Head of Dermato-Venerological Clinic in the same institute. Next year. church liberation becomes a first stage in a wide legal movement for national emancipation. There is a story about his grandparent Stoyan who was one time "muchtar" /mayor/ of Kazanluk. Christo Tanev Stambolsky is born on 8 August 1843 in the town of Kazanluk situated in the heart of the "valley of the roses". "Well come. he makes a good impression as a diligent student which gives him a chance to be appointed as an assistant in the High Military Medical Academy after graduation. Young Christo studied his primary education in his native town with teacher Ivan Naydenov. CHRISTO STAMBOLSKY AND HIS DOCUMENTARY "CHEF D'OEUVRE" rank "major" in the army. Stambolsky. But let us take a look at the medical activities of Dr.

1879". Doctor Vulkovich and Doctor Stambolsky are sent to exile. Part Two . So. What is important here is the recognition which a bulgarian received among the Ottoman court and next year 1875 Dr. T. Stambolsky is back in the newly liberated Principality of Bulgaria. The latter is popular as the first translator of Konstantin Irechek's "History of the Bulgarians" /1876/. on 10 December 1878 the bulgarian patriot receives an amnesty /"Allah Kerim"/. To make the long story short. that is representatives of political jingoism at the time. There are some articles printed in the newspaper "Napredak". In fact. The work has not been translated and is unknown in Bulgaria.he departs for Sanna. Part Three . the affair with the censoring of some "surras" from the Koran ended with the rehabilitation of the bulgarian doctor and his friend editor Naydenov. The order is without appeal against sentence. Suffice to say. In a primitive surrounding Dr. Mass . the book is an authorized compilation from a work of French professor in anatomy Prof. Stambolsky is appointed new post . i. What happened in the year 1877 is narrated in some 100 pages at Dr. Stambolsky returns to the medical field. that show in 1875 he was already very famous. edited by Ivan Naydenov /1834-1910/. Disappointed from political carrier Dr. in the spring of 1879 Dr.the illustrated atlas itself. Stambolski. The authorities in the capital appreciate very well the versatile talents of the young medical doctor and assign him the task to compile an anatomical atlas for the needs of education in the institute.a dictionary of anatomic terminology. Karatheodoridi in Tzarigrad. From this parasite he makes a preparation which he sends to the Medical School in London together with a referral named "De ver de Medine. Stambolsky practice his medical profession. The great "vizier" Midhat Pasha orders that Bishop Antim.Stambolsky works on a part time basis as a surgeon in the clinic of Prof. This causes him great trouble as a prefect in the town of Sliven where he had conflict with the so called "red belts". Thrace. Now. Christo Stambolsky . . Stambolsky's memoir.e. His main contribution from that period is the study of filariosis epidemics /caused by worm Filaria Medinensis/.head of "Directorate for Transport and Communications" in Eastern Rumelia. It is difficult to describe such a change in conditions for someone who is used to live in the relative luxury of capital Stambuli.reader from the Medical School in Paris. we see that four bulgarian state employees are accused for pro-russian campaigning during the Russo-Turk War /1877-78/. He goes to native town Kazanluk to start a private medical practice. Yemen. Stambolsky becomes a full time professor in the Military Medical Academy. First he stays in the town of Gabrovo but soon is elected deputy in the Regional Assembly of Eastern Rumelia. de Kazanlik. Christo Stambolsky is involved with the conservative elements in the parliament. Ivan Naydenov. There he stays until 8 December 1883 when a liberal coalition force him to resign. par d-r Chr. On arrival he is appointed chief ordinator in the district hospital. This immense work is accomplished in 1874: a book entitled "Meftih tetrih" is published by the empirial printing office in turkic language with arabic script.text of the atlas. On July 1881 Dr. on 7 September 1877 starts a new period in the life of Dr. The aforementioned book comprised in three parts: Part One .

Recollections" published in three volumes: Volumes 1-2 in 1927. Stambolsky's memoirs. from about 1300 pages. Stambolsky in the camp of the "legalists". Todor Kozaroff from Paris. On 4 June 1932. There he stays until the Balkan War when in the years 1912-1913 he becomes a head of "Directorate of Public Health". It did exist in the catalogue of the National Library. it happened that during the bombardments of Sofia in January 1944 from the British Aircraft. Finally. After the Great War Dr.The Unification of Bulgaria in the year 1885 finds a doctor in his mid-forties with a rich biography behind himself. This causes him trouble with the regime of Premier Stephan Stambolov /1854-1895/ who registers Dr. Towards the year 1918 he starts his work on the memoirs. Stambolsky retires from public activity. the archives of the doctor represented extremely valuable source of the Bulgarian Revival. Volume 3 in 1931. the archive perished from a bomb fallen at the office "Kazanlukska Druzhba" where it was stored. The archives of Dr. As we mentioned. but. Diaries. See for further details * . above. This magnum opus is still unpublished in its totality. and. I personally checked for the published part of the memoirs . we could get hold of the book.a bulk. and we could obtain a photo copy of the whole book. some time ago. Addendum: Recently. he dies in Sofia. However. But in 1893 he is back again with a new carrier as administrative physician in the Alexander's Hospital in Sofia. on my inquiry they couldn't produce a viable copy for research purposes.someone. It is an inscribed copy to a grandson of the doctor . He toils some 14 years on that "chef d'oeuvre" and we see a work called "Autobiography. Stambolsky wait to be republished. we get on some new information on Dr. an old man in his 88s. Pity for such a loss! Later.

Dr. he is little cousin of Dr Christo Chomakov whom we have spoken about earlier. Vulkovich receive a new assignment.H along the "Nish-Sofia's Strip". It was an arena for struggle between royalists and republicans and preceding the commune of the Third Republic. according newspaper "Svoboda" in Tzarigrad from 1850. Vulkovich was "not so lazy he could not tie his own shoelaces". Three years later. In 1872 Dr. Vulkovich made an interesting correspondence with bulgarian revolutionary G. S. as a well known aristocrat Comte de Chambord remarked at that time. This allowed him to excel .he make sharp advance in the army and is promoted to a rank "colonel" with a pay increase. GEORGI VULKOVICH AND "BULGARIAN EASTER" Georgi Vulkovich is born in the city of Odrin and the year is 1833.drovers and retail dealers. He joined an underground organization called "Circle of Faithful Friends" which defended the patriotic rights of Tzarigrad's youth. Vulkovich went to London where he met with russian anarchist Mikhail Bakunin /18141876/. as well as. Georgi Vuvkovich is the first bulgarian admitted to study in the Military Medical Academy. He is already an adjunct professor in surgery at the Military Medical Academy and head of the board of directors at "Hayder Pasha's Hospital". In Paris during the 60s swarms a multitude of people from different nationalities and various creeds. he depart for Paris to study for a qualification and here is a place to remain for long years and entangle in political activities. In 1876 during the Serbo-Turk War he is raised further to a position of "mirilay-bey" in the occupied territory of Serbia and head of M. His parents are settlers from Koprivtiza and are from the big and influential Chalukov's family . . Vulkovich gets a fame as a skilled and able medicus. many a local "effendies" or high-stream civilians and their families. saying "… by the way. In fact.Vulko Kurtovich . Vulkovich is already a "bey" in the civil administration of the town. as well.DR. in the autumn of 1871 Dr. In 1857 a young graduate. a man who fell out with Marx and a tireless yet strangely ineffective revolutionary leader. We don't have much information about that period of his life but we see him again back in Tzarigrad in 1870. Now. He is transferred to serve in Syria where he becomes chief surgeon in "shamsi villaet" of Damask. Dr.did not saved his pocket to educate his son. Georgi received solid primary education for the time at the greek community in Odrin and his father . swords.S.founder of First Bulgarian Legion in Belgrade. we need a man who could treat wounds made of guns. Georgi Vilkovich with a letter from 27 December 1861. reply "… I accept readily such a honorable position and it is a high time that every patriotic bulgarian should give a token for love in front of his homeland …". Rakovsky . The latter made a strong influence on the young patriot. Next. Vulkovich entered for an examination in the hospital of Hayder Pasha in the town and is appointed chief ordinator in surgery. A letter dated from 14 November 1861 is sent from Rakovsky. Dr. etc …".A. in year 1865 Dr. Via this organization Dr. Thus. He had a private practice that was in quest by all foreign attaches in Tzarigrad.

This episodes from his life are well described in the memoirs of Dr. Vulkovich's carrier as a politician: 1. he acquired from the "Great Vizier" of the Golden Horn to make direct contacts with the "harjie" or foreign minister. This act of patriotism. during the Russo-Turk War next year everything comes to an abrupt end. on 3 March 1878 the peace treaty in San Stefane. he moves to Plovdiv and becomes member of the Regional Assembly. 3. minister of "Foreign Affair and Religion" /1883/. however. While it is impossible to enumerate every contribution he made in the administration and legislation field. minister of "Post Office and Telegraph" /1881/. The purpose of the Balkan Federation is double-fold: once. to fence off the influence of the "Great Concert" in the affairs on the peninsula. Dr. gives an amnesty to all political prisoners of bulgarian descent. The acceptance of Bulgaria as a separate unit and not as a privileged province is an important step towards a retribution of Modern Bulgaria and the establishment of the Third Bulgarian Kingdom in 1908. this makes him write a report and send it to the British Council. 2. in the strategic interests of each participating county in the region and twice. especially. for people with a rich biography in administration work. Serbia. Let us communicate briefly on Dr. Dr. Vulkovich is appointed member of "International Committee on Atrocities of War" and after visiting the destructed villages and towns in Bulgaria and meeting remnants from the partisan's detachments of the April Uprising. Afterwards. Christo Stambolsky .Rumania. Dr. Trade and Public Building" 1882/. The dawn of modern history in Bulgaria is a fruitful field for progress. Vulkovich with a position in the Ist Great National Assembly. This is made by signing mutually beneficial trade and communication conventions with the neighboring countries . consequently. This are in chronological order: minister of "Agriculture. Midhad Pasha's agents make a report which accuse Dr. In the parliamentary season 1885-1886. Vulkovich of betrayal and a sentence is issued that he is exiled in Damask. Georgi Vulkovich died in the turkish capital on 14 February 1892. is ill appraised. So far. Thus. He makes everything possible for achieving cooperation between the Balkan States on a larger scale. He protects bulgarian economical interests from collapse in national and international relations. Dr. invites Dr. a suburb of Tzarigrad. second-time minister of "Agriculture. He was instrumental in the Kingdom's early statute as an independent nation. Accidentally.another well known bulgarian medicus on service in the turkish army. Vulkovich join the conservative party and participate actively in the elaboration of the new constitution. temporary governor of newly liberated bulgarian lands. Greece and Turkey. Trade and Public Building" /1879/. Prince Dondukov-Korsakov. some more important are: opening an Agricultural . Vulkovich is appointed Chairman of the National Assembly and next year on March 1887 is sent Bulgarian Diplomatic Attache in Tzarigrad.However. He is first to establish diplomatic relations with Monte Negro. Until the Unification Act in 1885. Vulkovich occupies different posts in the commanding apparatus of the autonomous region of Eastern Rumelia.

. opening a Telegraphic School in Sofia. For instance. transferring new telegraph lines. So far. Silistra and Rouse. building new roads on a line. building new hospitals in Sofia. Vulkovich's work is his effort to enhance the communication network of the country. etc. modernization of the harbor in Varna. etc.School in Sadovo. the most important asset of Dr. in Vienna and much more. We must point out his efforts to strengthen the railway system in the country. he organized the state purchase of the line Rouse-Varna from the Hirsh Co. viz.

Miller. he was grammar-school teacher in Kotel /from 1848 to 1847/ and in Shumen /from 1848 to 1852/. seen as partly due to Kossuth's harsh policy to the non-Magyar nationalities. namely. New York: McGraw-Hill. leader of the 1848 Hungarian Revolution. The chronology is better described in his "Short autobiography" from 1893. master Sava Dobroplofni return back to his homeland. led to his exile. After the Russo-Turk War from 1828-1829. What the aim of our narrative is to point out the contribution Sava Dobroplodni made to the development of health education in those lands. I. while all my schoolmates having no such notes . G. in the town of Sliven. Sava Dobroplodni occupied for some time a tenure track with Kossuth's news agency. finally. Bogorov. where he published his "Hygiaenomics. An interesting episode is left from this time.. Re: "… with the lecturer in classic studies. etc. but soon quit the job to make a roundtrip in Central and Eastern Europe. In year 1835. literally meaning . Dobroplodni make friends with Lajos Kossuth /1802-1894/. What the point is. here. who was himself high turkish official and to continue the lineage. from Sliven. The defeat of his movement in 1849.B. master Evtivuliss. father Ilya and mother Trendphila from the Slavov's genus. the family moves to the walachian city of Ploesti where the father dies from cholera. Sava receives his primary education with daskal Gavril Krustevich . p.Sava Know How. viz. Sava Dobroplodni is an excellent student there and makes friend with many a famous bulgarians who study there. I.find it difficult to give correct answers. The mother takes care of the family . So far. all-in-all. S. That is. Thus my nickname remained "evcarpidiss" …". which Sava narrates in a letter to his friend N.brothers Nikola. "A philosopher". This master E. 1987. we see him as a private student with presbyter Nathanail in Tzarigrad and making a living of translating old greek manuscripts. was a factor that young Sava should be sent to continue his tuition in Tzarigrad. N. grandfather Sophroni Vrachanski of the town Kotel. So this man. SAVA DOBROPLODNI . The latter was nephew of bulgarian Prince Bogoridi /1780-1859/. In Shumen. Krustevich. 2 nd edition. 3. Hristaki and sister Maria while they return back to their hometown. Rakovski. one day reads my name instead "Savvas Ilyadiss" to "Savvas Evcarpidiss".Ed. …" After graduation. within the context of Bulgarian Revival.MR. receives a ticket for the famous Kuru-Cheshme School in Tzarigrad. Kossuth aimed at Hungarian independence from Austria of the Habsburgs. L. to the end of his life. He becomes a schoolteacher for fifty years in a row. Haralambo.Kotliyanin. in 1842. the extract is from . Questions that matter: An invitation to philosophy. I made stenographic notes and on the next day I was in a position to answer all his questions. Both his parents were grammar-school teachers. he said./: "… when Leon the tyrant of Philius asked him who he was.UNIVERSAL EDUCATOR Sava Dobroplodni is born on 3 December 1820 (old style calendar). 2 nd edition" and "A guide for . He visited the city of Zemun in 1853. almost. at the same time he applies for a sponsorship to a group of merchants from his hometown and. who was examining us on a bulletin sheets. Makariopolski. also: G. an allusion /N.

how to ignore healthisms coming from medical folklore. Varna /1862-1864/. called Preslav. "Hygiaenomics". etc. Now.grammar schools". Sava Doproplodni dies on 19 April 1894 in Sofia. Saraccieff Auspice at the "Galata-Saray Medical School" in Tzarigrad. newspaper editor-in-chief of the "New Bulgarian Bee". is born in 1857. he continues to give a contribution to bulgarian enlightenment: he is a school inspector and. "babi". where some of the furtherers of Bulgarian dramaturgy studied . 1865. Tulca /1864-1867/. simultaneously. It is written on a prophylactic agenda and contains chapters on rational nutrition. on labour hygiene. this is a time for a fruitful literary activity. On 15 August 1856. printed in Bolgrad. We have found two medical books written by master Sava Dobroplodni. which put him on the forefront of bulgarian medical science of XIX century: 1. like "sueverie". he produced and directed the first Bulgarian comedy play "Michail Mishkoed" and is known to have arranged a theatrical art-school. This second book is on Hyppocrate's medicine. This book is an authorized translation from lecturer S. The end of the Crimean War finds him back in Shumen. Stoyanov. . printed in Tzarigrad. Drumev. this time for a longer period of time. on some principles of raising infants. 1846. when Dobroplodni excels as a playwright. Silistra /1867-1872/. master Sava Dobroplodni gets married to Maria Gencheva and a son of his. During the period 1853-1856. Voinikov. 2. V. he is college professor in greek languages at Sremska Karlovtsi. There are interesting propositions made here how diseases are generated. which gives him a right place among the figures of Bulgarian Revival: Sliven /1859-1862/. etc. etc. "Viewpoints in healthism". D. etc. Kustendja /1872-1875/. At this mature age. Last word should be given to his work in the field of public health education. The Liberation in 1878 finds master Sava Dobroplodni in an active position as a chairmen of the District Administrative Council in Varna. A. honorary pensioner of the state /from 1887/.V. accordingly: part time member /from 1881/ and full time member /from 1884/ of Bulgarian Academy of Science. how to beware of magic id est God has not given power to mortals on making decisions for life and death. Also. Following is a long list of his tenures as an educator. The state gives a tribute to his wholesome career.

Further. The revivalist wave blowing from Europe and the political ideas of bourgeois-democratic revolutions. Feminism. in the town of Gabrovo . nothing comes to indicate that a better future is stemmed for a community of thirty or so dwelling houses. at the vicinity of Stara Zagora town. Knyazeski lives and studies in Odessa and it is the bulgarian colony in the town that gives him a warm welcome.e. buried in the mud of slavery and with a horizon of secularity not higher than a celebrity for Christmas and Easter. Zahary Knyazeski is. the old russian metrology: 1 "pood" = 40 "foonts" = 16.ACE TRANSLATOR FOR BULGARIA In the year 1810. Jerusalem. Serbia. etc. Bodyansky. viz. tried their utmost to keep and tolerate maidens rights. as well. to become one of the pillars and true entrepreneur of enlightenment in the town of Stara Zagora. he travel to Syria. Poverty makes him turn at ten years of age and go to Stara Zagora as apprentice to daskal Doncho and to learn pottery and soapery /i. much of the Balkans and all the Arab lands except Morocco. ZAHARY KNYAZESKI . and a place for the early childhood of Zhivko. entered the communications parlance not earlier than the 1890s probably. I do not know. We do not aim to give full account for his russian period. This activity has.MR. already. from France. traditionally. together with educator Alexander Exarch-Beyoglu /1810-1891/. Monte Negro.where the secondary school of Neophit Rilski /1793-1881/ is functioning.Pogodin. reflected through the prism of Greek uprising from 1821-1828. give an impetus for development in the bulgarian society. Main activity for Zahary Knyazeski is girls' erudition through stipend promotion and technical enhancement. bulgarians. wins a stipend to the High Theological School in Odessa. This is the vicinity of "Pishmani". the eight son of Peter and Sanda Russevi is born. dialectically called "gruntcharstvo" and "sapundjiistvo"/.. that the Ottoman Empire had sovereignty over Turkey. His great influence and authority in Russia become a guarantee for advancement of culture not only in the region but in the country.personally. Vlachia and. today called "Pokayane". however. In 1835. Backwards as they were. Someone said that it was donated to the Monastery of Mugliz but later perished in the fire of April uprising 1876 .38 kilograms. His numerous letters make him an accepted member in the circle of russian academia and let me mention few of them . Facts on file is that his library measured in "poods" and "foonts". details on Zahary Knyazeski's book-treasure are lost in the mist. The rest is obsolete and no one knows for sure how this immense library made a transfer back to hometown Stara Zagora. This make young Zhivko to launch on a traditional journey abroad . cf. graduating the Odessa Seminary in 1845. been obliterated in the vast but rotting Ottoman Empire from the XIX c. It suffice to say that he made a lot of acquaintances for a lifetime and in the first time with famous bulgarian revivalists Vasil Aprilov /1789-1847/ and Nikola "Art" Palauzov /1776-1853/. subsequently. to change his name at Zahary "hadji" Knyazeski. Whatever. So. afterwards. From 1839 to 1845. included. The year 1847 sees him.that is. Knyazeski is maybe one of the patriarchs in that . master Zahary Knyazeski traveled around Russia for two years. Here Zahary excels to the rank of assistant and. The boy is called Zhivko and. North Africa. cultural live in Stara Zagora. seemingly.

Krustevich and marked "B". further for the association between Zahary Knyazeski and Mithhad Pasha one can find in the archives but we must emphasize a point. This is evident from a book he wrote and published . What is interesting for the purpose of our presentation are three books written by the author and a number of papers: 1. The author is negative about grandmotherly superstitions. 2. That man. In 1858 it has a second edition. Also. Sometime about 1860. We don't have full information whether Zahary Knyazeski had any special medical preparation. how to dwell in a spacious room. represents a book by french authors Tissot-Furcroa-Salmaud. In fact. which. The book is reviewed by G. served for 15 years as a secretary in the Tzarigrad's Chancellery. Tzani Ginnchev. latter. Wait here for a moment and see who Mithad Pasha is and what he did for the bulgarian people. Published in typography Tzarigradski vestnik at Tzarigrad in 1853. The work centers on the psychological aspects of alcoholism and its reflection on physical beauty of man. he is appointed governor or "valiya" to the Russe Villaette and here he excels as a bold reformator and organizator. given are some symptoms of the alcoholic disease. he is the bulgarian Robert Owen and his co-ops near Russe at "Obraztzov chiflik" is a rudiment like the Rochdale's pioneers in Europe /more/. published in typography Damianoff at Smirna in 1842. Well. The year is 1863 and the region is Russe Villaette of Mithad Pasha. The book contains 34 rules for the young couple: how to get dressed. how to eat wholesome food. revised and enlarged. in the autobiography of one Anastasia Tosheva /1837-1919/. medical care for pregnancy is a task for grammercy by the parents and not so much a concern by the side of the medical practitioner. always. born in Tzarigrad and educated in most of the european capitals of the time. Knyazeski does not live to see the liberation. his legendary effort to smuggle two girls disguised as boys at Odessa is well documented. he was self-educated like other revivalists Savva Dobroplodni. "First aid on syncope" is originally published as a serial in the Tzarigradski vestnik. Most probably. More or less. 1859". interested in the theory and practice of cooperatives. Hard times and broken finances make master Zahary Knyazeski to apply as a translator or "dragoman" at the Russian consulate in Turnovo. For instance in 1850. Tzarigrad.movement. Knyazeski & associates helped some 10 girls go and study midwifery for a period between the 60s and the 70s. The latter is founder of the first Bulgarian Woman Association "Mothers' Love" in 1869 at Gabrovo. "The origins of alcoholism" is a small book."Practical handbook on silkworn. etc. . In brief. six pages in total. 3. He died on 23 January 1877 in Russe. namely … Zahary Knyazeski was. "On childbirth and how to feed a baby" is transliteration from russian.

in the Bebrovo Balkan.LIFE STATIONS OF A GENIUS . 3/. Dimitar as the eldest son was prepared to be ordained. The child received his early education in the local primary grammar school. in order. Mollov is advanced with his doctoral dissertation: "One modification of chloroform anesthesia a la Clode Bernar" is result from his efforts in the pharmacological laboratory of Prof. But before this date."molla". he is first enrolled in the Philology Faculty and. Dr. make him well known. Meanwhile. The central theme of his research is "pre-medication with morphine". was a pastor famous for his sermons in the region and the Turks called him . again.from the fraction of Petko Karavelov /1843-1903/ . are presented chronicles from the Assembly life and. he volunteers as a member of the "Russian Red Cross" and is. to make a living. In the next years. then.six doctors with auxiliary personal . Mollov is with the liberals . Next. the Founding National Assembly is convened in Turnovo and Mollov elected deputy member.former. Supported by the "Slav Charitable Society". translations from the worlds . on 26 December 1845. In 1876. remains to a position of an assistant doctor in the surgical clinic of Prof. the second General Governor Dondukov-Korsakov orders him that a new sanitary structure is necessary . his uncle Evstati "Hilendarski" /unknown dates/.and managing editor of the liberal whip with library "St. we see him to be a prospective young physician . takes him to study in Kiev Seminary where Dimitar graduates with a monastic degree in 1867. during Russian-Turk War /1877/. His father. Petar. from which. As many youngsters of the time. professor/ and Vladimir /jurist. Dr. provinces of the Ottoman Empire. already. The years 1876 and 1877 are crucial for the fate of the Balkan states . this is not enough for the spiritual endeavors of the young man. Dr. in the Medical Faculty of Odessa University as a student. Dimitar Mollov is within the organisational plan of General Governer Cherkasky. Sokolovsky. First. 1. Bassov in Moskow and publications in the journal "Moskovskje vedomosti". fasc. his team . also. son Vasil /physician. This was a time when he worked in the districts of Eski Djumaya and Shumla. Mollov is at the frontline of battle. appointments in the clinic of Prof. his "Temporary rules for administration of medical services in Bulgaria". which. team with a sanitary train composition.according.works at a sanitary train and get supplied by the "Moskow Trade Union". In 1862.DR. from 1878 to 1881. In the period. Kliment". the liberation of Bulgaria form Turkish dependence. Dimitar Mollov. On 16 April 1879. Gaga. DIMITAR MOLLOV Dimitar Mollov is born at the town of Elena. Dr. In 1879. Petar Molla had eight children. during Serbian-Turk War /1876/. 20-30 min before narcosis and is evaluated as "good" contribution to the developing science of anesthesiology.whose. However. now as a Russian citizen. he is among 279 national electors ratifying a "new constitution". More details on the two wars are found in the Mollov's archive. recommended. He is appointed "gubernks" physician of the newly liberated Vidin sandjak /cf. Dimitar started as a private teacher. comprise the story of three generations of the family: Dimitar. Graduation year 1873 and Dr. community activist/! Year 1878. chap.

As such. Vienna: Yanko Kovachev Print. Hospital team. it was mentioned before. Konstantin Popov. This journal is in the good traditions of the french "Bibliotheque Utile" and the german "Universal Bibliotek". Anna" III degr. The jurisdiction. Tolstoy. Mollov is elected Minister of Public Education in the cabinet of Dragan Tzankov. ponders on the effects of this case together with the precedence on criminal law in Bulgaria.classics . or how to prevent health and maintain good disposition. "Medizinski Napredak". The work of the Bulgarian Red Cross is in accord with an international team from the Red Cross-Red Crescent movement /more details …/. Simple as that. namely: 1. Thus. in connection to the Serb-Bulgarian War /1885/. The latter position is continued. we must point out one of his many medical publications.with minor revisions . Mollov is very helpful to sanitary reforms in the capital and never shirk from his duties as community activist. Dimitar Mollov. Lermontov. during period 1891-1894. Medical University of Leipzig. Mollov is always at the frontline of the Bulgarian Red Cross. also. Carrier of decorations "St. Petrarka. in the "Alexander's Hospital" and taking care of the wounded in the rearguard. Longfellow. still. in the period 7 September 1883 . . Nekrasov. Dr. The year 1879. the organization comprise two divisions: 1. He is subjected. during the war. but. life for Dr. However. ends with 4 people sentenced to death /i. is landmark for the formation of the "Supreme Medical Council" /SMC/ in Bulgaria. Numerous are his secondary social engagements. While serving his mandate. is chairman of the first SMC and his "Temporary rules …" are in power . Koltzov. Dr. Outpatient team.former.. they couldn't be proven and he is interned … in his birth place of Bebrovo. Svetoslav Milarov. Guy de Mopassan. Flobeur.also.Platon.. this being a condensation from a book by Prof. working as a mobile ambulance sanitary hospital /MASH/ in the hills of Slivnitza. Dr. namely . with strings. First chairman of the Bulgarian Medical Association /1901/.e. Editor for the first bulgarian medical journals. like. Karl Reklama. Saltikov-Chtedrin. Chekov. Stanislav" II degr. Dimitar Mollov is back on the political stage. but. The accusations are to be an accomplice in the murder of finance-minister Christo Belchev.29 June 1884. The year is 1894 and Dr. Toma Georgiev & Alexander Karagyulev/ and some one dozen other people put to prison. Last but not least. "St. the People's Party submit his candidacy for mayor of Sofia. . to persecution from the cabinet of prime-minister Stafan Stambolov. Alexander" III degr. 5. 1878" . 2. Associate /1881/ and full /1884/ member of the Bulgarian Academy of Science . a boost event for the time. Mollov has not always been smooth and easy.further. "For Civil Valor" II degr. 4. Meanwhile. Zolla. 3. etc. from 1895 to 1897. Hayne. with the organization and administration of the "Bulgarian Red Cross". This time. The trial. "St. carrier of many medal attachments. as a member of the parliamentary committee investigating the illegal actions of Stambolov's government. with respect to our primary orientation to public health issues. as a member of the governing body and as one of the few qualified surgeons at that time in Bulgaria.until 1903. Bulgarian Literary Association. Pushkin. 2."Hygiene. "Bulgarski Lekar" and others. we will briefly give account for the important ones. Dr. namely. Bayron. Goete.

. Dimitar Mollov dies on 8 January 1914 in Sofia.Dr.

Dr. His family stems from the big Hadji Kirko's genus and is far-away relative to famous penman Ivan Vazov. Kirkovich always suffered from inadequate material circumstances and until 1860. banker Ivan Evstatiev Geshov and bishop Panaret. namely: 1."masters" P. Its principal duties are to keep the roads and bridges in proper repair. 100 kilometers east of Moscow . in his bestseller "Under the yoke". has such an assembly and such a bureau". Kirko Kirkovich graduated medicine in the year 1870. in Sofia during that times. he becomes a bursar from the "Slav-Bulgarian Committee". he spent 10 years and became a Russian citizen. G. The town of Orel is situated.Geshov remarks: "We lost our best man". in his life Dr. Chr. 2. as the turks called Sopot. D. Hasan . Leipzig: Bernard Tauchnitz. he marries to Rada Gugova . Kirkovich leaves Plovdiv and transfers to Sofia I.niece to famous enlightener Nayden Gerov. Dr.A BURNING DAYLIGHT TO DR. has described a beautiful picture of life in a 19 th century bulgarian town ."Akche Klise" or "White Chapel". some. for some time he was volunteer in a trade company at the city of Plovdiv. Danov. viz . the second son Stoyan becoming famous professor of internal medicine. Gorbanov. there were only two physicians working. which. II. he spent the next two years as a "zemski" doctor in Orlovska gubernks. Dr. The young family have three children. into which the province is subdivided. D. Anyway. "Russia. he becomes active participant in community life and in the upsurge of Enlightenment culture. to provide means of conveyance for the rural police and other officials. in the end of 1874. Naderne from Moravia. Mackenzie Wallace. left tributary of Volga. who. KIRKO KIRKOVICH Kirko Kirkovich is born in the town of Sopot. Dr. "booksellers" Chr. Subsequently. is standing for the Russian Consulate in the period from 1857 to 1877. fighting with misery. V. we see him settle in Plovdiv for a position of private medical practice. From that time he wears a beard like the russian "raznochintsi" . cf. to look after primary education and sanitary affairs. "The Zemstvo is a kind of local administration. etc. to elect the justices of peace. On 2 September 1873. Pavlov. In Moscow. Kirkovich is welcomed by the bulgarian high-life in Plovdiv.on the bank of river Oka. whatever seems likely to increase the material and moral well-being of the population … Every province /"guberniya"/ and each of the districts /"uyezdi"/. Kirkovich will be back in the town of Orel but for the moment.. Then. Manchev. 1878". among the others. Further. Here. individual communes cannot possibly satisfy.to make a difference.E. supplements the action of the rural communes and takes cognisance of those higher public wants. Dr. Blagoev. vol. But. in 1872. year 1840. Whatever. Young Kirko first studied with the grammar school of daskal Yordan Nenov in his birthplace town. when. however hard he worked. to watch the state of the crops and take measures against approaching famine and in short to undertake. within certain clearly-defined limits. Here is what I found written about "Zemstvo" in a book by traveler D. When. etc. The later. which.

Sometime. Kirkovich moves back to Russia and with the help of council Nayden Gerov. First. Permission for Austria-Hungary to occupy Bosnia-Hercegovina. Rada Kirkovich was the real support for the family. Traikovich and others.where he has started his medical carrier. already. Kirkovich.e. being a russofil and wearing a beard. and Dr. From that time on. unequivocal. Soon after his arrival and Dr. Kirko Kirkovich. Thus. that this led to the Treaty of Berlin /July 1878/ and its major accomplishments.. The conflict elevated from the "sandjack" of Bosnia-Hercegovina. Hadjikotev. so called. he was in a constant contact with patriots. Unfortunately.Bey from Anatolia. Dr. namely: 1. Independent principalities existed in the region since the 14th century and the revolts from 1875-8 assumed the character of a national independence struggle. In memoriam . It is narrated. yet. Kirkovich wishes to spent his last days in the town of Orel . It was a time when motor vehicles were not existent. in early 1876 begin the uprisings in South Bulgaria or. around the place of now-a-day "Vuzraghdane Square". there. 2. The end was. "April's Uprising". Dim. who. also. Second. vividly. A woman of extreme education . Here. Within the context of our story we continue by mentioning several facts. Dr. until his death from tuberculosis. life proceeded in constant suffering for Dr. He manages to run a private office and a drugstore with a pharmacist . with the starting of the conflict on the Balkans Dr. Kirkovich had to make his round-abouts on foot.situated. In the last days of her ill husband.graduate with gold medal from "Funduklii Gymnasium" in Kiev /1866/ . Division of Bulgaria into three parts. beforehand. has a prosperous clientele. he is under the auspices of benefactors Sava and Yordanka Philaretoff but. "tuberculosis" or "scrofulosis" /i. accounted. for Dr. for the complex religious and ethnic structure of the region. Kirkovich lost a tolerance from the side of the turks. 3. Mass conversions to Islam and its intermediate position between Catholic Croatia and Orthodox Serbia. and Dr. great turmoil stirred on the Balkans. After a short stay in Odessa and living with the immigrant community. Kirkovich. by his wife Rada Kirkovich in her "Memoirs". Kirkovich appears to be the first bulgarian doctor working in that town.she was one of the first woman-translators in Bulgaria. Recognition of the independence for Serbia. He died on 22 October 1877. in a situation which threatens his life and that of his family. Third. We will mention. with the honors from "chorbadjii" or "nobleman" such as Dim. about year 1875. Montenegro and Romania. the old name of the disease but almost synonymous in symptoms/ was untreatable for that time and most patients died from pulmonary consumption. demanded from him to serve as a link in a revolutionary setup.

having an orientation towards humanitarian sciences. ATANAS GRANITSKI Atanas Granitski. four students were sent from Kotel to Tzarigrad to continue their education. in the town of Kotel or "bulgarian Kazan" . . he was "kaymakan" in Moldova.DR. arabic. rendered a trust to the city council of Kotel. he was principal in "St. Atanas "Pop Petra" Granitski. latin. let us make a containment. and. we see Atanas Granitski in the role of a "school teacher". Thus. Granitski entered the "Military Medical School" at Galata Saray. At that time "prince" Stephan Bogoridi /1775-1859/. sometime about year 1859. Now. c. namely: Gavril Krustevich. It is well known. english. we present our pros and cons later in the story. Granitski fell in neglect. first. Later. Georgi Rakovski. forgot about his origin and contributed greatly for the cultural-spiritual advance of the bulgarians. Tasse Nikolaevich will sponsor some of his book publishing . he suffered from a depression and after a short illness died 23 May 1879. representatives Konstantin Nikolaevich. b. Some of his students recount. In order to make a living. This bulgarian with a "fez". and.italian. He had also a brother. he was "bey" in Samos Island. in the town of Sliven. who. we don't know. All we know about the family of Granitski is scarce.Shumen /1859-1863/. Granitski showed a gust with studying languages .as they called it and not to be mistaken with a russian one at the tributary of the rivers Volga and Kama. there. More than that. he was in disfavor with the turkish authorities in Tzarigrad and left the capital. After the Liberation War /1877-1878/. before we continue. there. who.a sign for gratitude to bulgariandom. Only. once made a big carrier in the High Porte . born 1825. He was the son of a priest /"pop"/ Petar. he was "tanzimat" member to Sultan Abdul Medjit. stayed as a proto-singer in town. How long he studied. and. that. About year 1848. Marin Russev /1864-1935/. Turnovo /1864-1877/. Atanas "Pop Nicola" Izvorski. that. and.a. fellowcitizen and grandson of enlightener Sophroni Vratzanski. not pretending to stir "art of the soluble". While. entered the "International College" at Kuru Cheshme. Lovech /18631864/. never.ONE MAN SHOW . Supposedly he had a daughter. Thus. one time was a teacher in the town of Svishtov or so. greek. married the eminent scholar and organizer of health care in Bulgaria Dr. his daughter attended him to the funeral. who. Bogoridi studied diplomacy. Obviously. Granitski was teacher for long years . etc. In the data we could gather about Granitski. no sure evidence were found whether he graduated medicine eventually. Next. Specifically. Young Atanas Granitski. due to his guardianship. His fluency in communications gave him chance to start part-a-time work with the "Serbian Legation" in Tzarigrad. language tuition was honorary job in many a "class-rooms" in Bulgaria. Cyril and Metodius Grammar School" in Turnovo for 12 years. Atanas Granitski received his primary education in his birth place town.

So far. theology. we see an unhappy life for one of the most productive writers in the MiddleBulgarian Revival. but. Hippocratic aphorisms. while. 3. Pirovo. and. as first manual on practical medicine.d. In: Tzarigrad Vestnik. Granitski is excellent medical encyclopedist. We shall give some account. This is a critique. head. literature Granitski wrote on medical themes: 1. Constantinople: Tadeos Divichian Typographers.e. philosophy.original . Second volume: on materia medica /i. understandable both to professional and non-professional. First volume: on pathology of the human body. vols 1-3. Written in the early epidemiologic tradition. dietetics. outdated its time with some hundred years. The importance of this work is threefold. the latter has been still in the bonds of quacks and charlatans robbing the population /"ignorance"?!/. also. "On the modes of cholera. 534 pp". Includes.from Granitski. technology of the drugs/. extremities. etc. Third volume: on practical aspects of anatomy. namely: i. written in verse. possibly. ii. iii. against quacks and empirism in medicine.evident from 8 figures in the text drawn from the translator.medicine. and. Gets a severe response on the pages of the above-mentioned newspaper. neck-thorax. having no real scientific value. good artist . with. etc in the light of system diseases. himself. bille-bozadji hekims.". . a pharmacopoeia. rather than. and. etc. Could this book. № 266. as a book written in philological correct bulgarian. Translated from italian work of Prof. "Practical Medicine. as an early attempt to organize a bulgarian medical nomenclature. This is a capital work for bulgarian medicine. who. eyes-nose-throat. 1854. Tzarigrad: n. writes in the introduction: "Better not write a book. write something that will send you to condemnation" 2. an introduction . "Reflections on greco-arnaut maggus. second introduction from the author. A long list of more than 30 books came out from his pen . be written by a non-medic? Let us give the answer to the translator. hygiene. physiology. about. art. reference. November 1856". which. viz. fiction. commerce.

by the good will of the sultan. and. when. He was. that has not involved the name of Dr. from the first days of his arrival as a medical practitioner. rejected the archmandrite Ignatius . those who are converted bulgarians. who. because.DR. while. we see Strumski enrolled as a medical student in Athens. By far. Dr. He was one of the few practitioners. he is the first health care manager for Bulgaria. Sultan Abdul Medjid died at age 39. He was subscribed for the newspaper "Danube's Swan". In year 1839. Other bulgarian representatives for the "church question" . also. Dr. Cairo's school on the Island of Andros. at that time in the sandjack of Northern Macedonia. Even. In the mist of ignorance. Some 10 years of age.. in the 50s and 60s of the century. Zachari Strumski is his attitude towards hospital organization in Tzarigrad. His compatriots from Kyustendil. who. he was registered as a student in T. Whatever.". The only other bulgarian in that period . from alcoholism and sick lungs. Strumski excels as a an able physician .e.. Zachari Strumski settles in Tzarigrad and makes a medical residency.in Tzarigrad are: Dr. He got this position. that. the most important activity of Dr. There is hardly an event within the bulgarian community in Tzarigrad. We shall continue to pay attention to this canonical struggles. he spent his time "feasting-and-drinking". Strumski takes the position of a mediator in the conflict . In a way. is believed to belong to the "karaman greeks" /i. a young boy from Kyustendil cf. In the capital of the Osmann Empire. He is keenly interested in the bulgarian affairs.1820.the year 1961. buying a house in the good quarters of the city. supposedly. he was a permanent resident in the capital. published in Belgrad by Georgi Rakovski.. Ivan Seliminsky. More probable is the latter as concordant with an age 18-19. the greek bishop Artemius at town takes care of the son of poor parents. in our articles. this is the early age curriculum of a doctor. The latter had deserved the nickname .he was consulted by the bulgarian colony there and by foreigners. within and without the boundaries of the enslaved homeland. from there to Paris to get a diploma in 1847. following with deep concern the conflict with the Greek Patriarchate . Ultimately. Sometime about 1847. Strumski was privileged as ". etc."the sick man of Europe" because. Christo Tpcheleshtov. At that time .a doctor with "karaman" type of descent is Dr. as well. deserved the honor to privately treat the Sultan Abdul Medjid in his palaces at "Top-Kapu Sarai". and.as his schoolmate G.. he realized that . Georgiev recollects Zachari Strumski deserved the post "chairmen" of the Secret Slavobulgarian Committee. Dr. Zachari is sent to continue his education via Tzarigrad to the Archipelago Islands.. Stoyan Chomakov. their mitropolite Avxentius should be sent a representative in Tzarigrad. ZACHARI STRUMSKI The year of his birth is debatable: some say 1815.appointed from Greek Patriarchate .and insisted. others .the "Phenere Machala" in Tzarigrad. Dr. a skillful physician and a good patriot . Nicola hadji Minchooglu. further. Zachari Strumski.A BULGARIAN "JATAG" IN COURT OF THE SULTAN . but could hardly speak or understand their mother language/.

Thus. However. Dr. had two daughters and a son.B. Tzarigrad Vestnik from 1853. to attend a dance ball on the Island of Chalki at 20. he transfers to Paris to continue his education. From 1869. churches and schools . also. and. he writes a series of articles in the "Tzarigrad vestnik". Strumski as a medical essayist and translator. "The seven races of man". etc". 3. evident are two letters form the russian consul in town Alexei Lobanov-Rostovski . Tzarigrad Vestnik from 1856.and the german community in town immediately raised some funds for building a hospital. I.namely. there was a scandal in Tzarigrad regarding the death of two german citizens.Dr. "Manual on Hygiene". help from the euphoria of Eulogy Georgiev. E. As a "karaman" type. only the bulgarians don't have a hospital".while. he could not read or write bulgarin. "On how to prevent from hair loss". Tzarigrad Vestnik from 1856. Eugene Choll. "his compatriots are more interested in material and spiritual investments .namely. the name of Dr. All his articles are written in turkish language. but. ignoring the fact that a sick person don't care about whether he can read or write or going to church. Zachari Strumski communicated directly with the medical manager of the german hospital in town . remained relatively unknown to the bulgarian public . in the long run. 4. Orphille. Stephan Strumski. attended from 1867 a Medical School in Tzarigrad. In year 1851. his son. Zachari Strumski was a man of good character. namely the need for a hospital. and 03. "Manual on Snake Poisoning with instructions for self-treatment". He was respected by his compatriots and fellow citizen. "good health is a fundamental for the wellbeing of human life". Tzarigrad Vestnik from 1852. We shall give a short list from his most important works /N. He insisted that. "his idea for a bulgarian health establishment did not held a good reception". They died because. with. 1860. For the good disposition of the foreign community. Strumski writes with disappointment that. II. Later in the same year Dr. Immense are the contributions of Dr. Tzarigrad Vestnik from 1851 . as well. all his works are dispersed in issues of "Tzarigrad Vestnik" from 18511861/: 1. he mentioned that "from all nationalities living in the capital. Here is a place to make another point. after the death of his father. an important publicist. on the pages of "Tzarigrad Vestnik" which is a bilingual edition. when. rector of medical academy in Paris. some 40 years later the idea for a bulgarian hospital is realized.his writings widely popular from his time await to be translated in bulgarian. "from lack of adequate sanitary conditions" . 5. Zachari Strumski remains as a first benefactor for hospital care in Tzarigrad. In this writings. Well. This articles are given at a time. 2. This .his compatriots are suffering from lack of organized health care. "Magnetism and spiritism".translation from a book by Prof. He married a lady from a British descent. Dr.

Zachari Strumski. Strumski . Dr. At the funeral. on 20 April 1869..28. . Z. 1871/. dies the wife of Dr. he dies on the barricades of the Paris Commune /18. Christo Stambolsky writes in his memoirs: . was not present in town . came the gruesome news for the death of Dr.brave young man could not live to see the liberty. . dies a devastated Dr.he was on a military mission in Anadola. In memoriam. the wives of Nicola Minchooglu and Constantine Raynov. Four years later.. Strumski. also. that at the same epidemics perished. The funeral service comes to an end by mitropolite Ilarion Lovechki /1802-1884/..at an effort to save the suffering with the English Red Cross mission. thousands of people come to give their last tribute. During the cholera epidemics in Tzarigrad at 1864. The russian newspaper "Vremya" writes.. Dr.V. on the edge of Easter. He was a long time activist on bulgarian affairs in town . III. The greatest chronograph of the bulgarian life from that times in Tzarigrad.". there. Strumski. himself.

. Constantinople and at home were represented by the Benevolent Society and by the Bulgarian Trusteeship in Odessa. spread throughout the Bulgarian lands and involved the emigration in Romania. studying medicine and graduating in year 1848 with a doctorate. and their views are recorded in the periodicals and in a number of programme documents of the Revival Period. Political liberation of Bulgaria was set as the key goal of the struggle. p. Further. The next five years are spent in Paris.year 1849. he excells as a physician in the Russian Army at the battlefields of Romania." . which..at Andros Island from 1836 to 1843. founded in 1854 as a Central Bulgarian Trusteeship/.Dr.10 March 1821.. 1985. Georgi Atanasovich is born in the town of Svishtov. Information Bulgaria. Dr. The latter co-edited. Roughly from that time begin. namely: "De l'hemoragie uterine dependant du decollement du placenta. either diplomatic or military. Various social and political forces were active in the liberation movement. with Neophyte Boswelli. His primary education Georgi received in town.MEDICAL PROFESSOR IN ROMANIA We have the privilage to present the first university lecturer for Bulgaria. Heterogeneous in social composition and inconsistent in its political outlook. we shall give a slight touch by what is written in "Bulgarian Academy of Science /editors/. The Russophiles. among the "haute bourgeoisie" in Romania.GEORGI ATANASOVICH . Sofia-Oxford. consideree dans les derniers temps de la grossesse et pendant le travail de l'accduchement". Georgi Atanasovich continued his education in the school of Teophil Cairo . Russia. These placed their hopes for Bulgarian liberation chiefly in Russia's intervention. Russia. another occupation of his and which make him even more well-known . and flow parallel to his medical carrier. Georgi Atanasovich started a job as a toxicologist in Bucarest .. once the international situation was right. they objected on principle to all revolutionary methods .B. 189": ". While there are many pages written in bulgarian history regarding the Benevolent Society. Serbia and the Bulgarian colony in Cinstantinople. at the river Danube . with the distinguished revivalist and pedagogue Emanuil Vaskidovich.. six volumes of "The Slavbulgarian syllabus for children" which was published under the auspice of serbian prince Mikhail "Milosh" Obrenovich in 1835. Atanasovich become member of the Benevolent Society /N. During the Crimean War /1853-56/.

take the position of adjunct professor of obstetrics and gynecology . Let us return to the medical activity of Dr. G.e. his signature is evident on many of the official documents of the society . Dr.this gentleman is not a nice guy. Slovenia. "On the organization of infant hospital".an institution with international recognition. It was a time of everlasting enthusiasm. viz. he was a middle-aged man with greyish hair. This organization would later become known as Bulgarian Literary Association . "Forensic medical expertise".".. he is appointed Minister of Education in the government of premier Todor Burmov. finaly led to the accreditation of the Bulgarian Academy of Science in 1911 . which.. the so called "Matitzas" of Serbia. Latter.. distinguished bulgarian diplomat from the first half of the 20th century. this is a job to be done by the archivists. Atanasovich published during his Romanian period. we are not in a position to further elaborate on Dr. how.At this point. without department or salary. published in Sofia . and around him on two other chairs were the clerks. I understood that the minister is someone Dr. Georgi Atanasovich. a man with a clasical school of education and who has left the sure thing in a medical practice with a . to establish a cultural center with educational purposes. a statute of the association is voted in Braila. vol. Naturally. Atanasovich from Svishtov. There was a minister sitting at a table." In reality. The liberation of the country find Dr. all of it in a single room..else.35: ". Chroatia.namely. I went in the Ministry of Education. although. Atanasovich's activities as a member of the Benevolent Society. which. on page 22: . true patriot. Continuing with his political agenda. 1" by Konstantin Yiretchek. Czekia. together with other emminent bulgarians in Romania. he is not directly elected as a member of the syndic. whiskers and moustache. member of the Supreme Medical Council of Romania and until year 1879. formerly professor from the Medical Faculty in Bucarest. much like a turkish pasha. we find his name in the efforts to make scientific contacts of the newly found asociation with another "Slavic Academies". we shall give an extract from the memmoirs of his relative Petar Neykov. Enough is to say. as well. From 1858. Dr. Neverthless. From 1869.1959. From 1856. The latter narrates in his book "Yesterday and the day before yesterday . My first impression . i. From July 1879 to November 1879. etc and all of them written in Romanian. It is amazing. etc... Here is what we find written in the "Bulgarian Diary. when the Russian-Turk War from 1877-78 is waged. with a small stature but with obviously important behavior and all the time looking sharp eyed.. "Poisoning with arsenic". My uncle exceled in his efforts. Atanasovich a man of high prestige. that. On the epidemics of dyphteria from 1872".considering the fact that he was overburdened with political engagements.. p. he is appointed professor of pathology in the "Bucarest Medical School". Atanasovich was an active member of the founding fathers of the association. versatile is his work in the medical field . There are a number of medical articles. he is among those who join the chief command of the Danubian Army. I understood that he was of pure character.. when. the long time desired dream to have their own cultural institution was realized on 29 September 1869.

carrier as a diplomat .to be later voted in 1888. In memoriam.. Adjunct /1881/ and full /1884/ member of the New Bulgarian Literary Society /BLS/. Alexander III" /1885." We shall try to give some final touches to the portrait of this great bulgarin. with ill health.. Rewarded medal "St. . From 1883 to 1885 he was chairman of the Third Medical Council in Bulgaria. which cost him not a few and the loss of his pension .something. Introducing a project for a Sanitary Law . Owner of a rich personal library . He dies on 26 February 1892. The last years of his life. he spent with his family in Bucarest.donated to the BLS.

From that period of his life. However.settled in Turnovo at the nearby village of Arbanasi and started a business as a "beglikchia" or tax collector on cattle. Piccolo. Atanasovich. where. the full stardom of our subject for this narrative is associated with the work for the Medical Faculty of Bucharest. Dr. from the mother's side he is relative to well-known bulgarian academician Dr. he is chief ordinator in the "Murkutza Hospital". Bucharest . They come from the town of Kratovo. With a diploma in his pocket and a solid load of medical knowledge. a romantic poet with dreams for "messianic" restoration of a great nation for the Poles. He studies well. with the help of his uncle Dr. where the family name come from. During the Crimea War /1853-1856/.with a major in psychiatry. Much like his colleague and friend Dr. After the war. he works in the home front and is responsible for volunteer recruitment. In year 1850. in Macedonia. Protich starts a job as a sanitary inspector for the "Muntenja Prisons". Dr. chapter in biography list/. hence. first thing first. i. mention deserve contacts with polish emigrants and Adam Mickiewicz /1798-1855/ .a free state at that time with better opportunities for work than Bulgaria. Let us elaborate on . external pathology as the discipline was recognized from that time. supposedly. This company left a reflection in the life of the young scholar. makes him the first bulgarian with a degree in mental health. One of his sons Dimiter . Next year we see him transfer to Paris. Petar Protich was born on 12 March 1822.e. while. Nicola Piccolo /cf. From 1854 to 1860.SECOND MEDICAL PROFESSOR IN ROMANIA The genealogy of the Protich family is fairly old. the young doctor settles in Romania . an is consequently admitted a student in medicine from 1844. Protich becomes a member for the Benevolent Society of Bulgaria. The grand-grandfather was "prota" or senior clergyman in town. Petar is his son. he is executive for many missions of that pre-liberation patriotic organization.. in Bucharest. Petar Protich is appointed professor of surgery from 1857. Dr.PETAR PROTICH . studying for a medical degree until 1852.specifically."The Miracles of the Virgin Mary" from Yakim Kurchovski. Now. The grandfather served as a bishop in the nearby Lesnovsky Monastery and was sponsor for the first old-style bulgarian book from the district . His primer education is received at greek school in town and from year 1839 we see his as a sophomore in Athens Gymnasium. Petar Protich graduates medicine with a doctoral thesis: "Des phlegmons de la fosse iliaque interne". there. which.

initiated Romanian higher medical and pharmaceutic teaching. 1970.the topic for a while.." ". Iacob Felix. He was assisted by the hygienist Iacob Felix. The union of the Principalities and the double election of Alexandru Ioan Cuza as sovereign both in Moldavia and Wallachia /January 1859/ did not result in an immediate and automatic unification of the public health services of the two Principalities. the energetic and clearsighted Carol Davila /1828-1884/. He published two collections with poems. after 12 years of important achievements.waiting to be reanalyzed. Protich's career is concerned.. a university institution entitled to confer the title of doctor of medicine and surgery . some.holding a position as a department head in the Faculty of Medicine. The National School of Medicine and Pharmacy of Bucharest. Bucharest: Meridiane. etc. where. He was member of the Medical Council of Romania .. of which he was a brilliant exponent himself. the union of the Romanian principalities /1859/. established the organizational framework of modern Romanian medicine and paved the way to the following period of scientific creation in Romanian medicine.B. p 21. Possessing a comprehensive understanding of the tendencies of his time and of the aspirations of his nation. founded in 1857." Insofar as Dr. namely /N. became a renowned centre of medical teaching and attracted students not only from all Romanian provinces but from other Balkan countries as well. was an ardent poet as an influence from his Paris education and contacts with polish emigrants. This period of the organization stage in the history of Romanian medicine is called the "era of Carol Davila". He was editor-in-chief of the scientific journal "Romanian Physician". Protich. namely: "B. In September 1862 the office of Director General of the Public Health Service in the whole of Romania was taken over by Carol Davila. in his romanian period. from 1869. further points are of special interest. The data is taken from. out of 188 students 46 were from Bulgaria. many articles were published with his collaboration. Dutescu and N. the National School was substituted by the Faculty of Medicine of Bucharest. The period also represents a decisive stage in the development of medical teaching in Romania. the Land Reform Act /1864/ and the conquest of National Independence were the main political and social events that formed the background of these decades of important achievements in the organization of public health in Romania. In 1861/1862 for instance. The revolution of 1848 in the Romanian countries. those works written in romanian have received by now an undeservedly small attention . The first step in this direction was taken in the decree regulating the free medical practice in Wallachia and Moldavia /28 January 1862/. In 1869. especially Bulgaria. successfully reorganized and unified the military and public health services in the Principalities. assisted by physicians with advanced ideas.. those verses . Marcu. Dr. Romanian Medical Science. who devised and applied an ample programme of public health reforms with a view to unifying the public health offices in Moldavia and Wallachia and at the same time achieving definite progress in public health protection. Unfortunately. such as Nicolae Kretzulescu.

Radulescu. we see Dr." . when. "La voix de Bulgarie. Further. On March 1879. The Russo-Turk War of Liberation find the old tycoon in congratulations for the Bulgarians. on 1 February 1879. The FMC during the provisional Russian administration has the following participants. Anna. Assen Shishmanov. the work of the medical council during the period 1879-1880 is a subject of separate study. namely: 1. This is what prime-minister Todor Burmov says on his funeral: ". he had any children. Yordan Bradel. He dies from stroke on 24 September 1881. Protich as a medical resident in Sofia from 1879. prop. Protich continues his activities among friends and relatives. to be a towering personality was something unthinkable specifically. Dimitar Kalevich and Dr. now the Bulgarian Academy of Science /1881/. Bucuresti: Nouva typographie nationala. Before that. 1879".. Konstantin Bonev. 2. C. We have no information. N. Bucuresti: Nouva typographie nationala. he get married by that time and if so. Dr. who. prop. He was a fair man in times. Dr. He becomes adjunct member of the Bulgarian Literary Society. C. however. are ratified the so-called "Temporary Rules for the Medical Service" /cf. Dr. for a man of medicine . Dr. 1875". I see in his bibliography more poems published earlier in "Tzarigradski vestnik" about 1857. these works are difficult to obtain in visu. council members. whether. Dimitar Mollov. III degree".. Nevertheless.. made his living busting and toiling.were written in french and romanian/: 1. Dr. After retirement from the work with the council. Radulescu. N. Else. chapter in history highlight/. Dr. Stanislav. He is awarded with medals "St. Petar Protich. He was one of those rare bulgarians. "Poesii. IV degree" and "St. whether. he is appointed member of the "First Medical Council" in the Principality of Bulgaria. chairman. 2..

So. notably Marin Drinov. Bucharest in the 60s was a center for the national-liberation struggles of the bulgarian people. with his graduate medical diploma. Another famous bulgarian statesman and writer Zachary Stoyanov . Probably. head is Prof. From 1864.. There he enrolls as a student in the High Medical School. he performed well there. where. and. we engage very little in literature questions here and our aim is to give brief autobiography sketch of some eminent bulgarian medics. these. Such educational centers were something new for the bulgarian revival period. that... he was a corresponding member of "Branch for Natural and Medical Sciences" from year 1869. Nacho Planinski establishes for a private practice in his native town. Fact is. Some people from his Bucharest period witnessed. together.accordingly. supposed to be the first memoir book in the bulgarian literature/.. In the year 1870.NACHO PLANINSKI . From 1875 he is full member but after liberation period he neglected his activities with the Society. S. Carol Davila. In the town of Stara Zagora he completes some classroom studies until his age of seventeen. Planinski becomes one of the co-founders of Bulgarian Literary Society in Braila. Rakovsky introduces him in the circles.A MAN OF NOTE Nacho Planinski was born on 20 July 1847.the so-called "chitalishte". The local town leaders "chorbadjii" . with a stipend from the church syndics in town. Whatever. He always emphasized that. deservedly Planinski is acclaimed one of the forerunners for this small scale educational facilities . he is send for medical studies in Bucharest.harm with his medical practice. he left more traces with his public activity in Romania.e. soon young Nacho Planinski begins to publish a fly-sheet with revolutionary content. in this classroom. Dr. for the progress of the whole humanity . for reasons unexplained by the historical community. that. this is from the words of great bulgarian statesman Stilian Chilingirov. a legendary fighter for national freedom and author of a book with memoirs. Vassil Drumev and others. from his "Notes about the Bulgarian Uprisings": ". Dr. However. In Stara Zagora. chemistry. Noted revolutionary like G. he had served medical aid even before finishing his medical studies. He becomes the initiator for the establishment of a local community center with reading rooms .the latter.. Nacho Planinski served his compatriots with making presentations on various topics in the fields of physics. as is evident by his "Forte Binne" award on his graduation. We don't have much information about Planinski's achievements as a student. he stays for two years but disappointedly so.narrates about bulgarian "chitalishte" in Bucharest. and." With some friends of his. some people still live in the age of barbarism and that the only way out from this stage is to work "hand-in-hand". etc. notably the "My traveling on the Balkan Mountains" /i. hygiene. Planinski devotes to other activities . sociology. These are people from the rebel detachment of voivoda Panayot Hitov .

he is granted deserved honor for the rest of his life. However. the play "A tormented Genevieve" and some other plays. also. Planinski is back in Sliven. He also engages in some educational activities in the local "chitalishte". Dr. The initiated protest meeting demands. the lady advocates in front of the liberal government of Gladstone namely. those pezevenks /i. here. Planinski argues that the doctor has been helping all people suffering from the disasters of the uprising. and. he is arrested and sent to trial in Tzarigrad. On 24 December 1876. tough for dwelling. Dr. to send thousands of pounds sterling to help the victims from the uprising. His most well-known enterprise is.also. that is "Long live the Sultan". He stages and produces.. hardens the experience of the doctor. it will be possible to give a fuller account. The Sliven's "myufti-sarafin" Ali Bey attends the meeting. And. luckily Dr.with money and medical consummative . But Dr. Dr. the bulgarian bishops shouldn't be sent to exile . But the prosecutor Saduk Bey is firm in his accusations. The literature for the protest of the English government to the atrocities of the April Uprising is vast. Sometime in December 1877. The date is 28 January 1872. But. notably. saying: ".and most of all to drama. evidently turks who had also been wounded by the rebels. Planinski and Mihail Ikonomov are two bulgarians. Dr. he is known to have accepted for treatment some wounded rebels in his own house. he is among those who renders help to the rebels . This time he receives a good welcome from the town community. and. Even from the first days of his arrival he is involved in a political event with the bulgarian eparchy in town.e. being greeted by the crowd with exclamations: "Padishah chock yasha".the town of Sliven. some months after the suppression of the uprising. and. Nacho Planinski is able to practice his profession for 5 years in Sliven. He is considerably young. when. Later.. Nacho Planinski is one of the victims from the uprising. Lady Stanford from Edinburgh is visiting the town of Sliven on occasion of the reported atrocities with christian population. traitors/ helped the commits and are dangerous for the empire. dare to join the group of Lady Stanford to the demolished village of Boyadjick. Maybe in some other expose. With the signing of the San Stefan treaty. in 1872 Nacho Planinski transfers to another bulgarian town with good revivalist traditions . to a sultans "firman" from Tzarigrad. Further.". Planinski is enabled to practice medicine in that remote place and that makes it easier to await the victory of the russian army in the ensuing war. the defense of Dr. Like many other significant revolutionaries.accordingly. who. and. Together with another 20 bulgarian notables from Sliven. For his work. for some time an advertisement for his medical skills runs in the newspaper "Eastern Times". There. and. In the turmoil of the April Uprising from 1876. Dr. elected district physician of the town of Sliven and director . he receives good credit in the bulgarian circles. Planinski never put aside his links with the revolutionary process in the country. that. some days later the order for exile is revoked with the bulgarian bishops being able to go back to their native eparchies. This place. we couldn't list here all the sources. Planinski is sentenced and sent to exile in Mala Asia in the town of Bollu. Ali Bey is flattered so that he sends a telegram to the grand vizier in Tzarigrad.

He participates unsuccessfully for the royal election campaign of Alexander Exarches /1810-1891/.of the city hospital . In the year 1885 is waged the Bulgarian-Serb War. Planinski participates as a sanitary major in this war.based. Dr. we should recommend that a new bibliography is necessary for many of the revivalist scholars and men of letters from that period in Bulgaria. and. Perhaps. In memoriam . This benevolent society have the task to help and organize the network of hospital care in Eastern Rumelia . We couldn't find them catalogued in any public library. he writes a book about that bulgarian public activist. Planinski actively cooperate for the well-being of his electors. After demobilization from war. He also writes profusely in the local newspapers. he is elected consecutively member of parliament for the Third. 2. He participates actively in the public life of the country. Next year. Dr. he is elected member of parliament for Eastern Rumelia /1879-1882/. on the material resources left by the russian army. A textbook of gynecology. Fourth and Fifth National Assembly. Later.only. These books are difficult to obtain. this society is a foundation for the Bulgarian Red Cross. only 48 years of age. IVth and Vth degrees. 31 years of age. A textbook of zoology. on occasion of the unification for the two Bulgarian principalities. Dr. The citizens of Sliven remember him as a men with encyclopedic erudition. Dr. For his courage in helping the wounded. During that period. they exist in the collection of a private person. he is awarded medals "Saint Alexander". Planinski is in the accrediting board of the association "Saint Pantaleimon" in Plovdiv. While trying to be parsimonious. Dr. Dr. Later. Nacho Planinski dies from typhus on 8 November 1895. this is how the public activist Atanas Iliev remembers about him in his memoirs. Thus. Planinski is the one who puts a beginning to organized variola vaccination in the region. Planinski is also author of two other textbooks: 1. The year 1887 is an end for the political carrier of Nacho Planinski.

Dimitar Nachev. The bulgarian population in Bessarabia has been dislocated in the southern part of this region. from the resolutions from the end of Crimea War on 4 March 1856.ON HYGIENE . south . had to withdrawn their forces from the occupied northern part of Dobrudja. right for the moment. it changed the name to "Budjack" . which is in Moldova. It is limited: west .which.which. Map 1: Autonomous region Bessarabia. northwest by the upper Trayan's wall. Both. After the successes of the Russo-Turkish Wars. it became an autonomous region in the boundaries of Ukraine .in Bulgaria and Eastern Rumelia. which. Bessarabia was a Romanian domain .truly. This was certified with an "Emperor's Edict". The region was joined in the new Federation as a part of Southern Moldova. against the protests of the Bulgarians.by the delta of the river Danube. A more lengthy exposition is out from the scope of our agenda. The later was given to the Romanians.by Black Sea until the river Dnestur. And after World War II. called: 'Statutele colonilor bulgare din Bessarabia' or 'Edict for the bulgarian colonies in Bessarabia'. although. The bulgarians in Bessarabia are supposed to be refugees from the European part of the Turkish Empire . But the Bessarabians had their own Governor.nowadays. took part from the second part of the XVIII century /a. showed a negative attitude towards the russification of the region. A new impetus was given after the October Socialist Revolution in 1917. Ukraine . They regard this period the most prosperous in their existence. 1560/. See the geographical situation of the region on Map 1. We shall start with a short description of the region Bessarabia . In a time. 1752/. in the face of Prince Nikolai Bogoridi. However.by the river Prut. comes from the turkish translation of the name. DIMITAR NACHEV We intend to make a small presentation on the life and work of Dr. The bessarabians from that period. the Berlin Treaty from 1878 gave back the territories to the russians. they have retained their bulgarian names. on 29 December 1819 the region was given an autonomy from the russian emperor Alexander I. They do not consider themselves true bulgarians. southeast . corner". and their own nobility. known from historical sources under the name "Onglum" (ο η γ λ ο ζ ). proto-bulgarian and turkish names are derived from the meaning "angle. a westernmost part of Ukraine. when Khan Nogai's tatars came to the region /a. Some of them chose to emigrate back to the places of their ancestors . From 1857 to 1878.DR.a statute which has been retained until now.

when the obstacles have been overdone. He is appointed a lecturer on Natural History and Hygiene. He was born at the town of Bolgrad /or Bolhrad. that he participated as volunteer in the French-Prussian War /1870-1871/. The conflict was imminent after the process for Unification of Germany and the politics of "iron and blood" by chancellor Otto von Bismarck /18151898/. where he graduated in 1873. a coarse woolen cloth/. Cyril and Metodius". Saying the later in front of the bulgarian colonists: "The idea for such educational establishment has existed for some time earlier.Bolgrad. except. Dimitar had his primary and secondary studies at his native town gymnasium "St. In 1865. Let us say few words about this first educational institution for Bulgarians in the Revival Period. The school was accredited on 10 June 1858. he won a stipendium from the local authorities and went to study medicine in Paris. No more information is available on this period of his life.e. see on the map/ . But. it is time to realize our intentions. at the Central Bulgarian School . Nachev. the former Russian government and the waging wars in the region hampered out initiative. probably making their living in the trade with "abbyy" /i. Together with our brothers from the Izmail's region we intend to work hard for the .We made this historical excursion to add some flavor to the biography of Dr. Now. Dr. His family were settlers from Bulgaria. Dimitar Nachev's coming back to Bolgrad is uneventful.in the year 1850. Later he moved to study in Berlin and in Wurzburg. under the auspices of Prince Nikolai Bogoridi..

He practiced his teaching obligations until the year 1878. unfortunately.in fact. D.. outlined in some seven chapters. he gives a definition on hygiene: "Hygiene is a science for the prevention of health. Nachev gives information on the seasonal variations of a number of diseases. that it has been on a facultative agenda and existed to cover a gap in the curriculum. namely: "Health is a mode of functioning for the human body. and signed by Prince Alexander Yoan I. Following. when the territories were given back to the Russian Empire. This may be a theme for another presentation. unreservedly. a school should be situated. Suffice to say that Dr. where. D... The building was ceded to a Romanian Lyceum and it stayed there until now. This period of his life. reimbursements from our colonial lands. It will be impossible within the limits of our exposition to pay tribute on all of them. is poorly exploited in the literature. smallpox... Dr. We return to our work on Dr. 2." The curriculum was regulated under the Ministry of Education. At the same time classes will be ruled out in the vernacular /i.prosperity of our native language. 3. The city of Bolgrad attracted a pleiad of bulgarian scholars in the vicinities of the Central School. Nachev's contribution as first lecturer on a hygienic curriculum. that the clinics of the disease is influenced by quinine. We have appointed. Dimitar Nachev relays his motives for writing the book. Dimitar Nachev started a job on a solid background and a good academic surrounding. In the introduction. Bolgrad Central School ceased its existence. what. He says that it is caused by "miasma" evaporation. whether. is: "Nachev. Bolgrad. Special attention is paid on malaria. From 1878 on. in a row: typhus. he extrapolates on the functions of the human body in a state of health. Nachev was appointed medical director in the city hospital. Moldavian/. from rents at the inn's in the region. namely: 1." Next.e. 1875". On hygiene or lectures for the Bolgrad Central School. . for the support of the academic activities. At the end of the period under survey." From this definition. Central School Printers. rheumatism. from fishing in the lakes of the territories. etc. from taxes on the fords in the region. Bolgrad. school authorities were under the inspectorates of the emperor's court. come the body of the text: Chapter One: Here some basic information is given on the climate and its influence on health. as far as we know. when. After reformation of the school authorities. etc. all activities for the support of a living condition are regularly executed. He argues on the place. his archives still exist in some private library or are withheld by his successors. it should contain a sewage system. His first and only remaining book. curriculum was signed by His Royal Majesty King Carol I of Romania. should be its heating system. and. Chapter Two: Given is a debate on the role of the building construction as an exponent of school hygiene. After 1917 and the Socialist Revolution . Perhaps. It is remarked. at the Romanian Government.

but. Chapter Five: Given is information on the hygiene of sensory organs. riding. He describes some types of sport activity. The question of mental activity is compared as a reciprocal to physical activity. Nachev has presented many popular truths. its quality and origin. Christo Botev. Nachev comments on some functions of the brain. poet and revolutionary. the book received good response from the bulgarian community. namely: swimming. He supports the view that both are on a chemical basis of regulation. but. what should be a regimen for good nutrition. Chapter Seven: Debates the role of sport on the health of the organism. In a time. Whatever. He died in Bolgrad in 1903. Chapter Six: Here Dr. Dr. which are so important for the good education of the bulgarian. etc. . we regret that the scope was too limited for such an interesting discipline. Chapter Four: Water is a separate topic. but. different substances are participating in the processes. Dr." Moreover.Chapter three: Material is given on nutrition. Dimitar Nachev received acknowledgement from the new Bulgarian State. He points out the importance of sleep on the conditions of the living body. commented in his newspaper: "We had the pleasure to read the lectures of our young co-patriot.. fencing. He makes a note on alcohol consumption and its influence on the nervous system. the later knows.. He was associate /1874/ and full member /1902/ of the Bulgarian Literary Society. How is food prepared. which are the different types of food. etc. how to work. lacks the secrets of living.

PART III: OUTLINE OF MODERN BULGARIAN MEDICINE .

Russian Red Cross etc. In February 1878 Dr. Kazanluk. Razgrad.ORGANIZATION OF MEDICAL SERVICES DURING THE PROVISIONAL RUSSIAN ADMINISTRATION The Russo-Turkish War of Liberation /1877-78/ is a landmark in modern Bulgarian history. In the end of June 1877 a hospital with 200 beds is established in Turnovo. The best answer is given by Vidin sanjack physician Dr. M. Independence finds Bulgaria entirely backwards in sanitary conditions. General Gresser proposes that an organization of public health services is commissioned in the country with respect to physicians. Not regarding the short period for ruling of the newly independent bulgarian lands. Plovdiv etc. Mollov. It is so far the duty of the appointed during the war Prince V. Cherkaski to take care of of welfare questions during the advancement of the Russian army. hospitals and pharmacies with attracting local moral and material resources. Dimiter Mollov is given post in Vidin sanjack. On 1 July Dr. Meanwhile and parallel with regional medical administration a special attention to establishment of hospitals is paid. A provisional Russian administration is established for an year and ten months. With the advancement of war general-governor Prince Dondukov-Korsakov takes rapport. Dondukov-Korsakov. A. Stat Antonov takes health care of Turnovo and later the same month Dr. Alexis Christov is physician of Gabrovo. For East Roumelia /South Bulgaria/ it ends on 31 May 1879 when ruling is transferred to general-governor Alexander Bogoridi while for the Kingdom of Bulgaria it is held on 7 July 1879 when Prince Alexander Batemberg receives power from Russian A. It is to him that is due a plan for administering the medical services. His project “Temporary rules for medical administration in Bulgaria” is verified by Prince Dondukov-Korsakov on 1 . The sector for Internal Affairs of the created provisional Russian government deals with health care questions. As a result on 15 August 1878 the latter is commissioned to the provisional Russian administration. the provisional Russian administration of North and South Bulgaria makes deep social. As a whole 26 district physicians are appointed in the newly liberated lands. There are diploma-registered physicians only in the big cities of the country which hardly could supply the health needs of the population. With respect to limited number of physicians an institution of regional /”gubernsk”/ and district /”sanjack”/ care is created. This is priority of Slav Welfare Association. Later hospital facilities are made in Silistra. Three are the basic signs of transformation in bulgarian society: 1/ liquidating the Turkish feudal system 2/ making path for development of trade and commerce and 3/ giving wide political opportunities for the thuswhile mainly peasant masses. economical and political changes which in their entity equal a real bourgoasian revolution. Tutrakan. Stoian Radoslavov is appointed on 5 June 1877 in Svistov. Thus district physician Dr.

functionally it has approximately administrative independence. a Supreme Medical Council is set up which includes four physicians with a minister. To compensate the inadequacy of medical personal a school for assistant doctors /”feldsher”/ is opened with two departments – medical and veterinary. the first 10 days and the rest – for Ѕ Fr. In a program for 6 to 8 months a group of 150 feldshers graduates. First class hospitals are with 100 beds and second class hospitals are with 50 beds supplied mainly from the military resource. Estonia. Bradel /secretary of Council/. however. Himself he declared that credentials for seven years are wanted otherwise he refuses the crown. These are the first steps of a national health care system MEDICAL SERVICES DURING COUP D’ETAT OF THE RUSSIAN GENERALS On 27 April 1881 prince Batemberg suspended the constitution and appointed a cabinet of Russian generals. This is a primer official health document which authorizes sanitary law in Bulgaria. One way or another this political situation persisted till 7 September 1883 when the generals left for Russia and the constitution was introduced again for correction at the Great National Assembly. organization and function of health care. the . Dr. D. People from both gender can be treated for 1 Fr. gives rapport to the Sector of Internal Affairs. Mollov /senior at Internal Affairs/. His post was generalinspector on the medical part together with minister of the Supreme Medical Council. Accordingly. Within the country a hospital network provides treatment with a mixed scheme of repay. This is the foundation for special courses in Sofia. Mirkov /senior at War/. the Supreme Medical Council numbers six members – Grimm /minister/. There are lists of physicians authorized to practice in the country – 78 doctors. from which 55 Bulgarians. In his report to the provisional Russian administration from 14 March 1879 general Gresser remarks that hospitals network function well and it is part of the official Kingdom.February 1879. Turnovo and Plovdiv. First thing the general-inspector issues is an increase of staff: thus. Here some prophylactic tasks are clarified with respect the role of rural and urban physicians. Neyman /a military/ and Dr. He is directly subordinate to the prince while Dr. In 1882 seven additional sanitary laws are issued to complement the “Temporary rules for medical administration in Bulgaria” from 1879. Tegarten /senior at Chemical Laboratory/. The organization on the medical part of the kingdom during the period mentioned above is assigned to physician Ivan Vasilievich Grimm of Derpt. Mollov. per day. chief commissioner at the Council. Structurally it is a body commissioned at the Sector of Internal Affairs. Main points of the new medical services are improvement of legislation. Dr.

General-inspector Grimm succeeded for his short stay in the kingdom to embrace with a noteworthy consistency all spheres of health care. A serious fault in the medical services is lack of scientific associations and a medical community. Meanwhile in the country new hospitals are opened up – six with 50 beds. jurist Gavril Krastevich. It has the same features as that during the Provisional Russian Government and is under the control of the Directorate of Internal Affairs. A library at Alexander’s Hospital is administered and international book exchange started. Subscription is made to 5 Russian. 4 French. Boris Ox as a manager. A necessary step is publishing of periodicals. His indepth evaluations published in “Darzhaven Vestnik” /state paper/ have scholarly character and clarify every aspect of medical services administration. the need for health education. Also dental health care is provided for first time. Another scientific establishment is the Variola Institute at Razgrad district hospital with Dr. First in the list of those allowances is Dr. SANITARY WORK IN EASTERN RUMELIA The Organic Statutes of Eastern Rumelia /1879-1885/ pay little attention to sanitary work. 1 English and 1 American journal. Stephan Bocharov in the field of military hygiene at Petersburg Academy. microscopic. is in a difficult position for he is in front of a dilemma to choose between two opposite sanitary variants. sanitary-epidemiological activities under Supreme Medical Council constituency. 4 German. Head of laboratory is Albert Tegarten and activity extends on analytic. Mirkov and leading article on the antiseptic method of John Lister. According special instructions /”prikazi”/ organized psychiatry. forensic and other investigations. hospital. First leader.sanitary control in manufactures and schools. At the same time on general-inspectors initiative Bulgarian physicians are sent for specialization abroad. 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. First medical journal is “Medicinska Sbirka” /medical antilogy/ with editor Dr. Applied research and preparation of antivariola vaccine is done here. pharmacognostic. Statistics in the year 1883 shows a number of one hundred and thirty physicians in the kingdom including еight pharmaceutists and four veterinarians. According the Russian model health care is totally state powered including ambulatory. obstetrics-gynecology and dermato-venerology help is delivered. etc. Scientific information is scarce. Now a foundation for scientific institutions is established with a Chemical Laboratory at the Supreme Medical Council. four with 20 beds and also in seven towns construction of new hospital buildings is started. Thus from the necessity to choose in november .

instructions to regional physicians. diseased. Greater difficulties are presented by stationary pharmacies – lack of appropriate rooms. 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/. restrain from inspection tours. conditions for establishing a pharmacy. pharmacist and veterinarian. The higher institution is the Sanitary Council consisting of a minister. Turkey which attests a very high standard. Despite considerable decentralization of sanitary work prevailing statements contain good reference for hygienic. communications to the press etc. ambulatory and small surgical activities. Stoian Chomakov for a minister. three physicians. For a six year period in Rumelia the Council resolute sixteen normative documents. Sostrojonek /from 1884 A. Sostrojonek. The Council also includes a balanced staff from professionals with only one foreigner – K. An analysis of appointed medicals in the region reveals 28 district and 6 sector regulars – all of them graduates from France. Problem legislation decrees the statute of general practice physicians. which is half as much the compensation of the sanitary chief. show ethnic preferences etc. The Pharmaceutical Statute from february 1879 regulates strict control from the state. Bogoridi appoints Dr. Accusations against state physicians are unequivocal: refuse medical help to the peasants. dead burials. However.1879 G. Russia. lack of authority to impose hygienic norms. The governor of Eastern Rumelia A. do not control feldshers work. In such information against the Sanitary Council acts according a procedure determined from Director Krastevich /from 1884 superseded by Nachov/ . rules for preparing. professional standing of personal. 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. raports to the Director of Internal Affairs. 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 . communication with hospital base – all in all 17 such pharmacies are established. Approximately 20% from the doctors had to change their working place from two to three times. Naidenovich/.an inquiry commission is created which report leads to disciplinary sanction or denial with facts in the press. unfavorable working conditions are compensated with comparatively high salaries – 1700-1800 grosh. preservation and allotment of drugs. hospitalized. 4 Greek. 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. veterinary control. As a national proportion we see 25 Bulgarians. vaccinations. Main depot for medical goods is Pharmaceutical Store in Sofia and a branch in Plovdiv exists headed by member of Sanitary Council chemist K. Krastevich puts forward at the Regional Assembly a proposal for a Sanitary Law and Statute on the sanitary part. Roumania. Aside from legislature the Sanitary Council elaborates certain materials like statistics for sickness. 3 Russian and 2 Armenian physicians. pharmaceutical statute etc. Compared to the police force dismissals are seldom not so much for political reasons as for lack of professional qualifications.

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.

THE SANITARY LAW FROM 1888 The Sanitary Law is entered at the Vth Common National Assembly in the second regular session /15 October – 18 December 1888/. By that time the “Temporary Rules” commissioned by Dr D. Mollov in 1879 were valid and an annex with seven civil sanitary laws were complemented by Dr Iv. Grimm in 1882. This jurisprudence did not spread over Eastern Rumelia where other sanitary decrees were in order. Now there is a controversy aroused here. A contention is that in 1884 a sanitary law was enforced by Dr Georgy Atanasovich, the then health minister of the principality. However, stenographic protocols from the Vth CNA as well as the anniversary book by Dr M. Russev from 1904 show that such law was non-existent. It is true that Dr Atanasovich prepared a draft but the violent developments from 1885 hampered it being considered and approved. Principal cause for the creation of new law is the Unification of North and South Bulgaria – a tempestuous event in the first decade after the Liberation. There was a pressing need to revoke the outdated matters of the previous law and to provide an even development for the newly built country. Prime- minister Stephan Stambolov who was Minister of Interior as well, remark: I would like this new law to be a better one because it belongs to the bulgarian people and we all feel happy when he is well. Further, the particulars were elaborated by Dr Panayot Zhechev – head of the Supreme Medical Council. It was approved by the National Assembly under title”Sanitary Law” and ratified with princely edict /”ukase”/ on 18 December 1888. With the new law health care is included fully in the administrative apparatus of the state. Within the Ministry of Interior is created a Civil Sanitary Directorate which remains a governing body till 9 September 1944. The membership of the Supreme Medical Council is enlarged. It includes the most able and authoritative specialists with a prerequisite for them to be bugarian subject. The Supreme Medical Council is presided by the Minister of Interior but when he is out from the country – by the minister of the Civil Sanitary Directorate. Supreme Medical Council remains the upmost consultative organ. The Sanitary Law defines the liabilities of county, district and municipal doctors. Also county hygienic councils are created as most important local sanitary authorities which function by 9 September 1944. They include managers of administration and health care in the county, namely: the mayor of the central county city, the county physicians, a member from the county hospital, the county veterinary, an engineer, a pharmacist and a military. First time private medical establishments are regulated under state sanitary authorities. Also first time prostitution is put under surveillance. Official Pharmacopoeia until then is unequivocal – under Russian and Austrian supervision. Afterwards, remains only Russian Pharmacopoeia. Encouragement of drugeries is promoted and mainly by bulgarian subjects. A novell act is deliverance of free health care to poor strata of population. This is forerunner of future totally free socialist health care after 9 September 1944. Meanwhile, article 64 from the Sanitary Law, say: Municipal doctors are liable to take care of poor unwell according to a list of names declared poor in the community, tha t is, those people

should be treated for free. This is not superficial state charitable act. Its a critically considered plan answer to the demands of the needy. Also, special committees are formed in the community enforced to support municipal and private physicians. As far as we know, democratic innovations of such kind are not to be found in foreign sanitary legislation. In Russia sporadic cases of free health care for rural population is encountered in some rich gubernks /”zemstva”/. Working class movement in Germany makes Bismark government to create sick hospital funds but this is inconclusive reform. Free medical care for economically week social strata is introduced fully in Western Europe after World War II. More comments on the Sanitary Law from 1888 show that some proponents discuss whether the law was a copy of the actual one in Roumania. Dr Zolotovich points which exactly clauses are captured from it and what is not just a mechanic translation from a backward social origin from our northern neighbor. In fact, the law reflect the new democratic traditions of Bulgarian system of state. As early as 1861 in Tzarigrad an organization for free medical care for poor bulgarians exist. Not without importance is the mere vigor with which the surviving heroes from the fights for National Revival contribute. Chairman of the Vth National Assembly is famous Zachari Stoianov. Members of parliament are Georgi Zhivkov, Dimiter Petkov, Traiko Kitanchev, etc. The architect of the Sanitary Law is Dr Panayot Zhechev /1853-1903/ - graduated medicine in Bucharest, volunteer in the Liberation War as a battalion doctor in a Romanian regiment. All those people work for the moral and spiritual ideals for which they sacrificed. In 1903 enters another public health law which keeps many of the statutes of the previous one. Toma Vassilov, eminent character and contemporary from that period, writes 50 years later: Sanitary Law from 18 December 1888 gave a new and powerful impact towards improvement of sanitary care in the country.

Without its authoritative chief the perspectives of a political favorite seamed unhappy. because of weakness of monarchic institute at that historical period. we have a new Law which postulates an increase of health personnel and creates generally better opportunities for medical service of the population. The latter is eminent figure in the ranks of the Bulgarian Doctors Association. high mortality rate in hospitals versus home therapy etc. former members of the Conservative Party of Eastern Rumelia . ADVANCEMENT OF HEALTH CARE IN THE ADMINISTRATION OF PEOPLE'S LIBERAL PARTY /1903-1920/ The constitution of the People's Liberal Party unites some of the eminent political figures in the country. 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. Thus. after almost ten years of political lingering. Now. on 05 May 1903 the monarch summons the People's Liberal Party in the government.Stephan Stambolov. Vasil Radoslavov. Instead of 60 000 people per physician a new arrangement is made for 20 000 administered per physician. Finally.from the Sanitary Council shows that most of the hospitals have 10-15 beds with approximate rate of 135 patients per bed per year. The Law from 1903 has its chief architect in the face of Dr. d. Ivan Salabashev etc. a popular hygiene . the national destiny and long-term prestige of the country are put on high stake.Dr. one of the foremost balneologists in Bulgaria and author of many surveys on bulgarian health resorts. Again. Coburg 10 September 1948/. Next. poor hospital environment. The first session of the National Assembly on 30 December 1903 adopts the "Law on Protection of Public Health". Nikola Obretenov etc. 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. This time a new political leader excels .Dimiter Grekov. which revokes the Sanitary Law from 29 November 1888 and itself stays in power for the next 26 years. The assassination of S. a phrase is coined . also. Ivan HadjiEnev. inadequate medical qualification. Stambolov creates a confusion in the Party ranks. Georgi Zhivkov. Zachari Stoianov. In the long run. Marin Russev /1864-1935/. On such a historical canvass it is tempting to present the health care affairs in the country. Ivan Andonov. Obviously that low attendance of hospitals is due to distrust of the system. Vienna 26 February 1861. Dimiter Petkov. taking the helm of bulgarian administration /1887-1894/. For this purpose district constituency is subdivided into sanitary districts /"lekarski uchastuk"/ where physicians and feldshers are appointed according number of residents. the Party establishes a regime contributing to strengthen the political and economic positions of petty bourgeoisie in Bulgaria. however."The king reigns but does not rule over". until. This leads to ascension to the throne of Prince Ferdinand I /b. Among them are veterans from the National Liberation Period . both the king and the premier will end their life in exile.

57% from the gross domestic product. the problem for covering the newly opened vacancies with licensed physicians persists. the health care system is ruled over by the Directorate for Protection of Public Health. In 1905 a modern pediatric detachment is attributed to Alexander's hospital in Sofia. to someone trespassing the sanitary norms of cleanness in the environment and the behavior. The advancement in the Law stimulates the business of medical drug dealers. etc. The process enters into chaos after the country takes part into the tumultuous years of two Balkan Wars and the First World War. Most money are detached for Varna. If separate attention is paid to the absolute parameters of budget allocations distributed by regions. on a relative scale the health budget is alarmingly low . Gorna Bania. the inadequacy for hospital establishment is even greater. On 18 December 1907 the municipality of Balchik is allotted a grant and a terrain for building a healing center at the vicinities of the town. About that time a complex project to enhance the existing hospital base is launched. Varshetz. from the ruling circles. Still. This compels the supplement of the "Law for Protection of Public Health" in 1906. the crude number of hospitals rises from 51 in 1903 to 58 in 1908. their syndicates. competent circles from the country and abroad discuss the opinion that Bulgarian Spas have good future. Merichleri. Further. a department of the Ministry of Interior. in 1902 the budget jumped 3-4 fold in the next year. This being a fact. It is a dangerous step back in case that quality of medical care should failure but education at that time was affordable only from abroad and for a long period of time. . a constitution will be made that from 177 500 lv. Sofia. As a whole. Hissar etc. on 01 June 1904 that the government should rise the costs of medications with average 60-70%. saying that military feldshers and sanitary could work for the civil services. while in some big hospitals with 100 beds. the opposition in the face of the agrarians says: People have been already going to medicine-man and fortune-tellers out of poverty and You. Burgas. Most important advance in this direction was the allotted special credit for building of mineral baths at the spas of Kniazhevo. dare drive him even further by rising the price of medications. Another step is. Shumen districts. On average the logistics is increased by 30-40 beds. which reduces the role of the existing Supreme Medical Council and makes it an appendix to the directorate. introducing for the first time compulsory vaccination for smallpox to children 1-7 years old and youths 20 years old which is administered by a Central Medical Institute for manufacturing of serum. They insist. In the autumn of 1903 the first orthopedic clinic /with a workshop for prosthesis/ is opened. the hygiene councils had the power to impose a fine from 10 to 25 lv. In consideration with the historical period being examined full appreciation by the governing classes was paid to the development of balneologic centers. Meanwhile. While there is a shortage of medical personal. Altogether. Russe.on average 2. For instance.councils /"obshtinski higieni soveti"/ are established on a municipal level with membership from the government and aiming at administrative measures if the need should arise. Bankia. mainly new establishments in the countryside and financed by the local gentry.

.on 9 June 1923 a Popular Alliance /organizing representatives of all bourgeois parties with Military League and Great Masonic Lodge/ facilitated the government. In 1907. Alexander's hospital served as a hearth of bulgarian medicine. IMRO /Internal Macedonian Revolutionary Organization/ headed by Vanche Michailov and Menche Kurnicheva. etc. The puppet communist government of Alexander Stamboliiski with BAU /Bulgarian Agrarian Government/ was an obsolete landmark for the state of affairs. 2.Finally. Dr. The results are that 17 physicians are sent for specialization abroad. . . HEALTH 1921-1945 The world after World War I in which Bulgaria has to appear was of a quite difference. Alexander's hospital in association with Mother's Home. The treaty with the "Entante States" was signed in the Paris suburb of Neuilly on 27 November 1919. The fourth faculty of Sofia University have its birthday on a regular session of the National Assembly .20 January 1917. Dr. .on 19 May 1934 a Zveno Block overthrew the government and initiated a chain of sinister registration of state officials until the end of World War II. among them several future professors in the faculty: Dr.the country slid into a grave economic and political crisis. member of the Democratic Party. Royal Chancellery ebbing the tide of political . we should not like to omit the political role of other occasional formations like: 1.a medical museum. words should be said about the opening of Medical Faculty in Sofia.on 4 January 1926 a Second Alliance cabinet was formed at the head of which was Andrey Lyapchev /1866-1933/. Agrarian Union splitting to numerous divisions but most important are "Vrabcha" and "Pladne". organize three months qualifying courses in surgery. The need for separate medical school is debated by the end of the past century. First lectures are given on 10 April 1918. internal medicine/. eye&ear diseases/. hygiene/. obstetrics&gynecology and ophthalmology. UFC /United Fascist Center/ headed by Alexander Tzankov. Stephan Vatev /1866-1946/. . 3. Ivan Kiprov /Berlin. forensic medicine/. Atanas Teodorov /Vienna. Thus. a new chapter is open for homeland medicine in Bulgaria.on 29 June 1931 a Popular Block won the majority of the votes headed by Alexander Malinov /1867-1938/ and Nicola Mushanov /1872-1951/. Thusfore. The material basis is continuously updated. the wards are enlarged and adapted to host the clinics of the future faculty. Dr. The right hand for the opening of the faculty is most vigorously supported by Dr. By 1904 a medical library is bound on the territory of the hospital and by 1906 . Stoian Kirkovich /Vienna. Toshko Petrov /Tulusa. 4. About year 1923 the political parties began a process of consolidation. the other big health care establishment on the territory of Sofia-city. Aiming to be short.

Dr. Assen Zlatarov and Ilya Yanulov. The post Head of Directorate Public Health is succeeded by progressive Dr. like Prof. This is not surprising. One such organization is the Bulgarian Medical Union /BMU/. Progressive bulgarian scholars. One kilo of butter. So far.Dr. that head of Directorate of Public Health .04 lv /index 125/ and in year 1927. more information on BMU activities can be find in the journal of the organizaton "Annales De L'Union Des Medecins Bulgares". Veliko Georgiev /1872-1924/ quits his position. It is true.8.79 lv /index 105/. Yotov.forces. As a whole. a bread which have a mean price in year 1923: . on a commune principles. The bourgeois political development in Bulgaria.5.62 lv /index 97/ in year 1927. given that the laborer has. . which determine both the tendency and structure of specific socio-medical institutes. on average. there is somewhat of a decline from the side of medical and health policy in the country.some died or other emigrated abroad. i. On the mainstream. Dr. aprtially. Geneva: Health Section of the Secretariat of the League of Nations.08 lv /index 100/ in year 1923 and is 61.30 lv /index 147/. ten days that he is gainfully employed. Daskalov. etc. Meanwhile. Dr. Georgiev. together with other communist-agrarian reformers like Dr. HEALTH 1921-1945. make observations in their works that the very question of deteriorated health indicators of the general population is a reflection of poor labor conditions. on grounds that "he would not cooperate with authority uzurping the government". while he was one of the leaders in premier's Alexandre Stamboliisky "equipe medicalle" to reform the country and the health care. 1926" /to be continued/.7. costs respectively in year 1924: .93 lv /index 100/ and in year 1927: . As a matter of fact. confounds a series of occasional formations playing role in the governing of the country. Petar Tzonchev /1867-1947/ from Gabrovo. medicine and health care in Bulgaria develop on a background of complicated national and international political relations. the sharp turn in politics after 9 June 1923 does not reflect on organizations and levels of health care maintenance /?/ in the country. A comprehensive review of the subject can be found in "Golosmanoff. The Public Health Services in Bulgaria. I. Dr. Kaishev.e. PART 2 During the period 1921-1945. founded in 1903.63 lv /index 100/.37. Thus. in year 1923: . PopSavov. the next page of history is outlined by an organization of Socialist State in Bulgaria. perished in the political turmoil after June 1923 .34. issued volumes I- . which is in a nutshell radical and democratic. that works as a scissors on life style of the people. respectively. the mean daily wage of a worker is 63.

it hailed the constitutional "Law of State Defense" or LSD received on 4 January 1924. connected with his medical service or is pending".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". It took another 45 years that BMU had its revival under new auspices. This requirements are liberal but still they are looking for compromise between a public and a private mix. The BMU approved the sanctions taken against those members of the medical community which boycott the change of policy after June 1923. Art. This approach was not a new one. Art.the Supreme Medical Council at the Ministry of Interior and Public Health. The law transfers all expenditures on local health services to burden the budget of communities and municipalities. obviously realizing that this is an act of reproachment from an independent member towards the sway of terror and violence in the country. namely with tuberculosis. This gives some good opportunities for flowering of private stationary and ambulatory cabinets. The latter resigned from his post but the assembly of BMU. The PHL gives access for profitable investment of capitals coming from shareholders and stockholders. 25 December 1945. a social-democrat and council of BMU. gave him a tribute. the BMU had 26 assemblies but on the XXVI Assembly. prostitution. Thus. Russev's supporters. the union took in mind the arguments of Dr. 24. Orahovatz's and Dr. Now.XXXVIII. Ivanov of BMU says: "That means LSD has an inverse power … in relationship with the discharges of union members.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.LSD was abolished on 16 October 1944. according art. Next moment in health issues of the period is combat with social evils. However. On a new scale those fractions were classified by some modern socialhygiene narrators from the 70th and . Ahead of events Dr. The ethical issues connected with this file are not under consideration. Racho Angelov. 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 . Dr. alcoholism. The PHL aims at centralization of top medical leadership and further specialization and systematization of medical organs. 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. disciplinary or criminal. while before the WWI there were agitated debates between the two fractions of BMU: Dr. having in mind that those people have ever had communist convictions". 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. etc. held on 23. The PHL is acknowledged in a moment when the country economy is in a business recession and tax paying from the masses is scarce. the union came abruptly to an end. Here comes the "Public Health Law" or PHL from 9 March 1929. Angelov was right . In it's nearly 45th years.15 of the LSD. 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".

PART 3 The year is 1934. naturally. Let us examine what's going on with health care.for one day sanatorial treatment is 75-120 lv.for one day stationary treatment is 40-80 lv. while Medical Faculty in Sofia takes a narrow margin. meanwhile. HEALTH 1921-1945. The government is under pressure and legislation. Head of Directorate of Public Health is appointed Dr. Whatever. On 22 March 1935 is issued provisional draft for "Law for Compulsory Medical Practice in the Village" or LCMPV. . Further. a confounding of terminology. A greater number from the young medical practitioners are still graduates from abroad. The picture comes to a rest at the eve of WWII when in December 1939 an election campaign for the XXVth Ordinary National Assembly is held. in the countryside health is far removed from the population and the individual. .for hygienic douche is 5 lv. Those bachelors. 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". etc. given that all political parties are banned and National Assembly is disrupted. Georgi Ivanov /?/. etc. because the super-pretentious doctor can not get hold there and due to lack of elementary conditions for subsistence . in fact.80th decades as "bolshevik" and "reactionary" but we do not wish to devaluate what was written some 30-40 years ago. That is quite different in the city. .board and lodging". /to be continued/. have to deal with co-ops which. In the field of infectious disease prevention: . etc. At that time the prices are: . their backwardness and timidness. Despite that the number of physicians in the period is increased and there is an evidence for "physicians plethora". On 19 May the political power is taken by the military league "Zveno". on the continuously deteriorating status of the masses we can judge from the reports of the head of the Directorate of Public Health. The hard mode of life and work in the bulgarian village. classifications. repulses the young practitioners to stay in the ambulatory. represent the outrageous ordinary masses from the street. However.for desinfection of one kilogram stuff is 5 lv.for ambulatory exam is 20 lv. In an editorial from 1940 in the "Annales …" we read: "Most of the jobs offers in the village will remain chronically vacant. For the first time this create a "tower of Babel". Even IMRO had to put an end to its activity and leader Ivan Michailov /1896-1990/ fled away from the country in exile. apply the forms and methods of treatment which they have learned in the institutes of their education. specialization and . the burden of loose operational leadership has a timely effect on institutional settings.

Evidently. Dr. the existing bureaucratic system in Bulgaria prevent regular registration and/or intensive-extensive mix give misclassification of rates. Belgium /190-12/ is 7. still remained dim.5.to a western establishment. which issues a document that the specialist has served for "such and such" period and received a title. The candidates for a managing post are rated and graded on a percentile scale and the most successful ones are reported to the Council.without reimbursement .post-graduate education is necessary with respect to private clientele and that is organized in two manners: First.1 We see from the data that total mortality show a tendency for decline.7. demographic revolution in Western Europe is some 20-30 years ahead.8 17. 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.0 33. Here are some data on a comparative scale for natural increase per 1000 /N. there is a practical training available in a Bulgarian clinic .with a stipend .6 8. Or maybe.2 13. Usually. commissioned by the Supreme Medical Council.8 9. while every effort was made to prevent the corruption.5 13. the raising in medico-sanitary hierarchy is organized on the basis of a competition with a maturity exam. Finally.2 15.3. some experts lament. The information is for the period before WWI/: Bulgaria /1910-12/ is 19.7.1 29.8 15.5 Natural increase 18. Both lines were a matter of debate from the Bulgarian Medical Union. … Spain /1908-13/ is 9. However.1 Crude death rate 20.7 13.9. A concentration of main demographic indicators is presented on Table 1: Table 1: Crude birth rates.which leads to a certificate for a specialty. the medical doctor is sent abroad .2 22. this is a misnomer in the whole civilized world! . crude death rates and natural increase for the period 1921-44 /per 1000 population/. the administration of the procedure is supported by high taxes but the benefactor. Serbia /1909-12/ is 14. Russia /1912-13/ is 18. 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". France /1908-13/ is 6.4. Second.B. Year 1921-25 1926-30 1931-35 1936-40 1941-44 Crude birth rate 39. while it is associated with parallel slow down of the numbers for natality and their product limit.3 23.

Marcoff. Hitler's war shaked up the world to . where. Geneva: Health Organization of the League of Nations. 1934 . HEALTH 1921-1945. Swellengrebel.go to # 123 /to be continued/. sometime. Third Report on the situation of the Bulgarian refugees from the government of Bourgas in relation to malaria.go to # 11 2. Marcoff. there appear new data to accumulate. entitled: "Raport sur son voyage d'etude dans certin pays d'Europeen. Suggestions for further research on the topic are welcomed. Bulgaria. N. 1924 . The small scope of our study does not allow to give a more detailed picture on those organizations. Geneva: Health Organization of the League of Nations. I have got some information from a notebook belonging to two members of the "Teetotaler's Association in Bulgaria". Inspector General for Malaria: 1. it was connected with the eradication of malaria in Bulgaria. K. in the period 1931-34. Whoever said it proved to be politically shortsighted. PART 4 Let us continue our narrative by the beginning of WWII in September 1939.go to # 3 3. In the case we would like to give information on the activities of "Rockefeller's Foundation". Dimmo Burilkov. an imposing building for public health activities is mastered in Sofia. Hecht & Co. H. Malaria in Bulgaria in 1922. 1928 . Architect is Dr. Suffice to say. a huge six store building which stays on the "Regentska Street" some 100 meters away from the Mausoleum of Vassil Levsky. namely Dr. Three reports are given below from Dr. Haralambi Neykov and Dr. I have read somewhere a statement about Adolf Hitler: "Einem Trompeter gebe die Macht nicht". Marcoff. Addendum: While every effort has been made to be correct in our presentation. It is there that the Directorate of Public Health with Supreme Medical Council transfer its quarters under the name "Institutes for Public Health". K. 1924" we see that a project is undertaken for Bulgaria. K. It is pity that the archives of the "Institutes …" were ravaged after the World War. With the management of "Rockefeller's Foundation". from a special committee report presided by Prof. Geneva: Health Section of the Secretariat of the League of Nations.Now let us dwell on some international issues concerning health policy of the "League of Nations" /LN/ and "Rockefeller's Foundation" /RF/. The organization of the campaign against malaria in Bulgaria in 1922. K. Geneva: Health Organization of the League of Nations. Koev and the design is the biggest on the Balkan Peninsula.

e. i.24% versus 0. Tsankov surrendered to the U. he was released and emigrated to South America.65% for the general population /N. via a presentation of renegade man Aleksander Tsankov /1879-1959/. the architect of modern social security reform in Bulgaria. after Soviet troops had occupied Bulgaria. given it is not prohibited by a specific other formulation.. towards the end of the . where he died on 17 July 1959. From 1948 he lived in a suburb of Buenos Aires. drawn from the intelligentsia of various political parties and the mass of former officers. The law makes a reorganization for social security concerning the main biosocial risks by introducing insurance with "Fund for Social Security" /FSS/ which is functioning at the "Ministry of Trade. when he was replaced by Andrei Liapchev. Aleksander Tsankov is important for medico-sanitary historiography because he is. It is an old system of "leveling" coming from XVII century England. for the period until 1944. after military "coup d'etat". We concentrate our attention on Bulgaria's destiny by the period and that is done. born in 1879 in the town of Oriakhovo and studied law at Sofia University. Thus. where he became professor of economics. To him fell the premiership of the coalition government. the mean number of workers and employees covered with ambulatory. On 9 September 1944. forces and. these are numbers for services done. for several months. But we are not going to dwell on the evolution of the concept right now. Industry and Labor". The disturbance that broke out after Stamboliski's overthrow took thousands of lives.S. was interned at Kitzbuhel in Austria. However. purposefully." Prof.an unmeasureable scale. public and private level are cooperative to a certain degree. that took power on 9 June 1923. Here is an article about him from Encyclopedia Britannica Inc. they coordinate the operational activity for collecting the prestations and subsequently defend the interest of the insured. which cancelled all active decrees by that time. which aimed at combining the dispersed national forces for a struggle against the semidictatorship of Aleksander Stamboliski. The professional medical associations. Tsankov remained prime minister until 1926. stirred in the Cromwellian army. In 1922 he became leader of a small group called the National Concord /Naroden Zgovor/. domiciliary and some other services by the "Fund for Social Security" is: 1. Argentina. Later. B. What happened then is a matter of fact in numerous textbooks and files. representing all the political parties except the Communists. 1968: "Bulgarian statesman. subject to social security venture. in the preparation of which Tsankov's National Concord had its share. not for services paid/. Specific for the new system is the profile administration matrix. Tsankov formed a National Bulgarian Government in Austria under German auspices and tried to recruit a volunteer corps. all organizations on state. On 1 July 1924 is enforced the "Law for Social Security" /LSS/. are the Bulgarian Medical Association /BMA/ and the Bulgarian Dental Association /BDA/. His tenure of office coincided with one of the most tragic periods in modern Bulgaria's history. The advance of the Russians put an end to these efforts. presumingly.

for instance.e.14 1. We see here the principle that. index is 1939/: Table 2: Year Medical examinations number 1930 1931 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 185 657 209 855 431 410 642 796 752 337 841 369 891 873 778 647 882 158 808 209 671 629 306 865 index 20.02 100. Thus.3 2129.72 63.81 106. For the first time the "Institute …" administers: short-term.91 Disabled people number 433 425 … … … 21 084 21 586 19 023 10 167 952 7706 3577 percentage 0.3 3102.07 84.00 90.61 62.28 57.4 1472. decreed with the same law from April 1924.00 87. long-term and whole-term /or invalidity/ expertise on disability and done with the help of trained para-medical personal. because: 1.19 70.81 23.8 1981. On the left hand of the system /i.B.35 94.23 0.1 2424.4 2366.42 2.52 48.0 2903.30 34.44 1.63 76.20 … … … 2. the object/ is situated the "Institute for WorkingMedical Expertise".11 1.40 Exams per 1000 insured number 764.01 75.8 index 22.2 3432.50 2.04 42.23 0.3 2169.91 90.4 2595.37 72.period the costs for rendering such services are unrealistic. and 2. We present here some data on medical examinations of insured people with "Fund …" for the period 1930-1944 /N.16 .4 3629. the measurement for working incapacity /by organo-topographic signs/ is appreciated via percentage estimation and not by reimbursement of unrealized working income. whoever treats is the one who determines the length of treatment or "piggy-backing".64 75.33 100.30 98. The bureaucratization of the organization towards expenditures for administrative purposes.37 84. An increasing devaluation of the bulgarian currency.

Questions of interest to the municipality may be submitted to a referendum at the demand of at least one-sixth of the electors. the curve of medical examinations for the period 1930-1944 appear to have a binomial distribution. The Government generally draws up laws and takes the initiative in matter of reform. We shall briefly make a synopsis of the period 1921-1945 before continuing the subject with the reforms following the end of WWII.an international organization set up in 1919 to preserve peace and settle disputes by arbitration. of which 82 are urban and 2299 rural. Its remaining responsibilities were handed over to the United Nations in April 1946. The constitution of the League /"Covenant"/ was adopted by the Paris Peace Conference in April 1919 and written into each of the peace treaties. The fundamentals of legislation and administration in Bulgaria during the before mentioned period was elaborated at the League of Nations . The League's headquarters were in Geneva but its first secretary-general during the period 1919-32 was the British diplomat. have . which must.It is evident from the table that operational activity of "Fund …" is irregular. The representatives of the people. PART 5 Our review of Health Care Organizations in Bulgaria is towards its end. Bills are laid before the National Assembly by the minister of the department responsible for their promulgation. Bulgaria is divided into 16 provinces. each deputy representing 20 000 inhabitants. who are elected every four years. Private members may also introduce bills. appointed by the Minister of the Interior and assisted by a provincial council and provincial committee. Sofia possesses a special communal organization. The Government consists of the Head of the State. the council is elected by the inhabitants. who is assisted by one or more deputies elected by the municipal council. the representatives of the people and the Cabinet. Now. The legislative power is in the hands of the Crown and the National Assembly. let us make a survey of the General Administration of Bulgaria. constitute the National Assembly /"Sobranje"/. /to be continued/ HEALTH 1921-1945. The cabinet is composed of ten ministers. however. Sir Eric Drummond /1876-1951/. Each province is administered by a prefect. 82 districts and 2391 communes. the total number of the settlements being 5652. Also. The Head of the State is the King /"Tsar"/. During the Second World War the League maintained its nonpolitical functions. The districts are administered by sub-prefects. At the head of each commune is a major.

are the highest representatives of the executive power in the provinces. They may issue orders. revised with additions according the law. the Health Care organizations in Bulgaria are established with a decree № 2 from 7 February 1929 and published in the supplement of the "State Paper". The prefects. 277 from 9 March 1929. Ministers cannot promulgate new laws or amend. add to. the ministers and the Cabinet. published in the "State Paper". 223/1935 and 129/1940. the Crown may publish decrees having the force of law. In the communes. vol. These boards must not. these regulations must be sanctioned by royal decree. Here is an example of the structure of health organization in Bulgaria. however. and subject to a decision by the Cabinet.been signed by a quarter of the representatives in the National Assembly. Copyright © 2002. exceed the scope of the national laws. . 178. Ministers issue executive regulations under the laws passed by the National Assembly. The legislative bodies of the communes are the communal boards. issue regulations which are at variance with the national laws. or replace existing ones. The executive power is in the hands of the Crown. 68/1933 and 76. however. assisted by the provincial councils. which must not. Finally. In exceptional circumstances. The powers of sub-prefects are purely administrative. whose orders have the force of law. vols. the executive power is represented by the mayors.

B.Second. the collectivisation of small-scale. Accompanying several changes in Bulgarian party leadership was the Soviet transition from the Stalin to the Khrushchev eras. Second. institutionalization period from 1960 to 1990 . These plans honour the Soviet ideology which can be briefly retold. The single line of authority from party leadership to economic policy that is a hallmark of Soviet-style economies was doubtless present. the basic Soviet system for central planning is well known. And for such planning to include all production. reconstitution period from 1990 to present time We begin with the transition period to a socialist economy on the Soviet pattern which took longer than the immediate post-war period. the period of the first three Five-Year Plans is the most neglected in modern Bulgarian economic history. private agriculture seemed necessary. First.HEALTH SINCE 1945: TRANSITION PERIOD It is our privilege to begin a review for a long period of socialist health care in Bulgaria. Bulgaria published no statistical yearbook in the 1950s/. but harder for outside observers to discern. Bulgarian economists typically identify the date of its completion. So is Soviet development strategy: rapid growth of heavy industry to be achieved through concentrated investment from the state budget and a labour force augmented by peasant influx. A system of long-term central planning to coordinate outputs with inputs also had to be set in place. as the end of the transition to the Soviet system. Simply nationalising private industrial enterprises in the period was not enough. Each of the first three national plans followed a strategy of extensive growth. Our plan comprise of the following materials. Subsequent Bulgarian scholarship has trodden too lightly on these political links to make clear the inner dynamics of economic policy. where reliable statistical evidence is more available and connections to the international economy more important /N.Third. divided according time periods in economo-political aspect: . . transition period from 1945 to 1960 . Bulgaria's post-1948 transition to this planning system and strategy followed the Soviet pattern perhaps more closely than did any of the other Communist governments in Eastern Europe. Huge amounts of capital and labour were funneled into a few branches of industrial production. although its general pattern is familiar. Bulgarian political history from 1949 to 1960 also makes a detailed appraisal of these years more difficult. 1960. Western and Bulgarian economists have concentrated their efforts on the period since 1960. A smaller rural labour force is left on the mechanised collective farms to produce the surplus needed to feed a growing urban population.First.

staged unsuccessfully by the Nazis in 1934. but not the first step in Chervenkov's demotion. who were sent to concentration camps in the early 1950s. Todor Zhivkov emerged from the new generation of post-war party leaders to become First Secretary in 1954. Dimitrov enjoyed international prestige on the left as the eloquent defendant in the Reichstag fire trial. Criticism of Chervenkov for these excesses appeared in the Bulgarian Politburo as early as 1953. Georgi Dimitrov. had been trained in the Soviet Union for party work since his exile there in 1925. He co-ordinated propaganda for the Comintern from the late 1930s. In addition. Chervenkov came to power during Stalin's last years. we would like to point some attention at a concise outline of the topic under consideration. Now. and reappeared in 1955 because of continuing agricultural problems. he died in April 1949 after several months of treatment in the Soviet Union. Khrushchev's 1956 speech exposing Stalin's "mistakes" and his "cult of personality" was perhaps the most important. and for the Bulgarian party's Central Committee after his return to the country in 1946. The influence of the other two still remained to be reckoned with until the shortcomings of the Third Five-Year Plan had become clear. when the Soviet Union's own reliance on propaganda slogans and the threat of arbitrary punishment reached its post-war peak. prepare him to follow Stalin's lead after the split with Yugoslavia in 1948. and as head of the Comintern thereafter. this is "Part . Traicho Kostov. were peasants. But Chervenkov was to remain the other Deputy Prime Minister until 1961. and to reject any further delay in proceeding with rapid industrialisation and forced collectivisation according to the Soviet experience of the 1930s. despite his advocacy with Tito of a Balkan customs union and federation just a few months before the dispute erupted. Anton Iugov. The plan was itself a retreat from the harsh. The first challenges to Chervenkov's leadership none the less appeared surprisingly early in the Second Five-Year Plan /1953-1957/.The period began with the illness and death of the party's respected leader. A sick man at least from 1947 onward. These were distinguishing features of economic policy in both countries from 1950 until Stalin died in 1953. Specifically. however. Bulgarian economic policy did not therefore pass fully into the hands of Zhivkov and his post-war generation until the 1960s. His background did not prepare him well. All this made the atmosphere surrounding further collectivisation ominous. He kept his position as Bulgarian Prime Minister during the Tito-Stalin split. the Interior Minister during the mass arrests of 1949-1950 and one of the older generation of "home Communists" had re-emerged in 1956 as Prime Minister. like half of the party membership. The actual successor. So were many of the unknown numbers of suspected "enemies of the people". and Deputy Prime Minister in 1956. did not survive the purge following the Tito-Stalin split. sometimes counter-productive measures of the first. one of his logical successors and the party leader most responsible for economic policy since 1944. Many of those expelled. rather than encouraging. Vulko Chervenkov. before continuing to the main body of presentation. Chervenkov had begun his regime by expelling one-fifth of a party membership that had grown to half a million. Zhivkov strengthened his position in this triumvirate as the 1950s drew to a close. in other words. for overseeing the first Five-Year Plan. His two decades of Soviet exile did. at the age of 43.

it came out as a corollary from the "Ministry of Interior & Public Health" and by right of succession taking its actives and passives. Special health care of villages. System prevention of tuberculosis and all other infectious and social diseases 4. PART 2 The first act. 1985" /to be continued/. adolescents and other outcasts 9. Racho Angelov /1873-1956/ is appointed first minister-of-health and Dr.VI" from the monumental work of the Bulgarian Academy of Science /BAS/: "The Editors of BAS. Social care for adults. having a long dossier as professional revolutionaries. They are elaborated in the form of a State Plan. schools. also. de facto. containing eleven points: 1. Fight against infant mortality and provision of effective measures for combating infant diseases 3. Infiltration of the community with new health education . Information Bulgaria . workshops. meaning. 7. The new ministry is a split off organization. factories. Konstantin Kusitasev /1900-1955/ to the chair of secretary-in-chief: both well known as consistent public health activists. working for long years under the auspice of the Bulgarian Medical Union. This is a realization. Sports and physical activity recreation 8.a Short Encyclopaedia of the People's Republic of Bulgaria. Oxford: Pergamon Press. HEALTH SINCE 1945: TRANSITION PERIOD. which came to reflect the new attitude of the state towards health care. is establishment of the "Ministry of Public Health" /decree № 284 from 9 September 1944/ as a central state institution for co-ordinating health. Qualification and re-qualification of medical care at all levels 6. Sanitary development of dwelling settlements and all other populates 5. Dr. etc.which is the program documents of the expert group "Social Medic". The main tasks of health care in the transition period are formulated in the "Program of the Fatherland Front" from 17 September 1944. one of the main formulary from the health policy of the Party and the progressive medical community . Cultural and vital elevation of the living standard of the people 2.

approximately. Our job is to give a chronology of events in the years after WW II and in the period of Cold War. "polyclinics" and functioning on the basis of the former municipal health-services. who. in the year 1946 the hospital bed supply is 1 per 1000/ need a corrective down-and-up …" The LCSHE arranges the following subjects of cooperation: 1. workers health check-points.enacting a process of nationalization for drug industry and marketing. interest and participation from the side of the general population is shown towards the questions of health care. etc. Secondly. With voting on 11 July 1946 of the "Law for Cooperative Suffrage of Health Establishments" /LCSHE/. etc. 1940. with a decree № 43 from 21 December 1949. Speaking about "failure" is an issue from quality control. something. Here. altogether. Thus. Sofia: Hudojnik Print. 2. towards. de facto. let us remark that much speculation has been held on the meaning of the term "free" health care. As a facultative participants in the face . separately is employed in any kind of a state job. What is important here is that. What is important here is that coverage was eligible for everyone.B. the government emits obligation funds which are cashed unconditionally by the State Exchequer at a limited interest rate. called. This is. the present state of affairs /N. with decree № 4 from 12 May 1948. at the end of 1949 some 69. efforts are strained from the new government to overcome the ruins from the WW II. with decree № I-20-874 from 19 August 1949.coops. Pre-requisite for this act is the adoption of new "Constitution for People's Republic of Bulgaria" /5 December 1947/ . Social care for motherhood The platform is a demarcation of a new social approach for decision making in medicine.2 % is quite a good index for employment rate. The full project consist a booklet of some 40 pages and is printed in the early 40s but remained concealed by the group "Social Medic". This is emphasized by minister Angelov on a briefing at the National Assembly: "Evidently.in Art.. Thus. Consequently. we say that 69. a foundation is laid for intensive development of health care. As a compulsory participants in the face of state and municipalities. socialization of health care on a large scale. Mateev D. viz. companies. showing some realization of the principles of socialized medicine.2 % of the total population were covered with "free" medical services. Project for State Health Plan. Thirdly. district ambulatories. all . societies. Kusitasev K. which for the field of health care could encompass a lot of thick volumes. we should try to enumerate briefly what happened in the first five years. Meanwhile. associations. The bad point is that re-imbursement rate often proved wrong and that is what "Marxian" economists could not foresight. in caveat. Socialization on a small scale is attributed via district physicians principle. Firstly. all private hospitals and clinics were expropriated and put under the umbrella of the Ministry of Public Health. on 12 June 1947 was voted the "Law for Sanitary Pharmaceutical Enterprise" /LSPE/ . 81 is written. Activities.10. that: "Liability of the state is to take care of the health of the citizen". Making a universal medico-social insurance 11. Furthermore. a new health maintenance organization is arranged.

while. first time. Unification of ambulatory and stationary health care units in academic structures 3. Same year. was architect of socialist reform in health care. viz. /to be continued/. Sofia: Nauka i Izkustvo. 1952.which. within the frames of the "Second Five-Year Plan" led to a total socialization of state apparatus: cf. renamed "Ministry of Public Health & Social Care" /MPHSC/ from 29 November 1951.R. The basis of the decision making process."State Institute for Social Security" /SISS/. Dr. Consequently. under state umbrella. appointed from the minister-of-health and treating different social medical problems with the help of standing committees and commissions. was given state jurisdiction to a new nomenclature of health care organisation in the country. community and city public councils. interbrigadier from Spain and U. with decree № 2822 from 29 November 1951.in itself. accredited with ordinance № 911 from 14 April 1950. b. Kolarov P. The "Ministry of Public Health". On socialist transformation of public health care /2nd ed. In the periphery. such stations were created during WW I but abolished on a later stage/. A "Scientific Medical Council".S. a replica of the "Directorate of Public Health" before WW II.S. The "Sectors …" are responsible for management of hospital and ambulatory care on the territory of the corresponding council. function as a co-ordinating body which organise and run at the head a large network of branch structures . was appointed minister-of-health on 20 January 1950. The author. Categorization of health care establishments and health care appointments 2.establishments from the "Fund for Social Security" /FSS/ are expropriated and a new institution. PART 3 In the 50s. with decree № 2658 from 20 November 1950. some institutions on a national importance are under umbrella jurisdiction of the MPHSC. are established the "Sectors for Public Health" within the district. is the supreme consultative organ of the ministry for planning. already. Josef Stalin /1879-1953.B. is created .. HEALTH SINCE 1945: TRANSITION PERIOD.the public councils. Petar Kolarov /1906-1966/. all republican specialists in their corresponding working fields. I turn the pages of an old book./. Djugashvili/ and "Stalinism". It consist 25 members. research and development. Himself. included: 1. socialist transformation of health care was marching on a dynamic and rational scale . As a supplement and on a . Recreation of Sanitary Epidemiologic Stations /SES/ with prophylactic purpose /N. health care is administered by the local organs of state authority .

without. also. Planning is inseparable from budget and market extrapolations of any state economy. Insofar as medicine is concerned . ISUL and socialist international co-operation. a network of corollary consultative organs with duplicate functions: see example 1. to methodically upbring cadres and twice. joined World Health Organization /WHO/ and International Classification Diseases /ICD/ .expenditures. Ahead. once a deficit is settled and it can be reimbursed from the state reserve.fl. no making predictions. to nourish a peripheral structures with personnel on a mapping principle /editor note. /to be continued/ . In the long run. what could a wholesome world do if a trend on planning continue and this time in an inverse order under capitalist rules? Next step. so much.some. 1550 dentists. nevertheless. but. In a historical perspective . It consist from parallel lines of development and truncates to the left. with a matter of numbers as to their distribution and category level. understand here "geography"/. for Ministry and Sector health establishments. comes the reformation of cadres politics in the country. 2034 nurses in practice. year 1960. there are 5164 physicians. This is an issue of utmost importance and having in mind that Bulgaria could not boast a plethora of medical workers in year 1950. comes an ordinance № 1124 from 6 March 1951 that proclaims the "Institution for Specialization and Unification of Lectors" /ISUL/ . The question is. This seldom leads to discrepancies. Now. 50 years after WW II and the federation of socialist states collapsed under the burden of state deficit. viz.a doublefould organisation: once.middle level of management are constituent. medical planning has become particularly important characteristic for socialist health care. We see that health personnel management is not concerned. socialist countries. Socialist reorganization seemed incomplete. are planned within the total republican budget and allocated with the help of corollary consultative organs.

mainly.a Macedonian.4 35.4 30.8 48. What we see in Table 1. The migration of peasant population into the towns occurs at the expense. PART 4 When Stalin died in March 1953. as we said earlier.1 26. who passed through "Lenin's Institute for International Politics".5 % .8 59.HEALTH SINCE 1945: TRANSITION PERIOD. Together with a changing canvas of lifestyle and working. when. of the younger population rendered imperative by the industrialization process on a nationwide scale and developing at a very high rate.a miner's son. the real power in Bulgarian political life from 1956 to 1989 was vested with the secretary of the Bulgarian Communist Party. In the mainstream.2 40. led to significant system processes with a reflection on health care. Chervenkov slavishly copied Stalin until April 1956. and under his direction Bulgaria remained the loyalest supporter of Soviet policy in the Warsaw Pact. .6 69. an intensive social-economic development of the country in the Third Five-Year Plan. Vulko Chervenkov /1900-1980/.5 Obviously. the population structure of Bulgaria covering the period 19441967: Year Total Towns № 1944 1948 1953 1958 1963 1967 6 913 300 7 162 200 7 385 600 7 766 300 8 111 100 8 335 100 1 665 500 1 888 200 2 241 800 2 732 100 3 306 700 4 043 300 % 24. as well. bellow.urbanization gained momentum. a heavy industrialization. himself: . Todor Zhivkov /1911-1998/.5 Villages № 5 247 800 5 274 000 5 143 800 5 034 200 4 804 400 4 291 800 % 75. parallely to. via Party work in the "committees" for culture. the urban population proportion is rapidly increasing and in 1967. a vivid cooperatization. 48. he was replaced by Anton Yugov .6 64.in the villages. However. Thus.2 51.5 % of the total number are living in the towns and 51. etc . the days of his satellite followers were doomed.9 73. to Party work in the "central" apparatus.

In Bulgaria.but. thereafter. decree from "Ministry of Health" on 24 February 1953.1 We see.8 52.i. that.6 9.0 13. that. reaching 24.9 24. There is a multitude of literature written in the bulgarian parlance.3 7.1 8.0 8.from 120.e.3 12. Bulgaria" /editor note.2 9.7 0. when. with. expertise for incapacity. further.B. let us stay abreast with our theme.1 9. it showed a tendency for decrease. transliteration is in bulgarian/. the birthrate on a nationwide scale has augmented. infant mortality rate has sharply lowered . the 50s in Bulgaria. Ever since 1944.9 17. TKZS. This was done in a pace.6 per 1000 population in year 1948. On an organizational level. it falls to 33.there.6 per 1000 born alive in 1944. MTS.4 15.2 11.1 for year 1967. etc /N.0 8.6 20.8 1. workers health care grew on a local basis and culminating in the 70s with WHO's project "Dispensarization model in Gabrovo district.5 0.2 80.6 12. socialist transformation of health care in the village is more interesting and deserves a special attention. this. bellow.The demographic development of the country during the years of people's government is characterized in Table 2. were elaborated some aspects of health care network and within the context of town-village controversy.6 10. but.9 16. These are rudiments of "screening" and "monitoring" procedures. In our opinion. DZS. let us confess they had their precursors in the utopian literature.6 118. collectivization of agriculture accorded such megacomplexes .3 9.0 120. The aim was to promote preliminary and periodical medical examinations for the workers. in order to provide a qualified and ready service for the workers in the manufacture . Now. The bulgarian village gives good opportunities to sustain . Within a caveats mentioning.6 0. even earlier and before the WWII were functioning the "factories for health" . How to achieve this task? In a long term perspective.2 8.2 6. we'll talk about that later/. demographic development of the population of Bulgaria over the period 1944-1967: Year Marriages per 1000 inhabitants Divorces per 1000 inhabitants Livebirths per 1000 inhabitants Deaths per 1000 inhabitants Natural growth per 1000 inhabitants Infant mortality per 1000 livebirths 1944 1948 1953 1958 1963 1967 9.7 33.5 0..2 21.0 1."bridging over differences between workers and peasants".5 35.9 8. is a matter of folk psychology and we are not in a position to discuss the question.0 11. as early as. The leading principle was .

etc were developed on a smaller scale . What is given bellow is some statistics for the period 1944-1967. namely . we will be back on the issue later to do some reasoning.. subsequently. enabling the mothers to put their efforts in the production and research.with limited specialized cabinets. 266 hospices with 4028 beds in year 1957. Whereas during year 1944 there were only 7 "maternity and infantile homes" with 280 beds and not a single public nursery "creches".126 social service units have been established with 9774 beds. that.dispensarization by inclusion in special observation lists of all children. 300 in the end of year 1969 and were integrated to the "district" and "regional" hospitals. 674 seasonal "creches" with 17 466 beds were established throughout the country. These numbered. about. booming was extensive integration of village "district" health hospices. few words should be said for the geriatric and sanatorial care in the country. etc. The number of such establishments was .there. the sanatorial beds available per 10 000 population has increased from 3 to 19. Another establishments. . At first hand. . 20 units with 2134 beds during year 1944 . held his post in the long summer from 1950 to 1962. systematic observation ever since the very first week of gravidance.174 sanatorial units with 15 659 beds have been established for providing sanatorialresort treatment. Later in the 60s an involution process began and."Maternity and Infantile Homes" with operation carricula rules. Finally. new structures emerged in the face of "rural policlinics".requirement. 26 asylums for old in year 1944. as well as. building construction.complete dispensarization carried out for all pregnant woman. in the first month of life. They are within the framework of minister Dr. Petar Kolarov. than.e. but. include: . in year 1967 the "maternity and infantile homes" grow up to 31 with 2218 beds. against. founded with decree from "Ministry of Health" on 17 July 1953. .i. The flagpoints in this type of health care. urbanization of the country was not advanced and infrastructure roadways. . favorable conditions were provided for adequate cares and education of the children.and nourish the labor of the peasants. Here is some statistics for period 1944-1967: . Thus.92 hospices with 1500 beds in year 1951. who. against. as early as. In addition. were called . each delivery takes place in a hospital unit or maternity home is of paramount importance for the state and organization of obstetrical aid. Many efforts were made for securing normal life conditions for solitary old people and invalids with severe physical or mental defects. when.

neither. It was on this basis that economic development /i. is used. In 1971. although. when compared to economies of similar size in Wastern and Eastern Europe. If there was no economic miracle for Bulgaria in the 1960s. in particular. particularly. from growth based on increased inputs to growth based on greater productivity per input. For capital and other inputs. The concentration of more and more inputs into modern industrial production. Under this reorganization. Zhivkov has retained authority over the Council of Ministers. and.HEALTH SINCE 1945: INSTITUTIONALIZATION PERIOD The Bulgarian transition to economic priorities and institutions. based on the Soviet pattern. For labour. Yet the record of growth remains a remarkable one. Since 1960. he is no longer its chairman. between. Increasingly less attention was paid to discrepancies. they became less glaring after 1960 and virtually disappear after 1980. more precisely. how to improve the productivity of labour and capital. Raw materials have become more expensive. head of the party. Todor Zhivkov had consolidated his position as party "First Secretary" and had become Prime Minister. modern growth supported by structural change/ was under way for the first time in Bulgarian history. Enough younger . proceeded more rapidly than anywhere else in Eastern Europe. Bulgarian economic development derived in part from a larger commitment to foreign trade. The concentration of investment capital. The collective leadership of Politburo of the party's Central Committee. planned and actual growth. he exchanged the latter position for the Presidency of the new State Council. as spelled out earlier.. was essentially complete by the end of the 1950s. the overall rate of Bulgarian economic growth has itself declined. as well as. the arrival of factory labour from a newly collectivized agricultural sector were the key structural changes that sustained rapid growth of heavy industry and modern technology. moreover. Characteristically.e. that of the Soviet Union or of any other Eastern European country. The productivity of capital has failed to keep up. He was therefore head of state. By the early 1960s.about. and. was there a serious setback during the 1970s. than. has continued to be the principal source of structural change in the economy. Political continuity provides part of the explanation for this relatively stable performance. with. however. the transition was fuelled by massive injections of new fixed capital. This has been the transition from extensive to intensive growth. More attention was paid to statistical turning-points. equivalent bodies do in the Soviet Union. that of labour. The discussion has prompted recurring reforms in the initial Soviet system of central planning and ministerial control. the growth of productivity has been sporadic and remains illusive. 27 members of the slightly larger Council of Ministers have none the less come to play the wider role in making decisions . Management and technology have not improved consistently enough to increase the efficiency with which capital. Comparisons across the entire post-war period suggest another important change under way in the Bulgarian economy from about 1960 onward. as they have everywhere in the world. the making of Bulgarian economic policy has been marked by virtually unbroken discussion . and.whatever.

and. was never considered his probable successor nor equal. etc. likely successor to Zhivkov emerged /N. For example. It was evident that post-war Bulgaria lacks the plethora of specialists. this recent continuity must be of significance. UNESCO. has been concomitant since the end of WW II. On 4 August 1945. as well as. based on economic relations and fraternal cooperation. Stara Zagora /1982/ and after the conglomeration of the National Medical Academy in 1972.B. Pleven /1964/. constitutes the longest period of unbroken political stability under a single authority in modern Bulgarian history. Among a population whose historical memory of the 20th century was dominated by uncertainty and impermanence.members have entered the Politburo to lower the average age to below 60. she was none the less widely mourned at her early death in 1981/. PART 2 An important factor. In the rest of Eastern Europe. medical faculties were opened in Varna /1960/. an extremely important project of the WHO and a group of bulgarian clinicists with leader Prof. It hosted international socialism. hundreds of young specialists became . /to be continued/. some non-aligned countries like Finland. Bulgaria continued to support intensive contacts with the countries of the CMEA /Council for Mutual Economic Assistance/. Iraq. with decree № 180. was significantly younger than a Soviet figure. The tradition to specialization of cadres abroad continued . No independently powerful figure. until November 1989. Thus a massive trend was established towards production of medics. or. WHO. to reform a health care system. This cooperation aside. only Hungary has had a comparable experience. necessary. Whatever the form of cooperation. and. though a member of Politburo. Another important feature of medical science was the augmentation of medical cadres. is a drop out from the international isolation of the country . by brief triumphs and enduring defeats.as. was implemented on the research of Balkan Endemic Nephropathy from the early 60s. the bulgarian medics participated actively in the field of health progress. filials were bridged in the towns of Tolbuchin and Pazardjik. which. was established second medical faculty in Plovdiv. His leadership. His daughter Liudmila. the cardinal problems of men-environment-disease in the 20th century. an important step forward to following the tendencies and programs of world community. This is a welcome association with a number of international structures . Mexico on the basis of relevant agreements until dissolved in year 1989 by political liquidation. which determines the pace of medical science in Bulgaria from that period. from 3 500 in year 1944 to 28 500 in year 1989. . This international community of socialist countries.UN. was created in 1949. Namely. Consecutively. Alexi Puchlev. this gave an increase of physicians. HEALTH SINCE 1945: INSTITUTIONALIZATION PERIOD.that.

with. the principles of so called "democratic centralism" were broken and appeared ugly phenomenons. which functioned short after the war. But. more regulation towards the utility of resources. the main task of the social policy of the BCP is "to assure high vitality of the nation. with. the internal aspects of coordination were not neglected. as well as. Most important lines for the development of the state and the party. increased adaptability to the new lines of social-economic progress. The Bulgarian Medical Union /BMU/. Here are some excerpts from the concluding sections of the document: ". right now. we encountered some difficulties in the transfiguration of the material. The complex approach to health comprises the accelerated . In full accordance with the Thesises of the 9th Congress of the BCP. those were the realities of the 60s and we are not in a position to debate on the questions of Cold War. the new organization was responsible for a network of internal relations in the forms of congresses and seminars. This. "loss of a job" or "transfer to another place" or "financial penalties". However. GDR. entitled "Cardinal lines of health development in the People's Republic of Bulgaria".. regard to complex determining of health and social problems. 4.. namely: 1. and. however. state and party directives /N.sometime. Minister of Health from that period is Dr. and. Health care from the beginning of the institutionalization period is characterized by the following features. for providing an atmosphere of educational and ethical problem solving. In a future presentation we shall aim to give a fuller account of the state of health care system for the period. Hungary. Simultaneously. stepped place to an alternative organization . Czechoslovakia. mobilization of self-control specifically in the field of prophylaxis. Poland.. further democratization of the health care system in accord. presented by the Minister of Health in 1968. not always gave a positive result .candidates and doctors of medicine in the frame of WHO programs and exchange fellowships with CMEA countries. based on a topic principle. Now. capitalism was presented with a monster face and the era of senators Mackarthy and Fullbright sentenced to decay. are the decisions of the "9th Congress of BCP" /1966/ and "July Plenum of CC of BCP" /1968/. Ultimately.Union of Scientific Medical Associations in Bulgaria /USMAB/. viz. to build up more favorable conditions for the multilateral manifestation of the human personality". while trying to be parsimonious with the interpretation of data from that period. productive forces and surplus product/.B. etc. understand here development of relations of production. Kiril Ignatov /1962-1971/. enhanced cooperation of health care with other spheres of the social system. within frames of the Fourth and Fifth Five-Year Plans. 3. 2. Soviet Union. For the moment we have at hand some papers. like. to affirm a healthy way of life.

.A. and in the new edition of the Program of the CPSU enormous attention was paid to the development of health care in the Soviet Union.L..L.T. for increasing the sports and tourists base and its using..T.development and realization of all specific activities. with the public initiative and the activity of the population . sports and tourism. limiting defensive anti-ballistic missile systems and agreement was reached over certain other measures.-1/. affect the solution of the health problems.. means and ways of development are formed.. especially by children and youth. The information possibilities are of much better use now . The political report of the CC of the CPSU states. . production and organizational-methodological potential. representatives . With regard to this. that "For both man and society there is nothing more valuable than health.A. The first treaty was signed on May 1972 /S.. /Strategic Arms Reduction Talks/ . respectfully. additional efforts will be made for the further development of mass physical culture.. it fell short of American hopes when president Carter administration found it impossible to persuade the Senate to ratify the agreement. Our socialist health care was created and developed on the Soviet health care model. At Geneva on 1 July 1982. In the political report of the CC of the CPSU.T." /to be continued/. Soviet and American talks were renewed under the acronym S. That is the base on which the identical goals.L. Talks/.T. the nation-wide movement for high health culture.S.the Strategic Arms Limitation Talks /S. HEALTH SINCE 1945: INSTITUTIONALIZATION PERIOD. The preservation and consolidation of people's health is of primary importance".A. The leading force of the scientific and technical revolution in our socialist health care is the powerful scientific.as an optimistic . but. delivered by comrade L. held between Soviet and U. between our health care systems. the Comsomol. between our countries and nations.. and.. New forms of immediate transfer of the latest domestic and foreign scientific results to the consumers are organized . by involving the Councils. This identity in the Party's outlines for the development of our and Soviet socialist health care is determined by the decades old links and harmony between the BCP and the CPSU. as well as. Medical science has risen to a new higher level.. A second agreement /S. On an international plan this is a series of conversations aimed at restraining the arms race. using all the time its enormous experience and achievements.the health workers in the practical health network..A. The problems of health care must be considered and worked out from wide scope social positions.R. that.T. of its function and importance as such on account of the higher criteria and more important role of health care. its complex character.-2/ was concluded in June 1979. Brezhnev. PART 3 The beginning of the 70s were marked by several important events. The coordination of the research work programs is being improved. The Party pays a special attention to the establishment of a healthy way of living. educational. .

situated in the south-east of the Balkan peninsula. Main sources of information should be pin-pointed.substitute for the discredited S. Mention will be done. From: ***. Sofia. Its frontier in the east is the Black Sea.in the 70s and 80s . 40 to 59 .2 %. 20 to 39 . These S. Health Services in Europe (2nd edition). Copenhagen: WHO . Our choice has been a matter of personal preference. that. I.prohibition of the private medical practice. will serve as a guide in the following narratives: 1. which. Its territory covers 110 928 square kilometers and the population in 1972 was 8 576 200. 2. namely .R.Regional Office for Europe. The new institution is accredited with statutes and regulations by article № 0-9 from 7 February 1976. unified. A long time regime of socialist transformation comes to an end.T.8 per 1000.25. with. 1975. Important aspects of this law are. adoption of a new Moral Codex of the physician.A. the country falls in sharp political and economical crisis. with Yugoslavia in the west.e.quite an abundance from such materials.8 for males and 72. As viewed on a national scale. The capital. . Talks paved the way for international agreement in the 90s and continue until now. Angel Todorov /1971-1977/.30. The birth rate in 1972 was 15. etc. had a population of 877 000.6 %.T. during this period of institutionalization. We shall follow our agenda with some presentations. For the period 1965-67 the expectation of life was 68.3 persons per square kilometer. Background information The People's Republic of Bulgaria. make every effort to be succinct. 3. which. the 70s brought important changes in the structure of the socialist society and in health care in particular.3 per 1000 and the crude death rate 9. while the previous periods in the development of health care were scarce in materials with an international standard and here we have . ministers of health are. The natural increase was 0.14. therapeutical and organization-methodical complex /article № 921 from 30 April 1972/. The tenth congress of BCP /1971/ gives in details the quantitative and qualitative changes in Bulgarian society. the establishment of Medical Academy as a solid. Mincho Peychev /1987-1989/. A programme is outlined for building an advanced socialist model in the country. At the end of year 1989. 60 and over . Let us enumerate the items on an agenda.T.29. and with Greece and Turkey in the south.3 %.55 %. has boundaries with Romania in the north across the River Danube.A.7 for females. i. 77. A new "Public Health Law" is voted by the sixth Common National Assembly /31 October 1973/.L. The process of consolidation of medical science finds its height. Radoy Popivanov /1977-1987/ and Dr. scientific. Dr.9 %. namely: Dr. The age distribution showed a preponderance of the younger age -groups: under 20 . So far.

with a total of 3464 beds (including 2569 maternity beds) served rural areas. Of these facilities. gonorrhoea. Each rural health centre has a dental clinic. in descending order of incidence. The hospital physicians also work in the out-patient department and visit patients at their work and at home. There is a unified system of public health services and the Ministry of Public Health. which provides both curative and preventive care and is responsible for health education. 1866 health centres directed by feldshers and 903 rural maternity homes. The communicable diseases most frequently notified in 1971 were influenza. is now fully on a cooperative basis. Industrial workers receive . infectious hepatitis. dysentery. which is heavily mechanized. is the central authority for health matters. measles. In addition. All medical establishments are State-owned. dispensaries and other out-patient establishments. 181 rural health services. Bulgaria is being rapidly industrialized and industry now provides more than two-thirds of the total national product. care is usually provided by a feldsher working under medical supervision. The medical services are developing rapidly. Organization of medical care The basic unit of medical activity is the hospital. Every rural commune has a health service and nearly every village with a population of over 2000 has its own health service. The provinces are subdivided into urban and rural communes.The infant mortality rate. Agriculture.4 beds per 1000 inhabitants. which has been decreasing slightly in recent years. malignant neoplasms and pneumonia. with a total of 7362 beds. 1127 rural health centres. II.2 per 1000 live births. III. cerebrovascular diseases. In 1971. There were 1223 such centres in 1970. the city of Sofia has the status of province. in addition. was 26. which were formerly much neglected. At the provincial level the health services are directed by the public health departments of the Executive Committees of the People's Councils. tuberculosis and scarlet fever. Administrative organization of the health services The country is divided into 27 provinces ("okrugs") and. Education is free and is compulsory up to 14 years of age. set up in 1944. the main causes of death . In 1970 there were 200 hospitals with 56 009 beds and 185 sanatoria with 16 310 beds. 15 rural polyclinics. especially in rural areas. At the end of 1970 there were 9. In smaller settlements and in the more remote localities. Free medical care and health protection are guaranteed by law for the whole population. were: diseases of the heart. there were 3587 polyclinics. headed by a physician. Rural health services receive assistance from specialists in the regional hospitals.

both large and small. Treatment for tuberculosis is free.. Organization of preventive services The standard of hygiene in both urban and rural areas is steadily rising. In 1970 there were 1003 creches with 43 697 places for children. Each school doctor is in charge of some 2400 children. 1 physician per 530 inhabitants) . At the present time infectious diseases pose no great problem. rest homes. for Bulgaria is practically free of most epidemic diseases. the campaign to wipe out this disease continues and the population is subjected to compulsory and systematic X-ray examinations and BCG vaccinations. by the Institute of Health Education in conjunction with the Red Cross. polyclinics. Employed women are entitled to fixed periods of maternity leave. Public health information and research Research work in all major fields of public health is carried out by 12 central scientific research institutes under the Ministry of Health. sanatoria or at home. under the Ministry. Creches are at the disposal of all working mothers. who are organized in Red Cross groups. Special attention is paid to health education which is directed. Although tuberculosis is becoming increasingly less prevalent. co-operation between the local authorities and the population is giving good results. Towns. During pregnancy they are encouraged to undergo medical examinations and to follow special courses.specialized medical care over and above that provided by the general medical service. whether in hospitals. Sanitation and epidemiological stations provided with laboratory facilities play a very important role. and industrial centres have water supply and sewage disposal systems. the breakdown of principal categories of health personnel was as follows: 16 183 physicians (i. Guided by the central medical authorities. V. Some of these institutes were recently reorganized to form a Scientific Institute of Social Hygiene and Health Organization.e. IV. etc. There is well-developed school health service. Mental health dispensaries have been set up throughout the country to prevent and treat mental disorders. night sanatoria. Supply and training of health personnel In 1971. Big industrial plants have medical establishments of their own: hospitals. prophylaxis centres. as follows: 120 days for the first child. 150 days for the second and 180 for the third. VI.

3 131 stomatologists (dentists) (i. offer a six-year course of training for physicians. 1978. Financing of health services The cost of medical care is met. 1 stomatologist per 2739 inhabitants) 5 012 feldshers 2 464 pharmacists 6 016 midwives 26 381 nurses 807 physiotherapists 556 rehabilitation workers (in 1970) 3 847 laboratory assistants 886 X-ray technicians Three schools of medicine. . which has university status. who may receive further training at the Institute of Advanced Medical Studies. Plovdiv and Varna. HEALTH SINCE 1945: INSTITUTIONALIZATION PERIOD. Sofia: Medical Scientific Information Centre. Bulgaria also has 17 schools for nurses. feldshers. by the State. midwives and laboratory assistants (two-year and three-year courses). Fig. in Sofia. physicians must follow special courses and pass a State examination. PART 4 From: ***. either directly or indirectly. VII. 1: Public Health Administration in Bulgaria /to be continued/..e. In order to qualify as specialists. Primary Health Care in the Bulgarian National Public Health System.

An important characteristic of public health in the People's Republic of Bulgaria /PRB/ is its planning character. The right of every citizen for good health is guarantied by the Republic's Constitution and by the Public Health Law /31 October 1973/ which rests on the basic socialist principles. and. The successful social and economic development of the country created favorable conditions for the gradual decrease of the incidence of some and the complete eradication of other infectious and parasitic diseases. The state character of the public health is the first basic principle. The public health plan is an integral part of the uniform national economic plan. The institutional structure of the health network is built on a common hierarchical principle. promotion and restoration of the people's health are realized by a widely spread. Another basic principle of public health for the Bulgarian people is the insurance of a mass accessible. hierarchical. state functioning and mutually coordinated system of health establishments covering by their activities the population of the country .and every person individually from his birth till . Bulgarian Public Health nowadays represents a harmonious dynamic system connected functionally with the entire social and economic development of the country. Essential feature of the prophylactics in the PRB is its comprehensive character. It is created on the basis of thorough scientific researches on the alterations of the ecological system "man-environment".as a whole . for many years along a planned and comprehensive immunoprophylactics and other antiepidemic measures have been taken.Going through exclusively difficult stages of development. diagnostic. financed and directed by the State and for that reason it represents and integral part of its politics. the public health system is built. free of charge and qualified medical care for the whole population. organized. for the effective administration of public health activities. Prophylactics is a main tendency of Bulgarian Public Health. The activity sphere of the prophylactic measures is raised on a state level.some of the social ones for the protection. as well as. On the present stage the prophylactic. which. can be realized only when interests of the people and the State coincide and develop in an organic unity. This structural unity is an important stipulation for the even medical care distribution on the whole territory of the country. on the long-term prognostics for the development of productive forces. curative and rehabilitative measures as well as . etc. related to all spheres of social life. In the endeavor for good health the introduction of this principle is a qualitatively new and higher stage. the tendencies of the health and demographic state of the country. on the development of the public health resources. the incessantly changing requirements of the population for medical care. As a social structure. Under the organizational and systematic guidance of the "Inspectorates of Hygiene and Epidemiology" with the active participation of all prophylactic and curative establishments. compulsory for all administrative units in the country. as well as of the population itself. the agglomeration of the population and the growth of the settlement systems.

Regional (local) level inspectorates are units and groups of hygiene and epidemiology operating as branches of the "Inspectorates of Hygiene and Epidemiology". promotion and restoration the health of the population is a fundamental principle of Bulgarian public health.the Standing Committees at the National Assembly.chemists. Public health in Bulgaria is build up and developed on the principle for unity of medical science and practice. the members of the health groups organized in factories. The groups of hygiene and epidemiology are organized in regions with up to 80 000 inhabitants. This principle is realized by the wide development of the fundamental and applied medical scientific researches and by the implication of the latest scientific achievements into practice. the health teams at the medical establishments. I.his death. District inspectorates of hygiene and epidemiology are organized in the district towns with a population over 80 000 people. several sanitary inspectors. laboratory technicians. The insurance of scientific progress in the public health practice is a subject of special care on the part of the health authorities. . sanitary inspectors. National (central) inspectorates of hygiene and epidemiology is functioning on national level. is a powerful stimulating factor for the successful fulfillment of all prophylactic and medico-social measures. Some of the district inspectorates of hygiene and epidemiology are charged with national functions. This contributes to the permanent improvement of the people's health status. The primary health care in all its medical aspects and in some of its social ones is realized by team. The medical science provides the medical workers with modern methods of prophylaxis. treatment and rehabilitation. etc. The activity of the population. One group consists of 2-3 physicians. directed and supported by the state organs. diagnostics. laboratory technicians and others are working at them. in accordance with the administrative subdivisions of the country and the distributive principle of medical care. They are subordinated to the district inspectorates. The health structure of a higher level executes a more and more specialized activity and represents an integral part of the uniform public health system. too. Hygiene and epidemiological activities The hygiene and epidemiological care of the population is organized on different levels. Teams of 18-20 physicians and other specialists with high and secondary medical education . disinfectors and others. biologists. the district and municipal People's Councils. The organizational forms of the participation of the population in Public Health are . schools and agricultural units. The basic organizational unit of public health is the team of microregional physicians. The wide participation of society and of the population in the State activity for the protection.

The number of industrial and agricultural sites reorganized in accordance with the hygienic standards. A great success has been attained in mining dust control and in the sharp reduction of pneumoconioses. hygiene of children and adolescents. agricultural sites. Their wide application permits the attainment of a great progress in the infectious disease control. conducts a sanitary control over basic problems and over important sites with national significance.The groups of hygiene and epidemiology and the branches of the inspectorates conduct a current sanitary control on public utilities. public catering establishments and children educational institutions. hygiene of nutrition. They organize the fulfillment of the antiepidemic measures . in accordance with the requirements of ergonomics. etc. etc. according to the Public Health Law are performed annually in accordance with an adopted immunization calendar. reduction and eradication of the infectious diseases in Bulgaria. disinfection. The district services include microbiological. The achievements in the limitation of the harmful effect of the chemical substances used in industry and agriculture are also considerable. elaborate measures for prophylaxis and reduction of infectious and parasitic morbidity. considerable success was obtained in environmental sanitation on the basis of the respective sanitation programmes. The national inspectorates of hygiene and epidemiology exercise a systematic guidance and control over all local medical services. Considerable achievements have been obtained in the endeavor for prevention.immunizations. . The district inspectorates of hygiene and epidemiology execute specialized sanitary and epidemiological activities in the sphere of epidemiology. as for example. A number of physiological and ergonomical problems are solved more and more successfully. disinsection and deratization. parasitological and chemical laboratories. the introduction of new forking furniture. At present. occupational hygiene. for example. This activity is conducted systematically and purposefully by the inspectorates of hygiene and epidemiology and by the medical establishments with the active participation of the administrative services and the social organizations. which. social hygiene. a number of industrial enterprises polluting the atmosphere were moved out of settlements. industrial equipment. industrial enterprises. As a result of the close correlation of the services of hygiene and epidemiology and the network of medical services and the active cooperation of society and the population. the improvement of the regimens of work and rest.6 % from controlled local water sources. 96 % of the population of the country uses pure drinking water from the central water supply system and 3. over sites of national importance. renders practical assistance in the organization and execution of the state sanitary control. carries out measures for the medical and sanitary protection of the country against quarantine and especially dangerous infections. realizes the sanitary and technical expertises on standard projects. A basic role in that respect have the prophylactic immunizations. Thus. rules and requirements increase steadily.

0 0.1 193. Dysentery 11.0 2.0 0.3 1. Tetanus 7. will enable every citizen to protect and promote his own health as well as the health of his family and his relatives. Acute Poliomyelitis 2. Viral Hepatitis 1944 1.1 127. Whooping cough 8.8 231.5 23.5 0. transforming each citizen into an active champion of the people's health and welfare.7 3.1 250.0 408.2 184.4 57.0 0.Table 1: Achievements in the struggle against the infectious and parasitic diseases in the PRB /morbidity per 100 000 people/ Kinds of infectious and parasitic diseases 1.3 15.0 0.3 252.2 179.0 0.7 18.0 0.9 31.0 134. The health education is a State responsibility realized by its organs and is under its direct management. Health education The principles.1 0.2 0.6 179. Health education activities in the country are directed towards the formation of such health behavior and education.3 2.9 5.3 5.1 0.3 35.5 22.7 II.4 1965 0.1 0.5 0.5 400.1 9. Malaria 6.6 9.0 2.2 0.2 0.0 0.1 0.2 0. organization and management of health education activities in Bulgaria derive from the basic principles on which the public health system is organized.0 1955 1. Measles 10. Mumps 9.4 1.4 116.5 97.0 0. Typhoid fever 5.5 9.6 1975 1976 0. On the second place.2 233.1 52.9 354.0 0. which.0 0.3 15.4 4.3 152. Diphtheria 4. .4 151.3 1977 0. Typhus 3.0 0. the health culture stimulates the initiative of the population and of the individual person to participate in the realization of sanitary measures and measures for environmental sanitation.6 232. The significance of the health education in the public health system is stipulated by its prophylactic tendencies and by the active and mass participation of the population in the versatile activities for the health protection of the people.8 115. guiding planning.

Organization of primary medical care Out-patient and day-patient care is the most mass type of medical care. etc. Their duties were twofold . A considerable part of the work for the promotion of population health culture is carried out by the Fatherland Front . In only one year. The activity of all these institutions is coordinated and directed systematically by the Ministry of Public Health and the National Council for Health Education. also by a number of other state institutions and organizations . Especially significant is the activity of the Bulgarian Red Cross in the schools. on the hygiene of youth. There. This determines the leading role of the outpatient departments in the solving of the problems connected with the health status of the population. including their participation in the struggle against smoking and drinking. the Committee of Bulgarian Women. Series of health lectures are issued.the largest social and political mass organization in the country. specialized services for health education were formed in the framework of the public health system. "Nutrition and Health". to a large extent. Through this organization thousands of health lectures and various prophylactic measures are organized annually in towns and villages. "Health Lectures for the Worker". such as: theses for lectures and meetings. this activity is directed towards the hygiene education of the pupils. slides. The Bulgarian Red Cross also displays widescope activities in the field of health education. "Health Lectures for the Rural Population". The health education in the country is conducted not only by the organs of the public health system. but. etc.the Ministry of Education. leaflets. films. diagnostics. on hygiene of living conditions and others. Annually. too . on hygiene of marriage. In the outpatient departments. their sexual education and their training in the health posts for rendering first aid. more than 300 000 people attend the courses on nutrition. Thousands of health posts render first aid and take care of the hygiene and the dissemination of health education on social principles."Library of Health". on nursing ill people at home. thousands Bulgarian people are trained in different courses organized by this mass organization. the Committee of Culture. etc. occupation-medical expertise and rehabilitation of the majority of the people in need of medical care are solved. At the same time. department of Health Education were organized in all district inspectorates of hygiene and epidemiology.to carry out health education by their own means and to organize the involvement of all health establishments and medical workers in health educational activities. the Institute is responsible for the publication of different materials indispensable for the regular and purposeful direction of health education activities. the Trade Unions. exhibitions. the Bulgarian Cinematography. III. created on social principles at the same Ministry. Irrespective of that. aiming at the organization and scientific guidance of health education in the country. Health Lectures for the Pupil". . on longevity. the Committee of Soberness and others.In order to realize these activities. treatment. placards. An "Institute for Health Education" has been created at the Ministry of Public Health. the problems of prophylactics. booklets. the Youth Organization.

The obstetric and gynecological microregion is organized on a territory with a total population of 17 000 .P. a dentist. aged up to 15. A team of physician-general practitioner or specialist in internal medicine. in which an obstetric and gynecological microregion is not organized. in accordance with the size and the territory dislocation of the attended contingent: The village health microregion is organized in one or several villages with a population of 1500 . In them.pediatrician or internal medicine specialist . In enterprises with more than 800 women workers . the physician's assistants work under the guidance of the microregional physician.a midwife is included in the team.2000 workers. It covers a territory with adult population of 3000 . The medical team of the departmental microregion is composed of a physician (G. the therapeutic microregion includes in its structure physician's assistant's dispensaries in order to provide health care to the inhabitants of the nearby villages.The microregional principle (territorial and occupational) is accepted as a basic principle of primary medical care in the contemporary organization of outpatient care. The necessary pediatric or internal medical care is ensured in accordance with the age of the pupils. on an average.18 000 people or in industrial enterprises with more than 4000 women workers. Dispensaries headed by physician's assistants (sometime called feldshers) are organized in order to ensure health care in small constituent villages in the structure of the village health microregions. specialized obstetric and gynecological care is provided. Physician's assistants dispensaries are organized in distant departments of the enterprise with more than 200 workers. The microregional system for outpatient medical care reflects in its contents the synthesis of the prophylactic and curative medicine. a dentist. In the rural medical service.3500 people.a microregional nurse and a patronage nurse . There a school physician . Every microregion is attended by a team formed out by a physician. a midwife. The therapeutic microregion organized in the towns and cities is the basic unit in the infrastructure of the outpatient medical care of adults. physicians's assistants and auxiliary medical personnel. A primary. nurses and physician's assistants work there. Nurses and physician's assistants are included in the team.). In Bulgaria the following physician's and dentist's microregions are organized.are included in its structure.is working aiming at the specific medical problems of the rising generation. a maternity health . For the medical care of the nearby villages. The team of midwives is headed by an obstetrician-gynecologist. In such microregions qualified primary medical care is provided to the entire population.3500 people. The pediatric microregion is organized for the attendance of 1000 children. a physician's assistant and a nurse. nurses. The school health microregion is organized for 200 and more pupils. The enterprise-departmental physician's microregion is organized in enterprises for ensuring medical care for 1200 . A microregional pediatrician and two nurses .

1/. Primary medical care in the remaining aspects is provided by the general outpatient departments. The types of the health microregions described above. pediatric. obstetric-gynecologists. an eye-specialist. The medical services of general type.center is organized and managed by the medical worker in charge of the dispensary. It attends on a territorial principle the population elder than 18 years. pediatricians. while. or of the district stomatological outpatient department. The stomatological microregion forms an integral part of outpatient medical care and is a constituent part of the dispensary. obstetric gynecological and stomatological aspects. a neurologist. That creates a possibility for timeliness. provide the population with primary medical care classified according to their capacities are the following: . In the industrial enterprises a departmental stomatological microregion is organized. that. Structure of the primary medical establishments The widespread network of outpatient establishments and dispensaries in this country provides the population with free of charge. pediatricians and obstetrician-gynecologists but also for the other specialists in the outpatient departments. He ensures the prophylactic surveillance only on women with normal pregnancy. two or more teams are organized composed of 5-6 microregional internal disease specialists. accessible paramedical help and qualified. quality and complexity of the diagnostic and curative process. All these attend patients in a synchronized schedule. IV. while. a surgeon. specialized medical care. an otorhinolaryngologist and a dermatologist. the children and the pupils are attended by profiled children's and school's dentists.one. The basic sense and contents of this form is expressed in the following: the microregional principle becomes essential not only for the internal medicine specialists. In compliance with the capacity of the establishment . these with pathologic pregnancy are looked after in the outpatient department of the regional or district hospital. provided the majority of the people with primary medical care in internal medicine. in the specialized outpatient departments and in the district stomatological outpatient departments. or of the outpatient department's stomatological ward of the regional (local) hospital. A successful supplement to the microregional principle in the country is the widespread organizational form of team care /see Fig.

The outpatient departments are complex medical establishments, delivering qualified and specialized primary consultative outpatient medical care - both, to the urban and to the rural population. They are developed as part of the regional, district or labour hospitals and as an independent establishments. The number of the outpatient departments in the towns is in accordance with the number of the inhabitants, and, their dislocation is in conformity with their necessary closeness to the attended population. An outpatient department in the big cities attends about 40 000 people on an average. The outpatient departments, according to the number of the attended people and the functions they execute, are divided in five types. In them, an assistance of determined specialty is provided in conformity with the type of the outpatient department. The outpatient departments of type I, II and III are organized in the towns and cities. These of types IV and V are organized chiefly in the larger central villages. In the latter, according to prearranged schedules, different specialists are working - surgeons, neurologists, otorhinolaryngologists, ophthalmologists and others coming from the regional or district hospitals with a view to bringing the specialized primary medical care closer to the rural population. The labour outpatient departments are organized at the industrial sites and complexes with more than 10 000 workers. As a rule, they are included in the structure of the regional or the workers hospitals. The stations for urgent medical care exist as an independent health establishments only in the largest cities. They provide urgent medical care of the basic and some other specialties, such as: internal medicine, surgery, obstetrics-gynecology, cardiology, reanimation, traumatology, neurology, toxicology and others. The specialists according to their specialty are included in the staff of specialized teams, who, dispose of adequately equipped means of sanitary transportation. The departments for urgent and emergency care are structurally incorporated into the outpatient departments of the district hospitals. Teams of medical workers with higher college and secondary medical education who are specialists chiefly in internal medicine and pediatrics, together, with specialized teams in conformity with the needs of the population - are working in them. The services for urgent and emergency medical care at the regional hospitals have the same functions but their staff is smaller. All the stations, services and departments for urgent and emergency medical care use in their routine practice appropriate medical technology for the conduction of life-saving measures on the place of accident and during the transportation of the patient to the health establishment, as well as, modern means of communication: radio-telephone, distant recorder of electrocardiogrammes and others. In the structure of the National Station for Urgent Medical Care in the capital of Bulgaria - Sofia, the service of urgent consultations and medical aviation, disposing of modern transportation means including medical airplanes and helicopters, is included. At the day and night's disposal of this service are 250 habilitated specialists from the Medical Academy.

The dispensaries or so-called "outpatient and inpatient departments", provide primary specialized and consultative medical care on some problem disease in the public health network. Such are pneumophthisiologic, oncologic, psychiatric and dermovenerologic dispensaries. They provide specialized medical care to one or several districts, work in close interaction with health establishments of the general type and guide them systematically according to their specialized work. Parallel with the insurance of primary medical care by the microregional physicians and by the outpatient departments specialists, the citizens have the possibility to choose - in accordance with their desire and preferences - a free of charge medical care from a highly qualified specialist, such as: head of hospital ward, head of clinic, habilitated specialist, etc. For this purpose scheduled hours for consultations of the patients in the outpatient departments are fixed. In the PRB exists a specially created organizational system, which, permits every person for whom the physician in charge on a given level decides that he needs more qualified and specialized medical care - to be sent to an establishment of a higher level. The system stipulates a special documental exchange of information between the different levels including feed-back of information. In the activities of the general and specialized outpatient establishments network (the activities of the microregional physician and the different specialists working in those establishments) a basic method is the follow-up. These activities involve: - planning, organization and carrying out of different kinds of prophylactic examinations of certain age, sex and occupational groups of the population with a view to the early discovery of the risk factors - occupational, communal, hospital - and the diagnostics of the early forms of some diseases which at that stage have the characteristics of mass and problem diseases for the country; - the exact diagnostics of each individual case, clarification of the health condition of definite priority groups of the population (children, pupils, pregnant women, heavy load workers, etc), prescription of the necessary prophylactic curative and rehabilitative measures, planning and organization of dynamic surveillance of the followed-up patients and of the group of people at risk; - realization of the planned measures in respect of the protection and sanitation of labour and living environment of man, increasing and strengthening the protective forces and supporting the adaptive mechanisms of the organism, promotion of health knowledge and formation of healthy habits among the population, systematic and active control of the results of the conducted health measures, introduction of eventually imposed corrections of the primary programmes, etc. More on follow-up method in Bulgaria can be found in the monograph from WHO, namely: "D. K. Sokolov, J. E. Asvall, H. Zollner. The Gabrovo Health Services Model in the People's Republic of Bulgaria. Copenhagen: World Health Organization - Regional Office for Europe /EURO Reports and Studies 27/, 1980."

V. Organization of specialized medical care The hospital network in Bulgaria is organized as a stage system comprising four levels regional (local), district and national. On a regional level, hospital care is provided in the united regional hospital. Its capacity is about 300 - 600 hospital beds. There are wards for internal diseases, pediatrics, surgery, obstetrics-gynecology which are organized obligatory, as well as, some specialized wards such as ophthalmological, otorhinolaryngological, neurological and others. On a district level the district hospitals with 600 to 1200 hospital beds are organized for satisfying the needs of the population of the corresponding administrative unit (200 000 to 400 000 inhabitants). These are wards according to a broader nomenclature and include cardiologic, endocrynilogic, urologic, orthopedic, traumatologic and other wards. On a national level specialized centres of pulmo- and cardio- surgery, organ's transplantation, keratoplastics and others are organized. At the end of 1976, in 184 hospitals of the country 67 220 beds were functioning, which shows that the bed-population ratio was 85 beds per 10 000 people and that the admission rate was 16.4 per cent. The sanatorium-resort care in Bulgaria disposes of precious resorts. More than 500 mineral sources were discovered with different composition and temperature of the water. Besides, there are firths and peats-bogs sources of curative mud and resorts with favorable climatic conditions. Some of the mineral sources, as these in Hissar, Kyustendil, Sofia and others were discovered and have been used as curative centres as far back as the time of the Roman Empire. Sanatorium-resort care is considered as a stage in the carrying out of outpatient and hospital care. This type of medical care provides the realization of part of the planned in other medical establishments physioprophylactic, physiotherapeutic and medical rehabilitative measures. A harmonious system of continuity between the sanatorium resorts and the other medical establishments is organized, ensuring the sequence in the realization of the planned medical measures. In 1976, the sanatorium bed-population ratio was 21 beds per 10 000 people. Considerable part of these beds were determined for the treatment of children and adults. The medico-social assistance in Bulgaria comprise 15 209 berths in 158 establishments for social assistance - boarding houses for old people, boarding houses for honored revolutionists, homes for disabled people, homes for children and adults with physical impairment or mental disorders, hostels for students in the training and industrial enterprises, etc. In 49 settlements of the country the so-called "Social Home Patronage" is organized, by which different types of services (food delivery, cleaning of the lodgings

midwives. The challenge of "the attainment by all citizens of the world by the year 2000 of a level of health. VI.because . FOREWORD The adoption of the goal of "Health for All" by the year 2000 from the member states of the World Health Organization /WHO/ in May 1977 became a turning point in its history and an event with profound long-term implications for the health and social policies of all nations.and other services) are ensured for old and incapable for self-attendance persons. Bulgaria's Road to "Health for All". small or large. about the clinical diagnostic curative and rehabilitative problems. The paramedical staff is trained in institutes dislocated on the territory of the country.composed of 24 scientific institutes. Their training takes 2-3 years depending on the specialty. in which physician's assistants.it ensures the outlining. 1. assistant pharmaceutists. Medical science and training of medical staff Medical science is of special importance for public health in the broad sense of the term. 1987. etc. developing or . In order to make life of old people worthwhile. A basic element of science and of the realization of a comprehensive medical care is the medical staff.the Medical Academy . HEALTH SINCE 1945: INSTITUTIONALIZATION PERIOD. X-ray technicians. the planning and the conduction of scientifically grounded measures. All scientific and higher educational institutes in the country are integrated in an uniform scientific and educational complex . including primary medical care . PART 5 From: ***. 2 stomatological and 1 pharmaceutical Faculties. nutrition inspectors. In this complex. the post-graduate education of the medical staff and the scientific activities are concentrated. dental technicians and others are trained. 3 medical. Sofia: Publishing House at the Medical Academy. about the requirements to create an effective health organization. nurses. about the needs of the population in medical care. that. would enable them to lead socially and economically productive lives" has given birth to a programme of peaceful cooperation and competition between countries of different social and political systems. At present. rehabilitators. are of such nature that they can introduce essential changes in the approach to the protection and restoration and promotion of the health of the people. 356 "Clubs of the Pensioner" have been organized in Bulgaria. the training of the students in medicine. 19 institutes are functioning in Bulgaria. The scientific investigations about the health of the population and the conditions and the factors that determine it. laboratory technicians.

and ensuring social equity in health care. an intensive social and economic reorganization is taking place in PRB. i. One of the important prerequisites to the attainment of these objectives is the improvement of the health state of the population. The realization of the most human goals of "Health for All". social equity in the allocation of health resources. the eradication or control of some . material and other resources towards providing efficient and accessible primary health care. Many countries have succeeded in accomplishing profound structural reforms in their national health care systems and in re-orienting a considerable part of their human. In this. which. the health workers and the peoples of many other countries. Halfdan Mahler. the WHO secretariat has developed an orderly conceptual and practical system of methodological instruments and guidelines in support of the efforts of the member states. as well as. Under the leadership of Dr. dependence inherited from the colonial past and lack of a developed infrastructure. have experienced serious economic difficulties. however. are in full concordance with the ideology and the objectives of the social development of the People's Republic of Bulgaria /PRB/.developed. Bulgarian health workers and the entire Bulgarian society. "Health for All" has become a global task. hostilities. It is related to real needs arising in the process of building up a mature socialist society. For forty years the principles underlying Bulgarian socialist health care and social policy have been consonant with the fundamental requirements proclaimed by the WHO in 1977. USSR. the WHO and its member states have set an example of how different interests. the very survival of humankind. but. Other countries. In the course of this reorganization utmost priority is given to the satisfaction of human needs and to providing the optimal conditions for a harmonious development of the individual person.e. accessibility of health care. the Director General of WHO and a dedicated architect of the "Health for All" movement. At present. ideologies and political systems can work together in the name of an attainable goal promising well-being and better quality of life to the millions of ordinary people throughout the world. But irrespective of such divergences and of the uneven rate of progress towards the common goal. preventing socially significant disease and other health problems. took place in Alma Ata. The past ten years have witnessed some significant progress towards the achievement of this objective. as well as. The "International Conference of Primary Health Care". government and community responsibility for the health of all citizens and priority of prevention. a system of new values and a set of specific strategies within the framework of world health during the last quarter of the XX century. its accompanying system of values and the corresponding strategies. in 1978 was a major early landmark in the right direction. many difficulties and obstacles. are clearly aware of the fact that the achievement of "Health for All" could be significantly accelerated if the world could free itself of the burden of the colossal expenditures on arms. often aggravated by natural disasters. The mere existence of nuclear arsenals having the potential of a global destruction puts in question not only the achievements of "Health for All".

• Physical activity .. Promotion of environmental health .. • Reduction of alcohol consumption .Bulgaria's Road to "Health for All" .diseases.. 2.has been prepared in response to the unanimous decision of WHO member states for developing national strategies and plans of action in accordance with global and regional "Health for All" strategies. an outline of the approaches to its solution and a statement of the intermediate and final targets. which. will determine the attainment of the "Health for All" objectives. SYNOPSIS OF OBJECTIVES AND TARGETS Promotion of healthy lifestyles • Balanced nutrition . Naturally. The CC will analyze annually the progress towards the accomplishment of the specific tasks according to an agreed timetable. The present document . will monitor the implementation of the separate activities within the national strategy and coordinate the work of all the participants in the process. • Smoking cessation . national programmes dealing with key health and social problems have been drafted and adopted in accordance with the "Health for All" principles. trends and future projects in the main areas of public health and social development. Since 1977. An overall evaluation of the strategy will be carried out biennially by the "Collegium of the Ministry of Health" and the "Presidium of the Medical Academy".. the public opinion and the government. Each section of the paper contains a brief analysis of a particular problem... the significant decrease in the impairments and disabilities resulting from other diseases and the achievement of a harmony between man and his environment.. The intensive international exchange of information and experience and the programme documents and methodological tools produced by WHO. The results of these interim evaluations will be reported to the CC. which. the time has now come for an overall review of the current state. It is foreseen to set up a Coordination Council /CC/.. have found a vivid resonance among Bulgarian health workers and health planners.

Prevention and control of socially significant disease and related health problems . It was founded in year 681 and in the early Middle Ages became the cradle of the Slavonic script and a major focus of culture.. However. Biomedical science and technology: a prerequisite for achieving "Health for All" .. within the framework of the capitalist state.. The first health projects at the time were influenced by the advanced Russian community medicine.. emphasized prevention and democracy.. Improving the organization and management of health care .. . through centuries long struggles for national independence and self government.. Training and development of human resources .. Under the conditions of the bourgeois state the solution of national health problems suffered serious neglect. which.. International cooperation .. a project for the organization of a national health service was developed by Bulgarian physicians. 3. Its stormy history passed through periods of flourishing and decline.. Bulgarian public health policies were subordinated to the interests of the ruling class and gradually yielded to the private capitalist enterprise. HEALTH POLICY OF THE PEOPLE'S REPUBLIC OF BULGARIA The People's Republic of Bulgaria /area: 111 000 km2 and population: 8 949 618/ is one of the oldest countries in Europe.... Rearing a healthy and harmoniously developed young generation .. Already during the first years following the Liberation of the country from the Ottoman rule /in year 1878/.. Financial support of health care ..

the new People's government set itself the task to resolve the major problems of public health. to integrate medical science with medical practice. The essence of the health policy of the People's government was phrased in brief by Georgi Dimitrov: "Health and working capacity are the most precious national wealth". all the citizens of the country were entitled to medical care free of charge. health is "a basic human right safeguarded and promoted by the state and the socialist society".e. had been aggravated by the conditions resulting from the Second World War. The Socialist Revolution proved a turning point in Bulgarian public health. As of year 1951. The supreme principle underlying. to make highly qualified medical care available to the entire population free of charge. transfer of the best achievements in world health science and practice. as well as. A network of hygiene and epidemiological monitoring stations were established. etc. concentration of resources and establishment of health facilities with improved diagnostic and therapeutic potential. diphtheria. A decisive impetus to the advance of public health was given by the "April Plenum of the Central Committee of the Bulgarian Communist Party" in 1956."Everything in the name of man. The first step of the People's government towards the establishment of a new health care system was the putting into practice of the Leninist principles of socialist public health. Hospital services were inadequate and restricted to cities and big towns. everything for the welfare of man" . the "Ministry of Health" was assigned the important task to overcome the shortcomings of bourgeois public health and to develop a new system of health promotion and protection. After its establishment. i.Immediately after the victory of the Socialist Revolution on 9 September 1944. the active medical follow-up of large groups of the population. Its methodology emphasizes strongly the so-called dispensarization approach. to promote prevention as the mainstream of public health. such as. This political position ensured a lasting and comprehensive support to public health and laid down the lines for its further development: better coverage with health care. tuberculosis. typhoid fever. which. 167 social welfare homes. became known as the April policy of the Party . promotion of medical science and technology. Within the provision of the "Constitution of PRB". to promote the free and harmonious development of everybody. 4644 pharmacies. a "State Sanitary Inspectorate". 29 hygiene and epidemiological . exanthematic typhus and malaria. what. According to the "Constitution of PRB". In that period the health indices for the nation showed high infant mortality rates and high prevalence of communicable diseases. and to ensure the participation of all the sectors of society and the people's organizations in the implementation of health measures. The system for preventive and therapeutic care in Bulgaria at present is built up on the territorial principle /residential or occupational/. 1199 creches and nurseries.evolves from the ultimate goal of communism. i. the access to free health care is guaranteed to everybody in Bulgaria.e. 196 sanatoria. 187 hospitals with a bed/population ratio of 93 hospital beds for a population of 10 000. The comprehensive network of health facilities now includes 3851 outpatient and polyclinic services.

inspectorates, etc. The number of health workers is over 190 000, including 25 665 physicians, 5745 stomatologists, 4209 pharmacists and over 84 000 mid-level health personnel. The annual number of outpatient medical contacts is over 86 million, of hospital admissions - over 2 million, of persons covered by medical follow-up care - over 4 million, etc. Health care is being brought increasingly closer to the population by constantly strengthening the frontline of primary health care and emphasizing the coordinative role of the district physician. In the field of prevention the measures aiming at the improvement of the living environment become increasingly comprehensive and effective. The dynamic social and economic development, the rising standards of living and the involvement of the community are conductive to a constant improvement of the health status of the population. At present, the average life expectancy is over 71 years /versus 48.4 years in 1944/ and infant mortality has decreased to less than 15 per 1000 live births. Many communicable diseases have been eradicated and there is a trend towards a decrease in temporary and chronic disability; physical fitness and mental health, especially as concerns the younger generations, enjoy a high priority and the wellbeing of the entire population has been improved. It is foreseen to expand the principle of free medical care in the forthcoming years by providing all the essential drugs to those, who, need them free of charge. On a number of important health indicators the PRB ranks among the highly developed countries. The advances in public health run in parallel with the progress of Bulgarian medical science. At the "Tenth Congress of the BCP", a new approach towards science and education was adopted, aiming at interlinking them more closely with social, economic and cultural development. The "October Plenum of the CC of the BCP" in 1971 set the task of reorienting science to socially relevant goals and integrating research with training and practical work at all the institutions of higher education. As a result, the Medical Academy was established in 1972. It was entrusted with the following tasks:
• • •

further concentration of the scientific potential in biomedical research and its integration with medical education and medical care; integrated management of research, the development of science, medical technology and higher education; promotion of international collaboration;

The establishment of the Medical Academy led to an efficient concentration of cadres and resources, and, to their orientation towards key health problems. Health research was pursued not only within the Medical Academy, but, also in collaboration with the Bulgarian Academy of Sciences, the Academy of Agriculture and other institutions. During the past decade 25 biomedical research institutes, 5 higher medical institutes /medical schools/ and 3 centres for applied research and production were established. The

Medical Academy thus became a powerful research, diagnostic and therapeutic complex, which, also has the important function of training highly skilled health workers. Much of the research potential available at the Medical Academy is engaged in the development of new biomedical technologies, including original pharmaceutical products, advanced medical electronic equipment and other items produced to meet the local needs or for export in both developed countries and developing ones. More than 1600 technological inventions and innovations have been registered by the Medical Academy in the past 5 years. A number of scientific achievements have already been put into practice. The resolutions of February 1985 and January 1986 Plenums of the CC of the BCP emphasized, that, the further development of Bulgarian society would have to be based on the accelerated advance of science and technology and the application of their products in all spheres of life. The "Thirteenth Congress of the BCP", laid the foundations of a new important stage in the social development of Bulgaria by adopting a national long-term strategy for scientific and technological progress, developed under the guidance of Todor Zhivkov - Secretary General of the CC of the BCP. The strategy envisages a profound reorganization of science, with the aim of overcoming existing flaws in certain areas and mobilizing the creative potential of the nation. The accelerated implementation of scientific and technological advances and the transfer of leading world expertise, should provide the basis and conditions for a new stage in the promotion of health, prevention of diseases and the overall improvement of the work capacity and quality of life of people. The most important objective is to qualitatively upgrade health care, and, by means of a selective reorganization to direct all the efforts towards the solution of the most significant health problems. Bulgarian society has reached now a stage, when, it becomes possible to carry out a scientific and technological revolution in public health at an accelerated pace. Research into the molecular basis and mechanisms of heredity, of carcinogenesis, of hormonal and central nervous control over the physiological functions, hold out unexpected opportunities for preventing and treating disease and for promoting health. In due cognizance of the key importance of mental health and human behavior and of the role of the brain in the homeostasis of the organism, special attention and resources have been given to an integrated programme of neuroscience and behavioral science research. In the light of this, the control of socially significant diseases comes to the fore. Due to the high morbidity, mortality and disability and the serious social, economic and psychological impact of cardiovascular, cerebrovascular and respiratory diseases, malignant neoplasms, injuries, diabetes and mental disorders - these conditions have been selected as the targets of a major national programme for primary prevention, treatment and rehabilitation. The programme includes a variety of social, behavioral and medical measures and specifies clearly the responsibilities for their implementation both within and outside the health care system. Dyspensarization will remain a key approach and according to the plan 65 per cent of the population would be covered by active medical follow-up by year 1990.

At this stage it is particularly important to shift the focus from a preoccupation with the treatment of disease, only, towards health promotion and disease prevention, in order to maximize the chances of all the people to enjoy lives free from disease and disability at the highest possible levels of physical fitness and mental activity that are commensurate with their age. In accordance with the Constitution of the WHO, which, emphasizes that "health is a state of complete physical, mental and social well-being and not merely the absence of disease or disability", the activities of the health system will increasingly be directed not only towards the persons who are ill, but, also towards the healthy. An example of the new measures within this comprehensive approach to the promotion of health is the establishment of the so-called "health workshops" in the industrial enterprises and organizations. There is now in Bulgaria a growing awareness, that, in view of the multiple determination of health programmes for health promotion and disease prevention prompt actions by all the state, economic and social bodies and organizations; public health is now clearly seen as a national cause. According to this new approach, health care must begin with health education of the population and participation by the people is required in all programmes dealing with prevention, treatment, rehabilitation and social assistance. More than forty years have elapsed since the first People's government announced in its programme the strategy for the protection of the people's health. During that period of time fundamental changes have taken place in Bulgaria. The development of the health care system has paralleled the overall economic and cultural advance of the country. In the decades ahead, Bulgarian health workers and the nation as a whole, face major new tasks and challenges clearly outlined in the historic decisions of the "Thirteen Congress of the BCP". These decisions have set the signposts of Bulgaria's road to "Health for All" by the year 2000. 4. CONTEMPORARY STRUCTURE OF THE FRONTLINE OF HEALTH CARE IN BULGARIA Editor's note: This chapter, essentially, covers the same material given before in chapter 18 from our exposition: sketch 5. PROMOTION OF HEALTHY LIFESTYLES Balanced nutrition In the course of implementation of the System for Balanced Nutrition on a national scale, the following objectives will be pursued: 1. By the year 2000, the prevalence of obesity /expressed as overweight exceeding by 20 per cent or more the optimal weight/ should be reduced to less than 10 per cent in the male population, and, to less than 20 per cent in the female population;

Physical activity The most important objectives are as follows: 1. From 1988 on. obligatory labeling of foodstuffs should be introduced.87 mmol/l for children up to 14 years of age. in order to make them consistent with up-to-date scientific norms of balanced nutrition. 5. By the year 2000. amendments to the Bulgarian State Standards for processed and semi-processed foods should be initiated. fruit and fish should at least double and the production of vegetable and fruit juices and mousses additionally enriched with calcium and potassium should be substantially increased. the mean consumption of table salt per capita should be reduced to no more than 6-8 g sodium chloride per day. The number of curricular and extracurricular classes for physical activity of schoolchildren should be increased: for grades I to III up to 13-14 hours weekly.by 35 per cent. the consumption of fresh and frozen vegetables. by the year 2000 this percentage should be at least 60. a trend towards a further decrease to 4-6 g per day. The nutrition education of the population should be improved. By the year 2000. . as ascertained by questionnaire surveys. cholesterol content in the blood serum should be reduced to under 200 mg/100 ml or 5.2. in order to inform the consumers about their nutritive and biological value. with. By the year 2000. for grades IV to VII up to 12-13 hours weekly. and. 3. by the year 1990 no less than 40 per cent of the people from all ages would have adequate knowledge about the diet appropriate to them. to under 150 mg/100 ml or 3. at the same time. so that.17 mmol/l for the age groups 15 to 64 age. the concentration of sodium chloride should be indicated on the packing of commercially available table salt. 6. that of sugar and sugar products . the consumption of animal fats should be reduced by 30 per cent. for grades VIII to XII up to 8-9 hours weekly. By 1987. There should be at least six obligatory days for walking tours in each school term and a year round mountain camping base should be provided for about 5000 schoolchildren by 1988. 4. and. 2.

by the year 2000 no less than 90 per cent of the adult population in age groups 18 to 65 years should be acquainted .3. By the year 1990. and. From 1988 on. 6. 2. no less than 60 per cent. 4. the sales of cigarettes should be reduced by 20 per cent as compared with year 1985. by the year 2000. Smoking cessation The following specific objectives will be pursued: 1. no less than 75 per cent of the adult population should be able to specify the diseases related to smoking /as ascertained by questionnaire surveys/. and. by the year 2000 . short term courses on behavioral therapy aiming at smoking cessation and overcoming the smoking habit should be available at the outpatient and polyclinic units and in the "health workshops" attached to industrial enterprises. the proportion of the informed population should be 95 per cent. and.to under 1 per cent. 4. such courses should be organized with the support of the relevant research institutions and the Trade Unions. by the year 2000 . and. by year 2000 . the proportion of schoolchildren from 12 to 18 years of age who learn the smoking habit should be reduced to under 5 per cent. By the year 1990.80 per cent. and. By the year 1990. in order to provide support to all the . are engaged in adequate physical fitness activities three or more times a week should reach 50 per cent. the proportion of the adult population in age groups 18 to 65 years. 5. 3. to 25 per cent by year 2000. the contents of the obligatory warning notice on the packets of cigarettes about the hazardous effects of smoking should be amended to include information on the nicotine and tar content and on the amount of carbon monoxide released in the course of smoking.theoretically and practically .with the scientific norms of optimal physical fitness and activity. By the year 1990. who. to 35 per cent by year 1990. The proportion of smokers in the population should be reduced from 42 per cent in year 1985. From 1988 on.by further 30 per cent as compared with 1990. By the year 1990.

By the year 2000. By the year 1990.32 l absolute alcohol in 1985. the smoking habit among all physicians and teachers should be eradicated on a voluntary basis. 2. at least 25 towns and villages in each province of the country should be developed into models of sanitation and hygiene.smokers who have decided to give up smoking. 6. and. by the year 2000. the incidence of alcohol related disorders such as delirium tremens. A decrease of mean alcohol consumption per capita from 7. By the year 2000. 4. the number of people of specialized antialcoholic treatment should be reduced by 50 per cent as compared with their number in 1985. PROMOTION OF ENVIRONMENTAL HEALTH Measures are adopted by the Committee for the Protection of the Environment: 1.0 l in 2000. their proportion should exceed 90 per cent. 2. Reduction of alcohol consumption The most important objectives are: 1. By the end of 1990.0 l in 1990 and less than 4. mutual aid clubs or groups for exsmokers should be organized at their place of work. 3. By the end of 1990. a decrease should be achieved by at least one-third in the incidence of alcohol related liver disease. 7. Korsakoff's psychosis and fetal alcoholic syndrome should be reduced to a level that would make it possible to regard them as clinical rarities. the proportion of traffic accidents due to alcohol use should be reduced to under 50 per cent of all accidents. 55 per cent of the industrial enterprises /encompassing no less than 70 per cent of the industrial workforce/ should meet the requirements of hygienic regulation. to less than 5. By the year 2000. hallucinosis. 7. REARING A HEALTHY AND HARMONIOUSLY DEVELOPED YOUNG GENERATION The basic approaches towards the achievement of this objective are as follows: . at least 2 or 3 settlement systems.

the incidence of congenital malformation and anomalies.1.0 per 1000 live births in 1990 and to less than 3. By the year 2000. i. no less than 90 per cent of the pregnant woman should be thoroughly familiar with the risk factors that may affect fetal and infant health. 6. By the year 1990. especially those relating to the neural tube and the cardiovascular system. should be reduced to 2. the proportion of parentless children.5 per 1000 live births. to reduce it to 190 per 100 000 total population /all age . to 11 per 1000 live births in 1990 and to less than 8 per 1000 live births in 2000.6 per 1000 births in 1985. 2.1 per 1000 live births in 1985. are adopted or placed with foster families after a stay in an institution of no more than one year should increase to 85-90 per cent. The stillbirth rate should decrease from 6. By the year 2000. the infant mortality rates should be reduced to less than 11 per 1000 live births.5 per 1000 live births in 2000. by the year 2000 to achieve a decrease in the mortality rate from ischemic heart disease of 24 per cent as compared to 1985. 7. to less than 9 per 1000 live births by the year 2000. with a trend towards further decrease. no less than 80 per cent and by the year 2000.3 per 1000 live births in 1985. to 6.0 per 1000 births in 1990 and to less than 4. By the year 1990. and. 3. 8.e. A decrease in post-neonatal mortality rate /the mortality of live born children who die at an age from 1 month to 1 year/ should be attained. 5. 4. to 5. Cardiovascular diseases: The national objective is. By the year 2000. Perinatal mortality from all causes should decrease from 12. 8. who. PREVENTION AND CONTROL OF SOCIALLY SIGNIFICANT DISEASES AND RELATED HEALTH PROBLEMS A National Programme for the Prevention and Control of Socially Significant Diseases in Bulgaria has been developed and adopted: 1.0 per 1000 births in 2000. the rate of newborns with low birth weight /less than 2500 g/ should be reduced to under 6 per cent. from 7.

9 per 100 000 total population /1985/ malignant neoplasms rank second among the main causes of death in the entire population /all age groups/.e. will be reduced to 138 per 100 000 total population /all age groups/.2 per cent compared to 1985. 4. 5. BIOMEDICAL SCIENCE AND TECHNOLOGY: A PREREQUISITE FOR ACHIEVING "HEALTH FOR ALL" The general aim of health research and the development of new technologies during the following 10-15 years will be to ensure the scientific back-up to the Bulgarian strategy for attaining "Health of All". to reduce it to 184 per 100 000 total population. 9. i. and the incidence of infectious respiratory diseases by 16.3 per 100 000 total population.e. and. 3.8 per cent. 2. Accidents and injuries: In 1985 the mortality rate from accidents and injuries in Bulgaria was 63. i. respiratory diseases account for about 45 per cent of registered disease prevalence.5 per 100 000 total population. 6. the incidence of infectious intestinal diseases by 31. as compared with the previous five year period /1976-1980/. to decrease the mortality rate from cerebrovascular disease by 30. Respiratory diseases: With a mortality rate of 92. Mental disorders: About 1 per cent of the total population /all age groups/ is in need of therapeutic and rehabilitative care because of chronic or recurrent mental disorders. it is expected that the implementation of this strategy will result by the year 2000 a decrease in cancer mortality rate of about 16 per cent as compared to 1985. Infectious diseases: During 1981-85 the incidence of all infectious diseases /excluding influenza and acute respiratory diseases/ has been decreases by 21.9 per cent. to 66 per 100 000 total population for the age groups 45-54.groups/. This presupposes a priority development of those branches and trends of science which will: .6 per cent. it can be expected that the successful implementation of measures will result in a decrease by the year 2000 of the prevalence and mortality of respiratory diseases by about 25-30 per cent as compared to 1985. Malignant neoplasms: With a mortality rate of 164. and with a mortality rate of 384 per 100 000 total population are the leading cause of death for the age groups over 55 years.

6 per 10 000 citizens. a view to making predictions. identifying needs and improving health care management. Increase knowledge about the patterns and trends of morbidity and health in the community. 3. 2. 11. TRAINING AND DEVELOPMENT OF HUMAN RESOURCES The most important objectives. control of the socially significant diseases. 10. the number of doctors will increase to 28 235 or 31. FINANCIAL SUPPORT OF HEALTH CARE The global trend of rising health care costs also has its effects on health care support in Bulgaria.9 %. 12. In 1985 the health care expenditures amounted to 6.9 % and that of the government budget 8. the number of dentists will be 6228 or 6. While during the period 1970-1980 the average annual rate of national income growth was 6. health protection of children and adolescents. health expenditures grew at an annual rate of 10.1. with. Joint management of the health services by the state and the community. IMPROVING THE ORGANIZATION AND MANAGEMENT OF HEALTH CARE The further development of public health in Bulgaria will require certain decisive improvements of the organization and the system of management of health care. . viz: 1.3 per 10 000 citizens. namely: 1. environmental protection and rising the quality and accessibility of health care. are as follows: 1. Strengthening the role of the Ministry of Health.8 %. This is evident from the higher rate of increase of health expenditures in comparison to the growth of national income. and that of the nursing staff will be 94 223 or 104. 2. By year 1990.9 per 10 000. Guarantee the development and implementation of technologies directly serving the programmes for promotion of healthy lifestyles.1 % of the national income. Strengthening the role of the Medical Academy. The new requirements arise naturally in the course of construction of a mature socialist society. 2. as viewed by the national strategy.

within the framework of CMEA and WHO programmes: 1.7 doctors per 10 000 population. both. By year 2000. thus. The medium term Collaborative Programme between Bulgaria and WHO will focus increasingly during the coming years on the specific European targets for attaining "Health for All" by the year 2000. Jablensky and Associated Professor L. no less than 48 % of the net increase in the number of doctors will be absorbed by the "front line" of health care.56 at present will reach 1:2. CONCLUDING NOTES The present document has been prepared by a working group under the guidance of Academician Professor A.62 with a tendency towards further improvement up to 1:3. New proposals will be developed for its qualitative upgrading. the ratio between doctors and dentists on one hand. By year 1990. reaching a coverage of 33. The Bulgarian institutes designated as WHO Collaborating Centres will play the principal technical role in the implementation of joint programmes and activities with the WHO Regional Office for Europe and the WHO Headquarters in Geneva.50. the number of higher medical staff is expected to be 31 200.will improve. 14. and from 1:2. and. 3. 3. and. Maleev. by the year 2000. it is expected that by the year 2000 one-half of all doctors will work in primary health care. Ivanov .2. The participation of the Bulgarian research institutes in the conception and implementation of WHO programmes will be expanded and steps will be undertaken for the establishment of further WHO collaborating and reference centres in this country. nursing or supporting medical personnel on the other . INTERNATIONAL COOPERATION Multilateral cooperation in health is regarded by Bulgaria as being of key importance to the attainment of "Health for All". 2. Associated Professor A. 13.

The Bulgarian proletariat launched an organized struggle for mandatory social security for workers. Social security was first introduced in Bulgaria immediately after the Liberation from Ottoman rule in 1878.400 levs annually. the first Bulgarian Constitution. An important role in the proper direction of the workers' demands was played by the Bulgarian Workers' Social Democratic Party which. and of the hard conditions on the battle front during World War I led to the introduction in 1918 of compulsory social security covering industrial and office workers in the event of sickness and industrial injuries. teachers. ministers. laws on pensions were voted on covering disability pensions. from the third day of falling sick. stipulated that 'civil servants appointed by the Government are entitled to pensions the size of which will be fixed in a stated manner'. civil servants and those holding elective posts. those receiving up to 2. clergymen. Retirement pensions paid to the military were extremely high. The raising of the revolutionary spirit of the working people as a result of the victorious Great October Socialist Revolution. demanded social security for workers as well. When setting up their first trade union organization. whereby the State was compelled to establish mutual-aid funds and friendly societies. retirement pensions and pensions paid to dependants. in the programme adopted at its first congress in 1894. At first the social security scheme covered only civil servants as there was a strong desire to consolidate the Bulgarian State. compensation amounting to three . Information Bulgaria . PART 6 From: The Editors of BAS. With a view to legally regulating the social security scheme. which was the privilege of certain classes. 1985 SOCIAL SECURITY IN BULGARIA /1945-1989/ Basic Principles and Historical Evaluation. A law was adopted in 1905 regulating female and child labour in industrial enterprises and a social security scheme was introduced to cover sickness and industrial injuries for workers from the public building enterprises. workers from the private sector established mutual-aid funds to cover the event of unemployment. administrative and police officials. a struggle which achieved the first results.a Short Encyclopedia of the People's Republic of Bulgaria. Those entitled to these pensions included the military. This voluntary trade union security failed to provide the necessary social security against labour risks. The sickness insurance was confined only to low-paid workers. Oxford: Pergamon Press.HEALTH SINCE 1945: INSTITUTIONALIZATION PERIOD. sickness and death. Provisions were made for treatment of up to six months with the sick person receiving. The aim was to prevent civil servants and municipal workers from waging an organized struggle for better working and living conditions and from carrying out joint actions with the workers. The bourgeois State excluded the working-class people from social security. The Turnovo Constitution of 1879.

An unemployment insurance system was initiated in 1925. irrespective of what has necessitated such a contract. Under the conditions of the organized struggle of the workers. Bulgaria's experience in introducing insurance for private farmers in 1941 was interesting. as well as part-time workers. regulating state social provisions. the bourgeois Government was compelled to initiate a workers' social security scheme. sex. The principle of vocational risk was recognized. and there was no need to prove who was to blame for the labour accident. workers. In the event of hospital treatment. In 1920 the pensioning scheme covered 62. Those who suffered industrial injuries were allotted pensions in a statutory way rather then through the court. which is still in force. grouped in powerful trade unions led by the Bulgarian Workers' Party after the suppression of the world's first anti-fascist uprising of September 1923. That insurance originally covered only men. As a result of the 1924 social insurance act. nationality and form of pay. The main principles underlying social security may be summed up as follows: to protect all the working people (all people engaged in socially useful work are covered by the insurance scheme). the employers and the state. for women 55. sickness and maternity. disability and old age. re-enlisted officers and sergeants. Under the conditions of capitalist development social security was incomplete arid financially unstable. while from 1941 onwards insurance came to cover private craftsmen. The insurance against industrial injuries came to cover. It was aimed at promoting the working people's health and at raising their living standard. with full compensation being given in the event of any kind of industrial injury. for the first time. although some amendments and additions have been made to it. those . employees and co-operative farmers who are employed under a labour contract.000 people but insurance was poorly organized and inadequately financed. In 1949 all social security schemes were overhauled and were administered by a unified State Social Security Institute.quarters of his or her monthly wages when treatment was given at home. From the first years of the popular regime it was placed on solid foundations. and the size of pensions was insufficient. The size of pensions was not very high. and from 1946 on women as well. and from 1943 onwards it included merchants as well. while the contributions for the rest of the insurances were shared equally by those covered by the insurance scheme. The retirement age for men was 60. Social security in those days was characterized by various financial irregularities and bureaucratic administration. all workers and employees at state. the corresponding proportion was 50 per cent of the respective wages. The right to social security is guaranteed by the Constitution. occupational diseases. workers and employees on the regular payroll working half a day. It required that the insurance contributions be paid by the respective enterprise. In 1951 free medical care was introduced throughout the whole country and a Labour Code was adopted. an insurance scheme was introduced covering industrial injuries. The contributions for the 'labour injury" insurance were paid by the employers. After 9 September 1944 social security became part of Bulgaria's social policy. Since 1957 pensioning has been regulated by a law. and servicemen in the Bulgarian People's Army. that is. public and private enterprises and establishments irrespective of their age.

disability. confinement and maternity. attending a sick member of the family. In 1973 these contributions amounted to 12. thus restoring any deficit. for attending a sick member of the family (not including children up to the age of seven) depends on the uninterrupted length of service of the person involved and is calculated as a percentage of the nominal labour remuneration during the month preceding the onset of the incapacity for work. Insurance in the Event of Temporary Incapacity for Work. The insurance contributions are paid by the respective enterprise or establishment (workers and employers pay no contributions. The size of the insurance contributions should be sufficient to enable the working people to maintain their living standard even in the event of incapacity for work. The administration of social security should be handled by the workers. members of households and private persons. This is due to the extension of the population's rights to insurance. attendance of a sick member of the family. journalists. and by a medical team when its duration is over twenty days.vocationally rehabilitated who are on a shorter working day. except freelances). old age and death. suspension from work on medical advice. establishments. foreign workers and employees based in Bulgaria. writers. the accompanying of a sick man to a hospital situated in another area. or treatment abroad. When temporary incapacity for work continues for more than fifteen days. those working in small-scale private shops and farms. in 1974 the proportion was 20 per cent and in 1980-30 per cent. quarantines. hence the financial stability of social security in this country. those serving in the Bulgarian Orthodox Church. to cover all risks against temporary or permanent incapacity for work due to industrial injuries. These contributions are deducted from the wage fund and are paid out of the funds of enterprises and establishments. Temporary incapacity for work must be certified by the doctor in attendance when it lasts up to twenty days. quarantine. confinement. Social security in Bulgaria is based on the insurance contributions paid by enterprises. masters of arts and crafts. and through the extension of maternity leave. infectious disease. There has been a great increase in the size of these deductions. quarantine. Bulgarian citizens working abroad. The amount of compensation for temporary incapacity for work due to sickness. This covers workers who are unable to work because of sickness. cooperatives and public organizations. occupational diseases. general sickness or injuries other than industrial ones. compensation and pensions. urgent medical examinations. artists and sculptors. or maternity leave. Under a 1960 law this administration was entrusted to the trade unions. Social security in Bulgaria is based on the principle of the pure system of distribution. The percentages are differentiated and depend on the number of years worked: 70 per cent of those with ten years of service.in the event of pregnancy. No reserves for meeting future payments are formed. 80 per cent for people with service of between ten and fifteen years and 90 per cent for a service of over fifteen years. and for women workers and employees . Any surplus at the end of the year is deposited in the State Budget. accidents other than labour ones. the largest organization of working people in Bulgaria. mainly through the increase in the size of child allowances. the size of the compensation . occupational diseases. industrial injuries.5 per cent. Current expenditures are met by current revenues. balneological treatment.

90 per cent and again 90 per cent. It gives the duration of that rehabilitation and the kind of job the expectant mother is capable of doing. Paid leave has been extended and the size of compensation has been raised to 100 per cent of the basic labour remuneration. Insurance in the Event of Pregnancy. When the income of expectant mothers has fallen as a result of vocational rehabilitation. unless permanent disability is certified. compensation is paid for 90 days. for being a germ carrier. All women covered by the insurance scheme are entitled to paid maternity leave. or when accompanying him or her to another area for the purpose of undergoing treatment or medical examinations. A special commission made up of the respective administrative manager. or trade union representatives. This vocational rehabilitation begins from the day pregnancy is confirmed. The duration of the compensation for attending a sick member of the family is ten calendar days per calendar year for each insured person.000. Vocational rehabilitation is carried out on the basis of a medical certificate issued by the respective doctor. The compensation for attending a sick child up to the age of nine is 100 per cent of the nominal wages. while in 1982 the corresponding figure was 2 million. every mother-to-be working in conditions harmful or arduous to the pregnancy is transferred to another lighter job corresponding to her health condition and qualifications. With a view to preserving the health of expectant mothers and to ensuring normal pregnancy. When someone is suspended from work for suffering from an infectious disease. In the event of balneological treatment the compensation paid covers the whole period of treatment. or for having been in contact with people suffering from contagious diseases. a representative of the Inspectorate of Hygiene and Epidemiology and a doctor from the maternity health centre defines the place of work and posts expectant mothers should not occupy and those to which they can be transferred.90 per cent. In 1944 the number of people covered by insurance was 54. compensation is paid as long as the person involved is under quarantine. plus three days travel allowance to and from the spa. or when accompanying him or her abroad for the same purpose. In cases of quarantine. Vocational Rehabilitation of Expectant Mothers. mothers are entitled to the same job they have held before their vocational rehabilitation. Confinement and Care of Young Children. When attending a sick child under the age of sixteen. Maternity Leave. This applies to all those who have been employed.after the fifteenth day is 80 per cent. Temporary incapacity for work due to sickness and industrial injuries is considered to have begun from the first day of its onset and runs until the day the person involved is proved to be fit for work again. even only for one . in which case a disability pension is granted. 2. Once back to work after the delivery. and for temporary incapacity for work due to industrial injuries and occupational diseases . the chairman of the trade union. respectively. In both these cases the size of the compensation does not depend on the number of years worked. Insurance coverage may be summarized as follows: 1. the accompanying mother or father is entitled to compensation for up to 60 calendar days per calendar year. the balance of the average monthly nominal wages received during the previous twelve months is restored out of the social security fund.

i. before going on maternity leave (which begins 45 days before confinement).day. If a mother (or an adoptive mother) on maternity leave. They too are covered by the insurance scheme and are entitled to cash compensation. In addition. Mothers who for one reason or another are not employed and do not study are likewise entitled to maternity grants. Seasonal and other women workers who are not permanently employed are also covered by the insurance scheme. issued in April 1984. mothers enjoy additional unpaid leave until the child is three years old. which are fixed throughout the country. the student wife receives 50 per cent of the grant. seven months for the second. regardless of whether they are studying in Bulgaria or abroad. 150 days for the second.e. too. The period is considered as length of service. 40 levs. When mothers do not wish to take such leave and prefer to return to work. If after the paid maternity leave the child is not placed in a nursery or a child-care establishment (this is done of the parents' own free will). and the grants will be equal to the country's minimum wages. is taken ill or dies. The maternity leave and the leave for looking after the child is not considered an interruption of the length of service. Student mothers at all higher educational establishments and at special secondary schools receive a grant of up to 80 levs a month after their maternity grants have terminated. 3. which is twelve months for the first child. as of 1 July 1985 this leave is extended to 24 months. or on leave to look after her child. Only fulltime students are entitled to this grant. Adoptive mothers. Family income supplements were first paid in Bulgaria in 1941 to state . fourteen months for the second child and eighteen months for the third child. When the husband is employed. and six months for each subsequent child. eight months for the third. mothers (adoptive mothers included) enjoy an additional leave of six months for the first child. are entitled to the same maternity leave. They are required to have been employed for seven consecutive days before going on maternity leave. Paid Leave for Looking after Young Children. Family Allowances are paid under the 1951 Decree for Promoting the Birth-rate and Large Families. the cash grant for looking after the newborn baby is given to the father or to another relative. and their jobs are held for them until the child is three years old. During that leave mothers receive cash grants equal to their minimum wages. irrespective of the number of children born. and amount to 110 levs a month. During that leave they receive ten levs a month in the form of a cash grant. A decree of the Central Committee of the BCP and the Government. Throughout the maternity leave mothers receive cash grants equal to 100 per cent of the nominal wages they have received during the preceding month before going on leave (which is not less than the wage scale and not higher than 120 per cent of that same scale). provides for this leave to go up to 24 months. and to grants for looking after their children. 180 days for the third and 120 days for each subsequent child. Student mothers are entitled to a 90 lev cash grant per month. as well as their wages they also receive 50 per cent of the cash grants given to mothers on leave for looking after their children. and 14 months for the third child. Mothers enjoy 120 days of paid maternity leave for the first child. This grant is given to them for ten months for the first child. 12 months for the second child. Forty-five days of this leave are given before delivery.

As of 1 July 1985 the monthly allowances for children are set as: for a second child to 30 levs. 40 and 85 per cent of the minimum monthly pay. Funds allocated for temporary disability indemnities. As a rule it is the wife who draws the maternity grant. 4. amounting respectively to 15. a two-child family 40 levs supplement. The Pension Scheme. An employed person falling into a rectified disability class. The monthly child-care grants for families of students.000 levs of the loan are remitted. young newlywed couples are entitled to a loan of 5.1 million levs to 24. and monthly grants for student families and for those of post-graduate student and conscripts. in the event of death through an accident at work the sum is 120 levs. In the event of the death of a member of the insured person's family. Under legislation currently in effect. after the birth of a second child. up to the sum of 15. post-graduate students and conscripts are 30 levs per child. so that a one-child family receives monthly a 15 levs supplement. are continually on the increase. As of 1 July 1985 young newlyweds are entitled to state loans for the construction or purchase of a flat. Apart from the loan for construction or purchase of a flat. Bulgaria's pension scheme is one of the most democratic in the world. though in some specific contingencies it can be drawn by the husband or the guardian. if he is graded Class 3 disabled.7 million in 1982. able-bodied persons are entitled to a lump-sum cash grant in the event of confinement.000 levs are remitted. without having to pay a deposit. and a three-child family an 85 levs supplement. a fourth and each additional child. and especially those of the child allowances. and who has been re-posted to a job suitable for his health status. for a third child to 55 levs.employees only. The monthly child allowance rate is 15 levs for a first. State allocations for child allowances come second after those for pensions. For the birth of a second child within four years after the birth of the first child the entire remaining unpaid part of the loan should be remitted.8 million levs in 1970 to 504. a fourth and each additional child. the monthly allowance for the first child increases from 15 levs to 30 levs. but not eligible for a disability pension because of incomplete length of service. and of a third child .000 levs for other purposes. and are allowed up to 30 years to repay it. to be paid off within ten years. and over the course of six months-if Class 2 or 1.another 4. On the birth of a second child (four years after the birth of the first child) 3. can qualify for financial aid starting from the date of disability. Foreign nationals giving birth to a child in Bulgaria are not entitled to cash grants.000 levs. 25 for a second. and have grown from 219. a death grant to the rate of 80 levs is payable to the person paying the funeral expenses. to monthly child allowances. 250 levs for a second and 500 levs for a third child are paid to all Bulgarian women. During the period 1970-82 the sum total of maternity grants rose from 17. Other Benefits.1 million. Lump-sum cash grants for live-born children at the rate of 100 levs for a first. to be paid over the course of three months. Child allowances are given until the age of 16. regardless of whether they are covered by the social security scheme. and 45 for a third. Especially increased provision was made for pensions following the April 1956 Plenum of the .

however. the total rate of such additions cannot. In cases where an insured person has worked in more than one of the above-mentioned categories of labour. Factory and office workers and co-operative farmers come under a unified pension scheme which covers practically all Bulgarian citizens. State expenditure on it keeps growing. Class 2 . When. Disability pensions can be claimed in the event of partial or complete. Class 2-20 years of service. and is deducted as a percentage of the basic remuneration . They are granted in cases where the disability was caused in the course of employment. Disability Security.starting from 80 per cent for the lowest. ailments do not improve and the chances of regaining capacity for work are slight or non-existent. Persons having reached the required pensionable age and completed the specified length of service are entitled to a 6 per cent addition to their basic pension for each extra year of service. required pensionable age varies with the category of labour. Persons of pensionable age not having completed the specified length of service may qualify for a retirement pension with reduced rates. The pension scheme is being systematically improved in compliance with the extensive programme for raising the population's living standards adopted in 1972. and Class 3 . lawyers and others) this is the term during which they have been selfemployed. Having completed the specified length of service. and 20 years of service and at the age of 55 for women. Mothers of five or more children aged eight and over are entitled to a retirement pension after fifteen years of service and 40 years of age in Class 1 labour. provided they had been paying the necessary contributions. journalists. at the age of 50 for men. public or co-operative enterprises for which labour remuneration has been paid.fifteen years of service. or not later than two years after termination of contract (the former contingency not applying to the congenitally blind or to persons deprived of sight before entering employment. for freelances (workers in the arts. For those under pensionable age each year of service above the term specified in the Law on Pensions brings an addition of up to 2 per cent to the basic retirement pension. the rate of his pension is determined according to the class in which he has served the longest. exceed 12 per cent. Class 3-25 years of service and at the age of 60 for men. The length of service is defined as the time under contract in state. temporary or permanent disability. in spite of treatment.labour under normal conditions. Just as with the length of service. Retirement Pensions. A retirement pension can be claimed under the following terms: Class 1 labour . down to 55 per cent for the highest labour remuneration. Retirement pensions are regularly being up-graded in line with changing economic conditions. the socially insured person of pensionable age is eligible for a retirement pension.Central Committee of the BCP. the invalid must appear before a Medical Commission on Labour (MCL)-a specialized commission of medical . There are three categories in Bulgaria which classify the degrees of hard and harmful labour: Class 1 .very hard and harmful labour. so that the pensioner's living standards do not suffer. The rate of the retirement pension is based on the average nominal monthly pay received during three consecutive years out of the last fifteen years of service as chosen by the person himself.hard and harmful. and after the same length of service and 45 years of age for classes 2 and 3. at the age of 55 and 50 respectively. proportional to the length of service they have completed. 45 for women. the term of the latter being longer for certain prescribed diseases).

Disability pensions fall into the following categories: industrial injury or occupational disease pensions.in all other cases In the first case the disabled person can claim reassignment to another disability class with more favourable pension terms. authorized to ascertain permanent disability: to pronounce on the degree of disability and the date of disablement. and in inverse proportion to the basic labour remuneration. The aim is to ensure that the disabled receive approximately the same income as before the disablement. or when taking part in voluntary workdays and sports competitions. because of health considerations. in cases of occupational diseases. The percentage determining the rate of a disability pension grows in direct proportion to the degree of disability established. The rate of the pensions granted for disability through labour accident or occupational disease is fixed according to the disability class and the basic labour remuneration. Disability pensions are granted in the event of general illness or injuries arising from accidents other than labour accidents to disabled persons pronounced by an expert medical commission on labour to fall into one of the three disability groups and provided that they had completed the specific length of service graded in conformity to the respective age before the pronouncement of disability (up to 20 years of age . in saving a person's life or property. all injuries arising out of or in the course of employment as well as those resulting from work in emergencies c: under conditions not normal for the respective occupation if it has caused the insured person's temporary disability invalidity or death. Disability pensions are payable to congenitally blind persons having been deprived of sight before entering employment with five years of service regardless of their age. the relation between employment and ailment. have lowered or been induced to lower. in cases when his condition has worsened. up to 25 years of age-with three years of service. and civil acts military disability pensions. their standard or occupation. A disability class is granted permanently when there are no indications that the disability will be cured. pensions for general illness or injuries arising from accidents other than labour accidents. Occupational diseases fall under the class of industrial injuries. The nature of the disease and the degree of disability are established by the MCL. Thus Class 1 disability pensions vary from 70 per cent for the highest basic remuneration to 100 per cent for the lowest. Three disability classes have been set out in Bulgaria according to the degree of disability: Class 1 includes persons unable to perform any work (the severely disabled). Industrial injuries are likewise suffered in performing any service in the interest of the employer. during breaks in work-time. or temporarily . or been induced to change. the disability . Class 2-persons unable to perform either the job they have been trained for.by the MCL. and to redeploy persons with partially impaired capacity for work. . Class 3 includes persons who.experts and a representative of the trade unions. An industrial injury is ascertained by the head of the enterprise through an Industrial Injury Certificate.regardless of the length of service. Industrial injuries comprise. their conditions of labour. or any other. on the way to and from work. or have changed. over 25 years of age-with five years of service). but who can work in specially provided conditions. for Class 2 the percentage is respectively 55 to 85 and for Class 3-35 and 65. to establish.

Disability pensions granted in the event of general illness or injuries from accidents other than labour accidents are rated in a percentage based on the basic labour remuneration. sisters and grandchildren under eighteen.for group I . the grandfather and grandmother if they have no other . 15 per cent after twenty years of service and over. brothers. or before if disabled. the size of which depends on the length of services prior to the date of pronouncement on disability and is fixed according to the basic pension as follows: 5 per cent after ten to fifteen years of service. are granted a 25 per cent addition to the basic pension. If the injured have been socially insured before enlisting in the army. one of the parents or the wife. 10 per cent after fifteen to twenty years of service. to members of sports teams injured during training sessions or competitions. The parents are also entitled to dependant pensions. and those studying at educational establishments up to 25 years of age and over if they have lost their capacity for work before reaching 18 or 25 respectively. The dead and missing also come into this category. Dependant pensions secure an income for the heirs to the deceased if he was insured. The monthly size of pensions is 65 levs for disability group I. if this is to their benefit. regardless of their rank and to persons injured in rendering assistance to troops. to students injured during practical training or studies and to convicts injured in labour accidents. The major requirement in Bulgaria is for the dependant to have been supported by the deceased prior to his death. 60 levs for disability group II and 50 levs for disability group III. to members of the auxiliary defense organizations. to regular servicemen in the engineering corps or to reservists summoned to training. Military disability pensions are granted to persons injured while serving in the army. Pensions with 25 years of service.from 50 per cent to 25 per cent. if they are unemployed and look after children.rating from 73 per cent for the lowest to 55 per cent for the highest labour remuneration. Students are entitled to dependant pensions after 25 years of age if they have served their regular terms in the army or in the labour corps. at the age of 55 for men. on reaching sixteen. depending on the respective disability group. to called-up reservists. for group II-from 65 per cent to 40 per cent and for group III . and 20 years of service and at the age of 50 for women. 50 for women. the husband or wife on reaching the age of 60 for men. The beneficiaries entitled to dependant pensions are the children. the size of their pensions is fixed on a similar scale to the rating of disability pensions that would have been granted in the event of industrial injuries and occupational diseases. This term is extended by as many years as served in the army or in the labour corps. Persons who fall into disability groups I and II due to general illness are entitled to an addition to the basic pension. The percentage is graded according to the size of labour remuneration and the disability group as follows . Disability group Dependant Pensions (Death Insurance). inspection or practical muster roll. regardless of their capacity for work or age. or the brothers and sisters of the late head of family. to regular privates and NCOs in the armed forces. Civil disability pensions are granted to persons injured in the performance of civil or public duties.

should this be of benefit to the dependants. These pensions are small and the same for all entitled to them. monthly child allowances. receipts and expenditures is carried out by the Trade Unions. At enterprises and departments. the dependants' pension is fixed on the basis of the former. and to old people having reached 70 whose annual income is lower than the specified minimum income. The planning of social security funds. Heirs of a person whose death was caused by general disease are entitled to a pension fixed on the basis of the disability pension of group II that had been granted to the deceased. The Trade Unions fulfill their rights and obligations through their specialized bodies: the Social Security Board with the Central Council. and maternity lump-sum cash grants) is transferred by enterprises and departments to the bank account of the social security with the Trade Union's Central Council. Sums for the payment of pensions are drawn from this bank account. Social pensions were introduced in 1973. Jointly with the Council of Ministers the Trade Unions issue regulations. The control over the correct deduction and payment of security contributions and over the lawful spending of the social security fund is exercised by the Trade Unions. The remainder of contributions deducted (after the payment of indemnities. The Trade Unions are in charge of the social security budget. indemnities cannot be paid without the signature of the Trade Union Chairman or of the person authorized by the former. The size of pensions payable to the heirs of a person who has died from industrial injuries is fixed on the basis of group I disability pensions if disability was caused by an accident. They draft bills on social security issues and. the social security departments with the district and city councils. Such pensions are granted to invalids falling into disability groups I and II (aged over sixteen). They are insignificant in number and are granted to persons who have not been insured or do not have at least half the length of service required for retirement or disability pensions. the Trade Unions and the social security commissions set up with them at every enterprise.income or if there are no persons bound by law to support them. If the deceased had the required length of service entitling him or her to a personal retirement pension. department and organization. . 75 per cent if there are two dependants and 100 per cent if there are three dependants. decrees and instructions. submit them to the National Assembly. jointly with other departments concerned. Pension commissions and expert medical commissions on labour must include representatives of the respective Trade Union bodies. The size of dependant pensions is fixed on the basis of the personal pension that had been paid to the deceased: 50 per cent if there is one dependant. Social security has been entrusted to the Bulgarian Trade Unions.

among pediatricians — 55. treatment.000 children.000 of the population). At regional level operate stomatological polyclinics. It is.000 of the population). Plovdiv. In crèches and nurseries there are 38. The network of healthcare centers which render medical aid (diagnostics. 4 national centers with clinical bases. a measure of the social. The private sector comprises 7.991 beds (107 beds per 10.PART IV: HEALTH CARE IN BULGARIA FROM 1989 UP-TO-DATE /FINANCING AND DELIVERY THROUGH A TRANSITION PERIOD/ NEW LAWS REGULATE THE PROBLEMS OF ORGANIZATION. Children up to 3 years of age are procured with 132. and 6 centers of transfusing hematology. at municipal level — dental surgeries in polyclinics and health services in the villages. 5 stations for fast and urgent medical aid. 64 private health utilities have also been established. regional and municipal.278 beds (23 per 10. Among therapists the relative share of the specialists is 50. and one dentist per 1. rehabilitation.8 per cent. laboratories.8 per cent. including hospitals. Stara Zagora) with a number of faculty clinics.445 medical consulting rooms and 3. The medical aid network disposes of considerable in number personnel — one physician per 314 persons of the population. Here we must mark the fact that in the field of dental aid considerable portion of the necessities are already being covered by privately practicing dentists. as well. In Bulgaria about 60 per cent of the physicians have recognized specialties.723 ambulatory-clinical units. The public sector comprises 5 higher medical institutes (in Sofia. Varna. among surgeons — 70.3 per cent.692 dental surgeries. dispensaries. among obstetricians — 77. 163 sanatorium-recreational establishments.4 beds in crèches per 1. Besides. disposes of the necessary basis and a considerable number of academic. in sanatoriums — 19.5 per cent.5 per cent. among orthopedist-traumatologists — 71. MANAGEMENT AND FINANCING From: Almanac Bulgaria 1996 People’s health is a national wealth and prerequisite for the advancement of any nation. economic and political development of society. Pleven. . some types of prophylactic activity) in Bulgaria is well distributed. 917 crèches. The number of specialists with college and high-school education is increasing. The in-patient wards of the hospitals dispose of 90.340 beds. Dental aid at national level is procured by a Faculty of Stomatology with a clinic. college and highschool graduates and other personnel. 287 hospitals and 3. The macro-scheme of medical aid includes three levels — national.487 of the population. out-door patients clinics (polyclinics). until the end of 1995.

syphilis. The actual priority in the Government’s program in the field of healthcare is the drug policy. The amendments in the Law of Public Health go parallel with the preparation and adoption of regulations for new organization of pre-hospital medical aid which is correctly distributed by territory in order to guarantee access of all Bulgarian citizens to medical specialists in polyclinic units. This treatment is carried out under out-patient conditions and is financed directly from the budget of the Ministry of Health. The efforts to overcome this heavy situation are in several directions. is guaranteed throughout the whole year. etc. Discussion is being held on the Law of Professional Organizations which will stipulate obligatory membership like it is practiced in almost all European countries. Rendering legislative ground of the drug policy in compliance with the contemporary. on behalf of all who offer medical aid. Thus. consumables. the treatment of which is life-saving and life-supporting. In 1996 the National Assembly is going to adopt important amendments in the Law of Public Health which will guarantee the right of a free choice of a healer and free medical aid to every Bulgarian citizen. During the last years these funds sharply shrunk.This highly developed in quantitative respect system operates with funds of state financing. consumables. endocrine disorders. Changes are also envisaged to reflect the transitional period towards health insurance system by virtue of which the health establishments will receive legal independence. rabies. generally accepted norms of the European Union member countries is considered an achievement of the National Health Strategy. The problems in healthcare and inadequate nutrition brought back some forgotten diseases like tuberculosis. before all. These diseases are 11 and a hundred-per cent availability of respective drugs. foodstuffs. Another 114 diseases are financed from the municipalities’ budgets. hepatitis. This results in closing hospitals. professional organizations will receive the right. psychoses. the preparation for adoption of the Law of Health Insurance. etc. Unemployment and stress over the uncertain future led to mass neuroses. But. light. as well. adopted by the Government and approved by Parliament. The absolute increase of funds for healthcare in 1995 cannot cover the enormous relative fall-behind on the background of the general increase in the cost of living — medications. serious efforts were made to render legislation in conformity with the new conditions. which the patients receive in ambulatory conditions. abdominal typhoid. patients procuring themselves medicines. a large section is dedicated to . adapted to the already adopted Law of Creation of a National Insurance Fund and Separation of the Social Insurance Fund from the State Budget. heating. to be a party to the conclusion of a national accord. Healthcare is closely linked to prophylaxis. At a final stage is. blood for transfusion. The Law of Drugs in Human Medicine and of Pharmacies regulates drug supply for some diseases. therefore in the National Health Strategy.

to go down. Bulgaria is a typical representative of a centralized hierarchical system with the hospital sub-system as its dominant part. the demographic problems in the Republic of Bulgaria continue to go deeper.2 % with . Life expectancy begins. the negative growth of the population is -3. that is. the permanent rise of drug habits. Such is the approach of the rich countries — to allocate money for prophylaxis of the healthy person because afterwards much more means will be needed for his healing. although slowly. The start of the health reform in Bulgaria. too. This increase is most significant among the rural population.3 births and 13. It is a system financed only at the entrance without any effective feed-back. To be explained. the chronic stress. and especially among the male part of the population. including negative ones. and there is no search. such as: the change in the living conditions. They lack all the elements of the market and the competition. It could be a therapist. was preceded by a long social and professional discussion. which is already a fact. This kind of systems lack any financial incentives for the working professionals. the worsened conditions in the environment. The trend towards demographic collapse has been deepening since the late 80s and at present. a pediatrician (for children). The new organization of pre-hospital medical aid envisages the right of every citizen to choose his personal physician on the territory where he lives. etc. with surplus of low-paid and discouraged personnel and relatively poorly developed primary health attendance service. certain structures are financed without any actual measurement of the product at the outlet. a gynecologist (for women). for economic instruments that would improve the system.9 (9. there is no search for measures of effectiveness and efficiency. and in Bulgaria in the beginning of 1996 it was 4. Such a system is financed with low percentage by the GNP. that is.work to prevent disease. these facts should be viewed by considering a great number of factors. the decrease of the purchasing capacity of the individual — with more than a hundred times for the people of the third age. all factors to be precisely taken into consideration. The signals coming from the system are not considered from the point of view of the general economic theory. the increasing alcohol and smoking abuse. There is a strong tendency to a slight rise in the death rate including the younger ages. so that the country would not lose whatever is already national possession in healthcare. THE CRISIS IN BULGARIAN PUBLIC HEALTH SERVICES From: Almanac Bulgaria 1997 From the point of view of public health. the sharp reduction of the nation’s wealth in the last few years. The position of the Ministry of Health is that the valuables of the already achieved must be preserved.2 deaths per one thousand people).

and the personnel in the system will not be considerably re-structured. Applied were standards for national health structure long developed by the present team of specialists of the Ministry of Health.5 per 1000 people). Meanwhile. The campaign was done very hastily without elucidating the people to what this might mean to them and above all. Ninety-nine per cent of the structures and the activity is state property and less than 1 % is private property. in which hundreds of beds are not used effectively. passed it on first reading.5 %. according to which the salary contains a shifting part up to a certain limit. The bed space is 10. which will outline the aims and the means for their accomplishment. based on the number of treatments and the seriousness in the conditions of the patients treated by them. by creation of projects supported by the PHARE program and the EU. The Ministry of Health introduced attestation of the directors of hospitals. did not achieve their aim to stop the growth of these prices. as well as. the experts opinions are used and altered to the advantage of the political doctrine and not as a response to public interests. practice used 20 years ago by the Communist Party. In addition to this evident deficit of funds. Surprisingly the Government submitted in Parliament a Draught Health Insurance Law and remarkably quickly. An Instruction on Prehospitalization Aid was passed. There is a discussion of health policy in that field running in the country in an informal order. The result is that only about 37 % of the people have been enlisted and have chosen such a doctor. These standards do not add any changes to the structure of big hospitals. However.galloping inflation and lack of flexibility in the budgetary response making it drop to 2. there are 29 269 working doctors or 34. which it introduced. which continues to outstrip the rate of general inflation in the country. but the high rate of inflation “has eaten out” some of its positive elements. What is being claimed and done in 1996 in this direction? The implementation of the National Strategy "Health for Bulgaria" began and was developed as a strategy for primary health attendance directed to the establishment of General Practitioners and of every citizens right to choose his/her own physician.9 per 10 000 people. which is almost twice as much as the average in Europe (5. which provided for free choice of a General Practitioner. All . by way of a proposal on behalf of the government. The application of the Law on Medications and the regulation mechanisms of the prices of medicaments. the Parliament passed extremely unpopular measures amending the National Health Act and actually prohibiting to the doctors to practice privately if they work for a public health institution. which is one of the highest indexes in Europe. These are widely known figures and it is clear that there is necessity for serious change in the structure and the functions of the health care system. by cosmetic changes in the payment of doctors from whom it is expected to act as GPs and “gatekeepers”. breaching all legal procedures. Good teams of specialists give their views and suggestions and this will act as the basis for specific documents. A new regulation on doctors’ salaries in hospitals and polyclinics was applied. The regulation is in a process of adoption. In the country.6 per 1000 people. the structure of the system is such that some quite inefficient health care structures are financed.

where practically do not come patients who need treatment. which only doubled the national one and had been ineffective. but one that could turn health insurance into an appended warehouse to a huge National Insurance Institute. and the number of beds and wards in them were set in compliance with the actual demands of the municipalities. as well as. there is a lack of financial incentives and there is no talk of shift of property and consensus-based public agreement. without any transparency of costs.000 beds (105 beds per 10. ultimately.medical professionals were shocked by the fact that that was not the long discussed project from 1993. was shut down. The system had been surveyed for several months and then began the process of hospital accreditation. by the inadequate structure of the health system itself. to an end. During the years of socialism Bulgarian people grew unused to thinking about the price of healthcare. The achievements of the transition period as municipal self-government are being replaced by new recentralization. There is a running reorganization in public health resorts.000 which are not used for treatment of those who need to he hospitalized. The delayed reform and the established legislative and ruling vacuum deepened seriously the problems facing Bulgarian physicians. The rules of use of that care by people were broadly notified. The first to be accredited were 80 municipal hospitals. the working rights of the medical professionals and the right to choose are being restricted. The accreditation of big district hospitals. and without a real process of negotiation between producers and consumers of health services.000 people) were reduced by 30. without any structures to stand for the interests of the insured. which reproduce the structure of the old system and do not change it. university hospitals and national centers is continuing. the patients. health institutions and. Therefore the confusion arising when the question of compulsory medical insurance is put forward is natural although the insurance does not cover the multitudinous possibilities in the process of medical treatment. Everything was just “free”. PAID MEDICAL CARE — WITH PREFERENCE AND AT ONE'S CHOICE AND WILL From: Almanac Bulgaria 1998 The crisis in Bulgarian health service was provoked by the critical economic situation in the country. the analysis of the activities of the majority in Parliament and the Government leads to the judgment that in progress are activities called reform. In conclusion. With regard of the aggravated economic situation. But the government has decided to bring its intentions of rudimentary reform in the health service. There was created a possibility for alternative use of the system (without observing the established order and . The over 90. financing priorities have been established: which health institutions and which types of medical care should take priority in funding. Part of the departmental pre-hospital and hospital network.

This temporary measure has been taken until the introduction of health insurance takes place in order to restrain the black market of health services. The role of the Ministry of Health will gradually shift from governing to directing. There are training courses where hospital managers are being educated. diagnostic centers. thus increasing the share of costly hospital aid within the overall framework of health care. The creation of a case-mix index for all hospitals in the country will allow for planning and fair distribution of the necessary resources in accordance with the work done. The institution of “General Practitioners” was adopted for pre-hospital aid. and the state commission for admission of medical students has been reduced. It is intended to stimulate those doctors so that they could be able to serve as “gatekeepers” and restrict the cases of unnecessary hospitalization The former system of socialist healthcare was mainly hospital-oriented and very often patients were needlessly hospitalized for minor reasons and had to stay in hospital for a long time. They will look after the health of patients and whole families who have chosen them.without waiting — in return for immediate payment) by patients who would like to choose a doctor and a hospital by themselves. This resulted in the creation of many narrow specialists in the hospitals and the term “family doctor” was deprived of any meaning. Family doctors will also take prophylactic measures in protecting and recovering people’s health. to establish the controlling mechanisms. The legislative program permitting the transition to a self-governing system of health care is being implemented. A National Case-mix Office will ill he established. Medical universities in the country will he consolidated. which envisages a preparatory period of a year and a half necessary to build administration. A plan for the introduction of a health insurance system was designed. an information system. coordinating. controlling and planning. All directors of hospitals. There was no organization of medical treatment at home. the methods of bargaining and payment of health services. There are new specialties at university for nurses and health managers. The programs for these courses have been developed in collaboration with EU experts and they include modern methods of management in the circumstances of market economy. public healthcare and health policy. In Parliament was discussed and adopted the Law on Health Insurance. too. The big problem is to accomplish the reform in a way that the social price in the transition period should be as low as possible. where information about treatment of patients from all hospitals in the country will be collected. and for equality of use of health services throughout the hole country as well as a guarantee for good quality. and it will indicate tariffs and effectiveness of hospital production. It is essential to find redirecting and retraining solutions for that medical manpower whose jobs will be made redundant. Reform in the educational system also began. . The hospital product evaluation system (Bulgarian variant of Diagnostic Related Groups) will be utilized by the health insurance system for payment of the medical service done to the insured. emergency aid centers and municipal health administration do such courses.

. ultimately. it will engage about 10 % of industry and will fit the health care system in the normal proportions of public revenue distribution. increase the quality of health services. where patients will be able on an equal and free basis to choose their own doctor. and this means more jobs and higher incomes. The authorities of the NHIF are the Assembly of Representatives. but it has an immediate effect on the economy itself. Simultaneously. The system will receive revenue from more than one source. which is often forgotten. That means matched access of all in need to medical services of good quality and effect. which in 2 years’ time will spend nearly 7 % of GDP. The Bulgarian health insurance system has a three level structure . 1998 will lay the foundations of a real economized financing system for health care.The role of the municipalities in setting the regional schemes of health care will increase in the process of decentralization. the Governing Board and the Supervisory Board and Director. and with strictly established rules of the game. and it will hold the increase of expenditure through mechanisms similar to the so called managed care. The compulsory health insurance is a system for health protection of the population. The health institutes will function in a competing environment in respect with public funds. and. The Act regulates the signing of a National Framework contract between the NHIF and the professional associations of the healthcare providers. regional (RHIF) and local (local health insurance services). Health care intensification is intended as a result of economic intensification. NATIONAL HEALTH INSURANCE FUND . and is administered by a National Health Insurance Fund. The aim of all undertaken activities is to reform the health care system so that it should function in the circumstances of regulated market and competition. guaranteeing a package of healthrelated services. and turn into a dynamically developing industry. According to governmental forecasts.national (NHIF). the regulated market will permit planning of needs and resources and their correct distribution.1 From: Almanac Bulgaria 2000 The Health Insurance Act was adopted in July 1998 and so the compulsory and the voluntary health insurance was introduced in Bulgaria. it will allow the opportunity of choice of different schemes according to the variety of individual and group necessities. At present we are facing the challenge to build a brand new organization with more than 280 territorial structures and 4500 employees throughout the whole country. In the developed countries approximately 17-18 % of the economy works for health care providing raw materials and resources. which will introduce new technologies quickly.

as well as. and control on the availability of medical care and its quality. etc. the evaluation of the financial result of the health insurance. The Assembly adopts and amends the Regulations on the structure and activities of the NHIF and the RHIF. medical and information activities. insured persons and the state. The Board prepares the annual budget and the annual report of the Fund and takes decisions on the signing of contracts. approves the draft annual budget of the NHIF and its annual report. and general administration. analysis of the health necessities of their region. The Director of the NHIF represents the Fund within the powers vested in him by the Governing board and organizes and directs the activities of the Fund in accordance with the law. the RHIF defines the specific duties and obligations of the local health insurance services. the regional health structures of the outpatient and hospital care. preparation of the essential pharmaceuticals list. and development of policy. international activities and cooperation. The functions of the RHIF include the preparation of the regional health insurance scheme. preparation of the National Framework Contract. make evaluation of the health status of the population and of the volume of activities in the health institutions. In addition to that it appoints and releases members of the Governing Board and the Supervisory Board. human resources. analysis and proposals for the prices of medical services. the NHIF Director and the RHIF Directors. The Governing Board together with the Director of the NHIF represents the Fund at the negotiations on the preparation of the National Framework contract and signs it. the number and the structure of the covered population. In addition to that. public relations and international cooperation. controls the implementation of the individual contracts with the health service providers on the territory of the region. the preparation of the individual contracts with the outpatient and hospital care providers within the municipality. evaluation of the health insurance costs.The Assembly of Representatives includes representatives of employers elected for a period of 4 years on quota principle. The main task of the NHIF and its structures is ensuring equal use of medical services and their payment to the provider. The functions of the local health insurance services are connected with the preparation of registers of the insured persons and the health service providers. incl. The Supervisory Board executes general control over the activities of the Governing Board. . The functions of the central management of NHIF include overall management of the system and redistribution of revenues in accordance with the regional characteristics. strategy and methodology of NHIF. The organizational structure of the NHIF includes five main streams of activities: finance. legal and public relations activities. training of staff. the distribution of the revenues and costs. development of models for the influence of the price policy on the health and health insurance systems.

it appoints and releases members of the Governing . 250 of them employed at the NHIF Central Office and the rest of them — at its regional structures.THE NATIONAL HEALTH INSURANCE FUND . Additional 300 employees will be employed at the municipal offices of the NHIF. The National Framework Contract sets the parameters and procedures related to the functioning of the whole health insurance system. Under the Health Insurance Act the Bulgarian National Health Insurance Fund (NHIF) was established and principles defining the relationship between the NHIF and the health care providers were set. the NHIF has 1800 employees. the Governing Board. The Health Insurance Act was a result of detailed analysis of the previous system. Health care reforms are meant to improve the quality of health care services. Its term expires at the end of this calendar year. the insured persons and the state. The NHIF has a Central Office in Sofia and 28 regional structures (regional health insurance funds (RHIFs). adds and amends the Regulations on the structure and activities of the NHIF and the RHIF. Furthermore. The Assembly adopts. The Assembly of Representatives includes elected for a period of 4 years on quota principle representatives of the employers. The compulsory health insurance is a system for health protection of the population. It defines the order. the Supervisory Board and the Director. The Health Insurance Act regulates the signing of the National Framework Contract between the NHIF and the professional associations of the health care providers. which set the basis for restructuring of the outdated and inefficient in present conditions public health care system in Bulgaria. and is administered by the National Health Insurance Fund. To this moment. The first National Framework Contract was signed on 27 April 2000 and was published in the State Gazette on 23 May. 2000. the contents and the payment of the health care activities and services to be provided to the insured population. The National Framework Contract is signed for a period of one year between the NHIF and the professional associations of doctors and dentists. An additional number of 100 local offices are now to be established. in favor of the insured persons.2 From: Almanac Bulgaria 2001 In 1998 the Bulgarian Parliament adopted the Health Insurance Act. The managing bodies of the NHIF are the Assembly of Representatives. operation and management of the compulsory health insurance scheme in Bulgaria. and address the state’s inability to finance the entire health care system. The NHIF is responsible for the development. It is the basis for the introduction of both compulsory and voluntary health insurance in Bulgaria. and builds upon the recent developments in other countries facing similar problems. which guarantees a basic package of health services.

In addition to that. control the implementation of individual contracts with the health service providers on the territory of the region. as well as. The main task of the NHIF and its regional structures is to ensure equal access to medical services for all insured persons and payment of the services provided by the health care providers. medical and information activities. development of models for the impact of the price policy on the health and health insurance systems. staff training. The functions of the RHIFs include: the development of the regional health insurance scheme. the strategy and the methodology of NHIF. . incl.Board and the Supervisory Board. and general administration. preparation of the essential pharmaceuticals list. The functions of the local health insurance offices are connected with the preparation of registers of the insured persons and the health service providers. The organizational structure of the NHIF covers five main areas of activities: finances. the number and the structure of the covered population. The Director of the NHIF represents the Fund within the powers vested in him by the Governing board and organizes and directs the activities of the Fund in accordance with the law. human resources. the control on the availability of medical care and its quality. analysis and proposals for the prices of medical activities. The Board prepares the annual budget and the annual report of the Fund. as well as development of the policy. the NHIF Director and the RHIF Directors. The functions of the central management of NHIF include: overall management of the system and redistribution of revenues in accordance with the regional characteristics. the preparation of the individual contracts with the outpatient and hospital care providers on the territory of the municipality. The Supervisory Board executes general control over the activities of the Governing Board. approves the draft annual budget of the NHIF and its annual report. evaluation of the health insurance costs. the distribution of revenues and costs. analysis of the health needs of the respective region. activities concerning legal issues and public relations. The Governing Board together with the Director of the NHIF represents the Fund in all negotiations concerning the preparation of the National Framework contract and signs it. preparation of the National Framework Contract. and takes decisions for signing of the contracts. the RHIFs define the specific duties and responsibilities of the local health insurance offices. the evaluation of the financial results of health insurance. make evaluation of the health status of the population and of the volume of activities in the health institutions. public relations and international cooperation. international activities and cooperation. the regional health structures of outpatient and hospital care.

3 From: Almanac Bulgaria 2002 In 1998 the Bulgarian Parliament adopted the Health Insurance Act which set the basis for restructuring of the outdated and inefficient in present conditions public health care system in Bulgaria. At present NHIF has 1800 employees. concerning outpatient care. The Health Insurance Act regulates the signing of the National Framework Contract between NHIF and the professional associations of the health care providers. The NHIF enters into contractual relations with some 5000 general practitioners. the contents and the payment of the health care activities and services to be provided to the insured population. An additional number of 121 municipal offices have also been established. in favor of the insured persons. Additional 300 employees are employed at the municipal offices of NHIF. was signed on 22 December 2000 and is effective until the end of the year 2001. medical professionals providing outpatient services. The first National Framework Contract was signed on 27 April 2000 and its term expired at the end of the year 2000. and for the inpatient (hospital) cases — as of 1st January 2001. which concerns hospital care. NHIF is responsible for the development. operation and management of the compulsory health insurance scheme in Bulgaria. as well as. The Health Insurance Act was a result of detailed analysis of the previous system. NHIF has a Central Office in Sofia and 28 regional structures (regional health insurance funds (RHIFs). which guarantees a basic package of health services. and address the state’s inability to finance the entire health care system. and is administered by the National Health Insurance Fund. The National Framework Contract sets the parameters and procedures related to the functioning of the whole health insurance system. It is the basis for the introduction of both compulsory and voluntary health insurance in Bulgaria. 250 of them employed at the NHIF Central Office and the rest of them — at its regional structures. The compulsory health insurance is a system for health protection of the population. Under the Health Insurance Act the Bulgarian National Health Insurance Fund (NHIF) was established and principles defining the relationship between the NHIF and the health care providers were set. It defines the order. .According to the Health Insurance Act the new health care system for the outpatient cases is operational as of 1st July 2000. Health care reforms are meant to improve the quality of health care services. and builds upon the recent developments in other countries facing similar problems. In May 2001 an addition to the National Framework Contract 2001 was signed. THE NATIONAL HEALTH INSURANCE FUND . The National Framework Contract is signed for a period of one year between NHIF and the professional associations of doctors and dentists. The second one. a number of hospitals in Bulgaria.

The Supervisory Board executes general control over the activities of the Governing Board. the Board of Directors. activities concerning legal issues and public relations. development of models for the impact of the price policy on the health and health insurance systems. preparation of the essential pharmaceuticals list. represents the Fund in all negotiations concerning the preparation of the National Framework contract and signs it. approves the draft annual budget of the NHIF and its annual report. The organizational structure of the NHIF covers five main areas of activities: finance. staff training. public relations and international cooperation. the distribution of revenues and costs. The main task of the NHIF and its regional structures is to ensure equal access to medical services for all insured persons and payment of the services provided by the health care providers. analysis and proposals for the prices of medical activities. The Board prepares the annual budget and the annual report of the Fund. The functions of the RHIFs include: the development of the regional health insurance scheme. as well as. control the implementation of individual contracts with the health service providers on the territory of the region. preparation of the National Framework Contract. make evaluation of the health status of the population and of . and takes decisions for signing of the contracts. The Board of Directors. the number and the structure of the covered population. medical and information activities. together with the Director of NHIF. supplements and amends the Regulations on the structure and the activities of NHIF and RHIFs. the insured persons and the state. human resources.The managing bodies of NHIF are the Assembly of Representatives. The Director of NHIF represents the Fund within the powers vested in him by the Board of Directors and organizes and manages the activities of the Fund in accordance with the law. The Assembly of Representatives includes elected for a term of 4 years on quota principle representatives of the employers. international activities and cooperation. the RHIFs define the specific duties and responsibilities of the municipal health insurance offices. the regional health structures of outpatient and hospital care. The functions of the central management of NHIF include: overall management of the system and redistribution of revenues in accordance with the regional characteristics. development of the policy. evaluation of the health insurance costs. the strategy and the methodology of NHIF. Furthermore it appoints and releases members of the Board of Directors and the Supervisory Board. the evaluation of the financial results of health insurance. The Assembly adopts. incl. In addition to that. the NHIF Director and the RHIF Directors. and general administration. the Supervisory Board and the Director.

2001 NHIF has concluded contracts with 140 hospitals in Bulgaria. the preparation of the individual contracts with the outpatient and hospital care providers on the territory of the municipality. 2001 NHIF started financing the hospital care and currently pays the medication of patients for 30 clinical pathways. the control on the availability of medical care and its quality. which cover 159 diagnoses. NHIF pays completely or partially for 1054 medicines and medical supplies for the outpatient health care service. analysis of the health needs of the respective region. . NHIF enters into contractual relations with 12 096 general practitioners. Since July 1. In addition.the volume of activities in the health institutions. The functions of the municipal health insurance offices are connected with the preparation of registers of the insured persons and the health service providers. as well as. According to the Health Insurance Act the new health care system for outpatient cases is operational as of 1st July 2000. On July 1. medical professionals providing outpatient services. Nowadays. dentists and laboratories.

Indonesia etc. the North Atlantic Treaty Organization etc. accident Wars in Cuba.namely. etc. India. Western Europe as keeper of a tradition in Anglo-Saxon partnership etc. towards. • Many countries became oriented. like super-populated countries China. the United Nations. Libya. thus. the Wars in former Yugoslavia. leaving a hegemony in world politics . secondly to stay aloof. Russia as a global world contester.namely. Such changes are subject of commentary from the viewpoint of the most astute political annalists. However.namely.ADDENDUM: First Update It is a timely matter to update our history on the health care in Bulgaria. also. Korea.namely. the First and Second Gulf Wars. in the face of the United States of America. being on-line!/ have broadly speaking two alternatives . Here is an overview in a very detached manner: • Cold War has ended. our job is unrelated to such commentaries right now. firstly to stick to alliances on a regional and interregional level. • Major political institutions failed to prove their /assumed?/ leadership role namely. etc. a status of independent sovereign states and lacking interest in international collaboration . . • Small and middle-to-low income countries /Bulgaria. The world has lived through tremendous changes at the end of the XXth century. • It was a precursory to a series of local political conflicts in different parts of the world . like European Union.

and we must state that beyond mere symbolism . a reader would have omitted as well as the first We are at the brink of year 2005.viz. They speak for themselves about the Transition Period in Bulgaria. Thanks God. the world is more than ever divided around an old paradigm . the affluent Occident in the west and the havocked Orient in the east.namely. that. This being the problem and we are going to briefly outline a summary of events from the past year: • United States won that last war. international terrorism has won the upper hand. The Editor hopes. and..here. a more comprehensive chapter could be written in view of the changes having taken place. the train bombing in Spain etc. the War in Iraq is over and with success for United States and the coalition. which. by year 2007 a succession mechanism to the European Union will be complete. which.• Preventive diplomacy failed to prove its purpose aim . the country is in a badly need for more cash and more soldiers regarding a next conflict. • Western European partnership seems to linger with France and Germany constantly on some "not so well planned" crusades around the world and being lured by more investment projects in the Far East and the South Americas. 16 May 2004 Sofia Second Update. is evident from the September 11 attack. However. Peaceful parliamentary elections are held and it seems the Iraqi problem is solved for the time. Then. let us present to our historical column some important links .namely. . Without further debating on contemporary political turmoil. even though .

These are reflections on a worldwide scale and are not supposed to influence anyone except a personal ego of the . I wish to mention. a country depressed by it’s own misfortunes or because of them.here. • "Third World" countries . as well as. while. as poor as before on terms with a GDP and indebtedness to world financial institutions. Bulgaria – namely. with all benefits and negatives. to some political analyzers and the country looks too distant and too slow to be a real competitor in world affairs. separate members are under constant stress that they should be misunderstood and by the pattern of reactions from their Western counterparts. • Countries from the former Eastern block are being sequentially included and in a row to a rather inert working succession mechanism. that this transition has not been a happy one and with respect to the physical and social wellbeing of the nation.e. We have not forgotten and to bring our history project to an end. however. I don’t see easy solutions for a long term perspective. with timeliness and calmness as to the future of a nation We. are going to be happy members of the European Union. Just some more time and resources would be necessary. Bulgarians. while. 25 February 2005 Sofia Third Update. while.• Russia remains alone and isolated. The Editor is encouraging and for the time being every volatile reader to consult the list of links . understand here countries from the West/ against each other or confronting them with its own demands. By this time next year and we are joining the Eurozone.so generously endowed with space and resource appear to be important as an actors of a global scale and only where it succeeded in playing out two rivals /i. even Japan finds difficulty flexing their economic muscles beyond terms of political clout..

I am not very definite on the fact. have lately imbued as important in national and international politics /and history?/: • Firstly. This has been given successful check by two of the main contenders – namely. It seems that country like United States is going to make an easy prey on anyone. have not been so united since the early Middle Ages/. it has received a lot of scolding and petting. before making conclusions on the winner and the looser. sooner or later are going to accept their new role. whatsoever.. It has not been an easy war however. we wish to . look at what is going on a worldwide scale. I am far from making a prognosis on debates within the circles of world capital. And let me remind everyone for a lesson from the not so far gone past – viz. this has been a leading theme in many an official visitors from EU. let us think on the collective attitude of the Great European Powers towards a new member state. Bulgaria – as a newcomer – has been a bad child and a problem one. at the end of the World War II and at a time when a fate of the nation was decided by the world powers. by the way. This seems to be far from the case right now – when. this was a time when a tradeoff has postulated that Bulgaria should join the East rather than West as a geo-strategically unit. whether. the War in Iraq and its repercussions on the future of nations. moreover. This has left a definite impression on the character of the Bulgarians – which. But let me pond on another poignant question – namely. With such resolutions in mind and we are going to proceed to some two themes. It is by far unequivocal and unsolicited. France and Germany /which. world powers are rather unwilling to loose a utility again. which. • Secondly.author. unfortunately. Old Europeans have been nourishing the New Europeans – although.

rather then a strategically directed effort to contribute for an improvement /or deterioration?/ of the wellbeing of a nation. Now. as of today’s date. One group. has been augmented with an important list of links . which has been third in a row for the past several years. it is not so much the human factor /i. Expressly. are followers of the Two Towers approach – viz. we have been approaching our ultimate target to present a picture of Bulgarian healthcare with a view on international politics. So these people..e. which stand more like a personal reflection I heard these day someone. This update. The rest is interplay of time and chance schedules. Norway and Iraq – it becomes evident that both are totally dependant on their crude oil resources.e. By the way. that. political divide has become wider than ever and nowadays you can find within a perimeter of 50 km2 – namely.here. but it is not. 2001 disaster /i. Timeliness and calmness have been our leading principle. If we contend. 22 January 2006 Sofia Fourth Update.. belonging to a Nordic or Mediterranean races/. is a believer of the values of September 11. let me answer to a “friend” like this and to other skeptical political eyes in the neighborhood. I see adherents of two political lines. saying that the United States will not be able to exploit it’s hard-won victory in the Middle East. let as name allegorically the WTO twin-skyscrapers on .. Obviously. It came to reestablish a role for the Middle East and not less important than that of the Scandinavian Peninsula. genetic drift is minimal in the civilized world and the role of society has become boosted to a tremendous dimensions. for instance.remind to the public that it has been a racial war. Someone will say that this is a surprising statement. we are speaking of cultural differences which could have accumulated for thousand years. as if by an interplay of chance and the same year my best friend died in a car accident/. If one compares two countries – likely.

In passim. instead to continue terrible cleansing and defeatist policy. Other group. The British Empire can be proud with it’s children states – namely. in this case the country of the United States/. It is for now on a private perusal and a hand-to-hand basis. in passim. and not without much consensusness we resemble it to the Orwellian’ year 1984. Albeit. It doesn’t matter. who believe that hatred and physical force could stop the pace of world progress. Australia. I categorize myself and other people from the alternative group mentioned above. As if..Manhattan Island in New York. or when words doesn’t make much sense At the brink of year 2007. is the people with the King Kong approach – viz. It has been a long ride and with much trouble alongside some 17 years of transition. Those people. I firmly believe in a total defeat for the brutal side in the white race. Canada. New Zealand. while somebody could smash such an asset in the center of the world civilization and that could be done with the rest of the world. I want to finish this excise with a statement on the British character and British civilization. The new Eurodollar zone. England has been a bearer of the spirit of the great Roman Empire. The reasons for this are manifold and we are not going to argue with anyone about the rightfulness of this thesis. our project is continuing and unfortunately we still can not register our site for general purposes. finally we arrived at our final destination in the European Union /EU/.e. let me mention that the fact you are wearing an American passport doesn’t make you less dangerous for world democracy. However. the future is bright for the whole world and if we could unite ourselves. Whatever. 27 April 2006 Sofia Fifth Update. etc. . with United States. whom I already mentioned and have been living in close neighborhood with us – namely. the enemy is within or without the country /i. explicitly. here. which. has been created on the old European continent is eager to resist and will pose threat to a new expansion from the side of the British and allied forces. whether. there are still people with animal instincts and psyche. the same people had stopped hundreds of years ago great events and world clashes of civilization. South Africa. You can still use it’s links – namely. let as use this allegory for the abysmal brute from the novel of Edgar Wallace and filmed three times with major cinema success. as well. I think. that. The philosophy of such people is.. They have been hampering efforts from United States and allied forces to fulfill a mission of globalization and prosperity for all.

e. Difficult issues are proceeding on the international arena. already. but they don’t waste any time to support the conflict with money and arm force whenever their interest allows them. Meanwhile.. The War that has been waged in the Near East has become strictly a business war. from the unsystematically gathered material in our site. which. we are there and have to look around us. ditto. These can be found here. unequivocally I would recall as orderly and happy. which is regrettably somewhat away from being neither safe nor being well. In the midst of these squeeze of muscle and nerves is the tiny.. at least for the author of these lines.whatever. But let me comment on it with an example from the not so long ago past. This above mentioned factotum have been curtailing definition for some time. The Communists are sneering from aside with their slant eyes. It’s a world apart but for how long? We finish this short excise with dubious attitude and not any real expectations at all. I go back to the year 1989. obviously this “equity” was objective in its underground and while we were still living in a quasi-state of non-democracy. preparing their body for the funeral and going for the “Jihad”. The appended commentary to our short history – i. ordinary citizen of the “Civilized” world – viz. nothing personal to whomever. it has occurred to the mind of the author of these lines that a second book could be produced. perceive it as you wish and with whatever outlook you find proper for your own tastes. but it necessitates some reshaping and more confidence. that has been shaped in a chronological manner – further. Unleashing the potentials of a common market space and giving the individual the rights of his own destiny. we are there and we perceive subjectively the need for “equity”. These were times. with some bearable degree of affluence that was not so much but enough for the time being. We define “equity” as a subjective status of relative safety and a state of wellbeingness. However. when the whole “proclaimed” democratic change started. And as we have already said. provides links for enhancing the story contained within. Other people may perceive it otherwise. . The first thing that catches one’s eye is the problem of “equity”. subsequently upturned the whole stuff upside down. The Muslims are more fanatical than ever. The solution of the philosophical dilemma is closed ended.

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