|Year : 2018 | Volume
| Issue : 4 | Page : 213-220
Modernization of medicine in the ottoman empire and its effects on forensic sciences
Ferat Buran1, Erdem Özkara2
1 The Council of Forensic Medicine, Şanlıurfa Branch Office, Şanlıurfa, Turkey
2 Department of Forensic Medicine, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey
|Date of Web Publication||27-Dec-2018|
Dr. Ferat Buran
The Council of Forensic Medicine, Sanliurfa Branch Office, Sanliurfa
Source of Support: None, Conflict of Interest: None
Modernization in medicine began in the Ottoman Empire in the 19th century. Until that time, medical education had been provided through the traditional master–apprentice practices and its methods had relied on custom or religion. The most important of these reforms was in 1827, when the first medical schools in surgical and clinical branches were opened in İstanbul. The lack of contemporary understanding in medical education until that time had caused an underdevelopment in forensic sciences as it had in various other fields. Following the reform movements, the contents of the forensic medicine curriculum, mainly influenced by the French medical schooling, touched upon all areas of forensic sciences such as pathology, toxicology, organic chemistry, neuropsychiatry, gynecology, handwriting analysis and criminalistics. It was noteworthy to see such rapid development in scientific modernization considering the fact that, before the reform movements, the religion had a repressive effect and it was forbidden to even perform laboratory tests or examinations on corpses. In the modern Turkish Republic, founded in 1923 after World War I, scientific reforms gained momentum and began competing with the modern world. Such that, after a letter sent to the Turkish Government by Albert Einstein in 1933, the contemporary Turkish universities embraced the scientists who escaped from the Nazi regime.
Keywords: Forensic medicine, history of forensic medicine, legal medicine, medical history, Ottoman Empire, Turkish Republic
|How to cite this article:|
Buran F, Özkara E. Modernization of medicine in the ottoman empire and its effects on forensic sciences. J Forensic Sci Med 2018;4:213-20
| Introduction|| |
Apart from many reforms in the public field and state structure, modernization activities in medical education also took place in the Ottoman Empire in the 19th century. The most important of these reforms was the opening of first medical schools in surgical and clinical branches in İstanbul in 1827. Later in 1839, these two military schools were restructured under a single frame as “Mekteb-i Tıbbiye-i Şahane” (the Royal School of Medicine) which was the country's first faculty of medicine., This school was equipped with a wide range of facilities, including classrooms and materials for modern medical teaching, as wells as a zoology laboratory [Figure 1] and [Figure 2].
|Figure 1: A class from the modern faculty of medicine established under the name of Royal School of Medicine|
Click here to view
Dr. Charles Ambroise Bernard, who came from Austria in 1838 upon the invitation of the Ottoman Empire, started the education activities in the faculty of medicine. He graduated as a medical doctor in 1838 from the “Josephinum” and established as an academy to provide services for the poor in Vienna in the 18th century. Today, the Josephinum serves as a museum in the history department of the Medical University of Vienna. Dr. Bernard convinced the sovereign of the time, Sultan Abdülmecid I, to allow autopsies, on the strict condition that it would be applied for educational purposes and on Christians only. Subsequently, the first autopsy in the country was performed in 1841.
From the available records, it is understood that forensic medicine was first included the curriculum of the military medical school in 1846 and was lectured by Dr. Serovpe Viçenyan (Dr. Serviçen Efendi). He graduated from the Paris Medical Faculty in 1839. Apart from being a medical doctor, he was also a famous linguist and one of the most important intellectuals of the Armenian community in İstanbul which was the capital of the Ottoman Empire at that time.
The first civilian medical faculty of the country, “Mekteb-i Tıbbiye-i Mülkiye”, was founded in İstanbul in 1867 and Dr. Agop Handanyan began teaching forensic medicine lessons in this school. Dr. Handanyan, a member of the Armenian community in Diyarbakır (one of the eastern provinces of the Ottoman Empire), completed his education in the Military School of Medicine in 1860. While teaching forensic medicine in the civilian medical faculty, he not only translated the books “Médecine Légale” and “Chimie Légale” from French into Ottoman Turkish but also wrote a forensic medicine book called “Tıbb-i Adli” (Forensic Medicine) in 1877 and a toxicology book called “Kimya-yi Kanuni” (Forensic Chemistry) in 1885. He also had great contributions in the provision of medical education in Ottoman Turkish, which was previously taught in French.
| Tıbb-I Adli (Forensic Medicine)|| |
This book contains four main parts on the following subjects:
- Part one: Sexual assault, homosexuality, conditions constituting impediments to marriage, conditions requiring the termination of marriage, hermaphroditism, pregnancy, abortus, stillbirth, neonatal viability, and infanticide cases
- Part two: Murder, assault, injury, suicide, duello, wounds, burns, scars, evaluation of injury cases according to the laws, corpse examination in murder cases, contagious diseases, asphyxia cases, suffocation, hanging, poisoning cases and autopsy, and drugs
- Part three: Loss of conscience, dementia, mania, sleepwalking, delusion, epilepsy, hysteria, and cranial stroke
- Part four: Personal identification, simulation cases, dissimulation, feigning disease, and diseases causing exemption from military service.
A page from the book which was translated by Dr. Agop Handanyan in 1877 can be seen in [Figure 3].
| Kimya-Yi Kanuni (Forensic Chemistry)|| |
This book includes seven main parts as follows:
- Part one: Poisoning cases caused by organic materials and detoxification of the body
- Part two: Information on nonmetals, nonmetal acids, and metals
- Part three: Volatile gases, anesthetic materials and alcohol, and the effects of these materials
- Part four: Organic acids, alkaloids, and poisons of plant and animal origin
- Part five: Information on detecting poisons
- Part six: Usage areas for microscope in forensic sciences: examining blood, rust, vine, sperm, saliva, brain parenchyma, and fecal stains
- Part seven: Examining the purity of food products (such as flour, grains, legumes, and milk), authenticity of fabric and money, handwriting analysis, getting the description of individuals, and evaluating the remains of firearm discharge.
A page from the book which was translated by Dr. Agop Handanyan in 1885 can be seen in [Figure 4].
Ali Rüştü Pasha started to teach forensic medicine lessons after Dr. Agop Handanyan retired in 1896. He was a Turkish national who graduated from the Military School of Medicine in 1877 and also worked as a medical doctor in the Ottoman Palace.
There was a regime change in 1908 from absolute monarchy to constitutional monarchy. Modern medical education reforms regained speed after this period, namely the mortuary department for autopsy procedures and the chemistry department for toxicological examinations were founded in 1908. Ali Rüştü Pasha left his post in the medical faculty in 1909 and worked as the director of the mortuary department until he died in 1913.
The military and civilian medical faculties were merged in 1909, thereby laying the foundations of today's İstanbul University Faculty of Medicine. Dr. Bahaeddin Şakir, who completed his education in the Paris Medical Faculty, began teaching forensic medicine at the faculty of medicine. He was a senior manager in the Party of Union and Progress which was the ruling party of the time. He then served in the Caucasian front during World War I but had to leave the country when the Ottoman Empire lost the war. Afterward, he was selected as a member of Soviet Congress of the Peoples of the East in 1921 but was assassinated in Berlin in 1922. Thus, he is an important and interesting historical figure not only for Turkey but also for the whole world. His significance in forensic medicine field is due to authoring the country's first copyrighted forensic medicine book called “Tıbb-i Kanuni Dersleri” (Textbook of Forensic Medicine) which he wrote in Ottoman Turkish between 1910 and 1911. He also has two other books, namely “Tababet-i Adliye Rehberi” (Guide of Legal Medicine) and “Tıbb-i Kanuni” (Legal Medicine) he wrote in 1914 and 1918, respectively, in Ottoman Turkish.
| Tıbb-I Kanuni Dersleri (Textbook of Forensic Medicine)|| |
Known for being the first copyrighted work in the country in on Forensic Medicine, this was certainly the most important among Dr. Bahaeddin Şakir's books in this field. This book contained five fascicles, the first two of which were published in 1910 and the last three in 1911. This book was used in forensic medicine education at the faculty of medicine and it was regarded as a reference book until the 1st year of the Turkish Republic.
In the foreword, Dr. Bahaeddin Şakir stated that he took his highly esteemed master Professor Dr. Brouardel from the Paris Medical Faculty as reference when preparing the theoretic part of the notes while also benefiting from the books of the famous forensic medicine expert and criminologist Lacassagne from the Lyon Medical Faculty and other prominent forensic scientists of the time such as Charles-Albert Vibert, Victor Balthazard and Léon-Henri Thoinot, by whom he had the chance of being lectured. This section points out different academic backgrounds constituting the basis of the book.
Asphyxias constituted the basis of this fascicle of 194 pages published in 1910. Subjects such as asphyxia, drowning in water, autopsy in asphyxia cases, putrefaction in asphyxia cases, origin in asphyxia cases, hanging and being hanged, strangling, uncompleted act of strangling, suffocation, asphyxias due to volatile gases/vapors and reporting, and forensic medicine application samples were covered in the fascicles.
Wounds constituted the basis of this fascicle of 186 pages published in 1910. Subjects such as wounds, classification of wounds, blunt object wounds, stab/sharp object wounds, gunshot wounds, effect of individual's health on wound prognosis, burns, homicide cases, deaths caused by freezing, lightning strike, electric shock and reporting, and forensic medicine application samples were covered in the fascicle.
Death constituted the basis of this fascicle of 218 pages published in 1911. Subjects such as death, agony, estimation of postmortem interval, death findings and perimortem period, death symptoms, declaration of death, sudden death, reporting, and forensic medicine application samples were covered in the fascicle.
Infant deaths constituted the basis of this fascicle of 119 pages published in 1911. Subjects such as infanticide, infants in neonatal period, vitality symptoms in neonates, estimation of neonatal gestational age, distinction of neonate's live birth, intrauterine fetal death, death of the infant during birth, killing a neonate and the causes (strangling, burning, wounding, etc.), neonatal neglect, reporting, and forensic medicine application samples were covered in this fascicle.
Abortus/curettage constituted the basis of this fascicle of 94 pages published in 1911. Subjects such as abortion, abortion of fetus, abortion causes and types, maternal or paternal abortion causes, infection-related abortions, uterine disorder-related abortions, medicines and tools causing abortion, examination in abortion cases, investigation and doctor's responsibility, reporting, and forensic medicine application samples were covered in the fascicle.
A page from the book about “Uterine Disorders” which was written by Dr. Bahaeddin Şakir between 1910 and 1911 can be seen in [Figure 5].
|Figure 5: A section about “Uterine Disorders” from the Textbook of Forensic Medicine book|
Click here to view
| Tababet-I Adliye Rehberi (Guide of Legal Medicine)|| |
This book was published in 1914 and consisted of two sections focusing on the legal and the scientific aspects, and it contained important information on forensic medicine, legal responsibilities, and legislation that mostly appealed to the doctors working in provinces.
He mentioned in the foreword of this book that he made use of the works of Alexandre Lacassagne, who was a professor at the Forensic Medicine Department of the Lyon Medical Faculty, and Léon-Henri Thoinot, his teacher in the Paris Medical Faculty. He also stated that the applications in forensic medicine field improved in line with the improvement of the country and that this book was written to satisfy the needs of doctors working in the field and to draw attention to the points which should not be forgotten in the reports to be issued.
Subjects such as the laws and legal sanctions which were in force and binding for the doctors at that time, registration of diplomas, importance of work permit, and precautions to prevent people other than health professionals from working in the field were solemnly covered in the legal section of the book. It further discussed the relevant articles of the penal code of the period, patient–doctor relations, and their ethical dimension.
In the scientific section of the book, the primary focus was on subjects such as an individual's characteristics, medical identification, and preparation of forensic reports.
In the chapter on forensic traumatology, subjects such as penal code articles on wounds and injuries, wound types and their distinction, detection of a trauma's origin (e.g., murder, suicide, and jumping/being thrown off from heights), blunt trauma wounds, stab/sharp object wounds, burns, electric shocks and lightning strikes, asphyxia, and strangling were covered, as well as poisoning and exposure to chemical gases.
The forensic thanatology chapter talked about autopsy and its stages, examination of the cause of death, detection of the time of death through postmortem interval estimation, examination for detecting the origin of the death, and autopsy facts according to case types.
In the chapter on forensic entomology, the author explained the use of arthropod and insect types which could be detected on the corpse in postmortem interval estimation.
Subjects covered in the chapter on forensic gynecology included examination of sexual assault cases, taking and examining the samples, and evaluating curettage and abortus.
The chapter on forensic psychiatry deliberated upon the examination of individuals with psychiatric problems and mental diseases affecting criminal liability with references to the Ottoman Code of Civil Law (Mecelle-i Ahkam-ı Adliye) which was in force at the time.
Finally, in the forensic biology chapter of the book, he covered the detection of bodily fluids such as blood and semen, as well as the sampling and examination processes.
A page from Dr. Bahaeddin Şakir's book about “Forensic Entomology” (1914) can be seen in [Figure 6].
|Figure 6: A section about “Forensic Entomology” from the Guide of Legal Medicine book|
Click here to view
| Tıbb-I Kanuni (Legal Medicine)|| |
Dr. Bahaeddin Şakir wrote this book – comprised two sections – in collaboration with Dr. Vasfi Bey and published it in 1918. After Dr. Şakir left the country in 1918, Dr. Vasfi Bey became the head of forensic medicine department in the Faculty of Medicine.
This book generally covered matters related to “Death.” Death symptoms, declaration of death, death at organ level, corpse decomposition phase and the affecting factors, conditions demanding corpse preservation, detection of the time death, corpse examination, autopsy, exhumation, sudden deaths, fatal diseases, and the laws on the subject were covered in the book.
| Discussion|| |
The inability to follow the scientific and intellectual developments taking place after the middle ages had a great influence on the decline and fall of the Ottoman Empire which ruled over three continents for 624 years. For the reform movements in many fields of science, culture, and government organization in the 19th century, the established systems in Europe and the West were taken as model. Similar reform movements had also been becoming more and more visible in other comparable empires such as Iran and Japan.
Throughout the period between 1450 and 1826 – also known as the classical era of the Ottoman medicine – medical education was based on master–apprentice practices which were far away from the contemporary, scientific and universal principles. Two images representing the traditional period before the transition to modern medical education in the Ottoman Empire can be seen in [Figure 7] and [Figure 8].
|Figure 7: Image representing the traditional period before modern medical education in the Ottoman Empire|
Click here to view
|Figure 8: Image representing the traditional period before modern medical education in the Ottoman Empire|
Click here to view
The lack of contemporary understanding in medical education in the Ottoman Empire until that time had caused the underdevelopment in the field of forensic medicine as it had in many other fields. A fatwa given in 1496 by the Shaykh al-Islam, the highest official authority in religious matters, stated that reopening graves or performing examinations on corpses were restricted in Islam and those who made such attempts would be considered infidel.
Considering that, after the opening of the first medical faculty in the country (1827), it took 14 years for the first autopsy procedure to be performed (1841) and 19 years for forensic medical education to be included in the curriculum (1846), such a quick improvement in forensic medicine education field is remarkable. The progress was praiseworthy since it was achieved despite the fact that the Ottoman Empire was under the effect of the fatwa indicating that 'those attempting to perform an autopsy would be considered infidel' for 345 years although the first autopsy in Europe in academic terms was performed in 1302.
Even though it was under the influence of reform movements, the Islamic conservatism dominating the government showed its effect also in the field of education for a long time. Academics invited from abroad and the medical students taught by these academics, Armenian doctors among non-Muslim citizens, and doctors who joined the Ottoman academia by returning to the country after an education abroad played a significant role in breaking that effect. Two ethnic Armenian doctors, Dr. Serovpe Viçenyan who lectured the first forensic medicine course to be included in the curriculum in 1846 and Dr. Agop Handanyan who wrote the first forensic medicine book translated into Ottoman Turkish, were the most significant examples of this development. Besides, their contribution in changing the language of education from French to Ottoman Turkish was also a very important reflection of the multinational culture of the empire of the period on the medical faculty.
When the contents of forensic medicine book translated from French by Dr. Agop Handanyan in 1877 are considered, the richness and scientificity of the curriculum are interesting. The topics treated in this work were not only limited to forensic medicine but also referred to forensic medicine approaches to gynecology, psychiatry and neurology cases.
Although it was written on forensic toxicology, another book translated from French by Dr. Agop Handanyan in 1885 went far beyond the medical faculty in terms of content and covered independent fields of science such as chemistry, agriculture, textile, graphology, criminology, and ballistics. A doctor graduated from medical faculty could work anywhere in the Ottoman Empire spreading across three continents at that time. The contribution of a doctor graduating with such an extensive knowledge, not only in the medical field but also all vital areas, cannot be denied in the provision of justice.
It is interesting that the Ottoman education in medicine and forensic medicine was vastly influenced by the French école despite the presence of a political alliance formed with the Kingdom of Prussia in the 19th century. In fact, even the revisions made to the penal code in the 19th century as to the hearing of doctors' opinions before a court took their basis from the French Criminal Code. The French école of the period was also leading the field of forensic medicine in Europe. In the 19th century, the Paris Medical Faculty hosted academics such as Auguste Ambroise Tardieu, Paul Brouardel, and Victor Balthazard whose explorations in forensic medicine are still steering the field today, while the Lyon Medical Faculty took pride in Lacassagne, the founder of the science of criminology. On completing his studies at the Paris Medical Faculty, Dr. Bahaeddin Şakir returned to his country where he wrote the first copyrighted forensic medicine book of the country between 1910 and 1911. He mentioned his education in France and expressed his gratitude by mentioning the names of his lecturers in the foreword of this book titled the Textbook of Forensic Medicine.
It is also interesting to know that doctors such as Dr. Bahaeddin Şakir studying forensic medicine in the Paris Medical Faculty were also educated in the field of psychiatry. Thus, forensic medicine experts were also working as experts in the field of forensic psychiatry in the Ottoman Empire in the beginning of the 20th century. As an important result of this approach at the time, “observation clinics” were set up within the forensic medicine institution. In these clinics, patients were followed up for a certain amount of time in order to be able to submit opinions to legal authorities with regard to subjects affecting the criminal liability. Psychiatry department became an independent branch through the efforts of psychiatry doctors when the Ottoman Empire fell and the modern Turkish Republic was founded.
Forensic thanatology and forensic traumatology were covered more specifically in forensic medicine course book written by Dr. Bahaeddin Şakir between 1910 and 1911. The guidebook he wrote in 1914 for doctors working in provinces consisted of a wide range of subjects such as forensic entomology, forensic gynecology, forensic psychiatry, and forensic biology in addition to the aforementioned main topics. It is clear that a doctor using this book would not have any difficulty in their provincial area of assignment when ensuring justice using contemporary knowledge. The aim of the forensic medicine book he wrote in 1918 was to provide information specifically on death and postmortem phases for the doctors who wanted to specialize in this field.
After the launch of a mortuary directorate within the ministry of health in 1913, a more systematic service was provided in autopsy application to education and legal operation in an independent unit outside the faculty. Dr. Bahaeddin Şakir was appointed as the manager of this unit. This unit was later annexed to the ministry of justice in 1917 and is still in service today as its branch.
| Conclusion|| |
The quality and scientificity of the forensic medicine education changed admirably as a reflection of the reform movements beginning in the last century of the Ottoman Empire. Even World War I witnessing the final years of the Ottoman Empire could not prevent these changes and innovations, which continued with the foundation of the modern Republic of Turkey in 1923. After the establishment of the Republic, educational and governmental institutions were completely saved from the influence of religion and conservative mentality and reached a secular level, integrating with the modern world. The founder of the modern Turkish Republic, Mustafa Kemal Atatürk, can be seen in [Figure 9] and [Figure 10] with university students and academics.
|Figure 9: Mustafa Kemal Atatürk, the founder of the modern Turkish Republic, with university students and academics |
Click here to view
|Figure 10: Mustafa Kemal Atatürk, the founder of the modern Turkish Republic, with university students and academics|
Click here to view
In addition to reinforcing the scientific approach, new universities of the Republic have fulfilled their duty of hospitality toward scientists by housing the academics running away from the Nazi regime in Germany since 1933. It is known that Albert Einstein, who was a Nobel laureate physicist also suffering from the Nazi regime, sent a letter in this regard to the Government of the Republic of Turkey in 1933. This letter's original copy can be seen in [Figure 11]. Professor Dr. Philipp Schartz who had an important role in forensic medicine and pathology fields and Rudolph Nissen from the field of surgery were among the famous scientists invited to Turkey (Nissen was also the doctor who operated on Albert Einstein's intestinal cyst in 1948).
|Figure 11: Letter from Albert Einstein to the Prime Minister of the Republic of Turkey, dated September 17, 1933|
Click here to view
Even though the French-German school (i.e., école) of forensic medicine dominated the academia from the 19th until the mid-20th century, the US school has evidently come to the lead since the end of World War II. Under a new law passed in 1953, eight departments were added, namely morgue, physics, chemistry, observation, biology, psychiatry, traffic, and graphology. This law laid the foundations of the modern institution that is known today as the “Council of Forensic Medicine.”
Scientists working in the field of forensic science in today's Turkey serve their country within universities, the ministry of justice, the ministry of health, the police and the military, where they fulfill such scientific discoveries and practices that compete with the modern world in academic terms.
We contacted the related publishing houses on the figures used in the study and cited from published sources and took consent that they may be used in the publication as long as references are stated. We would like to thank these publication houses for this.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Öztürel A, editor. Development of forensic medicine branch in Turkey in 50 years and present situation. In: The Book of Ankara Law School Fiftieth Year 1925-1975. Ankara: Sevinç Matbaası [Sevinç Publication]; 1977. p. 51-77.
Öztürel A. Council of forensic medicine law amendment and the critique of new draft law. Ankara Univ Fac Law J 1979;1:305-17.
Sarı N, Akgün B, Kurt UE. From Foundation, to the 1933 Reform; Darülfünun Medical Faculty with Photos. İstanbul: İstanbul University Press; 2011.
Bilgin NG, Ögenler O, Akça T. History of forensic autopsy in Turkey. Lokman Hekim J 2011;1:8-12.
Yıldırım RV. Advances and Development of Forensic Medicine Education in Turkey (1846-1933). İstanbul: Istanbul University Institute of Health Sciences, Department of Medical History and Ethics, Doktora Tezi [Doctorate Thesis]; 2011.
Şakir B. Textbook of Forensic Medicine which Taught at the Ottoman Medical Faculty. İstanbul: National Press; 1910-1911.
Şakir B, Vasfi D. Guide of Legal Medicine. İstanbul: National Press; 1914.
Şakir B, Vasfi D. Legal Medicine. İstanbul: Medical Faculty Student Association; 1918.
Arda B, Aciduman A. Legal Medicine in Turkey. In: Beran RG, editor. Legal and Forensic Medicine. 1st
ed. Berlin, Heidelberg: Springer; 2013. p. 175-92.
Uzel İ. Miniatures of Cerrahiyyetü'l Haniyye. İstanbul: The Bank Cultural Publications; 1990.
Salaçin S. Forensic medicine in Turkey. Am J Forensic Med Pathol 1982;3:179-80.
Reisman A. Jewish Refugees from Nazism, Albert Einstein, and the Modernization of Higher Education in Turkey (1933-1945). Aleph; 2007. p. 253-81.
Gulmen MK, İnce CH. Forensic medicine and sciences in Turkey. In: Ubelaker DH, editor. The Global Practice of Forensic Science. 1st
ed. Chichester, West Sussex: John Wiley and Sons Inc.; 2014. p. 280.
Oguz P, Cem U. History of forensic medicine in Turkey. Leg Med (Tokyo) 2009;11:107-10.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11]