Sultan Bayezid II Complex: A Center of Medical Treatment
Permanent Delegation of Turkey to UNESCO
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Located on the north shore of the Tunca River in Edirne, the second capital of the Ottoman Empire, Sultan Bayezid II Külliyesi (complex) consists of a mosque, tabhanes (guest-houses), a madrasah, (medical school), darüşşifa (hospital), imaret (soup kitchen-cellar), pharmacy, and food-storage areas. The main center of the Külliye, however, is the darussifa (hospital) and madrasa (medical school). The other constructed units were built to complete the hospital service in social, cultural, religious and financial aspects. The Bayezid Khan Bridge over the Tunca River, built to connect the külliye to the city.
The construction of the Külliye started in 1484 by the order of Sultan Bayezid II (AD 1447/48–1512) and was completed in 1488. There are several opinions as to the identity of the architect. According to some researches, the complex was built by the architect Hayrettin who constructed many important structures in the period of Sultan Bayezid II. The others claimed that it was built by the architect Yakub Shah.
Sultan Bayezid II, the son of Sultan Mehmet the Conqueror Fatih, had a qualified education and always gave importance to public works during his time. The Sultan was also known as ‘’Bayezid-ı Veli’’ because of the importance he gave to “charity” work. Sultan Bayezid II Külliyesi (complex) which is a foundational work was built so as to meet the requirements of the physical and mental treatments of the patients as well as the possible socio-cultural needs of the patients and their relatives in accordance with the understanding of a “Holistic Medicine” approach.
A brief description of the major components of the complex is as follows:
Darüşşifa (the Hospital):
As the principal aim of the complex built by Sultan Bayezid II is to be established a hospital in Edirne, the most important unit of the complex is Darüşşifa. It consists of three sections with central plans. In the first courtyard, there were six outpatient rooms and service rooms serving as kitchen, laundry, and şurup room (laboratory). The four rooms in the second courtyard were the administrative rooms. The third part was the inpatient section called şifahane.
The rooms are placed opposite to each other along the first courtyard of Darüşşifa which has a rectangular shape. There are service rooms such as kitchen, cellar, and laundry room to the east of the first courtyard and a system of arched colonnades with seven sections to the west. Six of the seven rooms behind these colonnades are the domed polyclinic rooms. It is stated in various resources that at least one of these rooms is the guardroom and that mental patients with severe conditions are held under isolation in one of these rooms. The kitchen at the first courtyard of the Darüşşifa separate from the large kitchen at the imaret which is another unit of the külliye used to serve only the patients. The meals of the patients were prepared separately from others under the control of their doctors. Each patient had a different diet in order to balance the “four fluids of the body” and to treat their disease in accordance with the understanding of “holistic medicine”.
The passage from the first courtyard to the rectangular second courtyard is made via the cross vaulted entry. There are rectangular halls covered with two domes each on both sides of this entry. The large halls here were probably used for different purposes such as “women’s ward, pharmaceutical storage, cellar, etc.” There are two rooms opposite to each other to the east and west in the second courtyard as well as iwans located in the middle of these rooms. Some sources indicate that the rooms bound to the first courtyard wall are pharmacies, whereas the rooms next to the şifahane are surgery rooms. These rooms could also be reserved for the high level medical staff works.
The inpatient section, which is called şifahane (cure-house), has an outstanding architectural style. The building is passed through a broken arched door. This section was built with a central hexagonal plan. There are spaces with iwan which functions as summer patient rooms opening to the central hexagonal space at the side of each section. The central plan applied here is the first among its predecessors and contemporaries that eases patient follow up significantly for the doctors. The iwan and each of the square rooms surrounding the central space are covered with domes. The central space is also covered with a larger dome. This spherical dome is a dodecagon structure resting on five lines of stalactites. There is an arched window on each face. There is a lighting lantern right at the center of the dome which also functions as a ventilation device. The windows and chimney systems at the şifahane along with the lantern and ventilation on the central dome have been completed in a very successful manner. Thus, the lighting and ventilation system at the Darüşşifa are among the most advanced and successful examples of the time.
There is a polygonal marble şadırvan (water tank with a fountain) right under the dome. It is also thought that the şadırvan is placed right at the center not only to provide water but also to ensure that patients can benefit from its relaxing sound during their treatment. On the other hand, the iwan in the southern direction has been extended outwards via a semi-dome thus obtaining a pentagonal area. This area has a high platform formed of block rocks. Musicians perform on this platform to support the treatment of the patients accompanying the sound of flowing water. The building also has excellent acoustics because music and water sounds from the fountain were used in the treatment of mentally ill patients. The acoustic characteristics allow the music to be heard through the patient rooms.
Darüşşifa used to serve a wide range of people. Patients from the wide geographical coverage of the Empire encompassing the Balkans used to come here. In addition to the inpatients, the doctors working at the darüşşifa also used to go to the houses of patients to provide treatment. The drugs required for the outpatients at the polyclinics of the Darüşşifa were prepared by the pharmacists of the complex and were provided to all the patients free of charge just like all the other services.
Madrasah (Medical School):
Medical education in the Ottoman period was provided under the structure of hospitals and through a master-apprentice relationship. Located at the northeastern corner of the Darüşşifa, the building has a classical madrasah plan schema with colonnaded gardens surrounded by eighteen student cells covered with domes. There is also a mahfil (gathering place) in this classroom where students can follow the courses. This section is also considered to have been used for the practice of students’ medical education which distinguishes this madrasah from others. It is also known that the students did not only receive medical education here but also other positive sciences. Those students who completed their fundamental education at the madrasah could continue their theoretical and practical medical education at the Darüşşifa. The library of the madrasah contained the most important books and manuscripts on medicine of the period including ‘’Kanun’’, ‘’Minhacü’l Beyan’’, ‘’Müfredat-ı İbn-i Baytar’’, ‘’Şerh-i Aylaki’’, ‘’Kitab-ı Adab el-Tıp’’, ‘’Zahire-i Harzemşahhi’’, ‘’Şifaü’l eskam ve Devaü’l alam’’, ‘’Kitabu Edebü’t-Tabib’’. These are now under protection at the Edirne Selimiye Mosque Library of Manuscripts. The conditions for the use of books by students along with the responsibilities of the librarian have been provided in detail in the foundation deeds.
Located at the center of the külliye, the mosque raises as a cubic block with its dome with a diameter of 20.55 meters. It is a monumental work among the single domed mosques with regard to the diameter of its dome and the architectural system that carries the dome. There is no foot-column system. Instead, the dome has been placed directly on the walls. The mihrab (shrine or altar) and the mimbar of the mosque have been built plainly of marble. There is an elegant mahfil (gathering place) for the sovereignty placed on marble columns to the right of the mihrab. The mosque has a classical serene internal space thanks to these structural elements. The woodworking on the interior doors and windows is among the best examples of Ottoman woodworking. There is a large courtyard in front of the mosque with an elegant gazebo in its center.
Tabhanes (Hospice for travelers, guest-house):
There are two tabhanes with nine lower domes located at the east and west of the mosque. The patients who were discharged from the Darüşşifa after being treated used to spend their recuperation periods at these spaces to benefit from the peaceful environment provided by the natural landscape around. The relatives of the patients could also stay at these tabhanes free of charge. The tabhanes were open to all travelers who came to the city or those who wished to rest while passing through the city. The visitors who were not patients could stay for three days at these tabhanes free of charge. The guests who stayed there during this period could eat at the imaret. In this regard, the külliye also had units that functioned as a hospital hotel.
Located at the very eastern end of the külliye, the imaret units consist of two large blocks for the units of kitchen, fodlahane (bakery) mumhane, (candle house), cellar, storage area and stable. The kitchen at the imaret served the residents of the surrounding neighborhoods, guests residing at the tabhane as well as all the külliye staff. Gastronomy was an important issue since it affected not only the physical status of the patients and the külliye staff but also their emotional and mental status. It is known that the ingredients of the meals prepared here helped preserve the physical and mental balances of the staff that needed to be patient, understanding and good humored by nature of their duties.
Located along the Tunca River, the Külliye has been built within a modest, calm and peaceful landscape. It was designed as a plain stone structure and with hundred domes of different sizes amidst the green landscape surrounding the river. The gardens inside the courtyard support the treatment of the patients. The outer walls of the külliye have been built low enough so that they will not isolate the patients from the outside, but high enough to control the entries to the darüşşifa and madrasah. Even though outside the courtyard walls, the bridge is also part of the complex that connects it to the city. The bridge with five pointed arches was also constructed by the cut limestone like all other units of the külliye.
There were a total of 167 people employed at the külliye at the time of its foundation. According to the records of the year 1617, the number of staff increased to 228 including doctors, ophthalmologists, book keepers, nurses, mudarris, hodjas, imams, cooks, halva makers, cleaners, time keepers. Sultan Bayezid II has provided many foundational estates in order to ensure that the finances required for the high quality services are given here are met. The immovable properties at Edirne, İstanbul and the Balkans in addition to many villages in Anatolia and the Balkans are among these.
Justification of Outstanding Universal Value
Sultan Bayezid II Complex illustrates a significant stage on the way to the modern hospital and the patient-treatment perception in a modern sense thanks to its central plan that enables the doctors to follow up their patients easily, the acoustic system that supports the treatment procedure by music and sound of water as well as the modern treatment methods and the medical education provided.
Darüşşifa (the hospital) of the complex is one of the best examples of the transformative attempts towards a “central system” not only for the early modern period Islamic world but also in Europe. With its plan layout consisting of a hexagonal inpatient treatment area covered by a large dome at its center as well as the other medical units located around the two courtyards connected to each other, the darüşşifa has enabled the provision of medical services in an optimum manner. Darüşşifa also played an important role in providing protective health services. The smallpox vaccine applied to the children at the Darüşşifa was taken to England by Lady Mary Wortley Montagu who visited the Ottoman Empire in 1718 and started to be applied there as well.The architectural layout and function of the units within the complex were all designed as components of a holistic medicine understanding in which nutrition, clean air and water (for drinking, cleaning and for therapy) were considered to be as important as medicines. The medical center provided the best known systematic use of treatment with music, as part of the medical treatment understanding of the early modern period and Islamic societies, which has been considered at the beginning of its planning stage. Furthermore, the layout of the mosque, tabhanes, imaret and darüşşifa and madrasah parallel to the Tunca River and peaceful greenery environment around shows the importance given to landscape during the construction of the complex.
Criterion (ii): With its central planning system, ventilation and lighting details, polyclinic and inpatient section, laboratory and storage rooms, acoustic system and modern treatment methods, Sultan Bayezid II Complex is the first example of centrally planned medical center and considered to be the forerunner of the modern hospitals. The architectural plan and layout of the complex reflects the attempts the search for the most suitable plan for medical services that went back to ancient Asklepions. In addition to traditional methods acquired from previous darüşşifa structures in the Islamic world, the complex contains many novel design and details, thus creating the most successful example of the “central plan scheme.” The design, the plan layout and the medical treatment methods used in the complex exerted great influence not only through the Ottoman world but also in Europe in later periods. The smallpox vaccine applied to the children at the Darüşşifa was taken to England by Lady Mary Wortley Montagu who visited the Ottoman Empire in 1718 and started to be applied there as well.
Criterion (iv): Sultan Bayezid II Külliye is the most authentic structure reflecting the “Holistic Medicine” understanding with its central planning system, ventilation and lighting details, summer and winter patient rooms, music stage, acoustic system, administrative rooms, polyclinic, gardens, kitchen, laundry room, laboratory, staff and medicine storage rooms. The complex played an active role as a hospital and school of medicine for five hundred centuries. The healthcare services based on the “Holistic Medicine” understanding of the Islamic and Ottoman societies were applied in the most successful manner towards uniting the “body and the soul”. The Külliye is also among the most successful examples in terms of meeting the socio-cultural demands of the patient individuals in order to ease their return to the society.
Criterion (vi): In addition to medical and surgical interventions, the property also provided traditional treatment methods including water and music therapy with the most systematic and professional manner, as part of the holistic treatment approach. To this aim, the acoustics was given importance in the building, a music stage was built in the inpatient section and musicians were employed. The existence of a music stage in the inpatient section of a hospital of the 15th century is remarkable, considering during the same period in some countries mentally ill people were condemned to death. The location of the Darüşşifa along the river and at a certain distance away from the city center and at the center of a peaceful greenery environment chosen at the construction of the complex is also considered as part of the mental treatment.
Statements of authenticity and/or integrity
Sultan Bayezid II Külliye contains all the key attributes with its structural integrity and authenticity that convey its outstanding universal value. Its completeness is represented by the fact that the property exists today in an unchanged form since its foundation in the 15th century.
The description of the Külliye are registered in the foundation certificates dated to the 14th and 15th centuries (These include the establishment certificate dated 1487, foundation certificates dated 1489-90, 1493, 1574, 1617 etc.) and the ledgers that contain details of all the expenses made between 15th and 19th centuries. There also several historical texts that provide information regarding the architectural features and the use of the property including Tacü’t Tevarih written by Hoca Sadettin Efendi (1536-1599) and Enis-ül Müsamirin by Abdurrahman Hibri (1636), Fihrist-i Şahan written by Solakzade Mehmet Efendi (17th century), etc. The City of Edirne Yearbooks also provides information between 19th and 20th centuries.
Sultan II Bayezid Külliye is under the protection and inspection of the Regional Directorate of Foundations as a foundational work in accordance with the Law of Foundations dated 2008 and numbered 5737. The structures that are used and maintained by the Trakya University are under the protection of the Law of Protection of Cultural and Natural Properties dated 1983 and numbered 2863. The property was also registered as a “monumental building” by the Supreme Board of Cultural Heritage Preservation in 1997. The registration was revised in 2003 by the Edirne Cultural and Natural Heritage Preservation Council with the decree numbered 7697. The bridge is under the inspection and maintenance of the Directorate General for the Highways.
All units of the Külliye have undergone only one major repair despite its 530 years of history. Following the maintenance works carried out towards the end of the 1800’s, the beginning of the 1900’s and in 1964; the structures were last repaired between 2010 and 2013. The authenticity of all the units of the Külliye with regard to planning, architectural detail and material were preserved during these repair and maintenance works.
All units of the darüşşifa and külliye excluding the mosque were closed since they lost their functions following the 1913 Balkan Wars and the Greek invasion of 1920-22. The darüşşifa and madrasah units were restored in 1964 after which they were used for providing different services as dormitory, guest house and family health center. The darüşşifa was designed as a “Museum of Health”, after it was transferred to the Trakya University Faculty of Medicine in 1984. The furnishing of the Museum of Health was developed during the beginning of the 2000’s which went on to receive the European Council Museum Award in 2004. The madrasah unit continues to function as an educational unit of the Trakya University where different handcrafts trainings are provided. The mosque and imaret units of the külliye underwent restoration during 2010-2013. The imaret units are used as the Trakya University Balkan Research Institute. The Sultan Bayezid II Bridge continues its function connecting Edirne and the külliye over the Tunca River as the main route. According to the foundation deeds of the külliye, a windmill and Turkish bath had also been built along the Tunca River in order to provide income to the Külliye. However, these two structures that were outside the külliye borders have not reached our day. Although various changes have occurred over time, the units of the complex have been used in their original purposes of teaching the science of medicine, accommodation-hostel and social support center.
Comparison with other similar properties
A health care center with such a detailed design has not been built until the 18th and 19th century. When we consider the other hospital structures included in the UNESCO World Heritage List or not, the superior position of the Sultan Bayezid II Külliye structure becomes more clearly.
There are different medical and healthcare structures included in the UNESCO World Heritage List or the Tentative Lists of various countries. The Franja Partisan Hospital (Slovenia, 2001), included in the Tentative List, is a hospital complex that was built to meet the demands that occurred during the extraordinary environment of the 2nd World War. It is thus naturally impossible to see the central plan, corporate administration and architectural elements of the Bayezid II Darüşşifa. The Paimio Hospital (Sanatorium) (Finland, 2004) stands out as a modern period hospital dating back to the 1930’s. The Estate Zonnestraal (Netherlands, 2011), is another sanatorium reflecting the architectural features of the 1920’s and the 1930’s with an architectural plan that enables the patients to recuperate in a well lit environment with clean air just like Paimio. The Gateway to the Old King’s Yards (Sierra Leone, 2012) is included in the UNESCO World Heritage List as the “entrance” opening to the central hospital of Freetown. What makes this gateway authentic is its universal importance as part of the efforts to end the ‘slavery system’. In addition, Palau de la Música Catalana and Hospital de Sant Pau (Spain, 1998) are also important examples of 20th century Catalonian Modernism. It has structural elements and decorations that reflect the unique Catalonian identity and art in a perfect manner.
There is also hospital sections of monasteries dated to the Middle Ages. The Monastery and Site of the Escurial (Spain, 1984) as well as the Poblet Monastery (Spain, 1991) included in the UNESCO World Heritage List, are among the best examples. The plan layout of hospitals inside monasteries enabled the provision of healthcare services as part of a religious solidarity within the scope of the facilities of the complex rather than in accordance with the requirements of proper medical services.
When we compare the Bayezid complex with other Islamic and Ottoman healthcare structures, we see that despite the maximum care to ensure that all Islamic Darüşşifa complexes are built in accordance with a plan scheme that will enable the provision of medical services, Sultan Bayezid II Complex stands out with its excellent plan layout and features. This observation is true for all monuments such as Nureddin Zengi’s Darüşşifa complexes at Aleppo and Damascus, Mardin Emüniddin Külliye, Kayseri Gevher Nesibe Darüşşifa and Madrasah Complex, Sivas İzzeddin Keykavus Darüşşifa, Divriği Turan Melik Darüşşifa, Gökmadrasah in Tokat and Amasya.
The Great Mosque and Hospital of Divriği (Turkey, 1985), has also the form of a Külliye, similar to the Bayezid Darüşşifa. The complex that combines a monumental hypostyle mosque with a two storey hospital was included in the World Heritage List due to its architectural features and extraordinary decorations that reflect the 13th century Seljuk art and architectural development.
The courtyard madrasah plan of the Seljuq period was applied for the darüşşifa structures of the Ottoman Period. However, it is observed that the Ottomans are seeking a “central plan” for the specific needs of their medical services. In search for a central plan, we see a move away from the courtyard madrasah plan, especially in the Haseki Külliye Darüşşifa in Istanbul and the Edirne Sultan Bayezid II Darüşşifa. The Darüşşifa structures built at in Bursa, Istanbul, Manisa, Cairo, and Mecca in different periods have not been able comparable to the Sultan Bayezid II Külliye in terms of its perfection in the application of the central plan as well as its lighting and ventilation systems.
There has also been a search for a central plan in Europe throughout the Renaissance and the Early Modern Period. The Ospedale Maggiore built in Milano in 1457 is accepted as a turning point for the hospital architecture of the Western societies. With its cross plan, it resembles the madrasah plan of the Islamic societies which has been used for a very long period of time. The hexagonal-octagonal plans resembling a circle have also been used during the 18th and 19th centuries. Ventilation and lighting were also started to be perceived as main problems of hospitals during this period in addition to the search for a central plan. This has resulted in various different trials in hospital architecture during the 18th and 19th centuries. Similarities with the Bayezid II Darüşşifa structural plan can be seen in the octagonal structure of the Johns Hopkins Hospital built in Baltimore during the 19th century, the Stuivenberg Hospital in Antwerpen, the Presbytarian Hospital in Philadelphia, the Bradfort Pediatric Hospital and the Seafort Military Hospital in Liverpool despite the fact that they have all been built four centuries later that Sultan Bayezid II Complex.