Author: Varty Keshishian, 15 Dec. 2013 (Last modified 16 Dec. 2013) - Translator: Nayiri Arzoumanian
The climate of Marash, its clear air, and the abundance of water and food there have had a positive impact overall on the health of the local population. In the last years of the 19th century, the advent of modern medicine and the improvement of health conditions provided the city with satisfactory health conditions.  But the primitive water distribution systems, and the absence of preventive measures and hygiene, saw the spread of communicable diseases in the city.  Disease spread through contaminated water, in particular, causing great suffering and many deaths. Regularly encountered diseases included cholera, typhus, measles, rubella, etc. Tuberculosis also spread among the population. The Marashtsis referred to it as ince ağrı, which corresponds to the word «հալեւմաշ» (halevmash) used in medieval Armenian medicine. 
The water streams and irrigation systems serving the neighboring fields of Marash and, in particular, the water collected for the processing of rice, carried diseases that caused fever. In the summer heat, especially, the population in the plain areas of Marash suffered from malaria transmitted by mosquitos and other fever-causing illnesses. 
The Marashtsis had a primitive understanding of illnesses and, consequently, their remedies too were primitive. Depending on the kind of illness, they resorted to inducing sweat; bloodletting; cupping therapy (şişe çekme), which the locals called «հաճամաթ քաշել» (hajamat kashel); herbal remedies, etc. 
The infant mortality rate was extremely high, both as a consequence of a lack of hygiene and the ignorance of the population. Among children, diseases like measles, rubella, and chickenpox were common.  Infant mortality was so common that it was reflected in the wishes Marashtsis made for the newborn, like «Աստուած մնացական ընէ» (asdvadz mnatsagan ene), May God grant him life.
In one statistic, in a family of nine, six of the children died before the age of one.  Thus, the child mortality rate was 60-70 percent in Marash. The survival rate was higher for older age groups.  One can say that having cleared the threshold of childhood, Marashtsis, particularly villagers, lived a long life.
In old times, there were no doctors in Marash. That void was filled in part by people who had certain medical knowledge and experience, the so-called folk or herbal doctors, who cured a plethora of diseases with folk medicine and practices they had come to learn through experience. Unfortunately, many of these practices have been lost and forgotten. Only shards of folk medicine, herbs, their curative properties, and their modes of preparation have survived in historical accounts of the Marash region. But certain practices were passed down in Marashtsi families and have survived to this day, attesting to the rich folk medicine traditions of the region. Moreover, certain words preserved in the Marash dialect bear a resemblance to terms used in medieval Armenian medicine; these include ղուլունճ-կոլինճ (ghulunj-golinj; kulunç in Turkish, lumbago), թխթապ-դեղթափ (tkhdam-teghdab), տապաս-ցան (dabas-tsan), քէօսէ-գօշ (keose-kosh), շէաշ-շղարշ (sheahs-shgharsh; bandaid), etc.  Such similarities in terms provide support to the argument that folk doctors in Marash benefitted from traditional Armenian medicine, particularly that practiced in Cilicia. This is not altogether surprising given the fact that Marash, which was within the borders of medieval Cilicia, with its monasteries and seminaries, was not disconnected from the medical advancements of the period. Surely, the medical treatises written in the monasteries of the area were known to the folk doctors of Marash, who passed the knowledge down from one generation to the other. Marash elders attested to the fact that certain families were in possession of manuscripts called hekimaran, where numerous recipes of herbal medicine were written down.
Nerses Shnorhali and Mkhitar Heratsi. Two prominent Armenian men of letters (12th Century) known for their writings on medicine (Source: Mesrop Mashtots Repository-Matenadaran, Yerevan; Manuscript 7046, 1644)
Herbal medicine occupies a central place in Marash folk medicine, just as it does in traditional Armenian medicine and medical practices in Cilicia, in particular. Herbs that abounded in the Marash area were used in abundance. The forests and fertile fields around Marash produced marvelous herbs. The majority were used as spices in food as well as in the preparation of medicines. Different parts of plants were used fresh or dried, intact or in powdered form, as ointments, pills, or potions, often mixed with other herbs.
Herbs with curative properties for which Marash was known included kos, chemen (çemen, cumin), kundjud (küncüd, sesame), menemshen (menekşe, violet), mamukh (prunus spinosa), chirish (çiriş, asphodel), ermarug-anmerug (helichrysum arenarium), mezdeki-mazdake (mastic), basil with large, green and violet leaves, anoukh (mint), aghdor (sumak), salep (sorchis mascula), gangari khej (kitre, tragacanth gum), mushg (musk), kazbe (kudret helvası, gazangubin), and kahri (reseda luteola). 
A page of the “Illustrated Pharmaceutical Dictionary” (Source: Mashtots Repository-Matenadaran, Yerevan; Manuscript 6594, 17th – 18th century)
Broadly used were herbs with disinfecting and anti-inflammatory oils commonly available in Marash. They included the white water lily, the violet, the mullein, the licorice plant, and other medicinal herbs. By mixing some of these ingredients in designated amounts, medicines were prepared for a number of illnesses.
Certain medicinal herbs like azorole, coriander, mint, madder, and licorice plant helped regulate blood circulation, heart functioning, and blood pressure, and were thus used to prevent several illnesses.
When the patient suffered from a fever, a specific diet rich in vegetables and fruits and their soups was recommended. Those who had fevers were also fed coriander, basil, okra, purslain (pirpirim in Turkish), pomegranate, quince, etc.
To clean the blood and regulate blood pressure, Marashtsis resorted to leeches (sülük in Turkish) or bloodletting from the neck or back.
In the spring and summer months, the women and girls gathered and dried colorful flowers from the nearby fields and drank it as medicinal tea. To regulate digestion, they used flowers called geyik ğöbeği  and kar çiçeği , while yoğurt çiçeği worked marvels for those suffering from stomachaches. 
Alongside the medicinal herbs, honey and beeswax were also employed in folk medicine. For example, a mixture of beeswax and oil was melted and the resulting mix was used to cover wounds.
Before professional physicians arrived in Marash, and even after, the Marashtsis resorted to using folk doctors, some of whom were specialized in certain diseases.
For the treatment of pain and diseases affecting the eyes, Marashtsis had otacıs (herbalists, in Ottoman Turkish). Women generally practiced this type of folk medicine, preparing red, blue, and white powders and drops to cure eye diseases. The person suffering from eye pain would lie down on his or her back, while the otacı sat cross-legged near the patient’s head and applied folk medicine.  Diseases affecting the eye were common particularly in the summer, as the sun, dust, sweat, lack of hygiene, and infectious eye diseases conspired against the population.
Illustrations regarding medicine taken from Armenian manuscripts (Source: Walters Art Museum, Armenian Manuscripts; W541_000412_sap and W540_000219_sap)
Among the well-known otacıs in Marash were Otacı Dudu (of the Shekerdere neighborhood), Kohar Sislian and her daughter Gurcu Semerdjian (Kumbet neighborhood), Sevgul Keshishian (Uzun-Oluk neighborhood), Otacı Muteber (Ekmekdji neighborhood), Yeghsa Kalpakian (Khatouniye neighborhood), Sultan Sultanian (Kumbet neighborhood),  and Mahdesi Markarid or Hammal Ana, who had learned the craft from a 90-100-year-old matriarch in her family. 
The çıkıkcıs (sınıkcıs) specialized in bone-settings. They were experienced folk doctors who treated bone fractures and joint dislocation.  Well-known çıkıkcıs in Marash included Sınıkcı Gukur (Akarbashi neighborhood), Hagop Chiviyan (Bostanci neighborhood), Vartig Partamian (Ghuytul neighborhood), Mariam Tanielian (Shekerdere neighborhood), and Annig Chblakian (Sheikh Mahallesi neighborhood). 
In old times, pulling decayed teeth was the profession of barbers (berber), as there were no dentists. Many of them also specialized in bloodletting, leech therapy, cupping therapy, treating jaundice, etc.  Well-known barbers included Berber Hovhannes Khrlakian (surgeon) and his son, Nshan Khrlakian. 
According to tradition, childbirth took place at home. The midwife (beber), usually an experienced and elderly woman, was summoned to the house to deliver the baby.  The newborn was placed in salt for a few hours, then washed and swaddled. This tradition has no medical or scientific explanation, but it was thought that salt would prevent skin and other diseases, and that the salted baby would grow up in good health and full of energy. 
Herbalists (attar/aktar) sold herbal medicines in their shops, but most were also experienced pharmacists and prepared medicines based on age-old recipes. People approached attars not only for medicine, but also for advice on illnesses. There were many such attars in Marash, including the noted Attar Hadji Charekdjian. 
1) A page of the “Illustrated Pharmaceutical Dictionary” (Source: Mashtots Repository-Matenadaran, Yerevan; Manuscript 6594, 17th – 18th century)
2) A page of the “Illustrated Pharmaceutical Dictionary” (Source: Mashtots Repository-Matenadaran, Yerevan; Manuscript 6594, 17th – 18th cent.)
3) Parchment flyleaf of Manuscript 141 (Source: Mashtots Repository-Matenadaran, Yerevan)
Water therapy played an important role in Marash and was part of traditional medical practices aimed at promoting health. It included water massage and bathing. The springs on the mountains in and around the Marash region provided mineral water that was used in abundance by the Marashtsis. People firmly believed in the healing powers of these springs. It was customary on holidays to go on pilgrimages to these sites. Pilgrims washed themselves and bathed the sick in these springs, hoping they would get cured. Misconceptions and superstitions notwithstanding, it is important to note that the presence of springs with healing properties in the Marash area constituted a veritable gift of wellbeing to the population.
Bucaği licasi is a hot spring well known for its abundant water and healing properties. It was found west of Marash, near the village Dongele, on the slope of a rocky mountain. Two rooms were built there for visitors, one for men, and another for women. 
Among the springs with healing properties, there was Uyuz pınarı (the Fountain of Lepers), which is in the southeast of the city. It had two springs, one covered with an arch, another with a dome. There were many old and new legends and stories surrounding this fountain. According to one legend, St. Thaddeus the Apostle baptized converts to Christianity and healed lepers at this fountain.  Women and girls came there during Vartavar lent, believing they would be cleansed of all illnesses if they bathed in the fountain. 
Also known for their healing properties are three fountains north of Marash on the Taksarakol heights (named after St. Thaddeus). They are Kırk göz, Yalnız göz, and St. Catherine’s fountains. The latter is a well-known pilgrimage site for women. Sick people, particularly those suffering from fever, bathed in this fountain. 
Many ceremonies and traditions existed in Marash, often centuries-old and reflecting generations of experience. The holiday calendar of Marash Armenians is a veritable canon of wellness: fasting and abstinence on church holidays, which proved to be ideal for health. Lent and fasting was of particular importance for Marashtsis. The following illustrates the point: Marashtsis believed that in the 40-day fasting in preparation for Easter, the body fat of the person would dissolve and be reduced to the size of an almond, which, in turn, dissolved on Spy Wednesday (Armenians called it «Աւագ Չորեքշաբթի» Avak Chorekshapti, Grand Wednesday), after eating a plant called khurug. This particular herb, which helps reduce blood cholesterol and has other regulating properties, is the foundation for this tradition: “And when they eat the khurug, the remaining body fat will also dissolve.” 
Folk traditions and beliefs have their special place alongside all of this. When a family member turned ill, the priest was called to read from the Bible and say a prayer for the person’s health. It was also customary to read from the Lamentations of Nareg. It is interesting to note that the Bible and Nareg were read to the ill not only by priests, but also by certain individuals who were known for their moral compass and piety. Some of these readers were well known not only among Armenians, but among all Christians of Marash. It is also said that some readers sang the words of Nareg. A man named Asdvadzadur, a tailor, was reputed among Marash Armenians for being a pious man, and hence he was a much sought-after reader.  Also well known was Toros Kalfa, a teacher at the Sourp Karasun Manug School, who had a beautiful voice and knew entire passages of the Nareg by heart. 
In old times, amuletic traditions like nuskhe (nuhuset yapmak in Turkish) and remil (remil atmak in Turkish) were commonly practiced.  These charms protected the sick from evil spirits and the evil eye. In more recent times, such practices were frowned upon and shunned. Dr. Harutyun Der Ghazarian, writing about healthcare in old times, notes that until the 1850’s, when physicians first appeared in Marash, practices aimed at curing the ill were extremely primitive and often laughable: “writing nouskha, applying leeches, hadjamat kashel, placing louse in grapes, and feeding it to the person as a cure for louse, etc.” 
In the 1880’s, with the appearance of medical doctors and the establishment of hospitals and dispensaries, health conditions in Marash gradually improved. Communicable diseases became less common, particularly among the Armenian population of Marash, and child mortality rates dropped as immunization and other precautionary measures were embraced.
In the early 1900s’, Marash already had a number of physicians, dentists, and pharmacists, who opened their dispensaries and pharmacies in the city, encouraging modern medical practices. In the same period, the Central Turkey College of Ayntab became a blessing not only for Marash, but for the entire Armenians of Cilicia. Kalusd Nadjarian and Vartan Poladian became the first doctors to graduate from the college. Gradually, doctors who had graduated from colleges in Beirut, Darson, and Istanbul also settled in Marash.  Among the doctors serving in the city, the following are mentioned: Sarkis Azadian (1884-1915), Hagopdjan Kalpakian (1849, Ayntab-1913), Oskian Topalian (1880-?), Kevork Guluzian (1840-1895), Kalust Nadjarian (1856-1920), Endzayeg Der Stepanian (1892-1920), Khacher Keshishian (1857-1920), Hmayag Keshishian (1887-1915), Simon Kupelian (1895-1915), Djanig Kalpakian (1881-1933), and Vartan Keshishian (1883-1920). 
After the Hamidian massacres of 1895, the German mission in Marash embarked on establishing a clinic to provide medical aid to the sick and the wounded. The clinic initially operated in a rented house with two rooms, where the sick received care. In 1912, the German Hospital of Marash opened its doors.  This was the first hospital in Marash. In the past, those who needed medical care would go to Dr. Shepard’s renowned hospital in Ayntab. 
Salem - The German Mission hospital, Marash (Source: Hugo Grothe, Geographische Charakterbilder, Leipzig, 1909)
1) (Source: Sonnen-Aufgang, Heft 4., 13. Jahrgang, Jan. 1911)
2) (Source: Sonnen-Aufgang, Heft 4., 19. Jahrgang, Jan. 1917)
According to Dr. Harutyun Der Ghazarian, the hospital had separate sections for men and women, each with 22 beds. It had a maternity ward with 10 beds, as well as an operating room equipped with the best medical devices of the day. Nearby, another building served those suffering from infectious diseases, while a third served as a dispensary and pharmacy. The entire complex was perched on a garden and was surrounded by a wall. 
The head doctor was Dr. Müllerleile. The hospital owed its reputation and success to his selfless efforts. A surgeon, Dr. Müllerleile was prompted by the needs of his environment to also specialize in women’s health, eye diseases, and eye surgery. 
The name of Paula Schaefer is recalled among the nurses who have worked in the hospital. The expenses of the hospital were underwritten by the “Deutscher Hülfsbund für Christliches Liebeswerk im Orient” and its director, Pastor Lohmann. 
Salem Hospital – Property of the German Mission in Marash (Source: Sonnen-Aufgang, Heft 4., 19. Jahrgang, Jan. 1917)
The 1912-1913 annual report of the hospital, shared by Dr. Der Ghazarian, demonstrates the significant role played by the institution. During the 9-month period from October 1912 to July 1913, the hospital received 512 patients, the majority of whom were Armenians, while the rest were Turks, Circassians, Kurds, etc. Exactly 485 surgeries were conducted at the hospital; the number does not include minor operations and medical interventions. The dispensary, in turn, was visited by 18,000 patients. These figures demonstrate the enormity of the services the hospital provided to the population of the region. The Armenian doctors working at the hospital were Dr. Kalousd Najarian and Dr. Haroutyun Der Ghazarian, as well as pharmacist Soghomon Arevian. The nurses and hospital staff was comprised mostly of Armenians. 
The German Hospital of Marash, with its doctors and modern facilities, was a veritable blessing for the population of Marash. During the deportations and genocide, the hospital housed and supported those who stayed behind and, later, those who returned.
-  Krikor Kalusdian, Marash or Kermanig and Heroic Zeytun [Marash gam Kermanig yev Heros Zeytun], Second Edition, New York, 1988, p. 327. Many of the cures, traditions, and herbal medicines presented here are still maintained and used in Marashtsi families who have settled in Aleppo. I personally have witnessed these practices in Aleppo. Among these folk medicines, most common is a cream made of seven types of herbs, called zahrene mahlam. Unfortunately, I do not remember what all the herbs were. I only remember that they included musk, incense, mazdeki, and other aromatic plants and powders, purchased from the attars of Aleppo’s covered market. This miraculous cream was found in every home, and used as cure for all kinds of wounds and burns.
-  Ibid., pp. 326-327.
-  Ibid.
-  Ibid., p. 326.
-  See Stella Vardanyan, A History of Medicine in Armenia: From Ancient to Modern Times [Hayasdani pjshgutyan badmutyun: Hnakuyn jamanagnerits minchev mer orere] Yerevan, 2000, p. 100-101.
-  Kalusdian, p. 259.
-  Ibid., p. 327.
-  Ibid.
-  Ibid., p. 317-318.
-  Ibid., p. 327.
-  Ibid., p. 411-425.
-  Ibid., p. 278, 303-305.
-  Ibid., p. 91.
-  The Memoirs of Fr. Ghevont, edited by Vartan Der Ghevontian, Yerevan, 2013, p. 112. [in Armenian]
-  Kalusdian, 339.
-  Ibid., p. 327.
-  Ibid., p. 328.
-  The Memoirs of Fr. Ghevont, p. 168-169.
-  Kalusdian, p. 328.
-  Ibid.
-  Ibid.
-  Ibid.
-  Ibid., p. 315.
-  Hovsep Der-Vartanian, The Massacre of Marash in 1920 [Marashi charte 1920-in], Aleppo, 2010, p. 68; Kalusdian, p. 100.
-  The Memoirs of Fr. Ghevont, p. 46.
-  Kalusdian, p. 56-57.
-  Ibid., p. 233; Der-Vartanian, p. 48.
-  Kalusdian, p. 233.
-  Ibid.
-  Ibid., p. 337.
-  The Memoirs of Fr. Ghevont, p. 46.
-  Ibid., p. 54.
-  Kalusdian, p. 327.
-  Ibid., p. 694.
-  Ibid., p. 328.
-  Ibid., p. 910-913.
-  Ibid., p. 694.
-  Ibid., p. 692.
-  Ibid.
-  Ibid., p. 693.
-  Ibid.
-  Ibid., p. 909-10.