The 15th Century Turkish Physician Serefeddin Sabuncuoglu

Author of Cerrahiyetu l-Haniyye

by: Salim Aydu and !sman Sabuncuoglu
The Turkish physician Serafeddin Sabuncuoglu (13851470) is he au hor of a fa!ous rea ise of surgery" #errahiye $%l &aniyye ('!perial Surgery)" co!posed in Turkish in 14(5) ' *as he firs illus ra ed surgical a las and he las !a+or !edical encyclopedia fro! he 'sla!ic *orld) Though he rea ise *as largely based on ,l-.ahra*i%s ,l-Tasrif" Sabuncuoglu in roduced !any inno/a ions of his o*n" a!ong *hich he in roduc ion of /ie*s in *hich *e see fe!ale surgeons illus ra ed for he firs i!e) 'n his ar icle" 0r 1s!an Sabuncuoglu and 0r) Sali! ,ydu2 presen he life and *orks of his original scholar and charac erise he con en s of his *orks) Dr. Osman Sabuncuoglu* and Dr. Salim Ayduz** Table of con en s 1" #iogra$hy %" &orks %"1" Cerr'hiyet( l-H'niyye %"%" )(cerrebn'me %"*" Terceme-i Akrabadin *" Anaesthesia techni+ues in Cerrahiye-i ,lhaniye -" .eferences and further readings

Figure 1: Illustration of treatment for "Ml-I-Huly" or cauterization for certain neurotic disorders. Reprinted with permission from the Fatih National Li rary! Istan ul.

1) 3iography The full name of our $hysician is Sabuncuoglu Sharafaddin b" Ali b" al-Ha// ,ly's b" Sha0b'n al-Am's1 al)utatabbib" He 2as born at Amasya around 1*35 and died at Amasya4 after 1-53" He 2as of Turkish origin and li6ed in the !ttoman State during the time of its $rogressi6e e7$ansion in the 15th century" His grandfather Ha//i ,lyas #eg 2as a $alace $hysician in #ursa during the Sultan 8elebi )ehmed reign 91-1*: 1-%1;" Amasya4 the hometo2n of Sabuncuoglu4 2as a centre of commerce4 culture and arts4 in northern Anatolia in 2hat is no2 Turkey" There is 6ery limited information about his early childhood life and education" He started his medical career 2hen he 2as se6enteen years old4 2hen he took medical lessons from #urhan al<in Ahmed ibn Al-=akhchi6'n1" As soon as he com$leted his medical education4 he $racticed medicine as a chief $hysician for fourteen years at the 2ell-kno2n Sel/uk Hos$ital4 kno2n today as Amasya Hos$ital founded in 1*>3-? by Anber b" Abdullah on behalf of Sultan !lcayto and his 2ife @ildi Hatun" <uring the Candaroglu ,sfendiyar #ey .eign 91*35-1-->;4 Sabuncuoglu 2ent to Aastamonu and $racticed medicine for a 2hile for the ruler4 then returned back to Amasya again" He 2ent to ,stanbul4 sometime4 most $robably to $resent his book"errhiyet#$l-Hniyye to the Sultan )ehmed ,," !n his 2ay back4 he 6isited the cities #olu4 Berede and Tosya"

His book "errahiyet#$l Haniyye 9,m$erial Surgery; is the first e7am$le of an illustrated surgical te7tbook in the Turkish and ,slamic medical literature" !nly three co$ies of the book sur6i6e today 9,stanbul Cni6ersitesi ,stanbul Ti$ Dak(ltesi Ti$ Tarihi 6e <eontolo/i Anabilim <ali library4 )S =o" *5E Datih )illet Fibrary4 )S no" G?E #ibliothH+ue =ationale de Drance4 Paris4 )S =o" 5?*;" Sabuncuoglu 2as a $olymath $hysician and $articularly 2as 6ery famous on surgery" He treated so many $atients 2hom came to him from 6arious $laces of Anatolia and registered some of his o$erations in his book"errhiyet#$l-Hniyye" A$art from $ractical e7$eriences4 he also endea6oured to com$ose books on medicine and 2rote three books on this sub/ect"

4igure 2: Incision and e%acuation of hydrocephalus. Note the re%ersed &-type incision and wide and sharp pointed scalpel. Reprinted with permission from the Fatih National Li rary! Istan ul! M' ()! f. *+ ,.

Through Sabuncuoglu0s book4 beside surgical $ractices4 2e understand that he $aid big attention to the medical deontology too" Although he kne2 Arabic and Persian4 he 2rote all his book in Turkish and contributed to im$ro6e the Turkish medical 6ocabulary" He used many medical books of his $redecessors" <ue to his long medical life4 he had numerous medicine students" !ne of them 2as Phyiscian Biyas )uhammed al-,sfahan1 2ho 2rote a medical book in Persian I1J"

5) 6orks Sabuncuoglu is the author of se6eral medical 2orks4 all 2ritten in Turkish language4 testifying thus of the linguistic shift that ha$$ened in the 1-th and 15th centuries: the $rogressi6e transformation of Turkish4 but also of Persian4 as languages of science and medicine4 besides Arabic4 2hich 2as almost the uni+ue linguistic 6ehicle of kno2ledge in the ,slamic 2orld for centuries" The list of Sabuncuoglu0s 2orks contain the follo2ing titles" 2.1. Cerrhiyet !l"#niyye The "errhiyet# -l-Hniyye 9,m$erial Surgery; 2as 2ritten in Turkish" ,t is a 2ell illustrated surgery book 2ritten for Sultan )uhammad ,, and dedicated to him" ,t 2as com$osed in 1-554 2hen the author 2as eighty-three years old" The book is mainly the translation of the thirtieth cha$ter of the famous book .it /l-&asr0f li-man -a1iza -an al-ta$l0f by the Andalusian $hysician and medical 2riter Abu al-Kasim AlLahra21 9d" 1>*5;E this cha$ter is de6oted to surgery" ,n addition4 Sabuncuoglu 2rote t2o more cha$ters 9fasil; and abundant illustrations of surgical instruments and o$eration scenes in the form of miniatures and illumination"

Figure $: 'ome sur2ical instruments drawn y 'a uncuo2lu. Reprinted with permission from the Fatih National Li rary! Istan ul.

,n the e7tant manuscri$ts of the "errhiyet# -l-Hniyye4 the book consists of three cha$ters di6ided into 1?* sections" The latter deal 2ith all fields of surgery4 including o$hthalmology" The author +uoted rele6ant Breek4 Arabic and Persian te7tbooks" He also added his o2n e7$eriences that he gained during his $ractice of surgery4 2hile treating $atients" His additions incor$orate original information on the sub/ect" Some of his ideas carry inno6ations of 2hich go back to the Central Asia Turkish-)ongol medicinal tradition and some Dar Mast medicine e7$erience" An im$ortant as$ect of the originality of the "errhiyet# -l-Hniyye rests u$on the inclusion of colour miniatures of the surgical $rocedures4 incision techni+ues and instruments4 all dra2n by Sabuncuoglu himself" #eside the surgical instruments dra2n by Al-Lahra2i in his book4 he added ne2 images about the treatment of $atients that brought a ne2 6ie2 to the ,slamic medicine" These ne2 images indicate ho2 to make a surgical o$eration and surgical inter6ention" The use of human images re$resented an im$ortant ste$ in the history of the Turkish-,slamic medicine" ,n the e$ilogue of the book4 Sabuncuoglu e7$lains 2hy he 2rote this book in Turkish: N#u kitabi T(rk1 ya dum" T(rk1 ya dugum sol ecilden oldu kim Aa6m-i .Om T(rk1 dilin sPylerler""""okuyanlari dahi T(rk1 kitablar okurlar"" 9, 2rote this book in Turkish" The reason is that the nation of the .um 9Anatolia; talks in Turkish languageQ and the readers also read in Turkish languageN" Durthermore4 he added4 the surgeons 2ho ignore Arabic cannot read the books 2ritten in Arabic and4 conse+uently4 cannot follo2 the $rogress of medicine4 2hich may result in making mistakes in o$erations they conduct" He said also that it is necessary to 2rite academic books to introduce himself to Sultan )uhammed ,, and to take the attention of the sultan" He s$ecified that )uhammed ,, liked scientific books and also su$$orted science at that $eriod of time"

Figure %: &he instruments necessary for e3tractin2 the foetus. Reprinted with permission from the Fatih National Li rary! Istan ul! &ur4ey.

The "errhiyet#$l-Hniyye could also be considered as an im$ortant $aediatric surgical atlas" ,ts colourful4 descri$ti6e $ictures of 6arious o$erations and surgical instruments make it a significant $iece of 2ork" This im$ortant te7tbook combines kno2ledge of Breek4 Arabic4 and Turkish surgery techni+ues and nourishes

the basic conce$ts in this s$ecialty4 2ith Sabuncuoglu0s original contributions on surgical $rocedures4 $osto$erati6e care4 and surgical instruments" Thus4 Breek4 Arabic4 and Turkish surgery combined e7traordinarily in his book" This book is also im$ortant due to its anatomy sections and the richness of the medical terminology used in it4 $articularly Turkish medical terminology" ,t also echoes of the Anatolian Turkish features of that time" &e find in the book that 6o2els $oints 2ere carefully added" Dor the history of the Anatolian Turkish language4 the book is also a significant source for the roots4 6ocabulary and grammatical structure of this language in the mid-15th century" #eside the language features4 the images are also a 6ery im$ortant source for the historians of Turkish art"

Figure &: &reatment of a chronic flu3 of itter tears into the eyes 5hyper-lachrymation,. Rreprinted with permission from the Fatih National Li rary! Istan ul.

,n the field of medical kno2ledge4 the "errhiyet#$l-Hniyye re$resents the le6el of the Turkish surgery during the 15th century" The book e7$lains the reasons of diseases" Dor instance4 concerning the NHumoral PathologyN 2hich 2as common at that time4 he refers scholars such as Hi$$ocrates4 ,bn Sina4 Balen and AlLahra2i"

The Drench national library in Paris 9#ibliothH+ue =ationale4 Su$$lRment Turc4 )S 5?*4 %>5 folios; holds the original co$y of "errhiyet#$l-Hniyye dedicated to the Sultan )uhammed ,, and 2ritten by Sabuncuoglu himself" ,n addition4 there are t2o more co$ies in ,stanbul libraries: in the ,stanbul =ational Fibrary of Datih and Ca$a )edical History <e$artment of ,stanbul Sni6ersity I%J" "errhiyet#$l-Hniyye contains four ma/or $arts: Cauterisation Techni+ues: Beneral Surgery including Paediatric and Plastic SurgeryE !rtho$aedicsE and )edical Pre$arations inno6ated by Sabuncuoglu" The three different manuscri$ts of the book 2ere translated into modern Turkish language and com$ared 2ith Al-Lahra210s treatise and other ancient surgical te7tbooks" Sabuncuoglu0s s$ecial contributions and original remarks 2ere in6estigated" The book 2as $ublished first by A" S(heyl Cn6er under the title 'harafaddin 'a uncuo2lu .it #$l-"errahiyei Ilhaniye 5"errahnme,4 9,stanbul 1?*?; and later on by ,lter S el 2ith transliteration and commentaries 96ols" ,-,,4 Ankara 1??%;" #esides se6eral original contributions noted by the scholars4 Sabuncuoglu0s book is uni+ue for the re6olutionary illustrations used to sho2 details of the surgical $rocedures described" <uring the $re6ious $re6ailing $eriod of ,slamic medicine4 it 2as not common use to illustrate medical te7ts 2ith images re$resenting the human body" An original as$ect of Sabuncuoglu0s book is that it contains a fe2 sections related to $sychiatry 2ith the earliest kno2n colour illustrations of the field4 dra2n by the $hysician himself" !ne section is on the cauteri ation of Nm'l-i huly'4N 2hich refers to a 6ariety of neurotic disorders4 and the other is about NunutsagulukN4 2hich means forgetfulness" Sabuncuoglu recommended a ste$2ise a$$roach in treating both disorders: the use of herbal medicine4 then the a$$lication of 2arm oil deri6ed from shee$0s tail fat to the 6erte7 area4 and finally4 if all efforts failed4 cauteri ation 2ith heat at certain $oints4 2ith caution against the risk of harming the skin"

Figure ': Fi2ures of treatment of %arious illnesses. Reprinted with permission from the Fatih National Li rary! Istan ul.

A$$arently4 Sabuncuoglu did not $ractice as a surgeon but as a general $hysician ca$able of treating all kinds of medical surgical conditions4 including $sychiatric ones" ,n the follo2ing centuries4 Amasya Hos$ital 2here he $racticed e6ol6ed from a general hos$ital into one $ro6iding ser6ices only to mentally ill $eo$le and remained so for a long time" Along 2ith his $ioneering 2ork4 Sabuncuoglu deser6es attention and recognition for his $rofessional +ualities as a modest researcher4 a fine clinician4 and a de6oted medical educator 2ith high ethical standards" =o doubt4 his ad6ice to colleagues is still 6alid today4 regardless of their s$ecialty: NAee$ your com$assion se$arate from your fame and ambitionN I*J" 2.2. ( cerrebnme After his 2orks at Amasya <'russifa 9Amasya Hos$ital; for fourteen years4 Sabuncuoglu 2as asked by his friends to 2rite a book 9Ncom$ose a book u$on your e7$erience you gained so far4 hence 2e should not look to other booksN;" He thus 2rote in 1-53 an abridged book4 the M#cerre nme 9!n Attem$tion;4 2hile he 2as eighty t2o years old" The S(leymaniye library o2ns a co$y of this treatise 9Ayasofya4 )S *G%>4 1>5 folios; I-J" &hen 2e com$are it to his other books4 this one is more common" He e7$lains ho2 he $re$ared the drugs 2hich he e7$erienced himself on humans and animals and ho2 they can be used"

The book consists of se6enteen cha$ters" ,t starts from the most common drugs and ends 2ith the less used ones" This is a 6ery im$ortant $harmacology book on the history of medicine 2hich e7$lains ho2 to use and in 2hich case you ha6e take these $ills4 drugs4 syru$s4 dust4 $aste4 $laster4 enemata etc"" ,t can be said that this book is the first em$irical book on the sub/ect" 2.$. )erceme"i A*rabadin The third book by Sabuncuoglu is &erceme-i /4ra adin 9Translation of $harmacology;4 in thirty three cha$ters 9S(leymaniye Fibrary4 Datih4 )S *5*54 %*? folios;" ,t is a Turkish translation of the $harmacology $art in Abu ,brahim al-Tur/'n10s Arabic book 6ah0re-i Harezmshh04 2hich is the tenth and last cha$ter of the book" Sabuncuoglu carried on this translation u$on the re+uest of the $hysician Sheikh )ehmed b" Ahmed of Prince #aye id 2ho 2as $rince at that time in Amasya4 in 1---" the author added t2o more cha$ters to the original book4 2hich has only thirty-one cha$ters" He also added Arabic4 Persian and Turkish medical 2ords and technical terms"

Figure +: &reatment of lu3ation of the ac4 %erte rae. Reprinted with permission from the Fatih National Li rary! Istan ul.

,n the e$ilogue of the book4 he e7$lains 2hy he translated this book into Turkish saying: N""" ir' kim ilm-i tibbin kit'blari D'ris1 6e T' 1 dilinde d( (lmisd(r" .Om ehl(n(n ekseri Arab1 6e D'ris1 dil(n bilmey($ 'ci 6e 'til olmuslardiN 9because most of the medical books 2ere 2ritten in the Persian and Ta i languages4 most of the Anatolians do not understand these languages4 and they became useless;"

Sharafaddin Sabuncuoglu 2as also a good calligra$her and he co$ied one of his students4 )uhiddin )eh14 lyric book Nazm al-tash0l and Hal1m10s Persian lyric medical book" 3) ,naes hesia echni7ues in Cerrahiye"i ,lhaniye Serafeddin Sabuncuoglu o$erated throughout the human body 2ell before the de6elo$ment of sterile techni+ue and modern anaesthesia" He used a combination of mandrake root and almond oil for analgesia and general anaesthesia" )andrake 9mandra2ora officinarum L"4 of the nightshade family ISolanaceaeJ; has the general $ro$erties of belladonna and 2as formerly used as a narcotic and sedati6e" ,t contains the alkaloids mandragorine4 hyoscyamine4 and sco$olamine" The kno2ledge of medicine and $harmacy in Anatolian Sel/uk0s <ynasties and the !ttoman $eriod is the continuation of the former ,slamic ci6ilisation" ,n ,slamic ci6ilisation4 many hos$itals 2ere established 2ith functioning $harmacies that $re$ared medicines for their $atients" ,n hos$itals4 those in charge of drug-$re$aration as $harmacists 2ere named 'aydalan orIspen2iyar" Serafettin Sabuncuoglu discusses o$erational anaesthesia in his book "errahiye-i Ilhaniye as follo2s: NSome $atients might be able to resist incisions and cauteri ation4 2hile others might not" Therefore4 narcotic medicine called murkid is necessary to $re$are 2hen needed4 so that the o$eration might be $ossible" Take and cut the fresh $arts of Fuffah 9mandragora;4 $ound and mi7 it 2ith almond oil and let it stay for a day and night" Then4 the surgeon 2ho 2ants to use it must gi6e one drachm 9dirhem U dram U g; of it to be eaten before meal" A little later4 you0ll see that the $atient 2ill lie do2n and fall aslee$ 2ithout $ercei6ing you" Then4 $ractice 2hate6er treatment you 2ant to do" Bi6e one drachm of it to the adult4 but administer only the amount needed for children4 so that no mal$ractice occurs" This is the narcotic , used all through my life and did not need any other aesthetic medicine"N 4) 8eferences and fur her readings

Adnan Adi6ar4 7smanli &#r4lerinde Ilim4 ,stanbul l?3%4 $$" 51-5%4 5G"

Adnan Ter ioglu4 NSharafaddin Sabuncuoglu Datih <Pneminin Cnl( T(rk HekimiN4 &arih %e &oplum4 15 91??1;4 $$" %3-*1" Ali Cani$4 NCerrahiye-i ,lhaniye-Tab'bet Tarihimi =oktai =a arindan )(him #ir MserN4 Hayat Mecmuasi4 -% 91?%G;4 $" *" Ali Haydar #ayat4 NAmasya0li Sabuncuoglu Sharafaddin 9G33V1*35-3G*V1-530den sonra; #ibliyografyasiN4&ip &arihi /rastirmalari4 % 91?33;4 $$" ?%-1>1" Ali Haydar #ayat4 NCerr'hiyye-i ,lh'niyyeN4 8I/4 W,,4 $" -%>" #edii Sehsu6aroglu4 &ip &arihi4 s" 5*-5-" #ursali )ehmed Tahir4 7smanli M#ellifleri4 ,,,4,stanbul4 $$"" %%>4 *5?" Ce6at , gi4 7smanli Medreselerinde Ilim4 ,satnbul 1??34 ,4 s" GG"

<emirhan Mrdemir NSifali #itkiler <ogal ilaXlarla geleneksel teda6ilerN in Medicinal 9lants: &raditional &reatments with Natural 8ru2s" ,stanbul: Alfa4 %>>1: 1>>-1" Duat A'mil4 NCerrah Sharafaddin Sabucuoglu Mserinin Ab(lkasim Lehra61 Mserile )ukayesesiN4 &#r4 &ip &arihi /r4i%i4 11 91?*?;4 $$" ?5-?3" ;e%her Nesi e 'ultan /nisina 8#zenlenen "'erafeddin 'a uncuo2lu .on2resi" &e li2leri <* Mart <)+= .ayseri 9yay" A" H" APker-@" Mrdogan;4 Aayseri" H" Aafali4 Aksoy S4 Atmaca D4 San ," NColored illustrations of obstetrics mani$ulations and instrumentation techni+ues of a Turkish surgeon Serafeddin Sabuncuoglu in the 15th centuryN4 >ur ? 7 stet ;ynecol Reprod @iol4 %>>%E 1>5: l4 ?G-%>%"

History of the literature of medical sciences durin2 the 7ttoman period4 ed" M" ,hsanoglu" ,stanbul: ,.C,CA4 %>>34 ,4 55-5>" H(seyin H(s'meddin4 /masya &arihi4 ,stanbul 1*%34 ,4 1%54 1G%" ,brahim #asagaoglu4 S" Aaraca4 Liya Salihoglu4 NAnaesthesia techni+ues in the fifteenth Century by Serafeddin Sabuncuoglu"N /nesth /nal24 %>>5:1>%:1%3G-??" ,lter S el4 "errhiyet#$l-Hniyye4 Ankara 1??%4 $$" %>-*5" Aadircan Aeskinbora4 NTurkish: The language of science in Anatolia bet2een 1*th and 15th centuriesN4 AI. Bluslararasi &#r4 8ili .urultayi4 %>-%5 !ctober %>>34 Turkey" !sman Se6ki4 @es @uCu4 /sirli4 &#r4 &a a eti &arihi4 ,stanbul 1*-1V1?%54 $" 15?" .ama an Sesen4 Fihris# Mahtutat#$l-ti i$l-Islmi4 $$" %G--%G5"

S" =" Cenk #uyukunal and =il Sari4 Serafeddin Sabuncuoglu4 the Author of the Marliest Paediatric Surgical Atlas: "errahiye-i Ilhaniye 9$ublished G Se$tember %>>5;" S"=" #(y(k(nal and =" Sari4 NSerafeddin Sabuncuoglu4 the author of the earliest $ediatric surgical atlas: Cerrahiye-i ,lhaniyeN4 ? 9ediatr 'ur2ery4 1??1E%5:11-3-51" S(heyl Cn6er4 N#es Asirlik #ir Cerrahi Aitabimi N4 @elediye Mecmuasi4 nr" G?4 ,stanbul 1?*14 ?1%" T" <ogan4 #ayramicli )4 =umanoglu A" NPlastic surgical techni+ues in the fifteenth century by Serafeddin SabuncuogluN4 9last Reconstr 'ur24 1??GE ??: 1GG5-?" W" #" Aurdoglu4 'ir &a i ler4 ,stanbul 1?5G4 $$" 1%>-1%*"

4oo no es I1J See A" H" #ayat4 N,," #'ye 1d <Pnemi Hekimlerinden Biy's ibn )uhammed es-Sayraf1 el,sfeh'n1N4 &ip &arihi /rastirmalari4 6ol" 34 1???4 $$" 13G-%>*" I%J ,stanbul4 Datih )illet Fibrary4 )S G?4 1st manuscri$t of the code7E ,stanbul Sni6ersity4 Ca$a )edical History <e$artment Ti$ Dak(ltesi Ti$ Tarihi 6e <eontolo/i Anabilim <ali library;4 )S *54 *rd manuscri$t of the code7" I*J ,lter S el4 "errahiyet#$l-Haniyye4 Ankara4 Turkey4 T(rk Tarih Aurumu @ayinlari4 1??%4 6ol" 14 $" 55" I-J Lafer Ynler4 NZW" @( yil Hekimlerinden Sabuncuoglu Serefeddin0in N)(cerrebn'meN Adli MseriN4 Firat Dni%ersitesi 8er2isi 5'osyal @ilimler,4 1 91?3G;4 $$" 15?-1?>" E M. 8.! 8epartment of "hild 9sychiatry! 'chool of Medicine! Marmara Bni%ersity! Istan ul! &ur4ey. EE 'enior Researcher! F'&"! B..

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