Medicine

Medical History

Women Dealing with Health during the Ottoman Reign

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
4. Midwifery
5. Female Nurses
6. Males treating females
7. Training of Female Practitioners
8. Sources

* * *

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Figure 1: Pulse examination and diagnosis of the illness of a young girl by Nizami Aruzi, author of the well known Çehar Makale (1431). Türk Islam Eserleri Museum, item n° 1954. The illustration is published by kind permission of Nil Sari and Ulker Erke. Source: 38th International Congress on History of Medicine, Turkish Medical History Through Miniature Pictures Exhibition (Drawn by U. Erke, Organizer and Editor Nil Sari), Istanbul 2002. © Nil Sari and Ulker Erke.

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.

1. Female Physicians

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Figure 2: A woman with a belly wrap (Paris, Bibliothèque Nationale, Département des Estampes, Od. 26-26a). © Nil Sari and Ulker Erke.

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".

2. Female Healers Practicing Traditional Hearth Medicine

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Figure 3: A Turkish woman with her head wrapped to signify her illness. (Les Portraits Des Différens Habillemens Qui Sont en Usage A Constantinople Et Dans Toute La Turquie, Istanbul: Deutschen Archaologischen Institutes, Tafel 188). © Nil Sari and Ulker Erke.

3. Women Preparing and Selling Drugs

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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.

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".

4. Midwifery

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Figure 5: Illustration of a Seljuk woman, painted by Nil Sari. © Nil Sari.

5. Female Nurses

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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.

6. Males treating females

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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.

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.

7. Training of Female Practitioners

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.

8.Sources

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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.

by: Nil Sari, Sat 28 February, 2009