100 YEARS ORGANIZED DENTISTRY IN BULGARIA
It is December 20, 1905. In 10.30 am, a few people gather together in the small hall of “Slavyanska Beseda” in Sofia, in order to initiate the organized life of the emerging dental profession in Bulgaria. This will be the First Congress of Bulgarian dentists aiming: “… to hear several essays in Odontology and Stomatology by colleagues wishing to read them, to vote the Constitution of the Society, and finally to elect a Board meant to run the Society’s business”.
The oldest attendant is 61 years old, and by right he fills the chair of the Congress. This is Friedrich Flamich, born in Prague, who had left the former Austro-Hungarian empire in order to become the first and only dentist in Bulgaria in 1878. As a Chairman, Dr. Flamich declares the Constituent Congress open.
A Congress Bureau was elected with chairman Mihail Elmazov, and secretary Dimitar Toshkov, who are actually the initiators of the convention of the congress and the establishment of the Society.
The first editor of the journal “Zabolekarski Pregled” (Dental Review), organ of the Bulgarian Dental Association, was Dr. Mincho Stoyanov, elected later by the 6th Congress as President of the Association.
Dr. Stoyanov was followed by Solomon Tadjer as an editor of the journal.
The Bulgarian Dental Association recently received a donation by Mrs. Antonia Petrova Stoyanova, inheritor of a dental “dynasty” from the beginning and the middle of the past century: her grand father, the above mentioned Dr. Mincho Stoyanov, one of the founders and long-lived President of the Bulgarian Dental Association (BgDA), and her father Dr. Petar Stoyanov. (The daughter of Dr. Mincho Stoyanov is Dr. Zorka Vlahova, mother of our renowned pharmacologist prof. Vitan Vlahov). The archive contains interesting personal and professional documents, as well as several issues of the journal “Zabolekarska missal” (Dental Thought), dated before WW 2.
Even the superficial reading of these documents reveals interesting facts from our professional life in the recent past, shows how well organized and intensive it was – and also gives us some important lessons…
The Constitution of BgDA from 1910 states:
“Article 1. The Society of Bulgarian Dentists, established on Dec. 20, 1905… shall be renamed by the 4th Regular Congress into a “Dental Association” with main office in Sofia.
Article 2. The hitherto existing dental societies, as well as the ones which will be established in the future, shall represent branches of the Association.
Article 3. The Dental association is aiming at: a) working to promote and preserve the prestige of the dental profession…, and b) taking care of the material welfare and the scientific perfection of its members.
Article 4. In order to achieve its goals, the Association shall act: a) to unite all dentists in the Association; b) to educate its members by establishing libraries, organizing written and oral reports, publishing a scientific-popular journal in dentistry; c) to establish a mutual aid fund; d) to review the enacted laws related to the dentistry in the country; d) to organize appeals and protests to the respective authorities or the public opinion.
Article 5. The members of the Association shall be: a) founding members who have participated in the 1st Dental Congress and have signed the Minutes…, b) regular, and c) honorary, who have certain contribution in Odontology”.
In the Constitution of BgDA from 1927, we can already find the professional jurisdiction:
“Article 3. … c) to care for establishment of collegial relationships among its members, as well as to arbitrate in the arrangement of arguments between them.
Article 4. … f) shall settle a Collegial Court according to Bylaws adopted by the Congress.”
Article 30. In order to regulate the collegial relationships among the members of the Association, and to resolve arising professional ethic issues, a Judiciary Committee shall be established…”
An interesting detail: the donated copy of the Constitution from 1910 contains autographic notes of Dr. Mincho Stoyanov, which are already a fact in the Constitution from 1927. I. e., according to one of them, if the Association is disbanded, its possessions do not go on to the Red Cross (as it was in the beginning), but to the Dental Cooperative User Society – a powerful cooperation of Bulgarian dentists, designed for supplying its members with dental products. Its draft bylaws from 1931 state:
“Article 8. The sales are performed in cash. Only the regular members are entitled to purchase on credit which amount shall be determined by the Board according to the disbursed shares.
Article 62. It is a duty of every member to purchase materials and instruments form the stock of the Society.”
It is worth looking at the monthly dental journal “Zabolekarska misal” (Dental Thought), edited by Dr. Mincho Stoyanov until his death in 1940. There we can see advertising of companies and products we still know well today – Siemens and Ritter dental units, Vita furnaces, Meisinger burs and stones, Harvard cement. The front place is occupied by the advertisement of the Bulgarian Dental Cooperative User Society, which “is the pride of the profession and indicates the power of its united efforts.” The journal contains rubrics like “Free Tribune”, “Scientific Section”, “History of Dentistry”, “Dental Forensic Section”, “In The Practice”.
Here is for example a practical hint on how to determine the correct occlusion: “Winkler is suggesting a very simple but quite logic technique: Place the patient in semi-recumbent position, and make him bend his head forward ad maximum. The occlusion registered in this position is impeccable.”
Interesting professional comments can be found in the journal. In No.5/Sept. 1938, Dr. Peyu G. Peev is writing on “… the unfair competition, i. e. the non-compliance of the neighbor-colleague with the unified price of the dentist’s work. Some colleagues are unscrupulous in their strive to build up a practice. These are not wishing to wait for the moment when the public, satisfied with their achievements, will appreciate and demand their services. They see no other way to build up a practice but underbidding the prices…
It goes without saying that any member of a professional organization, who underbids the prices, is harming himself most of all; this reckless game with the dental fees also has some other, equally bad consequences: patients learn to bargain, they leave the practice with the words “I’ll think about it”; they wander from one practice to another and stay with the one with the lowest prices, should the difference only be 2-3 leva… In this way, they turn the dental practice to a trade fair, they spin yarns about the fees charged here and there, thus instigating a real war between the dentists in the neighborhood…
A price-list could be observed by the colleagues only if being enforced by law with severe sanctions… This price-list should only include the minimum fees. Above it, everyone should be allowed to charge as much as they want.”
Sounds like it has been written today, right?
The archive also contains documents of the Sofia Branch of BgDA – the Constitution, and a particularly interesting declaration of its management, dated May 1930 – “Statement on the dental care in the Social Insurance Fund” (former analog of health insurance), stating as follows:
“In November 1927, the Labor Department restricted in the highest degree the right of the insured persons to dental care; therefore, the dentists in Sofia, estimating this restriction as detrimental for the insured, and incompatible with the principles of science, have temporarily discontinued any services. After 3½ months, following the personal assurance of the Head of the Labor Department… dental care was renewed in its limited scope – 2 fillings and a few extractions per year.
During this two-year period, a number of other disorders emerged involving the dental care, and the dentists practicing for the Fund… so we came to the decision to discontinue again the dental care, and give the Fund management the opportunity to finally arrange the dental care in its integrity… Here are our specific demands:
All these demands have been accepted in general by the Head of the Labor Department, and he promised to draft the necessary regulation… However, so far we have not been consulted… We are expecting the management of the Fund to abide by the obligations they assumed.
The circles involved have to be aware of all this, in order to comprehend who is defending the interests of the insured persons… The lack of arrangement of the dental care is a severe damage of the legal rights and the general health of the insured, and the Fund authorities are only responsible for this.”
The above statement demonstrates unambiguously the activity of the dental guild, as well as the explicit defense of its interests before the State machine – as well as the reluctance of this machine to abide to these interests, even if they coincide with the interests of the public. It probably does look familiar to you?
Immediately after the establishment of the Communist regime in Bulgaria in the end of WW 2 (Sept. 9, 1944), exceptional powers have been granted to the Minister of People’s Health, and among them – the right to determine the fees of private dental practitioners in the country. The archive of the Stoyanov family includes the respective order of the Minister Racho Angelov, dated March 1945.
Another interesting document, submitted to the head-office of BgDA by the President of the Sofia City Regional College Dr. Borislav Milanov, is the Price-list of the Branch of BgDA in the town of Chirpan, dated 1941. There we can find the following notes:
“1) No credits and deferred payments are permissible for dental services.
2) All dentists in Chirpan shall charge the same prices.
Treatment is initiated upon prepayment of half of the price according to this price-list, and the rest is payable upon the termination of the treatment.”
Yet today, unified prices of dental services are introduced in some European countries. The essential is that they should be determined and controlled by the dental profession, as in Bulgaria in 1941, and not by the State – as in the very beginning of the Communist regime under the excuse of war-time powers of the Minister. Actually, the cited order of Minister Angelov is the precursor of the total distrainment of the management and control in healthcare by the still young totalitarian State, deployed later in the well known administrative-command system, along with the interdiction of the professional organizations, and culminated in the prohibition of private practice in 1971.
This is all a good nurture of the mind, right?