Medicine and Healthcare in Ottoman Society

From the fourteenth century to the end of the Ottoman sultanate in 1922, patients received care at home, from independent practitioners, and in an endowed hospital. A physician might assess a patient’s pulse and urine, prescribe a diet, and order a compound medicine; a midwife might attend childbirth in a family’s rooms; a hospital patient might receive meals prescribed by a doctor. Care changed as medical schools and epidemic services developed in the nineteenth century.

On this page5 sections

Practitioners and care at home

Medical work included physicians, surgeons, eye specialists, bonesetters, pharmacists, paste-makers and midwives. In Ottoman Egypt, from 1517 to 1805, practitioners learned through apprenticeship: a learner observed an experienced healer and gradually took on tasks. The occupations were distinct. A physician diagnosed illness and prescribed; a surgeon performed operations, while a barber-surgeon combined shaving with minor procedures. An apothecary prepared and sold drugs, and a paste-maker turned ingredients into medicinal confections.

Women also practiced medicine. In Cairo, Egypt, female doctors and midwives visited patients at home and sometimes kept shops. Midwives assisted births, advised women during pregnancy and treated childhood complaints. They could serve as witnesses or advisers in women’s legal matters as well as provide care. These household visits brought practitioners directly to patients in their family rooms.

Court care followed a separate protocol. Robert Withers’s 1650 English text relayed Venetian representative (bailo) Ottaviano Bon’s description of a 1604–1607 visit. It recounts a physician entering the palace harem, the household quarters, with permission from the Ottoman sultan and an escort of eunuchs. The patient held out her arm beneath a cover so he could feel her pulse. He then withdrew and prescribed a diet or medicine. The account describes how the physician examined a secluded patient without entering her view.

Diagnosis and remedies

Ottoman medical writers drew on humoral medicine, which explained health through the balance of four bodily fluids: blood, phlegm, yellow bile and black bile. Physicians considered symptoms such as heat, sweating or yellowing, and examined pulse, urine and stool. They interpreted these signs as evidence of imbalance and could respond with changes to diet or medicines that purged, induced vomiting or increased urination.

Remedies combined plant, animal and mineral ingredients. A pharmacist or paste-maker pounded or crushed raw ingredients, processed extracts, and mixed them into pastes, ointments, oils, powders, pills or tablets. Liquid medicines were prepared to a physician’s prescription. Diet was also part of treatment: physicians recommended particular foods and drinks alongside a medicinal regimen.

In seventeenth-century Istanbul, Turkey, Ottoman chief physician Salih ibn Nasrullah, also known as Ibn Sallum, translated works by European physicians into chemical recipe collections. He selected material from books by Oswald Croll, Johann Jacob Wecker and Daniel Sennert for medical use. His 1664 book Gayetü’l-Beyan described new drugs and compounds, and cures for diseases he said were absent from established books.

The hospital at Edirne

The Bayezid II complex at Edirne in northwestern Turkey was built from 1484 to 1488 and included a darüşşifa, or hospital. Its three courtyards organized movement from outpatient care to administration and inpatient wards. Six rooms in the first courtyard received outpatients; a pharmacy and rooms for preparing syrups, cooking and laundry supported the service. Four rooms in the next courtyard housed administration. The innermost section held patients.

The central inpatient ward was a domed hexagon with four iwans, open-sided rooms around the hall, used for patients in summer. Doctors prescribed meals for patients, and the kitchen supplied them separately. The complex also had a free outpatient clinic: pharmacists prepared medicines for patients who came for treatment. Doctors could visit patients at home as well.

Music was part of the hospital’s treatment environment. Musicians played from a platform beneath the dome, and the sound carried into patient rooms. A madrasa, an Islamic school, beside the hospital had eighteen student cells. Students completed foundational study there and then continued medical training in the hospital. In Istanbul, the Süleymaniye complex later housed the first dedicated medical madrasa.

The Bayezid hospital belonged to an older darüşşifa tradition, which Ottoman rulers no longer built after the seventeenth century. In the nineteenth century, institutions opened for new patient groups and for medical training.

Smallpox inoculation and quarantine

In the early eighteenth century, local practitioners in Ottoman lands used variolation: they deliberately introduced material from smallpox sores to produce an infection intended to protect against the disease. Lady Mary Wortley Montagu, wife of the British ambassador in Constantinople (modern Istanbul), described the practice in a 1717 letter. In 1718, an experienced local woman inoculated Montagu’s son with a needle; the embassy physician Charles Maitland used his own method on the other arm. The reports helped carry the practice to Britain. Variolation used smallpox material; Edward Jenner’s later vaccination used cowpox instead.

Epidemic controls also developed through port procedures. During the cholera outbreak of 1831, ships bound for Istanbul were held in the Bosporus for five days. Ottoman ships from the Black Sea were assigned to Büyük Liman, while vessels of other states were sent to İstinye. In 1835, authorities set up tents at Çanakkale, on the Dardanelles in northwestern Turkey, for ships headed to Istanbul and required movement certificates. A central Quarantine Council established in 1838 coordinated the system, while local stations issued health papers that travelers needed to continue their journeys.

Medical schools and new hospitals

Mahmud II, sultan (Ottoman ruler) from 1808 to 1839, opened the Tıbhâne-i Âmire, the Imperial School of Medicine, in Istanbul in 1827. Its admissions were limited to Muslims until 1839. In 1866, the government authorized a separate civil medical school; Turkish-language instruction began in its civilian section in 1867 and in the military section in 1870. At Haydarpaşa, students completed a two-year internship in the teaching hospital and passed an examination before receiving credentials for medical posts. The Gülhane hospital school opened in 1898.

An institution for poor and unmarried patients opened at Edirnekapı in Istanbul in 1836. Bezmiâlem’s hospital, also in Istanbul, was completed in 1845 and began admitting patients in 1847, after the smallpox outbreak of 1843 exposed inadequate facilities.