State, peasant, mosquito: The biopolitics of public health education and malaria in early republican Turkey

Political Geography 31 (2012) 311e323

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State, peasant, mosquito: The biopolitics of public health education and malaria in early republican Turkey Kyle T. Evered a, *, Emine Ö. Evered b,1 a b

Department of Geography, Geography Building, Michigan State University, East Lansing, MI 48824-1117, USA Department of History, Morrill Hall, Michigan State University, East Lansing, MI 48824-1036, USA

a b s t r a c t Keywords: Biopolitics Education Governmentality Malaria Public health Turkey

State officials in early republican Turkey framed malaria as both a medical and a political issue. In doing so, they engaged in public health education campaigns not only to resolve medical concerns but also to better govern the country’s population and promote a broader modernist agenda. This article employs primary sources from Turkish archives and other collections in order to examine the governmental and the biopolitical implications of this experience. We thus scrutinize the civilizational discourse employed by politicians and physicians as they dealt with this “village disease,” the peoples who they encountereddand taught, and the obstacles that they perceived to exist within the traditional curative beliefs and practices found throughout rural Anatolia. Emphasizing modernist ideals in their medicine as much as in their politics, we conclude that health officials’ lessons for waging an effective “war” on malaria targeted not just the disease but also its perceived societal sources of origin anddhencedthe very populace it presumably sought to protect. Ó 2012 Elsevier Ltd. All rights reserved.

Governance, biopolitics, and public health education Over the past decades, scholars in political geography have employed often Foucault’s concept of governmentality (cited from 1991, 2003, and 2007, among other versions). Most address the ways in which states either create spheres of services in order ostensibly to improve conditions for their citizens (i.e., spheres of governing) or how they implement associated schemes to better know and monitor their subject populations (e.g., at the nationstate scale, Hannah, 2000; or at an international scale, Ingram, 2011; on governmentality, see also Elden, 2007a, 2007b; Ettlinger, 2011). In so far as such institutionalizations of governance and statistics acquisition enable states to more readily know and intervene in the lives of their citizens, such projects also constitute the essence of states’ biopolitical engagements with their populations (Legg, 2005, p. 139; also note Miller & Rose, 2008, pp. 199e218). This politicization of life and states’ attempts to govern it (i.e., biopolitics) is characterized to be a prime objective for the modern

* Corresponding author. Tel.: þ1 517 432 4746 (O), þ1 517 337 2445 (R); fax: þ1 517 432 1671. E-mail addresses: [email protected] (K.T. Evered), [email protected] (E.Ö. Evered). 1 Tel.: þ1 517 432 8222x153 (O), þ1 517 337 2445 (R); fax: þ1 517 353 5599. 0962-6298/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.polgeo.2012.05.002

(or “liberal”) state and entails all that may be associated with a population, its wellbeing and livelihood, and the many factors that impact upon it (Foucault, 2008; Rose, 2007; also note Dean, 2010, pp. 118e121). Viewed as transpiring during the eighteenth and nineteenth centuries, Foucault asserts that states then initiated a shift in their focus from territories to populationsdespecially for economic motives (2007 and 2008). While territory is arguably still quite importantdand its conceptualization may even be thoroughly integral with conceptualizations of the biological, many initiatives to govern began to target more directly the demographic domains of states; their citizenries (both on the constructed nature of territory and population and on various bio-territorial notions of power, note Alatout, 2006). Though clinics may be opened, schools built, roads and bridges constructed, laws passed, information collected and analyzed, the achievement of liberal governance through these initiatives is mediated by a population’s receptiveness to these developments as fulfilling its collective interest. In this respect, education may be regarded as a critical sphere of governingdmuch like state interventions in public health, resource management, infrastructural agglomeration, the economy, or security. Educationdframed alternatively as propaganda or public relations, however, is also an essential mechanism in the practice of biopolitics and governance. As a practice integral to states’ “conduct of conduct” (Foucault, 1991, p. 48), schooling/training/propagandizing is a technique exercised in

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concert with states’ deployments of their resources throughout their territories to fulfill their populations’ perceived needsdand to reassure their populations that these needs have been addressed. Seen otherwisedfrom a Gramscian perspective, education enables the rendering of popular consent that is requisite for a polity to attain hegemony (1971). Alternatively, schooling enables the “highmodernist” state to make “legible” (i.e., centralize, universalize, and normalize) its preferences for its population (Scott, 1998, p. 219). Connecting these concepts of governance, citizenship, and biopolitics, Rose establishes the notion of “biological citizenship,” noting that “biological presuppositions, explicitly or implicitly, have underlain many citizenship projects, shaped conceptions of what it means to be a citizen, and underpinned distinctions between actual, potential, troublesome, and impossible citizens” (2007, p. 132). Receptiveness to instruction (i.e., consent) regarding biopolitical normsdbroadly conceiveddnot only facilitates governance, it also underlies states’ concepts of inclusion and exclusion. Situating themselves as teachers vis-à-vis their populations, modern states thus employ education both to attain economic and developmental goals within their lands and to reaffirm presumed commitments to and successes on behalf of their peoples. In the sphere of public health, therefore, the politics of framing particular diseases and of engaging (i.e., teaching) the public about these ailments (and the state’s efforts on their behalf) can entail far more energy on the part of state officials than that which they expend in actually rendering curative therapies (on framing disease, note Rosenberg, 1992; Rosenberg & Golden, 1992; also, focusing on malaria, see Packard, 2007). Though historical geographies of public health and disease have yet to focus solely on the politics of educationdas this article seeks to initiate with respect to early Turkey’s lessons on malaria, they have established how states sought to dominate the discursive framing of particular maladies (on malaria in Argentina, note Carter, 2007 and 2008; also, on framing syphilis and associated practices of regulation in Turkey, note Evered & Evered, 2011a, 2012, in press). The existing literature on geographies of public health that engage with educational politics is likewise not especially abundant, but we note two exceptions. First, Carter provided a succinct discussion of the geographies of public health education with respect to schooling, propaganda, and public relations amid a wider examination of the state’s efforts to attain control over (i.e., frame) the “malaria question” in Argentina (2008, pp. 288e289; also, providing greater detail on this issue as a historian of Argentina, note Alvarez, 2008). Perhaps of greater conceptual relevance to our studydin terms of the roles of state officials in communities and the forging of state-society connections, however, Caprotti employed a Gramscian approach to deal with fascist Italy’s “organic intellectuals” and their deployment of demographic and statistical data to aid statist initiatives to impose hegemony (2008, pp. 944e945). As we address in a subsequent section, public health officials were among the leading “organic intellectuals” of the nationdboth collecting and disseminating information for the Turkish state. Beyond geography, however, historians of (and other scholars dealing with) public health and medicine have engaged increasingly with education and the wider associations between media and medicine (Friedman, 2004; Hansen, 2009; Reagan, Tomes, & Treichler, 2007; also, dealing with media, medicine, and both state and industry, Berridge and Loughlin, 2005). Finally, from a geographic perspective, the development and application of educational agendas for public health reveal abundant spatial dimensions in form and content at various scales. Apart from the geopolitical ramifications of modern states employing lessons in health to better govern their territories and populations (Caprotti, 2008; Carter, 2008), the diffusion of such propaganda is constitutive of, and reinforces, political and socioeconomic

hierarchies. Transmissions of public health lessons, like other forms of media, from center to periphery (re)impose profound top-down messages (or lessons) regarding idealized (and excoriated) norms for social, state-society, and societyenature relations. Moreover, though provision of actual medical services and supplies may diminish in developing states’ peripheries due to logistical constraints, the informational reach of their public health lessons may extend more broadly throughout their territories. Within such messages, the imagery conveyed is spatialized geographically as welldand may be profoundly simplified and/or embedded with particular biases. As addressed in subsequent sections, Turkish authorities often relied upon stark contrasts in the conduct of these lessons, as between urban and rural, modern and peasant (or nomadic) communities, and so forth. While understanding a population’s reception of such narratives is crucial in analyzing the exercise of biopolitical power, during the single-party era of the early republic, spaces for coordinated resistancedor alternative narrativesdwere minimal. In this setting, we contend, reliance upon traditional healers and practices constituted (at times) a significantdalbeit “hidden” dmeans of resisting the state’s will (as per Scott, 1985). Within this study we thus engage with public health education as a distinctive practice of governing throughout Turkey from the 1920s and into the 1940s, and we explore these political geographies of public health and its instruction by examining the related socio-cultural and governmental landscapes of the early republic. In addition to analyzing the institutionalization of public health and its propaganda, we present how the state established itself as an educator on topics of wellness and disease. In doing so, republican officials sought to convey to the wider populace that malaria had particular biologicaldand thus preventabledorigins, but they also endeavored to reiterate their framing of the disease as a principally “rural” ailment. Part and parcel of its broader efforts to attain biopolitical control over its populace, the early secular republic’s political framings of public health and disease sermonized about modern medicine and condemned societal traditions that were deemed ineffective, unscientific, or simply superstitious. Following our examination of the political geographies of public health education and statist concerns over malaria, we address how state officials promoted their educational agendas within their profession and among the wider populace. Though the state focused its lessons in public health both on promoting proper therapies for those infected and on preventative measures for the broader society, its program to educate the nation about malaria was profoundly consistent with contemporary public health concerns observable in the West over hygiene, sanitation, and civilization. Not only targeting traditional curative practices and practitioners for displacement by state services and officials, the modernist republic’s lessons often marginalizeddand graphically miniaturized (note Scott, 1998, pp. 4, 257e261)dthe largely rural population that it ostensibly sought to rescue from state-defined biopolitical threats. In our research, we utilize official (i.e., state-authored and published) and unofficial (i.e., unpublished state documents and other printed materials) primary sources written in both Ottoman and modern Turkish in order to survey and analyze major themes associated with state-led campaigns against what early republican leaders depicted as one of the nation’s greatest biopolitical threats: malaria. Our analysis is thus based upon documents that we acquired from: the Bas¸bakanlık Cumhuriyet Ars¸ivi (the Prime Minister’s Archive of the Republic; cited as BCA), the Türkiye Büyük Millet Meclisi Kütüphanesi (the parliament’s library for rare books and associated records; cited as TBMM), and the Refik Saydam Library (for public health-related items), all located in Ankara, Turkey. We also accessed primary materials through the Wellcome

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Library in London, England (state posters and other propaganda) and the Center for Research Libraries in the United States (publications printed by the Turkish state). Finally, we have been informed significantly by our ongoing assessment of latenineteenth- and early-twentieth-century materials pertaining to public health, malaria, and other maladies from the collections of the Bas¸bakanlık Ars¸ivi (the archive for Ottoman-era materials) in Istanbul, Turkey. Institutionalizing public health and the struggle against malaria Despite an abundant literature on the rise of the Turkish nationstate and its policies of modernization, a dimension to this history often neglected by scholars is the profound role played by institutions of public health and associated officials (among the first of exceptions to this pattern of disregard, we would identify Tekeli & _ Ilkin, 1999). On 20 May 1920, while the 1919e1923 War of Independence was being fought (on health during this period, see lu, 2009), nationalist leaders based in Ankara established Dervis¸og _ the Sıhhat ve Içtimai Muavenet Vekaleti (or Ministry of Health and Social Assistance)dpreceding by more than three years the 29 October 1923 demise of the Ottoman Empire and the official establishment of the republic. Initially led by Dr. Adnan (Adıvar) (1882e1955), spouse of nationalist and feminist Halide Edıb (Adıvar) (1884e1964), and then by Dr. Refik (Saydam) (1881e1942)dlater prime minister of Turkey (1939e1942)dthis ministry identified a number of key medical concerns facing the nascent republic: malaria, syphilis, trachoma, and tuberculosis, among others. Endeavoring to overcome these and other diseases, the ministry directed provincial health officials to begin a comprehensive survey of the nation’s lands and peoplesdserving as “organic intellectuals” (recall Caprotti, 2008), and it eventually published these _ rafyası (“The Medical-Social records as Türkiye’nin Sıhhî-i Içtimaî Cog Geography of Turkey,” with subtitles designating specific provinces). The first of these socio-medical surveys came out in 1922 (Besim Zühtü, 1922; Hıfzı Nuri, 1922; Kemal, 1922; Mehmet Hayri, 1994; Nazmi, 1922) and the last was published in 1932 (Hasan Tahsin, 1932). With the exception of the final survey from 1932, all were published in Ottoman Turkish, and thus far, only two have been transcribed in modern Turkish (Mehmet Ali, 1991; Mehmet Hayri, 1994). As official primary sources, they aredat their bestdprofoundly rich in detail beyond matters of disease and public health, and their more narrative sections offer unique insights into the perspectives and prejudices of their authorsdthe early republic’s chief officials for public health (for greater discussion and analysis of these surveys with respect to syphilis, note Evered & Evered, 2011a, 2012). In addition to the ministry and its officials, a good number of representatives in the first several parliaments of the republic were also physicians (Tınal, 2009). Amid a highly nationalistic “demographic discourse” that pervaded many policy discussions and forecast a possible population collapse for Anatolia (on the politics of these anxieties in Turkey, note Evered & Evered, 2011b; on their basis of population in the literature on biopolitics, see Foucault, 2008; also, on population and governmentality, see Legg, 2005) and with numerous allies in parliament, the mandate to the ministry and its officials meant that their influence was thus considerable. As an example, we note the republic’s first comprehensive law for public health, the 1930 Umumî Hıfzısıhha Kanunu (or Public Health Law), as published (and thus enacted) in the state’s circular Resmî Gazete (1930) on 24 April 1930. This landmark legislation was authored almost entirely by the Ministry of Health and Social Assistance and passed by parliament with negligible levels of debate. Perceiving and presenting public

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health as essential to the republic’s survival and prosperity, ministry officials not only responded to medical concerns that arose, they defined for the nation their own indispensable contribution and discursively controlled depictions of their adversariesdbiological and societal. As Turkish health authorities thus came to classify and command their own “malaria question,” we see that the experience was not entirely distinct from similar episodes involving malaria (e.g., Carter, 2008) or even other maladies, as Brandt observed with respect to America’s Progressive-era constructs of venereal disease and the ways in which they empowered agendas both political and societal (1987, p. 9). As the state framed and prescribed a course of action to take for malaria, it thus framed and confronted perceived social ills, as well.

State lessons on malariadand civilization Throughout Turkey’s histories of governance, the image of the state as educator has been both iconic and ubiquitous; this was true for the late Ottoman Empire (discussed as the “educator state” in Deringil, 1999; see also Evered, 2012; Fortna, 2002) and continues to be so during the republican era (e.g., Kaplan, 2006). Embodying the Kemalist state itself throughout his presidencydand since, Mustafa Kemal (Atatürk) (1881e1938) was photographed imparting lessons to the nation on, for example, the new alphabet, the ideals of the republic, and other topics. These images of instruction are among the most commonly reproduced photographs of the leader and feature routinely in murals and posters found upon the interior and exterior walls of Turkish schools and other buildings. Extending the state’s lessons to include public health, Atatürk, a chronic sufferer from malaria, even submitted to one of the state’s mandatory screenings for the disease in 1926. In doing so, he rendered a “teachable moment” for the nation that would be distributed and commemorated in publications (see Fig. 1) that later declared a war upon and then claimed victory for both the republic and its population over the disease (e.g., Süyev, 1952). On the surface, public health education in Turkey entailed representational themes that ranged from the mundane and innocuous (e.g., posters promoting washing, resting, eating properly, and using screens) to the fantastic and cataclysmic (e.g., illustrations of giant mosquitoes descending upon peasant farmers and laying waste to villages)dnot unlike the monstrosities seen in early B-movies. At first glance, such illustrations quickly bring to

Fig. 1. Leading by example, Atatürk submits to a blood examination for malaria, “like all inhabitants of Ankara during the first application of Malaria campaign low [sic] No: 839” (Süyev, 1952, p. 80; for more on Law No. 839, the Anti-Malaria Campaign Law, see Evered & Evered, 2011b).

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mind the images and analysis presented by Edmund Russell in his environmental history War and Nature (2001). In his study of insects as Cold War metaphors, Russell addressed the parallels between entomologists and politicians as they proposed to combat their enemiesdhuman and insectdwith chemicals. As addressed in our conclusion to this article, however, the graphic content of Turkey’s antimalarial campaigns is reflective of rather different anxieties; statist presumptions regarding its largely rural populace and associated views that promoted teaching through fear. As such, these images were significant discursive themes associated with the state’s research about, political framing of, and planned and declared agendas for confronting malariadthus revealing various statist and particular officials’ motives and intentions. Furthermore, these records also convey their thoughts and prejudices regarding Turkey’s largely rural populace (as a related example, note Fedunkiw, 2003, on the ways in which analysis of public health films enhances our understanding of the socio-cultural biases endemic to many health initiatives). Though many sources on the early republic perpetuate the “great man” narrative associated with Mustafa Kemal (Atatürk) or depict it in simplistic, unitary terms, we strived to not do so in this and in our other studies. Rather, our views on the early Turkish state are informed by perspectives that conceive of the state as collections of practices (and, as noted, education may be one of them) that conveydsometimes in misleading fashionddistinct/discrete frameworks and that exhibit externally a sort of structure (Mitchell, 1991, p. 94; see also Painter, 2006). Indeed, a principal challenge in studying authoritarian or single-party politiesdand the early republic could be regarded as bothdis to discern how policies are formulated and implemented. In our researchdboth for this article and in others, concentration on the perceptions of and the policies advocated by individuals within the Ministry of Health and Social Assistance has allowed us to progress in this direction. Through our examination of such singular voices, we have been able to discern not only how actors arrived at consensus but also how contestation transpireddas in the debates over syphilis and the regulation/prohibition of prostitution (Evered & Evered, 2012). Beginning with the earliest of republican documents that we examineddand reflecting continuities in ideas and attitudes that were entrenched throughout the late Ottoman period,2 physicians and health officials commonly referred to malaria as a köylü ı (or “village disease”). As such, it was an ailment of the hastalıg peasants and the pastoralists of Anatolia (on comparable associations of malaria as a “tropical” disease in the West or a “Southern” disease in the United States, note Packard, 2007, pp. 67e83). In the sociopolitical framing of the disease, this perceived and imposed antagonism between modern/enlightened/urban and traditional/ primitive/rural (i.e., rural and diseased) was reinforced continuouslydsuch that the state’s mission entailed clearly interventions to cure malaria the disease but also to enlighten (or cure civilizationally) the peasantry as a class. Underscoring these connections between good health and _ _ progress, Prime Minister Ismet (Inönü) Pas¸a declared at Turkey’s medical congress of 1931, “Medenî hayat her s¸eyden evvel sıhhî hayattır” (or “A civilized life is first and foremost a healthy life”; lık ve Sosyal Yardım Bakanlıg ı, 1947: 3). Despite quoted in T.C. Sag the tremendous slogans of Mustafa Kemal (Atatürk) on behalf of the nation’s peasantry, especially the often-quoted Köylü yurdun efendisidir!d“The true master [of Turkey] is the peasant/farmer!”, the health ministry and other branches of the republican state continuously sought to cure the existential malady of the peasant through education. As a means to effecting such changes among the general populace, the ministry strived to school young citizens in hygiene and health, with an emphasis on elementary education

lık Dergisi, 1948, pp. 64e65). In the subsequent sections of this (Sag article, we continue to address how the republic institutionalized public health, health education, and the malaria struggle, but in doing so we also reveal how the health ministry trained its own personnel, prioritized lessons against traditional (i.e., peasant) medicine and healers, cared fordbut also counseleddthose infected with malaria, and prescribed images of proper citizenship and lifestyle to the wider nation. Mobilizing to teach against malaria In support of the republic’s biopolitical operations to educate the public, the health ministry had a separate section known as the general directorate. Divided into two branchesdone for each of its main concerns, the directorate established (1) a public health propaganda branch and (2) a medical statistics branch. Broad categories of statistical records assembled included data on diseases, deaths, births, marriages, population trends and movements, and types of medicines consumed in Turkey and their rates lık Dergisi, 1948, p. 65). Broadly conceived, the of consumption (Sag propaganda branch was tasked with “enlightening” the nation. To achieve their biopolitical goals, it relied upon all means of modern communication, including free brochures and posters, books, medical programs and information for the republic’s radio stations, and even silent and non-silent movies. Compiling figures for the numbers of free brochures and posters distributed between 1923 and 1948, the statistics branch of the ministry’s general directorate cited a nationwide distribution of approximately 5,864,000 brochures and 725,000 posters, both black-and-white and colored (BCA 490-01-1211-22-1-38, p. 51). On an annual basis, with agricultural calendars often in mind in order to avoid conflicts with planting and harvesting, the ministry dispatched in rotation cinema operators with projectors throughout the country to show films in the nation’s many cities and towns. Winters were generally the best seasons for distributing propaganda in most rural communities of Anatolia. Among archival documents examined, it is interesting to note the presence of complaints from local communities over matters of scheduling. For example, the provincial council of Adana wrote in April 1935 that the twelve or thirteen films scheduled to be shipped in the prior two or three months to Izmir, Aydin, Denizli, Afyon, Konya, and then Adana had not yet been delivered. Local officials were concerned that, if the films did not arrive by the end of May, people would be too busy tending to the cotton fields in the evenings due to the increasing daytime temperatures of summer (BCA 490-011211-22-1-38, pp. 33 and 34). Although we might assume that these officials were concerned about delivering effectively the ministry’s educational messages, we also suspect that these films were a novel and popular form of entertainment for the people of 1920s through 1940s rural Anatolia (on the entertainment aspects of early public health educational films, note especially Stein’s analysis of their place in 1930s Java, 2006). Of the health-related films shown, American films were reportedly the most popular. Shown free-of-charge, public health and hygiene movies were viewed by an estimated 461,441 people between 1923 and 1948, according to the statistics branch of the directorate. The titles of these health and social films included (in translation) Malaria; New Methods in Anti-malaria Campaigns; Child Care; The Importance of Influenza; Healthy Water; Once upon a Time There Were Three Friends; Early Diagnosis and Treatment of Tuberculosis; Dangers of a Fly; Solutions to Living a Long and Healthy Life; The Value of Mother’s Milk; Punishment for Neglect; Why Did Willie Want to Be Washed?; and Getting Used to Protecting Health and Achieving It (BCA 490-01-1211-22-1-38, p. 51). Based upon related ongoing research into historical geographies of syphilis eradication

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in the republic (e.g., Evered & Evered, 2011a, 2012, in press), we learned that Once upon a Time There Were Three Friends was actually the 1927 French film Il était une fois trios amis (more commonly rendered in English as The Three Friends). This film dealt with the responsibilities of good citizens to be tested (and treated) for syphilis. In the last of the socio-medical geographies to be published, its author, Dr. Hasan Tahsin, also referred to screenings of the following films in Sivas: Malaria; New Methods in Anti-malaria Campaigns; Child Care; Once upon a Time There Were Three Friends; Dangers of a Fly; and The Value of Mother’s Milk, among others. He also indicated that the desired audiences for these films included expectant mothers, schoolchildren, and soldiers (1932, p. 308). Promoting the professionalization of Turkey’s medical and health cadre, the propaganda branch of the general directorate also published the state’s key health journal Sıhhiye Mecmuası, later lık Dergisi (Sag lık Dergisi, 1948, p. 64). According to renamed Sag Özpekcan, Sıhhiye Mecmuası was actually initiated under the Ottomans in 1913 and later selected by the republican health ministry to be its official journal (2002, p. 241). Between 1923 and 1948, 200,000 copies of this journal were published and distributed (BCA 490-01-1211-22-1-38). Viewing itself as short on time and funds in dealing with its priority health concerns, the ministry further tasked the directorate with keeping abreast of medical developments in Europe and the United States. It thus facilitated the publication of Turkish books and translations of foreign texts (between 1923 and 1948, the ministry distributed roughly 150,000 copies of such translations; BCA 490-01-1211-22-1-38). One of the more popular foreign titles that the ministry prioritized for translation was Luckett and Gray’s The Elements of Public Health Administration (1923), which was translated promptly into Turkish for the ministry’s officials (1926). Articulating his commitment to learning from the West, Dr. Refik (Saydam) wrote in the preface to this translated volume of Turkey’s desire “to benefit from the experiences of all other nations” (Luckett & Gray, 1926, p. 2). This commitment to public health education, internalized to include the ministry and its officials and staff, is still reflected in a plaque in the minister’s office, preserved at the Refik Saydam Library in Ankara: “When establishing new institutions, instead of conducting new experiments, we strode along paths that were already tested by implementing practices that would protect the health of the Turkish nation.”3 Beyond the nation’s largest cities, the ministry relied upon another state institutiondespecially for film screenings, the Halkevleri (or “People’s Houses”), evidenced in official documents and archival letters. Within such correspondence, the Halkevleri were emphasized as unique gathering places for the young people of communities, and they were promoted as sites to show more films on a regular basis in order to improve “people’s health and social knowledge” (e.g., BCA 490-01-1211-22-1-38, pp. 25 and 31). Established in provincial cities and towns, these gathering places for the socialization of old and young were venues for the state to lu, 1998; disseminate information and ideology (Karaömerliog Karpat, 1963, 1974). In villages, there was a smaller equivalent known as the Halkodası (or “People’s Room”). Featuring their own publications and events with readings, presentations, performances, and films, the Halkevleri were envisioned by republican leaders as places where people would form social bonds within their communities and political bonds with the state. According to the Ministry of Interior, by 1938 there were 209 Halkevleri throughout Turkey (BCA 490-01-1211-22-1-22). As satellites for the diffusion of state information, the Halkevleri were the crucial sites where the health ministry screened films, distributed information, and taught the importance of public health and physiciansdand, at rudimentary levels, the scientific truths of modern epidemiology

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and medicine. In locations where Halkevleri were not available, other state institutions were utilized. Indeed, with particular regard to malaria, apart from the usual sites and media of instruction, even imams were encouraged to convey public health lessons about the disease through the sermons they delivered in the secular republic’s state-run mosques (Temel, 2008, pp. 74e75). Another form of media delivery involved public health museums in Ankara, Istanbul, and Izmir, with traveling museums to visit other locations. The Turkish republic was not alone in facilitating public health education through museums. Indeed, the Ottoman Empire opened a health museum in Istanbul, though the conditions of World War I prevented its continued operation (Özpekcan, 2002, p. 240). Additionally, according to a contemporary League of Nations report from its 1924 survey of Eastern Europe, Russia had “excellent hygiene museums” and also facilitated the delivery of propaganda via mobile museums on railway cars (1925, p. 41). The Istanbul health museum began operations under republican authority in 1924, and some of its materials were loaned to an Ankara museum that opened in 1926dthough most of these items and the museum were damaged severely in 1931 by a fire. A similar public exhibit was displayed in Gençlik Parkı (or “the People’s Park”) in Ankara in the 1940s. Furthermore, in several towns, the ministry encouraged local businesses to support the opening of such museums (Özpekcan, 2002, pp. 240e241). For locations too remote for health exhibits, the ministry also published in 1926 the Sıhhî Müze Atlası (or “Medical Museum Atlas”). Although no location or publication house information is provided in the atlas, Özpekcan noted that 1000 copies were distributed throughout the country (2002, p. 241); we were able to utilize the copy of this volume held at TBMM. Intended as a portable, concise version of the health exhibits found in the big cities of Turkey, the Sıhhî Müze Atlası featured colored images and descriptive textdthough no actual maps. In his preface to the volume, Minister of Health Refik (Saydam) explained the purpose of the atlas: “to educate the public to avoid such [contagious and social] diseases and to display the damage and terrible outcomes _ that they cause” (T.C. Sıhhiye ve Muavenet-i Içtimaîye Vekaleti, 1926, n.p.). While the atlas presented graphic and shocking images of victims of syphilis who suffered from facial deformities, it also offered educational approaches to malaria. Just as Refik (Saydam) indicated, there was a heavy emphasis on cause and consequence. Stressing that the scientifically proven source of malaria was Plasmodium (i.e., the malaria parasite), which was depicted in figures of a microscope’s slides, and that victims acquired it from a particular type of mosquito (a concept that recurs in various ways as an instructional imperative in this historical geography of public health education and malaria)dand not another variety of the insect, the atlas presented two associated images (see Fig. 2). Portraying the consequences of malaria, the atlas followed the images of the mosquito and bacterium with two portraits of the physical victims of the disease; a man with his spleen detailed in both healthy and enlarged proportions, and a child with a distended abdomen due to an enlarged spleen (see Fig. 3). In the publications of the Turkish health ministry, such representations of those suffering from malaria with distended stomachsdespecially childrendwere almost as omnipresent as those of the mosquito. These figures were followed by two additional pages that pictured villages (one image from the exhibit in Ankara and the other from the exhibit in Istanbul) that were idyllicdexcept for a relative lack of inhabitants. Conveying succinctly the Foucauldian connection between population and economy (analyzed with regards to governmentality in Evered & Evered, 2011b), the sub-caption above each of the landscapes read, “Protection from malaria increases the power and wealth of the country” (see Fig. 4). Below these images another caption stated, “A malarial village and its surroundings attracted

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Fig. 2. This page titled “Sıtmadmalarya” provided viewers with an image of malaria as seen in a scientist’s slides and a depiction of the types of mosquitoes that did and did not _ transmit the disease (T.C. Sıhhiye ve Muavenet-i Içtimaîye Vekaleti, 1926, p. 2; TBMM).

many villagers with its lush vegetation and a beautiful panorama that enticed them to settle, but [this malarial village] gradually devastated the inhabitants and condemned them to decay” (T.C. _ Sıhhiye ve Muavenet-i Içtimaîye Vekaleti, 1926, pp. 4e5).

Zeki Gencosman visited one of the republic’s public health exhibits, which promoted a new ten-year health plan. In his narrative, diseasesdand especially malariadendured as shameful markers of civilizations’ underdevelopment and their relative lack of progress:

The atlas’ biopolitical associations between disease and declinedbiological and civilizationaldfor both individual and society/state endured in republican discourse for many years. Twenty years after publication of the atlas, the journalist Kemal

Victory means defeating the enemy. So long as it lives as a mosquito in the air, as a bacillus in the liver, as trachoma in the eye or under various names such as syphilis, plague, and typhus

Fig. 3. A page titled “Sıtmadmalarya” depicted bodily aspects of the disease, displaying a man on the right with both his actual spleen and the extent to which it might become _ enlarged due to malaria and, on the left, a child with his abdomen distended severely due to his enlarged spleen (T.C. Sıhhiye ve Muavenet-i Içtimaîye Vekaleti, 1926, p. 3; TBMM).

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Fig. 4. “A malarial village and its surroundings attracted many villagers with its lush vegetation and a beautiful panorama that enticed them to settle, but [this malarial village] gradually devastated the inhabitants and condemned them to decay” (T.C. _ Sıhhiye ve Muavenet-i Içtimaîye Vekaleti, 1926, p. 5; TBMM).

among people, we cannot talk about victory. In an age when talking about malaria is not considered a shame only in the middle of Africa, we are dealing with treating 2.5 million people for malaria in a yeardthat is, based on who we could contact and turn into statistics. .The mosquito was and will be the major enemy of any civilization in Anatolia (“On Yıl Sürecek Bir lık Sergisinde Bir Saat,” Ulus, 6 May Mücadelenin Tablosu: Sag lık ve Sosyal Yardım Bakanlıg ı, 1947, 1947, reprinted in T.C. Sag pp. ixex and xii).

Deploying an educateddand embeddeddcadre As we have indicated, the health ministry made priorities of learning from other countries, of self-education, and of professionalizing Turkey’s medical community. To enable these advances, the government established international connections and deployed its physicians to various European countries to be trained in the prevention and treatment of malaria and other ailments. As examples from the archival record, even President Mustafa Kemal (Atatürk) was involved in authorizing such initiatives; as he approved directly a proposal from Dr. Cevdet, director of Konya’s antimalarial campaign, to attend a 1932 League of Nations malaria workshop held in Paris (BCA 030-18-01-02/31-69-008). Similar approval was granted in March 1933 for two physicians to attend another League of Nations malaria workshop hosted in Rome (BCA 030-18-01-02/34-18-003). In making these connections abroad, Turkey asserted its presence and presented its achievements at international symposia such as the 1931 international public health lık Dergisi, 1948, p. 64). The ministry also exhibit in Dresden (Sag educated physicians about and standardized therapeutic regimes for many of the diseases that they confronted. In addition to regulations and legislation, the ministry convened national health congresses to convey innovations in medicine and encourage research. In total, ten such congresses were held lık Dergisi, 1948, pp. 64e65). Each between 1925 and 1948 (Sag

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congress emphasized a particular national health concern. The first of these meetings featured malaria, was organized under the auspices of Mustafa Kemal (Atatürk) and took place in September 1925 in Ankara (Anonymous, 1926), and some of its most significant papers focused on the disease and its geographic aspects (e.g., Abdülkadir Lütfi & Ahmed Fikri, 1926; analyzed in Evered & Evered, 2011b). Delivering the opening remarks to the roughly 300 physicians _ who attended this inaugural congress, Prime Minister Ismet _ (Inönü) Pas¸a declared, “Today, as it was on the first day of the republic, we are determined to do everything at our disposal in our struggle [to realize] public health [as we] elevate our citizens’ wellbeing to the highest level.” He continued by extolling the curative and pedagogical missions of the physician in achieving this task: “There is no more effective way to demonstrate the virtues of science and mathematics than by applying their results to the bodies of the people, to sustain their most treasured possession, health. You must employ this powerful weapon over the next twenty-five years by being among the people, being among the most underdeveloped, the most needy, and the most suffering of communities and by bringing [the benefits and lessons of modern _ science] to them” (Ismet Pas¸a, 1926, pp. 2 and 4). In his following remarks, Minister of Health and Social Assistance Dr. Refik (Saydam) encouraged the republic’s physicians to be models of a civilized life for the nation’s peasantry and to embrace this challenge, rather than simply enjoy the comforts of a city life (1926, pp. 5e7). This populist approach to medicine that would place the physicians “among the people” was promoted not only by establishing research centers in areas most affected (e.g., the malaria center located in Adana) but also through regimes of professional training and certification and as a legislated requirement for early-career physicians (Evered & Evered, 2011b). Believing that national success in public health was “proportionate to the level of information that villagers had and how well they believed in that knowledge,” the ministry employed traveling doctorsdserving as “organic intellectuals” within the nation’s communities (recall Caprotti, 2008), and it instructed them how best to educate the peasant populace of Anatolia regarding health and medical matters in terms that they could comprehend. In 1934, the health ministry posted its “instructions regarding the duties of traveling doctors” (a talimatname). This 51-item regulation detailed the qualifications and appropriate payment for traveling physicians and outlined the state’s expectations for these doctors. Among the topics that these doctors-teachers should cover was malaria, a major priority in many regions, especially matters associated with the disease’s derivation (i.e., wetlands) and methods for treatment and preventiondlessons that lık were emphasized repeatedly in texts and in law (e.g., note Sag Dergisi, 1934, p. 333). In this context of asserting biopolitical control, tradition represented both an obstacle and a mode of resistance. Teaching against rural traditiondand instilling fear For physicians and provincial health directors, modern lessons in health seemed dependent upon reducing villagers’ reliance upon local cures and healers. As the nascent republic and its advocates sought to facilitate modernization in a manner that was spatially and socially comprehensive (thus distinguishing itself in practice and in self-representations from the empire), these rural traditions were perceived to be anathema to the vaunted sciences of modern medicine and statecraft. In this context of a state that was expanding rapidly its biopolitical reach, we contend, tradition may also be construed as having constituted a significant means of resistance for peasant communities (Scott, 1985). In the earliest of the socio-medical geographies that provincial health directors authored, these perceived barriers to overcoming underdevelopment and malaria were condemned as primitive and

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ineffectual. Describing local customs, the director of Bayezid wrote of locals’ habits of tying rags to the trees near cemeteries and along _ roads to remedy the disease (Ibrahim Edhem, 1925, p. 17). Dr. Mehmet Said, the provincial health director for Sinob (today’s Sinop), complained about villagers’ treating those stricken with malaria by having them wear shirts soaked with garlic and vinegar la (1922, p. 41). Criticizing the superstitious peasantry of Mug (Mentes¸e), the director for that province wrote, In order to be cured from malaria, people carry amulets inscribed with the blood of a pigeon or a blackbird, or they go to people who read and then blow religious verses as a cure. The reason for this is [their] ignorance (Esad, 1923, p. 70). Similar commentaries were echoed by other provincial health directors in their socio-medical geographies of Turkey. In one of the Turkish medical texts published in the late 1920s, traditional practices were connected with malaria’s ongoing spread among the people of Anatolia: In health matters there exist some false beliefs and superstitions that provide no benefits but do inflict harm. Others cause neither benefit nor harm. However, even though they may not inflict harm on the surface, they are to be considered harmful because they waste time in countering the disease by taking the place of necessary measures. Let us present an example to explain what these superstitions mean: For example, unfortunate people who remain in ignorance in protecting [their] health expect remedies from amulets written with the blood of pigeons or blackbirds when they have malaria. They tie cotton threads with three knots on their wrists and ankles, they cut [their] spleens in the midst of incense and prayers, and they tie lead pieces over the spleen. They fool themselves with these [remedies] and cause the disease to get out of hand (Res¸it Galip, 1929, p. 14). In the eyes of the republic’s proponents, these beliefs and practices needed to be refuted by science in the modern republic: “Incompatible with today’s science and knowledge, these beliefs must be uprooted and thrown away” (Res¸it Galip, 1929, p. 14). Apart from their scientific and societal disdain for traditional curatives, physicians further perceived these practices as a real obstacle to proper therapies and to eventual control and eradication of the malaria. However, in the experience of the provincial health director of Gelibolu, changing popular perceptions regarding the efficacy of modern medicine were impeded by its lack of immediate physical results; in other words, for many villagers, modern therapies did not appear to be evidence-based treatments. undan, or Writing in colorful prose (i.e., Halkın aklı gözünde oldug “People’s minds do not go beyond what their eyes see”) and responding to ministry inquiries as to locals’ levels of receptiveness to modern medicine, Dr. Fahri Cemal wrote, [Since p]eople’s minds do not go beyond what their eyes see, the benefits of a doctor’s treatment must be very clear and visible. Thus, they have more faith in surgical branches of medicine because there are incisions. [By contrast, remedies for] malaria, typhoid fever, and syphilis require time to cure, and this becomes a motive to avoid the doctor. Since people expect to be cured over a short period of time, they cannot persist with a long treatment, even if it is free. (1925, p. 20) Ministry officials and physicians also communicated their dismay over a perceived lack of popular receptiveness to lessons from modern science. In particular, regarding the epidemiologies of malaria, modern scientific ideas of its causes (i.e., from Plasmodium) and vectors of transmission (i.e., the mosquito) contradicted firmly entrenched traditional views on the derivation of malaria. Such

views ranged widely, but they most commonly centered on miasmic notions of the disease and opinions concerning the consumption of contaminated food or water. Though physicians were often shocked by these assumptions, their reactions were more telling regarding their own social and/or scientific posturing vis-à-vis their patients than they were about the local populations and the peasants’ “backward” perspectives. Indeed, attributions of malaria to miasmic origins were not entirely uncommon within “modern” medicine only a few decades earlier, and many of the presumed luminaries of Western medicine not only promoted such views but were also very much informed by their own observations within Anatolia (e.g., on miasma and the earliest of malariologists, Hippocrates and Galen, note Mitchell, 2011, pp. 536e538). Addressing these concerns about rural “superstitions” in his paper on malaria at the republic’s first medical congress in 1925, Nes¸et Ömer wrote, The organization for the campaign against malaria must be uniform and scientific and must extend down to the villages especially. It is only then that we can have an effective campaign against malaria (1926, p. 266). Animated commentaries followed Nes¸et Ömer’s paperdand provided a good indication of the varied perspectives that existed at the time regarding not only public health but also views on society and policy formulation, in general. For many of the attendees, instilling fear in the peasantry seemed a requisite to achieving desired goals, and these messages needed to be disseminated as widely as possible. As Said Cemil Bey stated, knowledge “must be propagated, there must be sermons in villages, maps and pictures must be prepared, and people must be shown pictures that reflect the devastation of malaria” (1926, _ p. 286). Asıf Ibrahim Bey also remarked on “scientific ignorance” and communicated his views on how to overcome itdin terms that both marginalized and established possession over the peasantry: graphic propaganda depicting the effects of malaria and the specter of mosquitoes. As he stated, Our peasants are very ignorant. Our peasants never believe that malaria is carried by mosquitoes. We cannot make them believe that malaria is not caused by eating spoiled food. They assume that is the cause. In order to inject the truth into our peasants we need to have some pictures, as some friends suggested, and hang them in the mosques, the coffeehouses, and the schools. For instance, we can have colored anopheles pictures and display them; we can have images of anopheles biting people; then, we can show the accumulation of these [mosquitoes]; we can have images of marshes and depict the spread of [eggs or larvae] in the marshes. These could be shown in vivid pictures. Thus our villages will discover that malaria is carried by mosquitoes. Furthermore, in those posters we can show malaria-stricken people. Villagers will see these conditions and learn to associate the two; that those people are like that because of the mosquitoes. We can succeed in protecting people from the mosquito and let them know that it is a harmful enemy. Furthermore, one of the posters could depict an individual with an enlarged spleen who looks lifeless [as he] stands up (1926, p. 288). As will be seen in the subsequent sections, this emphasis upon fear in Turkish public health education would assume fantastic proportions as the state sought to communicate graphically the dangers of killer mosquitoes to an assumedly naïvedand resistantdpeasantry.

Regulating therapies In scientific and medical education there was also an emphasis on inculcating discipline and knowledge in the matter of selected therapies employed to treat the disease. Commenting on socio-cultural

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barriers to proper therapeutic treatment, Dr. Mehmet Said wrote that the local population seemed to “respect and trust Sulfato”dbut only until the immediate attack ended. Subsequently, the doctor lamented, the typical malaria patient would assume that he or she had been cured after the first “three to five pills” (1922, p. 59). Similar complaints derived from the director in Kayseri as well. Indicating that many villagers in the area never even heard ofdmuch less encounteredda modern physician, Dr. Hıfzı Nuri stated that most had learned about “Sulfato.” However, their efforts to acquire the treatment extended only as far as the local herbalists, who often purveyed small amounts in highly adulterated forms (1922, p. 32). Commenting on a presumed laxity in observing the instructions that people received from their physicians, Said Cemil Bey stated, When we tell patients that they have malaria, they take it as if malaria is not a [real or serious] illness. Some take quinine for five days; sometimes, without even consulting with a doctor, they go to a pharmacy to acquire it as if they are buying bread and cheese (1926, p. 286). In Said Cemil Bey’s view, such incomplete or unprescribed uses of quinine were worse than not taking the medicine at all (1926, p. 286). Such complaints over poor compliance with prescriptions and inappropriate uses of medicines led to endorsements of laws and regulations that would mandate uniform standards in treatment and enforce observance of prescribed therapies (Nes¸et Ömer, 1926, p. 266). Although many provincial health directors blamed villagers or local healers for their inappropriate uses of medicines, the director from Kırs¸ehir instead identified another dimension to the problem. _ _ For Dr. Ibrahim Ismail, the same state that the peasants were grateful todand even prayed fordneeded to recognize that the insufficient supply of free quinine was the real culprit: Some villagers have not even heard about doctors. It is appreciated that they all learned that Sulfato is the right medicine for malaria. They welcome the free quinine given to the poor and pray for those who provide it [i.e., the state]. Unfortunately, this quinine cannot be provided regularly. Therefore its benefits cease after a few malaria attacks. [This is] because, with quinine treatment, in order to give the scientifically required dose, there _ must be thousands of kilograms of quinine available (Ibrahim _Ismail, 1925, p. 40). Apart from possible logistical impediments, however, many observers still emphasized prescription compliance and lessons about the disease and its derivation. To enhance observance of prescriptions among children, there were even proposals to provide chocolate quinine (Özpekcan, 2002, p. 222). Again, however, with respect to the extended regimes of treatment with medication, some of the major recommendations were not only logistical but educational. As Nes¸et Ömer wrote, Treating malaria patients with quinine is the most important part of the struggle against malaria. Therefore, for this purpose, at least 15 tons of state quinine must be distributed. It is highly desirable to establish a kinin darussanayisi [a quinine industrial house]. To succeed in this struggle against malaria, people must know the way it is spread and they must trust quinine. In order to achieve this goal, an intensive propaganda campaign must commence that employs every medium (1926, p. 266).

Regulating preventiondand the consequences of not doing so From its earliest years, administrators and physicians working for the Ministry of Health and Social Assistance envisioned and

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prioritized a pronounced role for preventative health measures in the republic’s confrontation with malaria. In doing so, they established lessons for the peoples of Anatolia that extended far beyond the disease itself. Moreover, through their graphic educational materials, they reinforced the top-down orientation of a state that was more apt to apply its policies to a populace rather than work with it to arrive at ideal outcomes. In such a context, inducing fear as a means of warning people of the ramifications of ignoring public health directives was common, and the ideals of civilizational development were inextricable from goals of disease control or eradication. A passage from Res¸it Galip’s text illustrates how public health measures were encouraged with suggestions to incorporate them into traditions that state leaders accepted (e.g., the dowry of a bride). Malaria spreads from person to person by mosquitoes. Use mosquito nets during the seasons when mosquitoes are alive. Make a habit of putting a mosquito net in a bride’s dowry. Do not tolerate any standing water in your city, village, or neighborhood. Mosquitoes breed in these water collections. Once a month completely empty the fountains, drinking basins (yalaklar), and garden pools and let them stay dry for twentyfour, or better yet, forty-eight hours. This will cause all mosquito eggs and mosquito larvae to die. (1929: 19) In other cases, idyllic imagery was combined with dangerous consequences to communicate clear messages to the wider publicdas the ministry’s 1926 atlas’ verdant yet barren landscapes attempted to convey. Employing its own artist, Refet Bas¸okçu, the Ministry of Health and Social Assistance produced posters that emphasized vividly the state’s desired lessons in preventive medicine and appropriate behavior. In the case of malaria, one such poster from the 1930s (see Fig. 5) depicted in words and images what was at stake (i.e., home, health, and prosperity) and what was the nation’s enemy in this struggle (i.e., the mosquito). Containing eleven small portraits, the poster begins with a “strong and healthy baby.” During his nighttime sleep, the otherwise fit baby is bitten on the check by a mosquito. Left untreated, the boy as an older child is weakened, with “less blood” and “less energy,” and he is shown in the next image with a distended abdomen, suffering from an enlarged spleen. Incorporating the socioeconomic ramifications of disease, for both the individual and the republic’s population, the subsequent images reveal a young man incapable of tilling the soil of his own farm and devoid of prospects for marriage and a meaningful family life. In the bottom row of small portraits, the poster indicates the measures that each citizen can take to inhibit the spread of malaria and mosquitoes. It encourages people to drain standing pools of water, to sleep under mosquito nets at night, and to hang screens on windows and doors to prevent the intrusion of mosquitoes into the home. Another image and text encourages citizens to take the quinine and Atebrin prescribed by state physicians and dispensed free of charge by state clinics, and to follow associated instructions. In its final portrait, the poster depicts a former victim of malaria who sought treatment, took his medicine, and followed instructions. This obedient citizen has lived to realize a happy family and enjoy a successful farmduniting in one image the individual’s aspirations for health, home, and prosperity, on the one hand, and the state’s biopolitical objective for a vigorous and productive populace, on the other hand. Themes of appropriate and inappropriate behaviors and stark contrasts between the outcomes associated with these respective behaviors continued in state and state-related brochures, posters, and other media in the coming decades. Though there were variations in content, the health ministry continued to emphasize the biological origins of malaria as part of its preventative message to

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_ Fig. 5. A Turkish public health poster of the 1930s states, “MalariadEnemy of Our Home, Health, and Development: Malaria Is Spread Only by Mosquitoes” (Sıhhat ve Içtimai Muavenet Vekaleti; image courtesy of Wellcome Library, London).

the nation’s largely rural populace. The recurring image of the 1930s and 1940s came to be that of an enormous mosquito descending upon peasants and their villages. Oftentimes depicting communities in close proximity to wetlands or other bodies of water, these portrayals of place and of an alarming and colossal mosquito were especially evident in the public health media developed by the Ministry of Health and Social Assistancedsometimes in concert with international pharmaceutical interests or health organizations. For example, the ministry’s promotion of prevention and proper treatment complemented Bayer’s marketing of Atebrin. In line with both sets of interests, Bayer issued, and the Turkish republic approved, brochures with vivid cover pages. Simply titled Sıtma (or “Malaria”), one four-page brochure (see Fig. 6) features a gigantic mosquito looming over the horizon and a swampdunderscoring the perils to the populace of failing to heed the state’s warning regarding settlements near wetlands. Within its pages, the Sıtma brochure depicts the story of Ahmet and Ays¸e (titled simply Ahmet ve Ays¸e Hikâyesi). Both are infected by the same mosquito, but Ahmet neglects his instructions for proper treatment and suffers in the fields. Once both Ahmet and Ays¸e heed their physician’s advice, however, they are a thoroughly cured couple and are depicted as a productive family in their fields, and as happy parents with their child. In this imagery tailored to the Turkish public, Ahmet not only resembles a Turkish farmer but Ays¸e is the quintessential image of an Anatolian wife and mother, wearing a headscarf and s¸alvar (the traditional, baggy trousers worn by rural Anatolian women). On the back page, information is presented regarding Atebrindalong with the seals of both Bayer and the Turkish republic. Once again, the goals of the individual for a fit, fruitful, and joyful life are depicted in consonance with the state’s objective to protect the health, wealth, and progeny of the populace. On the cover of another brochure (Fig. 7), titled Sıtma Geliyor (or “Malaria is Coming”), another giant mosquito hovers over a village adjacent to a wetland from which hapless peasants are fleeing. Stressing a preventative message, this eight-page brochure

Fig. 6. Sıtma (or “Malaria”) an educational brochure that advertised Atebrin, produced and distributed by Bayer and Turkey’s Ministry of Health and Social Assistance, ca. 1930se1940s (authors’ collection).

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“Eliminating mosquito nests wherever they exist means closing up a grave that opened to suffocate a citizen and devour a family.” Even heavier emphasis was placed upon preventiondand the duties of the responsible citizendin the republic’s four-page ız? (or “How to Protect brochure titled Sıtmadan Nasıl Korunacag Oneself from Malaria?”), published in 1943. It encouraged the elimination of opportunities for mosquitoes to breed by draining standing water and the avoidance of mosquito bites. Its biopolitical rhetoric of citizenship almost evidenced a regard for eugenics: Citizens: As you all know, malaria is a disease that washes out the population, ruins the lineage, and prevents our prosperity. The main medicines for malaria are “quinine” and “Atebrin.” Under the conditions of today’s world, acquiring them has become very difficult. .[Citizens thus have a duty] not to acquire malaria and employ all means to [guarantee] protection from it. Although this emphasis upon prevention continued throughout the 1940s, along with themes of the mosquito-imperiled peasant and his community (see Fig. 8), by the years following World War II Turkey began to rely upon DDT to eliminate the threat of malaria, especially under conditions of external support from the United

Fig. 7. Sıtma Geliyor (or “Malaria is Coming”), an educational brochure that advertised Atebrin, produced and distributed by Bayer and Turkey’s Ministry of Health and Social Assistance, ca. 1930se1940s; authors’ collection.

underscores essential messages regarding the origins of malaria, keys to its prevention, and the consequences of infection (with another common image of a young male with a distended abdomen on the last page). Although this brochure also promotes Atebrin, it refers to the short supply of medicines during this period and thus devotes far greater attention to the preventative obligations that all Turkish citizens must assume in this national struggle. Indeed, stated shortages of Atebrin and quinine in the 1930s and early 1940s compelled the Ministry of Health and Social Assistance to further underscore prevention as an essential duty for good citizens of the republic. Discourse emphasizing the link between prevention and citizenship was especially evident in state brochures. Stressing that malaria derived not from foul air associated with wetlands but from the mosquito, the health ministry’s ten-page 1939 brochure titled Sıtma (or “Malaria”) focused on transmission, the nature of attacks of the disease, treatment by appropriate medicines, the observance of prescription instructions, and the free provision of treatment by the state (BCA 490-01-1405_ 653-13; T.C. Sıhhî ve Içtimaî Muavenet Vekaleti, 1939). The preventative lessons this brochure imparted emphasized malaria as the world’s number one killer and the greatest cause of poverty among both individual households and the wider global economy due to decimation of the workforce. Included within this brochure was a sample quinine usage card, intended to familiarize the public with its ease of use and the importance of taking regular and appropriate doses. Depicting the mosquito graphically, the brochure also conveyed in words the imperatives of prevention:

Fig. 8. The cover of a 1948 booklet titled Sıtma (“Malaria”) that was published by the itim Bakanlıg ı Köy state’s Ministry of Education in its village library series (Millî Eg ı; authors’ collection). Kitaplıg

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States through the Truman Doctrine and the Marshall Plan. Under these circumstances, depictions shifted from the peasant as absolute victim to images that portrayed DDT as a shield, a tank, or a fortress to protect people and their communities. No longer showing a panic-stricken and defenseless populace, most posters and brochures from the period of the Marshall Plan depicted villagers and their children with smiling facesdhappy in the knowledge that DDT was protecting them. In line with these changes, both in fighting against malaria and in the lessons conveyed to the public, a greater emphasis was placed on humanity’s chemical arsenal and on eradication of (and not just control over) malaria in Anatolia. This goal, however, remains to be realized. Conclusion We have noted how, at first glance, images from Turkey’s public health educational campaigns against malaria from the 1920s through the 1940s appear strikingly similar to B-movie posters from America’s early Cold War era. Indeed, considering the gigantic mosquitoes, the panicked people, and the threat of disease, it is tempting to regard these images, the connected discourse, and the biopolitical motives of republican officials in light of metaphors shared by early Cold War politicians and entomologists (as analyzed in Russell’s 2011 environmental history). In the Turkish case, however, the rhetoric was not about a foreign menace, anddat least until the late 1940sdthere was no chemical solution. Rather, the adversaries in the early republic’s war on malaria were construed as internal enemies; the largely rural majority of the republic’s population itself. Surely mosquitoes were involved, but the greatest amount of energy deployed in educating the public concerned socio-cultural cures for what officials and physicians deemed ignorance, indolence, resistance, and superstition. Civilizationaldnot biologicaldills were thus the state’s primary targets. In light of this ongoing and institutionalized depiction of malaria as a “village disease,” perhaps the mosquito of statist propaganda loomed so large instead because of the republic’s profound diminution of the peasantry and their rural communities. In Seeing Like a State, Scott writes of such instances of a miniaturization of society and space in the plans of ultra-modernist governments (1998, pp. 223e261 and 347e357). In reducing the dimensions of a population and their communities amid top-down planning, state officials not only shrink society to a “thin” abstraction of itself, they also alienate the very population and communities they seek to educate and govern. While Turkey’s biopolitical schemes to combat malaria have not resulted in “failure” (as per Scott’s thesis), they have not yet resulted in an absolute victory, either. Striving to implement a “legible” program to educate/govern the Turkish population regarding malaria both as a disease and as a surmountable problemdand frequently lacking adequate supplies of appropriate medications to dispense, state officials opted for instilling fear of the disease and its vectors more commonly than instilling actual knowledge or reliability in material resources. While this approach and more tangible programs (e.g., the opening of clinics, increased efforts to obtain medications, and the draining of wetlands) collectively yielded results, setbacks in this progressdmeasurable in terms of periodic episodes of resurgence in the rates of infectiondarose most commonly when the republic’s resource limitations prevented its provision of _ requisite therapies (Tekeli & Ilkin, 1999). Clearly, such experiences underscored the inadequacies of education alone in confronting the disease. Despite such impediments and shifts within the state’s lessons toward a greater promotion of prevention and a heavier emphasis

on the responsibilities of its (“biological”) citizens, subsequent narratives regarding the successes of antimalarial campaigns never revealed the republic’s shortcomingsdmaterial or otherwise. Rather, such narratives and later declarations of victory reinforced statist lessons regarding the health-related requisites of good citizenship. In this context, neglecting one’s obligations “not to acquire malaria” were taught to be regarded as not merely individual acts of irresponsibility but transgressions against the republic itself. In these regards, the goal for rural inclusion in Turkey and a realization of Atatürk’s slogan Köylü yurdun efendisidir! (Turkey’s true master is the peasant farmer)dmuch like eradication itselfdremains today an elusive objective. Acknowledgments We thank the anonymous reviewers and James Sidaway for their comments and advice. We also enjoyed and benefitted from our discussions regarding this and other projects with doctoral candidates Jordan P. Howell and David L. Baylis, both at Michigan State University. We are especially grateful for assistance received from personnel at the Bas¸bakanlık Cumhuriyet Ars¸ivi, the Türkiye Büyük Millet Meclisi Library, and the Refik Saydam Library, Turkey. We also appreciate the assistance received from our friend Timur lu in locating particular materials for inclusion, and we Kocaog _ continue to thank Ilhan Tekeli for inspiring this trajectory of research. Support for this project was awarded by Michigan State University’s Center for the Advanced Study of International Development (CASID), Center for Gender in a Global Context (GenCen), and Muslim Studies Program, and assistance with acquiring materials was also received from the interlibrary loan services at Michigan State University. Endnotes 2 While many excellent works on histories of the Turkish nation-state and its engagement withdeven its pronounced glorification ofdmodernity have illuminated problems with the modernization project of the republic (beginning most an & Kasaba, 1997), too few historicize forcefully with the contributions in Bozdog modernism in Turkey prior to the republic. In fact, many in the late Ottoman state also espoused a profoundly modernist agenda and, in keeping with their ideals, had less than favorable sentiments regarding vast segments of the empire’s citizens, who were viewed as less than enlightened. Although Makdisi (2002) made a significant contribution in examining “Ottoman Orientalism” in terms of Turkish perspectives on the empire’s Arab territories, a similar project might look at the Othering practiced by modernist elites of the empire vis-à-vis rural populationsdand how such practices persisted well into the republican period. 3 il, denenmis¸ yollarda “‘Yeni kurumlar açarken, yeni deneyimler elde etmek için deg lıg ını koruyacak ög eleri yetis¸tirmeyi amayürüyerek Türk milletinin sag çladık’dRefik Saydam, 2 December 1936.” We are grateful to the library employees who allowed us to visit and photograph this office, which is otherwise closed to the public.

References rafyası. In AnonAbdülkadir Lütfi, & Ahmed Fikri. (1926). Türkiye’de sıtmanın cog ymous. (Ed.), Birinci Millî Türk Tıb Kongresi Müzakerâtı (1e3 September 1925) (pp. 212e233). Istanbul: Kader. Alatout, S. (2006). Towards a bio-territorial conception of power: territory, population, and environmental narratives in Palestine and Israel. Political Geography, 25(6), 601e621. Alvarez, A. (2008). Malaria and the emergence of rural health in Argentina: an analysis from the perspective of international interaction and co-operation. Canadian Bulletin of Medical History/Bulletin canadien d’histoire de la médicine, 25(1), 137e160. Anonymous. (1926). Birinci Millî Türk Tıb Kongresi Müzakerâtı (1e3 September 1925). Istanbul: Kader. _ _ Asıf Ibrahim Bey. (1926). Münakas¸a [“Discussion”dAsıf Ibrahim Bey’s comments on Nes¸et Omer’s paper]. In anonymous. (Ed.), Birinci Millî Türk Tıb Kongresi Müzakerâtı (1e3 September 1925) (pp. 288e290). Istanbul: Kader. BCAdBas¸bakanlık Cumhuriyet Ars¸ivi (the Prime Minister’s Archive of the Republic), Ankara, Turkey. Berridge, V., & Loughlin, K. (Eds.). (2005). Medicine, the market and the mass media: Producing health in the twentieth century. London: Routledge.

K.T. Evered, E.Ö. Evered / Political Geography 31 (2012) 311e323 _ rafyası: Hamidabad (Isparta) Besim Zühtü. (1922). Türkiye’nin Sıhhî-{ Içtimaî Cog ı. Ankara: Ög üd Matbaası. Sancag an, S., & Kasaba, R. (Eds.). (1997). Rethinking modernity and national identity Bozdog in Turkey. Seattle: University of Washington Press. Brandt, A. M. (1987). No magic bullet: A social history of venereal disease in the United States since 1880, expanded edition. Oxford: Oxford University Press. Caprotti, F. (2008). Internal colonization, hegemony and coercion: investigating migration to Southern Lazio, Italy, in the 1930s. Geoforum, 39(2), 942e957. Carter, E. (2007). Development narratives and the uses of ecology: malaria control in Northwest Argentina, 1890e1940. Journal of Historical Geography, 33(3), 619e650. Carter, E. (2008). State visions, landscape, and disease: discovering malaria in Argentina, 1890e1920. Geoforum, 39(1), 278e293. Dean, M. (2010). Governmentality: Power and rule in modern society (2nd ed.). London: Sage Publications. Deringil, S. (1999). The well-protected domains: Ideology and the legitimation of power in the Ottoman Empire, 1876e1909. London: I.B. Tauris. lu, F. M. (2009). Milli Mücadele’de sag lık tes¸kilatı’na bir bakıs¸. Ankara: Cedit Dervis¸og Nes¸riyat. Elden, S. (2007a). Rethinking governmentality. Political Geography, 26(1), 29e33. Elden, S. (2007b). Governmentality, calculation, territory. Environment and Planning D: Society and Space, 25(3), 562e580. rafyası: Mug la (Mentes¸e) Sancag ı. Ankara: Esad. (1923). Türkiye’nin sıhhî-{ içtimaî cog üd Matbaası. Ög Ettlinger, N. (2011). Governmentality as epistemology. Annals of the Association of American Geographers, 101(3), 537e560. Evered, E.Ö. (2012). Empire and education under the Ottomans: Politics, reform, and resistance from the Tanzimat to the young Turks. London: I.B. Tauris. Evered, E.Ö., & Evered, K. T. (2011a). Sex and the capital city: the political framing of syphilis and prostitution in early republican Ankara. Journal of the History of Medicine and Allied Sciences, . doi:10.1093/jhmas/jrr054. Evered, K. T., & Evered, E.Ö. (2011b). Governing population, public health, and malaria in the early Turkish republic. Journal of Historical Geography, 37(4), 470e482. Evered, K. T., & Evered, E.Ö. (2012). Syphilis and prostitution in the socio-medical geographies of Turkey’s early republican provinces. Health and Place, 18(3), 528e535. Evered, E. Ö., & Evered, K. T. “Protecting the national body”: regulating the practice and the place of prostitution in early republican Turkey. Gender, Place, and Culture, in press. rafyası: Gelibolu Vilayeti. Istanbul: Fahri Cemal. (1925). Türkiye’nin sıhhî-{ içtimaî cog ıtçılık ve Matbaacılık Anonim S¸irketi. Kag Fedunkiw, M. (2003). Malaria films: motion pictures as a public health tool. American Journal of Public Health, 93(7), 1046e1056. Fortna, B. C. (2002). Imperial classroom: Islam, the state, and education in the Late Ottoman Empire. Oxford: Oxford University Press. Foucault, M. (1991). Governmentality. In G. Burchell, C. Gordon, & P. Miller (Eds.), The Foucault effect: Studies in governmentality (pp. 87e104). Chicago: University of Chicago Press. Foucault, M. (2003). Governmentality. In P. Rabinow, & N. Rose (Eds.), The essential Foucault: Selections from essential works of Foucault, 1954e1984 (pp. 229e245). New York: The New Press. Foucault, M. (2007). Security, territory, population: lectures at the Collège de France, 1977e78. In M. Senellart (Ed.), G. Burchell (trans.). Basingstoke: Palgrave Macmillan. Foucault, M. (2008). The birth of biopolitics: lectures at the Collège de France, 1978e79. In M. Senellart (Ed.), G. Burchell (trans.). Basingstoke: Palgrave Macmillan. Friedman, L. D. (Ed.). (2004). Cultural sutures: Medicine and media. Durham: Duke University Press. Gramsci, A. (1971). Selections from the prison notebooks. In Q. Hoare, & G. N. Smith (Eds.). New York: International Publishers. Hannah, M. G. (2000). Governmentality and the mastery of territory in nineteenthcentury America. Cambridge: Cambridge University Press. Hansen, B. (2009). Picturing medical progress from Pasteur to polio: A history of mass media images and popular attitudes in America. Piscataway: Rutgers University Press. rafyası: Sivas Vilâyeti. Istanbul: Hasan Tahsin. (1932). Türkiye’nin sıhhî-{ içtimaî cog Hilâl Matbaası. rafyası: Kayseri Sancag ı. Ankara: Hıfzı Nuri. (1922). Türkiye’nin sıhhî-{ içtimaî cog üd Matbaası. Ög _Ibrahim Edhem. (1925). Türkiye’nin sıhhî-{ içtimaî cog rafyası: Bayezit Vilayeti. ıtçılık ve Matbaacılık Anonim S¸irketi. Istanbul: Kag _Ibrahim Ismail. _ rafyası: Kırs¸ehri Vilayeti. Istan(1925). Türkiye’nin sıhhî-{ içtimaî cog ıtçılık ve Matbaacılık Anonim S¸irketi. bul: Kag Ingram, A. (2011). The Pentagon’s HIV/AIDS programmes: governmentality, political economy, security. Geopolitics, 16(3), 655e674. _ _ Ismet Pas¸a. (1926). Bas¸vekil Ismet Pas¸a Hazretleri’nin nutku. In anonymous. (Ed.), Birinci Millî Türk Tıb Kongresi Müzakerâtı (1e3 September 1925) (pp. 1e4). Istanbul: Kader. Kaplan, S. (2006). The pedagogical state: Education and the politics of national culture in post-1980 Turkey. Stanford: Stanford University Press. lu, M. A. (1998). The People’s Houses and the cult of the peasant in Karaömerliog Turkey. Middle Eastern Studies, 34(4), 67e91. Karpat, K. H. (1963). The People’s Houses in Turkey: evolution and growth. Middle East Journal, 17(1/2), 55e67.

323

Karpat, K. H. (1974). The impact of People’s Houses on the development of communication in Turkey: 1931e1951. Die Welt des Islams, 15(1e4), 69e84. rafyası: Kastamonu Vilayeti. Ankara: Kemal. (1922). Türkiye’nin sıhhî-{ içtimaî cog üd Matbaası. Ög League of Nations. (1925). League of Nations, Health Organisation, Malaria Commission: Report on its tour of investigation in certain European countries in 1924. Geneva: League of Nations. Legg, S. (2005). Foucault’s population geographies: classifications, biopolitics and governmental spaces. Population, Space and Place, 11(3), 137e156. Luckett, G. S., & Gray, H. F. (1923). The elements of public health administration. Philadelphia: P. Blakiston’s Son and Company. Luckett, G. S., & Gray, H. F. (1926). Sıhhat-ı içtimaîye idaresi esasatı, translation. Istanbul: Hamid Matbaası. Makdisi, U. (2002). Ottoman orientalism. The American Historical Review, 107(3), 768e796. rafyası: Çatalca Mehmet Ali. (1991, 1925 original). Türkiye’nin sıhhî-{ içtimaî cog ı. Vilayeti [transcribed by M S Koz]. Istanbul: Çatalca Belediye Bas¸kanlıg rafyası: Nig de Mehmet Hayri. (1994, 1922 original). Türkiye’nin sıhhî-{ içtimaî cog ı [transcribed by I_ Gedik]. Nig de. Sancag rafyası: Sinob Sancag ı. Ankara: Mehmet Said. (1922). Türkiye’nin sıhhî-{ içtimaî cog üd Matbaası. Ög Miller, P., & Rose, N. (2008). Governing the present: Administering economic, social and personal life. Cambridge: Polity Press. itim Bakanlıg ı Köy Kitaplıg ı, no. 2. (1948). Sıtma. Istanbul: Millî Eg itim Millî Eg Basımevi. Mitchell, T. (1991). The limits of the state: beyond statist approaches and their critics. American Political Science Review, 85(1), 77e96. Mitchell, P. (2011). Geographies/aerographies of contagion. Environment and Planning D: Society and Space, 29(3), 533e550. rafyası: Konya Vilayeti. Ankara: Ög üd Nazmi. (1922). Türkiye’nin sıhhî-{ içtimaî cog Matbaası. Nes¸et Ömer. (1926). Sıtma mücadelesi. In Anonymous. (Ed.), Birinci Millî Türk Tıb Kongresi Müzakerâtı (1e3 September 1925) (pp. 253e267). Istanbul: Kader. Özpekcan, M. (2002). Büyük Millet Meclisi tutanaklarına göre Türkiye Cumhuriyeti’nde lık politikası (1923e1933) II. Bölüm. Yeni Tıp Tarihi Aras¸tırmaları, 8, 163e274. sag Packard, R. M. (2007). The making of a tropical disease: A short history of malaria. Baltimore: The Johns Hopkins University Press. Painter, J. (2006). Prosaic geographies of stateness. Political Geography, 25(7), 752e774. Reagan, L. J., Tomes, N., & Treichler, P. A. (2007). Medicine’s moving pictures: Medicine, health, and bodies in American film and television. Rochester: University of Rochester Press. _ Refik Bey. (1926). Sıhhiye ve Muavenet-i Içtimaîye Vekili Doktor Refik Beyefendi’nin nutku. In Anonymous. (Ed.), Birinci Millî Türk Tıb Kongresi Müzakerâtı (1e3 September 1925) (pp. 5e7). Istanbul: Kader. Res¸it Galip. (1929). Sıhhat Koruma Bilgisi. Istanbul: Devlet Matbaası. Resmî Gazete. (6 May 1930). Umumî Hıfzısıhha Kanunu (24 April 1930). Resmî Gazete. Rose, N. (2007). The politics of life itself: Biomedicine, power, and subjectivity in the twenty-first century. Princeton: Princeton University Press. Rosenberg, C. E. (1992). Explaining epidemics and other studies in the history of medicine. Cambridge: Cambridge University Press. Rosenberg, C. E., & Golden, J. (Eds.). (1992). Framing disease: Studies in cultural history. New Brunswick: Rutgers University Press. Russell, E. (2001). War and nature: Fighting humans and insects with chemicals from World War I to Silent Spring. Cambridge: Cambridge University Press. lık Dergisi. (1934). Seyyar tabiplerin vazifeleri hakkında talimatname. Sag lık Sag Dergisi, 10(70), 315e334. lık Dergisi. (1948). Sag lık Dergisi. Fevkalâde Nüsha 25 (Ekim-Kasım 1948), no. 10e11. Sag Said Cemil Bey. (1926). Münakas¸a [“Discussion”dSaid Cemil Bey’s comments on Nes¸et Omer’s paper]. In Anonymous. (Ed.), Birinci Millî Türk Tıb Kongresi Müzakerâtı (1e3 September 1925) (pp. 286e288). Istanbul: Kader. Scott, J. C. (1985). Weapons of the weak: Everyday forms of peasant resistance. New Haven: Yale University Press. Scott, J. C. (1998). Seeing like a state: How certain schemes to improve the human condition have failed. New Haven: Yale University Press. Stein, E. A. (2006). Colonial theatres of proof: representation and laughter in 1930s Rockefeller Foundation hygiene cinema in Java. Health and History, 8(2), 14e44. Süyev, M. (1952). Sıtma savas¸ı çalıs¸maları albümü. Istanbul: Hüsnütabiat Matbaası. TBMMdTürkiye Büyük Millet Meclisi Kütüphanesi (the Library of the Grand National Assembly of Turkey), Ankara, Turkey. _ T.C. Sıhhiye ve Muavenet-i Içtimaîye Vekaleti. (1926). Sıhhî müze atlası. _ T.C. Sıhhî ve Içtimaî Muavenet Vekaleti. (1939). Sıtma. no. 65. Ankara: T.C. Sıhhî ve _Içtimaî Muavenet Vekaleti. _ ız?. no. 86 T.C. Sıhhat ve Içtimaî Muavenet Vekaleti. (1943). Sıtmadan nasıl korunacag _ Ankara: T.C. Sıhhî ve Içtimaî Muavenet Vekaleti. lık ve Sosyal Yardım Bakanlıg ı. (1947). Millî Sag lık Plânı (Birinci On Yıllık). T.C. Sag Sayı no. 124. Ankara: Bas¸bakanlık Devlet Matbaası. _ _ Tekeli, I., & Ilkin, S. (1999). Türkiye’de sıtma mücadelesinin tarihi. In G. E. Kundakcı (Ed.), 70. Yılında Ulusal and Uluslararası Boyutlarıyla Atatürk’ün Büyük Nutuk’u ve _ ¸ lig u Teknik Üniversitesi Basım Is i. Dönemi (pp. 209e255). Ankara: Orta Dog Temel, M. (2008). Atatürk döneminde bulas¸ıcı ve salgın hastalıklarla mücadele. Istanbul: Nehir Yayınları. Tınal, M. (2009). Türkiye Büyük Millet Meclisi birinci döneminde doktor milletvekilleri. Uluslararası Sosyal Aras¸tırmalar Dergisi, 2(6), 617e627.