MILITARY SURGERY IN GREECE 
AND TURKEY 
BY N. -SENN, M.D., Ph.D., LL.D. 
CHICAGO, ILL. 
REPRINTED FROM 
THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 
AUGUST 28 and SEPTEMBER 18, 1897. 
CHICAGO : 
American Medical Association Press. 
1897. Military Surgery in Greece MILITARY SURGERY IN GREECE 
The war between Greece and Turkey is ended. It 
was a short and in many respects a remarkable com- 
bat. After six or seven conflicts little Greece was 
conquered by an overpowering foe. In a little more 
than a month the little kingdom found itself trampled 
under the feet of a fanatic and greedy conqueror. 
Fate was against Greece from the beginning of the 
conflict. The scanty resources of the country made 
it impossible to maintain an army upon a modern war 
footing and its citizens, the descendants of the proud 
and warlike Hellenes, are no longer the equals of their 
forefathers whose daring exploits and victories have 
been immortalized in prose and poetry. Centuries of 
subjugation to foreign power and policies have resulted 
in a loss of confidence and a diminution in the intrin- 
sic resisting power of the nation that once, under the 
leadership of great statesmen and warriors, constituted 
the central power in Southern Europe. When Greece 
found herself confronted by a war with its envious 
and bloodthirsty neighbor, she discovered too late the 
lack of a well disciplined and well equipped army and 
navy. The first call to arms brought an army into the 
field of less than (50,000 men. Second-hand guns 
(Gras) bought from the French government were the 
arms used. Ammunition was scarce and frequently be- 
yond reach when most needed. According to the testi- 
mony of all who were in the field, the Greek soldiers 
behaved heroically. The quick and complete defeat 
is evidently attributable more to defective leadership 
than a want of valor on the part of the troops. The 
campaign was badly planned by those who were in 
power and the first defeat resulted in a loss of confi- 
dence which was never restored. Turkey rapidly 
mobilized a well organized and splendidly equipped 
army of at least 100,000 men along the Grecian border, 
which at once assumed decidedly aggressive opera- 
tions. The first battle was fought April 14, the last 
at Domoko, May 17. The great powers watched the 
unequal struggle with intense interest, and when it 
became evident that a complete annihilation of the 
Greek army was only a matter of a few days, they 
stepped forward and rendered valuable service by 
dictating the terms of peace. The Sultan has now to 
deal with the great powers in adjusting his claims 
against a conquered and humiliated country. The 
arms are stacked and the two armies are facing each 
other almost within speaking distance until the treaty 
is signed, when they will be withdrawn, and peace, at 
least for the time being, will be restored. Upon their 
return the Turks will sing the praises of victory, while 
the Greeks will bring sorrow and disappointment to 
their unhappy homes. 
During my visit in Patras and Athens I have made 
faithful attempts to obtain reliable information con- 
cerning the treatment and transportation of the 
wounded on the Greek side. I visited all of the mil- 
itary hospitals and interviewed many military and 
medical officers and nurses, but the reports received 
and the statements made were often so conflicting 
that I find it exceedingly difficult to write upon an 
authoritative basis. I shall harmonize the facts eli- 
cited as much as possible in preparing this report. 
Transportation of wounded.—From what I could 
learn from different sources, the Greek army had few 
ambulances. The simplest kind of litters were used 
in conveying the wounded from the fighting line to 
the dressing station. Two-wheeled carts and donkeys 
were employed largely in transporting the wounded 
and sick to the field hospitals. As soon as possible 
the sick and wounded were conveyed to the nearest 
landing station and from thence by boat to the hospi- 
tals at Athens and Patras. It appears that the wounded 
bore the rough methods of transportation with great 
patience and fortitude. 
Hospitals.—Germany and Russia sent field-hospi- 
tals, which proved of the greatest value during the 
short campaign. The large military hospitals in 
Patras and Athens were soon filled and additional room 
had to be secured foi the rapidly increasing number 
of sick and wounded. In Athens the two military 
schools and Polytechnicum were transferred into tem- 
porary hospitals with accommodations for at least 700 
patients. All of the hospitals were found in excellent 
order, comfortable beds and well-ventilated wards and 
rooms. The patients receive substantial nutritious 
food and a liberal allowance of native wine. In one 
of the hospitals I found twelve wounded Turkish 
prisoners who received, if anything, better attention 
than their former enemies. The hospital provided 
each one of the prisoners with eight cigarettes a day. 
The prisoners are model patients, but notwithstanding 
that they are treated with the utmost kindness they 
are anxious to return to their native land. 
Medical officers.—Greece has more doctors to its 
population than any other country in the world. On 
an average, two thousand medical students attend the 
University at Athens annually. Five years is the 
time required to prepare the student for graduation. 
Doctors in Greece lead a life of leisure owing to the 
salubrity of the climate and the overcrowding of the 
profession. When the war broke out Greece could 
furnish doctors in abundance, hence the numerous 
applications of volunteer doctors from the different 
countries far and near were as a rule declined with 
thanks. Among the few foreign doctors who did ser- 
vice for the Red Cross Association must be mentioned 
Abbot, Moffat and Osborne of England. Dr. Abbot 
performed a number of operations and is highly 
esteemed by his Greek colleagues. Dr. Skoufas is 
the Surgeon-General of the Greek army, with the rank 4 
of Colonel. He has served in this capacity for two 
years and during the campaign just ended was busy 
in his office daily, from 8 a.m. until 2 to 3 o’clock in 
the morning. He shows the effect of overwork at the 
present time. He is a most genial gentleman and did 
every thing in his power to further my object during 
my sojourn in Athens. He detailed Lieutenant 
Schultze, a member of his staff, to conduct Col. For- 
wood of the U. S. Army, Dr. Fowler of Brooklyn and 
the writer through all of the military hospitals in the 
city. Prof. Galvani of the University did service in 
Thessaly. He is the most persistent and ablest sur- 
geon in Greece. He has charge of the Evangelismos 
Hospital, where he operates daily at 10 a.m. A num- 
ber of our party, among them Dr. Lucy Waite of Chi- 
cago, and Dr. Southard of San Francisco, witnessed 
two of his operations, one ovariotomy and an amputa- 
tion of the leg for advanced tuberculosis of the knee- 
joint. His conveniences for carrying out antiseptic 
details are limited and yet his results are said to be 
remarkable. He is a conscientious and pains-taking 
operator. Among the other prominent physicians of 
Athens must be mentioned Dr. Savas, the physician 
of the Crown Princess, and Dr. Kalopothakes, the first 
female physician in Greece, both of whom have done ex- 
cellent service in the medical department of the army. 
The medical officers in the army are distinguished 
from the line officers by the color of the velvet on the 
collar of fhe uniform, which is a dark purple. The 
surgeons wear side arms and spurs in the hospitals 
and streets: 
Graduates who desire to enter the army must study 
an additional year and are then commissioned after 
passing a satisfactory competitive examination. 
Hospital corps.—The Greek army has three thou- 
sand soldiers who are instructed to serve as litter- 
bearers and render the first aid to the wounded, but 
of these only 300 are non-combatants, the remainder 
being detailed for special duty as emergencies arise. 
Before I received this information I was astonished 
to find the entrance of every military hospital guarded 
by a soldier wearing the brassard and handling at the 
same time a Gras gun with bayonet fixed. 
Red Cross.—The Red Cross Association of differ- 
ent countries did much to relieve the immediate wants 
of the sick and wounded. England and Denmark 
sent quite a number of well-trained nurses who did 
most efficient work in the field and city hospitals. 
The nursing in the Polytechnicum is performed ex- 
clusively by native female nurses. On my arrival in 
Athens I met two English nurses who had just 
returned from the seat of war and who were to return 
home next day. From them I obtained much valua- 
ble information regarding the worth of the Red Cross 
Association. They were Miss C. E. F. Bull and Miss 
Isabel Carter of Brighton. I requested them to give 
me some of their experiences in writing which was 
very promptly done by Miss Bull. It will be of inter- 
est to read in her own words a description of the 
retreat from Larissa. 
“ Being in Athens when rumors of war between Turkey and 
Greece were spread, I offered my services to the Greek Red 
Cross Society as a volunteer nurse for the front. 
“ On April 13 the first party of six English Red Cross nurses 
arrived with Mrs. Chant, and the following morning I received 
a command from H. R. H. the Crown Princess to go to the pal- 
ace. There I found the English sisters, and was asked by 
H. R. H. to accompany herself and three of the sisters to 
Larissa, it having been arranged that two should remain at 
the Greek Red Cross hospital at Volo and that one should 
accompany Mrs. Chant to Crete. 
“We arrived at Larissa on Easter Sunday and were taken 
around to see all the hospitals. At first we found it very diffi- 
cult to get a footing in any of them, for the Greek doctors did 
not like the idea of female help. However, we installed our- 
selves in the theater of the military hospital, which was over- 
crowded with untrained orderlies, doctors off duty, wounded 
men waiting to be attended to; in fact, a crowd of useless 
individuals falling in each other’s way and hindering the work 
of two or three really good military doctors who were trying 
to work. At last the value of the English sisters was discov- 
ered and by degrees the room was cleared, and we found our- 
selves hard at work in the operating theater with two clever 
young surgeons who, we were thankful to find, kept a most 
strict regime as far as antiseptic treatment was concerned. 
“The wounded were brought straight down from the field 
on mules or in rough wagons. Very little attention could be 
paid to them in the wards, but when we got a few spare 
moments we did our best to find out those who were the most 
severely wounded and had them brought to the theater as soon 
as possible. Comfort for the poor fellows was out of the ques 
tion, and it was with the greatest difficulty that a drink of 
milk could be got for a dying man who was craving for it. 
Our work was the same from morning till night, and lasted 
from Easter Sunday until the following Friday night. On the 
Thursday we had put up a model hospital of twenty beds 
which had been provided by H. R. H. the Crown Princess. 
Everything was in readiness for patients who were too badly 
wounded to be moved on to Volo, and we were to have received 
them on Saturday morning, but alas! the Turks had only to 
march in and find everything in readiness for them! 
“ On Friday night we retired at 11 o’clock, tired as usual 
after our day’s work. The only thing we remarked was that 
the firing being very much nearer, the Turks were not far off ; 
however, that did not make much impression on us, for we had 
been sleeping amid the boom of the cannon for the last six 
days. 
“ At midnight our hostess burst into our room crying out, 
‘ Fly for your lives, the Turks are coming into Larissa ! ’ We 
did not believe it, and when dressed I went over to the Crown 
Prince’s headquarters to learn the truth. 1 was told that there 
was no occasion to fear, and on my return the sisters returned 
to their beds. We were not left quiet for long, for soon both 
host and hostess informed us that they were going, and carried 
out their intention by leaving the house and locking the doors 
after them ; so that in one sense of the word we were prisoners. 
At about 2 a.m. a wagon under military escort was brought 
round, and in spite of any wish of our own to remain we were 
hoisted up on top of our kit bags and taken down to the rail- 
way station, which was surrounded by a panic-stricken crowd 
waiting for the first train to start, and expecting the Turks to 
swoop down upon them at the first dawn of day. 
“ All the wounded from the military hospitals were placed 
in the train, and to our lot fell standing room in a horse box. 
“We left Volo on Saturday evening with the wounded on 
board the Thessaly, and arrived in Athens at 1 a.m. on Monday. 
“On Tuesday I left for Arta Caravassera with a Greek lady 
and three English sisters. On the Epirus side we all settled 
down to steady hard work under a most clever and able sur- 
geon, Mr. Zainie of the Greek Red Cross. 
“Cath. E. F. Bull. 
“July 26, 1897.” 
Only a few of the foreign nurses remain at the 
present time. I found a Danish nurse at the Poly- 
technicum and Miss Morris of Manchester, England, 
in one of the military hospitals. The German Red 
Cross Association was represented by von Reichenbach 
of Munich, who brought with him a large supply of 
medicines and dressing materials. Most all of the 
dressing material in the different huspitals is of Ger- 
man manufacture. Many of the rich Greeks living 
in foreign countries sent money, nurses and hospital 
supplies, which did much to alleviate the sufferings of 
the victims of the late war. A wealthy lady who lives 
in Marseilles endowed and maintained a large ward in 
one of the temporary military hospitals in Athens. 
The impression prevails on this side that the Turks 
did not respect the Red Cross, that the wounded pris- 
oners were often tortured and mutilated, especially in 
the interior of Thessaly, where their conduct could not 
be watched by representatives of foreign countries. 
On the other hand, it is asserted that the Greek insur- 5 
gents abused the privileges of the Red Cross, which 
angered the Turks, who in turn resorted to revenge 
by ignoring the Red Cross protection. 
Turkish projectiles— The Turko-Grecian war was 
characterized by an immense waste of ammunition. 
The wounds on the Greek side show evidences that 
the firing was done at great distances. It is related 
that as a rule the shooting commenced as soon as the 
enemy came into view. Capt. Dorst of the U. S. 
Army tells of a little incident which shows how reck- 
less the troops were in the use of ammunition. The 
Turkish commander sent out about twelve cavalrymen 
as scouts to determine the position and strength of 
the enemy. As soon as the men came into view one 
of the Greek soldiers more than a mile distant opened 
fire, and in less than a minute firing was heard all 
along the line at a safe distance from the Turks. The 
scouts had no difficulty in reporting to their comman- 
der the exact location and probable strength of the 
enemy without coming within reach of the Greek 
guns. According to all accounts the marksmanship 
on both sides was exceedingly poor. The Greeks used 
the Gras gun with a forty-five caliber bullet of lead 
as the projectile. The Turks used the Martini single 
breech-loading rifle with a bullet of the same caliber 
and material. A single Turkish brigade was armed 
with the Mauser gun of small caliber and jacketed 
bullets. The Greek military surgeons say that many 
of the wounds which they saw were small and pre- 
sented all the appearances of having been inflicted 
with a projectile of small caliber. All of the bullets 
which I saw in the military hospitals of Athens were 
large bullets of lead, evidently the ammunition for 
the Martini rifle. Miss Morris, the English nurse, 
informed me that she saw two bullets of small caliber 
metal-jacketed removed in the field hospitals. In both 
instances the bullet was removed from a flesh wound 
of the leg. In neither case was the bullet depressed. 
It is evident that the injuries were received at a great 
distance from the enemy or that the force of the bul- 
lets was diminished by striking a medium between 
the contending forces. I saw a number of injuries 
inflicted by the contents of exploding shells. In one 
instance the missile was a small round bullet of lead 
of about thirty-two caliber. 
The Greek soldier.—The Greek people are almost 
proverbial for their honesty, modesty and simplicity 
of habits. The Greek laborer is generally industrious, 
strongly attached to his family and anxious to provide 
for his children a good education equal, if not superior, 
to the peasantry of any of the other countries in 
Europe. Theft and premeditated murder are almost 
unknown. Murder is not infrequent but when com- 
mitted it is the result of a quarrel, a sudden excitement 
of passion. Drunkenness does not exist in Greece. 
Old and young, rich and poor drink a moderate 
amount of native wine, but the favorite national 
drinks are coffee and water. The cafetiers and water- 
venders do a thriving business in restaurants and pub- 
lic places. Cigarette smoking is common, but the use 
of tobacco in any other form is exceptional. The 
temperate eating and drinking in Greece has created 
a typical race. 
The ordinary Greek is below our average size with- 
out an ounce of superfluous fat, muscular and well 
calculated to do excellent service in a short active 
campaign. There can be no question that the excel- 
lent results which have followed the often imperfect 
treatment of the wounded during the late war are 
largely due to the unvitiated, vigorous constitutions 
of the patients. The uniform and equipment of the 
Greek soldier are of the simplest and cheapest kind. 
All efforts at display are lacking. 
Woman soldiers.—Three Greek women have be- 
come famous during the war just ended. Conspicu- 
ous among them is Katarina, who joined the insurgents 
with her brother, did brave work, was wounded and 
was brought to one of the field-hospitals for treat- 
ment. The illustration shows her upon the cot in 
the hospital surrounded by nurses. Another woman 
did similar service with her brother. A third woman 
carried water to the wounded in the firing line, 
received several wounds, one of which made amputa- 
tion of the arm necessary. She died eventually from 
the effects of the injuries. 
First dressing — The many wonderful recoveries 
from serious gunshot injuries which came under my 
own observation seem to prove that great pains were 
taken to prevent infection on the field and later in the 
hospitals. A representative of the staff of the Sur- 
geon-General informed me that the wounds received 
early attention. The instructions were to shave the 
injured part, rub thoroughly with a solution of 
corrosive sublimate, dust the wound with iodoform 
and dress with antiseptic gauze. Wire splints were 
used mostly for immobilizing fractured extremities. 
In the hospitals plaster-of-paris was used to some 
extent for the same purpose. Diagnosis tags were 
not used, consequently many primary dressings were 
THE GREEK SOLDIER. 6 
removed unnecessarily, and I have no doubt in some 
instances to the detriment of the patient. All the 
primary dressings were applied by the military sur- 
geons; the hospital corps were not expected to take an 
important part in this work, serving simply as assist- 
ants to the surgeons. Elastic constriction and anti- 
septic tamponade for the purpose of arresting hem- 
orrhage on the field appear to have had only a limited 
application. One of the nurses whom I met expressed 
her belief that many lives could have been saved if 
more attention had been paid to this part of first aid 
to the wounded. 
Operations.—Chloroform was used exclusively as an 
anesthetic without a single death that could have 
been attributed to this source. A number of amputa- 
Greeks killed and wounded 50,000 Turks, while the 
Greek loss was 15,000. From the observations made 
in the different hospitals it is more than probable that 
the number of wounded on the Greek side did not 
exceed 3,000. Many of these wounds were slight and 
either did not disable the soldiers or they recovered 
from the injuries in a few days and returned to their 
regiments for duty. In no instance was a primary 
laparotomy performed for penetrating wounds of the 
abdomen. Dr. Socrate Sp. Tsakona, Prof. Galvani’s 
assistant, informed me that he saw in the Evangelis- 
mos Hospital two patients recover from penetrating 
wounds of the abdomen. In both instances the bul- 
let passed through the abdominal cavity at or above 
the level of the umbilicus in an antero-posterior direc- 
KATARINA, THE GREEK AMAZON. 
tions were made in the field-hospitals, but few if any 
primary resections. Secondary hemorrhage appears 
to have the been very infrequent, undoubtedly owing 
to the aseptic conditions of most wounds. More or less 
rigid antiseptic precautions were always carried out, 
which explains the rapid handling of most of the op- 
erative wounds. The instrument supply was simple 
and obtained almost exclusively of French manufac- 
turers. 
Bullet wounds and results of treatment.—I found 
it impossible to ascertain even approximate data con- 
cerning the number of killed and wounded on either 
side. The statements made by different persons are 
so at variance that it is impossible at the present time 
to estimate the loss of the Greek army. A lieutenant of 
the Greek army had ready figures claiming that the 
tion, passing through the body. In one of the mili- 
tary hospitals I saw a patient fully convalescent from 
a gunshot injury which implicated the cavity of the 
chest and liver. Bile escaped through the anterior 
opening for a number of days; no operation; rapid 
recovery under expectant treatment. Cases of erysip- 
elas were few and mild. In gunshot fractures of the 
extremeties progressive phlegmonous inflammation 
occasionally set in, necessitating extensive drainage or 
amputation. The Surgeon-General's office had no record 
of any cases of pyemia. Death caused by infection 
resulted from progressive sepsis. Field and hospital 
practice did not show a single case of hospital gan- 
grene. Many of the large lead bullets obtained by 
extraction or amputation were greatly depressed. I 
will now give a brief account of some of the cases of 7 
gunshot injuries which I had an opportunity to exam- 
ine in the different military hospitals for the purpose 
of showing what modern surgery has done in the way 
of saving life and lessening suffering of those engaged 
in warfare, thus greatly mitigating the remote horrors 
of the battlefield. Antiseptic surgery can not claim 
all the good results which followed the treatment of 
the wounded during the last war, as after the battle of 
Bordino in 1812, long before antiseptic surgery was 
known and practiced, comparatively few cases became 
infected. The good results in part at least are due to 
the favorable climatic influences and the excellent 
constitutional condition of the injured. 
Marseilles Hospital.—This one of the temporary 
military hospitals has received its name in honor of 
a wealthy lady of Marseilles who endowed it so liber- 
ally for the present purpose. It. is the Polytechnic 
school, and as soon as all the patients are disposed of 
will again become an educational institution. The 
nursing in this hospital has been done principally by 
a number of Danish sisters from Copenhagen, whose 
are complicated by visceral injuries of sufficient 
severity to require abdominal section, or to become 
the immediate cause of death. The nursing in this 
hospital is done by soldiers and a few English nurses. 
The operating room is small, but is supplied with all 
the essential equipments and materials for aseptic 
work. All of the operations are performed by the 
regular military surgeons. 
Case 1. -Gunshot wound of the head. The bullet entered 
above the orbit and passed out of the skull in the parietal 
region on the same side. No operative treatment. Healing of 
the wounds of entrance and exit by primary intention. No 
focal symptoms at any time. Patient fully convalescent. 
Case 2.—Gunshot wound of forearm. No fracture of the 
bones. A German surgeon attempted to find and extract the 
bullet with negative result. A long scar marks the line of 
incision. Slight suppuration. Wound now nearly healed. 
Patient walking about with the forearm supported in a sling. 
Case 3.—Bullet wound at the base of right thigh ; wound of 
entrance near the border of the sartorius muscle, wound of 
exit near gluteal crease. Healing by primary intention. 
Case 4. —Wound of right knee joint, received in Epirus. 
The bullet fractured the internal condyle of the femur, opened 
MILITARY HOSPITAL AT ATHENS. 
services have proved most acceptable to the authori- 
ties and patients. Of 100 patients admitted into this 
hospital suffering from gunshot wounds, only one 
died. At present about fifteen wounded soldiers 
remain, all of them on the way to recovery. The med- 
ical cases are made up of malaria and two typhoid 
fever patients. 
Tratiotikon nosocomion— This is the regular mili- 
tary hospital, erected and used for the exclusive use 
of sick and wounded soldiers. It is sixty years old 
and has a capacity of 500 beds. It is built on the 
barrack system and is well lighted and ventilated. It 
is asserted that in this hospital three patients recov- 
ered without laparotomy who were admitted with per- 
forating gunshot wound of the adbomen. The fatal 
cases of this kind of injury probably never reached 
their ultimate destination. There can be but little 
doubt that a number of cases of perforating gunshot 
wound of the abdomen recovered without operative 
intervention, which only goes to prove what the writer 
demonstrated years ago experimentally that not all 
perforating gunshot wounds of the abdominal cavity 
the knee joint and was removed by an incision over the outer 
aspect of the joint. Aseptic healing of the wound with fair 
degree of motion of the joint. Considerable thickening of the 
capsule of the joint remains. 
Case 5.—Gunshot fracture of leg, with extensive comminu- 
tion of fibula. Wound received during the first week of the 
war. Healing by secondary intention and slow formation of 
callus. 
Case 6.—Bullet wound of base of neck. The bullet passed 
transversely through the soft tissues of the neck, behind the 
vertebral column and probably caused a fracture of one or more 
of the spinous processes. The special symptoms due to con- 
cussion which followed the injury have now disappeared and 
were probably caused by concussion of the cord. Healing of 
the wound without suppuration. 
Case 7.—Bullet wounds of chest. Three wounds of entrance 
over the anterior and upper aspect of the chest. One of the 
bullets passed through the chest on the leftside of the sternum, 
point of exit over the scapula on the same side. The other 
two wounds were inflicted by the contents of a bursting shell. 
The size of the scars indicate that the missiles were less than 
38 caliber in size. No attempt was made to locate and remove 
these bullets. Free hemoptysis immediately after the injury. 
The patient recovered without any grave complications 
setting in. 
Case 8.—Comminuted gunshot fracture of tibia. Many frag- 
ments of bone were removed soon after the injury was received, 8 
leaving a large bone defect. Wound healed ; no union and but 
slight callus production. An operation for pseudo arthrosis will 
become necessary in the near future. 
Case 9.—Gunshot wound of chest with fracture of spinous 
processes of one or more dorsal vertebrae. Track made by bullet 
transverse, about the junction of the middle with the upper 
third of the dorsal portion of the spine. Pleural cavity not 
opened. Wound of entrance on one side of the spine, incision 
made for the extraction of the bullet on the other side on the 
same level. Spinal symptoms were well marked immediately 
after the injury was received and are disappearing rapidly. 
Wound healed without suppuration. 
Case 10. Gunshot wound of knee joint with extensive com- 
minution of internal tuberosity of tibia. Patient a captain in 
the Greek army. First dressing applied fifteen hours after the 
injury was received, redressed on the sixth day. Bullet passed 
through the joint and escaped between the head of the fibula 
and the external condyle of the femur. Injury inflicted during 
the beginning of the war. Slight suppuration. Wound now 
healed; capsule of joint and para-articular tissues remain 
somewhat swollen and indurated. Considerable impairment of 
motion. No operative treatment. 
Case 11.- -Gunshot injury of leg. Patient a lieutenant in the 
Greek army. Bullet passed from before backward through the 
leg a few inches below the knee joint, between the tibia and 
fibula, without fracturing either of the bones. Primary heal- 
ing of the wound without much functional impairment. 
Case 12.—Gunshot wound of the shoulder joint. Wound of 
entrance two inches below the acromion process. The bullet 
passed through the head of the humerus and the shoulder 
joint and was removed in the field hospital at a point two inches 
below the middle of the clavicle. Conservative treatment. 
Healing of wound without suppuration. No anchylosis and 
no swelling of joint. Humerus at the seat of injury consider- 
ably enlarged by callus formation. Patient is able to raise arm 
at a right angle to the body. 
Hospital Evangelismos.—This is the best hospital in 
Athens and furnishes accommodation for 150 patients. 
The surgical wards are in charge of Professor Galvani, 
who performs on an average 350 capital operations 
annually. During the war and at the present time 
this institution has been used largely in receiving and 
caring for sick and wounded soldiers. The care of 
the sick is in the hands of native female nurses. 
These nurses are devoted workers Out lack a thorough 
training. My attention was called to a number of 
very interesting gunshot injuries involving different 
parts of the body. 
Case 13.—Gunshot wound of knee joint. The bullet perfor- 
ated the external condyle of the femur and passed out over the 
minor aspect of the joint. Course of active treatment. Mod- 
erate swelling of joint; no suppuration. The wound healed by 
primary intention. Recovery with fair action of joint. 
Case 14.—Injury of ankle joint produced by the bursting of 
a shell. Slight infection, healing of the wound by granula- 
tion. Joint remains considerably swollen and somewhat ten- 
der to pressure. Motion of joint limited. 
Case 15.—Bullet wound of soft tissues of the leg. Healing 
by primary intention. 
Case 16.—Similar wound. Healing without suppuration. 
In both instances the bullet passed through the limb without 
producing any injury to the bones. 
Case 17.—Cretan, gunshot wound of shoulder joint. Bullet 
passed through head of humerus and joint, point of exit below 
coracoid process. Fistulous opening remains, through which 
a limited amount of pus passes daily. Anchylosis not complete. 
Considerable atrophy of deltoid muscle which may be due to 
nerve injury. 
Case 18.—Gunshot wound of chest. Bullet not extracted ; 
injury followed by empyema. Free drainage without rib 
resection. Injured side of chest contracted ; respiratory move- 
ments greatly diminished. Patient is pale and emaciated and 
shows the effects of prolonged suppuration. 
Case 19.—Gunshot fracture of thigh. Injury received four 
months ago. Wound healed ; bone united by massive callus ; 
limb considerably shortened and femur curved. 
Case 20.— Gunshot wound of chest and abdomen. Bullet 
entered dorsal side of chest on level with eighth rib four inches 
from median line, took a downward and forward course and 
escaped below costal arch an inch below cartilage of seventh 
rib. No operation. Bile escaped through anterior perforation 
for a number of days. Wound healed by primary intention. 
No serions inflammatory complications. Patient is now fully 
convalescent. 
Case 21.—Gunshot wound of ankle joint. Moderate suppura- 
tive synovitis followed the injury. Wound of entrance granu- 
lating. Joint considerably swollen; heel retracted; motion 
greatly impaired. 
Case 22.— Gunshot wound of patella opening knee joint. 
Secondary suturing of patellar fragments with satisfactory 
result. Motion of knee joint greatly impaired, which in part 
is due to the swelling and induration of the soft structures 
which still remain. Suturing material, silkworm gut; opera- 
tor, Professor Galvani. 
Dase 23.—Gunshot wound of heel. Extraction of bullet in 
the field hospital. Suppurative; suppurating fistula leading 
down to denuded os calcis remains. 
Case gunshot wound of the abdomen. Re- 
covery without operation. 
Case 25.—Gunshot wound of abdomen. Recovery without 
operation. Cases previously mentioned. Both of these cases 
entered the hospital ten days after the injury was received. 
Case 26.—Gunshot fracture of both bones of the forearm. 
Bullet and loose fragments of bone removed in the field hospi- 
tal. No union and no callus formation. Wound healed. 
Case 27. -Gunshot fracture of the humerus. Bullet passed 
through the arm near the middle. Nerves escaped injury. 
Healing by primary intention. No splints. Fixation by band 
aging arm to the side of the chest with forearm fixed and sup- 
ported by the same bandage. Union by bony callus with good 
functional result. 
Military academy transformed into temporary 
hospital.—This institution could readily accommo- 
date 300 to 400 patients. It is well adapted for hos- 
pital use. Twelve English nurses were employed 
during the war in caring for the sick and wounded, 
assisted by soldiers. At present only one nurse re- 
mains and the number of patients has been reduced 
to less than two hundred. 
Case 28.—Gunshot wound of thigh. Infection. Secondary 
amputation. Osteomyelitis of the bone made it necessary to 
perform a second operation, which consisted in enucleating 
the bone. Wound still suppurating and healing slowly by 
granulation. 
Case 29.—Gunshot wound of clavicle and scapula. Clavicle 
united by a massive callus. Bullet passed from before back- 
ward, above the large vessels and nerves. Motion of arm 
greatly impaired. 
Hypaxiomatikon Hospital. — This is another 
temporary military hospital. It is an old military 
school which was converted into a hospital soon after 
the breaking out of the war. More than five hundred 
patients have been treated here. It gives accommo- 
dation for 110 patients and is fairly well equipped for 
the present purpose. It is now used for convales- 
cents almost exclusively. Of the present 110 patients 
50 are recovering from injuries received during the war. 
Camp and hospital diseases.—The prevailing dis- 
ease among the soldiers in the field and in the hospi- 
tals is malaria. The average soldier is perfectly 
familiar with the use of quinin, which is the only 
drug used in the treatment of this affection. Typhoid 
fever and pneumonia have claimed a number of vic- 
tims. As a rule typhoid fever pursues a compara- 
tively mild course and is not treated by any of the 
aggressive methods. Complications are watched for 
and promptly treated when they appear. 
Athens, July 28, 1897. flilitary Surgery in Turkey .111 LIT ARY SURGERY IN TURKEY 
The journey from Athens to Constantinople at this 
time does not reveal anything that would remind the 
traveler that a war raged so recently between the two 
countries. The olive trees, which are seen every- 
where, are laden with their oily fruits, and the endless 
vineyards promise a rich harvest of luscious grapes. 
The patient donkey carries his burden to the market 
in slow measured steps as though nothing had dis- 
turbed so recently the financial prospects and calcula- 
tions of his master. In the many fatherless houses the 
dusky black- eyed children sing and play merrily, ignor- 
ant of the violent political eruptions which so recently 
threatened their lives and homes. The great caravans 
of camels bringing grain, fruit, spices and oil from 
distant parts of Asia wind their way along the narrow, 
crooked streets of Smyrna unmindful of the presence 
of armed soldiers who are arriving daily from the late 
seat of war. The few birds that inhabit the rural 
districts chirp and sing the praises of their Creator 
with the same regularity and devotion as before the 
war cry between the two angry nations disturbed the 
atmosphere in which they breathe and move. The 
Turk who has returned from the scene of war is a 
different man from his less fortunate opponent. He 
is conscious of his victory and all that pertains to it. 
He holds his head high and in loud and emphatic 
language relates to admiring crowds the story of the 
war, the many hairbreadth escapes, the successive vic- 
tories won, and in prophetic words paints the future 
glory and prosperity that await his country. The 
haughty victorious Turk has placed his foot upon the 
prostrate, trembling little Greece, demanding a war 
indemnity that they may eventually promise but which 
they never will be able to pay. The Sultan, intoxi-' 
cated by the effects of an easily won victory, is defi- 
ant and counts himself among the leading rulers of 
the world. It is impossible to predict the ultimate 
outcome of the war. What now appears as a defeat 
for Greece may eventually reflect to her permanent 
advantage. This faint hope is cherished by all civil- 
ized nations and by every lover of art and science. 
The average Turk is opposed to innovation and 
progress. In many respects he resembles the North 
American Indian. He takes no interest in history 
and tradition. To him the past is a blank and the 
future immaterial. His mind is engaged with the 
present. His inborn wishes and desires are in appro- 
priating day after day, from his surroundings, every- 
thing within reach that will satisfy his flesh, leaving 
his soul to die of gradual starvation. He has no sense 
for beauty. Turkish architecture has gone into decay. 
Some of the magnificent mosques erected centuries 
ago are neglected and crumbling into dust. Science 
and art never had a foothold in this country, and there 
are no prospects under the present form of govern- 
ment that they will receive attention for centuries to 
come. The most auspicious national trait of the Turk 
is his laziness. Indolence is apparent everywhere. 
Even the numerous dog population of Constantinople 
has imbibed this national vice. The miserable half- 
starved brutes, half wolf and half dog, lie listless and 
motionless on the stone pavements all day, obstruct- 
ing sidewalks and streets, and if perchance stepped 
upon have not sufficient energy to change their posi- 
tion or resent the intrusion in genuine dog fashion. 
Over all bony prominences the hair and often the skin 
is worn away at points where the almost lifeless car- 
cass rests against the hard, rough bed of stone. Dur- 
ing the night they muster up sufficient courage to 
prowl about for their scanty food supply and clear 
their dusty throats by violent efforts at barking. 
These hideous nightly concerts are the trial and terror 
of the traveler. The scavenger duty these dogs per- 
form is but an inadequate recompense for the noise 
and disturbance they create during the night. They 
are the property of the community and eke out a 
miserable existence by gathering up the bones and 
crumbs which fall by the wayside. They are local 
tramps without a single legitimate function. The 
fanatic Turk would revenge a wilful injury to one of 
these beasts as quickly as if it had been inflicted upon 
a member of his family. The foot passengers and 
drivers are very careful to walk and drive around them 
for their own peace and safety as well as to prevent 
unpleasant street scenes. The dogs know that the 
Turks are their friends and behave themselves accord- 
ingly. The filthy streets and the whole aspect of the 
business world furnish additional evidences of the 
widespread indolence that prevails here. If it were 
not for the influx of immigration from countries 
where indolence does not exist to the same degree as 
an epidemic disease, the Turks would have died out 
long ago from starvation. Constantinople, with its 
nearly a million of inhabitants, is the most cosmopol- 
itan city in the world. In its streets representatives 
of all nations can be seen. A free mixture of races 
for centuries has resulted in staining the skin various 
shades from an almost pure white to an ebony black 
color. Similarity of dress is unknown here. From 
the primitive dress of the original. races inhabiting 
Asia and Africa to the most costly costumes of the 
Parisian tailor, there are innumerable grades. The 
red fez is the distinctive headdress of the Turk, 
whether civilian or soldier. The white and green 
turban distinguish the Mohammedans in mosque and 
street. The green turban is an evidence that its 
wearer is a direct descendant of the great prophet. 
The Turkish women are in reality married nuns. 
From the time they reach puberty they are shut out 
from the gaze of infidels by veil and screen. The 
windows of every house occupied by a Turk are per- 
manently screened. The women are seldom seen in 
the streets and public places. In various ways the 
Turk secures their isolation from the outer world. 
They are to a certain extent prisoners in their own 
homes, slaves in more than one sense of the word. 
The inferior position occupied by women has had its 
decidedly baneful influence in degrading the male 
population. It is my opinion that greater freedom of 
the women would be the very best measure to rouse 
their sluggish husbands to greater activity and to 
awaken a keener sense of domestic and national 
responsibility. Let the women attend the little shops 
and put the men to work in the fields, workshops and 
streets, and Turkey would soon be able to pay her 
debts and become one of the most prosperous coun- 
tries of Southern Europe. 
The Turk as a soldier.—It is not generally known 
that the material for the Turkish army, with the 
exception of the medical office, is recruited exclusively 12 
from the Mohammedan portion of the population. 
Every Turkish soldier is a believer in the Moham- 
medan faith. The military schools and barracks are 
closed to every Armenian and Greek. The Sultan 
has no faith in the patriotism of any of his subjects 
who differ with him in his religious views, and he 
places his own safe-keeping and the fate of his fam- 
ily exclusively in the hands of the Faithful. The 
Greeks, Armenians and other nationalities, who are 
citizens of Turkey but do not confess the faith of 
Islam, subject to military duty, pay a special tax of 
twenty piastres every year for the support of the army. 
The Turkish soldier as a rule is larger and stronger 
than the Greek soldier. The Greek is temperate in 
his habits of life as far as alcoholic drinks are con- 
cerned. The Turk is an almost complete abstainer. 
Coffee is his national drink. It would be difficult to 
find a habitual drunkard anywhere in the country. 
of death. On the Turkish side the last war was noted 
for the quick mobilization of troops and well planned 
sudden attacks, a repetition of Moltke’s methods of 
warfare. In observing the maneuvers of the troops 
the hand of German drill-masters can be seen every- 
where. The organization of the Turkish army is 
closely patterned after the German army. The Turk- 
ish fleet is in a somewhat deplorable condition, far 
inferior to that of the Greek fleet. A naval war 
between Greece and Turkey would be a more equal 
contest than the late conflict on land. The privates and 
non-commissioned officers possess a common school 
education, as education is compulsory in the country. 
The officers receive a careful military education in 
the military schools at the expense of the government. 
Boy soldiers.—During the late war a number of 
boys from 13 to 15 years of age, served as volunteers. 
In one of the military hospitals I was shown three 
Masticho, a mild beer, and native wines are about the 
only alcoholic drinks used, and always with great 
moderation. The use of tobacco is limited largely to 
cigarettes and the water-pipe. The men are physically 
well developed and present the appearances of robust 
health. Among the officers many handsome men can 
be seen. The greatest diversity in uniform prevails. 
The cavalry horses are splendid animals. They are 
of medium size and high-spirited. The riding equip- 
ment is plain but practical. From what I have seen 
I am not astonished that the Greek feared the Turk- 
ish cavalry. The mounted force brought terror and 
consternation whenever it made an onslaught in 
earnest. The cavalry and artillery are armed with 
Winchester rifles, the infantry with Martini and 
Mauser guns. The Turkish soldier is brave when led 
by a competent commander and when he sees victory 
ahead. The faith in his religion takes away his fear 
A TROOP OF TURKISH CAVALRY. 
of these little heroes who faced the Greeks on the 
battlefield. All of them received serious injuries but 
fortunately recovered. They were anemic and ema- 
ciated, but happy in the thought that they had con- 
tributed their share in saving their country from 
foreign invasion. One of the officers took great 
delight in praising the courage and endurance of 
these faithful patriots and made the remark that 
when they did move it was always in the direction of 
the enemy. Let us hope that the Sultan will rec- 
ognize their services and that he will see to it that 
when they leave the hospital it will be with a deco- 
ration for heroic conduct, which they can show to 
their relatives and friends as precious mementoes of 
their patriotic deeds. 
Red, Cross societies.—The Red Cross Societies of 
Germany, Russia and Austria sent physicians, nurses 
and hospital supplies to the Turkish troops. The 13 
German Red Cross Society was represented by three 
surgeons and twelve nurses. Russia sent four sur- 
geons and Austria three. Most of the surgeons and 
nurses did duty in the regular military hospitals 
under the supervision of the medical staff. The 
Turkish troops were well supplied with native doctors 
and there was, therefore, little need of physicians 
from foreign countries. The English Red Cross sent 
financial aid. All of the nurses and doctors that 
remained in the city on my arrival left for their 
respective homes the next day. The appreciation of 
the Sultan, of the services rendered by the German 
branch of the Red Cross Society, was manifested by a 
gala dinner at the royal palace to the representatives 
of Germany and Austria the evening before their 
departure. A notice of this event appeared in one of 
the daily papers the next day. “The members of the 
Red Cross Missions sent by their Majesties, the 
Emperors of Germany and Austria, and who are about 
was to bring aid and comfort to soldiers disabled for 
duty by sickness or injury. This movement was 
undoubtedly conceived and fostered by Florence 
Nightingale, who was then stationed here. After the 
war the Society remained in existence, but very little 
interest was taken in its work until after the founding 
of the Red Cross Association at Geneva during the 
great War of the Rebellion. The Turks, for obvious 
reasons, objected to the red cross as the insignia of 
neutrality of the new society, and adopted in its place 
the red crescent on a green field. The red crescent 
has never been popular in Turkey. Not a single 
member of the army has joined it. It is composed of 
a few prominent wealthy Turks but the bulk of the 
list of members is made up of foreigners. The non- 
combatant soldiers who serve as nurses and litter- 
bearers wear the red crescent on the left sleeve. The 
hospital flag bears the same insignia. Practically, the 
red crescent is equivalent to and is used as a substi- 
to return to their countries on the accomplishment of 
their task, were entertained at dinner at the Imperial 
Palace of Yildiz yesterday, Monday. Their excel- 
lencies, Mavroyeni Pasha, physician-in-chief of his 
Imperial Majesty, the Sultan; Munir Pasha, Grand 
Master of Ceremonies, and Dragoman of the Imperial 
Divan; and Marshal Shakir Pasha, Chief of the Im- 
perial Military Household, were also present at the 
dinner. His Majesty was pleased to confer decora- 
tions upon his guests, who received them on taking 
leave after enjoying the Imperial hospitality.” 
Although the Turk is not in sympathy with the work 
done by the Red Cross societies, he is beginning to 
appreciate the blessings which these societies bring 
to the sick and wounded soldiers in time of war irre- 
spective of creed and nationality. 
Red Crescent.—During the Crimean war an organ- 
ization was effected in Turkey, the object of which 
TUBKISH ABTILLERY. 
tute for the red cross in the Turkish Army. During 
the war just ended the Red Crescent expended 8,000 
francs for the relief of the sick and wounded and 
fitted out a hospital ship which transported many of 
the wounded from the seat of war to Constantinople. 
No members of the Red Crescent attended the troops 
on the battle-field and in the field hospitals. A bet- 
ter organization of the Red Crescent Society is very 
desirable and should be encouraged and assisted by 
the Red Cross societies, particularly by those belong- 
ing to adjacent European countries. 
Medical corps.—The Turkish troops are well sup- 
plied with medical officers, who are specially trained 
for military service. This branch of the military 
force is open to all nationalities, including the Greeks 
and Armenians. The medical officers are educated at 
the expense of the government. The University of 
Constantinople is attended by about two thousand 14 
students, of which number five hundred belong to the 
Medical Department. The medical course extends 
over six years, when the candidates for graduation are 
examined by the Faculty. If the examination proves 
satisfactory the candidate is reported upon favorably 
to the Civil Medical Council, in whose hands alone 
rests the power to grant the degree or licence to 
practice. As the only university in Turkey is in 
Constantinople it is somewhat unusual and refreshing 
to know that the Medical Department contains such a 
small number of students. The medical student who 
chooses the military course must pursue his studies 
the same length of time. The department for medi- 
cal officers is distinct and the final examination is 
conducted by a board of examiners composed of seven 
military surgeons. The president of this board is the 
Surgeon-General of the Army, who has the rank of a 
major-general, This board is called the Council of 
Hygiene and besides deciding upon the merits of the 
candidates for the medical corps, superintends and 
controls the work of the medical department of the 
army. The old custom of training barber-surgeons 
for the army is still in vogue in Turkey. This low 
grade of surgeons is composed of men with a limited 
preliminary education. The barber-surgeon is re- 
quired to attend lectures and demonstrations for two 
years before he is permitted to come up for examina- 
tion prior to his entering the army. His rank in the 
army is low, his pay scanty and his duties menial. 
He is allowed to cup, bleed and blister as in years 
gone by, but is always under the strictest supervision 
of the military surgeons. He is not allowed to dress 
a recent wound or prescribe. In a most humble 
capacity he assists the surgeons in their work. By 
extraordinary effort and perseverance occasionally 
such a surgeon is commissioned, when he leaves the 
barber’s trade and is entitled to enter the medical ser- 
vice proper. Two of these surgeons are assigned to 
each regiment. The medical officers enter the service 
with the rank and pay of captain. The pay is small 
and promotion slow unless favored by strong political 
influences, which here as elsewhere, are the easiest step- 
ping-stones to position and rank. The medical officer 
in the Turkish army is known by the iEsculapius 
staff in the center of the narrow shoulder-straps. The 
rank is indicated by stripes of gold braid on the lower 
end of the coat sleeve, the stripes running parallel 
with the sleeve. Officers of high rank are known by 
the number, color and direction of the stripes. The 
medical officer, when he enters the army, pledges 
himself to serve for twenty-six consecutive years, 
when he can retire with a pension. If, for any reason 
except disability, he leaves the service before the 
expiration of this time he is obliged to refund the gov- 
ernment for his expenses incurred in obtaining his 
medical education. That advancement in the medical 
corps of the army does not always take place in the 
regular order was made very plain to me when I was 
introduced to the chief of staff of the Yildiz Military 
Hospital, who is a pasha with the rank of brigadier 
general, and is only 27 years old. I was informed 
later that this rapid advancement was at least in part 
due to his being the son-in-law of an influential poli- 
tician who has great influence with the Sultan. It 
must have been somewhat discouraging to the many 
gray-haired captains and colonels who have served 
their country for more than twenty years, to see one 
so young promoted over their heads. Specialism in 
military practice is recognized by the Turkish Gov- 
ernment. I met two military surgeons, with the rank 
of colonel, who for years have devoted their whole 
time and attention to ophthalmology. They attend 
large wards in the military hospitals set aside for this 
special kind of work. Both of these men appeared to 
be familiar with the great advances that have been 
made during the last twenty-five years in this branch 
of surgery. There are few men in Turkey who do 
anything like a large surgical practice. The furor of 
operations has not reached this part of the world. 
The ovaries and prostate gland are comparatively 
safe. The Turkish women are not as anxious to be 
operated upon as their American sisters. The pro- 
posal to castrate a Turk for enlargement of the pros- 
tate gland would mean personal danger to the 
would-be operator. The military surgeons are 
entirely conservative in their work. Unnecessary 
operating is universally condemned. 
Dr. Marie Siebold, a graduate of a Swiss university, 
is the only female doctor in Turkey. Her sex pre- 
vents her from receiving a diploma from the Constan- 
tinople University. She has, however, obtained a 
license to practice her profession. She is an earnest 
student, a careful and able practitioner and, while not 
fully recognized by her male colleagues, she is cer- 
tainly fully their equal. Dr. Siebold has seen mili- 
tary surgery, but during the last war took no active 
part. 
Hospital corps.—The hospital corps is composed 
of 8,000 non-combatants specially trained for the 
transportation of the wounded and the care of the 
sick; litter bearers, detailed as emergency demands, 
and hospital stewards, The hospital stewards are 
graduates in pharmacy and are enlisted as such after 
having passed a satisfactory examination, The army 
is supplied with 8 ambulances and 200 litters. This 
equipment for the transportation of sick and wounded 
during the late war proved inadequate and the most 
of the wounded had to be carried from the battlefield 
to the field hospitals on mules, donkeys and rough 
carts. It is said that many cases of penetrating 
wounds of the abdomen were strapped on the back of 
donkeys and died before reaching the hospital. The 
dressing materials which I saw in the different mili- 
tary hospitals were either of French or German 
manufacture. Considering the many modern im- 
provements which have been made in the arms and 
equipments of the Turkish army, it is to be regretted 
that so little money has been spent in bringing the 
hospital corps up to the high standard of the present 
requirements in field and hospital practice. 
Military hospitals.—All of the field-hospitals were 
either buildings used for this purpose temporarily or 
hospital tents. The permanent military hospitals in 
Constantinople are large and commodious structures. 
Everyone is located on an eminence surrounded by 
ample grounds beautified by semi-tropical trees and 
flowers. 
Yildiz Hospital.—This structure embraces twenty- 
two barracks and overlooks the palace of the present 
Sultan. Before the war a few old barracks furnished 
ample accommodation for the sick of the military 
force in that part of the city. When the war broke 
out new barracks were built, and in less than four 
weeks it furnished room and ample accommodations 
for 1,000 patients. This is the hospital to which most 
of the wounded were brought and in which most of 
the operations were performed. At the time of my 
visit it contained 900 patients, most of them surgical. 15 
It is under the charge of Djemil Pasha, who is chief 
of the large medical staff. The surgeon-in-chief is 
only 27 years of age and is a graduate of Paris. He 
is a fine-looking man, a polished gentleman and is 
said to be the best military surgeon in Turkey. The 
oculist in this institution is Professor Behdjet, who, 
in the army has the rank of colonel. Colonel 
Behdjet has a large number of cases under his care 
and has made some very interesting observations on 
wounds of the eyeball and orbit. He has had under 
his personal observation twenty-two cases of trau- 
matic destruction of the eye without a single case 
of sympathetic implication of the opposite organ, 
although in a number of cases enucleation was refused. 
In several cases shown the injured eyeball had been 
removed, the patients wearing a glass eye with most 
excellent cosmetic result. It is a somewhat singular 
circumstance that in all cases it was the right eye 
which was injured. One of the barracks is used 
exclusively for operative work. There are two oper- 
ating rooms, one at each end of the building, one of 
which is used for aseptic the other for infected cases. 
Attached to each of the operating rooms is a small 
ward with four beds where the patients who have 
been operated on are taken care of until they have 
recovered from the immediate effects of the operation. 
The operating rooms are supplied with all the mate- 
rials and instruments for aseptic work. Until recently 
two barracks were in charge of four German female 
nurses belonging to the German branch of the Red 
Cross Society. The patients are well fed. The day 
I visited the hospital the bill of fare for dinner in- 
cluded soup, rice, spaghetti, roast mutton and squash. 
The evening meal includes vegetables. The coffee 
and bread are better than in the average restaurant 
and hotel in the city. Wine is served only when 
prescribed by the attending surgeon. 
Haidar Pasha Hospital.—This hospital is one of 
the oldest in the city. It was erected a few years 
before the Crimean war. It is located across the 
Bosphorus in Scutari, is an enormous structure with 
a capacity for 1,000 patients, and is surrounded by 
beautiful grounds extensively supplied with trees, 
shrubs and plants. This hospital has been made 
famous by the work of Florence Nightingale. It is 
here that during the Crimean war so many soldiers 
received her skilful and faithful services. I was some- 
what astonished not to find a reminder of her unsel- 
fish humanitarian work. The Turks speak of her with 
great reverence and respect, and in many ways mani- 
fest their highest esteem for her, but have done 
nothing, as far as I could see, to commemorate her 
memory. The Turkish military hospitals are closed 
to the outside world. All foreigners have to obtain 
permission through the minister of war to visit them. 
The doors once open every possible courtesy is shown 
from the highest to the lowest officials. Coffee is 
invariably served at the conclusion of the visit. Sol- 
diers, officers and visitors are expected to smoke cig- 
arettes whenever they feel inclined to do so. As the 
doors and windows are always wide open this general 
practice does not vitiate the atmosphere. The Turk- 
ish soldier eyes the visitor with great interest and is 
always willing to subject himself for examination. 
He is especially pleased to exhibit the effects and 
marks of recent gunshot injuries. The Haidar Pasha 
Hospital is now occupied by a large number of con- 
valescents, medical and eye cases; it contains but few 
cases of recent gunshot injuries. The ophthalmic 
department is in charge of Col. Dicran Bey Adjeinian; 
it now numbers 140 patients. Colonel Adjeinian is a 
graduate of Berlin and devotes his whole attention to 
diseases of the eye. He has had a large experience 
in the treatment of ectropium. During the last five 
years he has operated on forty-two cases by the use 
of Thiersch’s grafts. The contracting scar is excised; 
the margin of the wound away from the free border 
of the eyelid is transfixed at two points with a needle 
armed with silk. The silk sutures are fastened upon 
the surface of the skin with collodium in such a way 
as to secure extension, thus widening the wound as 
far as possible. The raw surface is then covered 
under strictest antiseptic precautions, with one 
Thiersch graft. The graft is covered with a few layers 
of gauze wrung out of a 1 to 5000 corrosive sublimate 
solution, over which a thick compress of absorbent 
cotton is placed, the whole confined in place with an 
ordinary or gauze bandage. In applying the dressing, 
care is exercised to secure equable compression of the 
wound. The dressing remains for six days. He has 
operated by this method forty-two times with twenty- 
seven perfect, ten partial successes and five failures. 
He claims that in the cases which terminated favora- 
bly there was no tendency to relapse, and that the 
functional as well as the cosmetic results were excel- 
lent. The operating theater is well lighted and fur- 
nishes all the necessary equipments for aseptic work. 
Formerly typhoid fever was common, but since the 
water supply has been changed it has almost disap- 
peared. The drinking water is now brought in casks 
from the mountains. The nursing is done exclu- 
sively by male nurses. 
Kumuch Sou Hospital.—This is the third large 
military hospital in Constantinople. It is used for 
medical and surgical cases. It has about the same 
number of beds as the Haidar Pasha. Each of these 
hospitals is in charge of a chief of staff, assisted by the 
requisite number of surgeons. 
Killed and wounded of the late tear.—It has been 
impossible for me to obtain reliable data relating to 
the strength of the Turkish army or the number 
engaged in the last war. From what I could ascer- 
tain the war footing of Turkey is in the neighborhood 
of 750,000, and of this number about 100,000 to 150,000 
were sent to the front. At the present time Constan- 
tinople is full of soldiers. All of the barracks are 
crowded and nothing indicates that a large army still 
occupies Thessaly. Last Friday I had the pleasure 
of seeing the Sultan drive from his palace to the 
mosque, which he attends every week on the same 
day and at the same hour. This is always a gala day 
for the military. On this day at least 10,000 soldiers 
in full dress, representing the infantry, cavalry and 
navy, were drawn up to do honor to their chief and 
protect his person when outside of his prison palace. 
The officers and soldiers made a splendid appearance 
and the whole exercises passed off with a regularity 
and dispatch that would do credit to any country. 
The cavalry attracted special attention. The soldiers 
for this branch of the military service are selected with 
special care and the horses are the finest I have ever 
seen. The Greeks uged large caliber guns and lead 
projectiles. The wounds on the Turkish side were 
all inflicted by large lead bullets. Although the 
Greeks were defeated, the victory seems to have cost 
many lives. The Turkish army lost 1,450 killed and 
2,850 wounded; many of the latter died subsequently. 
The wounded were dressed on the field and were con- 16 
veyed as quickly as possible by such means as could 
be secured to the field hospitals. A good many died 
here from the immediate and remote effects of their 
injuries. Those that could be transported were taken 
either by boat or railway to Constantinople, where 
ample room and accommodations were furnished by 
the regular military hospitals. I was given an oppor- 
tunity to see and examine at least one thousand cases 
of gunshot injuries, most of them on the way to recov- 
ery. Infection was much more frequent on the Turk- 
ish than on the Greek side. A partial explanation 
for this difference is probably furnished by the size 
of the bullets in use and the difference in distance in 
conveying the wounded to the permanent hospitals. I 
took notes of a few cases of interest of which I will 
give brief accounts. 
Case 1.—Secondary resection of shoulder joint. Bullet en- 
tered in front, passed through the head of the humerus and 
escaped behind. Resection of about three inches of the upper 
end of the bone was made, anterior and posterior incisions, and 
pieces of cloth removed from the wound. Infection. Fistulous 
opening remained in front; the posterior incision healed. Very 
little use of arm. Patient’s general condition good. 
Case 2.—Gunshot wound of knee joint. Bullet comminuted 
internal condyle of the femur and opened the joint. Extrac- 
tion of bullet and atypical resection of joint in the field-hos- 
pital. Primary healing. Joint partially anchylosed, with leg 
in useful position. 
Case 3.—Bullet wound of orbit. Bullet entered over the 
right superciliary ridge, passed backward, outward and down- 
ward, and escaped below and in front of external ear. Wound 
healed and patient is wearing an artificial eye with comfort. 
Case 4.—Gunshot wound of knee joint. Bullet located by 
the use of the Roentgen ray. No suppuration. Incision of 
joint on both sides and removal of bullet. Primary healing of 
wounds. Motion of joint almost perfect. 
Case 5.—Gunshot fracture of the spinous process at the 
junction of the dorsal with the lumbar vertebrae. Paraplegia 
complete immediately after receipt of injury. Paralysis re 
mained until laminectomy at the seat of injury was performed. 
Operation followed by prompt improvement. Patient is now 
able to walk without the use of crutches. Depression of frac- 
tured vertebral arch was found to be the cause of the paralysis. 
Case 6.—Typical resection of shoulder joint for comminuted 
gunshot fracture of head of humerus. Wounds of entrance 
and exit were enlarged, through which the fragments and pro- 
jecting pieces of bone were removed. Wounds healed. Fair 
degree of motion. 
Case 7.—Gunshot injury of shoulder joint. Bullet passed 
obliquely through joint. Anterior and posterior incisions 
made through which loose fragments were removed. Opera- 
tion performed in field-hospital. Slight infection. Fistulous 
opening remains behind ; anterior incision healed by primary 
intention. Use of arm very limited. 
Case 8.—Gunshot wound of shoulder joint, Ddbridement 
in the field hospital. Rapid healing of wounds of entrance 
and exit. Function of arm returning gradually. 
Case 9.—Gunshot injury of axillary plexus. Bullet entered 
below the level of the shoulder joint and on the inside of the 
surgical neck of the humerus, and escaped behind, half way 
between the scapula and the dorsal spine. Complete paraly- 
sis. Patient complains of great pain, which he refers to the 
paralyzed limb and caused probably by a traumatic neuritis 
or neuroma. Secondary nerve suture is being considered. 
Case 10.—Gunshot injury of elbow joint. Bullet passed 
obliquely through the joint, fracturing the internal condyle of 
the humerus. Primary atypical resection of joint. Infection. 
Fistulous opening remains behind the joint. The injured 
parts were exposed by a posterior bayonet-shaped incision. 
Active motion, none ; passive motion, slight. 
Case 11.—Gunshot injury of spine in lumbar region. Paral- 
ysis complete from the beginning. Bullet remains in the tis- 
sues. Wound healed. Cord has probably been crushed by 
the bullet or fragments of bone. 
Case 12.—Resection of knee joint for gunshot injury. Great 
comminution of articular ends of femur and tibia. Primary 
resection. Healing of wound without suppuration. Consoli- 
dation not complete after two and a half months. 
Case 13.—Secondary resection of knee joint for gunshot in- 
jury. Slight infection. Healing by granulation. Limb in 
good position. Bony union quite firm. 
Case 14.—Gunshot injury of right crest of ilium. Partial 
resection for the purpose of removing bullet and loose frag- 
ments. Wound healed. Abdominal cavity not opened. 
Case 15.—Loss of right eye caused by gunshot injury ; loss 
of a portion of the orbital arch. Wound healed. Patient 
wearing artificial eye with comfort. 
Case 16.—Retrobulbar gunshot wound of right eye. Bullet 
entered orbit, passed behind the eyeball and escaped in front 
of the external meatus on the same side. Traumatic optic 
neuritis destroyed the eyesight completely. Patient refuses 
enucleation. No sympathetic complications. 
Case 17.—Loss of right eye from gunshot injury. Enuclea- 
tion of stump. Complete healing of wound. Wears artificial 
eye without any inconvenience. 
Case 18.—Gunshot wound of right groin. Bullet entered 
one inch above Poupart’s ligament to the under side of the 
large blood vessels and escaped through the perineum on the 
same side. Intestinal fistula remains. Use of limb not much 
impaired. 
Case 19.—Volunteer, 13 years old. Wound of right iliac 
region. Infection followed the injury and resulted in the for- 
mation of a large perityphlitic abscess, which was later opened 
and drained. Rapid recovery. Boy much emaciated and very 
anemic, but able to walk about the hospital grounds. 
Case 20.—Volunteer, 14 years old. Gunshot wound of arm. 
Bullet passed from behind backward about an inch to the 
inside of the surgical neck of the humerus. Healing of wound 
by primary intention. Little or no impairment of function of 
the muscles of the arm. 
Case 21.—Volunteer, .13 years old. Flesh wound of leg. 
Healing of wound under primary dressing. 
Case 22.—Gunshot injury of skull. Primary operation. Re- 
moval of depressed fragments of bone. Wound healed leaving 
a pulsating cranial defect. 
Case 23.—Secondary amputation of arm for gunshot wound. 
Stump healing by granulation. 
Case 2^.—Gunshot wound of superior maxilla. Partial sec- 
ondary resection. Wound healing by granulation. 
Case 25.—Partial resection of lower jaw for comminuted gun- 
shot fracture. Considerable deformity. 
Case 26.—Gunshot fracture of humerus. Great loss of bone 
caused by the injury and later by an operation for the removal 
of sequestra. Although periosteum was saved there is no 
callus at the end of two months, and a false joint without fur- 
ther interference will be inevitable. No nerve injury. 
Case 27.—Gunshot wound of right groin. Abscess forma- 
tion. Incision and drainage. Rapid improvement. Fistula 
remains. No intestinal complications. 
Case 28.-—Resection of shoulder joint. Wounds healed. Arm 
remains almost useless. Great muscular atrophy. 
Case 29.—Gunshot injury of skull. Removal of fragments 
of bone. No focal symptom. Wound healed leaving a pul- 
sating scar. 
Case 30.—Loss of right eye from gunshot wound. Wound 
healed. Wearing artificial eye. 
Case 31.—Gunshot wound of nose and hard palate. Bullet 
entered the center of the bridge of the nose and entered the 
mouth through the hard palate. Patient spit out the bullet 
from the mouth immediately upon the receipt of the injury. 
The perforation in the hard palate was closed by a plastic 
operation. External wound healed. Saddle nose. 
Case 32.—Gunshot wound of face and lower jaw. Bullet 
entered over the ascending ramus of the lower jaw on the 
right side, entered the mouth, perforated the tongue and es- 
caped through the mouth. A suppurating fistula communi- 
cating with the jaw remained. Recently this fistulous tract 
was laid open and a detached tooth was removed, after which 
the fistula closed rapidly and permanently. 
Case 33.—Gunshot wound of ascending ramus of jaw on 
right side. Bullet chipped away part of the bone and lodged 
behind near the spine, from where it was successfully removed 
by a tedious and difficult operation. Movements of lower jaw 
limited, otherwise no functional disturbances. 
Case 34.—Resection of elbow for gunshot injury. Secondary 
operation through posterior bayonet incision. Fistulous open- 
ings and considerable swelling of soft parts remain. Muscles 
of arm and forearm much atrophied. 
Trephining for traumatic abscess of the brain.—Djemil 
Pasha, of the Yildiz Hospital, informed me that trephining 
for abscess of the brain following gunshot injuries with 
lodgement of the bullet in the cranial cavity, was performed 
three times. In all of the cases the indications for the opera- 
tion were furnished by the intracranial suppuration. In all 
of the cases the abscess was found and the bullet removed. 
Two of the cases recovered and one died. 
Constantinople, Aug. 6, 1897.