Tanıdık Bir Hikâye: Müessesat-ı Hayriye-i Sıhhiye Müdiriyeti / Direction Générale de l’Assistance Publique de Constantinople (1909-1912)Cem Hakan Başaran
İkinci Meşrutiyet’ten sonra, mevcut sağlık kurumlarının fiziki ve idari sorunlarını düzeltmek, yeni hastaneler ve hayır kurumları açmak için İstanbul’da kurulan Müessesat-ı Hayriye-i Sıhhiye Müdiriyeti, 1909-1912 yılları arasında faaliyette bulunmuştur. Müdür Dr. Muhittin Nuri ve Müfettiş Dr. Ahmed Nureddin Beyler belediyeleri ve sağlık kurumlarını teftiş etmek için Avrupa’ya gönderilmişler ve hazırladıkları raporlar çerçevesinde oluşturulan bir program ile müdürlük kurulmuştur. Kuruluşundan kapandığı tarihe kadar mali problemler ve bütçe kısıtlamaları ile hareket etmek durumunda kalan müdürlük, mevcut kurumları modernleştirmek ve yeni kurumlar açmak için çalışmıştır. İdare heyeti, nizamname çalışmaları sürerken, yönetimindeki hastanelere hekim atama hususunda Meclis-i Umur-ı Tıbbiye-i Mülkiye ve Sıhhiye-i Umumiye ile sorunlar yaşamıştır. Kolera salgını nedeniyle bütçesinin büyük bir bölümünü salgınla mücadeleye ayırmak durumunda kalan müdürlük, söz verilen bütçenin tahsis edilmemesi ve Haseki Mecanin Müşahedehanesi’nin açılması ile ekonomik krize girmiştir. Müdür Dr. Muhittin Nuri Bey, Haziran 1912’de yolsuzluk ve başka şeylerle suçlanarak görevinden uzaklaştırılmış ve müdürlük, Ekim 1912’de, Belediye Başkanı Dr. Cemil Topuzlu’nun başkanlığında toplanan Cemiyet-i Umumiye-i Belediye toplantısında kapatılmıştır.
A Familiar Story: The Istanbul General Directorate of Public Assistance (1909-1912)Cem Hakan Başaran
The Müessesat-ı Hayriye-i Sıhhiye Müdiriyeti [The Constantinople General Directorate of Public Assistance] was established after the Second Constitutional Era (II. Meşrutiyet) with the aims of solving the physical and administrative problems of existing health institutions and of opening new hospitals and charitable institutions. The directorate was active between 1909-1912. The Director Dr. Muhittin Nuri and General Inspector Dr. Ahmed Nureddin were sent to Europe to inspect municipalities and health institutions, and the Directorate was established with a program based on their reports. From its establishment until its closure, the Directorate tried to modernize existing institutions and open new ones while dealing with financial problems and budget constraints. The Board of Directors encountered problems with the Meclis-i Umur-ı Tıbbiye-i Mülkiye ve Sıhhiye-i Umumiye [Council of Civil Medicine and Public Health] while working on its statutes regarding the appointment of physicians to the hospitals under its administration. The Directorate experienced financial difficulties due to subsidy non-payment, costs for fighting the cholera epidemic, and the opening of the Haseki Mecanin Müşahedehanesi [Haseki Mental Observatory]. Accused of corruption and other charges, the Director Dr. Muhittin Nuri Bey was suspended in June 1912. Finally, the Directorate was closed down in October 1912 at a meeting of the Cemiyet-i Umumiye-i Belediye [Municipal Council of Istanbul] that had been convened under Istanbul Mayor Dr. Cemil Topuzlu.
This article provides a modest contribution to the history of the General Directorate of Public Assistance of Constantinople (Müessesat-ı Hayriye-i Sıhhiye Müdiriyeti), which formed an important step in Türkiye’s social policy history. With the Second Constitutional Era and the Young Turks Revolution (II. Meşrutiyet), the reorganization of health organizations (teşkilat-ı sıhhiye) became necessary due to many reasons such as institutions’ financial conditions, corruption in hospitals and institutions, mismanagement, dysfunction in Istanbul’s health organizations, the new government’s need for caderization. Following the Second Constitutional Era, health workers had great expectations that the order would change, and the Constitutional administration quickly began to purge the cadres from the Abdul Hamid II era (tensikat); however, the expectations did not bear fruit, and civilian physicians began to protest in front of the Ministry of Health (Sıhhiye Nezareti). Many articles emphasized the financial and moral statuses of municipal physicians in the provinces. In the meantime, the new government sent Dr. Muhittin Nuri and Dr. Ahmed Nureddin to Europe to inspect municipalities and health institutions and establish a new health administration specific to Istanbul (Müessesat-ı Hayriye-i Sıhhiye Müdiriyeti) for managing certain hospitals and charitable institutions there. The institutional structure of the directorate was modeled on the Assistance Publique organization in Paris, which transparently managed hospitals and charities from one location. Many debates occurred during the drafting of the regulations of the directorate, which was directly affiliated with the Istanbul municipal council (Cemiyet-i Umumiye-i Belediye) and indirectly with the Council of Civil Medicine and Public Health (Meclis-i Umur-ı Tıbbiye-i Mülkiye ve Sıhhiye-i Umumiye) and the Ministry of the Interior (Dahiliye Nezareti). An administration of 20 members, including a president and a general inspector, as well as deputy mayors, merchants, and physicians, took over and organized the budget, kept tenders free of corruption, and improved hospitals.
Protracted disputes occurred between the directorate and the Council of Civil Medicine and Public Health, which wanted to take the appointment and dismissal of physicians working in the hospitals under its own authority, and this authority was eventually taken away from the directorate. The Istanbul municipality had been providing the budget for the directorate but suffered a financial crisis after the Second Constitutional Era and sought to borrow money. This loan was not used effectively, and the required payments were not transferred to the directorate. In addition to dealing with financial crises and austere policies, the directorate was subordinate to the Istanbul municipal council, which meant that many matters were difficult to resolve. Significant modernizations were made in almost all hospitals under the directorate’s administration; however, syphilis, tuberculosis, and cholera epidemics could not be prevented. In addition to this, the Toptaş Mental Hospital had received a new annex, thus increasing its patient capacity, and the Haseki Mental Observatory (Haseki Mecanin Müşahedehanesi) had been opened to serve mentally ill patients. The directorate experienced financial difficulties as a result of the subsidy non-payment, the cost of fighting the cholera epidemic that had broken out in 1910, and the opening of the Haseki Mental Observatory. The reasons for the directorate’s failure include the financial crisis, a lack of interinstitutional coordination, political struggles, and epidemics. Upon being accused of corruption and other charges, the director Dr. Muhittin Nuri Bey was suspended in June 1912. Finally, the Directorate was closed down in October 1912 at a meeting of the Cemiyet-i Umumiye-i Belediye [Municipal Council of Istanbul] that had been convened Istanbul, Mayor Dr. Cemil Topuzlu. In 1919, Dr. Abdullah Cevdet, the Director General of Health (Sıhhiye Müdir-i Umumisi), attempted to reestablish the directorate, but these attempts yielded no results. In general, the directorate had carried out important modernization activities in hospitals and made institutions functional with the instructions it had issued. In Türkiye’s social policy history, the directorate is one of the critical step toward institutionalization.