The Sick Man and his Medicine

This paper is submitted in satisfaction of the Food & Drug Law course requirement and the third-year written work requirement at Harvard Law School by Layla J. Aksakal, April 26, 2003 / Mr. Peter Barton Hutt
Abstract
This paper examines the transformation of public health institutions in the Ottoman Empire and Egypt in the nineteenth century. I argue that the region’s political, financial, and military vulnerability in that period led to a wide-ranging institutional reform movement that also had a great impact on the public health system. As the state centralized, it began to intervene directly in the lives and bodies of its population with the purpose of developing a strong, healthy polity that would be able to compete in the international arena of states. Examples of this intervention included the establishment of professional medical and pharmacy schools and the implementation of compulsory vaccinations, quarantines, and rigorous inspection of food and drugs in the marketplace. Although these measures were often contested and resisted, and despite a perennial shortage of financial resources, the efforts of nineteenth-century Ottoman and Egyptian statesmen and professionals did lay the groundwork for modern public health care in the Middle East.
Mavi Boncuk |

The Sick Man and his Medicine:

Public Health Reform in the Ottoman Empire and Egypt by Layla J. Aksakal


Introduction

When the Russian Tsar Nicholas I described the Ottoman Empire in 1853 as the “sick man” of Europe, he was giving voice to the reigning diplomatic assumption of the impending fall of a once great and powerful empire. The Ottoman Empire (1300-1922) had at its apex extended over the entire Middle East, North Africa, and the Balkans and had on two occasions laid siege to Vienna. Istanbul, its capital since 1453, was a vibrant imperial city. But by the nineteenth century, the Ottoman Empire was in military and financial disarray. It no longer posed a threat to Europe’s Great Powers, whose statesmen spent almost a hundred years engaged in debate over the potential consequences of the Ottoman Empire’s anticipated demise.

The paradigm of the “sick man” of Europe gave enduring color to the diplomatic vocabulary of European statesmen, but it might just as well have referred to the actual state of public health in the Middle East at the time. Throughout the Ottoman Empire, the quality of medical care was inadequate, and the central government took limited interest in the health of its people. The sale of food and medicines had for centuries been regulated as part of general commercial regulations whose purpose was to prevent economic fraud and ensure the adequacy of provisions for the capital city and the sultan’s palace. Public hospitals existed, usually under the auspices of religious foundations, but the level of care was not advanced and did not receive much governmental support. The state in general did not see much of a role for itself in the arena of public health.

As part of a wide-ranging reform movement that swept the Ottoman Empire in the nineteenth century, however, the government began to see a connection between a healthy populace and a strong state. Institutional reforms were implemented to modernize the medical and pharmacy professions. The importance of disease prevention through monitoring the food supply and maintaining public sanitation was realized. Similar modernizing reforms were also introduced in Egypt, which became an autonomous entity of the Ottoman Empire in the early nineteenth century. There was, in other words, a reconceptualization of the state and a willingness to incorporate new ideas about public health into a Middle Eastern context.

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