Descriptions of hospitals
Author: TEKİR SULEYMAN
*Ph.D. (Research Assistant), Kafkas University, Kars, Turkey
Among the cities on the coastline of the Black Sea, Kastamonu, in particular, and its settlements such as Safranbolu, Inebolu and Sinop were those where epidemics broke out in the final period of the Ottoman Empire. During the period, it is possible to observe the epidemics in Sinop and the measures taken by the State against them. There were several factors that triggered the emergence of these outbreaks. The foremost among those factors was the fact that the domestic and foreign ships passed through Sinop, which was a port city with significant commercial activities and communications with other Black Sea and Mediterranean port cities. Ships, apart from cargoes and links to the rest of the world, carried contagious diseases with them. Moreover, the proximity of the region with Istanbul and the ease of sea transportation were among the reasons of the widespread epidemics.
The hospitals in Sinop had often been established to fight against epidemics. Upon necessity, it was decided on 15 September 1855 to build a single-storey and wooden city hospital.  The construction of the hospital could not be completed for a long time due to the lack of finance.  Finally, during the governorship of Abdurrahman Pasha, the Hospital of Sinop was built on a high elevation, to protect it from the sea, on the north-west of the city in 1887. Although the building was ready, the hospital did not function for another 12 years, until 1899. After that date, however, the Sinop Hospital was renovated and its conditions largely improved; particular attention was given to syphilis. The hospital had seven wards including five for men and two for women, an excellent surgery room, which was one of the best in all Anatolia, a bacteriology laboratory, consulting rooms and other facilities.  As Sinop was also a citadel, the construction of a military hospital to serve its artillerymen was established in 1877.  A physician, a surgeon and a pharmacist were in charge of this hospital. 
The diseases frequently encountered among the population of Sinop included seasonal diseases beside the common ones. Other than these, syphilis, malaria, tuberculosis, variola and diphtheria were among the epidemics which were observed in the history of the city.
Syphilis was the main epidemic that affected Sinop for a long time. There were multiple reasons for the diffusion of syphilis, which was frequently encountered in the region and transmitted sexually. The primary reason was the fact that the soldiers brought to the region of Kastamonu, to which Sinop was subordinate administratively, had served in Galata where brothels were most commonly found in Istanbul. So when their duties ended in Galata and they came to Sinop, they brought also syphilis. The second significant reason was the fact that the workers who went from the region of Sinop to Istanbul brought this disease when they returned. Besides, the workers who went to the cities of the Russian Empire returned to the Ottoman cities of the Black Sea region with contagious diseases. Syphilis was spreading easily as it was transmitted not only sexually but also through utilities commonly used and shared. When syphilis was transformed into a serious epidemic and became hereditary, stillbirths and deaths of children who were of primary school age began.  The Organization "Fighting Against Syphilis", based in Kastamonu, was established in 1897. 
A serious syphilis epidemic broke out in Sinop between 1886 and 1887. In order to control the situation, four physicians and two pharmacists were assigned for the fight against the epidemic. However, no positive result was obtained through this effort. The outbreak was especially widespread in the regions of Boyabat and Istefan. Upon the failure of the efforts taken by the existing health establishments, the Governor of Kastamonu applied to the Ministry of Internal Affairs on 25 January 1887 for the establishment of hospitals, one in Sinop and one in Safranbolu. After the necessary research was carried out, the Council of Ministers took a decision on 14 August 1887 to establish hospitals in Sinop and Safranbolu for the fight against syphilis. It was also decided that the construction costs would be covered by a municipality budget and by the money that remained from the salaries of the physicians and pharmacists who were dismissed.  The fight against syphilis continued by physicians that were brought periodically until the hospital construction was completed. When the physicians who were firstly assigned proved insufficient, were all dismissed. In their place, Pol Gazaryan, Agop Manukyan and Anastasyadis Efendi of Sinop were assigned.  Upon an attempt to use the hospital building, as originally planned, in July 1892 the Ministry of Internal Affairs intervened to ensure the building was used for syphilis patients. In 1904, the worn sections of the Syphilis Hospital were repaired. 
Of the 1250 males who had applied to the Syphilis Hospital of Sinop between the years of 1886 and 1899, 1193 were treated and discharged while 12 individuals died. In the same time period, 6 out of the 912 women who had applied to the hospital for suspected syphilis lost their lives. And 104 out of 362 foreigners who had applied to the hospital in the same period also died. 
As Sinop was a commercial and passenger port, epidemics were breaking out due to the ships which stopped by. When cholera was diagnosed in the laborers who had been sent to Batoum by train in July 1892, a quarantine station was decided to be established in Sinop in order to prevent those who would return from Batoum to avoid cholera to be spread to Istanbul.  The Quarantine Station of Sinop began to function on 24 August 1892.  Later on, this station assumed a very significant mission. Upon the observation that many cholera outbreaks were occurring in Russia, all the passenger ships coming from Russian cities had to pass to be checked in the quarantine station in Sinop. Those ships which were suspected of being infected by cholera were taken to quarantine for 5 to 10 days. When cholera was observed in Trabzon, all the ships were directed to Sinop. After a cholera epidemic broke out in Nikolaev, at the northern shore of the Black Sea, the ships coming from the Russian coast from Kerch to the border of Romania were taken to quarantine in Kavak or Sinop. The cholera outbreaks that were seen in all the countries on the coast of the Black Sea and in the Caucusus were also spread to Sinop despite all the measures taken. In order to protect Sinop against diseases, a coastal area called Yalı Köşkü was also assigned in 1893 as a quarantine station. The quarantine rules were applied so firmly that even fishing was prohibited as long as the danger continued.  Thanks to the Quarantine Station of Sinop, and the fight against cholera, a significant number of ships entered Sinop from 1892 to the eve of the First World War.
There were about 20 ships annually, some domestic and some foreign, some commercial and some passenger ships, that stopped by the Sinop port. Only the passengers of those ships counted more than 5,000 making the hazards of epidemics almost inevitable. Therefore, during the 19th century, Sinop became a medical center where diseases were being diagnosed cured, like scurvy, which was being diagnosed in the navy soldiers during the Crimean War, then syphilis and cholera. Therefore, two hospitals and a quarantine station were established in the city.
 BOA. (Office of the Prime Minister Ottoman Archives) İ.MVL, 340.014693.001.001-002.
 BOA. İ.SD, 045.02425.001.001.
Sinop Sıhhiye Müdüri Doktor Mehmed Said, Türkiye’nin Sıhhi-i İçtimai Coğrafyası: Sinop Sancağı, Ankara 1338,
 BOA, İ.DH, 0814.065717.001.001.
Kastamonu Vilayet Salnamesi, H.1321/M.1903, s.389.
 Nurhan Yıldırım, “Tanzimat’tan Cumhuriyet’e Koruyucu Sağlık Uygulamaları”, Tanzimat’tan Cumhuriyet’e Türkiye Ansiklopedisi, İletişim Yayınları, İstanbul 1999, s.1326.
 BOA. MV, 51/20. ; BOA. İ. MMS, 1333/197.
 BOA. İ. MMS, 92/3899. ; BOA. MV, 78/22. ; BOA. ŞD.2519/4.
 BOA. DH. MKT, 1447/66.
 BOA. DH. MKT, 1968/68. ; BOA. DH. MKT, 918/26.
 Kastamonu Vilayet Salnamesi, H.1321/M.1903, s.356-357.
 BOA. İ..DH.102475/1295.
 Mesut Ayar, Osmanlı Devletinde Kolera İstanbul Örneği (1892-1895), Kitabevi Yayınları İstanbul 2007, s.68.
 BOA. BEO. 53/3909. ; BOA. BEO. 53/3913. ; BOA. BEO. 53/3958. ; BOA. BEO. 76/5641. ; BOA. BEO. 99/7376. ; BOA. DH. MKT, 138/8.