Masic: 150 Years of Organized Health Care Services in Bosnia and Herzegovina

Izet Masic: The Most Influential Physicians in the Development of Health Care in Bosnia and Herzegovina (article 1 of 3)

Prof Izet Masic MD, PhD Photo: izetmacic.org


Introduction: Austro-Hungarian monarchy had a great impact on the healthcare system in Bosnia and Herzegovina (B&H), and the consequences that exist today. Aim: To launch the section „The Most Influential Physicians in the Development of Health Care in Bosnia and Herzegovina“, in which, within the next issues of the Medical Archives will be presented the prominent physicians, dentists, and pharmacists who gave contributions to the development of healthcare system in B&H.

Results: This paper provides a full overview of the literature about health care circumstances during 150 years in Bosnia and Herzegovina and the importance of the role of health care institutions and of all the doctors working in B&H during the Austro-Hungarian administration.

Some of them devoted more attention to the texts about their life and work and their contribution to the development of the health service in B&H. Also, the author gave descriptions of the others, except for the medical activities who have contributed to our homelands, such as Dr. Jozef Kecet, Dr. Julije Makanec, Dr. Teodora Krajewska, Dr. Josef von Preindlsberger, Dr. Hamdija Karamehmedovic, and others, but there are many more that we should know about and mention them.

Conclusion: The fact is Austro-Hungarian model of the healthcare system in that time was functional for that period and had great improvement in comparison to the past and the fact is that that system represents a basis even for modern medicine in the territory of Bosnia and Herzegovina.


In Bosnia and Herzegovina (B&H), before its occupation by the Austro-Hungarian military in 1878, the territory was covered by the current state and some eastern regions, which belonged to it at the time of its independence, with no major resorts. The state was located in a mountainous region, surrounded by countries of different religions and interests, and conflict had a significant impact on the state and progress (1-3).

There was little literate population, while practically the only literacy gained in madrasas and mosques in Maktab the major towns, the Muslim population, then the monasteries perched in the rugged and little affordable areas, and partly in the Bosnian nobility and gentry.

Epidemics are constantly ravaging almost all of its parts, people are exhausted because it was not drugs (4-6).

Population assistance is sought by a variety of fortune and priests, the wealthy approached Dubrovnik that they are in the city to provide treatment, or that they send a doctor from Dubrovnik (5, 6).

Hospitals and health care and treatment of patients were not established until the second half of the nineteenth century, and the largest percentage of the population is generally treated in their homes (7-10).

The arrival of the Turks in the territory of B&H in 1463 which brought with them a new state structure, significantly changed the views of the entire life of man and society. Turks bring with them experience and medical literature that was adopted from the Arabs, which was already at an extremely high level (11-20).

Turks after his arrival in Bosnia brought a new way of social and personal life, which, in addition to prescribing the maintenance of high levels of personal hygiene, insist on some other activities and measures of personal and social life. Raise the public baths, and every Muslim house had a special form of a home bathroom (5, 6, 7).

Raised in the first water supply, thereby establishing a practical first sanitary facility in B&H. According to data from Alija Karahasanovic (1), up to half of the seventeenth century in 92 towns in B&H, there were a total of 56 public baths, and only the fourth in Sarajevovo He also built public toilets.

The first was built in Kovaci around 1526 and later raised another in the present clock tower at the bazaar, and one on the Miljacka. At each place, they built a public fountain for washing before the regular religious observance, and wealthy citizens brought the water into their backyard (5, 6).

The first modern water supply received Mostar 1886, Sarajevo 1890, Banja Luka 1908, and Tuzla 1910. In 1910 another 36 major sites in B&H received water, and sewage work included a little slower. The first was built in Sarajevo in 1896. In addition, every mosque is built in a public fountain. The very measure of personal hygiene is not sufficient in order to prevent various diseases, especially those of epidemic character, which then ravaged Bosnia and relate the lives of many Bosnians.

Figure 1. “Mahmutćehajina ćuprija” – bridge in front of City hall (Rathaus) in Sarajevo, on the top of the picture is Vakuf’s hospital (Hastahana), built on October 8th, 1866, the first hospital in B&H

The most frequent diseases were: syphilis (which, was apparent by French cruisers and they called “Frenjak”. The first description was from 1790 when local physicians in the village Škrljevo near Rijeka (Fiume), Croatia, reported about “new disease” and named it “Morbus Skrljevo”, in French – “Mal di Fiume”), tuberculosis, leprosy, trachoma, favus, and other fungal diseases, etc. (5).

The last two centuries in B&H, ravaged the acute infectious diseases, some of which are related to epidemics and the lives of endemic diseases cholera, which is frequently penetrated from other countries, smallpox, which in B&H was a frequent and inevitable phenomenon until the 1907 year, followed by typhoid fever and dysentery, due to poor water supply and poor hygiene of foodstuffs, as well as measles, scarlet fever, and diphtheria, among children (5, 6). Regarding mental illnesses, their prevalence, and treatment in the Turkish period, there is not much data.


The health situation in Bosnia and Herzegovina before the arrival of the Ottomans was closely linked with the economic and political situation in the country and depended mainly on interests and opportunities in the surrounding countries. Little has been written by the population consisting mostly of nobles or clerics.

Outbreaks are often ravaged, and the lack of drugs patients are very often killed. A strong influence on the education of the population played the Franciscans in the thirteenth century because they were among the first to begin to deal with health activities and the arrival of Jews from Spain to Bosnia in 1492. Later throughout B&H acting skilled physicians and pharmacists trained in medical schools of East and West.

By the annexation of B&H in 1878, the Monarchy has provided its educated staff from all fields of life and work that build, manage, and improve all forms of life, and also in the field of health care. Inherited health professionals in already built instructions during the rule of Topal Sherif Osman Pasha, and a staff who came from Vienna, Budapest, Bern, Paris, Prague, and other cities of the Monarchy played a very important role in the treatment of the population, all forms of health care and the needs of this population, especially in the prevention of many diseases that were spread in these areas. All the above, it was necessary to organize a good health service in towns and villages, introduce good legislation, build hospitals and health homes, and hire quality, educated staff (5-10).


During the period from the 16th to the 19th century, until the establishment of Vakuf’s hospitals Hastahana’s in the five Bosnian-Herzegovinian cities (Sarajevo, Tuzla, Mostar, Travnik, and Banja Luka), the population in B&H was mostly treated by medicines and herbs from the “ljekarusa’s”  rulebooks or other written documents written by trained but also learned „traditionalist’s“, attar’s (ittar’s), religious staff (hojja’s, friars, etc.); or they were transcripts of medical manuscripts from other languages that have been brought to our country in various ways (Arabic manuscripts of „Avicennian medicine“) (11-20).

More professionals were: barbers (they represented as surgeons) and healers who set the diagnosis and prescribed medication (used alternative medicine). The Franciscans, who studied in Western countries, treated the population with translated or personally written: „ljekarusa’s“ (medicine recipes), preparing herbs from grass, oil, and fat, or acquiring them from attars, the forerunner of pharmacists. Pharmacy has begun in the early 11th century when the monks in Monte Cassino (Italy) began to deal with medicine. This interest is linked to the emergence of the one of oldest medical schools in Europe, in the town of Salerno (Salernum in Campania, Southern Italy). That school had an enormous influence on the development of medicine and pharmacy and health in general in the 12th century.

Numerous works have been translated into such an environment into our languages. One of the most famous parts is “Regimen sanitariums Salernitanum or Flos Medicinae”. This work was in use until the 19th century. In BiH, such writings have emerged from a national experience. The recipes were based on medicinal herbs and superstitions that the people of BiH were inclined to. Drugs are differently accepted from the medical side. Medical historians think that they were created at the time of the fall of ancient medicine, so there were some views on the world such as astrology, alchemy, magic, etc (16-23).

The books of Fr. Franjo Gracic and Fr. Petar Maresevic differ in form and form. In 1895, Fr. Gracic published his medical book in Latin in Padua: „A theoretical and practical analysis of the priests on the behavior of the crazies, the house, and the snake poison, about many other diseases and their main drugs, and some other things“. This work has first published in a book of medical content by one author from B&H. The most famous ljekarusa dates from 1774. It is preserved in Fojnica Monastery, written by a Bosancica.

In 1791 a ljekarusa called “Pharmacopoeia Familiaris Bossinensis” was published. The text „Summary Review of Health and Medical Opportunities of Bosnia and Herzegovina in the Past“, from the “Prosveta Calendar” (issued from 1905 to 1914), Dr. Risto Jeremic (2, 5) talks about health culture in BiH through a brief history. „With the arrival of the Turks, we began to cultivate a healthy culture in Bosnia…

The first graduate doctors of Bosnia were the Franciscans, the Friars of the Italian Universities: Fr. Petar Bustrović (1708), Fr. Franjo Gracic (1720- 1799), Fr. Tadija Lagarevic (1761-1840) Fr. Mato Nikolic (1784-1844), Fr. Tomo Dafinic, Fr. Petar Maresevic (since 1837 he was the first doctor of medical sciences in B&H) and Fr. Mijo Sucic (since 1850 he was the first specialist in surgery in B&H). Ivan Franjo Jukic founded the first journal in BiH „Bosnian Friend“. Drugs and recipes were published there. Until then, they were released in some other editions, most often in calendars. In 1795, Fr. Franjo Gracic printed a medical booklet in Latin on the treatment of certain diseases. Fr. Mato Nikolic graduated medicine in Feldsberg in 1807 and he is the first doctor in the history of B&H.

In his personal skill was physician-surgeon Fr. Mijo Sucic (died 1865). Numerous documents testify that the Franciscans in their medical practice aided all people, regardless of their religious or other differences. In Italy, he graduated from Padua in 1850 and he was graduated from Sarajevo by Isaac Salom, a military doctor and a member of the Sarajevo Administrative Council. The first physicians of Muslims were Mehmed Serbic and Zarif Skender, who graduated in Istanbul in 1873. At the end of the 18th and early 19th centuries in Sarajevo, practitioners of Jews: Jozef Haim Salom and Samuel Sumbul. There were also foreign doctors, such as Dr. Franz ?, Dr. Pavle Kramer, Dr. Gustav Gaal Velibeg, and Dr. Gabor Galanthay.

By the middle of the 19th century, the Turks or Greeks worked in BiH, often serving Turkish military sanitation. The first among them was the Swiss Jozef Kecet, who was a personal physician of Omer Pasha Latas, and later Topal Sherif Osman Pasha, and his bibliographer, who left two books with a factorial description of events in B&H during that period. The new power of laws and regulations initiates the construction of new, more modern health care institutions to primarily protect their new citizens. The health service is organized according to the laws governed by the Monarchy itself. A major obstacle to these efforts was the conservative perception of the local population, the lack of financial resources, and the educated medical staff. For this reason, a special department was established at the State(Land) Government in Sarajevo, headed by a doctor from the Austro-Hungarian Monarchy.

Figure 2. The network of health care institutions in B&H was built up during the Austro-Hungarian period, in 1901. Cover page of the book “The Roots of Medicine and Health Care in Bosnia and Herzegovina”, written by Izet Masic

There are 6 districts from Bihac, Banja Luka, Mostar, Sarajevo, Travnik, and Tuzla, and they are placed at the expense of the terrestrial budget, with an annual salary of 1200 forints. Each county has represented a special healthcare community with one doctor who performs health care services privately and manages its own home apothecary. The poor population was treated free of charge.

At the time of occupation, the city of Sarajevo had two Turkish hospitals (Figure 1) Vakuf’s and Military (both opened in 1866), and a quarantine (Churche Han). The military hospital was a closed type and used for stationary treatment, mostly for soldiers, and the Vakuf’s hospital had modest capacities (a total of 40 beds). There were four trained doctors: Dr. Theophil Koetschet, Dr. Leopold Kramer, Jacov(b) Sumbul and Rafo Atijas. There was a modern pharmacy in which Eduard Plajell worked, who came to Sarajevo in 1877 (5, 6).

On the basis of the Austro-Hungarian Government’s order of 1879, all „promoted, graduate or probed doctors, ranches (Wundaerzte), dentists, veterinarians and midwives who attended school at the appropriate school establishments in the Austro-Hungarian Monarchy are allowed to practice in B&H. That is why all doctors had to file a healthcare application. They were obliged to do the practice neatly, keeping a professional secret.

With the Austro-Hungarian annexation of Bosnia and Herzegovina in 1878, the state is changing its material base and social structure. With the occupation army, came skilled workers: the Germans, Hungarians, Czechs, Polish, and others who build the barracks, railways, and housing for the military. All of them must be well-organized health services. It called for the formation of the first social insurance funds, so in 1888 Bosnia formed the so-called fraternal insurance fund intended for minors, such as those that have already been formed on the territory of Slovenia, Croatia, and Dalmatia in 1854, and Serbia in 1866.

True, the social legislation in Austria dates back to 1810, and from 1887- 1888 was released in Austria the Health Insurance Act (5, 6). The Government of Bosnia adopted a Law on Social Insurance, which entered into force in 1910. Otherwise, the Basic Health Act was passed in Austria in 1870, and in Hungary in 1876 (the law written by renowned hygienist Fodor). These data suggest that illustrate the Austro-Hungarian Empire took strict care of the health care of your appliances and citizens of countries that were occupied. According to the unique concept of the organization, socially oriented health services, with strict organizational principles proclaimed that every hospital (district, county, municipal), each clinic must arrange the outpatient service and maintain appropriate hygiene and safety measures.

First, so-called „Necessary hospitals“ (Notsspittaler) which had a small number of beds and only the most basic equipment were founded, and since 1886 the construction of the so-called „municipal hospitals“ that were run by municipal doctors or district doctors.

Such hospitals were founded in Tuzla (1886, 30 beds), Prijedor (1886, 13 beds), Brcko (1886, 16 beds), Mostar

(1887, 42 beds), Konjic (1889, 14 beds), Banja Luka, 64

beds), Visegrad (1896, 11 beds), Bijeljina (1900, 27 beds),

Trebinje  (27  beds),  Foca  (6  beds),  Prnjavor  (20 beds),

Bosanski Novi (20 beds), Derventa (32 beds). From 1892 to 1903 county hospitals were founded in Kotor Varos, Kladanj, Srebrenica, Cazin, Livno, Vares, Gacko, Kljuc, and Gorazde (see Health institutions network in 1901 in Figure 2).

In 1879, a total of 7 doctors were employed in the civil service in BiH, and in 1893, that number in- creased to 64, out of which 41 were in the civil service, 19 were in municipal services, and 3 doctors worked only as private doctors. The end of the Austro-Hungarian rule in BiH is characterized by the increased number of healthcare staff, so that the total number of doctors in BiH amounted to 168, out of which 106 were in the state administration, 30 in the municipality, in the company and factory 9, in the terrestrial railways 5, and there were 18 private doctors. By taking the Austro-Hungarian monarchy into power in Bosnia, the social structure is changing. Qualified workers from Germany, the Czech Republic, Hungary, and Poland are eligible to settle. Railways, barracks, residential buildings, and hospitals are built.

The lack of hospital capacities was motivated by the authorities to build the State/Provincial (“Landesspital”) in Sarajevo, which was built and opened on July 1, 1894. In the “State Hospital” were employed high-quality doctors who, besides the clinical part, also engaged in scientific research in the field of medicine. So many of the scientific and professional papers that were recognized outside the borders of B&H were also published. Many of them were published in the first scientific journal in B&H  “The Annual of the State hospital in Sarajevo – Godisnjak Zemaljske bolnice u Sarajevu”, which dates from 1897 to 1903 in German.

At the beginning of the First World War in 1914, a total of 234 physicians, 141 inpatients, 8 dentists, and 71 MA Pharmacists worked in 17 hospitals (837 beds), 58 municipal ambulances, and 43 public pharmacies. On average, one inhabitant had 0.6 beds, one physician was 12.912, one had 16.222 inhabitants and one apothecary had 40.384 inhabitants.

Notice: The column is divided into three articles!

Masic: 150 Years of Organized Health Care Services in Bosnia and Herzegovina 2/3

Masic: 150 Years of Organized Health Care Services in Bosnia and Herzegovina 3/3

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