By Giorgio Ennas
In the summer of 1865, a new wave of cholera arrived in Europe along the routes of Muslim pilgrims. Within a few months, it invaded the port cities of Constantinople, Alexandria, and Messina, and crossed the Atlantic Ocean. In 1866, after a winter break, it reached Mediterranean countries, including the Ottoman province of Bosnia. When cholera arrived in the city of Sarajevo, the only civil doctor active on the ground was Josef Koetschet. The Swiss doctor was responsible for advising the vâlî, the governor general, about sanitary and quarantine measures to prevent the spread of the disease. He would play a crucial role in the containment of cholera in the region.
The present article will delve into the figure of Josef Koetschet and his work as a physician and sanitary adviser to the Ottoman administration of Bosnia during the cholera epidemic of 1866. Koetschet’s importance also stems from the fact that his view of the Ottoman Empire and its populations was different from that of most of his European colleagues and consuls. While many of them adhered to widespread Orientalist stereotypes that framed Ottoman populations as natural carriers of epidemics, Koetschet, as noted by historians, had a clear pro-Ottoman, or at least pro Bosnian tendency and was therefore not so sensitive to the “sirens” of European Orientalisms. No doubt he was not the only one, but there were relatively few like him who believed the Ottoman government would be successful in the fight against the epidemic. It was exactly because of this different point of view, probably gained during his travels in the Empire and through his contacts with members of the imperial elite, that made Koetschet a good advisor and valuable asset to the local authorities.
A Swiss doctor in Ottoman Bosnia
Charles Henri Josef Koetschet was born in Grellingen, in the Canton Basel-Landschaft, to a family of Dutch origin. He left Switzerland during his medical studies at the University of Bern because of his political proximity to the Bernese “radical-liberal” students of the Neu-Zofingerverein, the forerunner of the Helvetia society, which followed radical-democratic principles. At a time of intense political strife, it was probably these principles that put Koetschet at odds with the Bernese authorities, especially after the election of a conservative government in Bern between 1850 and 1856, which complicated the relations between the university and the canton. He later continued his studies at the universities of Heidelberg, Vienna, and Paris.
Koetschet travelled to the Ottoman Empire during the Crimean War (1853-56) as did many other young Europeans, because it gave them an opportunity to pursue their businesses and careers. Indeed, in the second half of the 19th century agents of the Red Cross and numerous physicians ventured to Egypt, the Ottoman Empire, or to India - countries that were considered as “naturally” infectious in the European public opinion and according to medical doctrines of that time.
Moreover, Koetschet was part of the Swiss diaspora that had settled in the Ottoman Empire, the Levant, in the Balkans, as well as in North Africa. For various reasons its members could not or did not want to practice in their homeland and worked for the Ottomans in the fields of medicine, sanitation or engineering. In the 19th century, this kind of immigration was atypical because it was not directly related to national colonial projects, as was the case with French and Italian immigration.
The immigration from Switzerland had started at the end of the 15th-16th century with the result that a large community of Swiss citizens lived and worked in the Ottoman Empire as watchmakers, goldsmiths, and textile merchants. These communities were established in important trade centres like the cities of Constantinople (now İstanbul), Bursa and İzmir, and placed themselves under the protection of European Great Powers, such as Austria-Hungary, Italy, or France. The migration began to increase with the reforms, or Tanzimat, of Sultan Mahmud II and his son Abdülmecid I (1826-61), that opened possibilities for business, investment, and rapid advancement in the imperial administration and army. The Ottoman administration employed some of these Swiss migrants because of the specialised knowledge they had gained during their studies in Europe.
Settled in Sarajevo
Josef Koetschet completed his military service in the Ottoman army and entered the imperial administration when he became the personal physician and secretary of the famous Ottoman General Ömer Lütfi Pasha Latas. He obtained this prestigious position not least because of the good relationship he had with the General. As the historian David Auberson reported in his work “Josef Koetschet (1830-1898): Un Suisse dans l’Empire ottoman”, Koetschet, after arriving in Constantinople, followed his benefactor, who had been dismissed by the sultan from his post as governor of the Ottoman Iraq after a series of misappropriations and violence on the part of his administration, and was confined to his estate on the shores of the Sea of Marmara. In this difficult period of disgrace, Koetschet remained one of the Pasha’s few faithful companions and the bonds of friendship and complicity between the two men seemed to grow even closer. Apparently, they also engaged in “numerous discussions on the fate of the Ottoman Empire and how to solve its problems.”
After a lot of travels in the service of Ömer Pasha, Josef Koetschet finally decided to settle in Sarajevo. In the meantime, he had married Maria Ergelie Giustiniani, the descendant of an important family of Genoese merchants that, according to David Auberson, “for centuries had owned the island of Chios in the Aegean Sea”. In 1863, one year after the birth of their first child, Koetschet was appointed as the official doctor of the city, as secretary, interpreter, and personal advisor to the new Ottoman vâlî of Bosnia, Topal Osman Pasha, whom he would later include in his memoirs “Osman Pascha, der letzte grosse Wesier Bosniens, und seine Nachfolger”, published in Sarajevo in 1909.
Osman Pasha is generally known for the reforms he had carried out in Bosnia on behalf of the Sublime Porte. He had built new infrastructure, like roads and quarantines, and modernized the Bosnian provincial administration. Among his most important reforms was undoubtedly the foundation of the first public hospital of Bosnia in Sarajevo that was open to patients of all religions – a reform, that had been suggested by Koetschet.
Koetschet described the period of Osman Pasha’s governorship as an era of inter-faith peace, when Muslims, Christians and Jews apparently lived side by side and with each other, equally enjoying their peaceful, blessed co-existence. Even though this idyllic description of 1860s Bosnia might have been exaggerated, it proves that Koetschet indeed had a positive view of late Ottoman provincial society - in contrast with other European physicians as well as consuls who had often been led astray by their Orientalist perspectives and their focus on foreign policy objectives of their own states.
In his memoirs, Koetschet was generally discreet about his work as physician in Sarajevo, as he wished to appear as a statesman and diplomat rather than as a simple doctor or sanitary official. Nonetheless, in “Osman Pascha”, he wrote about the beginning and the development of the 1866 cholera epidemic. In this volume, the Swiss physician described himself as a strong supporter of sanitary cordons and quarantines to protect the population of Sarajevo. Quarantines were temporary or permanent facilities in the 19th century often placed in city-ports or border areas where the infected had time to manifest eventual symptoms, allowing the local authorities to stop contagion immediately.
“Sanitary cordon” on the other hand, refers to a practice of cutting off circulation to and from a specific area to prevent further infection through the intervention of military or police forces. However, at that time there was an intense debate between the advocates of the sanitary practices of hygienism, contagionism, or neo-contagionism. Many Europeans were sceptical about the Ottoman sanitary efforts and the efficacy of isolation measures. They strongly endorsed hygienic measures rather than the use of quarantines, even though the former came at the expense of the health of local populations. But - hygienic measures didn’t cause problems for international trade.
Epidemic Orients and Balkans
The contagionist and neo-contagionist knowledge used by Koetschet in the Bosnian context was the result of a long process of development in medical science between the 18th and 19th century: First, there was the ancient religious-magic medicine, that considered diseases as the product of the action of evil spirits or divine will. According to this logic, diseases can be averted through magic rituals or prayers. Second, the miasmatic-hygienist theory identified the origin of contagion in the inhalation of “infected” air and prescribed optimal hygienic conditions as the solution to prevent the spread of epidemics.
In the 19th century, these theories were joined by the contagionist, and neo-contagionist theories, which were probably brought to the Ottoman Empire by doctors educated in Europe. An initial version of this theory was developed in the 16thcentury and supported the existence of contagion between people through the exchange of unidentified “substances”. It suggested the isolation of infected people through quarantines and sanitary cordons to limit the spread of the disease. A later version, the so-called “neo-contagionist” doctrine, was an approach that conjugated empirical evaluation of incubation times and the use of disinfection and isolation methods. Until the late 1870s however, the miasmatic-hygienist theory remained prevalent in Europe due to the lack of knowledge about the bacterial or viral nature of diseases, as well as by the necessity to preserve international trade shared by European elites.
As efficaciously described by Salvatore Speziale in “Oltre la Peste: Sanità, popolazione e società in Tunisia e nel Maghreb (XVIII-XX secolo)”, these theories were acknowledged also by elites in most Islamic countries. However, the disappearance of plague from the European continent in the early 18th century had reinforced the traditional stereotype already widespread among European societies about the particular infectiveness of Islamic populations. This was linked to the so-called Islamic “fatalism”, or the supposed tendency of Muslims to surrender to the divine will without opposing epidemics or natural disasters.
When the International Sanitary Conference of Constantinople in 1866 identified the origin of cholera pandemics in the Indian sub-continent and the Islamic Hajj, or Great Pilgrimage, as the main vector of contagion that had reached the European continent several times since in 1817, this identification strengthened what Alexander I.R. White, sociologist, and historian of medicine, named “epidemic orientalism.” He described it as a “Eurocentric epidemiological interpretation of the Orient” that prioritized the “control of diseases emanating” from the Asian continent and European “colonial sites” that could potentially “threaten entry into Europe or contaminate or halt trade.”
The idea of the necessity to protect Europe in case of pandemics through the imposition of quarantines and sanitary cordons, had definitively been sanctioned by the Conference, even if this meant to jeopardize the safety of Persian, Egyptian, or Ottoman populations. Physicians like Koetschet were convinced that preventive isolation measures could be crucial in maintaining international public health in times of epidemics, and also keep the local and non-European populations safe in “epidemic scenarios”. Thanks to his Ottoman experience, Koetschet had developed a better understanding of the sanitary situation in the Balkans and the techniques through which epidemics could be contained, going beyond the stereotypes associated with epidemic Orientalism. This emerges clearly from his efforts to help the people of Sarajevo, rather than attempt to prevent the contagion from reaching Europe.
Fighting cholera
When the cholera wave hit Sarajevo in 1866, Koetschet immediately devoted himself to mapping and trying to isolate the human vectors of the infection. He affirmed to have reconstructed the path of cholera, which, in his opinion, was imported by four Jewish Sephardic women who had escaped the epidemic in Belgrade with their children. Koetschet tried to impose a sanitary cordon around several buildings inhabited by infected people to prevent the spread of the disease to other parts of the city.
But although the Swiss physician informed the Governor General Osman Pasha of the sanitary threat and urged him to adopt vigorous measures, Osman Pasha postponed the decision. As many governments would do centuries later during the Covid-19 pandemic, Osman Pasha probably tried to avoid the imposition of quarantines and sanitary cordons as he considered them to be potentially detrimental to the Bosnian economy.
When the sanitary cordon around the infected houses was finally implemented, they turned out to be ineffective. And in the middle of September 1866 cholera broke out in the Jewish quarter of Sarajevo, gradually infecting the quarters of Miljacka, Hiseta, Potok, as well as Bistrik. In the following weeks, the epidemic got worse, and, under the pressure of foreign consuls in Bosnia, Osman Pasha closed the borders with the Principality of Serbia and Austria-Hungary, to impose some quarantines, and adopt measures at the local level.
Following Koetschet’s advice, the governor moved to an isolated fortress close to the Višegrad Gate and ordered the creation of a sanitary board led by the administrator (mutasarrıf) Munib Pasha, Josef Koetschet as civil sanitary officer, the Italian vice-consul Cesare Durando as representative of the consular corps, and by several members of local and religious notabilities. This sanitary board elaborated and imposed the temporary closure of administrative offices, the recruitment of personnel to disinfect buildings, and the adoption of new regulations to limit the exposure of corpses during funerals. In this gradually worsening situation, as Cesare Durando reported in his dispatches, Koetschet was the only official civil doctor to take care of those members of the community who had remained in Sarajevo.
However, the passive resistance of the local notability and later of the population of Sarajevo against the implementation of these measures proposed by Koetschet and Durando greatly limited their impact. At the end of October 1866, Durando described the measures adopted by the imperial administration even as a failure. Due to this passive resistance, the disease spread to areas of Mostar, Travnik, Banja Luka, and Zvornik. According to consular reports officially 434 people died in Sarajevo, of which were 257 Muslims, 112 Orthodox Christians, 34 Catholics, 19 Jews, and 12 “Gypsies or Bohemians”, but not including members of the Ottoman army or clandestine burials.
Having always been close to the Ottoman positions and genuinely interested in the welfare of Sarajevo’s community, Koetschet downplayed both the negative assessment and the number of deaths, which he reduced to around 400. However, in November 1866 foreign observers registered the gradual decline of the disease from Sarajevo, attributing it to the constant efforts of Koetschet and the Ottoman administration - and to the arrival of the cold season. After four intense and “anxious” weeks Koetschet finally announced the end of the epidemic to Osman Pasha, who re-opened Bosnia’s borders.
Josef Koetschet died in Sarajevo in 1898. He never returned to Switzerland, because he felt that he was an integral part of Bosnian society. This sense of belonging was shared also by his son Theophil Koetschet, who, although trained as neuropsychiatrist in Germany and employed in Austria, in the end returned to Sarajevo.
Koetschet in the light of the Covid-19-Pandemic
What can Koetschet’s role as a foreign physician fighting epidemics within a multi-ethnic and multi-cultural context such as late Ottoman Bosnia teach us today?
The end of the cholera waves and the Spanish Flu of 1918 and 1919, the eradication of malaria from areas where it had been endemic, as in Sardinia, and the discoveries of microbiology and border sanitary measures had led to the idea that the era of the great global pandemics was over in Europe and North America. Covid-19 has showed us that this assumption was wrong.
The remarkable efforts of the Swiss doctor Koetschet highlights not only the contribution migrants can make to their adoptive societies, but also the importance of going beyond well-consolidated stereotypes and the fear of the other in fighting diseases. Even though it is evident today that contagion is linked to the movements of individuals, the tendency to discriminate against or even to be ready to sacrifice groups in the name of common health, as was the case with Chinese citizens, has become as prevalent during the Covid-19-Pandemic as it had been in Koetschet’s time. This is not only unfair and irrational, but also unnecessary for pandemic control. Koetschet’s fight against Cholera and as well as the fight of innumerable doctors all around the world against Covid-19 should make us understand, that the only strategy to prevent pandemics – then and today – is based on international collaboration.
Giorgio Ennas is Postdoctoral Fellow and Adjunct Professor at Franklin University Switzerland in Lugano. Among his publications are the article ‘Negotiating Protection. The Inclusion of Ottoman-Swiss Relations in the Diplomatic Germansphere during the First World War’, published in 2022, and the volume ‘Reports of Cesare Durando Italian Vice-Consul in Sarajevo (1863-1867)’ published in 2020. Between 2021 and 2023, he worked as the Principal Investigator (PI) of a two-year project entitled ‘Pandemics and Borders. Pandemics as Driver towards Modern Borders and International Collaboration in 19th century Mediterranean and South eastern European Periphery’ funded by the Swiss Network for International Studies (SNIS). He is currently working on a one-year project funded by the Giunta Centrale per gli Studi Storici (GCSS) of Rome, entitled ‘The Profession of Consul. Cesare Durando and the Professionalisation of the Consular Career of the Historical Right (1863-1876)’.
Further Reading
Auberson David, «Josef Koetschet (1830-1898): Un Suisse dans l’Empire ottoman», in Actes SJE, Delémont, 2008.
Boschung Urs, “Josef Koetschet”, in Historisches Lexikon der Schweiz (HLS), 2013, hls-dhs- dss.ch/it/articles/046486/2007-08-23/, (accessed 16 February 2023, 10.44).
Koetschet Josef, Osman Pascha, der letzte grosse Wesier Bosniens, und seine Nachfolger, Studnička, Sarajevo, 1909.
Speziale Salvatore, Oltre la Peste: Sanità, popolazione e società in Tunisia e nel Maghreb (XVIII-XX secolo), Luigi Pellegrini Editore, Cosenza, 1997.
Levental Zdenko, „Josef Koetschet – ein Schweizer in ärztlichen und diplomatischen Diensten der Türkei“, Gesnerus, 35, Aarau/Frankfurt am Main/Salzburg, 1978, pp. 79–86.
White I.R. Alexandre, Epidemic Orientalism. Race, Capital, and Governance of Infectious Disease, Stanford University Press, Stanford, 2023.