Chahrour-civilisingmission[1 of Austrian Medicine in t Ott Empire

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‘A civilizing mission’? Austrian medicine and the reformof medical structures in the Ottoman Empire, 1838–1850

Marcel Chahrour

Medical University of Vienna, Institut fu r Geschichte der Medizin, Wa hringerstraße 25 A–1090 Vienna, Austria

Abstract

During the 1840s, physicians from the Habsburg Empire played a decisive role in the reform of medical structures in the OttomanEmpire. This paper discusses different aspects of this scientific and cultural encounter. It emphasizes the importance of Austrian healthcare structures as a model for the work of these physicians in the Ottoman Empire and studies the role of the medical school ran by theAustrians as a means of representing, on the one hand, the reformatory efforts of the Ottoman Empire and, on the other hand, the moti-vations of the Habsburg monarchy for an involvement in Ottoman health care affairs, strongly bound up with its own quarantine politicstowards the Ottoman Empire. 2007 Elsevier Ltd. All rights reserved.

Keywords: Medicine; Ottoman Empire; Habsburg Empire; Reform; Bilateral relations; Transfer of knowledge

When citing this paper, please use the full journal title Studies in History and Philosophy of Biological and Biomedical Sciences

1. Introduction

In 1917, Max Neuburger—then professor of history of medicine in Vienna—wrote a short article on ‘Austrianphysicians as pioneers of scientific medicine and hygienein Turkey’ examining the work of Austrian physicianswho had been involved in the transformation of medicalstructures in the Ottoman Empire in the middle of the nine-teenth century.1 The First World War—during which Neu-burger published his article— had turned a former foe intoone of the major allies of the Habsburg Monarchy. Neu-burger’s study emphasises the Habsburg Empire’s role as

a partner in what was then perceived as a ‘civilizing mis-sion’, bringing the light of science to the ‘uncivilized Ori-ent’. The pride of the Vienna medical school in doing sois summed up by Neuburger’s introductory statement:‘The first attempt to create a sanitary administration inTurkey and to form an educated class of physicians datesback to the civilizing work of Austria’.2 Neuburger’semphasis on the ‘civilizing’ character of the work of thephysicians is typical of his generation of historians of science, as Pyenson (1993) has shown. But it also reflectsthe self-conscious and ‘missionary’ approach of thenew generation of Austrian physicians that was involved

1369-8486/$ - see front matter 2007 Elsevier Ltd. All rights reserved.

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E-mail address: [email protected] Neuburger (1917).2 Ibid., p. 1.

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Stud. Hist. Phil. Biol. & Biomed. Sci. 38 (2007) 687–705

Studies in Historyand Philosophy of Biological andBiomedical Sciences

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in medical reforms in the Ottoman Empire during the1840s.3

This episode of Austrian influence on medical affairs inthe Ottoman Empire lasted just over fifteen years, roughlybetween 1838 and 1854. At the beginning of the 1850s itcame to a rather sudden and surprising end—especially in

the light of the fact that the rapid progress of German/Aus-trian medicine in the second half of the nineteenth centurywas then just beginning.4 As we will see, the ‘export’ of medical science from Vienna to Constantinople was muchmore a matter of political and economic considerations,closely linked to the influence and ambitions of Habsburgdiplomacy, than of scientific progress.

Much of my research on this episode in Habsburg–Otto-man relations is based on the extensive coverage of thetopic in the German and Austrian medical periodicals inthe mid 1840s. The intensity with which both the Austrians’work in the medical school in Constantinople and the stateof public sanitary affairs in the Ottoman Empire were dis-

cussed in Viennese medical media went beyond what couldbe considered pure ‘Orientalist enthusiasm’. It reflected theprofessional and political interest that the Habsburg Mon-archy (and the individual physicians) had in the state of thesanitary conditions in the Ottoman Empire, at a time wheninfectious diseases such as cholera were posing a consider-able threat to the European population. From the Austrianperspective, the efforts to reform medical education in theOttoman Empire were an essential part of the HabsburgEmpire’s own quarantine policy.

On the Ottoman side, the reform of medical structures isclosely linked to the serious crisis the Empire experienced

in the 1820s and 1830s and the subsequent reform politics.In Ottoman history, the period of reform starting with the‘Imperial Rescript of Gulhane’ in 1839 is called tanzimat

and has been one of the core subjects of modern Ottomanscholarship. European historiography has related theinvolvement of Europeans in the process of reforms in this

period to the imperial ambitions of the ‘European powers’5

and with the influence of their respective economies.6 Morerecently, scholars have begun to emphasize the importanceof the transfer of science and technology.7

Medicine is in many respects linked to the reformatoryefforts of the tanzimat period. The introduction of new

medical educational institutions, sanitary administration,8

professional associations9 and a restrictive medical legisla-tion10 brought about a centralization and standardizationof medicine and thus affected the whole Ottoman society.These reforms gradually reduced the existing ‘free market’in health care and eventually replaced it with a more regu-lated, structured system both in education and in medicalpractice, which was in many respects modelled after Euro-pean examples and, especially in the beginning, dependenton European assistance. ‘Civilizing’ here meant structuringand establishing what was perceived to be a ‘European-style’ order in health care affairs, as it would be done inthe f ormer Ottoman province of Bosnia some three decades

later.11 Recent studies analyzing the development of mod-ern medicine in other regions of the modern Middle Easthas shown that the establishment of such European struc-tures and/or of medical schools has played a key role in thisprocess.12

The formation of an ‘educated class of physicians’—asNeuburger put it—brought about with the Habsburg Mon-archy’s assistance was much more than an accidental epi-sode in the history of bilateral relations between the twoEmpires. This paper shows how the work of the Austrianphysicians at the Imperial Medical School in Constantino-ple was based on Habsburg models and contributed to the

change in the structures of health care and medical servicesin the Ottoman Empire. It furthermore argues that medi-cine served as a means of pursuing Austrian diplomaticand economic ambitions especially as far as internationalquarantine politics were concerned. Crucially, these physi-cians at the same time perceived themselves as agents of a

3 A few remarks on terminology in this paper: the term ‘Austrian physicians’ is used here as shorthand for physicians from the Habsburg Monarchyirrespective of their nationality. The attributions ‘European’ and/or ‘European style’ will refer to institutions of Central and Western European origin. Theterm ‘reform’ is used in this paper to describe a process of change and does not imply the superiority of Western societies. For a further discussion of the

use of the term ‘reform’, see Davison (1963), p. 5. He points out that the term—even though sometimes (mis)used by European authors to implicate amoral superiority of their own European ways—was used in its Turkish equivalent ıslah by contemporary Turks in the same sense.4 On how, around 1850, Vienna replaced Paris as the leading European centre of medical education, see Warner (1998) and Bonner (1995).5 Examples of the vast literature on this period with emphasis on political history include Anderson (1966); Deringil (1998); Cleveland (1994). The

‘European powers’ here refers to the pentarchy of five great powers of the eighteenth and nineteenth centuries: Habsburg Monarchy, Russia, Prussia,Britain and France.6 Just a few examples: Pamuk (1987); Owen (1981); Kasaba (1988). Very insightful descriptions with emphasis on social history are Quataert (2000) and

Faroqhi (1995).7 Much work on Turkish history of science has been done by Ekmeleddin _Ihsanoglu. See _Ihsanoglu (1992, 2000, 2004).8 On the introduction of a sanitary administration in the Ottoman Empire, see Panzac (1986) and Kurz (1999).9 On the genesis of learned societies in the Ottoman Empire see _Ihsanoglu (1996).

10 A legal regulation of pharmacy was introduced in 1862: see Young (1905), p. 99.11 On the period of Austrian administration in Bosnia see Haselsteiner (2000), Stachel (2003) and Kurz (2005).12 Kuhnke (1990); Sonbol (1991); Gallagher (1993); Ebrahimnejad (2000) and Fahmy (2002) have analyzed the development of medical structures in the

Ottoman Empire, Egypt and Persia in the nineteenth century. Both in Teheran and Cairo, the establishment of medical schools formed a decisive part of

this process.

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‘European civilization’.13 Based on a thorough reassess-ment of contemporary sources, including newspapers andfiles of the Haus-, Hof- und Staatsarchiv in Vienna as wellas a critical review of the secondary literature, this papersheds new light on the substantial and multifaceted Aus-trian part in the process of medical reform in the Ottoman

Empire.

2. Medicine and the relations between the Ottoman and

Habsburg empires up to the 1840s

Even though mid nineteenth-century visitors to theOttoman Empire in their accounts stress the differencesbetween ‘Oriental’ and ‘European’ medicine,14 there isgood reason to assume that methods and concepts of health and sickness that prevailed in the Ottoman Empirewere not much different from those that had been usedby European medicine at least up to the second half of the eighteenth century. Ottoman physicians and theirEuropean counterparts had been in a constant communica-tion and knowledge circulated not just from the West to theEast, but also in the reverse direction—the cowpox varioli-sation being the most widely cited example.15 Medical ser-vices in much of the Ottoman Empire were offered by avariety of practitioners who specialized in treatments of certain groups of symptoms rather than standardized dis-eases and who drew their knowledge from various non-aca-demic sources.16 In addition to these ‘specialists’, whopassed down their skills from generation to generation, amore formal medical education was offered by the medre-

ses. Their course of training, however, differed f rom the

standardized curricula of European universities.17

The central difference between ‘European’ and ‘Otto-man’ medicine was its organisation. While universitiesand the state in Europe had a strong influence on medicinethrough legislation and academic education (including,importantly, examination), in the Ottoman Empire medi-cine remained largely independent from such institutional

influence up to the 1840s. The medical school modelledafter a European example was the first major institutionto challenge this independence and is therefore a turningpoint for medicine in the Ottoman Empire in general.

Considering the bilateral history of the two Empires, thefact that Ottoman officials turned to the Habsburg Empire

for help with the establishment of medical structures is notso surprising. In spite of wars and conflicts, the HabsburgMonarchy and the Ottoman Empire had continuous andintense economic and political relations since the firstmajor military confrontations in the sixteenth century.18

After a period dominated by armed conflicts, culminatingin the siege of Vienna in 1683 and the subsequent wars,at the end of the eighteenth century the Habsburg–Otto-man relations turned into a coalition of common interests.Strongly influenced by the Austrian chancellor Metter-nich’s doctrine of stability that was aimed at an equilibriumof power among the ‘European Powers’, Austria grantedboth military and non-military help to the Ottoman

Empire in order to secure Turkish resistance to Russianexpansionist politics. Next to military instruction and min-ing expeditions, medicine formed a crucial part of this sup-port during the first half of the nineteenth century.19

There were several reasons why the Porte20 gave priorityto the establishment of a western-style medical school inthe late 1830s. The most obvious was the demand for med-ical personnel for the Ottoman army. During the first half of the nineteenth century, medical services in the army wereincreasingly provided by foreigners, whose employmentwas expensive and whose medical skills were often doubt-ful.21 It was certainly not desirable for an army to depend

on the often unreliable medical assistance of Europeanadventurers, whose main interest was to amass a fortune,rather than to provide efficient medical service.

Furthermore, European trade with the Ottoman Empireconsiderably increased during the first decades of the nine-teenth century. At the same time, European public opinionattributed the threat of diseases such as the plague and the

13 A considerable number of articles on the subject have been published by Austrian and Turkish historians of medicine. Most of them drew on the sameset of contemporary sources but failed to provide their critical assessment. A large share of the research on the topic of medical relations between Austriaand the Ottoman Empire has been done by the Turkish historian of medicine Arslan Terziog lu. For a general review of his research, see Terzioglu (1996).Several bilateral symposia of Turkish and Austrian historians of medicine between the mid 1980s and the 1990s discussed various aspects of the topic. Theproceedings of these meetings were published in German and Turkish language and may be found in the reference list at the end of this paper. For a short

English-language monograph on the history of medicine in Turkey, see Kahya & Erdemir (1997).14 One example is the Austrian physician Lorenz Rigler, who wrote a major work on the state of healthcare and typical diseases of the Ottoman Empire.

See Rigler (1852).15 Some historians of Turkish medicine draw a sharp line between what is claimed to be superstitious folk medicine and ‘modern’ European medicine. For

a very insightful discussion of different approaches towards Ottoman medical history see Murphey (1992), pp. 376–381.16 Accounts on these medical practitioners and practices are numerous. Next to the extensive descriptions in Rigler (1852), Vol. 1, pp. 342–361, a report in

the Vienna periodical Wiener Medicinal Halle (1861) is especially informative. See N. N. (1861).17 Kahya & Erdemir (1997), pp. 66–87.18 For a summary of the medical relations between Vienna and Constantinople, see Terzioglu (1974, and extended 1987).19 The long and rich history of relations between these two empires is discussed in a large number of studies. The most recent contribution is the

proceedings of the congress on the bilateral history, edited by Kurz (2005).20 The term ‘Porte’ is shorthand for the Imperial Court and the central authorities in Constantinople, coined by European diplomacy after the main gate

of the Imperial palace.21 European quacks are mentioned in many travelogues of the time: see for example MacFarlane (1829), p. 355, Oppenheim (1833), p. 10, and Rigler

(1852), p. 343. The employment of foreigners seems to have been much more expensive than instructing and employing local physicians. A calculation for

the case of Egypt is given by Sonbol (1991), p. 31.

M. Chahrour / Stud. Hist. Phil. Biol. & Biomed. Sci. 38 (2007) 687–705 689



cholera—which had struck Central Europe for the firsttime at the beginning of the 1830s—to the unsanitary con-ditions in the Ottoman Empire.22 The threat of a new out-break of cholera or, even worse, the plague terrified Europeand increased the pressure on the Ottomans to take stepsfor what Europeans thought to be effective measures

against a new pandemic. The ‘European powers’ urgedthe Ottoman authorities to set up quarantine stations inharbours and on the main land routes, although the effi-ciency of quarantines against plague and cholera was ques-tioned even in Europe.23 A European-style sanitary policecould only be enforced with a sufficient number of trainedexperts familiar with European languages, medical scienceand Ottoman culture. Therefore, the establishment of san-itary institutions and a school able to supply the necessarynumber of specialists who would help set up a new kind of European-style order in medical affairs became importantpreconditions. Additionally, worries about populationdecline were increasingly influencing decisions in the Otto-

man Empire.24 The establishment of a regular civil sanitarysystem, which would not only affect military and commer-cial affairs but also regulate the life of Ottoman citizens in anovel way, thus became a concern of Ottoman politics bythe end of the 1830s and formed one of the major incen-tives for the establishment of a medical school.25

The first major reform undertaken in the field of sani-tary affairs was the establishment of sanitary authoritiesto issue quarantine regulations and organize quarantines.26

During the 1830s, European diplomacy had acquired con-trol over the quarantine administration in some of the lar-ger ports of the empire, notably in Alexandria and Tunis,27

and the central sanitary council had been established inConstantinople in 1838. This Conseil de Sante of Europeandiplomats and representatives of the Ottoman state in Con-stantinople was supposed to supervise and direct the mea-sures taken against the spread of contagious diseases. Forthe administration of quarantines, the Porte asked the Aus-trian internuncio28 in Constantinople to send personnel

from the Austrian quarantine station in Semlin,29 a townon the Ottoman–Austrian border, who were held in highesteem because they were the only experts available whospoke Turkish.30 But language skills were not the only rea-son for this choice.

Ottomans had frequently visited Viennese medical insti-

tutions. The first descriptions of Austrian medical institu-tions in Turkish date back to the seventeenth century.31

Some physicians were sent to Vienna to complete theirmedical studies—most prominently, Mustaf a Mes‘ud, ason of the h

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ekım basi32 Nu‘man Efendi, whose departurefor Vienna caused protest in the Ottoman capital.33 Itwas the establishment of a new military medical school inVienna at the end of the eighteenth century which attractedthe special attention of Ottoman visitors.

Modelled after the plans of Giovanni AlessandroBrambilla under the auspices of Emperor Joseph II, theImperial Medico-Surgical Academy, popularly known asthe Josephinum, offered two courses of medical education,

leading either to a surgical Magister or a doctoral degree(Fig. 1: The Josephinum in Vienna).34 The latter did notlimit practice to surgery, but included medicine as well.Most of the graduates of the academy were employed inthe army and some were additionally responsible for thetreatment of the civil population of the Milita rgrenze, astrip of land under military administration bordering theOttoman Empire.

In 1807, a delegation from the Ottoman Empire visitedthe Josephinum to adopt the concept of the Josephinumfor a school for navy surgeons in Constantinople.35 At thatpoint, the impact of the ‘Austrian model’ on medicine in

the Ottoman Empire was rather limited. The school oper-ated only a couple of years until the building was destroyedby a fire in 1822. Between 1827 and 1838, several similarinstitutions provided medical education. These schoolswere modelled after European institutions, but both theorganisation of instruction and curricula seem to have beendifferent from comparable European schools.36 The new

22 For a discussion of the topic see Delaporte (1986).23 For a very useful study of the complex relations between quarantine regulations, European politics and trade, see Coons (1989). For more recent

discussions of the topic, see Harrison (2006) and Huber (2006).24 Zurcher (2004), p. 9.25 On the Austrian perception of the Ottoman sanitary policy and the early years of tanzimat, see the diplomatic reports in HHStA, PA Staatenabteilung

Turkei VIII, K10–K17.26 Austrian quarantine politics is discussed in Bratescu (1979). The Ottoman Empire’s position in the struggle against the plague and the formation of the

sanitary council are extensively discussed by Panzac (1986, 1996).27 For a description of the involvement of European diplomacy in the establishment of the quarantine authorities of these two ports, see Gallagher (1993)

and Kuhnke (1990).28 Internuncio was the official title of the Austrian envoy to the Ottoman Empire.29 Today Zemun in Serbia.30 HHStA, PA Staatenabteilung Turkei VIII, K11, report of the Austrian Internuncio from 28 March. For an extensive discussion of the establishment of

quarantine administration in the Ottoman Empire, see Panzac (1985).31 See Terzioglu & Lucius (1993b), p. 30.32 Hek ım basi is the title of a physician occupying a leading administrative position, similar to the European protomedicus.33 Nu‘man Efendi was h

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ek ım basi at the imperial court. His son’s decision to study in the ‘land of the infidels’ provoked controversy, because he belongedto a distinguished Muslim family. See Heyd (1993), p. 49.34 On the history of the Josephinum see Jantsch (1956), Wyklicky (1985) and Schmidt (1991).35 Terzioglu (1987), pp. 44–5.36

See Jagailloux (2000).


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Fig. 1. The Josephinum in Vienna (from original at the Bildarchiv, Institut fur Geschichte der Medizin, Medizinische Universitat Wien



medical school, formed in Galata Sarai in 1838 out of twopreviously existing schools, heralded a change in thisrespect. Once again, the Josephinum was to serve as amodel for the new school37 —but this time, the schoolwas to leave deeper marks on the Ottoman health carestructures.

3. ‘Magnificent and well equipped’: the medical school and

the staging of ‘modernity’ for the European public

At the time of the establishment of the ‘Imperial Medi-cal School’, education in the Ottoman Empire was in thefirst stages of transformation towards a more differentiatedsystem. New institutions of advanced education were intro-duced, among them the ru sdiyye-schools that were sup-posed to close the gap between primary and highereducation. Military schools had been set up in Constanti-nople, offering specialized instruction in various fields.Guidance—and influence—in this initial impulse to mod-

ernize the army came from France and many of the mili-tary schools were based on French models. The generalargument that Ottoman educational institutions attemptedto copy European models has been challenged by BenjaminFortna (2002). He points out that especially the late Otto-man state assigned education the task of ‘warding off’ Wes-tern encroachment and that it would be oversimplifying toassume that efforts taken to reform education merely emu-lated European educational institutions.38 Yet this cer-tainly does not apply to the case of the Imperial MedicalSchool, which from its foundation until the early 1860swas essentially a European school on the Ottoman soil.

Planned, established and directed by European scholarsand run on European curricula, it was intended to be anexact copy of a European institution, the Vienna ‘Josephi-num’. But it was precisely this concept that, as we shall see,would cause profound problems.

Metternich’s personal physician Friedrich Jager, whomthe Austrian chancellor had entrusted with the task of find-ing teachers for the new school in Constantinople, chosetwo of his disciples for the mission, Carl Ambros Bern-

hard39 and Jacob Neuner.40 Both had studied at theJosephinum; Neuner was promoted to the rank of a per-sonal physician to Sultan Mahmut immediately after hisarrival. He returned to Austria after the death of his mostimportant patient in 1839 and was replaced by the physi-cian Sigismund Spitzer.41 Together with Lorenz Rigler42,

who arrived two years later, Bernhard and Spitzer becamechief protagonists of medical reform in the OttomanEmpire during the following years.43

These four physicians were not the only Austrians prac-ticing medicine in the Ottoman Empire at the time. In theearly 1840s, several smaller missions of varying numbers of physicians and surgeons from the Josephinum were sent tothe Ottoman Empire, partly to serve with the troops andpartly to reorganize military hospitals.44 Next to thosewho were officially invited via diplomatic contacts, anincreasing number of medical graduates from the universi-ties of the Habsburg Empire, mostly from Vienna, andsome German states, were attracted by the ‘new openness’

of the Ottoman Empire. A position in Constantinople or inone of the provinces, either in the sanitary administrationor in the army, was quite attractive for a young and ambi-tious physician from the Habsburg Empire. Even a recentgraduate could expect a responsible position in the Otto-man Empire and a more than reasonable salary; thoseworking in Constantinople could also run a lucrative pri-vate practice. All in all, the combination of an academicor a civil career with a chance to earn much more moneythan what the pre-revolutionary Vienna offered openedup interesting prospects.45

In its report to the Sultan, the delegation that had visited

Paris and Vienna in 1807 stated that although a similarinstitute existed in Paris, it was not as ‘magnificent and wellequipped’ ( pra chtig und gut ausgestattet) as the Josephinumin Vienna.46 These two expressions were not used acciden-tally. Medical reform did not only mean setting up newinstitutions. Convincing Europeans of the rapid progressin medical education was an essential part of the effortstaken by the new sanitary administration. The impressionthat Western-style institutions in Constantinople left on

37 See the Ottoman documents cited in Terzioglu (1987) p. 46.38 Fortna (2002), p. 12.39

Carl Ambros Bernard, b. 19 December 1808, Starkenbach/Bohemia, d. 9 November 1844, Constantinople.40 Jacob Neuner, b. 30 October 1806, Celje/Slovenia, d. 27 December 1842, Leoben/Styria.41 Sigismund Spitzer, b. 1813 Nikolsburg/Bohemia, d. 1894 Vienna.42 Lorenz Rigler, b. 20 September 1815, Graz/Styria, d. 16 September 1862, Graz/Styria.43 Rigler, Bernhard, Neuner and Spitzer are the most prominent of the Austrian physicians who were in the Ottoman Empire at the time. Biographical

sketches can be found in Terzioglu (1987); Terzioglu & Lucius (1993a,b). The reconstruction of other doctors’ biographies, including Warthbichler,Popovich, Weingartshofer, Reinwald, Hermann, Eder, Blau and others mentioned in the sources, is part of the author’s ongoing research.44 There is no exact count of the number of physicians from the Habsburg monarchy sent to the Ottoman Empire as an ‘official’ mission. Available

sources indicate that the total number of physicians sent on request of the Ottoman government was between twelve and fifteen. Most of them wereoperating in the Constantinople area, but at least one mission was also working in Palestine. For the reports on a mission of physicians sent to Palestine,see HHStA, PA Staatenabteilung Turkei VIII, K 16.45 Next to those posted officially, there was a large number of physicians from the Habsburg Empire who were practising medicine in lower ranks of the

Ottoman army and in towns in different parts in the Empire. Rigler (1852), Vol. 1, p. 394 comments on the salaries paid for medical personnel in theottoman army. In a letter to the Viennese anatomist Joseph Hyrtl, the Austrian physician Alexander Sotto gives and idea of the income of a Europeandoctor in Constantinople. See Gasser (1994), p. 114.46

See the report cited in Terzioglu & Lucius (1993b), p. 30.




European visitors formed an important part of how theyassessed the progress of reforms in the Ottoman Empire.47

By the mid-1840s, the medical school in Constantinoplewas one of the key institutions used to ‘advertise’ thereform efforts of the Ottoman Empire. It was in the mutualinterest of both the Ottoman and the Habsburg Empire to

publicly promote these medical reforms. While the Otto-mans were under pressure by the European powers toimprove their sanitary administration, the HabsburgEmpire was pursuing its own anti-quarantine policy, aimedat reducing the number of quarantine stations. ‘Medicalprogress’ in the Ottoman Empire, consisting of an educa-tion that could stand comparison with similar Europeaninstitutions and the establishment of a sanitary administra-tion contributed to this policy, as we shall see later.48 Mag-nificence in style and setting and ‘state of the art’equipment therefore became the main features of the med-ical school.49

The list of acquisitions for the newly established school

in 1838 is impressive. More than 1,000 books were boughtin Europe and shipped to the school in Constantinople thatat its beginning had only a handful of students capable of reading European languages.50 Experimental tools forphysics and chemistry were bought in London with fundingfrom the Sultan. A large number of anatomical modelswere bought in Paris, at 4,000 francs a piece, and inVienna.51 A gardener was brought from Vienna to set upa European-style botanical garden. The school itself wassituated directly in the vicinity of the imperial palace, thusenhancing the impression of ‘magnificence’ it was supposedto convey to its frequent European visitors.52

The description of the dissection room by the Russianphysician Artemis Rafalowitch after he was taken on a tourby Bernard’s successor, Spitzer, illustrates the efforts takenin order to make the school a real showpiece of thereforms.

The dissection room was bright, the floors were covered

with marble, there was a pond in the middle with a foun-

tain, which could be shut down with a mechanism.

Around it, there were four marble tables where the

corpses were dissected. Each marble table stood on

top of a bent foot. There were pipes on these bent feet

through which the water that washed the corpses flew.The water flew through a hole in the middle of the table.

After flowing through the pipes, water reached a marble

basin in front of the table.53

The description of this bright room decorated with marbleand its technical equipment is of special interest for tworeasons. First, Rafalowitch had been sent on his trip bythe Russian government to assess the danger of a new out-break of cholera and to give an account of the ‘sanitaryconditions’ in the Ottoman Empire.54 The brightness andcleanliness of the room contrast sharply with descriptionsof the darkness and shabby facilities in other places, even

in Europe.55 A properly equipped medical school was goodnews for the Russian government. Secondly, the fact thatdissection was practised in the school was an argumentfor the readiness of the Ottoman government to reform.It was commonly assumed in Europe that the Quran for-bade dissection.56 Teachers of the school presented the factthat dissection was part of the curriculum as a majorachievement for which they had to fight. Dissection wasturned into a symbol of civilization itself. ‘Who would havethought this possible ten years ago?’ asked rhetorically theAustrian diplomat Victor Weiß von Starkenfels in an 1843description of the dissection hall, praising Spitzer’s ef-

forts.57

While restrictions in using the corpses of Muslimsdid exist, a general ban of dissection, as had been reportedby Europeans to illustrate Ottoman backwardness, hadnever been issued, nor did the sunna explicitly prohibitit.58 As a matter of fact, dissections had been performed

47 For an insightful description of the staging of European visits to the medical institutions in Cairo, see Fahmy (1998).48 Francis Delaporte has pointed out that during the first cholera epidemics in Europe the battle against this disease was seen as a struggle between

‘Civilization’ and ‘Barbary’ in which Europe and the Orient were opposing each other. In a contemporary account of the cholera epidemics in Paris, aFrench physician states that ‘the admirable people of Paris, who are so heroically confronting the cholera of poverty . . . were not made to serve as fodderfor the cholera of Asia and to die like Slaves in pain and terror . . . One more step for France and Europe will be in a position to teach the East that the sun

has changed course and that henceforth the day is dawning for the nations in the West of the old world’ (Delaporte, 1986, p. 2).49 Attempts of the Ottoman Empire to influence public opinion in Europe are discussed in Davison (1995), who argues that the main task of Ottoman

diplomats was to influence European public opinion rather than perform ‘classic’ diplomatic duties.50 Terzioglu (1987), p. 48.51 Allgemeine Medizinische Central–Zeitung (1840), p. 623.52 Accounts of visits to the medical school and regular short notices were published in German and Austrian periodicals such as the Allgemeine

Medicinische Central-Zeitung , Medicinische Jahrbu cher des k. k. o sterreichischen Kaiserstaates, Zeitschrift der k. k. Gesellschaft der A rzte, Sonntagsbla tter

des Wiener Boten and later in the Wiener Medizinische Wochenschrift and the Wiener Medizinische Presse.53 Allgemeine Medicinische Central–Zeitung , 68 (1844), p. 23. The English translation is taken from Terzioglu (1995, p. 95).54 Kuhnke (1990), p. 208.55 On the poor state of the anatomical dissection hall of the University of Vienna, see Chapter 3 in Buklijas (2005).56 See for example the simplistic explanations by the anatomist Joseph Hyrtl (1879).57 Sonntags–Bla tter, 16 April 1843, p. 363.58 Many studies of the relation between Islam and medicine fall back to vague terms such as ‘Islamic ethics’ (Ebrahimnejad, 2000, p. 174) when trying to

define why dissection was controversial in Islamic countries. For an interesting discussion of the topic in Ottoman/Islamic context, asking if there is any

Quranic or non-Quranic legal basis for a ban of dissection, see Maskar (1978).




in the school of marine surgeons in Constantinople as earlyas 1807/1808.59 Nevertheless, the Austrian physicianswanted to give the impression that they had introduced dis-section in the Ottoman Empire.60

The majority of early reports were full of praise for theachievements of Bernard and his successor Spitzer. Almost

no visitor of the school neglected to mention that the pre-sumed resistance of conservative religious circles had beenovercome and the establishment of the school had beenmade possible by an enlightened Sultan and his ‘brave’European counsellors. Again, Rafalowitch’s words arerevealing:

Thus, the Institute improved with every year against the

resistance and the dark attacks of intrigue, which in the

classical land of the Orient is almighty and has now

reached a degree of development, which does honour

to the government and those persons who, in spite of

the numerous difficulties, bravely followed the noble

aims.61

The diplomat Victor Weiß von Starkenfels praised the

unselfish help granted by the Habsburg Monarchy,

claiming that, henceforth, the Porte was obliged to call

Austria its oldest and truest friend.62

The Habsburg Empire’s ambitions were not as selfless asStarkenfels’s statement suggests. Transferring Europe’s‘first line of defence’ against contagious diseases as far tothe East as possible had been a major aim of Austrian eco-nomic policies since the end of the 1830s.63 The AustrianLloyd, which had established steamship connections

between Trieste and the major ports of the Levant, exertedpressure on the Austrian administration to reduce andeventually drop quarantine restrictions for ships arrivingfrom these ports.64 For travellers and goods delivered bythese ships, quarantine meant a delay in their journey of up to three weeks. The same was true of the continentalborder between the two Empires. Quarantine restrictionswere less strict along the land border, but the stations withtheir bureaucratic procedures were nevertheless considereda major impediment for trade. The dermatologist CarlLudwig Sigmund, who would later become one of the mosteminent medical experts on contagious diseases in theHabsburg Empire, explicitly requested a shift in quarantinepolitics during the 1840s. In his pamphlet Zur Pest- und

Quaranta nefrage Sigmund argued that, in the long run,

the plague and cholera should be fought in their countriesof origin—in his opinion, in the Ottoman Empire andEgypt.65 ‘After all . . . we will come to the conclusion thatit is safer and more just to set the home of the plague underquarantine and to seclude it from the rest of the world’,than to rely on the costly and unreliable quarantines in

Europe.66

In the context of this discussion overshadowingEurope’s relations with the Ottoman Empire, the effortsof the Austrian physicians appear in a different light.

Next to the efforts in establishing quarantine stations,the continuing positive reports by visitors of the schooland other European-style medical institutions in the Otto-man Empire played a substantial role in the gradual shift of Austrian (and European) quarantine politics. As soon asthe first reports of the successful establishment of theschool and the work in the quarantine administrationand other fields of Ottoman healthcare reached Vienna,the Austrian Hofkanzlei —the central administrative unitresponsible for quarantine affairs—decided to reduce quar-

antine for ships coming from Turkey to eleven days. In1844, what was called ‘further medical progress in the Otto-man Empire’67 enabled the Hofkanzlei to issue furtherquarantine reductions for all ships arriving from theLevant. By 1847, quarantine in seaports had practicallybeen abolished for the ships of the Austrian Lloyd.Similarly, the restrictive quarantine regulations at theHabsburg–Ottoman border were abandoned during the1850s.

After Sigismund Spitzer had taken over the directorshipof the school in 1844/1845, it was about time to present thesuccess of the school back home. In 1847, Spitzer sent four

of his best students to Vienna to take the Rigorosum, thefinal examinations, and earn doctoral degree at the medicalfaculty of the University. Again, the report of this ‘exoticvisit’ in the popular Sonntagsbla tter was rather euphoric.The results of the examinations were ‘convincing’, statedthe author of the report, himself a physician, not withoutnoting, however, that Spitzer had asked in advance to havethe emphasis of the exams put on practical skills ratherthan theoretical knowledge.68

In Constantinople, the Sultan himself regularly visitedthe school at the end of each academic year, thus par-ticipating in the ‘staging’ of the school’s success (Fig. 2).His visit in the summer of 1847 is described by theBritish physician John Mason, who was a guest at thefinal examinations:

59 Terzioglu & Lucius (1993b), p. 35.60 See for example Rafalowitch’s account in Das Ausland (1847), p. 420, in which he describes what he thought had been the first dissection ever done in

the Ottoman Empire.61 Ibid.62 Sonntags–Blatter, 16 April 1843, p. 364.63 Coons (1989), p. 47.64 Ibid., p. 48.65 Sigmund (1847).66 Ibid., p. 21.67 Coons (1989), p. 51.68

Sonntags–Bla tter, 2, (1848), p. 26.




Fig. 2. The Sultan visiting his medical school (from original in the archives of the Department of Medical History, Istanbul Medical Faculty, Istanbul U



On the first day of August, the examination of the stu-

dents of the Turkish medical college of Galata Serai

. . . took place with great p.omp and ceremony. Every

year at the end of the academical session, his majesty

the Sultan accompanied by his ministers and the highest

functionaries of the Empire repairs to this medical col-

lege at the Galata Serai. This imposing ceremony, whichtestifies the great interest taken by the Sultan in the pro-

gress of letters, and in the development of public instruc-

tion in his empire, occurred this day . . . with all the

usual pomp . . . Three students, a Mussulman Djafar

Effendi and two Christians, Nekefar and Stephane Ilias,

were separately examined in presence of the Sultan; their

answers were completely satisfactory. They were after-

wards habited in the robe of the doctor of medicine

and took the oath—the Mussulman upon the Koran,

and the two Christians upon the New Testament. The

prizes were then distributed to the students according

to their merits, and the examination was concluded by

some questions on physical science, answered by one

of the students, Constandi Belisaire, and several experi-

ments, which perfectly succeeded and were witnessed

with much interest by the Sultan and all his ministers.

Never on any occasion had the examination been con-

ducted in a more satisfactory manner, and his Majesty,

at its close, testified his entire approbation to the profes-

sors and employees of the college.69

The positive publicity for the school contrasted with its ac-tual success. Most descriptions of the school mentioned theimpressive number of up to 400 students taught in the insti-

tution. Yet a closer look at the statistics shows that only fewreached the final examinations and, as we shall see later, thequality of the education did not come up to the Europeanstandards its Austrian founders had been claiming to offer.

The curriculum was very similar to its model, theJosephinum. Five years of medical studies led to a doctoraldegree in surgery that included a licence to practise in allfields of medicine. Neither German nor Turkish but Frenchwas chosen as the language of instruction, mainly becausein the early 1840s the literature that was considered ‘cuttingedge’ was predominately in French. Besides, French hadearlier been used in other military institutions.70 The Sul-tan, however, stated at his inaugural speech that the trans-lation of medical knowledge into Turkish was an important

aim of the school.71 Concerning the language and methodof instruction, the Austrians could rely on the experience of their French colleagues in Cairo, where a medical schoolhad been set up by the French physician Antoine Barthel-mey Clot (Bey) in 1827.72 In the Cairo school, French wasthe language of instruction, but instead of teaching the lan-

guage to the students to enable them to follow the courses,a complicated system of translation and supervision wasused in the classes. Even more problems were created bythe fact that most of the technical terms used in teachingdid not exist in Arabic and had to be created anew. The dis-advantages of this system were described by the Austriantraveller Joseph Russegger (1802–1863) who worked inEgypt in the 1830s and whose writings were probablyknown to the Austrian physicians in Constantinople.73 Inorder to balance the lack of general education among thestudents and to teach them French, preparatory classesof three years duration were introduced as a mandatorypart of the school.

During the first ten years of the school’s existence, moststudents took these preparatory classes, but without suc-cess. In 1847, 238 out of 454 students were in the first of the preparatory classes—and none of the actual medicalclasses held more than 15 students,74 even though theschool had had more than 300 students from its very start.In 1843, only 80 out of 340 students managed to advance tothe next class, while the others failed to meet the expecta-tions of their teachers and had to remain on the same levelfor another year.75 Despite the fact that in the same yearthe first army surgeons had finished the school and threeof them acquired a doctoral degree—they had been admit-

ted to the school without preparatory tuition—improve-ments in the curriculum seemed unavoidable. By 1845,another two years were added to the preparatory classes,one of them exclusively for reading and writing. In 1847,Sigismund Spitzer reported to the Sultan that ‘severalyoung pupils who were summoned from the provinces . . .

to study medicine and to serve as physicians in the commu-nities who chose them, have been sent home again onaccount of their complete ignorance, and will be replacedby others, who can fulfil the conditions now demandedby the regulations of the school’.76 The state in which theywere admitted to the school was ‘deplorable’, as most of the students were poor and had not received any primaryeducation comparable with the compulsory schooling in

69 Mason (1860), p. 155. Note that two of the three students mentioned here are Christians. From the very beginning, Christian students of the schoolwere said to be excelling in their studies. This fact is regularly used in accounts of European visitors, usually connected to the notion that Muslims arepromoted to higher ranks after their studies anyway, irrespective of their academic success. See Wiener Medicinal Halle, 52 (1862), p. 491.70 Kazamias (1966), p. 52.71 Panzac (1996) p. 111. French nevertheless remained the language of instruction in the school up to 1870. Even then, the European teachers of the

school resisted the change, claiming that Turkish would not work as a language of instruction. _Ihsanoglu & Gunergun (1994) pp. 127–134.72 See Sonbol (1991).73 See Russegger (1842), p. 99.74 Mason (1860), p. 177.75 Kernbauer (1993a), p. 176.76 Mason (1860), p. 178. This and the following quotations are taken from an English translation of Spitzer’s annual report to the Sultan for 1847,

published in ibid.




the Habsburg Monarchy. ‘These children . . . who manifestthe best character and disposition, arrive here covered withrags, speaking a corrupt dialect, incapable in general of either reading or writing, with a hatred to all intellectuallabour, and abhorring the state to which they are destined’,he declared in his report to the Sultan in 1847.77 He even

confessed that the qualification of the first physicianswho had left the school rather resembled those of the ‘offi-cers of health’ in the major European armies.78 As theschool’s inability to meet the aim of continually producinga large number of physicians became obvious, a secondoption was introduced, allowing those who failed the finalexaminations in the first run to try again after one year of practical instruction in a hospital. If they failed again, theywere given the rank of medical officers and left without adoctoral degree.

The lack of primary education remained a commoncomplaint in many of the reports by the Austrian physi-cians. While in the Habsburg Empire primary education

was compulsory since the second half of the eighteenth cen-tury and medical students were required to have a basictraining in their native language, Latin and philosophy, acomparable standardized education did not exist in theOttoman Empire. Even though first steps of reform in pub-lic instruction had been taken by then, secondary educationwas still in its infancy.79 In 1846, the Ottoman governmentappointed a committee to investigate options for a com-plete overhaul of education in the Empire. Its report rec-ommended a three-stage system consisting of primary,secondary and higher schools and the establishment of anOttoman University, the daru lfu nu n.80

Spitzer suggested a two-year course of higher education,similar to the compulsory Philosophicum at the universitiesin the Habsburg Empire, to raise the level of general educa-tion of school entrants. The problem of the language of instruction, which was foreign to both teachers and studentsand therefore very likely a cause of the poor education, waslargelyavoided in official reports. Visitors saw in the fact thatthe Ottomans had to study a European language to obtaineducation a chance for what they called ‘civilization’, andhardly ever an impediment to instruction.81

The German botanist and physician Karl Koch visitedthe school in 1843 and his account gives a good idea of how the school was presented to visitors in spite of all these

difficulties. His sceptical attitude—Koch was very criticalof the Ottoman reform policy—makes his description espe-cially revealing. The director of the school, Carl AmbrosBernard, took Koch on a tour of the school and the newlyopened clinic that was attached to it. In the hospital, Kochnoticed the order and cleanliness that would stand compar-

ison with any clinic in Vienna or elsewhere in Central Eur-ope.82 When taken to the language courses attended bystudents from the lower classes, Koch was impressed bytheir rapid progress, although he suspected that only thebetter students were asked questions. The same was truefor the clinical instruction that Bernard invited him tosee. Koch mentions, quite sceptically, that he was ‘amazedby the students’ answers’ to Bernard’s questions during theexamination of patients.83

After Bernard had left, the professor of botany tookKoch to the botanical garden. It had been arranged bythe gardener Joseph Skalak from Vienna, who had beenin charge of the garden since 1840.84 He had been dismissed

by Bernard only a few weeks before Koch’s arrival after aserious disagreement. Upon leaving the school, Skalak hadremoved the signs showing the plant names and swappedthem randomly. Nobody noticed this change and evenwhen Koch pointed out the mistake, the professor of bot-any remained unimpressed.85

Koch’s account is symptomatic of the state of the schoolin this early stage. The standards of tuition were not as‘European’ as official reports by the Austrian patrons of the school claimed—and, as we shall see later, conse-quences would follow.

4. ‘Pillars of civilization’: healthcare as part of a ‘civilizingmission’ for the Ottoman Empire

While struggling with the operational problemsdescribed above, the Austrian physicians gained influencein another field where their work was to leave deepermarks. Having successfully treated the Sultan Abdulmecitin 1845, Sigmund Spitzer became a friend of the Sultan, ayoung man in his early twenties. Spitzer was officiallyappointed a court physician with unlimited access to theSultan.86 Spitzer’s close relation with the sultan wentbeyond a purely private friendship. How he perceived hisposition as an Austrian official on a mission in a foreign

77 Ibid., p. 165.78 Ibid., p. 193.79 The most recent studies of the development of the educational system in the Ottoman Empire during the nineteenth century are Somel (2001) and

Fortna (2002).80 Kazamias (1966), pp. 56–60.81 Carl Ambros Bernard, the first director of the school had studied Turkish himself. It is not clear whether he had planned to change the language of

instruction, but he published several books in Turkish, obviously intended for an audience wider than the students of his school. For more biographicalinformation on his Turkish publications, see Skopec (1987).82 Koch (1846), p. 253.83 Ibid., p. 254.84 HHStA, PA Staatenabteilung Turkei VIII, K 16, 12 May 1841.85 Koch (1846), p. 255.86

For a general view of Spitzer’s position at the court see also Kernbauer (1993b).




country is documented by various official reports writtenfor the Austrian internuncio in Constantinople. Thesereports contain accounts of personal conversations andof the situation at the Ottoman court.87

At the time Spitzer was admitted to the imperial court,the Imperial Rescript of Gulhane had already led to several

changes in Ottoman politics. As far as medicine was con-cerned, reforming the empire meant increasing the state’sgrip on the way healthcare services were delivered to itssubjects, independent of their religious or national affilia-tion. Whereas the traditional organization of civil healthservices had been largely arranged on the local level withinan unregulated healthcare market or by religious commu-nities, the new politics tried to offer something akin to arudimentary secular public health system.88

The multinational Habsburg Empire with its Josephinisthealthcare structure was, in many respects, the best modelfor these measures.89 Under the auspices of Bernard andhis successor Spitzer, many measures aiming at regulating

all sorts of medical services available to the people wereput into practice: vaccination programs were initiated,the construction of larger hospitals was funded and a vari-ety of sanitary regulations were introduced.

The medical school in Constantinople played a key partin the implementation of these changes. This wider scope of duties assigned to the school and its graduates resembledthe situation of its model, the Josephinum in Vienna. Sur-geons trained for the army at the Josephinum were alsoprepared for civil duties, especially for the care of the pop-ulation in the Militargrenze: they learnt legal medicine(Staatsarzneikunde), as well as obstetrics and other subjects

that were not necessarily important for a strictly militarysurgeon. The Josephinum offered a separate half-yearcourse for the training of midwives who were supposedto work in the Milita rgrenze after their graduation90 andthe Military Hospital (Garnisonspital ) in Vienna served asa clinic for the student instruction.

The Constantinople school was organized in a similarway. From its very beginning, legal medicine and coursesin ‘sanitary police’ were part of the curriculum. A schoolof midwifery, in which both midwives and prospective phy-

sicians were trained by an Ottoman physician and a mid-wife from Vienna, and a two-year course inpharmaceutics, directed by the Austrian pharmacist Hof-mann, were established.91 Simultaneously with the founda-tion of these courses, the government issued regulationsthat aimed to force those wishing to practice midwifery

or pharmacy to attend the school. As early as 1838, a com-mission had been appointed to ban voluntary abortion inthe Empire. Midwives, physicians and pharmacists wereforbidden to practice abortion and had to swear an oaththat they would not do so.92 From 1847, pharmacists wereonly allowed to open or take over a shop after havingearned a degree at the school.93 In the same year, Spitzerestablished a chair of legal medicine and medical police.Two of the school graduates were recruited by the policeas counsellors in medico-legal matters.94 It remains unclearhow effective these measures were, but the 1853 punish-ment of a pharmacist who had been found guilty of mal-practice and the public announcement of the case in the

government newspaper indicates that medical policeremained an area of central importance to the governmentofficials in subsequent years.95

By making the school more than an institute for theeducation of military surgeons, its founders had alsosecured political influence for its teachers. This, however,turned out to be an impediment to the school’s academicdevelopment. In 1844, Bernhard proposed the foundationof an academic council whose members would berecruited among the school’s professors.96 Originally, thecouncil was only responsible for affairs directly relatedto instruction and its decisions were subject to mandatory

confirmation by the h_ ek ım bas

i . As the school becameinvolved in the health care administration of the Empire,however, its council of professors was given a wide rangeof duties and competences. Most importantly, the councilobtained judiciary power in all professional conflicts,making membership in the council desirable for everyphysician. This resulted in a constant growth in the num-ber of teachers who were appointed without respect totheir academic merit, mainly due to the protection theyenjoyed.97

87 Spitzer’s close relation with the sultan during those years is documented by various official reports written for the Austrian Internuncio in

Constantinople. These reports contain accounts of personal conversations and of the situation at the Ottoman court. See HHStA, PA StaatenabteilungTurkei VI, 1845–1852.88 For a discussion of Ottoman health care in the pre-Tanzimat era, see Murphey (1992).89 The era of Emperor Joseph II was a period of ‘enlightened reform’ in the Habsburg-ruled provinces, introducing centralized structures in various fields,

including education and medicine. For a detailed description of the reformatory efforts of Emperor Joseph II in healthcare, see Lesky (1959).90 Steiner (1860) p. 78.91 Some students of the school of midwifery appear to have been slaves. In his annual report of 1847, Spitzer mentions that among the students of

midwifery an Arab slave woman, named Fatma, had shown the greatest talent (Mason, 1860, p. 178). For midwifery and the role of women in Ottomanhealth care, see Sarı (1997); for an interesting comparison with the school of midwifery in Cairo, see Fahmy (1998).92 HHStA, PA Staatenabteilung Turkei VIII, K11, 16 November 1838.93 Mason (1860), p.180.94 Ibid.95 See Altintas (1998).96 See Kernbauer (1993a), p.176.97 In 1862, Wiener Medicinal Halle went as far as claiming that ‘the school seemed to be existing for the professors and not the professors for the school’

(Wiener Medicinal Halle, 52, 1862, p. 491).




These measures and regulations gave the school muchmore importance than a simple academy for military sur-geons would have been expected to have. During the1840s, the school became a focus for centralized healthcareactivities in the Empire. Large vaccination campaignsagainst smallpox were started, using the students of theschool as vaccinators in a clinic set up in the medicalschool. The academic year 1841 saw 3,000 children beingvaccinated there,98 and in 1847 Spitzer claimed that inConstantinople alone close to 100,000 children had been

vaccinated.99

Another 80,000 children were vaccinated inthe provinces, partly by five students sent to accompanyEuropean scientific expeditions going to various provincesof the Empire and partly by local vaccination clinics.100

In 1845, every province of the Empire was invited tosend five students to Constantinople to study at the

school.101 After their education at the institution, they weresupposed to return home and work as physicians or phar-macists in the local communities. Similarly to the Austriansystem, in which Kreisa rzte (district physicians) supervisedthe provinces, the Ottoman provinces were supposed toemploy these physicians.102 The new politics followingthe Imperial Rescript of Gulhane aimed at attracting mem-bers of the non-Muslim groups of the Empire to enrol inthe school. Sigismund Spitzer, born into a Jewish familyhimself, especially encouraged the Jewish community to

send students to the school (Fig. 3). Theoretically open toall confessions from its very beginning, the school hadnot seen any Jewish students until 1845. The Jewish com-munity had been reluctant to send students and was con-vinced only after negotiations between the h

_

ek ım basi and the grand rabbi.103 A cook and a rabbi were employed

Fig. 3. Sigismund Spitzer (from original at the Bildarchiv, Institut fur Geschichte der Medizin, Medizinische Universitat Wien; used with permission).

98 See the annual report published in the Allgemeine Medicinische Central–Zeitung , 13 (1844), p. 223.99 Mason (1860) p. 184. This number includes vaccinations in two separate stations outside the school and in the military hospitals.100 Ibid.101 In 1845, the establishment of military preparatory schools in provincial centres was also decided. Their graduates were to be sent to the Imperial WarAcademy in Constantinople and possibly other schools in the capital. Somel (2001), p. 23.102 Annual report to the Sultan for 1846 in Kernbauer (1993a), p. 178.103

Mason (1860), p. 178.




by the school to provide proper environment for the stu-dents. This attempt to involve the third major religiousgroup of the empire—Muslims and Greek and ArmenianChristians had been enrolled in the school from its verybeginning—was successful. In 1856, the Austrian travellerLudwig August Frankl noted in his travel diary that there

was a group of sixteen Jewish students at the medicalschool and that one of the first Jewish doctors becamethe director of a military hospital in Aleppo.104

In Constantinople, the school directly offered medicaltreatment at its clinic and the attached ambulatory. Thelatter treated 18,500 patients during the year 1847, a con-siderable share of whom were women who came to see amidwife f rom Vienna placed in charge of femalepatients.105 The increasing number of patients in the ambu-latory led to the inauguration of two new, similar institu-tions in other parts of the city, in which students of theschool were also given practical instruction.106 The con-struction of state-owned hospitals became one of the most

prestigious projects of these years. New physicians fromthe Josephinum were called to Constantinople during theearly 1840s to take over the directorship of the larger mil-itary hospitals. One of them was the young Lorenz Rigler,whose successful introduction of new sanitary regulationsin a hospital that had seen extraordinarily high rates of mortality due to unsanitary conditions was celebrated inVienna as a major success of Viennese medicine.107 Subse-quently, he was promoted to the rank of a chief inspectorof the medical services in the Ottoman army.

Like the school, these large Constantinople hospitalsbecame the showpieces of the new Ottoman policy. In

1853, the physician Joseph Dietl108

travelled to Constanti-nople on a ‘fact-finding mission’, to gather informationfor the construction of a new hospital in Vienna. Dietl,who was well aware of the work of his countrymen, was sur-prised to find that Constantinople had a number ‘of not onlysufficient, but good’ hospitals and that Constantinople haddone more for the construction of new hospitals than ‘somerich cities of civilized Europe’.109 Dietl considered the Mar-ine Hospital, then under the direction of a graduate of theVienna School of Medicine, one of the best equipped in Eur-ope. The larger military hospitals and some of the civil insti-tutions were described in a similarly favourable way.

The praises of extraordinarily rich food, cleanliness andorder in the Ottoman hospitals stand in contrast with thelack of patients in most of them. Especially the non-military

institutions were virtually empty because women avoidedhospitals in which men were responsible for the treatment,and the population in general preferred the care of the f amilyto the regulated concept of a European hospital.110 Thisemptiness of the hospitals resembles the school’s shiny sur-face under which many problems were hidden during its

early years. Both symbolised the Ottoman Empire’s willing-ness to keep up with what was considered to be Europeanstandards at any cost and reflected the ambitions of theEuropeans running these institutions. The latter perceivedthemselves as agents of a larger process of ‘civilization’.The school, the hospitals and the first steps towards a ‘Euro-pean-style’ public health care meant more to the Austriansthan simply offering medical services. In Spitzer’s opinion,physicians graduating from the school would play a key rolein the process of reform in the Ottoman Empire and wereassigned the duty of ‘civilizing’ the country.

As a physician, he has intercourse with every class of

society that is capable of exercising considerable influ-ence on all classes of society. Restored to his native

province, he finds his own family, his countrymen, at

first cold and reserved on seeing the complete change

effected in him, become soon actuated by different sen-

timents overcome by the ascendancy with instruction,

elevation of character and the office of physician always

gives to him who exercises this profession in a worthy

manner. These men learn to recognize his superiority,

appreciate his merit, his professional services and social

position, and desire to procure similar advantages for

their own children. This young physician will exercise

great moral influence upon his countrymen, and, if he

be at the height of his social position, will be one of

the pioneers and pillars of civilization.111

Spitzer’s enthusiastic report to the Sultan tells us very muchabout his own ambitions and the plans the Austrians werepursuing. In his view, medicine served as an important argu-ment in the process of ‘modernizing’ the Empire. Those whostill doubted the ability of the Ottoman Empire to reform it-self ‘will see that the people of the East are accessible to civ-ilization—that they are capable of acquiring every species of knowledge—that their character becomes softened, and thatreligious intolerance, less strong in Turkey than in manycountries in Europe, begins to disappear, and to give placeto sentiments of equity, which, as far as regards education,at least, makes no religious distinction’.112 Through its key

104 Frankl (1858), p. 222.105 The surname of this midwife was Messani. Her first name is not known.106 Mason (1860), p. 185.107 A description of his work and the measures taken in the hospitals is in Wiener Medizinische Wochenschrift, 42 (1862), p. 667.108 Joseph Dietl (1804–1878) is known in history of medicine as an exponent of the controversial idea of ‘therapeutic nihilism’. He was a member of the‘Second Vienna School’ of the mid nineteenth century. On Dietl, see Wiesemann (1991).109 Dietl (1854), p. 317.110 Reports on the emptiness of newly opened hospitals may be found in Rigler (1852), Vol. 1, p. 382, Dietl (1854), p. 331 and in various reports incontemporary medical journals.111 Mason (1860), p. 172.112

Ibid., p. 19.


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role in many of the measures and regulations taken by Otto-man authorities, the school’s impact as a main agent of ‘med-icalization’ in Ottoman society went far beyond simpleeducation. The school indeed set in motion a process thatwas to lead to a gradual but irreversible change of the med-ical structures in the Ottoman Empire.

5. A failed ‘mission’? The end of Austrian influence on the

medical school and its consequences

In the early 1850s, the impact of physicians from theHabsburg Empire on Ottoman medical affairs came to arather sudden end. Sigismund Spitzer, who had a strongpersonal influence on the Sultan and affected many deci-sions during the early stage of the public health system, leftConstantinople for Vienna in 1850, after his life had beenthreatened in the course of a plot against the Sultan’s life.Some of the Austrian physicians who had held importantpositions in the Ottoman sanitary administration had either

died or returned to the Habsburg Monarchy. Lorenz Rigler,the former head of the military hospitals, was the only mem-ber of these official missions to remain in Constantinopleafter 1852. The revolution of 1848 and the end of the ancien

re gime under Metternich, whose personal interest in Otto-man affairs had been one of the pillars of Habsburg–Otto-man relations, cooled down the Habsburg Monarchy’sinterest in sending new personnel and supporting Ottomanreforms.113 But the revolution in the Habsburg monarchywas not the only reason for the Austrian retreat.

Public criticism of the school as an academic institutionhad started in Europe by the end of the 1840s. In an article

in a Paris medical journal, the French physician AugusteMonneret, then on a mission to inspect the progress of medical reform and quarantine administration in the Otto-man Empire, criticised the poor quality of the education atthe school.114 Once again, the juxtaposition of Europeancivilisation and the ‘uncivilized Orient’ served as the mainargument—but in this case against the work of the physi-cians from the Habsburg Empire. Monneret’s claim thatmedicine could not be moved to an ‘uncivilized country’as easily as some kind of a technical development waswidely discussed as an explanation for the observation thatthe Austrian’s efforts had not been as successful as it hadbeen described in their own earlier accounts. The Berlinbased Allgemeine Medicinische Central-Zeitung welcomed

Monneret’s account, for previous reports ‘had been biasedby partial interests of Austrian physicians’.115 The latter,however, remained confident. ‘We are well aware of the jealousy of the French who are naively trying to questionGerman success’, replied Lorenz Rigler to the French crit-icism of the school in 1852,116 trying to conceal the fact

that the position of the Austrian physicians had becomeweak.The Crimean war, in which Austria remained neutral

and British and French physicians came to the OttomanEmpire in large numbers revealed the weaknesses of theeducation at the medical school. European medical profes-sionals who were serving in one of the allied—French, Brit-ish or Ottoman—armies heavily criticised the lack of ability of the physicians trained in Constantinople. TheBritish physician John Netten Radcliffe, who had beenattached to the staff of Omer Pasha during the war, statedin his memoirs that some of the Turkish physicians had a‘highly creditable acquaintance with their profession in its

different branches, but others, and by far the greater num-ber, are very ignorant’. The surgery he saw in the hospitalswas ‘exceedingly barbarous’ and medical practice ‘of asomewhat haphazard description’.117 Humphrey Sandwith,who had been serving in a British unit during the siege of Kars, was more sympathetic towards Turkish medicalpractitioners but still critical: only a few among his Turkishcolleagues deserved to be called ‘fair operators’ and ‘wellgrounded in the principles of their profession’.118 Thesereports that indicated the failure of the school to producea sufficient number of physicians or at least army surgeons,who in the eyes of their colleagues from France and Britain

performed at ‘European standards’, were, of course, lesswidely discussed in Austria than the previous reports bytheir Viennese colleagues.

In Vienna, medical journals accused the French physi-cians in Constantinople of stealing what was considered achild of Viennese medicine. Two years before the outbreakof the Crimean war, the Wiener Medizinische Wochenschrift

complained that French physicians had gained total controlof the school in Constantinople, as the French professorAntoine Fauvel had taken over directorship from SigmundSpitzer upon the latter’s return to Vienna in 1850.119 Allega-tions indicating that the French physicians owed theirpositions mainly to diplomatic pressure and not theirscientific skills were frequent.120 After the revolution of

113 Besides, the Ottoman Empire had gained a considerable number of medical specialists in the aftermath of the revolution, as many Austrian–Germanand Hungarian physicians sought protection from prosecution in the Ottoman Empire. Especially physicians of the Hungarian Honve d (army) fled thereafter the defeat of the Hungarian Revolution in 1849. The Vienna-educated Karl Eduard Hammerschmidt, who later founded the organisation todayknown as the ‘Red Crescent’, and Dr Arnold Mendelssohn, a German revolutionary and cousin of the composer Felix Mendelssohn-Bartholdy, are themost famous of this group.114 Allgemeine Medicinische Central-Zeitung , 18 (1849), p. 269.115 Ibid., p. 271.116 Wiener Medizinische Wochenschrift, 42 (1852), p. 676.117 Radcliffe (1858), p. 50.118 Sandwith (1856), p. 236.119 Wiener Medizinische Wochenschrift, 38 (1852), p. 616.120

See for example the Wiener Medicinal Halle, 44 (1863), p. 426, calling the French takeover of the school an ‘invasion’.




1848, during which many physicians in Vienna sided withthe revolutionaries, the Viennese medical press turned moreor less openly nationalist and their accounts were full of open hostility against ‘the French’. Proponents of theFrench medical schools were considered rivals who weretrying to steal medical influence not only in the Ottoman

Empire but also in Egypt.121

At least as far as Spitzer’snow vacant position was concerned, these allegations hadno point. As a matter of fact, the Porte had invited Viennato nominate a successor for the returning Spitzer, but DrGraziadion Vallon, who was sent to Constantinople, diedshortly after his arrival in the Ottoman Empire. The Frenchphysician Sulpice Antoine Fauvel122 who had representedFrance in the sanitary Council since 1848, was to followSpitzer as director of the medical school, changing the focusof bilateral relations from Vienna to Paris.123

Quarantine administration, organisation of the healthcare system and education of a sufficient number of adequately trained physicians for the army and new

administrative structures remained main concerns of Ottoman medical politics during the years followingthe Crimean war.124 European medicine was consolidat-ing its position in the Empire through the formation of a medical society. The Societe Medicale de Constantino-ple, which was founded in 1856 during the Crimean warby British and French Physicians, became the centre of the propagation of the ‘European-style’ medical organi-sation.125 These efforts obviously found the highest con-sent: the Society was granted a monthly allowance bythe Sultan to meet its expenses. Membership wasrestricted to graduated physicians, surgeons, medical

officers and pharmacists, thus practically excludingTurkish medical scholars who had not yet acquired aEuropean degree. In 1862, Turkish graduates of theimperial medical School formed a society of their

own, the Cemiyet-i Tibbiye-i Osmaniye, dedicated tothe translation of medical literature and the promotionof Turkish as a language of instruction, which soonbrought them into conflict with the Societe Medicale.The European dominated Societe advocated the use of French, while its Turkish counterpart called for the

use of Turkish, which was finally introduced as a lan-guage of instruction in the Imperial medical school in1870.126

The Habsburg Monarchy had lost its influential posi-tion in this process after 1850, as most of the AustrianPhysicians had left Constantinople.127 But as we haveseen, the active involvement of Austrian physicians inOttoman health care politics had nevertheless paid off for the Habsburg Monarchy. By shaping the way Ottomanhealth care—and especially the quarantine administra-tion—was organized, the Habsburg Monarchy couldadvance its aim of abandoning its own expensive quaran-tine system.

The Milita rgrenze and with it the quarantine stationsalong the Ottoman–Austrian border were dissolved dur-ing the following years, eliminating what was consideredto be a major impediment for trade with the OttomanEmpire and the emerging states of the Balkans. The bur-den of fighting contagious diseases was thus transferred tothe Ottoman Empire, whose efforts were anxiouslyobserved and discussed by the European powers in anumber of international conferences starting from1851.128 Turning the Ottoman Empire into what was per-ceived to be a ‘civilized’ nation was therefore an impor-tant step in justifying the Habsburg Monarchy’s own

sanitary politics. The short but influential period of Aus-trian influence on Ottoman healthcare structures was akey part in this process.

121 The nationalist attitude of some of the (German–)Austrian physicians, the political conflict between the Habsburg Monarchy and France that waslooming especially in Italy, and the rivalry between the Vienna medical school and its French counterparts stood behind a series of professionalconfrontations more or less openly fought in the medical journals in this period. In 1858, a scientific dispute in Alexandria between French physicians andtheir German speaking colleagues from the Habsburg Empire and Prussia turned into a diplomatic crisis, showing how deeply rooted these resentmentshad become. The death of a sailor that was ascribed to the plague by a group of French sanitary physicians aroused the opposition of German-speakingphysicians, who felt that this diagnosis would threaten Habsburg trade with the Levant. For the coverage of this confrontation in the Wiener Medizinische

Wochenschrift see Chahrour (2007), pp. 263–266.122

b. 7 November 1813, Paris; d. 4 November 1884, Paris. Panzac (1996), p. 109.123 By 1870, forty-one students had been sent to France to acquire a doctoral degree at a French university. See ibid.124 By the early 1860s, the school had been through a severe crisis that eventually led to organisational changes and the introduction of Turkish as thelanguage of instruction. By the time these changes took place, the Josephinum in Vienna was not able to serve as a model any more. The revolution of 1848had led to a temporary closure of the institution. When the Josephinum was reopened a few years later, it had to face severe opposition by the medicalfaculty of the University, questioning the necessity of a separate medical university for the military. See the discussions in the Wiener Medizinische

Wochenschrift, for example in Wiener Medizinische Wochenschrift, 2 (1852), p. 61. The academy was finally dismantled in 1874. See Wyklicky (1985).125 For the history of the society, see _Ihsanoglu (1996). In 1863, pharmacists with predominantly European education formed a similar society aiming atthe legislative limitation of the practice of pharmaceutics. The society was closed after a short period but was re-established in 1879.126 Panzac (1996) p. 199 states that the French influence on Ottoman medicine came to an end with this change of the language of instruction. TheOttoman Empire remained a contested area for French and German medicine. The episode of the introduction of modern bacteriology by the French isdiscussed by Moulin (1992), for German participation in later reorganisations of the school, see Goerke & Terzioglu (1978).127 In 1858, only a handful of the total number of seventy-six regular members of the newly founded Societe Imperiale de Me dicine were German-speakingresidents of Constantinople. See the table of regular members in Gazette Medicale d’Orient, 9 (1858), p. 19.128 These conferences, the first of which took place in Paris in 1851, are considered as the nucleus of international cooperation in health affairs. For a

discussion of the scientific discourse of these conferences see the widely cited book by Howard-Jones (1975) and, recently, Huber (2006).


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Acknowledgements

This paper is based on research done for a Ph.D. thesisat the Medical University of Vienna, on Austrian physi-cians in the Ottoman Empire and Egypt in the nineteenthcentury. My thanks go to Dr Tatjana Buklijas (University

of Cambridge), Univ. Doz. Dr Walter Sauer (University of Vienna), Univ. Doz. Dr Sonia Horn (Medical University of Vienna) and Dr Arın Namal (University of Istanbul) fortheir support. All translations are my own unless otherwisestated.

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