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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Note of the Editor: This article “Turkish Medical History of the Seljuk Era” by Professor Ali Haydar Bayat* was first published 3rd April 2009. (2014 – 2019). It has been republished again to honour the passing of Prof Ali Bayat.
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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:
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.
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).
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.
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).
Figure 6. Gevher Nesibe Sultan’s statue. (Source).
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].
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].
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 books, that he should not discriminate between the rich and the poor, and that he should enlighten the students with precise proofs during their education at the hospital [24].
We are able to gather information on the Turkish Seljuk physicians from history books, publications, literature, and from their writings that have survived to the present. Although some present publications state that the position of head physician was given, there are no documents to prove this [25]. Seljuk rulers appointed some of the valuable physicians for their own health problems when they saw fit.
From sources that have survived until now, we can see that in the Anatolian Seljuk era, due to developments in the medical field, there were many physicians active in the cities. Especially during the rule of Kilic Arslan II and Ala Al-Din Keykubad, there were many physicians invited to Anatolia. Because of their wide range of knowledge, their reputation and intellectual personalities, some physicians were sent on political missions to foreign countries by their administrators (for instance, Abu Bakr bin Yusuf) [26].
Some of the physicians worked in hospitals, but some of them travelled from city to city, practicing medicine. For example, the physician Saduddin Mes’ud, in a letter he wrote to a friend, mentioned going to Sinop, Kastamonu, Amasya and Niksar to heal patients and that he longed to return but that he had to go to the Canik area to cure some patients. We learn from the narratives of Evhadudduddin Kirmani that in Anatolia there were ear cleaners that travelled with a copper flask that contained oil and alcohol [27], similar to the quack eye physicians that roam the same areas today performing cataract operations.
Well known physicians with good reputations were addressed as: “Malik al-Hukama’, Sultân al-Atibbâ, Aflâtun al-Dahr, Bakurat al-‘Asr, Masîh al-Zaman, Fakhr al-Milla wa-l-Din… “ [28]
There were many physicians who created works during the Anatolian Seljuk era, who were invited by the rulers to come to Anatolia temporarily to do their job. Some of these physicians are as follows:
Adviyat al-Adviya: A book on pharmaceuticals, the gathering of medicines, how to store, burn, cook and use the formulas of ink medicine and how they are made.
Ihtisaru Fusuli al-Bukrat: An Arabic copy of Hippocrates’ Aphorisms.
Kifayat al-Tibb: This work consisted of two books and 224 chapters. It was written in Persian and was presented to Meliksah.
Risala fi Sharh Ba’zi al-Masail- li-Asbab and ‘Alamat Muntahabe Min al- Qanun: It is a pamphlet that explains the reasons and symptoms of illnesses, using examples from Ibn Sina’s Qanun.
Other works include Sihhat al-Abdan, Takdîm al-‘ilac and Bezrekat al-Minhac, Rumuz al-Minhac and Kunuz al-‘Ilac and Lubab al-Asbab [33].
Other than these physicians whom we know about from their works, there are also those who we know about from their being in the sultan’s service such as: Hasnun, Faridaddin Muhammed Câcermi, Izzeddin ibn Hubel, ‘Isâ, Carrah Vasil, Ebu Salim b. Keraya, Safiyuddevle, Rakkali Ridvan bin Ali (1247) [39], Resü’laynli Takiyeddin Abu Bakr [40], and Erzincanli Ala Al-Din [41]. There are those who had also been mentioned for being around the Sultan, such as Sarafaddin Ya’kub, Burhanuddin Abu Bakr, Sa’duddin Mas’ud, Badraddin ibn Hariri, Bedruddin Ceriri, Shamsuddin b. Hubel, Fahruddin Abu Bakr Ahmed b. Mikail bin Abdullah Konevî. There were also those physicians who had been temporarily invited to come to Anatolia. Abdullatif bin Yusuf el-Bagdadi, who had been invited by Ala Al-Din Davutshah of the Mencunuk at a high salary, wrote many books when he was in Erzincan [42]. It is also known of a physician in Konya named Mevlana Emir Hasan [43]. There was also Gabriel, Urfali Hasnun (1227) and his student ‘Isa, Harputlu Shamon and Ahron who worked in Malatya. From libraries that kept written works in Sivas, Erzincan, Konya, Aksaray, the copied works of great physicians prove that there was a dynamic and active scientific life in these areas [44].
It is understood that a portion of these scientists had a very active life. For example the physicians from Konya Fahreddin Abu Bakr Ahmed bin Mika’il bin Abdullah and Fahreddin Abu al-Barakat bin Abdussalam bin Mansur Mardini [45], pharmacist Kutbeddin Sancar bin Abdullah Atik es-Sahib Ala Al-Din Ata el-Melik Cuveyni er-Rumi, had moved to Tabriz from Anatolia [46]. After the battlefield loss in Kosedag in 1241, there was a lot of activity in the Eastern cities and the physician Imaduddin Malati and other scientists moved from Malatya to Konya [47].
During Seljuk times, medicines were prepared and sold in herbal stores (attar). The medicines were prepared accordingly to the medical books and the main ingredients consisted mainly of plants from Anatolia. The rest of the raw material was obtained from India and other Islamic countries through the Spice and Silk Roads. Hospitals and caravanserais had their own little pharmacists [48].
6. Epidemics
Throughout history one of the greatest disasters humankind has seen are epidemics. In their most critical times, they have killed millions, causing people to migrate, paralyzing work forces, agriculture and stockbreeding decline, creating numerous negative effects on the economy. The worst epidemics of the Middle Ages were the plague, black death/peste noir, peste, pestis in the West, ta’un in the Islamic world and kiran, olet among the Turks.
Because Anatolia is a bridge between the East and West, it has seen many epidemics throughout its history. The first great epidemic was seen in the Mediterranean countries during the 6th century, called the Justinian Plague. It lasted three years and destroyed a great number of the population it hit. There are no records of the deaths and destruction in Anatolia but just in Istanbul about 16,000 died per day, which gives an idea of its destruction.
There were many epidemics in various places where the Seljuks ruled that came from Anatolia and foreign countries. Mostly epidemics started after military campaigns, sieges and famines. The main epidemics were: the plague that started in Istanbul; during the time of Suleyman Shah I (1078), killing 160,000 in four months; during the time of Kilicarslan I (1093), during the siege of Antakya, during the First Crusade (1098) when just from the French military 100,000 died; during the time of the Danismand ruler Melik Muhammed (1143), an epidemic in Malatya first killed poultry, then humans, mostly small children; during the military campaign to Cukurova of Mesud I (1153), a part of the Seljuk and Konya military; during the rule of Kilicarslan II (1178) a plague due to a famine in Syria, Iraq, Diyarbakir and Ahlat, the people were not able to bury their dead in time as the rate of death was too high; during the Third Crusade (1189), the French army had many casualties due to an epidemic stemming from the heat and famine; during the rule of Ala Al-Din Keykubad (1221), an epidemic in Konya, in 1244 in Malatya, in 1259 in Syria and in Anatolia due to a famine; and the Mongolian invasion that took place at the same time brought an epidemic in Mardin and Meyyafarikin (Silvan) that caused immense damage.
The reasons for the epidemics were not known, and they were explained by supernatural causes, as the people tried to stop the epidemic material and spiritual ways. In the Christian world, sacrifices, magic, religious ceremonies were performed and miracles were expected from saints. In the Islamic world they obeyed the saying of Prophet Muhammed: “Do not enter a place of plague, and do not leave it,” creating a quarantine, but as they did not know the cause of the epidemics other from trying various medicines, they also tried superstitious beliefs [49].
Figure 10. Picture of Sultanhan on the Konya-Aksaray Road: the main portal, the stalactite arch of the main portal, an inscription detail, and the side arcades of the main portal. Source: Miniaturk-Istanbul.(Source) (Archived)
7. The Practice of folk medicine
In Anatolian Seljuk society, as it has always been over time, the people attempted to cure diseases apart from science, by going to sheikhs for religious (Tibb-i Nebevi), magical and practical solutions.
We are able to follow the folk physicians, like all social life of the era, through the writings about Mevlana Jalal Al-Din Rumi and his environment. Examples of folk medicine are: recitations by sheikhs for inability to hold urine, boils, malaria; writing words of ailment on cloves of garlic and almonds for swallowing; drinking water containing a piece of paper with religious writings; fumigating with dog hair; in the case of eye diseases having the sheikhs rub their fingers on patients eyes with their saliva while praying; and for broken bones canting religious words over the broken bone; wiping with the palm of the hand for ablution; reading or writing religious words over the skin with boils and warts.
Other than the already mentioned methods of treatment, herbal remedies were also used in scientific medication that was also used by the people. For example, garlic for prolonged fevers (allium sativum) or honey made into a paste; myrobalan (fructus myrobalani citrinae) for diarrhea; a mix of honey and vinegar to lower fever; honey, garlic and yogurt for colds; eating of raw turnip to strengthen the eye; scammony plant for constipation; myrobalan roots (radix scammoniae) for diarrhea; theriacs for intestinal pains; visits to thermal baths for skin diseases; drinking watered wine for reaction to weather changes; opium milk for over sleeping (opium, succus papaveris); hot springs for leprosy; blood letting for colds and visits to a hamam [50].
The most important part of the Anatolian Seljuk medical practice for Turkish cultural history is probably that it started to put medical practice into Turkish, and within the paradigm of Islamic medicine, the first Turkish works were produced. This started in 1233 when the physician Baraka moved from Harezm to Anatolia and translated his own book Tuhfa-i Mubârizi, that he had written in Arabic into Turkish, and continued during the Beylik (principality) era when works written in Aydinoglu, Mentese, Karesi, Candaroglu Beyliks were in Turkish [51].
The articles published on Muslim Heritage website on the Seljuks’ art, culture, history and knowledge:
Footnotes
*The late Professor Dr Ali Haydar Bayat (1941-2006) belonged to Ege University in Izmir (Turkey). He was member of the Medical Faculty, Medical Ethics and History Department. He published extensively on the history of medicine, especially in the Ottoman period. See this list, this one also, and the references mentioned in the footnotes.
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