Series VI: Medical Sciences – SUPPLEMENT ... - Krongres

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Vol. 2 (51) <strong>–</strong> 2009<br />

<strong>Series</strong> <strong>VI</strong><br />

<strong>Series</strong> <strong>VI</strong>: <strong>Medical</strong> <strong>Sciences</strong><br />

<strong>–</strong> <strong>SUPPLEMENT</strong> <strong>–</strong><br />




ISSN IS N 2065-2224 2065 2224



OF THE<br />


OF<br />

BRAŞOV<br />

VOL. 2 (51) <strong>–</strong> SERIES <strong>VI</strong><br />

ISSN 2065-2224<br />

Special Issue No.1, 2009<br />



October 2009<br />


Published by<br />

Transilvania University Press<br />

Braşov, Romania<br />

2009<br />

Volume 1

Bulletin of the Transilvania University of Braşov. <strong>Series</strong> <strong>VI</strong>: <strong>Medical</strong> <strong>Sciences</strong>. Vol. 2 (51), 2009.<br />

ISSN 2065-2216 printed version;<br />

ISSN 2065-2224 CD-ROM version<br />

continues<br />

Bulletin of the Transilvania University of Braşov. <strong>Series</strong> <strong>VI</strong>: <strong>Medical</strong> <strong>Sciences</strong>. Vol. 1 (50), 2008.<br />

ISSN 2065-2216 printed version;<br />

ISSN 2065-2224 CD-ROM version<br />

and<br />

Bulletin of the Transilvania University of Braşov. <strong>Series</strong> B3.<br />

Vol. 14 (49), 2007. ISSN 1223-964X printed version.<br />


Editor in Chief<br />

Ion <strong>VI</strong>ŞA, Dr.Eng., Prof.<br />

Co-editors:<br />

Elena HELEREA, Dr.Eng., Prof.<br />

Anca DUŢĂ, Dr.Eng., Prof.<br />

Liliana ROGOZEA, MD, PhD, Prof.<br />

Coordinating Editor <strong>Series</strong> <strong>VI</strong><br />

Gheorghe COMAN, PhD, Prof. chem.<br />

Editorial Assistant:<br />

Mihaela BADEA, PhD, Assoc. Prof. chem<br />

Nicusor Bagiu, M.D., Assist<br />

English Language Supervision<br />

Lucian RADU, Lecturer<br />

Web-site: http://but.unitbv.ro/BU2009<br />

Address: 29, Eroilor st., 500036, Braşov, Romania<br />

Phone: +40-268-410525<br />

E-mail: rector@unitbv.ro<br />

© All rights reserved


Assoc. Prof. chem. Mihaela BADEA, Ph.D., Transilvania University of Brasov, Romania<br />

Prof. Salem ABDEL-BADEEH, Ph.D., Ain Shams University, Cairo, Egypt<br />

Prof. Dr. Doina Paula BALABAN, PhD., Ovidius University of Constanta, Romania<br />

Prof. Cristina BORZAN, M.D., Ph.D., UMF Iuliu Haţieganu, Cluj-Napoca, Romania<br />

Prof. Sorin BUZINSCHI, M.D., Ph.D., Transilvania University of Brasov, Romania<br />

Dr. Daniel CATALAN, European Center for Disease Prevention and Control<br />

Prof. chem. Gheorghe COMAN, Ph.D., Transilvania University of Brasov, Romania<br />

Prof. Nina Micosa CADIZ, Ph.D., University of the Philippines Los Banos, Philippines<br />

Prof Dan Mircea CHETA, MD, Ph.D., UMF Carol Davila, Bucharest, Romania<br />

Assoc. Prof. Carmen DOMNARIU, M.D., Ph.D., University Lucian Blaga, Sibiu, Romania<br />

Prof. Alin CUCU, M.D., Ph.D., Transilvania University of Brasov, Romania<br />

Prof. Dan DUMITRASCU, M.D., Ph.D., UMF Iuliu Hatieganu, Cluj-Napoca, Romania<br />

Prof. Leonida GHERASIM, M.D., Ph.D, UMF Carol Davila, Bucharest, Member of Romanian<br />

Academy, Romania<br />

Prof. Ove HELLZEN, Ph.D., Faculty of Health <strong>Sciences</strong>, Norway<br />

Prof. Kornelia HELEMBAI, Ph.D., University of Szeged, Hungary<br />

Prof. Teodor LEASU, M.D., Ph.D., Transilvania University of Brasov, Member of the World Academy<br />

of Medicine, Romania<br />

Prof. Roger Maurice LEBLANC, Ph.D., University of Miami, USA<br />

Prof. Peter MANU, Ph.D., Albert Einstein College of Medicine, New York, USA<br />

Prof. Jean-Louis MARTY, Ph.D., Universite de Perpignan via Domitia, France<br />

Prof. Dan MINEA, M.D., Ph.D., Transilvania University of Brasov, Romania<br />

Prof. Aurel MIRONESCU, M.D., Ph.D., Transilvania University of Brasov, Romania<br />

Prof. Nicolae MIU, M.D., Ph.D., UMF Iuliu Hatieganu, Cluj-Napoca, Romania<br />

Assoc. Prof. Marius MOGA, M.D., Ph.D., Transilvania University of Brasov, Romania<br />

Prof. Ioana MOISIL, Ph.D., University Lucian Blaga, Sibiu, Romania<br />

Prof. Dimitrie NANU, M.D., Ph.D., UMF Carol Davila, Bucharest, Romania<br />

Assoc. Prof. Laurenţiu NEDELCU, M.D., Ph.D., Transilvania University of Brasov, Romania<br />

Prof. Dr. Marian NEGUŢ, M.D., Ph.D., UMF Carol Davila, Bucharest, Romania<br />

Prof. Codruta NEMET, M.D., Ph.D., Transilvania University of Brasov, Romania<br />

Prof. Gilvanda Silva NUNES, Ph.D., Federal University of Maranhao, Brasil<br />

Prof. Lazar ONISÂI, M.D., Ph.D., Transilvania University of Brasov, Romania<br />

Assoc. Prof. Candan OZTURK, Ph.D., Dokuz Eylul University, Turkey<br />

Prof. farm. Honorius POPESCU, Ph.D., UMF Iuliu Haţieganu, Cluj-Napoca, Member of the<br />

“Academie Internationale d’Histoire de la Pharmacie”, Romania<br />

Assoc. Prof. Mariusz PUSZCZEWICZ, M.D., Ph.D., Poznan University of <strong>Medical</strong> Science, Poland<br />

Prof. Mariana RADOI., M.D., Ph.D., Transilvania University of Brasov, Romania<br />

Assoc. Prof. Patrizia RESTANI, Ph.D., Universita degli Studi di Milano, Italy<br />

Prof. Ilia REUBEN, M.D., Ph.D., Ben Gurion University of the Negev, Israel<br />

Prof. Liliana ROGOZEA, M.D., Ph.D., Transilvania University of Brasov, Romania<br />

Prof. Iosif SAMOTA, M.D., Ph.D., Transilvania University of Brasov, Romania<br />

Prof. Erich SORANTIN, M.D., Ph.D., <strong>Medical</strong> University Graz, Austria<br />

Assoc. Prof. Claudia STIHI, Ph.D., Valahia University of Târgovişte, Romania<br />

Assoc. Prof. Mihaela IDOMIR, MD., Ph.D., Transilvania University of Brasov, Romania<br />

Prof. Caius ZAMORA, MD., Ph.D., UMF Iuliu Haţieganu, Cluj-Napoca

Conference Organizing Committee<br />

- Liliana Rogozea<br />

- Nicolae Marcu<br />

- Mariana Rădoi<br />

- Teodor Leaşu,<br />

- Gabriel Moraru,<br />

- Botezatu Maria<br />

- Curesciuc Cerasela<br />

- Manolachescu Doina<br />

- Dorina Popa<br />

- Leaşu Florin,<br />

- Corina Derczeni,<br />

- Adrian Rotaru,<br />

- Geta Miron,<br />

- Nemet Codruţa,<br />

- Mihai Ţurcanu,<br />

Scientific Conference Committee:<br />

- Philippe Albou - (France)<br />

- Miladin Apostolov (Bulgaria)<br />

- Dana Baran (Romania)<br />

- Gheorghe Bratescu - (Romania)<br />

- Victoria Burtea - (Romania)<br />

- Nicolae Constantin -(Romania)<br />

- Aysegül Demirhan Erdemir (Turkey)<br />

- Athanassios Diamandopoulos (Greece)<br />

- Daniela Ion (Romania)<br />

- Cristina Ionescu (Romania)<br />

- Teodor Leasu (Romania)<br />

- Elena Helerea (Romania)<br />

- Nicolae Marcu (Romania)<br />

- Emeritus Spyros G. Marketos(Greece)<br />

- Ioana Moisil (Romania)<br />

- Codruta Nemet (Romania)<br />

- Manu Peter (USA)<br />

- Honorius Popescu (Romania)<br />

- Liliana Rogozea (Romania)<br />

- Mariana Radoi (Romania)<br />

- Alfredo Musajo Somma (Italy)<br />

- Carlos Viesca-Trevino (Mexico)<br />

- Jean-Pierre Tricot (Belgium)<br />

- Giorgio Zanchin (Italy)<br />

- Pascu Alina,<br />

- Miclăuş Roxana,<br />

- Gabriela Sechel<br />

- Andreea Fleancu<br />

- Adela Bădău,<br />

- Gabriela Mailat,<br />

- Mioara Georgescu,<br />

- Bălescu Alexandru,<br />

- Sanda Hondor,<br />

- Ana Ionescu,<br />

- Crisitina Egri,<br />

- Tatiana Oglindă,<br />

- Mihaela Cardiş,<br />

- Godri Dora

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />




Ay�egül Demirhan ERDEMIR 1<br />

Abstract: The responsibility of the physician is also an important theme of<br />

the history of Turkish medical ethics. Turks believed in a polytheistic<br />

religion, namely Shamanism, before Islam. This religion is a religion with<br />

regard to nature. Ottoman physicians were educated in the form of masterapprentice.<br />

The responsibility of the physician was examined both by the<br />

Islamic Penal Code and by Ottoman Lawbooks in the Ottoman period. Some<br />

interesting characteristics were found in some medical manuscripts and some<br />

documents in the period of the Ottoman Turks. Afterwards, the responsibility<br />

of the physician showed a modern characteristic and some modern laws<br />

came into force. An education in the type of medrese (an Islamic High<br />

School) was seen in the Islamic World in the Middle Ages. A Medrese was a<br />

kind of high school, and this foundation was also seen in the field of<br />

medicine. The persons who graduated from medreses got their diplomas in<br />

the name of educator in the period of Otoman Turks. The period of high<br />

school began with the foundation of Tıphane and Cerrahhane-i Amire<br />

(<strong>Medical</strong> and Surgical School) in 1827. So, some modern laws were passed<br />

about the responsibility of the physician. So, today, a physician is responsible<br />

in all the medical practices according to Turkish Criminal Law, The Turkish<br />

Obligation Law, Turkish Civilian Law, Medicine and Its Branches’ Law,<br />

Turkish <strong>Medical</strong> Ethics Regulation, Health Protection Law, Turkish <strong>Medical</strong><br />

Association. The Agreement on Patients Rights with the date of 1998 contains<br />

the subjects such as justice, the choosing of of foundation of health, informed<br />

consent, fidelity, confidentiality, privacy, veracity, the refuse of the treatment,<br />

the suing of the patient. In this paper, we will comment about laws on<br />

<strong>Medical</strong> Ethics in Turkey from the past to nowadays.<br />

Key words: law, history of medicine, malpractice<br />

1. Introduction<br />

In the world of Turks, remarkable<br />

developments have always taken place in<br />

terms of physician responsibilities and<br />

duties and there are many archive materials<br />

on it. This study gives examples from such<br />

materials and makes some comments.<br />

2. Historical context<br />

Before Islam, Turks followed<br />

Shamanism, which was a polytheist<br />

totemic religion of nature. In it, the sky,<br />

sun, moon, stars, earth and animals were<br />

all holy beings believed to have spirits and<br />

angels in them and Turks kept a deep kind<br />

of mysticism in their souls.<br />

Ottoman physicians held onto<br />

Islamic traditions too. For long years,<br />

medical training was given by masters to<br />

medical students. Therefore, the loopholes<br />

1 Department of <strong>Medical</strong> History and Ethics, Faculty of Medicine, Uludag University, Bursa/TURKEY.

6<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

in the Islamic law were tried to be closed<br />

and an alternative code of laws based on<br />

local traditions was developed. The<br />

statutes like those of Fatih Sultan Mehmed,<br />

Kanuni Sultan Süleyman and Mehmed IV<br />

closed some of the loopholes in the Islamic<br />

penal law. The sanctions on physicians<br />

were imposed by the edicts of the sultans<br />

and mandates of the head physicians until<br />

the 19th century. In all the decisions taken<br />

during that period, the emphasis was on the<br />

fact that physicians could not be held<br />

responsible for any medical situation<br />

unless the consent of patients was<br />

obtained.<br />

3. Aspects of medical ethics in X<strong>VI</strong> th<br />

Century<br />

The Ottoman Turkish physicians<br />

of the 16th century kept dealing with<br />

physician responsibilities in their books. In<br />

a document dated 1573, it is mentioned<br />

that the head physician Garaseddinzâde<br />

Muhiddin wants to prevent ignorant people<br />

from practicing medicine and those who<br />

want to do it need to take examinations to<br />

be awarded a diploma. A document from<br />

the Religious Court Records of the city of<br />

Ayıntap (Gaziantep) is dated 1540 and it<br />

talks about the removal of stones clogging<br />

up the urinary system. For such operations,<br />

the permission of patients and the religious<br />

court was needed and surgeons were paid a<br />

certain amount of money. Physicians could<br />

be sued when patients who gave their<br />

consent died during or after operations.<br />

4. Aspects of medical ethics in X<strong>VI</strong>I-<br />

X<strong>VI</strong>II th Century<br />

In the 17th century, physicians and<br />

surgeons having informal training from<br />

masters were allowed to practice medicine<br />

only after taking some examinations and<br />

proving that they have perfected their<br />

crafts. This was the same in the 18th<br />

century and the offices and consulting<br />

rooms of the unauthorized physicians were<br />

all closed. Some medical manuscripts<br />

dated the 18th century and the Ottoman<br />

Archives of the Prime Ministry talk about<br />

physician responsibilities. In his “Ra’is al<br />

Cerrahin” written in 1720, Cerrah Mes’ud<br />

Efendi reports that good physicians are<br />

compassionate, good-humored and kind<br />

people who do their best to help other<br />

people. In 1704 when Ahmed III was the<br />

sultan and Nuh bin Abdülmennan the head<br />

physician, the decision was taken that<br />

ignorant and unqualified physicians were<br />

to be prohibited from practicing the<br />

profession. In a judgment dated 1729, it is<br />

written that medical practice was to be<br />

learned from master physicians in an<br />

informal training process and a diploma<br />

given after passing some particular<br />

examinations was needed to become a<br />

physician.<br />

5. Aspects of medical ethics in XIX th<br />

Century<br />

Some documents dated the early<br />

19th century give information about the<br />

understanding of physician responsibilities.<br />

A Prime Ministry Archives material dated<br />

1848 reports that the head physicians and<br />

physicians of Ayıntab (Gaziantep), Birecik<br />

and Haleb hospitals were all dismissed<br />

from their posts because of unacceptable<br />

behavior. A document dated 1849 is about<br />

some new regulations designed to impose<br />

that physicians should treat poor patients<br />

for free.<br />

Another one dated 1890 is about<br />

the investigation launched into the wrong<br />

treatment given by Cerrah Malik Efendi at<br />

Gümü�suyu Hospital. In the Ottoman<br />

Empire, patients’ consent was obtained<br />

before giving any treatment. It is written in<br />

a document dated 1899 that some of the<br />

wounded soldiers at Yıldız Hospital were<br />

to be operated on after obtaining their<br />

written consent.<br />

Before the foundation of the<br />

Republic, the Islamic Penal Law was in

A. D. Erdemir - Laws on medical ethics in turkey from the past to nowadays and comments<br />

force about abortion. A document dated<br />

1788 is a written copy of a final court<br />

decision and aims to inform the provinces<br />

that the physicians and pharmacists in<br />

Istanbul were prohibited from prescribing<br />

for abortion. There are also some 19th<br />

century documents about abortion. One of<br />

them dated 1826 talks about a midwife<br />

known as “the bloody midwife” to be<br />

punished for prescribing abortive drugs.<br />

Another document dated 1828 says that<br />

women should never be prescribed<br />

abortive drugs. A document dated 1838 is<br />

about the announcement of the decision<br />

which banned abortion. The 193rd article<br />

of the Imperial Penal Law dated 1857 says<br />

that people who cause or help abortion are<br />

to be sentenced to imprisonment between 6<br />

months and 2 years. The Ottoman<br />

Archives of the Prime Ministry show that<br />

there were also some physicians who wrote<br />

misleading reports. A document dated<br />

1900 says that the Mayor Adbullahim<br />

Efendi, who was a lecturer in the Mekteb-i<br />

Fünun <strong>Medical</strong> School then, wrote a<br />

misleading report.<br />

As it is the way today, the<br />

physicians of those times had to be careful<br />

about what they wrote in their reports of<br />

any type and abide by all the medical<br />

ethics rules. They always tried to adhere to<br />

the principles of privacy, loyalty, honesty<br />

and not harming patients.<br />

Afterwards, the responsibility of<br />

the physician showed a modern<br />

characteristic and some modern laws came<br />

into force. Penal Code and Civil Law had<br />

some articles about this theme.<br />

The medical education in Turkey<br />

showed three periods. These are the<br />

periods of medrese, high school and<br />

faculty. The period of high school began<br />

with the foundation of Tıphane and<br />

Cerrahhane-i Amire (<strong>Medical</strong> and Surgical<br />

School) on the 14th March, 1827, and it<br />

continued until the foundation of Mekteb-i<br />

Tıbbiye-i Adliye-i �ahane in Galatasaray<br />

in 1838, and then the period of faculty<br />

began. So, some modern laws were passed<br />

about the responsibility of the physician.<br />

For example Karantina Talimatnamesi<br />

(Quarantine Agreement) in 1838, Tababeti<br />

Belediye Nizamnamesi (Agreement of<br />

Medicine of Municipality) in 1861<br />

mentioned the responsibility of physicians.<br />

Articles 192 and 193 of Ceza Kanunname-i<br />

Humayunu (Penal Law) in 1857 mentioned<br />

the punishments for abortion. Article 215<br />

of this code had the responsibilities about<br />

the revealing of medical secrets .Moreover,<br />

according article 182, if a patient died<br />

because of his physician’s negligence that<br />

was punished.<br />

6. Aspects of medical ethics in XX th<br />

Century<br />

Today, if a doctor causes death of a<br />

patient because of a technical mistake he is<br />

punished with prison sentence according to<br />

the article 456 of the Turkish Penal Code.<br />

The Agreement of Patient’s Rights<br />

with the date of 1998, 1 August and with<br />

the number of 23420 contains the subjects<br />

such as justice, the choosing of of foundation<br />

of health, informed consent, fidelity,<br />

confidentiality, privacy, veracity, the refuse<br />

of the treatment, the suing of the patient.<br />

Moreover, Turkish Law of Patients’<br />

Rights, the informed consent of persons is<br />

necessary in all of the medical practices.<br />

The law about population planning<br />

dated 1965 and numbered 557 was changed.<br />

It was issued on 12.06.1967 a population<br />

planning regulation and a bylaw about<br />

pregnancy termination and sterilization.<br />

The law about population planning dated<br />

1983 and numbered 2827 is a modernized<br />

version of the law issued in 1965.<br />

According to the Turkish Law of<br />

Family Planning with the date of 1983,<br />

curettage can be applied up to the 10th<br />

week with the desire of woman. Birth<br />

control drugs and apparatus can be used<br />

with the prescription of physician.<br />


8<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

As there was not an administrative<br />

law concerning organ transplantation in<br />

Turkey before 1979, many operations were<br />

not possible to perform and physicians did<br />

not have much to do to save lives. The law<br />

numbered 2238 and dated 29.5.1979 on<br />

transplanting and keeping organs and<br />

tissues allowed the operations and relieved<br />

physicians of many hesitations.<br />

If a person allows it in his will<br />

orally and/or verbally, organ transplantation<br />

can be made from his body after<br />

he dies. Even if this is not mentioned in the<br />

will, the law suggests that the closest<br />

relatives can permit transplantation from<br />

the dead body.<br />

According to the 14 th article of the<br />

law, an organ of a person who dies with<br />

enormous damages in an accident or<br />

natural disaster can be given to an urgently<br />

needing patient not considering the will or<br />

consent in any way.<br />

7. Conclusion<br />

Moreover, some agreement drafts<br />

are present in Turkey. One of them is<br />

Rules on Ethics of <strong>Medical</strong> Profession. It<br />

was accepted by Turkish <strong>Medical</strong><br />

Association. Another law is malpractice<br />

law. In near future, it will be passed.<br />


1) Ceza Kanunname-� Hümayunu (Penal<br />

Code). �stanbul: Takvimhane-i Amire<br />

Mat; 1857.<br />

2) Ceza Kanunname-i Hümâyunu (Penal<br />

Law): Takvimhane-i Âmire Matbaası,<br />

�stanbul, 1857, pp.45<br />

3) Hasta Hakları Yönetmeli�i (Patient’s<br />

Rights Regulation), Resmi Gazete,<br />

No.23420, 1998, p.67.<br />

4) Kahya, E., Demirhan, E. A.: <strong>Medical</strong><br />

Studies and Institutions in the Ottoman<br />

Empire, Ankara, 2008.<br />

5) Nüfus Planlaması Hakkında Kanun<br />

(Family Planning Code): 2827. Date:<br />

25.5.1983 Resmi Gazete No: 18059<br />

(27.5.1983).<br />

6) Ottoman Archives Cevdet, Sıhhiye<br />

Book. Date: 1729<br />

7) Ottoman Archives, A.MKT.MHM.<br />

Dosya No: 50 Gömlek No: 42, Date<br />

1853.<br />

8) Ottoman Archives, Cevdet, Sıhhiye<br />

No: 1026, Date: 1788.<br />

9) Ottoman Archives, Cevdet, Sıhhiye<br />

No: 1790, Date: 1838.<br />

10) Ottoman Archives, Sadaret Evrakı<br />

Mektubi Mühimme Dosya No: 9,<br />

Gömlek: 63, Date:1849 .<br />

11) Ottoman Archives, Y.PRK.ASK.<br />

Dosya No: 240 Gömlek no: 40, Date:<br />

1909.<br />

12) Ottoman Archives, Y.PRK.SH. Dosya<br />

No: 68 Gömlek No: 68, Date Date:<br />

1891.<br />

13) Ottoman Archives, Y.PRK.SH. Dosya<br />

No: 7 Gömlek No: 13, 1900.<br />

14) Ottoman Archives. Cevdet, Sıhhiye<br />

Book, No.1128, Date: 1848.<br />

15) Ottoman Archives: Cevdet, Sıhhiye<br />

Defteri, No.566, Date :1828<br />

16) Resmi Gazete: No. 16655, 3.6.1979,<br />

Organ ve Doku Saklanması ve Nakli<br />

Hakkında Kanun (Organ and Tissue<br />

Transplantation Law): No. 2238,<br />

29.5.1979.<br />

17) Sehsuvaroglu B. N., Demirhan A.,<br />

Güre�sever G., Türk Tıp Tarihi<br />

(History of Turkish Medicine). Bursa:<br />

Ta� Kitabevi; 1984.<br />

18) Tıbbi Deontoloji Tüzü�ü (Agreement of<br />

Turkish <strong>Medical</strong> Deontology with the<br />

Date of 1960) No: 4/12578, Jan 3, 1960.<br />

19) Türk Ceza Kanunu (Turkish Penal<br />

Code). No: 5237, Date: 26.09.2004.<br />

20) Ucok, C., Osmanlı Kanunnamelerinde<br />

�slam Ceza Kanununa Aykırı Hükümler,<br />

Ottoman Law Books, A.Ü. Hukuk Fak.<br />

Mec., 1946; 3: 124-46.

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />

1 Bucharest University<br />




C. BOGDAN 1<br />

Abstract: The date of birth of bioethics in the world is the early 70s, when<br />

it was realized that medical ethics remained predominantly centered on<br />

physician-patient relationship and it covers no more the progress of scientific<br />

research in biology and medicine and their applications in genetics,<br />

reproductive medicine, transplant or end of life issues, bio-technology.<br />

Even if preoccupation about bioethics exist before 1989, until after this year<br />

it was possible to establish some governmental and non-governmental<br />

organization with experts in this field: doctors, researchers, lawyers,<br />

theologians.<br />

The first organization was the Committee of Bioethics attached to the<br />

<strong>Medical</strong> <strong>Sciences</strong> Academy, which has appeared as initiative of acad. St. M.<br />

Milcu and prof. dr. Constantin Maximilian, joined later by dr.Constantin<br />

Bogdan, dr. Sebastian Nicolau, dr. G. Litarczek and others.<br />

The echo of this committee inspired medical students, who develop “Student<br />

Society in Bioethics - Constantin Maximilian”, with an intense activity over a<br />

decade; the original animators of this group are Consuela Georgescu and<br />

Gabriel Raicu.<br />

With the death of the founders, the Academy Commission’s work was stopped<br />

and remain, only for a short time, a Bioethics Committee in addition of<br />

Forensic Institute lead by prof. Vl. Beli�. By tradition, bioethics remained<br />

linked with Forensic Medicine and History of Medicine.<br />

In the early 2000s it was set up the Romanian National Committee of<br />

Bioethics in addition to the Romanian National Commission for UNESCO. In<br />

the same period, in Iasi was developed a group of Bioethics with intense<br />

activity (including publishing a journal), animated by prof. dr. Vasile<br />

Astarastoae. Finally, appear bioethics committees in educational and<br />

research institutions, and in clinical hospitals.<br />

Key words: bioethics, Romania, historical landmarks.<br />

Bioethics is a relatively young discipline<br />

and science, its act of birth dating<br />

from 4 decades ago, at the same time with<br />

the launch of its concept and name by<br />

American biochemist dr. Van Renssalaer<br />

Potter at the beginning of the 70s. [2]<br />

Bioethics was born out of ethics, has<br />

focused on biologics and has gradually<br />

developed and diversified, along with the<br />

scientific advancement in bio-medicine<br />

research and biotechnologies and their<br />

applications’ development.<br />

In Romania, even if there were some<br />

physicians, researchers and lawyers’

10<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

opinions regarding bioethics before the<br />

1989’s political changes, only after that<br />

date there were possible open debates, the<br />

set up of a movement, the appearance of<br />

governmental and non-governmental<br />

bodies, as a result of gaining the right to<br />

free speech and express thoughts, right to<br />

be informed, freedom of association [4].<br />

Regarding the historic of bioethics,<br />

concerns can be identified even since<br />

Antiquity, that are to be found in the<br />

religious concepts, philosophical necessity,<br />

regulations and laws during time, medical<br />

practice codes. Towards the end of 19 th<br />

Century some attends to conceptualize a<br />

kind of bioethics were made, but bioethics,<br />

in its actual modern meaning is a recent<br />

concept, as I mentioned before, established<br />

in the second half of the last century,<br />

together with genetics and especially<br />

biotechnologies further developments, the<br />

term being introduced by dr. Van<br />

Renssalaer Potter in the paper “Bioethics:<br />

Bridge to the Future” (1971). [2]<br />

There are several definitions, the filed<br />

being complex and in full extension,<br />

imposed by new scientific developments,<br />

moral’s adjusted answers and the right to<br />

the “cascading” challenges of science and<br />

research developments.<br />

One of the said definitions considers<br />

bioethics which, based on using an<br />

interdisciplinary methodology, has as<br />

object the systemic exam of human<br />

behaviour in the field of life sciences and<br />

health, analyzed in the light of moral’s<br />

values and principles.<br />

Other more concise definition, but<br />

complete at the same time, was introduced<br />

by dr. Constantin Maximilian, the great<br />

geneticist and one of the pioneers of the<br />

revival of bioethics in Romania after 1990,<br />

in its modern, international concept:<br />

“bioethics is the meeting point of all who<br />

follow human destiny subject to science<br />

pressure”. [4]<br />

UNESCO’s General Director considers<br />

that the scope of bioethics is to frame the<br />

scientific and technological progress in a<br />

ethic reflection that is having the roots in<br />

the cultural, juridical, philosophical and<br />

religious background of diverse human<br />

communities.<br />

From other perspective, bioethics,<br />

beyond life and death and existential limits<br />

of human life, provide answers to any of<br />

science and technique’s real challenges<br />

under the form of new developments. [3].<br />

Bioethics is seen by other specialists<br />

and as the moral’s answer to the reality of<br />

a science that evolves quicker than the<br />

human being as regards its capacity of<br />

understanding, reaction and adaptation.<br />

Bioethics becomes a source of law that<br />

is no more than a minimum of moral.<br />

Bioethics is the reconsideration of<br />

classic (medical) ethics beyond a strictly<br />

medical perimeter which remains however<br />

prevailing.<br />

As a conclusions of enumeration<br />

diverse definitions, we consider that a<br />

more comprehensive delimitation, more<br />

adjusted to its actual dimensions and<br />

mission, suggested also by its name<br />

“bioethics” could take into account the<br />

term of “ethics of life”, because nowadays<br />

bioethics covers not only health field but<br />

also the overall aspects of life, based on<br />

principles such as respect of life, autodetermination,<br />

universality, equality,<br />

justice and equity, utilitarianism, fact that<br />

indicates its extension in social and<br />

political areas <strong>–</strong> inter-human relationships,<br />

non-discrimination, relation with environmental,<br />

nature, the need for building up of<br />

a bridge balance between the progress of<br />

science and human rights; in other words,<br />

all the developments of science must be<br />

directed only for the common good of<br />

humanity. The great thinker and moralist<br />

Montaigne properly stated: “science<br />

without conscience is the ruin of soul” and<br />

physician and humanist Albert Schweitzer<br />

drew the attention on the fact the science’s

C. BOGDAN.: Historic highlights and perspectives of Bioethics in Romania 11<br />

successes have not always had as a result<br />

the happiness of mankind.<br />

Therefore, along with the 1990 change<br />

of politic regime and afterwards through<br />

our country’s accession to European<br />

structures (Council of Europe, European<br />

Union), bioethics, together with other left<br />

behind fields, wished to recover in the<br />

shortest possible period of time, all the<br />

existing gaps between us and “free” and<br />

developed countries.<br />

The first 4-5 years after 1990 had been<br />

necessary for the organisation, gathering of<br />

information regarding other countries’<br />

related experience, debates, collecting of<br />

related data and comments, the adjusted<br />

implementation of international specialised<br />

institutions’ recommendations launched<br />

during diverse discussions forums.<br />

A first institutional structure that<br />

appeared soon after 1990 was Romanian<br />

Commission for Bioethics (Comisia de<br />

Bioetic� a României), affiliated to<br />

Academy of <strong>Medical</strong> <strong>Sciences</strong>; this<br />

“parrainage” had two reasons: on one hand<br />

the high patronage of a official and<br />

prestigious institution with authority in<br />

bio-medicine and research was needed in<br />

order to affirm itself and be known, and,<br />

on the other hand, the initiative came from<br />

two distinguished figures of medicine and<br />

medical scientific research <strong>–</strong> academician<br />

dr. �tefan-Marius Milcu, professor of<br />

Endocrinology and academician dr.<br />

Constantin Maximilian, professor of<br />

<strong>Medical</strong> Genetics, signer of The Oviedo<br />

Convention for Human Rights and Biomedicine<br />

in April 4, 1997. I personally had<br />

the great honour of being invited to take<br />

part in the Commission, being entrusted,<br />

based on my expertise and previous<br />

research, the following issues: ethical and<br />

social responsibility in health, end of life’s<br />

bioethics aspects, protection of vulnerable<br />

persons’ rights and dignity. [4]<br />

This first bioethics institution was the<br />

predecessor of the current Romanian<br />

National Committee for Bioethics (Comitet<br />

Na�ional Român de Bioetic�), that was<br />

affiliated, based on the same abovementioned<br />

reasons, to Romania’s National<br />

Commission for UNESCO (“Comisia<br />

Na�ional� pentru UNESCO a României”).<br />

Moreover, the major involvement of<br />

UNESCO in bioethics, beginning with the<br />

‘90s, bioethics being constantly included in<br />

its agenda, with two subordinated<br />

specialised entities and an ample program<br />

of activities, i.e. International Committe<br />

for Bioethics (Comitetul International<br />

pentru Bioetica - CIB) and Intergovernmental<br />

Committee for Bioethics<br />

(Comitetul Interguvernamental pentru<br />

Bioetica - CIGB). [3]<br />

It’s worth mentioning here that these<br />

patronages did not affect in any way the<br />

independent character of the committee, on<br />

the contrary they increased its power and<br />

efficiency; our relationship with CIB and<br />

CIGB was a privileged one and a very<br />

stimulating one for the activities of the<br />

committee.<br />

Also, we would like to mention that the<br />

initiative for the creation of a organised<br />

movement in bioethics belonged to<br />

physicians!<br />

If bioethics means also control,<br />

monitoring and arbitrage- a judge of the<br />

evolution of science and practice in<br />

biomedicine - then this control started from<br />

inside; in general, in other countries, the<br />

lawyers, to which in some cases the<br />

theologians rallied too, had been the ones<br />

that initiated movements and associations,<br />

attracting also obviously physicians and<br />

researchers.<br />

However, we should state also that<br />

neither a confiscation nor a domination of<br />

bioethics by physicians does not constitute<br />

a benefit for the further development of<br />

bioethics, due to the risk of a lack of an<br />

objective approach from outside of it and<br />

also due to the risk of an attempt to defend<br />

certain practice of minimize the effects.

12<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

Therefore, through the decision of<br />

setting up these institutions, currently<br />

active in our country, a multi-disciplinary<br />

component was intended - bioethics<br />

experts, researchers, physicians, biologists,<br />

lawyers, theologians, philosophers, psychologists<br />

and sociologists and an active<br />

model of horizontal co-operation between<br />

all the other bioethics’ formations.<br />

Although, other important thing, with a<br />

negative impact, that must be specified is<br />

the relatively reduced interest of some<br />

indispensable specialists category <strong>–</strong> the<br />

lawyers <strong>–</strong> most of them being focused on<br />

other more interesting and profitable areas<br />

<strong>–</strong> as a consequence of the previous politic<br />

regime when justice was controlled by the<br />

state, the law domain being therefore<br />

guided and poorly remunerated; other<br />

explanations are the absence of bioethics<br />

from the universities’ programs of study<br />

and from the postgraduate specialization<br />

and, also, the lack of specializations in<br />

bio-law or medical law. We have managed<br />

to partially rectify this shortcoming by<br />

attracting within a partnership specialists<br />

from Romanian Institute for Human Rights<br />

(Institutul Român pentru Drepturile<br />

Omului); we are benefiting also from the<br />

expertise of physicians that graduated also<br />

law universities. The involvement of<br />

theologians is also very important <strong>–</strong> we<br />

mention here The Commission for<br />

Bioethics of the Patriarchate <strong>–</strong> then it’s<br />

worth mentioning the professors of<br />

bioethics within Orthodox and Catholic<br />

Theological Institutes and also the<br />

presence of theologians within other<br />

important commissions.<br />

Other bioethics entities currently active<br />

in Romania besides Romanian National<br />

Committee are the following:<br />

- Commission for bioethics of Ministry<br />

of Public Health (Comisia de Bioetic� a<br />

Ministerului S�n�t��ii Publice) whose<br />

members are appointed by the ministry,<br />

commission with an advisory role;<br />

- Committee for Bioethics of the<br />

National College of Physicians (Comitetul<br />

pentru Bioetica al Colegiului Na�ional al<br />

Medicilor), whose members are appointed<br />

by the College’s National Council and that<br />

has an advisory role especially regarding<br />

the changes in the Etichs Code related to<br />

the developments recorded in the medical<br />

bioethics field.<br />

- National Committee for clinical study<br />

on human subjects (Comitetul Na�ional<br />

pentru studiu clinic pe subiec�i umani)<br />

affiliated to the <strong>Medical</strong> <strong>Sciences</strong> Academy,<br />

that works together with the National<br />

Agency for Medication (Agen�ia Na�ional�<br />

pentru Medicament), the latter being the<br />

main institution involved in the regulation<br />

and control of the activity related to<br />

medication and clinical studies on human<br />

subjects.<br />

- Commission for Bioethics of the<br />

Patriarchate (Comitetul de Bioetic� al<br />

Patriarhiei), religious body that expresses<br />

its own position and participates in<br />

bioethics related debates. [1]<br />

There was also a honest initiative of<br />

medicine students materialised in mid ’90s<br />

in a body active for a few years, that<br />

developed a prestigious program of<br />

education and multiple other events:<br />

Medicine Students’ Group for Bioethics <strong>–</strong><br />

“Constantin Maximilian” (Grupul de<br />

Bioetic� al studen�ilor în medicin�<br />

”Constantin Maximilian”).<br />

Other notable achievement is the<br />

outstanding activity of Iasi Group<br />

(“Grupului de la Ia�i”) conducted by Prof.<br />

dr. Vasile Ast�r�stoaie, that publishes<br />

Romanian Bioethics Magazine (“Revista<br />

Român� de Bioetic�”) under the aegis of<br />

Commission for Bioethics of Romanian<br />

National College of Physicians (Comisiei<br />

de Bioetic� a Colegiului Medicilor din<br />

România), prestigious magazine wellknown<br />

both locally and worldwide and<br />

also internationally classified and<br />

authorised, that publishes in each issue

C. BOGDAN.: Historic highlights and perspectives of Bioethics in Romania 13<br />

articles written by renowned bioethicians.<br />

Finnaly, there are the committees for<br />

bioethics (ethics) within National<br />

Authority for scientific research (Autorit��ii<br />

Na�ionale pentru cercetarea �tiin�ific�),<br />

Ministry of Education (Ministerului<br />

Înv���mântului �i Educa�iei), Universities<br />

(Universit��i). [5] Lately, the creation of<br />

many committees for ethics within<br />

academic centres and research institutions<br />

can be noticed, this fact being stimulated<br />

by the progressive introduction of<br />

bioethics courses in the university<br />

curricula or by the requests regarding<br />

research in general and on human subjects<br />

especially. Perhaps, as a particularity, can<br />

be considered also the absence of National<br />

Committee affiliated do the Parliament or<br />

Presidential Administration, entity that can<br />

centralise all the reflections and comments<br />

from other independent bodies (advises,<br />

expertises, recommendations, consultations)<br />

and would assure a more prompt<br />

materialisation of legislative initiatives.<br />

The debates and approaches at the high<br />

level of this two authorities - Parliament<br />

and Presidential Administration <strong>–</strong> have not<br />

fulfilled yet the needs in this field with the<br />

exception of the approval and change of<br />

important laws referring to bioethics<br />

aspects such as: research of human<br />

embryos, assisted pro-creation, transplant<br />

of organ and tissue, this being done due to<br />

alignment requirements, more or less<br />

adjusted, to models existing in other countries<br />

or as a result of acquiring international<br />

institutions’ recommendations.<br />

There is not a Bioethics law in Romania<br />

yet.<br />

The first activities of The Romanian<br />

National Committee for Bioethics that<br />

were considered as a priority for our<br />

country were the ones in the field of<br />

raising awareness and education. As a<br />

result, an Appeal entitled CONCERN<br />

(“ÎNGRIJORARE”) that drew attention in<br />

its ten points on the elimination of the risks<br />

related to the detriment of human rights,<br />

dignity and integrity as a result of the<br />

implementation of scientific research’s<br />

conclusions, and on the need for wide<br />

knowledge of the bioethics principles <strong>–</strong> not<br />

only by specialists, young researchers but<br />

also by the general public. [3]<br />

An extensive program of Bioethics<br />

Education was elaborated, distributed and<br />

implemented, program that is a permanent<br />

one.<br />

Romania is currently going through the<br />

process of alignment to the European<br />

regulations regarding Ethics in Research<br />

and Science.<br />

For the time being, there are regulations<br />

adopted for the most important and up-todate<br />

aspects in this field: [1]<br />

- general rules and regulations that<br />

constitute the framework for the<br />

development of specific legislation;<br />

- provisions in the Constitution of<br />

Romania (art. 11, International law and<br />

internal law chapter) based on which the<br />

Romanian State undertakes to respect the<br />

obligations assumed within international<br />

treaties and regulations, in the case that<br />

Romania does not have in place (or does<br />

not have yet in place) its own regulations.<br />

(“art 11 <strong>–</strong> Constitution of Romania: [3] <strong>–</strong><br />

Romanian State undertakes to fully and in<br />

good faith comply with the obligations<br />

incumbent from all the treaties signed. [5]<br />

<strong>–</strong> The treaties ratified by the Parliament, in<br />

accordance with the law, are part of the<br />

internal right”.<br />

- there are laws in preparation, being<br />

currently under parliament procedure and<br />

having to be promulgated in the next<br />

period (e.g.: the law regarding the animal<br />

protection against being used for research<br />

or other purposes, the law regarding the<br />

protection of the wildlife etc.)<br />

One of the important laws ratified by<br />

Romania is: The law no. 17 from 2007<br />

regarding the ratification of European<br />

Convention for the Protection of Human

14<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

Rights and Dignity of the Human Being<br />

with regards to Application of Biology and<br />

Medicine, the Convention regarding<br />

Human Rights and Biomedicine signed at<br />

Oviedo on April 4, 1997, the additional<br />

Protocol to Convention for the Protection<br />

of Human Rights and Dignity of the<br />

Human Being with regards to Application<br />

of Biology and Medicine signed in Paris<br />

on January 12, 1998, referring to the<br />

interdiction of human being cloning.<br />

The European Convention, the<br />

Convention regarding Human Rights and<br />

Biomedicine and the additional Protocol to<br />

the European Convention were submitted<br />

for ratification to Romanian Parliament by<br />

Ordinance no. 324 dated October 4, 1999.<br />

This law covers: Fair access to health<br />

care, Consent, Protection of persons<br />

suffering from mental disorders, Private<br />

life and right to be informed; Human<br />

genome: Non-discrimination, Predictive<br />

genetic tests, choosing of sex; Scientific<br />

research: protection of persons that are<br />

subject to research, protection of persons<br />

that are not in the capacity to give their<br />

consent for the research; in vitro embryo<br />

research, prelevation of organ and tissue<br />

from alive persons for the purpose of<br />

transplantation; interdiction of financial<br />

gain and use of a part of the human body.<br />

Finally, a enumeration of the main<br />

challenges that bioethics must answer<br />

today, is shaping also the concern and<br />

approach perspectives of Romanian<br />

bioethics, without forgetting that bioethics<br />

is aiming to maximize the benefits of the<br />

scientific acquisitions and to minimize the<br />

negative effects:<br />

- discrimination and genetic<br />

manipulation, use of embryo in research<br />

and experiments, research on human<br />

subjects, reproductive cloning, transplant<br />

of organ and tissue, commercialization<br />

trends within this field, pre-set of the sex<br />

of the future fetus, protection of vulnerable<br />

persons, defending the biodiversity,<br />

monitoring of genetic modified organisms,<br />

fair distribution of research’s benefits,<br />

euthanasia, assisted suicide etc. [4]<br />

Reference:<br />

[1]. Bogdan C., Ursu �.: Bioetica în<br />

activit��ile UNESCO, în vol.<br />

”Educa�ia în Bioetic� �i Drepturile<br />

Omului în România” editat de<br />

Comisia Na�ional� a României<br />

pentru UNESCO, Bucure�ti 2006<br />

[2]. Bogdan C.: Probleme actuale ale<br />

bioeticii <strong>–</strong> în “Maramure�ul <strong>Medical</strong>”<br />

nr. 5, 17 septembrie 2004<br />

[3]. Nicolau S.: Nevoia de bioetic�.<br />

Începuturile înv���mântului<br />

universitar de bioetic�, în volumul:<br />

”Educa�ia în Bioetic� �i Drepturile<br />

Omului în România” editat de<br />

Comisia Na�ional� a României<br />

pentru UNESCO, Bucure�ti 2006<br />

[4]. Raicu G.: Legisla�ia Na�ional� în<br />

domeniul eticii în cercetare în<br />

România, în vol.: ”Educa�ia în<br />

Bioetic� �i Drepturile Omului în<br />

România” editat de Comisia<br />

Na�ional� a României pentru<br />

UNESCO, Bucure�ti 2006<br />

[5]. *** Institutul Român pentru Drepturile<br />

Omului: Bioetica <strong>–</strong> Mijloace �i c�i de<br />

ac�iune, Bucure�ti 2004

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />

THREE PERSONALITIES OF MEDICINE <strong>–</strong><br />



L. ROGOZEA 1 , F. LEA�U 1 , L. NEDELCU 1 , A. B�LESCU 1 ,<br />

C. NEMET 1 , N. MARCU 2<br />

Abstract: Kernbach, Nicolae Minovici and I. St�nescu are three<br />

outstanding personalities of medicine, famous not only for their research, but<br />

also for their involvement in developing medical ethics. If Kernbach<br />

substantiated a few notions about medical responsibility in 1935, Nicolae<br />

Minovici, one of the most important forensic doctors of his time, is also<br />

known for his important research in the deontology field, illustrated by his<br />

two written works: “Professional Secret” and “Ethics of <strong>Medical</strong><br />

Responsibility”, worked out in collaboration with I. St�nescu. We have<br />

recognized nowadays that medical ethics of our century must be approached<br />

and dealt with from historical perspective; the acquaintance with the<br />

predecessors’ point of view is a favorable element in the restoration process<br />

upon medical ethics in the current context of medical development<br />

Key words: M. Kernbach, N. Minovici, I. St�nescu medical ethics.<br />

1. Introduction<br />

Ever since the period of Hammurabi’s<br />

Babylon or Hypocrites’ Greece so far,<br />

medical ethics has stood for the system<br />

of moral and social laws that marked<br />

professional activity so that it should<br />

comply with the highest standards of<br />

society.<br />

In this context, the medical ethics of<br />

the 20 th century must likewise be<br />

considered from the historical<br />

perspective; therefore the acquaintance<br />

with our predecessors’ standpoints will<br />

constitute a favorable element in the<br />

process of restoring medical ethics in the<br />

framework of the medical progress.<br />

The fear of “public opinion”, the fear<br />

lest we should be considered nostalgic<br />

1 Faculty of Medicine, Transilvania University, Brasov<br />

2 UMF Carol Davilla, Bucharest<br />

has brought about that an everdiminishing<br />

number of physicians cope<br />

with the theoretical aspects of medical<br />

ethics.<br />

Within this very context there<br />

inscribes the tendency manifested by the<br />

leaders of Romanian medical education,<br />

to neglect the importance of medical<br />

ethics, as well as the emphasis we should<br />

lay on those materials which contribute<br />

to modeling the moral and spiritual<br />

profile of the future professionals within<br />

the medical staff. We make reference at<br />

this point to the history of medicine, to<br />

medical sociology, to medical<br />

anthropology or to medical psychology.<br />

We should not overlook that “The<br />

physician, through a happy dignity of his

16<br />

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fate is likewise followed and obeyed<br />

outside his battlefield” (Ozun, Poenaru).<br />

Therefore, bearing in mind and<br />

bringing to memory the example offered<br />

by some forerunners is not only a duty<br />

incumbent on us, but also a necessary step<br />

for rekindling ethical and moral values in<br />

the attention of both medical staff and<br />

general audience.<br />

Noteworthy personalities of the<br />

Romanian medical world have been<br />

preoccupied with emphasizing the<br />

physician’s role, with positively assessing<br />

and appraising the particularities of the<br />

medical act, of the responsibility<br />

incumbent on the medical professionals,<br />

with the high moral standards applied by<br />

society to these professionals.<br />

2. Historical background.<br />

Since Antiquity so far, medical science<br />

has greatly evolved, however a series of<br />

ethical percepts have kept their<br />

authenticity.<br />

There is worth reminding at this point<br />

the muniment (charter) issued by Scarlat<br />

Calimachi in 1813, in his quality of<br />

waiwode of Moldavia, muniment that<br />

points out the obligations of the doctors<br />

of those times.<br />

“At any time, by night or in daytime,<br />

either called for by the boyars, or by the<br />

clergy or by the poorest and foreigner, no<br />

one should dare allege encumbering<br />

tasks or delay their medical examination<br />

for the following day, thereby therefore<br />

people’s life; who, either by carriage, or<br />

on foot, should run themselves out of<br />

breath towards the suffering ones.”<br />

The text emphasizes the fact that<br />

these doctors must provide medical<br />

assistance indiscriminately, whatsoever<br />

the patient’s material status or<br />

nationality; furthermore, the same text<br />

specifies that medical assistance can only<br />

be provided in case of illness; otherwise<br />

the patient being excluded from the<br />

medical corpus.<br />

We should not forget that this<br />

legislative act, regulating the person’s<br />

right to medical assistance and the<br />

physician’s duty to perform his duty, is<br />

dated in the 19 th century.<br />

That very century, however after<br />

approximately 50 years, the great<br />

reformer of medical assistance in<br />

Romania, physician Carol Davila put<br />

forth in writing: “The physician of the<br />

circumscription, beside his medical<br />

appointment, also performs a moral,<br />

foreseeing mission.”<br />

V. Gomoiu <strong>–</strong> “Within medical<br />

profession, nothing can be mechanical,<br />

reflex, this is the profession compelling<br />

to a permanent strain of consciousness,<br />

as our profession directly addresses<br />

human being, his life and health.<br />

3. Kernbach<br />

Great personality of Romanian forensic<br />

medicine Mihai Kernbach studies at<br />

Berlin, Graz, Lyon and Zürich and work in<br />

Cluj where he through all steps of the<br />

academics hierarchy up to professor. After<br />

Cluj period he became doctor at Iasi<br />

University, where he taught forensic<br />

medicine.<br />

Mihail Kernbach it was not only a<br />

distinguished educator but also a important<br />

researcher. He publish more than 250<br />

scientific paper, including article, books.<br />

In 1935, Kernbach substantiated a few<br />

notions in connection with medical<br />

responsibility: “No social group can avail<br />

from immunity. We have long overcome<br />

the epoch of the privileged classes upon<br />

the law”; however, not supporting the<br />

thesis of medical irresponsibility,<br />

Kernbach stated: “The tendency of the<br />

doctrine, within our days, is incontestably<br />

towards raising the physician’s<br />

responsibility, so that he should be brought<br />

to account for the slightest error, as soon as<br />

it may be framed within a text of law.”

L. ROGOZEA, et all, Three personalities of medicine <strong>–</strong> representative for medical ethics within 17<br />

Romania<br />

4. Nicolae Minovici and I. St�nescu<br />

In this context, we deem of usefulness<br />

to submit and analyze two works drawn<br />

up by the physicians Nicolae Minovici, I.<br />

St�nescu: “Professional Secret”, issued<br />

in the Bulletin of the College of<br />

Physicians, during 1938, and “Ethics of<br />

<strong>Medical</strong> Responsibility”, issued an year<br />

later, during 1939.<br />

In these two articles, the noteworthy<br />

physicians prove themselves to be<br />

valuable historians of ethics, who<br />

managed to achieve a tour of ethics<br />

history on worldwide level and<br />

throughout our country.<br />

Physicians of outstanding value, they<br />

likewise became conspicuous as ethics<br />

theoreticians of great value, given the<br />

proof of this statement: “As practicing<br />

physicians, we do not only cure the<br />

disease, but the individuals suffering<br />

from such or such illness; whatsoever the<br />

conscientiousness we would apply in<br />

repairing the motor propelling human<br />

life, it is almost utterly excluded to<br />

neglect a mere single piece within this<br />

system, whose perfect knowledge is only<br />

held by the one who created human<br />

being.”<br />

They also deemed that “the physician<br />

has to continuously update his medical<br />

knowledge; he must not mistake his<br />

university diploma for a license patent,<br />

which might occupy him for his personal<br />

benefit and not for collective interests.”<br />

The obligation to comply in due time<br />

with any patient’s request is enforced,<br />

bringing forth to memory the fact that<br />

ever since 1813, Scarlat Calimachi<br />

stated: „The doctors and the midwives<br />

should be under obligation to get out of<br />

breath with running when called for not<br />

only by the boyars (only these ones were<br />

able to render themselves cured by<br />

doctors!) but also by the poor and by the<br />

wretched, as the word of Bible urges<br />

them to, which compels them to: „when<br />

being summoned and called for at any<br />

time, by night or during daytime, no one<br />

should dare to allege encumbering duties<br />

as pretext, or to delay the medical examination<br />

for the following day, therefore<br />

endangering people’s lives, otherwise,<br />

unless justified by well grounded reason<br />

of “bodily powerlessness”, any of the<br />

doctors will be cast out of the healers’<br />

corporate body and his wages will be<br />

blasted and ultimately will count to<br />

nothing”.<br />

The main preoccupation consists in<br />

the professional secrecy, which he deems<br />

an enigma so great and so ancient, as this<br />

ever-rising edifice which, through social<br />

consciousness, constitutes “human soul”,<br />

“collective mentality”, as a “nervus<br />

rarum of consumption life.”<br />

Conspicuously, the most important<br />

thing should be “conscience <strong>–</strong> that form<br />

of manifestation put on by collective soul<br />

<strong>–</strong> and only afterwards the rigid article of<br />

law.”<br />

Consciousness is often deemed an<br />

abstract notion. For the two Romanian<br />

physicians, consequently for Minovici,<br />

too “Conscience cannot be conceived but<br />

as the wholeness of the “moral laws”<br />

precepts, as an expression of social<br />

harmony, on whose bases the individuals<br />

within an organized collectivity should<br />

cultivate the “good” and give a wide<br />

berth to “evil” “and obnoxiousness” from<br />

the standpoint of the individual or<br />

collective interest.”<br />

Minovici agrees with these<br />

information, the proof being the<br />

acknowledgement upon the fact that if<br />

“every individual only had rights and we<br />

denied him any duty, and especially his<br />

moral duty, then, within a State there<br />

would be a permanent fight, battled by<br />

the individual against community, and<br />

therefore battled by everybody against<br />

all. ”<br />

Furthermore, Nicolae Minovici’s

18<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

brother, Mina Minovici declared his<br />

opinion in this respect, considering:<br />

“Much like a laic father confessor, the<br />

physician has ears to hear and eyes to<br />

behold; in comprehending his moral<br />

duty, he has no other judge than his<br />

conscience”, and “the duty dictated by<br />

consciousness needs no longer be<br />

defined.”<br />

We may remark on the occasion of<br />

reading these materials that the idea of<br />

absolute or relative secret is not new.<br />

This way, Ch. Vibert states that:<br />

“Whatever the authors might say, there is<br />

obvious that medical secrecy cannot be<br />

absolute in all cases. Name the physician<br />

who will decline informing the husband<br />

about his wife’s illness, informing the<br />

environment about an epidemic<br />

disease?!”<br />

A. Lacassagne places himself in<br />

favour of absolute secrecy: “the<br />

obligation to secrecy places upon the<br />

ones involved the interdiction to reveal<br />

it, even when they are called to testify in<br />

Courts of Justice.”<br />

Other preoccupations upon secrecy<br />

submitted in the article herein are the<br />

statements by: A. Lutaud: “<strong>Medical</strong><br />

secret is not only a moral duty and a<br />

sacred obligation for the physician, but<br />

the secrecy is also formally enforced by<br />

law” ; or the rules advanced by Gabriel<br />

Tourdes and Ed. Metzquer: “The<br />

physician must never reveal what he has<br />

come up against during the exercise of<br />

his profession: however there are<br />

admitted exceptions, there are legal<br />

restrictions, debt conflicts, this issue<br />

having remained one of the most delicate<br />

and controversial.”<br />

“There are so many moral and legal<br />

restrictions in favour of the relative<br />

secret; the physician is under obligation<br />

to keep professional secret, however<br />

there are certain cases in which this<br />

obligation places one in a difficult<br />

position.”<br />

There is certain that, as Henri<br />

Contagne stated: “<strong>Medical</strong> secrecy<br />

displays within current practice multiple<br />

facets. In the matter of crimes against the<br />

State, the law requires revealing the<br />

secret, for the other crimes, divulging the<br />

secret will only occur in exceptional<br />

cases <strong>–</strong> dictated by the physician’s<br />

consciousness.”<br />

The two doctors also worked out a<br />

study correlated to the legislation in<br />

force. There is this way presented the<br />

article 350 in the former Penal Code:<br />

“The physicians, the surgeons, the<br />

pharmacists, the midwives any other<br />

such persons, who “following to be, in<br />

line with the nature of their profession,<br />

acquainted with and therefore stated as<br />

keepers of the secrets they have been<br />

entrusted <strong>–</strong> will let them out <strong>–</strong> excepting<br />

the occurrences when the law asks for<br />

such a disclosure <strong>–</strong> will be sentenced to<br />

prison, from one month to six months,<br />

and will be fined from 100 lei/Romanian<br />

currency to 500 lei.”<br />

In Romania, there were also other<br />

legal regulations connected to ethics.<br />

This way, the Penal Code of Charles the<br />

2 nd , article 505, paragraphs1, 2.5<br />

stipulated such regulations:<br />

1. The offence of revealing<br />

professional secrets, which was<br />

“stipulated by the ancient Penal<br />

Code, in the art. 305, has as<br />

constitutive elements: 1) the<br />

quality of the person acquainted<br />

with a secret “in virtue of one’s<br />

situation, position, profession or<br />

appointment 2) the secret that one<br />

of the persons enumerated above<br />

is under obligation to keep; 3) the<br />

divulging or the revealing deed;<br />

4) the divulgation of the secret<br />

might constitute a possibility of<br />

prejudice; 5) he who divulges the<br />

secret might not be authorized by

L. ROGOZEA, et all, Three personalities of medicine <strong>–</strong> representative for medical ethics within 19<br />

Romania<br />

law to divulge it, 6) intention of<br />

fraud.”<br />

2. The first element of the offence<br />

represented by the deed of<br />

divulging the professional secret<br />

is the quality of the person who is<br />

acquainted with a secret; the<br />

legislator only makes reference to<br />

those persons who, in virtue of<br />

their position, profession or<br />

appointment receive certain<br />

confidences from those who need<br />

the services falling into their<br />

attributions. If a person is<br />

entrusted a confidence that<br />

however has no direct connection<br />

with the situation, position<br />

profession or appointment of the<br />

person who was entrusted the<br />

secret, the offence of revealing<br />

the professional secret cannot<br />

have been performed.<br />

3. The second element of the<br />

offence represented by the deed<br />

of divulging the professional<br />

secret is the secret itself. Secret<br />

constitutes any confidence that<br />

one of the persons fitting within<br />

the provisions of the art. 505 has<br />

found out, only by virtue of the<br />

quality, of the position, of the<br />

profession or of the appointment<br />

he holds, there being obvious the<br />

desire of the confidant for his<br />

confidence not to be found out by<br />

others.<br />

The law refers to the conditions in<br />

which we do not speak of professional<br />

secrecy (the facts have no connection with<br />

the quality, with the profession of the<br />

confided person, the information are<br />

obtained on private path).<br />

There is afterwards mentioned Max<br />

Simon: “when the physician has taken hold<br />

on the patient’s spirit, when the former has<br />

raked up the most remote and hidden<br />

nooks of the latter’s soul, he has contracted<br />

against the patient a new obligation, the<br />

one of absolute discreetness, which seals<br />

within his conscience not only the secrets<br />

revealed to him, but also those he has<br />

caught glimpse of during his medical<br />

investigations.”<br />

Conclusion<br />

History brings forth that in life, the<br />

balance inclines more often towards lie<br />

than towards truth. <strong>Medical</strong> ethics is<br />

compelled to do its best so as to contradict<br />

statistics. When somebody wishes to<br />

become physician, pharmacist or nurse, we<br />

dare say one is naturally strongly<br />

motivated. Sometimes, nevertheless, one’s<br />

subsequent activity makes us doubt as to<br />

these motivations.<br />

This is the reason why the example of<br />

forerunners such the brothers Minovici,<br />

Kernbach or I. St�nescu is more than<br />

essential.<br />

Selective bibliography<br />

1. Dumitra�cu, D <strong>–</strong> Medicine between<br />

Miracle and Deception, Dacia<br />

Publishing House, Cluj Napoca, 1986<br />

2. Du�escu, B <strong>–</strong> Victor Gomoiu 1882-<br />

1960, <strong>Medical</strong> Publishing House,<br />

Bucharest, 1970<br />

3. Iorga, N <strong>–</strong> <strong>Medical</strong> Men and Medicine<br />

within Romanian Times of Yore,<br />

Bucharest 1919<br />

4. Marin, Fl. <strong>–</strong> Lives Dedicated to<br />

Human Being, vol. 1-6, Dacia<br />

Publishing House, Cluj Napoca, 1993-<br />

1997<br />

5. Ozun, R., Poenaru, E. <strong>–</strong> Professional<br />

and Social Responsibility incumbent<br />

on Physician, <strong>Medical</strong> Publishing<br />

House, 1973<br />

6. Rogozea L. - Nicolae Minovici �i<br />

Secretul Profesional, Al IV-lea<br />

Simpozion Na�ional de Istoria<br />

Psihiatriei, Bucure�ti, 20-22 Mai,<br />

2004, p.42<br />

7. Rogozea L., Marcu N. - Doctor

20<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

Nicolae Minovici <strong>–</strong> un theoretician at<br />

medical ethical, 40 th International<br />

Congress on the History of Medicine,<br />

Budapest, Hungary, August 26- 30,<br />

2006 <strong>–</strong> pg. 775-77.<br />

8. The Handbook on <strong>Medical</strong> Ethics <strong>–</strong><br />

Clarke, Doble and Brendon, London,<br />

1981<br />

9. Rogozea L. <strong>–</strong> Etic� �i deontologie<br />

medical�, vol. 1, Ed. Universit��ii<br />

Transilvania, 2006, 158 pg.<br />

10. Rogozea L., Beldean L. - Aspecte ale<br />

eticii medicale în România, Acta<br />

Medica Transilvanica nr.2, 2000,<br />


Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />




M. YAPRAK 1 N. GÖKÇE 2<br />

Abstract:<br />

Dr. �brahim Temo (1865-1945) one of the founders of The Committee of<br />

Union and Progress (�ttihat ve Terakki Cemiyeti) was born in Struga as an<br />

Ottoman citizen with Albanian origin. He graduated from Gülhane Military<br />

<strong>Medical</strong> School in 1892. He began his ophthalmology education in Istanbul<br />

but finished in Romania, because he had to escape from dictatorship of II.<br />

Abdülhamid. He opened a lot of bureaus of Committee in Bulgaria and<br />

Romania. Temo returned to �stanbul in 1908 but didn’t get on with his<br />

Committee. He founded Osmanlı Demokrat Partisi (Ottoman Democratic<br />

Party). In 1911 he returned to Romania because of pressures and threats.<br />

Temo was not only a doctor and a politician. He was also an author. He<br />

always wrote. He sent writings from Romania to Türkish journals especially<br />

the �çtihad of Abdullah Cevdet who was also one of the founders of The<br />

Committee. It is reported that achieve of Temo is in Tiran. In his writing in<br />

the �çtihat of 01 February 1925, he notices first the importance and misery of<br />

the Bursa thermal springs. Later he introduced some important thermal<br />

springs and hospitals of Romania. He gives communications about the<br />

attaining, prices and medical utilities of these organizations. According to<br />

this important writing about history of thermal medicine of Türkiye and<br />

Romania, thermal springs of Romania were in better condition than Bursa<br />

thermal springs in 1925<br />

Key words: Ibrahim Temo, Romania, Thermal Spring, Bursa, Türkiye<br />

In 1920’s hydrotherapy, balneotherapy,<br />

spa centres and sanitarium therapy were<br />

more popular treatment modalities than<br />

today’s modern medicine and physical<br />

therapies. There are a few articles focusing<br />

on thermal therapies of those times.<br />

An interesting and comparative article<br />

was written by Dr. �brahim Temo (3). He,<br />

in his article, compared Turkish and<br />

Pomanian thermal therapy centres from<br />

medical history point of view. Temo’s<br />

article provides important information on<br />

thermal therapies of 1920’s.<br />

Dr. �brahim Temo (1865-1945), one of<br />

the founders of the Committee of Union<br />

and Progress (�ttihat ve Terakki Cemiyeti),<br />

was born in Struga as an Ottoman citizen<br />

of Albenian origin (See Figure 1).<br />

After graduated from Gülhane Military<br />

<strong>Medical</strong> School in 1892, he started studing<br />

ophtalmology in Istanbul. Since he had to<br />

escape from the dictatorship of<br />

Abdülhamid II, he completes his training<br />

period in Romania. He opened a lot of<br />

1 Trakya University, <strong>Medical</strong> Faculty Departments of Physiology, Edirne - Turkye<br />

2 Trakya University, <strong>Medical</strong> Faculty Departments of History of Medicine - Edirne - Turkye

22<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

bureaus of the Committee in Bulgaria and<br />

Romania. Temo returned back to �stanbul<br />

in 1908 but didn’t get along with his<br />

Committee. He founded Osmanlı<br />

Demokrat Partisi (Ottoman Democratic<br />

Party). Because of the pressures and<br />

threats, he returned to Romania in 1911<br />

[10, 11].<br />

Figure 1: Dr. �brahim Temo as Red Cross<br />

physician in �stanbul, 1913.<br />

Temo was not only a doctor or a<br />

politician, but also an author. Before and<br />

later from his second migration to<br />

Romania, he wrote a lot of articles and<br />

several books. Some of his books are Aile<br />

Hekimi (Family Practitoner), Tagaddi ve<br />

Devam-ı Hayat (Nutrition and Life),<br />

Kuduz (Rabies), Türkçe-Romence<br />

Mükaleme (Turkish-Romanian Conversation),<br />

Tababet-i avam Dersleri (Lessons<br />

in Public Health), Hareket (Motion; coauthered<br />

by Ali �efik), Atatrürk’ü Niçin<br />

Severim (Why I Admire Atatürk; 1937-<br />

Medgidia, 2001 Prizen), �ttihat ve Terakki<br />

Cemiyeti’nin Te�ekkülü ve Hidemat-ı<br />

Vataniye ve �nkılab-ı Milliye Dair<br />

Hatrıratım (Foundation of the Committee<br />

of Union and Progress and my Memories<br />

of the national Revolution and Services to<br />

the Motherland; 1939 Medgidia, 1987<br />

�stanbul), Usul-ü Mükaleme (Method of<br />

Conversation) [3, 4, 5, 6, 7, 8, 9, 11].<br />

It is reported that achieve of Temo is in<br />

Tiran [1-2].<br />

He submitted his articles from Romania<br />

to Turkish journals, especially to the<br />

�çtihad of Abdullah Cevdet, who was<br />

another founder of the Committee (See<br />

Figure 2).<br />

Figure 2: �ctihad journal<br />

His article published in the February<br />

1925 issue of the �çtihat on the subject of<br />

the thermal springs of Bursa and Romania<br />

(See Figure 3).<br />

Figure 3: The title of Temo’s article

M. YAPRAK et al: One Writing from �brahim Temo about Thermal Springs of Bursa and Romania 23<br />

Temo made several journeys to Vienna<br />

(1901), Paris (1902, 1918), Egypt (1907),<br />

Türkiye (1913, 1923, 1930), Albania<br />

(1914) and two migration to Romania<br />

(1895, 1912). These expressions must be<br />

related with his first visit to Türkiye after<br />

the foundation of Republic [10-11].<br />

The article begins with the expression<br />

of Temo about Bursa thermal springs.<br />

According to Temo the baths are<br />

miserable. They need reanimation, medical<br />

servants, water analysis and legal<br />

regulation. There isn’t any hotel and<br />

restaurant around the Bursa thermal<br />

springs [3].<br />

In the second part of article, the thermal<br />

springs in Romania are introduced. He<br />

gave information about the transportation<br />

options, prices and medical utilities of<br />

these facilities [3].<br />

According to the article, the important<br />

thermal springs of Romania are Episkubus<br />

or Krian (Baile 1 Mai), Feliks (Baile<br />

Felix), Moneasa (Moneasa), Gorgiya<br />

(Geoagiu), Dobruca (Spa Dobrich?),<br />

Kovana (Covasna Spa), Mangalya<br />

(Mangalia), Tekir Gölü (Lake<br />

Techirghiol), Lagülsarat (Salt Lake),<br />

Govora (Baile Govora), Herculane (Baile<br />

Herculane), Mohad (Mehadia), Moldovya<br />

(Slanic Moldova) Bijular, Siriya, and Vace<br />

[3].<br />

In the study, Kasalata (Calimanesti-<br />

Caciulata), Pani (in Bukovina) and<br />

Devrnavanr mineral waters are praised.<br />

Some promanade like as Agpaya, Azoga,<br />

Bireza, Berabu, Berazova, Buztin Geçine,<br />

Kimpolonoa, Aliye�te, Çaba, Komurniki,<br />

Kurtedu, Erçi, Duverna, Morillan,<br />

Nemçen, Puya, Naçavluj, Brodevud,<br />

Grillet, Marillan, Nemçu, Payanaçabuluji,<br />

Borodeal, Rugfer, Sinaya, Suvi, Suzana,<br />

Tirguavgana, Tizmana, Valenda, Mevneta<br />

and Veratik are also praised in the writing<br />

[3].<br />

Temo gives some information about<br />

important health centers of Romania like<br />

as Antuvaniyu, Diyaguneselur, Jeravta,<br />

Naturaliyust, Alberabeta, Alanaherakayede<br />

(Sabtane) Gayllart, Tekirgölü sanitariums;<br />

Kulçe, Brankuvenasa, Eforiya, Markoca,<br />

Bantalemun, Manernimate, Kuluj (Cluj)<br />

University and Çernaviçe hospitals and<br />

dentistry college [3].<br />

The names in the writing need to be<br />

critized by an expert. It may be said that<br />

the study has some smell of advertising of<br />

thermal springs and other medical centres<br />

of Romania.<br />

References<br />

[1]. Kutlay N: �ttihat Terakki ve Kürtler.<br />

Beybun, Ankara, 1992<br />

[2]. Polat A: Arnavutluk Devlet Ar�ivleri<br />

Genel Müdürü Prof. Dr. Shaban<br />

Sinani ile mülakat. Türk Kültürü ve<br />

Hacı Bekta� Veli Ara�tırma Dergisi.<br />

Sayı: 33, 2005.<br />

[3]. Temo �: Romanya’nın sanatoryumları,<br />

kaplıcaları, hava almaya ve tedaviye<br />

mahsus mevsim istasyonları. �ctihat,<br />

February 1925, Year: 20, Nu: 174,<br />

pp: 3498-3501.<br />

[4]. Temo �: �ttihad ve Terakki<br />

Cemiyeti'nin Te�ekkülü ve Hidemât-i<br />

Vataniyye ve �nkılâb-ı Millîye Dair<br />

Hatıratım. Medgidia, 1939.<br />

[5]. Temo �: �brahim Temo'nun �ttihad ve<br />

Terakki Anıları. Arba, �stanbul,<br />

1987.<br />

[6]. Temo �: Atatürk'ü Niçin Severim,<br />

Medgidia, 1937.<br />

[7]. Temo �: Atatürk'ü Niçin Severim,<br />

BAL-TAM Yayınları, Prizen, 2002.<br />

[8]. Uygur S: �brahim Temo’nun Bilinmeyen<br />

Bir Eseri: Usûl-i Mükâleme.<br />

Modern Türklük Ara�tırmaları<br />

Dergisi, 5/2:65-73, 2008.<br />

[9]. Ülgen E, Aksu A: Mektep ve Aile<br />

Mecmuası (1915-1916). Constanta,<br />


24<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

[10]. Ünver S: Doktor �brahim Temo. CTF<br />

Tıp Tarihi ve Dontoloji Ar�ivi (Cilt<br />

1). �stanbul, 1935.<br />

[11]. Yaprak M, Gökçe N: Dr. �brahim<br />

Temo. Proceedings of the 38th<br />

International congress on the History<br />

of Medicine. �stanbul, 1-6 September<br />


Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />


ZERVOS (1842-1901) AND HIS<br />



1 SRIM,<br />

2 National Medicines Agency, SRIF,<br />

3 SRIF<br />

A. LUCASCIUC 1 , M.-G. SULIMAN 2 ,<br />

O. ELEFTERIU 3 , C. GRECU 3<br />

Abstract: Hereby we intend to follow the road along Zervos family in<br />

Romania, from the first appearance in the city of Sulina (1872), the<br />

pharmacist Gherasimos Zervos, originating in Kefalonia Greece and up to its<br />

recent descendants, Zervos physicians from Bucharest, who expatriated<br />

themselves to New York in 1994. Sulina town located in the Danube Delta<br />

was under a great economic and cultural development due to the installation<br />

here, in 1856, of the European Commission for the Danube. Thus, the city<br />

becomes an attractive place for many physicians and pharmacists, as well as<br />

for young pharmacist Zervos, a diplomat of the University of Padova (Italy).<br />

He will soon become the owner of the pharmacy "Minerva" (1881),<br />

pharmacy which subsequently will receive the name of "Speranta" in 1895.<br />

From the six children of pharmacist Gherasimos Zervos, Jack and George -<br />

the first-born children - will be sent to a high school education and medicine<br />

in Greece capital, Athens. The first will meet a great professional ascension:<br />

he was the physician and personal adviser of Abyssinia’s Emperor, Haille<br />

Sellasie I (who reigned from 1930 to 1974), the second will continue the<br />

Zervos physicians „dynasty” in Romania.<br />

Key words: Zervos, pharmacist<br />

Hereby we intend to follow the long<br />

history of the Zervos family in Romania,<br />

during 1872-1994.<br />

At the very beginning of this adventure,<br />

the milestone was represented by<br />

Gherasimos Zervos, born in 1842, in<br />

Zervata, Kefalonia Island, Greece.<br />

His name was mentioned in 1872 [1] in<br />

the �free port� of Sulina located in the<br />

Danube Delta, where he was about to settle<br />

�a true and genuine dynasty�: five sons and<br />

two daughters, the first two born, Jack and<br />

George, would become physicians; other<br />

nephews and grand-grandchildren would<br />

be spread around the world.<br />

The last descendant in Romania was<br />

doctor Gherasim Tuchiditi Harilaos<br />

Zervos, who has emigrated, together with<br />

his wife, in 1994, in the USA, where his<br />

sons were living.<br />

The young Zervos, who graduated from<br />

the Faculty of Pharmacy in Padova (Italy),

26<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

was already encountering a prosperous<br />

material status, which allowed him at his<br />

arrival, in 1872, to open a pharmacy in the<br />

free port of Sulina, under the name of the<br />

wise deity �Minerva� [2].<br />

Notwithstanding, from the beginning he<br />

received the help of two business partners<br />

right from the beginning: dr. Contomihalos<br />

and after his departure, dr. Valentin Stais<br />

[3].<br />

In this prosperous city, which was the<br />

residence of the European Danube<br />

Commission ever since 1856, the<br />

pharmacist Zervos was the sole owner of a<br />

pharmacy: a medical statistic study of<br />

November 14 th , 1879 (the official date of<br />

the Romanian administration commencement<br />

in Dobrogea), mentions only 2<br />

pharmacies in Sulina: �Minerva� and the<br />

pharmacy of the European Danube<br />

Commission’s Hospital [3].<br />

The legal framework under continuous<br />

change brought amendments also for the<br />

�Pharmacy’s business carrying out�: by<br />

means of the Ministers’ Council Journal<br />

no. 8 of February 6 th , 1881, the pharmacies<br />

with foreign owners (without Romanian<br />

citizenship) as in the case of the �Minerva�<br />

pharmacy from Sulina, were only<br />

acknowledged under �personal right� [3].<br />

The grounds of the name change, of<br />

Gherasimos Zervos’ pharmacy, are<br />

unknown in 1895, subsequently being<br />

renamed �Speran�a�. Under this optimistic<br />

name the pharmacy was run for another<br />

five years by Gherasimos Zervos, until his<br />

death on January 30 th , 1901 [4].<br />

Starting that year, the family of the<br />

deceased Zervos gives under concession<br />

the pharmacy up to 1916 to the<br />

pharmacists: Nicolae Lupescu, Pavel<br />

Avram and Gh. C�lin [4].<br />

The First World War breaks off the<br />

ordinary course of life in the Sulina free<br />

port as well: subsequently, the destiny of<br />

Zervos family and of the pharmacy<br />

changed, the documents of those times<br />

having provided no statement at all. Under<br />

the same silence were also placed the<br />

successors of the pharmacist Gherasimos<br />

Zervos (1842-1901) from Sulina.<br />

Their discovery was revealed upon the<br />

reading of the travel book �Abyssinia� [5],<br />

signed by the reporter-writer Mihai Tican-<br />

Rumano (1895-1967), who had travelled<br />

along five continents and represented a<br />

genuine ambassador of our country.<br />

In 1934, having journalistic interests<br />

concerning the Italo-Abyssinian conflict,<br />

recently begun at the country borders, he<br />

travels to Ethiopia, hoping that his dream<br />

would come true, namely that of seeing<br />

�an African Christian-Orthodox country<br />

by excellence, the country of the world’s<br />

most pious emperor, Haile� Selassié I� [6].<br />

Being under preparation and alert due<br />

to the war, the audience to the emperor<br />

became unachievable. He was advised to<br />

ask for help from the personal counselor<br />

and physician of the Imperial Court of<br />

Abyssinia’s capital, Addis-Abeba.<br />

A cordial reception was held in the<br />

doctor’s house, a certain dr. Zervos.<br />

The business card of the Romanian<br />

writer stirred great emotions and<br />

enthusiasm: the doctor started to speak<br />

Romanian!<br />

Although having strong Greek<br />

influences, the Romanian language spoken<br />

in the heart of Abyssinia by the doctor<br />

caused a great surprise also to the reporter<br />

Mihai Tican-Rumano.<br />

He was in front of Dr. Jaques Zervos,<br />

the private physician of the Imperial Court<br />

and resident minister of Greece in Addis-<br />

Abeba.<br />

Jaques Zervos had confessed about his<br />

native and childhood city, Sulina, where<br />

his parents rest in peace, about his<br />

children, �a boy and a girl who learn at our<br />

schools�, about his big family from<br />

Romania and about the studies at the<br />

Faculty of Medicine in Athens, together

A LUCASCIUC et al: The Greek pharmacist Gherasimos Zervos (1842-1901) and his successors, 27<br />

the Zervos physicians from Romania<br />

with his brother George Zervos, physician<br />

in Bucharest [7].<br />

Thus one of the most famous sons of<br />

Zervos was identified. Where are the<br />

others?<br />

60 years later.<br />

Bucharest, March 1995.<br />

In the most original way, we found out<br />

that the last Zervos was preparing to leave<br />

Romania: we are speaking about Dr.<br />

Gherasim T. H. Zervos (dr. George<br />

Zervos’ son), an obstetrician, former<br />

manager of Filantropia Hospital in<br />

Bucharest.<br />

Although surprised that there is another<br />

person who succeeded in solving the<br />

present �puzzle� regarding his family, the<br />

pharmacist’s nephew confirmed us the<br />

bibliography and the pages wrote by Mihai<br />

Tican-Rumano, in the chapter �A<br />

counselor of the Imperial Court� of<br />

�Abyssinia� [8].<br />

The ZERVOS family, Gala�i 1930<br />

The first on the left on the third upper row is Dr. Jacques ZERVOS (Ethiopia),<br />

together with his four brothers.<br />

References:<br />

1. Georgescu-Tulcea N., Istoricul<br />

asisten�ei cu medicamente a popula�iei<br />

din Dobrogea de nord, p. 381-386, vol.<br />

<strong>Medical</strong> Retrospectives <strong>–</strong> studies,<br />

notes and documents, published by Dr.<br />

G. Br�tescu, <strong>Medical</strong> Publishing<br />

House, Bucharest, 1985, p. 382.<br />

2. Georgescu-Tulcea N., Istoricul<br />

asisten�ei cu medicamente a popula�iei

28<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

din Dobrogea de nord, p. 381-386, vol.<br />

<strong>Medical</strong> Retrospectives <strong>–</strong> studies,<br />

notes and documents, published by Dr.<br />

G. Br�tescu, <strong>Medical</strong> Publishing<br />

House, Bucharest, 1985, p. 382.<br />

3. Georgescu-Tulcea N., Istoricul asisten�ei<br />

cu medicamente a popula�iei din<br />

Dobrogea de nord, p. 381-386, vol.<br />

<strong>Medical</strong> Retrospectives <strong>–</strong> studies,<br />

notes and documents, published by Dr.<br />

G. Br�tescu, <strong>Medical</strong> Publishing<br />

House, Bucharest, 1985, p. 384.<br />

4. Georgescu-Tulcea N., Istoricul asisten�ei<br />

cu medicamente a popula�iei din<br />

Dobrogea de nord, p. 381-386, vol.<br />

<strong>Medical</strong> Retrospectives <strong>–</strong> studies,<br />

notes and documents, published by Dr.<br />

G. Br�tescu, <strong>Medical</strong> Publishing<br />

House, Bucharest, 1985, p. 385.<br />

5. Tican-Rumano M., Abisinia, 2 nd Edition,<br />

Cartea Româneasc� Publishing House,<br />

Bucharest, 1935, 281 p.<br />

6. Tican-Rumano M., Abisinia, 2 nd Edition,<br />

Cartea Româneasc� Publishing House,<br />

Bucharest, 1935, p. 128.<br />

7. Tican-Rumano M., Abisinia, 2 nd Edition,<br />

Cartea Româneasc� Publishing House,<br />

Bucharest, 1935, p. 114.<br />

8. Tican-Rumano M., Abisinia, 2 nd Edition,<br />

Cartea Româneasc� Publishing House,<br />

Bucharest, 1935, p. 112-122.

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> <strong>VI</strong>: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />




A. LUCASCIUC 1 M.-G. SULIMAN 2,3<br />


Abstract: The present work will present a bibliographical list containing<br />

only Greek physicians and pharmacists with specialist training in Athens<br />

(Greece). The few names that have been lost in obscurity are offset by other<br />

personalities who gave medical and pharmaceutical professions resonance in<br />

Romania. Amongst these physicians we mention: Jack and George Zervos,<br />

sons of the pharmacist Gherasimos Zervos (1842-1901) from Sulina,<br />

Comboti Nicholas with doctorate in medicine in 1845, which, subsequent to<br />

the achievement of the free practice right, became a prominent member of<br />

medical society and even the top of the scientific pyramid - chief doctor of<br />

Bucharest in 1869, doctor Androcles Fotino, born in Braila (1834) has<br />

accomplished higher education in Paris and Athens. Upon his return back<br />

home, he achieved higher grades as officer-doctor and professor at the<br />

Bucharest School of Medicine, Pharmacy and Veterinary Science. Amongst<br />

the pharmacists we mention: Petzalis Rasti Sophocles, which graduated with<br />

apothecary diploma in Athens in 1857, in 1864 is the owner of the pharmacy<br />

"Esculap" in Braila until 1883, when his son-in-law receives the ownership<br />

of the pharmacy, Dr. Mina Minovici (Father of forensics in Romania),<br />

continues to work in the laboratory, until his death (1894); Andreea Nicolae,<br />

master in pharmacy graduate from Athens, known in 1864 as owner of the<br />

pharmacy "Spiteria Romana" from Galati, etc.<br />

Key words: Athens, Romania, pharmacists.<br />

Within the bibliographical inventory<br />

presented are listed, in alphabetical order,<br />

the professionals with studies and medical<br />

and pharmaceutical diplomas achieved in<br />

Athens. The primary bibliographical<br />

source is presented abbreviated.<br />

Physicians<br />

1. Adamantis Apostol<br />

(„Veriotul-doctoru”) born in Veria<br />

(Macedonia) in 1822.<br />

1 ISHM, Bucharest.<br />

2 National Medicines Agency, Bucharest.<br />

3 RSHP, Bucharest.<br />

He was for 3 years the apprentice of<br />

medicine attached to Vretos (Serafim<br />

Vreton Ion „the Armenian”), born in<br />

Bucharest, „Parisian doctor, from 1815”;<br />

he was the physician and the teacher of the<br />

prince of Walachia, Ion Caragea.<br />

Vretos, physician, philosopher and<br />

remarkable bibliophile, dr. Adamantis<br />

wrote that his mentor had also the intention<br />

to publish the manuscripts collected, but<br />

all of them burned during the fire in April<br />

1847, together with Bucharest houses.

30<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

Supposing that, the last journey<br />

performed by dr. Serafim Vretos in<br />

Greece, during 1841-1844, had as main<br />

goal the guidance of the young<br />

Hippocrates’ apprentice regarding the<br />

improvement of serious medicine studies<br />

in Athens.<br />

Therewith, we settle the return year in<br />

Walachia (1844), since, subsequent to this<br />

date, both of them are mentioned in the<br />

documents. Dr. Adamantis mentions him,<br />

„in a prologue”, as being his mentor and<br />

inoculating him the passion for introducing<br />

into thesaurus the written word, thus, he<br />

collected treasure, in his turn, consisting in<br />

books and manuscripts „800 volumes of<br />

medicine and literature”, which he had to<br />

offer for sale when his daily subsistence<br />

was threatened. [3 p.7; 392-393; 452; 461]<br />

2. Cantili Vasile<br />

1829 <strong>–</strong> medicine diplomat in Athens;<br />

1860 <strong>–</strong> unrestricted practice license in<br />

Bucharest;<br />

1863 <strong>–</strong> 1 st class regiment physician<br />

competition [2, No. 18 <strong>–</strong> 25 June];<br />

1863 <strong>–</strong> member in the Hygiene and<br />

Sanitation Council of Ploiesti [3 p. 60].<br />

3. Colovos Anastasie<br />

1854 <strong>–</strong> medicine diplomat in Athens;<br />

1858 <strong>–</strong> Bucharest;<br />

1863 <strong>–</strong> physician with the free consult<br />

service of the Col�ea Hospital health centre<br />

[2, No. 5];<br />

1863-1876 <strong>–</strong> private clinic physician and<br />

the same position for free consults (Health<br />

Service Yearbook) [3, p. 77].<br />

4. Comboti Nicolae<br />

1845 <strong>–</strong> PhD in medicine in Athens and<br />

unrestricted practice license in Bucharest;<br />

1860 <strong>–</strong> physician of the Black Sector,<br />

Bucharest;<br />

1863 <strong>–</strong> physician of the Red Sector,<br />

member of the Scientific <strong>Medical</strong> Society;<br />

1863-1866 - member of the Hygiene<br />

and Sanitation Council of Bucharest;<br />

1870 <strong>–</strong> Head of the Bucharest Health<br />

Division [3, p. 77].<br />

5. Fotino Androcles (Andrei),<br />

11 th of November, 1834 Br�ila <strong>–</strong> 9 th of<br />

May 1907 Bucharest.<br />

1859 <strong>–</strong> PhD in medicine in Athens;<br />

1860 - unrestricted practice license in<br />

Bucharest;<br />

1860<strong>–</strong>1864 <strong>–</strong> regiment physician,<br />

promoted to head of the 5 th medical<br />

division of the Military Hospital, while<br />

teaching „the recruit and reform course at<br />

the National Medicine School” to the<br />

veterinary division;<br />

1864 <strong>–</strong> Head of the 1 st Surgery Division<br />

of the Military Hospital; publishes various<br />

scientific works and clinical observations<br />

from the division he runs;<br />

1865 <strong>–</strong> member of the Superior Health<br />

Council and promoted to 1 st class senior<br />

physician (1875);<br />

1876 <strong>–</strong> member of the Red Cross<br />

Committee;<br />

1877-1878 <strong>–</strong> takes part in the<br />

Independence War, driving the ambulance<br />

of the Main Sector of Mecika; starting with<br />

December 1877, he manages the military<br />

hospitals; awarded the Military Virtue;<br />

1882 <strong>–</strong> senator of Mehedin�i; Law<br />

Reporter of the Health Service<br />

Organisation Law;<br />

1885 <strong>–</strong> General Manager of the Civil<br />

Health Service;<br />

1891 <strong>–</strong> participated in the Hygiene and<br />

Demography Congress in London;<br />

1893 <strong>–</strong> severally awarded for his heroic<br />

deeds, honesty and professional<br />

competence, he reached his full retirement<br />

age [3, p. 148 <strong>–</strong> 149].<br />

6. Kefalos Trasivul<br />

Son of physician Kefalos from<br />

Constan�a;<br />

1865 <strong>–</strong> medicine diplomat in Athens,<br />

returns in Constan�a;

A. LUCASCIUC et al.: Greek Physicians and Pharmacists Graduated in Athens Practicing in … 31<br />

1868 <strong>–</strong> dies due to typhoid, buried in the<br />

Greek Church’s yard (after dr. H. Serafidi<br />

„Medicine in Dobrogea”) [3, p. 223].<br />

7. Micralopulo, physiscian<br />

Diplomat of the Athens Faculty of<br />

Medicine (-), he settled in 1864 in Tulcea,<br />

but the newspaper „Sanitarul” [3, p.280]<br />

mentions that he left Tulcea soon after that.<br />

8. Orlando, physician<br />

1865 <strong>–</strong> PhD in Athens, domiciled in<br />

Tulcea where he was employed „as family<br />

doctor” for 20 houses, later he went to<br />

Paris and never returned [3, p. 308].<br />

9. Sacorafos Michail<br />

1850 <strong>–</strong> PhD in Athens and unrestricted<br />

practice license in Romania;<br />

1862-1866 <strong>–</strong> physician of districts II and<br />

III, Gala�i;<br />

December 1868 <strong>–</strong> 1873 <strong>–</strong> owner of the<br />

„Domneasc�” pharmacy in Gala�i (Dr.<br />

Cazacu and C. Frunz�) [3, p. 372].<br />

10. Stavridi Constantin<br />

1857 <strong>–</strong> PhD in Athens and unrestricted<br />

practice license in Gala�i;<br />

1865 <strong>–</strong> publishes the „Report over the<br />

epidemic of cholera morbus occurred in<br />

Gala�i in 1865” [2 (nr. 3,4,6), 3 (p. 410)].<br />

11. �u�u (�utzu) Alexandru<br />

1837 <strong>–</strong> 1919 Bucharest<br />

Subsequent to secondary school, went to<br />

Athens where he acquires the bachelor’s<br />

degree in medicine.<br />

1865 <strong>–</strong> PhD degree for the<br />

„Considérations sur la dyspepsie<br />

essentielle” (Paris);<br />

October 1865 <strong>–</strong> unrestricted practice<br />

license in Bucharest (M. M. no. 33);<br />

March 1866 <strong>–</strong> secondary physician;<br />

starting with 1867, chief physician of<br />

M�rcu�a asylum;<br />

1867 <strong>–</strong> 1868 <strong>–</strong> registered with the<br />

National Medicine School program for the<br />

course „mental illness clinic” (Sunday<br />

courses);<br />

1876 <strong>–</strong> 1877 <strong>–</strong> „The alienated in front of<br />

the society and in front of science. <strong>Medical</strong><br />

and psychological studies” <strong>–</strong> psychiatry<br />

forensic study (DCMF);<br />

1877 <strong>–</strong> founder of the „Caritatea”<br />

Institute on Plantelor St., Bucharest<br />

(„Private health house for mental illness”);<br />

1879 <strong>–</strong> mental pathology and forensics<br />

professor, in 1881 became the Lecturer’s<br />

chair for mental and psychic diseases from<br />

the Faculty of Medicine in Bucharest;<br />

awarded the „Sf. Ana” Order, 2 nd degree;<br />

1884 <strong>–</strong> publishes „The Forensic and<br />

Psychiatry Magazine” (the first in this<br />

domain) where he publishes: „A few words<br />

about the intellectual epidemics” (No. 2),<br />

„Psychosis classification” (his last work);<br />

1901 <strong>–</strong> member of the Superior <strong>Medical</strong><br />

Council and correspondent member of the<br />

Romanain Academy [3, p. 419 <strong>–</strong> 420].<br />

12. Vaias Teodosie<br />

1862 <strong>–</strong> PhD in Athens; on October 17 th<br />

he achieved the unrestricted practice<br />

license in Bucharest [2, No. 28];<br />

1863 <strong>–</strong> resigns from the Calafat city<br />

physician position and on June 10 th is<br />

appointed as Caracal city physician;<br />

1864 <strong>–</strong> physician in Tg. Jiu Hospital<br />

(Gorj County) [3, p.144].<br />

Pharmacists<br />

1. Andreea Nicolae<br />

Magister in pharmacy with bachelor’s<br />

degree in Athens (1856).<br />

1858 <strong>–</strong> unrestricted practice license in<br />

Romania;<br />

1860 <strong>–</strong> opens a pharmacy in Gala�i (N.<br />

Angelescu, p. 170 - 171);<br />

1864 <strong>–</strong> owner of the pharmacy „Spi�eria<br />

Român�” in Gala�i (Health Service<br />

Yearbook/1864 up to 1875).

32<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

2. Aescht Rudolf<br />

Diplomat in Athens mentioned in the<br />

Health Service Yearbook 1864 with<br />

unrestricted practice license [3, p. 7].<br />

3. Mihailidis spi�erul<br />

Diplomat in Athens (-), opens a<br />

pharmacy in Tulcea between 1859-1860;<br />

due to competition grounds, he moves to<br />

Sulina [3, p. 382], where he is no longer<br />

certified by the bibliographies researched.<br />

4. Petzalis Rasti Sofocle<br />

1857 - Diplomat in Athens;<br />

1864 <strong>–</strong> owner of the pharmacy „Esculap”<br />

in Br�ila until 1883, when the pharmacy is<br />

taken-over by his son-in-law, dr. Mina<br />

Minovici, however he continues to work in<br />

the laboratory, up to his death in 1894.<br />

References<br />

1. Dic�ionar cronologic de medicin� �i<br />

farmacie <strong>–</strong> sub redac�ia G. Br�tescu,<br />

Editura �tiin�ific� �i Enciclopedic�,<br />

Bucure�ti, 1975 (DCMF).<br />

2. Monitorul <strong>Medical</strong> (M M).<br />

3. Repertor de medici, farmaci�ti,<br />

veterinari (personalul sanitar) din<br />

�inuturile române�ti vol. I (înainte de<br />

1870) - Dr. V. Gomoiu �i farmaci�tii<br />

Gh. Gomoiu �i Maria V. Gomoiu, Tip.<br />

„Presa” Br�ila, 1938 (RMFV).

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />


M. BESCIU 1<br />

“Orthodox Church remains intangible by extending its arms in the<br />

Eastern European territories and preserving an entire art and<br />

almost an entire civilization” (N.Iorga)<br />

Abstract: The organization level of the sanitary security shows the<br />

unquestionable level of Byzantine medicine. The people from that period<br />

believe in healings gods. Cosma and Damian are representatives for the cult<br />

of physicians without silver. During this period the charity institutions was<br />

developed, and the physicians could study individual or in dedicated schools.<br />

The schools activated near hospitals and the candidate who succeeded at the<br />

exam, receive a sort of symbol that made the difference between physicians<br />

and impostors. The interesting thing is that the doctor accord an important<br />

attention to the nutrition, not only to the medical treatment Rich professional<br />

libraries were also found in hospitals, and they are endow with important<br />

medical books such as magnificent manuscript which includes the work of<br />

Dioscoride, Materia Medica, since 512, wrote for Anicia Iuliana. All of these<br />

it will be presented to you with all the Byzantine medical personalities’<br />

contributions: Oribas, Alexandru from Trales, Aetius from Amida, Pavel<br />

from Egina, Jac Psycristul. In 1453 the Byzantine medicine moved the torch<br />

in the young hands of the European medicine fated to lead the medicine<br />

further<br />

Key words: Byzantine medicine, physicians, manuscript, Dioscoride.<br />

The Byzantine Empire lasted for over<br />

1100 years and the organization of a<br />

functional health care system was<br />

undeniable merit of Byzantine medicine.<br />

Pagan healing gods were replaced by the<br />

"Saints healers”.<br />

Unmercenary physicians or "Doctors<br />

without Silver" cult <strong>–</strong> Cosma and Damian,<br />

with Theraphon, Tecla, Kyr, John, Julian-<br />

was established from the very beginning.<br />

According to data transmitted over the<br />

centuries, Cosma and Damian were<br />

brothers and doctors. They came from<br />

Arabia in the town of Cyr. Here they<br />

1 University of the Medicine and Pharmacy „Carol Davila” Bucharest<br />

dedicated themselves to patients, both<br />

human and animal.<br />

Unlike other doctors, they followed the<br />

Biblical advice: "as a gift you received as a<br />

gift you give” they did not want to receive<br />

any reward. For that reason they were<br />

called "Saints Doctors without Silver"-<br />

Anargyres.<br />

One day, however, in violation of the<br />

decision on which both brothers had<br />

agreed, Damian received a sum of money<br />

from a noble woman, Palade, who, in the<br />

name of Christ, asked him to accept her<br />

gift. His brother, Cosma, was so angry that

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he said he does not want to work together<br />

with his brother anymore.<br />

After Damian had explained him why he<br />

made that gesture, that is not to humiliate<br />

and not sad the noble lady who asked the<br />

name of Christ, they were reconciled and<br />

continued their work.<br />

Governor Lysis, finding that they are<br />

Christians and attract many to the Faith,<br />

called them into court and asked them to<br />

offer sacrifice to the gods of the empire.<br />

As they refused resolutely, they were<br />

sentenced to death and executed by<br />

decapitation. Their bodies were taken into<br />

town by Christians and buried in honor.<br />

In Byzantium, hospitals functioned near<br />

monasteries. The administrative head of<br />

the entire institution was called the<br />

nosocomos. Two doctors and a lot of<br />

assistants, who learned, not helped, were<br />

working in each section. Women were<br />

cared for by a woman doctor, and at night<br />

there was a service call.<br />

Two inspectors were visiting the hospital<br />

day and night inquiring whether patients<br />

are satisfied or have any complaint to<br />

make.<br />

Each hospital had a dispensary in which<br />

worked two doctors and a number of<br />

assistants<br />

There were specialized hospitals - i.e.<br />

hospital doctors in Mangane dealt exclusively<br />

with diseases of the digestive tract.<br />

Nurses were instructed on the spot and<br />

formed health care professionals’<br />

associations.<br />

Doctors were trained in two ways,<br />

individually or in groups ie in school.<br />

Generally, medical profession was<br />

transmitted from father to son.<br />

<strong>Medical</strong> schools were established around<br />

hospitals and one of the doctors acted as a<br />

teacher. Students were practicing in<br />

hospitals or clinics. Education was free.<br />

Teachers were chosen very carefully and<br />

students had to accumulate a lot of<br />

experience before start practicing as<br />

physicians. This period of training was<br />

called kronia.<br />

After the training, the student had to pass<br />

proficiency exam and answer question of a<br />

maestro, the head of the school or the<br />

emperor’s physician, bearing the title of<br />

actuarios.<br />

The candidate who passed the<br />

examination received as a sign of<br />

promotion a medal or badge to distinguish<br />

himself from impostors.<br />

<strong>Medical</strong> practice was based on the theory<br />

of the four humors.<br />

In therapy, Byzantine physicians used,<br />

along with the old remedies, news exotic<br />

ones, made from the three regna.<br />

An important role was played by diet<br />

recommendations. There were used<br />

curative and preventive diets, but there<br />

were also exaggeration. Doctors used to<br />

recommend to their patients diets<br />

according to different seasons, months,<br />

professions or social class.<br />

In order to master these diets and<br />

astrological data, doctors had to read a lot<br />

and collect many books. So, they had<br />

copies of classical medicine textbooks and<br />

many copybooks of diets and complicate<br />

recipes.<br />

Hospitals sheltered vast libraries with<br />

valuable medical works. Till the 15th<br />

century, there was in Sarb King’s hospital<br />

in Prodrom a magnificent manuscript of<br />

Dioscoride’s work “Materia Medica”. It<br />

was written for the princess Anicia Juliana,<br />

daughter of the Roman emperor Olybrius.<br />

Nowadays, this manuscript is kept in<br />

Vienna.<br />

A copy of Dioscoride’s famous pharmaceutical<br />

textbook, written in the first<br />

century A.C., was made in 512 and it is<br />

now sheltered in the National Library in<br />

Viena. This manuscript was made for the<br />

Byzantine princess Juliana Anicia, Gallea<br />

Placida’s great grand daughter and<br />

Areobindus wife. The portraits of the<br />

author talking to Heuresis (the Gift of

M. Besciu: The Byzantine physicians 35<br />

discovery) and Epinola (Attention), groups<br />

of physicians and different plants’ drawings<br />

are closed imitations of ancient<br />

copies of the textbook, which were in a<br />

pure Roman-Greek tradition. The use of<br />

gold was, however, a Byzantine<br />

innovation.<br />

Only the damaged thumbnail portrait of<br />

Iuliana Anicia can be considered a genuine<br />

work of the 6th century painter. The<br />

princess, dressed up in a splendid heavy<br />

plated dress, according to her status, looks<br />

forward and has a solemn attitude, as aulic<br />

ceremonies imposed. She is surrounded by<br />

allegories of Intelligence, at her left, and<br />

Kindness, at her right. The last keeps gold<br />

coins in her lap that Juliana Anicia spreads<br />

on the book handled by a little genius,<br />

called “the passion of the one who loves to<br />

build”. She imitated the generosity acts<br />

made by consuls at their appointments.<br />

The whole composition remembers the<br />

consular ivory diptychs or the pictures of<br />

the Virgin surrounded by angels, as in an<br />

icon from the Mount Sinai. At the<br />

princess’s feet stays a woman, “the Arts’<br />

Gratitude”, who kisses the princess’s right<br />

shoe. In the corners there are theme scenes,<br />

in gray “grisaille” tones, painted in a free<br />

Greek style, which evoke the generosity of<br />

the princess who build up or renovate<br />

many churches in Constantinople, winged<br />

genius, comparable to those in Pompey,<br />

who dealt with architecture and painting<br />

works.<br />

ORIBASIUS (329-403)<br />

No doubt, one of the famous Byzantine<br />

physicians was Oribasius, born in<br />

Pergamos, as Galenus, and received<br />

medical training under supervision of<br />

Zenon from Cyprus. He was the physician<br />

and friend of Flavius Claudius Julian, the<br />

Renegate.<br />

Julian the Renegate, appointed Cesar by<br />

Constantine when he was sent to Galls,<br />

asked Oribasius to follow him. Also, he<br />

ordered Oribasius to edit Galenus’ works<br />

in a short form.<br />

In 362, Julian succeeded Constantine on<br />

the throne, and his physician became<br />

Quaestor of Constantinople. Unfortunately,<br />

Emperor Julian was killed in 363;<br />

Oribasius lost his protection and was<br />

exiled between Goths. His exile ended<br />

before 369.<br />

ORIBASIUS’s medical works<br />

His first work, written for Julian and<br />

called “Galenus’s Synopsis” is lost.<br />

At the Emperor’s request, a <strong>Medical</strong><br />

books collection was created. It contained<br />

70 books, but only 25 resisted through<br />

ages.<br />

He wrote another Synopsis in his old<br />

ages for his son Eustatios, who was also a<br />

doctor. He also wrote Euporistes, with his<br />

recommendations for travelers. In this<br />

book, he described symptoms for each<br />

disease; presented the main drugs and most<br />

common substances used for drug’s<br />

manufacture and their effects.<br />

Books 11 to 13 were dedicated to<br />

Diocoride’s Materia Medica exposition<br />

and books 14 to 16 described simple and<br />

complex remedies. Information was varied,<br />

rich and accurate, but his prudence in<br />

prescribing needs the reader’s full<br />

attention.<br />

Oribasius described for the first time the<br />

melancholy delirium, lycanthropy. He<br />

prescribed hot oil instillation for earaches;<br />

for poisoning he recommended a mix of oil<br />

with water in large quantities, then teriac in<br />

wine or juniper fruits and 20 rut fruits. He<br />

used pharmaceutical forms like<br />

trochiscusurile pills and purgatives bread<br />

(cathartics) and ”Buccellata cathartici”<br />

(purgative electuary).<br />

Oribasius presented Caryophyllus

36<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

aromaticus as medicine for the first time.<br />

Through its research and knowledge of<br />

medical and pharmaceutical literature,<br />

Oribasius remains one of the leading<br />

authors and practitioners of the Byzantine<br />

Empire.<br />

ALEXANDER OF TRALES (525-605)<br />

The greatest physician from the times of<br />

Galen until the Renaissance was probably<br />

Alexander of Trales.<br />

His work, 12 medical books, inspired<br />

medical schools in the Middle Ages, even<br />

if he criticized some opinions of<br />

Hippocrates and Galenus.<br />

He studied medicine, in private, at<br />

Ephesus, Pergamus, Athens and, certainly,<br />

in Alexandria. After he finished studies, he<br />

arrived in Constantinople, where his<br />

brother Antemios, a well known engineer<br />

and mathematician, together with Isidor of<br />

Milet, was building famous church of Saint<br />

Sofia.<br />

He inspired from Hipocrates’s work,<br />

who considered that the first mission of a<br />

doctor was to ease the illness by all the<br />

means.<br />

He was cautious regarding the treatment<br />

of cerebral disorders with white hellebore,<br />

which could induce fainting, and he was<br />

against the use of opium drugs in patients<br />

with tuberculosis.<br />

He described remedies like: Mala punica,<br />

ether oils, of chamomile decoction,<br />

coriander seeds, pomegranate, and castor<br />

oil as treatment for intestinal worms,<br />

colchium autumnale as gout treatment. He<br />

was against opium abuse. In his work, he<br />

focused on eye drops. He described very<br />

well pleurisy and its treatment, he focused<br />

on digestive diseases, gout, ascites and<br />

made first differential diagnosis between<br />

edema and hypertrophy using thumb<br />

pressure, diagnosed intestinal worms and<br />

recommended powerful remedies for this<br />

disease.<br />

“He is not a compiler, but a practitioner<br />

who knew how less valuable wors are at a<br />

patient bed”, said P.Brunet about<br />

Alexandre, whom work he has translated<br />

into French.<br />

Alexander also recommended the use of<br />

Ka-Ra-aa formula and amulets, but only if<br />

the treatment was unsuccessful.<br />

PAUL from EGINA (626-690)<br />

Alumni of Alexandria’s <strong>Medical</strong> School,<br />

Paul was well-known as a great surgeon<br />

who practice nasal polyps’ extraction,<br />

catheterize of the bladder, tracheotomy. He<br />

was the one who gave the name of cancer<br />

<strong>–</strong> Karkinos, crab <strong>–</strong> to malignant tumors,<br />

because he differentiated them from the<br />

benign ones and discover that malignant<br />

tumors send branches as a crab’s pincers in<br />

the surrounding tissues. He treated breast<br />

cancers by excision, not by cauterization.<br />

Paul from Aegina used rectal and vaginal<br />

speculum. In his days, medical art had no<br />

essential progress, but based on the known<br />

techniques it was improving.<br />

He thought of the use of catheter to treat<br />

liver abscess and he described correctly the<br />

technique of lithotomy.<br />

He remains in the history as an expert in<br />

lymph nodes surgery, superficial tumors<br />

surgery, uterine and breast tumors<br />

removal.<br />

Only Abreviar medical, a 7 volume<br />

textbook wrote by Paul lasted till our days.<br />

Books V and <strong>VI</strong>I are dedicated more to<br />

pharmacology and describe venomous<br />

animal bites remedies, poison, antidotes,<br />

simple and complex medicines and their<br />

methods of fabrication. Book <strong>VI</strong> covers<br />

surgery issues and Book <strong>VI</strong>I describes<br />

terrible plague epidemics.<br />

“… even if they have poor knowledge,<br />

surgeons’ technical abilities were so<br />

advanced that allowed them to have

M. Besciu: The Byzantine physicians 37<br />

important success in delicate and difficult<br />

interventions”, said Castiglioni about the<br />

surgeons of that period.<br />

AETIUS OF AMIDA (502-575)<br />

He was born in Mesopotamia and was<br />

trained in Alexandria. He became physician<br />

at imperial court of emperor<br />

Justinian. It is said that Aetius was the first<br />

Greek physician who embraced<br />

Christianity.<br />

He knew very well the Asian remedies.<br />

He wrote a medical synthetic textbook<br />

with medical recipes and mineral, vegetal<br />

and animal remedies. He was the first<br />

doctor who used camphor and cloves in<br />

therapy.<br />

His most important work is called Tetrabiblion<br />

and contains 16 books. It is Aetius’<br />

worth to a better knowledge of surgical<br />

skills of Rufus of Ephesus and Leonidas,<br />

as well as of obstetrics and gynecological<br />

skills of Soran and Philumenos.<br />

The best Aetius’s clinical descriptions<br />

were his observations on the diphtheria<br />

with suffocation, palate paralysis and<br />

regurgitation through the nose. He made<br />

the first description of brachial artery’s<br />

ligature in case of aneurism. He was<br />

interested in intestinal worm infestation.<br />

Aetius used to recommend prayers in<br />

preparation of ointments and emplastres.<br />


XIII)<br />

Nicolaus Alexandrinos was known as<br />

Myrepsos <strong>–</strong> “The one who makes<br />

ointmens”.<br />

He wrote Dynameron, divided in 48<br />

chapters, an important work containing<br />

2656 drug formulations, as well as an<br />

important number of other pharmaceuticals<br />

remedies, based on their action.<br />

He was inspired by salarniteanian<br />

physician Nicolaus Salernitanus’s work<br />

Antidodarium. His work contains materia<br />

medica and pharmacology with therapy<br />

applications. His work had been the Paris<br />

<strong>Medical</strong> School’s Codex till 1651.<br />


Simion Seth is the author of an<br />

encyclopedia of material medica <strong>–</strong> an<br />

alphabetical presentation of food beneficial<br />

effects. It contains an important number of<br />

remedies.<br />

Musk, amber and hashish are presented<br />

in his work from Arabian books. He<br />

noticed the camphor’s sedation effect on<br />

genitor-urinary tract. He presented the<br />

ointments and syrup from Arabian recipes.<br />

MIHAIL PSELLOS (1018-c.1078)<br />

Mihail Psellos, philosopher, historian,<br />

politician, naturalist physician, professor at<br />

the „High School” of Constantinopol. He<br />

wrote about „the action of the jinns<br />

(demons) in the diseases appearance” and<br />

the medicamentary effect of the jewels.<br />

In 1453 the byzantine medicine mooved<br />

the torch in the young hands of the<br />

european medicine fated to lead the<br />

medicine further.<br />

Bibliography:<br />

1. Ursea N. - Enciclopedia medical�<br />

româneasc� de la origini pân� în<br />

present, Bucure�ti, Ed. Universitar�<br />

“Carol Davila”, 2009;<br />

2. Iftimovici, R. <strong>–</strong> Istoria Universal� a<br />

medicinei �i farmaciei.- Bucure�ti: Ed.<br />

Academiei Române, 2008;<br />

3. Bologa. V. red - Istoria medicinei<br />

universale - Bucure�ti: Ed. <strong>Medical</strong>�,<br />


38<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

4. Izsak, S. Farmacia de-a lungul<br />

secolelor .- Bucure�ti: Ed. �tiin�ific� �i<br />

enciclopedic�, 1979;<br />

5. Sprin�eroiu, M. L.; Vasile R. D. <strong>–</strong><br />

Farmacia în civiliza�iile omenirii.-<br />

Bucure�ti, Ed. Multi Press<br />

International, 2003.<br />

6. http://sfintii-zilei.weblog.ro/2007-09-<br />

26/193889/Sfin%C5%A3ii-Cosma-<br />


Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />



LANDS<br />

D. BARAN 1<br />

Abstract: Constantinople, the second Rome, its orthodox Patriarchate and<br />

Academy, represented a model for the Romanian Lands. After the Byzantine<br />

Empire fall, Greek families settled in or travelling to Wallachia and<br />

Moldavia contributed to local society emancipation. In the Romanian<br />

Principalities, Phanariot rulers initiated «Early Enlightenment»,<br />

strengthened Balkan “koinonia” and encouraged both national and western<br />

European values. «Homo Balcanicus» was becoming European. Italian,<br />

French and English contacts were frequent. Medicine was privileged.<br />

Nicolae Mavrocordat, the first Phanariot prince, the humanist owner of a<br />

famous library including medical books, wrote against tobacco. His wife<br />

preceded Lady Montague in variolating her children. Timoni, the Ghika<br />

princely family`s doctor, described variolation at the London Royal Society.<br />

Pylarino published in Venice the first scientific approach to variolation, a<br />

method he also presented to the British „Philosophical Transactions”, and<br />

which Romanians performed, too. While a Court physician, Pylarino<br />

encouraged medical education and hospital building in Wallachia<br />

Key words: Early Enlightenment, Phanariot rulers, variolation.<br />

Greek and Roman Confluences<br />

From ancient times, the ancestors of<br />

present day Romanians lived and forged<br />

their own cultural background mixing<br />

original ideas to strong Greek and Roman<br />

influences. This is true for Romania as a<br />

whole, but particularly for Dobrogea,<br />

Transylvania and Banat. The archaeological<br />

discoveries on the Black Sea shore,<br />

in Tomis-Constan�a, Callatis-Mangalia,<br />

Histria or Herakleia Pontike are in keeping<br />

with the vestiges in Apullum-Alba Iulia,<br />

Germisara-Geoagiu Spa, Aquae-C�lan and<br />

Herculaneum-Herculane Spa. Apollo,<br />

Artemis and the nymphs, Asklepios and<br />

Hygieia, Telesphoros and Glykon are<br />

always there next to Bendis, Darzos or the<br />

1 “Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Romania<br />

Thracian Rider, assisting the environmental<br />

macrocosmic and the human<br />

microcosmic nature, providing health and<br />

mastering disease. Through the centuries<br />

Romanian history continued to evolve<br />

along these two coordinates of the „first<br />

and second Rome”.<br />

<strong>Medical</strong> European Renaissance in<br />

Moldavia<br />

In the X<strong>VI</strong>-th century, an intelligent,<br />

violent and ambitious Greek adventurer<br />

challenged Moldavia`s destiny. Jacob<br />

Basilides the Heraklid (1511<strong>–</strong>1563), a<br />

highly cultivated humanist, was born in<br />

Crete or, more probably, in Samos.<br />

Between 1548 and 1552 he studied

40<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

medicine in Montpellier at the renowned<br />

Faculty founded there in 1220. [11]<br />

However, he soon proved fighting skills<br />

and followed a successful military career<br />

in the service of Carol Quintus. In 1561,<br />

Jacob became a short-lived Prince of<br />

Moldavia (1561-1563) and in 1562<br />

founded a Latin School (Schola Latina) at<br />

Cotnari, not far from Ia�i. As a fervent<br />

adept of Reformation, the Heraklid<br />

appointed protestant teachers, the first of<br />

them chosen among those in the city of<br />

Bra�ov, at the boundaries between<br />

Transylvania,Wallachia and Moldavia.<br />

Biological concepts were probably taught<br />

in this ante letteram Academy, whereas<br />

medical lectures were seemingly envisaged<br />

by Jacob Basilides to be also given, in a<br />

future that never came for him. [15]<br />

Historians surmise that the precious library<br />

of the Cotnari School included medical<br />

books, too. [1, 15]<br />

Early Enlightenment in Moldavia<br />

and Wallachia<br />

In the X<strong>VI</strong>I-th century, once again, the<br />

Romanian Lands were reborn to a new life<br />

under the conjoint impact of Greece and<br />

Rome. On the one hand, Greek intellectuals<br />

fleeing the Turkish oppression<br />

potentiated the existence of a „Byzance<br />

after Byzance”, trying to maintain and<br />

further develop Greek values and culture.<br />

On the other hand, Italians were fulfilling<br />

diplomatic, religious and scientific<br />

missions in the vecinity of the “Sublime<br />

Porte” of Constantinople. Noble Greek<br />

families settling down in or travelling to<br />

the Romanian Countries of Wallachia and<br />

Moldavia contributed to local society<br />

emancipation and cultural flourishing.<br />

Phanariot rulers marked the «Early<br />

Enlightenment» period, opened these<br />

Lands towards both Western European<br />

horizons and ethnic ideals, stimulated<br />

national awakening. [4, 5] The Greeks<br />

mediated cultural contacts mainly with<br />

Italy, England and France, encouraging<br />

medical practice and teaching to develop,<br />

as they tried to restore their identity within<br />

this diasporas of a «historic exile».<br />

Constantin Cantacuzino<br />

Constantin Cantacuzino (1650-1716),<br />

high steward of Wallachia, studied<br />

medicine in Padua, travelled to Venice,<br />

and possessed an impressive library<br />

including updated medical works. (16) Part<br />

of them ended up in Nicolae<br />

Mavrocordatos` library. [2, 3]<br />

Fig.1. Constantin Cantacuzino<br />

He drew the first map of Wallachia<br />

with the aid of Ioan Comnen (Ioannis<br />

Comnenos), a Greek-born theologian and<br />

physician who graduated at the same<br />

famous University of Padua. [2, 3] It was<br />

Hrysant Notara (Chrysanthos Nottaras),<br />

patriarch of Jerusalem, who corrected and<br />

edited it in Padua in 1700. Born at Trikkala<br />

in Peloponnese, Notara studied medicine in<br />

Padua, spent many years in Wallachia and<br />

contributed to the flourishing of the<br />

Princely Academy in Bucharest and of its<br />

library. He probably promoted medical<br />

studies there.<br />

Nicolae Mavrocordat<br />

Nicolae Mavrocordat (Nicolaos<br />

Mavrocordatos, 1680-1730) of Chios, the<br />

first Phanariot prince, was the humanist<br />

owner of “the richest library in Oriental<br />

Europe” with medical treatises. He wrote a<br />

satire against tobacco “A Word against<br />

Nicotine” - and about life and death.<br />

(4,5,14) Prince of both Moldavia (1709-<br />

1710; 1711<strong>–</strong>1715) and Wallachia (1715<strong>–</strong>

D. BARAN, - Greek physicians and medical emancipation of the Romanian lands 41<br />

1716; 1719<strong>–</strong>1730), this “authentic citizen<br />

of the cosmopolitan «republic of letters»”,<br />

also interested, for instance, in the writings<br />

of Hobbes and Locke, introduced,<br />

reorganized and stimulated education and<br />

schools' activity.<br />

Fig.2. Nicolae Mavrocordat<br />

He used to practice medicine within his<br />

family and medically assisted his close<br />

friends. Among them Hrisant Notara was a<br />

remarkable personality. He suffered from<br />

“reumatika” and Mavrocordatos would<br />

have treated him from 1715 to 1731, as<br />

mentioned by chronicler Nicolae Costin. In<br />

1714, Notara donated books to the<br />

Academy of Ia�i and helped its<br />

reorganization.<br />

Alexander Mavrocordatos, the<br />

Exaporite<br />

Alexander Mavrocordatos (Alexandru<br />

Mavrocordat, 1641-1709), father to Prince<br />

Nicolaos Mavrocordatos, had married<br />

Princess Sultana, descending from the<br />

princely family of Alexandru Ilie�, who<br />

ruled over Wallachia (1616-1618; 1627-<br />

1629) and Moldavia (1620-1622; 1631-<br />

1633). Physician, philosopher and<br />

physiologist, Alexandros Mavrocordatos<br />

studied in Padua and Bologna, where he<br />

graduated in medicine.<br />

He was professor at the<br />

Constantinopolitan Academy of the<br />

Orthodox Patriarchate and, in 1644, he<br />

wrote a book on blood flow entitled “The<br />

Pneumatic Instrument of Blood Circulation”<br />

which disseminated information<br />

about Harvey`s discovery in this part of the<br />

world. Even though not directly involved<br />

in the history of Romanian medicine,<br />

Mavrocordatos` destiny was undoubtedly a<br />

representative example of “Balkan<br />

koinonia” which also included the<br />

Romanian Lands.<br />

Pulcheria, a “Lady Montagu” of Moldavia<br />

On February 19 th , 1713, Nicolae<br />

Mavrocordatos` second wife, Pulcheria<br />

Tzoukis (?-1716), variolated her two<br />

healthy children in Constantinople, after<br />

another one already got small-pox.<br />

Fig.3. Pulcheria<br />

As it comes out from a letter addressed<br />

to Hrisant Nottara, patriarch of Jerusalem,<br />

she could have done this herself since she<br />

had medical knowledge and skills.<br />

Pulcheria anticipated by several years the<br />

similar initiative of Lady Mary Wortley<br />

Montagu (1689-1762), who only in 1718<br />

had her son inoculated in Constantinople,<br />

probably by Dr. Timoni, and her daughter<br />

in 1721, in London.<br />

Emanuel Timonis<br />

Emanuel Timonis (Emmanouel<br />

Timonis,1669-1720) of Chios described<br />

variolation in Royal Society`s Philosophical<br />

Transactions, in 1714-1716, no. 29,<br />

pg. 72-82, in an article titled "An account,<br />

or history, of the procuring of the smallpox<br />

by incision or inoculation, as it has for<br />

some time been practiced at<br />

Constantinople, being the Extract of a<br />

Letter from Emanuel Timonius, Oxon. &<br />

Patav. M.D.SR.S. dated at Constantinople,

42<br />

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December, 1713. Communicated to the<br />

Royal Society by John Woodward, M.D.<br />

Profes. Md. Gresh. and S.R.S“. [6]<br />

Timonis was Ghika princely family`s<br />

doctor, in Moldavia (1680-1700). [8] He<br />

was even accused of involvement in<br />

Grigore I Ghica's death in 1678 and<br />

plotting with the rival Cantacuzino family.<br />

In Padua, Timoni studied medicine, at the<br />

reputed Faculty whose pro-rector he<br />

became in 1691. [6] In 1703 he was doctor<br />

of the Oxford University and member of<br />

the Royal Society. In 1713, Timoni<br />

published in Constantinople “Historia<br />

variolarum quae per incisionem excitantur”,<br />

whereas, in 1721, in Leiden,<br />

appeared his “Tractatus de nova variolas<br />

per transmutationem excitanti methodo”.<br />

Better known than Pylarino, his contribution<br />

to immunology and vaccinelogy has<br />

been more frequently mentioned. [6]<br />

Jacob Pylarino<br />

Doctor Jacob Pylarino (Jakovos<br />

Pylarinos/ Giacomo Pilarino, 1659-1718)<br />

of Lixouri, Kefallonia, graduated in Padua.<br />

He learned in 1701 about “transplanttation”,<br />

as a popular means to prevent<br />

smallpox, from a woman in Thessaly who<br />

inoculated 40000 people.<br />

Fig.4. «Nova et tuta variolas»<br />

After having performed this technique,<br />

Pylarino published in Venice, in 1715, the<br />

first approach to variolation, his paramount<br />

opus "Nova et tuta variolas excitandi per<br />

transolantationem methodus, nuper inventa<br />

et in usum tracta qua rite per acta<br />

immuniaa in posterum praesenvatur ab<br />

hujus modi contagio corpora: Per Jacobum<br />

Pylarinum, Venetum M.D. et Peripublicae<br />

Venetae apud Smyrnenses Nuper<br />

Consulem“.<br />

Fig.5. Philosophical Transactions of the Royal<br />

Society, 1714-1716<br />

He also presented variolation in the<br />

British „Philosophical Transactions of the<br />

Royal Society”, in 1714-1716, no. 29, pg.<br />

393-399 as "Nova et tuta variolas excitandi<br />

per transplantationem methodus, nuper<br />

inventa et in usum tracta: Per Jacobum<br />

Pylarinum, Venetum M.D. et Peripublicae<br />

Venetae apud Smyrnenses Nuper<br />

Consulem“. [12] As a court physician, he<br />

travelled a lot to Germany and Russia,<br />

where he was the personal doctor of Tsar<br />

Peter the Great, Serbia and Moldo-Vlachia.<br />

[2, 6] In 1684 indeed, Pylarino came to<br />

Wallachia, as doctor to Prince �erban<br />

Cantacuzino and remained in Bucharest<br />

until 1687. Between 1694 and 1708, when<br />

appointed Venetian councilor in Smirna,<br />

Pylarino was again in Wallachia, as<br />

physician to the Ruling Prince Constantin<br />

Brâncoveanu. [3, 8] He encouraged<br />

medical lectures to be given at the “Saint<br />

Sava” Princely Academy in Bucharest,<br />

where teachers were usually Greek<br />

physicians and theologians. [2, 3] Among<br />

them: Markou Porphyropoulou, Ioan<br />

Comnen, Nicolaos Kerameos (Nicolae<br />

Kerameus). Remarkably, young Greeks<br />

living in Wallachia could get scholarships<br />

from Prince Brâncoveanu and study

D. BARAN, - Greek physicians and medical emancipation of the Romanian lands 43<br />

medicine abroad, as did Giorgos<br />

Hypomenas of Trabzon, who after<br />

graduating in Padua, became a practitioner<br />

in Bucharest. [3] Pylarino supported the<br />

achievement of the “Col�ea” Hospital in<br />

Bucharest, in 1704, the first great hospital<br />

in the Romanian Lands.<br />

Fig.6. Bucharest. Col�ea Hospital and Church<br />

Fig.7. Venice. «San Lazzaro» Hospital<br />

Built at the expense of High Stewart<br />

Mihail Cantacuzino who studied humanist<br />

disciplines in Padua, the institution<br />

reproduced the model of the “San Lazzaro<br />

dei Mendicanti” («Saint Lazarus of the<br />

Beggars») Hospital in Venice.<br />

Fig.8. Mihail Cantacuzino<br />

Pylarino, who in his youth was a<br />

physician there, yielded the plan of the<br />

Venetian establishment. [3, 8]<br />

Variolation from Timoni and<br />

Pylarino to Jenner<br />

In 1722, convinced of the utility of<br />

inoculation or engrafting, Lady Montagu<br />

intervened to the College of Physicians of<br />

London for determining acceptation of<br />

variolation for anti-smallpox protection. In<br />

1796, Timoni`s and Pylarino`s method of<br />

vaccination, i.e. variolation, of 1713,<br />

reemerged. It was modified by Dr. Edward<br />

Jenner, who took the vaccination liquid not<br />

from smallpox patients, as Timoni and<br />

Pylarino, but from cowpox vesicles. [3]<br />

Jenner`s method gave better results, also<br />

because it caused a decreased mortality.<br />

Romanian popular medicine did the same.<br />

Variolation in Romanian Popular<br />

Medicine<br />

Alexander the Good, Prince of Moldavia<br />

(1400-1432), mentioned in his Code of Laws<br />

(«Pravila») of 1400 the «engrafting»<br />

technique of variolation. Doctor Andreas<br />

Wolf, who lived in Moldavia from 1780 to<br />

1797, related that the country had been<br />

severely affected by smallpox for three-four<br />

years and variolation officially introduced<br />

since 1780. In 1803, vaccination was<br />

performed by dr.Hesse and dr. Fröhlich,<br />

without any fee, and was recommended by<br />

the Princely Court.<br />

Griselini<br />

Francesco Griselini (1717-1784), an<br />

Italian biologist and painter, agrarian<br />

economist and journalist illustrating the<br />

Venetian Enlightenment, visited Banat. It<br />

happened between 1774 and 1777, when<br />

both Venice and Banat were under<br />

Austrian authority.<br />

Fig.9.Francesco Griselini

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Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

In 1780, he published “Geschichte des<br />

Temeswarer Bannats” («History of<br />

Temesvarer Banat», Vienna, 1780). He<br />

described variolation, which only<br />

Romanians performed in various ways:<br />

pustular smallpox fluid from sick persons<br />

was inoculated to healthy children after<br />

scarifying or rubbing their arm skin;<br />

pustular fluid was directly placed on the<br />

arm skin previously strongly rubbed with a<br />

rugged cloth until it became inflamed or a<br />

superficial incision of the arm skin was<br />

performed into which smallpox pustular<br />

fluid was placed. [7] Griselini communicated<br />

his impressions about Banat in<br />

Letters addressed to outstanding personalities<br />

of his time, including Lazzaro<br />

Spallanzani (1729-1799). As in the case of<br />

Spallanzani, Griselini benefitted from the<br />

patronage of Habsburg officials during his<br />

travel through Banat and Wallachia.<br />

Franz Joseph Sulzer<br />

In 1781-1782, Franz Joseph Sulzer<br />

published his “Geschichte der<br />

Transalpinischen Daciens” («History of<br />

Transalpinian Dacians») where he<br />

reported variolation of young ladies on<br />

the forehead or wrist, practiced by<br />

Romanian girls of Transylvania”to<br />

preserve their beauty”. [3, 10]<br />

Nyulas Ferenc<br />

In 1802, the Hungarian Physician<br />

Nyulas Ferenc wrote about “Kolozsvári<br />

tehénhiml�” («Vaccination in Cluj»). He<br />

reported that peasants from Some� and<br />

F�g�ra� bathed their children in the milk of<br />

cows with cowpox, after washing with it<br />

the udder having cowpox vesicles. Other<br />

times, cowpox pustules were pricked with<br />

a fine needle which was then passed<br />

through the child’s ear lobe. In Ceanul<br />

Mare and Cicud, the Valach priests<br />

inoculated smallpox according a<br />

“mysterious” method known only by them.<br />

[3, 10]<br />

Famous Followers in Modern Times<br />

Ioan Cantacuzino<br />

The particular «genetic design» of this<br />

continous Greek-Romanian cohabitation<br />

generated towering medical specialists that<br />

continued to be involved in immunology<br />

and vaccinology.<br />

Ioan Cantacuzino (1868-1934) came<br />

from a mixed Greek-Romanian family,<br />

descending from its first «Enlightened»<br />

representatives of the X<strong>VI</strong>I-th century,<br />

already mentioned: Constantin, Mihail and<br />

�erban. Ioan Cantacuzino studied in Paris,<br />

with Ilya Mechnikov (Nobel Prize, 1908).<br />

Fig.10 Ioan Cantacuzino<br />

A highly reputed microbiologist, he<br />

founded, in 1901, a laboratory of<br />

experimental medicine and in 1921,<br />

established the Institute for Sera and<br />

Vaccines in Bucharest, bearing now his<br />

name.<br />

Fig.11. Bucharest. “Cantacuzino” Institute<br />

He distinguished himself during the IInd<br />

Balkan War, when «the great Romanian<br />

experience» of 1912-1913 revealed the<br />

efficiency of his anticholeric mass<br />

vaccination performed in epidemic foci.<br />


D. BARAN, - Greek physicians and medical emancipation of the Romanian lands 45<br />

The «contact immunity» was thus<br />

definitely proved. During World War I,<br />

Cantacuzino successfully fought epidemics<br />

by antityphic-paratyphic, anti-diphtheric<br />

and anticholeric vaccination. He efficiently<br />

set up antituberculosis and antimalaria<br />

strategies in Romania. Due to him, a close<br />

friend to Calmette, his country was the<br />

second one, after France, to introduce<br />

Calmette-Guérin bacillus-based antituberculosis<br />

vaccination.<br />

At the Faculty of <strong>Sciences</strong> in Ia�i,<br />

Cantacuzino was professor of Animal<br />

Morphology (1894-1896).<br />

In 1917, during World War I, he<br />

founded in Ia�i, along with Russian and<br />

French physicians, "The Medico-Surgical<br />

Society of the Russian-Romania Front”.<br />

At the end of the war, in 1920,<br />

Cantacuzino represented Romania in Paris<br />

at the peace treaty, a document he signed<br />

with Titulescu on behalf of their country.<br />

Constantin Levaditi<br />

Born at Gala�i as the son of a Romanian<br />

mother and a Macedo-Romanian (Vlach)<br />

father from the Pindos Mountains,<br />

Constantin Levaditi (1874-1953) studied<br />

medicine in Bucharest and was trained in<br />

Victor Babe�’ school for five years, as an<br />

eminent research assistant. He then left for<br />

Paris, were he had a brilliant career at the<br />

„Pasteur” Institute. [9, 13]<br />

Fig.12. Constantin Levaditi<br />

Levaditi laid the basis of virology and<br />

further developed immunology in universal<br />

medicine. He authored the first treatise of<br />

virology ever published -“Les ultravirus<br />

des maladies humaines” (Paris, 1937)- and<br />

pioneered viral cultures techniques,<br />

including viral multiplication in tumoral<br />

tissues. He investigated poliomyelitis,<br />

syphilis and cancer, their origin and<br />

therapy. [9, 13]<br />

Levaditi was nominated several times<br />

to the Nobel Prize for Medicine between<br />

1930-1934.<br />

Indirectly, he fathered microbiology in<br />

Romania, too, through his disciple,<br />

professor �tefan S. Nicolau (1896-1967).<br />

[3]<br />

They first met in 1921 in Cluj, where<br />

Levaditi was appointed professor and<br />

Nicolau graduated. Levaditi put a mark on<br />

Nicolau, who, in 1942, inaugurated in<br />

Bucharest the first Chair of Inframicrobiology<br />

in the world.<br />

Fig.13. �tefan S. Nicolau<br />

Nicolau contributed to the<br />

characterization of the Borna virus and<br />

virus replication in tumours.<br />

In 1939, when he returned to Romania,<br />

Nicolau was initially appointed professor<br />

of Bacteriology at Ia�i, where he remained<br />

only for a short lapse of time.<br />

Homo Balcanicus<br />

«Balkan countries» result to be more<br />

than simply a geographical concept. This<br />

south-eastern European region shared<br />

common historical circumstances and<br />

challenges. Balkan peoples developed<br />

related features and adopted comparable<br />

behavioural patterns. At the crossroads of<br />

Orient and Occident, of three great

46<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

monotheistic religions - christianity,<br />

judaism and islam -, of three great empires<br />

- Austro-Hungarian, Ottoman and Russian,<br />

of three great ideologies - democracy,<br />

dictatorship, anarchy, and three great<br />

political systems - capitalism, communism<br />

and liberalism, the Balkan community<br />

seemed to display intertwined complementary<br />

faces. Paradoxically, the «powder<br />

barrel» of Europe enabled a transcultural<br />

melting pot to exist, living this diversity,<br />

revealing identities, transforming mentalities<br />

between health and disease, life and<br />

death. Medicine in the Romanian Lands<br />

evolved along both Western European and<br />

Balkan coordinates and its original<br />

contribution to the progress of science still<br />

awaits to be acknowledged and officially<br />

integrated to the universal history of the<br />

healing art. The peculiarities of Balkan<br />

medicine are in keeping with both homo<br />

balcanicus and homo europaeus and<br />

express the same aspirations of homo<br />

universalis.<br />

References<br />

1. Bârs�nescu �t, Schola Latina de la<br />

Cotnari, Litografia �i Tipografia<br />

Înv���mântului, Bucure�ti, 1957.<br />

2. Berza M, Pentru o istorie a vechii<br />

culturi române�ti, Ed. Eminescu,<br />

Bucure�ti, 1985, 173-193.<br />

3. Bologa V, Istoria Medicinei<br />

Universale, Ed. <strong>Medical</strong>�, Bucure�ti,<br />

1970, 284-8,398-9, 741-5.<br />

4. Bouchard J, L'aube des Lumières dans<br />

les Pays Roumains, Rev Hist Inst Rech<br />

Néohell, 2005, 2:31-51.<br />

5. Bouchard J,Nicolae Mavrocordat,<br />

domn �i c�rturar al Iluminismului<br />

timpuriu, Ed. Omonia, Bucure�ti,<br />

2006.<br />

6. De Raymond J-F, Querelle de<br />

l'inoculation, ou, Préhistoire de la<br />

vaccination, Librairie Philosophique<br />

J.Virin, Paris, 1982, 31-39.<br />

7. Giselini F, Încercare de istorie politic�<br />

�i natural� a Banatului Timi�oarei,<br />

Ed.Facla, Timi�oara, 1984.<br />

8. Iftimovici R., History of Science in<br />

South-Eastern Europe, Newsletter,<br />

2001, 5: 13:14.<br />

9. Iftimovici R, Grama S, Newsletter for<br />

the History of Science in Southeastern<br />

Europe, 2003, 7:13-14.<br />

10. .Ionescu C, Prophylaxis of Smallpox in<br />

Romanian Traditional Medicine, J<br />

Prev Med, 2001, 9: 74-76.<br />

11. Izsák S, Étudiants roumains à<br />

l`Université montpelleraine, 16e Cong<br />

Int Hist Méd, Montpellier, 1958.<br />

12. Karamberopoulos D, The medical<br />

European knowledge in the Greek<br />

region 1745-1821, Library on the<br />

History of Medicine, Publishing House<br />

Ath. Stamoulis, Athens, 2003, 1: 312.<br />

13. Lascaratos J,.Kalantzis G, Skiadas P,<br />

Constantin Levaditi: An unknown<br />

pioneer in immunology research, Arch<br />

Hell Med, 2003, 20, 3:319<strong>–</strong>325.<br />

14. Radu R, Cultura Mavrocorda�ilor,<br />

Economia, 2004, 2: 91-93.<br />

15. Romanescu C, Note medico-istorice la<br />

domnia lui Despot Vod�, Rev.Med,<br />

1969, XV, 1: 110-112.<br />

16. Ruffini M, Biblioteca stolnicului<br />

Constantin Cantacuzino, Ed. Minerva,<br />

Bucure�ti, 1973.

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />


PHILOSOPHERS AND PHYSICIANS (5 TH <strong>–</strong><br />




D. DIACONESCU 1 , S. TOMA 1 ,<br />


Abstract:<br />

The nature of psychic life, the anatomical seat of cognitive, motor and<br />

sensory functions, and the origin of neurological diseases were broadly<br />

debated by ancient Greek scientists since the earliest times. Within a few<br />

centuries, speculation of philosophers and physicians laid to foundations of<br />

modern experimental and clinical neuroscience. In this review we shall<br />

present the most important Greek philosophers and physicians living between<br />

the 5th and the 3rd century before Christ (B.C.) and examine some of their<br />

leading theories concerning the mechanisms of cognitive activity, the nature<br />

of perception and voluntary movement, and the causes of neurological and<br />

psychiatric disorders<br />

.<br />

Key words: History of neuroscience; Presocratic philosophers;<br />

Alexandrian medicine; Hippocratic medicine.<br />

Introduction<br />

Since the earliest times ancient Greek<br />

scientists debated the nature of psychic life,<br />

the anatomical seat of motor, sensory and<br />

cognitive functions, and the basis of some<br />

neurological and psychiatric diseases.<br />

The aim of this study was to present the<br />

theories of the most important ancient<br />

Greek philosophers and physicians (5 th -3 rd<br />

century B.C.).<br />

Content<br />

The origin of thinking activity was<br />

explained by Greek philosophers and<br />

physicians based on two theories. The<br />

encephalocentrism considered the brain as<br />

1 Transilvania University of Brasov<br />

the seat of human consciousness, sensation<br />

and knowledge, all these faculties being<br />

attributed by the cardiocentrism to the<br />

heart. Both theories generated controversy<br />

within the scientific community [4].<br />

a. Philosophers<br />

Hippon of Samos (4 th century BC)<br />

localized the main part of the soul to the<br />

head, particularly to the brain. Anaxagoras<br />

of Clazomenae (500<strong>–</strong>428 BC) and<br />

Diogenes of Apollonia (ca. 460 BC)<br />

believed that all sensations had connection<br />

to the brain [4].

48<br />

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Empedocles of Acragas (490<strong>–</strong>430 BC)<br />

thought that “the blood around the heart is<br />

men’s thought” [5]. Thus, humans think<br />

with the blood and the level of intelligence<br />

depends on blood’s composition. That is<br />

why he considered the heart also as the<br />

seat of mental disorder [19].<br />

In the opinion of Empedocles, sensation is<br />

a purely physical process, depending on pores<br />

and affluences. Affluences enter continually<br />

in another body through pores and sensation is<br />

a matter of symmetry of pores [5].<br />

Fig.1. Empedocle <strong>–</strong> source Wikipedia<br />

Aristotle (384 BC <strong>–</strong> 322 BC) was<br />

probably the first anatomist in the modern<br />

sense of this term [11]. According to<br />

Aristotle, the soul is defined as the the<br />

form of a living body [18].<br />

Aristotle had interesting contributions<br />

to brain anatomy. He observed that the<br />

brain was placed in the front part of the<br />

head and was surrounded by the meninges,<br />

two membranes containing blood vessels.<br />

The external membrane was the thickest<br />

and located next to the bone of the skull;<br />

the more delicat internal membrane was<br />

localized around the brain itself.<br />

For the first time an important<br />

anatomical distinction between cerebrum<br />

(enkephalos, brain) and cerebellum<br />

(parenkephalis, para-brain) was made by<br />

Aristotle. The para-brain was positioned<br />

beyond the brain, and its shape and tissues<br />

were different from those of the brain.<br />

Aristotle also identified three possible<br />

nerves - “poroi” (ducts) <strong>–</strong> two of them<br />

leading to the cerebellum and one to the<br />

brain [1]. These ducts might refer to the<br />

optic nerve and tract, and to trigeminal and<br />

oculomotor nerves [3]. He also described a<br />

cavity in the brain, probably the ventricular<br />

system, and made the observation that man<br />

has the largest brain in proportion of his<br />

size. He also referred to “liquidity about<br />

the brain”, probably the cerebrospinal<br />

fluid. Aristotle described the spinal cord as<br />

an extension of the brain and the similar<br />

constitution for both structures [1]. But<br />

Aristotle’s theories about brain function<br />

were rather dissapointing. In his view,<br />

brain had no sensory properties and was<br />

insensible when touched. He concluded that<br />

the brain was a cooling organ, after he<br />

noticed a lot of blood vessels on the surface<br />

of the brain, therefore having no intellectual<br />

meaning. Aristotle also considered the brain<br />

as the sleep generator [3].<br />

Fig.2. Aristotle <strong>–</strong> source<br />

www.wicknet.org/.../gallery_of_the_greats.htm<br />

b. Physicians<br />

The sensory and cognitive significance<br />

of the brain was probably first recognized<br />

by Alcmaeon of Croton (500 BC) [15]. He<br />

asserted that “all the senses are connected<br />

with the brain” through channel-like<br />

structures called “poroi”, two of them, no

DIACONESCU et al.: The importance of studying Greek philosophers and physicians (5 th <strong>–</strong> 3 rd<br />

century B.C.): contribution to the development of neuroscience in medical schools<br />

doubt the optic nerves, joining the eyes to<br />

the brain. Alcmaeon claimed that the brain<br />

was the seat of consciousness and<br />

sensation because he recognized that all<br />

senses “are compromised if the brain is<br />

moved and changes its place” [5].<br />

He distinguished sensation from<br />

understanding: “man differs from the other<br />

animals in that he alone has understanding,<br />

wheras, they have sensation but do not<br />

understand” [4].<br />

Based on anatomical evidence, he<br />

proposed that the brain was essential for<br />

perception [6, 7] and “the seat, in which<br />

the highest, principal power of the soul is<br />

located” [5].<br />

Alcmaeon was wrong saying that sleep<br />

occurs when blood vessels in the brain are<br />

filled and that waking is caused by the<br />

emptying of these vessels [16].<br />

�<br />

Fig.3. Alcmeon <strong>–</strong> source philosophers.endlessgreece.com/alcmaeon.php<br />

In the fourth century BC, Hippocrates<br />

(ca. 460 BC <strong>–</strong> ca. 370 BC), the “Father of<br />

Medicine”, started a new way of looking at<br />

illness. The main theory stated that disease<br />

is the result of an imbalance of body<br />

constituents or humors and that disease has<br />

nothing to do with demons [10].<br />

For Hippocrates the human brain is<br />

cleft into two symmetrical halves by a<br />

vertical membrane and is also the seat of<br />

human intellect and the cause of<br />

neurologcal disorders. In De morbo sacro,<br />

epilepsy, called in antiquity “the sacred<br />

disease”, is not “any more divine or more<br />

49<br />

sacred than other disease, but has a natural<br />

cause, and its supposed divine origin is due<br />

to men’s inexperience and to their wonder<br />

at its peculiar character”. In the same<br />

treatise, the brain was considered the seat<br />

of judgement, emotions and aesthetic<br />

activity [12]. Thus thinking activity, moral<br />

consciousness, perceptive elaboration and<br />

control of body’s movement, were<br />

functions all localized to the brain.<br />

Hippocrates explained mental insanity<br />

as a process of brain corruption induced by<br />

bile, one of the four humours.<br />

In a case report about sudden loss of<br />

speech and paralysis of the right hand, the<br />

term “spasm” is used [13].<br />

It was stated that “an incised wound in<br />

one temple produces a spasm in the<br />

opposite side of the body” and that loss of<br />

speech occurred with “paralysis of the<br />

tongue or of the arm and the right side of<br />

the body” [2].<br />

Hippocrates was also one of the most<br />

prominent ancient greek physician who<br />

practiced trepanation [17]<br />

Fig.4. Hippocrates <strong>–</strong> source<br />

http://commons.wikimedia.org/wiki<br />

Diocles of Carystus (ca. 375<strong>–</strong>300 BC)<br />

stated that the right half of the brain<br />

provided sensation and the left<br />

intelligence, and that the heart is the centre<br />

for hearing and understanding. In his<br />

opinion, madness was “boiling of the

50<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

blood in the heart”, lethargy was “a<br />

chilling of the psychic pneuma about the<br />

heart and the brain and a freezing of the<br />

blood dwelling in the heart”, and<br />

melancholy was considered as a disorder<br />

arising “from thickening of black bile<br />

around the heart” [8].<br />

Erasistratus of Chios (ca. 304 <strong>–</strong> ca. 250<br />

BC) founded, together with Herophilus, a<br />

school of anatomy in Alexandria, where<br />

the two performed human dissections on<br />

criminals [21].<br />

Erasistratus described a system of<br />

humors consisting of nervous spirit -<br />

carried by nerves -, animal spirit - carried<br />

by arteries -, and blood - carried by veins.<br />

Erasistratus considered that atoms are the<br />

essential body element. Atoms were<br />

activated by pneuma (external air) that<br />

circulated through the nerves. He thought<br />

that the inspired air is transformed into<br />

“vital spirit” and transported to the brain’s<br />

ventricles, where it becomes “animal<br />

spirit”. The animal spirit filled the empty<br />

nerves and let them control the muscle<br />

movement [21].<br />

According to Erasistratus, the dura<br />

mater had the greatest significance, being<br />

considered the center of sensitive, motor,<br />

and cognitive functions. Therefore,<br />

psychiatric and neurological disorders<br />

were thought to depend on pathological<br />

changes of this membrane. He considered<br />

that lethargy “arises from an affection of<br />

the psychic faculty in the meninx, which is<br />

precisely where lethargy occurs”. Delirium<br />

was “a disorder of the activity of the<br />

meninx” [9].<br />

Erasistratus is one of the first who<br />

described the cerebrum and cerebellum.<br />

Initially, he asserted that nerves also<br />

originate from the meninges. Later, he<br />

recognizes that nerves originate from<br />

brain. He also established a relationship<br />

between the the number and complexity of<br />

the human brain convolutions and<br />

intelligence [8].<br />

Fig.5. Erasistratus of Chios <strong>–</strong> source<br />

http://www.encyclopedia.com/<br />

Herophilus of Chalcedon (335-280<br />

BC), the “Father of Anatomy”, is also<br />

considered the founder of human anatomy<br />

as a distinct branch of medicine [14].<br />

Fig.5. Erasistratus of Chios <strong>–</strong> source<br />

womenshealth.medinfo.ufl.edu/.../slide5.html<br />

He made a series of accurate<br />

descriptions of neuroanatomical structures.<br />

He also made a clear distinction of the<br />

brain ventricles, identifying that they are in<br />

reciprocal communication and therefore<br />

allow passage of the psychic pneuma.<br />

He described precisely the cerebellar<br />

ventricle, the fourth ventricle or the<br />

posterior ventricle. He also described and<br />

nominated some structures visible on the<br />

floor of this cavity, such as the calamus

DIACONESCU et al.: The importance of studying Greek philosophers and physicians (5 th <strong>–</strong> 3 rd<br />

century B.C.): contribution to the development of neuroscience in medical schools<br />

scriptorius, the posterior median sulcus<br />

and the colliculus facialis. He accepted<br />

Aristotle’s distinction between enkephalos<br />

and paraenkephalos, recognizing that they<br />

are separated by a thick membrane <strong>–</strong><br />

tentorium cerebelli.<br />

He described a membrane covering the<br />

ventricles of the brain as the “choroid<br />

meninx”. Along with Erasistratus, he was<br />

considered the first anatomist who<br />

identified motor and sensory nerves and<br />

who located their origin correctly in the<br />

brain or in the spine. He described the<br />

References<br />

1. Aristotle, Gotthelf A. Historia<br />

Animalium, vol. I: Books I-X -<br />

Cambridge Classical Texts and<br />

Commentaries, No. 38, 2002<br />

2. Chadwick J, Mann NW. The <strong>Medical</strong><br />

Works of Hippocrates. Blackwell,<br />

London, 1950.<br />

51<br />

optic, oculomotor, trigeminal, motor root<br />

of the trigeminal, facial, acoustic and<br />

hypoglossal nerves [4, 20].<br />

Erasistratus and Herophilus first<br />

identified that cutting nerves causes<br />

paralysis.<br />

Conclusions<br />

All these theories represent great<br />

achievements transmitted by Greek<br />

philosophers and physicians to later<br />

generations of neuroscientist.<br />

3. Clarke E. Aristotelian concepts of the<br />

form and function of the brain. Bull<br />

Hist Med All Sci 1963;37:1-14.<br />

4. Crivellato E, Ribatti D. Soul, mind and<br />

brain: Greek philosophy and the birth<br />

of neuroscience. Brain Research<br />

Bulletin 2007;71(1):327-338.<br />

5. Diels H, Kranz W. Die Fragmente der<br />

Vorsokratiker. 12th ed, Berlin, 1966.

52<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

6. Doty RW. Alkmaion’s discovery that<br />

brain creates mind: A revolution in<br />

human knowledge comparable to that<br />

of Copernicus and of Darwin.<br />

Neuroscience 2007; 147(3):561-568.<br />

7. Doty RW. Alkmaion, ca 500 BC,<br />

discovers that mind is in the brain.<br />

Neuroscience Research 2007; 58<br />

(suppl.1): S243.<br />

8. Garofalo I. Figure della medicina<br />

ellenistica. In: G. Cambiano, L.<br />

Canfora, D. Lanza “Lo spazio<br />

letterario della Grecia antica”, vol. 1.<br />

2, Roma 1993:345-368.<br />

9. Garofalo I. Anonimi Medici, De<br />

Morbis acutis et chroniis. EJ Brill,<br />

Leiden 1997<br />

10. Garrison FH. History of Medicine.<br />

Philadelphia, W.B. Saunders, 1966<br />

11. Gross CG. Aristotle on the brain. The<br />

Neuroscientist 1995;1(4):245-250.<br />

12. Hanson AE. Hippocrates: The “Greek<br />

Miracle” in Medicine. In: Medicine,<br />

Lee T. Pearcy, The Episcopal Academy,<br />

Merion, PA 19066, USA, 2006<br />

13. Hippocrates. Of the Epidemics (400<br />

BCE). Section III, case 13. Translated<br />

by F. Adams.<br />

14. Longrigg J. Anatomy in Alexandria in<br />

the third century BC. Brit J Hist Sci<br />

1988; 21: 455-488.<br />

15. Lloyd GER. Alcmaeon and the early<br />

history of dissection. Sudhoffs Arch<br />

1975; 59: 113-147.<br />

16. Lyons AS, Petrucelli RJ. Medicine. An<br />

Illustrated History. New York: Harry<br />

N. Abrams, Inc., 1987:187,192<br />

17. Mission S. Hippocrates, Galen, and the<br />

uses of trepanation in the ancient<br />

classical world. Neurosurg Focus<br />

2007;23(1):E11.<br />

18. Movia G. Aristotele. Anima, Milano:<br />

Rusconi, 1996<br />

19. Phillips ED. Greek Medicine (Aspects<br />

of Greek and Roman Life). London,<br />

Thames and Hudson, 1973.<br />

20. Rowe CJ. Plato: Phaedo (Cambridge<br />

Greek and Latin Classics). Cambridge,<br />

University Press, 1993.<br />

21. Wright JP, Potter P. Psyche and soma:<br />

physicians and metaphysicians on the<br />

mind-body problem from antiquiry to<br />

Enlightenment. Oxford: Clarendon<br />

Press 2000.

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />




L. TARTAU 1 , R. V. LUPUSORU 2 , C. E. LUPUSORU 1 ,<br />

C. ANDRITOIU 1 , O. DUMA 3<br />

Abstract: A descriptive study, regarding some ethical issues within the<br />

physician-patient relationship in the management of neuropathic pain.<br />

Method: This study was performed on a sample of 278 patients with<br />

neuropathic pain, in a comparison between urban and rural area medical<br />

centers, from Iasi County. This investigation was based on medical records<br />

and anonymous questionnaire; the informal consent was required. Results:<br />

The doctor-patient relationship in rural medical centers is better than in<br />

urban, patients being more satisfied with the medical consultation and more<br />

likely to comply with the treatment than patients in urban area. Opioids,<br />

antidepressants and anticonvulsants were recommended especially in urban<br />

medical center, but in a small number of patients. Conclusion: Even though<br />

there are some differences and meanings of the interactions between the<br />

physicians and sick peoples in urban and rural medical care centers, the<br />

study shows that in both cases, neuropathic pain is often undertreated, due to<br />

insufficient acquainted of the literature data, regarding the new modern<br />

therapeutic strategies in this type of pain.<br />

Key words: neurophatic pain, ethic, doctor-patient relationship.<br />

Aim: The paper represents a descriptive<br />

study, concerning in a comparison between<br />

urban and rural area from Iasi county, one<br />

of the most representative in the region of<br />

Moldova, regarding the physician-patient<br />

relationship in the management of<br />

neuropathic pain.<br />

General data<br />

The family physician plays a key role,<br />

being the first contact person for the<br />

patient. Addressability to medical services<br />

takes a central position in patient-physician<br />

communication and relationship. [9] The<br />

1 Pharmacology, Algesiology Department, „Gr.T. Popa”, UMF, Ia�i, Romania<br />

2 Pathophysiology Department, UMF, Ia�i, Romania<br />

3 Public Health and Sanitary Management Department, UMF, Ia�i, Romania<br />

establishment of an optimal rapport<br />

between the physician and patient is<br />

essential to both parties, a successful collaboration<br />

depending on the physician’s<br />

ability to manage unhealthy person<br />

expectations. [1, 7, 18]<br />

This relationship concerns the<br />

foundation of contemporary medical<br />

ethics, and implies the existence of the<br />

physician, who offers specialized and<br />

responsible services first, and, on the other<br />

hand, the existence of the patient, who<br />

needs medical assistance. [22] These both<br />

parties can openly discuss the risks of

54<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

patient during medical procedures, and<br />

choices regarding the possibilities to<br />

improve his quality of life. [3, 15, 21]<br />

In terms of bioethics, patient-physician<br />

interrelation comprises patient’s right to<br />

the confidentiality of his medical problem,<br />

his consent to treatment, but also the right<br />

to health and to not be at pains. Physician’s<br />

vocation implies all activities targeted to<br />

preserve population health status, to<br />

prevent illnesses, to improve the patient<br />

healthy living conditions. [1, 13, 15]<br />

The major requirements of this complex<br />

physician-patient relationship are based on<br />

friendship, effective communication,<br />

respect, and mutually trust. Patient health<br />

outcomes can be improved with good<br />

physician-patient communication. [14, 25]<br />

Working together, the potential exists to<br />

pursue interventions that can significantly<br />

improve the patient's quality of life and<br />

health status. [13, 17, 20]<br />

Pain plays a central role in the health<br />

care system, and is one of the most<br />

frequent reasons for consulting a doctor.<br />

Primary care is the most frequent care<br />

provider for pain. [11]<br />

Neuropathic pain is a complex, chronic<br />

pain state that usually is accompanied by<br />

tissue injury. Within neuropathic pain, the<br />

nerve fibers themselves may be damaged,<br />

dysfunctional or injured. Major pathophysiological<br />

mechanisms include peripheral<br />

sensitization, sympathetic activetion,<br />

disinhibition, and central sensitization.<br />

[4, 16] Neuropathic pain is<br />

associated with many diseases, including<br />

diabetic peripheral neuropathy, postherpetic<br />

neuralgia, human immunodeficiency<br />

virus <strong>–</strong> related disorders, and chronic<br />

radiculopathy. [5, 6, 10] Neuropathic pain<br />

is described as burning, electric, tingling<br />

and shooting in nature. [4, 10] Numerous<br />

therapeutic options are available, including<br />

systemic medications, physical rehabilitation,<br />

behavioural modification, and<br />

invasive procedures. [5, 8] Unfortunately,<br />

most neuropathic syndromes respond<br />

poorly to nonsteroidal antiinflamatory<br />

drugs and opioid analgesics. First-line<br />

agents for modern treatment of neuropathic<br />

include tricyclic antidepressants,<br />

pregabaline, gabapentin, topical lidocaine,<br />

tramadol, and opioids. [12, 19, 23, 24]<br />

Method<br />

This exploratory study was performed,<br />

during six months (September 2008 -<br />

February 2009) on a sample of 278<br />

patients with neuropathic pain, aged 25-70<br />

years, from urban (157 cases) and rural<br />

medical centers (121 cases) in county of<br />

Iasi. This investigation was based on both<br />

medical records and anonymous questionnnaire,<br />

to obtain detailed information,<br />

regarding intensity of pain, associated<br />

diseases, and the treatment of neuropathic<br />

pain.<br />

The purpose of this study was to<br />

describe the socio-demographic patterns,<br />

consultations, pathology and the treatment<br />

of attendants at general practitioners at<br />

these two primary health care centers. The<br />

questionnaires involved epidemiologic<br />

characteristics and also, patient-reported<br />

relevance and performance of the<br />

consultation aspects. It was also identified<br />

the impact that physician-patient interpersonal<br />

interactions have had upon the<br />

satisfaction of primary medical services.<br />

The authors designed the questionnaire<br />

according to those presented in the<br />

literature. The study was performed with<br />

the support of the family physicians, for<br />

data collection. All questionnaires were<br />

distributed and collected, trying to<br />

maintain the confidentiality of the recorded<br />

data. All patients were informed about the<br />

aim and purpose of the investigation and<br />

how to fill in the questionnaire. Once they<br />

had given their consent, patients were<br />

asked to complete the self-administered<br />

questionnaire. Incomplete questionnaires<br />

were excluded. Data were scored and

L. TARTAU, ez al.: - Doctor-patient relationship in neuropathic pain: a comparative study between 55<br />

urban and rural zone<br />

statistically analyzed with t test from<br />

Windows EXCEL program.<br />

Results and discussions<br />

This study intended to directly compare<br />

data about medical services between urban<br />

and rural primary care centres. Interviews<br />

in the practices of both general practitioners<br />

have indicated a higher prevalence<br />

of neuropathic pain in male subjects, of<br />

57% in urban, 55% in rural area.<br />

Analysis and statistical processing of<br />

data shows that in more than 75% of<br />

patients seeking medical advice in both<br />

medical centres, the pain was reported to<br />

be intense to severe (range 6 to 10) to<br />

visual analogue scale of 0-10 values (with<br />

0 being no pain, 5 mild pain and 10 being<br />

the worst pain imaginable). (Fig. 1)<br />

Fig. 1<br />

The average score computed by<br />

residence area didn’t show significant<br />

differences between urban and rural<br />

subjects (p>0.05). Impairment in everyday<br />

life caused by neuropathic pain was<br />

significant in both medical care centres.<br />

The fact that more than 72% see<br />

themselves as impaired in their daily<br />

activities illustrates the extent of the<br />

restrictions due to pain. Emotional changes<br />

due to pain lead to high psychological<br />

strain and loss of quality of life.<br />

The most frequent causes of neuropathic<br />

pain are represented by chronic<br />

radiculopathy, diabetic (55.4% in urban,<br />

61.2 in rural), followed by neoplastic and<br />

postherpethic neuralgia. (Fig. 2)<br />

Fig. 2<br />

In both medical centres the<br />

pharmacologic treatment of neuropathic<br />

pain consists of nonopioid analgesics<br />

administration, drugs that proved no<br />

efficacy in this type of chronic pain,<br />

according to the literature data findings of<br />

the checks. [12, 23]<br />

Nonsteroidal anti-inflammatory drugs<br />

were administered to all patients,<br />

associated or not with analgesic-antipiretic<br />

drugs. Opioid, antidepressant and anticonvulsant<br />

drugs were recommended especially<br />

in urban medical centre, but in a<br />

small number of neuropathic patients.<br />

Tramadol was the only one type of opioid<br />

medication recommended in patients with<br />

neuropathic pain, especially in urban<br />

medical centre. (Fig. 3)<br />

Fig. 3

56<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

Regarding the physician-patients<br />

relations, the investigation showed that<br />

there are some differences and meanings of<br />

the interactions between the doctors and<br />

sick peoples in urban and rural medical<br />

care centres.<br />

However, only a few patients have<br />

received pain treatment properly adjusted<br />

to their needs. Around 18% of patients<br />

consider any of their therapies satisfactory<br />

in reducing their pain.<br />

In a rural medical centre, the patients’<br />

satisfaction with the consultation was<br />

related to the longer consultation times.<br />

Opposite to this, in urban medical centre,<br />

most patients complains sometimes about<br />

busy doctor, who has too little time to<br />

listen, only a small number of patients<br />

being satisfied with the time given to<br />

medical consultation. (Fig. 4) This aspect<br />

is inconclusive, because it is possible that a<br />

patient’s estimation may be altered by his<br />

experience consultations.<br />

Fig. 4<br />

The results of questionnaires evaluating<br />

patient expectations prior to the visit have<br />

been compared with his satisfaction<br />

measured after the consultation. In rural<br />

area the patients are more satisfied and<br />

more likely to comply with treatment<br />

recommended. On the other hand, the<br />

urban patients tend to identify the doctor as<br />

their main source of information wishing<br />

to receive detailed data and explanation<br />

about their diagnosis, treatment and course<br />

of illness, attitude that may disturb the<br />

stages in the medical consultation<br />

procedure.<br />

These results are concordant with<br />

literature data which stipulate that the lack<br />

of sufficient attention to psychosocial<br />

issues may be even more related to<br />

dissatisfaction, than the presence of<br />

attention is related to satisfaction. [2, 25]<br />

Our study revealed a better physicianpatient<br />

interrelation in rural than in urban<br />

medical centre, because in the first case,<br />

the practitioner is more familiar with<br />

patient and his medical history, dealing<br />

that strongly increases patient trust in<br />

doctor. (Fig. 5) It is also true that in some<br />

situations this relationship may be<br />

impaired by the deficiency of communication,<br />

due to the poor intellectual level<br />

of the patients. The mentioned communication<br />

difficulties can be described with<br />

reference to problems of diagnosis, a lack<br />

of patient’s involvement in the discussion,<br />

or the inadequate provision of information<br />

to the patient. [2, 14]<br />

Fig. 5<br />

Secondly, despite the fact that the rural<br />

family physician is insufficient scientific<br />

documented about the new trends of<br />

pharmaco-therapeutic strategies in the

L. TARTAU, ez al.: - Doctor-patient relationship in neuropathic pain: a comparative study between 57<br />

urban and rural zone<br />

treatment of neuropathic pain, he proved<br />

high overall responsiveness to the patients<br />

and tasks performed complies their<br />

demands.<br />

Conclusions<br />

� in this two medical centres, the most<br />

frequent causes of neuropathic pain are<br />

represented by chronic radiculopathy,<br />

diabetic, neoplastic and postherpethic<br />

neuralgia;<br />

� in both medical centers, the pharmacological<br />

treatment of neuropathic pain<br />

consists of nonopioid analgesic drugs<br />

(especially the nonsteroidal antiinflammatory<br />

- ketoprofen, indometacin,<br />

and analgesic antipyretic <strong>–</strong> acetaminophen)<br />

administration.<br />

� opioid, antidepressant and anticonvulsant<br />

drugs were recommended especially in<br />

urban medical center, but in a small<br />

number of neuropathic patients.<br />

� in our country, most health care<br />

practices are not sufficiently prepared<br />

to manage neuropathic pain;<br />

� neuropathic pain is often undertreated,<br />

due to insufficient acquainted of the<br />

literature data, regarding the new<br />

modern therapeutic strategies in this<br />

type of pain.<br />

� primary health care system particularities<br />

are less important for doctorpatient<br />

communication that was<br />

expected;<br />

� patients in rural area are more satisfied<br />

with the medical consultation and more<br />

likely to comply with the treatment,<br />

than patients in urban area;<br />

� the doctor-patient relationship in rural<br />

health care is better than in urban<br />

medical care;<br />

� the obtained data has provided detailed<br />

understandings of the strengths and<br />

limitations of primary medical care<br />

services, not evident in official reports.<br />

References:<br />

[1]. Ast�r�stoaie V., Almo� T. B., Esentialia<br />

in Bioetica, Ia�i, Ed. Cantes, 1998.<br />

[2]. Bell R. A., Kravitz R. L., Thom D. et<br />

al., Unmet expectations for care and<br />

the patient-physician relationship, J.<br />

Gen. Int. Med., 2002, 17: 817-824.<br />

[3]. Benatar S. R., Public health and public<br />

health ethics, Acta Bioethica, 2003; 9 (2).<br />

[4]. Cavenagh J., Good P., Ravenscroft P.,<br />

Neuropathic pain: are we out of the woods<br />

yet?, Intern. Med. J., 2006; 36: 251-5.<br />

[5]. Cruccu G., Anand P., Attal N. et al.,<br />

EFNS guidelines on neuropathic pain<br />

assessment. Eur. J. Neurol., 2004 Mar;<br />

11(3):153-62.<br />

[6]. Cruciani R., Update on the management<br />

of neuropathic pain in cancer<br />

patients, in Burton, A. (ed.), Current<br />

Thinking in Trends in Cancer Pain<br />

Management: Towards optimal<br />

symptom management, The Biomedical<br />

& Life <strong>Sciences</strong> Collection,<br />

Henry Stewart Talks Ltd, London,<br />

2009.<br />

[7]. Dugdale L. S., Siegler M., Rubin D. T.,<br />

<strong>Medical</strong> Professionalism and the Doctor-<br />

Patient Relationship, Perspectives in<br />

Biology and Medicine, Volume 51,<br />

Number 4, Autumn 2008, pp. 547-553.<br />

[8]. Finnerup N. B., Otto M., Jensen T. S.<br />

et al, An evidence-based algorithm for<br />

the treatment of neuropathic pain,<br />

Med. Gen. Med., 2007 May 15; 9 (2):<br />

36.<br />

[9]. Freeman G. K., Olesen F., Hjortdahl<br />

P., Continuity of care: an essential<br />

element of modern general practice?.<br />

Fam. Pract., 2003, 20: 623-627.<br />

[10]. Gore M., Dukes E., Rowbotham D.J.,<br />

Clinical characteristics and pain management<br />

among patients with painful<br />

peripheral neuropathic disorders in<br />

general practice settings, Eur. J. Pain,<br />

2007; 11(6):652<strong>–</strong>64.<br />

[11]. Hasselstrom J., Liu-Palmgren J.,<br />

Rasjo-Wraak G., Prevalence of pain in

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general practice. Eur. J. Pain., 2002, 6:<br />

375-385.<br />

[12]. Helme R. D., Drug treatment of<br />

neuropathic pain, Aust. Prescr., 2006;<br />

29:72-5<br />

[13]. Hottois G., Missa N. J., Nouvelle<br />

encyclopedie de bioethique, Bruxelles,<br />

DeBoeck Université éditions, 2001,<br />

229<strong>–</strong>35.<br />

[14]. Kerse N., Buetow S., Mainous A. et<br />

al., Physician-patient relationship and<br />

medication compliance: a primary care<br />

investigation, Ann. Fam. Med., 2004,<br />

2: 455-461.<br />

[15]. Knight B., The ethic of medical<br />

practice, Simpson`s Forensic Medicine,<br />

10 th Edition, Knight B. (ed.),<br />

Edward Arnold London Melbourne<br />

Aukland, 1991, pp. 236-243.<br />

[16]. Pasero C., Pathophysiology of<br />

neuropathic pain. Pain Manag. Nurs.,<br />

2004; 5: 3-8.<br />

[17]. Rao J. K., Anderson L. A., Inui T. S.<br />

et al., Communication interventions<br />

make a difference in conversations<br />

between physicians and patient,<br />

<strong>Medical</strong> Care, 2007, 45: 340-349.<br />

[18]. Rogozea L., Etica si deontologie<br />

medicala, vol. 1, Ed. Universit��ii<br />

Transilvania, 2006.<br />

[19]. Saarto T., Wiffen P. J., Antidepressants<br />

for neuropathic pain, Cochrane<br />

Database Syst. Rev., 2007 Oct 17;<br />

(4):CD005454. [abstract]<br />

[20]. Safran D. G., Defining the future of<br />

primary care: what can we learn from<br />

patients?, Ann. Intern. Med., 2003, 138<br />

(3): 248<strong>–</strong>55.<br />

[21]. Street R. L., O’Malley K. J., Haidet<br />

P. et al., Understanding concordance in<br />

patient-physician relationships: personal<br />

and ethnic dimensions, of shared<br />

identity. Ann. Fam. Med., 2008; 6(3):<br />

198-205.<br />

[22]. Veninga C. C., Denig P., Zwaagstra<br />

R. et al., Improving drug treatment in<br />

general practice. J. Clin. Epidemiol.,<br />

2000, 53:762-772.<br />

[23]. Wallace J. M., Update on pharmacotherapy<br />

guidelines for treatment of<br />

neuropathic pain, Curr. Pain Headache<br />

Rep., 2007; 11(3):208<strong>–</strong>14.<br />

[24]. Wiffen P., Collins S., McQuay H. et<br />

al; Anticonvulsant drugs for acute and<br />

chronic pain, Cochrane Database Syst.<br />

Rev., 2005 Jul 20; (3): CD001133.<br />

[25]. Williams S., Weinman J., Dale J.,<br />

Doctor-patient communication and<br />

patient satisfaction: a review, Fam.<br />

Pract., 1998: 480-492.

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />



L. ROGOZEA 1 , M. DRAGOMAN 1 , F. LEA�U 1 ,<br />

M. �URCANU 1 , R. MICL�U� 1 , M. CARDIS 1<br />

Abstract: „The nervous and mental illnesses, prevention and treatment”, a<br />

work of the former doctor Aurel Dobrescu from Bra�ov, is one of the most<br />

interesting book edited by “<strong>Medical</strong> ASTRA”, and it is an analyze of the<br />

human soul, of the normal life against the sick life<br />

Key words: manuscript, Dobrescu, ASTRA<br />

The book was edited in 1919 and one<br />

year later was awarded by the Romanian<br />

Academy. It has 163 pages and it addresses<br />

to the general audience with new<br />

information about neurology and<br />

psychiatry. It has a special part about<br />

developing the child’s mind, and it is of a<br />

real use for teachers and parents.<br />

Fig. 1. - A. Dobrescu <strong>–</strong> Book cover<br />

1 Faculty of Medicine, Transilvania University of Bra�ov.<br />

The knowledge of nervous system’s<br />

structure and physiology represents the<br />

fundament of all nervous phenomenon, dr.<br />

Dobrescu presents in his study some<br />

general issues, then reflexes and instincts<br />

and in the end the analyzes of the most<br />

abstract psychological activities.<br />

First part of the book is called<br />

”Generalities about the nervous system”<br />

and it has 5 chapters.<br />

Chapter 1, “The knowledge of the<br />

brain, throw which the soul’s life is<br />

produced, is necessary for everybody”<br />

highlights the importance of discovering<br />

the human brain’s secrets.<br />

Fig. 2. - A. Dobrescu <strong>–</strong> book illustration <strong>–</strong><br />

nervous system

60<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

The next chapter “The new direction of<br />

psychology to laboratory and clinic”<br />

follows the evolution of psychology in a<br />

new direction, from simple auto-intuitive<br />

observation to laboratory and clinic<br />

methods and in the end to helping methods<br />

as intoxications and hypnotism. Following<br />

the new direction, the author studied the<br />

psychology of the child, abnormal people,<br />

primitive populations, criminals and<br />

animals.<br />

Considering that ”a psychology which<br />

wouldn’t consider all the actual data were<br />

collected from these new sources of<br />

knowledge, is obsolete and narrows the<br />

horizon of modern man”, the author<br />

stresses the importance of evolution in<br />

science<br />

.<br />

Fig. 3. - A. Dobrescu <strong>–</strong> book illustration <strong>–</strong><br />

nervous cell<br />

Chapter 3 of the first part concludes:<br />

“Psychology proposed in nowadays<br />

schools is too theoretical” and recommends<br />

the use only of real data of<br />

physiology of the nervous system in<br />

textbooks, and then to study the causes,<br />

forms and means of preventing illness and<br />

treatment of nervous diseases. In Chapter 4<br />

we find that mental illness “however<br />

would be kaleidoscopic, are caused by the<br />

illness of a single organ, the brain”.<br />

Fig. 4. - A. Dobrescu <strong>–</strong> book illustration <strong>–</strong> brain<br />

The next chapter of the first part, ”The<br />

significance of the brain” shows that<br />

differences between humans and animals<br />

due to more complex structure of the<br />

human brain.<br />

The second part studies in 6 chapters<br />

the main functions of the nervous system.<br />

The first chapter presents, over 5 pages,<br />

the nervous cell, part of the nervous<br />

system. As the author states, "the nerve<br />

cell, the neuron, is composed of the actual<br />

cell and one or more threads that hang<br />

from it" Also, in this chapter, the author<br />

makes a distribution of the nervous<br />

system's tasks between sensory nerves,<br />

motor nerves, sympathetic nerves and<br />

central nervous system, which, in turn, is<br />

subdivided into large brain, hindbrain and<br />

spinal cord.<br />

Fig. 5. A. Dobrescu <strong>–</strong> book illustration <strong>–</strong> spinal<br />


L. ROGOZEA et al.- A reference analysis about the human soul 61<br />

The next chapter, Chapter 2, is called<br />

"The reflex" and is defined as "the simplest<br />

form of collaboration between different<br />

kinds of neurons". If for the animals the<br />

reflex plays a major role, in human<br />

reflexes are controlled by the brain and<br />

replaced with complex mental processes.<br />

Chapter 3 presents the importance of<br />

instincts, which often break the barriers of<br />

reason, being inherited from generation to<br />

generation within the same species.<br />

"The superior reflex (controlled)" is the<br />

title of the fourth chapter of the second part<br />

and presents the reflex circuit in which the<br />

impulse passes from peripheral sensory<br />

nerves to sensory nerves connecting the<br />

spinal cord to the brain; from hear, the<br />

impulse reaches the muscles, which<br />

according to the decision taken by the<br />

brain, will move or not.<br />

Fig. 6. A. Dobrescu <strong>–</strong> book illustration <strong>–</strong><br />

central nervous system<br />

Another chapter is titled "Locating the<br />

brain faculties". Here there are presented<br />

sensations reaching the brain and are<br />

printed at this level in the form of<br />

impressions, which, if the same kind,<br />

forms images. The images are grouped into<br />

concepts; concepts are divided into<br />

"faculties of intellect, feeling and will".<br />

Chapter 6 highlights "The map of the<br />

brain centers". Thus, "motor centers" are<br />

represented on the map corresponding to<br />

body parts and their illness it causes<br />

weakness or paralysis. "Intelligence is<br />

established throughout the cortex" and it is<br />

the resultant of the images and<br />

representations received by the senses.<br />

In Part III we take "a special look on<br />

the functioning of the nervous system".<br />

Chapter 1 provides the data "from the<br />

intimate life of the nervous system", thus<br />

being presented the evolution of our<br />

neurons as cells which develop many<br />

branches as they grow. The neurons'<br />

nutrition occurs through the process of<br />

assimilation, oxygen having a major role in<br />

this case.<br />

Fig. 7. A. Dobrescu <strong>–</strong> book illustration <strong>–</strong><br />

physiological aspects<br />

In Chapter 2 we learn "how to develop<br />

spiritual life". As muscle fibers increase<br />

after physical activity, "nerve elements<br />

continually grow and strengthen"<br />

following receipt, selection and setting<br />

processes of the concepts. These findings<br />

were very useful in education and also in<br />

the fact that in some children some centers<br />

are more susceptible to impressions and<br />

other are more rudimentary. Hence, the<br />

author concludes: "education wouldn't be<br />

made after a general block, but for each<br />

student's individuality".

62<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

Chapter 3 presents "the scheme of a<br />

psychological process". We'll see how<br />

sensory nerves transmit information to<br />

association centers, which, together with<br />

the memory centers and then via motor<br />

nerves will produce movement.<br />

In Chapter 4 we see a part "of the<br />

problems of intelligence" and find that the<br />

number of neurons you have at birth does<br />

not increase during life, innate concepts<br />

don't exist and genius and insanity are<br />

related.<br />

Part IV deals with "General pathology<br />

of the nervous system".<br />

Fig. 8. - A. Dobrescu <strong>–</strong> book illustration <strong>–</strong><br />

pathological aspects<br />

Chapter 1 describes the causes of<br />

diseases of nerve substance; in inherited<br />

diseases, they will be worse if taken from<br />

the mother, and if true psychopaths, they<br />

are born of both parents sick. Among won<br />

causes are the infectious diseases considered<br />

"among the greatest enemies of<br />

mankind", typhoid fever, articular rheumatism,<br />

erysipelas, Staphylococcus, Streptococcus,<br />

smallpox and pneumonia. The<br />

social poisons mentioned are alcohol,<br />

opium, cocaine, hashish. Diseases of<br />

endocrine glands are also included in the<br />

category of causes; from that type is<br />

education "too wanton and too early", that<br />

can lead to insanity. Emotions or spiritual<br />

kicks are occasional cases in individuals<br />

with predisposition for nervous diseases.<br />

Part V studies "most common forms of<br />

sickness of the nervous system", which are<br />

divided into peripheral nerve diseases and<br />

diseases of the nervous center.<br />

Chapter 1 considered "peripheral nerve<br />

illness", the main causes of disease being<br />

cold, compression, blow, degeneration,<br />

acute or chronic infectious disease toxins.<br />

Illness is made by inflammation and<br />

muscles corresponding to these nerves will<br />

become atrophic, and will regenerate<br />

following cessation of the inflammation.<br />

Sensory nerve disease will produce<br />

anesthesia or callousness and neuralgia or<br />

nerve pain. The disease will cause motor<br />

nerve paralysis.<br />

In Chapter 2 we learn that "Treatment<br />

of the illness of peripheral nerves" should<br />

be above all a treatment of the factors that<br />

cause the disease: rheumatism, syphilis,<br />

alcoholism, infectious disease, diabetes.<br />

Treatment usually consists of electrifying,<br />

warm baths, hot compresses, ointments<br />

and Belladona extract opium, narcotics and<br />

not least, a substantially diet .<br />

In Chapter 3 are presented "Diseases of<br />

central nervous system" as being divided<br />

into functional diseases and organic<br />

diseases.<br />

The next chapter is entitled "General<br />

symptoms of diseases of central nervous<br />

system" and treats disorders of the sphere<br />

of intellect in 7 pages (illusion, hallucination,<br />

disturbance of consciousness,<br />

eclipsing intellectual life, stupor, obsessions,<br />

phobias, paranoid ideas, anger),<br />

disturbances in the sphere of sense (the<br />

soul, apathy, hipertimia) and disturbances<br />

in the sphere of the will (aboulia, feverish<br />

excitement, catalepsy, catatonia, impulsive<br />

actions, impulsive obsession)<br />

Chapter 5 is of great complexity and<br />

studies the functional diseases, and the<br />

organic ones.

L. ROGOZEA et al.- A reference analysis about the human soul 63<br />

Fig. 9. - A. Dobrescu <strong>–</strong> book illustration <strong>–</strong><br />

pathological aspects<br />

The study begins with functional<br />

nervous disease, defined as "state of<br />

constant fatigue and irritability" following<br />

the weakening of the nervous system. The<br />

main symptoms of mild neurasthenia are<br />

the headaches, pain in the spinal cord,<br />

insomnia, digestive disorders followed by<br />

significant decrease in weight, angina<br />

pectoris. In patients with psychopathic<br />

predisposition will appear serious<br />

neurasthenia characterized by weakening<br />

memory, phobias appearance, imagination<br />

and fantasy taking the place of rational<br />

thinking.<br />

Fig. 10. - A. Dobrescu <strong>–</strong> book illustration <strong>–</strong><br />

pathological aspects<br />

Ipocondria is considered an obsessive<br />

analysis of the bodily condition, these<br />

patients being considered "imaginative<br />

sick people". An important part of this<br />

chapter is given to hysteria, the disease of<br />

"slightly irritable, very significantly,<br />

whims, falling quickly from one extreme<br />

to another". Symptoms of hysteria are<br />

varied and sensory nerves are affected by<br />

anesthesia and hyperesthesia, motor nerves<br />

by lack of activity or by contractions of<br />

muscles. Epilepsy, mania, melancholy, paranoia<br />

and madness are the last functional<br />

diseases described briefly in this chapter.<br />

Fig. 11. - A. Dobrescu <strong>–</strong> book illustration <strong>–</strong><br />

pathological aspects<br />

In organic diseases are studied idiocy,<br />

imbecility, cretinism, dementia, senile and<br />

especially alcoholism. In the following<br />

pages is the presentation of the forms of<br />

alcoholic psychosis: delirium, regular<br />

drunkenness, alcoholic dementia etc.<br />

The next topic is the influence of toxic<br />

syphilis on nervous system, leading to the<br />

progressive general paralysis, "an organic<br />

disease of the entire central nervous<br />

system, which arises in people who have<br />

been infected with syphilis" through fiber<br />

atrophy and degeneration of nerve cells.<br />

Another consequence of the ill with<br />

syphilis, is described in the following lines.<br />

Last of organic nerve diseases studied is<br />

apoplexy or cerebral hemorrhage, known<br />

as "damblaua" produced by tearing of<br />

arteries in the brain. We will stop to<br />

analyze the clinical picture for dorsal<br />

tabes, while trying to present known data<br />

in 1919 and that we have today about.

64<br />

Dorsal Dobrescu’s<br />

tabes book<br />

Defini- Destruction<br />

tion of peripheral<br />

sensory<br />

neurons and<br />

their<br />

continuation<br />

of the spinal<br />

cord.<br />

Walking Uncertainty<br />

walk,<br />

slouch,<br />

atactic<br />

Pain Killer pain<br />

in legs and<br />

torso<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

In current<br />

work<br />

Demyelination<br />

of posterior<br />

cords, dorsal<br />

roots and<br />

dorsal roots<br />

ganglia<br />

Gait ataxia<br />

with broad<br />

base of<br />

support and<br />

stepaj<br />

Paresthesia ,<br />

bladder<br />

disturbances,<br />

impotence,<br />

areflexia, loss<br />

of postural<br />

sensation, deep<br />

pain and<br />

thermal<br />

sensitivity<br />

Loss of pain<br />

sensitivity<br />

Joint<br />

degeneration,<br />

atrophic,<br />

perforated<br />

ulcers of the<br />

leg<br />

Pupil small,<br />

irregular,<br />

which reacts to<br />

accommodatio<br />

n but not light<br />

Tabel. 1. <strong>–</strong> Comparing the data from Dobrescu<br />

Book with the modern book<br />

Comparing data on disorders of intellect<br />

and the will of the book of Dr. Dobrescu<br />

with what we know today about the same<br />

concept, we see that differences are not<br />

large at all.<br />

Dobrescu’s<br />

book<br />

Illusion The patient<br />

receives via<br />

the senses<br />

all sorts of<br />

feelings<br />

about the<br />

things<br />

around him,<br />

but he<br />

exaggerates<br />

illness nerve<br />

centers, it<br />

turned into<br />

images that<br />

do not<br />

correspond<br />

to reality<br />

Hallucination The patient<br />

cause in<br />

nerve<br />

centers an<br />

image,<br />

without<br />

having<br />

received any<br />

outside<br />

perception<br />

In current<br />

psychiatric<br />

books<br />

In a false<br />

perception<br />

of real<br />

sensory<br />

stimuli<br />

False<br />

perception,<br />

failure in<br />

the<br />

absence of<br />

actual<br />

sensory<br />

stimulus<br />

Tabel. 2. <strong>–</strong> Comparing the data from Dobrescu<br />

Book with the modern book<br />

Part <strong>VI</strong> deals with &"prevention<br />

nervous system's diseases".<br />

Chapter 1 presents "the means of<br />

education" for prevention of these<br />

diseases: the fight against sexual diseases,<br />

combating alcoholism and overwork, the<br />

gym, exercise and trips.<br />

Chapter 2 highlights the role of spiritual<br />

education in preventing nerve diseases.<br />

The purpose of education is "to strengthen<br />

the will of the student, which can deal<br />

anytime with his impulses". It studies the<br />

importance of training character and<br />

temperament and the role of the character<br />

in preventing nerve diseases. Concluding,

L. ROGOZEA et al.- A reference analysis about the human soul 65<br />

Dr. Dobrescu says that "a strong character,<br />

meaning a mind that deals with tendencies<br />

and agitation (...) can do a lot to prevent<br />

nerve diseases".<br />

Part <strong>VI</strong>I deals with the study of nervous<br />

diseases’ treatment. The author proposes<br />

treatment regimens in patients with<br />

nervous breakdown, the scheme which will<br />

include ensuring peace for the patient,<br />

removing him from the environment, food<br />

care, idrotherapeutic, electrotherapeutic<br />

and psychotherapeutic treatment, general<br />

treatment for strengthening. In the<br />

following pages of the Treaty are discussed<br />

at length all these therapeutic methods.<br />

Fig. 11. - A. Dobrescu <strong>–</strong> book illustration <strong>–</strong><br />

pathological aspects<br />

Part <strong>VI</strong>II, the last part of this study is a<br />

warning, stating "how a family degenerate"<br />

by the appearance and inheritance of nerve<br />

diseases. Concluding, the author states that<br />

"the power of a nation depends on the<br />

ethical value of families", highlighting the<br />

importance of prevention and treatment of<br />

nervous diseases.<br />

The aim of this paper is to contribute to<br />

the development of the human race, as is<br />

clear even from the author's words: "In<br />

preparing this book, besides a brief<br />

appearance of normal and pathological<br />

mental life and the prevention and<br />

treatment of nervous diseases, I set one<br />

more goal: to draw attention to the<br />

significance of some agents of mental<br />

diseases on future generations; that is my<br />

contribution to the improvement of the<br />

human race”.<br />

Concluding, the book is a good<br />

example of the concerns of representatives<br />

of ASTRA in medicine.<br />

References<br />

[1]. Bologa V.L. <strong>–</strong> Istoria medicinei<br />

române�ti, Ed. <strong>Medical</strong>�; Bucure�ti,<br />

1972, 565 pg.<br />

[2]. Burtea Victoria — Manual de<br />

semiologie psihiatric�; Casa de<br />

Editur� Venus, Ia�i, 2003, 293 pag.<br />

[3]. Dobrescu Aurel — Boalele nervoase �i<br />

mentale, prevenirea �i tratamentul<br />

lor; Ed Institutul de arte grafice C.<br />

Sfetea, Bucure�ti, 1919, 163 pag.<br />

[4]. Harrison - Principiile medicinei<br />

interne; Ed Teora, Bucure�ti, 2001,<br />

2840 pag.<br />

[5]. Huttmann A., Barbu G. <strong>–</strong> Medicina în<br />

ora�ul Stalin ieri �i azi, Ed Societ��ii<br />

�tiin�elor medicale din R.P.R., Filiala<br />

regional� Stalin, 1959, 163 pag.<br />

[6]. Iftimovici R. <strong>–</strong> Istoria medicinei, Ed.<br />

ALL; Bucure�ti, 370 pg.<br />

[7]. Minea Dan — Neurologie, Reprografia<br />

Universit��ii Transilvania, Bra�ov,<br />

2003, 300 pg.<br />

[8]. Rogozea L. <strong>–</strong> Aspecte ale medicinii<br />

bra�ovene în perioada interbelic�, Acta<br />

medica Transilvanica, nr.1, 2003,<br />

pg.56-60<br />

[9]. Rogozea L. <strong>–</strong> Bra�ovul iatro-istoric, Ed.<br />

Universit��ii Transilvania, 2006, 217 pg.<br />

[10]. Rogozea L. <strong>–</strong> Doctorul Arnold<br />

Huttmann <strong>–</strong> iatroistoric transilv�nean,<br />

Acta Medica Transilvanica nr.2, 2002,<br />

an X<strong>VI</strong>II, pg. 121-123, ISSN 1453-1968<br />

[11]. Rogozea L. <strong>–</strong> Personalit��i ale

66<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

medicinii române�ti, vol. 1, Ed.<br />

Universit��ii Transilvania, 2006,<br />

[12]. Rogozea L. <strong>–</strong> Rolul Astrei în editarea<br />

unor publica�ii medicale, Acta<br />

Medica Transilvanica, nr 2, 2005, pg.<br />

102-104<br />

[13]. Rogozea L., Micl�u� R. <strong>–</strong> Via�a<br />

medical� bra�ovean� din anii 40<br />

reflectat� în ziarele locale, Sesiunea<br />

de comunic�ri a C.R.I.F.S.T <strong>–</strong><br />

Academia Român�, în Hermeneutica<br />

Historiae et Philosophiae Technicae,<br />

2003, Ed. Universit��ii Transilvania,<br />

pg.123-126,<br />

[14]. Sârbu A., Brânzei P.— Psihiatrie; Ed<br />

Didactic� �i Pedagogic�, Bucure�ti,<br />

1981, 340 pg.<br />

[15]. Setlacec D <strong>–</strong> Medicina Româneasc�<br />

<strong>–</strong> Medicina European� (1859-1916);<br />

Ed. <strong>Medical</strong>�; Bucure�ti, 1995, 328<br />


Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />


TURKISH PHYSICIAN) (1889-1948) AND HIS<br />




Abstract: Prof. Dr. Hulusi Behçet (1889-1948) is a famous Turkish<br />

physician. He translated many foreign articles into Turkish to help the<br />

education of new generations and published original case reports in the<br />

international reviews in order to make contact with foreign countries.<br />

Moreover, he published many books. Fifty-three of those appeared in<br />

prestigious European Scientific Journals. We know that is infected with<br />

vector phlebotomus can be seen in many regions of the world and has been<br />

known in Mediterrenean Region and Middle East for centuries. Many<br />

Turkish researchers like Celal Mu¬htar, Hulusi Behçet and some foreign<br />

scientists investigated some subjects about this disease. Leishmaniosis<br />

(Oriental Sore) was another disease which Dr. Behçet worked on, beginning<br />

in 1923. He first described "the nail sign" appearing by the removal of the<br />

crust of an Oriental Sore. Hulusi Behçet wrote an important book with the<br />

name of the Therapy of Oriental Sore with Diathermy (�ark Çıbanının<br />

Diyatermi �le Tedavisi in Turkish). This book is 23 pages. In this book, the<br />

therapeutical ways of Oriental Sore and some cases are present. Moreover,<br />

Dr. Behçet mentions diathermy in his book. In this paper, Prof. Dr. Hulusi<br />

Behçet’s biography and his book with the name of the Therapy of Oriental<br />

Sore are stressed and some comments are pointed out<br />

Key words: medical history, oriental sore, epidemics<br />

Prof. Dr. Hulusi Behçet is a famous<br />

Turkish physician [13].<br />

Fig. no.1 - Hulusi Behcet<br />

Hulusi Behçet’s book with the name of<br />

the Therapy of Oriental Sore with<br />

Diathermy (Haleb veya �ark Çıbanlarının<br />

Diyatermi ile Tedavisi in Turkish) is a<br />

monography of 23 pages and is with the<br />

date of 1925 [5].<br />

In this book, some medical cases are<br />

given and commented. According to Behçet<br />

the “Oriental Sore” is seen in Baghdad,<br />

Diyarbakır, Aleppo, Sivas, Yemen etc. Its<br />

therapy continues one year and a good result<br />

cannot be obtained every time” [8].<br />

1 Department of History of Medicine and Ethics, Faculty of Medicine, University of Uludag, Bursa <strong>–</strong>Turkey

68<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

Fig.2. Prof.Dr.Hulusi Behçet’s Book Cover on<br />

Oriental Sore<br />

We know reports of a disease simulating<br />

the type of lesion seen in cutaneous<br />

leishmaniasis were first made in 1756 by<br />

Hasselquist and Russel. Also in the middle<br />

of the nineteenth century, the same type of<br />

lesion was described by French medical<br />

officers in Africa. Laveran demonstrated in<br />

1880 that this condition could be transmitted<br />

and that a fly was an important factor. In<br />

1885 Cunningham described a histological<br />

picture and stated that there were bodies<br />

within the cells which were circular to<br />

elliptic in shape. Ryan, in 1886, also<br />

described some cells which were filled with<br />

bodies which he regarded as cocci with<br />

capsules. He attempted cultures in human<br />

blood but obtained no results. It was not until<br />

1903 that Leishman and Donovan made<br />

independent reports describing the<br />

protozoan. During the same year Wright in<br />

Boston described the organisms found in the<br />

first case of cutaneous leishmaniasis reported<br />

in this country.<br />

In this book, Behçet specified that:<br />

“The 'tin-tack' sign (TTS) was the<br />

appearance of horny processes that project<br />

from the under-surface of a crust.<br />

Although it was a well-known feature of<br />

discoid lupus erythematosus it might be<br />

also seen in other crusted lesions<br />

particularly in cutaneous leishmaniasis.”<br />

So, Hulusi Behçet mentioned the tin-tack<br />

sign for the first time in the world.<br />

Leishmaniasis (Oriental Sore) was another<br />

disease which Dr. Behçet worked on,<br />

beginning in 1923. He wrote about it in<br />

many articles and succeeded in its<br />

treatment with diathermic. He first<br />

described "the nail sign" appearing by the<br />

removal of the crust of an Oriental Sore in<br />

1916. To Behçet, this symptom was the<br />

most important sign of oriental sore.<br />

Oriental Sore was diagnosed both<br />

microbiologic analysis of Leishmianias<br />

and nail sign. A Turkish physician,<br />

Abimelek mentioned in his book named<br />

Discuss on Oriental Sore (Cilt<br />

Leischmaniose’ları Hakkında Münaka�a<br />

Münasebetiyle in Turkish) with the date of<br />

1934 that Behcet described nail sign in<br />

Oriental Sore for the first time in the<br />

world. Moreover, the paper of Alfred<br />

Marcionini and Kemal Turgut dated 1944<br />

with the name of Essays on the Pathology,<br />

Clinic and Treatment of Oriental Sore in<br />

the Middle Anatolia (Orta Anadolu’da<br />

Görülen �ark Çıbanlarının �nti�arı,<br />

Patojenisi, Klinik ve Tedavisi Hakkında<br />

Tecrübeler in Turkish) gave some<br />

knowledge about the Oriental Sore in the<br />

Middle Anatolia. To this paper, Oriental<br />

Sore was named as Diyarbakır Çıbanı<br />

(Sore), Mardin Çıbanı, Urfa Çıbanı etc. to<br />

the cities of Turkey. These physicians and<br />

the entire world also accepted that Hulusi<br />

Behçet described the nail-sign in the<br />

oriental sore for the first time in the world.<br />

We know that there are a number of<br />

types of protozoa which can cause<br />

leishmaniasis. Each type exists in specific<br />

locations, and there are different patterns<br />

to the kind of disease each causes. The<br />

overall species name is Leishmania<br />

(commonly abbreviated L.). The specific<br />

types include: L. Donovani, L. Infantum, L.<br />

Chagasi, L. Mexicana, L. Amazonensis, L.<br />

Tropica, L. Major, L. Aethiopica, L.<br />

Brasiliensis, L. Guyaensis, L. Panamensis,<br />

L. Peruviana. Some of the names are

A.D. ERDEMIR et al- Prof. dr. Hulusi Behcet (a famous Turkish physician) (1889-1948) and his 69<br />

book on cutaneous leishmaniasis (oriental sore)<br />

reflective of the locale in which the<br />

specific protozoa is most commonly found,<br />

or in which it was first discovered.<br />

This famous physician mentioned that<br />

some drugs such as Neosalvarsan or carbonic<br />

acide couldn’t treat it. But, to Behçet,<br />

diathermy therapy was the best way. Behçet<br />

mentioned diathermy in every page of his<br />

book. To Behçet: “Diathermy method is<br />

applied in developed cities and good results<br />

are obtained. “Behçet treated some<br />

leishmaniasis cases with this way from 1920<br />

to 1922. In this book, 4 cases are given. One<br />

of them was the son of a merchant from<br />

Adana. This patient was 19 years old and<br />

travelled to Syria for the trade occasionally.<br />

Ulcers were located on his right neck and<br />

these were combined in time and became in<br />

the size of silver coin (mecidiye). Other<br />

doctors couldn’t treat this patient.<br />

In this case, Hulusi Behçet determined<br />

Leishmania by preparing culture and<br />

diagnosed this disease as oriental sore.<br />

Moreover, in his book, Hulusi Behçet<br />

wrote that Dr. Resat Rıza and Mustafa<br />

Bakar prepared Leishmania Tropica<br />

cultures and this research was published in<br />

Gulhane Seririyatı Journal in German. In<br />

this first case, Hulusi Behçet examined<br />

microorganisms by ultramicroscope and<br />

saw flagellums. He informed about their<br />

dimensions. So, he applied diathermy to<br />

his patient. Hulusi Behcet accepted<br />

diathermy as the best therapy [3, 7, 9].<br />

The second case of Hulusi Behçet was a<br />

servant girl. She was 23 years old. Oriental<br />

sore was seen on finger of right hand and<br />

left cheek. It was of a dull red colour and<br />

was inflammatory, quite tender and<br />

painful. Hulusi Behçet also diagnosed this<br />

case as oriental sore.<br />

In his third case, Hulusi Behçet treated<br />

a porter from Diyarbakır. He was 42 years<br />

old. Sore was on his right eyebrow and left<br />

cheek. The fourth case belonged to a girl.<br />

She came from Tahran to Istanbul. She<br />

was relative of Iran Emperor. A deep sore<br />

was on her right cheek. Behçet also treated<br />

this case with diathermy.<br />

Famous Turkish physician Behçet gave<br />

some knowledge about the discovery of<br />

microorganisms and their names. Behçet<br />

mentioned that American scholar .Wright<br />

named this disease’s microorganism as<br />

Helcosome tropicum at that time and R.<br />

Ross gave the name of Leishmania<br />

tropicum ou furonculose to it. But,<br />

afterwards, Leishmania Donovani was<br />

known as its microbe.<br />

Moreover, Behçet gave some knowledge<br />

about Leismania kinds in his small book:<br />

“Leishmanias are in two forms: Forms with<br />

flagellums and without flagellums. Two kinds<br />

of Leismanias are present. One of them is<br />

Leishmania Donovani and another is<br />

Leishmania tropica L. We also know<br />

Leishmania Americana. Leishmania<br />

Donovani also causes Kala-azar.<br />

Hulusi Behcet also gave other useful<br />

knowledge in his important book. Oriental<br />

Sore was seen in India, South Asia,<br />

Mediterrenean Sea Region, North Africa,<br />

Crete and Greek Islands, Adana etc.<br />

Oriental Sore was named Halep (Aleppo),<br />

Nile, Tahran, Isfahan, Palestine, Ankara<br />

and Diyarbakır sores. Hulusi Behçet<br />

mentioned epidemiology of this disease.<br />

Especially, Oriental Sore was infected<br />

from animals to dogs, monkeys, mouses.<br />

Hulusi Behçet also mentioned the<br />

characteristics of oriental sore. To Behçet:<br />

“On an average a fully developed Oriental<br />

sore is an inch or so in diameter. While<br />

there is often but one, there may be several<br />

or more distinct and sometimes quite<br />

widely separated formations. An Oriental<br />

Sore, when developed, is of a dull red<br />

colour, is usually of sluggish nature<br />

throughout its course, unless constantly<br />

knocked, irritated, or having added an<br />

active pyogenic factor, when it may<br />

become much more inflammatory, and<br />

quite tender and painful [4, 6, 12]. The<br />

favourite regions are the face, hands and

70<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

forearms, and legs, but no part is exempt.<br />

Moreover, Behcet gave some<br />

knowledge about some ways used in<br />

oriental sore therapy. According to Behcet,<br />

arseno benzol and salvarsan couldn’t treat<br />

oriental sore. Neosalvarsan was good for<br />

syphilis. Famous physicians, Resad Rıza<br />

and Abdülkadir Bey accepted this<br />

condition. The best method was the<br />

diathermy [10]. This was an apparatus with<br />

electric. Namely, electric was applied to<br />

the sore. But this apparatus was present in<br />

the modern cities of Turkey at that time.<br />

To Behcet, in the other cities of Turkey,<br />

frozen carbonic acid was used for the<br />

therapy. But, he preferred diathermy<br />

therapy more than frozen carbonic acide.<br />

Hulusi Behcet applied diathermy by<br />

anaesthetizing his patients and the patient<br />

healed in ten or twenty days. So, he<br />

advised application of diathermy to every<br />

physician in his book.<br />

Hulusi Behcet gave a paper on nail sign<br />

of oriental sore in 1932 .M. Mayer and<br />

Ernst Nauck also accepted Behcet’s<br />

thoughts on this topic.<br />

Hulusi Behcet again mentioned these<br />

topics in his paper with the date of 1934<br />

and named Two Important Points on<br />

Wright Sores (Wright Çıbanları<br />

Seririyatında �hmal Edilmi� �ki Mühim<br />

Nokta in Turkish).<br />

Approximately 350 million people in 8<br />

countries are estimated to be under the<br />

threat of leishmaniasis. Most of the drugs<br />

used for the treatment of leishmaniasis are<br />

toxic and have many side effects. At<br />

present there is no vaccine against<br />

leishmaniasis. Vaccine development for<br />

parasitic infections is more difficult than<br />

for viruses and bacteria because of the<br />

antigenic complexity and parasitehost<br />

interactions [1, 2, 11].<br />

References<br />

[1]. Abimelek. Cilt leischmaniose’ları<br />

hakkında münaka�a münasebetile. Deri<br />

Hast Frengi Kl Ar� 1934; 1: 283-284.<br />

[2]. Berberian DA. Cutaneous Leishmaniasis.<br />

Arch Dermat&Syph, 1944;<br />

49: 433-435.<br />

[3]. Demirhan,E.A., Öncel,Ö.: Prof.Dr.<br />

Hulusi Behcet (A Famous Turkish<br />

Physician) (1888- 1948) and Behcet’s<br />

Disease from the Point of View of the<br />

History of Medicine and Some Results,<br />

ISHIM, 5(10):51-63 (2006).<br />

[4]. Forbes,M.A.: Exogenous Cutaneous<br />

Leishmaniasis Proved by Culture,<br />

Archives of Dermatology and<br />

Syphilology, 58( 3):301-307(1948).<br />

[5]. Hulusi Behçet. Haleb veya �ark Çıbanlarının<br />

Diyatermi ile Tedavisi. Dersaadet<br />

1925 (�kinci Tab’ı) Kader Matbaası.<br />

[6]. Marinkelle, C.J.: The control of<br />

leishmaniases. Bull. WHO. 58: 807-<br />

819, 1980.<br />

[7]. Mutlu S, Scully C.:The person behind<br />

the eponym: Hulusi Behcet (1889-<br />

1948). J Oral Pathol Med. 1994 Aug;<br />

23(7):289-90.<br />

[8]. Saylan T. Life Story of the Dr. Hulusi<br />

Behçet. Yonsei Med J 1997; 38: 327-332.<br />

[9]. �ehsuvaro�lu,B.N.: Yurdumuzda Deri<br />

Hastalıkları Tarihçesi, ve Muallim<br />

Dr.Hüseyin Hulki Beyden Bir<br />

Hatıra(History of Dermatology i,n<br />

Turkey), Deri Hastalıkları ve Frengi<br />

Ar�ivi, 3(8):462-504 (1966).<br />

[10]. Templeton HJ. Cutaneous Leishmaniasis<br />

Experimentally Produced. California&<br />

West. Med., 1941; 54:70-71.<br />

[11]. Turgay N. Leishmaniasis A�ı Çalı�malarında<br />

Son Geli�meler: Ne Zaman<br />

A�ılanabilece�iz? Türkiye Parazitoloji<br />

Dergisi, 29(4):232-234, 2005.<br />

[12]. Unat,E.K.: Leishmania’lar ve<br />

Leishmania’lı �nfeksiyonların<br />

Epidemiyolojisi Üzerine, Deri<br />

Hastalıkları ve Frengi Ar�ivi<br />

5(15):869-880(1968).<br />

[13]. Yemni O. Ord. Prof. Dr. Hulusi Behçet.<br />

Deri Hast Frengi Ar� 1964; 1: 58-59.

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />






Abstract: While the domed, yard type or closed yard type system had been<br />

holding on since Anatolian Seljuks constructed the main theme again in<br />

Ottoman, the devotion of Seljuks to the yawn-dome-yard-crown door<br />

relationship turned into complicate projects which responded to the needs<br />

more towards improving architectural orders, static improvements, the needs<br />

of the patients and the effects of renaissance which was the demand mode of<br />

the west. So that, Ottoman Dar’us Sifas, formed a prototype of the first<br />

hospitals in the West and America.<br />

Süleymaniye Dar’us Sifa was a treatment center for mental patients and<br />

other patients serving for a high number of patients in its period and was<br />

greatly improved with its bath, pharmaceutical warehouse, special part<br />

sheltering heavy mental patients, wide patient rooms with high ceiling and<br />

aeration, madrasah related to the construction just on the opposite, shops<br />

providing income for the vaqf, bakery, fountain, toilettes, Darüzziyafe<br />

(restaurant) building on the east side.<br />

After we give the architectural specialties of Seljuk and Ottoman Dar’us<br />

Sifas in this article, we will deal with Süleymaniye Dar’us Sifa of Sinan<br />

Period Dar’us Sifas as a whole.<br />

Key words: Süleymaniye Dar’us Sifa, treatment, architectural specialties<br />

Süleymaniye Dar’us Sifa which was<br />

designed within the body of social<br />

complex and constructed by Mimar Sinan<br />

in the years 1553-1559 when was called as<br />

his masterbuilder period, confronts us with<br />

a different design of central composition<br />

between rectangular shaped two yards and<br />

bodies lined up around them. There is a<br />

ward in the cellar in which hopeless mental<br />

patients were sheltered in bulk and shops<br />

that are opening to the exterior street.<br />

There is Medicine Madrasah and<br />

Darülâkâkir (pharmaceutical warehouse)<br />

1 Yildiz Technical University Istanbul / Turkiye<br />

2 Istanbul University, <strong>Medical</strong> Faculty of Cerrahpasha, Istanbul / Turkiye<br />

just on the opposite of the construction.<br />

Treatment with music was also carried<br />

out in the hospital in which approximately<br />

thirty employees were serving till XIX<br />

century.<br />

As it was in Seljuks, in Ottoman Dar’us<br />

Sifas, the treatment purpose baths serving<br />

to the patients have taken part in the social<br />

complex, as for Süleymaniye Dar’u Sifa,<br />

the bath is not on another construction but<br />

it is incorporated into the Dar’us Sifa.<br />

The fountain which is providing<br />

freshness and mental relaxation with the

72<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

flux of the water is in the second yard to<br />

which all the rooms are opened.<br />

In the west entry of the first yard of the<br />

construction, there is a double domed,<br />

wide area bakery place where a kind of<br />

bread named fodla is baked for the<br />

patients.<br />

Süleymaniye Dar’us Sifa was a<br />

treatment center for mental patients and<br />

other patients serving for a high number of<br />

patients in its period and was greatly<br />

improved with its bath, pharmaceutical<br />

warehouse, special part sheltering heavy<br />

mental patients, wide patient rooms with<br />

high ceiling and aeration, madrasah related<br />

to the construction just on the opposite,<br />

shops providing income for the vaqf,<br />

bakery, fountain, toilettes, Darüzziyafe<br />

(restaurant) building on the east side.<br />

The Specialities of Ottoman Dar’us<br />

Sifas<br />

Ottoman Empire had had its greatest<br />

period under the rule of Suleiman the<br />

Magnificent, its lands extended from<br />

Austria to Arabia while Egypt was<br />

included in North Africa, in addition, The<br />

Red Sea and East Mediterranean had<br />

become Turkish Seas. In every part of the<br />

empire art and culture were paid attention,<br />

many works of art, bridges, fountains,<br />

baths, schools, mosques, dar’us sifas, etc<br />

were built.<br />

�stanbul, which was the capital of<br />

Ottoman is magnificently reflecting most<br />

of the works of art that we talk about today<br />

and exhibiting the richness of the period.<br />

The Selatin mosques and magnificent<br />

social complexes which were built by<br />

Sultans or their wives in �stanbul, today<br />

also constitute the landmarks which<br />

determine the silhouette of the city.<br />

1. Military Hospitals: Mobile and<br />

stable military hospitals were built in<br />

different parts of the empire in order to<br />

cover the needs of the army (1)<br />

2. Palace Hospitals; The Hospital of<br />

odalisques which were built in Topkapı<br />

Palace in 15th century by Conquror Sultan<br />

Mehmed and The Palace Hospital made by<br />

Turkish-Mongol Emperor Ekber in<br />

Fatehpur-Sikri in the date 1569 are the<br />

oldest palace hospitals standing today with<br />

their original conditions (2).<br />

3. Dar’us Sifas and Madrasahs which<br />

were built for public; Ottomans went on<br />

working their dar’us sifas which were<br />

coming from Seljuk Period with the<br />

foundations. Some of these were<br />

respectively dar’us sifas such as Bursa,<br />

Edirne, �stanbul ve Selanik, Belgrad,<br />

Budape�te extending to the Balkans<br />

afterwards. Especially in the 16th century,<br />

many treatment centers had been built but<br />

apart from the Hospital of the odalisques in<br />

the Topkapı Palace and the ones made by<br />

Architect Sinan any of them determined to<br />

reach our day. Generally, the aim of the<br />

dar’us sifas built within the body of a<br />

social complex is to serve for public and<br />

benefit from the other places serving.<br />

Fatih social complex was the first big<br />

extensive constructions group and<br />

education unit was built by Conqueror<br />

Sultan Mehmed. Positioned on a hill<br />

prevailing to �stanbul by Architect Sinan<br />

and ordered by the sultan to be done by<br />

selecting the best marbles, stones and<br />

masters of the country, Süleymaniye social<br />

complex which was built after nearly<br />

hundred years from Fatih social complex is<br />

an important religious and social center<br />

with its dar’us sifa which we can accept as<br />

a step in the development of Ottoman<br />

health institutions with its library among<br />

the counted libraries of our day, in the<br />

medicine madrasah of where the best<br />

professors of the period give lessons and<br />

bring up famous doctors.<br />

Orders were made to extract and bring<br />

valuable marbles, colored columns from the<br />

historical constructions in the empire in order

B. BAKIR, et al: The effects of the medical functions on architecture in Süleymaniye Dar’us SIFA 73<br />

of the ottoman DAR’us SIFAS<br />

to use valuable stones in the Süleymaniye<br />

social complex which is the proficiency<br />

achievement of the famous Architect Sinan,<br />

valuable marble columns were barged from<br />

distant countries such as Alexandria.<br />

The madrasahs in the south and north of<br />

the social complex was a complex<br />

education center with the guesthouse and<br />

ottoman elementary primary school (fig.1).<br />

There was a rich employee and doctor staff<br />

in the dar’us sifa, constructions such as the<br />

medicine madrasah, darulakakir,<br />

guesthouse and darüzziyafe positioned as a<br />

whole in the northwest of the mosque in a<br />

different construction was showing the<br />

developing madrasah understanding in the<br />

best way.<br />

Fig.1. Süleymaniye Complex (from Cantay)<br />

It was normal that superior scientists<br />

gave lectures and palace doctors were<br />

appointed as professors to the medicine<br />

madrasah in the most developed social<br />

complex of the period (3). The difference<br />

of the Ottoman Dar’us Sifas from the<br />

Seljuk’s was the separation made in the<br />

Dar’us sifa according to the qualifications.<br />

While the women and men were treated in<br />

different parts generally, in the final stages<br />

hospitals for women and for men were also<br />

built. Besides separating according to<br />

sexuality, there were also different<br />

departments in which every sickness was<br />

treated such as dermatologic disorders,<br />

surgical, mental, inflammatory diseases<br />

and etc, which can be accepted as the first<br />

samples of recent “clinic” concept (4).<br />

Separation according to the illnesses in the<br />

hospitals guided dar’us sifa plans, a<br />

distinct department was made in the cellar<br />

for the heavy mental patients who were<br />

isolated from the other patients in the<br />

Süleymaniye Dar’us Sifa. In the 19th<br />

century, the pointed separation was made<br />

and it became an institution in which just<br />

male patients were sheltered.<br />

Architect Sinan:<br />

The big architect of Suleiman the<br />

Magnificent, worldwide reputated artificer<br />

Sinan was born in 1490, in the village<br />

A�ırnas of Gesi town in Kayseri.<br />

According to the written sources, he was<br />

given to the conscript boys school as a<br />

recruit in 1512, he had become a janissary<br />

before Sultan Selim the Stern’s 1521<br />

Belgrad campaign and he was elected as<br />

the Royal Architect of the palace in 1539<br />

when he became 50 years old. It is recoded<br />

in the sources that he made 364 works of<br />

art throughout his life. Among these,<br />

bridge, aqueduct, tap, fountain, tomb,<br />

mosque, social complex consrtuctions,<br />

bath, bazaar, madrasah, dar’us sifa and etc<br />

took place. His fist work of art in �stanbul<br />

was Haseki social complex and Dar’us Sifa<br />

that he made for Hürrem Sultan. �ehzade<br />

Mosque that he finished in 1544 when he<br />

was 54 years old is his apprenticeship<br />

work. Süleymaniye social complex that he<br />

finished in 1557 when he was 67 is his<br />

headworker piece and Edirne Selimiye<br />

Mosque that he finished when he was 80 in<br />

1574 is his proficiency work (5).<br />

Doctors and Patients in Dar’us Sifa<br />

In the 16th century, the greatest period<br />

of Ottoman Empire, within the frame of<br />

the new steps in the fields of science, art,<br />

economy, education, medicine, astronomy<br />

in Süleymaniye medicine madrasah and in<br />

its other madrasahs, reformary superior<br />

student educating program was carried up<br />

by Sheikh ul-islam Musa Kazım Efendi<br />

and Hayri Efendi which will reach up to<br />

the 20th century in education and qualified

74<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

doctors and scientists were brought up (6).<br />

Süleymaniye Dar’us Sifa which was built<br />

in 1577 had served in a different<br />

construction with the madrasah for the first<br />

time. Endowments were assigned for each<br />

dar’us sifa in Ottomans in order to provide<br />

their needs. Besides, according to the<br />

sources, helps were made by the<br />

endowment in the social complex where<br />

the dar’us sifa took place. In the<br />

Süleymaniye social complex endowment<br />

and records, the services, servants and<br />

helps given to the dar’us sifa were also<br />

listed. In the researches of S. Ünver, as the<br />

social complex’s endowment was<br />

determined in 1557, the administrative<br />

records about the guesthouse, medicine<br />

madrasah and dar’us sifa authenticate that<br />

the hospital was serving in that date (7).<br />

According to its endowment, the medicine<br />

madrasah’s professor had to be wise<br />

enough to be palace doctor. In the dar’us<br />

sifa where various illnesses had been<br />

treated, just the mental patients started to<br />

be treated after 1843 (8). It is indicated in<br />

the records that the poor patient were<br />

boarding in the hospital, polyclinic service<br />

was also given and doctors were working<br />

from morning hours to afternoon in the<br />

hospital (9). When Guraba Hospital was<br />

built by Bezm-i Alem Valide Sultan in<br />

1845, male patients were transferred from<br />

various hospitals to this hospital and male<br />

mental patients were sent to Süleymaniye<br />

Dar’us Sifa. Male patients were accepted<br />

while serving for quarantina in the colera<br />

outbreak of 1865 (10). Different from the<br />

other samples of the period there was a<br />

neurology service in the dar’us sifa. The<br />

method of curing with music which was<br />

used in Edirne dar’us sifa was applied to<br />

the mental patients treated in the neurology<br />

service, the medicine compositions<br />

prepared in the darülakakir on the opposite<br />

were distributed not only to the patients<br />

here but also to all of the hospitals and<br />

patients in �stanbul. In the beginning of the<br />

20 th century, Dar’us sifa construction<br />

served for military printery till 1927 (11).<br />

According to Peçevi, Tabip Ahmed Çelebi<br />

was the first one assigned here and<br />

Mustafa Bin Celâlüttevkii was chief<br />

physician in 1567 in the period of<br />

Suleiman the Magnificent. The chief<br />

physician between the years 1858-1873<br />

was the famous Italian doctor Louis<br />

Mongeri (12).<br />

The location of the constructions in<br />

Süleymaniye social complex and<br />

architecture of the dar’us sifa:<br />

Apart from the Süleymaniye Dar’us<br />

Sifa which was built by Architect Sinan on<br />

behalf of Suleiman the Magnificent<br />

between the years 1550-1557, there were<br />

darulhadis, bath, darülkurra, rabi and salis<br />

madrasahs on the south-east, Architect<br />

Sinan’s tomb on the north, sani and evvel<br />

madrasahs, medicine madrasah, dar’us<br />

sifa, darüzziyafe, darülakakir (pharmacy),<br />

library, fountain, guesthouse and Tiryakiler<br />

Bazaar (Bazaar of addicts), caravansary,<br />

ottoman elementary-primary school and<br />

lieutenant cabins on the south-west (the<br />

mosque regarded as the center of the social<br />

complex)(fig.2).<br />

Fig.2. Medicine Madrasah and Tiryakiler<br />

Bazaar<br />

Süleymaniye social complex, located<br />

prevailing to the city, was constructed in<br />

the land in which the old palace built by<br />

Conqueror Sultan Mehmet had a fire and<br />

destroyed (13). While the mosque forming<br />

the center of the social complex was<br />

located on a high hill, the madrasahs on its

B. BAKIR, et al: The effects of the medical functions on architecture in Süleymaniye Dar’us SIFA 75<br />

of the ottoman DAR’us SIFAS<br />

right and left were separated from the<br />

mosque via a narrow street. Rabi and Salis<br />

madrasahs on the slope looking to the<br />

Golden Horn in the east, Evvel and Sani<br />

Madrasahs on the other side, ottoman<br />

elementary primary school and Tiryakiler<br />

Bazaar consisting of 36 shop rooms under<br />

the medicine madrasah provide income for<br />

the complex (14). Guesthouse, daruzziyafe<br />

and dar’us sifa constructions were built<br />

with high ceilings because of topographic<br />

circumstances, the rooms were built to the<br />

downward slope through Golden Horn<br />

under the dar’us sifa and caravansary was<br />

built to the lower elevation of the<br />

daruzziyafe (15). Although the ending date<br />

is written as 1557 on the inscription on the<br />

main door (cümle kapi) of the mosque, the<br />

dar’us sifa and medicine madrasah were<br />

finished in 1556 and the constructions in<br />

the complex together with the other<br />

buildings were finished in 9 years (16).<br />

Plan organization:<br />

There is a different design from the<br />

central formations of the period in the<br />

dar’us sifa with two rectangles designed<br />

domed and porched courtyards and domed<br />

cabins with ovens lined up around them. In<br />

the cellar floor of the double floored<br />

constructions, there are shops opening to<br />

the outer street and an isolated ward<br />

without windows where hopeless patients<br />

sheltered as a whole. In the first courtyard<br />

there were administrative units and daily<br />

policlinic patients were accepted, in the<br />

second courtyard with a fountain, boarding<br />

patient rooms, and bath and in the cellar<br />

the places of the isolated mental patients<br />

were planned. When the plan of the<br />

complex is compared with the other<br />

constructions with courtyard, it is clearly<br />

seen that one court yarded madrasahs are<br />

generally square formed, but in the dar’us<br />

sifa draft, the rectangle shape is exerted to<br />

open place for a second courtyard. This<br />

order is spoiled just in Tabhane<br />

(guesthouse) construction; rectangle plan is<br />

used here also because of the locations of<br />

the other constructions in the area within<br />

the complex and the topographic reason of<br />

the land. All the usage fields of the bodies<br />

in the courtyard with fountain in the dar’us<br />

sifa are arranged equal to each other, so<br />

that, in order to give entrances to the<br />

corner places, these corners of the<br />

courtyard were beveled and a small<br />

entrance hall was opened. Beveled corner<br />

has taken place in the plan typology of<br />

“middle sofa” understanding in Turkish<br />

Architecture, the other reason of corner<br />

entrances may also be prevent to shrinks<br />

which would be due to entrances to the<br />

places. On the north of the medicine<br />

madrasah, an one floored darülakakir<br />

(pharmacy) is positioned where medicine<br />

compositions were made and stored, on the<br />

opposite of this building dar’us sifa is<br />

positioned. Building dar’us sifa and<br />

madrasah as different constructions from<br />

each other has started with Süleymaniye<br />

Dar’us Sifa. Medicine madrasah taking<br />

place within the body of the hospital until<br />

that time separated for the first time in this<br />

construction and turned into two buildings<br />

positioned facing one another. When<br />

entering to the first courtyard of the dar’us<br />

sifa from the hospital street, there is a<br />

bakery where a flat bread named “fodla”<br />

was cooked for the patients in the last of<br />

the three domed-bodies lined up on the left<br />

side as to the entrance and west facade, the<br />

body in the middle is opening to the other<br />

courtyard where the bath is (p.4).<br />

Fig.3. Bakery Building

76<br />

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The body on the corner which is on the<br />

east facade of the first courtyard was used<br />

for entrance to the second courtyard.<br />

According to the pictures in the sources<br />

there was a rectangle pool which had lion<br />

figures on its four corners in the middle of<br />

the courtyard and an octagon fountain in<br />

the second courtyard (17). The lions and<br />

other animals transported to the dar’us sifa<br />

in 1843 may be the reason for the location<br />

of the lion monuments in the first<br />

courtyard. Despite making out negative<br />

news about the lions put in the hospital by<br />

the foreign broadcasts, it is probable that<br />

these animals were held in caravansary<br />

rooms in the cellar floor or in some of the<br />

non-used rooms of the bath next to the<br />

hospital, however, these animals died in a<br />

short time in an airless and dark<br />

environment<br />

It could be only gone from the first<br />

courtyard to the barrel vaulted, narrow and<br />

long place where heavy mental patients<br />

were held in the cellar floor throughout<br />

stairs serving to that body. Ventilationillumination<br />

was made by the embrasures<br />

on the colonnade borders in the second<br />

courtyard. The chains and rings used here<br />

for the heavy mental patients haven’t<br />

removed till recent times.<br />

Structural Features: Although not so<br />

deep, the construction of the groundworks<br />

in the Süleymaniye social complex built on<br />

a hill looking to Golden Horn in �stanbul,<br />

had taken such a long time as 3 years<br />

according to the sources. In the drilling<br />

works made in 1970s, no deeper than<br />

6.20m was encountered (17). Khorasan<br />

mortar was used in the walls of the<br />

building constructed with (küfeki) stone,<br />

fairly high floor walls of the double<br />

floored construction were straightened<br />

with horizontal brick lines in every 1.20m<br />

and horizontal lying wooden binding<br />

elements sized 5/5cm. were settled<br />

between these brick lines. The higher the<br />

stone walls went, the thinner they were<br />

built.<br />

Entrance door and other doors: It is<br />

assumed that supplies were carried for the<br />

bakery in which bread was cooked from<br />

the courtyard entrance on the south-east<br />

facade. It is seen from the bare, plain<br />

tracks and tablet of the door that it was<br />

restored in the 19 th century. There is a bare,<br />

flat archway made of (küfeki) stone and its<br />

tablet on the wall. The main entrance wall<br />

is also remains from the period when the<br />

military used it. There is a “printery of<br />

Military” writing written on green<br />

background and Ruler Abdül Hamid’s<br />

signature in embossment cartridge. The<br />

whole archway from küfeki stone on the<br />

wall and its frames on the both sides are<br />

plain. It is a strong probability that supply<br />

entrance was made to the kitchen on the<br />

upper floor from a door reached by going<br />

down throughout stairs to the cellar from<br />

the second courtyard. The gap on the<br />

kitchen flooring is tied to the wall in<br />

question vertically and the supplies coming<br />

from the down door was pulled up from<br />

this hole.<br />

Windows: elevation differences in<br />

construction membranes affected also the<br />

windows, while there is rectangle shapes<br />

on the floor elevation in the south-west<br />

facade looking to the inner courtyard and<br />

obtuse arched window types on the up, on<br />

the fairly high, double floored north-west<br />

facade, discharging arches, obtuse arched<br />

rectangle windows on the shops in the<br />

down floor, the windows of the dar’us sifa<br />

rooms on the shops are first line<br />

discharging arched rectangle windows and<br />

obtuse arched plaster ornament (revzen)<br />

covered top window lines lie all along on<br />

the north-west facade on the up.<br />

Vault and arches: Entrance holes to<br />

the corner rooms in the second courtyard

B. BAKIR, et al: The effects of the medical functions on architecture in Süleymaniye Dar’us SIFA 77<br />

of the ottoman DAR’us SIFAS<br />

and barrel vault cover was used on the<br />

ceilings of the places in the down floor.<br />

Courtyard colonnades, window and door<br />

arches are obtuse arches named as Turkish<br />

arch or panj arch.<br />

Column headings: Marble column<br />

headings in the courtyard colonnades are<br />

muqarnased which reflect Ottoman<br />

architecture. Almost all headings were<br />

made in the same decoration sample. There<br />

is rosette motif on most of them.<br />

Courtyard colonnades: The bodies on<br />

the entrance made polyclinics take place<br />

on the right and left of the entrance door<br />

but the rooms are lined up just in three<br />

dimensions in the second cortyard where<br />

the patient rooms are. Colonnades obtain<br />

spatial coherence surrounding both<br />

courtyards in four dimensions.<br />

Buttress and waterspout: Yüksek, iki<br />

katlı kuzey-batı ve güney-batı cephelerinde<br />

belli aralıklarla, zemine do�ru geni�leyen<br />

payandalar mevcuttur. There are buttresses<br />

which are expanding towards ground on<br />

the double floored north-west and southwest<br />

facades in certain intervals.<br />

Physical features in structure: There<br />

are fireplace for heating, windows in both<br />

side of the fireplace furthermore a door<br />

opening to the courtyard and a window<br />

next to it in every room (fig.4). the<br />

windows were opening both to outside and<br />

to the courtside, so they were making light<br />

places while supplying adequate air and<br />

light for the patients. Windows opening to<br />

outside in the dar’us sifa shows that the<br />

patients were not isolated from the outer<br />

environment. Ventilation of the places in<br />

the cellar where the heavy mental patients<br />

were staying was made by the wide loophole<br />

on the upper floor opening to the<br />

second courtyard. The pools designed in<br />

both courtyards not only provided visional<br />

aesthetic but also created relaxing effect on<br />

the patients with the action of the water.<br />

On the south-west corner of the<br />

hospital, bath attendants were on duty in<br />

the bath, built next to the dar’us sifa, just<br />

to serve the patients here. As known, the<br />

bath of the dar’us sifa was also used to<br />

cure mental patients with hydrotherapy<br />

method apart from providing hygiene.<br />

Fig.4.Patient Room<br />

Restoration works of 2009:<br />

The construction is being tried to return<br />

its original condition in the restoration<br />

studies by fixing the changes of the<br />

construction made in the 20th century and<br />

the accessories made during its usage as<br />

military printer in 19th century. The<br />

separation walls between the colonnades in<br />

the courtyard were destroyed; closed fire<br />

places in the patient rooms were opened.<br />

The stairs entrance going down from<br />

north-west facade of the second courtyard<br />

to the cellar floor was re-opened; east<br />

courtyard ground where the bath and<br />

bakery constructions take place was<br />

lowered and brought to its original<br />

elevation. The pool in the first courtyard<br />

with lion monuments on its four corners<br />

which was closed in the past will be rebuilt<br />

in the last restoration study and lion<br />

monuments will be put on their places<br />

(fig.5). The fountain closed with concrete<br />

in the second courtyard will be functional<br />

again (18). The small bath located next to<br />

the dar’us sifa on the south-east dimension<br />

was only for the patients and bath

78<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

attendants working here were washing the<br />

patients. In the digging workout made for<br />

restoration, hot water wandering canals<br />

were discovered beneath the bath flooring.<br />

P.6. The Pool with Lion Statues (from Cantay)<br />

Footnotes:<br />

1. A big mobile hospital was built<br />

consisting of 70 surgeon tent and 40<br />

doctor shops serving to the<br />

wounded soldiers in the Crete<br />

blockade mentioned by Evliya<br />

Çelebi. In 16th century, the<br />

presence of a hospital serving for<br />

navy in the �stanbul Kasımpa�a<br />

dockyard is figured out in the<br />

sources. Apart from the two<br />

hospitals bound to Ottoman navy in<br />

Kasımpa�a, there were naval<br />

hospitals in Crete, Basra, Preveze<br />

and hospitals in Gemlik, �zmit,<br />

�znik, Rusçuk, Tulci, Vidin, Crete,<br />

Suez dockyards. Terzio�lu,<br />

Osmanlılarda Hastaneler…,p.5-6;<br />

Evliya Çelebi, Seyahatname,<br />

publisher: Zuhuri Danı�man, c.12,<br />

�stanbul 1943, p.202.<br />

2. “It is seen that hospitals were<br />

established for bondmaids in the<br />

hareem, for truckers in the Birun<br />

and for Ottoman hists in the palaces<br />

of Ottoman Sultans in Edirne and<br />

�stanbul. Terzio�lu, A,<br />

Osmanlılarda Hastaneler, p.2, 15.<br />

3. There had been Greeks, Rums,<br />

Armenians, Georgians, and Syrians<br />

when the Turks came to Anatolia.<br />

These had not recognized the<br />

attitude of the Orthodox Church.<br />

They welcomed the Seljuks with a<br />

great pleasure. Ortaylı, Türkler ve<br />

Ermeniler, p.128, Kahya, Erdemir,<br />

<strong>Medical</strong> Studies and Institions in<br />

the Otoman Empire, p.72.<br />

4. Say.”Türk Tıp Kurumları”, Türkler,<br />

C.11, p.321.<br />

5. We understand the informations<br />

about Koca Sinan from the 7<br />

handwritten works of art written<br />

down in the 16 th century. 1.Risaletül<br />

Mi’mariye, 2. Monography of<br />

Dayızade Mustafa Efendi named as<br />

Selimiye, 3. Padi�ahname of poet<br />

Eyyubi, 4.Adsız Risale, 5.Tezkiretül<br />

Bünyan, 6.Tezkiret-ül Ebniye,<br />

7.Tuhfet-ül Mi’marin. According to<br />

the sources, he was born in the<br />

village A�ırnas in the Cappadocia<br />

area and he was not exiled to<br />

Cyprus as the other region society<br />

of the period, he attended to many<br />

campaigns such as Iranian, Egypt in<br />

the period of Sultan Selim the<br />

Stern, Belgrad campaign of 1521<br />

and campaign of Vienna in 1529,<br />

and he built bridges here and<br />

worked as “sekban”, “zemberekçiba�ı”,<br />

“infantry colonel” in the<br />

army. He had built 3 galleys on his<br />

Iranian campaign, he gained<br />

appreciation of the Sultan by<br />

building a high bridge in 13 days on<br />

a marshland in Moldovia campaign<br />

of 1538. Aslanapa, Türk Sanatı,<br />

p.251-266; Kuran, Mimar Sinan,<br />

p.16-27.<br />

6. Calendar and astronomy studies<br />

were being done in the<br />

muvakkithane until 16 th century.<br />

But a observatory couldn’t be built.<br />

The famous astronomer Takiyeddin

B. BAKIR, et al: The effects of the medical functions on architecture in Süleymaniye Dar’us SIFA 79<br />

of the ottoman DAR’us SIFAS<br />

built an observatory in Tophane in<br />

the period of 3 rd Murad in the years<br />

1574-1595. There were various<br />

astronomy tools, mechanical clocks,<br />

astronomy drawing tools, miters,<br />

rulers, compasses and etc in the<br />

observatory of �stanbul. There were<br />

madrasahs and dar’us sifas in<br />

Manisa, Amasya, Bursa and Edirne<br />

in Anatolia and Trakya on the same<br />

period. There were very rich<br />

libraries serving to the madrasahs<br />

near these or within the body of the<br />

social complex, especially in<br />

Süleymaniye social complex and<br />

Haghia Sophia. Kahya, Erdemir,<br />

<strong>Medical</strong> Studies and Enstitions in<br />

The Otoman Empire, p. 72-74.<br />

7. Ünver, Süleymaniye Külliyesinde<br />

Darü��ifa, Tıp Medresesi ve<br />

Darül’akakire dair”, Vakıflar<br />

Journal II, Ankara 1942, p. 196.<br />

8. As to its endowment, there were 1<br />

professor, 8 counselors, 1<br />

doorkeeper, 1 ferra�, 1 pointillist in<br />

Süleymaniye Dar’us Sifa and 1<br />

head doctor, 2 doctors, 2 kehhal, 2<br />

surgeons, 2 chemists, 1 drug store<br />

official, 1 steward, 1 doorkeeper, 2<br />

cooks, 1 kaseke�, 4 trustees, 2<br />

ferra�, 4 manservants, 2 laundryen<br />

and a bath attendant in the dar’us<br />

sifa on duty. The fees of the<br />

personnel were provided from the<br />

income of 217 villages, 30 arable<br />

field, 2 districts, 7 mills, 2<br />

fishponds, 2 ports, 1 meadow, 2<br />

farms and 2 islands. Bayat,<br />

“�stanbul Süleymaniye<br />

Darü��ifası”, Ülker Erke’nin<br />

Yorumu ve Fırçasıyla, p. 55. Ünver<br />

read in Ankara Endowments Head<br />

Directorate that the daily wages<br />

given in the dar’us sifa were written<br />

down by Hüsameddin Efendi in the<br />

Sultan Süleyman Hanı Evvel<br />

Endowment of 1557; 1 chemist, 2<br />

chemist helpers, pantry worker,<br />

steward, clerk, tabbahı e�rife (some<br />

people), 4 trustees, 2 laundrymen,<br />

barber, bath attendant… Ünver,<br />

“Süleymaniye Külliyesinde<br />

Darü��ifa…”, Vakıflar Journal II,<br />

p.196-198.<br />

9. Ünver, “Süleymaniye Külliyesinde<br />

Darü��ifa, Tıp medresesi ve<br />

Darül’akakire dair”, Vakıflar<br />

Journal II, p. 198-199.<br />

10. There is a record about taking 4<br />

manservants because of the increase<br />

in the amount of the mental patients<br />

coming to the asylum in a<br />

document dated 1850-1851. Ünver,<br />

“Süleymaniye Külliyesinde<br />

Darü��ifa….”, Vakıflar Journal II,<br />

p205, 206.<br />

11. Kahya, Erdemir, <strong>Medical</strong> Studies<br />

and Instıtıons ın the Otoman<br />

Empire, p. 79.<br />

12. Cantay, a.g.e., 99.<br />

13. Bayat, A.H. “�stanbul Süleymaniye<br />

Darü��ifası”, Ülker Erke’nin<br />

Yorumu ve Fırçasıyla Türkiye’de<br />

Tarihi Sa�lık Kurumları , 38 th<br />

International History of Medicine<br />

Congress, Editor: Nil Sarı, �stanbul<br />

2002, p.55.<br />

14. There is the list of the recruiting<br />

staff taken from the ruins and from<br />

the constructions on various areas<br />

of the country in handwritten<br />

manuscripts of M. Cevdet,<br />

Seyahatname of Evliya Çelebi and<br />

Tezkeret-ül Bünyan. Ömer Lütfi<br />

Barkan published in 1974 the orders<br />

and records in the account books<br />

that he investigated in the archieves<br />

in the Topkapı Palace. Aslanapa,<br />

Osmanlı Devri Mimarisi, second<br />

edition, 2004, p. 220-228.<br />

15. Today, Süleymaniye maternity<br />

hospital is built on the land of<br />

medicine madrasah. Cantay,<br />

Anadolu Selçuklu ve Osmanlı

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Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

Darü��ifaları, p.97.<br />

16. Cantay, Anadolu Selçuklu ve<br />

Osmanlı, p.97.<br />

17. Two of the four lion monuments are<br />

in the garden of �stanbul Town<br />

Hall, one of them is in the park of<br />

Courthouse. Cantay, Anadolu<br />

Selçuklu ve Osmanlı, p.98.<br />

18. There is a record about taking 4<br />

temporary manservants because of<br />

the increase in the amount of the<br />

mental patients coming to the<br />

asylum in a document dated 1850-<br />

1851. Ünver, Süleymaniye<br />

Külliyesinde Darü��ifa….”,<br />

Vakıflar Journal II, p205, 206.<br />

19. The things found in the drilling<br />

study according to Barkan; a<br />

concrete groundwork surface with<br />

khorasan mortar of 20cm thickness,<br />

oak grills put on these, 3 lines of<br />

fire stones with 2 meters height<br />

going on narrower with küfeki<br />

stone until the sub basement.<br />

Ö.L.Barkan, Süleymaniye Camii<br />

Ve �mareti �n�aatı, p.49, 50..<br />

20. The lion monuments which were<br />

sent to Sultanahmet park and public<br />

building will be taken from here<br />

and put back to their original places<br />

on the corners of the pool in the last<br />

restoration work of 2009.<br />

Reference:<br />

[1]. Akyol,T. Ortaylı, �, Anadolu’da<br />

beraberlikten çatı�maya, Türkler ve<br />

Ermeniler, Do�an publications, 2009,<br />

p.127-132.<br />

[2]. Aslanapa, O., Osmanlı Devri Mimarisi,<br />

�nkılap Bookstore, second edition,<br />

�stanbul 2004.<br />

[3]. Aslanapa, O., Türk Sanatı, Remzi<br />

Bookstore, �stanbul 1984.<br />

[4]. Bakır, B. Ba�a�ao�lu, �., How <strong>Medical</strong><br />

Functions Shaped Architecture in<br />

Anatolian Seljuk Darüssifas (hospitals)<br />

and Especially Divri�i Turan Malik<br />

Darüssifa, Journal of The International<br />

Society for the History Of Islamic<br />

Medicine (ISHIM), 10 October 2006,<br />

p. 64-82.<br />

[5]. Barkan, Ö. L., Süleymaniye Camii ve<br />

�mareti �n�aatı, (1550-1557), book I,<br />

Ankara 1972.<br />

[6]. Cantay, G., Anadolu Selçuklu ve<br />

Osmanlı Darü��ifaları, Publication of<br />

Atatürk Culture Center Yayını,<br />

number: 61, Ankara, 1992.<br />

[7]. Erke, Ü., Ülker Erke’nin Yorumu ve<br />

Fırçasıyla Türkiye’de Tarihi Sa�lık<br />

Kurumları, 38.Uluslararası Tıp Tarihi<br />

Kongresi, Editör: Nil Sarı, �stanbul,<br />

2002.<br />

[8]. Evliya Çelebi, Seyahatname, yayınayan:<br />

Zuhuri Danı�man, cilt 12,<br />

�stanbul 1972, s.202; cilt 10, �stanbul<br />

1970, s.39.<br />

[9]. Kahya, E, Erdemir, A. D., <strong>Medical</strong><br />

Studies and Instıtıons in the Otoman<br />

Empire, Nobel yayın da�ıtım a.�,<br />

Ankara 2008<br />

[10]. Kuran, A., Mimar Sinan, Hürriyet<br />

Vakfı Yayınları, 1.baskı, �stanbul<br />

1986.<br />

[11]. Say, Y., Türk Tıp Kurumları,<br />

Türkler, C.11, s.320-347.<br />

[12]. Terzio�lu, A., Osmanlılarda Hastaeler,<br />

Eczacılık, Tababet ve Bunların<br />

Dünya Çapında Etkileri, �stanbul,<br />

1999.<br />

[13]. Ünver, S., Süleymaniye Külliyesinde<br />

Darü��ifa, Tıp Medresesi ve<br />

Darül’akakire dair (1557-1555),<br />

Vakıflar Dergisi II, Ankara 1942,<br />


Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />




N. GÖKÇE 1 M. YAPRAK 2<br />

Abstract: Malaria was the most serious illness among the epidemic<br />

diseases in the Thrace Region of Turkey. Swamps caused by Meriç, Tunca,<br />

Arda and Ergene Rivers flooding and rice farming used to provide ideal<br />

conditions for mosquito breeding.<br />

Malaria was seen in Edirne Palace during Ottoman Empire and caused<br />

deaths. Ottomans try to drain swamps by planting Eucalyptus trees; however,<br />

they were not succeeded.<br />

Fighting against malaria was continued in Thrace during Turkish Republic.<br />

Fighting Malaria Commission, founded in Edirne in 1924, aimed to drain<br />

swamps, detect and treat malaria patients, and raise public awareness.<br />

Fighting Malaria Law, numbered 839, was accepted in 1926. Urgent<br />

Fighting Malaria Law, numbered 4707, and Fighting Malaria Law,<br />

numbered 4871, was legislated in 1945 and 1946, respectively. The goal was<br />

to wipe out malaria in the country.<br />

Thrace Fighting Malaria Center was founded in Edirne in 1936. Branches of<br />

the organization were also founded in the counties of Edirne. Significant<br />

gains in the fight against malaria were made with the public support. Edirne<br />

still has a risk of malaria. Only one patient was diagnosed in last five years.<br />

Key words: malaria, Thrace, history of medicine.<br />

1 Introduction<br />

History of malaria, an infectious<br />

disease whose notification is obligatory, is<br />

as ancient as the history of mankind.<br />

Hippocrates was the first to describe the<br />

manifestations of the disease. He stated<br />

that malaria was a diseases characterized<br />

by intermittent fevers.<br />

Malaria is also one of the oldest and the<br />

most frequently occurring diseases in<br />

Thrace. People have developed different<br />

strategies to recover from malaria. In the<br />

old times, they tried to repel mosquitoes by<br />

burning fire and by fuming. During<br />

Ottoman period, water absorbing plants<br />

such as eucalyptus trees (eucalyptus<br />

globulus) and chamomile were grown up<br />

in order to wipe out the malaria in the<br />

region. Eucalyptus seeds and medicines<br />

such as sulfane and physicians were send<br />

from Istanbul to the regions affected by<br />

malaria. Malaria did not only affect the<br />

public, but also, sometimes, it affected the<br />

Sultan and the people living in the palace.<br />

Çadır Kö�kü (Tent Pavilion), on the<br />

shoulders of Muradiye, was reserved for<br />

the people living in the harem and affected<br />

by malaria [1].<br />

Fight against malaria was continued<br />

after the foundation of the Turkish<br />

1 Trakya University, <strong>Medical</strong> School, Department of History of Medicine and Deontology, Edirne, Turkey<br />

2 Trakya University, <strong>Medical</strong> School, Department of Physiology, Edirne, Turkey

82<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

Republic. In the early years of the republic,<br />

not only malaria but also other infectious<br />

diseases such as smallpox, trachoma, and<br />

typhus were widespread in Turkey.<br />

Turkish Republic has placed much<br />

emphasis on fighting against infectious<br />

diseases. However, the first target had been<br />

malaria. ”Fighting Malaria Law”,<br />

numbered 839, was legislated in May 13,<br />

1926. In 1928, Malaria Institute was<br />

founded in Adana for research and<br />

education. Fighting malaria organizations<br />

and malaria clinics started to be found in<br />

the cities. A malaria hospital was opened<br />

in Adana. Number of malaria centers grew<br />

to 11 in 1937 and increased to 16 in 1937.<br />

Branches of these organizations were also<br />

founded in the neighbor cities and<br />

counties. Malaria Field Hospital was<br />

founded in Aydın.<br />

In this study, we investigate the efforts<br />

of Turkish Government in the early years<br />

of Turkish Republic (1926-1960) to<br />

control and prevent the malaria disease in<br />

Thrace. The next section presents the<br />

foundation of the Thrace Fighting Malaria<br />

Organization and its studies.<br />

2 Thrace Fighting Malaria<br />

Organization<br />

In the early years of Turkish Republic,<br />

malaria was widespread in the cities and<br />

the villages of Thrace. Thrace Public<br />

Supervisor, Dr. �brahim Öngören, wrote in<br />

his report about the health conditions of<br />

the population in Thrace: “I discovered<br />

many sources of malaria at each part of<br />

Thrace. This is the main health problem of<br />

Thrace. Çanakkale region, especially<br />

Menderes area, has the same problem”.<br />

Malaria was mostly seen in rice-growing<br />

regions, lakes, and rivers. Gala Lake in<br />

Enez was one of the main mosquito<br />

breeding-places. Overflow of Meriç River<br />

causes swamps around �psala area. In<br />

Thrace, Malaria was not only widespread<br />

around Meriç, but also around the Black<br />

Sea coast.<br />

It is mentioned that Mustafa Kemal<br />

Atatürk affected by malaria infection<br />

during military trainings in Thrace in 1936.<br />

In the same year, Thrace Fighting Malaria<br />

Organization based in Edirne was founded.<br />

In a very short-time period, the fight<br />

against malaria came a long way with the<br />

support of public. Channels were<br />

constructed; swamps were drained;<br />

hollows and trenches were filled. Dams<br />

and bridges were built. Humans were<br />

inspected; patients were treated. Table 1<br />

and Table 2 show the activities of the<br />

Thrace Fighting Malaria Organization in<br />

1936 and the numbers of malaria patients<br />

treated in Thrace in the years 1936-1939,<br />

respectively. However, beginning of World<br />

War II slowed down the fight against<br />

malaria. Large number of people<br />

immigrated and Territory was almost<br />

empty of people.<br />

Table 1: Activities of Thrace Fighting<br />

Malaria Organization in 1936[2]<br />

Activity Statistics<br />

Number of counties 10<br />

i d<br />

Number of villages 137<br />

Number of people inspected 177,744<br />

Number of patients treated 54,888<br />

Number of people blood 65,933<br />

d<br />

Amount of free quinine 582<br />

Amount of vitamin 1,680<br />

Amount of sulphane used 71,627<br />

Number of quinine tube used 1,067<br />

Amount of gas used (kg) 1,940<br />

Amount of pure uranium 100<br />

d(k )<br />

Amount of wihz solution 290<br />

Amount of klesckt solution 3,000<br />

Number of house and barn 26.678<br />

Length of canal opened (m) 21.002<br />

Length of drain opened (m) 6.545

N, GÖKÇE: Short history of Thrace fighting malaria organization 83<br />

Length of stream cleaned 55.035<br />

Volume of gutter filled (m 3 ) 14.678<br />

Number of bridge 4<br />

Number of dam constructed 4<br />

Table II: Number of Malaria Patients<br />

Treated In Thrace<br />

Year Patients<br />

1936 37425<br />

1937 55489<br />

1938 59085<br />

1939 54954<br />

Total 206953<br />

In 1945, a course was offered by the<br />

Thrace Fighting Malaria Organization.<br />

Total number of person attended this<br />

course was 37; 11 of them were women.<br />

After successfully completing the course,<br />

attendees were assigned in the fight against<br />

malaria in Edirne.<br />

In the years 1950-1960, fight against<br />

malaria was very intensive. In 1957, a<br />

National Malaria Eradication Program, a<br />

cooperative undertaking by The World<br />

Health Organization and UNICEF, was<br />

established in Turkey; organizational<br />

structure was defined. In the new<br />

organization, Dr. Kemal Erdem was<br />

assigned as the Regional Director of<br />

Tekirda� Province and Dr. Ferruh Tepeköy<br />

as the Regional Director of Kırklareli<br />

Province. Dr. Ratip Kazancıgil, the<br />

Director of Organization of Thrace<br />

Fighting Against Malaria at that time,<br />

became the Group Regional Director of the<br />

group founded in Edirne. Some of the<br />

members of the organization can be seen in<br />

the picture below. Under the National<br />

Malaria Eradication Program, a group of<br />

malaria fighter was send to Italy for<br />

training. The group had been trained for a<br />

month in an institute, called “Istituto<br />

Superiore Di Sanita”, in Rome.<br />

Members of the Organization of<br />

Thrace Fighting Against Malaria (1952)<br />

� top row, from left to right<br />

Physician of the Edirne Branch Dr. Sacit<br />

Balkan, Physician of the Babaeski Branch<br />

Dr. Ferruh Tepeköy, Physician of the<br />

Saray Branch Dr. Osman, Physician of the<br />

Lüleburgaz Branch Dr. Kemal, Physician<br />

of the Kırklareli Branch Dr. Turhan,<br />

Physician of the Ke�an Branch Dr. Fuat<br />

� front row, from left to right<br />

Physician of the Gelibolu Branch Dr<br />

Mustafa, Physician of the Uzunköprü<br />

Branch, the Director of Organization of<br />

Thrace Fighting Against Malaria Dr. Ratip<br />

Kazancıgil, Physician of the �psala Branch<br />

Dr. Zeki Akçol, Physician of the Hayrabolu<br />

Branch<br />

Dr. Ratip Kazancgil, the Group<br />

Regional Director of Malaria Eradication<br />

Program at that time, narrates his<br />

experiences on fighting against malaria<br />

[3]:<br />

“We were fighting against malaria in<br />

the whole Trace Region. It was required to<br />

collect a blood sample from each suspect<br />

who was suffering from high body<br />

temperature. To analyze blood samples<br />

rapidly, mobile medical teams and services<br />

were formed. These mobile teams were<br />

picking up collected blood samples and<br />

delivering them to central laboratory<br />

quickly. This approach helped us<br />

determine malaria patients very fast. Our

84<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

efforts were being monitored by UNICEF<br />

Malaria Group who was working at Head<br />

Office of Fighting Against Malaria at<br />

Turkish Ministry of Health. Finally, it was<br />

decided that fighting against malaria was<br />

successful in Edirne. I, Dr. Ertu�rul Akel,<br />

Assistant Adviser at Turkish Ministry of<br />

Health, and Dr. Ferruh Çoruh, General<br />

Director of Malaria, were invited to<br />

UNICEF Head Office of Fighting Against<br />

Malaria in Copenhagen to discuss the<br />

status of malaria in Edirne. As a result, it<br />

was decided that malaria was eradicated<br />

in Edirne and the yellow dot, the malaria<br />

warning sign, on Edirne was removed from<br />

map of Turkey.”<br />

3 Conclusions<br />

Malaria is one of the oldest and the<br />

most frequently occurring diseases in<br />

Thrace. In the early years of Turkish<br />

Republic, malaria was also widespread in<br />

the cities and the villages of Thrace. In<br />

1936, Thrace Fighting Malaria<br />

Organization based in Edirne was founded<br />

with the aim of eradicating malaria in the<br />

Trace region. The organization achieved its<br />

goal with the support of public in a very<br />

short-time period.<br />

References<br />

[1]. Ahmet Süheyl Ünver and Rıfat Osman.<br />

Edirne Sarayi. Turkish Historical<br />

Society Publications.Ankara, 1989.<br />

[2]. Edirne Postası. May 11, 1938.<br />

[3]. Ratip Kazancıgil. Personal<br />

Communication. April 18, 2006.

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />


IN 1555<br />

P. ALBOU 1<br />

Abstract: The scene occurs in 1555: when Ambroise Paré (1510-1590),<br />

the famous French surgeon of the Renaissance, crossed in boat a river to<br />

go to visit with a horse a patient in the surroundings of Paris, his horse<br />

gave him “such a kick” that the two bones of his left leg were entirely<br />

broken, a few centimeters over the foot… The description of this accident<br />

and its consequences was written by Ambroise Paré himself and can be<br />

red in a text named History of the author having a broken leg that we can<br />

find in his Surgical Works.<br />

We will recall in this paper this accident and its consequences, which<br />

lasted several months. Beyond its biographical and anecdotic interest,<br />

this observation informs us about various aspects of the surgical practice<br />

of this time. It illustrates also Georges Canguilhem’s reflection: “The<br />

doctor have to know that he is a potential patient and he is not better<br />

assured than his patients to succeed, if necessary, to substitute its<br />

knowledge for its anguish”<br />

1 St-Amand-Montrond, France.<br />

Key words: Ambroise Paré, 1555.<br />

«Plato was therefore right to say that to be<br />

a true doctor would require that anyone<br />

who would practice as such should have<br />

recovered from all the illness which he<br />

claimed to cure and have gone thought<br />

all the symptoms and conditions on<br />

which he would seek to give an opinion.<br />

If doctors want to know how to cure<br />

syphilis it is right that they should first<br />

catch it themselves! I would truly trust<br />

the one who did»<br />

Montaigne, Essays, III, 13<br />

Ambroise Paré (1510-1590) was the<br />

surgeon of King Henry II and his<br />

descendants: François II, Charles IX and<br />

Henri III.<br />

The scene occurs in 1555: when<br />

Ambroise Paré (1510-1590), the famous<br />

French surgeon of the Renaissance,<br />

crossed in boat a river to go to visit with a<br />

horse a patient in the surroundings of Paris,<br />

his horse gave him “such a kick” that the<br />

two bones of his left leg were entirely<br />

broken, a few centimetres over the foot…<br />

The description of this accident and its<br />

consequences was written by Ambroise<br />

Paré himself and can be red in a text<br />

named History of the author having a<br />

broken leg, that we can find in his Surgical<br />

Works (Œuvres d’Ambroise Paré,1579,<br />

Livre 14, Chap. 23 to 28).

86<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

Ambroise Paré (1510-1590)<br />

(Copyright BIUM)<br />

Oeuvres d’Ambroise Paré (1579)<br />

(Copyright BIUM)<br />

We will recall in this paper this<br />

accident and its consequences, which<br />

lasted several months:<br />

After his leg was broken, his first<br />

thinking was to be afraid to have his leg<br />

cut off and he began to pray... Ambroise<br />

Paré tells us that when he fell on the<br />

ground, "the fractured bone through flesh,<br />

the trousers, and even the boot”, then he<br />

felt "such a pain it is possible for man to<br />

endure."<br />

After being rescued by his friends, he<br />

was transported to a nearby house with a<br />

lot of pain because, he says, "one brought<br />

the body, the other leg, the other foot and<br />

walking one rose on the left and the other<br />

bent on the right."<br />

First medical care<br />

While sweating profusely, a plaster was<br />

applied over the injury from the available<br />

ingredients: egg white, wheat flour,<br />

furnace soot, all mixed with fresh butter<br />

melted.<br />

He asked his friend Richard Hubert<br />

reduce the fracture "and forget the<br />

friendship he bore him, pulling hard on his<br />

foot and digging in the wound with a<br />

razor" to recover more easily bones in their<br />

normal position.<br />

Splints were then implemented his leg<br />

resting on a cushion "as you see in this<br />

figure":<br />

Paré’s figure<br />

(Copyright BIUM)

PHILIPPE ALBOU: Ambroise Paré’s broken left leg in 1555 87<br />

<strong>Medical</strong> treatment<br />

After being transported home, he was<br />

treated as follows:<br />

− bleeding in the left basilica vein<br />

− applying ointment (Onguent rosat)<br />

− light diet with prunes and bread, with<br />

water;<br />

− few mild purgatives as cassia or<br />

rhubarb, and suppositories or soap "to<br />

stimulate my abdomen."<br />

The evolution was complicated by two<br />

problems:<br />

− muscle cramp, so violent that the<br />

bones moved and had to be again pull<br />

to replace the leg in the good way…<br />

while he said feeling "more pain than<br />

first time "<br />

− fever on the 11th day, which lasted a<br />

week, with the appearance of an<br />

abscess on which a patch was applied<br />

to help evacuate.<br />

Prevention of bedsores<br />

The main Ambroise Paré’s thinking<br />

was to avoid pressure sores, especially in<br />

the sacrum and heel "because in these<br />

places there is little flesh."<br />

Techniques used for the prevention of<br />

bedsores:<br />

− regular elevation of the heel or lift<br />

from the bed by pulling on a rope<br />

attached to the foot of his bed, to “give<br />

breath to support zones” ;<br />

− use of a pillow under the buttocks and<br />

also under the heel;<br />

− application of plasters, ointment or<br />

cooked alum to "take out the bone<br />

fragments separated" and promote "the<br />

generation of callus"<br />

Albou’s figure<br />

Ambroise Pare’s invention of a notched<br />

splint<br />

Pare noted that he invented, after his<br />

own experience, “cassole de fer blanc”, or<br />

splint, notched heel so that it does not<br />

touch the bed.<br />

Paré’s figure<br />

(Copyright BIUM)<br />

Epilogue<br />

Let Paré concluded himself that<br />

episode: "I waited over three months that<br />

the callus is done. During this time, I lay in<br />

my bed, which is not agreeable to a sad<br />

sick. It took another month to put my feet<br />

on the ground without my cane... My good

88<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

leg was helping the injured leg, as does a<br />

sister’s hand or a friend’s arm, helping to<br />

lift, turning in one direction or the other... .<br />

Conclusion<br />

Beyond its biographical and anecdotic<br />

interest, this observation informs us about<br />

various aspects of the surgical practice of<br />

this time.<br />

It illustrates also Georges Canguilhem’s<br />

reflection: “The doctor have to know that<br />

he is a potential patient and he is not better<br />

assured than his patients to succeed, if<br />

necessary, to substitute its knowledge for<br />

its anguish”.<br />

References<br />

[1]. Ambroise Paré, Œuvres, divisées en<br />

vingt-sept livres, revus et augmentés<br />

par l’auteur pour la seconde édition. A<br />

Paris, chez Gabriel Buon, 1579<br />

(disponible sur www.gallica.fr)<br />

[2]. Georges Canguilhem, Puissance et<br />

limites de la rationalité en Médecine<br />

(1978), in « Etudes d’histoire et de<br />

philosophie des sciences », Vrin, Paris,<br />

2002, p. 409.

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />









Abstract: The history of Mechnikov’s phagocytal theory of immunity deals<br />

with the physicians’ Society in Odessa. As early as 1874 Mechnikov was<br />

elected to be a full member of the physicians’ Society in Odessa. However his<br />

active participation in the work of the Society began later on, i.e. in the 80ies<br />

of the XIX century, when Mechnikov formulated his phagocytal theory of<br />

immunity. The fact that he came to the physicians’ Society in Odessa was<br />

quite logically and it characterizes Mechnikov as a scientist who searches for<br />

qualified auditorium to discuss his hypotheses. Mechnikov attended 34<br />

meetings of the physicians’ Society in Odessa and made 6 reports, devoted to<br />

proofs of phagocytal theory of immunity. Meetings of the physicians’ Society<br />

in Odessa were the first auditorium where reports on the phagocytosis<br />

theory, suggested by Mechnikov, were thoroughly discussed, subjected to<br />

criticism and it promoted generation and formation of the theory that<br />

afterwards was internationally recognized.<br />

Key words: Physicians’ Society In Odessa, I.I. Mechnikov<br />

Ilya Ilyich Mechnikov (1845-1916) and<br />

Paul Ehrlich (1854-1915) became the<br />

Nobel Prize winners in Physiology or<br />

Medicine, 1908. They were Nobel Prize<br />

awarded «in recognition of their work on<br />

immunity».<br />

Considerable amount of literature is<br />

devoted to I.I. Mechnikov’s life and<br />

activities and at the same time the analysis<br />

of appearance and formation of the<br />

phagocytal theory idea, which became one<br />

of the bases in teaching on immunity<br />

against infectious diseases of a human<br />

1 Sumy State University, Ukraine.<br />

organism, takes a prominent place.<br />

However, a very important transition of<br />

Mechnikov’s-biologist to the field of<br />

studying a human organism’s fight against<br />

causative agents of infectious diseases has<br />

not been traced back yet, but the step was<br />

made by I.I. Mechnikov in the very<br />

beginning of the phagocytal theory<br />

formation in 1883-1887. I.I. Mechnikov’s<br />

collaboration with the prosectors Nicolay<br />

A. Stroganov (1843-1894) and Cheslav I.<br />

Chentsinsky (1851-1916) as well as<br />

discussion of Mechnikov’s reports in the

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meetings of the physician’s society in<br />

Odessa was of great importance.<br />

The physician’s society in Odessa was<br />

formed in 1849. At that age Odessa was a<br />

main commercial port of the Russian<br />

Empire in the Black Sea. The society<br />

united the physicians who worked in health<br />

stations of the city, maritime quarantine as<br />

well as general practitioners and military<br />

doctors. After establishment of<br />

Novorossiysk University in 1865 in<br />

Odessa some of the teachers of the<br />

University became its members.<br />

In 1867 I.I. Mechnikov arrives in<br />

Odessa after his election as an associate<br />

professor of Novorossiysk University but<br />

next year he moves to St. Petersburg<br />

University. In 1870 he returns to Odessa as<br />

professor of zoology department of<br />

Novorossiysk University.<br />

In 1874 the professor Mechnikov was<br />

elected as a full member of the society by<br />

Grygory N. Mynch’s (1836-1896) proposal<br />

who was a chairman of the latter at that<br />

time. However, his active participation in<br />

the work of the society began later and it<br />

dates back to the 80-ies of XIX century<br />

when I.I. Mechnikov formulated clearly<br />

his phagocytal theory as well as entirely<br />

devoted himself to its proof.<br />

As there could be a birth of this theory<br />

immunologist L.A.Zilber tells: « In the<br />

summer of 1882 of I.I.Mechnikov with a<br />

family has a rest in Italy on the bank of the<br />

Messinsky gulf. Tired sick eyes do not<br />

come off a microscope. He observes a life<br />

of mobile cells in a larva of starfishes. The<br />

larva is transparent and these cells are<br />

perfectly visible. And suddenly there is a<br />

thought that similar cells should serve in a<br />

human organism for „counteractions to<br />

harmful agents”» [1]<br />

It is difficult now to tell how much<br />

exact L.A.Zilbera's story was, but it is<br />

well-known, that the theory of<br />

phagocytosis arose just in 1882 and<br />

numerous zoological and embryological<br />

I.I.Mechnikov's researches about a role of<br />

intracellular digestion and protective<br />

function of cells, formed of mesoderm,<br />

preceded its occurrence.<br />

In the summer of 1883 <strong>VI</strong>I Congress of<br />

naturalists and doctors of Russia gathered<br />

in Odessa and in August, 28th<br />

I.I.Mechnikov made the report «About<br />

curative forces of a human organism» on a<br />

general meeting of the congress. Then a<br />

victorious road of the phagocytal theory<br />

began.<br />

In Odessa, where I.I.Mechnikov lived<br />

and worked at that time, microbiological<br />

researches were started on botany<br />

department of Novorossiysk University by<br />

the professor L.S. Tsenkovsky, and after<br />

his departure from Odessa in 1871, they<br />

were continued by Odessa doctors G.N.<br />

Minh, O.O. Mochutkovsky, Ch.I.<br />

Hentsinsky, N.A. Stroganov who were full<br />

members of the physicians’s society in<br />

Odessa and they reported about the results<br />

of their researches at its sessions.<br />

Thus physicians of Odessa, represented<br />

by the society, were ready for perception<br />

of I.I. Mechnikov’s ideas. On the other<br />

hand, Illya Ilyich required a medical<br />

audience for discussion of the hypothesis<br />

put forward by him.<br />

On November 26th, 1883 I.I.<br />

Mechnikov made the report «Comparative<br />

pathological research on inflammation in<br />

connection with a question on intracellular<br />

digestion» [2] at the session of the society.<br />

Here he stated the theory of phagocytosis<br />

for the first time after his report at <strong>VI</strong>I<br />

Congress of Russian naturalists and<br />

doctors.<br />

In March issue of the magazine<br />

«Russian medicine» in 1884 the “Open<br />

letter to the professor I.I. Mechnikov» was<br />

published by Odessa doctor Semyon<br />

Moiseyevich Shor (1845-1917). He wrote<br />

that doctors listened to Illya Ilyich’s report<br />

with a great interest, but at the same time it<br />

was necessary to prove that principles of

Y.K. VASYLYEV: Significance Of Physicians’ Society In Odessa In Generation And Formation Of<br />

Phagocytal (I.I. Mechnikov’s) Theory<br />

the theory of phagocytosis were applicable<br />

for infectious diseases of a human<br />

organism [3]. I.I. Mechnikov did not<br />

disregard the questions which were put<br />

before him.<br />

On May 12th, 1884 the society heard<br />

I.I. Mechnikov's report «About<br />

relationship of anthrax bacilli to<br />

phagocytes» [4]. It was his first research<br />

on medical microbiology problems which<br />

at the same time had immunological<br />

nature. New proofs of the phagocytal<br />

theory rightness were given in his work: it<br />

was shown that the phagocytosis<br />

phenomenon naturally occurs among<br />

vertebrates as well as invertebrates.<br />

In 1886 I.I. Mechnikov made two more<br />

reports in the society. The first of them,<br />

reported on May 17 th , was «About<br />

relationship of streptococci to phagocytes»<br />

[5] and the second one, made on October<br />

18th, was «About destiny of microorganisms<br />

in blood» [6]. These works were<br />

further substantiation of the phagocytal<br />

theory. The debate, caused by those reports<br />

in the society, definitely affected the<br />

subsequent course of I.I. Mechnikov’s<br />

work. So, on October 18th N.A. Stroganov<br />

and K.K. Iskersky told dissatisfaction with<br />

hypothetical explanation of phagocytes<br />

role in case of diseases progressing with<br />

crises. In his reply I.I. Mechnikov spent a<br />

series of new researches and on February<br />

7th, 1887 he represented the report<br />

«Concerning the doctrine about malaria»<br />

[7] and on May 16 th in the same year he<br />

made the report «About fight of<br />

phagocytes in case of relapsing fever» [8].<br />

The doctrine on phagocytosis was not only<br />

disproved by supervision over these<br />

infections, but, on the contrary, it received<br />

a new acknowledgement.<br />

In all during 1883-1887 I.I. Mechnikov<br />

was present at 34 sessions of the<br />

physicians’s society in Odessa and he<br />

made 6 reports. The sessions, at which he<br />

told about the researches, were among the<br />

91<br />

most visited and on November 26th, 1883<br />

when the society heard I.I. Mechnikov's<br />

report «Comparative pathological research<br />

concerning inflammation in connection<br />

with a question on intracellular digestion»,<br />

maximum number of visitors for those<br />

years, i.e. 69 full members and 16 visitors,<br />

gathered (in 1883-1887 there were 37-38<br />

full members at the society sessions on the<br />

average, taking into account that in 1883<br />

there were 11 honorary members, 92 full<br />

members and 9 correspondent members in<br />

the latter) [9].<br />

It is also necessary to notice that<br />

researches with use of medical<br />

microbiology methods were performed by<br />

I.I. Mechnikov in the prosectorium of the<br />

city hospital along with consultation and<br />

assistance of the full member of the<br />

Society doctor of medicine N.A. Stroganov<br />

who headed hospital prosectorium since<br />

1877. In 1887 I.I. Mechnikov worked in<br />

collaboration with the assistant N.�.<br />

Stroganov who was then a military doctor<br />

in the prosectorium; it was his second job.<br />

Ch.I. Hentsinsky was studying malaria<br />

causative agents for many years.<br />

Summarising all abovementioned it is<br />

possible to assert that sessions of the<br />

physician’s society in Odessa were the first<br />

audience where reports on the theory of<br />

phagocytosis, offered by I.I. Mechnikov,<br />

were not only heard both at <strong>VI</strong>I Congress<br />

of naturalists and doctors, but also they<br />

were thoroughly discussed, subjected to<br />

criticism and it promoted formation and<br />

becoming the theory that obtained<br />

international recognition afterwards. And<br />

full members of the society not only<br />

discussed and criticised I.I. Mechnikov's<br />

reports, but also assisted in laboratory<br />

researches (N.A. Stroganov, Ch.I.<br />

Hentsinsky).<br />

References:<br />

[1]. ������� �.�. �������� � ���<br />

������. <strong>–</strong> ������, 1945. <strong>–</strong> �. 10.

92<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

[2]. �������� �.�. �������������<br />

�������� ���������. <strong>–</strong> ������,<br />

1954. <strong>–</strong> �. 5. <strong>–</strong> �. 22-30.<br />

[3]. ��� �.�. // ������� ��������. <strong>–</strong><br />

1884. - � 12. <strong>–</strong> �.284-286.<br />

[4]. �������� �.�. �������������<br />

�������� ���������. <strong>–</strong> ������,<br />

1950. <strong>–</strong> �. 6. <strong>–</strong> �. 41-59.<br />

[5]. �������� �.�. �������������<br />

�������� ���������. <strong>–</strong> ������,<br />

1950. <strong>–</strong> �. 6. <strong>–</strong> �. 63-90.<br />

[6]. �������� �.�. �������������<br />

�������� ���������. <strong>–</strong> ������,<br />

1954. <strong>–</strong> �. 5. <strong>–</strong> �. 54-57.<br />

[7]. �������� �.�. �������������<br />

�������� ���������. <strong>–</strong> ������,<br />

1954. <strong>–</strong> �. 5. <strong>–</strong> �. 58-64.<br />

[8]. �������� �.�. �������������<br />

�������� ���������. <strong>–</strong> ������,<br />

1950. <strong>–</strong> �. 6. <strong>–</strong> �. 91-101<br />

[9]. ��������� ��������� ��������<br />

�������� ������ �� 1882-1883 ��. <strong>–</strong><br />

������, 1882-1883. <strong>–</strong> 23, 211 �.

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />





Abstract: Orthopaedics, dealing with the treatment of the irregularities in<br />

the locomotors system and traumatology, dealing with the treatment of<br />

injuries after trauma have been serving as independent treatments in the<br />

surgery clinics in Turkey as in the whole world. The independent science<br />

field becoming of Orthopaedics and Traumatology in Turkey has been<br />

released by the efforts and contribution of many respected physicians. In this<br />

presentation the efforts of the physicians Orhan Abdi Kurtaran, Akif Sakir<br />

Sakar, Burhaneddin Toker, Dervis Manizade and Rıdvan Ege who have<br />

contributed in the development of Orthopaedics and Traumatology in Turkey<br />

is going to be mentioned.<br />

Key words: Orthopaedics and Traumatology, History of Medicine, Turkey.<br />

Like in whole world, in Turkey as well<br />

the proceeding of surgery into a modern<br />

appearance has been in the 19 th century.<br />

The later separation of orthopaedics and<br />

traumatology from general surgery like<br />

urology, gynaecology and alike fields and<br />

its becoming as an independent science<br />

field has been in different dates and ways<br />

in every country. Orthopaedics, dealing<br />

with the treatment of the irregularities in<br />

the locomotor system and traumatology,<br />

dealing with the treatment of injuries after<br />

trauma have been serving as independent<br />

treatments in the surgery clinics until<br />

recent years [3].<br />

The independent science field<br />

becoming of Orthopaedics and Traumatology<br />

in Turkey has been realized by the<br />

efforts and contribution of many respected<br />

physicians. In this essay, the efforts of the<br />

physicians Orhan Abdi Kurtaran, Akif<br />

Sakir Sakar, Burhaneddin Toker, Dervis<br />

Manizade and Ridvan Ege who have<br />

contributed in the development of<br />

Orthopedics and Traumatology in Turkey<br />

is going to be mentioned.<br />

Dr. Orhan Abdi Kurtaran (1877-1948)<br />

After graduating from Military Medicine<br />

School in 1899, he worked as a surgery<br />

assistant with Prof. Reider and Dycke Pasha<br />

in Gulhane Hospital [1]. Dr. Orhan Abdi was<br />

sent to University of Bonn by Sultan<br />

Abdulhamid in 1900. He got training<br />

orthopaedics from Dr. Max Shede and<br />

learned the production of orthopaedics<br />

equipments from Eschaum. Later, he became<br />

an assistant of Prof. Hoff in University of<br />

Wurzburg (Baviera) and Prof. Sick in<br />

University of Eppendorff (Hamburg) [3, 12].<br />

In 1905, by the order of the Padishah, he<br />

returned to Istanbul and began to work as a<br />

trainer at Gulhane Hospital, “Orthopaedics<br />

and War Surgery” [13].<br />

1 Uludag University, Faculty of Medicine, <strong>Medical</strong> History and Ethics Depart., Bursa, Turkey<br />

2 . Uludag University, Faculty of Medicine, Orthopedics and Traumatology Depart., Bursa, Turkey

94<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

Fig. no.1. Dr. Orhan Abdi Kurtaran<br />

So, involvement of orthopaedics in<br />

medical training began in 1905 with Dr.<br />

Orhan Abdi. At the same year, he used ether<br />

in the operations and contributed for<br />

developing anaesthesia. With the foundation<br />

of <strong>Medical</strong> Faculty in 1909 it was seen that<br />

for the first time orthopaedics branch has<br />

become semi private and the name of the<br />

lesson was changed to “Orthopaedics and<br />

Big Surgery Operations” [13]. During those<br />

days there were three surgery clinics. The<br />

third one’s name was “Surgery and<br />

Orthopaedics” and the chairman of it was Dr.<br />

Orhan Abdi. However, when he became as<br />

the chairman of the second surgery clinic, the<br />

name orthopaedics was removed [3].<br />

Akif �akir �akar (1888-1961)<br />

After graduating from Military<br />

Medicine School in 1910, he underwent a<br />

period of training in Gulhane Military<br />

Practice Hospital, surgery clinic. At the<br />

end of 1911 he was inducted as a surgeon<br />

to Van Military Hospital. In 1912 he<br />

worked as an assistant in Vienna<br />

University with Prof. Eiselberg in surgery<br />

clinic and with Dr. Breitner in emergency<br />

service for a year. In the I. World War he<br />

worked as a physician in Jerusalem, Syria<br />

and Palestine. He was captured in<br />

Damascus. In 1919 he returned to Istanbul,<br />

in 1921 he graduated as a surgeon and<br />

began to work with Dr. Mouchet who was<br />

working with orthopaedics patients and<br />

giving lectures on “Paediatric Surgery and<br />

Orthopaedics”. He was appointed as an<br />

interpreter of Dr. Mouchet by Dr. Akil<br />

Muhtar Ozden, the Dean of that time. After<br />

becoming an associate professor in 1923,<br />

he began to give lectures between the years<br />

1923-1925. In 1925, after Dr. Mouchet<br />

changed to teach in “Surgery Operation<br />

and Techniques” he became the head of<br />

Paediatric Surgery and Orthopaedics<br />

Department, which did not have a clinic<br />

[6]. In 1927-1929, he worked in Hamburg<br />

University surgery clinic with Dr. Sudeck<br />

on bone and joint surgery. Seeing that fractures<br />

treatment and orthopaedics was not<br />

sufficient in Turkey, he showed effort to<br />

establish a modern orthopaedics clinic<br />

[13].<br />

Fig.no.2. Akif �akir �akar

E. ATICI, et al: Milestones physicians and their contributions in Turkish orthopaedics and<br />

traumatology<br />

Dr. Akif Sakir had three goals; the<br />

establishment of the clinic, paediatric<br />

surgery and orthopaedics becoming a<br />

specialization branch and separating<br />

paediatrics surgery from orthopaedics. In<br />

1930, the first Paediatric Surgery and<br />

Orthopaedics Clinic, which contained 30<br />

beds was founded by him [3]. In 1931, he<br />

became professor. For the first time in<br />

Turkey, he used visual materials<br />

(photographs and operation images of<br />

orthopaedics patients) in education, also he<br />

always demonstrated patients related with<br />

lesson [13]. The first book of the clinic<br />

was published by him in 1936 with the title<br />

“Paediatric Surgery and Orthopaedics”.<br />

With the aim of acceptance Paediatric<br />

Surgery and Orthopaedics as a<br />

specialization branch, he established<br />

“Turkish Orthopaedics and Traumatology<br />

Association” in 1939. The department took<br />

its place among 22 specialization branches<br />

in the date of 1947. In 1955, with the<br />

special efforts of Dr. Akif Sakir Sakar, the<br />

clinic moved to the new building that was<br />

formed of 5 floors and 100 beds. So, Dr.<br />

Sakar has founded the modern<br />

orthopaedics clinic that was his ideal [6,<br />

11, 13].<br />

He had a book with two volumes titled<br />

as “Lectures on Paediatric Surgery and<br />

Orthopaedics Clinic”, 100 papers publicshed<br />

in Turkish medical journals and 40<br />

papers published in German, French and<br />

Swiss medical journals [6].<br />

Turkish Orthopaedics and Traumatology<br />

Association has been given scientific<br />

prize in the name of Akif Sakir Sakar since<br />

1995. Also the same association arranged<br />

“28 th Akif Sakir Sakar Days” this year.<br />

Dr. Burhaneddin Toker (1890-1951)<br />

He began his medical education in<br />

Damascus <strong>Medical</strong> Faculty and completed<br />

in Istanbul in 1910. He went to Germany<br />

in 1913 to make his residency in surgery<br />

95<br />

and worked together with the popular<br />

surgeons of that period, Brauer and<br />

Küttnerfor for 7 years in Berlin and<br />

Hamburg [2]. During that period fracturesdeformations<br />

and injuries were cured in the<br />

general surgery. He specialized in modern<br />

bone surgery. After returning to Turkey, he<br />

started to work as an operator and the<br />

clinical director of the surgery department<br />

in Cerrahpasha Hospital. Surgery treatment<br />

opportunities were insufficient. Fracturedeformation<br />

treatment was mostly done by<br />

the bonesetters.<br />

Also most of the physicians were not<br />

interested in fracture treatment and plaster<br />

structure. He was aware of the lacking<br />

points in this field, so he dealt with<br />

especially with traumatology [3].<br />

Fig.no.3. Dr. Burhaneddin Toker<br />

In order to increase the number of<br />

patients, he made friendships with the<br />

policemen who take injured people to the<br />

hospital, and assured that all injured<br />

around were taken to Cerrahpasha. In a<br />

short time Cerrahpasha Hospital started to<br />

work as an accident surgery centre. He<br />

attained a mobile roentgen device and by

96<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

doing fractures reposition under radioscopy,<br />

he released the first conservative<br />

modern fracture treatment in Turkey.<br />

He brought Braun device schema and<br />

measures, which was used in fractures<br />

from Germany and had the smith done it.<br />

The first surgery journal “Journal of<br />

Turkish Surgery” was published by him in<br />

1927.<br />

Also, he took the lead in the foundation<br />

of “Turkish Surgical Association” in 1929<br />

with the aim of improvement in the<br />

scientific worlds [8, 9, 11].<br />

Subsequent to the "University Reform"<br />

in 1933, the world famous German<br />

surgeon Ord. Prof. Dr. Rudolf Nissen has<br />

been assigned as the "Director of the 1 st<br />

Surgery Clinic and the clinic was moved<br />

from Haydarpasha to Cerrahpasha. Dr.<br />

Burhaneddin Toker was first assigned to<br />

the staff of Dr. Nissen as an associate<br />

professor; five months later he became<br />

professor. Nissen went to U.S.A. because<br />

of his sickness and Dr. Toker became the<br />

director by proxy in 1941 and subsequent<br />

to definitive departure of Nissen, the new<br />

director of 1 st Surgery Clinic at <strong>Medical</strong><br />

School [7, 8]. Dr. Toker opened surgery<br />

building in 1943, the plan of which was set<br />

and started to build by Nissen in 1939. So,<br />

the clinic took a modern appearance [8].<br />

He had the degree of "Ordinaries<br />

Professor" in 1943 and leaded cardiovascular<br />

surgery, neurosurgery and<br />

anaesthesia departments in addition to the<br />

formation of new traumatology [7].<br />

He was also the first implementer of<br />

some medical applications: first<br />

systematically blood transformation, first<br />

stomach resection operation (1928),<br />

implementation of first Smith-Petersen nail<br />

(1941), first book on fracture and<br />

dislocation [2, 9, 11]. He had over 150<br />

papers and 3 books: Surgical Treatment of<br />

Lung Tuberculosis, Fracture and<br />

Dislocations, Lung Apses.<br />

Dr. Dervi� Manizade (1902-2003)<br />

After graduating from Vienna <strong>Medical</strong><br />

Faculty in 1932 he began to work in the<br />

Traumatology Service of the II. Surgery<br />

Clinic in the same place and was preparing<br />

for associate professorship. Prof. Nissen<br />

decided Dr. Manizade for the assistantship<br />

would be appropriate. In 1937 he started to<br />

work as an assistant of Nissen and Toker in<br />

Istanbul. He was established archive<br />

system for the first time in the clinic<br />

(1938). He prepared patient follow forms<br />

and made sure that these forms were filled<br />

completely and regularly for each patient.<br />

During those days fracture-deformation<br />

treatment, which was done within the<br />

general surgery, began to discuss that it<br />

should be the subject of orthopedics<br />

branch. After the death of Dr. Toker in<br />

1951, Cerrahpasha Surgery Clinic divided<br />

into two with the directorship Dr. Kazım<br />

Ismail Gurkan and Dr. Fahri Arel. In 1960,<br />

Dr. Manizade was appointed to the<br />

directorship of the third clinic and for the<br />

first time he gathered the traumatologic<br />

cases in one place.<br />

Fig.no.4. Dr. Dervi� Manizade

E. ATICI, et al: Milestones physicians and their contributions in Turkish orthopaedics and<br />

traumatology<br />

Between the years 1962-1963 by<br />

combining surgery clinics, one clinic with<br />

six sections was established. One of these<br />

sections was Traumatology Service with<br />

30 beds only for bone-joint injuries and<br />

orthopaedics cases. Dr. Manizade, who<br />

assured its establishment, was appointed as<br />

a director of this section [10].<br />

First intrameduller nail implementation<br />

in tibia fractures was performed by him in<br />

1950 [9, 11]. Turkish Orthopaedics and<br />

Traumatology Association has been given<br />

scientific prize in the name of Dervis<br />

Manizade since 2001. Also the same<br />

association is going to arrange “8 th Dervis<br />

Manizade Orthopaedics Days” on<br />

December in this year.<br />

Dr. Rıdvan Ege (1925- )<br />

After graduating from Istanbul <strong>Medical</strong><br />

Faculty in 1948, he underwent a period of<br />

training in Gulhane Military <strong>Medical</strong><br />

Academy, surgery clinic. In 1949, he was<br />

inducted to Erzincan and then Diyarbakır.<br />

In 1952 he worked as an assistant in<br />

Gulhane with Prof. Dr. Recai Erguler in<br />

surgery clinic. Although traumatology was<br />

very important for military, there was no<br />

specialization in Turkey. So, he went to<br />

U.S.A (Colombia University) in order to<br />

take orthopaedics and traumatology<br />

training in 1956. After returning to Turkey,<br />

he worked in general Surgery Clinic of<br />

Gulhane since Orthopaedics was not<br />

established yet [4]. He believed that<br />

skeleton traumatology was not the field of<br />

general Surgery and should be the<br />

specialist of orthopaedics. His aim was<br />

including Trauma into Orthopedics and<br />

separate Paediatric Surgery. To reach this<br />

aim first he completed 262 orthopaedic<br />

operations in a year and published these in<br />

Turkish and English. Then he visited three<br />

<strong>Medical</strong> Faculties in Turkey that dealt with<br />

orthopaedics and four Bone and Joint<br />

Illness Hospitals to start a communication<br />

97<br />

with colleagues. After presenting his works<br />

Professors Committee accepted to establish<br />

a clinic and also accepted Dr. Ege’s<br />

suggestion for naming the clinic as<br />

“Orthopaedics and Traumatology”. So, the<br />

separation of orthopaedics from paediatric<br />

surgery and traumatology from general<br />

surgery and joining them as an<br />

independent clinic was realized first in<br />

Gulhane Military <strong>Medical</strong> Academy in<br />

1961 by him [5]. Also after working with<br />

Dr. Carroll (New York Colombia<br />

University) and with Dr. Boyes (Los<br />

Angeles S California University) on hand<br />

surgery, he established first hand Surgery<br />

Clinic in Turkey.<br />

Fig.no.5. Dr. Rıdvan Ege<br />

Also he established Mediterranean and<br />

Middle East Orthopaedics and<br />

Traumatology Association (1960), Turkish<br />

Rehabilitation of Disabled Association<br />

(1960), Turkish Orthopaedics and<br />

Traumatology Union Association (1966),<br />

Modern Surgical Training and Research

98<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

Association (1970), Turkish Foundation of<br />

Traffic Accidents (1972), Turkish Hand<br />

and Upper Extremity Surgery Association<br />

(1977). He organized many national and<br />

international congresses. He has 111<br />

books, 451 papers. Today, he continues his<br />

works in Ufuk University (Ankara), which<br />

was established in 1999 by Turkish<br />

Foundation of Traffic Accidents. He is the<br />

president of board of trustee [4].<br />

Table 1. Contribution of physicians to<br />

Turkish Orthopaedics and Traumatology<br />

Dr. Orhan<br />

Abdi<br />

Kurtaran<br />

Dr. Akif<br />

Sakir Sakar<br />

� First lesson in<br />

orthopaedics:<br />

� “Orthopaedics and<br />

War Surgery”<br />

(Gulhane Hospital-<br />

1905)<br />

� “Orthopaedics and<br />

Big Surgery<br />

Operations” (<strong>Medical</strong><br />

Faculty-1909)<br />

� Used ether in the<br />

operations (1905)<br />

� First Clinic: “Surgery<br />

and Orthopaedics”<br />

(1909)<br />

� Establish modern<br />

orthopaedics in<br />

Turkey<br />

� Use visual materials<br />

in education for the<br />

first time<br />

� Establish Paediatric<br />

Surgery and<br />

Orthopaedics Clinic<br />

(1930)<br />

� Publish first book:<br />

Paediatric Surgery<br />

and Orthopaedics”<br />

(1936)<br />

� Establish Turkish<br />

Orthopaedics and<br />

Traumatology<br />

Association (1939)<br />

Dr.<br />

Burhaneddin<br />

Toker<br />

Dr. Dervis<br />

Manizade<br />

� Establish the first<br />

modern orthopaedics<br />

clinic (1955)<br />

� Released the first<br />

conservative modern<br />

fracture treatment in<br />

Turkey<br />

� Published the first<br />

surgery journal<br />

“Journal of Turkish<br />

Surgery” (1927)<br />

� He took the lead in<br />

the foundation of<br />

“Turkish Surgical<br />

Association” (1929)<br />

� Leaded traumatology,<br />

cardiovascular<br />

surgery, neurosurgery<br />

and anaesthesia<br />

departments<br />

� The first implementer<br />

of some medical<br />

applications:<br />

� first systematically<br />

blood<br />

transformation<br />

� first stomach<br />

resection operation<br />

(1928)<br />

� first<br />

implementation of<br />

Smith-Petersen nail<br />

(1941)<br />

� First book on fracture<br />

and dislocation<br />

� Established archive<br />

system for the first<br />

time in the clinic<br />

(1938)<br />

� Prepared patient<br />

follow forms<br />

� First intrameduller<br />

nail implementation in<br />

tibia fractures (1950)<br />

� Gathered the<br />

traumatologic cases in<br />

one place (1960)

E. ATICI, et al: Milestones physicians and their contributions in Turkish orthopaedics and<br />

traumatology<br />

Dr. Rıdvan<br />

Ege<br />

� Established<br />

Traumatology Service<br />

with 30 beds only for<br />

bone-joint injuries and<br />

orthopaedics cases<br />

(1962-1963)<br />

� Established the first<br />

“Orthopaedics and<br />

Traumatology” clinic<br />

(1961)<br />

� (separation of<br />

orthopaedics from<br />

paediatric surgery and<br />

traumatology from<br />

general surgery and<br />

joining them as an<br />

independent clinic<br />

was realized by him)<br />

� Established<br />

� Mediterranean and<br />

Middle East<br />

Orthopaedics and<br />

Traumatology<br />

Association (1960),<br />

� Turkish Rehabilitation<br />

of Disabled<br />

Association (1960)<br />

� Turkish Orthopaedics<br />

and Traumatology<br />

Union Association<br />

(1966)<br />

� Modern Surgical<br />

Training and Research<br />

Association (1970)<br />

� Turkish Foundation of<br />

Traffic Accidents<br />

(1972)<br />

� Turkish Hand and<br />

Upper Extremity<br />

Surgery Association<br />

(1977)<br />

Conclusion<br />

Orthopaedics began to its journey in<br />

Turkey in 1905 with Dr. Orhan Abdi<br />

Kurtaran by getting its place in the<br />

medicine training and got its first clinic<br />

99<br />

with the intensive efforts of Dr. Akif Sakir<br />

Sakar in 1930. Although it was accepted as<br />

a separate branch in 1947, until 1960 the<br />

clinic’s name was Paediatric Surgery and<br />

Orthopaedics. The development in<br />

Traumatology began with Dr. Burhaneddin<br />

Toker and as an effort of Dr. Dervis<br />

Manizade first Traumatology Service was<br />

established within General Surgery. With<br />

the efforts of Dr. Rıdvan Ege Orthopaedics<br />

was separated from Paediatric Surgery and<br />

Traumatology was separated from General<br />

Surgery in 1961 and took the name<br />

Orthopaedics and Traumatology.<br />

References<br />

[1]. Altınta� A. Turk Cerrahisinin Onemli<br />

Bir Sahsiyeti: Operatör, Muallim<br />

Orhan Abdi (Kurtaran). Sendrom<br />

1996; 8 (2): 80-85.<br />

[2]. Arel F. Ord. Prof. Dr. A. Burhaneddin<br />

Toker. �stanbul klinik Dersleri 1951;<br />

5 (27): 2-6.<br />

[3]. Atıcı E, Atıcı T. The Development of<br />

Orthopaedics and Traumatology in<br />

Turkey and Some Results. JISHIM<br />

2004; 3(5): 50-59.<br />

[4]. Ege R. 80 Yılın Ardından. Vol. 1.<br />

Ankara: Ufuk University<br />

Publications 2007.<br />

[5]. Ege R. Opening Speech. XV. National<br />

Congress of Turkish Orthopaedics<br />

and Traumatology. Proceedings<br />

Book. Publication of Turkish<br />

Ortopedics and Traumatology Union<br />

Assosiation. 1997. p.1-28.<br />

[6]. Frik F. Turkiye’de Ortopepedi Kurucusu<br />

Ord. Prof. Dr. Akif Sakir Sakar.<br />

Dirim 1958; 33(9-10): 227-228.<br />

[7]. Goksoy E. Ord. Prof. Dr. A.<br />

Burhaneddin Toker: Türk<br />

Cerrahisine Katkılar. Turkish Journal<br />

of Surgery 2005; 21(2): 102-111.<br />

[8]. Goksoy E. The Biography and Work of<br />

Prof. Dr. Burhaneddin Toker-On<br />

Occasion of the 50 th Anniversary of

100<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

His Death. The New History of<br />

medicine studies 2001; 7: 387-409.<br />

[9]. Manizade D. 65 Yıllık Cerrahpa�a<br />

hastanesi. �stanbul 1976: 82.<br />

[10]. Manizade D. Kemik ve Mafsal<br />

Travmatolojisi. In: Kırık Çıkıklar.<br />

Vol 1. �stanbul: Publication of<br />

Cerrahpasha <strong>Medical</strong> Faculty, no:<br />

119, 1983. p.1-21.<br />

[11]. Manizade D. Ortopedi ve<br />

Travmatoloji. In: Unat EK, editor.<br />

Dünyada ve Türkiye’de 1850<br />

Yılından Sonra Tıp Dallarındaki<br />

�lerlemelerin Tarihi. �stanbul: C<br />

Publisher; 1988. p. 338-343.<br />

[12]. Naderi S, Hakan T, Dinc G. Orhan<br />

Abdi Kurtaran ve Ameliyatı-<br />

Cerrahiye adlı Eserindeki Norosirurji<br />

ile Ilgili Bolumler. Turkish Journal<br />

of Neurochirurgia 2006; 16(3): 197-<br />

202.<br />

[13]. Tanacan H. Turk Ortopedisinin<br />

Tarihcesi I. Acta Orthop Traumatol<br />

Turc 1993; 27: 151-159.

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />



M. FULGA 1 , V. ANDREESCU 2 , D. LUPULESCU 1,3<br />

Abstract: Since 1964 there were written papers on the history of mining, in<br />

general (Ion Lungu, 1964: “The beginning of coal mining in Transilvania”,<br />

Acta Musei Napocensis) and of Valea Jiului mining (Sargetia V, 1968: “The<br />

beginnings of the industrial revolution in Valea Jiului mining”), in which the<br />

work conditions and the life of the miners were described. Coal was known<br />

and extracted in the ancient times. The first coal extraction in Europe was<br />

officially mentioned in 1113, at Kerkrade, near the border between Holland<br />

and Germany. In 1183 there opened the first mines in Shefield, England, in<br />

1240 in Durham and in 1291 in Walles. In our country, the first coal mines<br />

were discovered in 1771 at Doman, then, in 1788 at Secu and in 1790 at<br />

Anina, by Nicolae Hammer. The first mining was mentioned in 1792 at<br />

Seierdorf, Anina. The development of mining began at the end of the X<strong>VI</strong>II th<br />

century and the beginning of the XIX th century. The growing industry of coal<br />

mining and the lack of a careful monitoring of the work environment led to<br />

an increased risk of pneumoconiosis during the ‘50’s, when the pathology of<br />

coal dust was not recognized. Since then, the number of miners grew and so<br />

the number of diseases induced by dust inhalation.<br />

Key words: coal, silicosis, history of medicine.<br />

Introduction<br />

Jiu valley is the region located in the<br />

south of Hunedoara County, at the border<br />

among Transilvania, Banat, and Tara<br />

Romaneasca, region generic called “the<br />

country of the black diamond due to the<br />

exploitation of the pit coal deposit. This<br />

area started to be known since 1782 when<br />

layers of coals burning were noticed and<br />

those layers burnt much time after this.<br />

Although in Jiu valley there were rich<br />

deposits of coal, the interest for natural coal<br />

raised considerably just in the 4th decade of<br />

the 19-th century, as a consequence of the<br />

request of fuel, this request being a result of<br />

the development of the capitalism and also<br />

due to the extension of the internal and<br />

external market.<br />

1 Institute of Public Health Bucharest<br />

2 County Public Health Authority Hunedoara<br />

3 University of Medicine and Pharmacy “Carol Davila” Bucharest<br />

Historical aspects<br />

The human being has been an energy<br />

consumer since the primitive epoch.<br />

The coal has been known and used<br />

since antiquity. In 1113 started the first pit<br />

coal exploitation from Europe, officially<br />

registered in Kerkrade, at the border<br />

between Holland and Germany. In 1183<br />

the first coal mining exploitations were<br />

also opened and officially registered in<br />

England near Sheffield, after this appeared<br />

those from Durham, and in 1921 those<br />

from Walles. The coal was for a long time<br />

the only source of energy, it was used at<br />

the beginning as domestic fuel being the<br />

only source of heating in houses, after a<br />

while the coal started to influence the<br />

international economy.

102<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

The facts are mentioned in the work<br />

“The coal research history from ancient<br />

times till 1900” written by A Semaka,<br />

published in the Mine magazine, 13 in<br />

1962, also in the one written by N.<br />

Maghiar <strong>–</strong> ‘From the history of exploittation<br />

and using of mineral coals “publicshed<br />

in Mine Magazine nr 21 from 1971.<br />

The 19 th century was metaphorical<br />

defined the “coal” century. The increasing<br />

needs of energy used by the society led to<br />

the discovery and exploitation of new<br />

energy sources (petrol, natural gases,<br />

hydro electric power and atomic power<br />

etc.), without eliminating the coal as a<br />

source of energy.<br />

Moreover, the coal production increased<br />

also in other countries, the coal mining being<br />

different regarding their type, structure of the<br />

coal layers. The most important coal mining<br />

is the pit coal mining these contains coking<br />

coal used in chemical industry. The coal<br />

mining containing brown coals and lignite<br />

are composed of superior coals used as fuel.<br />

An inferior type of coal is peat coal; this is<br />

frequently used in the North Europe, Asia<br />

and North America. The most profitable coal<br />

mines are those of surface as they are in Germany.<br />

In USA the coal is extracted from coal<br />

mines in average of 50 % and in C.S.I. (The<br />

Independent Community) in average of 35%<br />

Europe was on the first place regarding<br />

the universal production of coal, but the<br />

production decreased more than 50 %<br />

around 1980, nowadays Europe produces<br />

just 1/3 from universal production.<br />

C.S.I. is known as one of the greatest<br />

coal manufacturer in the world and it has<br />

in stored about 2/3 of the universal<br />

reserves of coal and from these 90% is<br />

located in Asia zone.<br />

In our country the first discoveries of<br />

natural coal were made in 1771 in Doman,<br />

in 1788 in Secul and in 1790 in Anina by<br />

Nicolae Hammer. The first exploitments<br />

started in 1792 at Steierdorf-Anina. In our<br />

country the development of coal mining<br />

started at the end of 18-th century and the<br />

beginning of19-th. The first works were in<br />

1835 followed by those from 1840 done by<br />

Hoffmann brothers and Carol Maderspach,<br />

the owners of mines from Rosia Montana.<br />

The Maderspach brothers made exploittations<br />

in Jiu Valley and they were the ones<br />

who put the basis, develop and improved<br />

the rudimentary mining coals the likely<br />

areas could be Petrosani, Petrila, their<br />

work was continued in the 6-th decade of<br />

the 19 th century.<br />

In 1896 Hoffmann Rafel, made a serial<br />

of coal analyses of the coal extracted from<br />

Lupeni, he reached the conclusion that this<br />

coal belonged to the group of pit coal with<br />

long flame and weak agglutinated. He<br />

showed the difference between the coal<br />

from East part of Jiu Valley and the ones<br />

from Lupeni, which contained a higher<br />

value in carbon and less in oxygen .The<br />

coal was used as raw material, as domestic<br />

fuel, later as a development of exploitation<br />

industry the coal was used as raw material<br />

for energetic industry (hydro and energetic<br />

power) metallurgy, iron and steel industry,<br />

afterwards was used in chemical industry.<br />

As a consequence of the crisis and because<br />

many vacancies were eliminated, after<br />

1990 the coal exploitation industry decreased<br />

much being replaced by other sources<br />

of energy which are, more profitable,<br />

sources like petroleum or natural gases.<br />

About the beginnings and the<br />

development of mining in general and<br />

especially of Jiu valley was much written<br />

beginning with 1964 some works being as<br />

follows: ” Ion Lungu, 1964: “The beginning<br />

of the development of coal mining in<br />

Transilvania”, Acta Musei Napocensis)<br />

and “Aspects of the beginning of industrial<br />

revolution from Valea Jiului mining<br />

(Sargetia V, 1968: In these works was<br />

described miners’ work and life conditions<br />

from JIU valley and the history of<br />

exploitation and the usage of coal from old<br />

times <strong>–</strong> thing reflected in Mircea Baron’s

M. FULGA, et al.: Silicosis disease history in exploitation of coal in Jiu valley 103<br />

book ‘The coal and society in Jiu Valley <strong>–</strong><br />

inert-war period. (Fig. no. 1).<br />

Fig.no.1<br />

The work “Custom and continuity in<br />

the country <strong>–</strong> the stone which burns” is a<br />

monography of the mining in Jiu Valley,<br />

followed by the history of the Jiu Valley<br />

with the social and artistic development of<br />

the area, the customs and also the<br />

evolution of death rate due to the<br />

occupational disease as a consequence of<br />

the exposure to the coal dust (fig. nr 2)<br />

Fig.no.2<br />

In the work “Consideration regarding the<br />

coal usage in Romania” by Ion E Bujoiu and<br />

‘What is taken from coal” by I. Simionescu,<br />

are presented diverse aspects related to the<br />

development of the mining industry in<br />

connection with the social and economical<br />

conditions from Transilvania and Banat.<br />

Furthermore, during 1857-1858 the<br />

Uricani, Barbatenii de Sus, Lupeni,<br />

Macesd-Paroseni, Jiu Vaidei <strong>–</strong>Vulcan,<br />

Dalja, Petrila were bought by the<br />

Anonymous Society of mines and furnaces<br />

Brasov, which becomes a huge coal<br />

manufacturer of the Hungarian Austrian<br />

monarchy. The state made the first<br />

acquisition of coal fields in 1865.<br />

Other studies were made by the Blum<br />

engineer and were mentioned in 1939 in the<br />

study work “Le basin de charbons Petrosani-<br />

Jiu Valley. Etude chimico-technic, stade de<br />

metamorphose et classification” ans the dr M<br />

marinescu studies on 24 samples of coal<br />

from the mines described in the work ‘Piscu,<br />

Aninoasa,Petrosani- Est”.<br />

Other pieces of work in which is concluded<br />

that Jiu valley has superior coal are the works<br />

of the professor Ghe. Macovei- “Course of<br />

general geology and stratigraphy” another one<br />

is written by Ion E.Bujoiu “Encyclopedia of<br />

Romania “written in 1939.<br />

The studies made by Wartha Wincze in<br />

1876 proved that the coal from Petrosani<br />

can be used in the manufacture of coke<br />

needed in metallurgic industry and also in<br />

producing the light gas.<br />

Around 1950 the public opinion sustained<br />

the idea that the dust coal from the mines in Jiu<br />

Valley doesn’t cause occupational disease of<br />

lungs. In the same time was also a wrong idea<br />

that the deposit of pit coal dust in the lungs can<br />

lead to pulmonary fibrosis which could protect<br />

the lungs against the bacillus tuberculosis. The<br />

development of mining industry led to the<br />

increase of personnel .The lack of means of<br />

control against dust the number of people ill<br />

because of inhaling coal dust started to rise.<br />

The quantity of dust, in the absence of<br />

the means of control, rises in accordance<br />

with the quantity of coal extracted.<br />

Statistics from 1968 showed that during<br />

the last two decade, in Romania were<br />

declared 24000 cases of illness of silicosis.<br />

Over 80% were among the personnel of<br />

mining industry.

104<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

Regarding the existence of pneumoconiosis<br />

of ore coal were a lot of debates.<br />

Some considered the coal as an inert<br />

gas which is stored in lung and it could<br />

cause just a weak fibrosis called black lung<br />

disease (anthracosis) which has the<br />

opposite effect of the dust from barren<br />

gangue that led to silicosis a serious<br />

illness, irreversible with lethal end (due to<br />

the high level of quartz).<br />

There are different consequences when we<br />

talk about the place of work in a coal mine.<br />

The miners from mines of barren gangue<br />

exposed to the dust rich in silicon (sillicium)<br />

can get ill with classic silicosis and the ones<br />

who work in mines of coal will be ill with<br />

black lung. Between the two pure types there<br />

are also mixed ones, encountered to those<br />

who work with stone and coal.<br />

During 1950-1970 the level of dust was<br />

of 32, mg/mc air, and the ratio of working<br />

places which were exposed to a higher<br />

level than the maximum admitted doze was<br />

of 63%. During 1982-1996, as a<br />

consequence of mechanization and the<br />

improvement of the work environment the<br />

level of dust decreases at 25 mg/mc.<br />

When we want to establish the risk of<br />

getting ill because of dust in a working place<br />

we must take into consideration 3 factors: the<br />

type of dust, quantity, and the dimension of<br />

particles. In each mine the risk is different<br />

and it is in accordance with the technology of<br />

exploitation used, types of work and the<br />

operations done during the cycle of work In<br />

the same time the introduction of<br />

mechanized working in cutting and evacuate<br />

the coal led to an increase of the level of dust<br />

in mining mechanized excavations, so it<br />

appears “the second wave” of illness and by<br />

black lung. For this were taken measures<br />

against of the dust and the number of<br />

diseases and their frequencies to decrease.<br />

If between 1953-1996 the statistics<br />

showed that there were 2420 cases of disease<br />

due to inhaling of coal dust in Jiu Valley and<br />

the average of life was 42, today the<br />

incidence decreased at 1-0,5% and the<br />

average of age increased at 50.8 years.<br />

An estimation made before 1975 presented<br />

that from 100 ill people 24,9% have worked<br />

exclusively in coal extraction (and these were<br />

with black lung) 40,8% who worked in<br />

combined environment with stone and coal<br />

were ill with pneumoconiosis due to mixed<br />

dust and 34,3% who worked just in quarry they<br />

were ill with silicosis. Regarding the<br />

classifying of silicosis grade there can be emphasized<br />

the following percents: the first phase<br />

-84.4% the second 9,9% and the third 2,8%<br />

Beginning with the setting up of the<br />

commission of silicosis in Petrosani and<br />

the establishing of the criterion declare the<br />

illnesses the silicosis and black lung started<br />

to decrease. The level of dust decreased so<br />

that the number of cases of silicosis<br />

disease is much rarer.<br />

To sum up the morbidity of the personnel<br />

which is hired nowadays in mines from Jiu<br />

Valle, in comparison with the past? Decrease<br />

very much due to the mechanized<br />

technology used now in mines.<br />

References:<br />

[1]. Badea L. <strong>–</strong> Valea Jiului, Ed. �tiin�ific�,<br />

Bucuresti, 1971, p.7-26.<br />

[2]. Baron M. <strong>–</strong> C�rbune �i Societate în<br />

Valea Jiului, Ed. Universitas<br />

Petrosani, 1998.<br />

[3]. Baron M. <strong>–</strong> Tradi�ii �i continuitate în �ara<br />

«Pietrei care arde», Petro�ani, 1994.<br />

[4]. Darlea G. - Antracoza, Ed. Favior &<br />

Vidra, Or��tie, 1992.<br />

[5]. Fodor D., Baican, G. <strong>–</strong> Situa�ia actual�<br />

a mineritului românesc, Rev. Univers<br />

ingineresc. nr. 11/2002 si nr. 12/2002<br />

[6]. Fodor, D., Baicon, G. <strong>–</strong> Impactul<br />

industriei miniere asupra mediului,<br />

Ed. INFOMIN, Deva, 2001.<br />

[7]. Mocanu C., Tufescu V. <strong>–</strong> Depresiunea<br />

Petrosani, Ed. �tiin�ific� Bucure�ti,<br />

1964, p.11.

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />





S. G�BREAN 1<br />

Abstract: In the first decades of the XX th century, neurosyphilis was a<br />

frequently disease in the world, for which different types of treatments were<br />

experienced, for example drugs containing arsenic (Salvarsan and<br />

Neosalvarsan). These drugs were not 100% effective, especially in tertiary<br />

syphilis. In the years following the First World War, based on the<br />

observations that in same cases high fever is favourable in the treatment of<br />

syphilis, it was induced the malaria infection which determines a high and<br />

prolonged fever, at patients with late syphilis. The risk for the patients was<br />

acceptable because malaria could later be treated with quinine. We present<br />

some dates concerning the contributions of Ghe. Marinescu, M. Ciuca and<br />

their fellow-workers, who used paludotherapy and Salvarsan or<br />

Neosalvarsan as adjuvant therapy in treating neurosyphilis<br />

Key words: neurosyphilis, treatment, Romanian medical school<br />

Syphilis is caused by the spirochaete<br />

Treponema pallidum, which is 5-15�m in<br />

length and less than 0.3�m in thickness.<br />

This organism is generally sexually<br />

transmitted through mucosal membranes or<br />

small lesions of the skin. T. pallidum can<br />

be observed by silver stain, immunofluorescence,<br />

with dark-field, phasecontrast<br />

or electron microscopy. In 1913,<br />

after centuries of discussions concerning<br />

syphilis, H. Noguchi, a Japanese scientist,<br />

demonstrated the presence of T. pallidum<br />

on sections from the brain obtained at the<br />

necropsy of a patient with progressive<br />

paralysis, proving that T. pallidum was the<br />

cause of the disease. Short time afterwards,<br />

in the same year, Gheorghe Marinescu<br />

together with his assistant I. Minea,<br />

confirm this discovery and identify T.<br />

pallidum not only on sections from<br />

1 Faculty of Medicine, Transilvania University of Bra�ov.<br />

necropsies but also, for the first time, on<br />

sections from small fragments of brain<br />

obtained by the surgeon I. Jianu from a<br />

patient with progressive paralysis.<br />

The various manifestations of syphilis<br />

are time dependent. Acquired syphilis has<br />

four stages: primary, secondary, latent and<br />

tertiary. Neurosyphilis refers to a site of<br />

infection involving the central nervous<br />

system and may occur at any stage of<br />

syphilis. There are four clinical types of<br />

neurosyphilis: asymptomatic neurosyphilis,<br />

meningo-vascular syphilis, general<br />

paresis of the insane and tabes dorsalis.<br />

Before the treatment with antibiotics,<br />

neurosyphilis was observed in 25-35% of<br />

patients with syphilis. General paresis, also<br />

known as dementia paralytic is a severe<br />

manifestation of neurosyphilis, which<br />

occurs approximately 20-30 years after the

106<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

initial infection with Treponema pallidum<br />

and represents a chronic progressive<br />

fronto-temporal meningo-encephalitis with<br />

especially psychiatric symptoms [6, 12].<br />

Syphilis has been a major health<br />

problem since the X<strong>VI</strong> th century and was<br />

treated with some ineffective remedies<br />

(guaiacum, mercury and others) until the<br />

beginning of the XX th century, when<br />

treatments based on arsenic as Salvarsan<br />

(arsphenamine, developed in 1908 by S.<br />

Hata in the laboratory of Paul Ehrlich) and<br />

Neosalvarsan were used. Malario-therapy<br />

was used as treatment for neurosyphilis<br />

due to high prolonged fever (a form of<br />

pyreto-therapy), an acceptable risk because<br />

the malaria could later be treated with<br />

quinine. For discovering the treatment of<br />

dementia paralytica by malaria inoculation<br />

(1917), J.Wagner-Jauregg was awarded<br />

with The Nobel Prize for Medicine in<br />

1927. Malariotherapy was followed by<br />

either Salvarsan or Neosalvarsan as<br />

adjuvant therapy [1, 10].<br />

In our country, a number of medical<br />

personalities showed interest for the<br />

treatment of syphilis: Gh. Marinescu, C.<br />

Levaditi, M. Ciuc�, C. I. Urechia, Elena<br />

Pu�cariu-Densu�ianu and their co-workers.<br />

At the beginnings of Romanian medical<br />

education, the first reference concerning<br />

syphilis prevention was made by Carol<br />

Davila in his doctoral thesis sustained on<br />

23 February 1853, thesis which was<br />

entitled “Syphilis prophylaxis” [3].<br />

Gh. Marinescu was one of the first<br />

physicians in the world who received<br />

(1910) from Ehrlich the small doses of<br />

Salvarsan, which he managed to prepare in<br />

order to be tested in the great hospitals of<br />

the world [9]. If Salvarsan produced<br />

healing in some forms of syphilis (skin<br />

syphilis, for example), in neurosyphilis<br />

(tabes, general paresis) it gave no results.<br />

Gh. Marinescu tried to introduce<br />

Neosalvarsan into the body not by<br />

intramuscular or intravenous injections,<br />

but directly into the spinal canal or brain.<br />

He asked a former student, surgeon Ion<br />

Jianu, to do some small trepanations of the<br />

skull (it has to be mentioned that I. Jianu<br />

had never before worked on living brain);<br />

using these entries, Gh. Marinescu injected<br />

Neosalvarsan directly into the brain of the<br />

patients with dementia paralytica, but he<br />

didn’t obtain good results.<br />

Fig.no.1.<br />

As it was mentioned above, Treponema<br />

pallidum was identified in the brain of<br />

general paralytics in 1913 so, in 1910, Gh.<br />

Marinescu was only suspecting the<br />

presence of the spirochete in the brain of<br />

these patients. In order to destroy the<br />

spirochete, Marinescu introduces<br />

Neosalvarsan by intraspinal injections<br />

directly into the cerebrospinal fluid, but<br />

once again without the desired results, the<br />

drug being irritable and caustic for the<br />

nervous tissue. Together with his assistant<br />

I. Minea, Marinescu realized at the<br />

Pantelimon Hospital an original method of<br />

treatment for general paresis, which was<br />

based on injecting salvarsanized serum<br />

into the cerebrospinal fluid. The serum was<br />

obtained from patients with syphilis who<br />

were injected with an important quantity of<br />

Neosalvarsan. After a few hours, were<br />

taken 40-50 ml of blood from which the<br />

serum was obtained after coagulation; this<br />

serum contained both a very small dose of<br />

Salvarsan and the syphilis antitoxin<br />

produced by the organism. Injected to the<br />

patients with general paresis, this serum<br />

showed good results, even curative<br />

properties [5].

S. G�BREAN - Some contributions of romanian medical school in the treatment of neurosyphilis 107<br />

before the discovery of antibiotics<br />

After two years, in 1912, two American<br />

physicians, Swift and Ellis publish the<br />

same method of treating neurosyphilis with<br />

salvarsanized serum. Although Ehrlich<br />

himself, the discoverer of Salvarsan,<br />

mentions at a medical congress held in<br />

Königsberg in 1913, the world priority of<br />

Marinescu’s researches regarding the<br />

intraspinal injection of the salvarsanized<br />

serum, the discovery is attributed to the<br />

two American physicians, who later<br />

recognized that the paternity of treatment<br />

was belonging to Gh. Marinescu.<br />

However, they were saying that they had<br />

“improved” the serum, improvement<br />

which meant putting into phials the<br />

salvarsanized serum and commercializing<br />

it worldwide. There were also<br />

disapproving opinions regarding the<br />

treatment with salvarsanized serum, being<br />

considered that “it is a complicated<br />

method, and if sometimes may have a<br />

more or less curative effect, it still does not<br />

represent a preferable treatment or a<br />

progress in the treatment of nervous<br />

syphilis” (C. I. Urechia) [12].<br />

Fig.no.2.<br />

In the 1920s, Constantin Levaditi and<br />

Robert Sazerac introduced bismuth<br />

therapy. For the treatment of neurosyphilis,<br />

bismuth therapy was done as in the case of<br />

visceral or skin syphilis, taking into<br />

account possible accidents like stomatitis,<br />

intestinal problems, jaundice etc.<br />

Generally, bismuth drugs seemed to have<br />

good results. There were patients who<br />

reacted very well at this therapy and there<br />

were also cases in which the patients<br />

showed inability to tolerate the bismuth.<br />

As a consequence, it was preferred a<br />

combined treatment, based on alternating<br />

bismuth salts with Salvarsan [2, 7].<br />

In Romania, the artificial infection with<br />

malaria (malariotherapy) was successfully used<br />

in the treatment of neurosyphilis. The method<br />

was simple and consisted in the intravenous or<br />

subcutaneous injection of blood taken from a<br />

patient presenting a malarial attack; on average,<br />

in 8-10 days, the patients had malarial attacks<br />

and after 10-12 attacks they were given quinine<br />

and Salvarsan.<br />

The principle of treating neurosyphilis<br />

by impaludation was based on the high<br />

fever which, probably, nonspecifically<br />

inactivated T. pallidum and generated a<br />

complex neuro-immuno-endocrine defense<br />

and repair reaction of the body.<br />

Malariotherapy was performed at Socola<br />

Hospital in Ia�i under the direction of M.<br />

Ciuc�, at the Psychiatry Clinic of the<br />

Faculty of Medicine in Cluj under<br />

Professor’s C.I. Urechia direction, at the<br />

Neurological Service of the Institut for<br />

Mental, Nervous and Endocrine Diseases<br />

from Bucarest [11].<br />

Fig.no.3<br />

A special attention should be accorded<br />

to the researches made at Socola Hospital,<br />

the second internationally acknowledged<br />

centre for pyretotherapy, after Horton<br />

centre from England. At first, only<br />

Plasmodium vivax was used in treating<br />

neurosyphilis, being considered relatively<br />

safe and easy to control by quinine. After a<br />

few years, in 1925, Plasmodium

108<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

falciparum was used, first at Horton center<br />

and soon afterwards at Socola Hospital.<br />

The team working here under the direction<br />

of Professor M. Ciuc�, general secretary of<br />

the International Commission of Malaria<br />

for the League of Nations (1928-1938) also<br />

used in its researches indigenous strains of<br />

Plasmodium malariae, thus having an<br />

important contribution to knowledge of the<br />

sporogonic cycle of malaria parasites [4,8].<br />

C.I. Urechia recommended for the<br />

treatment of neurosyphilis pyretotherapy<br />

using intravenous injections with beer yeast,<br />

which were painless and induced the required<br />

high fever (39,6-41 0 C). The method was<br />

easily applicable and seemed to produce an<br />

important improvement, especially in the case<br />

of general paralysis [12].<br />

A special interest for neurosyphilis also<br />

showed Elena Densu�ianu-Pu�cariu (1875-<br />

1966), the first woman in the world professor<br />

at a clinic of ophthalmology. She had better<br />

established the share of syphilis in the<br />

etiology of ocular diseases and was one of the<br />

first authors in the world who concluded that<br />

malariotherapy had no curative effect in the<br />

optic nerve syphilis [12].<br />

From this short presentation, one may<br />

conclude that in a difficult socioeconomical<br />

context, the Romanian medical<br />

school managed to come with important,<br />

even original contributions in the treatment<br />

of neurosyphilis until the discovery of<br />

antibiotics.<br />

Bibliography<br />

[1]. Austin S., Stolley P., Lasky T.: The<br />

History of Malariotherapy for Neurosyphilis,<br />

JAMA, 268(4), 1992, 516-519.<br />

[2]. Bittner J.: Paul Ehrlich, Ed. �tiin�ific�,<br />

Bucure�ti, 1971, 128-133.<br />

[3]. Br�tescu G. Tinere�ea lui Carol Davila,<br />

Ed. Albatros, Bucure�ti, 1979, 113-117.<br />

[4]. Ciuc� M., Ballif L. et al: Note du<br />

secretariat resumant un rapport sur le<br />

progress des travaux de la station<br />

permanente de malariatherapie et<br />

d’etudes experimentales sur le<br />

paludisme (Institut Rockefeller) de<br />

Socola, Jassy, Roumanie, jusqu’au<br />

31/12/1933, Societe des Nations,<br />

Organisation d’Hygiene, Commission<br />

du Paludisme, Geneve, 1934.<br />

[5]. Floda L., Marioara G. Marinescu,<br />

Radovici. A.: Gheorghe Marinescu,<br />

Ed. Tineretului, 1958, 244-246.<br />

[6]. French P., Gomberg M. et al: IUSTI:<br />

2008 European Guidelines on the<br />

management of Syphilis, Internat. J.<br />

of STD & AIDS, 20, 2009, 300-302.<br />

[7]. Levaditi C.: Bismuthoprévention de la<br />

syphilis, Volume jubilaire en l’honneur<br />

du Professeur G. Marinesco, Institut<br />

d’Arts Graphiques E. Marvan<br />

Bucarest, 1933, 395-400.<br />

[8]. Lupa�cu G., Constantinescu P., Negulici<br />

E. et al: Parasitological and Clinical<br />

Investigations on Infections with the<br />

VS Romanian Strain of Plasmodium<br />

malariae Transmitted by Anopheles<br />

labranchiae atroparvus, Bull. Wld.<br />

Hlth. Org., 38, 1968, 61-67.<br />

[9]. Marinescu G.: Coresponden�a (1889-<br />

1938), Ed. �tiin�ific�, Bucure�ti,<br />

1968, 99-100.<br />

[10]. Rudolf G. de M.: Recent advances in<br />

therapeutic (induced) malaria, J.<br />

Neurol. Psychopathol., January<br />

16(63), 1936, 239<strong>–</strong>255.<br />

[11]. Paulian D.: Les résultats de la<br />

malariothérapie dans le Service<br />

Neurologique de L’Institut<br />

des Maladies Mentales, Nerveuses et<br />

d’Endocrinologie de Bucarest,<br />

Volume jubilaire en l’honneur du<br />

Professeur G. Marinesco, Institut<br />

d’Arts Graphiques E. Marvan<br />

Bucarest, 1933, 537-538.<br />

[12]. Urechia. C. I., Mih�lescu S.: Tratat<br />

de patologie neuro-mintal�, Ed.<br />

Lepage, Cluj, 1928, 491-502.

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />




Abstract:<br />

The Enlightment Revolution is a core element to understand grand narratives<br />

of the emergence of modern biomedical science. Despite attempts to create a<br />

more nuanced taxonomy of the remarkable transformation of knowledge of<br />

nature in this period, the hodoeporic writings by the Italian abbot Lazzaro<br />

Spallanzani are fundamental to understand a positivist and internalist<br />

approach in the development of experimental methods. During 1786 the<br />

sapiens’ travel from the Black Sea through Transylvania till Tara<br />

Ungureasca was full of natural, biological, social experiences coupled with<br />

medical and epidemiologic observations<br />

Key words: Natural science, medicine, hodoeporics.<br />

Science enlightment<br />

Collecting rare and ancient objects or<br />

things of aesthetic value, both natural<br />

and man-made, became very popular in<br />

European culture in the fifteenth and<br />

sixteenth centuries. These centuries<br />

witnessed the birth of Kunst und<br />

Wunderkammern “Rooms of Art and<br />

Wonders” in which the aim was to<br />

collect objects of astonishing originality<br />

which would stir and amaze visitors, as<br />

well as preserve the memory of<br />

Antiquity - indisputable aesthetic canon<br />

also for the modern.<br />

Naturalia that is nature byproducts -<br />

even if featured as monsters - and<br />

Artificialia that is human artifacts,<br />

stimulated the common sense of<br />

observation and, most important of all,<br />

scientific interest and curiosity.<br />

Those collections were the very start<br />

of natural history museums: tools for<br />

scientific research and cultural and<br />

social development. New technologies,<br />

1 ACTI Department, University of Bari, Italy<br />

geographic exploration and scientific<br />

traveling opened the pathway to famous<br />

scientists’ work. At the edge of X<strong>VI</strong>IIth<br />

century Antonio Vallisneri (1661-1730),<br />

Italian physician and biologist - a<br />

scholar at Bologna University with<br />

Marcello Malpighi (1628-1694) -<br />

appointed to the chair of Practical<br />

Medicine at the University of Padua,<br />

wrote:<br />

“Many have observed and many still<br />

expect to observe, but not everyone has<br />

observed well, and others do not know<br />

how to observe, nor perhaps do they<br />

know how tricky the art of observation<br />

is, easily misunderstanding one thing<br />

for another, being blinded by the light,<br />

or not looking with due attention and<br />

diligence at what is to be looked at”.<br />

He was one of the first researchers in<br />

medicine to reject the Aristotelian<br />

theories and he started the collection

110<br />

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which is one of the best examples of<br />

those scientific gabinetti (laboratories)<br />

which turned to be university research<br />

laboratories where the experimental<br />

method in which Galileo was a master,<br />

became daily practice for scientists.<br />

Padua, Pavia, Bologna, and Modena at<br />

different periods in the X<strong>VI</strong>II century<br />

bloomed with the discoveries of their<br />

brilliant teachers and philosophers.<br />

Biography<br />

In the very shadow of the Northern<br />

Italy institutions of learning, Lazzaro<br />

Spallanzani (1729-1799), another Italian<br />

researcher, was keenly interested in the<br />

natural sciences and over his lifetime<br />

collected numerous specimens of<br />

animals, minerals and other natural<br />

objects.<br />

He became a priest and eventually<br />

professor of natural history at Pavia,<br />

and was an enthusiastic traveller in<br />

pursuit of specimens for the natural<br />

history museum there as well as for his<br />

home private museum in Scandiano.<br />

Fig.1. Spallanzani marble statue in his<br />

home town Scandiano, Italy<br />

He was educated at the Jesuit<br />

College and studied law for three years<br />

before getting frustrated and<br />

dissatisfied. He then turned his great<br />

hunger for knowledge to science. He<br />

became a biologist and physiologist,<br />

studying body functions and the<br />

unknown wonders of the natural world.<br />

He also studied philosophy and<br />

mathematics and discovered that<br />

microbes can move through the air and<br />

can be killed by boiling. Almost a<br />

century later, Louis Pasteur (1822-1895)<br />

studied and then expanded his work, and<br />

got many of his ideas from Spallanzani.<br />

The Italian scientist studied many topics<br />

and stated that digestion is a chemical<br />

process and not just the grinding of<br />

food. He was first to do an artificial<br />

insemination of a dog. He wondered<br />

why a stone skipped over the water<br />

when it was thrown.<br />

In 1768 an offer by Empress Maria<br />

Theresa, then ruling over Austrian<br />

Lombardy, to give him the chair of<br />

natural history and keeper of the<br />

museum at Pavia proved too attractive<br />

to be refused. He held this position until<br />

his death thirty-one years later. During<br />

this period (1768-1799) he distinctly<br />

disproved the theory of spontaneous<br />

generation which had been done by Redi<br />

(1626-1697) before the discovery of<br />

microscopic organisms had given its<br />

exponents a new basis for argument. His<br />

work on fertility blazed the trail for<br />

future investigators.<br />

Mineralogy received distinct<br />

contributions from his labours. He was<br />

perhaps the first to study the ability of<br />

bats to avoid obstacles in flying after<br />

they had been blinded. The dissertations<br />

on digestion were read in all scientific<br />

circles; their contribution to physiology<br />

was monumental. The studies on<br />

circulation contained original and<br />

important observations. By his work on

A. MUSAJO SOMMA, et al: Lazzaro Spallanzani, in Transylvania drive 111<br />

respiration he first showed the real seat<br />

of combustion. Spallanzani was a<br />

Fellow of the Royal Society of London<br />

and a member of the Academies of<br />

Prussia, Stockholm, Gottingen.<br />

The first known exploration into<br />

ultrasound physics happened in the<br />

1790’s. Lazzaro Spallanzani wondered<br />

why bats could navigate at night and<br />

catch insects as they flew. He<br />

blindfolded them and they still<br />

manoeuvred very well. He then plugged<br />

their ears and found that they bumped<br />

into obstacles. He concluded that their<br />

primary mode of navigation was<br />

hearing. He deduced that they must emit<br />

ultrasound waves that are inaudible to<br />

humans and listen to the echoes to<br />

determine distance and direction of<br />

objects. This idea was received by his<br />

fellow scientists with ridicule and<br />

scepticism.<br />

After the French army under<br />

Napoleon invaded Italy in 1796<br />

Spallanzani was offered the position of<br />

professor of natural history at Paris but<br />

he declined because of his advanced<br />

age. On February 11 th 1799, three days<br />

after an attack of apoplexy, having<br />

recovered sufficiently to recite Latin<br />

verse and having received the papal<br />

benediction, he died suddenly at 2:30<br />

am suffering for a bladder cancer.<br />

Hodoeporics: eastbound travel<br />

Quite a few Italian travellers went to<br />

the Romanian area to work, to study, to<br />

make commerce, business and researches:<br />

Tommaso Alberti in the X<strong>VI</strong>I century<br />

and in the following century<br />

Maiolino Bisacioni (1582-1663),<br />

Francesco Griselini (1717-1783) and the<br />

“Astrologer” Lazzaro Spallanzani, as he<br />

was called by his scholars after he<br />

showed an early penchant for<br />

astronomy.<br />

Also another Italian naturalist,<br />

Domenico Sestini of Florence (1750-<br />

1832), crossed the Romanian area<br />

during the Century of Light almost in<br />

the same years when Maria Theresa’s<br />

son and previous co-regent Joseph II<br />

(1741-1790) was running the empire.<br />

In August 1785, at the end of<br />

university lessons, Lazzaro Spallanzani<br />

sails from Venice to Constantinople. In<br />

the places he visits, he studies plants<br />

and animals, weather, the life and habits<br />

of those populations. He comes back<br />

travelling on land so he visits some<br />

mines and collects minerals in<br />

Transylvania, in the salt pan of<br />

Salzburg, in the gold and silver deposits<br />

of Zalatina, in the Carpathian<br />

metalliferous mountains. On December<br />

7 th , 1786 he arrives in Vienna and rich<br />

collection of minerals will be delivered<br />

to his university town one year later.<br />

Transylvania experience<br />

On August 16 th , 1786 Spallanzani<br />

left Constantinople asking for the<br />

permission to go back home through the<br />

Transylvania drive to allow a deeper<br />

knowledge of mines and the natural area<br />

of Carpathian region.<br />

Fig.2. Spallanzani drive<br />

He comes back travelling on land so<br />

he visits some mines and collects<br />

minerals in Transylvania. The deep<br />

desire to visit new geographic areas and<br />

to learn as much as possible prompted<br />

Lazzaro Spallanzani to travel back from

112<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

Constantinople joining the carriages of<br />

the prince of Walachia for a safer trip<br />

and to save money. Indeed he had<br />

already collected by Baron Sperges and<br />

the Austrian government a huge amount<br />

of money, worth 100 Venetian sequins,<br />

through Baron of Herbert in<br />

Constantinople.<br />

On August 27 th the caravan crossed<br />

Donau River and stopped in Skiera-<br />

Ollenza, in Walachia. Simplicity of life<br />

and a sincere hospitality welcomed the<br />

Italian scientist. Women are almost<br />

dressed as in the Ottoman area and<br />

Bulgaria but their face is not covered by<br />

any clothes. Crossing the village of<br />

Valek-Negest he was surprised to detect<br />

that people was dark skinned and<br />

curiously, dark skinned women were not<br />

at all beautiful and their breasts were<br />

pendulous offering from time to time a<br />

bare-thorax to the visitors eyes, “but<br />

they do not smell at all”!<br />

After 12 nights he was forced to rest<br />

in the carriage, he arrived on August<br />

28 th in Bucarest where he was hosted by<br />

the prince Ypsilandi for five days.<br />

Indeed that nobleman was an employee<br />

of the realm, temporary nobility granted<br />

only to collect duties and local taxes,<br />

according to the arhondology’s laws.<br />

Spallanzani visited the salt mines of<br />

Hani-Hanik and collected a huge<br />

amount of minerals. On the 5 th of<br />

September he started his trip towards<br />

Kronstadt (Brasov) and the day after he<br />

stopped in the lazaret of Buza. Nearby<br />

the Bodza River a lazaret was open for<br />

quarantine every time plague was<br />

affecting people living in or crossing<br />

through Constantinople. The Empress<br />

Maria Teresa forced people crossing the<br />

borders to Transylvania to stop 3 or 6<br />

weeks in Buza lazaret if infection was<br />

affecting the Ottoman area.<br />

Corona or Kronstadt was only seven<br />

hours travelling from the lazaret and<br />

Spallanzani arrived there in the evening<br />

of 7 th September while a cold eastern<br />

wind was blowing across the area. Not a<br />

word he wrote on his trip from<br />

Kronstadt to Hermannstadt (Sibiu) -<br />

under the military protection of 30<br />

soldiers offered by Ospodaro<br />

Mauroceno - where he arrived on 12 th<br />

September.<br />

He visited the salt mine of<br />

Saltzbourg (Witazna) and gold and<br />

silver deposits of Zalatna, where he<br />

arrived, crossing through Portu, on 24 th<br />

September, in the metalliferous<br />

mountains very well known since<br />

ancient Roman time.<br />

In that geographical area and near<br />

Alba Iulia many illegal coin minters - an<br />

ethnic group called Moti - were working<br />

as outlaw gold dealers and moreover<br />

“they know how to mint gold coins of<br />

the best quality and having the right<br />

weight”.<br />

Moti lived in very miserable<br />

conditions and Spallanzani was very<br />

impressed by their skin chronic ulcers<br />

clearly related to advanced clinical<br />

syphilis: a terrifying map of typical<br />

open ulcers was covering all over their<br />

body.<br />

The Italian scientist underlines that<br />

in the Turkish area he was unable to<br />

detect such big amount of venereal<br />

diseases’ skin tags. Moreover he states<br />

that in the Moti villages there were<br />

almost no children, clearly relating<br />

advanced syphilis to impossible<br />

pregnancies.<br />

In Transylvania, the Walachi were<br />

about 1 million people; other inhabitants<br />

were Hungarians - the land owners -<br />

Siculi, Saxons, Germans, Armenians,<br />

Greeks (mainly merchants) and<br />

Bohemians. These were Gypsies<br />

classified as musicians, handcraft<br />

workers and Egyptians - that is gypsies<br />

working around and “mainly thieves”!

A. MUSAJO SOMMA, et al: Lazzaro Spallanzani, in Transylvania drive 113<br />

He left Transylvania for the Banat<br />

region and he arrived to Temeswar on<br />

the evening of 14 th October when a<br />

stormy weather and rain offered to the<br />

Italian biologist an awful welcome. He<br />

will report the poor quality of air<br />

because of several ponds and local<br />

people affected by intermittent fevers.<br />

Transylvania is left and Vienna<br />

welcomes the Italian scientist on 7 th<br />

December 1786.<br />

His hodoeporic writings about the<br />

scientific tour through the eastern<br />

European countries were printed only a<br />

century after his death.<br />

Conclusion<br />

Spallanzani, in all his life as well as<br />

in his Transylvania drive, took a<br />

necessary and decisive step away from<br />

scholastic Aristotelian natural<br />

philosophy, with its sterile metaphysics<br />

and reputed reluctance to value<br />

laboratory experience. Laboratory tools<br />

joined Spallanzani’s travels and his<br />

studies reoriented the research of natural<br />

sciences away from the world of<br />

common sense observation and made it<br />

rigorously measurable and testable.<br />

Beyond the stones, he collected<br />

through the Romanian area biologic,<br />

ethnologic, medical and social notes.<br />

A great biographer, as great as a<br />

botanist, the Transylvanian academician<br />

Emil Pop (1897-1972) paid his tribute to<br />

the extraordinary personality of the<br />

Italian savant printing in 1942 a study<br />

of great erudition related also to<br />

Spallanzani personality. In the<br />

supplement of Emil Pop’s paper, as<br />

published in Timisoara in 1942, there is<br />

also a list of 60 different minerals<br />

collected by Spallanzani in the region.<br />

Three big cases of minerals were<br />

dispatched, on Spallanzani order, by the<br />

Zalatna mines’ inspector, Immanuel<br />

Will by ship along the Donau River to<br />

Vienna. The acquisition of exhibits<br />

proved congenial to the most<br />

magnificent Museum of Natural History<br />

at University of Pavia. A great amount<br />

of natural history material items were<br />

collected in Spallanzani private museum<br />

in Scandiano, his hometown. The<br />

preservation of his private collection<br />

was a responsibility of his sister<br />

Marianna, a single woman who offered<br />

a great strength in the early attempts to<br />

preserve the items. She gained<br />

experience in taxidermy and in the<br />

preservation of stuffed-skins allowing a<br />

satisfactory preservation of the<br />

collections.<br />

Difficult Mountain passes, floods and<br />

torrents, brigands and cut-throats, mines<br />

inspection to collect more specimen<br />

allowed to set up a unique natural<br />

science collection and the written<br />

records by Spallanzani feed social<br />

history information and therefore the<br />

wider world of individuals and<br />

researchers interested into medical<br />

history.<br />

References<br />

[1]. Ellenberger F., Ovide et la géologie,<br />

Travaux du Comité Français<br />

d’Histoire de la Géologie, 3 e série, t.<br />

V, n° 3, 1991, pp. 17-24.<br />

[2]. Ferrone V., I profeti<br />

dell’illuminismo. Le metamorfosi<br />

della ragione nel tardo Settecento<br />

italiano, Laterza, Bari 1989, p. 446.<br />

[3]. Generali D., Antonio Vallisneri. La<br />

figura, il contesto, le immagini<br />

storiografiche, Olschki, Firenze<br />

2008.<br />

[4]. Musajo Somma A., Musajo Somma<br />

L., Italian doctors cruising on the<br />

Bosphorus, Proceedings 38 th<br />

International Congress on the<br />

History of Medicine (Istanbul 2002),<br />

Ankara 2005, vol. 2 pp.1009-1012.<br />

[5]. Pop E., Naturali�tii italieni din

114<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

veacul al X<strong>VI</strong>II-lea, cercet�tori ai<br />

�inuturilor române�ti (Italian<br />

naturalists of the 18th century,<br />

researcher of the Romanian land)<br />

Timisoara, 1942.<br />

[6]. Roman V., Notes from Lazzaro<br />

Spallanzani’s travel to the<br />

Roumanian lands, Comptes Rendues<br />

XXII International Congress ISHM<br />

(Bucarest 1970), 1972, pp. 261-262.<br />

[7]. Spallanzani L., Viaggio in Oriente, a<br />

cura di Naborre Campanili, Bocca<br />

Editori Torino, 1888.<br />

[8]. Vaccari E., Lazzaro Spallanzani:<br />

une naturaliste italien de dixhuitième<br />

siècle et sa contribution<br />

aux sciences de la terre, Travaux du<br />

Comité Français d’Histoire de la<br />

Géologie, XI, Paris 1996, pp. 72-89.<br />

[9]. Vaccari E., Spallanzani e le scienze<br />

geologiche del Settecento: un<br />

percorso interpretativo tra carteggi<br />

e diari di viaggio, Teorie e pratiche<br />

dell’esperienza scientifica. Lazzaro<br />

Spallanzani e le scienze della natura<br />

nel Settecento, “La sfida della<br />

modernità” Atti del Convegno di<br />

Studi a cura di W. Bernardi e P.<br />

Manzini, Olschki, Firenze 1999.<br />

[10]. Maiolino Bissaccioni �i r�zboaiele<br />

civile din Moldova (Maiolino<br />

Bissaccioni e le guerre civili in<br />

Moldavia), Arhiva Societ��ii<br />

�tin�ifice �i Literare (A.S.S.L.) di<br />

Ia�i, 1892: 645-651.<br />

[11]. C�l�toriile lui Domenico Sestini în<br />

Muntenia, 1779 (I viaggi di<br />

Domenico Sestini in Valacchia,<br />

1779), Arhiva Societ��ii �tin�ifice �i<br />

Literare (A.S.S.L.) din Ia�i, 1893:<br />


Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />

<strong>VI</strong>CTOR GOMOIU AND THE<br />


J. P. TRICOT 1<br />

Abstract: Thanks to the interacting efforts of the Belgian professor J.J. Tricot-<br />

Royer (1875 <strong>–</strong> 1951), founder -president of the International Society for the<br />

History of Medicine (I.S.H.M.) and of the Romanian professor V. Gomoiu (1882-<br />

1960), third president of this one, the study of medical folklore has been<br />

acquainted with huge development from the thirties of the XX Century on. During<br />

his whole life, prof. Gomoiu fully applied himself, not only to an exemplary<br />

surgical career and to the field of medical-social relief work (with the support of<br />

the Royal Family of his country) but also to the history of medicine. After having<br />

founded in 1929 the Romanian Society for History of Medicine and having<br />

organized in Bucharest in 1932 the IX congress of the I.S.H.M., prof. Gomoiu<br />

was elected in 1936 president of that society. During the whole fourth decade of<br />

the XX Century, medical folklore was one of the main issues of most of the<br />

congresses of the I.S.H.M. And so Gomoiu established in September 1935 a<br />

special international commission for the study of medical folklore: the<br />

Cantacuzene <strong>–</strong> Commission. The contribution of prof. Gomoiu to the study of<br />

Romanian medical folklore was very important. In this paper, reference will be<br />

made to a lot of unpublished documents: the letters sent by prof. Gomoiu and by<br />

the French prof. Guiart (his general secretary in the I.S.H.M.) to Prof. Tricot-<br />

Royer between 1934 and 1939. Prof. Gomoiu can be considered as an<br />

emblematic and exemplary figure into the study of History of Medicine and of<br />

medical folklore, as well on a national as on a international level.<br />

Key words: Victor Gomoiu, Cantacuzène-Commission<br />

On the 15 th of April 1939, the report<br />

upon the proceedings of the Cantacuzene<br />

Commission for the study of <strong>Medical</strong><br />

Folklore was submitted by the Belgian<br />

prof. Tricot <strong>–</strong> Royer at the yearly General<br />

Assembly of the International Society for<br />

the History of Medicine (I.S.H.M.), held in<br />

Paris under the presidency of the<br />

Romanian prof. V. Gomoiu.<br />

Who was the third president of the I.S.H.M.?<br />

How important was that Commission?<br />

Short biography of Prof. Victor<br />

Gomoiu [1, 3]<br />

Victor Gomoiu was born in 1882 in<br />

Vinju Mare (district of Mehenditi) in<br />

1 Univ. Leuven, Univ. Antwerpen (Belgium).<br />

Romania. After ending his secondary<br />

studies at the Lyceum of Turnu Severin, he<br />

enrolled himself at the Faculty of Medicine<br />

in Bucharest, where he finished his<br />

university curriculum in 1906 and obtained<br />

afterwards in 1909 his PHD magna cum<br />

laude. The subject of his thesis was: “The<br />

Anasplasties of face and head.”<br />

Between 1914 and 1942 he took up a<br />

successful surgical career and a lot of new<br />

procedures inherited his eponyme. He also<br />

invested himself within the field of<br />

medico-social assistance programs. He<br />

became Ephore of the public hospitals of<br />

Bucharest in 1920 and 1921 and thereafter<br />

from 1926 on he was appointed as trustee

116<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

of the “Princess Ileana” charitable fund<br />

(“A�ez�mintele A.S.R. Principesa Elena”)<br />

and also he became a relative of the<br />

Romanian Royal Family. After the Second<br />

World War he was blamed for it.<br />

In 1927 Gomoiu founded in a poor<br />

neighbourhood in one of the suburbs of<br />

Bucharest, Bariera Virgului, a hospital<br />

complex, Princess Ileana, on behalf of the<br />

most unprovided patients. Shortly<br />

thereafter this establishment became the<br />

“Children Hospital Victor Gomoiu”, still in<br />

activity nowadays.<br />

Gomoiu obtained plenty of official duties in<br />

the Ministry of Health and became at least<br />

Minister of Health from July to September<br />

1940, but he resigned quickly to not undergo<br />

the military- fascist dictatorship. Between 1940<br />

and 1950 he devoted himself only to his<br />

surgical and medical-historical activities. From<br />

1950 to 1954 he was imprisoned during 60<br />

months by the regime for political purposes.<br />

Nevertheless in 1956 the communist Minister<br />

of Health suggested him to accept a position at<br />

the Center for Health Organization and the<br />

History of Medicine, but he refused this offer<br />

which he viewed as a form of collaboration<br />

[15]. He died in Bucharest in 1960, almost<br />

forgotten by everyone.<br />

Doctor Gomoiu and the History of<br />

Medicine<br />

Already as student Gomoiu disposed of<br />

an important personal library, where as<br />

well medical as philosophical and<br />

historical works were assembled. In 1923<br />

he published a first important medico-<br />

historical book: “The History of Medicine<br />

and of <strong>Medical</strong> Teaching in Romania.” [4].<br />

In 1927 he sent to the French prof.<br />

Laignel-Lavastine, secretary-general of the<br />

very young I.S.H.M. (founded in 1921) the<br />

abstract of a communication he wanted to<br />

represent at the <strong>VI</strong> th congress of this<br />

association in Leiden and Amsterdam:<br />

“The first traces of Physicians in<br />

Romania” [5]. That was his first<br />

connection with the I.S.H.M. In 1929 prof.<br />

Gomoiu founded the Romanian Society for<br />

the History of Medicine under the high<br />

protection of Princess Ileana [6].<br />

Within the I.S.H.M. he shaved more and<br />

more ambition: he became national delegate<br />

of his country in 1928, attended the Congress<br />

of Oslo (1928) and Rome (1930) and<br />

organised his own congress in Bucharest<br />

from the 10 th to the 18 th of September 1932<br />

[8, 18]: a successful manifestation with the<br />

participation of the most famous historians of<br />

that time like e.g. the doctors and the<br />

professors Sigerist, Singer, Diepgen,<br />

Rolleston, Neuburger, Süheyl, De Lint,<br />

Jeanselme, Tricot-Royer, Castiglioni, and<br />

so on. The wife of the congress president,<br />

Mrs. Viorica Gomoiu, acted as general<br />

secretary of it.<br />

In 1933 prof. Gomoiu was elected vicepresident<br />

of the I.S.H.M. and president in<br />

1936, to the deep annoyance of the then<br />

acting Secretary General, prof. Maxime<br />

Laignel-Lavastine, who also competed for<br />

this position, but who statutory could not<br />

obtain it [16, 17]. In this connection<br />

Gomoiu would write in 1939 at the end of<br />

his mandate: “To believe to be hated by<br />

someone you love, is a more unendurable<br />

pain than mourning for his death”. [13].<br />

Laignel-Lavastine resigned and was<br />

replaced by prof. Jules Guiart (7). This one<br />

had particular links with Romania. As<br />

professor of Parasitology and of History of<br />

Medicine at the University of Lyon, he<br />

concluded a special agreement as titular<br />

professor of History of Medicine, of<br />

Pharmacy and of <strong>Medical</strong> Folklore at the<br />

University of Cluj (23), founded in 1919,<br />

and within the professors were chosen by an<br />

University Commission with the representtatives<br />

of the two Romanian universities,<br />

existing at that time: the one of Bucharest<br />

and the other of Iassy. Guiart was teaching at<br />

the medical faculty of Cluj between 1921<br />

and 1930, the year within he was replaced by<br />

his assistant, prof. Valeriu Bologa (1892-

J.-P. TRICOT: Victor Gomoiu and the Cantacuzène-Commission 117<br />

1971), originating from Bra�ov.<br />

Within the I.S.H.M., prof. Gomoiu was<br />

not conspicuous by his sense of diplomacy,<br />

and he took a lot of initiatives without the<br />

approval of his bureau and of his<br />

administrative council.<br />

Prof. Guiart confirmed there were<br />

sometimes troubles within the bureau. He<br />

wrote the following comments (14):: “I<br />

told him (= Gomoiu) firmly that the<br />

President has no rights to make some<br />

propositions without the preliminary<br />

approval of the Bureau. Otherwise he<br />

exposes himself to what happened to him:<br />

his proposals are not voted. He has no<br />

right to owe someone a grudge for it,<br />

because with having the right to vote, we<br />

got the duty to vote, not with the purpose to<br />

please him, but conscientiously! “<br />

The mandate of Gomoiu ended<br />

normally at the beginning of 1940, but, due<br />

to the Second World War, his successor,<br />

prof. Laignel-Lavastine could only begin<br />

his term in 1946, because during the<br />

conflict, all activities of the I.S.H.M. were<br />

interrupted [16].<br />

<strong>Medical</strong> folklore and the congresses<br />

of the I.S.H.M.<br />

The proposal to create a commission<br />

with the purpose to study medical folklore<br />

was formulated by prof. Gomoiu in<br />

September 1935, during the X th<br />

International Congress for the History of<br />

Medicine and has been approved<br />

unanimously. Previously during the <strong>VI</strong>I th<br />

Congress of the I.S.H.M. in Oslo in 1928,<br />

prof. Gomoiu showed his interest for this<br />

aspect of medical history, submitting a<br />

paper entitled: “<strong>Medical</strong> Folklore in<br />

Romania”. On the occasion of the next<br />

congress, the <strong>VI</strong>II th one in Rome in 1930,<br />

prof. Castiglioni from Padua, enumerated<br />

the two sources of medical folklore: the<br />

magical conception common to all<br />

primitive people and the experience [2].<br />

As for him, prof. Gomoiu described the<br />

contribution of medical folklore from an<br />

etymological, historical and medical point<br />

of view [12]. He drew the attention that,<br />

from an ethnological point of view, the<br />

folklore documents his adepts upon the<br />

way, man was feeling or thinking in the<br />

course of ages. It increases the number of<br />

characters which permit establishing<br />

resemblances and differences among the<br />

nations, and so new appreciation <strong>–</strong> criteria<br />

are acquired upon their degree of<br />

superiority and culture. For his part, the<br />

historian, comparing the different kinds of<br />

folklore with each other, can more easily<br />

deduce the relationships between the<br />

nations he is studying and consequently the<br />

moving of their migration. As for the<br />

physician, he often discloses in the popular<br />

practices the germs of the most modern<br />

therapeutics.<br />

On the other hand, very curiously, that<br />

same medical folklore was not hold back<br />

as a theme at the IXth Congress of the<br />

I.S.H.M., organized in Romania in 1932. It<br />

was only a delay, because during the next<br />

congress, the Cantacuzene Commission<br />

was born. The topics of the Bucharest<br />

Congress were: “The Evolution of<br />

Medicine in the Balkanic countries” and<br />

“Defence of Europe against the pest”.<br />

This last theme was the subject of the very<br />

last posthumous publication of prof.<br />

Tricot-Royer [22].<br />

The Cantacuzene Commission<br />

This commission was baptized<br />

“Cantacuzene”, after the name of a famous<br />

Romanian physician, bacteriologist and<br />

professor, Ion Cantacuzino (1863 <strong>–</strong> 1934),<br />

founder of microbiology and of<br />

experimental medicine in Romania. He<br />

was even Minister of Health, Work and<br />

Social Security [9].<br />

Although he has published nearly<br />

nothing about History of Medicine,<br />

Gomoiu proposed him as second president<br />

of the Romanian Society for the History of

118<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

Medicine. In his funeral oration, Gomoiu<br />

will say about him: “Our president,<br />

creator of his own history and also of<br />

others, passed himself into the history”.<br />

In a letter of the 21th of October 1935,<br />

written to prof. Tricot-Royer (10),<br />

founding president of the I.S.H.M., thus a<br />

short time before becoming himself<br />

president of the I.S.H.M., prof. Gomoiu<br />

specified the work to be done by the<br />

members of his commission:<br />

The first question that had to be asked was<br />

how to draw the bibliography of medical<br />

folklore and of folklore generally spoken in<br />

their respective country that means the names<br />

of the authors, their works, the specialized<br />

journals, the institutions, etc. Then the<br />

question of standard forms comes to collect<br />

the folkloristic material, which can be<br />

discussed some months afterwards. Firstly the<br />

names of the pathological entities have to be<br />

discussed as they are designed by the<br />

peasants of the different countries and their<br />

clinical pictures, so that people can conclude<br />

to their synonymy and compare their<br />

treatments. For each country a card of the<br />

territories, where the different denominations<br />

or treatments are used, has to be established.<br />

Prof. Tricot- Royer, nominated as<br />

president of this commission, was the<br />

Belgian delegate, whereas prof. Gomoiu<br />

became the secretary general and delegate<br />

for Romania. The commission included also<br />

Mrs Gomoiu, the doctors Bologa from Cluj,<br />

Laignel-Lavastine from Paris, Giuart from<br />

Lyon, Thaller from Zagreb, Süheyl from<br />

Istambul, and Ali Mihali from Albania.<br />

It is not astonishing that the tandem,<br />

Tricot-Royer <strong>–</strong> Gomoiu, was the most<br />

important pivot of this commission,<br />

because these two scholars have already<br />

published a lot of papers concerning the<br />

medical folklore in their respective<br />

country, and because they respect each<br />

other for many years.<br />

Concerning it, prof. Tricot-Royer had<br />

already made a through inquiry upon<br />

medical folklore in Belgium (21). He made a<br />

distinction, on the one hand between<br />

mystical folklore with the invocation of God,<br />

the Holy Mary or the Saints specialized in<br />

the cure of some illnesses, and on the other<br />

hand empiric folklore in which the Belgian<br />

popular remedies, originating from the fauna,<br />

the flora or of the third kingdom are<br />

described. His research works lead him to<br />

contact all the parish priests of the whole<br />

country, to give him all the useful<br />

information of that purpose.<br />

At the beginning of 1936, Gomoiu<br />

considered the possibility to create either<br />

an International Academy for <strong>Medical</strong><br />

<strong>Sciences</strong>, with a special section devoted to<br />

medical folklore, or an “Academia<br />

Demoiatrica“ (Academy for the study of<br />

the folklore), independent of the I.S.H.M.,<br />

but his projects were never realized.<br />

The Romanian physician distinguished<br />

4 categories of folklore:<br />

1. the original or primitive folklore;<br />

2. the altered original folklore either with<br />

foreign contribution or with borrowing<br />

from scientific medicine;<br />

3. the folklore adapted to the new times;<br />

4. the folklore completely based upon<br />

scientific medicine and practised by<br />

people without any qualification.<br />

Before being presented to the General<br />

Assembly of the I.S.H.M. in 1939, a part<br />

of the report of the Cantacuzene<br />

Commission has been already published<br />

by prof. Tricot-Royer in Brussels:<br />

“The <strong>Medical</strong> Folklore in the Balkan<br />

Area” [20] with a survey of the works of<br />

Prof. Süheyl (Turkey), Gomoiu<br />

(Romania), Stoianoff (Bulgaria), Ali<br />

Mihali (Albania) et Thaller (Yugoslavia).<br />

This last one, prof. Lujo Thaller, would<br />

preside in 1938 the XI th Congress of the<br />

I.S.H.M., the last one before the Second<br />

World War, where two themes were<br />

discussed: “The mystical medical folklore<br />

“and” Flora, Fauna and Minerals in popular<br />

medicine” [16]. During that congress the unti-

J.-P. TRICOT: Victor Gomoiu and the Cantacuzène-Commission 119<br />

ring prof. Gomoiu presented the report of another<br />

commission he set up within the I.S.H.M.,<br />

concerning the teaching of medical history<br />

within the different countries of the world [15].<br />

During 10 years, from 1928 on (<strong>VI</strong>I th<br />

congress of the I.S.H.M. in Norway) until<br />

1938 (XI th congress of the I.S.H.M. in<br />

Yugoslavia), medical folklore played a<br />

preponderant role among the topics dealed<br />

with. Even after the Second World War the<br />

Romanians continued to show their interest<br />

for that subject. In 1970, during the 2<br />

Congress of Bucharest (the 22 of the<br />

I.S.H.M.) presided by prof. Bologa, and with<br />

Dr Manoliu and Dr Br�tescu as general<br />

secretaries, “The scientific value of folklore”<br />

was one of the main topics [16]. In 2009, at<br />

the <strong>VI</strong>I th specific flora of Dacia, throwing a light upon<br />

the medicinal properties of some plants.<br />

On the other way, Gomoiu established<br />

that, ignorant the real cause of illness, people<br />

attribute it to God, to the devil and to other<br />

invisible genies, and the treatment will<br />

include incantation and conjuration tricks.<br />

Besides it, the Romanian people owns a<br />

traditional medicine, deprived of each<br />

supernatural element, constituted on one’s<br />

own found, increased with scientific<br />

contributions. During a: the centuries,<br />

original practices and imported ones<br />

mingled, but these last ones, either of an<br />

empiric or of a scientific nature, were<br />

modified or adapted according to the tastes<br />

Balkanic Congress for the History and the preferences from people adopting<br />

of Medicine, justice was again done to the them. Gomoiu believed that in Romania the<br />

popular Romanian Medicine.<br />

medicine with supernatural involvement and<br />

empirical medicine play an even important<br />

The contribution of Prof. Gomoiu to the part, but in most of the cases, one is being<br />

study of <strong>Medical</strong> Folklore<br />

serving as an assistant to the other. Plenty of<br />

In the beginning, the members of the examples of the prescience of our modern<br />

Cantacuzene Commission proceeded to<br />

make a survey of the folklore material of<br />

medicine were given by Gomoiu.<br />

each respective country. In this paper we Conclusion<br />

limited ourselves to the work of prof. The importance of the Study of <strong>Medical</strong><br />

Gomoiu [12].<br />

Folklore didn’t get past the historians of<br />

During all times, the inhabitants of medicine during the decade before the<br />

Romania were acquainted with a kind of Second World War. The contribution of<br />

medicine, as well empiric as religious. the I.S.H.M., of her third president<br />

Before the arrival of the Romans in Dacia Gomoiu and of her founding president<br />

(actually a region in South-East of Europe, Tricot- Royer is far from being negligible.<br />

on the left bank of the Danube, Prof. Gomoiu can be considered as an<br />

corresponding to the actual Romania), the emblematical and exemplary figure into<br />

inhabitants knew on an empiric way the the study of the History of Medicine,<br />

properties of medicinal plants. About 500 particularly in the study of medical<br />

years before Christ, when he conquested all folklore, as well on a national as on an<br />

these peoples, Darius already observed the<br />

curative properties of many sources in that<br />

international level.<br />

region. The Romans conquered the country References<br />

between 101 and 107, and erected many [1]. Baran D., personal communication,<br />

altars and monuments in honour of 22/06/09<br />

Aesculapios and Hygia. Dioscorides, [2]. Castiglioni A., Le folklore médical,<br />

physician of Greek descent, accompanied quoted by Tricot-Royer J.J., o.c., 1936<br />

those Roman legions, and studied the [3]. Dutescu B., Victor Gomoiu, french

120<br />

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • <strong>Series</strong> <strong>VI</strong><br />

summery, p. 244-258 in: Victor<br />

Gomoiu (258 p.) Ed. <strong>Medical</strong>�,<br />

Bucuresti, 1970<br />

[4]. Gomoiu V., Din istoria medicinii si a<br />

invantamintului medical din<br />

Romania, Bucuresti, 1923<br />

[5]. Gomoiu V., Les premières traces de<br />

médecine en Roumanie, p. 293-295<br />

in: Actes du <strong>VI</strong> Congrès<br />

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23/7/1927), (De Lint J.G., éd.),<br />

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Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009<br />

<strong>Series</strong> 6: <strong>Medical</strong> <strong>Sciences</strong><br />

Supplement <strong>–</strong> Proceeding of The IV th Balkan Congress of History of Medicine<br />




O. MURE�AN 1 , L. SAFTA 1<br />

Abstract:<br />

Several medical doctors turned their hand to writing at some point in their<br />

career, thus embedding their medical knowledge and expertise in valuable<br />

works of fiction. One of the most renowned of these practitioners remains Sir<br />

Arthur Conan Doyle (1859-1930), well-known as the creator of the most<br />

famous fictional detective, Sherlock Holmes. The paper presents aspects of<br />

Conan Doyle’s writings which pertain to his medical background, with a<br />

focus on drugs and poisons featuring in several of his stories.<br />

Key words: medicine and literature, detective fiction, drugs, poisons.<br />

After graduating from the Edinburgh<br />

University in 1881 with degrees of<br />

Bachelor of Medicine and Master of<br />

Surgery, Arthur Conan Doyle practised<br />

medicine for about ten years before giving<br />

up his first occupation to become a fulltime<br />

writer. He turned to medicine again<br />

only during the Boer War in South Africa<br />

where he volunteered as a surgeon. His<br />

public support of the British policy in this<br />

war led to his being knighted in 1902.<br />

Conan Doyle’s experience as a<br />

physician started with two sea voyages as a<br />

ship’s surgeon (to the Arctic on a whaling<br />

boat in 1880 and to the west coast of<br />

Africa in 1881).<br />

After that he practised medicine shortly<br />

in Plymouth and then opened his own<br />

practice in Southsea resort, where he<br />

gained reputation as a good practitioner. In<br />

1885 he was awarded an MD degree by the<br />

University of Edinburgh.<br />

Conan Doyle obtained a diploma in<br />

ophthalmology in Vienna in 1890 and then<br />

opened a practice in London. In the<br />

1 “Iuliu Ha�ieganu” University of Medicine and Pharmacy, Cluj-Napoca<br />

meantime, he also dedicated himself to<br />

writing, an activity he had always felt<br />

drawn to. While in Southsea, he created<br />