cause and effect of online learning essay

What is ADHD?

Signs and symptoms.

• Managing Symptoms

ADHD in Adults

More information.

ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.

It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue, can be severe, and can cause difficulty at school, at home, or with friends.

A child with ADHD might:

• daydream a lot
• forget or lose things a lot
• squirm or fidget
• talk too much
• make careless mistakes or take unnecessary risks
• have a hard time resisting temptation
• have trouble taking turns
• have difficulty getting along with others

Learn more about signs and symptoms

Get information and support from the National Resource Center on ADHD

There are three different ways ADHD presents itself, depending on which types of symptoms are strongest in the individual:

• Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.
• Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.
• Combined Presentation: Symptoms of the above two types are equally present in the person.

Because symptoms can change over time, the presentation may change over time as well.

 Learn about symptoms of ADHD, how ADHD is diagnosed, and treatment recommendations including behavior therapy, medication, and school support.

Causes of ADHD

Scientists are studying cause(s) and risk factors in an effort to find better ways to manage and reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. Recent studies link genetic factors with ADHD. 1

In addition to genetics, scientists are studying other possible causes and risk factors including:

• Brain injury
• Exposure to environmental risks (e.g., lead) during pregnancy or at a young age
• Alcohol and tobacco use during pregnancy
• Premature delivery
• Low birth weight

Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos. Of course, many things, including these, might make symptoms worse, especially in certain people. But the evidence is not strong enough to conclude that they are the main causes of ADHD.

Download and Print this fact sheet [PDF – 473 KB]

Deciding if a child has ADHD is a process with several steps. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, sleep problems, and certain types of learning disabilities, can have similar symptoms. One step of the process involves having a medical exam, including hearing and vision tests , to rule out other problems with symptoms like ADHD. Diagnosing ADHD usually includes a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, and sometimes, the child.

Learn more about the criteria for diagnosing ADHD

In most cases, ADHD is best treated with a combination of behavior therapy and medication. For preschool-aged children (4-5 years of age) with ADHD, behavior therapy, particularly training for parents, is recommended as the first line of treatment before medication is tried. What works best can depend on the child and family. Good treatment plans will include close monitoring, follow-ups, and making changes, if needed, along the way.

Learn more about treatments

Managing Symptoms: Staying Healthy

Being healthy is important for all children and can be especially important for children with ADHD. In addition to behavioral therapy and medication, having a healthy lifestyle can make it easier for your child to deal with ADHD symptoms. Here are some healthy behaviors that may help:

• Developing healthy eating habits  such as eating plenty of fruits, vegetables, and whole grains and choosing lean protein sources
• Participating in daily  physical activity based on age
• Limiting the amount of daily screen time from TVs, computers, phones, and other electronics
• Getting the recommended amount of sleep each night based on age

If you or your doctor has concerns about ADHD, you can take your child to a specialist such as a child psychologist, child psychiatrist, or developmental pediatrician, or you can contact your local early intervention agency (for children under 3) or public school (for children 3 and older).

The Centers for Disease Control and Prevention (CDC) funds the National Resource Center on ADHD , a program of CHADD – Children and Adults with Attention-Deficit/Hyperactivity Disorder. Their website has links to information for people with ADHD and their families. The National Resource Center operates a call center (1-866-200-8098) with trained staff to answer questions about ADHD.

For more information on services for children with special needs, visit the Center for Parent Information and Resources.  To find the Parent Center near you, you can visit this website.

ADHD can last into adulthood. Some adults have ADHD but have never been diagnosed. The symptoms can cause difficulty at work, at home, or with relationships. Symptoms may look different at older ages, for example, hyperactivity may appear as extreme restlessness. Symptoms can become more severe when the demands of adulthood increase. For more information about diagnosis and treatment throughout the lifespan, please visit the websites of the National Resource Center on ADHD  and the National Institutes of Mental Health .

• National Resource Center on ADHD
• National Institute of Mental Health (NIMH)
• Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., . . . Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews. doi:10.1016/j.neubiorev.2021.01.022

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Your chance of acceptance, your chancing factors, extracurriculars, what are some interesting persuasive essay topics.

Hey everybody! I need to write a persuasive essay for my English class, and I'm looking for some fresh ideas that I'd be passionate about. I'd like it to be related to current issues or something impactful. Any suggestions are greatly appreciated!

Hello! It's always exciting to write a persuasive essay on a topic you're passionate about. Since you're interested in current issues and impactful topics, here are a few ideas to consider:

1. Climate Change: Argue for the importance of global cooperation to mitigate the effects of climate change, or discuss the necessity of transitioning to renewable energy sources.

2. Mental Health Awareness: Advocate for better mental health support in schools or workplaces, or tackle the stigma surrounding mental health disorders and the need for increased public understanding.

3. Criminal Justice Reform: Write about the need to address issues in the criminal justice system, such as mass incarceration, racism, or the use of solitary confinement.

4. Internet Privacy: Argue for stronger data privacy regulations and the responsibility of tech companies and governments to protect people's personal information online.

5. Income Inequality: Discuss the growing income gap and its impact on society, arguing for policies that promote social and economic justice, such as universal basic income or progressive taxation.

6. Artificial Intelligence: Explore the ethical considerations of AI development and its impact on society, advocating for policies that ensure AI is developed responsibly and used to benefit all.

7. Education Inequality: Argue for addressing the disparities in educational opportunities and resources between schools in different socio-economic areas, focusing on the importance of equitable funding or access to quality teaching.

8. Animal Welfare: Advocate for stricter animal welfare regulations in industries like agriculture and cosmetics testing, or argue for the benefits of adopting a more ethical and sustainable approach to our treatment of animals.

9. Gun Control: Discuss the need for stronger gun control policies to reduce the incidence of mass shootings and gun-related crime, focusing on the balance between individual rights and public safety.

Remember to research your chosen topic thoroughly and present well-structured arguments backed up with evidence. Good luck with your persuasive essay!

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The Power of Evidence

An excerpt from Next Generation Evidence on building social impact through a broader and more inclusive definition of evidence

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By Michael D. Smith & Kelly Fitzsimmons Apr. 9, 2024

Next Generation Evidence: Strategies for More Equitable Social Impact

Kelly Fitzsimmons (Editor)

500 pages, Brookings Institution Press, 2023

Buy the book »

Evidence is powerful: It helps us understand the needs of communities, make decisions in times of complexity, and generate stronger and more equitable outcomes. However, practitioners face a number of structural and practical hurdles to building and using it. Traditional evaluation and research methods are often not timely, affordable, meaningful, or inclusive for helping practitioners make decisions to increase their impact for students, families, and communities. Too often and for too long, evaluation was a thing done to practitioners and the communities they serve, relegating them to a passive role when they should be regarded as leaders of this work. And for too long, evaluation practice has resisted broader, more modern methods, including data science, AI, and R&D approaches, that are relevant for users but perhaps not for researchers.

Next Generation Evidence: Strategies for More Equitable Social Impact features innovative thinking from leaders across policy, government, technology, philanthropy, research, community, and practice. ( Get the free ebook. ) Together, these leaders lay out a vision for a stronger, more equitable data and evidence ecosystem that uses actionable approaches and centers on the voices of people and communities most directly impacted by the problems we seek to solve.

In this excerpt, AmeriCorps’ CEO Michael D. Smith reflects on his experience championing the role of evidence in the past decade and calls for a broader and more inclusive definition of evidence. It is a powerful and personal story of a policy maker evolving his approach to measuring impact and making evidence-based decisions, and one that I believe many leaders in the social sector (myself included) can relate to. —Kelly Fitzsimmons

Systems Must Change: Dismantling, Disrupting, and Reimagining Evidence

As I was preparing to write this essay, I sat down to watch a talk I gave at TEDxMidAtlantic in 2014. At the time I delivered the talk, I was director of the Social Innovation Fund, a program of the Obama White House and the Corporation for National and Community Service. At the Social Innovation Fund, we sought to combine public and private resources to prove, improve, and scale promising interventions in low-income communities. It is never easy to watch yourself talk, especially after so much time has passed. But watching this one, I found myself wincing even more than usual. Because while my passion about investing in what works has stayed the same, my feelings about how we got here and what we need to do about it have evolved greatly since that talk. In the intervening years, I have spent more time working closely with organizations doing the hard work of building safety nets and springboards on top of what can feel like a bottomless cavern of neglect, institutional racism, and lack of investment where it is needed the most. What I have come to realize is that we need to radically reimagine our approach to evidence in the social sector.

During those remarks almost ten years ago, I discussed why we need to invest in evidence-based solutions if we want to transform the nonprofit sector, find a bigger impact, and get more results. Americans are obsessed with data, rating, and reviewing, but for some reason, that obsession does not apply to the nonprofit sector. Back then, we were spending $300 billion a year on more than 1.5 million nonprofit organizations, but one in eight nonprofits that year spent zero dollars on evaluation, and more than half did not have a theory of change or a logic model. And while these problems seemed to be getting bigger and more complex, we were making decisions on which nonprofits to invest in based on anecdotal stories of success and numbers served. I concluded that I believed the best way to ensure that our limited dollars find their way to the most deserving nonprofits was to follow the evidence of impact, and I cited the Social Innovation Fund as an example. At that time, the fund had invested more than half a billion state and federal dollars to more than 200 organizations that were testing about eighty-six different models with some evidence of impact.

This work matters deeply to me. I grew up in a poor Black neighborhood in a small city in New England. My mom and dad were single teenage parents; with what we knew from data on kids like me, I should have been an unfortunate statistic. My saving grace? The neighborhood Boys and Girls Club. But as I got older and spent my career working in the nonprofit sector and philanthropy, I was forced to wonder why, if that youth center was so transformative for me, did so many of my childhood friends end up struggling in so many different ways? In fact, in a less-than-five-mile radius in my little neighborhood, at least a half dozen organizations, all separate 501(c)(3)s, were doing very similar work, but with diminishing results. In spite of these well-intentioned organizations, my city struggled with poverty, teen pregnancy, and low graduation rates. Too many youths who looked like me were victims of homicide—including my younger brother, who was killed at the age of twenty-seven.

In my talk, I pondered aloud why, despite the fact that my family’s story is shared by countless others in this country, we keep doing the same things over and over again, expecting different results. Then I shared some thoughts on what we should do. First, I suggested that individuals, who are responsible for 80 percent of giving to all nonprofits, stop giving dollars to any organization that cannot articulate impact. I defined impact not just as how many people were served, or as isolated success stories but, rather, as how many kids went to college, and stayed in college; how many got jobs, and how many kept them. Second, I shared that we’ve got to know when to walk away. The nonprofit sector does not face the same market forces that drive dollars away from ineffective solutions in the business world. Sometimes when social sector approaches have been poked and prodded and they no longer work, we are going to have to say “No more money.” Finally, I shared that the philanthropic sector would have to push for more mergers or acquisitions to build stronger organizations instead of the “behemoths and masses of ineffective organizations that are out there.” (Cringe, I know.) And, we should then bet our money on the winners. Some nonprofits might shut their doors, I thought at the time. Some might go away, and many need to. That might sound harsh. But, perhaps, this focus could put an end to the “Hunger Games” that we’ve created where nonprofits that aren’t growing are fighting each other for scarce dollars.

Now, you can probably tell why I am cringing. So arrogant—so pompous. Somewhat out of touch. I put all the burden on the organizations doing the hardest work; trying to keep their doors open in and out of recessions and near-depressions. And organizations that so many families will turn to in times of greatest need, as we have just seen during the pandemic. Here is what changed my mind.

What Influenced Me?

At the Social Innovation Fund, I worked with hundreds of nonprofits of all shapes and sizes that were struggling to meet basic needs of their constituencies while also building evidence that would pass the scrutiny of funders. Imagine if the organizations could focus on their core missions without constantly trying to prove themselves? In the aftermath of the tragic killing of Trayvon Martin and the shocking trial where his murderer was acquitted, I helped design President Obama’s My Brother’s Keeper initiative (MBK), and in 2014, I left SIF to lead MBK. We aimed to address the persistent opportunity gaps facing boys and young men of color and ensure all youth could reach their full potential. And that is what the president talked about when he launched the program; he addressed the nation about the urgency of making sure every kid in this nation, no matter their background or neighborhood, knows that their country cares about them, values them, and is willing to invest in them. He also spoke about the urgent need to focus on evidence, data, and results, or, more simply, investing in what works and building on what works. “We don’t have enough money or time or resources to invest in things that don’t work, so we’ve got to be pretty hard-headed about saying if something is not working, let’s stop doing it. Let’s do things that work. And we shouldn’t care whether it was a Democratic program or a Republican program, or a faith-based program or—if it works, we should support it. If it doesn’t, we shouldn’t.” 1

In 2018, the MBK Alliance announced the winners of our inaugural national competition to identify and invest in communities making steady progress to substantially improve the lives of boys and young men of color. The critical importance of the work of these extraordinary organizations and countless nonprofits like them became even more clear in 2021. In the wake of the disproportionate effect that COVID-19 and ongoing racial injustice was having on under-resourced Black and brown communities, these high-performing organizations continued to meet their core operational goals to reduce barriers and expand opportunity for boys and young men of color and their families—but they did not stop there. In the face of so much uncertainty and overwhelming obstacles, they took on even more. They began serving meals; delivering food; handing out personal protective equipment and literature; creating mutual aid networks; helping organize and support calls to action against police violence; and responding to increases in street violence. When I sat back to think about the kind of hoops organizations like these—and many we invested in through SIF—have to go through to prove their work without the resources needed, it convinced me even more of the need to rethink how we approach gathering and applying evidence.

What Have I Learned in These Past Eight Years?

First, I would challenge us to tackle the system, not the nonprofits struggling to hold together a society that was never built to support its most vulnerable citizens. When I gave that TEDx talk, I did not spend any time talking about the massive gap in funding evidence-based programs versus the need to invest in evidence-based policy reforms that seek to dismantle the inequitable systems that created the conditions we need to address in the first place. When we put all the pressure on nonprofits trying to address the base of the hierarchy of need, we give policymakers, business leaders, and everyday citizens a pass on investing in change at society’s roots. No amount of randomized control trials and evidence-based interventions will combat the legacy of redlining; Jim Crow; redistricting; under-funded, inequitable schools; and the prison industrial complex. But even when approaching systemic change, there is an opportunity to invest in evidence-based policy reforms that prove they work, such as eliminating external school suspension; increasing support for restorative justice, diversion, and other violence-prevention initiatives; increasing access to public spaces for young people; and facilitating opportunities for trained adults to mentor underserved youth. We also cannot forget that the road to macro reform is paved with lots of micro changes that aren’t splashy but are pivotal to transformation, such as government budgeting processes; procurement processes; community engagement; capacity building; and data systems. One example of this micro shift is equity budgeting, which suggests radical intentionality about the inclusion of vendors, contractors, and businesses that are led by people of color and organizations led by residents.

Second, I downplayed the importance of balancing statistics and storytelling, as well as what we consider to be acceptable evidence from the start. Now I see it is not only about better science. It also is about being proximate to the need. It is about letting people closest to the pain be closest to the power because they hold both the causes and solutions in their daily, lived experience. It is about providing the time for rumination and reflection. It is about mirroring the data with the emotion. It is about spending time in communities that don’t have the resources to build complex evaluation models but, for some reason, are outperforming the rest. To paraphrase Edgar Villanueva, author of Decolonizing Wealth , we have to resist our colonized mindset. We have to resist wanting our solutions tied up in neat, polished packages with the perfect prose from elite institutions and, instead, set our sights precisely on where change is happening.

Here is an example. Early in my career, I was part of philanthropic efforts to bridge the digital divide, distributing computers and internet access across the country. I had one grantee that was not as responsive as others. He submitted reports late, and they were incomplete. I decided to make a site visit to ensure our funds weren’t being swindled. I landed at the airport with my MapQuest directions printed out, picked up my rental car, and headed to Ferriday, Louisiana (population 3,312). I drove by shotgun shacks, abandoned homes, and kids playing with homemade toys. I pulled up to our community technology center, which was housed in one of those homes that looked like it was on its last legs. Kids were running in and out, talking, laughing, and learning, and using the computers in a room heated by a wood stove. I met the director, who shared with me that his late mother, who had cared for children in the neighborhood, had left him the house; he could think of no better way to honor her than to create an informal afterschool program. It was one of the only safe places in the area kids could go after school, get some homework help and mentorship, use a computer, and get a snack. And the leader was keeping it together out of his own pocket with some occasional grants and some help from the neighbors. No quasi-experimental design could have shown me what I saw with my own eyes and heard in the stories from that servant leader and the children and families I met that day.

We need data. We need evidence-based approaches. We need to trust but verify. But we also need to listen, look closely, create avenues for storytelling, and clear on-ramps to creating social impact for individuals without access to the resources that come with privilege. We need to recognize that the organizations serving the soup and handing out warm coats also may be the best advocates and engineers of revolutionary reforms to address hunger and homelessness. And, we need to reimagine our definition of evidence-based approaches so each of these iterations and innovations at every stage is part of the solution.

Third, if we are asking nonprofits to save lives and stay on top of the science that guides their service delivery and advocacy, we have to do more than talk about it. We cannot tell nonprofits to invest in what works without changing the way government and philanthropy fund operations, administrative costs, evaluation, research and development, data collection, and analysis. And, we need to help build the capacity of organizations of all sizes so they can own their data collection and evaluation instead of having to rely on outside firms with less cultural competency, less understanding of the community, and approaches that turn participants into subjects of a study, which can feel punitive and remote.

We also cannot ignore the fact that smaller organizations, and organizations led by people of color, find themselves constantly facing closed doors when it comes to the kind of resources they need to invest in infrastructure and growth. A recent study by the Bridgespan Group and Echoing Green showed that, in 2019, the revenues of Black-led organizations were 24 percent smaller than those of their white-led counterparts, and the unrestricted net assets of the Black-led organizations were 76 percent smaller than those led by whites. We also know that bias shows up in evidence and evaluation processes on all points on the spectrum. White researchers receive National Institutes of Health (NIH) grants at nearly twice the rate Black researchers do. Changing this paradigm starts with funding small organizations; investing in building a pipeline of more researchers of color from the communities undergoing evaluation; expanding the evidence toolkit to be hyper-inclusive; and leveraging practices such as government budgeting, procurement, and pay-for-performance (paying based on outcomes)—all of which can be tools for creating meaningful community engagement and more equitable structures.

I have long believed in the proverb, “If you don’t know where you’re going, you’ll end up somewhere else.” None of us can afford to spend our days tilting at windmills, hoping our work will transform lives. We have to demand that governments, businesses, nonprofits, and philanthropies do more to shift the massive amount of dollars to solutions that have measurable evidence of impact. But, we also have to expand our understanding of what constitutes evidence. We have to grow our tent so more diverse voices and perspectives fit under it and have a seat at the table. And we must evolve our concept of an evidence-based solution from a program that meets an immediate need to include policy reform that dismantles, disrupts, and reimagines the broken systems that have failed far too many. If I could give my talk over today, that is what I would say.

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Museums of Medicine and Health: Curating Public Health

Uğurgül tunç.

1 Department of Archaeology and History of Art, Koç University Graduate School of Social Sciences and Humanities, İstanbul, Turkey

In the first quarter of the twentieth century, health and hygiene-themed exhibitions and museums became prevalent communication tools for public health throughout the world. However, the primary motivation behind their establishment as medical museums was the educational value they added to medical training. These museums became central to instruction at medical schools in the nineteenth century. This article presents an overview of the origins of museums of medicine, health and hygiene, their role in the Ottoman/Turkish context, and how they gained and lost their prominence. It then proposes ways in which these museums can be instrumental in our fight against infectious diseases and social injustices in the field of biomedicine.

• The origins of the Western medical museum are closely connected to the emergence of natural history as a discipline of humanistic inquiry.
• One of the first natural history museums of the Ottoman Empire was established as a part of the “Mekteb-i Tıbbiye-i Şahane” (Faculty of Medicine, est. 1827) in Istanbul. Campuses of some of the Empire's elite schools also housed zoological and natural history collections.
• The late nineteenth and early twentieth centuries witnessed a growing interest in curating Health and hygiene-themed exhibits to facilitate communication between the medical community and the public. Health and hygiene-themed exhibitions also had educational value in terms of medical training.
• The history of the Sıhhi Müze (Museum of Health) founded in Istanbul in 1918 demonstrates that the founders' primary concern was training future physicians. However, this Ottoman institution eventually served as an important vehicle for public health communication.
• Later in the twentieth century museums of medicine and health started losing their relevancy for medical education. There was also a shift in the purpose of medical collections towards exhibiting medical objects as 'heritage'.
• Present-day museums and exhibitions of medicine and health have the potential to play a key role in the medical and health humanities curriculum by raising awareness about social issues among tomorrow's healthcare workers and policy makers.
• Museums of medicine, health, and hygiene can also act as mediators by becoming spaces that welcome public discussions and debates on frequently polarized social constructs and concepts such as gender, race, religion, ethnicity, ability/disability, and health.

Introduction

In the first quarter of the twentieth century, health and hygiene-themed exhibitions and museums became prevalent communication tools for public health throughout the world. However, the primary motivation behind their establishment as medical museums was the educational value they added to medical training, and these museums became central to instruction at medical schools in the nineteenth century ( 1 ). This article presents an overview of the origins of museums of medicine, health and hygiene, their role in the Ottoman/Turkish context; and how they gained and lost their prominence. It then proposes ways in which these museums can be instrumental in our fight against infectious diseases and social injustices in the field of biomedicine.

The Origins of The Medical Museum

The sixteenth-century practices of collecting 'nature' and the Wunderkammer 1 collections of the early modern period could be considered prototypical medical museums. The origins of the Western medical museum are closely connected to the emergence of natural history as a discipline of humanistic inquiry as well as the revival of materia medica in medical thought and pedagogy. Paula Findlen writes that the typical mid-sixteenth-century physician viewed the study of nature as “the foundation of good medical and pharmaceutical practice.” ( 2 ). By the end of the sixteenth century, the study of medicinal simples such as vipers used as ingredients in theriac 2 became a requirement for obtaining a medical degree at European, particularly Italian universities and the corpus of expertise to establish oneself as a physician required knowledge of natural history ( 2 ).

The collections of nature accumulated by apothecaries, chemists, and physicians, or gathered by prominent members of society, facilitated the practical training of apprentices without having to send them on costly journeys ( 3 ). Demonstration and observation in the medical curriculum became more common thanks to the university botanical gardens and their natural history museums ( 2 ). Museums and botanical gardens were “thoroughly integrated into the teaching of materia medica in Italian universities” by the seventeenth century ( 2 ).

Two of the most notable collectors of medical specimens at the end of the eighteenth century were the brothers William and John Hunter. By the time he passed away in 1793, the latter's collection had boasted 14,000 items ( 4 ). Hunter's collection was later acquired by the British government and assigned to the Company of Surgeons in 1799 after the Royal College of Physicians turned it down ( 4 ). The collection, which Hunter had used for teaching, research, and demonstration purposes, was re-established as a museum in 1813. As anatomy became a key component of medical education, museums became as important as dissecting rooms, and the Hunterian collection served as “a model for other museums in Britain and beyond” ( 4 ) 3 . Traditions of apprenticeship which involved the use of a master physician's personal collection to train medical students was gradually replaced by substantial school museums and their collections ( 1 ).

Museum Collections and Medical Education in The Ottoman Empire

One of the first natural history museums of the Ottoman Empire was established as a part of the Mekteb-i Tıbbiye-i Şahane (Faculty of Medicine, est. 1827) in Istanbul where many of the leaders of the ' Jön Türkler ' (Young Turks) movement were educated. An 1872 catalog of the space known as the ' müzehane ' (the museum house) within the medical school stated the need for these collections in the Empire:

“ The sciences of natural history have barely been considered in the Ottoman Empire. […] without collections or well-organized museums, the task of teaching natural history remains illusory. ” ( 5 )

Although campuses of some of the Empire's elite schools, particularly those established by foreign powers, housed zoological and natural history collections ( 6 - 15 ) 4 , this was not a common occurrence for most Ottoman educational institutions ( 15 ). It can be assumed that the newly established müzehane in Istanbul had connections in Europe since the aforementioned catalog stated that the collection had recently received donations of anatomical and microscopic preparations from a physician in Vienna ( 5 ).

The müzehane collection at the Mekteb-i Tıbbiye-i Şahane consisted of stuffed mammals and birds, fish specimens held in spirits, reptiles, seashells, polyps, fossils, minerals, rocks, wooden models of crystals, physiological models, insects, and plants; all divided by phylum possibly favoring an evolutionist model of organization ( 5 ). Wendy Shaw argues that the inclusion of a natural history museum at the medical school in the nineteenth century should be considered within the political context of the Young Turks' agenda, which favored Western-style positivist thought. As stated in the catalog prepared by its curator, the physician Abdullah Bey, the objects in the collection were in poor condition and did not have much educational value for medical training ( 15 ). So exactly what purpose did this museum serve? The müzehane functioned almost as a metaphor for an alternative social order which the Young Turks Movement desired to achieve. Questioning the museum's raison d'être, Shaw writes:

“ More than teaching any object lesson from natural history, this small museum served to educate students about a style of science—natural history—that not only predicated the study of medicine but also promoted an orderly, universal, and progressive worldview as a natural ordering principle .” ( 15 )

Displaying Hygiene and Health: The Sıhhi Müze in İstanbul

The late nineteenth and early twentieth centuries witnessed a growing interest in curating health and hygiene-themed exhibits to facilitate communication between the medical community and the public. These exhibits also created a platform where official bodies such as governments, health ministries, and municipal administrations could demonstrate their supremacy. For instance, London's International Health Exhibition, or “The Healtheries,” was organized and promoted in 1884 as a celebration of the “international progress in the scientific study of health” ( 16 ) and gave the London Metropolitan Board of Works an opportunity to display their command through water fountains and the use of electricity ( 16 ). Another early example of such exhibitions was held in Buenos Aires, Argentina, in 1910 under the name Exposición Internacional del Centenario (Centennial International Exposition) ( 17 ). The Bulletin of the Pan American Union from the same year included a photograph of this Exposition of Hygiene and stated:

“ This exhibit is of particular interest to medical men and students of sanitary science. It is intended to illustrate to visitors the progress made in hygiene within the Republic and at the same time give to the people resident there an opportunity to note the developments that have taken place abroad. ” ( 17 )

As can be understood from this statement, health and hygiene-themed exhibitions also had educational value in terms of medical training. While the rise of these exhibitions should be considered within the larger context of cholera pandemics of the nineteenth century and the emergence of the International Sanitary Conferences that had begun in 1851 ( 18 ) 5 , curators of that time generally prioritized serving the medical community with their collections rather than contributing to public health education. The history of the Sıhhi Müze (Museum of Health), founded in the Ottoman capital of Istanbul in 1918, also demonstrates that the founders' primary concern was training future physicians. However, this Ottoman institution eventually served as an important vehicle for public health communication in İstanbul.

In 1917, physician, historian, and author Abdülhak Adnan (1882-1955), who later took the last name Adıvar, was appointed as the Sıhhiye Müdür-i Umumisi (General Director of Health). As a medical student, Abdülhak Adnan studied internal medicine under the direction of Friedrich Krauss at the Charité Hospital in Berlin for a brief period in 1902, and upon his graduation from the Mekteb-i Tıbbiye in İstanbul in 1905, he continued his medical training in Paris, Zurich, and again in Berlin until 1910 after a brief return to the Ottoman Empire in 1908 when the Young Turks came to power. During his time abroad, Abdülhak Adnan had the opportunity to see museums of health and hygiene in Europe and was determined to bring this type of institution to the Ottoman capital ( 19 ). To help him with this project, he recruited Hikmet Hamdi, a physician and a talented painter who, in his youth, had been a pupil of the renowned Ottoman painter and art teacher Hoca Ali Rıza Efendi (1858-1930). 6 Abdülhak Adnan's motivation in employing Hamdi Hikmet to establish the Sıhhi Müze was to create a venue where medical students would be able to obtain practical hygiene lessons in addition to those offered at the Mekteb-i Tıbbiye-i Şahane where Abdülhak Adnan had also taught upon his return to Istanbul in 1910 ( 20 ).

Abdülhak Adnan's goal for the Sıhhi Müze was to emulate European examples. After appointing Hikmet Hamdi to the Sıhhiye Müdüriyet-i Umumiyesi Hıfzıssıhha Şubesi (Hygiene Department of the Directorate of Public Health) ( 19 ), Abdülhak Adnan sent him to Germany to study how a hygiene museum could be established and operated. Hikmet Hamdi spent four months at museums of health and hygiene in Berlin, Frankfurt, and Dresden before his return to Istanbul in 1917 ( 19 ). 7 He returned with twenty-five descriptive plates explaining how to avoid contracting infectious diseases such as tuberculosis, syphilis, chancroid, gonorrhea, malaria, and smallpox, as well as the dangers of addiction to substances such as alcohol, morphine, and cocaine ( 19 ). Using his skills as a hattat (calligrapher), Hikmet Hamdi translated and reproduced these plates in the Ottoman “ rik'â ” script and prepared them for public display ( 19 , 20 ). The inaugural public display of these items took place at the Hilal-i Ahmer (Red Crescent) exhibition in 1917, in which Hikmet Hamdi participated as the representative of the General Directorate of Health with eight oil and ten watercolor paintings ( 21 , 19 ). According to Nuran Yıldırım, the popularity of Hikmet Hamdi's didactic works at this event became a major catalyst in accelerating the establishment of a museum of health and hygiene in İstanbul ( 19 ). The enthusiastic public response was also noticed by the Grand Vizier Mehmed Talat (1874-1921) and the Health Minister of the time, resulting in Hikmet Hamdi's appointment as the museum's first director with a salary of 3000 kuruş ( 19 ). 8 A technician by the name of Halit was hired to produce thirty wax moulages , or models, demonstrating lesions caused by certain diseases and was later awarded a Sanayi Madalyası (Medal of the Arts) for his services ( 19 ). Physician and professor of pathology Hamdi Suat (1873-1936), who later took Aknar as his last name, assisted in the efforts to prepare ten models displaying disease pathology. Sıhhi Müze 9 , a first of its kind in the Ottoman Empire, finally opened its doors to the public in the Ottoman capital with a ceremony on July 23, 1918, in the Müdafaa-i Milliye Cemiyeti (National Defence Society) building located in the Sultanahmet district of the city ( 23 ).

Including anatomically and pathologically demonstrative paintings at museums of health, hygiene, and medicine was not unique to the Sıhhi Müze, which boasted the custom-made works by Hikmet Hamdi. The Hunterian Museum also held drawings and paintings, such as the series by Henry Tonks, which displayed the different stages of patients' conditions and treatments before and after undergoing surgeries performed by Harold Gilles and his team at Queen Mary's Hospital during and after World War I ( 4 ). Hikmet Hamdi's paintings, however, differed from these examples as the majority were more didactic in purpose and concerned with informing the public about how diseases spread, how they could be prevented, and, if contracted, how the damages they caused could be treated ( 19 ). A section dedicated to water-borne diseases, mainly cholera, featured animated displays with dyed water representing dysentery bacteria ( 19 ). Besides educating the public about incubation periods, pathological effects, and the consequences of diseases such as smallpox, scarlet fever, measles, typhus, diphtheria, and rabies, the museum offered information on available inoculation and immunization practices. Panels promoting a healthy diet, complete with calorie charts, were exhibited as well. The dangers of alcoholism were also communicated through visual displays demonstrating how alcohol could cause damage to internal organs ( 19 , 21 ).

Narrative Shifts at Museums of Medicine and Health

With the establishment of the Turkish Republic in 1923 following World War I, the Sıhhi Müze went through some changes which reflected the education reforms of the new regime. The first edition of a thirty-two-page, text-only booklet Sıhhi Müze Rehberi (Guide to the Museum of Health) was printed in 1924 in the new Turkish Republic's capital city of Ankara. 10 Later, in 1926, a seventy-page educational book, titled Sıhhi Müze Atlası (Atlas of the Museum of Health), incorporating color reproductions of Hikmet Hamdi's paintings and illustrations of microbiological organisms was published by the museum ( 22 - 25 ). Published in the Ottoman script, Sıhhi Müze Atlası was intended to serve as one of the new regime's vehicles to promote specific notions of what constituted a 'healthy' citizen. Among its recommendations, specific gender roles were assigned to male and female members of the society, which were predicated on healthy living. One section of the Sıhhi Müze Atlası titled Yüksek Ökçeler (High Heels) began shortly after the section that warned the public about the dangers of alcoholism. Turkish women were addressed as follows:

“ The new fashion brought us the high heels; their use is rapidly becoming widespread. […] if ladies only knew that these are the cause of disease, they would never use them. Those who use high heels [...] initially have trouble walking. Then they start limping, and finally they can only go between short distances as they become incapable of walking for long periods of time. The reason for this is that the balance of the foot gets debilitated. ” 11

Two full pages of x-rays followed this warning to demonstrate the dangers of high heels through comparisons between feet and legs in high heels and flat shoes or bare feet and one page of illustrations depicting the damage high heels could do to women (Figures ​ (Figures1 1 - ​ -2). 2 ). Notably, Sıhhi Müze also became a representative of the newly established Turkish Republic by participating in international health expositions such as the Dresden Internationale Hygiene-Ausstellung (International Hygiene Exhibition) in 1930. 12 The Sıhhi Müze 's participation in this exhibit and the Sıhhi Müze itself was praised in Turkish newspapers of the time, and it was viewed as a source of national pride. 13

Sıhhi Müze Atlası (1926), p. 67.

Sıhhi Müze Atlası (1926), p. 68.

Shaw writes that "the nodes of proud national identification" constituted most of the Ottoman museum collections ( 15 ). This notion of national pride transformed into a nationalist discourse in the early years of the Turkish Republic under the influence of the Turkish History Thesis. 14 In recent decades, the efforts to revive 'national pride' in Turkey have concentrated on reimagining national identity with a strong emphasis on the Islamic tradition and the Ottoman past through venues such as the Sultan Bayezid II Health Museum. 15 Founded in 1997 on the grounds of a fifteenth-century Ottoman külliye in Edirne, this museum celebrates the Republic's Ottoman heritage and Islamic traditions of medicine. While the museum is being promoted as a 'medical museum' today, its vision appears to be more in line with heritage-oriented museums. The organizational structure of anatomically themed medical museums typically emphasizes certain notions of 'progressive modernism' through scientific discovery and such museums oftentimes also assume the role of a mediatory between the lay person and the scientist with a mission to 'educate the public' on matters of science and medicine. However, the tendency to display 'national pride' is evident in the long-established anatomical museums of Europe and North America as well. At the end of the day, the 'progressive modernism' of yesterday is sooner or later bound to become the 'heritage' of a bygone era. For instance, the College of Physicians of Philadelphia (founded in 1787), the Mütter Museum's founding institution, reinforces a national identity by being identified as the 'birthplace of American medicine'. Today its building, constructed in 1909, is a National Historic Landmark in the United States and is listed in the National Register of Historic Places. 16

Samuel J. M. Alberti writes that in Europe, by the turn of the twentieth century, there was also a shift in the purpose of medical collections towards exhibiting medical objects as 'heritage' ( 4 ). For instance, objects such as surgical instruments started entering the collections of the Royal College of Surgeons of England through donations in the 1870s. Notably, the College acquired Joseph Lister's cabinet in 1912, shortly after Lister became the first physician to join the House of Lords ( 4 ). In addition to training medical professionals, commemorating and celebrating the heritage of health and medicine became new objectives of medical museums around the globe in the first half of the twentieth century. A prime example of this new attitude is the Dittrick Museum in Cleveland. Dudley Peter Allen (1852-1915) was a surgeon whose interest in collecting artifacts to document the advance of medical sciences and their associated technologies formed the basis of the Dittrick Museum of Medical History. Allen's library was opened to the public in 1926, and the trustees of the Cleveland Medical Library Association (CMLA) asked Howard Dittrick, a medical editor and gynecologist, to curate their Museum of Historical and Cultural Medicine. Dittrick visited medical history museums across Europe and consulted their curators. In the words of James M. Edmonson, the museum's Chief Curator between 1999 and 2018, Dittrick's goal was to create “a 'doctors' museum' to venerate the scientific and humanitarian achievements of the medical profession” ( 26 ).

In the early part of the twentieth century, medical museums regained a new kind of eminence and functioned as part of the larger network of similar museums under the International Association of Medical Museums established in 1906. These museums had at least one dedicated curator who ensured regular maintenance of displays and collections ( 1 ). Later in the twentieth century, these museums started losing their relevancy to medical education. Douglas Waugh attributes this to “the medical schools' need for more space, the growing availability of excellent photography departments that can record specimens in vibrant color, and the declining emphasis on pathology in the medical curriculum” ( 27 ). Jonathan Reinarz, on the other hand, argues that the prioritization of hospital teaching marks the initial decline of medical museums and notes that museum spaces in medical schools, particularly after World War II, were repurposed as additional classrooms, or more recently, as computer clusters ( 1 ).

Technology and over-specialization transformed several aspects of medicine, including healthcare spaces and pedagogical approaches. Medical museums were not immune to these changes. In 1955 the International Association of Medical Museums was renamed as the 'International Academy of Pathology' ( 27 ). 17 The removal of the word 'museum' from the name of a professional body that once was considered a representative of medical culture and heritage further demonstrates the disconnect between humanities and medicine. Simply put, the concept of 'museum' was no longer associated with 'medicine,' and this body had to choose a side – a specialized side – as reflected in its current title: 'International Academy of Pathology'.

Medical museum collections such as the Wellcome and Hunterian in London, the Royal College of Surgeons in Edinburgh, or the Mütter Museum in Philadelphia continue to attract visitors today. They manage to serve both as heritage centers and institutions dedicated to research and education simultaneously. As highly interpretive media ( 28 ), museums and exhibitions of medicine, health, and hygiene also possess great potential to provide support for ongoing critical medical humanities efforts to 'democratize medical culture' ( 29 ). By offering a critique of the conformist choices made by previous generations of curators or questioning the objectifying attitudes present in the works of the turn-of-the-century physician-painters, 18 museums of medicine and health today can invite the public into conversations about the past, present, and future states of biomedical sciences.

The Sıhhi Müze in Recent Years and the Future of Museums of Health and Hygiene in Turkey

The Sıhhi Müze in İstanbul came to be known as the S ağlık Müzesi (Museum of Health) in the Republican Era and remained active until 1989 when restoration work began in the mid-nineteenth century building it occupied ( 30 ). In 1995, Hürriyet Yılmaz, the regional health director at the time, invited medical historians Ayten Altıntaş and Nuran Yıldırım to conduct research in the storage units of the museum building where they discovered approximately fifty paintings by Hikmet Hamdi and Ziya Hüzni, an apprentice of Hikmet Hamdi who later took the last name Korol. Twenty-three of the paintings were restored by Kemal İskender and Mehmet Çelikel and exhibited in the museum on March 14, 1995 ( 31 ). A group of scholars, in collaboration with the Directorate of Health in Istanbul, initiated talks in 2007 to revitalize the museum 19 and although it was never officially reinstated with legal museum status, an exhibition titled Sağlık Müzesi Sergisi (The Health Museum Exhibition) was curated and opened to the public in 2018 in its original building on Divanyolu Avenue in the Sultanahmet district of İstanbul.

Although laser-on-canvas printson display at the Sağlık Müzesi exhibit today are mere replicas of the oil paintings exhibited at the Sıhhi Müze of the 1920s and 1930s, they still present a great opportunity to promote public health, initiate critical debates, and raise awareness about social issues. In order to achieve this, the collection needs to be carefully contextualized and exhibited in a well-informed fashion, as has been recently done for similar collections in other parts of the world.

Among the Sıhhi Müze collection is a series of paintings by Hikmet Hamdi which tell the story of a man who brings Mycobacterium tuberculosis to his household after stepping on saliva in the streets of İstanbul, ultimately infecting his young child (Figures ​ (Figures3 3 - ​ -4). 4 ). The unsuspecting man and his family are depicted as members of the upper class who live in a well-decorated house with a view ( Figure 5 ). The wife plays the piano and is dressed in European fashion. The man who is the source of the saliva, on the other hand, is painted in headgear that was associated with the lower classes of Turkish society at the time. Looking at these images, we see certain biases of the time regarding socioeconomic class and gender. While the collection has a tendency to depict the lower classes of society as sources of disease, for the most part it envisions women as passive members of society who are defined by their maternal responsibilities in the domestic sphere. For instance, a label that reads “Comforter is Murder” accompanies a painting by Ziya Hüzni ( Figure 6 ). This depiction which labels a woman bottle feeding a baby as 'murderer' is currently on display at the Sağlık Müzesi exhibit without any reference to, or contextualization of, the historical biases, intent, and perspectives at the time it was created. Furthermore, the audience awareness factor, a key area of assessment for museum exhibitions according to the American Alliance of Museums (AAM) 21 , has not necessarily been taken into consideration in the Sağlık Müzesi exhibit. For instance, one of the paintings by Ziya Hüzni is accompanied by a label that repeats verbatim the original text written for it in 1932: “Make sure your kids wear white and blue as the Sun's highly beneficial UV rays only pass through these colours”; a piece of information that is no longer valid. This label can be misleading for some visitors who might not be properly informed on the subject matter. In the lack of well-informed curatorial decisions and without contextualization, images and objects at venues such as the Sağlık Müzesi exhibit might misinform the public, encourage discriminatory views which accuse 'the other' for the spread of disease, or reproduce outdated ideas of the past which envisioned women merely as passive child bearers lacking agency.

Sıhhi Müze Atlası (1926), p. 37.

Sıhhi Müze Atlası (1926), p. 38.

Sıhhi Müze Atlası (1926), p. 39.

Emzik Cinayettir (Comforter is Murder) by Ziya Hüzni, Korol 1931, oil on canvas.

Current location: İstanbul Sağlık Müzesi

Displayed here with the label it is presented with at the Sağlık Müzesi Sergisi

Today the Deutsches Hygiene-Museum in Dresden (DHMD), which was the main inspiration behind Hikmet Hamdi's curatorial decisions at the Sıhhi Müze a over hundred years ago, curates exhibitions that focus on subjects with socio-political connotations such as racism. The Racism exhibit curated by Susanne Wernsing at the DHMD took place between May 2018 and January 2019 with the secondary title The Invention of Human Races . 22 This exhibit offered a critique of scientists who tried to identify specific physical features in people of different backgrounds in order to prove the existence of distinct races. In the German context, the Racism exhibit also served as a means of facing the country's Nazi past with displays of works by artists such as Otto Dix (1891-1969), whose allegorical pieces critical of Nazi ideals had once been deemed as 'degenerate art' and burned by the Nazis. 23 The Racism exhibit can be defined as a critical medical humanities museum project that goes beyond the clinical realm. It also succeeds in bringing socio-political issues associated with biomedical sciences to the attention of the public. Exhibitions of this sort demonstrate that museums and exhibits of health, hygiene, and medicine have the potential to answer the critical “second wave” of medical humanities' call for action by critiquing ideas, images, and discourses that carry traces of racial prejudice, gender bias, and discrimination based on socio-economic status ( 29 ).

Emziren Anne (The Breast-feeding Mother) by Ziya Hüzni Korol, 1931, oil on canvas.

This image of a woman breast feeding a baby is displayed next to the bottle-feeding scene. It contrasts that painting in terms of lighting, use of softer colors, lighter skin tones of both figures chosen by the artist presumably to signify health, and the visibly smiling face of the mother figure.

On display are replicas of both paintings (Figures ​ (Figures6 6 - ​ -7). 7 ). The curators have informed the author that the originals are kept in a climate-controlled storage unit.

Museums and exhibitions also have the potential to play a key role in the medical and health humanities curriculum by raising awareness about social issues among tomorrow's healthcare workers and policymakers. A good example of this is the “Health is a Human Right: Race and Place in America” exhibit which took place between September 28, 2013, and April 25, 2014, at the David J. Spencer Museum located on the main campus of the Centers for Disease Control and Prevention (CDC) in Atlanta as part of the twenty-fifth anniversary of the founding of the Office of Minority Health and Healthy Equity (OMHHE) in the United States.. 24 During its seven months on display the exhibition attracted approximately 50,000 visitors ( 32 ). Sarah S. Willen, anthropologist and Director of the Research Program on Global Health and Human Rights at the University of Connecticut, asks one might learn from an exhibition of this nature about the “potential role of museums and museology in sparking public engagement with health and human rights issues” ( 32 ). For instance, Bisan A. Salhi and Peter J. Brown combined their lectures on the topics of health and human rights with visits to the “Health is a Human Right: Race and Place in America” exhibit for their introductory undergraduate global health course in 2014. Students enrolled in the class filled out a survey and submitted a reflective essay about “human rights abuses, as well as possibilities for realizing the right to health in the United States” ( 33 ). The students' reflections signaled that they were particularly interested in subjects they learned about for the first time at the exhibit, such as “eugenics and forced sterilization, deficits in water and sanitation, racism, and contradictions of American exceptionalism” ( 33 ). Salhi and Brown concluded that exhibitions with an “emphasis on the violations of human rights and their health effects using domestic examples from relatively recent history can be an effective pedagogical strategy” ( 33 ). While Willen is more skeptical about how effective exhibitions might be when the rhetorical power of human rights is hardly ever translated to legal or political traction ( 32 ), curating exhibitions of this nature can play an important role in shaping the policies of the future by informing the policymakers and healthcare workers about inequalities and human rights abuses of which they might otherwise be unaware.

Concluding Remarks

Medical and health humanities scholars representing the “second wave” argue that a more critical approach can allow us to “see meaning in illness” and “provide a point of resistance to reductive biomedical science” ( 34 ). Such approaches could be applied to the exhibitions and displays at museums of health, hygiene, and medicine. The present-day Sağlık Müzesi Sergisi in Istanbul demonstrates how museums and exhibits of health and hygiene often fail to offer a social critique of biomedicine and do not engage in dialogue with the community on controversial matters in medicine and healthcare.

In a broader sense, museums of medicine, health, and hygiene can act as mediators by becoming spaces that welcome public discussions and debates on frequently polarized social constructs and concepts such as gender, race, religion, ethnicity, ability/disability, and health. These debates could be instrumental in democratizing biomedicine and serve as catalysts for other causes, such as the cultivation of empathy, tolerance, and social harmony. In a post-COVID-19 world, we might witness the re-emergence of museums of medicine, health, and hygiene, which incorporate what new technologies have to offer and address the global rather than nationalist issues that concern all of humanity today. 24

Acknowledgements

I would like to thank Lucienne Thys-Şenocak and the external reviewers for their comments and suggestions which helped me improve this article. I would also like to express my gratitude to the American Research Institute in Turkey (ARIT) for their ongoing support.

1. Early modern cabinets of curiosities where collectors gathered notable objects.

2. The viper was considered an essential ingredient of the alexipharmic or preventative substance called theriac used by the upper classes of the society both as a precaution and cure. The lower classes used more plant-based medications. For instance, in his Preservatione dalla peste (1630), Lodovico Settala defines remedies such as garlic and onions as the “theriac of peasants and the poor”.

3. See also Alberti, Morbid Curiosities.

4. It should also be noted that a natural history division was considered for the antiquities museum ( Mecma-ı Âsâr-ı Atika , formed in 1869) in Istanbul in the 1870s with the inclusion of Carabella Efendi's collection of whale bones. This vision was never realized when the museum was organized formally as the Müze-i Hümayun (The Imperial Museum, est. 1891).

5. Often viewed as the predecessor of the World Health Organization, fourteen conferences were held between 1851 and 1838 attended by diplomats and medical representatives from approximately fifty countries.

6. For more information about the life and times of Dr. Hikmet Hamdi, see Gökay, “Hikmet Hamdi Merhum”; Osman Şerefettin, “Dr. Hikmet Hamdi Bey”; Ünver, “Ressam Dr. Hikmet Hamdi (1872-1931)”.

7. While Yıldırım indicates that Hikmet Hamdi spent four months in Germany, as per Topçu and Tokaç (2012), Yetimoğlu and Akyol (2013), and Tokaç (2015), Hamdi was recruited by Abdülhak Adnan in 1915 and immediately sent to Germany to spend two years there and gather information until his return to the Ottoman capital in 1917.

8. Turkish State Archives, Osmanlı Arşivi, DUİT, 60/2, 21 N. 1335 [11 July 1917].

9. Also known as Hıfzıssıhha Müzesi

10. The Marmara University Library has a copy of the second edition of this booklet which was published in 1928 in the Ottoman script just prior to the Republican era reform of the Turkish alphabet in the same year. A Latinized edition was published in 1931. The 1926 edition has been digitized by the Library of the Turkish Parliament (TBMM) and is publicly available: https://acikerisim.tbmm.gov.tr/handle/11543/1662 .

11. Sıhhi Müze Atlası (1926), p. 65. Latinized transcription and translation by Uğurgül Tunç.

12. For more information see Kemal Rıfat, “Dresden Hıfzıssıhha Sergisi'nde Türk dairesi” and Muley, “Dresden'de Sıhhi Muze ve Beynelmilel Hıfzısıhha Sergisi”.

13. See for example Mazhar Osman, Sıhhi Müze and Kemal Rıfat “Dresden Hıfzıssıhha Sergisi'nde Türk dairesi”.

14. An ethno-nationalist view of Turkish history constructed and promoted in the early years of the Turkish Republic through state-sponsored publications such as Türk Tarihinin Ana Hatları (The Main Tenets of Turkish History) (1930). For a critical understanding of the Turkish History Thesis (Türk Tarih Tezi), see for example Nazan Maksudyan, Türklüğü Ölçmek: Bilimkurgusal Antropoloji ve Türk Milliyetçiliğinin Irkçı Çehresi (1925-1939); Çiğdem Atakuman “Cradle or crucible: Anatolia and archaeology in the early years of the Turkish Republic (1923-1938)”, Journal of Social Archaeology, 2008; 8; 214; Elif Kök, “Strzygowski in Turkey” in Orient oder Rom? History and Reception of a Historiographical Myth (1901-1970), eds. Ivan Foletti and Francesco Lovino, Rome: Viella, 2018.

15. For more information see https://saglikmuzesi-en.trakya.edu.tr/pages/history (accessed on Mar. 10, 2023)

16. For more information, see https://www.collegeofphysicians.org/ (accessed on Oct. 20, 2022)

17. For further information, see the organization's website: https://www.iapcentral.org/home/history . (accessed on Oct. 20, 2022)

18. There were physician-painters in other parts of the world as well during this time. For instance, Georges-Alexandre Chicotot (1865-1921), one of the first radiologists of the world, was a contemporary of Hikmet Hamdi. Besides being a physician, Chicotot was also trained as a painter at the École des Beaux-Arts in Paris. He painted medical scenes primarily for documentary reasons often objectifying the patient while focusing on medical instruments and their use.

19. Uğurgül Tunç's interview with Sibel Alemdar, one of the curators of the current Sağlık Müzesi exhibit, on Feb. 14, 2020.

20. For more information see https://www.aam-us.org/programs/accreditation-excellence-programs/community-engagement-assessment/ (accessed on Mar. 10, 2023)

21. Rassismus: Die Erfindung der Menschenrassen; For more information, see https://www.dhmd.de/en/exhibitions/archive/racism/ (accessed on Oct. 20, 2022)

22. Kimmelman, “In a Rediscovered Trove of Art, a Triumph Over the Nazis' Will”; also see https://dresden-magazin.com/en/culture/exhibition-racism/ (accessed on Oct. 20, 2022)

23. For more information, see exhibition website: https://www.cdc.gov/museum/exhibits/health.htm (accessed on Oct. 20, 2022)

24. For a current list of museums of medicine and health in the Turkish Republic, see http://www.saglikmuzesi.org/category/turkiyede-saglik-muzeleri/ (accessed on Jan. 5, 2023). Additionally, there are also rare manuscript collections related to health and medicine such as those housed in the Necip Paşa Library in İzmir.

Additional Information

Ethical approval, informed consent, peer-review.

Externally peer-reviewed

Conflict of Interest

The author declares no conflict of interest.

Financial Disclosure

he author is a fellow of the American Research Institute in Turkey (ARIT).

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The Effects of Advertisement for Children Essay

1. introduction.

Any message, be it a sentence, a jingle, or a picture, that is intended to promote a product, is said to be on advertisements. It has been shown that before the age of 2, children cannot distinguish between program and commercial content and many children under the age of 6 do not understand the persuasive intent of advertisements. In 1900, at the age of 2 years, we were informed by our mother that during a bath-time squabble we had demanded, "We want a piece of Fels-Naptha soap!" We assuredly had no more notion than a two-year-old neighbor who said, "Cabman, take me to the tobacconist's" and so was carried off to the tobacconist's shop. Fels-Naptha soap having failed to get in its work might have failed to work if it had been intended to "sell" us the soap. Commercial ends as animating a series of acts do not appear until quite a few years later and an the more recent instance of our grand-daughter who, at the age of three, insisted that red and coppery brown Frosties cereal box characters appearing on her TV program should be made to leave the show, is still lacking a social issue and may not even be understood by the advertising media personnel at General Mills. We chose to conduct a content analysis of Children's TV advertisements in order to obtain a more representative picture of the world that early primary school children are now growing up in. By identifying specific themes in ads, we informed by the obtained information, will be better able to counsel parents who are concerned about the effects of ads on their children. Six to seven year olds were approved for this analysis because at age seven, a dimensional leap in a child's cognitive understanding of advertising occurs. We expect that children will have little difficulty in understanding the ads and the fact that other children their age produced these very ads will be a bonus. However, a phenomenal amount of food and toy ads aimed specifically at younger children are similar to those slated for six to seven years in age. Data regarding this second category of TV ads, while inappropriate for younger children, may provide some interesting insights as we compare and contrast the children's reactions to the ads created for kids of different ages.

1.1. Definition of advertisement

Advertisement and other innovative types of publicizing are progressively picking up the consideration of the overall population. They connect with the general public and shape the perspectives on what is viewed as satisfactory in this day and age. It has been accounted for that the normal time a child, possibly 3-4 years old, watches TV for 2 hours out of every day. This increments fundamentally as the child ages. By the time of 18, the average teen will have watched more than 22,000 ads. The consequences for a child's learning and improvement is an intriguing region needing further examination. The term "advertisement" is hard to characterize considering the numerous kinds of advertising available and restrictions in the English language to give a decent definition. Advertisement, however, can be summed up as any publicly supported non-personal message generally on TV, radio, newspapers, magazines, films, music, the internet, and even training programs to advertisers or customers. This is finished by giving unique exhibits of selling points, messages, or "jingles". What might be viewed as increasingly significant is past examination of advertising to children and the possibility this is a particularly helpful route for the teaching of the English language. It might be contended that numerous sorts of advertisements for children are essentially language instruction with selling a customer the last item. TV advertisements and sponsored programs are the best method to concentrate how children navigate through what might be viewed as authentic media content. Occasions will regularly utilize ads and sponsored programs to instruct English to the people in question. Despite the fact that it might be less complex than the actual advertisement, numerous educators of non-English language speaking children may utilize simple print advertisements as textbooks to instruct basic reading and writing. This can still be viewed as a useful teaching method. In order to research these points and assess the effects of modern advertising, we must first gain an understanding of the history of advertising to children and the types of advertisements, foreign and domestic, that children are exposed to.

1.2. Importance of studying the effects of advertisement on children

As our nation becomes more developed economically, either instant or not, children become potential targets for marketing purposes. Up to now, children have become a target of marketing effort in Indonesia. Marketing aimed at children is a highly controversial issue due to its various effects upon children's lifestyle and health. Indonesia is a country with a great number of growing children and such condition becomes an interesting target for marketing with its promising prospects to be a better spending market. According to data from the Indonesian Central Bureau of Statistics in 2004, the percentage of children aged 4-14 years reached 24.97% and it's predicted to be relatively stable until 2015. Children and teenagers population reaching about 84 million represents a great opportunity for the industry in marketing their products. This data is also supported by research done by Yuli Tri Cahyono, a marketing observer from Airlangga University. Based on his research in 2006, products that are most often purchased by children are food and beverage products. These products reached 30% of the entire products marketed for children. Other than that, education products and toys are the next products purchased by children. In contrast, the products are actually not the ones necessitated by the children. This indicates the presumption that children tend to engage in a lifestyle that does not fit their age; it is a lifestyle of older people. It happens because children are formed by their experience and structure of marketing is their best instructor. This fact makes sense since promoting a product using a child icon without giving a ban on children to buy the product attaches rates the children to the character; children want to be like the models which are older. Step by step, the children are formed by the character he or she adores. This happens because children do not have their perceptions formed as well as adults.

2. Positive Effects of Advertisement for Children

Advertisements geared towards children can have positive effects as well. One positive effect is the educational value of many ads. It has been shown that children can learn from educational television geared toward their level of comprehension (Dorr 149). Advertisers recognize this as well. According to Loh and Parc, in the 1970s the Federal Trade Commission in the U.S. did an extensive study which showed that nearly 90% of all television advertisements aimed at children were for food and that half of those were for cereals. In a more recent study, it showed that food remained the first and more frequently advertised product to children on U.S. television, although there was a dramatic decrease to 35% by 2005 (Loh and Parc 636). While the type of food might be questionable, many food ads have an educational theme as well. For example, one ad may feature a nutritious food product which comes in letter-shaped forms and the purpose of the ad would be to convince both the child and the parent that this is the ideal combination of fun and nutrition. In addition to a similar food product, the ad may make the claim that in a month's time a child's intelligence increased after regular consumption of product x. The parents must first buy the product and second the child will have personal evidence that the advertisement's claim is true or false. This, in turn, teaches the child the power of cause and effect; intelligence can be related to a food product, a nutrition fact which holds much more academic weight. Finally, in a more direct approach, an ad may have funds dedicated to making a more positive future for children. By using a sad atmosphere and music, the advertisement sets a scene on malnourished children living in poor conditions. This is an excellent chance for a parent to explain to their child the living conditions in other areas of the world and how it compares to life in their homeland.

2.1. Educational value of advertisements

The final positive effect of advertising on children is the educational value it has. Advertisements encourage children to gather information on something they want and then process that information in some way to make a decision (adsforhealth.org). This correlates with Kaiser's conclusion that children are a primary audience for ads because they are easier to persuade. But knowing how children are, ads that are too difficult to repeat and understand, or simply not interesting, will get ignored. Children will most often forget about it. We want to make advertisements not only simpler but more interesting for children so they can take in as much information as they can. This is good cognitive activity for the child. The Carter-Brown and Patterson report, "Which ads are most effective in creating cognitive activity in children," states, "children's comprehension of television advertising does not begin with viewing it, nor does it necessarily end after viewing it. Rather, the impact of the ad is dependent on its complexity and the frequency with which the child thinks about it." This means the most effective way to have a child learn is to have an ad that is easy to comprehend and will stick in the child's mind, thus prolonging the period of time the child processes the information. Although the cognitive activity may not be good if the child ends up playing with an empty box that the toy came in. Children learn more when the information is retained is a form of conditioning for desired future behavior. This seems to be the hidden agenda to most advertisements. Children want the product being shown, and they will learn to get it in many ways, often learning the disappointments of sale and purchase (buying something that wasn't what they thought), or saving for something they really want. Step one towards this goal is having a knowledgeable consumer. This is a consumer that is well informed on a product and purchase. This consumer can be about anyone, but an 8-10-year-old child is no exception. They are the most inquisitive and the most eager to learn what an "ad" and "sale" is all about. This is now the point where an ideal education through television can take place. Instructors can use certain ads to show children good and bad purchases or what they consider useful teaching comparing the old Marketing Advocacy for Healthy Lifestyles for Youth program, to teach children to discriminate marketplace information in an informed and critical manner will promote the learning of what being a knowledgeable consumer is all about. Children love to pretend to be adults, and once a child is shopping for a product, they are doing just that. The child's informed purchases are often monitored by parents who have the final say on what is bought. This may take away from a child's self-gratification, but the child will learn that parents or adult figure often times regret impulse buys. This will create a parallel of regret between the child and the adult, and it will roundabout teach the child that a good buy can bring long-term satisfaction. A lifetime skill in a sea of knowledge; all beginning with that first ad sparked curiosity. This is a strategic plan for teaching more on education in the marketplace and consumer learning, but it has become a long-term lesson plan in which the child will learn through mere exposure to ads on various products and make change in the habits learned from a lifetime of experiences. This is best summed up by Shani, "Consumer socialization is a multidimensional process, involving acquisition of the essential knowledge, awareness, attitudes, and skills to become a more prudent and confident participant in the marketplace."

2.2. Encouragement of creativity and imagination

Advertisements are not necessarily terrible influences on childhood. While certain ads can be detrimental to a child's concept of themselves and reality, there are in fact advertisements which encourage healthy cognitive development. The content of most children's ads encourage concrete operational (ages 7-12) thinking and help organize the necessary skills needed to solve a problem. Studies have shown that many plaything advertisements actually illustrate to children what they need to do to acquire a certain toy. It has been observed that even four year olds figured out that it's possible to attain the desired object by first learning what it cost and then persuading their parents to buy it. In a different study, Imaizumi and Odagiri examined Japanese television ads and found that more than half of the 24 ads they analyzed utilized the 'if...then' persuasion and most of these were for snack foods. Since the conditional is a concept that children do not grasp until about 7 or 8 years old, these ads were deemed too advanced and potentially harmful for young children. An ad comparing two different snacks was set up so that when the child chose the advertised snack, a positive outcome would occur. This too is a more sophisticated concept that younger children would not understand. Although it's obvious that these two specific examples are not conducive to healthy development, it is suggested that children of higher cognitive ability could benefit from more intellectual ads geared toward an older audience. Snack food ads and fast food ads are a major part of commercials for children. Unfortunately, many of these products are not the best choices in a child's diet. It was found in one study cited by content writer Saki that a higher nutritional value the prosaic value. Using Taguchi's index to evaluate the healthfulness of nutritious food, snack food and fast food ads were compared to other food and drink ads in their nutritional value. It was found that healthy ads scored higher in the prosaic value, whereas the snack food ads scored the lowest. Although it's unclear whether or not children understand the relationship between nutrition and health, any comparisons between the two types of ads could encourage a child to make the healthier choice through the realization of a greater positive outcome.

2.3. Development of critical thinking skills

Increased exposure to advertising has rendered entire generations to believe anything that is presented to them. It is because of this, that children need to be equipped with the essential thinking skills. Pestle & Roberts (1996), cited in Kotz K. (1997) state that, "Children are able to differentiate between programs and adverts from about 8 years of age, but do not understand the purpose of advertising until 10 years of age." More specifically, critical thinking can be defined to contain three essential elements. One is the questioning of information presented rather than passive acceptance. The second involves understanding the intention of the message as well as the ability to search for and finally, interpret hidden meaning and applying reason in the evaluation of the message. (Moller B 2006). By developing these skills, children will become less likely to be influenced by any advertiser with hopes to protect their self-esteem.

3. Negative Effects of Advertisement for Children

In this next section, the negative effects from exposure to advertising will be highlighted and discussed. The three main areas where the unwanted implications are most apparent involve the potential effects on children's materialistic/consumer-oriented attitude, and to a slightly lesser degree, their developing self and social identities. It must be noted that there are many positive influences that advertising can and does have upon children. For example, in some instances, it can be a beneficial source of information. Pester power can also be seen as a positive tool that enables children to nag their parents into purchasing products that may be beneficial to their development and education. However, in most instances today, the negatives far outweigh the positives and are doing substantial harm to the overall well-being of children. The first apparent effect of advertising on children is that of the increased materialism. Today, children are bombarded by the mass media with messages that encourage them to materialize and consume. Given the repetitiveness and power of many advertisements, it is no surprise that these messages are getting through. Times have changed since the days where children were happy to play outside with friends all day. Today, toys and material possessions have become symbolic indicators of a child's social status amongst their peer group. Because, as yet, they are unable to earn money of their own, children will often pester their parents into purchasing things for them in an attempt to keep up with the consumer-driven culture that the media has set. This behavior has been coined the "nag factor" by the marketing industry and frequently results in tensions between children and their parents. In a survey of US parents, 46% reported having bought something for their child that they had previously refused to purchase because of nagging.

3.1. Influence on children's preferences and behaviors

When children make purchases, which are often influenced by advertisements, it can result in parents getting into conflict with them. Due to a study done by John E. Calvert in 1987, it was noted that about 28% of the parents experienced conflict with their children because the children wanted an item which the parents felt was not needed. Also, children tend to feel a sense of entitlement to purchases. They believe that they have the right to get what they want, which may not be the case. An example of this occurred in 1993 when over 3000 children from Hong Kong went on a rampage after not being able to gain a McDonald's Power Ranger. They jeopardized their safety and seriously disrupted public order due to their strong desire to attain what was being advertised. This sense of entitlement can also manifest itself in pester power and can place a great financial burden on parents. Given that many advertised products are unhealthy foods and snacks with the use of premium offers, contests, and free sampling, children may develop lifelong preferences for brand name products that are nutritionally poor. Studies have shown that children tend to prefer the taste of food if it has popular characters on the packaging or if they have seen it advertised on television. A research experiment which involved preschool children tasting identical foods in McDonald's and unbranded wrapping noted that the children perceived the wrapped food to have different tastes and higher nutritional contents. High preference and consumption of unhealthy food can lead to obesity, a significant health problem prevalent among children in many developed countries today. An article by Linda Van Tassel (2005) stated that childhood obesity has doubled in children and tripled in adolescents in the past 30 years and that it is now a major cause for concern in North America.

3.2. Impact on body image and self-esteem

Although it appears that today's children may be more media literate than previous generations, it is apparent that the messages delivered to them through advertising have a primary goal: to create a consumer identity. One way consumer identity is developed is through body image. Advertising teaches children that self-worth is linked to the products they can purchase and the appearance in which those products will give them. This is a very important issue. The development of a positive or negative consumer identity will affect the lives of children and their eventual satisfaction or dissatisfaction with their actual selves. Research indicates that appearance is the most frequent theme in advertising, with direct and indirect messages encouraging children to focus on their looks as a source of personal satisfaction. Girls, in particular, are influenced by these messages, developing a self-importance on looks and clothing. A study by Lawrie and Reeves divided 102 primary school girls into low and high television viewing groups. The high viewing group, as opposed to the low viewing group, selected more image items for a hypothetical desert island stay, such as lipstick, soap, and a hairbrush. This is a clear indication that exposure to media, including advertising, greatly influences the view girls have of themselves and the importance they place on looks. In the longer term, exposure to these messages has been linked to low self-esteem, eating disorders, and depression. These are symptoms that arise from a negative body image and are problems that are becoming more and more apparent in today's society.

3.3. Potential for increased materialism and consumerism

What is materialism and consumerism? Materialism and consumerism represent the acquisition of goods and services by purchasing and spending. The acquisition of material possessions is often driven by emotional, psychological, or social values. It promotes the idea that happiness and fulfillment come only with the attainment of material wealth in the form of the latest product or service. Materialism has been defined as the "set of values that are focused on the accumulation of money and material goods as the path to happiness and fulfillment." The process of learning and development for children involves the initial phase of concrete learning, where children learn predominantly by acting upon and directly experiencing the environment. They learn by touching, manipulating, and observing concrete objects, and from a young age, they are exposed to various forms of advertising via toys, food, and other products to enhance their learning potential. Under the age of 8 years old, children are thought to be unable to understand the purpose and subtle nature of advertising, and with limited capability of understanding and evaluating the intent, children below this age are unable to differentiate advertising from other programming or understand its persuasive intent. This would further suggest that children would involve purchasing a product which is advertised with little evaluation of need and in terms of impulse buying. With a repeating pattern of behavior, these experiences and purchasing situations can develop into repeated purchase of items as a symbol of success and happiness, whether or not the product brings satisfaction and repeated purchasing. Children have shown to have knowledge of brand loyalty by age 2 and have created a meaningful attachment to a brand by the age of 6. This is creating a generation of habitual consumers and increasing the overall consumption of society.

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