Journal of the History of the Neurosciences, 23:127–139, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 0964-704X print / 1744-5213 online DOI: 10.1080/0964704X.2013.835521

More than a Disease: The History of General Paralysis of the Insane in Turkey FATIH ARTVINLI Department of Medical History and Ethics, Acibadem University School of Medicine, Istanbul, Turkey This article explores the history of general paralysis of the insane (GPI) and its treatment in Turkey. GPI was considered as “a disease of civilization” at the end of the nineteenth century. From the early years of the twentieth century, Turkish psychiatrists discussed and interpreted the causes of GPI and followed the European diagnostic and treatment methods of the disease. Austrian psychiatrist Julius Wagner-Jauregg (1857–1940) introduced and developed “malaria fever therapy” for general paralysis in 1917. Malaria fever therapy spread to other countries and, during the 1920s, the treatment was also used in Turkey. This article not only aims to illuminate an unnoticed aspect of the history of psychiatry in Turkey but also uses GPI as a model to illustrate how psychiatry in Turkey was influenced by the developments in Europe. Keywords general paralysis of the insane, malaria fever therapy, Turkish psychiatry, Topta¸sı Asylum

Introduction General paresis, also known as general paralysis of the insane or paralytic dementia, is a neuropsychiatric disorder affecting the brain and central nervous system, caused by syphilis infection. It was originally considered a psychiatric disorder when it was first scientifically identified around the early-nineteenth century. General paralysis of the insane (GPI) was first identified as a distinct disease by Antoine Laurent Bayle in the 1820s (Brown, 2000). French psychiatrists like Esquirol and Georget were also studying GPI in these years noting the increasing number of cases (Brown, 1994). By the mid-nineteenth century, the physical and mental symptoms considered characteristic of GPI were placed in medical textbooks. The disease generally progressed through three stages. In the first, patients would exhibit slight defects of speech, uncoordinated facial muscles, pupil irregularities, and mental exaltation. Unless the patient died of exhaustion or convulsions, he or she would be expected to pass into the second stage, characterized by increased muscular incoordination, paralysis, and mental enfeeblement. The final stage was said to be one of fairly complete paralysis and “mental extinction,” the complete loss of intellectual and physical functions culminating in certain death (Davis, 2012). Originally, the causes were believed to be hereditary, head trauma, excessive cold, fright, alcoholism, venery, or exhaustion (Pearce, 2012). While Esmarch and Jessen had asserted as early as 1857 that syphilis caused general paresis, the general acceptance by Address correspondence to Fatih Artvinli, Department of Medical History and Ethics, Acibadem University School of Medicine, Icerenkoy Mh. Kayisdagi Cd. No. 32, 34752 Atasehir-Istanbul, Turkey. E-mail: [email protected]

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the medical community of this idea was accomplished by the syphilologist Alfred Fournier (1832–1914), who linked statistically a primary syphilis infection to the later appearance of general paresis and tabes dorsalis (Shorter, 2005, p. 193). In 1913, all doubt about the syphilitic nature of general paresis was finally eliminated when Noguchi and Moore demonstrated the syphilitic spirochaetes in the brains of patients with GPI (Brown, 2000). At the turn of the twentieth century, new optimism was fostered by scientific discoveries, in particular, the neurobiological etiology of GPI. The attitudes regarding the hopeless prognosis of and treatments for GPI changed (Warren, 2000, p. 68). Although antisyphilitic treatments such as mercury and potassium iodide and later salvarsan and neo-salvarsan were recommended for GPI treatment, the first therapeutic breakthrough was introduced by the discovery of malaria fever therapy. The relationship between fever and madness was a subject of medical inquiry especially at the end of the nineteenth century. In 1887, Julius Wagner-Jauregg (1857–1940) had proposed that it might be possible to treat psychosis through the use of fever. He injected tuberculin into several patients whose psychotic symptoms were caused by GPI, with the aim of giving them a tuberculous fever. He discontinued his experiments with tuberculin because it was considered to be toxic. Then he returned to the possibility of giving patients with GPI a fever with malaria, which, unlike other possible infections, had the advantage of being controllable with quinine (Shorter, 1997, p. 193). In 1917, Julius Wagner-Jauregg discovered that infecting GPI patients with malaria could halt the progression of general paresis. While World War I was raging, a soldier from the Macedonian front was admitted to the hospital in Vienna. The soldier had tertiary malaria with chills, sweating, and regular attacks of fever, and Wagner-Jauregg considered the possibility of using the soldier’s blood to induce fever in the hospital’s patients with general paralysis. On June 14, 1917, he drew blood from the soldier during an attack of fever and injected it subcutaneously between the shoulder blades of two patients with paralysis. Then he used the blood from the two patients to inoculate a new group of paralytic patients. The patients’ first fever attack occurred about a week after the blood was injected. After having 7 to 12 fever attacks, the patients were given quinine to terminate the malarial infection (Whitrow, 1990). In 1918, Wagner-Jauregg reported a remarkable success rate: 67% improvement in treated patients (Braslow, 1997, p. 75). News of malaria fever therapy spread to other countries, and, in the early 1920s, the treatment was used not only in Europe but also in South America and the United States (Kragh, 2010). In 1927, Wagner-Jauregg won the Nobel Prize for his discovery of the therapeutic value of malaria inoculation in the treatment of general paralysis of the insane (Shorter, 2005, p. 194). GPI was known and diagnosed already in Turkey much like in European countries at the end of the nineteenth century. Ottoman and Turkish psychiatrists also discussed and interpreted the causes of GPI and followed the new diagnostic and treatment methods of the disease. Malaria fever therapy started to be used in Turkey in 1922 and became popular among Turkish psychiatrists. This article aims to search the history of GPI in Turkey and use GPI as a model to illustrate how psychiatry in Turkey was influenced by the developments in Europe.

General Paralysis of the Insane in the Late Ottoman Period (1859–1923) The history of GPI in Turkey can be researched as a specific part of the history of modern psychiatry in Turkey. The institutionalization of psychiatry started in the Ottoman Empire at the middle of the nineteenth century. An Italian physician/alienist Luigi Mongeri

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(1815–1882) who was called “Pinel of Istanbul” (Mahmud, 1910, p. 28) or “Pinel of the Turks” (Uzman, 1941, p. 78) was the pioneer of modern psychiatry in Turkey (Erkoç & Artvinli, 2011). He was appointed in 1856 to Süleymaniye Bimarhanesi [Suleymaniye Lunatic Asylum] that was the most important and central lunatic asylum of Istanbul, the Ottoman capital, in the nineteenth century. The first attempts to institutionalize psychiatry took place in this asylum; however, the greater transformation and practices occurred after the transfer of the mentally ill patients from Suleymaniye to Topta¸sı1 at the end of 1873 (Artvinli, 2013, p. 63). As the head-physician of the Suleymaniye Lunatic Asylum and later Topta¸sı Asylum, Mongeri published the asylum statistics and psychiatric case reports. While Mongeri witnessed numerous patients with GPI, his assistant Avram de Castro (1829–1918), who became the head physician of the Topta¸sı Asylum after the death of Mongeri, published more detailed statistics of the asylum (Artvinli, 2012) that also included the numbers of patients diagnosed as GPI. According to the statistics of Castro, there were seven males and three females patients with GPI,2 in Topta¸sı Asylum in the 1898–1899 period (Castro, 1900a, p. 174). The ratio of patients with GPI in the asylum was 2.18% in males and 2.34% in females in the year 1898. The number of deaths from GPI was very high: six of seven male patients and all three female patients with GPI died in the asylum. This means that the total death ratio from GPI was 90%. One year later there were six male patients and one female patient with GPI and the ratio of patients with GPI was 2.26% and 0.91%, respectively (Castro, 1900b, p. 200). Three of the six males and the one female patient died from GPI and the death ratio was 57%. In 1901, there were five male and no female patients with GPI in the asylum and only one patient died (Castro, 1901, p. 744). GPI was known and diagnosed in Turkey much like in European countries at the end of the nineteenth century. Dr. Luigi Mongeri (psychiatrist and son of Mongeri),3 after his long practice in Istanbul, published an article about general paralysis in Turkey. Mongeri, based on 144 cases, concluded that “general paralysis is invariably preceded by syphilis.” The patients of Mongeri were representative of various nations owing to differences in religion and mode of life and varied greatly in their susceptibility to syphilis and alcoholism.4 Turkish psychiatrists of the nineteenth century were clearly influenced by French psychiatry.5 Mongeri and Castro followed European psychiatry mostly in French and they 1

Topta¸sı is a neighborhood at Scutari (Uskudar) that was located in the Anatolian side of Istanbul. Topta¸sı Lunatic Asylum was a part of Valide-i Atik Complex built in 1583. The place was used as general hospital, military barracks, and military hospital before 1873 (Artvinli, 2013, pp. 64–67). 2 Castro used the French term paralysie progressive des aliénés for GPI. Castro’s statistics were published in Gazette Medicale d’Orient, the most important medical journal in the late Ottoman Period. The journal began to be published in 1857 as an official publication of the Société Impériale de Médecine de Constantinople that was founded by European physicians. 3 L. Mongeri (jun.) worked 12 years in Istanbul as psychiatrist (medico alienista) at various hospitals like the Italian Hospital, Surp Agop Armenian Hospital, and International La Paix Hospital. Mongeri wrote several books, one of which is a psychiatric texbook: Patologia special delle malattie mentali (Milano, U. Hoepli, 1907). 4 See Bernard Hart, 1907, p. 181. 5 This was largely related to the use of French in the teaching of medicine in Turkey. The language of instruction in the Imperial School of Medicine that was opened in 1839 was French until 1867. Ottoman physicians were sent to France at the second part of the nineteenth century for medical education and specialization in medicine. For example, Hilmi Kadri (1866–1920) was sent to Paris in 1890 for the education of neurology and he studied with Jean-Martin Charcot. In the same years, Dervish Pasha (1859–1909), physician at Topta¸sı Asylum, started to translate Emmanuel Régis’ book, namely Précis de la Psychiatrie, into Turkish.

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sent their articles and case reports to Annales Médico-Psychologiques. French influences in Turkish psychiatry started to diminish in the early-twentieth century and German influences increased. Ra¸sid Tahsin (1870–1936; see Figure 1), who studied with Emil Kraepelin in Germany, could be called the father of academic psychiatry in Turkey (Özaydın, 1999; Erkoç & Kutlar, 2001). More physicians learned about GPI by his academic courses on psychiatry, which began at the Imperial School of Medicine in 1896. As chief of the psychiatric clinic of the school, he mentored a group of Turkish neuro-psychiatrists at that time. Ra¸sid Tahsin participated in the 4th International Psychiatry Congress in Berlin in 1910 as the Ottoman delegate and presented a detailed report about mental diseases in Turkey. He also mentioned general paralysis in Turkey: The rate of “general paralysis” in Turkey is low if you compare with European countries. The percentage of GP in big cities and coast cities is higher than rest of the country. There are hardly any GP cases in villages and rural Turkey, because of the healthy and religious life styles of villagers. This disease is generally seen in upper socio-economic classes and especially among some professions like merchant, lawyer, poet, philosopher etc. (Tahsin, 1910, pp. 22–23) It is clear that Ra¸sid Tahsin identified GPI as a “city disease,” “disease of rich people,” and its cause was an “immoral” or “bohemian” lifestyle. Ra¸sid Tahsin’s comments on GPI reflect the common ideas of European physicians of the time. At the International Medical Congress in 1897, Austro-German psychiatrist Richard von Krafft-Ebing (1840–1902), suggested that the combination of “syphilization and civilization” was the cause of GPI. He and other European scientists argued that GPI was more common among “brain workers” who could only be found in civilized countries. The following sentences from A Reference Handbook of the Medical Sciences (1900), written by various authors and edited by Albert H. Buck, summarize the dominant paradigm about the causes of the disease at the turn of the twentieth century: Exciting Causes: The exciting or immediate causes of paresis are numerous, but one stands pre-eminent; that is, mental overstrain and worry, including the stress and anxiety of business and the struggle for existence under conditions of modern civilization. The best proof of this is the fact that paresis is almost exclusively a disease of civilization and almost unknown among barbarians and populations living under simple conditions; it is a disease of cities, where the struggle for life is keenest, and rare in rural districts and away from the temptations and excitement that abound in the great centres. (Buck, 1900, p. 87) Ra¸sid Tahsin emphasized that he had not seen this disease among women. On the basis of 10 years of clinical research, Tahsin reported that the ratio of the patients admitted with GPI to his institution was around 7% and generally the disease lasted for 4–6 years. According to him, Greek people had the highest rate of GPI because syphilis and other infectious diseases were more common in the Greek community. Armenians had twice as much GPI than Muslims and, similar to Muslims, GPI was rarely observed among Jews (Tahsin, 1910, p. 23; see Figure 2).

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Figure 1. Ra¸sid Tahsin (1870–1936), the father of academic psychiatry in Turkey (color figure available online).

GPI entered Turkish psychiatric textbooks at the beginning of the twentieth century.6 Fourteen patients were diagnosed as felc-i umumi-i müterakki-i mecanin [progressive general paralysis of the insane] at Topta¸sı Asylum in 1910. Twelve patients died from GPI in the asylum in the same year (Muessesat, 1911, pp. 60–61). There are different reasons for the low number of patients with GPI at Topta¸sı Asylum during the nineteenth and the early-twentieth centuries. Mazhar Osman Uzman (1884–1951; see Figure 3), student of Emil Kraepelin in 1910 and the last head physician of Topta¸sı Asylum, diagnosed 32 male and six female patients with GPI in 1923. Emphasizing the high rate of GPI, Uzman argued that the number of cases of GPI is not really much lower in Turkey than in Europe. The real reason for the low number of GPI cases in Turkish statistics is related to missed diagnoses. According to Uzman, there had been many cases of GPI before, but there were not enough physicians and laboratory tests to diagnose them (Uzman, 1925a). 6

Different terms including “felc-i umumi,” “felc-i umumi-i müterakki,” “felc-i umumi-i müterakki-i mecanin,” and “cümle-i asabiye frengisi” were used in the Turkish language to the parallel terms “general paralysis,” “progressive general paralysis,” “progressive paralysis of the insane,” and “neurosyphilis.”

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Figure 2. The title page of Ra¸sid Tahsin’s pamphlet about the mental diseases in Turkey (color figure available online).

Mazhar Osman Uzman challenged Krafft-Ebing’s “syphilization and civilization” theory (Uzman, 1935, p. 25). He criticized the “Orientalist discourse”7 produced by Western physicians, who associated syphilis with civilization and described Turkey as a noncivilized or non-Western country. Unlike Ra¸sid Tahsin, Uzman argued that GPI is widespread among people in Istanbul and Anatolia regardless of their social or religious 7 I used the term “Orientalist” in the sense of Edward Said’s conceptualization of Orientalism: “Orientalism is a style of thought based upon ontological and epistemological distinction made between ‘the Orient’ and (most of the time) ‘the Occident’. Thus a very large mass of writers, among who are poets, novelists, philosophers, political theorists, economists, and imperial administrators, have accepted the basic distinction between East and West as the starting point for elaborate accounts concerning the Orient, its people, customs, ‘mind’, destiny, and so on” (Said, 1978, pp. 2–3).

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Figure 3. Mazhar Osman Uzman (1884–1951) a leading figure in psychiatry in Turkey (color figure available online).

bases (Uzman, 1925a). He diagnosed GPI both in men and women, married and single, elderly and young, hodjas and priests, rural and urban, religious and nonreligious people (Uzman, 1925b, 1929). Fahreddin Kerim Gökay (1900–1987), former assistant of Uzman, also noted that “we found more GPI patients who are not ‘brain workers’ and ‘illiterate ones’” (Gökay, 1939, p. 63). Most of the earlier psychiatrists diagnosed patients with GPI according to patients’ social class or lifestyles. As Davis argued, “GPI was not recognized initially in some patients because they did not fit the ‘social’ profile of the disease” (2008, p. 240). The diversity in the social profile of patients, which Uzman supported as well, can be observed in the professions of patients (Table 1). Workers, artisans, small traders, and civil servants were the most affected groups and it shows that GPI was usually a “middle class” disease in Turkey (Gökay, 1929). This “middle class” character of the disease does not reflect the

Table 1 Profession of Male Patients with GPI Type of Profession Workers Artisans and small traders Sailor and boatman Naval officer Soldier Civil servant Teacher Doctor Merchant Farmer Beggar Unknown

Number of Patient

The Ratio

41 32 10 4 8 32 2 1 3 5 4 20

21.35 16.66 5.20 2.08 4.16 16.66 1 0.5 1.56 2.60 2.08 10.51

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Fatih Artvinli Table 2 GPI Statistics of Topta¸sı Asylum Number of Entrance

Number of GPI Patients

Year

Male

Female

Total

Male

Female

Total

1920 1921 1922 1923 1924 1925 Total

220 259 288 453 556 694 2470

113 140 156 235 255 308 1207

333 399 444 688 811 1002 3677

16 10 21 32 29 54 162

4 6 4 6 7 3 30

20 16 25 38 36 57 192

The Ratio of GPI 5.9 4 5.6 5.5 4.4 5.6

Table 3 GPI Statistics of Bakırköy Mental Hospital Year

Entrance

Male Patients with GPI

Female Patients with GPI

Total

1928 1929 1930 1931 1932 1933

951 849 1045 1144 1359 1674

98 83 112 96 122 146

15 14 17 20 32 37

113 97 129 116 154 183

truth as a whole, because there were hundreds of people not within the asylum, who could not be diagnosed as GPI or died in their homes. The hospitalization of people with GPI was still low and there were few mental asylums in Turkey other than the Topta¸sı Asylum. The number of patients diagnosed as GPI increased in Topta¸sı Asylum in the 1920–1925 period (Gökay, 1929; see Table 2) and in Bakırköy Mental Hospital in the 1928–1933 period (Uzman, 1935, p. 407; see Table 3). The number of patients with GPI also increased in other mental hospitals in 1920s and 1930s. On the other hand, general admissions to mental hospitals also increased during this period.

GPI and Its Treatment in the Republican Era (1923–1950) After the foundation of the Turkish Republic in 1923, Topta¸sı Asylum was transferred to Bakırköy Mental Hospital8 in ˙Istanbul and the new hospital served as the most important psychiatric institution in Turkey from 1924 (Erkoç, Karde¸s, & Artvinli, 2010). In the Republican era, there were two assistants of Mazhar Osman Uzman who especially studied GPI: Ahmed Sükrü ¸ Emed (1898–1970; see Figure 4) and Fahreddin Kerim Gökay (1900–1987). 8 Bakırköy is a district on the European side of Istanbul. Bakırköy Mental Hospital was founded in 1924 and today serves as the largest psychiatric hospital of Turkey under the name of Prof. Dr. Mazhar Osman Research and Training Hospital for Mental Health and Neurological Diseases.

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Ahmed Sükrü ¸ Emed studied more than a year at Kraepelin’s psychiatric clinic in Munich with Felix Plaut (1877–1940)9 and at other neuro-psychiatric clinics and serology laboratories in Vienna and Paris. After returning to Turkey, he founded a serology laboratory at the Topta¸sı Asylum and started to use laboratory tests, especially the Wassermann reaction, to diagnose GPI (Emed, 1977, pp. 116–117). He brought a rabbit infected with syphilis from Frankfurt and inoculated hundreds of rabbits. He began experiments on neuroimmunology and the treatment of GPI (Emed, 1929). Fahrettin Kerim Gökay studied with Kraepelin in Munich for a year and with Wagner-Jauregg in Vienna for seven months (Gökay, 1950, pp. 2–3). Emed and Gökay followed the discussions and literature about the treatment of GPI and contributed to the discussion after their experiences of malaria fever therapy. During the first half of the nineteenth century, the authorities on the treatment of syphilis were divided into mercurialists and non-mercurialists (Pearce, 2012). Mercury had been the oldest known treatment for syphilis, and it remained the primary medicine to treat syphilis in Turkey. The ointment form of mercury was used in Topta¸sı Asylum in the nineteenth century (Artvinli, 2010). At the beginning of the twentieth century, different compounds of iodine, bromine, and barbiturates were used in the asylum not to cure neurosyphilis but to diminish the symptoms (Etker, 2010). After the discovery of Salvarsan (arsphenamine) in 1909, it was also used in Turkey. But even Salvarsan and, later, Neosalvarsan, had little effect on the mortal progression of the GPI (Braslow, 1997, p. 74). Like European physicians, Mazhar Osman Uzman and Turkish psychiatrists had little trust in these arsenicals. Malaria fever therapy started to be used in Turkey in 1922 at Topta¸sı Asylum (Gökay, 1939, p. 280) and became popular among Turkish psychiatrists during the 1920s and the 1930s. Gökay explains the typical malaria fever therapy that they used in 1920s and early 1930s as follows: Before inoculating a patient with malaria-infected blood, the proper strain of malaria should be obtained. Although there are other strains to use, the ideal one is Plasmodium vivax. Initially, a malaria strain should be obtained from a patient incidentally infected. After medical clearance, the patient should be injected intravenously with malarial blood. The incubation period is 3–5 days on average. The fever usually peaked at about 39–40 degrees Celsius (102–104 degrees Fahrenheit). Treatment is complete following 8–10 febrile episodes around 39–40 C, usually for a total febrile period of 50 hours. After the bouts of fever, quinine sulfate should be given to the patients to terminate the infection. Finally, it is required to support the treatment with a course of neo-salvarsan starting from 0.15 to 0.45 and totally not more than 5 gr. (Gökay, 1934, p. 225) The malaria fever therapy described above was similar to the standard therapy used in Europe and the United States, yet, there were local differences. The first difference was the technology used. Adequate equipment to preserve the blood infected with malaria and 9 Felix Plaut was the director of the Department of Serology at the Deutsche Forschungsanstalt für Psychiatrie in Munich. His book The Wasserman Sero-Diagnosis of Syphilis in its Application to Psychiatry (originally published in German in 1909 as Die Wassermannsche Serodiagnostik der Syphilis in ihrer Anwendung auf die Psychiatrie) was translated in 1911. Plaut is remembered for his research on the syphilitic origin of general paralysis, as well as his work with August von Wasserman (1866–1925) in the development of a serological test for syphilis. Plaut performed extensive research of syphilis and its correlation to psychiatric disorders and conducted early studies in neuroimmunology involving the brain’s immune reaction to syphilitic infiltration.

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Figure 4. Ahmed Sükrü ¸ Emed (1898–1970) studied more than a year at Kraepelin’s psychiatric clinic in Munich (color figure available online).

to produce artificial fever was lacking. Turkish psychiatrists inoculated their patients with malaria-infected blood obtained from other patients that were incidentally found (Uzman, 1934). The second difference was that patients in Turkey developed a kind of immunity against malaria. As Gökay underlined, irregularity in recurrent fever observed in some patients caused the discontinuance of treatment in these cases. Wagner Jauregg, with whom Gökay discussed the reasons for this absence or irregularity of fever, explained that the patients might have been infected with malaria already previously (Gökay, 1934). Uzman agreed and opined that people in Turkey probably had a kind of immunity against this disease because most had been infected by malaria previously (Uzman, 1934).10 Malaria therapy was widely regarded as the most successful form of therapy for GPI, prior to penicillin. During these years, fever therapies were used not only on patients with GPI but also in schizophrenic patients. A truly effective treatment for syphilis was found in 1943 with the introduction of penicillin by Mahoney, Arnold, and Harris (1943). One 10 Malaria was one of the most significant public health problems of Turkey in the early republican era in the 1920s (see Evered & Evered, 2011).

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year later, it was clear that penicillin was also successful in the treatment of neurosyphilis (Stokes et al., 1944). Malaria was used in the United States most frequently during the 1940–1944 period but was rapidly replaced by penicillin in the subsequent five years (Patterson et al., 2012). The rate of GPI decreased dramatically after the introduction of penicillin treatment. In 1935, the rate of GPI at Bakırköy Mental Hospital was 8.5%, but the rate decreased to 1.2% in 1951. In the same period, the rates of GPI at the Psychiatry Clinic of Istanbul University Medicine Faculty decreased from 9% to 0.88% (Aksel, 1959, p. 58). The total number of registered syphilis patients in Turkey was 161,753 in 1935 and 104,941 in 1951. Turkish psychiatrists continued to use malaria as the only treatment choice until the mid-1950s. The general tendency among certain psychiatrists was to use both methods and combine them. Penicillin reduced the number of admissions of paralytic patients in Turkey. At the second half of the 1950s, the malaria-treatment era was over and penicillin was used more frequently. In the late 1950s and the 1960s, the incidence of GPI declined steadily and today GPI is quite rare in Turkey.

Conclusion GPI has been surprisingly neglected by historians (Davis, 2012). It was of capital importance in the history of psychiatry, because it often announced itself clinically in the form of psychiatric symptoms (Shorter, 1997, p. 53) and it is the first psychiatric illness of which the biological nature was determined with certainty (Braslow, 1996). It was formerly called “progressive paralysis” or “general paralysis of the insane,” because neurosyphilis progressed from psychiatric symptoms to neurological symptoms accompanying lesions in central nervous tissue (Shorter, 2005, p. 193). The interpretation of the causes of GPI varied due to the institutional, social, and cultural context, in which it was examined and discussed by psychiatrists. GPI was considered “a disease of civilization” at the end of the nineteenth century. Ottoman and Turkish psychiatrists also discussed and interpreted the causes of GPI and followed the new diagnostic and treatment methods of the disease. The history of GPI in Turkey not only shows the adaptation of Turkish psychiatry to European psychiatry within the context of a specific disease but also demonstrates the internalization of and resistance to social interpretations through GPI as observed in orientalism and civilization debates. As Edward Said noted that, like “people,” “ideas and theories travel — from person to person, from situation to situation, from one period to another.” Said suggested that this “circulation of ideas” may take the form of “acknowledged or unconscious influence, creative borrowing or wholesale appropriation” (Said, 1983, p. 226). Ottoman and Turkish psychiatrists had accepted Western psychiatry and used its tools and methodology, but at the same time they criticized the Orientalist discourse about GPI produced by Western physicians. This very short history of general paralysis of the insane in Turkey can be read also as the story of Western psychiatry, as a medical science in a different cultural sphere.

References Aksel IS¸ (1959): Psikiyatri [Psychiatry]. Istanbul, Ismail Akgün Matbaası. Artvinli F (2010): Topta¸sı Bimarhanesi eczanesi için ilaç istemi: Eczacı Yanko Efendi’nin 1878 tarihli listesi [Drugs for the Topta¸sı Lunatic Asylum in Scutari: A request list compiled in 1878 by Yanko Efendi, the hospital pharmacist]. Osmanlı Bilimi Ara¸stırmaları [Studies in Ottoman Science] 2: 23–28.

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More than a disease: the history of general paralysis of the insane in Turkey.

This article explores the history of general paralysis of the insane (GPI) and its treatment in Turkey. GPI was considered as "a disease of civilizati...
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