Ankara Üniversitesi Tıp Fakültesi Mecmuası 2009, 62(1) TARİHTEN BİR KESİT / A MOMENT IN HISTORY Davetli Derleme / Invited Review ; The Cradle of Modern Medicine*

Anadolu: Modern Tıbbın beşiği

Berna Arda

Ankara Üniversitesi Tıp Fakültesi Deontoloji Anabilim Dalı *Anatolia – The Cradle of Modern Medicine* (This Anatolia... Asia’s extended arm towards the west. A bridge connecting Asia to Europe. A prized text based on oral presentation, 1st International territory with a millennia old history of human habitation. The homeland of an unbroken series Symposium, Expo 2015 candidacy of Izmir, 16-17 of civilizations... This presentation is as a sort of sightseeing tour crossing the ages for a survey of October 2007) Anatolia’s legacy of preserving health and fighting disease. Not an easy task if you consider the time expanse involved, for human settlement in Anatolia dates back to as long ago as the Ninth or Tenth Millennium B.C. A tale covering merely the last few centuries would have been so much easier to recount, but I must take you through the progression of 12 thousand years, no less. Rest assured though, I will only touch upon the fundamentals, the turning points and the milestones of the story. Key Words : History of Medicine, Anatolia Anadolu... Asya’ nın batıya doğru uzanan kolu. Asya ve Avrupa’ yı bağlayan bir köprü. İnsanlık için binlerce yıldır yerleşim alanı olarak seçilmiş bir bölge. Binlerce yıldır uygarlıkların hiç kesin- tiye uğramadan evsahipliğini yapmış topraklar. Bu sunum sizi Anadolu’ nun tarihinde sağlığın korunması ve hastalıklarla mücadele konusunda yıllar içerisinde bir geziye çıkaracaktır. Sözü edi- len zaman diliminin genişliği, milattan önce onuncu hatta dokuzuncu yüzyıla kadar gerilere git- mesi, kısacası neredeyse 12bin yıllık bir süreyi kapsaması nedeniyle, elbette Anadolu’ nun yaşanan bütün olayların anlatılması mümkün değildir. Burada sadece ana noktalara, kırılma noktalarına ve kilometre taşlarına değinilecektir Anahtar Sözcükler: Tıp Tarihi, Anadolu

In overview let us follow the evolution of medical practice from its most primitive stages Did you know that Julius Caesar uttered to the highly advanced as legends gave his famous declaration, “Veni, vidi, way to history in Asia Minor. vici,” here in Anatolia, in Zile, Tokat; that the Trojan War was fought here; Trepanation in Anatolia that the nearly universal phrase “as rich as Croesus” refers to Croesus the king A medical as well as mystical practice, tre- of Lydia who ruled much of Western panation is possibly the oldest surgi- Anatolia from his capital city in Sardis cal procedure documented with evi- in present day Salihli, Manisa? Did you dence. It consisted of drilling a hole hear of the Phrygian king Midas, cur- into the skull so as to expel the ail- sed with the touch of gold; and were ment. Excavations in Aşıklı, Kuruçay you aware that Gordium where Ale- Tumulus, Kültepe, Dilkaya and Gor- xander the Great slashed the mythical dium in Anatolia have uncovered seve- Gordian knot in half was the capital of ral skulls with trepanation holes, some Received: 12.08.2009 • Accepted: 05.10.2009 Midas’ Phrygian Kingdom, today in of which show signs of healing in the Corresponding author the district of Polatlı about 60 kilome- bone structure. That patients nearly Prof. Dr. Berna Arda ters southwest of modern Ankara? Are eight thousand years ago could survi- Ankara Üniversitesi Tıp Fakültesi Deontoloji Anabilim Dalı Phone : +90 (312) 310 30 10 / 362 you familiar with the ancient Lydian, ve this critical surgery in the absence E-mail Address : [email protected] Urartean, Phrygian and Hittite civiliza- of anesthesia and antisepsis testifies to tions all rooted in Anatolian land? Aga- the achievement of the Neolithic age’s inst this rich and colorful background, empirical medicine. 8 Journal Of Ankara University Faculty of Medicine 2009, 62(1)

What we have learned from Dioscorides from Anazarba, Arateus offset by a strikingly different envi- the Hittites from Cappadocia, Galen from Perga- ronment in the East. Nestorian priests mon, Herophilus from Chalcedony, smuggled Antiquity’s entire medical One of the oldest Anatolian civilizati- Aetius from Amida... Let us take this compendium, that is to say, the works ons along with the Phrygians, Lydians occasion to celebrate all the old mas- of Hippocrates and Galen, to the east, and the Urartus, Hittites ruled central ters who grew up in this land to influ- saving them from certain destruction Anatolia from around 1650 to 1200 ence, and even shape, medicine as we at the hands of the Byzantine Empi- B.C. The medical tradition they inhe- know and practice it today. re. The texts were translated first into rited from indigenous Anatolian peop- Pahlavi and later into Arabic, the lan- les and from Mesopotamia were cen- “To help, or at least, to do no guage of science of the era, in Gondes- tered on deities. Disease agents inclu- harm” hapur between the 6th and 8th centu- ded disregard and disrespect towards ries. The body of scientific and cultu- the gods, blasphemy, betrayal of oath Hippocrates who resided in the Island of ral thought that burst forth in the en- or perfidy, and personal uncleanliness Cos (460 BC-375 BC) is rightly refer- suing intellectual golden age in the among other things. Based on magi- red to as the “father of medicine” in re- Arabic language was the joint accomp- cal rituals, Hittite medicine was a su- cognition for his lasting contributions. lishment of Arabic as well as Afghan, pernatural system of healthcare practi- He rejected superstitions and emphasi- Turkish, Persian, Assyrian and Hebrew ced by male as well as female healers. zed natural causes and effects. He iden- scholars. Illnesses came from Ishara the goddess tified epilepsy as a disease rather than a of oath, while Kamrusepa was the god- divine state, secularization of medicine The two greatest influences dess of healing and medicine. Healers outside the realm of the temple, trans- on Anatolian medicine in the made extensive use of Anatolian flora formation of the Asclepius cult into a Middle Ages: Al-Razi and including mandrake, henbane, poppy, professional lodge, the practice of ta- Avicenna gallnut, myrtle, licorice, saffron and king case stories prior to diagnosis, and olives in balms and ointments admi- the establishment of the clinical doctri- Al-Razi (854 – 932): Although the Rayy, nistered with magical incantations. nes of observation, documentation and Iran, born Al-Razi took up medicine Malaria and the plague are known to classification. The Hippocratic School’s relatively late in life, he left a lasting have struck the kingdom in epidemic emphasis on the philosophical concept contribution and is credited with ha- proportions, and King Mursili II’s pra- of the four humors influenced the dis- ving achieved a synthesis of Hippoc- yer for relief from the plague exempli- cipline of medicine right up to the Re- ratic and Galenic schools of medicine. fies Hittite faith. naissance. But Hippocrates’ most las- He placed emphasis on patient follow- ting legacy has been his firm focus on up, and avoided prescribing too many Death banished... disease as the product of environmental concoctions to treat and cure them. factors, diet and healthy living habits. Al-Razi wrote over a hundred treati- Sacred to Apollo’s son Asclepius, the demi- ses on medicine, philosophy and mat- god of medicine, asclepieia were sanc- “The virtuous physician must hematics, the most important among tuaries and healing temples where pre- a philosopher be” them -Kitab el-Havi -a monumen- Hippocratic mystic-empiric medicine tal medical encyclopedia. Razi was the was practiced. Several asclepieia were Galen (AD 130-200) was a follower of first physician to diagnose smallpox established across the Mediterranean Hippocrates. Born in Bergama, he and measles and the first one to dis- region, and priest-physicians meted out studied medicine in his native city as tinguish the differences between them. faith healing aided by simple healing well as in Izmir, Corinth and Alexand- Avicenna (980 – 1037): The Bukharan herbs and a visit to the baths. The ear- ria. His contributions to anatomy and Ibn Sina, or Avicenna as he is known liest destinations of health tourism, asc- physiology cannot be stressed strongly in the West, was an astronomer, che- lepieia regularly hosted stage and music enough. He is also known as Divinus mist, logician, poet – but above all, a performances as well. The asclepieion Galenus because of his belief in the di- paradigm shifting physician and phi- in Bergama where Galen studied in his vine spirit. The Galenic formulation losopher. He is most famous today for youth is an exceptionally well-preserved that deals with the principles of com- the Canon of Medicine,a didactic and representative of the genre. pounding medicines is named after systematic magnum opus that combi- him. Galen’s death heralded the dark ned ancient Greek and medieval Isla- Anatolian origins ages of medicine in Europe. mic medical teachings and remained a standard medical text at many Isla- Many of the ancient era’s philosopher- The period of translations physicians were Anatolian by birth and mic and European universities up until the 18th century. The more than 450 by origin. Soranus was from Ephesus, The benighted Middle Age of Europe was works Ibn Sina wrote on a wide range Berna Arda 9 Ankara Üniversitesi Tıp Fakültesi Mecmuası 2009, 62(1)

of subjects include a medical treatise representing life, and the eternally re- tients were given detailed explanation in verse, not to mention the revolutio- volving cosmos framed between them. of procedures and stated their consent nary scientific encyclopedia The Book The double-headed eagle decorating before legal witnesses provide a histo- of Healing. Ibn Sina took up Hippoc- the gate of Divriği darussifa is another ric milestone in the development of rates’ rational approach to medicine, relic from the same period, reminding patients’ rights and ethical medicine. and developed it. And it is to Ibn Sina us of the universality of symbols. The practice of music therapy is also that we owe the distinction between well documented. therapeutic and preventive medicine. Science migrates back, from the East to the West Smallpox vaccine and Lady A quote from the 11th century Mary Montague As academies and other institutions of “Medicine did not exist until Hippocrates higher learning grew more widespread Lady Mary Montague, wife of the British invented it. When he died, Galen revi- in the West, science retraced its steps Ambassador to , is known to ved it. It was blind; Huneyn bin İshak back. A new period of translations en- have detailed the Turkish practice of gave it eyes. Al-Razi bestowed on it co- sued, this time from Arabic into Latin. “variolisation” against smallpox in her herence. And Ibn Sina made it whole Nurtured under the protective wings letters to Britain in 1717. The ethnic- and hale.” – al-Juzcani. of the East, medical and other scienti- Latin Ottoman physician Emanuel Ti- fic knowledge were transmitted to Eu- monius had also written on the sub- The Seljuks: Anatolian rope over the Mediterranean via Anda- ject, first in 1714 in a London-based hospitals and the concept of lusia, triggering the Renaissance. Ibn science journal, and subsequently hospitalization Sina had almost been prophetic when in 1745 in Berlin. Hence, the met- he stated, “Science and arts won’t per- hod was familiar to European scien- From the 11th century onwards, Anato- sist where they aren’t appreciated.” tific circles. We have no way of kno- lia increasingly bears the mark of Sel- wing whether the practice provided juk civilization. This is an era of en- Anatolian medicine under the inspiration to Jenner as he developed lightenment and artistic vigor for the Ottomans his smallpox vaccine, but we can safely most part, and Anatolian Seljuk me- state that the two methods together sa- dicine is an inventive blend of pre- The second great empire after Eastern ved untold millions from death and Islamic Central Asian Turkic healing Rome (Byzantium) to rise in Anatolia, disfiguration. practices with the medical discipline the reigned from the of the Greater Seljuk Empire. One no- 13th century until early 20th century, Crimean War and Florence table Seljuk contribution to the field is establishing a territorial rule spanning Nightingale the concept of hospitals and hospita- three continents described as “supra- lization that gradually spread over to national” by historians. Ottoman me- Considered by many to be “the first mo- the Western world. Some of the ear- dicine followed in the footsteps of Sel- dern armed conflict”, the 1853-1856 liest public hospitals were established juk medicine before it, as testified by Crimean War is equally significant for in Anatolia along with those in im- several health institutions across Ana- the way it set the stage for the foun- portant Eastern metropolises such as tolia including Yıldırım Beyazıt Da- ding of the modern nursing professi- Damascus, Baghdad and Cairo. Sco- russifa in Bursa, Bayezid II Külliye in on. Florence Nightingale served in the res of ‘healing houses’, or Darussifas as Edirne and Havsa Sultan Külliye in British Army Hospital in Üsküdar, Is- we refer to them, were set up all across Manisa, as well as Fatih, Haseki, Sü- tanbul, for two years together with 42 Anatolia, including the one in Mardin leymaniye, Ahmet I and Atik Valide of her compatriots. The recognition in early 12th century, Kayseri in 1206, Sultan Külliyes in Istanbul. It expan- she gained as a national heroine hel- Sivas in 1217, Divriği in 1228, Konya, ded on the Turkic medical tradition ped her launch the Nightingale Trai- Aksaray and Çankırı in 1235, Kasta- in general. One characteristic of this ning School that revolutionized the monu in 1272, Tokat in the 13th cen- tradition was well-managed hospitals, concepts of hospital hygiene and pa- tury, and Amasya in early 14th cen- while another was humanistic and care tient care. tury, to name just a few. Itinerant hos- oriented treatment of mental patients. pitals and health dispensing chariti- I should note as well that “informed Medical schools and the es were also introduced by Anatoli- consent”, a practice that wasn’t intro- modernization of Anatolian an Seljuks. The darussifa built in the duced in the West until the 19th cen- medicine early 13th century in Kayseri in honor tury, was well established in Ottoman of Seljuk princess Gevher Nesibe be- medicine. Signed and sealed Ottoman The Ottoman Empire’s efforts towards ars Shamanic figures on its main gate records from as early as the 15th cen- modernizing its administrative struc- – a pair of male and female serpents tury documenting that pre-surgery pa- ture and education began to yield tan-

10 Anatolia; The Cradle of Modern Medicine Journal Of Ankara University Faculty of Medicine 2009, 62(1)

gible results from the early 19th cen- force. Epidemic diseases were ram- whose symptoms include mouth sores, tury onwards. Istanbul’s first wes- pant, including respiratory tuberculo- genital ulcerations and eye inflamma- tern style medical school was estab- sis, trachoma, and the highly prevalent tions, and the name (Morbus Behçet) lished in a small mansion in Şehzade- malaria. was formally adopted at the Internati- başı in 1827, and from that point on, onal Congress of Dermatology in Ge- Turkish medical education was thoro- Atatürk’s public health policy neva in September 1947. Currently re- ughly westernized. Allow me to pay (1923-1938) ferred to as Behcet Disease, the syndro- homage here to the Royal Physician me has a biennial World Congress de- Mustafa Behçet Efendi who spearhe- Mustafa Kemal Atatürk’s public health dicated to its study. aded the move towards modern me- policy centered on “preventive medi- dical training and also to the Vienna cine”. Tasked with rebuilding the co- 1933 university reform and born Dr. Karl Bernard who took over untry after decades of devastating war, refugees finding a home in as the principal of the school in 1838. the government prioritized eradication Having arrived in Istanbul as a young of epidemic diseases, ameliorating the physician, Dr. Bernard firmly focused shortage of trained healthcare person- Turkey launched a wide scale university re- the curriculum on basic sciences and nel, and drawing up the relevant regu- form in 1933, and academicians who dissection. He studied Anatolian flo- lations. had to flee Nazi Germany were invi- ra as well, and drew up Turkey’s ear- ted by Atatürk to work in the newly liest pharmacopoeia. Dr. Bernard’s fi- Refik Saydam and preventive founded Turkish universities. Champi- nal resting place is in Istanbul. May he medicine oned by Dr. Reşit Galip, the Minister rest in peace. of Education of the period, the reform Dr. Refik Saydam (1881 – 1942) gradu- and the infusion of German scientists Women in medical training ated from the Military Medical Aca- prompted by it, transformed the aca- demy in 1905, and specialized in His- demic field in Turkey. 42 foreign scien- The medical school that has since been tology and Embryology. He returned tists many of whom were Jewish took moved to Haydarpaşa began accepting to Turkey from his post in Berlin when up posts in various universities in Is- female students in 1922 – 1923, and the Balkan War broke out. He was one tanbul and Ankara. Philippe Schwartz, the earliest graduates were Drs Müfide of a handful of individuals who ac- Erich Frank, Fritz Reimann, Albert Kazım, Sabiha Süleyman, İffet Naim, companied Mustafa Kemal to Sam- Eckstein... Most learned our language Suat Rasim, Fıtnat Celal and Hamdiye sun as he set out to organize the resis- well enough to conduct classes in Tur- Abdürrahim in 1928. However, they tance. Saydam represented the Doğu- kish. Some of them returned to the- were preceded by Safiye Ali who studi- beyazıt province in the founding Na- ir home country at the end of World ed medicine in Germany and opened tional Assembly. He served as the Mi- War Two, while some became Turkish her office in Istanbul in 1922 and was nister of Health for five terms, and af- citizens and chose to stay here. But, the first Turkish woman doctor. Ever ter a term as the Minister of Interior, they all acknowledged Anatolia as the- since that date, Turkish women conti- he was elected to head the cabinet in ir adopted homeland, the one sanctu- nue the tradition of their Hittite an- 1939. Dr. Refik Saydam spearheaded ary that welcomed them in their dar- cestors by dispensing health across the the establishment of the Public Hygi- kest hour. In the words of Erich Frank, country as doctors and surgeons and ene Institute, promoted domestic pro- “When I was robbed of my citizenship make up a full third of Turkey’s acade- duction of vaccines and was the princi- and left homeless, only Turkey recei- micians in the field of health. pal force behind the campaign for pre- ved me with open arms. Turkey is my ventive medicine. homeland.” Birth of the Turkish Republic Following the War of Liberation in 1919-1923, modern Turkey was established as a se- Hulusi Behçet and Behcet Dr. Gazi Yaşargil: cular, social state that upholds the law. Disease Neurosurgery’s Man of the The Republic embodied enlightened 20th Century A 1910 graduate of the Military Medical ideals. Several physician friends ac- Academy, Dr. Hulusi Behçet (1889- Born in 1925 in Lice, Diyarbakır, Yaşargil companied Mustafa Kemal Atatürk as 1948) specialized in dermatology. He attended Ankara Atatürk High Scho- he successfully defended the country continued his studies in Budapest and ol and Ankara University. He studied against invading armies and proclai- Berlin, and was appointed as a profes- medicine in Basel, Switzerland and bu- med the republic. But the health inf- sor at ’s Faculty of ilt his highly acclaimed career in ne- rastructure that the young republic in- Medicine Department of Dermato- urosurgery in Zurich. In 1994 he ac- herited was in ruin, with only one me- logy and Venereal Diseases in 1933. cepted an appointment as Professor of dical school, 554 doctors in total and a He identified a chronic syndrome Neurosurgery at the College of Medi- woefully inadequate healthcare work- Berna Arda 11 Ankara Üniversitesi Tıp Fakültesi Mecmuası 2009, 62(1)

cine, University of Arkansas for Medi- schools of medicine. Over six thou- sential elements of what we refer to as cal Sciences where he is still active in sand public outpatient clinics dispen- human civilization originated here. the practice of micro-neurosurgery, re- se primary and preventive health care, The land’s ingrained culture is one of search, and teaching. Gazi Yaşargil is while hundreds of hospitals provide solidarity nurtured on diversity. 2007 universally recognized as the founder specialized and advanced medical ser- also happens to be the 800th anni- of micro-neurosurgery. He created a vice. The Turkish healthcare sector is versary of the great Anatolian thinker range of innovative instrumentation as accomplished in the field of primary Mevlana Jallaladdin Rumi. And I tri- to enable the advancement of micro- care from maternal and child health to ed to emphasize how the rich cultural surgical techniques, and his genius in eradication of epidemic diseases, as in milieu here contributed to our unders- developing microsurgical techniqu- highly advanced and complicated me- tanding of medicine. es transformed the outcomes of pati- dical procedures from cardiovascular ents with conditions that were previ- or brain surgery to organ transplanta- We are only a stone’s throw away from the ously inoperable. Yaşargil was named tion. Balçova Hot Springs, immortalized in “Neurosurgery’s Man of the Century” legend as the Bath of Agamemnon, in 1999. To conclude King of Mycenae. If the hot springs could wash away the pall of the Tro- Today... I tried to give you a brief overview of Ana- jan War, they can help with the jet-lag tolian medical culture. Asia Minor is you must be feeling after your flight As of 2007, Turkey has over a hund- the birthplace of ancient civilizations here from countries near and far. Do red thousand medical doctors and 54 and a significant proportion of the es- you agree?

Acknowledgment: I am grateful to H.E.Solmaz Unaydın, ambassador and chairperson of the EXPO 2015 Izmir Promotion Board, and to all the board members, who have, spent enormous effort on this symposium.

12 Anatolia; The Cradle of Modern Medicine