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BULLETIN OF THE

TRANSILVANIA UNIVERSITY
OF BRASOV

Vol. 2 (51) – 2009


Series VI

Series VI: Medical Sciences

– SUPPLEMENT –

PROCEEDING OF THE IVTH BALKAN


CONGRESS OF
HISTORY OF MEDICINE

ISSN 2065-2224
TRANSILVANIA UNIVERSITY OF BRAŞOV

BULLETIN
OF THE
TRANSILVANIA UNIVERSITY
OF
BRAŞOV

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

Published by
Transilvania University Press
Braşov, Romania
2009
Bulletin of the Transilvania University of Braşov. Series VI: Medical Sciences. Vol. 2 (51), 2009.
ISSN 2065-2216 printed version;
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continues

Bulletin of the Transilvania University of Braşov. Series VI: Medical Sciences. Vol. 1 (50), 2008.
ISSN 2065-2216 printed version;
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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: rector@unitbv.ro

© 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 - Pascu Alina,
- Nicolae Marcu - Miclăuş Roxana,
- Mariana Rădoi - Gabriela Sechel
- Teodor Leaşu, - Andreea Fleancu
- Gabriel Moraru, - Adela Bădău,
- Botezatu Maria - Gabriela Mailat,
- Curesciuc Cerasela - Mioara Georgescu,
- Manolachescu Doina - Bălescu Alexandru,
- Dorina Popa - Sanda Hondor,
- Leaşu Florin, - Ana Ionescu,
- Corina Derczeni, - Crisitina Egri,
- Adrian Rotaru, - Tatiana Oglindă,
- Geta Miron, - Mihaela Cardiş,
- Nemet Codruţa, - Godri Dora
- Mihai Ţurcanu,

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 Braov • 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

Ayegül 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. Introduction Shamanism, which was a polytheist


In the world of Turks, remarkable totemic religion of nature. In it, the sky,
developments have always taken place in sun, moon, stars, earth and animals were
terms of physician responsibilities and all holy beings believed to have spirits and
duties and there are many archive materials angels in them and Turks kept a deep kind
on it. This study gives examples from such of mysticism in their souls.
materials and makes some comments. Ottoman physicians held onto
Islamic traditions too. For long years,
2. Historical context medical training was given by masters to
Before Islam, Turks followed medical students. Therefore, the loopholes

1
Department of Medical History and Ethics, Faculty of Medicine, Uludag University, Bursa/TURKEY.
6 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

in the Islamic law were tried to be closed all closed. Some medical manuscripts
and an alternative code of laws based on dated the 18th century and the Ottoman
local traditions was developed. The Archives of the Prime Ministry talk about
statutes like those of Fatih Sultan Mehmed, physician responsibilities. In his “Ra’is al
Kanuni Sultan Süleyman and Mehmed IV Cerrahin” written in 1720, Cerrah Mes’ud
closed some of the loopholes in the Islamic Efendi reports that good physicians are
penal law. The sanctions on physicians compassionate, good-humored and kind
were imposed by the edicts of the sultans people who do their best to help other
and mandates of the head physicians until people. In 1704 when Ahmed III was the
the 19th century. In all the decisions taken sultan and Nuh bin Abdülmennan the head
during that period, the emphasis was on the physician, the decision was taken that
fact that physicians could not be held ignorant and unqualified physicians were
responsible for any medical situation to be prohibited from practicing the
unless the consent of patients was profession. In a judgment dated 1729, it is
obtained. written that medical practice was to be
learned from master physicians in an
3. Aspects of medical ethics in XVIth informal training process and a diploma
Century given after passing some particular
The Ottoman Turkish physicians examinations was needed to become a
of the 16th century kept dealing with physician.
physician responsibilities in their books. In
a document dated 1573, it is mentioned 5. Aspects of medical ethics in XIXth
that the head physician Garaseddinzâde Century
Muhiddin wants to prevent ignorant people Some documents dated the early
from practicing medicine and those who 19th century give information about the
want to do it need to take examinations to understanding of physician responsibilities.
be awarded a diploma. A document from A Prime Ministry Archives material dated
the Religious Court Records of the city of 1848 reports that the head physicians and
Ayıntap (Gaziantep) is dated 1540 and it physicians of Ayıntab (Gaziantep), Birecik
talks about the removal of stones clogging and Haleb hospitals were all dismissed
up the urinary system. For such operations, from their posts because of unacceptable
the permission of patients and the religious behavior. A document dated 1849 is about
court was needed and surgeons were paid a some new regulations designed to impose
certain amount of money. Physicians could that physicians should treat poor patients
be sued when patients who gave their for free.
consent died during or after operations. Another one dated 1890 is about
the investigation launched into the wrong
4. Aspects of medical ethics in XVII- treatment given by Cerrah Malik Efendi at
XVIIIth Century Gümüsuyu Hospital. In the Ottoman
In the 17th century, physicians and Empire, patients’ consent was obtained
surgeons having informal training from before giving any treatment. It is written in
masters were allowed to practice medicine a document dated 1899 that some of the
only after taking some examinations and wounded soldiers at Yıldız Hospital were
proving that they have perfected their to be operated on after obtaining their
crafts. This was the same in the 18th written consent.
century and the offices and consulting Before the foundation of the
rooms of the unauthorized physicians were 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 in 1838, and then the period of faculty
1788 is a written copy of a final court began. So, some modern laws were passed
decision and aims to inform the provinces about the responsibility of the physician.
that the physicians and pharmacists in For example Karantina Talimatnamesi
Istanbul were prohibited from prescribing (Quarantine Agreement) in 1838, Tababet-
for abortion. There are also some 19th i Belediye Nizamnamesi (Agreement of
century documents about abortion. One of Medicine of Municipality) in 1861
them dated 1826 talks about a midwife mentioned the responsibility of physicians.
known as “the bloody midwife” to be Articles 192 and 193 of Ceza Kanunname-i
punished for prescribing abortive drugs. Humayunu (Penal Law) in 1857 mentioned
Another document dated 1828 says that the punishments for abortion. Article 215
women should never be prescribed of this code had the responsibilities about
abortive drugs. A document dated 1838 is the revealing of medical secrets .Moreover,
about the announcement of the decision according article 182, if a patient died
which banned abortion. The 193rd article because of his physician’s negligence that
of the Imperial Penal Law dated 1857 says was punished.
that people who cause or help abortion are
to be sentenced to imprisonment between 6 6. Aspects of medical ethics in XXth
months and 2 years. The Ottoman Century
Archives of the Prime Ministry show that Today, if a doctor causes death of a
there were also some physicians who wrote patient because of a technical mistake he is
misleading reports. A document dated punished with prison sentence according to
1900 says that the Mayor Adbullahim the article 456 of the Turkish Penal Code.
Efendi, who was a lecturer in the Mekteb-i The Agreement of Patient’s Rights
Fünun Medical School then, wrote a with the date of 1998, 1 August and with
misleading report. the number of 23420 contains the subjects
As it is the way today, the such as justice, the choosing of of founda-
physicians of those times had to be careful tion of health, informed consent, fidelity,
about what they wrote in their reports of confidentiality, privacy, veracity, the refu-
any type and abide by all the medical se of the treatment, the suing of the patient.
ethics rules. They always tried to adhere to
Moreover, Turkish Law of Patients’
the principles of privacy, loyalty, honesty
Rights, the informed consent of persons is
and not harming patients.
necessary in all of the medical practices.
Afterwards, the responsibility of
The law about population planning
the physician showed a modern
dated 1965 and numbered 557 was chan-
characteristic and some modern laws came
ged. It was issued on 12.06.1967 a popula-
into force. Penal Code and Civil Law had
tion planning regulation and a bylaw about
some articles about this theme.
pregnancy termination and sterilization.
The medical education in Turkey
The law about population planning dated
showed three periods. These are the
1983 and numbered 2827 is a modernized
periods of medrese, high school and
version of the law issued in 1965.
faculty. The period of high school began
According to the Turkish Law of
with the foundation of Tıphane and
Family Planning with the date of 1983,
Cerrahhane-i Amire (Medical and Surgical
curettage can be applied up to the 10th
School) on the 14th March, 1827, and it
week with the desire of woman. Birth
continued until the foundation of Mekteb-i
control drugs and apparatus can be used
Tıbbiye-i Adliye-i ahane in Galatasaray
with the prescription of physician.
8 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

As there was not an administrative (Family Planning Code): 2827. Date:


law concerning organ transplantation in 25.5.1983 Resmi Gazete No: 18059
Turkey before 1979, many operations were (27.5.1983).
not possible to perform and physicians did 6) Ottoman Archives Cevdet, Sıhhiye
not have much to do to save lives. The law Book. Date: 1729
numbered 2238 and dated 29.5.1979 on 7) Ottoman Archives, A.MKT.MHM.
transplanting and keeping organs and Dosya No: 50 Gömlek No: 42, Date
tissues allowed the operations and relieved 1853.
physicians of many hesitations. 8) Ottoman Archives, Cevdet, Sıhhiye
If a person allows it in his will No: 1026, Date: 1788.
orally and/or verbally, organ trans- 9) Ottoman Archives, Cevdet, Sıhhiye
plantation can be made from his body after No: 1790, Date: 1838.
he dies. Even if this is not mentioned in the 10) Ottoman Archives, Sadaret Evrakı
will, the law suggests that the closest Mektubi Mühimme Dosya No: 9,
relatives can permit transplantation from Gömlek: 63, Date:1849 .
the dead body. 11) Ottoman Archives, Y.PRK.ASK.
According to the 14th article of the Dosya No: 240 Gömlek no: 40, Date:
law, an organ of a person who dies with 1909.
enormous damages in an accident or 12) Ottoman Archives, Y.PRK.SH. Dosya
natural disaster can be given to an urgently No: 68 Gömlek No: 68, Date Date:
needing patient not considering the will or 1891.
consent in any way. 13) Ottoman Archives, Y.PRK.SH. Dosya
No: 7 Gömlek No: 13, 1900.
7. Conclusion 14) Ottoman Archives. Cevdet, Sıhhiye
Moreover, some agreement drafts Book, No.1128, Date: 1848.
are present in Turkey. One of them is 15) Ottoman Archives: Cevdet, Sıhhiye
Rules on Ethics of Medical Profession. It Defteri, No.566, Date :1828
was accepted by Turkish Medical 16) Resmi Gazete: No. 16655, 3.6.1979,
Association. Another law is malpractice Organ ve Doku Saklanması ve Nakli
law. In near future, it will be passed. Hakkında Kanun (Organ and Tissue
Transplantation Law): No. 2238,
BIBLIOGRAPHY 29.5.1979.
17) Sehsuvaroglu B. N., Demirhan A.,
1) Ceza Kanunname- Hümayunu (Penal
Güresever G., Türk Tıp Tarihi
Code). stanbul: Takvimhane-i Amire
(History of Turkish Medicine). Bursa:
Mat; 1857.
Ta Kitabevi; 1984.
2) Ceza Kanunname-i Hümâyunu (Penal
18) Tıbbi Deontoloji Tüzüü (Agreement of
Law): Takvimhane-i Âmire Matbaası,
Turkish Medical Deontology with the
stanbul, 1857, pp.45
Date of 1960) No: 4/12578, Jan 3, 1960.
3) Hasta Hakları Yönetmelii (Patient’s
19) Türk Ceza Kanunu (Turkish Penal
Rights Regulation), Resmi Gazete,
Code). No: 5237, Date: 26.09.2004.
No.23420, 1998, p.67.
20) Ucok, C., Osmanlı Kanunnamelerinde
4) Kahya, E., Demirhan, E. A.: Medical
slam Ceza Kanununa Aykırı Hükümler,
Studies and Institutions in the Ottoman
Ottoman Law Books, A.Ü. Hukuk Fak.
Empire, Ankara, 2008.
Mec., 1946; 3: 124-46.
5) Nüfus Planlaması Hakkında Kanun
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

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.

Bioethics is a relatively young disci- focused on biologics and has gradually


pline and science, its act of birth dating developed and diversified, along with the
from 4 decades ago, at the same time with scientific advancement in bio-medicine
the launch of its concept and name by research and biotechnologies and their
American biochemist dr. Van Renssalaer applications’ development.
Potter at the beginning of the 70s. [2] In Romania, even if there were some
Bioethics was born out of ethics, has physicians, researchers and lawyers’

1
Bucharest University
10 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

opinions regarding bioethics before the that the scope of bioethics is to frame the
1989’s political changes, only after that scientific and technological progress in a
date there were possible open debates, the ethic reflection that is having the roots in
set up of a movement, the appearance of the cultural, juridical, philosophical and
governmental and non-governmental religious background of diverse human
bodies, as a result of gaining the right to communities.
free speech and express thoughts, right to From other perspective, bioethics,
be informed, freedom of association [4]. beyond life and death and existential limits
Regarding the historic of bioethics, of human life, provide answers to any of
concerns can be identified even since science and technique’s real challenges
Antiquity, that are to be found in the under the form of new developments. [3].
religious concepts, philosophical necessity, Bioethics is seen by other specialists
regulations and laws during time, medical and as the moral’s answer to the reality of
practice codes. Towards the end of 19th a science that evolves quicker than the
Century some attends to conceptualize a human being as regards its capacity of
kind of bioethics were made, but bioethics, understanding, reaction and adaptation.
in its actual modern meaning is a recent Bioethics becomes a source of law that
concept, as I mentioned before, established is no more than a minimum of moral.
in the second half of the last century, Bioethics is the reconsideration of
together with genetics and especially classic (medical) ethics beyond a strictly
biotechnologies further developments, the medical perimeter which remains however
term being introduced by dr. Van prevailing.
Renssalaer Potter in the paper “Bioethics: As a conclusions of enumeration
Bridge to the Future” (1971). [2] diverse definitions, we consider that a
There are several definitions, the filed more comprehensive delimitation, more
being complex and in full extension, adjusted to its actual dimensions and
imposed by new scientific developments, mission, suggested also by its name
moral’s adjusted answers and the right to “bioethics” could take into account the
the “cascading” challenges of science and term of “ethics of life”, because nowadays
research developments. bioethics covers not only health field but
One of the said definitions considers also the overall aspects of life, based on
bioethics which, based on using an principles such as respect of life, auto-
interdisciplinary methodology, has as determination, universality, equality,
object the systemic exam of human justice and equity, utilitarianism, fact that
behaviour in the field of life sciences and indicates its extension in social and
health, analyzed in the light of moral’s political areas – inter-human relationships,
values and principles. non-discrimination, relation with environ-
Other more concise definition, but mental, nature, the need for building up of
complete at the same time, was introduced a bridge balance between the progress of
by dr. Constantin Maximilian, the great science and human rights; in other words,
geneticist and one of the pioneers of the all the developments of science must be
revival of bioethics in Romania after 1990, directed only for the common good of
in its modern, international concept: humanity. The great thinker and moralist
“bioethics is the meeting point of all who Montaigne properly stated: “science
follow human destiny subject to science without conscience is the ruin of soul” and
pressure”. [4] physician and humanist Albert Schweitzer
UNESCO’s General Director considers 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 National Committee for Bioethics (Comitet
the happiness of mankind. Naional Român de Bioetic), that was
Therefore, along with the 1990 change affiliated, based on the same above-
of politic regime and afterwards through mentioned reasons, to Romania’s National
our country’s accession to European Commission for UNESCO (“Comisia
structures (Council of Europe, European Naional pentru UNESCO a României”).
Union), bioethics, together with other left Moreover, the major involvement of
behind fields, wished to recover in the UNESCO in bioethics, beginning with the
shortest possible period of time, all the ‘90s, bioethics being constantly included in
existing gaps between us and “free” and its agenda, with two subordinated
developed countries. specialised entities and an ample program
The first 4-5 years after 1990 had been of activities, i.e. International Committe
necessary for the organisation, gathering of for Bioethics (Comitetul International
information regarding other countries’ pentru Bioetica - CIB) and Inter-
related experience, debates, collecting of governmental Committee for Bioethics
related data and comments, the adjusted (Comitetul Interguvernamental pentru
implementation of international specialised Bioetica - CIGB). [3]
institutions’ recommendations launched It’s worth mentioning here that these
during diverse discussions forums. patronages did not affect in any way the
A first institutional structure that independent character of the committee, on
appeared soon after 1990 was Romanian the contrary they increased its power and
Commission for Bioethics (Comisia de efficiency; our relationship with CIB and
Bioetic a României), affiliated to CIGB was a privileged one and a very
Academy of Medical Sciences; this stimulating one for the activities of the
“parrainage” had two reasons: on one hand committee.
the high patronage of a official and Also, we would like to mention that the
prestigious institution with authority in initiative for the creation of a organised
bio-medicine and research was needed in movement in bioethics belonged to
order to affirm itself and be known, and, physicians!
on the other hand, the initiative came from If bioethics means also control,
two distinguished figures of medicine and monitoring and arbitrage- a judge of the
medical scientific research – academician evolution of science and practice in
dr. tefan-Marius Milcu, professor of biomedicine - then this control started from
Endocrinology and academician dr. inside; in general, in other countries, the
Constantin Maximilian, professor of lawyers, to which in some cases the
Medical Genetics, signer of The Oviedo theologians rallied too, had been the ones
Convention for Human Rights and Bio- that initiated movements and associations,
medicine in April 4, 1997. I personally had attracting also obviously physicians and
the great honour of being invited to take researchers.
part in the Commission, being entrusted, However, we should state also that
based on my expertise and previous neither a confiscation nor a domination of
research, the following issues: ethical and bioethics by physicians does not constitute
social responsibility in health, end of life’s a benefit for the further development of
bioethics aspects, protection of vulnerable bioethics, due to the risk of a lack of an
persons’ rights and dignity. [4] objective approach from outside of it and
This first bioethics institution was the also due to the risk of an attempt to defend
predecessor of the current Romanian certain practice of minimize the effects.
12 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Therefore, through the decision of - Committee for Bioethics of the


setting up these institutions, currently National College of Physicians (Comitetul
active in our country, a multi-disciplinary pentru Bioetica al Colegiului Naional al
component was intended - bioethics Medicilor), whose members are appointed
experts, researchers, physicians, biologists, by the College’s National Council and that
lawyers, theologians, philosophers, psy- has an advisory role especially regarding
chologists and sociologists and an active the changes in the Etichs Code related to
model of horizontal co-operation between the developments recorded in the medical
all the other bioethics’ formations. bioethics field.
Although, other important thing, with a - National Committee for clinical study
negative impact, that must be specified is on human subjects (Comitetul Naional
the relatively reduced interest of some pentru studiu clinic pe subieci umani)
indispensable specialists category – the affiliated to the Medical Sciences Acade-
lawyers – most of them being focused on my, that works together with the National
other more interesting and profitable areas Agency for Medication (Agenia Naional
– as a consequence of the previous politic pentru Medicament), the latter being the
regime when justice was controlled by the main institution involved in the regulation
state, the law domain being therefore and control of the activity related to
guided and poorly remunerated; other medication and clinical studies on human
explanations are the absence of bioethics subjects.
from the universities’ programs of study - Commission for Bioethics of the
and from the postgraduate specialization Patriarchate (Comitetul de Bioetic al
and, also, the lack of specializations in Patriarhiei), religious body that expresses
bio-law or medical law. We have managed its own position and participates in
to partially rectify this shortcoming by bioethics related debates. [1]
attracting within a partnership specialists There was also a honest initiative of
from Romanian Institute for Human Rights medicine students materialised in mid ’90s
(Institutul Român pentru Drepturile in a body active for a few years, that
Omului); we are benefiting also from the developed a prestigious program of
expertise of physicians that graduated also education and multiple other events:
law universities. The involvement of Medicine Students’ Group for Bioethics –
theologians is also very important – we “Constantin Maximilian” (Grupul de
mention here The Commission for Bioetic al studenilor în medicin
Bioethics of the Patriarchate – then it’s ”Constantin Maximilian”).
worth mentioning the professors of Other notable achievement is the
bioethics within Orthodox and Catholic outstanding activity of Iasi Group
Theological Institutes and also the (“Grupului de la Iai”) conducted by Prof.
presence of theologians within other dr. Vasile Astrstoaie, that publishes
important commissions. Romanian Bioethics Magazine (“Revista
Other bioethics entities currently active Român de Bioetic”) under the aegis of
in Romania besides Romanian National Commission for Bioethics of Romanian
Committee are the following: National College of Physicians (Comisiei
- Commission for bioethics of Ministry de Bioetic a Colegiului Medicilor din
of Public Health (Comisia de Bioetic a România), prestigious magazine well-
Ministerului Sntii Publice) whose known both locally and worldwide and
members are appointed by the ministry, also internationally classified and
commission with an advisory role; authorised, that publishes in each issue
C. BOGDAN.: Historic highlights and perspectives of Bioethics in Romania 13

articles written by renowned bioethicians. related to the detriment of human rights,


Finnaly, there are the committees for dignity and integrity as a result of the
bioethics (ethics) within National implementation of scientific research’s
Authority for scientific research (Autori- conclusions, and on the need for wide
tii Naionale pentru cercetarea tiini- knowledge of the bioethics principles – not
fic), Ministry of Education (Ministerului only by specialists, young researchers but
Învmântului i Educaiei), Universities also by the general public. [3]
(Universiti). [5] Lately, the creation of An extensive program of Bioethics
many committees for ethics within Education was elaborated, distributed and
academic centres and research institutions implemented, program that is a permanent
can be noticed, this fact being stimulated one.
by the progressive introduction of Romania is currently going through the
bioethics courses in the university process of alignment to the European
curricula or by the requests regarding regulations regarding Ethics in Research
research in general and on human subjects and Science.
especially. Perhaps, as a particularity, can For the time being, there are regulations
be considered also the absence of National adopted for the most important and up-to-
Committee affiliated do the Parliament or date aspects in this field: [1]
Presidential Administration, entity that can - general rules and regulations that
centralise all the reflections and comments constitute the framework for the
from other independent bodies (advises, development of specific legislation;
expertises, recommendations, consulta- - provisions in the Constitution of
tions) and would assure a more prompt Romania (art. 11, International law and
materialisation of legislative initiatives. internal law chapter) based on which the
The debates and approaches at the high Romanian State undertakes to respect the
level of this two authorities - Parliament obligations assumed within international
and Presidential Administration – have not treaties and regulations, in the case that
fulfilled yet the needs in this field with the Romania does not have in place (or does
exception of the approval and change of not have yet in place) its own regulations.
important laws referring to bioethics (“art 11 – Constitution of Romania: [3] –
aspects such as: research of human Romanian State undertakes to fully and in
embryos, assisted pro-creation, transplant good faith comply with the obligations
of organ and tissue, this being done due to incumbent from all the treaties signed. [5]
alignment requirements, more or less – The treaties ratified by the Parliament, in
adjusted, to models existing in other coun- accordance with the law, are part of the
tries or as a result of acquiring interna- internal right”.
tional institutions’ recommendations. - there are laws in preparation, being
There is not a Bioethics law in Romania currently under parliament procedure and
yet. having to be promulgated in the next
The first activities of The Romanian period (e.g.: the law regarding the animal
National Committee for Bioethics that protection against being used for research
were considered as a priority for our or other purposes, the law regarding the
country were the ones in the field of protection of the wildlife etc.)
raising awareness and education. As a One of the important laws ratified by
result, an Appeal entitled CONCERN Romania is: The law no. 17 from 2007
(“ÎNGRIJORARE”) that drew attention in regarding the ratification of European
its ten points on the elimination of the risks Convention for the Protection of Human
14 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Rights and Dignity of the Human Being manipulation, use of embryo in research
with regards to Application of Biology and and experiments, research on human
Medicine, the Convention regarding subjects, reproductive cloning, transplant
Human Rights and Biomedicine signed at of organ and tissue, commercialization
Oviedo on April 4, 1997, the additional trends within this field, pre-set of the sex
Protocol to Convention for the Protection of the future fetus, protection of vulnerable
of Human Rights and Dignity of the persons, defending the biodiversity,
Human Being with regards to Application monitoring of genetic modified organisms,
of Biology and Medicine signed in Paris fair distribution of research’s benefits,
on January 12, 1998, referring to the euthanasia, assisted suicide etc. [4]
interdiction of human being cloning.
The European Convention, the Reference:
Convention regarding Human Rights and [1]. Bogdan C., Ursu .: Bioetica în
Biomedicine and the additional Protocol to activitile UNESCO, în vol.
the European Convention were submitted ”Educaia în Bioetic i Drepturile
for ratification to Romanian Parliament by Omului în România” editat de
Ordinance no. 324 dated October 4, 1999. Comisia Naional a României
This law covers: Fair access to health pentru UNESCO, Bucureti 2006
care, Consent, Protection of persons [2]. Bogdan C.: Probleme actuale ale
suffering from mental disorders, Private bioeticii – în “Maramureul Medical”
life and right to be informed; Human nr. 5, 17 septembrie 2004
genome: Non-discrimination, Predictive [3]. Nicolau S.: Nevoia de bioetic.
genetic tests, choosing of sex; Scientific Începuturile învmântului
research: protection of persons that are universitar de bioetic, în volumul:
subject to research, protection of persons ”Educaia în Bioetic i Drepturile
that are not in the capacity to give their Omului în România” editat de
consent for the research; in vitro embryo Comisia Naional a României
research, prelevation of organ and tissue pentru UNESCO, Bucureti 2006
from alive persons for the purpose of [4]. Raicu G.: Legislaia Naional în
transplantation; interdiction of financial domeniul eticii în cercetare în
gain and use of a part of the human body. România, în vol.: ”Educaia în
Finally, a enumeration of the main Bioetic i Drepturile Omului în
challenges that bioethics must answer România” editat de Comisia
today, is shaping also the concern and Naional a României pentru
approach perspectives of Romanian UNESCO, Bucureti 2006
bioethics, without forgetting that bioethics [5]. *** Institutul Român pentru Drepturile
is aiming to maximize the benefits of the Omului: Bioetica – Mijloace i ci de
scientific acquisitions and to minimize the aciune, Bucureti 2004
negative effects:
- discrimination and genetic
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

THREE PERSONALITIES OF MEDICINE –


REPRESENTATIVE FOR MEDICAL
ETHICS WITHIN ROMANIA
1
L. ROGOZEA , F. LEAùU1, L. NEDELCU1, A. BĂLESCU1,
2
C. NEMET1, N. MARCU

Abstract: Kernbach, Nicolae Minovici and I. Stnescu 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. Stnescu. 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. Stnescu medical ethics.

1. Introduction has brought about that an ever-


Ever since the period of Hammurabi’s diminishing number of physicians cope
Babylon or Hypocrites’ Greece so far, with the theoretical aspects of medical
medical ethics has stood for the system ethics.
of moral and social laws that marked Within this very context there
professional activity so that it should inscribes the tendency manifested by the
comply with the highest standards of leaders of Romanian medical education,
society. to neglect the importance of medical
In this context, the medical ethics of ethics, as well as the emphasis we should
the 20th century must likewise be lay on those materials which contribute
considered from the historical to modeling the moral and spiritual
perspective; therefore the acquaintance profile of the future professionals within
with our predecessors’ standpoints will the medical staff. We make reference at
constitute a favorable element in the this point to the history of medicine, to
process of restoring medical ethics in the medical sociology, to medical
framework of the medical progress. anthropology or to medical psychology.
The fear of “public opinion”, the fear We should not overlook that “The
lest we should be considered nostalgic physician, through a happy dignity of his

1
Faculty of Medicine, Transilvania University, Brasov
2
UMF Carol Davilla, Bucharest
16 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

fate is likewise followed and obeyed medical corpus.


outside his battlefield” (Ozun, Poenaru). We should not forget that this
Therefore, bearing in mind and legislative act, regulating the person’s
bringing to memory the example offered right to medical assistance and the
by some forerunners is not only a duty physician’s duty to perform his duty, is
incumbent on us, but also a necessary step dated in the 19th century.
for rekindling ethical and moral values in That very century, however after
the attention of both medical staff and approximately 50 years, the great
general audience. reformer of medical assistance in
Noteworthy personalities of the Romania, physician Carol Davila put
Romanian medical world have been forth in writing: “The physician of the
preoccupied with emphasizing the circumscription, beside his medical
physician’s role, with positively assessing appointment, also performs a moral,
and appraising the particularities of the foreseeing mission.”
medical act, of the responsibility V. Gomoiu – “Within medical
incumbent on the medical professionals, profession, nothing can be mechanical,
with the high moral standards applied by reflex, this is the profession compelling
society to these professionals. to a permanent strain of consciousness,
as our profession directly addresses
2. Historical background. human being, his life and health.
Since Antiquity so far, medical science
has greatly evolved, however a series of 3. Kernbach
ethical percepts have kept their Great personality of Romanian forensic
authenticity. medicine Mihai Kernbach studies at
There is worth reminding at this point Berlin, Graz, Lyon and Zürich and work in
the muniment (charter) issued by Scarlat Cluj where he through all steps of the
Calimachi in 1813, in his quality of academics hierarchy up to professor. After
waiwode of Moldavia, muniment that Cluj period he became doctor at Iasi
points out the obligations of the doctors University, where he taught forensic
of those times. medicine.
“At any time, by night or in daytime, Mihail Kernbach it was not only a
either called for by the boyars, or by the distinguished educator but also a important
clergy or by the poorest and foreigner, no researcher. He publish more than 250
one should dare allege encumbering scientific paper, including article, books.
tasks or delay their medical examination In 1935, Kernbach substantiated a few
for the following day, thereby therefore notions in connection with medical
people’s life; who, either by carriage, or responsibility: “No social group can avail
on foot, should run themselves out of from immunity. We have long overcome
breath towards the suffering ones.” the epoch of the privileged classes upon
The text emphasizes the fact that the law”; however, not supporting the
these doctors must provide medical thesis of medical irresponsibility,
assistance indiscriminately, whatsoever Kernbach stated: “The tendency of the
the patient’s material status or doctrine, within our days, is incontestably
nationality; furthermore, the same text towards raising the physician’s
specifies that medical assistance can only responsibility, so that he should be brought
be provided in case of illness; otherwise to account for the slightest error, as soon as
the patient being excluded from the it may be framed within a text of law.”
L. ROGOZEA, et all, Three personalities of medicine – representative for medical ethics within 17
Romania
4. Nicolae Minovici and I. Stănescu being summoned and called for at any
In this context, we deem of usefulness time, by night or during daytime, no one
to submit and analyze two works drawn should dare to allege encumbering duties
up by the physicians Nicolae Minovici, I. as pretext, or to delay the medical exami-
Stnescu: “Professional Secret”, issued nation for the following day, therefore
in the Bulletin of the College of endangering people’s lives, otherwise,
Physicians, during 1938, and “Ethics of unless justified by well grounded reason
Medical Responsibility”, issued an year of “bodily powerlessness”, any of the
later, during 1939. doctors will be cast out of the healers’
In these two articles, the noteworthy corporate body and his wages will be
physicians prove themselves to be blasted and ultimately will count to
valuable historians of ethics, who nothing”.
managed to achieve a tour of ethics The main preoccupation consists in
history on worldwide level and the professional secrecy, which he deems
throughout our country. an enigma so great and so ancient, as this
Physicians of outstanding value, they ever-rising edifice which, through social
likewise became conspicuous as ethics consciousness, constitutes “human soul”,
theoreticians of great value, given the “collective mentality”, as a “nervus
proof of this statement: “As practicing rarum of consumption life.”
physicians, we do not only cure the Conspicuously, the most important
disease, but the individuals suffering thing should be “conscience – that form
from such or such illness; whatsoever the of manifestation put on by collective soul
conscientiousness we would apply in – and only afterwards the rigid article of
repairing the motor propelling human law.”
life, it is almost utterly excluded to Consciousness is often deemed an
neglect a mere single piece within this abstract notion. For the two Romanian
system, whose perfect knowledge is only physicians, consequently for Minovici,
held by the one who created human too “Conscience cannot be conceived but
being.” as the wholeness of the “moral laws”
They also deemed that “the physician precepts, as an expression of social
has to continuously update his medical harmony, on whose bases the individuals
knowledge; he must not mistake his within an organized collectivity should
university diploma for a license patent, cultivate the “good” and give a wide
which might occupy him for his personal berth to “evil” “and obnoxiousness” from
benefit and not for collective interests.” the standpoint of the individual or
The obligation to comply in due time collective interest.”
with any patient’s request is enforced, Minovici agrees with these
bringing forth to memory the fact that information, the proof being the
ever since 1813, Scarlat Calimachi acknowledgement upon the fact that if
stated: „The doctors and the midwives “every individual only had rights and we
should be under obligation to get out of denied him any duty, and especially his
breath with running when called for not moral duty, then, within a State there
only by the boyars (only these ones were would be a permanent fight, battled by
able to render themselves cured by the individual against community, and
doctors!) but also by the poor and by the therefore battled by everybody against
wretched, as the word of Bible urges all. ”
them to, which compels them to: „when Furthermore, Nicolae Minovici’s
18 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

brother, Mina Minovici declared his position.”


opinion in this respect, considering: There is certain that, as Henri
“Much like a laic father confessor, the Contagne stated: “Medical secrecy
physician has ears to hear and eyes to displays within current practice multiple
behold; in comprehending his moral facets. In the matter of crimes against the
duty, he has no other judge than his State, the law requires revealing the
conscience”, and “the duty dictated b y secret, for the other crimes, divulging the
consciousness needs no longer be secret will only occur in exceptional
defined.” cases – dictated by the physician’s
We may remark on the occasion of consciousness.”
reading these materials that the idea of The two doctors also worked out a
absolute or relative secret is not new. study correlated to the legislation in
This way, Ch. Vibert states that: force. There is this way presented the
“Whatever the authors might say, there is article 350 in the former Penal Code:
obvious that medical secrecy cannot be “The physicians, the surgeons, the
absolute in all cases. Name the physician pharmacists, the midwives any other
who will decline informing the husband such persons, who “following to be, in
about his wife’s illness, informing the line with the nature of their profession,
environment about an epidemic acquainted with and therefore stated as
disease?!” keepers of the secrets they have been
A. Lacassagne places himself in entrusted – will let them out – excepting
favour of absolute secrecy: “the the occurrences when the law asks for
obligation to secrecy places upon the such a disclosure – will be sentenced to
ones involved the interdiction to reveal prison, from one month to six months,
it, even when they are called to testify in and will be fined from 100 lei/Romanian
Courts of Justice.” currency to 500 lei.”
Other preoccupations upon secrecy In Romania, there were also other
submitted in the article herein are the legal regulations connected to ethics.
statements by: A. Lutaud: “Medical This way, the Penal Code of Charles the
secret is not only a moral duty and a 2nd , article 505, paragraphs1, 2.5
sacred obligation for the physician, but stipulated such regulations:
the secrecy is also formally enforced by 1. The offence of revealing
law” ; or the rules advanced by Gabriel professional secrets, which was
Tourdes and Ed. Metzquer: “The “stipulated by the ancient Penal
physician must never reveal what he has Code, in the art. 305, has as
come up against during the exercise of constitutive elements: 1) the
his profession: however there are quality of the person acquainted
admitted exceptions, there are legal with a secret “in virtue of one’s
restrictions, debt conflicts, this issue situation, position, profession or
having remained one of the most delicate appointment 2) the secret that one
and controversial.” of the persons enumerated above
“There are so many moral and legal is under obligation to keep; 3) the
restrictions in favour of the relative divulging or the revealing deed;
secret; the physician is under obligation 4) the divulgation of the secret
to keep professional secret, however might constitute a possibility of
there are certain cases in which this prejudice; 5) he who divulges the
obligation places one in a difficult secret might not be authorized by
L. ROGOZEA, et all, Three personalities of medicine – representative for medical ethics within 19
Romania
law to divulge it, 6) intention of against the patient a new obligation, the
fraud.” one of absolute discreetness, which seals
2. The first element of the offence within his conscience not only the secrets
represented by the deed of revealed to him, but also those he has
divulging the professional secret caught glimpse of during his medical
is the quality of the person who is investigations.”
acquainted with a secret; the
legislator only makes reference to Conclusion
those persons who, in virtue of History brings forth that in life, the
their position, profession or balance inclines more often towards lie
appointment receive certain than towards truth. Medical ethics is
confidences from those who need compelled to do its best so as to contradict
the services falling into their statistics. When somebody wishes to
attributions. If a person is become physician, pharmacist or nurse, we
entrusted a confidence that dare say one is naturally strongly
however has no direct connection motivated. Sometimes, nevertheless, one’s
with the situation, position subsequent activity makes us doubt as to
profession or appointment of the these motivations.
person who was entrusted the This is the reason why the example of
secret, the offence of revealing forerunners such the brothers Minovici,
the professional secret cannot Kernbach or I. Stnescu is more than
have been performed. essential.
3. The second element of the
offence represented by the deed Selective bibliography
of divulging the professional 1. Dumitracu, D – Medicine between
secret is the secret itself. Secret Miracle and Deception, Dacia
constitutes any confidence that Publishing House, Cluj Napoca, 1986
one of the persons fitting within 2. Duescu, B – Victor Gomoiu 1882-
the provisions of the art. 505 has 1960, Medical Publishing House,
found out, only by virtue of the Bucharest, 1970
quality, of the position, of the 3. Iorga, N – Medical Men and Medicine
profession or of the appointment within Romanian Times of Yore,
he holds, there being obvious the Bucharest 1919
desire of the confidant for his 4. Marin, Fl. – Lives Dedicated to
confidence not to be found out by Human Being, vol. 1-6, Dacia
others. Publishing House, Cluj Napoca, 1993-
The law refers to the conditions in 1997
which we do not speak of professional 5. Ozun, R., Poenaru, E. – Professional
secrecy (the facts have no connection with and Social Responsibility incumbent
the quality, with the profession of the on Physician, Medical Publishing
confided person, the information are House, 1973
obtained on private path). 6. Rogozea L. - Nicolae Minovici i
There is afterwards mentioned Max Secretul Profesional, Al IV-lea
Simon: “when the physician has taken hold Simpozion Naional de Istoria
on the patient’s spirit, when the former has Psihiatriei, Bucureti, 20-22 Mai,
raked up the most remote and hidden 2004, p.42
nooks of the latter’s soul, he has contracted 7. Rogozea L., Marcu N. - Doctor
20 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Nicolae Minovici – un theoretician at 9. Rogozea L. – Etic i deontologie


medical ethical, 40th International medical, vol. 1, Ed. Universitii
Congress on the History of Medicine, Transilvania, 2006, 158 pg.
Budapest, Hungary, August 26- 30, 10. Rogozea L., Beldean L. - Aspecte ale
2006 – pg. 775-77. eticii medicale în România, Acta
8. The Handbook on Medical Ethics – Medica Transilvanica nr.2, 2000,
Clarke, Doble and Brendon, London, pg.141-142
1981
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

ONE WRITING FROM øBRAHIM 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

In 1920’s hydrotherapy, balneotherapy, thermal therapies of 1920’s.


spa centres and sanitarium therapy were Dr. brahim Temo (1865-1945), one of
more popular treatment modalities than the founders of the Committee of Union
today’s modern medicine and physical and Progress (ttihat ve Terakki Cemiyeti),
therapies. There are a few articles focusing was born in Struga as an Ottoman citizen
on thermal therapies of those times. of Albenian origin (See Figure 1).
An interesting and comparative article After graduated from Gülhane Military
was written by Dr. brahim Temo (3). He, Medical School in 1892, he started studing
in his article, compared Turkish and ophtalmology in Istanbul. Since he had to
Pomanian thermal therapy centres from escape from the dictatorship of
medical history point of view. Temo’s Abdülhamid II, he completes his training
article provides important information on period in Romania. He opened a lot of

1
Trakya University, Medical Faculty Departments of Physiology, Edirne - Turkye
2
Trakya University, Medical Faculty Departments of History of Medicine - Edirne - Turkye
22 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

bureaus of the Committee in Bulgaria and Hatrıratım (Foundation of the Committee


Romania. Temo returned back to stanbul of Union and Progress and my Memories
in 1908 but didn’t get along with his of the national Revolution and Services to
Committee. He founded Osmanlı the Motherland; 1939 Medgidia, 1987
Demokrat Partisi (Ottoman Democratic stanbul), Usul-ü Mükaleme (Method of
Party). Because of the pressures and Conversation) [3, 4, 5, 6, 7, 8, 9, 11].
threats, he returned to Romania in 1911 It is reported that achieve of Temo is in
[10, 11]. 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


Figure 1: Dr. brahim Temo as Red Cross 1925 issue of the çtihat on the subject of
physician in stanbul, 1913. the thermal springs of Bursa and Romania
(See Figure 3).
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
Figure 3: The title of Temo’s article
Cemiyeti’nin Teekkülü ve Hidemat-ı
Vataniye ve nkılab-ı Milliye Dair
M. YAPRAK et al: One Writing from brahim Temo about Thermal Springs of Bursa and Romania
23

Temo made several journeys to Vienna as Antuvaniyu, Diyaguneselur, Jeravta,


(1901), Paris (1902, 1918), Egypt (1907), Naturaliyust, Alberabeta, Alanaherakayede
Türkiye (1913, 1923, 1930), Albania (Sabtane) Gayllart, Tekirgölü sanitariums;
(1914) and two migration to Romania Kulçe, Brankuvenasa, Eforiya, Markoca,
(1895, 1912). These expressions must be Bantalemun, Manernimate, Kuluj (Cluj)
related with his first visit to Türkiye after University and Çernaviçe hospitals and
the foundation of Republic [10-11]. dentistry college [3].
The article begins with the expression The names in the writing need to be
of Temo about Bursa thermal springs. critized by an expert. It may be said that
According to Temo the baths are the study has some smell of advertising of
miserable. They need reanimation, medical thermal springs and other medical centres
servants, water analysis and legal of Romania.
regulation. There isn’t any hotel and
restaurant around the Bursa thermal
springs [3]. References
In the second part of article, the thermal [1]. Kutlay N: ttihat Terakki ve Kürtler.
springs in Romania are introduced. He Beybun, Ankara, 1992
gave information about the transportation [2]. Polat A: Arnavutluk Devlet Arivleri
options, prices and medical utilities of Genel Müdürü Prof. Dr. Shaban
these facilities [3]. Sinani ile mülakat. Türk Kültürü ve
According to the article, the important Hacı Bekta Veli Aratırma Dergisi.
thermal springs of Romania are Episkubus Sayı: 33, 2005.
or Krian (Baile 1 Mai), Feliks (Baile [3]. Temo : Romanya’nın sanatoryumları,
Felix), Moneasa (Moneasa), Gorgiya kaplıcaları, hava almaya ve tedaviye
(Geoagiu), Dobruca (Spa Dobrich?), mahsus mevsim istasyonları. ctihat,
Kovana (Covasna Spa), Mangalya February 1925, Year: 20, Nu: 174,
(Mangalia), Tekir Gölü (Lake pp: 3498-3501.
Techirghiol), Lagülsarat (Salt Lake), [4]. Temo : ttihad ve Terakki
Govora (Baile Govora), Herculane (Baile Cemiyeti'nin Teekkülü ve Hidemât-i
Herculane), Mohad (Mehadia), Moldovya Vataniyye ve nkılâb-ı Millîye Dair
(Slanic Moldova) Bijular, Siriya, and Vace Hatıratım. Medgidia, 1939.
[3]. [5]. Temo : brahim Temo'nun ttihad ve
In the study, Kasalata (Calimanesti- Terakki Anıları. Arba, stanbul,
Caciulata), Pani (in Bukovina) and 1987.
Devrnavanr mineral waters are praised. [6]. Temo : Atatürk'ü Niçin Severim,
Some promanade like as Agpaya, Azoga, Medgidia, 1937.
Bireza, Berabu, Berazova, Buztin Geçine, [7]. Temo : Atatürk'ü Niçin Severim,
Kimpolonoa, Aliyete, Çaba, Komurniki, BAL-TAM Yayınları, Prizen, 2002.
Kurtedu, Erçi, Duverna, Morillan, [8]. Uygur S: brahim Temo’nun Bilin-
Nemçen, Puya, Naçavluj, Brodevud, meyen Bir Eseri: Usûl-i Mükâleme.
Grillet, Marillan, Nemçu, Payanaçabuluji, Modern Türklük Aratırmaları
Borodeal, Rugfer, Sinaya, Suvi, Suzana, Dergisi, 5/2:65-73, 2008.
Tirguavgana, Tizmana, Valenda, Mevneta [9]. Ülgen E, Aksu A: Mektep ve Aile
and Veratik are also praised in the writing Mecmuası (1915-1916). Constanta,
[3]. 2003.
Temo gives some information about
important health centers of Romania like
24 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

[10]. Ünver S: Doktor brahim Temo. CTF International congress on the History
Tıp Tarihi ve Dontoloji Arivi (Cilt of Medicine. stanbul, 1-6 September
1). stanbul, 1935. 2002.
[11]. Yaprak M, Gökçe N: Dr. brahim
Temo. Proceedings of the 38th
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

THE GREEK PHARMACIST GHERASIMOS


ZERVOS (1842-1901) AND HIS
SUCCESSORS, THE ZERVOS PHYSICIANS
FROM ROMANIA
1 2
A. LUCASCIUC , M.-G. SULIMAN ,
3
O. ELEFTERIU , 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

Hereby we intend to follow the long two daughters, the first two born, Jack and
history of the Zervos family in Romania, George, would become physicians; other
during 1872-1994. nephews and grand-grandchildren would
At the very beginning of this adventure, be spread around the world.
the milestone was represented by The last descendant in Romania was
Gherasimos Zervos, born in 1842, in doctor Gherasim Tuchiditi Harilaos
Zervata, Kefalonia Island, Greece. Zervos, who has emigrated, together with
His name was mentioned in 1872 [1] in his wife, in 1994, in the USA, where his
the free port of Sulina located in the sons were living.
Danube Delta, where he was about to settle The young Zervos, who graduated from
a true and genuine dynasty: five sons and the Faculty of Pharmacy in Padova (Italy),

1 SRIM,
2 National Medicines Agency, SRIF,
3 SRIF
26 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

was already encountering a prosperous having provided no statement at all. Under


material status, which allowed him at his the same silence were also placed the
arrival, in 1872, to open a pharmacy in the successors of the pharmacist Gherasimos
free port of Sulina, under the name of the Zervos (1842-1901) from Sulina.
wise deity Minerva [2]. Their discovery was revealed upon the
Notwithstanding, from the beginning he reading of the travel book Abyssinia [5],
received the help of two business partners signed by the reporter-writer Mihai Tican-
right from the beginning: dr. Contomihalos Rumano (1895-1967), who had travelled
and after his departure, dr. Valentin Stais along five continents and represented a
[3]. genuine ambassador of our country.
In this prosperous city, which was the In 1934, having journalistic interests
residence of the European Danube concerning the Italo-Abyssinian conflict,
Commission ever since 1856, the recently begun at the country borders, he
pharmacist Zervos was the sole owner of a travels to Ethiopia, hoping that his dream
pharmacy: a medical statistic study of would come true, namely that of seeing
November 14th, 1879 (the official date of an African Christian-Orthodox country
the Romanian administration commen- by excellence, the country of the world’s
cement in Dobrogea), mentions only 2 most pious emperor, Haile Selassié I [6].
pharmacies in Sulina: Minerva and the Being under preparation and alert due
pharmacy of the European Danube to the war, the audience to the emperor
Commission’s Hospital [3]. became unachievable. He was advised to
The legal framework under continuous ask for help from the personal counselor
change brought amendments also for the and physician of the Imperial Court of
Pharmacy’s business carrying out: by Abyssinia’s capital, Addis-Abeba.
means of the Ministers’ Council Journal A cordial reception was held in the
no. 8 of February 6th, 1881, the pharmacies doctor’s house, a certain dr. Zervos.
with foreign owners (without Romanian The business card of the Romanian
citizenship) as in the case of the Minerva writer stirred great emotions and
pharmacy from Sulina, were only enthusiasm: the doctor started to speak
acknowledged under personal right [3]. Romanian!
The grounds of the name change, of Although having strong Greek
Gherasimos Zervos’ pharmacy, are influences, the Romanian language spoken
unknown in 1895, subsequently being in the heart of Abyssinia by the doctor
renamed Sperana. Under this optimistic caused a great surprise also to the reporter
name the pharmacy was run for another Mihai Tican-Rumano.
five years by Gherasimos Zervos, until his He was in front of Dr. Jaques Zervos,
death on January 30th, 1901 [4]. the private physician of the Imperial Court
Starting that year, the family of the and resident minister of Greece in Addis-
deceased Zervos gives under concession Abeba.
the pharmacy up to 1916 to the Jaques Zervos had confessed about his
pharmacists: Nicolae Lupescu, Pavel native and childhood city, Sulina, where
Avram and Gh. Clin [4]. his parents rest in peace, about his
The First World War breaks off the children, a boy and a girl who learn at our
ordinary course of life in the Sulina free schools, about his big family from
port as well: subsequently, the destiny of Romania and about the studies at the
Zervos family and of the pharmacy Faculty of Medicine in Athens, together
changed, the documents of those times
A LUCASCIUC et al: The Greek pharmacist Gherasimos Zervos (1842-1901) and his successors,
27
the Zervos physicians from Romania
with his brother George Zervos, physician manager of Filantropia Hospital in
in Bucharest [7]. Bucharest.
Thus one of the most famous sons of Although surprised that there is another
Zervos was identified. Where are the person who succeeded in solving the
others? present puzzle regarding his family, the
60 years later. pharmacist’s nephew confirmed us the
Bucharest, March 1995. bibliography and the pages wrote by Mihai
In the most original way, we found out Tican-Rumano, in the chapter A
that the last Zervos was preparing to leave counselor of the Imperial Court of
Romania: we are speaking about Dr. Abyssinia [8].
Gherasim T. H. Zervos (dr. George
Zervos’ son), an obstetrician, former

The ZERVOS family, Galai 1930


The first on the left on the third upper row is Dr. Jacques ZERVOS (Ethiopia),
together with his four brothers.

References: notes and documents, published by Dr.


1. Georgescu-Tulcea N., Istoricul G. Brtescu, Medical Publishing
asistenei cu medicamente a populaiei House, Bucharest, 1985, p. 382.
din Dobrogea de nord, p. 381-386, vol. 2. Georgescu-Tulcea N., Istoricul
Medical Retrospectives – studies, asistenei cu medicamente a populaiei
28 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

din Dobrogea de nord, p. 381-386, vol. notes and documents, published by Dr.
Medical Retrospectives – studies, G. Brtescu, Medical Publishing
notes and documents, published by Dr. House, Bucharest, 1985, p. 385.
G. Brtescu, Medical Publishing 5. Tican-Rumano M., Abisinia, 2nd Edition,
House, Bucharest, 1985, p. 382. Cartea Româneasc Publishing House,
3.Georgescu-Tulcea N., Istoricul asistenei Bucharest, 1935, 281 p.
cu medicamente a populaiei din 6.Tican-Rumano M., Abisinia, 2nd Edition,
Dobrogea de nord, p. 381-386, vol. Cartea Româneasc Publishing House,
Medical Retrospectives – studies, Bucharest, 1935, p. 128.
notes and documents, published by Dr. 7.Tican-Rumano M., Abisinia, 2nd Edition,
G. Brtescu, Medical Publishing Cartea Româneasc Publishing House,
House, Bucharest, 1985, p. 384. Bucharest, 1935, p. 114.
4. Georgescu-Tulcea N., Istoricul asistenei 8.Tican-Rumano M., Abisinia, 2nd Edition,
cu medicamente a populaiei din Cartea Româneasc Publishing House,
Dobrogea de nord, p. 381-386, vol. Bucharest, 1935, p. 112-122.
Medical Retrospectives – studies,
Bulletin of the Transilvania University of Braov • 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.

Within the bibliographical inventory He was for 3 years the apprentice of


presented are listed, in alphabetical order, medicine attached to Vretos (Serafim
the professionals with studies and medical Vreton Ion „the Armenian”), born in
and pharmaceutical diplomas achieved in Bucharest, „Parisian doctor, from 1815”;
Athens. The primary bibliographical he was the physician and the teacher of the
source is presented abbreviated. prince of Walachia, Ion Caragea.
Vretos, physician, philosopher and
Physicians remarkable bibliophile, dr. Adamantis
wrote that his mentor had also the intention
1. Adamantis Apostol to publish the manuscripts collected, but
(„Veriotul-doctoru”) born in Veria all of them burned during the fire in April
(Macedonia) in 1822. 1847, together with Bucharest houses.
1
ISHM, Bucharest.
2
National Medicines Agency, Bucharest.
3
RSHP, Bucharest.
30 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Supposing that, the last journey and Sanitation Council of Bucharest;


performed by dr. Serafim Vretos in 1870 – Head of the Bucharest Health
Greece, during 1841-1844, had as main Division [3, p. 77].
goal the guidance of the young
Hippocrates’ apprentice regarding the 5. Fotino Androcles (Andrei),
improvement of serious medicine studies 11th of November, 1834 Brila – 9th of
in Athens. May 1907 Bucharest.
Therewith, we settle the return year in 1859 – PhD in medicine in Athens;
Walachia (1844), since, subsequent to this 1860 - unrestricted practice license in
date, both of them are mentioned in the Bucharest;
documents. Dr. Adamantis mentions him, 1860–1864 – regiment physician,
„in a prologue”, as being his mentor and promoted to head of the 5th medical
inoculating him the passion for introducing division of the Military Hospital, while
into thesaurus the written word, thus, he teaching „the recruit and reform course at
collected treasure, in his turn, consisting in the National Medicine School” to the
books and manuscripts „800 volumes of veterinary division;
medicine and literature”, which he had to 1864 – Head of the 1st Surgery Division
offer for sale when his daily subsistence of the Military Hospital; publishes various
was threatened. [3 p.7; 392-393; 452; 461] scientific works and clinical observations
from the division he runs;
2. Cantili Vasile 1865 – member of the Superior Health
1829 – medicine diplomat in Athens; Council and promoted to 1st class senior
1860 – unrestricted practice license in physician (1875);
Bucharest; 1876 – member of the Red Cross
1863 – 1st class regiment physician Committee;
competition [2, No. 18 – 25 June]; 1877-1878 – takes part in the
1863 – member in the Hygiene and Independence War, driving the ambulance
Sanitation Council of Ploiesti [3 p. 60]. of the Main Sector of Mecika; starting with
December 1877, he manages the military
3. Colovos Anastasie hospitals; awarded the Military Virtue;
1854 – medicine diplomat in Athens; 1882 – senator of Mehedini; Law
1858 – Bucharest; Reporter of the Health Service
1863 – physician with the free consult Organisation Law;
service of the Colea Hospital health centre 1885 – General Manager of the Civil
[2, No. 5]; Health Service;
1863-1876 – private clinic physician and 1891 – participated in the Hygiene and
the same position for free consults (Health Demography Congress in London;
Service Yearbook) [3, p. 77]. 1893 – severally awarded for his heroic
deeds, honesty and professional
4. Comboti Nicolae competence, he reached his full retirement
1845 – PhD in medicine in Athens and age [3, p. 148 – 149].
unrestricted practice license in Bucharest;
1860 – physician of the Black Sector, 6. Kefalos Trasivul
Bucharest; Son of physician Kefalos from
1863 – physician of the Red Sector, Constana;
member of the Scientific Medical Society; 1865 – medicine diplomat in Athens,
1863-1866 - member of the Hygiene returns in Constana;
A. LUCASCIUC et al.: Greek Physicians and Pharmacists Graduated in Athens Practicing in …31

1868 – dies due to typhoid, buried in the course „mental illness clinic” (Sunday
Greek Church’s yard (after dr. H. Serafidi courses);
„Medicine in Dobrogea”) [3, p. 223]. 1876 – 1877 – „The alienated in front of
the society and in front of science. Medical
7. Micralopulo, physiscian and psychological studies” – psychiatry
Diplomat of the Athens Faculty of forensic study (DCMF);
Medicine (-), he settled in 1864 in Tulcea, 1877 – founder of the „Caritatea”
but the newspaper „Sanitarul” [3, p.280] Institute on Plantelor St., Bucharest
mentions that he left Tulcea soon after that. („Private health house for mental illness”);
1879 – mental pathology and forensics
8. Orlando, physician professor, in 1881 became the Lecturer’s
1865 – PhD in Athens, domiciled in chair for mental and psychic diseases from
Tulcea where he was employed „as family the Faculty of Medicine in Bucharest;
doctor” for 20 houses, later he went to awarded the „Sf. Ana” Order, 2nd degree;
Paris and never returned [3, p. 308]. 1884 – publishes „The Forensic and
Psychiatry Magazine” (the first in this
9. Sacorafos Michail domain) where he publishes: „A few words
1850 – PhD in Athens and unrestricted about the intellectual epidemics” (No. 2),
practice license in Romania; „Psychosis classification” (his last work);
1862-1866 – physician of districts II and 1901 – member of the Superior Medical
III, Galai; Council and correspondent member of the
December 1868 – 1873 – owner of the Romanain Academy [3, p. 419 – 420].
„Domneasc” pharmacy in Galai (Dr.
Cazacu and C. Frunz) [3, p. 372]. 12. Vaias Teodosie
1862 – PhD in Athens; on October 17th
10. Stavridi Constantin he achieved the unrestricted practice
1857 – PhD in Athens and unrestricted license in Bucharest [2, No. 28];
practice license in Galai; 1863 – resigns from the Calafat city
1865 – publishes the „Report over the physician position and on June 10th is
epidemic of cholera morbus occurred in appointed as Caracal city physician;
Galai in 1865” [2 (nr. 3,4,6), 3 (p. 410)]. 1864 – physician in Tg. Jiu Hospital
(Gorj County) [3, p.144].
11. uu (utzu) Alexandru
1837 – 1919 Bucharest Pharmacists
Subsequent to secondary school, went to
Athens where he acquires the bachelor’s 1. Andreea Nicolae
degree in medicine. Magister in pharmacy with bachelor’s
1865 – PhD degree for the degree in Athens (1856).
„Considérations sur la dyspepsie 1858 – unrestricted practice license in
essentielle” (Paris); Romania;
October 1865 – unrestricted practice 1860 – opens a pharmacy in Galai (N.
license in Bucharest (M. M. no. 33); Angelescu, p. 170 - 171);
March 1866 – secondary physician; 1864 – owner of the pharmacy „Spieria
starting with 1867, chief physician of Român” in Galai (Health Service
Mrcua asylum; Yearbook/1864 up to 1875).
1867 – 1868 – registered with the
National Medicine School program for the
32 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

2. Aescht Rudolf Minovici, however he continues to work in


Diplomat in Athens mentioned in the the laboratory, up to his death in 1894.
Health Service Yearbook 1864 with
unrestricted practice license [3, p. 7]. References

3. Mihailidis spierul 1. Dicionar cronologic de medicin i


Diplomat in Athens (-), opens a farmacie – sub redacia G. Brtescu,
pharmacy in Tulcea between 1859-1860; Editura tiinific i Enciclopedic,
due to competition grounds, he moves to Bucureti, 1975 (DCMF).
Sulina [3, p. 382], where he is no longer 2. Monitorul Medical (M M).
certified by the bibliographies researched. 3. Repertor de medici, farmaciti,
veterinari (personalul sanitar) din
4. Petzalis Rasti Sofocle inuturile româneti vol. I (înainte de
1857 - Diplomat in Athens; 1870) - Dr. V. Gomoiu i farmacitii
1864 – owner of the pharmacy „Esculap” Gh. Gomoiu i Maria V. Gomoiu, Tip.
in Brila until 1883, when the pharmacy is „Presa” Brila, 1938 (RMFV).
taken-over by his son-in-law, dr. Mina
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

THE BYZANTINE PHYSICIANS


1
M. BESCIU

“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.

The Byzantine Empire lasted for over dedicated themselves to patients, both
1100 years and the organization of a human and animal.
functional health care system was Unlike other doctors, they followed the
undeniable merit of Byzantine medicine. Biblical advice: "as a gift you received as a
Pagan healing gods were replaced by the gift you give” they did not want to receive
"Saints healers”. any reward. For that reason they were
Unmercenary physicians or "Doctors called "Saints Doctors without Silver"-
without Silver" cult – Cosma and Damian, Anargyres.
with Theraphon, Tecla, Kyr, John, Julian- One day, however, in violation of the
was established from the very beginning. decision on which both brothers had
According to data transmitted over the agreed, Damian received a sum of money
centuries, Cosma and Damian were from a noble woman, Palade, who, in the
brothers and doctors. They came from name of Christ, asked him to accept her
Arabia in the town of Cyr. Here they gift. His brother, Cosma, was so angry that

1
University of the Medicine and Pharmacy „Carol Davila” Bucharest
34 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

he said he does not want to work together physicians. This period of training was
with his brother anymore. called kronia.
After Damian had explained him why he After the training, the student had to pass
made that gesture, that is not to humiliate proficiency exam and answer question of a
and not sad the noble lady who asked the maestro, the head of the school or the
name of Christ, they were reconciled and emperor’s physician, bearing the title of
continued their work. actuarios.
Governor Lysis, finding that they are The candidate who passed the
Christians and attract many to the Faith, examination received as a sign of
called them into court and asked them to promotion a medal or badge to distinguish
offer sacrifice to the gods of the empire. himself from impostors.
As they refused resolutely, they were Medical practice was based on the theory
sentenced to death and executed by of the four humors.
decapitation. Their bodies were taken into In therapy, Byzantine physicians used,
town by Christians and buried in honor. along with the old remedies, news exotic
In Byzantium, hospitals functioned near ones, made from the three regna.
monasteries. The administrative head of An important role was played by diet
the entire institution was called the recommendations. There were used
nosocomos. Two doctors and a lot of curative and preventive diets, but there
assistants, who learned, not helped, were were also exaggeration. Doctors used to
working in each section. Women were recommend to their patients diets
cared for by a woman doctor, and at night according to different seasons, months,
there was a service call. professions or social class.
Two inspectors were visiting the hospital In order to master these diets and
day and night inquiring whether patients astrological data, doctors had to read a lot
are satisfied or have any complaint to and collect many books. So, they had
make. copies of classical medicine textbooks and
Each hospital had a dispensary in which many copybooks of diets and complicate
worked two doctors and a number of recipes.
assistants Hospitals sheltered vast libraries with
There were specialized hospitals - i.e. valuable medical works. Till the 15th
hospital doctors in Mangane dealt exclu- century, there was in Sarb King’s hospital
sively with diseases of the digestive tract. in Prodrom a magnificent manuscript of
Nurses were instructed on the spot and Dioscoride’s work “Materia Medica”. It
formed health care professionals’ was written for the princess Anicia Juliana,
associations. daughter of the Roman emperor Olybrius.
Doctors were trained in two ways, Nowadays, this manuscript is kept in
individually or in groups ie in school. Vienna.
Generally, medical profession was A copy of Dioscoride’s famous pharma-
transmitted from father to son. ceutical textbook, written in the first
Medical schools were established around century A.C., was made in 512 and it is
hospitals and one of the doctors acted as a now sheltered in the National Library in
teacher. Students were practicing in Viena. This manuscript was made for the
hospitals or clinics. Education was free. Byzantine princess Juliana Anicia, Gallea
Teachers were chosen very carefully and Placida’s great grand daughter and
students had to accumulate a lot of Areobindus wife. The portraits of the
experience before start practicing as author talking to Heuresis (the Gift of
M. Besciu: The Byzantine physicians 35

discovery) and Epinola (Attention), groups Constantine when he was sent to Galls,
of physicians and different plants’ dra- asked Oribasius to follow him. Also, he
wings are closed imitations of ancient ordered Oribasius to edit Galenus’ works
copies of the textbook, which were in a in a short form.
pure Roman-Greek tradition. The use of In 362, Julian succeeded Constantine on
gold was, however, a Byzantine the throne, and his physician became
innovation. Quaestor of Constantinople. Unfortunately,
Only the damaged thumbnail portrait of Emperor Julian was killed in 363;
Iuliana Anicia can be considered a genuine Oribasius lost his protection and was
work of the 6th century painter. The exiled between Goths. His exile ended
princess, dressed up in a splendid heavy before 369.
plated dress, according to her status, looks
forward and has a solemn attitude, as aulic
ceremonies imposed. She is surrounded by ORIBASIUS’s medical works
allegories of Intelligence, at her left, and
Kindness, at her right. The last keeps gold His first work, written for Julian and
coins in her lap that Juliana Anicia spreads called “Galenus’s Synopsis” is lost.
on the book handled by a little genius, At the Emperor’s request, a Medical
called “the passion of the one who loves to books collection was created. It contained
build”. She imitated the generosity acts 70 books, but only 25 resisted through
made by consuls at their appointments. ages.
The whole composition remembers the He wrote another Synopsis in his old
consular ivory diptychs or the pictures of ages for his son Eustatios, who was also a
the Virgin surrounded by angels, as in an doctor. He also wrote Euporistes, with his
icon from the Mount Sinai. At the recommendations for travelers. In this
princess’s feet stays a woman, “the Arts’ book, he described symptoms for each
Gratitude”, who kisses the princess’s right disease; presented the main drugs and most
shoe. In the corners there are theme scenes, common substances used for drug’s
in gray “grisaille” tones, painted in a free manufacture and their effects.
Greek style, which evoke the generosity of Books 11 to 13 were dedicated to
the princess who build up or renovate Diocoride’s Materia Medica exposition
many churches in Constantinople, winged and books 14 to 16 described simple and
genius, comparable to those in Pompey, complex remedies. Information was varied,
who dealt with architecture and painting rich and accurate, but his prudence in
works. prescribing needs the reader’s full
attention.
Oribasius described for the first time the
ORIBASIUS (329-403) melancholy delirium, lycanthropy. He
prescribed hot oil instillation for earaches;
No doubt, one of the famous Byzantine for poisoning he recommended a mix of oil
physicians was Oribasius, born in with water in large quantities, then teriac in
Pergamos, as Galenus, and received wine or juniper fruits and 20 rut fruits. He
medical training under supervision of used pharmaceutical forms like
Zenon from Cyprus. He was the physician trochiscusurile pills and purgatives bread
and friend of Flavius Claudius Julian, the (cathartics) and ”Buccellata cathartici”
Renegate. (purgative electuary).
Julian the Renegate, appointed Cesar by Oribasius presented Caryophyllus
36 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

aromaticus as medicine for the first time. disease.


Through its research and knowledge of “He is not a compiler, but a practitioner
medical and pharmaceutical literature, who knew how less valuable wors are at a
Oribasius remains one of the leading patient bed”, said P.Brunet about
authors and practitioners of the Byzantine Alexandre, whom work he has translated
Empire. into French.
Alexander also recommended the use of
Ka-Ra-aa formula and amulets, but only if
ALEXANDER OF TRALES (525-605) the treatment was unsuccessful.

The greatest physician from the times of


Galen until the Renaissance was probably PAUL from EGINA (626-690)
Alexander of Trales.
His work, 12 medical books, inspired Alumni of Alexandria’s Medical School,
medical schools in the Middle Ages, even Paul was well-known as a great surgeon
if he criticized some opinions of who practice nasal polyps’ extraction,
Hippocrates and Galenus. catheterize of the bladder, tracheotomy. He
He studied medicine, in private, at was the one who gave the name of cancer
Ephesus, Pergamus, Athens and, certainly, – Karkinos, crab – to malignant tumors,
in Alexandria. After he finished studies, he because he differentiated them from the
arrived in Constantinople, where his benign ones and discover that malignant
brother Antemios, a well known engineer tumors send branches as a crab’s pincers in
and mathematician, together with Isidor of the surrounding tissues. He treated breast
Milet, was building famous church of Saint cancers by excision, not by cauterization.
Sofia. Paul from Aegina used rectal and vaginal
He inspired from Hipocrates’s work, speculum. In his days, medical art had no
who considered that the first mission of a essential progress, but based on the known
doctor was to ease the illness by all the techniques it was improving.
means. He thought of the use of catheter to treat
He was cautious regarding the treatment liver abscess and he described correctly the
of cerebral disorders with white hellebore, technique of lithotomy.
which could induce fainting, and he was He remains in the history as an expert in
against the use of opium drugs in patients lymph nodes surgery, superficial tumors
with tuberculosis. surgery, uterine and breast tumors
He described remedies like: Mala punica, removal.
ether oils, of chamomile decoction, Only Abreviar medical, a 7 volume
coriander seeds, pomegranate, and castor textbook wrote by Paul lasted till our days.
oil as treatment for intestinal worms, Books V and VII are dedicated more to
colchium autumnale as gout treatment. He pharmacology and describe venomous
was against opium abuse. In his work, he animal bites remedies, poison, antidotes,
focused on eye drops. He described very simple and complex medicines and their
well pleurisy and its treatment, he focused methods of fabrication. Book VI covers
on digestive diseases, gout, ascites and surgery issues and Book VII describes
made first differential diagnosis between terrible plague epidemics.
edema and hypertrophy using thumb “… even if they have poor knowledge,
pressure, diagnosed intestinal worms and surgeons’ technical abilities were so
recommended powerful remedies for this advanced that allowed them to have
M. Besciu: The Byzantine physicians 37

important success in delicate and difficult He was inspired by salarniteanian


interventions”, said Castiglioni about the physician Nicolaus Salernitanus’s work
surgeons of that period. Antidodarium. His work contains materia
medica and pharmacology with therapy
applications. His work had been the Paris
AETIUS OF AMIDA (502-575) Medical School’s Codex till 1651.

He was born in Mesopotamia and was


trained in Alexandria. He became phy- SIMION SETH (SEC. XI)
sician at imperial court of emperor
Justinian. It is said that Aetius was the first Simion Seth is the author of an
Greek physician who embraced encyclopedia of material medica – an
Christianity. alphabetical presentation of food beneficial
He knew very well the Asian remedies. effects. It contains an important number of
He wrote a medical synthetic textbook remedies.
with medical recipes and mineral, vegetal Musk, amber and hashish are presented
and animal remedies. He was the first in his work from Arabian books. He
doctor who used camphor and cloves in noticed the camphor’s sedation effect on
therapy. genitor-urinary tract. He presented the
His most important work is called Tetra- ointments and syrup from Arabian recipes.
biblion and contains 16 books. It is Aetius’
worth to a better knowledge of surgical
skills of Rufus of Ephesus and Leonidas, MIHAIL PSELLOS (1018-c.1078)
as well as of obstetrics and gynecological
skills of Soran and Philumenos. Mihail Psellos, philosopher, historian,
The best Aetius’s clinical descriptions politician, naturalist physician, professor at
were his observations on the diphtheria the „High School” of Constantinopol. He
with suffocation, palate paralysis and wrote about „the action of the jinns
regurgitation through the nose. He made (demons) in the diseases appearance” and
the first description of brachial artery’s the medicamentary effect of the jewels.
ligature in case of aneurism. He was In 1453 the byzantine medicine mooved
interested in intestinal worm infestation. the torch in the young hands of the
Aetius used to recommend prayers in european medicine fated to lead the
preparation of ointments and emplastres. medicine further.

NICOLAUS ALEXANDRINOS (Sec. Bibliography:


XIII) 1. Ursea N. - Enciclopedia medical
româneasc de la origini pân în
Nicolaus Alexandrinos was known as present, Bucureti, Ed. Universitar
Myrepsos – “The one who makes “Carol Davila”, 2009;
ointmens”. 2. Iftimovici, R. – Istoria Universal a
He wrote Dynameron, divided in 48 medicinei i farmaciei.- Bucureti: Ed.
chapters, an important work containing Academiei Române, 2008;
2656 drug formulations, as well as an 3. Bologa. V. red - Istoria medicinei
important number of other pharmaceuticals universale - Bucureti: Ed. Medical,
remedies, based on their action. 1970;
38 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

4. Izsak, S. Farmacia de-a lungul International, 2003.


secolelor .- Bucureti: Ed. tiinific i 6. http://sfintii-zilei.weblog.ro/2007-09-
enciclopedic, 1979; 26/193889/Sfin%C5%A3ii-Cosma-
5. Sprineroiu, M. L.; Vasile R. D. – %C5%9Fi-Damian-(sec--IV).html.
Farmacia în civilizaiile omenirii.-
Bucureti, Ed. Multi Press
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

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.

Greek and Roman Confluences Thracian Rider, assisting the environ-


From ancient times, the ancestors of mental macrocosmic and the human
present day Romanians lived and forged microcosmic nature, providing health and
their own cultural background mixing mastering disease. Through the centuries
original ideas to strong Greek and Roman Romanian history continued to evolve
influences. This is true for Romania as a along these two coordinates of the „first
whole, but particularly for Dobrogea, and second Rome”.
Transylvania and Banat. The archaeo-
logical discoveries on the Black Sea shore, Medical European Renaissance in
in Tomis-Constana, Callatis-Mangalia, Moldavia
Histria or Herakleia Pontike are in keeping In the XVI-th century, an intelligent,
with the vestiges in Apullum-Alba Iulia, violent and ambitious Greek adventurer
Germisara-Geoagiu Spa, Aquae-Clan and challenged Moldavia`s destiny. Jacob
Herculaneum-Herculane Spa. Apollo, Basilides the Heraklid (1511–1563), a
Artemis and the nymphs, Asklepios and highly cultivated humanist, was born in
Hygieia, Telesphoros and Glykon are Crete or, more probably, in Samos.
always there next to Bendis, Darzos or the Between 1548 and 1552 he studied

1
“Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Romania
40 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

medicine in Montpellier at the renowned Italy, England and France, encouraging


Faculty founded there in 1220. [11] medical practice and teaching to develop,
However, he soon proved fighting skills as they tried to restore their identity within
and followed a successful military career this diasporas of a «historic exile».
in the service of Carol Quintus. In 1561,
Jacob became a short-lived Prince of Constantin Cantacuzino
Moldavia (1561-1563) and in 1562 Constantin Cantacuzino (1650-1716),
founded a Latin School (Schola Latina) at high steward of Wallachia, studied
Cotnari, not far from Iai. As a fervent medicine in Padua, travelled to Venice,
adept of Reformation, the Heraklid and possessed an impressive library
appointed protestant teachers, the first of including updated medical works. (16) Part
them chosen among those in the city of of them ended up in Nicolae
Braov, at the boundaries between Mavrocordatos` library. [2, 3]
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 Fig.1. Constantin Cantacuzino
books, too. [1, 15]
He drew the first map of Wallachia
Early Enlightenment in Moldavia with the aid of Ioan Comnen (Ioannis
and Wallachia Comnenos), a Greek-born theologian and
In the XVII-th century, once again, the physician who graduated at the same
Romanian Lands were reborn to a new life famous University of Padua. [2, 3] It was
under the conjoint impact of Greece and Hrysant Notara (Chrysanthos Nottaras),
Rome. On the one hand, Greek inte- patriarch of Jerusalem, who corrected and
llectuals fleeing the Turkish oppression edited it in Padua in 1700. Born at Trikkala
potentiated the existence of a „Byzance in Peloponnese, Notara studied medicine in
after Byzance”, trying to maintain and Padua, spent many years in Wallachia and
further develop Greek values and culture. contributed to the flourishing of the
On the other hand, Italians were fulfilling Princely Academy in Bucharest and of its
diplomatic, religious and scientific library. He probably promoted medical
missions in the vecinity of the “Sublime studies there.
Porte” of Constantinople. Noble Greek
families settling down in or travelling to Nicolae Mavrocordat
the Romanian Countries of Wallachia and Nicolae Mavrocordat (Nicolaos
Moldavia contributed to local society Mavrocordatos, 1680-1730) of Chios, the
emancipation and cultural flourishing. first Phanariot prince, was the humanist
Phanariot rulers marked the «Early owner of “the richest library in Oriental
Enlightenment» period, opened these Europe” with medical treatises. He wrote a
Lands towards both Western European satire against tobacco “A Word against
horizons and ethnic ideals, stimulated Nicotine” - and about life and death.
national awakening. [4, 5] The Greeks (4,5,14) Prince of both Moldavia (1709-
mediated cultural contacts mainly with 1710; 1711–1715) and Wallachia (1715–
D. BARAN, - Greek physicians and medical emancipation of the Romanian lands 41

1716; 1719–1730), this “authentic citizen in the history of Romanian medicine,


of the cosmopolitan «republic of letters»”, Mavrocordatos` destiny was undoubtedly a
also interested, for instance, in the writings representative example of “Balkan
of Hobbes and Locke, introduced, koinonia” which also included the
reorganized and stimulated education and Romanian Lands.
schools' activity.
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.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 Fig.3. Pulcheria
Academy of Iai and helped its
reorganization. As it comes out from a letter addressed
to Hrisant Nottara, patriarch of Jerusalem,
Alexander Mavrocordatos, the she could have done this herself since she
Exaporite had medical knowledge and skills.
Alexander Mavrocordatos (Alexandru Pulcheria anticipated by several years the
Mavrocordat, 1641-1709), father to Prince similar initiative of Lady Mary Wortley
Nicolaos Mavrocordatos, had married Montagu (1689-1762), who only in 1718
Princess Sultana, descending from the had her son inoculated in Constantinople,
princely family of Alexandru Ilie, who probably by Dr. Timoni, and her daughter
ruled over Wallachia (1616-1618; 1627- in 1721, in London.
1629) and Moldavia (1620-1622; 1631-
1633). Physician, philosopher and Emanuel Timonis
physiologist, Alexandros Mavrocordatos Emanuel Timonis (Emmanouel
studied in Padua and Bologna, where he Timonis,1669-1720) of Chios described
graduated in medicine. variolation in Royal Society`s Philoso-
He was professor at the phical Transactions, in 1714-1716, no. 29,
Constantinopolitan Academy of the pg. 72-82, in an article titled "An account,
Orthodox Patriarchate and, in 1644, he or history, of the procuring of the smallpox
wrote a book on blood flow entitled “The by incision or inoculation, as it has for
Pneumatic Instrument of Blood Circula- some time been practiced at
tion” which disseminated information Constantinople, being the Extract of a
about Harvey`s discovery in this part of the Letter from Emanuel Timonius, Oxon. &
world. Even though not directly involved Patav. M.D.SR.S. dated at Constantinople,
42 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

December, 1713. Communicated to the et in usum tracta qua rite per acta
Royal Society by John Woodward, M.D. immuniaa in posterum praesenvatur ab
Profes. Md. Gresh. and S.R.S“. [6] hujus modi contagio corpora: Per Jacobum
Timonis was Ghika princely family`s Pylarinum, Venetum M.D. et Peripublicae
doctor, in Moldavia (1680-1700). [8] He Venetae apud Smyrnenses Nuper
was even accused of involvement in Consulem“.
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, Fig.5. Philosophical Transactions of the Royal
appeared his “Tractatus de nova variolas Society, 1714-1716
per transmutationem excitanti methodo”.
Better known than Pylarino, his contri- He also presented variolation in the
bution to immunology and vaccinelogy has British „Philosophical Transactions of the
been more frequently mentioned. [6] Royal Society”, in 1714-1716, no. 29, pg.
393-399 as "Nova et tuta variolas excitandi
Jacob Pylarino per transplantationem methodus, nuper
Doctor Jacob Pylarino (Jakovos inventa et in usum tracta: Per Jacobum
Pylarinos/ Giacomo Pilarino, 1659-1718) Pylarinum, Venetum M.D. et Peripublicae
of Lixouri, Kefallonia, graduated in Padua. Venetae apud Smyrnenses Nuper
He learned in 1701 about “transplant- Consulem“. [12] As a court physician, he
tation”, as a popular means to prevent travelled a lot to Germany and Russia,
smallpox, from a woman in Thessaly who where he was the personal doctor of Tsar
inoculated 40000 people. 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,
Fig.4. «Nova et tuta variolas» where teachers were usually Greek
physicians and theologians. [2, 3] Among
After having performed this technique, them: Markou Porphyropoulou, Ioan
Pylarino published in Venice, in 1715, the Comnen, Nicolaos Kerameos (Nicolae
first approach to variolation, his paramount Kerameus). Remarkably, young Greeks
opus "Nova et tuta variolas excitandi per living in Wallachia could get scholarships
transolantationem methodus, nuper inventa from Prince Brâncoveanu and study
D. BARAN, - Greek physicians and medical emancipation of the Romanian lands 43

medicine abroad, as did Giorgos Variolation from Timoni and


Hypomenas of Trabzon, who after Pylarino to Jenner
graduating in Padua, became a practitioner In 1722, convinced of the utility of
in Bucharest. [3] Pylarino supported the inoculation or engrafting, Lady Montagu
achievement of the “Colea” Hospital in intervened to the College of Physicians of
Bucharest, in 1704, the first great hospital London for determining acceptation of
in the Romanian Lands. 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
Fig.6. Bucharest. Colea Hospital and Church 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
Fig.7. Venice. «San Lazzaro» Hospital Wolf, who lived in Moldavia from 1780 to
1797, related that the country had been
Built at the expense of High Stewart severely affected by smallpox for three-four
Mihail Cantacuzino who studied humanist years and variolation officially introduced
disciplines in Padua, the institution since 1780. In 1803, vaccination was
reproduced the model of the “San Lazzaro performed by dr.Hesse and dr. Fröhlich,
dei Mendicanti” («Saint Lazarus of the without any fee, and was recommended by
Beggars») Hospital in Venice. 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.8. Mihail Cantacuzino

Pylarino, who in his youth was a


physician there, yielded the plan of the
Venetian establishment. [3, 8]
Fig.9.Francesco Griselini
44 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

In 1780, he published “Geschichte des Famous Followers in Modern Times


Temeswarer Bannats” («History of
Temesvarer Banat», Vienna, 1780). He Ioan Cantacuzino
described variolation, which only
Romanians performed in various ways: The particular «genetic design» of this
pustular smallpox fluid from sick persons continous Greek-Romanian cohabitation
was inoculated to healthy children after generated towering medical specialists that
scarifying or rubbing their arm skin; continued to be involved in immunology
pustular fluid was directly placed on the and vaccinology.
arm skin previously strongly rubbed with a Ioan Cantacuzino (1868-1934) came
rugged cloth until it became inflamed or a from a mixed Greek-Romanian family,
superficial incision of the arm skin was descending from its first «Enlightened»
performed into which smallpox pustular representatives of the XVII-th century,
fluid was placed. [7] Griselini commu- already mentioned: Constantin, Mihail and
nicated his impressions about Banat in erban. Ioan Cantacuzino studied in Paris,
Letters addressed to outstanding persona- with Ilya Mechnikov (Nobel Prize, 1908).
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 Fig.10 Ioan Cantacuzino
Transalpinischen Daciens” («History of
Transalpinian Dacians») where he A highly reputed microbiologist, he
reported variolation of young ladies on founded, in 1901, a laboratory of
the forehead or wrist, practiced by experimental medicine and in 1921,
Romanian girls of Transylvania”to established the Institute for Sera and
preserve their beauty”. [3, 10] Vaccines in Bucharest, bearing now his
name.
Nyulas Ferenc
In 1802, the Hungarian Physician
Nyulas Ferenc wrote about “Kolozsvári
tehénhiml” («Vaccination in Cluj»). He
reported that peasants from Some and
Fgra bathed their children in the milk of
cows with cowpox, after washing with it
the udder having cowpox vesicles. Other Fig.11. Bucharest. “Cantacuzino” Institute
times, cowpox pustules were pricked with
a fine needle which was then passed He distinguished himself during the II-
through the child’s ear lobe. In Ceanul nd Balkan War, when «the great Romanian
Mare and Cicud, the Valach priests experience» of 1912-1913 revealed the
inoculated smallpox according a efficiency of his anticholeric mass
“mysterious” method known only by them. vaccination performed in epidemic foci.
[3, 10] [3]
D. BARAN, - Greek physicians and medical emancipation of the Romanian lands 45

The «contact immunity» was thus des maladies humaines” (Paris, 1937)- and
definitely proved. During World War I, pioneered viral cultures techniques,
Cantacuzino successfully fought epidemics including viral multiplication in tumoral
by antityphic-paratyphic, anti-diphtheric tissues. He investigated poliomyelitis,
and anticholeric vaccination. He efficiently syphilis and cancer, their origin and
set up antituberculosis and antimalaria therapy. [9, 13]
strategies in Romania. Due to him, a close Levaditi was nominated several times
friend to Calmette, his country was the to the Nobel Prize for Medicine between
second one, after France, to introduce 1930-1934.
Calmette-Guérin bacillus-based antituber- Indirectly, he fathered microbiology in
culosis vaccination. Romania, too, through his disciple,
At the Faculty of Sciences in Iai, professor tefan S. Nicolau (1896-1967).
Cantacuzino was professor of Animal [3]
Morphology (1894-1896). They first met in 1921 in Cluj, where
In 1917, during World War I, he Levaditi was appointed professor and
founded in Iai, along with Russian and Nicolau graduated. Levaditi put a mark on
French physicians, "The Medico-Surgical Nicolau, who, in 1942, inaugurated in
Society of the Russian-Romania Front”. Bucharest the first Chair of Inframicro-
At the end of the war, in 1920, biology in the world.
Cantacuzino represented Romania in Paris
at the peace treaty, a document he signed
with Titulescu on behalf of their country.

Constantin Levaditi
Born at Galai as the son of a Romanian
mother and a Macedo-Romanian (Vlach)
father from the Pindos Mountains,
Constantin Levaditi (1874-1953) studied
Fig.13. tefan S. Nicolau
medicine in Bucharest and was trained in
Victor Babe’ school for five years, as an
eminent research assistant. He then left for Nicolau contributed to the
Paris, were he had a brilliant career at the characterization of the Borna virus and
„Pasteur” Institute. [9, 13] virus replication in tumours.
In 1939, when he returned to Romania,
Nicolau was initially appointed professor
of Bacteriology at Iai, 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
Fig.12. Constantin Levaditi common historical circumstances and
challenges. Balkan peoples developed
Levaditi laid the basis of virology and related features and adopted comparable
further developed immunology in universal behavioural patterns. At the crossroads of
medicine. He authored the first treatise of Orient and Occident, of three great
virology ever published -“Les ultravirus
46 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

monotheistic religions - christianity, timpuriu, Ed. Omonia, Bucureti,


judaism and islam -, of three great empires 2006.
- Austro-Hungarian, Ottoman and Russian, 6. De Raymond J-F, Querelle de
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and liberalism, the Balkan community 7. Giselini F, Încercare de istorie politic
seemed to display intertwined comple- i natural a Banatului Timioarei,
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melting pot to exist, living this diversity, South-Eastern Europe, Newsletter,
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lities between health and disease, life and 9. Iftimovici R, Grama S, Newsletter for
death. Medicine in the Romanian Lands the History of Science in Southeastern
evolved along both Western European and Europe, 2003, 7:13-14.
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contribution to the progress of science still Romanian Traditional Medicine, J
awaits to be acknowledged and officially Prev Med, 2001, 9: 74-76.
integrated to the universal history of the 11. Izsák S, Étudiants roumains à
healing art. The peculiarities of Balkan l`Université montpelleraine, 16e Cong
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express the same aspirations of homo European knowledge in the Greek
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domn i crturar al Iluminismului
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

THE IMPORTANCE OF STUDYING GREEK


PHILOSOPHERS AND PHYSICIANS (5TH –
3RD CENTURY B.C.): CONTRIBUTION TO
THE DEVELOPMENT OF NEUROSCIENCE
IN MEDICAL SCHOOLS
1
D. DIACONESCU , 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.

Introduction the seat of human consciousness, sensation


Since the earliest times ancient Greek and knowledge, all these faculties being
scientists debated the nature of psychic life, attributed by the cardiocentrism to the
the anatomical seat of motor, sensory and heart. Both theories generated controversy
cognitive functions, and the basis of some within the scientific community [4].
neurological and psychiatric diseases.
The aim of this study was to present the a. Philosophers
theories of the most important ancient
Greek philosophers and physicians (5th-3rd Hippon of Samos (4th century BC)
century B.C.). localized the main part of the soul to the
head, particularly to the brain. Anaxagoras
Content of Clazomenae (500–428 BC) and
The origin of thinking activity was Diogenes of Apollonia (ca. 460 BC)
explained by Greek philosophers and believed that all sensations had connection
physicians based on two theories. The to the brain [4].
encephalocentrism considered the brain as

1
Transilvania University of Brasov
48 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Empedocles of Acragas (490–430 BC) Aristotle also identified three possible


thought that “the blood around the heart is nerves - “poroi” (ducts) – two of them
men’s thought” [5]. Thus, humans think leading to the cerebellum and one to the
with the blood and the level of intelligence brain [1]. These ducts might refer to the
depends on blood’s composition. That is optic nerve and tract, and to trigeminal and
why he considered the heart also as the oculomotor nerves [3]. He also described a
seat of mental disorder [19]. cavity in the brain, probably the ventricular
In the opinion of Empedocles, sensation is system, and made the observation that man
a purely physical process, depending on pores has the largest brain in proportion of his
and affluences. Affluences enter continually size. He also referred to “liquidity about
in another body through pores and sensation is the brain”, probably the cerebrospinal
a matter of symmetry of pores [5]. 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.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.
Fig.2. Aristotle – source
The external membrane was the thickest
www.wicknet.org/.../gallery_of_the_greats.htm
and located next to the bone of the skull;
the more delicat internal membrane was
b. Physicians
localized around the brain itself.
For the first time an important
The sensory and cognitive significance
anatomical distinction between cerebrum of the brain was probably first recognized
(enkephalos, brain) and cerebellum by Alcmaeon of Croton (500 BC) [15]. He
(parenkephalis, para-brain) was made by
asserted that “all the senses are connected
Aristotle. The para-brain was positioned
with the brain” through channel-like
beyond the brain, and its shape and tissues
structures called “poroi”, two of them, no
were different from those of the brain.
DIACONESCU et al.: The importance of studying Greek philosophers and physicians (5th – 3rd 49
century B.C.): contribution to the development of neuroscience in medical schools
doubt the optic nerves, joining the eyes to sacred than other disease, but has a natural
the brain. Alcmaeon claimed that the brain cause, and its supposed divine origin is due
was the seat of consciousness and to men’s inexperience and to their wonder
sensation because he recognized that all at its peculiar character”. In the same
senses “are compromised if the brain is treatise, the brain was considered the seat
moved and changes its place” [5]. of judgement, emotions and aesthetic
He distinguished sensation from activity [12]. Thus thinking activity, moral
understanding: “man differs from the other consciousness, perceptive elaboration and
animals in that he alone has understanding, control of body’s movement, were
wheras, they have sensation but do not functions all localized to the brain.
understand” [4]. Hippocrates explained mental insanity
Based on anatomical evidence, he as a process of brain corruption induced by
proposed that the brain was essential for bile, one of the four humours.
perception [6, 7] and “the seat, in which In a case report about sudden loss of
the highest, principal power of the soul is speech and paralysis of the right hand, the
located” [5]. term “spasm” is used [13].
Alcmaeon was wrong saying that sleep It was stated that “an incised wound in
occurs when blood vessels in the brain are one temple produces a spasm in the
filled and that waking is caused by the opposite side of the body” and that loss of
emptying of these vessels [16]. 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.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 Fig.4. Hippocrates – source
nothing to do with demons [10]. http://commons.wikimedia.org/wiki
For Hippocrates the human brain is
cleft into two symmetrical halves by a Diocles of Carystus (ca. 375–300 BC)
vertical membrane and is also the seat of stated that the right half of the brain
human intellect and the cause of provided sensation and the left
neurologcal disorders. In De morbo sacro, intelligence, and that the heart is the centre
epilepsy, called in antiquity “the sacred for hearing and understanding. In his
disease”, is not “any more divine or more opinion, madness was “boiling of the
50 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

blood in the heart”, lethargy was “a intelligence [8].


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 - Fig.5. Erasistratus of Chios – source
carried by nerves -, animal spirit - carried http://www.encyclopedia.com/
by arteries -, and blood - carried by veins.
Erasistratus considered that atoms are the Herophilus of Chalcedon (335-280
essential body element. Atoms were BC), the “Father of Anatomy”, is also
activated by pneuma (external air) that considered the founder of human anatomy
circulated through the nerves. He thought as a distinct branch of medicine [14].
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 Fig.5. Erasistratus of Chios – source
that lethargy “arises from an affection of womenshealth.medinfo.ufl.edu/.../slide5.html
the psychic faculty in the meninx, which is
precisely where lethargy occurs”. Delirium He made a series of accurate
was “a disorder of the activity of the descriptions of neuroanatomical structures.
meninx” [9]. He also made a clear distinction of the
Erasistratus is one of the first who brain ventricles, identifying that they are in
described the cerebrum and cerebellum. reciprocal communication and therefore
Initially, he asserted that nerves also allow passage of the psychic pneuma.
originate from the meninges. Later, he He described precisely the cerebellar
recognizes that nerves originate from ventricle, the fourth ventricle or the
brain. He also established a relationship posterior ventricle. He also described and
between the the number and complexity of nominated some structures visible on the
the human brain convolutions and floor of this cavity, such as the calamus
DIACONESCU et al.: The importance of studying Greek philosophers and physicians (5th – 3rd 51
century B.C.): contribution to the development of neuroscience in medical schools
scriptorius, the posterior median sulcus optic, oculomotor, trigeminal, motor root
and the colliculus facialis. He accepted of the trigeminal, facial, acoustic and
Aristotle’s distinction between enkephalos hypoglossal nerves [4, 20].
and paraenkephalos, recognizing that they Erasistratus and Herophilus first
are separated by a thick membrane – identified that cutting nerves causes
tentorium cerebelli. paralysis.
He described a membrane covering the
ventricles of the brain as the “choroid Conclusions
meninx”. Along with Erasistratus, he was All these theories represent great
considered the first anatomist who achievements transmitted by Greek
identified motor and sensory nerves and philosophers and physicians to later
who located their origin correctly in the generations of neuroscientist.
brain or in the spine. He described the

References 3. Clarke E. Aristotelian concepts of the


form and function of the brain. Bull
1. Aristotle, Gotthelf A. Historia Hist Med All Sci 1963;37:1-14.
Animalium, vol. I: Books I-X - 4. Crivellato E, Ribatti D. Soul, mind and
Cambridge Classical Texts and brain: Greek philosophy and the birth
Commentaries, No. 38, 2002 of neuroscience. Brain Research
2. Chadwick J, Mann NW. The Medical Bulletin 2007;71(1):327-338.
Works of Hippocrates. Blackwell, 5. Diels H, Kranz W. Die Fragmente der
London, 1950. Vorsokratiker. 12th ed, Berlin, 1966.
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6. Doty RW. Alkmaion’s discovery that 14. Longrigg J. Anatomy in Alexandria in


brain creates mind: A revolution in the third century BC. Brit J Hist Sci
human knowledge comparable to that 1988; 21: 455-488.
of Copernicus and of Darwin. 15. Lloyd GER. Alcmaeon and the early
Neuroscience 2007; 147(3):561-568. history of dissection. Sudhoffs Arch
7. Doty RW. Alkmaion, ca 500 BC, 1975; 59: 113-147.
discovers that mind is in the brain. 16. Lyons AS, Petrucelli RJ. Medicine. An
Neuroscience Research 2007; 58 Illustrated History. New York: Harry
(suppl.1): S243. N. Abrams, Inc., 1987:187,192
8. Garofalo I. Figure della medicina 17. Mission S. Hippocrates, Galen, and the
ellenistica. In: G. Cambiano, L. uses of trepanation in the ancient
Canfora, D. Lanza “Lo spazio classical world. Neurosurg Focus
letterario della Grecia antica”, vol. 1. 2007;23(1):E11.
2, Roma 1993:345-368. 18. Movia G. Aristotele. Anima, Milano:
9. Garofalo I. Anonimi Medici, De Rusconi, 1996
Morbis acutis et chroniis. EJ Brill, 19. Phillips ED. Greek Medicine (Aspects
Leiden 1997 of Greek and Roman Life). London,
10. Garrison FH. History of Medicine. Thames and Hudson, 1973.
Philadelphia, W.B. Saunders, 1966 20. Rowe CJ. Plato: Phaedo (Cambridge
11. Gross CG. Aristotle on the brain. The Greek and Latin Classics). Cambridge,
Neuroscientist 1995;1(4):245-250. University Press, 1993.
12. Hanson AE. Hippocrates: The “Greek 21. Wright JP, Potter P. Psyche and soma:
Miracle” in Medicine. In: Medicine, physicians and metaphysicians on the
Lee T. Pearcy, The Episcopal Aca- mind-body problem from antiquiry to
demy, Merion, PA 19066, USA, 2006 Enlightenment. Oxford: Clarendon
13. Hippocrates. Of the Epidemics (400 Press 2000.
BCE). Section III, case 13. Translated
by F. Adams.
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

DOCTOR-PATIENT RELATIONSHIP IN
NEUROPATHIC PAIN: A COMPARATIVE
STUDY BETWEEN URBAN AND RURAL ZONE

L. TARTAU1, R. V. LUPUSORU2, C. E. LUPUSORU1,


3
C. ANDRITOIU 1, O. DUMA

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.

Aim: The paper represents a descriptive establishment of an optimal rapport


study, concerning in a comparison between between the physician and patient is
urban and rural area from Iasi county, one essential to both parties, a successful colla-
of the most representative in the region of boration depending on the physician’s
Moldova, regarding the physician-patient ability to manage unhealthy person
relationship in the management of expectations. [1, 7, 18]
neuropathic pain. This relationship concerns the
foundation of contemporary medical
General data ethics, and implies the existence of the
The family physician plays a key role, physician, who offers specialized and
being the first contact person for the responsible services first, and, on the other
patient. Addressability to medical services hand, the existence of the patient, who
takes a central position in patient-physician needs medical assistance. [22] These both
communication and relationship. [9] The parties can openly discuss the risks of

1
Pharmacology, Algesiology Department, „Gr.T. Popa”, UMF, Iai, Romania
2
Pathophysiology Department, UMF, Iai, Romania
3
Public Health and Sanitary Management Department, UMF, Iai, Romania
54 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

patient during medical procedures, and most neuropathic syndromes respond


choices regarding the possibilities to poorly to nonsteroidal antiinflamatory
improve his quality of life. [3, 15, 21] drugs and opioid analgesics. First-line
In terms of bioethics, patient-physician agents for modern treatment of neuropathic
interrelation comprises patient’s right to include tricyclic antidepressants,
the confidentiality of his medical problem, pregabaline, gabapentin, topical lidocaine,
his consent to treatment, but also the right tramadol, and opioids. [12, 19, 23, 24]
to health and to not be at pains. Physician’s
vocation implies all activities targeted to Method
preserve population health status, to This exploratory study was performed,
prevent illnesses, to improve the patient during six months (September 2008 -
healthy living conditions. [1, 13, 15] February 2009) on a sample of 278
The major requirements of this complex patients with neuropathic pain, aged 25-70
physician-patient relationship are based on years, from urban (157 cases) and rural
friendship, effective communication, medical centers (121 cases) in county of
respect, and mutually trust. Patient health Iasi. This investigation was based on both
outcomes can be improved with good medical records and anonymous question-
physician-patient communication. [14, 25] nnaire, to obtain detailed information,
Working together, the potential exists to regarding intensity of pain, associated
pursue interventions that can significantly diseases, and the treatment of neuropathic
improve the patient's quality of life and pain.
health status. [13, 17, 20] The purpose of this study was to
Pain plays a central role in the health describe the socio-demographic patterns,
care system, and is one of the most consultations, pathology and the treatment
frequent reasons for consulting a doctor. of attendants at general practitioners at
Primary care is the most frequent care these two primary health care centers. The
provider for pain. [11] questionnaires involved epidemiologic
Neuropathic pain is a complex, chronic characteristics and also, patient-reported
pain state that usually is accompanied by relevance and performance of the
tissue injury. Within neuropathic pain, the consultation aspects. It was also identified
nerve fibers themselves may be damaged, the impact that physician-patient inter-
dysfunctional or injured. Major patho- personal interactions have had upon the
physiological mechanisms include peri- satisfaction of primary medical services.
pheral sensitization, sympathetic active- The authors designed the questionnaire
tion, disinhibition, and central sensiti- according to those presented in the
zation. [4, 16] Neuropathic pain is literature. The study was performed with
associated with many diseases, including the support of the family physicians, for
diabetic peripheral neuropathy, posther- data collection. All questionnaires were
petic neuralgia, human immunodeficiency distributed and collected, trying to
virus – related disorders, and chronic maintain the confidentiality of the recorded
radiculopathy. [5, 6, 10] Neuropathic pain data. All patients were informed about the
is described as burning, electric, tingling aim and purpose of the investigation and
and shooting in nature. [4, 10] Numerous how to fill in the questionnaire. Once they
therapeutic options are available, including had given their consent, patients were
systemic medications, physical rehabilita- asked to complete the self-administered
tion, behavioural modification, and questionnaire. Incomplete questionnaires
invasive procedures. [5, 8] Unfortunately, were excluded. Data were scored and
L. TARTAU, ez al.:- Doctor-patient relationship in neuropathic pain: a comparative study between
55
urban and rural zone
statistically analyzed with t test from postherpethic neuralgia. (Fig. 2)
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 Fig. 2
medical centres, the pain was reported to
be intense to severe (range 6 to 10) to In both medical centres the
visual analogue scale of 0-10 values (with pharmacologic treatment of neuropathic
0 being no pain, 5 mild pain and 10 being pain consists of nonopioid analgesics
the worst pain imaginable). (Fig. 1) 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.
Fig. 1 Tramadol was the only one type of opioid
medication recommended in patients with
The average score computed by neuropathic pain, especially in urban
residence area didn’t show significant medical centre. (Fig. 3)
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, Fig. 3
61.2 in rural), followed by neoplastic and
56 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Regarding the physician-patients to receive detailed data and explanation


relations, the investigation showed that about their diagnosis, treatment and course
there are some differences and meanings of of illness, attitude that may disturb the
the interactions between the doctors and stages in the medical consultation
sick peoples in urban and rural medical procedure.
care centres. These results are concordant with
However, only a few patients have literature data which stipulate that the lack
received pain treatment properly adjusted of sufficient attention to psychosocial
to their needs. Around 18% of patients issues may be even more related to
consider any of their therapies satisfactory dissatisfaction, than the presence of
in reducing their pain. attention is related to satisfaction. [2, 25]
In a rural medical centre, the patients’ Our study revealed a better physician-
satisfaction with the consultation was patient interrelation in rural than in urban
related to the longer consultation times. medical centre, because in the first case,
Opposite to this, in urban medical centre, the practitioner is more familiar with
most patients complains sometimes about patient and his medical history, dealing
busy doctor, who has too little time to that strongly increases patient trust in
listen, only a small number of patients doctor. (Fig. 5) It is also true that in some
being satisfied with the time given to situations this relationship may be
medical consultation. (Fig. 4) This aspect impaired by the deficiency of commu-
is inconclusive, because it is possible that a nication, due to the poor intellectual level
patient’s estimation may be altered by his of the patients. The mentioned commu-
experience consultations. 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. 4

The results of questionnaires evaluating


patient expectations prior to the visit have
been compared with his satisfaction
measured after the consultation. In rural Fig. 5
area the patients are more satisfied and
more likely to comply with treatment Secondly, despite the fact that the rural
recommended. On the other hand, the family physician is insufficient scientific
urban patients tend to identify the doctor as documented about the new trends of
their main source of information wishing pharmaco-therapeutic strategies in the
L. TARTAU, ez al.:- Doctor-patient relationship in neuropathic pain: a comparative study between
57
urban and rural zone
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medical care; Clinical characteristics and pain mana-
ƒ the obtained data has provided detailed gement among patients with painful
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services, not evident in official reports. 2007; 11(6):652–64.
[11]. Hasselstrom J., Liu-Palmgren J.,
Rasjo-Wraak G., Prevalence of pain in
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general practice. Eur. J. Pain., 2002, 6: [19]. Saarto T., Wiffen P. J., Antidepre-
375-385. ssants for neuropathic pain, Cochrane
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[13]. Hottois G., Missa N. J., Nouvelle primary care: what can we learn from
encyclopedie de bioethique, Bruxelles, patients?, Ann. Intern. Med., 2003, 138
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[14]. Kerse N., Buetow S., Mainous A. et P. et al., Understanding concordance in
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medication compliance: a primary care nal and ethnic dimensions, of shared
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[15]. Knight B., The ethic of medical [22]. Veninga C. C., Denig P., Zwaagstra
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[16]. Pasero C., Pathophysiology of cotherapy guidelines for treatment of
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[17]. Rao J. K., Anderson L. A., Inui T. S. [24]. Wiffen P., Collins S., McQuay H. et
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Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

A REFERENCE ANALYSIS ABOUT THE


HUMAN SOUL

L. ROGOZEA1, M. DRAGOMAN 1, F. LEAùU1,


M. ğURCANU1, R. MICLĂUù1, M. CARDIS1

Abstract: „The nervous and mental illnesses, prevention and treatment”, a


work of the former doctor Aurel Dobrescu from Braov, 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

The book was edited in 1919 and one The knowledge of nervous system’s
year later was awarded by the Romanian structure and physiology represents the
Academy. It has 163 pages and it addresses fundament of all nervous phenomenon, dr.
to the general audience with new Dobrescu presents in his study some
information about neurology and general issues, then reflexes and instincts
psychiatry. It has a special part about and in the end the analyzes of the most
developing the child’s mind, and it is of a abstract psychological activities.
real use for teachers and parents. 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. 1. - A. Dobrescu – Book cover Fig. 2. - A. Dobrescu – book illustration –


nervous system

1
Faculty of Medicine, Transilvania University of Braov.
60 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

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 Fig. 4. - A. Dobrescu – book illustration – brain
wouldn’t consider all the actual data were
collected from these new sources of The next chapter of the first part, ”The
knowledge, is obsolete and narrows the significance of the brain” shows that
horizon of modern man”, the author differences between humans and animals
stresses the importance of evolution in due to more complex structure of the
science 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. 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 Fig. 5. A. Dobrescu – book illustration – spinal
would be kaleidoscopic, are caused by the cord
illness of a single organ, the brain”.
L. ROGOZEA et al.- A reference analysis about the human soul 61

The next chapter, Chapter 2, is called body parts and their illness it causes
"The reflex" and is defined as "the simplest weakness or paralysis. "Intelligence is
form of collaboration between different established throughout the cortex" and it is
kinds of neurons". If for the animals the the resultant of the images and
reflex plays a major role, in human representations received by the senses.
reflexes are controlled by the brain and In Part III we take "a special look on
replaced with complex mental processes. the functioning of the nervous system".
Chapter 3 presents the importance of Chapter 1 provides the data "from the
instincts, which often break the barriers of intimate life of the nervous system", thus
reason, being inherited from generation to being presented the evolution of our
generation within the same species. neurons as cells which develop many
"The superior reflex (controlled)" is the branches as they grow. The neurons'
title of the fourth chapter of the second part nutrition occurs through the process of
and presents the reflex circuit in which the assimilation, oxygen having a major role in
impulse passes from peripheral sensory this case.
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. 7. A. Dobrescu – book illustration –


Fig. 6. A. Dobrescu – book illustration – physiological aspects
central nervous system
In Chapter 2 we learn "how to develop
Another chapter is titled "Locating the spiritual life". As muscle fibers increase
brain faculties". Here there are presented after physical activity, "nerve elements
sensations reaching the brain and are continually grow and strengthen"
printed at this level in the form of following receipt, selection and setting
impressions, which, if the same kind, processes of the concepts. These findings
forms images. The images are grouped into were very useful in education and also in
concepts; concepts are divided into the fact that in some children some centers
"faculties of intellect, feeling and will". are more susceptible to impressions and
Chapter 6 highlights "The map of the other are more rudimentary. Hence, the
brain centers". Thus, "motor centers" are author concludes: "education wouldn't be
represented on the map corresponding to made after a general block, but for each
student's individuality".
62 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Chapter 3 presents "the scheme of a kicks are occasional cases in individuals


psychological process". We'll see how with predisposition for nervous diseases.
sensory nerves transmit information to Part V studies "most common forms of
association centers, which, together with sickness of the nervous system", which are
the memory centers and then via motor divided into peripheral nerve diseases and
nerves will produce movement. diseases of the nervous center.
In Chapter 4 we see a part "of the Chapter 1 considered "peripheral nerve
problems of intelligence" and find that the illness", the main causes of disease being
number of neurons you have at birth does cold, compression, blow, degeneration,
not increase during life, innate concepts acute or chronic infectious disease toxins.
don't exist and genius and insanity are Illness is made by inflammation and
related. muscles corresponding to these nerves will
Part IV deals with "General pathology become atrophic, and will regenerate
of the nervous system". 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
Fig. 8. - A. Dobrescu – book illustration –
central nervous system" as being divided
pathological aspects
into functional diseases and organic
diseases.
Chapter 1 describes the causes of
The next chapter is entitled "General
diseases of nerve substance; in inherited
symptoms of diseases of central nervous
diseases, they will be worse if taken from
system" and treats disorders of the sphere
the mother, and if true psychopaths, they
of intellect in 7 pages (illusion, hallu-
are born of both parents sick. Among won
cination, disturbance of consciousness,
causes are the infectious diseases consi-
eclipsing intellectual life, stupor, obse-
dered "among the greatest enemies of
ssions, phobias, paranoid ideas, anger),
mankind", typhoid fever, articular rheu-
disturbances in the sphere of sense (the
matism, erysipelas, Staphylococcus, Strep-
soul, apathy, hipertimia) and disturbances
tococcus, smallpox and pneumonia. The
in the sphere of the will (aboulia, feverish
social poisons mentioned are alcohol,
excitement, catalepsy, catatonia, impulsive
opium, cocaine, hashish. Diseases of
actions, impulsive obsession)
endocrine glands are also included in the
Chapter 5 is of great complexity and
category of causes; from that type is
studies the functional diseases, and the
education "too wanton and too early", that
organic ones.
can lead to insanity. Emotions or spiritual
L. ROGOZEA et al.- A reference analysis about the human soul 63

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.

Fig. 9. - A. Dobrescu – book illustration –


pathological aspects

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
Fig. 11. - A. Dobrescu – book illustration –
predisposition will appear serious
pathological aspects
neurasthenia characterized by weakening
memory, phobias appearance, imagination
In organic diseases are studied idiocy,
and fantasy taking the place of rational imbecility, cretinism, dementia, senile and
thinking.
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
Fig. 10. - A. Dobrescu – book illustration – been infected with syphilis" through fiber
pathological aspects atrophy and degeneration of nerve cells.
Another consequence of the ill with
Ipocondria is considered an obsessive syphilis, is described in the following lines.
analysis of the bodily condition, these Last of organic nerve diseases studied is
patients being considered "imaginative apoplexy or cerebral hemorrhage, known
sick people". An important part of this as "damblaua" produced by tearing of
chapter is given to hysteria, the disease of arteries in the brain. We will stop to
"slightly irritable, very significantly, analyze the clinical picture for dorsal
whims, falling quickly from one extreme tabes, while trying to present known data
to another". Symptoms of hysteria are in 1919 and that we have today about.
varied and sensory nerves are affected by
64 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Dobrescu’s In current
Dorsal Dobrescu’s In current book psychiatric
tabes book work books
Defini- Destruction Demyelination Illusion The patient In a false
tion of peripheral of posterior receives via perception
sensory cords, dorsal the senses of real
neurons and roots and all sorts of sensory
their dorsal roots feelings stimuli
continuation ganglia about the
of the spinal things
cord. around him,
Walking Uncertainty Gait ataxia but he
walk, with broad exaggerates
slouch, base of illness nerve
atactic support and centers, it
stepaj turned into
Paresthesia , images that
bladder do not
disturbances, correspond
impotence, to reality
areflexia, loss Hallucination The patient False
of postural cause in perception,
sensation, deep nerve failure in
pain and centers an the
thermal image, absence of
sensitivity without actual
Pain Killer pain Loss of pain having sensory
in legs and sensitivity received any stimulus
torso outside
Joint perception
degeneration, Tabel. 2. – Comparing the data from Dobrescu
atrophic, Book with the modern book
perforated
ulcers of the Part VI deals with &"prevention
leg nervous system's diseases".
Pupil small, Chapter 1 presents "the means of
irregular, education" for prevention of these
which reacts to diseases: the fight against sexual diseases,
accommodatio combating alcoholism and overwork, the
n but not light gym, exercise and trips.
Tabel. 1. – Comparing the data from Dobrescu Chapter 2 highlights the role of spiritual
Book with the modern book education in preventing nerve diseases.
The purpose of education is "to strengthen
Comparing data on disorders of intellect the will of the student, which can deal
and the will of the book of Dr. Dobrescu anytime with his impulses". It studies the
with what we know today about the same importance of training character and
concept, we see that differences are not temperament and the role of the character
large at all. in preventing nerve diseases. Concluding,
L. ROGOZEA et al.- A reference analysis about the human soul 65

Dr. Dobrescu says that "a strong character, appearance of normal and pathological
meaning a mind that deals with tendencies mental life and the prevention and
and agitation (...) can do a lot to prevent treatment of nervous diseases, I set one
nerve diseases". more goal: to draw attention to the
Part VII deals with the study of nervous significance of some agents of mental
diseases’ treatment. The author proposes diseases on future generations; that is my
treatment regimens in patients with contribution to the improvement of the
nervous breakdown, the scheme which will human race”.
include ensuring peace for the patient, Concluding, the book is a good
removing him from the environment, food example of the concerns of representatives
care, idrotherapeutic, electrotherapeutic of ASTRA in medicine.
and psychotherapeutic treatment, general
treatment for strengthening. In the References
following pages of the Treaty are discussed
at length all these therapeutic methods. [1]. Bologa V.L. – Istoria medicinei
româneti, Ed. Medical; Bucureti,
1972, 565 pg.
[2]. Burtea Victoria — Manual de
semiologie psihiatric; Casa de
Editur Venus, Iai, 2003, 293 pag.
[3]. Dobrescu Aurel — Boalele nervoase i
mentale, prevenirea i tratamentul
lor; Ed Institutul de arte grafice C.
Sfetea, Bucureti, 1919, 163 pag.
[4]. Harrison - Principiile medicinei
interne; Ed Teora, Bucureti, 2001,
2840 pag.
[5]. Huttmann A., Barbu G. – Medicina în
oraul Stalin ieri i azi, Ed Societii
tiinelor medicale din R.P.R., Filiala
regional Stalin, 1959, 163 pag.
[6]. Iftimovici R. – Istoria medicinei, Ed.
ALL; Bucureti, 370 pg.
Fig. 11. - A. Dobrescu – book illustration –
pathological aspects
[7]. Minea Dan — Neurologie, Reprografia
Universitii Transilvania, Braov,
Part VIII, the last part of this study is a 2003, 300 pg.
warning, stating "how a family degenerate" [8]. Rogozea L. – Aspecte ale medicinii
by the appearance and inheritance of nerve braovene în perioada interbelic, Acta
diseases. Concluding, the author states that medica Transilvanica, nr.1, 2003,
"the power of a nation depends on the pg.56-60
ethical value of families", highlighting the [9]. Rogozea L. – Braovul iatro-istoric, Ed.
importance of prevention and treatment of Universitii Transilvania, 2006, 217 pg.
nervous diseases. [10]. Rogozea L. – Doctorul Arnold
The aim of this paper is to contribute to Huttmann – iatroistoric transilvnean,
the development of the human race, as is Acta Medica Transilvanica nr.2, 2002,
clear even from the author's words: "In an XVIII, pg. 121-123, ISSN 1453-1968
preparing this book, besides a brief [11]. Rogozea L. – Personaliti ale
66 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

medicinii româneti, vol. 1, Ed. Historiae et Philosophiae Technicae,


Universitii Transilvania, 2006, 2003, Ed. Universitii Transilvania,
[12]. Rogozea L. – Rolul Astrei în editarea pg.123-126,
unor publicaii medicale, Acta [14]. Sârbu A., Brânzei P.— Psihiatrie; Ed
Medica Transilvanica, nr 2, 2005, pg. Didactic i Pedagogic, Bucureti,
102-104 1981, 340 pg.
[13]. Rogozea L., Miclu R. – Viaa [15]. Setlacec D – Medicina Româneasc
medical braovean din anii 40 – Medicina European (1859-1916);
reflectat în ziarele locale, Sesiunea Ed. Medical; Bucureti, 1995, 328
de comunicri a C.R.I.F.S.T – pg.
Academia Român, în Hermeneutica
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

PROF. DR. HULUSI BEHCET (A FAMOUS


TURKISH PHYSICIAN) (1889-1948) AND HIS
BOOK ON CUTANEOUS LEISHMANIASIS
(ORIENTAL SORE)
1
AYùEGÜL DEMIRHAN ERDEMIR , 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

Prof. Dr. Hulusi Behçet is a famous Hulusi Behçet’s book with the name of
Turkish physician [13]. 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
Fig. no.1 - Hulusi Behcet cannot be obtained every time” [8].

1
Department of History of Medicine and Ethics, Faculty of Medicine, University of Uludag, Bursa –Turkey
68 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

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,
Fig.2. Prof.Dr.Hulusi Behçet’s Book Cover on
Abimelek mentioned in his book named
Oriental Sore
Discuss on Oriental Sore (Cilt
Leischmaniose’ları Hakkında Münakaa
We know reports of a disease simulating
Münasebetiyle in Turkish) with the date of
the type of lesion seen in cutaneous
1934 that Behcet described nail sign in
leishmaniasis were first made in 1756 by
Oriental Sore for the first time in the
Hasselquist and Russel. Also in the middle
world. Moreover, the paper of Alfred
of the nineteenth century, the same type of
Marcionini and Kemal Turgut dated 1944
lesion was described by French medical
with the name of Essays on the Pathology,
officers in Africa. Laveran demonstrated in
Clinic and Treatment of Oriental Sore in
1880 that this condition could be transmitted
the Middle Anatolia (Orta Anadolu’da
and that a fly was an important factor. In
Görülen ark Çıbanlarının ntiarı,
1885 Cunningham described a histological
Patojenisi, Klinik ve Tedavisi Hakkında
picture and stated that there were bodies
Tecrübeler in Turkish) gave some
within the cells which were circular to
knowledge about the Oriental Sore in the
elliptic in shape. Ryan, in 1886, also
Middle Anatolia. To this paper, Oriental
described some cells which were filled with
Sore was named as Diyarbakır Çıbanı
bodies which he regarded as cocci with
(Sore), Mardin Çıbanı, Urfa Çıbanı etc. to
capsules. He attempted cultures in human
the cities of Turkey. These physicians and
blood but obtained no results. It was not until
the entire world also accepted that Hulusi
1903 that Leishman and Donovan made
Behçet described the nail-sign in the
independent reports describing the
oriental sore for the first time in the world.
protozoan. During the same year Wright in
We know that there are a number of
Boston described the organisms found in the types of protozoa which can cause
first case of cutaneous leishmaniasis reported
leishmaniasis. Each type exists in specific
in this country.
locations, and there are different patterns
In this book, Behçet specified that:
to the kind of disease each causes. The
“The 'tin-tack' sign (TTS) was the
overall species name is Leishmania
appearance of horny processes that project
(commonly abbreviated L.). The specific
from the under-surface of a crust. types include: L. Donovani, L. Infantum, L.
Although it was a well-known feature of
Chagasi, L. Mexicana, L. Amazonensis, L.
discoid lupus erythematosus it might be
Tropica, L. Major, L. Aethiopica, L.
also seen in other crusted lesions
Brasiliensis, L. Guyaensis, L. Panamensis,
particularly in cutaneous leishmaniasis.”
L. Peruviana. Some of the names are
So, Hulusi Behçet mentioned the tin-tack
A.D. ERDEMIR et al- Prof. dr. Hulusi Behcet (a famous Turkish physician) (1889-1948) and his69
book on cutaneous leishmaniasis (oriental sore)
reflective of the locale in which the was on her right cheek. Behçet also treated
specific protozoa is most commonly found, this case with diathermy.
or in which it was first discovered. Famous Turkish physician Behçet gave
This famous physician mentioned that some knowledge about the discovery of
some drugs such as Neosalvarsan or carbonic microorganisms and their names. Behçet
acide couldn’t treat it. But, to Behçet, mentioned that American scholar .Wright
diathermy therapy was the best way. Behçet named this disease’s microorganism as
mentioned diathermy in every page of his Helcosome tropicum at that time and R.
book. To Behçet: “Diathermy method is Ross gave the name of Leishmania
applied in developed cities and good results tropicum ou furonculose to it. But,
are obtained. “Behçet treated some afterwards, Leishmania Donovani was
leishmaniasis cases with this way from 1920 known as its microbe.
to 1922. In this book, 4 cases are given. One Moreover, Behçet gave some knowledge
of them was the son of a merchant from about Leismania kinds in his small book:
Adana. This patient was 19 years old and “Leishmanias are in two forms: Forms with
travelled to Syria for the trade occasionally. flagellums and without flagellums. Two kinds
Ulcers were located on his right neck and of Leismanias are present. One of them is
these were combined in time and became in Leishmania Donovani and another is
the size of silver coin (mecidiye). Other Leishmania tropica L. We also know
doctors couldn’t treat this patient. Leishmania Americana. Leishmania
In this case, Hulusi Behçet determined Donovani also causes Kala-azar.
Leishmania by preparing culture and Hulusi Behcet also gave other useful
diagnosed this disease as oriental sore. knowledge in his important book. Oriental
Moreover, in his book, Hulusi Behçet Sore was seen in India, South Asia,
wrote that Dr. Resat Rıza and Mustafa Mediterrenean Sea Region, North Africa,
Bakar prepared Leishmania Tropica Crete and Greek Islands, Adana etc.
cultures and this research was published in Oriental Sore was named Halep (Aleppo),
Gulhane Seririyatı Journal in German. In Nile, Tahran, Isfahan, Palestine, Ankara
this first case, Hulusi Behçet examined and Diyarbakır sores. Hulusi Behçet
microorganisms by ultramicroscope and mentioned epidemiology of this disease.
saw flagellums. He informed about their Especially, Oriental Sore was infected
dimensions. So, he applied diathermy to from animals to dogs, monkeys, mouses.
his patient. Hulusi Behcet accepted Hulusi Behçet also mentioned the
diathermy as the best therapy [3, 7, 9]. characteristics of oriental sore. To Behçet:
The second case of Hulusi Behçet was a “On an average a fully developed Oriental
servant girl. She was 23 years old. Oriental sore is an inch or so in diameter. While
sore was seen on finger of right hand and there is often but one, there may be several
left cheek. It was of a dull red colour and or more distinct and sometimes quite
was inflammatory, quite tender and widely separated formations. An Oriental
painful. Hulusi Behçet also diagnosed this Sore, when developed, is of a dull red
case as oriental sore. colour, is usually of sluggish nature
In his third case, Hulusi Behçet treated throughout its course, unless constantly
a porter from Diyarbakır. He was 42 years knocked, irritated, or having added an
old. Sore was on his right eyebrow and left active pyogenic factor, when it may
cheek. The fourth case belonged to a girl. become much more inflammatory, and
She came from Tahran to Istanbul. She quite tender and painful [4, 6, 12]. The
was relative of Iran Emperor. A deep sore favourite regions are the face, hands and
70 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

forearms, and legs, but no part is exempt. Hast Frengi Kl Ar 1934; 1: 283-284.
Moreover, Behcet gave some [2]. Berberian DA. Cutaneous Leishma-
knowledge about some ways used in niasis. Arch Dermat&Syph, 1944;
oriental sore therapy. According to Behcet, 49: 433-435.
arseno benzol and salvarsan couldn’t treat [3]. Demirhan,E.A., Öncel,Ö.: Prof.Dr.
oriental sore. Neosalvarsan was good for Hulusi Behcet (A Famous Turkish
syphilis. Famous physicians, Resad Rıza Physician) (1888- 1948) and Behcet’s
and Abdülkadir Bey accepted this Disease from the Point of View of the
condition. The best method was the History of Medicine and Some Re-
diathermy [10]. This was an apparatus with sults, ISHIM, 5(10):51-63 (2006).
electric. Namely, electric was applied to [4]. Forbes,M.A.: Exogenous Cutaneous
the sore. But this apparatus was present in Leishmaniasis Proved by Culture,
the modern cities of Turkey at that time. Archives of Dermatology and
To Behcet, in the other cities of Turkey, Syphilology, 58( 3):301-307(1948).
frozen carbonic acid was used for the [5].Hulusi Behçet. Haleb veya ark Çıban-
therapy. But, he preferred diathermy larının Diyatermi ile Tedavisi. Dersaadet
therapy more than frozen carbonic acide. 1925 (kinci Tab’ı) Kader Matbaası.
Hulusi Behcet applied diathermy by [6]. Marinkelle, C.J.: The control of
anaesthetizing his patients and the patient leishmaniases. Bull. WHO. 58: 807-
healed in ten or twenty days. So, he 819, 1980.
advised application of diathermy to every [7]. Mutlu S, Scully C.:The person behind
physician in his book. the eponym: Hulusi Behcet (1889-
Hulusi Behcet gave a paper on nail sign 1948). J Oral Pathol Med. 1994 Aug;
of oriental sore in 1932 .M. Mayer and 23(7):289-90.
Ernst Nauck also accepted Behcet’s [8].Saylan T. Life Story of the Dr. Hulusi
thoughts on this topic. Behçet. Yonsei Med J 1997; 38: 327-332.
Hulusi Behcet again mentioned these [9]. ehsuvarolu,B.N.: Yurdumuzda Deri
topics in his paper with the date of 1934 Hastalıkları Tarihçesi, ve Muallim
and named Two Important Points on Dr.Hüseyin Hulki Beyden Bir
Wright Sores (Wright Çıbanları Hatıra(History of Dermatology i,n
Seririyatında hmal Edilmi ki Mühim Turkey), Deri Hastalıkları ve Frengi
Nokta in Turkish). Arivi, 3(8):462-504 (1966).
Approximately 350 million people in 8 [10]. Templeton HJ. Cutaneous Leishmaniasis
countries are estimated to be under the Experimentally Produced. California&
threat of leishmaniasis. Most of the drugs West. Med., 1941; 54:70-71.
used for the treatment of leishmaniasis are [11]. Turgay N. Leishmaniasis Aı Çalı-
toxic and have many side effects. At malarında Son Gelimeler: Ne Zaman
present there is no vaccine against Aılanabileceiz? Türkiye Parazitoloji
leishmaniasis. Vaccine development for Dergisi, 29(4):232-234, 2005.
parasitic infections is more difficult than [12].Unat,E.K.: Leishmania’lar ve
for viruses and bacteria because of the Leishmania’lı nfeksiyonların
antigenic complexity and parasitehost Epidemiyolojisi Üzerine, Deri
interactions [1, 2, 11]. Hastalıkları ve Frengi Arivi
5(15):869-880(1968).
References [13]. Yemni O. Ord. Prof. Dr. Hulusi Behçet.
[1]. Abimelek. Cilt leischmaniose’ları Deri Hast Frengi Ar 1964; 1: 58-59.
hakkında münakaa münasebetile. Deri
Bulletin of the Transilvania University of Braúov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

THE EFFECTS OF THE MEDICAL


FUNCTIONS ON ARCHITECTURE IN
SÜLEYMANøYE DAR’US SIFA OF THE
OTTOMAN DAR’US SIFAS

BETÜL BAKIR1, øBRAHIM BAùAöAOöLU2

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

Süleymaniye Dar’us Sifa which was just on the opposite of the construction.
designed within the body of social Treatment with music was also carried
complex and constructed by Mimar Sinan out in the hospital in which approximately
in the years 1553-1559 when was called as thirty employees were serving till XIX
his masterbuilder period, confronts us with century.
a different design of central composition As it was in Seljuks, in Ottoman Dar’us
between rectangular shaped two yards and Sifas, the treatment purpose baths serving
bodies lined up around them. There is a to the patients have taken part in the social
ward in the cellar in which hopeless mental complex, as for Süleymaniye Dar’u Sifa,
patients were sheltered in bulk and shops the bath is not on another construction but
that are opening to the exterior street. it is incorporated into the Dar’us Sifa.
There is Medicine Madrasah and The fountain which is providing
Darülâkâkir (pharmaceutical warehouse) freshness and mental relaxation with the
1
Yildiz Technical University Istanbul / Turkiye
2
Istanbul University, Medical Faculty of Cerrahpasha, Istanbul / Turkiye
72 Bulletin of the Transilvania University of Braúov • Vol. 2 (51) - 2009 • Series VI

flux of the water is in the second yard to 2. Palace Hospitals; The Hospital of
which all the rooms are opened. odalisques which were built in Topkapı
In the west entry of the first yard of the Palace in 15th century by Conquror Sultan
construction, there is a double domed, Mehmed and The Palace Hospital made by
wide area bakery place where a kind of Turkish-Mongol Emperor Ekber in
bread named fodla is baked for the Fatehpur-Sikri in the date 1569 are the
patients. oldest palace hospitals standing today with
Süleymaniye Dar’us Sifa was a their original conditions (2).
treatment center for mental patients and
other patients serving for a high number of 3. Dar’us Sifas and Madrasahs which
patients in its period and was greatly were built for public; Ottomans went on
improved with its bath, pharmaceutical working their dar’us sifas which were
warehouse, special part sheltering heavy coming from Seljuk Period with the
mental patients, wide patient rooms with foundations. Some of these were
high ceiling and aeration, madrasah related respectively dar’us sifas such as Bursa,
to the construction just on the opposite, Edirne, østanbul ve Selanik, Belgrad,
shops providing income for the vaqf, Budapeúte extending to the Balkans
bakery, fountain, toilettes, Darüzziyafe afterwards. Especially in the 16th century,
(restaurant) building on the east side. many treatment centers had been built but
apart from the Hospital of the odalisques in
The Specialities of Ottoman Dar’us the Topkapı Palace and the ones made by
Sifas Architect Sinan any of them determined to
Ottoman Empire had had its greatest reach our day. Generally, the aim of the
period under the rule of Suleiman the dar’us sifas built within the body of a
Magnificent, its lands extended from social complex is to serve for public and
Austria to Arabia while Egypt was benefit from the other places serving.
included in North Africa, in addition, The Fatih social complex was the first big
Red Sea and East Mediterranean had extensive constructions group and
become Turkish Seas. In every part of the education unit was built by Conqueror
empire art and culture were paid attention, Sultan Mehmed. Positioned on a hill
many works of art, bridges, fountains, prevailing to østanbul by Architect Sinan
baths, schools, mosques, dar’us sifas, etc and ordered by the sultan to be done by
were built. selecting the best marbles, stones and
østanbul, which was the capital of masters of the country, Süleymaniye social
Ottoman is magnificently reflecting most complex which was built after nearly
of the works of art that we talk about today hundred years from Fatih social complex is
and exhibiting the richness of the period. an important religious and social center
The Selatin mosques and magnificent with its dar’us sifa which we can accept as
social complexes which were built by a step in the development of Ottoman
Sultans or their wives in østanbul, today health institutions with its library among
also constitute the landmarks which the counted libraries of our day, in the
determine the silhouette of the city. medicine madrasah of where the best
professors of the period give lessons and
1. Military Hospitals: Mobile and bring up famous doctors.
stable military hospitals were built in Orders were made to extract and bring
different parts of the empire in order to valuable marbles, colored columns from the
cover the needs of the army (1) historical constructions in the empire in order
B. BAKIR, et al: The effects of the medical functions on architecture in Süleymaniye Dar’us SIFA
73
of the ottoman DAR’us SIFAS
to use valuable stones in the Süleymaniye distinct department was made in the cellar
social complex which is the proficiency for the heavy mental patients who were
achievement of the famous Architect Sinan, isolated from the other patients in the
valuable marble columns were barged from Süleymaniye Dar’us Sifa. In the 19th
distant countries such as Alexandria. century, the pointed separation was made
The madrasahs in the south and north of and it became an institution in which just
the social complex was a complex male patients were sheltered.
education center with the guesthouse and
ottoman elementary primary school (fig.1). Architect Sinan:
There was a rich employee and doctor staff The big architect of Suleiman the
in the dar’us sifa, constructions such as the Magnificent, worldwide reputated artificer
medicine madrasah, darulakakir, Sinan was born in 1490, in the village
guesthouse and darüzziyafe positioned as a A÷ırnas of Gesi town in Kayseri.
whole in the northwest of the mosque in a According to the written sources, he was
different construction was showing the given to the conscript boys school as a
developing madrasah understanding in the recruit in 1512, he had become a janissary
best way. 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
Fig.1. Süleymaniye Complex (from Cantay)
took place. His fist work of art in østanbul
was Haseki social complex and Dar’us Sifa
It was normal that superior scientists that he made for Hürrem Sultan. ùehzade
gave lectures and palace doctors were
Mosque that he finished in 1544 when he
appointed as professors to the medicine was 54 years old is his apprenticeship
madrasah in the most developed social work. Süleymaniye social complex that he
complex of the period (3). The difference
finished in 1557 when he was 67 is his
of the Ottoman Dar’us Sifas from the headworker piece and Edirne Selimiye
Seljuk’s was the separation made in the
Mosque that he finished when he was 80 in
Dar’us sifa according to the qualifications. 1574 is his proficiency work (5).
While the women and men were treated in
different parts generally, in the final stages
Doctors and Patients in Dar’us Sifa
hospitals for women and for men were also In the 16th century, the greatest period
built. Besides separating according to
of Ottoman Empire, within the frame of
sexuality, there were also different
the new steps in the fields of science, art,
departments in which every sickness was
economy, education, medicine, astronomy
treated such as dermatologic disorders,
in Süleymaniye medicine madrasah and in
surgical, mental, inflammatory diseases
its other madrasahs, reformary superior
and etc, which can be accepted as the first
student educating program was carried up
samples of recent “clinic” concept (4). by Sheikh ul-islam Musa Kazım Efendi
Separation according to the illnesses in the
and Hayri Efendi which will reach up to
hospitals guided dar’us sifa plans, a the 20th century in education and qualified
74 Bulletin of the Transilvania University of Braúov • Vol. 2 (51) - 2009 • Series VI

doctors and scientists were brought up (6). 20th century, Dar’us sifa construction
Süleymaniye Dar’us Sifa which was built served for military printery till 1927 (11).
in 1577 had served in a different According to Peçevi, Tabip Ahmed Çelebi
construction with the madrasah for the first was the first one assigned here and
time. Endowments were assigned for each Mustafa Bin Celâlüttevkii was chief
dar’us sifa in Ottomans in order to provide physician in 1567 in the period of
their needs. Besides, according to the Suleiman the Magnificent. The chief
sources, helps were made by the physician between the years 1858-1873
endowment in the social complex where was the famous Italian doctor Louis
the dar’us sifa took place. In the Mongeri (12).
Süleymaniye social complex endowment
and records, the services, servants and The location of the constructions in
helps given to the dar’us sifa were also Süleymaniye social complex and
listed. In the researches of S. Ünver, as the architecture of the dar’us sifa:
social complex’s endowment was Apart from the Süleymaniye Dar’us
determined in 1557, the administrative Sifa which was built by Architect Sinan on
records about the guesthouse, medicine behalf of Suleiman the Magnificent
madrasah and dar’us sifa authenticate that between the years 1550-1557, there were
the hospital was serving in that date (7). darulhadis, bath, darülkurra, rabi and salis
According to its endowment, the medicine madrasahs on the south-east, Architect
madrasah’s professor had to be wise Sinan’s tomb on the north, sani and evvel
enough to be palace doctor. In the dar’us madrasahs, medicine madrasah, dar’us
sifa where various illnesses had been sifa, darüzziyafe, darülakakir (pharmacy),
treated, just the mental patients started to library, fountain, guesthouse and Tiryakiler
be treated after 1843 (8). It is indicated in Bazaar (Bazaar of addicts), caravansary,
the records that the poor patient were ottoman elementary-primary school and
boarding in the hospital, polyclinic service lieutenant cabins on the south-west (the
was also given and doctors were working mosque regarded as the center of the social
from morning hours to afternoon in the complex)(fig.2).
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 Fig.2. Medicine Madrasah and Tiryakiler
method of curing with music which was Bazaar
used in Edirne dar’us sifa was applied to Süleymaniye social complex, located
the mental patients treated in the neurology prevailing to the city, was constructed in
service, the medicine compositions the land in which the old palace built by
prepared in the darülakakir on the opposite Conqueror Sultan Mehmet had a fire and
were distributed not only to the patients destroyed (13). While the mosque forming
here but also to all of the hospitals and the center of the social complex was
patients in østanbul. In the beginning of the located on a high hill, the madrasahs on its
B. BAKIR, et al: The effects of the medical functions on architecture in Süleymaniye Dar’us SIFA
75
of the ottoman DAR’us SIFAS
right and left were separated from the (guesthouse) construction; rectangle plan is
mosque via a narrow street. Rabi and Salis used here also because of the locations of
madrasahs on the slope looking to the the other constructions in the area within
Golden Horn in the east, Evvel and Sani the complex and the topographic reason of
Madrasahs on the other side, ottoman the land. All the usage fields of the bodies
elementary primary school and Tiryakiler in the courtyard with fountain in the dar’us
Bazaar consisting of 36 shop rooms under sifa are arranged equal to each other, so
the medicine madrasah provide income for that, in order to give entrances to the
the complex (14). Guesthouse, daruzziyafe corner places, these corners of the
and dar’us sifa constructions were built courtyard were beveled and a small
with high ceilings because of topographic entrance hall was opened. Beveled corner
circumstances, the rooms were built to the has taken place in the plan typology of
downward slope through Golden Horn “middle sofa” understanding in Turkish
under the dar’us sifa and caravansary was Architecture, the other reason of corner
built to the lower elevation of the entrances may also be prevent to shrinks
daruzziyafe (15). Although the ending date which would be due to entrances to the
is written as 1557 on the inscription on the places. On the north of the medicine
main door (cümle kapi) of the mosque, the madrasah, an one floored darülakakir
dar’us sifa and medicine madrasah were (pharmacy) is positioned where medicine
finished in 1556 and the constructions in compositions were made and stored, on the
the complex together with the other opposite of this building dar’us sifa is
buildings were finished in 9 years (16). positioned. Building dar’us sifa and
madrasah as different constructions from
Plan organization: each other has started with Süleymaniye
There is a different design from the Dar’us Sifa. Medicine madrasah taking
central formations of the period in the place within the body of the hospital until
dar’us sifa with two rectangles designed that time separated for the first time in this
domed and porched courtyards and domed construction and turned into two buildings
cabins with ovens lined up around them. In positioned facing one another. When
the cellar floor of the double floored entering to the first courtyard of the dar’us
constructions, there are shops opening to sifa from the hospital street, there is a
the outer street and an isolated ward bakery where a flat bread named “fodla”
without windows where hopeless patients was cooked for the patients in the last of
sheltered as a whole. In the first courtyard the three domed-bodies lined up on the left
there were administrative units and daily side as to the entrance and west facade, the
policlinic patients were accepted, in the body in the middle is opening to the other
second courtyard with a fountain, boarding courtyard where the bath is (p.4).
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 Fig.3. Bakery Building
76 Bulletin of the Transilvania University of Braúov • Vol. 2 (51) - 2009 • Series VI

The body on the corner which is on the stone walls went, the thinner they were
east facade of the first courtyard was used built.
for entrance to the second courtyard.
According to the pictures in the sources Entrance door and other doors: It is
there was a rectangle pool which had lion assumed that supplies were carried for the
figures on its four corners in the middle of bakery in which bread was cooked from
the courtyard and an octagon fountain in the courtyard entrance on the south-east
the second courtyard (17). The lions and facade. It is seen from the bare, plain
other animals transported to the dar’us sifa tracks and tablet of the door that it was
in 1843 may be the reason for the location restored in the 19th century. There is a bare,
of the lion monuments in the first flat archway made of (küfeki) stone and its
courtyard. Despite making out negative tablet on the wall. The main entrance wall
news about the lions put in the hospital by is also remains from the period when the
the foreign broadcasts, it is probable that military used it. There is a “printery of
these animals were held in caravansary Military” writing written on green
rooms in the cellar floor or in some of the background and Ruler Abdül Hamid’s
non-used rooms of the bath next to the signature in embossment cartridge. The
hospital, however, these animals died in a whole archway from küfeki stone on the
short time in an airless and dark wall and its frames on the both sides are
environment plain. It is a strong probability that supply
It could be only gone from the first entrance was made to the kitchen on the
courtyard to the barrel vaulted, narrow and upper floor from a door reached by going
long place where heavy mental patients down throughout stairs to the cellar from
were held in the cellar floor throughout the second courtyard. The gap on the
stairs serving to that body. Ventilation- kitchen flooring is tied to the wall in
illumination was made by the embrasures question vertically and the supplies coming
on the colonnade borders in the second from the down door was pulled up from
courtyard. The chains and rings used here this hole.
for the heavy mental patients haven’t
removed till recent times. Windows: elevation differences in
construction membranes affected also the
Structural Features: Although not so windows, while there is rectangle shapes
deep, the construction of the groundworks on the floor elevation in the south-west
in the Süleymaniye social complex built on facade looking to the inner courtyard and
a hill looking to Golden Horn in østanbul, obtuse arched window types on the up, on
had taken such a long time as 3 years the fairly high, double floored north-west
according to the sources. In the drilling facade, discharging arches, obtuse arched
works made in 1970s, no deeper than rectangle windows on the shops in the
6.20m was encountered (17). Khorasan down floor, the windows of the dar’us sifa
mortar was used in the walls of the rooms on the shops are first line
building constructed with (küfeki) stone, discharging arched rectangle windows and
fairly high floor walls of the double obtuse arched plaster ornament (revzen)
floored construction were straightened covered top window lines lie all along on
with horizontal brick lines in every 1.20m the north-west facade on the up.
and horizontal lying wooden binding
elements sized 5/5cm. were settled Vault and arches: Entrance holes to
between these brick lines. The higher the the corner rooms in the second courtyard
B. BAKIR, et al: The effects of the medical functions on architecture in Süleymaniye Dar’us SIFA
77
of the ottoman DAR’us SIFAS
and barrel vault cover was used on the aesthetic but also created relaxing effect on
ceilings of the places in the down floor. the patients with the action of the water.
Courtyard colonnades, window and door On the south-west corner of the
arches are obtuse arches named as Turkish hospital, bath attendants were on duty in
arch or panj arch. the bath, built next to the dar’us sifa, just
to serve the patients here. As known, the
Column headings: Marble column bath of the dar’us sifa was also used to
headings in the courtyard colonnades are cure mental patients with hydrotherapy
muqarnased which reflect Ottoman method apart from providing hygiene.
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 Fig.4.Patient Room
courtyards in four dimensions.
Restoration works of 2009:
Buttress and waterspout: Yüksek, iki The construction is being tried to return
katlı kuzey-batı ve güney-batı cephelerinde its original condition in the restoration
belli aralıklarla, zemine do÷ru geniúleyen studies by fixing the changes of the
payandalar mevcuttur. There are buttresses construction made in the 20th century and
which are expanding towards ground on the accessories made during its usage as
the double floored north-west and south- military printer in 19th century. The
west facades in certain intervals. separation walls between the colonnades in
the courtyard were destroyed; closed fire
Physical features in structure: There places in the patient rooms were opened.
are fireplace for heating, windows in both The stairs entrance going down from
side of the fireplace furthermore a door north-west facade of the second courtyard
opening to the courtyard and a window to the cellar floor was re-opened; east
next to it in every room (fig.4). the courtyard ground where the bath and
windows were opening both to outside and bakery constructions take place was
to the courtside, so they were making light lowered and brought to its original
places while supplying adequate air and elevation. The pool in the first courtyard
light for the patients. Windows opening to with lion monuments on its four corners
outside in the dar’us sifa shows that the which was closed in the past will be re-
patients were not isolated from the outer built in the last restoration study and lion
environment. Ventilation of the places in monuments will be put on their places
the cellar where the heavy mental patients (fig.5). The fountain closed with concrete
were staying was made by the wide loop- in the second courtyard will be functional
hole on the upper floor opening to the again (18). The small bath located next to
second courtyard. The pools designed in the dar’us sifa on the south-east dimension
both courtyards not only provided visional was only for the patients and bath
78 Bulletin of the Transilvania University of Braúov • Vol. 2 (51) - 2009 • Series VI

attendants working here were washing the 3. There had been Greeks, Rums,
patients. In the digging workout made for Armenians, Georgians, and Syrians
restoration, hot water wandering canals when the Turks came to Anatolia.
were discovered beneath the bath flooring. 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-
P.6. The Pool with Lion Statues (from Cantay)
ül Mi’mariye, 2. Monography of
Dayızade Mustafa Efendi named as
Selimiye, 3. Padiúahname of poet
Footnotes:
Eyyubi, 4.Adsız Risale, 5.Tezkiret-
1. A big mobile hospital was built
ül Bünyan, 6.Tezkiret-ül Ebniye,
consisting of 70 surgeon tent and 40
7.Tuhfet-ül Mi’marin. According to
doctor shops serving to the
the sources, he was born in the
wounded soldiers in the Crete
village A÷ırnas in the Cappadocia
blockade mentioned by Evliya
area and he was not exiled to
Çelebi. In 16th century, the
Cyprus as the other region society
presence of a hospital serving for
of the period, he attended to many
navy in the østanbul Kasımpaúa
campaigns such as Iranian, Egypt in
dockyard is figured out in the
the period of Sultan Selim the
sources. Apart from the two
Stern, Belgrad campaign of 1521
hospitals bound to Ottoman navy in
and campaign of Vienna in 1529,
Kasımpaúa, there were naval
and he built bridges here and
hospitals in Crete, Basra, Preveze
worked as “sekban”, “zembere-
and hospitals in Gemlik, øzmit,
kçibaúı”, “infantry colonel” in the
øznik, Rusçuk, Tulci, Vidin, Crete,
army. He had built 3 galleys on his
Suez dockyards. Terzio÷lu,
Iranian campaign, he gained
Osmanlılarda Hastaneler…,p.5-6;
appreciation of the Sultan by
Evliya Çelebi, Seyahatname,
building a high bridge in 13 days on
publisher: Zuhuri Danıúman, c.12,
a marshland in Moldovia campaign
østanbul 1943, p.202.
of 1538. Aslanapa, Türk Sanatı,
2. “It is seen that hospitals were
p.251-266; Kuran, Mimar Sinan,
established for bondmaids in the
p.16-27.
hareem, for truckers in the Birun
6. Calendar and astronomy studies
and for Ottoman hists in the palaces
were being done in the
of Ottoman Sultans in Edirne and
muvakkithane until 16th century.
østanbul. Terzio÷lu, A,
But a observatory couldn’t be built.
Osmanlılarda Hastaneler, p.2, 15.
The famous astronomer Takiyeddin
B. BAKIR, et al: The effects of the medical functions on architecture in Süleymaniye Dar’us SIFA
79
of the ottoman DAR’us SIFAS
built an observatory in Tophane in chemist helpers, pantry worker,
the period of 3rd Murad in the years steward, clerk, tabbahı eúrife (some
1574-1595. There were various people), 4 trustees, 2 laundrymen,
astronomy tools, mechanical clocks, barber, bath attendant… Ünver,
astronomy drawing tools, miters, “Süleymaniye Külliyesinde
rulers, compasses and etc in the Darüúúifa…”, Vakıflar Journal II,
observatory of østanbul. There were p.196-198.
madrasahs and dar’us sifas in 9. Ünver, “Süleymaniye Külliyesinde
Manisa, Amasya, Bursa and Edirne Darüúúifa, Tıp medresesi ve
in Anatolia and Trakya on the same Darül’akakire dair”, Vakıflar
period. There were very rich Journal II, p. 198-199.
libraries serving to the madrasahs 10. There is a record about taking 4
near these or within the body of the manservants because of the increase
social complex, especially in in the amount of the mental patients
Süleymaniye social complex and coming to the asylum in a
Haghia Sophia. Kahya, Erdemir, document dated 1850-1851. Ünver,
Medical Studies and Enstitions in “Süleymaniye Külliyesinde
The Otoman Empire, p. 72-74. Darüúúifa….”, Vakıflar Journal II,
7. Ünver, Süleymaniye Külliyesinde p205, 206.
Darüúúifa, Tıp Medresesi ve 11. Kahya, Erdemir, Medical Studies
Darül’akakire dair”, Vakıflar and Instıtıons ın the Otoman
Journal II, Ankara 1942, p. 196. Empire, p. 79.
8. As to its endowment, there were 1 12. Cantay, a.g.e., 99.
professor, 8 counselors, 1 13. Bayat, A.H. “østanbul Süleymaniye
doorkeeper, 1 ferraú, 1 pointillist in Darüúúifası”, Ülker Erke’nin
Süleymaniye Dar’us Sifa and 1 Yorumu ve Fırçasıyla Türkiye’de
head doctor, 2 doctors, 2 kehhal, 2 Tarihi Sa÷lık Kurumları , 38th
surgeons, 2 chemists, 1 drug store International History of Medicine
official, 1 steward, 1 doorkeeper, 2 Congress, Editor: Nil Sarı, østanbul
cooks, 1 kasekeú, 4 trustees, 2 2002, p.55.
ferraú, 4 manservants, 2 laundryen 14. There is the list of the recruiting
and a bath attendant in the dar’us staff taken from the ruins and from
sifa on duty. The fees of the the constructions on various areas
personnel were provided from the of the country in handwritten
income of 217 villages, 30 arable manuscripts of M. Cevdet,
field, 2 districts, 7 mills, 2 Seyahatname of Evliya Çelebi and
fishponds, 2 ports, 1 meadow, 2 Tezkeret-ül Bünyan. Ömer Lütfi
farms and 2 islands. Bayat, Barkan published in 1974 the orders
“østanbul Süleymaniye and records in the account books
Darüúúifası”, Ülker Erke’nin that he investigated in the archieves
Yorumu ve Fırçasıyla, p. 55. Ünver in the Topkapı Palace. Aslanapa,
read in Ankara Endowments Head Osmanlı Devri Mimarisi, second
Directorate that the daily wages edition, 2004, p. 220-228.
given in the dar’us sifa were written 15. Today, Süleymaniye maternity
down by Hüsameddin Efendi in the hospital is built on the land of
Sultan Süleyman Hanı Evvel medicine madrasah. Cantay,
Endowment of 1557; 1 chemist, 2 Anadolu Selçuklu ve Osmanlı
80 Bulletin of the Transilvania University of Braúov • Vol. 2 (51) - 2009 • Series VI

Darüúúifaları, p.97. [4]. Bakır, B. Baúa÷ao÷lu, ø., How Medical


16. Cantay, Anadolu Selçuklu ve Functions Shaped Architecture in
Osmanlı, p.97. Anatolian Seljuk Darüssifas (hospitals)
17. Two of the four lion monuments are and Especially Divri÷i Turan Malik
in the garden of østanbul Town Darüssifa, Journal of The International
Hall, one of them is in the park of Society for the History Of Islamic
Courthouse. Cantay, Anadolu Medicine (ISHIM), 10 October 2006,
Selçuklu ve Osmanlı, p.98. p. 64-82.
18. There is a record about taking 4 [5]. Barkan, Ö. L., Süleymaniye Camii ve
temporary manservants because of ømareti ønúaatı, (1550-1557), book I,
the increase in the amount of the Ankara 1972.
mental patients coming to the [6]. Cantay, G., Anadolu Selçuklu ve
asylum in a document dated 1850- Osmanlı Darüúúifaları, Publication of
1851. Ünver, Süleymaniye Atatürk Culture Center Yayını,
Külliyesinde Darüúúifa….”, number: 61, Ankara, 1992.
Vakıflar Journal II, p205, 206. [7]. Erke, Ü., Ülker Erke’nin Yorumu ve
19. The things found in the drilling Fırçasıyla Türkiye’de Tarihi Sa÷lık
study according to Barkan; a Kurumları, 38.Uluslararası Tıp Tarihi
concrete groundwork surface with Kongresi, Editör: Nil Sarı, østanbul,
khorasan mortar of 20cm thickness, 2002.
oak grills put on these, 3 lines of [8]. Evliya Çelebi, Seyahatname, yayın-
fire stones with 2 meters height ayan: Zuhuri Danıúman, cilt 12,
going on narrower with küfeki østanbul 1972, s.202; cilt 10, østanbul
stone until the sub basement. 1970, s.39.
Ö.L.Barkan, Süleymaniye Camii [9]. Kahya, E, Erdemir, A. D., Medical
Ve ømareti ønúaatı, p.49, 50.. Studies and Instıtıons in the Otoman
20. The lion monuments which were Empire, Nobel yayın da÷ıtım a.ú,
sent to Sultanahmet park and public Ankara 2008
building will be taken from here [10]. Kuran, A., Mimar Sinan, Hürriyet
and put back to their original places Vakfı Yayınları, 1.baskı, østanbul
on the corners of the pool in the last 1986.
restoration work of 2009. [11]. Say, Y., Türk Tıp Kurumları,
Türkler, C.11, s.320-347.
Reference: [12]. Terzio÷lu, A., Osmanlılarda Hasta-
[1]. Akyol,T. Ortaylı, ø, Anadolu’da eler, Eczacılık, Tababet ve Bunların
beraberlikten çatıúmaya, Türkler ve Dünya Çapında Etkileri, østanbul,
Ermeniler, Do÷an publications, 2009, 1999.
p.127-132. [13]. Ünver, S., Süleymaniye Külliyesinde
[2]. Aslanapa, O., Osmanlı Devri Mimarisi, Darüúúifa, Tıp Medresesi ve
ønkılap Bookstore, second edition, Darül’akakire dair (1557-1555),
østanbul 2004. Vakıflar Dergisi II, Ankara 1942,
[3]. Aslanapa, O., Türk Sanatı, Remzi s.195-208
Bookstore, østanbul 1984.
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

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 Introduction such as eucalyptus trees (eucalyptus


History of malaria, an infectious globulus) and chamomile were grown up
disease whose notification is obligatory, is in order to wipe out the malaria in the
as ancient as the history of mankind. region. Eucalyptus seeds and medicines
Hippocrates was the first to describe the such as sulfane and physicians were send
manifestations of the disease. He stated from Istanbul to the regions affected by
that malaria was a diseases characterized malaria. Malaria did not only affect the
by intermittent fevers. public, but also, sometimes, it affected the
Malaria is also one of the oldest and the Sultan and the people living in the palace.
most frequently occurring diseases in Çadır Kökü (Tent Pavilion), on the
Thrace. People have developed different shoulders of Muradiye, was reserved for
strategies to recover from malaria. In the the people living in the harem and affected
old times, they tried to repel mosquitoes by by malaria [1].
burning fire and by fuming. During Fight against malaria was continued
Ottoman period, water absorbing plants after the foundation of the Turkish

1
Trakya University, Medical School, Department of History of Medicine and Deontology, Edirne, Turkey
2
Trakya University, Medical School, Department of Physiology, Edirne, Turkey
82 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Republic. In the early years of the republic, Sea coast.


not only malaria but also other infectious It is mentioned that Mustafa Kemal
diseases such as smallpox, trachoma, and Atatürk affected by malaria infection
typhus were widespread in Turkey. during military trainings in Thrace in 1936.
Turkish Republic has placed much In the same year, Thrace Fighting Malaria
emphasis on fighting against infectious Organization based in Edirne was founded.
diseases. However, the first target had been In a very short-time period, the fight
malaria. ”Fighting Malaria Law”, against malaria came a long way with the
numbered 839, was legislated in May 13, support of public. Channels were
1926. In 1928, Malaria Institute was constructed; swamps were drained;
founded in Adana for research and hollows and trenches were filled. Dams
education. Fighting malaria organizations and bridges were built. Humans were
and malaria clinics started to be found in inspected; patients were treated. Table 1
the cities. A malaria hospital was opened and Table 2 show the activities of the
in Adana. Number of malaria centers grew Thrace Fighting Malaria Organization in
to 11 in 1937 and increased to 16 in 1937. 1936 and the numbers of malaria patients
Branches of these organizations were also treated in Thrace in the years 1936-1939,
founded in the neighbor cities and respectively. However, beginning of World
counties. Malaria Field Hospital was War II slowed down the fight against
founded in Aydın. malaria. Large number of people
In this study, we investigate the efforts immigrated and Territory was almost
of Turkish Government in the early years empty of people.
of Turkish Republic (1926-1960) to
control and prevent the malaria disease in Table 1: Activities of Thrace Fighting
Thrace. The next section presents the Malaria Organization in 1936[2]
foundation of the Thrace Fighting Malaria Activity Statistics
Organization and its studies. Number of counties 10
i d
2 Thrace Fighting Malaria Number of villages 137
Organization Number of people inspected 177,744
In the early years of Turkish Republic, Number of patients treated 54,888
malaria was widespread in the cities and Number of people blood 65,933
the villages of Thrace. Thrace Public d
Supervisor, Dr. brahim Öngören, wrote in Amount of free quinine 582
his report about the health conditions of Amount of vitamin 1,680
the population in Thrace: “I discovered
Amount of sulphane used 71,627
many sources of malaria at each part of
Thrace. This is the main health problem of Number of quinine tube used 1,067
Thrace. Çanakkale region, especially Amount of gas used (kg) 1,940
Menderes area, has the same problem”. Amount of pure uranium 100
Malaria was mostly seen in rice-growing d (k )
Amount of wihz solution 290
regions, lakes, and rivers. Gala Lake in
Enez was one of the main mosquito Amount of klesckt solution 3,000
breeding-places. Overflow of Meriç River Number of house and barn 26.678
causes swamps around psala area. In Length of canal opened (m) 21.002
Thrace, Malaria was not only widespread 6.545
Length of drain opened (m)
around Meriç, but also around the Black
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 Members of the Organization of
1937 55489 Thrace Fighting Against Malaria (1952)
1938 59085
ƒ top row, from left to right
1939 54954
Physician of the Edirne Branch Dr. Sacit
Total 206953 Balkan, Physician of the Babaeski Branch
Dr. Ferruh Tepeköy, Physician of the
In 1945, a course was offered by the Saray Branch Dr. Osman, Physician of the
Thrace Fighting Malaria Organization. Lüleburgaz Branch Dr. Kemal, Physician
Total number of person attended this of the Kırklareli Branch Dr. Turhan,
course was 37; 11 of them were women. Physician of the Kean Branch Dr. Fuat
After successfully completing the course, ƒ front row, from left to right
attendees were assigned in the fight against Physician of the Gelibolu Branch Dr
malaria in Edirne. Mustafa, Physician of the Uzunköprü
In the years 1950-1960, fight against Branch, the Director of Organization of
malaria was very intensive. In 1957, a Thrace Fighting Against Malaria Dr. Ratip
National Malaria Eradication Program, a Kazancıgil, Physician of the psala Branch
cooperative undertaking by The World Dr. Zeki Akçol, Physician of the Hayrabolu
Health Organization and UNICEF, was Branch
established in Turkey; organizational
structure was defined. In the new Dr. Ratip Kazancgil, the Group
organization, Dr. Kemal Erdem was Regional Director of Malaria Eradication
assigned as the Regional Director of Program at that time, narrates his
Tekirda Province and Dr. Ferruh Tepeköy experiences on fighting against malaria
as the Regional Director of Kırklareli [3]:
Province. Dr. Ratip Kazancıgil, the
Director of Organization of Thrace “We were fighting against malaria in
Fighting Against Malaria at that time, the whole Trace Region. It was required to
became the Group Regional Director of the collect a blood sample from each suspect
group founded in Edirne. Some of the who was suffering from high body
members of the organization can be seen in temperature. To analyze blood samples
the picture below. Under the National rapidly, mobile medical teams and services
Malaria Eradication Program, a group of were formed. These mobile teams were
malaria fighter was send to Italy for picking up collected blood samples and
training. The group had been trained for a delivering them to central laboratory
month in an institute, called “Istituto quickly. This approach helped us
Superiore Di Sanita”, in Rome. determine malaria patients very fast. Our
84 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

efforts were being monitored by UNICEF Thrace. In the early years of Turkish
Malaria Group who was working at Head Republic, malaria was also widespread in
Office of Fighting Against Malaria at the cities and the villages of Thrace. In
Turkish Ministry of Health. Finally, it was 1936, Thrace Fighting Malaria
decided that fighting against malaria was Organization based in Edirne was founded
successful in Edirne. I, Dr. Erturul Akel, with the aim of eradicating malaria in the
Assistant Adviser at Turkish Ministry of Trace region. The organization achieved its
Health, and Dr. Ferruh Çoruh, General goal with the support of public in a very
Director of Malaria, were invited to short-time period.
UNICEF Head Office of Fighting Against
Malaria in Copenhagen to discuss the References
status of malaria in Edirne. As a result, it [1]. Ahmet Süheyl Ünver and Rıfat Osman.
was decided that malaria was eradicated Edirne Sarayi. Turkish Historical
in Edirne and the yellow dot, the malaria Society Publications.Ankara, 1989.
warning sign, on Edirne was removed from [2]. Edirne Postası. May 11, 1938.
map of Turkey.” [3]. Ratip Kazancıgil. Personal
Communication. April 18, 2006.
3 Conclusions
Malaria is one of the oldest and the
most frequently occurring diseases in
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

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.

«Plato was therefore right to say that to be Ambroise Paré (1510-1590) was the
a true doctor would require that anyone surgeon of King Henry II and his
who would practice as such should have descendants: François II, Charles IX and
recovered from all the illness which he Henri III.
claimed to cure and have gone thought The scene occurs in 1555: when
all the symptoms and conditions on Ambroise Paré (1510-1590), the famous
which he would seek to give an opinion. French surgeon of the Renaissance,
If doctors want to know how to cure crossed in boat a river to go to visit with a
syphilis it is right that they should first horse a patient in the surroundings of Paris,
catch it themselves! I would truly trust his horse gave him “such a kick” that the
the one who did» two bones of his left leg were entirely
Montaigne, Essays, III, 13 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).

1
St-Amand-Montrond, France.
86 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

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
Ambroise Paré (1510-1590) applied over the injury from the available
(Copyright BIUM) 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":

Oeuvres d’Ambroise Paré (1579)


(Copyright BIUM) 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: Albou’s figure
− muscle cramp, so violent that the
bones moved and had to be again pull
to replace the leg in the good way… Ambroise Pare’s invention of a notched
while he said feeling "more pain than splint
first time "
− fever on the 11th day, which lasted a Pare noted that he invented, after his
week, with the appearance of an own experience, “cassole de fer blanc”, or
abscess on which a patch was applied splint, notched heel so that it does not
to help evacuate. touch the bed.

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 Paré’s figure
fragments separated" and promote "the (Copyright BIUM)
generation of callus"
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 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

leg was helping the injured leg, as does a


sister’s hand or a friend’s arm, helping to References
lift, turning in one direction or the other... . [1]. Ambroise Paré, Œuvres, divisées en
vingt-sept livres, revus et augmentés
Conclusion par l’auteur pour la seconde édition. A
Beyond its biographical and anecdotic Paris, chez Gabriel Buon, 1579
interest, this observation informs us about (disponible sur www.gallica.fr)
various aspects of the surgical practice of [2]. Georges Canguilhem, Puissance et
this time. limites de la rationalité en Médecine
It illustrates also Georges Canguilhem’s (1978), in « Etudes d’histoire et de
reflection: “The doctor have to know that philosophie des sciences », Vrin, Paris,
he is a potential patient and he is not better 2002, p. 409.
assured than his patients to succeed, if
necessary, to substitute its knowledge for
its anguish”.
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

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

Ilya Ilyich Mechnikov (1845-1916) and organism, takes a prominent place.


Paul Ehrlich (1854-1915) became the However, a very important transition of
Nobel Prize winners in Physiology or Mechnikov’s-biologist to the field of
Medicine, 1908. They were Nobel Prize studying a human organism’s fight against
awarded «in recognition of their work on causative agents of infectious diseases has
immunity». not been traced back yet, but the step was
Considerable amount of literature is made by I.I. Mechnikov in the very
devoted to I.I. Mechnikov’s life and beginning of the phagocytal theory
activities and at the same time the analysis formation in 1883-1887. I.I. Mechnikov’s
of appearance and formation of the collaboration with the prosectors Nicolay
phagocytal theory idea, which became one A. Stroganov (1843-1894) and Cheslav I.
of the bases in teaching on immunity Chentsinsky (1851-1916) as well as
against infectious diseases of a human discussion of Mechnikov’s reports in the

1
Sumy State University, Ukraine.
90 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

meetings of the physician’s society in I.I.Mechnikov's researches about a role of


Odessa was of great importance. intracellular digestion and protective
The physician’s society in Odessa was function of cells, formed of mesoderm,
formed in 1849. At that age Odessa was a preceded its occurrence.
main commercial port of the Russian In the summer of 1883 VII Congress of
Empire in the Black Sea. The society naturalists and doctors of Russia gathered
united the physicians who worked in health in Odessa and in August, 28th
stations of the city, maritime quarantine as I.I.Mechnikov made the report «About
well as general practitioners and military curative forces of a human organism» on a
doctors. After establishment of general meeting of the congress. Then a
Novorossiysk University in 1865 in victorious road of the phagocytal theory
Odessa some of the teachers of the began.
University became its members. In Odessa, where I.I.Mechnikov lived
In 1867 I.I. Mechnikov arrives in and worked at that time, microbiological
Odessa after his election as an associate researches were started on botany
professor of Novorossiysk University but department of Novorossiysk University by
next year he moves to St. Petersburg the professor L.S. Tsenkovsky, and after
University. In 1870 he returns to Odessa as his departure from Odessa in 1871, they
professor of zoology department of were continued by Odessa doctors G.N.
Novorossiysk University. Minh, O.O. Mochutkovsky, Ch.I.
In 1874 the professor Mechnikov was Hentsinsky, N.A. Stroganov who were full
elected as a full member of the society by members of the physicians’s society in
Grygory N. Mynch’s (1836-1896) proposal Odessa and they reported about the results
who was a chairman of the latter at that of their researches at its sessions.
time. However, his active participation in Thus physicians of Odessa, represented
the work of the society began later and it by the society, were ready for perception
dates back to the 80-ies of XIX century of I.I. Mechnikov’s ideas. On the other
when I.I. Mechnikov formulated clearly hand, Illya Ilyich required a medical
his phagocytal theory as well as entirely audience for discussion of the hypothesis
devoted himself to its proof. put forward by him.
As there could be a birth of this theory On November 26th, 1883 I.I.
immunologist L.A.Zilber tells: « In the Mechnikov made the report «Comparative
summer of 1882 of I.I.Mechnikov with a pathological research on inflammation in
family has a rest in Italy on the bank of the connection with a question on intracellular
Messinsky gulf. Tired sick eyes do not digestion» [2] at the session of the society.
come off a microscope. He observes a life Here he stated the theory of phagocytosis
of mobile cells in a larva of starfishes. The for the first time after his report at VII
larva is transparent and these cells are Congress of Russian naturalists and
perfectly visible. And suddenly there is a doctors.
thought that similar cells should serve in a In March issue of the magazine
human organism for „counteractions to «Russian medicine» in 1884 the “Open
harmful agents”» [1] letter to the professor I.I. Mechnikov» was
It is difficult now to tell how much published by Odessa doctor Semyon
exact L.A.Zilbera's story was, but it is Moiseyevich Shor (1845-1917). He wrote
well-known, that the theory of that doctors listened to Illya Ilyich’s report
phagocytosis arose just in 1882 and with a great interest, but at the same time it
numerous zoological and embryological was necessary to prove that principles of
Y.K. VASYLYEV: Significance Of Physicians’ Society In Odessa In Generation And Formation Of 91
Phagocytal (I.I. Mechnikov’s) Theory
the theory of phagocytosis were applicable most visited and on November 26th, 1883
for infectious diseases of a human when the society heard I.I. Mechnikov's
organism [3]. I.I. Mechnikov did not report «Comparative pathological research
disregard the questions which were put concerning inflammation in connection
before him. with a question on intracellular digestion»,
On May 12th, 1884 the society heard maximum number of visitors for those
I.I. Mechnikov's report «About years, i.e. 69 full members and 16 visitors,
relationship of anthrax bacilli to gathered (in 1883-1887 there were 37-38
phagocytes» [4]. It was his first research full members at the society sessions on the
on medical microbiology problems which average, taking into account that in 1883
at the same time had immunological there were 11 honorary members, 92 full
nature. New proofs of the phagocytal members and 9 correspondent members in
theory rightness were given in his work: it the latter) [9].
was shown that the phagocytosis It is also necessary to notice that
phenomenon naturally occurs among researches with use of medical
vertebrates as well as invertebrates. microbiology methods were performed by
In 1886 I.I. Mechnikov made two more I.I. Mechnikov in the prosectorium of the
reports in the society. The first of them, city hospital along with consultation and
reported on May 17th, was «About assistance of the full member of the
relationship of streptococci to phagocytes» Society doctor of medicine N.A. Stroganov
[5] and the second one, made on October who headed hospital prosectorium since
18th, was «About destiny of micro- 1877. In 1887 I.I. Mechnikov worked in
organisms in blood» [6]. These works were collaboration with the assistant N.
.
further substantiation of the phagocytal Stroganov who was then a military doctor
theory. The debate, caused by those reports in the prosectorium; it was his second job.
in the society, definitely affected the Ch.I. Hentsinsky was studying malaria
subsequent course of I.I. Mechnikov’s causative agents for many years.
work. So, on October 18th N.A. Stroganov Summarising all abovementioned it is
and K.K. Iskersky told dissatisfaction with possible to assert that sessions of the
hypothetical explanation of phagocytes physician’s society in Odessa were the first
role in case of diseases progressing with audience where reports on the theory of
crises. In his reply I.I. Mechnikov spent a phagocytosis, offered by I.I. Mechnikov,
series of new researches and on February were not only heard both at VII Congress
7th, 1887 he represented the report of naturalists and doctors, but also they
«Concerning the doctrine about malaria» were thoroughly discussed, subjected to
[7] and on May 16th in the same year he criticism and it promoted formation and
made the report «About fight of becoming the theory that obtained
phagocytes in case of relapsing fever» [8]. international recognition afterwards. And
The doctrine on phagocytosis was not only full members of the society not only
disproved by supervision over these discussed and criticised I.I. Mechnikov's
infections, but, on the contrary, it received reports, but also assisted in laboratory
a new acknowledgement. researches (N.A. Stroganov, Ch.I.
In all during 1883-1887 I.I. Mechnikov Hentsinsky).
was present at 34 sessions of the
physicians’s society in Odessa and he References:
made 6 reports. The sessions, at which he [1].  .
.   
told about the researches, were among the  . – , 1945. – . 10.
92 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

[2].   ..


!      ". – ,
    ". – , 1954. – #. 5. – . 54-57.
1954. – #. 5. – . 22-30. [7].   ..
! 
[3]. $ .. // %& ! ' . –     ". – ,
1884. - * 12. – .284-286. 1954. – #. 5. – . 58-64.
[4].   ..
!  [8].   ..
! 
    ". – ,     ". – ,
1950. – #. 6. – . 41-59. 1950. – #. 6. – . 91-101
[5].   ..
!  [9]. +/ < = " >?/
    ". – ,  @ " = 1882-1883 . –
1950. – #. 6. – . 63-90. >, 1882-1883. – 23, 211 .
[6].   ..
! 
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

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.

Like in whole world, in Turkey as well contributed in the development of


the proceeding of surgery into a modern Orthopedics and Traumatology in Turkey
appearance has been in the 19th century. is going to be mentioned.
The later separation of orthopaedics and
traumatology from general surgery like
urology, gynaecology and alike fields and Dr. Orhan Abdi Kurtaran (1877-1948)
its becoming as an independent science After graduating from Military Medicine
field has been in different dates and ways School in 1899, he worked as a surgery
in every country. Orthopaedics, dealing assistant with Prof. Reider and Dycke Pasha
with the treatment of the irregularities in in Gulhane Hospital [1]. Dr. Orhan Abdi was
the locomotor system and traumatology, sent to University of Bonn by Sultan
dealing with the treatment of injuries after Abdulhamid in 1900. He got training
trauma have been serving as independent orthopaedics from Dr. Max Shede and
treatments in the surgery clinics until learned the production of orthopaedics
recent years [3]. equipments from Eschaum. Later, he became
The independent science field an assistant of Prof. Hoff in University of
becoming of Orthopaedics and Trauma- Wurzburg (Baviera) and Prof. Sick in
tology in Turkey has been realized by the University of Eppendorff (Hamburg) [3, 12].
efforts and contribution of many respected In 1905, by the order of the Padishah, he
physicians. In this essay, the efforts of the returned to Istanbul and began to work as a
physicians Orhan Abdi Kurtaran, Akif trainer at Gulhane Hospital, “Orthopaedics
Sakir Sakar, Burhaneddin Toker, Dervis and War Surgery” [13].
Manizade and Ridvan Ege who have

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
94 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

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
Fig. no.1. Dr. Orhan Abdi Kurtaran Department, which did not have a clinic
[6]. In 1927-1929, he worked in Hamburg
So, involvement of orthopaedics in University surgery clinic with Dr. Sudeck
medical training began in 1905 with Dr. on bone and joint surgery. Seeing that frac-
Orhan Abdi. At the same year, he used ether tures treatment and orthopaedics was not
in the operations and contributed for sufficient in Turkey, he showed effort to
developing anaesthesia. With the foundation establish a modern orthopaedics clinic
of Medical Faculty in 1909 it was seen that [13].
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 ùakir ùakar (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 Fig.no.2. Akif akir akar
University with Prof. Eiselberg in surgery
E. ATICI, et al: Milestones physicians and their contributions in Turkish orthopaedics and 95
traumatology
Dr. Akif Sakir had three goals; the and worked together with the popular
establishment of the clinic, paediatric surgeons of that period, Brauer and
surgery and orthopaedics becoming a Küttnerfor for 7 years in Berlin and
specialization branch and separating Hamburg [2]. During that period fractures-
paediatrics surgery from orthopaedics. In deformations and injuries were cured in the
1930, the first Paediatric Surgery and general surgery. He specialized in modern
Orthopaedics Clinic, which contained 30 bone surgery. After returning to Turkey, he
beds was founded by him [3]. In 1931, he started to work as an operator and the
became professor. For the first time in clinical director of the surgery department
Turkey, he used visual materials in Cerrahpasha Hospital. Surgery treatment
(photographs and operation images of opportunities were insufficient. Fracture-
orthopaedics patients) in education, also he deformation treatment was mostly done by
always demonstrated patients related with the bonesetters.
lesson [13]. The first book of the clinic Also most of the physicians were not
was published by him in 1936 with the title interested in fracture treatment and plaster
“Paediatric Surgery and Orthopaedics”. structure. He was aware of the lacking
With the aim of acceptance Paediatric points in this field, so he dealt with
Surgery and Orthopaedics as a especially with traumatology [3].
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 Fig.no.3. Dr. Burhaneddin Toker
1995. Also the same association arranged
“28th Akif Sakir Sakar Days” this year. In order to increase the number of
patients, he made friendships with the
Dr. Burhaneddin Toker (1890-1951) policemen who take injured people to the
hospital, and assured that all injured
He began his medical education in around were taken to Cerrahpasha. In a
Damascus Medical Faculty and completed short time Cerrahpasha Hospital started to
in Istanbul in 1910. He went to Germany work as an accident surgery centre. He
in 1913 to make his residency in surgery attained a mobile roentgen device and by
96 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

doing fractures reposition under radio- Dr. Derviú Manizade (1902-2003)


scopy, he released the first conservative
modern fracture treatment in Turkey. After graduating from Vienna Medical
He brought Braun device schema and Faculty in 1932 he began to work in the
measures, which was used in fractures Traumatology Service of the II. Surgery
from Germany and had the smith done it. Clinic in the same place and was preparing
The first surgery journal “Journal of for associate professorship. Prof. Nissen
Turkish Surgery” was published by him in decided Dr. Manizade for the assistantship
1927. would be appropriate. In 1937 he started to
Also, he took the lead in the foundation work as an assistant of Nissen and Toker in
of “Turkish Surgical Association” in 1929 Istanbul. He was established archive
with the aim of improvement in the system for the first time in the clinic
scientific worlds [8, 9, 11]. (1938). He prepared patient follow forms
Subsequent to the "University Reform" and made sure that these forms were filled
in 1933, the world famous German completely and regularly for each patient.
surgeon Ord. Prof. Dr. Rudolf Nissen has During those days fracture-deformation
been assigned as the "Director of the 1st treatment, which was done within the
Surgery Clinic and the clinic was moved general surgery, began to discuss that it
from Haydarpasha to Cerrahpasha. Dr. should be the subject of orthopedics
Burhaneddin Toker was first assigned to branch. After the death of Dr. Toker in
the staff of Dr. Nissen as an associate 1951, Cerrahpasha Surgery Clinic divided
professor; five months later he became into two with the directorship Dr. Kazım
professor. Nissen went to U.S.A. because Ismail Gurkan and Dr. Fahri Arel. In 1960,
of his sickness and Dr. Toker became the Dr. Manizade was appointed to the
director by proxy in 1941 and subsequent directorship of the third clinic and for the
to definitive departure of Nissen, the new first time he gathered the traumatologic
director of 1st Surgery Clinic at Medical cases in one place.
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 Fig.no.4. Dr. Dervi Manizade
Dislocations, Lung Apses.
E. ATICI, et al: Milestones physicians and their contributions in Turkish orthopaedics and 97
traumatology
Between the years 1962-1963 by with colleagues. After presenting his works
combining surgery clinics, one clinic with Professors Committee accepted to establish
six sections was established. One of these a clinic and also accepted Dr. Ege’s
sections was Traumatology Service with suggestion for naming the clinic as
30 beds only for bone-joint injuries and “Orthopaedics and Traumatology”. So, the
orthopaedics cases. Dr. Manizade, who separation of orthopaedics from paediatric
assured its establishment, was appointed as surgery and traumatology from general
a director of this section [10]. surgery and joining them as an
First intrameduller nail implementation independent clinic was realized first in
in tibia fractures was performed by him in Gulhane Military Medical Academy in
1950 [9, 11]. Turkish Orthopaedics and 1961 by him [5]. Also after working with
Traumatology Association has been given Dr. Carroll (New York Colombia
scientific prize in the name of Dervis University) and with Dr. Boyes (Los
Manizade since 2001. Also the same Angeles S California University) on hand
association is going to arrange “8th Dervis surgery, he established first hand Surgery
Manizade Orthopaedics Days” on Clinic in Turkey.
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 Fig.no.5. Dr. Rıdvan Ege
including Trauma into Orthopedics and
separate Paediatric Surgery. To reach this Also he established Mediterranean and
aim first he completed 262 orthopaedic Middle East Orthopaedics and
operations in a year and published these in Traumatology Association (1960), Turkish
Turkish and English. Then he visited three Rehabilitation of Disabled Association
Medical Faculties in Turkey that dealt with (1960), Turkish Orthopaedics and
orthopaedics and four Bone and Joint Traumatology Union Association (1966),
Illness Hospitals to start a communication Modern Surgical Training and Research
98 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Association (1970), Turkish Foundation of ƒ Establish the first


Traffic Accidents (1972), Turkish Hand modern orthopaedics
and Upper Extremity Surgery Association clinic (1955)
(1977). He organized many national and Dr. ƒ Released the first
international congresses. He has 111 Burhaneddin conservative modern
books, 451 papers. Today, he continues his Toker fracture treatment in
works in Ufuk University (Ankara), which Turkey
was established in 1999 by Turkish ƒ Published the first
Foundation of Traffic Accidents. He is the surgery journal
president of board of trustee [4]. “Journal of Turkish
Surgery” (1927)
Table 1. Contribution of physicians to ƒ He took the lead in
Turkish Orthopaedics and Traumatology the foundation of
“Turkish Surgical
Dr. Orhan ƒ First lesson in Association” (1929)
Abdi orthopaedics: ƒ Leaded traumatology,
Kurtaran ƒ “Orthopaedics and cardiovascular
War Surgery” surgery, neurosurgery
(Gulhane Hospital- and anaesthesia
1905) departments
ƒ “Orthopaedics and ƒ The first implementer
Big Surgery of some medical
Operations” (Medical applications:
Faculty-1909) ƒ first systematically
ƒ Used ether in the blood
operations (1905) transformation
ƒ First Clinic: “Surgery ƒ first stomach
and Orthopaedics” resection operation
(1909) (1928)
Dr. Akif ƒ Establish modern ƒ first
Sakir Sakar orthopaedics in implementation of
Turkey Smith-Petersen nail
ƒ Use visual materials (1941)
in education for the ƒ First book on fracture
first time and dislocation
ƒ Establish Paediatric Dr. Dervis ƒ Established archive
Surgery and Manizade system for the first
Orthopaedics Clinic time in the clinic
(1930) (1938)
ƒ Publish first book: ƒ Prepared patient
Paediatric Surgery follow forms
and Orthopaedics” ƒ First intrameduller
(1936) nail implementation in
ƒ Establish Turkish tibia fractures (1950)
Orthopaedics and ƒ Gathered the
Traumatology traumatologic cases in
Association (1939) one place (1960)
E. ATICI, et al: Milestones physicians and their contributions in Turkish orthopaedics and 99
traumatology
ƒ Established with the intensive efforts of Dr. Akif Sakir
Traumatology Service Sakar in 1930. Although it was accepted as
with 30 beds only for a separate branch in 1947, until 1960 the
bone-joint injuries and clinic’s name was Paediatric Surgery and
orthopaedics cases Orthopaedics. The development in
(1962-1963) Traumatology began with Dr. Burhaneddin
Dr. Rıdvan ƒ Established the first Toker and as an effort of Dr. Dervis
Ege “Orthopaedics and Manizade first Traumatology Service was
Traumatology” clinic established within General Surgery. With
(1961) the efforts of Dr. Rıdvan Ege Orthopaedics
ƒ (separation of was separated from Paediatric Surgery and
orthopaedics from Traumatology was separated from General
paediatric surgery and Surgery in 1961 and took the name
traumatology from Orthopaedics and Traumatology.
general surgery and
joining them as an References
independent clinic [1]. Altınta A. Turk Cerrahisinin Onemli
was realized by him) Bir Sahsiyeti: Operatör, Muallim
ƒ Established Orhan Abdi (Kurtaran). Sendrom
ƒ Mediterranean and 1996; 8 (2): 80-85.
Middle East [2]. Arel F. Ord. Prof. Dr. A. Burhaneddin
Orthopaedics and Toker. stanbul klinik Dersleri 1951;
Traumatology 5 (27): 2-6.
Association (1960), [3]. Atıcı E, Atıcı T. The Development of
ƒ Turkish Rehabilitation Orthopaedics and Traumatology in
of Disabled Turkey and Some Results. JISHIM
Association (1960) 2004; 3(5): 50-59.
ƒ Turkish Orthopaedics [4]. Ege R. 80 Yılın Ardından. Vol. 1.
and Traumatology Ankara: Ufuk University
Union Association Publications 2007.
(1966) [5]. Ege R. Opening Speech. XV. National
ƒ Modern Surgical Congress of Turkish Orthopaedics
Training and Research and Traumatology. Proceedings
Association (1970) Book. Publication of Turkish
ƒ Turkish Foundation of Ortopedics and Traumatology Union
Traffic Accidents Assosiation. 1997. p.1-28.
(1972) [6]. Frik F. Turkiye’de Ortopepedi Kuru-
ƒ Turkish Hand and cusu Ord. Prof. Dr. Akif Sakir Sakar.
Upper Extremity Dirim 1958; 33(9-10): 227-228.
Surgery Association [7]. Goksoy E. Ord. Prof. Dr. A.
(1977) Burhaneddin Toker: Türk
Cerrahisine Katkılar. Turkish Journal
Conclusion of Surgery 2005; 21(2): 102-111.
Orthopaedics began to its journey in [8]. Goksoy E. The Biography and Work of
Turkey in 1905 with Dr. Orhan Abdi Prof. Dr. Burhaneddin Toker-On
Kurtaran by getting its place in the Occasion of the 50th Anniversary of
medicine training and got its first clinic
100 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

His Death. The New History of lerlemelerin Tarihi. stanbul: C


medicine studies 2001; 7: 387-409. Publisher; 1988. p. 338-343.
[9]. Manizade D. 65 Yıllık Cerrahpaa [12]. Naderi S, Hakan T, Dinc G. Orhan
hastanesi. stanbul 1976: 82. Abdi Kurtaran ve Ameliyatı-
[10]. Manizade D. Kemik ve Mafsal Cerrahiye adlı Eserindeki Norosirurji
Travmatolojisi. In: Kırık Çıkıklar. ile Ilgili Bolumler. Turkish Journal
Vol 1. stanbul: Publication of of Neurochirurgia 2006; 16(3): 197-
Cerrahpasha Medical Faculty, no: 202.
119, 1983. p.1-21. [13]. Tanacan H. Turk Ortopedisinin
[11]. Manizade D. Ortopedi ve Tarihcesi I. Acta Orthop Traumatol
Travmatoloji. In: Unat EK, editor. Turc 1993; 27: 151-159.
Dünyada ve Türkiye’de 1850
Yılından Sonra Tıp Dallarındaki
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

SILICOSIS DISEASE HISTORY IN


EXPLOITATION OF COAL IN JIU VALLEY
1 2 3
M. FULGA , V. ANDREESCU , D. LUPULESCU1,

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.

Introduction Historical aspects


Jiu valley is the region located in the The human being has been an energy
south of Hunedoara County, at the border consumer since the primitive epoch.
among Transilvania, Banat, and Tara The coal has been known and used
Romaneasca, region generic called “the since antiquity. In 1113 started the first pit
country of the black diamond due to the coal exploitation from Europe, officially
exploitation of the pit coal deposit. This registered in Kerkrade, at the border
area started to be known since 1782 when between Holland and Germany. In 1183
layers of coals burning were noticed and the first coal mining exploitations were
those layers burnt much time after this. also opened and officially registered in
Although in Jiu valley there were rich England near Sheffield, after this appeared
deposits of coal, the interest for natural coal those from Durham, and in 1921 those
raised considerably just in the 4th decade of from Walles. The coal was for a long time
the 19-th century, as a consequence of the the only source of energy, it was used at
request of fuel, this request being a result of the beginning as domestic fuel being the
the development of the capitalism and also only source of heating in houses, after a
due to the extension of the internal and while the coal started to influence the
external market. international economy.

1
Institute of Public Health Bucharest
2
County Public Health Authority Hunedoara
3
University of Medicine and Pharmacy “Carol Davila” Bucharest
102 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

The facts are mentioned in the work started at the end of 18-th century and the
“The coal research history from ancient beginning of19-th. The first works were in
times till 1900” written by A Semaka, 1835 followed by those from 1840 done by
published in the Mine magazine, 13 in Hoffmann brothers and Carol Maderspach,
1962, also in the one written by N. the owners of mines from Rosia Montana.
Maghiar – ‘From the history of exploit- The Maderspach brothers made exploitta-
tation and using of mineral coals “public- tions in Jiu Valley and they were the ones
shed in Mine Magazine nr 21 from 1971. who put the basis, develop and improved
The 19th century was metaphorical the rudimentary mining coals the likely
defined the “coal” century. The increasing areas could be Petrosani, Petrila, their
needs of energy used by the society led to work was continued in the 6-th decade of
the discovery and exploitation of new the 19th century.
energy sources (petrol, natural gases, In 1896 Hoffmann Rafel, made a serial
hydro electric power and atomic power of coal analyses of the coal extracted from
etc.), without eliminating the coal as a Lupeni, he reached the conclusion that this
source of energy. coal belonged to the group of pit coal with
Moreover, the coal production increased long flame and weak agglutinated. He
also in other countries, the coal mining being showed the difference between the coal
different regarding their type, structure of the from East part of Jiu Valley and the ones
coal layers. The most important coal mining from Lupeni, which contained a higher
is the pit coal mining these contains coking value in carbon and less in oxygen .The
coal used in chemical industry. The coal coal was used as raw material, as domestic
mining containing brown coals and lignite fuel, later as a development of exploitation
are composed of superior coals used as fuel. industry the coal was used as raw material
An inferior type of coal is peat coal; this is for energetic industry (hydro and energetic
frequently used in the North Europe, Asia power) metallurgy, iron and steel industry,
and North America. The most profitable coal afterwards was used in chemical industry.
mines are those of surface as they are in Ger- As a consequence of the crisis and because
many. In USA the coal is extracted from coal many vacancies were eliminated, after
mines in average of 50 % and in C.S.I. (The 1990 the coal exploitation industry decrea-
Independent Community) in average of 35% sed much being replaced by other sources
Europe was on the first place regarding of energy which are, more profitable,
the universal production of coal, but the sources like petroleum or natural gases.
production decreased more than 50 % About the beginnings and the
around 1980, nowadays Europe produces development of mining in general and
just 1/3 from universal production. especially of Jiu valley was much written
C.S.I. is known as one of the greatest beginning with 1964 some works being as
coal manufacturer in the world and it has follows: ” Ion Lungu, 1964: “The begi-
in stored about 2/3 of the universal nning of the development of coal mining in
reserves of coal and from these 90% is Transilvania”, Acta Musei Napocensis)
located in Asia zone. and “Aspects of the beginning of industrial
In our country the first discoveries of revolution from Valea Jiului mining
natural coal were made in 1771 in Doman, (Sargetia V, 1968: In these works was
in 1788 in Secul and in 1790 in Anina by described miners’ work and life conditions
Nicolae Hammer. The first exploitments from JIU valley and the history of
started in 1792 at Steierdorf-Anina. In our exploitation and the usage of coal from old
country the development of coal mining 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 – Furthermore, during 1857-1858 the
inert-war period. (Fig. no. 1). 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
Fig.no.1 marinescu studies on 24 samples of coal
from the mines described in the work ‘Piscu,
The work “Custom and continuity in Aninoasa,Petrosani- Est”.
the country – the stone which burns” is a Other pieces of work in which is concluded
monography of the mining in Jiu Valley, that Jiu valley has superior coal are the works
followed by the history of the Jiu Valley of the professor Ghe. Macovei- “Course of
with the social and artistic development of general geology and stratigraphy” another one
the area, the customs and also the is written by Ion E.Bujoiu “Encyclopedia of
evolution of death rate due to the Romania “written in 1939.
occupational disease as a consequence of The studies made by Wartha Wincze in
the exposure to the coal dust (fig. nr 2) 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
Fig.no.2 because of inhaling coal dust started to rise.
The quantity of dust, in the absence of
In the work “Consideration regarding the the means of control, rises in accordance
coal usage in Romania” by Ion E Bujoiu and with the quantity of coal extracted.
‘What is taken from coal” by I. Simionescu, Statistics from 1968 showed that during
are presented diverse aspects related to the the last two decade, in Romania were
development of the mining industry in declared 24000 cases of illness of silicosis.
connection with the social and economical Over 80% were among the personnel of
conditions from Transilvania and Banat. mining industry.
104 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Regarding the existence of pneumo- the average of life was 42, today the
coniosis of ore coal were a lot of debates. incidence decreased at 1-0,5% and the
Some considered the coal as an inert average of age increased at 50.8 years.
gas which is stored in lung and it could An estimation made before 1975 presented
cause just a weak fibrosis called black lung that from 100 ill people 24,9% have worked
disease (anthracosis) which has the exclusively in coal extraction (and these were
opposite effect of the dust from barren with black lung) 40,8% who worked in
gangue that led to silicosis a serious combined environment with stone and coal
illness, irreversible with lethal end (due to were ill with pneumoconiosis due to mixed
the high level of quartz). dust and 34,3% who worked just in quarry they
There are different consequences when we were ill with silicosis. Regarding the
talk about the place of work in a coal mine. classifying of silicosis grade there can be em-
The miners from mines of barren gangue phasized the following percents: the first phase
exposed to the dust rich in silicon (sillicium) -84.4% the second 9,9% and the third 2,8%
can get ill with classic silicosis and the ones Beginning with the setting up of the
who work in mines of coal will be ill with commission of silicosis in Petrosani and
black lung. Between the two pure types there the establishing of the criterion declare the
are also mixed ones, encountered to those illnesses the silicosis and black lung started
who work with stone and coal. to decrease. The level of dust decreased so
During 1950-1970 the level of dust was that the number of cases of silicosis
of 32, mg/mc air, and the ratio of working disease is much rarer.
places which were exposed to a higher To sum up the morbidity of the personnel
level than the maximum admitted doze was which is hired nowadays in mines from Jiu
of 63%. During 1982-1996, as a Valle, in comparison with the past? Decrease
consequence of mechanization and the very much due to the mechanized
improvement of the work environment the technology used now in mines.
level of dust decreases at 25 mg/mc.
When we want to establish the risk of References:
getting ill because of dust in a working place [1]. Badea L. – Valea Jiului, Ed. tiinific,
we must take into consideration 3 factors: the Bucuresti, 1971, p.7-26.
type of dust, quantity, and the dimension of [2]. Baron M. – Crbune i Societate în
particles. In each mine the risk is different Valea Jiului, Ed. Universitas
and it is in accordance with the technology of Petrosani, 1998.
exploitation used, types of work and the [3]. Baron M. – Tradiii i continuitate în ara
operations done during the cycle of work In «Pietrei care arde», Petroani, 1994.
the same time the introduction of [4]. Darlea G. - Antracoza, Ed. Favior &
mechanized working in cutting and evacuate Vidra, Ortie, 1992.
the coal led to an increase of the level of dust [5]. Fodor D., Baican, G. – Situaia actual
in mining mechanized excavations, so it a mineritului românesc, Rev. Univers
appears “the second wave” of illness and by ingineresc. nr. 11/2002 si nr. 12/2002
black lung. For this were taken measures [6]. Fodor, D., Baicon, G. – Impactul
against of the dust and the number of industriei miniere asupra mediului,
diseases and their frequencies to decrease. Ed. INFOMIN, Deva, 2001.
If between 1953-1996 the statistics [7]. Mocanu C., Tufescu V. – Depresiunea
showed that there were 2420 cases of disease Petrosani, Ed. tiinific Bucureti,
due to inhaling of coal dust in Jiu Valley and 1964, p.11.
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

SOME CONTRIBUTIONS OF ROMANIAN


MEDICAL SCHOOL IN THE TREATMENT
OF NEUROSYPHILIS BEFORE THE
DISCOVERY OF ANTIBIOTICS

S. GĂBREAN1

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 necropsies but also, for the first time, on
Treponema pallidum, which is 5-15Qm in sections from small fragments of brain
length and less than 0.3Qm in thickness. obtained by the surgeon I. Jianu from a
This organism is generally sexually patient with progressive paralysis.
transmitted through mucosal membranes or The various manifestations of syphilis
small lesions of the skin. T. pallidum can are time dependent. Acquired syphilis has
be observed by silver stain, immuno- four stages: primary, secondary, latent and
fluorescence, with dark-field, phase- tertiary. Neurosyphilis refers to a site of
contrast or electron microscopy. In 1913, infection involving the central nervous
after centuries of discussions concerning system and may occur at any stage of
syphilis, H. Noguchi, a Japanese scientist, syphilis. There are four clinical types of
demonstrated the presence of T. pallidum neurosyphilis: asymptomatic neurosyphi-
on sections from the brain obtained at the lis, meningo-vascular syphilis, general
necropsy of a patient with progressive paresis of the insane and tabes dorsalis.
paralysis, proving that T. pallidum was the Before the treatment with antibiotics,
cause of the disease. Short time afterwards, neurosyphilis was observed in 25-35% of
in the same year, Gheorghe Marinescu patients with syphilis. General paresis, also
together with his assistant I. Minea, known as dementia paralytic is a severe
confirm this discovery and identify T. manifestation of neurosyphilis, which
pallidum not only on sections from occurs approximately 20-30 years after the

1
Faculty of Medicine, Transilvania University of Braov.
106 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

initial infection with Treponema pallidum but directly into the spinal canal or brain.
and represents a chronic progressive He asked a former student, surgeon Ion
fronto-temporal meningo-encephalitis with Jianu, to do some small trepanations of the
especially psychiatric symptoms [6, 12]. skull (it has to be mentioned that I. Jianu
Syphilis has been a major health had never before worked on living brain);
problem since the XVIth century and was using these entries, Gh. Marinescu injected
treated with some ineffective remedies Neosalvarsan directly into the brain of the
(guaiacum, mercury and others) until the patients with dementia paralytica, but he
beginning of the XXth century, when didn’t obtain good results.
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 Fig.no.1.
dementia paralytica by malaria inoculation
(1917), J.Wagner-Jauregg was awarded As it was mentioned above, Treponema
with The Nobel Prize for Medicine in pallidum was identified in the brain of
1927. Malariotherapy was followed by general paralytics in 1913 so, in 1910, Gh.
either Salvarsan or Neosalvarsan as Marinescu was only suspecting the
adjuvant therapy [1, 10]. presence of the spirochete in the brain of
In our country, a number of medical these patients. In order to destroy the
personalities showed interest for the spirochete, Marinescu introduces
treatment of syphilis: Gh. Marinescu, C. Neosalvarsan by intraspinal injections
Levaditi, M. Ciuc, C. I. Urechia, Elena directly into the cerebrospinal fluid, but
Pucariu-Densuianu and their co-workers. once again without the desired results, the
At the beginnings of Romanian medical drug being irritable and caustic for the
education, the first reference concerning nervous tissue. Together with his assistant
syphilis prevention was made by Carol I. Minea, Marinescu realized at the
Davila in his doctoral thesis sustained on Pantelimon Hospital an original method of
23 February 1853, thesis which was treatment for general paresis, which was
entitled “Syphilis prophylaxis” [3]. based on injecting salvarsanized serum
Gh. Marinescu was one of the first into the cerebrospinal fluid. The serum was
physicians in the world who received obtained from patients with syphilis who
(1910) from Ehrlich the small doses of were injected with an important quantity of
Salvarsan, which he managed to prepare in Neosalvarsan. After a few hours, were
order to be tested in the great hospitals of taken 40-50 ml of blood from which the
the world [9]. If Salvarsan produced serum was obtained after coagulation; this
healing in some forms of syphilis (skin serum contained both a very small dose of
syphilis, for example), in neurosyphilis Salvarsan and the syphilis antitoxin
(tabes, general paresis) it gave no results. produced by the organism. Injected to the
Gh. Marinescu tried to introduce patients with general paresis, this serum
Neosalvarsan into the body not by showed good results, even curative
intramuscular or intravenous injections, properties [5].
S. GXBREAN - Some contributions of romanian medical school in the treatment of neurosyphilis
107
before the discovery of antibiotics
After two years, in 1912, two American showed inability to tolerate the bismuth.
physicians, Swift and Ellis publish the As a consequence, it was preferred a
same method of treating neurosyphilis with combined treatment, based on alternating
salvarsanized serum. Although Ehrlich bismuth salts with Salvarsan [2, 7].
himself, the discoverer of Salvarsan, In Romania, the artificial infection with
mentions at a medical congress held in malaria (malariotherapy) was successfully used
Königsberg in 1913, the world priority of in the treatment of neurosyphilis. The method
Marinescu’s researches regarding the was simple and consisted in the intravenous or
intraspinal injection of the salvarsanized subcutaneous injection of blood taken from a
serum, the discovery is attributed to the patient presenting a malarial attack; on average,
two American physicians, who later in 8-10 days, the patients had malarial attacks
recognized that the paternity of treatment and after 10-12 attacks they were given quinine
was belonging to Gh. Marinescu. and Salvarsan.
However, they were saying that they had The principle of treating neurosyphilis
“improved” the serum, improvement by impaludation was based on the high
which meant putting into phials the fever which, probably, nonspecifically
salvarsanized serum and commercializing inactivated T. pallidum and generated a
it worldwide. There were also complex neuro-immuno-endocrine defense
disapproving opinions regarding the and repair reaction of the body.
treatment with salvarsanized serum, being Malariotherapy was performed at Socola
considered that “it is a complicated Hospital in Iai under the direction of M.
method, and if sometimes may have a Ciuc, at the Psychiatry Clinic of the
more or less curative effect, it still does not Faculty of Medicine in Cluj under
represent a preferable treatment or a Professor’s C.I. Urechia direction, at the
progress in the treatment of nervous Neurological Service of the Institut for
syphilis” (C. I. Urechia) [12]. Mental, Nervous and Endocrine Diseases
from Bucarest [11].

Fig.no.2.
Fig.no.3
In the 1920s, Constantin Levaditi and
Robert Sazerac introduced bismuth A special attention should be accorded
therapy. For the treatment of neurosyphilis, to the researches made at Socola Hospital,
bismuth therapy was done as in the case of the second internationally acknowledged
visceral or skin syphilis, taking into centre for pyretotherapy, after Horton
account possible accidents like stomatitis, centre from England. At first, only
intestinal problems, jaundice etc. Plasmodium vivax was used in treating
Generally, bismuth drugs seemed to have neurosyphilis, being considered relatively
good results. There were patients who safe and easy to control by quinine. After a
reacted very well at this therapy and there few years, in 1925, Plasmodium
were also cases in which the patients
108 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

falciparum was used, first at Horton center permanente de malariatherapie et


and soon afterwards at Socola Hospital. d’etudes experimentales sur le
The team working here under the direction paludisme (Institut Rockefeller) de
of Professor M. Ciuc, general secretary of Socola, Jassy, Roumanie, jusqu’au
the International Commission of Malaria 31/12/1933, Societe des Nations,
for the League of Nations (1928-1938) also Organisation d’Hygiene, Commi-
used in its researches indigenous strains of ssion du Paludisme, Geneve, 1934.
Plasmodium malariae, thus having an [5]. Floda L., Marioara G. Marinescu,
important contribution to knowledge of the Radovici. A.: Gheorghe Marinescu,
sporogonic cycle of malaria parasites [4,8]. Ed. Tineretului, 1958, 244-246.
C.I. Urechia recommended for the [6]. French P., Gomberg M. et al: IUSTI:
treatment of neurosyphilis pyretotherapy 2008 European Guidelines on the
using intravenous injections with beer yeast, management of Syphilis, Internat. J.
which were painless and induced the required of STD & AIDS, 20, 2009, 300-302.
high fever (39,6-410C). The method was [7]. Levaditi C.: Bismuthoprévention de la
easily applicable and seemed to produce an syphilis, Volume jubilaire en l’honneur
important improvement, especially in the case du Professeur G. Marinesco, Institut
of general paralysis [12]. d’Arts Graphiques E. Marvan
A special interest for neurosyphilis also Bucarest, 1933, 395-400.
showed Elena Densuianu-Pucariu (1875- [8]. Lupacu G., Constantinescu P., Negulici
1966), the first woman in the world professor E. et al: Parasitological and Clinical
at a clinic of ophthalmology. She had better Investigations on Infections with the
established the share of syphilis in the VS Romanian Strain of Plasmodium
etiology of ocular diseases and was one of the malariae Transmitted by Anopheles
first authors in the world who concluded that labranchiae atroparvus, Bull. Wld.
malariotherapy had no curative effect in the Hlth. Org., 38, 1968, 61-67.
optic nerve syphilis [12]. [9]. Marinescu G.: Corespondena (1889-
From this short presentation, one may 1938), Ed. tiinific, Bucureti,
conclude that in a difficult socio- 1968, 99-100.
economical context, the Romanian medical [10]. Rudolf G. de M.: Recent advances in
school managed to come with important, therapeutic (induced) malaria, J.
even original contributions in the treatment Neurol. Psychopathol., January
of neurosyphilis until the discovery of 16(63), 1936, 239–255.
antibiotics. [11]. Paulian D.: Les résultats de la
malariothérapie dans le Service
Bibliography Neurologique de L’Institut
[1]. Austin S., Stolley P., Lasky T.: The des Maladies Mentales, Nerveuses et
History of Malariotherapy for Neuro- d’Endocrinologie de Bucarest,
syphilis, JAMA, 268(4), 1992, 516-519. Volume jubilaire en l’honneur du
[2]. Bittner J.: Paul Ehrlich, Ed. tiinific, Professeur G. Marinesco, Institut
Bucureti, 1971, 128-133. d’Arts Graphiques E. Marvan
[3]. Brtescu G. Tinereea lui Carol Davila, Bucarest, 1933, 537-538.
Ed. Albatros, Bucureti, 1979, 113-117. [12]. Urechia. C. I., Mihlescu S.: Tratat
[4]. Ciuc M., Ballif L. et al: Note du de patologie neuro-mintal, Ed.
secretariat resumant un rapport sur le Lepage, Cluj, 1928, 491-502.
progress des travaux de la station
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

LAZZARO SPALLANZANI, IN
TRANSYLVANIA DRIVE

A. MUSAJO SOMMA1, L. MUSAJO SOMMA 1

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.

Science enlightment geographic exploration and scientific


Collecting rare and ancient objects or traveling opened the pathway to famous
things of aesthetic value, both natural scientists’ work. At the edge of XVIIIth
and man-made, became very popular in century Antonio Vallisneri (1661-1730),
European culture in the fifteenth and Italian physician and biologist - a
sixteenth centuries. These centuries scholar at Bologna University with
witnessed the birth of Kunst und Marcello Malpighi (1628-1694) -
Wunderkammern “Rooms of Art and appointed to the chair of Practical
Wonders” in which the aim was to Medicine at the University of Padua,
collect objects of astonishing originality wrote:
which would stir and amaze visitors, as
well as preserve the memory of “Many have observed and many still
Antiquity - indisputable aesthetic canon expect to observe, but not everyone has
also for the modern. observed well, and others do not know
Naturalia that is nature byproducts - how to observe, nor perhaps do they
even if featured as monsters - and know how tricky the art of observation
Artificialia that is human artifacts, is, easily misunderstanding one thing
stimulated the common sense of for another, being blinded by the light,
observation and, most important of all, or not looking with due attention and
scientific interest and curiosity. diligence at what is to be looked at”.
Those collections were the very start
of natural history museums: tools for He was one of the first researchers in
scientific research and cultural and medicine to reject the Aristotelian
social development. New technologies, theories and he started the collection

1
ACTI Department, University of Bari, Italy
110 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

which is one of the best examples of He was educated at the Jesuit


those scientific gabinetti (laboratories) College and studied law for three years
which turned to be university research before getting frustrated and
laboratories where the experimental dissatisfied. He then turned his great
method in which Galileo was a master, hunger for knowledge to science. He
became daily practice for scientists. became a biologist and physiologist,
Padua, Pavia, Bologna, and Modena at studying body functions and the
different periods in the XVIII century unknown wonders of the natural world.
bloomed with the discoveries of their He also studied philosophy and
brilliant teachers and philosophers. mathematics and discovered that
microbes can move through the air and
Biography can be killed by boiling. Almost a
In the very shadow of the Northern century later, Louis Pasteur (1822-1895)
Italy institutions of learning, Lazzaro studied and then expanded his work, and
Spallanzani (1729-1799), another Italian got many of his ideas from Spallanzani.
researcher, was keenly interested in the The Italian scientist studied many topics
natural sciences and over his lifetime and stated that digestion is a chemical
collected numerous specimens of process and not just the grinding of
animals, minerals and other natural food. He was first to do an artificial
objects. insemination of a dog. He wondered
He became a priest and eventually why a stone skipped over the water
professor of natural history at Pavia, when it was thrown.
and was an enthusiastic traveller in In 1768 an offer by Empress Maria
pursuit of specimens for the natural Theresa, then ruling over Austrian
history museum there as well as for his Lombardy, to give him the chair of
home private museum in Scandiano. 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
Fig.1. Spallanzani marble statue in his circulation contained original and
home town Scandiano, Italy important observations. By his work on
A. MUSAJO SOMMA, et al: Lazzaro Spallanzani, in Transylvania drive 111

respiration he first showed the real seat Domenico Sestini of Florence (1750-
of combustion. Spallanzani was a 1832), crossed the Romanian area
Fellow of the Royal Society of London during the Century of Light almost in
and a member of the Academies of the same years when Maria Theresa’s
Prussia, Stockholm, Gottingen. son and previous co-regent Joseph II
The first known exploration into (1741-1790) was running the empire.
ultrasound physics happened in the In August 1785, at the end of
1790’s. Lazzaro Spallanzani wondered university lessons, Lazzaro Spallanzani
why bats could navigate at night and sails from Venice to Constantinople. In
catch insects as they flew. He the places he visits, he studies plants
blindfolded them and they still and animals, weather, the life and habits
manoeuvred very well. He then plugged of those populations. He comes back
their ears and found that they bumped travelling on land so he visits some
into obstacles. He concluded that their mines and collects minerals in
primary mode of navigation was Transylvania, in the salt pan of
hearing. He deduced that they must emit Salzburg, in the gold and silver deposits
ultrasound waves that are inaudible to of Zalatina, in the Carpathian
humans and listen to the echoes to metalliferous mountains. On December
determine distance and direction of 7th , 1786 he arrives in Vienna and rich
objects. This idea was received by his collection of minerals will be delivered
fellow scientists with ridicule and to his university town one year later.
scepticism.
After the French army under Transylvania experience
Napoleon invaded Italy in 1796 On August 16 th , 1786 Spallanzani
Spallanzani was offered the position of left Constantinople asking for the
professor of natural history at Paris but permission to go back home through the
he declined because of his advanced Transylvania drive to allow a deeper
age. On February 11th 1799, three days knowledge of mines and the natural area
after an attack of apoplexy, having of Carpathian region.
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 Fig.2. Spallanzani drive
Maiolino Bisacioni (1582-1663),
Francesco Griselini (1717-1783) and the He comes back travelling on land so
“Astrologer” Lazzaro Spallanzani, as he he visits some mines and collects
was called by his scholars after he minerals in Transylvania. The deep
showed an early penchant for desire to visit new geographic areas and
astronomy. to learn as much as possible prompted
Also another Italian naturalist, Lazzaro Spallanzani to travel back from
112 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Constantinople joining the carriages of Spallanzani arrived there in the evening


the prince of Walachia for a safer trip of 7 th September while a cold eastern
and to save money. Indeed he had wind was blowing across the area. Not a
already collected by Baron Sperges and word he wrote on his trip from
the Austrian government a huge amount Kronstadt to Hermannstadt (Sibiu) -
of money, worth 100 Venetian sequins, under the military protection of 30
through Baron of Herbert in soldiers offered by Ospodaro
Constantinople. Mauroceno - where he arrived on 12th
On August 27th the caravan crossed September.
Donau River and stopped in Skiera- He visited the salt mine of
Ollenza, in Walachia. Simplicity of life Saltzbourg (Witazna) and gold and
and a sincere hospitality welcomed the silver deposits of Zalatna, where he
Italian scientist. Women are almost arrived, crossing through Portu, on 24 th
dressed as in the Ottoman area and September, in the metalliferous
Bulgaria but their face is not covered by mountains very well known since
any clothes. Crossing the village of ancient Roman time.
Valek-Negest he was surprised to detect In that geographical area and near
that people was dark skinned and Alba Iulia many illegal coin minters - an
curiously, dark skinned women were not ethnic group called Moti - were working
at all beautiful and their breasts were as outlaw gold dealers and moreover
pendulous offering from time to time a “they know how to mint gold coins of
bare-thorax to the visitors eyes, “but the best quality and having the right
they do not smell at all”! weight”.
After 12 nights he was forced to rest Moti lived in very miserable
in the carriage, he arrived on August conditions and Spallanzani was very
28th in Bucarest where he was hosted by impressed by their skin chronic ulcers
the prince Ypsilandi for five days. clearly related to advanced clinical
Indeed that nobleman was an employee syphilis: a terrifying map of typical
of the realm, temporary nobility granted open ulcers was covering all over their
only to collect duties and local taxes, body.
according to the arhondology’s laws. The Italian scientist underlines that
Spallanzani visited the salt mines of in the Turkish area he was unable to
Hani-Hanik and collected a huge detect such big amount of venereal
amount of minerals. On the 5 th of diseases’ skin tags. Moreover he states
September he started his trip towards that in the Moti villages there were
Kronstadt (Brasov) and the day after he almost no children, clearly relating
stopped in the lazaret of Buza. Nearby advanced syphilis to impossible
the Bodza River a lazaret was open for pregnancies.
quarantine every time plague was In Transylvania, the Walachi were
affecting people living in or crossing about 1 million people; other inhabitants
through Constantinople. The Empress were Hungarians - the land owners -
Maria Teresa forced people crossing the Siculi, Saxons, Germans, Armenians,
borders to Transylvania to stop 3 or 6 Greeks (mainly merchants) and
weeks in Buza lazaret if infection was Bohemians. These were Gypsies
affecting the Ottoman area. classified as musicians, handcraft
Corona or Kronstadt was only seven workers and Egyptians - that is gypsies
hours travelling from the lazaret and working around and “mainly thieves”!
A. MUSAJO SOMMA, et al: Lazzaro Spallanzani, in Transylvania drive 113

He left Transylvania for the Banat Vienna. The acquisition of exhibits


region and he arrived to Temeswar on proved congenial to the most
the evening of 14th October when a magnificent Museum of Natural History
stormy weather and rain offered to the at University of Pavia. A great amount
Italian biologist an awful welcome. He of natural history material items were
will report the poor quality of air collected in Spallanzani private museum
because of several ponds and local in Scandiano, his hometown. The
people affected by intermittent fevers. preservation of his private collection
Transylvania is left and Vienna was a responsibility of his sister
welcomes the Italian scientist on 7 th Marianna, a single woman who offered
December 1786. a great strength in the early attempts to
His hodoeporic writings about the preserve the items. She gained
scientific tour through the eastern experience in taxidermy and in the
European countries were printed only a preservation of stuffed-skins allowing a
century after his death. satisfactory preservation of the
collections.
Conclusion Difficult Mountain passes, floods and
Spallanzani, in all his life as well as torrents, brigands and cut-throats, mines
in his Transylvania drive, took a inspection to collect more specimen
necessary and decisive step away from allowed to set up a unique natural
scholastic Aristotelian natural science collection and the written
philosophy, with its sterile metaphysics records by Spallanzani feed social
and reputed reluctance to value history information and therefore the
laboratory experience. Laboratory tools wider world of individuals and
joined Spallanzani’s travels and his researchers interested into medical
studies reoriented the research of natural history.
sciences away from the world of
common sense observation and made it References
rigorously measurable and testable. [1]. Ellenberger F., Ovide et la géologie,
Beyond the stones, he collected Travaux du Comité Français
through the Romanian area biologic, d’Histoire de la Géologie, 3 e série, t.
ethnologic, medical and social notes. V, n° 3, 1991, pp. 17-24.
A great biographer, as great as a [2]. Ferrone V., I profeti
botanist, the Transylvanian academician dell’illuminismo. Le metamorfosi
Emil Pop (1897-1972) paid his tribute to della ragione nel tardo Settecento
the extraordinary personality of the italiano, Laterza, Bari 1989, p. 446.
Italian savant printing in 1942 a study [3]. Generali D., Antonio Vallisneri. La
of great erudition related also to figura, il contesto, le immagini
Spallanzani personality. In the storiografiche, Olschki, Firenze
supplement of Emil Pop’s paper, as 2008.
published in Timisoara in 1942, there is [4]. Musajo Somma A., Musajo Somma
also a list of 60 different minerals L., Italian doctors cruising on the
collected by Spallanzani in the region. Bosphorus, Proceedings 38 th
Three big cases of minerals were International Congress on the
dispatched, on Spallanzani order, by the History of Medicine (Istanbul 2002),
Zalatna mines’ inspector, Immanuel Ankara 2005, vol. 2 pp.1009-1012.
Will by ship along the Donau River to [5]. Pop E., Naturalitii italieni din
114 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

veacul al XVIII-lea, cercettori ai percorso interpretativo tra carteggi


inuturilor româneti (Italian e diari di viaggio, Teorie e pratiche
naturalists of the 18th century, dell’esperienza scientifica. Lazzaro
researcher of the Romanian land) Spallanzani e le scienze della natura
Timisoara, 1942. nel Settecento, “La sfida della
[6]. Roman V., Notes from Lazzaro modernità” Atti del Convegno di
Spallanzani’s travel to the Studi a cura di W. Bernardi e P.
Roumanian lands, Comptes Rendues Manzini, Olschki, Firenze 1999.
XXII International Congress ISHM [10]. Maiolino Bissaccioni i rzboaiele
(Bucarest 1970), 1972, pp. 261-262. civile din Moldova (Maiolino
[7]. Spallanzani L., Viaggio in Oriente, a Bissaccioni e le guerre civili in
cura di Naborre Campanili, Bocca Moldavia), Arhiva Societii
Editori Torino, 1888. tinifice i Literare (A.S.S.L.) di
[8]. Vaccari E., Lazzaro Spallanzani: Iai, 1892: 645-651.
une naturaliste italien de dix- [11]. Cltoriile lui Domenico Sestini în
huitième siècle et sa contribution Muntenia, 1779 (I viaggi di
aux sciences de la terre, Travaux du Domenico Sestini in Valacchia,
Comité Français d’Histoire de la 1779), Arhiva Societii tinifice i
Géologie, XI, Paris 1996, pp. 72-89. Literare (A.S.S.L.) din Iai, 1893:
[9]. Vaccari E., Spallanzani e le scienze 571-589.
geologiche del Settecento: un
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

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

On the 15th of April 1939, the report Romania. After ending his secondary
upon the proceedings of the Cantacuzene studies at the Lyceum of Turnu Severin, he
Commission for the study of Medical enrolled himself at the Faculty of Medicine
Folklore was submitted by the Belgian in Bucharest, where he finished his
prof. Tricot – Royer at the yearly General university curriculum in 1906 and obtained
Assembly of the International Society for afterwards in 1909 his PHD magna cum
the History of Medicine (I.S.H.M.), held in laude. The subject of his thesis was: “The
Paris under the presidency of the Anasplasties of face and head.”
Romanian prof. V. Gomoiu. Between 1914 and 1942 he took up a
Who was the third president of the I.S.H.M.? successful surgical career and a lot of new
How important was that Commission? procedures inherited his eponyme. He also
invested himself within the field of
Short biography of Prof. Victor medico-social assistance programs. He
Gomoiu [1, 3] became Ephore of the public hospitals of
Victor Gomoiu was born in 1882 in Bucharest in 1920 and 1921 and thereafter
Vinju Mare (district of Mehenditi) in from 1926 on he was appointed as trustee
1
Univ. Leuven, Univ. Antwerpen (Belgium).
116 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

of the “Princess Ileana” charitable fund connection with the I.S.H.M. In 1929 prof.
(“Aezmintele A.S.R. Principesa Elena”) Gomoiu founded the Romanian Society for
and also he became a relative of the the History of Medicine under the high
Romanian Royal Family. After the Second protection of Princess Ileana [6].
World War he was blamed for it. Within the I.S.H.M. he shaved more and
In 1927 Gomoiu founded in a poor more ambition: he became national delegate
neighbourhood in one of the suburbs of of his country in 1928, attended the Congress
Bucharest, Bariera Virgului, a hospital of Oslo (1928) and Rome (1930) and
complex, Princess Ileana, on behalf of the organised his own congress in Bucharest
most unprovided patients. Shortly from the 10th to the 18th of September 1932
thereafter this establishment became the [8, 18]: a successful manifestation with the
“Children Hospital Victor Gomoiu”, still in participation of the most famous historians of
activity nowadays. that time like e.g. the doctors and the
Gomoiu obtained plenty of official duties in professors Sigerist, Singer, Diepgen,
the Ministry of Health and became at least Rolleston, Neuburger, Süheyl, De Lint,
Minister of Health from July to September Jeanselme, Tricot-Royer, Castiglioni, and
1940, but he resigned quickly to not undergo so on. The wife of the congress president,
the military- fascist dictatorship. Between 1940 Mrs. Viorica Gomoiu, acted as general
and 1950 he devoted himself only to his secretary of it.
surgical and medical-historical activities. From In 1933 prof. Gomoiu was elected vice-
1950 to 1954 he was imprisoned during 60 president of the I.S.H.M. and president in
months by the regime for political purposes. 1936, to the deep annoyance of the then
Nevertheless in 1956 the communist Minister acting Secretary General, prof. Maxime
of Health suggested him to accept a position at Laignel-Lavastine, who also competed for
the Center for Health Organization and the this position, but who statutory could not
History of Medicine, but he refused this offer obtain it [16, 17]. In this connection
which he viewed as a form of collaboration Gomoiu would write in 1939 at the end of
[15]. He died in Bucharest in 1960, almost his mandate: “To believe to be hated by
forgotten by everyone. someone you love, is a more unendurable
pain than mourning for his death”. [13].
Doctor Gomoiu and the History of Laignel-Lavastine resigned and was
Medicine replaced by prof. Jules Guiart (7). This one
Already as student Gomoiu disposed of had particular links with Romania. As
an important personal library, where as professor of Parasitology and of History of
well medical as philosophical and Medicine at the University of Lyon, he
historical works were assembled. In 1923 concluded a special agreement as titular
he published a first important medico- professor of History of Medicine, of
historical book: “The History of Medicine Pharmacy and of Medical Folklore at the
and of Medical Teaching in Romania.” [4]. University of Cluj (23), founded in 1919,
In 1927 he sent to the French prof. and within the professors were chosen by an
Laignel-Lavastine, secretary-general of the University Commission with the represent-
very young I.S.H.M. (founded in 1921) the tatives of the two Romanian universities,
abstract of a communication he wanted to existing at that time: the one of Bucharest
represent at the VIth congress of this and the other of Iassy. Guiart was teaching at
association in Leiden and Amsterdam: the medical faculty of Cluj between 1921
“The first traces of Physicians in and 1930, the year within he was replaced by
Romania” [5]. That was his first his assistant, prof. Valeriu Bologa (1892-
J.-P. TRICOT: Victor Gomoiu and the Cantacuzène-Commission 117

1971), originating from Braov. contribution of medical folklore from an


Within the I.S.H.M., prof. Gomoiu was etymological, historical and medical point
not conspicuous by his sense of diplomacy, of view [12]. He drew the attention that,
and he took a lot of initiatives without the from an ethnological point of view, the
approval of his bureau and of his folklore documents his adepts upon the
administrative council. way, man was feeling or thinking in the
Prof. Guiart confirmed there were course of ages. It increases the number of
sometimes troubles within the bureau. He characters which permit establishing
wrote the following comments (14):: “I resemblances and differences among the
told him (= Gomoiu) firmly that the nations, and so new appreciation – criteria
President has no rights to make some are acquired upon their degree of
propositions without the preliminary superiority and culture. For his part, the
approval of the Bureau. Otherwise he historian, comparing the different kinds of
exposes himself to what happened to him: folklore with each other, can more easily
his proposals are not voted. He has no deduce the relationships between the
right to owe someone a grudge for it, nations he is studying and consequently the
because with having the right to vote, we moving of their migration. As for the
got the duty to vote, not with the purpose to physician, he often discloses in the popular
please him, but conscientiously! “ practices the germs of the most modern
The mandate of Gomoiu ended therapeutics.
normally at the beginning of 1940, but, due On the other hand, very curiously, that
to the Second World War, his successor, same medical folklore was not hold back
prof. Laignel-Lavastine could only begin as a theme at the IXth Congress of the
his term in 1946, because during the I.S.H.M., organized in Romania in 1932. It
conflict, all activities of the I.S.H.M. were was only a delay, because during the next
interrupted [16]. congress, the Cantacuzene Commission
was born. The topics of the Bucharest
Medical folklore and the congresses Congress were: “The Evolution of
of the I.S.H.M. Medicine in the Balkanic countries” and
The proposal to create a commission “Defence of Europe against the pest”.
with the purpose to study medical folklore This last theme was the subject of the very
was formulated by prof. Gomoiu in last posthumous publication of prof.
September 1935, during the Xth Tricot-Royer [22].
International Congress for the History of
Medicine and has been approved The Cantacuzene Commission
unanimously. Previously during the VII th This commission was baptized
Congress of the I.S.H.M. in Oslo in 1928, “Cantacuzene”, after the name of a famous
prof. Gomoiu showed his interest for this Romanian physician, bacteriologist and
aspect of medical history, submitting a professor, Ion Cantacuzino (1863 – 1934),
paper entitled: “Medical Folklore in founder of microbiology and of
Romania”. On the occasion of the next experimental medicine in Romania. He
congress, the VIIIth one in Rome in 1930, was even Minister of Health, Work and
prof. Castiglioni from Padua, enumerated Social Security [9].
the two sources of medical folklore: the Although he has published nearly
magical conception common to all nothing about History of Medicine,
primitive people and the experience [2]. Gomoiu proposed him as second president
As for him, prof. Gomoiu described the of the Romanian Society for the History of
118 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Medicine. In his funeral oration, Gomoiu medical folklore in Belgium (21). He made a
will say about him: “Our president, distinction, on the one hand between
creator of his own history and also of mystical folklore with the invocation of God,
others, passed himself into the history”. the Holy Mary or the Saints specialized in
In a letter of the 21th of October 1935, the cure of some illnesses, and on the other
written to prof. Tricot-Royer (10), hand empiric folklore in which the Belgian
founding president of the I.S.H.M., thus a popular remedies, originating from the fauna,
short time before becoming himself the flora or of the third kingdom are
president of the I.S.H.M., prof. Gomoiu described. His research works lead him to
specified the work to be done by the contact all the parish priests of the whole
members of his commission: country, to give him all the useful
The first question that had to be asked was information of that purpose.
how to draw the bibliography of medical At the beginning of 1936, Gomoiu
folklore and of folklore generally spoken in considered the possibility to create either
their respective country that means the names an International Academy for Medical
of the authors, their works, the specialized Sciences, with a special section devoted to
journals, the institutions, etc. Then the medical folklore, or an “Academia
question of standard forms comes to collect Demoiatrica“ (Academy for the study of
the folkloristic material, which can be the folklore), independent of the I.S.H.M.,
discussed some months afterwards. Firstly the but his projects were never realized.
names of the pathological entities have to be The Romanian physician distinguished
discussed as they are designed by the 4 categories of folklore:
peasants of the different countries and their 1. the original or primitive folklore;
clinical pictures, so that people can conclude 2. the altered original folklore either with
to their synonymy and compare their foreign contribution or with borrowing
treatments. For each country a card of the from scientific medicine;
territories, where the different denominations 3. the folklore adapted to the new times;
or treatments are used, has to be established. 4. the folklore completely based upon
Prof. Tricot- Royer, nominated as scientific medicine and practised by
president of this commission, was the people without any qualification.
Belgian delegate, whereas prof. Gomoiu Before being presented to the General
became the secretary general and delegate Assembly of the I.S.H.M. in 1939, a part
for Romania. The commission included also of the report of the Cantacuzene
Mrs Gomoiu, the doctors Bologa from Cluj, Commission has been already published
Laignel-Lavastine from Paris, Giuart from by prof. Tricot-Royer in Brussels:
Lyon, Thaller from Zagreb, Süheyl from “The Medical Folklore in the Balkan
Istambul, and Ali Mihali from Albania. Area” [20] with a survey of the works of
It is not astonishing that the tandem, Prof. Süheyl (Turkey), Gomoiu
Tricot-Royer – Gomoiu, was the most (Romania), Stoianoff (Bulgaria), Ali
important pivot of this commission, Mihali (Albania) et Thaller (Yugoslavia).
because these two scholars have already This last one, prof. Lujo Thaller, would
published a lot of papers concerning the preside in 1938 the XI th Congress of the
medical folklore in their respective I.S.H.M., the last one before the Second
country, and because they respect each World War, where two themes were
other for many years. discussed: “The mystical medical folklore
Concerning it, prof. Tricot-Royer had “and” Flora, Fauna and Minerals in popular
already made a through inquiry upon 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- specific flora of Dacia, throwing a light upon
ther commission he set up within the I.S.H.M., the medicinal properties of some plants.
concerning the teaching of medical history
On the other way, Gomoiu established
within the different countries of the world [15].
During 10 years, from 1928 on (VIIth that, ignorant the real cause of illness, people
congress of the I.S.H.M. in Norway) until attribute it to God, to the devil and to other
1938 (XIth congress of the I.S.H.M. in invisible genies, and the treatment will
Yugoslavia), medical folklore played a include incantation and conjuration tricks.
preponderant role among the topics dealed Besides it, the Romanian people owns a
with. Even after the Second World War the traditional medicine, deprived of each
Romanians continued to show their interest supernatural element, constituted on one’s
for that subject. In 1970, during the 2 own found, increased with scientific
Congress of Bucharest (the 22 of the contributions. During a: the centuries,
I.S.H.M.) presided by prof. Bologa, and withoriginal practices and imported ones
Dr Manoliu and Dr Brtescu as general mingled, but these last ones, either of an
empiric or of a scientific nature, were
secretaries, “The scientific value of folklore”
was one of the main topics [16]. In 2009, atmodified or adapted according to the tastes
the VIIth Balkanic Congress for the History and the preferences from people adopting
of Medicine, justice was again done to the them. Gomoiu believed that in Romania the
popular Romanian Medicine. medicine with supernatural involvement and
empirical medicine play an even important
The contribution of Prof. Gomoiu to the part, but in most of the cases, one is being
study of Medical Folklore serving as an assistant to the other. Plenty of
In the beginning, the members of the examples of the prescience of our modern
Cantacuzene Commission proceeded to medicine were given by Gomoiu.
make a survey of the folklore material of
each respective country. In this paper we Conclusion
limited ourselves to the work of prof. The importance of the Study of Medical
Gomoiu [12]. Folklore didn’t get past the historians of
During all times, the inhabitants of medicine during the decade before the
Romania were acquainted with a kind of Second World War. The contribution of
medicine, as well empiric as religious. the I.S.H.M., of her third president
Before the arrival of the Romans in Dacia Gomoiu and of her founding president
(actually a region in South-East of Europe, Tricot- Royer is far from being negligible.
on the left bank of the Danube, Prof. Gomoiu can be considered as an
corresponding to the actual Romania), the emblematical and exemplary figure into
inhabitants knew on an empiric way the the study of the History of Medicine,
properties of medicinal plants. About 500 particularly in the study of medical
years before Christ, when he conquested all folklore, as well on a national as on an
these peoples, Darius already observed the international level.
curative properties of many sources in that
region. The Romans conquered the country References
between 101 and 107, and erected many [1]. Baran D., personal communication,
altars and monuments in honour of 22/06/09
Aesculapios and Hygia. Dioscorides, [2]. Castiglioni A., Le folklore médical,
physician of Greek descent, accompanied quoted by Tricot-Royer J.J., o.c., 1936
those Roman legions, and studied the [3]. Dutescu B., Victor Gomoiu, french
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summery, p. 244-258 in: Victor [15]. Manoliu V., The report of Victor
Gomoiu (258 p.) Ed. Medical, Gomoiu at the XIth International
Bucuresti, 1970 Congress for the History of Medicine,
[4]. Gomoiu V., Din istoria medicinii si a Zagreb-Belgrade, 1938, on the State of
invantamintului medical din Education in History of Medicine in
Romania, Bucuresti, 1923 Various Countries. P.301-306 in:
[5]. Gomoiu V., Les premières traces de Proceedings of the 37th Congress on the
médecine en Roumanie, p. 293-295 History of Medicine, (Burns C., O’Neill
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23/7/1927), (De Lint J.G., éd.), [16]. Tricot J.P., Esquisse Historique de la
Anvers, 1929 Société Internationale d’Histoire de la
[6]. Gomoiu V., Societatea Regala Romana Médecine/ Historical Sketch of the
de Istoria Medicinei, p. 5-17 in: Analele International Society for the History of
Asezamintelor A.S.R. Principesa Elena Medicine/ Boceto Historico se la
(112 p.), Cultura, Bucuresti, 1932 Sociedad Internacional de Historia de la
[7]. Gomoiu V., Biographie (de 1870 à Medicina (35 p.), ISHM, Galveston, 2000
1932) de Jules Guiart (1870-1965) , [17]. Tricot J.P., La Société Internationale,
p 45-48 in Gomoiu V., o.c. fille de la Société Française d’Histoire
(Analele), 1932 de la Médecine, Histoire des Sciences
[8]. Gomoiu V. et Gomoiu V., Neuvième Con- Médicales, 37 (3): 357-366, 2003
grès International d’Histoire de la Méde- [18]. Tricot-Royer J.J.: Le IXème Congrès
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(Romania), 10-18 septembre 1932, 794 Bucarest (1932) – Comte Rendu:
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[10]. Gomoiu V., Letter sent on 21th [20]. Tricot-Royer J.J. : Le folklore
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[11]. Gomoiu V., Letter sent on 21th April faits, 1937-1938
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[12]. Gomoiu V., La médecine populaire 52, Lisboa, 1938
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Royer, 1937-1938 s’est-elle défendue contre la peste?, La
[13]. Gomoiu V., Letter sent on 9th May Roumanie, 11 p., Le Scalpel n 30, 1951
1939 to prof. Tricot-Royer (pers. coll [23]. xxx: La Faculté de Médecine de
of the author) l’Université «Roi Ferdinand le Ier»
[14]. Guiart J., Letter sent on 28th de 1919 à 1928. Cluj (Roumanie-
December 1938 to prof Tricot-Royer Transsylvanie), 48 p, 1928.
(pers. coll. of the author)
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

MEDICAL AND TOXICOLOGICAL


ASPECTS IN ARTHUR CONAN DOYLE’S
WRITINGS

O. MUREùAN 1, 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.

After graduating from the Edinburgh meantime, he also dedicated himself to


University in 1881 with degrees of writing, an activity he had always felt
Bachelor of Medicine and Master of drawn to. While in Southsea, he created
Surgery, Arthur Conan Doyle practised the famous sleuth Sherlock Holmes, who
medicine for about ten years before giving first appeared in the novel A Scarlet in Red
up his first occupation to become a full- (1887). The author acknowledged that the
time writer. He turned to medicine again celebrated detective was actually inspired
only during the Boer War in South Africa by Dr. Joseph Bell, a professor at the
where he volunteered as a surgeon. His University of Edinburgh whom Conan
public support of the British policy in this Doyle admired for his remarkable skills of
war led to his being knighted in 1902. observation, logic and deduction in making
Conan Doyle’s experience as a a diagnosis, which helped him identify not
physician started with two sea voyages as a only the disease, but also the patient’s
ship’s surgeon (to the Arctic on a whaling occupation and character.
boat in 1880 and to the west coast of Besides the detective stories which
Africa in 1881). made him famous, Conan Doyle’s vast
After that he practised medicine shortly literary work includes historical novels,
in Plymouth and then opened his own science-fiction stories, plays, romance
practice in Southsea resort, where he novels, poetry and reality-based texts,
gained reputation as a good practitioner. In revealing a complex versatile writer with
1885 he was awarded an MD degree by the various interests and concerns. Later in his
University of Edinburgh. life, the author became interested in
Conan Doyle obtained a diploma in spiritism and travelled the world to deliver
ophthalmology in Vienna in 1890 and then lectures on this topic.
opened a practice in London. In the Critics have often presented Conan
1
“Iuliu Haieganu” University of Medicine and Pharmacy, Cluj-Napoca
122 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Doyle as an unsuccessful physician, in [8, 11]


spite of evidence which shows the Significant for Doyle’s scientific
contrary. Rodin and Key argue that in fact curiosity is the publication in the British
“he left the practice of medicine not Medical Journal (1879) of a letter
because he was a failure, but because he presenting his self-experimentation with
was so successful that it interfered with his gelsemium. “Gelseminum as a Poison”
writings.” [11] contains a detailed description of the
Although Conan Doyle’s scientific experiment in which he tried to find out
medical writings are few in comparison “how far one might go in taking the drug,
with his literary work, they reveal both his and what the primary symptoms of an
keen interest in the medical research of the overdose might be”. One of his
time and his potential for becoming a conclusions was that “the system may
renowned medical professional. learn to tolerate gelseminum, as it may
Publications related to infectious opium, if it be gradually inured to it.” [11]
diseases indicate Doyle as a supporter of At the end of the 19th century, when
compulsory vaccination to prevent Conan Doyle practised medicine, old
smallpox, which at the time aroused public methods of treatment were still in use,
opposition, and of inoculation for the whereas new, more scientific and rational
prevention of typhoid fever. On the other ones emerged. The most dramatic
hand, he was the first to draw attention to improvement occurred in the field of drug
the hasty world-wide use of tuberculin as a therapy, with a strong reaction against
cure for tuberculosis in 1890, after overdosing, a practice that had been in use
analyzing its effects and the pathological for centuries. An analysis of Conan
changes in lung tissue. [6, 7, 11] Doyle’s work, concepts and knowledge of
Medical bacteriology, a science that diseases suggests that he was familiar with
was just emerging at the time, was another and followed the new trends in medicine.
field where Conan Doyle’s insights into Thus, an examination of the drugs referred
the pathology of infectious diseases were to in the canon of Sherlock Holmes (fifty-
remarkable. Thus, for example, he six short stories and four novels) would be
predicted the eradication of bacterial conclusive.
diseases several generations in the future The drugs and chemicals mentioned in
and in 1883, as a general practitioner, the Canon include alkaloids, ammonia,
wrote that many human diseases were amyl nitrate, belladonna, chloroform,
caused by bacteria, whereas at the time cocaine, curare, ether, hormones, mor-
only a few were identified to be so. phine, opium, prussic acid, snake venom,
Given his humanistic formation, Conan and strychnine. This is the highest number
Doyle sustained causes related to the need of drugs that has appeared in a series of
for physical and psychological well being. detective stories [11]. Several poisons are
Thus, for instance, he supported mentioned as well, but in most cases their
vivisection as an important means to nature is not specified.
alleviate human suffering. [9, 11] According to Rodin [10], drugs are
Conan Doyle was described as being used for several purposes in the Canon: for
“ethical and compassionate” in all aspects treatment (e.g. ammonia and brandy to
of his life: as a doctor and writer, in his revive someone who has fainted, amyl
private life and public activities, and a true nitrate for catalepsy, morphine for pain);
“Renaissance Man” with vast knowledge for simulating disease (e.g. in “The Dying
and active interest in various areas of life. Detective” Holmes placed belladonna in
O. MUREAN et al: Medical and Toxicological Aspects in Arthur Conan Doyle’s Writings 123

his eyes to produce dilated pupils, as are plinary attempt to write stories combining
those of a dying person); for poisoning his literary talent and imagination with
(e.g. curare in “The Sussex Vampire”, knowledge and good research skills in the
strychnine in The Sign of Four); to induce field of medicine and other related
anaesthesia (e.g. ether and chloroform); for sciences.
addiction (cocaine, morphine, opium). To conclude, although Sir Arthur
The most medical story in the Canon is Conan Doyle changed his first profession
considered to be “The Resident Patient”, as a physician to that of full-time writer, he
where both Holmes and Watson continued to show interest in medicine.
demonstrate an understanding of the Moreover, the influence of his medical
medical practice. Alcohol is presented not training and experience on his work and
as an addictive drug but as a favorite activities also contributed to the
medicament in the Canon. For instance, in recognition he received as an author even
“The Engineer’s Thumb”, Watson uses during his lifetime. Although his second
brandy and water as a painkiller, and in profession was the one that brought him
“Blue Carbuncle”, brandy is given to the fame and fortune, he was always proud of
hotel attendant as a stimulant. Holmes also being a physician: “The title I value most
makes use of his knowledge of chemistry is that of ‘Doctor’, which was conferred by
to solve crimes, such as in “The Naval your self-sacrifice and determination”, he
Treaty”. The most fanciful use of poisons wrote in a letter to his mother. [2]
in the Canon appears in “The Devil’s In the article The Romance of Medicine,
Foot.” The hallucinatory and lethal effects he also stated that “a medical training is a
of “devil’s-foot root” described in this most valuable possession for a man, even
story seem to have no correspondence in if he did not afterwards engage in practice”
the pharmacopoeia or in the literature of [4], a belief that has been shared by other
toxicology. [5] ““Radix pedis diaboli” ... renowned writers and artists throughout
has strange properties … it stimulates the time.
those brain centres which control the
emotion of fear and … either madness or References
death is the fate of the unhappy native who
is subjected to the ordeal by the priest of 1. Baring-Gould WS. The Annotated
his tribe.” [1] Billings believes that in this Sherlock Holmes, 2 vols. Clarkson N.
way Conan Doyle might have deliberately Potter, New York 1967.
attempted to “divert prospective users of 2. Bendiner E. Elementary My Dear
poisons by switching the type of one lethal Doctor Doyle. Hosp Pract 1982,
alkaloid for another.” [3] 17:180-212.
Conan Doyle’s heavily annotated 3. Billings H. The Materia Medica of
Pharmacopoeia [3] (containing, in the Sherlock Holmes. Baker Street Journal
margins, brief summaries of detailed 2006, 56(3): 37-46.
topics, directions for preparing medication 4. Doyle AC. The Romance of Medicine.
and descriptions of effects of drugs on the Lancet 1910, 2: 1066-8.
human body) appears to have contributed 5. Jones KI. The Sherlock Holmes
to the accurate presentation of drugs Pharmacopoeia: Being an
mentioned in the Canon and other literary Examination into the Uses and Effects
works. This evidence accounts for the of Drugs and Poisons in the Sherlock
professionalism the physician writer Holmes Stories. Oakmagic Books,
employed in approaching the interdisci- Weston-super-Mare, England, 2002.
124 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

6. Lycett A. The Man Who Created débat actuel. Med et Hyg 1985, 43:
Sherlock Holmes: The Life and Times 1996-7.
of Sir Arthur Conan Doyle. Free Press, 10. Rodin AE. The Nature and
New York, 2007. Significance of Drugs and Poisons in
7. Markel H. The Medical Detectives. N the Sherlock Holmes Canon. Calabash
Engl J Med 2005, 353(23): 2426-8. 1982, 1:42-49.
8. Owen AH. Doctor Behind the 11. Rodin AE, Key JD. Medical Casebook
Supersleuth. Br Med J, Oct 1977: 33- of Doctor Arthur Conan Doyle: From
57. Practitioner to Sherlock Holmes and
9. P.H. William Osler et Arthur Conan Beyond. Robert E. Krieger Publishing
Doyle contre les antivivisectionnistes: Company, Inc. Malabar, Florida, 1984.
quelques leçons de l’histoire pour un
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

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
Haydarpaa Military Hospital, Zeynep Kamil Hospital, Demirkapı and
Haydarpaa 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.

Introduction. administered by a French man Sade de


The history of surgery in our country is Calliére. After establishment of this
in parallel with the West. Nevertheless, it institution, opening in 1839 the Military
is generally accepted that Islamic world Medical School began to offer special
had advanced in surgery comparing it with surgery classes. By the way, distinction
the West in the middle Ages. For instance, made between doctors and surgeons in
Ebul Kasım Zehravi’s (X-XI centuries) Military Medical School ended in 1892.
work, Cerrahiyet-ül Haniye, was In 1890’s, the new generation doctors,
noteworthy at that time. who owned modern surgery apprehensions
Treatment and surgery of the eyes in and techniques through their observations
the Ottoman period, was conducted by and experiences at the abroad, started to
professional experts, “Kehhals”, and take over the profession in the hospitals of
surgeons were never involved in Istanbul. That means those old generation
operations. medicals out of modern comprehension on
Till mid 19th century the profession medicine and their collaborators, the old
was the arena of barbers, bonesetters, surgeons without antisepty knowledge
circumcisers and the dressers, in way were discharged. Emergent surgeons with
transferring the skills from father to son. their new label, the operators, discarded
The emergence of surgery as a school old devices of wooden-handle tools and
based profession was in 1827 through the medical dressing kits composed of mohair,
establishment of the Cerrahhane-i Amire, balm, sponge and mush. Putting exported
which was a military organization modern devices and sterile materials into

1
Istanbul University Istanbul Faculty of Medicine.
126 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

use they also change the image of the Medical Association. After having deemed
operations. In this way, modern surgery worth of honorary professor in ordinary by
occurred initially in Istanbul then after Istanbul University, he passed away
extended to whole country and western because of pneumonia in 1958.
innovations at surgery were transferred by Having a social and sympathetic
new European style surgeons such as personality Cemil Pasha drove an effective
Cemil Pasha and his friends. and attracting surgeon portrait in early
Looking to his biography we coincide years of Turkish surgery through putting
with a fast, attractive and amazing life. forward the truths that was based on his
professional observation and instinct. His
Biography performance of educating is arguable.
Born in March 6 in 1866 in stanbul, Moreover, he tried to make a carrier on
Cemil Pasha graduated from Medical High politics as well.
school of Çengelkoy in Istanbul in 1881. In According to his grandson, Topuzlu
1886, as a young captain he completed was fully an action men. He never deviated
Military Medical School ranking first in from the right way in his occupations as
class and began to work in Military surgeon, dean, mayor and ministry of
Hospital of Sütlüce Kumbarhane Military public work and when he realized that the
Hospital. He was officially sent to Paris things were halting or locked, he preferred
and served at Tillenx and Péan clinics and resigning or directing himself new fields
after his return he became assistant of rather than waiting to see what would
Aristidi Pasha in Military Medical School. happen.
In 1894 he started giving lecture as a Surgery was the most long-lasting and
professor and in two years time he was the most popular identity of him. Indeed,
promoted from lieutenant colonel to he was indebted all of his reputation
general. Following his surgery service for gained in his life to the operations that he
wounded in war at Yıldız Hospital, in 1897 made successfully.
he was appointed to the membership of Attending Just-Lucas Championniére’s,
Tıbbiye-i Mülkiye and Sıhhiye-I Lefort’s, Trelat’s, Guyon’s, Tillaux’s and
Umumiye. After his membership to Péan’s surgery operations and lessons in
Turkish Medical Association in 1902, he France he got a certificate thanks to Péan’s
was granted marshal degree by the Sultan close attention and sympathy devoted to
Hamit in 1905. Cemil Pasha was the first him. During 1890- 1911, when he was at
dean of the Medical Faculty of Ottoman the peak of his carrier, Cemil Pahsa
University and also was a professor at the worked at the surgery clinics of
Surgery Clinic I in that school. Both of Haydarpaa Military Hospital, Military
these two services came to an end in 1911 Medical Faculty and Civil Medical Faculty
and he continued his civil life as a mayor of Haydarpasa.
and later lieutenant governor of Istanbul. It Apart from his official duties he
is worth mention here that during his operated a private office in Istanbul and
period, the city of Istanbul met with even he made operations at patient’s home
automobiles for the first time. Despite his but “medico-social” objections deterred
resign from official jobs in 21 November him to follow this path. He worked also
1914, he became mayor again in 1919 and Zeynep Kamil and ili Etfal Hospitals at
moreover he was assigned minister of the same time and continued his operations
public works at this time. In 1945 he was in Egypt at summers. In addition to his
elected as a honorary president of Turkish contribution of asepsis and antisepsis and
H. ERTIN et al - Ord. Prof. Dr. Cemil Topuzlu (1866-1958) and his contributions to Turkish surgery127

anesthesia with chloroform Cemil Topuzlu suture is presented.


provided pyloroplasty, scapula-torasik 3- Scientific Surgery and painless
amputation and caesarian section. delivery translated from Crener and
Moreover his contributions to surgery can Conbet. The book of 318 pages deals with
be counted as follows: anesthesia in surgery and gynecology.
1. Stitching of cut arteries while blood Despite its a translation Cemil Pasha
stream goes on. included his own original observations and
2. An apparatus easily sterilized in methods
hemorrhoidectomy 4- Systematic appendisectomy on
3. A genuine technique in “Z” plasty of terminal phase appendicitis, presentation
Achilles tendon. made in 15 December 1936 at French
4. Clamp for circumcision, clump for Academy of Surgery
suturing technique 5- Is circumcision beneficial to health?
He brought institutionalization of Presented at the meeting of Turkish
internship at the faculty, publishing Medical Commission in 30 January 1934
operation statistics and researches at 6- Senile spots, presentation made in
national and international level and the Turkish and French in 18 April 1944 at the
membership to international associations conference held by Turkish Medical
into his country. Association
He retired officially from surgery when 7- Tongue Cancer presented at the
he was 80 but went on giving conferences meeting of Turkish Medical Association in
publishing articles, working in his clinics. 2 February 1937.
In his article “Preventive measures before
the operation”, he mentioned that it was Apparatus invented by Cemil Pasha
not just sufficient to obey “asepsis and 1- Clamp that can be fixed on pinpoint
technique operatoire”. “The history of of Reverdin needle and that provides
surgery in our country” in 1943, “How the operating deeply It was published in Presse
surgery progressed just in 50 years” in Médicale in 03.02.1932.
1947 were the two most important article 2- A specific apparatus for holding and
of him that is shedding light on the history pushing hemorrhoids and tying them off
of modern surgery in Turkey. In addition the body
to these he wrote several articles about 3- Clamp for circumcision
medicine, surgery, municipal works and
educational matters in newspapers and A Memory From Cemil Topuzlu
journals. Pasha
First published in 1951, in his book
Other works “My Memories of 80 years in Autocracy-
1- Clinical Instruction of Surgery Constitutional Monarchy and Republican
(Seririyat-ı Cerrahiye), published in 1897 Period” Cemil Topuzlu narrated his several
in stanbul, with 107 pages and 155 case precious observations and memories about
presentations the periods of Sultan Abdulhamid II and
2- Memories and Medical Observations Constitutional Monarchy in the Empire.
(Mémories et observation médicales), The memory below cited from this book.
Published in French in 1905, stanbul. “I am operating on an Albanian in a
Having 196 pages, the most specific aspect house in ehzadebaı. Besim Omer Pasha
of this book is its first chapter in which chloroformed the patient while Suleyman
Cemil Topuzlu’s own invention the artery Numan Pahsa was assisting me. In the
128 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

room only another Albanian, close relative We remember him with respect.
of the patient and swordsmen of the Sultan,
was standing. When the operation was References
about to finish, patient’s respiration and
pulse stopped suddenly. Besim Omer [1]. Ada, ., Prof. C. Topuzlu’nun Meslek
Pasha mentioned in French “we have lost Hayatına Ait Hatıralar, Vatan Gazetesi.
the patient”, hearing this fact that the 15.04.1953
swordsmen who understood also French, [2]. Enis, R., eyhületibba Meslek Hayatını
went out and yelled the bad news at the Anlatıyor, Cumhuriyet. 28.10.1953.
outside. In a moment all relatives of the [3]. Gürkan, K. ., Cemil Topuzlu. Türk
patient gathered in front of the door and Tıp Cemiyeti Mecmuası, 5.04.1958
shouted: “If you can not save our patient den aynı baskı.
we all are going to kill you”. Meanwhile [4]. .Ü. stanbul Tıp Fakültesi. Deontoloji
we were striving for artificial respiratory. ve Tıp Tarihi Anabilim Dalı Arivleri.
We tightly shut the door and hilled table Lexicon. Cemil Topuzlu Dosyası.
and chairs behind the door. We told them [5]. Kadıolu, S., Türkiye’de Cerrahi
their patient had not died and not to baffle Devrim. Doktora Tezi Tıpkı Basım
us through coming inside the room Salık Bilimleri Enstitüsü .Ankara.
otherwise we could not going on the [6]. Kavur, Ekrem. ., Askeri Hekimliin
operation. Under this condition, we made Sıhhiye Hizmetlerinde Bir Etüd, Dirim,
an effort about 20 minutes and saved the No.8. s. 376.
patient from an absolute dead. That is to [7]. Namal. A., Ö. Öncel., A. Demirhan
say we also survived with patient. Erdemir: Ülkemizin lk Dihekimlii
Cemil Pasha was not the first and the Okulu. stanbul Üniversitesi
single one among the Turkish surgeons, he Dihekimlii Fakültesi 100. Yıla
was one of the most precious one. Indeed, Armaan. st. 2008.
he was a member of “the revolutionary [8]. Topuzlu, Cemil. 80 Yıllık Hatıralarım.
surgeon generation” emerged in 1890’s Hüsrev Hatemi, Aykut Kazancıgil
whose profound success was not only Dördüncü Baskı 2002 Edit. Cemalletin
considering antisepsis and asepsis Topuzlu
important but also reaching a modern [9]. Topuzlu, Cemalettin. Günümüzde
comprehension at surgery and establishing Genel Cerrahi Hipokrat Aylık Salık
bases of modern surgery in a modernizing Meslek Dergisi. S. 38 (5). 1995.
country.
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

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.

Introduction unconventional medicine and indeed any


African traditional medicine is a kind of therapeutical method that has been
mystery to much of the western world. It is handed down by the tradition of a
misunderstood, sometimes to the point of community or ethnic group. [3]
causing fear. In this study, emphasis will be more on
The traditional medical practices of the the history of Yoruba medicine than on the
Yoruba in Nigeria, however, offer fresh actual practices and methodology.
outlooks on the concept of health and A brief insight into these practices will
unique healing treatment to the world put popular medicine into perspective
medical community. [1, 2] before taking a more detailed look at its
These methods should be examined beginnings.
with an open mind, further developed, and
finally integrated with western medical Yoruba medicine and healers in
procedures in order to provide the best Nigeria
medical service possible. [4] Among the Yoruba in Nigeria, as in
Traditional medicine, as is well known, many African cultures, health and religion
represents a cultural gem of various are tightly interrelated. In the Yoruba
communities around the world and mindset, all healing comes from God,
encompasses all kinds of folk medicine, including that of the western medical

1
Nigeria.
2
„Gr.T.Popa” University of Medicine and Pharmacy, Iai, Romania
130 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

doctor. [3] It was revealed by the mystic prophet


The Yoruba tribes believe in a power Orunmila (Orula or Orunla), about 4,000
called Ifà which is God’s angel thought to years ago in the ancient city of Ile-Ife, now
have been choosen to possess an infinite known as Yoruba Land. Orunmila taught
source of knowledge. Ifà’s knowledge people the customs of divination, prayer,
includes animals, plants, oral incantations dance, symbolic gestures, personal, and
or ofo, divination, medicinal plants, and all communal elevation.
sciences associated with healing diseases. He advised them on spiritual baths,
This “wise man to whom nature has meditation, and herbal medicine in
taught her secrets” is the controller of particular. In Yoruba mythology, Orunmila
language, culture, philosophy, and religion. corresponds to the «highly knowledgeable
Ifà knows the causes, secret names, Irunmole», deity of destiny and prophecy.
origins, and chemical compositions of all He is recognized as "ibi keji
things. Olodumare", i.e. second only to
This Supreme Being gives the Olodumare (Almighty God)) and "eleri
knowledge of healing through the power of ipin", i.e. witness to creation. Orunmila is
Ifà to those who prove themselves worthy. the Orisha of divination, the Supreme
[1, 2, 7] Oracle, the great benefactor of humanity
It is important to realize that there are and its main adviser. He reveals the future
several aspects of Yoruba healing from the secret of Ifá, is a great healer and
practices. those who ignore his advice may suffer
The main types are herbal medicine and avatars produced by Eshu. Also referred to
rituals including incantations, prayer and as Ifá ("ee-FAH"), Orunmila personifies
sacrifice. [6, 7] knowledge and wisdom and the highest
The feature most accepted by western form of divination practice among the
doctors is herbal medicine. [7, 12] Yoruba people. Orunmila carried Ifà, the
Since the dawn of time, leaves, fruits, wisdom of Olodumare, to Earth. [1, 12, 14]
seeds and roots of plants were selected A Yoruba legend explains that the first
beneficial for the maintenance of health who practiced the art of herbal healing was
and cure of the ailments man suffered Orunmila, whom God had endowed with
from. this knowledge and skill. [3]
Yoruba doctors have an impressive Orunmila is not Ifà itself, but he leads
store of knowledge on a wide range of the priesthood of Ifà. He embodies the
plant species. archetype of the civilizing and healing
These plants are often used in a similar hero. [9, 10].
way to medications provided by western
doctors. Babalawo, the diviner-priest
Much less accepted are ritual healings. Priests of Ifà are called «Babalawo», ie
Rituals are open to the public, as healing is father of mysteries, or, for a female Ifà
seen as a group effort. [7, 12] priest, Iyan Ifà. Babalawos possess an
additional Orúnmila consecratio.
Orunmila and Babalawos They divine and interpret for people the
word of Orunmila, such as revealed by the
Orunmila, the herbal healer oracle of Ifá.
In Yoruba medicine, the «Ifà Corpus» Babalawos communicate with Orula
is considered the foundation of divine and with the Yoruba pantheon. Orunmila
herbal medical practice. [13, 14] («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 Orisha in Yoruba medicine. Osain rules
salvation”, is imagined as a sage. [1, 13, over all wild herbs.
14] He is regarded as the greatest herbalist
Babalawos can give the "Hand of who knows the powers of all plants.
Orula", known as "Ikofa" for women, and The plants and herbs of Osain have
"Awofakan" for men and other various their purely medicinal value as well as
deities. their magical value.
Some plants have to be gathered at
Orishas in Yoruba Medicine certain times of the day or night, according
The Yoruba religion has a multitude of to cosmic rhythms of sacred events. (2,3)
deities, the major of which are called Osain is the God of traditional medicine
Orisha. [1, 13, 14] and all of nature is at his disposal.
There are around 201 deities, thirty of Without the necessary herbs provided
which are commonly worshipped. In by an Olú Osain, the consecration of an
diagnosing illness, each one of the Orishas orisha would be impossible.
manifests interdependent physical qualities
and herbal attributes, each affecting one Obatala, the creator and healer of
another. humans
The Orishas stand for higher energies Deity of Creation, custodian of the Ifà
that govern living matter destinies, Oracle, Obatala is an alternative source of
transcend sensory faculties, and knowledge.
intermediate contact with the supreme Creator of Human Form and Purity, he
God, Olodumare. [12, 14] cures illness and deformities.
His priests are the Babalawos and his
Eshu, the mediator and accomplisher primary effects are on the brain, bones, and
Olodumare used the command known white fluids of the body.
as "Ashe" (ase) to accomplish his Herbs he controls Body skullcap, sage,
assignments. kola nut, basil, hyssop, blue vervain, white
Eshu, Èsù or Elegbara,, his best friend, willow, and valerian are [4, 13, 14]
exerts this «ashe» to this day and will use
it forever. Nothing, good or bad, can be Ogun, the iron like power of health
done without Eshu, who mediates between Orisha of Iron, Ogun is the divinity of
humans, Irunmole and Orisha. Eshu is clearing paths, specifically in respect to
indispensable to man and Orishas. blockages or interruption of the flow of
As Irumnole, he carries sacrifices for vital energy at various points in the body,
whatever purpose to the appropriate and he is the liberator.
quarters. [1, 2, 13, 14] Effects are on the heart, kidney (adrenal
Èsù, Gateman of the Heavens, is prime glands), tendons, and sinews. Herbs used
negotiator between negative and positive are eucalyptus, alfalfa, hawthorn,
forces in the body. He enforces the "law of bloodroot, parsley, motherwort, and garlic.
being” and enhances the power of herbs. [2, 12]
He mainly acts on the sympathetic Ogun, Irunmole of war, of the hunt,
nervous system and is involved with all iron or steel expresses the force of this
herbal effects. deity who can be powerful or/and cruel. [5,
13, 14]
Osain, the herbalist, God of traditional
medicine Yemoja, the mother goddess
Osain is the other most important Mother of Waters, Primal Waters, and
132 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Nurturer, Yemoja symbolizes the amniotic Oya, the goddess of death and rebirth
fluid in the womb of the pregnant woman, Guardian of the Cemetery, Oya is
as well as the breasts which nurture. connected with Tempests, Winds of
She signifies the protective energies of Change, Storms, and Progression. Usually
the feminine element, manifesting her in the company of her masculine
specific effects at the level of the womb, counterpart, Shango, she is the deity of
liver, breasts and buttocks. rebirth.
The medicinal herbs she governs are Things must die so that new beginnings
kelp, squaw wine, cohosh, dandelion, arise. In the same way, disease must come,
yarrow, aloe, spirulina, mints, passion so that evil can be destroyed, enabling
flower, and wild yam root. [6, 14] living beings to heal and be reborn to a
new life. [9, 10]
Oshun, the goddess of feminine energy Oya`s effects are on the lungs,
and hydrotherapy bronchial passages, mucous membranes.
Sensuality, Beauty and Gracefulness, Herbs used for such pathologies are
are personified by Oshun. mullein, comfrey, cherry bark, pleurisy
She is responsible for clarity and root, elecampane, horehound, chickweed.
flowing motion and has power to heal with [6, 14]
cool water. She is also the divinity of
fertility and feminine essence. Intertwined archaic and modern
Women appeal to her for child-bearing medicines
and for the alleviation of gynaecologic or As in many other vivid traditional
obstetrical disorders. civilizations from Asia, Americas and
She is fond of babies and is sought if a Africa, modern medicine intermingles with
baby becomes ill. Oshun is known for her popular concepts and therapies.
love of honey. Nigeria is no exception. In a fascinating
She acts on the circulatory system, melting pot, local ancient African healing
digestive organs, elimination system, and techniques combined not only with
women’s pubic area. [6, 14] western scientific practices and theories,
Herbs consecrated to her include yellow but also with different religious and
dock, burdock, cinnamon, damiana, anis, magical approaches.
raspberry, yarrow, chamomile, lotus, uva- Archaic ethomedicine mixed up with
ursi, buchu, myrrh, Echinacea. Christian and Islamic perspectives to
health and disease. In Cuba, eg, in the
Shango, the god of masculine energy second half of the XVIII-th century,
Kingly, virile Shango, associates with syncretism between the Yoruba cult and
masculinity, fire, lightning, stones and the Catholic religion resulted in the
magnetism. “Santeria”. Santeria is similar to the «Rule
This Great Warrior and protector of Osha» and expresses the oracular
transform base substances into pure and revelation mystery of Ifá. Even though an
valuable essences. animistic system of beliefs and rituals, Ifà
He controls the male reproductive is a monotheistic religion with one God,
system, bone marrow, life force. creator of everything, with polytheistic
Herbs incorporating his virtues are worshipping rules. [6, 13, 14]
plantain, saw palmetto, hibiscus, foti, Every natural object is enlivened by a
sarsaparilla, nettles, and cayenne. [6, 14] spirit, similar to angels and saints
(Spanish: santo-saint; «Santeria»-multitude
O. AWOJOODU et al: Traditional Yoruba medicine in Nigeria: a comparative approach 133

of saints). transformed and updated by nominated


Potentiating the power of Ifà, the "pathfinders", "pioneers" and "pacesetter,
Judeo-Christian God bestows the each of them a "first among equals”
knowledge of healing to those who prove personality, „the vanguard of the
themselves worthy of him/them. [12] innovation”.
Herbs and popular remedies are
Eleggua, the trickster at the crossroads described in accordance with current
In Santeria, Eleggua is probably the medical diagnoses and defined as capable
most important of the Orishas for many of treating incurable diseases. Inherited
practitioners. etnomedical botany is „different and
He is a trickster, constantly testing unique", an evidence based alternative to
people's character, waiting for them at orthodox medicine.
crossroads. Without him, one cannot take The dominant „compare and contrast”
advantage of opportunities, and the proper propaganda labels hospital medicine
way in a given situation might not be negatively and performed by inhuman
easily found. Like Eshu, Èsù or Elegbara, unprofessional practitioners.
Eleggua delivers sacrifices to the other If appealing to natural therapies: "..no
Orishas. doctor can sentence you to death" any
Receiving Eleggua is the first thing any longer. In traditional as well as in scientific
practitioner must do in the religion of Ifà- medicine, market policies often infringes
Santeria. Both the trans- Atlantic Slave professional ethics and deontology.
Trade and the colonization of Africa, Educated practitioners should be
contributed to this evolution. [12] assisted in their endogenous expert roles of
archaic techniques, whereas herbalists
Voodoon magic medicine should become aware of the risks they
Yoruba religion metamorphosed and take. [11]
different species of it emerged. One of Attention has to be drawn, indeed, not
them is Vodoun, Voodoun or Vodou, a only to the ethics of orthodox practitioners,
mixture of Nigerian and Congolese but of traditional herbalists and healers,
Yoruba, Haitian traditional belief system, too. Claims that Agencies for Drug
Catholicism, and even Freemasonry. Administration and Control, or Ministries
It is usually met in Haiti, South of Health approved traditional herbal
America, the Caribbean, and Central remedies and alternative or complementary
America. In Haiti, it is considered to have practices always need critical examination.
shaped almost every aspect of cultural Charlatanism, ignorance and despair often
patterns and health practices. Commonly, go together.
lower or peasant classes have recourse to
Voodoo rituals. [8] Discussion
The Yoruba tribe is one of the largest
Art of Advertising and Medical tribe in Africa with an estimated 30 million
Ethics people throughout West Africa.
In countries, such as Nigeria, where The Yoruba medicine is Orisha (deity
traditional medicine encounters official or spirit) based and closely associated with
„Western scientific medicine”, advertising the Yoruba religion.
the supremacy of ancestral healing systems Therefore this presentation focused
becomes an important market strategy. primarily on the Orishas that form the
Herbal therapies are presented as foundation of Yoruba medicine, in the
134 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

same way that Hippocrates addressed the and goddesses, energies and vital forces,
Greek gods when solemnly swearing to all able to produce and cure illnesses.
assist his patients properly: ”....and I take Beside them specific gods of medicine
to witness all the gods, all the exist: Osain, the herbalist, God of
goddesses....” (Hippocratic Oath). [5] traditional medicine and Obatala, the
Analyzing Yoruba medicine, numerous creator and healer of humans. Osain
convergences with other cultures and resembles Asklepios, a celebrated master
medical systems are brought to light. of vegetal drugs in Ancient Greece, or to
Comparable archetypes are found. Magical Zamolxis, in Dacia, - ancient name of
and empirical medicines are closely related today`s Romania. [9]
in everyday practices. Fathering Humans and Purity, Obatala
The Supreme Almighty God and recreates or reshapes human beings - body
derived divine entities are deeply involved and soul-, as he cures disorders and
in causing diseases, life and death. Gods deformities. Oya, the goddess of death and
and vital energies work together with rebirth, teaches that getting rid of disease
priests, prophet-diviners and humans. signifies killing evil and decayed matter,
Civilizing deities and heroes testify the fact restoring robustness and welfare.
that life, knowledge and health depend Death as a source of improved life is
upon supernatural entities. [9, 10, 13] another mental archetype religions and
Their course is strictly dependent on related traditional civilizations share.
human moral behaviour and respect of the (9,10) In many respects, the rich Yoruba
divine rules and laws. pantheon reminds various North African,
Consequently, openness to medical Greek, Indian or pre-Columbian
mystical experiences has to be maintained. mythologies: masculine and feminine
[12] elements complement each others,
Undoubtedly, herbal medicine holds a goddesses of beauty, grace and fertility rub
place of choice in all archaic medicines shoulders with frightening gods of war and
that preceded and equally coexist with disaster. Ogun, Orisha of Iron, the cleanser
contemporary ”evidence based medicine”. that opens the paths, hints to Chinese and
Ancient Asian, European and African Indian energetic points, meridians and
medicines perfectly agree from this networks. The vital trajectories he surveys
perspective. In ancient Dacia, too, herbal seem to ensure an enviable health
remedies were many and highly condition.
appreciated. [9] As defined in a well known Romanian
Syncretism is another characteristic traditional New Year`s wish for health,
feature of cultures and civilizations. It can humans should become or maintain
also be distinguished in the Yoruba themselves “hard as iron, sharp as steel”,
medical tradition. able to “blossom like apple-trees” and
It occurs due to the likeliness of basic roses all lifelong.
conceptions and practical approaches, As in ancient Egypt and other pagan
which express common archaic religious mystic beliefs, but also in Christianity,
principles and ancestral ideas about health deities specialize in curing specific organs
and disease, life and death, destruction and and diseases. [5]
rebuilding, essential intertwined realities. Eleggua, the trickster at the crossroads,
Errors are thus corrected or mitigated, reiterates the role of Hercules, the Greek
lest evil be eternal. civilizing hero, healer and savoir. [5]
Yoruba medicine has recourse to gods Tradition gives authority. Both human-
O. AWOJOODU et al: Traditional Yoruba medicine in Nigeria: a comparative approach 135

and divine-revealed testimonies keep hope interrelated mental and behavioural


alive. patterns.
Important ethical issues equally result.
The true relationship between disease
and healing experiences and their spiritual Reference:
and behavioural expression are still to be
determined. 1. Abimbola K., Yoruba Culture: A
Hermeneutics should aim at the Philosopical Account, IAP,
transformative potential of the experience Birmingham, 2006, 90-129.
of the world, at identifying the sacred and 2. Ademulegun Z.A., The Relevance of
profane roots of magical and empirical Yoruba Medicine Men. In Pub Health
medicine. Rep Nigeria, 1969, 84, 12: 1085-1091.
3. Babalola, E. O., The Relevance of
Conclusion Herbal Medicine to the Practice of
The Yoruba tribe`s members are African Traditional Religion, Islam
convinced believers in natural preventive and Christianity in Yoruba Land,
Ekpoma JRelS, 2003, 5, 1: 103–110.
and curing medicine.
4. Babalola, E. O., The Scientific Basis
They are obvious criticizers of modern
of African Traditional Medicine. The
western medicine where problems caused Yoruba Example, Ekpoma JRelS,
by drug use and abuse are masked, 2005, 6, 1- 2.
whereas the person as a whole is largely 5. Baran D, An outline history of
neglected. medicine, Ed. Tehnopress, Iai, 2007
According to the medicine-men of 6. Buckley A. D., Yoruba Medicine,
Yoruba, if humans listen to their bodies, Athelia Henrietta PR, 1997.
these bodies will provide them with the 7. Danesi, Mustapha A., Traditional
preparation and appropriate knowledge Medicine in Africa. In: Oluwole, S. B.,
necessary to regain the balance with the Faluyi K., (eds.), The Essentials of
Earth and cosmic environment. African Studies, Lagos, 1998, 2: 143–
Modern-day technology, innovations 163.
and education have, however, made a lot 8. DeSantis, Thomas J.T., The immigrant
of impact on the herbalist and on the Haitian mother: Transcultural nursing
practice of traditional medicine in Yoruba perspective on preventive health care
Land. for children, JTranscult Nurs, 1990, 2:
The general populace now wants to 2-15.
compare the herbalist with the orthodox 9. Eliade M,De la Zalmoxis la Genghis-
medicine general practitioner. Han, Ed. tiinific i Enciclopedic,
Herbalists have now to be encouraged Bucureti,1980,80 .
to improve on the quality of their practice, 10. Eliade M., Istoria credinelor i ideilor
to be stimulated to identify correctly the religioase. De la epoca marilor
medicinal plants and other ingredients used descoperiri geografice pîn în prezent
in the preparation of herbal products. (vol.4), Ed. Polirom, Iai, 2007.
They should be mindful of the sources 11. Iroegbu P., Harvesting Knowledge of
of their raw materials and avoid Herbal Resources and Development of
adulteration and mystification, in an effort Practitioners in Nigeria, Indilinga:
to ensure safe and efficient medicines. African Journal of Indigenous
The intercultural and transcultural Knowledge Systems, 2006, 5, 1: 32–
approaches to Yoruba medicine display 50.
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12. Olson J., Nkiwane S., Integrate for http://www.orishanet.org/ocha.html


Efficiency: Traditional Yoruba 14. Yoruba_Medicine, wikipedia
Medicine in Nigeria, GS 218 http://en.wikipedia.org/wiki/Yoruba_
Introduction to Africa, Colorado medicine
College, 2006.
13. Orisha Net,
Bulletin of the Transilvania University of Braúov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of 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

Biographical and professional Medical Students` Society.


landmarks He equally began law studies.(10)
Undoubtedly, Dr. Victor Gomoiu`s Between 1903 and 1909, Dr. Gomoiu was
name remains tightly connected with trained in various hospitals of Bucharest.
History of Medicine in Romania, in the In 1909 he passed magna cum laude his
Balkans and in the world, as a whole. He doctoral degree thesis entitled “Anaplastic
was born on April 18th, 1882, in the Surgery of Face and Head” which earned
village of Vânju Mare, in the MehedinĠi him the gold medal. He chose the position
County, not far from the Danube shore and of librarian of the Bucharest Faculty of
the Roman ruins of the Apollodor of Medicine Library between 1909 and 1911.
Damascus` bridge at Turnu Severin (today, In 1911, Dr. Gomoiu was appointed
Drobeta-Turnu Severin). physician and director of the «Sanatorium
Son of an orthodox priest, he was a for the Fight against Tuberculosis in
strictly moral and diligent pupil. In 1900 Children» of Tekirghiol, a Romanian
he began his medical studies and in 1906 Black Seaside resort.
he graduated the Faculty of Medicine in Between 1914 and 1927, he was again
the Romanian capital. From 1906 to 1908, present as a surgeon in the great Bucharest
he was vice-president and president of the hospitals of “Philanthropy”, “Coltzea” and

1
University of Medicine and Pharmacy “Grigore T. Popa”, Iaúi
138 Bulletin of the Transilvania University of Braúov • Vol. 2 (51) - 2009 • Series VI

“Brâncovenesc”. From 1927 until soon Health for about three months, from July 4,
after World War II (1948), he continued to September 14, 1940.
his medical activity within the “Verg He was soon dismissed by the National
Barrier Medical Social Complex” which he Legionary government instituted in
was the founder of. Romania on September 6th, 1940, and
Dr. Victor Gomoiu also became overthrown on January 23rd, 1941.
professor of surgical clinique at the Faculty An incident troubled his life in 1933.
of Medicine of Bucharest. [6] For his After the Romanian Prime Minister I. G.
professional qualities, he was the private Duca`s assassination by “The Iron Guard”
physician of Queen Elena of Romania. fascist movement, several suspects were
He married Dr. Viorica Tincutza put into jail including important names of
Ionescu who shared with him the same Romanian political and cultural life: Nae
passion for both medicines - surgery above Ionescu, Nichifor Crainic, Grigore ForĠu.
all- and medical history. Dr. Gomoiu died Dr. Victor Gomoiu was among them. Once
on the 6th February 1960, at 78 years of their innocence was proved they were
age. 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 Lăzăreanu
(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
Fig. no.1. Dr. Victor Gomoiu decisive influence on her son, King
Michael, earned Queen Elena the title
“Righteous among Nations” conferred by
Political interferences and civic Yad Vashem. [5]
consciousness Dr. Victor Gomoiu developed a
Since he was a good and extremely multifaceted activity based on his interest
honest manager, in 1929 Dr. Gomoiu was and skills in surgery, social medical
appointed Technical Counselor and in projects and history of medicine. His
1930 General Secretary at the Ministry of intransigent character made him suffer
Health. Eventually he was Minister of 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 Unfortunately, following the revolution
foundation of a social-christian party, able of 1989, other problems, especially
to oppose communism. In 1950, after economical, but also moral ones, impeded
having lost almost all his goods, due to the full valorization of this great spiritual
nationalization, after having witnessed the heritage.
partial destruction of his archives, when 68 Thus, in 1996, the “Gomoiu” History of
year old, he was imprisoned by the Medicine and Pharmacy Museum in
communists and spent approximately five Craiova was itself dismantled after the
years in prison. [7] building retrocession to former owners.
The imprisonment was due to his
closeness to the «exploiting class», to the Dr. Victor Gomoiu, the surgeon
Royal Family of Romania, and his position Victor Gomoiu was professor,
of Minister of Health under a previous practitioner and passionate researcher in
regime. the field of surgery and topographic
The real cause was his constant refusal anatomy.
to «enroll» and cooperate with the In the domain of surgery, Victor
communist government, give up Gomoiu greatly contributed to plastic
correspondence with foreign scientists, surgery, sympathetic system surgery,
deny his friends, and formally recognize traumatology and urology, imagining and
the new political order. Gomoiu could not implementing new operatory techniques
worship these international and national and procedures.
«last-minute masters» whose portraits Cervical sympathectomy was such a
already replaced, even in his office, personal procedure, often recommended in
beloved figures: Stalin - Queen Elena; Ana treating angina pectoris crises.
Pauker and an unknown woman - his Solarectomy was another original method.
“marvelous angels”, his two deceased little His approaches were appreciated by the
girls; another bearded man - his father. [7] French surgeon René Leriche (1879-1955),
After the relative opening of the famous for his pain and sympathetic
communist camp towards a more humane system surgery. [6]
attitude, in 1964, Dr.Gomoiu was From 1903 to 1905 Dr. Gomoiu
rehabilitated and his heritage officially specialised in the surgical clinique of the
reconsidered. reputed professor Thoma Ionescu (1878-
Monographs, communications and 1885). Professor Ionescu studied medicine
studies were dedicated to him. In 1970, his and law in Paris.
widow, Dr. Viorica Gomoiu participated He was awarded the Laborie prize of
with a communication in the XXII-nd the Surgery Academy in Paris, and the
Congress of the ISHM held in Bucharest silver medal for surgery, as laureate of the
once more. In 1972, she accepted to donate Hospitals in Paris.
Dr. Gomoiu`s remnant collections and He was an anatomy agrégé between
other personal objects to the History of 1892-1895 in the French capital, and in
Medicine Museum founded in Craiova, 1895 returned to Romania.
under the auspices of the local University Thoma Ionescu pioneered anaesthetic
and its Faculty of Medicine. [6)] surgical procedures and in 1919 published
Soon it became a famous establishment in Paris, at Masson et Cie Editing House, a
and gathered some other important momograph on «General Rachianesthesia»
collections belonging to towering where cervical anaesthesia was described.
personalities of Romanian medicine. [1]
140 Bulletin of the Transilvania University of Braúov • Vol. 2 (51) - 2009 • Series VI

That is probably why the very young the basis a medical, social and cultural
dr. Gomoiu had to share with his master establishment at the periphery of
the success of his own cervical Bucharest, in the district named “Bariera
sympathectomy method for angina pectoris Vergului” (“The Verg`s Barrier”). [10]
pain management, a fact that seriously Vartolomei Vergu (Vergo or Virgo) had
afflicted him. [6] been a medieval merchant, civic dignitary,
More operatory procedures were given lord steward and diplomat at
his name, e.g. Gomoiu-Eden method for Brâncoveanu`s and Cantacuzino`s Court,
the myoplastic treatment of facial in 1693-1697. In the XX-th century, this
paralysis, or the Gomoiu-Phocas method muddy zone was the land of the
for the surgical management of inguinal- disinherited “poor and ignorant” people.
scrotal hernia. [8, 10] For accomplishing his utopist dream
In 1906, Dr. Gomoiu was member of with the scarce available funds, most of
the editorial board of „Spitalul” („The which originated in his own financial
Hospital”) journal [6, 10] Along with Drs. contribution, Dr.Gomoiu offered to assist
Gr. Georgescu and V. Săvescu, he edited patients of this hospital without any fee for
the shortlived publication „Le journal de 10 years. Money was also donated by the
chirurgie de Bucarest”, (“The Bucharest «Princess Elena» charity foundation.
Surgical Journal”) directed by professor Dr. Gomoiu`s idea seemed to many a
Constantin Angelescu. Only few issues of Don Quixote’s foolish initiative and was
it appeared. [12] harshly criticized.
Victor Gomoiu himself adapted the
The Balkan Wars initial architectural building plans,
Dr. Gomoiu participated in the Balkan enabling more sections to be created:
Wars (1912-1913). internal medicine, surgery, obstetrics and
In October 1912, he left Bucharest, gynecology, pediatrics and stomatology.
leading a Romanian sanitary ambulance to An Institute for Social and Charity Nurses
Turkey. and a public bath were included, too.
One month later, with the agreement of "The Vergului barrier complex for
the Turkish Red Crescent, he organized a medical-social assistance", the accom-
field hospital at Dede Agath. [7, ]8] plishment of which he personally carefully
For his successful effort, the Turkish surveyed, was comprised of 10 medical
government conferred upon him the specialty offices, 60 beds, a pharmacy and
„Medgidia” order and „The Red Crescent” two laboratories, and was cited as a model
Medal, whereas the Romanian authorities institution by the Sanitary Department of
awarded him the Silver Medal of the Red the League of Nations in Geneva. [10]
Cross and the „Bravery and Loyalty” To the hospital, a popular Athénée for
Medal, I-st class. Dr. Gomoiu was also educational programs, a cinema, a park and
mobilised during the two World Wars. [7] a church were added. Gomoiu and other
After World War I he was awarded the outstanding intellectuals gave conferences
Légion d`Honneur. there, aimed at common people eman-
cipation through culture and knowledge.
Dr. Gomoiu, the benefactor Gomoiu was awarded the „Djuvara”
In 1925, Dr. Gomoiu was appointed prize for his lectures. The first meetings of
manager of the «Princess Elena» charity the Romanian Society for the History of
foundation. Medicine took place equally there.
In 1925, he courageously decided to lay Sanitary education held a privileged place,
D. BARAN: Dr. Victor Gomoiu, Balkan paradigms and lessons of a lifetime 141

and focused on the fight against Dr. Gomoiu, historian of medicine


alcoholism, tabacco dependence, tuber- and sciences
culosis, pellagra, malaria, various In 1929, Dr. Gomoiu founded the
infectious or job related diseases, hypnosis. Romanian Royal Society for the History of
It aimed at a science- and ethics-based Medicine, Pharmacy, Veterinary Medicine
comprehension of the surrounding world and Medical Folklore (RSHM), another
and facts. visionary attempt of this true «Knight of
Similar lectures were given by Gomoiu the Sad Figure» of his time.
at the "House of Light" cultural center in Between 1929 and 1946, Dr. Gomoiu
Turnu Severin. was general secretary, president and
The «Vergului Complex» also known honorary president of the RSHM. The
as the «Princess Elena Establishments», Society had also a valuable Museum,
was directed by Dr. Gomoiu until 1948, decommissioned after 1947. [7]
when it was nationalized, immediatly after Valeriu Bologa, a well known
the King`s forced abdication and leave for Romanian historian of medicine, too,
exile. confessed in his study “Wheat Grains”
Victor Gomoiu also founded several (“Boabe de grâu”) that he himself thought
tuberculosis preventoria on the Teleajean Gomoiu`s intention of creating a
Valley, at Brebu and Mâneciu-Ungureni, Romanian Society for the History of
the latter bearing now his name Medicine was quite unrealistic since rather
(«Dr.Gomoiu» Preventorium), two others few medical historians existed by then in
at Baba Runca and ùanĠuri, not far from the great academic centers of Romania:
Braúov, and one in Mangalia at the seaside. Bucharest, Cluj and Iaúi.
[10] Time instead proved that Gomoiu was
A school was named after him at Vânju right and his efforts paid off. Professors
Mare, his birthplace and his bust by Ilie Constantin D. Severeanu (1840-1930), the
Berindei stands today in front of this 1st RSHM president, and Ioan Cantacuzino
college. supported Gomoiu and the young RSHM.
Following World War II, the «Princess [6, 10]
Elena» Establishments had to be renamed In 1932, the RSHM was entrusted with
"Saint Helen" and after the «storm of preparing the IXth Congress of the
nationalization», they became the "30th International Society for the History of
December" Pediatric Hospital. [6, 7] Medicine (ISHM), to which it was
The latter denomination was a token of affiliated.
the historic proclamation of the republic in This first congress took place in
1947. Romania, in Bucharest. The renowned
In 1990, after the 1989 Romanian historian Nicolae Iorga (1871-1940) was
Revolution, the Hospital was rebaptised in directly involved in the manifestation as its
the name of «Dr.Victor Gomoiu». In 2004, vice-president. Gomoiu, as president, and
it was enlarged and updated. his wife, as general secretary, were the
It presently counts 184 beds, main organizers of this event. Professor
departments of pediatric internal medicine, Cantacuzino (1863-1934), minister of
neurology, otorhinolaryngology, two health (1931-1932), was then the RSHM
compartments of intensive therapy units president.
and an external section for disabled The Bucharest Faculty of Medicine
children. partly tempted to boycott the RSHM and
the Congress, but King Carol II`s support
142 Bulletin of the Transilvania University of Braúov • Vol. 2 (51) - 2009 • Series VI

granted the final success of the meeting. A dedicated historian of medicine, Dr.
(7) The King opened the Congress in state, Gomoiu was also a skilled and inventive
as president of honour. [11] surgeon and devoted anthropologist. Many
Subsequently, from 1933 to 1936, Dr. of his papers were awarded important
Gomoiu was elected vice-president, from prizes. [6, 10]
1936 to 1946, president and then from
1946 to 1960 honorary president of the Victor Gomoiu and Petre Sergescu
ISHM. [1, 6, 11] Gomoiu was particularly close to Petre
He equally was member of about 50 Sergescu.
national and international scientific Native of the same Mehedinti County,
societies and academies. (6, 10) Along member of the Romanian Academy
with the mathematician Petre Sergescu (1937), president of the IAHS (1947-
(1893-1954) and the physician Valeriu 1950), after having been its vice-president
Bologa (1892-1971), he belonged to the (1937–1947) and future executive
National Group who represented Romania secretary of the IUHS (1947–1954),
to the International Academy for the Sergescu replaced Mieli as IAHS perpetual
History of Sciences (IAHS) [2, 3, 6] secretary in 1950. He was director of the
Concurrently, he was member of the collection «Travaux sur l’histoire des
International Union for the History of mathématiques» in Paris and chief editor
Sciences (IUHS). [6] and director of the «Archives
In 1937, Gomoiu became corres- Internationales d’Histoire des Sciences, la
ponding member, and in 1947 effective Nouvelle Série d’Archeion». «Archeion»
member of the IAHS. [2, 3] journal, Mieli founded in 1927, continued
This society established by Aldo Mieli his «Archivio di Storia della Scienza», first
(1879-1950) in Paris, in 1929, numbered edited in 1919, in Rome. [2, 3]
six other founder-members: Abel Rey Sergescu exiled himself to France when
(philosopher), George Sarton (chemist), communists ascended to power in
Henry E. Sigerist (physician), Charles Romania. His secretary, René Taton
Singer (physician), Karl Sudhoff (1915-2004) helped him overcome
(physician), Lynn Thorndike (historian). censorship and keep in touch with Gomoiu
All these three physicians were and Romania. [7]
celebrated historians of medicine with
whom Professor Victor Gomoiu Dr. Gomoiu and Balkan countries
collaborated. Dr.Gomoiu developed friendly
In 1936, the VIII-th IAHS Meeting (1-st relationships with Balkan countries and
IAHS extraordinary international meeting their representatives to the ISHM.
or «little congress») took place in He devoted medical historical studies to
Bucharest and Cluj, organized by the Balkan traditional medicine, since archaic
Romanian Group, as mentioned in the ethnomedicine survived longer in this part
Academy`s journal ”Archeion” (1936, 18: of the world and shared related elements
204-226). and mentality patterns.
The RSHM held a solemn session on In 1932, during the IX-th ISHM
Appril 15, 1936 in Bucharest, on this very Congress in Bucharest he envisaged the
occasion. In 1981, Bucharest hosted the foundation of the «Centre for Medical-
XVI-th International Congress of the IAHS, Ethnographic Studies in South-East
too. [2, 3] Europe».
One of Gomoiu`s supporters was Ioan
D. BARAN: Dr. Victor Gomoiu, Balkan paradigms and lessons of a lifetime 143

Cantacuzino, member of the Romanian post-


Academy and president of the RSHM, by World War II circumstances, Valeriu
then. Gomoiu`s attitude earned him the Bologa had chosen a different, more
titles of honorary member of the Greek “materialistic” way. [7]
Society for the History of Medicine Bologa bowed to political pressure and
(Athenes, 1932), honorary member of the advised Gomoiu to accept reality. But for
Association of the Serbian, Croatian and Gomoiu «moral death seemed more
Slovene Physicians (Zagreb, 1933), serious than physical decay».
member of the «Hippocrates» Society in It was unbearable for the intransigent
Belgrad (1939); honorary member of the Gomoiu who, to metamorphosing into a
Turkish Society for the History of «new man», preferred martyrdom and the
Medicine (Istambul, 1940). [6, 10] final «judgement of history» which gave
him a sense of relief. Bologa, instead,
Resistance and correspondence coped with the new social order and
After 1946, Dr.Victor Gomoiu was political rules.
marginalized by the communist regime. Gomoiu exceptionally pioneered and
He ostentatively refused to integrate the sanctioned medical historical research in
new political and ideological realities of Romania; Bologa exceptionally developed
his country, even though he turned down this domain and became a reference author
the royal family`s proposal to accompany of classic writings and of the first
them in their exile. handbooks.
He simply tried to resist imposture and President of the RSHM (1949-1971)
fight for his country and people, for his and vice-president of the ISHM (1964-
credo, to the end of his life, assuming the 1970), Bologa organized in 1970 the
supreme sacrifice. [7] XXIInd ISHM Congress in Bucharest and
Immediately after 1945, communists Constantza, the second of this kind in
imposed their own rigorous laws. Romania.
Opposing psychological pressure and Which was the right choice for
ostracization, Gomoiu maintained his intellectuals under «the terror of history»?
correspondence with former friends and This still is both a Romanian and Balkan
collaborators: Tricot-Royer, Giordano, dilemma, another tragic «riddle of
Siegerist, Castiglioni, Diepgen, Pazzini, history».
Guiart, Verhoeven, Sergescu.
Letters were censored and details had to References
be unvoiced or subtly implied. Western [1]. Bologa V. L., Brătescu G. et al., Istoria
correspondents had a faint idea about what medicinei româneúti, Ed. Medicală,
was going on beyond the iron curtain. Bucureúti, 1972.
When addressing colleagues from the [2]. Colan H., Petre Sergescu, historien des
communist camp, e.g., Bulgaria or sciences ou la fascination de la
Yugoslavia, Gomoiu`s language became générosité, à travers quelques
more sympathetic and even direct. [7] souvenirs, Noesis, Académie
They were experiencing a similar tragedy. Roumaine, 2006, 30-31: 195-204.
[3]. Colan H., Bref historique du
Behavioural paradigms and the développement de l’histoire des
lessons of history sciences et des techniques en
Victor Gomoiu`s memoirs reveal his Roumanie. Noesis, Académie
disappointment that under the particular Roumaine, 2002, XXVII: 95–100.
144 Bulletin of the Transilvania University of Braúov • Vol. 2 (51) - 2009 • Series VI

[4]. Constantin Gh., ùerbu M., Miniútrii de [9]. Priminescu R. M., EvoluĠia activităĠii
interne (1862-2007) – mică enci- institutelor de cercetare, reflectată în
clopedie, Ed. Ministerului Internelor documentele fondului arhivistic
úi Reformei Administrative, naĠional, Noema, 2009, III: 550-566.
Bucureúti, 2007: 252. [10]. Scheau M, Olaru A, Simpozion
[5]. Deletant D., Memoriul unor Victor Gomoiu, Universitatea
intelectuali români către Palat în vara Craiova, 1972.
1942, Sfera Politicii,2004,107:49-53. [11]. Sondervorst F. A., Backward Glance
[6]. DuĠescu B., Victor Gomoiu, Ed. at the International Society for the
Medicală, Bucureúti, 1970, 103. History of Medicine 1920-1982,
[7]. Gomoiu V., Memorii (vol. VI), Ed. www.bium.univ-
Sitech, Craiova, 2006-2007, 167- paris5.fr/ishm/eng/hist
285. [12]. Târcoveanu E., Ernest Juvara, J Chir,
[8]. Iancu ùt., Dezvoltarea útiinĠei úi Iasi, 2005, 1, 4: 469-475.
tehnicii în perioada interbelică,
Noema, 2003, II, 2: 130- 133.
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

THE ASPIRIN – THE FIRST DRUG


OBTAINED BY SINTHESYS –
FREQUENTLY USED CURRENTLY

A. BĂLESCU1 L. NEDELCU 1

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 Similar accounts have been found in
aspirin is the first drug obtained by synthesis Egyptian papyruses translated and published
while being the most used, with the longest in 1875 by Georg Ebers who bought them in
lasting commercial success, being considered 1869 from Edwin Smith, a passionate
the most popular drug of the modern era. American historian and archeologist. The
The oldest written accounts of the papyruses describe a number of other
curative properties of the willow bark remedies and curative practices used in
extract are from the Sumerian civilization. antiquity: turtle shells, snake skins, milk,
The therapeutic properties of the willow myrtle, figs, and dates [2]. Many of these
have been discovered by chance as many remedies have kept their use even when
other scientific discoveries. Egypt was part of empires.

1
Faculty of Medicine, Transilvania University of Braov.
146 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Hippocrates, the most renown and the salicylic acid. The saturated water
important Greek medical practitioners, was solution of salicin has a pH of 2.4 thus a
recommending the willow bark for high acidity and is known as salicylic acid.
diminishing the birth pains and the fever. The irritative effect of salicin on the
In ancient Rome, Celsius was using the stomach was mentioned in 1839.
willow leaf extract for treating fever, pains, In 1853, the French chemist born in
swallowing and inflammation. Alsace Charles Frederic Gerhard managed
Pedanius Dioscorides, a Nero era to synthesize the pure salicylic acid.
botanist, writes about the therapeutic Felix Hoffman is considered the inventor
potential of the willow in the book: “De of the aspirin, replacing a hydroxyl from
Materia Medica”, which was kept in the the salicylic acid with an acetyl chain
Arab translation. obtaining acetyl-salicylic acid (1897). By
Claudius Galen has studied in Egypt and changing the chemical structure the
after he used to treat the gladiators in negative effects on the stomach were
Greece, afterwards he uses his medical significantly reduced. Felix Hoffman
knowledge at the emperor’s Marcus tested the antalgic and anti-inflammatory
Aurelius court. He was recommending the effects on his father.
willow for moderate pains. The acetyl-salicylic acid is considered
A long period of time the medical the first sensitized drug.
knowledge as many of the initially used Arthur Eichengrün claimed the rights to
remedies were forgotten or ignored. the aspirin invention because he has
There have been trialed other remedies overseeing the team work from which
and in 1763, in England, the therapeutic Felix Hoffman was part.
properties of the willow have been noticed The Eichengrün version is sustained by
in the fever decrease by the reverend Walter Sneader, Professor at Strathclyde
Edmund Stone. He administered the University in 1999.
willow bark extract to 50 feverish persons, However the French consider that
observing a decrease of the fever. Charles Frederic Gerhard is the inventor of
Later research discovered the active the aspirin by isolating the pure state
principle from the willow bark, the salicin. salicylic acid.
The Italians Brugnatelli and Fontana have After the defeat of Germany in 1918, the
isolated, in 1826, the impure willow bark Allies have confiscated and sold the Bayer
extract but have failed to demonstrate the facilities and the exclusivity over the
link between this extract and its Aspirin trade mark. The buyer was the
pharmacologic effects. The salicin was American firm Sterling that makes and
isolated in its pure state, in crystalline sells in the USA and Canada the acetyl-
form, in 1828 at the University of salicylic acid under the name generic name
München by Johann Büchner. of Aspirin.
In 1829, Henri Leroux improvised a In 1950 the aspirin was included in the
method to extract salicin from the willow Guinness Book of records as the most
bark and obtained 30 grams of salicin from common analgesic in the world. No other
1.5 kilograms of bark. The obtained salicin drug was frequently used as the aspirin.
has adverse effects (gastric pains and The prescriptions for the use of aspirin are
diarrhea) which prevented it to be used well known [6]:
with a therapeutic aim. • Analgesic – in the treatment of low and
In 1838, Raffaele Piria, Italian chemist, moderate pains (muscular, joint, dental
managed to separate salicin and to obtain and menstrual pains and headaches);
A. BALESCU et al: The Aspirin- The First Drug Obtained by Synthesis - Frequently Used Currently
147

• Antipyretic; endorsed; research conducted on


• Anti-inflammatory – the treatment of 987,590 persons with a evolution
acute articular rheumatism and other followed for 18 years (1982-2000)
acute inflammatory diseases; after demonstrated that the sue of aspirin
1950, by discovering other drugs with the purpose to reduce the
with analgesic, antipyretic and anti- pancreatic cancer incidence or the
inflammatory actions the aspirin had mortality caused by it does not have
major competitors; a significant effect [1].
• As an antithrombotic agent – in the • The prevention of hepatic diseases
prophylaxis of acute myocardial caused by alcohol and medication
infarction, acute angina, transitory overdose – a study done by Yale
acute angina and ischemic cerebro- University shows that daily use of
vascular stroke; in 1971 the pharmacist aspirin is preventing hepatic
John Robert Vane proves the effects of diseases; for prevention a daily dose
the aspirin on prostaglandins [2] and of aspirin is recommended and if the
the antithrombotic effect of the aspirin, lesions are already present it is
fact that determines the use in the recommended the administering of
prophylaxis of cardiovascular diseases, immune stimulant substances;
this being the moment of the • Decrease of relapse risk for colon
commercial revival of the aspirin; at and rectal cancers [3]; the
the European Society of Cardiology mechanism of action of the aspirin
Congress, in Barcelona, 2009, were on tumor development is not well
described the results of studies done in known, it is considered that some
Scotland on 29000 persons with ages aspirin doses act at endothelial level,
between 50 and 75 followed for 8 controlling the development of the
years; the conclusions suggest that the blood vessels and implicit the
aspirin should not be prescribed to the development of the tumor; these test
general population because the healthy have been done only at a laboratory
persons that take aspirin do not reduce level and are necessary studies to
their cardiac risk but increase their confirm this hypothesis;
hemorrhagic risk [4]. • The prevention of some types of
• As antithrombotic agent – in the cataract – research done by the Yale
treatment of cardiovascular cerebro- University shows that the salicylic
vascular diseases; it is ascertained acid is capable to prevent or delay
the favorable effect in the secondary the onset of the cataract, acting on an
prevention of those diseases; but in enzyme involved in the sorbitol
the case of the primary prevention creation in the crystalline;
the benefit from administering • Prevention of severe migraines;
aspirin are annulled by the high risk • Prevention of obesity;
of cerebral hemorrhage [3]. • Effects on arterial tension – aspirin
Recently it was confirmed that the administered in the morning
aspirin has n important role also in: increases the arterial tension and in
• Pancreatic cancer prevention – the the evening decreases the arterial
results of some epidemiologic tension;
studies suggested that aspirin can • The association of aspirin with
reduce the risk of pancreatic cancer, caffeine and ephedrine can have a
but this conclusion is not fully positive influence on the
148 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

development of the muscular mass Some studies show that associating


and the reduction of the fatty tissues; aspirin with vitamin C is an efficient
this association has the advantage of treatment against viral infections but
lipolysis stimulation and decrease of administering aspirin during flu can be
protein use in the energy production harmful. Using aspirin and other salicylate
with the disadvantage of heart rate based drugs in treating flu can lead to Reye
increase and muscular tremor [5]. syndrome. This syndrome affects children
The efficiency and safety of aspirin between 4 and 16 years of age and when
administering in cardiovascular prevention the flu is epidemic.
has been evaluated by including in the The 20th century was surnamed the
study a population group with apparently aspirin century. Aspirin represented the
healthy persons and persons with subject of over 3000 scientific papers.
myocardial infarction or stroke. On The annual quantity of aspirin is 50000
patients with occlusive vascular disease the tons (20 tablets /person).
individual studies and randomized trials The daily use of aspirin is 100000000
showed that small doses (75-162 mg/day) tablets.
decrease the risk of serious cardiovascular
events with 25% [3]. Studies on a group of References:
95000 persons with low to medium risk
confirm that the preventive use of aspirin [1]. Jacobs, E.J., Connel, C.J., Rodriguez,
reduces with a fifth the myocardial C. Et al: Aspirin use and pancreatic
infarction risk without significantly cancer mortality in a large United
influencing the stroke risk and the stroke States cohort. In: Journal of the
mortality. National Cancer Institute Vol. 96(7),
There are studies that show the effect of 2004, p. 524-8.
the aspirin being dependent on age and [2]. Jeffryes, D.: Aspirin - The
sex. Research in aspirin intake for primary Extraordinary Story of a Wonder
prevention significantly reduces the Drug, Bloomsbury Publishing PLC,
myocardial infarction risk in men without 2005.
reducing the vascular risk. In women, the [3]. Montalescot, G.: The major risk of
aspirin lowers the vascular risk but has no aspirin as with all NSAIDs, is
significant influence on myocardial bleeding,. In: ESC Congress
infarction risk. The variations dependent Barcelona, 2009.
on sex on the secondary prevention have [4]. Patrono, C.: While the benefits of
not been demonstrated [3]. In general aspirin exceed the risk/benefit ratio is
elderly people and women have higher marginal in low-risk populations. In:
hemorrhagic risk but this predisposition is ESC Congress Barcelona, 2009.
not influencing alone the personal safety [5]. erban D.: Efedrina + Cofeina +
when administering aspirin. The Aspirina = Combinaie reuit în
association with other drugs (statins and eliminarea masei adipoase i în
anti thrombosis drugs) can decrease the dezvoltarea muscular. Available at:
risk of cardiovascular events. The benefits http://www.doctor.info.ro/eca.html.
of associating aspirin with other drugs in [6]. xxx- Agenda medical. Editura Medical
the secondary prevention of cardiovascular Bucureti, 2007.
events are ascertained [3].
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

HIPPOCRATES’ MEMORIES OF SCYTHIA:


STORIES AND FAIRYTALES

ǹ. 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

Introduction laudatory statements.


Usually, when one speaks of As if he was a meteorite that fell from
Hippocrates, at least to his admirers, not the sky and illuminated the hitherto
dissenters, he will mention that “He was superstitious and obscurantist medicine. If
the first who separated medicine from the speaker is more educated on the matter,
religion and laid the foundations of he will try to mention his intellectual
scientific medicine. He is considered as the ancestors, namely the Pre-Socratic
Father of Medicine” and such similar philosophers and scientists. In a more in-

1
Past –President ISHM, Greece.
150 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

dept analysis, he would comment on the Hippocrates acquired a mythical dimension


cultural or political climate during in the public mind soon after his death and,
Hippocrates’s era, which allowed his perhaps, even more so today.
creative output. Pretty much though, we He competes only with Alexander the
will experience an attempt to link the Great who through the century-old popular
Father of Medicine in the Golden Age and book Phyllada, became a favourite story in
its various exponents, such as Socrates and East and West alike.
Plato, Pericles and Pheidias. I will present first, only a few
This review approach is rarely extended Illustrations from three beautiful medieval
beyond the Greek space. So, we thought manuscripts.
that, in this open and productive event of
the IV-th Balkan Congress of History of Illustration 1
Medicine and the VII-th National Congress The left side of the first Illustration
of History of Medicine we should dare shows the delegation of Queen Saracinthe
something quite different. visiting Hippocrates’ grave somewhere in
To present the political and cultural Greece. Saracinthe was supposed to have
environment of regions we know, with been converted to Christianity by Joseph of
certainty or even with some doubts that he Arimathea.
visited, outside the Greek territory. The Hippocratic shrine was decorated
To proceed, that is, a more international with crosses, which makes sense, as in the
description of said environment. Middle Ages the Father of Medicine was
considered more or less a Christian. I do
Material not know if the finding of the actual tomb
This presentation will deal with of Hippocrates in Greece in the early 19th
Hippocrates’ journey to Scythia and with century is any less mythical; the upper
medical and general observations on that right side of the Illustration shows the
country and its people. same scene in another manuscript that we
The bulk of this information is derived will analyse later.
from his work “On airs, waters and The tale culminates with the fabled
places” which is generally regarded as discovery in Hippocrates’s tomb of an
authentic. ivory box, containing the work “The Book
It is a comprehensive study of ethno- of Prognostics”, which was in fact written
geography, correlating the medical seven hundred years after Hippocrates’s
problems of residents with climate death, a predictive text on dermatological
changes, the political situation and the lesions.
psychological aspects of their personality. In the centre of the Illustration, we see
I thought that an interesting way to an Arabic copy of the work from the 13th
present this would be in the form of a century.
story, both because the country itself was
considered legendary, and because its Illustration 2
people - men and women – that invaded The tale becomes extravagant, when,
Greek myths and the descriptions by Greek the same manuscript, from the Circle of the
authors were reminiscent of fairytales. And “Holy Grail”, shows Hippocrates treating
even perhaps because we were often the nephew of Emperor Augustus (who
narrated the life and works of Hippocrates lived half a millennium later).
as a tale. The good doctor then stayed at in
I will not delve into the general reasons 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, produced vast quantities of gold, guarded
as shown on the right side of the image. by the mythical sphinxes, creatures with a
Given that such fictitious follies on a female body, a lion’s head and griffin
fully documented historical person were wings. From the 4th BC century, we can
largely credible, particularly in the West, talk about two different groups, those who
we can see the room for the fantastic that live in northern Scythia and continue their
folk tales about distant and unknown traditional lifestyles and those of the
countries, like Scythia, allowed. South, who are somehow Hellenised.
Let us try to understand this place. From the culture of the first group, we
Starting from the land, this is a fabulous present in the next Illustration, an 8th
area with dark woods, mist, dragons and century bronze buckle and a gold Panther,
fairies. But let us define it geographically. while, from South Scythia a golden comb
It is a huge land, north of the Black Sea. with Greek influences.
Scythia’s location and size varied over This influence is most obvious in works
time, from the Altai Mountains where from the Greek commercial cities of the
Mongolia, China, Russia, and Kazakhstan North Black Sea, as shown by the
meet, along southern Ukraine to the area of comparison between leaden bull head from
the lower section of the Danube, Bulgaria their religious worship centre near Olvia of
and Georgia. The Chinese called the Sake Scythia and similar relief heads from the
(Asian Scythians) Sai. Scythia was noted base of a marble column in the sanctuary
for its large rivers like the Don, which of Delos.
formed its main communication routes, As time goes by, the Greek influence
and its many high snow-capped mountains, becomes more striking, as shown by A
which were responsible for the ever-lasting Scythian coin of the 1st century BC, which
cold in the country. Its people, the brings to mind Cavafy’s poem on
Scythians were tribes of undefined origin. Orophernes, son of Ariarathus.
They were first referred to in Assyrian Before applied art however, religion
codes of the 7th century BC. had introduced Scythia in the cultural
After many adventures, they left for the subconscious as a distant country that
above areas where they lived as nomads raised gods or as a place of exile imposed,
for centuries. again by the gods.
Both men and women were excellent From the time lost in the mists of myth
equestrians and warriors. More about these it was said that the father of Uranus, that is
fearless women will be said in the body of the great-grandfather of Zeus, was born in
speech on Hippocrates’ medical Scythia. Uranus’ father was Acmon of
information. Later, the Scythians come in Scythia. That was where the northernmost
contact with the Greek colonies of the gods were born.
Black Sea; have extensive commercial, The son of Hercules, Scythis, became
political and cultural contact with them and king of Scythia. Prometheus was exiled to
are partly urbanised. Scythia, where Iphigenia was also taken, in
Typical cultural elements of the specific to Tauris, when the goddess
Scythian civilisation include abundant Artemis took her in a cloud from Aulis to
scattered mined tombs containing spare her from being sacrificed.
impressive gold jewellery. It fact, it was in In his tragedy “Iphigenia in Tauris”,
the broader area of Scythia that the Euripides beautifully describes the moment
Argonauts found the Golden Fleece, when Orestes recognizes his sister at the
where, according to Pausanias, the land sanctuary: “During the preparatory ritual,
152 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Orestes started talking with Iphigenia in The Scythians, as I said, take some of
Greek; to their great joy, they quickly this hemp-seed, and, creeping under the
discovered who they were. felt coverings, throw it upon the red-hot
When she learned of the purpose of his stones; immediately it smokes, and gives
mission, she immediately pulled down the out such a vapour as no Grecian vapour-
statue from its pedestal so that Orestes bath can exceed; the Scythians, delighted,
could take it... According to this version, shout for joy”.
the ship finally moored in Vravrona, where The History of Herodotus was
Iphigenia placed the statue and, while the confirmed by archaeological findings,
temple was being built, followed Orestes to when, in 1292, Professor SI Rudenko
Delphi. At the sanctuary of Delphi she met unearthed, in a tomb in Pazryk, in the
Electra, brought her back to Athens and Western Altai area, a device for its use and
wed her to Pylades” (9). cannabis seeds.
A similar description exists in the third Herodotus also mentions the story of
hymn of Callimachus. Anacharsis, a young noble Scythian who
The area was also visited by Herodotus, travels to many countries, including
who provides us with extensive Greece, is impressed by its customs and
descriptions of its geography, inhabitants tries, in vain, to introduce them to Scythia,
and diseases that complement the picture where he is murdered. In his Panegyricus,
that emerges from the work of Isocrates (436-338 BC) states that the
Hippocrates. Scythians are the most powerful and
His work is believed to have been majestic people. (Panegyricus 67, 08 -5)
written around the same time with We thus see that Scythia, a faraway
Hippocrates’ “On airs, waters and places”, country, unknown and charming, had, long
although it seems that neither of the two before Hippocrates’ visit, penetrated Greek
authors knew of the other’s book. thought through mythology, religion,
At the end of his “Histories”, the Father commerce and art and the descriptions of
of History attributes the self-indulgence of contemporary travellers, like Herodotus.
Asians to the stable climate, while, Although still regarded as semi-
regarding the Scythians, he is mainly barbarous, contacts with Greece constantly
concerned with the relationship between increased. Therefore, it was not surprising
the local geologic and climatic conditions that Hippocrates travel there, nor that he
and their war tactics, than with their did not be feeling alienated or treated as a
ordinary diseases. curiosity. It should be noted here that
A similar method was later used by the certain historians are unconvinced that he
Romans to explain the martial arts of travelled to Scythia and believe, instead,
Germans living in similar conditions with that he describes the impressions of
the Scythians. another.
An early description by Herodotus of His work, however, “On airs, waters
the use of cannabis by the Scythians is of and places”, is believed to be authentic. It
particular interest to the history of begins with a description of this nation,
medicine. writing that “What is called the Scythian
According to many linguists, the word desert is prairies, rich in meadows, high-
cannabis itself is of Scythian origin. In lying, and well watered; for the rivers
book four of his “Histories”, Herodotus which carry off the water from the plains
describes the ritual use of cannabis after a are large. There live those Scythians which
funeral “[...] are called Nomades, because they have no
Z. DIAMANDOPOULOS: Hippocrates’ memories of Scythia: Stories and Fairytales 153

houses, but live in wagons. […] In these women, he assumes that their infertility is
wagons the women live, but the men are due to their obesity, which prevents the
carried about on horses, and the sheep, sperm from reaching the vagina
oxen, and horses accompany them; […]. unobstructed. Hippocrates brings as proof
They eat boiled meat, and drink the milk of the fact that the female slaves of the
mares, and also eat hippace, which is Scythians who are thinner and more agile
cheese prepared from the milk of the mare. because of their constant activity, and bear
[…] the Scythian race, like the Egyptian, children immediately when they come into
have a uniformity of resemblance, different contact with another man.
from all other nations. […] The changes of However, the indigenous population
the seasons, too, are not great nor violent, attributes this testicular atrophy and
for, in fact, they change gradually; and accompanying eunuch-like conduct to a
therefore their figures resemble one divine curse. For this reason, after they fail
another, […]. two or three times to impregnate a woman,
For these reasons their shapes are gross they believe that their goddess cursed
and fleshy, with ill-marked joints, of a them, wear women’s clothing and engage
humid temperament, […] I will give you a in womanly occupations.
strong proof of the humidity of their Hippocrates however believes that the
constitutions. You will find the greater part true cause is the phlebotomy of the
of the Scythians, and all the Nomades, posterior auricular vein, which they often
with marks of the cautery on their perform. He believes that this vein is
shoulders, arms, wrists, breasts, hip-joints, responsible for the creation of sperm.
and loins, and that for no other reason but Hippocrates’ description of a feature
the humidity and flabbiness of their unique to the race of the Scythians is also
constitution, for they can neither strain very interesting. That is, that their women
with their bows, nor launch the javelin ride and fight like men. In infancy, they
from their shoulder owing to their cauterise their right breast so that they may
humidity and atony: […] and as to the be able to shoot comfortably with their
women, it is amazing how flabby and arrows. They do not marry without first
sluggish they are. The Scythian race are killing three enemies. These were the
tawny from the cold, and not from the legendary Amazons, of we know much
intense heat of the sun, for the whiteness of mainly through the mythological cycle of
the skin is parched by the cold, and Theseus.
becomes tawny”.
The main diseases they suffer from are Illustration 3
infertility and testicular atrophy. In the third Illustrations we see first a
Hippocrates attributes the first to the scene from a vessel, with the battle
years thee spend horse-riding, which between the Athenians under Theseus and
hardens the outer genitalia and the heavy the Amazons under Hippolyta, while in the
clothes they wear because of cold that next illustration we see a classical display
prevent even the palpation of the male of a wounded Amazon and, for
genitalia and therefore their sexual comparison, a corresponding painting of
stimulation. 1904, but in the next, militancy has been
Relating to the above is an incised replaced by the love of Theseus for the
decoration in an amber vase from the Amazon Antiope. On the side however,
Kul’Oba region, now in the Hermitage Hercules continues his labours.
Museum in St. Petersburg. Regarding the Summing up the work of Hippocrates
154 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

on the nosology of the Scythians, and more these people, based mainly on reports of
generally on the influence of climate on Greek and Roman historians, were
health, it should be noted that despite his considered synonymous with brutality. A
many insightful comments, he did not book that published ten years ago attempts
entirely avoid ambiguities and generalities to collect all the European myths whose
that raised controversy from a very early core originates from corresponding
point. Already, his most ardent admirer, Scythian stories.
Galen, six centuries later, tried to reconcile In his King Lear, Shakespeare presents
the statements of his idol with his own the Scythian as a cannibal who eats his
knowledge. children. Old English writers, who wanted
To this end, he wrote “Comments On to prove the superiority of their race over
airs, waters and places”, which was the Irish, held them as descendants of the
unfortunately lost. It exists only in a Scythians based on a rumour that they
translation from Syrian by Hunayn ibn drank human blood and were nomads.
Ishaq (809-873 AD) Not surprisingly, the other Celtic race
Rather than end with the classic of the British Isles, the Scots, also claimed
fairytale ending “they lived happily ever a Scythian origin. As far back as 1320, the
after”, I will present a brief overview of famous Declaration of Arbroath, signed by
events after Hippocrates’ visit there and all the Scottish nobles and sent to the Pope,
the exchange of cultural with Greek the proudly advocates their Scythian origin,
area. In the early Christian era, it is said concluding that for this reason that they
that St. Andrews visited Asia Minor, cannot tolerate an English king.
Byzantium and Scythia, where he preached Through a complex alleged genealogy
Christianity in Kiev. tree, even the French kings of the
From the later Byzantine period, we Carolingian Dynasty proudly claimed that
know of the wartime relations of the they descended from the Scythians. The
Byzantines with the Scythians. The famous romantic spirit of the 19th century
miniature of Hippocrates donning identified the wild Scythian warriors with
Byzantine clothes, from the work of incorruptible democratic fighters,
Ioannes Actuarius was dedicated to his something like Cavafy’s barbarians, who
patron, the Grand Duke Alexios would save mankind through the
Apokaukos, who is shown the next destruction of Rome. Tellingly, the French
miniature. He was given this as a medical work of the Cycle of the Enlightenment
handbook to accompany him on his “Voyage Du Jeune Anacharsis” written by
expedition against the Scythians. In an Jean Jacques Barthelemy (1715-1795),
ironic twist of history, his daughter which repeated the Scythian’s ancient
eventually married the brother of the admiration for the democratic structures of
Scythians’ ruler, Theodore. Classical Greece, was translated into Greek
Being nomads and warriors, in by Rigas Feraios. Similar claims are made
subsequent centuries, the Scythians spread in modern times by the Serbs, Croats and
out in many directions so the effect of the Lithuanians. Even the website of the the
Scythians on European civilisation is much Australian Skopjans, who advance the idea
more pronounced than generally believed. of an Aegean Macedonia, features a map
Most blue-eyed blond Europeans have, at showing the supposed origin of all the
some point in their history, attempted to peoples of the southeastern Balkans from
prove their Scythian origin. the Scythians; the Skopjans see themselves
This seems surprising at first, since are their legitimate successors. It was
Z. DIAMANDOPOULOS: Hippocrates’ memories of Scythia: Stories and Fairytales 155

natural for the Jews believe Scythians as


their compatriots. They are supposed to References:
originate from prisoners of the ten tribes of [1]. Antiquities of the Jews, 11 .5.2, from
Israel who fled to the North Black Sea The Works of Josephus, translated by
after the occupation of Babylon Aeschylus, Whiston, W., Hendrickson
Herodotus (Book 4, chapters 24, 46) and Publishers, 1987, 13th Edition. p.294
Strabo (Book 8, chapters 3, 7), and even [2]. Callimachus, Hymn 3 to Artemis 170
Keating’s Irish history in 1723, “prove” ff (trans. Mair)
that the Scythians were smart, excellent [3]. Ernest Abel, 1980, Shaffer Library of
traders using a multitude of translators, Drugs Policy, Marihuana, the First
honest and did not eat pork, “thus” Jews. 12,000 Years.
Art provides objects that could be used as [4]. Esther Jacobson, The Art of the
“evidence”. It is with this contribution of Scythians: The Interpenetration of
art in the understanding of the spread of Cultures at the Edge of the Hellenic
the relationships of love and prejudice World (Handbook of Oriental
between Europeans and the Scythians that Studies, Vol 2.
I will conclude. [5]. Euripides, Iphigenia in Tauris,
Translation G. Ioannou, Kedros Publ.
Illustration 4 House, 1969, Athens
I present a series of illustrations of [6]. Federico Borca, Luoghi, Corpi,
Sphinxes from various eras starting with a Costumi. Determinismo ambientale
Classic Greek krater from Eretria showing ed etnografia antica. Roma: Edizioni
a Sphinx and proceeding with a pre- di storia e letteratura, 2003. Pp. 161.
classical fresco from northern Iran, which ISBN 88 -84 98-1
shows a Scythian horseman behind a [7]. Galen’s Commentary on Hippocrates’
surprisingly similar Sphinx. Then a plate “On airs, waters and places”, Prof.
with the scene of Oedipus and the Sphinx Gotthard Strohmaier,
and finally, we jump to the 19th century, www.manuscriptcenter.org/history/R
presenting, on the one hand a French gold esearches/Gotthard_Strohmaier.doc
and enamel buckle with the Sphinx and on [8]. Herodotus, Histories, 4.74
the other a set of cast-iron railings from a [9]. Herodotus, Histories, 9, 122, 3-4,
19th century mansion of Patras, now part of [10]. Hippocrates, Law on art, “On airs,
my personal collection. Please forgive me waters and places”, Translation:
for finishing with an even more personal Pournaropoulos G., Publisher:
testimony: A photo of me from my visit to Papyros, Athens
current Scythia, in Ukraine. I arrived at the [11]. http://www.apaclassics.org/AnnualM
city of Nizna, headquarters of the national eeting/08mtg/abstracts/Romm.pdf
benefactors Zosimades brothers, and, at the [12]. Isocrates, Panegyricus, 67, 08 -5
entrance of the school, I was welcomed by [13]. Karaberopoulos D., Rigas
young students with Greek flags and Velestinlis, The young Anacharsis,
evzone uniforms. The love, admiration and Vienna 1797 - Athens 2006, ISBN:
cultural affinity that the locals feel for the 960-87458 -3-7
Greeks are still as pronounced as we [14]. Scythians: From Wikipedia, the free
suppose and hope it was when Hippocrates encyclopaedia.
visited them to write his “On airs, waters [15]. Shakespeare, King Lear, Act One,
and places”. Scene First.
[16]. The New Encyclopedia Britannica,
156 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

15th edition - Micropaedia on [18]. www.cannabisculture.com/.../jul95/s


«Scythian», 10:576 cythians.html
[17]. The Riddle of Edmund Spenser’s A
view of the Present State of Ireland
(c.15 96)’, in: History Ireland
(Summer 1996).
Bulletin of the Transilvania University of Braúov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

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.

After more than 36 years of practice as One of the most interesting parts of his
a physician and service in the Army of the activities during this time in Moldova was
principality of Moldova as a high ranking the publication of one of the first scientific
officer, Dr. Jacob von Czihak returned to books, which was written in the Romanian
his motherland Germany and birth town language: “Historia Naturalis”, Iasi, 1837.
Aschaffenburg [3]. He was one of the first scientific writers to
Dr. Czihak helped with his personal prove that it was possible to use the
involvement to build up the civil and Romanian language for writing scientific
military medical service of the principality texts [1].
of Moldova during the years 1827 to 1863. His scientific life in the Moldavian
He was part of the movement working principality had many other highlights, but
towards modernisation and change in the these could be read in other publications.
still medieval like society of the Even after his retirement he still could
principality of Moldova during the first not stop with his enormous scientific
part of the 19th century. engagement to part his experiences in

1
Germany, PhD Student, University of Medicine and Pharmacy “Grigore T. Popa”, Iasi.
2
University of Medicine and Pharmacy “Grigore T. Popa”, Iasi.
158 Bulletin of the Transilvania University of Braúov • Vol. 2 (51) - 2009 • Series VI

Moldova with the western scientific world Society in Regensburg [4].


of his time. A short period after he This science newspaper was published
returned to Aschaffenburg in the Kingdom from 1818 until 1888 by the Royal
of Bavaria, he contacted the oldest Bavarian Botanic Society in Regensburg.
scientific botanic newspaper in the world Since 1995 this publication can be found
in the town Regensburg to publish an digitalized by the Missouri Botanical
encyclopaedia like article of the fauna of Garden in the World Wide Web under the
Moldova. It was named “Flora” or known web address: http://www.botanicus.org/
as “allgemeine botanische Zeitung” title/b11691608
published by the Royal Bavarian Botanic

Fig.no.1. Flora no.15

Dr. Jacob v. Czihak did not write this 10, 12, 14 to 20 of the year 1863.
article alone. He had a very competent co Both writers used a very modern and
writer named Dr. Iosef Szabo, a pharmacist systematic way to catalogue this number of
from Iasi. With his help he was able to plants. They use the Linné - System, which
collect and catalogue over a 3 year period was named after its inventor Carl von
from 1858 to 1861, over 391 plants and Linné from Sweden [5]. At first they
fungi of the Moldavian flora. They both identified the plant by it’s Latin name, then
produced a 71 page long article that was Dr. Czihak used the common German
published in nine parts in the “Flora” No. 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 published159
in
a western science paper was written by colonel dr. Jakob von Czihak and dr. Iosef Szabo
the Romanian name in a third position. In Romanian could be written. For example at
case the Romanian name was very the plants “Pitschor Kokoschului” or
different from the German one, he “Tschimbrischoare” you could see these
translated the Romanian words into behaviours, but he also had a Russian
German too. Dr. Cizhak was an emigrant influence in the way he wrote the
from Germany when he came to Moldavia Romanian language, for example by the
and so he learned the Romanian language name of the plant “Jarwa Stupului”. He
at the age of 27 years. The Romanian used the Cyrillic character and translated it
language at this time was in its early stages directly into German without considering
of being used as a language for scientific the change of articulation in this case. In
purpose. So a modern day Romanian could summary, he tried to make the Romanian
easily remark that Czihak wrote the language known in the German speaking
Romanian words like a German think scientific world of the time [6].

Graphic no.1 – Statistic about structure of Czikak text

By reading Dr. Czihaks text you note economic scope. With fungi he only
some structure of his catalogue. In the first mentioned the eatable or curative fungi.
part of his text you find the normal plants, Poisonous mushrooms where not
in the last part the fungi. The plants were mentioned at all.
first named, and then he described where Dr. Czihak tried to focus his article on
they could be found in the Moldavian the ethnic naturopathy use of the plants
Nature, or in which regions of Moldova and fungi in the Romanian society. This
they grew if they did not grow everywhere. aspect fills most of the information Dr.
The next step was to describe how the Czihak put in the descriptions of the plants
Romanians used the plants. If the plant had and fungi. All other aspects were for him
a curative effect he wrote this first, of secondary interest.
thereafter he mentioned the possibility of One example translated into English:
using the plant for eating or other Lilium candidum L., German: “weisse
160 Bulletin of the Transilvania University of Braúov • Vol. 2 (51) - 2009 • Series VI

Lilie” modern Romanian: “Crin” – lived in publications and scientific work from Dr.
gardens and vineyards often. The tree oil Czihak to make his beloved Moldavia and
was mixed with flowers to macerate. It was the Romanian language better known in
used to treat contusions and abscesses. The the Western European scientific world.
bulb was used to treat leucorrhoea. There
are also known the subtypes: L. bulbiferum References
L., L. pyrenaicum L., L. Martagon L. [2]
Dr. Czihak noted many common habits [1]. Czihak Ch. I., Istoria Naturala,
and uses of the ethno naturopathy of the Tipografia Albinei, Iasi, 1837
Moldavian and Walachian people, but also [2]. Flora Nr. 15, Regensburg 1863
a couple of different uses to his known [3]. Flora Nr. 20, p. 310, Regensburg 1863
German habits, which he mentioned in his [4]. http://www.regensburgische-
article. botanische-
Finally it is remarkable that his 71 page gesellschaft.de/geschichte.html
long article in the “Flora” was one of his [5]. http://de.wikipedia.org/wiki/Carl_von_
longest publications in a scientific Linn%C3%A9
magazine or newspaper outside of [6]. Pruteanu P., Iacob Cihac, Ed.
Moldavia. This article was one of his last Stiintifica Bucuresti, 1966, 90-98; 99-
publications and part of a lot of other 126
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

ANA ASLAN, THE WOMAN WHO


DEFEATED TIME

L. NEICA 1 N. ALDULEA 1

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
Polovrgeanu) the geriatric product Aslavital, breveted and industrially
produced since 1980.

Key words: Aslan, Gerovital, Aslavita.

1. Biographical data. Central School of Bucharest. There was no


Ana Aslan was born on January 01st obstacle that could not be surpassed for
1897, in Brila, being the youngest child of Ana Aslan so that at the age of 16, she
the fourth children of a family of dreamed of becoming a pilot and even flew
a small plane type Bristol - Coand.
intellectuals. The father, Mrgrit Aslan
Eventually, she decides to become a doctor
wasted his fortune because of his inability –,”undesirable” field for the women in that
in business and because of his passion for particular time. She declares the hunger
the card games. The mother, Sofia Aslan, strike to fight her mother’s opposition and
20 years younger than her husband, was a registers at the Faculty of Medicine,
beautiful young woman from Bucovina, attending it between 1915-1922 [2].
with a special education [1].
2. Professional Activity and Inventions.
She attended the courses of
Endowed with a generous spirit, during the
“Romacanu” College in her hometown, First World War, she nurses the soldiers
her childhood being marked by a sad within the military hospitals behind the front
event, namely the death of her father of Iai. She returns to Bucharest where she
(when she was 13 years old). After this works together with the well-known
event the Aslan family leaves their neurologist Gheorghe Marinescu (1919).
hometown and moves to Bucharest. Three years later, she graduated the Faculty
of Medicine. She was assigned as assistant
In 1915, Ana Aslan graduated the within Clinic II of Bucharest, managed by
1
Faculty of Medicine, Transilvania University of Braov.
162 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

professor Daniel Danielopolu, who is being incorporated, the first one of this
supervised her doctorate thesis. 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
Fig. no.1. Ana Aslan – source in the pharmaceutical circuit. She
www.mediafax.ro/.../ emphasised the importance of novocain in
the treatment of the dystrophic age-related
During 1945-1949 she carries out her troubles.
activity as tenured teacher in the Medical
Clinic of Timioara. 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 Fig. no.3.National Institute of Geriatrics
centre and she emphasises the importance source www.mediafax.ro/
of procaine in the improvement of the
dystrophic troubles related to age. She As she was highly passionate by
obtains remarkable results informed to the cardiology, Ana Aslan used procaine, a
Romanian Academy, whose member she local anaesthetic that has secondary effects
becomes in 1974 [3]. such as vasodilatation in the peripheral
In 1952, under the management of Ana arterial diseases. The condition of the
Aslan, the Geriatrics Institute of Bucharest 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 approached beauty according to health.
amazed. This represented the uniqueness The name of the product represents the
of professor Aslan who, in 1950 stated that combination of two words: “gero” coming
ageing could be stopped and the procaine from Greek and meaning “old” or
was a rejuvenating factor. “powerful” and “vital” that in Latin means
Ana Aslan Geriatrics Institute becomes “life” [6].
one of the most well known institutes of The products created by Ana Aslan are
this kind in the world, offering solutions in Gerovital H3 Deluxe and Gerovital H3
ageing fighting, both from the point of Regular.
view of the outside appearance and from In 1956 the researcher presented her
the point of view of the inside one. Most of discoveries at the European Gerontology
the treatments are meant for the people Congress of Germany, where they was
over 40 years old, age when the body starts regarded with scepticism. Novocain was
losing its elasticity and tonicity. 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
Fig. no.4. Gerovital H3 that period an epidemic flue affected the
communist countries. The mortality rate of
The patients are assisted by a series of those who had received the placebo was of
doctors in making the treatment that 13% and of those who had received
includes the re-fortification of the muscles Gerovital was of only 2.7%. Gerovital was
of the body, by means of massages and breveted in over 30 countries, initially
gymnastics, therapy and drugs specific to being considered a miraculous drug; it has
the age. an effect of balance on the vegetative
Gerovital H3 – the range of products nervous system, with visible improvement
conceived to fight the skin-ageing effects on various physical diseases.
phenomenon, formula adapted to the In 1976, the researcher is awarded the
various types of skin and to their specific inventor patent for Aslavital (together with
problems. The component elements of the the pharmacist Elena Polovrgeanu)
formula play a decisive role in the process efficient product in the therapy of the
of cellular regeneration, in the stimulation nervous system and of the cardiovascular
of the blood circulation and the system. Aslavital represents the first range
normalisation of the sebum secretion. The of products in the country based on clay;
genius of this formula resides in the fact she uses an original concept of preventing
that the distinguished researcher and delaying skin aging, emphasizing the
164 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

exceptional potential of clay. The concept Aslan Health SPA, Poiana Brasov - Sport
of anti-aging proposes a complete program Hotel, Bradul Hotel, Poiana Hotel,
of sensitive skin care, having as Bucharest - Athenée Palace Hilton,
ingredients clay, rice natural oil, vitamins, CrownPlaza.
extracts of marigold and ginseng. Eight
years later (1984), Aslavital for children Personalities such as Charles de Gaulle,
is being homologated, being successful in Indira Gandhi, Charlie Chaplin, Salvador
treating nervous deficiencies. Dali, Winston Churchill or Pablo Picasso
She creates the concept of "aging had had treatment with Gerovital in
prophylaxis" and she is concerned with the Bucharest.
elder people abandoned by their families. In time, the reputation of the products
She refuses to charge the care home taxes and of the treatments offered at Ana Aslan
for these unfortunate people, audacity centers attracted numerous celebrities such
costing her 1,500,000 lei, such money as Ymma Sumak, Somerset Maugham,
being imputed to her by the Party Salvador Dali, Charlie Chaplin, Pablo
authorities. After seven years of court Neruda, Aristotel Onassis, Jacqueline
harassment, she is acquitted. Yet, the Kennedy, Indira Gandhi, Marlene Dietrich,
acquittal comes rather late, five months Charles de Gaulle, Lilian Gish and Tito.
before becoming forever a legend. Justice
is made far too late, taking into account 3. Personal life.
that the outcome of her researches had Paradoxically, this special woman who
brought incomes of 17,000,000 dollars perfectly spoke French, German, Italian
annually, to the state. who could easily have a conversation in
Moreover, the reputation of Ana Aslan English, Greek, Spanish and Polish, who
products stimulates local tourism. Several read the greatest Russian prose writers in
hotels in the country offer their guests the the language of Balzac, used to believe
possibility of undergoing treatments and fortune tellers. Ana Aslan used to
procedures using Gerovital and Aslavital. systematically receive in her house of
These programs – generically called Ana Aviatorilor Boulevard a woman who was
Aslan Health Spa – combine the natural telling her fortune using cards or coffee.
environment factors specific to mountain Some people were certain that the fortune
or seaside resorts (the air with intense teller was – as many other people who
ionization, the salt water and the used to come to her house – informers of
saprophilous mud, plants having healing the Security Services. In the same time,
effects) with a multiple of classical Ana Aslan believed in God who used to
procedures. The clients have access to permanently have on her an icon of Virgin
hydrotherapy rooms, massage rooms, Mary. Ana Aslan was not only a scientist
facial and body aesthetic care, electro and and a doctor, but also an extraordinary
magnetic therapy, individual kinesitherapy woman. Among her patients there were
and fitness rooms. The list of the most kings, presidents of states, heads of the
famous resorts of this type includes Eforie secret services, actors and simple
Nord - Astoria Hotel, Europa Hotel - Ana earthlings. Otherwise, she avoided doctors
L. NEICA et al.: Ana Aslan, the woman who defeated time 165

all her life, having troubles in letting 4. Titles. Prizes and Distinctions.
herself on their hands, as she was her own The geriatric researches and the
doctor. She hardly accepted being operated development of Gerovital H3 formula
of colon cancer by professor Setlacec, at brought Ana Aslan the quality of honor
member in numerous medical societies and
Elias Hospital. A surgery is performed on organizations, thus becoming one of the
her and when they thought they made it, as most important Romanian researchers.
it was incipient colon cancer, less Consequently she was a member of several
aggressive in elder people, the final act societies [7]:
occurred. A new surgery is proceeded
because of an infection with Pseudomonas ƒ Member of the Academy of Sciences,
of New York;
aeruginosa taken from the hospital, but the
ƒ Member of the World Union of
infection had already seized the entire Prophylactic Medicine and Social
abdomen. Hygiene;
ƒ Honor Member of the European
On Thursday, May 19th 1988 Ana Aslan Center of Applicative Medical
died at Elias Hospital. Elena Ceausescu Researches;
refused to make her last wishes come true: ƒ Member of the Board of Directors of
funerals with a priest, together with her the Gerontology International
mother and brother, in Kalindero- Association;
Danielopolu crypt and she is buried in ƒ Member of the National Society of
Bellu Orthodox Cemetery without a priest Gerontology of Chile;
and without candles. ƒ President of the Romanian Society of
On the Internet, at the address GERO Gerontology.
Vital Web Site, a totally different version ƒ Her activity was crowned with
of the death of the savant is launched - in numerous Prizes and distinctions:
Portuguese. Mysterious sources assert that ƒ "Leon Bernard" international prize
she died in suspect circumstances and that and medal, prestigious distinction
some historians conform that she had been awarded by the World Health
assassinated by the Security Services. It is Organization, for the contribution
asserted that investigations have never brought to the development of
been made related to this issue. gerontology and geriatrics, 1952;
The international fame and the numerous ƒ Merito della Republica, Italia;
distinctions granted to her, the number and ƒ Cavalier de L’Ordre Palmas
rank of the patients in the political, Academica, France ;
scientific and artistic sphere all over the ƒ Honoris Causa Professor and Doctor
world include Ana Aslan in the Emeritus of Braganza Paulista
constellation of the most well-known University, of Brazil;
world personalities who "moved" the ƒ Commemorative Gold Medal,
Universe. No doubt that she was the most Nicaragua, 1971;
interesting medical personality living ƒ Merit Cross, Class I, Germany,
before 1989 in Romania. 1971;
“Being forever young does not mean being ƒ Hero of the Socialist Work, Romania,
20 years old. It means being optimistic, 1971;
feeling good, having an ideal to fight for and ƒ "Augusto Pinaud" Medal, Venezuela,
reaching this ideal.” (Ana Aslan) 1972;
166 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

ƒ Knight of the New Europe, Oscar References


Prize, Italy, 1973; 1. http://ro.wikipedia.org/wiki/Ana_Aslan
ƒ "Eva" International Prize, Italy, 2. http://biografii.famouswhy.ro/ana_aslan/
1974; 3. Avram A., Femei celebre, Ed. All,
ƒ Commander degree in the Order "De
2006.
Orange Nassau", Holland, 1975;
ƒ "L’Ordre du Merite" in the rank of 4. http://www.medicalstudent.ro/personal
Grand Officer, Senegal, 1976; itati/profunivdr-ana-aslan.html
ƒ "Dag Hamarskjoeld" Prize, 1977; 5. http://www.ici.ro/romania/ro/stiinta/asl
ƒ "Dama di Collare Del Santo Graal," an.html
Nice, 1978; 6. http://www.arhimag.ro/Gerovital-H3-
ƒ Citizen of Honor and Sciences este-redefinit-de-compania-unde-a-
Honorific Professor, Philippines,
fost-produsprimaoara++
1978 etc.
articles+article.aid+10334.html
7. http://www.travelworld.ro/romanesc/m
edicina/ana_aslan.php
Bulletin of the Transilvania University of Braúov • 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 BRAùOV
- 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

1. History processing, medical information processing,


The first computer was building in medical information science, medical
USA 1946 named ENIAC, having a weight software engineering, and medical computer
of 30 tons and a surface of 160 square technology.” [http://en.wikipedia.org/ wiki/
metres. Health_informatics#Aspects_of_the_field]:
If in the 1950 with the medical Medical informatics provides a new
informatics began to take off in the USA, approach of the applications in the medical
in Romania, Acad. Prof. Grigore C. Moisil area. In 1989 the International Medical
formed a research group whose expertise Informatics Association (IMIA) was
was the algebrical theory of automate established, under Swiss law as an
mechanisms (in other terms, the first steps independent organization. This association,
in computer science). Medical informatics IMIA, had an important role in application
is a interdisciplinary domain applying of information science and technology in
methods specific to informatics to the fields of healthcare and research in
medicine [1]. medical, health and bio-informatics. Some
“Medical informatics includes medical of the important objectives of the
computing, medical computer science, association IMIA are to introduce in health
computer medicine, medical electronic data care and health research the informatics
processing, medical automatic data applications. In 1976 the European

1
Transilvania University of Braúov, Faculty of Mathematics and Computer Science
168 Bulletin of the Transilvania University of Braúov • Vol. 2 (51) - 2009 • Series VI

Federation for Medical Informatics (EFMI) in this domain should be taught and trained
was established in Copenhagen in Septem- as to use efficiently and in a correct way
ber 1976. EFMI functions as the autono- this new equipment. This is the reason that
mous European Regional Council of IMIA. has led to the development of small
In our days there are a lot of types of applications meant to solve urgent
medical software as: problems related to the recording of the ill
9 software to interpret the sensor persons or of the diseases, as well as
information and display it on a monitor; statistic processing. These applications do
9 devices that are programmed to not require an up-to-date infrastructure.
pump some medication or other solution We shall show some of these
into a patient; applications designed by a mix team of
9 processing row data obtained by researchers of Transilvania University of
measured and create images that doctors Braúov.
can read and understand;
9 expert systems that indicate what 2. Online application
should be done; On line applications in the medical area
9 software used as an educational or have been designed and developed since
study tool for healthcare. 2004, in Transilvania University of
Brasov. These applications were the
We enumerate a series of software products of a research team comprising
products able to assist the doctor or the computer scientists, statisticians and
patient and are divided into categories physicians, and were presented on the
according the particularity of the medical occasion of the international conferences.
area or for the medical environment: At present, this team is at the final stage of
9 Public Health and Biosurveillance: designing these applications as to be
Epi Info, EpiSPIDERE, iDART; implemented in the emergency room and
9 Electronic health or medical record : to be used as didactic material for the
CHITS, FreeMED, GNUmed, Open classes of computer science within the
Healthcare; Faculty of Medicine. The development of
9 Medical Practice Management this software has been possible, due to the
Software : Care2x, ClearHealth, fact that the author of this paper dedicated
FreeDiams ; her research work to the web technology
9 Health System Management: DHIS, and the on-line applications. At the same
iHRIS Suite; time, the curriculum of computer science
9 Imaging/Visualization: 3D Slicer, for the students in the Faculty of Medicine
Brain Visa, BioImageXD; has been improved, the main goal being
9 Telemedicine: Ipath. ZephyrOPen. the students’ training in using the on-line
informatics products.
One can say that health informatics is Biostatistics tackles with the analysis of
meant to include not only computers but biological and medical data.
also the clinical guidelines and the corres- Statistics is important not only in
ponding information and communication analyzing the health status of patients but
systems. It is applied to the areas of public also for analyzing the administrative work
health, (bio)medical research and also in a clinic and developing modalities for
eLearning in medicine. Software and improving these types of activities.
platforms already designed are extremely Important information one can obtain from
useful, instead, the medical staff working the patient record that must be field, when
L. SANGEORZAN: Historical aspects of computer science in the emergency room in Transilvania
169
university of Braúov - a study case -
the patient is coming in the emergency measurements for describing the
room. It is important to improve the quality distribution, to draw pictures (histograms,
of healthcare and this is possible if one can polygons, etc.) of the distributions and to
collect in real time, data about patients. use certain measurements which are most
This entire one can do with statistical commonly used to describe a distribution.
methods using IT tools and with specific
online software. 2.2. OnLine_Patient_Record -
There are two types of on-line Problem Formulation
applications designed by the mix team, OnLine_Patient_Record is an online
made up of computer scientists, statistic- informatics system, dedicated to the patient
cians and physicians, within Transilvania care in an emergency room in a hospital
University, such as: and comprises several applications
9 Application of recording the patient designed to reach the following aims:
for emergency cases [4]. - to get important information regarding
This patient record can be stored on the patient
the computers with the application called - to get summary statistics and the chart
OnLine_Patient_Record. Each user will type for the selected variables ;
introduce the information in an Excel file - to support students in health sciences
and this can be printed out and/or one can to improve their research during their
see also statistical result. medical training and university
9 On-line statistic processing of data studies.
related to the patients or the diseases. This
information can be processed on-line with Following the fields enclosed in the
the application “e-Statistics“ and it support Hospital patient record (Fiúa de observaĠie
the training of medical students and clinică generală) (Fig.1) we build the web
nursing students with the aim of becoming application. The model is realized in such
familiar with elements of statistics and the way that the access to the application is
use of Excel files in on-line processing of granted for two categories of users: the
statistic data [3]. administrator and the user.
The administrator - is the person which
2.1 Theoretical aspects has access to all parts of the application
The written applications called uses at allowing him to manage the database
implementation level the PHP server information.
scripting language. The language PHP has The user - is an employee of the
a special flexibility which permits to be hospital -doctor or nurse - which has
used with other technologies. These access to certain parts of the application,
languages/technologies make possible to after authentication.
obtain remarkable results. WEB 2.0 is a The software system OnLine_Patient_Record
term describing the trend in the use of allow to display or print the information
word wide Web technology and Web stored in the current Excel file, the
design that aims at enhancing creativity, database that is an Excel list. The menu bar
information sharing and communication (Fig.2) contains the following applications:
among users [4]. The input data stored in 9 Hospital patient general record (Fiúa
the created database are processed by using de observaĠie clinică generală) allow, after
elements of mathematical statistics. In authentication, the introducing of patient
order to investigate the character of a data in the Excel files ;
distribution, it is useful to have various 9 e_Statistics – allow to generate the
170 Bulletin of the Transilvania University of Braúov • Vol. 2 (51) - 2009 • Series VI

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.3. Selecting a variable for generating


the summery

Fig.1. Hospital patient record

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:
ƒ In the first sheet, named
data_sheet, must be stored the data to be
Fig.2. The main Interface of Online analyzed. The first row must contain the
Patient Record 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
171
university of Braúov - a study case -
ƒ In the next sheets, for each example for the Sex variable we give 1 for
variable with text values, we must give male and 2 for female (fig.6).
them a number, a codification. For

Fig.5. Data Base for Online Patient Record

Fig.6. Codification for variable Sex


Bulletin of the Transilvania University of Braúov • 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 References
application from the Web Server after [1]. Mocanu N.-M. T., Informatica
authentication medicală - Ed. Transilvania Brasov,
c. On the Server we store all the 1996.
uploaded data for later use. The data is [2]. O’Reilly T., Web 2.0 Compact
made accessible for other authenticated Definition: Trying Again. 2006–12–
users for viewing and analyzing. 10, Retrieved on 2007.
[3]. Sângeorzan L., Florin T., Rogozea L.,
3. Conclusion Miclăuú R., Summary statistics for
This software application has been Training Medical Students, 29th
created as to be easily scalable and International Conference of the
adaptable (on request) to other emergency Romanian Medical Informatics
room and also for eLearning for students Society, MEDINF 2007, e_Health
studying medicine or nursing. The Days in Sibiu, pg. 299-304, 8-11 Nov.
application uses PHP server side scripting 2007, ISSN 1843-651X.
language, Excel list as database, all of [4]. Sangeorzan L., Nedelcu A., Mazgaciu
these technologies are open source, and C., Rogozea L., Podoasca C., Online
allow easy implementation on any server Patient Record in an Emergency Room
with any operating system. The application Based on WEB 2.0 Technologies,
is very dynamic; it allows storing the Mathematical Methods and Applied
information in the emergency room in real Computing, Vouliagmeni, Athens,
time. Greece, September 28-30, 2009,
Proceeding of the ACC’09, pg.622-
626, ISBN: 978-960-474-124-3, ISSN:
1790-2769
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

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. The resources to analyse the ƒ Average number of papers for one author
quotes and to measure the impact factor ƒ Average number of quotes in one year
of publications ƒ Hirsch Index and linking parameters
Publish or Perish – is a soft designed to ƒ Egghe g Index (EGGHE L., 2006 )
analyse the quote in the aim of helping ƒ h contemporaneous Index
scientists in increasing the impact of their ƒ Age Importance in quote rate
research. ƒ Two variations of individual h index
This software is available no charge on ƒ Analysis of the number of authors for
the web page of Prof. Anne Wil one paper
HARZING, International Management Publish or Perish is designed to
Specialist in University of Melbourne, individual empower scientists to present their
Australia (Harzing A.-W., 1997-2009). personal experience of researches’ impact in
Willing to reveal the researches the most advantageous way. Is not
influences of the publications not quoted in recommending being mechanical in
ISI Journals the best recommendation is academic evaluation. It is highly reco-
the soft Publish and Perish designed to mmended to consider the following aspects:
process and analyse the quotes .The soft is a) If a teacher has good performance
using Google Scholar to find the based on publications’ quotes is
references, quote sources and then analyse obvious he has a significant impact in
them leading to statistics based on the that field of science. The backhand is
following parameters: not valid every time.
ƒ Total number of papers b) If a teacher has not very good results
ƒ Total number of quotes in his publications’ quotes, one cause
ƒ Average number of quotes for one author can be the lack of impact of his
ƒ Average number of quotes for one domain of research. Another causes
publication might be linked with a small domain

1
Faculty of Mechanics, Transilvania University of Braov.
2
Faculty of Medicine, Transilvania University of Braov.
174 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

he is working in or his publications are new indicator for measuring personal


in a different language then English scientific results was quickly considered
(LOTE- Languages Other Than by informatics’ specialists and
English) or his publications are only bibliometrics’ researchers.
books or papers in books. In the specific literature (Borgman,
Although from this point of view, 1990) the specialists found approximate 30
Google Scholar has better performance publications referral to h Index in one year
than Web of Science it has no performance after Hirsh paper. Also, there were a lot of
in taking quoting from books or books’ comments, critics and an evaluation
chapters. regarding h index and was revealed that H
Measuring the quoting in Social index is less sensitive in the most quoted
Sciences and Humanist Sciences they are references in a publications and is
underestimated because they are published dependent of the domain of science.
in LOTE - Language Other Then English Different variants of Index were
and in books’ chapters more than Precise designed in the aim to eliminate the
Sciences. disadvantages: m coefficient, h index
Google Scholar provides more quotes (Hirsch, 2005), g index (Egghe L., 2006), h
than ISI but not in all domains. Both soft index (2) (Kosmulski, 2006), A index (Jin,
are covered Social, Humanist and 2006), R index (Jin B., 2006), AR index
Engineering sciences with quotes in books, (Jin B. L., 2007) and hw index (Egghe L.
proceedings of conferences and a large R., An h-index weighted by citation
amount of journals. Natural Sciences and impact, in press). The most representative
Health Sciences are well represented in ISI and productive score of researchers’
and subsequently Google Scholar cannot impact is weighted by h index and g index
provide more quotes. In addition, journals and the papers’ impact is weighted by R
are not generally covering Google Scholar. index and AR index.
This is the reason way quoting in this To optimise the presented indexes was
domains can be smaller then in ISI suggested b index as indicator with two
(Harzing A.-W., 2008). values (suggesting to enclose or to disclose
As recommendation, Google Scholar the publications in weighted the author’s
can be preferable in the following productivity) and result of the researcher’s
domains: characteristics. B index is based on value
a) Business, Administration, Finance & comparing of researchers’ indexes.
Economics;
b) Engineering, Computer Science & 2. The research in Google Scholar
Mathematics; scientometric database. The analyze of
c) Social Sciences, Arts & Humanities. history of medicine’s publications
Better, is recommended to processed A simple request for searching “History
this analysis in parallel and comparative of medicine” will arise 2810000 results.
with Scopus and Web of Science. The most quoted book is FH Garrison
Hirsh (Hirsch, 2005) suggests h Index : An introduction to
as a criterion to quantify the scientific the history of medicine, 1914. This book
impact of an author as following: a has 814 quotes.
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
A. REPANOVICI et al: Analysis of the impact of publications in the history of medicine 175

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. 1: Image from scientometric


database Google Scholar

Analysing h index for the most quoted


authors for published books give the next
results:

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
Figure no. 2: Analyse of the search impact new instrument of measuring the research
for author FH Garrison performances.
176 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Quoting is an intellectual transaction or [4]. Harzing, Anne-Wil. Google Scholar - a


an intellectual responsibility to other new data source for citation analysis.
people work. H index depends as well on 20 December 2008. 13 August 2009,
the number of publication as on the impact http://www.harzing.com/pop_gs.htm.
on the users. [5]. Hirsch, J. E. „An index to quantify an
Publish and Perish Soft represents an individual's scientific research
instrument very easy to use in analysing output.” Proceedings of the National
the researches’ impact. It is free of charge Academy of Sciences of the United
and evaluates the research’s impact and his States of America. Washington:
visibility on the internet through Google National Academy of Sciences of the
Scholar. United States of America, 2005. 102
ISI Web of Science is a very expensive (46): 16569-16572.
database and a very low number of [6]. Repanovici, A. Managementul resurse-
institutions have access to this database. It lor informaionale în cercetarea tiin-
is recommended to consider the domain of ific. Braov: Editura Universitii
research, when academic evaluation TRANSILVANIA din Braov, 2008.
because the results are different from one [7]. Repanovici, A. „Marketing Research
domain to another. about Attitudes, Difficulties and
Interest of Academic Community
References: about Institutional Repository,
[1]. Egghe, L. „An improvement of the h- PLENARY LECTURE.” Advances
index: the g-index.” ISSI Newsletter in Marketing, Management and Fi-
(2006): 2(1): 8-9. nances, Proceedings of the 3rd Inter-
[2]. Egghe, L., Rousseau, R. „An h-index national Conference in Management,
weighted by citation impact.” Marketing and Finances, (MMF’09),
Information Processing & Houston, USA, April 30-May 2,
Management (in press): in press. 2009, ISSN 1790-2769, ISBN 978-
[3]. Harzing, Ane-Wil. HARZING HOME. 960-474-073-4, pag.88-95. Houston,
1997-2009. 13 August 2009, USA: WSEAS, 2009. 88-95..
http://www.harzing.com/index.htm.
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

„MEDICAL HYDROTHERAPY” OF
GEORGE BAIULESCU – AN HISTORICAL
PERSPECTIVE

R. MICLĂUù1, L. ROGOZEA1, G. SECHEL1,


A. FLEANCU 1, 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.

Among a sum of cultural treasures hosted in the field of history of medicine in Brasov
inside the old walls of Brasov County and Romania.
Library, “Medical Hydrotherapy” is one of The “Medical Hydrotherapy” was
the rare books useful to understand the old published in 1904 in Bucharest, at Minerva
times, époques and the Romanian culture Publishing House, Institute of Graphic Arts.
evolution. A part of these books were the The rare sample of the book has the owner’
property of the physician Emil Bologa, local autograph fromApril 18, 1938 and an “ex-
doctor and very well known for his research libris Dr. Emil I. Bologa” representing a a

1
Faculty of Medicine, Transilvania University of Braov.
2
Faculty of Mechanics, Transilvania University of Braov
178 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

skull, a snake, a book and contained the machineries necessary to provide the
Latin expression „mulla dies sine linea”. 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 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. Fig. no 2 Illustration from book
Written in the beautiful and authentic
old Romanian language of the beginning of In the chapter “Introduction” doctor
the 20th, full of neologisms century the Baiulescu underlined the factors that
book is structured in one Introduction and physiotherapy and watery application
two parts, collecting in 698 pages 53 depends on the: 1. water’s temperature; 2.
photographs and a lot of medical time of application; 3. individuality of the
information very new for the beginning of patient; 4. skin’s sensibility; 5. nervous
the 20th century. activity and reaction; 6. peripheral circu-
The first part has two big chapters „The lation; 6. patient’s reactivity; 7. type of
physiologic action of Hydrotherapy” and pathology and others. Additionally, the
„The Reaction” and the second part is author showed that „there is a big differ-
structured on five chapters: „The Technique rence in practicing hydrotherapy’s appli-
of Hydrotherapy”, „The Hydrotherapic appli- cations” in France where the main
cations for sudation”, „The Compresses”, procedure were showers comparing with
„The Irrigations”, „The Drinking Water”. Germany and Switzerland where are used
The book shows pictures of the cure more often Priessnitz procedures like half
rooms of Brasov hydrotherapic depart- bath, frictions with wet and cold sheet, wet
ment, one for men, one for women and the or dry packages, perineum bath.
technical conditions and electrical The physiological effects of hydrotherapy
R. MICLXU et al.: George Baiulescu – an historical perspective 179

are very well described. First, Baiulescu thousands red blood cells/cube mm and the
postulated: „all applications not included in number of white blood cells is three times
33-36 C are excitants for a body and induce higher and haemoglobin is 14% higher
physiological changes”. The book included than before the applications.
detailed actions of hydrotherapy on central On muscles, “cold applications increase
nervous system, blood circulation, the muscles’ capacity and labor and warm
„morphology” of the blood, „organic applications decrease the muscles labor and
exchanges”, breathing, muscle strength, effort capability if not combined with
temperature, secretion and excretion. mechanic action”.
In addition, the cardiovascular effects In the chapter „The Reaction” is a
depend on the temperature and on the time of description of hydrotherapic effects and a
application. There are precisely described the classification of these effects in primary and
effect of warm application in intensive or non- secondary. Also, “each technique of
intensive application. Considering that the applications has to specify tree periods: 1.
effects of hydrotherapy influence the central action period; 2. reaction period and 3.
nervous system, the circulation, the equilibrium seting”.
“morphologic condition of blood”, the The book presented a very modern
“organic exchange”, the breathing, the concept related to the medical management:
muscles strength, the temperature, the secre- 1. The patient admission is mandatory to
tion and excretion, doctor Baiulescu is detai- assure the continuity and regularity of
ling these domains further. Concerning the hydrotherapic applications. 2. The favorable
hydrotherapic effects on central nervous effect of the cure mostly depends of the
system Baiulescu considered that hydro- “hospital management meaning the doctors’
therapy influences as well locally as at experience and the pluming and technical
distance thus “a cold application on feet has a installations (modern machines able to
reflex influence of brain and meninx’s mathematically control in short time the
vessels. A hot bath of hands influences on water temperature and pressure)”
respiratory organs.” Convinced of the medical effect and
Based on the assertion of reflex points importance of hydrotherapy, George
and their stimulation techniques Baiulescu Baiulescu sustained in 1904 that
described the tonic or relaxing effects of „hydrotherapy is recognized today from the
massage and as well physical effects as majority of physicians as an excellent
psychic influences of hydrotherapy. “medication” not only in chronically
Baiulescu wrote the conclusions related diseases but in acute pathology, too,
to the effects of intensive warm application especially in typhus fever”. „The patients
vs. cold applications: „through local cold won a strong confidence in watery therapy
and warm applications and depending on beyond doubt. The proof is the high
the intensity of thermal excitation will be addressability of patients in all hospitals
induced a primary vascular constriction appropriate equipped with good techniques,
followed sooner or later by a vasodilatation plumbing and a run with good
inducing a skin hyperemia”. management”. “Still, there are many
Concerning the influence of hydro- reasons that hydrotherapy is not enough
therapic applications on „the morphology” valued, known and practiced”. Baiulescu
of the blood there are remind the public- explained that the procedures are not
cations of Winternitz, Rovighi sau Thayer. enough known because hydrotherapy was
Thus, the author remembered „Wintermitz practiced for many centuries by false
found a maximal increase of 1860 “therapists” being completely compro-
180 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

mised, also because “physicians considers of medical practice, more practical then
hydrotherapic practice as a “humiliation” others and which needed advertising and
and not practicing is a vicious circle motivation to be operable.
leading to a deep lack of skills” and because Even the book received objections from
“hydrotherapic techniques are considered Criniceanu as not being a valuable book as
as “inconvenience”, not cozy and medical literature, the initiative to write a
completely neglected”. 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,
Bucureti, 698 de pagini, 1904
[2]. Bologa V.L. – Contribuii la istoria
Fig. no 3 Ex libris Dr. Emil I. Bologa medicinii în Ardeal, Tipografia
Ardealul, Cluj, 1927
Another author’s concerns are that [3]. Bologa V.L. i colab. – Istoria
hydrotherapy “is not included as compulsory Medicinii Româneti, Ed. Medical,
into Medical Universities’ curricula and this is Bucureti, 1970,
the reason why young doctors’ medical [4]. Brtescu Gh. – Dicionar cronologic
education is not complete”. In some de medicin i farmacie, Ed. tiinific
universities abroad the students are able to i enciclopedic, Bucureti, 1975
attend courses about the hydrotherapic theory [5]. Huttmann A., Barbu G. – Medicina în
but they cannot have a solid preparation, hold oraul Braov ieri i astzi, Ed.
the technique and observe the therapeutic Medical, Bucureti, 1959, 162 p.
effects of hydrotherapy” [6]. Ivan N., Crciun I., Lotreanu C. –
Further, doctor Baiulescu insisted on Istoria Medicinei, Ed. Universitii
the mandatory of doctors’ theoretical Lucian Blaga din Sibiu, 1998
knowledge to be complete with practical [7]. Izsak S. – Aspecte din trecutul
skills on the manner of applying the medicinii româneti, Ed. Medical,
hydrotherapic techniques.” If the doctor Bucureti, 1970, 902p.
has not enough skills and experience in [8]. Izsak S. – Farmacia de-a lungul
handling the apparatus and tools used to secolelor, Ed. tiinific i
apply hydrotherapy, he will be fallible and Enciclopedic, Buc, 1979
the benefit effects of the applications can [9]. Rogozea Liliana - Farmacognozia în
be compromised”. pregtirea studenilor mediciniti din
Each doctor should be able to apply all România, de-a lungul timpului, Ed.
the procedures but if this is not possible is Universitii Transilvania, 2002
compulsory at least to supervise the [10]. *** – Gazeta de Transilvania, 1850-
applications he prescribed” 1945.
Finally, the importance and value of
“Medical Hydrotherapy” is non contestable
as a very bold publication about a new field
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

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.

The experience made during the “tainted” pesthouse, to become later the
epidemics of the XIVth century contributed “old” lazaret (Fig. 1), the first institution to
to the affirmation of the contagionist be established for this purpose.
hypothesis of which Venice remained In this last case, according to the
vigorous supporter for the entire period of habitual formula, the location was decreed
its history [5] as “healthy (thanks to God) and free from
This theory maintained that the cause of any doubt of contagious illness”: a “fede di
the plague, identified with the so called sanità” that is a specific written licence
“miasma”, corrupting the air and decom- bearing this statement, was released in
posing the bodies, could attach from an such a condition by the local sanitary
individual to another, or even adhere itself officers.
to clothing or to objects, thereafter passing Otherwise, only when the prescribed
to whoever touched them. period of the quarantine was terminated
Accordingly, systematic measures of without evidence of the plague the “libera
isolation, such as sanitary cordons, quaran- prattica” (that is free entrance) was
tine and disinfection were taken [1] granted. Even today in the “new” lazaret
In 1423, the Senate ruled out to assign are still visible the “graffiti” done mostly
the monastery of Saint Mary of Nazareth during the sixteen century by people kept
to the isolation of people affected by the in isolation for such a long time.
plague. This was thus transformed into the

1
Department of Neurological Sciences, University of Padua Medical School.
182 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

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 the merchandise, but from a sanitary


Republic were particularly directed upon standpoint two large groups were distin-
people and goods originating from the guished: “susceptible” and “not susceptible”.
territories of the Ottoman Empire, with Under the name of “susceptible” goods were
which Venice maintained commercial ties encompassed those items that were
of utmost relevance and where the plague considered to be able to transmit the
was constitutive. contagion; to the contrary, “not susceptible”
On the terrestrial side, at the border were those incapable of such a transmission.
between Dalmatia and the Ottoman These included materials that by their
Empire, a pesthouse at Cattaro was nature seemed to retain more easily the
constructed and other pesthouses were “contagious miasma” such as wool,
built in the Venetian possessions in the clothes, rags, skins, feathers, rope;
“Levante” (the Venetian word for the whereas, within the first group, were listed
territories facing the oriental Medite- (quotation from a XVIth century Venetian
rranean sea), to control the busy traffic document) “all of the lumber, wines, oils,
with the Turkish domains, from where cured and fresh meats, cheeses, metals,
periodic bouts of epidemics originated. jewellery, money”, and further on
The measures of prevention against the “animals, without leash and harness,
importation of the contagion included the however; except dog, cat, sheep, mutton
disinfection of objects. The treatments because these sorts of animals are able to
varied according to the quality and value of propagate contagion”.
G. ZANCHIN: The Lion’s Republic fight against the plague originating from the Levante Veneto
183

Disinfection of the goods took place (Public Attorney) Lorenzo Alugara on the
with the “sborro”, that is the exposure to successful containment of the plague
air and sun; or with heating, immersion in which reached the lagoon on an Ottoman
sea water, spraying with vinegar, “perfu- ship in 1793 [6].
ming” that is with fumigation which aimed The way we found it is rather curious.
at neutralizing the miasma substituting it Since the year 1521, the Venetian Doge
with the “fumes” of aromatic woods. used to have coined every year a special
The finding of a manuscript notebook of silver medal, called “osella”, commemo-
the end of XVIIIth century of medical content rating the most relevant events of the
allowed us the examination of an Serenissima Republic [3].
unpublished report contained within, that Being interested on the impact of the
treats the problem of the propagation of plague on the Venetian traditions, our
contagion, in relation with the closely research brought us to identify, among the
attached problem regarding “susceptible” 275 osellas coined until the end of the
and “not susceptible” goods (Fig. 2). Such a Venetian State, five occasions in which the
distinction, obviously with reference to the coins were referring to the plague [4].
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


Fig.3. Coined in 1793 under the Doge
quibusdam aliis (1812), unpublished
Ludovico Manin (first), this “osella”
manuscript by Ignazio Lotti, Protomedico del
commemorates the successful prevention of
Magistrato di Sanità Marittima di Venezia.
plague epidemics in the port of Venice. On the
Private collection.
second, in the forefront we see the Vierge,
encircled by the inscription Nec nuper defeci
A second important document, (Even in this distress I did not abandon you). In
preserved in the State Archive of Venice, the background, the little church identifying the
will be also examined in this context. It is a island of Poveglia is well reconignizable, as
detailed report by the “Avvocato fiscale” well as a ship put in quarantine.
184 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

This rather unknown iconography appeared surviving crew.


indeed as a relevant document of the popular The examination of the above
faith, since in most instances a religious symbol- mentioned primary sources put in evidence
lism is prominent. However, the picture of the last relevant aspects of the Venetian fight
osella “of the plague series” (Fig. 3), struck in against the plague. Indeed, until its end the
1793, makes a reference not only to the Virgin Serenissima constantly supported the
protection, but also to factual measures of isola- contagionist hypothesis as witnessed by
tion, clearly quoting a very interesting episode of the establishment in its lagoon of the first
a successful fight against the plague, the detailed lazaret since 1423, playing for all the span
report of which we were then able to identify in of its history the role of pioneer and model
the State Archives of the Republic in Venice. for the measures adopted to prevent the
On a “Tartanella”, a little commercial diffusion of epidemics.
ship, with Ottoman flag and a crew of
thirty people, a case of bubonic plague References
developed with “petacchie nere, antraci,
buboni”. [1]. Bergdolt K., La peste nera e la fine del
Strict preventive measure were medioevo. Edizioni Piemme, Casale
immediately taken “to stop the infection in Monferrato 1997.
the same place” in the Poveglia’s canal, [2]. Lotti I., De multis rebus et de
that for this purpose was get rid of any quibusdam aliis. Unpublished
other ship. The crew, put ashore, was manuscript (Private collection) 1812.
divided in affected and in suspect groups, [3]. Paolucci R., La zecca di Venezia.
which were held in separate locations. An Paolucci editore, Padova 1991.
internal ward of soldiers was established [4]. Zanchin G, Mainardi F, Dainese F,
on the island; around it an external circle Maggioni F. La pestilenza nelle
of armed ships was put. As a whole, “oselle”, monetazione celebrativa della
internal and external wards were formed Repubblica di Venezia. Atti del XLI
by one hundred forty individuals, plus nine Congresso Nazionale della Società
ships and two boats. Everything -food, Italiana di Storia della Medicina.
water, garments- that was necessary for the Mesagne (Br) 2002, p. 145-154.
well-being of the crew was brought ashore [5]. Zanchin G. Health and disease in the
and continuous fires were kept alive to relationships between Venice and
purify the air from the contagious miasma. Istanbul. Proceedings of the 38th
At the end, twenty crew members International Congress on the History
survived and the plague was successfully of Medicine. Istanbul 2002, p. 285
contained within the island. The feelings of [6]. Archivio di Stato di Venezia,
gratitude for the Republic are well Provveditori alla Sanità, filza 251.
documented by a letter wrote to the Venice
health officers by the captain and the
Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009
Series 6: Medical Sciences
Supplement – Proceeding of The IVth Balkan Congress of History of Medicine

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.

Introduction Edouard Adolphe Duchesne (1794-1869)


The eponyme Duchenne is well known from Paris, a respected doctor of the local
in relation with the most common form of salons at the time. [6]
childhood muscular distrophy, even though
Duchenne was not the first to describe this Duchenne’s life
disease, but the one to clarify both clinical Duchenne (1806-1875) was born on the
manifestations and microscopically charac- 17th of September 1806, in Boulogne-sur-
teristics based on muscular biopsy studies. [5] Mer (Pas-de-Calais, France), the place
Guillaume-Benjamin-Amand Duchenne where his family had lived since the
was a French neurologist of the XIXth middle of the XVIII century. His father
century, a pioneer of muscular electro- was marine captain during Napoleon
physiology based on Galvani’s research. Bonaparte’s wars. He was affectively
Although the father of modern neurology connected to his birth places for his whole
is thought to be Charcot, he truly life. Both his personality – active, ambi-
appreciated Duchenne’s work and called tious, yet very calm and his accent and his
him „my master”. look prove his Boulogne origins. [9]
Duchenne chose „de Boulogne” as a Although his family’s tradition was related
post-nom in order not to be mistaken for to sea and his father had hoped Duchenne

1
Braov.
2
Faculty of Medicine, Transilvania University of Brasov.
186 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

would follow his steps, love for science Along the description of diseases named
was stronger. after him, Duchenne also contributed to
Duchenne went to local school, than to differentiation of facial nerve paralysis
highschool in Douai and he was 19 years caused by central and peripheral neuron; he
old when he got his Bachelor diploma, described the cog wheel sign in Parkinson
along with his colleague and firned dr. C. disease, the characteristics of Lead intoxi-
Gros. Next, he tudied Medicine at Paris cations and the epigastric respiratory
which he graduated in 1831, with a licence depression of frenic paralysis is called
thesis about burns called „Essai sur la Duchenne sign. [12]
brillure”, having probably been influenced In „De l'électrisation localisée et de son
in choosing the theme by Dupuytren. application à la physiologie, à la patho-
As a doctor, he returned to his birth city logie et à la thérapeutique” published in
where he activated as a general practitioner 1955, Duchenne describes the advantages
for 10 years. He got married in 1831, but, and disadvantages of static and dinamic
after about 2 years, his wife died of puer- electric power use in therapy and
peral sepsis. Duchenne’s mother in law diagnosis. He presents the influence of
spread many rumours regarding the fact electricity on skin and the relationship
that, as a sole witness of his wife’s labor, between intensity and other characteristics
he was responsible for her death; this lead of electricity and penetrability in order to
to the separation of his only son.[12] obtain a biological effect – muscular
In 1833, along with dr Gors, Duchenne contraction and resistance of living
made the first experiments of electro- structures to electricity, for example. In the
puncture, a new technique, invented by same book, there is described also the
Magendie and Saralndiere. Thus was the machine built by Duchenne for nerve and
beggining of his neuroelectrophysiology muscle stimulation. There are presented
research. In 1842, Duchenne moved to the indications of faradisation, the
Paris for research that could not be done in treatment technique using electricity:
Boulogne. He was viewed reticently and he profound coetaneous anaesthesia of hands
never received an academic post; at first, he or feet, the method seamed to be the only
worked in charity hospitals and earned his way to obtain sensation of various degrees,
existence from private practice. He worked depen-ding on the electrodes and the
for more than 30 years; daily visiting particularities of the subject; also,
hospitals form Paris in the quest of particular electrical stimulation determines focal
cases he could research, devoting his entire contraction of the muscles of the face.
life and passion to medicine and his patients. Duchenne believed there was no other
Lonely spirit, he showed an admirable therapeutically agent as efficient as
ambition, in spite of the fact that his merits faradisation. The use of the method in
were appreciated only after death. Duchenne various types of muscular dystrophies,
died in the 15th of September 1875, 2 days atrophies and paralysis are described.
before his 69th anniversary, following a Faradisation using wet electrodes was
cerebral haemorrhage. proven to be effective in preventing tisular
necrosis. [2]
Duchenne’s activity and work Using faradisation as a diagnostic tool, with
More than his fellow clinicians of the emphasis on contractility, Duchenne
time, Duchenne emphasized the discovered the aetiology of poliomyelitis,
importance of neurology examination and suggesting that the lesion was in the spinal
electrophysiological studies. cord. [8]
A.V.Plotogea et al.: Guillaume-Benjamin-Amand Duchenne - between medicine and art 187

One of Duchenne’s innovations that affected in a northerly fashion. The


brought precision to diagnosis of muscular characteristic positions of hands were also
diseases was a harpoon that allowed the reported: if the abductor policis was
percutaneous prelevation of muscle tissue. affected, the first metacarpal muscle is
The instrument is thought to be a predecessor closer to the second than it is normally;
of modern biopsy. Duchenne used it for the whereas, if the interossei muscles are
diagnosis of progressive muscular atrophy affected the claw hand appears. The
and pseudohypertrophic paralysis that is muscles of the lower limbs are later and
nowadays named after him. [8] inconstantly affected and control of
Duchenne was the first to describe sphincters is preserved. Duchenne empha-
syphilitic ataxia and chronic progressive sized that the contractility is normal, based
bulbar paralysis. on electrophysiological studies. Histopa-
In spite of the fact that pseudohypertro- thological studies revealed the loss of
phic paralysis of childhood is Duchenne’s muscle fibers striations due to replacement
myopathy nowadays, he was not the firstt o with granular material and adypocites. [8]
describe it, the controversy between him One of Duchenne;s masterpieces is
and Meryon being well known. Duchenne „Mecanisme de la physionomie Humaine”
prefer not to read the new scientific published in 1862. The book combines
discoveries in order not to be influenced by contraction electrophysiology studies,
them. [1] Edward had described the photography and the study of human
condition ever since 1851, mentioning the reactions and emotions. He was influenced
male predominance, the necrotic aspect of by physiognomy, a conception that the
granular degradation. According to personality and emotions externalize as
Gowers, the first to describe the disease physical characteristics, especially of the
was Charles Bell, in 1831. [7] face. Moreover, he thought of the face as a
Duchenne described the pesudohypertro- map of spiritual feeling, that divinity had
phic paralysis in 1868, using also his not created face muscles only for
harpoon for the studies Duchenne charac- mechanical purposes.
terises the muscle weakness that first appears By isolated, followed by combined
in the lower limbs and lumbar region, muscle stimulation, he described the role of
followed by progression to upper limbs, the each muscle of the face: the frontal muscle is
increase in muscle mass due to dvelopment for attention, the superior part of orbicularis
of interstitial connective tissue and overpor- is for reflection, the great zygomaticus is for
duction of fibroses and adipose tissue in mo- joy. The description of Duchenne’s smile
re advanced stages. He thought that the term remains classical – there can be
myo-sclerotic paralysis was more appropiate differentiated a fake from a sincere smile, as
based on histopathologic aspect. [10] the second involves both the contraction of
His first studies about muscular great zygomaticus and inferior part of
dystrophies date from 1850. In 1849, based orbicularis, while the first is the simple
on his research, François Amilcar Aran contraction of the great zygomaticus. [3]
presented a case of progressive muscular In his studies, Duchenne used subjects
atrophy that began in the hands and that suffer form a minor mental retard. The
forearms and arms. In 1870, Duchenne most famous one is an old man who suffered
published the description of the from near complete facial anaesthesia that
aforementioned condition, mentioning the was useful for Duchenne, because the
vermicular fibrilar movements of limbs electrodes determine an unpleasant feeling in
and the fact that the upper limbs were more a person with intact facial sensibility.
188 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

Duchenne believed that the reactions of his [2]. Duchenne, G., De l'électrisation
subjects were common to any individual. In localisée et de son application à la
this work, there are also photographs he did physiologie, à la pathologie et à la
in cooperation with Adrien Tournachon. thérapeutique: et de son application a
Some of the photographs are compared to la physiologie, a la pathologie et a la
classical art masterpiece to show how art thérapeutique, Chez J.-B. Baillière,
does not always reflect the true feelings. Paris, 1855, pag 5-35
(Fig. 1) One of the critics of his time [3]. Duchenne, G. B., Cuthbertson, A., The
reproached him that he takes away from art mechanism of human facial expre-
its idealism, reducing it to an anatomical ssion, Cambridge University Press,
realism. [11] 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,
Fig 1. – Stimulation of eye lids, mandibula Basel, Numarul 54, 2005, pag 46–48
and frontal reion simulate terror. [11] [8]. Pearce, J. M. S., Some contributions of
Duchenne de Boulogne, Journal of
Conclusions Neurology, Neurosurgery, and
Duchenne remains a remarkable figure Psychiatry, BMJ Publishing Group,
of neurology, which he inovated both as Londra, 1999; nr. 67, pag 322
diagnosis and therapy. As an open minded [9]. Poore, G.V., Selections from the
brilliant researcher, he had his work clinical works of Dr. Duchenne de
recognized only after death, but nowaday, Boulogne, The New Sydenham
he is considered one of the greatest minds Society, London, 1884, pag 95.
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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

Ten years after his death, Eugen Ionesco Now the situation in Romania was so
is still the most celebrated playwright in bad that Ionesco, in May 1942 , had no
France. other choice than return to France with his
His life was shared between France and wife Rodica Burileanu.
Romania : Ionesco was born in 1909 in A long difficult period began for Ionesco
Slatina near Bucharest, but, soon after, was until the fifties and the premiere of his
brought by his family to Paris but, in 1922 play, "The Bald Soprano" still performed
Ionesco returned to Romania together with at the Théatre de la Huchette in Paris : the
his sister. There; he learnt Romanian and 15000th representation was recently
attended the college Sfântul Sava in celebrated !
Bucharest and passed the baccalaureate at Ionesco gained gradually fame in the
the secondary school in Craiova in 1928. sixties as founder of the Theatre of Absurd,
In 1938, Ionesco comes back to Paris capturing, alongside Samuel Beckett, Jean
after having obtained a state grant to write Genet, and Arthur Adamov, all the
a thesis (which he never finished…) on meaninglessness of existence.
"Topics of sin and topics of death in Celebrated everywhere in the world,
French poetry since Baudelaire". Ionesco, suffering since long time of a
However, when the 2nd World War was severe form of diabetes, died in Paris in
declared, he decided to return home to 1994
work there as French teacher at Sfântul In most great pieces of art, comedy and
Sava. tragedy live side by side, and this is the
case with Eugene Ionesco’s Exit the King,

1
International Société for Hstory of Medicine, France
190 Bulletin of the Transilvania University of Braov • Vol. 2 (51) - 2009 • Series VI

the most emblematic play of Ionesco References


created by Jacques Mauclair in 1962 at the
Théatre de l'Alliance in Paris. 1. Béhar H.: Le théâtre dada et
In the play, a parodic patriarch is ruling surréaliste. Gallimard, Paris, 1979
over less than a thousand prematurely-aged 2. Bonnefoy Cl.. "Entretiens avec Eugène
subjects : now he feels that death will Ionesco". "Entre la vie et la rêve". Pierre
come soon and howls against his fate, Belfond. Gallimard, Paris, 1966.
moving from denial to terror towards a 3. Cleynen-Serghiev E.: La jeunesse
final, moving, acceptance littéraire d'Eugène Ionesco. Paris :
Around the King, two rival queens, Presses universitaires de France, 1993
Marie who tries to make Berenger face the 4. sselin M.. The Théâtre of the absurde.
reality of his impending death and the Doubleday, New York. 1961
sweet Marguerite, attempting to keep the 5. Hamdan A.. Ionescu avant Ionesco :
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astrologer and bacteriologist roumains d'Eugène Ionesco. 1926-
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CONTENT

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 THE
TRANSILVANIA UNIVERSITY
OF BRASOV

Vol. 2 (51) – 2009


Series VI

Series VI: Medical Sciences

– SUPPLEMENT –

PROCEEDING OF THE IVTH BALKAN


CONGRESS OF
HISTORY OF MEDICINE

ISSN 2065-2224