In 1820, American Protestant missionaries entered into the Western Anatolian lands and communities of the Ottoman Empire. Within thirty years, they succeeded both in establishing Protestant missionary communities throughout some of the empire’s territories and in acquiring official recognition from the Sultan. Apart from their direct propagation of Protestantism, missionaries also concentrated their energies on projects that might be viewed, on the one hand, as rendering assistance to the local populations but that, on the other hand, as both attracting a wider demographic and legitimizing their presence and allied spiritual-political missions. Such projects ranged from acts of charity and relief, to education, schooling, and publishing, and to fostering public health and delivering medical services. Locally establishing themselves in this manner vis-à-vis the empire’s populace, American missionaries positioned themselves to be far more than just spiritual caregivers. While past studies of missionaries in the Middle East examined their socio-political consequences, educational agendas, and religious endeavors, few addressed the profound impacts that they had in terms of public health and medicine. This is surprising in that missionaries established themselves in positions of socio-psychological superiority over indigenous populations not only in terms spiritual, civilizational, and educational but also through discourses of health, hygiene, and well-being. Indeed, during the late nineteenth century, there were neither modern hospitals nor doctors in many Ottoman territories, except in some larger cities. Identifying this deficiency as an opportunity, the American Board dispatched missionary doctors to their stations and opened hospitals and dispensaries. By the early twentieth century, they managed about ten hospitals and an equal number of dispensaries, with the largest in Anatolia in Antep, Elazig, and Merzifon. With over 30,000 patients visiting them on average three times per year, charitable exchanges with locals were frequent and abundant as those of means who were treated were charged while the poor received free care. Through healthcare, missionaries solidified their relations with locals but also left enduring influences in medicine and public health. Based on my collection and analysis of documents from the American Board, my paper renders a critical view of the American Protestant project in Ottoman lands during the nineteenth and early-twentieth centuries in terms of prevailing health conditions and epidemic diseases, the practice and politics of quarantine, the missionaries’ own roles in shaping the fields of health and medicine in the region, and their engagements with Ottoman authorities and local and Ottoman responses.

Starting with the second half of the nineteenth century, the typical response to insanity underwent a dramatic change. Whereas in the previous centuries only the most violent persons would have been segregated and confined away, in the modern period, the asylum and the doctor were endorsed as the sole officially approved responses to the insane and mental illness. In the nineteenth century, parallel to the re-centralization efforts of the state, coupled with a rising concern with the security and well-being of the population, the insane – like other outcast groups (such as beggars, orphans, vagabonds and the unemployed) – were gradually segregated and found themselves incarcerated in a specialized, state-supported asylum system. A regulation known as Bîmârhânelere Dair Nîzamnâme, which was promulgated in 1876, and which was adapted from 1838 French mental health regulation, in that regard came to play an important role in the officialization of mental health services and monopolization of the confinement and discharge of mental patients, and required a license for one’s incarceration to be given by a doctor for the first time in the Ottoman Empire. The present paper discusses the state’s motivation and the professional agenda in the preparation of the regulation, and investigates the legislative process which culminated in the designation of the insane and as patient by conteztualizing it in the social, political and economic developments of the period.

This paper examines the discourse of the Ottoman elite as well as the official policies regarding public hygiene in ?stanbul in the Abdülhamid II period (1876-1909). Several examples of how the policies were manifested in everyday life are included in the analysis. The combined evidence makes two interrelated suggestions. First is a much stronger attempt of the political power to penetrate into the social life through innovative medical organizations and regulations. As a result of the intersection of the various lines of development such as the rise of cholera epidemic in the early 1890s, the emergence of bacteriology, the problem of control of the city population’s becoming much more urgent because of the extreme crowding, and the long term evolution of the modern mechanisms of governing throughout the nineteenth century, the regulation of the social environment in terms of hygiene, especially that of the domestic space, became one of the foremost issues on the agenda of the political power. Second is that the main objects of this policy of control over urban population were the poor who were perceived as a threat to the social body, both in terms of decreasing its capacity, and constituting a danger for the more privileged parts of it, as they, and their domestic space, were perceived as potential sources of disease. When looked at from a broader perspective, the public hygiene measures, along and in connection with the coercive measures and welfare strategy formed another constituent of the politics of the social control of the poor in this period.

During the Second Constitutional Period (1908-1918) prison reform became a major concern for the Committee of Union and Progress (CUP), which spent vast sums of time and resources attempting to transform the empire’s decentralized prison system according to modern standards of centralization and state oversight. Horrific conditions and inadequate hygiene practices dominated the Ottoman Empire’s sprawling network of over a thousand prisons when the CUP initiated its penal reform programs in 1911. Based upon inspection reports, prison regulations, and administrative debates this paper investigates prison conditions and health reforms, particularly regarding health and hygiene in Ottoman prisons during the Second Constitutional Period in order to argue that prison health and hygiene were intrinsic concerns for the CUP. These prison reforms include the employment of doctors, the construction of hospitals, clinics, indoor washrooms and toilets, new hygiene regulations and practices, improved rationing and provisions, health check-ups, and disease tracking, treatment, and prevention. In fact, the CUP justified its overall prison reform program based on the fact that it was attempting to bring Ottoman prison health and hygiene standards “in conformity with the laws of civilization.” These efforts in the prison reflect broader societal and administrative concerns in the late Ottoman Empire regarding the state’s role in assuming greater responsibility for the welfare and protection of the empire’s citizenry, even the incarcerated.

In 1897, the renowned psychiatrist Richard von Krafft?Ebing asserted that he had discerned a link between civilization and syphilization; for him the two went “hand in hand.” In proof, he and others argued, paresis and tabes did not exist among “barbarian,” and “uncivilized,” peoples around the world, but only among Europeans. In this equation, Ottomans, along with other Muslim and Asian peoples, found themselves excluded from among the civilized. Did the Ottoman and later Turkish doctors accept the validity of the European science without questioning it, or did they challenge it? This paper argues that Ottoman?Turkish neuropsychiatrists challenged the equation of civilization and syphilization not only in the name of their own empire and nation, but also in the name of other Muslim and Asian peoples. Some even suggested that these European doctors, having been raised with the stories of fairytales and 1001 Nights about the East, were actually the victims of their own baseless beliefs about non?Western peoples. Mounting a two?pronged attack, they first argued that the assumed link between civilization and syphilization was flawed. Secondly, lest their first assertion was not enough for the European men of science, they produced statistics to show that paresis and tabes existed among the subjects of the Empire and citizens of the republic in numbers comparable to Europe.