Anatolia; The Cradle of Modern Medicine

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					                                                                                                                Ankara Üniversitesi Tıp Fakültesi Mecmuası 2009, 62(1)
    Davetli Derleme / Invited Review

Anatolia; 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;
                                                                that the nearly universal phrase “as rich
                                                                                                                    Trepanation in Anatolia
                                                                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 :                    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.
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-                                                                     guage of science of the era, in Gondes-
  tered on deities. Disease agents inclu-
                                                      “To help, or at least, to do no
                                                                                                         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
  dess of healing and medicine. Healers
                                                                                                      The two greatest influences
                                                         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
  including mandrake, henbane, poppy,
                                                                                                      Middle Ages: Al-Razi and
                                                         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-                                                               hematics, the most important among
    tuaries and healing temples where pre-
                                                      “The virtuous physician must
                                                                                                         them -Kitab el-Havi -a monumen-
    Hippocratic mystic-empiric medicine
                                                      a philosopher be”
                                                                                                         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-
    herbs and a visit to the baths. The ear-                                                          Avicenna (980 – 1037): The Bukharan
                                                         ria. His contributions to anatomy and
    liest destinations of health tourism, asc-                                                           Ibn Sina, or Avicenna as he is known
                                                         physiology cannot be stressed strongly
    lepieia regularly hosted stage and music                                                             in the West, was an astronomer, che-
                                                         enough. He is also known as Divinus
    performances as well. The asclepieion                                                                mist, logician, poet – but above all, a
                                                         Galenus because of his belief in the di-
    in Bergama where Galen studied in his                                                                paradigm shifting physician and phi-
                                                         vine spirit. The Galenic formulation
    youth is an exceptionally well-preserved                                                             losopher. He is most famous today for
                                                         that deals with the principles of com-
    representative of the genre.                                                                         the Canon of Medicine,a didactic and
                                                         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
Many of the ancient era’s philosopher-                                                                   a standard medical text at many Isla-
  physicians were Anatolian by birth and
                                                      The period of translations                         mic and European universities up until
  by origin. Soranus was from Ephesus,                                                                   the 18th century. The more than 450
                                                      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 Istanbul, 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-
                                                  rope over the Mediterranean via Anda-            ject, first in 1714 in a London-based
The Seljuks: Anatolian
                                                  lusia, triggering the Renaissance. Ibn           science journal, and subsequently
hospitals and the concept of
                                                  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-                                                         inspiration to Jenner as he developed
                                               Anatolian medicine under the
   lightenment and artistic vigor for the                                                          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 Ottoman Empire 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-
   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-                                                                neva in September 1947. Currently re-
                                                      Atatürk’s public health policy
    ughly westernized. Allow me to pay                                                                  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       Turkey
    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-                                                              founded Turkish universities. Champi-
    nal resting place is in Istanbul. May he
                                                      Refik Saydam and preventive
                                                                                                        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 Istanbul University’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.                                                                                        King of Mycenae. If the hot springs
                                                To conclude
                                                                                                     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

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