Hospitals on the territory of Vardar Macedonia as part of Serbia during the Kingdom of Serbs, Croats and Slovenes/Yugoslavia (1918–1941)

The period after the First world war (FWW) is considered as one of the most intensive periods of hospital openings in the Vardar Region of Macedonia as part of Serbia. Vardar Macedonia (today's Republic of Macedonia) was part of the Kingdom of Serbia in the period 1912–1915, the province of Serbia within the Yugoslav Kingdom until 1929, and Vardar Banovina within the Kingdom of Yugoslavia from 1929 to 1941. Because the situation was unsatisfactory as a result of the lack of hospitals, minimalistic capacities and the low hospital equipment the hospital’s opening started with the new country formation and the foundation of the Ministry of National Health. If we follow some chronological order we should mention first the hospitals in the cities that existed before the war but because the Vardar Region of Macedonia was practically ruined there was no evidence of them. That is why we use the term new hospitals not the old ones. When we say new hospitals, in the period after the war we do not think of building new hospitals but forming hospitals in places where they did not exist before. According to the data given in the telegram sent by the Head of the Sanitary to the Management of all hospitals in the Kingdom of Serbs, Croats and Slovenes (SCS), of 14 May 1919, by which it was called on purchasing products and equipment for the hospitals, in the Vardar Region in 1919, four public hospitals only existed in Skopje, Štip, Bitola and Tetovo .


Introduction
The period after the First world war (FWW) is conside- If we follow some chronological order we should mention first the hospitals in the cities that existed before the war but because the Vardar Region of Macedonia was practically ruined there was no evidence of them. That is why we use the term new hospitals not the old ones. When we say new hospitals, in the period after the war we do not think of building new hospitals but forming hospitals in places where they did not exist before.
According to the data given in the telegram sent by the The Sanitary Law of the Kingdom of SCS imposed on the state and its bodies to build a hospital at their own expense. When they were not in condition to do that the state must have helped them or finance the building of the hospitals. Thus, to 1930 when the Skopje's hospital became regional, there were no hospitals with public status in the Vardar Region, although, as a result of bad financial conditions, the state fully covered the expenses for the hospitals openings 3 .
The hospital staff did not satisfy the hospital needs. There was a lack of doctors and professionals. According to the law, one doctor should cover 25 hospital beds, and in Vardar region he/she covered 32 3 .
Great working difficulty represented the post of a hospital manager and a house keeper which the law did not stipulate. In the regional hospitals, with a few exceptions, the duty manager of the hospitals was led by epidemiologists. The same happened with the local hospitals where the duty of a manager was performed by the local doctor. In places where hospitals were bigger, two doctors were posted as managers. The law had other negative side and that was the administrative work which was manager's duty. That prevented the manager to dedicate himself/herself to the professional and real hospital work. That was the reason for imposing the need for opening the post of a manager with professional qualifications and legal responsibility. The Sanitary Law predicted posts such as a chief of ward, secondary doctor, or honorary doctor. These doctors received free home for living in the hospital surroundings, food, energy and heating materials. Secondary doctors should have spent 3 years in one ward and worked under a supervision of the chief of the ward and after that, they could run the ward by themselves. The greatest difficulty in hospitals was the equipping of helping professional staff, doctor's assistant, and nurses 3 . That was why schools for necessary professional profiles were opened.
According to the Law, for a normal functioning of a hospital, the following was needed: a manager, secondary doctor, honorary doctor, doctor's assistant, nurses, midwives, laboratory assistant, pharmacist, recorder, procurement clerk, technician, electrician, priest and hospital service for hygiene maintenance, preparation of hospital food, bedding and hospital clothes, ironing, and laundering of the clothes 3 .
According to the report of the president of the permanent hospital commission and assistant to the minister of national health Dr. Dobrivoje Ger. Popovic, since 1923, all hospital buildings in the Vardar Region of Macedonia, except for the hospital in Veles, did not provide for the hospital needs. For them, the Ministry of National Health (MNH) paid rent because they were placed in private property buildings, except for the hospital building in Skopje which was a state one. Without an exception, for all of them, it was given a recommendation that a new hospital should be built 4 .
After 1929, with the division of Kingdom of SCS on 9 regions, so called banovina, all state hospitals as well as the public ones were under the supervision of the region where they belonged to. The centres of the regions were appointed as state hospitals. So, the hospital in Skopje became the State hospital. It was actually the unique state hospital in the Vardar Region.
The municipality of the cities managed the municipal hospitals, under which authority were the hospital expenses.
The state was in charge of building new hospitals and their opening for regions and municipalities with over 20,000 citizens. But, at some private hospitals, under special conditions, the minister could give them the right to charge a number of hospital expenses.

Regional hospitals from 1918 to 1929
Regional hospital in Bitola The regional hospital in Bitola existed from December 1, 1916 and it was placed in an old Turkish building which was a private property the state paid a rent for.
The hospital building was placed in the centre of the town. Besides the main building, the hospital had one smaller building and barracks with 137 beds. The buildings were so destroyed in the last explosion that it was very difficult to readapt them.
Bitola Regional Hospital was reopened in 1919 and it functioned with 3 wards: internal, surgical, and venereal ward. The following posts were fulfilled: a manager, chiefsergeant, 2 secondary doctors, 1 honorary doctor, 1 pharmacist, 1 midwife, 1 procurement clerk, 1 recorder, 11 nurses, other services 6, 1 technician, and 1 priest. According to the stipulations in the law there were no medical assistants, laboratory assistant, supervisor, and electrician.
The hospital, according to the grade given in the Dr. Popovic's report, was not adequate for the hospital needs and it was recommended to build a new one with 125 beds at least, and about 10 million denars should have been provided for it. As cited in the report, it was an old, half ruined building, a property of the ex-Greek hospital called 'Evangelizmos' which should, according to the doctor Popovic's opinion, be rebuilt and transformed into a new hospital.
Those hospital capacities could not satisfy the city needs. In addition to those claims, there was the article in the local newspapers 'Novi Sjaj' 6 in which it was stated: "It can freely be said that Bitola even today does not have its own hospital. The comfort and hospital accommodation should correspond to all hygiene rules. The current hospital capacities should be significantly increased. We had two major hospitals during the war and now we have only one. Because of that, the issue of a hospital in Bitola does not stop to be actual and necessary for the citizenship." Besides many initiatives, the problem of the hospital remained unsolved. Since 1920, when the regional manager of the hospital was Dr. Vasa Petrovic, an initiative for renovation of "spitaljeto" was raised and as a result the hospital capacities were significantly increased. Unfortunately, this was not realized because '.... one pure philanthropic movement was raised in a political issue 7 . The conditions did not change even though the need for the children ward instead of the internal in the hospital in Bitola, and the gynecology ward instead of the surgical was seen. What was essential in the Bitola hospital, was to open an ophthalmology ward, and to place venereal ward in the barracks as it is today. It was also important to have a tuberculosis ward because it was very difficult to admit people ill with tuberculosis in the hospital. A high percentage of tuberculosis affected in our villages was a result of not having a place in the hospitals where they could have been treated 6 .
In the period after 1920, the citizens were convinced that a new hospital in Bitola would be built as a result of the manager's intervention, Dr. Dragoljub G. Popovic. The location was the place 'Devejani' at today's Ohrid Street. It was predicted to have a pavilion system in the hospital and to build one pavilion per year. The idea remained unrealized and the city was forced to be satisfied with the small inadequate hospital.
Because of this, the poor suffered the most, and the rich solved their problems in private hospitals.
In such hospital conditions, the city entered World War II and faced the Bulgarian administration 8-10 † .

Regional hospital in Skopje
Right after World War I, the Minister of National Health of the Kingdom of SCS, approved the English Mission 'Lady Paget' to form a hospital in Skopje by a decision number 15517. At that time, Skopje had a population of 144,848 inhabitants. The hospital was opened on September 1st 1919 at the state property buildings in the barracks 'King Petar' at the Skopje fortress. The first venereal ward was formed then and it was led by Dr. Nikola Megeri, a native from Vojvodina, gynecology ward was led by Dr. Ante Anicin, X-ray ward by Dr. Nikola Nastic, and surgical ward was led by Dr. Vladimir Rojic. The manager of the hospital was Dr. Etta Gray, an "American Women's Hospitals" representative 1  The hospital had 80 beds, without a sanitation system, and rooms did not correspond to the needs of a hospital. In Dr. Popovic's report it was alerted that a new building should be built with a capacity of 300 beds and a sum of 20 million dinars to cover the expenses 8 .
The hospital was moved to the barracks of the War hospital in the 2nd army area 'Half-moon' in 1920. It was renamed in Skopje Regional hospital and placed into two new pavilions, seven Decker's barracks, five wooden houses; one part was set up in the army hospital. It had 200 beds, 7 wards: internal ward (56 beds), surgical ward (27 beds), gynecology and lying -in ward (16), venereal ward (33), ophthalmology ward (33), children ward (50 beds) and X-ray ward 1 .
The hospital was financed by the English mission and a small amount of the state budget was allocated. Its manager was a regional physicist in Skopje 1 .
Staff in Skopje's regional hospital in 1920 were: the manager, Dr. Zivojin Milenkovic, a regional physicist; Besides doctor staff, 22 nurses, 1 laboratory assistant, 2 recorders, and 7 helping assistants worked in the hospital. There were no doctor assistants 1 .
Besides the venereal ward, in the Regional Hospital in 1921, as a result of increased prostitution, a unit for venereal diseases was opened and the sick were treated for free.
In 1923, Skopje Hospital got its own manager, and the regional physicist was released from that obligation. Milan Zankovic was appointed as the manager of the hospital and performed this duty for 9 years. Since 1927, the hospital was transferred in Dolno Vodno where it is today, and it was renamed as Regional Skopje Hospital.
Since 1929, when a new reorganization in the Kingdom was done, the hospital was renamed as Regional Hospital.
Skopje Regional Hospital covered a territory where 2 million citizens lived, and that is from Leskovac to Gevgelija, from Albanian to Bulgarian border, the whole Vardar Region and one part of the Zeta Region.
Since The Great Pavilion for the surgical and gynecological ward started to be built in 1931. Besides the beds for the sick in the building, there was a space for the central laboratory, physical therapy and x-ray diagnosis and a therapy. The schedule of the interior parts, in pavilion, apparatus, and everything else corresponded to the modern technologicalmedical rules.
Even after having built the new pavilion in 1938 (today's building of the gynecology ward) the space problems were partially solved 11  other things, it is said that the Skopje Hospital was the largest hospital in the "newly liberated country" and that it had 500 beds. It was situated in four hospital buildings: Administration Building, a two storey massive building built in 1928 with funds from the mission of American women from New York; a three storey massive central building with a basement in the form of a letter "H" built in 1938 with state funds; Infectious Diseases building, a two storey massive building in which the Department for Lung Diseases is situated. It is located 200 meters from the administrative building; pavilion for the mentally ill, one-storey small building.
The Administrator gives a comprehensive description of the apparatus found in the radiology ward. He says that the department is very well established and it has three X-ray apparatuses: one apparatus for diagnosing -a Siemens model "Tuto Heliofos" with four valves and equipped with full automation, an X-ray apparatus for diagnostics, type Galon-Pilon-Pariz, about 16 years old, and a Siemens X-ray apparatus for treatment of the type "Tuto Multi-Volt 12 .

Regional hospital in Štip
Štip's Regional Hospital was opened on April 1, 1919 (it was formed in 1914), with 30 beds as one hospital without dividing the wards. A motive for the urgent opening of the hospital was the epidemic of typhus fever in the city. The hospital was in the centre of the city in the so called Ceramidsko neighbourhood, in privately owned buildings, and supplied with water from the city pipe line. The buildings were not appropriate for the hospital needs but they were adapted by the MNH.
According to Dr. Popovic recommendation, it was necessary to build a new hospital ** for which 6 million denars were needed.

Regional hospital in Tetovo
Tetovo Hospital was opened on July 16, 1919 by the sanitary mission 'Scottish women' located right to the object ** The project for the Stip's Hospital was done in 1931 and the building started in 1936 when a credit from the bank was taken for the costs. In 1941 the hospital was completely equipped, and before it was opened it should have been connected to the sanitary system. But, on April 6, 1941 when Stip was bombardeded all windows of the hospital were destroyed. Right after the bombardement , the city was a victim of robbery and a large number of the equipment was robbed. When the Bulgarians came in Stip, it was started with new reequipping of the hospital and on July 5, 1943 it was prepared to receive the first patients. Hospital capacity was 100 beds and its manager was Dr. Georgi Rahlij (Russian immingrant).
where recently was the geodetic management, in the old private buildings (one of them was the house of Scanderbeg Bey) with 10 rooms, 50 beds which did not correspond to the needs 14 . That was why Dr. Popovic recommended that a new building should be built with 75 beds, which would cost around 5 million dinars 15 .
The hospital had one two-storey building, and a smaller building in which was the manager's office, the ambulance and maternity hospital with 10 beds 16 .
Its staff were: a manager, Dr. Stojan Stefanivic; regional physicist, Dr. Edit Harley 17, 18 † † who was the manager of the hospital pharmacy which was supplied with all the necessary medicaments by the sanitary mission 13 ; procurement clerk, Janikije Davinic; midwife, Mara Todorovic; 5 nurses and 4 clerks.

Regional hospital in Ohrid
The Ohrid's Hospital was opened on September 27, 1920 in two privately owned buildings and one building which was the property of the Ministry of the Army. The hospital had 80 beds and 4 hospital wards: surgical, infective, and the ward for internal diseases. The buildings partially corresponded to the hospital needs. As one of the main problems in the hospital was the lack of hospital clothes and bedclothes.
According to Dr. Popovic's report recommendations a new hospital should have been built and for that occasion 4 million dinars was needed. This hospital admitted soldiers because there was no other hospital in the city.
Dr. Catherine Mary Harley, 1853-1917, Scottish origin, was sister of the Field marshal Sir John French, executive commander of the English troupes in France. The mission "the Scottish Women's Hospitals Motor Ambulance Column" known as 'Transport Unit' based in England as special unit with 18 members, 6 Fords, came in Macedonia as chief administrator of the most modern ambulance service with sanitary column. She administrated the Dr.iving department and beside the Dr.ivers the workers were equipped for mechanics of their Dr.iving vehicles. In her unit, beside her two daughters, were many famous women from the English and Scottish circles. She also took care of the wounded, injured, and hungry people after the bombing in Bitola in 1917. She was hit in her head on March 7, 1917 and died immediately while doing that mission. Her tomb is in Serbian cemetery in Zejtinlik (Thessaloniki) as unique woman between all other dead soldiers. Her daughters continued with her work. Right after the Great War Edit Harley worked in the Tetovo Hospital Territorial hospitals in the period from 1918 to 1929

Territorial hospital in Strumica
In 1919, in the Bey Inn, at the same place where the Bulgarian hospital was from 1912 ‡ ‡ hospital of the American women mission was formed. Professional and assistance staff were all women at the hospital. The head of the hospital was Dr. Etta Gray, a specialist for surgical and ophthalmological diseases, and miss Teppi, a doctor specialist internal, miss Eliot, a general practicioner and two nurses. There were also staff nurses and translators from English into Macedonian: Vasil Panov and Zaev from Strumica. The whole medical help was free and people from distant towns came to be treated here. Koce Pesev from Novo Selo, Stip, had a plastic surgery on his eyebrow.
Unfortunately, the Hospital of the American women did not work long. In 1921, it was burned by a forgery, leaving behind a beautiful memory of one professional team that gained all sympathy of the population in Strumica region 19 .

Territorial hospital in Veles
The Veles's Hospital was opened on March 21, 1922, in the buildings of the Children hospital of the American mission which was formed in 1919 and its manager was Dr. Etta Gray.
It was placed in buildings, the property of the Ministry of War and in Dr. Popovic's report, it was evaluated as a hospital appropriate for the hospital needs, but because it did not have its own building it was recommended to build a new hospital for 4 million dinars.
It was placed in a two-storey house on the upland of Veles. The hospital had two helping or in total three buildings: building for patients, building for the staff nurses, washing machine, infective ward, and the other building for the dead.
The hospital had the adult ward, children ward, and the infective ward. Besides the civilians, soldiers were also treated because there was no other hospital in the city.
Of the total amount of 100 beds, 50 were used for adults, 41 for children, and 9 for the zymotic disease. It was connected to the sanitary system. The hospital was financed by MNH except for the children's ward which was financed by the American mission. The whole equipment was supplied by Dr. Etta Gray who was the manager of the hospital until 1922.
Staff that worked in the Territorial Hospital in Veles in 1922 were: a manager, Dr. Antun Saso; honorary doctor, Dr. Stanislava Simonovic -Ilic; procurement clerk, Spasoje Ostojic; 9 nurses and 5 clerks. The largest number of patients from the hospital in 1922, according to Dr. Popovic's report, were ill with malaria (n = 166), and tuberculosis infected (n = 48). The number of patients who were injured was 49. They completed 21 surgery and 3 autopsies and made 84 ambulance's medical check ups 4 .
On August 27, 1922 the American mission left Veles and went to America. Dr. Whiste was the only person that stayed there, one surgeon and a medical nurse.
In the annual report for 1923 the manager Anton Saso gave a description of the hospital: '...the hospital is placed on the hill above the barracks, one kilometre distant, with three buildings, one for the hospital wards, the other for the infective ward, staff nurses and washing machine, and the third building is a chapel. There are three hospital wards with 100 beds, the children ward with 41 bed and infective ward with 9 beds. The heating in the building is with metal stoves on wood, lighting by kerosene, sanitary system. The laundry washing is made manually. The hospital needs hospital equipment (laundry, setting, bed equipment) laboratory and laboratory assistant. There is a pharmacy without a pharmacist, and there is no duty doctor 20 . In this hospital workers who built the railway Veles-Prilep and Veles-Štip were received.
In the annual report to the territorial inspection in Skopje, Dr. Saso reported for the malaria outbreak in 1923. Out of 560 infected people, 46 were infected by malaria quartana, 147 terciana, 201 of tropic malaria and 156 of chronical malaria. Most of the infected were between 20 and 30 years old, and a smaller number was from 1 to 20 years old. In the second half of 1924, the number of the malaria infected increased to 761 21 .
Veles Hospital did not manage to find the appropriate place for its dislocation and the ministry could afford money for a new one. It was at the same place in the Second World War (SWW).

Territorial hospital in Prilep
Territorial hospital in Prilep functioned from 1919, under the management of the American mission 'Hospitals of the American women'. Since January 23, 1922, the management was taken by the Territorial sanitary management. The hospital had only 30 beds and was placed in a private building, located between the house of Pance Magar and the Evangelic church, and water was supplied from the hospital well.
In Dr. Popovic's report, it was noted that the hospital was not the adequate for the needs of a hospital and it was necessary to build another hospital with at least 50 beds and 3 million dinars for building it 4 .

Territorial hospital in Gevgelija
A Hospital in Gevgelija was opened in 1920 in the old building, which was in a private property of the recent catholicunite pension). The rent was paid by MNH for a sum of 400 dinars monthly. It had three hospital rooms with 15 beds, an ambulance, office and kitchen. The lighting was with kerosene, he-ating by wood stoves, and water supply by street taps and wells. There were no enough blankets and sheets, dividers and setting.
The rooms did not correspond to the hospital needs and that is why Dr. Popovic recommended that a new hospital should be built and the amount for it was 3 million dinars.
As a conclusion to this report, Dr. Popovic recommended that a new hospital should be built in Kumanovo with a capacity of 100 beds and amount of 10.500 million dinars. Also he recommended that another hospital should be built in Strumica with 30 beds and amount of 3 million dinars 4 .
The hospitals in the Vardar Region of Macedonia were financed by the American charity mission which did successful work with its staff. The work of Dr. Etta Gray should be mentioned who had Children Hospital in Veles. The American mission gave 10.000 dollars to support the building of a children's pavilion in Skopje with 80 beds 22 .
Besides the fact that hospitals were opened as temporary at first, with recommendation that they were not the adequate for hospital needs, and that new hospitals should be built, many hospitals waited the WW II in this condition.

Hospital in Kumanovo
Kumanovo Hospital was built with resources of Nikola Spasic's fund; he was a respectable merchant and philanthropist from Belgrade. The hospital building was a modern edifice and the amount for its construction was 1,382,022 dinars. Fully equipped with 60 beds, it was opened on July 11, 1935. Today, this building is a part of the hospital in Kumanovo 23 .

Conclusion
The opening and construction of hospitals in Vardar Macedonia located within the South Serbia during the Kingdom of SCS/Yugoslavia, in the period between the two world wars were carried out with great intensity because of the urgent need. The fact is that the state budget allocated huge funds to build hospitals that were built by all regulations of the modern architecture of the time. The quality of these buildings was high and many of them are still operational. As an example, I will mention the Hospital in Stip built in 1936, which after 80 years still works in the same premises, all the time as a Regional Hospital and, most recently with the opening of the Faculty of Medicine of the University "Goce Delchev", it has grown into a Clinical Hospital -Štip. As for the provision of experts, particularly from specialist activities, the shortage of these was very obvious because the conditions were incredibly complex and difficult. Mostly, staff was taken on by recruitment and civil mobilization but also by sending doctors on a regular job in order to open new departments and services. The Ministry of Public Health of the Kingdom of SCS / Yugoslavia always took care about the quality of professional staff enabling them to handle difficult and responsible tasks, especially in the areas where infectious diseases, primarily malaria, reigned.