Cem Hakan Basaran

This article provides a modest contribution to the history of the General Directorate of Public Assistance of Constantinople (Müessesat-ı Hayriye-i Sıhhiye Müdiriyeti), which formed an important step in Türkiye’s social policy history. With the Second Constitutional Era and the Young Turks Revolution (II. Meşrutiyet), the reorganization of health organizations (teşkilat-ı sıhhiye) became necessary due to many reasons such as institutions’ financial conditions, corruption in hospitals and institutions, mismanagement, dysfunction in Istanbul’s health organizations, the new government’s need for caderization. Following the Second Constitutional Era, health workers had great expectations that the order would change, and the Constitutional administration quickly began to purge the cadres from the Abdul Hamid II era (tensikat); however, the expectations did not bear fruit, and civilian physicians began to protest in front of the Ministry of Health (Sıhhiye Nezareti). Many articles emphasized the financial and moral statuses of municipal physicians in the provinces. In the meantime, the new government sent Dr. Muhittin Nuri and Dr. Ahmed Nureddin to Europe to inspect municipalities and health institutions and establish a new health administration specific to Istanbul (Müessesat-ı Hayriye-i Sıhhiye Müdiriyeti) for managing certain hospitals and charitable institutions there. The institutional structure of the directorate was modeled on the Assistance Publique organization in Paris, which transparently managed hospitals and charities from one location. Many debates occurred during the drafting of the regulations of the directorate, which was directly affiliated with the Istanbul municipal council (Cemiyet-i Umumiye-i Belediye) and indirectly with the Council of Civil Medicine and Public Health (Meclis-i Umur-ı Tıbbiye-i Mülkiye ve Sıhhiye-i Umumiye) and the Ministry of the Interior (Dahiliye Nezareti). An administration of 20 members, including a president and a general inspector, as well as deputy mayors, merchants, and physicians, took over and organized the budget, kept tenders free of corruption, and improved hospitals.

Protracted disputes occurred between the directorate and the Council of Civil Medicine and Public Health, which wanted to take the appointment and dismissal of physicians working in the hospitals under its own authority, and this authority was eventually taken away from the directorate. The Istanbul municipality had been providing the budget for the directorate but suffered a financial crisis after the Second Constitutional Era and sought to borrow money. This loan was not used effectively, and the required payments were not transferred to the directorate. In addition to dealing with financial crises and austere policies, the directorate was subordinate to the Istanbul municipal council, which meant that many matters were difficult to resolve. Significant modernizations were made in almost all hospitals under the directorate’s administration; however, syphilis, tuberculosis, and cholera epidemics could not be prevented. In addition to this, the Toptaş Mental Hospital had received a new annex, thus increasing its patient capacity, and the Haseki Mental Observatory (Haseki Mecanin Müşahedehanesi) had been opened to serve mentally ill patients. The directorate experienced financial difficulties as a result of the subsidy non-payment, the cost of fighting the cholera epidemic that had broken out in 1910, and the opening of the Haseki Mental Observatory. The reasons for the directorate’s failure include the financial crisis, a lack of interinstitutional coordination, political struggles, and epidemics. Upon being accused of corruption and other charges, the director Dr. Muhittin Nuri Bey was suspended in June 1912. Finally, the Directorate was closed down in October 1912 at a meeting of the Cemiyet-i Umumiye-i Belediye [Municipal Council of Istanbul] that had been convened Istanbul, Mayor Dr. Cemil Topuzlu. In 1919, Dr. Abdullah Cevdet, the Director General of Health (Sıhhiye Müdir-i Umumisi), attempted to reestablish the directorate, but these attempts yielded no results. In general, the directorate had carried out important modernization activities in hospitals and made institutions functional with the instructions it had issued. In Türkiye’s social policy history, the directorate is one of the critical step toward institutionalization.

Bu makalede tıbbi etiğin, hekimin ceza sorumluluğu ve hukuk tarihi ile ilişkisinden ziyade kendi içinde tarihsel ve politik gelişimi ele alınmıştır. Hekimlik mesleği Antik Çağ’dan bugüne uzunca bir zaman aristokrasi ve erkeklerin tekelinde olmuştur. Bu tarihsel süreç, kendi içinde ahlaki bir kimlik arayışına koyulan hekimlerin kabul ettikleri ahlaki yükümlülükler ve tıp etiğinin kurumsallaşmasına dair bir derleme ortaya konulmaya çalışılmıştır. Bu tarihsel sürece tekil bazı çabaların ve kurumsallaşmanın, insanlık dramlarının şüphesiz etki ve katkıları olmuştur. Deontolojik prensipler ve etik kodların entegrasyonu uzun ve sancılı bir sürecin sonunda ortak mutabakatla ortaya çıkmıştır. Bugünün perspektifinden tıp etiği ve deontoloji literatürünün 18. Yüzyıl itibariyle rekabet, ticari kaygılar ve dayanışma ihtiyacı ile artmaya başladığı gözlenmektedir. Ortaya konulan ilk taslaklar genelde meslektaşlar arasındaki geleneksel ilişkilerin yeniden düzenlenmesi ve mevcut sorunların bertaraf edilmesine yönelik olmuştur. Hekimin ayrım gözetmeden herkese bakma yükümlülüğü farklı sosyokültürel, sosyoekonomik ve sosyopolitik unsur ve yapılardan, topluluk çıkarlarından dolayı yakın bir tarihe kadar tartışma konusu olamamıştır. Bugün bütün bu unsur ve yapılarda farklılıklar bulunuyor, ayrımcılık açık ve örtük biçimde sürüyor olsa da dünyadaki tüm deontoloji nizamnamelerinin ilk maddesi; hekimlerin başlıca vazifesinin ayrımcılık gözetmeden insan sağlığına, hayatına ve şahsiyetine ihtimam ve hürmet göstermek, muayene ve tedavi hususunda azami dikkat ve ihtimamı göstermesi gerektiği ile ilgilidir. Hekimin başlıca ödevlerinden biri ayrımcılık yapmamaktır.

The journal Gazette des Hôpitaux Civils et Militaires de l’Empire Ottoman / Ceride-i Emâkinü’s-Sıhha was published between 1887 and 1897 by Spiridon Mavrogeny Pasha, the private physician of Sultan Abdul Hamid II (r. 1876-1909) and studied by Feza Günergun in 2002. This article is an addendum to Günergun’s article in light of the newly opened periodical collection at Bibliothèque interuniversitaire de Santé [Interuniversity Health Library] in Paris, France and the documents kept in the Ottoman Archives in Turkey. Currently, no library is found to hold a complete collection of the journal. The journal was censured due to the articles Dr. David Pardo had written and was discontinued due to funding restrictions. Subsequently, it continued to be published in line with the Gazette Médicale d’Orient, the official publication of the Cemiyet-i Tıbbiye-i Şahane [Imperial Medical Society] in Istanbul. Gazette des Hôpitaux was the first bilingual (French and Turkish) medical journal to be published in Ottoman Turkey. Its originality could not be maintained after being censored, and its publication was suspended despite Dr. Mavrogeny Pasha’s continued efforts. This article contains the French and Turkish index of the 26 issues of the journal (in addition to Günergun’s article) as well as the testimonial account of Dr. David Pardo about the death of Dr. Marko Pasha’s wife and children from diphtheria in its appendix section. The Gazette des Hôpitaux Civils et Militaires de l’Empire Ottoman was a dramatic case that witnessed the effects of Abdul Hamid II’s repressive rules on medical publishing, which made publishing a journal not in allegiance with Abdul Hamid II’s Yıldız Palace impossible. Publications were also controlled by funding restrictions and censorship. Dr. David Pardo had attempted to draw attention in his articles to the inadequate measures that were being taken during the cholera epidemic, the scandalous decisions taken at Toptaşı Asylum, the failures in epidemic management, and the infrastructural problems of Istanbul. During the period when Gazette des Hôpitaux Civils et Militaires de l’Empire Ottoman was published and censored, the scientific activities of the Cemiyet-i Tıbbiye-i Osmaniye [Ottoman Medical Society] in Istanbul were also being impeded. The sessions the Society held were banned because the government had deemed them to be unsuitable, and the Society’s function of supervising and encouraging scientific publications had been transformed into one of inspecting publications that were deemed harmful. The Society functioned as a censorship commission until the beginning of the Second Constitutional Era in 1908, when it almost entirely lost its actual function. 

Moreover, physicians during this period were not allowed to create associations. According to the Ottoman archival documents, the Ottoman Medical Society did not have enough linguistically qualified officers to supervise the suitability of medical works for publishing (i.e., to perform its censorship function). While this did impede the publication of medical works, it also prevented the publication of many pamphlets, booklets, books, and journals in other languages in Istanbul. Therefore, many authors lost a great deal of time, spending their efforts all in vain. Another medical society, Cemiyet-i Tıbbiye-yi Şahane [Imperial Medical Society] had also been subjected to various pressures in the same period. Important testimonies occurred about the pressure exerted on the Society as well as on sleuthing and whistleblowing activities in Istanbul. Additionally, authorities tried to put the Imperial Medical Society in a difficult situation by reducing its financial aid and even delaying it payments of the reduced aid. This article presents documents regarding what these pressures had led to. Mavrogeny Pasha also appears to have been subjected to various incidents during the period in which he’d published the Gazette des Hôpitaux. He was followed by the Sultan’s sleuths, and reports were written about him. Mavrogeny Pasha was regularly prosecuted, and many investigations were conducted against him. During one investigation, a memoir written in Greek about Abdul Hamid II as well as other personal documents were found in the Pasha’s house. He was interrogated and news about his arrest began to appear in the foreign press. After this incident, Mavrogeny Pasha was forced to swear an oath of loyalty in the presence of the Ecumenical Patriarch of Constantinople, Neophytos VIII and two other witnesses. These events led the Pasha to lose his reputation. As a result of the absolute centralization of the reign of Abdul Hamid II, institutions such as Matbuat Dairesi [the Press Office] lost their authority, and applicants had to apply to the Yıldız Palace either directly or through intermediaries in order to republish journals that had been shut down or to publish new journals; applications needed to include certificates of good status, warrants of guarantee, and safety documents from the communities to which the applicant belonged, with the final decisions being left directly to the will of the Sultan. Journals and newspapers have been directly controlled through funds and censorship. According to archival documents, Gazette des Hôpitaux Civils et Militaires de l’Empire Ottoman was the only scientific publication among the journals and newspapers to have received financial aid from the government. Despite this privileged position the journal had, its publication and content seem to have been overshadowed by Mavrogeny Pasha’s private life and the sensationalist atmosphere of the period. Even today that medical phenomenon, deaths from epidemics, and the inadequate measures taken are well known to have been censored in various ways by those in power in various states. Thus the microhistory of Gazette des Hôpitaux Civils et Militaires de l’Empire Ottoman invites historical researchers to once again subject medical sources to a more careful reading.

Anadolu Tıb Mecmuası (1921-1922) is one of the few medical journals published in Anatolia before the Republic. It was published during Dr. Ekrem Hayri Üstündağ’s Directorate of Hygiene Department of the Ministry of Health. The journal was published to facilitate physicians’ access to European medical publications, which was especially difficult for those practicing in Anatolia under wartime conditions. It also aimed to disseminate medical knowledge among the public and publish opinions on the diagnosis and treatment of social diseases. Until Ankara became the center of the National Struggle, the center (Istanbul) did not pay attention to civilian physicians (etibba-yı mülkiye) who lacked opportunites to make their voices heard in the provinces there they served. Anadolu Tıb Mecmuası offers researchers glimpses into the solidarity and cooperation among the provincial physicians, polemics between central and provincial physicians, and medical practice in Anatolia during the War of Independence. Anadolu Tıb Mecmuası can be read as the harbinger of reform expectations in medicine.

Sağlık hakkı, temel insan hakları yaklaşımı içerisinde ele alınmalıdır. Uluslararası sözleşmeler ve bildirgelerde, sağlık hakkının öznesinin herkes olduğu açıkça tanımlanmasına rağmen bugün sosyoekonomik ve politik nedenlerle bu hakkın yalnızca bir retorikten ibaret kaldığına tanıklık etmekteyiz. Yerel ve küresel sağlık politikalarının iç içe geçtiği günümüzde, sağlık hakkı ilkelerinin, insan haklarının doğası ve bunların etrafında inşa edilmesi gerekliliği hakkında bitmemiş felsefi, politik ve yasal tartışmalar şimdilik bitmeyecek gibi gözükmektedir. Politik öznelikleri olmayan vatansız kişilerin, devletlerin biyopolitik çıkarlarına alet olduğu ve onların gerçekte insandan daha aşağıya indirgenen yaşamlarının hümaniteryen faaliyetlerle meşrulaştırıldığı iddia edilmektedir. Vatansızlık, birçok ülkede kişileri kamplarda yahut şehirlerde düşük ücretlerle ve sigortasız çalışmak ve sağlık güvencesi olmadan yaşamaya mahkûm etmiş ve onları toplumların günah keçileri hâline getirmiştir. Bazı kamplarda ve bölgelerde insani yaşam koşullarından uzak, hatta sağlıklarını bozacak bir iklimde yaşamak durumunda kalan vatansız kişilerin, birçok ülkede sağlık hakları acil bakım düzeyine indirgenmiştir. Sonuç olarak dünyanın her yerinde ıskarta hayatlar birikmiş ve sağlıkları da zaten önemsiz zannedilen hayatlarına mukabil ıskartaya çıkarılmıştır. Hukuki statüleri ne olursa olsun kişiler (vatansız, mülteci, şartlı mülteci, sığınmacı, göçmen veya belgesiz göçmen), birçok ülkede hastalandıklarında tedaviye ulaşabilmek için haysiyetlerini alt-üst eden bir dizi prosedür veya engellerle karşı karşıya kalmaktadırlar. Bu çalışmada, konuya yönelik bir literatür derlenmeye çalışılmıştır.

This study was conducted to reveal how physicians view the access of refugees, who have difficulties in accessing health services and who may experience various health rights violations, to health services and to discuss the case in terms of medical ethics and deontology. Xenophobia, which is one of the main causes of discrimination in health, needs to be evaluated. In this context, quantitative research methods were used to measure the xenophobia levels of physicians working in Eskişehir province. Stratified sampling method was used to evaluate the views of the physicians. The study data were collected through the Xenophobia Scale developed by Kees Van Der Veer et al. and a questionnaire created by the researchers. The age distribution of the physicians in the study was 38,069±10,337. The distribution of the scores obtained from the xenophobia scale was found to be high (56.20±11.54). Of the physicians in the study, 34.3% stated that they would not want to provide health services for refugees if they were given the right to choose. They mainly thought that health services should not be provided free of charge for refugees and should be provided in separate places, refugees affected the access of the citizens of the Turkish Republic to health services negatively, the number of children should be limited, refugees would increase violence in health and public health problems, and that there should be an interpreter in health institutions. "Refugees do not deserve discrimination in health services" in terms of medical ethics. "Physicians should reach a common consensus against all kinds of discrimination while carrying out their profession." When xenophobia shows its effect in the field of health, it turns into a phenomenon that damages human dignity, causes all kinds of inequality, and moves medicine away from its deontology.

Türk Hekimi, published with Arabic letters in Ankara, is one of the medical journals that have not been studied so far. Its publication began on March 1, 1336 (1920) and ended, most probably, the same year. Only two issues are extant in Turkey, and these are kept at the Department of Medical History and Ethics, Istanbul Faculty of Medicine, Istanbul University. The present article, while introducing these two issues, will present a bio-bibliography of doctor Ömer Vasfi Aybar, the owner of the journal. The article will analyze the journal within the conditions of the period, taking into consideration Ömer Vasfi Aybar's political identity and relations. Its appendix includes an article by Dr. Aybar that narrates his surgical activities and memoirs at the Battle of Gallipoli; a list of his works; his letter of 1919 written to Dr. Abdullah Cevdet, and the case report of the surgery he performed on his mother.

Gulhane Hospital was officially opened in 1898 and German physicians managed the hospital until 1918. The hospital had been managed by Julius Wieting Pasha between 1907 - 1914. During this time many reforms had been made. The hospital had become a school where military physicians improved their theoretical and practical knowledge. Scientific meetings and activities, as well as publications had been accelerated significantly. On the occasion of the 10th anniversary of the establishment of the hospital, Wieting Pasha published the “Gülhane-Festschrift” to present important information on the activities and history of Gulhane Hospital. Three years later, in 1912, Wieting Pasha published a work titled Gülhane Hakkında Üçüncü Lâyiha (Eng. “Third report about Gulhane”), describing the activities of Gulhane Hospital between 1910 - 1912. It should be noted that “Gülhane Hakkında Üçüncü Lâyiha” has not been mentioned previously in the literature on history of Gulhane Hospital. This work provides detailed and interesting information about this period. In this article, the transliteration of the work is presented.

In this work, Osmanli Seririyat Mecmuasi / Revue Médicale Ottomane published between 1910-1914 is studied and a detailed List of Contents is presented. Osmanlı Seririyat Mecmuası was a very important clinical journal with its editorial board and content. It’s scope covered the medical literature of the time within medical journals written in Ottoman Alphabet. The Journal was not published for one year due to the 1st Balkan War. The most recent treatments of the time, clinical observations, and medical news were published by the Journal, whose editorial board was comprised of the faculty members of the Darülfünun School of Medicine, in Istanbul. Unfortunately, The Journal should be considered as a part of the project of the transformation of the Cemiyet-i Tıbbiye-i Osmaniye into a “Ottoman Medical Academy. it’s publication was terminated due to World War I.

In 1924, Büyük Ada Musa Kâzım Sanatorium was opened by way of renting a private building on an island. The sanatorium is the first sanatorium of the Republic of Turkey of which had facilities of treatment with modern techniques. In 1928, MD Musa Kâzım succeeded in publishing Turkey’s second tuberculosis journal named Verem Mecmuası with his special efforts, but the journal was only published twice, and the publication of the journal ended without any letter or declaration of closure. The journal is mainly important due to the limited medical periodicals on the Ottoman Alphabet. It is a unique journal in terms of presenting the latest therapy techniques of its era, guiding on chest emergencies, having statistics of tuberculosis fighting, introducing radiological examinations, showing the effort of fighting against tuberculosis which was one of the contagious diseases in the Republic of Turkey at the time. Given that it is likely to say that this periodical is a very important source on the history of chest diseases

The Âfiyet newspaper, published between 1913-1915, was a popular weekly newspaper
of its era which -despite the hardships at the start of the first world war- continued
publication until its 62nd and final issue. Its editor was Avanzade Mehmed Süleyman Bey
who was a popular writer of his era, and its publisher was Sisak Ferid Bey. The paper pursued
a colorful editorial policy; in addition to covering politics and religious affairs, the
paper featured many topics, ranging from scientific and medical subjects to matters of fashion
and food culture. This article presents the conclusion and full index of the newspaper
and also attempts to illuminate the biographies of Avanzade Mehmed Süleyman Bey and
Sisak Ferid Bey.