proceeding of the ivth balkan congress of history of medicine 2009

BULLETIN OF THETRANSILVANIA UNIVERSITY

OF BRASOV

Vol. 2 (51) – 2009Series VI

Series VI: Medical Sciences

– SUPPLEMENT –

PROCEEDING OF THE IVTH BALKAN CONGRESS OF

HISTORY OF MEDICINE

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TRANSILVANIA UNIVERSITY OF BRAŞOV

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THE IV-TH BALCAN CONGRESS OF HISTORY OF MEDICINE

October 2009 BRAŞOV, ROMANIA

VOL. 2 (51) – SERIES VI ISSN 2065-2224 Special Issue No.1, 2009

Volume 1

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Braşov, Romania 2009

Bulletin of the Transilvania University of Braşov. Series VI: Medical Sciences. Vol. 2 (51), 2009. ISSN 2065-2216 printed version; ISSN 2065-2224 CD-ROM version

continues Bulletin of the Transilvania University of Braşov. Series VI: Medical Sciences. Vol. 1 (50), 2008.

ISSN 2065-2216 printed version; ISSN 2065-2224 CD-ROM version

and Bulletin of the Transilvania University of Braşov. Series B3. Vol. 14 (49), 2007. ISSN 1223-964X printed version. EDITORIAL BOARD Editor in Chief Ion VIŞA, Dr.Eng., Prof.

Co-editors: Elena HELEREA, Dr.Eng., Prof. Anca DUŢĂ, Dr.Eng., Prof. Liliana ROGOZEA, MD, PhD, Prof. Coordinating Editor Series VI Gheorghe COMAN, PhD, Prof. chem. Editorial Assistant: Mihaela BADEA, PhD, Assoc. Prof. chem Nicusor Bagiu, M.D., Assist English Language Supervision Lucian RADU, Lecturer Web-site: http://but.unitbv.ro/BU2009 Address: 29, Eroilor st., 500036, Braşov, Romania Phone: +40-268-410525 E-mail: [email protected] © All rights reserved

SCIENTIFIC COMMITTEE

Assoc. Prof. chem. Mihaela BADEA, Ph.D., Transilvania University of Brasov, Romania Prof. Salem ABDEL-BADEEH, Ph.D., Ain Shams University, Cairo, Egypt Prof. Dr. Doina Paula BALABAN, PhD., Ovidius University of Constanta, Romania Prof. Cristina BORZAN, M.D., Ph.D., UMF Iuliu Haţieganu, Cluj-Napoca, Romania Prof. Sorin BUZINSCHI, M.D., Ph.D., Transilvania University of Brasov, Romania Dr. Daniel CATALAN, European Center for Disease Prevention and Control Prof. chem. Gheorghe COMAN, Ph.D., Transilvania University of Brasov, Romania Prof. Nina Micosa CADIZ, Ph.D., University of the Philippines Los Banos, Philippines Prof Dan Mircea CHETA, MD, Ph.D., UMF Carol Davila, Bucharest, Romania Assoc. Prof. Carmen DOMNARIU, M.D., Ph.D., University Lucian Blaga, Sibiu, Romania Prof. Alin CUCU, M.D., Ph.D., Transilvania University of Brasov, Romania Prof. Dan DUMITRASCU, M.D., Ph.D., UMF Iuliu Hatieganu, Cluj-Napoca, Romania Prof. Leonida GHERASIM, M.D., Ph.D, UMF Carol Davila, Bucharest, Member of Romanian

Academy, Romania Prof. Ove HELLZEN, Ph.D., Faculty of Health Sciences, Norway Prof. Kornelia HELEMBAI, Ph.D., University of Szeged, Hungary Prof. Teodor LEASU, M.D., Ph.D., Transilvania University of Brasov, Member of the World Academy

of Medicine, Romania Prof. Roger Maurice LEBLANC, Ph.D., University of Miami, USA Prof. Peter MANU, Ph.D., Albert Einstein College of Medicine, New York, USA Prof. Jean-Louis MARTY, Ph.D., Universite de Perpignan via Domitia, France Prof. Dan MINEA, M.D., Ph.D., Transilvania University of Brasov, Romania Prof. Aurel MIRONESCU, M.D., Ph.D., Transilvania University of Brasov, Romania Prof. Nicolae MIU, M.D., Ph.D., UMF Iuliu Hatieganu, Cluj-Napoca, Romania Assoc. Prof. Marius MOGA, M.D., Ph.D., Transilvania University of Brasov, Romania Prof. Ioana MOISIL, Ph.D., University Lucian Blaga, Sibiu, Romania Prof. Dimitrie NANU, M.D., Ph.D., UMF Carol Davila, Bucharest, Romania Assoc. Prof. Laurenţiu NEDELCU, M.D., Ph.D., Transilvania University of Brasov, Romania Prof. Dr. Marian NEGUŢ, M.D., Ph.D., UMF Carol Davila, Bucharest, Romania Prof. Codruta NEMET, M.D., Ph.D., Transilvania University of Brasov, Romania Prof. Gilvanda Silva NUNES, Ph.D., Federal University of Maranhao, Brasil Prof. Lazar ONISÂI, M.D., Ph.D., Transilvania University of Brasov, Romania Assoc. Prof. Candan OZTURK, Ph.D., Dokuz Eylul University, Turkey Prof. farm. Honorius POPESCU, Ph.D., UMF Iuliu Haţieganu, Cluj-Napoca, Member of the

“Academie Internationale d’Histoire de la Pharmacie”, Romania Assoc. Prof. Mariusz PUSZCZEWICZ, M.D., Ph.D., Poznan University of Medical Science, Poland Prof. Mariana RADOI., M.D., Ph.D., Transilvania University of Brasov, Romania Assoc. Prof. Patrizia RESTANI, Ph.D., Universita degli Studi di Milano, Italy Prof. Ilia REUBEN, M.D., Ph.D., Ben Gurion University of the Negev, Israel Prof. Liliana ROGOZEA, M.D., Ph.D., Transilvania University of Brasov, Romania Prof. Iosif SAMOTA, M.D., Ph.D., Transilvania University of Brasov, Romania Prof. Erich SORANTIN, M.D., Ph.D., Medical University Graz, Austria Assoc. Prof. Claudia STIHI, Ph.D., Valahia University of Târgovişte, Romania Assoc. Prof. Mihaela IDOMIR, MD., Ph.D., Transilvania University of Brasov, Romania Prof. Caius ZAMORA, MD., Ph.D., UMF Iuliu Haţieganu, Cluj-Napoca

Conference Organizing Committee - Liliana Rogozea - Nicolae Marcu - Mariana Rădoi - Teodor Leaşu, - Gabriel Moraru, - Botezatu Maria - Curesciuc Cerasela - Manolachescu Doina - Dorina Popa - Leaşu Florin, - Corina Derczeni, - Adrian Rotaru, - Geta Miron, - Nemet Codruţa, - Mihai Ţurcanu,

- Pascu Alina, - Miclăuş Roxana, - Gabriela Sechel - Andreea Fleancu - Adela Bădău, - Gabriela Mailat, - Mioara Georgescu, - Bălescu Alexandru, - Sanda Hondor, - Ana Ionescu, - Crisitina Egri, - Tatiana Oglindă, - Mihaela Cardiş, - Godri Dora

Scientific Conference Committee: - Philippe Albou - (France) - Miladin Apostolov (Bulgaria) - Dana Baran (Romania) - Gheorghe Bratescu - (Romania) - Victoria Burtea - (Romania) - Nicolae Constantin -(Romania) - Aysegül Demirhan Erdemir (Turkey) - Athanassios Diamandopoulos (Greece) - Daniela Ion (Romania) - Cristina Ionescu (Romania) - Teodor Leasu (Romania) - Elena Helerea (Romania) - Nicolae Marcu (Romania) - Emeritus Spyros G. Marketos(Greece) - Ioana Moisil (Romania) - Codruta Nemet (Romania) - Manu Peter (USA) - Honorius Popescu (Romania) - Liliana Rogozea (Romania) - Mariana Radoi (Romania) - Alfredo Musajo Somma (Italy) - Carlos Viesca-Trevino (Mexico) - Jean-Pierre Tricot (Belgium) - Giorgio Zanchin (Italy)

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 Series 6: Medical Sciences Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

LAWS ON MEDICAL ETHICS IN TURKEY FROM THE PAST TO NOWADAYS AND

COMMENTS

Ay�egül Demirhan ERDEMIR1

Abstract: The responsibility of the physician is also an important theme of the history of Turkish medical ethics. Turks believed in a polytheistic religion, namely Shamanism, before Islam. This religion is a religion with regard to nature. Ottoman physicians were educated in the form of master-apprentice. The responsibility of the physician was examined both by the Islamic Penal Code and by Ottoman Lawbooks in the Ottoman period. Some interesting characteristics were found in some medical manuscripts and some documents in the period of the Ottoman Turks. Afterwards, the responsibility of the physician showed a modern characteristic and some modern laws came into force. An education in the type of medrese (an Islamic High School) was seen in the Islamic World in the Middle Ages. A Medrese was a kind of high school, and this foundation was also seen in the field of medicine. The persons who graduated from medreses got their diplomas in the name of educator in the period of Otoman Turks. The period of high school began with the foundation of Tıphane and Cerrahhane-i Amire (Medical and Surgical School) in 1827. So, some modern laws were passed about the responsibility of the physician. So, today, a physician is responsible in all the medical practices according to Turkish Criminal Law, The Turkish Obligation Law, Turkish Civilian Law, Medicine and Its Branches’ Law, Turkish Medical Ethics Regulation, Health Protection Law, Turkish Medical Association. The Agreement on Patients Rights with the date of 1998 contains the subjects such as justice, the choosing of of foundation of health, informed consent, fidelity, confidentiality, privacy, veracity, the refuse of the treatment, the suing of the patient. In this paper, we will comment about laws on Medical Ethics in Turkey from the past to nowadays. Key words: law, history of medicine, malpractice

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

1. Introduction In the world of Turks, remarkable

developments have always taken place in terms of physician responsibilities and duties and there are many archive materials on it. This study gives examples from such materials and makes some comments.

2. Historical context

Before Islam, Turks followed

Shamanism, which was a polytheist totemic religion of nature. In it, the sky, sun, moon, stars, earth and animals were all holy beings believed to have spirits and angels in them and Turks kept a deep kind of mysticism in their souls.

Ottoman physicians held onto Islamic traditions too. For long years, medical training was given by masters to medical students. Therefore, the loopholes

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • Series VI

6

in the Islamic law were tried to be closed and an alternative code of laws based on local traditions was developed. The statutes like those of Fatih Sultan Mehmed, Kanuni Sultan Süleyman and Mehmed IV closed some of the loopholes in the Islamic penal law. The sanctions on physicians were imposed by the edicts of the sultans and mandates of the head physicians until the 19th century. In all the decisions taken during that period, the emphasis was on the fact that physicians could not be held responsible for any medical situation unless the consent of patients was obtained.

3. Aspects of medical ethics in XVIth

Century The Ottoman Turkish physicians

of the 16th century kept dealing with physician responsibilities in their books. In a document dated 1573, it is mentioned that the head physician Garaseddinzâde Muhiddin wants to prevent ignorant people from practicing medicine and those who want to do it need to take examinations to be awarded a diploma. A document from the Religious Court Records of the city of Ayıntap (Gaziantep) is dated 1540 and it talks about the removal of stones clogging up the urinary system. For such operations, the permission of patients and the religious court was needed and surgeons were paid a certain amount of money. Physicians could be sued when patients who gave their consent died during or after operations.

4. Aspects of medical ethics in XVII-

XVIIIth Century In the 17th century, physicians and

surgeons having informal training from masters were allowed to practice medicine only after taking some examinations and proving that they have perfected their crafts. This was the same in the 18th century and the offices and consulting rooms of the unauthorized physicians were

all closed. Some medical manuscripts dated the 18th century and the Ottoman Archives of the Prime Ministry talk about physician responsibilities. In his “Ra’is al Cerrahin” written in 1720, Cerrah Mes’ud Efendi reports that good physicians are compassionate, good-humored and kind people who do their best to help other people. In 1704 when Ahmed III was the sultan and Nuh bin Abdülmennan the head physician, the decision was taken that ignorant and unqualified physicians were to be prohibited from practicing the profession. In a judgment dated 1729, it is written that medical practice was to be learned from master physicians in an informal training process and a diploma given after passing some particular examinations was needed to become a physician. 5. Aspects of medical ethics in XIXth

Century Some documents dated the early

19th century give information about the understanding of physician responsibilities. A Prime Ministry Archives material dated 1848 reports that the head physicians and physicians of Ayıntab (Gaziantep), Birecik and Haleb hospitals were all dismissed from their posts because of unacceptable behavior. A document dated 1849 is about some new regulations designed to impose that physicians should treat poor patients for free.

Another one dated 1890 is about the investigation launched into the wrong treatment given by Cerrah Malik Efendi at Gümü�suyu Hospital. In the Ottoman Empire, patients’ consent was obtained before giving any treatment. It is written in a document dated 1899 that some of the wounded soldiers at Yıldız Hospital were to be operated on after obtaining their written consent.

Before the foundation of the Republic, the Islamic Penal Law was in

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

7

force about abortion. A document dated 1788 is a written copy of a final court decision and aims to inform the provinces that the physicians and pharmacists in Istanbul were prohibited from prescribing for abortion. There are also some 19th century documents about abortion. One of them dated 1826 talks about a midwife known as “the bloody midwife” to be punished for prescribing abortive drugs. Another document dated 1828 says that women should never be prescribed abortive drugs. A document dated 1838 is about the announcement of the decision which banned abortion. The 193rd article of the Imperial Penal Law dated 1857 says that people who cause or help abortion are to be sentenced to imprisonment between 6 months and 2 years. The Ottoman Archives of the Prime Ministry show that there were also some physicians who wrote misleading reports. A document dated 1900 says that the Mayor Adbullahim Efendi, who was a lecturer in the Mekteb-i Fünun Medical School then, wrote a misleading report.

As it is the way today, the physicians of those times had to be careful about what they wrote in their reports of any type and abide by all the medical ethics rules. They always tried to adhere to the principles of privacy, loyalty, honesty and not harming patients.

Afterwards, the responsibility of the physician showed a modern characteristic and some modern laws came into force. Penal Code and Civil Law had some articles about this theme.

The medical education in Turkey showed three periods. These are the periods of medrese, high school and faculty. The period of high school began with the foundation of Tıphane and Cerrahhane-i Amire (Medical and Surgical School) on the 14th March, 1827, and it continued until the foundation of Mekteb-i Tıbbiye-i Adliye-i �ahane in Galatasaray

in 1838, and then the period of faculty began. So, some modern laws were passed about the responsibility of the physician. For example Karantina Talimatnamesi (Quarantine Agreement) in 1838, Tababet-i Belediye Nizamnamesi (Agreement of Medicine of Municipality) in 1861 mentioned the responsibility of physicians. Articles 192 and 193 of Ceza Kanunname-i Humayunu (Penal Law) in 1857 mentioned the punishments for abortion. Article 215 of this code had the responsibilities about the revealing of medical secrets .Moreover, according article 182, if a patient died because of his physician’s negligence that was punished. 6. Aspects of medical ethics in XXth

Century Today, if a doctor causes death of a

patient because of a technical mistake he is punished with prison sentence according to the article 456 of the Turkish Penal Code.

The Agreement of Patient’s Rights with the date of 1998, 1 August and with the number of 23420 contains the subjects such as justice, the choosing of of founda-tion of health, informed consent, fidelity, confidentiality, privacy, veracity, the refu-se of the treatment, the suing of the patient.

Moreover, Turkish Law of Patients’ Rights, the informed consent of persons is necessary in all of the medical practices.

The law about population planning dated 1965 and numbered 557 was chan-ged. It was issued on 12.06.1967 a popula-tion planning regulation and a bylaw about pregnancy termination and sterilization. The law about population planning dated 1983 and numbered 2827 is a modernized version of the law issued in 1965.

According to the Turkish Law of Family Planning with the date of 1983, curettage can be applied up to the 10th week with the desire of woman. Birth control drugs and apparatus can be used with the prescription of physician.


8

As there was not an administrative law concerning organ transplantation in Turkey before 1979, many operations were not possible to perform and physicians did not have much to do to save lives. The law numbered 2238 and dated 29.5.1979 on transplanting and keeping organs and tissues allowed the operations and relieved physicians of many hesitations.

If a person allows it in his will orally and/or verbally, organ trans-plantation can be made from his body after he dies. Even if this is not mentioned in the will, the law suggests that the closest relatives can permit transplantation from the dead body.

According to the 14th article of the law, an organ of a person who dies with enormous damages in an accident or natural disaster can be given to an urgently needing patient not considering the will or consent in any way. 7. Conclusion

Moreover, some agreement drafts are present in Turkey. One of them is Rules on Ethics of Medical Profession. It was accepted by Turkish Medical Association. Another law is malpractice law. In near future, it will be passed.

BIBLIOGRAPHY

1) Ceza Kanunname-� Hümayunu (Penal Code). �stanbul: Takvimhane-i Amire Mat; 1857.

2) Ceza Kanunname-i Hümâyunu (Penal Law): Takvimhane-i Âmire Matbaası, �stanbul, 1857, pp.45

3) Hasta Hakları Yönetmeli�i (Patient’s Rights Regulation), Resmi Gazete, No.23420, 1998, p.67.

4) Kahya, E., Demirhan, E. A.: Medical Studies and Institutions in the Ottoman Empire, Ankara, 2008.

5) Nüfus Planlaması Hakkında Kanun

(Family Planning Code): 2827. Date: 25.5.1983 Resmi Gazete No: 18059 (27.5.1983).

6) Ottoman Archives Cevdet, Sıhhiye Book. Date: 1729

7) Ottoman Archives, A.MKT.MHM. Dosya No: 50 Gömlek No: 42, Date 1853.

8) Ottoman Archives, Cevdet, Sıhhiye No: 1026, Date: 1788.

9) Ottoman Archives, Cevdet, Sıhhiye No: 1790, Date: 1838.

10) Ottoman Archives, Sadaret Evrakı Mektubi Mühimme Dosya No: 9, Gömlek: 63, Date:1849 .

11) Ottoman Archives, Y.PRK.ASK. Dosya No: 240 Gömlek no: 40, Date: 1909.

12) Ottoman Archives, Y.PRK.SH. Dosya No: 68 Gömlek No: 68, Date Date: 1891.

13) Ottoman Archives, Y.PRK.SH. Dosya No: 7 Gömlek No: 13, 1900.

14) Ottoman Archives. Cevdet, Sıhhiye Book, No.1128, Date: 1848.

15) Ottoman Archives: Cevdet, Sıhhiye Defteri, No.566, Date :1828

16) Resmi Gazete: No. 16655, 3.6.1979, Organ ve Doku Saklanması ve Nakli Hakkında Kanun (Organ and Tissue Transplantation Law): No. 2238, 29.5.1979.

17) Sehsuvaroglu B. N., Demirhan A., Güre�sever G., Türk Tıp Tarihi (History of Turkish Medicine). Bursa: Ta� Kitabevi; 1984.

18) Tıbbi Deontoloji Tüzü�ü (Agreement of Turkish Medical Deontology with the Date of 1960) No: 4/12578, Jan 3, 1960.

19) Türk Ceza Kanunu (Turkish Penal Code). No: 5237, Date: 26.09.2004.

20) Ucok, C., Osmanlı Kanunnamelerinde �slam Ceza Kanununa Aykırı Hükümler, Ottoman Law Books, A.Ü. Hukuk Fak. Mec., 1946; 3: 124-46.


HISTORIC HIGHLIGHTS AND PERSPECTIVES OF BIOETHICS IN

ROMANIA

C. BOGDAN1

Abstract: The date of birth of bioethics in the world is the early 70s, when it was realized that medical ethics remained predominantly centered on physician-patient relationship and it covers no more the progress of scientific research in biology and medicine and their applications in genetics, reproductive medicine, transplant or end of life issues, bio-technology. Even if preoccupation about bioethics exist before 1989, until after this year it was possible to establish some governmental and non-governmental organization with experts in this field: doctors, researchers, lawyers, theologians. The first organization was the Committee of Bioethics attached to the Medical Sciences Academy, which has appeared as initiative of acad. St. M. Milcu and prof. dr. Constantin Maximilian, joined later by dr.Constantin Bogdan, dr. Sebastian Nicolau, dr. G. Litarczek and others. The echo of this committee inspired medical students, who develop “Student Society in Bioethics - Constantin Maximilian”, with an intense activity over a decade; the original animators of this group are Consuela Georgescu and Gabriel Raicu. With the death of the founders, the Academy Commission’s work was stopped and remain, only for a short time, a Bioethics Committee in addition of Forensic Institute lead by prof. Vl. Beli�. By tradition, bioethics remained linked with Forensic Medicine and History of Medicine. In the early 2000s it was set up the Romanian National Committee of Bioethics in addition to the Romanian National Commission for UNESCO. In the same period, in Iasi was developed a group of Bioethics with intense activity (including publishing a journal), animated by prof. dr. Vasile Astarastoae. Finally, appear bioethics committees in educational and research institutions, and in clinical hospitals. Key words: bioethics, Romania, historical landmarks.

1 Bucharest University

Bioethics is a relatively young disci-pline and science, its act of birth dating from 4 decades ago, at the same time with the launch of its concept and name by American biochemist dr. Van Renssalaer Potter at the beginning of the 70s. [2]

Bioethics was born out of ethics, has

focused on biologics and has gradually developed and diversified, along with the scientific advancement in bio-medicine research and biotechnologies and their applications’ development.

In Romania, even if there were some physicians, researchers and lawyers’


10

opinions regarding bioethics before the 1989’s political changes, only after that date there were possible open debates, the set up of a movement, the appearance of governmental and non-governmental bodies, as a result of gaining the right to free speech and express thoughts, right to be informed, freedom of association [4].

Regarding the historic of bioethics, concerns can be identified even since Antiquity, that are to be found in the religious concepts, philosophical necessity, regulations and laws during time, medical practice codes. Towards the end of 19th Century some attends to conceptualize a kind of bioethics were made, but bioethics, in its actual modern meaning is a recent concept, as I mentioned before, established in the second half of the last century, together with genetics and especially biotechnologies further developments, the term being introduced by dr. Van Renssalaer Potter in the paper “Bioethics: Bridge to the Future” (1971). [2]

There are several definitions, the filed being complex and in full extension, imposed by new scientific developments, moral’s adjusted answers and the right to the “cascading” challenges of science and research developments.

One of the said definitions considers bioethics which, based on using an interdisciplinary methodology, has as object the systemic exam of human behaviour in the field of life sciences and health, analyzed in the light of moral’s values and principles.

Other more concise definition, but complete at the same time, was introduced by dr. Constantin Maximilian, the great geneticist and one of the pioneers of the revival of bioethics in Romania after 1990, in its modern, international concept: “bioethics is the meeting point of all who follow human destiny subject to science pressure”. [4]

UNESCO’s General Director considers

that the scope of bioethics is to frame the scientific and technological progress in a ethic reflection that is having the roots in the cultural, juridical, philosophical and religious background of diverse human communities.

From other perspective, bioethics, beyond life and death and existential limits of human life, provide answers to any of science and technique’s real challenges under the form of new developments. [3].

Bioethics is seen by other specialists and as the moral’s answer to the reality of a science that evolves quicker than the human being as regards its capacity of understanding, reaction and adaptation.

Bioethics becomes a source of law that is no more than a minimum of moral.

Bioethics is the reconsideration of classic (medical) ethics beyond a strictly medical perimeter which remains however prevailing.

As a conclusions of enumeration diverse definitions, we consider that a more comprehensive delimitation, more adjusted to its actual dimensions and mission, suggested also by its name “bioethics” could take into account the term of “ethics of life”, because nowadays bioethics covers not only health field but also the overall aspects of life, based on principles such as respect of life, auto-determination, universality, equality, justice and equity, utilitarianism, fact that indicates its extension in social and political areas – inter-human relationships, non-discrimination, relation with environ-mental, nature, the need for building up of a bridge balance between the progress of science and human rights; in other words, all the developments of science must be directed only for the common good of humanity. The great thinker and moralist Montaigne properly stated: “science without conscience is the ruin of soul” and physician and humanist Albert Schweitzer drew the attention on the fact the science’s

C. BOGDAN.: Historic highlights and perspectives of Bioethics in Romania 11

successes have not always had as a result the happiness of mankind.

Therefore, along with the 1990 change of politic regime and afterwards through our country’s accession to European structures (Council of Europe, European Union), bioethics, together with other left behind fields, wished to recover in the shortest possible period of time, all the existing gaps between us and “free” and developed countries.

The first 4-5 years after 1990 had been necessary for the organisation, gathering of information regarding other countries’ related experience, debates, collecting of related data and comments, the adjusted implementation of international specialised institutions’ recommendations launched during diverse discussions forums.

A first institutional structure that appeared soon after 1990 was Romanian Commission for Bioethics (Comisia de Bioetic� a României), affiliated to Academy of Medical Sciences; this “parrainage” had two reasons: on one hand the high patronage of a official and prestigious institution with authority in bio-medicine and research was needed in order to affirm itself and be known, and, on the other hand, the initiative came from two distinguished figures of medicine and medical scientific research – academician dr. �tefan-Marius Milcu, professor of Endocrinology and academician dr. Constantin Maximilian, professor of Medical Genetics, signer of The Oviedo Convention for Human Rights and Bio-medicine in April 4, 1997. I personally had the great honour of being invited to take part in the Commission, being entrusted, based on my expertise and previous research, the following issues: ethical and social responsibility in health, end of life’s bioethics aspects, protection of vulnerable persons’ rights and dignity. [4]

This first bioethics institution was the predecessor of the current Romanian

National Committee for Bioethics (Comitet Na�ional Român de Bioetic�), that was affiliated, based on the same above-mentioned reasons, to Romania’s National Commission for UNESCO (“Comisia Na�ional� pentru UNESCO a României”). Moreover, the major involvement of UNESCO in bioethics, beginning with the ‘90s, bioethics being constantly included in its agenda, with two subordinated specialised entities and an ample program of activities, i.e. International Committe for Bioethics (Comitetul International pentru Bioetica - CIB) and Inter-governmental Committee for Bioethics (Comitetul Interguvernamental pentru Bioetica - CIGB). [3]

It’s worth mentioning here that these patronages did not affect in any way the independent character of the committee, on the contrary they increased its power and efficiency; our relationship with CIB and CIGB was a privileged one and a very stimulating one for the activities of the committee.

Also, we would like to mention that the initiative for the creation of a organised movement in bioethics belonged to physicians!

If bioethics means also control, monitoring and arbitrage- a judge of the evolution of science and practice in biomedicine - then this control started from inside; in general, in other countries, the lawyers, to which in some cases the theologians rallied too, had been the ones that initiated movements and associations, attracting also obviously physicians and researchers.

However, we should state also that neither a confiscation nor a domination of bioethics by physicians does not constitute a benefit for the further development of bioethics, due to the risk of a lack of an objective approach from outside of it and also due to the risk of an attempt to defend certain practice of minimize the effects.


12

Therefore, through the decision of setting up these institutions, currently active in our country, a multi-disciplinary component was intended - bioethics experts, researchers, physicians, biologists, lawyers, theologians, philosophers, psy-chologists and sociologists and an active model of horizontal co-operation between all the other bioethics’ formations.

Although, other important thing, with a negative impact, that must be specified is the relatively reduced interest of some indispensable specialists category – the lawyers – most of them being focused on other more interesting and profitable areas – as a consequence of the previous politic regime when justice was controlled by the state, the law domain being therefore guided and poorly remunerated; other explanations are the absence of bioethics from the universities’ programs of study and from the postgraduate specialization and, also, the lack of specializations in bio-law or medical law. We have managed to partially rectify this shortcoming by attracting within a partnership specialists from Romanian Institute for Human Rights (Institutul Român pentru Drepturile Omului); we are benefiting also from the expertise of physicians that graduated also law universities. The involvement of theologians is also very important – we mention here The Commission for Bioethics of the Patriarchate – then it’s worth mentioning the professors of bioethics within Orthodox and Catholic Theological Institutes and also the presence of theologians within other important commissions.

Other bioethics entities currently active in Romania besides Romanian National Committee are the following:

- Commission for bioethics of Ministry of Public Health (Comisia de Bioetic� a Ministerului S�n�t��ii Publice) whose members are appointed by the ministry, commission with an advisory role;

- Committee for Bioethics of the National College of Physicians (Comitetul pentru Bioetica al Colegiului Na�ional al Medicilor), whose members are appointed by the College’s National Council and that has an advisory role especially regarding the changes in the Etichs Code related to the developments recorded in the medical bioethics field.

- National Committee for clinical study on human subjects (Comitetul Na�ional pentru studiu clinic pe subiec�i umani) affiliated to the Medical Sciences Acade-my, that works together with the National Agency for Medication (Agen�ia Na�ional� pentru Medicament), the latter being the main institution involved in the regulation and control of the activity related to medication and clinical studies on human subjects.

- Commission for Bioethics of the Patriarchate (Comitetul de Bioetic� al Patriarhiei), religious body that expresses its own position and participates in bioethics related debates. [1]

There was also a honest initiative of medicine students materialised in mid ’90s in a body active for a few years, that developed a prestigious program of education and multiple other events: Medicine Students’ Group for Bioethics – “Constantin Maximilian” (Grupul de Bioetic� al studen�ilor în medicin� ”Constantin Maximilian”).

Other notable achievement is the outstanding activity of Iasi Group (“Grupului de la Ia�i”) conducted by Prof. dr. Vasile Ast�r�stoaie, that publishes Romanian Bioethics Magazine (“Revista Român� de Bioetic�”) under the aegis of Commission for Bioethics of Romanian National College of Physicians (Comisiei de Bioetic� a Colegiului Medicilor din România), prestigious magazine well-known both locally and worldwide and also internationally classified and authorised, that publishes in each issue

C. BOGDAN.: Historic highlights and perspectives of Bioethics in Romania 13

articles written by renowned bioethicians. Finnaly, there are the committees for

bioethics (ethics) within National Authority for scientific research (Autori-t��ii Na�ionale pentru cercetarea �tiin�i-fic�), Ministry of Education (Ministerului Înv��mântului �i Educa�iei), Universities (Universit��i). [5] Lately, the creation of many committees for ethics within academic centres and research institutions can be noticed, this fact being stimulated by the progressive introduction of bioethics courses in the university curricula or by the requests regarding research in general and on human subjects especially. Perhaps, as a particularity, can be considered also the absence of National Committee affiliated do the Parliament or Presidential Administration, entity that can centralise all the reflections and comments from other independent bodies (advises, expertises, recommendations, consulta-tions) and would assure a more prompt materialisation of legislative initiatives.

The debates and approaches at the high level of this two authorities - Parliament and Presidential Administration – have not fulfilled yet the needs in this field with the exception of the approval and change of important laws referring to bioethics aspects such as: research of human embryos, assisted pro-creation, transplant of organ and tissue, this being done due to alignment requirements, more or less adjusted, to models existing in other coun-tries or as a result of acquiring interna-tional institutions’ recommendations.

There is not a Bioethics law in Romania yet.

The first activities of The Romanian National Committee for Bioethics that were considered as a priority for our country were the ones in the field of raising awareness and education. As a result, an Appeal entitled CONCERN (“ÎNGRIJORARE”) that drew attention in its ten points on the elimination of the risks

related to the detriment of human rights, dignity and integrity as a result of the implementation of scientific research’s conclusions, and on the need for wide knowledge of the bioethics principles – not only by specialists, young researchers but also by the general public. [3]

An extensive program of Bioethics Education was elaborated, distributed and implemented, program that is a permanent one.

Romania is currently going through the process of alignment to the European regulations regarding Ethics in Research and Science.

For the time being, there are regulations adopted for the most important and up-to-date aspects in this field: [1]

- general rules and regulations that constitute the framework for the development of specific legislation;

- provisions in the Constitution of Romania (art. 11, International law and internal law chapter) based on which the Romanian State undertakes to respect the obligations assumed within international treaties and regulations, in the case that Romania does not have in place (or does not have yet in place) its own regulations. (“art 11 – Constitution of Romania: [3] – Romanian State undertakes to fully and in good faith comply with the obligations incumbent from all the treaties signed. [5] – The treaties ratified by the Parliament, in accordance with the law, are part of the internal right”.

- there are laws in preparation, being currently under parliament procedure and having to be promulgated in the next period (e.g.: the law regarding the animal protection against being used for research or other purposes, the law regarding the protection of the wildlife etc.)

One of the important laws ratified by Romania is: The law no. 17 from 2007 regarding the ratification of European Convention for the Protection of Human


14

Rights and Dignity of the Human Being with regards to Application of Biology and Medicine, the Convention regarding Human Rights and Biomedicine signed at Oviedo on April 4, 1997, the additional Protocol to Convention for the Protection of Human Rights and Dignity of the Human Being with regards to Application of Biology and Medicine signed in Paris on January 12, 1998, referring to the interdiction of human being cloning.

The European Convention, the Convention regarding Human Rights and Biomedicine and the additional Protocol to the European Convention were submitted for ratification to Romanian Parliament by Ordinance no. 324 dated October 4, 1999.

This law covers: Fair access to health care, Consent, Protection of persons suffering from mental disorders, Private life and right to be informed; Human genome: Non-discrimination, Predictive genetic tests, choosing of sex; Scientific research: protection of persons that are subject to research, protection of persons that are not in the capacity to give their consent for the research; in vitro embryo research, prelevation of organ and tissue from alive persons for the purpose of transplantation; interdiction of financial gain and use of a part of the human body.

Finally, a enumeration of the main challenges that bioethics must answer today, is shaping also the concern and approach perspectives of Romanian bioethics, without forgetting that bioethics is aiming to maximize the benefits of the scientific acquisitions and to minimize the negative effects:

- discrimination and genetic

manipulation, use of embryo in research and experiments, research on human subjects, reproductive cloning, transplant of organ and tissue, commercialization trends within this field, pre-set of the sex of the future fetus, protection of vulnerable persons, defending the biodiversity, monitoring of genetic modified organisms, fair distribution of research’s benefits, euthanasia, assisted suicide etc. [4]

Reference:

[1]. Bogdan C., Ursu �.: Bioetica în activit��ile UNESCO, în vol. ”Educa�ia în Bioetic� �i Drepturile Omului în România” editat de Comisia Na�ional� a României pentru UNESCO, Bucure�ti 2006

[2]. Bogdan C.: Probleme actuale ale bioeticii – în “Maramure�ul Medical” nr. 5, 17 septembrie 2004

[3]. Nicolau S.: Nevoia de bioetic�. Începuturile înv��mântului universitar de bioetic�, în volumul: ”Educa�ia în Bioetic� �i Drepturile Omului în România” editat de Comisia Na�ional� a României pentru UNESCO, Bucure�ti 2006

[4]. Raicu G.: Legisla�ia Na�ional� în domeniul eticii în cercetare în România, în vol.: ”Educa�ia în Bioetic� �i Drepturile Omului în România” editat de Comisia Na�ional� a României pentru UNESCO, Bucure�ti 2006

[5]. *** Institutul Român pentru Drepturile Omului: Bioetica – Mijloace �i c�i de ac�iune, Bucure�ti 2004


THREE PERSONALITIES OF MEDICINE – REPRESENTATIVE FOR MEDICAL

ETHICS WITHIN ROMANIA

L. ROGOZEA1, F. LEA�U1, L. NEDELCU1, A. B�LESCU1,

C. NEMET1, N. MARCU2

Abstract: Kernbach, Nicolae Minovici and I. St�nescu are three outstanding personalities of medicine, famous not only for their research, but also for their involvement in developing medical ethics. If Kernbach substantiated a few notions about medical responsibility in 1935, Nicolae Minovici, one of the most important forensic doctors of his time, is also known for his important research in the deontology field, illustrated by his two written works: “Professional Secret” and “Ethics of Medical Responsibility”, worked out in collaboration with I. St�nescu. We have recognized nowadays that medical ethics of our century must be approached and dealt with from historical perspective; the acquaintance with the predecessors’ point of view is a favorable element in the restoration process upon medical ethics in the current context of medical development

Key words: M. Kernbach, N. Minovici, I. St�nescu medical ethics.

1 Faculty of Medicine, Transilvania University, Brasov

2 UMF Carol Davilla, Bucharest

1. Introduction Ever since the period of Hammurabi’s

Babylon or Hypocrites’ Greece so far, medical ethics has stood for the system of moral and social laws that marked professional activity so that it should comply with the highest standards of society.

In this context, the medical ethics of the 20th century must likewise be considered from the historical perspective; therefore the acquaintance with our predecessors’ standpoints will constitute a favorable element in the process of restoring medical ethics in the framework of the medical progress.

The fear of “public opinion”, the fear lest we should be considered nostalgic

has brought about that an ever-diminishing number of physicians cope with the theoretical aspects of medical ethics.

Within this very context there inscribes the tendency manifested by the leaders of Romanian medical education, to neglect the importance of medical ethics, as well as the emphasis we should lay on those materials which contribute to modeling the moral and spiritual profile of the future professionals within the medical staff. We make reference at this point to the history of medicine, to medical sociology, to medical anthropology or to medical psychology.

We should not overlook that “The physician, through a happy dignity of his


16

fate is likewise followed and obeyed outside his battlefield” (Ozun, Poenaru).

Therefore, bearing in mind and bringing to memory the example offered by some forerunners is not only a duty incumbent on us, but also a necessary step for rekindling ethical and moral values in the attention of both medical staff and general audience.

Noteworthy personalities of the Romanian medical world have been preoccupied with emphasizing the physician’s role, with positively assessing and appraising the particularities of the medical act, of the responsibility incumbent on the medical professionals, with the high moral standards applied by society to these professionals.

2. Historical background.

Since Antiquity so far, medical science has greatly evolved, however a series of ethical percepts have kept their authenticity.

There is worth reminding at this point the muniment (charter) issued by Scarlat Calimachi in 1813, in his quality of waiwode of Moldavia, muniment that points out the obligations of the doctors of those times.

“At any time, by night or in daytime, either called for by the boyars, or by the clergy or by the poorest and foreigner, no one should dare allege encumbering tasks or delay their medical examination for the following day, thereby therefore people’s life; who, either by carriage, or on foot, should run themselves out of breath towards the suffering ones.”

The text emphasizes the fact that these doctors must provide medical assistance indiscriminately, whatsoever the patient’s material status or nationality; furthermore, the same text specifies that medical assistance can only be provided in case of illness; otherwise the patient being excluded from the

medical corpus. We should not forget that this

legislative act, regulating the person’s right to medical assistance and the physician’s duty to perform his duty, is dated in the 19th century.

That very century, however after approximately 50 years, the great reformer of medical assistance in Romania, physician Carol Davila put forth in writing: “The physician of the circumscription, beside his medical appointment, also performs a moral, foreseeing mission.”

V. Gomoiu – “Within medical profession, nothing can be mechanical, reflex, this is the profession compelling to a permanent strain of consciousness, as our profession directly addresses human being, his life and health.

3. Kernbach

Great personality of Romanian forensic medicine Mihai Kernbach studies at Berlin, Graz, Lyon and Zürich and work in Cluj where he through all steps of the academics hierarchy up to professor. After Cluj period he became doctor at Iasi University, where he taught forensic medicine.

Mihail Kernbach it was not only a distinguished educator but also a important researcher. He publish more than 250 scientific paper, including article, books.

In 1935, Kernbach substantiated a few notions in connection with medical responsibility: “No social group can avail from immunity. We have long overcome the epoch of the privileged classes upon the law”; however, not supporting the thesis of medical irresponsibility, Kernbach stated: “The tendency of the doctrine, within our days, is incontestably towards raising the physician’s responsibility, so that he should be brought to account for the slightest error, as soon as it may be framed within a text of law.”

L. ROGOZEA, et all, Three personalities of medicine – representative for medical ethics within Romania

17

4. Nicolae Minovici and I. St�nescu In this context, we deem of usefulness

to submit and analyze two works drawn up by the physicians Nicolae Minovici, I. St�nescu: “Professional Secret”, issued in the Bulletin of the College of Physicians, during 1938, and “Ethics of Medical Responsibility”, issued an year later, during 1939.

In these two articles, the noteworthy physicians prove themselves to be valuable historians of ethics, who managed to achieve a tour of ethics history on worldwide level and throughout our country.

Physicians of outstanding value, they likewise became conspicuous as ethics theoreticians of great value, given the proof of this statement: “As practicing physicians, we do not only cure the disease, but the individuals suffering from such or such illness; whatsoever the conscientiousness we would apply in repairing the motor propelling human life, it is almost utterly excluded to neglect a mere single piece within this system, whose perfect knowledge is only held by the one who created human being.”

They also deemed that “the physician has to continuously update his medical knowledge; he must not mistake his university diploma for a license patent, which might occupy him for his personal benefit and not for collective interests.”

The obligation to comply in due time with any patient’s request is enforced, bringing forth to memory the fact that ever since 1813, Scarlat Calimachi stated: „The doctors and the midwives should be under obligation to get out of breath with running when called for not only by the boyars (only these ones were able to render themselves cured by doctors!) but also by the poor and by the wretched, as the word of Bible urges them to, which compels them to: „when

being summoned and called for at any time, by night or during daytime, no one should dare to allege encumbering duties as pretext, or to delay the medical exami-nation for the following day, therefore endangering people’s lives, otherwise, unless justified by well grounded reason of “bodily powerlessness”, any of the doctors will be cast out of the healers’ corporate body and his wages will be blasted and ultimately will count to nothing”.

The main preoccupation consists in the professional secrecy, which he deems an enigma so great and so ancient, as this ever-rising edifice which, through social consciousness, constitutes “human soul”, “collective mentality”, as a “nervus rarum of consumption life.”

Conspicuously, the most important thing should be “conscience – that form of manifestation put on by collective soul – and only afterwards the rigid article of law.”

Consciousness is often deemed an abstract notion. For the two Romanian physicians, consequently for Minovici, too “Conscience cannot be conceived but as the wholeness of the “moral laws” precepts, as an expression of social harmony, on whose bases the individuals within an organized collectivity should cultivate the “good” and give a wide berth to “evil” “and obnoxiousness” from the standpoint of the individual or collective interest.”

Minovici agrees with these information, the proof being the acknowledgement upon the fact that if “every individual only had rights and we denied him any duty, and especially his moral duty, then, within a State there would be a permanent fight, battled by the individual against community, and therefore battled by everybody against all. ”

Furthermore, Nicolae Minovici’s


18

brother, Mina Minovici declared his opinion in this respect, considering: “Much like a laic father confessor, the physician has ears to hear and eyes to behold; in comprehending his moral duty, he has no other judge than his conscience”, and “the duty dictated by consciousness needs no longer be defined.”

We may remark on the occasion of reading these materials that the idea of absolute or relative secret is not new. This way, Ch. Vibert states that: “Whatever the authors might say, there is obvious that medical secrecy cannot be absolute in all cases. Name the physician who will decline informing the husband about his wife’s illness, informing the environment about an epidemic disease?!”

A. Lacassagne places himself in favour of absolute secrecy: “the obligation to secrecy places upon the ones involved the interdiction to reveal it, even when they are called to testify in Courts of Justice.”

Other preoccupations upon secrecy submitted in the article herein are the statements by: A. Lutaud: “Medical secret is not only a moral duty and a sacred obligation for the physician, but the secrecy is also formally enforced by law” ; or the rules advanced by Gabriel Tourdes and Ed. Metzquer: “The physician must never reveal what he has come up against during the exercise of his profession: however there are admitted exceptions, there are legal restrictions, debt conflicts, this issue having remained one of the most delicate and controversial.”

“There are so many moral and legal restrictions in favour of the relative secret; the physician is under obligation to keep professional secret, however there are certain cases in which this obligation places one in a difficult

position.” There is certain that, as Henri

Contagne stated: “Medical secrecy displays within current practice multiple facets. In the matter of crimes against the State, the law requires revealing the secret, for the other crimes, divulging the secret will only occur in exceptional cases – dictated by the physician’s consciousness.”

The two doctors also worked out a study correlated to the legislation in force. There is this way presented the article 350 in the former Penal Code: “The physicians, the surgeons, the pharmacists, the midwives any other such persons, who “following to be, in line with the nature of their profession, acquainted with and therefore stated as keepers of the secrets they have been entrusted – will let them out – excepting the occurrences when the law asks for such a disclosure – will be sentenced to prison, from one month to six months, and will be fined from 100 lei/Romanian currency to 500 lei.”

In Romania, there were also other legal regulations connected to ethics. This way, the Penal Code of Charles the 2nd, article 505, paragraphs1, 2.5 stipulated such regulations:

1. The offence of revealing professional secrets, which was “stipulated by the ancient Penal Code, in the art. 305, has as constitutive elements: 1) the quality of the person acquainted with a secret “in virtue of one’s situation, position, profession or appointment 2) the secret that one of the persons enumerated above is under obligation to keep; 3) the divulging or the revealing deed; 4) the divulgation of the secret might constitute a possibility of prejudice; 5) he who divulges the secret might not be authorized by

L. ROGOZEA, et all, Three personalities of medicine – representative for medical ethics within Romania

19

law to divulge it, 6) intention of fraud.”

2. The first element of the offence represented by the deed of divulging the professional secret is the quality of the person who is acquainted with a secret; the legislator only makes reference to those persons who, in virtue of their position, profession or appointment receive certain confidences from those who need the services falling into their attributions. If a person is entrusted a confidence that however has no direct connection with the situation, position profession or appointment of the person who was entrusted the secret, the offence of revealing the professional secret cannot have been performed.

3. The second element of the offence represented by the deed of divulging the professional secret is the secret itself. Secret constitutes any confidence that one of the persons fitting within the provisions of the art. 505 has found out, only by virtue of the quality, of the position, of the profession or of the appointment he holds, there being obvious the desire of the confidant for his confidence not to be found out by others.

The law refers to the conditions in which we do not speak of professional secrecy (the facts have no connection with the quality, with the profession of the confided person, the information are obtained on private path).

There is afterwards mentioned Max Simon: “when the physician has taken hold on the patient’s spirit, when the former has raked up the most remote and hidden nooks of the latter’s soul, he has contracted

against the patient a new obligation, the one of absolute discreetness, which seals within his conscience not only the secrets revealed to him, but also those he has caught glimpse of during his medical investigations.”

Conclusion History brings forth that in life, the

balance inclines more often towards lie than towards truth. Medical ethics is compelled to do its best so as to contradict statistics. When somebody wishes to become physician, pharmacist or nurse, we dare say one is naturally strongly motivated. Sometimes, nevertheless, one’s subsequent activity makes us doubt as to these motivations.

This is the reason why the example of forerunners such the brothers Minovici, Kernbach or I. St�nescu is more than essential. Selective bibliography 1. Dumitra�cu, D – Medicine between

Miracle and Deception, Dacia Publishing House, Cluj Napoca, 1986

2. Du�escu, B – Victor Gomoiu 1882-1960, Medical Publishing House, Bucharest, 1970

3. Iorga, N – Medical Men and Medicine within Romanian Times of Yore, Bucharest 1919

4. Marin, Fl. – Lives Dedicated to Human Being, vol. 1-6, Dacia Publishing House, Cluj Napoca, 1993-1997

5. Ozun, R., Poenaru, E. – Professional and Social Responsibility incumbent on Physician, Medical Publishing House, 1973

6. Rogozea L. - Nicolae Minovici �i Secretul Profesional, Al IV-lea Simpozion Na�ional de Istoria Psihiatriei, Bucure�ti, 20-22 Mai, 2004, p.42

7. Rogozea L., Marcu N. - Doctor


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Nicolae Minovici – un theoretician at medical ethical, 40th International Congress on the History of Medicine, Budapest, Hungary, August 26- 30, 2006 – pg. 775-77.

8. The Handbook on Medical Ethics – Clarke, Doble and Brendon, London, 1981

9. Rogozea L. – Etic� �i deontologie medical�, vol. 1, Ed. Universit��ii Transilvania, 2006, 158 pg.

10. Rogozea L., Beldean L. - Aspecte ale eticii medicale în România, Acta Medica Transilvanica nr.2, 2000, pg.141-142


ONE WRITING FROM �BRAHIM TEMO ABOUT THERMAL SPRINGS OF BURSA

AND ROMANIA

M. YAPRAK 1 N. GÖKÇE2

Abstract: Dr. �brahim Temo (1865-1945) one of the founders of The Committee of Union and Progress (�ttihat ve Terakki Cemiyeti) was born in Struga as an Ottoman citizen with Albanian origin. He graduated from Gülhane Military Medical School in 1892. He began his ophthalmology education in Istanbul but finished in Romania, because he had to escape from dictatorship of II. Abdülhamid. He opened a lot of bureaus of Committee in Bulgaria and Romania. Temo returned to �stanbul in 1908 but didn’t get on with his Committee. He founded Osmanlı Demokrat Partisi (Ottoman Democratic Party). In 1911 he returned to Romania because of pressures and threats. Temo was not only a doctor and a politician. He was also an author. He always wrote. He sent writings from Romania to Türkish journals especially the �çtihad of Abdullah Cevdet who was also one of the founders of The Committee. It is reported that achieve of Temo is in Tiran. In his writing in the �çtihat of 01 February 1925, he notices first the importance and misery of the Bursa thermal springs. Later he introduced some important thermal springs and hospitals of Romania. He gives communications about the attaining, prices and medical utilities of these organizations. According to this important writing about history of thermal medicine of Türkiye and Romania, thermal springs of Romania were in better condition than Bursa thermal springs in 1925 Key words: Ibrahim Temo, Romania, Thermal Spring, Bursa, Türkiye

1 Trakya University, Medical Faculty Departments of Physiology, Edirne - Turkye 2 Trakya University, Medical Faculty Departments of History of Medicine - Edirne - Turkye

In 1920’s hydrotherapy, balneotherapy, spa centres and sanitarium therapy were more popular treatment modalities than today’s modern medicine and physical therapies. There are a few articles focusing on thermal therapies of those times.

An interesting and comparative article was written by Dr. �brahim Temo (3). He, in his article, compared Turkish and Pomanian thermal therapy centres from medical history point of view. Temo’s article provides important information on

thermal therapies of 1920’s. Dr. �brahim Temo (1865-1945), one of

the founders of the Committee of Union and Progress (�ttihat ve Terakki Cemiyeti), was born in Struga as an Ottoman citizen of Albenian origin (See Figure 1).

After graduated from Gülhane Military Medical School in 1892, he started studing ophtalmology in Istanbul. Since he had to escape from the dictatorship of Abdülhamid II, he completes his training period in Romania. He opened a lot of


22

bureaus of the Committee in Bulgaria and Romania. Temo returned back to �stanbul in 1908 but didn’t get along with his Committee. He founded Osmanlı Demokrat Partisi (Ottoman Democratic Party). Because of the pressures and threats, he returned to Romania in 1911 [10, 11].

Figure 1: Dr. �brahim Temo as Red Cross

physician in �stanbul, 1913. Temo was not only a doctor or a

politician, but also an author. Before and later from his second migration to Romania, he wrote a lot of articles and several books. Some of his books are Aile Hekimi (Family Practitoner), Tagaddi ve Devam-ı Hayat (Nutrition and Life), Kuduz (Rabies), Türkçe-Romence Mükaleme (Turkish-Romanian Conver-sation), Tababet-i avam Dersleri (Lessons in Public Health), Hareket (Motion; co-authered by Ali �efik), Atatrürk’ü Niçin Severim (Why I Admire Atatürk; 1937-Medgidia, 2001 Prizen), �ttihat ve Terakki Cemiyeti’nin Te�ekkülü ve Hidemat-ı Vataniye ve �nkılab-ı Milliye Dair

Hatrıratım (Foundation of the Committee of Union and Progress and my Memories of the national Revolution and Services to the Motherland; 1939 Medgidia, 1987 �stanbul), Usul-ü Mükaleme (Method of Conversation) [3, 4, 5, 6, 7, 8, 9, 11].

It is reported that achieve of Temo is in Tiran [1-2].

He submitted his articles from Romania to Turkish journals, especially to the �çtihad of Abdullah Cevdet, who was another founder of the Committee (See Figure 2).

Figure 2: �ctihad journal

His article published in the February 1925 issue of the �çtihat on the subject of the thermal springs of Bursa and Romania (See Figure 3).

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

Temo made several journeys to Vienna (1901), Paris (1902, 1918), Egypt (1907), Türkiye (1913, 1923, 1930), Albania (1914) and two migration to Romania (1895, 1912). These expressions must be related with his first visit to Türkiye after the foundation of Republic [10-11].

The article begins with the expression of Temo about Bursa thermal springs. According to Temo the baths are miserable. They need reanimation, medical servants, water analysis and legal regulation. There isn’t any hotel and restaurant around the Bursa thermal springs [3].

In the second part of article, the thermal springs in Romania are introduced. He gave information about the transportation options, prices and medical utilities of these facilities [3].

According to the article, the important thermal springs of Romania are Episkubus or Krian (Baile 1 Mai), Feliks (Baile Felix), Moneasa (Moneasa), Gorgiya (Geoagiu), Dobruca (Spa Dobrich?), Kovana (Covasna Spa), Mangalya (Mangalia), Tekir Gölü (Lake Techirghiol), Lagülsarat (Salt Lake), Govora (Baile Govora), Herculane (Baile Herculane), Mohad (Mehadia), Moldovya (Slanic Moldova) Bijular, Siriya, and Vace [3].

In the study, Kasalata (Calimanesti-Caciulata), Pani (in Bukovina) and Devrnavanr mineral waters are praised. Some promanade like as Agpaya, Azoga, Bireza, Berabu, Berazova, Buztin Geçine, Kimpolonoa, Aliye�te, Çaba, Komurniki, Kurtedu, Erçi, Duverna, Morillan, Nemçen, Puya, Naçavluj, Brodevud, Grillet, Marillan, Nemçu, Payanaçabuluji, Borodeal, Rugfer, Sinaya, Suvi, Suzana, Tirguavgana, Tizmana, Valenda, Mevneta and Veratik are also praised in the writing [3].

Temo gives some information about important health centers of Romania like

as Antuvaniyu, Diyaguneselur, Jeravta, Naturaliyust, Alberabeta, Alanaherakayede (Sabtane) Gayllart, Tekirgölü sanitariums; Kulçe, Brankuvenasa, Eforiya, Markoca, Bantalemun, Manernimate, Kuluj (Cluj) University and Çernaviçe hospitals and dentistry college [3].

The names in the writing need to be critized by an expert. It may be said that the study has some smell of advertising of thermal springs and other medical centres of Romania. References [1]. Kutlay N: �ttihat Terakki ve Kürtler.

Beybun, Ankara, 1992 [2]. Polat A: Arnavutluk Devlet Ar�ivleri

Genel Müdürü Prof. Dr. Shaban Sinani ile mülakat. Türk Kültürü ve Hacı Bekta� Veli Ara�tırma Dergisi. Sayı: 33, 2005.

[3]. Temo �: Romanya’nın sanatoryumları, kaplıcaları, hava almaya ve tedaviye mahsus mevsim istasyonları. �ctihat, February 1925, Year: 20, Nu: 174, pp: 3498-3501.

[4]. Temo �: �ttihad ve Terakki Cemiyeti'nin Te�ekkülü ve Hidemât-i Vataniyye ve �nkılâb-ı Millîye Dair Hatıratım. Medgidia, 1939.

[5]. Temo �: �brahim Temo'nun �ttihad ve Terakki Anıları. Arba, �stanbul, 1987.

[6]. Temo �: Atatürk'ü Niçin Severim, Medgidia, 1937.

[7]. Temo �: Atatürk'ü Niçin Severim, BAL-TAM Yayınları, Prizen, 2002.

[8]. Uygur S: �brahim Temo’nun Bilin-meyen Bir Eseri: Usûl-i Mükâleme. Modern Türklük Ara�tırmaları Dergisi, 5/2:65-73, 2008.

[9]. Ülgen E, Aksu A: Mektep ve Aile Mecmuası (1915-1916). Constanta, 2003.


24

[10]. Ünver S: Doktor �brahim Temo. CTF Tıp Tarihi ve Dontoloji Ar�ivi (Cilt 1). �stanbul, 1935.

[11]. Yaprak M, Gökçe N: Dr. �brahim Temo. Proceedings of the 38th

International congress on the History of Medicine. �stanbul, 1-6 September 2002.


THE GREEK PHARMACIST GHERASIMOS ZERVOS (1842-1901) AND HIS

SUCCESSORS, THE ZERVOS PHYSICIANS FROM ROMANIA

A. LUCASCIUC1, M.-G. SULIMAN2,

O. ELEFTERIU3, C. GRECU3

Abstract: Hereby we intend to follow the road along Zervos family in Romania, from the first appearance in the city of Sulina (1872), the pharmacist Gherasimos Zervos, originating in Kefalonia Greece and up to its recent descendants, Zervos physicians from Bucharest, who expatriated themselves to New York in 1994. Sulina town located in the Danube Delta was under a great economic and cultural development due to the installation here, in 1856, of the European Commission for the Danube. Thus, the city becomes an attractive place for many physicians and pharmacists, as well as for young pharmacist Zervos, a diplomat of the University of Padova (Italy). He will soon become the owner of the pharmacy "Minerva" (1881), pharmacy which subsequently will receive the name of "Speranta" in 1895. From the six children of pharmacist Gherasimos Zervos, Jack and George - the first-born children - will be sent to a high school education and medicine in Greece capital, Athens. The first will meet a great professional ascension: he was the physician and personal adviser of Abyssinia’s Emperor, Haille Sellasie I (who reigned from 1930 to 1974), the second will continue the Zervos physicians „dynasty” in Romania. Key words: Zervos, pharmacist

1 SRIM,

2 National Medicines Agency, SRIF,

3 SRIF

Hereby we intend to follow the long history of the Zervos family in Romania, during 1872-1994.

At the very beginning of this adventure, the milestone was represented by Gherasimos Zervos, born in 1842, in Zervata, Kefalonia Island, Greece.

His name was mentioned in 1872 [1] in the �free port� of Sulina located in the Danube Delta, where he was about to settle �a true and genuine dynasty�: five sons and

two daughters, the first two born, Jack and George, would become physicians; other nephews and grand-grandchildren would be spread around the world.

The last descendant in Romania was doctor Gherasim Tuchiditi Harilaos Zervos, who has emigrated, together with his wife, in 1994, in the USA, where his sons were living.

The young Zervos, who graduated from the Faculty of Pharmacy in Padova (Italy),


26

was already encountering a prosperous material status, which allowed him at his arrival, in 1872, to open a pharmacy in the free port of Sulina, under the name of the wise deity �Minerva� [2].

Notwithstanding, from the beginning he received the help of two business partners right from the beginning: dr. Contomihalos and after his departure, dr. Valentin Stais [3].

In this prosperous city, which was the residence of the European Danube Commission ever since 1856, the pharmacist Zervos was the sole owner of a pharmacy: a medical statistic study of November 14th, 1879 (the official date of the Romanian administration commen-cement in Dobrogea), mentions only 2 pharmacies in Sulina: �Minerva� and the pharmacy of the European Danube Commission’s Hospital [3].

The legal framework under continuous change brought amendments also for the �Pharmacy’s business carrying out�: by means of the Ministers’ Council Journal no. 8 of February 6th, 1881, the pharmacies with foreign owners (without Romanian citizenship) as in the case of the �Minerva� pharmacy from Sulina, were only acknowledged under �personal right� [3].

The grounds of the name change, of Gherasimos Zervos’ pharmacy, are unknown in 1895, subsequently being renamed �Speran�a�. Under this optimistic name the pharmacy was run for another five years by Gherasimos Zervos, until his death on January 30th, 1901 [4].

Starting that year, the family of the deceased Zervos gives under concession the pharmacy up to 1916 to the pharmacists: Nicolae Lupescu, Pavel Avram and Gh. C�lin [4].

The First World War breaks off the ordinary course of life in the Sulina free port as well: subsequently, the destiny of Zervos family and of the pharmacy changed, the documents of those times

having provided no statement at all. Under the same silence were also placed the successors of the pharmacist Gherasimos Zervos (1842-1901) from Sulina.

Their discovery was revealed upon the reading of the travel book �Abyssinia� [5], signed by the reporter-writer Mihai Tican-Rumano (1895-1967), who had travelled along five continents and represented a genuine ambassador of our country.

In 1934, having journalistic interests concerning the Italo-Abyssinian conflict, recently begun at the country borders, he travels to Ethiopia, hoping that his dream would come true, namely that of seeing �an African Christian-Orthodox country by excellence, the country of the world’s most pious emperor, Haile Selassié I� [6].

Being under preparation and alert due to the war, the audience to the emperor became unachievable. He was advised to ask for help from the personal counselor and physician of the Imperial Court of Abyssinia’s capital, Addis-Abeba.

A cordial reception was held in the doctor’s house, a certain dr. Zervos.

The business card of the Romanian writer stirred great emotions and enthusiasm: the doctor started to speak Romanian!

Although having strong Greek influences, the Romanian language spoken in the heart of Abyssinia by the doctor caused a great surprise also to the reporter Mihai Tican-Rumano.

He was in front of Dr. Jaques Zervos, the private physician of the Imperial Court and resident minister of Greece in Addis-Abeba.

Jaques Zervos had confessed about his native and childhood city, Sulina, where his parents rest in peace, about his children, �a boy and a girl who learn at our schools�, about his big family from Romania and about the studies at the Faculty of Medicine in Athens, together

A LUCASCIUC et al: The Greek pharmacist Gherasimos Zervos (1842-1901) and his successors, the Zervos physicians from Romania

27

with his brother George Zervos, physician in Bucharest [7].

Thus one of the most famous sons of Zervos was identified. Where are the others?

60 years later. Bucharest, March 1995. In the most original way, we found out

that the last Zervos was preparing to leave Romania: we are speaking about Dr. Gherasim T. H. Zervos (dr. George Zervos’ son), an obstetrician, former

manager of Filantropia Hospital in Bucharest.

Although surprised that there is another person who succeeded in solving the present �puzzle� regarding his family, the pharmacist’s nephew confirmed us the bibliography and the pages wrote by Mihai Tican-Rumano, in the chapter �A counselor of the Imperial Court� of �Abyssinia� [8].

The ZERVOS family, Gala�i 1930 The first on the left on the third upper row is Dr. Jacques ZERVOS (Ethiopia),

together with his four brothers.

References: 1. Georgescu-Tulcea N., Istoricul

asisten�ei cu medicamente a popula�iei din Dobrogea de nord, p. 381-386, vol. Medical Retrospectives – studies,

notes and documents, published by Dr. G. Br�tescu, Medical Publishing House, Bucharest, 1985, p. 382.

2. Georgescu-Tulcea N., Istoricul asisten�ei cu medicamente a popula�iei


28

din Dobrogea de nord, p. 381-386, vol. Medical Retrospectives – studies, notes and documents, published by Dr. G. Br�tescu, Medical Publishing House, Bucharest, 1985, p. 382.

3. Georgescu-Tulcea N., Istoricul asisten�ei cu medicamente a popula�iei din Dobrogea de nord, p. 381-386, vol. Medical Retrospectives – studies, notes and documents, published by Dr. G. Br�tescu, Medical Publishing House, Bucharest, 1985, p. 384.

4. Georgescu-Tulcea N., Istoricul asisten�ei cu medicamente a popula�iei din Dobrogea de nord, p. 381-386, vol. Medical Retrospectives – studies,

notes and documents, published by Dr. G. Br�tescu, Medical Publishing House, Bucharest, 1985, p. 385.

5. Tican-Rumano M., Abisinia, 2nd Edition, Cartea Româneasc� Publishing House, Bucharest, 1935, 281 p.

6. Tican-Rumano M., Abisinia, 2nd Edition, Cartea Româneasc� Publishing House, Bucharest, 1935, p. 128.

7. Tican-Rumano M., Abisinia, 2nd Edition, Cartea Româneasc� Publishing House, Bucharest, 1935, p. 114.

8. Tican-Rumano M., Abisinia, 2nd Edition, Cartea Româneasc� Publishing House, Bucharest, 1935, p. 112-122.

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 Series VI: Medical Sciences Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

GREEK PHYSICIANS AND PHARMACISTS GRADUATED IN ATHENS

PRACTICING IN ROMANIA

A. LUCASCIUC1 M.-G. SULIMAN2,3

O. ELEFTERIU3 C. GRECU3

Abstract: The present work will present a bibliographical list containing only Greek physicians and pharmacists with specialist training in Athens (Greece). The few names that have been lost in obscurity are offset by other personalities who gave medical and pharmaceutical professions resonance in Romania. Amongst these physicians we mention: Jack and George Zervos, sons of the pharmacist Gherasimos Zervos (1842-1901) from Sulina, Comboti Nicholas with doctorate in medicine in 1845, which, subsequent to the achievement of the free practice right, became a prominent member of medical society and even the top of the scientific pyramid - chief doctor of Bucharest in 1869, doctor Androcles Fotino, born in Braila (1834) has accomplished higher education in Paris and Athens. Upon his return back home, he achieved higher grades as officer-doctor and professor at the Bucharest School of Medicine, Pharmacy and Veterinary Science. Amongst the pharmacists we mention: Petzalis Rasti Sophocles, which graduated with apothecary diploma in Athens in 1857, in 1864 is the owner of the pharmacy "Esculap" in Braila until 1883, when his son-in-law receives the ownership of the pharmacy, Dr. Mina Minovici (Father of forensics in Romania), continues to work in the laboratory, until his death (1894); Andreea Nicolae, master in pharmacy graduate from Athens, known in 1864 as owner of the pharmacy "Spiteria Romana" from Galati, etc. Key words: Athens, Romania, pharmacists.

1 ISHM, Bucharest. 2 National Medicines Agency, Bucharest. 3 RSHP, Bucharest.

Within the bibliographical inventory presented are listed, in alphabetical order, the professionals with studies and medical and pharmaceutical diplomas achieved in Athens. The primary bibliographical source is presented abbreviated.

Physicians

1. Adamantis Apostol („Veriotul-doctoru”) born in Veria (Macedonia) in 1822.

He was for 3 years the apprentice of medicine attached to Vretos (Serafim Vreton Ion „the Armenian”), born in Bucharest, „Parisian doctor, from 1815”; he was the physician and the teacher of the prince of Walachia, Ion Caragea.

Vretos, physician, philosopher and remarkable bibliophile, dr. Adamantis wrote that his mentor had also the intention to publish the manuscripts collected, but all of them burned during the fire in April 1847, together with Bucharest houses.

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • Series VI 30

Supposing that, the last journey performed by dr. Serafim Vretos in Greece, during 1841-1844, had as main goal the guidance of the young Hippocrates’ apprentice regarding the improvement of serious medicine studies in Athens.

Therewith, we settle the return year in Walachia (1844), since, subsequent to this date, both of them are mentioned in the documents. Dr. Adamantis mentions him, „in a prologue”, as being his mentor and inoculating him the passion for introducing into thesaurus the written word, thus, he collected treasure, in his turn, consisting in books and manuscripts „800 volumes of medicine and literature”, which he had to offer for sale when his daily subsistence was threatened. [3 p.7; 392-393; 452; 461]

2. Cantili Vasile

1829 – medicine diplomat in Athens; 1860 – unrestricted practice license in

Bucharest; 1863 – 1st class regiment physician

competition [2, No. 18 – 25 June]; 1863 – member in the Hygiene and

Sanitation Council of Ploiesti [3 p. 60].

3. Colovos Anastasie 1854 – medicine diplomat in Athens; 1858 – Bucharest; 1863 – physician with the free consult

service of the Col�ea Hospital health centre [2, No. 5];

1863-1876 – private clinic physician and the same position for free consults (Health Service Yearbook) [3, p. 77].

4. Comboti Nicolae 1845 – PhD in medicine in Athens and

unrestricted practice license in Bucharest; 1860 – physician of the Black Sector,

Bucharest; 1863 – physician of the Red Sector,

member of the Scientific Medical Society; 1863-1866 - member of the Hygiene

and Sanitation Council of Bucharest; 1870 – Head of the Bucharest Health

Division [3, p. 77].

5. Fotino Androcles (Andrei), 11th of November, 1834 Br�ila – 9th of

May 1907 Bucharest. 1859 – PhD in medicine in Athens; 1860 - unrestricted practice license in

Bucharest; 1860–1864 – regiment physician,

promoted to head of the 5th medical division of the Military Hospital, while teaching „the recruit and reform course at the National Medicine School” to the veterinary division;

1864 – Head of the 1st Surgery Division of the Military Hospital; publishes various scientific works and clinical observations from the division he runs;

1865 – member of the Superior Health Council and promoted to 1st class senior physician (1875);

1876 – member of the Red Cross Committee;

1877-1878 – takes part in the Independence War, driving the ambulance of the Main Sector of Mecika; starting with December 1877, he manages the military hospitals; awarded the Military Virtue;

1882 – senator of Mehedin�i; Law Reporter of the Health Service Organisation Law;

1885 – General Manager of the Civil Health Service;

1891 – participated in the Hygiene and Demography Congress in London;

1893 – severally awarded for his heroic deeds, honesty and professional competence, he reached his full retirement age [3, p. 148 – 149].

6. Kefalos Trasivul Son of physician Kefalos from

Constan�a; 1865 – medicine diplomat in Athens,

returns in Constan�a;

A. LUCASCIUC et al.: Greek Physicians and Pharmacists Graduated in Athens Practicing in … 31

1868 – dies due to typhoid, buried in the Greek Church’s yard (after dr. H. Serafidi „Medicine in Dobrogea”) [3, p. 223].

7. Micralopulo, physiscian Diplomat of the Athens Faculty of

Medicine (-), he settled in 1864 in Tulcea, but the newspaper „Sanitarul” [3, p.280] mentions that he left Tulcea soon after that.

8. Orlando, physician 1865 – PhD in Athens, domiciled in

Tulcea where he was employed „as family doctor” for 20 houses, later he went to Paris and never returned [3, p. 308].

9. Sacorafos Michail 1850 – PhD in Athens and unrestricted

practice license in Romania; 1862-1866 – physician of districts II and

III, Gala�i; December 1868 – 1873 – owner of the

„Domneasc�” pharmacy in Gala�i (Dr. Cazacu and C. Frunz�) [3, p. 372].

10. Stavridi Constantin 1857 – PhD in Athens and unrestricted

practice license in Gala�i; 1865 – publishes the „Report over the

epidemic of cholera morbus occurred in Gala�i in 1865” [2 (nr. 3,4,6), 3 (p. 410)].

11. �u�u (�utzu) Alexandru 1837 – 1919 Bucharest Subsequent to secondary school, went to

Athens where he acquires the bachelor’s degree in medicine.

1865 – PhD degree for the „Considérations sur la dyspepsie essentielle” (Paris);

October 1865 – unrestricted practice license in Bucharest (M. M. no. 33);

March 1866 – secondary physician; starting with 1867, chief physician of M�rcu�a asylum;

1867 – 1868 – registered with the National Medicine School program for the

course „mental illness clinic” (Sunday courses);

1876 – 1877 – „The alienated in front of the society and in front of science. Medical and psychological studies” – psychiatry forensic study (DCMF);

1877 – founder of the „Caritatea” Institute on Plantelor St., Bucharest („Private health house for mental illness”);

1879 – mental pathology and forensics professor, in 1881 became the Lecturer’s chair for mental and psychic diseases from the Faculty of Medicine in Bucharest; awarded the „Sf. Ana” Order, 2nd degree;

1884 – publishes „The Forensic and Psychiatry Magazine” (the first in this domain) where he publishes: „A few words about the intellectual epidemics” (No. 2), „Psychosis classification” (his last work);

1901 – member of the Superior Medical Council and correspondent member of the Romanain Academy [3, p. 419 – 420].

12. Vaias Teodosie 1862 – PhD in Athens; on October 17th

he achieved the unrestricted practice license in Bucharest [2, No. 28];

1863 – resigns from the Calafat city physician position and on June 10th is appointed as Caracal city physician;

1864 – physician in Tg. Jiu Hospital (Gorj County) [3, p.144].

Pharmacists

1. Andreea Nicolae Magister in pharmacy with bachelor’s

degree in Athens (1856). 1858 – unrestricted practice license in

Romania; 1860 – opens a pharmacy in Gala�i (N.

Angelescu, p. 170 - 171); 1864 – owner of the pharmacy „Spi�eria

Român�” in Gala�i (Health Service Yearbook/1864 up to 1875).

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 • Series VI 32

2. Aescht Rudolf Diplomat in Athens mentioned in the

Health Service Yearbook 1864 with unrestricted practice license [3, p. 7].

3. Mihailidis spi�erul Diplomat in Athens (-), opens a

pharmacy in Tulcea between 1859-1860; due to competition grounds, he moves to Sulina [3, p. 382], where he is no longer certified by the bibliographies researched.

4. Petzalis Rasti Sofocle 1857 - Diplomat in Athens; 1864 – owner of the pharmacy „Esculap”

in Br�ila until 1883, when the pharmacy is taken-over by his son-in-law, dr. Mina

Minovici, however he continues to work in the laboratory, up to his death in 1894.

References

1. Dic�ionar cronologic de medicin� �i farmacie – sub redac�ia G. Br�tescu, Editura �tiin�ific� �i Enciclopedic�, Bucure�ti, 1975 (DCMF).

2. Monitorul Medical (M M). 3. Repertor de medici, farmaci�ti,

veterinari (personalul sanitar) din �inuturile române�ti vol. I (înainte de 1870) - Dr. V. Gomoiu �i farmaci�tii Gh. Gomoiu �i Maria V. Gomoiu, Tip. „Presa” Br�ila, 1938 (RMFV).


THE BYZANTINE PHYSICIANS

M. BESCIU1

“Orthodox Church remains intangible by extending its arms in the Eastern European territories and preserving an entire art and

almost an entire civilization” (N.Iorga)

Abstract: The organization level of the sanitary security shows the unquestionable level of Byzantine medicine. The people from that period believe in healings gods. Cosma and Damian are representatives for the cult of physicians without silver. During this period the charity institutions was developed, and the physicians could study individual or in dedicated schools. The schools activated near hospitals and the candidate who succeeded at the exam, receive a sort of symbol that made the difference between physicians and impostors. The interesting thing is that the doctor accord an important attention to the nutrition, not only to the medical treatment Rich professional libraries were also found in hospitals, and they are endow with important medical books such as magnificent manuscript which includes the work of Dioscoride, Materia Medica, since 512, wrote for Anicia Iuliana. All of these it will be presented to you with all the Byzantine medical personalities’ contributions: Oribas, Alexandru from Trales, Aetius from Amida, Pavel from Egina, Jac Psycristul. In 1453 the Byzantine medicine moved the torch in the young hands of the European medicine fated to lead the medicine further

Key words: Byzantine medicine, physicians, manuscript, Dioscoride.

1 University of the Medicine and Pharmacy „Carol Davila” Bucharest

The Byzantine Empire lasted for over 1100 years and the organization of a functional health care system was undeniable merit of Byzantine medicine.

Pagan healing gods were replaced by the "Saints healers”.

Unmercenary physicians or "Doctors without Silver" cult – Cosma and Damian, with Theraphon, Tecla, Kyr, John, Julian- was established from the very beginning.

According to data transmitted over the centuries, Cosma and Damian were brothers and doctors. They came from Arabia in the town of Cyr. Here they

dedicated themselves to patients, both human and animal.

Unlike other doctors, they followed the Biblical advice: "as a gift you received as a gift you give” they did not want to receive any reward. For that reason they were called "Saints Doctors without Silver"- Anargyres.

One day, however, in violation of the decision on which both brothers had agreed, Damian received a sum of money from a noble woman, Palade, who, in the name of Christ, asked him to accept her gift. His brother, Cosma, was so angry that


34

he said he does not want to work together with his brother anymore.

After Damian had explained him why he made that gesture, that is not to humiliate and not sad the noble lady who asked the name of Christ, they were reconciled and continued their work.

Governor Lysis, finding that they are Christians and attract many to the Faith, called them into court and asked them to offer sacrifice to the gods of the empire.

As they refused resolutely, they were sentenced to death and executed by decapitation. Their bodies were taken into town by Christians and buried in honor.

In Byzantium, hospitals functioned near monasteries. The administrative head of the entire institution was called the nosocomos. Two doctors and a lot of assistants, who learned, not helped, were working in each section. Women were cared for by a woman doctor, and at night there was a service call.

Two inspectors were visiting the hospital day and night inquiring whether patients are satisfied or have any complaint to make.

Each hospital had a dispensary in which worked two doctors and a number of assistants

There were specialized hospitals - i.e. hospital doctors in Mangane dealt exclu-sively with diseases of the digestive tract.

Nurses were instructed on the spot and formed health care professionals’ associations.

Doctors were trained in two ways, individually or in groups ie in school. Generally, medical profession was transmitted from father to son.

Medical schools were established around hospitals and one of the doctors acted as a teacher. Students were practicing in hospitals or clinics. Education was free.

Teachers were chosen very carefully and students had to accumulate a lot of experience before start practicing as

physicians. This period of training was called kronia.

After the training, the student had to pass proficiency exam and answer question of a maestro, the head of the school or the emperor’s physician, bearing the title of actuarios.

The candidate who passed the examination received as a sign of promotion a medal or badge to distinguish himself from impostors.

Medical practice was based on the theory of the four humors.

In therapy, Byzantine physicians used, along with the old remedies, news exotic ones, made from the three regna.

An important role was played by diet recommendations. There were used curative and preventive diets, but there were also exaggeration. Doctors used to recommend to their patients diets according to different seasons, months, professions or social class.

In order to master these diets and astrological data, doctors had to read a lot and collect many books. So, they had copies of classical medicine textbooks and many copybooks of diets and complicate recipes.

Hospitals sheltered vast libraries with valuable medical works. Till the 15th century, there was in Sarb King’s hospital in Prodrom a magnificent manuscript of Dioscoride’s work “Materia Medica”. It was written for the princess Anicia Juliana, daughter of the Roman emperor Olybrius. Nowadays, this manuscript is kept in Vienna.

A copy of Dioscoride’s famous pharma-ceutical textbook, written in the first century A.C., was made in 512 and it is now sheltered in the National Library in Viena. This manuscript was made for the Byzantine princess Juliana Anicia, Gallea Placida’s great grand daughter and Areobindus wife. The portraits of the author talking to Heuresis (the Gift of

M. Besciu: The Byzantine physicians 35

discovery) and Epinola (Attention), groups of physicians and different plants’ dra-wings are closed imitations of ancient copies of the textbook, which were in a pure Roman-Greek tradition. The use of gold was, however, a Byzantine innovation.

Only the damaged thumbnail portrait of Iuliana Anicia can be considered a genuine work of the 6th century painter. The princess, dressed up in a splendid heavy plated dress, according to her status, looks forward and has a solemn attitude, as aulic ceremonies imposed. She is surrounded by allegories of Intelligence, at her left, and Kindness, at her right. The last keeps gold coins in her lap that Juliana Anicia spreads on the book handled by a little genius, called “the passion of the one who loves to build”. She imitated the generosity acts made by consuls at their appointments.

The whole composition remembers the consular ivory diptychs or the pictures of the Virgin surrounded by angels, as in an icon from the Mount Sinai. At the princess’s feet stays a woman, “the Arts’ Gratitude”, who kisses the princess’s right shoe. In the corners there are theme scenes, in gray “grisaille” tones, painted in a free Greek style, which evoke the generosity of the princess who build up or renovate many churches in Constantinople, winged genius, comparable to those in Pompey, who dealt with architecture and painting works.

ORIBASIUS (329-403) No doubt, one of the famous Byzantine

physicians was Oribasius, born in Pergamos, as Galenus, and received medical training under supervision of Zenon from Cyprus. He was the physician and friend of Flavius Claudius Julian, the Renegate.

Julian the Renegate, appointed Cesar by

Constantine when he was sent to Galls, asked Oribasius to follow him. Also, he ordered Oribasius to edit Galenus’ works in a short form.

In 362, Julian succeeded Constantine on the throne, and his physician became Quaestor of Constantinople. Unfortunately, Emperor Julian was killed in 363; Oribasius lost his protection and was exiled between Goths. His exile ended before 369.

ORIBASIUS’s medical works His first work, written for Julian and

called “Galenus’s Synopsis” is lost. At the Emperor’s request, a Medical

books collection was created. It contained 70 books, but only 25 resisted through ages.

He wrote another Synopsis in his old ages for his son Eustatios, who was also a doctor. He also wrote Euporistes, with his recommendations for travelers. In this book, he described symptoms for each disease; presented the main drugs and most common substances used for drug’s manufacture and their effects.

Books 11 to 13 were dedicated to Diocoride’s Materia Medica exposition and books 14 to 16 described simple and complex remedies. Information was varied, rich and accurate, but his prudence in prescribing needs the reader’s full attention.

Oribasius described for the first time the melancholy delirium, lycanthropy. He prescribed hot oil instillation for earaches; for poisoning he recommended a mix of oil with water in large quantities, then teriac in wine or juniper fruits and 20 rut fruits. He used pharmaceutical forms like trochiscusurile pills and purgatives bread (cathartics) and ”Buccellata cathartici” (purgative electuary).

Oribasius presented Caryophyllus


36

aromaticus as medicine for the first time. Through its research and knowledge of

medical and pharmaceutical literature, Oribasius remains one of the leading authors and practitioners of the Byzantine Empire.

ALEXANDER OF TRALES (525-605) The greatest physician from the times of

Galen until the Renaissance was probably Alexander of Trales.

His work, 12 medical books, inspired medical schools in the Middle Ages, even if he criticized some opinions of Hippocrates and Galenus.

He studied medicine, in private, at Ephesus, Pergamus, Athens and, certainly, in Alexandria. After he finished studies, he arrived in Constantinople, where his brother Antemios, a well known engineer and mathematician, together with Isidor of Milet, was building famous church of Saint Sofia.

He inspired from Hipocrates’s work, who considered that the first mission of a doctor was to ease the illness by all the means.

He was cautious regarding the treatment of cerebral disorders with white hellebore, which could induce fainting, and he was against the use of opium drugs in patients with tuberculosis.

He described remedies like: Mala punica, ether oils, of chamomile decoction, coriander seeds, pomegranate, and castor oil as treatment for intestinal worms, colchium autumnale as gout treatment. He was against opium abuse. In his work, he focused on eye drops. He described very well pleurisy and its treatment, he focused on digestive diseases, gout, ascites and made first differential diagnosis between edema and hypertrophy using thumb pressure, diagnosed intestinal worms and recommended powerful remedies for this

disease. “He is not a compiler, but a practitioner

who knew how less valuable wors are at a patient bed”, said P.Brunet about Alexandre, whom work he has translated into French.

Alexander also recommended the use of Ka-Ra-aa formula and amulets, but only if the treatment was unsuccessful.

PAUL from EGINA (626-690) Alumni of Alexandria’s Medical School,

Paul was well-known as a great surgeon who practice nasal polyps’ extraction, catheterize of the bladder, tracheotomy. He was the one who gave the name of cancer – Karkinos, crab – to malignant tumors, because he differentiated them from the benign ones and discover that malignant tumors send branches as a crab’s pincers in the surrounding tissues. He treated breast cancers by excision, not by cauterization. Paul from Aegina used rectal and vaginal speculum. In his days, medical art had no essential progress, but based on the known techniques it was improving.

He thought of the use of catheter to treat liver abscess and he described correctly the technique of lithotomy.

He remains in the history as an expert in lymph nodes surgery, superficial tumors surgery, uterine and breast tumors removal.

Only Abreviar medical, a 7 volume textbook wrote by Paul lasted till our days.

Books V and VII are dedicated more to pharmacology and describe venomous animal bites remedies, poison, antidotes, simple and complex medicines and their methods of fabrication. Book VI covers surgery issues and Book VII describes terrible plague epidemics.

“… even if they have poor knowledge, surgeons’ technical abilities were so advanced that allowed them to have

M. Besciu: The Byzantine physicians 37

important success in delicate and difficult interventions”, said Castiglioni about the surgeons of that period.

AETIUS OF AMIDA (502-575) He was born in Mesopotamia and was

trained in Alexandria. He became phy-sician at imperial court of emperor Justinian. It is said that Aetius was the first Greek physician who embraced Christianity.

He knew very well the Asian remedies. He wrote a medical synthetic textbook

with medical recipes and mineral, vegetal and animal remedies. He was the first doctor who used camphor and cloves in therapy.

His most important work is called Tetra-biblion and contains 16 books. It is Aetius’ worth to a better knowledge of surgical skills of Rufus of Ephesus and Leonidas, as well as of obstetrics and gynecological skills of Soran and Philumenos.

The best Aetius’s clinical descriptions were his observations on the diphtheria with suffocation, palate paralysis and regurgitation through the nose. He made the first description of brachial artery’s ligature in case of aneurism. He was interested in intestinal worm infestation. Aetius used to recommend prayers in preparation of ointments and emplastres.

NICOLAUS ALEXANDRINOS (Sec.

XIII) Nicolaus Alexandrinos was known as

Myrepsos – “The one who makes ointmens”.

He wrote Dynameron, divided in 48 chapters, an important work containing 2656 drug formulations, as well as an important number of other pharmaceuticals remedies, based on their action.

He was inspired by salarniteanian physician Nicolaus Salernitanus’s work Antidodarium. His work contains materia medica and pharmacology with therapy applications. His work had been the Paris Medical School’s Codex till 1651.

SIMION SETH (SEC. XI) Simion Seth is the author of an

encyclopedia of material medica – an alphabetical presentation of food beneficial effects. It contains an important number of remedies.

Musk, amber and hashish are presented in his work from Arabian books. He noticed the camphor’s sedation effect on genitor-urinary tract. He presented the ointments and syrup from Arabian recipes.

MIHAIL PSELLOS (1018-c.1078) Mihail Psellos, philosopher, historian,

politician, naturalist physician, professor at the „High School” of Constantinopol. He wrote about „the action of the jinns (demons) in the diseases appearance” and the medicamentary effect of the jewels.

In 1453 the byzantine medicine mooved the torch in the young hands of the european medicine fated to lead the medicine further. Bibliography: 1. Ursea N. - Enciclopedia medical�

româneasc� de la origini pân� în present, Bucure�ti, Ed. Universitar� “Carol Davila”, 2009;

2. Iftimovici, R. – Istoria Universal� a medicinei �i farmaciei.- Bucure�ti: Ed. Academiei Române, 2008;

3. Bologa. V. red - Istoria medicinei universale - Bucure�ti: Ed. Medical�, 1970;


38

4. Izsak, S. Farmacia de-a lungul secolelor .- Bucure�ti: Ed. �tiin�ific� �i enciclopedic�, 1979;

5. Sprin�eroiu, M. L.; Vasile R. D. – Farmacia în civiliza�iile omenirii.- Bucure�ti, Ed. Multi Press

International, 2003. 6. http://sfintii-zilei.weblog.ro/2007-09-

26/193889/Sfin%C5%A3ii-Cosma-%C5%9Fi-Damian-(sec--IV).html.


GREEK PHYSICIANS AND MEDICAL EMANCIPATION OF THE ROMANIAN

LANDS

D. BARAN1

Abstract: Constantinople, the second Rome, its orthodox Patriarchate and Academy, represented a model for the Romanian Lands. After the Byzantine Empire fall, Greek families settled in or travelling to Wallachia and Moldavia contributed to local society emancipation. In the Romanian Principalities, Phanariot rulers initiated «Early Enlightenment», strengthened Balkan “koinonia” and encouraged both national and western European values. «Homo Balcanicus» was becoming European. Italian, French and English contacts were frequent. Medicine was privileged. Nicolae Mavrocordat, the first Phanariot prince, the humanist owner of a famous library including medical books, wrote against tobacco. His wife preceded Lady Montague in variolating her children. Timoni, the Ghika princely family`s doctor, described variolation at the London Royal Society. Pylarino published in Venice the first scientific approach to variolation, a method he also presented to the British „Philosophical Transactions”, and which Romanians performed, too. While a Court physician, Pylarino encouraged medical education and hospital building in Wallachia Key words: Early Enlightenment, Phanariot rulers, variolation.

1 “Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Romania

Greek and Roman Confluences From ancient times, the ancestors of

present day Romanians lived and forged their own cultural background mixing original ideas to strong Greek and Roman influences. This is true for Romania as a whole, but particularly for Dobrogea, Transylvania and Banat. The archaeo-logical discoveries on the Black Sea shore, in Tomis-Constan�a, Callatis-Mangalia, Histria or Herakleia Pontike are in keeping with the vestiges in Apullum-Alba Iulia, Germisara-Geoagiu Spa, Aquae-C�lan and Herculaneum-Herculane Spa. Apollo, Artemis and the nymphs, Asklepios and Hygieia, Telesphoros and Glykon are always there next to Bendis, Darzos or the

Thracian Rider, assisting the environ-mental macrocosmic and the human microcosmic nature, providing health and mastering disease. Through the centuries Romanian history continued to evolve along these two coordinates of the „first and second Rome”.

Medical European Renaissance in Moldavia

In the XVI-th century, an intelligent, violent and ambitious Greek adventurer challenged Moldavia`s destiny. Jacob Basilides the Heraklid (1511–1563), a highly cultivated humanist, was born in Crete or, more probably, in Samos. Between 1548 and 1552 he studied


40

medicine in Montpellier at the renowned Faculty founded there in 1220. [11] However, he soon proved fighting skills and followed a successful military career in the service of Carol Quintus. In 1561, Jacob became a short-lived Prince of Moldavia (1561-1563) and in 1562 founded a Latin School (Schola Latina) at Cotnari, not far from Ia�i. As a fervent adept of Reformation, the Heraklid appointed protestant teachers, the first of them chosen among those in the city of Bra�ov, at the boundaries between Transylvania,Wallachia and Moldavia. Biological concepts were probably taught in this ante letteram Academy, whereas medical lectures were seemingly envisaged by Jacob Basilides to be also given, in a future that never came for him. [15] Historians surmise that the precious library of the Cotnari School included medical books, too. [1, 15]

Early Enlightenment in Moldavia and Wallachia

In the XVII-th century, once again, the Romanian Lands were reborn to a new life under the conjoint impact of Greece and Rome. On the one hand, Greek inte-llectuals fleeing the Turkish oppression potentiated the existence of a „Byzance after Byzance”, trying to maintain and further develop Greek values and culture. On the other hand, Italians were fulfilling diplomatic, religious and scientific missions in the vecinity of the “Sublime Porte” of Constantinople. Noble Greek families settling down in or travelling to the Romanian Countries of Wallachia and Moldavia contributed to local society emancipation and cultural flourishing. Phanariot rulers marked the «Early Enlightenment» period, opened these Lands towards both Western European horizons and ethnic ideals, stimulated national awakening. [4, 5] The Greeks mediated cultural contacts mainly with

Italy, England and France, encouraging medical practice and teaching to develop, as they tried to restore their identity within this diasporas of a «historic exile».

Constantin Cantacuzino Constantin Cantacuzino (1650-1716),

high steward of Wallachia, studied medicine in Padua, travelled to Venice, and possessed an impressive library including updated medical works. (16) Part of them ended up in Nicolae Mavrocordatos` library. [2, 3]

Fig.1. Constantin Cantacuzino

He drew the first map of Wallachia

with the aid of Ioan Comnen (Ioannis Comnenos), a Greek-born theologian and physician who graduated at the same famous University of Padua. [2, 3] It was Hrysant Notara (Chrysanthos Nottaras), patriarch of Jerusalem, who corrected and edited it in Padua in 1700. Born at Trikkala in Peloponnese, Notara studied medicine in Padua, spent many years in Wallachia and contributed to the flourishing of the Princely Academy in Bucharest and of its library. He probably promoted medical studies there.

Nicolae Mavrocordat Nicolae Mavrocordat (Nicolaos

Mavrocordatos, 1680-1730) of Chios, the first Phanariot prince, was the humanist owner of “the richest library in Oriental Europe” with medical treatises. He wrote a satire against tobacco “A Word against Nicotine” - and about life and death. (4,5,14) Prince of both Moldavia (1709-1710; 1711–1715) and Wallachia (1715–

D. BARAN, - Greek physicians and medical emancipation of the Romanian lands 41

1716; 1719–1730), this “authentic citizen of the cosmopolitan «republic of letters»”, also interested, for instance, in the writings of Hobbes and Locke, introduced, reorganized and stimulated education and schools' activity.

Fig.2. Nicolae Mavrocordat

He used to practice medicine within his

family and medically assisted his close friends. Among them Hrisant Notara was a remarkable personality. He suffered from “reumatika” and Mavrocordatos would have treated him from 1715 to 1731, as mentioned by chronicler Nicolae Costin. In 1714, Notara donated books to the Academy of Ia�i and helped its reorganization.

Alexander Mavrocordatos, the Exaporite

Alexander Mavrocordatos (Alexandru Mavrocordat, 1641-1709), father to Prince Nicolaos Mavrocordatos, had married Princess Sultana, descending from the princely family of Alexandru Ilie�, who ruled over Wallachia (1616-1618; 1627-1629) and Moldavia (1620-1622; 1631-1633). Physician, philosopher and physiologist, Alexandros Mavrocordatos studied in Padua and Bologna, where he graduated in medicine.

He was professor at the Constantinopolitan Academy of the Orthodox Patriarchate and, in 1644, he wrote a book on blood flow entitled “The Pneumatic Instrument of Blood Circula-tion” which disseminated information about Harvey`s discovery in this part of the world. Even though not directly involved

in the history of Romanian medicine, Mavrocordatos` destiny was undoubtedly a representative example of “Balkan koinonia” which also included the Romanian Lands.

Pulcheria, a “Lady Montagu” of Moldavia On February 19th, 1713, Nicolae

Mavrocordatos` second wife, Pulcheria Tzoukis (?-1716), variolated her two healthy children in Constantinople, after another one already got small-pox.

Fig.3. Pulcheria

As it comes out from a letter addressed

to Hrisant Nottara, patriarch of Jerusalem, she could have done this herself since she had medical knowledge and skills. Pulcheria anticipated by several years the similar initiative of Lady Mary Wortley Montagu (1689-1762), who only in 1718 had her son inoculated in Constantinople, probably by Dr. Timoni, and her daughter in 1721, in London.

Emanuel Timonis Emanuel Timonis (Emmanouel

Timonis,1669-1720) of Chios described variolation in Royal Society`s Philoso-phical Transactions, in 1714-1716, no. 29, pg. 72-82, in an article titled "An account, or history, of the procuring of the smallpox by incision or inoculation, as it has for some time been practiced at Constantinople, being the Extract of a Letter from Emanuel Timonius, Oxon. & Patav. M.D.SR.S. dated at Constantinople,


42

December, 1713. Communicated to the Royal Society by John Woodward, M.D. Profes. Md. Gresh. and S.R.S“. [6] Timonis was Ghika princely family`s doctor, in Moldavia (1680-1700). [8] He was even accused of involvement in Grigore I Ghica's death in 1678 and plotting with the rival Cantacuzino family. In Padua, Timoni studied medicine, at the reputed Faculty whose pro-rector he became in 1691. [6] In 1703 he was doctor of the Oxford University and member of the Royal Society. In 1713, Timoni published in Constantinople “Historia variolarum quae per incisionem exci-tantur”, whereas, in 1721, in Leiden, appeared his “Tractatus de nova variolas per transmutationem excitanti methodo”. Better known than Pylarino, his contri-bution to immunology and vaccinelogy has been more frequently mentioned. [6]

Jacob Pylarino Doctor Jacob Pylarino (Jakovos

Pylarinos/ Giacomo Pilarino, 1659-1718) of Lixouri, Kefallonia, graduated in Padua. He learned in 1701 about “transplant-tation”, as a popular means to prevent smallpox, from a woman in Thessaly who inoculated 40000 people.

Fig.4. «Nova et tuta variolas»

After having performed this technique,

Pylarino published in Venice, in 1715, the first approach to variolation, his paramount opus "Nova et tuta variolas excitandi per transolantationem methodus, nuper inventa

et in usum tracta qua rite per acta immuniaa in posterum praesenvatur ab hujus modi contagio corpora: Per Jacobum Pylarinum, Venetum M.D. et Peripublicae Venetae apud Smyrnenses Nuper Consulem“.

Fig.5. Philosophical Transactions of the Royal

Society, 1714-1716

He also presented variolation in the British „Philosophical Transactions of the Royal Society”, in 1714-1716, no. 29, pg. 393-399 as "Nova et tuta variolas excitandi per transplantationem methodus, nuper inventa et in usum tracta: Per Jacobum Pylarinum, Venetum M.D. et Peripublicae Venetae apud Smyrnenses Nuper Consulem“. [12] As a court physician, he travelled a lot to Germany and Russia, where he was the personal doctor of Tsar Peter the Great, Serbia and Moldo-Vlachia. [2, 6] In 1684 indeed, Pylarino came to Wallachia, as doctor to Prince �erban Cantacuzino and remained in Bucharest until 1687. Between 1694 and 1708, when appointed Venetian councilor in Smirna, Pylarino was again in Wallachia, as physician to the Ruling Prince Constantin Brâncoveanu. [3, 8] He encouraged medical lectures to be given at the “Saint Sava” Princely Academy in Bucharest, where teachers were usually Greek physicians and theologians. [2, 3] Among them: Markou Porphyropoulou, Ioan Comnen, Nicolaos Kerameos (Nicolae Kerameus). Remarkably, young Greeks living in Wallachia could get scholarships from Prince Brâncoveanu and study


medicine abroad, as did Giorgos Hypomenas of Trabzon, who after graduating in Padua, became a practitioner in Bucharest. [3] Pylarino supported the achievement of the “Col�ea” Hospital in Bucharest, in 1704, the first great hospital in the Romanian Lands.

Fig.6. Bucharest. Col�ea Hospital and Church

Fig.7. Venice. «San Lazzaro» Hospital

Built at the expense of High Stewart

Mihail Cantacuzino who studied humanist disciplines in Padua, the institution reproduced the model of the “San Lazzaro dei Mendicanti” («Saint Lazarus of the Beggars») Hospital in Venice.

Fig.8. Mihail Cantacuzino

Pylarino, who in his youth was a

physician there, yielded the plan of the Venetian establishment. [3, 8]

Variolation from Timoni and Pylarino to Jenner

In 1722, convinced of the utility of inoculation or engrafting, Lady Montagu intervened to the College of Physicians of London for determining acceptation of variolation for anti-smallpox protection. In 1796, Timoni`s and Pylarino`s method of vaccination, i.e. variolation, of 1713, reemerged. It was modified by Dr. Edward Jenner, who took the vaccination liquid not from smallpox patients, as Timoni and Pylarino, but from cowpox vesicles. [3] Jenner`s method gave better results, also because it caused a decreased mortality. Romanian popular medicine did the same.

Variolation in Romanian Popular

Medicine Alexander the Good, Prince of Moldavia

(1400-1432), mentioned in his Code of Laws («Pravila») of 1400 the «engrafting» technique of variolation. Doctor Andreas Wolf, who lived in Moldavia from 1780 to 1797, related that the country had been severely affected by smallpox for three-four years and variolation officially introduced since 1780. In 1803, vaccination was performed by dr.Hesse and dr. Fröhlich, without any fee, and was recommended by the Princely Court.

Griselini Francesco Griselini (1717-1784), an

Italian biologist and painter, agrarian economist and journalist illustrating the Venetian Enlightenment, visited Banat. It happened between 1774 and 1777, when both Venice and Banat were under Austrian authority.

Fig.9.Francesco Griselini


44

In 1780, he published “Geschichte des Temeswarer Bannats” («History of Temesvarer Banat», Vienna, 1780). He described variolation, which only Romanians performed in various ways: pustular smallpox fluid from sick persons was inoculated to healthy children after scarifying or rubbing their arm skin; pustular fluid was directly placed on the arm skin previously strongly rubbed with a rugged cloth until it became inflamed or a superficial incision of the arm skin was performed into which smallpox pustular fluid was placed. [7] Griselini commu-nicated his impressions about Banat in Letters addressed to outstanding persona-lities of his time, including Lazzaro Spallanzani (1729-1799). As in the case of Spallanzani, Griselini benefitted from the patronage of Habsburg officials during his travel through Banat and Wallachia.

Franz Joseph Sulzer In 1781-1782, Franz Joseph Sulzer

published his “Geschichte der Transalpinischen Daciens” («History of Transalpinian Dacians») where he reported variolation of young ladies on the forehead or wrist, practiced by Romanian girls of Transylvania”to preserve their beauty”. [3, 10]

Nyulas Ferenc In 1802, the Hungarian Physician

Nyulas Ferenc wrote about “Kolozsvári tehénhiml�” («Vaccination in Cluj»). He reported that peasants from Some� and F�g�ra� bathed their children in the milk of cows with cowpox, after washing with it the udder having cowpox vesicles. Other times, cowpox pustules were pricked with a fine needle which was then passed through the child’s ear lobe. In Ceanul Mare and Cicud, the Valach priests inoculated smallpox according a “mysterious” method known only by them. [3, 10]

Famous Followers in Modern Times Ioan Cantacuzino

The particular «genetic design» of this

continous Greek-Romanian cohabitation generated towering medical specialists that continued to be involved in immunology and vaccinology.

Ioan Cantacuzino (1868-1934) came from a mixed Greek-Romanian family, descending from its first «Enlightened» representatives of the XVII-th century, already mentioned: Constantin, Mihail and �erban. Ioan Cantacuzino studied in Paris, with Ilya Mechnikov (Nobel Prize, 1908).

Fig.10 Ioan Cantacuzino

A highly reputed microbiologist, he

founded, in 1901, a laboratory of experimental medicine and in 1921, established the Institute for Sera and Vaccines in Bucharest, bearing now his name.

Fig.11. Bucharest. “Cantacuzino” Institute

He distinguished himself during the II-

nd Balkan War, when «the great Romanian experience» of 1912-1913 revealed the efficiency of his anticholeric mass vaccination performed in epidemic foci. [3]


The «contact immunity» was thus definitely proved. During World War I, Cantacuzino successfully fought epidemics by antityphic-paratyphic, anti-diphtheric and anticholeric vaccination. He efficiently set up antituberculosis and antimalaria strategies in Romania. Due to him, a close friend to Calmette, his country was the second one, after France, to introduce Calmette-Guérin bacillus-based antituber-culosis vaccination.

At the Faculty of Sciences in Ia�i, Cantacuzino was professor of Animal Morphology (1894-1896).

In 1917, during World War I, he founded in Ia�i, along with Russian and French physicians, "The Medico-Surgical Society of the Russian-Romania Front”.

At the end of the war, in 1920, Cantacuzino represented Romania in Paris at the peace treaty, a document he signed with Titulescu on behalf of their country.

Constantin Levaditi Born at Gala�i as the son of a Romanian

mother and a Macedo-Romanian (Vlach) father from the Pindos Mountains, Constantin Levaditi (1874-1953) studied medicine in Bucharest and was trained in Victor Babe�’ school for five years, as an eminent research assistant. He then left for Paris, were he had a brilliant career at the „Pasteur” Institute. [9, 13]

Fig.12. Constantin Levaditi

Levaditi laid the basis of virology and

further developed immunology in universal medicine. He authored the first treatise of virology ever published -“Les ultravirus

des maladies humaines” (Paris, 1937)- and pioneered viral cultures techniques, including viral multiplication in tumoral tissues. He investigated poliomyelitis, syphilis and cancer, their origin and therapy. [9, 13]

Levaditi was nominated several times to the Nobel Prize for Medicine between 1930-1934.

Indirectly, he fathered microbiology in Romania, too, through his disciple, professor �tefan S. Nicolau (1896-1967). [3]

They first met in 1921 in Cluj, where Levaditi was appointed professor and Nicolau graduated. Levaditi put a mark on Nicolau, who, in 1942, inaugurated in Bucharest the first Chair of Inframicro-biology in the world.

Fig.13. �tefan S. Nicolau

Nicolau contributed to the

characterization of the Borna virus and virus replication in tumours.

In 1939, when he returned to Romania, Nicolau was initially appointed professor of Bacteriology at Ia�i, where he remained only for a short lapse of time.

Homo Balcanicus «Balkan countries» result to be more

than simply a geographical concept. This south-eastern European region shared common historical circumstances and challenges. Balkan peoples developed related features and adopted comparable behavioural patterns. At the crossroads of Orient and Occident, of three great


46

monotheistic religions - christianity, judaism and islam -, of three great empires - Austro-Hungarian, Ottoman and Russian, of three great ideologies - democracy, dictatorship, anarchy, and three great political systems - capitalism, communism and liberalism, the Balkan community seemed to display intertwined comple-mentary faces. Paradoxically, the «powder barrel» of Europe enabled a transcultural melting pot to exist, living this diversity, revealing identities, transforming menta-lities between health and disease, life and death. Medicine in the Romanian Lands evolved along both Western European and Balkan coordinates and its original contribution to the progress of science still awaits to be acknowledged and officially integrated to the universal history of the healing art. The peculiarities of Balkan medicine are in keeping with both homo balcanicus and homo europaeus and express the same aspirations of homo universalis.

References 1. Bârs�nescu �t, Schola Latina de la

Cotnari, Litografia �i Tipografia Înv��mântului, Bucure�ti, 1957.

2. Berza M, Pentru o istorie a vechii culturi române�ti, Ed. Eminescu, Bucure�ti, 1985, 173-193.

3. Bologa V, Istoria Medicinei Universale, Ed. Medical�, Bucure�ti, 1970, 284-8,398-9, 741-5.

4. Bouchard J, L'aube des Lumières dans les Pays Roumains, Rev Hist Inst Rech Néohell, 2005, 2:31-51.

5. Bouchard J,Nicolae Mavrocordat, domn �i c�rturar al Iluminismului

timpuriu, Ed. Omonia, Bucure�ti, 2006.

6. De Raymond J-F, Querelle de l'inoculation, ou, Préhistoire de la vaccination, Librairie Philosophique J.Virin, Paris, 1982, 31-39.

7. Giselini F, Încercare de istorie politic� �i natural� a Banatului Timi�oarei, Ed.Facla, Timi�oara, 1984.

8. Iftimovici R., History of Science in South-Eastern Europe, Newsletter, 2001, 5: 13:14.

9. Iftimovici R, Grama S, Newsletter for the History of Science in Southeastern Europe, 2003, 7:13-14.

10. .Ionescu C, Prophylaxis of Smallpox in Romanian Traditional Medicine, J Prev Med, 2001, 9: 74-76.

11. Izsák S, Étudiants roumains à l`Université montpelleraine, 16e Cong Int Hist Méd, Montpellier, 1958.

12. Karamberopoulos D, The medical European knowledge in the Greek region 1745-1821, Library on the History of Medicine, Publishing House Ath. Stamoulis, Athens, 2003, 1: 312.

13. Lascaratos J,.Kalantzis G, Skiadas P, Constantin Levaditi: An unknown pioneer in immunology research, Arch Hell Med, 2003, 20, 3:319–325.

14. Radu R, Cultura Mavrocorda�ilor, Economia, 2004, 2: 91-93.

15. Romanescu C, Note medico-istorice la domnia lui Despot Vod�, Rev.Med, 1969, XV, 1: 110-112.

16. Ruffini M, Biblioteca stolnicului Constantin Cantacuzino, Ed. Minerva, Bucure�ti, 1973.


THE IMPORTANCE OF STUDYING GREEK PHILOSOPHERS AND PHYSICIANS (5TH – 3RD CENTURY B.C.): CONTRIBUTION TO

THE DEVELOPMENT OF NEUROSCIENCE IN MEDICAL SCHOOLS

D. DIACONESCU1, S. TOMA1,

R-S DIACONESCU1

Abstract: The nature of psychic life, the anatomical seat of cognitive, motor and sensory functions, and the origin of neurological diseases were broadly debated by ancient Greek scientists since the earliest times. Within a few centuries, speculation of philosophers and physicians laid to foundations of modern experimental and clinical neuroscience. In this review we shall present the most important Greek philosophers and physicians living between the 5th and the 3rd century before Christ (B.C.) and examine some of their leading theories concerning the mechanisms of cognitive activity, the nature of perception and voluntary movement, and the causes of neurological and psychiatric disorders . Key words: History of neuroscience; Presocratic philosophers; Alexandrian medicine; Hippocratic medicine.

1 Transilvania University of Brasov

Introduction Since the earliest times ancient Greek

scientists debated the nature of psychic life, the anatomical seat of motor, sensory and cognitive functions, and the basis of some neurological and psychiatric diseases.

The aim of this study was to present the theories of the most important ancient Greek philosophers and physicians (5th-3rd

century B.C.). Content The origin of thinking activity was

explained by Greek philosophers and physicians based on two theories. The encephalocentrism considered the brain as

the seat of human consciousness, sensation and knowledge, all these faculties being attributed by the cardiocentrism to the heart. Both theories generated controversy within the scientific community [4].

a. Philosophers Hippon of Samos (4th century BC)

localized the main part of the soul to the head, particularly to the brain. Anaxagoras of Clazomenae (500–428 BC) and Diogenes of Apollonia (ca. 460 BC) believed that all sensations had connection to the brain [4].


48

Empedocles of Acragas (490–430 BC) thought that “the blood around the heart is men’s thought” [5]. Thus, humans think with the blood and the level of intelligence depends on blood’s composition. That is why he considered the heart also as the seat of mental disorder [19].

In the opinion of Empedocles, sensation is a purely physical process, depending on pores and affluences. Affluences enter continually in another body through pores and sensation is a matter of symmetry of pores [5].

Fig.1. Empedocle – source Wikipedia Aristotle (384 BC – 322 BC) was

probably the first anatomist in the modern sense of this term [11]. According to Aristotle, the soul is defined as the the form of a living body [18].

Aristotle had interesting contributions to brain anatomy. He observed that the brain was placed in the front part of the head and was surrounded by the meninges, two membranes containing blood vessels. The external membrane was the thickest and located next to the bone of the skull; the more delicat internal membrane was localized around the brain itself.

For the first time an important anatomical distinction between cerebrum (enkephalos, brain) and cerebellum (parenkephalis, para-brain) was made by Aristotle. The para-brain was positioned beyond the brain, and its shape and tissues were different from those of the brain.

Aristotle also identified three possible nerves - “poroi” (ducts) – two of them leading to the cerebellum and one to the brain [1]. These ducts might refer to the optic nerve and tract, and to trigeminal and oculomotor nerves [3]. He also described a cavity in the brain, probably the ventricular system, and made the observation that man has the largest brain in proportion of his size. He also referred to “liquidity about the brain”, probably the cerebrospinal fluid. Aristotle described the spinal cord as an extension of the brain and the similar constitution for both structures [1]. But Aristotle’s theories about brain function were rather dissapointing. In his view, brain had no sensory properties and was insensible when touched. He concluded that the brain was a cooling organ, after he noticed a lot of blood vessels on the surface of the brain, therefore having no intellectual meaning. Aristotle also considered the brain as the sleep generator [3].

Fig.2. Aristotle – source

www.wicknet.org/.../gallery_of_the_greats.htm b. Physicians The sensory and cognitive significance

of the brain was probably first recognized by Alcmaeon of Croton (500 BC) [15]. He asserted that “all the senses are connected with the brain” through channel-like structures called “poroi”, two of them, no

DIACONESCU et al.: The importance of studying Greek philosophers and physicians (5th – 3rd century B.C.): contribution to the development of neuroscience in medical schools

49

doubt the optic nerves, joining the eyes to the brain. Alcmaeon claimed that the brain was the seat of consciousness and sensation because he recognized that all senses “are compromised if the brain is moved and changes its place” [5].

He distinguished sensation from understanding: “man differs from the other animals in that he alone has understanding, wheras, they have sensation but do not understand” [4].

Based on anatomical evidence, he proposed that the brain was essential for perception [6, 7] and “the seat, in which the highest, principal power of the soul is located” [5].

Alcmaeon was wrong saying that sleep occurs when blood vessels in the brain are filled and that waking is caused by the emptying of these vessels [16].

�Fig.3. Alcmeon – source philosophers.endless-

greece.com/alcmaeon.php In the fourth century BC, Hippocrates

(ca. 460 BC – ca. 370 BC), the “Father of Medicine”, started a new way of looking at illness. The main theory stated that disease is the result of an imbalance of body constituents or humors and that disease has nothing to do with demons [10].

For Hippocrates the human brain is cleft into two symmetrical halves by a vertical membrane and is also the seat of human intellect and the cause of neurologcal disorders. In De morbo sacro, epilepsy, called in antiquity “the sacred disease”, is not “any more divine or more

sacred than other disease, but has a natural cause, and its supposed divine origin is due to men’s inexperience and to their wonder at its peculiar character”. In the same treatise, the brain was considered the seat of judgement, emotions and aesthetic activity [12]. Thus thinking activity, moral consciousness, perceptive elaboration and control of body’s movement, were functions all localized to the brain.

Hippocrates explained mental insanity as a process of brain corruption induced by bile, one of the four humours.

In a case report about sudden loss of speech and paralysis of the right hand, the term “spasm” is used [13].

It was stated that “an incised wound in one temple produces a spasm in the opposite side of the body” and that loss of speech occurred with “paralysis of the tongue or of the arm and the right side of the body” [2].

Hippocrates was also one of the most prominent ancient greek physician who practiced trepanation [17]

Fig.4. Hippocrates – source

http://commons.wikimedia.org/wiki Diocles of Carystus (ca. 375–300 BC)

stated that the right half of the brain provided sensation and the left intelligence, and that the heart is the centre for hearing and understanding. In his opinion, madness was “boiling of the


50

blood in the heart”, lethargy was “a chilling of the psychic pneuma about the heart and the brain and a freezing of the blood dwelling in the heart”, and melancholy was considered as a disorder arising “from thickening of black bile around the heart” [8].

Erasistratus of Chios (ca. 304 – ca. 250

BC) founded, together with Herophilus, a school of anatomy in Alexandria, where the two performed human dissections on criminals [21].

Erasistratus described a system of humors consisting of nervous spirit - carried by nerves -, animal spirit - carried by arteries -, and blood - carried by veins. Erasistratus considered that atoms are the essential body element. Atoms were activated by pneuma (external air) that circulated through the nerves. He thought that the inspired air is transformed into “vital spirit” and transported to the brain’s ventricles, where it becomes “animal spirit”. The animal spirit filled the empty nerves and let them control the muscle movement [21].

According to Erasistratus, the dura mater had the greatest significance, being considered the center of sensitive, motor, and cognitive functions. Therefore, psychiatric and neurological disorders were thought to depend on pathological changes of this membrane. He considered that lethargy “arises from an affection of the psychic faculty in the meninx, which is precisely where lethargy occurs”. Delirium was “a disorder of the activity of the meninx” [9].

Erasistratus is one of the first who described the cerebrum and cerebellum. Initially, he asserted that nerves also originate from the meninges. Later, he recognizes that nerves originate from brain. He also established a relationship between the the number and complexity of the human brain convolutions and

intelligence [8].

Fig.5. Erasistratus of Chios – source

http://www.encyclopedia.com/

Herophilus of Chalcedon (335-280 BC), the “Father of Anatomy”, is also considered the founder of human anatomy as a distinct branch of medicine [14].

Fig.5. Erasistratus of Chios – source

womenshealth.medinfo.ufl.edu/.../slide5.html He made a series of accurate

descriptions of neuroanatomical structures. He also made a clear distinction of the brain ventricles, identifying that they are in reciprocal communication and therefore allow passage of the psychic pneuma.

He described precisely the cerebellar ventricle, the fourth ventricle or the posterior ventricle. He also described and nominated some structures visible on the floor of this cavity, such as the calamus

DIACONESCU et al.: The importance of studying Greek philosophers and physicians (5th – 3rd century B.C.): contribution to the development of neuroscience in medical schools

51

scriptorius, the posterior median sulcus and the colliculus facialis. He accepted Aristotle’s distinction between enkephalos and paraenkephalos, recognizing that they are separated by a thick membrane – tentorium cerebelli.

He described a membrane covering the ventricles of the brain as the “choroid meninx”. Along with Erasistratus, he was considered the first anatomist who identified motor and sensory nerves and who located their origin correctly in the brain or in the spine. He described the

optic, oculomotor, trigeminal, motor root of the trigeminal, facial, acoustic and hypoglossal nerves [4, 20].

Erasistratus and Herophilus first identified that cutting nerves causes paralysis.

Conclusions All these theories represent great

achievements transmitted by Greek philosophers and physicians to later generations of neuroscientist.

References 1. Aristotle, Gotthelf A. Historia

Animalium, vol. I: Books I-X - Cambridge Classical Texts and Commentaries, No. 38, 2002

2. Chadwick J, Mann NW. The Medical Works of Hippocrates. Blackwell, London, 1950.

3. Clarke E. Aristotelian concepts of the form and function of the brain. Bull Hist Med All Sci 1963;37:1-14.

4. Crivellato E, Ribatti D. Soul, mind and brain: Greek philosophy and the birth of neuroscience. Brain Research Bulletin 2007;71(1):327-338.

5. Diels H, Kranz W. Die Fragmente der Vorsokratiker. 12th ed, Berlin, 1966.


52

6. Doty RW. Alkmaion’s discovery that brain creates mind: A revolution in human knowledge comparable to that of Copernicus and of Darwin. Neuroscience 2007; 147(3):561-568.

7. Doty RW. Alkmaion, ca 500 BC, discovers that mind is in the brain. Neuroscience Research 2007; 58 (suppl.1): S243.

8. Garofalo I. Figure della medicina ellenistica. In: G. Cambiano, L. Canfora, D. Lanza “Lo spazio letterario della Grecia antica”, vol. 1. 2, Roma 1993:345-368.

9. Garofalo I. Anonimi Medici, De Morbis acutis et chroniis. EJ Brill, Leiden 1997

10. Garrison FH. History of Medicine. Philadelphia, W.B. Saunders, 1966

11. Gross CG. Aristotle on the brain. The Neuroscientist 1995;1(4):245-250.

12. Hanson AE. Hippocrates: The “Greek Miracle” in Medicine. In: Medicine, Lee T. Pearcy, The Episcopal Aca-demy, Merion, PA 19066, USA, 2006

13. Hippocrates. Of the Epidemics (400 BCE). Section III, case 13. Translated by F. Adams.

14. Longrigg J. Anatomy in Alexandria in the third century BC. Brit J Hist Sci 1988; 21: 455-488.

15. Lloyd GER. Alcmaeon and the early history of dissection. Sudhoffs Arch 1975; 59: 113-147.

16. Lyons AS, Petrucelli RJ. Medicine. An Illustrated History. New York: Harry N. Abrams, Inc., 1987:187,192

17. Mission S. Hippocrates, Galen, and the uses of trepanation in the ancient classical world. Neurosurg Focus 2007;23(1):E11.

18. Movia G. Aristotele. Anima, Milano: Rusconi, 1996

19. Phillips ED. Greek Medicine (Aspects of Greek and Roman Life). London, Thames and Hudson, 1973.

20. Rowe CJ. Plato: Phaedo (Cambridge Greek and Latin Classics). Cambridge, University Press, 1993.

21. Wright JP, Potter P. Psyche and soma: physicians and metaphysicians on the mind-body problem from antiquiry to Enlightenment. Oxford: Clarendon Press 2000.


DOCTOR-PATIENT RELATIONSHIP IN NEUROPATHIC PAIN: A COMPARATIVE

STUDY BETWEEN URBAN AND RURAL ZONE

L. TARTAU1, R. V. LUPUSORU2, C. E. LUPUSORU1, C. ANDRITOIU1, O. DUMA3

Abstract: A descriptive study, regarding some ethical issues within the physician-patient relationship in the management of neuropathic pain. Method: This study was performed on a sample of 278 patients with neuropathic pain, in a comparison between urban and rural area medical centers, from Iasi County. This investigation was based on medical records and anonymous questionnaire; the informal consent was required. Results: The doctor-patient relationship in rural medical centers is better than in urban, patients being more satisfied with the medical consultation and more likely to comply with the treatment than patients in urban area. Opioids, antidepressants and anticonvulsants were recommended especially in urban medical center, but in a small number of patients. Conclusion: Even though there are some differences and meanings of the interactions between the physicians and sick peoples in urban and rural medical care centers, the study shows that in both cases, neuropathic pain is often undertreated, due to insufficient acquainted of the literature data, regarding the new modern therapeutic strategies in this type of pain. Key words: neurophatic pain, ethic, doctor-patient relationship.

1 Pharmacology, Algesiology Department, „Gr.T. Popa”, UMF, Ia�i, Romania 2Pathophysiology Department, UMF, Ia�i, Romania 3Public Health and Sanitary Management Department, UMF, Ia�i, Romania

Aim: The paper represents a descriptive study, concerning in a comparison between urban and rural area from Iasi county, one of the most representative in the region of Moldova, regarding the physician-patient relationship in the management of neuropathic pain.

General data The family physician plays a key role,

being the first contact person for the patient. Addressability to medical services takes a central position in patient-physician communication and relationship. [9] The

establishment of an optimal rapport between the physician and patient is essential to both parties, a successful colla-boration depending on the physician’s ability to manage unhealthy person expectations. [1, 7, 18]

This relationship concerns the foundation of contemporary medical ethics, and implies the existence of the physician, who offers specialized and responsible services first, and, on the other hand, the existence of the patient, who needs medical assistance. [22] These both parties can openly discuss the risks of


54

patient during medical procedures, and choices regarding the possibilities to improve his quality of life. [3, 15, 21]

In terms of bioethics, patient-physician interrelation comprises patient’s right to the confidentiality of his medical problem, his consent to treatment, but also the right to health and to not be at pains. Physician’s vocation implies all activities targeted to preserve population health status, to prevent illnesses, to improve the patient healthy living conditions. [1, 13, 15]

The major requirements of this complex physician-patient relationship are based on friendship, effective communication, respect, and mutually trust. Patient health outcomes can be improved with good physician-patient communication. [14, 25] Working together, the potential exists to pursue interventions that can significantly improve the patient's quality of life and health status. [13, 17, 20]

Pain plays a central role in the health care system, and is one of the most frequent reasons for consulting a doctor. Primary care is the most frequent care provider for pain. [11]

Neuropathic pain is a complex, chronic pain state that usually is accompanied by tissue injury. Within neuropathic pain, the nerve fibers themselves may be damaged, dysfunctional or injured. Major patho-physiological mechanisms include peri-pheral sensitization, sympathetic active-tion, disinhibition, and central sensiti-zation. [4, 16] Neuropathic pain is associated with many diseases, including diabetic peripheral neuropathy, posther-petic neuralgia, human immunodeficiency virus – related disorders, and chronic radiculopathy. [5, 6, 10] Neuropathic pain is described as burning, electric, tingling and shooting in nature. [4, 10] Numerous therapeutic options are available, including systemic medications, physical rehabilita-tion, behavioural modification, and invasive procedures. [5, 8] Unfortunately,

most neuropathic syndromes respond poorly to nonsteroidal antiinflamatory drugs and opioid analgesics. First-line agents for modern treatment of neuropathic include tricyclic antidepressants, pregabaline, gabapentin, topical lidocaine, tramadol, and opioids. [12, 19, 23, 24]

Method This exploratory study was performed,

during six months (September 2008 - February 2009) on a sample of 278 patients with neuropathic pain, aged 25-70 years, from urban (157 cases) and rural medical centers (121 cases) in county of Iasi. This investigation was based on both medical records and anonymous question-nnaire, to obtain detailed information, regarding intensity of pain, associated diseases, and the treatment of neuropathic pain.

The purpose of this study was to describe the socio-demographic patterns, consultations, pathology and the treatment of attendants at general practitioners at these two primary health care centers. The questionnaires involved epidemiologic characteristics and also, patient-reported relevance and performance of the consultation aspects. It was also identified the impact that physician-patient inter-personal interactions have had upon the satisfaction of primary medical services.

The authors designed the questionnaire according to those presented in the literature. The study was performed with the support of the family physicians, for data collection. All questionnaires were distributed and collected, trying to maintain the confidentiality of the recorded data. All patients were informed about the aim and purpose of the investigation and how to fill in the questionnaire. Once they had given their consent, patients were asked to complete the self-administered questionnaire. Incomplete questionnaires were excluded. Data were scored and

L. TARTAU, ez al.:- Doctor-patient relationship in neuropathic pain: a comparative study between urban and rural zone

55

statistically analyzed with t test from Windows EXCEL program.

Results and discussions This study intended to directly compare

data about medical services between urban and rural primary care centres. Interviews in the practices of both general practi-tioners have indicated a higher prevalence of neuropathic pain in male subjects, of 57% in urban, 55% in rural area.

Analysis and statistical processing of data shows that in more than 75% of patients seeking medical advice in both medical centres, the pain was reported to be intense to severe (range 6 to 10) to visual analogue scale of 0-10 values (with 0 being no pain, 5 mild pain and 10 being the worst pain imaginable). (Fig. 1)

Fig. 1

The average score computed by

residence area didn’t show significant differences between urban and rural subjects (p>0.05). Impairment in everyday life caused by neuropathic pain was significant in both medical care centres. The fact that more than 72% see themselves as impaired in their daily activities illustrates the extent of the restrictions due to pain. Emotional changes due to pain lead to high psychological strain and loss of quality of life.

The most frequent causes of neuro-pathic pain are represented by chronic radiculopathy, diabetic (55.4% in urban, 61.2 in rural), followed by neoplastic and

postherpethic neuralgia. (Fig. 2)

Fig. 2

In both medical centres the

pharmacologic treatment of neuropathic pain consists of nonopioid analgesics administration, drugs that proved no efficacy in this type of chronic pain, according to the literature data findings of the checks. [12, 23]

Nonsteroidal anti-inflammatory drugs were administered to all patients, associated or not with analgesic-antipiretic drugs. Opioid, antidepressant and anticon-vulsant drugs were recommended espe-cially in urban medical centre, but in a small number of neuropathic patients. Tramadol was the only one type of opioid medication recommended in patients with neuropathic pain, especially in urban medical centre. (Fig. 3)

Fig. 3


56

Regarding the physician-patients relations, the investigation showed that there are some differences and meanings of the interactions between the doctors and sick peoples in urban and rural medical care centres.

However, only a few patients have received pain treatment properly adjusted to their needs. Around 18% of patients consider any of their therapies satisfactory in reducing their pain.

In a rural medical centre, the patients’ satisfaction with the consultation was related to the longer consultation times. Opposite to this, in urban medical centre, most patients complains sometimes about busy doctor, who has too little time to listen, only a small number of patients being satisfied with the time given to medical consultation. (Fig. 4) This aspect is inconclusive, because it is possible that a patient’s estimation may be altered by his experience consultations.

Fig. 4

The results of questionnaires evaluating

patient expectations prior to the visit have been compared with his satisfaction measured after the consultation. In rural area the patients are more satisfied and more likely to comply with treatment recommended. On the other hand, the urban patients tend to identify the doctor as their main source of information wishing

to receive detailed data and explanation about their diagnosis, treatment and course of illness, attitude that may disturb the stages in the medical consultation procedure.

These results are concordant with literature data which stipulate that the lack of sufficient attention to psychosocial issues may be even more related to dissatisfaction, than the presence of attention is related to satisfaction. [2, 25]

Our study revealed a better physician-patient interrelation in rural than in urban medical centre, because in the first case, the practitioner is more familiar with patient and his medical history, dealing that strongly increases patient trust in doctor. (Fig. 5) It is also true that in some situations this relationship may be impaired by the deficiency of commu-nication, due to the poor intellectual level of the patients. The mentioned commu-nication difficulties can be described with reference to problems of diagnosis, a lack of patient’s involvement in the discussion, or the inadequate provision of information to the patient. [2, 14]

Fig. 5

Secondly, despite the fact that the rural

family physician is insufficient scientific documented about the new trends of pharmaco-therapeutic strategies in the

L. TARTAU, ez al.:- Doctor-patient relationship in neuropathic pain: a comparative study between urban and rural zone

57

treatment of neuropathic pain, he proved high overall responsiveness to the patients and tasks performed complies their demands.

Conclusions

� in this two medical centres, the most frequent causes of neuropathic pain are represented by chronic radiculopathy, diabetic, neoplastic and postherpethic neuralgia;

� in both medical centers, the pharma-cological treatment of neuropathic pain consists of nonopioid analgesic drugs (especially the nonsteroidal antiinfla-mmatory - ketoprofen, indometacin, and analgesic antipyretic – aceta-minophen) administration.

� opioid, antidepressant and anticonvulsant drugs were recommended especially in urban medical center, but in a small number of neuropathic patients.

� in our country, most health care practices are not sufficiently prepared to manage neuropathic pain;

� neuropathic pain is often undertreated, due to insufficient acquainted of the literature data, regarding the new modern therapeutic strategies in this type of pain.

� primary health care system parti-cularities are less important for doctor-patient communication that was expected;

� patients in rural area are more satisfied with the medical consultation and more likely to comply with the treatment, than patients in urban area;

� the doctor-patient relationship in rural health care is better than in urban medical care;

� the obtained data has provided detailed understandings of the strengths and limitations of primary medical care services, not evident in official reports.

References: [1]. Ast�r�stoaie V., Almo� T. B., Esentialia

in Bioetica, Ia�i, Ed. Cantes, 1998. [2]. Bell R. A., Kravitz R. L., Thom D. et

al., Unmet expectations for care and the patient-physician relationship, J. Gen. Int. Med., 2002, 17: 817-824.

[3]. Benatar S. R., Public health and public health ethics, Acta Bioethica, 2003; 9 (2).

[4]. Cavenagh J., Good P., Ravenscroft P., Neuropathic pain: are we out of the woods yet?, Intern. Med. J., 2006; 36: 251-5.

[5]. Cruccu G., Anand P., Attal N. et al., EFNS guidelines on neuropathic pain assessment. Eur. J. Neurol., 2004 Mar; 11(3):153-62.

[6]. Cruciani R., Update on the mana-gement of neuropathic pain in cancer patients, in Burton, A. (ed.), Current Thinking in Trends in Cancer Pain Management: Towards optimal symptom management, The Biome-dical & Life Sciences Collection, Henry Stewart Talks Ltd, London, 2009.

[7]. Dugdale L. S., Siegler M., Rubin D. T., Medical Professionalism and the Doctor-Patient Relationship, Perspectives in Biology and Medicine, Volume 51, Number 4, Autumn 2008, pp. 547-553.

[8]. Finnerup N. B., Otto M., Jensen T. S. et al, An evidence-based algorithm for the treatment of neuropathic pain, Med. Gen. Med., 2007 May 15; 9 (2): 36.

[9]. Freeman G. K., Olesen F., Hjortdahl P., Continuity of care: an essential element of modern general practice?. Fam. Pract., 2003, 20: 623-627.

[10]. Gore M., Dukes E., Rowbotham D.J., Clinical characteristics and pain mana-gement among patients with painful peripheral neuropathic disorders in general practice settings, Eur. J. Pain, 2007; 11(6):652–64.

[11]. Hasselstrom J., Liu-Palmgren J., Rasjo-Wraak G., Prevalence of pain in


58

general practice. Eur. J. Pain., 2002, 6: 375-385.

[12]. Helme R. D., Drug treatment of neuropathic pain, Aust. Prescr., 2006; 29:72-5

[13]. Hottois G., Missa N. J., Nouvelle encyclopedie de bioethique, Bruxelles, DeBoeck Université éditions, 2001, 229–35.

[14]. Kerse N., Buetow S., Mainous A. et al., Physician-patient relationship and medication compliance: a primary care investigation, Ann. Fam. Med., 2004, 2: 455-461.

[15]. Knight B., The ethic of medical practice, Simpson`s Forensic Medi-cine, 10th Edition, Knight B. (ed.), Edward Arnold London Melbourne Aukland, 1991, pp. 236-243.

[16]. Pasero C., Pathophysiology of neuropathic pain. Pain Manag. Nurs., 2004; 5: 3-8.

[17]. Rao J. K., Anderson L. A., Inui T. S. et al., Communication interventions make a difference in conversations between physicians and patient, Medical Care, 2007, 45: 340-349.

[18]. Rogozea L., Etica si deontologie medicala, vol. 1, Ed. Universit��ii Transilvania, 2006.

[19]. Saarto T., Wiffen P. J., Antidepre-ssants for neuropathic pain, Cochrane Database Syst. Rev., 2007 Oct 17; (4):CD005454. [abstract]

[20]. Safran D. G., Defining the future of primary care: what can we learn from patients?, Ann. Intern. Med., 2003, 138 (3): 248–55.

[21]. Street R. L., O’Malley K. J., Haidet P. et al., Understanding concordance in patient-physician relationships: perso-nal and ethnic dimensions, of shared identity. Ann. Fam. Med., 2008; 6(3): 198-205.

[22]. Veninga C. C., Denig P., Zwaagstra R. et al., Improving drug treatment in general practice. J. Clin. Epidemiol., 2000, 53:762-772.

[23]. Wallace J. M., Update on pharma-cotherapy guidelines for treatment of neuropathic pain, Curr. Pain Headache Rep., 2007; 11(3):208–14.

[24]. Wiffen P., Collins S., McQuay H. et al; Anticonvulsant drugs for acute and chronic pain, Cochrane Database Syst. Rev., 2005 Jul 20; (3): CD001133.

[25]. Williams S., Weinman J., Dale J., Doctor-patient communication and patient satisfaction: a review, Fam. Pract., 1998: 480-492.


A REFERENCE ANALYSIS ABOUT THE HUMAN SOUL

L. ROGOZEA1, M. DRAGOMAN1, F. LEA�U1, M. �URCANU1, R. MICL�U�1, M. CARDIS1

Abstract: „The nervous and mental illnesses, prevention and treatment”, a work of the former doctor Aurel Dobrescu from Bra�ov, is one of the most interesting book edited by “Medical ASTRA”, and it is an analyze of the human soul, of the normal life against the sick life Key words: manuscript, Dobrescu, ASTRA

1 Faculty of Medicine, Transilvania University of Bra�ov.

The book was edited in 1919 and one year later was awarded by the Romanian Academy. It has 163 pages and it addresses to the general audience with new information about neurology and psychiatry. It has a special part about developing the child’s mind, and it is of a real use for teachers and parents.

Fig. 1. - A. Dobrescu – Book cover

The knowledge of nervous system’s structure and physiology represents the fundament of all nervous phenomenon, dr. Dobrescu presents in his study some general issues, then reflexes and instincts and in the end the analyzes of the most abstract psychological activities.

First part of the book is called ”Generalities about the nervous system” and it has 5 chapters.

Chapter 1, “The knowledge of the brain, throw which the soul’s life is produced, is necessary for everybody” highlights the importance of discovering the human brain’s secrets.

Fig. 2. - A. Dobrescu – book illustration –

nervous system


60

The next chapter “The new direction of psychology to laboratory and clinic” follows the evolution of psychology in a new direction, from simple auto-intuitive observation to laboratory and clinic methods and in the end to helping methods as intoxications and hypnotism. Following the new direction, the author studied the psychology of the child, abnormal people, primitive populations, criminals and animals.

Considering that ”a psychology which wouldn’t consider all the actual data were collected from these new sources of knowledge, is obsolete and narrows the horizon of modern man”, the author stresses the importance of evolution in science

. Fig. 3. - A. Dobrescu – book illustration –

nervous cell

Chapter 3 of the first part concludes: “Psychology proposed in nowadays schools is too theoretical” and reco-mmends the use only of real data of physiology of the nervous system in textbooks, and then to study the causes, forms and means of preventing illness and treatment of nervous diseases. In Chapter 4 we find that mental illness “however would be kaleidoscopic, are caused by the illness of a single organ, the brain”.

Fig. 4. - A. Dobrescu – book illustration – brain

The next chapter of the first part, ”The

significance of the brain” shows that differences between humans and animals due to more complex structure of the human brain.

The second part studies in 6 chapters the main functions of the nervous system.

The first chapter presents, over 5 pages, the nervous cell, part of the nervous system. As the author states, "the nerve cell, the neuron, is composed of the actual cell and one or more threads that hang from it" Also, in this chapter, the author makes a distribution of the nervous system's tasks between sensory nerves, motor nerves, sympathetic nerves and central nervous system, which, in turn, is subdivided into large brain, hindbrain and spinal cord.

Fig. 5. A. Dobrescu – book illustration – spinal

cord

L. ROGOZEA et al.- A reference analysis about the human soul 61

The next chapter, Chapter 2, is called "The reflex" and is defined as "the simplest form of collaboration between different kinds of neurons". If for the animals the reflex plays a major role, in human reflexes are controlled by the brain and replaced with complex mental processes.

Chapter 3 presents the importance of instincts, which often break the barriers of reason, being inherited from generation to generation within the same species.

"The superior reflex (controlled)" is the title of the fourth chapter of the second part and presents the reflex circuit in which the impulse passes from peripheral sensory nerves to sensory nerves connecting the spinal cord to the brain; from hear, the impulse reaches the muscles, which according to the decision taken by the brain, will move or not.

Fig. 6. A. Dobrescu – book illustration –

central nervous system

Another chapter is titled "Locating the brain faculties". Here there are presented sensations reaching the brain and are printed at this level in the form of impressions, which, if the same kind, forms images. The images are grouped into concepts; concepts are divided into "faculties of intellect, feeling and will".

Chapter 6 highlights "The map of the brain centers". Thus, "motor centers" are represented on the map corresponding to

body parts and their illness it causes weakness or paralysis. "Intelligence is established throughout the cortex" and it is the resultant of the images and representations received by the senses.

In Part III we take "a special look on the functioning of the nervous system".

Chapter 1 provides the data "from the intimate life of the nervous system", thus being presented the evolution of our neurons as cells which develop many branches as they grow. The neurons' nutrition occurs through the process of assimilation, oxygen having a major role in this case.

Fig. 7. A. Dobrescu – book illustration – physiological aspects

In Chapter 2 we learn "how to develop

spiritual life". As muscle fibers increase after physical activity, "nerve elements continually grow and strengthen" following receipt, selection and setting processes of the concepts. These findings were very useful in education and also in the fact that in some children some centers are more susceptible to impressions and other are more rudimentary. Hence, the author concludes: "education wouldn't be made after a general block, but for each student's individuality".


62

Chapter 3 presents "the scheme of a psychological process". We'll see how sensory nerves transmit information to association centers, which, together with the memory centers and then via motor nerves will produce movement.

In Chapter 4 we see a part "of the problems of intelligence" and find that the number of neurons you have at birth does not increase during life, innate concepts don't exist and genius and insanity are related.

Part IV deals with "General pathology of the nervous system".


pathological aspects

Chapter 1 describes the causes of diseases of nerve substance; in inherited diseases, they will be worse if taken from the mother, and if true psychopaths, they are born of both parents sick. Among won causes are the infectious diseases consi-dered "among the greatest enemies of mankind", typhoid fever, articular rheu-matism, erysipelas, Staphylococcus, Strep-tococcus, smallpox and pneumonia. The social poisons mentioned are alcohol, opium, cocaine, hashish. Diseases of endocrine glands are also included in the category of causes; from that type is education "too wanton and too early", that can lead to insanity. Emotions or spiritual

kicks are occasional cases in individuals with predisposition for nervous diseases.

Part V studies "most common forms of sickness of the nervous system", which are divided into peripheral nerve diseases and diseases of the nervous center.

Chapter 1 considered "peripheral nerve illness", the main causes of disease being cold, compression, blow, degeneration, acute or chronic infectious disease toxins. Illness is made by inflammation and muscles corresponding to these nerves will become atrophic, and will regenerate following cessation of the inflammation. Sensory nerve disease will produce anesthesia or callousness and neuralgia or nerve pain. The disease will cause motor nerve paralysis.

In Chapter 2 we learn that "Treatment of the illness of peripheral nerves" should be above all a treatment of the factors that cause the disease: rheumatism, syphilis, alcoholism, infectious disease, diabetes. Treatment usually consists of electrifying, warm baths, hot compresses, ointments and Belladona extract opium, narcotics and not least, a substantially diet .

In Chapter 3 are presented "Diseases of central nervous system" as being divided into functional diseases and organic diseases.

The next chapter is entitled "General symptoms of diseases of central nervous system" and treats disorders of the sphere of intellect in 7 pages (illusion, hallu-cination, disturbance of consciousness, eclipsing intellectual life, stupor, obse-ssions, phobias, paranoid ideas, anger), disturbances in the sphere of sense (the soul, apathy, hipertimia) and disturbances in the sphere of the will (aboulia, feverish excitement, catalepsy, catatonia, impulsive actions, impulsive obsession)

Chapter 5 is of great complexity and studies the functional diseases, and the organic ones.




The study begins with functional nervous disease, defined as "state of constant fatigue and irritability" following the weakening of the nervous system. The main symptoms of mild neurasthenia are the headaches, pain in the spinal cord, insomnia, digestive disorders followed by significant decrease in weight, angina pectoris. In patients with psychopathic predisposition will appear serious neurasthenia characterized by weakening memory, phobias appearance, imagination and fantasy taking the place of rational thinking.



Ipocondria is considered an obsessive analysis of the bodily condition, these patients being considered "imaginative sick people". An important part of this chapter is given to hysteria, the disease of "slightly irritable, very significantly, whims, falling quickly from one extreme to another". Symptoms of hysteria are varied and sensory nerves are affected by

anesthesia and hyperesthesia, motor nerves by lack of activity or by contractions of muscles. Epilepsy, mania, melancholy, pa-ranoia and madness are the last functional diseases described briefly in this chapter.



In organic diseases are studied idiocy, imbecility, cretinism, dementia, senile and especially alcoholism. In the following pages is the presentation of the forms of alcoholic psychosis: delirium, regular drunkenness, alcoholic dementia etc.

The next topic is the influence of toxic syphilis on nervous system, leading to the progressive general paralysis, "an organic disease of the entire central nervous system, which arises in people who have been infected with syphilis" through fiber atrophy and degeneration of nerve cells. Another consequence of the ill with syphilis, is described in the following lines. Last of organic nerve diseases studied is apoplexy or cerebral hemorrhage, known as "damblaua" produced by tearing of arteries in the brain. We will stop to analyze the clinical picture for dorsal tabes, while trying to present known data in 1919 and that we have today about.


64

Dorsal tabes

Dobrescu’s book

In current work

Defini-tion

Destruction of peripheral sensory neurons and their continuation of the spinal cord.

Demyelination of posterior cords, dorsal roots and dorsal roots ganglia

Walking Uncertainty walk, slouch, atactic

Gait ataxia with broad base of support and stepaj

Paresthesia , bladder disturbances, impotence, areflexia, loss of postural sensation, deep pain and thermal sensitivity

Pain Killer pain in legs and torso

Loss of pain sensitivity

Joint degeneration, atrophic, perforated ulcers of the leg

Pupil small, irregular, which reacts to accommodation but not light

Tabel. 1. – Comparing the data from Dobrescu Book with the modern book

Comparing data on disorders of intellect

and the will of the book of Dr. Dobrescu with what we know today about the same concept, we see that differences are not large at all.

Dobrescu’s book

In current psychiatric books

Illusion The patient receives via the senses all sorts of feelings about the things around him, but he exaggerates illness nerve centers, it turned into images that do not correspond to reality

In a false perception of real sensory stimuli

Hallucination The patient cause in nerve centers an image, without having received any outside perception

False perception, failure in the absence of actual sensory stimulus

Tabel. 2. – Comparing the data from Dobrescu Book with the modern book

Part VI deals with &"prevention

nervous system's diseases". Chapter 1 presents "the means of

education" for prevention of these diseases: the fight against sexual diseases, combating alcoholism and overwork, the gym, exercise and trips.

Chapter 2 highlights the role of spiritual education in preventing nerve diseases. The purpose of education is "to strengthen the will of the student, which can deal anytime with his impulses". It studies the importance of training character and temperament and the role of the character in preventing nerve diseases. Concluding,


Dr. Dobrescu says that "a strong character, meaning a mind that deals with tendencies and agitation (...) can do a lot to prevent nerve diseases".

Part VII deals with the study of nervous diseases’ treatment. The author proposes treatment regimens in patients with nervous breakdown, the scheme which will include ensuring peace for the patient, removing him from the environment, food care, idrotherapeutic, electrotherapeutic and psychotherapeutic treatment, general treatment for strengthening. In the following pages of the Treaty are discussed at length all these therapeutic methods.



Part VIII, the last part of this study is a warning, stating "how a family degenerate" by the appearance and inheritance of nerve diseases. Concluding, the author states that "the power of a nation depends on the ethical value of families", highlighting the importance of prevention and treatment of nervous diseases.

The aim of this paper is to contribute to the development of the human race, as is clear even from the author's words: "In preparing this book, besides a brief

appearance of normal and pathological mental life and the prevention and treatment of nervous diseases, I set one more goal: to draw attention to the significance of some agents of mental diseases on future generations; that is my contribution to the improvement of the human race”.

Concluding, the book is a good example of the concerns of representatives of ASTRA in medicine. References [1]. Bologa V.L. – Istoria medicinei

române�ti, Ed. Medical�; Bucure�ti, 1972, 565 pg.

[2]. Burtea Victoria — Manual de semiologie psihiatric�; Casa de Editur� Venus, Ia�i, 2003, 293 pag.

[3]. Dobrescu Aurel — Boalele nervoase �i mentale, prevenirea �i tratamentul lor; Ed Institutul de arte grafice C. Sfetea, Bucure�ti, 1919, 163 pag.

[4]. Harrison - Principiile medicinei interne; Ed Teora, Bucure�ti, 2001, 2840 pag.

[5]. Huttmann A., Barbu G. – Medicina în ora�ul Stalin ieri �i azi, Ed Societ��ii �tiin�elor medicale din R.P.R., Filiala regional� Stalin, 1959, 163 pag.

[6]. Iftimovici R. – Istoria medicinei, Ed. ALL; Bucure�ti, 370 pg.

[7]. Minea Dan — Neurologie, Reprografia Universit��ii Transilvania, Bra�ov, 2003, 300 pg.

[8]. Rogozea L. – Aspecte ale medicinii bra�ovene în perioada interbelic�, Acta medica Transilvanica, nr.1, 2003, pg.56-60

[9]. Rogozea L. – Bra�ovul iatro-istoric, Ed. Universit��ii Transilvania, 2006, 217 pg.

[10]. Rogozea L. – Doctorul Arnold Huttmann – iatroistoric transilv�nean, Acta Medica Transilvanica nr.2, 2002, an XVIII, pg. 121-123, ISSN 1453-1968

[11]. Rogozea L. – Personalit��i ale


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medicinii române�ti, vol. 1, Ed. Universit��ii Transilvania, 2006,

[12]. Rogozea L. – Rolul Astrei în editarea unor publica�ii medicale, Acta Medica Transilvanica, nr 2, 2005, pg. 102-104

[13]. Rogozea L., Micl�u� R. – Via�a medical� bra�ovean� din anii 40 reflectat� în ziarele locale, Sesiunea de comunic�ri a C.R.I.F.S.T – Academia Român�, în Hermeneutica

Historiae et Philosophiae Technicae, 2003, Ed. Universit��ii Transilvania, pg.123-126,

[14]. Sârbu A., Brânzei P.— Psihiatrie; Ed Didactic� �i Pedagogic�, Bucure�ti, 1981, 340 pg.

[15]. Setlacec D – Medicina Româneasc� – Medicina European� (1859-1916); Ed. Medical�; Bucure�ti, 1995, 328 pg.


PROF. DR. HULUSI BEHCET (A FAMOUS TURKISH PHYSICIAN) (1889-1948) AND HIS BOOK ON CUTANEOUS LEISHMANIASIS

(ORIENTAL SORE)

AY�EGÜL DEMIRHAN ERDEMIR1, SEZER ERER1

Abstract: Prof. Dr. Hulusi Behçet (1889-1948) is a famous Turkish physician. He translated many foreign articles into Turkish to help the education of new generations and published original case reports in the international reviews in order to make contact with foreign countries. Moreover, he published many books. Fifty-three of those appeared in prestigious European Scientific Journals. We know that is infected with vector phlebotomus can be seen in many regions of the world and has been known in Mediterrenean Region and Middle East for centuries. Many Turkish researchers like Celal Mu¬htar, Hulusi Behçet and some foreign scientists investigated some subjects about this disease. Leishmaniosis (Oriental Sore) was another disease which Dr. Behçet worked on, beginning in 1923. He first described "the nail sign" appearing by the removal of the crust of an Oriental Sore. Hulusi Behçet wrote an important book with the name of the Therapy of Oriental Sore with Diathermy (�ark Çıbanının Diyatermi �le Tedavisi in Turkish). This book is 23 pages. In this book, the therapeutical ways of Oriental Sore and some cases are present. Moreover, Dr. Behçet mentions diathermy in his book. In this paper, Prof. Dr. Hulusi Behçet’s biography and his book with the name of the Therapy of Oriental Sore are stressed and some comments are pointed out Key words: medical history, oriental sore, epidemics

1 Department of History of Medicine and Ethics, Faculty of Medicine, University of Uludag, Bursa –Turkey

Prof. Dr. Hulusi Behçet is a famous Turkish physician [13].

Fig. no.1 - Hulusi Behcet

Hulusi Behçet’s book with the name of the Therapy of Oriental Sore with Diathermy (Haleb veya �ark Çıbanlarının Diyatermi ile Tedavisi in Turkish) is a monography of 23 pages and is with the date of 1925 [5].

In this book, some medical cases are given and commented. According to Behçet the “Oriental Sore” is seen in Baghdad, Diyarbakır, Aleppo, Sivas, Yemen etc. Its therapy continues one year and a good result cannot be obtained every time” [8].


68

Fig.2. Prof.Dr.Hulusi Behçet’s Book Cover on

Oriental Sore

We know reports of a disease simulating the type of lesion seen in cutaneous leishmaniasis were first made in 1756 by Hasselquist and Russel. Also in the middle of the nineteenth century, the same type of lesion was described by French medical officers in Africa. Laveran demonstrated in 1880 that this condition could be transmitted and that a fly was an important factor. In 1885 Cunningham described a histological picture and stated that there were bodies within the cells which were circular to elliptic in shape. Ryan, in 1886, also described some cells which were filled with bodies which he regarded as cocci with capsules. He attempted cultures in human blood but obtained no results. It was not until 1903 that Leishman and Donovan made independent reports describing the protozoan. During the same year Wright in Boston described the organisms found in the first case of cutaneous leishmaniasis reported in this country.

In this book, Behçet specified that: “The 'tin-tack' sign (TTS) was the appearance of horny processes that project from the under-surface of a crust. Although it was a well-known feature of discoid lupus erythematosus it might be also seen in other crusted lesions particularly in cutaneous leishmaniasis.” So, Hulusi Behçet mentioned the tin-tack

sign for the first time in the world. Leishmaniasis (Oriental Sore) was another disease which Dr. Behçet worked on, beginning in 1923. He wrote about it in many articles and succeeded in its treatment with diathermic. He first described "the nail sign" appearing by the removal of the crust of an Oriental Sore in 1916. To Behçet, this symptom was the most important sign of oriental sore. Oriental Sore was diagnosed both microbiologic analysis of Leishmianias and nail sign. A Turkish physician, Abimelek mentioned in his book named Discuss on Oriental Sore (Cilt Leischmaniose’ları Hakkında Münaka�a Münasebetiyle in Turkish) with the date of 1934 that Behcet described nail sign in Oriental Sore for the first time in the world. Moreover, the paper of Alfred Marcionini and Kemal Turgut dated 1944 with the name of Essays on the Pathology, Clinic and Treatment of Oriental Sore in the Middle Anatolia (Orta Anadolu’da Görülen �ark Çıbanlarının �nti�arı, Patojenisi, Klinik ve Tedavisi Hakkında Tecrübeler in Turkish) gave some knowledge about the Oriental Sore in the Middle Anatolia. To this paper, Oriental Sore was named as Diyarbakır Çıbanı (Sore), Mardin Çıbanı, Urfa Çıbanı etc. to the cities of Turkey. These physicians and the entire world also accepted that Hulusi Behçet described the nail-sign in the oriental sore for the first time in the world.

We know that there are a number of types of protozoa which can cause leishmaniasis. Each type exists in specific locations, and there are different patterns to the kind of disease each causes. The overall species name is Leishmania (commonly abbreviated L.). The specific types include: L. Donovani, L. Infantum, L. Chagasi, L. Mexicana, L. Amazonensis, L. Tropica, L. Major, L. Aethiopica, L. Brasiliensis, L. Guyaensis, L. Panamensis, L. Peruviana. Some of the names are

A.D. ERDEMIR et al- Prof. dr. Hulusi Behcet (a famous Turkish physician) (1889-1948) and his book on cutaneous leishmaniasis (oriental sore)

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reflective of the locale in which the specific protozoa is most commonly found, or in which it was first discovered.

This famous physician mentioned that some drugs such as Neosalvarsan or carbonic acide couldn’t treat it. But, to Behçet, diathermy therapy was the best way. Behçet mentioned diathermy in every page of his book. To Behçet: “Diathermy method is applied in developed cities and good results are obtained. “Behçet treated some leishmaniasis cases with this way from 1920 to 1922. In this book, 4 cases are given. One of them was the son of a merchant from Adana. This patient was 19 years old and travelled to Syria for the trade occasionally. Ulcers were located on his right neck and these were combined in time and became in the size of silver coin (mecidiye). Other doctors couldn’t treat this patient.

In this case, Hulusi Behçet determined Leishmania by preparing culture and diagnosed this disease as oriental sore.

Moreover, in his book, Hulusi Behçet wrote that Dr. Resat Rıza and Mustafa Bakar prepared Leishmania Tropica cultures and this research was published in Gulhane Seririyatı Journal in German. In this first case, Hulusi Behçet examined microorganisms by ultramicroscope and saw flagellums. He informed about their dimensions. So, he applied diathermy to his patient. Hulusi Behcet accepted diathermy as the best therapy [3, 7, 9].

The second case of Hulusi Behçet was a servant girl. She was 23 years old. Oriental sore was seen on finger of right hand and left cheek. It was of a dull red colour and was inflammatory, quite tender and painful. Hulusi Behçet also diagnosed this case as oriental sore.

In his third case, Hulusi Behçet treated a porter from Diyarbakır. He was 42 years old. Sore was on his right eyebrow and left cheek. The fourth case belonged to a girl. She came from Tahran to Istanbul. She was relative of Iran Emperor. A deep sore

was on her right cheek. Behçet also treated this case with diathermy.

Famous Turkish physician Behçet gave some knowledge about the discovery of microorganisms and their names. Behçet mentioned that American scholar .Wright named this disease’s microorganism as Helcosome tropicum at that time and R. Ross gave the name of Leishmania tropicum ou furonculose to it. But, afterwards, Leishmania Donovani was known as its microbe.

Moreover, Behçet gave some knowledge about Leismania kinds in his small book: “Leishmanias are in two forms: Forms with flagellums and without flagellums. Two kinds of Leismanias are present. One of them is Leishmania Donovani and another is Leishmania tropica L. We also know Leishmania Americana. Leishmania Donovani also causes Kala-azar.

Hulusi Behcet also gave other useful knowledge in his important book. Oriental Sore was seen in India, South Asia, Mediterrenean Sea Region, North Africa, Crete and Greek Islands, Adana etc. Oriental Sore was named Halep (Aleppo), Nile, Tahran, Isfahan, Palestine, Ankara and Diyarbakır sores. Hulusi Behçet mentioned epidemiology of this disease. Especially, Oriental Sore was infected from animals to dogs, monkeys, mouses.

Hulusi Behçet also mentioned the characteristics of oriental sore. To Behçet: “On an average a fully developed Oriental sore is an inch or so in diameter. While there is often but one, there may be several or more distinct and sometimes quite widely separated formations. An Oriental Sore, when developed, is of a dull red colour, is usually of sluggish nature throughout its course, unless constantly knocked, irritated, or having added an active pyogenic factor, when it may become much more inflammatory, and quite tender and painful [4, 6, 12]. The favourite regions are the face, hands and


70

forearms, and legs, but no part is exempt. Moreover, Behcet gave some

knowledge about some ways used in oriental sore therapy. According to Behcet, arseno benzol and salvarsan couldn’t treat oriental sore. Neosalvarsan was good for syphilis. Famous physicians, Resad Rıza and Abdülkadir Bey accepted this condition. The best method was the diathermy [10]. This was an apparatus with electric. Namely, electric was applied to the sore. But this apparatus was present in the modern cities of Turkey at that time. To Behcet, in the other cities of Turkey, frozen carbonic acid was used for the therapy. But, he preferred diathermy therapy more than frozen carbonic acide.

Hulusi Behcet applied diathermy by anaesthetizing his patients and the patient healed in ten or twenty days. So, he advised application of diathermy to every physician in his book.

Hulusi Behcet gave a paper on nail sign of oriental sore in 1932 .M. Mayer and Ernst Nauck also accepted Behcet’s thoughts on this topic.

Hulusi Behcet again mentioned these topics in his paper with the date of 1934 and named Two Important Points on Wright Sores (Wright Çıbanları Seririyatında �hmal Edilmi� �ki Mühim Nokta in Turkish).

Approximately 350 million people in 8 countries are estimated to be under the threat of leishmaniasis. Most of the drugs used for the treatment of leishmaniasis are toxic and have many side effects. At present there is no vaccine against leishmaniasis. Vaccine development for parasitic infections is more difficult than for viruses and bacteria because of the antigenic complexity and parasitehost interactions [1, 2, 11].

References

[1]. Abimelek. Cilt leischmaniose’ları hakkında münaka�a münasebetile. Deri

Hast Frengi Kl Ar� 1934; 1: 283-284. [2]. Berberian DA. Cutaneous Leishma-

niasis. Arch Dermat&Syph, 1944; 49: 433-435.

[3]. Demirhan,E.A., Öncel,Ö.: Prof.Dr. Hulusi Behcet (A Famous Turkish Physician) (1888- 1948) and Behcet’s Disease from the Point of View of the History of Medicine and Some Re-sults, ISHIM, 5(10):51-63 (2006).

[4]. Forbes,M.A.: Exogenous Cutaneous Leishmaniasis Proved by Culture, Archives of Dermatology and Syphilology, 58( 3):301-307(1948).

[5]. Hulusi Behçet. Haleb veya �ark Çıban-larının Diyatermi ile Tedavisi. Dersaadet 1925 (�kinci Tab’ı) Kader Matbaası.

[6]. Marinkelle, C.J.: The control of leishmaniases. Bull. WHO. 58: 807-819, 1980.

[7]. Mutlu S, Scully C.:The person behind the eponym: Hulusi Behcet (1889-1948). J Oral Pathol Med. 1994 Aug; 23(7):289-90.

[8]. Saylan T. Life Story of the Dr. Hulusi Behçet. Yonsei Med J 1997; 38: 327-332.

[9]. �ehsuvaro�lu,B.N.: Yurdumuzda Deri Hastalıkları Tarihçesi, ve Muallim Dr.Hüseyin Hulki Beyden Bir Hatıra(History of Dermatology i,n Turkey), Deri Hastalıkları ve Frengi Ar�ivi, 3(8):462-504 (1966).

[10]. Templeton HJ. Cutaneous Leishmaniasis Experimentally Produced. California& West. Med., 1941; 54:70-71.

[11]. Turgay N. Leishmaniasis A�ı Çalı�-malarında Son Geli�meler: Ne Zaman A�ılanabilece�iz? Türkiye Parazitoloji Dergisi, 29(4):232-234, 2005.

[12]. Unat,E.K.: Leishmania’lar ve Leishmania’lı �nfeksiyonların Epidemiyolojisi Üzerine, Deri Hastalıkları ve Frengi Ar�ivi 5(15):869-880(1968).

[13]. Yemni O. Ord. Prof. Dr. Hulusi Behçet. Deri Hast Frengi Ar� 1964; 1: 58-59.


THE EFFECTS OF THE MEDICAL FUNCTIONS ON ARCHITECTURE IN

SÜLEYMAN�YE DAR’US SIFA OF THE OTTOMAN DAR’US SIFAS

BETÜL BAKIR1, �BRAHIM BA�A�AO�LU2

Abstract: While the domed, yard type or closed yard type system had been holding on since Anatolian Seljuks constructed the main theme again in Ottoman, the devotion of Seljuks to the yawn-dome-yard-crown door relationship turned into complicate projects which responded to the needs more towards improving architectural orders, static improvements, the needs of the patients and the effects of renaissance which was the demand mode of the west. So that, Ottoman Dar’us Sifas, formed a prototype of the first hospitals in the West and America. Süleymaniye Dar’us Sifa was a treatment center for mental patients and other patients serving for a high number of patients in its period and was greatly improved with its bath, pharmaceutical warehouse, special part sheltering heavy mental patients, wide patient rooms with high ceiling and aeration, madrasah related to the construction just on the opposite, shops providing income for the vaqf, bakery, fountain, toilettes, Darüzziyafe (restaurant) building on the east side. After we give the architectural specialties of Seljuk and Ottoman Dar’us Sifas in this article, we will deal with Süleymaniye Dar’us Sifa of Sinan Period Dar’us Sifas as a whole.

Key words: Süleymaniye Dar’us Sifa, treatment, architectural specialties

1 Yildiz Technical University Istanbul / Turkiye 2 Istanbul University, Medical Faculty of Cerrahpasha, Istanbul / Turkiye

Süleymaniye Dar’us Sifa which was designed within the body of social complex and constructed by Mimar Sinan in the years 1553-1559 when was called as his masterbuilder period, confronts us with a different design of central composition between rectangular shaped two yards and bodies lined up around them. There is a ward in the cellar in which hopeless mental patients were sheltered in bulk and shops that are opening to the exterior street.

There is Medicine Madrasah and Darülâkâkir (pharmaceutical warehouse)

just on the opposite of the construction. Treatment with music was also carried

out in the hospital in which approximately thirty employees were serving till XIX century.

As it was in Seljuks, in Ottoman Dar’us Sifas, the treatment purpose baths serving to the patients have taken part in the social complex, as for Süleymaniye Dar’u Sifa, the bath is not on another construction but it is incorporated into the Dar’us Sifa.

The fountain which is providing freshness and mental relaxation with the


72

flux of the water is in the second yard to which all the rooms are opened.

In the west entry of the first yard of the construction, there is a double domed, wide area bakery place where a kind of bread named fodla is baked for the patients.

Süleymaniye Dar’us Sifa was a treatment center for mental patients and other patients serving for a high number of patients in its period and was greatly improved with its bath, pharmaceutical warehouse, special part sheltering heavy mental patients, wide patient rooms with high ceiling and aeration, madrasah related to the construction just on the opposite, shops providing income for the vaqf, bakery, fountain, toilettes, Darüzziyafe (restaurant) building on the east side.

The Specialities of Ottoman Dar’us

Sifas Ottoman Empire had had its greatest

period under the rule of Suleiman the Magnificent, its lands extended from Austria to Arabia while Egypt was included in North Africa, in addition, The Red Sea and East Mediterranean had become Turkish Seas. In every part of the empire art and culture were paid attention, many works of art, bridges, fountains, baths, schools, mosques, dar’us sifas, etc were built. �stanbul, which was the capital of

Ottoman is magnificently reflecting most of the works of art that we talk about today and exhibiting the richness of the period. The Selatin mosques and magnificent social complexes which were built by Sultans or their wives in �stanbul, today also constitute the landmarks which determine the silhouette of the city.

1. Military Hospitals: Mobile and

stable military hospitals were built in different parts of the empire in order to cover the needs of the army (1)

2. Palace Hospitals; The Hospital of odalisques which were built in Topkapı Palace in 15th century by Conquror Sultan Mehmed and The Palace Hospital made by Turkish-Mongol Emperor Ekber in Fatehpur-Sikri in the date 1569 are the oldest palace hospitals standing today with their original conditions (2).

3. Dar’us Sifas and Madrasahs which

were built for public; Ottomans went on working their dar’us sifas which were coming from Seljuk Period with the foundations. Some of these were respectively dar’us sifas such as Bursa, Edirne, �stanbul ve Selanik, Belgrad, Budape�te extending to the Balkans afterwards. Especially in the 16th century, many treatment centers had been built but apart from the Hospital of the odalisques in the Topkapı Palace and the ones made by Architect Sinan any of them determined to reach our day. Generally, the aim of the dar’us sifas built within the body of a social complex is to serve for public and benefit from the other places serving.

Fatih social complex was the first big extensive constructions group and education unit was built by Conqueror Sultan Mehmed. Positioned on a hill prevailing to �stanbul by Architect Sinan and ordered by the sultan to be done by selecting the best marbles, stones and masters of the country, Süleymaniye social complex which was built after nearly hundred years from Fatih social complex is an important religious and social center with its dar’us sifa which we can accept as a step in the development of Ottoman health institutions with its library among the counted libraries of our day, in the medicine madrasah of where the best professors of the period give lessons and bring up famous doctors.

Orders were made to extract and bring valuable marbles, colored columns from the historical constructions in the empire in order

B. BAKIR, et al: The effects of the medical functions on architecture in Süleymaniye Dar’us SIFA of the ottoman DAR’us SIFAS

73

to use valuable stones in the Süleymaniye social complex which is the proficiency achievement of the famous Architect Sinan, valuable marble columns were barged from distant countries such as Alexandria.

The madrasahs in the south and north of the social complex was a complex education center with the guesthouse and ottoman elementary primary school (fig.1). There was a rich employee and doctor staff in the dar’us sifa, constructions such as the medicine madrasah, darulakakir, guesthouse and darüzziyafe positioned as a whole in the northwest of the mosque in a different construction was showing the developing madrasah understanding in the best way.

Fig.1. Süleymaniye Complex (from Cantay)

It was normal that superior scientists

gave lectures and palace doctors were appointed as professors to the medicine madrasah in the most developed social complex of the period (3). The difference of the Ottoman Dar’us Sifas from the Seljuk’s was the separation made in the Dar’us sifa according to the qualifications. While the women and men were treated in different parts generally, in the final stages hospitals for women and for men were also built. Besides separating according to sexuality, there were also different departments in which every sickness was treated such as dermatologic disorders, surgical, mental, inflammatory diseases and etc, which can be accepted as the first samples of recent “clinic” concept (4). Separation according to the illnesses in the hospitals guided dar’us sifa plans, a

distinct department was made in the cellar for the heavy mental patients who were isolated from the other patients in the Süleymaniye Dar’us Sifa. In the 19th century, the pointed separation was made and it became an institution in which just male patients were sheltered.

Architect Sinan: The big architect of Suleiman the

Magnificent, worldwide reputated artificer Sinan was born in 1490, in the village A�ırnas of Gesi town in Kayseri. According to the written sources, he was given to the conscript boys school as a recruit in 1512, he had become a janissary before Sultan Selim the Stern’s 1521 Belgrad campaign and he was elected as the Royal Architect of the palace in 1539 when he became 50 years old. It is recoded in the sources that he made 364 works of art throughout his life. Among these, bridge, aqueduct, tap, fountain, tomb, mosque, social complex consrtuctions, bath, bazaar, madrasah, dar’us sifa and etc took place. His fist work of art in �stanbul was Haseki social complex and Dar’us Sifa that he made for Hürrem Sultan. �ehzade Mosque that he finished in 1544 when he was 54 years old is his apprenticeship work. Süleymaniye social complex that he finished in 1557 when he was 67 is his headworker piece and Edirne Selimiye Mosque that he finished when he was 80 in 1574 is his proficiency work (5).

Doctors and Patients in Dar’us Sifa In the 16th century, the greatest period

of Ottoman Empire, within the frame of the new steps in the fields of science, art, economy, education, medicine, astronomy in Süleymaniye medicine madrasah and in its other madrasahs, reformary superior student educating program was carried up by Sheikh ul-islam Musa Kazım Efendi and Hayri Efendi which will reach up to the 20th century in education and qualified


74

doctors and scientists were brought up (6). Süleymaniye Dar’us Sifa which was built in 1577 had served in a different construction with the madrasah for the first time. Endowments were assigned for each dar’us sifa in Ottomans in order to provide their needs. Besides, according to the sources, helps were made by the endowment in the social complex where the dar’us sifa took place. In the Süleymaniye social complex endowment and records, the services, servants and helps given to the dar’us sifa were also listed. In the researches of S. Ünver, as the social complex’s endowment was determined in 1557, the administrative records about the guesthouse, medicine madrasah and dar’us sifa authenticate that the hospital was serving in that date (7). According to its endowment, the medicine madrasah’s professor had to be wise enough to be palace doctor. In the dar’us sifa where various illnesses had been treated, just the mental patients started to be treated after 1843 (8). It is indicated in the records that the poor patient were boarding in the hospital, polyclinic service was also given and doctors were working from morning hours to afternoon in the hospital (9). When Guraba Hospital was built by Bezm-i Alem Valide Sultan in 1845, male patients were transferred from various hospitals to this hospital and male mental patients were sent to Süleymaniye Dar’us Sifa. Male patients were accepted while serving for quarantina in the colera outbreak of 1865 (10). Different from the other samples of the period there was a neurology service in the dar’us sifa. The method of curing with music which was used in Edirne dar’us sifa was applied to the mental patients treated in the neurology service, the medicine compositions prepared in the darülakakir on the opposite were distributed not only to the patients here but also to all of the hospitals and patients in �stanbul. In the beginning of the

20th century, Dar’us sifa construction served for military printery till 1927 (11). According to Peçevi, Tabip Ahmed Çelebi was the first one assigned here and Mustafa Bin Celâlüttevkii was chief physician in 1567 in the period of Suleiman the Magnificent. The chief physician between the years 1858-1873 was the famous Italian doctor Louis Mongeri (12).

The location of the constructions in

Süleymaniye social complex and architecture of the dar’us sifa:

Apart from the Süleymaniye Dar’us Sifa which was built by Architect Sinan on behalf of Suleiman the Magnificent between the years 1550-1557, there were darulhadis, bath, darülkurra, rabi and salis madrasahs on the south-east, Architect Sinan’s tomb on the north, sani and evvel madrasahs, medicine madrasah, dar’us sifa, darüzziyafe, darülakakir (pharmacy), library, fountain, guesthouse and Tiryakiler Bazaar (Bazaar of addicts), caravansary, ottoman elementary-primary school and lieutenant cabins on the south-west (the mosque regarded as the center of the social complex)(fig.2).

Fig.2. Medicine Madrasah and Tiryakiler

Bazaar Süleymaniye social complex, located

prevailing to the city, was constructed in the land in which the old palace built by Conqueror Sultan Mehmet had a fire and destroyed (13). While the mosque forming the center of the social complex was located on a high hill, the madrasahs on its


75

right and left were separated from the mosque via a narrow street. Rabi and Salis madrasahs on the slope looking to the Golden Horn in the east, Evvel and Sani Madrasahs on the other side, ottoman elementary primary school and Tiryakiler Bazaar consisting of 36 shop rooms under the medicine madrasah provide income for the complex (14). Guesthouse, daruzziyafe and dar’us sifa constructions were built with high ceilings because of topographic circumstances, the rooms were built to the downward slope through Golden Horn under the dar’us sifa and caravansary was built to the lower elevation of the daruzziyafe (15). Although the ending date is written as 1557 on the inscription on the main door (cümle kapi) of the mosque, the dar’us sifa and medicine madrasah were finished in 1556 and the constructions in the complex together with the other buildings were finished in 9 years (16).

Plan organization: There is a different design from the

central formations of the period in the dar’us sifa with two rectangles designed domed and porched courtyards and domed cabins with ovens lined up around them. In the cellar floor of the double floored constructions, there are shops opening to the outer street and an isolated ward without windows where hopeless patients sheltered as a whole. In the first courtyard there were administrative units and daily policlinic patients were accepted, in the second courtyard with a fountain, boarding patient rooms, and bath and in the cellar the places of the isolated mental patients were planned. When the plan of the complex is compared with the other constructions with courtyard, it is clearly seen that one court yarded madrasahs are generally square formed, but in the dar’us sifa draft, the rectangle shape is exerted to open place for a second courtyard. This order is spoiled just in Tabhane

(guesthouse) construction; rectangle plan is used here also because of the locations of the other constructions in the area within the complex and the topographic reason of the land. All the usage fields of the bodies in the courtyard with fountain in the dar’us sifa are arranged equal to each other, so that, in order to give entrances to the corner places, these corners of the courtyard were beveled and a small entrance hall was opened. Beveled corner has taken place in the plan typology of “middle sofa” understanding in Turkish Architecture, the other reason of corner entrances may also be prevent to shrinks which would be due to entrances to the places. On the north of the medicine madrasah, an one floored darülakakir (pharmacy) is positioned where medicine compositions were made and stored, on the opposite of this building dar’us sifa is positioned. Building dar’us sifa and madrasah as different constructions from each other has started with Süleymaniye Dar’us Sifa. Medicine madrasah taking place within the body of the hospital until that time separated for the first time in this construction and turned into two buildings positioned facing one another. When entering to the first courtyard of the dar’us sifa from the hospital street, there is a bakery where a flat bread named “fodla” was cooked for the patients in the last of the three domed-bodies lined up on the left side as to the entrance and west facade, the body in the middle is opening to the other courtyard where the bath is (p.4).

Fig.3. Bakery Building


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The body on the corner which is on the east facade of the first courtyard was used for entrance to the second courtyard. According to the pictures in the sources there was a rectangle pool which had lion figures on its four corners in the middle of the courtyard and an octagon fountain in the second courtyard (17). The lions and other animals transported to the dar’us sifa in 1843 may be the reason for the location of the lion monuments in the first courtyard. Despite making out negative news about the lions put in the hospital by the foreign broadcasts, it is probable that these animals were held in caravansary rooms in the cellar floor or in some of the non-used rooms of the bath next to the hospital, however, these animals died in a short time in an airless and dark environment

It could be only gone from the first courtyard to the barrel vaulted, narrow and long place where heavy mental patients were held in the cellar floor throughout stairs serving to that body. Ventilation-illumination was made by the embrasures on the colonnade borders in the second courtyard. The chains and rings used here for the heavy mental patients haven’t removed till recent times.

Structural Features: Although not so

deep, the construction of the groundworks in the Süleymaniye social complex built on a hill looking to Golden Horn in �stanbul, had taken such a long time as 3 years according to the sources. In the drilling works made in 1970s, no deeper than 6.20m was encountered (17). Khorasan mortar was used in the walls of the building constructed with (küfeki) stone, fairly high floor walls of the double floored construction were straightened with horizontal brick lines in every 1.20m and horizontal lying wooden binding elements sized 5/5cm. were settled between these brick lines. The higher the

stone walls went, the thinner they were built.

Entrance door and other doors: It is

assumed that supplies were carried for the bakery in which bread was cooked from the courtyard entrance on the south-east facade. It is seen from the bare, plain tracks and tablet of the door that it was restored in the 19th century. There is a bare, flat archway made of (küfeki) stone and its tablet on the wall. The main entrance wall is also remains from the period when the military used it. There is a “printery of Military” writing written on green background and Ruler Abdül Hamid’s signature in embossment cartridge. The whole archway from küfeki stone on the wall and its frames on the both sides are plain. It is a strong probability that supply entrance was made to the kitchen on the upper floor from a door reached by going down throughout stairs to the cellar from the second courtyard. The gap on the kitchen flooring is tied to the wall in question vertically and the supplies coming from the down door was pulled up from this hole.

Windows: elevation differences in

construction membranes affected also the windows, while there is rectangle shapes on the floor elevation in the south-west facade looking to the inner courtyard and obtuse arched window types on the up, on the fairly high, double floored north-west facade, discharging arches, obtuse arched rectangle windows on the shops in the down floor, the windows of the dar’us sifa rooms on the shops are first line discharging arched rectangle windows and obtuse arched plaster ornament (revzen) covered top window lines lie all along on the north-west facade on the up.

Vault and arches: Entrance holes to

the corner rooms in the second courtyard


77

and barrel vault cover was used on the ceilings of the places in the down floor. Courtyard colonnades, window and door arches are obtuse arches named as Turkish arch or panj arch.

Column headings: Marble column

headings in the courtyard colonnades are muqarnased which reflect Ottoman architecture. Almost all headings were made in the same decoration sample. There is rosette motif on most of them.

Courtyard colonnades: The bodies on

the entrance made polyclinics take place on the right and left of the entrance door but the rooms are lined up just in three dimensions in the second cortyard where the patient rooms are. Colonnades obtain spatial coherence surrounding both courtyards in four dimensions.

Buttress and waterspout: Yüksek, iki

katlı kuzey-batı ve güney-batı cephelerinde belli aralıklarla, zemine do�ru geni�leyen payandalar mevcuttur. There are buttresses which are expanding towards ground on the double floored north-west and south-west facades in certain intervals.

Physical features in structure: There

are fireplace for heating, windows in both side of the fireplace furthermore a door opening to the courtyard and a window next to it in every room (fig.4). the windows were opening both to outside and to the courtside, so they were making light places while supplying adequate air and light for the patients. Windows opening to outside in the dar’us sifa shows that the patients were not isolated from the outer environment. Ventilation of the places in the cellar where the heavy mental patients were staying was made by the wide loop-hole on the upper floor opening to the second courtyard. The pools designed in both courtyards not only provided visional

aesthetic but also created relaxing effect on the patients with the action of the water.

On the south-west corner of the hospital, bath attendants were on duty in the bath, built next to the dar’us sifa, just to serve the patients here. As known, the bath of the dar’us sifa was also used to cure mental patients with hydrotherapy method apart from providing hygiene.

Fig.4.Patient Room

Restoration works of 2009: The construction is being tried to return

its original condition in the restoration studies by fixing the changes of the construction made in the 20th century and the accessories made during its usage as military printer in 19th century. The separation walls between the colonnades in the courtyard were destroyed; closed fire places in the patient rooms were opened. The stairs entrance going down from north-west facade of the second courtyard to the cellar floor was re-opened; east courtyard ground where the bath and bakery constructions take place was lowered and brought to its original elevation. The pool in the first courtyard with lion monuments on its four corners which was closed in the past will be re-built in the last restoration study and lion monuments will be put on their places (fig.5). The fountain closed with concrete in the second courtyard will be functional again (18). The small bath located next to the dar’us sifa on the south-east dimension was only for the patients and bath


78

attendants working here were washing the patients. In the digging workout made for restoration, hot water wandering canals were discovered beneath the bath flooring.

P.6. The Pool with Lion Statues (from Cantay)

Footnotes:

1. A big mobile hospital was built consisting of 70 surgeon tent and 40 doctor shops serving to the wounded soldiers in the Crete blockade mentioned by Evliya Çelebi. In 16th century, the presence of a hospital serving for navy in the �stanbul Kasımpa�a dockyard is figured out in the sources. Apart from the two hospitals bound to Ottoman navy in Kasımpa�a, there were naval hospitals in Crete, Basra, Preveze and hospitals in Gemlik, �zmit, �znik, Rusçuk, Tulci, Vidin, Crete, Suez dockyards. Terzio�lu, Osmanlılarda Hastaneler…,p.5-6; Evliya Çelebi, Seyahatname, publisher: Zuhuri Danı�man, c.12, �stanbul 1943, p.202.

2. “It is seen that hospitals were established for bondmaids in the hareem, for truckers in the Birun and for Ottoman hists in the palaces of Ottoman Sultans in Edirne and �stanbul. Terzio�lu, A, Osmanlılarda Hastaneler, p.2, 15.

3. There had been Greeks, Rums, Armenians, Georgians, and Syrians when the Turks came to Anatolia. These had not recognized the attitude of the Orthodox Church. They welcomed the Seljuks with a great pleasure. Ortaylı, Türkler ve Ermeniler, p.128, Kahya, Erdemir, Medical Studies and Institions in the Otoman Empire, p.72.

4. Say.”Türk Tıp Kurumları”, Türkler, C.11, p.321.

5. We understand the informations about Koca Sinan from the 7 handwritten works of art written down in the 16th century. 1.Risalet-ül Mi’mariye, 2. Monography of Dayızade Mustafa Efendi named as Selimiye, 3. Padi�ahname of poet Eyyubi, 4.Adsız Risale, 5.Tezkiret-ül Bünyan, 6.Tezkiret-ül Ebniye, 7.Tuhfet-ül Mi’marin. According to the sources, he was born in the village A�ırnas in the Cappadocia area and he was not exiled to Cyprus as the other region society of the period, he attended to many campaigns such as Iranian, Egypt in the period of Sultan Selim the Stern, Belgrad campaign of 1521 and campaign of Vienna in 1529, and he built bridges here and worked as “sekban”, “zembere-kçiba�ı”, “infantry colonel” in the army. He had built 3 galleys on his Iranian campaign, he gained appreciation of the Sultan by building a high bridge in 13 days on a marshland in Moldovia campaign of 1538. Aslanapa, Türk Sanatı, p.251-266; Kuran, Mimar Sinan, p.16-27.

6. Calendar and astronomy studies were being done in the muvakkithane until 16th century. But a observatory couldn’t be built. The famous astronomer Takiyeddin


79

built an observatory in Tophane in the period of 3rd Murad in the years 1574-1595. There were various astronomy tools, mechanical clocks, astronomy drawing tools, miters, rulers, compasses and etc in the observatory of �stanbul. There were madrasahs and dar’us sifas in Manisa, Amasya, Bursa and Edirne in Anatolia and Trakya on the same period. There were very rich libraries serving to the madrasahs near these or within the body of the social complex, especially in Süleymaniye social complex and Haghia Sophia. Kahya, Erdemir, Medical Studies and Enstitions in The Otoman Empire, p. 72-74.

7. Ünver, Süleymaniye Külliyesinde Darü��ifa, Tıp Medresesi ve Darül’akakire dair”, Vakıflar Journal II, Ankara 1942, p. 196.

8. As to its endowment, there were 1 professor, 8 counselors, 1 doorkeeper, 1 ferra�, 1 pointillist in Süleymaniye Dar’us Sifa and 1 head doctor, 2 doctors, 2 kehhal, 2 surgeons, 2 chemists, 1 drug store official, 1 steward, 1 doorkeeper, 2 cooks, 1 kaseke�, 4 trustees, 2 ferra�, 4 manservants, 2 laundryen and a bath attendant in the dar’us sifa on duty. The fees of the personnel were provided from the income of 217 villages, 30 arable field, 2 districts, 7 mills, 2 fishponds, 2 ports, 1 meadow, 2 farms and 2 islands. Bayat, “�stanbul Süleymaniye Darü��ifası”, Ülker Erke’nin Yorumu ve Fırçasıyla, p. 55. Ünver read in Ankara Endowments Head Directorate that the daily wages given in the dar’us sifa were written down by Hüsameddin Efendi in the Sultan Süleyman Hanı Evvel Endowment of 1557; 1 chemist, 2

chemist helpers, pantry worker, steward, clerk, tabbahı e�rife (some people), 4 trustees, 2 laundrymen, barber, bath attendant… Ünver, “Süleymaniye Külliyesinde Darü��ifa…”, Vakıflar Journal II, p.196-198.

9. Ünver, “Süleymaniye Külliyesinde Darü��ifa, Tıp medresesi ve Darül’akakire dair”, Vakıflar Journal II, p. 198-199.

10. There is a record about taking 4 manservants because of the increase in the amount of the mental patients coming to the asylum in a document dated 1850-1851. Ünver, “Süleymaniye Külliyesinde Darü��ifa….”, Vakıflar Journal II, p205, 206.

11. Kahya, Erdemir, Medical Studies and Instıtıons ın the Otoman Empire, p. 79.

12. Cantay, a.g.e., 99. 13. Bayat, A.H. “�stanbul Süleymaniye

Darü��ifası”, Ülker Erke’nin Yorumu ve Fırçasıyla Türkiye’de Tarihi Sa�lık Kurumları , 38th International History of Medicine Congress, Editor: Nil Sarı, �stanbul 2002, p.55.

14. There is the list of the recruiting staff taken from the ruins and from the constructions on various areas of the country in handwritten manuscripts of M. Cevdet, Seyahatname of Evliya Çelebi and Tezkeret-ül Bünyan. Ömer Lütfi Barkan published in 1974 the orders and records in the account books that he investigated in the archieves in the Topkapı Palace. Aslanapa, Osmanlı Devri Mimarisi, second edition, 2004, p. 220-228.

15. Today, Süleymaniye maternity hospital is built on the land of medicine madrasah. Cantay, Anadolu Selçuklu ve Osmanlı


80

Darü��ifaları, p.97. 16. Cantay, Anadolu Selçuklu ve

Osmanlı, p.97. 17. Two of the four lion monuments are

in the garden of �stanbul Town Hall, one of them is in the park of Courthouse. Cantay, Anadolu Selçuklu ve Osmanlı, p.98.

18. There is a record about taking 4 temporary manservants because of the increase in the amount of the mental patients coming to the asylum in a document dated 1850-1851. Ünver, Süleymaniye Külliyesinde Darü��ifa….”, Vakıflar Journal II, p205, 206.

19. The things found in the drilling study according to Barkan; a concrete groundwork surface with khorasan mortar of 20cm thickness, oak grills put on these, 3 lines of fire stones with 2 meters height going on narrower with küfeki stone until the sub basement. Ö.L.Barkan, Süleymaniye Camii Ve �mareti �n�aatı, p.49, 50..

20. The lion monuments which were sent to Sultanahmet park and public building will be taken from here and put back to their original places on the corners of the pool in the last restoration work of 2009.

Reference:

[1]. Akyol,T. Ortaylı, �, Anadolu’da beraberlikten çatı�maya, Türkler ve Ermeniler, Do�an publications, 2009, p.127-132.

[2]. Aslanapa, O., Osmanlı Devri Mimarisi, �nkılap Bookstore, second edition, �stanbul 2004.

[3]. Aslanapa, O., Türk Sanatı, Remzi Bookstore, �stanbul 1984.

[4]. Bakır, B. Ba�a�ao�lu, �., How Medical Functions Shaped Architecture in Anatolian Seljuk Darüssifas (hospitals) and Especially Divri�i Turan Malik Darüssifa, Journal of The International Society for the History Of Islamic Medicine (ISHIM), 10 October 2006, p. 64-82.

[5]. Barkan, Ö. L., Süleymaniye Camii ve �mareti �n�aatı, (1550-1557), book I, Ankara 1972.

[6]. Cantay, G., Anadolu Selçuklu ve Osmanlı Darü��ifaları, Publication of Atatürk Culture Center Yayını, number: 61, Ankara, 1992.

[7]. Erke, Ü., Ülker Erke’nin Yorumu ve Fırçasıyla Türkiye’de Tarihi Sa�lık Kurumları, 38.Uluslararası Tıp Tarihi Kongresi, Editör: Nil Sarı, �stanbul, 2002.

[8]. Evliya Çelebi, Seyahatname, yayın-ayan: Zuhuri Danı�man, cilt 12, �stanbul 1972, s.202; cilt 10, �stanbul 1970, s.39.

[9]. Kahya, E, Erdemir, A. D., Medical Studies and Instıtıons in the Otoman Empire, Nobel yayın da�ıtım a.�, Ankara 2008

[10]. Kuran, A., Mimar Sinan, Hürriyet Vakfı Yayınları, 1.baskı, �stanbul 1986.

[11]. Say, Y., Türk Tıp Kurumları, Türkler, C.11, s.320-347.

[12]. Terzio�lu, A., Osmanlılarda Hasta-eler, Eczacılık, Tababet ve Bunların Dünya Çapında Etkileri, �stanbul, 1999.

[13]. Ünver, S., Süleymaniye Külliyesinde Darü��ifa, Tıp Medresesi ve Darül’akakire dair (1557-1555), Vakıflar Dergisi II, Ankara 1942, s.195-208


SUMMARY OF THE HISTORY OF THE THRACE FIGHTING MALARIA

ORGANIZATION

N. GÖKÇE1 M. YAPRAK2

Abstract: Malaria was the most serious illness among the epidemic diseases in the Thrace Region of Turkey. Swamps caused by Meriç, Tunca, Arda and Ergene Rivers flooding and rice farming used to provide ideal conditions for mosquito breeding. Malaria was seen in Edirne Palace during Ottoman Empire and caused deaths. Ottomans try to drain swamps by planting Eucalyptus trees; however, they were not succeeded. Fighting against malaria was continued in Thrace during Turkish Republic. Fighting Malaria Commission, founded in Edirne in 1924, aimed to drain swamps, detect and treat malaria patients, and raise public awareness. Fighting Malaria Law, numbered 839, was accepted in 1926. Urgent Fighting Malaria Law, numbered 4707, and Fighting Malaria Law, numbered 4871, was legislated in 1945 and 1946, respectively. The goal was to wipe out malaria in the country. Thrace Fighting Malaria Center was founded in Edirne in 1936. Branches of the organization were also founded in the counties of Edirne. Significant gains in the fight against malaria were made with the public support. Edirne still has a risk of malaria. Only one patient was diagnosed in last five years.

Key words: malaria, Thrace, history of medicine.

1 Trakya University, Medical School, Department of History of Medicine and Deontology, Edirne, Turkey 2 Trakya University, Medical School, Department of Physiology, Edirne, Turkey

1 Introduction History of malaria, an infectious

disease whose notification is obligatory, is as ancient as the history of mankind. Hippocrates was the first to describe the manifestations of the disease. He stated that malaria was a diseases characterized by intermittent fevers.

Malaria is also one of the oldest and the most frequently occurring diseases in Thrace. People have developed different strategies to recover from malaria. In the old times, they tried to repel mosquitoes by burning fire and by fuming. During Ottoman period, water absorbing plants

such as eucalyptus trees (eucalyptus globulus) and chamomile were grown up in order to wipe out the malaria in the region. Eucalyptus seeds and medicines such as sulfane and physicians were send from Istanbul to the regions affected by malaria. Malaria did not only affect the public, but also, sometimes, it affected the Sultan and the people living in the palace. Çadır Kö�kü (Tent Pavilion), on the shoulders of Muradiye, was reserved for the people living in the harem and affected by malaria [1].

Fight against malaria was continued after the foundation of the Turkish


82

Republic. In the early years of the republic, not only malaria but also other infectious diseases such as smallpox, trachoma, and typhus were widespread in Turkey. Turkish Republic has placed much emphasis on fighting against infectious diseases. However, the first target had been malaria. ”Fighting Malaria Law”, numbered 839, was legislated in May 13, 1926. In 1928, Malaria Institute was founded in Adana for research and education. Fighting malaria organizations and malaria clinics started to be found in the cities. A malaria hospital was opened in Adana. Number of malaria centers grew to 11 in 1937 and increased to 16 in 1937. Branches of these organizations were also founded in the neighbor cities and counties. Malaria Field Hospital was founded in Aydın.

In this study, we investigate the efforts of Turkish Government in the early years of Turkish Republic (1926-1960) to control and prevent the malaria disease in Thrace. The next section presents the foundation of the Thrace Fighting Malaria Organization and its studies.

2 Thrace Fighting Malaria

Organization In the early years of Turkish Republic,

malaria was widespread in the cities and the villages of Thrace. Thrace Public Supervisor, Dr. �brahim Öngören, wrote in his report about the health conditions of the population in Thrace: “I discovered many sources of malaria at each part of Thrace. This is the main health problem of Thrace. Çanakkale region, especially Menderes area, has the same problem”. Malaria was mostly seen in rice-growing regions, lakes, and rivers. Gala Lake in Enez was one of the main mosquito breeding-places. Overflow of Meriç River causes swamps around �psala area. In Thrace, Malaria was not only widespread around Meriç, but also around the Black

Sea coast. It is mentioned that Mustafa Kemal

Atatürk affected by malaria infection during military trainings in Thrace in 1936. In the same year, Thrace Fighting Malaria Organization based in Edirne was founded. In a very short-time period, the fight against malaria came a long way with the support of public. Channels were constructed; swamps were drained; hollows and trenches were filled. Dams and bridges were built. Humans were inspected; patients were treated. Table 1 and Table 2 show the activities of the Thrace Fighting Malaria Organization in 1936 and the numbers of malaria patients treated in Thrace in the years 1936-1939, respectively. However, beginning of World War II slowed down the fight against malaria. Large number of people immigrated and Territory was almost empty of people.

Table 1: Activities of Thrace Fighting

Malaria Organization in 1936[2] Activity Statistics Number of counties

i d10

Number of villages 137

Number of people inspected 177,744

Number of patients treated 54,888 Number of people blood

d65,933

Amount of free quinine 582

Amount of vitamin 1,680

Amount of sulphane used 71,627

Number of quinine tube used 1,067

Amount of gas used (kg) 1,940 Amount of pure uranium

d (k )100

Amount of wihz solution 290

Amount of klesckt solution 3,000

Number of house and barn 26.678

Length of canal opened (m) 21.002

Length of drain opened (m) 6.545

N, GÖKÇE: Short history of Thrace fighting malaria organization 83

Length of stream cleaned 55.035

Volume of gutter filled (m3) 14.678

Number of bridge 4

Number of dam constructed 4 Table II: Number of Malaria Patients

Treated In Thrace Year Patients 1936 37425

1937 55489

1938 59085

1939 54954

Total 206953

In 1945, a course was offered by the

Thrace Fighting Malaria Organization. Total number of person attended this course was 37; 11 of them were women. After successfully completing the course, attendees were assigned in the fight against malaria in Edirne.

In the years 1950-1960, fight against malaria was very intensive. In 1957, a National Malaria Eradication Program, a cooperative undertaking by The World Health Organization and UNICEF, was established in Turkey; organizational structure was defined. In the new organization, Dr. Kemal Erdem was assigned as the Regional Director of Tekirda� Province and Dr. Ferruh Tepeköy as the Regional Director of Kırklareli Province. Dr. Ratip Kazancıgil, the Director of Organization of Thrace Fighting Against Malaria at that time, became the Group Regional Director of the group founded in Edirne. Some of the members of the organization can be seen in the picture below. Under the National Malaria Eradication Program, a group of malaria fighter was send to Italy for training. The group had been trained for a month in an institute, called “Istituto Superiore Di Sanita”, in Rome.

Members of the Organization of

Thrace Fighting Against Malaria (1952)

� top row, from left to right Physician of the Edirne Branch Dr. Sacit Balkan, Physician of the Babaeski Branch

Dr. Ferruh Tepeköy, Physician of the Saray Branch Dr. Osman, Physician of the Lüleburgaz Branch Dr. Kemal, Physician

of the Kırklareli Branch Dr. Turhan, Physician of the Ke�an Branch Dr. Fuat

� front row, from left to right Physician of the Gelibolu Branch Dr Mustafa, Physician of the Uzunköprü

Branch, the Director of Organization of Thrace Fighting Against Malaria Dr. Ratip Kazancıgil, Physician of the �psala Branch Dr. Zeki Akçol, Physician of the Hayrabolu

Branch Dr. Ratip Kazancgil, the Group

Regional Director of Malaria Eradication Program at that time, narrates his experiences on fighting against malaria [3]:

“We were fighting against malaria in

the whole Trace Region. It was required to collect a blood sample from each suspect who was suffering from high body temperature. To analyze blood samples rapidly, mobile medical teams and services were formed. These mobile teams were picking up collected blood samples and delivering them to central laboratory quickly. This approach helped us determine malaria patients very fast. Our


84

efforts were being monitored by UNICEF Malaria Group who was working at Head Office of Fighting Against Malaria at Turkish Ministry of Health. Finally, it was decided that fighting against malaria was successful in Edirne. I, Dr. Ertu�rul Akel, Assistant Adviser at Turkish Ministry of Health, and Dr. Ferruh Çoruh, General Director of Malaria, were invited to UNICEF Head Office of Fighting Against Malaria in Copenhagen to discuss the status of malaria in Edirne. As a result, it was decided that malaria was eradicated in Edirne and the yellow dot, the malaria warning sign, on Edirne was removed from map of Turkey.”

3 Conclusions Malaria is one of the oldest and the

most frequently occurring diseases in

Thrace. In the early years of Turkish Republic, malaria was also widespread in the cities and the villages of Thrace. In 1936, Thrace Fighting Malaria Organization based in Edirne was founded with the aim of eradicating malaria in the Trace region. The organization achieved its goal with the support of public in a very short-time period.

References

[1]. Ahmet Süheyl Ünver and Rıfat Osman. Edirne Sarayi. Turkish Historical Society Publications.Ankara, 1989.

[2]. Edirne Postası. May 11, 1938. [3]. Ratip Kazancıgil. Personal

Communication. April 18, 2006.


AMBROISE PARÉ’S BROKEN LEFT LEG IN 1555

P. ALBOU1

Abstract: The scene occurs in 1555: when Ambroise Paré (1510-1590), the famous French surgeon of the Renaissance, crossed in boat a river to go to visit with a horse a patient in the surroundings of Paris, his horse gave him “such a kick” that the two bones of his left leg were entirely broken, a few centimeters over the foot… The description of this accident and its consequences was written by Ambroise Paré himself and can be red in a text named History of the author having a broken leg that we can find in his Surgical Works. We will recall in this paper this accident and its consequences, which lasted several months. Beyond its biographical and anecdotic interest, this observation informs us about various aspects of the surgical practice of this time. It illustrates also Georges Canguilhem’s reflection: “The doctor have to know that he is a potential patient and he is not better assured than his patients to succeed, if necessary, to substitute its knowledge for its anguish” Key words: Ambroise Paré, 1555.

1 St-Amand-Montrond, France.

«Plato was therefore right to say that to be a true doctor would require that anyone

who would practice as such should have recovered from all the illness which he claimed to cure and have gone thought

all the symptoms and conditions on which he would seek to give an opinion.

If doctors want to know how to cure syphilis it is right that they should first catch it themselves! I would truly trust

the one who did» Montaigne, Essays, III, 13

Ambroise Paré (1510-1590) was the surgeon of King Henry II and his descendants: François II, Charles IX and Henri III.

The scene occurs in 1555: when Ambroise Paré (1510-1590), the famous French surgeon of the Renaissance, crossed in boat a river to go to visit with a horse a patient in the surroundings of Paris, his horse gave him “such a kick” that the two bones of his left leg were entirely broken, a few centimetres over the foot…

The description of this accident and its consequences was written by Ambroise Paré himself and can be red in a text named History of the author having a broken leg, that we can find in his Surgical Works (Œuvres d’Ambroise Paré,1579, Livre 14, Chap. 23 to 28).


86

Ambroise Paré (1510-1590)

(Copyright BIUM)

Oeuvres d’Ambroise Paré (1579)

(Copyright BIUM)

We will recall in this paper this accident and its consequences, which lasted several months:

After his leg was broken, his first thinking was to be afraid to have his leg cut off and he began to pray... Ambroise Paré tells us that when he fell on the ground, "the fractured bone through flesh, the trousers, and even the boot”, then he felt "such a pain it is possible for man to endure."

After being rescued by his friends, he was transported to a nearby house with a lot of pain because, he says, "one brought the body, the other leg, the other foot and walking one rose on the left and the other bent on the right." First medical care

While sweating profusely, a plaster was applied over the injury from the available ingredients: egg white, wheat flour, furnace soot, all mixed with fresh butter melted.

He asked his friend Richard Hubert reduce the fracture "and forget the friendship he bore him, pulling hard on his foot and digging in the wound with a razor" to recover more easily bones in their normal position.

Splints were then implemented his leg resting on a cushion "as you see in this figure":

Paré’s figure

(Copyright BIUM)

PHILIPPE ALBOU: Ambroise Paré’s broken left leg in 1555 87

Medical treatment After being transported home, he was

treated as follows: − bleeding in the left basilica vein − applying ointment (Onguent rosat) − light diet with prunes and bread, with

water; − few mild purgatives as cassia or

rhubarb, and suppositories or soap "to stimulate my abdomen."

The evolution was complicated by two problems: − muscle cramp, so violent that the

bones moved and had to be again pull to replace the leg in the good way… while he said feeling "more pain than first time "

− fever on the 11th day, which lasted a week, with the appearance of an abscess on which a patch was applied to help evacuate.

Prevention of bedsores

The main Ambroise Paré’s thinking was to avoid pressure sores, especially in the sacrum and heel "because in these places there is little flesh."

Techniques used for the prevention of bedsores: − regular elevation of the heel or lift

from the bed by pulling on a rope attached to the foot of his bed, to “give breath to support zones” ;

− use of a pillow under the buttocks and also under the heel;

− application of plasters, ointment or cooked alum to "take out the bone fragments separated" and promote "the generation of callus"

Albou’s figure

Ambroise Pare’s invention of a notched splint

Pare noted that he invented, after his own experience, “cassole de fer blanc”, or splint, notched heel so that it does not touch the bed.

Paré’s figure

(Copyright BIUM) Epilogue

Let Paré concluded himself that episode: "I waited over three months that the callus is done. During this time, I lay in my bed, which is not agreeable to a sad sick. It took another month to put my feet on the ground without my cane... My good


88

leg was helping the injured leg, as does a sister’s hand or a friend’s arm, helping to lift, turning in one direction or the other... . Conclusion

Beyond its biographical and anecdotic interest, this observation informs us about various aspects of the surgical practice of this time.

It illustrates also Georges Canguilhem’s reflection: “The doctor have to know that he is a potential patient and he is not better assured than his patients to succeed, if necessary, to substitute its knowledge for its anguish”.

References [1]. Ambroise Paré, Œuvres, divisées en

vingt-sept livres, revus et augmentés par l’auteur pour la seconde édition. A Paris, chez Gabriel Buon, 1579 (disponible sur www.gallica.fr)

[2]. Georges Canguilhem, Puissance et limites de la rationalité en Médecine (1978), in « Etudes d’histoire et de philosophie des sciences », Vrin, Paris, 2002, p. 409.


SIGNIFICANCE OF PHYSICIANS’ SOCIETY IN ODESSA IN GENERATION AND FORMATION OF PHAGOCYTAL

(I.I. MECHNIKOV’S) THEORY (DEDICATED TO CENTENARY OF I.I.

MECHNIKOV’S NOBEL PRISE AWARDING)

YURIY K. VASYLYEV1

Abstract: The history of Mechnikov’s phagocytal theory of immunity deals with the physicians’ Society in Odessa. As early as 1874 Mechnikov was elected to be a full member of the physicians’ Society in Odessa. However his active participation in the work of the Society began later on, i.e. in the 80-ies of the XIX century, when Mechnikov formulated his phagocytal theory of immunity. The fact that he came to the physicians’ Society in Odessa was quite logically and it characterizes Mechnikov as a scientist who searches for qualified auditorium to discuss his hypotheses. Mechnikov attended 34 meetings of the physicians’ Society in Odessa and made 6 reports, devoted to proofs of phagocytal theory of immunity. Meetings of the physicians’ Society in Odessa were the first auditorium where reports on the phagocytosis theory, suggested by Mechnikov, were thoroughly discussed, subjected to criticism and it promoted generation and formation of the theory that afterwards was internationally recognized. Key words: Physicians’ Society In Odessa, I.I. Mechnikov

1 Sumy State University, Ukraine.

Ilya Ilyich Mechnikov (1845-1916) and Paul Ehrlich (1854-1915) became the Nobel Prize winners in Physiology or Medicine, 1908. They were Nobel Prize awarded «in recognition of their work on immunity».

Considerable amount of literature is devoted to I.I. Mechnikov’s life and activities and at the same time the analysis of appearance and formation of the phagocytal theory idea, which became one of the bases in teaching on immunity against infectious diseases of a human

organism, takes a prominent place. However, a very important transition of Mechnikov’s-biologist to the field of studying a human organism’s fight against causative agents of infectious diseases has not been traced back yet, but the step was made by I.I. Mechnikov in the very beginning of the phagocytal theory formation in 1883-1887. I.I. Mechnikov’s collaboration with the prosectors Nicolay A. Stroganov (1843-1894) and Cheslav I. Chentsinsky (1851-1916) as well as discussion of Mechnikov’s reports in the


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meetings of the physician’s society in Odessa was of great importance.

The physician’s society in Odessa was formed in 1849. At that age Odessa was a main commercial port of the Russian Empire in the Black Sea. The society united the physicians who worked in health stations of the city, maritime quarantine as well as general practitioners and military doctors. After establishment of Novorossiysk University in 1865 in Odessa some of the teachers of the University became its members.

In 1867 I.I. Mechnikov arrives in Odessa after his election as an associate professor of Novorossiysk University but next year he moves to St. Petersburg University. In 1870 he returns to Odessa as professor of zoology department of Novorossiysk University.

In 1874 the professor Mechnikov was elected as a full member of the society by Grygory N. Mynch’s (1836-1896) proposal who was a chairman of the latter at that time. However, his active participation in the work of the society began later and it dates back to the 80-ies of XIX century when I.I. Mechnikov formulated clearly his phagocytal theory as well as entirely devoted himself to its proof.

As there could be a birth of this theory immunologist L.A.Zilber tells: « In the summer of 1882 of I.I.Mechnikov with a family has a rest in Italy on the bank of the Messinsky gulf. Tired sick eyes do not come off a microscope. He observes a life of mobile cells in a larva of starfishes. The larva is transparent and these cells are perfectly visible. And suddenly there is a thought that similar cells should serve in a human organism for „counteractions to harmful agents”» [1]

It is difficult now to tell how much exact L.A.Zilbera's story was, but it is well-known, that the theory of phagocytosis arose just in 1882 and numerous zoological and embryological

I.I.Mechnikov's researches about a role of intracellular digestion and protective function of cells, formed of mesoderm, preceded its occurrence.

In the summer of 1883 VII Congress of naturalists and doctors of Russia gathered in Odessa and in August, 28th I.I.Mechnikov made the report «About curative forces of a human organism» on a general meeting of the congress. Then a victorious road of the phagocytal theory began.

In Odessa, where I.I.Mechnikov lived and worked at that time, microbiological researches were started on botany department of Novorossiysk University by the professor L.S. Tsenkovsky, and after his departure from Odessa in 1871, they were continued by Odessa doctors G.N. Minh, O.O. Mochutkovsky, Ch.I. Hentsinsky, N.A. Stroganov who were full members of the physicians’s society in Odessa and they reported about the results of their researches at its sessions.

Thus physicians of Odessa, represented by the society, were ready for perception of I.I. Mechnikov’s ideas. On the other hand, Illya Ilyich required a medical audience for discussion of the hypothesis put forward by him.

On November 26th, 1883 I.I. Mechnikov made the report «Comparative pathological research on inflammation in connection with a question on intracellular digestion» [2] at the session of the society. Here he stated the theory of phagocytosis for the first time after his report at VII Congress of Russian naturalists and doctors.

In March issue of the magazine «Russian medicine» in 1884 the “Open letter to the professor I.I. Mechnikov» was published by Odessa doctor Semyon Moiseyevich Shor (1845-1917). He wrote that doctors listened to Illya Ilyich’s report with a great interest, but at the same time it was necessary to prove that principles of

Y.K. VASYLYEV: Significance Of Physicians’ Society In Odessa In Generation And Formation Of Phagocytal (I.I. Mechnikov’s) Theory

91

the theory of phagocytosis were applicable for infectious diseases of a human organism [3]. I.I. Mechnikov did not disregard the questions which were put before him.

On May 12th, 1884 the society heard I.I. Mechnikov's report «About relationship of anthrax bacilli to phagocytes» [4]. It was his first research on medical microbiology problems which at the same time had immunological nature. New proofs of the phagocytal theory rightness were given in his work: it was shown that the phagocytosis phenomenon naturally occurs among vertebrates as well as invertebrates.

In 1886 I.I. Mechnikov made two more reports in the society. The first of them, reported on May 17th, was «About relationship of streptococci to phagocytes» [5] and the second one, made on October 18th, was «About destiny of micro-organisms in blood» [6]. These works were further substantiation of the phagocytal theory. The debate, caused by those reports in the society, definitely affected the subsequent course of I.I. Mechnikov’s work. So, on October 18th N.A. Stroganov and K.K. Iskersky told dissatisfaction with hypothetical explanation of phagocytes role in case of diseases progressing with crises. In his reply I.I. Mechnikov spent a series of new researches and on February 7th, 1887 he represented the report «Concerning the doctrine about malaria» [7] and on May 16th in the same year he made the report «About fight of phagocytes in case of relapsing fever» [8]. The doctrine on phagocytosis was not only disproved by supervision over these infections, but, on the contrary, it received a new acknowledgement.

In all during 1883-1887 I.I. Mechnikov was present at 34 sessions of the physicians’s society in Odessa and he made 6 reports. The sessions, at which he told about the researches, were among the

most visited and on November 26th, 1883 when the society heard I.I. Mechnikov's report «Comparative pathological research concerning inflammation in connection with a question on intracellular digestion», maximum number of visitors for those years, i.e. 69 full members and 16 visitors, gathered (in 1883-1887 there were 37-38 full members at the society sessions on the average, taking into account that in 1883 there were 11 honorary members, 92 full members and 9 correspondent members in the latter) [9].

It is also necessary to notice that researches with use of medical microbiology methods were performed by I.I. Mechnikov in the prosectorium of the city hospital along with consultation and assistance of the full member of the Society doctor of medicine N.A. Stroganov who headed hospital prosectorium since 1877. In 1887 I.I. Mechnikov worked in collaboration with the assistant N.. Stroganov who was then a military doctor in the prosectorium; it was his second job. Ch.I. Hentsinsky was studying malaria causative agents for many years.

Summarising all abovementioned it is possible to assert that sessions of the physician’s society in Odessa were the first audience where reports on the theory of phagocytosis, offered by I.I. Mechnikov, were not only heard both at VII Congress of naturalists and doctors, but also they were thoroughly discussed, subjected to criticism and it promoted formation and becoming the theory that obtained international recognition afterwards. And full members of the society not only discussed and criticised I.I. Mechnikov's reports, but also assisted in laboratory researches (N.A. Stroganov, Ch.I. Hentsinsky). References: [1]. �� .. ��

��. – ��, 1945. – �. 10.


92

[2]. �� .�. ��!�� ". – ��, 1954. – #. 5. – �. 22-30.

[3]. $�� .�. // %��& !��'��. – 1884. - * 12. – �.284-286.

[4]. �� .�. ��!�� ". – ��, 1950. – #. 6. – �. 41-59.

[5]. �� .�. ��!�� ". – ��, 1950. – #. 6. – �. 63-90.

[6]. �� .�. ��!��

�� ". – ��, 1954. – #. 5. – �. 54-57.

[7]. �� .�. ��!�� ". – ��, 1954. – #. 5. – �. 58-64.

[8]. �� .�. ��!�� ". – ��, 1950. – #. 6. – �. 91-101

[9]. +��/�� < =��" >�?��/�� @ ��" =� 1882-1883 ��. – >��, 1882-1883. – 23, 211 �.


MILESTONES PHYSICIANS AND THEIR CONTRIBUTIONS IN TURKISH

ORTHOPEDICS AND TRAUMATOLOGY

ELIF ATICI1, TEOMAN ATICI2

Abstract: Orthopaedics, dealing with the treatment of the irregularities in the locomotors system and traumatology, dealing with the treatment of injuries after trauma have been serving as independent treatments in the surgery clinics in Turkey as in the whole world. The independent science field becoming of Orthopaedics and Traumatology in Turkey has been released by the efforts and contribution of many respected physicians. In this presentation the efforts of the physicians Orhan Abdi Kurtaran, Akif Sakir Sakar, Burhaneddin Toker, Dervis Manizade and Rıdvan Ege who have contributed in the development of Orthopaedics and Traumatology in Turkey is going to be mentioned. Key words: Orthopaedics and Traumatology, History of Medicine, Turkey.

1 Uludag University, Faculty of Medicine, Medical History and Ethics Depart., Bursa, Turkey 2. Uludag University, Faculty of Medicine, Orthopedics and Traumatology Depart., Bursa, Turkey

Like in whole world, in Turkey as well the proceeding of surgery into a modern appearance has been in the 19th century. The later separation of orthopaedics and traumatology from general surgery like urology, gynaecology and alike fields and its becoming as an independent science field has been in different dates and ways in every country. Orthopaedics, dealing with the treatment of the irregularities in the locomotor system and traumatology, dealing with the treatment of injuries after trauma have been serving as independent treatments in the surgery clinics until recent years [3].

The independent science field becoming of Orthopaedics and Trauma-tology in Turkey has been realized by the efforts and contribution of many respected physicians. In this essay, the efforts of the physicians Orhan Abdi Kurtaran, Akif Sakir Sakar, Burhaneddin Toker, Dervis Manizade and Ridvan Ege who have

contributed in the development of Orthopedics and Traumatology in Turkey is going to be mentioned.

Dr. Orhan Abdi Kurtaran (1877-1948)

After graduating from Military Medicine School in 1899, he worked as a surgery assistant with Prof. Reider and Dycke Pasha in Gulhane Hospital [1]. Dr. Orhan Abdi was sent to University of Bonn by Sultan Abdulhamid in 1900. He got training orthopaedics from Dr. Max Shede and learned the production of orthopaedics equipments from Eschaum. Later, he became an assistant of Prof. Hoff in University of Wurzburg (Baviera) and Prof. Sick in University of Eppendorff (Hamburg) [3, 12].

In 1905, by the order of the Padishah, he returned to Istanbul and began to work as a trainer at Gulhane Hospital, “Orthopaedics and War Surgery” [13].


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Fig. no.1. Dr. Orhan Abdi Kurtaran

So, involvement of orthopaedics in

medical training began in 1905 with Dr. Orhan Abdi. At the same year, he used ether in the operations and contributed for developing anaesthesia. With the foundation of Medical Faculty in 1909 it was seen that for the first time orthopaedics branch has become semi private and the name of the lesson was changed to “Orthopaedics and Big Surgery Operations” [13]. During those days there were three surgery clinics. The third one’s name was “Surgery and Orthopaedics” and the chairman of it was Dr. Orhan Abdi. However, when he became as the chairman of the second surgery clinic, the name orthopaedics was removed [3].

Akif �akir �akar (1888-1961) After graduating from Military

Medicine School in 1910, he underwent a period of training in Gulhane Military Practice Hospital, surgery clinic. At the end of 1911 he was inducted as a surgeon to Van Military Hospital. In 1912 he worked as an assistant in Vienna University with Prof. Eiselberg in surgery

clinic and with Dr. Breitner in emergency service for a year. In the I. World War he worked as a physician in Jerusalem, Syria and Palestine. He was captured in Damascus. In 1919 he returned to Istanbul, in 1921 he graduated as a surgeon and began to work with Dr. Mouchet who was working with orthopaedics patients and giving lectures on “Paediatric Surgery and Orthopaedics”. He was appointed as an interpreter of Dr. Mouchet by Dr. Akil Muhtar Ozden, the Dean of that time. After becoming an associate professor in 1923, he began to give lectures between the years 1923-1925. In 1925, after Dr. Mouchet changed to teach in “Surgery Operation and Techniques” he became the head of Paediatric Surgery and Orthopaedics Department, which did not have a clinic [6]. In 1927-1929, he worked in Hamburg University surgery clinic with Dr. Sudeck on bone and joint surgery. Seeing that frac-tures treatment and orthopaedics was not sufficient in Turkey, he showed effort to establish a modern orthopaedics clinic [13].

Fig.no.2. Akif �akir �akar

E. ATICI, et al: Milestones physicians and their contributions in Turkish orthopaedics and traumatology

95

Dr. Akif Sakir had three goals; the establishment of the clinic, paediatric surgery and orthopaedics becoming a specialization branch and separating paediatrics surgery from orthopaedics. In 1930, the first Paediatric Surgery and Orthopaedics Clinic, which contained 30 beds was founded by him [3]. In 1931, he became professor. For the first time in Turkey, he used visual materials (photographs and operation images of orthopaedics patients) in education, also he always demonstrated patients related with lesson [13]. The first book of the clinic was published by him in 1936 with the title “Paediatric Surgery and Orthopaedics”. With the aim of acceptance Paediatric Surgery and Orthopaedics as a specialization branch, he established “Turkish Orthopaedics and Traumatology Association” in 1939. The department took its place among 22 specialization branches in the date of 1947. In 1955, with the special efforts of Dr. Akif Sakir Sakar, the clinic moved to the new building that was formed of 5 floors and 100 beds. So, Dr. Sakar has founded the modern orthopaedics clinic that was his ideal [6, 11, 13].

He had a book with two volumes titled as “Lectures on Paediatric Surgery and Orthopaedics Clinic”, 100 papers public-shed in Turkish medical journals and 40 papers published in German, French and Swiss medical journals [6].

Turkish Orthopaedics and Traumato-logy Association has been given scientific prize in the name of Akif Sakir Sakar since 1995. Also the same association arranged “28th Akif Sakir Sakar Days” this year.

Dr. Burhaneddin Toker (1890-1951) He began his medical education in

Damascus Medical Faculty and completed in Istanbul in 1910. He went to Germany in 1913 to make his residency in surgery

and worked together with the popular surgeons of that period, Brauer and Küttnerfor for 7 years in Berlin and Hamburg [2]. During that period fractures-deformations and injuries were cured in the general surgery. He specialized in modern bone surgery. After returning to Turkey, he started to work as an operator and the clinical director of the surgery department in Cerrahpasha Hospital. Surgery treatment opportunities were insufficient. Fracture-deformation treatment was mostly done by the bonesetters.

Also most of the physicians were not interested in fracture treatment and plaster structure. He was aware of the lacking points in this field, so he dealt with especially with traumatology [3].

Fig.no.3. Dr. Burhaneddin Toker

In order to increase the number of

patients, he made friendships with the policemen who take injured people to the hospital, and assured that all injured around were taken to Cerrahpasha. In a short time Cerrahpasha Hospital started to work as an accident surgery centre. He attained a mobile roentgen device and by


96

doing fractures reposition under radio-scopy, he released the first conservative modern fracture treatment in Turkey.

He brought Braun device schema and measures, which was used in fractures from Germany and had the smith done it.

The first surgery journal “Journal of Turkish Surgery” was published by him in 1927.

Also, he took the lead in the foundation of “Turkish Surgical Association” in 1929 with the aim of improvement in the scientific worlds [8, 9, 11].

Subsequent to the "University Reform" in 1933, the world famous German surgeon Ord. Prof. Dr. Rudolf Nissen has been assigned as the "Director of the 1st Surgery Clinic and the clinic was moved from Haydarpasha to Cerrahpasha. Dr. Burhaneddin Toker was first assigned to the staff of Dr. Nissen as an associate professor; five months later he became professor. Nissen went to U.S.A. because of his sickness and Dr. Toker became the director by proxy in 1941 and subsequent to definitive departure of Nissen, the new director of 1st Surgery Clinic at Medical School [7, 8]. Dr. Toker opened surgery building in 1943, the plan of which was set and started to build by Nissen in 1939. So, the clinic took a modern appearance [8]. He had the degree of "Ordinaries Professor" in 1943 and leaded cardio-vascular surgery, neurosurgery and anaesthesia departments in addition to the formation of new traumatology [7].

He was also the first implementer of some medical applications: first systematically blood transformation, first stomach resection operation (1928), implementation of first Smith-Petersen nail (1941), first book on fracture and dislocation [2, 9, 11]. He had over 150 papers and 3 books: Surgical Treatment of Lung Tuberculosis, Fracture and Dislocations, Lung Apses.

Dr. Dervi� Manizade (1902-2003) After graduating from Vienna Medical

Faculty in 1932 he began to work in the Traumatology Service of the II. Surgery Clinic in the same place and was preparing for associate professorship. Prof. Nissen decided Dr. Manizade for the assistantship would be appropriate. In 1937 he started to work as an assistant of Nissen and Toker in Istanbul. He was established archive system for the first time in the clinic (1938). He prepared patient follow forms and made sure that these forms were filled completely and regularly for each patient.

During those days fracture-deformation treatment, which was done within the general surgery, began to discuss that it should be the subject of orthopedics branch. After the death of Dr. Toker in 1951, Cerrahpasha Surgery Clinic divided into two with the directorship Dr. Kazım Ismail Gurkan and Dr. Fahri Arel. In 1960, Dr. Manizade was appointed to the directorship of the third clinic and for the first time he gathered the traumatologic cases in one place.

Fig.no.4. Dr. Dervi� Manizade


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Between the years 1962-1963 by combining surgery clinics, one clinic with six sections was established. One of these sections was Traumatology Service with 30 beds only for bone-joint injuries and orthopaedics cases. Dr. Manizade, who assured its establishment, was appointed as a director of this section [10].

First intrameduller nail implementation in tibia fractures was performed by him in 1950 [9, 11]. Turkish Orthopaedics and Traumatology Association has been given scientific prize in the name of Dervis Manizade since 2001. Also the same association is going to arrange “8th Dervis Manizade Orthopaedics Days” on December in this year.

Dr. Rıdvan Ege (1925- ) After graduating from Istanbul Medical

Faculty in 1948, he underwent a period of training in Gulhane Military Medical Academy, surgery clinic. In 1949, he was inducted to Erzincan and then Diyarbakır. In 1952 he worked as an assistant in Gulhane with Prof. Dr. Recai Erguler in surgery clinic. Although traumatology was very important for military, there was no specialization in Turkey. So, he went to U.S.A (Colombia University) in order to take orthopaedics and traumatology training in 1956. After returning to Turkey, he worked in general Surgery Clinic of Gulhane since Orthopaedics was not established yet [4]. He believed that skeleton traumatology was not the field of general Surgery and should be the specialist of orthopaedics. His aim was including Trauma into Orthopedics and separate Paediatric Surgery. To reach this aim first he completed 262 orthopaedic operations in a year and published these in Turkish and English. Then he visited three Medical Faculties in Turkey that dealt with orthopaedics and four Bone and Joint Illness Hospitals to start a communication

with colleagues. After presenting his works Professors Committee accepted to establish a clinic and also accepted Dr. Ege’s suggestion for naming the clinic as “Orthopaedics and Traumatology”. So, the separation of orthopaedics from paediatric surgery and traumatology from general surgery and joining them as an independent clinic was realized first in Gulhane Military Medical Academy in 1961 by him [5]. Also after working with Dr. Carroll (New York Colombia University) and with Dr. Boyes (Los Angeles S California University) on hand surgery, he established first hand Surgery Clinic in Turkey.

Fig.no.5. Dr. Rıdvan Ege

Also he established Mediterranean and Middle East Orthopaedics and Traumatology Association (1960), Turkish Rehabilitation of Disabled Association (1960), Turkish Orthopaedics and Traumatology Union Association (1966), Modern Surgical Training and Research


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Association (1970), Turkish Foundation of Traffic Accidents (1972), Turkish Hand and Upper Extremity Surgery Association (1977). He organized many national and international congresses. He has 111 books, 451 papers. Today, he continues his works in Ufuk University (Ankara), which was established in 1999 by Turkish Foundation of Traffic Accidents. He is the president of board of trustee [4].

Table 1. Contribution of physicians to

Turkish Orthopaedics and Traumatology

� First lesson in orthopaedics:

� “Orthopaedics and War Surgery” (Gulhane Hospital-1905)

� “Orthopaedics and Big Surgery Operations” (Medical Faculty-1909)

� Used ether in the operations (1905)

Dr. Orhan Abdi Kurtaran

� First Clinic: “Surgery and Orthopaedics” (1909)

� Establish modern orthopaedics in Turkey

� Use visual materials in education for the first time

� Establish Paediatric Surgery and Orthopaedics Clinic (1930)

� Publish first book: Paediatric Surgery and Orthopaedics” (1936)

Dr. Akif Sakir Sakar

� Establish Turkish Orthopaedics and Traumatology Association (1939)

� Establish the first modern orthopaedics clinic (1955)

� Released the first conservative modern fracture treatment in Turkey

� Published the first surgery journal “Journal of Turkish Surgery” (1927)

� He took the lead in the foundation of “Turkish Surgical Association” (1929)

� Leaded traumatology, cardiovascular surgery, neurosurgery and anaesthesia departments

� The first implementer of some medical applications:

� first systematically blood transformation

� first stomach resection operation (1928)

� first implementation of Smith-Petersen nail (1941)

Dr. Burhaneddin Toker

� First book on fracture and dislocation

� Established archive system for the first time in the clinic (1938)

� Prepared patient follow forms

� First intrameduller nail implementation in tibia fractures (1950)

Dr. Dervis Manizade

� Gathered the traumatologic cases in one place (1960)


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� Established Traumatology Service with 30 beds only for bone-joint injuries and orthopaedics cases (1962-1963)

� Established the first “Orthopaedics and Traumatology” clinic (1961)

� (separation of orthopaedics from paediatric surgery and traumatology from general surgery and joining them as an independent clinic was realized by him)

Dr. Rıdvan Ege

� Established � Mediterranean and

Middle East Orthopaedics and Traumatology Association (1960),

� Turkish Rehabilitation of Disabled Association (1960)

� Turkish Orthopaedics and Traumatology Union Association (1966)

� Modern Surgical Training and Research Association (1970)

� Turkish Foundation of Traffic Accidents (1972)

� Turkish Hand and Upper Extremity Surgery Association (1977)

Conclusion Orthopaedics began to its journey in

Turkey in 1905 with Dr. Orhan Abdi Kurtaran by getting its place in the medicine training and got its first clinic

with the intensive efforts of Dr. Akif Sakir Sakar in 1930. Although it was accepted as a separate branch in 1947, until 1960 the clinic’s name was Paediatric Surgery and Orthopaedics. The development in Traumatology began with Dr. Burhaneddin Toker and as an effort of Dr. Dervis Manizade first Traumatology Service was established within General Surgery. With the efforts of Dr. Rıdvan Ege Orthopaedics was separated from Paediatric Surgery and Traumatology was separated from General Surgery in 1961 and took the name Orthopaedics and Traumatology.

References

[1]. Altınta� A. Turk Cerrahisinin Onemli Bir Sahsiyeti: Operatör, Muallim Orhan Abdi (Kurtaran). Sendrom 1996; 8 (2): 80-85.

[2]. Arel F. Ord. Prof. Dr. A. Burhaneddin Toker. �stanbul klinik Dersleri 1951; 5 (27): 2-6.

[3]. Atıcı E, Atıcı T. The Development of Orthopaedics and Traumatology in Turkey and Some Results. JISHIM 2004; 3(5): 50-59.

[4]. Ege R. 80 Yılın Ardından. Vol. 1. Ankara: Ufuk University Publications 2007.

[5]. Ege R. Opening Speech. XV. National Congress of Turkish Orthopaedics and Traumatology. Proceedings Book. Publication of Turkish Ortopedics and Traumatology Union Assosiation. 1997. p.1-28.

[6]. Frik F. Turkiye’de Ortopepedi Kuru-cusu Ord. Prof. Dr. Akif Sakir Sakar. Dirim 1958; 33(9-10): 227-228.

[7]. Goksoy E. Ord. Prof. Dr. A. Burhaneddin Toker: Türk Cerrahisine Katkılar. Turkish Journal of Surgery 2005; 21(2): 102-111.

[8]. Goksoy E. The Biography and Work of Prof. Dr. Burhaneddin Toker-On Occasion of the 50th Anniversary of


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His Death. The New History of medicine studies 2001; 7: 387-409.

[9]. Manizade D. 65 Yıllık Cerrahpa�a hastanesi. �stanbul 1976: 82.

[10]. Manizade D. Kemik ve Mafsal Travmatolojisi. In: Kırık Çıkıklar. Vol 1. �stanbul: Publication of Cerrahpasha Medical Faculty, no: 119, 1983. p.1-21.

[11]. Manizade D. Ortopedi ve Travmatoloji. In: Unat EK, editor. Dünyada ve Türkiye’de 1850 Yılından Sonra Tıp Dallarındaki

�lerlemelerin Tarihi. �stanbul: C Publisher; 1988. p. 338-343.

[12]. Naderi S, Hakan T, Dinc G. Orhan Abdi Kurtaran ve Ameliyatı-Cerrahiye adlı Eserindeki Norosirurji ile Ilgili Bolumler. Turkish Journal of Neurochirurgia 2006; 16(3): 197-202.

[13]. Tanacan H. Turk Ortopedisinin Tarihcesi I. Acta Orthop Traumatol Turc 1993; 27: 151-159.


SILICOSIS DISEASE HISTORY IN EXPLOITATION OF COAL IN JIU VALLEY

M. FULGA1, V. ANDREESCU2, D. LUPULESCU1,3

Abstract: Since 1964 there were written papers on the history of mining, in general (Ion Lungu, 1964: “The beginning of coal mining in Transilvania”, Acta Musei Napocensis) and of Valea Jiului mining (Sargetia V, 1968: “The beginnings of the industrial revolution in Valea Jiului mining”), in which the work conditions and the life of the miners were described. Coal was known and extracted in the ancient times. The first coal extraction in Europe was officially mentioned in 1113, at Kerkrade, near the border between Holland and Germany. In 1183 there opened the first mines in Shefield, England, in 1240 in Durham and in 1291 in Walles. In our country, the first coal mines were discovered in 1771 at Doman, then, in 1788 at Secu and in 1790 at Anina, by Nicolae Hammer. The first mining was mentioned in 1792 at Seierdorf, Anina. The development of mining began at the end of the XVIIIth century and the beginning of the XIXth century. The growing industry of coal mining and the lack of a careful monitoring of the work environment led to an increased risk of pneumoconiosis during the ‘50’s, when the pathology of coal dust was not recognized. Since then, the number of miners grew and so the number of diseases induced by dust inhalation.

Key words: coal, silicosis, history of medicine.

1 Institute of Public Health Bucharest 2 County Public Health Authority Hunedoara 3 University of Medicine and Pharmacy “Carol Davila” Bucharest

Introduction Jiu valley is the region located in the

south of Hunedoara County, at the border among Transilvania, Banat, and Tara Romaneasca, region generic called “the country of the black diamond due to the exploitation of the pit coal deposit. This area started to be known since 1782 when layers of coals burning were noticed and those layers burnt much time after this.

Although in Jiu valley there were rich deposits of coal, the interest for natural coal raised considerably just in the 4th decade of the 19-th century, as a consequence of the request of fuel, this request being a result of the development of the capitalism and also due to the extension of the internal and external market.

Historical aspects The human being has been an energy

consumer since the primitive epoch. The coal has been known and used

since antiquity. In 1113 started the first pit coal exploitation from Europe, officially registered in Kerkrade, at the border between Holland and Germany. In 1183 the first coal mining exploitations were also opened and officially registered in England near Sheffield, after this appeared those from Durham, and in 1921 those from Walles. The coal was for a long time the only source of energy, it was used at the beginning as domestic fuel being the only source of heating in houses, after a while the coal started to influence the international economy.


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The facts are mentioned in the work “The coal research history from ancient times till 1900” written by A Semaka, published in the Mine magazine, 13 in 1962, also in the one written by N. Maghiar – ‘From the history of exploit-tation and using of mineral coals “public-shed in Mine Magazine nr 21 from 1971.

The 19th century was metaphorical defined the “coal” century. The increasing needs of energy used by the society led to the discovery and exploitation of new energy sources (petrol, natural gases, hydro electric power and atomic power etc.), without eliminating the coal as a source of energy.

Moreover, the coal production increased also in other countries, the coal mining being different regarding their type, structure of the coal layers. The most important coal mining is the pit coal mining these contains coking coal used in chemical industry. The coal mining containing brown coals and lignite are composed of superior coals used as fuel. An inferior type of coal is peat coal; this is frequently used in the North Europe, Asia and North America. The most profitable coal mines are those of surface as they are in Ger-many. In USA the coal is extracted from coal mines in average of 50 % and in C.S.I. (The Independent Community) in average of 35%

Europe was on the first place regarding the universal production of coal, but the production decreased more than 50 % around 1980, nowadays Europe produces just 1/3 from universal production.

C.S.I. is known as one of the greatest coal manufacturer in the world and it has in stored about 2/3 of the universal reserves of coal and from these 90% is located in Asia zone.

In our country the first discoveries of natural coal were made in 1771 in Doman, in 1788 in Secul and in 1790 in Anina by Nicolae Hammer. The first exploitments started in 1792 at Steierdorf-Anina. In our country the development of coal mining

started at the end of 18-th century and the beginning of19-th. The first works were in 1835 followed by those from 1840 done by Hoffmann brothers and Carol Maderspach, the owners of mines from Rosia Montana. The Maderspach brothers made exploitta-tions in Jiu Valley and they were the ones who put the basis, develop and improved the rudimentary mining coals the likely areas could be Petrosani, Petrila, their work was continued in the 6-th decade of the 19th century.

In 1896 Hoffmann Rafel, made a serial of coal analyses of the coal extracted from Lupeni, he reached the conclusion that this coal belonged to the group of pit coal with long flame and weak agglutinated. He showed the difference between the coal from East part of Jiu Valley and the ones from Lupeni, which contained a higher value in carbon and less in oxygen .The coal was used as raw material, as domestic fuel, later as a development of exploitation industry the coal was used as raw material for energetic industry (hydro and energetic power) metallurgy, iron and steel industry, afterwards was used in chemical industry. As a consequence of the crisis and because many vacancies were eliminated, after 1990 the coal exploitation industry decrea-sed much being replaced by other sources of energy which are, more profitable, sources like petroleum or natural gases.

About the beginnings and the development of mining in general and especially of Jiu valley was much written beginning with 1964 some works being as follows: ” Ion Lungu, 1964: “The begi-nning of the development of coal mining in Transilvania”, Acta Musei Napocensis) and “Aspects of the beginning of industrial revolution from Valea Jiului mining (Sargetia V, 1968: In these works was described miners’ work and life conditions from JIU valley and the history of exploitation and the usage of coal from old times – thing reflected in Mircea Baron’s

M. FULGA, et al.: Silicosis disease history in exploitation of coal in Jiu valley 103

book ‘The coal and society in Jiu Valley – inert-war period. (Fig. no. 1).

Fig.no.1

The work “Custom and continuity in

the country – the stone which burns” is a monography of the mining in Jiu Valley, followed by the history of the Jiu Valley with the social and artistic development of the area, the customs and also the evolution of death rate due to the occupational disease as a consequence of the exposure to the coal dust (fig. nr 2)

Fig.no.2

In the work “Consideration regarding the

coal usage in Romania” by Ion E Bujoiu and ‘What is taken from coal” by I. Simionescu, are presented diverse aspects related to the development of the mining industry in connection with the social and economical conditions from Transilvania and Banat.

Furthermore, during 1857-1858 the Uricani, Barbatenii de Sus, Lupeni, Macesd-Paroseni, Jiu Vaidei –Vulcan, Dalja, Petrila were bought by the Anonymous Society of mines and furnaces Brasov, which becomes a huge coal manufacturer of the Hungarian Austrian monarchy. The state made the first acquisition of coal fields in 1865.

Other studies were made by the Blum engineer and were mentioned in 1939 in the study work “Le basin de charbons Petrosani- Jiu Valley. Etude chimico-technic, stade de metamorphose et classification” ans the dr M marinescu studies on 24 samples of coal from the mines described in the work ‘Piscu, Aninoasa,Petrosani- Est”.

Other pieces of work in which is concluded that Jiu valley has superior coal are the works of the professor Ghe. Macovei- “Course of general geology and stratigraphy” another one is written by Ion E.Bujoiu “Encyclopedia of Romania “written in 1939.

The studies made by Wartha Wincze in 1876 proved that the coal from Petrosani can be used in the manufacture of coke needed in metallurgic industry and also in producing the light gas.

Around 1950 the public opinion sustained the idea that the dust coal from the mines in Jiu Valley doesn’t cause occupational disease of lungs. In the same time was also a wrong idea that the deposit of pit coal dust in the lungs can lead to pulmonary fibrosis which could protect the lungs against the bacillus tuberculosis. The development of mining industry led to the increase of personnel .The lack of means of control against dust the number of people ill because of inhaling coal dust started to rise.

The quantity of dust, in the absence of the means of control, rises in accordance with the quantity of coal extracted.

Statistics from 1968 showed that during the last two decade, in Romania were declared 24000 cases of illness of silicosis. Over 80% were among the personnel of mining industry.


104

Regarding the existence of pneumo-coniosis of ore coal were a lot of debates.

Some considered the coal as an inert gas which is stored in lung and it could cause just a weak fibrosis called black lung disease (anthracosis) which has the opposite effect of the dust from barren gangue that led to silicosis a serious illness, irreversible with lethal end (due to the high level of quartz).

There are different consequences when we talk about the place of work in a coal mine.

The miners from mines of barren gangue exposed to the dust rich in silicon (sillicium) can get ill with classic silicosis and the ones who work in mines of coal will be ill with black lung. Between the two pure types there are also mixed ones, encountered to those who work with stone and coal.

During 1950-1970 the level of dust was of 32, mg/mc air, and the ratio of working places which were exposed to a higher level than the maximum admitted doze was of 63%. During 1982-1996, as a consequence of mechanization and the improvement of the work environment the level of dust decreases at 25 mg/mc.

When we want to establish the risk of getting ill because of dust in a working place we must take into consideration 3 factors: the type of dust, quantity, and the dimension of particles. In each mine the risk is different and it is in accordance with the technology of exploitation used, types of work and the operations done during the cycle of work In the same time the introduction of mechanized working in cutting and evacuate the coal led to an increase of the level of dust in mining mechanized excavations, so it appears “the second wave” of illness and by black lung. For this were taken measures against of the dust and the number of diseases and their frequencies to decrease.

If between 1953-1996 the statistics showed that there were 2420 cases of disease due to inhaling of coal dust in Jiu Valley and

the average of life was 42, today the incidence decreased at 1-0,5% and the average of age increased at 50.8 years.

An estimation made before 1975 presented that from 100 ill people 24,9% have worked exclusively in coal extraction (and these were with black lung) 40,8% who worked in combined environment with stone and coal were ill with pneumoconiosis due to mixed dust and 34,3% who worked just in quarry they were ill with silicosis. Regarding the classifying of silicosis grade there can be em-phasized the following percents: the first phase -84.4% the second 9,9% and the third 2,8%

Beginning with the setting up of the commission of silicosis in Petrosani and the establishing of the criterion declare the illnesses the silicosis and black lung started to decrease. The level of dust decreased so that the number of cases of silicosis disease is much rarer.

To sum up the morbidity of the personnel which is hired nowadays in mines from Jiu Valle, in comparison with the past? Decrease very much due to the mechanized technology used now in mines.

References:

[1]. Badea L. – Valea Jiului, Ed. �tiin�ific�, Bucuresti, 1971, p.7-26.

[2]. Baron M. – C�rbune �i Societate în Valea Jiului, Ed. Universitas Petrosani, 1998.

[3]. Baron M. – Tradi�ii �i continuitate în �ara «Pietrei care arde», Petro�ani, 1994.

[4]. Darlea G. - Antracoza, Ed. Favior & Vidra, Or��tie, 1992.

[5]. Fodor D., Baican, G. – Situa�ia actual� a mineritului românesc, Rev. Univers ingineresc. nr. 11/2002 si nr. 12/2002

[6]. Fodor, D., Baicon, G. – Impactul industriei miniere asupra mediului, Ed. INFOMIN, Deva, 2001.

[7]. Mocanu C., Tufescu V. – Depresiunea Petrosani, Ed. �tiin�ific� Bucure�ti, 1964, p.11.


SOME CONTRIBUTIONS OF ROMANIAN MEDICAL SCHOOL IN THE TREATMENT

OF NEUROSYPHILIS BEFORE THE DISCOVERY OF ANTIBIOTICS

S. G�BREAN1

Abstract: In the first decades of the XXth century, neurosyphilis was a frequently disease in the world, for which different types of treatments were experienced, for example drugs containing arsenic (Salvarsan and Neosalvarsan). These drugs were not 100% effective, especially in tertiary syphilis. In the years following the First World War, based on the observations that in same cases high fever is favourable in the treatment of syphilis, it was induced the malaria infection which determines a high and prolonged fever, at patients with late syphilis. The risk for the patients was acceptable because malaria could later be treated with quinine. We present some dates concerning the contributions of Ghe. Marinescu, M. Ciuca and their fellow-workers, who used paludotherapy and Salvarsan or Neosalvarsan as adjuvant therapy in treating neurosyphilis Key words: neurosyphilis, treatment, Romanian medical school


Syphilis is caused by the spirochaete Treponema pallidum, which is 5-15Qm in length and less than 0.3Qm in thickness. This organism is generally sexually transmitted through mucosal membranes or small lesions of the skin. T. pallidum can be observed by silver stain, immuno-fluorescence, with dark-field, phase-contrast or electron microscopy. In 1913, after centuries of discussions concerning syphilis, H. Noguchi, a Japanese scientist, demonstrated the presence of T. pallidum on sections from the brain obtained at the necropsy of a patient with progressive paralysis, proving that T. pallidum was the cause of the disease. Short time afterwards, in the same year, Gheorghe Marinescu together with his assistant I. Minea, confirm this discovery and identify T. pallidum not only on sections from

necropsies but also, for the first time, on sections from small fragments of brain obtained by the surgeon I. Jianu from a patient with progressive paralysis.

The various manifestations of syphilis are time dependent. Acquired syphilis has four stages: primary, secondary, latent and tertiary. Neurosyphilis refers to a site of infection involving the central nervous system and may occur at any stage of syphilis. There are four clinical types of neurosyphilis: asymptomatic neurosyphi-lis, meningo-vascular syphilis, general paresis of the insane and tabes dorsalis. Before the treatment with antibiotics, neurosyphilis was observed in 25-35% of patients with syphilis. General paresis, also known as dementia paralytic is a severe manifestation of neurosyphilis, which occurs approximately 20-30 years after the


106

initial infection with Treponema pallidum and represents a chronic progressive fronto-temporal meningo-encephalitis with especially psychiatric symptoms [6, 12].

Syphilis has been a major health problem since the XVIth century and was treated with some ineffective remedies (guaiacum, mercury and others) until the beginning of the XXth century, when treatments based on arsenic as Salvarsan (arsphenamine, developed in 1908 by S. Hata in the laboratory of Paul Ehrlich) and Neosalvarsan were used. Malario-therapy was used as treatment for neurosyphilis due to high prolonged fever (a form of pyreto-therapy), an acceptable risk because the malaria could later be treated with quinine. For discovering the treatment of dementia paralytica by malaria inoculation (1917), J.Wagner-Jauregg was awarded with The Nobel Prize for Medicine in 1927. Malariotherapy was followed by either Salvarsan or Neosalvarsan as adjuvant therapy [1, 10].

In our country, a number of medical personalities showed interest for the treatment of syphilis: Gh. Marinescu, C. Levaditi, M. Ciuc�, C. I. Urechia, Elena Pu�cariu-Densu�ianu and their co-workers.

At the beginnings of Romanian medical education, the first reference concerning syphilis prevention was made by Carol Davila in his doctoral thesis sustained on 23 February 1853, thesis which was entitled “Syphilis prophylaxis” [3].

Gh. Marinescu was one of the first physicians in the world who received (1910) from Ehrlich the small doses of Salvarsan, which he managed to prepare in order to be tested in the great hospitals of the world [9]. If Salvarsan produced healing in some forms of syphilis (skin syphilis, for example), in neurosyphilis (tabes, general paresis) it gave no results. Gh. Marinescu tried to introduce Neosalvarsan into the body not by intramuscular or intravenous injections,

but directly into the spinal canal or brain. He asked a former student, surgeon Ion Jianu, to do some small trepanations of the skull (it has to be mentioned that I. Jianu had never before worked on living brain); using these entries, Gh. Marinescu injected Neosalvarsan directly into the brain of the patients with dementia paralytica, but he didn’t obtain good results.

Fig.no.1.

As it was mentioned above, Treponema pallidum was identified in the brain of general paralytics in 1913 so, in 1910, Gh. Marinescu was only suspecting the presence of the spirochete in the brain of these patients. In order to destroy the spirochete, Marinescu introduces Neosalvarsan by intraspinal injections directly into the cerebrospinal fluid, but once again without the desired results, the drug being irritable and caustic for the nervous tissue. Together with his assistant I. Minea, Marinescu realized at the Pantelimon Hospital an original method of treatment for general paresis, which was based on injecting salvarsanized serum into the cerebrospinal fluid. The serum was obtained from patients with syphilis who were injected with an important quantity of Neosalvarsan. After a few hours, were taken 40-50 ml of blood from which the serum was obtained after coagulation; this serum contained both a very small dose of Salvarsan and the syphilis antitoxin produced by the organism. Injected to the patients with general paresis, this serum showed good results, even curative properties [5].

S. GXBREAN - Some contributions of romanian medical school in the treatment of neurosyphilis before the discovery of antibiotics

107

After two years, in 1912, two American physicians, Swift and Ellis publish the same method of treating neurosyphilis with salvarsanized serum. Although Ehrlich himself, the discoverer of Salvarsan, mentions at a medical congress held in Königsberg in 1913, the world priority of Marinescu’s researches regarding the intraspinal injection of the salvarsanized serum, the discovery is attributed to the two American physicians, who later recognized that the paternity of treatment was belonging to Gh. Marinescu. However, they were saying that they had “improved” the serum, improvement which meant putting into phials the salvarsanized serum and commercializing it worldwide. There were also disapproving opinions regarding the treatment with salvarsanized serum, being considered that “it is a complicated method, and if sometimes may have a more or less curative effect, it still does not represent a preferable treatment or a progress in the treatment of nervous syphilis” (C. I. Urechia) [12].

Fig.no.2.

In the 1920s, Constantin Levaditi and Robert Sazerac introduced bismuth therapy. For the treatment of neurosyphilis, bismuth therapy was done as in the case of visceral or skin syphilis, taking into account possible accidents like stomatitis, intestinal problems, jaundice etc. Generally, bismuth drugs seemed to have good results. There were patients who reacted very well at this therapy and there were also cases in which the patients

showed inability to tolerate the bismuth. As a consequence, it was preferred a combined treatment, based on alternating bismuth salts with Salvarsan [2, 7].

In Romania, the artificial infection with malaria (malariotherapy) was successfully used in the treatment of neurosyphilis. The method was simple and consisted in the intravenous or subcutaneous injection of blood taken from a patient presenting a malarial attack; on average, in 8-10 days, the patients had malarial attacks and after 10-12 attacks they were given quinine and Salvarsan.

The principle of treating neurosyphilis by impaludation was based on the high fever which, probably, nonspecifically inactivated T. pallidum and generated a complex neuro-immuno-endocrine defense and repair reaction of the body. Malariotherapy was performed at Socola Hospital in Ia�i under the direction of M. Ciuc�, at the Psychiatry Clinic of the Faculty of Medicine in Cluj under Professor’s C.I. Urechia direction, at the Neurological Service of the Institut for Mental, Nervous and Endocrine Diseases from Bucarest [11].

Fig.no.3

A special attention should be accorded to the researches made at Socola Hospital, the second internationally acknowledged centre for pyretotherapy, after Horton centre from England. At first, only Plasmodium vivax was used in treating neurosyphilis, being considered relatively safe and easy to control by quinine. After a few years, in 1925, Plasmodium


108

falciparum was used, first at Horton center and soon afterwards at Socola Hospital. The team working here under the direction of Professor M. Ciuc�, general secretary of the International Commission of Malaria for the League of Nations (1928-1938) also used in its researches indigenous strains of Plasmodium malariae, thus having an important contribution to knowledge of the sporogonic cycle of malaria parasites [4,8].

C.I. Urechia recommended for the treatment of neurosyphilis pyretotherapy using intravenous injections with beer yeast, which were painless and induced the required high fever (39,6-410C). The method was easily applicable and seemed to produce an important improvement, especially in the case of general paralysis [12].

A special interest for neurosyphilis also showed Elena Densu�ianu-Pu�cariu (1875-1966), the first woman in the world professor at a clinic of ophthalmology. She had better established the share of syphilis in the etiology of ocular diseases and was one of the first authors in the world who concluded that malariotherapy had no curative effect in the optic nerve syphilis [12].

From this short presentation, one may conclude that in a difficult socio-economical context, the Romanian medical school managed to come with important, even original contributions in the treatment of neurosyphilis until the discovery of antibiotics.

Bibliography

[1]. Austin S., Stolley P., Lasky T.: The History of Malariotherapy for Neuro-syphilis, JAMA, 268(4), 1992, 516-519.

[2]. Bittner J.: Paul Ehrlich, Ed. �tiin�ific�, Bucure�ti, 1971, 128-133.

[3]. Br�tescu G. Tinere�ea lui Carol Davila, Ed. Albatros, Bucure�ti, 1979, 113-117.

[4]. Ciuc� M., Ballif L. et al: Note du secretariat resumant un rapport sur le progress des travaux de la station

permanente de malariatherapie et d’etudes experimentales sur le paludisme (Institut Rockefeller) de Socola, Jassy, Roumanie, jusqu’au 31/12/1933, Societe des Nations, Organisation d’Hygiene, Commi-ssion du Paludisme, Geneve, 1934.

[5]. Floda L., Marioara G. Marinescu, Radovici. A.: Gheorghe Marinescu, Ed. Tineretului, 1958, 244-246.

[6]. French P., Gomberg M. et al: IUSTI: 2008 European Guidelines on the management of Syphilis, Internat. J. of STD & AIDS, 20, 2009, 300-302.

[7]. Levaditi C.: Bismuthoprévention de la syphilis, Volume jubilaire en l’honneur du Professeur G. Marinesco, Institut d’Arts Graphiques E. Marvan Bucarest, 1933, 395-400.

[8]. Lupa�cu G., Constantinescu P., Negulici E. et al: Parasitological and Clinical Investigations on Infections with the VS Romanian Strain of Plasmodium malariae Transmitted by Anopheles labranchiae atroparvus, Bull. Wld. Hlth. Org., 38, 1968, 61-67.

[9]. Marinescu G.: Coresponden�a (1889-1938), Ed. �tiin�ific�, Bucure�ti, 1968, 99-100.

[10]. Rudolf G. de M.: Recent advances in therapeutic (induced) malaria, J. Neurol. Psychopathol., January 16(63), 1936, 239–255.

[11]. Paulian D.: Les résultats de la malariothérapie dans le Service Neurologique de L’Institut des Maladies Mentales, Nerveuses et d’Endocrinologie de Bucarest, Volume jubilaire en l’honneur du Professeur G. Marinesco, Institut d’Arts Graphiques E. Marvan Bucarest, 1933, 537-538.

[12]. Urechia. C. I., Mih�lescu S.: Tratat de patologie neuro-mintal�, Ed. Lepage, Cluj, 1928, 491-502.


LAZZARO SPALLANZANI, IN TRANSYLVANIA DRIVE

A. MUSAJO SOMMA1, L. MUSAJO SOMMA1

Abstract: The Enlightment Revolution is a core element to understand grand narratives of the emergence of modern biomedical science. Despite attempts to create a more nuanced taxonomy of the remarkable transformation of knowledge of nature in this period, the hodoeporic writings by the Italian abbot Lazzaro Spallanzani are fundamental to understand a positivist and internalist approach in the development of experimental methods. During 1786 the sapiens’ travel from the Black Sea through Transylvania till Tara Ungureasca was full of natural, biological, social experiences coupled with medical and epidemiologic observations

Key words: Natural science, medicine, hodoeporics.

1 ACTI Department, University of Bari, Italy

Science enlightment Collecting rare and ancient objects or

things of aesthetic value, both natural and man-made, became very popular in European culture in the fifteenth and sixteenth centuries. These centuries witnessed the birth of Kunst und Wunderkammern “Rooms of Art and Wonders” in which the aim was to collect objects of astonishing originality which would stir and amaze visitors, as well as preserve the memory of Antiquity - indisputable aesthetic canon also for the modern.

Naturalia that is nature byproducts - even if featured as monsters - and Artificialia that is human artifacts, stimulated the common sense of observation and, most important of all, scientific interest and curiosity.

Those collections were the very start of natural history museums: tools for scientific research and cultural and social development. New technologies,

geographic exploration and scientific traveling opened the pathway to famous scientists’ work. At the edge of XVIIIth century Antonio Vallisneri (1661-1730), Italian physician and biologist - a scholar at Bologna University with Marcello Malpighi (1628-1694) - appointed to the chair of Practical Medicine at the University of Padua, wrote:

“Many have observed and many still

expect to observe, but not everyone has observed well, and others do not know how to observe, nor perhaps do they know how tricky the art of observation is, easily misunderstanding one thing for another, being blinded by the light, or not looking with due attention and diligence at what is to be looked at”.

He was one of the first researchers in

medicine to reject the Aristotelian theories and he started the collection


110

which is one of the best examples of those scientific gabinetti (laboratories) which turned to be university research laboratories where the experimental method in which Galileo was a master, became daily practice for scientists. Padua, Pavia, Bologna, and Modena at different periods in the XVIII century bloomed with the discoveries of their brilliant teachers and philosophers.

Biography In the very shadow of the Northern

Italy institutions of learning, Lazzaro Spallanzani (1729-1799), another Italian researcher, was keenly interested in the natural sciences and over his lifetime collected numerous specimens of animals, minerals and other natural objects.

He became a priest and eventually professor of natural history at Pavia, and was an enthusiastic traveller in pursuit of specimens for the natural history museum there as well as for his home private museum in Scandiano.

Fig.1. Spallanzani marble statue in his

home town Scandiano, Italy

He was educated at the Jesuit College and studied law for three years before getting frustrated and dissatisfied. He then turned his great hunger for knowledge to science. He became a biologist and physiologist, studying body functions and the unknown wonders of the natural world. He also studied philosophy and mathematics and discovered that microbes can move through the air and can be killed by boiling. Almost a century later, Louis Pasteur (1822-1895) studied and then expanded his work, and got many of his ideas from Spallanzani. The Italian scientist studied many topics and stated that digestion is a chemical process and not just the grinding of food. He was first to do an artificial insemination of a dog. He wondered why a stone skipped over the water when it was thrown.

In 1768 an offer by Empress Maria Theresa, then ruling over Austrian Lombardy, to give him the chair of natural history and keeper of the museum at Pavia proved too attractive to be refused. He held this position until his death thirty-one years later. During this period (1768-1799) he distinctly disproved the theory of spontaneous generation which had been done by Redi (1626-1697) before the discovery of microscopic organisms had given its exponents a new basis for argument. His work on fertility blazed the trail for future investigators.

Mineralogy received distinct contributions from his labours. He was perhaps the first to study the ability of bats to avoid obstacles in flying after they had been blinded. The dissertations on digestion were read in all scientific circles; their contribution to physiology was monumental. The studies on circulation contained original and important observations. By his work on

A. MUSAJO SOMMA, et al: Lazzaro Spallanzani, in Transylvania drive 111

respiration he first showed the real seat of combustion. Spallanzani was a Fellow of the Royal Society of London and a member of the Academies of Prussia, Stockholm, Gottingen.

The first known exploration into ultrasound physics happened in the 1790’s. Lazzaro Spallanzani wondered why bats could navigate at night and catch insects as they flew. He blindfolded them and they still manoeuvred very well. He then plugged their ears and found that they bumped into obstacles. He concluded that their primary mode of navigation was hearing. He deduced that they must emit ultrasound waves that are inaudible to humans and listen to the echoes to determine distance and direction of objects. This idea was received by his fellow scientists with ridicule and scepticism.

After the French army under Napoleon invaded Italy in 1796 Spallanzani was offered the position of professor of natural history at Paris but he declined because of his advanced age. On February 11th 1799, three days after an attack of apoplexy, having recovered sufficiently to recite Latin verse and having received the papal benediction, he died suddenly at 2:30 am suffering for a bladder cancer.

Hodoeporics: eastbound travel Quite a few Italian travellers went to

the Romanian area to work, to study, to make commerce, business and resear-ches: Tommaso Alberti in the XVII cen-tury and in the following century Maiolino Bisacioni (1582-1663), Francesco Griselini (1717-1783) and the “Astrologer” Lazzaro Spallanzani, as he was called by his scholars after he showed an early penchant for astronomy.

Also another Italian naturalist,

Domenico Sestini of Florence (1750-1832), crossed the Romanian area during the Century of Light almost in the same years when Maria Theresa’s son and previous co-regent Joseph II (1741-1790) was running the empire.

In August 1785, at the end of university lessons, Lazzaro Spallanzani sails from Venice to Constantinople. In the places he visits, he studies plants and animals, weather, the life and habits of those populations. He comes back travelling on land so he visits some mines and collects minerals in Transylvania, in the salt pan of Salzburg, in the gold and silver deposits of Zalatina, in the Carpathian metalliferous mountains. On December 7th, 1786 he arrives in Vienna and rich collection of minerals will be delivered to his university town one year later.

Transylvania experience On August 16th, 1786 Spallanzani

left Constantinople asking for the permission to go back home through the Transylvania drive to allow a deeper knowledge of mines and the natural area of Carpathian region.

Fig.2. Spallanzani drive

He comes back travelling on land so

he visits some mines and collects minerals in Transylvania. The deep desire to visit new geographic areas and to learn as much as possible prompted Lazzaro Spallanzani to travel back from


112

Constantinople joining the carriages of the prince of Walachia for a safer trip and to save money. Indeed he had already collected by Baron Sperges and the Austrian government a huge amount of money, worth 100 Venetian sequins, through Baron of Herbert in Constantinople.

On August 27th the caravan crossed Donau River and stopped in Skiera-Ollenza, in Walachia. Simplicity of life and a sincere hospitality welcomed the Italian scientist. Women are almost dressed as in the Ottoman area and Bulgaria but their face is not covered by any clothes. Crossing the village of Valek-Negest he was surprised to detect that people was dark skinned and curiously, dark skinned women were not at all beautiful and their breasts were pendulous offering from time to time a bare-thorax to the visitors eyes, “but they do not smell at all”!

After 12 nights he was forced to rest in the carriage, he arrived on August 28th in Bucarest where he was hosted by the prince Ypsilandi for five days. Indeed that nobleman was an employee of the realm, temporary nobility granted only to collect duties and local taxes, according to the arhondology’s laws.

Spallanzani visited the salt mines of Hani-Hanik and collected a huge amount of minerals. On the 5th of September he started his trip towards Kronstadt (Brasov) and the day after he stopped in the lazaret of Buza. Nearby the Bodza River a lazaret was open for quarantine every time plague was affecting people living in or crossing through Constantinople. The Empress Maria Teresa forced people crossing the borders to Transylvania to stop 3 or 6 weeks in Buza lazaret if infection was affecting the Ottoman area.

Corona or Kronstadt was only seven hours travelling from the lazaret and

Spallanzani arrived there in the evening of 7th September while a cold eastern wind was blowing across the area. Not a word he wrote on his trip from Kronstadt to Hermannstadt (Sibiu) - under the military protection of 30 soldiers offered by Ospodaro Mauroceno - where he arrived on 12th September.

He visited the salt mine of Saltzbourg (Witazna) and gold and silver deposits of Zalatna, where he arrived, crossing through Portu, on 24th September, in the metalliferous mountains very well known since ancient Roman time.

In that geographical area and near Alba Iulia many illegal coin minters - an ethnic group called Moti - were working as outlaw gold dealers and moreover “they know how to mint gold coins of the best quality and having the right weight”.

Moti lived in very miserable conditions and Spallanzani was very impressed by their skin chronic ulcers clearly related to advanced clinical syphilis: a terrifying map of typical open ulcers was covering all over their body.

The Italian scientist underlines that in the Turkish area he was unable to detect such big amount of venereal diseases’ skin tags. Moreover he states that in the Moti villages there were almost no children, clearly relating advanced syphilis to impossible pregnancies.

In Transylvania, the Walachi were about 1 million people; other inhabitants were Hungarians - the land owners - Siculi, Saxons, Germans, Armenians, Greeks (mainly merchants) and Bohemians. These were Gypsies classified as musicians, handcraft workers and Egyptians - that is gypsies working around and “mainly thieves”!

A. MUSAJO SOMMA, et al: Lazzaro Spallanzani, in Transylvania drive 113

He left Transylvania for the Banat region and he arrived to Temeswar on the evening of 14th October when a stormy weather and rain offered to the Italian biologist an awful welcome. He will report the poor quality of air because of several ponds and local people affected by intermittent fevers. Transylvania is left and Vienna welcomes the Italian scientist on 7th December 1786.

His hodoeporic writings about the scientific tour through the eastern European countries were printed only a century after his death.

Conclusion Spallanzani, in all his life as well as

in his Transylvania drive, took a necessary and decisive step away from scholastic Aristotelian natural philosophy, with its sterile metaphysics and reputed reluctance to value laboratory experience. Laboratory tools joined Spallanzani’s travels and his studies reoriented the research of natural sciences away from the world of common sense observation and made it rigorously measurable and testable.

Beyond the stones, he collected through the Romanian area biologic, ethnologic, medical and social notes.

A great biographer, as great as a botanist, the Transylvanian academician Emil Pop (1897-1972) paid his tribute to the extraordinary personality of the Italian savant printing in 1942 a study of great erudition related also to Spallanzani personality. In the supplement of Emil Pop’s paper, as published in Timisoara in 1942, there is also a list of 60 different minerals collected by Spallanzani in the region.

Three big cases of minerals were dispatched, on Spallanzani order, by the Zalatna mines’ inspector, Immanuel Will by ship along the Donau River to

Vienna. The acquisition of exhibits proved congenial to the most magnificent Museum of Natural History at University of Pavia. A great amount of natural history material items were collected in Spallanzani private museum in Scandiano, his hometown. The preservation of his private collection was a responsibility of his sister Marianna, a single woman who offered a great strength in the early attempts to preserve the items. She gained experience in taxidermy and in the preservation of stuffed-skins allowing a satisfactory preservation of the collections.

Difficult Mountain passes, floods and torrents, brigands and cut-throats, mines inspection to collect more specimen allowed to set up a unique natural science collection and the written records by Spallanzani feed social history information and therefore the wider world of individuals and researchers interested into medical history.

References

[1]. Ellenberger F., Ovide et la géologie, Travaux du Comité Français d’Histoire de la Géologie, 3e série, t. V, n° 3, 1991, pp. 17-24.

[2]. Ferrone V., I profeti dell’illuminismo. Le metamorfosi della ragione nel tardo Settecento italiano, Laterza, Bari 1989, p. 446.

[3]. Generali D., Antonio Vallisneri. La figura, il contesto, le immagini storiografiche, Olschki, Firenze 2008.

[4]. Musajo Somma A., Musajo Somma L., Italian doctors cruising on the Bosphorus, Proceedings 38th International Congress on the History of Medicine (Istanbul 2002), Ankara 2005, vol. 2 pp.1009-1012.

[5]. Pop E., Naturali�tii italieni din


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veacul al XVIII-lea, cercet�tori ai �inuturilor române�ti (Italian naturalists of the 18th century, researcher of the Romanian land) Timisoara, 1942.

[6]. Roman V., Notes from Lazzaro Spallanzani’s travel to the Roumanian lands, Comptes Rendues XXII International Congress ISHM (Bucarest 1970), 1972, pp. 261-262.

[7]. Spallanzani L., Viaggio in Oriente, a cura di Naborre Campanili, Bocca Editori Torino, 1888.

[8]. Vaccari E., Lazzaro Spallanzani: une naturaliste italien de dix-huitième siècle et sa contribution aux sciences de la terre, Travaux du Comité Français d’Histoire de la Géologie, XI, Paris 1996, pp. 72-89.

[9]. Vaccari E., Spallanzani e le scienze geologiche del Settecento: un

percorso interpretativo tra carteggi e diari di viaggio, Teorie e pratiche dell’esperienza scientifica. Lazzaro Spallanzani e le scienze della natura nel Settecento, “La sfida della modernità” Atti del Convegno di Studi a cura di W. Bernardi e P. Manzini, Olschki, Firenze 1999.

[10]. Maiolino Bissaccioni �i r�zboaiele civile din Moldova (Maiolino Bissaccioni e le guerre civili in Moldavia), Arhiva Societ��ii �tin�ifice �i Literare (A.S.S.L.) di Ia�i, 1892: 645-651.

[11]. C�l�toriile lui Domenico Sestini în Muntenia, 1779 (I viaggi di Domenico Sestini in Valacchia, 1779), Arhiva Societ��ii �tin�ifice �i Literare (A.S.S.L.) din Ia�i, 1893: 571-589.


VICTOR GOMOIU AND THE CANTACUZÈNE-COMMISSION

J. P. TRICOT1

Abstract: Thanks to the interacting efforts of the Belgian professor J.J. Tricot- Royer (1875 – 1951), founder -president of the International Society for the History of Medicine (I.S.H.M.) and of the Romanian professor V. Gomoiu (1882-1960), third president of this one, the study of medical folklore has been acquainted with huge development from the thirties of the XX Century on. During his whole life, prof. Gomoiu fully applied himself, not only to an exemplary surgical career and to the field of medical-social relief work (with the support of the Royal Family of his country) but also to the history of medicine. After having founded in 1929 the Romanian Society for History of Medicine and having organized in Bucharest in 1932 the IX congress of the I.S.H.M., prof. Gomoiu was elected in 1936 president of that society. During the whole fourth decade of the XX Century, medical folklore was one of the main issues of most of the congresses of the I.S.H.M. And so Gomoiu established in September 1935 a special international commission for the study of medical folklore: the Cantacuzene – Commission. The contribution of prof. Gomoiu to the study of Romanian medical folklore was very important. In this paper, reference will be made to a lot of unpublished documents: the letters sent by prof. Gomoiu and by the French prof. Guiart (his general secretary in the I.S.H.M.) to Prof. Tricot-Royer between 1934 and 1939. Prof. Gomoiu can be considered as an emblematic and exemplary figure into the study of History of Medicine and of medical folklore, as well on a national as on a international level. Key words: Victor Gomoiu, Cantacuzène-Commission

1 Univ. Leuven, Univ. Antwerpen (Belgium).

On the 15th of April 1939, the report upon the proceedings of the Cantacuzene Commission for the study of Medical Folklore was submitted by the Belgian prof. Tricot – Royer at the yearly General Assembly of the International Society for the History of Medicine (I.S.H.M.), held in Paris under the presidency of the Romanian prof. V. Gomoiu.

Who was the third president of the I.S.H.M.? How important was that Commission?

Short biography of Prof. Victor Gomoiu [1, 3]

Victor Gomoiu was born in 1882 in Vinju Mare (district of Mehenditi) in

Romania. After ending his secondary studies at the Lyceum of Turnu Severin, he enrolled himself at the Faculty of Medicine in Bucharest, where he finished his university curriculum in 1906 and obtained afterwards in 1909 his PHD magna cum laude. The subject of his thesis was: “The Anasplasties of face and head.”

Between 1914 and 1942 he took up a successful surgical career and a lot of new procedures inherited his eponyme. He also invested himself within the field of medico-social assistance programs. He became Ephore of the public hospitals of Bucharest in 1920 and 1921 and thereafter from 1926 on he was appointed as trustee


116

of the “Princess Ileana” charitable fund (“A�ez�mintele A.S.R. Principesa Elena”) and also he became a relative of the Romanian Royal Family. After the Second World War he was blamed for it.

In 1927 Gomoiu founded in a poor neighbourhood in one of the suburbs of Bucharest, Bariera Virgului, a hospital complex, Princess Ileana, on behalf of the most unprovided patients. Shortly thereafter this establishment became the “Children Hospital Victor Gomoiu”, still in activity nowadays.

Gomoiu obtained plenty of official duties in the Ministry of Health and became at least Minister of Health from July to September 1940, but he resigned quickly to not undergo the military- fascist dictatorship. Between 1940 and 1950 he devoted himself only to his surgical and medical-historical activities. From 1950 to 1954 he was imprisoned during 60 months by the regime for political purposes. Nevertheless in 1956 the communist Minister of Health suggested him to accept a position at the Center for Health Organization and the History of Medicine, but he refused this offer which he viewed as a form of collaboration [15]. He died in Bucharest in 1960, almost forgotten by everyone.

Doctor Gomoiu and the History of

Medicine Already as student Gomoiu disposed of

an important personal library, where as well medical as philosophical and historical works were assembled. In 1923 he published a first important medico- historical book: “The History of Medicine and of Medical Teaching in Romania.” [4].

In 1927 he sent to the French prof. Laignel-Lavastine, secretary-general of the very young I.S.H.M. (founded in 1921) the abstract of a communication he wanted to represent at the VIth congress of this association in Leiden and Amsterdam: “The first traces of Physicians in Romania” [5]. That was his first

connection with the I.S.H.M. In 1929 prof. Gomoiu founded the Romanian Society for the History of Medicine under the high protection of Princess Ileana [6].

Within the I.S.H.M. he shaved more and more ambition: he became national delegate of his country in 1928, attended the Congress of Oslo (1928) and Rome (1930) and organised his own congress in Bucharest from the 10th to the 18th of September 1932 [8, 18]: a successful manifestation with the participation of the most famous historians of that time like e.g. the doctors and the professors Sigerist, Singer, Diepgen, Rolleston, Neuburger, Süheyl, De Lint, Jeanselme, Tricot-Royer, Castiglioni, and so on. The wife of the congress president, Mrs. Viorica Gomoiu, acted as general secretary of it.

In 1933 prof. Gomoiu was elected vice-president of the I.S.H.M. and president in 1936, to the deep annoyance of the then acting Secretary General, prof. Maxime Laignel-Lavastine, who also competed for this position, but who statutory could not obtain it [16, 17]. In this connection Gomoiu would write in 1939 at the end of his mandate: “To believe to be hated by someone you love, is a more unendurable pain than mourning for his death”. [13].

Laignel-Lavastine resigned and was replaced by prof. Jules Guiart (7). This one had particular links with Romania. As professor of Parasitology and of History of Medicine at the University of Lyon, he concluded a special agreement as titular professor of History of Medicine, of Pharmacy and of Medical Folklore at the University of Cluj (23), founded in 1919, and within the professors were chosen by an University Commission with the represent-tatives of the two Romanian universities, existing at that time: the one of Bucharest and the other of Iassy. Guiart was teaching at the medical faculty of Cluj between 1921 and 1930, the year within he was replaced by his assistant, prof. Valeriu Bologa (1892-

J.-P. TRICOT: Victor Gomoiu and the Cantacuzène-Commission 117

1971), originating from Bra�ov. Within the I.S.H.M., prof. Gomoiu was

not conspicuous by his sense of diplomacy, and he took a lot of initiatives without the approval of his bureau and of his administrative council.

Prof. Guiart confirmed there were sometimes troubles within the bureau. He wrote the following comments (14):: “I told him (= Gomoiu) firmly that the President has no rights to make some propositions without the preliminary approval of the Bureau. Otherwise he exposes himself to what happened to him: his proposals are not voted. He has no right to owe someone a grudge for it, because with having the right to vote, we got the duty to vote, not with the purpose to please him, but conscientiously! “

The mandate of Gomoiu ended normally at the beginning of 1940, but, due to the Second World War, his successor, prof. Laignel-Lavastine could only begin his term in 1946, because during the conflict, all activities of the I.S.H.M. were interrupted [16].

Medical folklore and the congresses

of the I.S.H.M. The proposal to create a commission

with the purpose to study medical folklore was formulated by prof. Gomoiu in September 1935, during the Xth International Congress for the History of Medicine and has been approved unanimously. Previously during the VII th Congress of the I.S.H.M. in Oslo in 1928, prof. Gomoiu showed his interest for this aspect of medical history, submitting a paper entitled: “Medical Folklore in Romania”. On the occasion of the next congress, the VIIIth one in Rome in 1930, prof. Castiglioni from Padua, enumerated the two sources of medical folklore: the magical conception common to all primitive people and the experience [2].

As for him, prof. Gomoiu described the

contribution of medical folklore from an etymological, historical and medical point of view [12]. He drew the attention that, from an ethnological point of view, the folklore documents his adepts upon the way, man was feeling or thinking in the course of ages. It increases the number of characters which permit establishing resemblances and differences among the nations, and so new appreciation – criteria are acquired upon their degree of superiority and culture. For his part, the historian, comparing the different kinds of folklore with each other, can more easily deduce the relationships between the nations he is studying and consequently the moving of their migration. As for the physician, he often discloses in the popular practices the germs of the most modern therapeutics.

On the other hand, very curiously, that same medical folklore was not hold back as a theme at the IXth Congress of the I.S.H.M., organized in Romania in 1932. It was only a delay, because during the next congress, the Cantacuzene Commission was born. The topics of the Bucharest Congress were: “The Evolution of Medicine in the Balkanic countries” and “Defence of Europe against the pest”. This last theme was the subject of the very last posthumous publication of prof. Tricot-Royer [22].

The Cantacuzene Commission This commission was baptized

“Cantacuzene”, after the name of a famous Romanian physician, bacteriologist and professor, Ion Cantacuzino (1863 – 1934), founder of microbiology and of experimental medicine in Romania. He was even Minister of Health, Work and Social Security [9].

Although he has published nearly nothing about History of Medicine, Gomoiu proposed him as second president of the Romanian Society for the History of


118

Medicine. In his funeral oration, Gomoiu will say about him: “Our president, creator of his own history and also of others, passed himself into the history”.

In a letter of the 21th of October 1935, written to prof. Tricot-Royer (10), founding president of the I.S.H.M., thus a short time before becoming himself president of the I.S.H.M., prof. Gomoiu specified the work to be done by the members of his commission:

The first question that had to be asked was how to draw the bibliography of medical folklore and of folklore generally spoken in their respective country that means the names of the authors, their works, the specialized journals, the institutions, etc. Then the question of standard forms comes to collect the folkloristic material, which can be discussed some months afterwards. Firstly the names of the pathological entities have to be discussed as they are designed by the peasants of the different countries and their clinical pictures, so that people can conclude to their synonymy and compare their treatments. For each country a card of the territories, where the different denominations or treatments are used, has to be established.

Prof. Tricot- Royer, nominated as president of this commission, was the Belgian delegate, whereas prof. Gomoiu became the secretary general and delegate for Romania. The commission included also Mrs Gomoiu, the doctors Bologa from Cluj, Laignel-Lavastine from Paris, Giuart from Lyon, Thaller from Zagreb, Süheyl from Istambul, and Ali Mihali from Albania.

It is not astonishing that the tandem, Tricot-Royer – Gomoiu, was the most important pivot of this commission, because these two scholars have already published a lot of papers concerning the medical folklore in their respective country, and because they respect each other for many years.

Concerning it, prof. Tricot-Royer had already made a through inquiry upon

medical folklore in Belgium (21). He made a distinction, on the one hand between mystical folklore with the invocation of God, the Holy Mary or the Saints specialized in the cure of some illnesses, and on the other hand empiric folklore in which the Belgian popular remedies, originating from the fauna, the flora or of the third kingdom are described. His research works lead him to contact all the parish priests of the whole country, to give him all the useful information of that purpose.

At the beginning of 1936, Gomoiu considered the possibility to create either an International Academy for Medical Sciences, with a special section devoted to medical folklore, or an “Academia Demoiatrica“ (Academy for the study of the folklore), independent of the I.S.H.M., but his projects were never realized.

The Romanian physician distinguished 4 categories of folklore: 1. the original or primitive folklore; 2. the altered original folklore either with

foreign contribution or with borrowing from scientific medicine;

3. the folklore adapted to the new times; 4. the folklore completely based upon

scientific medicine and practised by people without any qualification.

Before being presented to the General Assembly of the I.S.H.M. in 1939, a part of the report of the Cantacuzene Commission has been already published by prof. Tricot-Royer in Brussels:

“The Medical Folklore in the Balkan Area” [20] with a survey of the works of Prof. Süheyl (Turkey), Gomoiu (Romania), Stoianoff (Bulgaria), Ali Mihali (Albania) et Thaller (Yugoslavia).

This last one, prof. Lujo Thaller, would preside in 1938 the XI th Congress of the I.S.H.M., the last one before the Second World War, where two themes were discussed: “The mystical medical folklore “and” Flora, Fauna and Minerals in popular medicine” [16]. During that congress the unti-

J.-P. TRICOT: Victor Gomoiu and the Cantacuzène-Commission 119

ring prof. Gomoiu presented the report of ano-ther commission he set up within the I.S.H.M., concerning the teaching of medical history within the different countries of the world [15].

During 10 years, from 1928 on (VIIth congress of the I.S.H.M. in Norway) until 1938 (XIth congress of the I.S.H.M. in Yugoslavia), medical folklore played a preponderant role among the topics dealed with. Even after the Second World War the Romanians continued to show their interest for that subject. In 1970, during the 2 Congress of Bucharest (the 22 of the I.S.H.M.) presided by prof. Bologa, and with Dr Manoliu and Dr Br�tescu as general secretaries, “The scientific value of folklore” was one of the main topics [16]. In 2009, at the VIIth Balkanic Congress for the History of Medicine, justice was again done to the popular Romanian Medicine.

The contribution of Prof. Gomoiu to the

study of Medical Folklore In the beginning, the members of the

Cantacuzene Commission proceeded to make a survey of the folklore material of each respective country. In this paper we limited ourselves to the work of prof. Gomoiu [12].

During all times, the inhabitants of Romania were acquainted with a kind of medicine, as well empiric as religious. Before the arrival of the Romans in Dacia (actually a region in South-East of Europe, on the left bank of the Danube, corresponding to the actual Romania), the inhabitants knew on an empiric way the properties of medicinal plants. About 500 years before Christ, when he conquested all these peoples, Darius already observed the curative properties of many sources in that region. The Romans conquered the country between 101 and 107, and erected many altars and monuments in honour of Aesculapios and Hygia. Dioscorides, physician of Greek descent, accompanied those Roman legions, and studied the

specific flora of Dacia, throwing a light upon the medicinal properties of some plants.

On the other way, Gomoiu established

that, ignorant the real cause of illness, people attribute it to God, to the devil and to other invisible genies, and the treatment will include incantation and conjuration tricks. Besides it, the Romanian people owns a traditional medicine, deprived of each supernatural element, constituted on one’s own found, increased with scientific contributions. During a: the centuries, original practices and imported ones mingled, but these last ones, either of an empiric or of a scientific nature, were modified or adapted according to the tastes and the preferences from people adopting them. Gomoiu believed that in Romania the medicine with supernatural involvement and empirical medicine play an even important part, but in most of the cases, one is being serving as an assistant to the other. Plenty of examples of the prescience of our modern medicine were given by Gomoiu.

Conclusion The importance of the Study of Medical

Folklore didn’t get past the historians of medicine during the decade before the Second World War. The contribution of the I.S.H.M., of her third president Gomoiu and of her founding president Tricot- Royer is far from being negligible. Prof. Gomoiu can be considered as an emblematical and exemplary figure into the study of the History of Medicine, particularly in the study of medical folklore, as well on a national as on an international level.

References

[1]. Baran D., personal communication, 22/06/09

[2]. Castiglioni A., Le folklore médical, quoted by Tricot-Royer J.J., o.c., 1936

[3]. Dutescu B., Victor Gomoiu, french


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summery, p. 244-258 in: Victor Gomoiu (258 p.) Ed. Medical�, Bucuresti, 1970

[4]. Gomoiu V., Din istoria medicinii si a invantamintului medical din Romania, Bucuresti, 1923

[5]. Gomoiu V., Les premières traces de médecine en Roumanie, p. 293-295 in: Actes du VI Congrès International d’Histoire de la Médecine (Leyde-Amsterdam/ 18-23/7/1927), (De Lint J.G., éd.), Anvers, 1929

[6]. Gomoiu V., Societatea Regala Romana de Istoria Medicinei, p. 5-17 in: Analele Asezamintelor A.S.R. Principesa Elena (112 p.), Cultura, Bucuresti, 1932

[7]. Gomoiu V., Biographie (de 1870 à 1932) de Jules Guiart (1870-1965) , p 45-48 in Gomoiu V., o.c. (Analele), 1932

[8]. Gomoiu V. et Gomoiu V., Neuvième Con-grès International d’Histoire de la Méde-cine, Comte-Rendu, Bucuresti (Romania), 10-18 septembre 1932, 794 p., 1932

[9]. Gomoiu V., Eloge funèbre de Jean Cantacuzène (1863-1934), non published text, 1934 (personal collection of the author)

[10]. Gomoiu V., Letter sent on 21th October 1935 to prof Tricot-Royer (pers. coll. of the author)

[11]. Gomoiu V., Letter sent on 21th April 1936 to prof Tricot-Royer (pers. coll. of the author)

[12]. Gomoiu V., La médecine populaire en Roumanie, p. 10-23 in o.c. Tricot-Royer, 1937-1938

[13]. Gomoiu V., Letter sent on 9th May 1939 to prof. Tricot-Royer (pers. coll of the author)

[14]. Guiart J., Letter sent on 28th December 1938 to prof Tricot-Royer (pers. coll. of the author)

[15]. Manoliu V., The report of Victor Gomoiu at the XIth International Congress for the History of Medicine, Zagreb-Belgrade, 1938, on the State of Education in History of Medicine in Various Countries. P.301-306 in: Proceedings of the 37th Congress on the History of Medicine, (Burns C., O’Neill Y.V., Albou P. and Rigau-Perez J.M., University of Texas Medical Branch, Galveston, 2000

[16]. Tricot J.P., Esquisse Historique de la Société Internationale d’Histoire de la Médecine/ Historical Sketch of the International Society for the History of Medicine/ Boceto Historico se la Sociedad Internacional de Historia de la Medicina (35 p.), ISHM, Galveston, 2000

[17]. Tricot J.P., La Société Internationale, fille de la Société Française d’Histoire de la Médecine, Histoire des Sciences Médicales, 37 (3): 357-366, 2003

[18]. Tricot-Royer J.J.: Le IXème Congrès International d’Histoire de la Médecine- Bucarest (1932) – Comte Rendu: Aesculape, 23 : 121-144, 1933

[19]. Tricot-Royer J.J.Le Xème Congrès International d’Histoire de la Médecine (Madrid-1935)- Compte-Rendu, Asculape, 26: 145-168, 1936

[20]. Tricot-Royer J.J. : Le folklore médical dans les Balkans, 36 p., Revue catholique des idées et des faits, 1937-1938

[21]. Tricot-Royer J.J., Le folklore médical belge, Petrus Nonius, 1: 1-52, Lisboa, 1938

[22]. Tricot-Royer J.J., Comment l’Europe s’est-elle défendue contre la peste?, La Roumanie, 11 p., Le Scalpel n 30, 1951

[23]. xx

x: La Faculté de Médecine de l’Université «Roi Ferdinand le Ier» de 1919 à 1928. Cluj (Roumanie-Transsylvanie), 48 p, 1928.


MEDICAL AND TOXICOLOGICAL ASPECTS IN ARTHUR CONAN DOYLE’S

WRITINGS

O. MURE�AN1, L. SAFTA1

Abstract: Several medical doctors turned their hand to writing at some point in their career, thus embedding their medical knowledge and expertise in valuable works of fiction. One of the most renowned of these practitioners remains Sir Arthur Conan Doyle (1859-1930), well-known as the creator of the most famous fictional detective, Sherlock Holmes. The paper presents aspects of Conan Doyle’s writings which pertain to his medical background, with a focus on drugs and poisons featuring in several of his stories. Key words: medicine and literature, detective fiction, drugs, poisons.

1 “Iuliu Ha�ieganu” University of Medicine and Pharmacy, Cluj-Napoca

After graduating from the Edinburgh University in 1881 with degrees of Bachelor of Medicine and Master of Surgery, Arthur Conan Doyle practised medicine for about ten years before giving up his first occupation to become a full-time writer. He turned to medicine again only during the Boer War in South Africa where he volunteered as a surgeon. His public support of the British policy in this war led to his being knighted in 1902.

Conan Doyle’s experience as a physician started with two sea voyages as a ship’s surgeon (to the Arctic on a whaling boat in 1880 and to the west coast of Africa in 1881).

After that he practised medicine shortly in Plymouth and then opened his own practice in Southsea resort, where he gained reputation as a good practitioner. In 1885 he was awarded an MD degree by the University of Edinburgh.

Conan Doyle obtained a diploma in ophthalmology in Vienna in 1890 and then opened a practice in London. In the

meantime, he also dedicated himself to writing, an activity he had always felt drawn to. While in Southsea, he created the famous sleuth Sherlock Holmes, who first appeared in the novel A Scarlet in Red (1887). The author acknowledged that the celebrated detective was actually inspired by Dr. Joseph Bell, a professor at the University of Edinburgh whom Conan Doyle admired for his remarkable skills of observation, logic and deduction in making a diagnosis, which helped him identify not only the disease, but also the patient’s occupation and character.

Besides the detective stories which made him famous, Conan Doyle’s vast literary work includes historical novels, science-fiction stories, plays, romance novels, poetry and reality-based texts, revealing a complex versatile writer with various interests and concerns. Later in his life, the author became interested in spiritism and travelled the world to deliver lectures on this topic.

Critics have often presented Conan


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Doyle as an unsuccessful physician, in spite of evidence which shows the contrary. Rodin and Key argue that in fact “he left the practice of medicine not because he was a failure, but because he was so successful that it interfered with his writings.” [11]

Although Conan Doyle’s scientific medical writings are few in comparison with his literary work, they reveal both his keen interest in the medical research of the time and his potential for becoming a renowned medical professional.

Publications related to infectious diseases indicate Doyle as a supporter of compulsory vaccination to prevent smallpox, which at the time aroused public opposition, and of inoculation for the prevention of typhoid fever. On the other hand, he was the first to draw attention to the hasty world-wide use of tuberculin as a cure for tuberculosis in 1890, after analyzing its effects and the pathological changes in lung tissue. [6, 7, 11]

Medical bacteriology, a science that was just emerging at the time, was another field where Conan Doyle’s insights into the pathology of infectious diseases were remarkable. Thus, for example, he predicted the eradication of bacterial diseases several generations in the future and in 1883, as a general practitioner, wrote that many human diseases were caused by bacteria, whereas at the time only a few were identified to be so.

Given his humanistic formation, Conan Doyle sustained causes related to the need for physical and psychological well being. Thus, for instance, he supported vivisection as an important means to alleviate human suffering. [9, 11]

Conan Doyle was described as being “ethical and compassionate” in all aspects of his life: as a doctor and writer, in his private life and public activities, and a true “Renaissance Man” with vast knowledge and active interest in various areas of life.

[8, 11] Significant for Doyle’s scientific

curiosity is the publication in the British Medical Journal (1879) of a letter presenting his self-experimentation with gelsemium. “Gelseminum as a Poison” contains a detailed description of the experiment in which he tried to find out “how far one might go in taking the drug, and what the primary symptoms of an overdose might be”. One of his conclusions was that “the system may learn to tolerate gelseminum, as it may opium, if it be gradually inured to it.” [11]

At the end of the 19th century, when Conan Doyle practised medicine, old methods of treatment were still in use, whereas new, more scientific and rational ones emerged. The most dramatic improvement occurred in the field of drug therapy, with a strong reaction against overdosing, a practice that had been in use for centuries. An analysis of Conan Doyle’s work, concepts and knowledge of diseases suggests that he was familiar with and followed the new trends in medicine. Thus, an examination of the drugs referred to in the canon of Sherlock Holmes (fifty-six short stories and four novels) would be conclusive.

The drugs and chemicals mentioned in the Canon include alkaloids, ammonia, amyl nitrate, belladonna, chloroform, cocaine, curare, ether, hormones, mor-phine, opium, prussic acid, snake venom, and strychnine. This is the highest number of drugs that has appeared in a series of detective stories [11]. Several poisons are mentioned as well, but in most cases their nature is not specified.

According to Rodin [10], drugs are used for several purposes in the Canon: for treatment (e.g. ammonia and brandy to revive someone who has fainted, amyl nitrate for catalepsy, morphine for pain); for simulating disease (e.g. in “The Dying Detective” Holmes placed belladonna in

O. MURE�AN et al: Medical and Toxicological Aspects in Arthur Conan Doyle’s Writings 123

his eyes to produce dilated pupils, as are those of a dying person); for poisoning (e.g. curare in “The Sussex Vampire”, strychnine in The Sign of Four); to induce anaesthesia (e.g. ether and chloroform); for addiction (cocaine, morphine, opium).

The most medical story in the Canon is considered to be “The Resident Patient”, where both Holmes and Watson demonstrate an understanding of the medical practice. Alcohol is presented not as an addictive drug but as a favorite medicament in the Canon. For instance, in “The Engineer’s Thumb”, Watson uses brandy and water as a painkiller, and in “Blue Carbuncle”, brandy is given to the hotel attendant as a stimulant. Holmes also makes use of his knowledge of chemistry to solve crimes, such as in “The Naval Treaty”. The most fanciful use of poisons in the Canon appears in “The Devil’s Foot.” The hallucinatory and lethal effects of “devil’s-foot root” described in this story seem to have no correspondence in the pharmacopoeia or in the literature of toxicology. [5] ““Radix pedis diaboli” ... has strange properties … it stimulates those brain centres which control the emotion of fear and … either madness or death is the fate of the unhappy native who is subjected to the ordeal by the priest of his tribe.” [1] Billings believes that in this way Conan Doyle might have deliberately attempted to “divert prospective users of poisons by switching the type of one lethal alkaloid for another.” [3]

Conan Doyle’s heavily annotated Pharmacopoeia [3] (containing, in the margins, brief summaries of detailed topics, directions for preparing medication and descriptions of effects of drugs on the human body) appears to have contributed to the accurate presentation of drugs mentioned in the Canon and other literary works. This evidence accounts for the professionalism the physician writer employed in approaching the interdisci-

plinary attempt to write stories combining his literary talent and imagination with knowledge and good research skills in the field of medicine and other related sciences.

To conclude, although Sir Arthur Conan Doyle changed his first profession as a physician to that of full-time writer, he continued to show interest in medicine. Moreover, the influence of his medical training and experience on his work and activities also contributed to the recognition he received as an author even during his lifetime. Although his second profession was the one that brought him fame and fortune, he was always proud of being a physician: “The title I value most is that of ‘Doctor’, which was conferred by your self-sacrifice and determination”, he wrote in a letter to his mother. [2]

In the article The Romance of Medicine, he also stated that “a medical training is a most valuable possession for a man, even if he did not afterwards engage in practice” [4], a belief that has been shared by other renowned writers and artists throughout the time. References 1. Baring-Gould WS. The Annotated

Sherlock Holmes, 2 vols. Clarkson N. Potter, New York 1967.

2. Bendiner E. Elementary My Dear Doctor Doyle. Hosp Pract 1982, 17:180-212.

3. Billings H. The Materia Medica of Sherlock Holmes. Baker Street Journal 2006, 56(3): 37-46.

4. Doyle AC. The Romance of Medicine. Lancet 1910, 2: 1066-8.

5. Jones KI. The Sherlock Holmes Pharmacopoeia: Being an Examination into the Uses and Effects of Drugs and Poisons in the Sherlock Holmes Stories. Oakmagic Books, Weston-super-Mare, England, 2002.


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6. Lycett A. The Man Who Created Sherlock Holmes: The Life and Times of Sir Arthur Conan Doyle. Free Press, New York, 2007.

7. Markel H. The Medical Detectives. N Engl J Med 2005, 353(23): 2426-8.

8. Owen AH. Doctor Behind the Supersleuth. Br Med J, Oct 1977: 33-57.

9. P.H. William Osler et Arthur Conan Doyle contre les antivivisectionnistes: quelques leçons de l’histoire pour un

débat actuel. Med et Hyg 1985, 43: 1996-7.

10. Rodin AE. The Nature and Significance of Drugs and Poisons in the Sherlock Holmes Canon. Calabash 1982, 1:42-49.

11. Rodin AE, Key JD. Medical Casebook of Doctor Arthur Conan Doyle: From Practitioner to Sherlock Holmes and Beyond. Robert E. Krieger Publishing Company, Inc. Malabar, Florida, 1984.


ORD. PROF. DR. CEMIL TOPUZLU (1866-1958) AND HIS CONTRIBUTIONS TO TURKISH

SURGERY

H. ERTIN, O. USMANBAS, I. BASAGAOGLU1

Abstract: Cemil Pasha was the most important figure in the history of Turkish surgery. He was a pioneer in a modernizing country thorough observing new approaches, models, techniques in the advanced countries and applying them in his own country. Establishing novel surgery techniques in Haydarpa�a Military Hospital, Zeynep Kamil Hospital, Demirkapı and Haydarpa�a Medical Hospitals Cemil Pasha strived to present the Turkish surgeons how hospitals and clinics should have been organized in a modern way; the efforts that resulted in high confidence of Turkish public opinion to surgeons. With his contributions to anesthesia and asepsis-antisepsis field Dr. Topuzlu is a path-breaking medical scientist, a fervent professor and administer in Turkey, who executed Istanbul mayoralty as well

Key words: Turkish Surgery, Cemil Topuzlu.

1 Istanbul University Istanbul Faculty of Medicine.

Introduction. The history of surgery in our country is

in parallel with the West. Nevertheless, it is generally accepted that Islamic world had advanced in surgery comparing it with the West in the middle Ages. For instance, Ebul Kasım Zehravi’s (X-XI centuries) work, Cerrahiyet-ül Haniye, was noteworthy at that time.

Treatment and surgery of the eyes in the Ottoman period, was conducted by professional experts, “Kehhals”, and surgeons were never involved in operations.

Till mid 19th century the profession was the arena of barbers, bonesetters, circumcisers and the dressers, in way transferring the skills from father to son.

The emergence of surgery as a school based profession was in 1827 through the establishment of the Cerrahhane-i Amire, which was a military organization

administered by a French man Sade de Calliére. After establishment of this institution, opening in 1839 the Military Medical School began to offer special surgery classes. By the way, distinction made between doctors and surgeons in Military Medical School ended in 1892.

In 1890’s, the new generation doctors, who owned modern surgery apprehensions and techniques through their observations and experiences at the abroad, started to take over the profession in the hospitals of Istanbul. That means those old generation medicals out of modern comprehension on medicine and their collaborators, the old surgeons without antisepty knowledge were discharged. Emergent surgeons with their new label, the operators, discarded old devices of wooden-handle tools and medical dressing kits composed of mohair, balm, sponge and mush. Putting exported modern devices and sterile materials into


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use they also change the image of the operations. In this way, modern surgery occurred initially in Istanbul then after extended to whole country and western innovations at surgery were transferred by new European style surgeons such as Cemil Pasha and his friends.

Looking to his biography we coincide with a fast, attractive and amazing life.

Biography Born in March 6 in 1866 in �stanbul,

Cemil Pasha graduated from Medical High school of Çengelkoy in Istanbul in 1881. In 1886, as a young captain he completed Military Medical School ranking first in class and began to work in Military Hospital of Sütlüce Kumbarhane Military Hospital. He was officially sent to Paris and served at Tillenx and Péan clinics and after his return he became assistant of Aristidi Pasha in Military Medical School. In 1894 he started giving lecture as a professor and in two years time he was promoted from lieutenant colonel to general. Following his surgery service for wounded in war at Yıldız Hospital, in 1897 he was appointed to the membership of Tıbbiye-i Mülkiye and Sıhhiye-I Umumiye. After his membership to Turkish Medical Association in 1902, he was granted marshal degree by the Sultan Hamit in 1905. Cemil Pasha was the first dean of the Medical Faculty of Ottoman University and also was a professor at the Surgery Clinic I in that school. Both of these two services came to an end in 1911 and he continued his civil life as a mayor and later lieutenant governor of Istanbul. It is worth mention here that during his period, the city of Istanbul met with automobiles for the first time. Despite his resign from official jobs in 21 November 1914, he became mayor again in 1919 and moreover he was assigned minister of public works at this time. In 1945 he was elected as a honorary president of Turkish

Medical Association. After having deemed worth of honorary professor in ordinary by Istanbul University, he passed away because of pneumonia in 1958.

Having a social and sympathetic personality Cemil Pasha drove an effective and attracting surgeon portrait in early years of Turkish surgery through putting forward the truths that was based on his professional observation and instinct. His performance of educating is arguable. Moreover, he tried to make a carrier on politics as well.

According to his grandson, Topuzlu was fully an action men. He never deviated from the right way in his occupations as surgeon, dean, mayor and ministry of public work and when he realized that the things were halting or locked, he preferred resigning or directing himself new fields rather than waiting to see what would happen.

Surgery was the most long-lasting and the most popular identity of him. Indeed, he was indebted all of his reputation gained in his life to the operations that he made successfully.

Attending Just-Lucas Championniére’s, Lefort’s, Trelat’s, Guyon’s, Tillaux’s and Péan’s surgery operations and lessons in France he got a certificate thanks to Péan’s close attention and sympathy devoted to him. During 1890- 1911, when he was at the peak of his carrier, Cemil Pahsa worked at the surgery clinics of Haydarpa�a Military Hospital, Military Medical Faculty and Civil Medical Faculty of Haydarpasa.

Apart from his official duties he operated a private office in Istanbul and even he made operations at patient’s home but “medico-social” objections deterred him to follow this path. He worked also Zeynep Kamil and �i�li Etfal Hospitals at the same time and continued his operations in Egypt at summers. In addition to his contribution of asepsis and antisepsis and

H. ERTIN et al - Ord. Prof. Dr. Cemil Topuzlu (1866-1958) and his contributions to Turkish surgery 127

anesthesia with chloroform Cemil Topuzlu provided pyloroplasty, scapula-torasik amputation and caesarian section. Moreover his contributions to surgery can be counted as follows: 1. Stitching of cut arteries while blood

stream goes on. 2. An apparatus easily sterilized in

hemorrhoidectomy 3. A genuine technique in “Z” plasty of

Achilles tendon. 4. Clamp for circumcision, clump for

suturing technique He brought institutionalization of

internship at the faculty, publishing operation statistics and researches at national and international level and the membership to international associations into his country.

He retired officially from surgery when he was 80 but went on giving conferences publishing articles, working in his clinics. In his article “Preventive measures before the operation”, he mentioned that it was not just sufficient to obey “asepsis and technique operatoire”. “The history of surgery in our country” in 1943, “How the surgery progressed just in 50 years” in 1947 were the two most important article of him that is shedding light on the history of modern surgery in Turkey. In addition to these he wrote several articles about medicine, surgery, municipal works and educational matters in newspapers and journals.

Other works 1- Clinical Instruction of Surgery

(Seririyat-ı Cerrahiye), published in 1897 in �stanbul, with 107 pages and 155 case presentations

2- Memories and Medical Observations (Mémories et observation médicales), Published in French in 1905, �stanbul. Having 196 pages, the most specific aspect of this book is its first chapter in which Cemil Topuzlu’s own invention the artery

suture is presented. 3- Scientific Surgery and painless

delivery translated from Crener and Conbet. The book of 318 pages deals with anesthesia in surgery and gynecology. Despite its a translation Cemil Pasha included his own original observations and methods

4- Systematic appendisectomy on terminal phase appendicitis, presentation made in 15 December 1936 at French Academy of Surgery

5- Is circumcision beneficial to health? Presented at the meeting of Turkish Medical Commission in 30 January 1934

6- Senile spots, presentation made in Turkish and French in 18 April 1944 at the conference held by Turkish Medical Association

7- Tongue Cancer presented at the meeting of Turkish Medical Association in 2 February 1937.

Apparatus invented by Cemil Pasha 1- Clamp that can be fixed on pinpoint

of Reverdin needle and that provides operating deeply It was published in Presse Médicale in 03.02.1932.

2- A specific apparatus for holding and pushing hemorrhoids and tying them off the body

3- Clamp for circumcision A Memory From Cemil Topuzlu

Pasha First published in 1951, in his book

“My Memories of 80 years in Autocracy-Constitutional Monarchy and Republican Period” Cemil Topuzlu narrated his several precious observations and memories about the periods of Sultan Abdulhamid II and Constitutional Monarchy in the Empire. The memory below cited from this book.

“I am operating on an Albanian in a house in �ehzadeba�ı. Besim Omer Pasha chloroformed the patient while Suleyman Numan Pahsa was assisting me. In the


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room only another Albanian, close relative of the patient and swordsmen of the Sultan, was standing. When the operation was about to finish, patient’s respiration and pulse stopped suddenly. Besim Omer Pasha mentioned in French “we have lost the patient”, hearing this fact that the swordsmen who understood also French, went out and yelled the bad news at the outside. In a moment all relatives of the patient gathered in front of the door and shouted: “If you can not save our patient we all are going to kill you”. Meanwhile we were striving for artificial respiratory. We tightly shut the door and hilled table and chairs behind the door. We told them their patient had not died and not to baffle us through coming inside the room otherwise we could not going on the operation. Under this condition, we made an effort about 20 minutes and saved the patient from an absolute dead. That is to say we also survived with patient.

Cemil Pasha was not the first and the single one among the Turkish surgeons, he was one of the most precious one. Indeed, he was a member of “the revolutionary surgeon generation” emerged in 1890’s whose profound success was not only considering antisepsis and asepsis important but also reaching a modern comprehension at surgery and establishing bases of modern surgery in a modernizing country.

We remember him with respect. References

[1]. Ada, �., Prof. C. Topuzlu’nun Meslek Hayatına Ait Hatıralar, Vatan Gazetesi. 15.04.1953

[2]. Enis, R., �eyhületibba Meslek Hayatını Anlatıyor, Cumhuriyet. 28.10.1953.

[3]. Gürkan, K. �., Cemil Topuzlu. Türk Tıp Cemiyeti Mecmuası, 5.04.1958 den aynı baskı.

[4]. �.Ü. �stanbul Tıp Fakültesi. Deontoloji ve Tıp Tarihi Anabilim Dalı Ar�ivleri. Lexicon. Cemil Topuzlu Dosyası.

[5]. Kadıo�lu, S., Türkiye’de Cerrahi Devrim. Doktora Tezi Tıpkı Basım Sa�lık Bilimleri Enstitüsü .Ankara.

[6]. Kavur, Ekrem. �., Askeri Hekimli�in Sıhhiye Hizmetlerinde Bir Etüd, Dirim, No.8. s. 376.

[7]. Namal. A., Ö. Öncel., A. Demirhan Erdemir: Ülkemizin �lk Di�hekimli�i Okulu. �stanbul Üniversitesi Di�hekimli�i Fakültesi 100. Yıla Arma�an. �st. 2008.

[8]. Topuzlu, Cemil. 80 Yıllık Hatıralarım. Hüsrev Hatemi, Aykut Kazancıgil Dördüncü Baskı 2002 Edit. Cemalletin Topuzlu

[9]. Topuzlu, Cemalettin. Günümüzde Genel Cerrahi Hipokrat Aylık Sa�lık Meslek Dergisi. S. 38 (5). 1995.


TRADITIONAL YORUBA MEDICINE IN NIGERIA: A COMPARATIVE APPROACH

O. AWOJOODU 1 D. BARAN 2

Abstract: From the earliest beginnings of medicine, mankind has associated the act of curing disease with gods, goddesses and other forms of divine forces. Deities were greatly thought to be responsible for people’s wellness and preservation of their wellness. Sickness was regarded as a consequence of disobedience to or sin against these supernatural agents and their moral rules. Concurrently, empiric medicine developed, mainly based on herbs, minerals and animal-derived substances, which were directly linked to the above mentioned supernatural elements. Spirits, gods and goddesses had tremendous effects on the early practice of medicine. Magical-empirical approaches to health and disease, still vivid today, characterized all archaic civilizations, being also identified in Nigeria. This presentation focuses on the significance of such comparable behavioural archetypes. An intercultural and transcultural insight into this early, yet classical, stage of medical practice in a tribe on the west coast of Africa - the Yoruba Land- is given. Key words: magical-empirical medicine, transcultural archetypes, yoruba.

1 Nigeria. 2 „Gr.T.Popa” University of Medicine and Pharmacy, Ia�i, Romania

Introduction African traditional medicine is a

mystery to much of the western world. It is misunderstood, sometimes to the point of causing fear.

The traditional medical practices of the Yoruba in Nigeria, however, offer fresh outlooks on the concept of health and unique healing treatment to the world medical community. [1, 2]

These methods should be examined with an open mind, further developed, and finally integrated with western medical procedures in order to provide the best medical service possible. [4]

Traditional medicine, as is well known, represents a cultural gem of various communities around the world and encompasses all kinds of folk medicine,

unconventional medicine and indeed any kind of therapeutical method that has been handed down by the tradition of a community or ethnic group. [3]

In this study, emphasis will be more on the history of Yoruba medicine than on the actual practices and methodology.

A brief insight into these practices will put popular medicine into perspective before taking a more detailed look at its beginnings.

Yoruba medicine and healers in

Nigeria Among the Yoruba in Nigeria, as in

many African cultures, health and religion are tightly interrelated. In the Yoruba mindset, all healing comes from God, including that of the western medical


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doctor. [3] The Yoruba tribes believe in a power

called Ifà which is God’s angel thought to have been choosen to possess an infinite source of knowledge. Ifà’s knowledge includes animals, plants, oral incantations or ofo, divination, medicinal plants, and all sciences associated with healing diseases.

This “wise man to whom nature has taught her secrets” is the controller of language, culture, philosophy, and religion. Ifà knows the causes, secret names, origins, and chemical compositions of all things.

This Supreme Being gives the knowledge of healing through the power of Ifà to those who prove themselves worthy. [1, 2, 7]

It is important to realize that there are several aspects of Yoruba healing practices.

The main types are herbal medicine and rituals including incantations, prayer and sacrifice. [6, 7]

The feature most accepted by western doctors is herbal medicine. [7, 12]

Since the dawn of time, leaves, fruits, seeds and roots of plants were selected beneficial for the maintenance of health and cure of the ailments man suffered from.

Yoruba doctors have an impressive store of knowledge on a wide range of plant species.

These plants are often used in a similar way to medications provided by western doctors.

Much less accepted are ritual healings. Rituals are open to the public, as healing is seen as a group effort. [7, 12]

Orunmila and Babalawos Orunmila, the herbal healer In Yoruba medicine, the «Ifà Corpus»

is considered the foundation of divine herbal medical practice. [13, 14]

It was revealed by the mystic prophet Orunmila (Orula or Orunla), about 4,000 years ago in the ancient city of Ile-Ife, now known as Yoruba Land. Orunmila taught people the customs of divination, prayer, dance, symbolic gestures, personal, and communal elevation.

He advised them on spiritual baths, meditation, and herbal medicine in particular. In Yoruba mythology, Orunmila corresponds to the «highly knowledgeable Irunmole», deity of destiny and prophecy.

He is recognized as "ibi keji Olodumare", i.e. second only to Olodumare (Almighty God)) and "eleri ipin", i.e. witness to creation. Orunmila is the Orisha of divination, the Supreme Oracle, the great benefactor of humanity and its main adviser. He reveals the future from the secret of Ifá, is a great healer and those who ignore his advice may suffer avatars produced by Eshu. Also referred to as Ifá ("ee-FAH"), Orunmila personifies knowledge and wisdom and the highest form of divination practice among the Yoruba people. Orunmila carried Ifà, the wisdom of Olodumare, to Earth. [1, 12, 14]

A Yoruba legend explains that the first who practiced the art of herbal healing was Orunmila, whom God had endowed with this knowledge and skill. [3]

Orunmila is not Ifà itself, but he leads the priesthood of Ifà. He embodies the archetype of the civilizing and healing hero. [9, 10].

Babalawo, the diviner-priest Priests of Ifà are called «Babalawo», ie

father of mysteries, or, for a female Ifà priest, Iyan Ifà. Babalawos possess an additional Orúnmila consecratio.

They divine and interpret for people the word of Orunmila, such as revealed by the oracle of Ifá.

Babalawos communicate with Orula and with the Yoruba pantheon. Orunmila («Orun-ni-mi-Ela»), whose name means

O. AWOJOODU et al: Traditional Yoruba medicine in Nigeria: a comparative approach 131

“only heaven knows the keys to my salvation”, is imagined as a sage. [1, 13, 14]

Babalawos can give the "Hand of Orula", known as "Ikofa" for women, and "Awofakan" for men and other various deities.

Orishas in Yoruba Medicine The Yoruba religion has a multitude of

deities, the major of which are called Orisha. [1, 13, 14]

There are around 201 deities, thirty of which are commonly worshipped. In diagnosing illness, each one of the Orishas manifests interdependent physical qualities and herbal attributes, each affecting one another.

The Orishas stand for higher energies that govern living matter destinies, transcend sensory faculties, and intermediate contact with the supreme God, Olodumare. [12, 14]

Eshu, the mediator and accomplisher Olodumare used the command known

as "Ashe" (ase) to accomplish his assignments.

Eshu, Èsù or Elegbara,, his best friend, exerts this «ashe» to this day and will use it forever. Nothing, good or bad, can be done without Eshu, who mediates between humans, Irunmole and Orisha. Eshu is indispensable to man and Orishas.

As Irumnole, he carries sacrifices for whatever purpose to the appropriate quarters. [1, 2, 13, 14]

Èsù, Gateman of the Heavens, is prime negotiator between negative and positive forces in the body. He enforces the "law of being” and enhances the power of herbs.

He mainly acts on the sympathetic nervous system and is involved with all herbal effects.

Osain, the herbalist, God of traditional

medicine Osain is the other most important

Orisha in Yoruba medicine. Osain rules over all wild herbs.

He is regarded as the greatest herbalist who knows the powers of all plants.

The plants and herbs of Osain have their purely medicinal value as well as their magical value.

Some plants have to be gathered at certain times of the day or night, according to cosmic rhythms of sacred events. (2,3)

Osain is the God of traditional medicine and all of nature is at his disposal.

Without the necessary herbs provided by an Olú Osain, the consecration of an orisha would be impossible.

Obatala, the creator and healer of

humans Deity of Creation, custodian of the Ifà

Oracle, Obatala is an alternative source of knowledge.

Creator of Human Form and Purity, he cures illness and deformities.

His priests are the Babalawos and his primary effects are on the brain, bones, and white fluids of the body.

Herbs he controls Body skullcap, sage, kola nut, basil, hyssop, blue vervain, white willow, and valerian are [4, 13, 14]

Ogun, the iron like power of health Orisha of Iron, Ogun is the divinity of

clearing paths, specifically in respect to blockages or interruption of the flow of vital energy at various points in the body, and he is the liberator.

Effects are on the heart, kidney (adrenal glands), tendons, and sinews. Herbs used are eucalyptus, alfalfa, hawthorn, bloodroot, parsley, motherwort, and garlic. [2, 12]

Ogun, Irunmole of war, of the hunt, iron or steel expresses the force of this deity who can be powerful or/and cruel. [5, 13, 14]

Yemoja, the mother goddess Mother of Waters, Primal Waters, and


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Nurturer, Yemoja symbolizes the amniotic fluid in the womb of the pregnant woman, as well as the breasts which nurture.

She signifies the protective energies of the feminine element, manifesting her specific effects at the level of the womb, liver, breasts and buttocks.

The medicinal herbs she governs are kelp, squaw wine, cohosh, dandelion, yarrow, aloe, spirulina, mints, passion flower, and wild yam root. [6, 14]

Oshun, the goddess of feminine energy

and hydrotherapy Sensuality, Beauty and Gracefulness,

are personified by Oshun. She is responsible for clarity and

flowing motion and has power to heal with cool water. She is also the divinity of fertility and feminine essence.

Women appeal to her for child-bearing and for the alleviation of gynaecologic or obstetrical disorders.

She is fond of babies and is sought if a baby becomes ill. Oshun is known for her love of honey.

She acts on the circulatory system, digestive organs, elimination system, and women’s pubic area. [6, 14]

Herbs consecrated to her include yellow dock, burdock, cinnamon, damiana, anis, raspberry, yarrow, chamomile, lotus, uva-ursi, buchu, myrrh, Echinacea.

Shango, the god of masculine energy Kingly, virile Shango, associates with

masculinity, fire, lightning, stones and magnetism.

This Great Warrior and protector transform base substances into pure and valuable essences.

He controls the male reproductive system, bone marrow, life force.

Herbs incorporating his virtues are plantain, saw palmetto, hibiscus, foti, sarsaparilla, nettles, and cayenne. [6, 14]

Oya, the goddess of death and rebirth Guardian of the Cemetery, Oya is

connected with Tempests, Winds of Change, Storms, and Progression. Usually in the company of her masculine counterpart, Shango, she is the deity of rebirth.

Things must die so that new beginnings arise. In the same way, disease must come, so that evil can be destroyed, enabling living beings to heal and be reborn to a new life. [9, 10]

Oya`s effects are on the lungs, bronchial passages, mucous membranes. Herbs used for such pathologies are mullein, comfrey, cherry bark, pleurisy root, elecampane, horehound, chickweed. [6, 14]

Intertwined archaic and modern

medicines As in many other vivid traditional

civilizations from Asia, Americas and Africa, modern medicine intermingles with popular concepts and therapies.

Nigeria is no exception. In a fascinating melting pot, local ancient African healing techniques combined not only with western scientific practices and theories, but also with different religious and magical approaches.

Archaic ethomedicine mixed up with Christian and Islamic perspectives to health and disease. In Cuba, eg, in the second half of the XVIII-th century, syncretism between the Yoruba cult and the Catholic religion resulted in the “Santeria”. Santeria is similar to the «Rule of Osha» and expresses the oracular revelation mystery of Ifá. Even though an animistic system of beliefs and rituals, Ifà is a monotheistic religion with one God, creator of everything, with polytheistic worshipping rules. [6, 13, 14]

Every natural object is enlivened by a spirit, similar to angels and saints (Spanish: santo-saint; «Santeria»-multitude


of saints). Potentiating the power of Ifà, the

Judeo-Christian God bestows the knowledge of healing to those who prove themselves worthy of him/them. [12]

Eleggua, the trickster at the crossroads In Santeria, Eleggua is probably the

most important of the Orishas for many practitioners.

He is a trickster, constantly testing people's character, waiting for them at crossroads. Without him, one cannot take advantage of opportunities, and the proper way in a given situation might not be easily found. Like Eshu, Èsù or Elegbara, Eleggua delivers sacrifices to the other Orishas.

Receiving Eleggua is the first thing any practitioner must do in the religion of Ifà-Santeria. Both the trans- Atlantic Slave Trade and the colonization of Africa, contributed to this evolution. [12]

Voodoon magic medicine Yoruba religion metamorphosed and

different species of it emerged. One of them is Vodoun, Voodoun or Vodou, a mixture of Nigerian and Congolese Yoruba, Haitian traditional belief system, Catholicism, and even Freemasonry.

It is usually met in Haiti, South America, the Caribbean, and Central America. In Haiti, it is considered to have shaped almost every aspect of cultural patterns and health practices. Commonly, lower or peasant classes have recourse to Voodoo rituals. [8]

Art of Advertising and Medical

Ethics In countries, such as Nigeria, where

traditional medicine encounters official „Western scientific medicine”, advertising the supremacy of ancestral healing systems becomes an important market strategy.

Herbal therapies are presented as

transformed and updated by nominated "pathfinders", "pioneers" and "pacesetter, each of them a "first among equals” personality, „the vanguard of the innovation”.

Herbs and popular remedies are described in accordance with current medical diagnoses and defined as capable of treating incurable diseases. Inherited etnomedical botany is „different and unique", an evidence based alternative to orthodox medicine.

The dominant „compare and contrast” propaganda labels hospital medicine negatively and performed by inhuman unprofessional practitioners.

If appealing to natural therapies: "..no doctor can sentence you to death" any longer. In traditional as well as in scientific medicine, market policies often infringes professional ethics and deontology.

Educated practitioners should be assisted in their endogenous expert roles of archaic techniques, whereas herbalists should become aware of the risks they take. [11]

Attention has to be drawn, indeed, not only to the ethics of orthodox practitioners, but of traditional herbalists and healers, too. Claims that Agencies for Drug Administration and Control, or Ministries of Health approved traditional herbal remedies and alternative or complementary practices always need critical examination. Charlatanism, ignorance and despair often go together.

Discussion The Yoruba tribe is one of the largest

tribe in Africa with an estimated 30 million people throughout West Africa.

The Yoruba medicine is Orisha (deity or spirit) based and closely associated with the Yoruba religion.

Therefore this presentation focused primarily on the Orishas that form the foundation of Yoruba medicine, in the


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same way that Hippocrates addressed the Greek gods when solemnly swearing to assist his patients properly: ”....and I take to witness all the gods, all the goddesses....” (Hippocratic Oath). [5]

Analyzing Yoruba medicine, numerous convergences with other cultures and medical systems are brought to light. Comparable archetypes are found. Magical and empirical medicines are closely related in everyday practices.

The Supreme Almighty God and derived divine entities are deeply involved in causing diseases, life and death. Gods and vital energies work together with priests, prophet-diviners and humans. Civilizing deities and heroes testify the fact that life, knowledge and health depend upon supernatural entities. [9, 10, 13]

Their course is strictly dependent on human moral behaviour and respect of the divine rules and laws.

Consequently, openness to medical mystical experiences has to be maintained. [12]

Undoubtedly, herbal medicine holds a place of choice in all archaic medicines that preceded and equally coexist with contemporary ”evidence based medicine”.

Ancient Asian, European and African medicines perfectly agree from this perspective. In ancient Dacia, too, herbal remedies were many and highly appreciated. [9]

Syncretism is another characteristic feature of cultures and civilizations. It can also be distinguished in the Yoruba medical tradition.

It occurs due to the likeliness of basic conceptions and practical approaches, which express common archaic religious principles and ancestral ideas about health and disease, life and death, destruction and rebuilding, essential intertwined realities.

Errors are thus corrected or mitigated, lest evil be eternal.

Yoruba medicine has recourse to gods

and goddesses, energies and vital forces, all able to produce and cure illnesses.

Beside them specific gods of medicine exist: Osain, the herbalist, God of traditional medicine and Obatala, the creator and healer of humans. Osain resembles Asklepios, a celebrated master of vegetal drugs in Ancient Greece, or to Zamolxis, in Dacia, - ancient name of today`s Romania. [9]

Fathering Humans and Purity, Obatala recreates or reshapes human beings - body and soul-, as he cures disorders and deformities. Oya, the goddess of death and rebirth, teaches that getting rid of disease signifies killing evil and decayed matter, restoring robustness and welfare.

Death as a source of improved life is another mental archetype religions and related traditional civilizations share. (9,10) In many respects, the rich Yoruba pantheon reminds various North African, Greek, Indian or pre-Columbian mythologies: masculine and feminine elements complement each others, goddesses of beauty, grace and fertility rub shoulders with frightening gods of war and disaster. Ogun, Orisha of Iron, the cleanser that opens the paths, hints to Chinese and Indian energetic points, meridians and networks. The vital trajectories he surveys seem to ensure an enviable health condition.

As defined in a well known Romanian traditional New Year`s wish for health, humans should become or maintain themselves “hard as iron, sharp as steel”, able to “blossom like apple-trees” and roses all lifelong.

As in ancient Egypt and other pagan mystic beliefs, but also in Christianity, deities specialize in curing specific organs and diseases. [5]

Eleggua, the trickster at the crossroads, reiterates the role of Hercules, the Greek civilizing hero, healer and savoir. [5]

Tradition gives authority. Both human-


and divine-revealed testimonies keep hope alive.

Important ethical issues equally result. The true relationship between disease

and healing experiences and their spiritual and behavioural expression are still to be determined.

Hermeneutics should aim at the transformative potential of the experience of the world, at identifying the sacred and profane roots of magical and empirical medicine.

Conclusion The Yoruba tribe`s members are

convinced believers in natural preventive and curing medicine.

They are obvious criticizers of modern western medicine where problems caused by drug use and abuse are masked, whereas the person as a whole is largely neglected.

According to the medicine-men of Yoruba, if humans listen to their bodies, these bodies will provide them with the preparation and appropriate knowledge necessary to regain the balance with the Earth and cosmic environment.

Modern-day technology, innovations and education have, however, made a lot of impact on the herbalist and on the practice of traditional medicine in Yoruba Land.

The general populace now wants to compare the herbalist with the orthodox medicine general practitioner.

Herbalists have now to be encouraged to improve on the quality of their practice, to be stimulated to identify correctly the medicinal plants and other ingredients used in the preparation of herbal products.

They should be mindful of the sources of their raw materials and avoid adulteration and mystification, in an effort to ensure safe and efficient medicines.

The intercultural and transcultural approaches to Yoruba medicine display

interrelated mental and behavioural patterns.

Reference:

1. Abimbola K., Yoruba Culture: A Philosopical Account, IAP, Birmingham, 2006, 90-129.

2. Ademulegun Z.A., The Relevance of Yoruba Medicine Men. In Pub Health Rep Nigeria, 1969, 84, 12: 1085-1091.

3. Babalola, E. O., The Relevance of Herbal Medicine to the Practice of African Traditional Religion, Islam and Christianity in Yoruba Land, Ekpoma JRelS, 2003, 5, 1: 103–110.

4. Babalola, E. O., The Scientific Basis of African Traditional Medicine. The Yoruba Example, Ekpoma JRelS, 2005, 6, 1- 2.

5. Baran D, An outline history of medicine, Ed. Tehnopress, Ia�i, 2007

6. Buckley A. D., Yoruba Medicine, Athelia Henrietta PR, 1997.

7. Danesi, Mustapha A., Traditional Medicine in Africa. In: Oluwole, S. B., Faluyi K., (eds.), The Essentials of African Studies, Lagos, 1998, 2: 143–163.

8. DeSantis, Thomas J.T., The immigrant Haitian mother: Transcultural nursing perspective on preventive health care for children, JTranscult Nurs, 1990, 2: 2-15.

9. Eliade M,De la Zalmoxis la Genghis-Han, Ed. �tiin�ific� �i Enciclopedic�, Bucure�ti,1980,80 .

10. Eliade M., Istoria credin�elor �i ideilor religioase. De la epoca marilor descoperiri geografice pîn� în prezent (vol.4), Ed. Polirom, Ia�i, 2007.

11. Iroegbu P., Harvesting Knowledge of Herbal Resources and Development of Practitioners in Nigeria, Indilinga: African Journal of Indigenous Knowledge Systems, 2006, 5, 1: 32–50.


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12. Olson J., Nkiwane S., Integrate for Efficiency: Traditional Yoruba Medicine in Nigeria, GS 218 Introduction to Africa, Colorado College, 2006.

13. Orisha Net,

http://www.orishanet.org/ocha.html 14. Yoruba_Medicine, wikipedia

http://en.wikipedia.org/wiki/Yoruba_medicine


DR. VICTOR GOMOIU, BALKAN PARADIGMS AND LESSONS OF A LIFETIME

D. BARAN1

Abstract: Victor Gomoiu founded the Romanian Royal Society for the History of Medicine and was member of the International Academy for the History of Science. He was elected vice-president, president and honorary president of the International Society for the History of Medicine. Enabling the expression of Balkan medical identities, he created a Center for South-Eastern European Medical Ethnographic Studies. Gomoiu tried to save Romanian Jews from atrocities perpetrated by fascist movements. Eminent surgeon, he implemented original sympathectomy techniques and participated in medical missions during the Balkan War, and World Wars I and II. He developed an outstanding social and educational work within the “Vergului Barrier” Establishments. Doctor Gomoiu was imprisoned and then rehabilitated by the communist regime. He embodied the paradigm of the idealistic intellectual who endeavored to affirm traditional Romanian medical, cultural and moral values. His lesson equally bears upon the continuous trial between intransigent resistance and lucrative compromise in history.

Key words: Romanian surgery, medical ethnology, philanthropy, resistance

1 University of Medicine and Pharmacy “Grigore T. Popa”, Ia�i

Biographical and professional landmarks

Undoubtedly, Dr. Victor Gomoiu`s name remains tightly connected with History of Medicine in Romania, in the Balkans and in the world, as a whole. He was born on April 18th, 1882, in the village of Vânju Mare, in the Mehedin�i County, not far from the Danube shore and the Roman ruins of the Apollodor of Damascus` bridge at Turnu Severin (today, Drobeta-Turnu Severin).

Son of an orthodox priest, he was a strictly moral and diligent pupil. In 1900 he began his medical studies and in 1906 he graduated the Faculty of Medicine in the Romanian capital. From 1906 to 1908, he was vice-president and president of the

Medical Students` Society. He equally began law studies.(10)

Between 1903 and 1909, Dr. Gomoiu was trained in various hospitals of Bucharest. In 1909 he passed magna cum laude his doctoral degree thesis entitled “Anaplastic Surgery of Face and Head” which earned him the gold medal. He chose the position of librarian of the Bucharest Faculty of Medicine Library between 1909 and 1911.

In 1911, Dr. Gomoiu was appointed physician and director of the «Sanatorium for the Fight against Tuberculosis in Children» of Tekirghiol, a Romanian Black Seaside resort.

Between 1914 and 1927, he was again present as a surgeon in the great Bucharest hospitals of “Philanthropy”, “Coltzea” and


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“Brâncovenesc”. From 1927 until soon after World War II (1948), he continued his medical activity within the “Verg Barrier Medical Social Complex” which he was the founder of.

Dr. Victor Gomoiu also became professor of surgical clinique at the Faculty of Medicine of Bucharest. [6] For his professional qualities, he was the private physician of Queen Elena of Romania.

He married Dr. Viorica Tincutza Ionescu who shared with him the same passion for both medicines - surgery above all- and medical history. Dr. Gomoiu died on the 6th February 1960, at 78 years of age.

Fig. no.1. Dr. Victor Gomoiu

Political interferences and civic

consciousness Since he was a good and extremely

honest manager, in 1929 Dr. Gomoiu was appointed Technical Counselor and in 1930 General Secretary at the Ministry of Health. Eventually he was Minister of

Health for about three months, from July 4, to September 14, 1940.

He was soon dismissed by the National Legionary government instituted in Romania on September 6th, 1940, and overthrown on January 23rd, 1941.

An incident troubled his life in 1933. After the Romanian Prime Minister I. G. Duca`s assassination by “The Iron Guard” fascist movement, several suspects were put into jail including important names of Romanian political and cultural life: Nae Ionescu, Nichifor Crainic, Grigore For�u. Dr. Victor Gomoiu was among them. Once their innocence was proved they were released. [4]

In 1941, he stood in front of the Martial Court for having revealed the toxic effects of Prontosyl abusively given to soldiers, whereas, in December 1918, he refused to mystify the necropsy results of some victims of the dramatic typographers` strike in Bucharest.

In 1942, Queen Mother Elena learned from Dr. Victor Gomoiu that a new group of Jews was to be sent to Transnistria and how miserable their condition was.

Seemingly, Barbu L�z�reanu (Lazarovici) (1881-1957), a Romanian Jewish literary historian and publicist, member of the Romanian Academy, informed his friend, Dr. Gomoiu, about this scheduled deportation and was himself finally saved due to Gomoiu`s intervention with the royal family.

Later, the constant defence of the Jews against fascist persecution, enabled by her decisive influence on her son, King Michael, earned Queen Elena the title “Righteous among Nations” conferred by Yad Vashem. [5]

Dr. Victor Gomoiu developed a multifaceted activity based on his interest and skills in surgery, social medical projects and history of medicine. His intransigent character made him suffer throughout his entire lifetime. In 1945-

D. BARAN: Dr. Victor Gomoiu, Balkan paradigms and lessons of a lifetime 139

1946, Gomoiu took part in debates on the foundation of a social-christian party, able to oppose communism. In 1950, after having lost almost all his goods, due to nationalization, after having witnessed the partial destruction of his archives, when 68 year old, he was imprisoned by the communists and spent approximately five years in prison. [7]

The imprisonment was due to his closeness to the «exploiting class», to the Royal Family of Romania, and his position of Minister of Health under a previous regime.

The real cause was his constant refusal to «enroll» and cooperate with the communist government, give up correspondence with foreign scientists, deny his friends, and formally recognize the new political order. Gomoiu could not worship these international and national «last-minute masters» whose portraits already replaced, even in his office, beloved figures: Stalin - Queen Elena; Ana Pauker and an unknown woman - his “marvelous angels”, his two deceased little girls; another bearded man - his father. [7]

After the relative opening of the communist camp towards a more humane attitude, in 1964, Dr.Gomoiu was rehabilitated and his heritage officially reconsidered.

Monographs, communications and studies were dedicated to him. In 1970, his widow, Dr. Viorica Gomoiu participated with a communication in the XXII-nd Congress of the ISHM held in Bucharest once more. In 1972, she accepted to donate Dr. Gomoiu`s remnant collections and other personal objects to the History of Medicine Museum founded in Craiova, under the auspices of the local University and its Faculty of Medicine. [6)]

Soon it became a famous establishment and gathered some other important collections belonging to towering personalities of Romanian medicine.

Unfortunately, following the revolution of 1989, other problems, especially economical, but also moral ones, impeded the full valorization of this great spiritual heritage.

Thus, in 1996, the “Gomoiu” History of Medicine and Pharmacy Museum in Craiova was itself dismantled after the building retrocession to former owners.

Dr. Victor Gomoiu, the surgeon Victor Gomoiu was professor,

practitioner and passionate researcher in the field of surgery and topographic anatomy.

In the domain of surgery, Victor Gomoiu greatly contributed to plastic surgery, sympathetic system surgery, traumatology and urology, imagining and implementing new operatory techniques and procedures.

Cervical sympathectomy was such a personal procedure, often recommended in treating angina pectoris crises. Solarectomy was another original method. His approaches were appreciated by the French surgeon René Leriche (1879-1955), famous for his pain and sympathetic system surgery. [6]

From 1903 to 1905 Dr. Gomoiu specialised in the surgical clinique of the reputed professor Thoma Ionescu (1878-1885). Professor Ionescu studied medicine and law in Paris.

He was awarded the Laborie prize of the Surgery Academy in Paris, and the silver medal for surgery, as laureate of the Hospitals in Paris.

He was an anatomy agrégé between 1892-1895 in the French capital, and in 1895 returned to Romania.

Thoma Ionescu pioneered anaesthetic surgical procedures and in 1919 published in Paris, at Masson et Cie Editing House, a momograph on «General Rachianesthesia» where cervical anaesthesia was described. [1]


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That is probably why the very young dr. Gomoiu had to share with his master the success of his own cervical sympathectomy method for angina pectoris pain management, a fact that seriously afflicted him. [6]

More operatory procedures were given his name, e.g. Gomoiu-Eden method for the myoplastic treatment of facial paralysis, or the Gomoiu-Phocas method for the surgical management of inguinal-scrotal hernia. [8, 10]

In 1906, Dr. Gomoiu was member of the editorial board of „Spitalul” („The Hospital”) journal [6, 10] Along with Drs. Gr. Georgescu and V. S�vescu, he edited the shortlived publication „Le journal de chirurgie de Bucarest”, (“The Bucharest Surgical Journal”) directed by professor Constantin Angelescu. Only few issues of it appeared. [12]

The Balkan Wars Dr. Gomoiu participated in the Balkan

Wars (1912-1913). In October 1912, he left Bucharest,

leading a Romanian sanitary ambulance to Turkey.

One month later, with the agreement of the Turkish Red Crescent, he organized a field hospital at Dede Agath. [7, ]8]

For his successful effort, the Turkish government conferred upon him the „Medgidia” order and „The Red Crescent” Medal, whereas the Romanian authorities awarded him the Silver Medal of the Red Cross and the „Bravery and Loyalty” Medal, I-st class. Dr. Gomoiu was also mobilised during the two World Wars. [7] After World War I he was awarded the Légion d`Honneur.

Dr. Gomoiu, the benefactor In 1925, Dr. Gomoiu was appointed

manager of the «Princess Elena» charity foundation.

In 1925, he courageously decided to lay

the basis a medical, social and cultural establishment at the periphery of Bucharest, in the district named “Bariera Vergului” (“The Verg`s Barrier”). [10] Vartolomei Vergu (Vergo or Virgo) had been a medieval merchant, civic dignitary, lord steward and diplomat at Brâncoveanu`s and Cantacuzino`s Court, in 1693-1697. In the XX-th century, this muddy zone was the land of the disinherited “poor and ignorant” people.

For accomplishing his utopist dream with the scarce available funds, most of which originated in his own financial contribution, Dr.Gomoiu offered to assist patients of this hospital without any fee for 10 years. Money was also donated by the «Princess Elena» charity foundation.

Dr. Gomoiu`s idea seemed to many a Don Quixote’s foolish initiative and was harshly criticized.

Victor Gomoiu himself adapted the initial architectural building plans, enabling more sections to be created: internal medicine, surgery, obstetrics and gynecology, pediatrics and stomatology. An Institute for Social and Charity Nurses and a public bath were included, too.

"The Vergului barrier complex for medical-social assistance", the accom-plishment of which he personally carefully surveyed, was comprised of 10 medical specialty offices, 60 beds, a pharmacy and two laboratories, and was cited as a model institution by the Sanitary Department of the League of Nations in Geneva. [10]

To the hospital, a popular Athénée for educational programs, a cinema, a park and a church were added. Gomoiu and other outstanding intellectuals gave conferences there, aimed at common people eman-cipation through culture and knowledge.

Gomoiu was awarded the „Djuvara” prize for his lectures. The first meetings of the Romanian Society for the History of Medicine took place equally there. Sanitary education held a privileged place,


and focused on the fight against alcoholism, tabacco dependence, tuber-culosis, pellagra, malaria, various infectious or job related diseases, hypnosis. It aimed at a science- and ethics-based comprehension of the surrounding world and facts.

Similar lectures were given by Gomoiu at the "House of Light" cultural center in Turnu Severin.

The «Vergului Complex» also known as the «Princess Elena Establishments», was directed by Dr. Gomoiu until 1948, when it was nationalized, immediatly after the King`s forced abdication and leave for exile.

Victor Gomoiu also founded several tuberculosis preventoria on the Teleajean Valley, at Brebu and Mâneciu-Ungureni, the latter bearing now his name («Dr.Gomoiu» Preventorium), two others at Baba Runca and �an�uri, not far from Bra�ov, and one in Mangalia at the seaside. [10]

A school was named after him at Vânju Mare, his birthplace and his bust by Ilie Berindei stands today in front of this college.

Following World War II, the «Princess Elena» Establishments had to be renamed "Saint Helen" and after the «storm of nationalization», they became the "30th December" Pediatric Hospital. [6, 7]

The latter denomination was a token of the historic proclamation of the republic in 1947.

In 1990, after the 1989 Romanian Revolution, the Hospital was rebaptised in the name of «Dr.Victor Gomoiu». In 2004, it was enlarged and updated.

It presently counts 184 beds, departments of pediatric internal medicine, neurology, otorhinolaryngology, two compartments of intensive therapy units and an external section for disabled children.

Dr. Gomoiu, historian of medicine and sciences

In 1929, Dr. Gomoiu founded the Romanian Royal Society for the History of Medicine, Pharmacy, Veterinary Medicine and Medical Folklore (RSHM), another visionary attempt of this true «Knight of the Sad Figure» of his time.

Between 1929 and 1946, Dr. Gomoiu was general secretary, president and honorary president of the RSHM. The Society had also a valuable Museum, decommissioned after 1947. [7]

Valeriu Bologa, a well known Romanian historian of medicine, too, confessed in his study “Wheat Grains” (“Boabe de grâu”) that he himself thought Gomoiu`s intention of creating a Romanian Society for the History of Medicine was quite unrealistic since rather few medical historians existed by then in the great academic centers of Romania: Bucharest, Cluj and Ia�i.

Time instead proved that Gomoiu was right and his efforts paid off. Professors Constantin D. Severeanu (1840-1930), the 1st RSHM president, and Ioan Cantacuzino supported Gomoiu and the young RSHM. [6, 10]

In 1932, the RSHM was entrusted with preparing the IXth Congress of the International Society for the History of Medicine (ISHM), to which it was affiliated.

This first congress took place in Romania, in Bucharest. The renowned historian Nicolae Iorga (1871-1940) was directly involved in the manifestation as its vice-president. Gomoiu, as president, and his wife, as general secretary, were the main organizers of this event. Professor Cantacuzino (1863-1934), minister of health (1931-1932), was then the RSHM president.

The Bucharest Faculty of Medicine partly tempted to boycott the RSHM and the Congress, but King Carol II`s support


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granted the final success of the meeting. (7) The King opened the Congress in state, as president of honour. [11]

Subsequently, from 1933 to 1936, Dr. Gomoiu was elected vice-president, from 1936 to 1946, president and then from 1946 to 1960 honorary president of the ISHM. [1, 6, 11]

He equally was member of about 50 national and international scientific societies and academies. (6, 10) Along with the mathematician Petre Sergescu (1893-1954) and the physician Valeriu Bologa (1892-1971), he belonged to the National Group who represented Romania to the International Academy for the History of Sciences (IAHS) [2, 3, 6]

Concurrently, he was member of the International Union for the History of Sciences (IUHS). [6]

In 1937, Gomoiu became corres-ponding member, and in 1947 effective member of the IAHS. [2, 3]

This society established by Aldo Mieli (1879-1950) in Paris, in 1929, numbered six other founder-members: Abel Rey (philosopher), George Sarton (chemist), Henry E. Sigerist (physician), Charles Singer (physician), Karl Sudhoff (physician), Lynn Thorndike (historian).

All these three physicians were celebrated historians of medicine with whom Professor Victor Gomoiu collaborated.

In 1936, the VIII-th IAHS Meeting (1-st IAHS extraordinary international meeting or «little congress») took place in Bucharest and Cluj, organized by the Romanian Group, as mentioned in the Academy`s journal ”Archeion” (1936, 18: 204-226).

The RSHM held a solemn session on Appril 15, 1936 in Bucharest, on this very occasion. In 1981, Bucharest hosted the XVI-th International Congress of the IAHS, too. [2, 3]

A dedicated historian of medicine, Dr. Gomoiu was also a skilled and inventive surgeon and devoted anthropologist. Many of his papers were awarded important prizes. [6, 10]

Victor Gomoiu and Petre Sergescu Gomoiu was particularly close to Petre

Sergescu. Native of the same Mehedinti County,

member of the Romanian Academy (1937), president of the IAHS (1947-1950), after having been its vice-president (1937–1947) and future executive secretary of the IUHS (1947–1954), Sergescu replaced Mieli as IAHS perpetual secretary in 1950. He was director of the collection «Travaux sur l’histoire des mathématiques» in Paris and chief editor and director of the «Archives Internationales d’Histoire des Sciences, la Nouvelle Série d’Archeion». «Archeion» journal, Mieli founded in 1927, continued his «Archivio di Storia della Scienza», first edited in 1919, in Rome. [2, 3]

Sergescu exiled himself to France when communists ascended to power in Romania. His secretary, René Taton (1915-2004) helped him overcome censorship and keep in touch with Gomoiu and Romania. [7]

Dr. Gomoiu and Balkan countries Dr.Gomoiu developed friendly

relationships with Balkan countries and their representatives to the ISHM.

He devoted medical historical studies to Balkan traditional medicine, since archaic ethnomedicine survived longer in this part of the world and shared related elements and mentality patterns.

In 1932, during the IX-th ISHM Congress in Bucharest he envisaged the foundation of the «Centre for Medical-Ethnographic Studies in South-East Europe».

One of Gomoiu`s supporters was Ioan


Cantacuzino, member of the Romanian Academy and president of the RSHM, by then. Gomoiu`s attitude earned him the titles of honorary member of the Greek Society for the History of Medicine (Athenes, 1932), honorary member of the Association of the Serbian, Croatian and Slovene Physicians (Zagreb, 1933), member of the «Hippocrates» Society in Belgrad (1939); honorary member of the Turkish Society for the History of Medicine (Istambul, 1940). [6, 10]

Resistance and correspondence After 1946, Dr.Victor Gomoiu was

marginalized by the communist regime. He ostentatively refused to integrate the

new political and ideological realities of his country, even though he turned down the royal family`s proposal to accompany them in their exile.

He simply tried to resist imposture and fight for his country and people, for his credo, to the end of his life, assuming the supreme sacrifice. [7]

Immediately after 1945, communists imposed their own rigorous laws. Opposing psychological pressure and ostracization, Gomoiu maintained his correspondence with former friends and collaborators: Tricot-Royer, Giordano, Siegerist, Castiglioni, Diepgen, Pazzini, Guiart, Verhoeven, Sergescu.

Letters were censored and details had to be unvoiced or subtly implied. Western correspondents had a faint idea about what was going on beyond the iron curtain. When addressing colleagues from the communist camp, e.g., Bulgaria or Yugoslavia, Gomoiu`s language became more sympathetic and even direct. [7] They were experiencing a similar tragedy.

Behavioural paradigms and the

lessons of history Victor Gomoiu`s memoirs reveal his

disappointment that under the particular

post- World War II circumstances, Valeriu

Bologa had chosen a different, more “materialistic” way. [7]

Bologa bowed to political pressure and advised Gomoiu to accept reality. But for Gomoiu «moral death seemed more serious than physical decay».

It was unbearable for the intransigent Gomoiu who, to metamorphosing into a «new man», preferred martyrdom and the final «judgement of history» which gave him a sense of relief. Bologa, instead, coped with the new social order and political rules.

Gomoiu exceptionally pioneered and sanctioned medical historical research in Romania; Bologa exceptionally developed this domain and became a reference author of classic writings and of the first handbooks.

President of the RSHM (1949-1971) and vice-president of the ISHM (1964-1970), Bologa organized in 1970 the XXIInd ISHM Congress in Bucharest and Constantza, the second of this kind in Romania.

Which was the right choice for intellectuals under «the terror of history»? This still is both a Romanian and Balkan dilemma, another tragic «riddle of history».

References

[1]. Bologa V. L., Br�tescu G. et al., Istoria medicinei române�ti, Ed. Medical�, Bucure�ti, 1972.

[2]. Colan H., Petre Sergescu, historien des sciences ou la fascination de la générosité, à travers quelques souvenirs, Noesis, Académie Roumaine, 2006, 30-31: 195-204.

[3]. Colan H., Bref historique du développement de l’histoire des sciences et des techniques en Roumanie. Noesis, Académie Roumaine, 2002, XXVII: 95–100.


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[4]. Constantin Gh., �erbu M., Mini�trii de interne (1862-2007) – mic� enci-clopedie, Ed. Ministerului Internelor �i Reformei Administrative, Bucure�ti, 2007: 252.

[5]. Deletant D., Memoriul unor intelectuali români c�tre Palat în vara 1942, Sfera Politicii,2004,107:49-53.

[6]. Du�escu B., Victor Gomoiu, Ed. Medical�, Bucure�ti, 1970, 103.

[7]. Gomoiu V., Memorii (vol. VI), Ed. Sitech, Craiova, 2006-2007, 167-285.

[8]. Iancu �t., Dezvoltarea �tiin�ei �i tehnicii în perioada interbelic�, Noema, 2003, II, 2: 130- 133.

[9]. Priminescu R. M., Evolu�ia activit��ii institutelor de cercetare, reflectat� în documentele fondului arhivistic na�ional, Noema, 2009, III: 550-566.

[10]. Scheau M, Olaru A, Simpozion Victor Gomoiu, Universitatea Craiova, 1972.

[11]. Sondervorst F. A., Backward Glance at the International Society for the History of Medicine 1920-1982, www.bium.univ-paris5.fr/ishm/eng/hist

[12]. Târcoveanu E., Ernest Juvara, J Chir, Iasi, 2005, 1, 4: 469-475.


THE ASPIRIN – THE FIRST DRUG OBTAINED BY SINTHESYS –

FREQUENTLY USED CURRENTLY

A. B�LESCU1 L. NEDELCU1

Abstract: Hippocrates mentions the use of a bitter powder, obtained from willow bark to ease the pains and the fever. In 1828 the apothecary Henri Leroux and the chemist Raffaele Piria succeed to isolate under the crystalline form the salicin from the willow bark. The saturated water based solution has a pH of 2.4 which gives the acidity and is known as the salicylic acid. The irritant effect of the salicin on the stomach is recorded in 1839. By replacing, in 1897, a hydroxyl group from the salicylic acid with an acetyl group, the negative effects on the stomach are significantly reduced thus the resulting acetyl salicylic acid. The acetyl salicylic acid (Aspirin) is the first drug obtained through synthesis in 1897, but of the inventor there are doubts. Officially, Felix Hoffman is considered the inventor of the aspirin but this right is claimed also by Arthur Eichengrun. Since many years, the aspirin is used as an analgesic, antipyretic or anti-inflammatory, but it was proved to be efficient as antiplatelet effect or in the prevention of the pancreatic cancer, the decrease of the relapse risk of the rectal or colonic cancers, the prevention of some types of cataract and the prevention of severe migraines. It has come into prominence that a reassessment of the current indications and contraindications is needed Key words: Aspirin, history of the discovery, role.


Acidum Acetylsalycilicum, the well known aspirin is the first drug obtained by synthesis while being the most used, with the longest lasting commercial success, being considered the most popular drug of the modern era.

The oldest written accounts of the curative properties of the willow bark extract are from the Sumerian civilization. The therapeutic properties of the willow have been discovered by chance as many other scientific discoveries.

Similar accounts have been found in Egyptian papyruses translated and published in 1875 by Georg Ebers who bought them in 1869 from Edwin Smith, a passionate American historian and archeologist. The papyruses describe a number of other remedies and curative practices used in antiquity: turtle shells, snake skins, milk, myrtle, figs, and dates [2]. Many of these remedies have kept their use even when Egypt was part of empires.


146

Hippocrates, the most renown and important Greek medical practitioners, was recommending the willow bark for diminishing the birth pains and the fever.

In ancient Rome, Celsius was using the willow leaf extract for treating fever, pains, swallowing and inflammation.

Pedanius Dioscorides, a Nero era botanist, writes about the therapeutic potential of the willow in the book: “De Materia Medica”, which was kept in the Arab translation.

Claudius Galen has studied in Egypt and after he used to treat the gladiators in Greece, afterwards he uses his medical knowledge at the emperor’s Marcus Aurelius court. He was recommending the willow for moderate pains.

A long period of time the medical knowledge as many of the initially used remedies were forgotten or ignored.

There have been trialed other remedies and in 1763, in England, the therapeutic properties of the willow have been noticed in the fever decrease by the reverend Edmund Stone. He administered the willow bark extract to 50 feverish persons, observing a decrease of the fever.

Later research discovered the active principle from the willow bark, the salicin. The Italians Brugnatelli and Fontana have isolated, in 1826, the impure willow bark extract but have failed to demonstrate the link between this extract and its pharmacologic effects. The salicin was isolated in its pure state, in crystalline form, in 1828 at the University of München by Johann Büchner.

In 1829, Henri Leroux improvised a method to extract salicin from the willow bark and obtained 30 grams of salicin from 1.5 kilograms of bark. The obtained salicin has adverse effects (gastric pains and diarrhea) which prevented it to be used with a therapeutic aim.

In 1838, Raffaele Piria, Italian chemist, managed to separate salicin and to obtain

the salicylic acid. The saturated water solution of salicin has a pH of 2.4 thus a high acidity and is known as salicylic acid. The irritative effect of salicin on the stomach was mentioned in 1839.

In 1853, the French chemist born in Alsace Charles Frederic Gerhard managed to synthesize the pure salicylic acid.

Felix Hoffman is considered the inventor of the aspirin, replacing a hydroxyl from the salicylic acid with an acetyl chain obtaining acetyl-salicylic acid (1897). By changing the chemical structure the negative effects on the stomach were significantly reduced. Felix Hoffman tested the antalgic and anti-inflammatory effects on his father.

The acetyl-salicylic acid is considered the first sensitized drug.

Arthur Eichengrün claimed the rights to the aspirin invention because he has overseeing the team work from which Felix Hoffman was part.

The Eichengrün version is sustained by Walter Sneader, Professor at Strathclyde University in 1999.

However the French consider that Charles Frederic Gerhard is the inventor of the aspirin by isolating the pure state salicylic acid.

After the defeat of Germany in 1918, the Allies have confiscated and sold the Bayer facilities and the exclusivity over the Aspirin trade mark. The buyer was the American firm Sterling that makes and sells in the USA and Canada the acetyl-salicylic acid under the name generic name of Aspirin.

In 1950 the aspirin was included in the Guinness Book of records as the most common analgesic in the world. No other drug was frequently used as the aspirin. The prescriptions for the use of aspirin are well known [6]: • Analgesic – in the treatment of low and

moderate pains (muscular, joint, dental and menstrual pains and headaches);

A. BALESCU et al: The Aspirin- The First Drug Obtained by Synthesis - Frequently Used Currently 147

• Antipyretic; • Anti-inflammatory – the treatment of

acute articular rheumatism and other acute inflammatory diseases; after 1950, by discovering other drugs with analgesic, antipyretic and anti-inflammatory actions the aspirin had major competitors;

• As an antithrombotic agent – in the prophylaxis of acute myocardial infarction, acute angina, transitory acute angina and ischemic cerebro-vascular stroke; in 1971 the pharmacist John Robert Vane proves the effects of the aspirin on prostaglandins [2] and the antithrombotic effect of the aspirin, fact that determines the use in the prophylaxis of cardiovascular diseases, this being the moment of the commercial revival of the aspirin; at the European Society of Cardiology Congress, in Barcelona, 2009, were described the results of studies done in Scotland on 29000 persons with ages between 50 and 75 followed for 8 years; the conclusions suggest that the aspirin should not be prescribed to the general population because the healthy persons that take aspirin do not reduce their cardiac risk but increase their hemorrhagic risk [4].

• As antithrombotic agent – in the treatment of cardiovascular cerebro-vascular diseases; it is ascertained the favorable effect in the secondary prevention of those diseases; but in the case of the primary prevention the benefit from administering aspirin are annulled by the high risk of cerebral hemorrhage [3].

Recently it was confirmed that the aspirin has n important role also in:

• Pancreatic cancer prevention – the results of some epidemiologic studies suggested that aspirin can reduce the risk of pancreatic cancer, but this conclusion is not fully

endorsed; research conducted on 987,590 persons with a evolution followed for 18 years (1982-2000) demonstrated that the sue of aspirin with the purpose to reduce the pancreatic cancer incidence or the mortality caused by it does not have a significant effect [1].

• The prevention of hepatic diseases caused by alcohol and medication overdose – a study done by Yale University shows that daily use of aspirin is preventing hepatic diseases; for prevention a daily dose of aspirin is recommended and if the lesions are already present it is recommended the administering of immune stimulant substances;

• Decrease of relapse risk for colon and rectal cancers [3]; the mechanism of action of the aspirin on tumor development is not well known, it is considered that some aspirin doses act at endothelial level, controlling the development of the blood vessels and implicit the development of the tumor; these test have been done only at a laboratory level and are necessary studies to confirm this hypothesis;

• The prevention of some types of cataract – research done by the Yale University shows that the salicylic acid is capable to prevent or delay the onset of the cataract, acting on an enzyme involved in the sorbitol creation in the crystalline;

• Prevention of severe migraines; • Prevention of obesity; • Effects on arterial tension – aspirin

administered in the morning increases the arterial tension and in the evening decreases the arterial tension;

• The association of aspirin with caffeine and ephedrine can have a positive influence on the


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development of the muscular mass and the reduction of the fatty tissues; this association has the advantage of lipolysis stimulation and decrease of protein use in the energy production with the disadvantage of heart rate increase and muscular tremor [5].

The efficiency and safety of aspirin administering in cardiovascular prevention has been evaluated by including in the study a population group with apparently healthy persons and persons with myocardial infarction or stroke. On patients with occlusive vascular disease the individual studies and randomized trials showed that small doses (75-162 mg/day) decrease the risk of serious cardiovascular events with 25% [3]. Studies on a group of 95000 persons with low to medium risk confirm that the preventive use of aspirin reduces with a fifth the myocardial infarction risk without significantly influencing the stroke risk and the stroke mortality.

There are studies that show the effect of the aspirin being dependent on age and sex. Research in aspirin intake for primary prevention significantly reduces the myocardial infarction risk in men without reducing the vascular risk. In women, the aspirin lowers the vascular risk but has no significant influence on myocardial infarction risk. The variations dependent on sex on the secondary prevention have not been demonstrated [3]. In general elderly people and women have higher hemorrhagic risk but this predisposition is not influencing alone the personal safety when administering aspirin. The association with other drugs (statins and anti thrombosis drugs) can decrease the risk of cardiovascular events. The benefits of associating aspirin with other drugs in the secondary prevention of cardiovascular events are ascertained [3].

Some studies show that associating aspirin with vitamin C is an efficient treatment against viral infections but administering aspirin during flu can be harmful. Using aspirin and other salicylate based drugs in treating flu can lead to Reye syndrome. This syndrome affects children between 4 and 16 years of age and when the flu is epidemic.

The 20th century was surnamed the aspirin century. Aspirin represented the subject of over 3000 scientific papers.

The annual quantity of aspirin is 50000 tons (20 tablets /person).

The daily use of aspirin is 100000000 tablets.

References:

[1]. Jacobs, E.J., Connel, C.J., Rodriguez, C. Et al: Aspirin use and pancreatic cancer mortality in a large United States cohort. In: Journal of the National Cancer Institute Vol. 96(7), 2004, p. 524-8.

[2]. Jeffryes, D.: Aspirin - The Extraordinary Story of a Wonder Drug, Bloomsbury Publishing PLC, 2005.

[3]. Montalescot, G.: The major risk of aspirin as with all NSAIDs, is bleeding,. In: ESC Congress Barcelona, 2009.

[4]. Patrono, C.: While the benefits of aspirin exceed the risk/benefit ratio is marginal in low-risk populations. In: ESC Congress Barcelona, 2009.

[5]. �erban D.: Efedrina + Cofeina + Aspirina = Combina�ie reu�it� în eliminarea masei adipoase �i în dezvoltarea muscular�. Available at: http://www.doctor.info.ro/eca.html.

[6]. xxx- Agenda medical�. Editura Medical�

Bucure�ti, 2007.


HIPPOCRATES’ MEMORIES OF SCYTHIA: STORIES AND FAIRYTALES

�. DIAMANDOPOULOS1

Abstract: This presentation will deal with Hippocrates’ journey to Scythia and with medical and general observations on that country and its people. The bulk of this information is derived from his work “On airs, waters and places” which is generally regarded as authentic. It is a comprehensive study of ethno-geography, correlating the medical problems of residents with climate changes, the political situation and the psychological aspects of their personality. We thought that an interesting way to present this would be in the form of a story, both because the country itself was considered legendary, and because its people - men and women – that invaded Greek myths and the descriptions by Greek authors were reminiscent of fairytales. We thus see that Scythia, a faraway country, unknown and charming, had, long before Hippocrates’ visit, penetrated Greek thought through mythology, religion, commerce and art and the descriptions of contemporary travellers, like Herodotus. It should be noted here that certain historians are unconvinced that he travelled to Scythia and believe, instead, that he describes the impressions of another. His work, however, “On airs, waters and places”, is believed to be authentic. It begins with a description of this nation, writing that “What is called the Scythian desert is prairies, rich in meadows, high-lying, and well watered; for the rivers which carry off the water from the plains are large. There live those Scythians which are called Nomades, because they have no houses, but live in wagons. The main diseases they suffer from are infertility and testicular atrophy. The love, admiration and cultural affinity that the locals feel for the Greeks are still as pronounced as we suppose and hope it was when Hippocrates visited them to write his “On airs, waters and places”

Key words: Hippocrates, Scythia, Herodotus, Testicular atrophy, Scythian legends

1 Past –President ISHM, Greece.

Introduction Usually, when one speaks of

Hippocrates, at least to his admirers, not dissenters, he will mention that “He was the first who separated medicine from religion and laid the foundations of scientific medicine. He is considered as the Father of Medicine” and such similar

laudatory statements. As if he was a meteorite that fell from

the sky and illuminated the hitherto superstitious and obscurantist medicine. If the speaker is more educated on the matter, he will try to mention his intellectual ancestors, namely the Pre-Socratic philosophers and scientists. In a more in-


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dept analysis, he would comment on the cultural or political climate during Hippocrates’s era, which allowed his creative output. Pretty much though, we will experience an attempt to link the Father of Medicine in the Golden Age and its various exponents, such as Socrates and Plato, Pericles and Pheidias.

This review approach is rarely extended beyond the Greek space. So, we thought that, in this open and productive event of the IV-th Balkan Congress of History of Medicine and the VII-th National Congress of History of Medicine we should dare something quite different.

To present the political and cultural environment of regions we know, with certainty or even with some doubts that he visited, outside the Greek territory.

To proceed, that is, a more international description of said environment.

Material This presentation will deal with

Hippocrates’ journey to Scythia and with medical and general observations on that country and its people.

The bulk of this information is derived from his work “On airs, waters and places” which is generally regarded as authentic.

It is a comprehensive study of ethno-geography, correlating the medical problems of residents with climate changes, the political situation and the psychological aspects of their personality.

I thought that an interesting way to present this would be in the form of a story, both because the country itself was considered legendary, and because its people - men and women – that invaded Greek myths and the descriptions by Greek authors were reminiscent of fairytales. And even perhaps because we were often narrated the life and works of Hippocrates as a tale.

I will not delve into the general reasons

Hippocrates acquired a mythical dimension in the public mind soon after his death and, perhaps, even more so today.

He competes only with Alexander the Great who through the century-old popular book Phyllada, became a favourite story in East and West alike.

I will present first, only a few Illustrations from three beautiful medieval manuscripts.

Illustration 1 The left side of the first Illustration

shows the delegation of Queen Saracinthe visiting Hippocrates’ grave somewhere in Greece. Saracinthe was supposed to have been converted to Christianity by Joseph of Arimathea.

The Hippocratic shrine was decorated with crosses, which makes sense, as in the Middle Ages the Father of Medicine was considered more or less a Christian. I do not know if the finding of the actual tomb of Hippocrates in Greece in the early 19th century is any less mythical; the upper right side of the Illustration shows the same scene in another manuscript that we will analyse later.

The tale culminates with the fabled discovery in Hippocrates’s tomb of an ivory box, containing the work “The Book of Prognostics”, which was in fact written seven hundred years after Hippocrates’s death, a predictive text on dermatological lesions.

In the centre of the Illustration, we see an Arabic copy of the work from the 13th century.

Illustration 2 The tale becomes extravagant, when,

the same manuscript, from the Circle of the “Holy Grail”, shows Hippocrates treating the nephew of Emperor Augustus (who lived half a millennium later).

The good doctor then stayed at in Rome, got involved in a love affair and hid

Z. DIAMANDOPOULOS: Hippocrates’ memories of Scythia: Stories and Fairytales 151

in a hanging basket to visit his illicit lover, as shown on the right side of the image.

Given that such fictitious follies on a fully documented historical person were largely credible, particularly in the West, we can see the room for the fantastic that folk tales about distant and unknown countries, like Scythia, allowed.

Let us try to understand this place. Starting from the land, this is a fabulous area with dark woods, mist, dragons and fairies. But let us define it geographically. It is a huge land, north of the Black Sea. Scythia’s location and size varied over time, from the Altai Mountains where Mongolia, China, Russia, and Kazakhstan meet, along southern Ukraine to the area of the lower section of the Danube, Bulgaria and Georgia. The Chinese called the Sake (Asian Scythians) Sai. Scythia was noted for its large rivers like the Don, which formed its main communication routes, and its many high snow-capped mountains, which were responsible for the ever-lasting cold in the country. Its people, the Scythians were tribes of undefined origin. They were first referred to in Assyrian codes of the 7th century BC.

After many adventures, they left for the above areas where they lived as nomads for centuries.

Both men and women were excellent equestrians and warriors. More about these fearless women will be said in the body of speech on Hippocrates’ medical information. Later, the Scythians come in contact with the Greek colonies of the Black Sea; have extensive commercial, political and cultural contact with them and are partly urbanised.

Typical cultural elements of the Scythian civilisation include abundant scattered mined tombs containing impressive gold jewellery. It fact, it was in the broader area of Scythia that the Argonauts found the Golden Fleece, where, according to Pausanias, the land

produced vast quantities of gold, guarded by the mythical sphinxes, creatures with a female body, a lion’s head and griffin wings. From the 4th BC century, we can talk about two different groups, those who live in northern Scythia and continue their traditional lifestyles and those of the South, who are somehow Hellenised.

From the culture of the first group, we present in the next Illustration, an 8th century bronze buckle and a gold Panther, while, from South Scythia a golden comb with Greek influences.

This influence is most obvious in works from the Greek commercial cities of the North Black Sea, as shown by the comparison between leaden bull head from their religious worship centre near Olvia of Scythia and similar relief heads from the base of a marble column in the sanctuary of Delos.

As time goes by, the Greek influence becomes more striking, as shown by A Scythian coin of the 1st century BC, which brings to mind Cavafy’s poem on Orophernes, son of Ariarathus.

Before applied art however, religion had introduced Scythia in the cultural subconscious as a distant country that raised gods or as a place of exile imposed, again by the gods.

From the time lost in the mists of myth it was said that the father of Uranus, that is the great-grandfather of Zeus, was born in Scythia. Uranus’ father was Acmon of Scythia. That was where the northernmost gods were born.

The son of Hercules, Scythis, became king of Scythia. Prometheus was exiled to Scythia, where Iphigenia was also taken, in specific to Tauris, when the goddess Artemis took her in a cloud from Aulis to spare her from being sacrificed.

In his tragedy “Iphigenia in Tauris”, Euripides beautifully describes the moment when Orestes recognizes his sister at the sanctuary: “During the preparatory ritual,


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Orestes started talking with Iphigenia in Greek; to their great joy, they quickly discovered who they were.

When she learned of the purpose of his mission, she immediately pulled down the statue from its pedestal so that Orestes could take it... According to this version, the ship finally moored in Vravrona, where Iphigenia placed the statue and, while the temple was being built, followed Orestes to Delphi. At the sanctuary of Delphi she met Electra, brought her back to Athens and wed her to Pylades” (9).

A similar description exists in the third hymn of Callimachus.

The area was also visited by Herodotus, who provides us with extensive descriptions of its geography, inhabitants and diseases that complement the picture that emerges from the work of Hippocrates.

His work is believed to have been written around the same time with Hippocrates’ “On airs, waters and places”, although it seems that neither of the two authors knew of the other’s book.

At the end of his “Histories”, the Father of History attributes the self-indulgence of Asians to the stable climate, while, regarding the Scythians, he is mainly concerned with the relationship between the local geologic and climatic conditions and their war tactics, than with their ordinary diseases.

A similar method was later used by the Romans to explain the martial arts of Germans living in similar conditions with the Scythians.

An early description by Herodotus of the use of cannabis by the Scythians is of particular interest to the history of medicine.

According to many linguists, the word cannabis itself is of Scythian origin. In book four of his “Histories”, Herodotus describes the ritual use of cannabis after a funeral “[...]

The Scythians, as I said, take some of this hemp-seed, and, creeping under the felt coverings, throw it upon the red-hot stones; immediately it smokes, and gives out such a vapour as no Grecian vapour-bath can exceed; the Scythians, delighted, shout for joy”.

The History of Herodotus was confirmed by archaeological findings, when, in 1292, Professor SI Rudenko unearthed, in a tomb in Pazryk, in the Western Altai area, a device for its use and cannabis seeds.

Herodotus also mentions the story of Anacharsis, a young noble Scythian who travels to many countries, including Greece, is impressed by its customs and tries, in vain, to introduce them to Scythia, where he is murdered. In his Panegyricus, Isocrates (436-338 BC) states that the Scythians are the most powerful and majestic people. (Panegyricus 67, 08 -5)

We thus see that Scythia, a faraway country, unknown and charming, had, long before Hippocrates’ visit, penetrated Greek thought through mythology, religion, commerce and art and the descriptions of contemporary travellers, like Herodotus.

Although still regarded as semi-barbarous, contacts with Greece constantly increased. Therefore, it was not surprising that Hippocrates travel there, nor that he did not be feeling alienated or treated as a curiosity. It should be noted here that certain historians are unconvinced that he travelled to Scythia and believe, instead, that he describes the impressions of another.

His work, however, “On airs, waters and places”, is believed to be authentic. It begins with a description of this nation, writing that “What is called the Scythian desert is prairies, rich in meadows, high-lying, and well watered; for the rivers which carry off the water from the plains are large. There live those Scythians which are called Nomades, because they have no


houses, but live in wagons. […] In these wagons the women live, but the men are carried about on horses, and the sheep, oxen, and horses accompany them; […]. They eat boiled meat, and drink the milk of mares, and also eat hippace, which is cheese prepared from the milk of the mare. […] the Scythian race, like the Egyptian, have a uniformity of resemblance, different from all other nations. […] The changes of the seasons, too, are not great nor violent, for, in fact, they change gradually; and therefore their figures resemble one another, […].

For these reasons their shapes are gross and fleshy, with ill-marked joints, of a humid temperament, […] I will give you a strong proof of the humidity of their constitutions. You will find the greater part of the Scythians, and all the Nomades, with marks of the cautery on their shoulders, arms, wrists, breasts, hip-joints, and loins, and that for no other reason but the humidity and flabbiness of their constitution, for they can neither strain with their bows, nor launch the javelin from their shoulder owing to their humidity and atony: […] and as to the women, it is amazing how flabby and sluggish they are. The Scythian race are tawny from the cold, and not from the intense heat of the sun, for the whiteness of the skin is parched by the cold, and becomes tawny”.

The main diseases they suffer from are infertility and testicular atrophy.

Hippocrates attributes the first to the years thee spend horse-riding, which hardens the outer genitalia and the heavy clothes they wear because of cold that prevent even the palpation of the male genitalia and therefore their sexual stimulation.

Relating to the above is an incised decoration in an amber vase from the Kul’Oba region, now in the Hermitage Museum in St. Petersburg. Regarding the

women, he assumes that their infertility is due to their obesity, which prevents the sperm from reaching the vagina unobstructed. Hippocrates brings as proof the fact that the female slaves of the Scythians who are thinner and more agile because of their constant activity, and bear children immediately when they come into contact with another man.

However, the indigenous population attributes this testicular atrophy and accompanying eunuch-like conduct to a divine curse. For this reason, after they fail two or three times to impregnate a woman, they believe that their goddess cursed them, wear women’s clothing and engage in womanly occupations.

Hippocrates however believes that the true cause is the phlebotomy of the posterior auricular vein, which they often perform. He believes that this vein is responsible for the creation of sperm.

Hippocrates’ description of a feature unique to the race of the Scythians is also very interesting. That is, that their women ride and fight like men. In infancy, they cauterise their right breast so that they may be able to shoot comfortably with their arrows. They do not marry without first killing three enemies. These were the legendary Amazons, of we know much mainly through the mythological cycle of Theseus.

Illustration 3 In the third Illustrations we see first a

scene from a vessel, with the battle between the Athenians under Theseus and the Amazons under Hippolyta, while in the next illustration we see a classical display of a wounded Amazon and, for comparison, a corresponding painting of 1904, but in the next, militancy has been replaced by the love of Theseus for the Amazon Antiope. On the side however, Hercules continues his labours.

Summing up the work of Hippocrates


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on the nosology of the Scythians, and more generally on the influence of climate on health, it should be noted that despite his many insightful comments, he did not entirely avoid ambiguities and generalities that raised controversy from a very early point. Already, his most ardent admirer, Galen, six centuries later, tried to reconcile the statements of his idol with his own knowledge.

To this end, he wrote “Comments On airs, waters and places”, which was unfortunately lost. It exists only in a translation from Syrian by Hunayn ibn Ishaq (809-873 AD)

Rather than end with the classic fairytale ending “they lived happily ever after”, I will present a brief overview of events after Hippocrates’ visit there and the exchange of cultural with Greek the area. In the early Christian era, it is said that St. Andrews visited Asia Minor, Byzantium and Scythia, where he preached Christianity in Kiev.

From the later Byzantine period, we know of the wartime relations of the Byzantines with the Scythians. The famous miniature of Hippocrates donning Byzantine clothes, from the work of Ioannes Actuarius was dedicated to his patron, the Grand Duke Alexios Apokaukos, who is shown the next miniature. He was given this as a medical handbook to accompany him on his expedition against the Scythians. In an ironic twist of history, his daughter eventually married the brother of the Scythians’ ruler, Theodore.

Being nomads and warriors, in subsequent centuries, the Scythians spread out in many directions so the effect of the Scythians on European civilisation is much more pronounced than generally believed. Most blue-eyed blond Europeans have, at some point in their history, attempted to prove their Scythian origin.

This seems surprising at first, since

these people, based mainly on reports of Greek and Roman historians, were considered synonymous with brutality. A book that published ten years ago attempts to collect all the European myths whose core originates from corresponding Scythian stories.

In his King Lear, Shakespeare presents the Scythian as a cannibal who eats his children. Old English writers, who wanted to prove the superiority of their race over the Irish, held them as descendants of the Scythians based on a rumour that they drank human blood and were nomads.

Not surprisingly, the other Celtic race of the British Isles, the Scots, also claimed a Scythian origin. As far back as 1320, the famous Declaration of Arbroath, signed by all the Scottish nobles and sent to the Pope, proudly advocates their Scythian origin, concluding that for this reason that they cannot tolerate an English king.

Through a complex alleged genealogy tree, even the French kings of the Carolingian Dynasty proudly claimed that they descended from the Scythians. The romantic spirit of the 19th century identified the wild Scythian warriors with incorruptible democratic fighters, something like Cavafy’s barbarians, who would save mankind through the destruction of Rome. Tellingly, the French work of the Cycle of the Enlightenment “Voyage Du Jeune Anacharsis” written by Jean Jacques Barthelemy (1715-1795), which repeated the Scythian’s ancient admiration for the democratic structures of Classical Greece, was translated into Greek by Rigas Feraios. Similar claims are made in modern times by the Serbs, Croats and Lithuanians. Even the website of the the Australian Skopjans, who advance the idea of an Aegean Macedonia, features a map showing the supposed origin of all the peoples of the southeastern Balkans from the Scythians; the Skopjans see themselves are their legitimate successors. It was


natural for the Jews believe Scythians as their compatriots. They are supposed to originate from prisoners of the ten tribes of Israel who fled to the North Black Sea after the occupation of Babylon Aeschylus, Herodotus (Book 4, chapters 24, 46) and Strabo (Book 8, chapters 3, 7), and even Keating’s Irish history in 1723, “prove” that the Scythians were smart, excellent traders using a multitude of translators, honest and did not eat pork, “thus” Jews. Art provides objects that could be used as “evidence”. It is with this contribution of art in the understanding of the spread of the relationships of love and prejudice between Europeans and the Scythians that I will conclude.

Illustration 4 I present a series of illustrations of

Sphinxes from various eras starting with a Classic Greek krater from Eretria showing a Sphinx and proceeding with a pre-classical fresco from northern Iran, which shows a Scythian horseman behind a surprisingly similar Sphinx. Then a plate with the scene of Oedipus and the Sphinx and finally, we jump to the 19th century, presenting, on the one hand a French gold and enamel buckle with the Sphinx and on the other a set of cast-iron railings from a 19th century mansion of Patras, now part of my personal collection. Please forgive me for finishing with an even more personal testimony: A photo of me from my visit to current Scythia, in Ukraine. I arrived at the city of Nizna, headquarters of the national benefactors Zosimades brothers, and, at the entrance of the school, I was welcomed by young students with Greek flags and evzone uniforms. The love, admiration and cultural affinity that the locals feel for the Greeks are still as pronounced as we suppose and hope it was when Hippocrates visited them to write his “On airs, waters and places”.

References:

[1]. Antiquities of the Jews, 11 .5.2, from The Works of Josephus, translated by Whiston, W., Hendrickson Publishers, 1987, 13th Edition. p.294

[2]. Callimachus, Hymn 3 to Artemis 170 ff (trans. Mair)

[3]. Ernest Abel, 1980, Shaffer Library of Drugs Policy, Marihuana, the First 12,000 Years.

[4]. Esther Jacobson, The Art of the Scythians: The Interpenetration of Cultures at the Edge of the Hellenic World (Handbook of Oriental Studies, Vol 2.

[5]. Euripides, Iphigenia in Tauris, Translation G. Ioannou, Kedros Publ. House, 1969, Athens

[6]. Federico Borca, Luoghi, Corpi, Costumi. Determinismo ambientale ed etnografia antica. Roma: Edizioni di storia e letteratura, 2003. Pp. 161. ISBN 88 -84 98-1

[7]. Galen’s Commentary on Hippocrates’ “On airs, waters and places”, Prof. Gotthard Strohmaier, www.manuscriptcenter.org/history/Researches/Gotthard_Strohmaier.doc

[8]. Herodotus, Histories, 4.74 [9]. Herodotus, Histories, 9, 122, 3-4, [10]. Hippocrates, Law on art, “On airs,

waters and places”, Translation: Pournaropoulos G., Publisher: Papyros, Athens

[11]. http://www.apaclassics.org/AnnualMeeting/08mtg/abstracts/Romm.pdf

[12]. Isocrates, Panegyricus, 67, 08 -5 [13]. Karaberopoulos D., Rigas

Velestinlis, The young Anacharsis, Vienna 1797 - Athens 2006, ISBN: 960-87458 -3-7

[14]. Scythians: From Wikipedia, the free encyclopaedia.

[15]. Shakespeare, King Lear, Act One, Scene First.

[16]. The New Encyclopedia Britannica,


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15th edition - Micropaedia on «Scythian», 10:576

[17]. The Riddle of Edmund Spenser’s A view of the Present State of Ireland (c.15 96)’, in: History Ireland (Summer 1996).

[18]. www.cannabisculture.com/.../jul95/scythians.html


ONE OF THE FIRST ARTICLES ABOUT THE ROMANIAN ETHNO NATUROPATHY

PUBLISHED IN A WESTERN SCIENCE PAPER WAS WRITTEN BY COLONEL DR. JAKOB

VON CZIHAK AND DR. IOSEF SZABO

E. G. BRODEL1 C. IONESCU2

Abstract: Dr. Czihak, a highly decorated and high-ranking colonel doctor in the Moldavian army, originally from Germany, worked from 1827 to 1863 in the principality of Moldavia. He earned a lot of respect there by helping both Moldavian society and the army to build up modern a medical educational system. He also was part of the early movement of writers who used the Romanian language in science and higher education. After his final return to Germany 1863, he wrote a remarkable article together with his friend Dr. Iosef Szabo, a pharmacist from Iasi, in the oldest and most famous scientific magazine of his time about the Moldavian flora. In this publication he gave us a deep insight into the ethnic naturopathic treatments and use of plants by the Moldavian and Walachian people. This was also one of the first publications in Western Europe where the Romanian language was used. On the other hand the article in the “Flora” was one of his last and largest publications in Western Europe referring to his work in Moldavia

Key words: Flora, Czihak, Szabo.

1Germany, PhD Student, University of Medicine and Pharmacy “Grigore T. Popa”, Iasi. 2 University of Medicine and Pharmacy “Grigore T. Popa”, Iasi.

After more than 36 years of practice as a physician and service in the Army of the principality of Moldova as a high ranking officer, Dr. Jacob von Czihak returned to his motherland Germany and birth town Aschaffenburg [3].

Dr. Czihak helped with his personal involvement to build up the civil and military medical service of the principality of Moldova during the years 1827 to 1863. He was part of the movement working towards modernisation and change in the still medieval like society of the principality of Moldova during the first part of the 19th century.

One of the most interesting parts of his activities during this time in Moldova was the publication of one of the first scientific books, which was written in the Romanian language: “Historia Naturalis”, Iasi, 1837. He was one of the first scientific writers to prove that it was possible to use the Romanian language for writing scientific texts [1].

His scientific life in the Moldavian principality had many other highlights, but these could be read in other publications.

Even after his retirement he still could not stop with his enormous scientific engagement to part his experiences in


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Moldova with the western scientific world of his time. A short period after he returned to Aschaffenburg in the Kingdom of Bavaria, he contacted the oldest scientific botanic newspaper in the world in the town Regensburg to publish an encyclopaedia like article of the fauna of Moldova. It was named “Flora” or known as “allgemeine botanische Zeitung” published by the Royal Bavarian Botanic

Society in Regensburg [4]. This science newspaper was published

from 1818 until 1888 by the Royal Bavarian Botanic Society in Regensburg. Since 1995 this publication can be found digitalized by the Missouri Botanical Garden in the World Wide Web under the web address: http://www.botanicus.org/ title/b11691608

Fig.no.1. Flora no.15

Dr. Jacob v. Czihak did not write this

article alone. He had a very competent co writer named Dr. Iosef Szabo, a pharmacist from Iasi. With his help he was able to collect and catalogue over a 3 year period from 1858 to 1861, over 391 plants and fungi of the Moldavian flora. They both produced a 71 page long article that was published in nine parts in the “Flora” No.

10, 12, 14 to 20 of the year 1863. Both writers used a very modern and

systematic way to catalogue this number of plants. They use the Linné - System, which was named after its inventor Carl von Linné from Sweden [5]. At first they identified the plant by it’s Latin name, then Dr. Czihak used the common German name of the plant, and by 391 he could use

E. G. BRODEL et al.: One of the first articles about the Romanian ethno naturopathy published in a western science paper was written by colonel dr. Jakob von Czihak and dr. Iosef Szabo

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the Romanian name in a third position. In case the Romanian name was very different from the German one, he translated the Romanian words into German too. Dr. Cizhak was an emigrant from Germany when he came to Moldavia and so he learned the Romanian language at the age of 27 years. The Romanian language at this time was in its early stages of being used as a language for scientific purpose. So a modern day Romanian could easily remark that Czihak wrote the Romanian words like a German think

Romanian could be written. For example at the plants “Pitschor Kokoschului” or “Tschimbrischoare” you could see these behaviours, but he also had a Russian influence in the way he wrote the Romanian language, for example by the name of the plant “Jarwa Stupului”. He used the Cyrillic character and translated it directly into German without considering the change of articulation in this case. In summary, he tried to make the Romanian language known in the German speaking scientific world of the time [6].

Graphic no.1 – Statistic about structure of Czikak text

By reading Dr. Czihaks text you note

some structure of his catalogue. In the first part of his text you find the normal plants, in the last part the fungi. The plants were first named, and then he described where they could be found in the Moldavian Nature, or in which regions of Moldova they grew if they did not grow everywhere. The next step was to describe how the Romanians used the plants. If the plant had a curative effect he wrote this first, thereafter he mentioned the possibility of using the plant for eating or other

economic scope. With fungi he only mentioned the eatable or curative fungi. Poisonous mushrooms where not mentioned at all.

Dr. Czihak tried to focus his article on the ethnic naturopathy use of the plants and fungi in the Romanian society. This aspect fills most of the information Dr. Czihak put in the descriptions of the plants and fungi. All other aspects were for him of secondary interest.

One example translated into English: Lilium candidum L., German: “weisse


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Lilie” modern Romanian: “Crin” – lived in gardens and vineyards often. The tree oil was mixed with flowers to macerate. It was used to treat contusions and abscesses. The bulb was used to treat leucorrhoea. There are also known the subtypes: L. bulbiferum L., L. pyrenaicum L., L. Martagon L. [2]

Dr. Czihak noted many common habits and uses of the ethno naturopathy of the Moldavian and Walachian people, but also a couple of different uses to his known German habits, which he mentioned in his article.

Finally it is remarkable that his 71 page long article in the “Flora” was one of his longest publications in a scientific magazine or newspaper outside of Moldavia. This article was one of his last publications and part of a lot of other

publications and scientific work from Dr. Czihak to make his beloved Moldavia and the Romanian language better known in the Western European scientific world.

References

[1]. Czihak Ch. I., Istoria Naturala, Tipografia Albinei, Iasi, 1837

[2]. Flora Nr. 15, Regensburg 1863 [3]. Flora Nr. 20, p. 310, Regensburg 1863 [4]. http://www.regensburgische-

botanische-gesellschaft.de/geschichte.html

[5]. http://de.wikipedia.org/wiki/Carl_von_Linn%C3%A9

[6]. Pruteanu P., Iacob Cihac, Ed. Stiintifica Bucuresti, 1966, 90-98; 99-126


ANA ASLAN, THE WOMAN WHO DEFEATED TIME

L. NEICA 1 N. ALDULEA1

Abstract: Encyclopaedias, medical dictionaries, various speciality studies refer to the name of Ana Aslan briefly mentioning: Romanian doctor specialist in gerontology, academician since 1974, manager of The National Institute of Geriatrics and Gerontology (1958 - 1988). Behind all these biographical data there is the life of a lady who chose to devote to research and innovation, who, at the beginning of the XXth century, had the courage to propose and apply innovatory methods to bring us closer to the long-craved “youth without old age”. She emphasised the importance of the procaine in the improvement of the dystrophic troubles related to age, applying it at a large scale within the geriatrics clinic, under the name of Gerovital. Ana Aslan invented (together with the pharmacist Elena Polovr�geanu) the geriatric product Aslavital, breveted and industrially produced since 1980. Key words: Aslan, Gerovital, Aslavita.


1. Biographical data. Ana Aslan was born on January 01st

1897, in Br�ila, being the youngest child of the fourth children of a family of intellectuals. The father, M�rg�rit Aslan wasted his fortune because of his inability in business and because of his passion for the card games. The mother, Sofia Aslan, 20 years younger than her husband, was a beautiful young woman from Bucovina, with a special education [1].

She attended the courses of “Roma�canu” College in her hometown, her childhood being marked by a sad event, namely the death of her father (when she was 13 years old). After this event the Aslan family leaves their hometown and moves to Bucharest.

In 1915, Ana Aslan graduated the

Central School of Bucharest. There was no obstacle that could not be surpassed for Ana Aslan so that at the age of 16, she dreamed of becoming a pilot and even flew a small plane type Bristol - Coand�. Eventually, she decides to become a doctor –,”undesirable” field for the women in that particular time. She declares the hunger strike to fight her mother’s opposition and registers at the Faculty of Medicine, attending it between 1915-1922 [2].

2. Professional Activity and Inventions. Endowed with a generous spirit, during the

First World War, she nurses the soldiers within the military hospitals behind the front of Ia�i. She returns to Bucharest where she works together with the well-known neurologist Gheorghe Marinescu (1919). Three years later, she graduated the Faculty of Medicine. She was assigned as assistant within Clinic II of Bucharest, managed by


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professor Daniel Danielopolu, who supervised her doctorate thesis.

Fig. no.1. Ana Aslan – source

www.mediafax.ro/.../

During 1945-1949 she carries out her activity as tenured teacher in the Medical Clinic of Timi�oara. In 1949 she becomes the head of the Physiology Section of the Institute of Endocrinology of Bucharest, year marking the beginning of her carrier of gerontologist and of the period when Ana Aslan would change the global approach for gerontology and geriatrics.

She experiments the procaine in the rheumatic diseases, in the case of a student bedrid because of a crisis of arthritis. She continues the researches in an old persons centre and she emphasises the importance of procaine in the improvement of the dystrophic troubles related to age. She obtains remarkable results informed to the Romanian Academy, whose member she becomes in 1974 [3].

In 1952, under the management of Ana Aslan, the Geriatrics Institute of Bucharest

is being incorporated, the first one of this kind in the world, whose organization manner was recommended by the World Health Organization (WHO) for all the similar institutes, creating in the same time a new medical specialty - gerontology and geriatrics - sciences that deal with the study of ageing process and namely the prevention and treatment of all the diseases associated with ageing. [4].

In the same year she prepares vitamin H3 (Gerovital) [5], a cream meant for women over 40 years old preventing and treating the ageing phenomenon, being efficient also in the old age diseases such as arteriosclerosis, vitiligo, sclerodermia etc. The product is based on the discovery of the regenerating property of procaine’s trophicity applied in the chronic treatment. In 1958, when she becomes the manager of the National Institute of Geriatrics and Gerontology, she begins to prepare the product on a large scale and to introduce it in the pharmaceutical circuit. She emphasised the importance of novocain in the treatment of the dystrophic age-related troubles.

Fig. no.3.National Institute of Geriatrics

source www.mediafax.ro/ As she was highly passionate by

cardiology, Ana Aslan used procaine, a local anaesthetic that has secondary effects such as vasodilatation in the peripheral arterial diseases. The condition of the patients improved so much after having

L. NEICA et al.: Ana Aslan, the woman who defeated time 163

used the substance that the doctors were amazed. This represented the uniqueness of professor Aslan who, in 1950 stated that ageing could be stopped and the procaine was a rejuvenating factor.

Ana Aslan Geriatrics Institute becomes one of the most well known institutes of this kind in the world, offering solutions in ageing fighting, both from the point of view of the outside appearance and from the point of view of the inside one. Most of the treatments are meant for the people over 40 years old, age when the body starts losing its elasticity and tonicity.

Fig. no.4. Gerovital H3

The patients are assisted by a series of

doctors in making the treatment that includes the re-fortification of the muscles of the body, by means of massages and gymnastics, therapy and drugs specific to the age.

Gerovital H3 – the range of products conceived to fight the skin-ageing phenomenon, formula adapted to the various types of skin and to their specific problems. The component elements of the formula play a decisive role in the process of cellular regeneration, in the stimulation of the blood circulation and the normalisation of the sebum secretion. The genius of this formula resides in the fact that the distinguished researcher

approached beauty according to health. The name of the product represents the combination of two words: “gero” coming from Greek and meaning “old” or “powerful” and “vital” that in Latin means “life” [6].

The products created by Ana Aslan are Gerovital H3 Deluxe and Gerovital H3 Regular.

In 1956 the researcher presented her discoveries at the European Gerontology Congress of Germany, where they was regarded with scepticism. Novocain was known until that time only as an anaesthetic used by the stomatologists.

The specialists could not easily accept that this was a fountain of youth. In order to confirm her results, dr. Aslan organizes a wide research program. For two years blood samples were taken from over 15.000 people, all around the country. In this experiment 400 doctors from 140 clinics took part. Some of them received Gerovital and the other ones a placebo, but nobody except the doctors who were giving the drugs knew what he/her was receiving. 40% of the ones who had taken the drug took less sick-leave days. During that period an epidemic flue affected the communist countries. The mortality rate of those who had received the placebo was of 13% and of those who had received Gerovital was of only 2.7%. Gerovital was breveted in over 30 countries, initially being considered a miraculous drug; it has an effect of balance on the vegetative nervous system, with visible improvement effects on various physical diseases.

In 1976, the researcher is awarded the inventor patent for Aslavital (together with the pharmacist Elena Polovr�geanu) efficient product in the therapy of the nervous system and of the cardiovascular system. Aslavital represents the first range of products in the country based on clay; she uses an original concept of preventing and delaying skin aging, emphasizing the


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exceptional potential of clay. The concept of anti-aging proposes a complete program of sensitive skin care, having as ingredients clay, rice natural oil, vitamins, extracts of marigold and ginseng. Eight years later (1984), Aslavital for children is being homologated, being successful in treating nervous deficiencies.

She creates the concept of "aging prophylaxis" and she is concerned with the elder people abandoned by their families. She refuses to charge the care home taxes for these unfortunate people, audacity costing her 1,500,000 lei, such money being imputed to her by the Party authorities. After seven years of court harassment, she is acquitted. Yet, the acquittal comes rather late, five months before becoming forever a legend. Justice is made far too late, taking into account that the outcome of her researches had brought incomes of 17,000,000 dollars annually, to the state.

Moreover, the reputation of Ana Aslan products stimulates local tourism. Several hotels in the country offer their guests the possibility of undergoing treatments and procedures using Gerovital and Aslavital. These programs – generically called Ana Aslan Health Spa – combine the natural environment factors specific to mountain or seaside resorts (the air with intense ionization, the salt water and the saprophilous mud, plants having healing effects) with a multiple of classical procedures. The clients have access to hydrotherapy rooms, massage rooms, facial and body aesthetic care, electro and magnetic therapy, individual kinesitherapy and fitness rooms. The list of the most famous resorts of this type includes Eforie Nord - Astoria Hotel, Europa Hotel - Ana

Aslan Health SPA, Poiana Brasov - Sport Hotel, Bradul Hotel, Poiana Hotel, Bucharest - Athenée Palace Hilton, CrownPlaza.

Personalities such as Charles de Gaulle, Indira Gandhi, Charlie Chaplin, Salvador Dali, Winston Churchill or Pablo Picasso had had treatment with Gerovital in Bucharest.

In time, the reputation of the products and of the treatments offered at Ana Aslan centers attracted numerous celebrities such as Ymma Sumak, Somerset Maugham, Salvador Dali, Charlie Chaplin, Pablo Neruda, Aristotel Onassis, Jacqueline Kennedy, Indira Gandhi, Marlene Dietrich, Charles de Gaulle, Lilian Gish and Tito.

3. Personal life. Paradoxically, this special woman who

perfectly spoke French, German, Italian who could easily have a conversation in English, Greek, Spanish and Polish, who read the greatest Russian prose writers in the language of Balzac, used to believe fortune tellers. Ana Aslan used to systematically receive in her house of Aviatorilor Boulevard a woman who was telling her fortune using cards or coffee. Some people were certain that the fortune teller was – as many other people who used to come to her house – informers of the Security Services. In the same time, Ana Aslan believed in God who used to permanently have on her an icon of Virgin Mary. Ana Aslan was not only a scientist and a doctor, but also an extraordinary woman. Among her patients there were kings, presidents of states, heads of the secret services, actors and simple earthlings. Otherwise, she avoided doctors

L. NEICA et al.: Ana Aslan, the woman who defeated time 165

all her life, having troubles in letting herself on their hands, as she was her own doctor. She hardly accepted being operated of colon cancer by professor Setlacec, at Elias Hospital. A surgery is performed on her and when they thought they made it, as it was incipient colon cancer, less aggressive in elder people, the final act occurred. A new surgery is proceeded because of an infection with Pseudomonas aeruginosa taken from the hospital, but the infection had already seized the entire abdomen.

On Thursday, May 19th 1988 Ana Aslan

died at Elias Hospital. Elena Ceausescu refused to make her last wishes come true: funerals with a priest, together with her mother and brother, in Kalindero-Danielopolu crypt and she is buried in Bellu Orthodox Cemetery without a priest and without candles.

On the Internet, at the address GERO Vital Web Site, a totally different version of the death of the savant is launched - in Portuguese. Mysterious sources assert that she died in suspect circumstances and that some historians conform that she had been assassinated by the Security Services. It is asserted that investigations have never been made related to this issue.

The international fame and the numerous distinctions granted to her, the number and rank of the patients in the political, scientific and artistic sphere all over the world include Ana Aslan in the constellation of the most well-known world personalities who "moved" the Universe. No doubt that she was the most interesting medical personality living before 1989 in Romania.

“Being forever young does not mean being 20 years old. It means being optimistic, feeling good, having an ideal to fight for and reaching this ideal.” (Ana Aslan)

4. Titles. Prizes and Distinctions. The geriatric researches and the

development of Gerovital H3 formula brought Ana Aslan the quality of honor member in numerous medical societies and organizations, thus becoming one of the most important Romanian researchers. Consequently she was a member of several societies [7]:

� Member of the Academy of Sciences,

of New York; � Member of the World Union of

Prophylactic Medicine and Social Hygiene;

� Honor Member of the European Center of Applicative Medical Researches;

� Member of the Board of Directors of the Gerontology International Association;

� Member of the National Society of Gerontology of Chile;

� President of the Romanian Society of Gerontology.

� Her activity was crowned with numerous Prizes and distinctions:

� "Leon Bernard" international prize and medal, prestigious distinction awarded by the World Health Organization, for the contribution brought to the development of gerontology and geriatrics, 1952;

� Merito della Republica, Italia; � Cavalier de L’Ordre Palmas

Academica, France ; � Honoris Causa Professor and Doctor

Emeritus of Braganza Paulista University, of Brazil;

� Commemorative Gold Medal, Nicaragua, 1971;

� Merit Cross, Class I, Germany, 1971;

� Hero of the Socialist Work, Romania, 1971;

� "Augusto Pinaud" Medal, Venezuela, 1972;


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� Knight of the New Europe, Oscar Prize, Italy, 1973;

� "Eva" International Prize, Italy, 1974;

� Commander degree in the Order "De Orange Nassau", Holland, 1975;

� "L’Ordre du Merite" in the rank of Grand Officer, Senegal, 1976;

� "Dag Hamarskjoeld" Prize, 1977; � "Dama di Collare Del Santo Graal,"

Nice, 1978; � Citizen of Honor and Sciences

Honorific Professor, Philippines, 1978 etc.

References 1. http://ro.wikipedia.org/wiki/Ana_Aslan 2. http://biografii.famouswhy.ro/ana_aslan/ 3. Avram A., Femei celebre, Ed. All,

2006. 4. http://www.medicalstudent.ro/personal

itati/profunivdr-ana-aslan.html 5. http://www.ici.ro/romania/ro/stiinta/asl

an.html 6. http://www.arhimag.ro/Gerovital-H3-

este-redefinit-de-compania-unde-a-fost-produsprimaoara++ articles+article.aid+10334.html

7. http://www.travelworld.ro/romanesc/medicina/ana_aslan.php

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 Series 6: Medical Sciences - Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

HISTORICAL ASPECTS OF COMPUTER SCIENCE IN THE EMERGENCY ROOM IN TRANSILVANIA UNIVERSITY OF BRA�OV

- A STUDY CASE -

L. SANGEORZAN1

Abstract: Health care or medical informatics, represent an intersection between information care, computer science and health care. In the Health Services, computers are being introduced not only to provide direct care for the patients but also to obtain some important information regarding the type of: assurance, diagnosis (main or secondary) etc. The paper presents some historical aspects of developing the applications for helping: the physician and the patients that are in the emergency room; the students who want to learn more about the evolution of the diesis using descriptive statistics. Several software applications designed by the team, made up of computer scientists, statisticians and physicians, within Transilvania University of Brasov are described. Key words: Descriptive statistics, HTML, PHP, Excel, Health Services

1Transilvania University of Bra�ov, Faculty of Mathematics and Computer Science

1. History The first computer was building in

USA 1946 named ENIAC, having a weight of 30 tons and a surface of 160 square metres.

If in the 1950 with the medical informatics began to take off in the USA, in Romania, Acad. Prof. Grigore C. Moisil formed a research group whose expertise was the algebrical theory of automate mechanisms (in other terms, the first steps in computer science). Medical informatics is a interdisciplinary domain applying methods specific to informatics to medicine [1].

“Medical informatics includes medical computing, medical computer science, computer medicine, medical electronic data processing, medical automatic data

processing, medical information processing, medical information science, medical software engineering, and medical computer technology.” [http://en.wikipedia.org/ wiki/ Health_informatics#Aspects_of_the_field]:

Medical informatics provides a new approach of the applications in the medical area. In 1989 the International Medical Informatics Association (IMIA) was established, under Swiss law as an independent organization. This association, IMIA, had an important role in application of information science and technology in the fields of healthcare and research in medical, health and bio-informatics. Some of the important objectives of the association IMIA are to introduce in health care and health research the informatics applications. In 1976 the European


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Federation for Medical Informatics (EFMI) was established in Copenhagen in Septem-ber 1976. EFMI functions as the autono-mous European Regional Council of IMIA.

In our days there are a lot of types of medical software as:

� software to interpret the sensor information and display it on a monitor;

� devices that are programmed to pump some medication or other solution into a patient;

� processing row data obtained by measured and create images that doctors can read and understand;

� expert systems that indicate what should be done;

� software used as an educational or study tool for healthcare.

We enumerate a series of software

products able to assist the doctor or the patient and are divided into categories according the particularity of the medical area or for the medical environment:

� Public Health and Biosurveillance: Epi Info, EpiSPIDERE, iDART;

� Electronic health or medical record : CHITS, FreeMED, GNUmed, Open Healthcare;

� Medical Practice Management Software : Care2x, ClearHealth, FreeDiams ;

� Health System Management: DHIS, iHRIS Suite;

� Imaging/Visualization: 3D Slicer, Brain Visa, BioImageXD;

� Telemedicine: Ipath. ZephyrOPen. One can say that health informatics is

meant to include not only computers but also the clinical guidelines and the corres-ponding information and communication systems. It is applied to the areas of public health, (bio)medical research and also eLearning in medicine. Software and platforms already designed are extremely useful, instead, the medical staff working

in this domain should be taught and trained as to use efficiently and in a correct way this new equipment. This is the reason that has led to the development of small applications meant to solve urgent problems related to the recording of the ill persons or of the diseases, as well as statistic processing. These applications do not require an up-to-date infrastructure.

We shall show some of these applications designed by a mix team of researchers of Transilvania University of Bra�ov.

2. Online application On line applications in the medical area

have been designed and developed since 2004, in Transilvania University of Brasov. These applications were the products of a research team comprising computer scientists, statisticians and physicians, and were presented on the occasion of the international conferences. At present, this team is at the final stage of designing these applications as to be implemented in the emergency room and to be used as didactic material for the classes of computer science within the Faculty of Medicine. The development of this software has been possible, due to the fact that the author of this paper dedicated her research work to the web technology and the on-line applications. At the same time, the curriculum of computer science for the students in the Faculty of Medicine has been improved, the main goal being the students’ training in using the on-line informatics products.

Biostatistics tackles with the analysis of biological and medical data.

Statistics is important not only in analyzing the health status of patients but also for analyzing the administrative work in a clinic and developing modalities for improving these types of activities. Important information one can obtain from the patient record that must be field, when

L. SANGEORZAN: Historical aspects of computer science in the emergency room in Transilvania university of Bra�ov - a study case -

169

the patient is coming in the emergency room. It is important to improve the quality of healthcare and this is possible if one can collect in real time, data about patients.

This entire one can do with statistical methods using IT tools and with specific online software.

There are two types of on-line applications designed by the mix team, made up of computer scientists, statistic-cians and physicians, within Transilvania University, such as:

� Application of recording the patient for emergency cases [4].

This patient record can be stored on the computers with the application called OnLine_Patient_Record. Each user will introduce the information in an Excel file and this can be printed out and/or one can see also statistical result.

� On-line statistic processing of data related to the patients or the diseases. This information can be processed on-line with the application “e-Statistics“ and it support the training of medical students and nursing students with the aim of becoming familiar with elements of statistics and the use of Excel files in on-line processing of statistic data [3].

2.1 Theoretical aspects The written applications called uses at

implementation level the PHP server scripting language. The language PHP has a special flexibility which permits to be used with other technologies. These languages/technologies make possible to obtain remarkable results. WEB 2.0 is a term describing the trend in the use of word wide Web technology and Web design that aims at enhancing creativity, information sharing and communication among users [4]. The input data stored in the created database are processed by using elements of mathematical statistics. In order to investigate the character of a distribution, it is useful to have various

measurements for describing the distribution, to draw pictures (histograms, polygons, etc.) of the distributions and to use certain measurements which are most commonly used to describe a distribution.

2.2. OnLine_Patient_Record -

Problem Formulation OnLine_Patient_Record is an online

informatics system, dedicated to the patient care in an emergency room in a hospital and comprises several applications designed to reach the following aims: - to get important information regarding

the patient - to get summary statistics and the chart

type for the selected variables ; - to support students in health sciences

to improve their research during their medical training and university studies.

Following the fields enclosed in the

Hospital patient record (Fi�a de observa�ie clinic� general�) (Fig.1) we build the web application. The model is realized in such way that the access to the application is granted for two categories of users: the administrator and the user.

The administrator - is the person which has access to all parts of the application allowing him to manage the database information.

The user - is an employee of the hospital -doctor or nurse - which has access to certain parts of the application, after authentication.

The software system OnLine_Patient_Record allow to display or print the information stored in the current Excel file, the database that is an Excel list. The menu bar (Fig.2) contains the following applications:

� Hospital patient general record (Fi�a de observa�ie clinic� general�) allow, after authentication, the introducing of patient data in the Excel files ;

� e_Statistics – allow to generate the


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summary statistic and the chart type for the selected variable (Fig.3) after authentication and also the visualization of the corresponding chart (Fig.4);

The application OnLine_Patient_Record is software based on Web technologies and Open Source products.

Fig.1. Hospital patient record

Fig.2. The main Interface of Online

Patient Record

Fig.3. Selecting a variable for generating

the summery

Fig.4. Summery statistics for sex

variable and chart statistic and the type of chart

The application e_Statistics can be used

as independent software by any user, at any time without restriction. The steps to be followed in running the application are:

a. Create an Excel formatted file taking into account the following rules:

� In the first sheet, named data_sheet, must be stored the data to be analyzed. The first row must contain the names of the variables and the following the measured values (Fig.5). All the values of the variables that we want to study must be numerical.

L. SANGEORZAN: Historical aspects of computer science in the emergency room in Transilvania university of Bra�ov - a study case -

171

� In the next sheets, for each variable with text values, we must give them a number, a codification. For

example for the Sex variable we give 1 for male and 2 for female (fig.6).

Fig.5. Data Base for Online Patient Record

Fig.6. Codification for variable Sex

Bulletin of the Transilvania University of Bra�ov • Vol. 2 (51) - 2009 Series 6: Medical Sciences - Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

b. Using a Browser we start the application from the Web Server after authentication

c. On the Server we store all the uploaded data for later use. The data is made accessible for other authenticated users for viewing and analyzing.

3. Conclusion This software application has been

created as to be easily scalable and adaptable (on request) to other emergency room and also for eLearning for students studying medicine or nursing. The application uses PHP server side scripting language, Excel list as database, all of these technologies are open source, and allow easy implementation on any server with any operating system. The application is very dynamic; it allows storing the information in the emergency room in real time.

References [1]. Mocanu N.-M. T., Informatica

medical� - Ed. Transilvania Brasov, 1996.

[2]. O’Reilly T., Web 2.0 Compact Definition: Trying Again. 2006–12–10, Retrieved on 2007.

[3]. Sângeorzan L., Florin T., Rogozea L., Micl�u� R., Summary statistics for Training Medical Students, 29th International Conference of the Romanian Medical Informatics Society, MEDINF 2007, e_Health Days in Sibiu, pg. 299-304, 8-11 Nov. 2007, ISSN 1843-651X.

[4]. Sangeorzan L., Nedelcu A., Mazgaciu C., Rogozea L., Podoasca C., Online Patient Record in an Emergency Room Based on WEB 2.0 Technologies, Mathematical Methods and Applied Computing, Vouliagmeni, Athens, Greece, September 28-30, 2009, Proceeding of the ACC’09, pg.622-626, ISBN: 978-960-474-124-3, ISSN: 1790-2769


ANALYSIS OF THE IMPACT OF HISTORY OF MEDICINE’S PUBLICATIONS

A. REPANOVICI1, L. ROGOZEA2, R. MICLAUS2

Abstract: The impact of publications is an indicator of quality. For measuring the impact of publications usually are used scientometric indicators, and the most common way is to use the internet and the scientometric database Google Scholar. We use a soft-wear Publish and PERISH who can calculate the index for authors. The article is a study about the impact of published books on the history of medicine and analyzed the impact of authors Key words: history of medicine, Hirsh index, Google Scholar, scientometric indicators.

1 Faculty of Mechanics, Transilvania University of Bra�ov. 2 Faculty of Medicine, Transilvania University of Bra�ov.

1. The resources to analyse the quotes and to measure the impact factor of publications

Publish or Perish – is a soft designed to analyse the quote in the aim of helping scientists in increasing the impact of their research.

This software is available no charge on the web page of Prof. Anne Wil HARZING, International Management Specialist in University of Melbourne, Australia (Harzing A.-W., 1997-2009).

Willing to reveal the researches influences of the publications not quoted in ISI Journals the best recommendation is the soft Publish and Perish designed to process and analyse the quotes .The soft is using Google Scholar to find the references, quote sources and then analyse them leading to statistics based on the following parameters: � Total number of papers � Total number of quotes � Average number of quotes for one author � Average number of quotes for one

publication

� Average number of papers for one author � Average number of quotes in one year � Hirsch Index and linking parameters � Egghe g Index (EGGHE L., 2006 ) � h contemporaneous Index � Age Importance in quote rate � Two variations of individual h index � Analysis of the number of authors for

one paper Publish or Perish is designed to

individual empower scientists to present their personal experience of researches’ impact in the most advantageous way. Is not recommending being mechanical in academic evaluation. It is highly reco-mmended to consider the following aspects: a) If a teacher has good performance

based on publications’ quotes is obvious he has a significant impact in that field of science. The backhand is not valid every time.

b) If a teacher has not very good results in his publications’ quotes, one cause can be the lack of impact of his domain of research. Another causes might be linked with a small domain


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he is working in or his publications are in a different language then English (LOTE- Languages Other Than English) or his publications are only books or papers in books.

Although from this point of view, Google Scholar has better performance than Web of Science it has no performance in taking quoting from books or books’ chapters.

Measuring the quoting in Social Sciences and Humanist Sciences they are underestimated because they are published in LOTE - Language Other Then English and in books’ chapters more than Precise Sciences.

Google Scholar provides more quotes than ISI but not in all domains. Both soft are covered Social, Humanist and Engineering sciences with quotes in books, proceedings of conferences and a large amount of journals. Natural Sciences and Health Sciences are well represented in ISI and subsequently Google Scholar cannot provide more quotes. In addition, journals are not generally covering Google Scholar. This is the reason way quoting in this domains can be smaller then in ISI (Harzing A.-W., 2008).

As recommendation, Google Scholar can be preferable in the following domains: a) Business, Administration, Finance &

Economics; b) Engineering, Computer Science &

Mathematics; c) Social Sciences, Arts & Humanities.

Better, is recommended to processed this analysis in parallel and comparative with Scopus and Web of Science.

Hirsh (Hirsch, 2005) suggests h Index as a criterion to quantify the scientific impact of an author as following: a researcher has h Index for his Np publications if he has at least h quotes for each one and no more than h quotes for each one of the others (Np - h) papers. This

new indicator for measuring personal scientific results was quickly considered by informatics’ specialists and bibliometrics’ researchers.

In the specific literature (Borgman, 1990) the specialists found approximate 30 publications referral to h Index in one year after Hirsh paper. Also, there were a lot of comments, critics and an evaluation regarding h index and was revealed that H index is less sensitive in the most quoted references in a publications and is dependent of the domain of science.

Different variants of Index were designed in the aim to eliminate the disadvantages: m coefficient, h index (Hirsch, 2005), g index (Egghe L., 2006), h index (2) (Kosmulski, 2006), A index (Jin, 2006), R index (Jin B., 2006), AR index (Jin B. L., 2007) and hw index (Egghe L. R., An h-index weighted by citation impact, in press). The most representative and productive score of researchers’ impact is weighted by h index and g index and the papers’ impact is weighted by R index and AR index.

To optimise the presented indexes was suggested b index as indicator with two values (suggesting to enclose or to disclose the publications in weighted the author’s productivity) and result of the researcher’s characteristics. B index is based on value comparing of researchers’ indexes.

2. The research in Google Scholar

scientometric database. The analyze of history of medicine’s publications

A simple request for searching “History of medicine” will arise 2810000 results.

The most quoted book is FH Garrison : An introduction to the history of medicine, 1914. This book has 814 quotes.

A. REPANOVICI et al: Analysis of the impact of publications in the history of medicine 175

Figure no. 1: Image from scientometric

database Google Scholar Analysing h index for the most quoted

authors for published books give the next results:

Figure no. 2: Analyse of the search impact

for author FH Garrison

FH Garrison wrote 330 papers in the field of history of medicine, written between 1914-1921 and has an h index equal to 20. The higher quoted .have the following publications: “An introduction on history medicine”-800 quotes, “History of medicine”-206 quotes and “Garrison’s history of neurology”-158 quotes.

Figure no. 3: Analyse of the search

impact for author CC Metler FH Metler wrote 45 papers in the

domain of history of medicine, written between 1935-1979 and has a 10 h index. The higher quoted .have the following publications: “History of medicine”, 248 quotes.

Conclusions The most important application of

scientometry is the performance evaluation of scientific research. Hirsch index is a new instrument of measuring the research performances.


176

Quoting is an intellectual transaction or an intellectual responsibility to other people work. H index depends as well on the number of publication as on the impact on the users.

Publish and Perish Soft represents an instrument very easy to use in analysing the researches’ impact. It is free of charge and evaluates the research’s impact and his visibility on the internet through Google Scholar.

ISI Web of Science is a very expensive database and a very low number of institutions have access to this database. It is recommended to consider the domain of research, when academic evaluation because the results are different from one domain to another.

References:

[1]. Egghe, L. „An improvement of the h-index: the g-index.” ISSI Newsletter (2006): 2(1): 8-9.

[2]. Egghe, L., Rousseau, R. „An h-index weighted by citation impact.” Information Processing & Management (in press): in press.

[3]. Harzing, Ane-Wil. HARZING HOME. 1997-2009. 13 August 2009, http://www.harzing.com/index.htm.

[4]. Harzing, Anne-Wil. Google Scholar - a new data source for citation analysis. 20 December 2008. 13 August 2009, http://www.harzing.com/pop_gs.htm.

[5]. Hirsch, J. E. „An index to quantify an individual's scientific research output.” Proceedings of the National Academy of Sciences of the United States of America. Washington: National Academy of Sciences of the United States of America, 2005. 102 (46): 16569-16572.

[6]. Repanovici, A. Managementul resurse-lor informa�ionale în cercetarea �tiin-�ific�. Bra�ov: Editura Universit��ii TRANSILVANIA din Bra�ov, 2008.

[7]. Repanovici, A. „Marketing Research about Attitudes, Difficulties and Interest of Academic Community about Institutional Repository, PLENARY LECTURE.” Advances in Marketing, Management and Fi-nances, Proceedings of the 3rd Inter-national Conference in Management, Marketing and Finances, (MMF’09), Houston, USA, April 30-May 2, 2009, ISSN 1790-2769, ISBN 978-960-474-073-4, pag.88-95. Houston, USA: WSEAS, 2009. 88-95..


„MEDICAL HYDROTHERAPY” OF GEORGE BAIULESCU – AN HISTORICAL

PERSPECTIVE

R. MICL�U�1, L. ROGOZEA1, G. SECHEL1, A. FLEANCU1, L. CRISTEA2, M. BARITZ2

Abstract: The “Medical Hydrotherapy” was published in 1904 in Bucharest, at Minerva Publishing House and is kept in the County Library of Brasov next to other very valuable books. In 698 pages George Baiulescu MD, head of Hydrotherapy Department and professor of hygiene at Romanian Gymnasium in Brasov, included 53 photographs. The book is written in the Romanian language of the beginning of the 20th century and is structured in one Introduction and 2 parts: „The physiologic action of Hydrotherapy” and „The Reaction”. The first part has two chapters „The Technique of Hydrotherapy”, „The Hydrotherapic applications for sudation”, „The Compresses”, „The Irrigations”, „The Drinking Water”. There are pictures of procedures done into the hospitals: foot shower, ascending shower, massage shower, wet package, bath of light, steaming bath with warm air. There are also are presented warm and cold applications and the therapy with ice. The author clearly underlined that the watery therapy is depending of many factors as water’s temperature, time of application, individuality of the patient, skin’s sensibility, nervous activity and reaction, peripheral circulation, patient’s reactivity and type of pathology and others. The book included the actions of hydrotherapy on Central Nervous System, blood circulation, „morphology” of the blood, „organic exchanges”, breathing, muscle strength, temperature, secretion and excretion and is giving details about these actions. It is a proof that the doctors of that time tried to reach above their condition of practitioners, becoming theorists in the same time. Key words: Medical Hydrotherapy, history of medicine, book.

1 Faculty of Medicine, Transilvania University of Bra�ov. 2 Faculty of Mechanics, Transilvania University of Bra�ov

Among a sum of cultural treasures hosted inside the old walls of Brasov County Library, “Medical Hydrotherapy” is one of the rare books useful to understand the old times, époques and the Romanian culture evolution. A part of these books were the property of the physician Emil Bologa, local doctor and very well known for his research

in the field of history of medicine in Brasov and Romania.

The “Medical Hydrotherapy” was published in 1904 in Bucharest, at Minerva Publishing House, Institute of Graphic Arts. The rare sample of the book has the owner’ autograph fromApril 18, 1938 and an “ex-libris Dr. Emil I. Bologa” representing a a


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skull, a snake, a book and contained the Latin expression „mulla dies sine linea”.

Fig no 1: First page of the book

Head of Hydrotherapy Department and

Professor of Hygiene at Romanian Gymnasium in Brasov at the dawn of 20th century, George Baiulescu MD wrote this book in the aim to help the students, doctors and specialists to understand, learn and prac-tice hydrotherapy in their medical practice.

Written in the beautiful and authentic old Romanian language of the beginning of the 20th, full of neologisms century the book is structured in one Introduction and two parts, collecting in 698 pages 53 photographs and a lot of medical information very new for the beginning of the 20th century.

The first part has two big chapters „The physiologic action of Hydrotherapy” and „The Reaction” and the second part is structured on five chapters: „The Technique of Hydrotherapy”, „The Hydrotherapic appli-cations for sudation”, „The Compresses”, „The Irrigations”, „The Drinking Water”.

The book shows pictures of the cure rooms of Brasov hydrotherapic depart-ment, one for men, one for women and the technical conditions and electrical

machineries necessary to provide the hydrotherapic treatment: lifting tank for water - Carré system, pressure accumulator tank - Henry System, showers’ plumbing. In addition, the book describes the tech-nical details of hydrotherapic procedures provide into the hospitals: foot shower, ascending shower, massage shower, wet package, bath of light, steaming bath with warm air (general warm air bath and local warm air bath and steam). There are also presented warm and cold applications and the therapy with ice: wet sheet friction, refrigerating bag, coil rubber tubes, ice bag, and rectal refrigerating bag.

Fig. no 2 Illustration from book

In the chapter “Introduction” doctor

Baiulescu underlined the factors that physiotherapy and watery application depends on the: 1. water’s temperature; 2. time of application; 3. individuality of the patient; 4. skin’s sensibility; 5. nervous activity and reaction; 6. peripheral circu-lation; 6. patient’s reactivity; 7. type of pathology and others. Additionally, the author showed that „there is a big differ-rence in practicing hydrotherapy’s appli-cations” in France where the main procedure were showers comparing with Germany and Switzerland where are used more often Priessnitz procedures like half bath, frictions with wet and cold sheet, wet or dry packages, perineum bath.

The physiological effects of hydrotherapy

R. MICLXU� et al.: George Baiulescu – an historical perspective 179

are very well described. First, Baiulescu postulated: „all applications not included in 33-36 C are excitants for a body and induce physiological changes”. The book included detailed actions of hydrotherapy on central nervous system, blood circulation, „morphology” of the blood, „organic exchanges”, breathing, muscle strength, temperature, secretion and excretion.

In addition, the cardiovascular effects depend on the temperature and on the time of application. There are precisely described the effect of warm application in intensive or non-intensive application. Considering that the effects of hydrotherapy influence the central nervous system, the circulation, the “morphologic condition of blood”, the “organic exchange”, the breathing, the muscles strength, the temperature, the secre-tion and excretion, doctor Baiulescu is detai-ling these domains further. Concerning the hydrotherapic effects on central nervous system Baiulescu considered that hydro-therapy influences as well locally as at distance thus “a cold application on feet has a reflex influence of brain and meninx’s vessels. A hot bath of hands influences on respiratory organs.”

Based on the assertion of reflex points and their stimulation techniques Baiulescu described the tonic or relaxing effects of massage and as well physical effects as psychic influences of hydrotherapy.

Baiulescu wrote the conclusions related to the effects of intensive warm application vs. cold applications: „through local cold and warm applications and depending on the intensity of thermal excitation will be induced a primary vascular constriction followed sooner or later by a vasodilatation inducing a skin hyperemia”.

Concerning the influence of hydro-therapic applications on „the morphology” of the blood there are remind the public-cations of Winternitz, Rovighi sau Thayer. Thus, the author remembered „Wintermitz found a maximal increase of 1860

thousands red blood cells/cube mm and the number of white blood cells is three times higher and haemoglobin is 14% higher than before the applications.

On muscles, “cold applications increase the muscles’ capacity and labor and warm applications decrease the muscles labor and effort capability if not combined with mechanic action”.

In the chapter „The Reaction” is a description of hydrotherapic effects and a classification of these effects in primary and secondary. Also, “each technique of applications has to specify tree periods: 1. action period; 2. reaction period and 3. equilibrium seting”.

The book presented a very modern concept related to the medical management: 1. The patient admission is mandatory to assure the continuity and regularity of hydrotherapic applications. 2. The favorable effect of the cure mostly depends of the “hospital management meaning the doctors’ experience and the pluming and technical installations (modern machines able to mathematically control in short time the water temperature and pressure)”

Convinced of the medical effect and importance of hydrotherapy, George Baiulescu sustained in 1904 that „hydrotherapy is recognized today from the majority of physicians as an excellent “medication” not only in chronically diseases but in acute pathology, too, especially in typhus fever”. „The patients won a strong confidence in watery therapy beyond doubt. The proof is the high addressability of patients in all hospitals appropriate equipped with good techniques, plumbing and a run with good management”. “Still, there are many reasons that hydrotherapy is not enough valued, known and practiced”. Baiulescu explained that the procedures are not enough known because hydrotherapy was practiced for many centuries by false “therapists” being completely compro-


180

mised, also because “physicians considers hydrotherapic practice as a “humiliation” and not practicing is a vicious circle leading to a deep lack of skills” and because “hydrotherapic techniques are considered as “inconvenience”, not cozy and completely neglected”.

Fig. no 3 Ex libris Dr. Emil I. Bologa Another author’s concerns are that

hydrotherapy “is not included as compulsory into Medical Universities’ curricula and this is the reason why young doctors’ medical education is not complete”. In some universities abroad the students are able to attend courses about the hydrotherapic theory but they cannot have a solid preparation, hold the technique and observe the therapeutic effects of hydrotherapy”

Further, doctor Baiulescu insisted on the mandatory of doctors’ theoretical knowledge to be complete with practical skills on the manner of applying the hydrotherapic techniques.” If the doctor has not enough skills and experience in handling the apparatus and tools used to apply hydrotherapy, he will be fallible and the benefit effects of the applications can be compromised”.

Each doctor should be able to apply all the procedures but if this is not possible is compulsory at least to supervise the applications he prescribed”

Finally, the importance and value of “Medical Hydrotherapy” is non contestable as a very bold publication about a new field

of medical practice, more practical then others and which needed advertising and motivation to be operable.

Even the book received objections from Cr�iniceanu as not being a valuable book as medical literature, the initiative to write a useful book for doctors is remarkable. This book encouraged all doctors to learn and practice hydrotherapy and finally is a proof that the doctors of that time tried to reach above their condition of practitioners, becoming theorists in the same time.

Reference:

[1]. Baiulescu G. - Idroterapia medical�, Minerva, Institutul de Arte grafice, Bucure�ti, 698 de pagini, 1904

[2]. Bologa V.L. – Contribu�ii la istoria medicinii în Ardeal, Tipografia Ardealul, Cluj, 1927

[3]. Bologa V.L. �i colab. – Istoria Medicinii Române�ti, Ed. Medical�, Bucure�ti, 1970,

[4]. Br�tescu Gh. – Dic�ionar cronologic de medicin� �i farmacie, Ed. �tiin�ific� �i enciclopedic�, Bucure�ti, 1975

[5]. Huttmann A., Barbu G. – Medicina în ora�ul Bra�ov ieri �i ast�zi, Ed. Medical�, Bucure�ti, 1959, 162 p.

[6]. Ivan N., Cr�ciun I., Lotreanu C. – Istoria Medicinei, Ed. Universit��ii Lucian Blaga din Sibiu, 1998

[7]. Izsak S. – Aspecte din trecutul medicinii române�ti, Ed. Medical�, Bucure�ti, 1970, 902p.

[8]. Izsak S. – Farmacia de-a lungul secolelor, Ed. �tiin�ific� �i Enciclopedic�, Buc, 1979

[9]. Rogozea Liliana - Farmacognozia în preg�tirea studen�ilor medicini�ti din România, de-a lungul timpului, Ed. Universit��ii Transilvania, 2002

[10]. *** – Gazeta de Transilvania, 1850-

1945.


THE LION’S REPUBLIC FIGHT AGAINST THE PLAGUE ORIGINATING FROM THE

LEVANTE VENETO

G. ZANCHIN1

Abstract: Until its end the Serenissima constantly supported the contagionist hypothesis, playing for all the span of its history the role of pioneer and model for the measures adopted to prevent the diffusion of epidemics. The sanitary preoccupations of the Republic were particularly directed upon people and goods arriving from the territories of the Ottoman Empire from where periodic bouts of plague originated. The examination of the written and iconographic primary sources here considered puts in evidence relevant aspects of the Venetian fight against the plague Key words: Republic of Venice, plague, epidemics, lazaret, quarantine, osella.

1 Department of Neurological Sciences, University of Padua Medical School.

The experience made during the epidemics of the XIVth century contributed to the affirmation of the contagionist hypothesis of which Venice remained vigorous supporter for the entire period of its history [5]

This theory maintained that the cause of the plague, identified with the so called “miasma”, corrupting the air and decom-posing the bodies, could attach from an individual to another, or even adhere itself to clothing or to objects, thereafter passing to whoever touched them.

Accordingly, systematic measures of isolation, such as sanitary cordons, quaran-tine and disinfection were taken [1]

In 1423, the Senate ruled out to assign the monastery of Saint Mary of Nazareth to the isolation of people affected by the plague. This was thus transformed into the

“tainted” pesthouse, to become later the “old” lazaret (Fig. 1), the first institution to be established for this purpose.

In this last case, according to the habitual formula, the location was decreed as “healthy (thanks to God) and free from any doubt of contagious illness”: a “fede di sanità” that is a specific written licence bearing this statement, was released in such a condition by the local sanitary officers.

Otherwise, only when the prescribed period of the quarantine was terminated without evidence of the plague the “libera prattica” (that is free entrance) was granted. Even today in the “new” lazaret are still visible the “graffiti” done mostly during the sixteen century by people kept in isolation for such a long time.


182

Fig. 1. The Old Lazaret “Lazzaretto Vecchio”.

Established into the Venetian lagoon in 1423, it was the first institution to be devoted to the isolation of people affected by plague.

The sanitary preoccupations of the

Republic were particularly directed upon people and goods originating from the territories of the Ottoman Empire, with which Venice maintained commercial ties of utmost relevance and where the plague was constitutive.

On the terrestrial side, at the border between Dalmatia and the Ottoman Empire, a pesthouse at Cattaro was constructed and other pesthouses were built in the Venetian possessions in the “Levante” (the Venetian word for the territories facing the oriental Medite-rranean sea), to control the busy traffic with the Turkish domains, from where periodic bouts of epidemics originated.

The measures of prevention against the importation of the contagion included the disinfection of objects. The treatments varied according to the quality and value of

the merchandise, but from a sanitary standpoint two large groups were distin-guished: “susceptible” and “not susceptible”. Under the name of “susceptible” goods were encompassed those items that were considered to be able to transmit the contagion; to the contrary, “not susceptible” were those incapable of such a transmission.

These included materials that by their nature seemed to retain more easily the “contagious miasma” such as wool, clothes, rags, skins, feathers, rope; whereas, within the first group, were listed (quotation from a XVIth century Venetian document) “all of the lumber, wines, oils, cured and fresh meats, cheeses, metals, jewellery, money”, and further on “animals, without leash and harness, however; except dog, cat, sheep, mutton because these sorts of animals are able to propagate contagion”.

G. ZANCHIN: The Lion’s Republic fight against the plague originating from the Levante Veneto 183

Disinfection of the goods took place with the “sborro”, that is the exposure to air and sun; or with heating, immersion in sea water, spraying with vinegar, “perfu-ming” that is with fumigation which aimed at neutralizing the miasma substituting it with the “fumes” of aromatic woods.

The finding of a manuscript notebook of the end of XVIIIth century of medical content allowed us the examination of an unpublished report contained within, that treats the problem of the propagation of contagion, in relation with the closely attached problem regarding “susceptible” and “not susceptible” goods (Fig. 2). Such a distinction, obviously with reference to the pre-Pasteurian era, possessed remarkable importance. Indeed, in the case a good was classified as susceptible, it became necessary to adopt the above mentioned measures, all of which had noteworthy direct and indirect costs. From the verbatim citations, the author is clearly identifiable as Ignazio Lotti, head physician of the Venetian Magistrate of Maritime Health, known for his endeavours at diffusing the practice of variolization in the domains of the Serenissima Republic [2].

Fig.2. Front cover of De multis rebus et de

quibusdam aliis (1812), unpublished manuscript by Ignazio Lotti, Protomedico del Magistrato di Sanità Marittima di Venezia.

Private collection. A second important document,

preserved in the State Archive of Venice, will be also examined in this context. It is a detailed report by the “Avvocato fiscale”

(Public Attorney) Lorenzo Alugara on the successful containment of the plague which reached the lagoon on an Ottoman ship in 1793 [6].

The way we found it is rather curious. Since the year 1521, the Venetian Doge

used to have coined every year a special silver medal, called “osella”, commemo-rating the most relevant events of the Serenissima Republic [3].

Being interested on the impact of the plague on the Venetian traditions, our research brought us to identify, among the 275 osellas coined until the end of the Venetian State, five occasions in which the coins were referring to the plague [4].

Fig.3. Coined in 1793 under the Doge Ludovico Manin (first), this “osella”

commemorates the successful prevention of plague epidemics in the port of Venice. On the

second, in the forefront we see the Vierge, encircled by the inscription Nec nuper defeci

(Even in this distress I did not abandon you). In the background, the little church identifying the

island of Poveglia is well reconignizable, as well as a ship put in quarantine.


184

This rather unknown iconography appeared indeed as a relevant document of the popular faith, since in most instances a religious symbol-lism is prominent. However, the picture of the last osella “of the plague series” (Fig. 3), struck in 1793, makes a reference not only to the Virgin protection, but also to factual measures of isola-tion, clearly quoting a very interesting episode of a successful fight against the plague, the detailed report of which we were then able to identify in the State Archives of the Republic in Venice.

On a “Tartanella”, a little commercial ship, with Ottoman flag and a crew of thirty people, a case of bubonic plague developed with “petacchie nere, antraci, buboni”.

Strict preventive measure were immediately taken “to stop the infection in the same place” in the Poveglia’s canal, that for this purpose was get rid of any other ship. The crew, put ashore, was divided in affected and in suspect groups, which were held in separate locations. An internal ward of soldiers was established on the island; around it an external circle of armed ships was put. As a whole, internal and external wards were formed by one hundred forty individuals, plus nine ships and two boats. Everything -food, water, garments- that was necessary for the well-being of the crew was brought ashore and continuous fires were kept alive to purify the air from the contagious miasma.

At the end, twenty crew members survived and the plague was successfully contained within the island. The feelings of gratitude for the Republic are well documented by a letter wrote to the Venice health officers by the captain and the

surviving crew. The examination of the above

mentioned primary sources put in evidence relevant aspects of the Venetian fight against the plague. Indeed, until its end the Serenissima constantly supported the contagionist hypothesis as witnessed by the establishment in its lagoon of the first lazaret since 1423, playing for all the span of its history the role of pioneer and model for the measures adopted to prevent the diffusion of epidemics.

References

[1]. Bergdolt K., La peste nera e la fine del medioevo. Edizioni Piemme, Casale Monferrato 1997.

[2]. Lotti I., De multis rebus et de quibusdam aliis. Unpublished manuscript (Private collection) 1812.

[3]. Paolucci R., La zecca di Venezia. Paolucci editore, Padova 1991.

[4]. Zanchin G, Mainardi F, Dainese F, Maggioni F. La pestilenza nelle “oselle”, monetazione celebrativa della Repubblica di Venezia. Atti del XLI Congresso Nazionale della Società Italiana di Storia della Medicina. Mesagne (Br) 2002, p. 145-154.

[5]. Zanchin G. Health and disease in the relationships between Venice and Istanbul. Proceedings of the 38th International Congress on the History of Medicine. Istanbul 2002, p. 285

[6]. Archivio di Stato di Venezia, Provveditori alla Sanità, filza 251.


GUILLAUME-BENJAMIN-AMAND DUCHENNE - BETWEEN MEDICINE AND ART

A. VADANUTA PLOTOGEA1, A. KERESZTES2,

M. MOARCAS1

Abstract: Guillaume-Benjamin-Amand Duchenne was one of the most ingenious minds of the 19th century. By combining physics and a thorough knowledge of medicine, he described several neuromuscular disorders; his work also developed physiology of human facial expression and psychology. Born in 1806 in Boulogne-sur-Mer, he studied medicine in Paris and became a physician in 1831. Duchenne conducted many experiments using electricity as therapeutical and diagnostic tool. In 1850, he published his first results regarding the connection between facial expression and electrical stimulation of muscles. Duchenne studied paralysis and several myopathies. He created a harpoon that could be used to extract sample of muscle tissue and this instrument was a predecessor of modern biopsies. Duchenne wrote three major books summarizing his research: "De l'électrisation localisée", "Mecanisme de la physionomie humaine" and "Physiologie des mouvements". Duchenne died in 1875 without having yet obtained respect of the medical community; later, his reputation arouse evidently. Key words: Duchenne, myopathy, human facial expression.

1 Bra�ov. 2 Faculty of Medicine, Transilvania University of Brasov.

Introduction The eponyme Duchenne is well known

in relation with the most common form of childhood muscular distrophy, even though Duchenne was not the first to describe this disease, but the one to clarify both clinical manifestations and microscopically charac-teristics based on muscular biopsy studies. [5]

Guillaume-Benjamin-Amand Duchenne was a French neurologist of the XIXth century, a pioneer of muscular electro-physiology based on Galvani’s research. Although the father of modern neurology is thought to be Charcot, he truly appreciated Duchenne’s work and called him „my master”.

Duchenne chose „de Boulogne” as a post-nom in order not to be mistaken for

Edouard Adolphe Duchesne (1794-1869) from Paris, a respected doctor of the local salons at the time. [6]

Duchenne’s life Duchenne (1806-1875) was born on the

17th of September 1806, in Boulogne-sur-Mer (Pas-de-Calais, France), the place where his family had lived since the middle of the XVIII century. His father was marine captain during Napoleon Bonaparte’s wars. He was affectively connected to his birth places for his whole life. Both his personality – active, ambi-tious, yet very calm and his accent and his look prove his Boulogne origins. [9] Although his family’s tradition was related to sea and his father had hoped Duchenne


186

would follow his steps, love for science was stronger.

Duchenne went to local school, than to highschool in Douai and he was 19 years old when he got his Bachelor diploma, along with his colleague and firned dr. C. Gros. Next, he tudied Medicine at Paris which he graduated in 1831, with a licence thesis about burns called „Essai sur la brillure”, having probably been influenced in choosing the theme by Dupuytren.

As a doctor, he returned to his birth city where he activated as a general practitioner for 10 years. He got married in 1831, but, after about 2 years, his wife died of puer-peral sepsis. Duchenne’s mother in law spread many rumours regarding the fact that, as a sole witness of his wife’s labor, he was responsible for her death; this lead to the separation of his only son.[12]

In 1833, along with dr Gors, Duchenne made the first experiments of electro-puncture, a new technique, invented by Magendie and Saralndiere. Thus was the beggining of his neuroelectrophysiology research. In 1842, Duchenne moved to Paris for research that could not be done in Boulogne. He was viewed reticently and he never received an academic post; at first, he worked in charity hospitals and earned his existence from private practice. He worked for more than 30 years; daily visiting hospitals form Paris in the quest of particular cases he could research, devoting his entire life and passion to medicine and his patients. Lonely spirit, he showed an admirable ambition, in spite of the fact that his merits were appreciated only after death. Duchenne died in the 15th of September 1875, 2 days before his 69th anniversary, following a cerebral haemorrhage.

Duchenne’s activity and work More than his fellow clinicians of the

time, Duchenne emphasized the importance of neurology examination and electrophysiological studies.

Along the description of diseases named after him, Duchenne also contributed to differentiation of facial nerve paralysis caused by central and peripheral neuron; he described the cog wheel sign in Parkinson disease, the characteristics of Lead intoxi-cations and the epigastric respiratory depression of frenic paralysis is called Duchenne sign. [12]

In „De l'électrisation localisée et de son application à la physiologie, à la patho-logie et à la thérapeutique” published in 1955, Duchenne describes the advantages and disadvantages of static and dinamic electric power use in therapy and diagnosis. He presents the influence of electricity on skin and the relationship between intensity and other characteristics of electricity and penetrability in order to obtain a biological effect – muscular contraction and resistance of living structures to electricity, for example. In the same book, there is described also the machine built by Duchenne for nerve and muscle stimulation. There are presented the indications of faradisation, the treatment technique using electricity: profound coetaneous anaesthesia of hands or feet, the method seamed to be the only way to obtain sensation of various degrees, depen-ding on the electrodes and the particularities of the subject; also, electrical stimulation determines focal contraction of the muscles of the face. Duchenne believed there was no other therapeutically agent as efficient as faradisation. The use of the method in various types of muscular dystrophies, atrophies and paralysis are described. Faradisation using wet electrodes was proven to be effective in preventing tisular necrosis. [2]

Using faradisation as a diagnostic tool, with emphasis on contractility, Duchenne discovered the aetiology of poliomyelitis, suggesting that the lesion was in the spinal cord. [8]

A.V.Plotogea et al.: Guillaume-Benjamin-Amand Duchenne - between medicine and art

187

One of Duchenne’s innovations that brought precision to diagnosis of muscular diseases was a harpoon that allowed the percutaneous prelevation of muscle tissue. The instrument is thought to be a predecessor of modern biopsy. Duchenne used it for the diagnosis of progressive muscular atrophy and pseudohypertrophic paralysis that is nowadays named after him. [8]

Duchenne was the first to describe syphilitic ataxia and chronic progressive bulbar paralysis.

In spite of the fact that pseudohypertro-phic paralysis of childhood is Duchenne’s myopathy nowadays, he was not the firstt o describe it, the controversy between him and Meryon being well known. Duchenne prefer not to read the new scientific discoveries in order not to be influenced by them. [1] Edward had described the condition ever since 1851, mentioning the male predominance, the necrotic aspect of granular degradation. According to Gowers, the first to describe the disease was Charles Bell, in 1831. [7]

Duchenne described the pesudohypertro-phic paralysis in 1868, using also his harpoon for the studies Duchenne charac-terises the muscle weakness that first appears in the lower limbs and lumbar region, followed by progression to upper limbs, the increase in muscle mass due to dvelopment of interstitial connective tissue and overpor-duction of fibroses and adipose tissue in mo-re advanced stages. He thought that the term myo-sclerotic paralysis was more appropiate based on histopathologic aspect. [10]

His first studies about muscular dystrophies date from 1850. In 1849, based on his research, François Amilcar Aran presented a case of progressive muscular atrophy that began in the hands and forearms and arms. In 1870, Duchenne published the description of the aforementioned condition, mentioning the vermicular fibrilar movements of limbs and the fact that the upper limbs were more

affected in a northerly fashion. The characteristic positions of hands were also reported: if the abductor policis was affected, the first metacarpal muscle is closer to the second than it is normally; whereas, if the interossei muscles are affected the claw hand appears. The muscles of the lower limbs are later and inconstantly affected and control of sphincters is preserved. Duchenne empha-sized that the contractility is normal, based on electrophysiological studies. Histopa-thological studies revealed the loss of muscle fibers striations due to replacement with granular material and adypocites. [8]

One of Duchenne;s masterpieces is „Mecanisme de la physionomie Humaine” published in 1862. The book combines contraction electrophysiology studies, photography and the study of human reactions and emotions. He was influenced by physiognomy, a conception that the personality and emotions externalize as physical characteristics, especially of the face. Moreover, he thought of the face as a map of spiritual feeling, that divinity had not created face muscles only for mechanical purposes.

By isolated, followed by combined muscle stimulation, he described the role of each muscle of the face: the frontal muscle is for attention, the superior part of orbicularis is for reflection, the great zygomaticus is for joy. The description of Duchenne’s smile remains classical – there can be differentiated a fake from a sincere smile, as the second involves both the contraction of great zygomaticus and inferior part of orbicularis, while the first is the simple contraction of the great zygomaticus. [3]

In his studies, Duchenne used subjects that suffer form a minor mental retard. The most famous one is an old man who suffered from near complete facial anaesthesia that was useful for Duchenne, because the electrodes determine an unpleasant feeling in a person with intact facial sensibility.


188

Duchenne believed that the reactions of his subjects were common to any individual. In this work, there are also photographs he did in cooperation with Adrien Tournachon. Some of the photographs are compared to classical art masterpiece to show how art does not always reflect the true feelings. (Fig. 1) One of the critics of his time reproached him that he takes away from art its idealism, reducing it to an anatomical realism. [11]

Fig 1. – Stimulation of eye lids, mandibula and frontal reion simulate terror. [11]

Conclusions Duchenne remains a remarkable figure

of neurology, which he inovated both as diagnosis and therapy. As an open minded brilliant researcher, he had his work recognized only after death, but nowaday, he is considered one of the greatest minds of the XIX century. He was a complex personality, deoting his mind to medicine, but also art, technique and photography.

References

[1]. Bach, J. R., The Duchenne de Boulogne-Meryon Controversy and Pseudohypertrophic Muscular Dystro-phy, Journal of the History of Medicine and Allied Sciences, Oxford University Press, Oxford, Volum 55, Numarul 2, 2000, pag. 158-178

[2]. Duchenne, G., De l'électrisation localisée et de son application à la physiologie, à la pathologie et à la thérapeutique: et de son application a la physiologie, a la pathologie et a la thérapeutique, Chez J.-B. Baillière, Paris, 1855, pag 5-35

[3]. Duchenne, G. B., Cuthbertson, A., The mechanism of human facial expre-ssion, Cambridge University Press, Cambridge, 1990, pag 129-226

[4]. Eisen, A, Shaw, P., Aminoff, M. J., Motor neuron disorders and related diseases, Elsevier Health Sciences, New York, 2007, pag 8

[5]. Jay, V, On a Historical Note: Duchenne of Boulogne, Pediatric and Developmental Pathology, Springer New York, nr. 3, 1998, pag 254–255

[6]. Koehler, P. J., Bruyn, G., Pearce, J., Neurological eponyms, Oxford Univer-sity Press, New York, 2000, pag 301

[7]. Pearce, J.M.S., Early Observations on Duchenne-Meryon Muscular Dystro-phy, Eur Neurol, Karger Publishers, Basel, Numarul 54, 2005, pag 46–48

[8]. Pearce, J. M. S., Some contributions of Duchenne de Boulogne, Journal of Neurology, Neurosurgery, and Psychiatry, BMJ Publishing Group, Londra, 1999; nr. 67, pag 322

[9]. Poore, G.V., Selections from the clinical works of Dr. Duchenne de Boulogne, The New Sydenham Society, London, 1884, pag 95.

[10]. 10.Reincke, H., Nelson, K. R., Duchenne de boulogne: Electro-diagnosis of poliomyelitis, Muscle & Nerve, Wiley Interscience, Oxford, Volum 13, 2004, Pages 56 – 62

[11]. 11.Warner Marien, M., Photography: A Cultural History, Laurence King Publishing, Londra, 2006, pag 148-149

[12]. 12. Williams, M., Geryatric physical diagnosis: a guide to observation and assessment, McFarland, Jefferson, 2007, pag 147

.

Bulletin of the Transilvania University of Brasov • Vol. 2 (51) - 2009 Series 6: Medical Sciences Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

DISEASE AND DEATH IN THE WORK OF EUGENE IONESCO

A-J. FABRE 1

Abstract: Ten years after his death, Eugen Ionesco is still the most celebrated playwright in France. In most great pieces of art, comedy and tragedy live side by side, and this confirmed in Exit the King, written while Ionesco was ill and frightened of death The play holds a narrow link between comedy and tragedy : disease is seen by Ionesco as a disgrace to the intrinsic existence, medicine as burlesque distraction in the fate of human beings and physicians as grotesque personages anxious to assert their authority on patients. The Théatre de l'Absurde had a deep impact in France but very powerful links have always existed in French cultural life between France and Romania, among many other examples : Stephane Lupasco, Tristan Tzara, Emil Cioran, Paul Celan and Martha Lahovary, better known as Princess Bibesco Key words: Ionesco, Exit the King, Romania, Theatre of Absurd

1 International Société for Hstory of Medicine, France

Ten years after his death, Eugen Ionesco is still the most celebrated playwright in France.

His life was shared between France and Romania : Ionesco was born in 1909 in Slatina near Bucharest, but, soon after, was brought by his family to Paris but, in 1922 Ionesco returned to Romania together with his sister. There; he learnt Romanian and attended the college Sfântul Sava in Bucharest and passed the baccalaureate at the secondary school in Craiova in 1928.

In 1938, Ionesco comes back to Paris after having obtained a state grant to write a thesis (which he never finished…) on "Topics of sin and topics of death in French poetry since Baudelaire". However, when the 2nd World War was declared, he decided to return home to work there as French teacher at Sfântul Sava.

Now the situation in Romania was so bad that Ionesco, in May 1942 , had no other choice than return to France with his wife Rodica Burileanu.

A long difficult period began for Ionesco until the fifties and the premiere of his play, "The Bald Soprano" still performed at the Théatre de la Huchette in Paris : the 15000th representation was recently celebrated !

Ionesco gained gradually fame in the sixties as founder of the Theatre of Absurd, capturing, alongside Samuel Beckett, Jean Genet, and Arthur Adamov, all the meaninglessness of existence.

Celebrated everywhere in the world, Ionesco, suffering since long time of a severe form of diabetes, died in Paris in 1994

In most great pieces of art, comedy and tragedy live side by side, and this is the case with Eugene Ionesco’s Exit the King,


190

the most emblematic play of Ionesco created by Jacques Mauclair in 1962 at the Théatre de l'Alliance in Paris.

In the play, a parodic patriarch is ruling over less than a thousand prematurely-aged subjects : now he feels that death will come soon and howls against his fate, moving from denial to terror towards a final, moving, acceptance

Around the King, two rival queens, Marie who tries to make Berenger face the reality of his impending death and the sweet Marguerite, attempting to keep the King from knowing that end is imminent.

There is also a domestic help, Juliette, the wide-eyed servant, a Guard always prone to commemorate the Past and the Doctor, central symbol of authority proclaimed: both executioner physician, astrologer and bacteriologist

Ionesco in this play views medicine as mere distraction to help humans forget their fate, disease as a disgrace to intrinsic existence and physicians as grotesque personages only anxious to assert full authority on their patients.

References

1. Béhar H.: Le théâtre dada et surréaliste. Gallimard, Paris, 1979

2. Bonnefoy Cl.. "Entretiens avec Eugène Ionesco". "Entre la vie et la rêve". Pierre Belfond. Gallimard, Paris, 1966.

3. Cleynen-Serghiev E.: La jeunesse littéraire d'Eugène Ionesco. Paris : Presses universitaires de France, 1993

4. sselin M.. The Théâtre of the absurde. Doubleday, New York. 1961

5. Hamdan A.. Ionescu avant Ionesco : portrait de l'artiste en jeune homme. P. Lang, Berne, 1993

6. Ionesco E.. Littérature roumaine suivi de Grosse chaleur. Fata Morgana, Saint-Clément-la-Rivière, 1998

7. Ionescu G.. Les Débuts littéraires roumains d'Eugène Ionesco. 1926-1940. C. Winter, Heidelberg, 1989

8. Jacquart E.. Le théâtre de dérision. Gallimard, Paris, 1974

9. Plazy G.. Eugène Ionesco : le rire et l'espérance : une biographie. Julliard, Paris, 1994

10. Stolojan S.. Au balcon de l'exil roumain à Paris : avec Cioran. Eugène Ionesco. Mircea Eliade. Vintila Horia l'Harmattan, Paris Montréal (Québec) 1999

CCOONNTTEENNTT

Erdemir, A.D.: Laws on Medical Ethics in Turkey from the Past to Nowadays and

Comments............................................................................................................................... 5

Bogdan, C.: Historic Highlights and Perspectives of Bioethics in Romania ....................... .9

Rogozea, L.; Leasu, F.; Nedelcu, L.; Bălescu, A.; Nemet, C.; Marcu, N.: Three

Personalities of Medicine – Representative for Medical Ethics within

Romania ...................................................................................................................... 15

Yaprak, M.; Gökçe, N.: One Writing from ðbrahim Temo about Thermal

Springs of Bursa and Romania ................................................................................... 21

Lucasciuc, A.; Suliman, M.-G.; Elefteriu, O.; Grecu, C.: The Greek Pharmacist

Gherasimos Zervos (1842-1901) and his Successors, the Zervos

Physicians from Romania ........................................................................................... 25

Lucasciuc, A.; Suliman, M.-G.; Elefteriu, O.; Grecu, C.: Greek Physicians and

Pharmacists Graduated in Athens Practicing in Romania ........................................ 29

Besciu, M.: The Byzantine Physicians .................................................................................. 33

Baran, D.: Greek Physicians and Medical Emancipation of the Romanian Lands............... 39

Diaconescu, D.; Toma, S.; Diaconescu, R.-S.: The Importance of Studying

Greek Philosophers and Physicians (5th – 3rd Century B.C.):

Contribution to the Development of Neuroscience in Medical Schools ..................... 47

Tartau, L.; Lupusoru, R.V.; Lupusoru, C. E.; Andritoiu, C.; Duma, O.: Doctor-

Patient Relationship in Neuropathic Pain: A Comparative Study between

Urban and Rural Zone................................................................................................ 53

Rogozea, L.; Dragoman, M.; F. Leasu, F.; łurcanu, M.; R. Miclăus, R.; Cardis,

M.: A Reference Analysis about the Human Soul ....................................................... 59

Erdemir, A.D.; Erer, S.: Prof. Dr. Hulusi Behcet (A Famous Turkish Physician)

(1889-1948) and his Book on Cutaneous Leishmaniasis (Oriental Sore) ................. 67

Bakir, B.; Basağaoğlu, I.: The Effects of the Medical Functions on Architecture

in Süleymaniye Dar’us Sifa of the Ottoman Dar’us Sifas .......................................... 71

Gökçe, N.; Yaprak, M.: Summary of the History of the Thrace Fighting Malaria

Organization ............................................................................................................... 81

Albou, P.: Ambroise Paré’s Broken Left Leg in 1555........................................................... 85

Vasylyev, Y.K.: Significance of Physicians’ Society in Odessa in Generation

and Formation of Phagocytal (I.I. Mechnikov’s) Theory (Dedicated to

Centenary of I.I. Mechnikov’s Nobel Prise Awarding)............................................... 89

Atici, E.; Atici, T.: Milestones Physicians and their Contributions in Turkish

Orthopedics and Traumatology .................................................................................. 93

Fulga, M.; Andreescu, V.; Lupulescu, D.: Silicosis Disease History in

Exploitation of Coal in Jiu Valley............................................................................... 101

Găbrean, S.: Some Contributions of Romanian Medical School in the Treatment

of Neurosyphilis before the Discovery of Antibiotics ................................................. 105

Musajo Somma, A.; Musajo Somma, L.: Lazzaro Spallanzani, in Transylvania

Drive ........................................................................................................................... 109

Tricot, J.P.: Victor Gomoiu and the Cantacuzène-Commission ........................................... 115

Bulletin of the Transilvania University of Brasov • Vol. 6 (51) – 2009 • Series VI

Muresan, O.; Safta, L.: Medical and Toxicological Aspects in Arthur Conan

Doyle’s Writings ........................................................................................................ 121

Ertin, H.; Usmanbas, O.; Basagaoglu, I.: Ord. Prof. Dr. Cemil Topuzlu (1866-

1958) and his Contributions to Turkish Surgery ........................................................ 125

Awojoodu, O.; Baran, D.: Traditional Yoruba Medicine in Nigeria: A

Comparative Approach............................................................................................... 129

Baran, D.: Dr. Victor Gomoiu, Balkan Paradigms and Lessons of a Lifetime .................... 137

Balescu, A.; Nedelcu, L.: The Aspirin – The First Drug Obtained by Sinthesys –

Frequently Used Currently ......................................................................................... 145

Diamandopoulos , A.: Hippocrates’ Memories of Scythia: Stories and

Fairytales ................................................................................................................... 149

Brodel, E.G.; Ionescu, C.: One of the First Articles about the Romanian Ethno

Naturopathy Published in a Western Science Paper Was Written by

Colonel Dr. Jakob Von Czihak and Dr. Iosef Szabo 157

Neica, L.; Aldulea, N.: Ana Aslan, the Woman who Defeated Time..................................... 161

Sangeorzan, L.: Historical aspects of Computer Science in the Emergency

Room in Transilvania University of Brasov - A Study Case - .................................... 167

Repanovici, A.; Rogozea, L.; Miclăus, R.: Analysis of the impact of History of

Medicine’s Publications ............................................................................................ 173

Miclăus, R.; Rogozea, L.; Sechel, G.; Fleancu, A.; Cristea, L.; Baritz, M.:

„Medical Hydrotherapy” of George Baiulescu – an Historical

Perspective ................................................................................................................. 177

Zanchin, G.: The Lion’s Republic Fight against the Plague Originating from the

Levante Veneto............................................................................................................ 181

Vadanuta-Plotogea, A.; Keresztes, A.; Moarcas, M.: Guillaume-Benjamin-

Amand Duchenne - between Medicine and Art........................................................... 185

Fabre, A-J. : Disease and Death in the Work of Eugene Ionesco ......................................... 189

BULLETIN OF THETRANSILVANIA UNIVERSITY

OF BRASOV

Vol. 2 (51) – 2009Series VI

Series VI: Medical Sciences

– SUPPLEMENT –

PROCEEDING OF THE IVTH BALKAN CONGRESS OF

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