Grey Room

A Picture of Health: The Search for a Genre to Visualize Care in Late Ottoman Istanbul

Zeynep Devrim Gürsel

Nicolas Andriomenos. Tensüf Kadın, ca. 1890–1894. Image 1, Haseki Women’s Hospital album formerly part of Abdülhamīd II’s Yıldız Palace collection. This is the first photograph in the Haseki Women’s Hospital album compiled by Dr. Ahmed Nurrettin and sent to Sultan Abdülhamīd II. İstanbul Üniversitesi Nadir Eserler Kütüphanesi (Istanbul University Library of Rare Books).

Figure 1Nicolas Andriomenos. Tensüf Kadın, ca. 1890–1894. Image 1, Haseki Women’s Hospital album formerly part of Abdülhamīd II’s Yıldız Palace collection. This is the first photograph in the Haseki Women’s Hospital album compiled by Dr. Ahmed Nurrettin and sent to Sultan Abdülhamīd II. İstanbul Üniversitesi Nadir Eserler Kütüphanesi (Istanbul University Library of Rare Books).p. 37 I still remember the afternoon I encountered the portraits of seven women who had been treated at Haseki Women’s Hospital (Haseki Nisa Hastanesi), Istanbul. It was August 2009, and the gold-embossed insignia of Ottoman Sultan Abdülhamīd II was still perfectly intact on the century-old photo album’s crimson velvet cover. I could not possibly have known, as I turned to the first portrait, how much this album (which I will refer to as the Haseki portrait album) would teach me not only about photography and late Ottoman healthcare but about how the questions we ask as scholars shape the answers we discover. The very questions we ask make some historical experiences discoverable and, unbeknownst to us, obscure traces of others.

This article tells the story of how I learned to look at these extraordinary photographs and reflect on the medical care visualized in them. In what follows, I have deliberately sought to share my process of discovery rather than present the historical knowledge attained at the end, in the hopes of encouraging visual research that not only situates visuals in sociocultural and political contexts but renders visible the construction of what one might call “the possibility of visual history.”1 Hence I attempt to share how certain signs on a photographic surface transformed into clues that sparked my imagination and in turn allowed me to see in ways not available to me before.

If what follows is a detective narrative of sorts, it is one in which I have highlighted the moments in which visual detection became possible, often in conversation with others. This is a detective story focused less on the discovery at the end and more on the process by which specific visual details emerged as clues. Humbling as it is to admit, most of the clues that would emerge over the course of almost a decade of study were visible to me that afternoon in 2009. But I could neither see them nor comprehend their significance. This then is a story of how clues become detectable as clues.2

p. 38 Abdülhamīd II reigned from 1876 to 1909. These were critical and tumultuous years in Ottoman history. The Haseki portrait album is part of the rich collection of photographs amassed in Istanbul’s Yıldız Palace during the sultan’s reign, comprising some 911 albums containing 35,000 photographs.3 However, this particular album (unlike many others in the collection) is not one that was commissioned by the sultan. Rather, it was sent to the palace by an ambitious young doctor, Ahmed Nurettin, gynecologist and obstetrician of Haseki Women’s Hospital.

Haseki Women’s Hospital was a medical institution with a history going back to the sixteenth century.4 For a while it functioned as a women’s prison as well. In 1868 it was formally established as a women’s hospital, the only such institution in the entire Ottoman Empire. At a time when most women received medical treatment in their homes, Haseki served mainly homeless and indigent women.5 Medical historian Gülhan Balsoy details the multiple functions of the hospital, emphasizing the dual role of Haseki as a place that sheltered and cared for the most vulnerable Ottoman women while also keeping these unsuitable women away from public spaces. Haseki Hospital as a social institution was a site of both care and control, for the patients individually as well as for the empire. Hence the Haseki portrait album is particularly valuable as a historical trace of how the visibility and vulnerability of female patients as both medical and imperial subjects were negotiated.

The Haseki album consists of eight plates. What is perhaps most striking about the first six is how much they look like classic studio portraits of the late nineteenth century. In each we can clearly see a woman directly facing the camera. She stands on a carpet with a stylized studio backdrop behind her and a decorative table to her side. Each photograph is mounted onto an ornate mat with the photographer’s name—Nicolas Andriomenos—imprinted on it. All these details attest to the genre of this image as a studio portrait. Figure 2Nicolas Andriomenos. Tensüf Kadın, ca. 1890–1894. Image 1, Haseki Women’s Hospital album formerly part of Abdülhamīd II’s Yıldız Palace collection. Detail from the opening image of the album showing a median laparotomy scar and the tumor removed in the surgery. İstanbul Üniversitesi Nadir Eserler Kütüphanesi (Istanbul University Library of Rare Books).

The caption under the first portrait reads, “40 year old negroid [zenciye] resident of Kasımpaşa, Tensüf Kadın’s ‘picture of health’ following a median laparotomy resulting in the complete removal of the tumor and uterus.” Indeed, Tensüf Kadın is wearing a hospital-issued gown carefully pinned open to reveal the laparotomy scar on her abdomen. And on the decorative table beside her, in lieu of the typical stack of books or vase of spring blossoms, is a specimen jar containing the tumor that was removed from her, thus displaying to her, the photographer, possibly to p. 39 the sultan, and now to us, that which was once internal to her and hence invisible. That the album opens with a photograph of a black woman is noteworthy. Tensüf Kadın is the only black female patient in the album sent to the sultan. The issue of how race is represented in this album and more broadly in Ottoman photography is outside the scope of this article but is an important topic that deserves much more research.6

Figure 3Nicolas Andriomenos. Müzeyyen Hatun, ca. 1890–1894. Image 2, Haseki Women’s Hospital album formerly part of Abdülhamīd II’s Yıldız Palace collection. İstanbul Üniversitesi Nadir Eserler Kütüphanesi (Istanbul University Library of Rare Books).Figure 4Nicolas Andriomenos. Ayşe Hatun, ca. 1890–1894. Image 3, Haseki Women’s Hospital album formerly part of Abdülhamīd II’s Yıldız Palace collection. İstanbul Üniversitesi Nadir Eserler Kütüphanesi (Istanbul University Library of Rare Books).

With minor variations, the portraits are all similar: the women appear in full hospital uniform, all but Tensüf Kadın wear slippers, and each caption contains detailed information about the patient and what exactly was removed in the surgical process. Some include the dimensions or weight of the tumor: Müzeyyen Hatun’s tumor weighed over three kilograms. Each plate bears the surgeon’s name and title in French visible in the right-hand corner: “Opérateur Dr. A. Noureddin.”7 Gülizar Hatun’s portrait is the exception. Gülizar had a caesarean to remove the fetus who had died in her womb. She is photographed without an ornate table, and whether there is a backdrop behind her or merely a draped sheet is hard to determine. Hatice Kadın and Adviye Hatun are posed together. In each of the accompanying captions, the portraits are described as “a picture of health.” The image of Misli Hatun is described as her “asar-ısşifa” (state of healing) after a twenty-by-thirty-centimeter tumor was removed through a twenty-five-centimeter incision.

Figure 5Nicolas Andriomenos or unknown photographer. Gülizar Kadın, ca. 1890–1891. Image 4, Haseki Women’s Hospital album formerly part of Abdülhamīd II’s Yıldız Palace collection. “Picture of health” of twenty-two-year-old Gülizar Kadın, whose child had died in the womb, taken after her caesarean surgery. Gülizar’s case was communicated to Sultan Abdülhamīd II by letter from an Ottoman municipal health officer the morning after her surgery. This is the only portrait in the album showing only the patient. İstanbul Üniversitesi Nadir Eserler Kütüphanesi (Istanbul University Library of Rare Books).Figure 6Nicolas Andriomenos. Hatice Kadın and Adviye Hatun, ca. 1890–1894. Image 5, Haseki Women’s Hospital album formerly part of Abdülhamīd II’s Yıldız Palace collection. İstanbul Üniversitesi Nadir Eserler Kütüphanesi (Istanbul University Library of Rare Books).Figure 7Nicolas Andriomenos. Misli Hatun, ca. 1890–1894. Image 6, Haseki Women’s Hospital album formerly part of Abdülhamīd II’s Yıldız Palace collection. İstanbul Üniversitesi Nadir Eserler Kütüphanesi (Istanbul University Library of Rare Books).

In total, six variations of the phrase “picture of health” are used: “landscape of health,” “condition of a scar,” “sign of healing,” “a picture of health,” “image of convalescence,” and “state of healing.”8 This linguistic care suggests that drawing attention to the women’s recovered health was a central purpose of the album. These are not images of pathology but photographs that visualize successful medical care. Not only do they render visible that which was once internal to the body, a novelty before the invention of X-ray technology in 1895, but these photographs serve as evidence of the efficacy of medical procedures; these are photographs of regained health.

Figure 8Nicolas Andriomenos. Tumor lineup 1, ca. 1890–1894. Image 7, Haseki Women’s Hospital album formerly part of Abdülhamīd II’s Yıldız Palace collection. İstanbul Üniversitesi Nadir Eserler Kütüphanesi (Istanbul University Library of Rare Books).Figure 9Nicolas Andriomenos. Tumor lineup 2, ca. 1890–1894. Image 8, Haseki Women’s Hospital album formerly part of Abdülhamīd II’s Yıldız Palace collection. İstanbul Üniversitesi Nadir Eserler Kütüphanesi (Istanbul University Library of Rare Books).

The final two “group portraits” in the album might be considered a medical lineup. Jars of tumors lined up on a table. Each specimen identified by p. 40 type. The first jar, we are told, contains one stone the size of a walnut, the other the size of a hazelnut. The rest are tumors. All were removed vaginally. That the women from whom these were removed are not photographed alongside them suggests that the visibility of the surgical scar is central to the earlier portraits.9 Indeed the bared scar itself is the most direct site rendering healing visible. That is, we have no reason to doubt that these patients, too, regained their health, but their scars would not have been photographable in the same manner. The last page includes the doctor’s name and title—gynecologist and obstetrician of Haseki Women’s Hospital and the obligatory term servant (kulları), indicating an address directly to the sovereign. Captivated by the images, I set out to understand how and why such an album might have been produced.

p. 41 Upon searching the Ottoman state archives and studying published histories of the hospital, I soon encountered Dr. Kiryako, the hospital’s first dedicated doctor, appointed in 1871. The anxieties around the inappropriate visibility of the destitute women at Haseki were made exceptionally public in 1882 when a complaint letter bearing seventy-eight signatures charged the chief doctor, Kiryako, with mistreating the poor and looking at covered parts of Muslim women when there was no medical necessity to do so. The accusers wanted the Greek Ottoman, and hence non-Muslim, Kiryako replaced with an elderly Muslim doctor. Kiryako was promptly removed from the position he had held for eleven years while the authorities investigated the allegations against him.10 After a lengthy investigation lasting several years, the authorities decided p. 42 that the allegations were baseless and that Kiryako, though young, was an excellent doctor.11 He was reinstated in 1885 and remained the chief doctor of Haseki Hospital until his death in 1890.12 Significantly, one example of his medical excellence and dedication given in the documents clearing his reputation was that he photographed surgery patients before and after surgeries in accordance with scientific norms and even paid for this photography himself.13

Figure 10A complaint letter bearing seventy-eight signatures accusing Dr. Kiryako of inappropriate medical behavior at Haseki Women’s Hospital, Istanbul, 1882. Başbakanlık Osmanlı Arşivi (Prime Ministry Ottoman Archives).

Nurettin, the surgeon whose signature features heavily in the Haseki portrait album, arrived at Haseki Hospital as a junior doctor, the hospital’s third-ranked doctor, in 1890. This was the year Kiryako died. Faik Bey had succeeded Kiryako as chief doctor.14 Nurettin was appointed as a gynecologist and obstetrician. A photograph from the period shows him seated just next to Faik Bey, the new chief doctor.15 I strongly suspect that Nurettin knew of the accusations brought against Kiryako. According to Nimet Taşkıran’s history of the hospital, Nurettin’s father, Basri Bey, a naval doctor, had been appointed to temporarily direct the hospital during Kiryako’s suspension.16 Four years after he arrived, Nurettin left Haseki and appears to have practiced at another hospital under one of three Ottoman doctors who had been sent to France for surgical training. He returned to Haseki Hospital in 1903 as a general surgeon. He had an illustrious medical career and commanded much respect in his day. In 1907 he became chief doctor at Haseki Hospital and held this position until his death in 1924.

p. 43Figure 11Abdullah Frères (Abdullah Brothers). Group portrait of Haseki Women’s Hospital’s medical staff, ca. 1893. Dr. Ahmed Nurettin is third from right, front row. From Hasköy Hospital for Women, Fountains, Mausoleums, and Other Buildings and Views, part of the collection of fifty-one albums gifted to the Library of Congress by Abdülhamīd II. Courtesy Library of Congress. The other protagonist in the story of the Haseki portrait album is Greek Ottoman photographer Andriomenos, one of the most famous photographers of the era. Andriomenos had learned photography in the studio of Kosmi Abdullah, who had his own studio separate from that of his three brothers, the famous Abdullah Frères who were official photographers to the sultan. Andriomenos took over Kosmi Abdullah’s studio in 1879. He was one of the rare photographers who gained access to the palace and allegedly even gave photography lessons to Sultan Abdülhamīd’s younger brother, Prince Vahdettin.17

I assumed that what I saw in the Haseki portrait album was a visual medical convention, a genre of medical photography that had later fallen out of use. I assumed it was a Western medical genre that Dr. Nurettin had either seen examples of, been told of by other Ottoman doctors who had been trained abroad, or read about in one of the many foreign medical journals that circulated in the empire.18 However, a broad survey of medical historians, archivists, librarians, and medical museum curators not only in Istanbul but all over North America and Europe yielded no similar portraits.19 All consulted were surprised by the images and told me they had never seen anything like it. And by “like it” they meant a portrait of a live human with something that had been removed from them, an image in which the once internal was on display. They were reminded of images of corpses with an organ removed but could not think of one where the subject of the portrait was still alive, let alone “a picture of health” or “a landscape of healing,” as Nurettin described the patients in the Haseki portrait album.

Rather than an Ottoman application of a Western or universal medical photography, I now understand the Haseki portrait album as a visual negotiation at a moment when a genre of medical photography had not yet stabilized.20 New genres do not emerge fully formed but rather must be crafted from borrowing, reshaping, and repurposing existing forms. In the absence of an accepted method or style, Nurettin and photographer Andriomenos drew from the practices and codes of the existing genres of medical illustration and studio portraiture.21 However, I arrived at this conclusion only after appreciating the ways in which they must have collaborated.

Figure 12Nicolas Andriomenos. Studio portrait of a couple, ca. 1879– 1912. The same carpet appears in photographs from the Haseki Women’s Hospital album formerly part of Abdülhamīd II’s Yıldız Palace collection. Courtesy Gülderen Bölük.

My first question was where the portraits of the patients were taken, and so I searched private photography collections for portraits taken by Andriomenos in his studio. First, I recognized the carpet that appeared in many of the portraits.22 Then one of the collectors spotted the table in the Haseki portraits. Sure enough, p. 44 here was proof that the carpet and the table in the portraits were from Andriomenos’s studio. That the photographer would come to the hospital with all this equipment was hard to imagine, but less so than imagining the women and their tumors being transported to the photographer’s studio. But then I found a photograph that confirmed the women and their tumors must have been transported to the studio. In one portrait from the album, we clearly see the same floor design as in another Andriomenos studio portrait. Horse-drawn trams began operating in Istanbul in the 1870s and the route from Haseki Hospital to Andriomenos’s Beyazıt studio was on one of the earliest routes. The distance between the studio and the hospital was only 1.9 kilometers.23

Figure 13Nicolas Andriomenos. Studio portrait of a boy, ca. 1879–1912. The same decorative table appears in photographs from the Haseki Women’s Hospital album formerly part of Abdülhamīd II’s Yıldız Palace collection. Courtesy Adem Köse.Figure 14Nicolas Andriomenos. Studio portrait of a woman, ca. 1879–1912. The same floor appears in the portrait of Misli Hatun, image 6 of Haseki Women’s Hospital album formerly part of Abdülhamīd II’s Yıldız Palace collection. Courtesy Gülderen Bölük.

Nimet Taşkıran’s history of Haseki Hospital (published in 1972) states that there was an identical album to the one in Abdülhamīd’s collection in Yıldız Palace, and in the summer of 2014 I finally located a second album in a private collection.24 However, it was not identical. The crimson velvet cover is similar (if significantly more worn), and all of the images in the sultan’s album are also in this album, but the handwriting is much less ornate, and the captions include no biographical information about the women. Instead, only the medical terms for the surgeries and specific descriptors of the tumors are given, suggesting to me that this album was prepared by the doctor for himself or another medical p. 45 colleague. Should he want biographical information, Nurettin would be able to consult the hospitals records for the patients. Moreover, the second album has seven photographs that were not included in the sultan’s album. These additional images mostly seem to have been taken at the hospital itself, though two photographs feature the carpet and decorative table from the studio. We see the hospital’s bare floor and a stove, but the women are not uniformly dressed. One image shows two specimen jars. In another, two women have placed a hand on the same specimen jar, as if they shared a tumor. Perhaps the two shadows visible behind the woman in the seventh photograph belonged to the doctor and the photographer.

Figure 17Nicolas Andriomenos. Woman with two bell jars containing tumors, ca. 1893–1907. Image 1, Haseki Women’s Hospital album, private collection. Photograph not included in the Haseki portrait album sent to Yıldız Palace. Courtesy Ömer M. Koç Collection.Figure 18Nicolas Andriomenos, ca. 1893–1907. Image 2, Haseki Women’s Hospital album, private collection. Photograph not included in the Haseki portrait album sent to Yıldız Palace. Courtesy Ömer M. Koç Collection.Figure 19Nicolas Andriomenos. Two patients and a single tumor, ca. 1893–1907. Image 3, Haseki Women’s Hospital album, private collection. Photograph not included in the Haseki portrait album sent to Yıldız Palace. Courtesy Ömer M. Koç Collection.Figure 20Nicolas Andriomenos, ca. 1893–1907. Image 4, Haseki Women’s Hospital album, private collection. Photograph not included in the Haseki portrait album sent to Yıldız Palace. Courtesy Ömer M. Koç Collection.Figure 21Nicolas Andriomenos, ca. 1893–1907. Image 7, Haseki Women’s Hospital album, private collection. Photograph not included in the Haseki portrait album sent to Yıldız Palace. Courtesy Ömer M. Koç Collection.Figure 22Nicolas Andriomenos, ca. 1893–1907. Image 8, Haseki Women’s Hospital album, private collection. One of two photographs in the album seemingly photographed in Andriomenos’s studio. Photograph not included in the Haseki portrait album sent to Yıldız Palace. Courtesy Ömer M. Koç Collection.

Next I turned to the architectural record for clues and found that the early 1890s was a time of big changes for Haseki Hospital. The main building—the stone house that had been repurposed for patients (Taş konak)—was torn down in 1890, and the hospital made due in barracks for a few years before the pavilions that allowed for segregation of patients according to disease were opened in 1893. I had assumed that the photographs included in the second album were taken in the hospital rather than in Andriomenos’s studio. The stone house was a dark build-p. 47 ing with small windows, and prior to the invention of flash it would have been difficult to make these images in such an interior. The new pavilions were designed to let in maximum light. When I looked closely at the images, I saw that what I had taken for a shadow is not a shadow at all but rather a reflection. The light is coming from a window behind the photographer and the stove would have been placed close to an interior rather than external wall. Hence, these must be the reflections of the doctor and photographer on an interior window giving on to a dark corridor. When I found the architectural drawings that Patrocle Kampanaki made for the pavilions in a document dated 1891, the plans showed precisely such corridors with windows onto the postoperation patient rooms in the surgery pavilion.25

Figure 23Patrocle Kampanaki. Architectural plan for Haseki Women’s Hospital pavilions, 1891. The plan shows corridors with windows separating patient wards from the operating rooms. Başbakanlık Osmanlı Arşivi (Prime Ministry Ottoman Archives).Figure 24Nicolas Andriomenos. Photograph showing nurses standing in a window-lined corridor of the surgery building at Haseki Women’s Hospital, Istanbul, ca. 1914–1924. Courtesy Refhan Bilol.

After much searching I found Dr. Nurettin’s granddaughter (born in 1924, the year he died), and after many teas together she remembered where she had placed an album of Haseki Hospital, most likely created during World War I.26 Both the architectural details and floor tiles in the photographs confirmed my earlier hunches that the additional images in this second album, now in the collection of Ömer M. Koç, were taken in the hospital’s new pavilions opened in 1893 rather than in Andriomenos’s studio.27

The existence of a second album with significant differences from the album sent to Yıldız Palace proves that the palace album (full of “pictures of health” that visualize care and captions that underscore healing and recovery) was deliberately constructed for the sultan. The Haseki portrait album is undated but was likely produced between the time of Nurettin’s arrival at the hospital in 1890 and his departure in 1894— perhaps before the new pavilions opened in 1893, when it became possible to photograph patients in the hospital.

I kept searching through many photographs of tumors worldwide and eventually found two examples of comparable photographs taken within a few years of the Haseki portraits, one from Russia and the other from China. The Russian “publication”—in which the images are merely glued to the pages—was prepared by surgeon Ivan Kashkarov in St. Petersburg p. 48 and shows some of the celiotomies he performed from 1889 to 1892. However, in contrast to the Haseki portraits, the postsurgery women and the tumors are photographed separately. One patient is photographed holding a presurgery photograph of herself. The scrapbook-like publication seems intended mostly for other surgeons. In his preface, Kashkarov writes,

Side by side with good photographs I have had to put poor ones, because I thought that, much like poor photographs of familiar sites may evoke in our mind more elevated and lovely images, just in the same manner some of my lower quality photos are capable to evoke, by the law of ideational association, good images in the brains of those who truly love their craft. Another aim of this publication is instructional, and that could be deduced from my drawings by any specialist. My last aim is the desire to invite a range of more artistic images than my photographs, most of which were taken with rather inexpensive equipment.28

Figure 25From Ivan Kashkarov, Klinicheskiya besedy o chrevosecheniyakh pri boleznyakh zhenskikh polovykh organov (Photographic album of laparotomies in diseases of female sexual organs; 1893). Courtesy U.S. National Library of Medicine.Figure 26From Ivan Kashkarov, Klinicheskiya besedy o chrevosecheniyakh pri boleznyakh zhenskikh polovykh organov (Photographic album of laparotomies in diseases of female sexual organs; 1893). Courtesy U.S. National Library of Medicine.

The Chinese example comes from Shanghai. Elizabeth Reifsnyder, a doctor and medical missionary at the Margaret Williamson Hospital in Shanghai, sent three images to Philadelphia.29 The first shows Yu Yung Lan (a twenty-five-year-old married Chinese woman) before her ovariectomy in 1894. Another photograph shows her two months after the operation. From a letter giving an annual report of sorts written to a doctor in Philadelphia on March 31, 1892, we learn that Reifsnyder had been working in a somewhat rural hospital for some time, but that the Chinese were still wary of Western doctors. Reifsnyder informs her medical community back home,

Last year was a special one for us from the fact that two Chinese women with large ovarian tumors had the courage to be operated upon, and that in the face of all the opposition they met with from their friends, relatives and acquaintances. One of the patients is a Shanghai woman. I will forward her picture by this mail. Thinking p. 49 she might die, before coming to the hospital she had a photographer come to her house and take her picture. A few days ago she brought her picture, taken recently, four months after her operation. I send both copies. Her tumor weighed thirty-seven pounds.30

The Shanghai woman mentioned in this letter is not Yu Yung Lan, whose tumor weighed 182.5 pounds and was removed in 1894. But the tradition of photographing patients before and after surgery (started by the patient mentioned in the 1892 letter) must have continued. Reifsnyder’s letter assigns a great deal of agency to the Chinese patient for the decisions to undergo surgery and to be photographed before and after.31

Figure 27Photographer unknown. “Ovarian Cyst of 182 1/2 Pounds,” 1894. Front and back views. Courtesy the Historical Medical Library of the College of Physicians of Philadelphia.Figure 28Photographer unknown. “Yu Yung Lan. 4 ft 8 … 2 months after operation,” 1895. Front and back views. Courtesy the Historical Medical Library of the College of Physicians of Philadelphia.

Returning to the Haseki portrait album, I wondered how we might make sense of the surgeon’s signature on each plate (and also on each abdomen in the form of a scar), despite the images having been made by a prominent studio photographer? How does this album ask us to rethink agency in photography? The examples from St. Petersburg and Shanghai p. 50 each point to complex webs of power dynamics between patients and doctors and emerging medical establishments, yet aesthetically they are much closer to the genre of medical photography of illness or pathological specimens than to the portraits of Haseki patients taken by Andriomenos.

Still puzzling through why these photographs might have been taken, I came across a court record of a malpractice case brought against Nurettin.32 A clerk had charged him with negligence leading to the death of the clerk’s wife and child during childbirth. The case had been seen a second time after the clerk appealed the initial ruling, but Nurettin had eventually been acquitted. Unfortunately, only the acquittal decision, dated May 8, 1892, remains, so I do not know the date of the tragic incident or that of the original trial, only that this happened in the two years prior; that is, in the time that had elapsed since Nurettin’s arrival at the hospital in 1890. Whether the photographs were produced before, after, or during the time Nurettin was defending himself against charges of medical negligence, it is likely that the production of the Haseki portrait album and the malpractice case overlapped: both correspond to roughly the same period of the young doctor’s life.

Finally, I found a document in the Ottoman archives dated December 2, 1890, sent from the Ottoman municipal health officer to Sultan Abdülhamīd confirming that the portrait album was but one way of notifying the sultan about the successful surgeries Nurettin had performed. The document tells us about twenty-two-year-old Gülizar Hatun, whose child had died in the womb:

She was sent to Haseki Hospital last night… . Dr. Ahmed Nurettin who was on call determined that because her structure was not suitable there was no natural way to birth the child who had died two days prior. Upon Dr. Nurettin’s immediately sending word, the council of doctors met and decided to perform a caesarean. Ahmed Nurettin was able to perform the surgery in 20 minutes and the woman in question seemed to be in good health.33

The letter, written the day after the surgery, ends by praising both the surgeon and the sultan: “Caesareans are important surgeries and are easily performed by surgeons trained in the medical schools established by his majesty in hospitals furnished by his majesty. We understand from the report of the chief doctor of Haseki Hospital that patients offer many prayers of gratitude to the sultan.”

To put into context Nurettin’s surgical prowess, and the modesty of the claim that cesareans were easily performed, consider his U.S. contemporary Howard Kelly. In April 1888, Kelly performed a caesarean section, the first in Philadelphia in half a century where the mother p. 51 survived. This was hardly seen as an easily performed surgery. Kelly’s successful completion of three subsequent caesareans was seen as such an accomplishment that he was named assistant professor of obstetrics at the University of Pennsylvania’s medical school, and the following year (at the young age of thirty-one) he was made one of the founding members—one of the “Big Four”—of the medical faculty of Johns Hopkins University.34

Prompted by these documents, I went back to Gülizar’s photograph. And I discovered a clue. Despite having spent seven years working on the Haseki portrait album, I saw something I had never noticed. What I now saw had been in plain sight all along, but I had not been able to detect it as a clue. I had always thought of Gülizar’s portrait as the exception in the album—the woman alone without that which had been removed made visible. A photograph without a clear backdrop, perhaps not taken in the photographer’s studio. Moreover, the photograph had always seemed less sharp to me than the others. In reality, it was my own lack of focus that was at issue. For when I looked closely, I saw that the glass plate had been skillfully doctored by the photographer. Gülizar had initially been photographed revealing much more than her midriff. The folds of the front of her gown had been fabricated, complete with an entirely fictional linchpin that seeks to secure not only Gülizar’s gown but the propriety of the image.35 Propriety would have been essential for this gift of photographs to arrive at its destination. Ottoman court historians told me that the album would have easily passed through the hands of a dozen clerks before reaching the sultan.

Figure 29Nicolas Andriomenos or unknown photographer. Gülizar Kadın, 1891. Image 4, Haseki Women’s Hospital album formerly part of Abdülhamīd II’s Yıldız Palace collection. Detail showing that the original glass-plate negative had been painted over to close Gülizar’s gown over her lower body. She had been photographed holding her gown open. The area below her scar and between her hands has been overpainted to simulate the cloth of her gown. İstanbul Üniversitesi Nadir Eserler Kütüphanesi (Istanbul University Library of Rare Books).

Frustrated that I did not know the date of the clerk’s wife dying in childbirth or the date on which the clerk brought charges of malpractice against Nurettin, I looked at the photograph for anything that could be dated. Another visual detail, yet again one that had always been visible, emerged as a clue. Scars are also time-based media: perhaps a trained eye could read the time since her surgery in the photograph of Gülizar’s scar. I consulted with the oldest gynecologists and obstetricians I could find and asked them to date the women’s surgeries based on how well the scars had healed. In an attempt to make the process easier, I sent digital p. 51 copies of the images and asked them to zoom in on the surgery scars. They told me the photographs were not taken immediately after the surgeries but rather at least three months after the incisions had been made.36 Historical records talk about some poor patients at Haseki staying for lengthy recoveries, often because they had nowhere to go. The document sent to the palace the morning after Gülizar’s caesarean mentions that she had been sent over from the shelter for poor women without specifying whether this was the hospital’s own shelter or another municipal women’s shelter.37 Gülizar might not have returned to the hospital to pose for her photograph because she might never have left. Gülizar’s photograph in the album sent to the sultan indexes several moments of time: the night of the surgery, the day the photograph was made, the moment it was carefully doctored, and the decision to include it in the album with the portraits of women and their tumors.

For a while I was content. The doctor and the photographer had made a bold choice to photograph this young woman fully exposed upon recovery from her surgery to reflect the surgeon’s exceptional skill: At a time when surviving a caesarean was by no means guaranteed, here stood Gülizar as a picture of health. Gülizar’s is the only portrait whose caption even in the second nonidentical album includes the descriptor “picture of health.” Had the doctor and photographer taken the photograph without any intent to send it and then doctored it later for the eyes of the sovereign? Or in anticipation of the many others whose eyes the album would pass before reaching the sovereign? Perhaps this had been the first portrait made in the series?

Yet something nagged at me at night. Social norms do not change overnight. Nurettin almost certainly knew of the difficulties encountered by the former director of Haseki hospital, Kiryako, the young doctor who was accused of looking inappropriately at his Muslim female patients. Kiryako’s ordeal had ended with him being reinstated as chief doctor just five years before Gülizar’s surgery. Would taking a photograph of an exposed Gülizar not have been considered dangerous? The malpractice suit brought by the clerk against Nurettin almost certainly predates the moment the photographer and doctor photographed Gülizar. Would Nurettin not have been especially cautious to avoid arousing suspicions during such a trial?

I sought out a newly retired gynecologist, this time in Istanbul. He remembered visiting Haseki during his own medical training and seeing the album (presumably the copy once owned by the hospital) on the desk of the chief doctor. He described admiring Nurettin’s surgical skills even many decades after the images had been made. This time, however, I did not zoom in on Gülizar’s scar and ask him to date it. I showed him the p. 53 full image and shared the document sent to the palace the day after describing the surgery. An amateur medical historian as well as a doctor, he immediately asked a question I had not considered, thereby pointing out yet another clue: Why would the doctors risk Gülizar’s life by performing a caesarean if the child had already died? “The risks of infection at the time were so great,” he said, “that the first rule to even consider a caesarean was confirmation that the child was still alive. Why would Dr. Nurettin ever attempt such an irresponsible surgery? There must have been a reason.”

There was. The doctor looked again carefully at the portrait of Gülizar— not just a zoomed-in image of her surgical scar—but her full portrait. “Of course! Look at her posture and her miniature stature. This girl had rickets,” he stated confidently. Her pelvis must have been so deformed, he concluded, that even if they crushed the child in utero—craniotomy was the standard way that such a stillborn child would be delivered at the time—the doctors could not have removed the fetus vaginally.38 Nurettin performed the caesarean despite the fetus being confirmed dead two days prior—not at the risk of, but as the only way to save, Gülizar’s life.39

Perhaps it was precisely because he was already being investigated for malpractice, or at the very least because the judicial system allowed for such malpractice cases at the time, that Nurettin initially asked the photographer Andriomenos to take the photograph of Gülizar in a manner that fully exposed her highly deformed pelvic structure to show not only that she had survived and was a picture of health but also to explain why he had undertaken this surgery in defiance of the medical protocols of the day. Then at some later point Nurettin (or perhaps the photographer Andriomenos, or perhaps both together) decided it was important that Gülizar’s photograph as a picture of health be included in the album on tumors addressed to the sultan. After all, her case had already been mentioned to him in a letter. But before including the photograph, they took the precaution of re-dressing her.

Even now, when I can see beyond the fabricated hospital uniform covering Gülizar’s disfigured pelvis and surmise the set of conditions that led to her portrait being presented to the sultan in precisely this manner, I can conclude only by sharing some questions. Some I can venture to answer; others I can only ask in the hopes that answers might be unearthed when new clues emerge.40 How is care being visualized in this album and to what political end? Does the appearance of these images in an album at the sultan’s palace collapse traditional differences between medical and political images? What might have been the impact of these images that show the removal of tumors and serve as testimonies to the efficacy of medical interventions?

p. 53 Perhaps the images in the Haseki album were a preemptive effort to protect Nurettin against charges of improper treatment of Muslim women—such as those brought against his Greek Ottoman predecessor, Kiryako. After all, each photograph grants indigent women some of the aesthetic dignity afforded to women of means, those able to commission their portrait in a prominent photography studio.41

Perhaps the photographs were a visual defense case, a lineup of proof of Nurettin’s prowess as a surgeon that might serve as insurance against any malpractice claims brought against him. Nurettin was indeed acquitted in the malpractice case that concluded in 1892. Moreover, when he petitioned to travel to Paris for three months at his own expense to study the latest treatments of diphtheria with the physician Émile Roux in late 1894, he was granted permission.42 Neither the malpractice case nor any suspicions that might have arisen about his decision to perform a caesarean on Gülizar given the known death of the fetus seems to have prevented Nurettin from rising quickly in the ranks.

Perhaps the portraits were intended to proudly display for the sovereign the results of Nurettin’s surgical talents, to boast of the extraordinary surgeries performed by a young doctor. After all, Nurettin was merely twenty-four when he performed the caesarean on Gülizar.43 Upon his return from Paris, he studied general surgery at Gureba Hospital with a prominent Ottoman surgeon who had trained in France, and eventually returned to Haseki in 1903, where he was promoted to hospital director in 1907.44 Moreover, not only did he have a successful career in surgery; he was held in high esteem within the medical establishment and beyond and served in several leadership roles in emerging public health organizations, such as the Müessesât-ı Hayriye-i Sıhhiye İdaresi (Administration of Medical Charities in Istanbul).45 According to his granddaughter, Nurettin was also called on to care for women in the royal family.46

Perhaps the album served as visual evidence of the miracles of modern science and the lives being saved in the Ottoman Empire’s hospitals. p. 55 A 1907 document strongly endorsing Nurettin for the directorship of Haseki Hospital includes a table listing all 121 surgeries performed at the hospital of which only one resulted in a death.47 These near-perfect results are deemed to be worthy of the glory of the Ottoman Empire and the sultan himself, and hence the surgeon’s talents are presented at the service of the empire’s reputation. A second table sent in June that same year details surgeries performed since the first report and includes four photographs showing patients after their recovery.48 Attention is drawn to the surgery shown in one of the photographs, deemed to be a particularly critical surgical intervention. Another album sent to the palace and titled “Patients who have undergone surgery” includes nine prints showing recovering patients and opens with a photograph taken during surgery itself.49 That print is followed by one in which the patient being operated on in the prior photograph, Hüseyin of Arapkir, is baring his midriff, pointing to his scar with his left hand while holding in his right hand his removed spleen, which weighed just over five kilograms.50 The caption emphasizes the extreme rarity and importance of a patient surviving the surgery and living without a spleen.51

Figure 30Unknown photographer. View of an operation on the patient Hüseyin at Haseki Women’s Hospital, Istanbul, ca. 1903–1907. First image in Ameliyat-I Cerrahiye İcra Olunan Bazı Hastalar (Patients who have undergone surgery), formerly part of Abdülhamīd II’s Yıldız Palace collection. İstanbul Üniversitesi Nadir Eserler Kütüphanesi (Istanbul University Library of Rare Books).Figure 31Unknown photographer. Hüseyin pointing to his scar with his left hand while holding in his right hand his removed spleen, ca. 1903–1907. Second image in Ameliyat-I Cerrahiye İcra Olunan Bazı Hastalar (Patients who have undergone surgery), formerly part of Abdülhamīd II’s Yıldız Palace collection, showing the result of the operation depicted in the first image. İstanbul Üniversitesi Nadir Eserler Kütüphanesi (Istanbul University Library of Rare Books).Figure 32Unknown photographer. Hüseyin pointing to his scar with his left hand while holding in his right hand his removed spleen, ca. 1903–1907. Second image in Ameliyat-I Cerrahiye İcra Olunan Bazı Hastalar (Patients who have undergone surgery), formerly part of Abdülhamīd II’s Yıldız Palace collection, showing the result of the operation depicted in the first image. This copy of the photograph, mounted on a pink card and bearing the imprint of Greek Ottoman photographer Theodore Vafiadis, is part of a set of images of postoperative patients sent to Ottoman municipal health officials. Başbakanlık Osmanlı Arşivi (Prime Ministry Ottoman Archives).

These later postoperative and before-and-after surgery images are useful comparisons to the Haseki portrait album Nurettin prepared and sent to the palace in the early 1890s. The later images are proof that by the first decade of the twentieth century the genre of surgical photography had consolidated and become a well-known convention. Patients are still sometimes identified by name and place of origin, but these images are no longer captioned poetically as pictures of health or landscapes of healing, and they cannot be mistaken for commissioned studio portraits. While visible backdrops in some of the photographs suggest they were taken in prominent Greek photographer Theodore Vafiadis’s studio, they are stylistically much more akin to images illustrating accomplishments in surgery published in journals such as Revue de photographie médicale or Photography and Surgery.52 With the exception of the spleen held by the patient from whom it has been removed, p. 56 tumors or organs removed from the patients are no longer displayed. Gone are the tumors in bell jars on decorative tables. However, the album of surgery patients sent to the palace includes a print showing a woman who had survived a caesarean delivery holding a swaddled baby of several months.

The Turkish gynecologist I consulted with had been deeply impressed when he was new to the profession and viewed the Haseki portrait album, suggesting it may have been used as a pedagogical tool. Ottoman medical students in the nineteenth century learned childbirth by using charts and illustrations rather than attending actual births. Besim Ömer, the pioneer of Ottoman obstetrics and gynecology, was not permitted to establish an official maternity clinic upon his return to Istanbul in 1891 from Paris, where he had been trained. Therefore, he opened an undercover clinic where young obstetricians learned the basics of their craft by practicing on the bodies of destitute women.53 One of the allegations brought against Kiryako that was found to have some validity was that young doctors and midwives came to Haseki to watch childbirths. Hence, perhaps the Haseki portrait album was a permissible pedagogical tool in a climate where offering or receiving medical training could leave a doctor exposed to charges of impropriety. One indication that the album may have been seen by other doctors at the time is a photograph showing a woman who survived a caesarean in 1898, this time photographed with her baby.54 This cesaerean was performed not by Nurettin but by Besim Ömer, the young gynecologist making a name for himself at the time. Similarly, the photograph is signed with his name in 1903. The resonance between this image and the photograph showing another woman’s recovery from a caesarean performed at Haseki Hospital suggests Ömer and Nurettin were aware not only of one another’s surgeries but of one another’s photographic practices.

Figure 34Unknown photographer. Photograph showing a healthy recovery from a caesarean delivery, 1903. From Fotoğraf albümü: Yıldız Sarayı, insan fotoğrafları, vazo, kaide ve çeşitli bina fotoğrafları (Yıldız Palace, portraits, vases, pedestals, and architectural photographs). The caption is penned by the obstetrician Besim Ömer. Courtesy Halife Abdülmecid Efendi Library Collection, Dolmabahçe Palace, Istanbul.

Perhaps the Haseki portrait album was circulated as a subtle means of showing gratitude and requesting further funds, since the sovereign was central to the distribution of resources? Perhaps the letter written to the palace the day after Gülizar’s cesaerean which underscored that caesarean deliveries could be easily performed was intended to emphasize that as long as the sultan continued his financial support of the empire’s hospitals and medical school, Ottoman surgeons could effectively perform the most challenging surgeries. p. 57 The good work of surgeons is seen as a means of augmenting the reputation of the sultan as kind and benevolent and caring of his subjects. What the letter reflected back to the sultan was that surviving patients offered prayers of gratitude not only to their doctors but to the sultan responsible for the establishment of hospitals and the training of doctors.

Finally, the album was perhaps also intended as a medical argument for the effectiveness of asepsis. All of the photographed women had survived a surgery that, due to the high risk of infection at the time, could be as deadly if not more deadly than the tumors that had led to the need for operation. The French physician Roux (with whom Nurettin studied in Paris in 1894) was a major proponent of asepsis, a technique by which medical facilities—and operating rooms in particular—are kept free of disease-causing filth. Soon after he arrived as a junior doctor at the hospital (and thus before he went to Paris), Nurettin, while still the same rank as when he must have prepared the Haseki portrait album, wrote a report on the merits of the pavilion system whereby patients are separated by disease so as to minimize infection.55 This report, endorsed by the more senior doctors in the hospital, led to the construction of Haseki’s pavilions.56 Hence, the Haseki portrait album may also have been part of a persuasive plea for changes in medical curricula and hospital architecture most conducive to effective surgical hygiene.57 Nurettin eventually headed a commission for public health policy in Istanbul charged with effectively preventing and containing the spread of infectious diseases.

Regardless of Andriomenos’s or Nurettin’s initial intentions, the visualization of care in the Haseki portrait album made many arguments simultaneously: establishing prestige, protecting and augmenting reputations, protecting professional standing, fund-raising, advocating for certain medical procedures and architecture, illustrating modernity, reifying sovereign power, subjecting to scrutiny but also dignifying indigent women, and managing competing proprieties (religious and cultural norms versus medical norms).

There is no single discovery at the conclusion of this detective narrative. Rather, I have tried to show how clues became detectable over nearly a decade of investigation. Asking the same question in multiple ways, with multiple tools and by consulting multiple sources and experts can help us as scholars see afresh rather than merely confirm what we believe we have already seen. The Haseki portrait album required that I look closely not only at p. 58 each image but take seriously the album as an object and a collection of images. Many of the clues in this research emerged only when I moved away from both single images and the broad category of medical photography and considered how the album might have been constructed or through what routes it circulated. Genres can be powerful clues if, rather than serve as fixed identification charts to hold images up to, they provoke us to ask under what conditions they emerged. The Haseki portrait album illustrates the unsettlement that characterizes the period before a genre is consolidated. Photographs rarely conform to strict genre conventions, and precisely in the places where they do not—where different conventions clash or where deviations or dissonances can be detected as clues—we can begin to see new kinds of formations emerging or investigate unresolved tensions over competing demands for visibility and propriety.

In the process of preparing the images in this article for publication, I detected, perhaps fittingly, one final clue. Looking upon Gülizar’s portrait again, this time in conversation with a photographer knowledgeable about historical processes, we noticed that the glass plate had been signed before “Dr. A. Noureddin” was carefully written in the corner. The simple statement “your servant doctor” (tabip kulları) seems to have been etched into the glass plate before the doctor’s signature. I cannot be certain of this, for efforts have been made to erase the writing both above Nurettin’s signature and that to the left of Gülizar. The letters on the left suggest the name of a photographer, though one that has not appeared in my searches in the archives. Perhaps Nurettin asked a less-well-known photographer (maybe even one without his own studio) to take the original photograph of Gülizar baring her twisted pelvis to serve as evidence for what had necessitated the unconventional caesarean. Perhaps this was prompted by a malpractice suit. However, when the decision was made to doctor the image, perhaps the original photographer did not have the proper skills and Nurettin approached Andriomenos (one of the prominent portraitists of the era) not to make a photograph but to remake one taken by another photographer into an image that could be circulated. Perhaps that encounter sparked the larger collaboration that resulted in the Haseki portrait album.

A Picture of Health: The Search for a Genre to Visualize Care in Late Ottoman Istanbul

Zeynep Devrim Gürsel


Research for this essay was made possible by grants from Macalester College and the Institute for Turkish Studies. I am grateful to Edip Gölbaşı and Özgül Özdemir for their excellent research assistance, to Üzeyir Karataş for expert translations, and to the staff of Istanbul University Library of Rare Books. I could not have produced this article without the knowledge and generosity of medical historians Gülhan Balsoy, Fatih Artvinli, and Joel Howell; gynecologists Yavuz Ceylan and Tim Johnson; photography collectors Ömer Koç, Bahattin Öztunçay, Adem Köse, and Gülderen Bölük; and the careful eye of photographers Kristof Vranck and Keith Taylor. One of the pleasures of this research was meeting Nurettin’s formidable granddaughter Refhan Bilol, who kindly shared invaluable additional photographs and family stories. Earlier drafts of this essay were presented at “Bodies and Histories,” Photomedia, Helsinki, 30 March–2 April 2016; “The Impact of Images: Knowledge, Circulation and Contested Ways of Seeing,” European Association for Social Anthropology, Milan, 20–23 July 2016; the Humanities Colloquium at Macalester College; the Center for Bioethics and Medical Humanities, Northwestern University on 4 May 2017; the Department of Art History and Communication Studies at McGill University on 26 October 2017; and “Modern Bodies,” at Lebanese American University on 15 March 2018. Thanks are owed to the participants in those events for their insightful comments and questions. Additional thanks are owed to Engin Akarlı, Nurhan Atasoy, Kathryn Babayan, Karen Barkey, Gretchen Case, Amy Elkins, Natasha Ruiz-Gomez, Zeynep Çiğdem Kayaca, Selen Vanessa Ansen Lallemand, Kathryn Mathers, Rima Praspaliauskiene, Liz Roberts, Terry Snyder, Karen Strassler, Halide Velioğlu, Nuran Yıldırım, and two anonymous readers for this journal. Thanks also to Chrissie Perella at the Mütter Museum of the College of Physicians of Philadelphia, Stephen Greenberg at the National Library of Medicine, Ross Knapper of the George Eastman Museum, Jean- François Vincent at Bibliothèque interuniversitaire de Santé, Jack Eckert at Harvard Countway Library of Medicine, Brian Spatola and Alan Hawk at the National Museum of Health and Medicine, Matt Herbison at the Legacy Center: Archives and Special Collections, College of Medicine, Drexel University, and Jennifer Heubscher of the Minnesota Historical Society.

  1. I borrow the phrase “the possibility of history” from Eduardo Cadava. While I have inserted the adjective visual here, Cadava’s entire project is about the relationship between photography and the possibility of history. Eduardo Cadava, Words of Light: Theses on the Photography of History (Princeton, NJ: Princeton University Press, 1998).

  2. See Carlo Ginzburg, “Clues: Roots of an Evidential Paradigm,” in Clues, Myths, and the Historical Method (Baltimore: Johns Hopkins University Press, 2013), 96–125, for a touchstone discussion of the emergence of clues as an epistemological paradigm, particularly Ginzburg’s treatment of Enrico Castelnuovo’s analogy between Morelli’s method of art history and Sherlock Holmes’s method of investigation.

  3. Today the Yıldız collection resides in Istanbul University’s Library of Rare Books. Most of the albums are bound. However, a few “albums” consist of envelopes containing loose images, most mounted on cards of various shapes. Almost all of the images are photographs, though there are a few drawings and lithographs. The Haseki portrait album featuring female patients from Haseki Hospital and their tumors is cataloged as album 90608 in the Istanbul University Library of Rare Books. For an overview of the Abdülhamīd albums, see Nurhan Atasoy, Souvenir of Istanbul: Photographs from the Yıldız Palace, Istanbul (Istanbul: Akkök Publications, 2007); Zeynep Çelik and Ethem Eldem, eds., Camera Ottomana: Photography and Modernity in the Ottoman Empire 1840–1914 (Istanbul: Koç University Press, 2015); and Stephen Sheehi, The Arab Imago: A Social History of Portrait Photography, 1860–1910 (Princeton, NJ: Princeton University Press, 2016).

  4. My knowledge of the history of Haseki Hospital is based above all on the expertise of medical historian Gülhan Balsoy. I consulted with her extensively during this research while she was simultaneously writing on the precarious social conditions of female patients at Haseki. See Gülhan Balsoy, The Politics of Reproduction in Ottoman Society, 1838–1900 (London: Pickering and Chatto, 2013); and Gülhan Balsoy, “Visibility and Vulnerability of the Destitute Women of Nineteenth-Century Istanbul: The Case of Haseki Women’s Hospital” (forthcoming). For more on Haseki Hospital, see Ömür Saygılıgil, “Osmanlı devleti’nin son dönemlerinde kadınlara mahsus bir hastane: Haseki,” Yeni Tıp Tarihi Araştırmaları 5 (1999): 95–112; Nimet Taşkıran, Hasekinin kitabı: İstanbul Haseki Külliyesi: Cami-Medrese-İmaret-Sübyan Mektebi-Dar-üş-Şifa ve Yeni Haseki Hastanesi (Istanbul: Haseki Hastanesini Kalkındırma Derneği, 1973); Süheyl Ünver, Haseki Hastanesi tarihçesi: 400. Yıldönümü dolayısıyla (Istanbul: İstanbul Üniversitesi Tıp Tarihi Enstitüsü, 1939); and Nuran Yıldırım, “Haseki Hürrem Sultan Darüşşifası,” in İstanbul’un Sağlık Tarihi (Istanbul: 2010 Avrupa Kültür Başkenti Ajansı, 2010), 155–156. Taşkıran’s history places particular emphasis on Nurettin’s tenure at the hospital.

  5. According to one source, Haseki Hospital served 1,716 patients in 1898, 2,063 in 1910, 3,051 in 1914, and 3,748 in 1924. Eser Nurettin, “Haseki Hastanesi tarihçesi,” in Sihhat Almanakı, ed. M. Osman (Istanbul: Kader Matbaası, 1933), 135–141.

  6. Other documents in the Ottoman archives concerning Haseki Hospital mention black patients specifically. For example, document DH.MKT.1412.85.1 (dated 1887) in the Prime Ministry Ottoman Archives (Başbakanlık Osmanlı Arşivi) requests information about why an indigent black woman, Mecbure, was refused care at Haseki Hospital. Balsoy discusses the case of this same Mecbure, a black woman with an incurable eye disease, who spent a month at Haseki and struggled with the authorities to be readmitted once she was discharged. See Balsoy, “Visibility and Vulnerability.” One other black patient’s photograph appears in another copy of the album analyzed later in this article. This second black woman appears in yet another album produced at least a decade later in which she seems to be working as a caregiver, suggesting that over the years her status shifted from patient to staff. More research is required to explain whether it is significant that two of the seventeen female patients of Haseki Hospital photographed by Andriomenos were black. Since Haseki Hospital treated mainly indigent women—women who were described as “bikes ve bimekan” (without kin or home)—their presence in this photographic record might simply be representative of the social status of black women in the late Ottoman era. See Balsoy, “Visibility and Vulnerability,” for an extensive and insightful discussion of the social standing of Haseki patients, including black patients, likely former slaves, referred to as zenciye. Nonetheless, opening this album otherwise populated by white Muslim women with a black patient could also be read as according zenciye Tensüf Kadın the same aesthetic and medical care as the others, as if to show the sovereign that all of his subjects received excellent care. Ellen Samuels’s incisive analysis of photographs concerning free slaves Millie McKoy and Christine McKoy, conjoined twins who found themselves subject to medical photography after being freed, provides a provocative point of comparison from the United States. Samuels reminds us of “the racial double standard applied in both medical and exhibition settings in the nineteenth century: J. Marion Sims, the so called father of modern gynecology, for example, covered white women with a sheet while performing vaginal surgery but displayed his operations on undraped African American women to a paying audience in his backyard.” Ellen Samuels, “Examining Millie and Christine McKoy: Where Enslavement and Enfreakment Meet,” Signs: Journal of Women in Culture and Society 37, no. 1 (2011): 72. I am in no position to make assertions about the comparative medical treatment of black women in Haseki Hospital based on available documents and literature. However, the prominent placement of a black woman’s photograph as the opening photograph of the Haseki portrait album is significant. For an overview of slavery in the late Ottoman period, see Y. Hakan Erdem, Slavery in the Ottoman Empire and Its Demise, 1800–1909 (New York: St. Martin’s Press, 1996); Michael Ferguson and Ehud R. Toledano, “Ottoman Slavery and Abolition in the Nineteenth Century,” in The Cambridge World History of Slavery, ed. D. Eltis et al. (Cambridge, UK: Cambridge University Press, 2017), 197–225, available online at; Ceyda Karamürsel, “The Uncertainties of Freedom: The Second Constitutional Era and the End of Slavery in the Late Ottoman Empire,” Journal of Women’s History 28, no. 3 (2016): 138–61; Eve T. Powell, Tell This in My Memory: Stories of Enslavement from Egypt, Sudan, and the Ottoman Empire (Stanford, CA: Stanford University Press, 2013); and Ehud R. Toledano, Slavery and Abolition in the Ottoman Middle East (Seattle: University of Washington Press, 1998). In references to the Prime Ministry Ottoman Archives (Başbakanlık Osmanlı Arşivi), I use the acronym BOA, followed by the abbreviated name of the classification (DH.MKT) and the document number.

  7. This is the French transliteration of Nurettin’s name. Throughout this article I use the Turkish transliteration of the Ottoman surgeon’s name: Ahmed Nurettin. He most likely wrote his name in dark ink on each negative so that it would be reproduced in white on each print.

  8. The Ottoman terms are manzara-i şifaiyesi, hal-i iltiyam, suret-i ifakati, levha-i sıhhati, netayic-i afiyeti, and asar-ı şifası.

  9. While visually these photographs follow in the tradition of nineteenth-century engravings of tumors and calculi, I discuss them as a medical lineup because, regardless of whether they also functioned as pedagogical tools, they do the work here of standing in for Nurettin’s female patients whose portraits are absent from the album. Thomas Taylor, A Descriptive and Illustrated Catalogue of the Calculi of the Royal College of Surgeons (London, 1842).

  10. The original complaint petition can be found in BOA, I.DH.00887.070603.001.

  11. See BOA, I.DH.00887.070603.003 for the lengthy defense of Kiryako. The accusations against him are also discussed in Balsoy, “Visibility and Vulnerability”; and Taşkıran, Hasekinin kitabı.

  12. Taşkıran, in Hasekinin kitabı, mentions that another complaint was submitted just eleven days later leading to another suspension for Kiryako but that eventually it, too, was found to be baseless and he returned definitively to his position in 1885.

  13. BOA, I.DH.00887.070603.003, p. 1. This letter suggests that making photographs before and after surgery was already a recognizable practice and also that the costs associated were noteworthy.

  14. Petitions complaining about the conditions at the hospital continued while Haseki was under Faik Bey’s leadership. This time many of the complaints came from the women patients themselves. Balsoy, “Visibility and Vulnerability.”

  15. Printed also in Taşkıran, Hasekinin kitabı. This photograph must have been taken during Nurettin’s initial appointment at Haseki Hospital, as it is among the photographs included in one of the albums sent by Sultan Abdülhamīd to the Library of Congress in 1893 (LC-USZ62-46145). All the photographs of Haseki Hospital (referred to as “Haskoy Hospital for Women”) included in the Library of Congress Abdul Hamid II Collection appear to have been taken by Abdullah Frères, hence Andriomenos was not the only photographer to image the hospital. Abdullah Frères, three Ottoman photographers of Armenian descent (Viçen, Hovsep, and Kevork), were official court photographers at the time the gift albums were prepared for the Library of Congress and the British Library. They photographed many hospitals in Istanbul, and almost all of the photographs of hospitals included in the albums sent to the Library of Congress are architectural. The only “portrait” is a group shot of the doctors, and the single image that shows patients shows them as a group (all of the women in bed with two nurses standing at the entrance to the ward). There are no individual portraits either of doctors or of patients and no lineups of extracted tumors.

  16. Taşkıran, Hasekinin kitabı, 227. Nurettin’s granddaughter corroborated that Nurettin’s father, Basri Bey, was also a medical practitioner. Moreover, the sensitivities about the religious and cultural norms that should determine the proper care for the female patients at Haseki Hospital seem to have come up regularly during Nurettin’s tenure. For example, a debate in 1890 concerned whether to hire a male guard to prevent women from escaping over the hospital’s high walls. In the end the administration decided not to do so for fear that “a male guard keeping an eye on female patients might have violated religious and cultural norms.” Balsoy, “Visibility and Vulnerability.” Female patients had to be locked in at night. Before a doctor could enter a ward, the caretaker would announce the arrival of a man, and the women would cover their heads. See Taşkıran, Hasekinin Kitabı.

  17. Adnan Genç and Orhan M. Çolak, eds., Sultan II. Abdülhamid arşivi İstanbul fotoğrafları: Photographs of Istanbul from the Archives of Sultan Abdülhamid II (Istanbul: İstanbul Büyükşehir Belediyesi Kültür A.Ş. Yayınları, 2008).

  18. I include this confession because I believe it is illustrative of a dominant theme in late Ottoman historiography where modernity and the technological innovations that index modernization are a priori assumed to be European imports to the Ottoman Empire.

  19. In addition to consulting early publications that visualized illnesses or wounds photographically, notably Photographs of Surgical Cases and Specimens (published by the US Surgeon General’s Office in 1865), Photographic Review of Medicine and Surgery (published in Philadelphia, 1871–1872), and Revue photographique des hôpitaux de Paris (published in Paris, 1868–1872), I consulted the Burns Archive, New York; Daniel M. Fox and Christopher Lawrence, Photographing Medicine: Images and Power in Britain and America since 1840 (New York: Greenwood Press, 1988); Sander Gilman “History and Images in Medicine,” in History and … : Histories within the Human Sciences, ed. Ralph Cohen and Michael S. Roth (Charlottesville: University Press of Virginia, 1995), 90–112; L.A. Hiller, Surgery through the Ages: A Pictorial Chronical (New York: Hastings House, 1944); and Andreas-Holger Maehle, “The Search for Objective Communication: Medical Photography in the Nineteenth Century,” in Non-verbal Communication in Science Prior to 1900, ed. Renato G. Mazzolini (Florence: L.S. Olschki, 1993), 563–586. For a particularly theoretically sophisticated and comprehensive overview of the history of medical photography, see Jeffrey Mifflin, “Visual Archives in Perspective: Enlarging on Historical Medical Photographs,” American Archivist 70, no. 1 (2007): 32–69.

  20. The first textbook on medical photography (La photographie médicale) was published in 1893. Mifflin, “Visual Archives.”

  21. Art historian John Tagg argues, “The photograph is not a magical emanation but a material product of a material apparatus set to work in specific contexts, by specific forces, for more or less defined purposes.” John Tagg, The Burden of Representation: Essays on Photographies and Histories (Minneapolis: University of Minnesota Press, 1998), 3. As anthropologist Karen Strassler generatively proposes, “The analytic of genre, then, allows us to keep in view both photography’s material and historical coherence as a medium, and its profound malleability as it is put into the service of different kinds of projects and social actors.” Karen Strassler, Refracted Visions: Popular Photography and National Modernity in Java (Durham, NC: Duke University Press, 2010), 19; emphasis in original.

  22. I believe this backdrop might be the same as that in the Haseki album showing Müzeyyen Hatun. This backdrop and the decorative table appear in studio portraits made in both studios Andriomenos owned—the Beyazıt studio close to Haseki Hospital and the studio he opened in Pera, 281 Grande Rue de Pera, in 1895. Careful examination of the feet area in several of the images also reveals that the patients were almost all leaning on a kind of stand commonly used by studio portraitists of the era. In several images efforts have been made to buff out any trace of the stand but it remains visible upon magnification.

  23. The route in question was the Eminönü—Bab-ı Ali, Soğukçeşme, Divanyolu, Beyazıt, Aksaray line. The building housing Andriomenos’s Beyazit studio has since been demolished. The meticulous information regarding the history of Andriomenos’s studio at 99 Kioktchiler-Bachi (later 99 Okçular Başı Caddesi) was kindly and skillfully researched by Murat Tülek, Ph.D. candidate at Mimar Sinan University Department of Urban and Regional Planning and Architecture.

  24. I now believe that the album I located in the private collection of Ömer Koç (noted hereinafter as ÖMK) is not the same album referenced by Taşkıran, which as of 1972 was still on the premises of Haseki Hospital. When I visited the hospital in 2014, no one knew of such an album. Taşkıran mentions that the album at Haseki Hospital included a portrait of Nurettin with all of his medals, a photograph reproduced on page 320 of Taşkıran’s book. The album in the Ömer Koç collection has no such image, nor did I see any evidence of a photograph having been removed from the album, suggesting that there existed at least a third Haseki album. (Elsewhere I have seen albums featuring Ottoman hospitals in which a small image of the doctor responsible for putting the album together is included on the front inside cover.) However, the reproductions of the album included in Taşkıran’s book are identical to the album in Koç’s collection and not to album 90608 in Istanbul University’s collection. In fact, the specific retouching described below in endnote 38 of my article and evident in image 10 of the Koç album is visible in the photograph reproduced in Taşkıran’s book on page 322 (Hasekinin kitabı). I am grateful to the artist Berlinde de Bruyckere and curator Selen Vanessa Ansen Lallemand for unintentionally leading me to the Koç album and especially to Bahattin Öztunçay for arranging for me to view it on 10 July 2014. All images included in this article from the Koç album are reproduced courtesy of the collector, Ömer Koç. I have reproduced six of the seven images not included in the Haseki portrait album sent to the palace in the order they appear in the Koç album. The Koç album opens with a different portrait than the palace album and Tensüfe Kadın’s portrait appears as the sixth image.

  25. BOA, ŞD.756.3.10, dated 9 March 1891.

  26. Private collection of Refhan Bilol, granddaughter of Ahmed Nurettin.

  27. There are two exceptions that appear to have been taken at Andriomenos’s studio. I cannot claim for certain that all, or any, of the photographs produced in Andriomenos’s studio were taken prior to the photographs taken at the hospital. I am simply assuming that if Andriomenos was able to photograph the patients at the hospital, there would no longer be a need to go to the trouble of having the women and their tumors transported to his studio. Hence, in the absence of a document that tells us when precisely the Haseki portrait album was sent to the sultan, I am speculating that the palace album (90608) contains photographs that predate the light-filled pavilions completed in 1893 and that the Koç album added later portraits taken on site at the hospital. Furthermore, while the palace album (90608) is signed by “Ahmed Nurettin gynecological surgeon and obstetrician of Haseki Women’s Hospital,” the Koç album is signed “general surgery specialist,” a title Nurettin did not have until later in his career, after he had trained with surgeon Osman Paşa at Gureba Hospital. Nurettin returned to Haseki with this title in 1903. I have found no clues as to whether a short or long period separated the taking of the photographs and the binding of the album, nor any concrete knowledge of how long the photographic collaboration between Nurettin and photographer Andriomenos lasted. However, the album shared with me by Nurettin’s granddaughter, assumed to be taken after World War I, is also comprised of images taken by Andriomenos.

  28. Ivan Kashkarov, Klinicheskiya besedy o chrevosecheniyakh pri boleznyakh zhenskikh polovykh organov (Photographic album of laparotomies in diseases of female sexual organs) (Saint Petersburg: Tip. E. Arngol’da, 1893).

  29. Image is from the Mutter Museum, Philadelphia. Reifsnyder graduated from the Women’s College of Philadelphia in 1894.

  30. Drexel University, College of Medicine, Archives and Special Collections.

  31. See Larissa Heinrich, The Afterlife of Images: Translating the Pathological Body between China and the West (Durham, NC: Duke University Press, 2008) for a fascinating and well-researched account of visualizations of illness in the context of Western missionary medicine in China.

  32. BOA, BEO.1.6.

  33. BOA, Y.PRK.ŞH.3.50

  34. Adi E. Dastur and P.D. Tank, “Howard Atwood Kelly: Much beyond the Stitch,” Journal of Obstetrics and Gynecology of India 60, no. 5 (2010): 392–394; and Marc A. Shampo, “Howard A. Kelly: Pioneer American Surgeon,” Journal of Pelvic Surgery 7, no. 6 (2001): 324–326. The details of Nurettin’s surgery (e.g., duration and techniques) match what is described by Kelly in the 1888 “Discussion on the New Caesarean Section,” reprinted from the transactions of the American Gynecological Society. Kelly credits his success to a Dr. Sanger of Leipzig whose surgical innovations he implemented in Philadelphia. For more on birthing practices in the Ottoman Empire, see Balsoy, Politics of Reproduction.

  35. Many thanks to Kristof Vranck who helped me see this clue. My hypothesis is that Andriomenos scratched into the dry and likely already varnished glass negative and buffed away part of the image. Then, he probably used a combination of techniques— pencil and/or ink on the textured surface—to fill in the gown. The odd part at the ankles might be a byproduct of the buffing stage. See Gülderen Bölük, Fotoğrafın Serüveni: Osmanlı’dan Cumhuriyet’e stüdyoların ışığında (Istanbul: Kapı, 2014); Robert Johnson, A Complete Treatise on the Art of Retouching Photographic Negatives: And Clear Directions How to Finish and Colour Photographs, 4th ed. (London: Marion, 1898); and James B. Schriever, Complete Self-Instructing Library of Practical Photography, 8 vols. (Scranton, PA: American School of Art and Photography, 1908). The prints in the album sent to the sultan (90608) and the Koç album appear identical, and their surfaces show no signs of being altered. Therefore, Andriomenos must have made the changes directly on the negative rather than retouching the prints.

  36. Some scars were more jagged than others. The photographs taken in the hospital included in the Koç album generally show scars in earlier stages of healing than the portraits taken in Andriomenos’s studio.

  37. The extraordinary length of Gülizar’s labor—eight days—is not noted in the letter to the palace penned the next day but is mentioned in the caption underneath her portrait in the Haseki portrait album (90608). The author of the letter, the municipal authority, may not have known that Gülizar had been in labor for eight days. I have no explanation for why she was not brought to the doctor at Haseki Hospital sooner. On women’s shelters in hospital complexes, see Balsoy, “Visibility and Vulnerability”; and Nuran Yıldırım, “Dârüşşifalardan Modern Hastanelere,” in Tarihi sağlık kurumlarımız Darüşşifalar, ed. Nil Sarı (Istanbul: İstanbul Üniversitesi, 2010), 2.92–149.

  38. J.P. Boley, “The History of Caesarean Section,” Canadian Medical Association Journal 145, no. 4 (1991): 319–322; Harold Speert, Obstetrics and Gynecology: A History and Iconography, 2nd ed. (San Francisco: Norman, 1994); and John Harley Young, Caesarean Section: The History and Development of the Operation from Earliest Times (London: H.K. Lewis, 1944). Urbanization sharply elevated the rate of the nutritional disease rickets in city children by making it harder to access agricultural produce and more common for children to be exposed to little sunlight. Malformed pelvises due to rickets often prohibited normal delivery. “Caesarean Section—A Brief History: Part 3,” National Institutes of Health, U.S. National Library of Medicine, 27 April 1998,

  39. The retired gynecologist and I went back to the original Ottoman document that declared to the sultan, “because her structure was not suitable there was no natural way to birth the child that had died two days prior.” The translator I work with and I had both taken this sentence to explain the reason the child had died. We had assumed the structure not suitable to natural birth was the child’s, but in fact it was the mother Gülizar’s skeletal structure that was not fit for a vaginal delivery or craniotomy.

  40. The documents of the Ministry of Health (Sıhhiye Fonu) of the Ottoman Empire have just been opened for research. Hence, we might yet learn more about Nurettin’s career and the production and circulation of the Haseki portrait album.

  41. In addition to Gülizar’s photograph, one additional image shows signs of being doctored for the sake of propriety. The retouchings of Gülizar’s portrait in image 4 in the palace album (90608) and image 12 in the Koç album (ÖMK) seem identical to my eye. However, in the portrait of Hatice Kadın and Adviye Hatun posed together (image 5 of 90608 and 10 of ÖMK), the image appears to have been altered on the print itself. Blue ink appears to have been used to shade the smallest suggestion of pubic hair in the palace album. While the same area has been doctored on the negative in the Koç album, additional care has not been taken to render the editing invisible. Moreover, this particular image is also the only one that shows clear differences between the print in the palace album and the second album. Finally, I suspect that a slight shading might have been applied to the pubic area of the woman on the right in image 8 in the Koç album. The images I have from collectors show individuals posing in a less frontal manner than the women in the Haseki album, but they are also taken a few years later. Hence, I cannot determine whether the Haseki patients’ full-frontal pose was a norm that then changed or whether it signifies different power dynamics than those that Andriomenos might have had with paying clients.

  42. BOA, Y.A. HUS.00312.00073. Taşkıran (Hasekinin kitabı) also notes that Nurettin attended an international Surgery Congress in Paris on this visit.

  43. Nurettin’s birth year is given as 1866 in Şeref Etker, İkinci Meşrutiyetin Tabip Örgütleri (Istanbul: Libra Kitapçılık ve Yayıncılık, 2017). However, there is no birthdate on his tombstone.

  44. I have been unable to find detailed information about precisely when Nurettin returned from France nor the specific dates of his training in general surgery at Gureba Hospital. Taşkıran notes that there is some discrepancy between documents and dates Nurettin’s return to Haseki Hospital as general surgeon to the 1903–1905 period and his appointment as hospital director as 1907, 1909, and 1910 on different pages. A footnote in a recent source gives 24 August 1909 as the date for Nurettin’s appointment. Etker, İkinci Meşrutiyetin. However, a 20 March 1907 letter addressed to the palace by the municipal health authority forcefully argues that Nurettin, being an excellent surgeon, should be promoted to the directorship of the hospital. BOA, Y.MTV.00296.00009.001. Furthermore, in a similar document sent in June 1907, Nurettin signs his table of surgeries as “Director of Haseki Hospital.” BOA, Y.MVT.00299.00069.002. Finally, 1907–1908 is the date given by Eser Nurettin in the Sıhhat Almanakı (Almanac of health). Nurettin, “Haseki Hastanesi.”

  45. In 1908 Nurettin was selected to lead the Association des Médecins Civils Ottomans, a newly established association aiming to close the divide between military and civil medical establishments that emphasized the inclusion of multiethnic and multifaith doctors (Etker, İkinci Meşrutiyetin). Upon being appointed director of Haseki Hospital, he was also made a resident member of La société impériale de médecine de Constantinople in 1910. (A photograph of the certificate documenting this appointment was kindly shared by Nurettin’s great-grandson Nurettin Hasman.)

  46. The renovated hospital included a special room for members of the palace. See Nurettin, “Haseki Hastanesi”; and Taşkıran, Hasekinin Kitabı, 319.

  47. BOA, Y.MTV.00296.00009.001.

  48. BOA, Y.MVT.00299.00069.001. I have not been able to locate the photographs mentioned in this document anywhere in the archive.

  49. Album 90506 in Istanbul University Library of Rare Books. Neither the cover nor any of the captions identify the hospital where these patients had their surgeries; however, Taşkıran explicitly identifies this album as one illustrating activities in Haseki Hospital. Moreover, he claims the album must have been prepared by Nurettin after his return to Haseki in 1903 as a general surgeon.

  50. Arapkir is a town in eastern Turkey.

  51. This same photograph of Hüseyin from Arapkir is part of a series of six photographs showing postoperative patients. See BOA, FTG.1094–FTG.1099. These photographs are most likely not the four included with the Haseki Hospital surgery tables sent to the palace (BOA, Y.MVT.00299.00069.001), as there are six not four, and they are not numbered. They are not identified as operations conducted at Haseki Hospital, nor is this patient explicitly identified by name, but the photograph is identical to the second photograph in the album sent to the palace (90506). Furthermore, these six images are mounted on pink cards bearing the imprint of Greek Ottoman photographer Theodore Vafiadis. They signal that Nurettin likely sent photographs as part of his reports of Haseki Hospital’s activities on multiple occasions. Similarly, that the “Patients who have undergone surgery” album in the palace collection is not signed by the surgeon and does not have any inscription identifying it as being from Haseki Hospital also suggests that it was sent alongside other correspondence from which it must have later been separated.

  52. Before and after images of a woman with a tumor (90506-0010) visually resemble the photographs of the Chinese patients treated at Margaret Williamson Hospital in China.

  53. Balsoy, “Visibility and Vulnerability”; and Balsoy, The Politics of Reproduction.

  54. See the photograph in Fotoğraf albümü: Yıldız Sarayı, insan fotoğrafları, vazo, kaide ve çeşitli bina fotoğrafları (Yıldız Palace, portraits, vases, pedestals, and architectural photographs), Halife Abdülmecid Efendi Library Collection, Dolmabahçe Palace, Istanbul, This image is part of an album in the Yıldız Palace archives and is not part of the Abdülhamīd collection. Thanks to Gülhan Balsoy for passing on this reference from Saadet Özen.

  55. Nurettin, “Haseki Hastanesi”; and Taşkıran, Hasekinin kitabı.

  56. Fittingly, after many struggles and delays due to the outbreak of wars, Haseki Hospital’s new surgery pavilion was finally built and named in honor of Nurettin shortly after his death in 1924.

  57. Istanbul is the city where British nurse Florence Nightingale proved her then revolutionary contention that hospital hygiene could minimize infection and save lives. The Barracks Hospital (Scutari, Selimiye Kışlası) where Nightingale cared for British soldiers from 1854–1856, proving that contagion could be controlled, is just on the other side of the Bosporus from Haseki Hospital. Christopher J. Gill and Gillian C. Gill, “Nightingale in Scutari: Her Legacy Reexamined,” Clinical Infectious Diseases 40, no. 12 (2005): 1799–1805; and Cynthia I. Hammond, “Reforming Architecture, Defending Empire: Florence Nightingale and the Pavilion Hospital,” in (Un)healthy Interiors: Contestations at the Intersection of Public Health and Private Space, ed. Aaron S. MacKinnon and Jonathan Ablard (Carrollton: University of West Georgia, College of Arts and Sciences, 2005), 1–24.