Food as Medicine in Muslim Civilization (Continued)
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11. A Balanced Diet for Preserving Health
Figure 8: Makers of a sweet called "halva" (Surnâme-i Hümayun, year 1582). Topkapi Palace Museum Library, H. 1344.). Source: Turkish Medical History through Miniature Pictures Exhibition, published by Nil Sari-Ülker Erke, Istanbul: ISHIM, 2002.
Balancing the diet forms one of the leading branches of traditional medicine, which treats this subject within the framework of the humoral theory. The concept of balanced nutrition to give protection against disease and as a method of treatment is defined by the word mu'tedil (moderate). Medical books discuss how to guard against possible harmful effects on the digestion of eating and drinking freely by means of eating a food with the qualities of an antidote. For example, the harm done by foods like fruit and vegetables that possess curative properties can be avoided by consuming foods with the opposite qualities. If vegetables with cold qualities such as cucumber, squash or lettuce are eaten, the balance is redressed by eating some garlic, leek, white whorehound  or mint as a precaution against any possible harm that might be caused. Eating unripe grapes, sumac, thyme, pepper or ginger together with fish, which is a cold food; and after the fish eating sweets such as ginger murabbâ , honey, halva or rose jam, which are hot, is suggested as a precautionary measure. Drinking lemon and honey sherbet , sour lemon sherbet or sarab-i müselles  with fish helps its digestion and prevents adverse effects. If a hot food such as garlic, white horehound, onion or the like is eaten, its effects are offset by cucumber, fresh purslane , lettuce, squash or sour sherbets. However, eating a diversity of foods with opposing qualities at the same meal is itself harmful.
If a food has the property of obstructing the channels in the body, foods with the property of dissolving and expelling food and beverages are added to the diet. For example, woodcock meat is constipating and to avoid this harmful effect woodcock meat should be eaten with unripe grapes and lemon juice.
If coarse (galîz) foods such as keskek, sheep's trotters or starch halva are eaten, gentle foods such as pickled capers, pickled onions, pickled garlic, radish with vinegar, beetroot pickle with mustard or oxymel should be eaten together with them.
Moist and mildly flavoured foods such as squash and cucumber should be eaten following foods that are salty or have a sharp flavour, such as pickles and spices. Salty foods are harmful for the eyes.
A meal should consist of foods belonging to certain categories following in a specific order. According to these principles, "delicate, gentle and watery foods" should be eaten first. So, for example, soup is taken first, followed by tirid , meat and other foods. The failure to digest bread is more harmful than it is for meat.
Following physical exertion or hard work the body becomes heated and at such times delicate (nazik) foods such as milk, fresh fish, wild apricots, peaches and melons should be avoided. This is because foods entering the stomach when it is heated are corrupted, and these corrupted foods then disrupt the humours.
12. Food Combinations to Avoid Harm
Certain foods are thought to be harmful if eaten together. Ottoman medical writers give the following advice on this subject:
- Dishes made with yoghurt and unripe grapes should not be eaten together.
- Plums, wild apricots, peaches and sour pomegranates should not be eaten one after another.
- Dishes with vinegar should not be eaten together with dishes containing unripe grapes, salt fish or dried meat.
- Rice should not be eaten with vinegar.
- Young pigeon should not be eaten with garlic, onion and mustard. If these three foods are eaten together with young pigeon they boil the blood, which causes skin problems.
- Chicken should not be cooked with yoghurt.
- Chicken should not be eaten together with fish.
- Chicken together with sour foods should be eaten in moderation. These cause abdominal pain when eaten in large quantities.
- Iced water should not be drunk after fruit.
- Honey should not be eaten together with the honeycomb.
- Onion should not be eaten together with garlic.
- Drinking milk and wine on the same day causes gout.
- Fresh fish, milk, milk foods, fresh cheese and eggs should not be eaten together. Among the foods that should not be eaten with fish, eggs come first. It is even claimed that death may result from neglecting this dietary rule.
- One should not drink water after eating fish, but patiently put up with being thirsty.
- One should not eat yoghurt with fish.
- Eating meat, especially the meat of land animals, together with fish is very harmful and the cause of chronic disease.
13. Dietary Rules according to Temperament
Each individual should eat in accordance with their own temperament.
Figure 9: Soup cooks. (Album, Topkapi Palace Museum Library, Ahmed III Collection, MS 3690). Source: Turkish Medical History through Miniature Pictures Exhibition, published by Nil Sari-Ülker Erke, Istanbul: ISHIM, 2002.
When people have a balanced temperament and are therefore in good health their diet should consist of the following: meat, in particular lamb, veal or goat's meat; wheat; an appropriate sweetmeat; a fragrant and pure beverage. Foods apart from these serve to protect the health or treat diseases. Dishes such as those made with vegetables that do not satisfy the appetite for long should be eaten less often in winter and more often in summer.
People with a hot temperament should take food and beverages that are light and of a cold quality. In the mornings these people should eat one or two morsels of bread soaked in a sour sherbet made of pomegranate, sour grape, sour apple or lemon juice, and drink a sour sherbet of this kind. Dishes such as sour sherbet, stew with unripe grapes, stew with plums, stew of lentils with vinegar, or marrow kalye  are proper nutrients for a person with a hot disposition. Due to its cold quality fish calms hot humours and is therefore beneficial for people with hot temperaments. If a person with a hot temperament eats fish they should drink oxymel or some vinegar. If a person whose stomach is very hot eats late it will cause a headache. A person who gets "hot" after meals should be careful not to eat fast and should divide the meal into two small meals.
A person who is phlegmatic, that is, has a moist and cold temperament should eat gentle and hot foods; for example, mutton and chickpea soup, young pigeon, sparrow, and hot herbs such as mastic, cinnamon and cumin. Plump people with a moist temperament should eat red meat fried in walnut oil or olive oil, and seasoned with cumin, cinnamon and garlic. One dirhem of pounded black peppercorns tied in a piece of muslin and cooked with chickpea soup lends strength to the dish. Because fish have a cold and moist quality and increase phlegm, they are harmful for those with a cold temperament and those with phlegm in the stomach. An excess of phlegm is harmful for the nerves and brain, causing lumbago, apoplexy and paralysis. To expel this harmful phlegm from the body, laxative herbs, hot water or honey with vinegar should be taken.
People with a cold and dry melancholic temperament should eat moist foods and avoid dry foods such as millet, lentils, dried meat and salty foods. For example, salt fish seasoned in vinegar, a dry and cold foodstuff, prevents the building up of yellow bile in the stomach, which causes indigestion and an increase of black bile, resulting in furuncles and itching.
People with a choleric temperament and dry nature should eat cold and moist foods; for example, noodles, spinach cooked with rice and meat. Foods like salt fish, which is hot and dry, should be avoided since the power of the salt causes an increase in yellow bile.
14. Adjusting Diet According to the Season
Foods are closely related to the seasons, because the seasons affect the density of the humours. Therefore, diet should also be adjusted according to the season.
Figure 10: The Palace head coffee maker (Album, Topkapi Palace Museum Library, Ahmed III Collection, MS 3690). Source: Turkish Medical History through Miniature Pictures Exhibition, published by Nil Sari-Ülker Erke, Istanbul: ISHIM, 2002.
The nature of spring is hot and moist. So cold and dry foods should be eaten in ample amounts in the mornings and evenings as these prevent the blood from being corrupted. Very sweet foods that have bad effects on the blood should be avoided. During spring, foods such as meat and sherbet should be consumed.
The nature of summer is hot and dry. Because yellow bile increases in summer, foods that activate or produce yellow bile should not be eaten; while foods that cause the body to become cold and moist should be consumed in ample amounts. Sour foods and beverages are very appropriate for summer. Foods that decrease yellow bile, such as fruits, the juice of pomegranates, unripe grapes, lemons, roses and apples; cold vegetables like cucumbers, marrow and purslane, and dishes or soups flavoured with vinegar and other sour ingredients are beneficial. Foods preserved in brine, and those that are salty, spiced or have a strong flavour should be avoided in summer.
In autumn blood decreases and black bile increases. The temperament of this season is cold and dry. Therefore during this season one should avoid dry and salty food, instead eating foods that are hot and moist.
During winter phlegm increases and therefore one should avoid foods and beverages that increase this humour. The nature of this season is cold and wet, so it is appropriate to eat hot and dry foods during winter; for example, dishes cooked with garlic, onion or spices such as pepper and ginger; roast meat (kebab) and sweetmeats. Cold yahni  should be avoided in the winter. Dishes should be consumed hot in winter, and cold or warm in summer. At the same time foods and beverages should not be either excessively cold or excessively hot.
There is a list of dishes to be eaten according to the season in a document (D.9599) in the Topkapi Palace archive. In this document the dishes are listed by the season, taking into account the humoral theory that forms the basis of classical Ottoman medicine. For example, in summer, sour food and beverages, fruits and vegetables predominate and spices are avoided, as prescribed for people with a hot disposition; whereas in winter, coarse foods such as kebabs and sweets, and dishes seasoned with spices are recommended. The dishes consumed throughout the four seasons, such as pilaf with meat and chicken kebab, are those classified as "moderate", and do not upset the humoral balance. The document is entitled "an account of foods appropriate for the four seasons". Below are some examples of daily menus recommended for the summer months:
Summer Season: Additional light soups should be cooked from the beginning of summer to the end and hot plants (spices) should be avoided.
Friday: Fried pilaf with meat , sour grape soup, stuffed aubergine, barberry  soup, plain chicken soup without rice, chicken kebab.
Saturday: Rice cooked with milk, marrow burani  with unripe grapes , lemon soup, chicken soup with lemon juice, chicken kebab.
Sunday: Vegetable pilaf, kalye with Swiss chard, stuffed marrow with unripe grapes, chicken soup with sour pomegranate juice, and chicken kebab.
Monday: Pilaf, sumac  soup, fried marrow, meat kalye with lemon juice, plain chicken soup, chicken kebab.
Tuesday: Pilaf, marrow cooked with unripe grapes, pide  with marrow filling, rice cooked with sour juice , chicken soup, chicken kebab.
Wednesday: Rice cooked with milk, fried aubergine with meat, bozca soup , mint soup, chicken soup with lemon juice and eggs, chicken kebab.
Thursday: Soft boiled rice, fried marrow, tutmac  with sour juice, white soup  with sour pomegranate juice, chicken kalye with chickpeas and onion, chicken kebab.
From time to time these seasonal dishes may be replaced by the following dishes:
Noodle soup, umac soup , sour almond soup, sour soups, kalye with sour juice, hekim asi .
15. Meal Times and Amounts
There is nothing so harmful as becoming excessively hungry or eating to excess. Meals should not be eaten before one is really hungry, nor delayed for long after one is really hungry. If the appetite is not fulfilled, the stomach becomes upset and filled with unwholesome (fâsid) humours. When there is true hunger, one should not delay eating. The meal should be eaten with a "loyal appetite" (sâdik istihâ), that is, a real appetite, but one should stop eating before the appetite is entirely satiated. It is better to eat quickly and leave the table rather than sit all through the repast eating continuously and unnecessarily. Because when a repast is protracted, the food eaten earlier is digested, but that eaten later is not, giving rise to disorders. One should not eat too soon after a repast, but wait until the previous meal has been digested, to avoid harmful effects. If one is obliged to eat, then one should lie down and rest for a while after eating, and then do slow but plentiful exercises. To help digestion one should take some cûvâris  as appropriate to the temperament. Over-eating brings about accumulation of blood and satiation. Excessive consumption of either food or beverages is very harmful and could even cause death from congestion.
Figure 11: A parade of syrup makers. (Surnâme-i Hümayun, year 1582). Topkapi Palace Museum Library, MS H1344.). Source: Turkish Medical History through Miniature Pictures Exhibition, published by Nil Sari-Ülker Erke, Istanbul: ISHIM, 2002.
Preferably meals should be arranged as follows: three times every two days; that is, morning and evening meals on one day and lunch on the second day. However, a person who is in the habit of eating twice a day becomes weak if they start to eat once a day. And if a person in the habit of eating once a day then starts eating twice a day, they become weak and suffer from indigestion and distension of the stomach.
16. Importance Attached to Food Preparation and to the Cook
Information about the preparation of food to be used in protecting against and treating diseases is found in books called müfredât (materia medica) and mürekkebât (compound medicines) consisting of receipts for drugs and medicaments, as well as in general medical works. The subject of which cooking methods and ingredients should be used to make a dish healthier is regarded as an integral part of medical science. This can be illustrated by the following example recommending that fish be cooked in vegetable oils of various kinds: "[fish] should be cooked in walnut oil or olive oil, and should be served sprinkled with pepper; or it should be cooked in sesame oil, walnut and almond oil. This latter method provides special protection against the harmful effects of fish". In another example "grilling fish with unripe grape and sumac" is described as "the most appropriate cooking method" and "better" than frying in oil.
It was essential that the person who prepared the food and beverages so crucial to human health be an expert. When the close relationship between food and health in Ottoman medicine is considered the important role of the cook in the treatment of patients can be understood. For example, the person appointed as tabbah (cook) to a hospital prepared not only food for the patients but also syrups and medicaments known as matbûhât , always following recipes and formula prescribed by the physician "according to the temperament of the patients". The importance given to nutrition in the treatment of patients is clearly evident in the endowment deeds of hospitals. For example, the endowment deed for the Fatih Sultan Mehmed foundation (vakif) specifies that "two fine upstanding cooks" be appointed to prepare meals for the patients in the hospital. These two cooks must "work hard to lighten the wretched wounded hearts of the patients; cook food to nourish the life force of these suffering people whose skins are as sallow as an autumn leaf, who are afflicted by so many troubles, debilitated by diverse ailments, in need of compassion, in despair of a cure." Their wages were three akçe a day.
Evliya Çelebi writes that in the Hospital of Bayezid II in Edirne delicious dishes were distributed from the kitchen to every patient, whether their illness be mental or physicial, and each dish was prepared in accordance with their individual needs. In the endowment deed of the hospital it is emphasised that the cooks prepare diet food in accordance with the instructions of the physicians: "Two capable, clean, honest, upright master cooks shall do their utmost to cook whatever dishes the physicians may prescribe according to the malady of each patient in the mental hospital kitchen; and to carry out all the duties which by custom are their responsibility quickly and in a cleanly manner."
At the Süleymaniye Hospital we find that four master cooks are to be employed; two responsible for beverages and two for food. It is specified in the endowment deed that the two "beverage cooks" (tabbâh-i ashrîba) be people "accomplished and expert, whose skill at cooking syrups has been clearly demonstrated, and who will serve unceasingly with complete dedication, endeavour and perseverence." Meanwhile the two "food cooks" (tabbâh-i at'ima) must be people "whose understanding and knowledge of cooking food is complete in every way" and they are expected to "prepare diet dishes and other foods in accordance with the instructions given by the physician to suit the dispositions, temperaments and maladies of the patients, and make sure that the flavour and other attributes of the food they cook is as it should be."
The conditions laid down for the two cooks to be appointed to the Atik Valide Hospital were as follows: "they shall cook foods appropriate for the patients such that a clever master physician may place trust and confidence in them, and they shall be diligent and take great pains that the food they cook shall arouse the appetite of the patients."
The Halvahane (Halva Kitchen) at Topkapi Palace is of particular note in illustrating the importance attached to the kitchen and the cook with respect to health. As well as preparing sweet dishes of all kinds for the table the Halvahane was also a dispensary where medicines in the form of tissanes, preserves, sherbets and macun (a type of electuary, having a soft texture and sweetened with honey or sugar) were prepared. A book kept by the Halvahane cooks discovered by Nasid Baylav and translated by him into modern Turkish contains numerous receipts for medicines .
Palace physicians used food and beverages to protect the health and treat the medical disorders of members of the palace household. A report by the chief physician dated 10 February 1326 (23 February 1911) preserved in a Treasury Register shows clearly how physicians attached importance to cooking as an integral part of medical care right up to the end of the Ottoman period:
"Herewith it is strictly commanded that as a medical necessity special care shall be given to cooking the chicken and lamb cutlets for the table of her ladyship the first favourite, that chicken cooked in various ways shall be provided every day, and that similar care shall be taken when cooking cutlets and other dishes for her."
17. Prescriptions for Foods and Beverages Written by Physicians for Ailing Members of the Palace Household
Ottoman physicians prescribed particular foods and beverages as part of their treatment. However, I had never seen any surviving medical prescriptions of this kind written for particular patients until some examples were discovered in a Treasury register. These prescriptions written by the chief physician and other physicians used such phrases as "by medical necessity", "with regard to his/her ailment", "as appropriate for health", "in accordance with medical requirements" and "as medical science requires" to explain the diet specified. These documents show how seriously the relationship between food and medicine was regarded in Ottoman medical practice. We can assume that similar documents of an earlier date remain to be discovered. Examples of such prescriptions in the form of medical reports to the palace authorities given below reveal that preventive and clinical medicine continued to attach importance to food and beverages until the early 20th century. Since traditional medicine had already been superseded by European medicine in both medical training and practice, it is conceivable that traditional approaches to diet had been observed to produce favourable results. Below are some examples from the first page of the register containing dietary prescriptions written for members of the palace household for curative or preventive purposes:
"This report herewith submitted prescribes as a medical requirement a bowl of yogurt per day for her lady chief clerk of the Harem. 2 March of the year 327 (15 March 1911). Chief Physician."
"This report prescribes that Peyvend kalfa of the Harem Laundry Office be given chicken and soup for five days in accordance with the dictates of medical science. 19 March of the year 327 (1 April 1911). Evlamyus."
"This report prescribes that as appropriate for her ailment Bedrsafa kalfa shall be given mutton chops and apple compote every day until a second report shall be submitted. 27 March of the year 327 (9 April 1911). Nizameddin."
"This report herewith submitted prescribes that for medical reasons the meal on the table of Her Highness the mother of His Highness Prince Nazim shall consist of well cooked cutlets, and sometimes grilled meatballs and occasionally fried meat, and that sometimes milk pudding and pasta shall be provided. 29 March of the year 327 (11 April 1911). Head-physician."
"This report herewith submitted prescribes that Nevin kalfa of the Harem Treasury Office be given noodle soup made with chicken stock, mallow and okra every morning and evening for a week. 11 April of the year 327 (24 April 1911). Nazif."
"This report has herewith been written concerning the illness of Nevin Kalfa of the Harem Treasury Office, prescribing that boiled chicken and two cutlets be added to her meals on alternate days for the period of a week. 14 April of the year 327 (27 Nisan 1911). Nazif"
"This report prescribes that with respect to the illness of the honorable Nevin of the Harem Treasury Office she shall be served as formerly with chicken and cutlets on alternate days, together with artichokes cooked with minced meat in meat stock, marrow kalye and stuffed marrow to be served in turn, instead of soup and okra and milk pudding. 20 April 327 (3 May 1911). Nazif."
"This report prescribes that on medical grounds the honorable chief clark shall be given four fresh eggs every day for a month. 2 May 1327 (15 May 1911). Ahmed"
"This report herewith prescribes that as a medical requirement Besim Aga, gentleman-in-waiting, shall be given soup, cutlets, marrow and okra for three days on account of his illness. 21 June 327 (4 July 1911)."
18. From Today's Perspective
Physicians writing in the Ottoman period used to compile information taken from various medical books, sometimes adding their own experiences to those recorded by earlier physicians. This meant that while the effects of a particular substance were repeated in many sources, sometimes quite different effects were attributed to the same substance. It is difficult to determine whether such information was new knowledge first recorded by the writer. However, the use of food in preventive and clinical medicine is a common approach to all these works. Similarly use of the humoral theory to determine the temperament of patients, their ailments and appropriate medication, and in explaining diagnosis and treatment was also common to all physicians.
As can be seen, most of the methods of treatment by means of foods and beverages that I have illustrated here with examples from Ottoman period medical books differ considerably from recipes to which we are accustomed today. Nevertheless there are some similarities between this information and modern culinary practices in Turkey today. For example, fish is still cooked with sour ingredients like unripe grapes, vinegar or lemon; we still eat a sweet course after fish, usually halva; and we still avoid eating yogurt with fish. Such customs, whose origin we rarely stop to consider, are relics of traditional medicine that survive in our gustatory tastes.
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 Marrubium vulgare. The sap extracted from this plant or sweets made with this sap.
 Murabbâ: Fruit preserve in the form of a jelly or marmalade.
 Sherbets are sweetened drinks made of fruit juice or flavoured with spices or herbs.
 Sarab-i müselles: grape juice or wine boiled down to a third of the original quantity.
 Portulaca oleracea. Besides being eaten as a vegetable, purslane leaves are taken as a diuretic or used as a poultice for the treatment of hemorrhoids.
 Tirid: a dish of bread soaked in milk or stock.
 Kalye: a dish of vegetables or fruit cooked with small pieces of meat that have been fried.
 Yahni: Boiled meat dishes served with the juice.
 Dâne birinc. In a manuscript in the Ali Emiri Library the author writes that dâne birinc "fattens the body and strengthens the mind. It strengthens the heart and liver and is a most appropriate food for those with a sound constitution." (f. 28b).
 Berberis vulgaris. Dried barberries were frequently used in cooking.
 Burânî: a dish consisting of a vegetable, often aubergine, cooked with fried meat, spices, saffron and eggs. It enhanced the appetite and was said to be appropriate for all temperaments.
 Koruk: unripe fruit, especially sour unripe grapes.
 The fruits of Rhus coriaria. The sour sumac fruits were dried and used as a substitute for lemon juice.
 Pitta bread. This type of thin leavened bread was often spread with a filling before baking in the oven. The various fillings included cheese, and, as here, marrow.
 Eksi: the sour juice of lemon, sumac, pomegranate etc.
 Soup made with yogurt, chickpeas and coarsely ground wheat or barley.
 Tutmaç: noodle soup with yogurt. The noodle paste is cut into long strips and then cut crossways into narrow pieces. These are then boiled briefly in boiling water and cooked with onion, butter and minced meat. Yogurt is added if desired.
 Ak sorba: soup made with flour and yogurt, or with buttermilk and hulled whole wheat grains.
 Umac sorbasi: soup made with small noodles cooked in water with butter and tomato paste. The soup is served sprinkled with mint.
 Hekim asi: no recipe has been found for this dish.
 Cûvâris: an electuary for aiding digestion. These were in the form of a paste mixed with honey.
 Matbûhât: a general name for medicines in the form of tissanes prepared by boiling or steeping plants in water.
 This translation by Nasid Baylav was later published by Arslan Terzioglu.
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by: FSTC Limited, Fri 09 January, 2009