Spells, Herbs and Surgery: Medical Care in a Provincial Balkan Town in the 19th Century (3)

January 11, 2008

By Dejan Ciric

In the third of a three-part series, Serbian historian Dejan Ciric narrates the developments that led, by the end of the 19^th century, to the creation of a relatively modern health care system in the small town of Pirot.

During the time of the Turkish reign, there were several doctors in the town of Greek, Turkish and Serbian origin. The most popular was George, a Greek who worked in the middle of the 19th century.[1] The most well known doctor during the second part of the 19th century was Hechim Tana Popkrstic. He was born in Pirot, where his father prepared him for the priesthood, a family tradition; however, Popkrstic learned the art of healing from the Turkish military doctor and opted for the medical profession.

Apart from widely disseminated folk remedies and the Pirot Lekarusa, citizens had the opportunity to get drugs from a professional pharmacist during the Turkish reign. Mihail Andjelokovic opened his pharmacy in 1867 after two years of study in Constantinople and France. Andjelkovic usually ordered drugs and various substances from Belgrade and collaborated with the Serbian Army doctors during the liberation in 1876-1878. In several letters to the government, he mentioned these facts while completing the procedure to obtain a pharmacist’s certificate, in order to influence the ministry to assist him more quickly. However, he apparently failed to fulfill all the requests, and so closed his shop.[2] Pirot’s new pharmacist was Franc Suricek, of Czech origin, who came from the Austro-Hungarian Empire in 1880.[3]

The first academically educated doctors came to Pirot after the liberation in December1877. The first one, Yanko Sienkievicz, a man of Polish origin from Galicia, was the nephew of the significant Polish writer Henrich Sienkievicz. He became Pirot County doctor when he was 32 years old, on February 19, 1879. He graduated in medicine at the University of Vienna in 1875 and spoke Serbian, German, Polish and Russian. He participated as a military doctor in the liberation of south Serbia and showed loyalty to his new homeland[4]. With very modest equipment and staff, Sienkievicz did his job not only in the town, but in the very distant and hard-to-reach villages around it. During all of his short journeys in the region, the doctor famously rode a white horse, whereas physicians in England during the same period usually used different kinds of carriages as a symbol of their status.[5] Dr. Sienkievicz`s greatest achievement, however, was the founding of the County Hospital in 1881.[6] He married a Pirot citizen and stayed in the town until the end of his life in 1904.[7]

In 1883, along with Dr. Sienkievicz worked only one other doctor, a veterinarian and, sources claim, a not particularly skilled midwife.[8] The first veterinarian in Pirot was Radomir Arnautovic, a Serb from Fogaros in Transylvania, then under Austro-Hungarian rule. After secondary school in Kronstadt, he studied veterinary medicine at the University of Vienna and the University of Budapest. Soon after graduation, he joined the Serbian Army as a military doctor in 1876. With an official certification, he became the first Pirot County veterinarian when he was 28 years old in May 1881. Arnautovic spoke German, Romanian and Hungarian in addition to Serbian.[9] As an assistant to the doctors in the County Hospital came Dr. Abraham Mandelbaum, a Jew from Constantinople in 1881. Mandelbaum graduated medicine at Munich University and spoke Serbian, German, French and Russian.[10]

With official governmental permission, Dr. Jovan Valenta became the county doctor in October 1882. Czech by origin, he was born in Prague in 1826 where he graduated in philosophy and medicine. He earned a doctorate in surgery and an MA in the field of obstetrics. In the beginning, he was working in his native town, but he moved to Serbia in 1852 and worked in several small towns. He was a teacher at a Belgrade secondary school and one of the founders of the Serbian Medical Society in 1872.[11] Dr. Valneta first performed surgery in Pirot on November 1st 1883, and stayed in the town until his retirement in 1886.[12] Afterwards, he moved to Belgrade, where he died the following year.[13]

At the beginning of the 20th century, the number of medical staff in Pirot increased. Sinekievicz became a pensioner in 1903, but continued as a private doctor. Mladen Grujic succeeded him as Pirot’s new County Doctor. During the following years, there were several doctors of Serbian origin, as well as Dimitrje Kalijadis, a Greek and Samuel Poper, a Jew. During that period there were two pharmacies in the town managed by Uros Volic, a Serb, and Karlo Skacel from Poland. Aside from the staff in the County Hospital, three sick attendants and a clerk there were also two midwifes.[14]

From the available sources it is however hard to learn where hospitals were located in the town before the middle of the 19th century. The first rooms for healing purposes in that time were rented by the popular George the Greek on the second floor of the Ignjatovic`s family house, one of the prettiest and biggest houses in the town, built in 1854.[15] The other doctors probably worked from their own homes or at the patients’ house. During the liberation of 1877-1878, along with the former Turkish Military Hospital and schools, they used private houses because of the many injured solders[16]. During the short Serbian-Bulgarian war in 1885, according to the priest Djordje Ignjatovic, who was the supervisor and coordinator of all medical care, there were 12 hospitals in Pirot[17].

The town’s first pharmacy was situated on the left river bank next to Golemi Most (Big Bridge) and consisted of two rooms: a shop and a storage room, which lacked all the necessary equipment, keeping only one-third of the important drugs which the authorities had requested, and not maintaining the correct storage conditions for dangerous poisonous substances.[18] Unlike Andjelkovic, pharmacist Sirucek in the shop across the street had all the necessary drugs, many additional instruments and a well equipped laboratory with various materials, so governmental commission for medical care and drugs gave him a work permit.[19]

One of the biggest, most long-lasting problems for the local authorities at the end of the 19th and the beginning of the 20th century was a new County Hospital building. The old hospital building built in Turkish times was in very bad condition, and so even basic requests were not fulfilled. The building was also quite small, at only 133 square meters, with two floors. On the ground floor there was an office, a patient room, a small lobby, two storage rooms and a toilet. On the second floor there were four very small rooms where it was possible to put only sixteen beds[20]. It was obvious that the town must build a new hospital because the old one was in such bad condition that every reconstruction would mean losing money. The commission consisted of the County Chairman, County Doctor, County Engineer and two Pirot Community officials who decided to build a new County Hospital.[21]

Systematic primary and secondary education after the liberation in 1877 resulted in the first positive results in the last decade of the 19th century. A new generation of children was brought up with an adequate knowledge to continue education at any foreign university with financial help provided by the state and sometimes also by the municipality. The first was Sima Petrovic. He was born in 1875, and studied medicine in Graz and Vienna. After the First World War, he was one of the members of the Serbian mission at the Versailles Peace Conference, where he served as a negotiator for veterans’ issues.[22] After Petrovic there were several young Pirot cituzens who studied medicine at Graz, Vienna, Kiev and Moscow during the first decade of the 20th century. One of them was Nadezda Stanojevic, born in 1886, the first girl from Pirot to study medicine; her brother Vladimir also studied medicine. Nadezda would become famous as an author of the first Serbian textbook on pediatrics.[23]

Closely interconnected with health improvements was an increasing awareness of hygiene. Perception of its importance gradually increased across all social classes through the 19th century, as its obvious positive effects on preventing infection and diseases became more widely known. Descriptions of the Pirot town and village houses from the first half and the end of the 19th century of the average inhabitant showed very bad hygienic conditions which were accepted as the usual way of life. The best information about this issue is found in the papers of the village teacher Vladimir Nikolic, who collected ethnographic facts amongst the oldest inhabitants and secondary school biology teacher, Lujo Adamic who was traveling and researching through the Stara Planina mountain range. He had interesting experiences with the local peasants and wrote short and useful accounts of his journey.

The majority of the houses in the mountain villages were built of simple materials (stone, wood, mud) with usually only one ore two dark rooms and a small window covered with paper. There was usually no ventilation, and all the family members would sleep in the same room. In the town it was different. The older and wealthier families there, however, usually had houses with several rooms and clean water for drinking, washing and bathing.[24]

Even in other regions in Serbia, the situation was not much better. For example, in the central region of Kragujevac, village children bathed only in the rivers, and only on feast days, while older people often did not bathe at all throughout the year. They slept in the same clothes, changing them only once a week. They worked hard in the fields all day and were in constant interaction with livestock. The consequences of such behaviors were infectious diseases, different kinds of fever, respiratory diseases, various digestive problems and syphilis.[25]

In Dr. Sienkievicz`s account for 1883, we learn that at that time there were no public baths, though in the previous period (until 1878) there had been several Turkish baths in Pirot. According to Dr. Sienkievicz, town people did not have the habit of swimming and washing in the river. During the recruiting procedure, he saw that many boys did not bathe for two or three years.[26] Public places such as restaurants, cafes and hostels were usually dirty and full of various insects, so the local administration provided measures of strict health control. There was prostitution in the town in the last decades of the 19th century, which was hard to control. In 1883 there was a special place for such girls in the same time at a coffee shop. However, there were women who worked as prostitutes in their own homes and constantly there was medical inspection.[27]

Since all of the peasants and many of the town inhabitants worked on the land and with cattle as an additional occupation, their health condition depended on the health of the cattle. In the period of the Turkish reign, there were veterinarians, but the blacksmiths also had to treat some of the livestock’s medical problems.[28]

In order to comprehend the place of Pirot as a small community in Europe and better understand health conditions before and after the liberation, it would be useful to make a comparison with other small towns or regions. While precise and constant accounts about the health situation exist for Pirot only after 1878, in small communities in Sweden such as Linkoping, such records were a standard after 1749. In Denmark after 1829 such regular records are found.[29] At the beginning, accounts were written by local priests; after 1860 it was a task for the local doctors. Yet even in Sweden, there were similar problems as in the Balkans.[30]

Undoubtedly, the most interesting and complete medical account is Dr. Sienkievicz`s, from 1883. This very important document is not only a report about the health situation in the county, but proof of endeavors and new initiatives in medical care. In the main part of the account, after long and precise narrative descriptions followed by many analyses and suggestions, it concludes with 43 causes of death written in Latin and arranged by months. After that, there are facts about mortality arranged by sex and age. Dr. Sienkievicz wrote about food, hygienic conditions in the schools, prisons and coffee shops and analyzed the situation particularly concerning smallpox, prostitution and livestock.[31]

Linkoping in Sweden was a mid-sized provincial town in the 19th century, similar to Pirot in Serbia. Linkoping had 2,680 inhabitants in 1800, but by the beginning of the 20th century around 15,000 citizens[32]. However, despite the fact that the Swedish began to care for the official statistics about the health situation decades before the Serbs in Pirot, medical problems were almost the same in both towns. Infectious diseases, particularly respiratory diseases (17 percent of mortal cases), were most dangerous for both Swedish and Serbian provincial towns. The most dangerous disease for children in Linkoping was smallpox, the cause of death in 5 percent of cases, but vaccination began as early as 1802.[33] It is interesting to note that at that time directions for smallpox healing were being made in Pirot’s Lekarusa.[34] Inherited syphilis was a significant problem for Linkoping in the 1850s, as well as for Pirot in the 1880s.[35] Pirot citizens suffered from diphtheria and scarlet fever, almost as much as Linkoping‘s inhabitants during the second part of the 19th century, when the town lost many people to the disease. At the time this was common, even for metropolises like London.[36]

Indeed, big European towns often had similar problems to Pirot. In Lyon in France, waste waters were directed into the Rhone.[37] Pirot’s citizens did the same in their town, with the River Nisava. In Marseilles in 1886, out of 32,653 recorded houses, more than 14,000 had no capacity for disposal of waste; these people would thus throw away their trash in the gutters, directly onto the streets. If we take into consideration the size of Marseilles, and its location in a highly developed country like France, the shortage of bathrooms in many houses in small and provincial Pirot is not something out of the ordinary. In Dr. Sienkievicz`s account and in the papers of the teacher Vladimir Nikolic, we learn that only a small number of Turkish, Jewish and wealthy Serbian homes had bathrooms. At the time, even Paris had not been rid of infectious disease on a large scale- something that was an everyday fact for Balkan provincial towns like Pirot. For example, because of unhygienic houses in Paris, 33.9 percent of citizens lived in impoverished conditions; some 19.3 percent of inhabitants in the rest of the city died of cholera in 1832. After this epidemic, typhus came in two big waves in 1873 and 1882. Two years later, cholera was again the main cause of death in Paris.[38]

Further, even in highly developed France the practice of pseudo-medicine was widespread due to longstanding tradition, inherited customs, the existence of various spell-casters and the prevalence of uneducated priests. Of course, such conditions characterized the healing science in 19^th-century Serbia, a small Balkan country which was somewhere between an Oriental province under the dominant Turkish influence and a majority Orthodox Christian society prepared to accept every kind of Western European values.[39] One of these values was modern medical care.

Considering its relative disadvantages, these examples and comparisons with other towns and cities in Europe reflect rather well on little Pirot. In little over a hundred years, Pirot went from being a town living in almost constant fear of various diseases, a place with no organized medical care, to a community which, while still provincial, could boast a county hospital and educated doctors capable of working in any town in Europe.

[2] ˆšÃªÂ¬üˆšÃªÂ¬ˆˆšÃ«Â¬Ã„ˆšÃªÂ¬Ã¦ˆšÃ«Â¬Ã‡ ˆšÃªÂ¬ˆ ˆšÃ«?ˆšÃ«Â¬Ã„ˆšÃªÂ¬ÂµˆšÃªÂ¬ˆ‘ ˆšÃª?ˆšÃªÂ¬ˆˆšÃ«Â¬Ã ˆšÃªÂ¬ˆžˆšÃªÂ¬‰¤ˆšÃ«?ˆšÃªÂ¬ˆ«ˆšÃªÂ¬ˆ 1801-1883. ˆšÃªÂ¬Ã¬ˆšÃ«Â¬Ã„ˆšÃªÂ¬ˆžˆšÃ«Â¬ÃˆšÃªÂ¬ˆž I, ˆšÃªÂ¬üˆšÃ«Â¬Ã„ˆšÃªÂ¬ˆˆšÃ«Â¬Ã„ˆšÃªÂ¬ÂµˆšÃªÂ¬Â¥ˆšÃªÂ¬ˆˆšÃªÂ¬Ã¦ ˆšÃªÂ¬Ã². ˆšÃª?ˆšÃªÂ¬ˆˆšÃªÂ¬ˆ«ˆšÃªÂ¬Ã¦ˆšÃªÂ¬ÂªˆšÃªÂ¬ˆˆšÃ«Â¬Ãµ, ˆšÃªÂ¬üˆšÃªÂ¬ˆˆšÃ«Â¬Ã„ˆšÃªÂ¬Ã¦ˆšÃ«Â¬Ã‡ 1981, pp. 384-385, 406-407.

[5] I. Loudon, Doctors and Their Transport, 1750-1914, Medical History 45 (2001) pp. 185-206.

[7] Ibid, pp. 221-227.

[10] Ibid, pp. 670-671.

[11] http://www.sld.org.yu/sr/istorijat.asp

[12] http://www.zcpirot.co.yu/hirurgija.htm

[20] Ibid, p. 252.

[21] Ibid, pp. 252-254.

[27] Ibid, pp. 15-16.

[28] Ibid, pp. 166, 168.

[29] A. Lokke, Infant Mortality in Nineteenth Century Denmark, Hygeia Internationalis. An Interdisciplinary Journal for the History of Public Health, 3 (2002) p. 144.

[30] M. Bengsston, The Interpretation of Cause of Death Among Infants, Hygeia Internationalis. An Interdisciplinary Journal for the History of Public Health, 3 (2002) pp. 54-55.

[32] M. Bengsston, The Interpretation of Cause of Death Among Infants, Hygeia Internationalis. An Interdisciplinary Journal for the History of Public Health, 3 (2002) p. 62.

[33] Ibid, pp. 64-65.

[34] Pirot Lekarusa, p. 13b.

[35] M. Bengsston, The Interpretation of Cause of Death Among Infants, Hygeia Internationalis. An Interdisciplinary Journal for the History of Public Health, 3 (2002) p. 69; ˆšÃªÂ¬üˆšÃªÂ¬ˆˆšÃ«Â¬Ã„ˆšÃªÂ¬Ã¦ˆšÃ«Â¬Ã‡ ˆšÃªÂ¬ˆ ˆšÃ«?ˆšÃ«Â¬Ã„ˆšÃªÂ¬ÂµˆšÃªÂ¬ˆ‘ ˆšÃª?ˆšÃªÂ¬ˆˆšÃ«Â¬Ã ˆšÃªÂ¬ˆžˆšÃªÂ¬‰¤ˆšÃ«?ˆšÃªÂ¬ˆ«ˆšÃªÂ¬ˆ 1883-1893. ˆšÃªÂ¬Ã¬ˆšÃ«Â¬Ã„ˆšÃªÂ¬ˆžˆšÃ«Â¬ÃˆšÃªÂ¬ˆž II, ˆšÃªÂ¬üˆšÃ«Â¬Ã„ˆšÃªÂ¬ˆˆšÃ«Â¬Ã„ˆšÃªÂ¬ÂµˆšÃªÂ¬Â¥ˆšÃªÂ¬ˆˆšÃªÂ¬Ã¦ ˆšÃªÂ¬Ã². ˆšÃª?ˆšÃªÂ¬ˆˆšÃªÂ¬ˆ«ˆšÃªÂ¬Ã¦ˆšÃªÂ¬ÂªˆšÃªÂ¬ˆˆšÃ«Â¬Ãµ, ˆšÃªÂ¬üˆšÃªÂ¬ˆˆšÃ«Â¬Ã„ˆšÃªÂ¬Ã¦ˆšÃ«Â¬Ã‡, 1982, p. 10.

[36] Ibid, p. 71; A. Tanner, Scarlatina and Sewer Smells: Metropolitan Public Health Records (1850-1920) Hygeia Internationalis. An Interdisciplinary Journal for the History of Public Health, 1 (1999) 37-47.

[38] Ibid, pp. 289-290.

Balkanalysis.com

Spells, Herbs and Surgery: Medical Care in a Provincial Balkan Town in the 19th Century (3)

Balkanalysis on Twitter

2004-2009 Back Archives