Sex and the capital city: the political framing of syphilis and prostitution in early republican...

Sex and the Capital City: The Political

Framing of Syphilis and Prostitution

in Early Republican Ankara

EMINE O. EVERED* AND KYLE T. EVERED**

*Department of History, Morrill Hall Michigan, State University, East Lansing,

Michigan 48824-1036. Email: [email protected]

**Department of Geography, Michigan State University, East Lansing, Michigan

48824-1117. Email: [email protected]

ABSTRACT. In its initial years, the nascent Turkish republic establishedthe Ministry of Health and Social Assistance in order to promote publichealth. Beyond simply facilitating its modernizing agenda for the emergentnation-state as it sought to define itself against an Ottoman past, this insti-tution was also geared toward remedying a self-defined population crisis byprioritizing and confronting particular diseases and health conditions. Oneof the maladies of utmost concern was syphilis. Based upon an analysis ofofficial primary sources, this article engages with how the developingrepublic distinguished and consequently politically constructed—orframed—the syphilis problem from the vantage of its new forward capital,Ankara. Integral to this project of confronting this sexually transmitted

Notes on late Ottoman and early republican sources: Sources from this period sometimesappear with dates from the Hicri (i.e., Ottoman religious) calendar and at other times withdates from the Rumi (i.e., Ottoman fiscal/administrative) calendar. Thus a publication datedto 1924 on the Gregorian (i.e., Western) calendar may vary two years, or so, in the dates onwhat is assumed to be an “Islamic” calendar. In our bibliography, we include both the origi-nal and the Western dates. Also, prior to the universal application of its surname law in theearly 1930s, many citizens in Turkey had only one or two names. As this article concernsthe 1920s period, both in text and in citations we employ the original names and (whenpossible) list the surnames that were added later in parentheses—as is customary inOttoman/Turkish historiography. However, many of the names of the authors listed do notinclude obvious surnames, so their full (i.e., first or first and second) names are listed withtheir full name, in addition to their professional title (e.g., Dr. Muslihiddin Safvet, andthereafter as Muslihiddin Safvet).

JOURNAL OF THE HISTORY OF MEDICINE AND ALLIED SCIENCES, Volume 68, Number 2

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disease, public health officials projected upon both this ailment and theirunderstanding of the suitable means for its treatment their own views ofwhat constituted appropriate sexual practices and relations. In doing so,certain subgroups of the population, especially prostitutes, were particular-ized as targets for surveillance and policing through regimes of licensingand compulsory medical examinations. Stemming from the state’s framingof the disease—and its definition of appropriate sexual practices—thisarticle also examines the subsequent legislative and public health educationprojects that followed. KEYWORDS: Ankara, prostitution, public health,public health education, sexuality, syphilis, venereal disease, Turkey.

Years before the October 29, 1923, establishment of the

Turkish republic, the Ankara-based nationalist leadership ofthe emergent nation-state created an institutional infrastruc-

ture devoted to public health. Established on May 20, 1920, underthe direction of Dr. Adnan (Adıvar) (1882–1955), the husband ofnationalist and feminist Halide Edıb (Adıvar) (1884–1964), theSıhhat ve Ictimai Muavenet Vekaleti (i.e., the Ministry of Health andSocial Assistance) followed his initial plan as its officials confronted anumber of diseases and conditions that he deemed to pose a particu-lar threat to the populace.1 Among other diseases, syphilis was one ofthe few that were designated as a priority target for eradication.2 Thisidentification (or framing) of syphilis as a distinct danger to thepeoples of Anatolia had profound ramifications that pertained tohow the nascent state defined the disease but also to how it regarded,surveilled, and assembled records pertaining to its entire populationand to how it particularized certain subgroups (i.e., women, ingeneral, but prostitutes, in particular) for epidemiological policingand medical intervention.

In this article, we engage with the early Turkish republic and itsapproach to syphilis not merely as a problem of epidemiology but as

1. Although Dr. Adnan (Adıvar) occupied this position for only a brief period, until hisresignation, the initial public health policies established at this time were relatively constantunder the administrative leaderships of other key figures, such as Dr. Refik (Saydam)(1881–1942). On these formative and transitional (i.e., empire to republic) years in thedevelopment of Turkish public health, see Osman Gumuscu, “Osmanlı’dan CumhuriyeteGecis ve Cumhuriyetin Ilk Yıllarında Turkiye Halk Saglıgı,” Ataturk Arastırma MerkeziDergisi, 2003, 19, 125–46.

2. In addition to syphilis, other diseases identified by the early republic as particularlydetrimental were malaria, trachoma, and tuberculosis.

Evered and Evered : Sex and the Capital City 267

an issue of public health (i.e., as a matter of governance). Followingthe subsequent paragraphs, in which we survey the nature of theprimary sources analyzed and the historical geographic and concep-tual contexts of our study, we initiate our inquiry by analyzing howsyphilis was framed as a problem in modern medicine, in general,and from the vantage of the emerging modernist capital, in particu-lar.3 This question of the framing of the disease as a deliberate actundertaken by the state and its public health officials establishes thebasis for our own inquiry into the ways in which the early republicelected to confront it. From this foundation, we describe and analyzehow Dr. Muslihiddin Safvet, the provincial director of the Ministryof Health and Social Assistance for Ankara, enacted disease controlmeasures in the capital and its surrounding province and how heenvisioned the Ankara example as the ideal model for the widerrepublic.4 This anticipated model, not unlike programs observable inFrance and other European countries, established particular provi-sions for the monitoring and policing of brothels and prostitutes—thus sanctioning prostitution as an acceptable sexual practice, so longas it was mediated by the state and its medical officials. In addition tothese gendered and other measures addressed by Dr. MuslihiddinSafvet with regard to syphilis in the early capital—which also rendersus a view as to how the nascent state collected and assembled infor-mation regarding its populace, we also examine how theAnkara-based state came to engage with the disease through twoother mechanisms of governance: legislation and education.5 In

3. Although we will cite sources individually throughout the footnotes of our article, itbears mentioning that this study resulted from our collection and analysis of documents heldin the following collections: the Prime Minister’s Archive of the Republic (or theBasbakanlık Cumhuriyet Arsivi), the Turkiye Buyuk Millet Meclisi Library (for rare booksand parliamentary records), and the Refik Saydam Library (for public health-related items),all located in Ankara, Turkey; the Wellcome Library, in London, UK; and the Center forResearch Libraries, in Chicago, Illinois.

4. Dr. Muslihiddin Safvet, Turkiye’nin Sıhhı-i Ictimaı Cografyası: Ankara Vilayeti (Istanbul:Hilal Matbaası, 1341/1925).

5. In many regards, the basic organizational structure of each issue of one of the state’sprimary periodicals, or professional circulars, in public health (i.e., Sıhhiye Mecmuası—fromwhich we cite accordingly in this article) reveals this orientation toward statistics, legislation,and education in the Turkish community of medicine. In each monthly issue, prior to thepublication of research articles and other matter, there was an “official section” (or “Resmıkısım”) that was often quite substantial (e.g., twenty or more pages) with three categories ofinformation: Kanun, Nizamname, Talimatname ve Tamimler (or “Laws, Regulations,Ordinances and Circulars”); Istatistikler (or, “Statistics”—containing the results of varioussurveys and other data); and Memurin tebeddulat ve tahavvulatı (or, approximately, “Civil

Journal of the History of Medicine : Vol. 68, April 2013268

addressing the legislative efforts that ensued in the subsequent yearsand continued thereafter, the state’s expression of authority over thehealth and wellbeing of its citizens is laid bare, and through our anal-ysis of its initiatives in public health education, we see how the stateemployed medicalized knowledge and thus engaged directly with itscitizenry to shape gendered relations, sexual practices, and associatednotions of morality amid its more commonly studied agendas ofnation-building, modernization, and secularization.

Our research on the historical geographies of syphilis as viewed,defined, and confronted from the vantage of the emerging republic’sforward capital is based upon our collection, transcription and trans-lation, and analysis of official primary documents and our engage-ment with secondary academic sources pertaining broadly both tocomparative histories of syphilis and governance.6 We examine con-cepts of governmentality, in general, and the governmentalities ofpublic health and medicine, in particular.7 In Turkey’s early republi-can period, the state sought to achieve a comprehensive knowledgeof its many provinces but also of its citizenry.8 Reflecting not only

servants’ changes and developments”—a most interesting section that would outline in briefcharts the many studies of physicians throughout the country, effectively apprising/educat-ing professionals of the activities of their peers).

6. Such studies on syphilis and associated politics include the following: Allan M. Brandt,No Magic Bullet: A Social History of Venereal Disease in the United States since 1880 (Oxford:Oxford University Press, 1987); Allan M. Brandt, “The Syphilis Epidemic and Its Relationto AIDS,” Science, 1988, 239, 375–80; John Parascandola, Sex, Sin, and Science: A History ofSyphilis in America (Westport: Praeger, 2008); Claude Quetel, History of Syphilis, trans. JudithBraddock and Brian Pike (Oxford: Polity Press, 1990); Peter Baldwin, Contagion and theState in Europe, 1830–1930 (Cambridge: Cambridge University Press, 1999), 355–523.

7. Foundational for this work was Michel Foucault, “Governmentality,” in The EssentialFoucault: Selections from Essential Works of Foucault, 1954–1984, ed. Paul Rabinow and NikolasRose (New York: The New Press, 2003), 229–45. Also, influential were the followingsources, Bryan S. Turner, Medical Power and Social Knowledge (London: Sage Publishers,1987); Anita Peerson, “Foucault and Modern Medicine,” Nurs. Inq., 1995, 2, 106–14;Anthony Pryce, “Governmentality, the Iconography of Sexual Disease and ‘Duties’ of theSTI Clinic,” Nurs. Inq., 2001, 8, 151–61; Philip Howell, “Foucault, Sexuality, Geography,”in Space, Knowledge, and Power: Foucault and Geography, ed. Jeremy W. Crampton and StuartElden (Aldershot: Ashgate Publishing, 2007), 291–315; Gerry Kearns, “The History ofMedical Geography after Foucault,” in Space, Knowledge, and Power, ed. Crampton andElden, 205–22; and many of the individual chapters in Colin Jones and Roy Porter, eds.Reassessing Foucault: Power, Medicine, and the Body (London: Routledge, 1994); Alan Petersenand Robin Bunton, eds. Foucault, Health and Medicine (London: Routledge, 1997).

8. This shift from territory to population was entirely in-line with Foucault’s descriptionof Western states and their shifting focus in governance from the territorial to the demo-graphic since the eighteenth century, see “Governmentality,” 229–45.


this population-centered mission of the state and its drive to gatherinformation but also its bio-political essence, the republic initiatedan ambitious project whereby regional surveys were to be compiledat the provincial scale by those doctors assigned by the Ministry ofHealth and Social Assistance to function as provincial directors ofpublic health. Assembled province-by-province and published overthe course of the early 1920s (with a few reaching publication a bitlater), these volumes titled as the Turkiye’nin Sıhhı-i Ictimaı Cografyası(“The Medical-Social Geography of Turkey,” with subtitles that indi-cated specific provinces) rendered a fantastic amount of informationconcerning most parts of the country during these formative years ofthe nation-state.

As historical primary sources, these socio-medical surveys of theemergent republic’s provinces were the result of early questionnairesdeveloped by the ministry and assigned for completion by provincialhealth directors.9 While these inquiries yielded the anticipated dataconcerned with demographics, incidence of disease and other healthconditions, and the availability (or scarcity) of modern health serv-ices, they additionally probed to reveal much more information, aswell. Encompassing matters of ethnography and cultural traditions,folklore, language, socioeconomic data, and physical geographies,these sources also divulged a great deal about the perspectives andattitudes of their authors (i.e., the state’s provincial directors) con-cerning the peoples, places, and afflictions observed in Anatolia. Indoing so, the surveys are especially telling as to how particular dis-eases of concern were framed not just biologically but also socio-cul-turally and politically by the nascent republic’s chief medicalprofessionals and policy makers. Despite their rich factual and per-ceptual contributions to the historical record concerning thepeoples, officials, and health concerns of the early republic, theyhave been largely overlooked by historians, geographers, and otherscholars of public medicine, with the exception of a few general

9. Indeed, a good number of these surveys actually reached publication even prior to thestate’s 1923 declaration, such as Dr. Besim Zuhtu, Turkiye’nin Sıhhı-i Ictimaı Cografyası:Hamidabad (Isparta) Sancagı (Ankara: Ogud Matbaası, 1338/1922); Dr. Hıfzı Nuri,Turkiye’nin Sıhhı-i Ictimaı Cografyası: Kayseri Sancagı (Ankara: Ogud Matbaası, 1338/1922);Dr. Kemal, Turkiye’nin Sıhhı-i Ictimaı Cografyası: Kastamonu Vilayeti (Ankara: Ogud Matbaası,1338/1922); and Dr. Nazmi, Turkiye’nin Sıhhı-i Ictimaı Cografyası: Konya Vilayeti (Ankara:Ogud Matbaası, 1338/1922).


works that simply describe and categorize their contents.10 Orrather, others that detail singular volumes in narrative fashion forindividual provinces.11 Their oversight thus far may have resultedfrom either the more recent development of a broader interest insocial histories of health and disease (as contrasted with traditionalconcerns for historians—such as nationalism, state-building, and reli-gious–secular relations) or the fact that, with only two exceptionswherein they have been transcribed and translated from OttomanTurkish to modern Turkish.12 Many still remain in their originalOttoman text.13 With the exception of those few that were pub-lished at a somewhat later date.14

While these socio-medical geographies are excellent sources forcritical (i.e., deconstructive) analysis, they are also particularly reveal-ing of innovative and progressive trends in Turkish medicine. In par-ticular, the physicians and health officials of Anatolia were not onlyexamining the etiologies and epidemiologies of various afflictionswith regard to their bio-medical aspects. Rather, they were incorpo-rating considerations of physical geographic, socio-cultural, eco-nomic, political, and other geographies—and sometimes evenmapping these findings—in ways consistent with how so-calledfounders of medical geography would function in subsequentdecades.15 And in a manner that continues to typify the study of

10. Such descriptive surveys of the socio-medical geographies were provided byGumuscu, “Milli Mucadele Donemi Turkiye Cografyası Icin Bilinmeyen Bir Kaynak,‘Turkiye’nin Sıhhı-i Ictimaı Cografyası,’” Ataturk Arastırma Merkezi Dergisi, 1999, 15, 939–69; and M. Sabri Koz, “Turk Halk Kulturun’un Unutulmus Kaynaklarından Biri:‘Turkiye’nin Sıhhı-i Ictimaı Cografyası,’” in IV. Milletlerarası Turk Halk Kulturu KongresiBildirileri (published conference proceedings) (Ankara: Feryal Matbaası, 1992), 37–58.

11. One study, for example, provided details regarding Kırklareli; Turkan Dogruoz,“Kırklareli Tarihine Isık Tutacak Bir Eser: Turkiye’nin Sıhhi-i Ictimai Cografyası KırklareliVilayeti,” Hist. Stud., 2011, 3, 275–84.

12. Transcription and translation has been accomplished for some surveys, such as thosefor Nigde and Catalca; Dr. Mehmet Hayri, Turkiye’nin Sıhhı-i Ictimaı Cografyası: NigdeSancagı, trans. Ilhan Gedik (Nigde: n.p., 1994/1338/1922 original); and Dr. Mehmet Ali,Turkiye’nin Sıhhı-i Ictimaı Cografyası: Catalca Vilayeti, trans. M. Sabri Koz (Istanbul: CatalcaBelediye Baskanlıgı, 1991/1341/1922 original).

13. As was the case with the survey for Ankara; Muslihiddin Safvet, Turkiye’nin Sıhhı-iIctimaı Cografyası.

14. The survey for Sivas, for example, was not published until the early 1930s; Dr. HasanTahsin, Turkiye’nin Sıhhı-i Ictimaı Cografyası: Sivas Vilayeti (Istanbul: Hilal Matbaası, 1932).

15. As but one example, we might point to one figure, sometimes referred to as thefounder of American medical geography, Jacques M. May. Critiquing this crediting of Mayfrom another perspective, see Tim Brown and Graham Moon, “From Siam to New York:Jacques May and the ‘Foundation’ of Medical Geography,” J. Hist. Geog., 2004, 30, 747–63.


disease ecologies into the present day.16 Preventative medicine (esp. inthe form of prenuptial examinations) was also conveyed as an essentialcomponent for the development of a modern system of healthcare.Moreover, most of these appointed physicians were well aware of theconstraints imposed upon public health initiatives by both poverty andgeography, so many of them emphasized repeatedly the imperatives ofboth free and accessible treatment (e.g., often recommending travelingdoctors and other types of mobile services), preventative services, andassociated education.

Although a great many scholarly works have focused previouslyupon the emergence of Ankara as the new republic’s forwardcapital—and the associated rejection of Istanbul as that of both theOttoman sultans and the Caliphate,17 far fewer works have focusedupon the establishment of particular institutions of governanceduring this period.18 However, given the profound rural–urban con-trasts in 1920s Turkey, the distinctive institutional nature of Ankara inthis context of stark (and enduring) center-periphery disparitiescannot be overemphasized. In this setting, the ambitious policy ini-tiatives formulated in the capital rarely were realized with immediacyas applied policies in the country’s towns and villages.19 As such, ourarticle addresses primarily the political and medical framing (i.e., dis-course) of syphilis as it emanated from the capital and, to a limitedextent, as it was perceived from and applied there and within

16. On the juxtaposition of various factors that contribute to the disease ecologies ofsyphilis, for example, see James C. Thomas, Michele Clark, Jadis Robinson, MarthaMonnett, Peter H. Kilmarx, and Thomas A. Peterman, “The Social Ecology of Syphilis,”Soc. Sci. Med., 1999, 48, 1081–94.

17. On the origins of Ankara and the early Turkish nation-state, note the followingworks Ilhan Tekeli and Tarık Okyay, “Case Study of a Relocated Capital: Ankara,” in UrbanPlanning Practice in Developing Countries, ed. John L. Taylor and David G. Williams (Oxford:Pergamon, 1982), 123–43; Gonul Tankut, Bir Baskentin Imarı, Ankara: 1929–1939 (Istanbul:Anahtar Kitablar, 1993); Kyle T. Evered, “Symbolizing a Modern Anatolia: Ankara asCapital in Turkey’s Early Republican Landscape,” Comp. Stud. South Asia, Africa, MiddleEast, 2008, 28, 326–41; and several of the chapters in Erdal Yavuz and Umit Nevzat Ugurel,eds. Tarih Icinde Ankara (Ankara: Orta Dogu Teknik Universitesi, 1984).

18. We would qualify this generalization by pointing to the notable exception of thosestudies concerning the state, in general, or the parliament or military, or those devoted tocultural and ethnographic, linguistic, and religious reforms more in keeping with traditionalacademic inquiries into modernization, nationalism, and secularism.

19. Speaking to these enduring disparities between urban policy formulation and ruralpolicy application in Turkey, one historian wrote, “If we take something like electrificationas a measure of modernization, we note that as late as 1953 the total number of villages thathad been linked up to the electric grid was ten, or 0.025 per cent of Turkey’s 40,000 vil-lages!” Erik J. Zurcher, Turkey: A Modern History (London: I.B. Tauris, 2004), 206.


Ankara’s wider province rather than how these policies were experi-enced and realized (or not) throughout all of Anatolia. As we reveal,integral to this framing of syphilis was the combined framing (andhence the frequent endorsement) of prostitution, as conveyed largelyfrom a decidedly proregulationist perspective.20 With this limitationof the scope of our immediate inquiry in mind, it might also benoted that the ambitions (and the promises) of this newAnkara-based republic would be difficult to overstate.

The aspirations of the new state were many and are often summar-ized according to the six “arrows” of Kemalism.21 These includerepublicanism, populism, secularism, revolutionism, nationalism, andstatism.22 As the new republic’s forward capital, Ankara was not onlyintended to embody materially and symbolically these developmentaltrajectories; it was also envisioned to become the essence of everythingthat Istanbul was not under the preceding centuries of Ottoman rule.23

In this context, a good number of both the achievements and theobjectives claimed by early republican health officials were declared inways that juxtaposed them with the perceived neglect, shortcomings,or outright failures of Istanbul and their Ottoman predecessors.24

With respect to particular diseases and to the state of the entire popula-tion, in general, such discursive contrasts continued for many years.For instance, conveying the tenor and examples of such proclaimedjuxtapositions of imperial failure and republican achievement weremany of the works published by the Ministry of Health and SocialAssistance both during this period and in the subsequent decades.25

20. On historical geographies of regulationism (i.e., of prostitution), at least fromBritain’s Victorian contexts, see Phillip Howell, Geographies of Regulation: Policing Prostitutionin Nineteenth-Century Britain and the Empire (Cambridge: Cambridge University Press,2009).

21. Kemalism refers to the modernist ideology promulgated under the tutelage ofMustafa Kemal (Ataturk) (1881–1938), the founder and leader of the early Turkish republic.

22. For over a decade, critical evaluations of the modernist, state-building Kemalistproject have come to characterize a significant body of scholarship on the Turkish repub-lic—to which this article also contributes. Seminal in this body of literature were the studiesin Sibel Bozdogan and Resat Kasaba, eds. Rethinking Modernity and National Identity inTurkey (Seattle: University of Washington Press, 1997).

23. For greater analysis of these symbolisms and the planning of Ankara, seeK. T. Evered, “Symbolizing a Modern Anatolia.”

24. Such contrasts, it should be observed, were inherently ironic, as many of the leadingphysicians of the new Turkish nation-state had also been doctors working in the OttomanEmpire prior to their realignment with the nationalists.

25. While there were many examples of such accounts of republican triumphs over theshortcomings of the empire that were published by the Ministry of Health and Social


This setting characterized by abundant ambition and self-congratu-lation was also noteworthy, however, for contrasting expressions ofparticular anxieties. While most vivid among these concerns were theimages of losses of territory from World War I, of losses of sovereigntyduring the subsequent period of the British and French occupation ofIstanbul, and of invasion by foreign powers (as associated with thelanding of Greek forces and the 1919–23 War of Independence),overall, there were also particular concerns over the health andnumber of the national populace in terms of nationalistic, geopolitical,and economic. Reflecting the drive for reproducing and controllingthe populace, parliamentary and other meetings of state officials26

were replete with a “demographic discourse” that called for urgentmeasures.27 As a disease that undermined the health and (economic)wellbeing of the population and that contradicted the objectives ofassociated pronatalist policies, syphilis was a major concern for themedical officials and politicians of the early republic. Defining, legis-lating, and teaching the public about syphilis were thus projects thatwere seemingly as essential to the disease’s eradication as were actualtherapeutic regimes of treatment.

FRAMING SYPHILIS IN MODERN MEDICINE—AND IN A MODERN

CAPITAL

Syphilis plagued European societies since as early as the late-fifteenthcentury.28 However, little had been achieved in its accurate diagnosisand effective treatment until the first decades of the twentieth

Assistance and other governmental bodies—to include photo albums, as examples pertinentto our study, we would point to the two special anniversary issues (one for the tenth yearand the other for the twenty-fifth year of the republic) of the Turkish medical journal andcircular Sıhhiye Mecmuası (later published as Saglık Dergisi); Sıhhiye Mecmuası, FevkaladeNushası: Vekaletin 10 Yıllık Mesaisi (Istanbul: Hilal Matbaası, 1933); and Saglık Dergisi,Fevkalade Nusha, 1948, 22, no. 10–11.

26. Significant examples of such statements as to the republic’s perceived populationcrisis can be found in the many papers presented at the nation-state’s first medical congress,as held in September 1925 in Ankara. The proceedings from this congress were publishedthe following year, see Anon., ed. Birinci Millı Turk Tıb Kongresi (1–3 Eylul 1925) (Istanbul:Kader Matbaası, 1926).

27. For greater analysis of the early republic’s “demographic discourse” with regard toFoucault’s notions of governance and population, see Kyle T. Evered and Emine O. Evered,“Governing Population, Public Health, and Malaria in the Early Turkish Republic,” J. Hist.Geog., 2011, available online at: doi:10.1016/j.jhg.2011.02.002 (accessed August 16, 2011).

28. Regarding these early histories of the disease in Europe, see Quetel, History ofSyphilis, 9–130; J. D. Oriel, The Scars of Venus: A History of Venereology (London:


century.29 Indeed, as one historian of medicine observed, the diseaseseemed to thrive amid the advent of the modern age; “one of severaldiseases caused by members of the Treponema group of spirochetes, acorkscrew-shaped bacterium, . . . syphilis, like typhus, should beregarded as typical of the new plagues of an age of conquest and tur-bulence, one spread by international warfare, rising populationdensity, changed lifestyles and sexual behavior, the migrations of sol-diers and traders, and the ebb and flow of refugees and peasants.”30

Post-World War I Anatolia clearly fit within this category of turbu-lent contexts that were ideal for the disease’s increased transmission.By the early 1900s, however, scientists working mostly in Germanyidentified the disease with respect to its causative bacterium (i.e.,Treponema pallidum, though it was labeled initially as Spirochaetapallida), developed an effective diagnostic test (i.e., the Wassermanntest), and devised the first ever effectual treatment for the disease.While the chemotherapeutic approach to syphilis, as based upon thearsenic compound arsphenamine (known more commonly asSalvarsan), was hailed as a wonder drug by most—and as a “magicbullet” by its creator, immunologist Paul Ehrlich (1854–1915), it wasmodified to be less toxic shortly after its initial development due to anumber of fatalities and was distributed thereafter as Neosalvarsan.31

These revolutionary changes in how humanity might confrontsyphilis were matched by evolving notions of what medicine shouldentail under the auspices of the modern state. For public health offi-cials of the early twentieth century,

medicine . . . must become a positive and systematic enterprise, under-taking planned surveillance of seemingly healthy and normal peopleas well as the sick, tracing cohorts from infancy to old age, chartingthe incidence of inherited, chronic and constitutional conditions, andplotting ill-health against such variables as income, education, class,

Springer-Verlag, 1994); Peter Lewis Allen, The Wages of Sin: Sex and Disease, Past and Present(Chicago: University of Chicago Press, 2000).

29. On the state of medical knowledge and theory concerning syphilis in nineteenth-century France, for example, see Alex Dracobly, “Theoretical Change and TherapeuticInnovation in the Treatment of Syphilis in Mid-Nineteenth-Century France,” J. Hist. Med.Allied Sci., 2004, 59, 522–54.

30. Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity(New York: W.W. Norton, 1999), 167.

31. Brandt, No Magic Bullet, 40–47.


diet and housing. Disease thus became conceptualized in the twenti-eth century as a social no less than biological phenomenon, to beunderstood statistically, sociologically, psychologically—andpolitically.32

These developments in treating syphilis enabled public health offi-cials in Europe, the United States, and elsewhere “to take a moreaggressive stand in the fight against venereal diseases and to encour-age the growth of the public health field.”33 However, the matter ofhow officials were to apply their bio-political mandate was yet to bedetermined in many different cultural, socioeconomic, and politicalsettings. In these varied contexts, how the disease would be framedby public health officials, politicians, and others determined (1) theentire scope of the syphilis problem itself as understood and actedupon, (2) which segments of a populace would be associated withthe disease and its dispersion, and (3) what measures would bedeemed appropriate in attempting its resolution.

Accompanying these technological and professional/institutionalshifts in medicine, attitudes also changed regarding many diseases.Amid Europe’s transitions from the medieval and Renaissanceperiods to those of the early modern and modern periods, onemedical historian observed of syphilis that, “[a]s middle class moralitybecame dominant, the disease began to be considered a social stigma.It went underground, which greatly hindered efforts to control thedisease until very recently.”34 Additionally, diseases began to beregarded as the consequences not of ill fortune but of individual voli-tion, and this was particularly the case—and might still be viewed tobe so—with sexually transmitted diseases.35 Under these develop-ments in the re-framing of diseases—and especially of those transmit-ted sexually, our scrutiny of who was regarded to have volition is acrucial matter as state health officials prioritized the surveillance and

32. Porter, Blood and Guts: A Short History of Medicine (New York: W.W. Norton, 2002),158.

33. Brandt, No Magic Bullet, 40–47.34. George Rosen, A History of Public Health (Baltimore: Johns Hopkins University

Press, 1993), 74.35. On this matter of choice, or how some construe there to be adverse consequences to

free will, note themes from U.S. history that were covered in many of the chapters inCharles E. Rosenberg, Explaining Epidemics and Other Studies in the History of Medicine(Cambridge: Cambridge University Press, 1992).


policing of the assumed choices (i.e., the sexual practices) of somecitizens while overlooking entirely the choices of many others.

In the United States and most countries of Western Europe, stateand public health officials did not focus on the “soldiers and traders”associated with the geographic spread of syphilis—though the healthof military troops was one of the primary causes for governmentalconcern over sexually transmitted diseases. Rather, in the enforce-ment of public health, sex workers were targeted as modern statesidentified commonly the scourge of venereal diseases to be the prac-tice of prostitution—as embodied (symbolically and physically) bythe female sex worker (and not by her clients). In this manner, wecontend, prostitutes became the common scapegoats for sexuallytransmitted diseases as states and societies found their targeting to bemore socially and politically acceptable than an assignment of evenpartial responsibility to servicemen, veterans, or other male citizensof the nation.

In countries like France, the state solution thus entailed assertions ofgovernmental control as state officials mediated sexuality; brothelswere licensed, and registered prostitutes were compelled to submit toregular medical examinations. By contrast, both in Britain and (espe-cially) in the United States, the nature of governmental control overthe long term tended not toward the regulation of sexuality (withsome notable exceptions for Britain during the period of ContagiousDiseases legislation) but toward its prohibition, with varying out-comes.36 In the case of Turkey, the state and its officials exhibited aposture regarding public health, sexuality, and prostitution that was farmore consistent with the mediated French example.37

36. Providing a number of introductory examples of state enforcement involving syphilisand other diseases, see Porter, The Greatest Benefit to Mankind, 420–25. Also, with specificregard to experiences in Victorian Britain, see Judith R. Walkowitz, Prostitution and VictorianSociety: Women, Class, and the State (Cambridge: Cambridge University Press, 1980); andHowell, Geographies of Regulation.

37. It should be noted that this inclination toward mediating—rather than prohibiting—particular sexual practices (i.e., prostitution) had precedent in the Ottoman experience andwas not merely a republican invention. On the regulation of prostitution in late OttomanIstanbul, for example, see Muge Ozbek, “The Regulation of Prostitutes in Beyoglu,” Mid.East. Stud., 2010, 46, 555–68. For greater discussion of prostitution in contexts of theOttoman Empire, see Rıfat N. Bali, The Jews and Prostitution in Constantinople, 1854–1922(Istanbul: Isis Press, 2008); Elyse Semerdjian, Off the Straight Path: Illicit Sex, Law, andCommunity in Ottoman Aleppo (Syracuse: Syracuse University Press, 2008); and FaribaZarinebaf, Crime and Punishment in Istanbul, 1700–1800 (Berkeley: University of CaliforniaPress, 2010).


In the socio-medical geography report that he compiled for theMinistry of Health and Social Assistance, the provincial director ofhealth for Ankara, Dr. Muslihiddin Safvet, discussed what he viewedas the scope of the syphilis problem in Turkey:

Syphilis is the greatest misfortune left to our country by WorldWar I. A long time ago, Kastamonu was the province where syphiliswas most common; unfortunately, today, this sinister disease is inalmost every part of Anatolia, even in its smallest villages. Because ofpoverty, the numbers of people involved in open and secret prostitu-tion increased, and since they are not subject to any control, syphilisstarted to invade every part of the country with all its might, enteringinto [even Turkey’s] elite families.38

Identifying both social ills and sexual practices that he felt contrib-uted to a syphilis epidemic (i.e., poverty and prostitution),Dr. Muslihiddin Safvet spoke to the specific circumstances of Ankaraand the disease. Although he wrote that the city recently experiencedsubstantial population growth, he observed that any accurate estimateof the rate of this increase would be merely speculative. While a 1925

survey of the city and its surroundings provided figures for that year,ongoing trends (e.g., migrations, population exchanges, and otherdynamics) complicated further calculations of rates of growth. For1925, the provincial population of Ankara was numbered at 312,549

people (165,463 females and 147,086 males) by reports from thecity’s office of birth registration and from state physicians.39

Commenting on these demographic observations and processes, hewrote:

A major proportion of Ankara’s population is Turkish. In the city andits towns there are non-Muslims, especially Greeks, Armenians, andJews. Since the Greeks were subject to the population exchange fol-lowing the Lausanne Treaty, if one extracts them from thisnon-Muslim population, the remaining is a small number ofArmenians and Jews. . . . Due to the population exchanges, there aremigrants from Salonika and there are also people who were notsubject to the population exchanges but arrived from Serbia andBulgaria and their settlement is not yet complete. Therefore, we areunable to know the real number of [Ankara’s] population. In order to

38. Muslihiddin Safvet, Turkiye’nin Sıhhı-i Ictimaı Cografyası, 91.39. Ibid., 113.


get an accurate number, we must include people who migrated toAnkara after the 1912 Balkan War and the 1914 war [i.e., WorldWar I] as well as those who came following the Lausanne Treaty aspart of the population exchanges and those state officials who settledin Ankara after it became the capital.40

Of greater significance than matters of demographic statistics for Dr.Muslihiddin Safvet, however, were factors of socioeconomic stressthat derived from the turbulence of World War I, the War ofIndependence, and the transition from empire to republic. In hisview, such tensions contributed sharply to declining standards ofmorality in Turkish society.41 The diminished observance of moralsand decency, he continued, was a direct consequence of scarcitiesand privations. As he wrote:

Until World War I began, morality was very good in the area. Thehardship and poverty caused by the war altered public morality.Prostitution exists more in the villages than in the towns. Those whowere involved in secret prostitution in the villages gradually did soopenly, and thus, day-by-day, morality began to fall into disarray. Asan evil consequence of the war, young women who became sole sur-vivors [of their families] or who were widowed ended up working asmaids for people here and there, [but they] later fell into a seductivetrap and this led to their loss of chastity. These were the causes of thedecline of morality. Sometimes the fiances of young women werekilled at war and nobody showed an interest in them anymore, theybegan to become spinsters, and they ended up being raped amidpromises of marriage and [thus] lost their chastity.42

According to his narrative of these circumstances, once such womenlost their youth and their chastity, they sometimes would marryyoung men as much as fifteen or twenty years their junior, but rarelywith promising outcomes. These women, devoid of family support,their honor, or alternative economic opportunities, fell commonly

40. Ibid., 51.41. Although we emphasize in this article more the question of how public health offi-

cials promoted a science-based notion of sexual morality, prevailing ideas of social andsexual morality clearly entered into their discourse. Presenting an analysis of changingnotions of gender and sexuality in turn of the century Russia, see Laura Engelstein, TheKeys to Happiness: Sex and the Search for Modernity in Fin-De-Siecle Russia (Ithaca: CornellUniversity Press, 1992).

42. Muslihiddin Safvet, Turkiye’nin Sıhhı-i Ictimaı Cografyası, 55–56.


into prostitution.43 This societal stress, he concluded, thus contrib-uted not only to the moral declines that promoted prostitution, italso led to increased rates of diseases like syphilis.44 It also led to actsof criminality as perpetrated by male youths who sought money forthe services of prostitutes.45

Given the prevalence of such factors, the provincial directorfor Ankara reported the following figures for 1923 occurrences ofthe disease (Table 1).46 He cautioned, however, that he suspectedthat the actual number of persons with syphilis in Ankara was, inhis estimation, far higher than conveyed by the numbers ofreported cases that he was able to verify. In viewing these figures,it is interesting to speculate as to the far higher number of casesreported for November 1923—the month following the October29, 1923, declaration of the republic (and one presumes—associatedfestivities).

As Ankara emerged to become, first, the nationalists’ center ofoperations and, second, the republic’s new capital, Dr. MuslihiddinSafvet noted that women involved in prostitution in these other size-able urban centers likely departed for Ankara and then further spreadthe disease there. Since those sex workers who migrated to the newcapital for greater opportunities were not subject to immediatemedical examinations, syphilis in Ankara continued to, in his words,“sink its teeth into the youth.” In earlier times, he observed, it wassufficient to send the prostitutes taken in by authorities for a medicalexamination at the city hospital. Lately, he continued, in order tocompel them to remain in one location and thus facilitate moreeffective surveillance and policing, a brothel was established officiallynear the Kengri Gate—named for the city to which its outgoing

43. That these women might be helped out of their circumstances seemed unimaginableto most of the provincial health directors. Though all criticized the conduct of “secret”(i.e., unregulated) prostitution, only one seemed to envision creating an alternative realitythrough relocation, job training, and other measures to, in his words, “reform their bodiesand their morality” (Mehmet Hayri, Turkiye’nin Sıhhı-i Ictimaı Cografyası, 171–72).

44. Though tempting to accept Dr. Muslihiddin Safvet’s assessment of a recent rise in theincidence of syphilis in Ankara as occasioned by recent conflicts and socioeconomic instabil-ities, our ongoing examination of nineteenth-century archival documents held in theOttoman archive in Istanbul is revealing that Ankara experienced significant problems withthe disease in the nineteenth century, as well.

45. Muslihiddin Safvet, Turkiye’nin Sıhhı-i Ictimaı Cografyası, 55–56.46. Muslihiddin Safvet, Turkiye’nin Sıhhı-i Ictimaı Cografyası.


road led (now known as Cankırı).47 Their registration was handledby the police and health officials, they were inspected twice perweek, and their total number was between sixty and seventy. Hefurther stated that most of the women at the brothel came fromplaces beyond Ankara and that few were from the city itself or nearbylocal communities.48

Prior to the establishment of the registered and policed brothel atthe Kengri (Cankırı) Gate, prostitutes in Ankara were not subject toany serious enforcement of either examinations or treatment. In hisview, this absence of public health enforcement—and what he per-ceived as a prevalent state of local “ignorance and naivete,” contrib-uted to both the emergence of and the increasing rates of

TABLE 1

Reported Cases of Syphilis Patients Treated in Ankara, 1923

Month Number of reported cases of syphilis

January 14

February 11

March 21

April 46

May 90

June 22

July 23

August 34

September 49

October 63

November 103

December 18

Total 404

Source: Dr. Muslihiddin Safvet, Turkiye’nin Sıhhı-i Ictimaı Cografyası: Ankara Vilayeti(Istanbul: Hilal Matbaası, 1341/1925).

47. Ibid., 91. Also note that the Kengri (or Cankırı) Gate was not only the site desig-nated for the city’s registered brothel. Evidencing from Ankara’s history what was, perhaps,a classic example in its municipal leadership’s creation of urban disamenity (or, viewed con-versely, a case of NIMBY), this gate area was also one of the sites proposed by the citycouncil for the relocation of the city’s cemeteries due to concerns over the increased publichealth hazard posed by cemeteries amid rapid rates of urbanization. Muslihiddin Safvet,Turkiye’nin Sıhhı-i Ictimaı Cografyası, 76.

48. Ibid., 55–56.


transmission of syphilis in the city. As he concluded, once the diseasearrived in this otherwise unmonitored setting, it found a suitableenvironment in which it could thrive.49

By 1925, Dr. Muslihiddin Safvet claimed that measures taken tocombat syphilis thus far in his province had achieved a solid record ofsuccess. Based upon his accounts, these measures went beyondsimply responding to reported cases. The practices and proceduresthat he noted, in particular, included the establishment of the afore-mentioned licensed brothel, the registration of its prostitutes, and thetwice-weekly examinations of these licensed sex workers, on the onehand, and the implementation of mandatory prenuptial medicalexaminations for both men and women, on the other hand. Relyingupon his estimation that syphilis was increasingly contained in theAnkara region over the past few years, he indicated that it was timefor the rest of the nation to learn from this experience and thatsimilar procedures should be applied throughout Anatolia—espe-cially in those subregions that he viewed as syphilis-ridden.50

For Dr. Muslihiddin Safvet, Ankara served as a good model notonly due to his report of its relative successes thus far but alsobecause the city was sizeable and there were a large number of prosti-tutes in the vicinity of the capital. This presumed number of prosti-tutes, he speculated, enabled him to suggest both certain dynamicsassociated with the population, in general, and of prostitutes, in par-ticular. First, due to the city’s size, he considered it to have relativestanding with other large cities at the time, noting Istanbul, Bursa,and Izmir.51 Second, for him, the city revealed what might beaccomplished elsewhere should adequate resources be devoted to theproblem. Compared with other cities, Ankara seemed to possessmore funds and a greater scale of investment in public health. Thehospital that existed before Ankara became the new republic’s capitalwas renamed as Numune Hospital, and after 1924, it was repaired,renovated, and equipped with a new unit with three rooms devotedto treating venereal diseases. With its modern facilities for bacteriol-ogy and a surgery room, it was one of the most modern hospitals inAnatolia and boasted having 150 beds, of which 100 were for the free

49. Ibid., 91.50. Ibid.51. Ibid.


treatment of citizens while the remaining fifty were for payingpatients. Furthermore, dispensaries were established in neighboringtowns and all their expenses were paid by the Ministry of Health andSocial Assistance, so that both poor and rich could receive necessarytreatment at no cost.52

Based upon his assessment of the disease and its propensity forfurther transmission in the absence of direct confrontation and stateprovisions for treatment, Dr. Muslihiddin Safvet was a strongproponent for state-led surveillance and policing of the population atlarge and for making healthcare accessible. At the most rudimentarylevel, he sought to increase the scope of existing practices for every-one within the country as associated with their prenuptial examina-tions. Profoundly critical of merely practicing such examinations ofwould-be husbands and not their intended brides, he pointed outthat a large number of women might suffer from either acquired orinherited forms of syphilis and that their omission in prenuptialexaminations would enable the disease to spread further. However,this proposal was not without detractors. At least one deputy ofparliament rejected any examination of girls or women prior to mar-riage—assuming that it would impugn their presumed virginity.Regardless, by 1924, females were included in state requirements forprenuptial examinations. Positive results from the Wasserman test forsyphilis would necessitate a regime of treatment prior to beingapproved for marriage by the state. These measures were deemedessential, given that many who suffered from syphilis were unawareof their status or were otherwise inclined to keep their status asecret.53 He even indicated that subjecting those citizens seekingeither public employment or other official work to examinationswould also enhance broader, state-led efforts toward both the detec-tion and the treatment of syphilis.54

Consistent with the commentaries and recommendations (esp.regarding the establishment of state-monitored brothels) found inmany of the other provincial socio-medical geographies, however,Dr. Muslihiddin Safvet’s main focus regarding the disease con-cerned the state’s engagement of a perceived problem with

52. Ibid., 68.53. Ibid., 91.54. Ibid., 92.


prostitution.55 Returning to his discussion of successful resultsreportedly achieved in Ankara, he noted that any origin of venerealdiseases (esp., syphilis and gonorrhea) from brothels had been elimi-nated due to the enforcement of twice-weekly medical examinationsof licensed prostitutes. Viewing the Ankara example as a successstory in public health, he proposed that the time had arrived toexpand the fight against syphilis in the capital to other parts ofAnatolia—and with the goal of eventually targeting other similardiseases.56

A fervent sponsor of epidemiological surveillance, Dr. MuslihiddinSafvet advocated a powerful state role that would record and monitorthe nation’s syphilitics. To this end, he endorsed that all thosediagnosed with the disease should be subject to mandatory therapy,though they should have the option of having their own physicianadminister their treatment. This regime of compulsory treatmentwould be monitored through the maintenance of a treatment reportcard with weekly signatures from the treating physician that would bepresented regularly to local health officials. In the event of migration,syphilis patients were obliged to inform health officials in the jurisdic-tion of their new home. In order to achieve adherence—and eradica-tion of the disease, he also advocated enforcing compliance throughpunishment, when necessary.57

From our review and analysis of the other socio-medical geogra-phies authored by the health directors of Turkey’s additional provin-ces, Dr. Muslihiddin Safvet’s advocacy of a greater state role in publichealth was not unique. His detailed suggestions for the role of thestate did, however, distinguish his report from those of his peers, asmost of them did not articulate with so great a level of specificity themeasures that they also advocated—measures, as presented morethoroughly by Dr. Muslihiddin Safvet, that were codified eventuallyinto public health law, with only a few exceptions. Moreover, the

55. While most provincial directors expressed this perceived need for state-regulatedbrothels and the licensing of prostitutes on the grounds of public health, it was also detailedwith particular attention by the administrators for Kırkkilise, Mugla, and Kayseri; Dr.Ahmet Hamdi, Turkiye’nin Sıhhı-i Ictimaı Cografyası: Kırkkilise (Kırklareli) Vilayeti (Istanbul:Kagıcılık ve Matbaacılık Anonim Sirketi, 1341/1925); Dr. Esad, Turkiye’nin Sıhhı-i IctimaıCografyası: Mugla (Mentese) Sancagı (Ankara: Ogud Matbaası, 1339/1923); and Hıfzı Nuri,Turkiye’nin Sıhhı-i Ictimaı Cografyası.

56. Muslihiddin Safvet, Turkiye’nin Sıhhı-i Ictimaı Cografyası, 92.57. Ibid.


roles of physicians in the early republic and in its parliament were sig-nificant as many of them not only worked as officials who informedgovernmental policy through their appointments in the Ministry ofHealth and Social Assistance, but there were a good number ofdoctors serving as lawmakers in the Turkish parliament, as well.58

Even Turkey’s second Minister of Health and Social Assistance, Dr.Refik (Saydam) eventually rose to become the republic’s PrimeMinister (1939–42).

CONFRONTING SYPHILIS THROUGH LEGISLATION

In seeking to alleviate the problems of venereal disease, the Ankara-based republic was not the first state to seek a legislative remedy—even in Anatolia.59 Though the state that would later boast of itsachievements on behalf of its female citizenry—and not withoutgood cause.60 However, the republic may also be seen to have under-mined profoundly the standing of women through its endorsementof prostitution.61 In this section, we address the legislative efforts tocontrol syphilis and other venereal diseases, but we also engage with

58. The significant presence of physicians in the parliament of the early republic wasobserved and discussed in Melih Tınal, “Turkiye Buyuk Millet Meclisi Birinci DonemindeDoktor Milletvekilleri,” Uluslararası Sosyal Arastırmalar Dergisi, 2009, 2/6, 617–27. Beyondthese examples, we would also note that Dr. Refik (Saydam)—successor to Dr. Adnan(Adıvar) as director of the Ministry of Health and Social Assistance—even rose to becomethe nation-state’s fourth Prime Minister (1939–42).

59. Among imperial efforts to legislate sexual health, we might recall the OttomanEmpire’s 1884 Venereal Disease Law as but one example; addressed in Ozbek, “TheRegulation of Prostitutes in Beyoglu.”

60. Among a few of the many contributions of the republic to the status of women inAnatolia, we would note the 1920s extensions of political, educational, and social rights towomen, the legal abolition of polygamy, the early 1930s achievement of suffrage, and othermeasures to promote equality and inclusion. While critics of these measures often pointedeither to the existence of such rights “on paper alone” or to the diminished significance ofvoting rights in a single-party state, such criticisms could also be made of many similardevelopments for the inclusion of women that emerged in Western/European states—sometimes years or decades later.

61. Surveying academic and other sources with regard to the detrimental aspects of stateendorsements of prostitution—and perspectives that promote it, see Maggie O’Neill,Prostitution and Feminism: Towards a Politics of Feeling (Cambridge: Polity Press, 2001). Foradditional analysis of the socio-political geographies of regulationist perspectives, past andpresent, see also Phillip Howell, “Race, Space and the Regulation of Prostitution inColonial Hong Kong,” Urb. Hist., 2004, 31, 229–48, and Howell, Geographies of Regulation.Specific to the French experience with regulation, see Alain Corbin, Women for Hire:Prostitution and Sexuality in France after 1850, trans. Alan Sheridan (Cambridge: HarvardUniversity Press, 1990); Jill Harsin, Policing Prostitution in Nineteenth-Century Paris(Princeton: Princeton University Press, 1985).


the legislative provisions for prostitution, as mediated by the state—and thus endorsed as a measure in the promotion of public health.

Upon the establishment of the Ministry of Health and SocialAssistance, one of its first projects entailed the nascent state’s cam-paign against syphilis. Enhancing the ministry’s movement to fightagainst the disease, several legislative steps were taken in the 1920sand 1930s. Although the 1930 Public Health Law (or the UmumıHıfzısıhha Kanunu) is regarded as the most comprehensive legislativeaction in the early development of Turkey’s public health system,there were several prior measures that were subsequently combinedand augmented to become the backbone of this 1930 law. In 1921,the ministry passed the Law for the Prevention and Containment ofSyphilis (or the Frenginin Men-i Sirayet ve Intisarının Tahdidi Kanunu).This law mandated free, state-sponsored treatment for those sufferingfrom syphilis.62 As this law was further expanded to become part ofthe 1930 Public Health Law, the state further mandated that all statedoctors and state health institutions must treat syphilis patients free ofcharge. Furthermore, it required syphilis patients to obtain treatmentand, in case of neglect, allowed health officials to pursue them and tocompel their treatment.63

Although the 1921 law stipulated free treatment for syphilispatients, it was soon realized that many doctors utilized quite differ-ent treatments, often reflecting their diverse histories of medicaltraining and their varied understandings concerning the propertiesand appropriate uses of different medications. In order to achieve itsintended results, the Ministry of Health and Social Assistancesearched for ways to standardize treatment regimes. In 1925, itcreated a syphilis commission comprising some of the country’s mostprominent doctors. This commission worked to establish a standardof agreed-upon therapies for syphilis, including methods of treat-ment, acceptable medications, and appropriate dosages. Based uponthe recommendations of this commission, the ministry sponsored theRegulations for the Treatment of Syphilis and distributed theseguidelines to the nation’s health officials and practitioners. According

62. As restated in the later twenty-fifth anniversary issue of Saglık Dergisi; “Saglık IsleriGenel Mudurlugunun Calısmaları,” Saglık Dergisi, Fevkalade Nusha, 1948, 22, no. 10–11,10–45, 24.

63. As related in Sıhhiye Mecmuası, Fevkalade Nushası, 59.


to this regulation, the treatment of syphilis in Turkey would be basedupon only the latest scientific methods and these approved therapeu-tic measures would be applied uniformly throughout the country.64

As indicated, the most comprehensive legislative treatment ofsyphilis (among other afflictions) began in Ankara with the April 24

passage of the 1930 Public Health Law.65 In its entirety, this law hadfifteen sections and covered various health-related issues throughoutits 309 articles. With particular regard both to syphilis and to sexuallytransmitted diseases, in general, the law combined several previouslaws (which it elaborated upon), introduced distinctly new provi-sions, and deferred some matters for later clarification and resolution.Overall, it reflected the state’s ambitious project to create a central-ized system of medicine with both therapeutic and preventative mis-sions that would have the full authority and legitimacy of the state atits foundation.

With regard to its syphilis-related structure, the 1930 PublicHealth Law had provisions that dealt with (1) treatment, the report-ing of information, and patient confidentiality and education (i.e.,Articles 103 through 109), (2) preventative measures, patient andpopulation monitoring and examinations, and enforcement (i.e.,Articles 110 through 127), and (3) the governance of brothels andprostitutes (i.e., Articles 128 through 134).66 In the initial articlesdealing with sexually transmitted diseases, citizens were assignedlegal responsibility for undergoing treatment (or for having theirchildren treated) if infected, physicians were made responsible forreporting patient records to the state67 but also for maintainingpatient confidentiality, and state institutions were required to render

64. Ibid., 58.65. Shortly after the law’s April 24, 1930, passage, it was published for general distribu-

tion in the country in the state’s official gazette; Resmı Gazete, May 6, 1930, no. 1489.66. A number of the law’s articles were later translated and provided in English; Sven

Christiansen, “A Report on Syphilis Control in Turkey,” Bull. World Health Organ., 1954,10, 627–90. Christiansen’s rendering of these articles, however, seemed to derive frominformation provided at the time by the Turkish state and his text omitted many clauses(e.g., those pertaining to midwives, among others) to the particular articles cited by himand addressed in this article.

67. As revealed through the addition of a subsequent provision, the state’s anxieties overphysicians’ failures to report all cases and required details of each case led to a significanttightening of the law as early as 1933, with greater sanctions outlined for those who wouldfail to comply; “Vekaletin 12 Tesrinievvel 1933 Tarihli Hıfzısıhha No. 510 Tamimi,” SıhhiyeMecmuası, Vol. 9, no. 65 (Kanunuevvel 1933), 293.


free treatment.68 Furthermore, individuals suspected of beinginfected could be compelled to undergo an examination, to be pro-vided either by the state or by a person’s own physician, and thoseproven to be infected would be compelled to undergo a full courseof monitored treatment, with provisions for pursuit, isolation, andforce, if deemed necessary.69 Also, in line with state goals to bettereducate citizens about (and encourage conformity with) publichealth initiatives, the state required all patients (or their legal guardi-ans) to receive state-published informational pamphlets and counsel-ing from their treating physicians.70

Enforcing public health (and applying discipline in order toachieve it), the law also outlined the illegality of knowingly spreadingsexually transmitted diseases, with provisions for punishment, solong as infected victims brought forward their complaints within sixmonths of alleged transmission. Parents of children infected withsyphilis were also legally prohibited from hiring a wet nurse. Areaswith a high incidence of syphilis would warrant the formation oflocal commissions charged with eradicating the disease and enforcingall necessary state regulations. Infected soldiers would not be dis-charged until cured and both men and women would be subject toprenuptial examinations.71 Marriages were forbidden for those

68. Within a year of the passage of the law, the state seemed compelled to issue an addi-tional warning regarding the repercussions of failing to maintain patient confidentiality.Published in its monthly public health journal as a circular Sıhhiye Mecmuası, the state indi-cated that any health personnel who violated these provisions for confidentiality would befired from their positions; “Hıfzısıhha No. 382 Tamimi,” Sıhhiye Mecmuası, 1932, 8, no. 58

(Agustos 1932), 229–30.69. The broad scope of this article, as read, was later specified to come closer to its

framers’ original intent: to mandate particular measures for those citizens who worked incapacities that would bring them into contexts wherein their disease status might be ofconcern. Encouraging cautious restraint in its enforcement by public health officials, a sub-sequent circular from the state warned that it had been applied to peoples that were notenvisioned by the framers of the original law. Such errors in application, it was noted, leadto unnecessary (and understandable) complaints, compromised the standing of health offi-cials in their communities, and impugned the standing and reputation of otherwise upstand-ing citizens; “Hıfzısıhha No. 450 Tamimi,” Sıhhiye Mecmuası, 1933, 9, no. 63 (Haziran1933), 121–22.

70. In the following year (i.e., 1931), each of the provincial directorates of Health andSocial Assistance were furnished with 2,000 copies of the document and were reminded thatthey were required to provide these pamphlets to those patients who suffered from sexuallytransmitted diseases; “Umumı Hıfzısıhha Kanunun Tatbikine Dair Tamim, No. 22,” SıhhiyeMecmuası, 1931, 7, no. 52 (Agustos 1931), 277.

71. The specifics of prenuptial examinations—with distinct provisions for men andwomen—were enacted and disseminated in the following year (i.e., 1931); “Evlenme


infected with sexually transmitted diseases until a doctor could verifyboth full treatment and noncontagious status.72 Increased govern-mental scrutiny (i.e., compulsory examinations) was mandated forpersons working in presumably at-risk occupations (i.e., wet nurses,and those employed in hammam—or baths—and other hygiene-related positions), and associated examinations and treatments wouldbe rendered at no cost.

In its subsequent articles, the 1930 law outlined provisions relevantto brothels and prostitutes as part of its comprehensive plan forTurkey’s system of public health. As there were many questionsregarding prostitution that were yet to be resolved, the law also indi-cated that a more detailed regulation specific to brothels and prosti-tutes would be issued at a later date in order to further define thestate’s guidelines for each and designate their operational limitationsand geographic requirements.73 Given the anticipated regulation thatemerged in 1933, the measures in this law detailed simply broadguidelines and rules; it prohibited infected prostitutes from working,mandated their treatment—and detainment (if necessary), forbadealcohol consumption in brothels, and stipulated that municipalitieswere responsible for financing all measures enacted. To enablemunicipalities to carry out these requirements, the law also allowedfor the taxation of brothel owners. However, it also forbade expresslyany collection of taxes from the prostitutes themselves. Furthermore,

Muayenesi Hakkında Nizamname, Karar No. 11682,” Sıhhiye Mecmuası, 1931, 7, no. 54

(Kanunuevvel 1931), 458–61.72. Although physicians were required to report the names of all parties seeking prenup-

tial examinations, state health officials suspected that doctors were only registering thenames of those parties who were approved for marriage and dissuading verbally (i.e., not inwriting and without entering into a registry that the state could monitor) those who werenot approved (i.e., those who tested positive for syphilis) from making a formal applicationfor marriage until they had been treated. As officials were concerned that this suspectedpractice contributed to inaccuracies in information collection and constituted evasion ofstate laws on reporting, the expressly forbade such conduct in a circular published the fol-lowing year; “Hıfzısıhha No. 392 Tamimi,” Sıhhiye Mecmuası, 1932, 8, no. 59 (Tesrinievvel1932), 275–76.

73. This specific article in the law regarding prostitution and prostitution-related diseaseswas elaborated upon in detail by the state in 1933 and published thereafter in SıhhiyeMecmuası (i.e., “Fuhusla ve Fuhus Yuzunden Bulasan Zuhrevı Hastalıklarla MucadeleNizamnamesi, Kararname No. 15264,” Sıhhiye Mecmuası, 1933, 9, no. 65 [Kanunuevvel1933], 250–82); we address this document, its provisions, and political tensions that mightbe categorized in Western scholarship as occurring between supporters of regulationism andthose of prohibitionism of prostitution in a forthcoming article.


to better empower local officials over brothel owners and prostitutes,the law also stipulated in vague terms that both brothel owners andprostitutes could be prosecuted for not only employing minors asprostitutes but also for compromising in any way society’s moralstandards or violating public order. Finally, equating prostitutes withthose carrying infections, foreign prostitutes were banned fromentering the country along with all foreign nationals infected withany of a number of listed diseases (including those transmittedsexually).

CONNECTING STATE AND POPULACE: PUBLIC HEALTH

EDUCATION

While many works that employ Foucauldian concepts of govern-mentality focus on the expanding roles and grander ambitions of thestate and its officials, a key dimension to Foucault’s examination ofthe expansion of the state which is sometimes neglected entails theactual forging of crucial linkages between rulers and ruled. As hewrote of governmentality, as it developed in the sixteenth centuryonward, “how to govern oneself, how to be governed, how togovern others, by whom the people will accept being governed, howto become the best possible governor,” were all vital concerns withinstatecraft and for those devoted to its analysis.74 As we see in his ownwords, the true coercive power of the state—the power to instigateacceptance among the ruled—became far more adroit (and poten-tially insidious) than under prior schemes more reliant upon merebrute force, or its threatened application.75 As statecraft evolvedbeyond physical force to the fabrication of an acceptance of beinggoverned, particular practices of states that could instill such loyaltiesbecame especially important. Schooling (or “pedagogy”76) thusacquired greater significance as not only one of the many services tobe rendered in order to yield a compliant population but also as a

74. Foucault, “Governmentality,” 229–30.75. In this regard, we might note a profound convergence between Foucault’s conceptu-

alization of governmentality, on the one hand, and Gramsci’s articulation of achievinghegemony through the construction of consent, on the other. On matters of hegemony andsocial consent, see Antonio Gramsci, Selections from the Prison Notebooks, ed. Quintin Hoareand Geoffrey Nowell Smith (New York: International Publishers, 1971).

76. Foucault, “Governmentality,” 229.


means of directly instilling loyalties.77 In this regard, education as amechanism not just for state-/nation-building but as an adjunct toother state services (e.g., public health) became essential. As we assessthe politics of sickness and health in the early republic, public healtheducation—perhaps even as much as (or more than) the actual appli-cation of public health policies and specific regimes of treatment—thus demands greater attention.

In our survey and analysis of public health education initiativesregarding syphilis, we deal broadly with the question—consideringnot solely those lessons taught to the general public or specifically tothose afflicted with the disease but also guidelines and trainingadministered to medical practitioners, as well. Moreover, in view ofthe lines of discussion that we followed in many of the provincialsurveys, we would emphasize that state medical officials were some-times far more concerned with teaching against particular customs,ideas, and curative practices found throughout Anatolia (in additionto confronting nonmedical cultural traditions) than they weredevoted to diffusing sound lessons in preventative health and treat-ment that reflected contemporary innovations in health and medi-cine. Indeed, the modernist agendas of the state and its officials wereoften revealed alongside their own preconceptions and prejudices asthey sought to eradicate traditional (i.e., anti-modern/-scientific)approaches to health and wellbeing.

As key agents of a modernist state, Turkish physicians’ typicalexcoriation of the traditional curatives of rural peoples may be inter-preted as reflecting not only their own professional inclinations butalso various socio-political chauvinisms.78 In their descriptions ofhealthcare traditions found throughout Anatolia as perceived chal-lenges that the needed to overcome, local medical practitioners were

77. Beyond our own inquiry into matters of education with regard to governance andpublic health, there are, however, many other trajectories of study that engage with the roleof education and health. For example, we might note those pertaining to sex education.See, Alexandra M. Lord, “Models of Masculinity: Sex Education, the United States PublicHealth Service, and the YMCA, 1919–1924,” J. Hist. Med. Allied Sci., 2003, 58, 123–52.

78. On our description of Turkish public health officials’ decidedly modernist orienta-tions, we would not only reference standard works in Turkish studies (e.g., Bozdogan andKasaba, Rethinking Modernity and National Identity in Turkey), we also note profound parallelsbetween the politics of Turkish public health and the politics of similar “ultra-modernist”projects for development, as per James C. Scott, Seeing Like a State: How Certain Schemes toImprove the Human Condition Have Failed (New Haven: Yale University Press, 1998)—thoughwe would avoid assessing it in terms of absolute success or failure.


depicted commonly as adversaries to public health, science, andreason. In this context, the ocak (local individuals or families regardedas experts for particular diseases or conditions), the mutebbib(healers), the hoca (though translated commonly today as “teacher,”the term apparently had some application for faith healers whomight recite “incantations” in a few local contexts, as well), andother rural healers were portrayed as relying upon superstition,untested (or disproven) medicines, and backward assumptions, diag-noses, and practices.79 In addition to the local cures, one of the mostsignificant therapies that many provincial officials derided asunfounded and primitive was the use mercury fumigation.80

Another therapy for syphilis that had been common from the six-teenth century through the 1930s in parts of Europe, the UnitedStates, and elsewhere81 (including Turkey)—but which was alsoregarded by the provincial medical directors to be so outmoded as tobe primitive—was the use of sarsaparilla (or sasparilla).82 Such treat-ments were depicted as not only ineffective but also dangerous to thepatient and society.83 Likewise, local sexual practices and customswere also the objects of scorn, such as the frequenting of “secret”(i.e., non-regulated/-licensed) prostitutes. In these respects, thepoor, uneducated, and rural populace of Anatolia was viewed asbeing at particular risk of syphilis and other diseases as they wereassumed to be least likely visit a modern doctor or clinic and insteadseemed to avail themselves of the local services of traditionalhealers.84

While some provincial health directors were advocates of moredirect confrontations of traditional practices—either educationally or

79. As depicted in Nazmi, Turkiye’nin Sıhhı-i Ictimaı Cografyası, 20.80. It was ironic (and hypocritical) that many of the physicians commented so harshly

regarding the use of mercury beyond just its physical risks. Indeed, many of them (or theirteachers) likely applied mercury as the once-appropriate therapy for syphilis in previousdecades. As one historian wrote of nineteenth-century French doctors, “[m]uch as themight wish to avoid it, doctors and their patients understood that mercury was a necessaryevil”; Dracobly, “Theoretical Change and Therapeutic Innovation in the Treatment ofSyphilis in Mid-Nineteenth-Century France,” 552.

81. Parascandola, Sex, Sin, and Science, 80–81.82. Also noted in, Nazmi, Turkiye’nin Sıhhı-i Ictimaı Cografyası, 20.83. Emphasizing this point through the use of anecdotes of misdiagnosis and inappropri-

ate fumigation, see Ahmet Hamdi, Turkiye’nin Sıhhı-i Ictimaı Cografyası, 42–43.84. Speaking to the profound class dimensions of syphilis in the Turkish populace, note

the comments by Dr. Ibrahim Ismail; Turkiye’nin Sıhhı-i Ictimaı Cografyası: Kırsehri Vilayeti(Istanbul: Kagıcılık ve Matbaacılık Anonim Sirketi, 1341/1925), 49–50.


legislatively, Ankara director Dr. Muslihiddin Safvet proposed a lessdirect approach in generating popular acceptance of modern medi-cine and diminishing the roles played by the ocak, the hoca, the muteb-bib, and others. As he wrote, the most expedient means to promotepublic health policies and associated therapies entailed more effectivedelivery of state medical services to rural communities. In hisopinion, this emphasis on accessibility—both geographic and finan-cial (i.e., through free treatment)—seemed to be a natural means toachieving results and to displacing undesired practices and customs.For syphilis in the region of Ankara, he felt that such expandedefforts toward accessibility of services and the regulation of prostitu-tion (i.e., as an alternative the varied forms of “secret” prostitution)had together yielded appreciable results; a victory for education byexample in public health. In his words, the state needed to go to thevery doorsteps of the rural poor in order to treat syphilis and othermaladies. Doing so, he stipulated, would not only contribute to thetriumph of public health (and to the generation of populist consent),it would also mean the very end of those in the countryside who“pretended” to be physicians.85 Though most of his peers were lesssanguine about villagers’ levels of receptiveness to modern treatment,he felt more optimistic:

[P]eople are positive about medicine. . . . For syphilis there are a fewpoor villagers who still employ fumigation, but [now] the majority[of them] visit the doctor. Thanks to the work of traveling doctors invillages, it became possible to eliminate the area from this disaster [ofsyphilis]. With free medicine, free doctors, and especially doctors whotravel to the doorsteps of people to cure them, the villagers will showmore interest in medicine and doctors than in [mercury] fumigation.The hearths of the local mutebbib [quacks, or literally “pretenders”]will be extinguished by themselves.86

In addition to the aforementioned legislated policies of standardizingmedical training, promoting the ongoing education of physicians andhealth officials through the regular diffusion of professional publica-tions87 and the hosting of nation-wide medical congresses in

85. Muslihiddin Safvet, Turkiye’nin Sıhhı-i Ictimaı Cografyası, 63–64.86. Ibid., 64.87. Such as the state’s monthly journal Sıhhiye Mecmuası.


Ankara,88 and the extension of medical knowledge to those afflictedwith diseases through mandatory counseling and delivery of infor-mational pamphlets, the state also engaged in concerted effortstoward the translation and dissemination of foreign texts on medicineand public health within the wider medical community. Due tolimited time and resources in responding to the state’s self-definedmedical emergencies, doctors and politicians alike relied upon well-received foreign books as they sought to better educate themselvesand organize effectively a system of public health. For example, in1924, the Ministry of Health and Social Assistance initiated itsOttoman Turkish translation of the 1923 text The Elements of PublicHealth Administration.89 Citing the urgency and limitations of thetime, Dr. Refik (Saydam) wrote in his foreword to the translatededition, “We would like to benefit from the experiences of all othernations.”90 Because of the popularity of Luckett and Gray’s book inthe West, its translation was deemed essential—and it became ininfluential resource. With Luckett and Gray’s emphasis on venerealdisease as being more dangerous that cancer or tuberculosis, itseemed to speak to the circumstances in Turkey and to the nation-state’s concerns over population.91

The tone of the Luckett and Gray text must have had a great deal ofappeal in Turkey, as well, as recent matters of concern (i.e., the collec-tion of information and proper surveillance) were dealt with as recentchallenges in the West, as well: “until the last six years, although manystates were required to report the cases that they discovered, there wasalmost nothing published about it in the press.” Moreover, andperhaps reflecting a far greater challenge in the Victorian-era Westthan in Turkey, was the matter of social stigma, such that even talkingabout the disease, unless someone was in the medical profession, wasviewed as thoroughly “indecent and immoral.” Given elevated con-cerns about syphilis, however, they indicated how lessons about the

88. Beginning as early as 1925, as documented in Anon., Birinci Millı Turk Tıb Kongresi.89. George S. Luckett and Harold F. Gray, The Elements of Public Health Administration

(Philadelphia: P. Blakiston’s Son and Company, 1923).90. Dr. Refik (Saydam), foreword to Luckett and Gray, Sıhhat-i Ictimaıye Idaresi Esasatı,

trans. (Istanbul: Hamid Matbaası, 1926), 2.91. As we cite from the 1926 edition that was translated into Ottoman Turkish, often “it

[i.e., syphilis] harms ten percent of the population, and once a person acquires syphilis, itcontinues to harm the second or third generations.” Luckett and Gray, Sıhhat-i IctimaıyeIdaresi Esasatı, 327.


disease began to become integrated into various publications and evenelementary and secondary school curricula.92 Moreover, the virtues oftaking this state-led “scientific” approach to the disease enabled healthprofessionals to overcome what previously was solely “an occupationof the quacks, of people involved in fumigation and blowing to curediseases.” Thus taking responsibility away from “their dirty hands [to]place it in its rightful place, within medical, health, and social issues.”93

People were informed that they were given the opportunity to beexamined by the most knowledgeable and able scientists. While agood number of the provincial reports examined in our work werepublished prior to the publication of Luckett and Gray’s OttomanTurkish translation, it must have been well received as it seemed toaffirm many of the suppositions and the scientism (and biases)expressed throughout the provincial surveys.

As the state also sought to promote broader, popular knowledgeabout syphilis and its appropriate treatment to the wider public, italso had to contend with high rates of illiteracy found throughoutthe country. Moreover, while both instructional films and travelingmuseums and displays could help to overcome some of these limita-tions associated with literacy, they also were limited by geography,finances, and other resources.94 Already engaged in distributing pam-phlets to provincial health offices, the state also began to employinformational posters to promote its public health objectives.Employing an artist, Refet Basokcu, the ministry of health presentedposters that emphasized clear visual imagery and simple yet memora-ble lessons in preventive medicine and appropriate healthcare.

In its confrontation of syphilis, the state’s 1930s poster used briefwarnings and unambiguous imagery to convey their own scientific

92. Ibid., 327–28.93. Ibid., 328.94. By this time, globally, early educational films were emerging as a popular form of

public health instruction (and, likely, entertainment), as observed in Jean B. Pinney, “TheMotion Picture and Social-Hygiene Education,” J. Educ. Sociol., 1936, 10, 158–67. Indeed,one of the French films of 1927 that Pinney includes (though only by its English-languagetitle “The Three Friends,” 158). “Il etait une fois trios amis,” rendered something of a moralitytale—not so much about sexuality but about being tested and undergoing proper treatment.This film reportedly was shown in Ankara, though its copy quickly began to break andrequired frequent splicing (noted in Muslihiddin Safvet, Turkiye’nin Sıhhı-i Ictimaı Cografyası).However, most villages were too distant and resources (including power) were too scarce toenable such methods (recall above footnote from Zurcher’s Turkey regarding the delayedpace of electrification in the republic).


authority (note the image of the syphilis microbes, bottom center),the disease’s causes and consequences, and opportunities for state-provided treatment (Figure 1). Rendering something of a parableabout appropriate behavior, dangers, and potential salvation, theposter warned in bold, red letters: “Be afraid of catching syphilis.” Inaddition to encouraging a sense of alarm for the disease, in general,the poster also suggested unmistakably how the disease could be con-tracted as it cautioned: “Avoid these types of entertainment.” For theTurkish viewer, the chief cause of syphilis would be clear; “secret”(i.e., un-regulated) prostitution—as conveyed by the presence ofalcohol (which was outlawed in state-sanctioned brothels) in theassociated image of a mixed party (Figure 2). Moreover, the conse-quences both for the individual and for the family (and nation) ofnot heeding these warnings were made abundantly clear, as theposter depicted a young man in the secondary stage of his affliction,on the left, and the misfortune of premature and stillborn children,on the right (Figure 1). The consequences for those who woulddisobey the state’s advice (and laws) were portrayed as bleak (i.e., dis-figurement and incarceration) (lower right); “The end for those who

Fig. 1. A Turkish public health poster of the 1930s that proclaimed “FrengiyeYakalanmaktan Kork,” or “Be Afraid of Catching Syphilis” (Sıhhat ve IctimaiMuavenet Vekaleti; image courtesy of Wellcome Library, London, UK).


go untreated.” There were, however, clean, responsible, and freeoptions available at state-sponsored clinics that could save the indi-vidual and society (lower left). Far from preaching a morality of goodand evil behavior when it came to matters of sexuality and health,the secular state conveyed it own regulationist ethics that contrasted(and communicated the consequences of both) responsible and irre-sponsible behavior.95

CONCLUSION

Identified as not only a danger to the citizens of the emergentTurkish republic, syphilis was also viewed and confronted as if it were

Fig. 2. A close-up of the central image of the poster. Rendering a modern mor-ality tale, it advises “Boyle eglencelerde bulunmaktan sakın,” or “Avoid these types ofentertainment” (Sıhhat ve Ictimai Muavenet Vekaleti; image courtesy of WellcomeLibrary, London, UK).

95. It should be noted that the Ministry of Health and Social Assistance artist, RefetBasokcu, seemed to select and variously re-situate and then re-paint a number of theseimages of afflicted persons from early republican (or, possibly even late Ottoman) medicalphotographs and portraits that were contained in a previously issued medical atlas that theministry issued in the 1920s (T.C. Sıhhiye ve Muavenet-i Ictimaıye Vekaleti, Sıhhı MuzeAtlası [n.p., 1926]). In our research for this article, we witnessed one of these early atlases—intended for use throughout the country as a means to educate health professionals and citi-zens—while working in the parliamentary library (the Turkiye Buyuk Millet MeclisiLibrary) in Ankara. Including a preface by Dr. Refik (Saydam), it provided brief informationand abundant pictures relevant to not only syphilis but other priority illnesses, as well.


a threat to the very nation itself. While this alarm over the diseasecan be understood, in part, as deriving from both the state’s precari-ous geopolitical contexts amid transition from empire to republicand its associated demographic anxieties, it was also integral to thechanging dynamics of public health in a modernist Turkey. As inother modernizing states of the period, in many respects, Turkey pri-oritized its population as its foremost objective for governance.96 Instep with focus of its expression of sovereignty on to its citizenryrather than its territory, physicians and public health officials werealso shifting their clinical gaze from the bodies of individual patientsto that of the nation at-large. In doing so, their work began to takeon statist priorities of surveillance and policing, albeit under theavowed ideals of medicine and science, as they compiled data,assembled statistical measures, and made pronouncements regardingthe population.97

In our examination and analysis of the challenge of syphilis, bothas framed in and confronted from early republican-era Ankara, wesee a disease that was defined more by its ascribed socio-political cir-cumstances than by its biological properties. As such, the measures toconfront syphilis in the nation-state were socio-political more thanmedicinal in nature (i.e., informational, legislative, and educational).Under these circumstances, perhaps one of the most marginal groupsof the nation’s populace (i.e., that of its prostitutes) were depicted asepidemiological culprits. Prostitutes and brothels, therefore, becamethe targets of state legislation, surveillance, and policing—thusenduring levels of social and state scrutiny that their many customersevaded entirely. With more than a small measure of irony, however,once regulated as sex workers subordinate not only to their clientsbut also to the state, they were also idealized as one of the criticalmeans toward overcoming syphilis.98 In this regard, Turkey reveals

96. This observation on the priorities of the Turkish state corresponds closely withFoucault’s own commentary as to the ways in which population began to emerge “as theultimate end of government” for modernizing polities, see Foucault, “Governmentality,”241.

97. As a general survey of such engagements with and applications of what might becalled scientism—particularly with regard to geographic knowledge (e.g., as with the socio-medical geographies analyzed in this article), see David N. Livingstone, Putting Science in ItsPlace: Geographies of Scientific Knowledge (Chicago: University of Chicago Press, 2003).

98. In this regard, we might draw strong parallels between how regulated prostitutes wereidealized by the state with how pronatalist nation-states also promote idealized (yet pro-foundly subordinate) notions of motherhood. The connection is even more apparent when


another regime of not just regulation but of subordination of womenthat endures to this day; a practice of marginalization that paradoxi-cally may be seen as having derived, at least in part, from the nation-state’s foundational ideals as based upon medical science and publichealth, liberalism, and nationalism.99

ACKNOWLEDGMENTS

We would like to thank both the anonymous reviewers of this articleand Margaret Humphreys for their comments and advice. We arealso most grateful for the assistance received from staff personnel atthe Basbakanlık Cumhuriyet Arsivi, the Turkiye Buyuk MilletMeclisi Library, and the Refik Saydam Library, all in Ankara, Turkey,and for permission to reproduce the 1930s propaganda poster held atthe Wellcome Library, London, UK.

FUNDING

Support for this research was awarded by Michigan State University’sCenter for the Advanced Study of International Development(CASID), Center for Gender in a Global Context (GenCen), andMuslim Studies Program.

we consider how the nation’s mothers, as incubators of future generations and as the wivesof the prostitutes’ potential clients, functioned as states’ justifiers for enacting schemes ofregulating prostitution.

99. The persistence of prostitution in Turkey may be seen within the country in both itsregulated form (i.e., in the so-called genelevs or “brothels”) and with respect to Turkey’s roleas both a destination and transit site for trafficking, see Anti-Slavery International, ForcedProstitution in Turkey: Women in the Genelevs: A Report (London: Anti-Slavery International,1993); and Sema Erder and Selmin Kaska, Irregular Migration and Trafficking in Women: TheCase of Turkey (Geneva: International Organization for Migration, 2003).


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