Epidemic diseases during the World War I and Dr Server Kamil Tokgöz

Abstract

Server Kamil became one of the most prominent doctors during the period of the Ottoman Empirey. Server Kamil, who specialized in bacteriology and sanitation, made a name for himself primarily through his fight in the memories against epidemic diseases on the Caucasus front during World War I. He was sent to the Caucasus front as chief physician of Erzurum Red Crescent (Hilâl-i Ahmer) Hospital, and made great efforts to prevent the disease typhus—which was a major problem in the region—as soon as he reached the front line. He worked long and hard to develop a vaccine to prevent typhus, which affects thousands of soldiers and civilians. He also played a pioneering role in establishing important institutions such as the Sivas Smallpox Vaccine Laboratory and the Rabies Treatment Centre, which accomplished significant work and achieved great success both during the World War I and in the period that followed. This article attempts to clarify the activities of Server Kamil on Caucasus front during World War I based on the documents of the Turkish Red Crescent Archive, the reports of the Red Crescent Society.

Keywords

Server Kamil Tokgöz World War I Caucasus front typhus epidemics

His early life and services before World War I

Server Kamil Tokgöz¹ was born in Istanbul in August 1881 as the son of Muhtaroğlu Ahmet Kamil. Server Kamil began his school career in Çengelköy Primary School and he attended respectively Fatih High School (Fatih Rüştiyesi), Military Medical School (Askeri Tıp İdadisi), and the Imperial Military School of Medicine (Askeri Tıbbiye-i Şahane).² In 1902, he graduated as the second-best student with the rank of captain from the Imperial Military School of Medicine. At the end of 1902, he began working as an assistant teacher of bacteriology at the Military Medical School. From 1905, he worked as a bacteriologist in the hospitals of Serez and later Thessalonik.

In 1908, Server Kamil was sent by the Ottoman government to Paris for study and research in the field of bacteriology, where he worked at the Pasteur Institute for two years. Server Kamil attended microbiology courses here and took lessons from famous doctors, such as Émile Roux and Élie Metchnikoff (Figure 1).³

Upon his return to Istanbul, he was appointed bacteriologist at Haydar Pasha Hospital in September 1910.⁴ On 5 August 1912, Server Kamil was appointed as director of the Faculty of Medicine by proxy.⁵ When cholera was detected in the area around Terkos Lake, Server Kamil was assigned to the delegation sent there on 18 November 1912.⁶ During the Balkan Wars in March 1913, he participated in the Health Committee established under the Ministry of War to determine whether the epidemic disease in the army was typhoid or typhus. As a result of the committee's discussions, it was decided that the epidemic disease was typhus (Figure 2).⁷ The experiences he gained during these discussions in this health committee would contribute to the development of the typhus vaccine in the future.

Dr Server Kamil participated in the activities of the Department of Biology (Hayatiyat) of the Turkish Knowledge Association which was established in the second half of 1913.⁸ Although he resigned from his service at the Faculty of Medicine of Darülfünun, the Ottoman University in 1914,⁹ he began to work as a teacher of hygiene and bacteriology at the Schools of Pharmacy and Dentistry in the same year.¹⁰

Figure 1.

Server Kamil (2) at the Pasteur Institute in 1909–1910.¹¹

The chief physician of Erzurum and the red crescent hospital

One of the region on which the Ottoman Empire fought during the World War I was the Caucasus war. In the war that started in November 1914, especially after the Sarıkamış Operation (December 1914 to January 1915), there was a great need for health facilities in the region and on the Caucasus front. Due to the efforts of the governor of Trabzon, Azmi,¹² the Ottoman Red Crescent Society decided to establish a hospital in Erzurum in early February 1915. At this moment, Server Kamil was appointed as the chief physician of Erzurum Red Crescent Society Hospital.

Dr Server Kamil departed from Istanbul to Erzurum as a member of the Health Committee and arrived in Sivas in early March 1915. At that time, the typhus epidemic in Sivas had reached a very serious level. The main noteworthy reason for this peak was that there were about 15,000 soldiers in the city waiting to be sent to the Caucasian front.¹³ The governor of Sivas, Muammer, made efforts to contain the typhus epidemic in the city. Muammer, learning of the arrival of the bacteriologist Server Kamil in Sivas, asked his help in combating disease. Thereupon, he stayed in Sivas for three weeks and prevented the spread of typhus disease by strict measures. Towards the end of March 1915, he left Sivas and headed for Erzurum.

Dr Server Kamil was interested in the health problems of the people in all the villages he visited on the way to Erzurum. The delegation arrived in Erzincan on 8 April 1915, and stayed there for a week. During his stay in Erzincan, eight of his teammates including Dr Sufyan and Dr Recai, died from typhus. Apart from this, Server Kamil witnessed the deaths of up to 60 soldiers who died of typhus every day in Erzincan. From that time on, Server Kamil, who was greatly affected by this situation, searched for a way to prevent from this disease.¹⁴

As mentioned above, he participated in the health committee established in March 1913 to settle the debates among the Turkish doctors, regarding whether the disease that emerged during the Balkan Wars was typhus or typhoid. During the works of this committee, Server Kamil examined the researches and publications on typhus by Charles Nicolle,¹⁵ Director of the Pasteur Tunisian Institute. In addition to this, he received the following information about the typhus vaccination from Dr Reşat Rıza (Kor), who was known for his works on typhus among Turkish doctors, before his departure from Istanbul to Erzurum: “If the blood of those who have typhus disease is taken and defibrated and then heated at 58 °C degrees for 45 minutes, and so an inactivated vaccine can be obtained.” Reşat Rıza claimed that vaccination with this vaccine would have a protective effect against typhus.¹⁶

However, it should be noted that the developers of this vaccine were aware of the theoretical and practical deficiencies of the typhus vaccine. The administered dosage was determined empirically. Furthermore, widespread vaccination was not possible, as the vaccine could only produce a limited amount of blood from patients. From the blood of one patient, a vaccine sufficient for 2–4 people could be obtained. Therefore, this vaccine could be administered to protect a limited number of healthcare professionals, such as doctors and nurses, who are most at risk in times of epidemics.¹⁷

Figure 2.

Server Kamil in the Bacteriology Room in 1913 (Source: Unat, p. 45).

Server Kamil thought that, according to the available information on the typhus vaccine theory, despite its deficiencies, the vaccination to be made by inactivating the blood antigen to be taken from typhus patient would be beneficial. However, he knew this depended on the exact determination of the production and quantification of the antigen in order for this vaccine to be an absolute success.

Dr Kamil asked Dr Hamid, who was working in the Erzincan Central Hospital Laboratory at that time, to prepare a vaccine that was inactivated by high temperatures and taken from a typhus patient. However, Hamid said he actively vaccinated more than 120 soldiers after receiving orders not to make the inactive vaccine. Despite the promising results of his research on inactivated vaccine, he produced active typhus vaccine on government orders, and 20 people in the delegation were actively vaccinated against typhus in two sessions.¹⁸

In the Erzincan Laboratory, apart from Dr Hamit, another person working to prevent typhus disease was Dr Hamdi (Suat). He explained his work on typhus vaccine in an article he wrote in 1916 in German. Unlike Reşat Rıza and Server Kamil, Dr Hamdi Bey's vaccine method, aimed to inactivate the blood taken from a typhus patient by cooling it in ice.¹⁹ However, it was later revealed that the method of obtaining the typhus vaccine by heating, as suggested by Dr Reşat Rıza and Dr Server Kamil, was more effective in providing protection.

Dr Server Kamil and his delegation left Erzincan on 15 April and arrived in Erzurum on 22 April 1915. At that time Dr Kamil began to experience health problems, because he had caught typhus. Moreover, he saw that the majority of active vaccine recipients in Erzincan began to experience health problems. The reason for this was that the majority of the members of the delegation also caught typhus. Upon these developments, Server Kamil called and informed Tevfik Salim (Saglam) the head of the 3th Ottoman Army Medical Corps, by phone. When Tevfik replied that he had not given any instructions not to get active vaccination, Server Kamil realized that there had been a misunderstanding. Dr Kamil had vaccines made in Erzurum using his own methods, and vaccinated military and civil service personnel with these vaccines including the governor of Erzurum, Tahsin, and the commander of the Fortified Area, Fevzi Pasha. The result was that none of these vaccinated individuals contracted typhus.²⁰ Server Kamil's work on typhus especially about vaccination would play an active role in the fight against typhus disease on the Caucasus front (Figures 3–5).

Figure 3.

Server Kamil Tokgöz (Source: Red Crescent Archive).

The head of Erzurum Health Committee

While Dr Server Kamil was working as the chief physician of the Red Crescent Hospital in Erzurum, he was also the head of Erzurum Health Committee. At the beginning of World War I, the Erzurum Health Committee chaired by Dr Mehmet Emin was sent to Erzurum for the first time with a capacity of 500 beds. After the resignation of Mehmet Emin, Server Kamil was appointed as the head of the committee.

Immediately after his appointment, Server Kamil conducted bacteriology training in the hospital laboratory, using his previous experience as a lecturer. In this way, many experienced doctors were trained to meet the urgent needs of the army in bacteriological practice. In addition, the entire health committee worked very actively to eradicate the cholera outbreak in Erzurum.

Dr Server Kamil remained in Erzurum with the Health Committee and the Red Crescent Hospital until February 1916, but was transferred to Erzincan after Erzurum was occupied by the Russians.²¹ While serving in Erzincan, he arrived in Sivas on 12 April 1916, where he inspected and organized hospitals there, and successfully provided 2500 beds. He extinguished vibrio incidents in the city within eight days with the help of the military and the province, and then returned to Erzincan.²² In May 1916, he again went from Erzincan to Sivas to examine a patient with recurrent fever at the Sivas Red Crescent Hospital.²³

Dr Server Kamil also organized the structuring of health facilities in the region during the army's withdrawal. In May 1916, he applied to the General Centre of the Red Crescent Society for permission to establish the Erzincan Wounded Hospital as a convalescent home in Kayseri Zincidere with a capacity of 2000 beds.²⁴ The General Centre approved the request and the hospital was moved to Zincidere.²⁵ Apart from this, in June 1916, he established a separate 45-bed ward exclusively for officers at the Red Crescent Hospital in Erzincan.²⁶

Figure 4.

Server Kamil and the Erzincan Red Crescent Hospital (Source: Red Crescent Archive).

Due to the advancing campaign of the Russians on the Caucasian front, the Red Crescent Hospital and the Health Committee were transferred from Erzincan to Sivas in July 1916 under the direction of Server Kamil.²⁷ In addition to the beds in the Erzincan Red Crescent Hospital, the number of beds in the city reached 4000 with the transfer of the Erzincan Central and Military Hospitals and Konya Red Crescent Hospital to Sivas.²⁸ As a result, Sivas became the most crucial medical city behind the Caucasus front in this period. The documents of the Red Crescent Archives show that Server Kamil served as the head of the Health Committee as well as the chief physician of the Red Crescent hospitals in Sivas.

Along with the Health Committee headed by Dr Server Kamil, a vaccine laboratory was also moved to Sivas. This vaccine laboratory was established in 1915 in the hospital for the poor of Erzurum (Erzurum Gureba Hastanesi) for the vaccination of the army. After the Russian occupation of Erzurum in 1916, the vaccine laboratory was moved to Erzincan, and in July 1916 to Sivas due to the occupation of Erzincan. With the occupation of Trabzon by the Russians in April 1916, the Red Crescent's delivery of vaccines to the front by sea ceased. This situation increased the critical position of the vaccine laboratory in Sivas even more.

Figure 5.

Server Kamil at the Erzincan Red Crescent Hospital (Source: Red Crescent Archive).

The vaccine laboratory started to work in the building of Sivas Red Crescent Hospital and produced 254 kg of cholera vaccine as early as August, 1916. In September 1916, the vaccines produced in this facility were distributed to the soldiers and immigrants in the city²⁹ and typhus vaccines were also produced at the Sivas Red Crescent Hospital. Server Kamil played the most important role in the production of vaccines in this laboratory in Sivas.

Dr Server Kamil's book on typhus

Dr Server Kamil wrote about the history of the development of the typus vaccine in his book titled Kafkas Cephe-i Harbinde Lekeli Humma, in English Typhus on the Front of Caucasian War. This book—consisting of 80 pages—was published by Sivas Province Printing House in 1917. In the introduction, Server Kamil explained how he travelled from Istanbul to Erzurum on the Caucasus front and then the motivations behind the production and alongside the features of this vaccine. Server Kamil stated that, cholera, typhoid and dysentery vaccines were produced and successful, and that typhus vaccine could also be produced.

The book explains the preparation method of typhus vaccine at first. According to this method, at least 10–15 cm³ of blood is taken from a patient diagnosed with typhus in a sterile balloon with glass beads on the 7th and 8th days of the disease. It is defibrinated by shaking for 15 min. Then it is heated to 58–60 °C degrees for 45 min using the bain marie method. According to Server Kamil, heating to 60 °C for 45 min is sufficient to kill the typhus pathogens.

Dr Server Kamil later focused on the area to be vaccinated in his book. Although it is mostly recommended to administer the vaccine through the abdominal region, three-quarters of those injected from this region experienced some complaints. For this reason, he argues it would be more appropriate to inject the vaccine from the buttocks where the cell tissue is relatively higher. He emphasized that always a thick needle should be chosen for blood injection because a thin needle may not allow the passage of white blood cells. Based on the experiences of Charles Nicolle on monkeys, Server Kamil emphasized that the microbes that cause typhus disease were deep in the white blood cells. For this reason, the white blood cells must also pass through the needle.

According to Server Kamil, if one gets infected with typhus 15–20 days after vaccination, the vaccine will have time to produce some antibodies. In such cases, the disease will not be severe and will have a moderate course. If the disease occurs one month after the vaccination date, the disease is usually short and mild. He also emphasizes that no serious conditions were observed in such patients (Figure 6).

Figure 6.

Server Kamil (right) at the Erzincan Red Crescent Hospital (Source: Red Crescent Archive).

Based on his research, Server Kamil stated that although the degree of effectiveness of the typhus vaccine was uncertain, it definitely provided immunity to people. However, Recai, one of the doctors in his hospital, caught typhus nine months after the typhus vaccine and died. Server Kamil explained this with the fact that Recai relied on the vaccine and gave up the precautions and he was infested with lice several times. Additionally, Server Kamil argued that getting vaccinated at least for every four months was the best course of action.

Another topic of debate among Turkish doctors about typhus vaccine was whether it should be inactivated by heat or cold. Dr Hamdi, the pathology lecturer, claimed that the inactivation of the vaccine with coldness strengthened the immunity even more. Hamdi would defibrinate the patient's blood and leave it in the freezer for at least 12 h. However, Server Kamil informed him that most of the factors that cause disease could survive to temperatures as low as −20 °C degrees and that it would not be correct to rely on the destructive effect of coldness. As a matter of fact, Server Kamil was right, and Hamdi with two other people were vaccinated in way of the cold-treatment caught typhus on the eighth day of vaccination and were sent to the hospital for their treatment. After this experience, the vaccines were inactivated with heat, and the number of people who were vaccinated both by Server Kamil and by other doctors as such have exceeded 1000 in a very short period of time. Those who contracted typhus after vaccination in this method experienced a very mild form of the disease. Subsequently, in Bayburt, Dr Asım vaccinated about 400 people with this method. These people were followed up for three months and it was recorded that they did not get typhus.³⁰

In his book, Dr Server Kamil gave detailed information about typhus disease including its taxonomical class, the characteristics of the lice that cause the spread of the disease, and the agglutination³¹ issue in typhus disease. He performed the agglutination test on 298 people who were vaccinated against typhus. In his book, he presented the results of these tests in a table, indicating the days on which they were conducted and the positive or negative rates of 1/20, 1/40, 1/40, 1/80, 1/160, 1/320, 1/640, 1/1280, and 1/3000. In these tests, 267 patients were positive and 31 patients were negative. He interpreted this situation as the success of the vaccine. During the agglutination test, he used the Weil-Felix method. It should be noted that this method, introduced by Edmund Weil and Arthur Felix in 1916,³² was almost simultaneously used by Server Kamil and other Turkish doctors.³³

Server Kamil also gave information about the process of inoculation of typhus to animals during the agglutination issue. The production of typhus vaccine from the blood of the infected patient did not allow for the production of a sufficient amount of vaccine. Therefore, attempts were made to inoculate animals with the organism responsible for producing typhus and to produce the vaccine, or at least the serum, with the blood taken from them. Server Kamil also conducted research in this direction. Initially, Server Kamil attempted to infect rabbits with typhus through lice, but was unsuccessful. Subsequently, the same method was applied on cows and goats that was successful this time resulted in the studies especially on goats.

At the end of his book, Server Kamil writes that after the typhus vaccine has been applied by Charles Nicolle and Henrique da Rocha Lima³⁴ on monkey species such as macaques and bonnet chinoi. He succeeded on goats by treating the disease using serums obtained from typhus-contaminated goat blood.³⁵ Dr Kamil later published his research on the use of serum obtained from goats in the treatment of patients with typhus, as an article in the Military Medicine Journal with the title “Lekeli Hummanın Şafi Serumu / Therapeutic Serum of Typhus.”³⁶

Dr Server Kamil, who closely followed the studies on typhus disease in Turkey and in the world, tried to prevent its further spread within the limited conditions of war. However, it should be stated that due to the production difficulties of typhus vaccine or serum, they can be produced in limited numbers, unlike smallpox and other vaccines. When the devastating effect of typhus decreased in Turkey in 1918, studies on typhus vaccine began to decline.³⁷ Kamil also focused his work on smallpox vaccination and rabies treatment. Despite all this, it should be emphasized that the studies on typhus by both Kamil and other Turkish doctors were carried out almost simultaneously with the studies in the world.

The establishment of Sivas Smallpox vaccine laboratory and Rabies treatment

At the beginning of 1917, Dr Adnan (Adıvar) the General Director of the Ottoman Health and Tevfik Salim (Sağlam), the Chief of Health of the 3rd Army suggested the establishment of a Smallpox Vaccination Laboratory and a Rabies Treatment Center in Sivas.³⁸ Upon this suggestion, the construction of the building of these two institutions started in March 1917.³⁹ The Third Army and the Red Crescent Society donated approximately 300 Liras for this construction.⁴⁰

During construction, Dr Server Kamil was appointed as the Chief of the Health Department of Third Army upon the request of the Third Army⁴¹ and the approval of the Central Committee of the Red Crescent Society.⁴²Upon this appointment, Server Kamil went to Suşehri, where the General Headquarters of the Third Army was located, on 2 April 1917.⁴³ Even though Server Kamil was out of the city, he closely followed the construction process of this building. He even threatened to dismiss those responsible if this construction work was not completed on time.⁴⁴ In response to these threatening words of Server Kamil, the Rabies Treatment Center and Smallpox Vaccine Laboratory were inaugurated at the end of April 1917 (Figures 7 and 8).⁴⁵

Figure 7.

Sivas Smallpox Vaccine Laboratory and Rabies Treatment (Source: Unat, p. 52).

Server Kamil continued to follow the vaccine production even after the Smallpox Vaccine Laboratory opened. In his letter of 14 May 1917 to the Chief Physician of Sivas Red Crescent Hospital, he urgently requested to be informed about how much smallpox vaccine had been produced and how much could be produced.⁴⁶ As a result of this close monitoring, a total of 841,820 smallpox vaccines were produced at the Sivas Smallpox Vaccine Laboratory between June and December 1917.⁴⁷ Together with the vaccines produced in 1918, more than 1 million smallpox vaccines were produced in this laboratory alone for the military.⁴⁸ Not only the army, but also the civilian population was supplied with smallpox vaccines. More than 500,000 people in Sivas province were vaccinated against smallpox. In this way, slightly more than half of Sivas province, which has a population of about 1 million, was vaccinated against smallpox. The Sivas Smallpox Vaccine Laboratory covered the smallpox vaccine not only for Sivas, but also for the Elazığ, Erzurum, Diyarbakır, and Bitlis provinces and Kayseri district.⁴⁹

The Rabies Treatment Center to the establishment of which Server Kamil contributed greatly was put into operation in May 1917 with a capacity of 20 beds. This allowed rabies patients from the eastern provinces to be treated in Sivas without having to be sent to Istanbul.⁵⁰ In this institution, 87 patients were treated for rabies between June and December 1917.⁵¹

Transfer of Sivas Red Crescent Hospital to Samsun and status of other institutions

As a result of the Russian revolutions in March and November 1917, the war on the Turkish-Russian front came to a halt. With the signing of the Erzincan Armistice in December 1917, the Turkish-Russian War was effectively over. At this point, when the Turkish advance on the Caucasus Front began on 12 February 1918, it was decided to move the Sivas Red Crescent Hospital to Samsun. The purpose of moving the hospital to Samsun was to be able to help the wounded and sick soldiers more easily during the Turkish advance from the coast.⁵² Server Kamil, the chief physician of the Sivas Red Crescent Hospital, and the hospital staff arrived in Samsun on 21 March 1918.⁵³ The hospital was to perform its duties in Samsun from then on.

Figure 8.

Dr Server Kamil at Sivas Smallpox Vaccine Laboratory and Rabies Treatment (Source: Unat, p. 53).

The Health Committee, headed by Server Kamil, encountered a different disease in the coastal region where there are many swamps, than in inland cities like Sivas: which was malaria. Therefore, the Health Committee conducted a fight against malaria in the entire coastal region from Bafra to Trabzon. To this end, a laboratory was established in Samsun where malaria research was conducted and doctors sent by the army and the General Directorate of Health were trained in malaria issues. In addition, the Health Committee established a regular soup kitchen in Samsun for refugees and immigrants, whose numbers had greatly increased in Samsun. The soup kitchen, fed 3000 people daily from 13 July 1918 to the end of November 1918. In addition, needy refugees and immigrants were treated and provided with medicines free of charge.

The Red Crescent Committee on the Caucasian Front commenced its activities in Erzurum in November 1914, and continued for about four years in Erzincan, Sivas, and Samsun until its mission ended in November, 1918. Of these four years, about three years were spent by Server Kamil as the head of this Red Crescent Committee. During this time, the Red Crescent Committee treated a total of 8988 patients and wounded examined more than 100,000 carriers, and prepared cholera and smallpox vaccines for the needs of the army.⁵⁴

The Smallpox Vaccine Laboratory established in Sivas in 1917 at the initiative of Server Kamil was one of the largest vaccine production centers in Turkey until 1928. After the establishment of the Sanitation Institute in Ankara, this laboratory was also moved to Ankara. The Rabies Treatment Department continued its work until the 1940s.⁵⁵

His life after World War I

After the World War I, Server Kamil, who had served for a time as a lecturer of hygiene at the Faculty of Medicine in 1920,⁵⁶ was appointed to the Haydarpasha Hospital for Infectious Diseases that same year. In addition to his current duties, he was appointed chief physician of the Heybeliada Sanatorium in 1924, and in the same year was elected lecturer of hygiene course at the Faculty of Medicine.⁵⁷ Server Kamil represented Turkey at international medical congresses. In fact, he was sent by the Turkish government to the International Congress of Hydrology and Climatology in Lyon, France, on 8 October 1927.⁵⁸ Upon his return from the congress, he also submitted his report to the government.⁵⁹

During the 1933 University Reform implemented by the Turkish government, Server Kamil stayed away from the university. He was appointed as the second director of the Refik Saydam Central Hygiene Institute, established in Ankara in 1935, and became the director of this institute in 1941. He gave up this position when he was elected to the Turkish Parliament as a deputy from Denizli in 1943. He died of Hodgkin's disease in Ankara on 20 November 1943.⁶⁰

Epilogue

Dr Server Kamil, one of the most important doctors who grew up in the last period of the Ottoman Empire, came to the fore with his work especially during the World War I on the Caucasus front. He tried to develop a vaccine to protect against typhus disease, and also pioneered the production of vaccines against infectious diseases such as, cholera, especially smallpox, etc., saving hundreds of thousands of people from contracting these diseases. In addition, the Smallpox Vaccination Centre and the Rabies Treatment Centre, which he was instrumental in founding in Sivas, are among the most important health facilities in the Republic of Turkey, established after the Ottoman Empire.

Footnotes

Acknowledgments

We would like to thank the Red Crescent Archive and its staff for enabling us to access documents and Server Kamil's photographs.

Declaration of conflicting interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Mustafa Sarı

Author biography

Mustafa Sarı is an Associate Professor at History Department, Faculty of Social Sciences and Humanities, Sakarya University (Sakarya, Turkey).

References

Server Kamil took the surname “Tokgöz” in 1934 in accordance with the Law on Surnames. In the Turkish spelling, Kamil should be written as “Kâmil”, it is written as “Kamil” here.

Unat

. Osmanlı İmparatorluğunda Bakteriyoloji ve Viroloji, İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Yayınları, İstanbul, 1970, p.86. The Imperial Military School of Medicine, established by the Ottoman Sultan Mahmud in 1827, had been one of the most important modern medical education institutions of the Ottoman State for many years. About the Imperial Military School of Medicine, also known as the Medical School (Mekteb-i Tıbbiye), for more information see (Nil Sarı, “Mekteb-i Tıbbiyye”, TDV İslâm Ansiklopedisi, 2004, Ankara, V. 29, pp.2–5). Server Kamil obtained his medical qualifications firstly from this institution.

Unat . Osmanlı İmparatorluğunda Bakteriyoloji ve Viroloji, pp.86, 126–127. Server Kamil obtained his medical qualifications secondly from this institution.

Unat . Osmanlı İmparatorluğunda Bakteriyoloji ve Viroloji, p.86.

Presidency of the Republic of Türkiye Directorate State Archives - Ottoman Archives / Türkiye Cumhuriyeti Cumhurbaşkanlığı Devlet Arşivleri Başkanlığı - Osmanlı Arşivi / (BOA), Maarif Nezareti Mektubi Kalemi (MF.MKT), 1180/ 76.

BOA. Babıali Evrak Odası Evrakı (BEO), 4114/ 308525, 1.

Özdemir

. Salgın hastalıklardan Ölümler 1914–1918, 2. Ankara: Baskı, Türk Tarih Kurumu, 2010, p. 282– 283.

Toprak

. Türk Bilgi Derneği (1914) ve Bilgi Mecmuası. In: Osmanlı İlmi ve Mesleki Cemiyetleri, Yay.Haz. Ekmeleddin İhsanoğlu, İstanbul: Edebiyat Fakültesi Basımevi, 1987, pp. 247– 254.

Kahya

Erdemir

. Bilimin Işığında Osmanlıdan Cumhuriyete Tıp ve Sağlık Kurumları. Ankara: Türkiye Diyanet Vakfı Yayınları, 2000, p. 310.

10.

Uzluk

. “Ord. Prof. Server Kâmil Tokgöz, 1881–1943”, Türk Hıfzıssıhha ve Tecrübî Biyoloji Mecmuası, C. IV, 1944, p.5.

11.

The individuals in this photograph, noted as Pasteur Institute 1909–1910 Microbiology Trainees, are as follows: 1- Dr. Ethem Vasfi, 2- Dr. Server Kamil, 3- Dr. Riza Arif, 4- Prof. Émile Roux, 5- Prof. Élie Metchnikoff, 6- Dr. Osman Serafeddin, 7- Dr. Ferdi Recep, 8- Vet. Tekvor Kevorkian, 9- Dr. Mehmet, 10- Dr. Selahattin, 11- Dr. Arif Ata, 12- Dr. G. Yannoudis. Apart from Émile Roux and Élie Metchnikoff of these are the Turkish doctors who participated in the courses. https://www.tmc-online.org/userfiles/sunumlar/08_Kas/Ahmet_Basustaoglu.pdf (01.07.2023).

12.

Cemal Azmi was appointed to Trabzon on July 16, 1914, just before the outbreak of World War I (BOA, İrade Meclis-i Mahsus (İ.MMS), 187/ 13, 2).

13.

During the First World War, military training camps were opened in several places for the soldiers to be sent to the Caucasus Front. One of them was a 10,000-person training camp in Sivas (Aziz Samih İlter, Birinci Dünya Savaşı’nda Kafkas Cephesi Hatıraları, Yay.Haz. Zekeriya Türkmen, Elmas Çelik, Genelkurmay Askeri Tarih ve Stratejik Etüt Başkanlığı Yayınları, Ankara 2007, p.56).

14.

Kamil

. Kafkas Cephe-i Harbinde Lekeli Humma. Sivas: Matbaa-i Vilâyet, 1917, p. 3.

15.

French doctor Charles Nicolle (1866–1936) was the first to prove that the typhus agent in the blood is transmitted from person to person through lice. In his studies during the Tunisian epidemic from 1906 to 1909, he injected lice obtained from typhus patients into monkeys and then observed typhus symptoms in the monkeys. He did the same experiment with lice he had brought from outside the typhus region, and the monkeys were not affected by typhus. He also determined that typhus was not transmitted when he gave the serum obtained from the monkeys with typhus to the monkeys who did not. For details of Charles Nicolle’s work on typhus, see. Charles Nicolle, Charles Comte, and Conseil, “Transmission Expérimental du Typhus Exanthématique par le Pou de Corps” Comptes Rendus des Séances de l'Académie des Sciences, 149 (1909), pp.486–489 ; Charles Nicolle, “Reproduction du typhus exanthématique chez le singe”, Comptes Rendus des Séances de l'Académie des Sciences, 149 (1909), pp.157–164; Charles Nicolle, “Recherches Expérimentales sur le Typhus Exanthématique”, Annales de l'Institut Pasteur, 24 (1910), pp.243–75 and 25 (1911), pp.97–144. For a brief biography of Charles Nicolle, see. Kim Pelis, “Prophet for Profit in French North Africa: Charles Nicolle and the Pasteur Institute of Tunis, 1903–1936“, Bulletin of the History of Medicine, Vol. 71, No. 4 (Winter 1997), pp.583–622. It should be noted here that Maurice Nicolle, brother of Charles Nicolle, was the director of the Bacteriology Department in Istanbul between 1893–1902 (Unat, Osmanlı İmparatorluğunda Bakteriyoloji ve Viroloji, p.47–48).

16.

Kamil . Kafkas Cephe-i Harbinde Lekeli Humma, p.3.

17.

Karatepe

. I. Dünya Savaşı Yıllarında Tifüs Aşısının Uygulanmasında Türk Hekimlerinin Rolü. Mikrobiyoloji Bülteni 2008; 42: 301– 313.

18.

Kamil . Kafkas Cephe-i Harbinde Lekeli Humma, p.3.

19.

Hamdi

. Über die Ergebnisse der Immunisierungsversuche gegen typhus exanthematicus. Zeitschrift für Hygiene und Infektionskrankheiten 1916; 82: 235– 242. This article was later published in Turkish. Hamdi Suat, “Erzincan Menzil Hastanelerinde Lekeli Hummaya Karşı Yapılan Aşılar ve Neticeleri”, 46 (7), 1917, pp.101–106.

20.

Kamil . Kafkas Cephe-i Harbinde Lekeli Humma, p.3.

21.

Osmanlı’dan Cumhuriyete Hilâl-i Ahmer İcraat Raporları (1914–1928), Yay.Haz. Murat Uluğtekin, M..Gül Uluğtekin, Türk Kızılayı Derneği, Ankara 2013, p.12–13.

22.

Turkish Red Crescent Archive / Türk Kızılay Arşivi (KA), 325/ 149.

23.

KA, 325/ 471.

24.

KA, 325/ 151.

25.

Hilâl-i Ahmer İcraat Raporları (1914–1928), p.13–14.

26.

KA, 325/ 155.

27.

Hilâl-i Ahmer İcraat Raporları (1914–1928), p.12–13.

28.

Üçer

. “1900 Yılından Cumhuriyet’e Sivas’ta Tıbbî Kuruluşlar”, Yeni Tıp Tarihi Araştırmaları, Sayı: 17, Yıl: 2011, p.36.

29.

Aksu

. Sivas Telkihhanesi ve Çiçek Aşısı Üretim Tesisi. In: Nil Sarı-Ayşegül

(eds) VIII. Türk Tıp Tarih Kongresi, Kongreye Sunulan Bildiriler, (16–18 Haziran 2004, Sivas-Divriği). İstanbul: Erdemir, 2006, pp. 260, 262.

30.

Server Kamil did not mention exactly who these vaccinated people were in his book. But, as mentioned before, it was obvious that the healthcare professionals were given priority.

31.

The agglutination test is an important tool in evaluating the protective effect of typhus vaccine. This test is a common method used to determine the efficacy of the vaccine and to evaluate the efficacy of vaccination works. A positive agglutination reaction indicates that the vaccine elicits an immune response.

32.

Kamil states in his book that he was informed the weil-felix method by Tevfik Salim, who went to Istanbul. It should be noted that Artur Felix went to the German Red Cross Military Hospital in Constantinople in October 1916. See for more information about Arthur Felix and Weil-Felix method. J. Craigie, “Arthur Felix 1887–1956”, Biographical Memoirs of Fellows of the Royal Society, Vol. 3 (Nov. 1957), pp.52–79.

33.

In addition to his book, Server Kamil also wrote the following article about agglutination studies. Server Kamil, “Lekeli Hummada Agglutination”, Servet-i Fünun, 52 (1337), 1917, pp.143–144. Apart from Server Kamil, the published studies of Turkish doctors about the Weil-Felix method during the First World War are as follows: Kadri, “Lekeli Hummanın Weil-Felix Teamülüyle Teşhisi Misl-i Katisi”, Ceride-i Tıbbiye-i Askeriyye, 42 (15), 1916, 213–215; Reşat Rıza, “Weil-Felix Proteus’ü ve Lekeli Hummanın Serolojik Teşhisi”, Sıhhiye Mecmuası, 4–5 (11–12), 1917, pp.1133–1137; Arzuyan, “Weil-Felix Teamülü Hakkında Malumat-ı Mütemmime ve İstatistik”, Ceride-i Tıbbiye-i Askeriye, 47 (16), 1918, pp.417–419; Saadettin, “Tifüslülerde Weil-Felix Teamülü Hakkında”, Ceride-i Tıbbiye-i Askeriye, 43 (3), 1918, p.43

34.

Henrique da Rocha Lima, a Brazilian doctor, went to Germany to work in 1906. Rocha Lima worked with Stanislaus von Prowazek in Hamburg. During and after the Balkan Wars, Lima and Prowazek had researched epidemic typhus in Serbia and Istanbul. After the outbreak of World War I, he was appointed to fight typhus disease with Prowazek in a Russian prison camp in Cottbus. Both of them contracted typhus, and while Lima was recovering, Provek died on February 17, 1915. Rocha Lima discovered, the pathogen of epidemic typhus known as Rickettsia prowazekii, in memory of Stanislaus von Prowazek and Howard Tayler Ricketts. He published these works in the title of Zur Aetiologie des Fleckfiebers. See more information about his biography. Fred Bernardes Filho and João Carlos Regazzi Avelleira, Henrique da Rocha Lima, Anais Brasileiros de Dermatologia, 2015 May-Jun; 90(3): 363–366; André Felipe Cândido da Silva, “The Career of Henrique da Rocha Lima and German-Brazilian Relations (1901–1956)”, História, Ciências, Saúde - Manguinhos, Rio de Janeiro, 17(2), Apr-June 2010. And his articles. Henrique da Rocha Lima “Zur Aetiologie des Fleckfiebers”, Berliner Klinische Wochenschrift, 1916, 53, pp.567–569 and da H. Rocha Lima, “Untersuchungen über Fleckfieber”. Münch, med. Wschr. 63 (1916), pp.1381–1384. This last article of Lima was translated into Turkish by Ziya Nuri. See. H. da Rocha Lima, “Lekeli Hummaya Dair Taharriyat”, trans. Ziya Nuri, Darülfünun Tıp Fakültesi Mecmuası, 4 (1916), pp.343–348.

35.

For more information about the book see: Server Kamil, Kafkas Cephe-i Harbinde Lekeli Humma, Matbaa-i Vilâyet, Sivas, 1917.

36.

Kamil

. Lekeli Hummanin Şafi Serumu. Ceride-i Tıbbiye-i Askeriye 1917; 46: 51– 58. Server Kamil’s studies on goats attracted the attention of other Turkish doctors and they published articles on this subject. One of them was Reşat Rıza, who gave Kamil the idea for the typhus vaccine, emphasized that although the method of obtaining serum from goats was important for the treatment of typhus disease, it had need further confirmation. Reşat Rıza also pointed out that new researches were no longer carried out because the effect of typhus disease had decreased. Reşat Rıza, “Keçilere Lekeli Humma İntanının Tecrübesine Dair”, Sıhhiye Mecmuası, 4–5 (11–12), pp.1133–1137.

37.

Indeed, an effective typhus vaccine could be produced by Rudolf Weigl, a Polish biologist, in 1930s (Hervé Bazin, Vaccination: A History from Lady Montagu to Genetic Engineering, John Libbey Eurotext, p.346). The number of soldiers caught typhus and the number of deaths from only the 3rd Army region between 1915 and 1918 are as follows. 1915–9.489 / 4.377, 1916–6.641 /2.060, 1917–2.143 / 791 and 1918 - 577 / 82 (year - number of patients / number of deaths). Mustafa Karatepe, “I. Dünya Savaşı’nda Kafkas Cephesi’nde Tifüsle Mücadele” Yeni Tıp Tarihi Araştırmaları, 8, 2002, pp.107–162, As can be seen, the effect of typhus decreased considerably in 1917 and especially in 1918.

38.

Aksu . “Sivas Telkihhanesi ve Çiçek Aşısı Üretim Tesisi”, p.261.

39.

KA, 325/ 389.

40.

Aksu . “Sivas Telkihhanesi ve Çiçek Aşısı Üretim Tesisi”, p.260.

41.

KA, 714/ 68.

42.

KA, 325/ 394.

43.

KA, 325/ 388.

44.

KA, 325/ 412.

45.

KA, 587/ 196.

46.

KA, 325/ 535.

47.

Sağlam

. Büyük Harpte 3. Orduda Sıhhî Hizmet. İstanbul: Askerî Matbaa, 1941, p. 301.

48.

Birinci Dünya Savaşı’nda Doğu Cephesi’nde Sağlık Hizmetleri, Genelkurmay Askerî Tarih ve Stratejik Etüt Başkanlığı Yayınları, Genelkurmay Basımevi, Ankara 2011, p.81.

49.

Sağlam . Büyük Harpte 3. Orduda Sıhhî Hizmet, p.118, 302, 307.

50.

Hilâl-i Ahmer İcraat Raporları (1914–1928), p.13.

51.

Sağlam, Büyük Harpte 3. Orduda Sıhhî Hizmet, p.301–302.

52.

Hilâl-i Ahmer İcraat Raporları 1914–1928, p.13.

53.

KA, 864/ 106.

54.

Hilâl-i Ahmer İcraat Raporları (1914–1928), p.13.

55.

Aksu . “Sivas Telkihhanesi ve Çiçek Aşısı Üretim Tesisi”, p.262–263.

56.

Uzluk. “Ord. Prof. Server Kâmil Tokgöz, 1881–1943”, p.5.

57.

Unat . Osmanlı İmparatorluğunda Bakteriyoloji ve Viroloji, p.88.

58.

Presidency of the Republic of Türkiye State Archives Presidency - Republic Archive / Türkiye Cumhuriyeti Cumhurbaşkanlığı Devlet Arşivleri Başkanlığı - Cumhuriyet Arşivi / (BCA), 30–18-1-1/ 25-52 −9.

59.

BCA, 180-9-0-0/ 9-54-24.

60.

Kahya

. Fransa’da İhtisas Yapmış Olan Türk Hekimlerinden Bazıları. Ankara Üniversitesi Dil ve Tarih-Coğrafya Fakültesi Dergisi 1987; 31: 261.