Chahrour-Civilisingmission (1 of Austrian Medicine in T Ott Empire

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Studies in History
and Philosophy of
Biological and
Biomedical Sciences
Stud. Hist. Phil. Biol. & Biomed. Sci. 38 (2007) 687705
www.elsevier.com/locate/shpsc
A civilizing mission? Austrian medicine and the reform

of medical structures in the Ottoman Empire, 18381850
Marcel Chahrour
Medical University of Vienna, Institut fur Geschichte der Medizin, Wahringerstrae 25 A1090 Vienna, Austria
Abstract
During the 1840s, physicians from the Habsburg Empire played a decisive role in the reform of medical structures in the Ottoman
Empire. This paper discusses dierent aspects of this scientic and cultural encounter. It emphasizes the importance of Austrian health
care structures as a model for the work of these physicians in the Ottoman Empire and studies the role of the medical school ran by the
Austrians as a means of representing, on the one hand, the reformatory eorts of the Ottoman Empire and, on the other hand, the motivations of the Habsburg monarchy for an involvement in Ottoman health care aairs, strongly bound up with its own quarantine politics
towards 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 Neuburgerthen professor of history of
medicine in Viennawrote a short article on Austrian
physicians as pioneers of scientic medicine and hygiene
in Turkey examining the work of Austrian physicians
who had been involved in the transformation of medical
structures in the Ottoman Empire in the middle of the nineteenth century.1 The First World Warduring which Neuburger published his article had turned a former foe into
one of the major allies of the Habsburg Monarchy. Neuburgers study emphasises the Habsburg Empires role as
1
2
E-mail address: marcel.chahrour@meduniwien.ac.at

Neuburger (1917).
Ibid., p. 1.
1369-8486/$ - see front matter 2007 Elsevier Ltd. All rights reserved.
doi:10.1016/j.shpsc.2007.09.005
a partner in what was then perceived as a civilizing mission, bringing the light of science to the uncivilized Orient. The pride of the Vienna medical school in doing so
is summed up by Neuburgers introductory statement:
The rst attempt to create a sanitary administration in
Turkey and to form an educated class of physicians dates
back to the civilizing work of Austria.2 Neuburgers
emphasis on the civilizing character of the work of the
physicians is typical of his generation of historians of
science, as Pyenson (1993) has shown. But it also reects
the self-conscious and missionary approach of the
new generation of Austrian physicians that was involved
688
M. Chahrour / Stud. Hist. Phil. Biol. & Biomed. Sci. 38 (2007) 687705
in medical reforms in the Ottoman Empire during the

1840s.3
This episode of Austrian inuence on medical aairs in
the Ottoman Empire lasted just over fteen years, roughly
between 1838 and 1854. At the beginning of the 1850s it
came to a rather sudden and surprising endespecially in
the light of the fact that the rapid progress of German/Austrian medicine in the second half of the nineteenth century
was then just beginning.4 As we will see, the export of
medical science from Vienna to Constantinople was much
more a matter of political and economic considerations,
closely linked to the inuence and ambitions of Habsburg
diplomacy, than of scientic progress.
Much of my research on this episode in HabsburgOttoman relations is based on the extensive coverage of the
topic in the German and Austrian medical periodicals in
the mid 1840s. The intensity with which both the Austrians
work in the medical school in Constantinople and the state
of public sanitary aairs in the Ottoman Empire were discussed in Viennese medical media went beyond what could
be considered pure Orientalist enthusiasm. It reected the
professional and political interest that the Habsburg Monarchy (and the individual physicians) had in the state of the
sanitary conditions in the Ottoman Empire, at a time when
infectious diseases such as cholera were posing a considerable threat to the European population. From the Austrian
perspective, the eorts to reform medical education in the
Ottoman Empire were an essential part of the Habsburg
Empires own quarantine policy.
On the Ottoman side, the reform of medical structures is
closely 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 Ottoman
scholarship. European historiography has related the
involvement of Europeans in the process of reforms in this
period to the imperial ambitions of the European powers5

and with the inuence of their respective economies.6 More
recently, scholars have begun to emphasize the importance
of the transfer of science and technology.7
Medicine is in many respects linked to the reformatory
eorts of the tanzimat period. The introduction of new
medical educational institutions, sanitary administration,8
professional associations9 and a restrictive medical legislation10 brought about a centralization and standardization
of medicine and thus aected the whole Ottoman society.
These reforms gradually reduced the existing free market
in health care and eventually replaced it with a more regulated, structured system both in education and in medical
practice, which was in many respects modelled after European examples and, especially in the beginning, dependent
on European assistance. Civilizing here meant structuring
and establishing what was perceived to be a Europeanstyle order in health care aairs, as it would be done in
the former Ottoman province of Bosnia some three decades
later.11 Recent studies analyzing the development of modern medicine in other regions of the modern Middle East
has shown that the establishment of such European structures and/or of medical schools has played a key role in this
process.12
The formation of an educated class of physiciansas
Neuburger put itbrought about with the Habsburg Monarchys assistance was much more than an accidental episode in the history of bilateral relations between the two
Empires. This paper shows how the work of the Austrian
physicians at the Imperial Medical School in Constantinople was based on Habsburg models and contributed to the
change in the structures of health care and medical services
in the Ottoman Empire. It furthermore argues that medicine served as a means of pursuing Austrian diplomatic
and economic ambitions especially as far as international
quarantine politics were concerned. Crucially, these physicians at the same time perceived themselves as agents of a
A few remarks on terminology in this paper: the term Austrian physicians is used here as shorthand for physicians from the Habsburg Monarchy
irrespective of their nationality. The attributions European and/or European style will refer to institutions of Central and Western European origin. The
term 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 termeven though sometimes (mis)used by European authors to implicate a
moral superiority of their own European wayswas used in its Turkish equivalent slah 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 ve 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
_
_
lu. See Ihsanog
lu (1992, 2000, 2004).
Much work on Turkish history of science has been done by Ekmeleddin Ihsanog
8
On the introduction of a sanitary administration in the Ottoman Empire, see Panzac (1986) and Kurz (1999).
9
_
lu (1996).
On the genesis of learned societies in the Ottoman Empire see Ihsanog
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.
European civilization.13 Based on a thorough reassessment of contemporary sources, including newspapers and
les of the Haus-, Hof- und Staatsarchiv in Vienna as well
as a critical review of the secondary literature, this paper
sheds new light on the substantial and multifaceted Austrian 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 the
Ottoman Empire in their accounts stress the dierences
between Oriental and European medicine,14 there is
good reason to assume that methods and concepts of
health and sickness that prevailed in the Ottoman Empire
were not much dierent from those that had been used
by European medicine at least up to the second half of
the eighteenth century. Ottoman physicians and their
European counterparts had been in a constant communication and knowledge circulated not just from the West to the
East, but also in the reverse directionthe cowpox variolisation being the most widely cited example.15 Medical services in much of the Ottoman Empire were oered by a
variety of practitioners who specialized in treatments of
certain groups of symptoms rather than standardized diseases and who drew their knowledge from various non-academic sources.16 In addition to these specialists, who
passed down their skills from generation to generation, a
more formal medical education was oered by the medreses. Their course of training, however, diered from the
standardized curricula of European universities.17
The central dierence between European and Ottoman medicine was its organisation. While universities
and the state in Europe had a strong inuence on medicine
through legislation and academic education (including,
importantly, examination), in the Ottoman Empire medicine remained largely independent from such institutional
13
689
inuence up to the 1840s. The medical school modelled

after a European example was the rst major institution
to challenge this independence and is therefore a turning
point for medicine in the Ottoman Empire in general.
Considering the bilateral history of the two Empires, the
fact that Ottoman ocials turned to the Habsburg Empire
for help with the establishment of medical structures is not
so surprising. In spite of wars and conicts, the Habsburg
Monarchy and the Ottoman Empire had continuous and
intense economic and political relations since the rst
major military confrontations in the sixteenth century.18
After a period dominated by armed conicts, culminating
in the siege of Vienna in 1683 and the subsequent wars,
at the end of the eighteenth century the HabsburgOttoman relations turned into a coalition of common interests.
Strongly inuenced by the Austrian chancellor Metternichs doctrine of stability that was aimed at an equilibrium
of power among the European Powers, Austria granted
both military and non-military help to the Ottoman
Empire in order to secure Turkish resistance to Russian
expansionist politics. Next to military instruction and mining expeditions, medicine formed a crucial part of this support during the rst half of the nineteenth century.19
There were several reasons why the Porte20 gave priority
to the establishment of a western-style medical school in
the late 1830s. The most obvious was the demand for medical personnel for the Ottoman army. During the rst half
of the nineteenth century, medical services in the army were
increasingly provided by foreigners, whose employment
was expensive and whose medical skills were often doubtful.21 It was certainly not desirable for an army to depend
on the often unreliable medical assistance of European
adventurers, whose main interest was to amass a fortune,
rather than to provide ecient medical service.
Furthermore, European trade with the Ottoman Empire
considerably increased during the rst decades of the nineteenth century. At the same time, European public opinion
attributed the threat of diseases such as the plague and the
A considerable number of articles on the subject have been published by Austrian and Turkish historians of medicine. Most of them drew on the same
set of contemporary sources but failed to provide their critical assessment. A large share of the research on the topic of medical relations between Austria
and the Ottoman Empire has been done by the Turkish historian of medicine Arslan Terzioglu. 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. The
proceedings 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 dierent approaches towards Ottoman medical history see Murphey (1992), pp. 376381.
16
Accounts on these medical practitioners and practices are numerous. Next to the extensive descriptions in Rigler (1852), Vol. 1, pp. 342361, a report in
the Vienna periodical Wiener Medicinal Halle (1861) is especially informative. See N. N. (1861).
17
Kahya & Erdemir (1997), pp. 6687.
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.
690
cholerawhich had struck Central Europe for the rst

time at the beginning of the 1830sto the unsanitary conditions in the Ottoman Empire.22 The threat of a new outbreak of cholera or, even worse, the plague terried Europe
and increased the pressure on the Ottomans to take steps
for what Europeans thought to be eective measures
against a new pandemic. The European powers urged
the Ottoman authorities to set up quarantine stations in
harbours and on the main land routes, although the eciency of quarantines against plague and cholera was questioned even in Europe.23 A European-style sanitary police
could only be enforced with a sucient number of trained
experts familiar with European languages, medical science
and Ottoman culture. Therefore, the establishment of sanitary institutions and a school able to supply the necessary
number of specialists who would help set up a new kind of
European-style order in medical aairs became important
preconditions. Additionally, worries about population
decline were increasingly inuencing decisions in the Ottoman Empire.24 The establishment of a regular civil sanitary
system, which would not only aect military and commercial aairs but also regulate the life of Ottoman citizens in a
novel way, thus became a concern of Ottoman politics by
the end of the 1830s and formed one of the major incentives for the establishment of a medical school.25
The rst major reform undertaken in the eld of sanitary aairs was the establishment of sanitary authorities
to issue quarantine regulations and organize quarantines.26
During the 1830s, European diplomacy had acquired control over the quarantine administration in some of the larger ports of the empire, notably in Alexandria and Tunis,27
and the central sanitary council had been established in
Constantinople in 1838. This Conseil de Sante of European
diplomats and representatives of the Ottoman state in Constantinople was supposed to supervise and direct the measures taken against the spread of contagious diseases. For
the administration of quarantines, the Porte asked the Austrian internuncio28 in Constantinople to send personnel
22
from the Austrian quarantine station in Semlin,29 a town

on the OttomanAustrian border, who were held in high
esteem because they were the only experts available who
spoke Turkish.30 But language skills were not the only reason for this choice.
Ottomans had frequently visited Viennese medical institutions. The rst descriptions of Austrian medical institutions in Turkish date back to the seventeenth century.31
Some physicians were sent to Vienna to complete their
medical studiesmost prominently, Mustafa Mes
ud, a
son of the hekm basi32 Numan Efendi, whose departure
_
for Vienna caused protest in the Ottoman capital.33 It
was the establishment of a new military medical school in
Vienna at the end of the eighteenth century which attracted
the special attention of Ottoman visitors.
Modelled after the plans of Giovanni Alessandro
Brambilla under the auspices of Emperor Joseph II, the
Imperial Medico-Surgical Academy, popularly known as
the Josephinum, oered 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 not
limit practice to surgery, but included medicine as well.
Most of the graduates of the academy were employed in
the army and some were additionally responsible for the
treatment of the civil population of the Militargrenze, a
strip of land under military administration bordering the
Ottoman Empire.
In 1807, a delegation from the Ottoman Empire visited
the Josephinum to adopt the concept of the Josephinum
for a school for navy surgeons in Constantinople.35 At that
point, the impact of the Austrian model on medicine in
the Ottoman Empire was rather limited. The school operated only a couple of years until the building was destroyed
by a re in 1822. Between 1827 and 1838, several similar
institutions provided medical education. These schools
were modelled after European institutions, but both the
organisation of instruction and curricula seem to have been
dierent from comparable European schools.36 The new
For a discussion of the topic see Delaporte (1986).

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, K10K17.
26
Austrian quarantine politics is discussed in Bratescu (1979). The Ottoman Empires 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 ocial 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
Hekm basi is the title of a physician occupying a leading administrative position, similar to the European protomedicus.
33
Num
an Efendi was hekm basi at the imperial court. His sons decision to study in the land of the indels provoked controversy, because he belonged
_
to 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. 445.
36
See Jagailloux (2000).
23
Fig. 1. The Josephinum in Vienna (from original at the Bildarchiv, Institut fur Geschichte der Medizin, Medizinische Universitat Wien; used with permission).
691
692
medical school, formed in Galata Sarai in 1838 out of two

previously existing schools, heralded a change in this
respect. Once again, the Josephinum was to serve as a
model for the new school37 but this time, the school
was to leave deeper marks on the Ottoman health care
structures.
3. Magnicent and well equipped: the medical school and
the staging of modernity for the European public
At the time of the establishment of the Imperial Medical School, education in the Ottoman Empire was in the
rst stages of transformation towards a more dierentiated
system. New institutions of advanced education were introduced, among them the rus diyye-schools that were supposed to close the gap between primary and higher
education. Military schools had been set up in Constantinople, oering specialized instruction in various elds.
Guidanceand inuencein this initial impulse to modernize the army came from France and many of the military schools were based on French models. The general
argument that Ottoman educational institutions attempted
to copy European models has been challenged by Benjamin
Fortna (2002). He points out that especially the late Ottoman state assigned education the task of warding o Western encroachment and that it would be oversimplifying to
assume that eorts taken to reform education merely emulated European educational institutions.38 Yet this certainly does not apply to the case of the Imperial Medical
School, which from its foundation until the early 1860s
was essentially a European school on the Ottoman soil.
Planned, established and directed by European scholars
and run on European curricula, it was intended to be an
exact copy of a European institution, the Vienna Josephinum. But it was precisely this concept that, as we shall see,
would cause profound problems.
Metternichs personal physician Friedrich Jager, whom
the Austrian chancellor had entrusted with the task of nding teachers for the new school in Constantinople, chose
two of his disciples for the mission, Carl Ambros Bern37
hard39 and Jacob Neuner.40 Both had studied at the

Josephinum; Neuner was promoted to the rank of a personal physician to Sultan Mahmut immediately after his
arrival. He returned to Austria after the death of his most
important patient in 1839 and was replaced by the physician Sigismund Spitzer.41 Together with Lorenz Rigler42,
who arrived two years later, Bernhard and Spitzer became
chief protagonists of medical reform in the Ottoman
Empire during the following years.43
These four physicians were not the only Austrians practicing medicine in the Ottoman Empire at the time. In the
early 1840s, several smaller missions of varying numbers of
physicians and surgeons from the Josephinum were sent to
the Ottoman Empire, partly to serve with the troops and
partly to reorganize military hospitals.44 Next to those
who were ocially invited via diplomatic contacts, an
increasing number of medical graduates from the universities of the Habsburg Empire, mostly from Vienna, and
some German states, were attracted by the new openness
of the Ottoman Empire. A position in Constantinople or in
one of the provinces, either in the sanitary administration
or in the army, was quite attractive for a young and ambitious physician from the Habsburg Empire. Even a recent
graduate could expect a responsible position in the Ottoman Empire and a more than reasonable salary; those
working in Constantinople could also run a lucrative private practice. All in all, the combination of an academic
or a civil career with a chance to earn much more money
than what the pre-revolutionary Vienna oered opened
up interesting prospects.45
In its report to the Sultan, the delegation that had visited
Paris and Vienna in 1807 stated that although a similar
institute existed in Paris, it was not as magnicent and well
equipped (prachtig und gut ausgestattet) as the Josephinum
in Vienna.46 These two expressions were not used accidentally. Medical reform did not only mean setting up new
institutions. Convincing Europeans of the rapid progress
in medical education was an essential part of the eorts
taken by the new sanitary administration. The impression
that Western-style institutions in Constantinople left on
See the Ottoman documents cited in Terzioglu (1987) p. 46.

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 authors ongoing research.
44
There is no exact count of the number of physicians from the Habsburg monarchy sent to the Ottoman Empire as an ocial mission. Available
sources indicate that the total number of physicians sent on request of the Ottoman government was between twelve and fteen. Most of them were
operating 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 ocially, 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 dierent parts in the Empire. Rigler (1852), Vol. 1, p. 394 comments on the salaries paid for medical personnel in the
ottoman army. In a letter to the Viennese anatomist Joseph Hyrtl, the Austrian physician Alexander Sotto gives and idea of the income of a European
doctor in Constantinople. See Gasser (1994), p. 114.
46
See the report cited in Terzioglu & Lucius (1993b), p. 30.
38
European visitors formed an important part of how they

assessed the progress of reforms in the Ottoman Empire.47
By the mid-1840s, the medical school in Constantinople
was one of the key institutions used to advertise the
reform eorts of the Ottoman Empire. It was in the mutual
interest of both the Ottoman and the Habsburg Empire to
publicly promote these medical reforms. While the Ottomans were under pressure by the European powers to
improve their sanitary administration, the Habsburg
Empire was pursuing its own anti-quarantine policy, aimed
at reducing the number of quarantine stations. Medical
progress in the Ottoman Empire, consisting of an education that could stand comparison with similar European
institutions and the establishment of a sanitary administration contributed to this policy, as we shall see later.48 Magnicence in style and setting and state of the art
equipment therefore became the main features of the medical school.49
The list of acquisitions for the newly established school
in 1838 is impressive. More than 1,000 books were bought
in Europe and shipped to the school in Constantinople that
at its beginning had only a handful of students capable of
reading European languages.50 Experimental tools for
physics and chemistry were bought in London with funding
from the Sultan. A large number of anatomical models
were bought in Paris, at 4,000 francs a piece, and in
Vienna.51 A gardener was brought from Vienna to set up
a European-style botanical garden. The school itself was
situated directly in the vicinity of the imperial palace, thus
enhancing the impression of magnicence it was supposed
to convey to its frequent European visitors.52
The description of the dissection room by the Russian
physician Artemis Rafalowitch after he was taken on a tour
by Bernards successor, Spitzer, illustrates the eorts taken
in order to make the school a real showpiece of the
reforms.
47
693
The dissection room was bright, the oors were covered

with marble, there was a pond in the middle with a fountain, 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 ew.
The water ew through a hole in the middle of the table.
After owing through the pipes, water reached a marble
basin in front of the table.53
The description of this bright room decorated with marble
and its technical equipment is of special interest for two
reasons. First, Rafalowitch had been sent on his trip by
the Russian government to assess the danger of a new outbreak of cholera and to give an account of the sanitary
conditions in the Ottoman Empire.54 The brightness and
cleanliness of the room contrast sharply with descriptions
of the darkness and shabby facilities in other places, even
in Europe.55 A properly equipped medical school was good
news for the Russian government. Secondly, the fact that
dissection was practised in the school was an argument
for the readiness of the Ottoman government to reform.
It was commonly assumed in Europe that the Quran forbade dissection.56 Teachers of the school presented the fact
that dissection was part of the curriculum as a major
achievement for which they had to ght. Dissection was
turned into a symbol of civilization itself. Who would have
thought this possible ten years ago? asked rhetorically the
Austrian diplomat Victor Wei von Starkenfels in an 1843
description of the dissection hall, praising Spitzers efforts.57 While restrictions in using the corpses of Muslims
did exist, a general ban of dissection, as had been reported
by Europeans to illustrate Ottoman backwardness, had
never been issued, nor did the sunna explicitly prohibit
it.58 As a matter of fact, dissections had been performed
For an insightful description of the staging of European visits to the medical institutions in Cairo, see Fahmy (1998).
Francis Delaporte has pointed out that during the rst 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, a
French physician states that the admirable people of Paris, who are so heroically confronting the cholera of poverty . . . were not made to serve as fodder
for 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 inuence public opinion in Europe are discussed in Davison (1995), who argues that the main task of Ottoman
diplomats was to inuence European public opinion rather than perform classic diplomatic duties.
50
Terzioglu (1987), p. 48.
51
Allgemeine Medizinische CentralZeitung (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 Jahrbucher des k. k. osterreichischen Kaiserstaates, Zeitschrift der k. k. Gesellschaft der Arzte, Sonntagsblatter
des Wiener Boten and later in the Wiener Medizinische Wochenschrift and the Wiener Medizinische Presse.
53
Allgemeine Medicinische CentralZeitung, 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
SonntagsBlatter, 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
dene 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).
48
694
in the school of marine surgeons in Constantinople as early

as 1807/1808.59 Nevertheless, the Austrian physicians
wanted to give the impression that they had introduced dissection in the Ottoman Empire.60
The majority of early reports were full of praise for the
achievements of Bernard and his successor Spitzer. Almost
no visitor of the school neglected to mention that the presumed resistance of conservative religious circles had been
overcome and the establishment of the school had been
made possible by an enlightened Sultan and his brave
European counsellors. Again, Rafalowitchs words are
revealing:
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 diculties, bravely followed the noble
aims.61
The diplomat Victor Wei von Starkenfels praised the
unselsh help granted by the Habsburg Monarchy,
claiming that, henceforth, the Porte was obliged to call
Austria its oldest and truest friend.62
The Habsburg Empires ambitions were not as seless as
Starkenfelss statement suggests. Transferring Europes
rst line of defence against contagious diseases as far to
the East as possible had been a major aim of Austrian economic policies since the end of the 1830s.63 The Austrian
Lloyd, which had established steamship connections
between Trieste and the major ports of the Levant, exerted
pressure on the Austrian administration to reduce and
eventually drop quarantine restrictions for ships arriving
from these ports.64 For travellers and goods delivered by
these ships, quarantine meant a delay in their journey of
up to three weeks. The same was true of the continental
border between the two Empires. Quarantine restrictions
were less strict along the land border, but the stations with
their bureaucratic procedures were nevertheless considered
a major impediment for trade. The dermatologist Carl
Ludwig Sigmund, who would later become one of the most
eminent medical experts on contagious diseases in the
Habsburg Empire, explicitly requested a shift in quarantine
politics during the 1840s. In his pamphlet Zur Pest- und
Quarantanefrage Sigmund argued that, in the long run,
59
the plague and cholera should be fought in their countries

of originin his opinion, in the Ottoman Empire and
Egypt.65 After all . . . we will come to the conclusion that
it is safer and more just to set the home of the plague under
quarantine 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 overshadowing
Europes relations with the Ottoman Empire, the eorts
of the Austrian physicians appear in a dierent light.
Next to the eorts in establishing quarantine stations,
the continuing positive reports by visitors of the school
and other European-style medical institutions in the Ottoman Empire played a substantial role in the gradual shift of
Austrian (and European) quarantine politics. As soon as
the rst reports of the successful establishment of the
school and the work in the quarantine administration
and other elds of Ottoman healthcare reached Vienna,
the Austrian Hofkanzleithe central administrative unit
responsible for quarantine aairsdecided to reduce quarantine for ships coming from Turkey to eleven days. In
1844, what was called further medical progress in the Ottoman Empire67 enabled the Hofkanzlei to issue further
quarantine reductions for all ships arriving from the
Levant. By 1847, quarantine in seaports had practically
been abolished for the ships of the Austrian Lloyd.
Similarly, the restrictive quarantine regulations at the
HabsburgOttoman border were abandoned during the
1850s.
After Sigismund Spitzer had taken over the directorship
of the school in 1844/1845, it was about time to present the
success of the school back home. In 1847, Spitzer sent four
of his best students to Vienna to take the Rigorosum, the
nal examinations, and earn doctoral degree at the medical
faculty of the University. Again, the report of this exotic
visit in the popular Sonntagsblatter was rather euphoric.
The results of the examinations were convincing, stated
the author of the report, himself a physician, not without
noting, however, that Spitzer had asked in advance to have
the emphasis of the exams put on practical skills rather
than theoretical knowledge.68
In Constantinople, the Sultan himself regularly visited
the school at the end of each academic year, thus participating in the staging of the schools success (Fig. 2).
His visit in the summer of 1847 is described by the
British physician John Mason, who was a guest at the
nal examinations:
Terzioglu & Lucius (1993b), p. 35.

See for example Rafalowitchs account in Das Ausland (1847), p. 420, in which he describes what he thought had been the rst dissection ever done in
the Ottoman Empire.
61
Ibid.
62
SonntagsBlatter, 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
SonntagsBlatter, 2, (1848), p. 26.
60
Fig. 2. The Sultan visiting his medical school (from original in the archives of the Department of Medical History, Istanbul Medical Faculty, Istanbul University; used with permission).
695
696
On the rst day of August, the examination of the students 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 college at the Galata Serai. This imposing ceremony, which
testies the great interest taken by the Sultan in the progress of letters, and in the development of public instruction in his empire, occurred this day . . . with all the
usual pomp . . . Three students, a Mussulman Djafar
Eendi and two Christians, Nekefar and Stephane Ilias,
were separately examined in presence of the Sultan; their
answers were completely satisfactory. They were afterwards habited in the robe of the doctor of medicine
and took the oaththe 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 experiments, which perfectly succeeded and were witnessed
with much interest by the Sultan and all his ministers.
Never on any occasion had the examination been conducted in a more satisfactory manner, and his Majesty,
at its close, testied his entire approbation to the professors and employees of the college.69
The positive publicity for the school contrasted with its actual success. Most descriptions of the school mentioned the
impressive number of up to 400 students taught in the institution. Yet a closer look at the statistics shows that only few
reached the nal examinations and, as we shall see later, the
quality of the education did not come up to the European
standards its Austrian founders had been claiming to oer.
The curriculum was very similar to its model, the
Josephinum. Five years of medical studies led to a doctoral
degree in surgery that included a licence to practise in all
elds of medicine. Neither German nor Turkish but French
was chosen as the language of instruction, mainly because
in the early 1840s the literature that was considered cutting
edge was predominately in French. Besides, French had
earlier been used in other military institutions.70 The Sultan, however, stated at his inaugural speech that the translation of medical knowledge into Turkish was an important
aim of the school.71 Concerning the language and method

of instruction, the Austrians could rely on the experience of
their French colleagues in Cairo, where a medical school
had been set up by the French physician Antoine Barthelmey Clot (Bey) in 1827.72 In the Cairo school, French was
the language of instruction, but instead of teaching the language to the students to enable them to follow the courses,
a complicated system of translation and supervision was
used in the classes. Even more problems were created by
the fact that most of the technical terms used in teaching
did not exist in Arabic and had to be created anew. The disadvantages of this system were described by the Austrian
traveller Joseph Russegger (18021863) who worked in
Egypt in the 1830s and whose writings were probably
known to the Austrian physicians in Constantinople.73 In
order to balance the lack of general education among the
students and to teach them French, preparatory classes
of three years duration were introduced as a mandatory
part of the school.
During the rst ten years of the schools existence, most
students took these preparatory classes, but without success. In 1847, 238 out of 454 students were in the rst of
the preparatory classesand none of the actual medical
classes held more than 15 students,74 even though the
school had had more than 300 students from its very start.
In 1843, only 80 out of 340 students managed to advance to
the next class, while the others failed to meet the expectations of their teachers and had to remain on the same level
for another year.75 Despite the fact that in the same year
the rst army surgeons had nished the school and three
of them acquired a doctoral degreethey had been admitted to the school without preparatory tuitionimprovements 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 several
young pupils who were summoned from the provinces . . .
to study medicine and to serve as physicians in the communities who chose them, have been sent home again on
account of their complete ignorance, and will be replaced
by others, who can full the conditions now demanded
by the regulations of the school.76 The state in which they
were admitted to the school was deplorable, as most of
the students were poor and had not received any primary
education 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 school
were said to be excelling in their studies. This fact is regularly used in accounts of European visitors, usually connected to the notion that Muslims are
promoted 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
_
lu & Gunergun (1994) pp. 127134.
school resisted the change, claiming that Turkish would not work as a language of instruction. Ihsanog
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 Spitzers annual report to the Sultan for 1847,
published in ibid.
the Habsburg Monarchy. These children . . . who manifest

the best character and disposition, arrive here covered with
rags, speaking a corrupt dialect, incapable in general of
either reading or writing, with a hatred to all intellectual
labour, 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 qualication of the rst physicians
who had left the school rather resembled those of the ocers of health in the major European armies.78 As the
schools inability to meet the aim of continually producing
a large number of physicians became obvious, a second
option was introduced, allowing those who failed the nal
examinations in the rst run to try again after one year of
practical instruction in a hospital. If they failed again, they
were given the rank of medical ocers and left without a
doctoral degree.
The lack of primary education remained a common
complaint in many of the reports by the Austrian physicians. While in the Habsburg Empire primary education
was compulsory since the second half of the eighteenth century and medical students were required to have a basic
training in their native language, Latin and philosophy, a
comparable standardized education did not exist in the
Ottoman Empire. Even though rst steps of reform in public instruction had been taken by then, secondary education
was still in its infancy.79 In 1846, the Ottoman government
appointed a committee to investigate options for a complete overhaul of education in the Empire. Its report recommended a three-stage system consisting of primary,
secondary and higher schools and the establishment of an
Ottoman University, the darulfunun.80
Spitzer suggested a two-year course of higher education,
similar to the compulsory Philosophicum at the universities
in the Habsburg Empire, to raise the level of general education of school entrants. The problem of the language of
instruction, which was foreign to both teachers and students
and therefore very likely a cause of the poor education, was
largely avoided in ocial reports. Visitors saw in the fact that
the Ottomans had to study a European language to obtain
education a chance for what they called civilization, and
hardly ever an impediment to instruction.81
The German botanist and physician Karl Koch visited
the school in 1843 and his account gives a good idea of
how the school was presented to visitors in spite of all these
77
697
diculties. His sceptical attitudeKoch was very critical

of the Ottoman reform policymakes his description especially revealing. The director of the school, Carl Ambros
Bernard, took Koch on a tour of the school and the newly
opened clinic that was attached to it. In the hospital, Koch
noticed the order and cleanliness that would stand comparison with any clinic in Vienna or elsewhere in Central Europe.82 When taken to the language courses attended by
students from the lower classes, Koch was impressed by
their rapid progress, although he suspected that only the
better students were asked questions. The same was true
for the clinical instruction that Bernard invited him to
see. Koch mentions, quite sceptically, that he was amazed
by the students answers to Bernards questions during the
examination of patients.83
After Bernard had left, the professor of botany took
Koch to the botanical garden. It had been arranged by
the gardener Joseph Skalak from Vienna, who had been
in charge of the garden since 1840.84 He had been dismissed
by Bernard only a few weeks before Kochs arrival after a
serious disagreement. Upon leaving the school, Skalak had
removed the signs showing the plant names and swapped
them randomly. Nobody noticed this change and even
when Koch pointed out the mistake, the professor of botany remained unimpressed.85
Kochs account is symptomatic of the state of the school
in this early stage. The standards of tuition were not as
European as ocial reports by the Austrian patrons of
the school claimedand, as we shall see later, consequences would follow.
4. Pillars of civilization: healthcare as part of a civilizing
mission for the Ottoman Empire
While struggling with the operational problems
described above, the Austrian physicians gained inuence
in another eld where their work was to leave deeper
marks. Having successfully treated the Sultan Abdulmecit
in 1845, Sigmund Spitzer became a friend of the Sultan, a
young man in his early twenties. Spitzer was ocially
appointed a court physician with unlimited access to the
Sultan.86 Spitzers close relation with the sultan went
beyond a purely private friendship. How he perceived his
position as an Austrian ocial on a mission in a foreign
Ibid., p. 165.
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. 5660.
81
Carl Ambros Bernard, the rst 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 biographical
information 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 Spitzers position at the court see also Kernbauer (1993b).
78
698
country is documented by various ocial reports written

for the Austrian internuncio in Constantinople. These
reports contain accounts of personal conversations and
of 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 concerned, reforming the empire meant increasing the states
grip on the way healthcare services were delivered to its
subjects, independent of their religious or national aliation. Whereas the traditional organization of civil health
services had been largely arranged on the local level within
an unregulated healthcare market or by religious communities, the new politics tried to oer something akin to a
rudimentary secular public health system.88
The multinational Habsburg Empire with its Josephinist
healthcare structure was, in many respects, the best model
for these measures.89 Under the auspices of Bernard and
his successor Spitzer, many measures aiming at regulating
all sorts of medical services available to the people were
put into practice: vaccination programs were initiated,
the construction of larger hospitals was funded and a variety of sanitary regulations were introduced.
The medical school in Constantinople played a key part
in the implementation of these changes. This wider scope of
duties assigned to the school and its graduates resembled
the situation of its model, the Josephinum in Vienna. Surgeons trained for the army at the Josephinum were also
prepared for civil duties, especially for the care of the population in the Militargrenze: they learnt legal medicine
(Staatsarzneikunde), as well as obstetrics and other subjects
that were not necessarily important for a strictly military
surgeon. The Josephinum oered a separate half-year
course for the training of midwives who were supposed
to work in the Militargrenze after their graduation90 and
the Military Hospital (Garnisonspital) in Vienna served as
a clinic for the student instruction.
The Constantinople school was organized in a similar
way. From its very beginning, legal medicine and courses
in sanitary police were part of the curriculum. A school
of midwifery, in which both midwives and prospective phy87
sicians were trained by an Ottoman physician and a midwife from Vienna, and a two-year course in
pharmaceutics, directed by the Austrian pharmacist Hofmann, were established.91 Simultaneously with the foundation of these courses, the government issued regulations
that aimed to force those wishing to practice midwifery
or pharmacy to attend the school. As early as 1838, a commission had been appointed to ban voluntary abortion in
the Empire. Midwives, physicians and pharmacists were
forbidden to practice abortion and had to swear an oath
that they would not do so.92 From 1847, pharmacists were
only allowed to open or take over a shop after having
earned a degree at the school.93 In the same year, Spitzer
established a chair of legal medicine and medical police.
Two of the school graduates were recruited by the police
as counsellors in medico-legal matters.94 It remains unclear
how eective these measures were, but the 1853 punishment of a pharmacist who had been found guilty of malpractice and the public announcement of the case in the
government newspaper indicates that medical police
remained an area of central importance to the government
ocials in subsequent years.95
By making the school more than an institute for the
education of military surgeons, its founders had also
secured political inuence for its teachers. This, however,
turned out to be an impediment to the schools academic
development. In 1844, Bernhard proposed the foundation
of an academic council whose members would be
recruited among the schools professors.96 Originally, the
council was only responsible for aairs directly related
to instruction and its decisions were subject to mandatory
conrmation by the hekm basi. As the school became
_
involved in the health care administration of the Empire,
however, its council of professors was given a wide range
of duties and competences. Most importantly, the council
obtained judiciary power in all professional conicts,
making membership in the council desirable for every
physician. This resulted in a constant growth in the number of teachers who were appointed without respect to
their academic merit, mainly due to the protection they
enjoyed.97
Spitzers close relation with the sultan during those years is documented by various ocial 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 Staatenabteilung
Turkei VI, 18451852.
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 elds,
including education and medicine. For a detailed description of the reformatory eorts 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 Ottoman
health care, see Sar (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).
699
Fig. 3. Sigismund Spitzer (from original at the Bildarchiv, Institut fur Geschichte der Medizin, Medizinische Universitat Wien; used with permission).
These measures and regulations gave the school much

more importance than a simple academy for military surgeons would have been expected to have. During the
1840s, the school became a focus for centralized healthcare
activities in the Empire. Large vaccination campaigns
against smallpox were started, using the students of the
school as vaccinators in a clinic set up in the medical
school. The academic year 1841 saw 3,000 children being
vaccinated there,98 and in 1847 Spitzer claimed that in
Constantinople alone close to 100,000 children had been
vaccinated.99 Another 80,000 children were vaccinated in
the provinces, partly by ve students sent to accompany
European scientic expeditions going to various provinces
of the Empire and partly by local vaccination clinics.100
In 1845, every province of the Empire was invited to
send ve students to Constantinople to study at the
98
school.101 After their education at the institution, they were

supposed to return home and work as physicians or pharmacists in the local communities. Similarly to the Austrian
system, in which Kreisarzte (district physicians) supervised
the provinces, the Ottoman provinces were supposed to
employ these physicians.102 The new politics following
the Imperial Rescript of Gulhane aimed at attracting members of the non-Muslim groups of the Empire to enrol in
the school. Sigismund Spitzer, born into a Jewish family
himself, especially encouraged the Jewish community to
send students to the school (Fig. 3). Theoretically open to
all confessions from its very beginning, the school had
not seen any Jewish students until 1845. The Jewish community had been reluctant to send students and was convinced only after negotiations between the hekm basi
_
and the grand rabbi.103 A cook and a rabbi were employed
See the annual report published in the Allgemeine Medicinische CentralZeitung, 13 (1844), p. 223.
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 War
Academy 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.
99
700
by the school to provide proper environment for the students. This attempt to involve the third major religious
group of the empireMuslims and Greek and Armenian
Christians had been enrolled in the school from its very
beginningwas successful. In 1856, the Austrian traveller
Ludwig August Frankl noted in his travel diary that there
was a group of sixteen Jewish students at the medical
school and that one of the rst Jewish doctors became
the director of a military hospital in Aleppo.104
In Constantinople, the school directly oered medical
treatment at its clinic and the attached ambulatory. The
latter treated 18,500 patients during the year 1847, a considerable share of whom were women who came to see a
midwife from Vienna placed in charge of female
patients.105 The increasing number of patients in the ambulatory led to the inauguration of two new, similar institutions in other parts of the city, in which students of the
school were also given practical instruction.106 The construction of state-owned hospitals became one of the most
prestigious projects of these years. New physicians from
the Josephinum were called to Constantinople during the
early 1840s to take over the directorship of the larger military hospitals. One of them was the young Lorenz Rigler,
whose successful introduction of new sanitary regulations
in a hospital that had seen extraordinarily high rates of
mortality due to unsanitary conditions was celebrated in
Vienna as a major success of Viennese medicine.107 Subsequently, he was promoted to the rank of a chief inspector
of the medical services in the Ottoman army.
Like the school, these large Constantinople hospitals
became the showpieces of the new Ottoman policy. In
1853, the physician Joseph Dietl108 travelled to Constantinople on a fact-nding mission, to gather information
for the construction of a new hospital in Vienna. Dietl,
who was well aware of the work of his countrymen, was surprised to nd that Constantinople had a number of not only
sucient, but good hospitals and that Constantinople had
done more for the construction of new hospitals than some
rich cities of civilized Europe.109 Dietl considered the Marine Hospital, then under the direction of a graduate of the
Vienna School of Medicine, one of the best equipped in Europe. The larger military hospitals and some of the civil institutions were described in a similarly favourable way.
The praises of extraordinarily rich food, cleanliness and
order in the Ottoman hospitals stand in contrast with the
lack of patients in most of them. Especially the non-military
104
institutions were virtually empty because women avoided

hospitals in which men were responsible for the treatment,
and the population in general preferred the care of the family
to the regulated concept of a European hospital.110 This
emptiness of the hospitals resembles the schools shiny surface under which many problems were hidden during its
early years. Both symbolised the Ottoman Empires willingness to keep up with what was considered to be European
standards at any cost and reected the ambitions of the
Europeans running these institutions. The latter perceived
themselves as agents of a larger process of civilization.
The school, the hospitals and the rst steps towards a European-style public health care meant more to the Austrians
than simply oering medical services. In Spitzers opinion,
physicians graduating from the school would play a key role
in the process of reform in the Ottoman Empire and were
assigned the duty of civilizing the country.
As a physician, he has intercourse with every class of
society that is capable of exercising considerable inuence on all classes of society. Restored to his native
province, he nds his own family, his countrymen, at
rst cold and reserved on seeing the complete change
eected in him, become soon actuated by dierent sentiments overcome by the ascendancy with instruction,
elevation of character and the oce 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 inuence 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
Spitzers enthusiastic report to the Sultan tells us very much
about his own ambitions and the plans the Austrians were
pursuing. In his view, medicine served as an important argument in the process of modernizing the Empire. Those who
still doubted the ability of the Ottoman Empire to reform itself will see that the people of the East are accessible to civilizationthat they are capable of acquiring every species of
knowledgethat their character becomes softened, and that
religious intolerance, less strong in Turkey than in many
countries in Europe, begins to disappear, and to give place
to sentiments of equity, which, as far as regards education,
at least, makes no religious distinction.112 Through its key
Frankl (1858), p. 222.

The surname of this midwife was Messani. Her rst 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 (18041878) 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 in
contemporary medical journals.
111
Mason (1860), p. 172.
112
Ibid., p. 19.
105
role in many of the measures and regulations taken by Ottoman authorities, the schools impact as a main agent of medicalization in Ottoman society went far beyond simple
education. The school indeed set in motion a process that
was to lead to a gradual but irreversible change of the medical structures in the Ottoman Empire.
5. A failed mission? The end of Austrian inuence on the
medical school and its consequences
In the early 1850s, the impact of physicians from the
Habsburg Empire on Ottoman medical aairs came to a
rather sudden end. Sigismund Spitzer, who had a strong
personal inuence on the Sultan and aected many decisions during the early stage of the public health system, left
Constantinople for Vienna in 1850, after his life had been
threatened in the course of a plot against the Sultans life.
Some of the Austrian physicians who had held important
positions 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 member of these ocial missions to remain in Constantinople
after 1852. The revolution of 1848 and the end of the ancien
regime under Metternich, whose personal interest in Ottoman aairs had been one of the pillars of HabsburgOttoman relations, cooled down the Habsburg Monarchys
interest in sending new personnel and supporting Ottoman
reforms.113 But the revolution in the Habsburg monarchy
was not the only reason for the Austrian retreat.
Public criticism of the school as an academic institution
had started in Europe by the end of the 1840s. In an article
in a Paris medical journal, the French physician Auguste
Monneret, then on a mission to inspect the progress of
medical reform and quarantine administration in the Ottoman Empire, criticised the poor quality of the education at
the school.114 Once again, the juxtaposition of European
civilisation and the uncivilized Orient served as the main
argumentbut in this case against the work of the physicians from the Habsburg Empire. Monnerets claim that
medicine could not be moved to an uncivilized country
as easily as some kind of a technical development was
widely discussed as an explanation for the observation that
the Austrians eorts had not been as successful as it had
been described in their own earlier accounts. The Berlin
based Allgemeine Medicinische Central-Zeitung welcomed
701
Monnerets account, for previous reports had been biased

by partial interests of Austrian physicians.115 The latter,
however, remained condent. We are well aware of the
jealousy of the French who are naively trying to question
German success, replied Lorenz Rigler to the French criticism of the school in 1852,116 trying to conceal the fact
that the position of the Austrian physicians had become
weak.
The Crimean war, in which Austria remained neutral
and British and French physicians came to the Ottoman
Empire in large numbers revealed the weaknesses of the
education at the medical school. European medical professionals who were serving in one of the alliedFrench, British or Ottomanarmies heavily criticised the lack of
ability of the physicians trained in Constantinople. The
British physician John Netten Radclie, who had been
attached to the sta of Omer Pasha during the war, stated
in his memoirs that some of the Turkish physicians had a
highly creditable acquaintance with their profession in its
dierent branches, but others, and by far the greater number, are very ignorant. The surgery he saw in the hospitals
was exceedingly barbarous and medical practice of a
somewhat haphazard description.117 Humphrey Sandwith,
who had been serving in a British unit during the siege of
Kars, was more sympathetic towards Turkish medical
practitioners but still critical: only a few among his Turkish
colleagues deserved to be called fair operators and well
grounded in the principles of their profession.118 These
reports that indicated the failure of the school to produce
a sucient 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, less
widely discussed in Austria than the previous reports by
their Viennese colleagues.
In Vienna, medical journals accused the French physicians in Constantinople of stealing what was considered a
child of Viennese medicine. Two years before the outbreak
of the Crimean war, the Wiener Medizinische Wochenschrift
complained that French physicians had gained total control
of the school in Constantinople, as the French professor
Antoine Fauvel had taken over directorship from Sigmund
Spitzer upon the latters return to Vienna in 1850.119 Allegations indicating that the French physicians owed their
positions mainly to diplomatic pressure and not their
scientic 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 AustrianGerman
and Hungarian physicians sought protection from prosecution in the Ottoman Empire. Especially physicians of the Hungarian Honved (army) ed there
after the defeat of the Hungarian Revolution in 1849. The Vienna-educated Karl Eduard Hammerschmidt, who later founded the organisation today
known as the Red Crescent, and Dr Arnold Mendelssohn, a German revolutionary and cousin of the composer Felix Mendelssohn-Bartholdy, are the
most 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
Radclie (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.
702
1848, during which many physicians in Vienna sided with

the revolutionaries, the Viennese medical press turned more
or less openly nationalist and their accounts were full of
open hostility against the French. Proponents of the
French medical schools were considered rivals who were
trying to steal medical inuence not only in the Ottoman
Empire but also in Egypt.121 At least as far as Spitzers
now vacant position was concerned, these allegations had
no point. As a matter of fact, the Porte had invited Vienna
to nominate a successor for the returning Spitzer, but Dr
Graziadion Vallon, who was sent to Constantinople, died
shortly after his arrival in the Ottoman Empire. The French
physician Sulpice Antoine Fauvel122 who had represented
France in the sanitary Council since 1848, was to follow
Spitzer as director of the medical school, changing the focus
of bilateral relations from Vienna to Paris.123
Quarantine administration, organisation of the health
care system and education of a sucient number of
adequately trained physicians for the army and new
administrative structures remained main concerns of
Ottoman medical politics during the years following
the Crimean war.124 European medicine was consolidating its position in the Empire through the formation of
a medical society. The Societe Medicale de Constantinople, which was founded in 1856 during the Crimean war
by British and French Physicians, became the centre of
the propagation of the European-style medical organisation.125 These eorts obviously found the highest consent: the Society was granted a monthly allowance by
the Sultan to meet its expenses. Membership was
restricted to graduated physicians, surgeons, medical
ocers and pharmacists, thus practically excluding
Turkish medical scholars who had not yet acquired a
European degree. In 1862, Turkish graduates of the
imperial medical School formed a society of their
121
own, the Cemiyet-i Tibbiye-i Osmaniye, dedicated to

the translation of medical literature and the promotion
of Turkish as a language of instruction, which soon
brought them into conict 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 nally introduced as a language of instruction in the Imperial medical school in
1870.126
The Habsburg Monarchy had lost its inuential position in this process after 1850, as most of the Austrian
Physicians had left Constantinople.127 But as we have
seen, the active involvement of Austrian physicians in
Ottoman health care politics had nevertheless paid o
for the Habsburg Monarchy. By shaping the way Ottoman
health careand especially the quarantine administrationwas organized, the Habsburg Monarchy could
advance its aim of abandoning its own expensive quarantine system.
The Militargrenze and with it the quarantine stations
along the OttomanAustrian border were dissolved during the following years, eliminating what was considered
to be a major impediment for trade with the Ottoman
Empire and the emerging states of the Balkans. The burden of ghting contagious diseases was thus transferred to
the Ottoman Empire, whose eorts were anxiously
observed and discussed by the European powers in a
number of international conferences starting from
1851.128 Turning the Ottoman Empire into what was perceived to be a civilized nation was therefore an important step in justifying the Habsburg Monarchys own
sanitary politics. The short but inuential period of Austrian inuence on Ottoman healthcare structures was a
key part in this process.
The nationalist attitude of some of the (German)Austrian physicians, the political conict between the Habsburg Monarchy and France that was
looming especially in Italy, and the rivalry between the Vienna medical school and its French counterparts stood behind a series of professional
confrontations more or less openly fought in the medical journals in this period. In 1858, a scientic dispute in Alexandria between French physicians and
their German speaking colleagues from the Habsburg Empire and Prussia turned into a diplomatic crisis, showing how deeply rooted these resentments
had become. The death of a sailor that was ascribed to the plague by a group of French sanitary physicians aroused the opposition of German-speaking
physicians, 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. 263266.
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 the
language 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 1848
had 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 medical
faculty 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 nally 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 at
the 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 inuence on Ottoman medicine came to an end with this change of the language of instruction. The
Ottoman Empire remained a contested area for French and German medicine. The episode of the introduction of modern bacteriology by the French is
discussed 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 Medicine were German-speaking
residents of Constantinople. See the table of regular members in Gazette Medicale dOrient, 9 (1858), p. 19.
128
These conferences, the rst of which took place in Paris in 1851, are considered as the nucleus of international cooperation in health aairs. For a
discussion of the scientic discourse of these conferences see the widely cited book by Howard-Jones (1975) and, recently, Huber (2006).
Acknowledgements
This paper is based on research done for a Ph.D. thesis
at the Medical University of Vienna, on Austrian physicians in the Ottoman Empire and Egypt in the nineteenth
century. 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 Arn Namal (University of Istanbul) for
their support. All translations are my own unless otherwise
stated.
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Chahrour-Civilisingmission (1 of Austrian Medicine in T Ott Empire

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Available online at www.sciencedirect.

A civilizing mission? Austrian medicine and the reform

E-mail address: marcel.chahrour@meduniwien.ac.at

in medical reforms in the Ottoman Empire during the

period to the imperial ambitions of the European powers5

inuence up to the 1840s. The medical school modelled

cholerawhich had struck Central Europe for the rst

from the Austrian quarantine station in Semlin,29 a town

For a discussion of the topic see Delaporte (1986).

medical school, formed in Galata Sarai in 1838 out of two

hard39 and Jacob Neuner.40 Both had studied at the

See the Ottoman documents cited in Terzioglu (1987) p. 46.

European visitors formed an important part of how they

The dissection room was bright, the oors were covered

in the school of marine surgeons in Constantinople as early

the plague and cholera should be fought in their countries

Terzioglu & Lucius (1993b), p. 35.

aim of the school.71 Concerning the language and method

the Habsburg Monarchy. These children . . . who manifest

diculties. His sceptical attitudeKoch was very critical

country is documented by various ocial reports written

These measures and regulations gave the school much

school.101 After their education at the institution, they were

institutions were virtually empty because women avoided

Frankl (1858), p. 222.

Monnerets account, for previous reports had been biased

1848, during which many physicians in Vienna sided with

own, the Cemiyet-i Tibbiye-i Osmaniye, dedicated to

Panzac (Ed.), Histoire economique et sociale de lEmpire Ottoman et de

Historiae Medicinae I [Proceedings of the First International Congress

Owen, R. (1981). The Middle East in the world economy, 18001914.

4. Mai27. Oktober 1991 (pp. 626640). Vienna: Amt der NO

Wiesemann, C. (1991). Josef Dietl und der therapeutische Nihilismus: Zum

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