Leprosy, also known as Hansen's Disease in medical literature, is one of the oldest known infectious diseases in human history. The first records of this disease appear in the cuneiform writings of ancient Mesopotamia. Medical studies on the diagnosis and treatment of leprosy in Anatolia began early in the period with the work "Risale fi Baras" by Kutbeddin-i Şirazi, a Seljuk physician. This demonstrates that the Ottoman Empire's approach to leprosy was shaped by an existing foundation of medical knowledge and practice.
The presence of leprosy in the Ottoman Empire dates back to the state's founding. The disease's contagious nature, with no known cure at the time, led the Ottoman administration and society to develop specialized approaches to individuals with leprosy. These approaches included isolation policies aimed at preventing the spread of the disease, but also embodied a compassionate approach that considered the human needs of patients. The contagious and unknown nature of the disease was the primary motivation for isolation policies aimed at separating individuals with leprosy from society. This demonstrates how limited medical knowledge directly shaped administrative and social measures. The fear and terror the disease inflicted on society triggered a chain reaction that led to the inclusion of isolation provisions in legal codes and the establishment of leprosy asylums. The Ottoman struggle with leprosy was approached not only as a medical problem but also as a complex issue with social, legal, and humanitarian dimensions. The phrase "approach with compassion" suggests that isolation functioned as a mechanism of protection and care, rather than strict exclusion. Data such as the disease's public fear and the state guaranteeing the livelihoods of lepers despite the existence of isolation regulations in the law demonstrate that the Ottoman approach to lepers was more holistic and humane, different from the Western perception of "curse." This can be interpreted not only as an effort to control the disease but also to maintain the patients' quality of life to some extent.
Perception of Leprosy and Legal Regulations in Ottoman Society
In Ottoman society, leprosy was a widespread source of fear and terror. The very name of the disease was enough to instill fear and terror among the people. This demonstrates that leprosy was not only combated by its physical effects but also by the profound social stigma it created. Individuals accused of having leprosy within society were required to undergo examinations by doctors and obtain official documentation from judges proving they were free of leprosy in order to dispel this accusation and reintegrate into society. This practice demonstrates that diagnosis and social acceptance of the disease were subject to a legal process.
Due to the contagious nature of leprosy, the Ottoman Empire supported its isolation policies with legal regulations. The Rumelia Province Code of Law during the reign of Bayezid II included the provision, "And expel lepers from the city; they shall not keep them there." Similarly, the Central and General Codes of the reign of Suleiman the Magnificent and the code of laws during the reign of Ahmed I included the provision, "And observe the lepers; they shall not keep anyone from the leper race in the cities." These provisions clearly demonstrate that it was state policy to keep lepers away from city centers and under observation. Furthermore, it was stated that leper patients were required to wear distinctive clothing. Ottoman code of laws adopted a clear isolation policy aimed at preventing the spread of the disease by ordering the removal and observation of lepers from cities.
Despite the strict isolation provisions in the legal codes, the Ottoman Empire's approach to leprosy patients also contained a significant dimension of compassion and support. The Ottomans treated leprosy patients with compassion and viewed isolation as a necessity due to the contagious nature of the disease. Leprosy patients were considered "disabled," their livelihoods were guaranteed by the state, and their needs were met by the state. This demonstrates that isolation was not a punishment but a mechanism of care and protection. Despite the isolation clauses in the legal codes, such as "periods from the city," the fact that patients' livelihoods were guaranteed by the state demonstrates that the Ottoman approach was not one of mere exclusion, but rather encompassed a dimension of social security and care. This demonstrates the state's responsibility for the hardships posed by the disease. This demonstrates that a balance was struck that took precautions against the risk of contagion while simultaneously respecting the patients' fundamental rights to life and human needs.
The designation of the poorhouses as "nests of mercy" and the more benign name "tekke" (dervish lodge), reflecting the psychological well-being of the patients, emphasize the Ottomans' humanitarian approach. It has been stated that this designation was intended to avoid hurting the pride of leprosy patients by giving them a name they might not like and to prevent them from suffering psychological distress. This has been presented as an example of the kindness of Ottoman civilization. The Ottoman emphasis on "compassion" and "psychological support" towards lepers differs significantly from the Biblical perception of leprosy as a "punishment and curse" and the European practice of banishing them from cities by labeling them "cursed." This difference suggests that the Ottomans developed a more humane model within the framework of Islamic values and their own cultural codes. This suggests that Ottoman society and the state's perception of lepers, despite the need for isolation, was more of a "scourge" or "disease," and that they felt a sense of compassion and responsibility towards these individuals.
Diagnosis and Treatment of Leprosy in Ottoman Medicine
Ottoman medicine utilized knowledge from the Seljuk period to diagnose and treat leprosy. Kutbeddin-i Şirazi's "Risale fi Baras" served as an example of important medical work in this field. During the Ottoman period, various scientists offered different ideas about the causes of the disease and its treatment.
Because leprosy was a contagious disease with no known cure, the Ottomans attempted to treat people with leprosy using various methods in isolated settings. These methods generally consisted of traditional practices consistent with the general medical understanding of the time. Sabuncuoğlu Şerafeddin recommended cauterizing the head on five different points in leprosy treatment. Akşemseddin, on the other hand, argued that bloodletting, leeching, or cupping were effective. In addition, some herbal treatments were suggested to be beneficial for leprosy patients. Evliya Çelebi's travelogue highlighted the idea that thermal springs and healing waters were beneficial for leprosy patients. These methods represented efforts to alleviate or cure the symptoms of the disease through observational and traditional approaches at a time when modern microbiological knowledge was lacking. With the development of modern medicine, physicians like Mazhar Osman introduced modern methods of leprosy treatment to the country and established the first independent leprosy hospital.
Although leprosy was known to be contagious until the late 16th century, knowledge of the disease's pathophysiological mechanisms and definitive treatment remained limited. This limited medical knowledge and the lack of an effective treatment method led to the adoption of isolation of lepers as the primary method of control. This demonstrates how medical inadequacies directly shape public health policies. Due to a lack of complete understanding of the disease's etiology and the lack of modern medications, traditional and experimental treatments were generally symptomatic or palliative and did not provide definitive cures. Therefore, isolation emerged as the most reliable and applicable method for preventing the spread of the disease. This demonstrates that medical inadequacy necessitates social isolation.
In terms of institutional capacity, the Governor of Erzurum's request to establish a miskinhane (a leprosy) facility or to send lepers to Dersaadet (Istanbul University) for treatment was rejected due to a lack of funds, and patients were instead offered treatment at Gureba Hospital in the provincial capital. This demonstrates the limited capacity and financial constraints of specialized leprosy treatment centers. Similarly, the fact that all six beds in the Gülhane-i Seririyat-ı Hümayun were occupied highlights the inadequacy of existing medical institutions for leprosy patients. Governorship requests in the early 20th century and the bed capacity problems at Gülhane demonstrate that, even in the late Ottoman period, specialized medical infrastructure for leprosy patients remained inadequate, forcing general hospitals to shoulder this burden. This situation highlights the challenges faced in integrating modern medical approaches. The inadequate budget and the overcrowding of existing hospitals in response to reports of leprosy cases and requests for treatment facilities from the provinces indicate that the state struggled to establish a centralized and systematic healthcare network to combat leprosy, relying instead on localized, temporary solutions. This situation is consistent with the fact that public health services were not a primary responsibility of the state until the early 1900s.
The table below summarizes the main leprosy treatment methods used in Ottoman medicine and the relevant physicians/opinions:
This table summarizes the diverse, yet generally experimental and symptomatic, treatment approaches developed by Ottoman medicine against leprosy. By illustrating the medical understanding and approaches of the period, it helps understand the treatment paradigms of the period before modern medicine. The systematic presentation of the treatment methods mentioned sparsely throughout the text within a table provides a summary of the medical knowledge and practices of the period.
Ottoman Leprosy Hospitals (Miskinhanes): Their Establishment and Geographical Distribution
Leprosy asylums were established in the Ottoman Empire from an early period to prevent the spread of the disease and provide care for individuals with leprosy. The first known leprosy asylum during the Ottoman period was built by Murad II in Kirişhane, Edirne, and operated until 1627. This demonstrates the early establishment of leprosy asylums in the Ottoman Empire and the awareness of the need for such institutions.
Leprosy Asylums Established in the Ottoman Empire (Generated by AI)
The most important leprosy asylum in the Ottoman Empire was the Karacaahmet Miskinler Tekke, built on the Üsküdar-Kadıköy road in 1514 during the reign of Yavuz Sultan Selim and operating until 1927. This tekke was further expanded with additions made during the reign of Mahmud II in 1810. The longevity of the Karacaahmet Miskinler Tekke underscores the continuity and importance of these institutions. Other important leprosy asylums were located in Bursa (operating between 1551 and 1817), Cyprus, Heraklion (Crete), and Chios. A Miskinler Tekke was also noted in Antakya. This geographical distribution demonstrates that leprosy asylums were established at strategic points throughout the Ottoman Empire and served areas where the disease was prevalent.
It appears that leprosy had spread throughout the country by the early 20th century. It was particularly prevalent in the Kastamonu Province, and due to the disease's prevalence, an area known as "Leprosy Creek" emerged. Leprosy was also widespread in the Safranbolu Sanjak of the Kastamonu Province. The presence of leprosy in the Genç Sanjak of Bitlis is also confirmed by a memorandum of understanding sent to the Ministry of Internal Affairs by the Governor of Bitlis, Hasan Bey. Leprosy was also recorded in the Enfe area of the Gure village, which was under the control of the Governor of Cebel-i Beneben. The mention of four leper individuals arriving in Tripoli demonstrates the disease's widespread geographic spread. This prevalence highlighted the need for new institutions, such as the Governor of Erzurum's request for a new infirmary.
Records from the early 21st century indicate that leprosy was widespread in various regions of the empire (Kastamonu, Bitlis, Cebel-i Lebanon, Tripoli). This prevalence prompted the central government (Ministry of the Interior) to implement measures to prevent the spread of the disease through the governorates, creating a need for new leprosy asylums. Reports of leprosy cases from various regions of the empire highlighted the need for the central government to intervene and implement regional measures. The governors' demands for leprosy asylums and the capacity constraints of existing institutions demonstrate that the disease was no longer a local problem but a central public health issue. The state attempted to take a more active role in this area, but encountered resource and capacity limitations. Additions to the Karacaahmet Miskinler Tekke during the reign of Mahmud II demonstrate that leprosy asylums were expanded and adapted over time to meet growing needs or changing policies. This suggests that these institutions were not static structures but underwent a dynamic evolution. Following the initial establishment during the reign of Yavuz Sultan Selim, the leprosy asylums were established during the reign of Sultan Selim II. Expansions during Mahmud's reign demonstrate that leper asylums were more than just isolation areas; they were living institutions that needed to increase their capacity over time according to the increasing population or number of cases.
Living Conditions, Administrative Structure, and Financing in Leprosy Asylums
Ottoman leprosy asylums were institutions that met patients' basic needs and provided a certain order of life. At the Karacaahmet Miskinler Lodge, patients received soup, rice, and meat every evening, and zerde twice a week. This demonstrates the provision of regular nutrition and basic care. Donations left on the alms stone in front of the lodge were shared by the patients, and prayers were offered to those who helped. This practice demonstrates that, in addition to state support, philanthropy and social solidarity were also important sources of funding and support. The narratives at the Miskinler Lodge cover the period between the late Ottoman period and the early Republic, and it is noted that begging was also seen as a way of earning a living. This suggests that some patients managed to interact with the outside world to some extent to support themselves. Leprosy asylums were institutions that provided regular nutrition and basic care, financed by state support and public philanthropy.
Depiction of People with Leprosy. (Generated by AI)
The administrators of the Miskinler Tekke were called "sheikhs." Depending on the time, this "sheikh" could be a leper or someone who had gained trust, was trustworthy and just, and had not contracted the disease. This flexible administrative structure demonstrates that the institution served both a medical and social function. The fact that lepers, reluctant to mingle with the public, lived a solitary life suggests that isolation sometimes aligned with the patients' own preferences. The fact that the Miskinler Tekke was designated a "health institution" confirms that these institutions functioned not only as places of isolation but also as centers of treatment and care.
The fact that the meskinhanes were described as "houses of mercy" and the designation "tekke" was intended to protect the patients' pride and prevent psychological distress highlights the importance of the humane and psychosocial dimension in the Ottoman approach to leprosy. This demonstrates that not only physical isolation but also spiritual well-being was prioritized. Despite the social stigma and fear engendered by the disease, the Ottomans' use of the name "tekke" and the definition of "houses of mercy" for these institutions reflects an effort to protect the dignity of the patients, provide psychological support, and foster a sense of community.
In terms of funding, the livelihoods of leprosy patients were guaranteed by the state, and their needs were met by the state. This demonstrates the central government's financial responsibility in this matter. Public aid through alms stones diversified funding sources. The request for a salary to send an inspector, physician, and pharmacist to Bitlis in 1902 demonstrates that the state assigned personnel and allocated a budget for the care and treatment of lepers. The acceptance of external aid through alms stones and the mention of begging as a source of income suggest that leprosy asylums were not entirely isolated, closed institutions; they did maintain a certain level of interaction with the outside world and that patients enjoyed some autonomy. This suggests a "colony" or "village"-like lifestyle in these institutions. Despite the isolation of the patients, the existence of points of contact with the outside world, such as almshouses and begging, suggests that leper homes, rather than rigid prison models, contained a self-contained living order and space for social interaction, even functioning as "semi-autonomous" communities. This suggests that patients were not completely isolated, but lived within certain boundaries.
Architectural Features and Functions of Leprosy Hospitals
Ottoman leper asylums were based on the principle of isolation in their spatial configuration. Leper asylums were established "outside the city" to keep lepers away from the city's population. The construction of the Karacaahmet Miskinler Tekke, located in the middle of the Karacaahmet Cemetery on the old Baghdad Road, supports this principle of isolation. This suggests that leper asylums were located outside the city, often in isolated areas such as cemeteries. While the Karacaahmet Miskinler Tekke initially consisted of nine households, it was later expanded by Mahmud II with the addition of 11 more residences. This demonstrates that the institution grew structurally over time to meet increasing needs.
Academic studies on leprosarium architecture in general (albeit in a non-Ottoman context) indicate that such institutions were designed as "colonies isolated from society," and could include hospital units to meet all patient needs, residences, recreational areas, and agricultural/animal husbandry areas. These "small cities" were managed by administrative personnel. It has been noted that the spatial organization was based on the principles of disease prevention (prevention of spread) and the hierarchical classification of different social categories (healthy, sick, and varying degrees of sickness) and the control of their movements.
The reason these places where leprosy patients were isolated were called "tekke" was because they resembled the lodges located next to the tomb of the order's leader, which were suitable for people to live in self-contained groups. This designation gave the institution religious and social legitimacy. Another important reason for this designation was to avoid hurting the pride of leprosy patients by giving them a name they might not like and to prevent them from suffering psychological distress. This was presented as an "exemplary example of kindness" in Ottoman civilization. The designation of leprosy as "tekke" demonstrates that, beyond mere spatial isolation, these institutions aimed to create a sense of "community" or "family," to care for the psychological well-being of patients, and to provide them with a living space. This approach signified a "humane" approach that differed from the more rigid "institution" or "prison"-like leprosarium models in the West. Despite lepers being objects of social ostracism and fear, the Ottoman designation of these places as "tekke" reflects an effort to protect the dignity of the patients, provide psychological support, and provide them with a kind of "home" environment. This demonstrates that architectural naming served a social and psychological purpose, combining isolation with humanity.
While direct information on the architectural details of Ottoman leprosy asylums is limited, when studies on general leprosarium architecture and the nomenclature "tekke" are considered, it can be concluded that the Ottoman model embodied a structure resembling an "isolated colony" or "village," a structure that maintained its own life and met the needs of patients. This bears parallels with the modern concept of a "humane leprosarium." The location of Ottoman leprosy asylums outside the city and their large residential units, the nomenclature "tekke," and the aim of psychological support, combined with the general definition of leprosarium architecture as "isolated colonies" and "small cities," lead us to conclude that Ottoman leprosy asylums were not merely quarantine areas but also semi-autonomous settlements where patients could build new lives, their basic needs were met, and a sense of community was fostered. This suggests that the architecture aimed not only at physical isolation but also at social and psychological rehabilitation.
The Ottoman Empire's approach to leprosy adopted isolation as a fundamental public health measure due to the contagious nature of the disease, but implemented this isolation within a humanitarian framework. Despite exclusionary provisions in legal codes, the state's guarantee of leper livelihoods and the functioning of institutions like the "Miskinler Tekkesi" as "nests of mercy" demonstrate the Ottomans' unique approach to this issue. Unlike the Western perception of "curse" or "punishment," this approach embraced isolation as a public health imperative, while simultaneously offering a model focused on "compassion" and "social support," prioritizing the dignity and basic needs of patients. This can be considered a reflection of Ottoman social and religious values in their health policies. Comparing the legal obligation of isolation, state guarantees, and the designation "tekke" with the exclusionary approaches in the West, it becomes clear that the Ottoman approach to leprosy was an "Ottoman Model," blended with religious and cultural values, balancing pragmatic public health measures with humanity. This model prevented the spread of the disease while ensuring that patients lived within certain boundaries, rather than being completely excluded.
Given the limitations of medical knowledge at the time, traditional treatment methods generally remained symptomatic, increasing the importance of isolation. However, the designation of leprosy asylums as "tekke" (dervish lodge) and the commitment to the psychological well-being of patients reflect Ottoman civilization's understanding of social responsibility and compassion. The widespread prevalence of leprosy throughout the empire demonstrates the prevalence of these institutions and the ongoing need for central and local efforts to manage the disease.
