Turkish Medical History of the Seljuk Era

The Great Seljuk state was part of the medieval Islamic civilization. Most of its scientific institutions and educational traditions were inherited from previous and contemporary Muslim and Turkish states. In this well documented article, the late Professor Ali Haydar Bayat focuses on the medical life of the Seljuk State. After a short historical survey, he describes the medical tradition during the Turkish Seljukid period, focussing on hospitals, medical education, the physicians and their work, the healing of epidemics, and the practice of folk medicine.

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Professor Ali Haydar Bayat*

Table of contents
1. Some History: the Great Seljuk era
2. Medicine during the Turkish Seljukid period
3. Hospitals
4. Medical education
5. Physicians and their work
6. Epidemics
7. The Practice of folk medicine
8. Further resources

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1. Some History: the Great Seljuk era

The Oguzlar, who were a part of the Gokturk Empire that was disbanded in 744 CE, had settled in an area that was under Samanogullari's rule in Maveraunnehir, Harezm and Horasan. However, after a dispute, Seljuk Bey migrated with his followers to the banks of the Ceyhun River (present Oxus River). After they won the war of Dandanakan against the Gaznelis, the Seljuks established the Great Seljuk State in 1040 and conquered vast lands in the neighborhood, covering large regions from the Middle Asia to India, Iran, Iraq, Syria and Anatolia [1].

Figure 1: Prof. Dr. Ali Haydar. (Source).

The scientific and civil life of the Great Seljuk state cannot be separated from the Islamic civilization. During this era, although born and raised in Turkish states, medical great names like Ibn Sina and al-Biruni, who wrote their works in Arabic, the scientific language of the era, were real heroes of the Islamic scientific tradition. In an era when the idea of community was more important, it was not expected to question the scholar's nationality. Thus, the scientists were able to travel, settle, teach and carry on scientific and medical investigation without any political boundaries. This was a very common feature for this era.

To quote just few names, among the famous names pertaining to this tradition were Ibn al-Tilimdh, Abu ‘l-Barakat al-Baghdadi, Ibn Jazala. Ibn al-Tilmidh worked for the Sultan Sancak [2], whilst Sultan Mesud's physician Abu Al-Barakat from Baghdad worked in the palace and had been awarded once with a hilat, a robe of honour [3]. During the era of the Sultan Meliksah, there were such physicians as Saîd b. Hibetillah, who wrote Kitâb al-Mugni fi al-Tibb and Ibn Jazala who wrote Kitâb Taqwîm al-Abdân and Minhâj al-Bayan fî mâ Yasta'milah al-insan [4]. Abdullah ibn al-Muzaffar al-Bahalî from Andalusia had been the physician of Mahmud, the son of Sultan Meliksah [5]. One of the most important books on pharmaceuticals that was written in this era was Kitab al-Abniye ‘an Haqâyik al-Adwiya [6].

Hospitals that existed in the Muslim world before the Seljuks were developed and spread by them. However, we have little information on Seljuk hospitals. Among these there are the hospitals and madrasas that were built by order of the vizier to Sultan Sancak, Ahmed Kâshî, in Kâshan, Ebher, Zencan, Gence and Errân [7], hospitals in Kirmân (1281) and Berdesir (11th and 12th centuries) [8], and care centres for the blind and disabled in Mosul (1159). Additionally the vizier Kunduri, upon the order of Tugrul Bey, restored hospitals such as the hospital al-Adhudi built by Adhud Al-Dawla in Baghdad [9]. They also created field hospitals for the military, where camel- earned physicians, medical personnel, provided the wounded with medicines and medical supplies [10].

The Turkish Seljuks, in the beginning, acted as the western arm of the Great Seljuk State, but then became independent and created their own identity. The science of medicine in the era of Turkish Seljuks was not of their own but a continuation of the experience, tradition and knowledge of the Islamic medicine which they helped spread through the Seljuk territories.

Figure 2: A map showing the Great Seljuk Empire at its height, upon the death of Malikshah in 1092. (Source).

2. Medicine during the Turkish Seljukid period

After the victory of Alparslan in Malazgirt (Manzikert) in 1071, the doors to Anatolia opened for many Turks to migrate through. By the 13th century, Anatolia had become the homeland to one third of the Turks. Even Europeans started to call Anatolia by the name of "Turkey".

As Anatolia was an economical bridge between east-west and north-south, the economic and political policies of the sultans caused an economic rise of the region. Among the measures edited were: the lowering of the customs tax, the absence of taxes from wheat and metalwork, the guaranteeing of the safety of the international trade routes and the caravanserais on them, the safety provided to the traders. Therefore, the income of the country grew parallel to the agricultural and industrial production [11]. The budget of the state was 27 million dinars (gold), compared to 3 million in France and 4 million in England [12]. The treasury that was stored was used for making public works.

It is in this context that we understand the following statement by Ibn Havkal in the 10th century: "In the Islamic countries, the rich are spending their money for their own pleasures, where in Turkistan the rich population is using their wealth for religion and charity [13]." From his part, Ibn Battuta remarked in the 13th century: "Abundance in Damascus, compassion in Anatolia [14]." With these favorable factors, Anatolia, which knew a period of trouble and confusion in the previous period, started to experience an economic and cultural growth not seen before [15]. Cities, whose population exceeded one hundred thousand on important caravan routes like Konya, Kayseri, Sivas, became important centres. Mosques, madrasas, soup kitchens for the poor, lodges for the dervishes, bridges, inns, hammams and hospitals were built, and the social status of the people was raised. Especially during the reign of Kilic Asian II and Ala Al-Din Keykubat, many scientists and artists were invited to live in Anatolia, and these men, by moving in temporarily or permanently, helped the progress of sciences and arts.

Figure 3: The Kharaghan twin towers, built in 1053 in Iran, are the burial place of Seljuq princes. (Source).

Among the architectural works that have survived to the present, those that are important for medical history are the dar al-shifa-s (hospitals) that prove the civilized status of the Anatolian Seljuks.

3. Hospitals

During the Anatolian Seljuk times with its economic growth and cultural progress, hospitals called dar al-shifa, dar al-sihha or bimâristan were opened in every city. Medical assistance was given to those who got sick at caravanserais [16], and soup kitchens were create for the poor. The hospitals that were built by the royal family and supported by foundations were able to do their duties over a long period without becoming a financial burden on the state. Medical treatments were given free of charge and physicians, ophthalmologists, surgeons and pharmacists worked in these hospitals. Some of the many Seljuk hospitals that have made it to the present are as follows:

  • Mardin, Necmeddin Ilgazi Hospital (MâristanMâristan) [502-516 H/1108-1121: It was started by the Sultan of Artuklu Necmeddin Ilgazi and completed after his death in the name of his brother by Amin Al-Din Ilgazi. The hospital institution consisted of a mosque, a madrasa, a hammam and a fountain. The institution was built over a vast land and the mosque, madrasa, hammam and fountain survived until today in ruins. The hospital was in the area south of the hammam.
  • Kayseri, Gevher Nesibe Medical Madrasa and Hospital (Mâristan) [602 H/1205-1206]: It is the first medical building the Turkish Seljuks built in Anatolia. The ruler of the Seljuks Giyaseddin Keyhusrev, through the will of his sister Gevher Nesibe Sultan, who died at a young age, built the complex with a hospital (Shifâiye) on the west and a medical madrasa (Giyasiye) on the east.

Figure 4: Ince Minareli (founded in 1258) Madrasa in Konya and Sifahiye Madrasa (founded in 1217-18) in Sivas, both in Turkey. (Source).

The two buildings were connected by a corridor that was 1.5 x 11 meters; the hospital was 40 x 42 m (1680 m2), and the madrasa was 28 x 40m (1120 m2). Both sections had a plan that included a pool in the middle, a courtyard that was surrounded with pavilions and four antechambers. Together with the rooms around the courtyard, 18 cells that were discovered in the latest excavation on the western wall of the hospital were restored. As it was traditional among the Anatolian Seljuks to bury the founder of the place in the complex, one of the rooms in the medical madrasa with an octagon pyramid roof was built for Gevher Nesibe's grave.

  • Sivas, Izzeddin Keykavus Hospital (Dar al-Sihha) [614 H/1217): The hospital built by Izzedin Keykavus in Sivas in 1217, together with its destroyed parts (54.65 x 61.90m), was about 3400m2. It was the largest of the Seljuk hospitals.

The hospital was built like a madrasa with antechambers and a courtyard. The 690m2 courtyard was covered with stone and surrounded with 30 rooms with porches. The mausoleum of the donator, Izzeddin Keykavus, which is located inside the hospital, was built with the special Seljuk art of brick lying and mosaic tile.

The foundation deed, dated 1220 CE, is the only example from the Seljuk hospitals that has survived to the present. This is why it is very important. From this foundation deed, we are able to gather information on the hospital staff and how the hospital was run. The administration of the hospital foundation was given to the palace treasurer and founder of the Cankiri hospital, Cemaleddin Ferruh. The administrators decided on the wages of the experienced and well performing physicians, surgeons, ophthalmologists and pharmacists, and provided the raw material for the making of medicine. They also decided on the wages of the various workers in the hospital. Five farms, 7 pieces of land and 108 shops devoted to the foundation covered an area as big as a couple villages and the money generated from these economic resources was used in maintaining the hospital. The leftover money was used to buy more income generating resources [17].

Figure 5: Tile assemblage from the first half of the 13th-century Seljuq Anatolia. Composite body, overglaze-painted, its dimensions being 9,3 inches (23.3 cm). This composite tile formed by smaller elements to create a hexagon probably originates from the palace of ‘Ala' al-Din Kay-Qubadh (reigned in Konya from 1220 to 1237). © The Metroplolitan Museum of Art, New York. (Source).

  • Divrigi, Turan Melek Hospital (Dar al-Shifa) (628 H / 1228): The complex consisted of a mosque and a hospital. Ahmed Shah, the ruler of the Divrigi area of the Mengüceks, built the mosque and his wife, the daughter of the Erzincan Bey, Turan Melek Sultan, built the hospital. This one and only Ulucami and hospital complex was built on the east side of the city on sloping land. It is very fortunate for Anatolian Turkish art that this building has survived. The hospital had a plan of a madrasa with a courtyard with four antechambers and due to the harshness of the climate, it was covered with three vaults supported by four columns, and was lit up with a large lamp. There were seven rooms around the courtyard and an octagon pool under the place where the light was hanging. There was a stone stairway in the south corner that led to the mezzanine and there was a big hall and two rooms across the front. In the northeast corner of the courtyard, where the gate to the mosque and hospital was located was the mausoleum of Turan Melek.
  • Konya and Aksaray Hospital (Dar al-shifa): It is known that in Konya and Aksaray, as they were the capitals of the Anatolian Seljuk State and adorned with many monuments, there were three hospitals. The first of these three hospitals that has not survived to the present was probably commissioned by Kilic Arslan II and became the Mâristan-i Atik.
  • Dar al-shifa-i Alai, which was commissioned by Ala Al-Din Keykubad, was located on the north side of the Ala Al-Din hill, near the Seljuk kiosk, just in front of the Ertas gate, on the left side of the Ferhuniye/Sud Tekke street.

The third hospital in Konya was commissioned by one of the viziers of Izzeddin Keykavus II, the religious judge Izzeddin Muhammed. The complex had a mosque, a madrasa and a hospital. The hospital unit was funded from revenues from the Kestel and Kocmar villages near Kadinhani. In 1254, when Izzeddin Muhammed reorganized the foundation, the hospital was referred to as Mâristân-i Atik.

We do not have much information on the hospital that was established in Aksaray circa 13th century.

  • Cankiri, Cemaleddin Ferruh Hospital (Dar al-afiye) (633 H/1235): the foundation administrator of the Sivas hospital, Atabey Cemaleddin Ferruh, commissioned this hospital. The only remaining parts of the hospital are the inscription made by Atabey Cemaleddin Ferruh and a grail with two intertwined snakes.
  • Kastamonu, Ali bin Süleyman Hospital (Mâristan) [671 H/1272|: It was commissioned by Muhezzibuddin Ali, the son of one of the Seljuk viziers Muineddin Süleyman in 1272 in Kastamonu. After a terrible fire about one hundred and fifty years ago, only the front where the door was and some of the sidewalls remain.
  • Tokat, Muinuddin Suleyman Hospital (Dar al-Shifa) [1255-1275]: One of the buildings of the complex (madrasa, hospital) that was built in Tokat by one of the statesman of the Seljuk State, Pervane Muinuddin Süleyman, was a hospital. From the complex only the madrasa, now used as the Tokat Museum, has remained. Probably the hospital was one of the adjacent buildings to the madrasa.
  • Amasya, Anber bin Abdullah Hospital (Dar al-shifa) [708 H/1308/9]: It was built during the era of the Ilhan ruler Olcayto Mehmed, around the years 1308/09, by Amber bin Abdullah, the slave of princess Yildiz Hatun. The hospital was built on the side of the road next to the Yesilirmak river and its dimensions were 24.58x32.90m using a madrasa plan and with an antechamber and ten rooms.

Besides being a hospital complex, it was also known as a place that trained physicians. We have information about the physicians that were assigned there during the Ottoman era. Some of these physicians were Shukrullah (1488), Sabuncuoglu Serefeddin (after 1465), who worked here for ten years and created many valuable pieces of work for Turkish medical history, and Halimi (1516).

  • Hot springs: Due to its geological structure, Anatolia has rich healthy hot water sources. The hot springs that had been mentioned since antiquity by writers such as Homer, Calinos and Strabon were used for healing purposes. Hot springs that were left from the Roman and Byzantium eras were still used during the Turkish Seljuk State and new springs were opened for public use.

According to the 14th century writer Omari, there were over 300 thermal springs that the public used for healing purposes. The most famous was the Ilgin hot springs built by Ala Al-Din Keykubad in 1236 on top of the thermal springs that had been known about since the time of the Roman Justinian. This hot springs area that has remained intact along with its inscriptions consisted of two hammams with a pool under its domed roof [18]. We can also mention the other hot springs of the time as follows: Agamemnun in Izmir, Haymana, Kizilcahammam in Ankara, Cardak (1175) in Eskisehir, Yoncali (1233) in Kütahya, Kizozü/Aslanagzi (1256) in Havza, Karakurt (1135) in Kirsehir, Ilica in Erzurum and Karakaya in Ayas [19].

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Figure 6: Gevher Nesibe Sultan's statue. (Source).

Hammams also played an important role in the development of health areas during the Seljuk time. Many hammams were built by foundations, sultans and statesman for the public, for both men and women [20].

4. Medical education

In the Islamic world, in the Mustansiriye Madrasa in Baghdad, other than the professors teaching Islamic science, the existence of sheikh al-tibb professors that taught 10 students [21] and the announcement that medical classes were being given in the Mansuriyye and Muayyadiya madrasas in Cairo, show that medicine was taught in some of the madrasas. Also, Nuaymi's introduction of three medical madrasas in Damascus (Dinvariyya, Dunaysiriyya ve Labbudiyya), illustrates that although they were few, there were independent medical schools [22]. Private lessons were also given. Damascus physicians Muhazzab Al-Din and Muhaddab (1232) had left instructions that after their deaths their homes and books were to be used for medical studies [23].

There is no proof that medical classes were given in Turkish Seljuk madrasas. The Seljuk hospitals in Anatolia, on one hand being a health facility, were also places where physicians were educated through a master-apprentice relationship. Two documents regarding the appointment of physicians in hospitals have survived to the present. In one of these, the physician Burhan Al-Din Abu Bakr, who was appointed to succeed on the death of physician Izzeddin of the Konya hospital was told to take care of the sick with kindness and compassion, not to discriminate between the sick and the insane, and that his salary would be paid by the foundation of the hospital. The second document stated that Serafeddin Yakûb being a talented physician, he was to be appointed to the hospital, that he should not mix the medicines together other than what was stated in medical book