This article focuses on Bulgaria and looks at the interconnected processes of building public health services and military institutions in the late Ottoman Empire and its other Balkan successor states: Greece, Serbia, and Romania. An elite class emerged from this development that moved between the army and civil service and vice versa. The paper draws on four case studies to follow the career paths of physicians who straddled two worlds – empire and nation-state – and tried to merge Ottoman notions of modernization with a compressed version of state-led modernization, de-Ottomanization, and militarization of Bulgaria. Both the Ottoman Empire and the Balkan nation-states borrowed models from European military, medical, and sanitary institutions. Thus, these states embraced the army as the epitome of modernization with concomitant attention given to medicine as a sign of scientific advancement. Such pairing under the umbrella of progress eased the subsequent expansion of state, militarization, and nationalism. The initial public health structures were thereby influenced by visions that privileged the state’s military needs and compelled the new elites to champion nationalism. The article is grounded in archival materials, diaries, and memoirs and adds a neglected dimension to the understanding of the transition from empire to nation-state.