Development of Late Ottoman Health Structures and Investigation on Adana Province Sample
Nur Umar, Fatma Zehra SarıHaving adopted an understanding of a social state, the Anatolian Turkish States attached great importance to public health and built their health centres accordingly. The Turks, influenced by Islamic civilization, combined the word ‘dar’ which stood for ‘home’ in Arabic, and ‘şifa’ which meant ‘recovery’ and ‘cure’, and gave the name darüşşifa to these institutions providing public health care. After serving the Turkish society for centuries, darüşşifas were not able to adapt to the technical conditions of modern medicine, and were replaced by “hastane”s – a name borrowed from Persian with an Ottoman influence, first coined by Ahmet Vefik Pasha in 1876. In this study, after an investigation of how Ottoman health centres developed and were transformed from “darüşşifa” to “hastane”, the health structures of the Late Ottoman Period were evaluated with examples chosen particularly from the province of Adana. Within the scope of the study, architectural projects attained through literature were evaluated, theses and articles written on the subject were examined, and the Ottoman archives were consulted. The study aims to track the progress of Ottoman health institutions with respect to emerging requirements and provide a mass collection identifying late period hospital structures.
Geç Dönem Osmanlı Sağlık Yapılarının Gelişiminin Adana Vilayeti Örneği Üzerinden İncelenmesi
Nur Umar, Fatma Zehra SarıSosyal devlet anlayışını benimseyen Anadolu Türk Devletleri halk sağlığına önem vermiş ve bu doğrultuda sağlık yapılarını inşa etmişlerdir. İslam medeniyetinden etkilenen Türkler sağlık yapılarına “ev” anlamına gelen Arapça kökenli “darül” ile iyileşme, kurtulma anlamında kullanılan “şifa” kelimesini birleştirerek; topluma sağlık hizmeti sunulan yapılara “darüşşifa” ismini vermişlerdir. Uzun yıllar Türk toplumuna hizmet veren darüşşifalar tıp biliminin ilerlemesiyle birlikte çağın teknik şartlarına uyum sağlayamamış ve yerini Batılılaşmanın etkisiyle ilk defa 1876’de Ahmet Vefik Paşa tarafından kaleme alınan Lehçe-i Osmani ile dilimize isim olarak Farsçadan geçmiş olan hastanelere bırakmışlardır. Bu çalışmada, Osmanlı sağlık yapılarının, darüşşifalardan hastanelere kadar gelişim ve dönüşüm süreci incelendikten sonra Geç Dönem Osmanlı sağlık yapıları Adana vilayeti özelinde değerlendirilecektir. Çalışma kapsamında literatür taraması gerçekleştirilmiş, konu ile ilgili yazılmış tez ve makaleler incelenmiş, çeşitli kurum ve Osmanlı arşivleri araştırılmış, arşivlerden elde edilen mimari projeler değerlendirilmiştir. Çalışma, geç dönem Osmanlı sağlık yapılarının ihtiyaçlar doğrultusundaki gelişimini ve Adana Vilayetindeki geç dönem hastane yapılarının toplu bir tespitini sunmayı hedeflemektedir.
Darüşşifas are health institutions that are related to today’s hospitals in terms of their functions. However, they differ in terms of how the needs of these structures were handled by foundations. In darüşşifas, apart from health care, many activities were conducted such as plant cultivation for herbal medicine, or the nutrition of patients and physicians. In addition, the master-apprentice relationship, which constituted the backbone of traditional medical education, was organized at these institutions.
The Seljuk darüşşifas were built as madrasah1 plan schemes with iwans-courtyards. In Anatolia, next to the Seljuk darüşşifas, medical madrasahs were built as well. In the darüşşifa foundations constructed in Anatolia, the style of the double madrasah with iwans and courtyards was adopted and developed as a building type in Anatolian Turkish Architecture. This type consists of spaces opening under a riwaq, instead of them directly opening to the courtyard. Vaults, cones and domes were used in the covering systems of Anatolian Seljuk Darussifas. Stone and brick were used as materials.
The Ottoman State continued to use the old Seljuk darüşşifas, adding various extensions to them, and the blueprint madrasah plan scheme with riwaqs-courtyards in its simplest form was implemented for new structures as well. Darüşşifa structures that provided health services to people later failed to meet the requirements of the more recent eras, as their inadequacies began to become evident. Some of the darüşşifa institutions that were unable to respond to the conditions of the modern era began to serve the mentally ill. The darüşşifas were provided with various extensions in order to help them regain their functionality.
The Ottoman military, which lost its power in the stagnation period, turned its face to the west in order to take precautions against failures. Until this period, which is generally referred to as Westernization, the Ottoman darüşşifas had maintained their traditional forms consisting of rooms arranged around a central courtyard which evoke the plans of madrasahs. The first innovations in the field of health in the Ottoman Empire were realized after 1789 in Selim III’s reign. These innovations were first implemented in the army, parallel to new military arrangements, and started to be applied to general public health as well during Abdulmejid’s reign.
Military hospitals, which make up the first examples of innovation in the field of health, were set up using the barracks plan scheme, and they formed a bridge between the first modern hospitals built for civilians and the darüşşifa. These buildings were constructed with a barracks plan scheme representing the military order. In the first civilian hospitals which began to be constructed after some military hospitals, instead of open riwaqs, passages were provided in the form of closed corridors just like those in military barrack plans. In line with the health conditions of the period (in which epidemic diseases were rife), hospitals with independent units were built and these were later connected via enclosed ports to enable easier access throughout the complex. Although the innovations brought into the health institutions of the Ottoman Empire were first seen in the capital and its environs, in line with increasing needs (caused by epidemics, war, internal conflicts, etc.), they started to be implemented in Anatolia as well. These developments in health structures in the capital and the provinces formed the basis of the hospitals of the Republican period.
This study, which we have called “The Development of Late Ottoman Health Structures and Their Investigation through the Example of Adana Province”, contains a comprehensive examination of the historical development of Ottoman health institutions in the capital city (Istanbul), showing their locations, construction dates, plans, architectural features, and the way they altered over time. The study proceeds with a detailed examination of the health structures identified in the province of Adana, which grew in significance in the Ottoman Empire in the 19th century. In line with this, the study was completed in three main stages. In the first stage, architectural projects of the Ottoman health buildings found in literature were evaluated, theses and articles written on the subject were examined, Ottoman archives were delved into, and the literature was searched through. In the second stage of the study, health institutions identified in Adana province were examined on-site and detailed descriptions were drawn up. In the third stage, the health foundations of Adana province were evaluated in a more general way.
Within the scope of the study, 7 health structures were identified in Adana province, including its centre and sanjaks. 3 of the 7 detected structures have survived to the present day while 4 of them have not. The structures that have survived to the present day are the Mersin Millet Hospital, Silifke Gureba Hospital and the Kozan Old Hospital, and detailed on-site analyses are concentrated on these three buildings. The Adana Gureba Hospital, Tarsus Gureba Hospital, Hamidiye (Ceyhan) Gureba Hospital and the Adana Municipality Hospital, on the other hand, have not survived to the present day. These structures are documented mostly by archival research. Due to requirements of expansion in health structures and inadequacy of old buildings for new equipment, new structures had to be built. And as the old structures in hospital complexes lost their function, they could not be preserved.
The study also briefly examines the evolution of health institutions in the Ottoman state which developed in 19th century and tracks the traces of these structures in the Adana province. The main aim of this study was to make a contribution to literature in the fields of architectural history and conservation.