Amasya, on the banks of the Yeşilırmak, was for centuries a city of princes, calligraphers and poets, and equally a place where the sick came for healing. On the avenue that runs parallel to the river, the Amasya Darüşşifa (hospital and medical school) rises with its cut-stone façade and the cylindrical corner towers on either side, and it has stood as the emblem of that function since the early fourteenth century. In the fifteenth century a physician who worked in this building was not content to describe his operations and treatments in words; he drew them. The book that resulted entered the history of medicine as the first Turkish work to show surgical procedures in miniature paintings.

The life of Şerefeddin Sabuncuoğlu is scattered across the sources and is mostly given in approximate dates. This article concerns itself less with the physician's detailed biography than with the illustrated surgical tradition that bears his name: the structure of the Cerrâhiyyetü'l-Hâniyye, its relation to al-Zahrawi, its miniatures, its choice of language, his other works, and the path the manuscripts have traveled. The physician's life is given only as far as it helps to understand the book.

The Physician's Life

Sabuncuoğlu Şerefeddin belonged to a well-known family of physicians whose name still lives on in the Sabuncuoğlu (Hacı İlyas) quarter of Amasya. Some studies give his full name as Sabuncuoğlu Şerefeddin b. Ali b. al-Hajj Ilyas b. Sha'ban al-Amasi. His year of birth is not certain. Because he says he was eighty-three when he wrote the Cerrâhiyye, his birth is placed around 1386 (788); some researchers prefer about 1385. For the year 1468, when he wrote the Mücerrebnâme, the sources give figures for his age that range between eighty-two and eighty-five, so the date of birth remains an approximate value.

His grandfather, Hacı İlyas Çelebi Bey, was chief physician to Çelebi Sultan Mehmed (1413-1421) and, according to some studies, served at the palace in Bursa. His father, Ali Çelebi, had also been chief physician, and the family produced other physicians, such as Hekim Lütfullah (Hekim İsa), who died in 1426. Medicine continued in the line after Şerefeddin; Sabuncuoğlu İbrahim, who treated Prince Murad in Iran after the prince fled there under Selim I, was one of them. Şerefeddin probably received his medical training from Burhâneddin Ahmed en-Nahcuvânî. According to one account he began practicing medicine at seventeen. After fourteen years as a physician at the Amasya Darüşşifa, he spent some time in Kastamonu during the reign of Candaroğlu İsfendiyar Bey (1392-1440). When he completed the Cerrâhiyye he went to Istanbul and presented the book to Mehmed II the Conqueror, and on the way back he stopped in Bolu, Gerede and Tosya; he recounts this journey in his own Mücerrebnâme. Since he wrote his last book in 1468, his death must fall after that date. The exact year of his death is unknown; some studies state that he died in Amasya. Some compilation articles add that Şerefeddin rose to the post of chief physician at the Darüşşifa and witnessed the conquest of Istanbul at the age of sixty-eight; no document is cited for the first claim, and the second is merely an approximate age calculation if he was born in 1386.

One of the traits that set Sabuncuoğlu apart from his contemporaries was his artistic identity. It is noted that he prepared the calligraphy and the miniatures of his books himself. That he was a fine calligrapher can be seen from the fact that he copied the verse medical book Nazmü't-teshîl by his student Muhyiddin Mehî, as well as a Persian verse medical book by Halîmî. Researchers describe him as a modest researcher, a skilled clinician and a teacher of strong ethical concern. Another point that draws attention is his professional profile: Sabuncuoğlu was a general physician who could treat every kind of surgical and internal complaint, even mental disorders, and was not a specialist confined to surgery.

The Amasya Darüşşifa

The building in which Sabuncuoğlu worked was constructed on a madrasa plan in the Yâkutiye quarter. According to the Arabic inscription above its portal, it was built in 1308-1309 by Anber b. Abdullah, a slave of İlduş (Yıldız) Hatun, the wife of the Ilkhanid ruler Öljeitü Khan, together with the Emir of Anatolia, Ahmed Bey. Its architect is unknown. Other records show that its endowment deed, which has not survived, was drawn up in 1312. The building is laid out on an east-west axis over an area of roughly 33.60 × 25.60 meters, with two rows of arcades around a rectangular courtyard and long vaulted halls lined up behind these arcades. This plan of a courtyard with two iwans is formed by the entrance iwan standing opposite the main iwan. The arcades rise on pointed arches carried by columns whose capitals show varied forms such as plain, muqarnas and profiled types.

The darüşşifa should not be understood merely as a place where patients were seen. Physicians were trained here, and knowledge passed from one generation to the next through the master-apprentice relationship. His teacher, he himself and his students are interlinked links of this tradition. As far as the inscription shows, the building functioned in a general sense as a hospital. The habit of calling it a bîmarhane (asylum) arose from the idea that only the mentally ill were treated here, and although it is said that in later centuries the institution served in that field for a long time, its original function was that of a broad medical institution. That Sabuncuoğlu practiced medicine and surgery here is learned from his own Mücerrebnâme. In later centuries the building served various purposes; a study of the Amasya Sabuncuoğlu Museum of Medicine and Surgery History treats the path of this building, which began as a darüşşifa and madrasa and continues as a museum, as the story of the city's cultural fabric as well, and draws attention to the tradition of music therapy along with medicine. Today the building has been restored, its surroundings have been laid out as green space, and it is open to visitors as the Sabuncuoğlu Museum of Medicine and Surgery History, which bears the physician's name.

Cerrâhiyyetü'l-Hâniyye

The title of the book appears in the sources in two forms: Cerrâhiyye-i İlhâniyye and Cerrâhiyyetü'l-Hâniyye. The second is interpreted as "the surgical book presented to the sovereign." The work was written in 1465 (870) for Mehmed II and dedicated to him. The author was eighty-three at the time. In the epilogue he says that the sultan loved and supported learning and that he wrote the book also in order to attract the ruler's attention. That the work was written in Turkish, was vocalized, and was furnished with miniatures made it a subject of separate studies in the history of medicine, in Turkish linguistics and in art history.

The book was introduced to the scholarly world in 1927 by Ali Canip (Yöntem) in an article in the journal Hayat. A. Süheyl Ünver presented the work in Belediye Mecmuası in 1931 and as a book in 1939; Vecihe Kılıcıoğlu produced a study with the Turkish Historical Society in 1956. The study by Huard and Grmek, based on the copy in the Bibliothèque Nationale in Paris and noting its 140 miniatures, appeared in 1960. İlter Uzel's two-volume facsimile and transcription was printed in 1992 by the Turkish Historical Society.

Where It Departs from al-Zahrawi

The core of the work is the surgical part forming the thirtieth chapter of the medical compendium Kitab al-Tasrif by the Andalusian physician Abu al-Qasim al-Zahrawi. The sources give al-Zahrawi's death as 1013 or 1036. Sabuncuoğlu did not transmit this chapter as it stood. He added two new chapters to the text, contributed his own clinical observations and operating experience, and explained the causes of diseases by referring to Greek, Arabic and Persian medical books. He adopted the prevailing view of the age, the humoral pathology of the four fluids, and in this context drew on authorities such as Hippocrates, Avicenna, Galen and al-Zahrawi. It is also claimed that some of his ideas reach back to the Central Asian Turco-Mongol medical tradition and to Far Eastern experience. Many historians of medicine have treated the work as a translation of the Tasrîf; when the two books are set side by side, the basic information proves the same while the details differ considerably. The similarity between the instruments al-Zahrawi drew some four centuries earlier and Sabuncuoğlu's drawings is evident, and his debt to him cannot be denied. For this reason the book is regarded as a synthesis in which Greek, Arab and Turkish surgical learning met in Anatolia, and it is counted among the last great medical encyclopedias of the Islamic world.

Its Sections and Subjects

In the surviving copies the book consists of three chapters (bab) and a total of 193 headings; some researchers add a fourth part, the drug compounds the physician prepared himself. According to the description of the Paris copy, the work opens with a three-page preface, a poem of five couplets and a twenty-three-page table of contents. The first chapter describes the treatment of various diseases by cauterization and includes fifty-six miniatures and eleven drawings of surgical instruments. The second chapter has ninety-six sections; it shows various operations with fifty-eight miniatures and 146 drawings of instruments. The third chapter, of thirty-six sections, is devoted to the treatment of fractures and dislocations and carries twenty-four miniatures and eleven instrument figures. Added together, these figures reach 138 miniatures; the sources do not explain the difference from the commonly cited 140.

The range of subjects is wide. Eye diseases and eye operations, dentistry, women's diseases and childbirth, pediatric surgery, the nervous system, vascular surgery and the treatment of bone and joint conditions all appear in the same book. It has been established that some of the cauterization points coincide with acupuncture points, and this comparison has been the subject of studies by researchers such as Ali Haydar Bayat and Nil Sarı. The text also deserves attention for its anatomical sections and for the richness of its Turkish medical terminology.

Illustrated Surgery

What sets the Cerrâhiyye apart from an ordinary medical book is its roughly 140 miniatures. Al-Zahrawi's book contained drawings of surgical instruments. Sabuncuoğlu added to these scenes of patients being treated and operated on. The treatment of fractures and dislocations of regions such as the ribs, knee, back and shoulder, women's diseases and childbirth, operations of the urinary tract, the lancing of abscesses and the stitching of open wounds are explained through these pictures; even the position in which the patient is to be held during the procedure is drawn. How the incision is to be made, how the instrument is to be held and at which points the cautery is applied is laid out before the reader's eyes. The miniatures are in color, and it is noted that the incision techniques and the instrument drawings came from the author's own hand. In the earlier period of Islamic medicine it was not common practice to furnish medical texts with images showing the human body, which is why the book is regarded as the first illustrated surgical textbook of Turkish-Islamic medical literature and, in the words of some researchers, the first illustrated surgical atlas.

Later research showed that the miniatures were pioneering in separate fields. Büyükünal and Sarı assessed the book as the earliest pediatric surgery atlas. The drawings of the instruments needed to extract the fetus and of obstetric maneuvers have been examined from an obstetric standpoint, and the plastic surgical techniques were treated separately in the work of Doğan and colleagues. While Başağaoğlu and colleagues studied the anesthesia practices of the fifteenth century, Bademci argued that the female figures in the book could be read as the "first female neurosurgeons." Independently of these interpretations, the book is also known to contain scenes showing the drainage of hydrocephalus through a reversed T-shaped incision, the treatment of a constant flow of tears, and the reduction of a dislocation of the back vertebrae.

Some folios are decorated with flowers, vases, plant motifs and ceramic vessels (in the Paris copy, for example, folios 26a, 32a and 60a); these details are seen as a field that deserves separate study for Ottoman painting, decorative programs and the everyday objects of the period. The study of the miniatures from an art-historical viewpoint began relatively late. Gönül Güreşsever discussed the miniatures of the Istanbul copy at the Turkology Congress in 1973. A recent study on the cauterization chapter of the Paris copy examined the relation between text and image and the design features of the miniatures, and drew attention to the fact that the book had until then been assessed mainly from the viewpoint of the history of medicine and that only a limited number of studies had dealt with its artistic side.

Women Physicians and Nurses

About 56 of the miniatures contain female figures. Part of the figures are female patients; in some scenes women are depicted as physicians and nurses. Considering the religious, social and cultural conditions of the period, this choice is striking, and it is said that in some scenes female surgeons are depicted for the first time. The study by Gençel Efe and Süngü argues that these depictions show that women, present in every area of life, also had a place in fifteenth-century medicine, and it also asks to what extent the treatment procedures in the text are reflected in the depictions. A distinction needs to be made here: these scenes are visual evidence that women were present in health care at the time, but whether each figure represents an actual physician or an assisting nurse is a separate matter of debate.

Mental Disorders and Anesthesia

One of the interesting parts of the book is the sections devoted to mental ailments. For the various nervous disorders called "mâlihülyâ" (melancholia) and for "unutsaklık" (forgetfulness), Sabuncuoğlu describes cauterization and draws, with his own hand, the earliest known color illustrations in this field. The treatment he proposes is staged: first a herbal medicine, then warm sheep's tail fat applied to the crown of the head, and if all of this fails, cauterization at certain points; he also warns against the risk of damaging the skin.

The information he gives on anesthesia is also striking. Sabuncuoğlu notes that some patients can endure incision and cauterization while others cannot, and in that case he recommends preparing a narcotic drug called "murkid." He pounds fresh luffah (mandrake, mandragora) roots and mixes them with almond oil, lets the mixture stand for a day and a night, and has the patient eat one dirhem (about four grams) before the operation. The patient lies down, falls asleep and does not feel the procedure. He adds that for children only the necessary amount should be given, so that no error occurs, and says that this was the only narcotic he used in his lifetime. Mandrake root is a plant that was formerly used as a narcotic and sedative because of its alkaloids mandragorine, hyoscyamine and scopolamine. In Islamic hospitals the staff who prepared medicines were known as saydalan or ispengiyar.

The Choice to Write in Turkish

Sabuncuoğlu knew Arabic and Persian, yet he wrote all his works in Turkish. He states his reason plainly in the epilogue of the Cerrâhiyye: "Bu kitabı Türkî yazdum. Türkî yazdugum sol ecilden oldu kim Kavm-i Rûm Türkî dilin söylerler..." (I wrote this book in Turkish. I wrote it in Turkish because the people of Rum speak the Turkish tongue.) The people of Anatolia speak Turkish, and those who read also read Turkish books. Surgeons who did not know Arabic could not read books in that language and so could not follow advances in medicine, which could lead to errors in operations. In the epilogue of his Akrâbâzîn translation he gives the same reasoning: medical books were written in Persian and in "Tâzî," and since most of the people of Anatolia did not know Arabic and Persian, these books had become useless.

This choice had two results. The book became a valuable source for the vocabulary, the root structure and the grammar of fifteenth-century Anatolian Turkish; its vocalization makes it easier to establish the phonetic features of the period. It also became an important link in the development of Turkish medical terminology. On the other hand, the fact that the physician lived in Amasya and wrote his works in Turkish rather than in Arabic, the scientific language of the day, is counted among the main reasons why he was not sufficiently known. His name appears for the first time in a work dated 1505, the Alâim-i Cerrâhîn, in which the surgeon İbrâhim b. Abdullah, citing him by name, transmits a suppository formula for women's diseases taken from the Mücerrebnâme.

His Other Works

To consider the Cerrâhiyye alone would be incomplete; Sabuncuoğlu's three works complement one another.

The Akrâbâzîn Translation. The word akrâbâzîn comes from the Syriac form of the Greek word grafidion, "little book," and corresponds to the modern terms codex and pharmacopoeia. These books, to which physicians constantly turned, were written in narrow, long and small formats so that they could fit into a pocket, a sash or a bag; they showed from which substances, in what quantities and by what method compound drugs were to be prepared, and where and at what dose they were to be used. Sabuncuoğlu's translation was made in 1444 from the last chapter, titled "Akrâbâzîn," of the Persian book Zahîre-i Hârizmşâhî by İsmâil b. Hasan al-Jurjani. He expanded the section of thirty-one babs to thirty-three with additions and added Arabic, Persian and Turkish medical terms (Süleymaniye Library, Fâtih, no. 3536, 239 folios). The book opens with the methods of preparing drugs and then gives formulas in the order of simple and compound drugs, electuaries, eyâric, cevâriş, ıtrıfil, kurs, powders, laûk, syrups, perverde, gargles, oils and ointments. Among Ottoman-period akrâbâzîns, those of İshak b. Murad of Gerede, Sâlih b. Nasrullah of Aleppo, Ömer Şifâî and Ali of Bursa are also famous; Sabuncuoğlu's work is one of the best-known examples of this branch. In 1991 Kenan Süveren prepared a doctoral study at the GATA Faculty of Medicine comparing this work with Avicenna's book of the same name.

The sources show an inconsistency regarding the date of the translation. It is said to have been made "during Prince Bayezid's second governorship of Amasya" at the request of his physician, but Prince Bayezid (Bayezid II) was born in 1447, and his governorship of Amasya came much later. The given date of 1444 and the identity of the prince cannot both be right; which of the two is mistaken should be left open.

The Mücerrebnâme ("Book of Tested Things"). Written in 1468 at the request of his fellow physicians in Amasya, who said "write down the experience you have gained so far, so that we need not look at other books," this work rests on the physician's own experience. The drugs were tested on animals, on people and on the author himself, and their preparation and use are described. It consists of seventeen chapters; drugs are ordered from the most frequently used to the least, and the text contains expressions resembling today's case presentations. Sabuncuoğlu carried his empiricism as far as his own body: he developed antidote formulas against poisons, reported his observations on animals he had poisoned and, according to folio 4b of the Mücerrebnâme, let a venomous snake bite his finger and then drank a theriac he had prepared himself to test its effect. Because it is the first monograph in which a physician describes drugs and treatment methods of his own devising, it has a distinct place in Turkish medical history. The book was first introduced in 1920 by Rusçuklu Hakkı in the newspaper İkdam. The library and number of the manuscript are given differently in the sources: one cites the copy numbered Fâtih 3619 in the Süleymaniye Library, another the 106-folio copy numbered Ayasofya 3720. There may therefore be more than one manuscript.

A wrong attribution. Bursalı Mehmed Tâhir attributed the work Müfîd (Nazmü't-teshîl) to Sabuncuoğlu. Later studies have shown that the book belongs to the physician's student Muhyiddin Mehî.

The Story of the Manuscripts

Three copies of the Cerrâhiyye have survived to the present. The copy in the Bibliothèque Nationale in Paris (Supplément Turc, no. 693) and the copy in the Millet Library in Istanbul (Ali Emîrî, Tıp, no. 79) came from Sabuncuoğlu's own pen. The third copy, in the library of the History of Medicine department of the Istanbul University Faculty of Medicine (no. 35 or TY no. 263, according to the sources), is known for the high artistic value of its miniatures even though many of its pages are missing.

The number of folios is given differently in the sources: 205 folios are cited for the Paris copy, while some articles present the book as having 199 folios; it is not stated whether the difference comes from a particular copy or from the method of counting. The finest of these three manuscripts is the Paris copy, which was presented to Mehmed II and bears the seal of Bayezid II. This copy, measuring 18 × 26.5 cm, consists of 205 folios written in seventeen lines each of vocalized Turkish naskh; headings meant to be emphasized are written in red ink and framed with ruled borders. It is related that the copy left the palace at an unknown date, was given as a gift to a French physician in 1860 by Yâsincizâde İlmî Efendi, and passed to the Bibliothèque Nationale in 1871. The work was first published by A. Süheyl Ünver in 1939, and Uzel's facsimile and transcription of 1992 were added to these publications.

His Medical Outlook and His Students

In Sabuncuoğlu's books the ethical side of medicine stands out as much as the technical side. He stresses the physician's responsibility toward the patient and the need to act with care and moderation. According to Uzel, his advice to colleagues was to keep their compassion separate from their fame and ambition; the saying speaks to physicians even today.

His students carried this legacy forward. One of them, Gıyâs b. Muhammed al-Isfahani, in his Persian book Mir'âtü's-sıhha, dedicated to Bayezid II, praises his teacher's achievements in medicine and writes that he took him as a model. The physician Adıvar likewise ranks Sabuncuoğlu as the second most important physician of Mehmed II's reign. These lines are among the documents showing that the Amasya Darüşşifa had a tradition of training physicians. Muhyiddin Mehî's Nazmü't-teshîl also belongs to the same circle.

Some Frequently Repeated Claims

Certain statements that circulate about this physician either do not appear in the sources consulted or appear in a different form. It is said that the book is "a summary of sixty years of medical experience," yet this figure is not found in the sources. What is documented is the fourteen years of service at the Darüşşifa and the experience gained over a lifetime. That the book was written in Amasya is likewise uncertain; the sources do not state the place of writing, only that the author went to Istanbul to present the work to the sultan. The judgment that no surgical illustration as colorful and detailed existed in the West at the same period is an assessment and does not rest on a document.

Sabuncuoğlu in Amasya Today

Today Sabuncuoğlu's name lives on in Amasya in a neighborhood, in a museum and in the accounts of the city's medical history. A visitor walking through the old darüşşifa recalls that six centuries ago a physician decided to convey knowledge in pictures as well as in writing. This decision is an early example of presenting knowledge in the language the reader understands and in a form the eye can follow. The language in which the book was written, the scenes it drew and the notes it kept on drugs tie Amasya's healing tradition both to a building and to a book.

Chronology

1308-1309: The Amasya Darüşşifa is built by Anber b. Abdullah and the Emir of Anatolia, Ahmed Bey, in the name of Öljeitü Khan and his wife Yıldız Hatun.

1312 (712): The endowment deed of the darüşşifa, which has not survived, is drawn up.

Around 1385-1386: Şerefeddin Sabuncuoğlu is born in Amasya.

1444: The Akrâbâzîn Translation is written (the contradiction between the date and the identity of the prince is noted above).

1465 (870): The Cerrâhiyyetü'l-Hâniyye is written and dedicated to Mehmed II.

1468 (873): The Mücerrebnâme is written; the physician dies after this date.

1505 (911): Sabuncuoğlu's name is first mentioned in the Alâim-i Cerrâhîn.

1860-1871: The Paris copy passes to a French physician as a gift from Yâsincizâde İlmî Efendi and enters the Bibliothèque Nationale in 1871.

1920: Rusçuklu Hakkı introduces the Mücerrebnâme in the newspaper İkdam.

1927: Ali Canip (Yöntem) introduces the Cerrâhiyye to the scholarly world.

1939: A. Süheyl Ünver makes the first modern publication of the Cerrâhiyye.

1960: Huard and Grmek publish the study presenting the Paris copy with its 140 miniatures.

1992: İlter Uzel's facsimile and transcription is published in two volumes.

Bibliography

Academic studies

  • Emine Kef, "Kentten Dünyaya Yayılan Bilim ve Sanat: Amasya Sabuncuoğlu Tıp ve Cerrahi Tarihi Müzesi'nin Hikâyesi", Anadolu Üniversitesi Sosyal Bilimler Dergisi, 24/3 (2024), pp. 1065-1082 (DergiPark).
  • Nuran Yıldırım, "Sabuncuoğlu Şerefeddin", TDV İslâm Ansiklopedisi, vol. 35, Istanbul 2008, pp. 358-359 (islamansiklopedisi.org.tr). islamansiklopedisi.org.tr
  • Ali Haydar Bayat, "Cerrâhiyye-i İlhâniyye", TDV İslâm Ansiklopedisi, vol. 7, Ankara 1993, p. 420 (islamansiklopedisi.org.tr). islamansiklopedisi.org.tr
  • Gönül Cantay, "Amasya Dârüşşifâsı", TDV İslâm Ansiklopedisi, vol. 3, Istanbul 1991, pp. 5-6 (islamansiklopedisi.org.tr). islamansiklopedisi.org.tr
  • "Akrâbâzîn", TDV İslâm Ansiklopedisi, vol. 2, Istanbul 1989, pp. 287-288 (islamansiklopedisi.org.tr).
  • Zehra Gençel Efe - Merve Süngü, "15. Yüzyıl Osmanlı'da Kadın Hekim ve Hemşire Tasvirleri: Cerrâhiyyetü'l-Hâniyye Örneği", Türkiye İlahiyat Araştırmaları Dergisi, 8/4 (2024), pp. 641-664 (DergiPark).
  • Çiğdem Önkol Ertunç - Lütfiye Deperler Mazı, "Sabuncuoğlu Şerefeddin'in Paris Bibliotheque Nationale'de Bulunan Cerrahiyyetü'l Haniyye İsimli Eserinin Minyatür Özellikleri", İSTEM, no. 36, 2020, pp. 305-323 (DergiPark).

Other sources

  • Habibe Çalışkan, "Sabuncuoğlu Şerafeddin ve Cerrahiyetü'l-Haniyye", Tarih-i Kadim, 23 November 2017 (tarihikadim.com). tarihikadim.com
  • Osman Sabuncuoglu - Salim Ayduz, "The 15th Century Turkish Physician Serefeddin Sabuncuoglu Author of Cerrahiyetu 'l-Haniyye", Muslim Heritage, 30 December 2010 (muslimheritage.com).

Online sources