Leprosy in the Ottoman Empire

Leprosy, also known in medical literature as Hansen’s Disease, is one of the oldest infectious diseases known to human history. The earliest records of this disease appear even in the cuneiform texts of ancient Mesopotamia. Medical studies in Anatolia aimed at diagnosing and treating leprosy began in the early Seljuk period with the work of Kutbeddin-i Şirazi titled “Risale fi Baras.” This indicates that the Ottoman Empire’s approach to leprosy was shaped upon an existing foundation of medical knowledge and practice.

The presence of leprosy in the Ottoman Empire extends back to its founding era. The contagious nature of the disease and the lack of known treatments at the time led the Ottoman administration and society to develop special approaches toward individuals affected by leprosy. These approaches included isolation policies designed to prevent the spread of the disease, while also embodying a compassionate understanding that addressed the humanitarian needs of patients. The contagious and incurable nature of leprosy formed the primary motivation for policies of social separation. This reveals how the limitations of medical knowledge directly shaped administrative and social measures. The fear and terror generated by the disease in society triggered a chain reaction that resulted in the inclusion of isolation clauses in legal codes and the establishment of leprosaria. The Ottoman struggle against leprosy was not merely a medical issue but a complex matter encompassing social, legal, and humanitarian dimensions. The phrase “approach with compassion” indicates that isolation functioned not as harsh exclusion but as a form of protection and care. Although the disease provoked social fear and led to isolation decrees in legal codes, evidence such as the state’s provision of livelihood support for leprosy patients demonstrates that the Ottoman approach differed significantly from the Western “curse” perception, instead reflecting a more holistic and humane perspective. This can be interpreted not only as an effort to control the disease but also as an attempt to preserve, to some extent, the quality of life of patients.

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 sufficient to instill fear and dread among people. This indicates that the struggle against leprosy was not limited to its physical effects but also involved confronting the deep social stigma it produced. Individuals accused of being leprous were compelled to undergo medical examination by physicians and obtain an official document from a judge certifying that they did not suffer from leprosy, in order to clear their names and reintegrate into society. This practice reveals that the diagnosis of the disease and its social acceptance were tied to a legal process.

The Ottoman state supported its isolation policies for leprosy through legal regulations. The Rumeli Eyalet Kanunnamesi of the reign of Bayezid II included the provision: “Expel lepers from the city; do not allow them to remain within it.” Similar provisions were found in the central and general kanunnames of the Kanuni period and those of Ahmed I: “Observe lepers; do not allow any person from the leper community to reside in cities.” These clauses clearly demonstrate that the state policy required the removal of lepers from urban centers and their continued surveillance. Additionally, it was stipulated that lepers must dress in distinctive clothing. Ottoman legal codes adopted a clear isolation policy by ordering the removal of lepers from cities and their monitoring to prevent the spread of the disease.

Despite the strict isolation clauses in the legal codes, the Ottoman state’s approach to leprosy patients also contained a significant dimension of compassion and support. The Ottomans “approached lepers with compassion” and viewed isolation as a necessity due to the contagious nature of the disease. Leprosy patients were classified as “malul” (disabled), their livelihoods were placed under state guarantee, and their needs were met by the state. This demonstrates that isolation was not a punishment but a mechanism of care and protection. Although legal codes contained expressions such as “expel from the city,” the fact that the state guaranteed the patients’ livelihoods reveals that the Ottoman approach was not merely one of exclusion but also incorporated elements of social security and care. This illustrates the state’s assumption of responsibility in addressing the hardships caused by the disease. It also shows that a balance was maintained between taking preventive measures against contagion and respecting the fundamental rights and humanitarian needs of patients.

The designation of almshouses as “homes of compassion” and the use of softer names such as “tekke” for these institutions, instead of terms that might distress patients, underscores the Ottoman humanitarian approach. It has been noted that this naming aimed to preserve the dignity of leprosy patients and prevent psychological collapse. This has been presented as one of the examples of Ottoman civility. The Ottoman emphasis on “compassion” and “psychological support” for leprosy patients stands in clear contrast to the perception of leprosy as a “punishment and curse” in the Torah and the European practice of branding sufferers as “cursed” and expelling them from cities. This difference suggests that the Ottomans developed a more humane model within the framework of Islamic values and their own cultural codes. This indicates that Ottoman society and the state perceived leprosy not as a mark of divine retribution but rather as a “misfortune” or “illness,” evoking a sense of sympathy and responsibility toward those affected.

Diagnosis and Treatment of Leprosy in Ottoman Medicine

Ottoman medicine drew upon the medical legacy inherited from the Seljuk period. The work of Kutbeddin-i Şirazi, “Risale fi Baras,” serves as a significant example of medical scholarship in this field. During the Ottoman period, various scholars proposed differing views on the causes and treatments of the disease.

Due to its contagious nature and the absence of known cures, the Ottomans attempted to treat leprosy patients in isolation using various methods. These methods generally consisted of traditional practices consistent with the medical understanding of the era. Sabuncuoğlu Şerafeddin recommended cauterizing five specific points on the head for leprosy treatment. Akşemseddin argued that bloodletting, leeching, or cupping would be effective. In addition, some herbal remedies were believed to benefit leprosy patients. In his travelogue, Evliya Çelebi noted the perceived benefits of spa waters and healing springs for leprosy sufferers. These methods represent efforts, based on observation and tradition, to alleviate or improve symptoms in an era lacking modern microbiological knowledge. With the development of modern medicine, physicians such as Mazhar Osman introduced modern treatment methods to the country and established the first independent leprosarium.

Although it was known by the end of the 16th century that leprosy was contagious, knowledge regarding its pathophysiological mechanisms and definitive treatments remained limited. This medical ignorance and the absence of effective therapies led to the adoption of isolation as the primary strategy for combating the disease. This illustrates how medical inadequacies directly shaped public health policies. Due to the incomplete understanding of the disease’s etiology and the lack of modern pharmaceuticals, traditional and experimental treatments were generally symptomatic or palliative and did not lead to definitive recovery. Consequently, isolation emerged as the most reliable and practical method for preventing transmission. This demonstrates that medical insufficiency rendered social isolation a necessity.

In terms of institutional capacity, the request by the Governor of Erzurum to either construct a new almshouse or transfer leprosy patients to Istanbul for treatment was rejected due to insufficient funding, and patients were instead recommended to be treated at the Gureba Hospital in the provincial center. This highlights the limited capacity and financial constraints of specialized leprosy treatment centers. Similarly, the full occupancy of the six-bed ward at Gülhane-i Seririyat-ı Hümayun reveals the insufficient capacity of existing medical institutions to accommodate leprosy patients. Requests from provincial governors and bed shortages at Gülhane in the early 20th century demonstrate that even in the late Ottoman period, specialized medical infrastructure for leprosy patients remained inadequate, forcing general hospitals to assume this burden. This indicates the difficulties encountered in integrating modern medical approaches. In response to reports of leprosy cases and requests for treatment locations from provinces, budgetary shortages and overcrowding in existing hospitals hindered the state’s ability to establish a centralized and systematic healthcare network, leading instead to reliance on local and temporary solutions. This also aligns with the fact that public health services were not considered a primary state obligation until the early 1900s.

The following table summarizes the main leprosy treatment methods applied in Ottoman medicine and the associated physicians or opinions:

This table summarizes the various, yet generally experimental and symptomatic, treatment approaches developed by Ottoman medicine against leprosy. By concretely illustrating the medical understanding and physician perspectives of the era, it aids in comprehending the therapeutic paradigms of the pre-modern period. The systematic presentation of scattered treatment methods in tabular form provides a concise overview of the medical knowledge and practices of the time.

Ottoman Leprosaria (Miskinhaneler): Establishments and Geographic Distribution

In the Ottoman Empire, leprosaria were established from early periods to prevent the spread of the disease and provide care for leprosy patients. The first known leprosarium in the Ottoman period was built by Murad II in Edirne-Kirişhane and remained operational until 1627. This demonstrates that leprosaria were established at an early date and that the need for such institutions was recognized.

Leper Hospitals Established in the Ottoman Empire. (Chat GPT)

The most significant leprosarium in the Ottoman Empire was the Karacaahmet Miskinler Tekkesi, constructed in 1514 during the reign of Yavuz Sultan Selim along the Üsküdar-Kadıköy route and serving until 1927. This tekke was further expanded in 1810 during the reign of Mahmud II. The long-term operation of the Karacaahmet Miskinler Tekkesi underscores the continuity and importance of such institutions. Other important leprosaria existed in Bursa (active between 1551 and 1817), Cyprus, Candia (Crete), and Chios. It is also noted that a Miskinler Tekkesi existed in Antakya. This geographic distribution indicates that leprosaria were strategically located across the Ottoman Empire and provided services in regions where the disease was prevalent.

At the beginning of the 20th century, it became evident that leprosy had spread throughout the empire’s territories. It became particularly widespread in the Kastamonu Vilayeti, to the extent that a region known as “Cüzzamlılar Deresi” (Valley of the Lepers) emerged due to the high concentration of cases. Leprosy was also commonly observed in the Safranbolu Sancağı, subordinate to Kastamonu Vilayeti. Records from a petition sent by the Governor of Bitlis, Hasan Bey, to the Ministry of Interior confirm the presence of leprosy in the Genç Sancağı, subordinate to Bitlis. It is also recorded that leprosy was observed in the Enfe locality of Gure Karyesi, under the jurisdiction of the Mutasarrıflık of Cebel-i Lübnan. References to four leprosy patients arriving in Trablusgarb illustrate the extensive geographic spread of the disease. This prevalence prompted new demands for institutions, such as the request by the Governor of Erzurum for a new almshouse.

Records from the early 21st century indicate that leprosy was widespread in various regions of the empire (Kastamonu, Bitlis, Cebel-i Lübnan, Trablusgarb). This prevalence prompted the central administration (Ministry of Interior) to implement measures through provincial governors to curb its spread and triggered the need for new almshouses. Reports of leprosy cases from different geographic regions of the empire revealed the central administration’s need to intervene and adopt regional preventive measures. Governors’ requests for almshouses and capacity problems in existing institutions demonstrate that leprosy had evolved from a local issue into a central public health concern, prompting the state to assume a more active role, albeit constrained by resource and capacity limitations. The expansions made to the Karacaahmet Miskinler Tekkesi during the reign of Mahmud II indicate that leprosaria were expanded or adapted over time in response to increasing needs or changing policies. This suggests that these institutions were not static structures but underwent dynamic evolution. The initial establishment under Yavuz Sultan Selim and subsequent expansions under Mahmud II demonstrate that leprosaria were living institutions that increased their capacity in response to growing populations or case numbers, rather than merely serving as places of isolation.

Living Conditions, Administrative Structure, and Financing of Leprosaria

Ottoman leprosaria were institutions that provided patients with basic needs and a structured daily routine. At the Karacaahmet Miskinler Tekkesi, patients received soup, pilaf, and meat every evening and zerde twice a week. This demonstrates the provision of regular nutrition and basic care services. Donations left at the charity stone in front of the tekke were distributed among the patients, and donors received prayers for blessings. This practice illustrates that, alongside state support, philanthropy and social solidarity were vital sources of funding and assistance. The accounts of the Miskinler Tekkesi encompass the period from the late Ottoman era to the early Republican period and note that begging was also viewed as a means of livelihood. This suggests that some patients maintained limited interaction with the outside world to support themselves. Leprosaria were institutions funded by state support and public philanthropy, providing regular nutrition and basic care services to patients.

Depiction of Leprosy Patients. (Chat GPT)

The administrators of the Miskinler Tekkesi were called “şeyh.” This “şeyh” could be a leper, someone who had gained trust and respect, or a non-leprous individual deemed reliable and just. This flexible administrative structure demonstrates that the institution fulfilled both medical and social functions. The desire of lepers to live secluded lives, avoiding interaction with the public, suggests that isolation was sometimes aligned with the patients’ own preferences. The designation of the Miskinler Tekkesi as a “health institution” confirms that these institutions functioned not merely as places of isolation but also as centers of treatment and care.

The description of almshouses as “homes of compassion” and the use of the term “tekke” to avoid humiliating patients and prevent psychological collapse highlight the importance of the humanitarian and psychosocial dimensions in the Ottoman approach to leprosy. This demonstrates that not only physical isolation but also spiritual well-being was taken into account. Despite the social stigma and fear generated by the disease, the Ottoman practice of naming these institutions “tekke” and describing them as “homes of compassion” reflects an effort to preserve patients’ dignity, provide psychological support, and foster a sense of community.

In terms of financing, the livelihoods of leprosy patients were guaranteed by the state, and their needs were met by state resources. This demonstrates the central administration’s financial responsibility in this matter. Donations collected through charity stones diversified funding sources. In 1902, a request was made for the state to allocate salaries for a supervisor, physician, and pharmacist to be sent to Bitlis, indicating that the state assigned personnel to care for and treat leprosy patients and allocated budgets for this purpose. The acceptance of external aid through charity stones and the mention of begging as a livelihood source suggest that leprosaria were not entirely isolated or closed institutions but maintained certain points of contact with the outside world, allowing patients a degree of autonomy. This implies that these institutions resembled a “colony” or “village”-like living model. Although patients were isolated, the presence of external contact points such as charity stones and begging indicates that leprosaria were not rigid prison-like facilities but rather contained their own internal systems of daily life and social interaction, functioning as semi-autonomous communities. This demonstrates that patients were not completely excluded but lived within defined boundaries.

Architectural Features and Functions of Leprosaria

Ottoman leprosaria were designed according to the principle of isolation in their spatial configuration. Miskinhaneler were established “outside the city” to keep leprosy patients away from the general population. The construction of the Karacaahmet Miskinler Tekkesi in the middle of the Karacaahmet Cemetery along the old Baghdad Road supports this principle of isolation. This indicates that leprosaria were typically located in isolated areas outside cities, often near cemeteries. Initially consisting of nine dwellings, the Karacaahmet Miskinler Tekkesi was later expanded by Mahmud II with the addition of eleven more housing units. This demonstrates that the institution grew structurally over time in response to increasing needs.

Academic studies on the general architecture of leprosaria (even outside the Ottoman context) indicate that such institutions were designed as “isolated colonies” capable of meeting all patient needs, including hospital units, housing, recreational areas, and agricultural or livestock facilities. These “small towns” were managed by administrative personnel. Spatial arrangements were based on principles of disease prevention and hierarchical classification and control of different social categories (healthy vs. sick, varying degrees of illness).

The reason leprosaria were called “tekke” was due to their resemblance to Sufi lodges located beside the tomb of a spiritual leader, which provided space for individuals to live as independent communities. This naming conferred religious and social legitimacy upon the institution. Another important reason for this terminology was to avoid humiliating patients by assigning them a name they would find distressing and to prevent psychological collapse. This has been presented as one of the examples of Ottoman civility. Naming leprosaria as “tekke” indicates that these institutions aimed not only to achieve spatial isolation but also to foster a sense of community and belonging, attend to patients’ psychological well-being, and provide them with a living environment. This approach distinguishes the Ottoman model from the more rigid “institution” or “prison”-like leprosarium models in the West, representing a “humane” alternative. Despite being objects of social exclusion and fear, the Ottoman practice of naming these places “tekke” reflects an effort to preserve patients’ dignity, provide psychological support, and offer them a sense of “home.” This demonstrates that architectural naming served a social and psychological purpose, integrating isolation with humanity.

Although direct information on the architectural details of Ottoman leprosaria is limited, when combined with studies on general leprosarium architecture and the use of the term “tekke,” it can be inferred that the Ottoman model featured a structure resembling an “isolated colony” or “village,” self-sustaining and designed to meet patients’ needs. This bears parallels with the modern concept of the “humane leprosarium.” The location of Ottoman leprosaria outside cities, their inclusion of extensive housing units, the use of the term “tekke,” and the purpose of psychological support, when combined with the general description of leprosaria as “isolated colonies” or “small towns,” lead to the conclusion that Ottoman leprosaria were not merely quarantine zones but semi-autonomous settlements where patients could establish new lives, their basic needs were met, and a sense of community was encouraged. This demonstrates that architecture aimed not only at physical isolation but also at social and psychological rehabilitation.

In the Ottoman Empire, the approach to leprosy adopted isolation as a fundamental public health measure due to the contagious nature of the disease, yet implemented this isolation within a humane framework. Despite exclusionary clauses in legal codes, the state’s guarantee of patients’ livelihoods and the function of institutions such as the “Miskinler Tekkesi” as “homes of compassion” reveal the Ottoman Empire’s unique approach. Unlike the Western perception of leprosy as a “curse” or “punishment,” the Ottomans recognized isolation as a public health necessity while simultaneously respecting patients’ human dignity and basic needs through a model centered on “compassion” and “social support.” This can be interpreted as a reflection of broader Ottoman social and religious values in health policy. When compared with Western exclusionary approaches, the legal obligation of isolation, state guarantee, and the term “tekke” reveal that the Ottoman approach to leprosy constituted a “Turkish Model” that harmonized religious and cultural values with pragmatic public health measures and humanity. This model prevented the spread of the disease without completely excluding patients, instead enabling them to live within defined boundaries.

Considering the limitations of medical knowledge at the time, the traditional treatments applied were generally symptomatic, which increased the importance of isolation. However, the naming of leprosaria as “tekke” and the attention paid to patients’ psychological well-being reflect the Ottoman civilization’s understanding of social responsibility and compassion. The widespread presence of leprosy across the empire demonstrates the prevalence of these institutions and the continuous effort required at both central and local levels to manage the disease.