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i

Containing Balkan Nationalism

ii

RELIGION AND GLOBAL POLITICS

SERIES EDITOR
John L. Esposito
University Professor and Director
Prince Alwaleed Bin Talal Center for Muslim-​Christian Understanding
Georgetown University
ISLAMIC LEVIATHAN
Islam and the Making of State Power
Seyyed Vali Reza Nasr
RACHID GHANNOUCHI
A Democrat Within Islamism
Azzam S. Tamimi
BALKAN IDOLS
Religion and Nationalism in Yugoslav States
Vjekoslav Perica
ISLAMIC POLITICAL IDENTITY IN TURKEY
M. Hakan Yavuz
RELIGION AND POLITICS IN POST-​COMMUNIST ROMANIA
Lavinia Stan and Lucian Turcescu
PIETY AND POLITICS
Islamism in Contemporary Malaysia
Joseph Chinyong Liow
TERROR IN THE LAND OF THE HOLY SPIRIT
Guatemala under General Efrain Rios Montt, 1982–​1983
Virginia Garrard-​Burnett
IN THE HOUSE OF WAR
Dutch Islam Observed
Sam Cherribi
BEING YOUNG AND MUSLIM
New Cultural Politics in the Global South and North
Asef Bayat and Linda Herrera
CHURCH, STATE, AND DEMOCRACY IN EXPANDING EUROPE
Lavinia Stan and Lucian Turcescu
THE HEADSCARF CONTROVERSY
Secularism and Freedom of Religion
Hilal Elver
THE HOUSE OF SERVICE
The Gülen Movement and Islam’s Third Way
David Tittensor
MAPPING THE LEGAL BOUNDARIES OF BELONGING
Religion and Multiculturalism from Israel to Canada
Edited by René Provost
RELIGIOUS SECULARITY
A Theological Challenge to the Islamic State
Naser Ghobadzadeh
THE MIDDLE PATH OF MODERATION IN ISLAM
The Qur’ānic Principle of Wasaṭiyyah
Mohammad Hashim Kamali
CONTAINING BALKAN NATIONALISM
Imperial Russia and Ottoman Christians, 1856–​1914
Denis Vovchenko
iii

Containing
Balkan
Nationalism
Imperial Russia and Ottoman
Christians, 1856–​1914
z
DENIS VOVCHENKO

1
iv

1
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.

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© Oxford University Press 2016

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a retrieval system, or transmitted, in any form or by any means, without the
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above should be sent to the Rights Department, Oxford University Press, at the
address above.

You must not circulate this work in any other form

and you must impose this same condition on any acquirer.

Library of Congress Cataloging-in-Publication Data

Names: Vovchenko, Denis.
Title: Containing Balkan nationalism : imperial Russia and Ottoman
Christians, 1856–1914 / Denis Vovchenko.
Description: New York, NY : Oxford University Press, [2016] | Includes index.
Identifiers: LCCN 2015050170 | ISBN 9780190276676 (hardback : alk. paper)
Subjects: LCSH: Russia—Relations—Balkan Peninsula. | Balkan
Peninsula—Relations—Russia. | Turkey—Relations—Balkan Peninsula. |
Balkan Peninsula—Relations—Turkey. | Balkan Peninsula—Ethnic
relations—History—19th century. | Balkan Peninsula—Ethnic
relations—History—20th century. | Nationalism—Balkan
Peninsula—History. | Christianity and politics—Balkan
Peninsula—History. | Eastern churches—Balkan Peninsula—History. |
Religious minorities—Balkan Peninsula—History. | BISAC: HISTORY / Europe /
Eastern. | HISTORY / Military / World War I.
Classification: LCC DR38.3.R8 V68 2016 | DDC 949.6/038—dc23 LC record available
at http://lccn.loc.gov/2015050170

1 3 5 7 9 8 6 4 2
Printed by Sheridan Books, Inc., United States of America
v

To my wife
vi
vii

Contents

Preface ix

Acknowledgments xi

Introduction 1

1. Russian Messianism in the Christian East (1453–​1853) 19

2. Building an Ottoman Civic Nation: Secularization

and Ethnicization of Christian Minority Institutions (1853–​1860) 67

3. The Bulgarian Minority in Search of Ottoman

and Orthodox Autonomous Institutions (1860–​1870) 106

4. Reconciling Rival Ottoman Orthodox Churches (1870–​1875) 145

5. Making Peace in Times of War (1875–​1885) 191

6. Coping with State-​Sponsored Balkan Irredentism (1885–​1914) 242

7. Russians and Muslim Slavs: Brothers or Infidels? (1856–​1914) 296

Conclusion 329

Index 335
viii
ix

Preface

I should add a note on historical dates, geographical names, and terms.

Throughout the period under investigation, all Orthodox lands relied on the
Julian Calendar (also known as the Old Calendar), which was twelve days
behind the Gregorian Calendar in the nineteenth century. Unless otherwise
noted, the dates in the book will reflect that usage. I tried to follow the same
principle with place names. That is why I use “Constantinople” instead of
“Istanbul” or “Philippoupolis” instead of “Plovdiv.” Generally, for majority-​
Slavic northern Balkan provinces, I used common Serbian and Bulgarian
names rather than archaic Greek terms, for example, “Sliven” instead of
“Silimnos.” I followed conventional usage of key historical terms and names,
for example, “Russo-​Turkish War” instead of “Russo-​Ottoman War.” For the
most part, I have transliterated modern Greek, Slavic, and Turkish names
according to the Library of Congress System. Unless indicated otherwise, all
translations are my own. Below are the most important abbreviations.

GARF (State Archive of the Russian Federation, Moscow)

RGVIA (Russian State Military History Archive, Moscow)
RGALI (Russian State Archive for Literature and Art, Moscow)
AVPRI (Russian Imperial Foreign Policy Archive, Moscow)
OPI GIM (Manuscript Division of the State Historical Museum, Moscow)
OR RGB (Russian State Library Manuscript Division, Moscow)
RGIA (Russian State Historical Archive, St Petersburg)
OR RGPB (Russian State Public Library, Manuscript Division, St Petersburg)
AYE (Greek Foreign Ministry Archive, Athens)
ELIA (Greek Archive for History and Literature, Athens)
AEP (the Archive of the Ecumenical Patriarchate, Istanbul)
x
xi

Acknowledgments

This book had its start as my doctoral dissertation. First of all, I am grate-
ful to all my professors at the University of Minnesota, who trained me as
a historian and introduced to me some key political science concepts and
models. My advisor, Theofanis G. Stavrou, has truly changed my life. He in-
spired me to pursue this particular topic and to concentrate on Greek-​Russian
relations. He put together a wonderful dissertation committee including Drs.
Ron Aminzade, Caesar Farah, John Kim Munholland, and Martin Sampson.
Thanks to Kyria Freda Stavrou and Soterios G. Stavrou, my wife and I quickly
overcame the culture shock when we moved from Russia to Minnesota. The
pride that my wife and parents felt for me helped me persevere through many
years of coursework in Moscow and Minneapolis.
The University of Minnesota also funded most of my dissertation research
in the Russian archives with the Dunn Peace Fellowship, the Graduate School
Thesis Research Grant, and the History Department Thomas S. Noonan
Fellowship. My research in Greece was made possible by the Allison F. Frantz
Fellowship sponsored by the American School of Classical Studies at Athens.
Dr. Maria Georgopoulou and her amazing staff went out of the way to make
me feel comfortable in the stacks of the Gennadius Library in 2006 and 2007.
For several months, Loring Hall became a home away from home for me and
my wife.
Northeastern State University in Tahlequah had enough faith in me to
give me a job and to sponsor two of my summer trips through the Faculty
Research Council in 2009 and 2010. The College of Liberal Arts at NSU fa-
cilitated another research trip when it matched the Oklahoma Humanities
Council Summer Research Grant in the summer of 2013. The fellowship from
the American Research Institute in Turkey enabled me not only to improve
my Turkish-​language skills but also to access the archive of the Patriarchate
of Constantinople where Father Vissarion, Kyrios Kostas, and Kyrios Petros
opened my eyes to the past and present of the Orthodox community in Istanbul.
xii

xii Acknowledgments

On many occasions, I found in Ada Dialla, Iannis Karras, and Andreas

Sideris a living example of how to connect Greek and Russian cultures. It was
a great relief when Kyria Efthimia Papaspirou quickly gave her permission to
publish some rare posters I photographed at the Greek Historical Museum.
Under Alla Vladimirovna Rudenko, the reading room of the Russian Imperial
Foreign Policy Archive became a very welcoming place to me and other re-
searchers. Nina Ivanovna Abdulaieva was very patient with me when I began
exploring the holdings of the State Archive of the Russian Federation.
I am enormously grateful to the editors and the anonymous readers at
Oxford University Press for their valuable feedback. My colleagues are a com-
munity of teacher-​scholars who created a healthy intellectual environment
at NSU and encouraged me to keep improving my manuscript. Brad Agnew
and Norm Carlisle made extremely useful comments after reading my intro-
duction. Sylvia Nitti helped me modify Map 4.1 and deal with the challenges
of Greek handwriting. A special thanks goes to Donna Graham and Misti
Hanrahan, who have turned the Interlibrary Loan into an indispensable ser-
vice and tirelessly request dauntingly exotic materials for me.
xiii

Containing Balkan Nationalism

xiv
1

Introduction

The Balk ans had long fascinated the political imagination of Russian com-
mentators of all ideological stripes. Reporting on the Balkan Wars of 1912–​1913
for a Kiev newspaper, Leon Trotsky wrote, “The effects of the war demonstrate
only too clearly to the Balkan nations and first of all to Serbia that they can exist
only in a permanent economic and political federation.”1 Unlike Trotsky, most
Russian scholars and journalists who were interested in the Balkans tended
to be on the right wing of the political spectrum. They saw Russia as part and
parcel of a Balkan federation—​a vision rooted in a long history of messianic im-
perialism. Several months before the Russo-​Turkish War of 1877–​1878, Fyodor
Dostoevsky justified Russia’s right to take possession of Constantinople “as the
leader, protector, and guardian of Orthodox Christianity—​the role it was des-
tined to play since Ivan III who had elevated the double-​headed eagle of Tsargrad
over Russia’s ancient symbols.” Only that kind of claim would be acceptable to
both Balkan Slavs and Greeks, divided by ethnicity but united in faith.2
A future union of Russia and Balkan Christians was not always imag-
ined on the ruins of the Ottoman Empire. Some advocated including Turkey
into a Balkan federation. Still, the words of Trotsky and Dostoevsky capture
the many tensions that developed in contemporary views on Russian cultural
identity and foreign policy at the turn of the twentieth century. Secular nation-
alism was violently redrawing the map of Europe throughout the 1800s: Italy
and Germany became unified and the new nation-​states of Greece, Serbia,
Montenegro, Rumania, and Bulgaria emerged from the slow breakup of the

1. Trotsky, Leon, “Serbia v siluetakh,” in Andrei Shemiakin, ed., Russkiie o Serbii i ser-
bakh (St. Petersburg: Aleteia, 2006), p. 522. Unless otherwise noted, all translations into
English are mine.
2. Dostoevsky, Fyodor, “Dnevnik pisatelia. 1876,” in Dnevnik pisatelia (Moscow: Institut
russkoi tsivilizatsii, 2010), p. 376.
2

2 C on t a ining B a l k a n Na tiona l ism

Ottoman Empire. The debates about the significance of Russia’s connec-

tion to the Balkans reflected and to some extent even shaped the efforts of
Russian, Ottoman, Greek, Bulgarian, and Serbian statesmen and prelates to
adapt the newly politicized concept of ethnicity to existing religious and dy-
nastic structures.
The Bulgarian Church Question was one of those issues facing the po-
litical and religious leaders in Eastern Europe. My book focuses on the con-
sequences of the Bulgarian movement for independence of their national
church from the Ecumenical Patriarchate of Constantinople between 1856
and 1914. The story goes back to 1453 when the Ottoman Turks had com-
pleted their conquest of the Christian Balkan kingdoms and the Byzantine
Empire with the storming of Constantinople. By the early 1500s, they had
conquered the Arab Muslim states and taken control of what is today the
Middle East. With their capital in Constantinople, the Ottomans chose the
Patriarch of that city as the head of all Orthodox Christian churches in their
domains. As the only official mediator between the Orthodox Christians and
the Ottoman government, he was thus responsible for collecting taxes, ad-
ministering justice, and maintaining schools and charities. The Patriarchate
of Constantinople used its position to absorb the previously autonomous
Bulgarian and Serbian churches and to acquire great influence over the elec-
tions of chief prelates in ancient patriarchates of Alexandria, Jerusalem, and
Antioch.3
Already in the 1500s, ethnic Greeks or Hellenized locals had occupied
key positions in all Ottoman dioceses and introduced Greek as the language
of liturgy and instruction at urban schools.4 Some middle-​class non-​Greek
Christians, especially lower-​level clerics, increasingly resented this domina-
tion and their discontent crystallized in the mid-​1800s with a new ideology
of nationalism, which explicitly gave political significance to cultural distinc-
tions.5 In the aftermath of the French Revolution, the idea of national sover-
eignty challenged the rule of divinely ordained kings. All that was solid was
melting in the air in the 1800s despite the best efforts of conservative and

3. Runciman, Steven, The Great Church in Captivity (Cambridge: Cambridge University

Press, 1968), pp. 165–​185; Haddad, Robert, Syrian Christians in a Muslim Society: An
Interpretation (Princeton: Princeton University Press, 1970), pp. 63–​64.
4. Hopkins, James Lindsay, The Bulgarian Orthodox Church: A Socio-​Historical Analysis
of the Evolving Relationship Between Church, Nation, and State in Bulgaria (Boulder: East
European Monographs, distributed by Columbia University Press, New York, 2009),
pp. 56–​57.
5. Genchev, Nikolai, The Bulgarian National Revival Period (Sofia: Sofia Press, 1977),
pp. 36–​41.
3

Introduction 3

legitimist monarchs of the post-​Napoleonic Holy Alliance and the Concert of

Europe to maintain the status quo.6
In the Ottoman Empire, nationalism first developed among the Christians,
who unlike the Muslims had maintained closer contacts with Europe. From
1821 to 1830, the Greeks rebelled against the Ottoman sultan and created a tiny
but ambitious national kingdom in parts of mainland Greece. It then sought
to expand its influence in the Ottoman Balkans and the Middle East through
the ethnically Greek leadership of the Patriarchate of Constantinople.7 This
aggressive irredentist policy further politicized the ethnic divisions within
Orthodox Christian communities. In reaction, prosperous Bulgarian mer-
chant and craft guilds in Constantinople and Philippoupolis (modern Plovdiv)
became the core of an emerging Bulgarian nationalist movement directed
against the Patriarchate of Constantinople.8
The movement violated the principles of the Orthodox Church because it
rejected precise territorial boundaries and aimed at incorporating all Slavic-​
speaking Christians into its future church, thereby tearing apart mixed Greek-​
Bulgarian-​ Serbian communities. Independent church status meant legal
and cultural autonomy within the Islamic structure of the Ottoman Empire,
which recognized religious minorities rather than ethnic ones. With that in
mind, Bulgarian nationalist leaders appealed to the Ottoman government di-
rectly but also attempted to enlist the support of the European Great Powers.9

6. Schroeder, Paul, “The 19th-​Century International System: Changes in the Structure,”

World Politics, 39, 1 (October 1986): 1–​26.
7. Skopetea, Elli, To “protypo vasileio” kai i Megali Idea: Opseis tou ethnikou provlimatos
stin Ellada, 1830–​1880 (Athens: Polytypo, 1988); Grishina, Ritta, “Fenomen Bolgarskoi
Pravoslavnoi Tserkvi (1870–​1940e gg),” in Chelovek na Balkanakh: Sotsiokulturnye izmene-
niia protsessa modernizatsii (seredina XIX v—​seredina XX v) (St. Petersburg: Aletheia, 2007),
p. 228.
8. Mazhdrakova-​Chavdarova, Ogniana, “Bulgarskoto natsionalno predstavitelstvo—​idei i
opiti za suzdavaneto my (40-​te–​60-​te godini na XIX vek),” Istoricheskii Pregled, 49, 4–​5
(1993): 21–​54.
9. Clarke, James, Bible Societies, American Missionaries & the National Revival of Bulgaria
(New York: Arno Press and New York Times, 1971); Clarke, James F., “Protestantism and
the Church Question in 1861,” in Hupchick, Dennis, ed., The Pen & the Sword: Studies in
Bulgarian History by James F.Clarke (Boulder: East European Monographs. Distributed
by Columbia University Press, New York, 1988), pp. 328–​344; Merdzanov, Ivan, “Die
Habsburgermonarchie und die katholischen Missionen in den Bulgarischen Landen im
18. –​19. Jh.,” Bulgarian Historical Review, 2 (1994): 31–​59; Genchev, Nikolai, “Frantsia i
Bulgaro-​Grutskite tsurkovni otnoshenia prez 50–​70-​te godini na XIX v.,” Istoricheski
Pregled, 32, 4 (1976): 31–​56; Genov, Rumen, “Bulgarskoto tsurkovno-​natsionalno dvizhenie
v kraia na 60-​te godini na XIX v. prez pogleda na angliiskata diplomatsia,” Istoricheskii
Pregled, 42, 5 (1986): 73–​7 7.
4

4 C on t a ining B a l k a n Na tiona l ism

As the only major Orthodox Christian state, Russia was the obvious coun-
try for Bulgarian nationalists to turn to. Traditionally, however, the Russian
tsars backed the Patriarchate of Constantinople as the institutional bedrock of
their influence in the so-​called Christian East—​t he Russian term for the area
populated by Orthodox Christians of the Ottoman Empire.10
In February 1870, the Bulgarian church was established by the Sultan’s
decree as the “Exarchate” without the consent of the Patriarchate. The inabil-
ity to reach a compromise on the issue of jurisdictional and territorial delimi-
tation of mixed Greek-​Slavic areas led to the convening of the Local Council
of Ottoman Christian Orthodox churches in September of 1872. The Council
proclaimed as schismatics the Bulgarian church movement leaders and those
affiliated with them for having brought phyletismos or ethnonational divisions
into the Church. This Schism accelerated the ongoing splintering of the
previously united Ottoman Christian community and led to a series of local
armed conflicts in Ottoman Macedonia and Thrace, which would ultimately
snowball into the Balkan Wars of 1912–​1913 and influence the alignments of
the Balkan states in World War One.11

Research Objectives
I will demonstrate that Russian intellectuals and diplomatic, military, and
ecclesiastical agents especially on the higher level tirelessly worked with the
Ottoman government, rival churches, and various European diplomats to rec-
oncile the parties of the conflict based on the preservation of the overarch-
ing Orthodox Christian identity and the institution of the Patriarchate. This
experience will help direct today’s international efforts aimed at containing
ethnic nationalism and associated conflict in divided societies by promoting
federative and power-​sharing arrangements based on existing traditions and
structures.
Clearly, Russian officials and commentators were motivated by the need
to restore the unity of their traditional clientele in a geopolitically strategic
area. At the same time, many of them argued that the Patriarchate was more
consistent with the religious and dynastic foundations of both the Ottoman
and Russian Empires than was the ethnocentric Bulgarian Church. For the

10. Trubetskoi, Grigorii, “Rossia i Vselenskaia patriarkhia posle Krymskoi voiny (1856–​
1860),” Vestnik Evropy, 4 (1902): 549–​592; 5 (1902): 5–​51; and 6 (1902): 469–​507.
11. Stavrianos, Leften, “L’Institution de l’Exarcat Bulgare: Son influence sur les relations
inter-​Balkaniques,” Les Balkans, 11 (1939): 56–​69; Aarbakke, Vemund, Ethnic Rivalry and
the Quest for Macedonia, 1870–​1913 (Boulder: East European Monographs. Distributed by
Columbia University Press, New York, 2003).
5

Introduction 5

Russians, patching up Greco-​Slavic family feuds would stabilize the Ottoman

Empire, increase Russian influence, and empower Christian minorities
in regard to the Muslim majority and the centralizing Ottoman policies.
Responding to this strong political and cultural demand, scholars, clerics,
and journalists in Orthodox Christian centers in Russia and the Balkans
modernized the meaning of the Christian East as a source of new suprana-
tional alternatives to Western-​inspired secular nationalism.
Furthermore, my analysis of various abortive and successful attempts to
defuse ethnonationalism inside Ottoman Christian minority institutions may
offer another perspective on “consociationalism” or power-​sharing facilitated
by external involvement such as diplomacy, direct military occupation, inter-
national supervision of local police forces, and the press. The efforts of the
Ottoman authorities, Russian and Balkan diplomats, intellectuals, and prel-
ates often converged to strengthen the Orthodox Christian identity shared by
all parties to the conflict as the basis for territorial and hierarchical church au-
tonomy. Although the Bulgarian church was primarily ethnically based, from
the viewpoint of both the theocratic Ottoman state and canon law, it had to
remain part of the Orthodox minority led by the Patriarchate of Constantinople
if it wanted to operate legally.
Elements of democratic governance also developed in this process of
adapting traditional institutions to the challenge of nationalism. The ar-
rangements hammered out by the Ottoman government and Russian
diplomats and ecclesiastics enabled the followers of the Patriarchate of
Constantinople and the Bulgarian church movement to elect their repre-
sentatives to communal councils on the local and imperial levels. Their
lay members were instrumental in the selection of the bishops assigned
to their dioceses. The main difficulty was to move both parties to agree
on the territorial jurisdiction of each church and on the respective ethnic
minority rights within predominantly Slavic and Greek-​speaking Balkan
dioceses.

Mapping the Literature, Staking Out the Argument

My research contributes to the discussion of several important issues in
European and Middle Eastern history. To encourage interdisciplinary dia-
logue, I will draw on political science models of resolution and management
of conflicts caused or exacerbated by irredentism. Specifically, I will apply the
concepts of federation and power-​sharing to make sense of various Russian
initiatives to prevent internal and external nationalist agitation from destroy-
ing the Patriarchate of Constantinople.
6

6 C on t a ining B a l k a n Na tiona l ism

The book relies on a variety of archival and published sources from Russia,
Greece, Turkey, and Bulgaria to shed more light on the murky waters of the
Eastern Question. This curious name refers to the problem of Ottoman de-
cline and uncertainty over the future control of lands stretching from the
Danube to the Tigris and Euphrates. Historians have usually discussed the
Eastern Question as a purely diplomatic issue involving the European Great
Powers and the newly established small but rapacious Balkan nation-​states
from the late 1700s to the end of the Great War.12
My analysis will help broaden the horizons of the Eastern Question by
examining the extremely creative clash of modern and traditional paradigms
that affected not just politics and institutions but also popular loyalties and
identities at the time. As such, my book will be part of the study of the enor-
mously rich cultural aspects of the rivalry over the influence on the Balkans
and the Middle East started by Theofanis Stavrou.13
Within this historiography of the Eastern Question, my book is the first
one to examine the Bulgarian Church Question in its entirety rather than

12. Key works include Macfie, A. L., The Eastern Question, 1774–​1923 (London and
New York: Longman, 1996); Goldfrank, David, The Origins of the Crimean War (London
and New York: Longman, 1994); Jelavich, Barbara, Russia’s Balkan Entanglements, 1806–​
1914 (Cambridge and New York: Cambridge University Press, 1991); Schoellgen, Gregor,
Imperialismus und Gleichgewicht: Deutschland, England und die orientalische Frage 1871–​1914
(Munich: R. Oldenbourg Verlag, 1984); Rossos, Andrew, Russia and the Balkans: Inter-​Balkan
Rivalries and Russian Foreign Policy, 1908–​1914 (Toronto and Buffalo: University of Toronto
Press, 1981); Millman, Richard, Britain and the Eastern Question, 1875–​78 (Oxford: Oxford
University Press, 1979); Georgiev, Vladimir et al., eds., Vostochnyi vopros vo vneshnei poli-
tike Rossii (konets XVIII–​nachalo XXv.) (Moscow: Nauka, 1978); Jelavich, Charles and
Barbara, The Establishment of the Balkan National States, 1804–​1920 (Seattle: University
of Washington Press, 1977); Kofos, Evangelos, Greece and the Eastern Crisis, 1875–​1878
(Thessaloniki: Institute for Balkan Studies, 1975); Schroeder, Paul, Austria, Great Britain,
and the Crimean War: The Destruction of the European Concert (Ithaca: Cornell University
Press, 1972); Anderson, M. S., The Eastern Question, 1774–​1923: A Study in International
Relations (New York: St. Martin’s Press, 1966); Jelavich, Charles, Tsarist Russia & Balkan
Nationalism: Russian Influence in the Internal Affairs of Bulgaria & Serbia, 1879–​1886 (Berkeley
and Los Angeles: University of California Press, 1958); Taylor, A. J. P., The Struggle for
Mastery in Europe, 1848–​1918 (Oxford: Oxford University Press, 1956); Temperley, Harold,
England and the Near East (London and New York: Longman, 1936); Driault, Edouard, La
Question D’orient depuis ses origines jusqu’à la Paix De Sèvres (Paris, 1921).
13. Stavrou, Theofanis, Russian Interests in Palestine, 1882–​1914: A Study of Religious
and Educational Enterprise (Thessaloniki: Institute for Balkan Studies, 1963); Batalden,
Stephen, Catherine II’s Greek Prelate: Eugenios Voulgaris in Russia, 1771–​1806 (Boulder: East
European Monographs; New York: Distributed by Columbia University Press, 1982);
Bruess, Gregory, Religion, Identity and Empire: A Greek Archbishop in the Russia of Catherine
the Great (Boulder: East European Monographs; New York: Distributed by Columbia
University Press, 1997); Prousis, Theophilus, Russian Society and the Greek Revolution
(DeKalb: Northern Illinois University Press, 1994); Dialla, Anta, E Rosia Apenanti sta
Valkania: Ideologia kai Politike sto Devtero Miso tou 19ou Aiona (Athens: Alexandreia, 2009).
7

Introduction 7

in its separate stages.14 The existing scholarly literature on the Bulgarian

Church Question has added greatly to our knowledge of its major events and
developments. But it suffers from a teleological reading of local Balkan and
general European history. Whether in its nationalistic or less partisan form,
it privileges Bulgarian or Greek or Serbian nationalists over the allegedly out-
dated religious and dynastic alternatives.
Most scholarly studies on this topic are deterministic narratives explaining
how Ottoman Christian provinces and their populations came to be partitioned
and nationalized by 1912–​1922, with the focus mainly on which irredentist
movement was gaining the upper hand at a given time. They hardly ever dis-
cuss the possibility of containing Balkan nationalism outside or within tradi-
tional Ottoman institutions, thereby giving short shrift to efforts to propose a
supra-​nationalist alternative. Nationalist historians have generally dominated
the field, repeatedly presenting the typically primordialist account of eternal
nations acting as sleeping beauties until the late 1700s when they suddenly
began to “awaken” from Ottoman slumber and stupor. This “revival” natu-
rally led to national “liberation” struggles of varying degrees of intensity and
the gradual but inexorable “unification” of “unredeemed brethren” with their
“homelands.”15
Turkish academics turn this argument on its head by reversing the
heroes and villains. They tend to portray Ottoman Christians generally and
the Greek-​dominated Patriarchate of Constantinople specifically as ungrate-
ful and even treacherous subjects who supposedly rejected the blessings of
Ottoman tolerance and kept hatching up conspiracies to restore the medieval
kingdoms that were smashed by the early Ottoman sultans. Those intrigues

14. Bondareva, Victoria, Bolgarskii Ekzarkhat v 1878–​1897 godakh (unpublished Ph.D. dis-
sertation. Krasnodar: Kuban State University, 2006); Aarbakke, Vemund, Ethnic
Rivalry and the Quest for Macedonia, 1870–​1913 (Boulder: East European Monographs;
New York: Distributed by Columbia University, 2003); Lange-​ A khund, Nadine, The
Macedonian Question, 1893–​1908, from Western Sources (Boulder: East European
Monographs; New York: Distributed by Columbia University, 1998); Markova, Zina,
Bulgarskata ekzarkhia, 1870–​1879 (Sofia: Bulgarian Academy of Sciences, 1989).
15. See for example Papaconstantinou, Michael, “The Struggle of Hellenism over
Macedonia,” Balkan Studies, 1 (1960): 129–​1 42; Pundeff, Marin, “Bulgarian Nationalism,”
in Sugar, Peter, and Lederer, Ivo, eds., Nationalism in Eastern Europe (Seattle: University
of Washington Press, 1969), pp. 93–​ 98; Nikov, Petur, Vuzrazhdane na bulgarskiia
narod: Tsurkovnonatsionalni borbi i postizhenia (Sofia: Nauka i Izkustvo, 1971 [1929]);
Dakin, Douglas, The Unification of Greece, 1770–​1923 (New York: St. Martin’s Press, 1972);
Vakalopoulos, Konstantinos, O Voreios Ellinismos kata ten proime fase tou Makedonikou
Agona (1878–​1894) (Thessaloniki: Institute for Balkan Studies, 1983); Vakalopoulos,
Konstantinos, Modern History of Macedonia, 1830–​1912: From the Birth of the Greek State
until the Liberation (Thessaloniki: Barbounakis, 1988).
8

8 C on t a ining B a l k a n Na tiona l ism

and rebellions invited interventions of power-​hungry European empires and,

in the view of Turkish scholars, became the single most important cause of
Ottoman collapse.16
Many contemporary Balkan historians began to consciously distance
themselves from the nationalist narrative enshrined in the works of their
college professors and in the high school textbooks they had been raised
on. Instead, they subscribe to “constructivism”—​ a dominant trend in
nationalism studies.17 In the constructivist line of reasoning, starting in
the late 1700s, the Enlightenment notion of popular sovereignty politi-
cized ethnic distinctions thus encouraging novel and even unprecedented
claims by groups previously with little political power. Moreover, educated
elites, often for selfish socioeconomic reasons, invented or imagined the
idea of supposedly eternal nations and imposed it on the rest of their un-
suspecting societies through control of the print media and, if lucky, of the
government.
Having rejected primordialism, the constructivists produced their own
anachronistic historical lens with their bias in favor of modernization theory.
They share the assumption that secularism and industrialization inevita-
bly supersede “pre-​modern” cultural and socioeconomic structures. Thus,
the most recent Greek scholarly works paint a picture of an unavoidable
takeover of the Patriarchate of Constantinople by the brand new Western
ideology of nationalism. Established Ottoman Christian lay and clerical
leaders somehow forgot about their vested institutional and economic in-
terests. They inexplicably succumbed to the irresistible calls of homegrown
and foreign-​based nationalist sirens and pied pipers whom they blindly fol-
lowed all the way to the destruction of the Ottoman Empire. Although a
radical departure from Greek nationalist historiography, the constructivist
study by Paraskevas Matalas is limited to the pre-​1872 period and is funda-
mentally handicapped by the absence of sources from the Patriarchate of
Constantinople and Russia.18
In contrast, the book by Dimitris Stamatopoulos is well-​attuned to the
complex and often contradictory interplay of nationalist, religious, and

16. Sofuoglu, Adnan, Fener Rum Patrikhanesi ve Siyasi Faaliyetleri (Istanbul: Turan
Yayincilik, 1996), pp. 18–​29; Alkan, Hakan, Fener Rum Patrikhanesi: Uluslararasi Iliskiler
Acisindan Bir Yaklasim (Istanbul: Gunce, 1999), pp. 43–​45; Atalay, Bulent, Fener Rum
Patrikhanesi’nin Siyasi Faaliyetleri (1908–​1923) (Istanbul: TATAV, 2001), p. 5.
17. Hobsbawm, Eric, Nations and Nationalism since 1780: Programme, Myth, Reality
(Cambridge: Cambridge University Press, 1990).
18. Matalas, Paraskeuas, Ethnos kai Orthodoxia: Hoi Peripeteies Mias Scheses: Apo to
‘Helladiko’ sto Voulgariko Schisma (Herakleio: University of Crete Press, 2002).
9

Introduction 9

imperial identities pervading the efforts of the Patriarchate to strengthen its

legitimacy and influence in the face of the new challenges of lay-​dominated
mass politics. But in the end, Stamatopoulos portrays the Patriarchate as
gradually losing its traditional ecumenical role and inexorably adopting
Greek nationalism. This unwarranted conclusion is due to the chronological
limits (1873) and lack of Russian sources. As a result, Stamatopoulos insuffi-
ciently appreciates the staying power of what I would call “Pan-​Orthodoxy”—​
the principle of Orthodox unity in Russia’s foreign policy and in its educated
society.19
Unlike Stamatopoulos, Paschalis Kitromilides argues in favor of a more
dynamic and multilinear relationship between the Patriarchate and Greek
nationalism. When the Bulgarian church movement divided Christian
Orthodox communities after 1856, many bishops in Ottoman Thrace
and Macedonia reacted by turning to Greek nationalism and seeking the
support of local Greek diplomatic representatives. But their superiors in
Constantinople and pro-​O ttoman lay leaders sought to stop or even re-
verse the process of nationalization taking place on the provincial level. In
contrast, the Russian Church was allegedly promoting “active nationalist
strategies” in the Balkan Orthodox churches. The last point is clearly an
oversimplification on the part of Kitromilides due to the lack of Russian
sources.20
The most recent Bulgarian book on the Bulgarian church movement does
not go beyond 1870 and discusses the Russian role based only on published
and secondary sources rather than on archival sources.21 Other Bulgarian
scholars began to question the modern ethnocentric logic of the Bulgarian
Church, which never intended to include non-​Orthodox Bulgarian speakers.
Its leading Russian-​educated prelates and the Ottoman institutional frame-
work combined to maintain a distance between the Bulgarian Exarchate and
Bulgarian state-​sponsored irredentism.22

19. Stamatopoulos, Demetris, Metarrythmisi kai Ekkosmikevsi: Pros Mia Anasynthesi tis
Istorias tou Oikoumenikou Patriarheiou ton 19o aiona (Athens: Aleksandreia, 2003).
20. Kitromilides, Paschalis, “The Ecumenical Patriarchate,” in Leustean, Lucian,
ed., Orthodox Christianity and Nationalism in Nineteenth-​
Century Southeastern Europe
(New York: Fordham University Press, 2014), pp. 23–​26.
21. Boneva, Vera, Bulgarskoto tsukovnonatsionalno dvizhenie, 1856–​1870 (Sofia: Za bukvite–​
O pismenekh, 2010).
22. Kalkandjieva, Daniela, “The Bulgarian Orthodox Church at the Crossroads: Between
Nationalism and Pluralism,” in Krawchuk, Andrii, and Bremer, Thomas, eds., Eastern
Orthodox Encounters of Identity and Otherness: Values, Self-​
Definition, and Dialogue,
(New York: Palgrave-​McMillan, 2014), pp. 54–​55.
10

10 C on t a ining B a l k a n Na tiona l ism

On the other hand, the literature that does focus on the Russian role is
often written from the Bulgarian perspective,23 or tends to reduce complex at-
titudes and reactions to the Bulgarian Question to the supposedly unstoppable
rise of Pan-​Slav sympathies in Russian diplomacy and educated society.24 I will
put in the foreground resistance to nationalism in the political and intellectual
responses to the Bulgarian Church Question, using fresh methodology and
hitherto untapped archival materials and neglected published sources.25
Russia’s defeat in the Crimean War (1853–​1856) led to sweeping socioeco-
nomic reforms and provoked intense reexamination of cultural and political cer-
tainties.26 In the post-​Crimean context, Bulgarian appeals for support to Russian
diplomats and publicists helped politicize earlier Romantic Slavophile ideas of
cultural affinity and uniqueness of Russia, Orthodox Christians, and Slavs.
Bulgarian nationalists began posing as Russia’s unredeemed blood brothers vic-
timized not only by the Ottoman Turks but also by their fellow Orthodox Greeks.
Bulgarian activists were instrumental in inspiring Pan-​Slav organizations first
in Moscow and then in St. Petersburg and other major cities.27

23. Khevrolina, Victoria, Rossiiskii diplomat graf Nikolai Pavlovich Ignatiev

(Moscow: Russian Academy of Sciences, 2004); Kiril, Graf N. P. Ignatiev i Bulgarskiat tserk-
oven vopros: Izsledovane i dokumenti (Sofia: Sinodalno Izdatelstvo, 1958); Markova, Zina,
“Russia and the Bulgarian-​Greek Church Question in the Seventies of the 19th Century,”
Etudes Historiques, 11 (1983): 159–​187.
24. Kitromilides, Pashalis, “The Ecumenical Patriarchate,” p. 19; Stamatopoulos, Dimitris,
“The Orthodox Church of Greece,” in Leustean, Lucian, ed., Orthodox Christianity and
Nationalism in Nineteenth-​Century Southeastern Europe (New York: Fordham University
Press, 2014), p. 53; Sinno, Abdel-​ Raouf, “Pan-​ Slawismus und Pan-​ Orthodoxie als
Instrumente der Russischen Politik im Osmanischen Reich,” Welt des Islams, 28 (1988): 537–​
558; Liluashvili, Kukuri, Natsionalno-​osvoboditelnaia borba bolgarskogo naroda protiv fa-
nariotskogo iga i Rossia (Tbilisi: University of Tbilisi Press, 1978); Meininger, Thomas,
Ignatiev & the Establishment of the Bulgarian Exarchate (1864–​1872) (Madison: University
of Wisconsin Press, 1970).
25. Lora Gerd’s work on Russia’s involvement in the Bulgarian Church Question skill-
fully weaves together archival and published Russian, Bulgarian, and Greek sources but
doesn’t relate them to the discussion of modernity or ethnic conflict management—​
“Rossia i greko-​bolgarskii tserkovnyi vopros v 80–​90-​e gody XIX veka,” in Konstantinopol i
Peterburg: Tserkovnaia politika Rossii na Pravoslavnom Vostoke (1878–​1898) (Moscow: Indrik,
2006), pp. 225–​308; “Rossiia i greko-​bolgarskii tserkovnyi vopros v nachale XX v.,” in
Konstantinopolskii Patriarkhat i Rossiia, 1901–​1914 (Moscow: Indrik, 2014), pp. 136–​179.
26. Maiorova, Olga, “Searching for a New Language of Collective Self: The Symbolism
of Russian National Belonging during and after the Crimean War,” Ab Imperio, 4
(2006): 187–​222.
27. Nikitin, Sergei, “Iuzhnoslavianskie sviazi russkoi periodicheskoi pechati v 60-​e gody
XIX veka,” Uchenyie zapiski Instituta Slavianovedenia, 6 (1952): 89–​154; Nikitin, Sergei,
Ocherki po istorii iuzhnykh slavian i russko-​balkanskikh sviazei v 50–​70e gody XIX veka
(Moscow: Nauka, 1970).
11

Introduction 11

This pro-​ Bulgarian agitation created special dilemmas not only for
Russia’s longstanding religion-​based foreign policy in the Christian East
and but also for its cultural identity. Language and religion are central for
any national self-​image, but even the most chauvinistic Russians in and
outside government circles never clearly defined Russianness but profess-
ing Orthodoxy was assumed to be its main component at the turn of the
twentieth century.28
The debate about Russia’s relation to its coreligionists abroad spilled over
into the pages of Russia’s main newspapers, church periodicals, travelogues,
scholarly journals, and confidential government papers. The issue involved
the Greeks, who were the founding members of the Orthodox family, and
Bulgarian Slavs, who were kinsmen to the Russians. The Russians then were
forced to clarify for themselves the relative significance of faith and blood.
Dressed in modern garb, the ideal of Orthodox unity and Russian messia-
nism consistently trumped ethnocentrism in the minds of the supporters of
Pan-​Slavism, Pan-​Orthodoxy, and the Greco-​Slavic world.
That polemic affected Russian officials in St. Petersburg and in the
Ottoman Empire but the main Russian policy consistently promoted Orthodox
unity throughout this period. It made sense strategically as both a Russian
asset in its imperialist rivalry with the other Great Powers and as a valuable
resource for the local Greco-​Slavic Christian minorities in the Ottoman so-
ciety where the majority and the rulers defined themselves in Islamic terms.
Similarly, the Russian government prudently continued to rely on established
autonomous religious institutions to administer its Muslim population in
spite of nationalistic calls for implementing assimilation programs.29
I will argue that cultural responses to the Bulgarian Church Question
included not only Pan-​Slavism and Pan-​Orthodoxy but also Greco-​Slavism.
They never superseded one another but coexisted in a fruitful tension and
competition.30 All three visions clashed over how to reconcile the traditional
legitimacy of religious and imperial dynastic institutions and legitima-
tion with the new secular ethnonationalism. Pan-​Slavism has been much

28. Weeks, Theodore, Nation and State in Late Imperial Russia: Nationalism and
Russification on the Western Frontier, 1863–​1914 (DeKalb: Northern Illinois University
Press, 1996), pp. 30–​32, 68.
29. Crews, Robert, For Prophet and Tsar: Islam and Empire in Russia and Central Asia
(Cambridge, MA: Harvard University Press, 2009), pp. 294–​299.
30. Lora Gerd charts a progression of dominant ideologies starting from Pan-​Slavism of
the 1850s and 1860s to “imperial nationalism” and “Neo-​Byzantinism” of the late 1800s in
Russian Policy in the Orthodox East: The Patriarchate of Constantinople (1878–​1914) (Warsaw
and Berlin: De Gruyter Open, 2015), p. X.
12

12 C on t a ining B a l k a n Na tiona l ism

understudied31 and treated as a purely ethnic “conservative” ideology.32 Pan-​

Orthodoxy and Greco-​Slavism are virtually terra incognita in the uncharted
waters of the scholarly literature.33
These competing visions ultimately aimed to create a Russian-​centered
non-​Western civilization based on reformulated Orthodox Christian cultural
and political connections. Although these views rejected liberal or socialist
Progress, they should be seen as modern because they were invented intel-
lectual constructs. In addition, they advocated unprecedented geopolitical
changes, emphasized ethnic categories, and consciously used the concept of
cultural-​historical type to decenter Western civilization.34
What do other academics and foreign policy practitioners have to gain
from solving these fascinating history’s mysteries of these exotic Eastern lo-
cales? By highlighting the continued political and cultural significance and
the adaptability of religious institutions and identities, my book challenges
the dominant analytical social science paradigm. As in historical studies,
it is widely accepted in political science literature that national identity and
the nation-​state are key elements of modernity and as such they inevitably
assign traditional religious and dynastic institutions to the garbage heap of
history.35 For example, the most respected and regularly reprinted general
Balkan history textbook describes the entire nineteenth century as “the Age
of Nationalism.”36

31. Zlatar, Zdenko, “Pan-​Slavism: A Review of the Literature,” Canadian Review of Studies
in Nationalism, 17, 1–​2 (1990): 1–​17.
32. Jersild, Austin, Orientalism and Empire: North Caucasus Mountain Peoples and the
Georgian Frontier, 1845–​1917 (Montreal, Kingston, London, Ithaca: McGill-​ Queen’s
University Press, 2002), pp. 133–​135.
33. Pan-​Orthodoxy is discussed but not conceptualized in reference to Konstantin Leontiev’s
views—​Zhukov, Konstantin, Vostochnyi vopros v istoriosofskoi kontseptsii K. N. Leontieva (Saint
Petersburg: Aleteiia, 2005); Andronov, Iu. V., Miachin, A. G., Shiriniants, A. A., Russkaia
sotsialno-​politicheskaia mysl’ XIX-​nachala XX veka: K. N. Leontiev (Moscow: Knizhnyi dom
Universitet, 2000); Nelson, Dale, Konstantin Leontiev and the Orthodox East (unpublished
Ph.D. dissertation. Minneapolis: University of Minnesota, 1977); Lukashevich, Stephen,
Konstantin Leontev, 1831–​1891: A Study in Russian “Heroic Vitalism” (New York, Pageant
Press, 1967).
34. Vovchenko, Denis, “Modernizing Orthodoxy: Russia and the Christian East (1856–​
1914),” Journal of the History of Ideas, 73, 2 (April 2012): 295–​317.
35. Anderson, Benedict, Imagined Communities: Reflections on the Origins and Spread of
Nationalism (London: Verso, 1991); Gellner, Ernest, Nations and Nationalism (Ithaca: Cornell
University Press, 1983); Weber, Eugen, Peasants into Frenchmen: Modernization of Rural
France, 1870–​1914 (Stanford: Stanford University Press, 1976).
36. Stavrianos, Leften, The Balkans since 1453 (New York: New York University Press, 2000
[1958]), pp. 215–​412.
13

Introduction 13

Explicitly or implicitly most social scientists justify the breakup of

ethnically and religiously diverse dynastic empires as well as resulting
conflicts as objectively progressive developments. I will argue that despite
the appeal of nationalism as part of Western modernity in the late nine-
teenth century the Christian Orthodox centers in the Ottoman Empire,
the Russian Empire, Greece, Bulgaria, and Serbia formulated and pro-
moted supranational ideologies and public policies directed at containing
nationalism within existing structures in Eastern Europe up to the First
World War.
Recently, there has been some interest in resistance to nationalism.
Even in modern nation-​states such as Croatia, the Catholic Church and the
European Union were able to project an alternative supranational identity that
helped the country avoid sliding into a fascist state in the aftermath of the
Yugoslav wars of the early 1990s.37
There are even more reasons to doubt the inevitability of the triumph of
nineteenth-​century nationalist movements inside multiethnic and multicon-
fessional empires. The leaders of those movements did not have the resources
of nation-​states or modern mass media at their disposal. They did receive
support from the self-​proclaimed homeland states of Greece, Bulgaria, and
Serbia but the bureaucratic machinery of nascent Balkan nation-​states was
not available to them in Ottoman provinces. Most people do not usually em-
brace nationalism without the experience of state-​controlled propaganda,
schools, police, and armies.
On the other hand, the nationalists’ opponent, the Patriarchate of
Constantinople, could count on the appeal of the authority of tradition among
the largely illiterate and ethnically mixed Balkan Christian villagers. The patri-
archs could also obtain significant Russian diplomatic and financial support.
Just like other empires, the Ottoman Empire was built on conquest and domi-
nation by the center over the periphery. Since the beginning of their expansion
in the 1300s, the Ottomans declared that their true faith had enabled them to
wrest control of parts of Europe, the Middle East, and Africa from both infidel
kings and less pious Islamic potentates. While their Muslim subjects faced no
legal discrimination, Jews and Christians were treated as second-​class citizens
much like the racial divisions in twentieth-​century Western “bifurcated” colo-
nial states.38

37. Bellamy, Alex, The Formation of Croatian National Identity: A Centuries-​O ld Dream?
(Manchester: Manchester University Press, 2003), p. 183.
38. Mamdani, Mahmood, Citizens and Subjects: Contemporary Africa and the Legacy of Late
Colonialism (Princeton: Princeton University Press, 1996).
14

14 C on t a ining B a l k a n Na tiona l ism

However, foreign rulers like the Ottomans are often accepted if they pro-
vide such collective goods as security and prosperity. Another attraction of
the Ottoman system was indirect rule. Ironically, the more the Ottomans cen-
tralized their government, the weaker they became.39 The Romanov dynasty
used the institutions of local autonomy even more successfully to win the
hearts and minds of its largest religious minority.40 Between 1856 and 1914,
most Russian policymakers did not seek to destroy the Ottoman Empire but
aimed to turn it into a federated structure with significant rights for prov-
inces and religious minorities. Far from being a foreign import, that agenda
echoed the views of many Christian and Muslim interest groups especially in
the last decade before 1914.41
After the disturbing genocides and ethnic cleansings of the twentieth
century, historians are turning a more sympathetic eye to the experience
of multiethnic religious and dynastic empires.42 Some argue that without
the preventable and contingent outbreaks of the Balkan Wars and the First
World War, the Ottoman, Habsburg, and Russian Empires may not have been
doomed to disintegrate, as it turned out, into fractious nation-​states.43
Political scientists, however, seem to be oblivious to this changing
wind in historical studies. The chasm between our disciplines naturally
limits the prescriptions they can offer to resolve today’s tensions and con-
flicts. My book may help bridge the gap between the disciplines by offer-
ing a fresh cultural and institutional perspective. There is a consensus

39. Hechter, Michael, Alien Rule (New York: Cambridge University Press, 2013), pp. 2,
55–​60.
40. Crews, For Prophet and Tsar, pp. 353–​355.
41. Sean McMeekin’s The Russian Origins of the First World War made the case for Russian
aggressive designs in the Near East but his book met with a lot of criticism such as Bobroff,
Ronald, Revolutionary Russia, 26, 1 (June 2013): 82–​84.
42. Todorova, Maria, Imagining the Balkans (New York: Oxford University Press, 2009),
p. 187; Streusand, Douglas, Islamic Gunpowder Empires: Ottomans, Safavids, and Mughals
(Boulder: Westview Press, 2011), p. 2.
43. Mazower, Mark, The Balkans: A Short History (New York: Modern Library, 2000),
p. 115; Crews, For Prophet and Tsar, p. 355; Keyder, Caglar, “The Ottoman Empire,” Hagen
von, Mark, “The Russian Empire,” in Barkey, Karen, and von Hagen, Mark, eds., After
Empire: Multiethnic Societies and Nation-​Building: The Soviet Union and the Russian, Ottoman,
and Habsburg Empires (Boulder: Westview Press, 1997), pp. 30–​4 4; 58–​72. In that volume,
there is less optimism about Austria-​Hungary but Joachim Remak was more positive: see
his “Healthy Invalid: How Doomed the Habsburg Empire?,” Journal of Modern History, 41,
2 (June 1969): 127–​1 43. Pieter Judson has recently made a powerful argument against exag-
gerating the strength of nationalist movements in Guardians of the Nation: Activists on the
Language Frontiers of Imperial Austria (Cambridge, MA: Harvard University Press, 2006).
Another random document with
no related content on Scribd:
 Breslau, 1876), 1; case by Schultze (Virchow's Archiv, Bd. lxviii.; also Bd. lxxiii.),
autopsy, 1; case by Bernhardt (Archiv für Psych., Bd. ix., 1879); case by Sinkler
(Amer. Journ. Med. Sci., Oct., 1878), 5; case by Althaus (ibid., April, 1878), 2; case by
Ross (Dis. Nerv. Syst., vol. ii. p. 139), 1—total, 57 cases.

Morton (St. Bartholomew's Hospital Reports).

Others have doubtless been published since this date, but, as they do not
immediately concern our subject, need no further citation.

3 Vulpian, Leçons sur les Myelitis, 1880.

SUMMARY OF CLINICAL HISTORY.—The clinical features of an acute

attack of infantile paralysis are well known. The children affected are
usually between eighteen months and four years of age (Henoch).
The attack is more likely to occur in summer than in winter, as
Sinkler4 found that 47 out of 57 cases began between May and
September, and Barlow noted 27 out of 53 in July and August.5
4 Amer. Journ. Med. Sci., April, 1875.

5 Loc. cit., p. 75. Among Sinkler's 57 cases, only 6 furnish autopsies, thus:

Case by Cornil and Lepine and case by Webber (quoted and accepted by Erb in
Ziemssen's Handbuch, Bd. xi.); case by Gombault (rejected by Erb and Westphal);
case by Schultze; cases by Dejerine and Lucas Championnière (quoted by
Hallopeau).

The influence of heat is perhaps shown in the case related by Dyce-Duckworth in the
Lancet of 1877: a child two and a half years, after exposure to great heat on a
steamboat-landing, became paralyzed in all four limbs, but the paralysis was
subsequently confined to the lower extremities. Coincidently, the patient became
delirious; suffered from anæsthesia and temporary paralysis of the sphincters. The
paralyzed muscles wasted rapidly and lost faradic contractility. Treatment by
faradization was begun in a month from the date of the attack, and recovery was
complete three months later.
The onset of the paralysis is either really sudden, occurring in the
daytime, while the child is under competent observation, or
apparently sudden, being discovered in the morning after a quiet
night, the child having gone to bed in health (West); or is preceded
by some hours or days of fever or of nervous symptoms, especially
convulsions, or both. The paralysis is almost always at its maximum
of extent and intensity when first discovered, and from this maximum
begins, within a few hours or days, to retrocede. The improvement
may, however, be delayed much longer. A variable number of
muscles remain permanently paralyzed, and in these, within a week
(thirty-six hours, according to some observers), faradic contractility is
first diminished, then abolished; galvanic reaction is exaggerated,
ultimately is characterized by the degeneration signs (entartungs
reaction). The temperature of the paralyzed limbs falls; the muscles
waste; the atrophy may rapidly become extreme. The paralysis and
loss of faradic contractility are complete, however, while the atrophy
is only incipient and progressing. The absence of lesions of
sensibility, of visceral disturbance, of trophic lesions of the skin, or of
sphincter paralysis is as characteristic of the disease as are the
positive symptoms above enumerated.

In the third or chronic stage the paralyzed limbs often become

contracted and deformed. At other times, and with more complete
paralysis, the growth of the bones is arrested, the muscles remain
flaccid, the entire limb shrivels, and dangles so loosely from its
articulations that it may be dislocated by slight effort (membre de
Polichinelle). The general health of the patient remains remarkably
good, the intelligence clear, the disposition lively. The duration of life
seems to be in nowise shortened by the paralysis. Thus,
suddenness of development, intimate association of trophic, motor,
and electrical disturbance, absence of cerebral or sensory lesion,
peculiar localization and grouping of the permanent paralyses,—
such are the salient characteristics of this remarkable disease.

SYMPTOMS IN DETAIL.—Three well-defined stages exist—the initial, the

paralytic, and the chronic.
Initial Stage.—Seeligmüller6 signalizes three principal varieties in this
stage. The first is characterized by fever; the second by nervous
symptoms, principally convulsions, sometimes delirium or coma; in
the third no symptoms either precede or accompany the local
disease—"la paralysie est toute la maladie.”7
6 Gerhardt's Handbuch der Kinderkrankheiten, 1880 (separat Abdruck).

7 Rilliet et Barthez, Traité des Maladies des Enfants, ii. p. 551.

Mode of Invasion.—I have elsewhere8 described eight different

modes of invasion: absolutely sudden, coming on in the daytime;
morning paralysis (West), discovered after a quiet night, preceded by
fever or by vomiting alone (?), or by another typical disease,
especially one of the exanthemata, or, finally, by a traumatism,
generally slight. An interval of time almost always elapses between
the occurrence of the traumatism and the development of the
paralysis—a fact which already indicates that a definitely-evolved
morbid process must intervene between the two occurrences. An
exception is related by Duchenne fils;9 and some apparent
exceptions, in which recovery occurred rapidly, seem to belong to
the temporary paralysis of Kennedy,10 more recently described again
by Frey.11
8 Am. Journ. Obstet., May, 1874.

9 Archives gén., 1864. A father pulled his child from a table by the right arm, and set it
rather roughly on the ground. Immediate pain, almost immediate paralysis of arm,
which persisted, and was followed by atrophy of its muscles.

10 Dublin Quarterly, 1850.

11 Berlin. klin. Wochens., 1874. Frey considers these cases to be identical in nature
with, though differing in severity from, anterior poliomyelitis.

PRODROMATA.—There is rarely any lengthened period of prodromata.

Seeligmüller has noticed in some cases an indisposition on the part
of the child to stand or walk during several weeks before the
occurrence of the paralysis. He does not say whether such children
were rachitical. In marked contrast with cases of cerebral paralysis is
the habitual absence of generalized nervous symptoms. Thus in only
1 case of Seeligmüller's (total of 75) did the child suffer, and that
during six months preceding the paralysis, from intermittent muscular
contractions, and also from attacks of laryngismus stridulus.

The fever is usually of moderate severity (Seeligmüller), but

sometimes extremely high (Erb)12—as much as 41° C. (Henoch),13 or
104° F. (Barlow).14 Duchenne fils observed 7 cases alleged to be
entirely without fever, and Laborde counts 10 cases out of 50 as
apyretic.15
12 Ziemssen's Handbuch, Bd. xi. Abh. 12.

13 Vorlesung. über Kinderkrank., 2d Aufl., 1881. Seeligmüller (Jahrb. für Kinderheilk.,

1878, p. 345) quotes another case from Henoch's clinic where the fever lasted thirty-
six hours, the temperature on the first evening being 39.2°, the following morning
39.0°, the second evening 39.5°; the second morning, at which date the paralysis was
discovered, it was normal. The author states this to be the only case known to him in
which thermometric measurements were taken.

14 Loc. cit.

15 De la Paralysie de l'Enfance.

The duration of the fever usually varies from a single night to forty-
eight hours; much more rarely does it last six, eight, twelve, or
fourteen days, or even, but quite exceptionally, three or four weeks.
According to Duchenne, its intensity and duration increase with the
age of the child, perhaps indicating greater resistance on the part of
the nerve-tissues which are the seat of the morbid process of which
it is symptomatic. Rarely does it last after the paralysis has once
occurred, but ceases then with an abruptness which recalls the
defervescence of pneumonia when the exudation process is once
completed.16
 16 See p. 1144 for pathogenic inferences to be drawn from this fact. Seguin (New
York Med. Record, Jan. 15, 1874) seems to throw some doubt on the existence of
apyretic cases; but, as Seeligmüller remarks, there is too much testimony to this
possibility to render it really doubtful.

There is no proportion between the intensity of the fever and the

extent of the subsequent paralysis; nor is there any marked contrast
between the fever in children and that in adults in those rare cases in
which the disease, instead of being subacute, is sudden as in
children.

Erb considers the fever to be purely symptomatic of an inflammatory

process in the spinal cord.17 But Vogt regards it rather as an
essential factor in the development of a spinal lesion, and thus
explains the occurrence of this in the course of febrile diseases
which at the outset have no special relation to the cord.
17 Loc. cit., p. 279.

Convulsions, usually accompanied by fever, were observed in 11 of

Seeligmüller's cases out of 67; Duchenne had 13 out of 70; Heine, 9
out of 86;18 thus a total of 33 cases of convulsions in 223 cases of
infantile paralysis—nearly 15 per cent. The paralysis may set in after
a single brief convulsion, or this may be repeated several times at
variable intervals before the paralysis is definitely declared (Ross).19
The convulsive movements are apt to be particularly intense in the
limbs destined to become paralyzed (Vogt).
18 Die Spinale Kinderlahmung.

19 Loc. cit., p. 107. The author is quoting Laborde.

The convulsion may be very slight—an isolated spasm of a limb or

even a single group of muscles. Whether, on the other hand, it can
ever be so intense that the child succumbs to it before the
development of paralysis, is a question which could only be decided
by repeatedly examining the cord in the cases of convulsion which
have terminated fatally. In a case of Seeligmüller's the child was
affected for eight days preceding the paralysis by tremblings
generalized through all his muscles.

The convulsion is usually followed by a soporous or even comatose

condition, or this may replace the convulsion. Delirium may take the
place of either.

Special interest attaches to those cases where the paralysis

develops in the course of an acute specific disease; for then
becomes most plausible the suggestion of Vogt, that a fever excited
by some cause remote from the spinal cord may itself become a
cause of lesion in this centre. In Roger's first and most celebrated
case, paraplegia developed suddenly during the course of a fatal
scarlatina in a child already suffering from paralysis of the left deltoid
of two months' standing.20 The scarlatina was hemorrhagic, and, as
will be shown farther on, the autopsy showed traces of a
hemorrhagic extravasation in the cord. Thus a double influence was
presumably exerted by the scarlatina, while, moreover, the previous
and recent occurrence of a deltoid paralysis indicated a morbid
predisposition in the spinal cord. Of Seeligmüller's 75 cases, 1
occurred during scarlet fever, 1 with measles, 1 in the course of an
erysipelas, and 1 of pneumonia.
20 Gaz. méd., 1871.

Apyretic diseases, especially of the gastro-intestinal tract (Brown-

Séquard), also seem to have an influence on the development of
infantile paralysis. Two of my own cases occurred during an attack of
cholera infantum; another in a child who had been for several weeks
in bed with a purulent conjunctivitis. Study of these varied
antecedents is of interest in connection with the obscure question of
the etiology of infantile paralysis. In this latter connection we will
refer to them again.

Vomiting, or even the entire symptom-complex of gastric fever, not

infrequently ushers in the paralysis. Fever is then usually present,
but I have recorded one case of vomiting where, according to the
mother's assurance, no fever at all existed.
At the moment that the symptoms of the invasion subside, and the
child seems to enter upon convalescence, the terrifying discovery is
made that an arm or a leg or all four limbs, or even they and the
muscles of the trunk, are paralyzed.

In the severest form the child lies motionless, unable to stir hand or
foot, or even a finger or toe. Yet, singularly enough, this extensive
paralysis is sometimes overlooked, especially in very young children,
as the immobility of the patient is attributed merely to weakness
caused by previous illness. General paralysis, during at least the first
few hours of the paralytic stage, is probably more common than
appears from our present statistics. Not only, as has just been noted,
may this condition be overlooked, but it may exist during the hours of
sleep which precede the cases of morning paralysis. Seguin21
speaks as if the paralysis were at first always generalized, but this
statement seems to me somewhat exaggerated. Referring merely to
the statements of the parents, a considerable number of paralyses
would be found limited from the beginning. Heine's third table of
partial paralysis is entirely composed of cases so limited. In 16 out of
the 19 cases of hemiplegia (monoplegia) the original limitation of the
paralysis is also specified; similarly with 7 out of the 20 cases of
paraplegia contained in the first table.
21 Loc. cit.

Paralysis of one or both lower extremities is often first detected when

the child gets out of bed and attempts to walk; or in children too
young to walk the flaccid immobility of the limb attracts attention as
soon as they are again carried on the mother's arm. Paralysis of the
upper extremities is discovered early in proportion to the liveliness
recovered by the child, leading him to occupy himself with his toys as
usual. In unilateral paralysis of the trunk the child will fall over to one
side when placed in the sitting position; in bilateral paralysis it cannot
be made to sit up at all.

From lack of competent observation during the initial stage it is really

not quite certain whether any degree of paresis precedes the
paralysis; but from the testimony at present accumulated the
paralysis is nearly always complete when first observed. This is in
striking contrast with adult spinal paralysis. In some few cases the
paralysis has been observed to creep on slowly, and not reach its
maximum for several days (Ross). Laborde relates a case where
recovery from a first attack of paralysis was followed by two relapses
in the same limbs at intervals, each ushered in by fever. After the
second relapse the paralysis remained permanent.

Significance of Original Extent of Paralysis.—The question of the

original distribution of the paralysis is of special interest in
connection with that of the original distribution of the morbid process
in the spinal cord. The real effect of the latter cannot be adequately
measured by the permanent paralyses; for, as will be seen, it is not
unusual to find traces of an extensively diffused process in the cord
in cases of quite partial paralysis.

It is interesting to notice that certain muscles are always exempt

from paralysis. With the exception of a single case of paralysis of
one temporal muscle, cited by Seguin,22 the muscles of the head,
eyeballs, ears, larynx, and pharynx are always exempt, as are also
the diaphragm and intercostals. The arrest of the spinal lesion below
the medulla explains the immunity of muscles supplied by the vagus
and spinal accessory nerves. But since the cervical plexus is often
involved, the constant escape of the diaphragm, innervated by the
phrenic nerve which comes from this plexus, is remarkable. Still
more so the immunity of the intercostal muscles, whose nerves arise
in the dorsal region—a position of the cord frequently affected. This
fact tends to confirm Ross's hypothesis, that the nuclei of the
intercostal nerves lie in the vesicular columns of Clarke—columns
confined to the dorsal region of the cord, and which are invariably
found intact at autopsies of atrophic paralysis.
22 Loc. cit.

The immunity of these respiratory nerves explains the absence of

the dyspnœa which is so marked in Landry's ascending paralysis. In
the adult case described by Schultze and Erb23 dyspnœa was
present for a short time. The disease terminated fatally twenty
months from the time of invasion. In this case traces of myelitis were
found extending through the dorsal region of the cord, and including
not only the anterior nerves, but, to a less degree, the columns of
Clarke.
23 Arch. Virch., Bd. lxviii.

The facial nerve (itself a respiratory nerve) shares the immunity of

the phrenic and intercostals. In the cases in which facial paralysis
has been noted the limb paralysis has been hemiplegic, as in
Seeligmüller's twentieth case. A cerebral origin is then always to be
at least suspected.

Barlow24 has seen 6 cases of paralysis of the facial, but the histories
render a cerebral paralysis more probable in 4 out of those 6.
Henoch25 gives a case of paralysis of left arm, accompanied by
paralysis of corresponding facial nerve. The latter rapidly recovered,
but the paralysis of the arm persisted and was followed by atrophy.
Ross26 implies that the sides of the neck, face, and tongue are
always at first implicated in spinal hemiplegic paralysis, but do not
remain permanently affected.
24 Loc. cit.

25 Loc. cit., p. 205.

26 Loc. cit., p. 108.

That the facial should be affected while the other medullary nerves
escape probably depends on the more anterior position of its
nucleus.

The regression of the original paralysis is characteristic, indeed

almost pathognomonic, of the disease. It is on this account that
Barlow has proposed the name regressive paralysis.27 This author
quotes the case of a boy who at five months was affected with a
universal paralysis, even affecting the neck, but entirely recovered
except in the extensor longus digitorum of the foot. This
improvement constitutes a second apparent convalescence, as
deceptive as that which immediately succeeds the pyrexia. Only in
rare cases do all the muscles at first paralyzed remain so
permanently (Seeligmüller); nor, on the other hand, do all entirely
recover (temporary paralysis of Kennedy and Frey). Even when an
entire limb appears to be paralyzed, careful examination will usually
detect certain muscles that retain their faradic contractility. Thus the
order of frequency of paralysis in the different limbs must be
distinguished from that observed for different muscles.
27 Brit. Med. Journ., 1882.

Duchenne fils28 and Seeligmüller29 have tabulated, for lists of 62 and

75 cases respectively, the general locality of the permanent
paralyses in their order of frequency. The cases of monoplegia are
by far the most numerous. Thus in the table quoted below there are
97; in Heine's tables (86 cases), 47; in Sinkler's tables (86 cases), 29
—total, 173 from a total of 309, or nearly one-half:

Duchenne. Seeligmüller. Total.

Left lower extremity 7 27 34
Right lower extremity 25 15 40
Right upper extremity 9
10 13 23
Left upper extremity 4
All four extremities 5 2 7
Both upper extremities 2 1 3
Both lower extremities 9 14 23
Left over and under extremity 1 1 2
Right over and under extremity 0 1 1
Right over and left under extremity 2 1 3
Muscles of trunk and abdomen 1 0 1
62 75 137

This limitation is all the more noteworthy when compared with the
frequency of general paralysis at the outset.
28 Archives gén., 1864.
 29 Jahrbuch der Kinderheilkunde, N. H. xii. pp. 338-343.

The next peculiarity is the great preponderance of paralysis of the

lower over that of the upper extremities. This is noticeable even in
the monoplegias. In Sinkler's cases only two of these affected an
arm. But in bilateral paralysis the predilection is still more
remarkable, paraplegia of the lower extremities being among the
most frequent, paraplegia cervicalis the rarest, form of paralysis.
This is not because a lesion situated in the cervical spinal cord must
interfere with the motor tract going toward the lumbar, and hence
nearly always paralyze all four extremities, if any. Because when this
does happen the upper extremities alone exhibit the atrophic
changes characteristic of anterior poliomyelitis: the lower, though
paralyzed, do not atrophy and retain their faradic contractility. Heine
denied the existence of paraplegia cervicalis. But in the table of
Duchenne-Seeligmüller 3 cases are recorded; Rosenthal30 relates 1;
Lockhart Clarke, 1.31 This is the somewhat famous case, described
by Clarke as a progressive muscular atrophy, which contributed one
of the earlier autopsies.
30 Klinik der Nervenkrankheiten, 2 Aufl. p. 413.

31 Med.-Chir. Trans., li. p. 219.

Seeligmüller's case32 is remarkable in several respects. The

paralysis, occurring after a brief fever in a child seventeen months
old, exclusively attacked the two arms at the moment of invasion,
and never retreated from them, thus offering a double exception to
the usual rule. At four rears of age the arms were much atrophied,
and faradic contractility was lost in their muscles, the legs being
sturdily developed. Nevertheless, the child constantly fell in walking,
because, observes Seeligmüller, he was unable to balance himself
with his arms, as is habitual with little children learning to walk.
32 Jahrbuch, loc. cit., p. 349.

The hemiplegic variety of paralysis is again very rare. The

Duchenne-Seeligmüller table contains (out of 137) 3 cases; Sinkler
records (out of 86) 4; West, 5; Heine (out of 86), 1; Leyden, 1;
Duchenne, 1. West's 5 cases all present certain peculiarities, at least
unusual in spinal paralysis. In 2 the paralysis came out gradually; in
1 succeeded to remittent fever (pigmentary embolism?); in 1 was
preceded by heaviness of the head for several days; and in 1 the leg
was paralyzed fourteen days after the arm.33 It is probable that in
almost all, if not in all cases, hemiplegic spinal paralysis is the
residue of a paralysis originally generalized to all four limbs, if only
for a few hours.34
33 In three cases of hemiplegia observed by myself, and previously diagnosed as
spinal paralysis by other physicians, I doubted the diagnosis from the coincidence of
unusual cerebral symptoms. In the first case the hemiplegia appeared after coma,
during cerebro-spinal meningitis; in the second, after a violent convulsion the face
was drawn to the opposite side, and the patient, a child of seven, remained for a
month in a state of intense maniacal excitement. In a third case, developed during
convalescence from scarlet fever, the hemiplegia was preceded during two days by
hemiparesis, and accompanied for a year by complete aphasia. Finally, in these
cases faradic contractility persisted in the paralyzed limbs (Am. Journ. Obstet., May,
1874).

34 Seeligmüller relates one case where hemiplegia, including the facial nerve, was
observed in two days from the beginning of the fever.

The question of hemiplegia is closely connected with that of

paralysis of the facial nerve, inasmuch as the existence of the latter
often serves to suggest a cerebral paralysis—a suggestion
confirmed later by the absence of atrophy and of characteristic
electrical reactions. However, in some cases of undoubted spinal
paralysis the facial does really seem to have become involved. Thus
in the case just quoted from Seeligmüller (Case 20 of his table)
Henoch35 relates a case of paralysis of the left facial coinciding with
paralysis of the left arm. Rapid recovery from facial paralysis: arm
atrophied. Barlow36 records temporary facial paralysis in six cases,
but only two of these seem to be really spinal. Such temporary
paralysis is not altogether infrequent in the poliomyelitis anterior of
adults (Sinkler, Seguin). Ross37 implies that the sides of the neck,
face, and tongue are always implicated at first in hemiplegic spinal
paralysis, but do not remain so.
35 Loc. cit., p. 203.

36 Loc. cit., p. 76.

37 Loc. cit., p. 108.

Crossed paralysis is extremely rare. There are 3 cases in the

Duchenne-Seeligmüller table; Leyden38 has one. But paraplegia of
the lower extremities, coinciding with paralysis of one upper
extremity, is by no means so rare, especially as a residual paralysis.
38 Archiv Psychiatrie, Bd. vi.

Finally, as in cerebral paralysis, the muscles of the trunk, though

often paralyzed at the outset, rarely remain so in children—much
more often in adults. Eulenburg39 relates one interesting case of
complete paralysis and atrophy of the extensors of the back. Even
the interspinous muscles were involved, as shown by the divergence
of the spinous processes. The paralysis was observed in a girl of
fifteen affected since the age of three, and was completely cured in
five months by daily faradizations of ten minutes each, and two
gymnastic séances, each lasting two hours.
39 Arch. Virch., Bd. xvii., 1859.

Birdsall40 has described one case of unilateral paralysis of the

abdominal muscles.
40 Journal of Nervous Diseases.

Study of the precise combinations of the muscles paralyzed has

recently acquired peculiar interest in connection with the localization
in the spinal cord of the motor or trophic nuclei of their nerves.41
Several facts have been ascertained: 1st, that, in notable contrast
with progressive muscular atrophy, atrophic paralysis tends to
involve definite groups of muscles; 2d, that this grouping is not
effected in accordance with the proximity to each other of the
muscles on the limb, but with their functional association. Remak
affirms that Charles Bell had already called attention to the fact that
in cases of local muscular paralysis of the extremities the paralysis
does not spread by muscular continuity, but in accordance with the
functional association of muscles. Thus, paralysis of the thumb is
more often associated with that of the forearm than with paralysis of
the other muscles of the hand. 3d. From such grouping may often be
inferred a different localization of certain nerve-nuclei than would be
supposed from the position of the muscles alone. 4th. That the fibres
contained in a single nerve-trunk, but distributed to different muscles,
probably separate from each other within the cord, to be there
distributed to variously-situated nuclei.42
41 Ernst Remak, “Localis. der Atroph. lahmung,” Archiv f. Psych., ix., 1879; Ferrier,
Brain, vol. iv. No. 3; also, Proceedings Royal Society, No. 212, p. 12.

42 The theory of course assumes the truth of the demonstration by which atrophic
paralysis is rendered symptomatic of disease of the spinal cord, and the nutrition of a
muscle dependent on the integrity of the muscles of origin of its nerves.

In the arm two mutually correlative cases are observed: (a) Immunity
of the supinator longus during paralysis of the forearm muscles; (b)
paralysis of the supinator in association with paralysis of the deltoid,
biceps, and brachialis anticus. The latter constitutes Remak's upper-
arm type of localization, and is exhibited in his first case.43
43 Loc. cit.; also, cases 1st and 2d by Ferrier, in which, however, other shoulder-
muscles were involved.

Ferrier has experimentally confirmed this muscular association by

means of isolated irritation of the fourth cervical nerve, which threw
into contraction the supinator longus, together with the deltoid,
biceps, and brachialis internus. At the same time, in the experiment
the flexors and extensors of the wrist were excited, while in the
special form of paralysis noted they were exempt. This electrical
method is a less precise mode of analysis than the pathological, for
the double reason that (a) fibres whose nuclei are dissociated may
pass together in the same root; (b) because the same muscles
receive fibres from more than one root: thus the flexors and
extensors of the wrist from the fifth as well as the fourth cervical.
Thus when the nucleus of the latter was destroyed paralysis would
be averted by means of the fibres coming from the fifth root.

The experiment and the pathological observation, however, concur in

indicating that the fibres innervating the supinator longus, though
passing to it in the path afforded by the radial nerve, afterward
ascend in the cord to a ganglionic nucleus in close proximity to those
of the upper-arm muscles specified—liable, therefore, to be affected
with them. The purpose effected by such association is the
supination of the arm.

It is excitation of the fourth root in Ferrier's experiment which gives

results most closely corresponding to Remak's observations.
Excitations of the fifth and sixth root reveal other combinations,
which Ferrier has found realized in adult's spinal paralysis. Thus in
his second case, in addition to the group of muscles already
mentioned, the rhomboid, infraspinatus, and serratus magnus were
paralyzed, the last muscle indicating complication with the fifth root.
In the third and fourth cases muscles supplied from the sixth root
were joined to those innervated by the fourth and fifth—namely, the
pectoralis major and latissimus dorsi.

In this upper-arm type the muscles affected are supplied by three

different nerve-stems—the axillary, musculo-cutaneous, and the
radial. In the forearm type the most common variety consists in
paralysis of the extensors of the wrist, thus exactly imitating lead
palsy.44 The supinator remains intact, the intrinsic muscles of the
hand are sometimes intact, sometimes paralyzed. Sometimes,
however, the extensors are relatively intact; the interossei are
atrophied, and a clawed hand, resembling that characteristic of
cervical hypertrophic pachymeningitis, is developed.45
44 It is on this fact, indeed, that Remak has been led to argue the spinal nature of
saturnine paralysis (“Zur Pathogenie der Blei lahmung,” Archiv für Psych., Bd. vi.,
 1876).

45 The march of this disease, together with that of tabes dorsalis, furnishes data for
localizing the nervous nucleus for the wrist extensors. In both diseases the lesion is
ascending: in tabes disturbance of sensibility occurs first in the distribution of the
sensory fibres of the ulnar nerve; in cervical pachymeningitis the flexors and intrinsic
muscles of the hand are first paralyzed. Hence it is to be inferred that the central
nucleus for the latter muscles lies in the lower, that for the extensor muscles in the
middle, segment of the cervical enlargement of the cord.

The much greater frequency of extensor paralysis in the forearm

type of anterior poliomyelitis indicates that the lesion of this disease
begins about the middle of the cervical enlargement (see note).

The foregoing groupings have been made out almost entirely from
cases of adult spinal paralysis or else of lead palsy. In the lower
extremity it is much more difficult to establish such definite muscular
association. Certain laws, however, can be made out: 1st. The
liability to paralysis increases from the thigh toward the foot; thus,
the muscles moving the thigh on the pelvis are the least liable to
paralysis, then those moving the leg on the thigh, while the muscles
moving the foot and leg and thigh are the most frequently paralyzed
of any in the body. 2d. Of the upper thigh-muscles, the glutæi are not
infrequently paralyzed, the ilio-psoas hardly ever, the adductors
rarely except in total paralysis. 3d. Of the muscles moving the leg on
the thigh, the quadriceps extensor is very frequently paralyzed—the
most often, indeed, after the foot-muscles: the sartorius is almost
always exempt; the liability of the hamstring muscles corresponds to
that of the thigh adductors. 4th. At the foot the tibialis anticus often
suffers from isolated paralysis, sharing in this respect the fate of the
deltoid in the upper extremity—a fact already noticed by Duchenne.
On the other hand, (5th) the tibialis anticus often remains intact while
the other muscles supplied by the perineal nerve, the perineus
longus and brevis, are completely paralyzed.46
46 Thus Buzzard relates a case of paralysis involving the quadriceps extensor and
peroneal muscles, while the anterior tibial were intact.
The remarkable contrast in the morbid susceptibility of the
quadriceps on the one hand, and the sartorius on the other, suggests
dissociations of their nuclei. Remak relates one interesting case
(Obs. 13) where the sartorius was paralyzed—coincidently with the
quadriceps, it is true, but also with partial paralysis of the ilio-psoas
muscle, which is as rarely attacked as the sartorius itself. The two
facts, taken together, would indicate that the nucleus of the sartorius
lies high in the lumbar enlargement, in proximity to that of the ileo-
psoas. The inference, continues Remak, is reinforced by functional
considerations, since the sartorius, obliquely flexing the leg on the
thigh, is generally in action at the moment that the psoas flexes the
thigh on the pelvis.

Again: according to Remak the tibialis anticus is generally paralyzed

together with the quadriceps extensor, although supplied by a
different nerve.47 And this should be expected from the necessity of
exciting dorsal flexion of the foot by means of the tibialis anticus at
the moment of extending the leg for the act of walking.48
47 Obs. 14, 15, 16, 17, from Remak's essay.

48 At the moment that the foot is thus flexed, however, to allow the leg to be swung
forward, the thigh and leg are both slightly flexed.

Ferrier, from his experiments on the roots of the lumbar plexus, is

inclined to doubt this association of the tibialis anticus with the
quadriceps, and he adduces Buzzard's case, already quoted, to
show coincident paralysis of the quadriceps and peroneal muscles. It
is not improbable, however, that fibres associated together in nerve-
roots may again diverge in the cord, and thus the discrepancy would
be explained.

DIAGNOSIS OF SPECIAL PARALYSIS.—Paralysis of isolated muscles may

sometimes be concealed by the vicarious action of their synergists:
thus of the extensor communis for the tibialis anticus. Paralysis of
both legs and feet may even be partly concealed by the energy of
the thigh-muscles, which, using the paralyzed segments of the limbs
as inert supports, succeeds in effecting locomotion.49 On the other
hand, in limbs apparently abandoned to total paralysis persevering
search will often discover some muscles or parts of muscles which
respond to faradic electricity: these must be considered as
susceptible of ultimate recovery.
49 Thus in Cornil's famous case, Soc Biol., 1863.

The following table sums up some special diagnostic marks for the
different paralyses50 afforded by the position of the limb and loss of
movements:

Upper Extremity. Deltoid. Absence of deformity, which is averted by weight of arm.

Inability to raise arm. Sometimes subluxation. Frequent association with paralysis,
biceps, brachialis anticus, and supinator longus.

Lower Extremity. Ilio-psoas. Rare except with total paralysis. Associated with
paralysis, sartorius. Loss of flexion of thigh. Limb extended (if glutæi intact).

Glutæi. Thigh adducted. Outward rotation lost. Lordosis on standing. Frequent

association with paralysis of extensors of back.

Quadriceps extensor. Flexion and adducting of leg (if hamstrings intact). Loss of
extension of leg. Frequent association with paralysis of tibialis anticus.

Tibialis anticus. Often concealed if extensor communis intact. If both paralyzed, then
fall of point of foot in equinus. Dragging point of foot on ground in walking. Big toe in
dorsal flexion (if extensor pollicis intact). The tendons prominent. Hollow sole of foot
(if perineus longus intact).

Extensor communis. Nearly always associated with that of tibialis anticus. Toes in
forced flexion.

Peroneus longus. Sole of foot flattened. Point turned inward. Internal border elevated.

Sural muscles. Heel depressed. Foot in dorsal flexion (calcaneus). Sole hollowed if
perineus longus intact; flattened if paralyzed. Point turned outward (calcaneo-valgus).

Extensors of back. Lordosis on standing. Projection backward of shoulders. Plumb-

line falls behind sacrum (unilateral). Trunk curved to side. Trunk cannot be moved
 toward paralyzed side.

Abdominal muscles. Lordosis, without projection backward of shoulders.

50 See Duchenne, loc. cit., and also Roth, On Paralysis in Infancy, London, 1869.

After the paralysis the most remarkable symptom of anterior

poliomyelitis is the rapid wasting of the paralyzed muscles. The
atrophy begins within a week after the paralysis, and its progress is
even more rapid than that following the section of a nerve.
Sometimes all the flesh on a limb is shrivelled down to the bone; at
other times the muscular atrophy is concealed by an abnormal
development of fat, constituting a pseudo-hypertrophy. When all the
muscles surrounding a joint are equally paralyzed and atrophied, no
deformity develops,51 unless, indeed, the segment of a limb is used
by means of the non-paralyzed proximate segment. In this case
deformities may be produced by the effect of weight quite
irrespective of muscular action, or in directions opposed to what we
should expect from that.
51 Except talipes equinus.

The weight of the limb or a portion of it, by stretching paralyzed

muscles, often aggravates their atrophy. This is most likely to occur
with the paralyzed deltoid when the arm is unsupported, and with the
anterior tibial muscles when the foot is allowed to drop.

Muscular atrophy occurs in the spinal paralysis of adults as well as in

children; but in the latter alone does the atrophy extend to the bones
and cartilages, tendons, fascia, ligaments, and blood-vessels. The
osseous projections to which the muscles are attached waste; so do
the epiphyses.52 The long bones are thinner and shorter, the foot is
shorter, and the hand is shortened in paralysis of the upper
extremity, even where this is limited to the upper arm, and the
forearm is scarcely affected (Seeligmüller).
52 Seeligmüller, Centralbl. f. Chirug., No. 29, 1879.
In exceptional cases the limb may become even elongated from
passive extension of the ligaments of the articulation. The bones
may become soft and flexible, and break if pressure be applied.53
53 Ch. Salomon, “Des Lesions osseuses et articulaires lieés aux Maladies du
Système nerveux,” Revue mensuelle, No. 8, 1878.

Atrophy of the bones stands in no fixed relation to that of the

muscles, now exceeding, now falling short of that in intensity. This
naturally progresses more slowly; still, within seven or eight months
there may be a centimeter of difference between two limbs.

In marked contrast with this profound trophic disturbance of the

bones is the intact nutrition of the skin. The absence of decubitus is
indeed an important diagnostic mark from ordinary myelitis. The
subcutaneous fat, however, wastes so completely that the skin
seems to be closely adherent to the subjacent tissues, and cannot
be pinched up into folds.

The temperature of the skin always falls; the limb is perceptibly

colder to the touch than its fellow, and is often bluish and cyanotic.
Heine has observed that the temperature diminishes gradually from
the centre to the periphery, and at the coldest point may sink to 14°
R.54 Hammond relates a case where the local temperature was 75°
in an atmosphere of 72°. The author says that exact measurements
of surface temperature should be taken with Lombard's differential
calorimeter, especially when convalescence is expected, as then a
rise of temperature, however slight, is of most favorable augury.
54 Loc. cit., p. 16. This is not a difference of 14 degrees between the sound and
paralyzed limbs, as is erroneously quoted by Seeligmüller (loc. cit., p. 67).

General factors contribute to the fall of temperature: diminished

blood-supply from shrinkage of blood-vessels, or even atrophy of a
certain number among these; loss of nerve-influence upon the
oxidation processes; loss of muscular contractions, which should
attract an afflux of blood. Among these factors the loss of nerve-
supply is probably the most important, since the others exist in