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Figure 1: The head physician Ömer Efendi (above) and chief surgeon Nuh Efendizâde Süleyman Efendi (below) on horseback, accompanied by their assistants, in the procession of the circumcision festival for Sultan Ahmed III's princes in 1720. Source: Surnâme-i Vehbî illustrated by Levnî, Topkapi Palace Library, Ahmed III collection, MS 3593, folio 160a.

While describing the basic characteristics of Ottoman medicine and medical practice through the health practitioner's scientific approach and standards, I will try to put forward the priorities of Ottoman medicine, by means of primary sources such as archive documents and medical manuscripts. I will also mention, when needed, why some assumptions about the subject cannot be valid [1]. As a great number of primary sources, such as medical manuscripts and archive documents, are still to be studied, new viewpoints will certainly emerge.

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Figure 2: Portrait of Galen [Calinos] by Ahmed b. ‘Alî el-Mahallî al-Muneccim al-Rammâl (16th century). Source: Hâvî ‘acâibi'l-mahlûkât u câmi'i garâ'ibi'l- mevcûdat / Kanunü'd-Dünya, Topkapi Palace Library, MS Revan 1638, fol. 260.

Some writers believe the way medical staff were appointed to the profession at the Court was the main cause of the unsatisfactory development of medical sciences in the Ottoman period. The Court physicians were devsirme (boys recruited from different nationalities) and they argue that the criterion for the selection of the candidates was physical appearance and looks –that is the physiognomy- of the person, but intelligence and talent was ignored [6]. However, the assumption is not supported by archive documents. Reliable information concerning the appointment of the Court physicians is found in the registeries called mevacib-i cemâ'at-i müsaherehorân. These registeries indicate that physicians were not chosen from amongst those recruited as devsirme. Most of the physicians appointed to the Court were transferred to the post from hospitals (darüssifa) or of the lecturer (müderris), assistant (muid), apprentice (sakird) or students (danismend) employed in the Süleymaniye Medical Madrasa. In addition, most of them were among the scholars honoured as "mevlana", who had acquired all the qualifications of the madrasa education. Others were either members of families of physicians or had licences from famous physicians. Dozens of appointment (ruus) documents that I have studied confirm these registeries. While there were Ottoman physicians who went to countries like Persia-Central Asia (Iran-Turan), Damascus and Egypt for further study, European physicians who were attracted by the magnificence of the Ottoman Empire either came to Istanbul or were invited by sultans to the Court. Physicians coming from Europe, especially many Jewish physicians, were employed and served in the Court. However, the Court physicians were not assigned in accordance with the rule of devsirme [7].

Court surgeons and oculists were an important group in the quild ehl-i hiref, with their numbers reaching 113 in the late l6th century. Only 11 of the 50 members whose names are registered on the oldest list in the mevacib-i ehl-i hiref notebooks dating from l526 regarding the group of masters (ustad) and apprentices (sakird-çirak) were described as devsirme. It is not logical to generalize based on the evidence of this document alone. Besides, the word devsirme does not occur in the lists from the second half of the 16th up until the end of the 18th century. On the other hand, in some of the oldest lists, notes like Istanbulî (of Istanbul), Kibrisî (of Cyprus) and Bosnavî (of Bosnia) are inserted by the side of names, indicating where they came from. In the list of 90-100 surgeons, only one or two are noted as zimmî (Christian), Müslim-i nev (newly converted Muslim) or frenk (French, meaning European). Although the members of ehl-i hiref were considered as a group of kapikulu (palace personnel), according to the records of the "sanat birle" a phrase noted along with their names in these notebooks, most of the members had already been trained in their profession outside the Court. Some documents regarding the appointment of surgeons to the Court also indicate that either a large number of surgeons were from families practicing surgery or they had come as apprentices of proficient surgeons outside the Court. In short, members of the society of surgeons and oculists came to the Court via different pathways [8]. We should also keep in mind that the devsirme system started to be partially ignored towards the end of the l6th century; it degenerated in the 17th century and it had definitely been disregarded by the time of the spread of medical progress in Europe [9].

We have to consider other reasons in order to explain the apparent failure of Ottoman health practitioners to keep up with the progress of medical science and the development of the scientific outlook and approach. What might be the reasons for the slow and inadequate development of Ottoman medical science and the failure to provide satisfactory contributions to medicine? When asked, researchers interested in the subject will argue that "Ottoman physicians paid attention mainly to the practice of medicine." According to this point of view, the Ottomans being only interested in knowledge they could put into use, they acquired only the information they needed to use in practice. We have no information that the Ottomans tried to develop theories, aiming to discover new knowledge through research. The fact that most of the Turkish medical manuscripts of the Ottoman period focus on the practice of the profession rather than the philosophical and theoretical aspects of it, confirms this assumption. This attitude did not change until the mid 19th century. For example, during his visit to the Russian Academy of Sciences in Petersburg, the Turkish ambassador Sehdî Osman Efendi did not mention "the researches" he came across, because he did not find them worth describing [10]. To explain the reasons for this tendency, we should briefly study some features of the health care system pertaining to the traditional Ottoman system of administration; the basic qualifications which the Ottoman physician was expected to acquire, taking into consideration the definition and standards of science; the Ottoman physician's notion of science; the main characteristics of Ottoman medicine; the Ottoman physicians' inclinations regarding medical terminology; and their perspective about human life and their priorities regarding this outlook.

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Figure 3: Portrait of Ibn Baytar by Ahmed b. ‘Alî el-Mahallî al-Muneccim al-Rammâl (16th century). Source: Hâvî ‘acâibi'l-mahlûkât u câmi'i garâ'ibi'l- mevcûdat / Kanunü'd-Dünya, Topkapi Palace Library, MS Revan 1638, fol. 273.

Discrimination either by race or religion was not a factor in the Ottoman medical tradition. The archive documents and contracts in court records prove that both Muslims and non-Muslims were treated by one another, both in and outside the Court [11].

Justice was always assumed to be an ideal value in the Ottoman society and government in both in theory and in practice. Personnel were selected in accordance with their ability and efficiency (meritocracy) and payment was applied according to service in certain areas. For instance, of the professionals who were members of the Court's ehl-i hiref society, only the rare who were remarkable for their outstanding talent were marked in the salary registeries as "kabiliyet birle"; and differentiation of salaries according to the progress and promotion are indications that they observed the criteria of merit [12].

Health management was organised so as to assign duties in a hierarchical order. For example, the offices such as the head physician and head surgeon of the Court (seretibba-i hassa, ser-cerrahin-i hassa) and the army (ordu-yi hümayun hekimbasisi, cerrahbasisi) and the head oculist (kehhalbasi) employed in the state as well as the head physician (tabib-i evvel) and the assistant physician (tabib-i sani) in hospitals show that the duties assigned denoted the relation between the administrator and those they administrated. There was an hierarchy observed in the appointment of physicians, surgeons and oculists to official duties such as at Court, hospitals or the medical madrasa, regarding professional progress (terakki), which we conclude from the appointment documents (ruus) [13]. This established practice was never disregarded, unless from necessity and those next in line were appointed. However, qualities such as talented (müstaid), proficient (ehil), deserving (müstahik, erbab-i istihkak), able (muktedir), master (hâzik), perfect (kâmil), truthful (sadik), honest (müstakim) were taken as criteria for employment in the appointment certificate (ruus) of the candidates for appointment or promotion when this order of seniority was not observed [14]. Giving priority to those worthy by reason of their superior talent might have led to an extraordinary appointment which might also have been utilized as an excuse for favouritism. On the other hand, there are a great number of documents demonstrating the dismissal of unqualified, incompetent and negligent physicians, surgeons, oculists, pharmacists, circumcisers and other health practitioners. The practice of medicine being of vital importance, merits and qualifications such as reliability and sufficient professional knowledge, experience, skill and mastery were qualifications expected to be acquired by the medical practitioners. However, contrary to the modern appreciation, they were not expected to search for and to be acquainted with the latest information and methods of treatment and developments in the field of medicine. Loyalty was regarded as important as qualification and competence; moreover loyalty was given priority over other expectations, because it was a criterion of trust. However, due to the lack of decisive rules that observed safe traditions in appointments, from time to time assignments were arbitrary, which gave way to paying more importance to loyalty. Observing the order of seniority and competency in the medical school (madrasa) in the appointment of the professors (müderris), the assistant (muid) and the student (danismend) is an issue which requires special study, because of its great importance from the point of medical education; A number of orders and firmans were issued from time to time in order to improve the madrasas that had slowly started to corrupt in the early second half of the 16th century [15].

Appointment of the head physician was of great importance, due to his responsibility in implementing the medical affairs of the Court and the country. Of the known physicians, the sultan of the day used to appoint the one he preferred to the office, as the sultan's health was the primary responsibility of the head physician.. The following statement in an archive document confirms this fact:

"It is not possible to be appointed as the head physician through suggestion or recommendation. Who ever the sultan willed, was made to wear a fur coat at his presence. This is the traditional rule [16]."

Yet it was not possible for the sultan to get to know each candidate well enough to make a choice; he needed consultation and advice. As no regular and decisive rules existed to guide the appointments, except for the tradition of the Seyhü'l-islam's (dignitary responsible for religious affairs) introduction of the candidate for head physician, influences on the sultan and those trying to get their acquaintances appointed, might lead to assignment of someone unqualified to this office. The dismissal of Emir Çelebi (died in l638) and replacement of Zeynelabidin b. Halil (died in l647) and the appointments of Yenibahçeli Mehmed (died in l723), Halebi Mustafa (died after l757) and Numanzade Mustafa Mes'ud (died in l820) can be referred to as examples. However, as the health of the sultan and his family was at stake, it was not possible for an incompetent and unqualified head physician, appointed by the favour of the influential personalities of the Court circle, to hold his position for long [17].

The office of the head physician was allowed administrative authority. In an archive document, it is noted that the appointment of Muslim judges (kadi) as head physicians was a tradition. Indeed, most of the head physicians were transferred from an office as Muslim judge [18]. As we learn from the Sakayiks and their zeyls (the biographical works and their supplements), except for the last two, all head physicians were madrasa graduates and scholars (ilmiye sinifi); they were trained as physicians either by the master-apprentice method or were descendents of medical dynasties or were self-educated and well known physicians. Only a few of the head physicians were educated in the medical madrasa [19]. Fifteen out of forty-two head physicians in Ottoman history were authors of medical works; however only five of them utilized European medical literature; the others continued the Islamic medical tradition even after significant medical innovation and development in Europe [20]. Sanizade Mehmet Ataullah Efendi, one of the leading figures responsible for the transfer of medical knowledge from Europe was not appointed as head physician. This failure was attributed to the jealousy of other candidates and quoted as an example of preventing the appointment of a distinguished scientist. However, some archive documents claim that Sanizade lacked certain characteristics required by a sultan's physician [21].

The head physician who was the highest authority of the medical hierarchy was also responsible for resolving the problems of the medical personnel. It is noted in the archive documents that the head physician was expected to resolve disagreements and complaints of health personnel. This proves that his effectiveness as a member of the justiciary was as important as his competence in medicine [22]. On the issue of complaints, from time to time head physicians supervised and tested health practitioners to protect people against quacks, the unqualified and the inefficient, and so the ignorant were prohibited from practise [23]. However, these complaints occurred infrequently and some inconsistencies in the detail of the administrative system for medical affairs does not convince as a continuous factor in preventing medical progress.

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Figure 4: Dioscorides presenting a plant to his assistant, both clad with the Artukian Turkish clothes. Source: Kitab al-Hashâyish wa al- Hayvan, Topkapi Palace Library, Ahmed III collection, MS 2127, front page.

The qualifications expected from the Ottoman physician in accordance with the description of a good physician can be found clearly in the criteria of the trust deeds (vakfiye) of hospitals. According to the trust deeds of the Ottoman hospitals founded during the l5th and l7th centuries, the most important qualifications required from physicians were experience and mastery. Exactly what is meant by an experienced physician as a criterion of efficiency is explained in the trust deeds of Haseki and Atik Valide Hospitals as:

"One who develops and strengthens his theoretical knowledge by means of practice and experience; promotes and strengthens the rules and base of his craft by means of observing some severe cases; informed of his patients' temperaments and acquainted with the relation between drugs and temperaments, thus competent both in theory and practice; one who enhances his scientific knowledge through effort and experience... [24]"

An experienced physician meant someone who is experienced both in diagnosing the illness of the patient and successful in applying the four elements/humours theory (anasir-i erbaa, ahlat-i erbaa) in treatment; someone expert in determining the temperament of the patient and in determining the drug and its dose that would heal the patient and thus someone capable of putting theory into practice. Also, he should be able to confirm the basic knowledge of the medical craft through his clinical observations, that is to say, it meant a person confirming and strengthening the basic medical information acquired by the preceding medical authorities, through his own clinical experiences [25].

The request that the physician must have knowledge of anatomy (tesrih) is expressed in statements such as "the physician should have comprehensive information in anatomy" found in the trust deed of the Fatih Hospital, and "one highly informed in anatomy" found in the trust deed of the Atik Valide Hospital. However, the term anatomy (tesrih) was used in two different meanings: general knowledge of the human body and dissection of human corpses (cadavers) and dead animal bodies, such as monkeys and pigs. So, if it is not clearly described, it is difficult to interpret what the anatomical information means [26]. Some physicians, for example Emir Çelebi, Ömer Sifai and Abbas Vesim, also note briefly the importance of the science of anatomy in their works [27]. But, as was stated in the preface of Semseddin Itaki's book Kitab-i Tesrih-i Ebdan, maybe the most important reason for acquiring knowledge of anatomy was the opportunity it afforded one to see the sublimity of the Creator. The study and learning of anatomy was in a sense aimed at developing a physician's merit as a wise scholar (hakim/bilge). According to Itaki, the statement

"one who is not informed of anatomy and astronomy is unproductive" is a sound proof for the sublimity of the science of anatomy. He notes: "Oh, our God, you did not create this in vain; it is the candle lighting the way that leads to You and the requisite of the way to the true faith, which is the manifestation of the cause and the effect and the creation to the Creator [28]."

Like Galen, one of the foremost medical authorities of the Ottoman medicine, he conceived anatomy as the proof of God the Almighty and argued that a good physician should also be a philosopher. Ottoman physicians appreciated Galen not only as a physician, but also as a philosopher [29].

It is difficult to explain why the Ottoman physician was late in reaching the same level of knowledge of anatomy as in Europe by assuming prohibition by the rules of Islam . No verse exists in the Qur'an that forbids studying anatomy. No statement that approves or forbids anatomy is found either in the hadiths of early Islam or in the Islamic Canon law (fiqh) texts. Moreover, anatomy does not attract attention as an issue to be discussed and speculated about in Islamic culture. Galen's recommendation about dissection of human and animal cadavers to attain information was also mentioned in his works translated to Arabic. Furthermore, leading Islamic surgeons, such as Zahrawi, argued that knowledge of anatomy was a necessity for successful operations. Yet, even if we can regard tendencies such as respect for the dead or avoidance of disfiguring, the dead body as factors that hinder human dissection, anatomy could not given a priority in the knowledge of the leading physicians in those days when treatment consisted of providing balance amongst the humours. We must also accept an offputting appearance and upset to the senses as a theory for the lack of motivation to dissect corpses in those days. We can assume that a surgeon educated in line with the master-apprentice tradition would not be in searching for more anatomical information than the practice necessitated. As we consider patients' consents for operations, we notice that most of them were related to urinary bladder stone or hernia operations. According to the trust deed of the Süleymaniye Hospital, surgeons to be appointed to the hospital were required to be efficient mainly in external treatment, operating on wounds, ulcers, boils, abscesses, tumours and bloodletting. Consequently, I believe that surgeons were only expected to have acquired the knowledge of anatomy, necessary for the treatment that had been applied so far. Besides, we should not ignore the fact that the main purpose of the surgeon who was considered as a craftsman was not to seek new information, but was to carry out his craft; in other words, to practice it. Likewise, since surgeons were not educated in schools, but by being trained and gaining skill through the master-apprentice method, the number of surgical books belonging to the Ottoman period registered in libraries are no more than three or four and their copies do not exceed five or six until the 19th century [30].

As I pointed out above, although anatomical studies were described as one of the ways of reaching information, it was as late as the 19th century that the knowledge of anatomy was accepted as not only a useful, but also a necessary part of medical education [31]. However, the dissection of a cadaver was not the only question, as some writers assume today. Although cadavers were dissected in Europe for training from the 12th century on, Galen's doctrine did not change until the l6th century. Vesalius continued to repeat Galen s mistakes in his first work. The book titled De Fabrica Humani Corporia that he published in 1543, with the addition of his own observations, included errors of anatomy [32]. The most important fact that would lead to anatomy becoming a science was the perception that the existing schematic anatomical drawings did not describe real human anatomy and that the existing definitions did not reflect the reality. Acquisition of true knowledge of human anatomy was indispensable for medical practice. So long as the lack of application of anatomy continued, imaginary and schematic anatomical drawings would be sufficient for the practitioners [33].

The knowledge required of the Ottoman physician comprised the rules of philosophy (hikmet) in addition to mastery of a system of diagnosis and treatment based on the humoral theory. In accordance with the understanding of the "philosopher physician", a competent (hazik) physician ought to be considered as a highly wise man (hakîm) acquainted with other fields of information as well as medicine and observing his patients within their environment, bearing in mind the micro-macrocosm interrelation and order [34].

The idea that only the competent physician informed of all fields of knowledge could be entitled a wise man (hakîm) was such a widespread conviction that we also come across this view in literary works. For example, the criteria described by the poet Yusuf Nabi regarding the Ottoman physician of the 17th century, in the chapter titled Mebhas-i Lazime-i Hikmet ü Tib of his Hayriye, were not very different from the items in the trust deeds of the hospitals:

"A physician is called a master (hâzik)
And worthy of being called a wise man (hakîm);
Only if he is learned in many sciences.
(He) Must share information in every field
Above all, philosophy (hikmet) and astronomy (hay'at) is needed" [35].

To what degree did the Ottoman physician dedicate himself to be a philosopher? In what ways might being a wise man/philosopher-physician have influenced the development of medicine in the new and the modern ages? In order to answer these questions we have to discuss the meanings of the concepts of wisdom/philosophy (hikmet) and being a philosopher-physician (hakîm). Being a philosopher, that is to practice wisdom itself, was to look for the truth through reason and logic. Seeking and reaching the ultimate and the most perfect principles would lead man to wisdom. Searching for this ideal, and aiming to be a man of high morals might lead him to perfection. Wisdom (hikmet) was to be aware of the most sublime and the final reason of existence. Stepping over the senses of perception, it was possible to reach the real science, that is the most respected science aiming to acquire the basic reality through reasoning. As to the way leading to knowledge, it was acquired by arguments that proved the validity of the propositions. The current knowledge was based on the evidence reached by reasoning; that is, logic was used as a means in defending the truth of the knowledge. Comprehension necessitated proof by logical reasoning for which reference to common and general features and syllogism were adopted. One could apprehend a certain fact by reasoning, and knowledge was envisioned in mind and if one was not doubtful of his knowledge of a certain being, this reality was ascertained in the mind; thus in order to be able to understand one needed to believe. Wisdom was inevitable for one who achieved perfection in all the fields of knowledge. One who acquired all the existing knowledge in his field and acquired skill and reached profficiency and one who reached perfection in his profession, that is one who was a master (hâzik), was called wise and learned (bilge/hakîm) in his art. Wisdom formed the basis of not only philosophy and religion, but also of science; and the ultimate aim of science was also to reach wisdom. That is why for a long time biology and physics were termed as the wisdom of nature (hikmet-i tabiîyye). However, in the European intellectual tradition of the 16th and 17th centuries, while the idea of searching for the perfect and absolute was underdeveloped, the idea that knowledge was continuously subject to change and that probability was a factual and ever existing system had begun to be discussed. In describing the causes and results of occurrences in nature, Europeans began to utilize thinking, observation, logic, experimentation, measurement and calculation all together. The priority of the question of existence (varlik) that had been continuously discussed since ancient times was transferred to the search for knowledge. From the l9th century onwards, acquiring all of the rapidly increasing knowledge grew more and more difficult and the wise scholars who embraced all existing knowledge began to be replaced by experts in specific fields of knowledge [36].

[1] When I was preparing my PhD thesis, I studied various medical manuscripts. Then, a eminent professor I met during a meeting stated his assumption that the Ottomans had contributed to architecture only. I replied that I had read so many medical manuscripts, I wondered why a contribution ought not to be assumed. The book I was advised to read was "Osmanli Türklerinde ilim" (Turkish Ottoman Science) by Adnan Adivar (Istanbul, 1943). I read this book carefully once again and. concluded that Adnan Adivar had not studied most of the medical manuscripts. During the following years, I came across similar critical essays describing the reasons or discussing the necessity of this assumption. The reasons and explanations put forth were not satisfactory, yet sometimes there were important clues in these writings about reasons that had not attracted the attention of the writers themselves. O. S. Uludag had a rather uncritical approach to Ottoman medicine. See Besbuçuk Asirlik Türk Tababeti Tarihi. I. Uzel (Ed.) Kültür Bakanligi Publication, no. 1296, Ankara 1991.

[2] Medicine was paid great importance during the Islamic period. The Ottoman civilization was a part of the Islamic civilization, which was based on Islam. The basis of education was religious instruction and learning. In evaluating the worth of other fields of information, the probable contribution of it to Islam was important. The medical profession was highly important from this point of view. For example, the necessity to be healthy for not failing worship and consequently, the idea that knowledge of the human body ('ilm-i ebdân) that is medical knowledge is prior to religious knowledge (ilm-i edyân) is noted in the forwards of nearly all the Ottoman medical manuscripts. See R. Sesen: "Osmanlilar Döneminde Arap Dili ve Edebiyati Ögretimi". Studies on Turkish-Arab Relations. Annual 1986, Taiv, Foundation for Studies on Turkish-Arab Relations, pp. 267-278.
- E. Ihsanoglu: "Ottoman Sciences in the Classical Period and Early Contacts with European Science and Technology". Transfer of Modern Science and Technology to the Muslim World, Proceedings of the International Symposium on Modern Science and the Muslim World (Istanbul, 2-4 September 1987), Istanbul 1992, pp. 1- 48. See pp. 3,7.
- For the idea that the knowledge about the body is prior to the knowledge of religion, see N. Akdeniz (Sari): Osmanlilarda Hekim ve Deontolojisi. Istanbul 1977, p. 20.

[3] See the following publications about Court physicians, surgeons and oculists:
- R. M. Meriç: " Osmanli Tababeti Tarihine Ait Vesikalar I: Cerrahlar- Kehhaller " Tarih Vesikalari, vol. l, no. 1 (16), Agustos 1955, pp. 27-11; Ocak 1958, vol. 1, no. 2 (17), pp. 266-293.
- I. Baykal: "Enderun Hastanesi". Türk Tib Tarihi Arsivi, no. 5, 1940, p.17.
- I. H. Uzunçarsili: Osmanli Devletinin Saray Teskilâti. "Türk Tarih Kurumu, seri VIII, no. 15", Ankara 1945, pp. 364-5.
- I. H. Uzunçarsili: Osmanli Devleti Teskilâtindan Kapikulu Ocaklari I. "Türk Tarih Kurumu, seri VIII, no. 122", Ankara 1984, pp. 405-6; for the Court Craftsman (ehl-i hiref) School, see p. 35.
- F. Isfendiyaroglu: Galatasaray Tarihi. Istanbul 1952, vol. 1, pp. 110-113.
- I. H. Uzunçarsili: "Osmanli Saray'inda Ehl-i Hiref (Sanatkârlar) Defterleri". Türk Tarih Belgeleri Dergisi, vol. XI, no.15, Ankara 1986, pp. 23-76.
- Ahmed Kal'a: "Esnaf ". Türkiye Diyanet Vakfi Islam Ansiklopedisi, vol. XI, 1995, p. 424.
- BOA, Kamil Kepeci, Küçük Ruznamçe 3399; Cevdet Sihhiye, 632, 663, 1283 etc.
- BOA, Cevdet Saray 5886; Cevdet Sihhiye 167, 302, 579, 691 etc.

[4] N. Sari: " Osmanli Darüssifalarina Tayin Edilecek Görevlilerde Aranan Nitelikler". Yeni Tip Tarihi Arastirmalari I, Istanbul 1995, pp. 11-54.

[5] See the Ottoman Archive documents BOA, Ibnü'l Emin Sihhiye no. 82; Cevdet Sihhiye no. 124, 632, 699, 704, 1084, 1107, 1116, 1190, 1363; Maarif Cevdet no. 1516 etc. about the exchange of physicians between the Süleymaniye Medical Madrasa and the Court. See also I. H. Uzunçarsili: Osmanli Devletinin Ilmiye Teskilati. "Türk Tarih Kurumu, seri VIII, no. 17", Ankara 1965, p. 35,
- N. Sari: "Osmanlilarda Tiphanenin Kurulusuna Kadar Tip Egitimi". Türk Dünyasi Arastirmalari, no. 22, Subat 1983, pp. 152-182.

[6] G. A. Russel: "Physicians at the Ottoman Court". Medical History, A Quarterly Journal Devoted to the History of Medicine and Related Sciences, vol. 34, no. 3, July 1990, pp. 243-267. See pp. 254, 266.

[7] BOA, Kamil Kepeci Küçük Ruznamçe 3399; Kepeci 3438, 34, 39; Cevdet Sihhiye 946 etc.
- I. H. Uzunçarsili: Osmanli Devletinin Saray Teskilati, op.cit., pp. 364-65.
- Examples of Ottoman Archive documents about the exchange of physicians between the Süleymaniye Medical Madrasa and the Court: Ibnü'l Emin Sihhiye, no. 82, 99 (about employment at two places at the same date); Cevdet Sihhiye, no. 124, 632 (about employment at two places at the same date), 699, 704, 1083, 1084, 1085, 1107, 1116, 1190, 1363; Maarif Cevdet, no. 1516 etc.
- I. Kumbaraeizâde: Topkapi Sarayi Hazine-i Evrak Vesikalari- Hekimbasi Odasi, Ilk Eczane, Bas Lala Kulesi, Istanbul 1933. See pp. 32-34.
- For the meaning of ruus see N. Göyünç: "XVI. Yüzyilda Ruûs ve Önemi". Istanbul Üniversitesi Edebiyat Fakültesi Tarih Dergisi, XVII / 22, 1968, p.18.
- See footnotes 74 and 80 for the Jewish Court physicians.Physicians practising privately were invited to the Court when needed. From time to time compenent physicians attracted by the Ottoman land also came to Istanbul willingly and sought employment at the Court. See A. H. Bayat: "XV-XVI yy. Osmanli Saray Tabiplerinden Hekim Sah Mehmed Kazvînî." Türk Kültürü, vol. XXXVI, no. 426, 1998, pp. 603-615 (27-36); Also see A. H. Bayat: II. Bayezid Dönemi Hekimlerinden Giyas Ibn Muhammed es-Sayrafî el-Isfahânî, p. 2 (Also see T. Haydarzade: "Iran Alimlerinin Osmanli Devletine Gelisi ve Osmanli Bilimine Katkilari -Timur Döneminin Basindan Safevi Döneminin Sonuna Kadar, translated by A. Albayrak". Osmanli Bilimi Arastirmalari II, Istanbul 1998, p. 211.) ; A. Adivar: op.cit., p. 38; E. Ihsanoglu: Büyük Cihad'dan Frenk Fodulluguna. Iletisim Yay., Istanbul 1966, pp. 85-137 (see pp. 85-86); Sakaik-i Nu'maniye ve Zeyilleri I-V, Abdülkadir Özcan (Ed.), Istanbul 1989); N. Taskiran: "Osmanli Devletinin Ilk Zamanlarinda Baska Ülkelerden Çagirilan ve Kendiliginden Siginan Hekimlerin Durumu ve Türkiye'den Hekim Istenmesine Dair Bir Arsiv Belgesi." Haseki Tip Bülteni, vol. 13, no. 2, 1975, pp. 103-110; O. S. Uludag: "Osmanli Sarayinin Yabanci Hekimleri." Yeni Türk, vol. 4, no. 38, Subat 1936, pp. 189-194.

[8] Topkapi Palace Archive, D. 9706 (932/ 1526).
- R. M. Meriç: Osmanli Tababeti Tarihine Ait Vesikalar I: Cerrahlar – Kehhaller, op.cit., pp. 38-40, 85, 88-90, 276.
- I. H. Uzunçarsili: " Osmanli Saray'inda Ehl-i Hiref (Sanatkârlari) Defterleri". Türk Tarih Belgeleri Dergisi, vol. XI, no. 15, 1986, p. 23-76. See pp. 25, 61-64.
- G. Russel: op.cit., pp. 254, 256.

[9] B. Miller: The Palace School of Muhammad the Conqueror. "Harvard Historical Monographs XVII", 1941, pp. 171-183.
- I. H. Uzunçarsili: Osmanli Devleti Teskilatindan Kapikulu Ocaklari, op.cit., pp. 20, 24, 29-30.
- For the subject devsirme (recruiting of boys) see Z. Pakalin: Osmanli Tarih ve Deyimleri ve Terimleri Sözlügü. op.cit., pp. 444-448.
- For the devsirme (recruiting of boys) see Türkiye Diyanet Vakfi Islam Ansiklopedisi, vol. 9, Istanbul 1994, pp. 254-257. For Enderun (The Palace School) see Islam Ansiklopedisi, vol. II, Istanbul 1999, pp. 185-187.

[10] E. Ihsanoglu: "Osmanlilar ve Avrupa Bilimi". Bilim Tarihi, no: 5, 1992, pp. 3-11. See pp. 6, 7, 8.

[11] N. Sari: Osmanli Saglik Hayatinda Kadinin Yeri. Yeni Tip Tarihi Arastirmalari, no. 2-3, 1996-1997, pp. 11-64; N. Sari: "Osmanli Saglik Hayatinda Kadinin Yeri (Tamamlayici Belgeler)", Yeni Tip Tarihi Arastirmalari, no. 4, 1998, pp. 247-254.
- A. H. Bayat: "Seriye Sicilleri ve Tip Tarihimiz". Türk Dünyasi Arastirmalari, no. 79, Agustos 1992, pp. 9-21.
- H. H. Isik: Tam Ilmihal, Saâdet-i Ebediyye. 23. issue, Isik Kitabevi Yay., Istanbul 1979, p. 155.
- E. A. Gökpinar: "Seriye Sicillerine Göre Eski Zamanlarda Afyon'da Yasayis II". Taspinar, vol. 4, no. 47, 19 Eylül 1936, p. 214.
- R. Özdemir: XIX. Yüzyilin Ilk Yarisinda Ankara (Fizik, Demografik, Idari ve Sosyo-Ekonomik Yapisi) 1785-1840. "Kültür ve Turizm Bakanligi, no. 694", Ankara 1986, pp. 214-15.
- H. Sahillioglu: "Üsküdar'in Mamure (Cedide) Mahallesi Fitik Cerrahlari". Yeni Tip Tarihi Arastirmalari, no. 4, 1998, pp. 59-66.

[12] R. M. Meriç: "Osmanli Tababeti Tarihine Ait Vesikalar", op.cit., see foot note 2.

[13] N. Sari: "Osmanli Darüssifalarina Tayin Edilecek Görevlilerde Aranan Nitelikler", op.cit., pp. 26-27.
- See I. H. Uzunçarsili: Osmanli Devletinin Ilmiye Teskilati. "Türk Tarih Kurumu, seri VIII, no. 17", Ankara 1965, p. 35, for an example of the employment procedure between the head physician, the lecturer of the Süleymaniye Medical Madrasa and Court physicians.
- Information about the rulers and administration of health institutions can be obtained by reading Ottoman archive documents. For example, a letter by the head physician Yusuf Sinan (BOA. Kamil Kepeci, defter no. 238, p. 17) is one of the archive documents recording the appointment procedure amongst institutions: "Sultan's decree: 'The head physician sent a letter noting that the former Court head physician Molla Kasim, who was paid 60 akçes (small silver coin) daily, died; so Süleyman who was paid 30 akçes as the head physician (tabib-i evvel) of Süleymaniye Hospital shall be appointed as the Court (Dergâh-i âli) physician and paid 40 akçes daily; and Mehmed paid 30 akçes as the head physician of the Sultan Mehmed Han Hospital shall go on working as a physician and paid 30 akçes; and to his office Ahmed, paid 25 akçes as the head physician of the Haseki Sultan Hospital shall be appointed as the head physician and paid 30 akçes; and to his office Resul, paid 15 akçes as the assistant physician (tabib-i sani) of the said hospital shall be appointed as the head physician and paid 25 akçes; and to his office Ataullah, paid 10 akçes as the assistant physician of Sultan Bâyezid Hospital in Edirne shall be appointed as the assistant physician and paid 15 akçes; and to his office Ahmed, the apprentice (sakird) paid 5 akçes shall be appointed as the assistant physician and paid 10 akçes." (988/1580).

[14] BOA: Ibnü'l Emin Sihhiye 82, 99/1; Cevdet Sihhiye 632, 759, 1118, 1225; Mühimme defteri 4, no. 582, 583, p. 55. More examples can be quoted.
- E. Kâhya: "Ondokuzuncu Yüzyilin Ilk Yarisinda Osmanli Imparatorlugunda Tip Egitimi ve Kalburüstü Hekimlerimiz." Erdem, vol. I, no. 3, Eylül 1985, p. 687.

[15] For merit and loyalty see:
- See N. Sari: "Osmanli Darüssifalarina Tayin Edilecek Görevlilerde Aranan Nitelikler", op.cit., see pp. 31-32, 35, 37, 41- 42, 47.
- A. H. Bayat: "Osmanli Devleti'nde Hekimbasilik Kurumu ve Hekimbasilar. "Atatürk Kültür Merkezi Baskanligi, no.199", Ankara 1999. See pp. 24, 35, 43, 51, 65, 89, 103, 104, 108 etc.
- See A. Adivar: pp. 93, 105-6; see p. 93 for the Medical Madrasa.
- G. A. Russel: "Physicians at the Ottoman Court", op.cit., see pp. 250, 266-267.
- For the reorganization of the madrasa see I. H. Uzunçarsili: Osmanli Devletinin Ilmiye Teskilati. "Türk Tarih Kurumu, seri VI-II, no. 17, Ankara 1965", pp. 211-260.

[16] See Topkapi Palace Archive, no. E 668 for the appointment of the head physician.
- I. H. Uzunçarsili: Osmanli Devletinin Saray Teskilati. See pp. 71, 205, 364-368; Defter-i Yevmiye-i Oda-i Tesrifat 677 mükerrer.

[17] A. H. Bayat: Osmanli Devleti'nde Hekimbasilik Kurumu ve Hekimbasilar. See pp. 51, 89, 106, 154.

[20] Ibid, pp. 25, 38, 43, 56, 59, 62-64, 68, 71, 76-77, 87, 101, 105, 111, 117, 124, 128, 129, 148.

[21] N. K. Kurt: Sanizâde Mehmed Ataullah Efendi'nin Kânûnü'l- Cerrahîn Adli Kitabinin Incelenmesi. Unprinted PhD thesis guided by Ayten Altintas, Medical History and Ethics Department, Cerrahpasa Medical School, Istanbul University, Istanbul 1999, pp. 30-31; B.O.A., Hatt-i Hümayun, no. 31485.
- A. H. Bayat: Osmanli Devlet'inde Hekimbasilik Kurumu ve Hekimbasilar, op.cit. See p. 146.

[22] B.O.A.: Cevdet Sihhiye 132; Ibnü'l Emin Sihhiye 82. More examples can be quoted.

[23] For the supervision in 1573 by the head physician Garsüddînzâde Muhiddîn, see A. Refik: Onuncu Asr-i Hicride Istanbul Hayati. Kültür Bakanligi, Ankara 1984, pp. 93-94.
- For the supervision in 1592 by the head physician Yusuf Sinan, see H.T. Daglioglu: "Tababet Tarihimize Ait Vesikalar." Türk Tip Tarihi Arkivi, 1939, vol. IV, no. 13, 1939, pp. 41- 42.
- For the supervision in 1730 by the head physician Hayatizâde Mustafa Feyzi II, see A. Refik: "Hicrî On ikinci Asirda Istanbul Hayati (1100-1200)". Tarih Encümeni Külliyati, Istanbul 1930, pp. 106-107.
- For the supervision in 1768 by the head physician Katibzâde Mehmed Refi, see A. Refik: "Hicri On Ikinci Asirda Istanbul Hayati", ibid, pp. 214-215.
- H. Sahillioglu: " 1700 Yilinda Istanbul'da Muayenehane Açma Izni Olan Tabib ve Cerrahlar ". Türk Dünyasi Tarih Dergisi, no. 136, Nisan 1998, pp. 10-14.

[24] The trust of deeds of hospitals required the following qualifications for the physicians to be employed: "one known to be able and experienced" for Fatih; "skilful" for Bayezid II; "talented and experienced" for Süleymaniye; "master of medicine" for Atik Valide; and "a master cognizant of all issues by means of experience" for Manisa Hospital. See N. Sari: "Osmanli Darüssifalarina Tayin Edilecek Görevlilerde Aranan Nitelikler", op.cit., p.16.

[25] Ottoman medicine was based on the theory of four elements (anasir-i erbaa) and four temperaments (mizac). The four elements did not simply mean fire, water, earth and air; and the four qualities, heat, dryness, moisture and coldness were not evaluated simply as perceived in nature, because all the other elements and qualities were considered to be included in this theory. The four humours (ahlat-i erbaa), i.e. blood, phlegm, yellow bile and black bile believed to be found in the body, in correspondence to the four elements in nature, were supposed to have different qualities. The composition of the four humours was considered to form the character that is the temperament of a person; consequently, everyone has an individual character, for the composition of the four humours is particular to each person. There might be imbalance in the proportion of the humours, consequently some people are phlegmatic, others are melancholic, choleric or sanguine. See N. Sari: "Bilim Dogu'ya Göç Ediyor: Islam Dünyasi". Cerrahpasa Medical School Medical History Department 1995-96 lecture notes, pp. 1-2.

As Ottoman medicine was based on the theory of four elements and humours, consequently it was always strongly emphasized in the deeds of trust of hospitals; and physicians were required to be "skilful in diagnosing people's temperaments and dispositions"; "one who knows the characteristics of temperaments"; "a master in improving temperaments and informed of the effects of humours' qualities and the nature of food and syrups"; to have "full comprehension of temperaments' characteristics"; and to be one who "knows the characteristics of human nature". See N. Sari: Osmanli Darüssifalarina Tayin Edilecek Görevlilerde Aranan Nitelikler, op.cit., pp. 16-18.

[26] N. Sari: "Osmanli Darüssifalarina Tayin Edilecek Görevlilerde Aranan Nitelikler", op.cit., p. 18.
- E. Savage-Smith: "Attitudes Toward Dissection in Medieval Islam." The Journal of the History of Medicine and Allied Sciences. Jan. 1995, V 50, pp. 67-110. See pp. 69, 96 for the two different meanings of dissection.

[27] N. Sari: Osmanlilarda Hekim ve Deontolojisi, op.cit., pp. 76-7.
- Emir Çelebi advised not to be contended with learning anatomy by reading books, but to dissect animals and bodies of people who died during war, observing them carefully. See Enmüzecü't tib, Istanbul University Library, no. 7043, f. 248b.

[28] E. Kâhya: Semseddin-i Itakî'nin Resimli Anatomi Kitabi. "Atatürk Kültür, Dil ve Tarihi Yüksek Kurumu, no. 95", Ankara 1996", p. 123; criticized text: p. 14.
- Ömer Sifai notes that the knowledge of anatomy does not only contribute to successful treatment, but also helps to comprehend the worthy art God created in the human body. See Minhâcü's-Sifâî fi Tibb-i Kimyaî. Istanbul University Library, no. 7072, f. 3b.

[29] M. Türkel - Küyel: "Bilimin Felsefeye Dayandigi Görüsünün Bir Timsali Olarak Galenos", Erdem, 4/1, 1988, pp. 501-524.

See E. S. Savage-Smith: Attitudes Toward Dissection in Medieval Islam. op.cit., pp. 93-94, 95, 96 for the philosophical interpretation of anatomy as Galen and Medieval Muslim physicians viewed; and for the meaning of anatomy with respect to the comprehension of the wisdom and wonders of the Creator's miracles.

[30] Ü. Maskar: Islam'da ve Osmanlilar'da Otopsi Sorunu Üzerine Bir Etüd. Tarihte Türk-Alman Tibbi Iliskileri Sempozyum Bildirileri. (Istanbul, 18-19 Ekim 1976). A. Terzioglu (Ed.), Istanbul 1981, (Istanbul Universitesi Yay., no. 2669, Tip Fakültesi no. 120, Tip Tarihi ve Deontoloji Kürsüsü yeni seri no.1, pp. 83-92.
- There is no evidence so far that the practice of anatomy was prohibited in Medieval Islam, see E. Savage-Smith: "Attitudes Toward Dissection in Medieval Islam". pp. 71, 80, 81,82, 83, 100, 104, 105; for Galen's emphasis on the necessity of anatomical practice in order to gain knowledge and for successful surgery being described in the translations of his work to Arabic, see ibid, pp. 86, 90- 93; for the view that the practice of anatomy was not needed in Medieval Islamic medicine, see ibid, pp. 93, 105, 109, 110; for the influence of some attitudes in Medieval Islamic thought, such as the expectation that the integrity of the body should be preserved for resurrection, respect for the dead body, compassion for the deceased etc., on the deterrence from dissection of the dead body, see ibid, pp. 100, 104, 105, 106, 108.
- N. Sari: "Osmanli Darüssifalarina Tayin Edilecek Görevlilerde Aranan Nitelikler", op.cit., p. 33.
- E. Kâhya: Osmanlilarda Bilim, op.cit., pp. 496-497.

[31] E. Kâhya: "Bizde Disseksiyon Ne Zaman ve Nasil Basladi?". TTK Belleten, vol. XLII, no. 172 (1979), pp. 749-755.
- E. Kâhya: "Tanzimatta Eski ve Yeni Tip", 150. Yilinda Tanzimat. H. D. Yildiz (Ed.), Ankara 1992, pp. 296-297.
- S. Akinci: "Osmanli Imparatorlugu Tibbinda Disseksiyon ve Otopsi". Istanbul Üniversitesi Tip Fakültesi Mecmuasi, vol. 25, 1962, pp. 97-115.
- A. I. Gencer: "Istanbul Tersanesinde Açilan Ilk Tib Mektebi." Istanbul Üniversitesi Tib Fakültesi Mecmuasi, vol. 41, 1978, pp. 732-747. See p.737 and p. 743: The importance of anatomy in terms of medical and surgical instruction is indicated in the following sentences in the 1807 regulation of the Medical School Tibhâne built next to the Royal Dockyard Hospital (Tersâne-i Amire - Ispitalya): " Ilm-i tesrih maddesi cism-i fünûn-i mezkûrenin uzv-i lâzim-i gayr-i mefrûku mesâbesinde olmagin, talebe-i mezkûreye derûn-i vücûdda olan em'ânin yerlerini ve cihet-i tenâsüblerini ve siryân ve a'zânin ruûs ve usûllerini irâ'et hususu gerek ilm-i tibba ve gerek fenn-i cerrâhât isti'mâline elzem mevâddan olmagla...".

[32] E. Kâhya: "18. ve 19. Yüzyillarda Genel Çizgileriyle Osmanlilarda Bilim." Erdem, vol. 3, no. 8, 1987, p. 496.
- E. Kâhya: Osmanlilarda Bilim, op.cit., p. 496.
- N. Sari: "Bati'da Yeniden Dogus: Rönesans", Istanbul University Cerrahpasa Medical School Medical History and Ethics Department 1989 lecture notes, pp. 1-3.

[33] G. Russel: "The Owl and the Pussy Cat The Process of Cultural Transmission in Anatomical Illustration". Transfer of Modern Science and Technology to the Muslim World, Proceedings of the International Symposium on Modern Science and the Muslim World (Istanbul, 2-4 September 1987), Istanbul 1992, pp. 180-212.

[34] The following phrases are included in the deeds of trust of Fatih, Haseki, Manisa, Süleymaniye and Atik Valide hospitals, respectively: "Two physicians superior in their knowledge of medicine and treatment methods; those who know all the laws of medicine and philosophy and comprehend by experience all the related issues in detail; physicians informed of all the medical and philosophical issues through experience; physicians who have acquired all details of medicine and philosophy (hikmet), having filled their minds with knowledge of wisdom shall be employed." See N. Sari: Osmanli Darüssifalarina Tayin Edilecek Görevlilerde Aranan Nitelikler, op.cit., p. 18.
- See N. Akdeniz (Sari): Osmanlilarda Hekim ve Deontolojisi, op.cit., p. 70 for the requisite of the physician to be a scholar (learned wise man, âlim).

[35] S. Kadioglu: Nâbi'nin Hayriyye'sinin Mebhâs-i Lâzime-i Hikmet ü Tib Bölümü: Sair Gözüyle On Yedinci Yüzyil Osmanli Tibbina Elestirisel Bir Bakis. International Congress on Learning and Education in the Ottoman World, Istanbul, 12-14 Nisan 1999.
- M. Kaplan: Hayriyye-i Nabi (Inceleme-Metin), Ankara 1995.

Below are some of the publications describing and explaining the questions and sources of knowledge in Ottoman medicine and the philosophy (hikmet) / philosopher-physician (hakîm) concepts:
- N. Keklik: Türk-Islam Felsefesi Açisindan Felsefenin Ilkeleri." Istanbul University, Faculty of Literature, no. 3484", Ankara 1996, pp. 2-14.
- M. Türker-Küyel: "Türklerde Felsefe Gelenegi". Türk Yurdu, vol. 44, no. 390, Nisan 1991, pp. 5, 11, 12.
- S. Ural: Bilim Tarihi. "Kirkambar Yay. no. 27", Istanbul 1998, pp. 196-197, 200, 202, 204, 238-9,
- E. Kâhya: "Anadolu Selçuklularinda Bilim", Erdem, vol. 5/13, no. 13 Ocak 1989, pp. 63-79. See: pp. 65-68; The relation between man and cosmos, the question of existence; and mathematics being regarded as a bridge between the world of senses and the one perceived through mind/intellect in the Turkish-Moslem community is discussed.
- M. T. Türker-Küyel: "Felsefenin Tarifinde ve Tarihinde Bir Kaynak Olarak Farabi" / Al-Farabi As a Source of the History of Philosophy and Its Definition." Erdem, vol. 6, no. 18, 1992, pp. 725-735.
- I. Yakit: Ihvan-i Safa Felsefesinde Bilgi Problemi. "Akademik Kitaplar, seri 40", Istanbul 1985.
- I. Özel: Bilgi, Bilim ve Islam. "ISAV Tartismali Ilmi Toplantilar, seri 5", Istanbul, 1992.
- For a brief introduction about the principles of the change in medical science and philosophy that began during the Renaissance in Europe, see A.S. Duncan, G.R. Dunstan, R. B. Welbourn: Dictionary of Medical Ethics. New York, 1981, p. XXI; item: Medical Science.
- See Yesim Isil (Ülman): "XIX. Yüzyil Sonunda Ali Sedad Bey'in Kavaid-i Tahavvülât Fî Harekâti'z-Zerrat Adli Kitabinda Ilmi Zihniyet Meselesi Hakkinda." Tip Tarihi Arastirmalari 3, Istanbul 1989, pp. 108-115 for the question of scientific approach amongst Ottoman-Turkish intellectuals in the late 19th century. Also see: N. Öner: Tanzimattan Sonra Türkiye'de Ilim ve Mantik Anlayisi, Ankara Üniversitesi Ilahiyat Fakültesi, Ankara 1967.
- I. Özel: Bilgi, Bilim ve Islam I: "ISAV Tartismali Ilmî Toplantilar Dizisi 5", Istanbul 1992.