Perilous Modernity: History of Medicine in the Ottoman Empire and the Middle East from the 19th Century Onwards 9781463230005

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Perilous Modernity

Analecta Isisiana: Ottoman and Turkish Studies

A co-publication with The Isis Press, Istanbul, the series consists of collections of thematic essays focused on specific themes of Ottoman and Turkish studies. These scholarly volumes address important issues throughout Turkish history, offering in a single volume the accumulated insights of a single author over a career of research on the subject.

Perilous Modernity

History of Medicine in the Ottoman Empire and the Middle East from the 19th Century Onwards

Edited by

Anne Marie Moulin Yesim Isii Ulman

The Isis Press, Istanbul

preSS 2010

Gorgias Press LLC, 954 River Road, Piscataway, NJ, 08854, USA www.gorgiaspress.com Copyright © 2010 by The Isis Press, Istanbul Originally published in 2010 All rights reserved under International and Pan-American Copyright Conventions. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise without the prior written permission of The Isis Press, Istanbul. 2010

ISBN 978-1-61143-128-5

Reprinted from the 2010 Istanbul edition.

Printed in the United States of America

TABLE OF CONTENTS

Introduction The particular place of medicine in the debate on modernity and modernization in the Middle-East in the 19th and the 20th centuries, Anne Marie Moulin and Ye§im I§il Ulman

7

1. Between East and West, shared and diverging visions and methods Kostas Gavroglu, Some methodological issues concerning the sciences at the European periphery Emre Dôlen, Réflexions sur la perception ottomane de la science moderne Serif Mardin, Some preliminary thoughts about the Tanzimat and the idea of Nature Christoph K. Neumann, Making the Universal one's own. The diffusion of modern science through Ottoman journals addressing a general readership

23 35 43

55

2. Scenes and actors of modernization M'hamed Oualdi, Du hakim renégat au praticien européen : mutations d'identité des médecins de cour et modernisation du service rendu aux beys de Tunis, du milieu du XVHe siècle au milieu du XIXe siècle Marwa Elshakry, Darwinian conversions: science and translation in late Ottoman Egypt and Greater Syria Hormoz Ebrahimnejad, Glimpses of relationship between Hospital, State and Medicine in nineteenth-century Iran Ye§im I§il Ulman, Medical Modernization in 19th Century Ottoman Empire with special reference to the introduction of Roentgen Rays in Turkey Nuran Yliâinm. Les mesures de quarantaine prises pendant les épidémies de choléra et leurs répercussions sur la société ottomane (1831-1918)

69 85 97

105

119

6

P H R I 1.0 U S M O D E R N I T Y

3. Elusive modernity Sylvia Chiffoleau, Les quarantaines

au Moyen-Orient

:

vecteurs

ambigus de la modernité' médicale (XIXe-XXe siècles) Anne Marie Moulin, Changeante modernisation

modernité.

L'état égyptien

141 et la

de la santé publique (I9e-20e siècle)

Nadav Davidovitch and Zalman Greenberg, Smallpox and in a village in Palestine

in december

157 variolation

1921. A case study of

public health, culture and colonial medicine

177

Edhem Eldem, Sorrow and Illness: "Modern " expression of Death in Ottoman Muslim epitaphs of the 19th century Claire Beaudevin, Une médecine l'exemple de l'échographie

moderne

"coupée du passé"

obstétricale au sultanat d'Oman

191 : 209

INTRODUCTION THE PARTICULAR PLACE OF MEDICINE IN THE DEBATE ON MODERNITY AND MODERNIZATION IN THE MIDDLE-EAST IN THE 19th AND THE 20th CENTURIES A. M. MOULIN* and Y. I. ULMAN

Medicine and medical reforms were a prominent part of the measures taken by governments and reformers in the Middle East when they aimed at modernizing their country. As modernization was intended to improve the economic situation, and increase the prosperity of society as well as serve the expansionist goals of state (which admittedly could be a way of managing the interior situation) 1 , medicine was one of the pathways chosen to reach this target. 2 Most of the time, medical measures were primarily directed at improving the health of the army as a priority, but it can be easily agreed that inevitably such sanitary measures cross-reacted with the epidemiological status of the population (such as vaccination or prevention of sexually transmitted diseases), and also that the training of military doctors could ultimately result into the emergence of professionals trained for the care of larger communities, as it happened in other contexts: military medical doctors from the West progressively came to be responsible for the management of the great endemics and developed techniques for mass medicine (good examples are the control of sleeping sickness or malaria). But considerations on medicine, clearly one of the facets of social and political changes in the 19th century, lead to raise a whole specific set of questions. What means modernizing medicine, and did this modernization of

* 1

Directeur de recherche, C N R S - C E D E J , Cairo, [email protected]

A point pressed by Fred H Lawson, The Social Origins of Egyptian Mohammad 'Ali Period, Columbia University Press, 1992. 2

Expansionism

during

the

Laverne K u h n k e , Lives at Risk. Public Health in Nineteenth Century Egypt, University of California Press, Berkeley 1990 ; Nancy Gallagher, Egypt's Other Wars, Epidemics and the Politics of Public Health, Syracuse University Press, New York 1990, A M Moulin, L'esprit et la lettre de la modernité égyptienne, Cahier des Annales islamologiques, 2 0 0 2 , 2 2 , 119-134 ; M A n a s t a s s i a d o u - D u m o n t , Médecins et ingénieurs ottomans à l'âge des nationalismes, M a i s o n n e u v e et L a r o s e , Paris 2003 ; A M Moulin éd., Le labyrinthe du corps, Islam et modernité, Karthala, Paris, forthcoming.

8

A.M.

MOULIN

AND

Y.I.

ULMAN

institutions of care and learning, as well as the tentative regulation of the professionals, reflect the specific values, generally addressed as modernity, or other ones of a different type? In particular, was not medicine, more than other crafts or fields of knowledge, more capable to make the link with the past and thence to legitimize the whole enterprise of modernization while responding to social and religious demands for consolidating identities and eluding the reproach for giving up traditional values? The political men who took the lead of modernization usually assumed that modern medicine along its many aspects, educational, legal, regulatory, etc, meant enlarged efficacy. But we historians need instruments for measuring the real impact of its programs launched and implemented. These instruments may be of quantitative nature, such as the estimation of the lengthening of life expectancy and the appreciation of the gain in decreasing maternal and infant mortality. W e can also c o n f r o n t the few extant data on the creation of hospitals, quarantine stations and the like with vital statistics, and examine whether the decline of some infectious diseases (such as plague or cholera) or the improvement of any current affection, can be attributed to the sanitary reforms. W e have also to discuss the impact of i m p r o v e m e n t s , if a n y , in providing drinkable water and clean and spacious housing, and perhaps tentatively venture into assessing the elusive quality of life, irrespective of its duration, among the population concerned. Unfortunately, we d o not often find available neat data, which could o f f e r a nice view of the correlation between modernization and sanitary improvement. When Dr Anthelme Barthélémy Clot, personally appointed by M o h a m m e d Ali, the wali of Egypt, came in 1827 to take care of the A b o u Zabel hospital, with total c o n f i d e n c e in his master François Broussais's system, he claimed that with his coming the mortality rate of the hospital dramatically dropped. He had substituted the regime advocated by Broussais, a hydric diet based on herbal tea, light broth and regular bleeding, to the roborant regime anteriorly prescribed by the Italian doctors in charge of the hospital, disciples of "Brown's system". The Scottish Doctor Brown was the favorite target for Broussais' virulent attacks: Brown advocated a radically different regime which predominantly included meat and fortifiants. T h e assumption of change in mortality in the wards w a s based on Clot's adamant statement of the superiority of "physiological medicine", the name given by Broussais to his own system. T h e main thrust of the doctrine was that "plethora", meaning the excess of force and acridity of the circulating humors, is the source of all illnesses, because it causes chronic inflammation, originating most of the time in the gastrointestine and extending to the whole

9

INTRODUCTION

body, so that only a drastic restriction of liquids and depression induced in the circulatory system can limit the inflammation and permit to the body to return to its baseline of equilibrium. Unfortunately, we do not have, at the present time, a compilation of data enabling us to challenge or to verify Clot's bold statements. Even if we could analyze the evolution of the mortality and morbidity rate at the hospital, we still would be at loss to assess the results of the new organization of care. Hearing about the changes happening in the hospital could modify the type of patients admitted. The rise of conscription in Egypt could also induce more and more soldiers to try to escape from going to war, so that the wards, previously full of people looking for alimentary help, were perhaps replenished with malingering healthy soldiers. This is of course only a hypothesis but it is corroborated by the predominant use of hospital beds for soldiers, following Clot's arrival, and illustrates how the quantitative evaluation of modernization is fraught with difficulties of all kinds in interpretation. In the context of the Middle East, the movement of modernization in medicine pointed to essential questions on the finality of bodily care, the significance of individual and collective suffering, in the grip of ancient and new plagues, and the ethos of research in natural sciences in Islamic context, not to mention issues that would become later more strident, such as the emergence of the nationalist movements, Arab, Egyptian, Armenian..., in the context of the crisis of the Ottoman empire until its final dismantling, in the wake of the First World War. Hospitals are a good example of the difficulty of ascertaining the impact of modernization on effective improvement in the sanitary situation. Usually, as Hormoz Ebrahimnejad has shown, both in the present chapter of this book and his major work on Persian hospitals 1 , most notably thanks to the plentiful waqf archives, historians benefit from numerous documents

bearing on the internal

organization

of

the

establishments, their "règlement intérieur", the number of beds, the allocation of food for patients, the salary and the hierarchy among medical attendants. Although these data are invaluable elements, which permit to monitor the course of medical reforms to a certain extent, they do not tell us much on the degree of care that was provided, the accurateness of diagnosis and the pertinence and efficacy of the therapeutic regimen, and, as some authors have claimed 2 , we should turn to other sources, either literary such as poetry, or

' H E b r a h i m n e j a d , Medicine, Public Health and the Qadjar Modernization in 19th Century Iran, Brill, Leiden 2004. 2

State,

Patterns

of

A Ragab, in Writing locally the history of Sciences, Dar el Kutub, Cairo, forthcoming.

Medical

A.

10

M.

M O II I , I N

A N D

Y. I.

I J L M A N

religious and jurisprudeniial such as comment of hadiths and fiqh judgments, to explore these issues. In history of medicine, as for history of science in general, the difficulty of assessing the impact of modernization is related to the general debate on which are the specific goals of science and the character of scientific truth and what is the nature of scientific facts unraveled by experimentation and rational speculations. A r e scientific facts the result of a c o m p l e x n e g o t i a t i o n , w h i c h leads to select and r e s h a p e s c i e n t i f i c data

under

investigation, so that, at the extreme they may be considered as a "social construct"? 1 It is clear that the applications of science are more likely to be easily understood as pressed by the social demands of various groups rather than grand scientific theories. But the theoretical orientations may also reflect the interests of the involved actors. Religion is s u m m o n e d in many

issues

connected with the scientific activity . In Islamic lands as in Christendom, has happened a recurring debate on the respective importance and legitimacy of theoretical and applied science. As Christopher K. Neumann shows in his chapter on the popularization of science in journals at the end of the Ottoman Empire, the nature of science is relevant to the religious debate on the importance of the socially useful character of knowledge displayed for the good of the c o m m u n i t y . T h e usefulness of science can also be related to the importance of comfort and happiness in the believers' lives in this world and the status of goods and commodities released on the market. T h e status of doctors and of those w h o trade drugs on the market, domestic remedies, traditional herbs and chemical drugs, is also at stake. Ultimately, the relevance f o r religious speculations of a research activity aimed at elucidating the secrets of life and matter, and ameliorating the living standards of the population, is obvious. Religion can choose between encouraging the improvement of distributive justice or uprising the issue of poverty to a supramundane level, by ascribing a special place to the poor in hereafter life and discouraging them to pursue trivial objects such as bodily health and terrestrial wealth. If the ascetic and neoplatonist trend of considering the body as an obstacle to angelic and dev out life has been a strong component of Christian thought, on the contrary, both defenders and adversaries of Islam have pointed to the importance of bodily matters for the believers. T h e physiological functions, which are the objects of medical knowledge constitute daily events (iahdath) which are a source of major or minor impurity and indicate specific

1 P W r i g h t , T h e Sociology ol Medicine, Anthropological Quarterly, and P Wright and A Treacher, The Problem ofMeda-a! Knowledge, Edinburgh University Press, 1982.

11

INTRODUCTION

rituals (wudu') before engaging in prayer. The believer's life is a constant passage from the physiological to the spiritual. The fuqaha

have lengthily

discussed on medical matters such as digestion, reproduction, excretion and sexuality, although it is an open debate to know whether it involves or not a negative judgment on such activities, which are fundamental for the welfare and the survival of the body. In The Virtue and the Flesh, Ze'ev Maghen has vigorously contradicted those who equate Islam with a contempt for the bodily basic needs and pleasures' and shown men and women passing untroubled from fulfilling physiological functions to acts of worship. The material basis of life in Paradise, a source of mockery for the adversaries of Islam, can be used as a testimony of the importance of the body and the legitimacy of medical concerns. Even the acknowledgment of the preponderance of the divine will in the casting of human destinies can be balanced by the numerous hadiths that emphasize the importance of remedies, (such as "There is a remedy for each ailment ") or that insist on the benevolence of God, who does not require acts beyond the human forces. In regard to the importance of science for religion, and the comprehensive stance of Islam encompassing all domains of political and social life and constantly concerned with the doings of the body, the decision of Mohammed Ali of positing the medical school out of A1 Azhar, although the Azharis were recruited both as students in the school and experts for the production of textbooks in Arabic after translation from the Western languages, has been diversely interpreted. Was it a simple attempt to create an elite of officers and engineers, distinct from the traditional elite of ulemas and linked to the state which provided them in return with positions and functions in its administration, answering new needs linked to the economic and military transformation ? Or more specifically, did the pasha want to create a body of scholars and professionals, who would not draw their prestige and influence from the traditional sources of empowerment, the knowledge of Koran and hadiths and the teachings of fiqh ? It is clear in both cases that the viceroy created a duality that poisoned for long the intellectual life in Egypt and generated misunderstandings and mutual diffidence, prejudicial to intellectual development, as Mohammed Galal argued in the Istanbul workshop at the origin of this book. This long lasting distance between the adepts of modern science and those of traditional studies, despite the efforts displayed by Cheikh A1 Afghani and his Egyptian follower Mohammad Abduh, at the end of the 19th century, to bridge the gap, created

' Ze'ev Maghen, The Virtues of the Flesh, Passion and Purity in Early Islamic Brill, Leiden 2005.

a wound,

Jurisprudence,

A.M.

12

M O U L I N

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IJLMAN

which the progressive introduction of medical and scientific faculties in the A1 Azhar University, in the 1970s, perhaps did not suffice to cure until the present times.

Is Modernity

a rupture with the past ? Or the relation of Medicine

to time

and truth Medicine has a specific relation to time and truth which probably strongly differs from other sciences such as physics and chemistry. There are those, rather the anthropologically-minded, who in a long-term perspective, note the connections and the similarities, more important than currently recognized, between for example a follower of Hippocrates, and a 19th century Western practitioner, or a medieval disciple of Razi or Zahrawi, and a Persian or Egyptian clinician of ihe early 20th century, and in a still bolder extension, associate the contemporary doctor with the eternal physician, with the argument that the physician's encounter with human bodies and sufferings transcends periods of time as well as borders. At the other end of the spectrum, there are those, historians and /or sociologists, who favour a discontinuist view of medical development. They bear a marked attention lo the so-called scientific revolutions dear to Thomas K u h n 1 , it means the shifts in the theoretical framing of experience. If such revolutions exist in medicine, it is clear that such swift changes often coincided with the introduction of new medical instruments enabling to explore the body and its ailments, such as the microscope, the thermometer, the stethoscope, the electrocardiograph, the "manzar" (the fibroscope), the electric bisturi, the anesthesia apparatus, the echography in its various guises, to quote just a few technologies. But it is paramount difficult to establish, based on the invention of these new tools, a strict "periodization" in the diagnosis and treatment of diseases, to assess the scientific progress resulting from their introduction, since concurrently major changes occurred in disease classification, relying on criteria of changing nature, successively borrowed f r o m anatomico-pathological, bacteriological, immunological, chemical, genetical knowledge, so that nosology has continuously fluctuated, making the comparison between periods and between countries at the same time 2 extremely difficult.

' T S Kuhn, The Structure 2

Epidemics

in Troubled

of Scientific Revolutions,

University of Chicago Press, Chicago 1962.

Time\, I Borowy and M Gruner eds., Peter Haag, Basel 2005.

INTRODUCTION

13

It is clear that the modernizing of hospitals, creation of beds, allocation of food and equipment, did not necessarily impact on public health, even if it displayed, and indeed was intended to reflect it, the interest of the state for its subjects' welfare. Sultans, walls as well as princes, in a Christian or Moslem country, have been figured as absolute monarchs, whose arbitrary decisions were hard to predict and understandingly feared, reflecting an almost divine origin of their delegation of power, putting them above normal mortals. The "Sultani" literature, a literary genre prosperous until far into the 19th century, has often described a fantasque

sovereign displaying all the attributes of a

power without limits 1 . Close to God who has anointed him as his lieutenant (khalifa), he is not restricted by other norms than those he chooses to adopt. In front of him, his subjects are passive and subdued: yet their "flock of sheep" is trusted to a shepherd, an image suggestive of some paternal concern. Next to the metaphor of the shepherd, comes the one of the physician (hakim).

The sovereign is also by vocation the healer of his people. More

generally the image of a munificent prince protecting the hubs of knowledge and the charitable institutions, including hospitals in his sphere of interest, permeates the discourse of court throughout from the medieval to the modern times. In the 19th century, the prefaces to the modern medical textbooks translated in Arabic muqaddimat),

before detailing the anatomy of bones or

the management of sexually-transmitted diseases such as syphilis or scabies, revived this traditional model of the prince protector of knowledge and health, and reused it for new purposes. In the East in the 19th century, before the rayas (subjects) turned into active citizens endowed with rights, the responsibility of the kings in the protection of collective health emerged. In the past, caravans of pilgrims died in the desert because of epidemics before reaching safely their destinations. The quickening step of transportation changed all that. Iran, because of its huge deserts, appeared for long as protected from the epidemics that plagued its more densely populated Mediterranean neighbors. Progressively in the east and even in Persia, groups of travelers and numerous armies, more sensitive to contagion than before, happened to be annihilated by diseases. At the same time, Western powers, having more or less succeeded in getting rid of diseases such as leprosy and plague, imposed growing control of their eastern borders and interfered with the circulation of travelers, pilgrims and goods. For all these reasons, health and medicine occupied a more prominent place on the princely agenda than b e f o r e , although in a different way in Egypt, Persia and the Ottoman Empire. In Afghanistan, the

' S Gubert, Le Maître dans tous ses états. Sujétion, théologie politique et royauté au Maroc médiéval : dynastie mérinide (I3e-I5e siècles), thèse de doctorat, Paris, 2004.

A.M.

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IJLM A N

epidemiological situation evolved later: the geography and the demography of the country implied encounters between regiments of British and Indian troops with small groups of tribesmen in narrow valleys, where epidemic diseases were much less of a concern. This difference, joined to the fact that the Afghan "juzail" (long rifle) carried further than the British musket 1 , can explain the severe defeat of the British in 1838-1842, inflicted to them when they retreated from Kabul to the Indian border: about 1500 men perished on the way and although there were doctors in the army, their presence had no impact in reducing the fatalities.

What means Modernization

?

Modernization occurred both inside and at the periphery of the countries in the East. Inside the countries, the governments initiated a census (again, in various times according lo the countries: the Ottomans came first, then Egypt, then Persia), with the obvious goal of tightening control on living and human resources 2 . Sovereigns in the Middle East have displayed at various times their willingness to reform and also modernize their administration, their army and to develop supposedly crucially useful crafts such as medicine, both as a source of knowledge and an instrument of increased e f f i c a c y . This modernization has often been understood, as it coincided with the intervention of foreign experts and the flow of teachers from Western countries, as an adoption of the Western ways of doing, in short as an adoption of the Western model of society and go* ernment. But §erif Mardin shows that the Ottomans were much more pragmatic, and did not link the adoption of useful innovations to a questioning of their view of the world, of their own power, or even simply of Nature. Nuran Yildinm gives a precise documented description of the main events in the history of institutions concerning Ottoman public health. In the end of the 19 th century, Emre Dolen underlines the fact that the Universities as establishment of culture for the sake of culture did not expand, despite the brilliant start in 1900, before at least one generation. But while since at last thirty years, the idea of a simplistic adoption of a model has been ruled out as Kostas Gavroglu suggests, and the topic of "appropriation" has replaced the gross concept of a mere "transfer", it remains

' Lady Florentia Sale, Journal of the First Afghan Oxford University Press, 2002 2

T Mitchell, Colonizing

War (first published 1969), P. Macrory ed.,

Egypt. Cambridge University Press, London 1988.

INTRODUCTION

15

to understand how these scientific and technical changes impacted on the making of the modern states, and modern societies until today. What is the ultimate meaning of these attempts to modernization? And what values are associated with modernity, which means the norms by which the output of modernization programs can be measured and appreciated? Insofar as medicine is concerned, the situation is complex as medicine affects not only the material welfare but the intimacy of human lives. The scientific knowledge on the basis of which the effects of modernization were speculated and anticipated are far from being established without ambiguity. Numerous theoretical issues such as the existence of contagion and the mechanisms of transmission were passionately debated in the West and did not result into an academic consensus before the end of the 19th century. As we see in the book with Nadav Davidovitch, the introduction of vaccine against smallpox in the wake of Jenner's discovery was far from being universally considered as the best method to combat a severe disease that cut off many lives, especially in infants. In India, for years in the 19th century, the British had hesitated to enforce vaccine over traditional smallpox inoculation, not only because of the impingement on traditional uses, but because their own cowpox vaccine was not necessarily competitive with well monitored variolation as performed among the Brahman elites, with segregation of the variolated children 1 . In many countries of the Middle East, perhaps with the exception of Egypt, still a subject of controversy (Larrey's testimony that variolation was hardly known, except by the Bedouins, has often been accepted at face value), the ancient practice of variolation was acknowledged everywhere. Contemporary historians have revisited the period when variolation and vaccine were practiced side by side, and brought in a more complex picture than the simplistic opposition of an old folklore recipe, at high risk, and a safe and effective procedure. In countries such as India, aristocratic mansions (in a way very close to variolation in aristocratic circles as practiced by the Sutton family in Britain), the use of dried crusts, kept for some time in a cool place to attenuate virulence, administered to infants carefully supervised and isolated, could be both effective and relatively safe, while the arm-to-arm transfer of cowpox, originating from lymph of uncertain or dubious origin, could be conducive to unequal results at best and at worst, communicate various ailments such as syphilis or leprosy, and frequently procure deceptive prophylaxis. Nadav Davidovitch's description of the persistence of variolation refers to a period when the vaccine had become more stable and standardized (although it was nt the case in Talestine at the time), but such an achievement needed more than a century of trial and error, which amounted to a massive human experimentation.

' S Bhattacharya and coll., Fractured States. Smallpox, Public Health and Vaccination Policy in British India, 1800-1945, Orient, Longman, New Delhi 2005.

A.M.

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MOULIN

Which values stand for modernity Medicine, undoubtedly

AND

Y. I. U L M A N

? one ancient profession attested

in all

civilizations, one of the most ancient and respected crafts, is supposed to provide treatment for the patients. Modernity usually means the adoption of the most recent and innovative treatment. Medical history, f r o m this vantage point, is presented as a one way movement where the modern have always the predominance over the holders of tradition, and where new knowledge is constantly replacing the formerly admitted knowledge. It is clear that the history of medicine does not follow such a quiet and smooth unhindered pathway. In fact, the course of knowledge does not follow this pattern of constant i m p r o v e m e n t . It is true that doctors are o f t e n confronted in their life to radical changes in the dogmas on prevention as well as on cure. Antibiotics, once extolled as a panacea, are now considered more cautiously, being given the rising rate of resistance among current bacterial strains (in particular the so-called nosocomial infections, rising to an ominous rate of 10% in some hospitals), and messages are currently delivered to the physicians and the general public, advising them to avoid the widespread use of third generation antibiotics for ordinary infections, even if these messages largely pass unnoticed and unattended. There is a great difficulty in obtaining that doctors constantly update their knowledge, despite the frequent calls addressed at them, and the recent organization of programs on the net, taking advantage f r o m the newest numeric technologies (e-learning) to help them in refreshing their knowledge. The Harvard Program (called The New P a t h w a y ) of the 1990s aimed at transforming today medics into lifelong learning students, who never turn into a c c o m p l i s h e d "doctors" ( f r o m doctus,

a savant). In E u r o p e , it has been

proposed to submit doctors to a regular and periodical assessment of their knowledge and skills, which is, if not practical, at least logical. In the Middle East, similar programs are on the w a y , and the same takes place in the Maghreb. Far f r o m being a n i m a t e d by an e t h o s of o n e - w a y

cumulative

k n o w l e d g e , medicine is marked by a relative epistemological instability, despite its reluctance to take lessons f r o m the distant or near past. Clearly medicine is lacking a theoretical foundation f o r the status of mistakes and errors. T h e history of medical errors, mistakes and faults, is not a simple enterprise, but some of its events can be pitted against a unilateral view of its everflowing benefits. 1 Far from being comparable to a hard kernel being rid of

' C Bonah et coll. Eds., La médecine Contemporaines, Paris 2003.

expérimentale

au tribunal,

Editions des Archives

INTRODUCTION

17

its external impurities and envelopes, medicine is more adequately described as phases of transition between successive "régimes de vérité" (and proof and verification), which suggests the contextual status of medical truth. Modernity, if synonymous with critical, epistemologically-oriented approach, could well consist of this acknowledgement of the unstable or partial status of medical truths, which hardly accommodates a dogmatic teaching from the chair and privileges an approach and a mode of teaching enabling students of medicine to scrutinize in a spirit of freedom the teachings they have received. This perspective does not necessarily fit the doctors' needs in daily professional life, when they have to make rapid decisions in emergency situations and identify steps to be taken rapidly, to obviate life endangering situations or adjust to the social and cultural conditions of their patients.

Ambiguous

modernity

Because the beginning of the 19th century was marked by intimate and dramatic exchange between East and West, which conduced to medical reforms, we deliberately focused on the 19th and 20th centuries. This was a period of intensive transformations, where it is important to assert the ways and instruments of the "appropriation" of innovations by the East, as Kostas Gavroglu has urged to do, and to inquire behind the curtains on a scene preempted by the flamboyant intervention of the Western experts, in the name of the alleged preeminence of Western sciences. Again, what meant and means to be modern ? Modernity, it was hypothesized, is an ideological stance, an adhesion to permanent change and epistemological instability, and the acknowledgement of the importance of permanently reassessing and reconstructing the past tradition, an endless enterprise conceived for the contemporary needs. All the authors have made their best to answer these questions on the basis of original documents related to different countries and different contexts. But how to compare the Ottoman Empire, with its plethoric tradition of science and hospitals, from the Byzantine heritage through the Seldjukids to the reformist sultans of the 19th century, with the Oman sultanate, where the first hospital was created in 1931, or what happened in Istanbul and what emerged in the Palestinian province? The volume does not permit to give a global answer to all Vhc questions, but offers fascinating glimpses into a rich and complex landscape, which ultimately does not accomodate the dichotomy between East and West.

A.M.

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Y. 1.

III.MAN

If Emre Dolen gives us a narrative of a slow process of academic construction, culminating with the late foundation of the Istanbul University and perhaps best illustrated by professional centers such as the Institute of Agricultural Research, §erif Mardin turns to the r e m o t e Ottoman past to intuit the multiple visions of the world, which potentially coexisted in the seemingly unique Islamic sphere. Mardin thus suggests plasticity and resources which are still waiting to be explored. The religious sense of created nature permeated knowledge without excluding inquiries in mechanisms and cycles. Christoph K. Neumann shows how the newspapers, whatever limited be their audience, suggested an enlargement of the scholarly community and the diffusion of scientific news, recruiting new social categories and audiences. The terminology used requires due attention, with subtle shifts of meaning in the terms of ilm and fen. Modernization displayed itself on several scenes and involved different types of professionals M'hamed Oualdi pictures Western doctors as brokers of knowledge across borders. At the beginning of the 19th century, some of them converted to Islam, others not. It was no longer a requirement for practicing their art, even if science was still far f r o m being a shelter f r o m the ruler's anger. In 1818, the Bey in T u n i s , made angry by his physician breaking the news of a c o m i n g plague, c o n d e m n e d h i m to b a s t o n a d e , but this b e h a v i o u r w a s considered, even at the time, as archaic. Medical science was increasingly developing as an independent expertise, at the eve of the medical rise to power, when the medicalization of society was still in its infancy. Tackling scientific questions debated elsewhere could primarily have a profound symbolic value Marwa el Shawkry does not enter into the scientific controversy that raged in the West between supporters and adversaries of the interpretation of D a r w i n i s m in e v o l u t i o n , with a r g u m e n t s d r a w n f r o m paleontology and embryology. She shows how the interest for the Darwinian debate reflected in Arab lands the desire to participate to a debate which was by itself a dive into modernity, on the exploration of nature as matter. She also shows that the Arab scholars were in fact far more interested in the debate on consequences of Darwinism for the understanding of societies and the struggle between nations (the so-called social darwinism) than in the demonstration of Darwinian theses on natural selection, relevant to the evolution of the living beings. Nuran Yildirim elaborates quarantine organization and the allied disinfection stations network that underlied the fight against cholera epidemics all across the Ottoman territory between 1831-1918. She benefits the Ottoman archival sources and documents not only to bring the innovative actions of the

INTRODUCTION

19

Ottoman State to light, but also to trace the Ottoman people's attitude regarding those "modernizing" precautions. Edhem Eldem delineates a vivid tableau of the transformation of men's attitude and perception of death, over the course of time, from a traditional way of thinking into a more secular and modern world-view. Eldem utilizes epitaphs subtly as solid historical documents to prove the constant social change in favour of modernization. The origin of the hospital has been disputed between the West and the East where the existence of hospitals can be tracked back to a long past. The controversy bears on the functions performed by the hospital, beyond the provision of food and bedding, and the existence of medical treatment, and of a staff, being trained and training, in short on the existence of clinicians and clinical knowledge. Whatever be the answer, the medical reform in the East could be depicted either as a revival of an antique tradition or an adoption of a western model, or both, and certainly differed according to the recipients of the discourse. For example, the existence of maristans devoted to the care of the insane has been presented as a proof of a considerable advance in the Moslem countries, compared to the neglect of insanes in the West, but in the 19th century, the fate of alienates was not better, and travellers frequently observed the destitute situation of the patients in the places where they could be met. The chapter by Hormoz Ebrahimnejad emphasizes duly the importance of, neglecting quarrels of priority, describing as precisely as it is possible, the functions and internal organization of hospitals in Persia, thanks to original documents, reserving for the future the complete answers to the existence of a clinical knowledge and the efficacy of treatments provided to patients on the spot. The introduction of technical innovations did not immediately lead to useful applications. Ye§im Isil Ulman here shows how the X ray technology for exploring the body, was immediately

captured, little after its

announcement by Roentgen in the academic papers, by a brilliant and imaginative young Ottoman scholar. While it did not immediately develop into a full-fledged technology, despite its obvious potential in times of war for locating projectiles. Ye§im I§il Ulman drags attention to the way the innovation, intuited first by a solitary scholar, was in fact nurtured and amplified by a pluriethnic professional community, in an empire benefiting from the variety of its communities, some of them having privileged relations with the Mediterranean world and the rest of Europe. A bustling activity of the scientific communities, unique to the cosmopolitan Ottoman Empire, again can be pitted against a simplistic dichotomy between East and West.

20

A. M. M O U L I N

AND

Y.I.

U L MAN

If it is easy to follow the actors of modernization on the different scenes where they were \ isible, it is more difficult to characterize their values of reference. In Mohammed Ali's Egypt, the reformist Dr Clot alias Clot bey wanted forcefully to be modern, and actually felt himself to be modern and called himself so because he wanted to implement revolutionary changes in medical theory and practice. But what he formulated as his modern stance, his denial of plague contagion, is precisely which now for us derisively points to an obsolete knowledge, since we assert today that plague is actually contagious, either directly between people or by the intermediate of rats and fleas. Yet, in his management of his wards full of plague-stricken patients, for the sake of his demonstration of the non-contagious character of plague, Clot staged two components of modern science, experimentation on human subjects, and the examination of corpses. Besides, his denial of contagion led him to assume the care of patients who otherwise would have been denied any kind of assistance, something which retains its full modern value, in terms of the profession' ethics. Quarantines, as described by Sylvia Chiffoleau, show still more ambiguous. They were currently described in the West as an instrument having allowed to successfully oppose the diffusion of plague. Throughout the 19th century, they reflected more the routine of self-preservation among the neighbours than the breakthroughs of medical science. On the Eastern side, the popular resistance did not address so much the scientific doctrine of contagion than the rough manner quarantines were implemented, ignoring all rules of decency and denying personal comfort to unhappy travelers and pilgrims. If modern science was a apprenticeship of critical thinking and the instability of scientific truths, another facet of modernity was the emergence of the individual. Edhem Hldhem and Claire Beaudevin's contributions bear on the extremes of life, birth and death. The former describes the emergence of the individual through a survey of the content of the epitaphs, which with the passing of time, paid more attention to the details of personal life, disease and s u f f e r i n g . The latter, in the context of modern O m a n , explores the medicalization of the prenatal period. She shows the passage of the fetus from an obscure period, known only to the mother in a crucial and most intimate experience, to an official life shared between father and mother and the members of the family, and between the medics and the lay people. In the two examples, although apparently located in distinct settings, both in space and time, the medical knowledge, once only imparted to the f e w , shaped the imaginations of all and singled out the ephemeral individual, seized at two crucial moments of his or her advent on earth.

INTRODUCTION

21

Modernization is an unfinished and evergoing process, modernity a permanent quest for solving the global issues of science, society and power The book had the modest ambition, by confronting the efforts of the scholars in describing the scientific events that shaped the 19 th and 20 t h century, to stimulate future scholarly work. It has shaken the unsustainable idea of a profound and everlasting divide between the West and the East. No better topic than medicine could serve this purpose. The initial steps of the project paving way to the book owe a great deal to the valuable and scholarly support of l'Institut Français d'Etudes Anatoliennes (IFEA) together with its former and present directors Prof. Pierre Chuvin and Prof. Nora §eni in Istanbul where the meeting took place that resulted into the book. We are grateful to Ms Pinar Dost Niyego MA, the director's assistant and to Ms. Noémi Levy PhD, the fellow of IFEA for their efficient assistance. We are thankful to Ms. Ay§e Erdem, former assistant to the Director, Ôzgiir Turesay PhD, the associate researcher of IFEA and Mrs. Rebecca Erol for their skillful efforts. The estimable supports of CNRS in Paris and CEDE! in Cairo have made this Project come to fruition. This book would have never been accomplished without the kind and proficient support of the Isis Press led by Mr. Sinan Kuneralp, Lastly we deeply appreciate the zeal of the authors and would like to thank them for their original and eminent contributions.

SOME METHODOLOGICAL ISSUES CONCERNING THE SCIENCES AT THE EUROPEAN PERIPHERY Kostas GAVROGLU*

Received wisdom in the historiography of science claims, correctly in my view, that the scientific revolution of the 16th and 17th century is a European phenomenon. Strictly speaking it is a western

European

phenomenon, having, in fact, a rather well defined locality: it has been articulated within the boundaries of a polygon formed by Florence, Paris, London, Edinburgh, Krakow and Florence. What happened in Europe outside this polygon has been invariably been referred to as the transmission of the ideas of the Scientific Revolution together with those of Enlightenment to the European Periphery. Russia, the Baltic Countries, the Ottoman Empire which included the Balkans during the 18 th century, Spain and Portugal are all taken to be part of the European Periphery. Although some work has been done on the subject, themes surrounding the transfer of new scientific ideas, the mechanisms of their introduction, and the processes of their appropriation at the European periphery have not been studied systematically. In most of the works dealing with the issues of the transmission and the introduction of these ideas in the European Periphery, the historiography of transmission studies is about unsung heroes of the periphery and, in effect, the historiography of transmission is the history of all those who have become the bearers of Enlightenment in their respective societies. Of course, the whole notion of periphery brings into the fore the rather simplistic bipolar distinction between center and periphery. Though such reference of center and periphery is useful for broadly delineating the situation, it is incapable of capturing many salient details of the introduction of the scientific ideas in the societies of the European periphery. Three factors in particular require expanding any such static, bipolar conception. There are first of all many centers and many peripheries and not all centers and all peripheries share the same characteristics. This is rather self-evident: London, Florence, Paris were all centers whereas the Iberian Peninsula and the Balkans were

Professor of History of Science, Dept. of History and Philosophy of Science, University of Athens, Telephone 210 7 2 7 5 5 3 2 , Fax 210 7275530, e-mail: [email protected].

24

KOSTAS

GAVROGLU

peripheries. Secondly - depending on the subject one is discussing - a place may at one and the same time be both center and periphery. Such is the case of Spain with respect to 1 atin America. Thirdly, a single country may contain both centers and peripheries. France with the over concentration of activities in Paris, is such a case. Although the concept of idea transfer can be useful and even fruitful for further research, o n e must always recognize that ideas are not simply transferred like, as it were, material c o m m o d i t i e s . In being introduced in different localities, ideas and techniques are always transformed in unexpected and sometimes startling ways. Thus instead of talking about the transmission of ideas, it may be preferable to discuss these phenomena in terms of the appropriation of ideas and techniques by the multiple cultural traditions of a specific society during a particular period of its history.

Some questions In such a context, s o m e of the m a n y issues worth raising are the following: What were the ways in which the ideas and techniques of the Scientific Revolution and the Enlightenment were introduced to these countries? What were the particularities of their expression in each place? What were the specific f o r m s of resistance encountered by these new ideas? W h a t was the extent to which such expressions and resistances displayed national characteristics? What were the procedures through which new ways of dealing with nature were made legitimate ? What were the commonalities and the differences between the methods developed by scholars at (he 'periphery' for handling scientific issues and those of their colleagues in the c entral' countries of Western Europe? What were the institutions which helped legitimise the new view points? What has been the role of new scientific ideas, texts and popular scientific writings in forming the rhetoric concerning modernization and national identity? What

scientific institutions

became

prevalent

as p o w e r

was

consolidated and opposition by local scholars emerged? What characterized the prevailing mode of scientific discourse among local scholars?

SOME

METHODOLOGICAL

ISSUES

25

What was the relation between political power and scientific culture? What were the social agendas, educational policies and (in certain loci) the research policies of scientists and scholars? What shifts in ideological and political allegiances were brought about as the landscape of social hierarchy changed? What consensus and tensions appeared as disciplinary boundaries formed, especially as reflected in the establishment of new University chairs? Finally, what ideological undertones characterized the disputes, and what was their cognitive content?

Transmission

versus

appropriation

The concept of the "transfer" of ideas, used extensively by those who have discussed these issues is found to be ultimately inadequate in contextualizing the dissemination of the new sciences in the societies of the European periphery. It appears that the notion of "appropriation" can be a more coherent and fruitful analytic instrument. Appropriation directs attention to the measures devised within the appropriating culture to shape the new ideas. And these ideas have been appropriated within the local traditions which form the framework of local constraints -political, ideological as well as intellectual constraints. A historiography based on the concept of transfer can easily degenerate into an algorithm for keeping tabs on what is and what is not being "successfully" transmitted. A historiography built around the concept of appropriation is more comparable to the procedures of cultural history since acceptance or rejection, reception or opposition are intrinsically cultural processes. Such an approach also permits the newly introduced scientific ideas to be treated not as the sum total of discrete units of knowledge but as a network of interconnected concepts. In other words, the practical outcome of a historiography based on the notion of appropriation is to be able to articulate the particularities of a discourse that is developed and eventually adopted within the appropriating culture. Undoubtedly the concept of transmission of ideas is of some use to the historian of ideas. This, however, is apparent only when the transmission of ideas is used for certain specific cases within a wider procedure of appropriation

of multiple cultural traditions. In these occasions the

intellectual and institutional framework for the reception of the new ideas is, to a large extent, conditioned by the cultural and religious traditions of the societies in the periphery together with the role and structure of their

26

KOSTAS

GAVROd

HI

educational institutions The purpose of such an approach is not to examine how successful the transmission of the ideas of the Scientific Revolution or of the Enlightenment was. I'he notion of how successfully or faithfully a corpus of ideas and practices has been transmitted, is a theme that we meet very often in a large n u m b e r of works written by historians of the o l d , positivist approach. Honestly, I do not understand what is meant by such a question. If by posing the question as to how successfully or faithfully ideas have been transmitted, one means how much the local books resemble those of the books written in the centers, then one misses the whole point of the procedures of transmission, a n d , of c o u r s e , those of appropriation. A s I mentioned, ideas are not material commodities to be able to be transferred intact. Filtering processes, eclecticism and all kinds of other processes are at work when they are being introduced in a particular locality. So the emphasis should not be on how full) the center is being reproduced in the periphery. The emphasis should be on understanding the c h a n g e s , in assessing the metamorphoses that these ideas go though. Hence, our main consideration is to comprehend the m e c h a n i s m s of the production of a distinct scientific discourse whose features are being determined by the assimilation of scientific ideas formed at the center and their fusion with local intellectual traditions. T o trace the origins of the transmitted ideas, to compare the original ideas with their transmitted counterparts, without assessing the particularities of their appropriation is, 1 feel, a pointless exercise. There is, indeed, very little use in directing our attention to draw lists of w h a t has been s u c c e s s f u l l y t r a n s m i t t e d . I n s t e a d , w h a t should

be

systematically studied arc the moulding the new ideas go through at the initial stages and the kinds of attempts by the " l o c a l " scholars to incorporate them to existing traditions. One will have to a d o p t the view that the w h o l e enterprise of appropriating the new ideas during the 18th century could only be achieved through the formation of a new discourse as the o p t i m u m way of overcoming the local constraints. For it appears that at the initial stages of the attempts to introduce neu ideas, the respective scholars of the periphery could choose among many alternatives for developing a discourse which suits their aims, be they educational or ideological. Thus the adoption of a viewpoint w h e r e the notion of appropriation is d o m i n a n t , directs attention to the production of a distinctive scientific discourse through the reception of the new scientific ideas. O n e of the main aspects in such an approach is to understand the dynamics and the conditions under which the creation of legitimizing spaces for the new ideas becomes possible. T h e problem is relatively simple in those cases where we are confronted with the well discerned and clearly defined

SOME

METHODOLOGICAL

27

ISSUES

spaces such as universities and academies. But in many instances at the countries of the periphery one may not be able to even find such spaces. S o where shall we direct our attention to find these legitimizing

spaces?

Understanding the creation of legitimizing spaces for the new ideas cannot be achieved independent of understanding the ways resistance is expressed against these new ideas. Personal a g e n d a s , professional strategies, institutional flexibilities and social demands form different settings for the formation of the multifarious spaces of appropriation-or equivalently, in bringing out the multiplicity of legitimising spaces. Disputes among scholars reflect some aspects of such resistance and they have also been a particularly advantageous method for understanding the dynamics of legitimizing spaces. But somehow in the more standard accounts, disputes presuppose an audience with an inclination or at least a potential interest to engage in the issues involved in the dispute. Audiences have always been a necessary dimension for studying disputes and, it has quite often been the case that those who are directly involved in a dispute are preoccupied almost exclusively with the audience rather than their adversaries. But, there are localities where audiences may, on the whole, be totally ignorant of the issues involved in public disputes, yet supportive of the overall social or political

a g e n d a of particular s c h o l a r s .

Under such

circumstances,

understanding the cognitive content of disputes becomes a difficult, but not impossible, undertaking, if one stops looking at disputes as intricate rituals and analyse them as part of the educational processes. Apart from its emphasis on the notion of transfer rather than that of appropriation, another aspect of most existing scholarship is its almost exclusive dependence on two equations. In most of the historical works written about the sciences at the periphery, Enlightenment means almost exclusively, French Enlightenment. And whenever there is reference to scientific ideas, these historians mean Newtonianism in the form of mechanics found in later text-books. Such assumptions are particularly problematic. Both equations are at least incomplete, if not simply wrong. Enlightenment was not exclusively represented by French Enlightenment. And Newtonianism in the 18 t h century, was a dynamic set of concepts with no consensus as to its final form -- a state of affairs far away from its codified form found in textbooks written much nearer our own times. Let me make some comments on these aspects of transfer studies.

28 French

kOSTAS

GAVROGU)

Enlightenment The French Enlightenment has been particularly dear to the heart of a

number of historians at the countries of the periphery and, especially of philologists, whose studies concentrated on scholars whose social and political agenda was a significant part of their life and work. The French Enlightenment is, often, taken as the paradigmatic expression of the Enlightenment, and all other expressions of the Enlightenment are considered as being either unfulfilled versions of the French case or cases which tended to the ideal and pure program which was expressed by the French lumières and

philosophes.

If one looks, however, at the German case and studies a man like Christian Wolff, his followers and other rationalists of their time, we realise that they did not enter into a confrontation with either the political or the religious establishment, though they were definitely unwilling to accept their all pervasive power. In fact, this contradictory attitude, this practice of not wanting to come into a conflict, yet questioning the authority of the state and ecclesiastical powers, characterised this practice and set it apart from that of the French lumières. It was not an antagonistic view of the Enlightenment, but rather a complementary one. Let us be reminded of what Frederick II had proceeded to say that the philosophers "instruct the world through their reasoning, we through exemplary practice." It was a division of labour which also meant putting the philosophers in their place, a definition of enlightened absolutism. The point is clear: there have been many societies where it was often the case for persons holding high offices, to be consciously initiating elements which in the local context constituted Enlightenment policies. To study these cases -especially for the societies at the European periphery like Russia and the Ottoman Empire - through an almost exclusive reference to the French case would be surely leading to deadlocks. In this respect let me make three points concerning the sciences at the European Periphery . The first point is almost trivial. The Enlightenment was not a homogeneous and uniform movement. There are no more sanitized and less sanitized versions of the Enlightenment. They are all equally legitimate, and it is wrong to look at the French version as the more advanced and radical, if we want to see how the movement in Europe as a whole influenced the rest of the regions. Exclusive attention to the French Enlightenment when studying the reception of the new ideas at the societies at the European periphery during the 18th century is, we feel, a methodological choice which is historically sterile.

SOMH

METHODOLOGICAL

ISSUES

29

The second point is that we should look at the French Enlightenment and the German Enlightenment in their complementary aspects as well as in their contradictory aspects, and emphasis should be placed on the merging and the confluence of traditions. Let us be reminded that the Balkans turned out to be particularly receptive to the practice of enlightened despotism of Germany, Austria, Poland and Russia. And thirdly, we should deal with the scholars of the periphery as a group of people who turned what appeared a liability into an asset. These scholars functioned within a framework formed not by any paradigmatic philosophical discourse they may have perceived, but by their eclecticism among a number of alternatives. The scholars of the periphery became rather assertive and acquired a rather creative freedom when they realised that there was much to be gained by looking at the cracks of the French Enlightenment, by concentrating at its unfinished business, at its weaknesses and failures. In other words we should look at the scholars of the periphery not as passive agents whose only function was to distribute locally the well-packaged goods delivered to them from the centers of Europe, but rather as active subjects who received many goods with no particularly clear directions on how to dispose of them locally. The French Enlightenment as the paradigmatic case of the Enlightenment, apart f r o m being a historiographical construct much in demand in the twentieth century, is also a notion that reduces the local scholars to passive carriers of this otherwise " p e r f e c t " program.

Newtonianism Let us now come to Newtonianism. Almost all of the works written in the countries of the European Periphery discussing these issues take for granted that the developments in natural philosophy during the 18 th century were simply the unfolding of the Principia.

At best they consider the 18 th

century as the algebraization of the geometrical Principia.

Nearly no one

takes into consideration the deeply diverging opinions on the future, as it were, of mechanics. And even fewer people note that Newtonianism was in a state of flux and that such a state of affairs provided a much less

constraining

context to a lot of scholars of the periphery in their attempt to formulate a new discourse. Such considerations are rather significant for us since what we would be mainly concerned with is the understanding of the attempts to appropriate the new ideas through the formation of a new discourse. When we talk of the influence of N e w t o n i a n i s m , or still, when people talk of the w a y s newtonianism was introduced at the periphery, the tendency is to see how the

KOSTAS

30

GAVROdl.ll

local scholars were influenced by the Principia,

how faithful they w e r e to the

particular w o r k or how m u c h influenced they were by those w h o tried to either popularize N e w t o n ' s work or write simpler scholarly treatises about it. If o n e deals with the second hall of the 18 th century, this is a misguided e f f o r t . For it is the period w h e n t h e w hole status of the notion of f o r c e w a s still an o p e n q u e s t i o n , and the d e v e l o p m e n t of rational and a n a l y t i c m e c h a n i c s

was

intensely p u r s u e d . T o understand w h a t c a m e to be k n o w n as n e w t o n i a n i s m at the countries of the E u r o p e a n periphery, it will greatly h e l p to b e c o m e a w a r e of the failings and w e a k n e s s e s of the Principia

as well as of t h e constitutive

aspects of the p r o g r a m of rational m e c h a n i c s in order to understand better the w h o l e question of " t r a n s m i s s i o n " but even m o r e so in order to c o m p r e h e n d t h e p r o c e s s of " a p p r o p r i a t i o n " . T h e p r o c e s s of a p p r o p r i a t i o n

involved

e c l e c t i c i s m a n d d e c i s i o n s on the p a r t of the s c h o l a r s of t h e p e r i p h e r y concerning choices between ongoing programs and existing tradition, b e t w e e n , say, choosing " m o m e n t u m

or f o r c e p h y s i c s " o r p r e f e r r i n g " v i s

viva

conservation p h y s i c s . "

The axes Let m e try to s u m m a r i s e the salient f e a t u r e s of t h e s c h o l a r s h i p in the history of science based partly o n the notion of t r a n s f e r , but m o s t l y o n t h e notion of appropriation. T h e f o l l o w i n g a r e f o r the 18 th and early 19 t h c e n t u r y . T h e s e features can be articulated along f o u r axes. Firstly, in all the societies of the periphery in the 18 t h c e n t u r y t h e r e appear to be a number of scholars w h o s e role is predominantly educational and w h o are well versed about the scientific developments at the centre. S e c o n d l y , in the v orks of these scholars, o n e discerns the f o r m u l a t i o n of a rather idiosyncratic scientific-philosophical discourse in their attempts to adopt the new ideas within the local cultural milieu. T h i r d l y , f a r f r o m c o n s i d e r i n g t h e F r e n c h E n l i g h t e n m e n t as t h e e x c l u s i v e expression of (he E n l i g h t e n m e n t , scholars of t h e p e r i p h e r y h a v e been eclectic a m o n g the many expressions of Enlightenment. Fourthly, the scholars of the periphery did not have in their m i n d w h a t historians of ideas later on called N e w t o n i a n i s m , as a u n i f o r m , c o d i f i e d and closed system of ideas, but they w e r e a w a r e of the o n g o i n g debates during the 18 t h century concerning the theoretical status, the mathematical f o r m and the o n t o l o g i c a l i m p l i c a t i o n s of the N e w t o n i a n t h e o r y and t h e y , t h u s , had the opportunity to be eclectic a m o n g many alternatives.

SOMH European

METHODOLOGICAL

ISSUES

31

science

Let me now come to some issues concerning the overall theme of our Conference, always in relation with the issues raised about periphery. Europe is presently in the throes of its most dramatic transformations since the end of the Second World War. New nation-states have come into being, new borders emerged, new institutions appeared, and old institutions restructured themselves. Many historians and other scholars will look again at the past in the light of current changes. The work that has already been done, as well as newly available sources, combined with (comparatively) open intellectual environments and increases in funding for trans-national contacts offer an unprecedented opportunity for a critical re-examination of the historical character of science in Europe. But a critical re-examination of the historical character in Europe does not mean the construction of European Science. In a 1995 White Paper on the question of unemployment and on the ways young people can gain as many skills before finishing high school, the European Union proposed that history of science and technology be included in the school curricula. It was no doubt a good recommendation but for the wrong reasons. The White Paper suggested that by learning the history of science, and especially the history of technology, young people will acquire knowledge of a variety of skills and techniques and will become aware of the boundlessness, as it were, of human inventiveness. The recommendation of the report, however, is embedded in one of those interesting mental summersaults that the bureaucrats in Brussels are so fond of performing. It was noted that science had been a European phenomenon, that modern science has been born in Europe and that it should be taken as our common European heritage. From these, it is but a short step, to be confronted with the elusive notion of European Science. The danger of Europeanizing everything looms dangerously in Europe today, since Europe, as expressed by its new institutions, is badly in need of homogenizing everything, and the history of the sciences provides the obvious case. Here is one of those instances where there is such a dichotomy between the bureaucracy's goals and the aims of an academic pursuit. Never mind that historians of science have been trying to articulate local differentiations and trying to bring to surface the deviations from the view that holds the scientific enterprize to be an all inclusive homogeneous practice. European integration as planned in Brussels needs "European" notions like European Science and the spectre of European science will be continuously finding justification.

32

K. 0 S T A S

GAVROtiLI!

So here is another dimension about the sciences in the European periphery: Talking about the periphery will result in articulating differences and not in seeking identities. The view which considers the sciences at the European periphery as the out-of-focus reflections of what has been happening at the center is mostly for ideological use. The history of the sciences periphery

is not an attempt to chart the map of the watered

what happened

at the

down version of

at the center. W e should be continuously reminded that the

scholars of the center and those of the periphery had fundamentally similar profiles and similar agendas - t h o u g h , there were serious differences in the emphasis given to particular aspects of these agendas. It, then, b e c o m e s possible to bring forth the differences imbedded in what is only apparently homogeneous. W e make such an assumption, because we are convinced of the universality of the program of the respective scholars and because it may not b e c o m e possible to discern d i v e r g e n c e s unless the overall a g e n d a s are considered to be similar. The study of the sciences in the periphery will bring forth interesting historical issues only if such divergences in the European context are understood. Otherwise it would be trivial to study it: after all we do know that in the countries of the periphery there were no N e w t o n s , no Laplaces, no Leibnizes, and no Eulers.

The stages in the development

of

historiography

Before finishing, 1 would like to trace the development, as it were, of the historiography about these issues at the European Periphery and propose a possible venue for the n e \ t step. I think that it is not unfair to consider the following three stages as those historiographical approaches which have been unevenly perhaps, but steadily articulated by the various historians dealing with themes concerning the sciences at the European Periphery mainly in the 18 th and early 19 t h centuries. The first stage was the realization that there have, indeed, been local scholars who have been particularly decisive in the introduction of the new scientific ideas in the societies of the 18 th century at the European periphery. Many of these early works have concentrated on biographies. The second stage is. broadly speaking, the stage of studying the transfer and transmission of the scientific ideas. T h e r e have been c o m p a r a t i v e approaches, a lot of stock taking of what had been transmitted " p r o p e r l y " and what has been left out.

SOME

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33

The third, more recent, stage has examined processes of appropriation. The emphasis is on understanding the filtering processes, the character of resistance to the new ideas, and the idiosyncratic features of the discourses. I think that we may be in a position to discern the possibility of another, a fourth direction of basically programmatic character. Perhaps we are in such a juncture that we may start to examine the theoretical repercussions of dispensing with the notion of center-periphery altogether. Perhaps, the schema center-periphery is a rather constraining schema, and we should move away from thinking in terms of dipoles. This is especially so, since there may be value judgements intrinsic to the dipole itself. Such values may imply that what is happening in the center is better, is superior, is progressive. These are highly problematic values which may be trapping us into methodologies which lead us to deadlocks and vicious circles. If intrinsic to the specific model of center and periphery are some value judgments, and these value judgments are quite decisive in formulating methodologies, then, perhaps, these methodologies could only deal with the specific model. To get out of such possible vicious circles, we may tentatively propose the following steps. The first step is to change the geographical reference into a cultural reference. To change, that is, the spatial reference into a cultural reference. What do we mean when (as many of us do) talk of Danish, Italian, Greek, Portuguese or Spanish science instead of the sciences as practiced in Denmark, Italy, Greece, Portugal, or Spain? Should we treat this terminological shift as one from geography to culture? Locality primarily directs attention in dealing with cultural locality and not necessarily with spatial locality. The second step is to substantiate this cultural reference in terms of — cultural affinities — dispositions for adoption — potent proclivities to resistances. Scholars formed their discourses by trying to comprehend such affinities of their local culture for the new ideas or world views. They did their best to take advantage of dispositions for adoption. And in equally significant manners, they tried to be prepared, to counteract the potent proclivities to resistances which they felt would be expressed against their proposed discourses. The third is to articulate the notion of practice as a cultural category. Habits. Ways of reading, of observing, the place of pictures in their culture etc.

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GAVROOI. U

In raising all these i s s u e s , I a m not a t t e m p t i n g to push a n y kind of postmodernist agenda. I do not think that the excesses in the historiographical debates have ever brought any happiness in the historians' souls. T h e real test of any historiographical proposal is the concrete w o r k s , the specific studies of well posed questions and closely argued a n s w e r s . A f t e r all, all good historians arc the opportunist historians. G o o d history is written by all those w h o h a v e n o ethical d i l e m m a s to use a m u l t i t u d e of historiographical a p p r o a c h e s in order to probe the past and provide satisfactory answers to their questions. O n e of t h e most i n t r i g u i n g c h a l l e n g e s f o r h i s t o r i a n s of s c i e n c e , t e c h n o l o g y and m e d i c i n e is to chart their o w n t h e m a t i c atlas within t h e geographically expanded and culturally diverse Europe, whose

present

configuration provides a unique opportunity f o r symbiosis between established and e m e r g i n g c o m m u n i t i e s of h i s t o r i a n s . M e m b e r s of n e w e r c o m m u n i t i e s will soon decide h o w to recast what have o f t e n , and for m a n y years, been local topics in w a y s that can be linked to c o n t e m p o r a r y historiography of s c i e n c e . In Europe today we are at a fortunate juncture that offers an unprecedented, and p e r h a p s f l e e t i n g , opportunity to e x p a n d the d o m a i n of p r o b l e m s and issues in the history of science as a w h o l e . T h e assertive presence in the p r o b l é m a t i q u e of history of science of the European periphery not as a spatial entity, but as a plurality of views and practices a b o u t the s c i e n c e s , w i l l , I a m sure, recast a host of historical i s s u e s r e g a r d i n g the s c i e n c e s . T h e s y s t e m a t i c study of E u r o p e in S c i e n c e and S c i e n c e in E u r o p e , is not a call f o r d i s c o v e r i n g or constructing

homogeneities.

N o r is it a call f o r s e a r c h i n g

common

b e g i n n i n g s . For us historians of s c i e n c e , the s y s t e m a t i c s t u d y of E u r o p e in S c i e n c e a n d S c i e n c e in E u r o p e is a s e a r c h of the a m a z i n g p l u r a l i t y of practices.

REFLEXIONS SUR LA PERCEPTION OTTOMANE DE LA SCIENCE MODERNE Emre DÒLEN*

Introduction Les Ottomans commencent à rencontrer dès le début du XVIIIème siècle la science moderne et la technologie s'appuyant sur celle-ci. N'ayant pas participé au processus de formation de la science moderne et ne pouvant pas saisir son arrière-plan, ils la conçoivent comme une accumulation du savoir obtenu à la suite de découvertes personnelles. De ce fait, il est utile d'évoquer d'abord la naissance de la science moderne et le développement du lien entre la science et la technologie. Dans l'Antiquité et au Moyen Âge, les axes de développement de la science et de la technologie sont indépendants. La technologie est une accumulation empirique de savoir qui se développe par le biais d'expériences et de découvertes fortuites. Les spécialistes, voyageurs ayant accumulé le savoir technologique d'un domaine spécifique, travaillent au service des personnes ou des Etats qui les paient. L'ingénieur hongrois Urban qui mit son savoir de fondeur de canons au service de Mehmet le Conquérant (1432-1481), lors de la conquête de Constantinople, en est un exemple typique. Comme la technologie est transmise à cette époque-là par des spécialistes voyageurs, il n'y a pas une grande différence de niveau technologique entre les pays. Vers la fin du Moyen-Age, une révolution industrielle se produit qui accélère le développement technologique. La technologie ne peut évoluer vraiment que dans le cadre de la production. L'essor des villes à la fin du Moyen-Âge et la naissance du capitalisme, avec l'apparition de la bourgoisie marchande, donnent naissance à une nouvelle forme de société. Cette transformation sociale, avec le début des Grandes Découvertes, entraine une demande de savoir scientifique. Puisque le savoir classique qualitatif et descriptif ne peut pas répondre aux demandes de la pratique, la science se transforme. Ce que l'on appelle Révolution scientifique, qui commence au milieu du XVème siècle et atteint son apogée à la fin du XVIIème avec Isaac Newton (1642-1727), correspond à la naissance d'une P r o f e s s e u r de l'histoire de la Science et de la Chimie à la Faculté de la Pharmacie à l'Université de M a r m a r a , Istanbul-TURQUIE.

36

H M R E DÔL H N

nouvelle conception de la science, dite "moderne". Au fondement de cette transformation au cours de la Révolution scientifique est la naissance de la méthode scientifique, encore utilisée de nos jours, qu'il n'est pas possible de saisir sans comprendre l'approche philosophique sous-jacente. Avec la mise en place de la science moderne, les relations entre la science et la technologie s'amplifient de sorte que la création de nouvelles technologies exige de plus en plus le recours au savoir scientifique.

Vouverture

des écoles

supérieures

Après le choc de l'incendie de la flotte ottomane par la flotte russe dans le port de Çesme (1770), lurent ouvertes l'Ecole impériale de Génie naval, en 1776, pour former des officiers techniciens de marine, puis en 1795 l'Ecole impériale de génie terrestre afin de former des officiers techniciens pour l'armée de terre. Suite à l'ouverture de ces Ecoles de génie, en 1827, furent ouvertes une Ecole de Médecine (Tiphane-i

Amiré) afin de former des médecins et des

chirurgiens pour l'armée, et l'Ecole de Guerre pour former, avec des officiers de cavalerie et d'infanterie, des officiers d'État-Major. L'Ecole de Médecine, n'ayant pas pu se libérer de l'enseignement et de l'éducation traditionnels, ne réussit pas à former du personnel qualifié. C'est pourquoi, vers le milieu des années 1830, se fit sentir le besoin de la réorganiser. Ainsi lut ouverte, en 1839, l'École impériale de Médecine (Mekteb-i

Tibbiye-i

Sahane).

Toutes les écoles ouvertes durant les soixante-cinq ans qui s'écoulèrent entre 1776 et 1839 furent des écoles militaires. La raison fondamentale de leur échec est qu'elles ne s'appuyaient pas sur un enseignement secondaire. Ainsi, leur niveau dut s'abaisser à celui de l'enseignement secondaire pour résoudre ce problème. A partir des années 1830, à commencer par l'Ecole de Guerre et celle de Médecine, toutes les écoles se dotèrent d'un collège et se mirent à recruter pour les études supérieures parmi les diplômés de leurs collèges. Ces écoles militaires, tournées vers les applications pratiques, visaient à transmettre le savoir technique propre à leur domaine et, avec lui, le strict nécessaire de science théorique. Il s'agissait dans ces écoles non pas de créer du savoir scientifique mais d'en emprunter à l'Europe et de le diffuser en fonction des besoins.

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La transmission de la science Les livres scientifiques publiés surtout au XIXème siècle en Europe contiennent une introduction générale sur la méthodologie avant d'en venir au sujet précis du livre. On y donne, entre autres, des renseignements sur la portée de cette science, ses relations avec les autres sciences et ses lois fondamentales. Lors de la traduction en turc de ce genre de livres, on jugea la plupart du temps ces introductions inutiles pour transmettre directement les renseignements spécifiques. La même méthode fut suivie dans les recueils. Une exception importante à cette règle fut l'oeuvre d'Aziz Bey de Crimée. Aziz Bey (1840 - 1878) consacra les 69 pages de la longue introduction de son livre Kimya-yi Tibbî ("Chimie médicale") à l'histoire de la chimie. Dans cette partie, commençant par les chimistes musulmans du Moyen-Âge, il présente l'évolution de la chimie en Europe et les chimistes célèbres. Ensuite, il aborde les lois et les notions fondamentales sur la chimie et établit une nomenclature ottomane. Aziz Bey alla plus loin encore en utilisant l'alphabet arabe à la place de l'alphabet latin pour inventer des symboles pour les éléments chimiques et il écrivit les fonctions et les formules en utilisant ces symboles. Aziz Bey, suivant de très près les évolutions scientifiques en Europe tout en les transmettant, a conçu la méthode scientifique et la science comme un tout. Lorsqu'on commença à transmettre la science moderne, on évita d'utiliser le terme ilim utilisé traditionnellement, qui désignait les sciences religieuses. On préféra le remplacer par le terme fen (science). Mais la différence entre science et technologie n'ayant pas été très bien comprise, le terme fen fut utilisé indifféremment pour signifier l'une et l'autre. Les Ottomans n'avaient pas clairement compris que la formation de la science moderne reposait sur un questionnement méthodologique et des approches philosophiques, et que l'évolution scientifique était un processus systématique, et la science un tout. L'évolution scientifique et les inventions restaient perçues comme des découvertes personnelles. Au XIXème siècle, des étudiants de différentes disciplines furent envoyés périodiquement en Europe afin par ce biais d'assurer la transmission du savoir scientifique. L'évolution scientifiques en Europe fut suivie de très près à certaines périodes, de plus loin à d'autres. Les étudiants envoyés choisirent souvent, plutôt que de s'inscrire dans une université pour obtenir un diplôme, de suivre des cours dans différentes écoles et de travailler dans des cliniques ou laboratoires. Et comme à leur retour ils se contentèrent de transmettre le savoir scientifique acquis sans pouvoir en produire à nouveau, après un certain temps, le développement scientifique prit du retard.

HMRH DÔLEN

38

En règle générale.', la poursuite et le développement de la production d'un produit quelconque dépend de la demande, l a même loi est valable pour la science. Il n'est possible de produire du savoir scientifique que si une demande émane de la société. Le changement social et la naissance du capitalisme en Europe ont suscité une demande de science. Le marché de la science, c'est à dire ce qui provoque une demande de science, est représenté par la production et l'industrie. Pour différentes raisons, la société ottomane n'a pas connu ce tournant et par conséquent n'a pas suscité de demande de science. Une situation semblable prévalut pour l'imprimerie. L'imprimerie fut introduite à Istanbul peu après sa découverte. Des permis d'ouverture d'imprimerie furent accordés à des étrangers et aux minorités. Mais, bien qu'ils connussent l'imprimerie et les livres imprimés, les Ottomans ne créèrent pas d'imprimeries. Le fanatisme religieux est habituellement incriminé de différents bords comme la cause de ce retard, mais la vraie raison est le manque de demande sociale. Les livres en arabe imprimés à Rome ne trouvèrent pas de marché dans l'Empire ottoman. Finalement, ce n'est qu'en 1727 que la première imprimerie ottomane fut créée par Ibrahim Miiteferrika. Nous savons qu'à quelques exceptions près, le tirage des livres imprimés par Miiteferrika (1674-1742) oscilla entre 200 et 500 exemplaires. L'imprimerie de Miiteferrika, pourtant soutenue par l'Etat, connut la faillite. Une grande partie des livres publiés, toujours en vente dans les années 1820, n'était pas encore épuisée. Au cours du premier quart du XIXème siècle, les manuels des écoles militaires étaient tirés en fonction du nombre exact des étudiants et à la fin de chaque semestre on les récupérait pour les donner aux élèves des classes suivantes.

Les tentatives

pour créer une

université

À partir du milieu du XIXème siècle, il fut question de mettre en place une université (Daruljunun,

littéralement «maison de sciences»). En

choisissant ce nom, on évita d'utiliser le terme ilim pour adopter celui de fen. On voulait

à la fois distinguer les sciences qu'on allait y enseigner des

sciences (ilim) des medrese (écoles religieuses) et éviter de s'opposer aux medrese. Cependant, il n'y avait pas de conception claire de ce que devait être l'université. On mit en place en 1851 un Comité consultatif ( E n c u m e n - i Danis) pour préparer des manuels pour l'université. Bien que, lors de sa mise en place, l'exemple invoqué ait été celui des académies savantes de l'Europe, la majorité de ses m e m b r e s étaient des h o m m e s politiques

importants

de l'époque. Ce comité dont on attendait beaucoup se révéla en peu de temps

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inutile et disparut. C'est dans ce contexte que la première université s'ouvrit en 1863. Son enseignement consistait d'abord en cours auxquels assistaient des étudiants des medrese et des fonctionnaires; il s'interrompit avec l'incendie du bâtiment à avec tous ses matériaux, outils et livres. Le «Règlement général de l'Instruction publique» qui organisait l'éducation dans l'Empire ottoman entra en vigueur le 1er septembre 1869. Ce règlement qui s'inspirait avant tout du système d'enseignement français, traitait de l'université dans ses articles 79 à 128. Selon l'article 79 : «A Dersaadet, sera fondée une université nommée Darulfiinun-i Osmani», et selon l'article 80, cette université sera formée des trois unités d'enseignement suivantes: «Philosophie et Littérature», «Droit» et «Sciences de la nature et Mathématiques». Les articles suivants détaillaient et réglementaient les cours à donner au sein de ces unités, l'organisation, l'administration et surtout les finances. La durée des études était de trois ans, quatre pour ceux qui voulaient devenir miiderris

(professeur). Cependant, ce règlement ne disait rien des

objectifs de l'université ni de la situation des diplômés. Cette université qu'on voulait créer était seulement conçue comme une institution visant à transmettre le savoir. Cette conception était très loin de celle qui a été généralement adoptée en Europe au milieu du XIXème siècle, où la transmission et la production du savoir scientifique allaient de pair. L'idée sous-jacente à sa fondation était qu'il existât chez nous au moins une Université sur le modèle européen. Par la suite, de nouvelles tentatives eurent lieu pour refonder l'université. Cette deuxième université débuta ses cours libres en 1869 et fut ouverte en 1870. Son directeur, HocaTahsin Efendi (1813-1881), fut accusé d'impiété à cause de certaines expériences qu'il avait faites. Dans l'une de ses expériences, Hodja Tahsin Efendi, après avoir placé un oiseau dans une lanterne en verre, entreprit d'évacuer l'air par une pompe à faire le vide. Son but était de montrer que les êtres vivants ne peuvent pas subsister dans un milieu sans air. La mort de l'oiseau une fois le vide réalisé, et d'autres expériences du même genre, furent cause qu'il fut accusé d'impiété. A l'arrière-plan de ces accusations se trouvait sans nul doute le fait que Hoca Tahsin Efendi était bektachi. De même Cemalettin Efendi l'Afghan fut traité d'infidèle pour avoir dit que «la prophétie est un art», l'université fut fermée vers la fin de l'année 1871. En 1874, Dariilfunun-i Sultani fut ouverte dans le Mekteb-i Sultanî à Galatasaray. Cette école qui comprenait des sections de Droit, Littérature et Ingénierie, ne put pas davantage subsister et fut fermée en 1882. On notera que dans les tentatives de 1869 et 1874, les articles concernés

HM R H DO LHN

40

du Règlement général de l'Instruction publique avaient été négligés, que des formations différentes furent retenues et qu'on créa un nouveau règlement pour le Dariilfunun-û Sultanî. I,a mention de 1' «Ecole de droit» et de l'«Ecole des Ponts et Chaussées» montre que ce Dariilfiinun n'était pas une institution universitaire mais plutôt une réunion d'écoles professionnelles. La quatrième et dernière université f u t le Dariilfiinun-û Sahane qui s'ouvrit en 1900. Pour sa mise en place, un nouveau règlement de 27 articles fut publié en 1900 et la partie «Dariilfunun» du règlement sur l'Education fut tout simplement annulée. Cette nouvelle université dont le nombre d'étudiants était limité, n'était qu'une simple école supérieure destinée à dispenser une culture générale. Elle était formée de trois unités, à savoir: Études supérieures de T h é o l o g i e , Mathématiques et Sciences de la nature, Littérature. On y discernait un effort pour parvenir à une synthèse en incluant aussi les sciences religieuses. Cette institution a subi divers changements, mais a subsisté sans interruption jusqu'à nos jours - c'est l'Université d'Istanbul. À partir de la seconde période constitutionnelle, on fit b e a u c o u p d'efforts pour lui donner une structure universitaire, d'un côté en lui associant l'École de Droit et la Faculté de Médecine, et d'autre part en fermant l'unité de Sciences religieuses supérieures. Pendant la Première Guerre Mondiale, entre 1915 et 1918, on fit venir vingt instructeurs allemands mais malgré tous ces efforts, la tradition de la production du savoir scientifique ne s'est pas imposée et la tradition de la simple transmission du savoir a perduré.

Conclusion Quand on e x a m i n e les écoles supérieures militaires et civiles qui s'ouvrirent en Turquie de la fin du XVIIIème siècle à la fin du X I X è m e , on remarque que presque toutes sont des écoles professionnelles et que les écoles civiles ne sont pas véritablement «civiles» au sens où l'on parle de société civile. Ces écoles ont été planifiées et ouvertes afin de répondre au besoin d'employés qualifiés dans divers secteurs. Les universités qui produisent de la science sont des institutions de la société civile. Jusqu'au début du X X è m e siècle, les Ottomans n'ont pas pu fonder et faire vivre une université de ce genre. Bien quee celle qui s'est mise en place en 1900 ait survécu, une tradition de recherche scientifique ne s'y est établie qu'au terme d'une longue et douloureuse attente. La recherche scientifique, ou en d'autres termes la production du savoir scientifique, c o m m e n c e non pas dans ces institutions mais à l'Institut Supérieur d'Agriculture qui se met en place en 1933 à Ankara. Bien q u ' o n n o m m e cet établissement Institut, il s'agit en fait d ' u n e université

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composée de cinq facultés : Agriculture, Zoologie, Forêt, Arts d'agriculture et Sciences naturelles. Toute son organisation fut réglementée, les principes furent établies : le recteur et les dirigeants seraient élus ; les employés et les étudiants, par l'intermédiaire de leurs représentants élus, voteraient pour l'élection du recteur. Les promotions universitaires étaient déterminées uniquement par des critères scientifiques. Les assistants qui ne finiraient pas leur thèse de doctorat dans une période déterminée seraient renvoyés. De même, les titres de maître de conférences ainsi que de professeur seraient conférés sur critères académiques grâce à la préparation d'une thèse de doctorat. Des professeurs allemands qui n'étaient pas des réfugiés furent recrutés durant la période 1933-1939. Le principe de l'avènement des carrières sur critères scientifiques eut pour résultat la préparation des premières thèses de doctorat en sciences fondamentales au sein de cet établissement. Par conséquent, la tradition de la recherche scientifique en Turquie fut établie non par l'Université d'Istanbul mais par l'Institut Supérieur d'Agriculture. Lorsque cet institut fut supprimé en 1948, ses facultés furent partagées entre les Universités d'Istanbul et d'Ankara.

SOME PRELIMINARY THOUGHTS ABOUT THE TANZIMAT AND THE IDEA OF NATURE §erif M A R D I N *

Introduction There is one point at which a view of the nature as a totality operating beyond us has practical consequences. This is the understanding that nature is not only a lever to satisfy our material needs but that it is a repository of its own secret wisdom (both nomos and physis) that only needs to be read for man to enter an entirely new sphere of exploration of the ambient world. Such seems to me to be the connotation of the style of "reading" of nature of Bacon, of d'Holbach and of also of the Discours Préliminaire

of d' Alembert.

This style of an approach to nature does not seem to have been of much importance among mid-19th century Ottomans who appropriated some of the ideas of the key thinkers of the Enlightenment. In the first phase of that appropriation (1850's) Rousseau and his benign, penetrative 'nature' are also absent. Two ideas propelled my curiosity concerning the relation between an idea of nature and the progression of Western science in the Ottoman Empire in the 19th century. First, that the Ottoman's entry into the world of Western positive science in the 19th century does not show much creativity or originality. Second, that this slowness may be due to the mode of transformations of a specific "mind set" with all the complexities that this concept connotes in our day. In the Baconian view of the reading of the Book of Nature there is also a view of nature as full of secrets that have to be forcibly drawn out of it. I noticed that the Ottomans had a much gentler way of dealing with physical nature and wondered whether there existed some deeper cultural explanation of this contrast. The field that I had to study to answer these questions covered the momentous change that the Ottoman Empire experienced with the 19th Century, namely the series of fundamental reforms described under the general heading of Tanzimat, an Ottoman term for "regulations". Reformism was at Prof. Dr. Sabanci University, Faculty of Arts and Political Sciences, Department of Political Science, Istanbul, Turkey.

44

$ ERi F MAR DjN

first promoted by two relormist Sultans Selim III (1789-1807) and Mahmud II (1808-1839) but from lhc 1840 onwards was taken over by an incipient Ottoman bureaucracy. A new cultural capital was introduced both in comments of officials on the state of affairs in Europe (Mustafa Sami Efendi) 1 but also in descriptions of the way civil society functioned as an integral part of Western society (Sadik Rifat Pasha). 2 It appeared in early translations of Fenelon ( L e s Aventures

de Telemaque,

1862), Fontenelle, Voltaire, and somewhat later,

Rousseau. In the 1850s, the trend continued with the influence of Lamartine and Victor Hugo, 3 Journalism and the novel familiarized a new public with these ideas. Ottoman intellectuals had established some contact with the culture of the West before the 19th century but the systematic appropriation of European intellectual inheritance is a feature of the 19th century. In the 1860's this policy merged with a new public communication system fueled by the growth of Ottoman journalism. Between 1860 and 1890 both journalism and the availability of a new genre, the novel, made a permanent mark on Ottoman intellectual life. In a study like this one, earlier contacts that had brought the Empire within the ambit of European thought since the 15th century and the subtle cumulative influence of this exposure always has to be kept in mind. But, this is still one of the most underdeveloped field of the Ottoman history of ideas. 4 I propose that my subject has to be approached f r o m at last two viewpoints: first, the influence of the new Western cultural capital but also changes in the professional and group structure of the agents of change. For the Ottoman physicians who were often foreign origin in the 18 th century, this meant a state supported, solid, more public base for the practice of medicine, for the literati it meant their transformation into 'intellectuals.' Another change in the use of the stock of ideas available to the Ulema was that some members of the newly developing intelligentsia whether clearly secular, or deeply religious began to discuss religion by setting arguments within a new public sphere wider than the purview of the Medrese. It is under

' Mustafa Sami Efendi had written a treatise on Europe: Avrupa Risalesi. Mustafa Sami Efendi, Avrupa Risalesi. Ed. Remzi Demir. Ankara: Giindogan Y a y . , 1996. Another work has been composed by M . Fatih Andi: Hir Osmanli Biirokratnm Avrupa Izlenimleri, Istanbul: Kitabevi, 1996. 2 Mehmed Sadik Rifat Pa§a, Risale-i Ahlak, Istanbul: Ahmed Kamil Matbaasi, 1325. ' T h e trend of the translations from Europe might be followed from the article of §erif Hulusi, "Tanzimattan Sonraki TercUmt Haaliyeti : 1845-1918" in Terciime, vol. 1 (1940) n. 3, pp. 286296. He added to the list of translations composed by Hachtmann lots of extra titles at the end of his article. 4 Adnan Adivar, Osmanli Turklerinde ìlim, e d . Aykut Kazancigil ve Sevim Tekeli, Istanbul: Remzi Kitabevi, 1982.

T HK TANZIMAT

AND

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IDEA

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45

these circumstances that in the late 19th century some of the premises of modern Western culture such as conception of nature as an autonomous, selfpropelling universe emerged and became controversial among the emerging Ottoman intelligentsia. The process was one in which the conception of nature as part of the Western modern culture took some time to emerge as an area of cultural contention. Some of the premises of a Western view of nature seem to have touched a raw nerve only after the 1880s.

The Enlightenment and Nature We may summarize the debate about the laws of nature internal to the Enlightenment by underlining two of its approaches to the laws of nature it sought: the idea that there are necessities (d'Holbach) and the idea that there are simply humanly constructed regularities in nature (Hume). In this respect the basic Islamic-Ottoman position does not present much difficulty. It only requires that one conceives of these laws in the second mode. Tensions between a morality framed in a "geometrical" mode and a more traditional social morality were pinpointed as "false" as early as the 1860s by the liberal constitutionalist Ottoman Namik Kemal. "With all the benefits to which it has given rise, the experimental method, which has contributed more than anything else to the maturing and the progress of the world has not been able to clear itself of the onus of having overstepped all boundaries and having placed whatever beliefs there were in mind and whatever feelings there were in the soul under the light of reality and investigation. Among those who have made it a habit to use experimental method in their search for truth there are certain super-critics who limit their quest for answers to material occurrences and who would like to consider everything that cannot be touched or seen as either unreliable apparitions or as inferior to the manifestation of nature"'

Tensions took a more vehement expression in the 1880s and 1890s when European realism that had made its mark among Ottoman literati (Recaizade Ekrem in the 1870's) took the new form of naturalism and a "decadent" "materialism". In fact, this was a realization of the philosophical implications of the French literature of the 1890's, a literature that up to that time had provided a model for Turkish modernists. The important threshold here is the life and suicide of Be§ir Fuat, the first Turkish intellectual with a

"materialist"

world

view. Ottoman critics maintained that the French

of Turkish ' See my The Genesis of Young Ottoman Thought: A Study in the Modernization Political Ideas, Princeton, New Jersey: Princeton University Press, 1962, pp. 326-327, f n . 145, quoting from Kemal's article "Vatan" in Ibret, March 1 2 , 1 8 7 3 .

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"decadent" ideas, i .e., the denial of society's foundation of ethics, destroyed the equilibrium of society and had led him to despair and suicide. There are a variety of modes in which in the Ottoman 19th century the suspicion was expressed that Western ideas of nature, of positivism and materialism led to the destruction of the social order. I have located four of those, from the most violent of its expressions by a member of the Nakjibendi brotherhood to the Angst o f Ottoman intellectuals marked by Romanticism, to the protest against "decadence" of Ahmet Midhat Efendi and to the ideas of the Islamic reformer, Cemaleddin Afghani who attempted extremely subtly to overcome the distance between his thought and Western "materialism" in his published work while simultaneously condemning it. By contrast, I show how in the 19th century the School of Imperial Medicine sailed effortlessly through the increasingly "materialistic" premises of Western medicine. Here, the social position of the Ottoman literati who were the carriers of knowledge and the transformation of their position as literati has central relevance and needs to be covered in some detail. There were three fundamental Ottoman institutions that shared extant Ottoman knowledge all of which were transformed by the Tanzimat. In the traditional setting we may count, first, the Ilmiyye (broadly that of the Doctors of Islamic Law and other subordinate positions), second, the Kalemiye Seyfiyye

(the proto-bureaucracy) and finally the

(the military). Persons trained for positions in this hierarchy

followed different programs of specialized educations. For the Ilmiyye the training ground was that of the Medrese,

the Ottoman 'seminary'. For the

Kalemiye it was a mix of religious education with much practical knowledge acquired in the bureaus of the state. For the Seyfiye it means special training at a Palace S c h o o l 1 where the secular arts of war and administration were central to education. O f ihese partly interpenetrating streams the

Medrese

education was the most structured with levels of corresponding to Western first-primary, secondary and higher levels. All three types of instruction were diffused by a general cultural fund which we may describe as that of "Islamic Humanities". The point, of course, is that this substratum varied between the three institutions and that it also changed with time together with change in institutions. The necessity to study this original background with its special combinations and permutations is a difficult task and has yielded few reliable investigations. All statements about Ottoman "stocks of knowledge" have therefore to be considered provisional. With regard to the Ilmiyye however we 1 Mehmet Ip§irli, "Galata Sarayi" in D!A, vol. 13, pp. 3 2 2 - 3 2 3 . For the general and more detailed studies of the Palace School, see ismail H. Baykal, Enderun Mektehi Tarihi, Istanbul: Istanbul Fetih Dernegi, 1953, Hiker Akkutay, Enderun Mektebi, Ankara: Gazi Universitesi Egitim Fakultesi, 1984.

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have one solid venue, i.e., we cannot dispense with an account of some main trends in the Islamic history of ideas. These were features that the Ottomans had taken over from earlier "Islamicate"

civilization. From the viewpoint of

this study the most relevant of these philosophical foundations is what had been titled "Ash'arite Islamic occasionalism", a doctrine that has been described as follows: "Ash'arite doctors argued that the world, which they defined as everything other than God was composed of atoms and accidents. Now accidents cannot endure for two successive moments, but are continually created by God and can only endure by the accident of duration created in them by God. It follows from this premise (sic) that the world being created must necessarily have a creator."'

The Ash'arites, engrossed as they were with God's omnipotence and sovereignty in the world were of course extremely suspicious of an Aristotelian world view dominated by causal processes that unfold themselves almost mechanically, since it was ill-suited to their declared purpose of affirming God's prerogative to act freely and imperiously in the world. 2 In contrast to these philosophical strictures related to nature as "physis" what we see in the practice of Islam, is a number of scientific researches of the highest caliber. 3 While these thinkers and scientists do not rely on the idea of an unfolding of nature they, nevertheless, survey regularities in nature and draw practical consequences, or "laws" about specific manifestations of nature. One recent author has even written about the "materialistic tendencies" that appear in the writings of many Islamic philosophers on the study of natural sciences. 4

Nature in the Ottoman-Islamic

Notion of the Equilibrium of the Universe

In Ottoman learned circles the imaginative representation of nature never had the importance that it had in the West. Poetry used natural symbols but not to enter into a rapport with nature, rather, to give a foundation of naturalism to the expression of inner feelings. The rapport was therefore stereotypical, and consisted of the set of clichés. A much different view of ' Majid Fakhri, A History of Islamic Philosophy, Longman, 1 9 8 8 , p . 2 1 1 . 2 Ibid.,p. 214.

2nd ed. N.Y: Columbia Univ. Press & London-

" Toby E. H u f f , The Rise of Early Modern Science: Islam, China and the West, C a m b r i d g e : C a m b r i d g e U n i v . Press, 1993 11995], pp. 4 7 - 8 7 . In this section, the author discusses the achievements of the early Arabic science. 4 F a k h r i , / ! History of Islamic Philosophy, p. 365.

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n a t u r e as t h r o b b i n g with life a p p e a r s in f o l k p o e t r y but o n l y b e g i n s to infiltrate the l a n g u a g e of the literati very late. It e m e r g e s slowly in t h e late 18th c e n t u r y and a s s u m e s increased f o r c e at the t i m e w h e n r o m a n t i c i s m b e c a m e k n o w n in the O t t o m a n E m p i r e . A n u m b e r of T u r k i s h historians of l i t e r a t u r e s u r v e y this c h a n g e as a sort of l o n g - t e r m p r e p a r a t i o n f o r an a p p e a r a n c e , 1 It is their m a i n a r g u m e n t to e x p l a i n t h e s p e e d with w h i c h description of nature required popularity at the beginning of the 19th century. It is with this v e n u e , that of literature, that a reading public e m b r a c e d a n e w view of nature, either the black w a v e s of the stormy sea or the sweet baying of the l a m b to e x p r e s s the interpénétration of a living nature with the a f f a i r s of m e n . But O t t o m a n s also had an ontology that enabled t h e m to imaginatively r e c o n s t i t u t e t h e w o r k i n g s of n a t u r e as " p h y s i s " . In a r e c e n t

brilliant

r e c o n s t r u c t i o n of t h e O t t o m a n I s l a m i c c o n c e p t of "the O r d e r i n g of t h e Universe" ( N i / a m - i A l e m ) Tahsin Gorglin has shown that this t e r m does n o t 2 -as has been the c a s e in earlier research- d e n o t e an intention and will on the part of the O t t o m a n s t a t e s m e n t o p r o m o t e their o w n h e g e m o n i c , imperial view of the world o r d e r but that the e x p r e s s i o n can o n l y be u n d e r s t o o d in terms of its ontological f o u n d a t i o n , T h e s c h e m e to which the term refers is a total imbrication of the f o r c e s which keep the universe in equilibrium, ranging f r o m the decrees of heaven to man seen as a m i c r o c o s m of t h e u n i v e r s e , t o h u m a n institutions and to the f o r c e s of nature which he is to c o m m a n d . T h i s idea presents s o m e similarities with the Western Medieval conception of the Great Chain of B e i n g . But with o n e m a j o r distinction: in the I s l a m i c - O t t o m a n conception of Nizam-i A l e m at e a c h o n e of its levels w h a t prevails is an e m a n a t i o n of t h e principles of an e t h i c of d i v i n e o r i g i n . R e g a r d l e s s of t h e s p e c i f i c f o r m a s s u m e d by t h i s principle at each level of the c h a i n ( h u m a n , institutional, m u n d a n e ) - the active principle and the real f o u n d a t i o n of each f o r m is the unicity of divine being. An e x a m p l e of this imbrication w o u l d be that in this system the entire equilibrium can be upset by the impiety of a ruler. T w o c o n s e q u e n c e s f o l l o w , an u n d e r s t a n d i n g of the f o r m of e a c h level can be gathered by t a p p i n g t h e s y s t e m at any level, the k n o w l e d g e thus acquired is h o m o l o g o u s and in its e s s e n c e the s a m e , i.e. k n o w l e d g e of h u m a n institutions m a y b e a w a y of gaining k n o w l e d g e about the principles of nature. T h e reverse would also be

' As a leading example of such a view on the preparation period for the appearance we can state Ahmet Hamdi Tanpmar and his work on the history of the 19th century Ottoman/Turkish literature. Ahmet Hamdi Tanpmar, XIX. Asir Turk Edebiyati Tarihi, 6. Baski Istanbul, (Jaglayan Kitabevi, 1985. In his long introduction, he has written a chapter on the earlier phases of the confrontation of the West in the early 19th century which might be seen as a reflection of his view of the long-term stage of preparation. 2 Tahsin Gorgiln, "Osmanli Ni/.am-i Alem Fikri ve Kaynaklari Uzerinde Bazi Notlar" Arastirmalar Dergisi, 13/2,2000. pp. 180-188.

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possible. It is the religious specialist (the A l i m ) w h o is the legitimate interpreter of all levels of the Great Chain of Being when universals are being sought, institutional problems solved or when mysteries have to be explained. But the theory is also 'grounded' in the sense of the terrestrial expression of the telluric level of the working of nature involving human praxis. Indeed, in the Islamic-Ottoman concept of nature, we can distinguish two aspects of the concept of nature: the first "everyday" nature seen as operating outside deeper philosophical considerations as part of the everyday world, a nature that is malleable and changeable through the human will. Here, nature as regularities can be investigated with profit for humans. This view of nature enabled Ottomans to build an Empire but also bridges, open canals, practice empirical medicine and build automate dispersing water as well as adopt the practice of Western cannon foundries when this was found useful. A second aspect of nature is nature as a mystery with a reference to the divine order. This nature is full of questions which are not answerable through the exertions of rational praxis. It is an aspect of nature that reveals the mystery of creation which implodes on humans in a number of unaccounted ways. The method that enables us to understand that aspect of nature is to refer to the book of Creation, the Qur'an. The way to 'read' the Qur'an is provided by the interpretive tools of theologians who can seek to solve the questions posed both in terms of what to expect from nature's relation to man -limited controland to read the "nature" through the elements of sociability as a microcosm of an ethically constructed universe. When all of this is said, however it is the interpenetrating ethical foundation of the universe with that of society that is primordial for the Ottomans and the main focus of the history of their ideas. In the Ottoman cultural realm we therefore see an imbrication of the idea of nature as the projection of a divine order onto society. The positioning of the Ulema in the state is symmetrical to this order. The entire system is well articulated and does not present any obstacle to the investigation of nature. The position of the Ulema as the central carriers of Ottoman Culture is especially interesting in relation both to the legitimacy of the idea of nature as part of the everyday and that of what we may describe as multiple realities. T h e main point which 1 would like to propose is that the Ottoman physicians who had a background of Medrese studies, when encouraged by the state carried the ball of an increasingly materialistic medicine without m u c h protest throughout the introduction of Western medicine into the Tanzimat and further that the promotion of a new "official" field of medicine provided the support that enabled them to assume the new role of the Ottoman physicians wivh even less concern for the materialistic foundation of modern medicine. When the Ulema were given unlimited support by the state for the development of

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medicine in the 19th century, medicine did progress rapidly and with time became a differentiated profession shaped by its own values. But there exist a threshold here: "intellectuals", students w h o were concentrating on their professional ideals eventually took over f r o m the Ulema. A final element in Islamic-Ottoman culture and in its world view was a legitimate -but derived- ontological foundation teetering on the borders of unbelief, namely Islamic mysticism. Classic Islamic mysticism opens a door to an exit f r o m occasionalism in the sense that in "this world-view the dichotomy between Creator and Creation, inherent in the Qur'anic concept of God and the world is o v e r c o m e , and the world is presented as an eternal procession from the Necessary Being, and essentially the same substance as His." 1 I believe we can further clarify what I mean here by referring to the sociologically grounded concept of multiple realities and intellectual tool of the mystics. The Turkish sociologist Recep Sentiirk has claimed that it is this concept that allows us to see the flexibility of Medrese thinking and its halflegitimate extension into Sufism. 2 Ideetic fragmentation, an aspect of multiple realities, allowed the men of the Tanzimat to navigate on a field that could allow considerable - if possible illegitimate -leverage for secular projects. It is this field which may have allowed them to circumvent the main canon -not really in terms of a systematic of rigorous rethinking of the operations of nature- but through the always present, if underground, residues of the pantheism of the great mystic Ibn Arabi the canon of which the literati shared.

1 2

Fakhri, p. 365.

Recep §entlirk, "Toward an Open Science and Society: Multiplex Relations in Language, Religion and Society -Revisiting Ottoman Culture-" in Islam Ara§tirmalan Dergisi, n. 6 (2001), pp. 93-129. §cntiirk tries to show how the Islamic scientific understanding and interpretation of the universe influenced Ottoman practice by developing a flexible ontology, epistemology and axiology. He argues that this multiplexity might also be seen in the Ottoman classification of sciences (Meratib al- 'ulum). Bellah described Schutz' elaboration of this concept as follows: "Basic to Schutz's idea is that reality is never simply given, it is constructed. The apprehension of reality is always an active process involving subject and object. Multiple realities arise because of the variety of needs of consciousness and schemes of interpretation that link the two. Schutz pointed out that besides the world of everyday life, which is the social world par excellence, there is the world of dreams, the world of art, the world of science, the world of religion. By showing that these worlds are partially autonomous and irreducible one to the other, Schutz gave ... [a] powerful argument for the answers and multiplicity of the human spirit." Robert N. Bellah, Beyond Belief, New York: Harper & Row, 1970, p. 242. Quoted by Stanley Jeyaraja T a m b i a h , Magic, Science, Religion and the Scope of Rationality, Cambridge: Unnversity Press, 1990, p. 101. But see also Jiirgen Habermas on the three areas of "objective knowledge, moral-practical insight and aesthetic judgement" in Moral Consciousness and Communicative Action, Cambridge: Mass., 1990, p. 40. quoted by Craig Calhoun, Habermas and the Public Sphere, Cambridge Mass.: MIT Press, p. 102.

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Physicians There were two streams that fed traditional Ottoman medicine: the first were Ulema, graduates of the Medrese system, The second were Europeans, some of them émigrés established in the Empire, many of them Jews who had been accepted by the Ottomans when they were expelled from Spain in 1492, Renegades, political refugees, and converts had the advantage of claiming medical knowledge through their access to Western books. Medicine was a prestigious occupation part of Islamic "empirical" sciences. 1 Physicians graduated from Medreses with special programs for their formation. Ottoman medicine relied on an accumulation of knowledge in Islamic

culture, Dissection seems to have been practiced although not in

educational fora open to students. Since traditional medicine relied on vegetable remedies, Paracelsus with his use of crystals and hermetic practices attracted the attention of practitioners as somewhat bizarre but worth considering as a novelty 2 . Vesalius' influence on Ottoman medicine can also be traced. The progression from Paracelsus to a medicine increasingly reliant on the idea of chemical and physical foundations of bodily functions as well as the cures that evolved from such consideration however had with time an increasing impact on the practice of medicine. This development was known among Ottoman physicians as "stone medicine", or "new" medicine. This particular stage was one in which Ottoman physicians of the late 18th century somewhat grudgingly accepted that they had been upstaged by doctors trained in the West. What was happening was that Ottoman Greeks who had sent their sons to be trained in Universities in Italy came back with a medical practice that was more effective than local practice. The threshold is important in the sense that it was to show Ottomans that imitation of innovation was not sufficient to compete with the West. Even local Jewish doctors suffered from the new competition. In the West superiority in medical knowledge had evolved based on the importance of post-medieval universities but also on the sharing of a knowledge based on the circulation of books and

In the Islamic classification of sciences ( M e r a t i b al- Ulum), medicine belongs to the realm of "empirical" sciences. O n e of the leading scholars of the Ottoman Empire, Taskopruliizade (d. 1560) c o u n t s it under the Science on Nature (Ilm-i Tabiat). For a general study of the classification of sciences by d i f f e r e n t scholars see Hiiseyin A t a y , "Bazi Islam Filozof ve Dii§Unurlerine Gore ilimlerin Sayimi ve Tasnifi" in Islam Ilimleri Enstitiisii Dergisi, vol. 4 (1980) pp. 1-41. 2 Nil Sari, B. Ziilfikar, "The Paracelsus Influence on Ottoman Medicine in the XVIIth and XVIIIth Centuries" in Transfer of Modern Science and Technology to the Muslim World, ed. by Ekmeleddin Ihsanoglu. Istanbul; IRC1CA, 1992, pp. 157-179. Kazancigil also states that the Ottomans were aware of the developments in the medicine in the Western world and they knew Paracelsus under the name of "Baraklisus el-Cermani". Esin Kahya discusses the introduction of the dissection into the Ottoman medicine. Esin Kahya, "Bizde Disseksiyon Ne Z a m a n ve Nasil Bafladi?" in Bellelen, vol. 43 (1979) n. 172, pp. 739-759.

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on the growing quality of engraving in medical and botanical literature. 1 In the Ottoman Empire print had been introduced in 1727-1729 and only 180 titles had been published by 1800. The interactive communication network that relied both on books and scientific journals (1665 in Europe) was missing. This feeling of being upstaged appears in the discussion by the state to establish a medical school in 1802 specifically to train Greek Ottoman Physicians. The school must not have answered expectations since it was closed in 1805 and its chief physician executed. The narrowing effects of the discourse of the medrese as part of an official culture was soon realized by Ottomans aware of Western advances. After 1800 one notices a proliferation of centers still staffed by Ulema but operating outside the official teaching of Medicine. 2 The Ottoman state had already intervened to raise the level of teaching in modern mathematics, engineering and the arts of war in the 1790's by establishing the naval and land engineering schools. Both the teachers and the students in these schools were of Medrese origin but within a few years a professionalization at both levels could be followed. In 1827 the state intervened once more to support the project of a physician, a Doctor of Islamic Law, Mustafa Beh$et Efendi w h o had seen the medicine practiced in Italy and who wrote an extensive proposal for the establishment of a medical school on the European m o d e l . 3 But the very story of Mustafa Behcet Efendi, one that still has to be told, is that he gradually took over the secular outlook that was part of the system of multiple realities of the Ottomans and that was promoted by the era of reform. It was that outlook that the eager students of medicine of the 1890s carried further.

In Lieu of

Conclusion

Positivist Republican Turks w h o surveyed the history of science in Turkey have promoted an image of Ottoman science as blocked by religious c o n s e r v a t i s m , i.e., the idea that Islam and the U l e m a constituted a key impediment in the Ottoman appropriation of the Western ideas about nature and science. While

credit must be given to many of these authors for

' Marina Frasca-Spada and Nick Jardine, "Intoduction: Books and the Sciences" in Books and the Sciences in History, ed. b\ Marina Frasca-Spada and Nick Jardine. Cambridge: Cambridge University Press, 2000, pp. I Î0. 2 Ekmeleddin Ihsanoglu cites in his article the opening dates of this novel education institutions. He also calls this period as a transition period. See Ekmeleddin ihsanoglu, "19. Yiizyil Ba§inda Kultur Hayati ve Be§ikta§ Cemiyet-i llmiyesi" in Belleten, v. 51 (1987) 200, pp. 803-804. 3 Adnan Ataç, "14 Mart 1827'de Açilan T i p Okulunun Açilifi ile ilgili Dort Belge" in Yeni Tip Tarihi Araçtirmalari vol. 2-3 ( 1996-97) pp. 242-257.

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fundamental research such a latent evaluation emerges even f r o m serious scholarly works. In all cases the ideological foundation for such an evaluation is obvious. It depends on the f r a m e of values of the builders of the Turkish secular republic, A more subtle interpretation of the ways in which contact was established by the Ottomans with Western ideas of science still has to be developed. I have attempted to present a different interpretation of this process.

MAKING THE UNIVERSAL ONE'S OWN THE DIFFUSION OF MODERN SCIENCE THROUGH OTTOMAN JOURNALS ADDRESSING A GENERAL READERSHIP Christoph K. NEUMANN*

The history of specific fields of knowledge such as law, architecture, philosophy or science and technology is often written by scholars whose main academic formation is in that respective field. Quite naturally, these scholars are best qualified to understand the subject matter their sources talk about. On the other hand, and quite inevitably, they remain assured of assumptions that are constitutive for their respective discipline in the time they write. A good lawyer continues to look for good and wrong juridical decisions, even if he deals with history. Concurrently, an engineer is concerned with sound (or failing) technical solutions, and a scientist of today will have a hard time to forego, say, the notion of progress when he deals with science of the past. For a plain historian like me, who lacks the inside experience of an engineer or a natural scientist but is affected by all the professionelles

de'formations

of my craft, science is necessarily something else than it

constitutes for somebody with the education and background of a practitioner. In my perspective, talking about the "diffusion of science" does consequently not entail the notion that there is a given, but ever-growing body of knowledge of which parts can be taught, published, translated, and distributed without changing it. Instead, I tend to imagine modern science as the set of ideas and practices that claim universal truth based on the way they are produced or at least pretend to be produced: a systematic, impersonal and publicly available knowledge largely based on careful experimentation or observation of the outer world and formulated in a language that principally obeys mathematical or logical rules. This is no serious attempt at definition but rather one at avoiding definition: lacking the expertise of a scientist I should not feel at ease judging whether a specific idea is "really" scientific or not. By putting the word "really" into quotation marks, I spell out that as a

*

Prof. Dr. phil., Ludwig-Maximilians University Munich, Institute for Near and Middle Eastern Studies. G e r m a n y . I extend my thanks to Ye§im I§il Ülman (Acibadem University) without w h o s e g o o d - h u m o u r e d insistence this article would never have been written.

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historian after the linguistic turn I would have grave difficulties with the epistemological concepts of "reality" and "essence" while exercising my craft. The concept of "diffusion" of scientific knowledge, however, has been by now firmly connected to that of appropriation. In the Ottoman context, scholars from Athens have described how Orthodox authors incorporated scientific knowledge from the West in their Aristotelian world-view, thereby changing both of them and preparing a different path toward secular scientific thought in the Greek-writing communities of the Eastern Mediterranean. 1 The concept of a "European periphery" has been borrowed from Wallersteinian historical sociology as a label for countries such as the Ottoman Empire, Portugal or Poland. It off ers flexibility but also describes the relation with the Western and Central European centre as one of unequal power resulting in unequal exchange. Considering the diffusion of scientific knowledge in this wake, the channels through which such knowledge was communicated deserve special attention. Looking at them separately we may, in the future, be able to say something about the social hiérarchisation of knowledge, plainly by considering which parts of supposedly universal science was made available to whom and which aspects enjoyed higher prestige than others. This paper concentrates on a very limited section of the multilingual variety of media more or less available in the Ottoman Empire. It disregards everything that did not use the language

of

Turkish.

It leaves aside all f o r m s of verbal

communications including instruction at schools, all newspapers, books and the serious medical journals that were published in the Ottoman Empire, since 1849 also in Turkish. What is left are journals addressing a general readership (this term appears to be more adequate than that of "popular journal" because it seems not to be quite clear what "popular" meant in the late Ottoman Empire). In my v i e w , these are of special importance. Students of late Ottoman intellectual life have observed that the Ottoman press played a role comparable to that of the Encyclopédie

in France: collecting and presenting information

for the educated reader who was regarded as trustworthy and enlightening. 2 The comparison has its drawbacks. Since Darton we may be less sure about

' D i m i t r i s Dialetis, Kostas Gavroglu, Manolis Patiniotis, " T h e Sciences in the Greek Speaking Regions During the 17 lh and IX"1 Centuries", The Sciences in the European Periphery During the Enlightenment, ed. Kostas Gavroglu (Dordrecht, Boston, London: Kluwer, 1999), 41-71. 2 T h e high esteem of newspapers goes back to Ahmet Hamdi Tanpinar w h o , however, limits his positive judgement to the period until 1873. According to Tanpinar Vatan Yahud Silistre, which appeared in that year; commer and ond semicolon made the printed book the defining medium of Ottoman intellectual life. I'tuncu Avir Turk Edebiyati Tarihi, 5 l h e d . (Istanbul: £ a g l a y a n Kitabevi, 1982 (first ed. 1949]). 2 1 3 - 1 4 , 2 4 9 - 5 2 .

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the Ottoman press was certainly no

coordinated intellectual project with a relatively well defined philosophical framework. Still, the educative spirit that drove so many prominent Ottoman authors from §inasi and Namik Kemal to the prolific A h m e d Midhat and further on can be likened to the position that many contributors of the Encyclopédie

assumed toward their readers.

The most important authors of periodicals were often also their editors. While these men were always the very personal and identifiable backbone of the publication, the first real professionals of the Ottoman press were the printers who also acted as publishers. 2 The two periodicals that are the main concern of this article are special in the respect that they were dominated by one man who acted simultaneously as writer, editor, publisher and printer. The first of them Mecmua-i Ziya

Ebu'z-

was published between 15-N-1297 (21 .VIII.1880) and 2 - N - 1 3 3 0

(15.V1II.1912); but it had to discontinue its publication when its editor Ebu'zZ i y a T e v f i k 3 was sent into exile in Konya. The second journal, namely the Servet-Fiinun was very much modelled on the l'Illustration4

and had a wide circle of prominent contributors. Even

so, it depended throughout the 53 years of its publication on the political and economic well-being of the editor, Ahmed ihsan [Tokgoz], Whenever he was in trouble, the journal had to close down. It survived the man for only two years - certainly due also to the especially unfavourable conditions of the year 1944. The two are no exception. The Mecmua-i Fiinun of 1862 was more the journal of its editor Miinif Efendi (later Pasha) than that of his "Scientific Society" (Cem'iyet-i

llmiye).

As soon as Miinif had to withdraw from the

position of the editor the journal died. 5

' R o b e r t Darnton, The Business of Enlightenment: a Publishing History of the E n c y c l o p é d i e , 1775 1800 (Cambridge: Harvard University Press, 1979); idem, The Forbidden Bestsellers of Pre-Revolutionary France (New York: W . W . Norton, 1996); idem, The Literary Underground of the Old Regime (Cambridge, Mass.: Harvard University Press, 1982). C h r i s t o p h K . N e u m a n n , " B o o k and N e w s p a p e r Printing in Turkish, 18 t h — 20 l h Centuries = Buch- und Zeitungsdruck auf Türkisch, 18. bis 20. Jahrhundert". Middle Eastern Languages and the Print Revolution: A Cross-Cultural Encounter = Sprachen des Nahen Ostens und die Druckrevolution: Eine interkulturelle Begegnung, ed. Eva Hanebutt-Benz et al.-, ( M a i n z , Westhofen: Gutenberg M u s e u m Mainz, W V A - V l g . Skulima, 2002), 227-48, N B 236-37.-. 3 O n him see Alim Giir, Ebüzziya Tevfik : Hayati; Dil, Edehiyat, Basin, Yaytn ve Matbaacikga Katkilari (Ankara: Kültür Bakanligi, 1998). 4 It even used the French subheading "Illustration ottomane" for a number of years in the 1890's and 1900's. 5 E k m e l e d d i n i h s a n o g l u , "Cemiyet-i llmiye ve Mecmua-i U l u m " , Osmanli Ìlmlì ve Meslekî Cemiyetleri: 1. Milli Türk Bilim Tarihi Sempozyumu, 3-5 Nisan 1987, ed. Ekmeleddin ihsanoglu (Istanbul: Istanbul Üniversitesi Edebiyat Fakiiltesi, Isiàm Konferansi Teçkilâti Isiàm Sanat ve Kültür Aragtirma Merkezi, 1987), 221-45; Ali B u d a k , Batililaçma Sürecinde Çok Yiinlü bir Osmanli Aydim: Miinif Pa^a (Istanbul: Kitabevi,2004), 226-89.

58

C H R I S T O P H

K.

N E U M A N N

Under these conditions, journals had no chance to develop in a direction that made their existence relatively independent of their editor and printer: None of them evolved into a National Westermanns

Monatshejie.

Geographic,

into a I'Illustration,

or a

Apparently, the relationship between the journals

and its readers' remained much centred around the personal circle of the respective editor and a narrow Constantinopolitan environment. These social settings frustrated aspirations at a more institutionalised, anonymous way of publishing. By founding their own printing-offices Ebu 'z-Ziya Tevfik and A h m e d Ihsan succeeded to broaden the financial basis for their publication activities. 2 H o w e v e r , they may have even boosted the dependence of the respective journal on their person by becoming independent f r o m economic strains. 3

European Science as Part of Late Ottoman

Knowledge

Ottoman journals addressing themselves to a general readership display a number of features that liken each of them to the Encyclopédie:

many of

them define their field of interest in terms that can only be called encyclopedic. This applies also to the Servet-i

Fiinun and the Mecmua-i

Ebu 'z-Ziya.

Servet-i Fiinun announced in its subheading it was concerned with fiinun,

sanayi',

teracim

i ahval,

seyahat,

roman

ve saire

-

The

edebiyat,

"literature,

sciences, industry and arts, b i o g r a p h i e s , t r a v e l o g u e s , novels and other matters". 4 T h e subtitle of the Mecmua-i embracing: ulum ve maarifden

Ebu'z-Ziya

is shorter but equally all-

bahs eder - "it is concerned with the sciences

and matters of education". The difference in the wording is significant: The Servet-i

Fiinun employs the term "fiinun", used by modern Ottoman as

translation for positive sciences, while the Mecmua i Ebu'z-Ziya

prefers the

word "ilm" that comprised any kind of systematic knowledge.

'Klaus Kreiser, "Servet-i Fiinun und seiner Leser im Spiegel der tausendsten N u m m e r , 1910," Presse und Öffentlichkeit im blähen Osten, e d . C h r i s t o p h H e r z o g et al. ( H e i d e l b e r g : Heidelberger Orientverlag, 1995), 93-99. 2 S e e A h m e d I h s a n ' s r e m a r k s on this matter: „ S e r v e t i f i i n u n 5 0 Y a f i n d a 1 8 9 1 - 1 9 4 0 " Servetißnun Uyanq 50: 2275, 2" J ed. (28.111.1940): 4-5. ' A h m e d Ihsan repeatedly wrote that he had founded his press in order to give his journal a financial base that would survive him. More on this issue see in my "Printing as a mission civilisatrice:Ahmed Ihsan Tokgöz, Servet-i Fiinun and the Turkish public" (forthcoming in the proceedings of the Second International Conference on the History of Printing in the Regions and Languages of the Near East, hold in Paris in 2005. 4

T h i s was the subheading e m p l o y e d in the first issues. T h e journal should change its selfdescription quite frequently. 1928, with the change of the alphabet it even a d o p t e d - f o r a while - "The illustrated A w a k e n i n g " (Resimli Uyam$) as new name. Already in S e p t e m b e r 1891, after the first half year of publication, Servet-i Fiinun had introduced the following subheading: "Illustrated Ottoman Newspaper on Matters of Scientific and Industrial Progress along with Affairs of the Sciences and Civ ilisation Published Weekly on Thursdays" (Her Hafta Per%enhih Giini Qikar Terakkiyat-i Fiinun ve Sanayi' He ¡jiiunat-i Fenniye ve Medeniyeden Bahs Eder Musavver Osmanh Gazetesi): Servet-i Fiinun 1, 2: 27 (5-EylQI-1307).

M A K I N G

THH

U N I V E R S A L

O N E ' S

OWN

59

Even in this difference of formulation, the dependence of the periodicals on their respective publisher is obvious. A h m e d ihsan was a secular intellectual with a modernist agenda, but inclined to cooperate with all the regimes he lived through: he praised Abd iil-Hamid II, became mayor of Pera in the constitutional period and served as deputy of Ordu from 1931 until his death in 1942. 1 Ebu 'z-Ziya Tevfik, however, was a politically more active person and much interested in ideology. He was involved with the Y o u n g Ottoman movement of the 1860s ands 1870's and played an important role in the opposition after 1908. 2 Both the towering influence of the editors and the wide amount of topics covered by such journals make them into a kind of encyclopedia. Let me add that these journals were often prepared with the greatest typographical care and, in the case of the Servet-i Fiinun, with avant-garde techniques of illustrations. This helped to enhance the survival time of each copy, and to some degree transformed each number of the journals into a kind of fascicle of a collection of knowledge. It is useful to recall this fact. Today both the Servet-i Fiinun and the Mecmua-i Ebu 'z-Ziya are mainly known as literary journals and perhaps as pioneering enterprises in the printing history of the Ottoman Empire. Their role in the formation of a modern Ottoman corpus of knowledge has been much less appreciated. The encyclopedic orientation of tanzimat intellectuels has often been recognized. 3 With the important exception of Ahmed Midhat, intellectuals in the period of Abd iil-Hamid II, while still pursuing a wide range of interest, became somewhat more focused on certain fields of knowledge. In the time after 1880, it was really something of a rarity if somebody published about law, language, rhetoric, history, religion, logic and calendars as the famous Ahmed Cevdet had done two generations earlier. 4

'Main source on his life until 1914 is his autobiography Matbuat Hatiralarim, first published in the §ervet-i Fiinun - Uyanq (in installments) and were repeated there in the 1940's. Ahmed Ihsan, Matbuat Hatiralarim, 2 vols. (Istanbul: Ahmed Ihsan Matbaasi, 1930-31); a linguistically modernised version ed. Alpay Kabacali (Istanbul: ileti§im, 1993). A short biography in Türk Dili ve Edebiyati Ansiklopedisi [TDEAJiS: 367 |s.v. "Tokgöz, Ahmed ihsan"|. A critical reaction by Ali Birinci entitled "Matbuat Hatiralarimin Karartilan Tarihi" appeared in Tarih ve Toplum 20: 118 (1993): 253/61-256/64 was answered by Kabacali in Tarih ve Toplum 20: 119 (1993): 258/2. A reply to that ("Bay Kabacali'nin Cevap Niyetine Karaladigi Satirlarina Zoraki bir Cevabimiz") was first published in the journal Polemik but is better available in Ali Birinci. Tarih Ugrunda: Matbuat Aleminde Birkaf Adim (istanbul: Dergäh, 2001), 30-38 (see pp. 9-21 for his first review). 2

TDEA

3

2: 418-20 |s.v. "Ebüzziya Mehmed Tevfik", Ziyad Ebüzziya].

F o r Miinif Pa§a see Ismail Dogan, Tanzimatin Iki Ucu: Münif Pa§a ve Ali Suavi: Pedagojik bir Karylapirma (Istanbul: Iz Yayinciligi, 1991), 121-28, 369-79. 4

Sosyo-

N o t to speak about the reports, bylaws and laws that this man had formulated. On Cevdet see Christoph K. Neumann, Das indirekte Argument: Ein Plädoyer für die Tanzimat vermittels der Historie; Die geschichtliche Bedeutung von Ahmed Cevdet Pa§as Ta'rih (Hamburg, Münster: Lit, 1994), also available in Turkish as Araf Tarih, Ama( Tanzimat: Tarih-i Cevdet'in Siyasi Anlami, transl. Meltem Arun (Istanbul: Tarih Vakfi Yurt Yay., 1999); Türkiye Diyanet Vakfi Islam Ansiklopedisi [TDVtAj 7 (1993): 443-50 [s.v. "Cevdet Pa§a" - Yusuf Hala^oglu, M. Äkif Aydin|.

60

C H R I S T O P H

K .

N E U M A N N

T h e periodicals that addressed themselves to a general readership, however, retained this encyclopedic approach. It is important to mark that the belles lettres have as much a place in this context as geographical, political, technological and scientific knowledge. Under Abdiilhamidian rule, texts with an outright political content were difficult to publish (to say the least) 1 . Fiction and literary criticism also carried risks for their publishers. In 1901, the authorities closed down Servet-i Fiinun after an article by Huseyin Cahid [ Yal§in| on "Literature and Law" had been denounced. The weekly could open after a relatively short time, but the f a m o u s literary circle that is still identified with the name of the periodical broke up. For seven years fictional texts were virtually absent from the pages of Servet-i The Mecmua-i

Ebu

'z-Ziya,

Fiinun.2

h o w e v e r , retained its

all-embracing

approach. It published yearly tables of contents that listed the texts published not in alphabetic or chronological order, but in an systematic manner: Thus the collection of the issues turned into a kind of volume of an encyclopedia. 3 A v a n t - g a r d e Literature (especially if modelled along the lines of "Western" examples), science and technology shared one thing: They were emblematic for the notions of progress. Talking about science in itself was as modern as serialising a novel. That is one of the reasons why one of the key elements of scientific practice was never quite reflected in Servet-i

Fiinun or

the Mecmua-i Ebu 'z-Ziya: a critique of scholarly findings. Instead, admiration abounded. This admiration also extends to such controversial matters as the annihilation of street dogs, where Servet-i Fiinun praises the painlessness of gasification used in European countries. 4 Another aspect that severely limited the scope of scientific reporting was the degree of scientific knowledge a m o n g both readers and (potential) authors. At the present state it remains largely open to speculation what kind and degree of scientific understanding Ottoman journal readers could muster in the last decades of the empire; but there is no reason for extreme optimism. It must have been even more difficult to find people w h o could write about science.

' a good history of the censorship practices during that time is still lacking. See Alpay Kabacali, Baflangu;tan Giinumuze Tiirkixe'de Basin Sansitrii (Istanbul: Gazeteler Cemiyeti Yayinlari, 1990), 48-82. A critical review to this Ali Birinci, Kebikeg 1 (1995): 91-96. ^Tokgoz ed. Kabacali, Matbuat Hatiralarim, 88-102. 3

T h e following classification was employed in the first years: Literature/edebiyat, \erselnazm, history/to>i7i, sciences/^««™ (subdivisions: natural history/ta'rih-i tabu, miscellaneous scientific m a t t e r s / m e v a d d - i miitenevvia-i fenniye, a s t r o n o m y M e y ' e f ) , philosophical pleasantrieslletaif-i hikemiye, statistics! istatistik. historical anecdotes/miiltakat-i ta'rihiye, printingImatbuat, ethics/ahldk, m i s c e l l a n e a t m a k a l a t - i muhtelife, e t h n o g r a p h y / a r f a i - i akvam, civilisation n e w s l h a v a d i s - i medeniye. It is obvious that this classification reflects more the publication policy of the journal than an attempt at the division of h u m a n k n o w l e d g e . C o n c u r r e n t l y , scientific and technological matters issues could be touched upon in a number of these subdivisions. Still, the approach is clearly encyclopedic. 4 " K o p e k l e r i n ltlafi", Servet-i l-Unun 1,2: 4 5 (9-kan 11-1307): 2 2 0 , 2 2 4 - 2 2 5 .

MAKING

THE

UNIVERSAL

In this respect, Servet-i

ONE'S

OWN

61

Fiinun was relatively lucky. From its early

years on, Besim Omer [Akalin], one of the founding fathers of Turkish gynascology, 1 and Mahmud Sadik 2 were among its regular contributors. Besim Omer concentrated mainly on medical topics; in doing so, however, he also incorporated material that today would be regarded rather as ethnographic. 3 Mahmud Sadik covered a large array of topics pertaining both to science and technology. Two weeks after Röntgen's discovery of x-rays had been published in Europe, Mahmud Sadik wrote a long article on this topic in the Servet-i FUnun. 4 His "scientific conversations" (Musahabe-i

Fenniye)

became one of the stock items of the journal. The Mecmua-i Ebu 'z-Ziya had a much harder time to find people both able and willing to write about European science and technology. Much of the information conveyed remained on a rather anecdotic level. Sporadically the journal published under the heading "Statistics" (istatistik)

information that

can be best understood in the Ottoman tradition of "curiosities"

(garabat).

Among these are communications such as that 12.5% of the meat consumed in the United Kingdom had been imported from the USA, or that in 1880 sixty-four factories in Germany produced altogether 4.5 million sets of gambling cards. 5 On the other hand, the Mecmua-i

Ebu 'z-Ziya

published

articles that just compiled and slightly edited information on a certain concept or thing. Hakki, a judge at the court of appeal, thus could publish a text entitled "Crisis" (Buhran)

that consisted of two quoted definitions of the

medical term, one taken from al-Razi's Shark al-Maqamat,

the other from

Asim's translation of the Qamus. Ebu 'z-Ziya then added footnotes explaining the connection of this material to the French concept of crisis and Namik Kemal's usage of the word "buhran" for the French "crise" also in political and social contexts. 6 •inci Hot, "Besim O m e r Akalin, 1861-1940" Yeni Tip Tarihi Araçtirmalan 2-3 (1996-97): 21332 ; Yeçim Igil Ü l m a n , "Besim O m e r Akalin (1862-1940) ange gardien des f e m m e s et des e n f a n t s " in: M é d e c i n s et i n g é n i e u r s o t t o m a n s à l'âge des n a t i o n a l i s m e s , ed: M é r a p i Anastassiadou-Dumont, IFEA, Maissonneuve& Larose, Paris (France) 2003: 101-123. ^TDEA 6: 117 |s.v. " M a h m u d Sadik", Mustafa Kutlu], I suspect that a number of articles signed by a certain Kadrî are also from this m a n ' s pen. • ' a serialised article about the different kinds of swaddling and their negative consequences included detailed remarks and illustrations showing how babies were swaddled in different countries of the earth: Served FUnun 5, 9: 209 (2-mart-1311), 8-9, 13-15. 4

5 , 10: 256 (21-kan 1-1311): 240-43. On immediate Ottoman reactions to this discovery cf. Ye§im I§il-Ülman, " T ü r k i y e ' d e Ilk Kullamliçinin 100. Yilinda Röntgen I§inlanve Dr. Esad Feyzi" Tarih ve Toplum 13: 2 6 , 1 5 2 (1996): 112/48-114/50. S

Mecmua-i

6

Ebu 'z-Ziya 2: 14 (l-R-1298): 447.

Mecmua-i Ebu 'z-Ziya 18, 7 4 (15-B-1315): 1342-43. Ebu ' z - Z i y a ' s assertion that Kemal was the first to use that word in this way appears to be debatable: A h m e d Cevdet claims that he found the word as an equivalent of the French word "crise" in about 1852: Tezâkir, ed. Cavid Baysun, vol. 1 (Ankara: Turk Tarih K u r u m u , 1953), 21. As a medical term it is documented as early as 1437: Andreas Tietze, Tarihi ve Etimolojik Tiirkiye TUrkçesi Lugali, vol. 1 (Istanbul, Wien: Simurg, Österreichische Akademie der Wissenschaften, 2002), 390.

62 Useful

C H R I S T O P H

K .

N E U M A N N

Knowledge The e n c y c l o p e d i s m of the j o u r n a l s dovetails nicely with another

obvious aspect of the presentation of science: utilitarianism. It is an oftenrepeated statement that in appropriating European science and technology, Ottomans were mainly interested in its usefulness and applicability. 1 This practical-mindedness seems to belong to the stock of Ottoman intellectual life: Similar orientations can be found in other fields of knowledge that are not directly related to religion such as history. 2 Concurrently, the notion of progress that is conveyed in the periodicals has little to do with an idea of an accumulation of abstract knowledge. T h e r e is little or no interest in mathematics or theoretical physics, but chemistry, medicine, and other applied sciences are given much space. 3 When dealing with the zoological peculiarities of different animal species in a rather dry manner, the Mecmua-t Ebu 'z-Ziya thus publish a short article on the "Usefulness of Flies" (Sinegin

Faidesi)

with reference to the

results of microscopic research done by an anonymous English chemist. 4 In the same wake, the encyclopedism of the Servet-i Fiinun gave great weight to what the journal called 'Works of progress" (asar i terakki),

and especially

those that were related to the Ottoman Empire ("samples of Ottoman progress" or terakkiyat-i

osmaniye).

In the latter category fell also such texts as

the one that gave a paraphrase of an article in the Gazette

des

Beaux-arts

praising the Archeological (then Imperial) M u s e u m of Istanbul. Archeology was characterised as a scientific discipline, that occupied the first place among contemporary sciences. 5 The interest in technological progress was genuine. Even in a time such as the fall 1908, when restrictions on political and literary publications were largely absent, Servet-i

Funun published photographs of new agricultural

machinery and excavators in America praising the "service" they did to the farmers and workers. 6

' E k m e l e d d i n Ihsanoglu, "Modernization Efforts in Science, Technology and Industry in the Ottoman Empire, 18 lh and 19"1 Centuries" The Introduction of Modern Science and Technology to Turkey and Japan: international Symposium, October, 7-11, 1996, e d . Feza Giinergun, Kuriyama Shigehisa (Tokyo: International Research Center for Japanese Studies, s.a.), 15-35, NB 19-26. ^Christoph K. Neumann, Das indirekte Argument: Ein Plädoyer für die T a n z i m a t vermittels der Historie; Die geschichtliche Bedeutung von Ahmed Cevdet Papa's T a ' r i h ( H a m b u r g , Münster: Lit, 1994), 196-97. Parts of republican historiography invert this notion into the legitimizing concept of "service" rendered by Turks to the rest of the world: Etienne C o p e a u x , " H i z m e t : A Keyword in the Turkish Historical Narrative," New Perspectives on Turkey 14 (1996): 97-114. ^Even the Mecmua-t Fiinun thai was to some degree open to pure positive sciences generally stressed the utility of science and technology. Budak, MiinifPa^a, 281-82,287. 4 Mecmua-t Ebu 'z-Ziya 2: 24 (1299): 762-64. ^„Arkeoloji tesiniye olunur bir fenn-i mCihimm ve m u ' t e n a vardir ki el-yevm fiinun-i hazira m e y a n m d a birinci dereceyi i§gal e d e r . . . " Servet-i Fiinun 1, 2: 4 9 (6-§ubat-1307), 2 6 6 - 6 9 , quotation from p. 266. ^Servet-i

Fiinun 18, 36: 913 (U-te§rin 11-1324)44-45.

M A K I N G

T H E

U N I V E R S A L

Science and Technology as External

O N E ' S

O W N

63

Phenomena?

§crif Mardin has extensively dealt with the social repercussions the "import" of "Western" sciences had in the Ottoman Empire. 1 While it is true that the older knowledge elites such as the ulema did not engage in a debate that aimed at the rejection of modern science, 2 the social stratum of those who had acquired this kind of knowledge was a distinct one and carried the claim to social and political power. These people, among the military widely known as mektebli ("schoolboys") encountered foot-dragging reactions and sometimes open opposition from large parts of the population who sometimes were able to join forces with parts of the older elite. As a matter of course, neither the Mecmua-i Ebu 'z-Ziya, nor the Servet-i Funun gave their voice to doubts about the value of "Western" knowledge. Still, they assumed rather different attitudes toward their readers and their subject when they talked about modern science. None of them, however, the didactic strategy sometimes employed by the Mecmua-i Funun. Already in its first issue, Miinif lectured his readers about the superiority of scientific knowledge, loading the concept also with moral values. 3 This didactic, top-down approach, the typical attitude of a tanzimat politician and administrator, is largely absent from the pages of the Servet-i Funun. Already the titles of some of the recurring sections of the journal imply a slightly different approach: they are called Istanbul Postasi ("Mail from Istanbul"), Musahabe i Fenniye ("A Scholarly Conversation") or Resimlerimiz ("Our Pictures"). Author and reader are meeting here more or less on an equal level. This is not to say that articles in the Servet-i Fiinun were never didactic - very frequently, they were - , but in principle the newspaper assumed that its readership shared its basic understanding of science. At this stage, it is open to speculation, in how far the readership of the journal was more a real than an imagined community within an ocean of anonymous readers. According to Ahmed Ihsan, the print-run was at the beginning 600, and then increased. 4 It is well possible that the editor knew most of his regular readers personally.

§erif Mardin, "Power, Civil Society and Culture in the Ottoman Empire" Comparative Studies in Society and History 1 1 , 3 (1969): 258-81; idem, "Super-Westernization in Urban Life in the Ottoman Empire in the Last Quarter of the Nineteenth Century", Turkey: Geographic and Social Perspectives, ed. Peter Benedict et al. (Leiden et al.: E . J. Brill, 1974), 403-46. 2 E k m e l e d d i n Ihsanoglu, " S o m e Critical Notes on the Introduction of Modern Sciences to the Ottoman State and the Relation between Science and Religion up to the end of the Nineteenth C e n t u r y " . Comité International d'Etudes Pré-Ottomanes et Ottomanes: VIth Symposium; Cambridge, lrs'-4'h July 19M, eds. Jean-Louis Bacqué-Grammont, Emeri van Donzel (Istanbul "et al.": T h e Divit P r „ 1987), 235-53. 3

" M ü v a z e n e - i Ilm ve Cehl", Mecmua-i

Fiinun 1 , 1 (1279): 21-35.

^ A h m e d ihsan, „Servetifiinun 50 Y a § i n d a " , 4 .

64

CHRISTOPH

K.

NHUMANN

In marked difference to the Servet-i Fiinun, whose pages do not contain anything that would mark a Muslim identity, the Mecmua-i Ebu 'z-Ziya often refers to the sources of knowledge of the Ottoman past. Lacking (or not attracting) authors such as Besim Ómer and Mahmud Sadik, the journal treats science and technology frequently within the framework of what one could call "history of civilisation". A typical issue of the Mecmua-i

Ebu

'z-Ziya

would include the

following articles with scientific content: an article on earthquakes, giving a short explanation of the phenomenon with a list of important earthquakes in history would be followed by a text on "chemical experiments" kimyeviye)

(tecarib-i

which had also practical use in solving domestic questions such

as gluing broken glass or polishing tortoiseshell. The next article gives a medical and historical description of the plague. 1 The articles on the earthquakes integrates the "own" history of Islamic countries into the presentation of scientific facts by ways of chronology: earthquakes in the Islamic world are mentioned along with those in the rest of the world (the dates of the "Muslim" cases are given in hijra-years, the rest according to the Christian era). The article on the plague, however, first describes the medical facts to continue then with an account of a massacre against Swiss Jews who had been suspected of causing the plague there in 1348. Both the article on earthquakes and that on the plague not only explain a scientific phenomenon but also enable their Muslim readers to integrate it into a worldview that does not necessarily accept Kuropean superiority, at least not with regard to history and morals. The first article in the same issue, however, is employing another way of integrating knowledge about modern science into a worldview that understands itself as non-Western. It bears the title "Islamic Education: Academy and Abode of Sciences" (Maarif-i íslámiye: Ulüm)

Akademi - Dar iil-

and argues that "academy" is a misnomer for modern scientific

institutes. While the Athenian academy was no place where scholars were employed to perform their inquiries such institutions had been created first in early Islamic times. In Hurope, however, only in the fifteenth century something comparable was introduced. What now was called an "institute" was nothing else than a madrasa/medrese.

"Why have the Europeans who

take Academios' garden, where Plato taught philosophy, as the basis of their academies, not investigated and noted that the best-arranged teaching institutions have been invented by the people of Islam, and especially the Turks? We are convinced that this ignorance that can only be attributed to

l

Mecmua-i

Ebu 'z-Ziya

2, 17 ( LvCa-1298): 529-39.

M A K I N G

T H E

U N I V E R S A L

O N E ' S

O W N

65

either rancour or lack of examination, does not suit the scholars of Europe." 1 After praising also the Ottomans for their sponsorship of academic excellence, the article concludes: "What a pity! They [the Europeans] have taken our science and scholarship; and we have followed them in their ignorance and nescience!" 2 Already in 1956, Gustav von Grunebaum has labelled the strategy employed here as "orthogenesis", namely the integration of elements from a foreign culture into the own one by attributing it to a tradition that is regarded as one's own or by likening it to a cultural feature that one uses, anyway. 3 In this example, scholarship and science are turned into essentially Islamic, and even Turkish, achievements. Modern science thus ceases to be foreign.

Ottoman Science and

Technology

While orthogenesis appears in frequently, 4 the Servet-i Fiinun does not journal predominantly of mekteblis (Miilkiye),6 the circle of this journal

the Mecmua-i Ebu 'z-Ziya quite take recours to it very often. 5 Being a f r o m the school for civil servants had little difficulties in accepting

F e l a t u n ' u n ta'lim-i hikmet eyledigi A k a d e m y o s bagsesini akademiye esas add eden Avrupalilar bu diirlii dar iit-tedrislerin en m u n t a z a m l a n millet-i tslamiyeden bi'l-hassa Turklerin eser-i icadi oldigmi acaba ni§iin tahkik ve kayd etmemi§lerdir? Ya garaza veyahud noksan-i tahkike atf olunmakdan kurtulamayan §u gaflet Avrupa muhakkiklarina yaki§ir hallerden degildir i'tikadindadyiz." Mecmua-i Ebu "z-Ziya 2, 17 (15-Ca-l298): 516 (the article pp. 513-18). Hayf ki anlar bizim ilm ve irfanimizi ve biz anlann cehl ve nadanisini istihlaf eyledik." Mecmua-i Ebu 'z-Ziya 2 , 1 7 (15-Ca-1298): 518. The Problem of Cultural Influence", Charisteria orientalia praecipue ad Persiam pertinentia: [Festschrift] Jan Rypka, ed. Felix Tauer et al. (Praha: _ S A V , 1956), 86-99. I used the revised German version "Der Islam und das Problem kultureller Beeinflussung" in Gustav E. von Grunebaum, Studien z.um Kulturbild und Selbstverstandnis des Islams (Zurich, Stuttgart: Artemis, 1969), 107-24, 339, NB p. 121. It goes without saying that today, von Grunebaum's idea of "Western" and "Islamic" cultures as something essentially separate appears to be questionable. This objection, however, does not destroy the analytical power of the concept of orthogenesis. It would apply even if the differences between the other and the self were merely perceived. More on orthogenesis in my Das indirekte Argument, 188-90. 4

A similar example in Mecmua-i Ebu 'z-Ziya 1 8 , 7 5 (l-j-1315): 1361-67 with an article on the evil eye translated f r o m the German by Mehmed Rii§di and a note by Ebu 'z-Ziya that reintroduces popular knowledge as source of scientific deliberations. 5

T h e few cases I could find are very indirect ones. In Kadrt's article "Making Gold" (Altun Yapmak) a number of chemical debates are summarised such as whether sulphur is an element or not and whether it may be possible to produce gold if one electrifies lead. In conclusion, Kadri remarks that perhaps the investigations of contemporary chemists and ulema (zaman-i cedid kimyagerlerinin ve ulemasimn) may not lead to the production of gold but to new branches of scientific research. The usage of "ulema" in this context likens Islamic scholars to modern scientists: Servet-i Fiinun 5 , 9 : 225 (131 l-haz-22): 266-268. ® Ahmed Ihsan, Mahmud Sadik and many other contributors had graduated from that school. Besim Omer as a medical doctor was a graduate of the imperial medical school as were many of the Young Turks of the Society of Union and Progress: M. §iikru Hanioglu, Bir Siyasal pu$tinur Olarak Doktor Abdullah Cevdet ve Donemi (Istanbul: U?dal Nefriyat, H986]), 6-23; idem, The Young Turks in Opposition (New York, Oxford: Oxford University Press, 1995), 10-

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modern science and technology as an external invention as long as its universality promised Ottoman participation. This issue, however, was very important for the journal, indeed. Ahmed Ihsan used every opportunity to report industrial or

technological

improvements in Istanbul and the empire at large. He took photographs of such installations and published them. The desire to publish pictures from the Ottoman Empire was the driving force behind his introduction of new techniques of printing and reproduction such as zincography 1 ; and the fabrication of copperplates for the print of photography. 2 Among the many examples of technology in the Ottoman Empire that Servet-i Fiinun presented to its readers are the new quays and embankment constructions in Karakôy.'' a brick factory near to Gôksu at the Bosporus, 4 the tobacco factory of the Régie in Istanbul, 5 the Ottoman pavilion during the world exhibition in Chicago, 6 a secondary school (riiçdiye) in Davudpaça, 7 and the streetcars in Istanbul. 8 This list is far from exhaustive, of course, but should indicate the width of topical interest as much as the narrow geographical scope. The journal received very little material on issues of that kind from the provinces. With regard to scientific successes in the Ottoman Empire, very little can be found in the pages of Servet-i Fiinun. It is difficult to decide to which degree this situation is owed to the notional peculiarity that subsumed both science and technology under funun. Those instances that I have been able to spot are again of a practical nature. The hygiene of milk was an issue repeatedly addressed in the journal. 9 In 1904, a certain Doktor Edhem published an article entitled "Preserving the Pureness of Milk and an Ottoman Invention." 1 0 The author claimed that even if due to the protection offered by the sultan ("saye-i çahanede") in the

' " „ S e r v e t i f u n u n 5 0 Y a j i n d a 1 8 9 1 - 1 9 4 0 " " Servetifunun

UyamS

50: 2 2 7 5 , 2 n l i e d . (28.111.1940):

2. 2

Servet-i

Fiinun 5 , 9 ; 223 (8-ha/, 1311): 2 2 6 - 2 7 , 2 3 2 - 3 3 .

^Ibidem; see also the more critical presentation by M e h m u d Sadik in his " M u s a h a b e - i F e n n i y e " one w e e k later in n u m b e r 2 2 4 , 3p. 2 4 3 - 4 5 . ^Servet-i

Funun 5 , 1 0 : 231 (3 agustos 1311): title, 3 5 6 , 3 5 8 - 5 9 .

5

Servet-i

Funun

6

Servet-i

Funun 3 , 6 : 154 (10-§jbat-1309): 3 7 2 , 3 7 5 .

1

Servet-i

^Servet-i

Funun

3 , 6 : 149 (6-kanun II- 1309): 2 9 2 , 2 9 6 - 9 7 . 5, 9: 2 2 3 ( 8 - h a / i r a n - 1 3 1 1 ) , 3 8 8 - 9 1 .

Fiinun 2 1 , 4 1 : 1042 (12-mayis-1327), 2 9 , 32.

9

Servet-i Fiinun 3 , 6 : 144 (2-kanun 1-1309), 2 2 4 - 2 5 . T h i s article discussed different m e t h o d s of increasing the durability of milk d e v e l o p e d in F r a n c e , a m o n g others the t r e a t m e n t with ultrahigh t e m p e r a t u r e . Sttdlerin Safiyetini M u h a f a ' a ve bir K e f f - i O s m a n i " , Servet-i 11-1320), 130-31.

Fiinun

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Ottoman realm less children died due to diseases induced by adulterated milk than in Europe, contaminated milk constituted a health risk. Now, two Ottoman inventors by the names of Mehmed Necib and Mehmed Mir'at had found a solution for that problem that would be of great use not only to the Ottoman people but also to humanity at large ("yalmz millet-i Osmaniye degil bitiin cihan-i insaniyete istifade"). The invention in question was a cover for milk cans that was designed to make it impossible for germs to get into the milk and for retailers to water it down. Needless to say, this invention would work only if control by the municipality and consumer conscience secured its proper application. The modernity project of Servet-i Fiinun was encyclopedic, secular, practical-minded and full of the optimism induced by the belief in progress. All this made it important (and gave the journal the chance to survive) under very different regimes, namely Abd iil-Hamid's II authoritarianism, the difficult times of the Second Constitutional Regime and, later, the emerging Republic. It was, however, closely related to certain sections of the Turkish elite and would not quite reach out to larger parts of the population. Science and technology, understood as closely connected to each other, appeared as practical means for progress. Their discursive qualities and social repercussions were either neglected or assumed to be just wonderful. At least implicitly, the Mecmua-i

Ebu 'z-Ziya addressed a problem

totally ignored by Servet-i Fiinun: what science and technology would mean for the identity of their Ottoman users? While doing so, the Mecmua-i Ebu 'zZiya never joined ranks with the critics of progress. Due to its reservations against the Western character of science and technology, however, these occupied a much less prominent place on the agenda of the journal. Both types of Ottoman-Turkish modernities laid out here had their consequences in the intellectual life of the decades to come. None of them, though, paved the way to a truly critical and creative relationship with science and technology.

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1. Servet / Fiinun 3 6 149 (6 kanun li 1309) 292

2 . S e r v e t - i Fiinun 14 29 711 (25 te§rin II 1320) 131

DU HAKIM RENÉGAT AU PRATICIEN EUROPÉEN : MUTATIONS D'IDENTITÉ DES MÉDECINS DE COUR ET MODERNISATION DU SERVICE RENDU AUX BEYS DE TUNIS DU XVII e SIÈCLE AU MILIEU DU XIX e SIÈCLE M'hamed OUALDI*

Dans la eyalet de Tunis, comme en d'autres provinces arabes de l'Empire ottoman, à partir du XVII e siècle, s'est affirmé dans la proximité de gouverneurs locaux ayant titre de beys et de pachas, un corps de mamelouksrenégats, de serviteurs d'origine ou de condition servile issus des rives nord de la Méditerranée ou du Caucase. A ce groupe, ont pu être rattachés en certaines périodes, dans des chroniques locales et des correspondances consulaires européennes, des médecins convertis du christianisme à l'islam. Mais alors que les mamelouks occupant des fonctions administratives et politiques consolidaient leur position jusqu'à accaparer dans les années 1850 à 1870, les principales fonctions de l'Etat, pour leur part, les figures de médecins renégatsmamelouks, repérables au moins dès la fin du XVII e siècle, disparaissaient de la cour des beys de Tunis, dès les premières décennies du XIX e siècle. Les identités intermédiaires et de plus en plus troubles de ces médecins, la disparition progressive de leur figure et l'affirmation parallèle au chevet des beys de praticiens qui n'hésitaient pas à se présenter comme pleinement européens (qu'ils soient chrétiens, juifs, italiens, français ou espagnols) seront ici mises en relation avec les transformations du service rendu aux tenants du pouvoir, en se demandant en quoi ces mutations d'identité de médecins de cour permettent d'éclairer j u s q u ' à la seconde moitié du XIX e siècle, la modernisation du service princier.

Médecins convertis, renégats et

mamelouks

Identifier ces médecins mamelouks ou renégats n'est pas toujours chose aisée. Des chroniques en arabe aux correspondances consulaires, ces Européens convertis aux identités fluides se dérobent très rapidement, sur leur versant Doctorant, moniteur à l'Université Panthéon-Sorbonne Paris 1.

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chrétien ou musulman, aux regards de leurs congénères d'origine ou d'adoption. Ils sont perçus soit sous leur prénom arabe, soit selon leur prénom européen, rarement en une source commune qui mentionnerait leurs différentes identités. L'un des premiers médecins affectés au service des beys avec l'établissement du protectorat français reconnaît dans une note « sur la vie médicale à Tunis avant l'occupation », une difficulté à démêler l'écheveau : les noms des premiers médecins européens, estime-t-il, « ne sont pas reconnus » car « probablement arabisés »'. Le cas du mystérieux « Muhammad al-Mamluk » est, à cet égard, éclairant : en 1814, accusé d'avoir empoisonné le bey Hammuda Basha avec la complicité de l'esclave napolitain Mariano Stinca, ce médecin est clairement reconnu comme un mamelouk, un converti d'origine ou de condition servile au service des beys, dans la chronique du secrétaire de chancellerie b. Abu D h i y a f , 2 alors qu'il n'est que vaguement identifié à un « médecin renié, d'origine vénitienne » dans les correspondances du consul de France pourtant très au fait des moindres mouvements à la cour des beys de Tunis 3 . Seuls deux médecins d'origine italienne, proches du bey Hammuda, se distinguent dans les sources consulaires françaises de la fin du XVIII e siècle et du début du XIX e siècle et peuvent être rapprochés de la figure de « Muhammad al-Mamluk ». Mais tous les deux y sont seulement connus sous leurs noms d'origine : respectivement, Mendrici et Ronchi. Aucun n'est vénitien 4 .

1

F. Lovy, « Notes sur la vie médieale à Tunis avant l'occupation », La Tunisie médicale, mai 1931, p. 208. F. Lovy, ancien interne des hôpitaux de Paris, fut « Premier médecin du bey » à partir de 1892. 2 Dhiyaf, Ithaf ahl al-zama» bi-akhbar al-muluk Tunis wa 'ahd al-aman, Tunis, Maison tunisienne d'édition, 1985, tome III, p. 128, « Maryanu le Chrétien, un des mamluk-s de Hammuda Basha, un de ses proches, son homme de confiance pour ses richesses dans la chambre privée ainsi que son médecin dénommé Muhammad al-Mamluk furent tués. Ils étaient accusés d'avoir empoisonné Hammada Basha sur autorisation de son neveu Salih Bey. » 3 E. Plantet, Correspondance des beys de Tunis et des consuls de France avec la cour 15771830, tome 3 (1770-1830). Paris. Félix Alcan, 1899, p. 529-530, Astoin-Sielve au C t e d e Jaucourt, Tunis, 23 décembre 1814. « Sidi Mahmoud, aussitôt après l'assassinat de son cousin, se plaça sur le trône et fit appeler le sieur Mariano Stinca, et, après lui avoir fait de violents reproches sur la manière dont il s'était comporté envers les Princes de la famille et envers les chrétiens, et lui avoir fait avouer qu'un médecin renié, un Vénitien, et lui avaient empoisonné Sidi-Hamouda Bey, il lui fit couper la tête. Le médecin renié fut aussitôt assassiné. (...) Sidi Othmane n ' a point eu de parti en sa faveur » 4 Le premier, Mendrici, est génois (F. Plantet, op. cit., p. 325, Devoize à Talleyrand, Marseille, 5 octobre 1797, 14 vendémiaire an VI). Mentionné surtout dans des écrits diplomatiques de la fin du XVIII e siècle, il entretient cependant un lien indirect avec Venise : son frère est le chancelier du Consulat de la Sérénissime à Tunis (E. Plantet, op. cit., note 2 p. 330). Le second, Ronchi, plus contemporain des faits, est impliqué dans les révolutions de palais de 1814. De par ses origines napolitaines, il est lié au chef des esclaves du bey Hammuda, Mariano Stinca, exécuté sur la même accusation d'empoisonnement (H. Plantet, op. cit., p. 497. Devoize au duc de Bassano,Paris, 11 août 1811).

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A l'inverse, un médecin, soupçonné de s'être converti, peut n'être connu que sous son seul nom chrétien. Antoine Carlier, qualifié de « renié français, d'Agde » dans des ouvrages français du XVIII e siècle 1 , ne se présente que sous son nom d'origine et sous le titre officiel de « chirurgien du bey » 2 dans de très nombreux actes de la chancellerie française, aussi bien dans son contrat de mariage 3 , que pour la vente d'un navire 4 ou le recouvrement d'une dette 5 . Evoquant l'opération d'aveuglement du bey Murad III, généralement attribuée à ce même Antoine Carlier 6 , le chroniqueur du XIX e siècle, b. Abu Dhiyaf signale, pour sa part, que le praticien était simplement chrétien et qu'il fut contraint et forcé dans ses gestes 7 . Enfin, un simple nom et quelques fonctions en arabe sans indication de statut peuvent intrinsèquement susciter des hypothèses sur l'identité d'un médecin de cour. Ainsi du Khaznadar Rajab al-Tabib, apparaissant sous la plume du chroniqueur Wazir Al-Sarraj quand est évoquée, dans une lutte pour le pouvoir, la victoire d'un bey en 1695 : Rajab cumule, en ses dénominations, la fonction de médecin (al-tabib) et une charge généralement attribuée à un mamluk, celle de khaznadar, principal intendant ou gestionnaire de richesses d'une maison prépondérante. Il est aussi pourvu de compétences militaires puisque dans le passage de la chronique évoquant une reprise en main du pays, il est envoyé vers la capitale politique, Tunis, accompagné d'un groupe de cavaliers alors que son maître, le bey se rend pour sa part, dans la sainte cité de Kairouan 8 . Mais le statut de dépendance de Rajab al-Tabib à l'égard du bey n'est pas précisé, il n'est pas explicitement formulé et ce personnage ne laisse guère de trace dans les sources consulaires consultées.

1 J . B o y e r de S a i n t - G e r v a i s , « M é m o i r e s historiques qui concernent le g o u v e r n e m e n t de l ' a n c i e n et du nouveau royaume de T u n i s », Paris, 1736, p. 5 3 (cité dans Paul Sebag, La régence de Tunis à la fin du XVIIe siècle : mémoire pour servir à l'histoire de Tunis depuis l'année 1685, Paris, l ' H a r m a t t a n , 1993, note 6 p. 82). Dubois Fontanelle reprend cette affirmation dans une compilation tardive : «« Un chirurgien, renégat François, n o m m é Carlier, f u t choisi pour faire cette opération » ( A n e c d o t e s africaines depuis l'origine ou la découverte des différents royaumes qui composent l'Afrique jusqu'à nos jours, Paris, Vincent, 1775, p. 24). e Un ancien interprète au consulat de France à T u n i s , au X I X siècle, A l p h o n s e R o u s s e a u , diffuse la m ê m e version dans ses Annales tunisiennes ou aperçu historique sur la régence de Tunis, réédition par Bouslama, Tunis, 1980, p. 80. 2

P. G r a n d c h a m p , La France en Tunisie au XVII è siècle : inventaire des archives du Consulat de France à Tunis de 1582 à 1705, tome 8 , 1681-1700, Tunis, A l o c c i o , 1930, p. X X X I , 7 décembre 1697, il porte encore ce titre en juin 1700. J

Ibid., p. X X X , acte du 23 j u i n 1697 ; p. X X X I , le père de la jeune fille est originaire de Céphalonie et la mère de Pantelleria.

4

Ibid., tome 10,1701-1705, Tunis, Aloccio, 1933, p. 4 3 , 1 9 septembre 1702. Ibid., 54,13 avril 1703. Ibid., p. XXX. Dubois Fontanelle, op. cit., p. 24. 7 b. Abu Dhiyaf, op. cit., I, p. 87. 8 M u h a m m a d ai-Andalusi a l - W a z i r al-Sarraj, Hulal al sundusiyya fi-l-akhbar al-tunisiyya, deuxième édition, Beyrouth, Dar al-Gharb al-Islami, volume II, 1984-1985, p. 578, victoire de Muhammad Bey du 23 avril 1695. 5 6

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Ces variations d'identités, parfois cloisonnées, permettent justement de comprendre le recours à ces médecins qualifiés tour à tour de « renégats » ou de « mamelouks » du XVII e siècle jusqu'aux deux premières décennies du XIX e siècle. L'apport des renégats dans la course et l'adaptation des forces maritimes des « régence^ barbaresques » sont relativement connus. Mais cela a pu faire passer au second plan d'autres rôles attribués à ces convertis : — leur fonction d'intermédiaires entre leurs patrons (très généralement des chefs militaires) et les représentants d'autorités européennes dans des négociations commerciales pour la vente par exemple de navires ou le rachat d'esclaves ; — leur capacité à transmettre ou transformer un savoir-faire, en matière médicale, par exemple, d'une rive à l'autre de la Méditerranée ; — enfin, l'utilisation de ces dépendants pour renforcer l'emprise de leur maître sur une source de revenus, un groupe social ou un territoire. Le premier des médecins renégats repérable à la fin du XVII e siècle cumule justement ces fonctions. Le « renié italien » « Soliman Tabib », également surnommé « Soliman l'Affricano » ' , fut précisément chirurgien d'un des derniers beys de la dynastie mouradite. D'origine sicilienne, qualifié de « turc » dans un acte de la chancellerie française, pourvu de licences pour le commerce d'huile 2 , maître au moins d'un esclave chrétien 3 , homme de main chargé de récupérer avec l'appui de cinquante spahis les richesses de deux anciens serviteurs français et italien du bey 4 , « Soliman l'Affricano » remplit tous les critères qui définissent le mamelouk dans les chroniques arabes du XVII e siècle et du début du XVIII e siècle : d'origine chrétienne, converti, fortement dépendant du bey, il rend à son maître de multiples services et s'affirme comme l'un de ses intimes. Mais le terme de mamluk n'apparaît dans des sources européennes traitant du beylik de Tunis que dans les deux dernières décennies du XVIII e siècle 5 . Il ne supplante les qualificatifs de « renégat » et

1 P. Grandchamp, op. cit., tome 10, p. 35, mention dans un acte du 29 mai 1702 et p. 108, dans une lettre de Livourne, le 16 juin 1702, de Sebastiano Fucili au commerçant français Nicolas Béranger, à Tunis. Ce dernier en fait mention dans son mémoire publié par Paul Sebag (La régence de Tunis à la fin du XVIIe siècle : mémoire pour servir à l'histoire de Tunis depuis l'année 1685, Paris, l'Harmattan, 1993, p. 87). 2 P. Grandchamp, op. cit., tome 8, p. 323, acte du 7 juin 1700, « Moizé et Abram Mendez Ossuna, juifs, ont reçu de Soliman Tabib, turc, chirurgien de Amurath bey, trois teskras pour permettre de charger 6.000 « metars » d'huile, à 1000 piastres chacun ». 3 Ibid., tome 10, p. 29, acte du I 1 février 1702, un esclave florentin de ce chirurgien reçoit une somme du consul de France. 4 Ibid., tome 8, p. 379, acte du 22 avril 1700. Les deux serviteurs, Jean Baptiste Rousset, ancien « bach-kasaq » et Ventura Maruccio, « garde robe » (l'équivalent d'un « valet de chambre ») se sont noyés, après un naufrage, sur les côtes sardes. 5 Le terme apparaît notamment sous la plume de l'interprète consulaire J. M. Venture de Paradis séjournant à Tunis de 1780 à 1786 (Tunis et Alger au XVIIIe siècle, éd. J. Cuoq, Paris, Sindbad, 1983, p. 92 : « Les apostats, qu'on nomme mamluk en arabe, ont la garde de la porte intérieure du palais. >•).

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« renié » pour désigner un dépendant du bey d'origine ou de condition servile qu'au cours du XIX e siècle, lorsque le nombre des captifs de l'ouest européen s'est considérablement restreint à Tunis et que la figure du médecin renégat ou mamelouk tend à disparaître. L'ultime exemple recensé de ces médecins de cour aux identités fluides et aux appellations fluctuantes est en effet repérable en août 1818 dans la chronique de b. Abi Dhiyaf. Rajab al-Thabib 1 , présenté comme un docteur issus de « Francs convertis », est jeté « en prison comme un criminel » pour avoir le premier annoncé au bey la réapparition de la peste à Tunis 2 . Faiblesse d'un dépendant certes, fragilité surtout d'un serviteur dont le groupe d'origine et d'appartenance se marginalise. Le nombre de captifs européens, et par conséquent de potentiels renégats, n'a, en effet, cessé de se réduire au cours du XVIII e siècle, par intervention constante autant des consuls européens que des ordres de rédemption et surtout par affaiblissement chronique de la course qui avant de connaître un dernier regain entre la fin du XVIII e et le début du XIX e siècle 3 est abolie de facto au terme de l'expédition d'Exmouth en 1816 4 . Les convertis issus de l'ouest européen (d'Italie surtout) qui ont, dès lors, choisi de se maintenir au service des beys dans la première moitié du XIX e siècle, sont relégués au rang de « mamelouks du vestibule », chargés de la garde du palais et de missions subalternes tandis que les captifs venus le plus souvent dès l'enfance du Caucase (Géorgie, Circassie) ou de l'aire grecque se retrouvent souvent parmi les « mamelouks du sérail » appelés à de hautes fonctions administratives et militaires 5 . Parallèlement, les Européens, médecins mais aussi instructeurs militaires, interprètes, n'ont plus forcément besoin de se convertir pour servir le bey. Cependant, la marginalisation, le statut de forte dépendance de Rajab alTabib ne permettent de comprendre qu'en partie le traitement brusque de ce serviteur par un bey surtout soucieux de ne pas laisser circuler des nouvelles alarmantes dans son entourage et auprès des notables de la capitale. Car à la même époque, un autre médecin, cette fois non asservi, le Français Lombard

1

On notera l ' h o m o n y m i e avec le Rajab al-Tabib évoqué par Wazir al-Sarraj. b. Abi Dhiyaf, op. cit., III, 165. Le passage est traduit dans l'ouvrage de Mustapha Kraïem, La Tunisie préœloniale. Tome 2 : Economie, société, Tunis, Société tunisienne de diffusion, p. 372. 3 Lucette Valensi, « Esclaves chrétiens et esclaves noirs à Tunis au X V I I I e siècle », Annales ESC, 4 , novembre-décembre 1967, p. 1268. 4 Khelifa Chater, Dépendances et mutations précoloniales. La Régence de Tunis de 1815 à 1857, Tunis, Publications de l 'université de Tunis, 1984, p. 250-254. Voir aussi Daniel Panzac, Les corsaires harbaresques. La fin d'une épopée. 1800-1820, Paris, 1999, C N R S , 3 1 1 p . 2

5 C t e Filippi, « Fragmens historiques et stratistiques sur la Régence de Tunis suivis d ' u n itinéraire dans quelques régions du Sahra par le Comte Filippi, agent et consul général de S. M . à Tunis », Documents historiques sur la Tunisie : Relations inédites de Nyssen, Filippi et Calligaris (1788, 1829, 1834), (réunies par C. Monchicourt), Paris, Société d'éditions géographiques, maritimes et coloniales, 1929, p. 134-135.

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e s t i n c a r c é r é p u r e m e n t et s i m p l e m e n t p o u r a v o i r a d r e s s é d e s

propos

impertinents au consul de Hollande. Mais il est vrai q u e L o m b a r d , o p p o s a n t bonapartiste en rupture de ban a v e c la France de la restauration m o n a r c h i q u e , ne bénéficiait guère de la protection de son c o n s u l ' . L a n u a n c e entre ces d e u x c a s , e n t r e ces d e u x h o m m e s s a n c t i o n n é s par l ' a u t o r i t é p o l i t i q u e e s t , en l ' o c c u r r e n c e , décelable mais le c r o i s e m e n t d e ces f i g u r e s , à la m ê m e é p o q u e , t r a d u i t un d o u b l e m o u v e m e n t qui n ' e x c l u t p a s les c h e v a u c h e m e n t s , les influences : la disparition de la f i g u r e du médecin converti s ' e f f e c t u e - semblet-il dans la p r e m i è r e m o i t i é d u X I X e siècle - p a r a l l è l e m e n t et en lien a v e c l ' a f f i r m a t i o n c r o i s s a n t e d e l ' a u t o r i t é des m é d e c i n s e u r o p é e n s , italiens puis f r a n ç a i s dans une modernisation du service (de la khidma)

rendu aux beys. L e

m é d e c i n venu des rives italiennes ou f r a n ç a i s e s , q u ' i l soit chrétien ou j u i f 2 s e m b l e p o u v o i r d e m a n i è r e c r o i s s a n t e , e x e r c e r au grand j o u r sans renier, à partir d u m o m e n t où les beys le réclament aux autorités de son pays d ' o r i g i n e , n o t a m m e n t par le biais diplomatique, en s ' a d r e s s a n t aux consuls e u r o p é e n s de Tunis.

La montée en puissance

des médecins

européens

C a r ces m é d e c i n s e u r o p é e n s o n t a f f i r m é leur p r é p o n d é r a n c e sur les autres praticiens, sur les convertis et sur les umana' al-athibba'

( c h e f s locaux

de corporation médicale) en modifiant progressivement la nature de leur lien de d é p e n d a n c e à l'égard du bey, et en mettant en avant pour ce f a i r e , surtout à p a r t i r d e la s e c o n d e m o i t i é d u X V I I I e s i è c l e , la s u p é r i o r i t é d e

leurs

compétences. La première trace recensée d ' u n m é d e c i n chrétien présent au c ô t é d ' u n puissant d e la province o t t o m a n e de T u n i s , d a n s les actes d e la c h a n c e l l e r i e f r a n ç a i s e , remonte à 1624 D a n s un de ses actes daté du 2 7 d é c e m b r e , il est fait mention de Vittor di Tripoli, présenté c o m m e « esclave chirurgien » d e Y u s u f D e y , alors premier personnage politique d e la province 3 . Plus g é n é r a l e m e n t , ce statut servile f u t accolé à presque tous les soixante-quinze n o m s d e m é d e c i n s recensés dans les actes de chancellerie du c o n s u l a t de F r a n c e entre 1591 et 1705. D a n s cet e n s e m b l e , seuls trois ou quatre h o m m e s sont présentés c o m m e

1 A r c h i v e s n a t i o n a l e s f r a n ç a i s e ( A N F ) , A E B III 3 0 4 : R é g e n c e de T u n i s , T a b a r k a , la G a l i t e , 1 8 0 1 - 1 8 4 6 . M i s s i o n s en B a r b a r i e , 1 8 1 5 - 1 8 4 7 . Notice sur le gouvernement de la Régence de Tunis, te caractère des personnages qui le composent, ses forces, son commerce, ses revenus, les consuls qui y résident et les l'rançais qui y sont établis. O c t o b r e 1820. 2

J . M a g n i n , « M é d e c i n e d ' h i e r et m é d e c i n s d ' a u j o u r d ' h u i », ¡BLA, 8 0 , 4 ê m c t r i m e s t r e 1957, p . 3 9 8 : « Q u a n d le s c h i s m e se produisit en 1710 au sein de la c o m m u n a u t é Israelite de T u n i s i e , o n c o m p t a i t d e s m é d e c i n s p a r m i les i m m i g r é s o r i g i n a i r e s d e L i v o u r n e . » L ' a u t e u r é v o q u e , à la page s u i v a n t e , les c a s de Mendo/.c et Curillo, P. G r a n d c h a m p , op. cit., t o m e 4 ( 1 6 2 1 - 1 6 3 0 ) , P a r i s , A l o c c i o , 1926, p. 146.

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des reniés 1 . Mais par la suite, les mentions d'esclaves médecins - quand ils n'ont pas opté pour la conversion - se font beaucoup plus rares 2 . De fait, les relations de dépendance de ces médecins européens à l'égard des beys sont moins pesantes, moins formelles, elles empruntent de nouvelles voies. Dans la seconde moitié du XVIII e siècle, les beys s'attachent ainsi la fidélité de certains de leurs médecins européens en obtenant pour eux de fructueux consulats. Le chirurgien Cartier est ainsi qualifié en 1761 par le représentant des intérêts français de « créature » des beys car pour services rendus lors d'une période d'exil à Alger, il en a obtenu « les consulats de l'Empire et de la République de Raguse », « une maison à la ville et à la campagne et toute sorte de provisions de bouche pour sa nourriture annuelle, comme on use ici envers tous les officiers du gouvernement

Trois ans plus

tard, à la demande de 'Ali Bey, le consulat général de Venise est attribué à un autre chirurgien, le sieur Gazzo, originaire du comptoir génois de Tabarka dont les populations avaient été en partie asservies par une autre branche de la famille régnante en 1741 4 . Enfin, dans les années 1770, Bruno Jourdan est nommé, en reconnaissance de ses efforts diplomatiques, consul d'Autriche et de Toscane, pays où il a développé d'importants intérêts commerciaux 5 . Le mouvement implique autant une transformation, une atténuation des liens de dépendance avec les beys, qu'une consolidation du prestige des médecins européens à Tunis. Accédant à d'honorables et enrichissantes fonctions de représentants diplomatiques, ces médecins et leurs collègues qui leur rendent visite sont peu à peu convaincus de leur valeur, de leur réputation et de la qualité de leurs savoirs. Lors d'un voyage à Tunis en 1732, Johann Ernst Hebenstreit, professeur de médecine à l'Université de Leipzig, constate que les habitants du beylik « ont surtout une bonne opinion des médecins chrétiens ( . . . ) ; et, par un témoignage d'estime spécial, ils les appellent les savants 6 . » Un demi-siècle plus tard, lors d'une mission scientifique dans l'intérieur de la régence, René Louiche Desfontaines aboutit à un constat similaire lorsqu'à l'ouest, près de Gafsa, son accompagnateur fait prendre la

1

J. Magnin, op. cit., p. 396. Dans le beylik voisin de Constantine, en 1781, le voyageur français L. R. Desfontaines signale q u e le b e y « a v a i t p l u s i e u r s e s c l a v e s i t a l i e n s . S o n c h i r u r g i e n (...) était Napolitain » (« Fragments d ' u n voyage dans la Régence de Tunis et d ' A l g e r fait de 1783 à 1786 », édité dans les Voyages dans les Régences de Tunis et d'Alger, Paris, publiés par M . Dureau de la Malle, 1838,"p. 217 ). 2

3

Archives nationales françaises, A E B I 1139 : Tunis 1757-1762. T o m e 15 : Sulause, Tunis, 2 mars 1761.

4

E. Plantet, op. cit., p. 606, de Saizieu au duc de Praslins,Tunis, 25 février 1764.

5

N . Gallagher, Medicine and power in Tunisia. 1780-1900, Cambridge University Press, New York, 1983, p. 19. L'auteur cite notamment en référence E. Plantet, op. cit., p. 93 et 236-237. 6

J.E. Hebenstreit, Voyage à Alger, Tunis et Tripoli entrepris Annales des voyages, 1830, t. II, Paris, 1830, p. 50.

en 1732, (tome 4 6 , des Nouvelles

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0 1 J A L D 1

fuite à « quatre arabes ». en les prévenant que son maître est le médecin du bey 1 . Alors que dans un contexte de réapparition des grandes épidémies 2 , les portes s'ouvrent plus largement à ces médecins européens, leurs regards sur les praticiens locaux se font de manière concomitante, plus critiques. Le médecin belge Louis Frank, vétéran des armées impériales, passé par la cour du bey Hammuda à partir de 1806, est indigné par la transmission encore héréditaire du titre de hakim « cornac

(médecin) dans la régence, il s'emporte surtout contre le

médical » juif qui « prépare, sous les yeux du docteur, les tisanes,

les infusions, les décoctions » et que « les Maures (...) confondent bientôt avec le médecin à la suite duquel ils ont l'habitude de le voir » 3 . Indice de distinction, d'une prise considérable de valeur, le recrutement de ces médecins par les beys peut faire l'objet de véritables tractations diplomatiques 4 . En 1772. le bey 'Ali fait demander un médecin aux autorités françaises par le biais du consul de Saizieu. C ' e s t à la fois un h o m m e compétent et de confiance qui est r e c h e r c h é : « C ' e s t surtout l ' â g e et l'expérience que [le bey | désire dans son choix. L'habileté d'un jeune homme, ne servirait de rien auprès de ce Prince et n'obtiendra pas à son médecin l'entrée du harem » 5 La confession du médecin n'est plus évoquée. Qu'importe qu'il soit chrétien, l'homme appelé à servir le bey pourra se mouvoir dans les différentes parties du palais car sous le poids des années, il aura perdu de sa vigueur masculine et acquis la réputation d'un bon père de famille. La maturité est aussi synonyme, dans cet esprit, de savoir-faire. Tandis que les autorités parisiennes éprouvent des difficultés à trouver « un candidat pour cet emploi » 6 , au bout de près d'un an d'attente, le bey, visiblement excédé, fait 1 R. L. Desfontaines, op. cit., p 67. On peut citer également le chroniqueur M u h a m m a d Saghir b. Yusuf qui rapporte q u ' a p r è s divers e x a m e n s sans résultats, on c o n v o q u a f i n a l e m e n t un médecin européen afin de soigner Yunis, fils de 'Ali Basha (chronique traduite en français Mechra el melki, chronique tunisienne (1705-1771) pour servir à l'histoire des quatre premiers beys de la famille Husaynite, réédité à Tunis, Bouslama, 1978, p. 277-278). ^ A . - M . Planel (tome 1, p. 54. note 32) lie les recrutements de ces médecins par les beys hussaynides à la réapparition des grands fléaux « qui avaient exceptionnellement épargné Tunis depuis 1705 » et rappelle que deux épidémies ont frappé le pays en 1784-1785 et en 1818-1820. (De la Nation à la colonie. U. communauté française de Tunisie au XIXe siècle d'après les archives civiles et notariées du consulat général de France à Tunis, thèse sous la direction de Lucette Valensi, EHESS, 2 0 0 0 . 3 tomes, 773 p).

3 J.-J. Marcel, Histoire de Tunis • •• Précédée d'une description Frank,Tunis, Bouslama, 2tmcédition, 1979, p. 137. 4

de cette régence par le Dr

Louis

On trouve trace d'autres demandes de médecins à des souverains européens : voir la lettre du 12 décembre 1697. de M u h a m i n a d Bey à C o s m e III de Médicis, éditée par P. G r a n d c h a m p dans « Documents turcs relatifs aux relations entre T u n i s et la Toscane (1626-1703) », Revue tunisienne, 1940, p. 110. Mais ¿meune tractation diplomatique ne transparaît dans cette simple lettre. 5 A N F . A E B I 1 1 4 4 : Tunis 17"0-1772. Tome 20, de Saizieu, Tunis, 1 7 7 2 , 3 0 juin, f. 307. 6

¡bld.. f. 307 (E. Plantet, op. cil . p. 17).

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savoir qu'il ne voulait un « bon médecin » français que pour « guérir les Princes, ses fils et son gendre de la gravelle 1 ». Le « chef » de la famille régnante recherche une compétence qu'il ne semble pas trouver auprès de ses praticiens italiens. Et cela constituerait un ultime critère de recrutement, selon le consul de France qui met en valeur l'enjeu diplomatique de cette affaire. D'après le consul de Saizieu, le bey « est environné et dégoûté de tous les médecins italiens qui viennent chercher un asile, vu les moyens de vivre dans son pays, il veut les chasser de sa cour et donner leurs places et sa confiance à un bon médecin françois 2 . » Ce dernier, Mallet de la Brassière, issu de la Marine finit par arriver au début de l'année 1774. Malgré la « maison », le « drogman », les chevaux et « s i x milles livres d'appointements», le savant français ne parvient pas à s'imposer auprès de ses illustres patients. L'entremise du gendre du bey, un mamelouk francophile, n'y suffit pas. Ce sont toujours les Italiens qui « prétendent diriger (le) traitement » des souverains barbaresques-\ En 1775, Mallet de la Brassière se retire avec des « plaintes amères sur l'inexécution des conditions qui l'avaient déterminé à aller soigner le bey de Tunis 4 .» La greffe, peut être trop tardive, n'a pas pris. Cependant, cette affaire contient en germe une des principales mutations du service rendu aux beys par les médecins européens : le recrutement, la position et la prise d'influence d'un médecin auprès de la famille régnante deviennent des enjeux politiques, nourrissant parfois les rivalités entre puissances européennes à Tunis. Placer un médecin de sa nation auprès des beys n'est pas seulement, pour un consul, un moyen d'influence, c'est aussi un vecteur d'information. Par définition, les représentants diplomatiques ne révèlent pas l'identité de leurs informateurs les plus précieux. Les puissances rivales s'en chargent. C'est ainsi Mac Gill, un commerçant britannique qui, en 1811, révèle dans une édition anglaise de son récit de voyage à Tunis que le bey est espionné, pour le compte de la France impériale, à la fois par son «chef des esclaves », Mariano Stinca et son médecin français qui lui rend visite chaque matin 5 . Le négociant écossais ne va pas jusqu'à décliner l'identité de ce médecin qui fut soit le belge francophone

1 ANF, A E B I 1145 : Tunis 1773-1774. Tomes 21 et 22, de Saizieu, Tunis, 1773,13 avril, f. 61 r. La gravelle est une concrétion rénale, ce que l'on appelle plus communément un « petit calcul ». 2

ANF, A E B I 1144 : Tunis 1770-1772.Tome 2 0 , d e Saizieu,Tunis, 1772,30 j u i n , f . 307.

^ E. Plantet, op. cit., p. 28, de Saizieu à de Boynes, Tunis, 10 avril 1774. 4 5

E. Plantet, op. cit., p. 38, le Comte de Sartine à de Saizieu, Versailles, 31 juillet 1775.

T. MacGili, An Account of Tunis of its Government, Manners, Customs, and Antiquities ; especially of its Productions, Manufactures and Commerce, Glasgow, J . Hedderwick & Co, 1811, p. 98. L'ouvrage est édité quatre ans plus tard en France et la référence au médecin français y est censurée (Nouveau voyage à Tunis publie' en 181! par M. Thomas Maggill, et traduit de l'anglais avec des notes par M...., Paris, C.L.F. Pancoucke, 1815,p. 106).

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Louis Frank, r e c o m m a n d e au bey par le consul français Devoize, ou bien de manière plus probable, l'influent Laurent G a y . Présent au palais beylical du Bardo, durant un quart de siècle, de 1788 à sa mort en 1823, a u p a r a \ a n t chef de l'hôpital de la C o m p a g n i e commerciale d'Afrique au comptoir de la Calle, Laurent Gay semble d'abord introduit auprès du principal wazir

du bey, le m a m e l o u k géorgien, M u s t a f a K h u j a dont il

soigne maisonnée et dépendants, des f e m m e s du harem aux simples clients 1 . Bénéficiant à partir de 1813, du prestigieux titre de « Premier médecin » du b e y 2 , il j o u e par la suite un rôle d'intermédiaire entre sa nation et la cour du Bardo. En 1814, il informe le consul Devoize des motifs de mécontentement du bey à son é g a r d 3 . A l'occasion du rachat général d ' e s c l a v e s sardes par médiation française, il o f f r e une boîte d ' o r enrichi de diamants au garde des sceaux du b e y 4 . Ses interventions ne lui nuisent pas, bien au contraire. A la fin de sa vie, M a h m u d Bey le traite avec la plus grand h o n n e u r : le bey « l'admettait à sa table lors m ê m e que ses f e m m e s y étaient présentes » 5 . Dans les années 1840-1850, c ' e s t un médecin juif livournais, A b r a h a m Lumbroso, qui tirera les bénéfices de sa proximité avec le réformateur A h m a d Bey. Il obtient d ' u n gouvernement français qui tente de le séduire, la Légion d ' h o n n e u r ; de la cité-Htat italienne d e Saint-Marin u n e r e p r é s e n t a t i o n c o n s u l a i r e en 1856 6 et du roi Victor E m m a n u e l II le titre de baron pour « services rendus aux Italiens » 7 . A sa suite, un autre médecin livournais, G i a c o m o Castelnuovo favorise, pour sa part, ses compatriotes négociants avec la régence, conclut un traité commercial avec l'Italie pour Sadiq Bey q u ' i l représente également en 1869 dans une commission internationale sur la dette tunisienne 8 . Mais A b r a h a m L u m b r o s o tout c o m m e Laurent Gay ne peuvent être réduits aux rôles d'auxiliaires des consuls. Ils savent se détacher d ' i n t é r ê t s nationaux, distinguer leurs fonctions d'intermédiaires diplomatiques de leur

' A N F , A E B I 1153 : Tunis 1788-1791, tome 30, f. 230 extrait d ' u n e « Pièce arabe contenant quelques chefs d'accusation contre le Consul et les réponses émargées de Sidy Moustapha Khodja, envoyées officiellement par ce ministre du Bey de Tunis à Monsieur de Fleurieu » et de la traduction de cette pièce. 2 A.-M. P l a n e l . o p . cit., p. 51 : ioir aussi E. Plantet, o/>. cit., p. 505, il est qualifié de « médecin du bey » dans une « liste des Français de Tunis » datée du 2 janvier 1813. 3

E. Plantet, op. cit., p. 522, Devoize à Talleyrand, Lazaret de Toulon, 5 septembre 1814.

4

A N F , A E Bill 3 0 4 : Régence de Tunis. Tabarka, la Galite, 1801-1846. Missions en Barbarie, 1815-1847. « Notice historique sur l'invasion de l'Isle de St-Pierre par les Tunisiens, la captivité des habitants qui tombèrent en leur pouvoir et leur affranchissement »,9 juillet 1819. 5

E. Plantet, op. cit., Malivoirc au Vicomte de Chateaubriand, Tunis, 30 avril 1823.

^ N. Gallagher, op. cit., p. 61. 7

E. Molco, « L ' A r t médical en Tunisie avant le protectorat », ¿ a Tunisie médicale, mai 1931, p. 186. 8 N. Gallagher, op. cit., p. 89 Cet auteur estime q u e C a s t e l n u o v o considérait la r é f o r m e médicale c o m m e une phase préliminaire de colonisation économique du beylik par l'Italie.

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charge de médecins. Comme le note Anne Marie Planel dans sa thèse sur la « nation » française dans le beylik de Tunis au XIX e siècle, Laurent Gay est « parmi les premiers à introduire dans la régence le principe de vaccination. 1 » Représentant attitré du bey Ahmad aux conseils des quarantaines, Abraham Lumbroso, pour sa part, parviendra à convaincre le prince (parfois plus que de raison) de la nécessité de se retirer et de s'isoler en temps d'épidémies 2 . Symbole de la reconnaissance d'une prééminence de la médecine européenne sur la médecine arabe, c'est ce juif livournais qui remplacera au début des années 1860, Vamin al-atibba'

dans l'attribution des licences médicales.

Abraham Lumbroso, contrairement à Vamin, ne fut pas chargé de nommer les médecins, « il délivr(ait) seulement des certificats de capacité 3 . » Seulement, cette transmission de charge, ce relais de prépondérance eut une portée considérable 4 : les hukama' commencèrent à être déclassés, considérés au pire comme des charlatans 5 , ou placés progressivement sous le vocable de « médecins tolérés », tandis que les praticiens d'une médecine européenne continuaient à s'enraciner dans la province de Tunis. Car les médecins de cour à Tunis ne sont plus des renégats, ni même des expatriés provisoires, le temps d'un court service auprès des beys de Tunis. Ils naissent dans le pays ou y forment des lignées de successeurs. Les cas sont nombreux, à commencer par Abraham Lumbroso et son collègue Giacomo Castelnuovo, tous deux issus de familles de juifs livournais, bien établies à Tunis 6 . Abraham Lumbroso n'a quitté la régence dans son adolescence qu'afin de mener à bien ses études à Florence avant d'être rappelé en 1835 par le bey Mustafa, en personne, pour soigner son fils Ahmad alors « bey du camp », successeur attitré, chargé de la collecte fiscale dans l'intérieur du pays 7 . Un autre médecin d'Ahmad, le Français César Clément, a suivi un début de trajectoire parallèle. Issu d'une famille fondée à Tunis en 1789, fortement liée à la cour beylicale puisque son frère François en était l'horloger « officiel », César Clément se forme initialement aux côtés du médecin du bey Lombard, séjourne un temps à Naples pour des études plus approfondies avant d'exercer

' A .-M. Planel, op. cit., p. 54. 2

N. Gallagher, op. cit., p. 46-48. J. Magnin, op. cit., p. 405.

4

B. Dinguizli, « Aperçu rétrospectif sur l'exercice de la profession médicale et de l'assistance médicale en Tunisie avant l'occupation française dans ce pays », La Tunisie médicale, mai 1931,p.182.

5 N. Gallagher, op. cit., p. 87 : « in losing the authority of the Muslim oram al-atibba', however, indigenous doctors were generally relegated to an inferior status often equated with that of quacks and charlatans ( . . . ) . »

°Ibid., 1

p. 89.

E. Molco, op. cit., p. 185-186.

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dans la proximité des beys A h m a d (+ en 1855), M u h a m m a d (+ en 1859) et alSadiq 1 . D e s E u r o p é e n s de l'unis sont allés j u s q u ' à é c h a f a u d e r d e s alliances familiales pour maintenir entre leurs m a i n s , au fil des générations, la charge d e m é d e c i n s au service des beys. D a n s la seconde moitié du X I X e siècle, Nicolas Vignale, petit-fils du ministre des affaires étrangères Joseph R a f f o , médecin du bey a l - S a d i q , m a r i e ses d e u x fils à d e s M a s c a r o , p l a c é s à la tête d ' u n e pharmacie prospère à T u n i s . Nicolas Vignale introduit, du m ê m e c o u p , auprès du b e y , un d e s c e n d a n t des M a s c a r o , J e a n B a p t i s t e , p o u r lui s u c c é d e r . C e M a s c a r o , à son t o u r , fait a g r é e r « c o m m e d e u x i è m e m é d e c i n d u bey », le d o c t e u r P r a t , un c o n c i t o y e n e s p a g n o l q u ' i l a é l e v é « p e n d a n t q u e l q u e s a n n é e s » et pour qui « il paya une partie (des) f r a i s d ' é t u d e s . » 2

L'insertion

dans une transformation

plus large du service

princier

Ces m o u v e m e n t s d ' e n r a c i n e m e n t d e la m é d e c i n e e u r o p é e n n e au cours du X I X e siècle, l ' i n t r o d u c t i o n à partir du X V I I I e siècle d e praticiens qui ne choisissent plus f o r c é m e n t la voie d e la c o n v e r s i o n pour s o i g n e r les beys et leurs entourage, s'insèreni dans une transformation plus large de la distribution des charges et fonctions aftérentes au service princier. Dans une configuration prégnante aux X V I I e et X V I I I e siècle, trouvant ses m o d è l e s aussi bien dans le cadre o t t o m a n q u e dans des héritages locaux (almohades puis hafsides) le service se répartissait schématiquement entre : — des e n f a n t s du pays, inscrits dès leur naissance dans des filiations et des solidarités locales, — et des d é p e n d a n t s issus d u d e h o r s , des aires c h r é t i e n n e s , s ' i n s é r a n t d a n s la p r o x i m i t é d e s beys par la c o n v e r s i o n , l ' a c c u l t u r a t i o n , u n e f o r m e d ' a d o p t i o n ou le lien matrimonial. Les p r e m i e r s se c h a r g e a i e n t d e f o n c t i o n s r e l i g i e u s e s ( c a d i s d e la m o s q u é e du palais n o t a m m e n t , juristes du droit m u s u l m a n ) et en lien avec c e dernier m i l i e u , ils se retrouvaient surtout dans les métiers d e la c h a n c e l l e r i e (lignées d e kuttab,

d e secrétaires lettrés), t a n d i s q u e la c o m p t a b i l i t é et les

gestions matérielles pouvaient revenir à des Juifs.

' A . - M . Planel, op. cit., p. 262 263. Au temps de M u h a m m a d al-Sadiq, César Clément se vit confier une mission diplomatique à la cour de Napoléon III (voir F. Lovy, « Notes sur la vie médicale à Tunis avant l'occupation », La Tunisie médicale, mai 1931. p. 209). 2 F. Lovy, op. cit., p. 212-214.

DIJ

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RENÉGAT

AU

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Les seconds, intimes de la personne beylicale, se voyaient confier des missions de confiance (garde du sceau, du trésor domestique 1 , des portes du palais), de représentation de leur maître (lieutenance 2 militaire ou fiscale, négociation diplomatique ou commerciale), de réparation des corps (médecins) et de procréation (concubines serviles des beys 3 ou époux mamelouks des princesses). A partir de la seconde moitié du XVIII e et surtout au XIX e siècle, le second groupe subit une double mutation. Par volonté d'un bey chef de famille et de clientèles, ce groupe de dépendants accroît son emprise sur une administration et une armée en expansion tout en perdant certaines attributions (médecine, encadrement militaire, médiations diplomatique ou commerciale) qui s'exercent de moins en moins à travers le critère d'intimité avec les beys et beaucoup plus à travers celui de la compétence technique ou scientifique. Les mamelouks sont placés à des positions d'encadrement (ministres, gouverneurs, généraux). Ces fonctions se formalisent, se hiérarchisent avec le mouvement des réformes à partir du début des années 1830 et surtout du règne du bey Ahmad. Selon la volonté personnelle des souverains et les relations qu'ils entretiennent avec le monde occidental, ces mamelouks ont alors tendance à encourager les réformes modernisatrices de l'appareil étatique, mais le plus souvent, ils n'en maîtrisent pas les processus d'installation. Les instructeurs d'armée, médecins de cour, enseignants de l'école militaire du Bardo issus des nations européennes, dominant initialement ces savoirs, consolident leur place dans l'entourage des beys et rendent ces derniers plus dépendants encore de leurs compétences et des consuls qui en négocient la diffusion à Tunis et parfois le maintien. Plus largement encore, l'apparition et le maintien de serviteurs - et notamment de médecins - restés chrétiens ou juifs dans l'entourage des beys, est un des traits révélateurs de la transformation des relations entre tenants du pouvoir et sujets du beylik. Au cours du XIX e siècle, ces beys qui concèdent une place croissante aux Européens, apparaissent de moins en moins comme des maîtres à même de défendre leur population ou a fortiori de les entraîner dans des luttes contre l'ennemi chrétien, avec la fin de la course, le renforcement des pressions occidentales et l'occupation de la province voisine d'Alger. Dans la seconde moitié du siècle, des citadins fragilisés par la crise financière et la crise d'un artisanat concurrencé par les industries européennes, s'orientent vers le fonctionnariat 4 . Les « enfants du pays » participent à une ' Respectivement sahib al-thabi ' et khaznadar. Kahiya. 3 Jariyâ. 4 M.A. Ben Achour, Catégories de la société tunisoise dans la deuxième moitié du XIXe Les élites musulmanes, Tunis, INAA, 1989, p. 296-298. 2

siècle.

82

M ' H A M ED

Oli A L D I

compétition plus ou moins vive pour entrer au service des beys. Ce n ' e s t guère le groupe limité et éloigné des médecins de cour que ciblent alors mécontentements et frustrations des populations, notamment lors de la révolte de 1864, mais - semble-t il, si l'on suit la correspondance consulaire française - les mamelouks monopolisant les principales fonctions et les juifs qui ont bénéficié d ' u n e amélioration de leur sort à partir du Pacte fondamental de 1 8 5 7 1 . Les m é d e c i n s e u r o p é e n s , pour leur p a r t , m a i n t i e n n e n t ,

sans

c o n t e s t a t i o n , leur p r é p o n d é r a n c e a u p r è s des beys, encore au début du protectorat. Les mutations d'identité des médecins de cour relèvent donc de deux questions fortement liées l'une à l'autre : d ' u n e part, les modalités de contrôle des savoirs par un pouvoir provincial ottoman ; de l'autre, les transformations du lien de dépendance entre les beys et ceux qui acceptaient de rentrer à leur service. A partir du X V I L siècle j u s q u ' à la seconde moitié du XVIII e siècle, dans des sociétés de frontières et dans le contexte des guerres d e course, les deys puis les beys parviennent généralement à contrôler les hommes porteurs de savoirs médicaux. C ' e s t durant cette période que l'on parvient à repérer les profils de médecins captifs, convertis ou mamelouks. Ces profils n'excluent pas parallèlement le recours à des médecins européens aux termes de tractations diplomatiques. Mais ces procédures quasi-contractuelles ne semblent revêtir une importance politique q u ' à partir du milieu du XVIII e siècle. Dès lors, c o m m e n c e à s ' a f f i r m e r dans l ' e n t o u r a g e des beys, une prépondérance des médecins européens (italiens puis français) sur les praticiens locaux musulmans et juiis. Ces nouveaux venus n ' o n t pas à se convertir. Ils maintiennent une forte relation avec leurs pays d'origine et exercent leur métier dans un cadre négocié. Les liens avec les princes qu'ils soignent, se transforment. Leurs relations s'inscrivent beaucoup moins dans la sphère de la dépendance. En parvenant à mettre en valeur leurs compétences, en jouant parfois le rôle de médiateurs diplomatiques, ces médecins d'origine européenne affirment leurs positions dans la maison beylicale et c o n t r i b u e n t à asseoir

la

prépondérance d'une expertise étrangère dans un milieu princier, ouvrant, par là m ê m e , la voie à une prépondérance politique européenne. Parallèlement, ils entraînent - aux côtés d'instructeurs militaires, de traducteurs occidentaux - une redéfinition du rôle des serviteurs les plus dépendants (renégats et mamelouks) contraints à concéder, avec l'expansion de l'appareil administratif et militaire, plus de places aux agents libres, qu'ils soient des « enfants du pays » ou des Européens.

' J. Ganiage, Les Origines du Protectorat français en Tunisie (1861-1881), Paris, P U F , 1959, p. 218-230. Son contenu renvoie au khatt-i humâyûn (voir G.S.Van Krieken, Khayr al-Din et la Tunisie (1850-1881), Leiden, F..I. Brill, 1976, p. 6).

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83

Cependant, s'ils semblent moins dépendants, ces médecins de cour ne peuvent non plus être perçus comme pleinement autonomes. Leurs employeurs parviennent à les attacher à leur personne et à leurs proches en leur accordant titres, privilèges et rétributions confortables. De manière plus notable, au cours du XIX e siècle, ces médecins s'ancrent socialement dans la régence. Ils font souche. Certains y naissent et y reviennent après des études en Europe. Ils peuvent fonder des lignées, chercher à placer leurs descendants auprès de la famille beylicale. Une dernière évolution est peut être plus déterminante : on peut en effet se demander, au terme de ce parcours, si l'affirmation croissante d'un contrôle français sur la régence de Tunis n'a pas réduit les marges d'action de ces médecins placés aux contacts des beys. Les autorités qui ont préparé puis mis en place les institutions du Proctectorat, ont certainement été très vigilantes sur les qualités des serviteurs de beys placés sous tutelle à partir de 1881.

DARWINIAN CONVERSIONS: SCIENCE AND TRANSLATION IN LATE OTTOMAN EGYPT AND GREATER SYRIA MarwaELSHAKRY*

The translation of Darwin's ideas in the late nineteenth century Arabic press raises a number of questions about how we should read Western science in non-Western contexts. All too often the 'spread of Western science' to the extra-European world has been dcpicted in terms of a relatively straightforward transmission of knowledge—whole-sale and unmediated—from metropole to periphery. One early historian even referred to a 'three-stage model' that was said to describe 'the introduction of modern science into any non-European nation' (emphasis mine). 1 Needless to say, such a schema paid little attention to the broader socio-cultural or political context or to the ways in which imported scientific ideas interacted with prevailing modes of thought. This model has since largely been challenged by historians of science. 2 For the movement of science across borders entailed, after all, both a re-negotiation of pre-existing categories of knowledge and a reworking of cultural and social authority. Much of the literature on the 'transfer of modern science' to the Ottoman and wider Muslim world, however, has not taken this into account and is still largely bound up with older modernisation-theory paradigms. Thus the exiguous literature on Darwin's reception in the Arab world has misleadingly portrayed a struggle between his 'secularist' adherents and his 'traditionalist' opponents. In this way, the existing epistemological and religious landscape is relegated to the realm of 'tradition,' while science is equated with the cause of secularism and thereby modernisation itself. 3 *

Associate Professor of History of Science, Harvard University.

George Basalla, ' T h e Spread of Western Science: A Three-Stage Model Describes the Introduction of Modern Science into Any Non-European Nation,' Science 156 (1967): 611-622. B a s a l l a ' s model w a s heavily i n f l u e n c e d by C o l d W a r ideologies of d e v e l o p m e n t and modernisation. His three-stage model, for instance, follows along the lines of Walter R o s t o w ' s The Stages of Growth: An Anti-Communist Manifesto (Cambridge, 1960). 2 See: Warwick Anderson, 'Postcolonial Technoscience,' Social Studies of Science 32 (2002): 643-658. 3 Adel Z i a d e t ' s thorough and otherwise thoughtful Western Science in the Arab World: The Impact of Darwinism, 1860-1930 (Hong Kong, 1986), for instance, organizes the discussion around the 'secularist Christian,' 'traditionalist Christian' and 'Islamist' views of the authors in q u e s t i o n . See also: N a j m B e z i r j a n , ' T h e I s l a m i c W o r l d , ' in T h o m a s Glick (ed.) The Comparative Reception of Darwinism (Chicago, 1988): 375-387.

86

M A R W A

H l . S H A K R Y

Yet in the Arab world, as elsewhere, Darwin's ideas rarely met with either wholesale acceptance or wholesale rejection; they were often used selectively and reworked for or against particular understandings of science and its relation to religion (and politics). In fact, few used Darwin to cast doubt on religious faith; many more used his ideas to emphasize the modernity of their beliefs. Both committed Muslims and Christians debated the implications of these ideas and engaged in shared discussions of their connection to older notions of transmutation or their repercussions for the rise and fall of civilizations. In this setting, Darwin's Arabic translators and readers both mediated between communities and categories of knowledge and brought new ones into being. This paper explores some facets of that process.

Darwin's Arabic

Readers

While discussions of the transmission and popularisation of scientific thought in the European case have tended to take for granted the conditions of industrialized societies—mass literacy, popular print culture and the emergence of professional scientific communities—conditions were very different in the Arab world. The print revolution of Western Europe, for example, made possible a widespread circulation of ideas among the lettered-classes from at least the seventeenth century onwards; in the Arab world, this process began much later and was of a considerably different character. Starting in Egypt, the print revolution and widespread translation movement that contemporaries hailed as their Renaissance or Nahda began, essentially, as part of Mehmet 'Ali's nizam-i jedid) Whereas the rise in literacy rates in nineteenth century Western Europe, moreover, led to the mass popularisation of science, in the Arab world, low literacy rates meant that scientific works circulated among a more restricted class of readers.2 Readers were, on the whole, drawn neither from the traditional scholarly classes (the 'ulama) nor from the masses but chiefly from the civil service and the political and literary élite- a new educated class that preserved close links with journalists, newspaper proprietors and state-officials and whose appearance helped alter the geo-political and epistemologica! landscape of the late Ottoman Arab world.

' See: J . Heyworthe Dunne, Printing and Translation under Muhammad 'Ali of Egypt: The Foundation of Modern Arabic,' Journal of the Royal Asiatic Society (1940): 3 2 5 - 3 4 9 ; Ami Ayalon, The Press in the Arab Middle East: A History (New York, 1995). 2 While in England, adult literacy rates were as high as 95% by 1900, in Egypt—to take but one example—it was estimated to have been a mere 5.8% by 1897. (Of course, urban areas had much higher literacy rates than rural ones—21.6% and 19% are the figure quoted among adult males in Cairo and Alexandria, for instance.) British literacy rates from Carlton J . Hayes, A Generation of Materialism: 1871-1900 (New York, 1941): 174-5; Egypt from Ami Ayalon, The Press in the Arab Middle East. 144. It should be noted, however, that literacy rates in the late nineteenth century Middle East are difficult to calculate and highly uncertain, and therefore estimates vary widely.

DARWINIAN

CONVKRSIONS

87

While Darwin's ideas thus circulated chiefly through newspapers and journals whose readership rarely surpassed several thousand at most, this community of readers was nevertheless significant for the way in which it helped create new intellectual networks. Emerging in the commercial centers—Beirut, Alexandria and Cairo—these journals drew in readers across the confessional, social and geographic divides of the Empire (and beyond). Al-Muqtataf,

for instance, a 'journal of science and industry' founded by

Syrian Protestant College tutors and American mission acolytes Ya'qub Sarruf and Farris Nimr, was read as far afield as Tehran, Baghdad, Buenos Aires and New York. And when, in 1877, the journal became embroiled in a series of acrimonious debates with the Archimandrite of Antioch over its publications on astronomy, it was supported by 'Abdallah al-Fikri, a Muslim astronomer in the service of Riaz Pasha, the then Egyptian Minister of Education. In response to the Archimandrite's claims that Sarruf and Nimr's publications on the heliocentric nature of the heavens went against both scripture and good sense, al-Fikri backed the editors—and insisted on the harmony of the 'new astronomy' with shari'aHere,

in other words, was a Muslim civil servant

in Egypt coming to the public defense of the editors of a Syrian mission journal against a local Christian cleric. It is hard to conceive of a more vivid illustration of the way science and the press were between them transforming and redefining the epistemological communities of Ottoman society. Al-Muqtataf

itself was also undoubtedly the single most important vehicle

for the translation and popularisation of Darwin—nearly every issue of the long-lived journal (it was published in Beirut from 1876 to 1884 and then in Egypt until the revolutionary days of 1952) featured some reference to him or to the new evolutionary science—which is why although Darwin's Origin of Species

was not fully translated until well into the twentieth century, his

ideas were generally debated from the 1870s onward. 2 Later, Jurji Zaydan's Al-Hilal

would also prove important, as would a host of other shorter-lived

journals and papers, such as the American mission press medical journal AlTabib

and Shibli S h u m a y y i l ' s medical monthly Al-Shifa',

Protestant College paper, Al-Nashra Bashir and the journal Al-Mashriq,

Al-Usbu'iyya,

the Syrian

the Jesuit paper Al-

and, later, Salama Musa's

Even Rashid Rida's well-known religious monthly, Al-Manar,

Al-Mustaqbal. referenced the

'Thabut al-ard wa raddat ilayna hadha al-risalaAl-Muqtataf 1 (1876): 265-270; and 'al'Ulumal-tabi'ayya wa'l-nusus al-shari'a',' Al-Muqtataf 1 (1876): 217-220, this was also printed in full in the Ministry of Education's official gazette, Rawdat Al-Madaris, as: 'Risala ft muqarinatba'dmubahilh al-hay'a bi'l-waridfi nusus al-shari'a' 7:5 (1876): 2-23. The first six chapters of The Origin of Species were not published until 1918, translated by lsm'ail Mazhar as Asl al-anwa' wa nushu'iha bi'l-intikhab al-tabi'a wa hifi al-sufuf al-ghalib fi al'tanahur 'ala al-baqa' (Cairo, 1918). Mazhar added four more chapters in 1928; while the complete work did not appear until 1964.

88

M A R W A

E L S H A K R Y

n e w the n e w e v o l u t i o n a r y theory f r o m t i m e to t i m e . In short, D a r w i n and Darwinian ideas were very much a part of the late Ottoman Arabic press s c e n e , and much o f the Nahda

literature can be m i n e d for references not only to the

late Victorian scientist but to others, s u c h as S p e n c e r , H u x l e y , Biichner and H a e c k e l . A f t e r all, with little or n o laboratory s c i e n c e to speak o f b e f o r e the early twentieth century , much of this interest in the new b i o l o g y c o n c e r n e d its application to q u e s t i o n s of s o c i e t y or politics. In this s e n s e , S p e n c e r w a s at least as important as D a r w i n , and ' D a r w i n i s m ' b e c a m e m o r e and m o r e an 'arena f o r public d i s c u s s i o n ' in w h i c h D a r w i n h i m s e l f p l a y e d a d i m i n i s h i n g role.' W h e n publishing on this range o f i s s u e s , these journals relied not o n l y o n the o r i g i n a l w o r k s o f the a u t h o r s in q u e s t i o n , but a l s o o n s u m m a r i e s and c o m m e n t a r i e s . Al-Muqtataf,

popular

for i n s t a n c e , w h o s e v e r y n a m e

w a s ' T h e D i g e s t , ' t y p i c a l l y d r e w o n material f r o m British and A m e r i c a n journals s u c h as Scientific Century,

American,

Popular

and n e w s p a p e r s such as the Times?

Science

Monthly,

Nineteenth

E v e n in c a s e s w h e r e original

texts or b o o k s w e r e translated in their entirety, the actual translation o f t e n e l i c i t e d l e s s reaction than the translator's o w n p r é c i s . W h e n the radical m a t e r i a l i s t S h i b l i S h u m a y y i l , f o r i n s t a n c e , translated B i i c h n e r ' s

Sechs

Vorlesungen

Arten

iiber die Darwin

und die erste

Entstehung

der

'sche Theorie Organismenwelt

von der Verwandlung

der

| f r o m the French ¡1 in 1 8 8 4 ,

m o s t of the responses to it w e r e directed to S h u m a y y i l ' s 2 4 - p a g e introduction and not the actual 163 page translation. 3 T h u s w h e n the Sufi s c h o l a r and educational reformer H u s a y n al-Jisr w r o t e o n D a r w i n in his 1 8 8 7 Kitab risala

al-hamidiyya

al-muhammidiyya,

fi-haqiqat

al-diyana

al-islamiyya

wa haqiqat

al-

al-shari'a

he clearly based it on S h u m a y y i l ' s introduction. H e n e v e r ,

as far as w e can tell, read D a r w i n ' s original works (in any language).

James Secord, Victorian Sensation: The Extraordinary Publication, Reception and Secret Authorship of Vestiges of the Natural History of Creation (Chicago, 2000): 520. Indeed, as Adel Ziadat has pointed out, in the case of the Àrab world, 'Darwin became a minor figure in the movement called Darwinism.' Adel Ziadat, Western Science in the Arab World, 23. ^ For a complete list of Sarrut and Nimr's sources, see Nadia Farag, 'Al-Muqtataf, 1876-1900: A Study of the Influence of Victorian Thought on Modern Arabic Thought,' University of Oxford D.Phil. Thesis, 1969: 119-131. 3 Shumayyil based his translation on Auguste Jacquof s Conférences sur la théorie darwinienne de la transmutation des espèces et de l'apparition du monde organique et application de cette théorie à l'homme (Leipzig, 1879). published as: Ta'rib li sharh Bukhnir 'ala madhab Darwin ft intiqal al-'anwa' wa zuhur a-'ulam al-'udwi wa-itilaq dhalika 'alaal-insan (Alexandria, 1884).

D A R W I N I A N Science

in

89

C O N V E R S I O N S

Translation

Understanding how Darwin's ideas were translated—in the broader sense of the term—makes little sense without attending to the ways in which this process formed part of a larger shift in local understandings of knowledge itself. 1 For it was only by the late nineteenth century that 'ilm—the

broadest

word in Arabic for knowledge—came to encompass Western notions of 'science.' Originally its meaning had been quite different. In the classical lexicon 'ilm represented a broad categorisation of knowledge which could in fact encompass both revealed and acquired knowledge in one unified system of meaning. 2 Until the nineteenth century, moreover, it was the

'ulama

who, by

and large, had presided over its transmission and elaboration. With the opening of civil and technical schools in Egypt under Mehmet 'Ali, however, and continuing elsewhere in the Ottoman Empire during the period of the Tanzimat

reforms, these older communities and categories of knowledge came

under challenge from new Western-inspired disciplines and institutions. The growing popularity of new schools, the spread of 'student missions' abroad and the influx of foreign-trained technical advisors and instructors—along with the inroads made by increasing numbers of European and American Christian missionaries armed with treatises on natural theology and science—meant that Arab literati quickly became familiar with categories and notions of Western science. Rifa'a Rafi' al-Tahtawi, for instance, a religious scholar who embarked on Egypt's first educational 'mission' to France under Mehmet 'Ali, wrote at length about what he understood to be the classification of knowledge in the French educational system. 'Know that the French divide human knowledge into two sections,' he wrote in 1834, 'the sciences and the arts. The sciences consist of verified facts established by certain proofs, whereas art is the knowledge of techniques... But with us, the sciences and arts are often the same thing.' For Tahtawi, the French educational categories of his time— 'the elaborate classification by the French sages' —seemed unfamiliar. 'He who is said to be an

'alim

is one who has

knowledge of the rational sciences...Thus when they say one is an

'alim

in

France, they do not mean that he is well versed in his religion, but that he has knowledge of some other subject.' 3

On the work of translation in its broader sense, see: Lydia Liu (ed.), Tokens of Exchange: Problem of Translation in Global Circulations (Durham, 1999).

The

See: D. B. Macdonald, 'Ilm,' Encyclopaedia of Islam; Franz Rosenthal, 'Muslim Definitions of Knowledge,' in Carl Leiden (ed.) The Conflict of Traditionalism and Modernism in the Middle East (Austin, 1966): 117. 3 Rifa'a Rafi' al-Tahtawi, Takhlis al-ibriz fi talkhis Bariz (Cairo, 1834), translated as L'or de Paris: relation de voyage, 1826-1831, by Anouar Louca (Paris, 1988): 187-188 and 269-270; see Arabic reprint (Beirut, 2002): 180 and 245-246.

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MAkWA

ELSHAKRY

It was not long before what it meant to be an 'alim changed in the Ottoman Empire itself, f o r over the course of the long nineteenth century, the 'ulama

would come to he increasingly supplanted by the new class of civil

servants, educators and journalists who had immersed themselves in the new subjects of knowledge, or al-'ulum

al-haditha.

It was in this context of

contested categories and communities of knowledge that ideas of evolution were first encountered by the Arabic-reading public. In fact, the first official religious protest over Darwin's ideas in the Arab world was the result of a long reflection on the nature of knowledge by a Beirut missionary educator. In the annual graduating speech of the American Syrian Protestant College, delivered in the summer of 1882 in Arabic under the title 'at-'ilm

al-ma'rifa

wa'l-hikma'

[Science, Knowledge and Wisdom],

Edwin Lewis, an instructor of chemistry and geology at the College, provided a narrowing of the definition of 'ilm that would have seemed unfamiliar to most Arabic men of letters of the time. Knowledge, or ma'arifa,

explained

Lewis, was concerned with observable facts about the known-world, whereas science— 'ilm— both built upon this and constituted a much-higher order of being in that it involved itself with the derivation of universal laws and postulates through experimental study and 'long and careful examination.' To illustrate the point, Lewis described how Pasteur, Koch, Lyell and Darwin each served as examples of contemporary scientific achievement and greatness through this 'transformation of knowledge into science.' Lewis was, of course, familiar with Darwin's controversial status, and so he ended by stressing the unique and unrivaled nature of wisdom or hikma' (by which he meant divinely-ordained truth.) As he put it, 'through science man may know something about the existence of God, the Cause of all Causes, but he fails to apprehend who and what God i s ' — f o r ' n o telescope will show us God; no microscope will show us the soul of man, and no chemistry will disclose the secrets of life.' 1 In this way, he defined 'ilm in positivist terms, as something equivalent to the English 'science,' and as something completely separate from knowledge of God, or wisdom. Senior colleagues and administrators, however, failing to appreciate the distinction, found his praise of Darwin deeply suspect. Amidst much uproar on campus and beyond they lobbied for Lewis' dismissal—an incident which has since been recalled as 'the crisis of I882.' 2

' Lewis' speech was later reprinted in kl-Muqlatafl

2

(1882): 158-167.

See: Shafiq Juha, Darwin mi azmal IHS2 bi'l-da'irat al-tibiyya wa'l-awal thawra tulabiyya fi ul-'alam al-'arabi bi'l-kulliya al-suriya al-'arabi (Beirut, 1991).

D A R W I N I A N

91

C O N V E R S I O N S

The crisis proved significant in a number of ways, not least for the effect it had on Al-Muqtataf.

The editors, Sarruf and Nimr, disappointed by

the way the college had handled matters, moved from Beirut in 1884 and the following year re-launched their journal under the relatively liberal press laws of British-occupied Egypt. From there, they railed against those who were 'fanatical against some of the sciences taught in their institutions,' rallied much more openly than they had before in favour of Darwin, and began—like Lewis—to define Him, or 'science' in positivist terms. In fact,

Al-Muqtataf

had embarked on a highly ambitious and influential project of translation in both a semantic and semiotic sense: they not only translated novel concepts and coined their own terminology but also helped impart a new cultural understanding of categories of knowledge and science. This required considerable conceptual as well as stylistic inventiveness. In their efforts to translate new ideas, Sarruf and Nimr introduced a great deal of modern scientific terminology into Arabic. 'New discoveries in science and technology require new terminology,' they noted when they first introduced their column on technical terms translated from English, French and Latin, or mu'aribat,

later a staple item in the journal. 1 Al-Muqtataf

was one of the

first journals to systematically describe the new scientific instruments, such as al-mikroskob jiyolojiyya.

or al-tiliskob,

and disciplines- al-baleontolojiyya

They were also the first to use the term 'madhab

describe 'Darwinism,' deploying the term madhab—which referred to one of the orthodox schools of fiqh—to

or al-

Darwin'

to

traditionally

impart a sense of its

standing as a new school of thought. The journal was also one of the first of its kind to deploy a 'scientific' or 'telegraphic' prose style in Arabic and to help overthrow the more traditional classical or neo-classical rival in popular writing of the time. 2 As its editors later wrote, a newspaper 'must be written in a language at once comprehensible to the simple people and acceptable to the educated. We shall

1

'Al-Mu'arlbat,'

Al-Muqtataf

8 (1883):

107.

See: ' T a b a q a t al-kuttab,' Majallat Sarkis 13 (1910): 2 5 3 - 2 5 9 , w h i c h classified Y a ' q u b S a r r u f ' s style as 'scientific,' and Farris N i m r ' s as 'journalistic;' Nadia Farag, ' A l - M u q t a t a f , ' 92; and S a l a m a M u s a , Tarbiyyat Salama Musa (Cairo, 1947), trans. L . O . S c h u m a n , The Education of Salama Musa (Leiden, 1961). 38, which describes Sarruf's style as 'telegraphic.' Many Arabic writers even looked to the new sciences as a means of revitalising Arabic literary styles; Salama M u s a , f o r instance, wrote: 'There is no doubt that my strong sympathy f o r Darwin and my predilection f o r the theory of evolution have left their traces in my style of w r i t i n g . . . I do prefer D a r w i n ' s style, because of its relentless logic a n d its caution and measure.' Salama Musa, Tarbiyyat Salama Musa, 81. See, also: M . H . ' A b d al-Raziq, 'Arabic Literature Since the Beginning of the Nineteenth Century,' Bulletin of the School of Oriental Studies 2 (1922): 249-265; and Sasson S o m e k h , ' T h e Emergence of T w o Sets of Stylistic Norms: In the Early Literary Translation into Modern Arabic Prose,' Poetics Today 2 (1981): 193-200.

92

M A R W A

E L S H A K R Y

therefore seek to select correct and familiar w o r d s , simple phrases and uncomplicated expressions.' 1 T h e need to use 'familiar' concepts where possible meant that at the same time as the editors introduced new scientific terms and ideas into Arabic, so they stressed their connection to older forms. The effective popularisation of D a r w i n ' s ideas, after all, depended on being able to recast them in more familiar modes. T h e notion of evolution itself they sometimes described as 'an old idea': both ancient (¡reek and medieval Arab philosophers, they suggested, had come to similar conclusions. 2 This kind of appropriation struck a chord with the j o u r n a l ' s readers—the editors received scores of letters on the subject—and many later A r a b thinkers would replicate and develop more elaborately this line of argument. 3 The editors of Al-Muqtataf

themselves however quickly grew weary of

this kind of approach: in response to a reader's question in 1887, for instance, ' W a s D a r w i n ' s theory known among the Arabs and Persians?,' the editors replied curtly: ' D a r w i n ' s theory, meaning the transformation of species by natural selection, was not known among the Arabs or Persians or anyone else, otherwise scientists today would not have ascribed this theory to h i m . ' 4 The editors had initial!}

highlighted

s u c h a g e n e a l o g y to give

Darwin

respectability, and to defend him against those who ridiculed him for claiming that man was descended f r o m monkeys. T h e y never, however, engaged in a systematic comparison of his theories with older notions of transmutation, preferring in most cases to stress the novelty rather than the antiquity of contemporary scientific concepts. (If they made any sustained attempt to construct an older philosophical tradition for current thought, they looked to the ancient Greeks, a genealogy which, rather than that of medieval Muslim thought, for them constituted part of Western modernity.) Nevertheless, for others in the A r a b world, as e l s e w h e r e , it was precisely this f o r m of genealogical re-creation that allowed for the epistemological—and moral— legitimation of both modern evolutionary ideas and traditional cosmologies. 5 Whether new or old, the search for equivalences—and the indeterminate nature of newly translated concepts—meant that some terms could be rendered in any of a number of ways, with each carrying a slightly different shade of meaning and bringing with it new styles of reasoning and new ways of ' Quote f r o m : Ami A y a l o r . The Press in the Arab Middle East, 180 (citing AI-Muqattam 1889). 2 'Al-Madhab al-Darwini.' M-Muqtata.fi (1882): 33. 3 See, for instance: ' M a d h a h Darwin 'and alaqadimin,' Al-Muqtataf 10 (1885): 145-146. 4 'Masa'it wa ajwabatha,' Al-Muqtataf 14(1887): 359.

in

Cf. Dhruv Raina and Irfiiii Habib, 'The Moral Legitimation of Modern Science: Bhadralok Reflections on Theories of Kvolution' Social Studies of Science 26 (1996): 9-42.

DARWINIAN

CONVERSIONS

93

t h i n k i n g . 1 Shibli S h u m a y y i l , for instance, described his new school of materialism as al-madhab

al-madi,

deploying the term al-madiyya

materialism rather than rely on an al-dahriyya,

for

with its long-standing

connotation of irreligiosity and unbelief. (Muhammad ' A b d u h , by contrast, in his translation of A f g h a n i ' s Haqiqat-i

mazhabi-i

naichiriyan

and al-maddiyya

used the terms al-dahriyya

naichiri

va bayan-i

interchangeably. 2 )

T h e concept of ' e v o l u t i o n ' itself was variously referred to as tatawwur,

hal-i

tasalsala,

nushu' or irtiqa': the former implying descent (literally, 'to follow

in a chain'); the second, development; and the latter two meaning growth and ascent respectively, and both implying 'progress.' S h u m a y y i l ' s phrase 'almadhab al-nushu' wa'l-iritiqa'

(the school of evolution and progress) added a

completely new layer of meaning by giving the term a teleological and politicised character.

Darwinian

Conversions,

Ottoman

Scripts

The coming of D a r w i n ' s thought to the A r a b East coincided with the intensification of imperial rivalries, the loss of Ottoman territories and the onset of the scramble for Africa. It is not surprising therefore that the debate prompted by his ideas was overshadowed by geopolitical considerations: France, Britain and Russia were all rising imperial powers, while the A r a b East felt at first hand the impact of Ottoman territorial losses and experienced the humiliation of E g y p t ' s occupation by the British in 1882. Understanding Darwin, for some, was seen as a key to social and political revival, and his popularisers adopted the idea of a struggle for survival in an effort to explain the rise and fall of civilizations in the past, and to demonstrate his utility to the Arab world in the future. They used their faith in the new evolutionary science as a means of critiquing the political order of the day, whether to rail against Ottoman despotism or to call for a new future of liberal

laissez-faire

economy and polity. Shibli Shumayil, for instance, called for the need to restructure A r a b society and politics along 'natural lines' and advocated social reforms on the basis of what he described as 'proven, natural scientific laws.' He demanded that curricula consist only of natural science, called f o r a new religion of humanity \al-din al-bashariyya\,

and advocated quasi-socialist economic

C f . Ian Hacking, ' L a n g u a g e , Truth and Reason,' in Martin Hollis and Steven Lukes (ed.) Rationality and Relativism (Cambridge, 1982): 60-61. Translated as Radd (Cairo, 1320 A.H.).

'ala at-dahriyyin

by M u h a m m a d ' A b d u h and 'Arif Effendi A b u T a r i b

94

M A R W A

K L S H A K R Y

reforms along the lines of a 'natural social economy.' 1 Sarruf and Nimr, meanwhile, pursued a more liberal, laissez-faire

line. Through

and their controversial Cairo paper Al-Muqattam

| which may have had some

Al-Muqtataf

British-backing | they also proposed a rather unpopular explanation for the British-occupation of Kgypt, claiming it was a law of nature that the strong overtake the weak, and justifying the occupation on the grounds that the British were helping to restore order to Egypt, 'working to perfect the country's irrigation, organise its army, and improve public discipline.' 2 Needless to say, such opinions won them few friends, and made many suspicious of their promotion of Western science. In a letter sent to the editors in 1905, one reader criticised their predilection for including biographies of British scientists like Darwin, claiming it was another example of their 'exaggerated love of all things British.' 3 So strongly in fact did Darwin's name become linked with the British that when in 1899 Muhammad 'Abduh was appointed Grand Mufti, his opponents similarly used his enthusiasm for Darwin and Spencer to detract from his reputation. 'Abduh was a devoted fan of Spencer in particular: he translated his work On Education from the French and he even visited him in Brighton; he also frequently referred to Darwin's ideas in his lectures at AlAzhar.

'Abduh's persistent attempts to revise the Azhar

curriculum, his

interest in Western philosophy and science, and his enthusiasm for Darwinian thought could, for his critics, scarcely be disentangled from allegations of his close and treacherous associations with the British. 'I wonder why the English government has not honoured his Excellency the Professor with the title of Sir or Mister,' one satirical journalist wrote in a piecc entitled 'al-Mister Muhammad Al-Babaghallo

'Abduh'

published in the 1904 issue of the 'Egyptian Parrot,'

Al-Misri. i f you asked him to perform a marriage contract,'

ran the article, 'he would no doubt write it according to the madhab

of

Darwin.' 4 In this setting, understanding Darwin independently of politics becomes almost impossible. Darwinian conversions, such as those of Sarruf, Nimr, and Shumayyil, were as much a means of discoursing about politics in the late Hamidian Empire as they were a way of investigating the natural order of things. In fact, translators and readers of science increasingly looked to the 1

2 3

Shibli Shumayyil,Falsctfatet-i Fünün. 3 2 6 , 2 9 Mayis 1313/ l O J u n e 1897, pp. 210-211. 4 " C o m p t e s - R e n d u s de la Société Impériale de M é d e c i n e , Séance du 4 Juin 1897: C a s d'Actualité", Gazetle Médicale d'Orient, 42 (8), 15 Juin 1897, pp: 120-121. 5

lkdam.

6

" M e r h u m Esad Feyzi Bey". Sevsal-i

7

No. 1016, 18 May 1S97. Afiyet, ed: Besim Omer, Istanbul, 1902, p: 721

Kiittner, H. " U e b e r die Bedetung der R o e n t g e n s t r a h l e n f ü r die K r i e g s c h i r u r g i e , nach E r f a c h r u n g e n im griechisch-türkischen Krieg 1897". Beiträge zur Klinischen Chirurgie. Tubingen. 1898,20:1:167-23(1. there are also ten Roentgen films in the end of the report.

M E D I C A L

M O D E R N I Z A T I O N

115

Chalcis and Phalerum. Cases reported at Lancet in 18991 by Dr. Abbott have been described as the first application of X-rays in surgery in Greece. 2

A Pioneering book of clinical radiology After his graduation in December 1897, Capt. Dr. Esad Feyzi was appointed as a lecturer in physics at the (Military) Medical School; and also in geology and mineralogy at the Civilian Medical School, in Istanbul. He mainly worked at the Roentgen laboratory within the surgical department. His second book, Roentgen Rays, their Medical and Surgical Applications in 1898, remained as a manuscript and was not published. This is the first work ever written in Turkey on the X-ray radiography method and was one of the first examples in the world. In its foreword, Surg.Dr. Cemil Pasha emphasizes the function of the book, relates the early practices of radiography at the Istanbul School of Medicine and draws attention to the necessity of establishing radiological wards at hospitals. The author describes his two years of experiments in Roentgen rays and the technical aspects of radiography technique. He notes that radiography and radioscopy methods were used successfully in miltary surgery by Turkish physicians during the TurkishGreek war in 1897, but that this was overlooked by the international medical literature since no statistical data had been kept. The book includes many pictures of upper and lower extremities most probably drawn by Esad Feyzi himself, and is supplemented with the photographs of 12 Roentgen films in original dimensions 3 . The next year he published a long article on the same subject in Nevsal-i Afiyet (Yearbook of Health), an esteemed popular medical periodical of the time, and described surgical cases treated by Surg. Dr. Cemil Pasa at the surgical ward of the Medical School, such as the extract of a metal coin from the stomach of a child, which was dealt with in just a few minutes successfully, due to the radiological screening technique 4 . With his lectures, he established radiological examination as an integral branch of the surgical ward at the turn of the 20 th century. When he died unexpectedly due to erysipelas in 1902, his third book, The Coursebook of Physics for third-year ' Abbott FC. "Surgery in the Greco-Turkish War", The Lancet, No.20, 1899, pp: 14 80-81jNo.21,1899,152-156. Livadas G. "The first medical radiographics in Greece", Hellenic Radiology, Athens 1995 26:347-348.

•i

It is bound with red leather cover and gilded embroidery, contains 176 pages: Esad Feyzi. Roentgen §u'd'ati ve Tatbikat-i Tibbiye ve Cerrahiyesi (Roentgen Rays, its Medical and Surgical Applications). Istanbul. 1898. 4 Esad Feyzi, "Roentgen §u'a'atinm suret-i istihsali, havassi, mahiyeti, tatbikat-i tibbiyesi (Supply, features, content and medical application of Roentgen rays), Nevsal-i Afiyet, ed: Dr. Besim Omer, 1st. 1899, pp: 230-231.

VH§ i M

116

I § I I. U L M A N

students at the Medical School remained i n c o m p l e t e 1 . His assistant, Dr. Sufyan Bey, took over the Roentgen laboratory where treatment of cancer by X-rays was started by Dr. Cemil Pasha on 20 June 1903. 2 An independent department of radioing} was founded in 1924 within the Istanbul Faculty of Medicine supervised by l)r. Selahaddin (Erk) 3 .

Conclusion The introduction of X-ray techniques into Ottoman medicine, as with any other modern technique discussed a b o v e , can be evaluated as a process with multiple causes. It was helped by the sovereign's ingenious policies that discerned how his endurance (beqa) required him to embrace modernization, like his ancestors; the Slate's pragmatic policy 4 promoted modern techniques for the endurance of the Empire.

T o g e t h e r with this, there was an able

surgeon's farsighted encouragement of young intern doctors by giving them the chance they needed; as well as the great European powers' competitive rivalry to test Roentgen techniques in war surgery on both sides of the battle, which was a component of their programs for imposing their own influence over the Empire. But the most striking of all is the desire of young Ottoman elites to put into practice novel medical techniques emerging in the W e s t , despite the modest facilities they had. The steps taken for the modernization of medicine and medical education in the early 19th century bore fruit as indicated by the stories of young physicians at the turn of the 20th century, w h o could easily read foreign medical literature and follow developments in the W e s t . Their endeavour and de\ otion to put what they had learned into practice is even m o r e striking when the uncertain political and military situation of the country at that time is taken into consideration. The multicultural, multireligious and multiethnic character of Ottoman society at that time 5 created an unusual way in which novelties were brought into its own structural and d y n a m i c context. T h e introduction of X-ray photography techniques and radiology into Turkey provides a good example how Ottoman thought created its own style of modernization that derived organically from its own culture.

1

Dr. Rifat. Roentgen § u ' â ' â t i m n Fevaid ve Mehaziri, ikdam. Vol. 12, No. 4086,1st. 1905, p:3.

2

Dr. Djemil Pacha. Mémoires

3

et Observations

Médicales.

Erk S. Roentgen D e p a r t m e n t I.U.3. iç Hastahklari Internal Diseases Section), vol II, 1945, pp. 43-47.

4 5

Constantinople. 1905, p: 139.

Klinigi

Yilhgi (The yearbook of 1st Univ.

Mardin S Joe. cit, p. 16.

M u r p h e y R. " O t t o m a n Medicine and T r a n s c u l t u r a l i s m f r o m the Sixteenth through the Eighteenth Century", Bulletin of the History of Medicine, Vol. 6 6 , 1 9 9 2 : çev. T . Zorlu, "Osmanli tibbi ve kultUrlerustii karakteri" in Osmanli Bilimi Araçtirmalan, No. II, 1st 1998, p: 264.

2. Dr. Esad Feyzi. Nevsal-i

Afiyet, ed. Besim Omer, 1899; 1:226.

118

Y E § 1M

I§ I L

(ILMAN

1. Private Mehmet from Boyabat before the Röntgen apparatus: "La recherche d'une balle perdue par les rayons à l'Hospital de Yildiz (The search of a bullet piece by means of X-rays)". Source : Esad Feyzi, "Röntgen §u'ä'ätinin suret-i istihsali, havassi, mahiyeti, latbikat-i tibbiyesi, Nevsal-i Afiyet (Annals of Health), ed: Dr. Kesim Omer, first year, Istanbul 1899, p: 226.

LES MESURES DE QUARANTAINE PRISES PENDANT LES ÉPIDEMIES DE CHOLÉRA ET LEURS RÉPERCUSSIONS SUR LA SOCIÉTÉ OTTOMANE (1831-1918)* Prof. Dr. Nuran YILDIRIM**

L'Empire ottoman fut touché par toutes les pandémies de choléra. Carrefour entre deux continents, c'était en effet un point de passage pour les transports de biens et de marchandises, mais aussi un territoire riche en lieux saints pour les religions monothéistes, attirant notamment les pèlerins en provenance des régions d'Extrême-Orient infectées par le choléra, alors que le Hedjaz lui-même était un terreau favorable au développement des épidémies, du fait de ses conditions de vie peu hygiéniques. Pendant presque cent ans, l'Empire fut contraint de se battre contre le choléra qui le toucha pour la première fois en 1831. Durant le processus d'effondrement de l'Empire, le choléra ne cessa d'être à l'ordre du jour, du fait de la dureté des condition de vie induites successivement par les guerres balkaniques, la première guerre mondiale et la guerre d'Indépendance. Dans son combat contre l'épidémie, l'État, dès l'apparition de la première épidémie en 1831, chercha à suivre les mesures appliquées en France, Angleterre et Allemagne. Ainsi une circulaire que l'Etat français avait fait rédiger par des médecins français réputés sur l'épidémie de choléra fut traduite en turc et publiée dans le Takvim-i Vekayi (gazette officielle). Cette circulaire expliquait les règles à appliquer pour ne pas être contaminé par le choléra, ce qu'il fallait manger et boire pendant une épidémie et les mesures à prendre en urgence pour les malades du choléra avant l'arrivée du médecin 1 . C'est par l'intermédiaire des ambassades que ces circulaires étaient transmises car à cette époque, en dehors du médecin en chef, il n'y avait pas d'institution définissant les moyens de lutte contre le choléra. Pendant les années 1847-1848, alors qu'une deuxième épidémie se développait à Istanbul, un livre en deux volumes rédigé par une commission privée en

Remerciements : Je remercie Ye§im Igil Ulman qui m ' a aidée pour les sources en français, ainsi que Biilent Ôzaltay qui n ' a pas ménagé son aide pour les sources en allemand. Université d'Istanbul, Faculté de médecine, département de déontologie et d'histoire de la médecine. 1 Takvim-i Vekayi, No. 23, 21 Z A . 1247 [22 avril 1832]; No.24, 3 Z. 1247 [4 mai 18321; No.26, 17 Z . 1247 | 1 8 mai 18321.

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N I J R A N

Y I L D I R I M

Angleterre fut offert par le gouvernement anglais au sultan qui envoya au médecin en chef les morceaux choisis q u ' o n lui avait lus pour les faire traduire 1 . A la suite de la première épidémie de choléra, la mise en place de l'organisation de la quarantaine vint à l'ordre du j o u r et f u t confiée successivement au Dr. Minas de Vienne et à un Français, le Dr. Robert. Au sein du Conseil national de Santé, qui détenait l'autorité de décision sur l'organisation de la quarantaine, les consulats des Etats européens et des États frontaliers de l'Empire ottoman disposaient chacun d'un membre et l'Empire ottoman de deux membres. Les décisions étant prises à la majorité, l'Etat ottoman était, dans son propre pays, en situation de minorité dans cette institution. Le but de cet article est d'étudier la quarantaine, fondement de la lutte contre les épidémies de choléra dans les territoires ottomans, ainsi que les mesures de désinfection prises en lien avec elle et, à la lumière de documents d'archives et d'autres sources, de donner quelques exemples des réactions populaires face à ces mesures.

Les tentatives pour empêcher

l'entrée

sur le territoire

: l'organisation

de la

quarantaine Lorsque le choléra frappa l'Europe dans les années 1826-1837, on comprit que l'expérience acquise depuis longtemps pendant les épidémies de peste pourrait servir à la lutte contre cette maladie. Le monde médical ignorait la source de cette maladie, les modes et vecteurs de sa contagion. Pour se protéger, les États mirent en application les systèmes de quarantaine établis initialement contre la peste. Dans l'Empire ottoman, la quarantaine commença à être appliquée sur lu recommandation du médecin en chef Mustafa Behçet Efendi (1774 1834), au cours de la première épidémie de choléra qui toucha Istanbul (1831), à rencontre des navires en provenance de la mer Noire 2 . Dans la population, la rumeur circulait que la quarantaine, « coutume franque ». n'avait pas à être respectée par les Musulmans. En outre, pour ceux qui venaient d'endroits infectés par des maladies contagieuses mortelles comme la peste et le choléra, la quarantaine ne se réduisait pas à l'isolement, suivi de 1

B O A . A . M K T . 1 5 0 / 9 5 . 2 5 §. 1264 | 2 7 juillet 1848|. ; i . H R . 2 2 3 1 , 19 L. 1264 [ 18 septembre 1848]. 2 Takvim-i Vekayi, No.2. 7 C. 1247 ( 13 novembre 1831J. ; A h m e t Mithat Efendi: "Devlet-i Aliyye-i Osmaniye'de Karantina Yani Usûl-i T a h a f f u z u n Tarihçesi"|Histoire de la quarantaine dans l'Empire ottoman], Salname i Nezaret-i Umûr-i Hariciye. (1318 Hicri senesi). [Annuaire du ministère des Affaires étrangères, année de l'hégire 1318] D e f a 3. Istanbul 1318 11900], p. 437.

L E S

M E S U R E S

DE

Q U A R A N T A I N E

121

l'autorisation d'entrée sur le territoire des individus sains. Elle comprenait aussi la désinfection des affaires et des lieux, ainsi que des règles pour l'examen et l'enterrement des morts. Ce sont en particulier l'examen des morts et l'usage de la chaux pour les enterrements qui suscitaient des réticences, car ils étaient perçus comme une atteinte aux règles religieuses en vigueur. Mahmut II (1808-1839), qui avait compris l'importance de la quarantaine, fit écrire à Hamdan b. Osman un ouvrage sur l'utilité de la quarantaine pour vaincre cette résistance 1 . A Istanbul, lors de l'apparition de la première épidémie de choléra, les principes scientifiques de la quarantaine étaient totalement ignorés. Si auparavant certaines mesures de bon sens avaient été prises, c'est dans les années suivantes que la forte mortalité entraînée par les épidémies de peste d'Alexandrie, Izmir et Istanbul donna un coup d'accélérateur à la création d'une organisation de quarantaine fondée sur des principes scientifiques 2 . La quarantaine était une mesure de grande ampleur qui nécessitait une importante organisation sur les routes et dans tous les ports de l'empire et qui touchait les navires de commerce étrangers. Mahmut II craignait d'être humilié devant les Européens s'il échouait en matière de quarantaine. En outre, en raison des mesures qui semblaient s'opposer à la charia, comme l'enterrement sans accomplissement des devoirs religieux pour les morts de la peste, l'instauration de la quarantaine ne pouvait pas faire l'objet d'une annonce officielle. En conséquence, une grande assemblée, réunissant à la Sublime Porte les grands dignitaires de l'État et les oulémas, examina les aspects médicaux et géographiques de la quarantaine sous l'angle de la charia. En conclusion des débats, on s'accorda sur le fait que la quarantaine n'était pas contraire à la charia, mais, tout en décidant de l'imposer à l'ensemble du pays, on attira l'attention sur les désagréments et les difficultés qu'elle pouvait occasionner dans la vie commerciale. Ensuite, le §eyhiilislâm

Mekkizâde

Asim Efendi prononça une fatwa déclarant la quarantaine conforme à la charia, et un long article publié dans le Takvim-i

Vekayi exposa l'utilité de la

3

q u a r a n t a i n e . Précisant qu'elle était conforme à la charia, il proclama l'instauration de la procédure de quarantaine dans l'État ottoman. Une circulaire

Terciime-i ithafii'l-Udebâ (Istanbul, Matbaa-i  m i r e , 1254 [1838]. H a m d a n b. Osman qui rédigea cet ouvrage en arabe, puis le traduisit en turc s'était rendu plusieurs fois en Europe. Il utilisait l ' e x p r e s s i o n arabe « tefrîd-i mezrâ » pour désigner la quarantaine et expliquait le principe de quarantaine en interprétant les propos des érudits de l'Islam avec les hadiths. C f . N u r a n Y i l d i n m : "Tiirkçe Basili Ilk T i p Kitaplari H a k k i n d a " [Sur les p r e m i e r s livres de médecine imprimés en turc|, In Memoriam Ali Nihad Tarlan. Journal of Turkish Studies, Ed. Sinasi Tekin-Goniil A . Tekin, Harvard University Printing Office, Vol. 3 (1979), p. 459. 2 En 1835, 75 000 personnes moururent de la peste au Caire, 15 000 à Alexandrie ; en 1836, 25-30 000 à Istanbul ; en 1837, 15-16 000 à Izmir, 6 000 à Salonique. C f . Daniel Panzac, La peste dans l'Empire ottoman (1700-1850), Louvain, Peeters, 1985, p. 182-183. 3

Takvim-i

Vekayi, No. 1 6 4 , 1 1 S. 1254 | 6 mai 1838|.

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122

envoyée au kadi d'Istanbul, aux kadis du Bilâd-i Selase (Istanbul, Uskiïdar, Eyiip), au surintendant des marchés, aux patriarches des trois nations (grecque, arménienne et catholique) ainsi qu'au Grand Rabbin leur notifia que les morts de la peste ou d ' u n e maladie suspecte devaient être immédiatement signalés au Conseil supérieur de Santé 1 . Mais le Conseil supérieur de Santé n'avait pas encore été f o n d é . En o u t r e , il n ' y avait pas à Istanbul de médecin au fait des m é t h o d e s d e prophylaxie et il était nécessaire d'avoir recours aux Européens. Par ce biais, d ' u n e part les mesures de quarantaine seraient établies par des personnes qualifiées, d ' a u t r e part on gagnerait la confiance et l'estime des Francs. Le sultan, en raison de la confiance qu'il avait en l'État austro-hongrois, manda de Vienne trois personnes au fait des principes et conditions de la quarantaine 2 . Le docteur autrichien Minas fut en 1839, n o m m é directeur en chef de la quarantaine. Tout en rappelant que les Ottomans et les étrangers suivaient avec attention la question de la quarantaine, on le pria de porter attention à son application 3 . Sur le conseil du Dr. Minas, un Conseil supérieur de Santé fut f o n d é , c o m m e d a n s les États e u r o p é e n s , pour préciser les mesures de q u a r a n t a i n e 4 . Par la suite, lorsqu'il s ' a v é r a que le Dr. Minas ignorait la quarantaine maritime, il démissionna et regagna son pays 5 . Le docteur français Robert qui le remplaça, énonça en janvier 1840 les principes de travail de l'assemblée 6 . En

1841, le C o n s e i l s u p é r i e u r d e Santé f u t tenu

directement

responsable de la protection des territoires ottomans contre les épidémies, et reçut en contrepartie l ' i n d é p e n d a n c e pour toutes les d é c i s i o n s et leur a p p l i c a t i o n 7 . Le Conseil supérieur de Santé prépara des règlements sur la quarantaine et, par l'intermédiaire des stations de quarantaine présentes dans les provinces, fit appliquer les décisions prises dans tout le pays 8 . Dans chaque station de quarantaine, il y avait un directeur m u s u l m a n et un médecin européen. Dans les stations de quarantaine de province, il était impératif que le directeur soit m u s u l m a n . Le directeur m u s u l m a n était en relation a v e c les pouvoirs locaux, s'entretenait avec les communautés et jouait un rôle 1

B O A . D V N . N M H . 2/11. 19 §. 1254 |7 novembre 1838].

2

BOA. I. M M . 2540 [sans J a t e |

3

B O A . H H . 25543, 18 Z. 1254 [4 mars 1839]; C . SH. 1255, circulaire datée du 21 Z . 1254 [7 mars 1839]; Giilden Sariyildiz: "Karantina Meclisi'nin Kuruluçu ve Faaliyetleri"|La fondation et les activités du conseil de quarantaine]. Belleten, C. LV11I (août 1994), p. 349-351. 4 B O A . H H . 25563-projei d ' A . Minas'in ; A h m c t Mithat E f e n d i , a r t . cit., p. 4 4 4 . ; Giilden Sariyildiz, art. cit., p. 355-356 5 B O A . A. D V N . N M H . 3/17. Evail §. 1255 | n o v e m b r e 1839]. 6

B O A . A. D V N . 1/10,29 KA. 1256 [31 mai 18401.

7

Ahmet Mithat Efendi :art. cit., p. 449.

^Administration Sanitaire 1902, |lstanbul 1905].

de l'Empire

Ottoman:

Recueil

des Règlements

depuis

1840

jusqu'en

L H S

M H S U R H S

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important pour faire accepter au peuple les mesures de quarantaine 1 . Les médecins de la quarantaine avaient l'obligation d'envoyer tous les quinze jours à Istanbul un tableau de la mortalité précisant les noms, prénoms, âges, lieux de naissance et causes du décès, ainsi qu'un rapport sur l'état de santé général de la région. Lorsque dans la population humaine ou animale de la région une maladie contagieuse ou épidémie étaient identifiée, ils devaient avertir la population rurale et le signaler à Istanbul. En outre, il fallait qu'ils informent chaque semaine les représentants des ambassades étrangères et les fonctionnaires de l'État ottoman sur la santé de la population, et qu'ils prennent des mesures dans leur propre région en cas de peste ou d'autres maladies contagieuses et épidémies 2 . La quarantaine s'appliquait à tous sans exception, mais ses conditions pouvaient varier. Ainsi, en 1843, on octroya un kiosque à Ye§ilkôy au Prince Albert, le frère du roi de Prusse, pour qu'il attende la quarantaine 3 . Quant au sultan Abdiilmecit, au retour de son voyage en Roumelie, il ordonna que les mesures médicales fussent appliquées au navire Eser-i Ced.it, et fut remercié pour cette attitude par le Conseil supérieur de Santé 4 . Plusieurs années plus tard, l'ambassadeur d'Allemagne, de retour à Istanbul, fit une requête à la Sublime Porte pour qu'une baraque ou une tente lui soit allouée le temps de l'attente de la quarantaine, et on ordonna la construction d'une petite baraque de quatre pièces dans un lieu en altitude pour qu'il puisse rester trois jours dans le centre de quarantaine 5 . L'attente de la quarantaine ralentissait les relations commerciales et leur portait préjudice. C'est pourquoi les États européens désiraient l'abolition du système de quarantaine et son remplacement, dans les régions touchées par les épidémies, par un cordon sanitaire et des mesures de désinfection. En 1891, le V I P congrès international d'hygiène et de démographie qui se réunit à Londres débattit de ce sujet mais ne parvint pas à une décision. Quant à l'État ottoman, il n'était pas partisan d'une abolition du système de quarantaine. Aussi, lors du ' E m i n e Melek Atabek: I85l'de Paris'te Toplanan 1. Milletlerarasi Saglik Konferansi ve Turkler.\La 1ère c o n f é r e n c e internationale de la santé à Paris en 1851 et les Turcs] Istanbul 1974. p. 49-51. ; "Notice sur l'Organisation des Quarantaines de la Turquie", par M . le Dr. A . L e v a i , M e m b r e de l ' I n t e n d a n c e S a n i t a i r e de C o n s t a n t i n o p l e , Gazette Médicale de Constantinople, première année, Novembre 1849, pp: 16-24, cité par Y e f i m Içil Ulman: Gazette Médicale de Constantinople ve Tip Tarihimizdeki Onemi. | L a G a z e t t e m é d i c a l e de Constantinople et son importance dans notre histoire de la médecine] Doktora Tezi. Istanbul 1999,p.122-115. 2 Instructions Pour les Médecins Employés dans le Service Sanitaire de l'Empire Ottoman. Conseil de Santé, 25 mai 1840. 2 e et 17 e articles. • A . Siiheyl Unver: "Osmanli Tababeti ve Tanzimat Hakkinda Yeni Notlar" |Nouvelles notes sur la médecine ottomane et les T a n z i m a t ) , Tanzimat I. Yuzuncii Yildônumiï Munasehetile (Maarif Vekâleti). Maarif Matbaasi, Istanbul 1940, p. 948. 4 5

Ahmet Mithat Efendi: Art. cil, p. 454-455.

B O A . i. H U S . 3, 1 R A . 1311 [12 septembre 1893) ; i. H U S . 6, 2 R A . 1311 113 septembre 1893|.

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V I I I e congrès international d ' h y g i è n e et de d é m o g r a p h i e qui se réunit à Budapest, les délégués de l ' É t a t o t t o m a n , Hayrettin et M a h m u t , reçurent l'ordre de ne pas utiliser leur vote contre la quarantaine et de protester avec véhémence en cas de déclaration hostile à la quarantaine lors du congrès 1 . L'organisation de la quarantte fut dissoute avec les accords de Lausanne signés le 24 juillet 1923 2 .

Les réactions aux mesures de

quarantaine

La société ottomane avait été témoin presque au m ê m e m o m e n t de deux changements majeurs : les Tanzimat et la quarantaine. A cette époque, les métiers de la santé, tels la médecine, la chirurgie et la pharmacie étaient exercés en majorité par des étrangers et des membres des minorités. L'Ecole de médecine, entrée en activité en 1827, avait tout juste c o m m e n c é à fournir des diplômés. À Istanbul, au Conseil de Santé, les m e m b r e s étrangers étaient majoritaires. Dans les provinces, des médecins étrangers avaient été nommés dans les postes de quarantaine et les dispensaires municipaux. Le peuple ne faisait pas confiance aux mesures de quarantaine appliquées par les médecins non-musulmans et considérait avec suspicion les médicaments donnés contre le choléra. Il ne fut pas facile de faire accepter les mesures de quarantaine par les sujets musulmans.

Les p r i n c i p a l e s

s o u r c e s de d i f f i c u l t é s f u r e n t les

provocations lancées au peuple qui souffrait économiquement de la quarantaine par certains membres inconscients affirmant que la quarantaine était contraire à la charia, ainsi que les attitudes irrespectueuses de certains docteurs nonm u s u l m a n s de la quarantaine, méprisant les valeurs populaires. Après ces événements, une circulaire envoyée au médecin en chef ordonna le renvoi des docteurs étrangers employés dans les quarantaines pour cause de mauvais comportement, et leur remplacement par des docteurs ayant passé leur examen en présence du sultan 1 Nuran Yildirnn-Suzan Bozkurt: " VII. Uluslararasi Hijyen ve D e m o g r a f i K o n g r e s i l l 8 9 4 ] K o n g r e Ûyelerinin Istanbul G e z i s i " | L e V i l e c o n g r è s i n t e r n a t i o n a l d ' h y g i è n e et de d é m o g r a p h i e (1894) et la visite des membres du congrès à Istanbul!, Tarih ve Toplum, 130 (octobre 1994), p. 14-21. O s m a n Çevki Uludag: Son Kapitiilasyonlardan Biri Karantina" | L a quarantaine, une des dernières Capitulations!. Belleten, vol. 2, n° 7 - 8 (1938), p. 461-467. 3

B O A . H R . M K T . 5/79, 17 B. 1260 |2 août 1844|. L'expression "ayant passé leur e x a m e n en présence du sultan" (Padiyih'in huzurunda imtihan edilmiç) renvoie aux diplômés de l'Ecole impériale de médecine. En e f f e t , à cette époque, les e x a m e n s finaux de l ' E c o l e impériale de m é d e c i n e se d é r o u l a i e n t en p r é s e n c e du s u l t a n . C f . Yeçim I§il U l m a n : Journal de Constantinople'a Gôre Mekteb-i Tibbiye-i Adliye-i Çahane'nm Galatasaray Dônemi. [ l'Ecole impériale de médecine selon le Journal de Conxtantinople, époque de G a l a t a s a r a y l , Yiiksek Lisans Tezi. istanbul 1994. pp. 83-92.

LES

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125

Le 26 mai 1838, à Kusadasi, alors que le directeur Arif Bey, chargé de l'application du principe de quarantaine et un médecin tentaient d'accomplir leur devoir, l'imam Kara du quartier Turkmen, Haci Molla de Kaleiçi et le maire du quartier Turkmen, un nommé ibrahim, artisan du cuir, accompagnés d'une bande de femmes, abusèrent de la crédulité du peuple, l'excitèrent contre l'application du principe de quarantaine et furent la cause de plusieurs désordres. Les fonctionnaires de la quarantaine furent agressés et plusieurs stations de quarantaine furent détruites. Les coupables condamnés à l'exil sur l'île de Kos demandèrent neuf mois plus tard leur grâce au sultan en affirmant avoir été redressés et corrigés. Par la suite, ils furent graciés aux conditions de vivre avec bienséance, de ne pas s'opposer aux décisions de l'État, en particulier au principe de quarantaine qui était bénéfique pour la communauté musulmane, et de ne pas se prononcer sur le sujet. Le 11 mai 1840, une lettre envoyée aux dirigeants des lieux où se trouvaient des employés de quarantaine, attira l'attention sur la peur qu'avaient suscitée ces événements chez les employés de la quarantaine, demanda aux employés des quarantaines de se conduire en conformité avec les instructions remises en leurs mains et d'empêcher ce genre de désordres 1 . Dans la survenue de ces incidents, le manque de confiance à l'égard des médecins de quarantaine et des médecins municipaux, presque tous nonmusulmans ou étrangers, était un facteur important. Dans les premières années qui suivirent la fondation de l'organisation de la quarantaine, à Amasya, lors de l'épidémie de peste, les provocations de certains oulémas d ' A m a s y a furent la cause d'événements aux conséquences mortelles. Selon leur interprétation, l'examen post mortem effectué sur les parties génitales des hommes et surtout des f e m m e s ainsi que l'ensevelissement à la chaux étaient contraires aux principes de la charia. Après la proclamation des Tanzimat, alors que les principes de la quarantaine venaient d'être mis en application, en 1840, à Amasya sévissait la disette. Pendant que les pauvres subissaient la hausse du prix des céréales, le sultan ordonna la création d'un bureau de quarantaine dans la ville et nomma un fonctionnaire et un médecin de quarantaine. Cependant, alors même que les mesures de quarantaine n'étaient pas entrées en application, la peur de la quarantaine éprouvée par les habitants des bourgs et villages des environs les fit éviter Amasya, et le blé, l'avoine, le sel et autres produits de première nécessité devinrent introuvables. Tandis que les pauvres souffraient de la faim, après la mort de plusieurs musulmans, le docteur Paldi exigea de voir non seulement le visage des morts et des malades, mais aussi leurs parties

' B O A . C. SH. 29, instruction au directeur de la quarantaine en date du 27 Z A . 1254 111 août 1839]; Sadaret Defterleri. No. 5 8 5 , 2 6 M . 1254-17 M . 1262 [21 avril 1838-15 janvier 1846|.

126

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Y IL D I R I M

intimes, ce qui offensa la population. En effet, la croyance populaire était que la charia interdisait d ' e x a m i n e r les parties intimes, et que cela constituait un péché. En outre, le Dr. Paldi suscita un débat en déclarant : « Si la peste fait son apparition, j e ferai brûler les morts avec de la chaux, j e vous enfermerai pendant quarante jours chez vous et placerai un homme devant votre porte pour empêcher l'entrée de quelqu'un d'extérieur, ou la sortie d'un des habitants de la maison. En outre, je vous administrerai diverses pulvérisations tous les jours et vous ferai payer toutes les dépenses. » Le peuple déclara qu'il n ' a v a i t jamais rien vu de semblable j u s q u ' à présent et qu'il n'en avait pas entendu parler dans la charia. Mais le docteur poursuivit dans la m ê m e attitude et sans prendre en compte la sensibilité de la population m u s u l m a n e il déclara : « C'est la méthode française : et j e vous appliquerai la méthode française dans son intégralité ». En réponse, les habitants d ' A m a s y a rappelèrent q u ' i l s étaient sujets du sultan m u s u l m a n , et non de l'Etat français, et q u ' i l s ne toléreraient pas un lel traitement. Le docteur Paldi répliqua que le sultan lui avait donné l'autorisation d ' a p p l i q u e r sur eux ces m é t h o d e s et q u ' i l les appliquerait », ce qui tendit les relations entre le peuple et le médecin de la quarantaine. Quelques temps plus tard, l'insistance du docteur Paldi à examiner le cadavre d ' u n e f e m m e musulmane morte en couches qui passait par la rue du centre de quarantaine, puis sa volonté de voir le cadavre d ' u n e f e m m e nonmusulmane, provoqua la rupture. Si le 8 e article des instructions publiées par le Conseil supérieur de Santé d o n n a i t aux m é d e c i n s de q u a r a n t a i n e la permission d ' o b s e r v e r et d ' e x a m i n e r les cadavres des morts décédés d ' u n e maladie suspecte, il posait la condition que pour un cadavre du sexe féminin l'examen soit effectué par une f e m m e choisie par les institutions médicales 1 . Le Dr Paldi, qui n'appliquait pas cette circulaire et faisait fi des valeurs spirituelles du peuple fut l'objet de rumeurs selon lesquelles le médecin de la quarantaine déterminerait si les f e m m e s atteintes de la peste étaient ou non victimes de cette maladie en introduisant des bougies dans leurs parties intimes, et qu'il brûlerait les pestiférés avec de la chaux. Le mardi 4 août 1840, à la suite de la prière à la mosquée Beyazit d ' A m a s y a , les hodjas demandèrent à la communauté de ne pas se disperser. Ils déclarèrent q u ' i l fallait préparer une requête pour la suppression de la quarantaine et le renvoi de son médecin, et envoyèrent un h o m m e au marché pour appeler les m u s u l m a n s à la m o s q u é e . Les artisans et c o m m e r ç a n t s curieux d'apprendre ce qui se passait, fermèrent leur boutique et se rendirent à la mosquée. Le hodja Rcsit/ade Mustafa Efendi sortit dans la cour de la

' Instructions

pour les médecins

employés

C o n s e i l de S a n t é d ' I s t a n b u l . 25 mai 1 8 4 0 .

dans le service sanitaire

de l'Empire

ottoman.

LH S MESURES

DE

127

QUARANTAINE

mosquée et s'adressant aux religieux et au peuple s'exclama: « Allez, amenez cet infidèle ». Un groupe passa alors à l'action et attaqua le centre de quarantaine. Le Dr Paldi prit la fuite et se réfugia dans une église grecque, mais le groupe brisa la porte de l'église et tua le docteur. Les hodjas de la mosquée qui avaient été à l'origine de cet événement en excitant la population furent envoyés à Istanbul, interrogés par le Conseil supérieur et jugés. Re§itzade Hoca Mustafa Efendi et Yahya Efendi furent exilés à Gelibolu pour trois ans. Une pension de 250 kuruç fut octroyée à l'épouse et à l'enfant du docteur français Paldi qui avait travaillé sept ans dans la marine ottomane 1 . Deux artisans d'Amasya, jugés innocents, furent autorisés à regagner leur domicile 2 . Par la suite, il fut décidé de renvoyer chez eux les deux hodjas qui avaient accompli leur peine, ainsi que quatre hodjas détenus à Istanbul et déclarés innocents 3 . Alors que les six hodjas étaient renvoyés à Amaysa, le juge d'Amasya, le mufti et un fonctionnaire déjà renvoyé 4 , qui avaient assisté à l'événement sans tenter d'apaiser le peuple, furent convoqués à Istanbul pour y être interrogés 5 . Quatre sujets grecs attaquèrent la quarantaine d'Ibrail (Braila) et, après avoir tué à l'épée le gardien de la quarantaine et un employé, ils montèrent dans une barque et s'enfuirent. L'ordre fut donné au gouverneur de Silistre de traquer partout les assassins 6 . En 1845, on informa les pèlerins de retour du Hedjaz que, par mesure de précaution, ils seraient mis en quarantaine à l'extérieur d'Adana. On commença les préparatifs et des tentes furent montées dans un endroit choisi pour faire attendre les pèlerins. Le docteur de la quarantaine d'Adana, un fonctionnaire délégué par le mutasarnf

d'Adana et 150 soldats vinrent à la

rencontre des pèlerins. Les pèlerins, exaspérés par l'injonction qu'on leur faisait, demandèrent à voir le gouverneur. Celui-ci déclara que s'ils obéissaient et attendaient la quarantaine, c'était tant mieux, mais que dans le cas contraire ils pouvaient aller où ils voulaient. Environ 2500 pèlerins se rendirent alors à Adana et mirent à sac le centre de quarantaine. La désinvolture du mutasarnf d'Adana et la fatwa que le mufti de Demirci avait rendue, annoncée à la population par un crieur public, selon laquelle « l a quarantaine n'|était] pas nécessaire » avait suscité l'incident. Une division militaire fut envoyée de 1

B O A . I. M V L . 1 8 3 , 2 8 N . 1256 [23 novembre 1840) et 1. M V L . 333, 19 R A . 1257 111 mai 1841],

2

B O A . I. M V L . 2 3 1 , 2 2 Z A . 1256 115 janvier 18411.

3

BOA. i. M V L . 2 5 3 , 2 3 Z . 1256 115 février 1841 ].

4

L e fonctionnaire était un muhassil, fonction administrative subordonnée au mutassarif m ê m e rang q u e le kaymakan et le directeur.

5

B O A . I. MVL. 2 7 4 , 1 6 M . 1257 [10 mars 1841).

6

BOA. HR. MKT. 4 / 7 5 , 4 C. 1260 |21 juin 1844-].

7

Le mutassarif

tst à partir des Tanzimat la plus haute autorité administrative du

sancak.

et du

128

N II R A N

Konya à Adana, le mutasarrifiwi

Y 1LDI

R I M

révoqué et des instructions furent transmises

aux provinces concernées pour que les pèlerins qui fuyaient Adana sans avoir reçu leur certificat de non contagion soient arrêtés, mis 15 jours en quarantaine et emprisonnés 1 . En 1848, alors q u ' A l e p était touchée par une épidémie de choléra, le directeur de la station de quarantaine d ' A n t e p ne donnait pas l'autorisation aux arrivants d'entrer dans la ville sans attendre la quarantaine. Cependant, les gardiens employés au centre de quarantaine, à l'instigation du kaymakam et de certains autres employés, ne retenaient pas en quarantaine les caravanes, biens et voyageurs en provenance d ' A l e p . Alors que le directeur de la quarantaine insistait pour q u ' i l s accomplissent correctement leur mission, une agitation c o m m e n ç a à se développer dans la ville et les cas de choléra augmentèrent à A n t e p . La volonté du directeur de la quarantaine de placer en quarantaine l'épouse d ' u n homme mort de choléra accrut l'agitation. Avec l'espoir que l'intervention divine l'aiderait à échapper au choléra, le peuple se rendit le 20 juin 1848 pour prier sur le lieu de Kurban Baba. Les hommes du

kaymakam

et les gardiens de la quarantaine profitèrent de cette occasion pour exciter le peuple de retour de la prière, en déclarant que « tant que la quarantaine ne serait pas supprimée, l ' é p i d é m i e de choléra ne pourrait pas disparaître, et que désormais leurs femmes aussi seraient placées en quarantaine ». La quarantaine fut alors attaquée. Après avoir brisé les portes, fenêtres et détruit le drapeau de la quarantaine, ils voulurent tuer le directeur de la quarantaine, qui échappa à la mort grâce à l'intervention d'un cavalier

(sipahi)2.

Bien des années plus tard, cette fois-ci à Mitrovitza, nous savons que le docteur de la quarantaine fut assassiné 3 . Deux ou trois mille Albanais qui s'opposaient à l'application de la quarantaine traversèrent le cordon d e la quarantaine, entrèrent dans le bourg de Mitrovitza, attaquèrent la quarantaine et tuèrent son docteur. Les Albanais demandèrent la suppression de la quarantaine à Mitrovitza et la remise en liberté des individus détenus pour le meurtre du docteur, sous peine de prendre les armes et de se révolter. Une lettre envoyée le 7 février 1887 par la Sublime Porte au ministère de la Santé ordonnait d'avertir ces personnes, d'envoyer deux bataillons militaires à Mitrovitza et de mettre en application le cordon de quarantaine dont la formation avait été décidée par le Conseil des ministres. 4

' Giilden Sanyildiz, art. cit. p. 361. 2

B O A . A. M K T . 144/15, 17 N. 1264 | 6 août 1 8 4 9 | ; A . M K T . 149/81,21 L. 1264 [20 septembre 1848]. B O A . i. DH. 8 0 1 2 5 , 1 9 K. 1304 [ 15 janvier 18871.

3 4

B O A . DH. M K T . 1395/49. 1 C A . 1304 | 2 6 janvier 1887|.

I, H S M E S U R E S

DB

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129

Alors que ces faits étaient survenus dans les premières années d'application de la quarantaine, à la fin du XIXe siècle, Hilal Efendi, exprésident de la cour d'appel de Konya, envoya au sultan une brochure affirmant que le principe de quarantaine était conforme aux principes de la charia, avec des hadiths du prophète Mahomet en faveur de la quarantaine. 1 En 1900, environ 150 éminents négociants d'Izmir organisèrent une réunion où ils affirmèrent que, du fait de la quarantaine appliquée contre la peste, leur revenus liés à l'agriculture et au commerce avaient été affectés et qu'en outre le peuple était plongé dans la misère. Ils envoyèrent une requête au vilayet et demandèrent que la quarantaine et le cordon sanitaire soient élargis de manière à comprendre l'ensemble de la province d'Aydin. Le

vilayet

répondit que depuis neuf jours il n'y avait pas eu de morts de cette maladie et que, si cette situation perdurait, la quarantaine serait totalement supprimée 2 .

Les refus d'entrer en quarantaine et les fuites Selon les instructions, les pèlerins revenant du Hedjaz devaient être mis en quarantaine dans les stations correspondant à leur région d'origine et, après l'application des règles de quarantaine, attendre l'octroi d'un laissez-passer. Durant les premières années, certains pèlerins qui ne comprenaient pas l'importance de ce nouveau principe, passaient furtivement sans faire la quarantaine et rentraient chez eux. En 1845, environ 2500 pèlerins d'Aydin, Manisa, Amasya, Kastamonu, Taskoprii et des environs trouvèrent un moyen pour rentrer chez eux sans attendre la quarantaine à Edirne. Lorsque cette situation fut connue, un firman fut envoyé aux personnes intéressées pour ordonner l'arrestation des pèlerins qui n'étaient pas entrés en quarantaine et leur mise en quarantaine pour 15 jours pour éviter des complications. Mehmet Celalettin Pa§a, kaymakan

du sancak

de Hamid (Isparta) fit savoir que

quatorze pèlerins qui n'étaient pas passés par la quarantaine avaient été arrêtés à Isparta et mis en quarantaine ; Vasif Pa§a, mutasarrif d ' A n kara déclara que les pèlerins étant arrivés à Ankara sans avoir attendu la quarantaine avaient été placés en quarantaine sans avoir de contact avec personne 3 . Parmi les personnes mises en quarantaine ou sous cordon sanitaire, il y en avait qui contrevenaient aux règles et s'enfuyaient. Par exemple, en 1893, Halil bin Hasan, originaire de Çorum, et canonnier de la 6 e division du 5 e régiment s'enfuit de l'hôpital militaire d'Haydarpa§a où il était à l'isolement. 1

BOA. Y . P R K . B § K . 33/1) 1 , 1 3 C A . 1311 | 2 2 novembre 1893|.

2

B O A . Y . EE. KP. 8 6 - 1 1 / 1 0 8 0 , 1 5 S. 1318 [14 juin 1900|.

3

B O A . C. SH. 7 et 9 R. 1261| 15 et 17 avril 1845|.

130

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Y 1L D I R I M

Arrêté à Tophane, il lut conduit à l'hôpital municipal des environs 1 . Durant ces années, le choléra touchait de nombreuses régions du pays. Pour protéger la capitale du choléra, les individus qui arrivaient à Istanbul en train étaient mis en quarantaine à luzla. Cependant, les voyageurs qui voulaient échapper à la quarantaine descendaient du train à Gebze, allaient j u s q u ' à Pendik avec leurs bêtes puis reprenaient le train et le bateau et entraient à Istanbul sans attendre la quarantaine 2 . Pour y mettre un terme, le conseil d ' É t a t décida de mettre en application le paragraphe 3 de l'article 9 du code pénal. Selon celui-ci, les individus qui fuyaient d ' u n lieu infecté vers un lieu sain, seraient condamnés à une contravention de I à 15 livres, ou à une peine de prison allant de 2 4 heures à un m o i s 3 . Malgré cette mesure, pendant l ' é p i d é m i e d e choléra en 1910, la plupart des dizaines de milliers de personnes retenues en quarantaine dans les stations de Kavak, Sinop et surtout Tuzla s'étaient enfuies et avaient répandu la maladie 4 . En 1912, alors q u ' l z m i r était infectée par le choléra, les voyageurs prenant le train depuis cette ville étaient mis en quarantaine dans le centre de q u a r a n t a i n e installé à la gare d e K a b a k l i k . C e p e n d a n t , les v o y a g e u r s descendaient à la station précédente pour ne pas être placés en quarantaine. Afin d ' y remédier, des instructions furent envoyées aux unités de gendarmerie et employés des gares où ne se trouvait pas de centre de quarantaine pour qu'ils ne laissent sous aucun prétexte descendre les voyageurs 5 .

La

désinfection À une époque où l'idée de microbe n'était pas encore a p p a r u e , à

proximité de la frontière autrichienne, lorsque survenait une épidémie, les lettres en provenance des lieux considérés c o m m e infectés étaient désinfectées avec de la vapeur de vinaigre ou une fumigation. Le son, mélangé avec du soufre et de l'huile de sulfate d e cuivre, était versé à petites gouttes et les affaires désinfectées avec la f u m é e qui en sortait. Les parties habitées des maisons étaient pulvérisées de vapeurs d'acide chlorhydrique, les parties vides des vapeurs d'un mélange d'acide chlorhydrique et de soufre. 6 .

1 2

B O A . Y . PRK. B § K . 3 3 / 2 5 . 2 0 R A . 1311 [ 1er octobre 18931B O A . Y . P R K . D H . 8 / 1 2 . 19 S. 1312 122 août 1894],

3

B O A . DH. 1D. 87-1/37,11 N. 1329 118 mars 1894).

4

Siileyman Numan: A. g. c. . p. 171-175.

5

Oya Daglar, op. cit., p. 99.

6

Giilden Sanyildiz, art. c i t . . p. 330.

L HS

M E S U R E S

D H

Q U A R A N T A I N E

131

Dans l'Empire ottoman, les affaires qui étaient considérées comme infectées étaient pulvérisées d'une solution formée d'une dose de soufre et de salpêtre et d'une demie dose de son. Les affaires résistantes à l'eau étaient plongées dans l'eau pendant 48 heures 1 . Ainsi, dans le centre de quarantaine d'Istanbul, les navires en provenance de Méditerranée et de mer Noire, leur personnel et leurs passagers étaient contrôlés, et les affaires qui semblaient contaminées étaient désinfectées avec une pulvérisation de soufre 2 . Le Conseil de Santé, dans une circulaire datée du 7 mai 1845, précisait que l'or, l'argent et les monnaies en provenance d'endroits infectés ou suspects devaient être lavés au vinaigre avant utilisation 3 . Pendant l'épidémie de 1865, on conseilla aux habitants d'Istanbul pour se protéger de la maladie d'employer la solution désinfectante utilisée dans les décharges publiques et dans les toilettes pour empêcher les odeurs, ainsi que le sulfate de cuivre qui se trouvait dans toutes les pharmacies. Il fallait verser ce désinfectant sur les vomissures et les selles des malades après y avoir ajouté un peu de chaux et de charbon, et les draps et vêtements du malade devaient être brûlés, si le malade était riche ou, s'il était pauvre, emportés à distance avec précaution et bien lavés 4 . À l'initiative de Louis Pasteur (1822-1895), une fois faite la preuve de l'existence des micro-organismes, la théorie des microbes se développa en médecine et le monde médical entreprit des recherches pour éliminer les microbes et les méfaits des maladies qu'ils causaient. Puisque les épidémies causées par les microbes se répandaient par l'air, l'eau, la nourriture, les vêtements et le linge de maison on développa différents moyens et méthodes pour désinfecter ces éléments. On conçut des pulvérisateurs qui projetaient un désinfectant chimique, des filtres pour l'eau potable, des machines à étuve pour les vêtements et le linge de maison. Enfin, lorsqu'il fut avéré que la meilleure méthode de désinfection était l'eau comprimée à la pression de 100-150 degrés, plusieurs modèles d'étuves furent produits. A partir de 1870, les stations de désinfection qui avaient commencé à ouvrir en Angleterre se répandirent dans toute l'Europe, et surtout en France, et leur usage fut courant pour le

' "Miiteferriatiyla Karantina Nizamnamesr'[ Règlement sur la quarantaine et ses extensions! Dustur, Cild-i sani, 10 Safer 1290 [9 avril 1873), p. 873. 2

Giilden Sariyildiz: "Karantina Tarihinden Bir Yaprak: "Kuleli Tahaffuzhanesi" |Une page dans l'histoire de la quarantaine: le centre de désinfection de Kuleli], Bilim Tarihi, p. 19 (mai 1993), s. 25-30. 3

"Miiteferriatiyla Karantina Nizamnamesi", Ms/wr, Cild-i sani, 10 Safer 1290 19 avril 18731 p. 886. 4 "Zabtiye Mugiriyet-i Celilesinde kolera için tegkil kihnmi§ olan komisyonun ne§reyledigi varakada miinderic vesâyâ-yi sihhiyedir" [Recommandations médicales publiées dans le document diffusé par la commission formée à la direction de la Police contre le choléra| Tasfir-i Efkâr, No. 318,3 RA. 1282 [27 juillet 18651.

132

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YILDIRIM

nettoyage des vêtements et du linge pendant les épidémies et les maladies contagieuses, notamment les épidémies de choléra 1 . Une des produits désinfectants conseillé à la population et qu'il était facile de se procurer était la chaux. Pendant l'épidémie de 1893-1894 à Edirne, on exigea de peindre à la chaux les cuisines ainsi que les restaurants de kebab, les boutiques de primeurs, les coiffeurs et les tavernes. À l'apparition de la maladie dans une maison, il était recommandé de verser de la chaux brûlante dans la chambre du malade en attendant l'arrivée du docteur, de désinfecter les toilettes et les seaux avec de la chaux ou des produits conseillés par le médecin et, même en temps normal, de verser dans les toilettes deux fois par j o u r de la chaux diluée (un litre d ' e a u pour 100 g r a m m e s de c h a u x ) en refermant le couvercle 2 . A Istanbul aussi, on répandait de la chaux dans toutes les rues et les endroits susceptibles d'être porteurs de choléra. Les murs de la caserne Selimiye, touchée par le choléra, étaient passés à la chaux partout on nettoyait avec du chlorure de calcium et du lizol. On aspergeait les sols et les revêtements de solution sublimée à 10 et 5 pm. On versait de l'acide de soufre et de l'acide de nitrate de potassium en grande quantité dans les toilettes, ce qui e n d o m m a g e a i t les canalisations 3 . Le lieutenant c o m m a n d a n t M e h m e t Fahri E f e n d i , p r o f e s s e u r à l ' É c o l e de m é d e c i n e impériale, avait e n v o y é à la commission de médecine un rapport à e x a m i n e r , selon lequel un mélange d'acide phénique ne suffisait pas à éliminer les microbes et qu'il fallait ajouter à ce mélange à 2 % , un gramme d'acide chlorhydrique ou deux grammes d'acide tartrique. Selon lui, seul ce mélange aurait été à m ê m e de désinfecter les hôpitaux et casernes 4 . L'élimination des microbes par le feu était aussi une méthode souvent utilisée. En 1865, la grande épidémie de choléra qui toucha Istanbul prit fin avec le grand incendie qui ravagea Haskôy et ses environs. En août 1890, E§at Pa§a, ambassadeur à Paris, communiqua à la demande du sultan, les mesures prises à Paris pendant l'épidémie de choléra. Une des mesures concernant les maisons où il y avait eu des morts par choléra était de brûler les affaires se trouvant dans la chambre du malade et de désinfecter celle-ci 5 . Pendant la m ê m e épidémie, à Pangalti, dans la maison de Corci O s e b , de n o m b r e u x proches étaient décédés de choléra. Le pharmacien municipal Simon se rendit dans cette maison et, déclarant que le sultan l'ordonnait, fit brûler les affaires

1

E. Vallin: Traité des désinfectants

2

Niliifer Gokçe, art. cit., p. 5 3 , 5 6 .

3

et de la désinfection.

Dr. Mordtmann: "Die Cholera in der Türkei

Paris 1882, p. 476-481. und Konstantinople im Jahre

Saparatabdruck aus der Hygienischen Rundschau 1894, No. 7 et 8, p. 1 2 - 1 3 , 1 5 . 4 B O A . l . H U S . 2 , 1 RA. 1311 112 septembre 18931. 5

BOA. 1. HUS. 9 4 , 1 6 S. 1311 |29 août 1893).

1893",

LES

MESURES

DE

QUARANTAINE

133

présentes dans la maison, ce qui suscita des plaintes. Mais celles-ci restèrent sans suite, au motif qu'«une circulaire prévoyait que les affaires utilisées par les morts de choléra soient brûlées » ' . En 1901, la présidence du conseil, tout en donnant l'autorisation de brûler la maison d'une f e m m e qui était morte de choléra « au nom de la médecine et du bien-être public », demanda que la mairie du lieu verse 4 0 ou 50 livres, valeur estimée de la maison 2 . Alors que Sivas, Aydin et Bursa étaient en proie à l'épidémie de choléra en 1911, le Conseil national de santé publique et le Conseil de Santé déclarèrent qu'au vu des connaissances actuelles la mesure la plus efficace contre le choléra était le feu. Les affaires devaient être brûlées et, si leurs possesseurs étaient démunis, ils seraient indemnisés par la taxe pour le choléra. Quant aux personnes aisées, elles étaient dans l'obligation d'appliquer ce règlement. Les maisons dont les affaires étaient contaminées au point de ne pouvoir être désinfectées devaient être brûlées et leurs habitants dédommagés par la taxe pour le choléra. Ces principes furent communiqués à toutes les provinces par le ministère de l'Intérieur 3 .

L'utilisation

de l'étuve et les stations de

désinfection

En 1891, on fit venir de France deux étuves en provenance des usines Geneste et Hersher, qui furent installées dans les stations de quarantaine de Klazomen à Izmir et Kavak à Istanbul. En 1892, l'Empire ottoman qui suivait avec inquiétude l'épidémie qui s'étendait presque à toute l'Europe, commença à mettre en service de nouvelles stations de quarantaine dans un but préventif. Une station de quarantaine fut établie à Cisr-i Mustafa Pa§a 4 afin de placer en quarantaine les voyageurs arrivant en train d'Europe, et une étuve et un pulvérisateur furent fabriqués en urgence. À Yedikule, l'hôpital grec Balikli avait acheté une étuve du même type. L'étuve était une machine très chère, d'autant qu'au prix de fabrication s'ajoutait celui du montage. De ce fait, en 1892, le modèle d'étuve des usines Geneste et Herscher de Paris fut repris et commença à être produit aux usines des arsenaux. La première étuve produite fut essayée au palais, en présence du sultan. Très satisfait de ce qu'il voyait, Abdulhamid II félicita les employés et donna l'ordre nécessaire à la production de machines à étuve. Celles-ci étaient

1

B O A . Y. M T V . 8 7 / 1 9 0 , 2 6 C A . 1311[5 décembre 1893).

2

B O A . A. M K T . M H M . 5 6 7 / 1 1 , 3 0 RA. 1319 117 juillet 19011.

3

B O A . DH. ÎD. 5 0 - 2 / 1 , 7 B. 1329 | 4 juillet 19111.

4

Cisr-i Mustafa Pa§a est un bourg à 30 km au nord d ' E d i r n e , dont la dénomination actuelle est Svilengrad, situé aujourd'hui en Bulgarie.

134

N U R A N

Y 1 L D I R 1 M

envoyées dans les villes qui avaient besoin d ' é t u v e s et de pulvérisateurs, j u s q u ' à Beyrouth et au Hedjaz, et installées dans les stations de quarantaine. En août 1893, au début de l'épidémie de choléra à Istanbul, une étuve fut placée dans chaque hôpital d'Istanbul. Invité à Istanbul pour donner son avis sur la lutte contre le choléra, le docteur André Chantemesse de l'Institut Pasteur, en conclusion des observations menées dans la ville, déclara que l'une des méthodes de lutte les plus efficaces contre le choléra était la désinfection et qu'elle n'était pas appliquée à Istanbul. Il conseilla donc l'ouverture de trois centres de désinfection à Gedikpaça, T o p h a n e et Uskiidar. C h a n t e m e s s e souligna que pour l'application de la désinfection il fallait un expert en chimie ; sur son conseil, l'inspecteur des stations de fumigation de Paris fut invité pour superviser la désinfection. Mondragon arriva à Istanbul le 2 4 octobre 1893 et f u t n o m m é au poste d ' i n s t r u c t e u r pour les centres de fumigation. Dans les centres de désinfection construits à la hâte, on monta des étuves Geneste et Herscher de grande taille importées de Paris. Le centre de fumigation de Gedik Pa§a entra en service en décembre 1893, ceux de Tophane et Uskiidar en avril 1894. Jusqu'en 1908, ce fut Mondragon qui dirigea ces trois stations de désinfection dépendantes de la mairie d'Istanbul. Grâce aux efforts systématiques des stations de désinfection d'Istanbul, l ' é p i d é m i e de 1894 fut maintenue sous contrôle. Par la suite, les fonctions de désinfection f u r e n t p o u r s u i v i e s lors des é p i d é m i e s d e choléra et autres

maladies

contagieuses qui survenaient de temps à autre. Hors des périodes de maladies, des travaux de désinfection furent effectués à des fins sanitaires 1 . En dehors d ' I s t a n b u l , dès l ' a n n o n c e de la présence du choléra, on envoyait des docteurs et agents de désinfection 2 . En 1894, douze docteurs, deux agents de désinfection ainsi que des produits désinfectants et des pulvérisateurs furent envoyés à Sivas. La même année, alors que le choléra sévissait à Bursa et dans ses environs, le Dr. §eraffeddin (Magmumi) et le Dr. A g o p chargèrent des mules de pulvérisateurs et d ' u n e caisse pleine de médicaments contre le choléra et firent désinfecter les zones de la région de Bursa où le choléra avait fait son apparition. L ' a n n é e suivante sur la r e c o m m a n d a t i o n écrite de Bonkowski Pa§a, on mit à l ' o r d r e du j o u r l'envoi de quatre c o m m i s s i o n s ambulantes de santé dans une région comprenant les provinces d ' A d a n a , Alep et Damas, pour éliminer le choléra de l'est de l'empire. Le Dr. §eraffeddin fut ' Yildirim, Nuran: "Disinfccting Stations in Ottoman Empire", Science in Islamic Civilisation. Proceedings of the international symposia "Science Institutions in Islamic Civilisation " and "Science and Technology in the Turkish and Islamic World". E d . Ekmeleddin ihsanoglu-Feza Giinergun. Istanbul 2000, p. 267-277. Nuran Yildirim: "Tersane-i Âmire Fabrikalarmda T e b h i r Makinasi/EtUv Uretimi ve Kullanimi" |La machine de désinfection dans les usines des arsenaux impériaux/ La production de l'étuve et son usage], Dtinuve Bugiïnu ile Haliç Sempozyumu Bildirileri, 22-23 Mayis 2003 |Actes du colloque ''la Corne d ' O r , hier et a u j o u r d ' h u i ] , Ëd. S. Faruk Gonciioglu, Kadir Has Universitesi Y a y „ Istanbul 2004, p. 421-431. 2 BOA. Y. PRK. SGE. , 6 / 2 7 . 1 8 Z . 1311 [22 juin 1894|.

L H S M HSU R E S

I) H Q U A R A N T A I N E

135

nommé inspecteur pour l'une de ces commissions de santé. Quatre médecins et deux agents de désinfection étaient à leur tête. Chaque commission de santé reçut une caisse de médicaments et un pulvérisateur 1 . Après la proclamation de la Seconde Constitution, les stations de désinfection furent placées sous l'autorité de la direction générale de l'Assistance publique de Constantinople. En 1911, elles désinfectèrent 39 504 habitations, 607 écoles, 1333 lieux publics, 32541 voitures, 2981 tramways, 100 funiculaires, 1148 hammams,198 immeubles, 590 han, 60 hôtels, 8313 chambres de célibataire, 8741 boutiques, 23 798 barques, 236 bateaux à vapeur privés et publics. Dans ces lieux, au total 89 970 opérations de désinfection furent menées et 182 631 effets furent désinfectés. Les opérations de désinfection effectuées en particulier à Haskôy, Findikli et Balat, quartiers qui étaient des foyers de choléra, furent couronnées de succès et maîtrisèrent rapidement l'épidémie de choléra de 1910-19112.

Les réactions aux mesures de

désinfection.

Au début des années 1870, pendant l'épidémie de choléra qui dura près de quatre mois, Istanbul avait connu 4 000 décès. Les décisions prises par les pouvoirs publics pour lutter contre le choléra étaient source de peur et inquiétaient davantage la population que la maladie elle-même, comme l'observait George Washburn, enseignant au Robert College. Celui-ci mentionnait que le mot microbe, qui à cette époque était pour la première fois employé, créait le trouble dans la population et que les docteurs turcs, pour éviter la contagion des microbes, versaient dans le nez, les oreilles et la bouche des malades du chlorite de chaux 3 . Pendant l'épidémie de choléra de 1893, alors que commençaient à être mis en application les principes modernes de désinfection à Istanbul, une rumeur commença à circuler, selon laquelle sur l'ordre du sultan, non seulement les vêtements mais aussi les visages de certains malades du choléra étaient nettoyés avec du sulumen et de l'acide phénique et qu'on avait trouvé certains morts empoisonnés par eux. Ces bruits ne tardèrent pas à gagner le palais. Le 18 novembre 1893, des lettres envoyées aux ministères de l'Intérieur, de la Santé et de la Police, ainsi qu'à la préfecture précisaient que

1 2

Dr. Çerafeddin M a g m u m i , op. cit., p . 1 9 , 9 7 , 1 1 5 , 1 4 1 , 1 6 4

Direction générale de l'Assistance Slamboul 1911, p. 89-92.

Publique

de Constantinople.

Imprimerie Archak Garoyan

-I

George Washburn: Fifty Years in Constantinople and Recollections of Robert College. New York 1909, p. 54. sulumen et aksulumen veulent dire sublimé corrosif, bichlorure de mercure. *

Boston,

136

N U R A N

l'expression population

Y I L D I R I M

« désinfecter » signifiait nettoyer, mais que, comme

la

n'était pas habituée aux e x p r e s s i o n s « d é s i n f e c t e r » et •:A V I D O V I T C H A N D Z A L M A N

in

GREENBHRG

Context

As historians of colonial medicine have shown, colonial medicine occupied an important place within an expansive ideological order of the empires.' Colonial efforts to deal with the health of developing regions were closely linked to the economic interests of the colonizers. Health was not an end in itself, but rather a pre-requisite for development in conformity with these interests. Colonial medicine, or tropical medicine as it was called during late 19 th century, was concerned primarily with maintaining the health of Europeans living in the tropics, since they were viewed as essential to the success of the colonial project. The health of the colonized subjects was considered when their ill health threatened colonial economic enterprises or the health of the Europeans. Accordingly, the success or failure of health interventions was measured more in production terms than by measuring the levels of health among the native population. Another aspect of this logic was that colonial governments did little to build rural health serv ices for the general native populations. Rural services, when existing, were run by missionaries and focused primarily on maternal and child health. For most rural inhabitants, contact with Western medical services was limited to occasional medical campaigns such as mass vaccinations during infectious diseases epidemics. Yet, though this policy left a broad field for action for local traditional healers, colonial medical authorities generally discounted the medical knowledge of local populations, and at times persecuted indigenous health practitioners. 2 Another characteristic of colonial medicine was that they tended to be narrowly technical in their design and implementations. Health was defined in the pre-World War T w o era as mainly the absence of disease and could be' achieved by understanding and developing methods for attacking specific diseases, mainly infectious ones, at a time. A narrow disease approach to health and illness appeared to be cheaper and more manageable than efforts to

' There is a vast literature on the history of colonial medicine, for some overviews see: Marks Shula, What is Colonial about Colonial Medicine? And What has Happened to Imperialism and Health? Social History of Medicine 1997; 10: 205-219; Anderson W a r w i c k P , "Where is the postcolonial history of medicine?", Bulletin of the History of Medicine, 1998; 72: 522-530. There were important exceptions to this pattern, such as in colonial India w h e r e British doctors drew on local knowledge both for identification of local illnesses and for expending their pharmaceutical knowledge by incorporating local plants and herbs. See: Packard, Randall M, "Post Colonial Medicine," in Roger Cooter, John Pickstone (eds.), Companion to Medicine in the Twentieth Century, London and New York, Routledge, 2000, pp. 98-99. It is interesting to note that currently the W H O and other international health organizations have recognized the potential benefits in working with traditional healers in d e v e l o p i n g countries. For a recent o f f i c i a l d o c u m e n t which reflects this c h a n g e , see: W o r l d Health O r g a n i z a t i o n , WHO Traditional Medicine Strategy, 2002-2005, Geneva: World Health Organization, 2002

S M A L L P O X

AND

V A R I O L A T I O N

179

improve the general health and well-being of colonial subjects through social and economic development. Colonial authorities viewed both the provision of broad based health care and efforts to deal with the underlying social and economic determinants of illness as both impractical and unnecessary.

Health in

Palestine

At the turn of the 20th century Palestine was a distant part of the Ottoman Empire. Infectious diseases rates were high. Malaria and trachoma were common ailments. 1 As several historians of medicine described in their work on the everyday experiences of health and disease, we should remember that "epidemic streets" were an everyday encounter in many places for the local population, in Palestine as in other parts of the world. 2 High infant mortality rates, infectious diseases such as cholera, dysentery, malaria and tuberculosis, had a strong impact on daily life. On several levels, circumstances in Palestine were conducive to illness and disease. The geographical context did not provide an easy living, comprising a relatively small area with both swamps and deserts. Islamic pilgrims on their way to and from Mecca, provided steady influx of disease carriers. 3 Poverty, backwardness, absenteeism of the local elite and the frequent incompetence and indifference of the central government and the resulting lack of effective social administration further prepared the ground for an easy spread of diseases. T h e Ottoman public health system was influenced by increasing contact between the Ottoman Empire with European military, commerce and science, which triggered various reform movements ( T a n z i m a t ) . While reforms regarding health care institutions were hardly felt in Palestine, the economy experienced a marked improvement. Coastal towns, in particular,

For a recent account on health in Palestine mainly in the internar period, see: Borowy Iris, Davidovitch Nadav, "Health in Palestine: 1850-2000" in Borowy Iris, Davidovitch Nadav (eds.), Health in Palestine and the Middle Eastern Context, Dynamis, 2005; 25: 315-327. See also See Waserman Manfred, Kottek Samuel S. (eds.), Health and disease in the Holy Land: Studies in the History and Sociology of Medicine from Ancient Times to the Present, Lampeter, The Edwin Mellen Press, 1996. 9 See: Anne Hardy, The Epidemic Streets: Infectious Disease and the Rise of Preventive Medicine, 1856-1900, Oxford: Clarendon Press, 1993 -Î • Moslem pilgrimage to Mecca is still considered as a public health challenge, see: Memish ZA & Ahmed QA, "Mecca Bound: The Challenges Ahead," Journal of Travel Medicine, 2002; 9: 202 210.

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NADAV D A V I D O V I T C H A N D Z A L M A N G R E E N B E R G

benefited from the increasing European influence and improved infrastructure. 1 H o w e v e r , the o v e r w h e l m i n g majority of Palestinians remained peasants, vulnerable to social and economic hazards. At the beginning of the twentieth century, Palestine was still a relatively underdeveloped area even within an Arab context. 2 The f irst World War, which used Palestine as one of its battle grounds, disrupted local life. Ottoman authorities arrested both Arab and Jewish Zionist leaders, killing s o m e , conscripted tens of thousands of Arab farmers, deforested large areas and commandeered crops and livestock. As a result, the population declined substantially. Those who had remained faced starvation and political chaos and were an easy prey to infectious diseases. On

9

December

1917,

as

World

War

1 neared

its

end,

Jerusalem surrendered to the British forces. This act marked the end of four centuries of Ottoman rule. The most immediate task of occupying British forces was to provide food and medical supplies and to restore social and economic order. 3 According to the Interim Report on the Civil of Palestine,

Administration

the British forces found "a country exhausted by war. The

population had been depleted; the people of the towns were in severe distress; much cultivated land was left untilled; the stocks of cattle and horses had fallen to a low ebb; the woodlands, always scanty, had almost disappeared; orange groves had been ruined by lack of irrigation; commerce had long been at a standstill". 4 In July 1920 the British Mandate civil administration took over from the military. Public health was among the first concerns of the new rule, as expressed in various early written reports: "Both the military and the civil administrations have paid the closest attention to measures for safeguarding the health of the population. The Department of Public Health has a full) organised central and local establishment. The sanitation of the towns is efficiently supervised. A quarantine service is maintained ... at the present time the government maintains 15 hospitals, 21 dispensaries, 8 clinics and 5 epidemic posts". 5

' Schölch, Alexander. European penetration and the economic development of Palestine, 1856 82. In: Roger O w e n (ed.). Studies in the economic and social history of Palestine in the nineteenth and twentieth centuries, O x f o r d , Macmillan Press, 1 9 8 2 , 1 0 - 8 7 ; Kark, Ruth. T h e rise and decline of coastal town in Palestine. In: Gad G . Gilbar (ed.), Ottoman Palestine 1800-1914, Leiden, E J.Brill, 1990,69-89. 2

See Shvarts Shifra, The Workers Health Fund in Eretz Rochester: University of Rochester Press, 2002, p. 8 3

See: Smith Charles, Palestine Martin's Press, 1992, p. 68.

and the Arab-Israeli

Israel:

conflict,

4

2

Kupat nd

Holim,

1911-1937,

edition, New York : St.

See: An Interim Report on the Civil Administration of Palestine during the period 1st July, 1920—30th J u n e , 1921. United Nations Information System on the Question of Palestine. (http://domino.un.org/UNlSPAL.NSF. last visited, 18.1.2005) 5

United Nations Information System on the Question of Palestine

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The British government focused first and foremost on ridding Palestine of infectious diseases. The government embarked on installing new sewage and d r a i n a g e systems, invested in s w a m p drainage projects and hygiene education c a m p a i g n s , and established a school hygiene service. It also instituted the registration of all cases of infectious diseases, decreed several ordinances related to medical and public health matters such as licensing of various health care professions, pharmaceutical and food regulations and strengthening quarantine measures. All these measures, however, were only partially implemented or limited in scope, and investment was restricted. The British administration did not hesitate to rely on outside sources f o r the advancement of public health. 1 Although Palestine was not a British colony, it was run like a colony, without local representation and under tight supervision f r o m London. British authorities proceeded to govern the area much like a regular colony, without, h o w e v e r , incorporating it fully into its empire. T h e British M a n d a t e in Palestine hopelessly tried to accomplish two contradicting goals: to create a J e w i s h national home while also protecting the rights of the local A r a b population .What makes the British Mandate period a unique case study, is the coexistence side by side of the British administration, the Zionist bodies with their health organizations such as Hadassah and the General Sick Fund (Kupat Holim Clalit), religious related institutions, and other enterprises - each with its own agenda and a strong emphasis on public health issues. If w e add on top of that the local Palestinian Arab inhabitants, the Jewish people and their interaction, w e have an intricate network that demands further investigation into the complexities of the country's social history. Meanwhile the A r a b and the growing Jewish communities cooperated to some extent with British institutions but in parallel retained and built up internal q u a s i - g o v e r n m e n t a l bodies. T o sum up the situation: "interwar Palestine w a s one territory, inhabited by two ethnic communities of three religions, governed by four administrative structures." 2 In the next sections, we will take a specific case study in order to illuminate these complexities. W e describe a unique smallpox outbreak and its control by the British Authorities, as it unfolded. But first some background on smallpox in Palestine and the British Public Health Administration.

' For a general overview of the British administration in Palestine, including public health s e t also: Naomi Shepherd, Ploughing Sand: British Rule in Palestine 1917-1948, New Brunswick, 1999.

9

See Borowy, Davidovitch, p. 318.

NADAV D A V 1 D 0 V I T C H A N D Z A L M A N G R E E N B E R G

182

Smallpox

in

Palestine

S m a l l p o x , a viral disease that w a s officially eradicated in 1980, w a s an important i n f e c t i o u s disease d u r i n g history. 1 It is very c o n t a g i o u s , resulting usually in a b o u t 3 0 % mortality. It w a s also the first disease a g a i n s t which a vaccine was developed by Edward J e n n e r in 1796 as an empirical tool since the cause of the disease remained u n k n o w n . In Palestine, several outbreaks w e r e recorded during the 19 t h and early 20

th

c e n t u r i e s , as well as s p o r a d i c cases i m p o r t e d f r o m e n d e m i c a r e a s . 2 As

described a b o v e , in a similar way to other infectious diseases, o n e of the main routes of infection w a s the M o s l e m pilgrimage to M e c c a . During the Ottoman rule, vaccinations against smallpox w e r e carried only sporadically. According to an estimate only a b o u t 10 percent of the local population w a s vaccinated. 3 T h e British health services f o r Palestine c o m m e n c e d their activities in D e c e m b e r 1917 after the occupation of J e r u s a l e m and J a f f a , when the military c a m p a i g n in Palestine w a s still u n c o m p l e t e d . A c c o r d i n g to the annual report of the British d e p a r t m e n t of health "there w e r e f e w relics to be f o u n d of any p r e - e x i s t i n g G o v e r n m e n t H e a t h S e r v i c e s , a n d t h e t e s t i m o n y of p r e - w a r residents c o n f i r m e d the absence of any such organization". 4 W h i l e this British description can be regarded as biased, it is customary to say that d u e to lack of c o m p r e h e n s i v e and coordinated medical services under O t t o m a n rule and the h a r s h c o n d i t i o n s d u r i n g t h e First W o r l d W a r , British o f f i c i a l s a r r i v i n g in Palestine w e r e c o n f r o n t e d with a poverty and disease stricken population. 5 In 1922 the British u n d e r t o o k the first c e n s u s of the m a n d a t e . T h e population was 752,048, comprising 589,177 Muslims (78%), 83,790 Jews (11%). 7 1 , 4 6 4 Christians ( 1 0 % ) and 7 , 6 1 7 p e r s o n s ( 1 % ) belonging to other groups. 6 A s d e s c r i b e d a b o v e , both J e w i s h a n d A r a b c o m m u n i t i e s e x h i b i t e d a high incidence of disease and f a m i n e that raised mortality rates a m o n g all s e g m e n t s of society: M u s l i m , Christian and J e w i s h .

' O n the history of smallpox and its eradication see: Fenner F, Henderson D A , Arita 1 et al Smallpox and its eradication. World Health Organization, Geneva, Switzerland 1988. 2 F o r example, in 1921, apart f r o m the epidemic described in this paper, one fatal case occurred in Ramleh where "a child of 2 years not vaccinated had recently c o m e f r o m Beyrouth [sic] where smallpox is prevalent." See: Annual Report of the Department of Health, Government of Palestine for the Year 1921. p. 12. ^ See: John MacQueen, "Smallpox and Variolation in a Village in Palestine, Lancet, 1926: p. 212. 4

Annual Report, 1921, p. I.

5

On health conditions in Palestine in the early years of the British Mandate, see also: Shvarts, Shifra, Brown T e d . "Kupat Holim, Dr. Isaac Max Rubinow, and the American Zionist Medical Unit's Experiment to Establish Health Care Services in Palestine, 1918-1923," Bulletin of the History of Medicine, 1998:72: 28-46. 6

Census, 1922. After a second census in 1931, the population had grown to 1,036,339 in total, comprising 761,922 Muslims, 175,138 J e w s , 89,134 Christians and 10,145 people belonging to other groups. There were no further censuses during the British Mandate Administrarion, but statistics were maintained by counting births, deaths and migration.

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183

The British administration in Palestine was quick to adopt public health legislation. Already on May 16 th , 1918, Public Health Ordinance No. 1 was released in order to "regulate the General Health Service of the country such as the practice of medicine; notification of infectious diseases and births and deaths; vaccination; burials; and general sanitation." 1 Soon after, more public health legislation followed with quarantine regulations, pharmacy, anti-malarial ordinance, water sanitation and more. Government hospitals with annexes for infectious diseases were secured in large cities. These legislations together with other administrative regulations served as the basis for putting into action public health measures. One of these administrative regulations was related to the sanitation of villages and health duties of mukhtars. The mukhtar, the traditional head of the village, had in the British administration (as well as during the Ottoman period) important responsibilities in sanitation and hygiene such as reporting infectious diseases and implementing isolation or quarantine as needed. On the other hand, mukhtars' willingness to cooperate with the British Health Department was subjected to local variations. These tensions between the health administration and local communities were expressed during the smallpox epidemic that broke in December 1921 in the southern part of Palestine, in a small village called Duwaimeh. Duwaimeh at that time was a small village lying "among the western foothills of the Judean range, four hours ride f r o m Hebron." The people there were described as "strong and healthy and well suited for the pursuit on which a large number of them depend for a livelihood, for they are thieves of considerable distinction." 2 On December 19 th , 1921, a delegation of British public health workers visited Duwaimeh, following the notification of a smallpox case in the village. After conducting their investigation, the public health officers were satisfied to hear that there was no other new case of smallpox. After examining the smallpox patient the public health delegation left the village. At the time they had not known that during their visit, 300 hundred children were kept hidden in the village and surrounding caves. These children were variolated by Shaheen, the local village healer, following the mukhtar's order. The healer took lymph from pocks of the original first case, a female servant of Husein the mukhtar, and inoculated the children on the dorsal aspect of the hand between the thumb and forefinger, according to the "traditional method of the country." 3 The servant was first

' Annual Report of the Department of Health, Government of Palestine for the Year 1921, p. 4. 2

John M a c Q u e e n , "Smallpox and Variolation in a Village in Palestine, Lancet, 1926: 212-215.

3

Annual Report, 1921, p. 12

184

NADAV DAVIDOVITCH AND ZALMAN GRBENBKRG

seen by a physician on Dec 13 th 1921. She was already in a pustular stage, taken into isolation in a tent some distance f r o m the village. What was not known by the public health administration was that already 300 children had been inoculated by the local healer using infected matter f r o m the initial case. According to the article describing the e p i d e m i c , one half of the children developed eruption, many were seriously ill, some had died. T h e rumors were spread by the m u k h t a r ' s enemies and quickly a hospital was established in the mukhtar's house, staffed by a doctor, nurses, a cook and servants. The British Health Department wanted to initiate an immediate vaccination c a m p a i g n . A c c o r d i n g to J o h n M a c Q u e e n , "The w o r k of vaccination was pushed o n , and in a short time most of the inhabitants had been vaccinated". Yet the vaccination campaign did not proceed according to the original plan. T h e British group needed to m a k e a "systematic h o u s e to h o u s e inspection" and also to search in close caves, corn bins, roofs, gardens... every hole had to be searched." A s can be seen in Figure 1 and 2, public health workers were actually playing hide and seek with the village's children. Probably adults were not satisfied as well with these new "intruders" and did not make their life easy. A p a r t f r o m the practical d i f f i c u l t i e s of c o n v i n c i n g the village c o m m u n i t y to vaccinate their children in order to control the smallpox o u t b r e a k , another problem e m e r g e d . A p p a r e n t l y the vaccination l y m p h "proved quite unsatisfactory." Only 172 out of 2 7 5 4 vaccinations s h o w e d positive results. The smallpox vaccine was not produced by the British Health Department, which had started its work in the country j u s t recently. T h e Health Department v\as cooperating with the Pasteur Institute in Palestine, established by Dr. Leo B o e h m . In 1913, Dr. Leo B o e h m , a young Zionist doctor w h o immigrated f r o m Russia to Palestine, established the 'Pasteur Institute f o r Health. Medicine and Biology in Palestine.' B o e h m , w h o 'borrowed' Pasteur's name without the permission of the French laboratory, visited Palestine in 1906, and was astonished by the fact that under prevailing circumstance at the time, anyone suspected of having been exposed to rabies needed to be sent to Cairo or Constantinople. 1

' B o e h m ' s rhetoric w a s in k e e p i n g with Z i o n i s t ideology that v i e w e d scientific k n o w l e d g e and t e c h n o l o g i c a l a d v a n c e m e n t as an i m p o r t a n t a v e n u e f o r realizing a J e w i s h Utopian s o c i e t y in P a l e s t i n e . B o e h m ' s activities as the h e a d of the Union f o r Mastery of H e b r e w (in H e b r e w , Igud le-Hashlatat ha-Ivrit) and as a key f i g u r e in c o i n a g e , a d o p t i o n and d i s s e m i n a t i o n of m o d e r n H e b r e w m e d i c a l t e r m i n o l o g y , w a s but a n o t h e r e x p r e s s i o n of B o e h m ' s view f o r t h e centra] p l a c e of s c i e n c e a n d m e d i c i n e in a n a t i o n a l - s o c i a l c o n t e x t . T h r o u g h o u t t h e y e a r s t h a t t h e l a b o r a t o r y o p e r a t e d o n an i n d e p e n d e n t b a s i s , p r o v i d i n g its s e r v i c e s to J e w s a n d A r a b s alike w i t h o u t d i s c r i m i n a t i o n , it o p e r a t e d u n d e r t h r e a t of c l o s u r e . I n t e r n a l t e n s i o n b e t w e e n t h e l a b o r a t o r y a n d British M a n d a t e i n s t i t u t i o n s a n d b e t w e e n the l a b o r a t o r y a n d o t h e r J e w i s h m e d i c a l institutions in Palestine - particularly H a d a s s a h , a f f e c t e d its o p e r a t i o n . O n B o e h m see: N a d a v D a v i d o v i t c h , " P a s t e u r in Palestine: T h e P o l i t i c s of the L a b o r a t o r y , " u n p u b l i s h e d p a p e r presented at the A n n u a l C o n f e r e n c e of the Israeli A s s o c i a t i o n f o r the H i s t o r y and P h i l o s o p h y of S c i e n c e , V a n L e e r Institute. J e r u s a l e m , 2 0 0 4 .

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185

After these poor results, fresh lymph was obtained f r o m Egypt with much better results. As expressed by the vaccinator: "The natives themselves were struck by its greater potency and came forward readily enough even to be vaccinated for the third t i m e . . . Vaccination with ' C a i r o ' lymph marked the turning point in the campaign." It is hard to tell how this description reflects accurately the response of the Duvvaimeh villagers, since no written material documenting their reaction to the continuous vaccination efforts has remained with us. Yet, probably the new vaccine's higher "take," meaning its greater efficacy, left a better impression. An important fact to consider is that the local healer who performed the variolation

of

the v i l l a g e ' s c h i l d r e n , w h i c h

brought

with

it

grave

c o n s e q u e n c e s , still retained his respectable position in the c o m m u n i t y . Shaheen, the local healer, was described in the British report of the outbreak, as a "distinguished looking gentleman of over 5 0 years of age." It is clear f r o m his descriptions by the public health officers involved that they respected his w o r k . H e was part of a family of traditional healers. Even a m o n g the Bedouins he was considered as p o w e r f u l , " h e was held to have skill and experience in his profession." Nevertheless Shaheen was sent to prison for a month "as a result of his misguided efforts to limit the spread of the disease". According to the British testimony, his reputation was by no means lessened but rather considerably enhanced by his p e r f o r m a n c e in Duvvaimeh and especially after his imprisonment.

Conclusion Scholarship focusing on the Palestinian A r a b population during the Mandate period mainly centers on the politics of Palestinian nationalism. Public health has remained relatively unexplored. Given the current political situation, it is not hard to understand that the literature that does exist on Palestinian Arab health and medicine focuses mainly on contemporary health conditions. Another problem in the historiography of health in Palestine is that most of the studies of the history of public health f o c u s on Zionist efforts. In most part they take an uncritical stance toward Western medicine, m a n y of t h e m remain in the realm of institutional history, they fail to emphasize the colonial dimension of health in that period and show how the Palestinian Arab community took part in this process. W e should remember that Western medicine entered Palestine already f r o m the 19 th century, but it would be simplistic to understand this entrance as a smooth victorious conquest. Similarly to David Arnold's observation on the

186

NADAV D A V 1 D O V I T C H A N D ZAL.MAN G R E E N B E R G

history of colonial medicine in India, "there was nothing inevitable about this process of medical colonization, nor w a s it uncontested". 1 Part of the power of the colonial m e d i c i n e d i s c o u r s e of the period lay in the m a n n e r in which m e d i c i n e conceived of itself as a s c i e n c e , based on c a r e f u l local observation a n d e s c h e w i n g the i l l - i n f o r m e d " s p e c u l a t i o n " of t h e p a s t and t h e r a n k "superstition" associated with local traditional concepts of disease and healing. P a l e s t i n e , like o t h e r p l a c e s , c o n t i n u e d t o h a v e s i d e by s i d e an i m p r e s s i v e c o l l e c t i o n of h e a l e r s , c o n v e n t i o n a l a n d u n c o n v e n t i o n a l , and a strong tradition of self help. A s s h o w n in this case s t u d y , traditional healers had a f u n d a m e n t a l position within the local social f a b r i c . T h i s position w a s challenged by the British a d m i n i s t r a t i o n , yet the health p e r s o n n e l respected t h e m and m o r e than o n c e tried to negotiate b e t w e e n d i f f e r e n t w o r l d s . T h e e n t r a n c e of Western medicine into Palestine, as in other colonial regimes, had its o w n political d i m e n s i o n s . M e d i c i n e and public health as p o w e r f u l a g e n t s of "civilization" were a crucial part of the establishment of colonial r e g i m e s and within this s c h e m e , vaccinations had a vantage position. Y e t this w a s not a simple and uncontested process. A l t h o u g h v a c c i n a t i o n s are c o n s i d e r e d as o n e of t h e m o s t i m p o r t a n t a c h i e v e m e n t s of m e d i c i n e in the 2 0 t h c e n t u r y , e v e n b e f o r e the d i s c o v e r y of antibiotics, through the course of history of m e d i c i n e , they h a v e , m o r e than o n c e , e n g e n d e r e d o p p o s i t i o n that has e v e n r e a c h e d t h e level of a civil r e b e l l i o n . 2 R e c e n t ! ) , there has been a g r o w i n g recognition of the potential e m b o d i e d in historical research on opposition to vaccination, especially in its ability to serve as a v ehicle f o r gaining better understanding of the politics of the body and its relation to the m o d e r n state. 3 A n importani p o i n t f o r historical u n d e r s t a n d i n g of t h e r e l a t i o n s h i p between the state, public health personnel a n d the population is t h e fact that f o r a long time the issue of vaccinations w a s an i m p o r t a n t c o m p o n e n t in the colonial s y s t e m . W e s t e r n e r s b r o u g h t with t h e m various v a c c i n e s with w h i c h they w a n t e d to i m m u n i s e local p o p u l a t i o n s . D e s p i t e their g o o d i n t e n t i o n s , m a n y t i m e s , this fact c a u s e d local p o p u l a t i o n s t o i d e n t i f y t h e v a c c i n a t i o n policy westerners wanted to institute, with a repressive and foreign r e g i m e .

' David Arnold, Colonizing the Body: State Medicine and Epidemic Century India, Berkeley: I Iniversity of California Press, 1993, p. 12 2

Disease

in

Nineteenth-

See for example: Judith Walzer Leavitt, The Healthiest City: Milwaukee and the Politics of Health Reform, Princeton. 1982, pp. 76-121, Nadja Durbach, " ' T h e y Might as well Brand U s ' , Working-Class Resistance to Vaccination in Victorian E n g l a n d " , Social History of Medicine, 2000; 13:45-62. 3 On the civic potential of the history of anti-vaccinationism, see: Robert D. J o h n s t o n , The Radical Middle Class: Populist Democracy and the Question of Capitalism in Progressive Era, Portland, Oregon, Princelon: Princeton University Press, 2003, pp. 177-220.

SMALLPOX

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VARIOLATION

W h i l e this d o e s not mean to u n d e r e s t i m a t e the t e n s i o n s controversies a m o n g the various healers in Palestine: c o n v e n t i o n a l

187 and vs.

traditional, J e w i s h , Muslim or Christian, European or local, in general the " p r i v a t e " aspects of health - self h e l p , n e t w o r k s of public health and traditional healers - continued to coexist and to have a strong influence on everyday life, and still do today. Recently health as a historical category has been integrated more fully into the Palestine/Israel historiographies. But concerns of medicine and disease were often overshadowed by the more immediate interests of scholars of the Middle East and Zionism in the political and diplomatic histories of Palestine / Israel. Much of this scholarship tries to understand the origins and dynamics of the Palestinian-Israeli conflict and the development that precipitated the emergence of the state of Israel. Yet the exploration of medicine and health cut across a variety of policy issues, in a way that can help to reconstruct a richer social history of Palestine / Israel. Public health and m e d i c i n e are, an important part of the Zionist project and Palestinian historiography. T h e intersection of h e a l t h , politics and c o l o n i a l i s m can c o n t r i b u t e to the construction of a socio-cultural history of disease in Palestine. In contrast to the simplistic view that western medicine 'conquered the natives' hearts, in fact reciprocal relationships between colonizers and local population were far more complex in regard to perceptions of sickness and health. A s shown in the Dawaimeh smallpox outbreak, despite the fact that the outbreak was contained and stamped out, various narratives continued to circulate among the population vis-à-vis the event. Although the local healer in the village was accused of being the agent responsible for spreading the disease and causing the death of many children, the healer's incarceration by the British for his conduct did not adversely affect his popularity among his neighbors, just the opposite. In addition the Dawaimeh outbreak, following the variolation of over 300 children, gives us the opportunity to analyze the last large smallpox e p i d e m i c resulting f r o m variolation d o c u m e n t e d and recorded in details during the 20th century.

188

NADAV DAVIDOVITCH AND ZALMAN GRHHNBHRG

1. Figs 1 and 2. British public health officer looking for hidden children during the vaccination campaign. The photographs were contained in an album of photographs found at the Public Health Central Laboratories in Jerusalem, documenting an outbreak of smallpox in Palestine, 1922. Lettering on the front of the album: "Anti-smallpox campaign Dawaimeh-Hebron (?). January-February 1922".

SMALLPOX

AND

VARIOLATION

Local Healer variolating a child. This traditional procedure was conducted by inoculating the dorsal aspect of the hand between the thumb and forefinger.

189

SORROW AND ILLNESS: 'MODERN' EXPRESSIONS OF DEATH IN OTTOMAN MUSLIM EPITAPHS OF THE NINETEENTH CENTURY Edhem ELDEM*

Various aspects of the process of modernization undergone by Ottoman society in general and by individuals in particular have been studied to this day; death and its representations, however, still remains one rich and largely untapped domain in this respect. 1 This is all the more unfortunate if one considers that the immense wealth of information contained in thousands of epitaphs from the end of the eighteenth century and most particularly from the last century of the Empire is likely to reveal a number of fascinating aspects of changes in mentalities. I will, in this short piece, try to concentrate on a fairly large database of some 2,500 epitaphs—the base of a joint project with Nicolas Vatin 2 —and try to narrow it down to the specific issue of modernity as expressed through references to illness and to medical concerns surrounding death. Generally speaking, this particular aspect of modernity is part of a larger process of transformation undergone by Ottoman epitaphs from the eighteenth century on. Starting with the passage from Arabic to Turkish, generalized from the sixteenth century on, and with the gradual expansion of the epitaph from the eighteenth century on, Ottoman tombstones had acquired a much greater degree of expressiveness, geared towards a greater narrative detail focusing on two essential elements: death and identity. Indeed, better defining the deceased individual was probably one of the principal goals of Ottoman tombstones, to the point of turning them into social markers rather

*

Prof. Dr. Edhem Eldem, Bogazi5i (Bosphorus) University, Department of History. E-mail: [email protected] ' A typical, if classic, example of the use of death as an indicator of changing mentalities is: Philippe Aries, Western Attitudes toward Death, from the Middle Ages to the Present (Baltimore 1975). 2 Nicolas Vatin and I are currently working on a project concerning the evolution of Ottoman Muslim epitaphs from the fifteenth century down to the twentieth century, with, as its underlying theme, the correlation between these texts and changes in mentalities.

192

H D H E M

H L D H M

than purely religious monuments. 1 Conversely, the contextual backdrop, for t h o s e epitaphs which were not content with m o r e or less d e v e l o p e d biographical information, revolved around the notion of death, providing the reader/visitor with a number of information and considerations on the subject. T h e c o n t e n t of t h e s e r e f l e c t i o n s could

vary w i d e l y , f r o m a

rather

'conventional' emphasis on the ineluctability of death to images of a hoped afterlife, and f r o m the expression of grief at the departure of the loved one to details concerning the circumstances under which the event took place. In the course of this study, I will focus exclusively on this last dimension of the phenomenon, and, more particularly, on the contextualization of the causes of death related to some explicit or implicit form of illness. It would be wrong to think that a reference to illness was a staple element of Ottoman epitaphs. The phenomenon concerns only about 4 0 0 of the 2,500 epitaphs contained in our sample. True, the proportion is certainly not negligible, but it should be noted that only one quarter of these cases refer to a specific illness, while the remaining three quarters mention either an unspecified disease as the cause of death or make an implicit reference to illness by mentioning (unsuccessful) treatment or else simply by noting that "no remedy was found" to what was evidently some kind of ailment. 2

On this issue, see Nicolas Vatin, "Sur le rôle de la stèle funéraire et l'aménagement des cimetières musulmans d'Istanbul," A. Temimi (ed.), Mélanges Professeur Robert Mantran, Zaghouan, 1988. pp. 293 297; Edhem Eldem, "Degi§en Öliim. Osmanli Mezar Ta§larinda Gelenek ve Modernlik," Toplumsal Tarih, 110, February 2003, pp. 46-49. 2

The following cemeteries have been used on the basis of previous publications: Kuçiik Ayasofya (Jean-Louis Bacqué-Grammont, Hans-Peter Laqueur and Nicolas Vatin, "Stelae Turcicae I. Kiiçiik Aya Sofya," Istanbuler Mitteilungen 34 (1984), pp. 441-540); Sokoluu Mehmed Pa§a at Kadirga Limani and Eyiip, and Bostanci Ali (J.-L. Bacqué-Grammont, H.-P. Laqueur and N. Vatin, Stelae Turcicae II. Cimetières de la mosquée de Sokollu Mehmed Paça à Kadirga Limani, de Bostanci Ali et du tiirbe de Sokollu Mehmed Paça à Eyiib, Istanbuler Mitteilungen, Beiheft 36, Tübingen, 1990); §ile (J.-L. Bacqué-Grammont and N. Vatin, "Stelae Turcicae III. Le musée de plein air de §ile," J.-L. Bacqué-Grammont, B. F l e m m i n g , M. Gökberk and 1. Ortayl i (eds), Türkische Miszellen. Robert Anhegger Festschrift-ArmaganiMélanges, Istanbul, 1986. p p . 4 5 - 6 1 ) ; Karacaköy (J.-L. Bacqué-Grammont and N. Vatin, "Stelae Turcicae IV. Le cimetière de la bourgade thrace de Karacaköy," Anatolia Moderna / Yeni Anadolu,\[ (1991), pp. 7-27); Merdivenköy (J.-L. Bacqué-Grammont et al., "Le tekke bektachi de Merdivenköy." Anatolia Moderna / Yeni Anadolu,II (1991), pp. 29-135); Seyyid Bilal, Pervane Medresesi and Sinop Müzesi at Sinop (J.-L. Bacqué-Grammont and N. Vatin, "Stelae Turcicae VI. Stèles funéraires de Sinop," Anatolia Moderna / Yeni Anadolu, III (1992), pp. 105-207); Molla Giirani and Piri Mehmed Pa§a (J.-L. Bacqué-Grammont et al., "Stelae Turcicae, VII. Deux cimetières près de Findikzade à Istanbul : Molla Gürani et Piri Mehmed Pa§a ," Anatolia Moderna ! Yeni Anadolu, V ( 1 9 9 5 ) , pp. 233-318); Örcün (Ahmed Nezih Galitekin, Osmanli Dönemi Oölcük Mezar Taçlari, Gölcük, n.d.) ; Diyarbakir (M. Mehdi ilhan, "Diyarbakir'in türbe, yatir ve mezarliklan," J.-L. Bacqué-Grammont and A . T i b e t (eds), Cimetières et traditions funéraires dans le monde islamique, Ankara, 1 9 9 6 , 1 , pp. 179-221); Bursa (Demet Karaçag, Bursu'daki 14.-15. Yiizyil Mezartaçlari, Ankara, 1994); Sarajevo, Mostar and Travnik (Mehmed Mujezinovic, Islamska Epigrafika u Bosni i Hercegovini, Sarajevo, 1974-1982); various cemeteries of the Aegean region (GUI Tunçel, Bati Anadolu Bölgesi Cami Tasvirli Mezartaçlari, Ankara, 1989). Epitaphs from three cemeteries have been collected by the author i n view of future research and publication: Rumelihisari §ehitlik Dergâhi (in collaboration with Giinay Kut); Yahya Flendi Dergâhi and Nazperver Usta Sibyan Mektebi.

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Starting with the simplest and vaguest form of reference to illness, "derd"

is without any doubt the term, of Persian origin, most frequently

encountered on epitaphs. True, the term in itself is extremely vague, describing a wide range of feelings, from outright pain to trouble or annoyance. 1 Yet, within the specific context of funerary epitaphs, the term appears to have been used rather systematically and homogeneously as a description of illness or, more accurately, of the pain and suffering caused by illness. 2 The idea is further reinforced by the fact that the term is sometimes defined by the specific name of an illness (derd-i taun, the suffering of the plague; derd-i sill, the disease of tuberculosis...) and very often combined with the idea of the unnamed disease being incurable (derdine

gare/derman

bulamamak, to be unable to find a solution/remedy to one's suffering/illness). The popularity of this vague notion of disease is reflected in a number of stock verses or formulae centered on "derd". These formulae, a typical feature of the Ottoman funerary tradition, seem to have come into being in the eighteenth century, and from then on spread throughout the Ottoman lands, gradually becoming a staple element of modest gravestones until the end of the Empire. Their popularity evidently stemmed from the fact that they added a poetic touch to the epitaph, often bringing a welcome contextualization to some particular aspects of the deceased's life and death, while at the same time facilitating the interactive process between the author (speaking in the name of the dead or of his relatives) and the reader (viewed as the individual visitor or, more generally, as the community of believers). Repetitive as they may have been, these formulae benefited from a form of flexibility consistent with the oral nature of their composition, enabling stonecutters and customers alike to modify an occasional word or two to create slight variations in otherwise identical verses. 3 In the particular case of suffering/illness, one finds four such formulae centered on the notion of "derd":

R e d h o u s e ' s Lexicon gives the following definitions of the term: " 1 . Pain, suffering, agony. 2. D i s e a s e , illness. 3. A f f l i c t i o n , w o e ; trouble. 4 . An annoyance. 5. A g r i e v a n c e " (James W . Redhouse, A Turkish and English Lexicon, Constantinople, 1921, p. 895). 2

With the exception of some rare cases where "derd" refers to the suffering and sorrow of those who are left behind, as in "dertli valident" (my sad/sorrowful/pained mother). 3 M o s t of these formulae can be f o u n d in Ernst P r o k o s c h , Osmanische Grabinschriften. Leitfaden zu ihrer sprachlichen Erfassung, Berlin, 1993. For a discussion of the uses and creative processes behind these f o r m u l a e , see E . E l d e m , " L ' é c r i t funéraire ottoman : création, reproduction, transmission," Oral et écrit dans le m o n d e t u r c o - o t t o m a n . R e v u e du M o n d e Musulman et de la Méditerranée, 75/76 (1996), pp. 65-78.

194

K D HEM K LD H M derdine gare/derman gengligine/dunvasina

bulmayan1 (generally combined with doymayan2 and/or muradina ermeyen3

Nagehan bir derde du§diim bulmadim asla deva Kimse me'mul etmesin bu dehr-i faniden vefa Bi karar etdi nihal-i dmriimii bad-i ecel Hayiflar kim tazelik halimde oldum mubtela4 Ah kim bu alem igre ben de $adan olmadim Qaresiz bir derde dumdum def'e imkan bulmadim Gegdi omriim $u cihanda gormedim sihhat ytiziin Bir misafir gibi geldim ben de mihman olmadim5 Ah ne yank oldu bana gengligime doymadim fare olmaz derde du§diim def'e imkan bulmadim Yakdi yandirdi vucudum ¡¡ehrini kahr-i elem Gill gibi soldum cihanda ne oldugum bilmedinfi It is difficult to date the appearance of such general references to ailment in Ottoman tombstones. If one is to consider the fifteenth-century tombstones of Bursa, it appears that apart from one direct reference in Arabic to the plague. 7 illness is never mentioned. One could perhaps assume that the qualification of the deceased as "young" (a'sh-shabb) or as a "martyr" (a'shshahid) —due to the extension of the concept of martyrdom to violent deaths, including epidemics such as the plague 8 — could be included in a very flexible count of such cases, but the fact remains that a detailed account of the circumstances of death was not to appear before much later, most probably as the combined result of the passage to Turkish and the growth of the epitaph The earliest reference to "derd" in our sample dates from 1703; the first

' W h o could find no solution/remedy to his ill (9 o c c u r r e n c e s b e t w e e n 1177/1763 and 1284/1867). 2 Literally, " w h o has not become satiated with his youth/world," meaning " w h o has not enjoyed the pleasures of youth/life." generally associated with the youth of the deceased. 3 Literally, " w h o has not attained his wishes," meaning, " w h o has died unfulfilled," with an implicit reference to the \ o u n g age of the deceased. ^ 1 suddenly fell in pain « i t h o u t ever finding a remedy / No one should expect constancy f r o m this mortal world / The w ind of death has uprooted the sapling of my life / W h a t a pity that 1 should have been tested during my youth (9 occurrences between 1181/1767 and 1331/1912). ^ Alas, I too have not found pleasure in this world / 1 have fallen into an incurable pain, unable to do away with it / My life has passed in this world without seeing the f a c e of health / I have c o m e as a guest and have never received hospitality (1278/1861). 6

Alas, what a pity of me. as I have not lived my youth / 1 have fallen into an incurable pain, unable to do away with it ' T h e force of ailment burnt the city of my body / 1 wilted like a rose in this world, not knowing what had become of me (19 occurrences between 1238/1823 and 1325/1907). 7 8

Tuwuffi bi't-ta'un

(He died of the plague, 792/1389).

E. Kohl berg, "Shahid," The Encyclopaedia 207.

of Islam, Leiden-London, 1986, vol. I X , pp. 203

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195

formulae including the term go back to the mid-eighteenth century. Somewhat earlier occurrences could probably be found, but, by and large, it seems likely that these references should have started to appear at around that juncture. The term survived until the end of the Empire, especially on modest epitaphs, where formulaic poetry survived much longer than among the elite, who systematically moved towards a more sophisticated and original form of verse. Typically in those circles and at later dates, the word " d e r d " would often be replaced by a more specific description of a particular disease or would be used with much more bombastic qualifying epithets. 1 This is probably the reason why synonyms started to appear in the nineteenth century to the all-encompassing term "derd." "Hastalik" "hasta"

(illness),

(patient, ill) and the corresponding verb "hastalanmak" (to become

ill) thus appears in the 1820s as one of the most T u r k i s h - s o u n d i n g expressions of the same concept. 2 Other terms were also frequently used, also eliminating the ambiguity of "derd"

between illness and suffering: illet and

maraz, both Arabic terms describing illness and disease, came to be used in the nineteenth century, but more particularly in the last decades of the Empire. The plural of the latter term, emraz (diseases), was even the inspiration for two formulae widely used throughout the nineteenth century: Emr-i Hakla durlii emraz geldi benim

tenime

Bulmadi sihhat viicudum sebeb oldu

mevtime3

Hey meded bulunmadi

emrazinin bir garesi

GenQ ya$inda tekmil imi§ meger kirn vadesi Nice ruhani ve cismaniyle

tedbir

etdiler

Gelse Lokman neylesin dolmu§ ecel

peymanesi4

A s in "faresiz bir derd-i mihnet-mende olub mubtela" (subjected to an incurable disease of great affliction, 1299/1882) or "gent; iken mubtela oldugu derd-i deva na-pezirden tahlis-i giriban edemeyerek" (incapable of freeing himself f r o m the incurable disease he contracted at his young age, 1322/1904). 2

The term is of Persian origin, but is certainly the most commonly used in colloquial Turkish. "Hastalanub bulmadi gare" (s/he became sick and f o u n d no remedy, 1241/1825) "hastalanub eyledi ruhun teslim" (s/he fell ill and surrendered his/her soul, 1248/1832) "Hasta bir gonea-i nev-res fidan / Ku$ misali eyledi azm-i drum" (A sick rosebud just opened / Like a bird flew to Heaven, date illegible, second half of the 19" 1 century). 3

By G o d ' s decree various illnesses befell my body / M y body never regained its health and caused my death (37 occurrences between 1237/1822 and 1309/1891). 4 Woe is m e , no cure w a s found to his illnesses / Despite his young age his term had come / They tried many cures, both spiritual and material / But had Lokman been there, what could he have done, his cup of death had been filled (1257/1841, 1265/1848,1288/1871). (Lokman is the name of a mythical character with occult medical powers).

196

EDHEM

ELDEM

The picture would not be complete without a mention of the frequent use of terms specifically underlining the feeling of pain and suffering endured by the deceased. The use of adjectives qualifying the illness (¡edid, ciger-suz,

violent;

t o r m e n t i n g . . . ) or that of words of greater intensity than " d e r d "

(mihnet,

a f f l i c t i o n , torment; zahm,

blow, stroke of an instrument) are

frequently encountered in epitaphs describing the pain endured by an ailing individual. Far more important, however, is the mirror image of suffering, that of the obviously unsuccessful treatment to which the dying person was subjected. In most cases, the use of such descriptions is purely rhetorical, since the accounts converge toward a previously agreed notion of incurability, often associated with the Islamic principle of the ineluctability of death. Staple terms such as "gare" (solution, remedy), " i / a f " (medication) o r " d e v a " ( m e d i c i n e , r e m e d y ) occur very f r e q u e n t l y , 1 often overlapping with the terminology of pain and ailment. Needless to say, remedies and solutions appear only in the negative context of their absence and uselessness. Part and parcel of these expressions of despair are doctors (tabib, pi. etibba), portrayed as helpless in the face of disease: " m u d a v a t - i etibba olmadi

derman"

"gare-sazi oldular

generally

derdine

hig

(the remedies of doctors were no remedy to his illness),

olmadi

hayfa

tabib"

aciz ilac kar etmedi

(alas, the doctor was of no help); " e t i b b a

eyvah"

(alas, the doctors were helpless and

medication was of no use). One f o r m u l a —albeit a very infrequent o n e dwells specifically on the desperate efforts of doctors and patient alike in their fight against death: Ni§an if tin degildi mezarima Ecel geldi bilmedim

bu ta§

tabibler He eyledim

savaf-

Interestingly, the helplessness ascribed to doctors does not imply a negative appraisal of the medical profession. Death being ineluctable a n d , according to Islamic orthodoxy, the result of a divine decree, there seems to have been no point in blaming physicians for their failure. T h e image of Lokman, the mythical patron of the profession, is there to remind the reader of the pointlessness of fighting against the appointed hour of death

(ecel):

"oliime gare bulunsa Uikman bulurdu" (had there been a remedy to death, ' " f a r e " and its derivatives, such as garesiz (helpless, incurable) are found 83 times, followed by " i / a f " (30 times) and ".leva" (28 times). "This stone was not placed on my grave as a sign / Death caught me unaware as I fought for three days with the doctors." It should be noted that the expression "tabibler He eyledim savaf is s o m e w h a t a m b i g u o u s , as it can be read either "I fought with (in collaboration with) the doctors" or "I f o u g h t against the doctors." H o w e v e r , it is quite improbable that a formulaic verse on an epitaph should describe the deceased combating doctors in his struggle for life. T h e very popular western theme of doctors killing rather than curing their patients —a specialty of Moliere's plays— does not seem to have its equivalent in Ottoman literature. 2

SORROW

AND

ILLNESS

Lokman would have found it); "ferman-i ilahi boyle bulamaz

gareler

tahlis-i

giribanima"

197 imi§ olsa

Lokman

(thus was the divine decree; even

Lokman would have found no remedy to save me); "pare bulmaz

buna

Lokman hekim" ( | e v e n | Lokman the physician would not find a remedy to this). Quite to the contrary then, doctors —with Lokman as their e p i t o m e were used as a telling proof of every man's inescapable fate, an argumentation that did not question their professional skills and competence. A form of criticism, very rarely expressed, seems to have been directed against the illusory hope created by the presence of doctors: "bir acaib derde dumdum bulmadim asla deva / derdim efzun oldu umdukga etibbadan

vefa" (I fell into

a strange ailment and could never find a remedy / My pain grew stronger as I hoped for help from the doctors); "verir iken etibba sihhat iimidi siyaha

saldi

binlerce

derdmendi"

na-gah/hak-i

(while the doctors dispensed hopes of

health, suddenly / thousands of sufferers were thrown into the dark soil). Consistent with an orthodox vision of death as both ineluctable and desirable, one popular formula inverts the worldly order of things, and presents death as the final remedy to the painful experience of life: " I g d i m ecel tabibelLokman'a

§erbetini

hacet kalmadi" (I have drunk the medicine of death, I have

no need for doctors/Lokman anymore). Naming the disease is, as suggested earlier, rather infrequent. A total of 101 epitaphs display such precision, three quarters of which are monopolized by four m a j o r illnesses: the plague (veba, (verem,

taun;

33 cases) tuberculosis

sill; 21 cases), childbirth (vaz-i haml; 17 cases, obviously not an

illness but a medical condition) and smallpox (gigek,§iikufe;

10 cases). The

remaining 19 cases are distributed among a variety of diseases, described with more or less precision: croup ( b o g m a c a ; 1 case), pleurisy (zatiilecenb\ 1 case), pneumonia (zatiirree\ 1 case), pulmonary illnesses (zayk-i sadr, sadr\

2 cases), diphtheria (ku§palazi\

illet-i

2 cases), fever ( h u m m a ; 1 case),

hemorrhoids (basur, 2 cases), anthrax (^irpenge; 2 cases), heart failure (illet-i kalbiye;

2 cases), gastrointestinal diseases (illet-i mide\ 1 case), apoplexy

(niizul;

3 cases), and melancholy (melamet,

derd-i

i§tiyak;

2 cases).

Interestingly, the mention of only one particular disease seems to have been systematically avoided on the epitaphs: cholera, the first epidemic of which, in 1831, was followed by frequent and extremely violent outbreaks throughout the second half of the nineteenth century and well into the twentieth. Not a single tombstone seems to bear any reference to this illness, a fact that could be explained by the superstitious practice of not naming a much feared

H DHEM

198

danger, 1

F.LDHM

and by the use of the term veba (the plague, but also, originally,

any epidemic) to describe this new calamity that had come to replace the bubonic plague, which had effectively disappeared from the Ottoman Empire by the second quarter of the nineteenth century. 2 The predominance of certain illnesses over others is evident from the fact that formulaic verses seem to have been developed only for a very limited number of cases, namely the plague, death at childbirth, and tuberculosis: Nev-civanlikda terahhiim etmedi taun bana Ser-te-ser yakdi viicudum $ehrini kildi fencP Hamlini vaz eyler iken eyledi terk-ifena 01 Habibin hurmeti igiin magfiret kil ya Rabbena Alub masumun bile azm etdi bab-i cinana Rahmetine miistagrak ede gani Bari Huda4 Ceng ya$imda cihan ba§ima dar oldu illetim verem idi akibet mevtime sebeb

oldu5

The importance of the plague is further enhanced by the fact that some 'neutral' formulae could be modified and adapted to this particular context by simply replacing the very neutral word "ecel" (the term) by "veba"

(the

plague): Dar-i dunyada civan iken gezerdim bir zaman Nagehan geldi ecel/veba etdi yerim bag i cinan Fani dunyada muradun almadan terk eyledim Valideynim eylesinler bir zaman ah u figan6

' Quite strikingly, the use of the word cholera ( k o l e r a ) seems to have been systematically avoided, including in some of the official correspondence, where it w a s generally referred to with the euphemistic formula of the "known illness" (illet-i malume), or even on a medal issued on the occasion of the 1866 Sanitary C o n f e r e n c e , held just after the end of the 1865 cholera epidemic, where it simpK did not appear, as if not uttering the name of the calamity would somehow exorcise it (Eldem, Pride and Privilege. A History of Ottoman Orders, Medals, and Decorations, Istanbul, 2004, pp. 243-244, 248; E l d e m , Death in Istanbul, pp. 204-207; Nuran Y i i d i n m , "Kolera Salginlari." Diinden Bugtine Istanbul Ansiklopedisi, Istanbul, 1994, vol. 5, pp. 45-47). 2

T h i s is almost certainly the case with t w o epitaphs f r o m Istanbul, dated 1274/1858 and 1282/1865, which display the word " v e b a " to describe what was in fact cholera.

"The plague has had no mercy on me in my young age / It burnt the city of my body from one end to the other, killing it". The formula appears on two instances in 1228/1813. 4

"While giving birth she left this mortal world / 0 my Lord have mercy on her f o r the love of the Prophet / She left for the gates of Heaven, taking her innocent [child) with her / May God, the Creator, drown her in His grace." T w o instances found in 1223/1808 and 1256/1840. 5 " A t my young age, the world b e c a m e a place of suffering to me / Tuberculosis was my illness, finally it caused my death." T w o instances found in 1258/1842 and 1263/1847.

6 I once roamed this world as a youth I Suddenly the plague came and made paradise my abode / M y desires unfulfilled in this world, I left / May both m y parents sigh and cry for some time (1228/1813, see E. Eldem, Death in Istanbul. Death and Its Rituals in Ottoman-Islamic Culture, Istanbul, 2005, pp. 200-201). Out of 10 occurrences of this formula, between 1214/1799 and 1307/1889, only one displays this adaptation to the plague.

SORROW

AND

ILLNESS

199

Yet another formula displays a typical example of the flexibility and adaptability of these stock verses; four versions of the same poem exist, differentiated from one another only by the interchangeable name of the disease: the plague (taun or xeba). smallpox (gigek), or tuberculosis (vercm): Cihana doymadan canun Ecel aldi giribamm TaunlVebalQigeklVerem

zahmina du§ oldum

Boyle emr etdi Siibhanim) In absolute terms, it would be wrong to claim that naming the disease was in itself an innovation of the later centuries: at least one inscription from Bursa, dated 792/1389, clearly mentions the plague as the cause of death. Yet, considering that the next occurrence of the same disease in our sample dates from 1184/1770 and that the highest concentration is to be found between 1227/1813 and 1252/1836, there is no doubt that a direct reference to a specific disease was seldom seen before the mid-eighteenth century. The other diseases seem to conform to this pattern. Tuberculosis appears rather early, in 1129/1716, but apart from two other instances in the eighteenth century, all other cases belong to the nineteenth and early twentieth centuries. Despite a first appearance in 1197/1783, smallpox cases are concentrated in the first half of the nineteenth century. Death at childbirth may go back as far as 1188/1774, but a real concentration is witnessed only in the second half of the nineteenth century. As to the remaining diseases, they are all to be exclusively found in the nineteenth century, with a particular intensity in the second half of the century. Needless to say, these figures have absolutely no statistical significance beyond the relative overrepresentation of 'major' diseases, such as the plague, smallpox, and tuberculosis. In fact, it seems that the mention of a disease was so marginal as to render highly unlikely any correlation between epitaphs and the medical reality of the time. A concrete example will illustrate this point. In 1227-1228/1813, Istanbul was hit by one of the most severe plague outbreaks of its history, which claimed at least 100,000 victims,

"Before i could even live m y life / Fate has caught m e by the collar 11 have come across ihe plague/smallpox/tuberculosis / For such was the decree of my Lord." Four occurrences have been noted: the plague as taun (1184/1770); the plague as veba ( 1 2 5 0 / 1 8 3 4 ) ; tuberculosis (1244/1828); and smallpox (1245/1829).

200

EDHEM

ELDHM

representing a p p r o v i m a t e l y one fifth of the population. 1 This peak in mortality is immediately reflected in our s a m p l e , which includes on the average five times more epitaphs for that particular year than for any of the five years preceding or following the epidemic. Yet only 6 of the 60 epitaphs collected for that calamitous year bear a mention of the plague, while not a single one of the remaining 5 4 makes the slightest reference to even the vaguest notion of disease. 2 Basing himself on M o l t k e ' s remarks, Laqueur suggests that the reason may h a v e been the superstitious belief that mentioning the illness by name would attract it. 3 The argument could have been valid for cholera, whose mention is indeed totally absent f r o m epitaphs despite the frequency and violence of the epidemics in the nineteenth century; yet in the case of the plague, the existence of quite numerous gravestones mentioning it clearly makes it difficult to accept the idea that the disease should have been censored as the result of a sort of exorcism. The overall picture that emerges f r o m all this information suggests that the indication of an illness as the cause of death was certainly not a m o n g the top priorities of those who composed Ottoman funerary epitaphs. This should not really c o m e as a surprise, considering the way in which Ottoman funerary inscriptions developed in time. From a rather laconic model, heavily inspired f r o m the Arab-Islamic tradition, and bearing little m o r e than a succinct identity of the deceased, a date, and a few considerations of a purely religious nature, Ottoman epitaphs had gradually grown in size to display a lengthier and more sophisticated text. However, even a cursory glance at the mass of tombstones which have survived to this day indicates that this sophistication concerned first and foremost two specific constitutive elements of the epitaph: identity and style. Identity was developed by emphasizing career, status, and f a m i l y , more often than not by c o m b i n i n g these three elements. Style, on the other hand, was cultivated by the growing interest shown for poetry, be it in its simplest f o r m of formulaic stock verses or in the m u c h m o r e sophisticated f o r m a t of original p o e m s c o m p o s e d

by

mercenary artists. Both these concerns, often c o m b i n e d , had the c o m m o n objective of promoting the image of the deceased and of his family and entourage in the public sphere, generally to the detriment of less ' u s e f u l ' considerations, including a purely religious context. Within this f r a m e w o r k , the cause of d e a t h — a n d illness in particular — was almost irrelevant, as

1 Daniel Panzac, La pe.ste Jans I'Empire ottoman, Paris-Leuwen, 1985, p. 359. More dramatic estimates put this figure at about 150,000 or even 250,000 victims (Hans-Peter L a q u e u r , Htive'l-Baki. Istanbul'da Osmanh Mezarliklart ve Mezar Ta§lari, Istanbul, 1997, pp. 98-99). 2

A fact confirmed by the figures given by Laqueur of only 8 epitaphs out of 86 dated between 1226 and 1228 explicitly referring to the plague (Laqueur, Htive'l-Baki, p. 99).

3

Laqueur, Htive'l-Baki,

p. 99.

S O R R O W

A N D

I L L N E S S

201

it did not contribute directly to the promotional agenda of the epitaph. Given the limited inscribable surface available, a choice had to be made between essential and secondary elements of the epitaph. It was normal then that rather mundane indications concerning commonplace causes of death should be easily sacrificed to a lengthy genealogy, to a list of posts held, or to an appealing set of verses that contributed much more to the individualization of a monument. This would explain that illness and disease, whenever mentioned, should generally be so for purely rhetorical purposes, as part of a poetic text that chose to emphasize a sense of tragedy and suffering. The frequency with which some illnesses are presented with pun-like formulae and metaphors would tend to confirm this impression. Thus, the plague was often associated with piercing objects (spears, arrows, swords); 1 tuberculosis was generally linked to images of fire; 2 and diphtheria, literally called the "young bird" (ku§

palazi),

was combined with the image of the soul spreading its wings towards paradise. 3 Yet, there is no denying that the inclusion, infrequent and marginal as it may be, of details and comments on the causes of death of individuals in the eighteenth century and more particularly in the nineteenth century cannot be discarded altogether as insignificant or irrelevant. By all means, this 'novelty' cannot be dissociated from a more general trend that seems to characterize the evolution of Ottoman funerary literature from the eighteenth century on, namely the process of individualization of the epitaph. Indeed, describing the way in which death struck was an additional particularity to describe the individual, but, as we suggested earlier, this was only a marginal contribution to an identity which relied and often benefited from much more concrete and better suited elements for this particular purpose. However, there was one individualistic purpose that the cause of death could usefully promote in ways that were not really available by other means: a sense of individual tragedy. Viewed from this perspective, the description of the cause of death acquires a new functionality, that of turning the epitaph into an individual lament for the loss of a beloved one, with an underlying theme stemming from the combined feelings of helplessness and revolt in the face of an untimely, violent, painful,

1 A s in "zahm-i veba" (the stroke of the plague, 1212/1797), utig-i taun" (the sword of the plague, 1252/1836), "tir-i taun" (the arrow of the plague, 1252/1836), " t a ' n - i tarn" (the spear of the plague, 1252/1836), "nize-i taun" (the spear of the plague, 1252/1836), " u r d u tigin zalim taun henim sineme" (the cruel plague struck my chest with its sword, 1252/1836). 2

A s in "nar-i verem" (the fire of tuberculosis, 1275/1859);'"yakdi yandirdi vticudum $ehrini verem" (tuberculosis burnt the city of my body, 1305/1888); " d e r d - i ciger-suz-i verem" (the lung-burning pain of tuberculosis, 1306/1889). i "Ku^ palazi illetinden nagehan / Murg-i ruhu u$du gitdi cennete" (Suddenly, due to the illness of the ' y o u n g bird' / T h e bird of his soul flew away to Heaven, 1325/1905); "cihartdan ku$ palazi illetiyle eyleyiib pervaz" (flying away f r o m this world d u e to the illness of the ' y o u n g th bird,' date illegible, second half of the 19 century).

202

K DHHM

EL D E M

and inexorable death. I he stock verses which appeared in the eighteenth century and grew in popularity in the nineteenth served this purpose to a certain extent: even though they were inevitably stereotypical, these formulae brought to otherwise 'dry' epitaphs a sentimental dimension that contributed to a certain degree of individualization of each death. In that respect, they showed a tendency that was paralleled, at the level of the invocation, by the appearance of the new formula of "Ah mine'l-mevf

(best translated as " 0 ,

cruel death!"), whose most striking aspect was the fact that it was not an invocation of the name of God (as the 'conventional' " H u v e ' l - B a k i " ("He is the Eternal O n e " ) and other derivatives) but rather a lament, bringing in an implicit (and very unorthodox) sense of revolt against what should have been taken simply as a divine decree. The phenomenon is clearly observed at a quantitative level: in our sample, " A h mine'l-mevf'

appears in less than one

epitaph out of a hundred before 1750, moves up to 6 percent in 1750-1850, and reaches a peak of 21 percent in the last period, thus becoming the second most popular incipit after the 'bestselling'

"Huve'l-Baki."

Independently of any medical consideration, the instrumentalization of disease as a means of emphasizing grief and staging tragedy seems to have been one a m o n g many other f o r m s of a general transformation of Ottoman epitaphs f r o m the eighteenth century on. Expressions of lament and regret were to be found in their simplest and most direct forms in the frequent cries and outbursts of pain and sorrow that f o u n d their way into f u n e r a r y inscriptions: ah,hayf,

hayfa (alas), ah ile zar kilmak

ah u figan (cries and lamentations), aglamak

(crying and weeping),

(crying)... A mention of an

untimely death, more or less systematically associated with the young age of the deceased, was an additional 'tearjerker' designed to create a feeling of empathy between the visitor and the dead or their grieving relatives, often reinforced by the use of the first person. Within this dramatic context, a mention of illness as the cause of death brought an additional touch of personal tragedy to the epitaph. T h e r e is little doubt that this transformation reflected a change in mentalities. The traditional sobriety of Islamic funerary m o n u m e n t s , which rarely trespassed into the realm of sentimentality and grief, was being replaced by a much more expressive style and a remarkable stress on rather mundane concerns about pain, sorrow, frustration, and separation. Noting the growing use of "Ah mine'l-mevt'

and interpreting this novelty as a secular expression

of sorrow and complaint replacing an invocation that implied submission to fate and G o d ' s will, Laqueur associated this phenomenon with a radical change in mentalities through the expression of grief with an undertone of grievance.

S O R R O W

A N D

II,

L N H S S

203

I could not agree more, except for the opinion expressed that this change was to a large extent born of western cultural and intellectual influences. 1 Apart f r o m the difficulty to accept the notion that the emergence of a 'secularized' sense of sorrow and complaint in an Islamic society could only be justified by an external/western stimulus, the simple fact that this ' i n n o v a t i o n ' should have appeared well before the nineteenth century 2 suggests that 'internal dynamics' are quite sufficient to explain this gradual shift in Ottoman-Muslim perceptions of death. By the second half of the nineteenth century, this trend was further accentuated by the appearance of longer and much more detailed descriptions of illness and suffering. Instead of a single verse stating that the deceased had suffered f r o m a painful illness, some epitaphs boasted several verses depicting vivid scenes f r o m the agony endured by the victim: a burning f e v e r , an incapacity to eat or drink, trembling lips... Muztaribii

'l-hal olub ruzumu §eb

eyledim

Gormez oldu agzima darie hem bir katre su Sanmaniz Murad-i

kim def-i tedbirinde

noksan

eyledim

Hak boyle imi§ acizim ben

neyleyim eyledim3

Mevt eriijdi ehl i beytim size veda Lezzet-i §urb-i miyah u meyvadan

mahrum

Illet-i basur elinden gekdi zahmet her Qinki

ecza-hane-i

alemde derman

Akibet el gekdi tedbirinde

ciimle

kalub

zaman

kalmadi hazikan

Le bier in gak gak ederdi ate.y i derd u elem Gordii bu miilk-i fenada

' Laqueur, 2

•i

Huve'l-Baki,

nar-i duzahdan

ni^an^

p. 83.

T h e earliest occurrence we have noted dates from 1150/1730.

[...J I b e c a m e ill with tuberculosis / My suffering turned my days into nights / My mouth ceased to see the least drop of water / D o not think that I neglected remedies to end the pain / Such was the will of God, I am helpless, what can I do? / Death caught m e , o my family I must bid you farewell (1303/1886). ^ Deprived of the taste of water and of f r u i t / He a l w a y s s u f f e r e d f r o m the illness of hemorrhoids / As there w a s no medication left in the pharmacy of this world / All capable men finally abandoned any hope of remedy / His lips trembled under the fire of pain and suffering / On this mortal world he saw traces of the fire of hell (date illegible, second half of the 19 th century).

204

EDHEM ELDEM §ir-penge

gikarub iig defada bak

zahrinda

Yaralar agdi pii$tune hig bulmadi gare Bu hararetle Genglikde

tabib feminden1

gegilb gitmedi su katre

geldi bir derd hak eyledi

mekanim

Yakdi beni hararet kar etmedi su $erbet Perhiz iizere gegdi hayfa benim Nice tabib-i hazik etdi devalar

zamanim amma

Gitdikce artdi derdim kesdi benim

amamnfi

T h e phenomenon could be associated with a medicalization of the funerary discourse, and there is no doubt that the greater precision added to the definition and description of the disease, combined with a parallel development of the nomenclature of a widening range of illnesses was directly related to the gradual spreading of medical knowledge in this era of progress and modernity. Occasional references to the treatment administered to the patient, including therapeutic changes of climate, 3 further confirm this desire to give an accurate and complete account of the process. Y e t , once again, what seems to have counted more is the tragic element infused into the epitaph through the rhetoric of pain and suffering. The result was a kind of romanticism that gradually permeated funerary m o n u m e n t s and literature, with the inevitable consequence of presenting death as a painful, terrible, and fearful experience. T h e contradiction between this vision and the teachings of the Islamic tradition was occasionally corrected by assigning the responsibility of this injustice to a vague notion of fate and death (felek, garh, ecel...),

while still

recognizing the ineluciability and validity of God's decree. 4 Perhaps the most telling examples of the tragic twist provided by medical references arc those where the deceased is presented as having died of grief and unhappiness Be it in the case of a child described as slowly dying

1 See how an anthrax bursl on her back three times / [ . . . ] / It opened wounds in her back, and doctors found no remedy / Due to her fever, not a drop of water passed through her throat (date illegible, second half of the 19 lh century). 2

An illness befell me at my young age and made the earth my abode / 1 w a s burning f r o m the fever and water and syrup were of no use / Alas, all my time w a s spent dieting / Many capable doctors administered medication, but / My pain kept g r o w i n g , with no mercy f o r m e (date illegible, second half of the I9 l h century). 3 "Hak-i Beyrut'a gidUb tebdil i?Un ab u hava / Etmedi tedbire $are ( | H e | went to the land of Beirut f o r a change of air and water / [But) these precautions were useless, 1280/1863); "Tebdil-i hava tariki ile Der i Saadet'e gelmif (IHe] had come to Istanbul for a change of air, 1288/1871); "Gitdi imkan-i (leva bulmak ifiin Istanbul'a" ([He] w e n t to Istanbul to find a possible cure, date illegible, second half of the 19 lh century). 4 Death in Istanbul, pp. 202-203.

S O R R O W

A N D

I L L N E S S

205

f o r m the loss of his mother, or of a mother taken away by tuberculosis, caused by the tears she had shed after the loss of four children, melancholy was clearly to be added to the long list of fatal ailments displayed on funerary epitaphs: Zati derdine dii^dii bu masurn Anadan ayrilanin hali malum Yetim olub kalub bir ya§inda Bu matemde ana geldi Giiliib oynamadan kddi

masum

melamet feragat

Firak I'dI hasret-i mader nihayet carta kar etdi Olub Hakkin cinanda karar etdi] Sabavetde ayn du§dii ciger-i mader

hasreti

Henuz bir rahat ederken aldi evlad ate$i Her birini saklar idi hazeri canindan biri Verdi dort evladi amma oldu mecnun-ve§ Oldu artik aglamakdan zahm-i ciger hastasi Nice yillar yara oldu sinesinde

i§ledi

Hasili bir derde diqdii careler hig olmadi Hangerzen etdi tesmim camni terk

eyledfl

The scanty evidence I have produced certainly does not speak for the vast majority of Ottoman gravestones of the period under study. In that sense, claiming that these few examples constitute proof of a radical shift in the Ottoman-Muslim perception of death would certainly be a dangerous and misleading generalization. Yet, despite the limited s i g n i f i c a n c e and representativity of the examples studied above, it would probably not be wrong to view the gradual medicalization of the funerary discourse as a partial illustration of a broader process of change undergone by Ottoman-Muslim epitaphs in the last two centuries of the Empire. From a rather succinct and conventional format comprising a basic identification of the deceased and a very limited textual input generally revolving around religious maxims derived from sacred texts, the Ottoman epitaph had come to include much more ' This poor innocent was left with his pain / O n e knows the state of those w h o have been separated f r o m their mother / Orphaned and left alone at the age of one, this innocent / In his mourning was taken by melancholy / He stopped laughing and playing / Finally separation and the longing for his mother cost him his life / And he settled in the paradise of God (1284/1867). ^ At childhood they were separated from motherly love / As she had just found tranquility she burnt with the loss of a child / She tried to protect each of t h e m f r o m danger as she would hei soul / She lost four children but became like mad / She finally fell ill of the lungs f r o m crying / So many wounds opened in her chest throughout the years / Finally she fell ill and no remedy was found / Planting its blade it poisoned her and she surrendered her soul (1317/1899).

206

ED H E M

ELDEM

detailed biographical data combined with a relatively secularized discourse on death in general and on the particulars of the deceased's own tragic experience. Whether this evolution should really be interpreted as a form of modernization is open to discussion; but it is my belief that the three central points, on which this transformation rested, namely individualization, contextualization, and desacralization. cannot be dissociated f r o m a certain form of modernity, independently from the dynamics of westernization. Within this context, the inclusion of details concerning the disease that took away the deceased played an important role that reinforced the process described above. Quite evidently, it provided a contextual narrative that contributed to the individualization of each particular death. More importantly, however, it added a tragic dimension of pain, suffering, grief, and injustice, which seems to have corresponded to the growing need of ' m o d e r n ' O t t o m a n s to free these feelings f r o m the restraints and controls imposed by the Islamic tradition.

SORROW

AND

ILLNESS

UNE MÉDECINE MODERNE DISSOCIÉE DU PASSÉ OU L'AVÈNEMENT DE L'ÉCHOGRAPHIE OBSTÉTRICALE ET DU DIAGNOSTIC PRÉNATAL AU SULTANAT D'OMAN Claire BEAUDEVIN 1

« Quand, dans les années 1970, on demandait à un Omanais ce qu'il pensait du sultan Qabous bin Sa'id, il répondait invariablement qu'avant 1970 il n'y avait rien et que tout était arrivé après l'avènement de Qabous. La même question posée dans les années 80 aurait certainement reçu la même réponse.C'est également la version que le nouveau régime cultive obstinément depuis lors. » PETERSON (2002: 77)

Il s'agit dans cette contribution de s'intéresser aux rapports entre la modernité médicale criante de la société omanaise et l'histoire de cette dernière. Pour ce faire, nous examinerons l'introduction récente de l ' i m m e n s e innovation médicale qu'est l'échographie obstétricale. Cette technologie prend place dans un pays marginal dans le monde arabe et musulman, peu peuplé, encore récemment peu ouvert et qui plus est peu étudié par les sciences humaines. 2

Le Sultanat d'Oman

et son système de

santé

Le Sultanat d'Oman est une monarchie absolue du sud est de la péninsule Arabique. Le chef de l'État est le sultan Qabûs bin Sa c îd Al-Sa c îd, monarque d'une population d'environ 2,4 millions de personnes 3 qui augmente rapidement. 1 D o c t o r a n t e en A n t h r o p o l o g i e - C e n t r e d e R e c h e r c h e « C u l t u r e s , S a n t é , S o c i é t é s » ( C R e C S S ) , Université Paul Cézanne / Maison Méditerranéenne des Sciences de l ' H o m m e , Aix-enProvence, France [[email protected]] L a p r é s e n t e c o n t r i b u t i o n est b a s é e sur les d o n n é e s recueillies lors d ' u n D E A d ' A n t h r o p o l o g i e c o n s a c r é à l ' é c h o g r a p h i e o b s t é t r i c a l e d a n s le p a y s . L e d i t travail a o u v e r t sur u n e r e c h e r c h e d o c t o r a l e en c o u r s , c o n s a c r é e à la génétique en O m a n . 2 II est à n o t e r q u e les s o u r c e s sont d ' a u t a n t plus rares q u ' O m a n n ' a p a s é t é à p r o p r e m e n t dit c o l o n i s é , si l ' o n e x c e p t e la " t u t e l l e " b r i t a n n i q u e . Il n ' e x i s t e d o n c pas à son p r o p o s d ' a r c h i v e s "coloniales". -Î

• D o n t 0,5 millions d ' e x p a t r i é s , selon les c h i f f r e s du r e c e n s e m e n t de l ' a u t o m n e 2 0 0 3 .

CLAIRE

210

BEAUDEVIN

Depuis l ' A n t i q u i t é , O m a n entretient des relations étroites avec le sousc o n t i n e n t indien et l ' A f r i q u e o r i e n t a l e , lieux d ' i m p l a n t a t i o n d e n o m b r e u x comptoirs qui ont longtemps fait d u pays une importante puissance régionale. À la d é c o u v e r t e du pétrole - d o n t la production ne d é b u t e q u ' e n 1967 - , le sultan S a c î d bin T a y r n û r n e fait q u ' a m o r c e r l ' u t i l i s a t i o n d e c e s liquidités nouvelles 1 pour la modernisation du p a y s . Une révolution de palais s o u t e n u e par les B r i t a n n i q u e s le d é p o s e en 1970 et son fils Q a b û s prend en m a i n la gestion du p a y s . Parvenu à é c r a s e r une rébellion m e n é e d a n s le S u d par un f r o n t de libération d'inspiration c o m m u n i s t e , le n o u v e a u sultan lance un vaste p r o g r a m m e d e m o d e r n i s a t i o n et crée u n e a d m i n i s t r a t i o n , a v e c d ' i m p o r t a n t s investissements dans le d o m a i n e d e la s a n t é , d e l ' é d u c a t i o n , d u c o m m e r c e et des voies de c o m m u n i c a t i o n . Ceci crée un a f f l u x massif de m a i n d ' o e u v r e , spécialement en p r o v e n a n c e d u sous-continent indien. La réouverture d u pays p e r m e t é g a l e m e n t le retour d ' O m a n a i s déclarés indésirables par le p r é c é d e n t souverain et exilés à Zanzibar et en A f r i q u e . O m a n est a u j o u r d ' h u i un p a y s p a r a d o x a l : t h é â t r e d e p u i s 1970 de bouleversements é c o n o m i q u e s et sociaux c o m m e peu d ' a u t r e s contrées en ont c o n n u s , le sultanat f a i t p o u r t a n t f i g u r e d ' î l o t de stabilité d a n s la r é g i o n du G o l f e . L ' É t a t d e m e u r e paternaliste, i n c a r n é par et c e n t r é sur son m o n a r q u e malgré quelques timides signes de démocratisation. Pour mieux a p p r é h e n d e r la réalité o m a n a i s e , il e s t i m p o r t a n t de m e s u r e r à quel p o i n t E t a t , n a t i o n et g o u v e r n e m e n t sont r e p r é s e n t é s p a r le s u l t a n , lequel « e n l ' a b s e n c e d ' u n p r e m i e r ministre et d ' u n soutien de la part de sa f a m i l l e ou d ' u n c o r p s de f o n c t i o n n a i r e s p r o f e s s i o n n a l i s é s ( . . . ) a été p e r s o n n e l l e m e n t à l ' o r i g i n e d e presque toutes les décisions gouvernementales d ' e n v e r g u r e ». 2 *

L e s y s t è m e de santé o m a n a i s est en g r a n d e p a r t i e d e c o n s t r u c t i o n récente, bâti dans la période d ' i n t e n s e e f f e r v e s c e n c e politique, é c o n o m i q u e et sociale intervenue d e p u i s 1970. Il fait d o n c partie intégrante d u p r o c e s s u s d e modernisation impulsé par le sultan Q a b û s depuis son accession au pouvoir. Dès lors, la question d e savoir « quels cet habit de lumière

vieux oripeaux

subsistent

sous

» 3 est c e n t r a l e ; m a i s , si l ' o n p e u t a i s é m e n t i m a g i n e r

q u e l ' h i s t o i r e de la m é d e c i n e en O m a n e s t o r i g i n a l e , au r e g a r d d e la position géographique du pays et de ses relations c o m m e r c i a l e s séculaires, les

1 À noter que l'historiographie officielle et b e a u c o u p d ' a n a l y s t e s ne lui reconnaissent pas même cette impulsion (Peterson, 2002 : 78). 2 Ibid. : 80 3

Ibid. : 7 8

IJNH

MÉDHCINH

MODKRNH

DISSOCIÉE

DU

PASSH

211

informations à cet égard sont quasi inexistantes. Seuls les débuts de la biomédecine 1 dans le sultanat sont plus facilement accessibles, mais les rares récits qui les rapportent sont au mieux des chroniques d'aventures aux accents panégyriques 2 . Ils dépeignent par exemple la première clinique (1904), suivie du premier hôpital, resté unique jusqu'en 1970 et ouvert en 1933 par des missionnaires américains. La création du ministère de la Santé et l'adhésion à l'Organisation Mondiale de la Santé (OMS) ont figuré parmi les premiers décrets sultaniens, dans un pays alors totalement dénué de structures de soins. Depuis lors, l'historiographie officielle souligne volontiers - au besoin dans les journaux - l'ouverture de l'université et de la faculté de médecine en 1986, l'acquisition de nouveaux matériels de pointe ou encore l'ouverture du premier centre de soins oncologiques l'an dernier. Aujourd'hui, ce système de santé, majoritairement basé sur la biomédecine 3 , est matérialisé par un maillage dense de centres de santé et d'hôpitaux, dont des centres de pointe à Muscat (la capitale). Le secteur privé est très minoritaire et draine surtout une clientèle d'expatriés désormais non pris en charge 4 par le système public de protection sociale. À ce propos, il est utile de souligner l'énorme dichotomie créée par ces statuts différents : « Certes, tous les "nationaux" ne sont pas riches et "l'homme de la rue" de Bahreïn ou d'Oman connaît les angoisses de l'avenir, voire des fins de mois. Cependant, il jouit d'un statut privilégié et intouchable par rapport aux immigrés : sa nationalité est un t a l i s m a n qui lui assure certains droits sociaux liés à la redistribution de la rente (...) » 5 , et notamment l'accès gratuit aux soins. Ainsi, les trois dernières décennies ont vu la naissance d'un système de santé moderne, construit sur le modèle d'organisation rationnelle des soins prôné par l'OMS. Malgré la nette « tendance à l'hyperbole >/' des récits de la

L'anthropologie de la santé désigne par le terme biomédecine la médecine dominée par la biologie et dotée des fondements épistémologiques propres à la méthode expérimentale. Devenue ubiquitaire - bien que dominée par quelques pays - cette médecine ne saurait être appelée "médecine occidentale" sans ethnocentrisme. 2

•i Voir par exemple Bosch, 2000 ou AL-Kharusi, 1995.

Des médecines traditionnelles locales existent - spécialement à travers les "rebouteux" mais n'ont que peu de visibilité ; des médecines traditionnelles extérieures, comme l'ayurveda indien, sont présentes notamment dans des centres de santé privés. Cependant, Oman ne s'est pas lancé dans une entreprise de valorisation des médecines traditionnelles comme ont pu le faire les pays engagés dans la « Stratégie pour la médecine traditionnelle 2002-2005 » de l'OMS (voir OMS, 2002). 4

Suite à une réforme gouvernementale de la fin des années 90 visant à diminuer les dépenses de santé.

Lavergne, 2005: 9, c'est moi qui souligne. Selon l'expression ici fort adéquate que Christopher Dole ( 2004 : 260) applique à l'Etat kémaliste. 6

212

C L A I R E

B H A U D E V I N

fondation de ' T É t a t - Q a b o u s " 1 , l'analyse de sa politique de santé est ardue, du fait

du

profond

cl

« incontestable

changement »2

intervenu

dans

l'organisation sanitaire du pays, notamment en termes d ' o f f r e et d ' a c c è s aux soins. L'un des fleurons de ce système est la prise en charge materno-infantile dont le suivi de la grossesse, et l'un de ses versants clés, l ' é c h o g r a p h i e obstétricale.

l'échographie

obstétricale

comme technologie

importée

L'échographie est issue des techniques militaires de détection radar 3 . Sa première utilisation en gynécologie-obstétrique date des années cinquante, le premier échographe médical de 1960. En France, elle est devenue un recours fréquent en cas de grossesse à risque à la fin des années soixante-dix. Il s'agit d ' u n e technique d'imagerie médicale dynamique consistant à explorer le corps de l ' e m b r y o n puis du f œ t u s à l'intérieur de celui de sa m è r e , à l ' a i d e d'ultrasons de fréquence variable se réfléchissant sur les structures q u ' i l s rencontrent et donnanl ainsi des informations sur - entre autres - la densité et les dimensions de celles-ci. Les informations sont transcrites sur un écran sous f o r m e d ' u n e image i n f o r m a t i q u e m e n t c o n s t r u i t e en n i v e a u x de

gris.

L'échographie obstétricale permet de dater les grossesses, de déterminer le nombre de fœtus et de les mesurer, de détecter certaines anomalies, etc. Cette technique, née en Occident et exploitée là-bas depuis environ 30 ans, est en Oman une "denrée importée" dans le système de santé, c o m m e l'ont été nombre d'autres technologies, matériels et savoirs-faire. Le principal "moteur" décisionnel dans ce système est l ' e n s e m b l e des politiques de santé publique, au sens de « somme des efforts communautaires organisés pour la prévention de la maladie et la promotion de la santé. » 4 . Dans les pays du Sud, la mise en place des politiques de santé publique passe f r é q u e m m e n t par l'importation d'un corpus de normes comportementales d'origine occidentale, promulguées par les organisations internationales. Il s'agit donc ici d'examiner la place conférée à l'échographie obstétricale par les politiques de santé publique omanaises et plus largement ce qu'elle nous apprend du rapport au temps et à l'innovation du pays.

' L ' e x p r e s s i o n est de V a l e n , 2 0 0 5 a 2

Dole,2004 : 260

3

Pour plus de détails voir le site internet de Joseph W o o ( 1 9 9 8 - 2 0 0 3 ) - "A short history o f the development of Ultrasound in O b s t e t r i c s and Gynecology " : w w w . o b ultrasound .net/history .html 4

D é f i n i t i o n de Frenk citée par M a s s é & Saint-Arnaud, 2 0 0 3 . 2 3 3 - 2 4 1 .

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Comme la politique de santé publique omanaise accorde une grande importance à la santé materno-infantile - et notamment à la réduction de la mortalité infantile - , on peut supposer que l'échographie a été introduite en Oman dans les années quatre-vingt dans le but d'obtenir des informations obstétricales plus complètes permettant de réduire ce taux de mortalité, enjeu réel autant que symbolique pour l'État. La généralisation volontariste de cette technique depuis cette époque ne saurait être réduite à une simple application de consignes internationales résultant de l'adhésion du pays aux directives de l ' O M S . En effet, l'échographie ne fait pas partie des priorités établies par le protocole "Safe Motherhood Initiative" 1 . Cependant l'expansion de l'échographie dans le système de santé omanais s'est faite d'autant plus aisément qu'il avait été "formaté" sur le modèle des systèmes de santé occidentaux 2 . Concernant les buts initiaux, les objectifs et même l'identité des premiers promoteurs de l'échographie obstétricale en Oman, peu d'informations précises sont disponibles. Seuls quelques indices ouvrent des pistes, parmi lesquelles l'importance des liens avec l'Inde : en matière de coopération médicale tout d'abord, puisque l'Inde constitue un pays de référence vers lequel sont orientés les patients pour des actes thérapeutiques spéciaux (greffes, interventions lourdes, etc.) 3 , et que l'on peut donc imaginer le Sultanat suivant la voie de l'immense engouement indien pour la technologie échographique. Par ailleurs, du fait de la présence de très nombreux praticiens indiens dans le pays, y compris parmi les échographistes. De façon très proche du courant d'"évaluation" tous azimuts à l'intérieur de l'Union européenne, le gouvernement omanais souhaite actuellement évaluer les procédures et le degré d'intégration de l'échographie dans le système de santé, mais à ce jour, il ne semble disposer d'aucun chiffre officiel sur l'extension de la pratique. Si l'un des critères pour apprécier les transferts de technologie est l'efficacité comme « évaluation de la conformité d'un résultat avec un projet » 4 par le groupe receveur, il est difficile de porter un jugement sur le projet omanais d'amélioration de la santé maternelle et

T a u t z , Jahn, et al., 2000 : 690 - Ce protocole résulte d ' u n partenariat d ' a g e n c e s internationales et nationales ( U N I C E F , O M S , U N F P A , Banque M o n d i a l e , Fédération Intenationale de Gynécologie-Obstétrique, etc.) qui ont commandité la première conférence à ce sujet (Nairobi, 1987), et ont travaillé ensemble depuis lors. |www.safemotherhood.org] 2

En effet, des administrateurs britanniques ont tenu les rênes du pays durant le règne du père du Sultan Qabûs (voir à ce sujet Valeri, 2005a : 107-109) puis, après le coup d'état, participé officiellement au gouvernement jusque dans les années quatre-vingt, étant de ce fait en charge de nombre de décisions concernant la santé. De plus, les directives émanant de l ' O M S ont été largement suivies, -î ' Par exemple, en 2004, 289 personnes ont été envoyées officiellement se soigner en Inde par le ministère de la Santé, sur un total de 395. Chiffres : ministère de la Santé, 2005. 4 G e s l i n , 1999: 18-19

214

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infantile autour de l'échographie et du diagnostic prénatal. Les premières réflexions sur les buts de la pratique échographique généralisée ne datent a p p a r e m m e n t que de 1999, quand se manifeste pour la première fois une volonté officielle de s'attaquer au problème des pathologies congénitales. Bien que la pratique de l'échographie obstétricale recommandée dans le rapport conjoint de l'UNICHH et du ministère de la Santé omanais sur la mortalité périnatale (1999) soit aujourd'hui passée en routine, la pérennisation n ' e n est pas assurée, d'autant plus que la formation en médecine fœtale n'existe pas en Oman et l'omanisation 1 de ce secteur d'activité n'est pas encore réalisée. La diffusion de l'échographie se poursuit dans le Sultanat, alors m ê m e que certaines zones plus favorisées du point de vue des équipements de santé se l'approprient déjà pleinement : l'échographie s'enracine en O m a n - dans la z o n e de la capitale au m o i n s . Un des indices de ce processus est la dénomination de cette technique par le terme de " r a y o n s " utilisé par de n o m b r e u s e s patientes (qui n o m m e n t aussi l ' é c h o g r a p h i s t e " d o c t e u r des rayons"). L'échographie est ainsi reliée aux rayons X , déjà bien connus des usagers du tout récent système de soins (le radio-diagnostic a été introduit très tôt). D'autre part, son pouvoir prédictif rencontre sans doute la volonté de certaines f e m m e s d ' e n savoir plus sur l'avenir de l'enfant en gestation. D e plus, le terrain était déjà préparé par l'institution d ' u n suivi de grossesse à vocation généralisée. Kn effet, le protocole de soins prénatals mis en place par le ministère de la Santé fait intervenir tous les niveaux de l'arborescence des sites de soins, depuis les centres de santé de proximité, afin d'atteindre le m a x i m u m de personnes. Qui plus est, les f e m m e s enceintes ne présentant pas les documents officiels de suivi médical 2 rencontrent de grandes difficultés de prise en charge. Malgré une \ o l o n t é g o u v e r n e m e n t a l e r é c e n t e mais assez nette d'exploiter au mieux les possibilités offertes par cette technologie, l ' é t a p e actuelle relève du tâtonnement. Curieusement, par exemple, les prospectus d'éducation à la santé édités par le ministère de la Santé ne mentionnent q u e peu l'échographie - en dépit des efforts importants du gouvernement en termes d'achat et de diffusion de matériel. D'autre part, les échographistes évaluent ' Il s'agit d ' u n e politique ouverte de préférence nationale à l'embauche visant à ouvrir dans quelques années assez de postes aux 50% de la population actuellement âgés de moins de 15 ans. Ce programme directif et énergique a débuté il y a une dizaine d ' a n n é e s . Ses prémices peuvent être observées dans les premières nominations d'officiers omanais au début des années quatre-vingt. Des quotas-cibles sont fixés (jusqu'à 95% en 2020 dans le secteur public -Valeri, 2005c) dont la progression est suivie par secteur : actuellement l'omanisation atteindrait 8 0 % dans le secteur public (qui représente 15% des 750 000 emplois) et environ 13% dans le privé. En ce qui concerne les fonctionnaires dépendant du ministère de la Santé, elle serait d'environ 24% des médecins et 49% des infirmières (chiffres MoH 2004). Pour plus de détails concernant l'omanisation, et les précautions à prendre concernant l'analyse des chiffres, voir notamment Valeri, 2005c et Valeri, 2005b. 2

Voir plus loin les explications concernant la « carte verte ».

IINK M É D B C I N H M O D H R N E D I S S O C I K H DU P A S S H quotidiennement la croissance des fœtus à l'aide de «gradients normalité

215 de

»' matérialisés par des courbes de croissance théoriques. Ces

courbes se réfèrent à des études réalisées dans les pays du Nord, ce qui entraîne une surestimation des problèmes de croissance des fœtus omanais. En effet, leur morphologie ainsi que celle de leurs mères diffèrent de celle des fœtus et femmes enceintes occidentaux et rend les normes "du Nord" peu applicables. L'établissement de courbes de croissances locales n'est pas effectué à ce jour.

Uniformisation du suivi de grossesse : la politique de santé' publique Si l'on répartit les systèmes de santé le long d'un continuum représentant de manière croissante la délégation de décisions sanitaires aux individus, la surveillance de la grossesse en Oman classerait le pays dans une zone de faible délégation, où les grossesses sont le plus souvent considérées comme potentiellement à risque et étroitement "monitorées" en conséquence. Oman se détache largement d'états comme les Pays-Bas, où l'échographie est rare (zéro ou une par grossesse en moyenne, contre deux ou trois en France 2 ) et le suivi beaucoup moins resserré tant qu'aucune anomalie n'apparaît. Le modèle adopté est donc la volonté de « délégation de l'ensemble du parcours obstétrique à la médecine » 3 Par ailleurs, les politiques de santé publique omanaises à destination des mères et des enfants se situent plutôt "dans le / de SMF (santé maternoi n f a n t i l e ) 4 : les politiques de prévention de la mortalité infantile sont déployées à grande échelle, leurs résultats publiés dans les journaux, mais il est fait peu de cas des complications obstétricales affectant la santé des mères. À la situation omanaise s'applique exactement la description de Bernard HOURS 5 : « Dans les pays en voie de développement, les institutions de la santé publique mises en œuvre par l'Etat mesurent leurs résultats à la couverture préventive ou à la fréquentation. La satisfaction du malade, ou sa perception de la guérison, ne sont guère prises en compte dans la mesure où la fonction sociale prime sur les résultats intrinsèques. » Les statistiques se substituent ainsi fréquemment à l'évaluation qualitative des résultats.

Dans

les rapports du ministère de la Santé de la dernière décennie, aucune étude

' J ' e m p r u n t e cette expression à Ch. Cussins (1995) - « Les cycles de conception : les techniques de normalisation dans: un centre de traitement de la stérilité ». Techniques et culture 25-26:309. 2 •I

Akrich & Pasveer, 1996 : 66-67 Champenois-Rousseau, 2003 : 19

\ Selon l'expression de Fassin,2000 : 161 5

Hours, 1995 : 66-67

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C L A I R E BEAU DEVIN

qualitative dirigée vers le recueil de l'opinion des patients n'est mentionnée ; dans le programme de santé materno-infantile, pas un mot du vécu des mères. L'essentiel des efforts gouvernementaux se résume en chiffres - par ailleurs impressionnants comparés à des valeurs africaines - : 99,6% des f e m m e s ayant accouché dans les trois ans précédant l'étude avaient bénéficié de soins prénatals 1 ou encore plus de 90% des naissances sont enregistrées en milieu hospitalier 2 . L'uniformisation des itinéraires thérapeutiques obstétricaux est aussi liée à la "carte verte", autrement appelée "carte d e santé m a t e r n e l l e " , matérialisant le suivi normalisé de la grossesse. Elle est fournie à chaque f e m m e enceinte lors de la première consultation de grossesse, dont la date est très variable (beaucoup plus précoce dans les milieux aisés et la capitale). Cette carte est le support des comptes rendus tout au long de la grossesse, dans les diverses structures médicales fréquentées par sa détentrice. De manière générale, les politiques de santé publique impliquent la construction des corps par les stratégies d e surveillance et d e contrôle b i o m é d i c a l , « la stratégie recevoir

des patients

construits

des institutions

dont les pratiques

en santé publique.

| é t a n t | fondamentalement seraient

conformes

aux

de modèles

» 3 La gratuité des soins pour les Omanaises

suivies dans le service public est sans conteste un puissant m o y e n d e persuasion du gouvernement. À noter que la gestion gouvernementale de la santé materno-infantile perdure après l'accouchement, à travers la fourniture d ' u n e carte non plus verte mais

"rose"

ou " b l e u e " destinée à suivre l ' e n f a n t , puis d ' u n e «

d'espacement

des naissances

carte

» 4 . Le secteur privé n ' e s t pas en reste, qui

applique globalement le protocole g o u v e r n e m e n t a l , mais où le n o m b r e d'échographies par grossesse peut dépasser la vingtaine, parfois vendues en "stock d'examens en prépayé" de cinq, dix ou vingt échographies. La politique du gouvernement omanais se situe dans ce que Raymond MASSé 5 nomme la persuasion,

et pas (encore ?) dans la législation,

puisque,

officiellement, ce suivi n'est pas obligatoire. Cependant la portée - sinon l ' e f f i c a c i t é - de cette entreprise n o r m a t i v e à grande échelle peut être appréhendée à travers les propos de cette jeune patiente, selon qui on ne peut déroger à la prise en charge par le médecin :

' Source : Ministry of Health, n.d. : 95 2

Hill, Muyeed, et al., 2000 : chap. 3.26

3

Hours, 1995 : 67

4

Cette carte constitue le principal support d ' u n p r o g r a m m e national d ' e s p a c e m e n t des naissances (Birth Spacing Initiative) initié en 1994, qui prône la contraception (implants, pilulesstérilet, préservatifs...) et l'allaitement prolongé en cas de refus de contraception médicalisée. 5

Massé & Saint-Arnaud. 2003

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« Tout le monde a la même chose. Même à l'intérieur 1 , c'est pareil, les médecins n'accepteraient pas bien sûr que leurs patientes n'aient pas d'échographies. Le médecin doit avoir toutes les informations. Alors il donne un rendez-vous pour l'échographie. Si quelqu'un n'y va pas bien sûr il ne va pas accepter ça. Je suis sûre que personne ne peut passer une grossesse entière sans échographie. » 2 11 semble donc que l'Etat se soit immiscé jusque dans l'intimité des omanaises de manière e f f i c a c e . On peut voir l'intégration volontariste de la biomédecine dans le nouveau modèle de société institué par le sultan Qabûs comme

« un

moyen

d'insérer

la présence

de

l Etat

dans

la

vie

» 3 . D e plus, le "droit à la santé" est inscrit dans la récente

quotidienne

Constitution, légitimant par là m ê m e les efforts gouvernementaux pour assurer le bien-être de chacun...

L'échographie

obstétricale

en Oman au

quotidien

Il règne actuellement dans les pays du Nord un consensus social très étendu concernant les bienfaits de l'échographie et la légitimité de son utilisation. Cette situation, en partie fruit de la longue histoire de maîtrise accrue de la fécondité dans ces sociétés, n'a suscité que peu de recherches. Pour l'anthropologue Eugenia GEORGES, « on connaît peu de de la diffusion américain

et

de cette ouest

culturellement interagissent « expériences

technologie

européen,

infléchies avec

elle.

des

et

à l'extérieur encore

femmes

et

moins des

des sur

contextes

choses nord

les

expériences

obstétriciens

lorsqu'ils

» 4 II s'agit donc ici de s'intéresser à de telles

culturellement

infléchies

» en Oman, d ' e x a m i n e r "ce que

fait" cette modernité importée dans le contexte omanais, et "ce qu'elle dit" 5 de ce contexte. Les quelques études approfondies consacrées à l'échographie obstétricale 6 portant sur des sociétés du Nord ayant une culture iconographique et médicale sinon c o m m u n e du moins semblable, il paraît particulièrement intéressant d'appréhender le statut de cette technique dans un pays où le rapport à l ' i m a g e et à la m é d e c i n e a une histoire différente, malgré un matériel occidental et une formation technique des praticiens dans les facultés de médecine européennes ou nord-américaines.

' Dénomination c o m m u n e des provinces extérieures à la capitale, souvent présentées c o m m e "arriérées" par les muscatis. 2 •Ï

Entretien, Muscat, 1 e r décembre 2003

- Selon le schéma décrit par Christopher Dole (2004 : 256) concernant le passage du contrôle ottoman au kémalisme. 4

Georges, 1997: 91

5

J ' e m p r u n t e ces formulations à Duden, 1996 : 100.

6

À savoir principalement les travaux de Michèle Fellous (1991) et Bénédicte ChampenoisRousseau, (2003) pour la France, de Lisa M . Mitchell (2001) pour le C a n a d a , d ' E u g e n i a Georges (1997) pour la Grèce, et de Janelle S. Taylor (1998) pour les Etats-Unis.

218

CLAIR H BEAUDKV1N L'échographic est pratiquée dans les principaux hôpitaux publics, dans

les trois hôpitaux privés du pays (dont deux situés dans la capitale, Muscat), ainsi que dans quelques cabinets privés. Cette technique d ' i m a g e r i e est un recours signalé dans la procédure gouvernementale standard de suivi d e grossesse (carte verlc, voir plus haut) et très f r é q u e m m e n t prescrit par les médecins du pays. Une telle situation, dans une société dont le système de santé ne s'est administrativement organisé que dans les années soixante-dix, est assez singulière. Les patientes

des h ô p i t a u x

p u b l i c s sont très

majoritairement

omanaises, originaires de tout le pays (soins gratuits pour les nationaux), celles des structures privées pour la plupart expatriées. Les praticiens sont en fait toutes des p r a t i c i e n n e s , pour partie des g y n é c o l o g u e s f o r m é e s à l ' é c h o g r a p h i e et pour partie des f e m m e s " s o n o g r a p h e r s " (techniciennes échographistes, non médecins). On n'observe donc pas en O m a n la mainmise des « niveaux

les plus élevés de l'appareil

de soins » sur l ' é c h o g r a p h i e , à

l ' i n v e r s e de ce que Jean-François W E R N E R ' " signale pour l ' A f r i q u e de l ' O u e s t . Ainsi, la nouveauté de la technique n ' e n fait pas pour autant une "chasse gardée" du corps médical. Dans les pays du Nord, les représentations de l'échographie entrée en routine, largement partagées par les professionnels et les patientes, concernent des aspects divers de l'examen : •

le " r e m p l a c e m e n t " de la certitude "corporelle" personnelle de la grossesse par la certitude visuelle médiatisée par le praticien.

•

l'idée implicite que « les fœtus avortés

présentant

des anomalies

seront

» 2 : l ' é c h o g r a p h i e serait inscrite d a n s une c h a î n e de

"contrôle

de qualité'

assimilant la grossesse à une

"tentative"^,

que les vérifications technologiques à disposition des parents potentiels - amniocentèse, dosages sanguins - peuvent amener il abandonner. •

l'affirmation réitérée 4 des bénéfices psychologiques de l'examen

•

la r e c o n n a i s s a n c e g é n é r a l i s é e de la nature « hybride l'examen,

médical

mais aussi

« ludique

» car

» 5 de

fournissant

l'occasion d'une "rencontre" entre futurs parents et fœtus.

1

Werner, 2004 : 71

2

Taylor, 1 9 9 8 : 21

^ Voir notamment Ibid. : i 6 4

Entre (de n o m b r e u x ) autres : Tourrette & Bouhard, 1986; Jalenques, Coudert, et al., Thorpe, Harker, et al., 1993; Filly, 2000; Zechmeister, 2001. 5

Taylor, 1995 : 35

1991;

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Les aspects énumérés ci-dessus sont liés aux conceptions de la personne et de la parentalité, au crédit conféré à la médecine, bref, aux normes socioculturelles qu'on ne saurait simplement exporter d'une société vers une autre. D'ailleurs les professionnels de santé eux-mêmes n'entendent pas nécessairement les prendre tous en c o m p t e : VANGEENDERHUYSEN, ABDELLAHI et al. (2002) par exemple, à propos de la Mauritanie, considèrent surtout l'apport d'informations obstétricales strictement médicales. D'autre part, des auteurs soucieux de l'insertion et du sens social des technologies, comme l'économiste de la santé Ingrid ZECHMEISTER, soulignent que « la signification [de l'examen échographique] est formée par les mythes sociaux concernant la création du lien et l'amour maternel. »'. Les femmes subissant un examen échographique dès les premières semaines de grossesse étant très rares en Oman, l'échographie ne peut techniquement pas y revêtir le rôle de "révélateur" de l'état de femme enceinte. En général, les patientes perçoivent déjà les mouvements fœtaux lors du premier examen. D'autre part, on ne retrouve pas dans leurs propos l'idée de perfectibilité omniprésente dans les analyses portant sur les pays occidentaux, et surtout sur les États-Unis - cf. GINSBURG & RAPP (1995). Il s'agit de se rassurer, non pas sur la perfection du fœtus, mais sur son état de santé global. L'image ne semble pas personnifier le fœtus. En effet, la dénomination du fœtus comme "enfant" dans le discours est très peu fréquente, et je n'ai entendu aucune femme parler de « son fils » ou de « sa fille » à propos de son fœtus. On ne relève pas non plus de considérations sur son caractère éventuel ou sa ressemblance avec un membre de la famille - comme cela a été rapporté aux États-Unis entre autres. Il est majoritairement désigné textuellement comme fœtus (janîn). Cette distance face à la situation d'examen est une caractéristique observée chez les femmes. Les pères sont en effet absents dans la grande majorité des cas ; à nouveau, les cultures de genres inculquées en Oman dès l'enfance exercent leur influence. Ainsi, si la construction sociale de l'opposition des genres se matérialise dans la tendance « à exclure de l'univers du pensable et du faisable tout ce qui marque l'appartenance à l'autre genre » 2 , une activité aussi intimement proche des femmes que l'échographie obstétricale ne saurait être pratiquée par un homme. De plus, « il est inconvenant de parler en public des liens affectifs entre un homme et une femme, même s'ils sont mari et femme, bien que de tels liens existent souvent entre les époux. »•'. Assister ensemble à l'examen de son enfant à naître pourrait être considéré comme une actualisation publique de ces liens ; une telle situation est donc très rare.

1

Zechmeister, 2001 : 389

2

Bourdieu, 1998 : 29

Eickelman, 1984 : 128 ; noté également par Lila A b u Lughod dans son ouvrage Sentiments, au sujet des Bédouins d'Egypte.

Veiled

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220

Pour l ' O c c i d e n t , la portée

BEAUDEVIN

s y m b o l i q u e de l ' é c h o g r a p h i e

obstétricale

proviendrait de la jonction opérée par cette technologie entre « le visuel et le scientifique occidentale

- deux composantes moderne

hautement

significatives

de la

culture

» ' . Il existe p r o b a b l e m e n t diverses " c u l t u r e s de

l'imagerie médicale" dont la légitimité serait construite de manière différente et à divers degrés. Pour Oman la question est ouverte, de la signification de l'échographie dans une société qui a durant plusieurs siècles laissé peu de place à l'image, et où la perception de l ' i m a g e anatomique est nécessairement très différente. Malgré l'introduction relativement récente - une centaine d ' a n n é e s - du portrait et de la photographie dans les pays arabes, les outils pour évaluer une image à décoder semblent manquer. Hormis les portraits du sultan présents dans tous les lieux publics - et dans certaines résidences privées - , Oman n'est pas un pays où l ' i m a g e est o m n i p r é s e n t e , c o m m e d a n s certains p a y s musulmans affichant portraits de martyrs ou de dignitaires

religieux.

La majorité des patientes omanaises observées semble demeurée très indifférente à l'écran, donnant presque à penser qu'il n'y a "rien à voir" tant que le praticien ne parle pas. Dans un contexte où les images échographiques sont peu médiatisées et sont donc difficilement reconnaissables au premier coup d'œil par un profane, elles ne paraissent pas investies d ' u n e valeur affective. Une fois de plus, le discours prime : les patientes ne disent pas « j'ai vu le bébé », mais « on m'a dit / je sais que tout va bien ». Par ailleurs, l ' u n des indices d ' u n e culture iconographique en voie de constitution est la métaphore utilisée

pour nommer

une t e c h n i q u e

d'imagerie.

L'assimilation

de

l'échographie et de ses images à la télévision, relevée en Grèce par MITCHELL & GEORGES (1997). ne semble pas s'appliquer en O m a n . L'échographie est plutôt associée, on l'a vu plus haut, aux "rayons" des autres techniques d'imagerie. La dénomination conserve la spécificité médicale et non pas le côté "grand public" de la télévision. Les f e m m e s semblent rester extérieures à un savoir médical qui doit leur être expliqué, qui n ' a pas l'aspect immédiat du petit écran. 11 en est finalement du système de santé et plus précisément des soins anténatals c o m m e du « cadre de vie », qui n'est « pas façonné, encore apprivoisé,

par ses usagers,

les codes et les exigences, surprendre.

qui s'efforcent

avec d'ailleurs

seulement

une faculté

d'en

d'adaptation

ni

même

maîtriser qui peut

» 2 II est d'ailleurs à signaler q u ' e n l'absence de légalisation des

associations de patients et des O N G - et donc d ' u n e certaine "veille citoyenne" - c e t "apprivoisement" est encore plus malaisé... 1

2

Ibid.

Lavergne, 2005 : 6

UNE M É D E C I N E

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221

obstétricale : maillon d'une chaîne ?

L'échographie obstétricale trouve sa place dans les pays du Nord dans une séquence où les techniques de diagnostic prénatal se succèdent et se complètent à l'intérieur d'un arbre décisionnel complexe mais relativement standardisé1. Le ministère de la Santé omanais publie quelques chiffres et recommandations 2 montrant un intérêt croissant pour une gestion plus attentive des pathologies congénitales et génétiques se rapprochant des protocoles occidentaux. En effet, le taux d'anomalies congénitales élevé (supérieur à 9 pour 1000) serait responsable de 30% des décès périnatals 3 et de 41% des handicaps.

Interruption Médicale de Grossesse (IMG) : le flou La potentialité d'un recours à une interruption médicale de grossesse est intrinsèquement liée à l'échographie obstétricale dans les pays du Nord : la connaissance approfondie de l'état des foetus ouvre la question de leur "tri", phase "active" du diagnostic prénatal, autorisée dans de nombreux pays occidentaux. L'IMG commence d'ailleurs à être débattue en Oman, bien que les implications concrètes d'une telle possibilité ne soient jamais évoquées par les échographistes observés. L'existence même de tels actes médicaux en Oman est affirmée ou infirmée selon les professionnels interrogés. Quelle qu'en soit la cause, l'arrêt d'une grossesse est officiellement autorisé en Oman uniquement si la vie de la mère est en danger. Pourtant plusieurs professionnels admettent l'existence de cette pratique ou du moins sa prescription, s'accordant sur la rareté de ce recours, prescrit en cas d'anencéphalie surtout. Le contournement de l'interdit serait possible par le déclenchement prématuré de l'accouchement, aboutissant au décès de l'enfant, ou par l'envoi des familles dans des pays pratiquant les IMG. Mais il semble que depuis peu de temps (1999 environ), le ministère de la Santé considère la possibilité de légaliser l'IMG 4 pour pathologie fœtale.

En France par exemple, très rares sont les patientes subissant une échographie sans avoir été au préalable examinées par un gynécologue, de m ê m e que certains examens c o m m e les IRM f œ t a l e s ne sont d e m a n d é s et réalisés q u ' a p r è s impossibilité avérée de visualiser certaines structures anatomiques par échographie. 2

Ministry of Health & Unicef, 1999

3

Ibid. : 25

4

Ibid.:

35-36

222

CLAIRE

BKAUDEVIN

Dans la mesure où plusieurs professionnels a f f i r m e n t la possibilité certes rare - de décisions d'interruption médicale de grossesse et de conseil génétique, il est intéressant d'en savoir plus au sujet des structures de contrôle et de décision qui pourraient exister. M a i s si chacun a entendu parler de structures de référence nationales, personne n'est catégorique ou précis quant à leur organisation ou même à leur existence. A i n s i , par e x e m p l e , un comité de type C o m i t é P l u r i d i s c i p l i n a i r e de D i a g n o s t i c Prénatal

(CPDPN)',aux

activités floues, existerait au ministère de la Santé et impliquerait des experts du ministère des A f f a i r e s religieuses. Des réunions régulières de professionnels ayant pour but la discussion des cas auraient é g a l e m e n t lieu dans deux hôpitaux publics de Muscat. Quelles que soient ces institutions, leur existence semble

donc

q u a s i - c l a n d e s t i n e ; leur

activité

n'est

pas

commentée

officiellement. On constate donc de manière générale le peu de cohésion de la "chaîne de travail", du réseau constitué par l'ensemble des professionnels impliqués dans le suivi des grossesses. Malgré le tracé matérialisé par la carte verte, les informations ne circulent pas, parfois m ê m e au sein du même hôpital. Il semble qu'aucun acteur du suivi de grossesse n'ait une vision très nette du rôle des intervenants en amont ou en aval de sa propre intervention.

Tests et conseils génétiques, autres moyens de Diagnostic Prénatal (DPN) L e s précisions sont rares concernant l'introduction de n o u v e l l e s techniques de D P N , bien que l'intérêt pour la génétique en Oman aille croissant : les techniques de D P N complémentaires de l'échographie - dosages de marqueurs

sériques, amniocentèse

-

sont en cours

d'installation.

L'amniocentèse semble un recours exceptionnel, ne faisant l'objet d'aucune prescription systématique en lien a v e c le risque de malformation accru par l ' â g e de la f e m m e . L e s rares prélèvements e f f e c t u é s seraient analysés en E u r o p e , aux dires des praticiens. Il n ' e x i s t e pas en O m a n de dépistage systématique de la trisomie 2 1 , ni par échographie ni par voie sanguine.

' C e dernier se matérialise en F r a n c e par une réunion h e b d o m a d a i r e dans les h ô p i t a u x universitaires (et dans certains r é g i o n a u x ) lors de laquelle c h a q u e échographiste présente les c a s rencontrés et discute a v e c d'autres professionnels (obstétriciens, pédiatres, échographistes, g é n é t i c i e n s , chirurgiens pédiatriques, p s y c h i a t r e s , s a g e s - f e m m e s etc.) de la prise en c h a r g e périnatale à prévoir. L e but est de donner une information aussi c o m p l è t e q u e possible a u x parents et a u x p r o f e s s i o n n e l s en charge d ' u n e patiente c h e z qui une a n o m a l i e f œ t a l e ou obstétricale a été dépistée.

UNK

MÉDECINH

MODERNE

DISSOCIÉE

DU

PASSÉ

223

Dans ce pays où la consanguinité des époux est très fréquente - 35% des couples cousins germains - et la prévalence des pathologies sanguines héréditaires très élevée 1 , la prise de conscience de l'utilité d'un conseil génétique se dessine seulement. Les moyens de publicité restent assez modestes et se limitent pour l'instant à des plaquettes du ministère de la S a n t é ( 2 \ proposant une vulgarisation des connaissances sur la transmission génique des maladies et conseillant de réunir la famille élargie avant tout mariage afin d'évaluer les liens de parenté, et d'interroger les anciens sur les pathologies familiales connues.

DPN en Oman : une réflexion éthique en gestation ? Sous des dehors de pure technologie - émanation de la modernisation, détachée de tout contexte socioculturel d'origine - , l'échographie obstétricale véhicule nombre de débats et d'enjeux politiques, confrontant science et morale. Or, la résolution des dilemmes bioéthiques ne saurait « être séparé[e] des contextes institutionnel, politique, économique, social et culturel dans lesquels ils sont enchâssés. » 3 On peut donc s'interroger sur la manière dont la société omanaise formule les notions de moral / immoral, correct / incorrect et normal / anormal. Les interrogations bioéthiques commencent à trouver un écho dans les réflexions du gouvernement et des praticiens, notamment au sujet de l'interruption de grossesse pour motif thérapeutique, qui n'a pas pour autant de dénomination officielle 4 . Ce type d'intervention est en effet rendu possible par le diagnostic précoce de grossesse fourni par l'échographie, permettant une prise de décision quant à une éventuelle interruption. L'appropriation de l'échographie suscite des interrogations sur ses usages sociaux acceptables pour la société omanaise. L'arrivée de nouvelles techniques (transplantations, procréation médicalement assistée...) a d'ailleurs posé des problèmes de choix de santé publique dans certaines des sociétés arabes, bien que ne concernant d'abord qu'une faible part de la population.

Consanguinité : c h i f f r e ministère de la Santé / 2 nouveaux-nés sur 1000 atteints d'hémoglobinopathies, 6% de la population porteurs d'une anomalie. En comparaison, les chiffres saoudiens (comme ceux de la plupart des pays arabes) sont proches : 5%o et 10%. Au S o u d a n et au T c h a d par e x e m p l e , le n o m b r e de n o u v e a u x nés t o u c h é s par les hémoglobinopathies est supérieur à 19%o. S o u r c e s : O M S , Bureau de Méditerranée Orientale ( w w w . e m r o . w h o . i n t / p u b l i c a t i o n s ) et O M S (www.who.int/genomics). 2

Telle : Ministry of Health, ri.d. - « Faire connaissance avec la santé héréditaire. Ma mère et moi souhaitons connaître certains secrets génétiques. » |a't c araf c ala a'saha al-warathiya] 3 4

Olivier de Sardan, 1999 : 453

En France, on l'appelle Interruption Médicale de Grossesse, IMG, après avoir abandonné les dénominations IVGT, Interruption Volontaire de Grossesse à visée Thérapeutique et ITG, Interruption Thérapeutique de Grossesse.

224

CLAIRE

BHAUDKVIN

L'éthique médicale en Oman est enseignée en faculté de médecine dans sa version islamique, notamment sous la f o r m e d ' u n e semaine annuelle d e débats entre professeurs, professionnels de santé en exercice et étudiants en médecine (dès le premier cycle). L'enseignement est fondé sur des ouvrages importés du Koweït ou d ' A r a b i e Saoudite. Ce corpus est surtout constitué des fatwas égyptiennes, qui bénéficient d ' u n e écoute attentive dans le monde arabe. En l'absence «d'une

instance

unique

supranationale

» ' représentant les

musulmans, et malgré l'existence de "tendances" c o m m u n e s , aucune ligne de conduite partagée n'est définie absolument en matière d'innovations juridiques vis-à-vis de la médecine. Dans le contexte du développement rapide des techniques de D P N , on peut se demander si l'enseignement de l'éthique aux médecins locaux peut servir de frein au développement anarchique de celles-ci. Malgré quelques "initiatives isolées", il n'existait en 2004 en O m a n aucune institution, équipe ou organisation travaillant réellement à la constitution d ' u n référent bioéthique national en matière de pratique médicale. Pour ce qui est de la recherche, un Comité d'Ethique a été constitué au début des années 2 0 0 0 et évalue tous les projets de recherche portant sur la santé et envisagés sur le sol omanais.

Conclusion Au terme de cette évocation de l'échographie obstétricale en O m a n , une insistante question é m e r g e : le sort du "savoir sur le f œ t u s " acquis par l'examen échographique. Ce savoir a-t-il nécessairement des conséquences pratiques ? Si oui, vont-elles aller j u s q u ' à l'interruption d ' u n e grossesse ? A l ' h e u r e q u ' i l est, l'utilisation en semble surtout purement obstétricale détermination

de l ' o r i e n t a t i o n

et d e la taille du f œ t u s en vue

de

l'accouchement, etc. - et il est important de souligner que l'on n'observe pas en O m a n - au vu du sex ratio - d e dérive « fœticide

sexosélective

ce qui a été relevé en Inde, Indonésie ou encore en Chine.

»2 comme

3

D'autre part, la santé publique omanaise n ' é c h a p p e malheureusement pas à la constatation f r é q u e n t e des experts, que les politiques de santé publiques aggravent de manière générale les inégalités sociales préexistantes ou au mieux les conservent. En e f f e t , l ' a c c è s des f e m m e s aux techniques avancées de dépistage génétique (diagnostic préimplantatoire par exemple) ou même à l'interruption médicale de grossesse, est subordonné à leur capacité

1

Moulin, 1993: 13

2

Vella, 2003

3

Ibid. & Boukhari, Otechel. et al., 1999

IJN H M É D E C I N E

MODHRNH DISSOCIÉE

DU P A S S É

225

financière à se rendre à l ' é t r a n g e r , ainsi q u ' à leur " a u t o n o m i e " par rapport à leur famille. Dans ce contexte, il est très malaisé d ' é v a l u e r les c o n s é q u e n c e s de l ' i n t r o d u c t i o n de l ' é c h o g r a p h i e sur la mortalité maternelle et n é o n a t a l e . Si la volonté g o u v e r n e m e n t a l e de tirer le meilleur parti p o s s i b l e de l ' é c h o g r a p h i e paraît réelle, l ' o b s e r v a t i o n de terrain i n s i n u e des d o u t e s q u a n t à son réel impact, ceci étant largement dû à l ' a b s e n c e d ' u n e chaîne décisionnelle en D P N . E n f i n , cette contribution é v o q u e u n e m é d e c i n e c o u p é e d u passé, d u fait d e l ' a b s e n c e d e c o n t i n u u m réel entre la m é d e c i n e d ' a v a n t 1970 et celle d ' a p r è s . C e t t e c o u p u r e a à m o n s e n s une d o u b l e o r i g i n e . T o u t d ' a b o r d , le " s a u t sanitaire", qualitatif et quantitatif, a été si grand q u ' i l semble que les O m a n a i s n e puissent penser cet " a v a n t " et cet " a p r è s " avec les m ê m e s outils. A i n s i , les tradipraticiens dont l'activité a perduré après la scission des années soixante-dix ne sont que très peu visibles socialement. Mais d ' a u t r e part, cette invisibilité étant é g a l e m e n t i n s t i t u t i o n n e l l e , on pourrait é g a l e m e n t l ' e x p l i q u e r p a r u n e crainte gouvernementale de voir resurgir à travers ces acteurs d e santé un passé récent m a i s p o u r t a n t d é j à réinventé - j ' e m p r u n t e ici à C h r i s t o p h e r D O L E ( 2 0 0 4 ) son analyse c o n c e r n a n t la T u r q u i e kémaliste. Par un e f f e t d e s y m é t r i e , de résonance, on peut sans doute également c o m p r e n d r e en partie l ' e n g o u e m e n t p o u r l ' é c h o g r a p h i e o b s t é t r i c a l e 1 - m ê m e sans réelle i n t é g r a t i o n d a n s un p a r c o u r s d e soins - c o m m e un m o y e n d e d é t o u r n e r les y e u x d e c e m ê m e passé... Si - au p r e m i e r abord et c o m m e l ' h i s t o r i o g r a p h i e o f f i c i e l l e le conte - , l ' o n peut penser q u e la titanesque création du s y s t è m e de santé o m a n a i s s ' e s t faite " d e zéro", o n s ' a p e r ç o i t r a p i d e m e n t que c e " z é r o " fictif est peut-être plus palpable dans l ' O m a n de 1970 q u e nulle part ailleurs. Il est certes fiction, mais fiction bâtie, p u i s q u ' i l a fallu " c o n s t r u i r e le z é r o " avant de l'utiliser c o m m e point de d é p a r t . . . L e c o n s t r u i r e ne s u p p o s a i t pas é v i d e m m e n t d é t r u i r e des structures de soins e x i s t a n t e s , mais i m p o s e r r a p i d e m e n t à la p o p u l a t i o n des soins n o u v e a u x . A u vu de m e s r e r c h e r c h e s j u s q u ' à p r é s e n t , il s e m b l e que le régime n ' a pas choisi d e s ' a p p u y e r sur une tradition préexistante pour effectuer une transition. Il n ' y a pas eu d e patrimonialisation des tradipraticiens et des m é d e c i n e s traditionnelles c o m m e il y a eu patrimonialisation d e S i n d b a d le m a r i n ou des f o r t s d u p a y s , secteurs t r a d i t i o n n e l s d a n s la c o n s t r u c t i o n d e la légitimité s u l t a n i e n n e 2 . En fait, le passé médical du pays n ' e s t ni étudié ni

' Et nombre d ' a u t r e s techniques médicales qui ne sont pas encore totalement maîtrisées ou légalement intégrées dans le pays. 2 II en est ainsi par exemple de la patrimonialisation gouvernementale, exercée aussi bien sur des monuments, des danses ou des savoirs-faire : sortis de leur contexte historique, ces éléments ne servent plus que de faire-valoir au régime qui les sauvegarde.

226

C L A I R E BEAU DEVIN

mis en valeur', à la différence des efforts gouvernementaux développés ailleurs - par exemple en Afrique du Sud - pour intégrer la médecine traditionnelle dans le système de santé. On en vient donc à s'interroger sur le statut exact de l'histoire médicale du pays - moins ostensiblement occultée que le passé politique - : est-elle absente car potentiellement déstabilisante ? Et n'est-elle pas d ' a u t a n t plus absente q u ' e l l e est m é c o n n u e ? En e f f e t , la situation sanitaire omanaise est présentée sur place c o m m e la résultante d e bientôt trente-cinq années de "modernisation sultanienne" et non pas revendiquée c o m m e la continuité d'une tradition arabo-persane ancienne et d'un âge d ' o r des sciences arabes. L ' H i s t o i r e est presque "vidée" et, en ce qui concerne la médecine, pas même réécrite c o m m e cela peut être le cas ailleurs. Les propos d ' A n n e - M a r i e MOU U N 2 consacrés à d'autres sociétés arabes s'appliquent également à O m a n : dans un état où les forces démocratiques sont faibles, l'Histoire est presque uniquement modernisation

présentée c o m m e

«processus

de

», et celle de la médecine n'échappe pas à ce phénomène. Mais

le continuum de la modernisation n ' e s t pas ici pensé à la même échelle que dans d'autres sociétés arabo-musulmanes. Le "réveil" de la nation ferait suite à la longue " n u i t " 3 dont son sultan l ' a tirée. Dans ce contexte, la santé au présent

est un domaine clé : les réalisations gouvernementales en matière de

santé publique, vitrine valorisante et valorisée, consolident la légitimité du pouvoir. Finalement, les innovations sont conçues c o m m e offertes par le sultan - et la rente pétrolière - e t cette origine prime : l'importation d e technologies c o m m e l'échographie n'est pas vue comme "l'échec" des techniciens et savants du pays, mais comme une réalisation importante du régime, qui fournit à ses citoyens - et à eux seulement, porteurs du " t a l i s m a n " évoqué plus haut - le meilleur sans contrepartie financière. Les innovations, notamment médicales, s'inscrivent dans la suite de la nahda omanaise et scandent le temps sultanien. L ' a b o n d a n c e d e modernité scientifique, au sens large du t e r m e , semble légitimer l'absence d'historicité au regard des sciences. 11 y a ici à mon sens une conception omanaise du temps qui reste à examiner plus avant... Aussi lointaine et osée que puisse paraître l'analogie, j e reprends à mon c o m p t e en clôture les mots de Christopher D O L E 4 au sujet de la Turquie k é m a l i s t e : « (...) biomédecine

le développement

prolonge

des conceptions

d'un

système

de la subjectivité

de santé

basé

intimement

sur

la

liées

à

' L'absence de passé universitaire du pays participe aussi de cet état de faits. ^ C o m m u n i c a t i o n , 18 è m c congrès de l'Association Française pour l ' E t u d e du Monde A r a b e et Musulman, Lyon, juillet 2004. 3

Ces deux termes sont c e u \ consacrés par l'historiographie officielle. Ils sont présents dans les manuels scolaires. 4 D o l e , 2 0 0 4 : 273

UN K M É D E C I N E des formulations individuel),

MODERNE

idéologiques

de la modernité

du nationalisme

(citoyenneté,

de la sécularité

(pouvoir

religieux

où la médecine

parlait

le langage

servait

de médiateur

des individus

dans

(citoyens)

DISSOCIÉE

(rationalité,

santé

versus

DU P A S S É

autorité

et une société

d'une

politique

choix et

séculière).

et vice

relation

(nation)

raison,

individuelle/publique)

de la civilisation,

l'articulation

227

Là

versa,

elle

particulière

entre

(...) ». Et quelle articulation

plus intime et porteuse d'avenir que celle qui se noue autour de la naissance des futures générations ?

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la naissance

vient

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Les

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