Sağlık yapılarının İstanbul'un tarihsel topoğrafyası ile ilişkisinin süreklilik bağlamında incelenmesi
An analysis of the relationship between health structures and Istanbul's historical topography  regarding the context of continuity
Yazar: ZİŞAN YILDIZ
Danışman: DOÇ. DR. NEZİH RECEP AYSEL
Mimar Sinan Güzel Sanatlar Üniversitesi / Fen Bilimleri Enstitüsü / Mimarlık Ana Bilim Dalı / Bina Bilgisi Bilim Dalı
Derece: Yüksek Lisans, 2020
Konu: Mimarlık = Architecture

Özet:
İstanbul kuruluşundan itibaren Roma Dönemi, Osmanlı ve cumhuriyet döneminde konumunun yarattığı avantajla, ticaret ve kültür açısından önemli bir dünya kentidir. Coğrafi konumu sebebi ile tarih boyunca savaşlar, salgın hastalıklar ve felaketler, yangınlar yaşanmış olan bu şehirde halk sağlığına yönelik her dönemde çeşitli reformlar yapılmış, politikalar izlenmiş ve sağlık kuruluşları bu düzenlemeler doğrultusunda hizmet vermiştir. Roma döneminde ve Osmanlı döneminde imparatorluğun başkenti olan İstanbul Tıp eğitiminin de merkezi olmuştur. Sağlık yapıları imparatorluğun ordu ve halka hizmet amaçlı veya tıp eğitimi amacı ile bağımsız veya dini bir yapı grubunun bir parçası olarak inşa edilmiştir. Tıpta modernleşmenin etkisi ile sağlık yapılarının kimliği de işleyişi de zaman içinde değişimler geçirmiştir. Dini kurumların himayesinde hayır kurumu niteliğinde hizmet veren sağlık yapıları zamanla bilimsel kimlik kazanarak bağımsız eğitim ve sağlık kurumlarına evrilmiştir. İstanbul'da bu dinsel şifacılıktan bilimsel eğitim kurumlarına geçişin mekânsal izlerini ve bu gelişimi izlemek stratejik konumunun getirdiği avatajla mümkün olmuştur.  Kent gelişimini sürdürürken sağlık yapılarına yenisi eklenmiş ve İstanbul'da sağlık yapıları reformların ve yönetim biçimlerinin etkileriyle bulundukları yerde gelişimlerini sürdürmeye devam etmiştir.
"Sağlık Yapılarının İstanbul'un Tarihsel Topoğrafyası İle İlişkisinin Süreklilik Bağlamında İncelenmesi" başlıklı tez çalışması beş ana başlıkta incelenerek hazırlanmıştır.  Birinci bölümde tez çalışmasının amacı, kapsamı ve yöntemine ilişkin bilgiler verilmiştir. Sağlık yapılarına yönelik daha önce yapılmış olan çalışmalar Tıp Tarih, Mimarlık gibi  farklı alanlarda yapılan çalışmalarla birlikte incelenmiş ve literatür özeti aktarılmıştır. Tez çalışmasının araştırma konusunun belirlenmesi, araştırma sürecinde izlenilen yollar aktarılmıştır.
İkinci bölümde sağlık kavramı ve kent ilişkisi ele alınmış, mimarlıkta, sağlık yapılarında yer/topoğrafya seçimine dair Roma döneminden Osmanlı dönemine uzanan tarihsel süreç incelenmiştir. Kentlerin kuruluşunda dikkate alınan unsurlar ile birlikte sağlık yapılarında  yer seçiminde dikkate alınan unsurlar dönemsel olarak Vitruvius'tan başlanılarak farklı dönemlere ait farklı kaynaklardan yararlanılarak aktarılmıştır. 
İstanbul'un kentsel/ tarihsel topoğrafyasının ele alındığı üçüncü bölümde kentin kuruluşundan itibaren topoğrafyası, kentin sınırları, ana yollar, kamu yapıları, dini yapılar / manastırlar, ayazmalar, hamamlar, su sistemi vb. sağlık yapılarının konumlarını etkileyebilecek bilgiler harita ve belgeler eşliğinde aktarılmıştır. Kuruluş, başlangıç, büyüme, modernleşme ve cumhuriyet dönemindeki sağlık yapıları ve sistemleri tarihsel olarak açıklanmıştır. Bu başlıkta sağlık politikaları, plan kararları, kentin gelişimi için yapılan planlarda sağlık yapılarının yeri, büyüklüğü ve kentle ilişkisine dair bilgiler verilmiştir. 
Dördüncü bölümde ise sağlık yapılarının İstanbul'daki konumları ve kentle kurdukları ilişkiler süreklilik bağlamında incelenmiş ve kentsel hafızada edindikleri yer vurgulanmıştır. Bu yapıların kentle ve birbirleri ile ilişkileri, kente yerleşimleri ve gelişimleri tarihsel süreklilik bağlamında ortaya konulmuştur. Beşinci bölümde ise değerlendirme yapılmış ve günümüz koşulları üzerinden konu ele alınmıştır. 

Anahtar Kelimeler: Yer, Süreklilik, İstanbul, Sağlık Yapıları

Abstract:
Istanbul is an important city in terms of trade and culture with the advantage of its position since the Roman period, Ottoman and republic period. Due to its geographical location, wars, epidemics, disasters and fires that have been experienced throughout the history. Various reforms have been made in this period for public health, policies have been followed and health institutions have served in line with these regulations. Istanbul, the capital of the empire during the Roman and Ottoman periods, was also the center of medical education.
Health structures were built to serve the army and the public, or as part of an independent or religious group for medical education. With the effect of modernization in medicine, the identity and functioning of health structures have undergone changes in time. Health structures serving as a charity under the auspices of religious institutions have evolved into independent educational and health institutions by gaining scientific identity over time. In Istanbul, it was possible to follow the spatial traces of this transition from religious healing to scientific educational institutions. While the city continued its development, new health structures were added and the health structures in Istanbul continued to develop where  they were already established due to the effects of reforms and forms of management.
The thesis titled as "An Analysis of the Relationship between Health Structures and Istanbul's Historical Topography Regarding the Context of Continuity" has been prepared under four main chapters. In the first chapter, information about the purpose, scope and method of the thesis is given. Previous studies on health structures have been examined together with the studies conducted in different fields such as Medical History and Architecture and a summary of the literature has been given. Determination of the research subject of the thesis study, the paths followed in the research process are explained.
In the second chapter, the concept of health and the relationship between the city are discussed and the historical process from the Roman period to the Ottoman period is examined regarding the choice of place / topography in architecture and health structures. The elements considered in the establishment of the cities and the elements taken into consideration in the selection of place in the health structures were transferred periodically starting from Vitruvius by using different sources from different periods.
In the third chapter, where the urban / historical topography of Istanbul is discussed, the topography of the city since its foundation, the boundaries of the city, main roads, public buildings, religious buildings / monasteries, holy spring, baths, water system and so on. The information that may affect the location of the health structures were given with maps and documents.
In this chapter, health structures in Istanbul are discussed historically. Health structures and systems of the establishment, beginning, growth, modernization and republic period have been explained historically. In this title, health policies, plan decisions, the place, size and relation of health structures in the plans for the development of the city are given.
In the forth chapter, the position of the health structures in Istanbul and their relations with the city are examined in terms of continuity and their place in urban memory is emphasized. The relations of these structures with the city and with each other, their settlements and developments in the city have been put forward in the context of historical continuity. On the main axes where health structures are seen, the relationships of these health structures with the place and each other are examined in the context of continuity. It is observed that there is continuity in spatial, temporal and location context in "Haseki"  and Research Hospital, in particular "Balıklı" Holy Spring, "Bezmi Âlem Guraba" Hospital, "Surp Pırgiç" Armenian Hospital and "Cerrahpaşa" Hospital.
According to the information obtained from "Balıklı" Holy Spring on the historical "Silivrikapı" (Gate of the Pege) Axis, it was used as an "Asclepion" by the Roman Empire during the Pagan period. It was once again known as a sacred area during the Christian period and reached to the present with Balıklı Holy Spring. Today, the Greek hospital bearing the name of "Balıklı" Holy Spring on the historical route outside the city wall still exists as a health structure.
After entering through "Silivrikapı", The first health axis starts with Balıklı Holy Spring, continues with "Hekimoğlu Ali Paşa" and "Haseki" Street and then continues with "Keyci Hatun" Mosque opposite "Haseki" education and research Hospital. "Keyci" means treating by cauterizing. This mosque has reached today from the Fatih period. After Keyci Hatun Mosque, this health axis is connected to Dr. Adnan Adıvar street. Dr. Adnan Adıvar is the first health minister of the Republican period.
Haseki evolving structures of the modern era has been a pioneer darüşşifa westernization in Turkey. The first pavilion system was implemented at Haseki Hospital, and the pavilion system structures are still standing today, like the hospital. Haseki Hospital carries traces from all stages of development from darüşşifa to modern hospital. It bears traces of new buildings made in both the pavilion system and the block system. The architect of the Pavilion of Nurettin Bey, whose construction was completed after the Balkan wars, is Monsieur Mongeri. And this structure served until 2017. It was demolished by a decision made in 2017. The street mosque names mentioned in this health axis always refer to the health function. As an indicator of collective memory, health activities from the pagan period to the present day have continued in urban memory.
The continuity in the first health axis is followed by the second health axis on the street of oasis. The second Health Axis starts with the Belgradkapı. It continues with "Koca Mustafa Paşa" Street. "Koca Mustafa Paşa" Street continues with "Cerahpaşa" Street. There is a Gevherhan school just opposite the "Cerrahpaşa" Complex. "Gevherhan" school was built in the same period with "Cerrrahpaşa" Complex. "Cerrah Mehmet Paşa" is a court physician. In the 19th century, with the outbreak of cholera, the building of Takiyeddin mansion, which is the core of Istanbul University Cerrahpaşa Faculty, and the new buildings built by the Municipal Health Organization, started the development of this hospital. This hospital provided health services at the city level with health activities in "Haseki" and "Cerrahpaşa" along with the health axis on the upper street. This health axis extending from Belgradkapı to "Cerrahpaşa" has maintained its functional continuity till now.
After the 19th century, a third health axis in the Historic Peninsula was "Vatan" Street and "Millet" Street. Health activities here started with "Bezm-i Âlem Vakıf Gureba" Hospital. Bezm-i Âlem Vakıf Gureba Hospital was built in the 19th century as a foundation structure with a capacity of 200 beds. When Haydarpaşa University was moved to the Historic Peninsula in 1933 with the decision taken in the university reform, the construction activities of Bezm-i Âlem Vakıf Gureba Hospital began to develop. Since the health centers were mainly concentrated in the historical peninsula, and it was decided to move the University Hospital to the Historic Peninsula so that medical students could find more patient examination opportunities. Thus, health activities in the Historical Peninsula were increased and continued.
An example of functional continuity in the historical peninsula is the Surp Pırgiç Armenian Hospital. In the 18th century, while the Armenian Hospital and Mental Hospital were found in the church of Surp Hovhannes in Narlıkapı, a hospital structure was built outside the city walls and an Armenian hospital was built in the immediate vicinity of Balıklı Greek Hospital. Or Ahayım Hospital, which is one of the minority hospitals, is located in Balat. The location of Minority Hospitals is more developed according to property owners and neighborhoods of different nationalities. The location of these hospitals was influenced by the settlements of the nations. One of the factors influencing the location of Balıklı Greek Hospital is Balıklı Holy Spring's location. In this sense, it is possible to say that there is a health axis between Yedikule and Silivrikapı in the North-South direction and it is continuing. This axis also intersects with Ancient Holy Spring Balıklı.
According to Hülya Tezcan, the monastery of Lazarus is located at the base of the Gülhane Military Hospital where the military units for the protection of the Palace are located in and around the Topkapı Palace. Some art historians, although not certain, have the opinion that a health activity is being carried out within the monastery of Lazarus. The continuity that can be observed in the Acropolis is the existence of health structures developed in relation to the palace members. Until the Gülhane Seririyat Hospital moved to Ankara, it was an important health center for modernization in medicine.
While looking at the general picture of Istanbul, the health structures concentrated in the administrative center during the Byzantine period have settled on the main axes and strategic points of the city in the Ottoman period. Sultanahmet Darüşşifa is located on the walls of the Hippodrome. All Health structures provide health services to the city from these strategic locations. Public health buildings were located on the main intersections that reached the city from the Acropolis to the outskirts of the city during the Byzantine period. On the other hand, the health structures that developed in the north-south direction parallel to the walls serve today Zeytinburnu and all the people of Istanbul.
In the fifth chapter  acording to the discussions of the thesis approach a consideration and critisation has been made from today's perspective. Nowadays tere are some discussions about plans to change the location of Cerrahpaşa University Hospital, Istanbul University Çapa Medical Faculty, Haseki Education and Research Hospital. However, these hospitals should be located in the city center which has a place in urban memory. Each of them, even before the Ottoman period, continued health activities and developed together with the development of the Historic Peninsula. Considering the ease of transportation and in accordance with the reasons required by the education processes of the universities in the city center, it is considered appropriate to maintain these hospitals in place and to maintain their functions in the city center.

Keywords: Place, Continuity, İstanbul, Health Structures