In nineteenth-century Amasya, disease was as decisive a historical force as war or earthquake. The sanjak, attached to the province of Sivas, lay on the roads to Tabriz and Baghdad, and so sooner or later it met in its own streets most of the epidemics that broke out elsewhere in the empire. Plague, cholera, smallpox, syphilis, influenza and typhus caused losses across the sanjak between 1812 and 1918. In the same century the Ottoman state established its first institutional quarantine organization, and in 1840 that organization reached Amasya. Its founding was not easy: in the very first year the city's quarantine physician became the target of the crowd's anger because he wished to examine corpses. The only detailed study of the Amasya sanjak on this subject is Sabit Genç's 2020 article, based on Ottoman archive documents and the accounts of foreign travelers, and it forms the backbone of the account below.

The Late Birth of Quarantine in the Ottoman Empire

The history of quarantine in Europe goes back to the fourteenth century, when the first quarantine points were set up; quarantine stations followed in the fifteenth. In the republics of Dubrovnik and Venice these practices took on an institutional character in the second half of the fifteenth century. In Ottoman lands, by contrast, no central health organization existed against plague and similar diseases for centuries. The origin of illness was often read as a divine trial, and when people thought of protection they usually thought of leaving the place where the epidemic had broken out.

The empire's geography made it especially vulnerable. The Ottoman-controlled branches of the Silk Road and the Spice Road, and the thousands of pilgrims who came to the Hijaz each year from regions stretching from India to the Caucasus and from the Balkans to North Africa, carried diseases along with the caravans and their goods. Returning pilgrims scattered to their home regions and could spread an epidemic that had begun in the Hijaz to every corner of the empire. The plague records show the cost. In the epidemic of 1462-1476 an estimated fifteen to twenty thousand people died in Istanbul, and in 1513 alone about twenty thousand are thought to have perished. In the outbreak of 1812 one fifth of Izmir's population died and the toll in Istanbul and its surroundings reached 220,000. The epidemic of 1826 is said to have taken twenty to twenty-five percent of the Ottoman population. These figures are researchers' estimates and do not rest on a single document.

The shift to institutional quarantine came under Mahmud II. When a plague epidemic that began in Anatolia in 1834 spread as far as Istanbul and caused many deaths in the capital, it was decided to set up a quarantine organization in Istanbul, and checks began at the city's points of entry and exit. On 22 May 1838 two boards, the Meclis-i Tahaffuz-ı Evvel and the Meclis-i Tahaffuz-ı Sani, were formed to carry out the work of the quarantine procedure (usul-i tahaffuz). The first was to run quarantine affairs, the second to inform the public about epidemics and translate medical texts from foreign languages. In practice this division was not maintained and the two boards did not work separately. The board, initially attached to the Foreign Ministry, passed in later years between the Ministry of Commerce, the Foreign Ministry again, the Imperial Medical Directorate (Tıbhane-i Amire Müşirliği) and the Foreign Ministry once more, and in time came to be known as the Meclis-i Umur-ı Sıhhiye. Some accounts state that a quarantine ministry was established in 1839.

The state's lack of adequate expertise, and the objections of European states to the practices, pushed the Ottoman administration into cooperation with foreigners. Representatives of the embassies were placed on the quarantine boards, and many foreign physicians and quarantine officials were employed. Some foreign officials were rewarded for their diligence; in 1887 the French quarantine official Sekör received the Murassa Medal. Others did not take their duty seriously: in 1841 Lapir, serving on Cyprus, was dismissed for conduct contrary to procedure. International sanitary conferences to standardize quarantine measures began with one in Paris in 1851, and the second met in Istanbul in 1866. At home, a regulation of 1850 defined the duties and powers of quarantine officials, and the Ceraim-i Sıhhıye Law of 1884 imposed harsh penalties on those who broke the rules. Under its seventeen articles, violators of quarantine could be sentenced to row in the galleys, and guards could use weapons against those who tried to escape from a quarantine station.

Measures were also taken against epidemics abroad. In 1882, because of cholera in Sumatra, arrangements were made to hold pilgrims coming from India for ten to fifteen days of quarantine on Kamaran Island before they landed; the quarantine station there was staffed with six doctors, one pharmacist, six clerks, two hundred soldiers under an officer, and twenty-five guards. In 1884, after cholera appeared in France, 669 passengers arriving in Beirut and 33 arriving in Izmir were quarantined. In 1896, because of plague in India, travelers from India, Iran and the Persian Gulf were held for three days on Kamaran. Similar measures were applied inside the empire: in 1888, because of cholera at Foça, ships arriving from the coast between Izmir and Antalya were held in quarantine for five days. In 1893, when quarantine in Izmir left some people jobless and in need, a commission was set up to identify them and food aid was provided.

Quarantine Reaches Amasya

Once the benefit of the Istanbul arrangement had been seen, the organization began to spread to the provinces. On 4 March 1840 quarantine began to be applied in the provinces of Hüdavendigâr, Konya, Aydın, Ankara and Sivas in Anatolia, and Edirne, Silistra, Kosovo, Vidin and Salonica in Rumelia. Journal clerks (jurnal kâtibi) were appointed in the sanjak centers of these provinces to report epidemic diseases. For the Amasya sanjak, İbrahim Efendi was appointed journal clerk at a salary of 150 kuruş. In the same year an Italian physician, Paldi, took up his post as quarantine physician in Amasya. The German traveler Andreas David Mordtmann gives the name of the physician, who appears as Paldi in the archive documents, as Artze Bartoletti.

The organization expanded the following year. In 1841 a quarantine director and a quarantine physician were appointed to each of forty-one centers in Anatolia and Rumelia, Amasya among them. The salary of the Amasya quarantine director was set at 1,300 kuruş and that of the physician at 1,000. On 27 May 1843 Abdülhamid Bey was named director. Records of 12 August 1843 show that an organization had been set up in the district of Merzifon alongside the central district of Amasya. In Amasya, the director Hamid Efendi received 500 kuruş, the physician Rasih Efendi 1,000, the clerk İbrahim Efendi 150, and the head guard Abdullah Efendi 120, and four watchmen worked at 80 kuruş each. The quarantine station occupied a rented building, whose rent was 65 kuruş. In Merzifon, the director Mustafa Ağa received 150 kuruş, three watchmen 60 kuruş each, and the building rent was 15 kuruş. On 14 October 1852 the quarantine directorate in Amasya was held by Osman Ağa.

That Amasya and Merzifon were chosen first was no coincidence. Both lay on the roads linking Istanbul with Tabriz and with Basra and Baghdad. The left branch ran through Üsküdar, Gebze, Bolu, Tosya, Hacı Hamza, Merzifon, Niksar, Şebinkarahisar, Bayburt, Erzurum and Kars to Tabriz; the central branch continued from Merzifon through Tokat, Sivas, Malatya, Harput, Diyarbakır, Mosul and Baghdad to Basra. By checking those who came and went along the road, the authorities hoped to keep diseases from spreading within the sanjak.

The Killing of the Quarantine Physician Paldi

An incident soon after the organization's founding shows how the public regarded the new practice. According to the documents, on 4 August 1840 Paldi, while examining the bodies of several people who had died one after another, on suspicion of an epidemic and before burial, asked to see the bodies of women as well. The request enraged the crowd, and the physician was lynched. Serious disorder followed in the city, and the security forces had difficulty bringing the situation under control. According to Mordtmann, the government sent 5,000 Albanian guards from Istanbul. The 1841 record of the appointment of quarantine directors also suggests that a new physician was assigned after the incident.

In the investigation, those who had incited the crowd were sent to Istanbul on 23 November 1840. Among them were members of the ulema such as Reşidzade Hacı Mustafa Efendi, Yahya Efendi of Merzifon and Hacı Emin Efendi of Taşköprü, along with more than twenty-five tradesmen and people of other occupations. Amasya's judge Süleyman Efendi, the town mufti Mehmed Efendi, the mufti İsmail Efendi and the priest of the Greek church, Dimitri Efendi, were also summoned to Istanbul so that their knowledge could be consulted. After a detailed trial before the Meclis-i Vâlâ, it was decided to exile Reşidzade Hoca Mustafa Efendi and Yahya Efendi and to imprison Emiroğlu Hacı Mustafa. The others were kept under supervision in Istanbul on bail, without a prison sentence. A pension was granted to the murdered physician's wife.

The article places the event once at 1841; the date in the archive document is 4 August 1840.

Public Attitudes and Habits of Treatment

Resistance to quarantine was not peculiar to Amasya. In 1841 the quarantine physician of Bergama, when he wished to examine a body, fled to Istanbul because of the crowd's threats. In 1845 some 3,000 people returning from pilgrimage whom the authorities wished to quarantine at Adana left the area. In 1848 at Antep the relatives of patients placed in quarantine stoned the quarantine station and attacked the director. In 1887 at Mitrovica a quarantine officer was killed. In Tunis a Maliki teacher regarded quarantine as defying fate, while the Hanafi mufti found it consistent with the sharia. In 1814 in Epirus, the French consul Pouqueville's proposal for a quarantine station was met with ridicule, and a dervish said that plague had always existed in the world and would come if it was to come; some time later the plague spread through the town. The researcher notes that the habit of attributing the cause of disease to a divine source, without regard to way of life, diet and environment, belonged to more than the nineteenth century alone. According to Evliya Çelebi, the observatory opened in Istanbul at the end of the sixteenth century was regarded by some of the ulema as the cause of plague.

Foreign travelers recorded the attitudes in Amasya in detail. In 1827 the French naturalist Victor Fontanier, who had come to the city, was asked to examine two women who had fallen ill in the house of a prominent family. He was not allowed to see the women with the naked eye and could examine them only by touch, with his eyes shut. In 1861 the French archaeologist and linguist Georges Perrot, who stayed about twenty days in the city, recalled that a diplomaed Italian physician had earlier been lynched by a public displeased with his practice. According to Perrot, the sick were treated by people who applied what they had learned through apprenticeship, and these people were respected by the public and the authorities alike; even the governor's private physician was a farrier. Imams and hodjas who treated patients by writing verses believed to heal on paper, and who charged large sums for it, were also in great demand. Perrot adds that a swindler took advantage of the public's ignorance by claiming he would cure the sick and drive away jinn, and defrauded people.

The Ground for Epidemics: Roads, Refuse, Water and Marsh

Some of the epidemics in the Amasya sanjak came from outside, and some grew out of local conditions. The external factors included the road route, returns from the pilgrimage, migrants from Crimea and the Caucasus, and the population movements of the First World War. The migration that began after Russia annexed Crimea in 1783 continued in the nineteenth century, and Kabardian and Circassian groups were settled around Amasya, Merzifon and Suluova. In 1835 Tahir Bey of the Kabardian tribe and the fifty people with him were settled in the nahiye of Suluova, and in 1837 Hacı Yusuf Efendi and a group of Kabardian migrants were settled in the village of Yenice in Merzifon.

Local conditions were shaped by poverty and a lack of infrastructure. The British diplomat Robert Ker Porter, who came to the city in 1819, writes that the roads were covered with refuse and filth and that an unbearable smell hung over the place. In 1842 James Philip Fletcher, lodging in a village on the way from Samsun toward Amasya, and his party could not sleep for fleas and spent the night drinking coffee by a fire. In 1850 Mordtmann, leaving Amasya by the Mecidözü road, likewise could not sleep at the village of Zara, today's Doğantepe, despite the generous hospitality of his host. Mordtmann describes Amasya as having an unhealthy, feverish climate, notes that most of its people bore the marks of disease, and ties this to the pools of standing water left by the careless irrigation of the mulberry orchards used for silkworm rearing, and to the flies breeding over them.

The Sivas provincial yearbook draws the same picture. It records that in Suluova water drained poorly, that there were many marshes and in places rice fields, and that malaria therefore prevailed fiercely; that in recent years the harm of rice cultivation had been recognized and reduced, so that malaria had eased somewhat. It notes that in Kazova in Tokat sanjak, the villagers around Kaz Lake, which turned into a marsh in summer, did not wish the lake drained because of the benefit they drew from its reeds and meadows. In Taşova no such health hazard existed, though the drinking water was poor in many places.

The Plague Epidemics

Plague is a disease caused by the bacterium Yersinia pestis; the bacterium passes from rodents to humans through fleas, and black rats in particular play a part in this transmission. Anatolia and the Balkans first came to know plague in the middle of the sixth century, under the Byzantine emperor Justinian. In the following centuries recurrent epidemics concentrated in the nineteenth century in 1812-1819 and 1835-1838. The quarantine organization brought plague under control after the 1830s, but its effect lingered in places until the end of the century.

The plague in Amasya appears to have been an extension of the general epidemic that began in 1812. That year the British soldier and traveler Sir William Ouseley, going from Erzurum through Tokat toward Istanbul, witnessed fifteen or sixteen deaths in a day and a half at Niksar and many deaths within a few hours at Tokat. At the inn where he stayed in Amasya a Tatar arrived who was traveling from Istanbul to Tokat; he said that there was an epidemic in the capital, that the city had emptied, and that Ouseley should leave as soon as possible. The same Tatar had told how, while at Merzifon, he had seen the funerals of five people who died of plague within half an hour and heard cries from the city. Reaching Merzifon the next day, Ouseley and his companions heard that more than sixty people had died there that night, and did not enter the city but camped outside. He wrote that eleven more people were buried that day, that many freshly dug graves stood in the cemetery, that people were weeping beside the graves, and that some residents had abandoned the city.

A new wave of plague came in 1826. The British soldier James Edward Alexander, who entered Ottoman lands from Iran and advanced via Kars, Erzurum and Tokat, learned that plague had spread through Tokat and passed along the edge of the city toward Amasya without entering it. A vineyard owner he met at the city's exit told him that forty or fifty people were dying each day in the city of about 30,000, and that he himself had not left his garden for three months. Learning that four or five people were dying each day in Amasya, Alexander writes that the first thing he saw at Merzifon was many people digging graves. He notes that the public denied the existence of the epidemic and that he himself camped outside the city to protect himself.

The following year, 1827, Fontanier, who came from the Caucasus by way of Trabzon, Gümüşhane, Bayburt and Tokat, was held back on entering Amasya because of plague and stayed in the city for a time. He wrote that people were dying in the grip of plague and that mass deaths could not be prevented. He says that when he examined the patients of the prominent family mentioned above, he saw the symptoms of plague. The next great wave of epidemics came as cholera.

The Cholera Epidemics

Cholera is an intestinal infection spread through drinking water fouled by the excrement of the sick, and if not treated in time it ends in death. Remaining a local disease in the Ganges valley in India, cholera spread outward after 1817 and in the nineteenth century caused six pandemics. It was first seen in Ottoman lands in 1822.

Cholera was felt around Amasya in 1848. The epidemic was a continuation of the pandemic that began in India in 1829 and lasted until 1851, and it had reached Ottoman lands overland through Iran and the Caucasus and by sea at Trabzon. Amasya's position on the route running from Tabriz through Erzurum to Istanbul, and its role as a stopping place for migrants arriving from Crimea and the Caucasus at Trabzon and Samsun on their way into the Anatolian interior, made spread easier. The area around Amasya and Yozgat is named among the places where the epidemic ran severely. The Amasya governorate (mutasarrıflık) began quarantine in the sanjak at once when the epidemic started, asked for additional physicians and reported the measures it had taken to the government. The chief physician (hekimbaşı) found the measures appropriate, but stated that the three physicians in Amasya were sufficient and refused the request for more. In the same epidemic, in Istanbul alone about 10,000 people fell ill and 5,275 died. The chief physician İsmail Pasha had a booklet prepared on the symptoms of the disease and the ways it spread and could be avoided; it was translated into the minority languages as well as Turkish and distributed to officials and community leaders, and the sale of certain fruits and vegetables considered a danger to health was banned.

In 1863 a new wave of cholera spread from India through the Hijaz and Egypt to Anatolia and Europe and caused great fear among the people. The ambassadors in Istanbul consulted the Ottoman government about common action; the conference that met decided that quarantine stations should be built at suitable places to prevent the disease from entering from India, and that sacrificial animals slaughtered in the Hijaz should be buried rather than left lying about. At this time Amasya had no sewer system in the city center; the dirty water and toilet waste of houses was left in the streets and a foul smell spread. The Tanzimat-era statesman, thinker and poet Ziya Pasha served as governor (mutasarrıf) of Amasya from 1863 to 1865. In 1865, with the help of the public, he spent 35,000 kuruş to have a sewer network built for the city. This step helped clean the streets and reduce the risk of cholera in the city center. From 1871 the state began appointing municipal physicians (memleket tabibi) to cities, their pay to be met by the municipalities; in the same year Kiforik Efendi was appointed to the sanjak center of Amasya.

The most severe wave came in 1893. The epidemic, which came out of India and spread to Ottoman lands through the Hijaz and the pilgrimage, had killed 30,306 people in the Hijaz alone in 1892. When cholera appeared in the province of Trabzon in 1892, the governorate of Sivas built a quarantine station in each of the sanjaks of Amasya, Tokat and Karaağaç. In Amasya the first cases were seen a year later, in November and December 1893. On 11 November 1893 a private soldier died of cholera in the Amasya military hospital and a Greek woman also fell ill. When the disease appeared in villages of the central district and some patients died, the Sivas governorate asked the Ministry of Health for a total of seven physicians: two for the center and one each for the districts of Gümüşhacıköy, Havza, Mecidözü, Ladik and Osmancık. It also asked for a temporary quarantine station at Çengel Pass, on the Tokat-Amasya road northeast of present-day Turhal, and for two physicians to serve there. Soon afterward the station began work with a physician who came from Tokat.

In December the epidemic grew more severe, and as the physicians at hand did not suffice, on 10 December 1893 the government decided to send to Amasya the physician Çakıryan at a salary of 3,000 kuruş, the physician Yasef Efendi at 1,660 kuruş, and two military physicians to be designated by the office of the seraskier. On 14 December 1893 captains Hasan Fehmi and Ahmed Kâzım Efendi, military physicians of Haydarpaşa Hospital, and İsmail Efendi, a serving pharmacist of Maltepe Hospital, were sent to Amasya.

The epidemic continued to take lives in 1894 and 1895. Deaths were recorded in Merzifon, Yozgat, Sungurlu, İskilip, Tokat, Zile and Erbaa. In June 1894 twelve people died in Tokat, eight in Zile, nine in Erbaa, two in Boğazlıyan and sixty-three in Yozgat, ninety-four in all; two people died in Merzifon. After the rise in Merzifon the Ministry of Health sent the physician Hamburg there, and when the epidemic eased at the end of June he was transferred to Amasya on 27 June. The Meclis-i Umur-ı Sıhhiye decided that the cordon placed around houses with cholera in the province of Sivas should be drawn back to places half an hour's distance from the city, and that neighboring provinces should apply quarantine against Sivas. In the epidemic that ran through the sanjaks of Sivas, Tokat and Amasya during 1894, 600 people died in Sivas alone. The government had fifty machines for spraying disinfectant imported from abroad for use in the affected places; on 31 May 1895 medicine was sent from Istanbul by ship for Amasya and Tokat. After some time the epidemic lost its force thanks to the measures taken.

In 1910 a new wave of cholera entered overland through Russia and reached Erzurum, Van, Mamuretülaziz, Trabzon and Samsun, and from there Amasya, Merzifon, Tokat and Sivas. It is said that cholera was brought to Samsun by soldiers returning from Albania. From 3 November 1910 steamers taking passengers from Samsun were put in quarantine for five days at Sinop, and those carrying only goods at Manastır Ağzı. Travelers going from Samsun to Amasya and Tokat by road were examined daily by a physician as they left the city, and those showing signs of cholera were not allowed to continue but were treated in a separate place. In 1911, 12,143 people died of the disease across the empire. The Meclis-i Umur-ı Sıhhiye asked its president Besim Ömer Bey and the member Akil Muhtar Bey for a study that took into account the measures of other countries. The two physicians presented their report as "Kolera Hastalığında İttihazı Lazım Gelen Tedabir ve Etıbbaya Rehber", and the board had it printed in 1912, as a book of 240 pages, for the use of physicians and the public. The book contained the symptoms of the disease, the measures to be taken, illustrations of the equipment to be used, sample hospital plans and a map showing the routes by which cholera spread.

Smallpox

Smallpox is a contagious disease caused by a virus of the Poxvirus group, marked by high fever and pustular blisters. With Edward Jenner's discovery of the vaccine in 1796 it had become possible to control its spread. The disease appeared in Amasya in 1895. It had begun first in Tokat, and when the vaccines needed were not sent from the center in time, the response was delayed and the disease spread to other parts of Tokat sanjak, to Sivas, and shortly afterward to the Amasya sanjak. Bankovski Pasha, the chief inspector of public hygiene (Umum Hıfzısıhha Başmüfettişi), reported to the Ministry of the Interior that deaths had occurred because of the disease, that the vaccines requested earlier had not been sent, and that if vaccine was not sent urgently there was a risk of wider spread. The ministry in turn instructed the Ministry of Military Schools to send it. In the meantime some people lost their lives.

The government knew that vaccination was the most effective step against smallpox. In 1892 the first modern vaccine production facility, the Telkihhane-i Osmani, was opened. Many provinces, Sivas among them, were instructed to employ vaccinators able to give the smallpox vaccine, their pay to be met by the municipalities, and vaccination officials appear to have worked in the Amasya sanjak as well. In 1907 the vaccination official of the Amasya municipality was Raif Efendi. A regulation of 1894 set the rules for vaccination and provided that newborn children and everyone in a house where there was a patient should be vaccinated.

The form of the disease seen in small livestock also struck the flocks from time to time. In 1910 smallpox among sheep around Amasya ran severely in Gümüşhacıköy in particular and in Akviransu, today's village of Alören. On 31 August 1910 the Sivas governorate reported the situation to the Ministry of the Interior and asked for vaccine. The ministry replied that vaccine could be obtained from the Pasteur laboratory in Paris at ten francs per hundred animals, provided the cost was met by the owners. When the governorate wrote that the public was unwilling to pay and that it would be appropriate for the government to cover the cost, the government stated that no funds were available and proposed sending a limited quantity of vaccine, so that owners who saw its effect might be persuaded to have their animals vaccinated at their own expense. Despite the partial vaccination, losses continued. On 17 October 1910 the Sivas governorate reported that the disease was still spreading and asked for urgent measures.

Syphilis and Influenza

Syphilis is the disease that Ottoman physicians called the Frankish scab or the malady of Europeans, which spread through Europe after 1492 and was carried to Asia and Africa. In Ottoman lands it was seen only in isolated cases until 1886, and after that date it took epidemic form almost everywhere. In 1888 the government sent the military physician Captain Celadettin Efendi to Paris for specialist training; in the same year it was decided that every district (kaza), sanjak (liva) and province should have a health inspector, a physician, a pharmacy and a pharmacist. It appears that because of a shortage of personnel this decision could not be fully applied in Amasya. In 1891 only physicians served in Amasya and Merzifon, and no pharmacist had been appointed. In 1903 Merzifon had the pharmacist Yako Efendi alongside its physician, Gümüşhacıköy and Havza had only physicians, and the districts of Köprü, Mecidözü and Ladik had not even a physician.

A syphilis epidemic affected the Amasya sanjak in 1901-1902. The disease spread over a wide area, with the sanjaks of Amasya and Tokat and as far as the provinces of Sivas, Yanya, Adana, Bolu, Kastamonu, Ankara and Izmir, and lost its force in 1902. In Sivas a Health Commission was set up to control the epidemic, treat patients and carry out preventive measures. In the five-member commission, Tahir Ali Efendi served as health inspector, Mahmud Efendi as first, Artin Efendi as second and Faik Efendi as third physician, and Mehmed Efendi as vaccination official. In 1903 the disease continued in Köprü, Erbaa, Niksar and Gürün; the Sivas governorate treated patients by sending traveling physicians and also tried to have hospitals built in the places concerned. In 1904 a new syphilis epidemic reached Amasya from Sivas. Since the government regarded prostitution as the chief cause of spread, it took measures such as informing the public, examining women in brothels in the large cities twice a week, controlling prostitution and opening syphilis hospitals in regions where the disease was widespread. In 1907 the commission had four members, and the midwife Nazire Hanım was among them.

Influenza was seen in 1890. When influenza broke out in Amasya on 12 January 1890, the Sivas governorate took the necessary sanitary measures, reported the matter to the Ministry of the Interior and asked whether quarantine should be applied. The ministry saw no need for quarantine, because the disease had become general.

The First World War and Typhus

Typhus is a disease with high fever, passed from a sick person to a healthy one by the body louse. It had been seen in Ottoman lands during the Crimean War and the Ottoman-Russian War of 1877-1878. Before the First World War, in 1914, it broke out in Amasya and Merzifon, together with Samsun, Bayburt, Sivas, Tokat, Erzincan, Trabzon, Erzurum and Van. With the outbreak of war, poor nutrition, scarcity and above all problems of cleanliness among the soldiers spread the disease; mobilization and the population movements caused by the war made the situation worse. The epidemic continued with short pauses until the winter of 1918-1919, and it is said to have caused the deaths of about 600,000 Ottoman soldiers during the war.

After the failure of the Sarıkamış Operation, the advancing Russian forces occupied Trabzon, Erzincan and Erzurum, where the headquarters of the Eastern Front stood. As units in the region withdrew toward the interior, Amasya and its surroundings became in part a theater of war and began to experience more closely the typhus carried by transferred soldiers. When official buildings no longer sufficed for military needs, the government requisitioned certain private buildings. In Merzifon part of the buildings belonging to American missionaries was used as a hospital; according to George E. White, the director of Anatolia College, typhus patients were treated in one and smallpox patients in another. The American embassy complained to the Foreign Ministry about the requisition, claiming that the sick soldiers endangered the lives of the Americans and that American citizens in Merzifon were being ill treated. The inquiry concluded that these claims were untrue, that the missionaries had resorted to slander to get back the school buildings turned into hospitals, that the epidemic seen in one of the buildings had been brought under control, and that although they had been told it was unwise to live in a building shared with the hospital they insisted on staying; these findings were communicated to the American embassy on 7 November 1916. One source also records that the college lost many of its staff in these epidemics and remained closed until 1 October 1919, but it gives no reference. In August 1918 the son of Alphonse Kieger, a French civilian prisoner living in Merzifon with his wife and son, who had been released that month and allowed to leave, also caught typhus; Kieger asked permission to remain in the district until his son's treatment was complete.

The Ottoman administration took various measures against the disease. To destroy lice and fleas by disinfection, mobile steam and étuve machines were used, and in every district and subdistrict disinfection stations (tebhirhane) built around steam chests were established. In 1915 a vaccine laboratory was opened in Merzifon, along with Erzurum and Sivas; by 1919, 27,688,499 vaccine doses had been prepared at the vaccination stations and a large part of the army units had been vaccinated. Health services were raised to ministry level, and the Ministry of the Interior took the Directorate General of Health, the Quarantine Administration and the Hijaz Quarantine Administration into its structure and became the Ministry of the Interior and Health. The government asked provincial officials to disinfect shared places such as inns and bachelors' rooms and to place anyone showing symptoms under control at once; through health personnel it also tried to teach the public the causes of the disease and ways of protection.

The Inadequacy of Health Organization

Despite the organization's founding, physicians, pharmacists and funds remained inadequate in the Amasya sanjak in every period. The municipal physician Kiforik Efendi, appointed to the sanjak center in 1871, was followed in 1887 by Kiforik Ağa and in 1889 by İbrahim Efendi. In Merzifon in 1876 Manyan Karabet Efendi was appointed physician, his pay to come from municipal revenue, and in later years Aleksan, Yordanaki, Kirkor, Mehmet Suphi and Melkon Efendi served as municipal physicians in the same district. In 1884, while Merzifon and Osmancık had physicians, Ladik, Maden-i Sim, Köprü, Mecidözü and Havza had none. A shortage of physicians meant a physician could not be appointed to every place that had a municipality.

In Sabit Genç's assessment the causes of this weakness fed one another: the public's failure to grasp the importance of quarantine and scientific treatment, marshes and standing water, inadequate infrastructure, poverty, lack of hygiene, the sanjak's position on important east-west and north-south crossings, the population movements caused by wars, and the return of pilgrims. Despite the efforts of the central government and local health personnel, the sanjak was the scene of epidemics of various kinds until the end of the empire, and many people lost their lives.

Chronology

1812: Deaths were seen around Amasya as part of the general plague epidemic; the British traveler Ouseley reported the losses at Niksar, Tokat and Merzifon.

1826-1827: A new wave of plague reached Tokat, Amasya and Merzifon; the travelers Alexander and Fontanier recorded its effects.

22 May 1838: Two tahaffuz boards were formed in Istanbul to carry out quarantine work.

4 March 1840: Quarantine began in many provinces, Sivas included; a journal clerk was appointed to the Amasya sanjak.

4 August 1840: The Amasya quarantine physician Paldi was killed by the crowd.

23 November 1840: Those thought to have taken part in the incident were sent to Istanbul.

1841: A quarantine director and physician were appointed to 41 centers, Amasya among them.

12 August 1843: A quarantine organization was documented at Merzifon alongside the central district of Amasya.

1848: Cholera was severe around Amasya and in Yozgat; quarantine was begun in the sanjak.

1865: The governor Ziya Pasha had a sewer network built in Amasya.

1871: A municipal physician was appointed to the Amasya sanjak center.

1890: Influenza was seen in Amasya in January.

1892: The Sivas governorate built quarantine stations at Amasya, Tokat and Karaağaç; the Telkihhane-i Osmani was opened.

1893: The first cholera cases appeared in Amasya in November and December; physicians and pharmacists were sent.

1894-1895: Cholera continued to take lives in Merzifon, Tokat, Yozgat and the surrounding area; in 1895 smallpox reached Amasya.

1901-1902: A syphilis epidemic affected the Amasya sanjak; a new wave was seen in 1904.

1910: Cholera reached Amasya and Merzifon by way of Samsun; an epidemic of smallpox was seen among sheep.

1914-1918: Typhus affected Amasya and Merzifon; a vaccine laboratory was opened in Merzifon (1915).

Sources

Primary sources

  • Primary sources on which the article draws: Ottoman Archive documents (BEO, İ.MVL, C.SH, DH.MKT, Y.A.HUS and related series), the Salnâme-i Vilâyet-i Sivas and travelers' accounts (Ouseley, Alexander, Fontanier, Fletcher, Mordtmann, Perrot, Porter).

Academic studies

Other sources

Online sources