Spells, Herbs and Surgery: Medical Care in a Provincial Balkan Town in the 19th Century (2)

January 10, 2008

By Dejan Ciric

In the second of a three-part series, Serbian historian Dejan Ciric details those fun diseases — up to and including the plague — that periodically devastated the Balkans in the 19^th century.

Owing to its specific geographic location in the center of the Balkans, midway on the road between the two significant cities of Nis and Sofia, Pirot very often fell victim to infectious diseases. Many armies which penetrated from the Orient into the heart of Europe and vice versa brought various illnesses. Many merchants, who brought different goods from the Levant to the Danube region, carried in their bags smallpox, plague and other infectious diseases over the centuries. Less grand events brought diplomats, messengers and adventurers. In the period 1700-1850 in many Balkan regions, there were 126 years of plague- a significant fact illustrating the constant threat to the local population. Many of these infections were contained within small regions and villages, but several took on the appearance of mass destruction.[i]

Information about the first plague epidemic in Pirot during the 19th century is found in the Russian book Apostle, kept at the church in the village of Strelac. In this short note, we learn that disease came to the town in 1815, resulting in almost 8,000 deaths. Infections started from the direction of Sofia, and in 1813 spread to Pirot.[ii]

The second plague infection in Pirot started in 1838. It emerged first in 1834 in Alexandria, and with the help of sailors spread to Constantinople. The next year the disease passed into the towns of Thessalonica, Kavala and Drama in modern-day Greece. Carried by people who traveled very often, the illness spread from the north to the Danube and in the direction to the west, through Pirot to Nis.[iii]

Such events naturally caused the government of the Serbian Principality to take strong protective measures. Prince Milos decided to make stronger efforts at several border passes in December 1836, enforcing a quarantine that lasted ten days. At the same time, some Bulgarian merchants from Sofia brought news about plague in the region between Plovdiv (Philippopolis) and their town[iv].

However, the Turkish governor in Sofia who tried to take preventive measures did not succeed, and so the disease spread to Pirot in March 1837. In the beginning, there were only several isolated victims. Some of the citizens were saying that vampires killed the people, but shortly after, they would see the real deadly effects of the plague.[v] Widespread infection provoked great confusion and fear, so many town inhabitants moved to villages in order to survive. But disease spread to the villages. The consequences of this can be seen at the village graveyards of Trnjani and Krupac, which contain tombstones with five ore six names.[vi] One of those who was looking for safety in the Serbian Principality was the son of famous Pirot citizen Kostadin Filipovic. Many people were stopped at the border and turned back. Only a small number of merchants, solders, messengers and state officials were allowed to pass into Serbia during the quarantine.[vii]

During the summer, the disease spread to fifteen villages in the Pirot region. In the town itself, more than fifty people were dying every day. Very soon, the infection appeared in the small town of Bela Palanka, around twenty five kilometers to the west.[viii] Over three months, around 15 percent of the population was dead, something due, in the first place, to the low level of medical knowledge.[ix] Those with poor hygiene and their homes were the main reason for the very fast spread of the disease and large amount of victims. At the time, the local population had a custom of exchanging their clothes and footwear, and the activities of merchants, usually Jewish, who traded clothes made of wool and leather, created the conditions for the spread of infectious disease. Additionally, the Turkish population had its own attitude toward fatal diseases: they were taught that deadly illnesses represented destiny sent by Allah, and one of the 366 doors to Heaven, though there were many Muslims who sensibly tried to escape and save themselves while still on earth.[x]

Apart from the great state of fear and confusion, people were trying to protect themselves by keeping families in their homes, burning the clothes of the dead and their bodies, abandoning old houses and even moving entire villages. Many communities were looking for safety in the churches and from priests.[xi] The appearance of tuberculosis in Pirot was not an exception; it could be said that people were living with the disease every day, and suffered from it over their entire lives and through several family generations.

Not long after the liberation of Pirot in December 1877, the government started to realize a very difficult task to introduce some urgent measures in the field of medical care. At that time appeared the first county and municipal doctors, who noted the most important facts about diseases and mortal cases. According to an account of 1883, 25 percent of mortal cases occurred because of tuberculosis- double that of typhus victims, or five time that of fatalities due to diphtheria. This is one of the proofs of the very low level of hygiene in the local population of the time.[xii] According to an account of 1903, however, the situation was much better, because there were only 13 people ill of tuberculosis, and only one dead, though we can be sure there were more cases than noted.[xiii]

Stories about many sufferers could be important and useful for understanding the health circumstances in Pirot at the time. A teacher of Serbian language and literature in the Pirot Secondary school, Sima Popovic, presents a special case. He was working in Skopje and Prizren in Kosovo, at that time in the Ottoman Empire. Because of problems with the authorities, Popovic ended up in prison, where he got tuberculosis. In July 1900 he asked for and received permission to be absent from his job in order to heal (though he had not been working for two semesters in the previous year for the same reason). The next year too Sima Popovic was looking for a leave of absence from the Ministry of Education for health reasons.[xiv] There were accounts of several other teachers who were ill and out of their job for a time.[xv] In addition to this, because of the very bad living conditions of the children who lived in the school building in the village of Sopot, sixteen of them got tuberculosis in 1882. The Ministry of Education was informed about this and the school was closed for a short time. The county doctor suggested the same measures concerning sick schoolchildren in another two villages.[xvi]

Terrible hygienic conditions and very bad food lead to weak and sensitive bodies, vulnerable to various diseases. According to Dr. Sienkievicz`s medical account, it is possible to ascertain a general picture of the health situation in Pirot. During 1883, 25 percent of fatalities were caused by the infectious diseases of typhus, scarlet fever, diphtheria and dysentery. Various kinds of fevers were involved in 32 percent of all mortal cases. It is interesting that Dr. Sienkievicz noticed marasmus as a cause of death in 4.5 percent of cases. Most fascinating to note is that more than 50 percent of all mortal cases involved children of less than one year of age.[xvii]

In order to better comprehend these facts, we should compare them with those in developed countries. Fore example, in the USA, the mortality rate in children up to five years of age was 20 percent at the end of the 19th and beginning of the 20th centuries. The main cause of death there were infectious diseases (mainly diphtheria and smallpox), just as in Pirot.[xviii]

As a more effective measure against smallpox, healing doctors recommended vaccination; a priest, Dimitrije Cvetkovic, ordered in January 1881 that all clergymen must teach the local population about the significance and positive effects of vaccination. This order was enforced at all churches in the region.[xix] Smallpox healing was well known in the Pirot area decades before, but it had not been carried out systematically. The evidence of this can be found in the Pirot Lekarusa.[xx] Over the years, this measure showed positive results and became an obligation, so that by 1903 some 3,119 children in the county were vaccinated.[xxi] Similar measures were undertaken by many European states during the 19th century, so that by the beginning of the next it became almost a kind of national prestige.[xxii]

However, even this general improvement in living standards and conditions and better medical treatment could not help during the Balkan Wars in 1912-13. The difficult war situation caused a typhus epidemic in 1913, despite the fact that the local authorities introduced measures and the bishop of Nis resorted to prayers and extraordinary sermons.[xxiii] Pirot also had major problems in the fight against syphilis because the citizens of the town and local villages were so highly infected by the end of the 19^th century that doctors thought the disease to be an epidemic. Many of them were sure that the infection had come to town with the many seasonal workers returning from Wallachia (Romania), Bulgaria and Constantinople. Dr. Sienkievicz did not prove this with evidence, but did suggest, as a precautionary measure, establishing several quarantine areas at the border passes and providing fast transportation of infected persons to Pirot Hospital. This measure were justified by the facts that annually 8,000-10,000 men in the region from the ages of 12 to 40 went away for seasonal work, and many girls from the ages of 17 to 20 were appearing at the town hospital with high levels of syphilis. Twenty years later, in 1903, Pirot County Doctor Grujic in his annual account wrote that the local authorities were giving special funds for the fight against venereal diseases.[xxiv]

[ii] Ibid, p. 75.

[iii] Ibid, pp. 33-34.

[v] ˆšÃªÂ¬Ã²ˆšÃ«?ˆšÃ«Â¬Ã‡ˆšÃªÂ¬Ã¦, 77-79.

[viii] Ibid, p. 90.

[ix] Ibid, p. 9.

[x] Ibid, pp. 180-81.

[xi] Ibid, pp. 187-190.

[xiv] Ibid, pp. 326-27, 362.

[xvii] Ibid, pp. 8-10.

[xviii] A. Minna Stern and H. Markel, The History of Vaccines and Immunization: Familiar Patterns, New Challenges, Health Affairs, 24 (2005) p. 611.

[xx] Pirot Lekarusa, sheet 13b.

[xxii] A. M. Stern and H. Markel, p. 614; P. Domingo, The Triumph over the most Terrible of the Ministers of Death, Anales of Internal Medicine, 127 (1997) pp. 635-642; P.Skold, The Key to Success: The Role of Local Government in the Organization of Smallpox Vaccination in Sweden, Medical History 45 (2000), pp. 201-226.

[xxiii] Ibid, pp. 1036-37, 1039-40, 1042.

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