Serving the State: Military and Public Health Practices in Bulgaria (1878–1908)

Educating Military Doctors

Medical education and the formation of a professional medical corpus in the Ottoman Empire, as in many other countries, were tightly interwoven with the military and sanitary reforms introduced since the 1820s. Thus, in 1827, the Imperial Medical School opened as part of a larger military reform project. ⁵ In 1832, a Surgeon’s School was established and in 1839 both were merged. The school attracted residents of Istanbul and 280 students enrolled in 1830. ⁶ Instruction in the new Imperial Medical School was in French, and in 1842–1843 the first non-Muslim students enrolled. ⁷ Although the Hatt-ı-hümayun of 1856 guaranteed equal access to government schools, only the Naval School and the Medical School had implemented these regulations by 1861. ⁸ The latter’s graduates had an obligation to serve as military doctors: they received the rank of captain and a subsequent gradual promotion within the military hierarchy. After 1857 there were 300 Muslim, 74 Orthodox (including 15 Bulgarian), 30 Armenian, and a small number of Jewish and Catholic students. Most of them were initially sent to peripheral areas and returned to Istanbul usually to serve in the military hospitals or sanitary inspection facilities. ⁹ Between 1827 and 1877, around 139 Bulgarian students studied there and 71 of them received a diploma, which is the largest group of Bulgarian doctors to graduate in the period before the establishment of the Bulgarian Principality (1878). ¹⁰ At least 34 of these students worked as military doctors in the Ottoman army in the 1860s–1870s. ¹¹

Many of the teachers in the Military Medical School were non-Muslims or foreigners who exposed students not only to scientific achievements but also to liberal political ideas. It is not a coincidence that four students from that school founded the Ottoman Unity Society in 1889, which sought the restoration of the parliamentary regime. Other medical students practising in the Gülhane and Haydarpaşa hospitals joined them. The Society became part of what was later known as the Committee for Union and Progress. In fact, as Erik Zürcher has noted, the early Young Turk movement can be considered a ‘conspiracy of medical doctors’ since eight out of the 14 most significant members were trained as military doctors and seven of these graduated from the Military Medical School. ¹²

In 1867, the Medical Civil School was founded in Istanbul. Its main aim to produce local cadres was accompanied by a gradual shift from French to Ottoman Turkish as a language of instruction. ¹³ Egyptian reformers had initiated an analogous process some thirty years earlier, aptly called ‘Egyptianization’ of the Medical School by LaVerne Kuhnke. ¹⁴ In the Balkan successor states, with the exception of Greece and Romania, medical schools were founded much later: in 1837 in Athens, in 1857 in Bucharest, in 1918 in Sofia, in 1920 in Belgrade, and in 1952 in Tirana. There was, however, a chronic shortage of physicians before these schools emerged and most doctors were trained abroad. ¹⁵

In the case of Bulgaria, graduates from Russia had a significant impact on establishing public health and military sanitary institutions. Most of these acquired leading government positions in the early 1880s and promoted Russian models. Although they were not prevalent in quantitative terms, they became members of the Medical Council and heads of other sanitary services. Such was the case of Dumitŭr Mollov, Konstantin Bonev, Stefan Bocharov, and Petŭr Orakhovatz. Another noteworthy group who also contributed to the establishment of Bulgarian military medicine from the 1890s on consisted of graduates from the Vienna Medical School. Since many of them specialized in surgery and internal medicine, they were hired by divisional hospitals. Moreover, in the 1890s the Ministry of War sent a group of physicians to Vienna on state scholarships. ¹⁶ Likewise, Serbia’s War Ministry awarded scholarships to students specializing in internal medicine in the same school in Vienna. ¹⁷ Similar priority was manifested by an edict in Greece about establishing a school for nurses in 1861, which provided for the training of military nurses. ¹⁸ This trend towards the militarization of medical education was not an exception: in 1868, after the introduction of a new army law, medical students in the Habsburg Empire were required to serve for one year during their studies. ¹⁹ In other words, the institutional production and reproduction of medical professionals suggests that this process was intimately related to the military needs of the modern state.

Building Modern Armies

Military reforms and the creation of a modern army were at the heart of the Tanzimat reforms (1839–1876). ²⁰ Similarly, post-Ottoman states were also focused on their armies, and research has established that their military expenses were quite significant. For example, the Bulgarian military expenditures, as part of the overall budget, were 40.5 per cent in 1879, 44.7 per cent in 1880, and 49.5 per cent in 1886, and gradually declined before the Balkan Wars to 21.7 per cent in 1911. ²¹ Part of this high percentage was due to the early adoption of universal military conscription, which was already widely spread in Europe. ²² In April 1878, after the San Stefano preliminary peace treaty, the Russian Provisional Administration (1877–1879) proclaimed the ‘Interim rules for creating a Bulgarian zemska [territorial] army’, which introduced the system of universal conscription. By the end of 1878, on the basis of Bulgarian volunteers who participated in the 1877–1878 war, 30 battalions, eight artillery batteries, and other smaller units were formed to total 31,000 soldiers. They were trained by 394 officers, the majority of them Russians. ²³ The principle of universal conscription was confirmed by the Tǔrnovo Constitution (1879).

Similarly, in 1883 in Serbia a new army law was adopted and established a conscription model with two years of service. ²⁴ In Romania universal conscription was proclaimed two decades earlier in 1860. ²⁵ Compulsory military service was perceived as a significant tool for national integration, as a form of acculturation, and as an opportunity for upward social mobility. ²⁶ Conscription in the Ottoman Empire was also linked to the establishment of a European-style army and was first introduced in 1843 (influenced by Prussian models), but it failed as an instrument for nation building due to a complex system of exemptions. For example, military service for non-Muslims, although promulgated in 1856, remained a theoretical option until 1909. The Christians in the army were primarily in the medical corps. ²⁷ In the Bulgarian Principality, however, the issue of military exemption was reversed: it was the Muslim minority recruits who were trying to receive an exemption. This was still an option for the recruits in 1881, 1882, and 1883 but afterwards the Bulgarian governments began to apply a policy of universal conscription. ²⁸ The real building of the Bulgarian army began after the unification between the Bulgarian Principality and Eastern Rumelia in 1885, which was stimulated by the victory over the Serbs. The standing army in the Principality in September 1885 was 12,000; the militia in Rumelia was around 3500; Serbia’s army was 16,819. During the Serbo-Bulgarian War (1885) around 100,000 Bulgarian soldiers were mobilized. It was in the aftermath of the war that the military forces of both territories were merged with the Decree of December 1885. ²⁹

In 1879, the Military School in Sofia was established with Russian help; initially its teachers were Russians and the textbooks and language of instruction were Russian. ³⁰ Its first cohort of graduates was later very prominently represented among the administrative elite. ³¹ Overall, until the Balkan Wars, the organization and education of the Bulgarian army was shaped by Russian military doctrine. ³² In the 1880s, among the young Bulgarian officers there was a desire for a quick promotion and they saw the incoming Russian officers during the so-called Regime of Extraordinary Rule (1881–1883) as a threat. During that period, Prince Alexander Battenberg suspended the Tǔrnovo Constitution and charged the War Minister, General Ehrnrooth, with creating a cabinet that included two Russian generals – Sobolev and Kaulbars. This early turn towards prominent military presence in the political realm was due to lack of stable political structure and, to some extent, to the weakness of the first Bulgarian prince. For example, Konstantin Jireček, a Czech historian who was for a short period appointed a Minister of Education, commented on the fact that Prince Battenberg (1879–1886) was an ‘inexperienced youth with a mere military education’. ³³ Todor Ikonomov, a Bulgarian politician, also blamed Battenberg for involving the army, and the officers in particular, in partisan politics and policing. ³⁴ Simeon Radev, a journalist and diplomat, mentioned as well that during the Regime of Extraordinary Rule the Bulgarian Principality looked like a ‘Russian province’ wherein the ‘personality of the prince was lost behind the uniform of [General] Remlingen’. ³⁵

Such politicization of the army and foreign intervention was not unusual: the Bavarians in Greece provide an earlier analogy. They outnumbered the Greeks – with around 5000 volunteers by the end of 1834 – while a smaller number of Greeks joined the regular army. Moreover, this was not just quantitative but also qualitative dominance since the foreigners occupied the highest ranks and the position of the minister of war. As in the other Balkan states, the initial decrees of the Regency (1833–1834) were related to building a loyal army: they disbanded the remnants of the regular Greek army, dissolved the irregular troops, and created 10 battalions. However, Greeks and foreigners alike criticized the establishment of a regular army as expensive. ³⁶

Data for both Bulgaria and Serbia in the 1890s demonstrates that the state paid generous salaries to its military officers: in Serbia between 1883 and 1897 a major received 4537 dinars; in Bulgaria between 1899 and 1904, 6000 leva. By way of comparison, around the same period the teachers in both countries began their career on 400–800 leva/dinara. ³⁷ While initially the military was one of the most socially mobile groups, there was also a gradual process of restricting access to military education within the urban strata in predominantly rural Serbia. ³⁸

In Bulgaria, the military played a significant role in the persecution of political opponents, sending them to jail and exile. Officers were instrumental in all the coups in both Eastern Rumelia and the Principality in the 1880s, often declaring ‘civic motivations’ to justify such interventions. ³⁹ These interventions paved the way for the army’s deeper penetration into state functions; actually, the civic regulations legitimized such interferences. While practical military policies were focused on building a modern army capable of carrying out the national unification, the army’s theoretical documents highlighted domestic protection and repressive functions of the military. Such a discrepancy was derived from the influence of Russian military theory. ⁴⁰ For example, an edict of 1890 stated the cases in which the civil authorities could request the ‘army’s cooperation’ in order to ‘clamp down on social disturbances, riots, and tumult that have a character of obvious insubordination’ when there were legitimate concerns. Another act of 1900 reinforced those possibilities. Indeed, the army was used during elections and tax collections to ‘keep the peace’. However, since the late 1890s it distanced itself from direct political involvement and branded itself as a ‘non-political factor’ expressing a special alignment with the royal family. The arrival of Prince Ferdinand Saxe Koburg Gotha (1887) paved the way for expansion and reorganization of the army into brigades and divisions, and for increased rearmament with a new law in 1891. Thus, on the eve of the Balkan Wars, Bulgaria was the most militarized country, with nine regiments in comparison to Serbia’s eight, Romania’s 5.2, and the Ottoman Empire’s 3.4 regiments. ⁴¹ Such rapid process of militarization demanded an increased attention to health institutionalization in both military and civilian domains.

Establishing Public Health and Sanitary Institutions

All institutions were set out at the time of the Russian Provisional Administration (1877–1879), and this condensed period of state building led to the adoption of Russian models of centralized public health, and military-sanitary services. The intent of Prince Vladimir Cherkassky, the first imperial commissioner, was to build proto-administrative structures while waging the war, and he promoted a policy to attract educated Bulgarians. Consequently, around 2000 Bulgarians became part of the new civil administration; in 1896, their number was around 20,509. ⁴² After Cherkassky’s death, Prince Alexander Dondukov-Korsakov occupied his post and formed six departments. In May 1878, the Department of the Interior took on the role of organizing medical and sanitary services. It engaged Dimitǔr Mollov, a doctor in the Vidin sancak, who authored a report ‘Notes on the Organization of the Medical Sector’, to work on a project for the medical organization of the whole country; the end result was a document entitled ‘On the Sanitary Sector’. As a graduate from the Medical Faculty at the Moscow University and a surgeon, Dr Mollov was influenced by the Russian health organization. The principle of territorial organization (zemstvo) was adopted as well as free medical help, a focus on prophylactic medicine, and sanitary anti-epidemic measures. ⁴³ However, this initial intent was abandoned in favour of curative healthcare and hospitalization. ⁴⁴

The above-mentioned two texts were incorporated in the ‘Provisional Rules for Medical Organization in Bulgaria’ (1879), which played the role of the first public health law. It established the Medical Council as the highest administrative organ, which was subsumed within the Ministry of the Interior. ⁴⁵ The Council was in charge of both civil and army health sectors and included the chief doctor of each unit. District and town doctors headed local organs. ⁴⁶ In other words, the system was centralized and although the Medical Council represented a collective body, all positions were appointed by government. The Council controlled all professional appointments: doctors, pharmacists, feldshers (doctor’s aides), nurses; it was also in charge of forensic medicine, medical exams for practice permits, the control of sanitary conditions in hospitals and industrial premises, etc. ⁴⁷

In 1882, after the suspension of the Tǔrnovo Constitution (1881) when Russian generals dominated the government, new medical laws were inaugurated. They were designed by the Russian military doctor Ivan Grimm (1881–1883). All civil and military power was concentrated in the hands of the Inspector General of the Medical Sector who also chaired the Medical Council, which was under the purview of both the Ministry of Interior and the Ministry of War. The Inspector General was appointed by and accountable to the Prince. Because the former was in charge of both military and civil services, as head of the military medical ranks, he also reported to the War Ministry. ⁴⁸ Grimm was instrumental in the establishment of hospital statutes and record keeping; pharmacy regulations; sanitary control over industry; military veterinarian services; sanitary regulations for schools; dentistry, gynaecology, and psychiatry; and the publication of professional journals. ⁴⁹ In 1883, the position of Inspector General was eliminated and the power of the Medical Council was restored, but it became more susceptible to partisan strife. The new Sanitary Law of 1888 initiated some regionalization, including the introduction of hygiene councils, but it kept the principle of administrative centralization even though this time it followed the models of French and Romanian medical laws. ⁵⁰ A new administrative organ, called Civil Sanitary Direction, was established. Although it changed its name a few times subsequently, it remained the main administrative body in charge. While the Medical Council became the Supreme Medical Council, it lost its controlling role and became a consulting body. ⁵¹ Thus, the 1880s and 1890s were marked by several organizational changes, which maintained and even increased centralist trends.

The Bulgarian Military-Sanitary Sector consisted of district doctors, divisional hospitals, and lazarettos. Its first chief doctor was also a member of the Medical Council, and in such a way the early integration of military and public health was maintained. The post was first occupied by Konstantin Bonev (1879–1882), followed by Sava Mirkov (1882–1890), both Russian graduates. Due to a lack of medical professionals, military and civilian hospitals were combined and closely integrated. District physicians were in charge of both civil and military medical services. ⁵² In addition, hospitals were governed by a council that consisted of a district governor, a local military commander, and the chief doctor. ⁵³ Timid institutional decoupling began in 1882 with the ‘Provision for medical and veterinary service in the army’, which introduced the position of the brigade military doctor. ⁵⁴ Yet in 1888 there were only 51 military physicians; in 1915 that number grew to 113, while the minimum requirement was 190 doctors. After the Serbo-Bulgarian War the divorce between civil and military medical services led to the adoption of different foreign models. The public health administration introduced institutional changes that followed the French and Romanian models; the military medical service, however, remained under the influence of Russian sanitary models until the Balkan Wars. ⁵⁵

Similar development in Serbia occurred earlier: in 1838, sanitary service was established. According to its statutes, there were civil and military sanitary branches, both under the supervision of the Division (Popečitelstvo) of Internal Affairs. In 1852, the Chief Sanitary Council was created. Although a few years later, in 1858, there was an administrative reorganization, the principle of placing health under the supervision of the Division of Internal Affairs persisted for both civil and military sanitary services; it was fashioned after an Austrian model. In 1862, when a new unit – ministry – was established, the military sanitary service was separated and moved under the supervision of the Ministry of War, but the civil sanitary service remained under the Ministry of Internal Affairs. Dr Mihailo-Mika Marković, a colonel and head of the military sanitary service (1886–1903), contributed to the modernization of military medicine in Serbia. He participated in the 1876–1878 wars and knew the military’s needs from first-hand experience, paying a special attention to surgery. It was Dr Vladan Đorđević, another military doctor and chair of the Sanitary Division of the Ministry of Internal Affairs (1879–1884), who contributed to reforms in the field of public health and to the adoption of health laws. ⁵⁶ Along the same lines, it was not a coincidence that Emanuel Kusy R. V. Dubrav, the founder of the Austrian modern system of public health, was a graduate of Joseph’s Academy and worked as a military doctor. ⁵⁷ Thus, Bulgarian developments fitted well into a common European trend of building public health structures in close connection with military needs, which led to a ‘militarization’ of medicine and a ‘medicalization’ of warfare. ⁵⁸

The perennial issue of lack of medical personnel was apparent in both Serbia and Bulgaria. In the case of the latter, the total number of Bulgarian medical doctors before 1878 was 151. Out of these, only 32 practised in present-day Bulgaria. ⁵⁹ In 1880, 71 physicians obtained permits to work in the Bulgarian Principality (of these, 19 received their diplomas from the Medical School in Istanbul; 16 from Russia, eight from Romania, and the rest from other countries). ⁶⁰ The increase was due mainly to the arrival of foreign professionals, but the protocols of the Medical Council embodied an attempt at curbing this trend. ⁶¹ As mentioned, the Ministry of War introduced stipends for studying medicine abroad; the same was encouraged by the Ministry of Education in conjunction with the Medical Council. ⁶² In 1903, the situation improved and there were 559 doctors concentrated in 96 locations (74 towns and 22 villages). At the beginning of the Balkan Wars their numbers were not much improved, though: out of 640 doctors, 262 had a government job; 113 were in the military. ⁶³ The ratio of doctors occupying state jobs versus private practice was 3:1; and the distribution of physicians in Bulgarian territory was uneven, with availability much stronger in the big cities. ⁶⁴ Hence, this concentration did not serve the predominantly rural population.

In sum, the militarization of the successor states in the Balkans went hand in hand with building medical institutions. For example, it is telling that the first hospital in Athens, founded in 1834, was a military one. ⁶⁵ Initially, public health and army medical services were interwoven; often both were administratively set up by military physicians. Frequently doctors served in both civil and military hospitals and sanitary administrations, and intermittently returned to private practice. Military service, though, also enforced new demands on doctors: loyalty and service to the state rather than the individual patient. ⁶⁶ In the following section, four case studies will illustrate some of those trends.

Case Studies

Doctor Zheliaz Draganov (1846/47–1910) provides a typical peripatetic biography. Born into a Bulgarian family in Shumen, he studied in Tulcea and in a French school in Galați. In 1861, the Tulcea municipality’s board sent him to the Istanbul Military Medical School. While non-Muslims had been accepted there since the 1840s, Bulgarians only received state scholarships beginning in 1858. Thus, Draganov belonged to these early cohorts of students. He graduated ten years later – in 1871 – with a diploma in medicine and surgery. ⁶⁷

Upon graduation, Draganov was appointed to the rank of captain. In 1873, he became a principal doctor in the left wing of the army, third degree. ⁶⁸ After service in Istanbul (1871–1873), he also served in Bitola’s garrison (1873–1875). In 1875, he was again relocated to the vilayet of Yemen (1875–1880) as doctor, third degree, in the right wing of the army, where he specialized in the treatment of tropical diseases. In 1877, Draganov became a major (binbaşι) and was awarded a medal ‘Mecidiye’, fourth degree, for his work in the Seventh Army’s central hospital. ⁶⁹ A document, issued by the Sana’a municipality, attests that he was also a municipal doctor there and his salary was 1500 guruş monthly. ⁷⁰ In addition, Draganov was a personal physician to the Yemeni vali (governor) Mustafa Asιm Pasha, who allowed him to leave Yemen in 1880. ⁷¹ Draganov also helped other Bulgarian doctors to be relocated closer to Sana’a and later to leave the province. ⁷²

In 1881, Draganov settled in Silistra and served there as town doctor until his death in 1910. According to the medical laws of 1882, this was an elected position by the city council but it was conceived as a ‘link between the central medical governing body and the city governance’, especially with regards to sanitary service in the town. A town doctor’s duties included: control over abattoirs, markets and food-providing premises, street hygiene, weekly check-ups of prostitutes, examination of prisoners’ food and health, a health check of military recruits and vaccinations. ⁷³ The same laws recognized diplomas issued by the Medical School in Istanbul only from before 1875. ⁷⁴ Thus, in 1881, the Medical Council in Sofia issued Draganov with licence to practise medicine in the Bulgarian Principality. ⁷⁵ In 1881, the Romanian authorities in Tulcea also recognized his licence and later he was allowed to practise medicine in Romania. ⁷⁶ After almost ten years of service as town doctor, in 1892, Draganov was appointed county jail doctor. ⁷⁷

In Silistra, unlike with his prior Ottoman experience, Draganov also participated in political and public life at national and local levels. For example, he was elected a deputy to the Third Great National Assembly (1886–1887). ⁷⁸ He was also a board member of the joint-stock company ‘Future’ and an honorary fellow of the veterans’ society ‘Dobruja’, to which he gave a donation. ⁷⁹ Draganov also bequeathed a house to the Silistra municipality to serve as a canteen for students. Moreover, he donated 1000 leva to the Silistra hospital for clothes or minor allowances to patients ‘without any difference in ethnicity or religion’. ⁸⁰ Henceforth, he seemed to belong to the local elite and participated in various social and philanthropic initiatives.

Dr Draganov was awarded many medals, such as the already mentioned ‘Mecidiye’, fourth degree (1878); ‘St Stanislav’, third degree, as town doctor in Silistra by the Russian Emperor (1883); the ‘Cross for Remembrance’ for his participation in the Third Great National Assembly (1889); and the Military Cross for civil service (1906), which was a recognition for his twenty-fifth jubilee as a municipal doctor. ⁸¹ In addition, he gained written permission (1882) from Prince Battenberg to allow him to wear his Ottoman medals in public. ⁸² All these awards attest not only to his transnational career but also to authorities’ understanding of the medical profession’s role in military and civil modernization. These distinctions are both symbolic and material evidence of the representation of military acts as patriotic civic deeds. For example, there is a list of doctors who received various medals for their service during the Serbo-Bulgarian War, which consists of 73 names; special attention is paid to five who were forgotten and should be additionally awarded. ⁸³ As studies show, royal prerogatives were most prominent in two domains: the army and diplomacy. While the latter was a traditional European trait, the former was added due to the condensed process of national consolidation in the Balkans. ⁸⁴ Draganov, as a state employee, engaged in both public health and sanitary service. Due to the lack of cadres, the state efficiently used the capacities of medical professionals in civil as well as in military state building, and publicly celebrated such medical cooperation with an elaborate system of awards.

Josif Ljubenov (1847/49–1909) was another physician who served in the Ottoman and later Bulgarian army. He was born in Kiustedil into the family of a priest. ⁸⁵ Ljubenov graduated from the Galatasaray Lycée and the Military Medical School (1876). He began his career as a military doctor in the Ottoman army by participating in the Serbo-Ottoman War and served in the Ottoman hospital in Mostar. ⁸⁶ Afterwards, Ljubenov was sent to Yemen (1876–1880) where he continued his peripatetic life as he moved to different small garrison towns. For example, in Amran he took charge of the local military hospital. In 1879, he was sent to Manaha, a small town with about 2000 residents. His task was to set up a hospital because the climate there was one of the healthiest in Yemen. He also worked in Dhamar for more than a year and performed the duties of a municipal doctor there. As reported in his memoirs on his time in Yemen, Ljubenov divided the troops there into two main groups: graduates from the Military School and others, mostly illiterate, who formed the majority. The former, being Europeanized, did not have any connection to the more ordinary soldiers. The latter were deprived of many rights, including the right to marry, and their food was poor. Most often soldiers lived in tents and were consigned to army duties such as tax collection. ⁸⁷

As a physician, Ljubenov also commented on the sanitary situation in Yemen. There were no other doctors except the military ones and even those were few in number. Each battalion was supposed to have one doctor but that was usually not the case; hospitals had specially appointed physicians. Moreover, the six military hospitals in Yemen were also supposed to treat civilians, but only the one in Sana’a was well equipped for such purposes. It had one doctor-in-chief and four regular doctors; during Ljubenov’s time three of them were Bulgarians: Zheliaz Draganov, Khristo Stambolski, and Vasil Markov – town doctors in Silistra, Kazanlǔk, and Koprivshtitsa respectively (around the mid-1890s). ⁸⁸

Unlike the other physicians discussed in this article, when Ljubenov moved to Bulgaria he continued to work as a military doctor, participated in the Serbo-Bulgarian War, and became a sanitary lieutenant-colonel. For 25 years he was the chief of the Sanitary Service of Sofia district and afterwards became a doctor in private practice. Thus, Ljubenov held a relatively high administrative post and military rank. He also published books. For example, in his textbook on military hygiene he emphasized his personal experience, used sources from up-to-date French and Russian editions, and wrote an accessible pragmatic book for soldiers, officers, and civilians promoting prophylactic measures. ⁸⁹

The path of doctor Georgi Vŭlkovich (1833–1892), another graduate from the Military Medical School in Istanbul (1858), is also revealing about the integration of medicine and its professional practitioners into the military, social, and political fabric of the Ottoman and post-Ottoman space. Vŭlkovich came from a family that managed to accumulate wealth through celepçilik, or trade in sheep and cattle, and tax farming. Studies have suggested that many of the individuals who became medical practitioners came from the incipient middle classes. Most of them benefited from the early Tanzimat reforms, as a result of which their families amassed capital and were able to invest in their children’s professional education. ⁹⁰ While the other three physicians profited from Ottoman stipends after 1858, Vŭlkovich, who graduated in the same year, was probably financed by his family.

Upon graduation, Vŭlkovich specialized in surgery for three years in Paris (1860–1863) ⁹¹ and afterwards taught a course in surgery and was in charge of the surgery’s clinic. In 1864, he was appointed principal doctor at the Central Military Hospital in Damascus and was promoted in rank to colonel (kaymakam-bey). ⁹² In 1870, Vŭlkovich returned to Istanbul, taught surgery again at the Medical School, and became director of the Haydarpaşa Hospital. ⁹³ He kept abreast of scientific developments in the field and attended a medical congress in Vienna in 1873. ⁹⁴ He acquired some influential patients, such as Midhat Pasha and various ambassadors, and became a personal doctor of Rashid Pasha. ⁹⁵ In 1875, Vŭlkovich received a ‘Mecidiye’, fourth degree. ⁹⁶ He was promoted to brigadier (miralay-bey) for his services during the Serbo-Ottoman War, especially for heading hospitals in Niš and Sofia, and for being a member of the English Sanitary Mission at the Ottoman Headquarters. Unlike the other military doctors of Bulgarian origin, Vŭlkovich was exiled to Damascus instead of Yemen during the 1877–1878 war, because he was personal physician to the grand vizier. ⁹⁷

In 1879, Vŭlkovich moved to Bulgaria and was appointed member of the Constituent Assembly in Tŭrnovo by Prince Dondukov-Korsakov. In May of the same year he was in Eastern Rumelia and became Director of Agriculture, Commerce, and Public Buildings (1879–1881); later he was in charge of the Posts and Telegraphs. In 1881, due to disagreements with the Rumelian government, Vŭlkovich moved again to the Bulgarian Principality and joined the government there as Minister of Interior and subsequently of Foreign Affairs and of Agriculture and Commerce (1882). His mobility seems to corroborate Madzharov’s comment that there is evidence of two trends: intellectuals located in Plovdiv moving to the Principality, as well as educated Bulgarians moving to or remaining in Eastern Rumelia for ‘patriotic reasons’. As a result, there was a ‘reshuffling of the Bulgarian intelligentsia’. ⁹⁸ Memoirs describe Vŭlkovich as boastful and very ambitious but also as a politically savvy person. ⁹⁹ For example, he organized receptions in his home and invited other deputies, which was a novelty in Plovdiv. Moreover, his house was arranged in a ‘European manner’ and he dressed in a tailcoat. He combined ‘Byzantine slyness with a Turkish saltanat [ostentation]’, but his proclivity for luxury was not appreciated in the impoverished and frugal Bulgarian society. ¹⁰⁰

Vŭlkovich made significant contributions to military medicine during the Serbo-Bulgarian War. He drafted the first documents about military-sanitary services, such as rules for military hospitals and for the transportation of injured soldiers and ambulances, and a list of medications and instruments for regiments; he also published excerpts from the Geneva Convention for the establishment of the Red Cross in 1864. ¹⁰¹ Moreover, Vŭlkovich was head of the biggest hospital in Sofia, and during the Serbo-Bulgarian War he was in charge of all hospitals. He introduced statistical forms, rules for keeping hospital records, and procedures for managing the kitchen, laundry, and bathroom. ¹⁰² Since Vŭlkovich was one of the few surgeons, he travelled from one hospital to another to perform surgeries. During that period, he also became a member of the Medical Council (1885–1886) and was appointed President of the State Council.

During 1887–1892, Vŭlkovich acted as the Bulgarian diplomatic representative in Istanbul. ¹⁰³ His previous connections with powerful Ottoman administrators, especially the grand vizier Kâmil Pasha, played an important role in his diplomatic career. His assassination in 1892 interrupted some of his projects, including the building of a Bulgarian hospital in Istanbul, financed by the Bulgarian government. ¹⁰⁴ In sum, Vŭlkovich’s career landed him squarely in the highest Ottoman and Bulgarian political milieus. While his Ottoman connections were based on his medical expertise, his Bulgarian endeavours in many ways redirected him along a bureaucratic and diplomatic path.

Another military doctor, Khristo Stambolski (1843–1932), a native of Kazanlŭk, was accepted at the Military Medical School in 1858. He graduated in 1868 with the rank of sol kol ağasι (adjutant major of the left flank). Stambolski wrote three detailed volumes of memoirs and they reveal to some extent experiences shared by other students in the Military Medical School. For example, he mentions that he befriended one of his classmates, a Christian Orthodox Syrian of Damascus, which improved his French and Arabic. ¹⁰⁵ The school regularly exposed Bulgarian students from small townships to the wider Ottoman world; such phenomena were called ‘educational pilgrimages’ by Benedict Anderson. ¹⁰⁶

While Vŭlkovich enjoyed a strong relationship with Kâmil Pasha, Stambolski became close to Fuad Pasha through the grand vizier’s grandson, who was one of his schoolmates. ¹⁰⁷ Most teachers at the Military Medical School were non-Muslims and had connections with influential members of the government or palace who were among their patients. When Stambolski became a teacher himself, his network of patients expanded due to the successful treatment of some palace members. ¹⁰⁸ This was a pattern established by many Greek doctors: several of them received high positions in the government through their teaching jobs in the Imperial Medical School. ¹⁰⁹

In 1868, Stambolski began teaching anatomy in the newly opened Civil (Mülkiye) Medical School. He was engaged to teach and to adapt and translate French terminology into Ottoman Turkish at that school. ¹¹⁰ Stambolski translated the Anatomical Atlas by Masse and the Descriptive Anatomy by Jamin into Ottoman Turkish, and authored an anatomical atlas Meftih tetrih (1874) with vocabulary. As a result, he was awarded ‘Mecidiye’, fifth degree, and promoted to major (binbaşι). Thus, Khristo Effendi became part of the mid-level military ranks and a respected physician among the Ottoman elite. ¹¹¹ Like the other doctors discussed above, he participated in the Serbo-Ottoman War and was sent to Niš in 1876, where he was in charge of a military hospital with two colleagues and 40 medical students. ¹¹²

In 1877, like other Ottoman physicians of Bulgarian origin, Stambolski was exiled under a military guard to Yemen where Dr Draganov, a former student of his and the quarantine doctor in Jeddah – Dr Nuri Husein Bey, an ex-school-mate – helped him. ¹¹³ Through the recommendations of the alumni network, the vali Mustafa Asιm Pasha not only appointed him doctor in the Central Hospital in Sana’a, but also assisted him to flee in 1878 by providing him with money. In Yemen, Stambolski conducted research about soldiers who suffered from parasites (filaria Medinesis) and published his findings in French in 1879.

In 1879, Stambolski moved to Eastern Rumelia where he was elected member of the Provincial Assembly. Out of a total of 56 members, 40 were Bulgarians; according to Stambolski, seven (or 17.5 per cent) were Bulgarian physicians. One of them, Dr Stoian Chomakov, became the first chair of the Sanitary Council, the supreme organ established by the Sanitary Law (1880). ¹¹⁴ Dr Stambolski was elected member of the Permanent Council and later served as Sliven’s Prefect (1880–1881) and Director of Agriculture, Commerce, and Public Buildings (1881–1883). Like Vŭlkovich, he used his ‘connections’ in the Ottoman capital and negotiated a 10 per cent decrease of the railway tariffs in 1882 while on a visit in Istanbul. ¹¹⁵ Due to political divisions in 1883, he left the Directorate and moved back to his native Kazanlŭk, where he worked as a doctor and organized a hospital and a pharmacy. ¹¹⁶ After the unification of Bulgaria and Eastern Rumelia in 1885, he was in charge of the military hospital in Kazanlŭk. In 1903, he moved to Sofia and headed the State Sanitary Inspection and the dermatological clinic of the Aleksandrovska Hospital. During the Balkan Wars, he was Director of the Sanitary Directorate but afterward he left political and social life and dedicated his time to writing his memoirs.

All the doctors discussed above worked as state employees and contributed to building public health as well as military/prison medical systems. While some of them oscillated between administrative and medical jobs, all of them were in charge of hospitals and were, in some capacity, involved in sanitary structures. Other common features include: a multilingual background; experience of multi-ethnic diversity in school and in the Ottoman army; and close ties to local and central power representatives, based on their professional expertise. It seems pertinent to apply Pierre Bourdieu’s concept of converting various forms of social capital to these four peripatetic career trajectories. Here I am referring to his definition: ‘Social capital as made up of social obligations (“social connections”)’. ¹¹⁷ All these professionals were successful and they landed in the elite stratum of society. These ‘social connections’ also brought economic and political benefits, often intermixed. It is interesting to note the double standards applied to this elite group of former Ottoman employees in comparison to the critiques local members of the meclis (council) received. Ikonomov’s memoirs about Tulcea are quite eloquent in this respect: ‘It was enough for someone who served his [Bulgarian] community by working with the Turks to be labelled blood-sucker, traitor, Turcophile, and çorbacι’. ¹¹⁸

Conclusion: Unbalanced State Modernizing

These four case studies provide a window into the broader issue of transition from imperial to national structures and the role of medicine and its practitioners with regard to the expanding military needs of both types of states. The process of the emergence of modern professions, with their close links to and dependence on the state, had parallel equivalents throughout Europe and Russia. ¹¹⁹ These physicians were located at different socio-administrative nodes and most of them moved from military to civil service and vice versa. It is not a coincidence that they offer such life stories as both spatial and social mobility. Unlike some of their more eminent Greek counterparts, such as the Karatheodoris, who did not leave Istanbul, most Bulgarian military doctors after having been exiled to Yemen, moved to the newly established principality and autonomous province that provided plenty of job opportunities. Other reasons for the abandonment of the ‘Sick Man of Europe’ by those Ottoman physicians include the suspension of the first Ottoman Constitution in 1876 and the failed hopes for building the Ottoman ‘imagined community’; the expanded authoritarianism of Abdülhamid’s regime; and the increased economic dependence on foreign loans, especially after the establishment of the Public Debt Administration in 1881.

While the inclusion of various ethno-religious groups into the administrative structures during the Tanzimat was an expression of their semi-cooptation and promotion of Ottomanism, at the same time they were not really participating in political decision-making. ¹²⁰ A telling example of this feeling of exclusion is provided in a letter by Yordanka Filaretova, a Bulgarian philanthropist who visited Istanbul in August 1878 and wrote to the Director of Education in Sofia. She urged him to invite educated Bulgarians working for the Ottoman government to go back to the Bulgarian Principality after a conversation with Dr Vŭlkovich. The latter stated that, not only would he go back, but also that many other Bulgarian doctors in exile would do the same. ¹²¹ Thus, while they seemed to be loyal Ottoman subjects, their treatment during the Russo-Ottoman War, in tandem with the expansion of Balkan nation-states, was a watershed moment.

All these biographical and professional sketches follow the meanderings of the newly established states. As analysed by Max Weber and other scholars, there was a close link between the processes of state building and the formation of bureaucracy. ¹²² The emergence of a ‘swelling’ bureaucracy was a shared trait among the young Balkan states. ¹²³ And it is exactly this top-down model that engendered various issues by simultaneously building state and nation at an accelerated speed. Moreover, in both the Bulgarian Principality and in Eastern Rumelia, the political modernization was initiated by the Russian Provisional Administration (1877–1879). Hence, the state had to create the institutional preconditions for economic development and thus played a magnified role in every domain. ¹²⁴ The modernizing Balkan elites wanted to build centralized nation-states by copying institutions from Western Europe. As Diana Mishkova has noted, the logic of modernization in the ‘catching up societies’ was carried out by their tiny elites, which by necessity were simultaneously social, political, and intellectual leaders. ¹²⁵ They all tried to implement modern institutions modelled on the European state system and benefited from the ‘advantages of backwardness’ by taking ‘shortcuts’ in using European-made models and methods. ¹²⁶

Military modernization seems to capture the traits of nineteenth-century nation building. For example, the funding of the Serbian army and its diplomacy increased in just one decade (1858–1868) by 60 per cent and a progressive income tax was introduced to provide extra sources for such expenses. ¹²⁷ The trend towards militarization in the second half of the nineteenth century was not foreign to the Ottomans either. The Revolution of 1908 led to the rise of the military in the late Ottoman society and early republic. In the Bulgarian case, the national unification and restoration of San Stefano’s map had a state priority. As a result, economic resources were redirected through wars and militarization, and this delayed the development of social services and public health.

While a rupture with the past was fervently promoted by all Balkan states, there was also a continuity. For example, the promulgation of the 1867 Ottoman Municipal Law established the crucial institution of city councils that consisted both of appointed officials and of councillors elected by the local population. Those councils were charged with many public tasks, including social welfare, public sanitation, infrastructure construction, police, and firefighting. Doctors were permanent members of this multi-ethnic local administration. ¹²⁸ The post-Ottoman states continued similar policies, and Dr Draganov’s service as town doctor of Silistra resembles analogous duties in the 1880s. Furthermore, the establishment of the Medical Council in Bulgaria in 1879 can be compared to the Conseil supérieur de santé founded in 1838 by Sultan Mahmud II. Both the Ottoman Empire and the Balkan successor states borrowed from European military, medical, and sanitary institutions in order to modernize their states, but at a different time and with differing intentions. However, in both cases, the army was embraced as the epitome of modernization, with concomitant attention to medicine as a symbol of scientific advancement. The early pairing of both medicine and military under the umbrella of progress eased the subsequent expansion of state, militarization, and nationalism. Accordingly, many of the medals conferred to physicians for military and civil service manifest a focus on the importance of building military structures, but also on the role of the state in promoting national consolidation through awarding military markers of acknowledgment for civilians. It seems that the institutional link between medicine and its military application influenced the mindset and behaviour of this transitional generation of physicians who smoothly turned from Homo Ottomanicus into the Builders of Contemporary Bulgaria. ¹²⁹