Nada Darwish and Alan S. Weber
Although known only through court documents, legal proceedings, and references in the writings of male practitioners, the tabiba – a female practitioner of folk medicine, midwifery, and gynecology – was an important member of the medical community in the Ottoman Empire (1299-1923). The existing historical record unfortunately obscures the important role that women physicians, nurses, healers, midwives, and medical practitioners played in community health and in the healthcare of the royal court.
Yet as Pormann and Savage-Smith point out, women as mothers and wives have always tended to sick family members and neighbors, and as midwives or healers catered to the medical needs of a substantial part of the community.1,2 Topkapi Palace in Istanbul, founded by Mehmed the Conqueror in 1476, was an important medical center for the Ottomans, and records indicate that specialized female medical teams for members of the harem existed until the eighteenth century: “According to archival sources, such as the pay registers of 1798-99, there was a paid female health team in the Old Palace. Its existence proves that there was a health organization for the members of the harem too”.3
Women in many cultures have performed medical tasks they learned through experience and oral traditions. Minkowski observes about women healers in the Middle Ages that “untutored in medicine, they used therapies based on botanicals, traditional home remedies, purges, bloodletting, and native intelligence”.4 Pormann has also uncovered an account by a medieval physician from Rahba, Sā‘id ibn al-Hasan, complaining that patients frequently consulted untrained female neighbors or their relatives:
How amazing is this [that patients are cured at all], considering that they hand over their lives to senile old women! For most people, at the onset of illness, use as their physicians either their wives, mothers or aunts, or some [other] member of their family or one of their neighbours. He [the patient] acquiesces to whatever extravagant measure she might order, consumes whatever she prepares for him, and listens to what she says and obeys her commands more than he obeys the physician.5
More sophisticated medical knowledge was the privilege of male physicians, who could access the translated works of Galen and Hippocrates, and the encyclopedias by Ibn Sina and Al Rhazi. Women healers depended for the most part on learning without any formal training. As physicians they usually acquired their skills by shadowing a physician relative; other female healers may have had access to training with private instructors, but did not acquire a formal title of physician. Yet influential women connected to the Abbasid court in Baghdad, such as Shaghab, the mother of the Caliph al-Muqtadir bi-Allah (reigned 908-932), were involved in health policy and services by endowing charitable organizations for Hajj pilgrims and the needy.6
During the medieval and early modern period in the Ottoman Empire, the medical hierarchy had three official distinguishable positions: physicians (known as hekims or tabibs), surgeons (cerrahs), and ophthalmologists (kehhals).7 Physicians dealt with illnesses of the body and the mind; surgeons and ophthalmologists specialized in one or several body organs or medical techniques. Female healers, not being recognized as official medical practitioners, were excluded from the medical hierarchy, collectively called dayas (midwives), and regarded by their male counterparts as unreliable. This discrimination not only deprived them of their professional title but also reduced their pay.7
Nevertheless many women were able to pursue careers in medical institutes with established positions and regular salaries. Gadelrab, in her study of medical workers in Ottoman Egypt, confirms that physicians, surgeons and midwives held a pivotal role in the society, visiting patients in their homes and sometimes having their own shops.8 Furthermore, she gives an account of the traveler Prospero Alpini, who emphasized that large numbers of female physicians practiced in Egypt and some were official employees in the al-Mansuri hospital.8 Likewise, Pormann refers to a fatwa (legal advice) involving a female physician who treated the daughter of a woman.1 The dispute was about the payment for the physician’s consultation, showing that women practiced medicine to such an extent that they were entitled to be paid. Some Dayas and other female healers lived inside or closely outside the harem–the Ottoman elite women–and were frequently consulted on medical issues. According to Uluçay, the budget report of the household of Ottoman emperor Süleyman I in 1513 shows a woman doctor as a salary recipient.9 Indeed, it was female healers who provided primary medical care for women of the imperial family, male practitioners being called only in severe cases.
Women physicians were generally respected in Ottoman society. Murphey reports a lawsuit filed in 1635 against a physician called Fatma bint Abdallah by one of her patients who claimed to have paid Fatma for treating his skin illness. The treatment was at first successful but four years later the disease recurred. In her defense, Fatma stated that the patient suffered from a different disease, and the judge accepted her testimony without requiring any further validation, showing that female physicians were viewed as reliable experts.10
Illustrations of women performing surgery appear in the manuscript Cerrahiyyet’ül Haniyya (The Imperial Surgery) written and illustrated by Şerefeddin Sabuncuoğlu (1385-1468). In one illustration, a woman surgeon holds a scalpel about to perform a gynecological operation and in another to extract a dead fetus suffering from hydrocephalus.11 The strict customs preventing women exposing their awrah (private parts) to physicians (still prevalent in modern Islamic societies) and the highly restricted female areas of the Ottoman court (harem) argue that women in Ottoman society must have frequently turned to female practitioners as their only socially acceptable alternative. The experience of the court’s male chief physician in treating women was recorded by Ottaviano Bon, the Venetian ambassador to Istanbul, in the early seventeenth century:
…he sees none but the black eunuchs (all the other women being retired into some withdrawing rooms) who bring him into the sick woman’s chamber, and she being closely covered from head to foot with quilts, and blankets, holdeth out her arm only, so as the doctor may touch her pulse, who, when he hath given order what shall be done, both for her diet and medicines, goes his way immediately by the same way that he came.12
Sabuncuoğlu may have been influenced in his book of surgery by the Al Tasrif of Al-Zahrawi (Albucasis), which describes the surgical treatment of bladder stones in women. Again partly due to Muslim rules of modesty, Al-Zahrawi advises his fellow male physicians:
If necessity compels you to undertake this kind of case, you should take with you a competent woman doctor. … Have her with you and bid her to do all that you instruct.13
In these words, Al-Zahrawi highlights the key role of women physicians, particularly in caring for women patients, and confirms that they were allowed to practice surgery under the supervision of a male physician.
Women healers also held medical managerial positions, most notably the daughter of Sari Eldin al-Saigh, who was so competent that she succeeded her father as chief physician of al-Mansuri hospital.8 Women healers also treated female concubines in special hospitals and had titles such as manageress (hastalar kethüdası kadın), assistant slave (hastalar kethüdasının cariyesi), female physician (hekim kadın), and mistress of the sick (hastalar ustası hanım ana).7 Practicing at a professional level, women served the imperial family, attended to the sick as nurses, and provided advanced medical consultation and treatment to patients of both genders, and were highly skilled surgeons. Barred from holding professional titles and lacking formal medical training, they nevertheless became highly respected and authoritative members of society.
- Pormann, Peter E. and Emilie Savage-Smith. (2007).Medieval Islamic Medicine, p103,104. Washington, D.C.: Georgetown University Press.
- Pormann, Peter E. (2005). “The Physician and the Other: Images of the Charlatan in Medieval Islam.”Bulletin of the History of Medicine 79: 189-227, p226.
- Sari, Nil and Ali Haydar Bayat. (1999/00). “The Medical Organization at the Ottoman Court.”Studies in History of Medicine & Science 16, no. 1-2, n.s.: 31-51, p32.
- Minkowski, William L. (1992). “Women Healers of the Middle Ages: Selected Aspects of Their History.”American Journal of Public Health 82: 288-295.
- Pormann, Peter E. (2009). “The Art of Medicine: Female Patients and Practitioners in Medieval Islam.”The Lancet 373: 1598-1599, p1590.
- Hershkovits, Keren Abbou. (2014). “Medical Services and ʿAbbasid Ladies.” Journal of Women of the Middle East and the Islamic World12: 121–136, p126.
- Shefer-Mossensohn, Miri. (2011). “A Sick Sultana in the Ottoman Imperial Palace: Male Doctors, Female Healers and Female Patients in the Early Modern Period.”Journal of Women of the Middle East and the Islamic World 9, no. 3: 281–312, p289,301.
- Gadelrab, Sherry S. (2010). “Medical Healers in Ottoman Egypt, 1517-1805.”Medical History (pre-2012) 54: 365-38, p378.
- Uluçay, M. Çağatay. (1970). “Kanunî Sultan Süleyman ve Ailesi ile (İligili Bazı Notlar ve Vesikalar).”Kanuni Armağanı. Ankara, Turkey, p245.
- Murphey, Rhoads. (1992). “Ottoman Medicine and Transculturalism from the Sixteenth through the Eighteenth Century.”Bulletin of the History of Medicine 66, no. 3: 376-403, p389.
- Bademci, G. (2006). “First Illustrations of Female ‘Neurosurgeons’ in the Fifteenth Century by Serefeddin Sabuncuoğlu.” Neurocirugía 17: 162-5, p164.
- Withers, Robert.A Description of the Grand Signor’s Seraglio or Turkish Emperour’s Court. London: Printed for Jo. Martin, and Jo. Ridley, 1650, p110 [This is a translation of a work by Ottaviano Bon (1552-1623) wrongly attributed to the translator Withers].
- Spink, M.S. and G. L. (1973, 420-421).Albucasis on Surgery and Instruments. Berkeley and Los Angeles: University of California Press.
- Russell, G.A. (1990). “Physicians at the Ottoman Court.” Medical History, no. 34: 243-267.
NADA DARWISH, a second-year medical student at Weill Cornell Medicine-Qatar in Doha, Qatar, has held several leadership positions, including being a member of the Medical Students Executive Council, a Student Ambassador, and president of the Pediatrics Interest Group. She has worked for a year on a research project that is studying cancer cells and received several awards in story writing as well as in research.
ALAN S. WEBER, PhD, an associate professor of English, Weill Cornell Medicine-Qatar, Doha, Qatar, has taught in its Premedical Program since 2006. He was the managing editor of Isis and editor of Nineteenth Century Science and of women’s Renaissance medical texts. His recent publications include “Folk Medicine in Oman,” “Ibn Sina: the Islamic Polymath,” and “Patient Opinion of the Doctor-Patient Relationship in a Public Hospital in Qatar.”