Officially, the Romanian health system started functioning in 1874.
Officially, the Romanian health system started functioning in 1874, when the first modern healthcare law came into effect. There had been previous attempts to regulate health, many of them upon the initiative of physician Carol Davila. One of the regulations instituted upon his proposal was the creation of the position of sub-county physician. It was introduced in 1862, marking the birth of the rural health system. Health regulations had been around, as part of broader laws, since the 1830s, as part of the Organic Regulations, the first attempt to introduce constitutional law. The 1874 law in fact took over, codified and improved existing legislation. Historian Constantin Barbulescu told us about it:
Constantin Barbulescu: “On the one hand, the healthcare law regulated the activity of the healthcare system, but, in addition to regulating and defining the activity of every member of the system, it also introduced public hygiene regulations. For instance, it had chapters on the hygiene of cities, and even villages, food and water hygiene, etc. The latter were the hardest to enforce. Physicians kept complaining that the legislation, which was truly modern, up to European standards, was not being applied.”
The poor enforcement of the law was not the only complaint from physicians in the Romanian Principalities in the 19th century. Once they went to the countryside, physicians noticed the same things that the intellectual elites were complaining about, which amounted to a health and hygiene disaster. In their reports, they mentioned a number of recurring issues: bodily and clothing hygiene, home hygiene, the diet of peasants, and alcoholism. Constantin Barbulescu, however, told us that historians nowadays doubt the accuracy and objectivity of these reports:
Constantin Barbulescu: “We, as historians, can only rely on the testimony of the physicians of the time. They were saying that health legislation was not being enforced, in describing the health behavior of people in cities and villages. The general picture of the latter decades of the 19th century, even up to WWI, as physicians described it, was disastrous, a hygiene disaster. If you read the reports of doctors and the medical literature of the time, you get the impression that no regulation was observed, and nothing was changing. However, today's historians, having a different perspective, believe that this picture is blown out of proportion. In fact, things were improving, at least a bit. For instance, after 1860 the number of doctors went up considerably. They are the ones who write the reports, and many of them were trained abroad. The image provided by reports filed by a doctor who had been a country physician for 20 years is better compared to that provided by a young doctor recently returned from studying abroad.”
In addition, young physicians were faced not only with the attitude that rural people had towards hygiene, but also by the way the healthcare system had been designed in that era, as well as a lack of qualified staff:
Constantin Barbulescu: “Peasants were not seeking out doctors, as they do nowadays, but the doctors were seeking out the peasants. According to the 1874 law, the main obligation of a sub-county physician was to perform two general inspections of his area of responsibility per month. They had to go around the villages in their county, and to check on the physical health of the villagers, to see if anyone was sick, or if a disease was circulating. The system could not function very well. There were mountain counties with over 40 villages, and there was no way that a doctor could get to each and every one every month. Also, mayors did not always tell the doctor who was ill in their village. It was much easier to say that everyone was healthy. Because of this formal aspect of field inspections, starting around 1890, the authorities came to believe that the rural healthcare system was a piece of fiction.”
Therefore, the gap between expectations and reality was huge. Today, however, historians can look back at the steps forward taken at the time, which were very slow, and took decades. Romania's health situation in the 1890s had significantly improved compared to the 1860s, but the steps towards modernization became obvious only in the first half of the 20th century.
(translated by: Calin Cotoiu)