MEDICAL AND SANITARY DATA ON BULGARIA

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• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP79-01144A000100010018-1
• Release Decision: RIPPUB
• Original Classification: C
• Document Page Count: 14
• Document Creation Date: December 16, 2016
• Document Release Date: August 8, 2005
• Sequence Number: 18
• Publication Date: May 19, 1943
• Content Type: IS

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Appendix II
MEDICAL AND SANITARY DATA
ON
BULGARIA
(JANIS No. 38)
*
Compiled by
THE MEDICAL INTELLIGENCE BRANCH
PREVENTIVE MEDICINE DIVISION, OFFICE OF THE SURGEON GENERAL
U. S. ARMY
MAY 19, 1943
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C"'AN IN CIASS, O
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MEDICAL AND SANITARY DATA ON BULGARIA
(Prepared by the Medical Intelligence Branch, Preventive Medicine Division, Surgeon General's Office, U. S. Army, May 19, 1943.)
1. PUBLIC HEALTH AND ENVIRONMENTAL FACTORS
INFLUENCING HEALTH AND SANITATION.-1. Public
Health Department.-a. Organization. The national health
organization of Bulgaria is known as the Directorate of Public
Health (Direktsia na Narodno Zdrave) and forms part of the
Ministry of the Interior.. The Director of Public Health is
Dr. Ivan Balkansky, a former Rockefeller Fellow. Within the
Ministry of the Interior the Directorate of Public Health is
almost autonomous and maintains direct relations with other
ministries. The Directorate of Public Health is divided into
five Departments with duties as noted.
The Public Health Department has the following duties:
(1) Supervision of urban sanitation (water supply,
sewage).
(2) Reclamation and drainage of marsh-land.
(3) Medical inspection of schools, prisons, factories
and hospitals.
(4) Enforcement of sanitary regulations regarding
streets and public institutions.
(5) Inspection of food.
(6) Operation of the Chemical Institute.
The Public Health Department is directed by a doctor of
medicine assisted by an engineer and an architect.
The Infectious Diseases Department has the following duties:
(1) Investigation and control of infectious diseases.
(2) Operation of international quarantine stations
(frontier stations).
(3) Enforcement of laws and ordinances relating to
infectious diseases.
(4) Supervision of institutes of bacteriology and hygiene
and maintenance of depots of sera, vaccines and medicaments.
(5) Operation of the Bacteriological and Public Health
Institutes.
The Infectious Diseases Department is directed by a doctor
of medicine assisted by an epidemiologist, a chief medical
inspector for malaria, and an inspector for tuberculosis and
venereal disease. The malaria inspectorate though part of
the Infectious Diseases Department is in practice largely
independent.
The Department of Hospitals has the following duties:
(1) Administration of hospitals and sanatoria.
(2) Provision of supplies to these establishments and
also to quarantine stations and ambulances.
The Pharmaceutical Department has the following duties:
(1) Inspection of State pharmacies.
(2) Control of the Central Depot of Pharmaceutical
Products.
(3) Provision of drugs and bandages for State
Pharmacies.
(4) Control of the quinine monopoly (with coopera-
tion of the Malaria Inspectorate).
(5) Licensing of pharmacists.
The Financial Services Department has the following duties:
(1) Preparation of budgets of the Directorate of Public
Health.
(2) Consultation with the Director of Public Health,
the heads of Departments, and the General Medical Council.
The Directorate of Public Health is supplemented by an
advistory organization, the General Medical Council, composed
of ten members. These are the Director of Public Health, the
Chief of the Army Medical Service, the president of the
Bulgarian Medical Association, six physicians and one judge.
The more important functions of the General Medical
Council are as follows :
(1) Advice regarding proposed health laws.
(2) Approval of budgets of the Directorate of Public
Health and the health budgets of provinces and large towns.
(3) Advice regarding entry into the country of persons
suffering from infectious diseases; control of travel by persons
suffering from endemic diseases who may attempt to move
from one part of the country to another.
(4) Conduct of qualifying examinations for physicians;
supervision of the practice of medicine.
In addition to the Directorate of Public Health and the
General Medical Council there are. local health authorities. For
public health purposes Bulgaria is divided into seven provinces
corresponding to the administrative provinces and directed
by provincial medical officers. Each province is subdivided
into medical districts. There are 89 such districts, each of
which is directed by a district medical officer. These districts
are subdivided into medical sections. Of the 952 sections in
existence in 1938, 636 were administered by physicians, while
the remaining 316 were administered by "feldshers" (as-
sistants who have had 2-3 years of special instruction).
The district medical officer continuously watches health
conditions, orders any necessary improvements, investigates
outbreaks of disease, supervises the observance of health
ordinances and examines indigent patients free of charge
both at dispensaries and at his own office. He is permitted
to engage in private practice.
Every commune with a population of over 4,000 possesses
a special communal health service directed by a communal
medical officer. The larger communes have several such of-
ficers, as well as veterinary surgeons, "feldshers, " midwives,
and inspectors.
In addition to its central and local authorities the public
health system includes the public hospitals (see part B.1).
Approximately half of the hospitals in Bulgaria are govern-
ment institutions.
b. Scope and Estimate of Effectiveness. In the last few years
the Government has been vigorously attempting to enlarge
and fortify the health services. Despite the bad financial
condition of the country the Directorate of Public Health
has received relatively generous budgets. In 1941 the Govern-
ment authorized the Directorate of Public Health to conclude
a loan of 200 million leva ($2,500,000) for the construction
of hospitals and other medical buildings. During the next
year, 1942, 53 new health stations were completed. In March
1943 a bill introduced in Parliament by Gabrovsky, Minister
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Appendix II - 2
of the Interior, provided for a loan of 100,000,000 leva ($1,-
250,000) for antimalaria work.
There is abundant evidence that additional public health
facilities are needed. Thus in 1939 the tuberculosis death
rate was 119 per 100,000 inhabitants, as contrasted with a
rate of 46.5 for the United States. The infant mortality rate
was 138.9 per thousand live births; the rate in the United
States for the same year was 48.0. The morbidity rate for
typhoid fever was 46.6,per 100,000 in 1938 and 38.4 per 100,000
in 1939. Of the rural health services or primary health centers
in operation at the beginning of 1938, 65 per cent was directed
by physicians, the others by "feldshers." Only 9 per cent of
these rural health services could communicate with the out-
side world by railway and only 20 per cent by road. Of the
villages concerned, 36 per cent had a public water supply
and 20 per cent had electricity. The hospitals are inadequate
in number and facilities. There is an average of one bed per
600 inhabitants, whereas the proportion in western European
countries is generally one per 200, or even one per 100.
After the first world war the Bulgarians levied forces of
conscripted laborers, many of whom were assigned to public
works, especially antimalaria engineering. In January 1943
it was decreed that at least 30 per cent of the time of these
compulsory labor battalions must be devoted to malaria.
2. Water. Since 1934 piped water supplies have been pro-
vided for increasing number of villages. In 1939, 43 towns and
453 villages had water supply systems (drinking water) which
the League of Nations characterized, somewhat vaguely, as
"less modern." 77 per cent of the total urban population and
18 per cent of the rural population-i.e. 31 per cent of the
total population-were said to have "reasonably modern"
water supplies. It is not known whether these supplies are
acceptable according to American sanitary criteria. In 1942
approximately 200 additional villages were supplied. All
sources of water supply are examined by the health services;
approximately 8,000 samples of water are tested each year.
In 1934 Sofiya completed a dam which gives the city ample
water for present needs. In previous years there has been a
shortage each summer, due to the lack of facilities for storage.
3. Sewage. In Sofiya there is a system of sewers but there is
no sewage disposal plant. The untreated effluent drains into
the Iskr River, about six miles southeast of the city. Else-
where cesspools and ditches are employed. Soil and stream
pollution are widespread.
4. Insects and Animals of Importance to Man and Their Con-
trol.-a. Vectors of Disease.-(1) Mosquitoes. The following
anopheline vectors occur in Bulgaria: Anopheles maculipennis
var. typicus, A. maculipennis var. messeae. A. sacharovi (also
called A. maculipennis var. elutus), A. superpictus, A. bifurcatus
and A. pseudopictus. An element of vagueness is present in
certain of the published records due to the fact that in some
of the observations of A. maculipennis the varieties are not
distinguished. It will be remembered that the varietal taxonomy
of maculipennis is comparatively recent.
Hackett, in his book "Malaria in Europe, "says:" In southern
Europe malaria often uses a combination of two or more
anopheline species to prolong the season. In the Balkans
elutus (A. sacharovi) follows maculipennis [sc. typicus, messeae]
and superpictus follows elutus, and though none of them has
a very long season the combined transmission period lasts
from May to October, with a correspondingly intense malaria."
The most widely disseminated vector species of Bulgaria
is A. maculipennis. In the Danube valley the varieties messeae
and typicus occur. In regions near the Black Sea typicus and
elutus (A. sacharovi) are found, in addition to A. superpictus.
Studies at Burgaz on the Black Sea yielded elutus 75 per cent,
typicus 20 per cent, messeae 5 per cent. Near Petrich 95 per cent
of specimens of maculipennis were of the variety typicus. Here
the infection index varied between 0.3 per cent and 1.4 per
cent in different years, the average being 0.8 per cent. Infected
mosquitoes were found even in winter, although they were
most numerous in July, August and September. The blood
meals consisted of animal blood in 70-75 per cent of specimens
and of human blood in 25-30 per cent. The maximum flight
range was 4 kin. (2% miles).
Available descriptions of the ecology of Bulgarian vectors
are fragmentary and must be supplemented by data derived
from other areas. Anopheles maculipennis var. typicus in Bulgaria
and elsewhere is not fastidious in its choice of breeding sites.
It lays its eggs in fresh running water in plains or hilly regions,
in springs, or even in stagnant water, in borrow pits, or close
to the seacoast. This range of habitat is evidence of great
adaptability. A. maculipennis var. typicus is zoophilic both in
nature and in captivity. In a group of study areas near Petrich
in southwestern Bulgaria satisfactory control was achieved
by the use of Paris green. In other parts of the same region
more fundamental engineering operations were performed,
in order to control the channel of the Strumitsa river during
periods of diminished flow. It was also necessary to stop
mosquito breeding in irrigation ditches; Paris green was
used for this purpose. In the Petrich area the control problem
included A. superpictus as well as A. maculipennis.
A. maculipennis var. messeae, a zoophilic variety, breeds
in marshes and in the border zones of inland seas, where
reeds are abundant. It is found in Italy in lakes and river
valleys in stagnant or slowly flowing water. Whether these
ecological relations hold for messeae in Bulgaria is not known.
In available reports the control of messeae is not discussed as
a separate entity.
A. sacharovi (syn. A. maculipennis var. elutus) is an extremely
important vector. It ordinarily prefers brackish waters and
can tolerate a higher degree of salinity than the maculipennis
varieties previously mentioned. Studies in Albania showed
however that sacharovi could not develop in water having
salinity greater than 2.2 per cent, a fact which has been used
as a basis for control measures. Sacharovi breeds in coastal
marshes such as those near the Black Sea, in inland marshes
which are open to sunlight in midsummer, and in small
temporary collections of water in which vegetation is present.
It is found infrequently in slowly moving water. The species
is avid for the blood of man. It enters dwellings and has a
high sporozoite index. Control measures would presumably
consist of drainage, dusting, and tide-gates; the latter would
be employed to increase the salinity of certain coastal lagoons
and marshes. The feasibility of airplane dusting would have
to be considered. Buildings should be screened and sprayed.
A. superpictus is an extremely important vector in Bulgaria.
It is encountered all over the southern part of the country
and in the Vidin and Varna districts in the north. A. super-
pictus is ordinarily said to breed in hill country in sunny or
slightly shaded pools, beds of small streams, in rivers which
are nearly dry, in irrigation systems, and rice fields. In Bulgaria
it also breeds in clean slowly flowing brooks with sandy
banks. Since these brooks are rapid in the spring, superpictus
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does not appear in large numbers until July and August. Years
which have hot dry summers are known to be epidemic years
in Bulgaria. Such years favor the breeding of superpictus; the
mosquito then enters homes and stables regularly and bites
man and animals, with the result that the infection index
reaches 2-3 per cent. In unfavorable years the numbers are
smaller; superpictus then rarely enters houses and infected
specimens are not found. Whereas superpictus is the principal
vector in parts of Cyprus it was shown to be less important
in Greek Macedonia in spite of its abundance and relatively
high sporozoite index.
Control measures against superpictus should consist of the
spraying and dusting of small streams and pools. For more
enduring results it might be desirable to consider the regula-
tion of the channels of streams during periods of reduced
flow. It would also be necessary to remove boulders and other
small obstructions such as logs.
A. bifurcatus_and A. pseudopictus occur in Bulgaria but are
not regarded as important. A. bifurcatus has been observed
at Petrich and A. pseudopictus in rice fields at Plovdiv. Both
species are said not to enter homes and barns. In Palestine
A. bifurcatus has been known to breed in cisterns under houses
and thus produce intense urban malaria. It is not known
whether a similar type of breeding occurs in Bulgaria.
No data have been found concerning the genera Culex
and Aedes in Bulgaria. There is no evidence that diseases con-
veyed by Aedes aegypti-i.e. yellow fever and dengue-have
ever been endemic in Bulgaria.
(2) Lice. Pediculus humanus var. corporis, the body
louse, is common in Bulgaria. This insect is the vector of
epidemic typhus fever, trench fever and relapsing fever.
Phthirus pubis, the crab louse, is found throughout Europe
and hence presumably occurs in Bulgaria.
(3) Flies.-(a) Psychodidae (sandflies). Four species
occur in Bulgaria : Phlebotomus papatasii, P. minutes, P. sergenti,
and P. perniciosus. Phlebotomus flies are vectors of leishmaniasis
and papataci fever (sandfly fever). No records have been
found of the occurrence of leishmaniasis in Bulgaria. Papataci
fever occurs especially in warm areas such as Plovdiv. Sand-
flies lay their eggs in cracks and crannies, in soil, old ruinous
walls, piles of rubbish, and between boards of privies and
cesspools. The flying and. biting occur at night. Control
measures consist of cleaning and clearing of the ground,
removal of debris, and filling of crannies. The ground in the
immediate vicinity of barracks should be oiled.
(b) Muscidae. The common housefly, Musca domestica,
is widespread throughout southern Europe. It is filthy in its
habits and acts as a mechanical carrier of intestinal pathogens
such as those of typhoid fever, paratyphoid, dysentery, and
helminthiasis. Flies of the genus Stomoxys (stable flies, "biting
houseflies") are said to be numerous in Bulgaria but precise
data are not available.
(c) Other Diptera. Species of the families Ceratopo-
gonidae (biting midges) are known to occur. The Sarcophagidae
(flesh flies) are represented by the species Wohlfahrtia mag-
nifica. Both this species and a species of Hypoderma (bot fly)
and members of the Oestridae (sheep bots) have been known
to produce human myiasis in Bulgaria.
(4) Ticks and Mites. Twenty-two species of ticks have
been reported. These belong to the genera Ixodes, Rhipicephalus,
Boophilus, Hyaloma, Dermacentor, Haemaphysalis, Alloceraea
and Argas. Table 1 lists species whch are believed to be vectors
Appendix II - 3
of disease in Bulgaria or elsewhere. The chief tick-borne
disease of man which is suspected to occur in Bulgaria is
fievre boutonneuse, carried by Rhipicephalus sanguineus., the
brown dog tick.
Tick paralysis of cattle, sheep and goats has been reported
from southern Serbia; its occurrence in Bulgaria is probable
but definite records have not been found. In other countries
the disease has occurred in man. Ixodes ricinus, a probable
vector, occurs in Bulgaria. (See Table 1.)
Mites. Sarcoptes scabiei, the mange mite, is common in
Bulgaria, especially in schools and other institutions. The
grain mite, Pediculoides ventricosus, ordinarily parasitic on
insects, occasionally attacks man and produces acute dermatitis
accompanied by vesiculation and fever. The inflammation
may last for several weeks.. The condition usually occurs
during the autumn harvest. Trombicula autumnalis, a harvest
mite, is common throughout southern and central Europe.
It produces intense dermatitis.
(5) Fleas. Xenopsylla cheopis (the Oriental rat flea),
Pulex irritans (the human flea), Ctenocephalus canis (the dog
flea), C. felis (the cat flea), and Nosopsyllus fasciatus (European
rat flea) are said to occur throughout Europe and hence
presumably occur in Bulgaria.
(6) Rodents. The Norway rat (Rattus norvegicus) is
assumed to be the species most prevalent, although adequate
data are not available. The black rat, R. rattus rattus and the
roof rat R. rattus alexandrines are also believed to be present.
(7) Other animal species. The following are known to
occur in southern Europe or in the Balkans and presumably
occur in Bulgaria, although records have not been found.
Scolopendra eingulata, the common centipede, occurs in southern
Europe. Its bite is painful and may be followed by urticaria.
Butkus maurus, the poisonous black scorpion, occurs in southern
Europe and the Balkans. Latrodectus tredecimguttatus (black
widow spider) occurs in the Balkans. Its bite produces muscle
pain and severe circulatory depression.
b. Snakes. Vipera ammodytes, the sandviper or long-nosed
viper, occurs in Bulgaria. It prefers dry stony hills with low
bushes, which it frequently climbs. Its bite is is often fatal
to man. The common viper (Vipera berus), a poisonous snake,
and the less poisonous Orsini's viper (Viper ursinii) have
been reported from Yugoslavia.
c. Pests. Simuliidae (black flies, buffalo gnats).
Simulium reptans columbaczense (Golubatz or Columbacz
fly). This insect occurs in parts of Bulgaria, Rumania, and
Yugoslavia, especially along the Danube. It is present in
enormous numbers during April and May in certain years
only; at such times it could interfere with military operations,
since it is an active bloodsucker and causes painful bites.
This insect is said to be most annoying in cloudy weather
when the air is still. On the wind it may be carried 50 miles
or more. Breeding occurs in running water, e.g., shallow
creeks. Control is difficult.
Tabanidae (horseflies). Sixty-five species and varieties of
these bloodsucking flies are known to occur in Bulgaria. They
breed in water, earth, mud and sometimes in decaying wood.
No data are available on the importance of Bulgarian tabanids
in the transmission of disease. Presumably these insects act
chiefly as pests. It should be remembered however that
tabanidae are occasional transmitters of anthrax, a disease
which is common in Bulgaria. Surra, a highly fatal disease
of horses, has been reported in Bulgaria. The causative
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organism, Trypanosoma evansi, is believed to be transmitted
by tabanids.
Dogs are extremely numerous in Bulgaria (1,384,520 re-
ported in 1928); bpth rabies and echinococcus disease are
common.
5. Food and Dairy Products in Relation to Health. The majority
of Bulgarians (81 per cent) are engaged in agriculture. The
typical Bulgarian is a peasant who owns several very small
plots of land, which he cultivates with the aid of his family.
The methods of cultivation are crude and inefficient and the
yields are low. Hence poverty is widespread.
The Bulgarian peasant is typically lean and frugal. His
daily intake is about 3500 calories (carbohydrate 644 grams,
protein 114 grams, fat 55 grams) derived from the following
principal sources: flour 72 per cent, meat and fat 10 per cent,
dairy products and eggs 6 per cent. The diet is thus predomi-
nantly vegetarian. The high carbohydrate intake represents
a high consumption of bread whereas the intake of fat is low.
Most of the protein and carbohydrate is of vegetable origin.
The diet has been found to be inadequate in the mountain
districts especially; in other parts of the country it is inade-
quate only during certain seasons. Pellagra is said to be rel-
atively common.
An interesting and characteristic component of the Bulgarian
dietary is yoghurt, which is milk fermented by Lactobacillus
bulgaricus. In Bulgaria yoghurt is made from the milk of goats
or buffaloes rather than from cows' milk.
Milk is rarely drunk raw but is usually boiled by the
ultimate consumer and butter is made from the boiled prod-
uct; pasteurization is rare. Cows are tested annually with
tuberculin, the positive reactors being killed. In 1929-33
of 103,023 cows tested, 3.92 per cent reacted positively. In
1937 the rate was 2.13 per cent, and ranged from 0.2 per cent
near Sofiya to 12.1 per cent near Stara-Zagora. These statistics
show that the use of fresh milk and its derivatives is dangerous.
Boiling or pasteurization should not be omitted.
According to an official American statement, tuberculosis
and other diseases of poultry are uncontrolled. Hence local
fowl should be used only under strict supervision of Army
inspectors.
Because of the common practice of soil pollution and the
relatively high incidence of helminthiases and enteric in-
fections, vegetables of local origin should not be eaten raw
and locally produced meats should be cooked thoroughly.
Soil pollution, stream pollution and enteric infection are
frequent. Hence drinking water must always be boiled or
treated. The Bulgarians are also in the habit of using natural
ice, which is obtained from frozen rivers and hence is polluted.
6. Miscellaneous Problems of Sanitation. Bulgaria is a country
of impoverished backward peasants, undernourished but
long-lived. Public health is still in the stage of organization
and has as yet made relatively little progress.
The health problems of rural Bulgaria have been sum-
marized as follows :
"a. The organization of a campaign against the high
infant mortality rates and the high incidence of acute and
chronic contagious diseases;
"b. Improved medical assistance and the provision of
such assistance at an earlier stage in the villages;
"c. The inculcation of the main principles of prophylaxis
among country dwellers (i.e., the development of education
in health principles);
"d. The improvement of the diet of rural populations;
"e. The improvement of dwellings and the arrangement
of credits for the construction of sanitary houses;
"f. Measures to obviate the dangers to health presented
by organic waste matter."
II. MEDICAL FACILITIES.-1. Hospitals. In 1939 there
were 75 hospitals, with a total of 8,644 beds, under the
Directorate of Public Health; in addition there were three
municipal hospitals with 82 beds, and five other State hospitals
under other government departments (1,434 beds). This
gives a total of 83 government hospitals and 10,160 beds. To
this must be added 91 private hospitals with 1,834 beds.
This makes a grand total of 174 hospitals and 11,994 beds.
The official statistics will be found in the appendix (Table 3,
Hospitals and Dispensaries, 1939; Table 2, Hospitals of
Bulgaria, Location and Capacity, 1938). Not included in
these enumerations is a hospital on the premises of the former
Hotel Palais Zarevitz in Bankya village. This has been
organized as a military hospital and has 200 beds for surgical
cases. The staff is mainly German but includes a few Italians.
Throughout Bulgaria most of the hospital equipment is of
German origin. This is due partly to the fact that many of
the physicians are graduates of German universities and partly
to the fact that trade with Germany is conducted under a
special clearing agreement. According to a statement pub-
lished under the auspices of the League of Nations in 1940,
the number of beds and the facilities offered by the hospitals
of Bulgaria are insufficient, there being an average of one
bed per 600 inhabitants, whereas the proportion in Western
European countries generally is one per 200 or even one per 100.
2. Medical Practitioners. The most recent official Bulgarian
statistics were published in 1940 and represent the state of
affairs at the end of 1939. At that time there were 3,127
physicians for a population of 6,300,000, a proportion of
approximately 1:2000. In the preceding 4 years there had
been an increase of 15 per cent in the number of physicians,
whereas the population had increased 3.3 per cent. Eighty-
four per cent of the physicians were males, 16 per cent females.
Sixty per cent were in government service, 40 per cent were
in private practice. Most of the population is rural while
most of the physicians are urban. Thus in the cities there is
one physician to 570 persons; in rural districts 1 to 7,443.
In Sofiya, the proportion is 1: 346. Only 34 per cent of the
physicians obtained their diplomas in Bulgaria. In part this
is due to the fact that the only medical school in Bulgaria,
that at Sofiya, was not opened until 1918. The following table
shows the principal foreign countries of graduation:
Austria.......... ..... 577
Germany .................................. 396
France & Belgium .......................... 320
Russia .................................... 230
Switzerland ................................ 187
Italy ...................................... 155
Yugoslavia ......................... .... 71
1,936
Other medical personnel. The following table abstracted from
official government statistics represents the state of affairs
at the end of 1939:
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Physicians ................... ............... 3,127
Dentists ................................... 1,206
"Feldshers.................................. 1,190
Midwives .................................. 918
"Sisters of Charity.......................... 462
Pharmacists ................................ 860
Pharmacists' assistants ...................... 325
3. Medical Institutions, including Laboratories.
a. The University medical school at Sofiya.
b. The Institute of Hygiene at Sofiya, established with
the aid of the Rockefeller Foundation.
c. A rural health demonstration service at Noveseltsi,
maintained with the collaboration of the Rockefeller
Foundation.
d. Schools of nursing at Sofiya, Skoplje and Plovdiv.
e. A central veterinary institute at Sofiya with sub-
sidiaries at Trnovo and Stara-Zagora and other stations at
Burgaz, Plovdiv, Vrattsa, Pleven, Ruse, and Varna. These
institutes presumably possess laboratories.
f. In 1935 there were said to be 120 animal hospitals in
Bulgaria.
4. Social Services. Bulgaria possesses a Red Cross organiza-
tion, which has ratified the Geneva conventions of 1864,
190'6, and 1929. In 1939 the Bulgarian Red Cross was said to
have 850 local committees, 50,000 adult members; the junior
Red Cross had 730,000 members (children). The annual
receipts were 9,561,087 leva (approximately $100,000). The
Bulgarian Red Cross issues several periodicals, maintains
a hospital and a school of nursing, gives first-aid courses,
and is responsible for disaster relief. All government em-
ployees are required to join. There is evidence that the Bul-
garian Red Cross cooperates with or is coordinated with the
German military organization. Thus in 1942 the Bulgarian
Red Cross was stated to be operating a field hospital in col-
laboration with the Germans.
III. DISEASE INFORMATION.-1. Diseases of Special Mili-
tary Importance.-a. Malaria. Malaria is highly endemic or
even hyperendemic in certain regions of Bulgaria. Many
streams flow from the mountains and make their way through
plains and lowlands. As a result of flooding or other imper-
fections of drainage, large areas are permanently or temporarily
converted into swamps and thus become malarious. These
places are (1) the Danube valley, (2) the Maritsa valley, (3)
the Struma and Strumitsa valleys, (4) the coast of the Black
Sea [see map: Bulgaria: Principal Malarious Areas]. In these
malarious areas there are about 1,000,000 inhabitants, of
whom about 300,000 are infected with malaria. This equals
approximately 6 per cent of the total population of Bulgaria.
In a group of twelve trial areas near Petrich in southwest
Bulgaria the children were found to have spleen indices of
90-95 per cent and parasite indices of 60-65 per cent.
It must be remembered that the Balkans constitute the most
malarious part of Europe. Moreover the province of Mace-
donia, world-famous as a breeding ground of malaria, is
immediately adjacent to old Bulgaria; the eastern districts
have been partly occupied by the Bulgarians since the German
invasion of Yugoslavia and Greece.
The malaria season runs from May to October. P. vivax
is the species most often found, P. falciparum is next in fre-
quency; P. malariae is rare. Infections occurring in the spring
Appendix II - 5
are almost exclusively due to P. vivax. In the late summer
and autumn-i.e. at the height of the season-P. falciparum
appears in increasing numbers. Blackwater fever is seen at
Burgaz and Petrich.
The most important malaria vectors are A. maculipennis
var. typicus and messeae, A. sacharovi (also called A. maculi-
pennis var, elutes) and A. superpictus. A. bifurcates and A.
pseudopictus occur but are unimportant. In the Danube area
A. maculipennis var. messeae and typicus occur. Here only tertian
malaria is found, and the spleen index is 5-10 per cent. Near
the Black Sea the prevailing forms are sacharovi and typicus;
superpictus is also found. In this region P. vivax infections are
widespread in spring; in the autumn P. falciparum infections
are also abundant, so that the spleen index reaches 80 to 100
per cent. The same conditions prevail in the Struma region
in southwest Bulgaria. In the Maritsa district the morbidity
is intermediate between that of the Struma and that of the
Danube.
The incidence of malaria is affected by certain additional
factors. The population is predominantly agricultural and
each year many people migrate to the malarious lowlands
in search of agricultural employment. Since water is often
scarce, the population tends to concentrate near extant sup-
plies. The cultivation of, rice-e.g., at Plovdiv-involves
irrigation and thus is a factor in the occurrence of malaria.
At a conference of cabinet ministers in January 1943, the
Ministry of Agriculture was charged with inspecting rice
fields in order to suppress the cultivation of rice in fields closer
than 1 km. to human habitations.
In 1932 the League of Nations Health Organization esti-
mated the quinine requirements of Bulgaria as 6,000 to 7,000
kg.
b. Typhus. Typhus, a disease of immense military im-
portance, is endemic in Bulgaria and has been epidemic there.
In 1914-1916 the incidence averaged 7.9 per 100,000 inhabi-
tants. After Bulgaria's entry into the first World War the
incidence rose to 110.1 per 100,000. The following table
shows the occurrence of typhus since 1938:
Year Cases Cases per
100,000
1938
91
1939
129
1940
126
1941
253
1942
649
1.5
2.0
2.0
4.2
10.7
Additional data will be found in Tables 4, 5, 6, 10.
During the winter of 1942, 43 new cases occurred at the
rate of 30 to 50 per week; the Government established medical
detachments to combat the disease and also instituted a de-
lousing program. In Bulgaria the months of maximal incidence
have usually been February, March, and April.
c. Intestinal infections. Diseases of the enteric group-
typhoid fever, paratyphoid, and the dysenteries-constitute
a major military hazard. The Bulgarian Government has
recently (1942) given typhoid vaccination to a large but
unspecified number of people; this fact is of relatively little
weight since the total sanitary situation remains favorable
to the spread of all varieties of intestinal infection. In 1938,
2,911 cases of typhoid were reported; in 1939, 2,417 cases.
The morbidity rates for these two years were 46.6 and 38.4
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Appendix II - 6
per 100,000. The morbidity rates for cases reported as "diarrhea
and dysentery" were 23.4 and 14.1 for 1938 and 1939. It is
noteworthy that the case fatality rates for diarrhea and
dysentery were reported as 1.5 per cent and 15.0 per cent
during the same two years [see Table 10-Incidence of Con-
tagious Diseases].
The reports do not distinguish between bacillary and
amoebic dysentery. It is probably that both kinds are present
and that the bacillary type is the more common. Large out-
breaks due to the Shiga bacillus and to the Flexner bacillus
have been recorded. Numerous cases of mild enteritis like-
wise occur.
Cholera appeared during the first World War but is not
known to have reappeared in recent years. Contagious abortion
(brucellosis) of cattle exists in Bulgaria but precise data are
not available and no reports of human brucellosis have been
found.
d. Venereal Diseases. Very little information is available
as to the prevalence of venereal diseases in Bulgaria. In the
year 1939, 22 urban deaths were ascribed to syphilis, or 1.3
per thousand deaths. The cities of Burgaz and Varna on the
Black Sea are reported to have a high incidence of ''venereal
disease" but no detailed information has been found.
e. Acute Infectious Diseases and Exanthemata. Scarlet fever
and diphtheria are unusually prevalent. Thus in 1939, there
were 5,699 reported cases of scarlet fever, or 90.6 per 100,000
of population. In the winter of 1942-43 new cases occurred
at the rate of 120 per week. In 1939 there were 5,366 cases
of diphtheria or 85.3 per 100,000 [see Table 10: Incidence of
Contagious Diseases-1938-391. A campaign of diphtheria
immunization was conducted in 1942.
Meningitis increased sharply in incidence in 1939. Thus in
Sofiya the incidence was 2.7 cases per 10,000 of population
[see Table 9: Contagious Diseases-Sofiya-1938-391. During
the winter of 1942-43 new cases occurred in Bulgaria at the
rate of 5 to 10 per week.
Sandfly Fever. Sandfly fever (papataci fever), a virus disease
conveyed to man by species of Phlebotomus, has been reported
from Bulgaria. The disease resembles dengue in that it pro-
duces a high morbidity rate and can seriously interfere with
military activities.
2. Diseases of Potential Military Importance.-a. Endemic.-
(1) Relapsing Fever. Data are not available concerning the
occurrence of relapsing fever in Bulgaria. Louse-borne re-
lapsing fever is, however, endemic and occasionally epidemic
in Yugoslavia and other Balkan countries. The high incidence
of typhus, a louse-borne disease, is additional evidence that
louse-borne relapsing fever may break out. Less evidence
exists on the subject of tick-borne relapsing fever. The tick
Argas persicus which is a possible vector in Iran also occurs
in Bulgaria.
(2) Fievre boutonneuse. This disease is a rickettsial in-
fection and is transmitted to man by Rhipicephalus sanguineus,
the brown dog tick. The principal range of the disease is
the Mediterranean area. It occurs in Rumania and Greece,
and its vector is known to occur in Bulgaria. Hence the oc-
currence of fievre boutonneuse in Bulgaria is probable but
no reports of its presence have been received.
(3) Epidemic kerato-conjunctivitis, a virus disease of
potential military importance, has been reported from other
parts of the Balkans but there are no reports from Bulgaria.
b. Diseases That May be Introduced from Other Regions.-
(1) Cholera. There are no reports of cholera having occurred
in Bulgaria in the last two decades. A large outbreak occurred
in 1913 and cholera occurred elsewhere in the Balkans at the
end of the last war. Because of its situation between Turkey
and Russia, Bulgaria is believed to be constantly threatened
with cholera.
(2) Plague. There is no evidence of the recent occurrence
of plague in Bulgaria. Two cases were observed at Varna in
1924. Plague could conceivably be introduced through the
ports of Burgaz and Varna at any time.
(3) Trench Fever. This is a louse-borne rickettsiosis
which appeared in the Balkans during the first World War.
It has been reported on the Eastern Front during 1942 and,
like other louse-borne diseases, could occur in Bulgaria.
3. Serious Diseases of Non-Military Importance but Likely to
Affect Small Numbers of Troops.-a. Tuberculosis. In 1939,
4,392 deaths were ascribed to tuberculosis. In 1939 in the
urban population all forms of tuberculosis caused 2,262 deaths
(162 per 100,000). In the village population there were 2,130
deaths (119 per 100,000). In the United States during the
same year the death rate for tuberculosis (all forms) was
46.5. Thus the death rate in Bulgaria is approximately 3 to 4
times as high as that in the United States, if it be assumed
that the statistics are comparable.
b. Anthrax is endemic among human beings and domestic
animals. Between 1900 and 1933, 13,749 animals died of it in
Bulgaria. During the decade 1926-1935, there were 7,241
human cases and 597 deaths. Other statistics will be found
in Table 10-Incidence of Contagious Diseases. Anthrax of
lower animals occurs in many parts of Bulgaria especially
near river lowlands, such as those of the Danube and the
Maritsa. It is most often found among animals grazing in
pasture lands from which flood waters have recently receded
The disease is rare in mountain regions. Its incidence among
animals is greatest in the warm part of the year. It is seen
most often among sheep and cattle, less often among horses,
goats, swine and buffaloes.
c. Rabies is virtually uncontrolled in Bulgaria. In 1937
there were 1,371 cases reported in animals, including 1,081
dogs, 86 cattle, 88 swine, 57 cats, 11 buffaloes, and others.
During the same year 5,196 persons were given antirabic treat-
ment. In 1928 the reported canine population was 1,384,520.
d. Helminthiases. Worm infestations are stated to be
frequent in Bulgaria but little exact information is available.
Echinococcus disease is known to be present in about one-
third of the cattle and in three-fourths of the sheep. Reported
infection rates in dogs range from 3 per cent to 52 per cent.
One author states definitely that there are no statistical data
extant concerning prevalence of the disease in human beings
in Bulgaria. It has been observed that in cases seen in Bulgaria
the incidence of pulmonary involvement is higher than in
cases reported from other countries.
Fascicla hepatica infestation is said to be very widespread
in animals and has been known to occur in human beings.
4. Diseases Causing High Morbidity and/or Mortality Rates
Among the Native People.
a. Malaria.
b. Tuberculosis all forms; lupus.
c. Acute Infectious Diseases-scarlet fever, diphtheria,
epidemic meningitis. For the past decade a very virulent
form of scarlet fever has prevailed in eastern Europe and the
Balkans. Although definite data from Bulgaria are not avail-
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able, the case fatality rate in Rumania has ranged as high as
15-20 per cent in some localities. Diphtheria also has been
serious, a particularly severe epidemic having prevailed in
central Europe in the past winter.
d. Typhus.
e. Typhoid fever, paratyphoid fever, and the dysenteries.
f. Venereal diseases.
g. Anthrax.
h. Papataci fever.
i. Erysipelas. This disease is relatively common in
Bulgaria. Thus Table 9, which contains statistics for con-
tagious diseases in Sofiya, shows that 237 cases of erysipelas
were reported in that city in 1938 and 286 cases in 1939. Table
12 contains statistics for the whole of Bulgaria for six months
of 1938 and shows a grand total of 1,143 cases. It is possible
that the disease might be introduced into the armed forces.
5. Miscellaneous.-a. Yellow Fever. Yellow fever is not
known to have occurred in Bulgaria. However, it is thought
that the disease could conceivably be introduced from Africa
by airplane or might be introduced by a boat docking at Burgaz
or Varna in the spring or summer. No report is available of
the occurrence of Aedes aegypti in Bulgaria.
b. Tetanus is said. to occur frequently and is reported
to be relatively mild.
c. Poliomyelitis. Small numbers of cases occur during all
seasons. The maximal incidence is found in October. One
hundred and twenty cases were reported in 1939; there were
72 in 1940, and 421 in 1941. It is reported that the government
plans to open a special hospital near Sofiya for cases of
poliomyelitis.
d. Pellagra is of comparatively frequent occurrence but
no statistics as to prevalence are available.
e. Leptospirosis (Weil's disease). An extensive treatise
on the epidemiology of Weil's disease (1937) makes no
mention of Bulgaria although the occurrence of the disease
in Greece and Russia is recorded.
f. Epidemic jaundice. No record has been found of the
occurrence of epidemic jaundice in Bulgaria.
g. Infections of the Eyes. Trachoma is known to be com-
mon among the native population and could be transmitted
to the military personnel. Infectious kerato-conjunctivitis has
been reported from the Balkans. Concerning gonorrheal
ophthalmia no data are available.
Bibliography
1. Angeloff: Das Veterinarwesen and die Tierseuchenbekampfung
in Bulgarien, Deutsche tierarztl. Wchnschr. 47: 717-722, 1939.
2. Angeloff: Milzbrandbekampfung bei Tier and Mensch in Bul-
garien, Deutsche tierarztl. Wchnschr. 47: 457-463, 1939.
Annuaire de la Croix Rouge Internationale, Geneva, 1939.
Baehr, G.: Medical Experience in Southeastern Europe, M. Rec.
92: 350-351, 1917.
Batschwarov, W.: Ueber die Krankenhauser in Bulgarien,
Deutsche med. Wchnschr. 62: 74-75, 1936.
6. Batschwaroff, W.: Arztliches aus Bulgarien, Deutsche med.
Wchnschr. 67: 408-409, 1941.
7. Beroff, V.: Un Cas de Myase Rampante Cutanee, Clinica Bul-
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spec. 1: 125 (Jan.-Mar.) 1939.)
8. Blumenberg, W.: Ober den neuesten Stand der Epidemiologie
der Weilschen Krankheit, Ergebn. d. Hyg., Bakt., Immunitats-
forsch. u. exp. Therap. 22: 168-237, 1937.
9. Bulgarian Red Cross Society, Jubilee Volume 1885-1935: pp.
318, Sofiya, 1936.
10. Bulgarie, Direction Generale de la Statistique: Annuaire Sta-
tistique du Royaume de Bulgarie (Glavna Direktsiia Na
Statistikata: Statisticheski Godishnik Na Tzarstvo Bulgariia).
11. Buresch, I., and Drensky, P.: Beitrag zur Erforschung der
Zecken (Ixodidae) Bulgariens, Mitt. d. bulg. entomol. Gesell.
7:116-124, 1932.
12. Cochran, D. M.: Poisonous Reptiles of the World, a Wartime
Handbook, Smithsonian Institution War Background Studies,
No. 10, pp. 37, Washington, 1943.
13. Croix Rouge Bulgare, Edition Mensuelle.
14. Danailov, G. T.: Les Effets de la Guerre en Bulgarie, Paris, no
date (1932?).
15. Drenski, K.: The Varieties of Anopheles Maculipennis Meigen
and Their Relation to the Distribution of Malaria, Mitt. d.
bulg. entomol. Gesell. 10: 31-44, 1938.
16. Drenski, K.: Die Kugelbauchmilbe Pediculoides ventricosus
Newp. and die "Copra-Itch," Krankheit in Bulgarien, Mitt.
d. bulg. entomol. Gesell. 6: 94-97, 1931.
17. Drensky, K.: The Antimalarial Experimental Station at Petritch
1928-1933, Mitt. d. bulg. entomol. Gesell. 8: 85-96, 1934.
18. Drensky, K.: Malaria Control and Investigations in Petritsch
(Bulgaria), Ztsch. f. Hyg. u. Infektionskr. 122: 550-559,
1939-40.
19. Drenski, P.; Quelques Notes dur la Zoogeographie de la Bul-
garie, La Bulgarie devant le IVe Congres des Geographes et
Ethnographes Slaves, pp. 59-65, Sofiya, 1936.
20. Drenski, P.: Kleine Entomologische Mitteilungen II, Mitt. d.
Bulg. entomol. Gesell. 7: 62-66, 1932.
21. Drensky, P.: Blutsaugende Fliegen aus der Familie der Tabanidae
in Bulgarien, Mitt. a. d. Kgl. Naturwiss. Instit. in Sofiya, 2:
55-128, 1929.
22. Drensky, P., Die Parasitaren Fliegen der Familie Oestridae in
Bulgarien, Bull. Inst. Hist. Nat. Sofiya, 6: 125-149, 1933.
23. Dryenski, P. and Dryenski, K.: Contribution to the Study of
Phlebotomus and Three-Day Fever in Bulgaria, Mitt. d. bulgar.
entomol. Gesell. 4: 31-56, 1927.
24. Ganoff, V.: La distomiase en Bulgarie, Medicinsko Spisanio,
No. 1, 1938. (Abstract: Arch. balk. de med., chir., et spec. 1:
153 (Jan.-Mar.) 1939.)
25. Enciclopedia Italiana, art. Bulgaria, Vol. 8, pp. 66-102, 1930.
26. Gellert, J. F.: Mittelbulgarien: das Kultur-geographische Bild
der Gegenwart, Berlin, 1937.
27. Guntscheff, N.: Myiasis linguae, Deutsche Ztschr. f. Chit.
255: 751-755 (July 20) 1942.
28. Hackett, L. W.: Malaria in Europe, London, Oxford Press
1937, pp. 336.
29. Iwanoff, K.: Anthrax in Domestic Animals in Bulgaria, Arch.
wiss. prakt. Tierheilk. 70: 371-376, 1936.
30. Izvestiia na Glavnata Direktsiia na Narodnoto Zdrave (Bull.
of the State Dept. of Public Health, Bulgaria).
31. Karalambeff, N.: A Propos du Traitement de Morsures de
Viperidae, Clinica Bulgarska No. 4, 1939. (Abstract Arch.
balk. de med., chir., et spec. 2: 97-98 (Jan.-Mar.) 1940.)
32. Lafteheff, S. N.: Rapport de la Societe Bulgare de la Croix
Rouge Sur Son Activite Depuis L'Annee 1930-31, Jusqu' in
31 Decembre 1937, pp. 30, Sofiya, 1938.
33. League of Nations: European Conference on Rural Life ... Bul-
garia, pp. 59, Geneva, 1940.
34. League of Nations Health Organisation. Enquiry into the Quinine
Requirements of the Malarial Countries and the World Prev-
alence of Malaria, Geneva, 1932.
35. League of Nations Health Organisation: The Public Health
Services of Bulgaria, by I. Golosmanoff, pp. 74, Geneva, 1926.
36. League of Nations Weekly Epidemiological Records (furnished
by Public Health Methods, U. S. Public Health Service).
37. League of Red Cross Societies Bulletin 23: 9 (Jan.-Mar.) 1942.
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Appendix II - 8 MEDICAL AND SANITARY DATA ON BULGARIA
Markoff, K., Moroff, T.: Zur Kenntnis der Malariamucken in
Bulgarien, Arch. f. Schiffs--u. Tropen Hyg. 33: 430-432, 1929.
Mikhov, N. V.: Sources Bibliographiques Sur 1'Histoire de la
Turquie et de la Bulgarie, Sofiya, 1914-1934.
49. Radcoff: Dysenterie en Bulgarie, Bull. Office internat. d'hyg.
pub. No. 8, 1938. (Abstract: Arch. balk. de med., chir., et spec.
2: 94 (Jan.-Mar.) 1940.)
Rockefeller Foundation, International Division: Annual Reports.
Russeff, C.: Die Organisation des Veterinarwesens in Bulgarien,
Deutsche tierarztl. Wchnschr. 43: 805-807, 1935.
40. Mikhov, N. V. : Bibliographie des Articles de Periodiques
Allemands, Anglais, Francais et Italiens sur la Turquie et la
Bulgarie, Sofiya, 1938.
41. Missiroli, A.: Hackett,..-L. W., and Martini, E.: Le Razze di
Anopheles maculipennis e la Lora Importanza nella Distribuzione
della Mahtria; in alcune Regioni d'Europa, Riv. di malar. 12:
1-58, 1933.
42. Molloff, W.: Die Echinokokkenkrankheit beim Menschen in
Bulgarien, Tile Congr. Internat. de Path. Comp., Athens 2:
137-142, 1936.
Mollow, W.: Uber Malaria in Bulgarien, Acta Conventus Tertii
de Tropicis atque Malariae Morbis 2: 240-250, 1938.
44. Nedelkoff, S.: Le Charbon en Bulgarie, Paris med. 111: 141-143,
1939.
Oswald, B.: Yugoslavian (Balkan) ticks (Ixodeidea) Par-
asitology 31: 271-280 (Sept.) 1939.
50.
51.
52. Sliwensky, M.: Verbreitung, Klinik u. Therapie der schweren
Malariaformen in Bulgarien, unter besonderer Berucksichtigung
des Schwarzwasserfiebers. Festschrift Bernhard Nocht zum 80
Geburtstag, pp. 582-585, Hamburg, 1937.
53. Statistical Year-Book of the League of Nations 1936-37.
Geneva, 1937.
54. U. S. Department of Commerce: World Trade in Dental and
Surgical Goods prepared by George R. Donnelly, Washington,
U. S. Govt. Printing Office, pp. 264, 939.
55. U. S. Public Health Service: The Notifiable Diseases- Prevalence
in States, 1939. Supplement No. 163 to Public Health Reports,
Washington, U. S. Government Printing Office, 1941.
56. U. S. Public Health Service: Sanitary Reports and Statistics.
57. Wateff, S.: Uber Volksernahrung and einige Volksheilmittel
in Bulgarien, Wien. med. Wchnschr. 90: 792 (Oct. 12) 1940.
58. Weyer, F.: Die Malaria-Ubertrager. Eine Zusammenstellung der
wichtiger Anophelesarten mit Angaben Uber Verbreitung, Brut-
gewohnheiten Lebensweise u. Praktische Bedeutung, Leipzig,
Thieme, pp. 141, 1939.
59. Whipple, C. E.: Poultry Improvement in Southeastern Europe,
Foreign Agriculture 6: 379-383 (Nov.) 1942.
46. Pascheff, C.: Sur 1'echinococque de 1'orbite, Arch. balk. de
med., chir., et spec. 1: 63 (Jan.-Mar.) 1939.
47. Pawlow, P., Guenev, C.: Recherches sur un Trypanosome (T.
Evansi Steel 1885) Trouve dans le Sang d'un cheval de la Region
de Bourgas en Bulgarie, Ann. de Parasitol. 17: 158, 1939-40.
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Bulgarie actuelle, Paris med. 111-112: 105-108 (Feb. 11) 1939.
TABLE 1
TICKS FOUND IN BULGARIA WHICH ARE KNOWN TO BE DISEASE VECTORS IN BULGARIA OR ELSEWHERE
TICK
DISEASE
PATHOGEN
ANIMAL AFFECTED
Rhipicephalus
FIEVRE BOUTONNEUSE
Rickettsia rickettsi (?)
MAN
Canine piroplasmosis
Babesia canis
dogs
Bovine anaplasmosis
Anaplasma marginale
cattle
Rhipicephalus bursa
Bovine anaplasmosis
Anaplasma marginale
cattle
Ixodes ricinus
Canine piroplasmosis
Babesia canis
dogs
Bovine anaplasmosis
Anaplasma marginale
cattle
? Tick paralysis ?
unknown
cattle, sheep, goats, man
Boephilus annulatus
Texas cattle fever
Babesia bigemina
cattle
Dermacentor reticulatus
Equine piroplasmosis
Babesia caballi
equines
Canine piroplasmosis
Babesia canis
dogs
Fowl spirochaetosis
Spirochaeta gallinarum
fowl
RELAPSING FEVER
Borrelia duttoni
MAN
(Iran) ??
TABLE 2
HOSPITALS OF BULGARIA-LOCATION AND CAPACITY [1938]
LOCATION
Darjavna Bolnitz (State Hospital)
Burgaz
250
Darjavna Bolnitz (State Hospital)
Krdzhali
50
Varna
360
11 11 11
Lom
150
Vidin
200
Nevrokop
50
Vrattsa
200
Kyustendil
80
Orekhovo
80
Petrich
80
Lovech
350
Razgrad
150
Pazardzhik
250
Samokov
60
Plovdiv
600
Svishtov
150
Pleven
300
Sevlievo
90
Ruse
430
Ustovo
80
Sliven
150
Ferdinand
50
Sofiya
350
Yambol
70
Stara-Zagora
450
Aitos
20
Trnovo
240
Asenovgrad
15
Khaskovo
300
Botevgrad
35
Bela
30
Chirpan
150
Belogradchik
10
Shumen
200
Elena
15
Bela-Slatina
50
Gabrovo
80
Elkhovo
50
Dupnitsa
100
Karnobat
30
Kula
20
Kazanik
80
Lukovit
30
Karlovo
50
Ladzhene-Kamenitsa
20
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Appendix 11- 9
Figure App. II - 1
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Appendix 71-10
2 (Continued)
LOCATION
Darjavna Bolnitz (State Hospital) Malkb Trnovo 10
Nikonol 30
Novi Pazar- 10
Popovo 20
Panagyurishte 20
Provadiya 20
Radomir 20.
Razlog 20
Troyan 20,
Trevna .10
Kharmanli 10
Zdravna Klimatitchna Stantzia
Berkovitsa 36
Vetreno 30
Drenovo 30
Kubrat 25
Omort"ag 40
Pirdop 20
Teteven 30
Trn 50
Trgovishte 30
Chepelare 30
Krumovgrad 20
Alexandrova Bolnitza (University Hospital) Sofiya 900
Rabotnitcheska Bolnitza "Tzaritza Icanna" Sofiya 580
Bolnitza "Kniaginia Maria Louiza"
(Maternity Hospital) Sofiya 150
Sofiska Bolnitza za Gradobolni Sofiya 200
Bolnitza za Rovmatitchne-Bolni Sveti. Vrach 60
Bolnitza za Duchevno Bolni Gara Karlukovo 300
Bolnitza za Duchevno Bolni Majo Gara Bola 400
Bolnitz za Duchevno Bolni Nova Zagora 30
STATE SANATORIUMS AND ASYLUMS
Sanatorium "Ferdinand I"' Iskrets 420
Troyanski Sanatorium Troyan 200
Morski Dotski Sanatorium
"Tzaritza Icanna'." Varna 320
Sanatorium za Gradobolni Detza Peshtera 30
Print za Dushevno Bolni Kotel 40
Priut za Maloumni Detza General-Nikolayevo 60
Print za Bolni of Prokaza (Lepra) 15
In addition to the aforementioned state hospitals there were in
1938, 89 private hospitals (there were 91 in 1939) concerning which
the following data are available:
NAME
Bolnitza "Drujestvo Tcherven Krast"
(Red Cross Society) Sofiya 100
Bolnitza "Kniaginia Klementina Sofiya 100
Bolnitza "Ruski Tcherven Krast"
(Russian Red Cross) Sofiya 50
Bolnitza "Pamotnik" Sofiya 50
TABLE 3
HOSPITALS AND DISPENSARIES, 1939
From Statisticheski Godishnik (Annuaire Statistique) 1940
ADMINIS-
TRATIVE
REGIONS
Burgaz
Vrattsa
Plovdiv
Pleven
FIRST
CLASS
SECOND
CLASS
THIRD
CLASS
MATER-
NITY
HosPI-
TALS
INSANE
ASYLUMS
HOSPITALS
STATE'
COMMUNITY
ADMINIS-
GENERAL
SPECIAL
GENERAL
PRIVATE
TEATIVE
MATER-
REGIONS
FIRST
SECOND
THIRD
NITY
INSANE
CLASS
CLASS
CLASS
HOSPI-
ASYLUMS
TALS
,Sofiya
4
3
3
1
-
-
26
Stara-Zagora'
3
2
2
-
-
-
12
Shumen
3.
- 1
4
-
1
2
9
TOTAL
20
-17
24
1
2
2
94
Cities
20
16
21
1
2
2
89
Villages
-
--1
3
-
-
-
5
Burgaz
355
110
70
-
-
-
160
Vrattsa
337
280
40
-
-
-
240
Plovdiv
850
140
65
-
-
-
315
Pleven
980
150
120
-
300
-
325
Sofiya
1,485
200
75
150
-
-
950
Stara-Zagora'
900
100
35
-
-
-
180
Shumen
990
100
80
-
400
60
100
TOTAL
5,897
1,080
485
150
700
60
2;270
Cities
5,897
1;040
450
150
400
60
2,155
Villages
40
35.
-
300
115
Burgaz
5,427
2,101
1,006
-
-
-
2,523
Vrattsa
7,620
6,646
680
-
-
-
4,386
Plovdiv
12,629
3,819
627
-
-
-
4,844
Pleven
14,392
2,974
1,352
-
374
-
4,558
Sofiya
24,088
3,441
1,252
3,239
-
8,760
Stara-Zagora'
11,340
1,698
482
-
-
-
2,411
Shumen
12,717
1,770
1,034
-
889
669
793
TOTAL
88,213
22,449
6,433
3,239
1,263
, 669
28,275
Burgaz
88,213
28,630
11,678
-
-
-
21,870
Vrattsa
88,053,
63,728
6,231
-
-
-
30,022
Plovdiv
239,560
28,383
7,629
-
-
-
55,869
Pleven
231,249
61,812
24,264
-
88,953
44,865
Sofiya
473,822
36,292
20,328
46;442
-
-
157,765
Stara-Zagora'
372,042
20,418
7,550
-
-
-
19,530
Shumen
237,050
23,722
15,327
-
143,994
11,516
'6,980
TOTAL
1,729,989
262,985
93,007
46,442
232,947
11,516
336,901
TABLE 3
HOSPITALS AND DISPENSARIES, 1939 (Continued)
From Statisticheski Godishnik (Annuaire Statistique) 1940
INSTITUTIONS FOR, THE FIGHT AGAINST TUBERCULOSIS
SANATORIA
FOR - HOSPITAL STATIONS
TUBERCULOSIS SURGICAL SECTIONS IN
SANATORIA TUBERCULAR FOR THE FAVORABLE DISPENSARIES
STATE PRIVATE CASES TUBERCULAR CLIMATES STATE PRIVATE
NUMBER OF INSTITUTIONS AND SECTIONS
2 -
1
2 -
2
2
3 1
4
2
3 -
1
2
3 1
3 -
- -
1 3
2
2
1. 14
9
15 2
1 14
7
15 2
2
- -
NUMBER OF BEDS
36 -
-
- 40
-
185 60
-
200 -
-
149 60
-
480 143
-
120 75
-
- -
283 -
-
- -
32
0,
180 -65
-
680 143
32
0
953 -300
-
200 - .
32
0
953 - 240
-
480 143
-
- 60
NUMBER OF PATIENTS CARED FOR
318
657*2.
*2
-
492
236
-
- - 1,240
754
912
925 - - 1,017
439,
1,591
-
1,977 575 - 1,348
809
1,720
23
- - - 1,611
--
-
-
- - 592 893
433
762
-
2,902 575 592 6,427
2,357
5,720
935
'Includes "Alexandrovska" Hospital, headquarters of Minister of Public Instruction.
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 Approved For Release 2005/08/10 : CIA-RDP79-01144A000100010018-1
TABLE 3 (Continued)
INSTITUTIONS FOR THE FIGHT AGAINST TUBERCULOSIS
SANATORIA
FOR HOSPITAL STATIONS
TUBERCULOSIS SURGICAL SECTIONS IN
SANATORIA TUBERCULAR FOR THE FAVORABLE DISPENSARIES
STATE PRIVATE CASES TUBERCULAR CLIMATES STATE PRIVATE
NUMBER OF DAYS OF TREATMENT
*3 - 563
- 11,374 185
- 7,314 405
56,051 - - - 13,343 544
267
INSTITUTIONS FOR INFANT
WELFARE
CONSULTATION CLINICS
NURSERIES STATE
FOR AND
INFANTS COMMUNITY PRIVATE
- - 89,977 - 12,859 341 -
207,980 41,201 89,977 - 65,930 2,317 273
TABLE 3
HOSPITALS AND DISPENSARIES, 1939 (Continued)
From Statisticheski Godishnik (Annuaire Statistique) 1940
ANTI-VENEREAL DISEASE INSTITUTIONS
INSTITUTIONS
FOR THE
STATE ANTI- FIGHT
HOSPITAL DISPENSARIES SYPHILIS AGAINST
SECTIONS STATE PRIVATE CLINICS MALARIA
1 2 - 1 1
2 1 - - 2
1 1 1 - 1
2 2 - - 1
2 3 - - 1
1 -
3 1
Appendix II - 11
TABLE 4
Sanitary Reports and Statistics, U. S. Public Health Service
April 13, 1943
BULGARIA-TYPHUS FEVER CASES REPORTED
BY DISTRICTS-1940
Asenovgrad
Berkovitsa
Shumen
Elena
Elkhovo
12 10 1 2 6
12 - 1 2 6
20
30
35
70
100
20
90
365
365
1,214 754 -
1,005 24 -
546 1,315 621
1,995 83
1,473 1,049
33 -
2,823 20
9,089 3,245
405 383 -
458 80 -
295 221 266
669 117 -
643 610 -
86 - -
1,546 99 -
2,513 -
3,135 -
3,733 293
4,327 -
5,143 541
2,956 -
2,543 -
"Number of sick visited.
*'Number of days of treatment in these sections is included in the number of days
of treatment in the respective hospitals.
Ferdinand 1 1
Khaskovo 3 3
Yambol 1 1
Ikhtiman 1 1
Karnobat 1 1 2
Kubrat
Krumovgrad 10
Lom
Nevrokop 1 1
Nikopol
Omortag 3 1 4
Orekhovo 4 4
Orehov 2 2
Pazardzhik 3 12 3 9 1 1 29
Peshtera 3 10 1 1 2 5 22
Pleven
Plovdiv
Popovo
Razlog
Ruse
2
3 1 1
Samokov 2
Sevlievo
Sofiya
Trgovishte
Trnovo
2 2 6
1 1 2
a
c o z Q [?
1 1
1
4
1
1
Trogau 1 1
Yambol 3 3
- - - - - - - - - - - - -
Total 126
TABLE 5
Sanitary Reports and Statistics, U. S. Public Health Service
April 13, 1943
BULGARIA-TYPHUS FEVER CASES REPORTED
BY DISTRICTS-1941
AcadAnlar
Aitos
Ardino
Asenovgrad
Bitolj
Borisovgrad
Burgaz
Breznik
Brod
7 3
2
Dupnitsa
Elena
Ferdinand
Gabrovo
Gorna Dzhumaya
Isperikh
Kazanlk
Kharmanli
Kotel
Kubrat
w ci F
c 0 Z A H
2
3
24
10 1 11
1 1
4 1 5
2
1 1
3 1
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1 52 -
- 76 -
1 60 1
2 80 -
2 99 4
8 499 5
6 97 5
2 402 -
50
40
220
410
370
40
35 15,731 -
- 16,923 -
50 17,662 665
40 14,815 -
220 22,483 1,789
- 14,108 -
65 27,079 -
410 128,801 2,454
 Approved For Release 2005/08/10 : CIA-RDP79-01144A000100010018-1
Appendix II - 12 ~ MEDICAL AND SANITARY DATA ON BULGARIA
Kyustendil
Lovech
Lukovit
tL '~, '~ O D U H
J, 0 z t:)
Nevrokop 1 10 7
Omortag
Orekhovo
Pazardzhik 1
Peshtera
Pleven
Prilep
Provadiya
Radomir
Razgrad
Razlog
Ruse
TABLE 5 (Continued)
Sevlievo
Shumen
Svilengrad 7
Szilagy 2
Trgovishte
Chirpan
Teteven
Troyan
Varna
Yambol
6 2 8
1
TABLE 6
Sanitary Reports and Statistics, U. S. Public Health Service
April 13, 1943
BULGARIA-TYPHUS FEVER CASES REPORTED
BY DISTRICTS-1942
Ardino
Asenovgrad
Babusnica
Bela
Bela Station
Bitolva
Brod
Dobrich
Drama
Ferdinand
Isperikh
Karnobat
Kotel
Z SI
2
Krumovgrad
Lom 1
Lukovit
Nevrokop
Nikopol
Novi Pazar
Nova Zagora 13
Omortag
Orekhovitsa
Orekhovo 7
Pazardzhik
Peshtera
Pirot
Pleven
Plovdiv
e
'
c
z a
d] vI O
Z 4
22 5
5
2
2
7
5
6
1
19
1
2
1
6
5
3
4
1 2
24
42
18
9
2
2
2
35
1 2
1
1
2
1
1
5
253
a
d
d a' dzJ .5 D W U O W p
0 z Q H
Popovo 6 2 2 10
Razgrad 2 1 1 4
Razlog 3 2 5
Ruse 2 6 81 1 90
Sliver 3 9 5 3 6 26
Sofiya
Surdulica
Sveti Vrach
Trgovishte
Varna
2 1 7
24
1
1 7 2 10
1 1 11 5 2 20
Vranje
Vrattsa 1 4
Yambol 6 4 1 2
TABLE 7
BULGARIA-PRINCIPAL CAUSES OF DEATH
Village Population, 1938' and 19392
NUMBER OF DEATHS PER DEATHS PER
NAMES OP MALADY, AND NUMBER DEATHS 1,000 DEATHS 10,000 INHABIT.
IN INTERNATIONAL NOMENCLATURE 1938 1939 1938 1939 1938 1939
1. Pneumonia (27) 3,981 3,634 171.6 159.6 22.8 20.3
2. Old Age (39) 2,800 2,861 120.7 125.6 16.1 16.0
3. Heart disease (24) 2,061 2,116 88.8 92.9 11.8 11.8
4. Congenital defects (38) 1,846 1,676 79.6 73.6 10.6 9.3
5. Pulmonary tuberculosis (10) 1,601 1,644 69.0 72.2 9.2 9.2
6. Cerebral hemorrhage (22) 1,035 1,062 44.6 46.6 5.9 5.9
7. Diarrhea and dysentery (29) 923 743 39.8 32.6 5.3 4.1
8. Cancer and tumors (15) 732 734 31.6 32.2 4.2 4.1
9. Non-pulmonary tuberculosis (11) 490 486 21.1 21.3 2.8 2.7
10. Nervous ailments (23) 416 430 17.9 18.9 2.4 2.4
IStatisticheski Godirhnik na Tssrstvo B'lgariia, 1939-(Statistical Year-Book of the
Kingdom of Bulgaria), Sofiya, 1939, pp. 132-133.
2lbid. 1940, pp. 132-133.
TABLE 8
BULGARIA-PRINCIPAL CAUSES OF DEATH
Urban Population, 1939'
NAME OF MALADY, AND NUMBER NUMBER OF
IN INTERNATIONAL NOMENCLATURE DEATHS
DEATHS PER
1,000 DEATHS
DEATHS PER
10,000 INHABIT.
[2
1. Heart Disease (24)
2,700
156.3
19.3
Pneumonia (27)
2
2
103
121.7
15.1
8
.
,
3. Tuberculosis of
respiratory organs (10)
1
785
103.3
12.8
27
Cerebral hemorrhage (22)
4
,
1
498
86.7
10.7
5
.
,
Old Age (39)
5
1
253
72.5
9.0
22
.
6. Congenital defects (38)
,
1,023
59.2
7.3
7. Cancer or tumors (15)
1,006
58.2
7.2
9
8. Diarrhea and dysentery (29)
6462
37.4
4.6
2
9
9. Non-pulmonary tuberculosis (11)
477
27.6
3.4
3
10. Diseases of the digestive tract (32)
390
22.6
2.8
35
2
IStatisticheski Godishnik, 1940, pp. 126-129.
2The average annual deaths, 1933-36, numbered 1,117.
TABLE 9
1
1
2
BULGARIA-CONTAGIOUS DISEASES-SOFIYA-1938
-1939
20
CASES PER
DEATHS PER
2
CASES
DEATHS 10,000
100 CASES
13
1938
1939
1938
1939
1938
1939
1938 1939
7
Typhoid fever
329
125
27
8
1.1
4.3
8.2
6.4
4
Paratyphoid
56
31
-
1
0.2
1.1
-
3.8
Scarlatina
620
1,191
66
55
2.2
41.5
10.6
4.6
Diphtheria
695
660
28
28
2.4
23.0
4.0
4.2
84
Meningitis
40
77
14
26
0.1
2.7
35.0
33.8
24
Measles
63
949
-
7
0.2
33.1
-
0.7
2
Mumps
368
528
-
-
1.3
18.4
-
-
2
Whooping cough
174
145
4
11
0.6
5.0
2.3
7.6
42
Chickenpox
333
294
1
-
1.2
10.2
0.3
-
Erysipelas
237
286
7
9
0.8
10.0
3.0
3.1
3
Other
59
112
7
18
0.2
3.9
11.9
16.1
9
21
TOTAL
2,974
4,398
154
163
10.4
153.2
5.2
3.7
1
IStatisticheski Godirhnik; 1939, pp. 141.
1
'Ibid. 1940, pp. 143.
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 Approved For Release 2005/08/10 : CIA-RDP79-01144A000100010018-1
TABLE 10
BULGARIA-INCIDENCE OF CONTAGIOUS
DISEASES, 1938-19391
NAME OF DISEASE AND NUMBER of NUMBER OF CASES PER DEATHS PER
NUMBER OF INTERNATIONAL CASES DEATHS 100,000 100 CASES
NOMENCLATURE 1938 1939 1938 1939 1938 1939 1938 1939
Spotted typhus (2) 91 129 12 11 1.5 2.0 13.2 8.5
Typhoid fever (1) 2,911 2,417 252 227 46.6 38.4 8.7 9.4
Diphtheria (7) 5,728 5,366 488 486 91.6 85.3 8.5 9.1
Scarlatina (5) 4,056 5,699 514 461 64.9 90.6 12.7 8.1
Diarrhea and dysentery (29) 1,466 899 168 133 23.4 14.1 11.5 15.0
Measles (35) 5,858 10,357 41 162 93.7 164.6 0.7 1.6
Whooping cough (6) 5,908 3,505 283 139 94.5 55.7 4.8 4.0
Anthrax (?) 995 753 72 43 15.9 12.0 7.2 5.7
IStatisticheski Godishnik, 1940, pp. 141.
Appendix II - 13
TABLE 11
BULGARIA-OBSTETRICAL CARE, 19381 AND 19392
IN PER CENTS
PLACE OF BIRTH AND TYPE CITIES VILLAGES TOTAL
OF CARE 1938. 1939 1938 1939 1938 1939
At home-physician 5.8 5.5 1.7 1.8 2.4 2.4
-midwife 64.2 62.6 16.7 17.2 24.4 25.1
-neither 17.6 11.0 80.0 78.9 69.0 67.1
In hospital 20.8 2.1 5.3
Elsewhere-no professional care 0.1 0.1 0.0 0.0 0.0 0.1
INFANT MORTALITY-1938 AND 19393
Per 1,000 live births 118.1 105.3 149.6 146.1 144.4 138.9
'Statistichcski Godi.rhnik, 1939, pp. 111.
'Ibid., 1940, pp. 111.
'Ibid., pp. 121.
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