{"id":22115,"date":"2021-04-27T12:26:49","date_gmt":"2021-04-27T09:26:49","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=22115"},"modified":"2021-06-02T21:08:34","modified_gmt":"2021-06-02T18:08:34","slug":"osmanlidan-cumhuriyete-bulasici-hastaliklarla-savasim","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2021\/04\/27\/osmanlidan-cumhuriyete-bulasici-hastaliklarla-savasim\/","title":{"rendered":"Osmanl\u0131\u2019dan Cumhuriyet\u2019e Bula\u015f\u0131c\u0131 Hastal\u0131klarla Sava\u015f\u0131m"},"content":{"rendered":"<h2 class=\"p1\"><b>G\u0130R\u0130\u015e<\/b><\/h2>\n<p class=\"p2\">Anadolu, en eski insan yerle\u015fimi olan G\u00f6beklitepe gibi M.\u00d6. 10 000 y\u0131l\u0131ndan bu yana \u00e7a\u011flar boyu \u00e7ok say\u0131da medeniyete yurt olmu\u015f, bir\u00e7ok kavmin istilas\u0131na ve g\u00f6\u00e7lere sahne olmu\u015f bir co\u011frafyad\u0131r. Do\u011fald\u0131r ki bu istila ve g\u00f6\u00e7ler s\u0131ras\u0131nda \u00e7ok say\u0131da bula\u015f\u0131c\u0131 hastal\u0131k bu topraklara ta\u015f\u0131nm\u0131\u015f ve yerle\u015fik duruma ge\u00e7mi\u015ftir. Osmanl\u0131\u2019da modern anlamda sistematik t\u0131p e\u011fitiminin ba\u015flad\u0131\u011f\u0131 1827 y\u0131l\u0131na kadar Anadolu insan\u0131 sa\u011fl\u0131k konusunda geleneksel bilgiler ve y\u00f6ntemlerle ba\u015f\u0131n\u0131n \u00e7aresine bakmakta idi. \u00dclkede o d\u00f6neme kadar bir\u00e7ok bula\u015f\u0131c\u0131 hastal\u0131ktan b\u00fcy\u00fck ac\u0131lar ve kay\u0131plar ya\u015fanm\u0131\u015ft\u0131r. \u0130lk olarak \u201cT\u0131bhane-i Amire\u201d ismiyle II. Mahmut d\u00f6neminde, Hekimba\u015f\u0131 Mustafa Beh\u00e7et Efendi\u2019nin (1774-1834) \u00e7abalar\u0131 sayesinde 14 Mart 1827 tarihinde, askeri t\u0131bbiye a\u00e7\u0131lm\u0131\u015f ve bilimsel t\u0131p e\u011fitimi ba\u015flam\u0131\u015ft\u0131r. Daha sonraki y\u0131llarda silahl\u0131 kuvvetlerde ba\u015flay\u0131p yayg\u0131nla\u015fan ve giderek kurumsalla\u015fan t\u0131p e\u011fitimi ad\u0131 \u201cMekteb-i T\u0131bbiye-i Adliye-i \u015eahane\u201d olan ve Frans\u0131zca e\u011fitim veren askeri t\u0131bbiyenin bir k\u00f6\u015fesinde 1 Mart 1867\u2019de \u201cMekteb-i T\u0131bbiye-i M\u00fclkiye-i \u015eahane\u201d (Sivil T\u0131bbiye) kuruldu ve bu okulda T\u00fcrk\u00e7e e\u011fitim yap\u0131lmaya ba\u015fland\u0131. 1898\u2019de a\u00e7\u0131lan ve ba\u015flang\u0131\u00e7ta G\u00fclhane Hastanesi olan kurumun ad\u0131 1947 y\u0131l\u0131nda \u201cG\u00fclhane Askeri T\u0131p Akademisi\u201d olarak de\u011fi\u015fti. Me\u015frutiyet ilan\u0131ndan sonra 21 Kas\u0131m 1908\u2019de sivil t\u0131bbiyenin ad\u0131 de\u011fi\u015ftirilerek Fak\u00fclte olarak e\u011fitime ba\u015flad\u0131. Reisi (dekan\u0131) Cemil Topuzlu Pa\u015fa (1868-1958) oldu. 14 Eyl\u00fcl 1909\u2019da Sivil ve Askeri T\u0131bbiye birle\u015fti ve Dar\u00fclf\u00fcnun\u2019a ba\u011flanarak \u201cDar\u00fclf\u00fcnun-i Osman\u00ee T\u0131p Fak\u00fcltesi\u201d ad\u0131n\u0131 ald\u0131. T\u0131p e\u011fitimindeki bu modernle\u015fme \u00e7abalar\u0131 s\u00fcrerken 1. D\u00fcnya Sava\u015f\u0131\u2019n\u0131n ba\u015flamas\u0131 orduda sa\u011fl\u0131k hizmetlerinin a\u011f\u0131rl\u0131k kazanmas\u0131, k\u0131t olan kaynaklar\u0131n o alana kayd\u0131r\u0131lmas\u0131 zorunlulu\u011funu getirmi\u015f ve halk sa\u011fl\u0131\u011f\u0131 hizmetleri b\u00fcy\u00fck \u00f6l\u00e7\u00fcde sekteye u\u011fram\u0131\u015ft\u0131r.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">19. y\u00fczy\u0131lda ve T\u00fcrkiye Cumhuriyeti\u2019nin kurulu\u015funa kadar ge\u00e7en s\u00fcre i\u00e7inde Osmanl\u0131 Devleti bir\u00e7ok cephede sava\u015fm\u0131\u015f ve o d\u00f6nemde a\u011f\u0131rl\u0131kl\u0131 olarak ordunun sa\u011fl\u0131k hizmetleriyle me\u015fgul olmaktan halk\u0131n sa\u011fl\u0131\u011f\u0131yla ilgilenmek i\u00e7in yeterli zaman ve olanak bulamam\u0131\u015ft\u0131r.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">T\u00fcrkiye Cumhuriyeti\u2019nin ilk y\u0131llar\u0131nda devlet, bir\u00e7ok sorunun yan\u0131nda sa\u011fl\u0131k sorunlar\u0131 ve bula\u015f\u0131c\u0131 hastal\u0131klarla da m\u00fccadele etmi\u015ftir. Bu y\u0131llarda bula\u015f\u0131c\u0131 hastal\u0131klardan en s\u0131k rastlan\u0131lan verem, s\u0131tma, frengi, trahom, \u00e7i\u00e7ek ve kuduz hastal\u0131klar\u0131 idi ve o d\u00f6nemin Sa\u011fl\u0131k ve Sosyal Yard\u0131m Bakanl\u0131\u011f\u0131\u2019n\u0131n \u00f6nemli g\u00fcndem maddesi olmu\u015ftur. Daha sonraki y\u0131llarda T\u00fcrkiye Cumhuriyeti Devleti, bu hastal\u0131klardan korunma ve tedavide b\u00fcy\u00fck ba\u015far\u0131lar g\u00f6stermi\u015f; Cumhuriyetin kurulu\u015f d\u00f6neminde, olanaklar\u0131n yetersizli\u011fine ra\u011fmen ba\u015far\u0131yla y\u00fcr\u00fct\u00fclen sa\u011fl\u0131k \u00e7al\u0131\u015fmalar\u0131, daha sonraki d\u00f6nemlere de \u00f6rnek olmu\u015ftur.<\/p>\n<p class=\"p2\">1925 y\u0131l\u0131nda haz\u0131rlanan Sa\u011fl\u0131k \u00c7al\u0131\u015fma Program\u0131&#8217;yla \u015fu temel hedefler belirlenmi\u015fti:<\/p>\n<ul>\n<li class=\"p3\">Sa\u011fl\u0131k te\u015fkilat\u0131n\u0131 geni\u015fletmek,<\/li>\n<li class=\"p3\">Hekim, sa\u011fl\u0131k memuru ve ebe yeti\u015ftirmek,<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li class=\"p3\">Numune hastaneleriyle do\u011fum ve \u00e7ocuk bak\u0131mevleri a\u00e7mak,<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li class=\"p3\">S\u0131tma, verem, trahom, frengi gibi bula\u015f\u0131c\u0131 hastal\u0131klarla m\u00fccadele etmek,<\/li>\n<li class=\"p3\">Sa\u011fl\u0131kla ilgili kanunlar\u0131 yapmak,<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li class=\"p3\">Sa\u011fl\u0131k ve sosyal yard\u0131m te\u015fkilat\u0131n\u0131 k\u00f6ylere kadar g\u00f6t\u00fcrmek,<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li class=\"p3\">Merkez H\u0131fz\u0131ss\u0131hha Enstit\u00fcs\u00fc ve H\u0131fz\u0131ss\u0131hha Okulu kurmak (1).<\/li>\n<\/ul>\n<p class=\"p2\">Sonu\u00e7 olarak, \u00fclkenin i\u00e7inde bulundu\u011fu durum g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda, Cumhuriyetin ilk y\u0131llar\u0131ndaki bula\u015f\u0131c\u0131 hastal\u0131klarla m\u00fccadele \u00e7al\u0131\u015fmalar\u0131n\u0131n daha sonraki y\u0131llara ilham kayna\u011f\u0131 oldu\u011funu s\u00f6ylemek m\u00fcmk\u00fcn olabilir. Zor \u015fartlar alt\u0131nda, sa\u011fl\u0131\u011f\u0131n bir\u00e7ok alan\u0131nda oldu\u011fu gibi \u00f6zellikle halk sa\u011fl\u0131\u011f\u0131n\u0131 tehdit eden bula\u015f\u0131c\u0131 hastal\u0131klar\u0131n eradikasyonunda ve korunmada b\u00fcy\u00fck gayret g\u00f6sterilmi\u015ftir. G\u00fcn\u00fcm\u00fczde bula\u015f\u0131c\u0131 hastal\u0131kla m\u00fccadelede gelinen noktada Cumhuriyetin bu ilk d\u00f6neminde \u00e7izilen yol haritas\u0131n\u0131n b\u00fcy\u00fck etkisi oldu\u011fu s\u00f6ylenebilir.<\/p>\n<p class=\"p2\"><span style=\"font-weight: 400;\">Bu yaz\u0131da, Osmanl\u0131\u2019dan Cumhuriyet\u2019e bula\u015f\u0131c\u0131 hastal\u0131klarla sava\u015f\u0131m konusunun ve \u00fclkemizde b\u00fcy\u00fck sorunlar olu\u015fturmu\u015f hastal\u0131klar\u0131n kronolojik s\u0131rayla sunulmas\u0131 planland\u0131.<\/span> Her biri ba\u015fl\u0131 ba\u015f\u0131na bir konferans konusu olabilecek bu hastal\u0131klar i\u00e7in yap\u0131lan sava\u015f\u0131m\u0131 ayr\u0131nt\u0131l\u0131 olarak sunmak m\u00fcmk\u00fcn olamayaca\u011f\u0131 i\u00e7in konular ana hatlar\u0131yla sunulacakt\u0131r.<\/p>\n<h2 class=\"p1\"><b>KUDUZ<\/b><\/h2>\n<p class=\"p2\">Osmanl\u0131 \u0130mparatorlu\u011fu tarihinde kuduz vakalar\u0131na y\u00f6nelik ilk kay\u0131t 1586 tarihlidir. 1696 tarihinde Afyon\u2019da k\u0131rk ki\u015filik bir grupla, 1852\u2019de Antalya\u2019da 128 ki\u015finin kuduz birer hayvan taraf\u0131ndan \u0131s\u0131r\u0131lmalar\u0131 \u00f6nemli kay\u0131tlar olarak g\u00f6ze \u00e7arpar. Ancak kuduz vakalar\u0131 d\u00f6nem d\u00f6nem \u00fclkenin farkl\u0131 b\u00f6lgelerinde g\u00f6r\u00fclmesine ra\u011fmen bilinen bir tedavi y\u00f6ntemi bulunmamaktayd\u0131 (2).<\/p>\n<p class=\"p2\">1885\u2019te ilk defa Pasteur taraf\u0131ndan kuduz a\u015f\u0131s\u0131 geli\u015ftirilene kadar hastal\u0131\u011f\u0131n tedavisiyle ilgili halk aras\u0131nda ampirik y\u00f6ntemler s\u00f6z konusuydu. \u00d6rne\u011fin; \u0131s\u0131r\u0131lan b\u00f6lgenin k\u0131zg\u0131n demirle da\u011flanmas\u0131, dilalt\u0131n\u0131 kesmek, yaral\u0131 b\u00f6lgeye kuduz k\u00f6pe\u011fin t\u00fcy\u00fcn\u00fc veya fasulye tanelerini koymak vb. bir\u00e7ok y\u00f6ntem deneniyordu. Ayr\u0131ca halk aras\u0131nda <i>alag\u00fcl\u00fck <\/i>olarak bilinen zehirli bu\u011fday b\u00f6ce\u011fi kuduzdan kurtulmak i\u00e7in hastalara yediriliyordu. Bunlar\u0131n d\u0131\u015f\u0131nda <i>parparlamak <\/i>ad\u0131 verilen tuzla tedaviyle <i>parp\u0131lamak <\/i>ad\u0131 verilen y\u00f6ntemde ise kuduz hayvan\u0131n \u0131s\u0131rd\u0131\u011f\u0131 kimseler ocak denilen hocalara okutuluyordu (3).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<div id=\"attachment_22572\" style=\"width: 585px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_F.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22572\" class=\"wp-image-22572 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_F.png\" alt=\"\" width=\"575\" height=\"750\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_F.png 575w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_F-199x260.png 199w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_F-414x540.png 414w\" sizes=\"auto, (max-width: 575px) 100vw, 575px\" \/><\/a><p id=\"caption-attachment-22572\" class=\"wp-caption-text\"><strong>Resim 1. <\/strong>Haziran 1886 tarihinde, Pasteur\u2019e kuduz a\u015f\u0131s\u0131 i\u00e7in e\u011fitime gidenler; Mirliva (Tu\u011fgeneral) Aleksander Zoeros Pa\u015fa, Kaymakam (Yarbay) Dr. H\u00fcseyin Remzi Bey ve Kaymakam (Yarbay) Veteriner Hekim H\u00fcsn\u00fc Bey.<\/p><\/div>\n<p class=\"p4\"><span class=\"s1\">1885\u2019te Louis Pasteur taraf\u0131ndan geli\u015ftirilen a\u015f\u0131 vas\u0131tas\u0131yla t\u00fcm d\u00fcnyada oldu\u011fu gibi Osmanl\u0131 co\u011frafyas\u0131nda da kuduzla etkin bir m\u00fccadele yap\u0131labildi. Padi\u015fah II. Abd\u00fclhamid kuduz a\u015f\u0131s\u0131n\u0131n \u0130stanbul\u2019da \u00fcretilebilmesi i\u00e7in Pasteur\u2019\u00fc davet etmi\u015f fakat Pasteur ya\u015fl\u0131l\u0131k ve i\u015flerinin \u00e7oklu\u011fu nedeniyle gelemeyece\u011fini bildirince, mevcut kuduz a\u015f\u0131s\u0131n\u0131n geli\u015ftirilebilmesi i\u00e7in Paris\u2019te kurulan enstit\u00fcye 10 000 Frans\u0131z frang\u0131 yard\u0131m yap\u0131lm\u0131\u015f ve bu Enstit\u00fc&#8217;de e\u011fitim almalar\u0131 amac\u0131yla \u00fc\u00e7 ki\u015filik bir heyet Paris\u2019e g\u00f6nderilmi\u015ftir. O zaman\u0131n 10 000 frank\u0131yla Bebek semtinde orta halli 160 ev al\u0131nabilece\u011fi d\u00fc\u015f\u00fcn\u00fcl\u00fcnce yard\u0131m\u0131n de\u011feri daha iyi anla\u015f\u0131labilir (4). Enstit\u00fc&#8217;ye e\u011fitim amac\u0131yla g\u00f6nderilen ki\u015filer Zoeros Pa\u015fa, H\u00fcseyin Remzi Bey ve Veteriner Hekim H\u00fcsn\u00fc Bey\u2019dir (Resim 1). Haziran 1886\u2019da Paris\u2019te e\u011fitime ba\u015flayan ekip alt\u0131 ayl\u0131k e\u011fitimin ard\u0131ndan \u0130stanbul\u2019a d\u00f6nm\u00fc\u015ft\u00fcr. Zoeros Pa\u015fa d\u00f6n\u00fc\u015fte bizzat Pasteur taraf\u0131ndan a\u015f\u0131lanan ve kuduz virusu ta\u015f\u0131yan iki tav\u015fan\u0131 beraberinde getirmi\u015f, Paris\u2019ten getirilen bu iki tav\u015fan arac\u0131l\u0131\u011f\u0131yla H\u00fcseyin Remzi Bey taraf\u0131ndan T\u00fcrkiye\u2019de ilk kuduz a\u015f\u0131s\u0131 \u00fcretilmi\u015ftir. Paris\u2019ten d\u00f6nen heyetin verdi\u011fi rapor do\u011frultusunda II. Abd\u00fclhamid\u2019in emriyle 1887\u2019de T\u00fcrkiye\u2019de kuduz m\u00fccadelesinin en \u00f6nemli kilometre ta\u015flar\u0131ndan birisi olan ve d\u00fcnyada kurulmu\u015f 3 kuduz tedavi kurumundan biri olan \u201c\u0130stanbul D\u00e2-\u00fc\u2019l Kelp ve Bakteriyoloji Ameliyathanesi\u201d kurulmu\u015ftur. Bu m\u00fcessese Pasteur metodunu kullanarak ilk a\u015f\u0131y\u0131 3 Haziran 1887\u2019de \u00fcretti. \u00dcretilen a\u015f\u0131yla birlikte kuduza kar\u015f\u0131 etkin bir m\u00fccadeleye giri\u015fildi. Ba\u015flang\u0131\u00e7ta ba\u015fvuru say\u0131s\u0131 azd\u0131 (2 y\u0131lda 39 olgu). Halk\u0131n kuduzun tedavisinin bulundu\u011funu \u00f6\u011frenmesi ve faydalar\u0131n\u0131n g\u00f6r\u00fclmeye ba\u015flamas\u0131yla birlikte bu say\u0131 her ge\u00e7en y\u0131l artt\u0131. 1887-1899 y\u0131llar\u0131 aras\u0131nda 2359 ki\u015fi \u0130stanbul\u2019da tedavi edilirken 45 ki\u015fi ise hayat\u0131n\u0131 kaybetti. \u00d6l\u00fcm oran\u0131n\u0131n %2 seviyelerine \u00e7\u0131kmas\u0131n\u0131n en \u00f6nemli sebebi imparatorluk s\u0131n\u0131rlar\u0131n\u0131n geni\u015fli\u011fi yan\u0131nda ula\u015f\u0131m\u0131n \u00e7ok zaman almas\u0131 nedeniyle hastalar\u0131n gecikmesiydi. B\u00f6lgesinde ilk olma \u00f6zelli\u011fi g\u00f6steren merkeze Rumeli, Anadolu, Arabistan ba\u015fta olmak \u00fczere S\u0131rbistan, Yunanistan ve Bulgaristan\u2019dan tedavi i\u00e7in hastalar m\u00fcracaat etti (5).<\/span> <span class=\"s1\">\u0130stanbul\u2019un bir\u00e7ok yerle\u015fim yerine olan uzakl\u0131\u011f\u0131 ve kuduz hastal\u0131\u011f\u0131na yakalananlar\u0131n kente ula\u015f\u0131m\u0131nda ya\u015fanan problemler \u00fczerine tedavi merkezlerinin say\u0131lar\u0131n\u0131n art\u0131r\u0131lmas\u0131 g\u00fcndeme geldi. Buna ba\u011fl\u0131 olarak 1905\u2019te Selanik, 1917\u2019de Sivas ve \u015eam\u2019da birer kuduz tedavi merkezi ve laboratuvar kuruldu (6). Osmanl\u0131 Devleti\u2019nde kuduzla m\u00fccadele tek y\u00f6nl\u00fc yap\u0131lmad\u0131. \u0130stanbul sokaklar\u0131nda ba\u015f\u0131bo\u015f dola\u015fan k\u00f6peklerin \u015fehirden uzakla\u015ft\u0131r\u0131lmas\u0131 i\u00e7in de etkin bir m\u00fccadeleye giri\u015fildi. II. Me\u015frutiyetin ilan\u0131ndan sonra \u015fehirde bulunan 80 000 k\u00f6pek Hay\u0131rs\u0131z Ada\u2019ya g\u00f6t\u00fcr\u00fcld\u00fc. Op. Dr. Cemil (Topuzlu) Bey\u2019in \u0130stanbul Belediye Ba\u015fkanl\u0131\u011f\u0131 d\u00f6neminde de 30 000\u2019e yak\u0131n ba\u015f\u0131bo\u015f k\u00f6pek ise yava\u015f yava\u015f itlaf edildi (7).<\/span><span class=\"s2\"><span class=\"Apple-converted-space\">\u00a0<\/span><\/span><\/p>\n<h2 class=\"p5\"><b>T\u00dcRK\u0130YE CUMHUR\u0130YET\u0130&#8217;NDE KUDUZLA M\u00dcCADELE M\u00dcESSESELER\u0130\u00a0<\/b><\/h2>\n<p class=\"p4\">1919 y\u0131l\u0131nda \u0130stanbul merkezli devletin tamamen i\u015flevsiz hale gelmesi ve kurtulu\u015f \u00e7arelerinin bu merkez \u00fczerinden y\u00fcr\u00fct\u00fclemeyece\u011finin anla\u015f\u0131lmas\u0131 \u00fczerine Ankara\u2019da kurulan T\u00fcrkiye B\u00fcy\u00fck Millet Meclisi (TBMM) \u00fclkenin kurtar\u0131lmas\u0131 ad\u0131na b\u00fcy\u00fck bir sorumlulu\u011fu \u00fcstlenmi\u015fti. Oysaki Ankara, Osmanl\u0131 Devleti d\u00f6neminde yeterince yat\u0131r\u0131m alamam\u0131\u015f bir \u015fehir konumundayd\u0131. Anadolu\u2019nun bir\u00e7ok kenti gibi \u00e7o\u011fu konuda \u0130stanbul\u2019a muhta\u00e7 durumdayd\u0131. Bu muhta\u00e7l\u0131klardan birisi de \u015f\u00fcphesiz ki sa\u011fl\u0131k alan\u0131nda ortaya \u00e7\u0131k\u0131yordu. Hastal\u0131klara y\u00f6nelik ila\u00e7lar ve a\u015f\u0131lar\u0131n merkezi de \u0130stanbul\u2019da idi. 1920 y\u0131l\u0131ndaki genel panoramaya g\u00f6re \u0130stanbul H\u00fck\u00fcmeti TBMM\u2019yi k\u00f6\u015feye s\u0131k\u0131\u015ft\u0131rmak ve i\u015flevsiz hale getirmek ad\u0131na kentten g\u00f6nderilecek her t\u00fcrl\u00fc malzeme \u00fczerinde ambargo uyguluyordu. Silah ve cephane meselesinde oldu\u011fu gibi ila\u00e7 ve a\u015f\u0131 meselesinde de Kuva-y\u0131 Milliye ruhunu benimsemi\u015f kahraman vatan evlatlar\u0131 malzemeleri Ankara\u2019ya ta\u015f\u0131mak i\u00e7in g\u00f6n\u00fcll\u00fc oluyorlard\u0131.<\/p>\n<div id=\"attachment_22372\" style=\"width: 530px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22372\" class=\"wp-image-22372 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_2.png\" alt=\"\" width=\"520\" height=\"654\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_2.png 520w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_2-207x260.png 207w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_2-429x540.png 429w\" sizes=\"auto, (max-width: 520px) 100vw, 520px\" \/><p id=\"caption-attachment-22372\" class=\"wp-caption-text\"><strong>Resim 2. <\/strong>Dr. Zekai Muammer Tun\u00e7man.<\/p><\/div>\n<div id=\"attachment_22374\" style=\"width: 528px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22374\" class=\"wp-image-22374 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_3.png\" alt=\"\" width=\"518\" height=\"655\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_3.png 518w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_3-206x260.png 206w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_3-427x540.png 427w\" sizes=\"auto, (max-width: 518px) 100vw, 518px\" \/><p id=\"caption-attachment-22374\" class=\"wp-caption-text\"><strong> 3. <\/strong>H\u00fcseyin Remzi Bey.<\/p><\/div>\n<p class=\"p2\">1920 y\u0131l\u0131 itibariyle Ankara\u2019ya acilen s\u0131tma m\u00fccadelesinde kullan\u0131lan kinin, frengi hastal\u0131\u011f\u0131nda kullan\u0131lan ila\u00e7la birlikte y\u00fcz bin ki\u015filik \u00e7i\u00e7ek a\u015f\u0131s\u0131, pek \u00e7ok bakteri a\u015f\u0131s\u0131 ve ayr\u0131ca veba ve kolera k\u00fclt\u00fcrlerinin temin edilmesi gerekiyordu. Bu esnada \u0130stanbul\u2019da g\u00f6rev yapan Dr. Zek\u00e2i Muammer Bey (Tun\u00e7man) (Resim 2) Anadolu\u2019dan ald\u0131\u011f\u0131 bir mektupla harekete ge\u00e7ti. \u0130stanbul S\u0131hhiye M\u00fcd\u00fcr\u00fc Abdullah Cevdet Bey\u2019in g\u00f6z yummas\u0131 \u00fczerine laboratuvardan \u00e7\u0131kar\u0131lmas\u0131 yasak olan ila\u00e7, a\u015f\u0131, k\u00fclt\u00fcr ve deney hayvanlar\u0131yla birlikte gizlice deniz yoluyla \u0130nebolu\u2019ya ge\u00e7erek Kuvay-\u0131 Milliye hareketine kat\u0131ld\u0131. Dr. Zek\u00e2i Muammer Bey d\u00f6rt y\u0131l kald\u0131\u011f\u0131 Kastamonu\u2019da imk\u00e2nlar nispetinde gerekli a\u015f\u0131 ve serumlar\u0131n \u00fcretilmesinde \u00f6nemli rol oynad\u0131. Ayr\u0131ca Kurtulu\u015f Sava\u015f\u0131 y\u0131llar\u0131nda \u0130stanbul\u2019daki g\u00f6revine devam eden Ord. Prof. Dr. Ahmet Refik G\u00fcran \u0130stanbul\u2019da bulunan merkezde \u00fcretti\u011fi a\u015f\u0131 ve serumlar\u0131 \u00e7e\u015fitli yollarla milli orduya ve halka ula\u015ft\u0131rd\u0131 (8). Ankara merkezli ba\u015flayan Milli M\u00fccadele hareketi yaln\u0131zca askeri bir m\u00fccadele olman\u0131n \u00f6tesinde her alanda yeniden kalk\u0131nmay\u0131 \u00f6ng\u00f6ren bir hareketti. Buna ba\u011fl\u0131 olarak 2 May\u0131s 1920 ve 3 no.lu kanunla <i>\u201cS\u0131hhiye ve Muavenet-i \u0130\u00e7timaiye Vek\u00e2leti\u201d <\/i>kurulmas\u0131na karar verildi. Vek\u00e2let taraf\u0131ndan haz\u0131rlanan ilk b\u00fct\u00e7e tasar\u0131s\u0131na g\u00f6re kurulmas\u0131 \u00f6ng\u00f6r\u00fclen kurumlar aras\u0131nda Da-\u00fcl Kelp Tedavihanesi de bulunuyordu. Cumhuriyet d\u00f6neminde kuduzla m\u00fccadele \u00e7al\u0131\u015fmas\u0131n\u0131n ba\u015flang\u0131c\u0131, daha \u00f6nce \u0130stanbul Kuduz Tedavi Merkezinde \u00e7al\u0131\u015fm\u0131\u015f olan Adana vekili Dr. E\u015fref Bey\u2019in \u0130stanbul\u2019a giderek konunun uzman\u0131 Dr. Hay\u0131m Naum Bey ile g\u00f6r\u00fc\u015fmesidir. \u0130stanbul\u2019dan kuduz virusu ta\u015f\u0131yan bir tav\u015fanla d\u00f6nen E\u015fref Bey, Ankara\u2019da bir kuduz tedavi merkezi a\u00e7\u0131lmas\u0131n\u0131 sa\u011flam\u0131\u015ft\u0131r. Daha \u00f6nce \u0130stanbul\u2019daki Da-\u00fcl Kelp Ameliyathanesi, 1922 y\u0131l\u0131nda \u0130stanbul Kuduz M\u00fcessesesi ismini alarak faaliyetine devam etmi\u015ftir. 1925\u2019te Erzurum ve Sivas, 1926\u2019da Diyarbak\u0131r, 1927\u2019de Konya, 1930\u2019da \u0130zmir\u2019de birer kuduz hastanesi a\u00e7\u0131lm\u0131\u015ft\u0131r. 1937 y\u0131l\u0131nda ise H\u0131fz\u0131ss\u0131hha Merkezinde kuduz serumu \u00fcretilmeye ba\u015flam\u0131\u015ft\u0131r. 1 Haziran 1932 tarihinde Refik Saydam Merkez H\u0131fz\u0131ss\u0131hha M\u00fcessesinde kurulan kuduz laboratuvar\u0131yla T\u00fcrkiye\u2019de ilk kez fenoll\u00fc a\u015f\u0131 \u00fcretim \u00e7al\u0131\u015fmalar\u0131 ba\u015flam\u0131\u015ft\u0131r. Ankara Refik Saydam Merkez H\u0131fz\u0131ss\u0131hha M\u00fcessesesi\u2019ne ba\u011fl\u0131 olarak faaliyet g\u00f6steren kuduz tedavi istasyonlar\u0131n\u0131n say\u0131s\u0131 1933\u2019te 26 iken 1948\u2019de say\u0131 82 istasyona ula\u015fm\u0131\u015ft\u0131r.<\/p>\n<p class=\"p2\">Kuduzla m\u00fccadele kapsam\u0131nda, kuduz a\u015f\u0131s\u0131 istasyonlar\u0131n\u0131n art\u0131r\u0131lmas\u0131yla kuduz hastanelerinin say\u0131s\u0131 1945\u2019te \u00fc\u00e7e d\u00fc\u015f\u00fcr\u00fclm\u00fc\u015ft\u00fcr. Tespit edilen \u00f6l\u00fcml\u00fc vaka 1940\u2019ta 13, 1945\u2019te be\u015f ve 1950\u2019de 24 olarak tespit edilmi\u015ftir (9). 1957\u2019de yap\u0131lan say\u0131mda ise, on y\u0131ll\u0131k \u00f6l\u00fcm say\u0131s\u0131 120 olarak tespit edilmi\u015ftir. Son y\u0131llarda a\u015f\u0131lar ve korunma y\u00f6ntemleri yan\u0131nda ba\u015f\u0131bo\u015f k\u00f6pek kontrol\u00fc uygulamalar\u0131 sonucu kuduz hastas\u0131 say\u0131s\u0131 azalm\u0131\u015f olup, 2003-2007 y\u0131llar\u0131 aras\u0131nda 5 olgu, 2008-2018 y\u0131llar\u0131 aras\u0131nda 16 olgu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr.<\/p>\n<p class=\"p2\"><span class=\"s3\">\u00dclkemizde ge\u00e7mi\u015fte kuduz sava\u015f\u0131m\u0131nda \u00f6zveriyle \u00e7al\u0131\u015fm\u0131\u015f, ba\u015fta ilk a\u015f\u0131y\u0131 \u00fcreten H\u00fcseyin Remzi Bey (Resim 3) ve Kurtulu\u015f Sava\u015f\u0131 ve sonras\u0131nda g\u00f6rev yapan Dr. Zekai Muammer Tun\u00e7man (Resim 2) olmak \u00fczere katk\u0131da bulunan t\u00fcm meslekta\u015flar\u0131m\u0131z\u0131 rahmet ve minnetle an\u0131yorum.<\/span><\/p>\n<h2 class=\"p1\"><b>T\u0130F\u00dcS<\/b><\/h2>\n<div id=\"attachment_22379\" style=\"width: 530px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22379\" class=\"wp-image-22379 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_4.png\" alt=\"\" width=\"520\" height=\"652\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_4.png 520w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_4-207x260.png 207w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_4-431x540.png 431w\" sizes=\"auto, (max-width: 520px) 100vw, 520px\" \/><p id=\"caption-attachment-22379\" class=\"wp-caption-text\"><strong>Resim 4.<\/strong> Prof. Dr. Abd\u00fclkadir Noyan.<\/p><\/div>\n<div id=\"attachment_22381\" style=\"width: 530px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22381\" class=\"wp-image-22381 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_5.png\" alt=\"\" width=\"520\" height=\"656\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_5.png 520w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_5-206x260.png 206w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_5-428x540.png 428w\" sizes=\"auto, (max-width: 520px) 100vw, 520px\" \/><p id=\"caption-attachment-22381\" class=\"wp-caption-text\"><strong>Resim 5.<\/strong> Dr. Ahmet Fikri Bey.<\/p><\/div>\n<div id=\"attachment_22383\" style=\"width: 532px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22383\" class=\"wp-image-22383 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_6.png\" alt=\"\" width=\"522\" height=\"655\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_6.png 522w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_6-207x260.png 207w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_6-430x540.png 430w\" sizes=\"auto, (max-width: 522px) 100vw, 522px\" \/><p id=\"caption-attachment-22383\" class=\"wp-caption-text\"><strong>Resim 6. <\/strong>Bu\u011fu sand\u0131\u011f\u0131.<\/p><\/div>\n<div id=\"attachment_22385\" style=\"width: 530px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22385\" class=\"wp-image-22385 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_7.png\" alt=\"\" width=\"520\" height=\"652\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_7.png 520w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_7-207x260.png 207w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_7-431x540.png 431w\" sizes=\"auto, (max-width: 520px) 100vw, 520px\" \/><p id=\"caption-attachment-22385\" class=\"wp-caption-text\"><strong>Resim 7.<\/strong> 3. Ordu S\u0131hhiye Reisi Tevfik Salim Bey (1915) Erzurum.<\/p><\/div>\n<div id=\"attachment_22387\" style=\"width: 530px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22387\" class=\"wp-image-22387 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_8.png\" alt=\"\" width=\"520\" height=\"651\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_8.png 520w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_8-208x260.png 208w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_8-431x540.png 431w\" sizes=\"auto, (max-width: 520px) 100vw, 520px\" \/><p id=\"caption-attachment-22387\" class=\"wp-caption-text\"><strong>Resim 8.<\/strong> Re\u015fat R\u0131za (Kor) Bey (1877-1941).<\/p><\/div>\n<div id=\"attachment_22389\" style=\"width: 528px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22389\" class=\"wp-image-22389 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_9.png\" alt=\"\" width=\"518\" height=\"654\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_9.png 518w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_9-206x260.png 206w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_9-428x540.png 428w\" sizes=\"auto, (max-width: 518px) 100vw, 518px\" \/><p id=\"caption-attachment-22389\" class=\"wp-caption-text\"><strong>Resim 9.<\/strong> Prof. Dr. Behi\u00e7 Onul.<\/p><\/div>\n<div id=\"attachment_22391\" style=\"width: 530px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22391\" class=\"wp-image-22391 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_10.png\" alt=\"\" width=\"520\" height=\"656\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_10.png 520w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_10-206x260.png 206w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_10-428x540.png 428w\" sizes=\"auto, (max-width: 520px) 100vw, 520px\" \/><p id=\"caption-attachment-22391\" class=\"wp-caption-text\"><strong>Resim 10. <\/strong>Prof. Dr. \u00d6. Fethi Tezok.<\/p><\/div>\n<div id=\"attachment_22393\" style=\"width: 529px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22393\" class=\"wp-image-22393 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_11.png\" alt=\"\" width=\"519\" height=\"653\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_11.png 519w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_11-207x260.png 207w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_11-429x540.png 429w\" sizes=\"auto, (max-width: 519px) 100vw, 519px\" \/><p id=\"caption-attachment-22393\" class=\"wp-caption-text\"><strong>Resim 11.<\/strong> Dr. Refik Saydam.<\/p><\/div>\n<p class=\"p2\">Prof. Dr. Hikmet \u00d6zdemir <i>Salg\u0131n Hastal\u0131klardan \u00d6l\u00fcmler<\/i> isimli kitab\u0131nda \u201c1. D\u00fcnya Sava\u015f\u0131\u2019nda T\u00fcrkiye hastal\u0131klardan \u00f6l\u00fcmlerin sava\u015farak \u00f6lenlerden daha fazla oldu\u011fu tek \u00fclkedir. Bu sava\u015fta asker ve g\u00f6revli olarak orduya kat\u0131lanlar\u0131n \u00fc\u00e7te biri hastal\u0131klardan \u00f6lm\u00fc\u015ft\u00fcr. Dahas\u0131, silahalt\u0131na al\u0131nan gen\u00e7lerin yaln\u0131zca %10-20\u2019lik k\u0131sm\u0131 evlerine d\u00f6nebilmi\u015flerdir\u201d<i> <\/i>demektedir. Yukar\u0131daki ibare d\u00f6rt y\u0131ll\u0131k bu d\u00f6nemin ac\u0131 durumunu \u00e7ok net \u00f6zetlemektedir. Yine ayn\u0131 kitaptaki verilere g\u00f6re Osmanl\u0131 Ordusu\u2019nda hastal\u0131ktan \u00f6l\u00fcm 466 759, 3. Ordu\u2019da ise 116 182\u2019dir. Bunlar\u0131n 300 kadar\u0131 da sa\u011fl\u0131k personelidir. 3. Ordu\u2019daki \u00f6l\u00fcm nedenlerinin ba\u015f\u0131nda ise tif\u00fcs ve humma-i racia gelmektedir. Her ikisi de askerin bak\u0131ms\u0131zl\u0131\u011f\u0131 nedeniyle t\u00fcm orduyu saran bitler arac\u0131l\u0131\u011f\u0131yla yay\u0131lm\u0131\u015f, sava\u015f s\u0131ras\u0131nda yer de\u011fi\u015ftiren birlikler, cephe gerisinde kalanlar veya uzaklardan yaya olarak gelerek k\u00f6ylerde konaklayan erat k\u00f6ylerdeki sivil halka da bula\u015ft\u0131rm\u0131\u015flard\u0131r. Bit hem asker hem de sivil halk aras\u0131nda \u00e7ok yayg\u0131nd\u0131. Bu m\u00fcsait \u015fartlar alt\u0131nda tif\u00fcs k\u0131sa zamanda salg\u0131n halini ald\u0131. Sar\u0131kam\u0131\u015f Muharebesi&#8217;nden sonra ordunun b\u00fcy\u00fck k\u0131sm\u0131 yok olmu\u015f, geri kalanlar da b\u00f6lgedeki il, il\u00e7e ve k\u00f6ylerde peri\u015fan halde da\u011f\u0131lm\u0131\u015f, hastaneler hastalar\u0131 almaz olmu\u015f, zaten az olan doktor ve sa\u011fl\u0131k personelinin \u00e7o\u011fu tif\u00fcse yakalanm\u0131\u015ft\u0131. Tif\u00fcsten yeni iyile\u015fmi\u015f, nekahet d\u00f6neminde g\u00fc\u00e7l\u00fckle ayakta duran doktorlar hastalara hizmet i\u00e7in \u00e7\u0131rp\u0131n\u0131yorlard\u0131. Doktorlar ve di\u011fer subaylar hava de\u011fi\u015fimine gidince yerine yenilerinin gelmesi, onlar\u0131n da tif\u00fcse yakalanmas\u0131, en az 1\/3\u2019\u00fcn\u00fcn \u00f6lmesi ve uzun s\u00fcre \u00e7al\u0131\u015famamas\u0131 demekti.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\"><span class=\"s3\">Hasankale ve Erzurum Askeri Hastanelerindeki doktorlar: <b><i>\u201c<\/i><\/b>Erzurum ve Hasankale\u2019ye gelen her doktorun tif\u00fcse yakalanmas\u0131 ka\u00e7\u0131n\u0131lmazd\u0131r. \u00dclkenin b\u00fcy\u00fck \u00f6zverilerle yeti\u015ftirdi\u011fi doktorlar\u0131 \u00f6l\u00fcm\u00fcn kuca\u011f\u0131na atmak do\u011fru de\u011fildir. Tif\u00fcs ge\u00e7irerek ba\u011f\u0131\u015f\u0131kl\u0131k kazanm\u0131\u015f bizler i\u00e7in art\u0131k tehlike yoktur. Bizler burada kalmaya raz\u0131y\u0131z\u201d diye ortak bir karar ald\u0131lar. Bu durum Ordu\u2019yu a\u011f\u0131r bir karar almak zorunda b\u0131rakt\u0131 ve tif\u00fcsten iyile\u015fmi\u015f olanlar\u0131n b\u00f6lgede g\u00f6revlerine d\u00f6nerek devam etmelerine karar verildi (10).<\/span><\/p>\n<p class=\"p2\">Salg\u0131n ba\u015flang\u0131c\u0131nda ilk olgulara tan\u0131 koyma zorlu\u011fu ya\u015fanm\u0131\u015ft\u0131. O d\u00f6nem istatistiklerine bak\u0131ld\u0131\u011f\u0131nda \u00e7ok say\u0131da <i>nezle-i m\u00fcstevliye <\/i>(gripal infeksiyon) tan\u0131s\u0131 kondu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Yine ba\u015flang\u0131\u00e7ta kar\u0131\u015fabilecek bir ba\u015fka hastal\u0131k tifo idi. Bir d\u00f6nem tif\u00fcsl\u00fc hastalara tifo tan\u0131s\u0131 konmaktayd\u0131. Bu nedenle kesin tan\u0131 i\u00e7in o d\u00f6nemin olanaklar\u0131yla, laboratuvar testleriyle (kan k\u00fclt\u00fcr\u00fc ve agl\u00fctinasyon) do\u011frulamadan sonra tifo tan\u0131s\u0131 konan olgular azald\u0131.<\/p>\n<p class=\"p2\">Tif\u00fcs m\u00fccadelesi, bit m\u00fccadelesi demekti. Orduda bit m\u00fccadelesinin en \u00e7ok ihmal edildi\u011fi yerler sevkiyat merkezleri, hapishaneler, merkez komutanl\u0131klar\u0131 ve da\u011f\u0131t\u0131m noktalar\u0131yd\u0131. Bu kurulu\u015flar\u0131n \u015fehir merkezlerinde bulunmas\u0131 ve halkla i\u00e7 i\u00e7e olmas\u0131 nedeniyle bitlenmeye \u00e7ok a\u00e7\u0131kt\u0131. Buralardan gelen askerlerin tif\u00fcse yakalanmalar\u0131 ka\u00e7\u0131n\u0131lmazd\u0131. M\u00fccadele i\u00e7in dezenfeksiyon gere\u00e7leri son derece az ve yetersizdi. Bu ama\u00e7la elbise ve \u00e7ama\u015f\u0131rlar\u0131; Dr. Abd\u00fclkadir (Noyan) Bey (Resim 4)\u2019in geli\u015ftirdi\u011fi ekmek f\u0131r\u0131nlar\u0131nda \u0131s\u0131tmak, topra\u011fa g\u00f6m\u00fcp bitleri havas\u0131z b\u0131rakarak d\u0131\u015far\u0131 \u00e7\u0131karmak ve uzakla\u015ft\u0131rmak gibi bir\u00e7ok ampirik y\u00f6ntem kullan\u0131lm\u0131\u015ft\u0131r. Daha sonra Dr. Ahmet Fikri Bey (Resim 5)\u2019in bulu\u015fu olan bu\u011fu sand\u0131\u011f\u0131 kullan\u0131ma girmi\u015f (Resim 6) ve bir buhar kazan\u0131yla basit bir sand\u0131ktan ibaret olan gerecin geli\u015ftirilerek yayg\u0131nla\u015fmas\u0131ndan sonra salg\u0131n bast\u0131r\u0131labilmi\u015ftir. T\u00fcm bu \u00e7al\u0131\u015fmalar\u0131n mimar\u0131 ve koordinat\u00f6r\u00fc 3. Ordu S\u0131hhiye Reisi Tevfik Salim Bey (Ord. Prof. Tbp. Tu\u011fgn. Tevfik Sa\u011flam) (Resim 7) idi. Kendisi daha sonra \u0130stanbul \u00dcniversitesi Rekt\u00f6rl\u00fc\u011f\u00fc, \u00c7apa T\u0131p Fak\u00fcltesi Dekanl\u0131\u011f\u0131, III. Dahiliye ve Fitizyoloji Kliniklerinin kurucusu ve direkt\u00f6r\u00fc g\u00f6revlerinin yan\u0131 s\u0131ra T\u00fcrkiye Ulusal Verem Sava\u015f\u0131&#8217;nda unutulmaz \u00e7al\u0131\u015fmalar yapm\u0131\u015ft\u0131r (11).<\/p>\n<p class=\"p2\">Dr. Abd\u00fclkadir Bey ise daha sonra Ord. Prof. Tbp. T\u00fcmgn. olarak G\u00fclhane \u0130ntaniye Klini\u011finde \u00e7al\u0131\u015fm\u0131\u015f, 1945 y\u0131l\u0131nda Cumhurba\u015fkan\u0131 \u0130smet \u0130n\u00f6n\u00fc\u2019n\u00fcn \u00f6nerisiyle Ankara \u00dcniversitesi T\u0131p Fak\u00fcltesini kurarak ilk dekan\u0131 olmu\u015ftur.<\/p>\n<p class=\"p2\">Tif\u00fcs konusunda unutulmamas\u0131 gereken bir ba\u015fka ki\u015fi de Dr. Re\u015fat R\u0131za (Kor) Bey\u2019dir (Resim 8). <i>Rickettsia prowazekii<\/i>\u2019nin hen\u00fcz \u00fcretilemedi\u011fi bir devirde kullan\u0131lm\u0131\u015f olan tif\u00fcs a\u015f\u0131s\u0131n\u0131n fikir babas\u0131d\u0131r. Tif\u00fcste mikrobun ate\u015fli zamanda kanda bulundu\u011funu ve 55\u00b0C\u2019de 1 saat \u0131s\u0131t\u0131lacak olursa her mikrop gibi bunun da \u00f6lebilece\u011fini ve ate\u015fli zamanda tif\u00fcs hastas\u0131ndan al\u0131nan kan\u0131n steril ko\u015fullarda defibrine edilerek 58-60\u00b0C\u2019de inaktive edilen kandan 5 cc. injekte edilerek koruyucu etki sa\u011flanabilece\u011fini d\u00fc\u015f\u00fcnm\u00fc\u015ft\u00fcr. Bu fikrini Tevfik Salim Bey\u2019e a\u00e7m\u0131\u015f, daha sonra Tevfik Salim Bey d\u00fcnyada ilk tif\u00fcs a\u015f\u0131s\u0131n\u0131 28 Mart 1915\u2019te Hasankale\u2019de haz\u0131rlam\u0131\u015ft\u0131r. Bu a\u015f\u0131 ilk olarak g\u00f6n\u00fcll\u00fc olan be\u015fi doktor dokuz subaya uygulanm\u0131\u015ft\u0131r. <span style=\"font-weight: 400;\">A\u015f\u0131lananlardan 1\u2019i biri ayn\u0131 g\u00fcn, \u00fc\u00e7\u00fc ise 3, 5 ve 7. g\u00fcnlerde hastaland\u0131lar. Di\u011fer 5 ki\u015fi hasta olmad\u0131, hasta olanlardan ikisi hastal\u0131\u011f\u0131 hafif atlatt\u0131lar. <\/span>Ki\u015filerin hasta olmas\u0131 ba\u015flang\u0131\u00e7ta a\u015f\u0131da \u015f\u00fcphe uyand\u0131rm\u0131\u015f ancak hastalananlar\u0131n tif\u00fcsl\u00fc hastalarla u\u011fra\u015fan doktorlar olmas\u0131 ve \u00fczerlerinde bit bulunmas\u0131 nedeniyle etkeni a\u015f\u0131dan \u00f6nce alm\u0131\u015f olduklar\u0131 sonucuna var\u0131ld\u0131. Daha sonra bu y\u00f6ntemle haz\u0131rlanan a\u015f\u0131 Erzurum\u2019da Dr. Alaattin Bey taraf\u0131ndan 263 ki\u015fiye uygulanm\u0131\u015f, sadece 3 ki\u015fi tif\u00fcse yakalanm\u0131\u015f, Dr. Abd\u00fclhalim As\u0131m Bey Bayburt\u2019ta 130 ki\u015fiye a\u015f\u0131 yapm\u0131\u015f 1.5 ay sonra a\u015f\u0131 yap\u0131lanlarda olumsuz sonu\u00e7 g\u00f6r\u00fclmedi\u011fini bildirmi\u015ftir. Bunu takiben Sivas, Erzurum ve Hasankale\u2019de \u00e7ok say\u0131da ki\u015fi a\u015f\u0131lanm\u0131\u015f, hafif ge\u00e7irilen birka\u00e7 tif\u00fcs olgusu d\u0131\u015f\u0131nda genel kabul g\u00f6rm\u00fc\u015ft\u00fcr. Ayr\u0131ca Ba\u011fdat\u2019ta bulunan 6. Ordu\u2019da Dr. Abd\u00fclkadir (Noyan) Bey 76 subay, 20 hekim ve 20 hastabak\u0131c\u0131y\u0131 a\u015f\u0131lam\u0131\u015f, 6. Ordu Kumandan\u0131 Mare\u015fal Von der Goltz Pa\u015fa ve \u00f6zel doktoru Dr. Obendorfer g\u00fcvenmedikleri i\u00e7in a\u015f\u0131 olmay\u0131 reddetmi\u015fler ve tif\u00fcse yakalanarak Ba\u011fdat\u2019ta vefat etmi\u015flerdir. Di\u011fer t\u00fcm a\u015f\u0131lananlar ise kurtulmu\u015flard\u0131r (11).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">Daha sonraki y\u0131llarda G\u00fclhane\u2019nin Ankara\u2019ya ta\u015f\u0131nmas\u0131ndan sonra 2. D\u00fcnya Sava\u015f\u0131 s\u0131ras\u0131nda Prof. Dr. Dz. Tbp. Alb. Behi\u00e7 Onul (Resim 9) ve Prof. Dr. Tbp. Tu\u011fgn. \u00d6. Fethi Tezok (Resim 10) taraf\u0131ndan \u00fcretilen tif\u00fcs a\u015f\u0131s\u0131 \u0130talya\u2019n\u0131n Salerno \u015fehrindeki Amerikan Birlikleri taraf\u0131ndan kullan\u0131lm\u0131\u015ft\u0131r.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">\u00dclkemizdeki o d\u00f6nem tif\u00fcs sava\u015f\u0131m\u0131nda \u00e7al\u0131\u015fm\u0131\u015f ba\u015fta Ord. Prof. Tbp. Tu\u011fgn. Tevfik Sa\u011flam, Ord. Prof. Tbp. T\u00fcmgn. Abd\u00fclkadir Noyan, Dr. Re\u015fat R\u0131za Kor olmak \u00fczere bu u\u011furda canlar\u0131 pahas\u0131na g\u00f6rev yapm\u0131\u015f meslekta\u015flar\u0131m\u0131z\u0131 rahmet ve minnetle an\u0131yorum.<\/p>\n<p class=\"p2\">Ayr\u0131ca bu vesileyle bilim alan\u0131m\u0131z\u0131n ki\u015filik kazanmas\u0131 konusunda \u00f6nemli katk\u0131lar\u0131 olan, hocalar\u0131m\u0131z Prof. Dr. Behi\u00e7 Onul ve Prof. Dr. \u00d6. Fethi Tezok\u2019u rahmetle an\u0131yorum. Ruhlar\u0131 \u015fad olsun.<\/p>\n<h2 class=\"p1\"><b>KOLERA<\/b><\/h2>\n<div id=\"attachment_22407\" style=\"width: 1076px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_1.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22407\" class=\"wp-image-22407 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_1.png\" alt=\"\" width=\"1066\" height=\"850\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_1.png 1066w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_1-326x260.png 326w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_1-677x540.png 677w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_1-768x612.png 768w\" sizes=\"auto, (max-width: 1066px) 100vw, 1066px\" \/><\/a><p id=\"caption-attachment-22407\" class=\"wp-caption-text\"><strong>Tablo 1. <\/strong>1917-1925 Y\u0131llar\u0131nda Baz\u0131 \u0130llerdeki S\u0131tmal\u0131 Oranlar\u0131 (Dalak \u0130ndeksleri)<\/p><\/div>\n<div id=\"attachment_22627\" style=\"width: 2197px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Sekil_1-1.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22627\" class=\"wp-image-22627 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Sekil_1-1.png\" alt=\"\" width=\"2187\" height=\"1301\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Sekil_1-1.png 2187w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Sekil_1-1-390x232.png 390w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Sekil_1-1-810x482.png 810w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Sekil_1-1-768x457.png 768w\" sizes=\"auto, (max-width: 2187px) 100vw, 2187px\" \/><\/a><p id=\"caption-attachment-22627\" class=\"wp-caption-text\"><strong>\u015eekil 1.<\/strong> Cumhuriyet D\u00f6neminde S\u0131tma Epidemileri (1925-2002).<\/p><\/div>\n<div id=\"attachment_22816\" style=\"width: 1078px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_2.2.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22816\" class=\"wp-image-22816 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_2.2.png\" alt=\"\" width=\"1068\" height=\"584\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_2.2.png 1068w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_2.2-390x213.png 390w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_2.2-810x443.png 810w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_2.2-768x420.png 768w\" sizes=\"auto, (max-width: 1068px) 100vw, 1068px\" \/><\/a><p id=\"caption-attachment-22816\" class=\"wp-caption-text\"><strong>Tablo 2.<\/strong> Son Y\u0131llardaki S\u0131tma Olgu Say\u0131lar\u0131 (2002-2017)<\/p><\/div>\n<p class=\"p2\">Ge\u00e7mi\u015fte kolera, ki\u015fisel hijyenin \u00f6neminin takdir edilmedi\u011fi, \u00e7e\u015fitli altyap\u0131 hizmetlerinin aksad\u0131\u011f\u0131 veya hi\u00e7 olmad\u0131\u011f\u0131 toplumlarda salg\u0131nlar halinde g\u00f6r\u00fclerek b\u00fcy\u00fck oranda insan kay\u0131plar\u0131na yol a\u00e7m\u0131\u015ft\u0131r. 19. y\u00fczy\u0131l\u0131n ilk \u00e7eyre\u011finden itibaren s\u0131k s\u0131k kolera salg\u0131nlar\u0131na maruz kalan Osmanl\u0131 topraklar\u0131nda, \u00f6zellikle 1892-1895 d\u00f6neminde neredeyse hastal\u0131\u011f\u0131n u\u011framad\u0131\u011f\u0131 \u015fehir kalmam\u0131\u015f ve on binlerce insan bu hastal\u0131ktan dolay\u0131 hayat\u0131n\u0131 kaybetmi\u015ftir. \u0130stanbul ise bu d\u00f6nemde iki ayr\u0131 salg\u0131n ya\u015fam\u0131\u015ft\u0131r. \u0130lk salg\u0131nda Pasteur\u2019den yard\u0131m istenmi\u015f, o da Dr. Chantemesse\u2019i g\u00f6ndermi\u015ftir. Chantemesse, yapt\u0131\u011f\u0131 incelemeler ve haz\u0131rlad\u0131\u011f\u0131 raporla \u015fehirde hijyenik ko\u015fullar\u0131n d\u00fczeltilmesi, dereler ve \u00e7evresinin d\u00fczenlenmesi gibi \u00f6nerilerde bulunmu\u015ftur. Daha sonra gelen Nicolle ve Margeri isimli Frans\u0131z doktorlar da farkl\u0131 yerleri denetleyerek raporlar sunmu\u015flar, sular\u0131n ve yiyecek maddelerinin tahlilinin yap\u0131laca\u011f\u0131 bakteriyolojihanenin kurulmas\u0131 iste\u011fini belirtmi\u015flerdir. Kurulan laboratuvarda gerekli tahlilleri yapm\u0131\u015flar, ayr\u0131ca tifo ve difteri gibi hastal\u0131klar\u0131n te\u015fhisiyle de ilgilenmi\u015flerdir.<\/p>\n<p class=\"p2\"><span class=\"s4\">1893-1894 salg\u0131nlar\u0131nda Frans\u0131zlara itibar eden padi\u015fah, 1895 salg\u0131n\u0131nda bu kez Almanlarla i\u015fbirli\u011fi yapm\u0131\u015ft\u0131r. M\u00fcnih \u00dcniversitesinden gelen Prof. Emmerich \u0130stanbul\u2019un hemen her k\u00f6\u015fesini incelemi\u015f, la\u011f\u0131mlar\u0131n usul\u00fcne uygun yap\u0131lmas\u0131, yollar\u0131n d\u00fczeltilmesi, evlerin \u00e7\u00f6plerinin muntazam toplanmas\u0131, mezbahalar\u0131n d\u00fczeltilmesi, sa\u011fl\u0131ks\u0131z binalar\u0131n y\u0131k\u0131lmas\u0131 vb. gibi \u00f6nerilerde bulunmu\u015f, b\u00fcy\u00fck paralar gerektiren bu projeler do\u011fald\u0131r ki uygulanamam\u0131\u015ft\u0131r. Salg\u0131n\u0131n uzun s\u00fcrmesi nedeniyle bu kez Hindistan\u2019daki salg\u0131nlardan deneyimli olmalar\u0131 nedeniyle \u0130ngiliz doktorlara ba\u015fvurulmas\u0131 d\u00fc\u015f\u00fcn\u00fclm\u00fc\u015f, ancak zaman i\u00e7inde salg\u0131n\u0131n s\u00f6nmesi ve y\u00fcksek maliyet nedeniyle vazge\u00e7ilmi\u015ftir (12).<\/span><\/p>\n<p class=\"p2\">1910-1913 y\u0131llar\u0131 aras\u0131nda 3 kez tekrarlayan kolera salg\u0131n\u0131 zaman zaman %50\u2019ye varan mortaliteye ula\u015fm\u0131\u015f, k\u0131\u015f\u0131n gelmesiyle 1913 Ocak ay\u0131nda son bulduktan sonra 1913 A\u011fustos\u2019unda T\u00fcrk askerleri aras\u0131nda yeniden ba\u015flam\u0131\u015ft\u0131r. Bu d\u00f6nemde a\u015f\u0131 ve serum uygulamalar\u0131 g\u00fcndeme gelmeye ba\u015flam\u0131\u015ft\u0131r. A\u015f\u0131n\u0131n etkinli\u011fi tart\u0131\u015f\u0131l\u0131rken Japonya, Hindistan ve Rusya\u2019daki uygulamalarda olumlu sonu\u00e7lar bildirilmi\u015ftir. Bu s\u0131rada Dr. Cenap \u015eahabettin (\u015fair) \u0130zmir Urla Tahaffuzhanesinde (Karantina Merkezi) Dr. Florin\u2019in \u00fcretti\u011fi a\u015f\u0131y\u0131 karantinada bekleyenlere uygulam\u0131\u015f ve olumlu sonu\u00e7lardan bahsedilmi\u015ftir.<\/p>\n<p class=\"p2\">Daha sonra G\u00fclhane Tatbikat Mektebi ve Seririyat Hastanesi Bakteriyoloji Laboratuvar\u0131nda Mustafa Hilmi (Sagun) ve Re\u015fat R\u0131za (Kor) taraf\u0131ndan haz\u0131rlanan a\u015f\u0131 ordu birliklerinin tamam\u0131na 2-3 kez uygulanm\u0131\u015f ve o d\u00f6nemde g\u00f6revli Dr. Abd\u00fclkadir Bey (Noyan) ve Bakteriyolog H\u00fcsamettin Bey a\u015f\u0131 yap\u0131lm\u0131\u015f birliklerde koleraya yakalanma ve \u00f6l\u00fc say\u0131s\u0131nda en az bir kat azalma oldu\u011funu tespit etmi\u015flerdir. Filistin cephesindeki birliklerde salg\u0131n\u0131n h\u0131zla s\u00f6nmesi yap\u0131lan kolera a\u015f\u0131na ba\u011flanm\u0131\u015ft\u0131r. A\u015f\u0131 daha sonra Bakteriyolojihane-i Osmani\u2019de de \u00fcretilmi\u015ftir. Bu d\u00f6nemde \u00fclkede tifo ve \u00e7i\u00e7ek a\u015f\u0131s\u0131 da \u00fcretiliyordu.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">1. D\u00fcnya Sava\u015f\u0131 s\u0131ras\u0131nda b\u00fct\u00fcn kolordular h\u0131zla \u00e7i\u00e7ek, tifo ve koleraya kar\u015f\u0131 a\u015f\u0131lanm\u0131\u015ft\u0131. Buna g\u00f6re, 1. g\u00fcnde \u00e7i\u00e7ek ve tifo birinci a\u015f\u0131s\u0131, 3. g\u00fcnde kolera birinci a\u015f\u0131s\u0131, 5. g\u00fcnde tifo ikinci a\u015f\u0131s\u0131, 7. g\u00fcnde kolera ikinci a\u015f\u0131s\u0131, 9. g\u00fcnde tifo \u00fc\u00e7\u00fcnc\u00fc a\u015f\u0131s\u0131 yap\u0131larak a\u015f\u0131lama tamamlan\u0131yordu. \u0130lerleyen d\u00f6nemde \u0130stanbul\u2019dan yeteri kadar a\u015f\u0131 g\u00f6nderilmeyince Erzurum A\u015f\u0131 Dar\u00fclistihzar\u0131 (\u00dcretimevi) tifo a\u015f\u0131s\u0131 yap\u0131m\u0131n\u0131 durdurmu\u015f ve yaln\u0131z kolera a\u015f\u0131s\u0131 yapm\u0131\u015ft\u0131. Orduda al\u0131nan ba\u015far\u0131l\u0131 sonu\u00e7lardan sonra halka da kolera a\u015f\u0131s\u0131 yap\u0131lmaya ba\u015flanm\u0131\u015f S\u0131hhiye Nezareti\u2019nin teklifiyle uygun g\u00f6r\u00fclen yerlerde zorunlu a\u015f\u0131lama yap\u0131lm\u0131\u015ft\u0131r (10).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">Sonu\u00e7 olarak al\u0131nan tedbirler ve a\u015f\u0131lama kampanyalar\u0131 sonucu Balkan Sava\u015flar\u0131nda salg\u0131nlar sonucu b\u00fcy\u00fck sorunlar \u00e7\u0131karan kolera 1. D\u00fcnya Sava\u015f\u0131 s\u0131ras\u0131nda \u00e7ok b\u00fcy\u00fck bir problem olu\u015fturmam\u0131\u015ft\u0131r (13).<\/p>\n<p class=\"p2\">Sonraki y\u0131llarda da kolera \u00fclkemizde zaman zaman k\u00fc\u00e7\u00fck salg\u0131nlar (\u00f6rne\u011fin 1970 \u0130stanbul, Sa\u011fmalc\u0131lar Salg\u0131n\u0131) yapm\u0131\u015fsa da b\u00fcy\u00fck bir sorun olu\u015fturmam\u0131\u015ft\u0131r.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<h2 class=\"p1\"><b>SITMA<\/b><\/h2>\n<p class=\"p2\">Cumhuriyetin kurulu\u015f d\u00f6neminde s\u0131tma da b\u00fcy\u00fck sorunlardand\u0131. S\u0131tma sava\u015f\u0131 T\u00fcrkiye\u2019de devlet taraf\u0131ndan geli\u015ftirilen sistemli halk sa\u011fl\u0131\u011f\u0131 hizmetlerine bir ba\u015flang\u0131\u00e7 olu\u015fturma niteli\u011findedir. Cumhuriyeti kuranlar\u0131n, sa\u011fl\u0131k alan\u0131nda temel bir halk sa\u011fl\u0131\u011f\u0131 siyasas\u0131 izlediklerinin en \u00f6nemli kan\u0131t\u0131 san\u0131r\u0131z Cumhuriyet tarihine e\u015f olan s\u00f6z konusu s\u0131tma sava\u015f\u0131d\u0131r. Atat\u00fcrk\u2019\u00fcn \u00f6nc\u00fcl\u00fc\u011f\u00fcnde ve Dr. Refik Saydam (Resim 11)\u2019\u0131n teknokratl\u0131\u011f\u0131 alt\u0131nda ba\u015flayan s\u0131tma sava\u015f\u0131nda benimsenmi\u015f olan kavram ve ilkeler genelde g\u00fcn\u00fcm\u00fcz\u00fcn bu alandaki bilimsel, toplumsal, siyasal de\u011ferlerini de kapsamaktad\u0131r. S\u0131tma oranlar\u0131 Denizli ve Ankara gibi \u015fehirler ba\u015fta olmak \u00fczere \u00fclkenin \u00f6zellikle iklim ve co\u011frafi olarak uygun b\u00f6lgelerinde\u00a0 %90\u2019a kadar varmaktayd\u0131. Di\u011fer b\u00fcy\u00fck \u015fehirlerden \u0130stanbul ve Mardin\u2019de %80, Antalya\u2019da %86, \u0130zmir\u2019de ise %72 oran\u0131nda s\u0131tma olgusu g\u00f6r\u00fclmekteydi (14). 1917-1925 y\u0131llar\u0131nda baz\u0131 illerdeki s\u0131tmal\u0131 oranlar\u0131 (dalak indeksleri) Tablo 1\u2019de g\u00f6sterilmi\u015ftir.<\/p>\n<p class=\"p2\">Prof. Dr. Ekrem Kadri Unat\u2019a g\u00f6re \u201cS\u0131tma, t\u00fcm\u00fcyle T\u00fcrkiye Cumhuriyeti\u2019ne miras kalm\u0131\u015ft\u0131r\u201d (15). Yasal d\u00fczenlemeleri, \u00f6rg\u00fctlenmesi, toplumsal i\u015fbirli\u011fi, yurtta\u015flar\u0131n kat\u0131l\u0131m\u0131, gerekli t\u0131bbi altyap\u0131 ve ekonomik kaynaklar\u0131yla b\u00fct\u00fcnc\u00fcl bir devlet siyasas\u0131 \u0131\u015f\u0131\u011f\u0131nda s\u0131tma sava\u015f politikas\u0131ndan s\u00f6z etmek ancak Cumhuriyet\u2019le birlikte m\u00fcmk\u00fcn olabilmi\u015ftir. Bu \u015fartlar alt\u0131nda, yeni meclisin kurulmas\u0131ndan sonra ilk s\u0131tmayla m\u00fccadele bildirisi, 9 May\u0131s 1920\u2019deki 1. \u0130cra Vekilleri Heyeti (Bakanlar Kurulu) tutanaklar\u0131nda \u201cEmraz\u0131 sariyenin leh\u00fcl hamd memlekette bu sene evvelki harb senelerine nispeten pek az oldu\u011funu maraz\u0131 hamd\u00fc<b> <\/b>\u015f\u00fckranla zikretmekle beraber bug\u00fcn emraz\u0131 i\u00e7timaiye nam\u0131 alt\u0131nda zikrolunan malarya ve frenginin tahdidi mazarrat\u0131 i\u00e7in di\u011fer \u015fuabat\u0131 idare ile m\u00fcttehiden ittihaz-\u0131 tedabir olunaca\u011f\u0131n\u0131 s\u00f6ylemek isteriz (<i>Bu sene bula\u015f\u0131c\u0131 hastal\u0131klar\u0131n harb senelerine nispeten pek az oldu\u011funu hamd\u00fc<\/i> \u015f\u00fckranla zikretmekle beraber<i>, toplum hastal\u0131klar\u0131 ad\u0131 alt\u0131nda s\u00f6ylenen malarya ve frenginin s\u0131n\u0131rlanmas\u0131 i\u00e7in di\u011fer sa\u011fl\u0131k idareleriyle birlikte tedbirler al\u0131naca\u011f\u0131n\u0131 belirtmek isteriz)\u201d<\/i> s\u00f6zleriyle g\u00f6r\u00fc\u015f\u00fclm\u00fc\u015ft\u00fcr (16).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">Bundan bir y\u0131l sonraki TBMM a\u00e7\u0131l\u0131\u015f konu\u015fmas\u0131nda, Mustafa Kemal konuyla ilgili geli\u015fmelerin yetersizli\u011fini vurgulam\u0131\u015ft\u0131r. 1 Mart 1922 a\u00e7\u0131l\u0131\u015f konu\u015fmas\u0131nda ise, \u201cEmraz\u0131 s\u00e2riyeye kar\u015f\u0131 en kat\u00ee tedbir olan a\u015f\u0131lar art\u0131k tamam\u0131yla memleketimizde istihsal olunmaktad\u0131r. \u00dc\u00e7 milyon k\u00fcsur ki\u015filik \u00e7i\u00e7ek a\u015f\u0131s\u0131n\u0131n Sivas\u2019ta istihsal edilmi\u015f oldu\u011funu zikretmek bu bapta k\u00e2fi bir fikir verebilir. Memleketin malaryal\u0131 muhitlerinde miktar\u0131 k\u00e2fi kinin tevzi edildi. Frengi afetinin itfas\u0131 i\u00e7in de m\u00fcmk\u00fcn olan mebl\u00e2\u011f sarf edildi. Ve emraz\u0131 i\u00e7timaiye ile m\u00fccadelemizin daha m\u00fcsmir (<i>etkin<\/i>) ve daha <b>\u015f\u00e2mil<\/b> (<i>kapsaml\u0131<\/i>) bir \u015fekilde ifas\u0131 esbab\u0131 da ihzar edilmi\u015ftir\u201d diyerek s\u0131tmayla m\u00fccadele s\u00f6z konusu edilmi\u015ftir. Yine bundan sonraki d\u00f6nemlerde, mecliste s\u0131tmayla m\u00fccadele i\u00e7in al\u0131nacak \u00e7e\u015fitli tedbirlerin konu\u015fuldu\u011funu ve buna ait uygulamalar\u0131n ba\u015flat\u0131ld\u0131\u011f\u0131n\u0131 g\u00f6rmekteyiz. 1924\u2019te \u0130stanbul Bakteriyolojihanesi\u2019nde bir kurs tertip edilmi\u015f ve e\u011fitimli sa\u011fl\u0131k\u00e7\u0131larla Ankara, Afyon ve Adana m\u0131nt\u0131kalar\u0131nda birer m\u00fccadele merkezi a\u00e7\u0131lm\u0131\u015f, ancak as\u0131l \u00f6nemli ad\u0131m, 13 May\u0131s 1926\u2019da 21 maddeden olu\u015fan S\u0131tmayla M\u00fccadele Kanunu&#8217;nun kabul edilmesi olmu\u015ftur. D\u00fcnyada bir hastal\u0131k hakk\u0131nda \u00e7\u0131kar\u0131lan ilk kanun olan bu kanuna g\u00f6re 3 \u00f6nemli koldan m\u00fccadele planlanm\u0131\u015ft\u0131r; kanlar\u0131nda parazit bulunan hastalar\u0131 tedavi etmek, s\u0131tmay\u0131 yaymalar\u0131n\u0131 \u00f6nlemek i\u00e7in s\u0131tma hastalar\u0131n\u0131 s\u0131tma mikrobu ta\u015f\u0131yan anofellerden uzak tutmak, anofellerin \u00fcremelerine m\u00e2ni olmak ve batakl\u0131klar\u0131 kurutmak. Yasan\u0131n cezaland\u0131rmalar\u0131 da i\u00e7ermesi nedeniyle baz\u0131 k\u00fc\u00e7\u00fck tart\u0131\u015fmalara yol a\u00e7mas\u0131na ra\u011fmen, yasan\u0131n zorunlulu\u011fu ve b\u00fct\u00fcnl\u00fc\u011f\u00fc oybirli\u011fiyle kabul edilmi\u015ftir. \u00dclkemizde yap\u0131lan s\u0131tma sava\u015f\u0131nda yurtta\u015flara da baz\u0131 y\u00fck\u00fcml\u00fcl\u00fckler getirilmi\u015ftir. Bu y\u00fck\u00fcml\u00fcl\u00fcklerden biri de \u201cK\u00fc\u00e7\u00fck Say M\u00fckellefiyeti\u201d olarak bilinen arazi \u00e7al\u0131\u015fmalar\u0131d\u0131r. \u201cK\u00fc\u00e7\u00fck Say\u201d ifadesi herhangi bir yerdeki, k\u00fc\u00e7\u00fck sulak ve batakl\u0131k alanlar\u0131n iyile\u015ftirilip d\u00fczenlenmesi i\u00e7in ki\u015filere d\u00fc\u015fen \u00e7al\u0131\u015fma y\u00fck\u00fcml\u00fcl\u00fc\u011f\u00fc anlam\u0131na gelmektedir. Yukar\u0131da da de\u011findi\u011fimiz gibi s\u00f6z konusu y\u00fck\u00fcml\u00fcl\u00fck uyar\u0131nca ki\u015filere d\u00fc\u015fen g\u00f6rev s\u00fcresi y\u0131lda 5 g\u00fcnd\u00fcr. 15-65 ya\u015f aras\u0131 halk\u0131n kat\u0131ld\u0131\u011f\u0131 bu arazi \u00e7al\u0131\u015fmalar\u0131 i\u00e7in ya\u015f s\u0131n\u0131r\u0131 daha sonra 18-60 ya\u015f aras\u0131na \u00e7ekilmi\u015ftir. Zamanla sakatlar, \u00f6\u011frenci ve askerde bulunanlarla o \u00e7al\u0131\u015fma y\u0131l\u0131 orada bulunmayanlar y\u00fck\u00fcml\u00fcl\u00fck d\u0131\u015f\u0131 b\u0131rak\u0131lm\u0131\u015ft\u0131r. K\u00fc\u00e7\u00fck Say \u00e7al\u0131\u015fmas\u0131n\u0131n bir di\u011fer \u00f6zelli\u011fi, i\u015fg\u00fcc\u00fc olarak y\u00fck\u00fcml\u00fcl\u00fcklerini yerine getirmek istemeyenlerin, y\u00fck\u00fcml\u00fcl\u00fcklerinin kar\u015f\u0131l\u0131\u011f\u0131n\u0131 para olarak \u00f6deyebilmeleridir. Bireylere d\u00fc\u015fen bu y\u00fck\u00fcml\u00fcl\u00fck 1960\u2019tan sonra kald\u0131r\u0131lm\u0131\u015ft\u0131r (17).<\/p>\n<p class=\"p2\">1928\u2019de Adana\u2019da bir S\u0131tma Enstit\u00fcs\u00fc kurulmu\u015f ve bu Enstit\u00fc k\u0131sa s\u00fcrede malaryolojinin en iyi \u00f6\u011fretildi\u011fi\u00a0 merkez durumuna gelmi\u015f, \u00e7\u0131kar\u0131lan kanunla burada asker ve sivil t\u00fcm doktorlar s\u0131tma staj\u0131 yapm\u0131\u015ft\u0131r. Dalak ve kan muayeneleri, batakl\u0131klar\u0131n kurutulmas\u0131, jitlerin ve \u00e7eltik sahalar\u0131n\u0131n kontrol alt\u0131na al\u0131nmas\u0131 ve \u00fccretsiz kinin da\u011f\u0131t\u0131m\u0131yla 1940 y\u0131l\u0131na kadar s\u00fcrd\u00fcr\u00fclen m\u00fccadelede s\u0131tmal\u0131 oran\u0131 %50\u2019lerden %11\u2019e kadar d\u00fc\u015f\u00fcr\u00fcld\u00fc. Bu d\u00fc\u015f\u00fc\u015fte, 1936 y\u0131l\u0131nda \u00e7\u0131kar\u0131lan 3039 say\u0131l\u0131 \u00c7eltik Ekim Kanunu\u2019nun etkisini de hat\u0131rlamak gerekir. Bu kanuna g\u00f6re olu\u015fturulan \u00e7eltik komisyonlar\u0131, \u00e7eltik ekim alanlar\u0131n\u0131n kontrol\u00fc, sulama d\u00fczeni, \u00e7eltik i\u015f\u00e7ilerinin korunmas\u0131 gibi konularda denetleme ve d\u00fczenlemeler yapt\u0131 (18, 19).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">1945\u2019te 4707 say\u0131l\u0131 ola\u011fan\u00fcst\u00fc \u201cS\u0131tma Sava\u015f\u0131 Kanunu\u201d ve \u015eubat 1946\u2019da s\u0131tma sava\u015f\u0131n\u0131 devaml\u0131 y\u00fcr\u00fctmeyi \u00f6ng\u00f6ren 4871 say\u0131l\u0131 \u201cS\u0131tma Sava\u015f\u0131 Kanunu\u201d y\u00fcr\u00fcrl\u00fc\u011fe girdi. S\u0131tmayla m\u00fccadelede laboratuvar, enstit\u00fc ve dispanser say\u0131s\u0131 art\u0131r\u0131lm\u0131\u015f, diklorofeniltrikloroetan (DDT) ve 1949\u2019da mazot ve petrol kullan\u0131lmaya ba\u015flanm\u0131\u015f, b\u00f6ylece sava\u015f y\u0131llar\u0131nda binde 321.3\u2019e kadar \u00e7\u0131kan s\u0131tmal\u0131 oran\u0131 1950\u2019de binde 14.3\u2019e inmi\u015ftir. D\u00fcnyada 1934 y\u0131l\u0131nda klorokin kullan\u0131ma girmi\u015f, 1939\u2019da ise DDT\u2019nin insektisit oldu\u011fu ke\u015ffedilmi\u015ftir. Paul Miller\u2019a bu bulu\u015fu ile Nobel \u00f6d\u00fcl\u00fc kazanm\u0131\u015ft\u0131r (18). \u0130lerleyen y\u0131llarda DDT&#8217;nin \u00e7evrede ve v\u00fccutta birikerek insana toksik etki g\u00f6sterdi\u011fi farkedilmi\u015f ve ayr\u0131ca diren\u00e7li <i>Plasmodium<\/i> t\u00fcrlerinin ortaya \u00e7\u0131kmas\u0131na neden oldu\u011fu tespit edilerek yasaklanm\u0131\u015ft\u0131r. Bug\u00fcn 57 sivrisinek t\u00fcr\u00fcn\u00fcn herhangi bir insektisitle yok olmad\u0131\u011f\u0131 bilinmektedir (20).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">S\u0131tma Sava\u015f\u0131 Kanunu\u2019nda tan\u0131mlanan ve g\u00f6revleri belirlenen s\u0131tma sava\u015f\u0131 memurlar\u0131, s\u0131tmayla m\u00fccadelede \u00f6nemli rol oynam\u0131\u015flard\u0131. Her ne kadar k\u0131s\u0131tl\u0131 e\u011fitim ve tecr\u00fcbeleri olsa da bu memurlar s\u0131tma olgular\u0131n\u0131n ilk te\u015fhisi, s\u0131tma ila\u00e7lar\u0131n\u0131n da\u011f\u0131t\u0131m\u0131, entomolojik g\u00f6zlem, insektisit miktar\u0131n\u0131n takibi ve istatistiksel bilgi toplamada yerel d\u00fczeyde kilit g\u00f6revli idiler. Do\u011frudan h\u00fck\u00fcmet tabibine ba\u011fl\u0131 olan s\u0131tma sava\u015f\u0131 memuru, yakla\u015f\u0131k 15 k\u00f6yden sorumlu olup, ayda iki kez t\u00fcm k\u00f6yleri dola\u015f\u0131rd\u0131. S\u0131tma sava\u015f memurunun \u00f6n tan\u0131s\u0131n\u0131 koydu\u011fu olgular, h\u00fck\u00fcmet tabibi taraf\u0131ndan teyit edilirdi (21).<\/p>\n<p class=\"p2\">1946 y\u0131l\u0131ndaki \u00e7al\u0131\u015fmalar\u0131n kar\u015f\u0131l\u0131\u011f\u0131 al\u0131nm\u0131\u015f ve 1970 y\u0131l\u0131nda s\u0131tma insidans\u0131 y\u00fcz binde 3.55 olmu\u015ftur. Bu tarihten sonra ise gerek sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 ve gerekse halktaki toplumsal duyarl\u0131l\u0131\u011f\u0131n azalmas\u0131 sonucunda \u00fclkemizde 1977 y\u0131l\u0131nda \u00c7ukurova\u2019da (115 512 olgu) (y\u00fcz binde 293) ve 1994 y\u0131l\u0131nda G\u00fcneydo\u011fu Anadolu B\u00f6lgesi\u2019nde (84 345 olgu) (y\u00fcz binde 139.38) iki epidemi ya\u015fanm\u0131\u015ft\u0131r. 1994 y\u0131l\u0131ndaki epidemiden sonra \u00e7al\u0131\u015fmalara h\u0131z verilmi\u015f ve 1998 y\u0131l\u0131nda insidans y\u00fcz binde 57.92\u2019ye gerilemi\u015ftir (21,23).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">Cumhuriyet d\u00f6neminde s\u0131tma epidemileri toplu olarak (1925-2002) \u015eekil 1\u2019de, son y\u0131llardaki s\u0131tma olgu say\u0131lar\u0131 (2002-2017) Tablo 2\u2019de g\u00f6sterilmi\u015ftir.<\/p>\n<h2 class=\"p1\"><b>VEREM<\/b><\/h2>\n<div id=\"attachment_22395\" style=\"width: 529px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22395\" class=\"wp-image-22395 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_12.png\" alt=\"\" width=\"519\" height=\"654\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_12.png 519w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_12-206x260.png 206w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_12-429x540.png 429w\" sizes=\"auto, (max-width: 519px) 100vw, 519px\" \/><p id=\"caption-attachment-22395\" class=\"wp-caption-text\"><strong>Resim 12.<\/strong> Prof. Dr. Nusret Karasu.<\/p><\/div>\n<div id=\"attachment_22397\" style=\"width: 528px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22397\" class=\"wp-image-22397 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_13.png\" alt=\"\" width=\"518\" height=\"652\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_13.png 518w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_13-207x260.png 207w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_13-429x540.png 429w\" sizes=\"auto, (max-width: 518px) 100vw, 518px\" \/><p id=\"caption-attachment-22397\" class=\"wp-caption-text\"><strong>Resim 13. <\/strong>Prof. Dr. Tevfik Sa\u011flam T\u0131p Fak\u00fcltesi Dekanl\u0131\u011f\u0131 s\u0131ras\u0131nda.<\/p><\/div>\n<p class=\"p2\">Osmanl\u0131 d\u00f6neminde padi\u015fah II. Mahmut ve I. Abd\u00fclmecit\u2019in verem nedeniyle \u00f6ld\u00fckleri bilinmektedir. Abd\u00fclmecid\u2019in hareminde bulunan, l8 kad\u0131n\u0131n yar\u0131s\u0131 t\u00fcberk\u00fclozludur. Son padi\u015fah olan Vahdettin Sanremo&#8217;ya s\u0131\u011f\u0131nd\u0131ktan sonra orada \u00f6l\u00fcnce, onu takip eden \u0130talyan doktor, \u00f6l\u00fcm sebebinin koroner arter hastal\u0131\u011f\u0131 oldu\u011funu, ancak sa\u011f akci\u011ferinin t\u00fcberk\u00fclozdan tahrip edilmi\u015f oldu\u011funu rapor etmi\u015ftir (25).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">Cumhuriyet \u00f6ncesi d\u00f6nemde, 1890\u2019da Koch\u2019un t\u00fcberk\u00fclini, tedavi amac\u0131yla kulland\u0131\u011f\u0131n\u0131 a\u00e7\u0131klamas\u0131ndan sonra geli\u015fmelerin yerinde incelenmesini isteyen II. Abd\u00fclhamit bir sa\u011fl\u0131k heyetini Berlin\u2019e g\u00f6ndermi\u015ftir. \u0130nceleme yapan heyet t\u00fcberk\u00fclinin faydalar\u0131 yan\u0131nda zararl\u0131 da olabilece\u011fini bildirmi\u015flerdir. Veremle m\u00fccadelenin tarihi 1895\u2019e, Cemiyeti T\u0131bbiye-i \u015eahane\u2019nin toplanarak, verem sava\u015f programlar\u0131n\u0131n, dernek ve sanatoryumlar\u0131n kurulmas\u0131n\u0131n konu\u015fulmas\u0131na kadar dayan\u0131r. Padi\u015fah\u0131n emriyle veremin yay\u0131lmas\u0131n\u0131 \u00f6nleyici tedbirler al\u0131nm\u0131\u015f, verem hastanesinin kurulmas\u0131 fikri do\u011fmu\u015ftur. Osmanl\u0131\u2019da t\u00fcberk\u00fclin \u00fcretimi ve uygulamas\u0131 1910-1913 y\u0131llar\u0131 aras\u0131nda Bakteriyolojihane-i \u015eahane\u2019de Dr. Osman Nuri Bey taraf\u0131ndan ger\u00e7ekle\u015ftirilmi\u015ftir. II. Abd\u00fclhamit\u2019in emriyle g\u00f6revlendirilen Dr. \u0130brahim Bey\u2019in ba\u015fhekimli\u011finde Etfal Hastane-i \u00c2lisi (1899) hizmete girmi\u015ftir (26). \u0130lk \u00e7ocuk sanatoryumu 24 yatakl\u0131 olarak 1905\u2019te bu hastanede a\u00e7\u0131lm\u0131\u015ft\u0131r. 8 Haziran 1918\u2019de \u0130stanbul\u2019da \u201cVeremle M\u00fccadele Osmanl\u0131 Cemiyeti\u201d Cemal Pa\u015fa\u2019n\u0131n ba\u015fkanl\u0131\u011f\u0131nda kurulmu\u015ftur. Bu derne\u011fin ba\u015fkanl\u0131\u011f\u0131na Dr. Besim \u00d6mer Pa\u015fa se\u00e7ilmi\u015ftir. Bu kurulu\u015flar\u0131n amac\u0131, o y\u0131llarda veremin tedavisi bilinmedi\u011fi i\u00e7in, halk\u0131 ayd\u0131nlatmak ve verem dispanserleri kurulmas\u0131n\u0131 sa\u011flamakt\u0131. O tarihlerde yay\u0131mlanan bir bro\u015f\u00fcrden anla\u015f\u0131ld\u0131\u011f\u0131na g\u00f6re ba\u015fl\u0131ca ama\u00e7 \u201chastalar\u0131n tesellisi, hastal\u0131\u011f\u0131n \u00e7evreye bula\u015fmas\u0131n\u0131 \u00f6nlemek i\u00e7in hastalar\u0131n ve sa\u011flamlar\u0131n e\u011fitimi, yerlere t\u00fck\u00fcrmemeleri i\u00e7in hastalara t\u00fck\u00fcr\u00fck hokkas\u0131 sa\u011flanmas\u0131 ve g\u0131da yard\u0131m\u0131 yap\u0131lmas\u0131\u201d idi. 16 Mart 1920 tarihinde \u0130stanbul\u2019un i\u015fgaliyle dernek \u00e7al\u0131\u015fmalar\u0131 durmu\u015ftur (27-29). Milli T\u0131p Kongrelerinin ilk \u00fc\u00e7\u00fc, \u00f6zellikle bula\u015f\u0131c\u0131 hastal\u0131klarla m\u00fccadelede \u00f6nem arz etmektedir. Nitekim Milli T\u0131p Kongrelerinin ilki 1-3 Eyl\u00fcl 1925\u2019te d\u00fczenlenmi\u015f, s\u0131tma ve verem tedavisi ve m\u00fccadelesi ana g\u00fcndem maddelerinden olmu\u015ftur. 11-13 Eyl\u00fcl 1927\u2019de yap\u0131lan 2. Milli T\u0131p Kongresi\u2019nde ise \u00f6ncelikle trahom ve verem tedavisi, 17-19 Eyl\u00fcl 1929\u2019da ise frengi konu\u015fulmu\u015ftur. Daha sonra 1950\u2019de 11. Milli T\u0131p Kongresi\u2019nin ana temas\u0131 da t\u00fcberk\u00fcloz olmu\u015ftur (30).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">Mustafa Kemal Atat\u00fcrk 1 Mart 1923 tarihli TBMM a\u00e7\u0131l\u0131\u015f konu\u015fmas\u0131nda, \u015fimdiye kadar yeterince tedbir al\u0131nmad\u0131\u011f\u0131n\u0131, bir ba\u015flang\u0131\u00e7 olarak \u0130stanbul\u2019da bir verem tedavihanesinin a\u00e7\u0131lmas\u0131 gereklili\u011fini ortaya koymu\u015f ve ayn\u0131 y\u0131l \u0130stanbul\u2019da ilk verem sava\u015f dispanseri, 1924\u2019te ise Heybeliada Sanatoryumu 16 yatak kapasiteli olarak a\u00e7\u0131lm\u0131\u015ft\u0131r (31).<\/p>\n<p class=\"p2\"><span class=\"s1\">Devlet olanaklar\u0131n\u0131n k\u0131s\u0131tl\u0131 oldu\u011fu o d\u00f6nemde toplumun katk\u0131s\u0131n\u0131n da sa\u011flanmas\u0131 amac\u0131yla verem sava\u015f dernekleri kurulmas\u0131 g\u00fcndeme gelmi\u015ftir. Cumhuriyet d\u00f6nemindeki ilk verem sava\u015f derne\u011fi 1923\u2019te, Dr. Beh\u00e7et Uz ve arkada\u015flar\u0131 taraf\u0131ndan kurulan \u201c\u0130zmir Veremle M\u00fccadele Hayriyesi\u201ddir. Bunu takip eden dernekler \u0130stanbul (1927), Denizli (1944) ve Ankara (1946) dernekleridir. 1948\u2019de \u0130stanbul\u2019da yap\u0131lan 1. Verem Konferans\u0131\u2019nda, o tarihte say\u0131s\u0131 48 olan derneklerin bir \u00e7at\u0131 alt\u0131nda toplanmas\u0131na karar verilerek, \u201cT\u00fcrkiye Ulusal Veremle Sava\u015f Derne\u011fi (TUVSD)\u201d olu\u015fturulmu\u015f ve ba\u015fkanl\u0131\u011f\u0131na Tevfik Sa\u011flam getirilmi\u015ftir (27). Heybeliada Sanatoryumu daha sonraki d\u00f6nemlerde 600 yatak kapasitesine ula\u015fm\u0131\u015f, Tevfik Sa\u011flam T\u00fcberk\u00fcloz E\u011fitim ve G\u00f6steri Merkezi\u2019nin uygulama hastanesi olarak \u00e7al\u0131\u015fm\u0131\u015f ve uluslararas\u0131 alanda ismini duyurmu\u015f (26) ve 2005 y\u0131l\u0131nda tam a\u00e7\u0131klanamayan gerek\u00e7elerle kapat\u0131lm\u0131\u015ft\u0131r.<span class=\"Apple-converted-space\">\u00a0<\/span><\/span><\/p>\n<p class=\"p2\">1950\u2019lerde World Health Organization (WHO) ve United Nations International Children\u2019s Emergency Fund (UNICEF) ile yap\u0131lan anla\u015fmalar ve uluslararas\u0131 ili\u015fkilerin t\u00fcberk\u00fcloz sava\u015f\u0131nda \u00f6nemli etkileri olmu\u015ftur. \u0130stanbul\u2019da \u201cMilletleraras\u0131 Verem Sava\u015f\u0131 Olgunla\u015fma ve G\u00f6steri Merkezi\u201d kurulmas\u0131na karar verilmi\u015f, bu merkez Dr. Etienne Berthet taraf\u0131ndan faaliyete ge\u00e7irilmi\u015ftir. Y\u00f6netim May\u0131s 1952 tarihinde Prof. Dr. Tevfik Sa\u011flam ba\u015fkanl\u0131\u011f\u0131ndaki T\u00fcrk ekibine devredilmi\u015ftir. Tevfik Sa\u011flam T\u00fcberk\u00fcloz E\u011fitim ve G\u00f6steri Merkezi ad\u0131n\u0131 alan bu merkez yapm\u0131\u015f oldu\u011fu ara\u015ft\u0131rmalar ve d\u00fczenlemi\u015f oldu\u011fu kurslarla verem sava\u015f\u0131nda \u00e7al\u0131\u015facak olan bir\u00e7ok yerli, yabanc\u0131 doktor ve yard\u0131mc\u0131 sa\u011fl\u0131k personeline e\u011fitim vermi\u015ftir. 1951 y\u0131l\u0131nda Taksim\u2019de in\u015fa edilen binada \u0130stanbul Verem Sava\u015f\u0131 Derne\u011fi Merkez Bakteriyoloji Laboratuvar\u0131 kurulmu\u015f, idaresi Prof. Dr. Ekrem Kadri Unat\u2019a verilmi\u015ftir. Bu laboratuvarda teksifle mikroskopi, k\u00fclt\u00fcr, diren\u00e7 testleri yap\u0131labiliyor, \u0130stanbul ve \u00e7evresine, Trakya dahil t\u00fcm verem sava\u015f dispanserlerinden gelen \u00f6rneklere cevap verilebiliyordu, bu laboratuvar\u0131n ba\u015far\u0131l\u0131 \u00e7al\u0131\u015fmalar\u0131 devam etmektedir (25-27).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">Bacille Calmette-Gu\u00e9rine (BCG) a\u015f\u0131s\u0131 T\u00fcrkiye\u2019de ilk defa 1926 y\u0131l\u0131nda Prof. Dr. Refik G\u00fcran taraf\u0131ndan veremli annelerden do\u011fan 100 \u00e7ocu\u011fa oral olarak uygulanm\u0131\u015ft\u0131r. Refik Saydam Merkez H\u0131fz\u0131ss\u0131hha Enstit\u00fcs\u00fc\u2019nde 1931 y\u0131l\u0131nda BCG \u00fcretimine ba\u015flanm\u0131\u015f; geni\u015f bir uygulama alan\u0131 bulamam\u0131\u015ft\u0131r. \u0130skandinav \u00fclkelerinde BCG a\u015f\u0131s\u0131yla ilgili yeni geli\u015fmeleri ve uygulama tekniklerini \u00f6\u011frenen sa\u011fl\u0131k ekiplerimizin \u00e7al\u0131\u015fmas\u0131yla BCG a\u015f\u0131s\u0131 \u00fcretimi tekrar ba\u015flat\u0131lm\u0131\u015f, deri i\u00e7i a\u015f\u0131 19.06.1948 tarihinde Prof. Dr. Tevfik Sa\u011flam taraf\u0131ndan ilk defa uygulanm\u0131\u015ft\u0131r. 1980\u2019li y\u0131llardan sonra verem sava\u015f\u0131nda ya\u015fanan gev\u015feme nedeniyle Nisan 1998\u2019de Refik Saydam Merkez H\u0131fz\u0131ss\u0131hha Enstit\u00fcs\u00fc\u2019nde BCG a\u015f\u0131 \u00fcretimi durdurulmu\u015ftur. T\u00fcberk\u00fcloz sava\u015f\u0131n\u0131n ba\u015flang\u0131c\u0131nda yokluk i\u00e7inde yap\u0131lan ba\u015far\u0131l\u0131 \u00e7al\u0131\u015fmalar yads\u0131namaz. 11.04.1949 tarihinde 5368 say\u0131l\u0131 \u201cVerem Sava\u015f<b>\u0131<\/b> Hakk\u0131ndaki Kanun\u201d \u00e7\u0131kar\u0131ld\u0131. Resmi anlamda t\u00fcberk\u00fcloz kontrol<b>\u00fc<\/b> \u00e7al\u0131\u015fmalar\u0131 ba\u015flad\u0131. Ancak sistemli ve kararl\u0131 bir sava\u015f\u0131n ad\u0131mlar\u0131 Prof. Dr. Nusret Karasu\u2019nun May\u0131s 1960\u2019ta Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131\u2019na atanmas\u0131yla ba\u015flam\u0131\u015ft\u0131r. \u0130lk defa \u201cVerem Sava\u015f\u0131 Genel M\u00fcd\u00fcrl\u00fc\u011f\u00fc\u201d kurulmu\u015f ve ba\u015f\u0131na Dr. Hamdi A\u00e7an getirilmi\u015ftir. Bu d\u00f6nemde Milli Verem Sava\u015f\u0131 Program\u0131 olu\u015fturulmu\u015f, t\u00fcm \u00fclkede uygulamaya konulmu\u015ftur. Bu program 5 ana ilkeye dayanmaktad\u0131r:<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<ul>\n<li class=\"p6\">E\u011fitim ve propaganda,<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li class=\"p6\">Koruma,<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li class=\"p6\">Erken tan\u0131,<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li class=\"p6\">Erken tedavi,<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li class=\"p6\">Sosyal yard\u0131m.<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<\/ul>\n<p class=\"p7\">WHO ve UNICEF ile yap\u0131lan anla\u015fmalar \u00e7er\u00e7evesinde 67 il, 570 il\u00e7ede 1953-1972 y\u0131llar\u0131 aras\u0131nda uygulanan BCG kampanyas\u0131yla 63 milyon ki\u015fiye t\u00fcberk\u00fclin testi ve a\u015f\u0131lanmas\u0131 icap eden 28 milyon ki\u015fiye BCG a\u015f\u0131s\u0131 yap\u0131lm\u0131\u015ft\u0131r. 1960 y\u0131l\u0131nda pilot olarak ba\u015flat\u0131l\u0131p 1966\u2019dan 70\u2019li y\u0131llar\u0131n ortas\u0131na kadar programl\u0131 olarak y\u00fcr\u00fct\u00fclen kadastro usul\u00fc ile riskli gruplar\u0131n mikrofilm taramalar\u0131ndaki b\u00fcy\u00fck ba\u015far\u0131larda, Ulusal Verem Sava\u015f\u0131 Derne\u011fi ve mahalli derneklerin yapt\u0131\u011f\u0131 bilimsel ve maddi yard\u0131mlar\u0131n b\u00fcy\u00fck pay\u0131 vard\u0131r. 1967 yaz\u0131nda t\u0131p fak\u00fcltesi 5. s\u0131n\u0131f \u00f6\u011frencisi iken ben de o zaman 17 000 n\u00fcfuslu olan \u00c7anakkale \u015fehir taramas\u0131nda aktif olarak \u00e7al\u0131\u015fm\u0131\u015ft\u0131m.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">\u00dclkemizin ilk fitizyoloji k\u00fcrs\u00fcs\u00fc 1951 y\u0131l\u0131nda Ankara T\u0131p Fak\u00fcltesinde Prof. Dr. Nusret Karasu taraf\u0131ndan, daha sonra Prof. Dr. Tevfik Sa\u011flam\u2019\u0131n giri\u015fimleriyle \u0130stanbul \u00dcniversitesi T\u0131p Fak\u00fcltesi\u2019nde kurulmu\u015ftur. <span class=\"s5\">\u0130lk \u00f6nemli t\u00fcberk\u00fcloz kongresi 1953\u2019te \u0130stanbul\u2019da yap\u0131lm\u0131\u015ft\u0131r. <\/span>Verem Sava\u015f\u0131 Genel M\u00fcd\u00fcrl\u00fc\u011f\u00fc\u2019n\u00fcn 1960 tarihinde hayata ge\u00e7irilmesiyle, B\u00f6lge T\u00fcberk\u00fcloz Laboratuvarlar\u0131 kurulmu\u015ftur. Veremle sava\u015fta streptomisin (SM), para-aminosalisilik asid (PAS), (izoniazid) INH, pirazinamid (PZA) gibi ila\u00e7lar\u0131n yayg\u0131n kullan\u0131lmas\u0131ndan bir s\u00fcre sonra diren\u00e7 sorununun ortaya \u00e7\u0131kmas\u0131, diren\u00e7li hastalar\u0131n tedavi edilecekleri hastanelerde ve diren\u00e7 incelemelerinin yap\u0131laca\u011f\u0131 laboratuvarlarda yeni yap\u0131lanmalar\u0131 zorunlu k\u0131lm\u0131\u015ft\u0131r. Bu projenin altyap\u0131 \u00e7al\u0131\u015fmalar\u0131 1973 y\u0131l\u0131nda tamamlanm\u0131\u015f, Ankara, \u0130stanbul, Bursa, \u0130zmir, Adana, Samsun ve Trabzon illerinde b\u00f6lge laboratuvarlar\u0131 kurulmu\u015ftur. 1952\u2019den 1975 y\u0131l\u0131na kadar planl\u0131 bir anlay\u0131\u015fla y\u00fcr\u00fct\u00fclen t\u00fcberk\u00fcloz sava\u015f\u0131nda ula\u015f\u0131lan durum \u015fu \u015fekildedir: 0-3 ya\u015f grubunda infeksiyon oran\u0131 %0.08\u2019e d\u00fc\u015f\u00fcr\u00fclm\u00fc\u015ft\u00fcr. T\u00fcberk\u00fcloz kaynakl\u0131 \u00f6l\u00fcm oranlar\u0131 y\u00fcz binde 11.9\u2019a gerilemi\u015ftir. Bu geli\u015fmelerin yan\u0131 s\u0131ra kronik t\u00fcberk\u00fclozlularda ila\u00e7 direnci: INH\u2019a %12.8, streptomisine %6.8, iki ilaca diren\u00e7 d\u00fczeyi ise %80.4 olarak ger\u00e7ekle\u015fmi\u015ftir. 1980 y\u0131l\u0131nda aktif hasta oran\u0131 %0.1, basil-pozitif hastalar\u0131n oran\u0131 y\u00fcz binde 15, veremden \u00f6l\u00fcm oran\u0131 y\u00fcz binde 8.8 ve insidans\u0131 y\u00fcz binde 52.23 olmu\u015ftur. 1990\u2019da t\u00fcberk\u00fcloz \u00f6l\u00fcm oran\u0131 %3.2 ye gerilemi\u015ftir. 80\u2019li y\u0131llarda d\u00fcnya genelinde y\u00fcr\u00fct\u00fclmekte olan t\u00fcberk\u00fcloz sava\u015f\u0131nda ya\u015fanan gev\u015feme, AIDS\u2019te t\u00fcberk\u00fclozun f\u0131rsat\u00e7\u0131 infeksiyon olarak art\u0131\u015f g\u00f6stermesi ve ya\u015fanan g\u00f6\u00e7 hareketleri, WHO\u2019yu 1991 y\u0131l\u0131nda yeni bir t\u00fcberk\u00fcloz kontrol\u00fc program\u0131 uygulamaya y\u00f6neltmi\u015ftir. Do\u011fu Avrupa \u00fclkelerinde tedaviye diren\u00e7li olgular\u0131n artmas\u0131 ve 3. d\u00fcnya \u00fclkelerinde ya\u015fanan olumsuz geli\u015fmelerden dolay\u0131 WHO, 1993 y\u0131l\u0131nda \u201cAcil Durum\u201d ilan etmi\u015ftir. Bu yeni anlay\u0131\u015fla Do\u011frudan G\u00f6zetimli Tedavi Stratejisi (DGTS)\/\u201cDirectly Observed Treatment Short Course (DOTS)\u201d ile diren\u00e7 geli\u015fimi \u00f6nlenmesi ama\u00e7lanm\u0131\u015ft\u0131r. 2004 y\u0131l\u0131 verilerine g\u00f6re bakteriyolojik muayene oran\u0131 %30\u2019lardan %70\u2019lere \u00e7\u0131kar\u0131lm\u0131\u015f, hastal\u0131k insidans\u0131ndaki d\u00fc\u015fme devam etmi\u015ftir. 1990\u2019da insidans 44, 1995\u2019te 35.48, 2000\u2019de 26.24, 2003\u2019te 24.31\u2019dir. Mortalite ise 1945 y\u0131l\u0131nda y\u00fcz binde 262 iken 1950\u2019de 204, 1960\u2019ta 55, 1970\u2019te 20, 1980\u2019de 8.8, 1990\u2019da 3.2, 2000\u2019de 1.8\u2019dir. T\u00fcberk\u00fcloz, \u00f6l\u00fcm nedenleri aras\u0131nda 1980 y\u0131l\u0131nda 8. s\u0131rada iken, 2000 y\u0131l\u0131nda 19. s\u0131raya gerilemi\u015ftir. Bir \u00fclkede t\u00fcberk\u00fcloz sava\u015f\u0131, ulusal ve uluslararas\u0131 otoritelerin birlikte planl\u0131, programl\u0131 \u00e7al\u0131\u015fmas\u0131yla ba\u015far\u0131l\u0131 olur. Bu plan ve kararl\u0131l\u0131k i\u00e7inde t\u00fcberk\u00fcloz laboratuvarlar\u0131n\u0131n \u00f6nemi tart\u0131\u015fmas\u0131z \u00e7ok b\u00fcy\u00fckt\u00fcr. Mikobakteri laboratuvar\u0131 t\u00fcberk\u00fcloz kontrol\u00fc ve eradikasyonunda en \u00f6nemli ayaklardan birini olu\u015fturur. Laboratuvar yoksa tan\u0131 yoktur\u2014Tan\u0131 yoksa tedavi yoktur\u2014Tedavi yoksa DGTS yoktur\u2014DGTS yoksa t\u00fcberk\u00fcloz kontrol\u00fc yoktur (32-38).<\/p>\n<p class=\"p2\">Son y\u0131llardaki t\u00fcberk\u00fcloz olgu say\u0131lar\u0131 Tablo 3\u2019te g\u00f6sterilmi\u015ftir.<\/p>\n<p class=\"p2\">\u00dclkemizin en \u00f6nemli sa\u011fl\u0131k sorunlar\u0131ndan biri olan t\u00fcberk\u00fcloz sava\u015f\u0131nda de\u011feri bi\u00e7ilemeyecek katk\u0131lar yapm\u0131\u015f olan Ord. Prof. Dr. Tu\u011fgn. Tevfik Sa\u011flam, Prof. Dr. Nusret Karasu hocalar\u0131 rahmet ve \u015f\u00fckranla an\u0131yorum. Ruhlar\u0131 \u015fad, mekanlar\u0131 cennet olsun.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<h2 class=\"p1\"><b>TRAHOM<\/b><\/h2>\n<div id=\"attachment_22411\" style=\"width: 1078px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_3.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22411\" class=\"wp-image-22411 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_3.png\" alt=\"\" width=\"1068\" height=\"391\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_3.png 1068w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_3-390x143.png 390w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_3-810x297.png 810w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_3-768x281.png 768w\" sizes=\"auto, (max-width: 1068px) 100vw, 1068px\" \/><\/a><p id=\"caption-attachment-22411\" class=\"wp-caption-text\"><strong>Tablo 3.<\/strong> Son Y\u0131llardaki T\u00fcberk\u00fcloz Olgu Say\u0131lar\u0131<\/p><\/div>\n<div id=\"attachment_22413\" style=\"width: 2195px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_4.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22413\" class=\"wp-image-22413 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_4.png\" alt=\"\" width=\"2185\" height=\"879\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_4.png 2185w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_4-390x157.png 390w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_4-810x326.png 810w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Tablo_4-768x309.png 768w\" sizes=\"auto, (max-width: 2185px) 100vw, 2185px\" \/><\/a><p id=\"caption-attachment-22413\" class=\"wp-caption-text\"><strong>Tablo 4. <\/strong>1925-1972 Y\u0131llar\u0131 Aras\u0131nda Trahom Sava\u015f\u0131 \u00c7al\u0131\u015fmalar\u0131<\/p><\/div>\n<p class=\"p2\">Anadolu topraklar\u0131nda sporadik olarak bulunan trahom hastal\u0131\u011f\u0131 Yavuz Sultan Selim taraf\u0131ndan M\u0131s\u0131r seferi d\u00f6n\u00fc\u015f\u00fc halifelikle birlikte ordu arac\u0131l\u0131\u011f\u0131yla \u00fclkemize getirilmi\u015f ve hastal\u0131k Anadolu\u2019da yayg\u0131n hale gelmi\u015ftir.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">Trahom,<i> Chlamydia trachomatis<\/i>\u2019in A, B, Ba ve C serotiplerinin olu\u015fturdu\u011fu keratokonjonktivit, pannus olu\u015fumu ve kirpiklerin i\u00e7eriye do\u011fru b\u00fck\u00fclerek korneada damarla\u015fma ve yaralar olu\u015fmas\u0131 sonucu k\u00f6rl\u00fc\u011fe kadar gidebilen infeksiy\u00f6z bir hastal\u0131kt\u0131r ve bir d\u00f6nem T\u00fcrkiye\u2019de g\u00f6rme kayb\u0131n\u0131n katarakttan sonra ikinci s\u0131kl\u0131kta g\u00f6r\u00fclen nedeni olmu\u015ftur. K\u00f6t\u00fc, hijyenik ko\u015fullar ve \u00e7evre \u015fartlar\u0131 hastal\u0131\u011f\u0131n yay\u0131lmas\u0131n\u0131 kolayla\u015ft\u0131rd\u0131\u011f\u0131 i\u00e7in k\u0131rsal alanlarda daha \u00e7ok g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Gerek Osmanl\u0131 Devleti\u2019nin son y\u00fczy\u0131l\u0131nda gerekse Cumhuriyetin ilk y\u0131llar\u0131nda \u00fclkenin do\u011fu ve g\u00fcneydo\u011fusundaki bir\u00e7ok \u015fehir, kaza ve k\u00f6yler trahomun do\u011furdu\u011fu sonu\u00e7lardan olumsuz bi\u00e7imde etkilenmi\u015f, \u00f6zellikle Ad\u0131yaman, Besni, Gaziantep, Malatya, Kilis ve Urfa gibi yerle\u015fim birimlerinde bu hastal\u0131k yayg\u0131n bir \u015fekilde g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. O kadar ki Ad\u0131yaman i\u00e7in \u201ck\u00f6rler memleketi\u201d denmesi yan\u0131nda, Kilis\u2019te de \u201cK\u00f6rler \u00c7ar\u015f\u0131s\u0131\u201d denen bir yer bulunmakta imi\u015f (39). \u00d6nlenebilir k\u00f6rl\u00fck nedeni olan trahom, yine Cumhuriyet kuruldu\u011fu d\u00f6nemde b\u00fcy\u00fck sa\u011fl\u0131k sorunlar\u0131ndand\u0131. \u0130lk kez trahomla m\u00fccadele karar\u0131 1924\u2019te d\u00f6nemin S\u0131hhat Vekili Refik Saydam\u2019\u0131n, \u00e7e\u015fitli \u015fehirlerdeki g\u00f6z m\u00fctehass\u0131slar\u0131ndan bilgi toplayarak, Ankara Numune Hastanesi g\u00f6z doktoru Vefik H\u00fcsn\u00fc Bolat\u2019\u0131 \u00fc\u00e7 ayl\u0131\u011f\u0131na \u0130\u00e7 ve G\u00fcney Anadolu\u2019ya incelemeler i\u00e7in g\u00f6ndermesiyle ba\u015flam\u0131\u015ft\u0131r. Bolat, yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fma sonu\u00e7lar\u0131n\u0131, 1927\u2019de 2. Milli T\u0131p Kongresi\u2019nde \u201cT\u00fcrkiye\u2019de Trahom Co\u011frafyas\u0131\u201d ad\u0131 alt\u0131nda a\u00e7\u0131klam\u0131\u015f, yine ayn\u0131 kongrede Prof. Dr. Niyazi G\u00f6zc\u00fc de, \u201cTrahom Tedavisi ve Trahomla M\u00fccadele\u201d ad\u0131 alt\u0131nda bildiri sunmu\u015ftur. Bildirilerde bu sa\u011fl\u0131k sorununun bu kadar yay\u0131lmas\u0131n\u0131n sebebinin ihmal ve duyars\u0131zl\u0131k oldu\u011fu vurgulanm\u0131\u015f, ileri derecede yay\u0131lmaya ba\u011fl\u0131 baz\u0131 \u015fehirlerde de\u011fnekle gezenlerin de\u011fneksiz gezenlerden fazla oldu\u011fu bildirilmi\u015ftir (40).<\/p>\n<p class=\"p2\"><span class=\"s3\">\u00dclke genelinde trahoma kar\u015f\u0131 1925 y\u0131l\u0131ndan itibaren sistemli, programl\u0131 ve \u00f6zveriye dayanan bir m\u00fccadele ba\u015flat\u0131lm\u0131\u015ft\u0131r. Ba\u015flang\u0131\u00e7ta Ad\u0131yaman ve Malatya\u2019da a\u00e7\u0131lan trahom hastaneleri, daha sonra trahomun etkiledi\u011fi di\u011fer vilayetlerde de a\u00e7\u0131lm\u0131\u015ft\u0131r. Ayr\u0131ca bu hastanelerin d\u0131\u015f\u0131nda dispanserler, seyyar te\u015fkilatlar ve k\u00f6y tedavi evleri de olu\u015fturulmu\u015ftur. Hastal\u0131\u011f\u0131n yayg\u0131n oldu\u011fu yerlerde her y\u0131l taramalar yap\u0131lm\u0131\u015f, tespit edilen trahomlu hastalar tedavi alt\u0131na al\u0131nm\u0131\u015ft\u0131r. Okullarda da benzer \u00e7al\u0131\u015fmalar y\u00fcr\u00fct\u00fclm\u00fc\u015ft\u00fcr. Gen\u00e7 Cumhuriyete miras olarak kalan bir\u00e7ok b\u00fcy\u00fck sorunun aras\u0131nda e\u011fitim ve sa\u011fl\u0131k \u00f6nde gelen sorunlard\u0131. Trahoma \u00e7ocuklarda s\u0131k rastlanmas\u0131 ve temasla bula\u015fma nedeniyle, trahomlu \u00e7ocuklar\u0131n ayr\u0131lmas\u0131 fikri do\u011fmu\u015ftur. Ki\u015filer aras\u0131 s\u0131k\u0131 temasla bula\u015fan trahomun hasta \u00e7ocuklardan sa\u011flamlara bula\u015fmas\u0131n\u0131 \u00f6nleme yan\u0131nda hasta \u00e7ocuklar\u0131n e\u011fitiminin de aksamamas\u0131 gerekiyordu. Bu ama\u00e7la bu y\u00f6relerde trahomlu \u00e7ocuklar i\u00e7in ayr\u0131 okullar a\u00e7\u0131lmas\u0131 iki sorunun bir arada \u00e7\u00f6z\u00fcm\u00fc i\u00e7in bulunmu\u015f ilgin\u00e7 bir giri\u015fimdir. \u0130lkokul d\u00fczeyinde olan bu okullar\u0131n yan\u0131nda orta \u00f6\u011fretim kurumlar\u0131ndaki hasta \u00e7ocuklar i\u00e7in akut d\u00f6nemden sonra tedaviyle bula\u015f\u0131c\u0131l\u0131k bask\u0131land\u0131ktan sonra okula devam izni verilmekteydi. Tedavi ve kontrol program\u0131 i\u00e7in, 1925\u2019te Ad\u0131yaman\u2019dan ba\u015flamak \u00fczere s\u0131ras\u0131yla Malatya, Gaziantep, Adana, Urfa ve Mara\u015f\u2019ta dispanser veya hastaneler kurulmu\u015ftur. Yine 1930 y\u0131l\u0131nda Gaziantep\u2019te Trahom M\u00fccadele Reisli\u011fi Dr. Nuri Fehmi Ayberk ba\u015fkanl\u0131\u011f\u0131nda kurularak, trahomla m\u00fccadelede Bakanl\u0131k ile ta\u015fran\u0131n ileti\u015fim ve i\u015fbirli\u011fi ama\u00e7lanm\u0131\u015ft\u0131r. Hastane ve dispanserle birlikte k\u00f6y tedavi evleri a\u00e7\u0131lm\u0131\u015f, buralarda g\u00f6revli sa\u011fl\u0131k memurlar\u0131 yak\u0131n \u00e7evredeki k\u00f6ylerden de sorumlu olarak \u00e7al\u0131\u015fm\u0131\u015f ve hizmet yayg\u0131nla\u015ft\u0131r\u0131lm\u0131\u015ft\u0131r. Buralara 15 g\u00fcnde bir gelen tabip tedavileri d\u00fczenlerdi. Seyyar te\u015fkilat ise atl\u0131 sa\u011fl\u0131k memurlar\u0131ndan olu\u015fmaktayd\u0131 ve bunlar\u0131 da denetleyen tabipler mevcuttu. Bu te\u015fkilat baz\u0131 yerlerde seyyar hastane olarak da g\u00f6rev yapmaktayd\u0131 (41).<span class=\"Apple-converted-space\">\u00a0<\/span><\/span><\/p>\n<p class=\"p2\">1954 y\u0131l\u0131ndan sonra, trahom h\u0131zla d\u00fc\u015fmeye ba\u015flam\u0131\u015ft\u0131r. 1960\u2019larda \u00f6nemini kaybetmekle beraber, 22 ilde trahom m\u00fccadelesi devam etmekte idi. 1925\u2019te tespit edilen trahomlu say\u0131s\u0131 %69,9. iken, bu oran 1972\u2019de %2\u2019ye kadar d\u00fc\u015fm\u00fc\u015ft\u00fcr. En son kay\u0131t olarak 1988\u2019de sadece 98 olgu tespit edilmi\u015ftir (41). Bu \u00e7al\u0131\u015fmalar\u0131n sonu\u00e7lar\u0131 Tablo 4\u2019te toplu olarak g\u00f6r\u00fclmektedir.<\/p>\n<h2 class=\"p8\"><b>\u00c7\u0130\u00c7EK<\/b><\/h2>\n<p class=\"p2\">Binlerce y\u0131ld\u0131r insan hayat\u0131n\u0131 hemen her y\u00f6nden etkileyen \u00e7i\u00e7ek hastal\u0131\u011f\u0131, pek \u00e7ok toplum gibi Osmanl\u0131 Devleti ve toplumunu da as\u0131rlarca u\u011fra\u015ft\u0131rm\u0131\u015ft\u0131r. Osmanl\u0131 topraklar\u0131nda \u00e7i\u00e7ekle m\u00fccadele geleneksel y\u00f6ntemlerle ba\u015flam\u0131\u015f ve modern a\u015f\u0131n\u0131n Avrupa\u2019da ke\u015ffedilmesiyle birlikte ithal edilen a\u015f\u0131larla sistematik olarak devam etmi\u015ftir. 1885, 1894, 1903 ve 1915 y\u0131llar\u0131nda \u00e7i\u00e7ek a\u015f\u0131s\u0131yla ilgili d\u00f6rt farkl\u0131 nizamname yay\u0131mlanm\u0131\u015f ve nizamname h\u00fck\u00fcmlerinin ihlaline kar\u015f\u0131 halk\u0131 kanunlarla korkutma yoluna gidilmi\u015ftir. 1892 y\u0131l\u0131nda ilk defa yerli \u00e7i\u00e7ek a\u015f\u0131s\u0131 \u00fcretilmi\u015f ve salg\u0131n b\u00f6lgesine talebe g\u00f6re taze a\u015f\u0131, dolu a\u015f\u0131 kalemi veya \u00e7o\u011falt\u0131lmak \u00fczere bo\u015f a\u015f\u0131 kalemi g\u00f6nderilmi\u015ftir (42).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">20. y\u00fczy\u0131lda d\u00fcnya genelinde yaln\u0131z \u00e7i\u00e7e\u011fe ba\u011fl\u0131 \u00f6l\u00fcm say\u0131s\u0131 300 ila 500 milyon aras\u0131 olup, bu say\u0131, di\u011fer salg\u0131nlar ve sava\u015flardan \u00f6l\u00fcmlerin iki kat\u0131d\u0131r. Tedavisi olmayan hastal\u0131\u011f\u0131n korunma yolunun a\u015f\u0131lanma olmas\u0131 nedeniyle, m\u00fccadele de a\u015f\u0131lamayla yap\u0131l\u0131r. 1892\u2019de \u00f6nce \u0130stanbul\u2019da, daha sonra Mekke, Basra, Sana, Ba\u011fdat, \u015eam ve Sivas\u2019ta yerel a\u015f\u0131 \u00fcretim merkezi kurulmu\u015ftur. Osmanl\u0131\u2019n\u0131n \u00e7\u00f6k\u00fc\u015f\u00fcnden sonra \u0130stanbul ve Sivas d\u0131\u015f\u0131ndaki merkezler la\u011fvedilmi\u015f, Sivastaki \u201cDa-<i>\u00fcl<\/i> Kelp Tedavihanesi ve \u00c7i\u00e7ek A\u015f\u0131s\u0131 Dar\u00fclistihzar\u0131\u201d<i> <\/i>adl\u0131 kurulu\u015f Kurtulu\u015f Sava\u015f\u0131 s\u0131ras\u0131nda da \u00e7i\u00e7ek a\u015f\u0131s\u0131 \u00fcretmeyi s\u00fcrd\u00fcrm\u00fc\u015ft\u00fcr (9). 1921\u2019de 3 269 000 ki\u015filik a\u015f\u0131 \u00fcretilmi\u015ftir. 1928\u2019de \u00e7\u0131kar\u0131lan H\u0131fz\u0131ss\u0131hha Kanunu kapsam\u0131nda yap\u0131lan \u00e7al\u0131\u015fmalar\u0131n da etkisiyle, 1929\u2019da \u0130ran\u2019dan gelen \u00e7i\u00e7ek salg\u0131n\u0131 ba\u015far\u0131yla atlat\u0131lm\u0131\u015ft\u0131r (43). T\u00fcrkiye\u2019de a\u015f\u0131lama hizmetlerinin rutin olarak verilmesine 1930\u2019da ba\u015flanm\u0131\u015f, \u00f6nce \u00e7i\u00e7ek, daha sonra s\u0131ras\u0131yla difteri, bo\u011fmaca, tetanos, BCG, polio ve k\u0131zam\u0131k a\u015f\u0131lar\u0131 uygulamaya girmi\u015ftir. 1938\u2019de \u0130ran, 1942-1944\u2019te Suriye ve Irak\u2019tan ge\u00e7en geni\u015f bir \u00e7i\u00e7ek salg\u0131n\u0131 olmu\u015ftur. A\u015f\u0131 ve koruyucu tedbirlerle 1944\u2019te salg\u0131n tamam\u0131yla durdurulmu\u015ftur. 1950-60 y\u0131llar\u0131 aras\u0131nda toplam 14 431 000 \u00e7i\u00e7ek a\u015f\u0131lamas\u0131 yap\u0131lm\u0131\u015f olup, 1957\u2019den sonra \u00e7i\u00e7ek olgusu g\u00f6r\u00fclmemi\u015ftir. A\u015f\u0131lama program\u0131 t\u00fcm d\u00fcnyada 1977 y\u0131l\u0131nda bitirilmi\u015f olup en son a\u015f\u0131lama 1980\u2019de yap\u0131lm\u0131\u015ft\u0131r (43).<\/p>\n<h2 class=\"p1\"><b>FRENG\u0130<\/b><\/h2>\n<p class=\"p2\">Bir\u00e7ok b\u00fcy\u00fck sava\u015f\u0131n, felaketin ve yoklu\u011fun sonu\u00e7lar\u0131n\u0131 ya\u015fayan, yeni bir devlet kurmaya \u00e7al\u0131\u015fan \u00fclkemizin cinsel yolla bula\u015fan hastal\u0131klar (CYBH) ile m\u00fccadelesinin, aile kurumunun etkilenmesi ve sa\u011fl\u0131k denetimlerinin de yoklu\u011fu nedeniyle hem \u00f6nemli hem de g\u00fc\u00e7 oldu\u011fu anla\u015f\u0131lmaktad\u0131r. Nitekim o s\u0131ralar en s\u0131k g\u00f6r\u00fclen CYBH olan sifilis \u00f6zellikle \u0130stanbul ba\u015fta olmak \u00fczere artmakta ve bula\u015f\u0131n yay\u0131lmas\u0131 durdurulamamaktad\u0131r. 1883 y\u0131l\u0131nda ordumuzda g\u00f6rev alan Alman Generali Baron Von der Goltz bir\u00e7ok yeni erin frengili oldu\u011funu g\u00f6rerek padi\u015faha bu konuda bir rapor sunmu\u015ftur. Bunun \u00fczerine \u00fclkemize gelerek 1889-1902 y\u0131llar\u0131 aras\u0131nda g\u00f6rev yapan Mekteb-i T\u0131bbiye-i \u015e\u00e2h\u00e2ne\u2019nin Emr\u00e2z\u0131-\u0131 Cildiye ve Efrenciye Hocas\u0131 During Pa\u015fa ba\u015fkanl\u0131\u011f\u0131nda bir sa\u011fl\u0131k komisyonu toplanm\u0131\u015f ve \u00fclke \u00e7ap\u0131nda bir frengi sava\u015f\u0131 raporu haz\u0131rlanm\u0131\u015ft\u0131r (44). 1896\u2019da Kastamonu ve y\u00f6resinde frenginin y\u00fcksek oranda g\u00f6r\u00fclmesi nedeniyle m\u00fccadeleye buradan ba\u015flanmas\u0131na karar verilir ve Kastamonu Vilayeti ve Bolu Sanca\u011f\u0131 Frengi M\u00fccadelesi Te\u015fkilat\u0131 Nizamnamesi y\u00fcr\u00fcrl\u00fc\u011fe girer (45).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">O b\u00f6lgede hastal\u0131k s\u0131kl\u0131\u011f\u0131n\u0131n nedeni olarak Kastamonu\u2019da halk\u0131n i\u015f bulamad\u0131\u011f\u0131 i\u00e7in \u0130stanbul ve di\u011fer b\u00fcy\u00fck \u015fehirlere gitmeleri, pahal\u0131 bir \u00e7evrede ailelerini ge\u00e7indiremediklerinden bekar ve sefil bir hayat s\u00fcrmeleri sonucu olarak hastal\u0131\u011f\u0131 kendi b\u00f6lgelerine de yaymalar\u0131 g\u00f6sterilir. Di\u011fer bir neden de ba\u015fka yerlerde askerlik yapanlar\u0131n hastal\u0131\u011f\u0131n yay\u0131lmas\u0131nda etken olmalar\u0131d\u0131r. Gayri me\u015fru ili\u015fkiler, ki\u015filerin bilgisizlikleri, e\u011fitimsizlikleri, sa\u011fl\u0131ks\u0131z evlilikler hastal\u0131\u011f\u0131n yay\u0131lmas\u0131na neden olmu\u015ftur. O d\u00f6nemde \u015fehirler i\u00e7indeki han, hamam, otel gibi tesisler hastal\u0131\u011fa sebep oldu\u011fu gerek\u00e7esiyle daha fazla kontrol edilmi\u015ftir.<\/p>\n<p class=\"p2\">1919-1920 y\u0131llar\u0131nda 6510 kad\u0131n frengi ve bel so\u011fuklu\u011fu nedeniyle Emraz\u0131 Z\u00fchreviye Hastanesi\u2019ne yat\u0131r\u0131lm\u0131\u015ft\u0131. O d\u00f6nemde Bol\u015fevik ihtilalinden ka\u00e7an binlerce Rus\u2019un \u0130tilaf devletleri taraf\u0131ndan \u0130stanbul\u2019a getirilmesi, \u00f6zellikle \u0130stanbul\u2019da hastal\u0131\u011f\u0131n artmas\u0131na sebep olmu\u015ftu (31). Bu d\u00f6neme ait ilk yasal \u00e7al\u0131\u015fma, 18 Ekim 1915 tarihinde \u201cEmraz\u0131 Z\u00fchreviyenin Men-i Sirayeti\u201d (Z\u00fchrevi Hastal\u0131klar\u0131n Yay\u0131lmas\u0131n\u0131n Engellenmesi) hakk\u0131nda bir nizamname \u00e7\u0131kar\u0131larak y\u00fcr\u00fcrl\u00fc\u011fe konulmu\u015ftur. Bu nizamnameye g\u00f6re, z\u00fchrevi hastal\u0131klar\u0131n yay\u0131lmas\u0131n\u0131 ve bula\u015fmas\u0131n\u0131 engellemek amac\u0131yla \u00f6zel \u00f6rg\u00fct kurulacak, bu \u00f6rg\u00fct \u0130stanbul\u2019da Polis Genel M\u00fcd\u00fcrl\u00fc\u011f\u00fc\u2019ne, ta\u015frada m\u00fclki idareye ba\u011fl\u0131 olarak \u00e7al\u0131\u015facakt\u0131r. Z\u00fchrevi hastal\u0131\u011f\u0131 bulunan bir ki\u015fiyi muayeneden ka\u00e7\u0131ranlara, ba\u015fka bir ki\u015fiyle ili\u015fkide bulunmas\u0131na arac\u0131l\u0131k edenlere cezai h\u00fck\u00fcmler uygulanacak, bu su\u00e7lar\u0131n i\u015flendi\u011fi umuma ait binalar da ge\u00e7ici veya s\u00fcrekli olarak kapat\u0131lacaklard\u0131r. 23-26 Haziran 1920 tarihinde, bu nizamnamede Polis Genel M\u00fcd\u00fcrl\u00fc\u011f\u00fc ile Sa\u011fl\u0131k Genel M\u00fcd\u00fcrl\u00fc\u011f\u00fc\u2019n\u00fcn \u00f6nceki istekleri do\u011frultusunda de\u011fi\u015fiklik yap\u0131larak inzibatla ilgili i\u015fler Polis M\u00fcd\u00fcrl\u00fc\u011f\u00fc\u2019ne, sa\u011fl\u0131k ve idareyle ilgili i\u015fler de Sa\u011fl\u0131k Genel M\u00fcd\u00fcrl\u00fc\u011f\u00fc\u2019ne ba\u011flanm\u0131\u015f, Polis Genel M\u00fcd\u00fcrl\u00fc\u011f\u00fc\u2019ne ba\u011fl\u0131 olan Z\u00fchrevi Hastal\u0131klarla M\u00fccadele Tesisleri de Sa\u011fl\u0131k M\u00fcd\u00fcrl\u00fc\u011f\u00fc\u2019ne devredilmi\u015ftir (17). Yine 1919 y\u0131l\u0131nda frengiyle ilgili yap\u0131lan bilimsel giri\u015fim olarak, ba\u015fkan\u0131 Dr. Menahem Hodra olan Emraz\u0131 Cildiye ve Efrenciye Derne\u011fi ve edit\u00f6r\u00fc Dr. \u015e\u00fckr\u00fc Mehmet Seban olan, <i>Emraz\u0131 Cildiye ve Efrenciye Dergisi<\/i>\u2019ni saymak gerekir. Bu dergi 1934-1947 y\u0131llar\u0131 aras\u0131nda Hulusi Beh\u00e7et\u2019in edit\u00f6rl\u00fc\u011f\u00fcnde \u201cDeri Hastal\u0131klar\u0131 ve Frengi Ar\u015fivi\u201d ad\u0131n\u0131 alm\u0131\u015ft\u0131. Hulusi Beh\u00e7et\u2019in sifilis \u00fczerine \u00f6nemli \u00e7al\u0131\u015fmalar\u0131 ve yay\u0131mlanm\u0131\u015f bir kitab\u0131 mevcuttur (46). 1921 y\u0131l\u0131nda 90 numaral\u0131 \u201cFrenginin Men-i Sir\u00e2yet ve \u0130nti\u015f\u00e2r\u0131n\u0131n Tahdidi Kanunu\u201d ile frengililerin devlet taraf\u0131ndan paras\u0131z tedavisi m\u00fcmk\u00fcn olmu\u015f, hastan\u0131n kimli\u011fi a\u00e7\u0131klanmadan ihbar\u0131, hastan\u0131n kendini tedavi ettirmesinin mecburiyeti, bilerek bula\u015ft\u0131rmas\u0131 durumunda cezaland\u0131r\u0131lmas\u0131, frengi hastas\u0131na zorluk \u00e7\u0131karan tabibin de cezaland\u0131r\u0131lmas\u0131 gibi maddeler d\u00fczenlenmi\u015ftir (17, 18)). 1925 y\u0131l\u0131nda Frengi Komisyonu olu\u015fturulmu\u015f ve bu komisyonun \u00e7al\u0131\u015fmalar\u0131 do\u011frultusunda, 1926 y\u0131l\u0131ndan itibaren, hastal\u0131\u011f\u0131n s\u0131k g\u00f6r\u00fcld\u00fc\u011f\u00fc \u015fehirlerde \u00f6zel m\u00fccadele planlanm\u0131\u015ft\u0131r. 1933 y\u0131l\u0131na kadar Sivas, Bursa, Ordu, Bal\u0131kesir ve Zonguldak \u015fehirlerinde \u00e7al\u0131\u015fmalar yo\u011funluk kazanm\u0131\u015ft\u0131r. 1940\u2019ta mevcut 170 177 frengili say\u0131s\u0131 1950\u2019de 118 169\u2019a d\u00fc\u015fm\u00fc\u015ft\u00fcr. \u00dcsk\u00fcdar Mirahor Belediye Dispanseri\u2019nde, Haseki Nisa Hastanesi\u2019nde, Cerrahpa\u015fa Hastanesi Poliklinikleri\u2019nde, \u015ei\u015fli Z\u00fchrevi Hastal\u0131klar Hastanesi\u2019nde \u00fccretsiz muayene ve tedavi imkanlar\u0131 sa\u011flanm\u0131\u015f, Y\u0131ld\u0131z Askeri Hastanesi ile Be\u015fikta\u015f\u2019taki Gaziosmanpa\u015fa Mektebi Sultanisi de Z\u00fchrevi Hastal\u0131klar Hastanesi\u2019ne d\u00f6n\u00fc\u015ft\u00fcr\u00fclm\u00fc\u015ft\u00fcr. B\u00fct\u00e7edeki \u00f6deneklerin art\u0131r\u0131lmas\u0131n\u0131n yan\u0131 s\u0131ra tiyatro gelirlerinin be\u015fte biri de bu \u00e7al\u0131\u015fmalara ayr\u0131lm\u0131\u015ft\u0131r.<\/p>\n<p class=\"p2\">1948 y\u0131l\u0131nda Tokat, Giresun, Samsun, Karadeniz Ere\u011flisi, U\u015fak ve \u00c7orum \u015fehirlerinde 6 Frengi Sava\u015f Kurulu Ba\u015fkanl\u0131\u011f\u0131 faaliyette bulunmaktad\u0131r; 1949 y\u0131l\u0131na kadar 68 il ve il\u00e7enin, 6349 k\u00f6y\u00fcn taramalar\u0131 yap\u0131lm\u0131\u015ft\u0131r. 1951 y\u0131l\u0131nda \u00fc\u00e7\u00fc \u0130stanbul\u2019da, biri Ankara, biri \u0130zmir\u2019de olmak \u00fczere be\u015f z\u00fchrevi hastal\u0131klar hastanesiyle 19 z\u00fchrevi hastal\u0131klar dispanser poliklini\u011fi hizmet vermi\u015ftir (46). Penisilinin tedaviye eklenmesiyle tedavi s\u00fcreleri k\u0131salm\u0131\u015ft\u0131r. 1957 y\u0131l\u0131nda kabul edilen yeni Frengi Tedavi Y\u00f6netmeli\u011fi ile k\u0131sa s\u00fcrede ve etkili bir tedavi olana\u011f\u0131 sa\u011flanm\u0131\u015f ve bu y\u00f6netmelik 1964 y\u0131l\u0131nda tekrar g\u00f6zden ge\u00e7irilerek son \u015feklini alm\u0131\u015ft\u0131r. 1961 y\u0131l\u0131nda yay\u0131mlanan genelgede memleketimizde yeni frengi olgular\u0131n\u0131n artmakta oldu\u011fu belirtilmi\u015ftir. Ahlak zab\u0131tas\u0131nca fuhu\u015f yapanlar\u0131n ve bu halleri mahalli fuhu\u015fla m\u00fccadele komisyonlar\u0131nca da tespit edilmi\u015f olanlar\u0131n her on g\u00fcnde bir z\u00fchrevi muayeneden ge\u00e7irilmeleri gere\u011fi bildirilmi\u015ftir.<\/p>\n<p class=\"p2\">Devlet \u0130statistik Enstit\u00fcs\u00fc\u2019n\u00fcn verilerine g\u00f6re 1991 y\u0131l\u0131nda 16 deri ve tenas\u00fcl hastal\u0131klar\u0131 dispanseri mevcut iken 1998\u2019de 12 dispanser hizmet vermektedir. 1991\u2019de 3785 ki\u015fi kaydedilmi\u015ftir. Ayr\u0131ca bir adet Lepra-Deri ve Z\u00fchrevi Hastal\u0131klar Hastanesi ve 2014 y\u0131l\u0131 ilk alt\u0131 ay verilerine g\u00f6re 209 yeni olgumuz mevcuttur (47).<\/p>\n<p class=\"p2\">Sonu\u00e7 olarak, frengi modern tedavi olanaklar\u0131 sayesinde toplumsal sorun olmaktan \u00e7\u0131km\u0131\u015f durumdad\u0131r. 1915 y\u0131l\u0131nda \u00e7\u0131kar\u0131lan nizamnameyle ba\u015flayan frengi sava\u015f\u0131m\u0131 en son 1983 y\u0131l\u0131nda \u00e7\u0131kar\u0131lan y\u00f6netmeli\u011fin 06.07.2019 tarihinde \u00e7\u0131kar\u0131lan bir y\u00f6netmelikle y\u00fcr\u00fcrl\u00fckten kald\u0131r\u0131lmas\u0131yla resmen sona ermi\u015ftir.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<h2 class=\"p1\"><b>LEPRA (C\u00dcZAM)<\/b><\/h2>\n<div id=\"attachment_22399\" style=\"width: 531px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22399\" class=\"wp-image-22399 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_14.png\" alt=\"\" width=\"521\" height=\"654\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_14.png 521w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_14-207x260.png 207w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_14-430x540.png 430w\" sizes=\"auto, (max-width: 521px) 100vw, 521px\" \/><p id=\"caption-attachment-22399\" class=\"wp-caption-text\"><strong>Resim 14.<\/strong> Prof. Dr. Ethem Utku.<\/p><\/div>\n<div id=\"attachment_22401\" style=\"width: 532px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-22401\" class=\"wp-image-22401 size-full\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_15.png\" alt=\"\" width=\"522\" height=\"654\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_15.png 522w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_15-208x260.png 208w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/04\/kd.2021.02_Resim_15-431x540.png 431w\" sizes=\"auto, (max-width: 522px) 100vw, 522px\" \/><p id=\"caption-attachment-22401\" class=\"wp-caption-text\"><strong>Resim 15. <\/strong>Prof. Dr. T\u00fcrkan Saylan.<\/p><\/div>\n<p class=\"p2\">Olu\u015fturdu\u011fu anatomik bozukluklar nedeniyle insanl\u0131k tarihi boyunca en korkutucu hastal\u0131klardan biri olan c\u00fczam, bir\u00e7ok edebi esere konu olmu\u015f tarihi bir hastal\u0131kt\u0131r. Bir\u00e7ok dinde c\u00fczaml\u0131lar\u0131n Tanr\u0131 taraf\u0131ndan cezaland\u0131r\u0131lm\u0131\u015f kabul edilmesi ve insandan insana \u00e7ok yak\u0131n temasla bula\u015fmas\u0131 nedeniyle bu hastalar toplumdan d\u0131\u015flanm\u0131\u015flar, en ilkel ko\u015fullarda tecrit edilmi\u015flerdir. Sinema tarihinin \u015faheserlerinden olan 1959 yap\u0131m\u0131 Ben-Hur filminde de c\u00fczam konusu i\u015flenmi\u015ftir.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p class=\"p2\">Anadolu topraklar\u0131nda antik \u00e7a\u011flardan beri varl\u0131\u011f\u0131 bilinen c\u00fczam sava\u015f\u0131nda Bizans d\u00f6neminde ba\u015fta \u0130stanbul (5 adet) olmak \u00fczere Anadolu\u2019da \u00e7ok say\u0131da c\u00fczam \u00fcnitesi (Lepr\u00f6z\u00f6ri) bulundu\u011fu, Osmanl\u0131 d\u00f6neminde de imparatorlu\u011fun her taraf\u0131nda c\u00fczam \u00fcnitesi (c\u00fczamhane-miskinhane) varl\u0131\u011f\u0131 bildirilmektedir. (48,49). Osmanl\u0131 \u0130mparatorlu\u011fu zaman\u0131nda (19. y\u00fczy\u0131l sonlar\u0131), Dr. Dimitros Zambako Pa\u015fa\u2019ya g\u00f6re memlekette 600 000\u2019den fazla lepral\u0131 vard\u0131. \u00dcsk\u00fcdar\u2019da, Karacaahmet yan\u0131ndaki tekkede hasta say\u0131s\u0131n\u0131n 25-40 oldu\u011fu kaydedilmi\u015fti. Prof. Dr. Mazhar Osman Usman, hastalar\u0131 Topta\u015f\u0131\u2019ndaki Ak\u0131l Hastanesi\u2019nin bir ko\u011fu\u015funa ta\u015f\u0131m\u0131\u015ft\u0131r. Bu hastane 1919 y\u0131l\u0131nda Bak\u0131rk\u00f6y\u2019e ta\u015f\u0131n\u0131nca, lepral\u0131lar da hastaneden epey uzakta in\u015fa edilen 28. Servis ad\u0131 verilen bir b\u00f6l\u00fcme ta\u015f\u0131nm\u0131\u015ft\u0131r. Dr. Mazhar Osman, Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 i\u015fbirli\u011fiyle 1941 y\u0131l\u0131nda Elaz\u0131\u011f C\u00fczzam Hastanesi\u2019ni de in\u015fa ettirmi\u015ftir (50). Prof. Dr. Etem Utku 1961 y\u0131l\u0131nda yay\u0131nlad\u0131\u011f\u0131 <i>Lepra ve Modern Anlam\u0131<\/i> kitab\u0131nda 20 000 lepral\u0131dan s\u00f6z etmektedir (51). Ayn\u0131 y\u0131llarda Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 istatistiklerine g\u00f6re ise 1964 y\u0131l\u0131nda toplam 3439, 1967\u2019de toplam 3429 olgudan s\u00f6z edilmektedir. C\u00fczam Sava\u015f\u0131 \u00e7al\u0131\u015fmalar\u0131 bakanl\u0131k b\u00fcnyesindeki Sa\u011fl\u0131k \u0130\u015fleri Genel M\u00fcd\u00fcrl\u00fc\u011f\u00fc taraf\u0131ndan y\u00fcr\u00fct\u00fclmektedir. C\u00fczam sava\u015f\u0131 \u00e7al\u0131\u015fmalar\u0131n\u0131 y\u00fcr\u00fctmek \u00fczere 1962 y\u0131l\u0131nda Genel M\u00fcd\u00fcrl\u00fc\u011fe ba\u011fl\u0131 olarak Ankara, Bitlis, Erzurum, Kars, Mara\u015f, Mu\u015f, Sivas ve Van illerinde olmak \u00fczere 9 c\u00fczam sava\u015f dispanseri a\u00e7\u0131lm\u0131\u015f, daha sonra 2 dispanser daha a\u00e7\u0131larak dispanser say\u0131s\u0131 11\u2019e \u00e7\u0131kar\u0131lm\u0131\u015ft\u0131r. Di\u011fer taraftan El\u00e2z\u0131\u011f\u2019da 265 yatakl\u0131 c\u00fczam hastanesi, Ankara\u2019da Ankara \u00dcniversitesi T\u0131p Fak\u00fcltesi Cebeci kamp\u00fcs\u00fcnde 60 yatakl\u0131 <i>Lepra E\u011fitim<\/i>\u00a0ve Ara\u015ft\u0131rma \u00dcnitesi ile \u0130stanbul Bak\u0131rk\u00f6y Ak\u0131l ve Sinir Hastal\u0131klar\u0131 Hastanesi b\u00fcnyesindeki 100 yatakl\u0131 C\u00fczaml\u0131lar Pavyonu yatakl\u0131 tedavi kurumu olarak hizmet vermi\u015ftir (46).<\/p>\n<p class=\"p2\">1980\u2019li y\u0131llardan itibaren etkin tedavisi bilinen lepra olgular\u0131n\u0131n say\u0131s\u0131 gerek d\u00fcnyada gerekse \u00fclkemizde giderek azalmaktad\u0131r. Yeni olgular\u0131n %81\u2019inin ortaya \u00e7\u0131kt\u0131\u011f\u0131 Hindistan, Brezilya ve Endonezya\u2019da her y\u0131l 10 000\u2019den fazla yeni olgu g\u00f6r\u00fclmektedir. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 verilerine g\u00f6re T\u00fcrkiye\u2019de 570 kay\u0131tl\u0131 c\u00fczzam hastas\u0131 bulundu\u011fu kaydedilmektedir. (52). Halen Elaz\u0131\u011f C\u00fczam Hastanesi kapat\u0131larak Devlet Hastanesine d\u00f6n\u00fc\u015ft\u00fcr\u00fclm\u00fc\u015f olup hastalar\u0131 Palyatif Servis ad\u0131 verilen bir serviste bak\u0131m alt\u0131ndad\u0131r. \u0130stanbul\u2019daki hastane Deri ve Z\u00fchrevi Hastal\u0131klar Hastanesi ile birle\u015ftirilerek hizmet vermeye devam etmektedir. Ankara\u2019da ise Ankara \u00dcniversitesi T\u0131p Fak\u00fcltesi Dermatoloji Anabilim Dal\u0131\u2019na ba\u011fl\u0131 merkez hasta yoklu\u011fu nedeniyle kapat\u0131lm\u0131\u015ft\u0131r.<\/p>\n<p class=\"p2\">Lepra sava\u015f\u0131m\u0131ndaki ba\u015far\u0131 \u00f6yk\u00fcs\u00fcnde \u00fclkemizde 2 isim unutulmamas\u0131 ve sayg\u0131yla an\u0131lmas\u0131 gerekenlerin ba\u015f\u0131nda gelmektedir. Bunlardan birincisi, T\u00fcrkiye\u2019de lepraya dikkati \u00e7eken, ilk \u00e7al\u0131\u015fmalar\u0131 ba\u015flatan, lepra sava\u015f\u0131n\u0131n temellerini olu\u015fturan Prof. Dr. Etem Utku\u2019dur (Resim 14). Kendisi lepra \u00e7al\u0131\u015fmalar\u0131 s\u0131ras\u0131nda 1964 y\u0131l\u0131nda Van-Hakkari yolunda trafik kazas\u0131nda ya\u015fam\u0131n\u0131 yitirmi\u015ftir. \u0130kincisi ise yak\u0131n bir ge\u00e7mi\u015fte yitirdi\u011fimiz, t\u00fcm d\u00fcnyan\u0131n \u00e7ok iyi tan\u0131d\u0131\u011f\u0131 Prof. Dr. T\u00fcrkan Saylan\u2019d\u0131r (Resim 15). Bu iki b\u00fcy\u00fck insan lepral\u0131larla b\u00fct\u00fcnle\u015fmi\u015fler ve lepran\u0131n yaln\u0131zca bir hastal\u0131k de\u011fil ayn\u0131 zamanda sosyok\u00fclt\u00fcrel bir olay oldu\u011funu t\u00fcm kamuoyuna kabul ettirmi\u015flerdir. Her ikisini de rahmet ve minnetle an\u0131yorum.<\/p>\n<p class=\"p2\">Yukar\u0131da anlat\u0131lan sava\u015f\u0131m \u00e7al\u0131\u015fmalar\u0131nda ba\u015far\u0131ya, \u00f6zellikle a\u015f\u0131s\u0131 olan hastal\u0131klara kar\u015f\u0131 a\u015f\u0131lar\u0131n Sultan II. Abd\u00fclhamit d\u00f6neminden ba\u015flayarak \u00fclkede \u00fcretilmesi gayretleri sayesinde ula\u015f\u0131lm\u0131\u015ft\u0131r. 1980\u2019li y\u0131llar\u0131n ortalar\u0131na kadar \u00fclkenin rutin a\u015f\u0131 ve serum ihtiyac\u0131n\u0131n hemen t\u00fcm\u00fcn\u00fc kar\u015f\u0131layan Refik Saydam Merkez H\u0131fz\u0131ss\u0131hha Enstit\u00fcs\u00fc o y\u0131llardan itibaren mevcut iktidar taraf\u0131ndan piyasa ekonomisi gerek\u00e7esiyle ad\u0131m ad\u0131m \u00e7\u00f6kertilmi\u015f ve \u00fcretim yapamaz hale getirilmi\u015ftir. Bug\u00fcnlerde antijenden ba\u015flayarak difteri, bo\u011fmaca, tetanoz a\u015f\u0131s\u0131 \u00fcretimi \u00e7al\u0131\u015fmalar\u0131n\u0131n yerli ve milli a\u015f\u0131 slogan\u0131yla tekrar ba\u015flat\u0131ld\u0131\u011f\u0131n\u0131 sevinerek \u00f6\u011frenmi\u015f bulunuyorum.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>G\u0130R\u0130\u015e Anadolu, en eski insan yerle\u015fimi olan G\u00f6beklitepe gibi M.\u00d6. 10 000 y\u0131l\u0131ndan bu yana \u00e7a\u011flar boyu \u00e7ok say\u0131da medeniyete yurt olmu\u015f, bir\u00e7ok kavmin istilas\u0131na ve g\u00f6\u00e7lere sahne olmu\u015f bir co\u011frafyad\u0131r. Do\u011fald\u0131r ki bu istila ve g\u00f6\u00e7ler s\u0131ras\u0131nda \u00e7ok say\u0131da bula\u015f\u0131c\u0131 hastal\u0131k bu topraklara ta\u015f\u0131nm\u0131\u015f ve yerle\u015fik duruma ge\u00e7mi\u015ftir. Osmanl\u0131\u2019da modern anlamda sistematik t\u0131p e\u011fitiminin [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":22570,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5127],"tags":[],"class_list":["post-22115","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-derleme"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/22115","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=22115"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/22115\/revisions"}],"predecessor-version":[{"id":22902,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/22115\/revisions\/22902"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/22570"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=22115"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=22115"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=22115"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}