The Turkish physician Serafeddin Sabuncuoglu (1385–1470) is the author of a famous treatise of surgery, Cerrahiyetü'l Haniyye (Imperial Surgery), composed in Turkish in 1465. It was the first illustrated surgical atlas and the last major medical encyclopedia from the Islamic world. Though the treatise was largely based on Al-Zahrawi's Al-Tasrif, Sabuncuoglu introduced many innovations of his own, among which the introduction of views in which we see female surgeons illustrated for the first time. In this article, Dr Osman Sabuncuoglu and Dr. Salim Ayduz present the life and works of this original scholar and characterise the contents of his works.
Table of contents
The full name of our physician is Sabuncuoglu Sharafaddin b. ‘Ali b. al-Hajj Ilyâs b. Sha'bân al-Amâsî al-Mutatabbib. He was born at Amasya around 1385 and died at Amasya, after 1468. He was of Turkish origin and lived in the Ottoman State during the time of its progressive expansion in the 15th century. His grandfather Hajji Ilyas Beg was a palace physician in Bursa during the Sultan Çelebi Mehmed reign (1413–1421).
Amasya, the hometown of Sabuncuoglu, was a centre of commerce, culture and arts, in northern Anatolia in what is now Turkey. There is very limited information about his early childhood life and education. He started his medical career when he was seventeen years old, when he took medical lessons from Burhan al-Din Ahmed ibn Al-Nakhchivânî. As soon as he completed his medical education, he practiced medicine as a chief physician for fourteen years at the well-known Seljuk Hospital, known today as Amasya Hospital founded in 1308-9 by Anber b. Abdullah on behalf of Sultan Olcayto and his wife Yildiz Hatun. During the Candaroglu Isfendiyar Bey Reign (1385-1440), Sabuncuoglu went to Kastamonu and practiced medicine for a while for the ruler, then returned back to Amasya again. He went to Istanbul, sometime, most probably to present his book Cerrâhiyetü'l-Hâniyye to the Sultan Mehmed II. On his way back, he visited the cities Bolu, Gerede and Tosya.
His book Cerrahiyetü'l Haniyye (Imperial Surgery) is the first example of an illustrated surgical textbook in the Turkish and Islamic medical literature. Only three copies of the book survive today (Istanbul Üniversitesi Istanbul Tip Fakültesi Tip Tarihi ve Deontoloji Anabilim Dali library, MS No. 35; Fatih Millet Library, MS no. 79; Bibliothèque Nationale de France, Paris, MS No. 693).
Sabuncuoglu was a polymath physician and particularly was very famous on surgery. He treated so many patients whom came to him from various places of Anatolia and registered some of his operations in his book Cerrâhiyetü'l-Hâniyye. Apart from practical experiences, he also endeavoured to compose books on medicine and wrote three books on this subject.
Figure 2: Incision and evacuation of hydrocephalus. Note the reversed T-type incision and wide and sharp pointed scalpel. Reprinted with permission from the Fatih National Library, Istanbul, MS 79, f. 48b).
Through Sabuncuoglu's book, beside surgical practices, we understand that he paid big attention to the medical deontology too. Although he knew Arabic and Persian, he wrote all his book in Turkish and contributed to improve the Turkish medical vocabulary. He used many medical books of his predecessors. Due to his long medical life, he had numerous medicine students. One of them was Phyiscian Giyas Muhammed al-Isfahanî who wrote a medical book in Persian .
Sabuncuoglu is the author of several medical works, all written in Turkish language, testifying thus of the linguistic shift that happened in the 14th and 15th centuries: the progressive transformation of Turkish, but also of Persian, as languages of science and medicine, besides Arabic, which was almost the unique linguistic vehicle of knowledge in the Islamic world for centuries.
The list of Sabuncuoglu's works contain the following titles.
The Cerrâhiyetü ‘l-Hâniyye (Imperial Surgery) was written in Turkish. It is a well illustrated surgery book written for Sultan Muhammad II and dedicated to him. It was composed in 1465, when the author was eighty-three years old. The book is mainly the translation of the thirtieth chapter of the famous book Kitâb Al-Tasrîf li-man ‘ajiza ‘an al-ta'lîf by the Andalusian physician and medical writer Abu al-Qasim Al-Zahrawî (d. 1036); this chapter is devoted to surgery. In addition, Sabuncuoglu wrote two more chapters (fasil) and abundant illustrations of surgical instruments and operation scenes in the form of miniatures and illumination.
In the extant manuscripts of the Cerrâhiyetü ‘l-Hâniyye, the book consists of three chapters divided into 193 sections. The latter deal with all fields of surgery, including ophthalmology. The author quoted relevant Greek, Arabic and Persian textbooks. He also added his own experiences that he gained during his practice of surgery, while treating patients. His additions incorporate original information on the subject. Some of his ideas carry innovations of which go back to the Central Asia Turkish-Mongol medicinal tradition and some Far East medicine experience.
An important aspect of the originality of the Cerrâhiyetü ‘l-Hâniyye rests upon the inclusion of colour miniatures of the surgical procedures, incision techniques and instruments, all drawn by Sabuncuoglu himself. Beside the surgical instruments drawn by Al-Zahrawi in his book, he added new images about the treatment of patients that brought a new view to the Islamic medicine. These new images indicate how to make a surgical operation and surgical intervention. The use of human images represented an important step in the history of the Turkish-Islamic medicine.
In the epilogue of the book, Sabuncuoglu explains why he wrote this book in Turkish: "Bu kitabi Türkî yazdum. Türkî yazdugum sol ecilden oldu kim Kavm-i Rûm Türkî dilin söylerler....okuyanlari dahi Türkî kitablar okurlar.. (I wrote this book in Turkish. The reason is that the nation of the Rum (Anatolia) talks in Turkish language… and the readers also read in Turkish language". Furthermore, he added, the surgeons who ignore Arabic cannot read the books written in Arabic and, consequently, cannot follow the progress of medicine, which may result in making mistakes in operations they conduct. He said also that it is necessary to write academic books to introduce himself to Sultan Muhammed II and to take the attention of the sultan. He specified that Muhammed II liked scientific books and also supported science at that period of time.
The Cerrâhiyetü'l-Hâniyye could also be considered as an important paediatric surgical atlas. Its colourful, descriptive pictures of various operations and surgical instruments make it a significant piece of work. This important textbook combines knowledge of Greek, Arabic, and Turkish surgery techniques and nourishes the basic concepts in this specialty, with Sabuncuoglu's original contributions on surgical procedures, postoperative care, and surgical instruments. Thus, Greek, Arabic, and Turkish surgery combined extraordinarily in his book.
This book is also important due to its anatomy sections and the richness of the medical terminology used in it, particularly Turkish medical terminology. It also echoes of the Anatolian Turkish features of that time. We find in the book that vowels points were carefully added. For the history of the Anatolian Turkish language, the book is also a significant source for the roots, vocabulary and grammatical structure of this language in the mid-15th century. Beside the language features, the images are also a very important source for the historians of Turkish art.
In the field of medical knowledge, the Cerrâhiyetü'l-Hâniyye represents the level of the Turkish surgery during the 15th century. The book explains the reasons of diseases. For instance, concerning the "Humoral Pathology" which was common at that time, he refers scholars such as Hippocrates, Ibn Sina, Galen and Al-Zahrawi.
The French national library in Paris (Bibliothèque Nationale, Supplément Turc, MS 693, 205 folios) holds the original copy of Cerrâhiyetü'l-Hâniyye dedicated to the Sultan Muhammed II and written by Sabuncuoglu himself. In addition, there are two more copies in Istanbul libraries: in the Istanbul National Library of Fatih and Capa Medical History Department of Istanbul University .
Cerrâhiyetü'l-Hâniyye contains four major parts: Cauterisation Techniques: General Surgery including Paediatric and Plastic Surgery; Orthopaedics; and Medical Preparations innovated by Sabuncuoglu. The three different manuscripts of the book were translated into modern Turkish language and compared with Al-Zahrawî's treatise and other ancient surgical textbooks. Sabuncuoglu's special contributions and original remarks were investigated. The book was published first by A. Süheyl Ünver under the title Sharafaddin Sabuncuoglu Kitâbü'l-Cerrahiyei Ilhaniye (Cerrahnâme), (Istanbul 1939) and later on by Ilter Uzel with transliteration and commentaries (vols. I-II, Ankara 1992).
Besides several original contributions noted by the scholars, Sabuncuoglu's book is unique for the revolutionary illustrations used to show details of the surgical procedures described. During the previous prevailing period of Islamic medicine, it was not common use to illustrate medical texts with images representing the human body.
An original aspect of Sabuncuoglu's book is that it contains a few sections related to psychiatry with the earliest known colour illustrations of the field, drawn by the physician himself. One section is on the cauterization of "mâl-i hulyâ," which refers to a variety of neurotic disorders, and the other is about "unutsaguluk", which means forgetfulness. Sabuncuoglu recommended a stepwise approach in treating both disorders: the use of herbal medicine, then the application of warm oil derived from sheep's tail fat to the vertex area, and finally, if all efforts failed, cauterization with heat at certain points, with caution against the risk of harming the skin.
Apparently, Sabuncuoglu did not practice as a surgeon but as a general physician capable of treating all kinds of medical surgical conditions, including psychiatric ones. In the following centuries, Amasya Hospital where he practiced evolved from a general hospital into one providing services only to mentally ill people and remained so for a long time.
Along with his pioneering work, Sabuncuoglu deserves attention and recognition for his professional qualities as a modest researcher, a fine clinician, and a devoted medical educator with high ethical standards. No doubt, his advice to colleagues is still valid today, regardless of their specialty: "Keep your compassion separate from your fame and ambition" .
After his works at Amasya Dârussifa (Amasya Hospital) for fourteen years, Sabuncuoglu was asked by his friends to write a book ("compose a book upon your experience you gained so far, hence we should not look to other books"). He thus wrote in 1468 an abridged book, the Mücerrebnâme (On Attemption), while he was eighty two years old. The Süleymaniye library owns a copy of this treatise (Ayasofya, MS 3720, 106 folios) .
When we compare it to his other books, this one is more common. He explains how he prepared the drugs which he experienced himself on humans and animals and how they can be used.
The book consists of seventeen chapters. It starts from the most common drugs and ends with the less used ones. This is a very important pharmacology book on the history of medicine which explains how to use and in which case you have take these pills, drugs, syrups, dust, paste, plaster, enemata etc.. It can be said that this book is the first empirical book on the subject.
2.3. Terceme-i Akrabadin
The third book by Sabuncuoglu is Terceme-i Akrabadin (Translation of pharmacology), in thirty three chapters (Süleymaniye Library, Fatih, MS 3536, 239 folios). It is a Turkish translation of the pharmacology part in Abu Ibrahim al-Jurjânî's Arabic book Zahîre-i Harezmshâhî, which is the tenth and last chapter of the book. Sabuncuoglu carried on this translation upon the request of the physician Sheikh Mehmed b. Ahmed of Prince Bayezid who was prince at that time in Amasya, in 1444. the author added two more chapters to the original book, which has only thirty-one chapters. He also added Arabic, Persian and Turkish medical words and technical terms.
In the epilogue of the book, he explains why he translated this book into Turkish saying: "...zirâ kim ilm-i tibbin kitâblari Fârisî ve Tâzî dilinde düzülmisdür. Rûm ehlünün ekseri Arabî ve Fârisî dilün bilmeyüp âciz ve âtil olmuslardi" (because most of the medical books were written in the Persian and Tazi languages, most of the Anatolians do not understand these languages, and they became useless).
Sharafaddin Sabuncuoglu was also a good calligrapher and he copied one of his students, Muhiddin Mehî, lyric book Nazm al-tashîl and Halîmî's Persian lyric medical book.
Serafeddin Sabuncuoglu operated throughout the human body well before the development of sterile technique and modern anaesthesia. He used a combination of mandrake root and almond oil for analgesia and general anaesthesia. Mandrake (mandragora officinarum L., of the nightshade family [Solanaceae]) has the general properties of belladonna and was formerly used as a narcotic and sedative. It contains the alkaloids mandragorine, hyoscyamine, and scopolamine. The knowledge of medicine and pharmacy in Anatolian Seljuk's Dynasties and the Ottoman period is the continuation of the former Islamic civilisation. In Islamic civilisation, many hospitals were established with functioning pharmacies that prepared medicines for their patients. In hospitals, those in charge of drug-preparation as pharmacists were named Saydalan or Ispengiyar.
Serafettin Sabuncuoglu discusses operational anaesthesia in his book Cerrahiye-i Ilhaniye as follows:
"Some patients might be able to resist incisions and cauterization, while others might not. Therefore, narcotic medicine called murkid is necessary to prepare when needed, so that the operation might be possible. Take and cut the fresh parts of Luffah (mandragora), pound and mix it with almond oil and let it stay for a day and night. Then, the surgeon who wants to use it must give one drachm (dirhem = dram = 4 g) of it to be eaten before meal. A little later, you'll see that the patient will lie down and fall asleep without perceiving you. Then, practice whatever treatment you want to do. Give one drachm of it to the adult, but administer only the amount needed for children, so that no malpractice occurs. This is the narcotic I used all through my life and did not need any other aesthetic medicine."
- Adnan Adivar, Osmanli Türklerinde Ilim, Istanbul l982, pp. 51-52, 57.
- Adnan Terzioglu, "Sharafaddin Sabuncuoglu Fatih Döneminin Ünlü Türk Hekimi", Tarih ve Toplum, 16 (1991), pp. 28-31.
- Ali Canip, "Cerrahiye-i Ilhaniye-Tabâbet Tarihimiz Noktai Nazarindan Mühim Bir Eser", Hayat Mecmuasi, 42 (1927), p. 3.
- Ali Haydar Bayat, "Amasya'li Sabuncuoglu Sharafaddin (788/1386-873/1468'den sonra) Bibliyografyasi", Tip Tarihi Arastirmalari, 2 (1988), pp. 92-101.
- Ali Haydar Bayat, "Cerrâhiyye-i Ilhâniyye", DIA, VII, p. 420.
- Bedii Sehsuvaroglu, Tip Tarihi, s. 53-54.
- Bursali Mehmed Tahir, Osmanli Müellifleri, III,Istanbul, pp.. 220, 369.
- Cevat Izgi, Osmanli Medreselerinde Ilim, Isatnbul 1998, I, s. 77.
- Demirhan Erdemir "Sifali Bitkiler Dogal ilaçlarla geleneksel tedaviler" in Medicinal Plants: Traditional Treatments with Natural Drugs. Istanbul: Alfa, 2001: 100-1.
- Fuat Kâmil, "Cerrah Sharafaddin Sabucuoglu Eserinin Abülkasim Zehravî Eserile Mukayesesi", Türk Tip Tarihi Arkivi, 11 (1939), pp. 96-98.
- Gevher Nesibe Sultan Anisina Düzenlenen "Serafeddin Sabuncuoglu Kongresi" Tebligleri 14 Mart 1985 Kayseri (yay. A. H. Köker-Y. Erdogan), Kayseri.
- H. Kafali, Aksoy S, Atmaca F, San I. "Colored illustrations of obstetrics manipulations and instrumentation techniques of a Turkish surgeon Serafeddin Sabuncuoglu in the 15th century", Eur J Obstet Gynecol Reprod Biol, 2002; 105: l, 97-202.
- History of the literature of medical sciences during the Ottoman period, ed. E. Ihsanoglu. Istanbul: IRCICA, 2008, I, 56-60.
- Hüseyin Hüsâmeddin, Amasya Tarihi, Istanbul 1328, I, 125, 172.
- Ibrahim Basagaoglu, S. Karaca, Ziya Salihoglu, "Anaesthesia techniques in the fifteenth Century by Serafeddin Sabuncuoglu." Anesth Analg, 2006:102:1287-99.
- Ilter Uzel, Cerrâhiyetü'l-Hâniyye, Ankara 1992, pp. 20-36.
- Kadircan Keskinbora, "Turkish: The language of science in Anatolia between 13th and 15th centuries", VI. Uluslararasi Türk Dili Kurultayi, 20-25 October 2008, Turkey.
- Osman Sevki, Bes Buçuk Asirlik Türk Tababeti Tarihi, Istanbul 1341/1925, p. 159.
- Ramazan Sesen, Fihrisü Mahtutatü'l-tibbi'l-Islâmi, pp. 274-275.
- S. N. Cenk Buyukunal and Nil Sari, Serafeddin Sabuncuoglu, the Author of the Earliest Paediatric Surgical Atlas: Cerrahiye-i Ilhaniye (published 7 September 2005).
- S.N. Büyükünal and N. Sari, "Serafeddin Sabuncuoglu, the author of the earliest pediatric surgical atlas: Cerrahiye-i Ilhaniye", J Pediatr Surgery, 1991;26:1148-51.
- Süheyl Ünver, "Bes Asirlik Bir Cerrahi Kitabimiz", Belediye Mecmuasi, nr. 79, Istanbul 1931, 9-12.
- T. Dogan, Bayramicli M, Numanoglu A. "Plastic surgical techniques in the fifteenth century by Serafeddin Sabuncuoglu", Plast Reconstr Surg, 1997; 99: 1775-9.
- V. B. Kurdoglu, Sâir Tabibler, Istanbul 1967, pp. 120-123.
 See A. H. Bayat, "II. Bâyezîd Dönemi Hekimlerinden Giyâs ibn Muhammed es-Sayrafî el-Isfehânî", Tip Tarihi Arastirmalari, vol. 8, 1999, pp. 187-203.
 Istanbul, Fatih Millet Library, MS 79, 1st manuscript of the codex; Istanbul University, Capa Medical History Department Tip Fakültesi Tip Tarihi ve Deontoloji Anabilim Dali library), MS 35, 3rd manuscript of the codex.
 Ilter Uzel, Cerrahiyetü'l-Haniyye, Ankara, Turkey, Türk Tarih Kurumu Yayinlari, 1992, vol. 1, p. 66.
 Zafer Önler, "XV. Yüzyil Hekimlerinden Sabuncuoglu Serefeddin'in "Mücerrebnâme" Adli Eseri", Firat Üniversitesi Dergisi (Sosyal Bilimler), 1 (1987), pp. 169-190.