History of Islamic Medical Schools in Turkey’s Territory

In today’s political borders of the Republic of Turkey, there exist very old institutions that train physicians according to Islamic medical science. In this study, 19 health institutions whose locations have been determined and documents finalized were approached in a chronological order and classified according to the historical periods: XIIth and XIIIth centuries (Seljukian period)-10, XIVth century (Ilkhanate dominion)-1, and XVth-XVIIth centuries (Ottoman period)-8 institutions. Some of them have a history of 900 years (Konya Mâristan-ı Atik, 1113; and Mardin Eminüddin Bimaristanı, 1122). In addition, some are in the form of a medical madrasah and an application hospital (Kayseri, 1206; Sivas, 1217). In these institutions, great masters of Islamic medicine (Razi, Fârâbî, Bîrûnî, İbni Sina) and ancient authorities (Hippocrates, Dioscorides, Aretaeus, Galenos) were taught. These institutions had builders, rulers (sultan, melik) or mothers, wives, daughters, and sisters (the presence of female builders in these institutions attracted attention). During the Seljuk period, powerful viziers also built such institutions. These hospitals also provided free services which were considered as “charities” according to the Islamic religion. These institutions were financed by sources (shops, inns, Turkish baths, bridges, mills, vineyards, gardens, fields and annual taxes of many villages) that donated funds through the “foundation” method. Donations were made in the presence of the “kadi” (muslim judges) and many witnesses, with the written document “endowment.” These foundations were not touched by subsequent monarchs. Payment of fees, daily expenses of the physicians, assistant personel and repairing of buildings was done by the board of trustees. Twelve of these institutions are still in use for public interest (polyclinic, museum, health museum, library, university, and education center). When modern medical schools (1827) and hospitals (1842) began to be established as of the XIXth century, these historic buildings were allocated to mental patients, while some were devastated by neglect. However, in the Republic period, they have been restored and used for health and educational purposes.

In today's political borders of the Republic of Turkey, there exist very old institutions that train physicians according to Islamic medical science. In this study, 19 health institutions whose locations have been determined and documents finalized were approached in a chronological order and classified according to the historical periods: XII th and XIII th centuries (Seljukian period)-10, XIV th century (Ilkhanate dominion)-1, and XV th -XVII th centuries (Ottoman period)-8 institutions. Some of them have a history of 900 years (Konya Mâristan-ı Atik, 1113; and Mardin Eminüddin Bimaristanı, 1122). In addition, some are in the form of a medical madrasah and an application hospital (Kayseri, 1206; Sivas, 1217). In these institutions, great masters of Islamic medicine (Razi, Fârâbî, Bîrûnî, İbni Sina) and ancient authorities (Hippocrates, Dioscorides, Aretaeus, Galenos) were taught. These institutions had builders, rulers (sultan, melik) or mothers, wives, daughters, and sisters (the presence of female builders in these institutions attracted attention). During the Seljuk period, powerful viziers also built such institutions. These hospitals also provided free services which were considered as "charities" according to the Islamic religion. These institutions were financed by sources (shops, inns, Turkish baths, bridges, mills, vineyards, gardens, fields and annual taxes of many villages) that donated funds through the "foundation" method. Donations were made in the presence of the "kadi" (muslim judges) and many witnesses, with the written document "endowment." These foundations were not touched by subsequent monarchs. Payment of fees, daily expenses of the physicians, assistant personel and repairing of buildings was done by the board of trustees. Twelve of these institutions are still in use for public interest (polyclinic, museum, health museum, library, university, and education center). When modern medical schools (1827) and hospitals (1842) began to be established as of the XIX th century, these historic buildings were allocated to mental patients, while some were devastated by neglect. However, in the Republic period, they have been restored and used for health and educational purposes. Keywords: Historical hospital buildings, islamic physician training institutions, islamic foundations, medical history Seljuk Sultanate and some vassal emirates (kings) have built enormous and durable buildings by establishing educational, health, and social institutions according to Islamic traditions, some of which have survived till present day (2). Architectural designs in Baghdad, Damascus, and Aleppo were taken as examples; knowledgeable and experienced physicians were invited; Abu Bakr er-Râzî (Rhazes, 854-925), Fârâbî (Alpharabius, 872-950), Bîrûnî (Alberuni, 973-1050) and Ibni Sina (Avicenna, 980-1037) books were read as the main opus (3).
Considering that civilization has been very old in these lands (Göbeklitepe, 10,000 years BC), the medical knowledge is very old as well. The most famous physicians and pharmacists of ancient times grew up in Anatolia, absorbed and systematized the accumulation of the generations before them, and became the founders of medicine, dentistry, and pharmacy education in the world. These rudiments were not destroyed when the Muslim Arabs conquered Eastern Anatolia in the VII th century AD. On the contrary, Greek, Latin, Syriac, Armenian, and Hebrew medical books have been translated into Arabic and Persian for the benefit of the physicians. An extraordinary exchange of information and synthesis has emerged in this multilingual and multi-religious society that lived together in harmony. Bukrat (Hippocrates of Cos, 460-377 BC), who is of Western Anatolian origin and accepted as the "Father of Medicine" and Calinus (Galenos of Pergamon, 130-210), who greatly influenced Islamic Medicine, were accepted as undisputed authorities and thoughts (3,4). The great clinician Arete (Aretaeus of Cappadocia, 80-138), who was born in Kayseri (Caesarea) and Skoridos (Pedanius Dioscorides of Anazarbus, 40-90), who was born and raised on the lands of Çukurova (Cilicia) have taken their respected places in (5). Rational arrangements were made in the field of public health and the most advanced medical knowledge transferred to young physicians. A "head physician" (chief doctor, melik-ül-etıbba, şeyhül-hükema), who was the equivalent of the Minister of Health, made the appointments, transfers, and investigations of the physicians and subjected them to the "false physicians" examination. Builders of these physician-educating organizations became either rulers ("sultan" or "melik") or made buildings on behalf of their mothers, wives, or daughters. It is worth noting that female builders existed within an islamic society. As the sense of compassion of women was more evident in the care of patients, the power and reputation of women was at the highest level in these first Turkish states. A "foundation" was established according to the Islamic principles in order to guarantee the needs and expenses of these institutions for many years and an official written document ("endowment") was issued. Taxes of real estates (inns, baths, bridges, shops, fields) that yielded income through local endowments that were regulated in the presence of the local "kadi" and witnesses, as well as the taxes from many villages were donated and the board of trustees of the foundation were granted powers. The future of these "charities" made for religion and humanity were secured so well that these facilities operated until the XIX th century and their physical spaces were still partially standing. These health facilities that were established as charities provided free services; patients who received an outpatient exam or inpatient treatment were given free medication. No discrimination based on race, language, religion, sect, or gender had been made in this regard. Three meals, hospitalization, heating, and lighting expenses of the inpatients were also covered by the foundation. The foundation also paid the salaries of the chief physician, other physicians, "kehhal" (ophthalmologist), surgeons, and pharmacists (staff-accounting-teller, cleaning and maintenance staff). Daily medical allowance was given to medical students ("Şakird") who received free boarding education. Subsequent Islamic rulers (Ottomans) did not touch the foundation's properties and businesses that were donated before their time, approved the endowments, and also contributed materially and morally. The Ottoman Sultans (their mothers, wives, and daughters as well) also continued the same tradition in the Western Anatolia and European lands (Rumelia), who were later Islamized, and established and dedicated new health and welfare institutions. Although a portion of these endowments were lost, most of them have survived until today and are safeguarded by the General Directorate for Foundations of the Republic of Turkey. Information can be gathered from the rich archive of the Ottoman State, which has kept extraordinary bureaucratic, meticulous, and detailed records about those that disappeared. In terms of the traing of physicians, we can divided these institutions into two: 1) "Master-apprentice" model: Young candidates ("apprentice") starting from scratch sat under an experienced physician ("master") who had made a name for himself in inpatient treatment institutions that carried out diagnosis and treatment of patients, and learned the secrets of the profession by observing and questioning for years. They personally undertook studies in the areas of patient care, preparation and administration of medications, and discussed theoretical knowledge by reading the books given to them by their master. This included one or more people, their training period was individually determined by the master (not less than three years), and they would eventually receive "consent" (qualification) according to the personal opinion of their master. Different names have been used in Anatolia for this type of inpatient treatment institutions: "bimaristan" (Persian "bimar" = patient + "-istan" = place) or just "maristan" "Şifahane" (Arabic "şifa" = healing + Persian "-hane" = "home") and compound terms derived from "dâr-üş-şifa" (home of healing), "dâr-üs-Sıha" (home of health), "Dar-ül-afiye" (home of well-being). In the Ottoman period, the term "dar-üt-tıbb" (medical dormitory) was also used. The term "Hastahane" (hospital) is quite new (1845, Bezmiâlem Gureba Hastanesi). 2) "Medrese" (madrasah) model: It was different from general madrasahs (theology, philosophy, law, administration) and specialized higher education institutions were formed to train only physicians. They taught more students (10 and more), "lessons" (→ madrasah) were taught by more than one teacher; general culture, oratory and foreign language (Arabic and Persian) were taught as well. These were called "medrese-i etıbba" (faculty of medicine). Adjacent to these, there was always an application hospital (darüşşifa). In some cases, a general madrasah and a medical madrasah were built side-by-side (double madrasahs). The education period would be between four and six years, exams were applied, and the sultanate possessors would attend the graduation ceremonies. Graduates were given diplomas.

EARLY PERIOD (SELJUK PERIOD)
The biggest Turkish state established in Anatolia at the end of the XI th century was the Konya Seljuk Sultanate. They became relatives with the Great Seljuk Dynasty in Iran (uncle's sons) and were able to unite smaller emirates with their military superiority and spiritual reputation, as well as their strategic positions and rational governments in the center of Anatolia. They also took the Black Sea (Sinop, Synope) and Mediterranean (Antalya, Attaleia) beaches. Seljuk Sultans, who undertook extensive zoning activities in the lands they dominated, built hospitals and training institutions for physicians in the cities of Sivas, Çankırı, Kastamonu, and Tokat, especially the capital city of Konya (6,7). A) Konya Hospitals: Three health institutions started operating in Konya in the XII th and XIII th centuries according to written documents and some archaeological findings: 1) 1113, Mâristan-ı Atik was founded in the period of Sultan Melikşah. According to our present knowledge, it was the oldest medical training institution established in the territory of Turkey: 1 Şaban 506 Hicri (= Gregorian calendar January 21 th , 1113). Endowment of this facility was found in the Ottoman Archives and its first translation by Hakkı Öcal was published in 1937 (8). It is believed that today, it is located in the Şifahane Neighborhood in Konya. According to the definition of physicians and officers in the endowment, there are not only treatment services, but also physician training duties ("Şakird-i tabib" is mentioned). 2) 1221 in the period of Sultan Alâeddin Keykubat, the establishment of a second health institution, Alâeddin Dârüşşifası (Dârüşşifa-i Alâî) was implemented and served for many years (until 1858). As a result of invasions and earthquakes during the Crusades, the previous Mâristan-ı Atik, which was established 90 years ago, became unusable and was built once again at the same location by Konya Kadi Izzeddin Muhammed bin Mahmud upon the order of the Sultan. For this reason, it is referred to as "Kadi Izzeddin Mâristanı" in his foundation. However, it was mentioned in the later Ottoman documents as "Konya Alâeddin Dârüşşifası" (9,10). This health facility with its buildings such as complexes, madrasahs, and masjids in a complex style has remained till today with only its masjid in ruins ["Şifahane (Sakahane) Mescidi"] and was repaired and opened to visitors by the Municipality of Konya in 2018 ( Figure 1A).
3) 1254 As a third health institution, Kemaliye Dârüşşifası (Karatay-ı Sagîr Madrasah) came into service and its buildings survived until 1960 ( Figure 1B). After the famous Seljuk vizier Celâleddin Karatay built the Great Karatay Madrasah (nowadays a Museum) in 1251, he built the Karatay-ı Sagîr (i.e., Küçük Karatay) Madrasah right across it, for medical education and care of patients on a large field in 1254. He appointed his brother, Kemâleddin, who was a physician in his foundation of the same date, as the trustee of this facility. For this reason, this facility which we can call "the first private foundation medical school," was later called Kemaliye Dârüşşifası (11). Our famous medical historian, who visited Konya in 1956 and 1960: Distinguished Professor Doctor A. Süheyl Ünver saw and narrated about the buildings that were still standing but not used. In his visit in 1972, he regretfully found out that the local administrators were expanding the road passing through the building, which ended up destroying 700 years of historical artifacts. B) 1122, Mardin, Eminüddin Hospital: The southeastern corner of today's Republic of Turkey passed into the hands of Arab Muslims in as early as 640. With the weakening of the Baghdad Caliphate, these lands were left defenseless and after the Manzikert War, the House of Turkmen "Artuklular" (Artuqids) was established under the command of Artuk Bey (1102). Necmeddin İlgazi (1104-1122) was the head of the Mardin segment of this House, which was torn as a result of internal conflicts. His brother Melik-ul-Cebbar Eminüddin (referred to in the Ottoman records as Şeyh Eminüddin) started the construction of a large-scale complex (mosque, madrasah, bimaristan, Turkish bathhouse, fountain) as a charity, but when he died, Necmeddin, who was the ruler, completed it in 1122 (12,13). It was placed as stepped landings on the sloping land with natural hot healing water springs at the southwest end of the historic city of Mardin, located at the foot of a rocky hill overlooking the northern Mesopotamian plains. It has survived until today in the territory of Turkey as the oldest mosque complex, which benefits from natural water sources that can be counted as a hydrotherapy (spa) center ( Figure 1C). Although his endowment did not survive till today, it was mentioned as Eminüddin Bimaristan Foundation in the Ottoman Archives from 1518 until the beginning of the XX th century and his staff had two physicians. Today, the Maristan Turkish Bath and Maristan Fountain are still in use, but the other parts are in ruins. In the XIII th century, the Turkish states in Anatolia experienced their brightest periods and built many new health institutions besides the rich zoning activities. The Seljuk Sultans personally led the way and equipped large cities (Kayseri, Sivas) outside the capital with imposing madrasahs and hospitals. Viziers and commanders at their disposal have also built health facilities in northern provinces (Çankırı, Kastamonu and Tokat). The people of Mengüjek, who were vassal leaders, also built an extraordinary Cami-Darüşşifa complex in Divriği. C) 1206, Kayseri Gevher Nesibe Hospital: Sultan Gıyâseddin Keyhüsrev built the "Gevher Nesibe Dârüşşifası ve Tıp Medresesi" in the name of his sister Gevher Nesibe Sultan, who died due to tuberculosis in Kayseri in 1204 (historically Caesarea, the birthplace of Aretaeus) and built "Gıyâsiyye Medresesi" (open courtyard, adjacent "double madasah") right adjacent to it. The tomb of Gevher Nesibe is also in the madrasah. Eventhough the foundation cannot be found, the Ottoman records (1500,1584) mention professors and students. Until 1890, it carried out its purpose and physicians were trained. According to S. Ünver, "It is Turkey's first medical school" (17,18). It is the first monumental health facility restored by the government of the Republic and has been acting as a History of Medicine Museum since 1982 ( Figure 2A). D) 1217, Sivas İzzeddin Keykâvus Hospital: Izzeddin Keykâvus I, son of Gıyâseddin Keyhüsrev I, came to the throne in 1211 and used Sivas (historically "Sebastea") as the capital. In 1217, he built a large health institution ("Darüssıhha" or "Şifaiye Medresesi") on his own behalf. The endowment was found and published in 1938; this was a training school for physicians and was characterized as "Turkey's second medical school" by S. Ünver (19,20). The tomb of the Sultan, who died of tuberculosis in 1220, was also here. This architectural work, with an open courtyard, portico, and three iwans, has also been renovated and opened to visitors ( Figure 2B). Although the original foundation of 1243 is no longer present, the Mahmut Bey foundation of 1397 is attributed to the said foundation and informs about the Hospital staff. The hospital in Divriği, which lost its importance in the Ottoman period, was used as a general madrasah (21). Apart from the main roads, Divriği, which is in a mountainous area that is difficult to reach, is a small town today (10,000 population, altitude 1225 m), but thanks to the Ulu Camii-Darüşşifa complex, which is a masterpiece of stonemasonry, it invites architects and medical historians from all over the world ( Figure 2C). Regional administrators working under the command of the Konya Seljuk Sultans with the title of "atabey" or "pervâne" also did not fall behind and built health facilities as charities (25,26). F) 1235, Çankırı Atabek Cemâleddin Hospital: Atabey Cemâleddin Ferruh, who was the trustee of Sivas Darussıhası, built an interesting complex in his name in Çankırı (formerly Gangra city of Galatia). According to his inscription, in the year H. 633 (1235 AD), he added a "Darülâfiye" for patients and 7 years later, a two storey building adjacent to the north (in 1242): the upper floor Darülhadis, the lower floor Mausoleum. In the 1940s, Süheyl Ünver witnessed the Şifahane part (hospital) in an unrecognizable ruin. It was being used as a Mevlevihane (mevlevi lodge) with wooden additions (27). Darülhadis and its tomb, which are known as "Taşmescid" today, were restored by the Special Administration in 2011, and the foundations of Darülafiye were revealed by excavation ( Figure 3A).  Although neither its foundation nor its inscription has survived, the main building undergoing repairs stands in the city center under the name "Gök Medrese" (or "Kırkkızlar Medresesi") and has been used as a Museum since 1926 ( Figure 3C). It is a typical example of the Anatolian Seljuk architecture. When the banned Muîneddin Pervane, who was accused of treason, was put to trial and executed by the Mongols on August 2 nd 1277, it was completed by the daughter of Konya Seljuk Sultan Gıyaseddin Keyhüsrev III, who was his spouse (29,30).

INTERMEDIATE PERIOD (ILKHANID SOVEREIGNTY PERIOD)
The first half of the XIV th century was difficult for the Anatolian

A) 1308, Amasya Hospital: In the inscription of the Amasya
Darüşşifası, which is the most elegant hospital that has survived to the present day, it is written that it was built in the name of Ilduz Hatun by his free slave Anber bin Abdullah in H. 708 (1308) ( Figure 4A). However, it is mentioned in the Ottoman archives as "Sultan Alaeddin Darüşşifası" (there are documents showing that it was active until 1837). It is a typical Anatolian Seljuk work in terms of its architecture. Newly found documents also indicate Sultan I.
Alâeddin Keykubat as its builder (1220-1237). Since the original foundation had not recovered, it was repaired during the period of the İlkhanians, who captured Amasya in 1308, and a new inscription was put in place. "Kitab-ül Cerrahiyye-i İlhaniyye" (1465), written by Sabuncuoğlu Şerefeddin (1385-1468), who was a chief physician for 14 years, was considered as the reference work of Ottoman physicians (1465) ( Figure 4B). It was restored by the Municipality of Amasya in 2011 and opened as a "Sabuncuoğlu Tıp ve Cerrahi Tarihi Müzesi" (Sabuncuoğlu History of Medicine and Surgery Museum).

LATE PERIOD (OTTOMAN PERIOD)
The Ottoman state was established in Western Anatolia (Bithynia), a former Byzantine land, as a small House affiliated to Konya   earthquakes (1509, 1557, 1754, 1766), it continued to provide healthcare services until 1824. The hospital part was demolished with the consent of the trustee, while the private masjid ("Masjid Masjid") lasted until 1877 ( Figure 5B). It was not rebuilt due to the presence of other hospitals in İstanbul and European-type Medical schools started being preferred. The hospital ruins apparently could be seen until 1970. Today, "Eski Şifahane Sokak" (street), which lies outside the northeast corner of the complex, is the heirloom of this magnificent work. and opened to visitors as a museum in 2008. It won the "Council of Europe Museum Award" in 2004 and entered the UNESCO World Heritage Temporary List in 2016. Situated in Turkey's European territory, it is the best preserved and most well-organized health museum ( Figure 5C). D) 1539, Manisa Hafsa Sultan Hospital: Ayşe Hafsa Sultan, the wife of Sultan Selim I and the mother of Suleiman the Magnificent, lived in Manisa for 8.5 years during the governorship of her son, got sick there, and was treated by the famous doctor Merkez Efendi. She is the first woman to take the title of "sultan" in Ottoman history. Although she moved to Istanbul Palace when her son took the throne in 1520, she started the construction of a large Islamic complex ("Sultaniye Kulliyesi": mosque, madrasah, school, imaret) in Manisa in 1523. When she died in 1534 before completing, Suleiman the magnificent added a bathhouse (1538) and a hospital (1539) to the complex on behalf of his mother. This structure with three iwans without a porch and nine rooms around a rectangular open courtyard was located in the yard of the Sultaniye Mosque. According to the documents, 25 staff members received salaries from the foundation. According to Evliya Çelebi, "disciple physicians" were taught two days a week (1671). When Modern Hospitals were being established in the second half of the XIX th century, it assumed the role of "Bimarhane" ("madhouse" among the people) for the mentally ill. It was transferred to Celâl Bayar University in 1996 and opened to visitors as "Tıp Tarihi  . This Darüşşifa (hospital) was the largest imperial health institution seen in the Ottomans with two-courtyards (for patients and physicians), partly two storey, own bathhouse, bakery and medicine production (drug house), separate place for medical education (Dâr-üt-Tıbb, Medrese-i etıbba), and was superior to other hospitals ( Figure 6C). It continued to function as a hospital until 1873, then it was used as a printing house, and today it is home to the Süleymaniye Manuscript Library, although it is closed to visitors. The adjacent Medicine Madrasah became the highest-ranking physician training institution of the empire and was combined with the "Süleymaniye Doğumevi" (Suleymaniye Maternity Hospital) built in 1946. The existing building of the Gynecology and Obstetrics Hospital was added to the Süleymaniye Manuscript Library when its health care services were moved to Zeytinburnu in 2009 and to Halkalı in 2011 (42).
In the years after Suleiman the Great, the Empire hit a period of stagnation and the construction of new health and welfare institutions became sparse and lost their former glory. However, until the beginning of the XVII th century, islamic complexes containing some new hospitals were seen.   end of the same year, Sultan Ahmet I died at the age of 28 due to a febrile diseaese. Other complex units mentioned in his foundation of 1614 was completed by his son Sultan II Osman (Genç Osman) ( Figure 7B). The buildings in this complex were in a non-contiguous scattered order because they were built on the remains of the Great Palace of the Roman-Byzantine Constantinopolis and partly on the Hippodrome (Hippodrome) tribunes. For this reason, "Imaret" and "Darüşşifa" (hospital) units were located on the Sfendon (Sphendone) ledge, which is the continuation of Meydani in the direction of Marmara. When the Hippodrome area for horse car races came up short, Roman architects found the solution of "sphendone" (round extension, ergo "the back of the goal net" of football stadiums), building it on the dip slope going down using Roman bricks and mortar, enormous carrier arches, galleries, and corners. This 1700-year-old fortification still carries multistorey buildings on top of it, despite the earthquakes. After the conquest of İstanbul (in 1454), "Kılıçhane Binası" (building for forging swords) was built in this area and the foundry and iron processing workshops of the army were located here. In 1615, Kılıçhane was moved to another place and the Imaret of the Sultanahmet Külliyesi (kitchen, pantry, bakery, dining hall) and the Hospital (square plan, porched courtyard, single row domed spaces, own masjid and bath) were built (1621). This last hospital of the Ottoman State was allocated to mental patients in the beginning of the XIX th century (Sultanahmet Bimarhanesi), then In the Ottoman Empire, very detailed population and real estate counts were made, recorded periodically in books (cadastral record books), and maintained in a central archive. The edicts, charts, donations and foundations signed by the sultans have survived to the present day. "Kadi registers" (court minutes, notary contracts) belonging to every region of the empire were also collected in the central archive. There was no other empire that kept such rigorous and detailed records and preserved them for centuries. Today, Millions of documents are still be read and classified. Since it is also open to researchers from all over the world.
For this reason, new information about the health institutions whose buildings have been burned down and forgotten by local people can be obtained from the above-mentioned records.
We can collect information about health institutions such as Darüşşifa or hospitals, which were once active in Anatolia (Erzurum, Erzincan, Niksar, Aksaray, Harput, Silvan, Kütahya) and in the Balkans (Thessaloniki, Skopje, Sofia, Sarajevo, Belgrade, Budin), thanks to the reading and publication of these documents by experts.