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A Brief History of Turkish Neurosurgery Dr. Sait Naderi Neurosergery has a short background when compared to other surgical fields. The meaning of neurosurgery comes from "neuro", the neurons in the brain, and "surgery" the operation or work. In other words, neurosurgery is the work done on the nervous system of the body. We cannot mention about neurosurgery during the medieval times. Event hough there are many reports of skull trepanations in Anatolia, we are not sure the reasons of these cases whether they were done for a medical reason or they were just to get the bad spirits out of a person's body. We do know that in Medieval Anatolia, surgical operations were primitive as was it was in rest of the world. The main part for the evolution of the modern surgical operations surely belong to anticepts, acepts and the anesthetical improvements. Before this time period, the operations took place could not be improved. The real improvement took place after the 19th century. While these improvements happened in the world arena, we observe that Turkish Medical Education has shown progress catching up the Western World. During Sultan Mahmud the Second's term, March 14, 1827 "Tıphane" was built, and "Cerrahhane" followed it. Even though it was primitive, first surgical operation took place in Turkish World. Then these two schools melted into one academy, and "Mekteb-i Tıbbiye-i Şahane" was formed. Although main content of the students in this academy was the foreign nationals, after some years Turkish students also increased in numbers, so then the official language of the school was changed to Turkish. Especially in the second half of the 19th Century, many physicians were sent to Western Countries such as France and Germany, for higher education. In this way, the surgery in Turkey had improved rapidly, that before that era it was only for kidney stones and abscess in the body which were done mainly in a Turkish Bathhouse and had very high mortality rate. The return of Cemil Pasha from France and antisepsis, asepsis layed the corner stones of the modern surgery in Turkish World. In this time period, we know that neurosurgery also took place in Turkey. It is possible to talk about a couple of time periods for neurosurgery in Turkey: 1st Period: 1890 - 1909 2nd Period: 1909 - 1933 3rd Period: 1933 - 1950 4th Period: after 1950
Cemil Pasha (1866-1958): Pioneer of the modern surgery Cemil Pasha performed many improvements in operational surgery and neurosurgery. Laminectomies for removing spinal pressure in Pott disease, laminectomies for spinal injuries, trepanation for brain abscesses are some examples. Cemil Pasha had lectured on brain abscess in French Surgical Society. This was probably the first time a Turkish surgeon had published an operation internationally. Alexander Kamburoğlu (?- 1913): Kamburoğlu managed Cemiyet-i Tıbbiye-i Şahane between 1887-1888. He published German Hospital's 5 years' surgical operations and he mentioned that there were 5 brain tumor cases and 3 hydrocephalus. Garabe Yahoub (1865-1936): Dr. Yahoub has published 26 of the 301 papers after 1907 in Cemiyet-i Tıbbiye-i Şahane, this period's most important society. He was an active surgeon of the time. He also managed Cemiyet-i Tıbbiye-i Şahane in 1913. A part of his presentations was about "Brain Traumas and Trepanation", "Epilepsy cases and trepanation", "Trigeminal neuralgia benign gangliona physiologic injections". Wieting Pasha (1868-1922): During 1902-1907, he has vice-managed Gülhane Hospital and managed it during 1909-1915. He gave details of the surgical operations that took place in this hospital and published in 1908 with the name of "Gülhane Festschrift". He has performed laminectomy, meningocel, meningomyelocel, posterior rhisotomy in spasticity (Forestier). <>br
Professionaly, neurosurgical operations in this period were performed in Darülfunun Medical Academy Hospital (today's Haydarpaşa Numune Hospital), Gülhane Hospital, German Hospital, Rum Hospital, and after 1923 Zeynep Kamil Hospital. Darülfunun Medical Academy: Even though Cemil Pasha was the head surgeon and the dean of the academy, he has quit his position due to academic opinion differences in 1912. In this hospital, operations were performed in 1st and 2nd surgical clinics. One of the clinics was led by Dr.Orhan Abdi (Kurtaran) and the other one by Dr.Kerim Sebati (Göker) until 1933. When we take a closer look at the statistics of the 1st surgery clinic, for the year 1938, out of the 237 total number of surgeries, there were 50 cranial operations, 1 spinal pressure measurement, and 8 Pott's disease. During the same year, the numbers of the 2nd surgery clinic show that out of the 307 operations performed, there were 31 neurosurgery and spinal surgery operations. These operations were; for backbone fractures and spinal cord injury laminectomy (2), cerebral infections (10), scoliosis (3), ventriculitis, Pott's disease (9), sciatica, neuro-paralysis, and head trauma (4). This time period's famous ENT specialist Dr.Haydar İbrahim (Aydar) has also performed many neurosurgical operations. These operations were mainly for parasellar growth, sellar surgery and for trigeminal neuralgia gasser ganglion injections. Gülhane: During this time, Mazhar Osman's work has led the way for neurosurgical operations. From the case reports, we see that diagnostics were handled by Dr.Mazhar Osman, but the operations were performed by Wieting Pasha. The records show that many operations were performed for brain tumors, spinal traumas, spasticity and meningoceles. We see that the surgery for brain tumors were indeed unsuccessful. After the Armistice, two neurosurgical clinics were established in Gülhane, one was led by Dr.Mim Kemal (Öke) and the other one by Dr.Murat (Cankat). The period's famous surgeon, Dr.Mim Kemal has performed many neurotrauma operations. Mr. Mim Kemal has published the first Turkish Brain Surgery Book in 1924, entitled "Dimağ ve Cümcüme Afetleri ve Tedavileri". In Gülhane, the other clinic was led by Dr.Murat. Dr.Murat was experienced in combat surgery, and he excelled at craniocerebral, spinal, periferic nervous trauma and plastic surgery for cranial defects. Dr.Murat, in his "Harbde ilk yara tedavisi" / "First aid for wounds during war" book, writes "I have arranged the mobile operating room, so that it was possible to attend the wounded immediately. I was the only person allowed to treat certain injuries, but that did not stop me. I did what I could for the injuries that required trepanation and laparotomy. I changed our treatment styles to match the new conceptions. At that time, another surgeon, not too far from where I was operating, was doing just the opposite, treating injuries with only permanganated compressions. At that moment, a German Surgeon was inspecting the medical wing. In his report of the Çanakkale War, he said that while at one corner there was modern surgery performed, at the other corner it was medieval times all over again." After years passed, Dr.Murat has written a book called "Muhit sinirleri cerrahisi" in 1947. Other Hospitals: Neuroscience has excelled with the work of Mazhar Osman. He also sent many of the young people he was working with at the time, to overseas for education. One of these young doctors was Dr.Abdülkadir Cahit (Tuner) (1892-1980) was imprisoned by the English army during World War I in Sinai Desert. He returned to Istanbul after the war and worked as an assistant to Mazhar Osman at Toptaşı Hospital. He watched Mazhar Osman taken from the position he was occupying. When that happened, he was sent to Germany for neurosurgery education under Dr. Foerster, by Mazhar Osman. Dr. Abdülkadir Cahit has worked for a year with Dr. Foerster, and returned to Turkey. He started to work in Zeynep Kamil Hospital. He has renovated the operating room left from Cemil Pasha, and started to perform neurosurgical operations. The most known operations were spinal meningioma and fibroma, Gasser ganglion injections for trigeminal neuralgia and trepanations for brain tumors. He quits his position in Istanbul, because of differences in ideals, and moves to Ödemiş and gives up practicing neurosurgery. When we look at Dr.Abdülkadir Cahit's work, different from the time period's surgeons, he could either diagnose neurology and operate it. We should accept him as the first Turkish neurosurgeon and his clinic as the first Turkish Neurosurgical Clinic.
Istanbul University: Between 1933-1939 Dr.Nissen managed the Department of Surgery in Istanbul University. Some operations in neurosurgery were sellar masses, ventricular masses, and spinal operations. Nissen has believed that surgeons can operate on any area, he had his team work in this direction. As a result, the field of neurology did not develop in İstanbul University. In 1940's, Dr.Tercan went to England and Dr.Feyyaz Berkay went to U.S.A. for neurosurgical education. Bakırköy Hospital: When they have felt the absence of neurosurgical field work in Bakırköy Hospital, Mazhar Osman has sent Dr.Hami Dilek to France for neurosurgical education. Also, Dr.Cemil Şerif Baydur who has studied in France, has returned to Istanbul and started his neurosurgical work in Bakırköy Hospital. He, however, has to stop his job earlier because of an illness. Dr.Baydur was the author of the first Turkish Neurosurgical Book, "Nöroşirürji Bahisleri" / "Matters of Neurosurgery". Dr.Hami Dilek's work has continued, against all hard conditions. He has systematically worked on the improvement of neurosurgery. At the end of 1940's, he had problems with the management of the hospital, and transferred to Haydarpaşa Numune Hospital, he then has established the neurosurgery department there. In Bakırköy Hospital, Dr.Ertuğrul Saltuk continued Dr. Dilek's position. Private Şişli Surgical Hospital: Another surgeon who was sent overseas to get neurosurgical training was Dr.Cafer Tayyar Kankat. He did not work in a state hospital, but established a private hospital himself. He has published a periodical called "Modern Cerrahi ve Nöroşirürji Mecmuası" / "Journal of Modern Surgery and Neurosurgery". Gülhane Hospital: Unlike other hospitals, in Gülhane, the neurosurgical operations were done by regular surgeons for a long time. During 1930's Dr.Mustafa Sakarya has left for U.S.A., to get neurosurgical training in Dr.Walter E. Dandy's clinic. Since he was sent to Eastern Turkey and Afghanistan after return to Turkey, neurosurgical field in Gülhane has a delayed improvement. In 1947, government has approved the bill to accept neurosurgery as a separate field of medical specialization.
When we come to the 1960's, in Ankara and later on in Izmir we see the establishments of neurosurgical clinics. In 1960 Hacettepe University, in 1965 Ankara University, in 1967 Ege University neurosurgical departments were founded. Today in Turkey, there are 58 educational clinics (university hospitals, government hospitals, and foundation hospitals). In all the cities and towns of our country, we have 890 neurosurgeons. Government established time for education in neurosurgery is 5 years, and of this time 19 months is the rotation period to become a specialist.  |
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