In the history of Islamic civilization, many hospitals were founded by women, either as wives, daughters or mothers of sultans. All health personnel were male at these hospitals. In the Ottoman period, the female patients were treated either at their homes or at the residences of the medical practitioners until the 19th century. This feature somewhat explains the rich varieties of females practicing medicine both in and outside the Ottoman palace. In this article, Professor Nil Sari, provides information on the various medical practices dedicated to female patients under the Ottomans.
By Nil Sari*
Note of the editor
This paper was originally published in Turkish by Professor Nil Sari in The New History of Medicine Studies, 2-3, Istanbul, 1996-97, pp. 11-64.
Table of contents
1. Female Physicians
2. Female Healers Practicing Traditional Hearth Medicine
3. Women Preparing and Selling Drugs
5. Female Nurses
6. Males treating females
7. Training of Female Practitioners
* * *
Were there women dealing with health care during the Ottoman period? If so, where did they practice? Did they practice in specific fields of health, or did they practice in several fields? Did women traditionally accept to be treated by female practitioners? Did the social practice under the Ottomans favour or prohibit the treatment of female patients by male practitioners?
Though the role and function of women practicing medicine or dealing with health in the Ottoman Empire has not been studied thoroughly yet, my research has showed that there were women of all statuses and classes who had a relation with health, either in sponsoring health institutions or practicing medicine themselves. We know that some of the famous hospitals called dar-al-shifa were founded by ladies, either as wives or mothers of sultans, such as Hafsa Sultan hospital in Manisa (founded in 1539), Haseki Sultan hospital (founded in 1550) and Nurbanu Sultan hospital (founded in 1582) in Istanbul. However, females preferred to be treated either at their homes or at their residences by female physicians, midwives or healers, according to the case to be treated. This was considered to be a protection of the female, not underrating them, as the treatment of a female in a health institution might be commented as a sign of family indifference towards her. For example, in a juridical registry record dated 1673, on an attempt for hospitalizing an insane woman called Fatima for medical treatment in Konya Hospital, his son Ömer objected, saying he would look after his mother at home and treat her. The judge (kadi) decided on behalf of the son. However, women relatives were especially expected to look after the sick member in the family.
Wide outpatient treatment of females in a health institution dates back to 1839, at the Medical School clinics. The hospitalization of female patients started to be a usual practice at the Haseki hospital in 1843. However, especially those poor, homeless, unprotected or disabled females, began to be treated at the hospital, as we infer from archive documents. These facts explain the variety of the female practicing medicine both in and outside the Ottoman palace, which I came to discover during my research. In the following sections, I will present a concise information about various female medical practitioners.
Figure 2: A woman with a belly wrap (Paris, Bibliothèque Nationale, Département des Estampes, Od. 26-26a). © Nil Sari and Ulker Erke.
Primarily I will try to define the concept of female physician, which is somewhat different from that of a midwife, as the midwife was called "ebe" or "kabile" , and her main job was to help child birth.
As depicted in the miniature paintings of the 15th century Turkish manuscript on surgery, called Cerrahiyetü'l Haniye of Sabuncuoglu, the female physician who was involved with the operation of the female patient was called "tabibe" meaning female physician, whereas "tabib" meant male physician.
It is really interesting to note that female physicians named "tabibe" were depicted in Sabuncuoglu's treatise practicing gynecological operations, such as the treatment of hermaphrodite, imperforated female pudenda, hemorrhoids and warts, and red pustules arising in the female pudenda. In the same manuscript, midwifes called "kabile" were noted as treating perforation of eruptions occurring in the uterus, treating living fetuses when not brought forth in the natural manner, treating imperforate anus and the extraction of the dead fetus. The chapters on the forms of instruments necessary for extracting the fetus was addressed to the midwife, which is reasonable, for these last two chapters are related with child birth. However, it is difficult to describe the reason why some operations were addressed to female physicians, while others to midwifes.
It is interesting that Al-Zahrawi did not mention female physicians in the chapters dealing with gynecological operations given above. Actually, he did note midwifes in the chapters on childbirth in his book on surgery which Sabuncuoglu translated and enriched with his own experiences. In contrast, Sabuncuoglu as we noted mentioned female physicians and called them "tabibe" in the above mentioned chapters.
Several documents related with the Ottoman palace give us reliable information about female physicians. We know that both the palace in Adrianople built in 1450 and the old Palace at Bayezid and the Topkapi palace had a large hospital within the Harem and a bath for the patients in the Harem. The hospital, probably built at the beginning of the 17th century at the Harem of Topkapi Palace, called "Cariyeler Hastanesi", was for the residents of the Harem, most of whom were maids and their mistresses educated in a field of art or service. There was a female health team, a member called "hastalar ustasi", meaning the "patients mistress" and her assistant (cariyesi); and the "hastalar kethüdasi kadin" meaning the female warden of patients and her assistant (cariyesi); and the female physician, hekime kadin. Their salaries were registered in 1798-99. The Topkapi Palace Harem hospital, its bath and the "patients' kitchen" still exist.
We have archive documents about male patients who were operated by two female gypsy physicians. These patients were living in different parts of the country, far away from one another. Itinerant physicians, that is physicians without an office who traveled from one district to another and settled for a while when there were patients to be treated, greatly out numbered those who had offices.
When the treatment at the palace failed to heal a woman or a child of the Sultan (in the Harem), healers outside the court were called to the palace. Two documents in the Topkapi palace archive, dated from the mid 17th century, are about the head physician Cemalzade Mehmed Efendi's invitation of a famous female physician called "hekime kadin" from the country, residing at Scutari, to the old palace, "Saray-i Atik", to heal three female patients named Ferniyaz Kalfa, Lalezar Kalfa and Nazenin Kalfa in the department of the sick. "Hekime Kadin" and "hekim", means a female physician and a male physician, respectively. In the late 18th century, d'Ohsson, the acting Swedish ambassador, notes in his book on the tradition and customs about Turkey about female physicians named "hekime kadin", with little knowledge but great experience, who were also called to the Harem, when needed. For d'Ohsson, these female physicians practiced midwifery, too. (The function of the female physician (hekime kadin) usually embraced midwifery as well, while the midwife was usually responsible only for child birth).
Ali Riza Bey notes the invitation of a female healer called Meryem Kadin, as a result of the failure of the physician employed at the palace to cure Abdülmecid, the heir to the throne in the early 19th century. This women being successful to cure Abdülmecid, was awarded a monthly salary and free entrance to the Harem. Employment of female physicians at the palace was continued in the second half of the 19th century, too.
One of the four Muslim physicians amongst the ten physicians employed at the Royal Pharmacy of the Yildiz Palace in the year 1872 was a female physician named "Tabibe Gülbeyaz Hatun", whose monthly salary was "200 akçes". However, whether she was a pharmacist or physician is a matter of discussion. If we consider the different practice started in the 19th century when the pharmacies began to serve as clinics of a district where physicians served people in a part of the pharmacies, we can conclude that she might be either a physician or a pharmacist. We should keep in mind that medical practice was not differentiated strictly in various fields of the profession, as it is today.
Abdülaziz Bey's notes on the Ottoman traditions, ceremonies and terminology, probably composed in 1910, also mentions that female physicians were invited by the courtiers and were assigned salaries and awarded "Bairam", that is, yearly religious allowances.
Female physicians called "morti tabibe" were also employed at the quarantine office, probably for post mortem studies. We find their salaries listed in a register of salaries of the quarantine personnel, in a document dated 1842.
Another source which proves the existence of female physicians is epitaphs, of which an interesting example is found at the mosque yard of the small Aya Sophia (Hagia Sophia) mosque in Istanbul. A meaningful verse was engraved on the tome stone of the "tabibe kadin", a female physician, dated 1802. A line of the verse laments "Alas! The female physician, her own ailment she failed to heal".
Female healers practicing "traditional hearth medicine" formed another group of female practitioners who generally used to deal with a single illness they treated with folkloric medicine, usually ritually administered. The earliest samples related with hearth medicine goes back to the 14th century, when Karacaahmed, who lived in a village of Afyon, named after him, healed the insane. His grand daughters came to be known for the treatment of insane females. This tradition continued up to the 20th century. The most known of these healers were women inoculating against smallpox, the practice of whom lady Montagu, the wife of the English ambassador, described in her letters sent to her friend in England in 1717. Abdülaziz Bey notes of female physicians whose skill was used to be transferred traditionally from mother to daughter and the practice was called hearth medicine and each practitioner being a member of a hearth represented a family. Among these female healers, those who prepared drugs and were known for treating syphilis were called "hekim kadin". Abdülaziz Bey notes that these female drug preparers were invited to the palace and given salaries and Bairam presents. Among these healers, those treating stomach swelling and diarrhea of children were called "Kirbaci Kadinlar" who practiced in the neighborhood of Aksaray and Bozdogan Kemeri in Istanbul. They treated children with folkloric medicine, the main ingredient being cultured worms, ritually administered. Another group of female healers was the "alazci kadinlar" who cured the illness called "alaz", which was usually said to be seen on the cheeks of children, which was a kind of eczema with itching and crust. Children were taken to them or they were called home before sunrise and treated with medicine, the main ingredient being ash, in coordination with a ritual. Another group was the alopecia healers. At the beginning female healers of alopecia were Jewish, while later Moslem women came to practice the same art in Istanbul in several districts. Some of them were midwifes, too. Abdülaziz Bey describes this illness as a kind of eczema painful and itching, forming a thick crust bleeding and oozing continuously on the scalp. Its methods of treatment, though very painful, was often useful. The treatment was based on applying clay for a couple of days, then covering the head with a compound made of pitch and several herbal drugs, which was pulled off the scalp in 15 minutes following the application. After the crusts came off, the head was covered with a healing compound. This process was continued, with some changes until recovery. Women who treated phobias were called "Pressers on the fear vessel" which was believed to be in the inguinal region. Lead melters (those melting lead and pouring it into cold water over the head of the sick person) tried to treat children from insomnia and convulsions, and old women's headache, vomiting, anxiety etc.
Figure 4: Rustam's birth from Shahnamah Firdaws (Book of Kings of Firdaws), Türk Islam Eserleri Müzesi Kütüphanesi, 1984, fol. 48a. © Nil Sari and Ulker Erke.
Women preparing and selling drugs can be regarded as another group, though all health practitioners probably prepared the drugs they needed. The phrase, "old women's medicine" (koca kari ilaçlari), meaning folk remedy is a wide spread phrase defining the tradition of women preparing drugs. Ibn Serif, a known 15th century physician, advised his readers in his book Yadigar to use physicians' tried, hence known drugs and beware of taking old women's remedy.
There might have been a conflict between the professionals and the folk medicine practitioners.
Many of the prescriptions prepared were taken in the spring as prophylactic against illnesses. For example, as we learn from the travels of Evliya Çelebi of the 17th century there were women from Adrianople who prepared and sold rose water in large earthenware jars. Gypsy women collected fragrant flowers and medicinal herbs from fields and prepared paste. The notes of Abdülaziz Bey show us that there were various groups of women who prepared traditional medicine from medical herbs and animals. They were known according to the drug they prepared, such as "tosbagaci kadin", meaning "tortoiser women".
There was a long tradition of females practicing midwifery during the Ottoman reign as we infer from the documents and the literature we have studied. The art of midwifery was usually a family profession, transferred from mother to daughter or to a close female relative. There are archive documents recording the appointment of primary and secondary midwifes to the palace. Besides paid midwifes employed in the palace, there were others called in from time to time. The midwifes at the palace and those in the service of the nobles led a rich life. Cleanliness and good manners as well as efficiency in delivery were important merits in order to be favored and become famous. Although abortion was strictly forbidden, there are some documents proving that it was practiced from time to time especially in the 19th century. According to Abdülaziz Bey there were three classes of midwifes: the midwife of the palace (saray-i hümayun ebesi), the midwife of the noble (kibar ebesi), and the midwife of the common people (ahad-i nas ebesi). Some of the known midwifes of the 19th century were called by nicknames, such as "Silver Knifed" (Gümüs Çakili ebe); "Pretty Handed" (Eli Güzel ebe); "Ear Ringed" (Küpeli ebe); "Jugged" (Fuçulu ebe); "Virgin" (Kiz ebe) etc., and some were known with their birthplaces. Epitaphs of midwifes are found in cemeteries, the one of Emine Kadin, dated 1750 is an example.
Figure 6: Another depiction of Rustam's birth from Shahnamah Firdaws (Book of Kings of Firdaws), Türk Islam Eserleri Müzesi Kütüphanesi, 1945, fol. 67a. © Nil Sari and Ulker Erke.
Unlike medicine and midwifery, nursing as a profession for the female was not emphasized until the beginning of the 20th century, as mothers, wives, sisters, and relatives of the sick spontaneously acted as nurses, as we infer from the works of the gynecologist Besim Ömer Pasha who supported the formal nurse education in 1914. However, we must point out that all through Ottoman history there were male nurses called "kayyum", of whom the ethical qualifications expected are noted in detail in the waqfiyyes charts of hospitals. Male nurses were also found in armies. The only exception we know of female nurses are women called "nineler", meaning grandmothers or "analar", meaning mothers, who were paid nurses employed at the Palace School Hospitals for pages and in the Harem Hospitals. The head of the nurses was called Bas Hatun, who retired when pîr, meaning aged, which does not infer a certain age. The formal education of female nurses was started as an independent profession at the beginning of the 20th century and it was the Balkan and the 1st World War that showed the great need for female nurses in helping treatment of the wounded soldiers. Though Florence Nightingale practiced nursing at Istanbul during the Crimean War, she was to be taken as a model much later. Dr. Besim Ömer Pasha was the leading name in starting the education of female nurses.
Figure 7: The Main gate of Amasya Dar Al-Shifa. The image is depicting Sharaf al-Din Sabuncuoglu, the chief physician of the Dar Al-Shifa, with his two students. © Nil Sari and Ulker Erke.
A question we should point to is the male treating the female. The information found in medical manuscripts that women were permitted to treat men and men could treat women, if necessary, was driven from examples from the period of the prophet Mohammed, when women such as Ümmiyetü'l Gaffariye healed men wounded at war.
Though a female practitioner was preferred to treat the sick female, we know that, when needed, male physicians, even those who were non-Muslims, were allowed to treat them, according to the belief "necessity permits the forbidden". We have miniature paintings in Cerrahiyetü'l Haniye's copies depicting a male physician treating a female stark naked, on chapter 39 of the first book "on the cauterization of the womb". The 71st chapter on the circumcision of the female, that is "on cutting the clitoris and fleshy growths in the female genitalia" is also noted to be practiced by a "tabib", the male physician. In the 61st chapter of Cerrahiyetü'l Haniye on the extraction of a stone from the female, just as in Al-Zahrawi's text, it is noted that it was hard to find a woman competent in the art of surgery; though Sabuncuoglu says that if a woman physician, whom he calls "tabibe avret", could not be found, a competent male physician of good morality should be asked to do it.
The fact that the treatment of female patients could be carried out by men, as well as by women, can also be seen in the documents of illustrative cases of trials. We can quote two examples of juridical registrations from Afyonkarahisar in middle Anatolia. In the one dated 1654, Hasan the plaintiff sued the male surgeon Hüseyin, who operated a tumor on the forehead of his wife Zülfi, who lost her life because of the operation. The other document from Afyon dated 1691, is a written consent which was signed between the female patient Zeynep, suffering from a tumor in her throat, and a male surgeon named Abdurrahman Çelebi, for the operation.
Robert Withers, an official of the British Embassy, describing the life in Istanbul at the beginning of the 17th century, quoting the Venetian diplomat Ottaviano Bonn's studies, notes that, in case of need for a surgeon, the female disregarded her religious conviction and did whatever she could to regain her health and would not keep herself away from the male physician; however Withers and some other sources note that the sick female was usually covered with a thin cloth.
We have several other examples of men treating female, some of which are related with the Sultans' wives and mothers. We must note that, in addition to female physicians employed at the Harem, male physicians and surgeons were also appointed to the Harem. Several documents prove this. For example, in 1599, on the order of the Sultan (Mehmet III) the surgeon Ibrahim was appointed to the Harem of the Palace in Adrianople. Documents dating from 1667, 1700, 1715, 1770, 1834-1836, and the descriptions therein, such as "being a physician of the Harem of the Palace" or "one of the surgeons serving at the Palace Harem", or "the physicians and surgeons who serve the mother of the Sultan", show that the appointment of paid male physicians and surgeons to the Harem was a tradition. About five male medical practitioners -physicians and surgeons- were on duty. In addition, however, physicians and surgeons were called from the east before Westernization, later from the European countries, to treat the residents of the Harem. For example, a known oculist from Libya was called in; and Dr. Sigmund Spitzer from Austria, a faculty member at the School of Medicine (Mekteb-i Tibbiye), was called to the Harem by Sultan Abdülmecid to treat his third wife and his mother Bezm-i Alem, in 1845.
According to the school reports of the Medical School, male physicians, some non-Muslim, treated hundreds of Moslem "female" patients at the school clinic, in the years 1840's. In the late 19th century, famous male gynecologists, such as Vahid Bey and Besim Ömer Pasha, were called to the palace harem.
Finally, a question occurs about the training of female physicians and midwifes. There is no document showing or implying that women physicians were educated at an institution such as a medresse, hospital or palace school until 1922, when the female were admitted to the Medical school of Istanbul University. It is really hard to explain the source of training and the professional status of the Muslim female physicians employed at the palaces. It will not be wrong to say that women were trained in the master-apprenticeship method, the art usually being delivered from mother to daughter.
Raphaela Lewis notes that, both ignorant and educated people preferred talented female practitioners to the male. Though it was impossible for Muslim women to have medical education like the male, some talented and manually skilled women acquired efficiency in a short time through practice in the field and if such a female had an opportunity to be trained by a male physician, she could even acquire a skill for operating the sick.
Several juridical documents dating 1622 are about a woman surgeon called Saliha Hatun, and the 21 male patients whom she had operated, one of a tumor, the others of hernias.
Though the practice of the traditional practitioners were regarded as illegal in the second half of the 19th century, it continued for a long time along with that of the male health personnel who had a diploma. Gynaecological practices also came to be a problem, as a result of the modern medical education started in Istanbul at the Royal Medical School for educating male medical students. Only midwifery, though restricted to childbirth, was to be permitted for those who attended successfully the course of midwifery run at the Medical School, in accordance with the law passed in 1842. The midwifes, namely Vantor from Paris and Mesati from Austria, were invited to teach midwifery at Mekteb-i Tibbiye, respectively in 1841 and 1846. In addition to those employed at the Medical School, midwifes named Fatma and Nefise were also employed at hospitals of the government in 1863.
In the course of time the requirement for formal education resulted with the isolation and withdrawal of women, specially Muslim practitioners, from the field. European and Ottoman non-Muslim women who attended medical, midwifery and dentistry schools in Europe replaced the traditional Muslim practitioners in the field and they utilized the tendency to prefer female practitioners to men in the treatment of the female, though in case of necessity, as we mentioned, men were asked to treat women.
There were several female physicians educated at European schools who advertised in newspapers that they practiced medicine at their offices. For example, in 1840 Vantor from Paris; in 1840 Madame Anette, a graduate of the school of midwifery in Montpellier; in 1842, Amade Taylul, a midwife from England; in 1894 Madame Marry Marie Zibold, a practitioner of medicine, surgery and midwifery at Beyoglu in Istanbul; in 1896 Irini Anopiloiti, a graduate of the Paris Medical School, advertised in daily newspapers. In 1903, Madmazel Flora advertised that she was practicing dentistry for females at Babiali, in Istanbul.
In an archive document dated 1892, two American female physicians who applied and asked to be permitted to practice medicine in the Ottoman dominion, were welcomed, believing it to be more convenient for the female to be treated by the female.
Female students began to be admitted to the Medical School in 1922, almost a century after its foundation. This admittance during the years when Istanbul was occupied by the allies was proved to be painful. Though midwifery was always regarded as a proper profession for the female and nursing was considered to be a natural service for the female, contrary to the examples that continued for centuries, as we have noted, medicine as a profession was not regarded as a proper employment for the female during the late 19th and early 20th centuries. Turkish leaders of the feminist movement succeeded to win it as a right after a long struggle through the mass media against the male faculty members of the Medical School.
The first enrollment of six female students to the Medical School of Istanbul University was realized in 1922. This was in fact the official confirmation of the female service and employment following regular training in the health field, though female medical practitioners existed all through the Ottoman reign.
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* Professor Nil Sari, Ph. D., from Istanbul University Cerrahpasa Medicine Faculty, Department of Deontology and History of Medicine, is a world expert scholar in the history of medicine, Islamic medicine and culture and Ottoman science and medicine. Professor Sari is also a key FSTC associate. Presently Professor Nil Sari is Head of the Medical Ethics and History Department, Istanbul University, Cerrahpasa Medical School.