381

FROM TRADITIONALISM TO MODERNISM: MENTAL HEALTH IN THE OTTOMAN EMPIRE

This thesis aims to offer a perspective on the history of mental health in the
Ottoman Empire with a special focus on modernization. It is designed to be a modest
contribution towards studying social history of medicine relying on the Foucauldian
theoretical framework.
It first provides a literature review to delineate the changes in the Ottoman
medical history writing and the origins of the Ottoman social history of medicine.
Originally being a purely institutional history, Ottoman medical historiography has
become transformed in the late 1970s by discussing social effects of medicine.
This thesis then intends to portray the transition from traditionalism to
modernism. It investigates the limits of medical modernization and asks the question as
to what degree medical knowledge was used as a disciplinary mechanism. It searches
for how modernization shaped mental health in the Ottoman Empire with respect to
confinement practices and state control. With this regard this thesis is aimed to show a
comparative perspective between pre-modern and modern mechanisms in terms of
confinement practices and state control.
Up until the commencement of medical modernization confinement practices
were not standardized, and were not necessarily under the control of the state. Religious
institutions as well as and family and neighborhood members did play decisive roles in
confinement practices. However, from the second half of the nineteenth century,
medical knowledge was used as a disciplinary mechanism to a degree in which effective
organizational structures were established. Mental treatment, hospital conditions and
confinement practices were left to state control.
This project aims to show that state control was increased and confinement was
used as a disciplinary mechanism to a degree in which the required effective
organizational structures to be established. Discipline imposed upon individuals was not
experienced homogenously due to differences in the level of institutional effectiveness
and modernization throughout the Empire.
V
ÖZET
GELENEKSELCĐLĐKTEN MODERNLĐĞE: OSMANLI ĐMPARATORLUĞU’NDA
RUH SAĞLIĞI
Seyma Afacan
Tarih, Master Tezi, Bahar 2010
Tez Danısmanı: Y. Hakan Erdem
Anahtar Kelimeler: Osmanlı Modernlesmesi, Osmanlı Sosyal Tıp Tarihi, Ruh Sağlığı,
Akıl Hastanesi
Bu tez Osmanlı Đmparatorluğu’nun modernlesmesi bağlamında ruh sağlığı tarihi
alanında bir perspektif sunmaya çalısmaktadır. Arastırmanın amacı Foucault’cu teorik
bir çerçevede sosyal tıp tarihine mütevazi bir katkı sağlamaktır.
Đlk etapta literatür taraması yapılarak Osmanlı tıp tarih yazıcılığındaki değisimler
ve sosyal tıp tarihinin ortaya çıkıs süreci gösterilmistir. Baslangıçta sadece kurumsal
tarihten olusan Osmanlı tıp tarihyazıcılığı 1970’lerin sonlarına doğru yön değistirmis,
bu değisim ile tıp tarihi çalısmaları tıbbın toplum üzerindeki etkilerini de inceler hale
gelmistir.
Tez bundan sonra gelenekselcilikten modernliğe geçis sürecini irdelemistir. Bu
bağlamda tıbbi modernlesmenin sınırları ve tıbbi bilginin ne ölçüde bir disiplin aracı
olarak kullanıldığı sorgulanmıstır. Böylelikle Osmanlı Đmparatorluğu’nda
modernlesmenin ruh sağlığını ne yönde etkilediği tecrit uygulamaları ve devlet kontrolü
yaklasımı açılarından tartısılmaktadır. Bu anlamda modernite öncesi ve sonrası
dönemler arasında karsılastırmalı bir bakıs açısı sunulmaya çalısılmaktadır.
Tıbbi modernlesme sürecinin baslangıcı öncesinde tecrit pratikleri ne tek tip idi,
ne de tamamen devletin kontrolündeydi. Gerek dini kurumlar, gerekse aileler ve
mahalle sakinleri gerekli gördüklerinde hastaları tecrit edebiliyorlardı. Öte yandan on
dokuzuncu yüzyılın ikinci yarısından itibaren tıbbi bilgi bir disiplin aracına
dönüstürülmüstür. Buna karsın ancak gerekli organizasyon yapısı kurulduğu ölçüde
kullanılabilmistir.
Bu bağlamda bu çalısma devlet gözetiminin artısının ve tecrit uygulamasının bir
disiplin aracı olarak etkinlesmesinin ancak gerekli kurumsal altyapının insası ölçüsünde
gerçeklestiğini göstermek amacındadır. Hasta kisilere uygulanan disiplin, kurumların
aynı düzeyde yenilenmemesi sonucu esit bir sekilde ve aynı zamanda
gerçeklesmemistir.
VI
Acknowledgements
I am grateful to my thesis supervisor Y. Hakan Erdem. Without his attention and
care, this thesis could not be written. I am thankful to S. Aksin Somel for the interest he
showed in my work and his comments that enriched my thoughts. I am also grateful to
the whole history faculty for everything they taught during my graduate years. I am
thankful to Pınar Ceylan, Cenk Cengiz, Bojana D. Savić who have shared this
experience with me.
I owe my gratitude to my family, who has created a tolerant and creative
environment. Without their guidance, inspiration and care this thesis could not be
written. I must express my gratitude to my brother who has always supported me with
his endless support and friendliness.
VII
To my mother and Bora…
VIII
TABLE OF CONTENTS
INTRODUCTION…..……………………………………………..…………............1
CHAPTER I
LITERATURE REVIEW: HISTORY OF MEDICINE……………….......................5
CHAPTER II
OTTOMAN MEDICINE AND MODERNIZATION..………...……………..…...19
II. 1: Pre-modern Ottoman Medicine: Medical Pluralism; Therapy and
Preventism………….………………………………………………………......20
II.2: Ottoman Learned Medicine……..……...………………………..……..…26
II.3: Modernization of Medicine: Growing Institutionalization…...………..….35
CHAPTER III
GLIMPSES OF THE DEMENTED IN THE MEDIEVAL AND EARLY MODERN
PERIODS ……………………………………………………...……...………….....41
CHAPTER IV
MENTAL HOSPITALS IN THE LATE OTTOMAN EMPIRE WITH RESPECT
TO MODERNIZATION, CONFINEMENT AND GROWING STATE
CONTROL.………………………………………………………………………….60
IV.1: Growing State Control: The demented in Istanbul from Süleymaniye
Darüssifa to Toptası Bimarhane.………………………….………………..…..61
IV.2: Cases of Institutional Modernization and Confinement Practices Outside of
Istanbul: The Edirne Darüssifa and the Manisa Bimarhane…….……...……...71
CONCLUSION…………………………………………………………….……..…77
BIBLIOGRAPHY...…………………………………………………………....…....81
1
ITRODUCTIO
“All societies judge some people mad: any strict clinical justification aside, it is
part of the business of marking out the different, deviant, and perhaps dangerous”.1
According to Roy Porter marking out “the different” is rather a societal issue. Hence
studies on social history of mental health provide important clues both about the
demented as one of “the others” in society and about society itself. Thanks to Michel
Foucault the connection between mental health and culture is no more novel. Michel
Foucault’s work Madness and Civilization (1961) described mental illness not as a
natural phenomenon but as a cultural construct. For him history of mental disorders
would be an account of control, power, knowledge and freedom beyond a history of a
disease and its treatments. In that regard history of mental health provides weighty and
significant information on a particular society. Moreover the process of the treatment
and the question of how the demented were approached offer clues about confinement,
surveillance and control deployed by a power holder such as society and state. In a way
the discourses on the distinctions between normal versus abnormal, dangerous versus
safe and unhealthy versus healthy subjects, which have been constructed in a particular
society, could be studied via history of mental health. In other words studying history of
mental health serves to understand the changing attitude towards abnormality, and
thereafter towards comprehending the intertwined nature of concepts such as normality
and abnormality. Albeit one should be careful not to be oblivious of the fact that
discerning the changing nature of mental disorders from one society to another and from
one timeframe to another thus it is a heavy task. Still it is possible to make modest
contributions thanks to some existing notable scholarly works.
As far as I observe through my study many of the works on medical history of
the Ottoman Empire largely focus on institutional medicine and its transformations.
However, social implications of these transformations which might be analyzed via
1 Roy Porter, Madness: a Brief History, Oxford University Press, New York, (2002), p.62
2
interpretive framework and social theories are scarcely studied. Yet again thanks to the
existing literature on the subject, considerable information on the topic has provided the
author of this thesis the possibility to undertake an analytical study. In that regard this
study is designed to be a modest contribution towards analyzing history of medicine
with no intention but to integrate it with social science based theoretical framework thus
to make an attempt for a social history of medicine. In other words it is not only
intended to provide a descriptive account on the medical institutions and therein the
demented; but also to discuss the possible interpretations of the findings in
contemplation of the relation between mental health and society. It specifically focuses
on the transition from traditionalism to modernism and its consequences on the
demented with respect to the confinement practices and state control boosted by
modernization. In order to make a discussion this study is aimed to portray both premodern
and modern institutions and therein the demented with giving special focus on
the latter.
This brief survey is neither attempted to provide a panorama of each and every
dynamics playing roles in the definitions and treatments of mental disorders nor
attempted to make generalizations. In far smaller and down to earth way, it is intended
to compile and reformulate existing literature on the topic and more specifically it is
aimed to discuss the changes in the practices of confinement and state control with the
modernization process. As a theoretical framework it employs the Foucauldian theory
of asylum in which confinement is situated at the heart of the modernization, and
discusses whether this theory is applicable to the Ottoman Empire or not.
Throughout this study my expectancy to see the entire applicability of the
Foucauldian theory has been eventually challenged. My inspiration in the beginning
was originated by the points of intersection between the Toptası Bimarhane and the
Foucauldian theory. Yet throughout my study I have come across with important
differences among some other late Ottoman state asylums; the Edirne Darüssifa and the
Manisa Bimarhane in fact challenged my presupposition based on evaluating the
Toptası Bimarhane as a representative case. I eventually realized that evaluating the
Toptası Bimarhane as a case representing the whole major state asylums and the late
Ottoman medical modernization as a single process imposing surveillance upon subjects
homogenously and simultaneously would be an overgeneralization. In that regard I have
come to the conclusion that the Foucauldian theory provides a remarkable framework
which may be employed to discuss the nature of confinement in modernized
3
organizations such as Toptası Bimarhane. Yet this theory might not applicable to other
institutions away from the center and away from the state control.
In a nutshell this study is designed to be an attempt to analyze the transition from
traditionalism to modernism in the Ottoman mental healthcare. It focuses on
confinement practices and state control over the demented, especially those located at
the hospitals. It employs the Foucauldian theory of asylum and discusses the question of
whether or not his theory is applicable to medical modernization during the Ottoman
reform period. It is intended to show that late Ottoman medical modernization brought
increasing state control and disciplinary confinement practices to to the extent of the
employment of institutional modernization packages.
Chapter one is a literature review and portrays the changes in the way of medical
history writing from the early Republican era until the late 1970s where drastic changes
took place. It portrays that the discipline was previously studied from less theoretical
perspectives and was dominated by the nationalist discourses up until the late 1970s.
From then on some notable researches incorporating social theories and analytical
categories have been done. It secondly portrays that history of mental health in the
Ottoman Empire is one of the least studied subjects which needs further research.
Chapter two asks the questions of what Ottoman medicine was about and how it
was affected by modernization. It is aimed to portray both pre-modern and modern
Ottoman medicine while giving emphasis on the multiplicity of the former and growing
institutionalization which took place in the latter. In that regard learned medicine in the
pre-modern Ottoman Empire served only a limited part of the population. Meanwhile in
the nineteenth century major institutional transformations and medical modernizations
took place. Thereafter with the new concepts such as public health, procreation and
quarantine; masses were intended to be reached.
Chapter three aims to gather the bits and pieces of information on the demented
people in the medieval and early modern Ottoman Empire. It portrays “integrative
mechanisms” used in the pre-modern period and focuses on confinement practices. It
discusses the prevailing argument promoting “Islamic greater tolerance” as opposed to
“European great confinement” and challenges the ways the argument relies on
generalizations and essentialism.
Chapter four attempts to analyze mental hospitals in the late Ottoman Empire in
relation to modernization, confinement and growing state control. It discusses the
meaning of state regulations which aimed to increase the control and surveillance over
4
the demented. In that regard it is argued that the state attempted to establish efficient
structures for the sake of modernization and increasing control. In regard to the mental
hospitals, this chapter provides considerable analysis on the Toptası Bimarhane upon
which one could find more detailed accounts and few yet substantial information on
other two state asylums of the period namely the Edirne Darüssifa and the Manisa
Bimarhane, thus having the ability to make comparisons. The Toptası Bimarhane
reflects the increasing state control over the hospital and therein the demented. In that
regard the demented people of Istanbul might be seen as subjugated to surveillance
deployed by the state mechanisms. However the Edirne Darüssifa and the Manisa
Bimarhane apparently did not take their share from the increasing state control. In that
respect the concluding remark would be that the state did attempt to increase its power
over individuals via medical knowledge, though individuals in each province were not
subjugated homogenously possibly due to the organizational inadequacies.
5
CHAPTER I
LITERATURE REVIEW: HISTORY OF MEDICIE I TURKEY
Ottoman medical history has been studied since the late nineteenth century. This
chapter is intended to mention important works in the field and to highlight a
transformation that took place in the late 1970s. Up until the late 1970s the field has
been contributed by notable names who served a lot to accumulate substantial
knowledge on the history of medicine. Still the genre has been criticized for being
focused mainly on institutional histories and underlining “stories of glory” conditioned
by Turkish nationalist discourse and for neglecting societal and historical context.
Thanks to scholarly works written until the late 1970s, an important amount of
knowledge on the discipline has been accumulated and then after the late 1970s this has
enabled new generations to write more comprehensive works and make sounder
interpretations. After the late 1970s the discipline has been gaining a methodology
integrating historical context and an analytical framework employing social theories. In
a nutshell the field has been transformed from institutional histories to a social history
of medicine.
***
Foundation of the Imperial Medical School (Cemiyet-i Tıbbıye-i Sahane) and
their publication of medical journal Gazette Medicale d’Orient might be seen as a
cornerstone. Although articles mostly rely on European medicine of the time period,
still some historical remarks might be found. 2 The first generation was originated by
medical doctors wrote on various topics and history of medicine as well. One of the
2 Hüsrev Hatemi, “Türkiye’de Tıp Tarihi Biliminin Gelismesi”, in IInd Turkish Medical History
Congress, 20-21 September, 1990, Kongreye Sunulan Bildiriler, Ankara: Türk Tarih Kurumu, 1999,
pp:31-38; Hatemi mentions Dr Mongeri’s article named “Etudes sur l’attention mentale en Orient”, in
Gazette Medicale d’Orient, v.2, no:10, p.202, 1860
6
pioneering figures of medical doctors working on history of medicine was Hüseyin
Remzi Bey (1839-1896)3, who wrote “Tarih-i Tıb” (History of Medicine) in 1886.4 In
the preface of the book he mentioned his plans to provide a detailed historical analysis
on the history of Turkish Medicine up until his time period. In that regard the way he
included nineteenth century major physicians such as Ömer Sifai and Sanizade whom
were contended first time, deserves attention. 5 At the turn of the century, interest in
medical history was rather weak. 6 Two following books took attention to Turkish
Medical history were “Mir’at-ı Mekteb-i Tıbbiye” 7(1912) on the history of the Military
Medical School written by Rıza Tahsin Bey (1871-1950)8; and "Osmanlı Müellifleri”
9(1915) (Ottoman Writers) on 1691 Ottoman scholars including physicians written by
Tahir Bey (1861-1925).
In the third decade of the twentieth century, history of Turkish medicine was at
the heart of the works on medical history so as to prove that Turks performed medicine
and generated weighty medical works throughout their history. One example might be
Osman Sevki Uludağ (1889-1964) who was a military physician and his book
“Besbuçuk Asırlık Türk Tababeti Tarihi” (Five and a Half Centuries of Turkish Medical
History) published in 1925.10 This piece might exemplify the early years of the genre
having the agenda to refute European view evaluating Turks as enemies of science.
Noticeably the piece was quite important since it was one of the first comprehensive
works particularly on Turkish medical history. Yet the book was highly criticized by
3 See, Unat EK, “Muallim Miralay Dr. Hüseyin Remzi Bey ve Türkçe Tıp Dilimiz”, IV. Türk Tıp Tarihi
Kongresi Kitabı (Đstanbul, 18–20 Eylül 1996). Ankara: TTK Basımevi; 2003. s. 239- 252.
4 Hüseyin Remzi (Doktor, Kaimmakam, Yarbay) Tarihi Tıb, Karabet ve Kasbar Matbaası, Đstanbul 1304
(1886)
5 Hatemi, Türkiye’de Tıp Tarihi Biliminin Gelismesi, p. 34
6 Feza Günergun, “Medical history in Turkey: A review of past studies and recent researches”,
Symposium on the History of Medicine in Asia: Past Achievements, Current Research and Future
Directions, Academia Sinica, Taipei, Taiwan, 4-8 October, 2003; published as an online article
7 Rıza Tahsin, Mir’at-ı Mekteb-i Tıbbiye, Second Edition, Đstanbul 1330/1914
8 See Tıp Fakültesi Tarihçesi; Mir’at-ı Mekteb-i Tıbbiye: Rıza Tahsin, (ed) Prof Dr Aykut Kazancıgil.
Đstanbul: Özel Yayınlar; 1991
9 Mehmet Tahir, Osmanlı Müellifleri, 1915-1925
10 Osman Sevki Uludağ, Besbuçuk Asırlık Türk Tababeti Tarihi, Istanbul, 1925
7
Adıvar and Sehsuvaroğlu of being superficial.11 Still as Đlter Uzel highlights, Uludağ
wrote the book in twelve years during the times in which there was not enough
knowledge on Turkish medical history. Besides as Uzel mentions, Uludağ’s aim was to
prove the very existence of Turkish medicine and in that regard the book might be seen
as an accomplishment.12
Although above mentioned figures might be seen as the initiators of the
discipline, it became institutionalized in the coming years. After the University Reform
which took place in 1933 at Đstanbul University, the chairs of History of Medicine and
Deontology; and later Institute for Medical History were founded. In that regard studies
on history of medicine was upgraded in the coming years by the second generation
medical historians who were again mostly physicians; and research activities were
conducted by interested individuals. The institute collected books on classical history of
medicine, translations of ancient medical texts, Islamic –Turkic medicine and books by
graduates of Mekteb-i Tıbbiye (School of Medicine), publications of Ministry of Health
and Social Assistance and so on. Besides, the institute published a journal named “Türk
Tıp Tarihi Arsivi” (Archive of Turkish Medical History). In 1939 Türk Tıp Tarihi
Kurumu (the Turkish Society of Medical History) was founded. 13 The founder
members were as follows: Ord. Prof.Dr. Süheyl Ünver, Prof. Dr.Besim Ömer Akalın,
Prof. Dr. Akil Muhtar Özden, Prof. Dr. Fuad Kamil Beksan, Dr. Rusçuklu Hakkı Üzel,
Prof. Dr. Feridun Nafiz Uzluk, Dr. Metine Bilger, Dr. Đhsan Ünal.1415 In 1946 a chair for
medical history in Ankara was founded with the help of Feridun Nafiz Uzluk (1902 -
1974) who was appointed as professor of medical history. Uzluk, was as well an
11 Osman Sevki Uludağ, Besbuçuk Asırlık Türk Tababeti Tarihi, edited by Đlter Uzel, Ankara, Kültür
Bakanlığı, 1991, in preface written by Uzel, p. VI
12 Ibid, p. VI
13 Osman Ergin, Đstanbul Tıp Mektepleri ve Cemiyetleri, Đstanbul: Osmanbey Matbaası: Đstanbul
Üniversitesi Tıb Tarihi Enstitüsü, 1940, pp:73-74
14 Ekrem Kadri Unat, “Türk Tıp Tarihi Kurumu’nun Đlk Elli Yılının Tarihçesi”, in II. Türk tıp Tarihi
Kongresi, Đstanbul, 20-21 Eylül 1990, Kongreye Sunulan Bildiriler, Ankara: Türk Tarih Kurumu, 1999
pp:1-30
15 The presidents of the Turkish Society of Medical History are as follows: Besim Ömer Akalın (1938-
1940), Akil Muhtar Özden (1940-1949), Rıza Tahsin Gencer (1949-1950), Cemil Topuzlu (1950-1956),
Kazım Đsmail Gürkan (1956-1972), Hüsrev Hatemi (1990-2000), Nil Sarı (2000-2005), Aysegül Erdemir
(2005-2009), Đbrahim Basağaoğlu (2009-…) Retrieved from http://www.tttk.org.tr/tarihce.htm on
23.06.2010
8
important figure in the discipline, who published Turkish and Islamic physicians’ works
and translated numerous books on medical history to Turkish.
Institutionalization brought about both qualitative and quantitative advancement
in the genre. Numerous works on Ottoman and Turkish history of medicine were
produced in the period started with the foundation of the Institute. Participants of the
institute were played important roles in the accumulation of the required historical
information for the foundation of the genre which later works have relied upon.
Two other important figures were Adnan Adıvar (1882-1955) and Osman Nuri
Ergin (1883-1961). A Physician, a nationalist statesman and a scholar Adnan Adıvar
(professor of Süheyl Ünver in Medical School) wrote La Science chez les Turcs
Ottomans, in 1939, and four years later published second edition in Turkish Osmanlı
Türklerin’de Đlim (Science among the Ottoman Turks) in 1943.16 This book is also
important of being the first comprehensive research on Ottoman sciences. Adıvar
presented a chronological organization from the fourteenth century to the nineteenth
century in which each chapter offered a different period and a precise scientific activity
such as medicine, cartography, and printing. Another important figure was Osman Nuri
Ergin who wrote Istanbul Tıb Mektepleri Enstitüleri ve Cemiyetleri (Medical Schools,
Institutions and Associations of Istanbul) in 1940.17
Süheyl Ünver (1898-1986) who initiated foundation of the Society was one of
the most well-known figures among medical historians. Ünver wrote more than 2300
pieces such as books, articles, columns, prefaces.18 His pieces might be categorized in
two groups; studies on famous Turkish physician figures and institutional histories. He
primarily published works on sources of Turkish medicine. He worked on medical
institutional histories of ancient and medieval assumedly Turkic entities such as
16 Adnan Adıvar, Osmanlı Türklerin’de Đlim, Đstanbul, Maarif Vekaleti Basımevi, 1943, For detailed
information on her contributions see Halide Edip Adıvar, Doktor Abdülhak Adnan Adıvar (by Halide
Edib) Đstanbul, A.H. Yasaroğlu, 1965
17 Osman Ergin, Istanbul Tıb Mektepleri Enstitüleri ve Cemiyetleri, (Medical Schools, Institutions and
Associations of Đstanbul) Đstanbul Tıp Tarihi Ensitüsü, v.17, Osman Bey Matbaası, 1940; Osman Ergin
has been known with his famous work Türkiye Maarif Tarihi (Turkish History of Education), Đstanbul,
Osmanbey Matbaası, 1939
18 Ahmed Güner Sayar, A. Süheyl Unver, Hayatı, Sahsiyeti ve Eserleri, 1898-1986, 1994, p.563 For
detailed inf on his bibliography Prof. Dr. A. Süheyl Unver bibliyografyası/ Osman Ergin, ĐStanbul Milli
Mecmua Basım Evi, 1941; A. Süheyl Unver, Hayatı, Sahsiyeti ve Eserleri, 1898-1986 by Ahmed Güner
Sayar, 1994; Cf.,C.Yalın, “Ord. Prof. Dr. A. Süheyl Ünver Bibliyografyası”, IV, Đstanbul(1985)
9
Medicine of Uygurs (1936) and History of Seljuk Medicine.19 He attempted to prove
that figures such as Avicenna, al-Biruni and al- Farabi were of Turkish origin.20 In that
regard his researches were under the influence of Republican Ideology and nationalist
history writing.21 He has been one of the most praiseworthy medical historians since he
contributed a lot in commencing of systematic research in Turkish medical history and
the way he revealed various manuscripts and documents.22
A physician, Bedi Nuri Sehsuvaroğlu (1915-1977) was another important figure
should be added to the contributors of the genre. He wrote numerous pieces on
medicine, history of medicine and culture and society. 23 His works on history of
medicine were mostly articles presented on symposiums and conferences starting with
the one he published in 1959 on IXth International Symposium of History of Science.
He particularly worked on deontology, on history of pharmacy and on pioneering
figures in Turkish medical history such as Razi, Sabuncuoğlu, Sanizade. He contributed
to nationalist history writing both through the way he articulated Turkish medical
history and the way he contended personal life story of Atatürk from a medical
perspective. Anadolu’da Türkçe ilk Tıp Eserleri (First Medical Works in Turkish
Anatolia) (1957) 24 , Anadolu’da Dokuz Asırlık Türk Tıp Tarihi (Turkish History of
Medicine in Anatolia for Nine Centuries) (1957)25, Türk Tıp Tarihi (Turkish Medical
History) (1984)26 might exemplify the former, and Atatürk’in Sağlık Hayatı (1981)27
19 Feza Günergun, Medical History in Turkey: A review of past studies and recent researches”, p.6
20 Ibid, p.6
21 Aykut Kazancıgil, “1973’ten Bugüne Tıp ve Bilim Tarihi Arastırmaları Üzerine Bir Deneme”,
Türkiye’de Bilim, Teknoloji ve Tıp Tarihi Çalısmaları (1973-1998): Son 25 Yılın Değerlendirilmesi ve
Yeni Ufuklar (1998: Đstanbul, Turkey), Türkiye'de bilim, teknoloji ve tıp tarihi çalısmaları, (1973-1998) :
Türkiye Cumhuriyeti'nin kurulusunun 75. yılı münasebetiyle düzenlenen "Türkiye'de bilim, teknoloji ve
tıp tarihi çalısmaları (1973-1998): son 25 yılın değerlendirilmesi ve yeni ufuklar" sempozyumu'nun
(Đstanbul, 19-20 Ekim 1998) yeni yayınlar ile güncellestirilmis bildiri kitabı, edited by Feza Günergun,
Đ.Ü. Rektörlük, Đ.Ü. Bilim Tarihi Müzesi ve Dokümantasyon Merkezi, Ankara, 2000, (87-88), p.87
22 Feza Günergun, Medical History in Turkey: A review of past studies and recent researches”, p.7
23 See for example Çağan, Nazmi. Dr. Bedi <. Sehsuvaroğlu Biyografi ve Bibliyografyası (1948-1960),
Ankara: Đstanbul Üniversitesi Tıp Tarihi Enstitüsü, 1963
24 Bedi N. Sehsuvaroğlu, Anadolu’da Türkçe Đlk Tıp Eserleri, Đstanbul: Đsmail Akgün Matbaası, 1957
25 Bedi N. Sehsuvaroğlu, Anadolu’da Dokuz Asırlık Türk Tıp Tarihi, Đstanbul:Đsmail Akgün Matbaaası,
1957
10
might exemplify the latter. Türk Tıp Tarihi was published after his death by Aysegül
Erdemir and Gönül Cantay who were students of him. Erdemir and Cantay stated that
Sehsuvaroğlu highlighted the need to write a comprehensive Turkish medical history
textbook and in the end, the book was intended to fulfill the need.
The major and thus prevalent interpretation might be the nationalist discourse
promoted in the works. Apart from the criticisms originated by nationalist discourse,
another major criticism might be related with the way they ignore social and cultural
components. Medicine was presented as a separate entity, and societal context was not
deeply taken into account. Rhoads Murphy, in his article “Ottoman Medicine and
Transculturalism from the Sixteenth through the Eighteenth Century”28 written in 1992,
explicitly criticized the traditional medical history writing for many reasons but
primarily for ignoring cultural milieu. He categorized existing methodological schools
working on history of medicine in four groups: the first group studied history of
medicine as a branch of history of science and technology, the second group studied it
as a branch of history of ideas, the third group studied Ottoman medicine as a branch of
institutional histories focusing on training of physicians and the final group studies it as
a branch of biography analyzing the lives of famous physicians. Murphy is critical of
the first three groups for being focused exclusively on medical theory and ignored
practice, and he is critical of the last group for being highly subjective, and for being
cultural and national chauvinists. He rather points out the need for focusing on “cultural
milieu within which professional and popular medicine developed” instead of making
text based analysis of medical treatises. Apart from the criticisms, his article might be
seen as a seminal in the way he shows the importance of popular medicine and its
compatibility with professional medicine. For him professional medicine was highly
limited and majority of the population consulted to popular medical techniques. In that
regard popular and scientific medicines were indeed complimentary.
Ekmeleddin Đhsanoğlu whose contribution to history of science in the Ottoman
context is substantial, as well criticized the contributors to the genre up until the 1970s
26 Bedi N. Sehsuvaroğlu, Aysegül Erdemir Demirhan, Gönül Cantay Güressever, Türk Tıp Tarihi, Bursa,
Tas Kitapçılık-Yayıncılık, 1984
27 Bedi N. Sehsuvaroğlu, Atatürk’ün Sağlık Hayatı, Đstanbul, Hür Yayın, 1981
28 Rhoads Murphey, Ottoman Medicine and Transculturalism from the Sixteenth Century Through the
Eighteenth Century, Bulletin of the History of Medicine 66. Baltimore, MD, (1992),376-403, p. 378
11
and he labeled the contributors as “internalists”.29 For him, these figures were focused
on major medical developments, theories and figures. They did not pay attention to the
social and cultural milieu, economic and political factors which did play roles in
medicine. Medical developments, institutional histories, men of science were described
as separate and thereafter impenetrable entities; and thereof the historical context was
ignored to an extent. Đhsanoğlu does not push forward and does not explicitly criticize
“internalist”s, he rather makes an analysis. For him this is a methodological issue which
one should not utter critical sayings such as “should not be” or “wrong”.30
Đhsanoğlu does not only identify “internalist”s but also calls attention to the
origination of novel methodology by scholars which he called “externalist”s. For
Đhsanoğlu methodology of medical history has become more comprehensive after the
1970s and thus has established an understanding embracing socio-cultural and
economic factors with which science was directly related. For him due to former major
medical historians’ contributions and accumulation of knowledge, a transition from
“internalism” to “externalism” took place. Before going deeply into the pillars of the
novel genre, one striking question might be about the accuracy of the terminology.
External as a term still connotes the idea that social, cultural, political, religious,
economic and other factors are relational though still external to the contend. In other
words via internal and external dichotomy, medicine and its historical context are
presented as two relational though still different spheres. At this juncture the very
existence of the dichotomy might be problematic.
Recently, Shefer-Mossensohn’s criticisms originated by pretty much similar
observation. Shefer-Mossensohn criticizes the genre for simply focusing on great
success stories strengthening nationalist narrative and therefore ignoring those dynamics
outside of these great success stories. Besides, for her these “historians” presented
learned medicine and other medical traditions such as popular and religious ones were
vastly ignored. Other types of medical practices which were followed by large amount
29 Ekmeleddin Đhsanoğlu, “Açılıs Konusması”, Opening Speech, in Türkiye’de Bilim, Teknoloji ve Tıp
Tarihi Çalısmaları (1973-1998): Son 25 Yılın Değerlendirilmesi ve Yeni Ufuklar (1998: Đstanbul,
Turkey), Türkiye'de bilim, teknoloji ve tıp tarihi çalısmaları, (1973-1998) : Türkiye Cumhuriyeti'nin
kurulusunun 75. yılı münasebetiyle düzenlenen "Türkiye'de bilim, teknoloji ve tıp tarihi çalısmaları
(1973-1998): son 25 yılın değerlendirilmesi ve yeni ufuklar" sempozyumu'nun (Đstanbul, 19-20 Ekim
1998) yeni yayınlar ile güncellestirilmis bildiri kitabı, edited by Feza Günergun, Đ.Ü. Rektörlük, Đ.Ü.
Bilim Tarihi Müzesi ve Dokümantasyon Merkezi, Ankara, 2000, (5-14) p.9
30 Ibid, Đhsanoğlu, Açılıs Konusması, p.9
12
of the population were not covered. For example medical personnel, female healers and
healers performing folk medicine were neglected. These criticisms are related with the
former findings since for her the main reason of the negligence was because they
focused on great successes.31 Shefer- Mossensohn borrows Mary Lindemann’s term
“internalist history” relying on her observations on the history writing of early-modern
European medicine which again focused on great names and great successes. For
Lindemann the problem was caused by physicians willing to write history: “Physicians
wrote history of medicine from the point of view of physicians.”32
Đhsanoğlu is not the only one evaluating the 1970s as a turning point in medical
history writing. Shefer-Mossensohn also limits her critiques with the period up until the
late 1970s and then pinpoints the gradual change in the genre.33 For her, one of the real
reasons of the change was the gradual diminution of Nationalist discourse which was
still effective yet weaker than before. In that regard Shefer-Mossensohn provides a
rather ongoing gradual improvement instead of a complete transformation.
Hereafter the brief outline has been presented to show major works and medical
historians in the genre up until the late 1970s. The first generation medical historians
deserved great attention and appreciation since they indeed achieved to initiate the
discipline, provided very important books and presented very important outlines of
Turkish medical history. These works in a way enabled further studies employing
societal, historical contexts and social theories.
After the late 1970s, one might argue that the narratives covering large periods
have been replaced with series of descriptive articles on rather limited periods. On top
of that the number of works and scholars working on medical history has increased. The
number of symposiums has increased as well and this has created a chance to publish
numerous articles. Significant names might be mentioned such as Arslan Terzioğlu,
Aykut Kazancigil, Aysegül Demirhan Erdemir, Bedizel Aydın Zülfikar, Ekrem Kadri
31Miri Shefer-Mossensohn “A Tale of Two Discourses: The Historiography of Ottoman-Muslim
Medicine,” Social History of Medicine, 21:1 (April 2008), (1-12) p.4
32 As Lindemann quoted in Ibid, p.4
33 Ibid, p.5
13
Unat, Esin Kahya, Feza Gunergun, Vural Solok, Nuran Yıldırım, Nil Sarı, Mebrure
Değer.34
Another thought provoking point is that some of the pre and post 1970s Turkish
scholars of medical history had started their profession in other disciplines (especially in
medicine), and then later history of medicine turned into focus of their work. As Shefer-
Mossensohn argues there is the danger of medical background shaping the way in which
“they understood what the history of medicine was or how it should be written”.35
Nevertheless this enables them to be familiar with medical content of the material that
they come across. Nevertheless the link between those from medical origin and history
of medicine was beyond familiarity; the latter was thought to serve the former. Working
on historical medicine has been thought to contribute to current medical ethic. At this
point, history of medicine gains a new ethical function, proliferating medical ethic and
love for the nation which are needed especially for students of medicine. Aysegül
Demirhan Erdemir similarly attracts attention to the importance of medical history in
1999, in the booklet of the second Turkish Medical History Conference: “The most
valid reason to examine the history of medicine might be to understand medicine itself,
medical methods and medical organizations.”36 At this juncture history of medicine was
still seen as a branch of medicine in 1999.
As far as I observe, the recent genre has composed of important articles covering
specific periods, figures, institutions and developments. Many of these works have
presented detailed analysis. In addition scholars have integrated social scientific
34 For more information see Feza Gunergun, Türkiye’de Bilim, Teknoloji ve Tıp Tarihi Konusunda
Çalısmaları Bulunan Bazı Yazarların 1973-2000 Yılları Arasında Yaptıkları Yayınlar, in Türkiye’de
Bilim, Teknoloji ve Tıp Tarihi Çalısmaları (1973-1998): Son 25 Yılın Değerlendirilmesi ve Yeni Ufuklar
(1998: Đstanbul, Turkey) , Türkiye'de bilim, teknoloji ve tıp tarihi çalısmaları, (1973-1998) : Türkiye
Cumhuriyeti'nin kurulusunun 75. yılı münasebetiyle düzenlenen "Türkiye'de bilim, teknoloji ve tıp tarihi
çalısmaları (1973-1998): son 25 yılın değerlendirilmesi ve yeni ufuklar" sempozyumu'nun (Đstanbul, 19-
20 Ekim 1998) yeni yayınlar ile güncellestirilmis bildiri kitabı, edited by Feza Günergun, Đ.Ü. Rektörlük,
Đ.Ü. Bilim Tarihi Müzesi ve Dokümantasyon Merkezi, Ankara, 2000, (5-14) p.9 Unfortunately the list
represents only tiny part of the contributors, and numerous other contributors are not included. Since the
number of scholars have increased, only those published numerous works are included.
35Shefer-Mossensohn “A Tale of Two Discourses: The Historiography of Ottoman-Muslim Medicine,”
p.4
36 As Ceren Gülser Đlikan cited in her unpublished thesis; “Tıp tarihini incelemenin belki de en geçerli
nedeni, tıbbın kendini anlamak, tıp tekniklerini, tıp organizasyonunu kavramaktır.” Ceren Gülser Đlikan’s
translation, in Aysegül Demirhan Erdemir “Tıp Tarihi ve Deontoloji Anabilim Dalının Tıp Bilimleri
Đçindeki Yeri, Geleceğe Yönelik Özellikleri ve Bazı Orijinal Sonuçlar”, in II. Türk Tıp Tarihi Kongresi,
Đstanbul, 20-21 Eylül 1990, Kongreye Sunulan Bildiriler, Ankara, Türk Tarih Kurumu, 1999, p.54
14
perspectives by using new analytical categories. Good examples employing social
scientific perspective are numerous, though the ones integrating gender as an analytical
category into history of medicine written by Nuran Yıldırım and Nil Sarı might be more
important to remember. Nuran Yıldırım edited a book37 on the position of women in the
Ottoman health in which Nil Sarı, who had published several pieces on women in
history of medicine, 38 beside many other scholars contributed. Nuran Yıldırım has
offered numerous important pieces intersecting history and social sciences. She initiated
studies on public health in her article on preventive health measurements39 and thereof
public health has become a popular topic of interest on which several articles and
Master Thesis have written.40 Among many other important works written by her, one41
on Hamidiye Etfal Hospital portrays that institutional histories might be as well studied
as a branch of social history of medicine. Her significant book A Tour of the History of
Medicine in Đstanbul Taksim Beyoğlu Üsküdar 42 offers another important example of
social history of medicine.
Miri Shefer-Mossensohn is yet another important figure whose works rely on
social theories and their applications to medicine, health, madness and medical
37 Nuran Yıldırım,(eds) Sağlık Alanında Türk Kadını:Cumhuriyet’in ve Tıp Fakültesine Kız Öğrenci
Kabulünün 75. yılı, Đstanbul, Novartis, 1998
38 See for example, “Women dealing with health during the Ottoman reign”, 35th International Congress
on History of Medicine, Kos Island, 2-3 September, 1996, Book Abstracts, 1996, p.63, “Osmanlı Sağlık
Hayatında Kadının Yeri”, Yeni Tıp Tarihi Arastırmaları, V.2-3, Đstanbul, 1996-1997, pp.11-64; “Kadın
Hastabakıcılar ve Osmanlı Toplumunda Uyandırdığı Yankılar”, Sendrom, Year:4, V. 8, August 1992,
pp:6-15 (with Zuhal Özaydın)
39 Yıldırım, Nuran, “Tanzimat’tan Cumhuriyet’e Koruyucu Sağlık Uygulamaları” in Tanzimat’tan
Cumhuriyet’e Türkiye Ansiklopedisi,Đstanbul: Đletisim yayınları (1985) , v.5
40 See for example Đbrahim Halil Kalkan, an unpublished M.A. thesis “Medicine and Politics in the late
Ottoman Empire (1876-1909) Boğaziçi University, 2004; Kathryn Kranzler, an unpublished M.A. thesis
“Health Services in teh Late Ottoman Empire, (1827-1914)”, Boğaziçi University,2004; Ceren Gülser
Đlikan, an unpublished M.A. thesis “Tuberculosis, Medicine and Politics: Public Health in the Early
Republican Turkey”, Boğaziçi University, 2006
41 Nuran Yıldırım: “Hamidiye Etfal Hastane-i Alisi/Sisli Etfal Hastanesi (24 Mayıs 1315/5 Haziran
1899)- Hamıdıye Childrens’ Hospital/ Sisli Etfal Hospital (24 May 1315/5 June 1899”, Ülker Erke’nin
Yorumu ve Fırçasıyla Türkiye’de Tarihi Sağlık Kurumları. Historical Health Institutions in Turkey
Through Ülker Erke’s View and Style. Sergiyi Haz. Ülker Erke, Yay. Haz. Nil Sarı, Nobel Matbaacılık
Đstanbul 2002, 151-153
42 Nuran Yıldırım: A Tour of The History of Medicine in Đstanbul Taksim Beyoğlu Üsküdar, Đstanbul
2008, The Turkish Society of Clinical Microbiology and Infectious Diseases (KLĐMĐK)
15
institutions. Her seminal book named Ottoman Medicine: healing and medical
institutions, 1500-170043 is important since it applies post-modern discussions and
social theories and since she attempts to give voice to medical practices and
practitioners outside the learned medicine. On top of that her works are also important
in the way she touches upon history of mental health providing foundation for further
analysis.
Mental health is one of the least studied subjects. Although important books and
articles have been published, and major books on history of medicine have touched
upon the subject, it obviously needs for further elaborations. Existing literature provides
main pillars such as institutional descriptive histories of main institutions and figures
though still comprehensive analytical framework might be seen as rudimentary. Since
this thesis largely relies on these major important pieces, a detailed analysis on
historiography of mental health might be helpful. Yet, sources on different topics briefly
mentioning some aspects of it will not be included.
“Karacaahmet ve Delileri Tedavi Yurdu” (Karacaahmed and the Insane
Asylum), short, though important, this article was written by Edib Ali Baki in 1947.44
This article is one of the first pieces particularly on the demented and popular medicine.
It is about the insane asylum founded by Karacaahmet about whom we do not know
much except he had died before 1390 as a waqf deed reflected. Ali Baki argued that
Karacaahmet, his son and grandchildren had founded a dervish lodge serving like an
insane asylum and had cured the demented as physicians for centuries. In that respect
although the piece is rather short, it still proves the very existence of popular medical
curative practices by folk practitioners whom had believed to have knowledge and
wisdom on mental illnesses. Findings might be summarized as follows: first of all
primarily those in tantrum had been welcomed (and those stayed calm were supposed to
be taken care of by family members), and then they had been confined for a period until
recovery, special regimen had been enforced, sacred water had been given to drink and
bath; female patients had been welcomed as well, and all of these services had been free
of charge.
43 Miri Shefer Mossensohn, Ottoman Medicine: Healing and Medical Institutions, 1500-1700, State
University of New York Press, Albany, (2009)
44 Edip Ali Baki: Eski Bir Halk Hekimi: Karacaahmet ve Delileri Tedavi Yurdu, Đstanbul, Milli Mecmua
Basımevi, 1947
16
Nil Sarı one of the first historians working on the subject provides several new
findings on a rather unknown topic.45 In addition she offers great examples of social
history of medicine. In that regard her pieces offer both good examples of the way
social history of medicine might be done and very important knowledge on the field
such as classification of mental diseases in the manuscripts, detailed analysis of mal-i
hülya, a mental disease, and popular medicine in mental health treatment.
Michael Dols’s important piece “Majnun: The Madman in Medieval Islamic
Society” 46 is a distinguished enterprise. The book might be seen as a cornerstone since
writing on medicine itself a heavy task due to its changing nature. In that regard Dols’
work obviously deserved great attention in the way he presented richness of topics,
manuscripts, interpretations and application of social theories to an extent. This book is
an undeniable proof of how medicine and culture in that regard cultural and medical
histories are interrelated. In other words, he managed to study Islamic culture via
history of medicine which serves here to grasp a societal picture. Despite the fact that
the way he achieved his goal might be criticized, his work is still a great work to
position madness as a component of culture. Nevertheless his book has been highly
criticized despite the appreciations. The title even speaks for itself, “Madman in
Medieval Islamic Society”. The book follows orientalist discourse taking medieval
Islamic societies (this time plural) as a single and homogeneous entity and in that regard
neglects the very existence of heterogeneity. Besides he did not employ chronological
perspective and thus Islamic societies’ transformations were ignored, and thereafter they
were presented as frozen and unchanged. Shoshan’s article “The State and Madness in
Medieval Islam” deepens the criticisms.47 Shoshan was critical of the book for many
reasons such as being anachronistic, being inconsistent in the essential definition of
45 See for example, Nil Sarı, “Halk hekimliğinde ve Osmanlı Tıp Yazmalarında Akıl ve Sinir
Hastalıklarının Tedavisi” II. Milletlerarası Türk Folklor Kongresi Bildirileri, Ankara, 1982 Kültür ve
Turizm Bakanlığı, Milli Folklor Arastırma Dairesi Yayınları 40, Seminer- Kongre Bildirileri Dizisi II,
pp.429-443; Yeni Symposium, Yıl19, V. 3, Temmuz 1981, pp:72-84; Osmanlı’ca Tıp Yazmalarında
“Mal-i Hülya” ve Tedavisi (XV-XVIIth C.) Đstanbul Üniversitesi Cerrahpasa Tıp Fak. Tıp Tarihi ve
Deontoloji Kürsüsü, yayınlanmamıs Doçentlik tezi, Đstanbul, 1982; “The Classification of mental diseases
in the Ottoman medical manuscripts,” Tıp Tarihi Arastırmaları 1, Đ.Ü. Cerrahpasa Tıp. Fak. Deontoloji
Anabilim Dalı ve Tıp Tarihi Bilim Dalı Yayınları Özel Seri No:1, Đstanbul 1986, pp:105-112
46 Michael W. Dols: Majnun : the Madman in Medieval Islamic Society edited by Diana E. Immisch,
Oxford : Clarendon Press ; New York : Oxford University Press, 1992
47 Boaz Shoshan, The State and Madness in Mediaval Islam, International Journal of Middle east Studies,
Vol.35, No.2, May 2003, pp.329-340
17
madness, using dubious evidences in order to underscore Islamic tolerance towards the
demented and in order to refute applicability of Foucauldian theory to the Islamic
societies. Here what Shoshan attempts to do is not to prove the applicability of the
theory, rather he criticized the way Dols dubiously and inconsistently used sources. For
him other examples refuting the Islamic tolerance arguments did exist and thus
Shoshan’s portrayal of society was not that much tolerant.
Đç Bahçe: Toptası’ndan Bakırköy’e Akıl Hastanesi (The Courtyard: the Mental
Hospital from the Toptası to the Bakırköy)48 is another book written by Betül Yalçıner
and Lütfü Hanioğlu in 2001 that highlights the institutional history of the Bakırköy
Mental Hospital. Since the hospital has a long history from Ottoman Empire to the
Modern Turkey, the book presents important information on the transitional period and
pioneering figures in a way enabling further social analysis. This book is also important
to highlight the role of Mazhar Osman as the initiator of psychiatry in Turkey.
Turkiye <öroloji Tarihçesi (History of Turkish Neurology)49 published in 2004
by physician Dursun Kırbas head of the Turkish Neurological Sciences Association,
provides rather institutional history of neurology in Turkey in which major figures
might be founded. Similarly, physician Sait Naderi published a detailed book in 2004
“Mazhar Osman ve Türkiye’de Nörosirürjinin Doğusu” 50 on the emergence of
neurosurgery and particularly the contribution of Mazhar Osman to the discipline.
Similar to Đç Bahçe, the book sheds light on a rather unknown period, and provides
descriptive information on both Mazhar Osman’s personal life story and the emergence
of a discipline neurosurgery. In that regard the book portrays a scholar of mental health
working on not only psychiatry, but also neurology, neurosurgery. Thus it offers
important information on both Mazhar Osman, his period; but also the early years of
mental health treatment before the partition of disciplines such as neurosurgery,
neurology, psychiatry, psychology.
Apart from comprehensive books on the subjects, articles written by interested
psychiatrists are also quite illuminative. Sahap Erkoç a psychiatrists has contributed a
48 Betül Yalçıner,Lütfü Hanioğlu, Đç Bahçe: Toptası’ndan Bakırköy’e Akıl Hastanesi, Đstanbul, Okyanus
Yayın, 2001
49 Dursun Kırbas, Türkiye <öroloji Tarihçesi, Đstanbul, 2003
50 Naderi Sait, Mazhar Osman ve Türkiye’de <örosirürjinin Doğusu, Đzmir; Dokuz Eylül Yayınları, 2004
18
lot to the discipline. His articles so far revealed the importance of Mazhar Osman, of
first neuropsychiatric journal and of first psychiatric association “Osmanlı Tababet-i
Akliye ve Asabiye Cemiyeti”.51
Thanks to above mentioned scholars’ works, the main pillars and figures of the
transitional period are partially known. Still interpretive framework on the
characteristics of the transition and of the early psychiatry in Turkey is rather
rudimentary.
***
In a nutshell the history of medicine of the Ottoman Empire is one of the novel
subjects which still needs further elaboration. Thanks to the old established genre up
until the late 1970s originated by mostly physicians interested in the history of the
subject, a largely unknown topic became more known. This period was dominated by
nationalist discourse, therefore the excessive success stories of medical figures and
Ottoman science in general. Following the late 1970s the discipline has gained a deeper
historical understanding into which historical context have started to be integrated. The
entrance of certain analytical categories such as gender, public health, and abnormalitymadness
has been possible due to the endeavors of novel scholars and enthusiastic
students of medical history whose theses have been quite influential.
Mental health might still be seen as one of the novel topics on which few but
notable works have been published. Thanks to these works and other works on medicine
having touched also upon mental health, the foundational information has been partially
offered enabling analytical studies.
51 See for example Sahap Erkoç, “Mazhar Osman ve Alzheimer” Artimento, Sayı 1, 1999, 68-71;
“Melankoli, malihulya, karasevda” Artimento, Sayı 2, 1999, (80-85), “Đlk Türkçe nöropsikiyatri dergisi:
Sisli Müessesinde Emraz-ı Akliye ve Asabiye Müsamereleri”, Tıp Tarihi Arastırmaları, Sayı 10, 2000;
“Osmanlı Tababet-i Akliye ve Asabiye Cemiyeti’nin kurulusu ve cemiyetin ilk celselerinin zabıtları” VI.
Türk Tıp Tarihi Kongresi, Đzmir, 22-24 Mayıs 2000, Bildiri Özetleri, Đzmir, 2000
19
CHAPTER II
OTTOMA MEDICIE AD MODERIZATIO
Medical practices, the development of medical sciences, medicalization and
societies’ approaches to health bear the marks of historical, cultural, religious norms
and social orders. Thus they should be evaluated within the societal context. Before
questioning mental health issues in the Ottoman Empire the preliminary questions we
should raise here are what Ottoman medicine was about and how it was affected by
modernization. In that regard this chapter contains brief though required information on
both the pre-modern Ottoman medicine (including institutional and popular practices)
and on the emergence of modern Ottoman medicine in the nineteenth century. These
two questions are rather intertwined and required some attention since both highlight
the gradual increase of social control mechanisms.
Thanks to Michel Foucault the connection between medicine and power is no
more novel. Many of the concepts originated, articulated and rendered by Foucault has
been applied to historical analysis and in that regard has shed light on intensifying
control mechanisms during modernity.52 Although his theory has been highly criticized
of being ahistorical, still his emphasis on medical knowledge being used to indicate
marginal accordingly “dangerous” groups has been widely accepted.53 According to his
theory medical institutions (such as hospitals, clinics, and mental asylums) were more
relevant to exclusion and confinement than for medicine and health.
Applied to the Ottoman Empire, the second half of the nineteenth century was
marked by a dramatic increase in the institutionalization of medicine. In that regard it
52 Michel Foucault, The Archeology of Knowledge, trans. A. M.Sheridan Smith (New York: Pantheon
Books, 1972), Michel Foucault, The Birth of the Clinic: An Archeology of Medical Perceptions, trans. A.
M. Sheridan (London, Tavistock Publications, 1976) Michel Foucault, Discipline and Punish: The Birth
of the Prison, trans. A. M. Sheridan (New York: Vintage Books, 1979),Michel Foucault, Madness and
Civilization: A History of Insanity in the Age of Reason, trans. Richard Howard (London: Tavistock
Publications, 1967)
53 Miri Shefer Mossensohn, Health as a Social Agent in Ottoman Patronage and Authority, <ew
Perspectives on Turkey, no:37, 2007, p. 148
20
should be useful especially to start with the main characteristics of pre-modern Ottoman
medicine and then searching for how it did change during the nineteenth century.
II. 1: Pre-modern Ottoman Medicine: Medical Pluralism; Therapy and
Preventism
Medical pluralism: Coexistence of diverse medical traditions
Ottoman medicine was formed within a multicultural context thus was
embedded with plurality of medical techniques, thus offered multiple alternatives to
commoners who was faced with insufficiency of pre-modern institutions. It was
dominated by a combination in which multiple legitimate centers of inspiration did
coexist. Thus Ottoman medicine was a system enriched by multiple compatible subfields
of knowledge and medical practices three of which were folkloristic popular
medicine, mechanistic Greek medicine and Muslim religious medicine.
Popular medicine was an amalgamation of different traditions from “Hellenic
Anatolia” to “Christian Balkans”. Popular medicine was a custom based one thus it is
not easy to decompose it to each and every source of inspiration. It provided important
knowledge about therapeutic value of herbal preparations and proliferated from below
by inheritance of techniques and accumulation of knowledge.54 Given the low number
of Ottoman trained physicians, commoners relied on popular medicine and folk healers.
“Whatever the cause, whether physical and spiritual, it is an indisputable fact that
individuals from all social classes…in both rural and urban settings had universal and
frequent recourse to practice we would today describe as folk medicine or outright
superstition.” 55 In that regard in the pre-modern period the distinction between
superstition and medicine might be seen as a blurry one. Although it is rather hard to
determine each and every popular medical practice, prevalence of it, is also
indisputable.
54 Miri Shefer Mossensohn, Ottoman Medicine: Healing and Medical Institutions, p. 25
55 Rhoads Murphey, Ottoman Medicine and Transculturalism from the Sixteenth Century Through the
Eighteenth Century, p. 384
21
Another medical tradition was Mechanistic medicine inherited from Greek
antiquity. This tradition can be seen as the learned medicine of the time, was
incorporated through educated and literate Muslim urban elites who were keenly
interested in antique scientific treatises and major Greek medical figures up until the
nineteenth century. In addition humoral medicine had the priority among other medical
traditions and gained official support. 56 This system was practiced in the Ottoman
hospitals. Mechanistic medicine was based on the humoral theory which was rooted in
Greek philosophy, Hippocratic doctors’ practices and Galenism.57
It was a world view, beyond a simple medical principle. Essentially this theory
was an application of the concept of four elements of nature (air, earth, fire, water) to
human body. According to the theory, human body was composed of four humours
made in various organs: blood (air), phlegm (water), black bile (earth), yellow bile
(fire). Each humour was formed by two qualities; blood was moist and hot, black bile
was dry and cold, yellow bile was hot and dry, phlegm was cold and moist. Within the
doctrine these humours had to be in great equilibrium and the direct reason of an illness
was an imbalance in the body caused by either excess or deficiency of a humor or
humors. In the case of an illness humoral equality was supposed to be ensured by a
doctor via manipulation of humours by their qualities.58
Humoralism had also a preventive side. It provided not only curative but also
preventive techniques. The humoral doctor was supposed to know the requirements of
humoral balance and lead healthy individual to preserve it. Retaining humoral balance
was not an easy task and relied on many broadest variables’ integration, namely “diet”.
Diet comes from Greek word “diata” means “regimen for life”. It was a manner “by
which a man through his daily activity found himself in a lively and permanent relation
with his surrounding world”.59 Diet was actually used very different from existing food
regimen. It was a broader term meaning six non-naturals, promoted the idea that non-
56 Dror Ze’evi, Producing Desire: Changing Sexual Discourse in the Ottoman Middle East, 1500-1900,
Berkeley: University of California Press, 2006, p.18
57 Dols, Michael W.: Majnun, p.18
58 Ibid, p.18
59 Expiracion Garcia Sanchez, “Dietic Aspects of Food in al- Andulus” in Patterns of Everyday Life, ed.
David Waines (Alderson, UK: Ashgate,2002), p.276
22
naturals should be used in the proper order, place and time. Six non-naturals were light
and air, food and drink, work and rest, sleep and waking, excretions and secretions
(includes baths and sexual intercourse), dispositions and states of the soul.
From the ninth century onwards Muslim scholars developed Muslim religious
medicine a genre of medical writing known al-tibb al-nabawi or “Prophetic medicine”
used as an alternative to Greek based medical system.60Authors were usually clerics
rather than physicians. The genre relied mostly on hadiths, the written traditions of
Prophet Muhammad. Within this framework suffering was presented as a purifying
element, thus as a desired religious virtue. Thereafter illness became a mean on the way
of martyrdom and holiness, in a way accelerating an entrance into paradise. Prophetic
medicine and mechanical medicine cannot be evaluated as two unconnected or counter
entities. These two had many points of convergence and indeed the former employed
the latter to explain God’s acts in human body and to complement religious practices
with healing practices.61 The aim of the scholar might be seen as to legitimize medicine
in the eyes of Muslim scholars and making it pertinent to religious view point. The
treatises on the Prophetic medicine were not seen as competitive with Greek medicine.62
Muslim scholars have contributed to medicine, science and philosophy for many
centuries. Islamic medicine facilitated the preservation of Greek medicine as well.
“On the ground the preservation and promotion of Galenic teaching may be
explained by Galen’s popularity with the medical school of Alexandria.
Moreover, the survival of the Alexandrian school into the Islamic Era represents
the continuity between Greek medicine and Islamic medicine.”63
At this juncture major Muslim scholars were endowed with both the escalation
of Muslim medicine and continuation of Greek medicine. These scholars such as Đbn-i
Sina, ar-Razi, al-Majusi offered an amalgamation of the two and reformulation of the
60Emilie Savage- Smith, “Muslim Medicine” Encyclpedia of Islam, v.10, p. 453
61 Dols, Majnun, p.11
62 Ibid, p.453
63 Ibid, p.38
23
former; thus played significant roles. Đbn-i Sina (c.980-1037) known as Avicenna was
one of the most significant figures. He was considered the “second teacher” after
Aristotle since he was foremost an Aristotelian philosopher; applied to medicine, his
predominance was owing to his reconciliation of Aristotelian natural philosophy with
Galenic medicine.64 He offered numerous works on medicine, one of which was “el-
Kanun fi’t-Tıbb”. The book was translated to Latin by Gerard of Cremona and became
very prominent in medieval and Renaissance European medicine. It is divided into five
parts, covers principles of medicine, material medicine, diseases of bodily parts, general
diseases, cosmetics, and a formulary of compound medicine. Ibni Sina has been an
important scholar with regard to the way he contented madness, and mental illnesses.
He covered major mental illnesses such as melancholia, mania, love-madness (‘ishq)
and he emphasized not solely the treatment of the body, but also the psyche.
On top of that, these three medical traditions - folkloristic popular medicine,
Muslim religious medicine and mechanistic Greek medicine - indeed had many other
points of convergence and therefore they were not separate and exclusive. Especially
when it came to oral transmissions, medical knowledge and practice could no longer
carry with origins. Different practices with different origins and sources could be fused
and then used regardless of knowledge about their “high” origin. This shows two points,
first these three were indeed compatible and patients scrambled for the most effective
treatment regardless of the origin of the treatment.
One striking question might be to what extent learned medicine represents
medical practices shared by commoners. Learned medicine pervaded via manuscripts
and taught in educational and sanitarian institutions. On the other hand accesses to these
institutions were quite low.65 Beside learned and institutional medicine, there was a bulk
of therapeutic techniques constituted an important part of Ottoman medicine.
64 Ibid, p.73
65 Murphey, Ottoman Medicine and Transculturalism from the Sixteenth Century Through the Eighteenth
Century, p.384
24
Therapy and Preventism
Food and beverages were crucial therapeutic and preventive tools, hence used as
first courses of action. Food and beverages were seen as illness preventive tools and a
healthy regimen was considered as a protector of one’s body and soul. The
differentiation between gastronomy and pharmaceuticals was not so apparent.66 The fact
that medical concerns were considered in gastronomy and cuisine in the Ottoman palace
as reflected in European travel accounts shows the very existence of that knowledge but
remains silent about the practices of commoners.67 Health and food had social roles and
were used as a signifier for social status assigning social ties.68 Certain foods and dishes
were ascribed to preventive and curative aptitudes yet not all were present in local
regular meals. Thus rare items might be considered as less accessible for the commoner.
Medication was also employed for preventive and curative purposes. However
access to medication and especially to some rare and expensive ingredients was related
to the one’s financial conditions. Drugs wherein opium, hashish, pulverized gems
(colored and clear) and precious metals were not available for a regular hospital patient
yet given to patients in the imperial palace. Besides, these drugs and ingredients were
available for those who could purchase at full prices. Thus poor patients had hardly any
choices other than simple and coarse medication.69
Two of the popular medication forms mentioned in both scientific and
nonscientific works were syrup (Serbet in Ottoman Turkish) and doughy paste (Ma’cun
in Ottoman Turkish). They were prepared in various ways and popular among the
Ottomans. Syrup was a viscous juice mixture of fruits and plants. Doughty paste
included more than forty different ingredients such as raisins, honey, almonds,
66 Miri Shefer Mossensohn, Health as a Social Agent in Ottoman Patronage and Authority, p.152
67 Otavio Bon, the Sultan’s Seraglio: An Intimate Portrait of Life at the Ottoman Court, London: Saqi
Books, (1996)pp: 35-36, 64, 93-104,; C.G. Fisher and A. Fisher, “Topkapı Sarayi in the Mid-Seventeenth
Century: Bobovi’s Description”, Archivum Ottomanicum 10 (1985),pp.30-32,63-64
68 As Shefer noted see for example Tülay Artan, “Aspect of the Ottoman Elites’ Food Consumption:
Looking for ‘Staples’, ‘Luxuries’ and ‘Delicacies’ in a Changing Century” in Consumption Studies and
the History of the Ottoman Empire, 1550-1922, ed Donald Quataert (Albany: SUNY Press,2000) Amy
Singer, Constructing Ottoman Beneficence: An Imperial Soup Kitchen in Jerusalem (Albany: SUNY
Press, 2002), Amy Singer, “Serving Up Charity: The Ottoman Public Kitchen”, Journal of
Interdisciplinary History, 35, no:3 (2005)
69 Shefer-Mossensohn, Ottoman Medicine, p. 30
25
aromatics, red and black pepper, ginger, coriander, coconut, saffron, cinnamon,
mustard, nigella, cardamom and so on. Both were used for nourishment and sometimes
for medical purposes. Honey was assumed to be another popular preventive and
curative; and rather the cheaper one. It was believed to have high nourishing value thus
used for medical purposes. It had religious importance since it was attributed healing
quality by the Prophet.
Narcotics such as opium, hashish, wine, coffee and tobacco were among the well
known curative drugs yet there were some religious and ethical debates and sometimes
prohibitions on their usages. Despite the fact that opium was on the list of imperial
kitchen purchase list and used for patients in Topkapı, it was not the prerogative of the
upper stratum.70 It was as an easily found medicine and consumed rather by Ottomans
from all strata as a cure to ache. The demand for it was high. Apart from curing aches,
it was used for controlling and pacifying the insane. Addiction was seen as a threat for
social order, thus narcotic usages were open to prohibitions of authorities, and users
were suspects. Yet still narcotic drugs were tolerated.
Surgery was another curative option. Despite the fact that there were complaints
about malpractice against operators as reflected in court cases, it was still a common
practice. Surgeon was called jarrah in Arabic and cerrah in Ottoman Turkish which was
different from physician. Surgeons were paid less salaries then physicians as documents
on salaries paid to hospital employers reflect.71 Surgery was thus seen as a separate
medical field. The operations were usually done by surgeons, nevertheless surgery was
a field in which folk medicine thus folk healers played roles beside surgeons.
Phlebotomy (hijama) and cauterization were quite popular and practiced as well.
Phlebotomy has a religious legitimization since the Prophet approved it and also
humoral reasoning. Bloodletting which supposedly had both curative and preventive
function was thought to ensure the humoral equilibrium and cure illnesses caused by
excess of blood or that of corruption. It was a regular treatment for aches and pains and
operated through multiple methods. Cauterization, in Ottoman Turkish dağ and in
Arabic ‘ilaj bi-nar, was used for curing multiple illnesses such as headaches, fistulas,
hemorrhoids, and even mental illnesses such as forgetfulness and moods. It was
70 Ibid, p.39
71 Ibid, p.46
26
performed by placing a white-hot iron on a spot on the body and detaching it after few
seconds. Inoculation was another surgical operation done against smallpox by
specialists in folk medicine. Veins in the arms, chests, forehead of teenage boys
(whether it was given to girls is not specified in the sources) were opened and then
mucus received from wounds was inserted. Circumcision might also be seen as a form
of surgery. Although it was a religious practice recommended by his, namely sunna, it
had also medical purposes. The operation, cutting of the excess of skin from the male
genitals, was performed by surgeons.72
II. 2: Ottoman Learned Medicine
Physicians and Works
Ottoman Empire attached great importance to educational institutions in which
learned medicine was evolved. Scientific education was given by medrese institutions.
Medrese (Madrasah in Arabic) was an institution of higher education functioned
throughout the Empire. Ruling families and notables donated funds for the erection of
buildings; and tuition, lodging, food and medical care of students were free of charge.73
Medreses served to cultivate higher educated subjects constituting men of pen
specialized on different subjects, medicine as well. Medreses were firstly erected in the
capitals of the time such as Đznik, Bursa, Edirne and Đstanbul though there were many
other medreses founded in other newly conquered territories. Ottoman medreses
provided medical education, and even separate medical medreses were founded in
Edirne Darüssifa and Süleymaniye Darüssifa.74 From then on Ottoman learned medicine
which was largely relied on above mentioned Muslim men of medicine such as ar-Razi,
Harezmi and Ibni Sina, was evolved via prominent graduates. Though this project is not
aimed to be about Ottoman scholars, only relevant prominent figures worked on
medicine and published works originating learned medicine will be mentioned. In that
72
Ibid, pp:40-60
73 Encylopedia Britannica (online), Britannica Advanced Publishing, Inc., Chicago, IL, 1994-2000,
Medrese
74 Cevat Đzgi, Osmanlı Medreselerinda Đlim: Tabii Đlimler, Đstanbul, Đz Yayıncılık, 1997, II, pp:21-25
27
regard due to the limits of the project, numerous significant Ottoman men of science,
technology, natural sciences will be excluded.
The first medical manuscript written in the Empire was Müntehab-ı Sifa /
Edviye-i Müfrede written by Murat b. Đshak in 1387. 75 The manuscript was deliberately
written in Turkish to make it available to who made use of it. It contains considerable
information on both diseases (especially diseases observed in chest, head and stomach)
and possible medicaments containing plants. Đshaki mentioned that he used the works of
major men of science such as Galen, Hippokrates and Đbni Sina.76 Another important
physician of the fourteenth century was Cemaleddin Aksarayi (d.1389) who wrote “Hall
el-Mucez” in Arabic. In the book one can understand that Ottoman men of medicine
highly used humoral theory and Ibni Sina’s works employed, articulated and make
known the theory. Other important physicians and men of medicine of the century were
Celaleddin Hızır (d. 1417-1424) and Ahmedi (1334-1413).
Fifteenth century was a period in which several manuscripts were written and
translated in order to make known preceding Muslim medicine. Physicians of the period
mostly focused on specific organs such as eye and eye diseases. Considerable part of the
works was written in Turkish. One could say that many of the works written in the
fourteenth and fifteenth centuries were full or partial translations. 77 Prominent
physicians wrote reference works, made translations of the period were Đbn Serif,
Ahmed Dai, Seyhi Yusuf Sinaneddin (1371 ?-1431), Mümin b. Mukbil, Aksemseddin
Mehmet b. Hamza (1390-1459), Sükrullah Sirvani, Hekim Besir Çelebi, Amasyalı
Mehmed b. Lutfullah, Esref b. Muhammed and Serafeddin Sabuncuuğlu (1386 ?-
1470). 78 Sabuncuoğlu deserves special attention for the way he employed and
developed surgery. His famous work “Cerrahiyetül-Haniyye” has been one of the most
important manuscripts written in the Empire; since beside observations on surgery and
required apparatuses for surgery, Sabuncuoğlu included illustrations. The piece shows
that Ottoman men of medicine were familiar with preceding literature on medicine since
Sabuncuoğlu used “Kitabü’t- Tasrif” written by Ebu’l Kasım e’z-Zehravi, an eleventh
75 See Aysegül Demirhan Erdemir, “Geredeli b. Đshak”, Türk Dünyası Tarihi Dergisi, c8, 1994, (50-54)
76 Esin Kahya, Aysegül D. Ermedir, Osmanlıdan Cumhuriyete Tıp ve Sağlık Kurumları, p.100
77 Esin Kahya, On Besinci Yüzyılda Osmanlılarda Bilimsel Faaliyetlerin Kısa Bir Değerlendirilmesi, p.13
78 Esin Kahya, Aysegül D. Ermedir, Osmanlıdan Cumhuriyete Tıp ve Sağlık Kurumları, p.101
28
century physician from Andalusia. Sabuncuoğlu wrote “Mücerrebname” on medication
and “Akrabaddin Tercümesi” a partial translation of el Cürcani’s piece “Zahire-i
Harzemsahi”.
Prominent physicians offered important works in the sixteenth century were as
follows: Ahi Çelebi (1435-1524) who focused particularly on kidney diseases, Hekim
Atufi (d.1541) whose major work was “Ravd el-Esnan fi Tedbir-i Sıhhati’l-Edban”
promoting Prophetic medicine, Hekim Nidai whose major work was “Menafiü’n-<as”
one of the most comprehensive medical manuscripts of that period; Ali b. Osman, and
Davud el-Antaki (d.1599)79. Davud el-Antaki an interesting blind physician, received
education in Damascus and Cairo, learned Greek, wrote “Tezkiretü üli’l-elbab ve’lcami’I’l-
acebi’l ucab”, a comprehensive book mentioning numerous diseases, and
wrote “<ushet el-Mubhica fi Tashihi’l-Edhan” comprising human and animal anatomy.
“Tezkiretü üli’l-elbab ve’l- cami’I’l-acebi’l ucab” might be seen as one of the earliest
examples of early contacts with western medicine. Davud el-Antaki in his book wrote
about syphilis (frengi) and its treatment which was learned through European sources.
Throughout the Seventeenth century, major works on medicine were produced.
In addition, the century has been marked as a starting point of European medicine’s
influence over that of Ottoman. Yet previous medical traditions did not simply dropped
off, rather old and new traditions coexisted for a long time.80 Here is the list of major
men of medicine of that period.
Emir Çelebi (d.1638) studied in Egypt and then came to Đstanbul to serve the
ruling family and wrote “Enmuzec el-Tıb” in which he also mentioned medical ethic.
He highlighted the importance of dissection and anatomical knowledge which one could
learn via working on the cadavers of non-muslims. Zeynel Abidin (d.1646) wrote “Sifa
el-Fuad li Hazret-i Sultan Murad” in 1628 upon Murat IV’s request on healthy diet
showing the fact that diet was highly mattered for health. Dervis Siyahi yet another
figure working on medicament and one of his most important books was “Lugat-ı
Müskilat-ı Ecza” (1615). His other manuscript “Manzume-i Siyahi” in which he
emphasized the importance of humoral theory shows that humoral theory was still
79 Ibid, pp:157-166
80 Ibid, p:173
29
acknowledged by the physicians of that time. Sakızlı Đsa Çelebi (d.1649) wrote “<izam
el-Edviye” on medicament, “Deva el-Emraz” (Đbtida el-Tıbb) and “Mifredat el-Tıbb”.
“Deva el-Emraz” was a significant work since it contended mental illnesses as well. In
addition both “Deva el-Emraz” and “Mifredat el-Tıbb” (explaining medical
terminology) include syphilis as an illness implying the early contacts with the west.
Semseddin-i Đtaki el-Sirvani born in Sirvan, then came to Đstanbul, wrote “Tesrih-i
Ebdan ve Tercüman-ı Kıbale-i Feylusufan” on anatomy a first manuscript on anatomy
with illustrations then presented to Murat IV. “Tesrih-i Ebdan ve Tercüman-ı Kıbale-i
Feylusufan Đtaki” partially relied on “Teshir-i Ebdan” written by 14th century Muslim
scholar Ahmed b. Mansur with illustrations, still the former might be seen as a novel
manuscript. The manuscript was also seen as another example of early contacts since
Đtaki was supposedly used European sources on the subject.81
Hayatizade Mustafa Efendi (d. 1692) was yet another important physician of the
century of Jewish origin. One of his works “Hamse-i Hayatizade” consisting of five
chapters deserves attention for two reasons. First the work again proves that Ottomans
of that period were aware of European medicine since Hayatizade himself mentioned
some of the books on the diseases which were thought to be originated from Europe
such as syphilis. On top of that the book is quite important since the first and second
chapters “Risale-i Müsfiyye li el-Emraz el Müskile” and “Risale-i Sevda-i Merakiyye”
are related with a mental illness, anxiety (merakiyye). Both chapters explain the reasons
of anxiety with biological causes. In the second chapter he mentioned that sevda-i
merakiyye was caused by excess of black bile and this resulted melancholy. In that
regard the book seems quite informative about the discourse on mental health and
obviously deserves more attention and further studies. Salih b. Nasrullah (d. 1669) was
another important figure in the way he combined European medicine with that of
Ottoman in his works. Some of his works are “Gayet el-Đtkan fi Tedbir el-Bedeni’l
Đnsan” and “Tıbbı-ı Cedid-i Kimya”. He introduced Paracelsus in his work “Tıbbı-ı
Cedid-i Kimya” in which he highly utilized and made partial translations of Paracelsus.
Hazerfen Hüseyin Efendi (d.1672), Ayaslı Saban Sifaii (d.1705), Nuh Efendi (1628-
1707) were other important physicians of the period.
81 Aydüz, Salim, “On Sekizinci Yüzyıl Osmanlı Tıbbında Değisim: Doğu Tıbbından Batı Tıbbına Geçis
Üzerine Bir Deneme”, Proceedings of the 38th International Congress on the Histpry of Medicine, (1-6
September 2002)V.2, (Eds)Nil Sarı, Ali Haydar Bayat, Yesim Ülman, Mary Isın, Ankara: Türk Tarih
Kurumu 2005, (1031-1038), p.1031
30
The translation of German speaking Paracelsus (Philippus Aureolus
Theophrastus Bombastus von Hohenheim, d. 1541) on chemical medicine into Ottoman
Turkish and Arabic toward the end of the seventeenth century might be seen as a
turning point. 82 Afterwards a new medical doctrine named “Tıbb-ı Cedid, Tıbb-ı
Kimyai” New Medicine in which full translations and adaptations were proliferated.83
Major pioneering figures of the doctrine such as Salih b. Nasrullah (d.1669), Ömer b.
Sinan el-Đzniki (18th century), Ömer Sifai (d.1742), Ali Munsi (d.1747), Abbas Vesim
(d.1760) and Chief physician Suphizade Abdülaziz quoted, adopted and translated
European sources.
During the eighteenth century translations increased and “Tıbb-ı Cedid, Tıbb-ı
Kimyai” was highly promoted. Bas Hekim Hasan Efendi made important translations
such as “Gunyat el-Muhassilin fi Tercümet Tuhfeti’l Müminin” and “Gayet el-
Müteharrika fi Tedbir Kuli’l-Maraz” which were again partial translations of
Paracelsus’s books. Tokatlı Mustafa Efendi (d.1782) translated Đbni Sina’s work “el-
Kanun fi’t-Tıbb” to Turkish with some editions. Gevrekzade Hasan Efendi (d.1801)
followed “Tıbb-ı Cedid” by making partial translation form Paracelsus. Besides he
wrote several books one of which was “<eticetü’l-Fikriyye fi Tedbir el-Veladetai’l-
Bikriyye” on obstetrics and gynecology and on infantile diseases. Ömer Sifai (d.1472)
was educated in Konya, and then in Cairo then started to work at Darü’l-sifa in Bursa.
He was influenced by Tıbb-ı Cedid and Paracelsus as well as reflected in his works “el-
Cevherü’l-Ferid fi Tıbbi’l-Cedid” (Tıbb-ı Cedid-i Kimya). Bursalı Ali Münsi was
another important figure promoted Tıbb-ı Cedid. He also worked on surgery and
pharmacology. The former might be exemplified by his work “Cerrahname” and the
latter might be exemplified by “Bidayetü’l Mübtedi”. He made translations of European
medical manuscripts as well such as “Karabadin-i Mir’ab” written by Hadrian
Myntsich (1603-1638). Abbas Vesim Efendi, Muhammed Rıza Ahmed (d.1766),
82 On the translator of Paracelsus into Arabic and then Ottoman Turkish, the Ottoman Court physician
Salih b. Nasrallah Ibn Sallum (d. 1670) Al-Muhibbi,Muhammad Amin b. Fadlallah. Tarikh khulasat alathar
fi ayan al-mîa al-hadiya ashara, 4 vols, El Cairo, 1284H, vol. 2, pp. 240-242; Rashed, Muhammad
bin Mustafa. Tarih-i rashed, 6 vols, Istanbul, 1282H, vol. 1, p. 96;
Adıvar, Adnan Abdülhak. Osmanlı Türklerinde ilim, Đstanbul, Remzi Kitabevi, 1991, pp. 122-123, 131-
132; KÂHYA, Esin; Erdemir, Aysegül D. Bilimin ısığında osmanlıdan cumhuriyete tıp ve sağlık
kurumları, Ankara, Türkiye Diyanet Vakfı, 2000, pp. 179-184. Shefer, Miri. Old Patterns, New Meaning:
The 1845 hospital of Bezm-i Alem in Istanbul, BIBLID [0211-9536 (2005) 25; 329-350], 2005
83 Aydüz, Salim, On Sekizinci Yüzyıl Osmanlı Tıbbında Değisim: Doğu Tıbbından Batı Tıbbına Geçis
Üzerine Bir Deneme, p: 1032
31
Katipzade Mehmed Refi’ Efendi (1682-1769), Levhizade, Suphizade Abdülaziz Efendi
(1735-1783) were other important figures of that period.84
The nineteenth Century was important since modernization of medicine became
much more visible. Significant figures were as follows: Sanizade Mehmet Ataullah
(1771- 1826) was an important chronicler of his time. He wrote “Hamse-i Sanizade”
which is composed of five chapters on anatomy, physiology, illnesses, surgery and
medicament. Mustafa Behçet (1774-1834) was yet another physician of the nineteenth
century played an important role in modernization of Ottoman medicine. He made
important translations such as “Frengi Risalesi”, “Çiçek Asısı Risalesi”, “Tercüme-i
Fisilogica”, “Ruhiye Risalesi”, “Kolera Risalesi”. His translations and great efforts for
modernization generated a new terminology relied on western medicine. Charles
Amboris Bernard, Aziz Đdris, Mustafa Hami Bey, Ahmed Remzi Pasa, Nuri Kenan, Saip
Pasa Abdi Süleyman, Semsi Serif Efendi, Hasan Zühtü Pasa, Hasan Mazhar Pasa were
among the nineteenth century physicians who were influential on modernization of
medicine and translation of major medical books to Turkish.85
Medical institutions
Ottoman hospitals were named, Bimaristan, Maristan, Tımarhane, Darü’l-sifa,
or Dar al Atiya. Bimaristan often contracted to maristan from Persian bimar “sick” the
suffix istan denoting a place. In modern usages bimaristan is mental asylum.86 They
were financed by independent funds, and were arranged along with size, importance and
requirements of the locality.87 Ottoman hospitals were part of complexes of public
institutions named as imarets. Imarets were usually initiated by members of the ruling
elite including sultans. Hospitals and imarets were charitable institutions, namely waqf.
“Waqf is in Islamic law, the act of foundation a charitable trust, and hence the trust
84 Ibid.
85 Ibid.
86 D. M. Dunlop, “Bimaristan”, Encyclopedia of Islam, vol.1, p.1223
87 Ibid, p.1223
32
itself.”88 The essential components are a person disposed to commit a pious deed, stated
that part of his/her property to be unalienable and designating persons, or public utilities
as beneficiaries of its yields.89 In other words waqf is “a legal format to finance various
large projects for the benefit of the community as a whole”.90 Public leaders (sultans,
governors, bureaucrats, and notables at all hierarchical levels) regularly marked their
political power by establishing structures such as soup kitchens, places serving for other
types of services (imarets), social gathering places (turba), medical dispensaries
(bimaristan), infrastructural services in the shape of bridges, irrigation systems,
fortresses, water conduits, aqueducts and so on in urban and rural areas as well. 91
Ottoman hospitals were one of these charitable institutions erected usually by members
of ruling family and survived as markers of the political power and social status of the
donors. Since in medicine not smale scale (such as mosques) but big investment
required donations took place thus it was rather restricted to the imperial family.92
Ottoman hospitals provided treatment, inclusive of warm, clean beds, food, and physical
and mental therapy.
The major Ottoman hospitals, erected by the ruling family up until the
nineteenth century, were as follows: The first hospital founded in the Empire was built
in Bursa by Bayezid I, the second one was a leprosy hospital erected in Edirne by Murat
II. Later on Fatih Darüssifa was established in Istanbul by Mehmet II, in 1470.93 It was
also the primary medical institution up until 1556. Bayezid II founded another one in
Edirne namely Edirne Darüssifa. In the sixteenth century a leprosy hospital was erected
in Istanbul by Selim II, in 1514. In 1539 Hafsa Sultan the mother of Suleyman I
initiated a new hospital in Manisa namely Manisa Hafza Sultan Bimarhane. In the
sixteenth century three hospitals were founded in Istanbul. In 1550 Haseki Darüssifa
was founded in Đstanbul on behalf of Suleyman I’s favorite concubine (haseki) and wife
88 R. Peters, “Waqf”, Encylopeadia of Islam, v.11, p.59
89 Ibid, p.59
90 Mossensohn-Shefer, Ottoman Medicine, p.113
91 Randı Deguilhem, Encylopedia of Islam, v.11, p.89
92 Mossensohn-Shefer, Ottoman Medicine, p.105
93 Demirhan and Kahya; Medicine in the Ottoman Empire and Other Scientific Developments,
Istanbul:Nobel Medical Publications,1997, p: 36
33
Hurrem Sultan. In 1556 Süleymaniye Medical School and Darüssifa were founded in
Istanbul. Foundation of Süleymaniye Darüssifa and Medical School might be seen as
the turning point commencing a division of labor in the institutional organization.94 In
that regard the former started to train on practical issues while the latter contended with
theoretical ones. Toptası Atık Valide Bimarhane was erected in Istanbul, at Üsküdar on
behalf of Nurbanu Sultan the mother of Sultan Murad III. Ahmed I founded the only
hospital erected in the seventeenth century namely Sultan Ahmed Darüssifa in Istanbul
in 1617. As Kahya and Erdemir argued due to the financial problems, in the eighteenth
century the ruling family did not found a new hospital which required huge amount of
investment.95
The hospital might be seen as one of the most notable charity since it promised
symbolic presence of the donor for many years. Besides Ottoman hospitals were general
hospitals serving all kinds of patients. They were intended to satisfy several needs;
medical treatment service, convalescent home for those recovering from illness or
accidents, an insane asylum, and a retirement home providing basic maintenance needs
for the aged and infirm who were short of a family to care for them.96 Despite the
variety of services, compared to other forms of philanthropic activities, hospitals were
costly institutions. That is why a very limited wealthy group and primarily the ruling
family could afford erecting one.97 Therefore in early modern Ottoman Empire the size
of official medical institutions was very low in terms of hospitals and medical personnel
compared to the amount of population. In that regard one should remember that
inadequacy of professional physicians was endemic to pre-modern societies, and
Ottoman Empire was no different.98
94 Zorlu, Tuncay; “Süleymaniye Tıp Medresesi – II”, Osmanlı Tarih Arastırmaları, 4, no:1,2002, p:94
95 For a detailed information see Demirhan and Kahya, Osmanlıdan Cumhuriyete Tıp ve Sağlık
Kurumları, Türkiye Diyanet vakfı Yayınları, Ankara, 2000
96 Emilie Savage- Smith, “Muslim Medicine” p. 455
97 Shefer-Mossensohn, Health as a Social Agent in Ottoman Patronage and Authority, p.159
98 Murphey, Ottoman Medicine and Transculturalism from the Sixteenth Century Through the Eighteenth
Century, p.384
34
In the sixteenth century Istanbul with an estimated population of several hundred
thousand people99 as one of the crowded cities of that period in the world, had only five
hospitals with a few hundred beds.100 As Evliya Çelebi reflected Istanbul’s hospital
capacity was again quite low in the seventeenth century and majority of physicians did
not have official appointments thus did not have any access to professional training.
Relying on Evliya Çelebi’s account, for every thousand physicians in private practice,
only about thirty physicians obtained official appointments.101 Thus not more than three
percent of physicians had official appointment. The semiprofessional remainder
practitioners were classified within seven categories: 700 surgeons (cerrah); 80 oculist
(kehhal); 100 purveyors of eye solutions (tutyaciyan); 500 purveyors of therapeutic
pastes (macunciyan); 600 druggists, makers of prescription (edviye) and potions
(eshribe); 70 purveyors of perfumed waters (gülab); and 14purveyors of therapeutic oils
(edham).102
***
In contemplation of above mentioned figures Rhoads Murphy puts emphasis on
two full fledged findings. At the outset the majority of population did not drive the
benefit from the institutional medicine. In other words professors of medicine at the
medreses and hospitals served only a tiny part of the overall population. Above and
beyond treatment together with self administration of drug therapy was common among
the bulk of the population. As Murphy illustrated apart from surgeons and oculists all of
above mentioned groups reported by Evliya Çelebi were sellers of health care products.
Given the low level of hospital capacity, economic factors deterring consultation with
physicians and a possible awareness of the high risk of major medical interventions
such as surgery, patients especially from the lower and middle classes consulted to
inexpensive popular remedies.103
99 Halil Inalcık, “Istanbul”, Enclylopaedia of Islam, Second Edition
100 Shefer-Mossensohn, Ottoman Medicine, p.114 (Ot med)
101 As Murphy quoted: Evliya Çelebi, Seyahatname, 10 vols., Istanbul: Ikdam Matbaası, (vols.1-6),
Devlet Matbaası (vols.7,9,10), Orhaniye Matbaası,(vols 8), A.H. 1314, A.D. (1896-1938), 1:530
102 Ibid.
103 Murphey, Ottoman Medicine and Transculturalism from the Sixteenth Century Through the
Eighteenth Century, p.383
35
In a nutshell, prior to the nineteenth century Ottoman medicine was the
combination of variety of sources primarily folkloristic popular medicine, mechanistic
Greek medicine and Muslim religious medicine. Trained physicians served only a tiny
part of the population yet variety of sources provided numerous alternatives. Folk
healers, magicians, experts of occult sciences, pharmacists, druggists, amateur
psychologists and imams, rabbis and priests as well offered different alternatives for
commoners. At this juncture in daily life practices, learned institutional medicine
(comprising Greek and Muslim medicines) and popular custom based medicine were
practiced side by side, and both spheres were intermingled to an extent. Thus this
variety might pinpoint the fact that these two medicines were indeed complimentary
though to what degree and through which means this exchange of information came
about in daily life are rather little known. On top of that given the low level of medical
institutions and variety of alternatives to institutional medicine, pre-modern Ottoman
Empire was far from establishing intense social control and public health policy.
II. 3: Modernization of Medicine: Growing Institutionalization
During and after the nineteenth century major transformations took place.
Parallel to the transformations in the socio-political sphere, major changes took place
within the realm of Ottoman medicine. On top of that another type of a medicine
sponsored by Ottoman urban elite and influenced by Europe was included into the
Ottoman medical pluralism.
At the turn of the century European medicine became more visible yet it did not
immediately replace the older above mentioned medical traditions; for a long time old
and new practices coexisted.104 As mentioned before rising Ottoman interest in new
European medicine started long before the nineteenth century. Since it was rather a
gradual process, one can trace back the origin of the process to the first half of the
fifteenth century onwards. 105 Jewish physicians named “etibba-ı Yahudiyan” who
104 Shefer, Miri. Old Patterns, New Meaning: The 1845 hospital of Bezm-i Alem in Istanbul, BIBLID
[0211-9536 (2005) 25; 329-350], 2005
105 Aydüz, Salim, On Sekizinci Yüzyıl Osmanlı Tıbbında Değisim: Doğu Tıbbından Batı Tıbbına Geçis
Üzerine Bir Deneme, p. 1031
36
migrated to the Empire towards the end of the century contributed a lot to the Ottoman
medicine to be acquainted with that of the European. The contacts continued throughout
the sixteenth, seventeenth and eighteenth centuries.
Given that early contacts with western medicine started since the fifteenth
century, and translation of western sources started with the end of the seventeenth
century, these contacts were rather on account of intellectual curiosity and far away
from originating real durable effects.106 Real long lasting effects came with institutional
changes started with the nineteenth century during which modernization and
westernization of medicine was increased. Though this increase was rather gradual and
slow one and up until the end of it old and new medical traditions coexisted. In that
regard the nineteenth century might be seen as a period during which old and new
medical traditions coexisted in rivalry, then finally towards the end of it the latter
overcame the former with the help of institutional changes.
Institutional Transformations
Institutional changes affecting state and social mechanisms, and increasing
state management were initiated with the Tanzimat reforms. During the period covering
the nineteenth century and early twentieth century modern medical system was
endeavored to be founded. Medical education and institutional apparatus were
restructured; public health was entered into the state agenda.
In 1827 a new military medical school, the Tıbhane ve Cerrahhane-i Amire
(School of the Medicine and the Surgery) was founded in Sehzadebası, Istanbul. As the
official proposal prepared by chief physician for the establishment of this school
reflected, the requirement of physicians who were acquainted with new medicine and
requirement of French courses to enrich the studies on latest methods were
acknowledged.107 Later on in 1839 this school was moved to Galatasaray in Istanbul
and renamed Mekteb-i Tıbbıye-i Sahane (Military Medical School). Charles Ambroise
Bernard, an Austrian physician, was appointed as the chief director who was invited by
106 Shefer, Miri. Old Patterns, New Meaning: The 1845 hospital of Bezm-i Alem in Istanbul, 2005, p.333
107 Bedi N. Sehsuvaroğlu, “Türk Istanbul’da Tıp Öğretimi” in Türk Đstanbul’da Tıp Fakültesinin 500.
Yıldönümü, Đstanbul: Đstanbul Tıp Fakültesi, 1971, pp:40,41
37
the Sultan.108 He contributed to initiate anatomical dissections in 1841. Although the
foundation of Military Medical School adopting modern medicine might be seen as a
real turning point, the school did not solve the problem of professional physician
shortage. Because of the scarcity of Turkish medical literature, language of the
education was French up until 1866 when the school passed to Turkish. Between 1827 -
1870 it graduated only 300 students since students had difficulty following courses.109
Due to the low number of graduates, in 1867, the Mekteb-i Tıbbıye-i Mülkiye (Civilian
Medical School), the first civilian school, was opened. The language of the instruction
was Turkish. Throughout the century the problem of language barrier was taken
seriously. In 1909 Military and Civilian Medical Schools were unified in the new
building in the Istanbul district of Haydarpasa.
In 1856 Cemiyet-i Tıbbiye-i Sahane was founded and named as “Société de
Médecine de Constantinople” in Istanbul. 110A few months after the foundation, Sultan
Abdülmecit set a found and entitled the organization “Cemiyet-i Tıbbıye-i Sahane-i
Osmaniye” (Society of Ottoman Medicine).111 Society spent great efforts to accumulate
required background of medical education in Turkish and made several translations.112
Besides the society published a journal named Gazette Médicale d’Orient (which later
named Sark Tıb Mecmuası) for seventy years in order to introduce new European
medical developments.
108 Demirhan and Kahya, Medicine in the Ottoman Empire and Other Scientific Developments, Đstanbul:
Nobel Medical Publications, 1997, p. 116
109 Esin Kahya and Aysegül D. Erdemir: Bilimin Isığında Osmanlıdan Cumhuriyete Tıp ve Sağlık
Kurumları, Ankara: Türk Diyanet Vakfı, (2000), p. 264
110 for a detailed information see: Cinquantenaire de la Sociéte Impériale de Médecine de Constantinople
/ Dersaadet Cemiyet-i Tıbbiye-i Sahanenin Ellinci Sene-i Devriyesi (1856-1906). Constantinople 1908;
Türk Tıp Cemiyeti Mecmuası - 100 üncü Yıl Özel Sayısı, Yıl (c.) 22, 2 Haziran 1956, 470+XII sayfa;
Süheyl Ünver ve Bedi N.Sehsuvaroğlu, Türk Tıp Cemiyeti – Cemiyet-i Tıbbiye-i Sahane 1856-1956.
Đstanbul 1956; H.Hüsrev Hatemi ve Aykut Kazancıgil,“Türk Tıp Cemiyeti (Derneği) Cemiyet-i Tıbbiye-i
Sahane ve Tıbbın Gelismesine Katkıları,” Osmanlı Đlmi ve Mesleki Cemiyetleri. Đ.Ü. Edebiyat Fakültesi
Basımevi, Đstanbul 1987, s.111-119; E.Kadri Unat, Osmanlı Devleti’nde Tıp Cemiyetleri, Osmanlı Đlmi ve
Mesleki Cemiyetleri. Đ.Ü. Edebiyat Fakültesi Basımevi, Đstanbul 1987, s. 85-110; N. Tekül, H. Hatemi,
Türk Tıp Derneği (Cemiyet-i Tıbbiye-i Sahane) 130. Kurulus Yılında, Đstanbul, 1986 (1997’de 140.Yılı,
Değismemis Đkinci Baskı, Đstanbul, 1997); Feza Günergun & Nuran Yıldırım, “Cemiyet-i Tıbbiye-i
Sahane’nin Mekteb-i Tıbbiye-i Sahane’ye Getirdiği Elestiriler (1857-1867)”, Osmanlı Bilimi
Arastırmaları, c.III, sayı 1, 2001, s.19-63.
111 Bedi N. Sehsuvaroğlu, “Türk Istanbul’da Tıp Öğretimi”, pp:49-51
112 Kahya and Erdemir, Bilimin Isığında Osmanlıdan Cumhuriyete Tıp ve Sağlık Kurumları, p. 264
38
Beside the reorganization of medical education, medical institutions were
reformulated, modern hospitals were founded. Number of hospitals and medical
personnel were dramatically increased. Between 1800 and 1924, thirty six new hospitals
were founded. Military hospitals were opened along the lines of modernization of army;
four of the best-known military hospitals were the Mekteb-i Tıbbıye-i Sahane Hospital
(1839), the Gümüssuyu Military Hospital (1846), the Gülhane Military Hospital (1898)
and the Haydarpasa Military Medical Hospital (1904). In the very same period several
civilian hospitals were founded such as the Vakıf Gureba Hospital (Hospital of
Destitutes, 1862); Zeynep Kamil Maternity Hospital which was founded and supported
by members of dynasty and bureaucracy); The Women’s Hospital (Altıncı Daire-i
Belediyye <isa Hastanesi, 1879) which was founded to take care of prostitutes in order
to solve the problem of syphilis; The Darülaceze (House of the Weak, 1896) to give
shelter to orphans and paupers; the Sisli Children’s Hospital (1899) which was opened
to serve children. 113
During the century public and social health mattered and in time entered into the
state agenda. In the 1830s quarantine organizations were established in port cities like
Istanbul, Đzmir, Iskenderun to prevent the danger of cholera epidemic. 114 In 1838
Meclis-i Tahaffuz (Comiittee of Protection) was founded. Since activities of that
institution were limited, Meclis-i Sıhhıye-i Umumiye (Committee of Public Health) was
founded in 1881. Meclis-i Sıhhıye-i Umumiye had many functions; it conducted surveys
on health of the population, struggled against epidemics, organized quality of foods.
In 1871 the first municipal health organization was founded. Twenty years later
a Committee of Public Health was systematized in the municipality of Istanbul. In 1909
Müessasat-ı Hayriye-i Sıhhiye Müdüriyeti, a directory of health was established in the
municipality and important hospitals, tebhirnames (disinfection stations) and
müsahedehanes (observation unit) were involved to the directory.115 In 1869 Cemiyet-i
Tıbbıye-i Mülkiye (Civil Medical Association) was organized as the original form of
113 Bedi N. Sehsuvaroğlu, “Đstanbul’da 500 Yıllık Sağlık Hayatımız”, Đstanbul: Đstanbul Fetih Derneği,
(1953) pp:63-65
114 Demirhan and Kahya, Medicine in the Ottoman Empire p.123
115 Yıldırım, Nuran, “Tanzimat’tan Cumhuriyet’e Koruyucu Sağlık Uygulamaları” in Tanzimat’tan
Cumhuriyet’e Türkiye Ansiklopedisi v.5, (1985), p.1320
39
later Ministry of Health. Association was responsible for the appointment of medical
personnel, and for examining the capabilities of foreign school graduate physicians who
applied to work as physicians.116 In 1889 the association was renamed as Meclis-i
Tıbbıye-i Mülkiye ve Sıhhıye-i Umumiye (Committee of Civil Medicine and General
Health). In 1906 it was reorganized and named Meclis-i Maarif-i Tıbbiye (Committee of
Medical Education). Two years later it was renamed Meclis-i Tıbbıye-i Mülkiye ve
Sıhhıye-i Umumiye (Committee of Civil Medicine and General health). In 1913 this
association was abolished and Directory of Health (Sıhhiye Müdüriyet-i Umumiyesi)
under the Ministry of Interior was established. In 1914 Ministry of Interior and Health
replaced Ministry of Interior. Thereafter offices of governmental medical practitioners
(hükümet tabiplikleri) in provincial districts and directors of health in provinces were
opened. In 1920 Umur-u Sıhhiye ve Muavenet-i Đctimaiyye Vekaleti (Ministry of Health
and Social Aid) was founded by the Grand National Assembly (TBMM).117
With regard to population politics, procreation was emphasized. The edict of
1838 shows the first wide ranging systematic agenda against abortion.118 Midwives,
pharmacists, physicians were informed on not using abortifacient drugs and were
commanded to take oath before religious leaders on not using these drugs. Another
measurement taken by the state to control the practice was the “reorganization of
midwifery”. 119 Ottoman Empire aimed to achieve wider control not through force and
violence but through institutionalization and motivation of each individual, started to
open an institutional trainee for midwives in 1842. Opening of an institution was
announced and midwives were invited.
***
In this chapter, a brief overview has been provided about the pre-modern
Ottoman medicine and institutional transformations of the modern period. In a nutshell
Ottoman use of medicine as a social control mechanism began to take place during the
116 Ibid, p.1321
117 Ibid, p.1324
118 Demirci, Tuba and Somel, Selçuk Aksin: “Control over Feminine Body, Procreation and Public
Health: Demography, Bio-Politics and Abortion in the Ottoman Empire (1789-1908)”, Journal of the
History of Sexuality Vol.17-3 (2008), .p.393
119 Ibid, p.393
40
nineteenth century, (particularly towards the end of it) due to the qualitative and
quantitative rise in institutional mechanisms.
At this juncture a comparative perspective between pre-modern and modern
Ottoman medicine with regard to medical institutions has been presented. Pre-modern
Ottoman medicine was an amalgamation of different traditions and offered multiple
alternative therapeutics and medical practices. However, the majority of the population
had lesser access to learned medicine, medical institutions and professional
practitioners. On the other hand due to nineteenth century institutional transformations,
masses have been intended to be reached.
41
CHAPTER III
GLIMPSES OF THE DEMETED I THE MEDIEVAL AD EARLY
MODER PERIOD
The demented of the past might be seen as one of the most voiceless groups
since it is not easy to reach any of the sources documented by them, even if they did
exist. Instead one may find documents, illustrations on them, produced by others. In this
chapter a collection of bits and pieces of information on the pre-modern definitions and
treatments of mental illnesses; and a thin portrayal of the conditions in which the
demented were lived will be offered. In addition “integrative mechanisms” of these ages
will be highlighted.
A definition of insanity in a society is closely related with its socio-cultural
context. Since it is really hard to provide a valid definition of insanity, one can only
adhere to its unfixed nature. In other words definition of madness (or any form of
abnormality) has been a changing one from time to time, place to place. Since
characteristics of abnormality have been defined in accordance with a social group at a
specific time, and since they have been highly open to changes, the modern term insane
might be seen as inadequate in dealing with insanity in the past. According to Shefer-
Mossensohn the demented were described in the Ottoman Empire via three different
adjectives: deli (Turkish), divane (Persian) and majnun (Arabic). 120 Yet another
adjective meczub should be added to the list.121 Medical interpretation of insanity went
hand in hand with religious, literary and social perceptions. In that regard this
multiplicity might be explained with multicultural heritages of the Empire and diverse
120 Miri Shefer, The Ottoman Empire, in Enclylopedia of Women & Islamic Culture: Family, body,
sexuality and health, 2006, Vol.3, BRILL, p.273
121 Nil Sarı, Burhan Akgün, Türk Tarihinde Psikiyatriye Bakıs, Đ. Ü. Cerrahpasa Tıp Fakültesi Sürekli Tıp
Eğitimi Enkinlikleri, Türkiye’de Sık Karsılasılan Psikiyatrik Hastalıklar, Sempozyum Dizisi, No:62, Mart
2003, pp.1-24
42
perceptions of madness.122 Given the multiplicity of perceptions and changes in the
definition of insanity through time, to what extent these different terms corresponded to
each other and to what extent modern term insane corresponds to the old usages are
controvresial. Still an unassuming distinction might be presented as “if the reason
abandons the one, he or she becomes deli, and if one abandons the reason then he/she
becomes meczub or divane”.123 At this juncture the former might be seen as loosing of
conscious and the latter would be seen as the situation in which the person abandons
rationality and becomes insane (alike) because of an outside influence such as alcohol,
or excessive love, to be fond of God or a person.
Majnun and janna (cinnet) are derived from the word jinn to define evanescence
of reason. Majnun is the passive participle of the verb janna, “to cover, conceal, veil”;
the noun “junun” means “possession, obsession, mania, madness, insanity, dementia;
foolishness, folly; frenzy, rage, fury; ecstacy, rapture”.124 The passive verb means “to go
mad, become crazy, to be covered, veiled, concealed”. 125 Majnun metaphorically
defined the situation in which a person in an impossible love finally turned into the
divine love as one can see in the story of Majnun and Layla. It is a famous romance in
which a young man named Qays (nicknamed Majnun) falls in love with Layla and
finally this love drives him mad. Thus majnun metaphorically was seen as holy fool,
nevertheless literally not each majnun and others loosing rationality were assumed to be
holy fool having wisdom.126 Another usage of Majnun was the one to define epileptics
whom were supposed to be sickened because of divine causes such as jinn. “Jinn”
means “demons, invisible beings, either harmful or helpful, that interfere with the lives
of mortals”.127
122 Miri Shefer, The Ottoman Empire, p.273
123 As Nil Sarı, Burhan Akgün quoted, retrived from
http://www.kuranikerim.com/islam_ansiklopedisi/M/meczub.htm
124 Arabic English Dictionary, The Hans Wehr Dictionary of Modern Written Arabic, “junun”, ed .J.M.
Cowan, Fourth Edition, Spoken Languages Services, INC, Ithaca, N.Y. 1994, p.164
125 Arabic English Dictionary, The Hans Wehr Dictionary of Modern Written Arabic, “janna”, p.164
126 Sarı, Akgün, Türk Tarihinde Psikiyatriye Bakıs, p. 3
127 Arabic English Dictionary, The Hans Wehr Dictionary of Modern Written Arabic, “jinn”, p.164
43
In a nutshell these four major adjectives were primarily used to define insanity.
One cannot be sure about to what extent the minor and implicit differences between
these terms were acknowledged. Yet suffice it to say that these different and possibly
interchangeable terms were used by the Ottomans to define the demented.
Ottoman medicine inherited humoralism and developed philosophical and
medical integrative view of humans. The living being was situated at the center of the
complex world surrounded by the physical (material) realities, and spiritual (divine)
essence in which all forces ideally should interact in harmony and to which men should
be integrated.128 The human being was perceived as an integrated entity composed of
physical being and soul (body and mind). Likewise physical health and mental health
were taken as two related entities affecting one another. In other words physical
problem could or even did trigger mental problem and vice versa. “From the medical
point of view, it resulted in the belief that one cannot be sick in the body and totally
healthy in the mind, or to suffer mental problems yet be void of any physical
discomfort.”129 In the integrative approach health of the soul or heart and the health of
the body were mutually dependent. Integrative approach also included spirituality,
senses, and emotions as nonphysical elements which need to be examined. For example
excessive emotions such as love, passion, grief, envy and shame were seen as illnesses
which might cause physical disturbances as well. In that regard the modern dichotomy
of mental and physical health each having totally separate treatment techniques and
institutions might be seen as not entirely applicable. Thereafter one could conclude that
the demented had been treated and mental health had been an integrated part long before
the foundation of psychiatry as a separate discipline and mental hospitals. Ottomans
rather employed combined remedies to cure both mental and physical diseases; mental
treatments were used for physical illnesses and physical treatments were used for
mental illnesses as well.
128 Shefer –Mossensohn, Ottoman Medicine, p. 63
129 Ibid, p.66
44
Mental Illnesses
In order to have an insight on the hall marks of the mentally ill one should study
medical manuscripts of the period. In that regard Nil Sarı provides an important article
on the classifications of mental illnesses from the fifteenth century to the eighteenth
century.130 According to Sarı illnesses were studied under three parts as reasons (esbab),
symptoms (alamat) and treatment (ilac).131 Reasons were presented rather short and
treatments were explained longer. The mental illnesses were generally explained within
the framework of humoral theory and thus major reasons were investigated in the
imbalance of four humours. Illnesses having similar symptoms were categorized under
the same category. One example might be the classification of Mukbilzâde (Zahire-i
Muradiye, 1437) in which both mental and neurological diseases were classified as
“head diseases” implying the absence of the distinction between mental and
neurological diseases. As Sarı argues in the Mukbilzâde’s classification the relations
amongst these illnesses were discussed; classifications usually relied on organic
symptoms and etiology of illnesses according to humoralism. In addition some of the
diseases were more close to syndromes rather than illnesses. Several diseases
mentioned in the classification were as follows: Unutsaguluk (amnesia); "Ihtilât-i zihn"
(confusion of mind); Uykusuzluk (insomnia); Suban (liquid collection in the skull
around the hard membrane); Dawwar (feeling dizzy); Kabus (nightmare); Falic
(paralysis); Suda (headache); sakika (migraine); "Ahze" (catalepsy or catatonia); "Mal-i
hulyâ" (caused by fear, obsession, and sadness); “envâ-i dîvânelikler" (assorted
madness). Ashk (love) was portrayed as an illness causing one to be ill. Eblehlik was a
kind of feeblemindedness which was seen as hereditary illness. Sersâm (meningitis)
composed of two words ser meaning head, sam meaning swell, had different types such
as sersâm-ı safravi, sersâm-ı sevdâvî (which was the worst type very close to madness),
and “soguk sersam” sersam without fever. Sar’a (epilepsy) had also different types
such as sar’a-ı dimağ epilepsy of the brain, sar’a-i midevi epilepsy of the stomach, and
sar’a seen in women undergoing menopuse which was very close to ihtinakı’r-rahm
histeria.132 Another thought provoking point here is that, as Sarı portrays, other mental
130 Nil Sarı, The Classification of Mental Diseases in the Ottoman Medical Manuscripts, in History of
Medicine Studies, ed. Hasan Âli Göksoy, Hüsrev Hatemi, Nil Sari, Istanbul 1986, No. 1, pp. 105-112
131 Sarı, Akgün, Türk Tarihinde Psikiyatriye Bakıs, p. 10
132 Nil Sarı, The Classification of Mental Diseases in the Ottoman Medical Manuscripts, pp. 105-112
45
illnesses were classified as separate diseases, some of which were alcoholism (sûcîye
muptela olanlar) and opium eating (afyonkesler ve berse muptelâ olanlar), being
tobacco addict, teza'zu-i dimağ (traumatic head injuries), infiâlât-i nefsâniye (emotional
and personality disorders). In addition, although mental diseases were investigated as
head diseases, few mental illnesses were studied under other physical illnesses
categories instead of being studied under the head diseases category. These diseases
were "ihtinak-i rahm" (hysteria), "hafakan" or "yürek oynaması" (anxiety), 'sehvetü'l
kelbiyye" or "köpek gibi istahlı olmak" (obesity), "noksanü'l-sehvet" (lack of appetite)
and some other psychosomatic illnesses and sexual diseases.
Although it is too early to come to a conclusion one might say that in the
classification, Mukbilzâde used multilingual terminology relying on Persian, Arabic and
Turkish as well which might pinpoint the plurality of traditions inherited. In that regard
one can observe the very existence of a medical heritage accumulated considerable
knowledge on psychiatry, neurology, psychosomatics, and personality disorders.
Excessive emotions such as fear, sadness were presented as causes of the illnesses and
yet love was portrayed as a separate mental illness. Moreover the head (and not the
heart) was most possibly seen as the center since all were situated under the category of
“head diseases”. Yet the very existence of some mental diseases which were classified
as separate categories or situated under different categories seems confusing.
Nevertheless it is undeniable that Ottoman doctors of the fifteenth century had a
considerable understanding on the very existence of variety of mental diseases.
The Treatment
Foods and beverages were seen as both therapeutic and preventive tools, thus a
healthy regimen was used as first course of action. Since Ottoman medicine was largely
relied on humoralism, (after the diagnosis and detection of the possible excessive
homour); specific foods, beverages, doughty pastes, syrups having the healing quality
were given to the patients. Moreover drawing the blood, disgorging, bloodletting,
sweating, and medication usually of vegetable origin were amongst the remedies.133
133 Sarı, Akgün, Türk Tarihinde Psikiyatriye Bakıs, p. 10
46
Fomentation (particularly to the head), compress, bandaging, cautery, cupping and
massage with various oils also used for the treatment.134 Yet most dramatic treatment
might be seen as beating of the deranged.135
The mentally ill in the empire received treatment in several fields such as, home,
religious institutions (dervish lodges, mosques, monasteries), and hospitals called
Darüssifa or bimarhane. Medical care and treatment were usually given by the family,
and it was akin to the prime agent in distributing medical care. Obviously low capacity
of institutional treatment was another reason. Family here is used as non-strangers,
which is beyond the blood or marriage ties. It includes those who are close friends,
companions, and associates from work or religious order.136 Although we do not know
much about the familial care, still we know about the very existence of variety of
popular medical techniques. Thus one can assume the deranged could receive certain
kinds of treatments offered by popular practitioners and private physicians, afforded by
family members.
Although we do not have sufficient quantitative and qualitative information on
mental treatment in dervish lodges, existing sources reveal that there were some dervish
lodges offering treatment to the demented. Two of which were the dervish lodge of
Karacaahmet who lived circa the fourteenth century and dervish lodge of Pir Sultan
(d.1545) in Isparta. Karacaahmet, his son and grandchildren founded a dervish lodge
serving like an insane asylum and cured the deranged for centuries137. Similarly Pir
Sultan arranged a room in the lodge for the insane with a column to which the patient
was tied.138 Primarily those in outburst were welcomed and those stayed calm were left
to familial care. For the treatment they were confined at a room sitting alone for a
period having their hands tied, special regimen with some special syrup was enforced,
134 Dols, Majnun, 132
135 Dols, Majnun, 132
136 Shefer- Mossensohn, Ottoman Medicine, p. 121
137 Baki, Edip Ali: Eski Bir Halk Hekimi: Karacaahmet ve Delileri Tedavi Yurdu, Đstanbul, Milli Mecmua
Basımevi, 1947
138 As Sarı quoted Nuri Katırcıoğlu: Bütün Isparta–1958.
http://www.ispartaya.com/kutuphane/butun_isparta_1958.pdf
47
sacred water was given to drink and bath. Female patients were also welcomed to
Karacaahmet dervish lodge.
On the religious institutions Mazhar Osman provided considerable information.
He mentioned about the very existing religious institutions such as dervish lodges in
Anatolia and Istanbul up until the closure of dervish lodges in 1925.139 He also informed
that the demented in the Prince Islands of Istanbul were confined in monasteries for
many centuries.140 He also mentioned that he was told that several mosques contained
rooms for the demented such as Rüstem Pasa camii, though he did not give the detailed
information on the number of these mosques and their names.141 Yalçıner and Hanoğlu
also mention about twelve small mosques containing minor bimarhanes (“küçük
tımarhanecikler”) in Istanbul though they also did not give specific information both on
the sources that they rely, and on the names of these small bimarhanes. 142 In
consequence, some of local mosques most possibly hosted the demented for a period,
yet we do not know about the specifications such as when, where, by whom, and for
what purpose this took place. Likewise one cannot be sure about whether or not the
demented were received treatment or simply confined in each and every religious
institutions. Still confinement was not necessarily subjugated to government decision,
rather religious institutions and residential members played important roles as well.
Ottoman hospitals offered institutional treatment for many centuries. Although
Bimarhane in modern usages means mental asylum, Darüssifas and bimarhanes were
founded to serve patients suffered from both mental and physical diseases jointly up
until the nineteenth century during which some of existing hospitals turned into mental
asylums. The circumstances of the nineteenth century hospitals were rather known and
will be mentioned later. Though there has been a controversy on that of prior to the
nineteenth century. Yet one could gather certain amount of information and make an
ostensible portrayal.
139 Mazhar Osman Usman, Tababet-i Ruhiye, Đstanbul: Đstanbul Kader Basımevi, 1941, p. 55
140 Ibid, p.5
141 Ibid, p.61
142 Yalçıner, Betül and Lütfü Hanoğlu, Đç Bahçe: Toptası’ndan Bakırköy’e Akıl Hastanesi, Đstanbul,
Okyanus Yayın, 2001, p.11
48
Mazhar Osman relying on Libert’s account argued that the demented received
treatment first in Fatih Darüssifa.143 Evliya’s account on Fatih Darüssifa rather admires
the facilities of the hospital in which patients were given all sorts of comfort and
food. 144 From then on the demented received treatment in major hospitals such as
Edirne Darüssifa, Manisa Hafza Sultan Bimarhane, Haseki Darüssifa, (which in the
beginning was founded to serve for the demented females but then males were
welcomed as well), Süleymaniye Darüssifa, Toptası Atık Valide Bimarhane, Sultan
Ahmed Darüssifa. According to Mazhar Osman, the Süleymaniye Darüssifa was the
most effective mental hospital which “functioned as the madhouse of Turkey for
centuries” up until the last quarter of the nineteenth century.
The hospitals were generally placed at the center of the major cities near the
social institutions (apart from Edirne Darüssifa which was rather outside the city) and
this enabled the contact between patients and healthy inhabitants to an extent.145 As
Evliya mentioned that even the people of Edirne went to see the demented in the local
hospital in the seventeenth century since it was thought to be beneficial for the
demented. 146 Dols also argued that family and friends could sometimes visit the
patients.147
Ottomans attributed importance to the cleanliness and beauty of the hospital
environment since “disease associated with dirt and filth, health with cleanliness and
harmony.”148 Hospitals in which sweepers and cleaners were working; were filled with
gardens promoting well being and assumed to be promoters of well being and therapy.
Beside thin and thick walls, gardens functioned as barriers as well.
Hospitals facilitated certain different therapeutics such as music, water and pure
air. Music therapy was used as both preventive and therapeutic tool in the hospitals and
it was thought to be a model for human balance both in Greek and Muslim medicines. It
143 Mazhar Osman Usman, Tababet-i Ruhiye, p.57
144 Mazhar Osman Uzman, Tababet-i Ruhiye, p.56
145 Shefer-Mossensohn, The Ottoman Medicine, p.158
146 As Evliya quoted in Shefer-Mossensohn, The Ottoman Medicine, p.158
147 Dols, Majnun, 172
148 Ibid, p.158
49
was thought to have a power to put the world into harmony and likewise to have a
power to retain and reestablish harmony of integrated human body. 149 Professional
musicians were employed in Ottoman hospitals especially for the treatment of the
insane such as the hospitals of Bayezid II in Edirne and Mehmet II in Istanbul as Evliya
Çelebi’s account reflected. 150 Not the quality of music but the therapeutic value
mattered in the hospitals. Water was used as a therapeutic tool as well apart from being
used for general hygiene. Water was thought to restore humoral equilibrium for patients
suffering from dry symptoms. Pure air as well was used as a treatment method and the
hospital of Sultan Ahmed was primarily dedicated to the treatment of the insane due to
purity of its air. 151 According to Shefer-Mossensohn religious devotion was also
believed to have a healing power. Ottoman hospitals were situated together with central
mosques in grand imperial complexes. Religion was present in and around the
institution; hence for her religious practices were amongst the hospital therapeutics in a
non-formal way.152 Amulets consisted of sacred sayings and verses of Quran were also
widely used.
The Demented at the Hospitals
Some rooms are heated in the winter according to the nature of the sick; they lay in
beds provided with ample blankets and rest themselves on silk pillows, and moan
and groan. In the spring at the times of madness, those from the city who are
lovesick and melancholic are put into some of the rooms. Those brought to the
asylum by the police are restrained and fettered by gilded and silver chains around
their necks. Each one roars and sleeps like a lion in his lair. Some fix their eyes on
the pool and fountain and repeat the words like a begging dervish. And some doze
in rosegarden, grape orchards and fruit orchards… sing with the unmelodious voice
of the mad. 153
149 Ibid, p.88
150 Ibid, p.73
151 Dols, Majnun, p.126
152 Shefer- Mossensohn, The Ottoman Medicine, p. 88
153 A.Süheyl Ünver, Four Medical Vignettes from Turkey, International Record of Medicine, 171,1985,
pp.52-7
50
Evliya’s account on Edirne Darüssifa presented an important depiction. Here
Evliya again emphasized the facilities of the hospital providing heating, ample blankets,
silk pillows, gilded and silver chains, rosegarden, grape and fruit orchards. This shows
the very existence of heating, garden and chains; though the materials that they claimed
to be made of such as silk, gilded and silver, and portrayal of rosegarden and orchards
might not be taken at face values. If one considers his depiction as wishful thinking,
then it still pinpoints the idea that beauty of the hospital environment was highly
mattered.
Hospitals were mostly open to the insane who were usually seriously disturbed
individuals and harmful to themselves or to others.154 Sarı and Akgün relying on a
judiciary record of the seventeenth century argue that confinement was mostly practiced
when the neighborhood members made complaints and when the family members did
not successfully prove that they could care the demented, before the judge.155 Yet one
striking and highly unanswered question might be on what “disturbance” meant for the
Ottomans. In other words what sort of actions were evaluated as “dangerous”,
disturbing others and harmful to the self was highly blurry. Still one can speculate that
confinement might be rather related with being considered as harmful and the need for
institutional treatment was acknowledged in accordance with the limit of being
dangerous. Shefer-Mossensohn relying on again Evliya’s accounts argued that many
madmen in Istanbul roamed the streets, freely, wandered naked, danced, frightened
Jewish mourners. Some performed improper sexual, social, religious behaviors and not
faced with confinement.156 Noticeably they were not considered dangerous for others
and themselves, thus tolerated. Yet as above mentioned quotation reflected “love fools”
of Edirne were considered as harmful and confined by police force. Then what were the
explicit criteria determining the norms of being confined and not confined; if they
existed? Still one could assume that disturbing others or the self could be seen as the
primary criteria yet what they meant for disturbance might still be blurry. On top of that
and may be more importantly, being seen as mad was not necessitate to be confined
unless the demented embodied danger, and unless they had families to control them.
154 Dols, Majnun, p.128
155 Sarı, Akgün, Türk Tarihinde Psikiyatriye Bakıs, p. 15
156 Shefer- Mossensohn, The Ottoman Medicine, p. 140
51
Another interesting point might be about the temporariness, as Evliya depicted as
“in the spring at the times of madness”. Spring was considered as a period boosting the
number of the demented. One related point might be “madness and physical illness
catalogued a person as ‘other’ only temporarily: once people recuperated and left the
hospital, the ex-patients were once again equal members of the majority group in the
Ottoman society, the healthy.”157 Here what Shefer-Mossensohn argues is quite thought
provoking. Although it is rather impossible to really know whether or not they were
seen as “equal”, since it was more of a subjective issue thereafter hard to be
documented, still the very existence of a possibility of release and of integration to
society, renders madness as no more of a curse following one throughout a whole life.
Thus madness was seen as something treatable, if not at least controllable. Similarly
madness (cünun) was categorized into two different categories as “cünun-ı mutabık”
and “cünun-ı gayrı mutabık” meaning reversible madness and irreversible madness.158
In Islamic law, the deranged individual deprived of reason is unable to take judicial acts
(which is called “gayr-ı mümeyyiz”) thus has no penal liability except for the times of
lucidity. At this juncture, when one regains his/her lucidity, he or she can retake judicial
liability. In that regard the curse of being mad and thus expelled could be reversible, and
even temporary. Confinement was not necessarily permanent, thus might be seen as
action based instead of being subject based. Once the action such as disturbing others
was solved; the individual, could participate in to the social harmony again. This might
be seen as an example of the integrative mechanism over the demented.
Regarding with hospital conditions another passage from Evliya might be
helpful. Evliya mentioned about the “keepers at the hospitals for the insane” in his
account on guilds in Istanbul in 1670’s showing the very existence of special employees
controlling the insane.
Two hundred keepers of bedlams (tımarkhaneh) of Constantinople, at the public
procession, lead from two to three hundred madmen in golden and silver chains.
Some of the keepers carry bottles in their hands from which they give medicines to
the madman, while others beat or box the fools to keep them in order. Some of
them are naked, some cry, some laugh, some swear and some attack their keepers,
157 Shefer- Mossensohn, The Ottoman Medicine, p 147
158 H. F. Kumanlıoğlu: “Cinnet” in Samil Đslam Ansiklopedisi. Samil Yayınları.
which puts the spectators of flight. If I were to describe all at fits of the madmen
and fools on such a day of pu
Here the demented were not portrayed as simply in the middle of facilities, but rather
the ones were chained, beaten, boxed and also quite dangerous causing the keepers
running away from a chaotic environment. T
of controlling these dangerous subjects and more importantly shows the very existence
of violent control mechanisms such as beating and chaining. The notion of dangerous
madmen who were hardly being controlled was a
seventeenth century miniature depicts. It is part of an album
Ahmet I; shows a hospital room in which three chained madmen are in frenzy.
All three madmen are shackled by their necks to the walls; tw
bounded by their feet to a wood stock. Physicians are depicted as in physical danger,
since one patient threatens them with a knife, the other patient holds down a physician.
Three young men look in at the scene showing astonished expression
their fingers to their mouths through a window.
The miniature could be interpreted through multiple ways. On the very same
miniature Nil Sarı and Akgün highlight the patience of the physicians.
highlighted the “violent” madmen whose naked appearance is seen as a sign of
159 As Dols quoted, Evliya Efendi, narrative of travels, 118
160 Sarı, Akgün, Türk Tarihinde Psikiyatriye Bakıs, p. 13
52
public procession, I should fill a book.159
Thereby the passage connotes the hardship
common phenomenon as an early
muraqqa
118-19
hereby assembled for
two of them are
expressions such as raising
160 Dols
53
madness.161 Apparently madmen are depicted as violent, who try to take charge of the
situation; whereas physicians do not show any sign of anger or violence. Shefer-
Mossensohn on the same miniature highlights the accessibility of hospitals to the
healthy “The picture hints that it was possible - or at least deemed possible – for a
healthy person to peep into a hospital building”162 which is quite important. Hospitals
might not be seen as that much isolated, so that outsiders could know about the inside to
an extent.
Obviously to what extent the miniature (which is probably the only Ottoman one
depicting a hospital room163) should be taken at face value is controversial; since it does
not offer for certainty. Yet it offers a room for interpretation. In that regard the points
that Sarı and Akgün, Dols and Shefer-Mossensohn highlight are quite weighty. On the
patience of the physicians one could add the fact that one of them is depicted as in a
frightened gesture, turning around and closing his face. In that regard one could see how
frightened the physician is depicted, that is beyond the patience. The chaotic
environment and the danger of the madmen are vividly illustrated. Although madmen
are depicted as the subjects of the violence in a sense that they threaten the physicians;
they might be also interpreted as the objects of violence as well. Since they are the ones
chained and bounded in a wood stock; still somehow they depicted as the ones take the
charge of the control. One striking question might be on the reason to show the violence
embodied by patients and not by physicians or keepers. Obviously it would be bizarre to
argue that mental hospital was controlled by violent and omnipotent madmen. Yet the
image of violent, dangerous and mysterious madmen seemed present at least in the
imagination of the depicter. This image would be limited to those mads who had to be
confined, thus might not include those living in the quarters without embodying a threat.
How the demented behaved was a controversial issue. As Haseki and Atık
Valide pious deeds reflected the attitude of the medical personnel were mattered. In the
deeds medical personnel were supposed to behave kind, smiling, compassionate, father
alike towards the patients. 164 In addition the pious deed of Edirne Darüssifa was
161 Dols, Majnun, p. 130
162 Shefer-Mossensohn, The Ottoman Medicine, p. 169
163 Ibid, p.169
164 Sarı, Akgün, Türk Tarihinde Psikiyatriye Bakıs, p. 8
54
particularly mentioned about the responsibilities of the keepers of the hospital towards
the demented. Keepers called as kayyum were expected to be enduring with the young
and aggressive madmen, and to look after them appropriately. 165 A deed of
Suleymanive Darüssifa defined the responsibility of kayyums as serving, controlling the
madmen; and being tolerant towards their unpleasant behaviors.166 This shows the very
existence of the expectation from the keepers, though assuming that kayyums did adopt
a tolerant attitude towards the demented would be speculative. Per contra one could
speculate that the very existence of an order might pinpoint the imperfection of tolerant
attitude which urged authorities to make some regulations since it is known that
madmen were beaten and chained. In a nutshell both interpretations would be
speculative. Thus neither one sided totally humanitarian nor totally inhumane /
oppressive depictions would be fitting. Still it is safe to argue that state attempted to
conduct “appropriate” treatment.
Islamic Greater Tolerance…?
One last remark would be on the question of how madmen were perceived and
how they behaved in society. Since the question is rather associated with social life,
which has been hardly documented, answer might be adhered to the interpretation. Still
the argument that Islamic societies and Ottoman society showed greater tolerance
towards the demented seems preponderant. The argument is largely relied on the
traveler accounts and assumingly Ottoman low ratio of confinement. The argument has
a comparative perspective between European demonology, witchcraft, confinement; and
Islamic societies. In that regard Ottoman Empire’s similar to other Islamic societies’
“more humane” attitude towards the demented were portrayed both inside and outside
of hospital.
Michael Dols’s book Majnun: The Madman in Medieval Islamic Society is a
momentous enterprise in the way he implemented social history of medicine and he
portrayed madness as a component of culture. Though the book has been criticized for
165 Ibid, p.8
166 Ibid.
55
many reasons and some of these criticisms were already touched upon in the literature
review. One example might be Shoshan’s criticism of Dols for using evidences
dubiously in order to underscore the supposed Islamic tolerance.167 Here rather the
assertive depiction that he and successor scholars adopted will be studied. Michael Dols
in his work offered a rather romantic view of insanity and depicted Islamic madmen
surrounded by a tolerant society offering protection. His madman was slightly different
from a holy fool, a divine creature having wisdom. His insanity was largely an outcome
of Muslim religiosity and plural perceptions of insanity. According to him “The lack of
a unitive view of insanity surely allowed greater social tolerance of the mentally
afflicted.”168 Thus he was certain about the “greater social tolerance”. His concluding
remarks are more thought provoking.
As we have seen, the madman in medieval society could be a man not without
honour. This positive or more humane view of the madman was facilitated, on the
one hand, by the pluralism of healing, and on the other hand, by the Qur’anic view
of majnun as a divinely enthused and imperative of personal charity to the infirm.
Obviously Dols worked on numerous primary sources such as manuscripts and
traveler accounts covering medieval period to come to that conclusion; thus deserves
appreciation. Though his problematic makes the topic one sided. Asking a very
subjective and limited question of whether or not medieval Islamic society was “more
humane” towards the demented or not might easily lead narrator to ignore the very
existence of multiple dimensions and diversity. In the concluding remark he used
assertive, value loaded adjectives such as “humane” and “positive” which might be seen
as contrary to the essential plurality of a society. It might dictate an agenda to ignore
various “inhumane” implementations. What is more the topic of Islamic society and
therein the demented includes numerous dynamics, other than being humane or
inhumane. Obviously Dols as well presented numerous dynamics, yet still making value
loaded concluding remarks makes the narrative of “great success” as the focal point.
Then again the question of “whether or not it was so humane” puts the question of “how
it was” into shades. These two questions are totally different in terms of methodology.
167 Boaz Shoshan, The State and Madness in Mediaval Islam, Intenational Journal of Middle east Studies,
2003, p.334
168 Dols, Majnun, p. 476
56
The former is value loaded and presents either black or white depictions both of which
should be far from actuality; whereas the latter provides a more descriptive approach
embodying lesser judgmental and value loaded extreme poles.
Another striking question might be with which society, Islamic society was
contrasted since he concluded that Islamic society was “more humane”. Given that in
his piece he worked on Foucauldian great confinement theory in which early modern
Europe was contended; one could assume that the comparison was between the
European society and the Islamic one. Dols argued that Foucauldian idea of “great
confinement” in early modern Europe was unrelated to the history of Islamic asylum.169
Foucauldian argument is on early modern European confinement practices. Foucault
interpreted medical institutions such as hospitals, clinics and mental asylums as more
relevant to exclusion and confinement of “dangerous groups”, then medicine and health.
In that regard medicine was portrayed as a social mechanism controlling and marking
marginal groups. Dols’ book covers medieval period, thus might be seen as
anachronistic to the extent that Dols addressed to Foucauldian theory. Yet whether or
not one should talk about “the Islamic society” as a homogenous entity instead of
“Islamic societies” as plural and heterogeneous entities is also controversial. Besides
promoting the reason of tolerance as a religion, might again be seen as essentialism,
since Islam has multiple interpretations and cultural differences. Hence this approach
might narrow the limits of historical reconstruction and ignore the very existence of
complexity.
Islamic societies’, in that regard Ottoman Empire’s assumingly greater social
tolerance towards the demented is a highly prevalent argument especially among the
Turkish academia. Turkish scholars’ tendency to adopt nationalist narrative
emphasizing great successes of the Empire was already mentioned in the literature
review. Here one could sense the very same agenda in the rapid reluctance to employ
the argument. One could find the very existence of the argument in various short articles
such as “Osmanlı’nın Mahalle Sakinleri: Mecnunlar, Deliler ve Ölüler” (Inhabitants of
Ottoman Residential Areas: the Insane, the Crazy and the Dead) written by a
psychiatrist Hayrettin Kara. The article is quite important in the way Kara offers an
integrative approach in which psychology, social psychology and sociology are applied
169 Dols, Majnun, pp. 128- 129
57
to a historical period. He builds his article on the idea that “‘Ottoman culture’ could
perceive those who were considered to be witches in another contemporary culture
(Europe) to be perceived as mecnun and place them in residential areas”.170 In his short
article he analyzes the demented in both the Ottoman hospitals largely relying on
Evliya’s account and in residential areas namely in mahalles (quarter) relying on
observations of Mongeri, Resat Ekrem Koçu, and Ahmed Yüksel Özemre. As it is
known, Evliya was a seventeenth century traveler and his observations were on the
seventeenth century. Louis Mongeri (1818-1882) an Italian psychiatrist served as a
chief physician in Toptası Bimarhane a very important figure whose observations were
on the nineteenth century. Resat Ekrem Koçu and Ahmed Yüksel Özemre were again
important figures though they published their works in the twentieth century. In that
regard, in the article “Ottoman culture” was portrayed as a solid, unchanging entity for
almost three centuries which is debatable.
Kara’s article departs from the argument that mecnun who was perceived as
wise, romantic fool, was welcomed by the “Ottoman culture”. He makes psychological
analysis to understand the reasons of why madmen were included and tamed by the
“Ottoman culture” while being excluded by that of European. His work seems indeed
quite interesting and special in the way he adopts psychology. Though the genre
perceiving “Ottoman culture” as a homogenous and unchanging entity; and taking the
assuming Islamic or Ottoman tolerance towards the demented for granted; might be
criticized. Taking “Ottoman culture” as a single, homogenous, and frozen entity might
be seen as essentialism and directly ignores the very existence of dynamism and variety.
Moreover Islamic/Ottoman tolerance argument is a historical argument hence should be
in accordance with the methodology of history.
Here what I argue is not the point that Ottoman / Islamic culture did not adopt a
tolerant attitude towards the demented. Instead I argue that pre-modern Ottoman
medical institutions adopted certain more integrative mechanisms compared to modern
period; and the reasons would be searched in the degree of institutionalization instead of
being searched in societal attitudes. Because determining social attitude towards the
170 Hayrettin Kara, Osmnalı’nın Mahalle Sakinleri: Mecnunlar, Deliler ve Ölüler (Inhabitants of Ottoman
Residential Areas: the Insane, the Crazy, the Dead), Osmanlılarda Sağlık (Health in the Ottomans), ed.
Coskun Yılmaz, Necdet Yılmaz, Đstanbul: Bipfarma Đlaç Sanayi ve Ticaret A.S., 2006, Vol 1., pp.197-207
58
demented (instead of talking strictly about documented institutional mechanisms) and
using value loaded terms such as tolerant would be dangerous.
As mentioned above I rather try to explain integrative mechanisms via
institutionalization instead of societal attitude. One reason for being cautious about the
tolerant Islamic society argument is that, to the extent that the argument relies on the
low ratio of confinement and on the idea that the demented largely lived in residential
quarters, it ignores the scarcity of early modern Ottoman medical institutions in terms of
the number of hospitals and medical personnel. Ottoman medical institutions served
only to the limited part of the population especially until the nineteenth century. As
mentioned before, Rhoads Murphy greatly illustrated that majority of the population did
not utilize the benefit from medical institutions instead they were usually received
treatment outside hospitals via popular medicine, familial care and private physicians.
Hence it may not be so unexpected to see that the demented were usually lived in
residential areas. Moreover the argument might be seen as controversial to the extent
that it depends on the perception of the commoners lived in the residential quarters
since it was hardly reflected in the primary sources.
On the other hand Ottoman Empire did attempt to create facilitated hospital
environment as one can see in the deeds and Evliya’s account. The demented was
usually not subjugated to confinement unless a danger has occurred and had the
possibility to be released if he or she was considered as to be cured or controlled. Thus
the demented in pre-modern Empire were faced with integrative mechanisms and less
state control. And the reasons for that might be related with the low level of
institutionalization, instead of social attitude since talking about the latter as a
monolithic entity would be dangerous.
Foucauldian theory does not rely on the existence of imposition of power upon
individuals, subjugations, prohibitions and constraints. For him these techniques had
been there long before. He rather defined the momentous change as the change in the
way the scale, object and modality of the control; the economy and the efficiency of
movement; and internal organization has transformed. 171 Hence he did not address
confinement as a practice, but rather pinpointed a change in the nature of confinement /
171 Foucault, Michel: Discipline and punish: the birth of the prison, translated from the French by Alan
Sheridan, London; New York : Penguin Books, first printed in 1977, reprinted1991, p: 136
59
control which required efficient organizational changes. In that regard Foucauldain
argument could be inapplicable to pre-modern Ottoman Empire for two reasons. First of
all, it would be ahistorical since these two covers different periods. Secondly premodern
Ottoman institutions might not fit into Foucauldain transformed effective
institutional structures. One could argue that these changes took place during the
nineteenth century particularly at the center which will be studied in the coming
chapter.
***
In a nutshell, the pre-Western Ottoman medicine employed an integrative
approach in which mental health and physical health were seen as a whole. As
Mukbilzade’s classification has shown, there was a considerable accumulation of
knowledge on mental illnesses in the fifteenth century. In addition to giving special
foods, beverages, doughty pastes syrups; practices such as disgorging, bloodletting,
cauterization, fomentation, as well as physical measures like beating and chaining were
used for treatment. The demented were treated and controlled at home, religious
institutions and hospitals. Hospitals offered multiple facilities such as water, music
therapy and pure air.
In pre-modern Ottoman Empire the demented were mostly a part of integrative
mechanisms for certain reasons. Mental asylums were less isolated places with regard to
the visitors’ access and location. Confinement was practiced mostly when the demented
was seen as dangerous by the neighborhood members and when the family members
could not prove that they could provide care for the demented. State institutions were
not the only agents performing confinement. Healed patients were mostly allowed to be
released and madness was not necessarily considered to be a life time illness. Thus in
terms of institutional control and confinement practices, pre-modern Ottoman medicine
employed more integrative mechanisms and less state control compared to modern
period which will be studied in the coming chapter.
60
CHAPTER IV
METAL HOSPITALS I THE LATE OTTOMA EMPIRE WITH RESPECT
TO MODERIZATIO, COFIEMET AD GROWIG STATE COTROL
Late Ottoman medical history is more or less described as a deterioration of the
previously efficient pre-Western (medieval and early modern) institutional mechanisms.
In that respect, the previous centuries are narrated in a celebrated manner while the later
periods are depicted in terms of institutional deterioration. The nineteenth and early
twentieth century accounts on the topic reflect two main points: pre-Western hospitals
had vastly declined and therein the demented were subjected to very poor conditions;
however, the subsequent increase in state control over the demented took place via
modernization. In that regard this chapter is intended firstly to provide different
accounts of this deterioration discourse, secondly to portray the growing state control
over the demented being intensified by the process of modernization, and thirdly to
discuss the degree of state control. The regulation of 1876 as well as the situation of the
demented in state asylums of Istanbul, either in the Süleymaniye Darüssifa or in the
Toptası Bimarhane, will be used to discuss the modernist approach. Afterwards bits and
pieces of information concerning two other state asylums, namely the Edirne Darüssifa
and the Manisa Bimarhane, will be used with the purpose of comparisons with the
institutions in Istanbul and the provinces. In a nutshell it is argued that firstly, late
Ottoman mental asylums in fact had become corrupted, secondly, the Ottoman
administration did employ more effective state mechanisms to supervise demented
people mainly in Istanbul, and thirdly, two other state mental asylums of the Empire
located in provincial towns might show that the modernization and growing state
control were not experienced homogenously throughout the Empire. Hence it is aimed
in this chapter to argue that major efforts were made to increase state control over
mental asylums in the late nineteenth and early twentieth centuries, though this control
was not experienced to the same extent outside the imperial capital.
61
***
During the nineteenth century, certain darüssifas were converted into asylums
such as the Süleymaniye Darüssifa, the Manisa Hafza Sultan Bimarhane, the Edirne
Darüssifa and the Toptası Atık Valide Bimarhane.172 Among them, the Süleymaniye
Darüssifa functioned as the primary mental asylum until 1873. In 1873 Süleymaniye
Darüssifa was closed down due to an epidemic outbreak and patients were transferred
to the Toptası Atık Valide Bimarhane which from then onwards served as the primary
mental asylum between 1873 and 1927.173 In 1927, due to space problems, the patients
of the Toptası Bimarhane were transferred to Resadiye Kıslası which was later called
Bakırköy Psychiatric Hospital. The Edirne Darüssifa served as a mental asylum until
1915 (except the period between 1883 and 1893 when patients were transferred to the
Toptası Bimarhane) when it was closed down. 174 On the other hand, the Manisa
Bimarhane continued serving but rather in a mislaid position until 1926. In 1926 two
new mental asylums containing 50 beds were founded in Manisa and Elazığ by the
Republican government, and the former Manisa Bimarhane was closed. Hence during
the first three quarters of the nineteenth century, major mental asylums were the
Süleymaniye Darüssifa, the Manisa Bimarhane and the Edirne Darüssifa. From then on
the Toptası Bimarhane, the Edirne Darüssifa and the Manisa Bimarhane served as
mental asylums. In the early years of the Republic, there were three “newly” founded
hospitals at Bakırköy (Đstanbul), in Manisa and in Elazığ.
IV.1: Growing State Control: The demented in Istanbul from Süleymaniye
Darüssifa to Toptası Bimarhane
The Süleymaniye Darüssifa functioned as the primary mental asylum up until
1873. In 1873 the Süleymaniye Darüssifa was closed down due to an epidemic and
patients were transferred to Toptası Atık Valide Bimarhane.175Between 1873 and 1927
172 Sarı, Akgün, Türk Tarihinde Psikiyatriye Bakıs, p. 14
173 Mazhar Osman Usman, Tababeti Ruhiye, p.45
174 Nilüfer Gökçe, 19. Yüzyılın Sonlarında, Edirne Sultan II. Bayezıd Darüssifası’nın Durumu, T Klin Tıp
Etiği Hukuku- Tarihi, 2002, 10, 26-33, p.28
175 Toptası Atık Valide Bimarhane was transferred in to a barrack for Nizam-ı Cedid and Asakir-i
Mansure-i Muhammediye armies, abandoned for a period and later in 1864 turned in to a hospital again
62
Toptası Bimarhane served as the primary mental hospital of Istanbul. Hence these
institutions might be interpreted rather as successive institutions of Istanbul upon which
institutional modernization was implemented by innovative physicians such as Louis
Mongeri and Mazhar Osman. Moreover, the Toptası Bimarhane in particular greatly
exemplified the growing state control over the demented.
Mazhar Osman’s “Tababeti Ruhiye” constitutes a major account on the Toptası
Bimarhane. Mazhar Osman176 one of the founders of first modern mental hospital in the
Republican Turkey in 1927, graduated from the Military Medical School in 1904. Thus
he presented both what “he was told” by the former generations and what he observed
as an active participant of the transformation period. Since he started working at Toptası
Bimarhane in 1920, his observations are related largely on Süleymaniye and Toptası.
Hence one should be cautious before making generalizations since the two other mental
asylums in Edirne and Manisa were remained mostly silent. Mazhar Osman after
showing his admiration towards the golden ages of the medical institutions, complained
about its change for worse because of the negligence. His observations departed from
the argument that mental asylums had been severely deteriorated and innovative
physicians starting with Mongeri and his successors such as Mazhar Osman spent great
efforts to upgrade the hospital conditions and to implement the modernization
movement.
One example might be John Howard’s article “Etat des Prisons, des hopitaux et
des maisons de force” written in 1788 and narrated by Mazhar Osman in which Howard
reported the worsening of the mental hospitals which had been constructed as
fascinating buildings. 177 Similarly Mazhar Osman cited Delasiauve’s account who
showed his sorrow about degradation of that glory due to poverty and attitude: “These
glorious buildings were turned into wrecks; either totally abandoned or served for
due to epidemic, then again used as storage up until 1873. Between 1873 and 1927 it was used as a
mental asylum.
176 Mazhar Osman Usman (1884-1951) was a one of the founders of the psychiatry, neurology and
psychology in Turkey who was educated in Military Medical School. He served at Gülhane Military
Medical Hospital, Haseki Hospital, Haydarpasa Military Hospital, Istanbul University. He was one of the
founders of Bakırköy Mental Hospital. He also offered numerous articles and books on the discipline
such as Tababet-i Ruhiye, Sıhhat Almanakı, Psychiatri and Keyif Veren Zehirler.
177 Mazhar Osman Usman, Tababeti Ruhiye, p. 58
63
purposes other than being hospitals”.178 Mazhar Osman also reported an interesting
account that he was told though did not give credit and verify via documents. According
to the account, wild animals and the demented were placed under the same roof, and
treated the same way. Moreover, the demented and wild animals in a cage were shown
to public. Still it might be safe to argue that the image of the demented under miserable
conditions was promoted.179 Godel as well was cited who visited the hospital in 1835
and complaint about the dirt and malodor.
The period between 1857 and 1882 was marked with Louis Mongeri’s success
and endeavor.180 It was seen as a commencement of modernization thus a turning point,
since the deterioration of darüssifa conditions was no longer ignored. Louis Mongeri
(1818-1882) who was an Italian physician who took refuge to the Empire in 1848,
started to work at Süleymaniye Darüssifa in 1857 as a physician. Although the date of
his appointment as the chief physician was not known exactly, Süleymaniye Annual
indicated that he was already titled as the chief physician in 1860.181 Mongeri was
named as “the Pinel of Turks” since he was supposed to eradicate chaining and beating
of the demented.182 Mongeri also played important roles in the foundation of Cemiyet-i
Tıbbıye-i Sahane which was originally named as “Société Impériale de Médecine de
Constantinople” and their publication of medical journal Gazete Médicale d'Orient. He
spent great effort to enhance the hospital facilities and structure though he was
obviously not unaccompanied. In 1879 personnel in Toptası Bimarhane were as
follows: physician Mongeri, physician Castro, physician Manuk Agasi Efendi, surgeon
Hacı Süleyman Efendi, manager Osman Ağa, secretary Tahir Efendi, Đmam Hasan
Efendi, pharmacist Mösyö Yanko, and officers.183
178 “Bu kadar hasmetin inhisafa uğramasına teessüf etmemek elden gelmez. Bu güzel binalar tutum ve
parasızlıktan harabeye dönmüs ya büsbütün metruk bir halde kalmıs, yahut maksattan gayrı ise
hasredilmis.” (My translation), Mazhar Osman Usman, Tababeti Ruhiye, p.60
179 Ibid, p.60
180 Sarı, Akgün, Türk Tarihinde Psikiyatriye Bakıs, p. 14
181 Ayten Altıntas, Üsküdar’da Bir Akıl Hastanesi (Toptası Bimarhanesi 1873-1927), Üsküdar
Sempozyumu I V 391-412, p.396
182 Philippe Pinel (1745-1826) was a “French physician who pioneered in the humane treatment of the
mentally ill.” Encylopedia Britannica (online), Britannica Advanced Publishing, Inc., Chicago, IL, 1994-
2000, “Philippe Pinel”
183 Ayten Altıntas, Üsküdar’da Bir Akıl Hastanesi (Toptası Bimarhanesi 1873-1927), p.396
64
He implemented a series of modifications, one of which was the transference of
patients from Süleymaniye Darüssifa to Toptası Atık Valide Bimarhane. Mongeri
depicted the process of transformation and highlighted poor circumstances of
Süleymaniye Bimarhane in which not even the basic needs such as food, water, air and
shelter were satisfied.
Süleymaniye Bimarhane could contain only 100 or 130 patients. During this
time 375 patients (198 male) were given shelter. Foods were in short of fresh
vegetables and meats. Even water was not enough for using and drinking. The
number of patients was increasing day after day, and the air became not
breathable. Then I was informed that two patients suddenly died. On the 27th of
the month 3 and on the 29th 10 cases were seen. In eight days we see 39 cases,
29 of them died. Then patients were transported to a better place where I was
requesting to be allocated. After all the patients were cleaned, we moved away
to Toptası.184
Mongeri was inspired by 1838 French code and prepared a proposal of a
regulation concerning the demented and it was passed into law on 15 March 1876. The
code brought about significant police control on confinement. Moreover bimarhanes
which had been formerly regulated by chief physicians and Mekteb-i Tıbbıye (School of
Medicine) were reformulated under the responsibility of Umur-ı Tıbbıye (Medical
Affairs) and Zaptiye <ezareti (Ministry of Police) in order to inhibit possible arbitrary
confinements done by “only” non-muslims.185 The regulation containing 22 articles
evidently put conditions for confinement practices; for foundation and organization of
bimarhanes. First and the third articles concerned the locality and size, and entailed
184“Süleymaniye bimârhânesi ancak 100-130 kadar hasta alabilecek kapasitedeydi. Bu tarihte 198’i erkek
olmak üzere 375 deli barınıyordu. Besin taze sebze ve etten mürekkepti. Geceleri açık havada yatmayı
itiyat edinmislerdi. Soğuk havalarda odalarda izdiham had safhada idi. Su kullanmak için değil içmek için
bile kâfi değildi. Hastanın sayısı her geçen gün artıyordu, bimârhânenin havası teneffüs edilemez hale
geliyordu. Đki hastanın ani ölüm haberini aldım. Ayın 27’sinde 3 vaka, 29’unda 10 vaka görüldü. 8 gün
içinde 29’u ölümle neticelenen 39 vaka görülmüstü. Hastaların daha iyi bir yere tasınması gerçeklesti,
uzun zamandır istediğim yeri bana tahsis ettiler, bütün delileri yıkatıp temizlettikten sonra Toptası’na
tasıdık.” (My translation) As Sarı and Akgün quoted, Sarı, Akgün, Türk Tarihinde Psikiyatriye Bakıs, p.
14
185The code explicitly deemed non-muslim institutions responsible. “Dersaadette Toptası darüssifasından
baska yerlerde gayrı Müslim milletlerin hastanelerinde eskiden beri reis-i ruhaniyyeleri tarafından verilen
ruhsat üzerine mecânin kabul edilmekte ise de bu usul pek çok suiistimallere sebep olmus; bundan böyle
Dersaadette (Đstanbul’da) ve tasralarda bulunan veya insa edilecek olan bilcümle sifahane ve hastanelerin
düzeni için bu nizamname Sertabib Mösyö Mongeri tarafından kaleme alınmıs…” Osman Nuri Ergin,
Mecelle-i Umûr-ı Beleddiyye, Đstanbul Büyüksehir Belediyesi Kültür Đsleri Daire Baskanlığı Yayınları
No.21. Đstanbul 1995, V.6, p.3377.Sarı and Akgün as well stated that Turk and Muslim society never had
such a problem. Though whether or not one should take the code at face value and make such an assertive
statement might be controversial. See Sarı, Akgün, Türk Tarihinde Psikiyatriye Bakıs, v.6, p. 15
65
license. 186 The second article related to the procedure of confinement: “When a
demented is seen and when his or her family is required to tie him or her, the
government has to be informed. The demented is going to be examined by two
physicians one is appointed by the police and the other is appointed by the family.”187
This article might be interpreted as a way making confinement easier since a complaint
about the demented was no longer needed. According to Sarı and Akgün “this article
means that the demented could be forcefully taken away to the bimarhane without a
compliant”. 188 The confinement practice according to the article started by an
individual who saw the demented needed to be tied. Here the concern might be
interpreted as solely being a mad in the need of being tied and whether or not there was
a complaint was no longer a concern. What determined that s/he had to be tied was no
longer conditional to whether or not s/he was harmful to self or others. Moreover, the
article clearly showed that a demented in the need of being tied was no longer an
element of private sphere since his / her family was required to inform the state
mechanisms of his / her illness. Thus, a problem which was formerly seen as related
with the private sphere, turned into a problem directly related to the state mechanisms.
In that regard, one could argue that a former untouched private practice was intended to
be regulated under the direct control of the state mechanisms.
The forth article was about the patient admissions. The fifth article was related
with the procedure on the demented sent from the provinces. The seventh article was on
in what ways the demented has to be incarcerated. According to the article the
confinement practice was directly related with the government decision, yet in
provinces the council of elders and a physician were given the responsibility to decide
on whether or not there confinement was needed. This might show that the Empire
acknowledged the lack of required mechanisms to enhance state control, and under
these circumstances, neighborhoods were still power holders. In that regard, one could
argue that state control did not subjugate individuals homogenously due to
186 Osman Nuri Ergin, Mecelle-i Umur-u Belediyye, p.3373
187 “Hanelerde bir mecnun zuhur edip familyası bağlamaya mecbur olduğu halde bağlanıp akiben
hükümete ihbar ile kaide-i mezuasına tatbiken muayene ettirelecek ve o misüllü haber edilen mecanin biri
zabıta tarafından ve bir de familyası caninden iki tabip tayiniyle muayene olunacaktır.” Osman Nuri
Ergin. “Mecelle-i Umur-u Beleddiyye”. v. 6, p.3373
188 Sarı, Akgün, Türk Tarihinde Psikiyatriye Bakıs, p. 16
66
organizational shortages. The tenth, fifteenth, sixteenth and seventeenth articles
determined the ways of being released. The nineteenth article necessitated keeping
statistical records.189
According to Sarı and Akgün this regulation showed that the demented and
criminals were behaved the same.190 If not, one could evidently argue that state directly
intervened into mentally ill persons’ way of existence in the society and intended to
impose control upon them. Moreover state for the first time delineated in what ways
confinement practices had to be implemented and the demented had to be behaved. At
this juncture one could argue that the Empire attempted to establish efficient internal
organizations which were required for the modern disciplinary mechanisms.
During the following years partially because of the 1876 Regulation, the number
of patients was radically increased. Up until 1893 when incoming patients were not
accepted by the government decision due to epidemic, a significant number of patients
from Anatolia was sent to Toptası causing crowdedness. Mazhar Osman narrated
observations of journalist Ritti working for a French journal Dèbat on the period.
According to Ritti, patients were still under poor and miserable conditions and did not
receive health and treatment. For him hospital bed capacity was 150, though it was
occupied by 620 patients, 450 male and 170 female. In response physician Castro stated
that the number of patients was indeed 600, largely because the deranged outside of
Istanbul were transported to the hospital and non-muslim mental hospitals did not
accept new patients. According to him only 114 of 600 patients were from Đstanbul.
During the reign of Abdülhamit II, Toptası Bimarhane and the demented were
subjected to strict control. Usages of certain words connoting or basically meaning the
insanity (and the insane) were prohibited such as deli, mecnun, cinnet. 191 Patients’
entrance and release were controlled by Ministry of Police. Likewise visitors’ access to
the hospital depended upon Sultan’s approval thus was severely restrained.192 Kraeplin
for example was not allowed to see the interior. The period between 1893 and 1908 was
189 Osman Nuri Ergin. “Mecelle-i Umur-u Beleddiyye”. v. 6, p.3373-3377
190 Ibid, p.3373
191 Mazhar Osman Usman, Tababeti Ruhiye, p. 62
192 Ibid, p.62
67
marked with the topos “hospital turned out to be like jails”.193 Police forces who were in
charge of confinement practices detained the demented on the streets. During this period
the demented were first taken under custody in Hapishane-i Umumi (General Prison)
then those who labeled as the demented were sent to Toptası Bimarhane. According to
Mazhar Osman “these mental patients often stayed in prison for months. In time, their
number became too many for the prison. For days, they stayed at police station right
beside the criminals”. 194 Libert argued that during this period the demented were
chained by their feet and hands, and deprived of food and water.195 It might be safe to
argue that the demented were exposed to the poor conditions. Police forces were given
wide ranging power to the extent that they could confine the ones suspected to be
mentally ill. The demented and the criminals under the same roof and police forces as
the main mechanism of control might have symbolic meanings in terms of confinement
practices. Then those suspected individuals were subjugated to immediate disciplinary
mechanism of exclusion.
Mazhar Osman narrated the conditions of the asylum:
During the reign of Sultan Hamit, Toptası gained importance as much as to a
political prison. It was closed to everyone. No one wanted to send patients to
the bimarhane, no matter how dangerous the illness was. People hardly believed
that their patients would be released alive. On top of that it was belived that the
patients were indeed political victims who were not actually mentally ill but
those who were ascribed to be. Obviously this belief was a social indiscretion,
though it was highly prevalent among the commoners. There were reasons
reinforcing the belief. Families were not allowed to see their patients… They
did not see, and communicate with their patients; in the meantime due to a word
the patient was just saying to guardian, their conviction on the belief that their
patients were indeed not mentally ill became strong. The petitions given by the
family members to the Police Department after series of procedures were
delivered to Bimarhane chief physician, and again after series of consultations,
it was decided that the patient should stay for some more time. Then “some
more time” became extended. After months and years have passed, the patients
who were actually treated and became healthy were fed by empty promises.
After all, the patients were passed away because of cold or diarrhea.196
193 Ibid, p.63
194 “yer bosalıncaya kadar aylarca hapishanede kaldıkları çoktu. Zamanlar hapishaneye de sığmaz oldular.
Polis karakolunda deliler, sabıkalılarla beraber günlerce yatardı.” (My Translation) Mazhar Osman
Usman, Tababet-i Ruhiye, p. 66
195 Ibid, p.66
196“ Sultan Hamit zamanında Toptası siyasi bir zindan kadar ehemmiyet kazandı. Kapıları herkese kapalı
idi… Kimse ne kaadr siddetli olursa olsun buraya hastasını vermek istemezdi. Buradan, hastasının sağ
çıktığına inanan pek azdı. Hatta hastaların çoğu mecnun değil, cinnet isnat edilmis siyasi mağdur
68
The passage gives certain clues about the nature of confinement which took
place at Toptası Bimarhane. Here Mazhar Osman narrated that even “the patients who
were actually treated and became healthy” were hardly released from Toptası
Bimarhane. This might be mostly because of the stagnancy of the institution; hence it
would be speculative to argue that this was intended from the beginning. Yet still
Toptası patients were faced with the severe exclusivist mechanism since confinement
became easier and the chance of release was radically declined. This might pinpoint the
shift from integrative mechanism to the exclusivist mechanism in Istanbul. The former
chapter it is argued that the medieval and early modern Ottoman hospitals operated
integrative mechanisms through which one could participate in to the society again once
the problem of being harmful was solved. In that regard the medieval and early modern
Ottoman confinement practices might be seen as action based. However this passage
shows that regardless of whether the patients were controlled and treated or not; they
were kept being excluded from the streets of Istanbul. Moreover according to Mazhar
Osman it was believed that confinement was used as a tool to silence political victims.
This might show that confinement gained a new meaning among the commoners. It was
believed to be used as a weapon to divide “disobedient” subjects from the obedient ones
thus was believed to be used as a concrete disciplinary mechanism. One cannot argue
that Empire did confined “the political victims”, though the fear aroused among the
people of Istanbul per se did enable a disciplinary power which might be analogous to
Foucauldian disciplinary power. Applied to Foucauldian theory, one could argue that
medicine was intended to be used as a tool of control by the Empire. Still to what extent
subjugation managed to be efficiently established might be controversial, yet the period
sanılırdı. Süphesiz böyle bir sey olamazdı. Buna inanmak bir çesit içtimai belahetti, lakin halk arasında bu
itikat o kadar kök salmıstı ki… Bu itikadı besleyen sebepler de yok değildi.Ailelelere hastalıkları artar
diye hastalarını ziyarete müsade edilmezdi, pek çok ısrar edenler on metre uzakta kafesli bir tavan
penceresinden hastasını ancak bir iki dakika görebilirdi. Hastalarıyla görüsemiyorlar, dertlesemiyorlar, o
sırada hastanın gardiyana söylediği bir sözden, mağdurun mecnun olmadığı hakkındaki sarsılmaz
kanaatları daha da kuvvetleniyordu. Hastayı almak için ailenin polis müdüriyetine sehir emanetine verdiği
istidalar uzun muamelelerden sonra bimarhane sertabipliğine iade edilir, uzun muamelelerden sonra
bimarhane sertabipliğine iade edilir, uzun konsoltolardan sonra biraz durması münasip görülürdü. Artık o
biraz pek daha uzardı. Aylar, seneler geçer, cidden iyilesmis hasta aile ocağı hasretiyle sinirlenir,
kederlenir, bugün yarınla oyalanırdı. Nihayet bir soğuk algınlığı veya amel bi çareyi alıp götürürdü.”(My
translation) Ibid, p. 64
69
particularly between 1876 and 1909 might show that more efficient disciplinary
mechanisms were intended to be established.
Between 1909 and 1912, Toptası Bimarhane management was devolved to a
newly founded institution of health management “Müessesat-ı Hayriye-i Sıhhıye
Đdaresi”. An observation unit was founded for the deranged to be kept until the
Bimarhane could provide places. During the constitutional period the Bimarhane was
opened to visitors including public. It went through restoration and enlarged. 445 new
patients were accepted and the number of patients grew to 685 in 1910.197 According to
Mazhar Osman Toptası Bimarhane was not efficient as a mental asylum since it was
capable of hosting 300 patients and was rather a small place. Hence in 1911 it was
attempted to be transported again but the project did not come to realization.
In 1913 an instruction of mental hospital and observation unit (Bimarhane ve
Müsahedehane Talimatnamesi) was implemented.198 The instruction was intended to
define the duties of employees and the number of beds at the hospitals. Hence during
the constitutional period, due to escalating criticisms, certain regulations were
implemented. Though according to Mazhar Osman, they did not last long due to
financial crises and after a short period it turned back to its previous conditions and
conditions were not successfully upgraded. 199 Mazhar Osman repeatedly argued that
Toptası was not upgraded largely because of its place near the center and its small size.
For him a mental asylum should be situated not at the center and should have a
considerable free space for the demented spending time. The former might be seen as
the change in the understanding of bimarhane which had been at the center near the
residential quarters that one can see in the early modern period. This might be
interpreted as the emergence of modern understanding of mental asylum as an isolated
sphere.
In 1920 and 1922 Mazhar Osman’s work as the chief physician might be seen as
quite productive since bimarhane served as an educational institution. Major physicians
who later on became influential on psychiatry such as Sükrü Hazım, Abdülkadir Cahit,
Hakkı Ubeydullah, Ömer Naci, Cevat Zekai, Đsmail Ziya, Mazhar Cemil, Fahrettin
197 Osman Nuri Ergin, Müessesat-ı Hayriye-i Sıhhıye Müdüriyeti, Đstanbul, 1327, p. 45.
198 Osman Nuri Ergin. “Mecelle-i Umûr-ı Beleddiyye”. V. 6, pp. 3407-3409
199 Mazhar Osman Usman, Tababeti Ruhiye, p. 62
70
Kerim, Ahmet Sükrü, Đhsan Sükrü, Talha Münir and Necati Kemal. Mazhar Osman
raised the need for a new place in 1922; and after his request was rejected, he resigned.
A year later the newly founded Republic appointed him again. Finally in 1927 a new
place, Resadiye Kıslası, was allocated for the hospital thereafter it was transported.
In a nutshell, the late nineteenth century Toptası Bimarhane might exemplify the
instrumentalization of medical knowledge for growing state control over the demented.
Relying on Mazhar Osman’s arguments, for a period the demented in Istanbul were
confined beside criminals; Bimarhane was severely controlled; patients were faced with
life imprisonment although they were healed and the fear among the public served as a
social control mechanism. In that regard Shefer- Mossensohn’s arguments might be
important.
It was especially during the nineteenth century that medicine was intentionally and
successfully implemented in the Ottoman Empire with control as its aim. In the
early modern period, and mainly in the sixteenth and seventeenth centuries,
medicine was part of a cluster of agents that created and maintained the social
hierarchy and was not necessarily the most widely used aspect. In the nineteenth
century the situation changed. To be sure medicine was still one of several avenues
through which society was regulated, but now medicine played a decisive role in
comparison to the place it had held in earlier centuries and to other social
signifiers. 200
Shefer-Mossensohn in her article discusses the question of whether Foucauldian theory
might be applicable to the Empire or not. According to her Ottoman Empire
“intentionally” and “successfully” implemented “disciplinary mechanisms” in a
Foucauldian sense especially during the nineteenth century. The examples of 1876
Regulation, foundation of Institution of Health Management “Müessesat-ı Hayriye-i
Sıhhıye Đdaresi”, 1913 Instruction of Mental Hospital and Observation unit (Bimarhane
ve Müsahedehane Talimatnamesi) could prove that health and particularly mental health
started to be seen as highly important by the state. The demented at the hospitals and
streets were subjugated to government control. Although to what extent these
regulations managed to effectively discipline everyday life might be controversial, it is
still apparent that discipline was “intentionally” restored through more effective
institutions.
200 Miri Shefer Mossensohn, Health as a Social Agent in Ottoman Patronage and Authority, p. 149
71
One could argue that Mazhar Osman’s depiction of the late nineteenth and early
twentieth century Istanbul was analogous to Shefer-Mossensohn’s argument. In that
regard institutional regulations and the characteristics of confinement in Istanbul might
exemplify what Shefer-Mossensohn is argued. Given that the visitors who were not
allowed to see the patients and the interior; the demented at the streets who were faced
with police control; the demented at prisons who were confined right beside the
criminals; the demented inside hospitals who were faced with life time custody
regardless of being healed or not; and finally the fear among the public might show that
mental health was “successfully” used as a control mechanism in Istanbul.
Still Toptası Bimarhane was not the only state hospital serving the demented.
Although some patients outside Istanbul were transported to Toptası for a period;
Edirne Darüssifa and Manisa Bimarhane were still in use. Besides, after a short period
Toptası did not accept new patients outside Istanbul. Thus in order to have a
comprehensive insight on the use of medical knowledge by the state and on the
disciplinary, regulatory control mechanisms over the demented, one should study on
these two institutions as well. In that regard, this project asks for whether or not
contrary or similar regulations were implemented in these two institutions as well.
Although existing literature on these two institutions does not provide much, still one
could gather bits and pieces of information and thereafter posit an assumption. My
assumption here would be on rather incomplete and narrow control over Manisa and
Edirne as compared to Istanbul. Hence I would rather limit Shefer-Mossensohn’s
argument of the “successful” implementations of disciplinary mechanisms for Istanbul.
For the reasons that in Edirne one could see short term confinement practices and in
Manisa one could see problems in renovation. Moreover, Manisa Bimarhane was a
thought provoking institution which lacked of a physician for a long time.
IV.2: Cases of Institutional Modernization and Confinement Practices Outside of
Istanbul: The Edirne Darüssifa and the Manisa Bimarhane
The Edirne Darüssifa
Edirne Darüssifa served until 1915 except the period between 1883 and 1893
when patients were transferred to Toptası Bimarhane. An article written by Nilüfer
Gökçe provides significant primary sources on the late nineteenth century bimarhane.
72
As Gökçe mentions, these sources revealed that the demented in the bimarhane were
under severe deficiencies up until 1896. From then on it went through a renovation.
As Gökçe argues, relying on a contemporary journal, “Edirne Gazetesi” Edirne
Darüssifa which became an asylum in time, was severely criticized in the nineteenth
century. Saffet Pasa who was later appointed as Sadrazam wrote a letter to the current
Sadrazam in 1875 and the letter was published in the journal. In the letter he
complained about the poor conditions in the Darüssifa in which 21 madmen were
chained by their necks and were given nothing but water and bread. Moreover the
Darüssifa regularly became filled with overflowing. He directly criticized the governor
of Edirne who was informed about the situation. According to Saffet Pasa the governor
neither went there nor took the issue seriously.201 Few years later Edirne Bimarhane
was closed in 1883 and patients were transferred to Toptası. 202 In 1893 Edirne
Bimarhane was reopened after officials of Toptası Bimarhane sent an official letter
declaring that Toptası was no longer to accept new patients.203As Gökçe depicted in
1896 physician Sokrat was appointed. An article published in the journal in 1909 signed
as “Edhem” narrated how physician Sokrat Efendi improved the hospital conditions.204
“Edhem” started his article with a portrayal of the bimarhane before Dr. Sokrat Efendi,
a depiction which was similar to that of Saffet Pasa. Then he depicted Sokrat Efendi’s
entrance as a turning point, from then on the patients were provided with enough food
and health services, were examined regularly (once in a day or once in two days) and
were not chained. This might pinpoint that at the turn of the twentieth century, hospital
conditions were started to be a subject of and certain transformations were implemented
to an extent. Chaining and beating of the demented were, for some, abolished, though it
is safer to argue that they were generally seen as outdated methods thus criticized.
Edirne Gazetesi was also informative on one another point. Edirne Darüssifa
kept records of incoming and outgoing patients and some of these records were
201 Nilüfer Gökçe, 19. Yüzyılın Sonlarında, Edirne Sultan II. Bayezıd Darüssifası’nın Durumu, p.27
202 Mazhar Osman Usman, Tababeti Ruhiye, p. 63
203 Nilüfer Gökçe, 19. Yüzyılın Sonlarında, Edirne Sultan II. Bayezıd Darüssifası’nın Durumu, p.19
204 Ibid, p.19
73
published in the journal.205 One striking point was that the number of released patients
was quite substantial. Although the document does not specify the starting and the
ending days exactly, during the Julian year 315 (1899 in the Gregorian calendar), 60
new patients were accepted, and the total number was raised to 74; and at the end of the
year 57 were released, 3 died thus the total number was reduced to 19. Throughout the
coming year 56 new patients were accepted, the number was increased to 77 and 56
were released 6 died and at the end of the year the final number was 15. One
interpretation for the low number might be that the Edirne Darüssifa offered not so “no
way out” type of a confinement as Mazhar Osman depicted for contemporary Toptası
Bimarhane. Although one cannot be sure about whether the patients were indeed treated
or the hospital was not capable of containing that amount of patients (since the number
of patients stayed at the hospital was around 12 to 19 from 1898 to 1900); one could
still argue that Edirne Bimarhane, unlike Mazhar Osman’s Toptası Bimarhane
depiction, did often release a considerable amount of patients. Obviously the above
mentioned question is important to understand the disposition of treatment and release;
one could not give a definite answer relying on existing record. Still the fact that
considerable amount of patients was released from Edirne Darüssifa between 1898 and
1900, might provide a clue about the nature of the confinement. It might evoke the idea
that the control imposed upon the people of Istanbul and upon the people of Edirne
might be different in terms of strength and efficiency. Istanbul as the center of the
Empire can be easily seen as having more effective organizational structure. If not, it is
205 “H.1316 / M.1898 yılı Cemâzi-yel evvel Ayında: Dârüssifada tedavi gören on dört hastadan, dördünün
is yapabilecek düzeye geldiği için ayrıldığını, yeniden tedavi olmaları için getirilen iki hasta ile birlikte,
burada tedavi gören hastaların sayılarının on iki olduğunu; H.1316 / M.1898 yılı Cemâzi-yel âhir Ayında:
25 Cemâzi-yel âhir tarihinden iki hafta önce, dârüssifada tedavi gören hastalardan birinin, is yapabilecek
düzeye geldiği için ayrıldığı, bunun yerine gelen bir kisi ile birlikte tedavi görmekte olan akıl hastası
sayısının on bes olduğu; H:1317 / M:1899 yılı Cemâzi-yel âhir Ayında: Dârüssifada on iki akıl hastasının
bulunduğunu, bunlardan bir tanesi is yapabilecek düzeye geldiği için hastaneden ayrıldığını ve yeniden
getirilen dört kisi ile beraber on bes akıl hastasının tedavilerine devam edilmekte olduğu bildirilmistir.
Rumi:315 / M:1899 yılı içinde; Edirne Bimârhanesine altmıs akıl hastasının tedavi edilmek üzere geldiği,
dârüssifada tedavilerine devam edilen hastalarla birlikte, akıl hastası sayısının yetmis dokuz olduğunu,
bunlardan elli yedi hasta is yapabilecek düzeye geldiği için ayrıldıklarını, üç hastanın öldüğünü, ve geri
kalan on dokuz akıl hastasının tedavilerine devam edilmekte olduğunu;Rumi:316 / M: 1900 yılı
baslangıcından sonuna kadar, Edirne Bimârhanesine elli sekiz akıl hastasının geldiği, Rumi :315/ M:1899
yılından kalan on dokuz kisi ile birlikte tedavi gören akıl hastalarının sayılarının yetmis yedi olduğu, akıl
hastalarından elli altısının iyileserek ayrıldığını,altı akıl hastasının öldüğünü, geriye kalan 15 akıl
hastasının tedavisine devam edilmekte oldugunu;” Nilüfer Gökçe, 19. Yüzyılın Sonlarında, Edirne Sultan
II. Bayezıd Darüssifası’nın Durumu, p.29-30
74
still safe to argue that although confinement practices in Đstanbul might fit Foucauldian
“disciplinary mechanisms”, one could not assume that each and every subjects was
homogenously subjugated by these mechanisms.
The Manisa Bimarhane
Manisa Bimarhane served in a rather forgotten position until 1926 when it was
closed and a new mental hospital was founded. Nihad Yörükoğlu, wrote a quite
informative book on The Manisa Bimarhane, which was at the course of the nineteenth
century turned into a mental asylum. He offered a comprehensive book in which
numerous revealing accounts were narrated. Although Manisa Bimarhane was hardly
documented, he managed to provide primary sources starting from the sixteenth century
to the second half of the twentieth century. Applied to the nineteenth and early twentieth
century he portrayed a hospital in a rather forgotten position, providing very poor
conditions, and did not obtain its share from the renovations. Manisa was portrayed as a
hospital with no physician and offer nothing but religious healing until 1919. According
to Yörükoğlu, Manisa was open to visitors and thereafter the visitors of Manisa were
not faced with a restrictive policy contrary to what visitors of Toptası were faced.206
His book relies on narrations on the nineteenth century, and these narrations
were mostly about head guardians. One quite important thing was that Manisa
Bimarhane did not employ a physician and in the case of a need, physicians working at
Gureba Hastanesi were coming.207 Hence head guardians played significant roles for
institution management. One head guardian was Hacı Hasan who worked between 1863
and 1882. He became very known among the dwellers since he was intimidating the
patients. According to what Yörükoğlu was narrated, Hacı Hasan was responsible for
the treatment as well, though his sole therapy was beating.208 According to Yörükoğlu
after Hacı Hasan died, respectively Hacı Hafız Mehmet, Hacı Mehmed (1887-1902) and
Kesabalı Hasan took over the responsibility.
206 Nihad Nuri Yörükoğlu, Nihad Nuri: Manisa Bimarhanesi, Đstanbul, Đsmail Akgün Matbaası, 1948,
p.32
207 Ibid, p.28
208 Ibid, p.32
75
As Yörükoğlu highlighted Manisa Bimarhane was highly neglected and the
conditions were worsened. Süheyl Ünver also mentioned about the negligence, he cited
an article published in 1886 in Sıhhat Mecmuası, complaining that bimarhane’s
allowance was not paid.209 Yörükoğlu quoted a letter published in 1911 in a journal
Türk Yurdu Mecmuası, written by Kazım Nami who similarly complained about the
poor conditions of the hospital and who showed his pity towards the demented. For him
there were 116 patients.210 In 1919 physician Naci Aslay was appointed as a physician.
He complained about the continuing negligence and confirmed that there had been no
preceding doctor working at the hospital.
When I was appointed in 1919 as a physician, there was no other doctor. There was
only a healer (üfürükçü) working of therapy who was appointed by the evkaf
idaresi (PiousFoundation Management)…He had no treatment technique other
than making the patients drink a bowl of water in it few words were written.211
Hence Manisa Bimarhane was rather in a forgotten position which was rather far
away from institutional and medical modernization since for a period it provided
religious healing and less institutional medicine.
In a nutshell the situation in Manisa and Edirne could be seen as rather different
than one in Đstanbul. Edirne went through a renovation according to the above
mentioned article written by “Edhem” yet the number of patients who were released
was significantly different from Toptası. In that regard one might not generalize Mazhar
Osman’s depiction of life time confinements severely excluding patients from the
society. Instead one could take his depiction as a phenomenon of Istanbul since still we
do not know much about the rest of the Empire and since one example from Edirne
contradicts. Manisa as well contradicts in a sense that Toptası went through major
renovations and regulations which increased the efficiency of state control. Here Manisa
exemplifies rather a forgotten institution which lacked of a physician and indirectly
209 Ibid, p. 35
210 Ibid, p. 44
211 “Ben 1335 (1919) yılında Manisa Bimarhanesine tabip tayin edildiğimde müessesede benden baska
doktor yoktu. Evkaf idaresi tarafından tayin edilen bir üfürükçü tedavi isleriyle mesgul olmakta idi…Bir
kaseye yazı yazıp hastalara bu kase içine konulan sudan içirmekten ibaret olup yegane tedavi çaresi bu
idi.” (My translation) As Yörükoğlu quoted Yörükoğlu, Nihad Nuri: Manisa Bimarhanesi, Đstanbul,
Đsmail Akgün Matbaası, 1948, p 40
76
lacked of medical modernization, institutional renovation. Thereafter one could assume
that it was rather distant from regulations enhancing state control.
***
In a few words, late Ottoman mental asylums were depicted as having been in a
severe deficiency as reflected in several accounts. In the accounts the demented were
portrayed as being in deprivation who were even in short of basic needs. From the
second half of the nineteenth century onwards the Ottoman administration took crucial
measures such as the Regulation of 1876, the foundation of the Institution of Health
Management “Müessesat-ı Hayriye-i Sıhhıye Đdaresi”, and the Instruction of Mental
Hospital and Observation Unit of 1913 (Bimarhane ve Müsahedehane Talimatnamesi).
These steps intended to increase state control over the demented people through
methods of law enforcement. Confinement within mental asylums was necessitated to
be conducted by means of state institutions. Mazhar Osman’s account reflects the
increase of administrative control over the demented through modernization where
medical knowledge was used as a disciplinary mechanism, which was mainly true for
Đstanbul. However, to what extent the state intended or managed to establish medical
“disciplinary mechanisms” outside of Istanbul seems to be controversial. In order to
have a concrete answer to this question, evidently more detailed studies on the subject
are needed. Still one could argue that the situations in Edirne and in Manisa were rather
different. This situation shows that the growing control over the subjects in Istanbul and
over the demented patients in the Toptası Bimarhane might not represent the situation
of the whole country. Thus it is safe to argue that the demented in Istanbul were
subjugated to growing state control, and the Toptası Bimarhane went through major
renovations which aggrandized discipline, whereas the institutions in Edirne and Manisa
reflected dissimilarities in terms of the nature of confinement and renovations. In a
nutshell the control over the demented was highly increased, though due to
organizational inefficiencies this control was not experienced homogenously throughout
the Empire.
77
Conclusion
This study attempts to provide the history of mental health in the Ottoman
Empire with special focus on modernization. It has searched to determine how
modernization shaped mental health treatment and thus affected the demented at the
hospitals in the Ottoman Empire. It has aimed to provide a descriptive account on
Ottoman medical institutions and to search for the clues on the conditions experienced
by the demented. The findings provided by the existing literature have been studied to
provide a re-interpretation of how the demented were treated. For doing this it has been
endeavored to reach an understanding as to what extent and how modernization affected
the demented. For the endeavor this project has intended to portray both pre-modern
and modern periods with respect to confinement practices, hospitals, and state control.
Given the changing nature of treatments and perceptions of mental disorders
from one society to another and from one timeframe to another, one should be careful
before making generalizations. Because of that working on the mental disorders is a
difficult task. However, thanks to existing notable scholarly works one might reach to
certain conclusions. This project has intended to discuss as to what extent the transition
from traditionalism to modernism occurred and to what degree medical modernization
led to an increasing state control. From the second half of the nineteenth century with
the modernization process, medical knowledge was used as a disciplinary mechanism to
the extent in which effective organizational structures were established. This project has
shown that state control was increased and confinement was used as a disciplinary
mechanism only to the degree in which required effective organizational structures
could be established. As a consequence, the discipline imposed upon demented
individuals could not be implemented homogenously.
Up until the medical modernization, the demented largely enjoyed integrative
mechanisms for certain reasons. Asylums were less isolated places in terms of the
visitors’ access and location. Confinement was low largely because of the institutional
78
deficiencies since these institutions had less institutional capacities in terms of the
number of beds and personnel to serve the physically and mentally ill. Confinement was
mostly practiced when the neighborhood members complained and when the family
members could not prove convincingly before the judge that they could take care for the
demented. Those healed individuals were mostly allowed to be released. In addition the
demented in an outburst of crisis could be confined for a couple of days in religious
institutions as well. Thus it was not a matter directly under the control of state. However
this thesis has not the aim to prove the “greater Islamic tolerance argument” due to the
fact that it has no intention to fully portray the demented living in neighborhoods and
also because “tolerance” is a value loaded term carrying an impression of perfect
goodness and benevolence, leading to neglect counter examples. Rather this project has
intention to show that modernization brought about increasing state control and change
in the nature of confinement to the extent that institutional modernizations was
accomplished.
This thesis argues that the Ottoman Empire did attempt to increase its control via
medical knowledge with respect to institutional reformations and law regulations in
both (medical) educational institutions and medical institutions. The Ottoman
administration attempted to make certain regulations from the second half of the
nineteenth century as we know from the examples of the 1876 Regulation, the
foundation of the Institution of Health Management “Müessesat-ı Hayriye-i Sıhhıye
Đdaresi”, the 1913 Instruction of Mental Hospital and Observation Unit (Bimarhane ve
Müsahedehane Talimatnamesi). Through these regulations mental treatment became
subjugated to government control. Hospital conditions were intended to be
standardized; duties of hospital employers were clearly demonstrated.
Mazhar Osman’s account reflects that the Empire increased its control over the
demented via modernization and thereafter medical knowledge was indeed used as a
disciplinary mechanism, particularly in Đstanbul. The process of disciplining was
implemented through means of law enforcement, and the demented at the streets were
faced with police control. State control over the asylums in Đstanbul increased as well.
Visitors’ accesses to the interior were necessitated government permission.
79
Relying on Mazhar Osman’s depiction, we learn that confinement practices
changed at least in Đstanbul. Since confinement became easier, the chance of being
released radically declined and since the demented inside the Toptası institution faced
with life time custody, regardless of being healed or not, Toptası patients in effect faced
the exclusivist mechanism. In addition, the demented were virtually confined at prisons
for a period right along the criminals. On top of that the notion of confinement gained a
new meaning since it was prevalently believed by the commoners that confinement was
used as a weapon to segregate political victims from the commoners. Hence regardless
of whether or not medical knowledge was directly used to segregate political victims,
the growing belief among the commoners is thought provoking. Whether it was real or
not, the threat of being confined became widespread. Hence medical knowledge became
widely believed to segregate “disobedient” subjects, and eventually turned into a
disciplinary mechanism in Đstanbul, as Mazhar Osman’s depiction narrates.
However to what extent the state attempted or managed to create medical
“disciplinary mechanisms” outside of Istanbul appears to be controversial. This thesis
takes into consideration the three institutional mental asylums in Đstanbul, in Edirne, and
in Manisa; the Edirne Darüssifa and the Manisa Bimarhane in the provinces have been
used to investigate the degree of state control and the nature of confinement outside
Đstanbul. In some respects these two state mental asylums turn out to be rather different
from Mazhar Osman’s Toptası depictions. On the one hand the Edirne Darüssifa went
through certain renovations in parallel with Mazhar Osman’s early twentieth century
Toptası accounts. On the other hand the high number of released patients from Edirne
Darüssifa shows us that Mazhar Osman’s depiction of life time custody does not
represent the whole picture. The Manisa Bimarhane appeared to be rather far away
from the medical and institutional modernization, as reflected by Yörükoğlu. There,
patients did not receive medical treatment due to insufficiency of physicians for a
period, and instead recourse was taken to religious healing. These two examples show
that the growing control over the subjects and the disciplinary use of confinement on the
demented in the Toptası Bimarhane might not represent the whole situation. Thus this
project has intended to argue that the demented in Istanbul were subjugated to growing
state control and the Toptası Bimarhane went through renovations with an increase in
disciplinary measures, yet Edirne and Manisa reflected variations in terms of the nature
of confinement and renovations. In a nutshell the control over the demented could only
80
increase once the required effective organizations were established, and due to
organizational inefficiencies this control was not realized homogenously throughout the
provinces.
The Foucauldian theory defines a historic change as the change in the way the
scale, object and modality of control; economy and efficiency in mobility; and internal
organizational structures have been transformed. According to Foucault imposition of
power upon individuals, various forms of subjugation, prohibitions and constraints had
already existed before the historic change. He rather pinpoints a transformation in the
nature of control which requires efficient organizational changes and these changes
transforming confinement and medical knowledge into disciplinary mechanisms. In that
regard attempts of the Ottoman administration to increase its hegemony though such
measures is closely related with the processes of modernization and institutionalization.
To the degree in which institutional modernization is accomplished and to the degree in
which effective organizational structures are established, we see the aggrandizement of
state control in the long run. On the other hand, to a degree that these organizations
were not established homogenously, hegemony could not be realized homogenously as
well. In the late Ottoman case changes in the way of scale, modality, efficiency and
speed of control were not introduced evenly and simultaneously due to insufficiencies
in the internal organizations. In that regard the Foucauldian theory provides a model to
understand the dynamics of Istanbul and Toptası Bimarhane but the model might not
entirely be applicable to the broader picture since we do not know much about each and
every province and the reflections of these regulations on everyday life. It is rather a
model which might be used to understand the dynamics caused by growing
institutionalizations.
81
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