Istanbul, one of the cities where the first Christian hospitals were established in the 4th century, became a center where all developments regarding health issues occurred since it was the capital during the Byzantine and Ottoman eras. St. Sampson Hospital, built in the 6th century, and Pantokrator Hospital, which opened in the 11th century, are of great importance in the global history of hospitals. With plague epidemics, greater attention was paid to Constantinople because it was the center of the Justinian Plague. The Zotikos Leprosarium in the Byzantine era and the Üsküdar Leprosarium (1514) in the Ottoman era have great significance both in the history of the city and the history of leprosy worldwide.
During the Ottoman period, all health practices started and developed in Istanbul. The headquarters for sanitation, the office of the chief physician, was located in Topkapı Palace. The central health organizations, which later became the Ministry of Health, and the first municipal health organization were established in Istanbul. The history of the military hospitals, civil hospitals, and pharmacies also started there. The center of quarantine management, which aimed to protect the country from epidemic diseases, was also located in Istanbul. Efforts to control epidemics and contagious diseases that emerged in the rest of the empire were managed from Istanbul. The cosmopolitan feel of the city was also reflected in the health facilities; many countries opened hospitals for their citizens living in Istanbul.
Training in medicine, pharmacy, dentistry, nursing, and midwifery started in Istanbul. Medical training originated in the first Byzantine university, which opened in 425. The Byzantine hospitals, as well as the Fatih Hospital and the Süleymaniye Medical Madrasa and Hospital, grew over centuries. The Tıphane-i Âmire, which opened in 1827, became the Istanbul Medical Faculty without any interruption in its educational program, even though it went through changes over time. All the physicians in Turkey were educated in Istanbul until the first graduates of the Ankara University Medical Faculty in the 1950s. Today, Istanbul still has most medical faculties in Turkey. Over the centuries, municipal health services, contagious diseases, doctors, herbalists, chemists, and pharmacies have all affected Istanbul residents’ health.
A. HEALTH IN BYZANTINE İSTANBUL
Constantinople became the capital city of the Eastern Roman Empire (Byzantium) on the orders of Constantine I (306–337). When the emperor converted to Christianity, not only did the city undergo improvements in health service, but it also played a great role in the spread of Christianity. Later, when the emperor closed all the temples in which pagans had worshipped statues of Asklepios, god of medicine, people suffering from ill health went to the churches and appealed to saints and to Jesus Christ. After this, as in all aspects of life, health services came under the administration of the church. Some of the saints were physicians, known as the Anargyroi. Iustinianos II (565–578) had two churches built for the brothers Cosmos and Damianos, who were considered Anargyroi saints; these were in Gedikpaşa and Eyüp. Churches were later built for Lucas in Altımermer and the Nikomedian Panteleimon in Constantinople. Byzantine monks practiced various vocations including that of physician. From time to time, monks were banned from practicing medicine outside the monastery. Monasteries often maintained both outpatient and inpatient treatment facilities, with patients recovering in monastery guest rooms. The Myrelaion, which was later converted into the Bodrum/Mesih Paşa Mosque near Laleli, and St. Georgios monastery in Sarayburnu-Mangan had priest practitioners. Medicinal herbs, which gained in importance during this period, were grown in the monastery gardens. Books designed for public use in the treatment of ailments, known as iatrosofia, recommended cures that used grapes, quince, pomegranate, prickly thistle, sesame, almonds, parsley, dill, onions, and garlic. The books also contained incantations and magic formulas. The belief that evil spirits were responsible for the spread of disease resulted in the use of amulets. Aleksandros of the Tralles (Aydın) recommended wearing medals and rings covered with holy runes and shapes to protect against illness. In spite of objections from the church, these charms were very popular.
With a new regulation in 370, doctors were separated into different groups: palladios, iatrosofistes, and arkhiatros. The arkhiatros tes poleos, or municipal doctors, were chosen by the village council. Their number was seven. Doctors traveled throughout the Byzantine cities and were granted special rights, such as exemption from military service and taxes. According to the laws of justinian, although midwives, known as iatromaiai or iatrinai, had the same standing as doctors, they were paid significantly less. Under the laws of Justinian, poor people received free medical care.
I- Diseases and Treatments
Common diseases in the early Byzantine era included gout, rheumatism, fever, malnourishment, epilepsy, vision problems, mental disorders, leprosy, and plague. Gout, caused by excessive consumption of red meat and alcohol, was common in the upper classes. When he ascended the throne, Emperor Constantine IX (1042–1055) was suffering from gout; during his reign, he became bedridden with swollen knees and bent fingers. Widespread gout resulted in more attention to the relationship between food and disease, and charts were prepared to regulate food consumption, with advice that varied according to the season and bathing and sexual activities. Michael VIII Plaiologos (1261–1282) ordered Demetrios Pepagomenos, a well-known doctor, to write a book on gout, which was titled Syntagma peri tes podagras. At about the same time, Ioannes Humnos gave advice on preventing gout through nutrition in his book Diaita prophylaktike eis podagras. Spas were renowned for being beneficial for certain diseases. The Pythia (Yalova) spas were highly popular in the 4th and 5th centuries. In 529, the wife of Justinian I (527–565), Theodora, went to the Yalova spas with a group of 4,000 people.
Sacred springs (ayazmalar), dedicated to the memory of the baptism of Jesus Christ, played a significant role in health during the Byzantine era. According to Orthodox belief, drinking or bathing in holy water helped people to recover from despair and disease. Sacred springs, generally located inside or next to a church, were named after saints. Each had a special feast day on which people who sought healing went to the spring, prayed, drank the water, and applied it to the parts of their bodies that suffered from an illness, or simply washed their hands and faces in the water. Elderly and sick people who could not leave their homes had the water brought to them in small bottles. Visits to the sacred springs were not restricted to feast days but took place whenever there was a need. Muslims also adopted this ritual. More than 150 sacred springs have been identified in Istanbul. The water of different springs is believed to heal different illnesses. The most famous of the sacred springs in Istanbul, and the most prominent in terms of health benefits, was Balıklı Ayazma or Zoodikhos Pigi Ayazması in Yedikule. It is especially popular with those who suffer from paralysis. The patients would drink the water, bathe, and sometimes lie in the sacred spring until morning. A priest would pray for those suffering from mental disorders or have them drink water that had been blessed. Women who suffered from breast and lactation problems would visit the spring near St. Demetrios (Kuruçeşme) Church because the walls, eroded by water, contained bulges or bumps that resembled a woman’s breast. Patients would drink the spring water and kiss the bumps three times. Children who were unable to speak were bathed with the spring water and were considered to be healed afterward.
St. Panteleimon in Çengelköy was frequently visited by people with mental or neurological illness, paralysis, or rheumatism. St. Paraskevi sacred springs in Büyükdere, Arnavutköy, Çatmamesçit, and Yeniköy shared the same healing qualities for people with ophthalmic diseases. St. Therapon in Sirkeci was popular with those who were mute, blind, or depressed. People with malaria visited St. Menas sacred spring in Bebek wearing an old shirt and would dispose of it after bathing with the blessed water. The Analipsis sacred spring in Samatya was famous for healing all types of illnesses; St. Antonios in Galata for treating headaches, mental and spiritual diseases, and rheumatism; Agii Apostoloi in Bebek for indigestion; and St. Haralambos in Fener for ophthalmic diseases. St. Kiriaki in Arnavutköy was visited for rheumatism, skin diseases, and headaches; St. Marina in Tarabya for skin diseases; and St. Menas in Samatya and St. Nikolas in Kasımpaşa for skin, stomach, and bowel diseases. Patients who visited these sacred springs and were healed put talismans in the trees; for example, those suffering from ophthalmic diseases put up a silver talisman in the shape of eye; those who conceived after the visit would put up a silver baby figure; those with broken limbs would put up silver arm or leg. Over time, many of these sacred springs either dried up or were swallowed by construction, but some of them are still visited today.
A carved stone in the tunnels south of Hagia Sophia, believed to be the cradle of Jesus Christ, is another example of the hopes for miraculous healing. Mothers whose newborn children were ill believed that their children would get better when they placed them in this cradle.
Plague and leprosy, the two most prominent epidemic diseases of the Middle Ages, were widespread in Istanbul. The first large-scale plague epidemic that occurred in Istanbul was known as the Justinian Plague, as its timing coincided with the reign of the Roman emperor Justinian I. This epidemic, which started in September 541 in Alexandria, reached Istanbul in April 542 and lasted for many years. It spread from the center of Africa to the Mediterranean and Anatolia, growing stronger and then spreading from Arabia to Europe, including Denmark and Ireland, becoming a pandemic. The plague first reached Constantinople, a city with a population of 600,000 at the time, via a ship carrying grain from Egypt. Although the Byzantine historian Prokopios claimed that 10,000 people died every day from plague at its peak, this remains unproven. The only fact that is certain is that there was no place left to bury the bodies and they were left to rot, stacked one on top of another in boats that were set afloat to drift at the mercy of the wind and waves. The epidemic destroyed 40 percent of the city population, taking 240,000 lives. Despite the suggestion that residents marry young and have more children to compensate for the population loss, as the plague returned from time to time, this solution was not successful.
One of the greatest epidemics of the Byzantine era occurred during the reign of Emperor Michael VII (1071–1078). Nikephoros III (1078–1081), who rebelled and set out to establish his own empire, attacked Istanbul with the support of Suleyman Shah, the founder of the Seljuk state. During the four months of the siege, 160,000 people lost their lives in the plague epidemic following the great poverty caused by the siege. Sources agree that this disease, known as the Black Death, which dominated the world between 1346 and 1351, had traveled from the Crimea to Istanbul. Emperor Ioannes VI (1347–1354) lost his youngest son, Andronikos, to this epidemic, in which 25,000,000 lives were lost, presumably about one-third of the European population. The plague epidemics that took place between 1416/1417 and 1447/1448 also caused damage in Istanbul, and the bodies that were not buried were thrown into the sea. The Ottoman prince Kasım Çelebi, who was in Istanbul at the time, also died from plague. During the 1421 epidemic, Emperor Manuel II (1391–1425) sought refuge from the plague in a monastery. A few years prior to the conquest, the epidemic that started in 1448 and took many lives also took the life of the emperor’s second son. Evliya Çelebi stated that before the conquest those who came to Istanbul from areas with plague were not allowed into the city until they had been in quarantine in Yedikule for seven days. For this reason, this area was referred to as the nazarete (observation location).
Several leprosaria were built in the Byzantine era. In the 6th century Emperor Justinian had a leprosarium built near Yuşa (Jashua) Hill; this was known as St. Panteleimon Leprosarium. In the Middle Ages, it was believed that, with the deception of Satan, leprosy could spread like the plague. Stories of the lives of the saints in the Byzantine era mentioned leprosy. Emperor Justinian II (565–578) and his wife Sophia set aside a large allowance each year for the leprosaria. Emperor Mavrikios (582–602) had the leprosarium that was destroyed during the Avar attacks rebuilt with a stone dome in 596. This building was damaged during an attack by the Slavs on Constantinople and was rebuilt by Heraclius I (610–641) in 624. Later, Emperor Ioannes I (969–976) had the building restored and expanded. A Russian pilgrim who visited Constantinople two years before the Latin invasion wrote that the Zotikos leprosarium and church were located on a mountain. The documentary record indicates that this leprosarium was in use from the end of the 4th century until the end of the 11th century. Semavi Eyice thought that the Zotikos leprosarium was situated on a hill overlooking the Golden Horn near Hasköy. The Pantokrator Hospital also had a leprosarium.
The first Christian hospitals were established in Urfa (Edessa), Kayseri (Kaisareia), Sivas (Sebasteia), and Constantinople in the 4th century. The first religious hospitals in Istanbul were more like almshouses; but over time, they became more like modern hospitals. The record indicates that the first hospital in France opened in the 6th century, and the first Islamic hospital was opened in 707 by the Ummayad caliph al-Walid. It has been argued that the concept of a modern hospital developed out of the Byzantine hospitals in Istanbul. For this reason, the first Christian hospitals in Istanbul are believed to have a significant place in the history of hospitals around the world.
After Constantine I had the asclepions (healing temple) closed down, his mother, Helena, who was later declared a saint, founded a hospital in the city. In a letter to the Galata abbot Arsakios, the emperor demanded the establishment of a xenodochium in every city, to be funded by public revenues. A xenodochium or xenon was the general name for all social aid foundations, including hospitals, nursing homes, almshouses, orphanages, and leprosaria. Later, the construction of larger complexes for the ill and needy began. The complexes built in Istanbul contained a nosokomeion (hospital for patients), brefotrofion (foundling nursery), orfanotrofion (orphanage), ptokhokomeion (almshouse), and gerontokomeion (home for the elderly).
A number of xenons opened in Istanbul between 400 and 600. Empress Irene had another hospital built toward the end of the 8th century. Inspired by her example, Emperor Teophilos (829–842) ordered a hospital to be built in which patients could benefit from the fresh air carried by the breeze and enjoy the beautiful view of the Bosphorus. He believed that the improvement of the city walls and the foundation of this hospital were his greatest contributions to the people of Constantinople. After that time, building hospitals became one of the leading services offered by emperors. By the 11th century, there were 35 hospitals in Istanbul. Isaakios II (1185–1195) ordered a new hospital built on Mese (Divanyolu) Street near the Tessares Martyrs (40 Şehit) Church; the hospital was named after the church. Emperor Aleksios himself made use of the Mangana Xenon located on the Historic Peninsula (Sarayburnu).
Michael VIII is considered to be the emperor who returned the city to its former splendor; he had the city walls and churches repaired and opened new hospitals. By 1284 the emperor’s wife, Theodora, had expanded the Lips Monastery and attached a hospital to it. The hospital’s endowment deeds indicate that it had a 15-bed capacity and a doctor visited once a week. It is likely that nuns took care of the patients. After the conquest of Istanbul, Mollah Fenarizade Ali converted the Lips Monastery Church into a mosque.
As the Byzantine hospitals were properties of the church, they were also overseen by priests. The priests managed their financial resources and legal and administrative affairs with a clerical management staff. In the hospitals, for the most part, it was the iatroi (practitioner doctors) who worked. The head doctors who worked under the city administration would pay daily visits to the city hospitals (arkhiatroi). By the 10th century the doctors’ standing in the hospital management became stronger. After this time, it was doctors that decided the admission of patients to the hospital as well as their release dates.
St. Sampson Xenon
Sources agree that St. Sampson Xenon was the most famous hospital in Istanbul. Believed to have been located opposite Hagia Sophia and north of Hagia Irene Church, it functioned as both a hospital and an accommodation. According to Prokopios, Sampson (d. 530) was a doctor who, as a means of serving God, took care of the poor, the sick, and homeless strangers in his house near Hagia Sophia. When he treated Justinian I (527–565), the emperor expanded the doctor’s house and named the building after him. The house was destroyed, like the rest of the buildings in the city, during the Nicaea Riots (11–19 January 532), but it was repaired with funding from the emperor. The 6th century Biography of St. Artemios mentions an operation that took place in the eye clinic of this well-organized hospital. The deacon Stefanos of the Hagia Sophia, who suffered from a condition in his groin that never healed, was brought to the Sampson Xenon by his family and laid on a bed next to the ophthalmology unit. After three days of cold cauterization treatment, he underwent an operation that healed him. This anecdote shows that in the 7th century there were surgeons and that there was an ophthalmology department in the hospital. For this reason, it is believed that St. Sampson Xenon was designed as a real hospital rather than a social aid foundation. Between the 8th and 9th centuries there were three seals belonging to this hospital. St. Sampson Xenon was captured by St. Jean Knight during the Latin invasion in 1204.
Dr. Aleksandros G. Paspatis (1814–1891), a 19th century traveler, stated that St. Sampson Xenon collapsed along with other buildings during the fortification of the large city walls, carried out during the reign of Michael VIII, the founder of the Palaiologos Empire. However, Byzantine-era historical topography specialist P. Raymond Janin (1882–1972) argued that the hospital survived until the beginning of the 15th century and that it was probably buried under Soğukçeşme Street. In a Hünernâme of 1584, this site was identified as a lumber yard. Evliya Çelebi also described the lumber yard of the Matbah-ı Âmire as being in the same vicinity. In fact, the weights for the scales that were depicted in the Hünernâme, which were used to weigh the massive logs, were found next to Hagia Irene during the 2009 restoration. The ruins found next to Hagia Irene are also thought to be the remains of St. Sampson Xenon.
This xenon was affiliated with Pantokrator Monastery, which was established between 1118 and 1136 by Emperor Ioannes II’s (1118–1143) wife, Irene, near the Twelve Saints Church. In addition to the hospital outside the walls of the monastery, there was a leprosarium that was separate from the main complex. According to the original endowment, prepared in 1136 (and discovered in 1902), the hospital had five sections with a 50- to 55-bed capacity and a section reserved for patients with epilepsy. Residents of the monastery were treated in a different dispensary. The surgery section where wounds and broken limbs were treated had 10 beds. Another section, containing eight beds, was reserved for those suffering from acute illnesses and severely ill, bedridden patients. The other two sections contained 10 beds each and were reserved for chronic illnesses. The section for gynecological diseases had 12 beds. Each section held an extra bed. There were six beds with holes in the middle that were reserved for either severely wounded patients or hopeless cases. The belongings of the patients who were treated in the beds were washed, stored, and returned when the patient left. Poor patients were given extra clothes when they were discharged. Patients who were in pain or who screamed were taken into the emergency section to prevent the disturbance of other patients. There was a cemetery, two churches, and a hot bath for patients; patients were bathed twice a week.
There were daily visits and clinical examinations and, if the need arose, doctors would perform house calls to examine patients. First, an assistant would go and check up on patients outside the hospital and a doctor would be sent if the assistant’s report indicated this was necessary. There were two doctors, five assistants, and two attendants working in each section of the hospital, except the gynecological section, where there were two doctors, six assistants, one midwife, and two maids. The administrator of the Pantokrator was chosen from among the doctors, and the hospital was run by two head physicians. The head physicians visited the polyclinic daily and ordered patients to be moved to the hospital when necessary.
There was a medical school adjacent to the hospital and a nursing home with a 24-bed capacity. When someone in the nursing home fell ill, the priest would send for a doctor, and if necessary, the patient would be moved to the hospital after an examination. Doctors were banned from taking gratuities from patients at the Pantokrator Xenon. Emperor Julianus Augustus (361–363) enacted a law forbidding gratuities because he wanted doctors to serve poor patients in an honorable manner instead of serving only people who could afford to pay tips. With this law, the doctors were allowed to accept donations from people who were healthy, but were banned from promising to save the lives of patients who were at a risk of dying. When wealthier people (those who could afford tips) started using hospitals for their treatment, the hospitals’ social status and public respect improved.
Professors, who earned the most among the doctors at the hospital, were responsible for teaching younger doctors and improving their theoretical and practical medical knowledge. Patients in the obstetrics section were treated by a woman, the only female staff member at the hospital. She and the hernia doctor earned the lowest salaries at the hospital. Two head physicians, two senior physicians, two surgeons, six graduate doctors, and six trainee doctors served in a strict hierarchy. There were also doctors who specialized in nutrition. Doctors who worked at the hospital were exempt from military service. The doctors working in the hospital who had the lowest status were the obstetricians and gynecologists. Young doctors called perissoi, who worked in the polyclinics and were not part of the hospital staff, had even lower status. The hospital was also served by one chief pharmacist and five pharmacists and assistants.
The doctors lived in the city and visited the hospital every evening to examine patients and prescribe treatments and medications. Doctors were divided into two groups, one working in the hospital and one treating private patients, that switched places every six months. While working at the hospital, doctors earned a salary nearly as low as that of a clerk, but the prestige they derived from their hospital work allowed them to set higher fees in their private practice. This system was in place at the Hristodotes Xenon and likely at other hospitals in Constantinople.
There were two separate teams for patient care and hospital services. The care team consisted of 34 people and included both graduate and trainee caregivers. There was a night watch on duty in each ward. Each service team was on duty every other day; team members served meals twice a day, bathed patients at the hot baths, and cleaned the hospital wards twice a month. A tool sharpener was responsible for the care and cleanliness of the surgery equipment as well as for bleeding patients. Only three of the 11 people working on the service team were women. Six people worked in the hospital pharmacy: a pharmacist, who earned a little more than a female doctor, managed three graduates and two trainee pharmacists, and may have enrolled in their training too. The medical herbs used to treat patients were collected and left to dry in May.
It is clear that the hospital operated until the Latin invasion. The Pantokrator Monastery was converted to a mosque after the conquest of Istanbul until the Fatih Külliye was built. This structure is still in use as the Zeyrek Mosque today. The building that is believed to have been the library of the Pantokrator Monastery was converted to the Sheikh Süleyman Masjid.
B. MEDICINE AND HEALTH AFTER THE CONQUEST
I-Municipal Health Services
The qadi of Istanbul was considered the highest ranking official of the city; he served as governor, judge, and head of the municipality of the capital city from the conquest until the Tanzimat era, carrying out the tasks of ihtisab ağaları (city police inspectors) along with providing municipal services. After 1826, headed by the ihtisab nazır (minister of inspection), the qadi organization assisted in law enforcement and was responsible for keeping order in the markets and the entrances and exits to the city and the collection of some taxes. The organization was responsible for the cleanliness and quality of goods sold by the tradesmen. Bakeries, restaurants, and kebab shops were inspected. The çöplük subaşı (superintendent of garbage collection), who worked under the subaşı and was affiliated with the qadi, was responsible for the cleanliness of the streets. The çöplük subaşı collected waste from both houses and streets, along with animal droppings collected by tradesmen known as arayıcı (searchers), and were in charge of cleaning the streets. Collected waste was dumped directly into the sea, without consideration for pollution. The annual cleaning of the Hippodrome and the fortnightly cleaning of Beyazıt Square were also among the responsibilities of the çöplük subaşı. When the janissaries were abolished, the post of cöplük subaşı was also brought to an end; the work of cleaning Istanbul was first assigned to the İhtisab Nezareti (Ministry for Municipal Officials) and later to the şehremaneti (mayor’s office). After their founding, the Sıhhiye Meclisi (Health Council) and Karantina Meclisi (Quarantine Council) began to introduce precautions in the tanneries and slaughterhouses, which were thought to be possible starting points of illnesses.
The first cholera epidemic in Istanbul in 1831 drew attention to the need for cleanliness in the streets and the environment. Bad air was believed to be the cause of the disease. When a second cholera epidemic broke out in 1848, an imperial decree was issued that the streets should be kept clean, waste should not be left in the open, sheep should not be butchered at the butcher shops, and no skin, tripe, or intestines should be hung in the shops. With new outbreaks of cholera in some areas of Istanbul in November 1852, the Sıhhiye Meclisi suggested that as bad air was the cause of disease, the rules of general health should be applied everywhere, including cleaning between the streets and market places and getting rid of standing water. Following this, the Zaptiye Nezareti (Ministry of Police) wanted imams to be forewarned and to control cleanliness at all times; in addition, they were to make announcements about the situation to their congregations. In February 1854, it was discovered that the bachelor rooms in Davutpaşa were being used for tanning pelts and that the residents of Fener allowed piles of rubbish to accumulate; the minister for quarantine stated that such acts violated rules that were in place to protect against disease and therefore should be stopped. Although the frequency of cholera outbreaks diminished, the minutes of the Sıhhiye Meclisi for 12 October 1854, advocated the removal of the rubbish, which might have caused cholera by contaminating the air, and ordered the cleanup of the mecra-ı kebir (main sewer) that passed through the Demirkapı district, which had become blocked when it reached the coast, causing sewage to leak into the streets.
Altıncı Daire-i Belediye (Beyoğlu Municipality) was the first municipality to be established in Istanbul. Its service area included places with dense populations of foreigners and places in which foreign embassies were located, including parts of Beyoğlu, Galata, and Tophane. The responsibilities of the Beyoğlu Municipality were published in the Nizâm-ı Umumî (General Regulations) dated 7 June 1858. The Sokaklara Dair Nizamnâme (Regulations Concerning the Streets), which addressed the management and cleaning of streets, was published on 20 April 1859. Clauses 5 and 6 of this law divided the streets of the Beyoğlu Municipality into three classes. The first-class streets were to be swept once a day in winter and twice in summer, the second-class streets once a day, and the third-class streets once a week. House and shop owners had to wait to put out garbage for a regularly scheduled pickup by cart, horse, or donkey (clause 7). It was forbidden to leave trash piles in the streets or to pour water from a building into the street. Failure to obey the warnings to keep the streets clean was punishable by fine (clause 11). These regulations were not always observed, and yet it was underlined that cleanliness was part of the health regulations and thus everyone was required to pay more attention to sanitation.
For 11 years, the Beyoğlu Municipality was the only municipality in the capital. With the Dersaadet İdare-i Belediyye Nizamnâmesi (Regulation on the Administration of City Councils), which went into operation in 1868, 14 municipal departments were established in Istanbul. The Dersaadet Belediye Kanunu (Municipality Law), passed in 1877, increased the number of municipal departments to 20 and listed the preservation of public health, in collaboration with the Sıhhiye Nezareti (Health Ministry), among the duties of the municipality (clause 3). The fourth clause of this law stated that one member of the Municipal Council was to be a physician; this post was filled until the Meşrutiyet, for many years, by the bahriye heyet-i sıhhiye reisi (naval chief of health), Dr. Hüsnü Pasha. The doctor of the Municipal Council (Belediye Meclisi) was known as the sertabib (chief physician) and had a vote on health treatments in the municipality and monitored whether the medications provided by the municipality department for the poor were appropriate. However, the sertabip was not the head physician in the municipality departments.
The Founding of Municipal Medicine
The founding of the municipal medical office (belediye hekimliği) in Istanbul started with the İdare-i Umumiyye-i Tıbbiyye Nizamnâmesi (Regulation on Public Medical Administration), enacted on 21 July 1871. The first and second clauses of this regulation declared that the şehremaneti in Istanbul and governors in the provinces would discuss with the Umur-ı Tıbbiye-i Mülkiye Nezareti (Ministry of Civil Health)1 the appointment of public doctors to designated regions, the assignment of assistant physicians, if needed, the opening of pharmacies by Istanbul and provincial municipalities, and the payment of the salaries of these doctors and their assistants by the municipalities in which they worked. With a rise in smallpox in Istanbul by 1888, the Istanbul Şehremaneti Council suggested that municipalities assign 10 doctors to carry out vaccinations instead of having the doctors or surgeons on duty at the pharmacies or the vaccinators at the Mekteb-i Tıbbiye-i Şâhâne (Medical School) or health inspectors fulfill this task. Thus, municipal doctors were immediately assigned to 10 municipalities. They were responsible for examining patients at the on-call pharmacies twice a week without charge. At this time, there were five on-call pharmacies, affiliated with the Cemiyet-i Tıbbiye-i Mülkiye and working under the auspices of the Mekteb-i Tıbbiye-i Şâhâne in Istanbul. Later, through the Ministry of the Interior, on 15 August 1891, each municipality center was assigned a doctor in addition to the doctors who were at the pharmacies. Only the Birinci Daire-i Belediye center had two doctors. This meant that by 1891 there were 11 municipal doctors working at the 10 municipal centers. During the 1893 cholera epidemic in Istanbul, doctors were assigned to the municipalities and on-call pharmacies to take care of cholera patients. After the epidemic, poor patients were treated by municipal doctors at no charge, based on the ruling of 26 August 1895, and thereby the position of municipal doctor became official.
The first municipal doctors were responsible for visiting public venues such as mosques, masjids, tekkes, madrasas, schools, churches, imaret (soup kitchens), and inns. On these visits, if they encountered anyone who was ill, they sent them to the hospital appropriate to their nationality. They also inspected the food and drink provided in these places, reported any harmful substances to the municipal authorities, and had them dumped into the sea. They checked whether copper pots in restaurants and food and tripe shops were properly tin-plated, and if not, they ordered them to be re-plated immediately. They also sought to ensure that public venues that could be harmful to the environment—specifically toilets, slaughterhouses, and tanneries—were disinfected and kept clean. They treated the poor without charge and provided them free medications. Lastly, depending on the size of the municipality, they were expected to choose one or more central pharmacies.
The Şehremaneti Hıfzıssıhha-i Umumiye Commission
On the suggestion of Dr. André Chantemesse (1851–1919) of the Pasteur Institute, who visited the city during the 1893 cholera epidemic, the Hıfzıssıhha-i Umumiye (Public Health Commission) and the Heyet-i Sıhhiye (Health Commission) held a meeting in the şehremaneti; the şehremini was chairman and the meeting was run by the Heyât-ı Sıhhiye Müfettiş-i Umumiliği (General Inspectorate of the Public Health Commission). The result was that a heyet-i sıhhiye (health commission) was established in each municipality. The responsibilities of the first health commissions established in Istanbul in Üsküdar, Beyoğlu, and Beşiktaş were determined with a bylaw under which the doctors appointed to the health commissions were to reside at the predetermined pharmacies and to work under the Hıfzıssıhha-i Umumiye Komisyonu (Commission of Public Health). These doctors were to send cholera patients to designated hospitals, with the permission of the patients or their families or acquaintances, and to have their houses disinfected. If patients refused to go to the cholera hospital, the commission would ensure that they could be treated in their homes. The deputy chairman of the Teftiş-i Umur-ı Sıhhiye-i İnsaniye Komisyonu (General Human Health Inspection Commission), Ömer Paşa, was made the inspector of the health commissions and municipal doctors.
The Hıfzısıhha-i Umumiye Komisyonu, which was the core of the Istanbul municipal health organization, determined the steps to be taken during this epidemic and potential future ones. All doctors in Istanbul were required to report patients who showed cholera symptoms to the relevant municipal doctors; those who failed to do so would be held responsible by the government. Dr. Chantemesse, who was also a member of the first Hıfzıssıhha-i Umumiye, worked on distinguishing cholera patients from others and addressing problems related to quarantines. Once the epidemic was over, Abdulhamid II ordered the establishment of a permanent commission to inspect and control public health in the city. Subsequently, the Hıfzıssıhha-i Umumi Merkez Heyeti (Central Commission for Public Health) was established. This commission, headed by the şehremini Rıdvan Pasha, was responsible for maintaining sanitation in Istanbul and its vicinity and taking any necessary precautions to preserve public health. The commission met every day, except for Fridays and Sundays, to consider all health-related issues faced by the municipality departments. It was assigned the tasks of keeping the public healthy and preventing the spread of contagious diseases and searching for their causes. The health commissions included a number of military and civilian doctors, headed by a chief physician; the number of members varied depending on the size of the municipality to which they were attached. Among their main tasks were to examine and treat patients, provide death certificates, and ban activities that were detrimental to health. Inspectors were designated to oversee the work of these commissions. Five additional sanitary inspectors were to travel through the city, inspecting the health offices and health commissions and reporting to the general inspection office. Two more officials working in the municipality observed the health issues in the dams and in Kağıthane and surrounding areas.
Before the Meşrutiyet, there was a chief and 16 members of the Hıfzıssıhha Heyeti; altogether there were nine sanitary commission inspectors, one general inspector, and 81 doctors working at the Istanbul Municipality. With the additional 11 doctors who were paid by the municipality and the obstetricians and gynecologists who were gradually appointed after 1907, the number of health workers totaled 100. Following the declaration of the Meşrutiyet, in line with the minutes from 29 August 1908 of the Meclis-i Vükelâ (Grand Assembly), the Hıfzıssıhha Heyeti was abolished; the reasons for this step were its large number of members and high cost.
Şehremaneti İdare-i Sıhhiyesi
Following the declaration of the Meşrutiyet, the Şehremaneti Hıfzıssıhha-i Umumi Komisyonu was abolished and the Şehremaneti İdare-i Sıhhiye (Municipal Health Administration) was established in 1909. The doctors working under the Şehremaneti İdare-i Sıhhiye Şubesi in 20 different municipality departments in Istanbul were responsible for health care and public health in the city. A health commission was formed in which issues were discussed and decisions were made when necessary. This unit, known as the Municipal Health Directorate (Şehremaneti Sıhhiye Müdüriyeti), was to review all public health–related cases, manage all hospitals, almshouses, and asylums affiliated with the municipality, and inspect pharmacies and pharmacy stocks in the city. This unit worked directly under the şehremin (city mayor). The health officials at the şehremaneti and in affiliated departments were associated with this unit, which itself was directly attached to the şehremin. The administration of the disinfection unit was transferred to the Müessesat-ı Hayriye-i Sıhhiye İdaresi (Health Charity Enterprise Administration) based on a decision by the Municipal Council on 11 April 1911.
Within this organization, 48 doctors worked in 20 municipality departments. In addition, there were eight obstetricians—two in the municipality departments on the Istanbul side, two in the Rumelian coast municipality departments along the Bosphorus, two in the Anatolian coast municipality departments, and one each in the municipalities of Kadıköy and the Princes’ Islands. The obstetricians visited the municipalities from time to time to examine patients and make deliveries. Depending on the population of each municipality, there were one or more doctors working in the municipality departments. Their responsibilities were to examine patients, secure public health, and prevent contagious diseases through all necessary measures including disinfections. These tasks were determined according to the Dersaadet Devâir-i Belediyye Hey’ât-ı Tıbbiyyesinin Vezâifine Dair Tâlimat (Instructions on Tasks of the Istanbul Municipal Health Commission) in 1910. This document required the municipal doctors to investigate deaths within their departments and issue death certificates. In case of a death from a contagious disease, they had to inform the closest disinfection unit and keep the room closed until it was disinfected. A school also had to be disinfected if a student who attended it died from a contagious disease. The municipal doctors had to inform the municipal police, the zabıta, if they found evidence or heard an accusation of violence or poison. They also had to examine poor patients for free, sending them to a hospital when necessary. In cases of diphtheria, it was necessary to gain the consent of the patient to use serum. If the patient refused consent, the doctor had to give a different treatment. Medication was provided by the municipal pharmacy for free. The doctors were also responsible for smallpox vaccinations. According to the Aşı Nizamnâmesi (Vaccination Regulation), municipal doctors had to stock smallpox vaccinations in their departments. Moreover, they had to perform certain analyses if there was an outbreak of a contagious disease, to take precautions, and to report it to the municipality department chief and the Şehremaneti İdare-i Sıhhiyesi immediately.
The municipal doctors also inspected hotels, inns, bachelor rooms, and houses within the municipal borders at least once a week; they were expected to eliminate any threats to health. They were to walk through the marketplaces and check the foods and drinks offered for sale as well as the observance of health regulations at the bakeries, restaurants, cook shops, coffeehouses, cafes, entertainment houses, taverns, barbers, groceries, and butcher shops, as well as the dairy, pig’s foot, and tripe shops. Cotton fluffers, duvet-makers, and sofa-makers were also inspected to see if they used bedding, cotton, or fleece wool that had been properly cleaned and stamped as such by the disinfection unit. The municipal doctors also had to make sure that all places open to the public, including public transportation, were properly disinfected. Rental houses were also required to be disinfected upon their vacancy, brothels and Turkish baths once a month. Spittoons were provided in public spaces so that mucus, a carrier of tuberculosis contagion, was not spit on the ground. Animals with rabies were killed, and individuals bitten by a rabid animal were to be sent to the daülkelb tedavihanesi (rabies treatment center) within eight days. The doctors inspected the slaughterhouses within their jurisdiction, required improvements when necessary, and did not permit to the opening of new slaughterhouses. They inspected bakers, butchers, grocers, barbers, dairy workers, restaurant workers, cooks, maids, and even wet nurses, providing an esnaf tezkere (tradesperson’s memorandum) verifying that they did not carry a contagious disease.
These regulations, established in 1909, ceased with the introduction of the new Dersaadet Teşkilat-ı Belediye (Istanbul Municipality Organization) Law in 1912. The Şehremaneti Sıhhiye Reisliği (Municipal Health Directorate) was established according to the fourth article of this law. The sanitary directorate contained six branches: public health, hospitals, almshouses, asylums, disinfection, laboratories, sexual disease examination and inspection, and a veterinary unit. The hıfzıssıhha-i umumiye (public health unit) was divided into three sections: Istanbul, Beyoğlu, and Üsküdar. Each municipality department had a head physician, a physician, local physicians, obstetricians, vaccinators, and sanitary security guards. The disinfection unit was run by the disinfection inspector, and the laboratory branch had chemistry and bacteriology laboratories. The center of the emraz-ı zühreviye (sexual disease unit) was the Beyoğlu municipality department.
The Şehremâneti Sıhhiye Müdüriyeti and the Memurîn-i Sıhhiyesinin Vezâifini Hâvi Tâlimatnâme spelled out the job descriptions of the sanitary chairman, sanitary commission, sanitary inspectors, municipal doctors, and sanitary security guards who worked for the municipal health organization. The müessesat-ı sıhhiye (health enterprise) inspector was responsible for inspecting all hospitals and health organizations and their staffs. Health institutions that included beds and were affiliated with the municipality were identified after the declaration of the Second Constitution as follows: Haseki Women’s Hospital (200 beds), Toptaşı Asylum (500), Şişli Ottoman Children’s Hospital (150), Beyoğlu Men’s Hospital (30), Beyoğlu Women’s Hospital (30), Almshouse (1500), Cerrahpaşa Hospital (100), and Serviburnu Quarantine Stations (80).
Since there was an increase in contagious diseases and occasional epidemic outbreaks during World War I, the şehremaneti rented four Turkish baths and had the poor bathed and cleaned there. The poor, who were examined by municipal doctors, were also provided with free medication. A new regulation was established regarding prescriptions in 1915. The following year, the Şûrâ-yı Devlet (Council of Ministers) decided that it was the responsibility of the şehremaneti to collect and transfer waste in carts, but the responsibility for transferring waste and offal from slaughterhouses lay with the slaughterhouse owners.
The Müessesat-ı Hayriye-i Sıhhiye İdaresi
Following the declaration of the Meşrutiyet, in an attempt to revise health care regulations, the Müessesat-ı Hayriye-i Sıhhiye İdaresi (Health Administration for Charitable Enterprises) was established in 1909; under this agency, health organizations affiliated with the municipality were allocated to a specialized committee. Similar to the assistance publique in France, the Müessesat-ı Hayriye-i Sıhhiye was the head organization for the hospitals for men, women, and children; asylums; maternity hospitals; poorhouses; leprosaria; orphanages; nurseries; men’s and women’s nursing homes; schools for the deaf, mute, and blind; institutes for children who suffered from mental disorders; municipal quarantine stations; temporary hospitals; and all other charities and benevolent funds. There was a chairman and an administrative council. The reason for the establishment of this organization was stated as “the establishment of civilian health and social-service organizations with the latest equipment in Istanbul, changing the present administrative authorities and providing new equipment and applying research and practices so that the alarmingly rapid spread of damaging contagious and epidemic diseases, such as tuberculosis, syphilis, and the like, can be halted.” One of the first actions of the administration was to print record-keeping forms, patient identity cards, and charts for recording vital signs, similar to those used in European hospitals, and distribute them to all affiliated foundations. In this way, the medical and administrative records of the health organizations were put in order. A new branch was established to order directly from Europe all the equipment and medicine needed by the organizations under the administration, and to correspond with foreign authorities about scientific and administrative issues.
When the number of cholera cases increased significantly in Istanbul in January 1911, four pavilions were built, each containing 24 beds; these were in Demirkapı, Nuhkuyusu, Şişli and Yenibahçe. When these pavilions proved insufficient, a new temporary cholera hospital was established inside the Demirkapı Gülhane gardens, using portable sheds imported from Europe. A central chemistry laboratory was established in 1910 to examine and analyze food, drink, and medicine used in the establishments affiliated with the administration. Haseki Women’s Hospital, Children’s Hospital, Toptaşı Asylum, Beyoğlu Men’s Hospital, Beyoğlu Women’s Hospital, and the Serviburnu quarantine stations were repaired, upgraded, and equipped with medical tools and equipment brought from France. Patient beds, duvets, blankets, bed sheets, patient clothes, and military equipment were also renewed. While cloaks and aprons were given to female caretakers, male caretakers were given work shirts, and cleaners were given uniforms. Patients with mental disorders were transferred to the Haseki Darüşşifa, which had been renovated and began operations as the Haseki Mecanin Müşahedehanesi (Mental Observatory).
The Takiyüddin Paşa Mansion in Cerrahpaşa, purchased by the şehremaneti during the 1893 cholera epidemic, was converted into a cholera hospital known as Cerrahpaşa Men’s Hospital on 23 July 1910. In 1912, the Müessesat-ı Hayriye-i Sıhhiye was abolished as an austerity measure. With the Dersaadet Teşkilat-ı Belediyesi Hakkındaki Muvakkat (Provisional Regulation on the Organization of Istanbul Municipality), one head office and nine administrative branches were opened on 30 January 1913.
II-Epidemic Diseases and Their Treatment
Many diseases threatened public health in Istanbul, such as plague, smallpox, tuberculosis, cholera, rabies, and the Spanish influenza. It is thought that hundreds of thousands of Istanbul residents lost their lives to plague between the 15th century and the mid-19th century. During a plague epidemic, which was considered a curse or punishment from God, life would almost stop; the rich would abandon the city, and the rest of the residents would be occupied by burying those that had died from the plague and praying that the epidemic would stop. Tradesmen, who faced the loss of their workforce and income, were granted a council tax exemption or discount. There was a general fear of catching smallpox, tuberculosis, or syphilis. After 1831, cholera replaced the plague, which had essentially died out; cholera reappeared in Istanbul at intervals throughout the century with varying severity. Influenza pandemics started in 1868, and the Spanish influenza pandemic created havoc around the world in 1918, taking thousands of lives.
Smallpox was one of the oldest diseases observed in Istanbul. Before there was a cure for this disease, vaccinations were the only option, and were frequently used in Anatolia; the same practice began to be used in Istanbul in 1676. Fluid from an abscess of a child with a mild case of smallpox would be kept in a walnut shell to dry out; it was then diluted with rose water and applied to scratches made with a needle on both arms by the vaccination nurses. This practice spread throughout Europe thanks to the wife of the British ambassador to Istanbul, Lady Mary Wortly Mantagu (1689–1762); it came to be known as the Turkish style of smallpox vaccination (variolation, inoculation).
Turkish-style smallpox vaccination lost its significance with the discovery of cowpox vaccination by Edward Jenner in 1796. The first Jenner-style vaccination in Istanbul was performed on 23 December 1800. When Şanizade Ataullah Efendi considered the difficulties in such vaccinations—including transportation, storage, and cost—he decided to try vaccinating people with pus taken from people who had been given the vaccine that he created from cows in the village of Ayazağa. However, due to his competitors’ acts, this practice did not yield an effective vaccination.
Because of the frequency of smallpox outbreaks in Istanbul, Mekteb-i Tıbbiye-i Şâhâne (aImperial mMedical Sschool), from its opening in 1839, was designated to carry out smallpox vaccinations. In the following year, the school produced smallpox vaccines and provided free vaccinations. Sultan Abdulmecid, who had smallpox scars on his face, closely monitored the smallpox epidemic that broke out in Istanbul in 1845. During this epidemic, 2,500 children were vaccinated in vaccination centers in Üsküdar, Beyazıt, and Eyüp and at the Gureba Hospital, which had been established by Bezmiâlem Valide Sultan but had not yet been used. Traveling physicians were also appointed to carry out vaccinations. People who lived along the Bosphorus were vaccinated by a doctor who traveled in a rowboat.
Following the smallpox epidemic that broke out in 1871 in Istanbul, a vaccination inspectorate was established in 1872. Hüseyin Remzi Bey (1839–1896), the zoology teacher at the Mekteb-i Tıbbiye-i Şâhâne, was made chairman. Between 1892 and 1919, the Telkihhane (Vaccination House), later known as the Telkih-i Cüderî Surgery, Telkihhane-i Şâhâne, or Telkihhane-i Osmanî, prepared 34,949,233 bottles of smallpox vaccine. During the War of Independence (1920–1922), it provided Anatolia with enough vaccine for 3,619,000 people through the Red Crescent. After sending a commission to inspect the Telkihhane in Istanbul, the Entente Allies bought 211,020 bottles of vaccine for their armies and immigrants (1917–1919). The foreign embassies and foreign hospitals in Istanbul also met their smallpox vaccine needs through the Telkihhane. In 1934, the Telkihhane became part of the Merkez Hıfzıssıhha Müessese (Central Health Corporation) in Ankara.
In 1880, G. Battista Violi, an Italian doctor, established a private smallpox vaccination clinic in Beyoğlu; there families could have their children vaccinated for a fee. Dr. Violi also gave vaccinations at the Beyoğlu Municipality vaccination center on specific days free of charge.
After the Ottoman–Russian war of 1877–1878, a significant increase in smallpox cases in Istanbul took many lives; the outbreaks were in 1881, 1887, 1890–1891, 1894, 1908–1909, and 1918. These outbreaks occurred in various quarters, but mostly in Rum (Orthodox Greek) neighborhoods. Rum families did not have their children vaccinated and did not inform the authorities when their children caught the disease. The first smallpox vaccination regulation, passed in 1885, forbade those who were not vaccinated from attending school or taking part in the civil service. Smallpox vaccination became compulsory during World War I in 1915. From then on smallpox appeared in scattered cases in Istanbul, though it increased after 1938. When smallpox, which was widespread in Syria and Iraq in 1942, was carried via Midyat to Turkey, small outbreaks arose first in Anatolia and then in Istanbul in the following year. Vaccination was strictly enforced. When, during World War II, bread rationing became necessary in Istanbul, people who had not been vaccinated were declared ineligible for ration cards. Eighteen families who did not inform the authorities that they carried the disease were sued. Occurrences of smallpox continued to decrease and came to a halt after 1945.
Tuberculosis has been known for centuries as a disease that gradually destroys people’s lives. In Turkish, it was known as the “elegant disease,” and even caused the death of sultans and other palace residents.
After Robert Koch announced the discovery of tuberculin as a method of treatment, Abdulhamid II sent a team of Mekteb-i Tıbbiye-i Şâhâne teachers to Berlin to learn more about it in 1890. The team started treatment trials using the tuberculin in the German Hospital in Istanbul as soon as they returned. However, within a short time it was decided that tuberculin should not be used as a treatment, but rather as a diagnostic tool. The first sanatorium, established in 1859 by a German doctor, Dr. Bremer, became a new hope for both doctors and tuberculosis patients; this method quickly spread throughout Germany, France, and Russia. Dr. Stchhépotiew, a Russian doctor in Istanbul, stated that the Princes’ Islands (Büyükada, Heybeli, Burgaz and Kınalı) would be a suitable place for a sanatorium. The first sanatorium in Turkey was built for children in 1904. This sanatorium, which was part of Hamidiye Children’s Hospital and had 24 beds, was added to the hospital complex at the request of Abdulhamid II, who also paid for the construction. This sanatorium faced south and was protected from the wind by a pine grove.
During the second Meşrutiyet, one of every six deaths in Istanbul was due to tuberculosis. Between 1915 and 1920, the number of tuberculosis deaths in Istanbul reached 11,694, compared to 1,034 deaths from all other contagious diseases in the same period. One of the reasons behind the spread of tuberculosis in Istanbul was the great fires. The war prevented construction of new houses, and those who lost their homes in the war had to seek refuge in unhygienic places, such as mosques, madrasas, inns, or humid cellars around which fires had occurred. When a lack of nutrition was added to these factors, the outcome was terrifying. Due to all these factors, the Veremle Mücadele Osmanlı Cemiyeti (Ottoman Association for Defense Against Tuberculosis) was established in Istanbul in 1918. The association tried to raise funds to combat the disease and to raise public awareness of it. The American Near East Relief (Şark-ı Karib Cemiyeti) opened a children’s sanatorium in Balıklı Rum Hospital in Yedikule on 1 July 1920; two of its restored pavilions could accommodate 60 beds for minority children with tuberculosis.
At the time of the declaration of the Republic, tuberculosis was widespread in large cities, particularly Istanbul. The first tuberculosis dispensary was established in 1923 by the Istanbul İl Özel İdaresi (Provincial Administration). Later, the Istanbul Verem Savaş Derneği (Tuberculosis Combat Association) opened dispensaries in poorer quarters of the city. The Heybeliada Sanatorium opened with 50 beds in 1924, and other sanatoriums followed. The Kemik ve Mafsal Veremi (Bone and Joints Tuberculosis) Hospital in Baltalimanı (opened in 1944), the Yedikule Tuberculosis Hospital (1949), the Koşuyolu Tuberculosis Hospital (1951), and the Haydarpaşa Tuberculosis Hospital (1953) offered new hope for patients. When this disease was brought under control, all these hospitals were converted into hospitals for the treatment of pulmonary disease.
The first cholera epidemic arrived in Istanbul by sea and spread across the empire; the second took 6,000 lives in 1831. Hekimbaşı (Head Physician) Mustafa Behçet Efendi (1774–1834) wrote the Kolera Risalesi (Treatise on Cholera) in 1831, outlining the symptoms of this previously unknown disease and recommending protective measures. This booklet was distributed by the state to civil and military officials and to neighborhood headmen (muhtar). During epidemics, police were stationed at the gates of hospitals in Istanbul to control entry and exit. The epidemic accelerated the establishment of a quarantine organization. The second cholera epidemic in Istanbul broke out in October 1847. This time, starting in Iran and spreading to the Arabian Peninsula, Britain, and France, it took on the nature of a pandemic. It spread from Caucasia to Erzurum and Trabzon and finally arrived in Istanbul, where it took the lives of 5,275 out of 9,237 sick residents. The third epidemic, spread through allied French soldiers in the Crimean War, took 3,500 lives. Not long after this, another pandemic, which had spread through Asia, Africa, Europe, and America, reached the Ottoman state. Cholera arrived again in Istanbul on a ship that anchored in Kasımpaşa Harbor on 28 June 1865; by 10 August, it had spread throughout the city. It lasted for more than 40 days, and 30,000 Istanbul residents lost their lives.
Under such terrifying circumstances, an anti-cholera compound prepared by Vincent Pêche, a palace chemist, had great success. During these years there were frequent fires in Istanbul. While the cholera epidemic was spreading at full speed, the Hoca Paşa fire served to nearly disinfect the entire city. While the daily death rate from cholera had been more than 1,000, it dropped to 100 after the fire, and to zero within a week. The following year, the Uluslararası İstanbul Sağlık Konferansı (International Istanbul Health Conference) was held at Galatasaray to discuss scientific quarantine and other precautions against cholera. Those who helped fight this epidemic, which became known as the Grand Cholera, were awarded the Medal of Cholera. The Kolera Nizamnâme (Cholera Regulations) prepared by the Karantina Meclisi in 1867 remained in effect for many years.
After another outbreak in Russia in 1870, cholera returned to Istanbul by ship and spread throughout the city, causing 15,000 deaths. Another outbreak in 1876 resulted in the loss of 7,000 lives in Istanbul. All the European countries, except the Ottoman state, Sweden, Switzerland, and Greece, were brought to their knees by a severe cholera epidemic in 1892. To prevent cholera reentering the country, incubators were placed in quarantine stations in the harbors. The buoys with incubators were used to disinfect the ships and their contents, even including the mail. However, even this was not able to prevent cholera from entering Istanbul again, this time via Hasköy on 25 August 1893, and spreading across the city. Some suspicious deaths occurred in Üsküdar, but because these were not as numerous as in earlier outbreaks, rumors spread that the disease was not cholera and that a false cholera alarm had been given as an excuse for Şehremin Rıdvan Pasha to receive greater funding from the government. Official announcements published in the newspapers that referred to cholera only as a suspected disease were mocked mercilessly. As the disease spread, Dr. Zühtü Nazif and Dr. Rıfat Hüsamettin, who was carrying out microbiotic research in Toptaşı Asylum, confirmed on 17 September 1893, at a temporary hospital established by the şehremaneti in Üsküdar, that the disease was indeed cholera. As the European newspapers kept reporting on the “suspicious disease,” the deputy inspector of French medical institutes, Dr. André Chantemesse of the Pasteur Institute, was invited to Istanbul.
Dr. Chantemesse arrived in Istanbul on 26 September 1893, and after a series of bacteriological tests, he confirmed that the disease was cholera. At his suggestion, a Tedabir-i Sıhhiye Komisyonu (Health Precautions Commission) was established by the şehremaneti to determine precautions to be taken during any future epidemic. In the meantime, Dr. J. Karlinski from Austria was asked to analyze the city drinking water. Each municipality department started a temporary cholera hospital. In a short time, three disinfection stations opened in Galata, Üsküdar, and Tophane. Places where cholera was observed as well as objects from those sites were disinfected. The streets were cleaned, and the selling of fresh vegetables and fruits and seafood such as mussels was banned. In his inspection trips throughout the city, Dr. Chantemesse determined that the city drinking water had been contaminated by sewage water from Belgrad, Kömürcü, and Bağçecik villages, all of which were close to the reservoirs. These villages were expropriated and cleared out, and a filter was attached to the Göksu Embankment. A total of 2,683 patients were treated in the temporary cholera hospitals during the epidemic, which came to an end in April 1894; 1,537 died and 1,146 recovered. The Istanbul Municipality reported the statistics of this epidemic, and from this time on, it kept annual statistics on health trends in the city. Due to this last epidemic, more attention was paid to municipal services and the number of doctors in different municipality departments in Istanbul was increased. One of the most significant developments from the epidemic was the introduction of bacteriology education with the establishment of the Bakteriyolojihane-i Şâhâne (Imperial Bacteriology Laboratory).
When, after the epidemic, a few cases of cholera appeared outside of Istanbul, Dr. Rudolf Emmerich (1852–1914) from Berlin was invited to Istanbul to help with treatment and improve prevention. After his investigation, he issued a report stating that there was no sewage system in Hasköy, Balat, or Ayvansaray, some foods were being sold in the open, and well water in Yeniköy was not potable. Despite occasional cleanups, Kasımpaşa Creek was another source of cholera, as wastewater from regions on higher ground flowed into it. Subsequently Kasımpaşa Spring was covered.
As long as the streets were not kept clean, proper sewerage was not established, and drinking water was not circulated hygienically, it was not possible to eradicate cholera from Istanbul. Cases of cholera appeared between 16 October 1907 and 27 January 1908; these originated from Russian pilgrims passing through Istanbul. The next outbreak began in Okmeydanı on 13 September 1910 in a military unit that was carrying out fall maneuvers. The disease continued to appear around Galata, Hasköy, and the vicinity; because of the lack of precautions and the soldiers who were there, it quickly spread across Istanbul. This outbreak lasted until 13 December 1911; of 1,319 people who fell ill, 784 died. After this epidemic, temporary cholera hospitals were established in the garden of the palace at Demirkapı, Gülhane Park, Nuhkuyusu, Şişli, and Yenibahçe. In addition, the Takiyüddin Paşa Mansion in Cerrahpaşa was rented and used as a temporary cholera hospital. This mansion was purchased once the epidemic was over and became a permanent hospital in 1910, known as the Cerrahpaşa Men’s Hospital.
The epidemic that started among the troops of the defeated army, which had retreated to Çatalca at the end of the Balkan wars, reached Istanbul as the soldiers, most of whom were carrying the disease, were sent to Istanbul in 1912. To control the immigrants as well as the soldiers who came flooding into the city due to the panic brought on by this defeat, large hotels, waterside residences (yalı) and a number of schools along the Bosphorus were converted into hospitals. All the mosques in Istanbul, in particular Hagia Sophia, Blue Mosque, and Şehzadebaşı Mosque, were closed to worship and used only for treating patients. There were over 500 deaths a day at Hagia Sophia Mosque. Although precautions were introduced to bring the epidemic under control, the soldiers who were ill brought the disease to Anatolia. Cholera incidence started to decrease globally after World War I, including in Istanbul. In 1970, paracholera (a disease resembling cholera but caused by a different pathogen) broke out in the Sağmalcılar neighborhood (which was called Bayrampaşa after the incident), but this was quickly brought under control.
The quarantine stations (tahaffuzhane) were locations where people entering Istanbul by land or sea from countries with an epidemic were held for a quarantine period. Those who were ill were not allowed into the country, while the rest were able to continue their journey once the quarantine period was over.
When the quarantine organization was first established, there was no place to use for quarantine in Istanbul. Those who came from the provinces were kept in quarantine in the old customs building in Galata, and a ship anchored at the coast would have rowboats filled with vegetables and fruits fumigated and disinfected. When the customs building could longer accommodate the number of arrivals, some of them were quarantined in tents in Fenerbahçe. Since the cavalry was outside Istanbul, parts of Kuleli Barracks, at the time unoccupied, were renovated and put into service in 1838; this was known as the Kuleli Quarantine Station. The waiting room of this quarantine station had separate sections for men and women, as well as an additional room used for fumigating the mail. The hospital had three wards, each of which contained eight rooms and two bathing cubicles. There was a fumigation room, a pharmacy, and a stove used for making medicine. When the cavalry returned to Istanbul in 1842, the quarantine station was transferred to Anadolukavağı and called the Kavak/Manastırağzı Quarantine Station. Ships coming from the Black Sea were examined at this station. It remained in service for many years, but was torn down after 1950.
The şehremaneti had the Beykoz-Kavak-Serviburnu Quarantine Stations built in 1845. Facing Tarabya on the other side of the Bosphorus this station was used only when a contagious disease arose in the city. Worried by the cholera outbreaks in Russia in 1891, the Quarantine Administration had four new sheds built. Even more sheds were added during disease outbreaks in Istanbul in 1901. A bacteriology laboratory was established inside the Serviburnu Quarantine Station during this epidemic. Abdulhamid II found that bacteriology tests carried out in the city during the outbreak were inaccurate and ordered them to be conducted in Serviburnu instead. By 1906, the Serviburnu Quarantine Station consisted of four small sheds and two larger ones placed 30 meters apart. In addition to the sheds, each of which had a 50-bed capacity, there were four more sheds that were used as a pharmacy, incubator, bacteriology laboratory, and Turkish bath; a place for washing corpses was also provided. The sheds were 2,000 meters from the coast, and there were no paths leading to the coast. The quarantine station became affiliated with the Müessesat-ı Hayriye-i Sıhhiye after the establishment of the Second Constitution. The quarantine station was repaired, new equipment was imported from France, and a new incubator was installed. The quarantine station became the sole hospital for treating infectious diseases in Istanbul. During the cholera epidemic that broke out in 1910 in Istanbul, patients with suspected or confirmed cholera were sent there. Out of 339 suspected cases, 220 were kept under observation for five months, and the rest were treated for cholera. This quarantine station was used as a military quarantine after it was handed over to the naval ministry in 1911.
Passengers who came from Anatolia by land were kept in the Tuzla Quarantine Station for 24 hours as a precaution; those who were healthy were permitted to continue into the city. During an epidemic, travelers from places affected by the disease were kept in quarantine for 5 or 10 days, depending on the situation. When army units were transferred from one post to another, many soldiers needed to be quarantined, and tents were set up around this area. A quarantine station consisting of six sheds was under police protection night and day. In 1894, a police station, a disinfection station with a large incubator, and two hospital sheds, one for women one for men, were added. People with an infectious disease were treated there. On 1 October 1894, 39 ships, one ferry, 33 crew members, and 189 passengers were given a pratika (transfer pass) at the Tuzla Quarantine Station. Because military troops were to be cordoned off, new sheds with a capacity for 2,000 people were built in Tuzla for the soldiers in November 1894; at this time, cholera was raging in Anatolia and Istanbul. There were separate hospitals for men and women and a number of sheds within the quarantine station. Immigrants who traveled to Istanbul after the Balkan Wars stayed in Tuzla. People who were part of the exchange (Mübadele) under the Lausanne Treaty poured into Istanbul after 30 January 1923; they were accommodated for a few days, during which they underwent a health examination. As of 2013, the Tuzla Quarantine Station becameis part of the Istanbul Technical University Marine Faculty.
Influenza was a familiar disease in Istanbul. It appeared as an epidemic as early as January 1843, with a widespread but mild impact. An influenza outbreak in 1868 was studied by Dr. J. Mahé, the French delegate on the Sanitation Council, who was also a professor at the Mekteb-i Tıbbiye-i Şâhâne Seririyat-ı Dâhiliye (Department of Internal Medicine). The 1889–1892 influenza epidemic reached Istanbul in December 1889. While this epidemic started out with mild cases, within a few months it grew worse, with many cases leading to pneumonia. By January 1890 the disease was widespread among children in Üsküdar. Since more severe forms of influenza had been rare until then, the outbreak was initially not taken seriously, and it spread and took many lives. All schools in Istanbul were temporarily shut down due to this epidemic. The disease, at that time known as paçavra hastalığı (rag illness), caused people to stay home or in bed. There were minor epidemics in 1892 and 1893 as well. Mavroyeni Pasha delivered six lectures about influenza, a disease that was raging through Europe, at Gülhane, addressing its history, etiology, pathology, symptoms, complications, diagnosis, and treatment. The lectures were published in the book Conférences Sur l’Imfluenza in 1892.
The authorities had a hard time when influenza occurred simultaneously with cholera, which was present in Istanbul from August 1893 to January 1894. The Eczane-i Hümayun (Imperial Pharmacy) purchased medication for cholera and influenza at a cost of 24,054 and 10,003 kuruş, respectively.
Influenza again spread throughout Istanbul in 1903 and 1904, but there was no loss of life, although it caused numerous deaths in Europe. As a result, all medical scientific centers were researching influenza.
The Spanish flu first appeared in Şişli, Istanbul, in July 1918. Under the harsh living conditions of the Armistice years, a significant increase was noted in diseases such as syphilis, gonorrhea, scabies, typhus, and plague, and an unknown disease emerged that spread across the city and came as a surprise to all. Described in the press as “a strange disease on a journey around the world,” the Spanish flu arrived in Istanbul with passengers traveling from Berlin and Vienna, having been on the Grand Tour; although people who caught this illness were bedridden for nearly two months, there were no deaths. The Spanish flu appeared around the Golden Horn, İstinye, Kurbağalıdere, and Kuşdili Springs in July; many people contracted it in Istanbul. Government offices, firms, and shops were left without any staff. In December, the flu appeared again, this time as an epidemic. On December 9, 1918, all venues such as schools, theaters, cinemas, and entertainment houses were shut down until further notice. While cases of Spanish flu reached 400 in the first weeks of December 1918, the number dropped to 239 in the last week. As the number of flu cases dropped further during the first weeks of January 1919, shuttered public institutions were allowed to reopen if they met certain criteria. However, schools without heaters were not allowed to reopen; greater attention was paid to student health; and if 15 percent of the students enrolled in a school were unable to attend, that school would immediately be shut down. Classrooms and dormitories had to be ventilated when convenient. Only two movie screenings a day were allowed; between screenings, the space had to be ventilated for two hours and the floor had to be disinfected. Smoking, known to irritate the respiratory tract, was strictly prohibited.
As the course of the disease worsened, the director of the Şehremaneti Sıhhiye sent a notice to newspapers on 27 December 1919 reminding the public that this disease, which had swept the city for the past 15 days, had taken more than 14,000 lives in Istanbul in 1918 and announcingrecommending the several measures that should be taken. First, direct contact with the sick was to be avoided. Public venues such as cinemas, theaters, schools, marketplaces, and coffee and tea houses were highly dangerous. Appeals were made to close the schools. Since the Spanish flu microbe entered the body via saliva, the mouth had to be frequently washed with a disinfectant solution, and everyone had to be more careful about oral hygiene. Patients had to spit into spittoons that had lids and contained disinfectant. All underwear, handkerchiefs, bed sheets, and the like had to be boiled and washed thoroughly in case of contact with vomit.
To avoid the damage the disease caused in the previous year, the Sıhhiye Müdüriyet-i Umumiyesi on 28 December 1919 ordered all branches of the Darülfünun and high schools to close for 10 days. In the last week of December, 98 people died from the Spanish flu. There are no official statistics on the effects of the epidemic in Istanbul. According to the statistics prepared by Dr. Hikmet Süreyya Bey, 5,000 people died between summer 1918 and December 1919. Avanzade M. Süleyman wrote, “this inauspicious flu has cruelly taken the lives of more than 14,000 innocent people.” In 18 months, an estimated 16,000 Istanbul residents succumbed to this disease. Dr. A. Vahid of the Hamidiye Children’s Hospital wrote of the Spanish flu: “While it is not called plague, in truth it is much more dangerous and more fatal than the plague.”
The Spanish flu broke out again in winter 1920 and spread throughout Istanbul, affecting every household. Most of the state officials who caught this disease remained in bed. Pharmacists took advantage of the disease to increase prices, and doctors’ fees were so high that middle class families could not afford them. Patients could not be treated under these conditions. For this reason, the Dâhiliye Nezareti (Ministry of the Interior) asked the şehremaneti to increase the number of doctors working at the municipality departments; 30 military physicians from the Harbiye Nezareti (Naval Ministry) also worked with the municipal doctors until the epidemic ceased. However, the Harbiye Nezareti stated that it lacked enough doctors to meet the demands of the military and would not be able to provide the required number of doctors. The flu affected the rich as well as the poor; even Sultan Mehmed VI, Vahdeddin fell victim. Having recovered from this disease before leaving for Anatolia, Mustafa Kemal Atatürk sent a telegram to the sultan as the chairman of the Anatolian and Rumelian Müdafaa-i Hukuk Cemiyetleri (Associations for the Defence of the National Rights) give his best wishes. Grand Vizier Ahmed İzzet Pasha and Cemil Pasha (Topuzlu) also caught the Spanish flu. Selahaddin Ali Bey, the son-in-law of Prince Selahaddin Efendi, Haji Reşid Pasha, the former mayor of the Hejaz, and Zografos Efendi, a teacher at Galatasaray High School, all died from this disease.
The effect of climate on health was a popular topic at the end of the 19th century and the beginning of the 20th century. Using climatotherapy to treat illness was known as tebdil-i hava (climate alteration) or tebdil-i iklim-i tıbbi (medical climate alteration). This was done at the patient’s request, but was rather perceived as a necessity. Doctors selected a place that was suitable for a given illness in terms of temperature, humidity, and winds; different venues were considered beneficial for different illnesses. For injury to the bowels or chronic diarrhea, high-altitude locations such as Kısıklı, Yalnız Servi, Bulgurlu, Yakacık, or Hamidiye Village were seen to be beneficial. The best time to start climatotherapy was thought to be the beginning of November, before the first snowfall. Patients were advised to go to these places in mid-summer, or at the latest at the beginning of September, so that they could get used to the climate. It was thought that high altitudes were not suitable for patients with heart disease, arteriosclerosis, epilepsy, rheumatism, or osteolysis, or for the elderly.
Emphysema patients were advised to live beside the sea, protected from the winds in a dry climate and close to the forest, in locations such as the Princes’ Islands and the coast of the Bosphorus. As a cold and humid climate was considered harmful for rheumatism patients, Istanbul was seen as less than ideal for them, but the neighborhoods of Acıbadem, Koşuyolu, Nuhkuyusu, and Tophanelioğlu were considered better than the rest of the city. For pulmonic tuberculosis, the city did not offer any specifically appropriate climate conditions, but places of higher altitude, such as the secluded parts of the Princes’ Islands, the Bosphorus, Kadıköy, and Moda were recommended.
Diabetic patients with uncomplicated cases were advised to look for a moderate climate, as dry and cool as possible but with plenty of sunshine. Places such as the Marmara Sea and the relatively cooler Bosphorus were considered appropriate in the summer. The more pleasant the climate, the better it would be for the winter.
Malaria patients were advised to stay away from places that tended to have marshy areas in the autumn, such as Bakırköy, Yeşilköy, Kuşdili, and Yoğurtçu. The mountain climate was advised for those suffering from shortness of breath; places such as Yalnız Servi, Bulgurlu, Kısıklı, Hamidiye Köyü, Yakacık, and Şişli were considered ideal for these patients.
For those suffering from nervous diseases, living by the sea, especially right on the coast, was considered detrimental, due to the wind, the sun, and the noise of the waves. It was suggested that hypochondriacs live in Sarıyer, Hisarlar, Bebek, Adalar, or Şişli. People with a nervous disposition were advised to live for a long time in a place with a high altitude, such as Kısıklı or Hamidiye—in particular, one that overlooked a beautiful landscape, such as Yakacık, Libade, Yalnız Servi, Şişli, Nuhkuyusu, or Bağlarbaşı. For highly irritable women, soothing places with a subtle climate, such as Feneryolu, were recommended; for those with mental fatigue, the most appropriate places to live were considered to be Nuhkuyusu, Bağlarbaşı, Küplüce, and Acıbadem.
However, to choose a therapeutic location, the patient needed to have financial resources.
The first healing establishments that the Ottomans built in Istanbul were the darüşşifa and the palace hospitals which served those who lived in Topkapı Palace. Cariyeler Hospital, which served the staff of the harem, was one of the earliest of the palace hospitals that remain standing today. This hospital could be reached by 53 stairs, known as the Kırkayak, and was situated in the farthest corner of the harem. Midwives and chief midwives worked there, as well as regular nurses, known as nine, who took care of concubines who fell ill. The Cariyeler Hospital was run by the hastalar kethüdası or hastalar ustası (chief or mistress of the patients). In cases of serious illnesses, the woman on duty would inform the harem agha, who would fetch the palace doctor; if necessary, the doctor would send the patient to hospital. The Enderun Hospital, where the members of the Enderun were treated, was situated behind the Bâb-ı Hümayun, on the right in the first courtyard. Two palace doctors and two palace surgeons treated patients in this hospital every day at prearranged times. In addition, there was a clinic for the Bostancı (imperial guard) in Birun, next to the Yaldızlı Gate, close to Değirmenkapı on the coast.
The office of the chief physician, who was responsible for the health of the sultans and the court, was located in the Başlala Tower. This was the place where all the medicine was made for the sultans and high-ranking palace officials. Because some sultans were rumored to have died from poisoning, the medicine for the sultans was made by the chief pharmacist under the watchful eye of the chief physician and with strict security precautions. Another place where medicine was made in Topkapı Palace was the Helvahane. Medicinal pastes, syrup, theriacs, pills, and lozenges, as well as hair dye, soap, and powder were produced there; these preparations were stored in the physician’s room until needed.
By the middle of the 19th century, the Fatih and Sultanahmet Darüşşifası had been damaged or destroyed. At this time, one of the rooms in the Haseki Darüşşifa, where female patients, including those with mental disorders, were treated, was used as a women’s jail. The Süleymaniye Darüşşifa, reserved for patients with mental disorders, became the Süleymaniye Asylum. The Atik Valide Nurbanu Sultan Darüşşifa was first a military hospital and later converted into an asylum; it became known as the Toptaşı Asylum, and remained in use until 1927. There was no place left for Muslim citizens to be treated as inpatients. As a result, Muslim bachelors who traveled to Istanbul on their own had no place in this system. The madrassa in the courtyard of the Mihrimah Sultan complex in Edirnekapı was converted into a hospital and began to serve as Edirnekapı Gureba ve Bekâr (Foreigner and Bachelor) Hospital in 1837. Prisoners who fell ill in prison were sent there. It was taken out of service in 1847 when Gureba Hospital, established by Bezmiâlem Valide Sultan, opened.
Residents of Istanbul were entitled to be treated at the clinics of the Mekteb-i Tıbbiye-i Şâhâne, which started to function in 1839 in Galatasaray; during the Meşrutiyet era, they could be treated either in the polyclinic or as inpatients. Doctors examined patients, taking turns in the polyclinic. Patients were examined regardless of gender or religion, free of charge; those who were not well-to-do were given the necessary medication by the Eczahane-i Âmire, located within the school, at no charge. Residents of the capital city and 15,835 people from nearby areas were examined during the 1842/1843 academic year. Later, to reduce the need to transport patients to Galatasaray, a number of pharmacies were established in Beyazıt, Eyüp, Üsküdar (1845), Fındıklı (1865), and Topkapı (1870). These pharmacies had examination and treatment units and functioned as emergency clinics day and night. These on-duty (nöbet) pharmacies continued to operate until 1895. The Mekteb-i Tıbbiye-i Şâhâne, and later the Humbarahane (in Eyüp), provided medical services to the public through clinics in Demirkapı and Haydarpaşa. The Mekteb-i Tıbbiye-i Mülkiye, which opened in 1867, was active in Kadırga. The Tatbikat Mektebi ve Seririyatı (Gülhane Military Medical Academy) opened in 1898 to train military doctors; this hospital provided outstanding service to the residents of the Istanbul during times of peace and to the wounded during war. The Daülkelb Surgery, affiliated with the Mekteb-i Tıbbiye-i Şâhâne, opened in 1887, producing vaccines and treating cases of rabies. Women of Istanbul went to the maternity ward (viladethane) in cases of difficult labor.
When the inadequacy of the inpatient health establishments in Istanbul became clear during the smallpox epidemic of 1843, Sultan Abdulmecid’s mother, Bezmiâlem Valide Sultan, decided to open a hospital. The opening ceremony for this hospital, which was later called Gureba-yı Müslimîn or Vakıf Gureba Hospital, was held on 12 March 1847. The first rule of its endowment was to treat free of charge Muslims who were poor and had no family. The scientific authority of the hospital, which was affiliated with the Evkaf Nezareti (Ministry of Waqfs), fell to the chief physician.
In 1885, the Haseki Women’s Hospital started to treat female patients in a mansion that had been purchased near the Haseki Darüşşifa. Modern clinics were built in a pavilion system in the garden of the mansion; the mansion itself was torn down in 1891. The windows of the new buildings were barred.
The first municipal hospital in Istanbul opened in 1865 immediately following the cholera epidemic in a house rented by the Beyoğlu Municipality; this hospital was known as the Altıncı Daire-i Belediye Hospital. Run by the nuns of St. Vincent de Paul, it later became known as Beyoğlu Men’s Hospital during the Second Constitution. With the declaration of the Republic, the hospital became the Beyoğlu Municipal Hospital.
Zeynep Kamil Hospital was established by Grand Vizier Yusuf Kâmil Pasha and his wife, Zeynep Hanım, the daughter of the Hidiv of Egypt, Mehmed Ali Pasha. It was opened in Üsküdar on 2 March 1882. After Haydarpaşa Numune (Exemplary) Hospital opened, Zeynep Kamil Hospital specialized in obstetrics and gynecology.
Altıncı Daire-i Belediye Nisa Hospital, affiliated with the Beyoğlu Municipality, was established in 1883, after the Crimean War, to treat the women who worked in the brothels of Beyoğlu and Galata. The cost of the hospital and the salaries of the staff were funded by the inspection fees paid by the brothels; these fees were set according to the number of women they employed. The name of the hospital was later changed to the Emraz-ı Zühreviye (Venereal Diseases) Hospital.
The Hamidiye Etfal Hospital, built on the orders of Abdulhamid II in memory of his daughter, Hatice Sultan, who died from diphtheria when she was only eight months old, was based on the plans of the Kaiser und Kaiserin Friedrich Kinderkrankenhaus (Imperial Children’s Hospital) in Berlin; this hospital was built in a pavilion style. The hospital opened with a ceremony on 5 June 1899 with a staff composed of the most competent doctors in Istanbul and German nurses; all costs were met by the sultan. Women and children were examined and treated free of charge, and the necessary medication was provided by the hospital. At the sultan’s request, 16 beds were reserved for foreigners visiting Istanbul. The containers for the medicine used in the hospital pharmacy were produced in the ceramics studio in the garden of Yıldız Palace. There was a laboratory that prepared serums for scarlet fever, diphtheria, and smallpox vaccines in the hospital. The first sanatorium for children in Turkey opened on the grounds ofinside the hospital compound in 1906. Abdulhamid II had hundreds of poor boys circumcised at the hospital on every anniversary of his accession. Many types of medical equipment were imported from Europe and used for the first time in this hospital; it was considered the best Ottoman hospital.
Members of minorities and foreigners living in Istanbul started hospitals and medical establishments for their own communities. The first was the Balıklı Rum Hospital in 1793, followed by the Yedikule Surp Pırgıç Armenian Hospital in 1834, Surp Agop Hospital in 1836, and Or Ahaim Musevî (Jewish) Hospital in 1896.
With the Tanzimat and after the Crimean War, there was a significant rise in the foreign population in Istanbul; consequently, some countries and religious foundations opened hospitals in the city. The earliest of these were the St. Benoit (Galata, 1696), Pasteur (Taksim, 1846), La Paix (Şişli, 1858), and Jeremya (Beyoğlu, 1881) Hospitals and St. Benoit Dispensary (Galata, 1841). The hospitals belonging to other countries were the Austro-Hungarian (Azapkapı 1830, Galata-Taksim), Austrian St. George (Galata, 1873), St. George Children’s (Galata 1895, Şişli), German Catholic (Beyoğlu, 1846), German (Taksim, 1843), British (Galata, 1855), Dersaadet Italian (Galata, 1838), Russian (Galata 1874, Harbiye), Iranian (Sultanahmet, 1901), Bulgarian (Şişli, 1902), and American Hospitals (Taksim, 1920). All the religious and foreign missionary hospitals worked with doctors from their own communities and countries and with nurses who were nuns from the order of St. Vincent de Paul.
The Associazione Commerciale Artigiana di Piéta (Artigiana) was founded on 1 January 1838 to help European working-class families who had immigrated to Istanbul after the Tanzimat and fallen into financial difficulties because of the fires. This society first helped poor laborers. Then 42 small new houses were built in Harbiye, financed by donations, to shelter the poor. First house was ready for use in 1841. The administration of Artigiana, which was founded on a secular and humanist basis, was handed over to the nuns of St. Vincent de Paul in 1872. By 1874, this institution officially became Darülaceze Catholic. After the Ottoman–Russian War, in 1877, a hospital with a capacity of 20 beds was built in the garden of Artigiana society; this was for poor immigrants who had moved from Rumelia to Istanbul. Located in Pangaltı, this hospital is still in operation; the building was restored in 1960 and is now called the Artigiana-Düşkünler Evi İhtiyarlara Mahsus Cemiyeti Hayriye Derneği (Charitable Society for the Poor).
The Zaptiye Hospital was the first to serve certain members of a particular institution. This hospital, where all sick prisoners were sent, opened between 1855 and 1860; it was later called the Hapishane-i Umumi (General Prison) Hospital. The, established for beggars and other needy people in Istanbul in 1896, had two hospitals, one for women and one for men. Since institutionalization gained speed after the declaration of the Republic, it also led to the establishment of such hospitals. The Istanbul Esnaf (Tradesmen’s) Hospital (1937), Denizcilik Bankası (Mariner’s Bank) Hospital (1941), and Sümerbank Center Hospital (1945) were the first hospital corporations in the Republican era. With the establishment of the İşçi Sigortaları Kurumu (Worker’s Insurance Organization) in 1946, insurance was issued covering workplace accidents, occupational injuries, and maternity insurance, and affiliated hospitals were established in various neighborhoods, such as Nişantaşı (1949), Sultanahmet (1952), Eyüp (1952), Samatya (1960), Paşabahçe (1962), Şişli (1966), Okmeydanı (1971), and Göztepe (1972). Jurisdiction over all these hospitals was transferred to the Ministry of Health in 2005.
The first private hospitals and clinics were established during the reign of Abdulhamid II. The Russian Dr. Pleskoff opened the first private clinic, known as the Maison de Santé, in Beyoğlu. Under the Hususi Hastaneler Nizamnâmesi (Private Hospital Regulation), which took effect in 1898, the Cemil Paşa (Topuzlu) and Zeynep Kâmil Hospitals asked for permission to run these as private hospitals. These were followed by the Hususi Şifa Hospital, founded by Dr. Fuat Süreyya Bey in Cağaloğlu; in 1904, this hospital moved to Kadıköy-Caferağa. By the beginning of the 19th century and the early Republican Era, new private clinics and health institutions had been established in various quarters of Istanbul.
When the capitulations were revoked with the Lausanne Treaty, the foreign missionary hospitals that had been approved before 30 October 1923 were converted to a private hospital status. With a new law in 1937, minority hospitals were opened under the control of the Vakıflar Umum Müdürlüğü (General Foundations Directorate) and, as private hospitals, were inspected by the Ministry of Health.
The first military hospitals in Istanbul were established during the reign of Selim III (1789–1807) and continued during the reign of Mahmud II in parallel with the modernization of the army. While the exact dates of their opening is unknown, the Tophane-i Âmire Hospital and Levent Çiftliği Hospital were already running in 1796. These were followed by the Bahriye Merkez (1827), Maltepe (1827), Zeytinburnu (1828), Bâb-ı Seraskerî (1828), Humbarahane (1831), İplikhane and Liman-ı Kebir (1836), Topkapı, Tarabya, and Kuleli (1844), Haydarpaşa (1845), Gülhane (1848), and Gümüşsuyu (1849) military hospitals. To modernize the military hospitals, two doctors were invited from Austria, both of whom were originally from Germany. Dr. Lorenz Rigler and Dr. Eder arrived in Istanbul on 14 October 1842. While Dr. Rigler was made inspector of the military hospitals, he also worked actively in the reorganization of the Maltepe Military Hospital, rearranging it in the style of Josephinischen Medizinisch-Chirurgischen Akademie/Josephs-Akademie in Vienna. He was also a key figure in the planning and organization of the Haydarpaşa, Gülhane, and Gümüşsuyu Hospitals. The Gümüşsuyu Military Hospital, which was built by British architect W. J. Smith in a neoclassical style, became the first hospital to be heated by radiators.
During the 1877–1878 Ottoman–Russian War, the Ottoman Hilal-i Ahmer (Red Crescent) Association (later to become Kızılay) established hospitals in Istanbul with the support of the Red Cross. The quarantine stations in Anadolukavağı, under the name Kavak Hospital, admitted 490 patients and 430 wounded over 53 days. Under the chief physicianship of Dr. Peştemalcıyan, in the service courts of Beylerbeyi Palace, the Paşa Dairesi and Muzıka Dairesi Hospitals treated 2,606 military patients and wounded soldiers between 23 August 1877 and 31 May 1878. The patients were informed about the importance of the surgery and possible post-operative complications and asked for consent before being operated on. When the war was over, these hospitals continued to serve as a military hospital called the Beylerbeyi Hospital. In addition, the Gülhane, Çinili Köşk, Paşabahçe, Şemsi Paşa, Nakilbend and Tunuslu (Üsküdar), Humbarahane, Sirkeci, and Mirgûn Hospitals were reserved for sick and injured soldiers. When the war was over, the Muhacirîn Hastanesi Dul ve Eytamhanesi (Immigrant Hospital for Widows and Orphans) was established in the Kızıl Barracks in Gülhane; this was for those who had been widowed or orphaned or were ill or disabled in the territory that Turkey had lost in Rumelia.
The Yıldız Mobile Military Hospital (Yıldız Seyyar Askeri Hastanesi), established in 1884 for palace guards and the staff of the Yıldız-Balmumcu Barracks who lived near Beşiktaş, was assigned to treat the wounded in the Turkish–Greek War of 1897. This hospital was made of temporary sheds that were built in the Duquer system and imported from Germany. Dr. Salih Bey from the Mekteb-i Tıbbiye-i Şâhâne and two interns, Esad Feyzi and Rıfat Osman, brought their X-ray equipment, and by using parts from different machines they were able to detect shrapnel in the bodies of wounded soldiers returning from the front during the war. Dr. Kuttner and Dr. Nasse of the German Red Cross arrived in Istanbul toward the end of May 1897 and brought X-ray equipment with them. They expressed shock at the poor condition of the radiography equipment in the Yıldız Seyyar Military Hospital. British doctors on the Greek front used two X-ray machines sent by ship from England, arriving in Pire Harbor on 13 May 1897. Thus, the 1897 Ottoman–Greek War was recorded in radiological literature as the first war during which first the Turks, then the Germans and British took radiographic images. Some of the wounded patients from the 1897 Turkish–Greek War were treated at Gümüşsuyu Hospital.
After the Ottoman EmpireState’s defeat in the Balkan Wars (1912–1913), outbreaks of dysentery and cholera among the exhausted and defeated soldiers began to fall off. Tens of thousands of ill and injured soldiers and exhausted immigrants arrived in Istanbul within a few days. Those who came first were relocated in houses, inns, and hotels rented by the municipality. Cholera, dysentery, and smallpox epidemics broke out among the immigrants who, due to the shortage of accommodations, had camped out in cemeteries, mosque courtyards, vacant land, farms, and other areas. By November 1912, there were 2,500 cholera patients on the coast of the Historic Peninsula. The quarantine stations were filled with cholera patients. The Istanbul Municipality decided to use all suitable venues as hospitals. At first, large hotels and waterside residences on the Bosphorus were evacuated. Many schools were converted into hospitals. The Sıhhiye Nezareti established cholera hospitals made of sheds in Demirkapı. The municipality assigned the Haseki Women’s Hospital to provide services for pregnant, fragile, weak, and ill immigrant women. Approximately 90 cholera hospitals were established in Istanbul. When all the hospitals and barracks were full, there was still one last group of soldiers left without tents on the coast of the Historic Peninsula and Demirkapı; henceforth all mosques were closed for worship and allocated for use as hospitals.
Wounded soldiers sent back to Istanbul during World War I (1914–1918) were cared for in all hospitals, including the religious and foreign missionary hospitals, and in all mosques, schools, official departments, and mansions that were designated as hospitals by the Osmanlı Hilal-i Ahmer Association. Women from distinguished families and the şefkat hemşireleri (compassion nurses) sent to Istanbul by the Salib-i Ahmer (Red Cross) from various countries were part of the health commissions. Some of the foreign nurses served as army nurses on the front.
The Rum, Armenian, and Jewish congregations and Levantines who were also part of the Ottoman state, as well as the Catholics who had immigrated from other countries, were part of the fabric of Istanbul; they were granted minority rights by Sultan Mehmed II, and as a result, they could establish their own religious, educational, and health organizations and live according to their culture and traditions. It was also as if that occupations were divided up among different faiths. The Muslims, who were considered the basic component of the state, did not hold occupations such as medicine, pharmacy, and dentistry in high esteem. The Jews, whose people had lived in a number of countries over the centuries, chose jobs that were closely related to finance and trade, as well as jobs that could be practiced all over the world, including dentistry, medicine, and pharmacy. They were especially well known for their medical knowledge. Even in the Christian Middle Ages, the private physicians of high state and church officials were Jewish. This elevated position was due to the fact that the Jewish physicians made use of medical resources written in Hebrew, Arabic, and Greek and were also fluent in Latin, Spanish, and Italian. When religious bigotry became enflamed and hostility toward the Jews increased in the 14th and 15th centuries, Jews emigrated to the Ottoman territory from France, Germany, and Hungary. İsak Pasha, the head physician of Murad II (1421–1451), was a Jew. The Jewish palace physician Maestro later converted to Islam and changed his name to Yakup. He was also a private physician of Sultan Mehmed II;; some historians believed that he poisoned the sultan. Amirdovlat (d. 1496), one of the Amasya Armenians, was a surgeon and an ophthalmologist for Sultan Mehmed II. He was promoted to the position of chief surgeon of palace and head guardian. The palace physicians İshak Paşa Galeon and Ribi Sonsino were promoted to service in the Evlad-ı Musa Gariban Regiment, which was made up of Ottoman Jews, on the order of Sultan Mehmed II; this was during his struggle with Jean de Kapistrano, who was preparing for a Crusade.
Sultan Mehmed II held doctors in high esteem and encouraged them with rewards. Seven physicians are mentioned in the Ulema Defteri (Book of Scholars). Of these, the physician Kutbuddin Ahmed (d. 1497) was greatly appreciated by the sultan for his vast knowledge of medicine. Doctor Altunîzade (Altuncuzade, İbn Zeheb) was famous for his extensive knowledge of medical herbs and for being the first to use a tin catheter (invented by Ibn Sina or Avicenna) in Turkey to cure patients who suffered from urine retention. The physician Beşir Çelebi was a poet and a historian of the same period. He wrote a book titled Mecmûatü’l-fevâid on internal medicine. Lari, one of two physicians who tended Sultan Mehmed II on his deathbed, was also Bayezid II’s private physician. Sultan Mehmed II had the physician Arap brought to Istanbul after hearing about the reputation he gained while working with the governor of Skopje; Arap worked as the palace physician for both Mehmed II and Bayezid II. The other physicians listed in the Ulema Defteri were Hoca Ataullah and Yakub Pasha.
Ahî Çelebi, a significant figure during the reign of Mehmed II, continued his brilliant career as a physician during the reigns of Bayezid II, Sultan Selim I, and Sultan Suleyman I. When İsmail Bey ruled the Candaroğlu principality in Kastamonu, the area was incorporated into the Ottoman state and Ahî Çelebi moved to Istanbul. He operated a consultation room in Mahmutpaşa. He trained under Kutbuddin and Altunîzade, famous physicians of the time. Ahî Çelebi was then appointed to the Fatih Darüşşifası as a physician and eventually, during the reign of Bayezid II, was made head physician. Traditionally, when a sultan died, his head physician would be dismissed. Although he was dismissed from his post on the death of Bayezid II, Ahî Çelebi was made head physician again by Sultan Selim I. When this sultan died in 1520, Ahî Çelebi was dismissed again. His most important work, Risâle-i Hasâtü’l-kilye ve’l-mesâne, was about kidney and bladder stones. Ahî Çelebi spent his fortune on charities, and had a madrasa and school built in Edirne and a mosque at Yemiş Harbor in Istanbul. Today a district in the Eminönü section of Istanbul carries his name.
Physicians who emigrated from Spain as part of the Sephardic migration in 1492 excelled in their positions thanks to their grasp of medical literature in Spanish, Latin, and Arabic; these physicians were held in high esteem in the palace. The Hamon family was the most prominent among these physicians. Joseph (Yusuf) Hamon (b. 1450?) was the palace physician for Bayezid II and Sultan Selim I. His son, Moşe (Moses) bin Hamon (1490–1567), was the palace physician of Sultan Suleyman I and was rewarded with the position of vizier. His son Joseph Hamon was one of the most reputable physicians during the reign of Selim II.
Kaysunizade (d. 1611), who treated Selim I’s gout, was made head physician during the last years of Sultan Süleyman I’s reign. He attended the final battle of the reign and had the sultan’s corpse embalmed. Dr. Nidaî (b. 1512) was the palace physician for Prince Selim in Konya, and became palace physician in Istanbul when the prince became Sultan Selim II. He was originally called Şaban but became known as Nidaî. The most significant among his works was the Menâfiu’n-nâs, a medical book that includes some sections in prose. Completing this book in 1566, Nidaî dedicated it to Selim II. Menâfiu’n-nâs was a popular work among the public.
Salamon ben Natan Eşkenazi (1520–1602) was physician to Selim II and Murad III. He was even given the authority to represent the sultan in international negotiations. By 1604, there were 64 members of the Cemaat-i Etibba-yı Yahudiyân (Jewish doctors’ community), whose salaries were paid by the palace. Buha Eşkenazi, the widow of Salamon ben Natan Eşkenazi, treated Ahmed I for smallpox and was brought to the palace as physician in her late husband’s place.
Emir Çelebi (d. 1648), the companion and head physician of Murad IV, wrote his work Enmûzecü’t-tıb (Medical Cases) in 1624 for the vizier Recep Pasha. This book discusses the qualities of the air, earth, and climate as well as illnesses and their treatment.
After the 17th century, due to plots within the palace and with the participation of Sabbatai Sevi in palace intrigues, Jewish physicians lost their favorable reputation. With a decrease in Jewish migration from Europe, the Ottoman Jews were left without access to scientific developments or new technology, and their place, in terms of medical superiority, was filled by Rums and Armenians. By 1700, there was only one Venetian Jew among the physicians who held certificates in Istanbul. By this time, Eminönü and Bahçekapı, where the Jews tended to live, were also home to Christian doctors. The situation was similar in and around the palace. For instance, Panagioti Nicoussias (b. 1673), a graduate of the Padua Medicine Faculty, became the physician and consultant to Grand Vizier Köprülü Mehmed Pasha in 1656. He represented the Ottomans during negotiations with the Venetians after the invasion of Crete. Having studied medicine at Padua and Bologna, Alexander Mavrokordatos (d. 1709) served as chief translator during negotiations for the Treaty of Karlowitz in 1669. By the end of the 17th century, a Jewish physician could only serve in the palace if he had converted to Islam. The Sephardic Jewish physician Moşe Ben Raphael Abravanel was made chief physician and treated the sultan only after he converted to Islam; he was then known as Hayatizade Mustafa Feyzi Efendi. From the reign of Mustafa III (1757–1774) onward, European physicians, such as Karo of Naples and Gobis from Germany, were found in the Ottoman palace. Although these European physicians were only allowed to set up practice in Galata, their relocation to Istanbul could not be prevented.
By the 19th century, medical science, surgery, dentistry, and pharmacy were run by foreigners. As the Muslim physicians who were trained at the Darüşşifa, or under a master-apprentice relationship, or had classical training at the Süleymaniye Madrasa, did not keep up with new developments in medicine, the medical field in the Ottoman state was left to non-Muslims who had been trained in Europe and had kept their knowledge up to date. Initially, foreign physicians were not required to present a medical diploma. But fraudulent practitioners caused many deaths, and beginning in 1857, all foreign physicians starting a practice were required to hold a medical diploma2
In 1802, an edict was passed in Istanbul declaring that Europeans who were working as doctors, pharmacists, etc. would no longer be allowed to work in the city; if they continued to do so, their papers would be taken away. Selim III believed that the best people to solve this issue were not the kethüda (steward) of the chief physician or the necefçis. He reminded his vizier of the trickery of some European tradesmen and ordered him to punish some of them.3 Later, in a verdict delivered to the Istanbul qadi, the sultan demanded that those who worked as physicians wearing European dress be found and punished.
Health care for the army was also generally provided by members of minorities and foreigners. Tıphane-i Âmire was established to train Muslim doctors for the army, and classes began on 14 March 1827; this institution was reorganized in 1839 and renamed the Mekteb-i Tıbbiye-i Adliye-i Şâhâne (Imperial Medical School). The name Adliye, reflecting the era in which the school was opened, is derived from Adlî, the pen name Mahmud II used when he wrote poetry. This term was later removed and the school name was shortened to Mekteb-i Tıbbiye-i Şâhâne. When this school opened, lessons were held in French because there were no Turkish textbooks. Almost all of the teachers were either Rum or Armenian (including Konstantin Karatodori, Spiridon Mavroyeni, and Gaspard Sinapyan), Austrian (Sigmund Spitzer, C. A. Bernard, and Rigler), Italian (Antoine Calleja and Francesco Della Sudda), or French (Antoine Fauvel).
By 1858 there were 300 Muslim students and 150 non-Muslim students; graduates served as military doctors. While the original purpose of the school could not be completely achieved, at least it enabled qualified Muslim and non-Muslim physicians to take the place of foreign charlatans. In the following years, with increasing demand among non-Muslims, who did not want to spend money to send their children to Europe for medical training, and due to “the efforts of the authorities to please the reaya [Christian subjects],” the ratio of Muslim to non-Muslim students changed.
By the beginning of the 19th century, most successful and prominent Turkish doctors came from elite families. The family of Şanizade Ataullah Efendi (1771–1826), born in a waterside residence in Ortaköy, was renowned for producing qadis and müderris (madrassa lecturers). Mustafa Behçet Efendi (1774–1834), his brother Abdülhak Molla (1786–1854), and the latter’s son, Hayrullah Efendi (1817–1866), who was the director of the Mekteb-i Tıbbiye-i Şâhâne, were undeniably appointed to these posts because they belonged to the Hekimbaşı family. Keçecizade Mehmed Fuad Pasha (1815–1869), who entered politics after completing his training at the Tıphane-i Âmire, not only served the upper classes but also became minister of foreign affairs five times and grand vizier two times; this distinguished personage was the son of the famous poet Keçecizade İzzet Molla.
After completing their religious education at the madrasa, Şanizade Mehmet Ataullah, Mustafa Behçet Efendi, and Abdülhak Molla studied medicine. While undertaking religious studies, they also exercised their medical profession, working as chief physicians, medical ministers, and teachers. Şanizade Mehmet Ataullah and Mustafa Behçet Efendi established the basics of Turkish medical training by translating medical books into Turkish. They were also known for founding new establishments, such the Tıphane-i Âmire, and contributing to new practices such as quarantine.
Following this generation, a few people became well known for their education and skill. The surgeon İsmail Pasha (1807–1880) was captured during the Greek (Peloponnese) Riots and sold to another surgeon, where he received apprentice training. He not only became chief physician but also was the head of a middle-class family that survived to modern days. One of the first graduates of the Mekteb-i Tıbbiye-i Şâhâne, chief physician Salih Efendi (1816–1895) rose from a common background to fame through his successful medical education as well as his personal qualities, such as intelligence and honesty.
Doctors who were trained at the Mekteb-i Tıbbiye-i Şâhâne served as high-level administrators in the civil service and became indispensable personnel in the new institutions founded since the Tanzimat. Surgeons İsmail Pasha, Salih Efendi, and Hayrullah Efendi worked, respectively, as ministers of education, trade and public works, governors of large cities, and mayors of Istanbul and Beyoğlu. They also served on councils that directed public services. This illustrates that graduates of the Mekteb-i Tıbbiye-i Şâhâne used the power of their education to serve the public in all stages of public life.
The most important milestone in the challenge of the distinguished nature of the Turkish physician came in 1870, when medical education began to be taught completely in Turkish. In addition to the translations of medical works, the students who were sent to Europe for specialized training beginning in that year formed a bridge that provided access to medical knowledge. Contemporary methods and preventative health establishments started to open, and by the end of the 19th century, modern Turkish doctors emerged who could make scientific contributions to medicine.
Of the doctors completing specialized training in Europe between 1869 and 1900, Feyzi Pasha can be considered the founder of clinical medicine in Turkey. Hasan Mahzar Pasha translated fundamental books on anatomy. Şakir Pasha introduced the fundamentals of experimental physiology. Besim Ömer Pasha helped found the first maternity ward. Esad Pasha established the first ophthalmology clinic. In addition to his success in surgery, Cemil Topuzlu was known for his contributions to modern city planning during his tenure as mayor of Istanbul. Ali Rıza Bey expanded scientific methods in chemistry. Halit Şazi (Kösemihal) is considered the founder of modern dentistry in Turkey. While Asaf Derviş Pasha, who trained in Germany, laid the foundation for gynecological surgery, Raşit Tahsin (Tuğsavul) established the first neuropsychiatry clinic in Turkey. Ziya Nuri (Birgi) Pasha established the first independent Turkish otolaryngology clinic. Hamdi Suat (Aknar) conducted original research on skin pathology. Esad Feyzi was one of the first to use X-rays for battle injuries. Kadri Raşit (Anday) founded the first modern pediatrics clinic in Turkey. Tevfik Recep Örensoy examined tissues using a microscope. Kemal Cenap Berksoy pioneered experimental practices in digestive physiology. Aseptic surgery was introduced by Orhan Abdi (Kurtaran). The success of Refik Saydam’s work as minister of health was based on the experience he gained during the Balkan War, World War I, and the War of Independence. Nihat Reşat Belger established the hydroclimatology branch of medicine. Hasan Reşat Sığındım identified monocytic leukemia. Behçet Sabit Erduran contributed to the development of urology as a medical specialty. Hulusi Behçet had a dermatological disease named after him. Osman Cevdet Çubukçu developed physiotherapy and rehabilitation techniques.
Mazhar Osman’s (1884–1951) contribution was the medicalization of psychiatry in Turkey. Famous poets and authors such as Abdülhak Hâmid, Cenap Şehabettin, Süleyman Nazif, and Hüseyin Rahmi also attended conferences held at the La Paix Hospital. The relationship with the intellectuals made mental and nervous diseases more understandable and acceptable to the public. Mahzar Osman became a legend with the public, and his name became almost a symbol of mental measurement and a major topic of daily conversation. Those who were believed to be mentally ill were urged to be examined by Mazhar Osman or were considered a case for him. Expressions such as “off to Mazhar Osman” or “off to the asylum” implied that the person was mentally ill.
Those who studied general medicine and medical specialties in Europe worked as lecturers in medical schools when they returned to Turkey. At the end of a long challenge, Turkish doctors, who had become minorities in their own country, distinguished themselves. Foreigners working as physicians were banned in Turkey by the 28th clause of the Lausanne Treaty of 23 July 1923.
Physician Shops (Clinics)
Physicians, surgeons, pharmacists, ophthalmologists, and other health workers in Istanbul were affiliated with the tradesmen organization. They worked within the gedik (monopoly of trade rights) system, and their consultation rooms were known as dükkâns (shops, clinics). The hekim dükkânı (physician’s shop, clinic) of the chief physician Emir Çelebi (d. 1638) in Unkapanı is considered one of the earliest examples. By 1700, there were 21 consultation rooms (hekim dükkânı) and 27 surgeon rooms (cerrah dükkânı) in Üsküdar, Galata, Tophane, Kasımpaşa, and Hasköy. More specialized treatment was also available, for example from fıtıkçı kârhanesi (hernia specialists) and çıkıkçı dükkânı (bone setters).
Bursalı Ali Münşi (d. 1733) attracted attention from the palace by opening his hekim dükkânı in Istanbul; he was made palace physician. The well-known Vesim Abbas (d. 1760) owned a hekim dükkânı near Fatih Mosque. The chief physician Mehmed Refî allowed the surgeon Yorgi to open a fıtıkçı kârhanesi in 1765. A surgical clinic was in operation in Simkeşhane around the same time. A specialist in syphilis, Bedros, who worked at Koska, died in 1782; his shop was turned over to someone else. A 1785 document refers to frengi dükkânı (syphilis treatment centers) in Istanbul. Toward the end of the 18th century, David Oğlu Menteş and the surgeons Manol, Mihal, and İsakoğlu Yako were given gedik rights to start surgical clinics in Istanbul. In this period, the tabib-i ruhanî (physician of the soul) Haji Mehmed Efendi opened a shop in Istanbul to treat psychological illnesses through spiritual inspiration and prayer.
After the declaration of the Tanzimat in 1839, the majority of foreign doctors who traveled to Istanbul to pursue their trade settled around Beyoğlu and Galata. The cost of setting up a modern physician’s consultation room—including rent, furnishings, and modern equipment—was high. Therefore, some doctors used a room in their home as their consultation room. These included Louis Phélis, who came to Istanbul from Paris during the reign of Sultan Abdulmecid (1839–1861), and later the ophthalmologist Dr. Enrico (1875), both of whom lived and practiced medicine in Beyoğlu.
Most of the physicians in Istanbul worked with one or more pharmacies, with the pharmacies providing a consultation room. This was beneficial for both the doctor and the pharmacist and made life easier for patients. Around 1890, there were also Tibetan, Turkmen, and Chinese physicians who sat on the pavement between Tophane and Salıpazarı, waiting for patients; they were highly popular with female patients. At the same time, physicians who received specialist training in Europe and returned home left pharmacies and began opening their own private consultation rooms, adhering to European standards. The first was the surgery master of the Mekteb-i Tıbbiye-i Şâhâne, Dr. Cemil (Topuzlu) Bey, who started a private consultation room called Muayenehane-i Cerrahî in Bâbıâli in 1895. Dr. Hafız Hilmi Bey, Dr. Esad (Işık), and Dr. Besim Ömer (Akalın) followed his example in 1897. Besim Ömer Pasha’s consultation room was located above the Alâimüssema Pharmacy on Divanyolu. While a number of doctors opened their own consultation rooms, others treated their patients either in their homes or at pharmacies. Dr. F. Süreyya treated his patients at the Alibrandi Pharmacy in Beyoğlu in 1897, and Dr. Angelo Bohor examined his patients in the Büyük Paris Pharmacy. The British Pharmacy had a great number of doctors working there day and night. Dr. Dimitri Harmanidis, who trained in France and Italy, treated male patients in his consultation room in Galata and female patients at his home in Çukurbostan, in Beyoğlu. Dimitraki Çıkala treated patients suffering from gonorrhea at his home in Beyoğlu-Tarlabaşı; he treated female patients on Sundays and Thursdays.
Well-to-do people preferred to visit doctors in their consultation rooms or, if they were unable to go there, they would call the doctor for a house visit. While the fees of the famous expert physicians would be a mecidiye, other doctors charged 10 kuruş. The fees of Dr. Kâtipyan and Dr. Horasancıyan, who had their consultation rooms in Beyoğlu, were two mecidiye. Doctors charged a gold coin to visit patients in their homes. The doctors who examined and treated their patients at the pharmacies worked free of charge once a week. Poor and middle-class Istanbul residents usually opted for the Mekteb-i Tıbbiye-i Şâhâne, Mekteb-i Tıbbiye-i Mülkiye, Gülhane, or Haseki Women’s Hospitals, as well as the Gureba Hospital polyclinics that had been built by Bezmiâlem Valide Sultan.
By the beginning of the 19th century, the consultation rooms of Turkish doctors were located in and around Cağaloğlu, while minority and foreign doctors had their offices around Beyoğlu. With the Treaty of Lausanne, foreigners were allowed to work in Turkey under special conditions, and therefore foreign doctors had to close their consultation rooms after the declaration of the Republic.
By the 17th century there were female health workers with a variety of skills working in Istanbul. When a Jewish woman who worked as a tabibe (female physician) died in 1607, 25 akçe out of her salary of 35 akçe was given to a doctor and the remaining 10 akçe was transferred to the treasury. Fatma Hatun, who lived in Üsküdar, received 500 akçe for the treatment of Hüseyin’s alopecia. However, Hüseyin asked for his money back, stating that he had not been cured after four years. Fatma Hatun’s reply was that she had cured his alopecia and that he now suffered from leprosy. Between 1622 and 1624, Saliha Hatun of Üsküdar, a female surgeon, was known to have operated on 21 men to repair hernias and remove tumors.
The Mekteb-i Tıbbiye-i Şâhâne and Mekteb-i Tıbbiye-i Mülkiye did not accept female students. The shortage of female practitioners began to be filled by foreigners after the Tanzimat; by then, female gynecologists and dentists were allowed to open consultation rooms in Istanbul. The German Dr. Marie Sibold and Dr. İrini Anopilioti, a Rum citizen of the Ottoman state and graduate of the Paris Medicine Faculty, were the first female doctors to open their own consultation rooms in Istanbul, in 1894 and 1896, respectively. Marie Sibold carried out many abortions, despite the ban in the Ottoman state; after ignoring many warnings, she was deported from the country.
During World War I, there was a great need for doctors; women who wanted to be trained as doctors officially began to be sent to Europe. Suat Mahmud from İzmir and Fatma Saade (Süeda) were the first women sent by the Aydın Province Special Administration to École de Médecine Genève (Faculté de médecine de l’université de Genève) in 1915. Safiye Ali was sent to train at the Würtzburg University Medical Faculty in Germany in the following year, and in 1923 she was the first female doctor to open a consultation room in Istanbul. Hayrünnisa Ataullah, a graduate of the London University Medical Faculty, worked as a lavta (midwife) and a surgical obstetrics specialist in her consultation room on Moda Street in Kadıköy. Fatma (Reşit) Arif Atasagun (1901–1973), who settled in Istanbul in 1936 after graduating from Tufts University in Boston in 1926, opened her consultation room in Kadıköy. She was the first female obstetrics specialist. A graduate of the Ludwig-Maximilians-Universität München, Semiramis Rıfat (Tezel) started seeing patients in 1928 in the Lorendo Building in Tepebaşı as a pediatrics specialist.
Despite the decision in 1918 to allow women to work as doctors, dentists, and pharmacists alongside men, the first female students struggled initially to be accepted by and enrolled in the Medical Faculty; the first students were enrolled in 1922. Fatma Müfide (Küley, 1899–1995), Hamdiye Abdurrahman Rauf (Maral, 1895–1975), Emine Sabiha Süleyman (Sayın, 1903–1984), Suat Rasim (Giz, 1903–1980), Fitnat Celal (Taygun, 1898–1985), and İffet Naim (Onur, 1906–1995) completed their training by 1927 and their internships by 1928, thus receiving their diplomas. Fatma Müfide specialized in internal medicine, Hamdiye Abdurrahim Rauf in dermatology, physiotherapy, and radiotherapy, Emine Sabiha Süleyman in pediatrics, and Suat Rasim, Fitnat Celal, and İffet Naim in surgery. Fatma Müfide Küley became a professor at the Medical Faculty. Suat Rasim worked as a surgeon at the Şişli Children’s (Etfal) Hospital between 1931 and 1936; İffet Naim worked in the hospital owned by her uncle Dr. Asım Onur, who was also the owner of the Ortaköy Şifa Yurdu (Hospital), as a gynecologist and general surgeon. Suat Rasim was the first female doctor to open a private clinic in Istanbul. Hamdiye Abdurrahman Rauf worked as a physician in her private clinic in Kadıköy. While working as chief physician at the Üsküdar Health Center, Emine Sabiha Süleyman received a testimonial from the World Health Organization.
VI-Herbs and Pharmaceuticals
In the early days of the Ottoman state, medication was prepared and sold by doctors, surgeons, and ophthalmologists. Unlike in Europe, pharmacy as a separate specialization was an alien concept. However, those who worked in the Meâcin Kârhanesi within the Edirne II Beyazıt Darüşşifası (Macunlar İşliği, 1488) and the Darülakakir within the Süleymaniye Darüşşifası (Kökler Evi, 1556), which are assumed to be the first Ottoman pharmacies, as well as those who did not have an independent pharmacy but were known as saydalân and aşşâb, are all considered to be pharmacists. There were also personnel in the Darüşşifa who assisted in the preparation of medicine.
In Istanbul, medicine was prepared and sold by doctors, surgeons, and ophthalmologists, and in the consultation rooms of other health workers and some tradesmen’s shops. According to Evliya Çelebi, who also recorded the existence of an ot bulucu (herb finder), by the mid-17th century the following tradesmen sold ingredients with healing properties in Istanbul: 2,000 herbalists, 500 esnaf-ı meşrubat-ı deva (sellers of water with healing properties), 300 paste-makers, 41 gülabçı (rosewater sellers), 35 amber sellers, 25 frankincense sellers, and eight edhan-ı edviyeci (medical oil sellers). The basic ingredients of the medicine could generally be found at herbalists’ shops in the Spice Bazaar. The shops of the Meşrubat-ı deva tradesmen were located around Beyazıt and Hocapaşa. These tradesmen distilled the water for the drug that would be used in the making of a medicine, like endive, fir, mint, or thyme, and sold them in colorful bottles. Pastes were prepared by crushing substances such as cinnamon, galingale, and ginger and then mixing them in various ratios. The gülabçı sold not only rose water, but also frankincense water (distilled water of fragrant flowers), amber water, and jasmine water. The aromatic oils that were used in the making of medicine, such as almond, cypress, walnut, hazelnut, jasmine, hyacinth, rose, basil, and musk, were produced and sold by the edhan-ı edviyeci. Since the occupation of pharmacist did not exist in this period, there were no pharmacies.
The first private pharmacies in Istanbul were İki Kapılı Pharmacy (1757), located in Bahçekapı, owned by Georges Hurmus, and Kalleya Pharmacy, in Beyoğlu-Tunnel (1810), owned by Antoine Calléja, the chemistry teacher at the Mekteb-i Tıbbiye-i Şâhâne. Following these, Petraki, the son of Markoviç, was given permission to work in pharmaceutics in Beyoğlu Dörtyolağzı in 1824. The Nicolas Apéry Pharmacy (1831) and British Pharmacy (1833) were next. The pharmacists prepared medicine for each patient individually according to prescriptions provided by the physicians. At the time, there was no medicine available apart from the tiryak that was imported from Italy. Because almost all the pharmacies were destroyed in the great fire that broke out in Beyoğlu on 24 July 1831, the number of pharmacies in Beyoğlu and Galata was only 25, and remained at that number for a long time at the suggestion of the chairman of the pharmacists association, Antoine Calléja, and the association itself.
When Dr. Neuner, who was invited from Vienna, and the pharmacist Hofmann began to work at the palace on 9 July 1835, health workers whose specialties did not previously exist in the Ottoman state, such as pharmacist, assistant pharmacist, and apprentice pharmacist, were recruited by the health commission. A number of pharmacies opened in Galata, Bahçekapı, and Beyoğlu after the Crimean War, and the amount of medicine imported from Europe increased.
The first regulation concerning pharmaceuticals and pharmacies, the Nizamnâme-i Eczacıyan der Memâlik-i Osmâniyye (Ottoman State Pharmaceutical Regulation), entered into effect in 1852. This regulation, which was specifically enforced in Istanbul, was published in Turkish, Italian, and French. It required three years of work as an intern at a pharmacy before beginning pharmaceutical training. Those who earned an internship certificate were allowed to enroll in the pharmaceutical class at the Mekteb-i Tıbbiye-i Şâhâne. Ahmed Mustafa Efendi and Kadri Süleyman Efendi, who started their training at the Tıphane-i Âmire in 1839 and were among the students who transferred to the pharmaceutical class at the Mekteb-i Tıbbiye-i Şâhâne, graduated as military pharmacists in 1840. Civilian pharmacists graduated from the Mekteb-i Tıbbiye-i Mülkiye beginning in 1873 and opened pharmacies. When, after the Second Constitution, the Mekteb-i Tıbbiye-i Şâhâne and the Mekteb-i Tıbbiye-i Mülkiye were merged, becoming the Medical Faculty, pharmacy training was separated from medical training and the Pharmacist School (Eczacı Mekteb-i Âli) was established. This school still exists as the Istanbul University Pharmacy Faculty.
The first pharmacist association was established in 1879 in Istanbul and had 85 members from the Cemiyet-i Eczacıyan der Âsitane-i Aliye (Société de Pharmacie de Constantinople); this body included two Turkish pharmacists, Süreyya Efendi and Ziya Bekir Efendi. Of 252 pharmacies functioning in Istanbul in 1899, 223 belonged to Christians, 15 to Jews, and 14 to Muslims. While most were in Eminönü, there were 96 pharmacies on the coast between Eğrikapı and Yeşilköy. There were 72 pharmacies between Beyoğlu, Galata, and Nişantaşı, 44 pharmacies on the Anatolian side of the Bosphorus, including Kadıköy, and approximately 20 on the Rumelian side. The other pharmacies were in Halıcıoğlu, Hasköy, Büyükada, and Heybeliada.
The Beyoğlu pharmacies were the best in Istanbul in terms of the variety of medical ingredients, equipment, and skills. The earliest pharmacy in Beyoğlu was the Ottoni Pharmacy, which opened before 1832. Eduardo Ottoni, the owner of the pharmacy, arrived in Istanbul around 1819 from Italy, where he had been the pharmacist of a medical school in Rome and the chairman of the pharmacy association (comite pharmaceutique) in 1858.
The British Pharmacy (later the Canzuch -Kanzuk- Pharmacy), established by the brothers Joseph and Noel Canzuch, was active between 1833 and 1965. The Büyük Della Sudda Pharmacy was established by the Italian pharmacist Francesco Della Sudda in 1849. This pharmacist, who won awards at international exhibitions with his collection of Ottoman medicines, was given the title of pasha in recognition of his services. The Güneş Pharmacy was founded by the pharmacist Vincent Zanni near the Ağa Mosque in 1852. The Büyük Pharmacy, established by the pharmacist Pierre Apéry in 1874, contained a laboratory in which biological and industrial analyses were performed. The pharmacy was officially designated to perform food analysis for the Altıncı Daire-i Belediye.
The Büyük Paris Pharmacy was established by the French pharmacist Jean Cesar Reboul in 1895 at Grand Rue de Péra No. 116 (No. 94 today). It still functions under the name Rebul Pharmacy in the same location. The Rebul Lavander Cologne, which was launched in 1936, is still produced today. It received a gold medal from the World Quality Control Center in Brussels in 1981.
Pharmacist Ahmed Hamdi Bey opened a pharmacy in Zeyrek in 1880; this led to the development of the pharmaceutical industry in Turkey. At the Eczahane-i Hamdi (Hamdi Pharmacy), many students carried out their internships and famous Turkish pharmacists such as Beşir Kemal, Mehmed Kâzım, and Cemal Kâzım were trained.
In addition to preparing syrups, tablets, pomades, and other medicines according to doctors’ prescriptions, pharmacists also sold imported products. Due to their quality, imported products were popular with doctors and the public; later, doctors began producing their own pharmaceuticals in laboratories in their own pharmacies. Some of these, known as müstahzarat-ı tıbbiye-i Osmaniye (Ottoman medical products), were also produced in small factories established by pharmacists. To encourage the local pharmaceutical industry, the Sıhhat ve İçtimai Muavenet Vekâleti (Health and Social Aid Department) prohibited the import of 308 medicines that could be produced in Turkey. In the early Republican era, this ban encouraged pharmacists to produce their own pharmaceuticals. At Turkish medical congresses, which were held every two years, exhibitions of locally produced medicines encouraged pharmacists to continue such production. The pharmacists usually introduced their pharmaceuticals, which they named after themselves, at these exhibitions and at international exhibitions held in Europe, winning many gold and silver medals. When the production of medicine was prohibited in pharmacy laboratories under regulations enacted on 1 June 1955, the era of factory production of pharmaceuticals began; however, this required large investments. Most of the pharmacy laboratories, which could not afford such investments, closed down. The production of national pharmaceuticals thus came to a standstill.
Tradesmen such as barbers, soap-makers, furriers, halvah-sellers, and coffee-sellers also sold products they referred to as medicines in Istanbul. Such unlicensed medicines sometimes resulted in deaths. Chemical compounds sold by a halvah-maker from Karagümrük, Hüseyin, caused several deaths; he was punished and exiled to Rhodes in 1848.
The Honorary Chief Pharmacist Title
Abdulhamid II rewarded pharmacists who provided some medicines to state health and social aid institutions without charge with the title Fahri Eczacıbaşılık (Honorary Chief Pharmacist), which entitled them to display the Ottoman crest and seal. The pharmacist George Nalpas, owner of the Eczahane-i Türkiye in Sirkeci, received the title Dârülaceze, Dârüşşafaka ve Tophane-i Âmire Eczacıbaşılığı for his contribution of 100 liras worth of medical supplies to the Darülaceze, Darüşşafaka, and Dulhane in 1893.
The pharmacist Haçik Emirzéyan, whose pharmacy was in Çemberlitaş, annually donated pharmaceuticals worth 60 lira to the Haseki Women’s Hospital, and was given the title of Fahri Eczacıbaşılık of the Women’s Hospital in 1894. Joseph Zanni, both a pharmacist and a chemist, supplied schools, pharmacies, and hospitals with goods at a 10 percent discount in return for the title of Chimiste de S.M.I. le Sultan in 1895. Hamdi Bey, one of the first Muslim Turkish pharmacists, displayed the arma-i hümayun (imperial crest) on the doors of his pharmacies in Vezneciler and Sirkeci-Köprübaşı in recognition of his medical donations to Darülhayr in 1907. The doors of the Eczahâne-i Cemal Kâzım in Üsküdar-İskelebaşı also carried the Ottoman crest and seal.
Ban on Provincial Pharmacists in Istanbul
To prevent all qualified pharmacists from coming to Istanbul, pharmacists from other areas were not allowed to set up a business in the city. Although this was without legal basis, Istanbul-born pharmacists benefited.
After the declaration of the Second Constitution, provincial pharmacists argued that according to the principles of equality upheld in the constitution (kanun-i esasi), they had the right to open a pharmacy in Istanbul, and began to apply for permission to do so. The Meclis-i Tıbbiye-i Mülkiye and Sıhhiye-i Umumiye, which were responsible for all civilian health issues, asserted that if provincial pharmacists were allowed to open pharmacies in Istanbul, the number of pharmacies would increase, and competition over pricing would produce lower-quality medicine. Thus, they asked that the number of pharmacies be restricted. Meanwhile, the regulation of pharmacies was not applied due to wartime conditions, so provincial pharmacists could not be prevented from opening their own pharmacies. By 1927, the number of pharmacies reached 300. Following complaints from pharmacists who were facing financial hardship, the number of pharmacies was fixed under the Pharmacists and Pharmacies Act 964 (964 sayılı Eczacılar ve Eczaneler Hakkında Kanun). Ninety pharmacies in Istanbul that did not meet requirements were closed in 1928. In 1953 the restriction on pharmacy openings was lifted.
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1 Founded by the İdare-i Tıbbiye-i Mülkiye Nizamnâmesi in 1869, it dealt with all aspects of public health and forensics.
2 Cerîde-i Havâdis, nr. 837, 29 N. 1273 (23 Mayıs 1857).
3 BOA, HAT, nr. 1724 (1217/1802).