Yugoslavia

YUGOSLAVIA (Kingdom of Serbs, Croats and Slovenes), a state that formed in 1918-1919 after the war as a result of the annexation by Serbia of Austrian provinces and Montenegro. General data and population movement. Area - 248,987 km². Population density on average 48.1 per 1,000 (1929). Population movement is expressed in the following figures (see Table 1). Yugoslavia is a country with high birth rates and high mortality, especially child mortality, a country with low culture, impoverished, and having lost a significant part of its population during the world war. The provinces that went to Yugoslavia from Austria-Hungary - Bosnia and Herzegovina, Croatia and Slovenia - are particularly low, where mortality for 1922-1927 stood at around 22 per 1,000 inhabitants. Mortality in rural areas in Yugoslavia is much higher than in cities. On average in Croatia in 1931, there were 20 deaths per 1,000 in cities, and 23 in rural areas. According to the census of 1/IV 1931, there were 6,895,000 men and 7,036,000 women in Yugoslavia. Child mortality is one of the highest in Europe and shows no tendency to decrease: ю «73 Table 2. Child mortality per 1,000 live births. Years Absolute figures ^Г°Я^Ы figures 143 ИЗ 103 150 147 153 165 187 Sanitary organization. In the devastated and poor country, especially after the war, the development of epidemics and endemics reached such an alarming character that immediately after the formation of the independent kingdom of Serbs, Croats and Slovenes, by law of September 14, 1920, a ministry of national health was created, which was tasked with protecting health, combating infectious diseases, collecting data on population movement, sanitary-educational work, etc. In addition, the ministry of social policy also partially carried out work in the field of healthcare. The organization of healthcare was nevertheless different in old Serbia, in former Montenegro, and in the provinces that separated from Austria-Hungary. The first sanitary laws were included in the constitution of Yugoslavia. On the basis of these laws, the public healthcare organization was built, although weak in itself, but having a public character. The ministry of health, by laws of 7/XI 1929 and 27/H 1930, merged with the ministry of social policy under the name of the Ministry of Health and Social Policy with 3 departments: administrative, sanitary, and social security. Directly subordinate to the ministry are the Central Hygiene Institute in Belgrade, the School of Public Health in Zagreb, public hospitals, a shelter for the blind, and labor inspection in Belgrade. From it also depends the chief hygiene inspector, controlling the activities of 9 provincial hygiene institutes (one per banovina), 53 health houses (one per province) and 149 sanitary stations serving rural districts. Each banovina is governed by a prefect (ban), to whom is subordinate the local department of social security and healthcare, which is part of the banovina administration. This department also manages the activities of local doctors, hospitals, nurseries, etc., as well as the fight against infectious diseases and the protection of motherhood and infancy. Under the same law, each district is obliged to have a health house, as well as each city with a population of more than 4,000 inhabitants. There should be a municipal doctor and a qualified nurse at it. Villages can receive interest-free loans from the ministry of health for the construction of water supply systems, baths, sewers, etc. The social security section manages the protection of war invalids, orphans and the poor, the administration of resorts and sanatoriums, supervision of hospitals, and is the highest judicial authority in matters of non-compliance with sanitary legislation. The sanitary-educational department existed from 1920 to 1923, carrying out relatively large-scale work. The ministry's budget provides for an expenditure of 4½ million dinars per year on sanitary-educational work - an extremely meager amount. Particularly characteristic is the propaganda of hygiene through exhibitions, theatrical performances and even puppet theaters. However, as a whole, the ministry is very poor, its activity is relatively weak, the organization of medical care is insufficient, and under these conditions, sanitary-educational work gives almost no results. Infectious diseases. After the terrible epidemics that raged during the Serbian retreat of 1915 and in the first years after the war, morbidity began to decline. Thus, smallpox has not been observed since 1925, typhus is endemic in Macedonia and the littoral, but the number of deaths does not exceed 50-100 per year, while typhoid fever remains endemic due to the desperate insanitary condition and poverty of the villages - from 4 to 5 thousand cases per year. Dysentery is also endemic, although from 17,532 cases in 1919, their number has now decreased to 1,000-2,000 per year. Serbia is a livestock country and anthrax diseases are frequent there (several hundred per year). The fight is conducted mainly by the hygiene institute and sanitary centers (stations). The number of stations has grown from 4 in 1921 to 45 in 1929, the number of Pasteur stations has risen from 3 in 1921 to 28 at present. By law of 4/XI 1930, sanitary commissions were formed to combat infectious diseases. Reports of infectious diseases can be made by anyone - doctors, patients' parents, patients, priests, etc. Yugoslavia is one of the most malaria-affected countries in Europe. Macedonia, Dalmatia, and Montenegro suffer most from it. In Dalmatia, malaria research showed 27% of patients in 1922 and 12% in 1926. In general, there are at least 800,000 patients in the country. 85-90% of the population live in poverty, in huts 2-3 m^г high, covered with earth, together with livestock (Ivanich, Konstantinovich). The fight has been conducted in earnest only since 1923, with 10 million dinars allocated annually, a tropical institute has been organized in Skopje, anti-malaria stations have been created, work on draining swamps has begun, the state distributes quinine free of charge to the poor - in 1930, 1,078,339 doses of quinine were distributed and 254,374 people were examined. By law of 29/VI 1931, the entire territory of Yugoslavia is divided into three zones according to the degree of malaria infection, and the state plans to carry out work to combat it on a large scale. In Macedonia, on the basis of chronic malnutrition, anemia and malaria, an enormous number of abortions are observed in women, menstruation occurs once every 3-4 months on the basis of chronic anemia. Trachoma is extremely widespread, in Vojvodina and the littoral up to 5% of the population suffers from it. In 1932, only 12,960 patients were treated for trachoma, i.e. a negligible part of them. By law of 11/XI 1931, treatment of trachoma is compulsory and free, but this law is not applicable due to lack of doctors and resources. In 1929, 157,315 consultations were given for trachoma. Social diseases. According to Ivanich and Konstantinovich (1930), about 3 million people in Yugoslavia are affected by social diseases. Mortality from tbc varies from 25 per 10,000 in Serbia and Croatia to 40 and higher in Bosnia, Herzegovina and Montenegro. Tbc is everywhere the main cause of mortality in Yugoslavia - about 40,000 deaths per year. Mortality from tbc is especially high among Muslim women. The fight is conducted weakly. 20 million dinars per year are allocated in the state budget for the fight against tbc. The number of dispensaries has grown from 10 in 1921 to 35 in 1932 and decreased to 32 in 1933. In 1930, there were 20 preventoria with 2,900 beds and 3 sanatoriums with 2,000 beds. In addition, the fight is conducted through school polyclinics, children's dispensaries, etc. Venereal diseases are extremely widespread - in some areas up to 60% of the population is affected by them. About 2.5% of the population passes through venereal dispensaries. The fight is conducted on the basis of the law of 25/XI 1921 through dispensaries, the number of which has grown from 9 in 1921 to 41 in 1933. Dispensaries are established by the state and depend on the ministry of national health. Treatment of patients is theoretically compulsory and free, in fact dispensaries cannot serve all patients. Dispensaries also carry out preventive work. By law of 31/III 1931, the ban (prefect) has the right, if necessary, to order a general examination of the population for syphilis. The measures taken cannot actually be implemented due to lack of doctors and resources. Alcoholism is extremely widespread, in which the influential wealthy classes are interested. Almost no fight is conducted. The ministry allocates 200,000 dinars per year for the fight and prohibits the sale of alcoholic beverages in restaurants on the eve and on holidays. Medical personnel. In Yugoslavia there are three medical faculties (Zagreb, Belgrade and Ljubljana) with a course of 10 semesters and one year of mandatory internship in a hospital or hygiene institute. In 1929, there were 5,250 doctors (about 4 per 10,000 inhabitants - the lowest proportion in Europe), of which 866 were in state service.

The number of medical students decreased from 1,503 in 1926/27 to 1,299 in 1929/30. Medical practice. The law of November 27, 1930 regulates hospital affairs. The state maintains a number of hospitals for the poor, since the vast majority of the population lives in appalling poverty and is unable to pay for medical care. Expenses for maintaining patients are borne either by the patients themselves and their guarantors, or by workers' insurance bureaus and mutual insurance funds for the insured, the Ministry of Army and Navy—for military personnel, the Ministry of Health—for state employees and their families, for invalids and refugees. If a patient cannot pay and no one pays for them, by law the hospital expenses are covered by the state; if a patient is being treated for mental illness, tuberculosis, or venereal disease—by the municipality or district, if the patient has resided there for at least five years. In reality, medical care is so inadequate that far from all patients can make use of it. The number of hospitals grew rapidly: 25 in 1870, 107 in 1890, 135 in 1919, and 180 in 1928. The number of medical institutions and their personnel is indicated in Table 3. Since 1930, there has been a reduction in the number of medical institutions due to cuts in credits. We should particularly note the so-called sanitary cooperatives, whose members receive inexpensive medical care and medicines, organize sanitary-educational work, and fight against tuberculosis, venereal diseases, etc. These cooperatives are recognized by law and enjoy the same rights as state institutions. From 13 in 1923, their number reached 36 in 1929 and 41 in 1930 with 16,647 members; in 1930, 34,445 patients passed through them, and medicines worth 1,241,984 dinars were sold (in 1923 only 119,949 dinars). Protection of motherhood and childhood. Child mortality in Yugoslavia is high and shows no tendency to decrease (see Table 1). Maternal mortality in childbirth is also high, reaching over 7%. For insured working women and their families, the law establishes a series of benefits. For state institutions. Private medical institutions. Private sanatoriums. Number of hospitals... Beds in them... 20,896 1,199 Patients treated... 51,350 28,242 8,308 Institutes of hygiene... People's health houses... School polyclinics... Venereal dispensaries... Dispensaries for mothers... Trachoma dispensaries... Sanitary stations... Dentists... Dental technicians... Midwives... Schools for nurses... Schools for abnormal children... Midwifery schools... In 1930-2. In 1930-11. With 185 students. With 460 pupils. With 77 pupils. The advantages include: free midwifery care, a benefit is issued to a pregnant woman for two months before and two months after childbirth in the amount of 3/4 of her wages. A benefit is issued for the newborn in the amount of 14 days' wages. Night work for women and for children under 18 is prohibited. Child labor under 14 is prohibited. For feeding children, women have the right to necessary breaks during work. In enterprises employing more than 100 women and more than 25 young children with them, nurseries are provided. All this legislation remains on paper, all the more so since workers are deprived of the opportunity to monitor its implementation. Since 1928, all worker organizations have been dissolved. Under the law on the protection of childhood (1922), all orphans who lost their parents in the war or were completely or partially abandoned by their parents are placed under the care of the Ministry of Social Policy until the age of 18. In Ljubljana there is a special institute for childhood. In 1929, Yugoslavia had 28 consultations for infants and 77 school polyclinics (in 1922—3 dispensaries and 4 polyclinics). Sanitary-medical supervision of schools depends on the Ministry of Public Education. Medical examination of children entering school is mandatory; in the provinces it is entrusted to local paramedics, in cities—to doctors. Almost all secondary schools have their own doctor, usually appointed by the ministry. School clinics not only carry out preventive work but also treat children. In 1932, they examined 182,752 (in 1929—155,615) children in primary schools and 82,597 in secondary schools. But the role of this examination is negligible, since it is not accompanied by the adoption of any real measures for the protection of children's health.

tes et Slovenes, Belgrade, 1927; they same, Le Service d'hygiene dans le Royaume de Yougoslavie, Belgrade, 1930; Steinpar, L'organisation des services d'hygiene publique dans le Royaume des Serbes, Croates et Slovenes, Soc. d. Nat, Geneve, 1925.

A. Luvakij.