{"id":30407,"date":"2025-06-28T17:22:06","date_gmt":"2025-06-28T14:22:06","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=30407"},"modified":"2025-06-29T12:43:04","modified_gmt":"2025-06-29T09:43:04","slug":"doktor-milasli-ismail-hakki","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2025\/06\/28\/doktor-milasli-ismail-hakki\/","title":{"rendered":"Osmanl\u0131\u2019da S\u0131tma ile M\u00fccadele ve S\u0131tma ile M\u00fccadelenin \u00d6nc\u00fcs\u00fc Doktor Milasl\u0131 \u0130smail Hakk\u0131\u2019n\u0131n S\u0131tma ve S\u0131tmal\u0131 Yerlerde \u00c7are<\/i> Ris\u00e2lesinin De\u011ferlendirilmesi"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/h2>\n

S\u0131tma etkeni hen\u00fcz bilinmezken, hastal\u0131\u011f\u0131n \u00e7o\u011funlukla batakl\u0131k alanlara yak\u0131n yerlerde yayg\u0131n olarak g\u00f6r\u00fclmesi nedeniyle, batakl\u0131klar\u0131n \u00fcretti\u011fi k\u00f6t\u00fc kokular\u0131n solunmas\u0131yla bula\u015ft\u0131\u011f\u0131na inan\u0131l\u0131yordu. Antik M\u0131s\u0131r, \u00c7in ve Hint t\u0131bb\u0131na dair g\u00fcn\u00fcm\u00fcze ula\u015fan belgelerde s\u0131tman\u0131n varl\u0131\u011f\u0131ndan s\u00f6z edilmekte olup bu hastal\u0131\u011f\u0131n insanl\u0131k tarihi kadar eski oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmektedir. Yakla\u015f\u0131k 30 milyon y\u0131ll\u0131k jeolojik katmanlarda sivrisinek fosillerine rastlanmas\u0131 da s\u0131tman\u0131n insan sa\u011fl\u0131\u011f\u0131 \u00fczerindeki etkisinin \u00e7ok eski d\u00f6nemlere dayand\u0131\u011f\u0131n\u0131 g\u00f6stermektedir. Bu nedenle, baz\u0131 \u00e7evrelerde s\u0131tma t\u0131bb\u0131n tan\u0131mlad\u0131\u011f\u0131 ilk hastal\u0131klardan biri olarak kabul edilmektedir (1,2).<\/p>\n

S\u0131tma etkenini ortaya \u00e7\u0131karmak amac\u0131yla ara\u015ft\u0131rmalar yapan Dr. Ronald Ross (1857\u20131932), Anopheles<\/i> t\u00fcr\u00fc bir sivrisine\u011fin, s\u0131tma hastal\u0131\u011f\u0131ndan mustarip ki\u015filerin kanlar\u0131n\u0131 emerken edindi\u011fi \u00f6rnekler \u00fczerinde yapt\u0131\u011f\u0131 incelemelerde parazit benzeri canl\u0131lar g\u00f6zlemledi. Bu parazitlerin asl\u0131nda sivrisine\u011fin i\u00e7inde geli\u015ferek kan\u0131n\u0131 emdi\u011fi insan\u0131 infekte etti\u011fi sonucuna ula\u015ft\u0131. Bu g\u00f6zlemlerini, Aral\u0131k 1897 y\u0131l\u0131nda British Medical Journal<\/i>\u2019da yay\u0131mlanan \u201cOn some peculiar pigmented cells found in two mosquitoes fed on malarial blood\u201d ba\u015fl\u0131kl\u0131 makalesinde yay\u0131mlad\u0131. Daha sonra s\u0131tma etkeni olan Plasmodium<\/i> ile ilgili deneylerini sivrisinekler, ser\u00e7eler ve kargalar \u00fczerinde s\u00fcrd\u00fcrerek ku\u015flar\u0131n kan\u0131yla beslenen sivrisineklerin t\u00fck\u00fcr\u00fck bezlerinde sporozitleri tespit etti. Bu sayede s\u0131tma etkeninin ya\u015fam d\u00f6ng\u00fcs\u00fcn\u00fc ortaya koydu. Ross, 1898 y\u0131l\u0131nda \u0130ngiliz Tabipler Birli\u011fi\u2019nin (British Medical Association) Edinburgh \u00dcniversitesi\u2019nde d\u00fczenledi\u011fi toplant\u0131da bulgular\u0131n\u0131 bilim d\u00fcnyas\u0131na sundu. S\u0131tma \u00fczerine yapt\u0131\u011f\u0131 bu \u00f6nemli \u00e7al\u0131\u015fmalar, kendisine 1902 y\u0131l\u0131nda Nobel \u00d6d\u00fcl\u00fc kazand\u0131rd\u0131 (1).<\/p>\n

Ate\u015fli hastal\u0131klar\u0131n tedavisinde kullan\u0131lan kinin, G\u00fcney Amerika k\u00f6kenlidir. 17. y\u00fczy\u0131lda Peru\u2019da bir a\u011fac\u0131n kabu\u011fundan elde edilerek geli\u015ftirilen kinin ile \u0130spanyol Kontesi\u2019nin ate\u015fli hastal\u0131\u011f\u0131n\u0131n tedavi edildi\u011fi rivayet edilir. 1820\u2019de Frans\u0131z kimyagerler Joseph Pelletier ve Jean Bienam Caventou, Cinchona<\/i> kabu\u011fundan kinin izole ettiklerini duyurmu\u015flard\u0131r. Kinin h\u0131zla d\u00fcnyadaki intermitant ate\u015f i\u00e7in tercih edilen bir ila\u00e7 h\u00e2line gelmi\u015ftir. 19. y\u00fczy\u0131l\u0131n ortalar\u0131nda, \u0130ngiliz ve Hollandal\u0131 botanik\u00e7i ka\u015fifler, Hindistan, Seylan ve Hollanda Do\u011fu Hint Adalar\u0131\u2019nda kinin elde edilen Cinchona<\/i> a\u011fa\u00e7lar\u0131n\u0131 yeti\u015ftirmek i\u00e7in uygun bir yer aram\u0131\u015flard\u0131r. S\u00fcre\u00e7 i\u00e7erisinde daha II. D\u00fcnya Sava\u015f\u0131\u2019na gelmeden \u00f6nce Hollandal\u0131lar kinin \u00fcretiminde d\u00fcnyada \u00f6ne ge\u00e7mi\u015ftir (1). Buradan da s\u0131tma hastal\u0131\u011f\u0131n\u0131n d\u00fcnya genelinde yayg\u0131n oldu\u011fu ve uluslararas\u0131 d\u00fczeyde s\u0131tma ile m\u00fccadelenin ve tedavi y\u00f6ntemlerinin farkl\u0131 \u00fclkelerce y\u0131llar boyunca ara\u015ft\u0131r\u0131ld\u0131\u011f\u0131 anla\u015f\u0131lmaktad\u0131r.<\/p>\n

S\u0131tma hastal\u0131\u011f\u0131n\u0131n Anadolu topraklar\u0131nda ne derece olumsuz etkiler yaratt\u0131\u011f\u0131 tam olarak bilinmemekle birlikte, di\u011fer salg\u0131n hastal\u0131klarla birlikte d\u00fc\u015f\u00fcn\u00fcld\u00fc\u011f\u00fcnde b\u00fcy\u00fck y\u0131k\u0131mlara yol a\u00e7t\u0131\u011f\u0131 tahmin edilmektedir. Osmanl\u0131 d\u00f6nemine gelindi\u011finde s\u0131tman\u0131n \u00f6nemli bir halk sa\u011fl\u0131\u011f\u0131 sorunu oldu\u011funun kabul edilmesi, kininin d\u00fcnya genelinde oldu\u011fu gibi kullan\u0131lmaya ba\u015flamas\u0131yla anla\u015f\u0131lmaktad\u0131r. Osmanl\u0131 d\u00f6neminin \u00fcnl\u00fc hekimlerinden Bursal\u0131 Ali M\u00fcn\u015fi, 1732 y\u0131l\u0131nda yazm\u0131\u015f oldu\u011fu Risale-i Hasiyyet-i K\u0131nak\u0131na<\/i> adl\u0131 eserinde s\u0131tma tedavisi i\u00e7in kinin konusunu ele alm\u0131\u015ft\u0131r. S\u0131tmaya neden olan batakl\u0131klar eskiden beri de bilindi\u011finden, batakl\u0131klar kurutularak hastal\u0131kla m\u00fccadele edilmeye devam edilmi\u015ftir. Maltepe Askeri Hastanesi\u2019nin 1837\u20131838 y\u0131llar\u0131na ait eczane kay\u0131tlar\u0131nda, s\u0131tman\u0131n tedavisi i\u00e7in hastalara k\u0131nak\u0131na ve sulfato verildi\u011fi kaydedilmi\u015ftir. 1839 y\u0131l\u0131nda Viyana\u2019dan Mekteb-i T\u0131bbiye\u2019ye muallim olarak getirilen Dr. Bernard, malaryal\u0131 hastalara sulfato re\u00e7ete etmi\u015ftir. O d\u00f6nemlerde s\u0131tma malarya olarak an\u0131lmaktad\u0131r. Bursa Kad\u0131 Sicili\u2019ne ait 1841\u2019deki bir kay\u0131tta Bursa Sancak Beyi Dilaver Pa\u015fa\u2019n\u0131n \u0130stanbul\u2019a yazd\u0131\u011f\u0131 bir mektupta s\u0131tma hastal\u0131\u011f\u0131n\u0131n insan \u00f6l\u00fcmlerine neden oldu\u011fu, hayvanlara zarar verdi\u011fi ve s\u0131tmal\u0131 yerlerde ipek b\u00f6ceklerinin ya\u015famad\u0131\u011f\u0131 bildirilmi\u015ftir. Bu nedenle b\u00f6lgede pirin\u00e7 tar\u0131m\u0131 yasaklanm\u0131\u015ft\u0131r. S\u0131tma ile m\u00fccadele ve tedavi y\u00f6ntemleri, d\u00f6nemin \u015fartlar\u0131na uygun olarak t\u0131p okullar\u0131n\u0131n m\u00fcfredat\u0131na eklenmi\u015ftir. Balkan ve I. D\u00fcnya Sava\u015flar\u0131 s\u0131ras\u0131nda n\u00fcfusun \u00e7ok b\u00fcy\u00fck bir k\u0131sm\u0131n\u0131n s\u0131tma hastal\u0131\u011f\u0131ndan mustarip oldu\u011fu ve devletin s\u0131tma ile m\u00fccadelede etkin bir yol arad\u0131\u011f\u0131 bilinmektedir. Prof. Dr. Ekrem Kadri Unat\u2019\u0131n aktard\u0131\u011f\u0131na g\u00f6re, s\u0131tma ile m\u00fccadelede kullan\u0131lan kininin halka \u00fccretsiz da\u011f\u0131t\u0131lmas\u0131n\u0131 \u00f6ng\u00f6ren \u201cKinin Tedarik ve F\u00fcruhtu Hakk\u0131nda Kanun\u201d, \u201cKinin Tedarikine M\u00fctedair 20 Haziran 1332 Tarihli Kanunu Muvakkatin Sureti Tatbiyesi Hakk\u0131nda Nizamname\u201d ve \u201cS\u0131tmal\u0131 Mahallerde Fukarai Ahaliye ve Z\u00fcrraa Meccanen Kinin Tevzii Hakk\u0131nda Nizamname\u201d gibi d\u00fczenlemeler, s\u0131tma ile m\u00fccadelenin sorumlulu\u011funu T\u00fcrkiye Cumhuriyeti\u2019ne devretmi\u015ftir (3,4).<\/p>\n

1913\u20131914 y\u0131llar\u0131nda halka \u00fccretsiz olarak yakla\u015f\u0131k 2000 kilogram kadar kinin da\u011f\u0131t\u0131lm\u0131\u015ft\u0131r. Sava\u015f y\u0131llar\u0131nda s\u0131tma ile m\u00fccadelenin temel ilac\u0131 olan kinin temininde ya\u015fanan sorunlar nedeniyle 3 Temmuz 1916 tarihinde kinin temini ve halka da\u011f\u0131t\u0131m\u0131n\u0131 sa\u011flamak amac\u0131yla nizamname \u00e7\u0131kar\u0131lm\u0131\u015ft\u0131r. I. D\u00fcnya Sava\u015f\u0131 sonras\u0131nda Hicaz ve Irak gibi cephelerde sava\u015fan askerlerin Anadolu\u2019da s\u0131tmay\u0131 yayg\u0131nla\u015ft\u0131rd\u0131\u011f\u0131 tespit edilmi\u015ftir. Ancak Mill\u00ee M\u00fccadelenin \u015fiddetli bir \u015fekilde devam etmesi merkezden ta\u015fraya s\u0131tma ila\u00e7lar\u0131n\u0131n ula\u015ft\u0131r\u0131lmas\u0131n\u0131 zorla\u015ft\u0131rm\u0131\u015f, hatta engellemi\u015ftir (5).<\/p>\n

Yeni meclisin kurulmas\u0131n\u0131n ard\u0131ndan s\u0131tmayla m\u00fccadeleye ili\u015fkin ilk bildiri, 9 May\u0131s 1920\u2019deki 1. \u0130cra Vekilleri Heyeti kay\u0131tlar\u0131na \u201cBu sene bula\u015f\u0131c\u0131 hastal\u0131klar\u0131n harb senelerine nispeten pek az oldu\u011funu hamd\u00fc \u015f\u00fckranla zikretmekle beraber, 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 ge\u00e7mi\u015ftir. Cumhuriyet d\u00f6neminde ise devlet kurumlar\u0131, yeni d\u00fczenlemelerle, halk ile i\u015f birli\u011fini ve altyap\u0131y\u0131 geli\u015ftirerek ve ekonomik kaynaklar\u0131 art\u0131rarak s\u0131tma ile etkin m\u00fccadele politikalar\u0131n\u0131 hayata ge\u00e7irmi\u015flerdir (6).<\/p>\n

Osmanl\u0131\u2019n\u0131n son d\u00f6neminde g\u00f6r\u00fclen salg\u0131n hastal\u0131klardan biri olan s\u0131tma ile m\u00fccadele, bir yandan devletin geli\u015ftirdi\u011fi politikalarla s\u00fcrd\u00fcr\u00fcl\u00fcrken di\u011fer yandan da konuya ilgi duyan, alan\u0131nda uzman, iyi e\u011fitimli ve d\u00f6nemin ko\u015fullar\u0131na g\u00f6re yetkin hekimler taraf\u0131ndan kaleme al\u0131nan eserlerle bilimsel a\u00e7\u0131dan desteklenmeye \u00e7al\u0131\u015f\u0131lm\u0131\u015ft\u0131r. 20. y\u00fczy\u0131l ba\u015f\u0131ndan Cumhuriyet\u2019in ilan\u0131na kadar ge\u00e7en s\u00fcre i\u00e7erisinde s\u0131tma ile m\u00fccadeleye y\u00f6nelik sekiz eserin yaz\u0131ld\u0131\u011f\u0131 tespit edilmi\u015ftir. Bu eserlerden ilkini kaleme alan ki\u015fi Doktor Milasl\u0131 \u0130smail Hakk\u0131\u2019d\u0131r. 1910 y\u0131l\u0131nda yazd\u0131\u011f\u0131 S\u0131tma ve S\u0131tmal\u0131 Yerlerde \u00c7are<\/i> adl\u0131 ris\u00e2lesiyle s\u0131tma ile m\u00fccadelenin bilimsel temellerine katk\u0131 sunmu\u015f ve bu y\u00fczy\u0131lda \u00f6nc\u00fcl\u00fck etmi\u015ftir.<\/p>\n

Bu \u00e7al\u0131\u015fmada, Osmanl\u0131\u2019n\u0131n son d\u00f6neminde y\u00fcr\u00fct\u00fclen s\u0131tma ile m\u00fccadele faaliyetleri ele al\u0131nacakt\u0131r. Ayr\u0131ca, Doktor Milasl\u0131 \u0130smail Hakk\u0131\u2019n\u0131n S\u0131tma ve S\u0131tmal\u0131 Yerlerde \u00c7are<\/i> adl\u0131 eseri, yaz\u0131ld\u0131\u011f\u0131 d\u00f6nemin \u015fartlar\u0131 \u00e7er\u00e7evesinde s\u0131tma ile m\u00fccadeledeki rol\u00fc ve \u00f6nemi a\u00e7\u0131s\u0131ndan ar\u015fiv belgeleri \u0131\u015f\u0131\u011f\u0131nda de\u011ferlendirilecektir.<\/p>\n

Y\u00d6NTEMLER<\/h2>\n

Bu \u00e7al\u0131\u015fmada, nitel ara\u015ft\u0131rma y\u00f6ntemlerinden tarama modeli ve dok\u00fcman analizi teknikleri kullan\u0131ld\u0131. \u0130ncelenecek belgelere ula\u015fmak i\u00e7in T.C. Cumhurba\u015fkanl\u0131\u011f\u0131 Devlet Ar\u015fivleri Ba\u015fkanl\u0131\u011f\u0131 Osmanl\u0131 Ar\u015fivi (BOA) veri taban\u0131ndan yararlan\u0131ld\u0131. Ara\u015ft\u0131rman\u0131n konusuna ve amac\u0131na uygun olarak \u201cs\u0131tma\u201d anahtar kelimesi kullan\u0131larak arama yap\u0131ld\u0131. Elde edilen belgeler sistematik bir \u015fekilde incelendikten sonra, ara\u015ft\u0131rma kapsam\u0131na giren belgeler Osmanl\u0131 T\u00fcrk\u00e7esinden Latin harflerine transkribe edildi. Ayr\u0131ca, T\u00fcrkiye B\u00fcy\u00fck Millet Meclisi K\u00fct\u00fcphanesi\u2019nden Milasl\u0131 \u0130smail Hakk\u0131\u2019n\u0131n S\u0131tma ve S\u0131tmal\u0131 Yerlerde \u00c7are <\/i>adl\u0131 eserinin dijital kopyas\u0131 temin edildi ve Osmanl\u0131 T\u00fcrk\u00e7esi\u2019nden Latin harflerine transkripsiyonu yap\u0131ld\u0131ktan sonra analizi ger\u00e7ekle\u015ftirildi. Bu eser, 1326 (Miladi takvimle 1910)\u2019da Dersaadet\u2019te \u0130kdam Matbaas\u0131\u2019nda bas\u0131lm\u0131\u015f olup 16 sayfadan olu\u015fmaktad\u0131r.<\/p>\n

BULGULAR VE \u0130RDELEME<\/h2>\n

Osmanl\u0131\u2019n\u0131n Son D\u00f6neminde S\u0131tma ile M\u00fccadele<\/h3>\n

Osmanl\u0131 Devleti\u2019nde 19. y\u00fczy\u0131l\u0131n ikinci yar\u0131s\u0131ndan itibaren s\u0131tma olgular\u0131 hem endemik ve hem de epidemik olarak etkisini art\u0131rm\u0131\u015f; \u0130zmit, Kartal, Mecidiye, Biga, Ayd\u0131n, Hamid, Ankara, Konya, G\u00fcm\u00fclcine, Mara\u015f, H\u00fcdavendigar, Adana gibi pek \u00e7ok b\u00f6lgede s\u0131tma yayg\u0131n \u015fekilde g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. S\u0131tman\u0131n g\u00f6r\u00fcld\u00fc\u011f\u00fc b\u00f6lgelerde, yerel d\u00fczeyde tedbir almak amac\u0131yla \u00e7ok say\u0131da hekim ve eczac\u0131 g\u00f6revlendirilmi\u015ftir. Merkezden hekim veya eczac\u0131 g\u00f6nderilemedi\u011fi durumlarda serbest olarak hekimlik yapan ki\u015filer ayl\u0131k maa\u015f kar\u015f\u0131l\u0131\u011f\u0131nda ge\u00e7ici olarak s\u0131tma m\u00fccadelesinde istihdam edilmi\u015ftir. Bu s\u00fcre\u00e7te belediyeler de aktif rol \u00fcstlenerek maa\u015f \u00f6demelerini yapm\u0131\u015flard\u0131r. S\u0131tma ile m\u00fccadelede, \u00f6nemli bir kimyasal olan s\u00fclfat yo\u011fun bir \u015fekilde kullan\u0131lm\u0131\u015f olup \u00e7o\u011fu zaman mahalli h\u00fck\u00fcmet taraf\u0131ndan merkezden s\u00fclfat temini talep edilmi\u015ftir. Ayr\u0131ca s\u0131tmadan mustarip halka \u00fccretsiz ila\u00e7 da\u011f\u0131t\u0131lm\u0131\u015ft\u0131r. Devlet s\u0131tma ile m\u00fccadele konusunda batakl\u0131klar\u0131n kurutulmas\u0131na \u00f6nem vermi\u015f, s\u0131tma olgular\u0131n\u0131n artmas\u0131na neden oldu\u011fu gerek\u00e7esiyle pirin\u00e7 ekimini de b\u00f6lgesel olarak yasaklam\u0131\u015ft\u0131r (7\u201319). Bu kapsamda devletin s\u0131tma m\u00fccadelesi \u201ctedavi edici \u00f6nlemler\u201d ve \u201ckoruyucu \u00f6nlemler\u201d olmak \u00fczere iki ana ba\u015fl\u0131k alt\u0131nda de\u011ferlendirilebilir. Tedavi edici \u00f6nlemler aras\u0131nda; s\u0131tman\u0131n g\u00f6r\u00fcld\u00fc\u011f\u00fc b\u00f6lge i\u00e7in hekim, eczac\u0131, m\u00fcfetti\u015f ve hasta bak\u0131c\u0131 g\u00f6revlendirilmesi, kinin temin edilerek halka ula\u015ft\u0131r\u0131lmas\u0131, g\u0131da ve bar\u0131nma deste\u011fi sa\u011flanmas\u0131 say\u0131labilir. Koruyucu \u00f6nlemler kapsam\u0131nda ise; sa\u011fl\u0131k komisyonlar\u0131n\u0131n olu\u015fturulmas\u0131, temizlik faaliyetlerinin y\u00fcr\u00fct\u00fclmesi, kirli sular\u0131n ve batakl\u0131klar\u0131n temizlenmesi, hastalar\u0131n ba\u015fka yerlere nakledilmesi, pirin\u00e7 ve t\u00fct\u00fcn ekiminin kontrol alt\u0131na al\u0131nmas\u0131, s\u0131tma ara\u015ft\u0131rmalar\u0131n\u0131n desteklenmesi ve halk\u0131n bilin\u00e7lendirilmesi yoluyla kaotik ortamlar\u0131n \u00f6n\u00fcne ge\u00e7ilmesi gibi uygulamalar say\u0131labilir (20).<\/p>\n

S\u0131tma b\u00f6lgesel olarak \u015fiddetini art\u0131rd\u0131\u011f\u0131nda y\u0131k\u0131c\u0131 etkilere neden olmaktayd\u0131. Ayd\u0131n\u2019da 1868 y\u0131l\u0131nda g\u00f6r\u00fclen s\u0131tma olgular\u0131n\u0131n fazlal\u0131\u011f\u0131na ili\u015fkin olarak d\u00f6nemin kaynaklar\u0131nda \u015fu ifadeler yer almaktad\u0131r: \u201cAyd\u0131n vilayetinin her taraf\u0131nda zuhur eden s\u0131tma hastal\u0131\u011f\u0131 emsali g\u00f6r\u00fclmemi\u015f raddede olub bu hastal\u0131ktan kura ve kasabat ahalisinin %60\u2019\u0131ndan ziyadesi es\u00eer-i fir\u00e2\u015f ve r\u00fbz-merre vukua gelen vefayat ise m\u00fctecaviz hadd-i id\u00fc\u011f\u00fcnden\u2026<\/i>\u201d (21).<\/p>\n

Benzer \u015fekilde, s\u0131tman\u0131n m\u00fcstahkem ordular\u0131 \u00fczerinde ciddi etkiler yaratt\u0131\u011f\u0131 bilinmektedir. 1884 y\u0131l\u0131nda \u201c2. Ordu-y\u0131 H\u00fcmayun Piyade Nizamiye 13. Alay\u0131\u2019n\u0131n G\u00fcm\u00fclcine mevkiindeki 1. ve 4. Taburlar\u0131 Zabitan Efrad\u0131\u201d b\u00f6lgedeki batakl\u0131klar nedeniyle s\u0131tma hastal\u0131\u011f\u0131na yakalanm\u0131\u015f ve bu durum, taburlar\u0131n yerlerinin de\u011fi\u015ftirilmesi ve batakl\u0131klar\u0131n kurutulmas\u0131 y\u00f6n\u00fcnde \u00f6nlemler al\u0131nmas\u0131n\u0131 zorunlu k\u0131lm\u0131\u015ft\u0131r. S\u00f6z konusu belgede \u015fu ifadeler yer almaktad\u0131r: \u201c\u2026 taburlar\u0131n tebdilleriyle beraber badema oraya memur edilecek di\u011fer taburlar\u0131n dahi s\u0131k\u00e7a s\u0131k\u00e7a de\u011fi\u015ftirilmeleri laz\u0131meden oldu\u011fu gibi havan\u0131n vehameti mahal-i mezkurun etraf\u0131nda birtak\u0131m batakl\u0131klar olmas\u0131ndan ne\u015fet edip bunun mazarrat\u0131 ise hem oradaki asakire hem de ahaliye \u015famil oldu\u011fu cihetle zikrolunan batakl\u0131klar\u0131n tathiri \u00e7arelerinin istihsali mukteza-i halden olmas\u0131yla<\/i>\u2026\u201d (16).<\/p>\n

Bu ba\u011flamda, askerlerin s\u0131tmadan korunmas\u0131na y\u00f6nelik tedbirlere daima \u00f6zen g\u00f6sterilmi\u015ftir. \u00d6rne\u011fin, bir askerin s\u0131tma olmadan korunmas\u0131 ve hastal\u0131k durumunda tedavi edilmesi i\u00e7in ka\u00e7 gram \u201cs\u00fclfato\u201d almas\u0131 gerekti\u011fi konusu 1906 y\u0131l\u0131nda karara ba\u011flanm\u0131\u015ft\u0131r (22). S\u0131tma ile m\u00fccadele i\u00e7in Avrupa\u2019dan getirtilen ve \u201cs\u00fclfato\u201d veya \u201cs\u00fclfat d\u00f6 kinin\u201d (quinnine sulfate) olarak adland\u0131r\u0131lan kinin s\u00fclfat 19. y\u00fczy\u0131l\u0131n ortalar\u0131ndan itibaren kullan\u0131lmaya ba\u015flanm\u0131\u015ft\u0131r (23,24).<\/p>\n

II. Me\u015frutiyet\u2019in ilan\u0131n\u0131n ard\u0131ndan Osmanl\u0131 Devleti\u2019nin b\u00fcrokrasisinde ya\u015fanan d\u00f6n\u00fc\u015f\u00fcm, \u00fclkede her alanda oldu\u011fu gibi sa\u011fl\u0131k alan\u0131nda da bir dizi yeni geli\u015fmenin ya\u015fanmas\u0131na bir zemin haz\u0131rlam\u0131\u015ft\u0131r. Tar\u0131m\u0131 ve \u00fclke n\u00fcfusunu olumsuz etkileyen s\u0131tma hastal\u0131\u011f\u0131, bu d\u00f6nemde hem b\u00fcrokratlar hem de hekimler ve ayd\u0131nlar taraf\u0131ndan \u00f6nemle ele al\u0131nm\u0131\u015ft\u0131r (25). Bu d\u00f6nemde, Osmanl\u0131 Devleti\u2019nin y\u00f6neticilerinin s\u0131tma ile m\u00fccadeleye yakla\u015f\u0131mlar\u0131 farkl\u0131 a\u00e7\u0131lardan de\u011ferlendirilebilir. \u00d6ncelikle batakl\u0131klar\u0131n kurutulmas\u0131 konusunun \u00fczerinde dikkatle durulmu\u015f olup d\u00f6nemin belgelerinde \u201cs\u00f6\u011f\u00fct ve kavak ve bilhassa okalipt\u00fcs a\u011fa\u00e7lar\u0131n\u0131n gars edilmesi ve bunun i\u00e7in de ahaliye kolayl\u0131k olmak \u00fczere oralarda okalipt\u00fcs numune tarlalar\u0131n\u0131n tesisi elzem oldu\u011fu\u2026<\/i>\u201d \u015feklinde ifadeler yer alm\u0131\u015ft\u0131r (26). Y\u0131lda 200-250 bin ton su \u00e7ekerek h\u0131zl\u0131 bir \u015fekilde b\u00fcy\u00fcyen okalipt\u00fcs a\u011fa\u00e7lar\u0131, sivrisineklerin ya\u015fam alanlar\u0131n\u0131n ortadan kald\u0131r\u0131lmas\u0131nda etkili bir ara\u00e7 olarak de\u011ferlendirilmi\u015ftir (25). Ele al\u0131nan bir di\u011fer konu ise \u00e7eltik ve s\u0131tma aras\u0131ndaki ili\u015fki olmu\u015ftur. Bu konu 1910 y\u0131l\u0131nda Meclis-i Mebusan\u2019da g\u00f6r\u00fc\u015f\u00fclen Pirin\u00e7 Ziraat\u0131 Kanunnamesi s\u0131ras\u0131nda g\u00fcndeme gelmi\u015ftir. Devletin s\u0131tma ile m\u00fccadele ve \u00e7e\u015fitli \u00fcr\u00fcnlerin yeti\u015ftirilebilmesi amac\u0131yla batakl\u0131klar\u0131 kurutma \u00e7abas\u0131, sulak alanlara ihtiya\u00e7 duyan pirin\u00e7 ziraat\u0131n\u0131 te\u015fvik etmi\u015f ve bu da ekolojik bir sorunu beraberinde getirmi\u015ftir. Ancak, kanunnamenin nihai \u015fekli incelendi\u011finde pirin\u00e7 hastal\u0131k kayna\u011f\u0131 ve kirlilik sebebi olarak de\u011ferlendirilmi\u015f ve sa\u011fl\u0131kl\u0131 bir \u00fcretimin sa\u011flanabilmesi i\u00e7in yeti\u015ftiricilere baz\u0131 sorumluluklar y\u00fcklenmi\u015ftir (27). Kanunname g\u00f6r\u00fc\u015fmelerinden \u00f6nce, 1909\u2019da Selanik\u2019ten k\u00f6y muhtar\u0131 ve k\u00f6yl\u00fcler taraf\u0131ndan Osmanl\u0131 Devleti\u2019nde Sadaret\u2019e g\u00f6nderilen bir yaz\u0131 konunun \u00f6nemini ortaya koymaktad\u0131r: \u201c5-6 seneden beri hilaf nizam kasaba ittisalinde zer\u2019 edilen pirin\u00e7 ve k\u00fc\u015fad edilen \u00e7eltik tarlalar\u0131 dolay\u0131s\u0131yla kasabam\u0131zda s\u0131tma ve vefayat-\u0131 fevkalade bir dereceye vas\u0131l ve men\u2019 gayr-\u0131 m\u00fcmk\u00fcn bir hale gelmi\u015ftir s\u0131hhat-\u0131 umumiyeye taalluk eden ve umumuzu kemal-i yes ve heyecanda b\u0131rakan ve bir\u00e7ok aileleri meyus eden bu meselenin s\u00fcrat -i m\u00fcmk\u00fcne ile inzar-\u0131 adalete al\u0131nmas\u0131 ve h\u00fckm-i kanunun icras\u0131yla \u00e7eltik tarlalar\u0131n\u0131n kasabadan 5-6 kilometreye tebidi ve bu y\u00fczden olan tahamm\u00fcls\u00fcz vefayata art\u0131k bir an evvel nihayet verilmesi\u2026<\/i>\u201d (28). Bu iki temel meselenin yan\u0131 s\u0131ra, II. Me\u015frutiyet D\u00f6nemi\u2019nde devletin s\u0131tma ile m\u00fccadelede \u00fczerinde en fazla durdu\u011fu konu kinin kullan\u0131m\u0131 olmu\u015ftur. Bu ba\u011flamda, 1900 y\u0131l\u0131nda \u0130talya\u2019da ba\u015flayan \u201cdevlet kinini\u201d (veya h\u00fck\u00fcmet kinini) uygulamas\u0131n\u0131n benzeri, 1913\u2019ten itibaren Osmanl\u0131\u2019da y\u00fcr\u00fcrl\u00fc\u011fe giren bir dizi kanun ve nizamnamelerle hayata ge\u00e7irilmi\u015ftir (24,25,29). Meclis-i Umur-\u0131 T\u0131bbiye-i M\u00fclkiye ve S\u0131hhiye-i Umumiye Reis Vekili taraf\u0131ndan Dahiliye Naz\u0131r\u0131\u2019na g\u00f6nderilen 26 Ekim 1911 tarihli bir yaz\u0131da \u00fccretsiz olarak kinin da\u011f\u0131t\u0131lmas\u0131n\u0131n \u00f6neminden ve yap\u0131lmas\u0131 gerekenden \u015fu \u015fekilde bahsedilmekteydi: \u00a0 <\/span>\u201cH\u00fcmmey\u00e2t-\u0131 merzagiye kar\u015f\u0131 deva olduktan ba\u015fka ayn\u0131 zamanda kati bir \u00e7are-i tahaffuz olan kininin fiyat\u0131 gal\u00ee olmazdan na\u015fi merzagi mahallerde vas\u0131ta-i tahaffuz gibi her kese istimal ettirilmesi pek b\u00fcy\u00fck tahsisata vabeste oldu\u011fu cihetle baz\u0131 h\u00fck\u00fckatta herkesin kinin sat\u0131n alabilmesini ve bazen itas\u0131n\u0131 temin ve merzagi mahallerde suret-i tevzi tanzim i\u00e7in \u201cH\u00fck\u00fcmet Kinini\u201d nam\u0131yla imal etmi\u015fler ve bu babda kavanin ve nizamat-\u0131 mahsusa vaz\u2019 etmi\u015flerdir. Memleketimizin bir\u00e7ok aksam\u0131nda h\u00fck\u00fcmferma olub efrad-\u0131 ahaliyi mariz ve \u0131rk-\u0131 Osmaniyi zebun bir hale getiren h\u00fcmmey\u00e2t-\u0131 merzagiyeye kar\u015f\u0131 bu tarzda m\u00fcdafaya e\u015fedd-i ihtiya\u00e7 olub bu babda m\u00fc\u015femmir bir say\u2019 da bulunmak i\u00e7in evvel emirde k\u0131nak\u0131na zer\u2019iyle mahallinde kinin imal eden Cava\u2019da Batavya \u015eehbenderhanesinin kininin oradaki fiyat\u0131 ve ora fabrikalar\u0131 taraf\u0131ndan ne miktar kinin irsalini taahh\u00fct edebilecekleri ve kontrato \u015feraiti vesaire hakk\u0131nda izahat taleb edilmesi hususunun\u2026<\/i>\u201d (30). <\/span><\/p>\n

1913 y\u0131l\u0131nda \u00e7\u0131kar\u0131lan 11 maddelik \u201cS\u0131tmal\u0131 Mahallerde Fukara Ahaliye ve Z\u00fcrraya Meccanen Kinin Tevzii Hakk\u0131nda Nizamname\u201d ile devlet kinini uygulamas\u0131 resmen ba\u015flat\u0131lm\u0131\u015ft\u0131r. Bu nizamnameye g\u00f6re S\u0131hhiye M\u00fcd\u00fcriyet-i Umumiyesi taraf\u0131ndan her sene fakir halka ve \u00e7ift\u00e7ilere \u00fccretsiz da\u011f\u0131t\u0131lmak \u00fczere vilayet ve m\u00fcstakil livalara ihtiya\u00e7lar\u0131 nispetinde kinin g\u00f6nderilmesi kararla\u015ft\u0131r\u0131lm\u0131\u015ft\u0131r. H\u00fck\u00fcmet taraf\u0131ndan da\u011f\u0131t\u0131lacak kininin komprime formunda olmas\u0131 ve \u00fczerinde \u201cmeccanen\u201d (\u00fccretsiz) ibaresinin bulunmas\u0131 zorunlu k\u0131l\u0131narak para ile sat\u0131lmas\u0131 yasaklanm\u0131\u015f ve aksine hareket edenler hakk\u0131nda para cezas\u0131 uygulanaca\u011f\u0131 belirtilmi\u015ftir (31). Bu s\u00fcre\u00e7te \u00f6zellikle \u0130sko\u00e7ya ba\u015fta olmak \u00fczere Avrupa \u00fclkelerinden ciddi miktarda kinin ithal edilmi\u015ftir (32-35). I. D\u00fcnya Sava\u015f\u0131\u2019n\u0131n ba\u015flamas\u0131n\u0131n ard\u0131ndan, fiyatlar\u0131n y\u00fckselmesi ve ordunun artan ihtiyac\u0131 nedeniyle kinin tedarikinde olumsuzluklar ya\u015fanm\u0131\u015fsa da y\u00fcr\u00fcrl\u00fc\u011fe giren kanunlarla bu durumun \u00f6n\u00fcn\u00fcn al\u0131nmas\u0131na \u00e7al\u0131\u015f\u0131lm\u0131\u015ft\u0131r (24,29).<\/p>\n

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Tablo 1.<\/strong> II. Me\u015frutiyet\u2019ten Cumhuriyet\u2019in \u0130lan\u0131na Kadar S\u0131tma ile \u0130lgili Eserler (36)<\/p><\/div>\n

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Tablo 2.<\/strong> Milasl\u0131 Dr. \u0130smail Hakk\u0131\u2019n\u0131n Memuriyet Ge\u00e7mi\u015fi (37,40-45)<\/p><\/div>\n

II. Me\u015frutiyet D\u00f6nemi\u2019nden itibaren, s\u0131tma konusunda halk\u0131 ayd\u0131nlatmak, bilin\u00e7lendirmek ve s\u0131tma ile m\u00fccadelede hekimlere yol g\u00f6stermek amac\u0131yla \u00f6nemli eserler kaleme al\u0131nm\u0131\u015ft\u0131r. Halka y\u00f6nelik yaz\u0131lan eserlerde, metinler genellikle sade ve anla\u015f\u0131l\u0131r bir dilde haz\u0131rlanm\u0131\u015f; t\u0131bbi terimlerin kullan\u0131m\u0131na ise m\u00fcmk\u00fcn oldu\u011funca az yer verilmi\u015ftir. Bu eserlerde, okur-yazar kesimin metinleri anlayarak halka aktarmas\u0131 beklenilmi\u015f ve te\u015fvik edilmi\u015ftir. Sa\u011fl\u0131k mensuplar\u0131na y\u00f6nelik eserlerde ise adeta bir rehber niteli\u011finde yol g\u00f6sterici olmas\u0131 ama\u00e7lanm\u0131\u015ft\u0131r. Bu eserlerin neredeyse tamam\u0131nda hastal\u0131\u011f\u0131n tan\u0131t\u0131lmas\u0131na, te\u015fhis ve tedavi yollar\u0131na, korunma ve m\u00fccadele y\u00f6ntemlerine yer verilmi\u015ftir (36). Tablo 1\u2019de sunuldu\u011fu \u00fczere II. Me\u015frutiyet\u2019ten Cumhuriyet\u2019in ilan\u0131na kadar olan s\u00fcre\u00e7te do\u011frudan s\u0131tma ile ilgili olarak sekiz eser kaleme al\u0131nm\u0131\u015ft\u0131r. \u0130smail Hakk\u0131\u2019n\u0131n S\u0131tma ve S\u0131tmal\u0131 Yerlerde \u00c7are<\/i> adl\u0131 eseri bu d\u00f6nemde yaz\u0131lm\u0131\u015f ilk eserdir.<\/p>\n

Doktor Milasl\u0131 \u0130smail Hakk\u0131<\/h3>\n

Doktor Milasl\u0131 \u0130smail Hakk\u0131 (1868\u20131948) , Milasl\u0131 Hac\u0131 Mehmed A\u011fa\u2019n\u0131n o\u011flu olarak Ayd\u0131n Vilayeti\u2019ne ba\u011fl\u0131 Milas kasabas\u0131nda do\u011fmu\u015ftur. Milas\u2019ta bulunan S\u0131byan Mektebi\u2019nde ve R\u00fc\u015fdiye\u2019de e\u011fitim g\u00f6rm\u00fc\u015ft\u00fcr. 20 Mart 1890\u2019da Mekteb-i T\u0131bbiye-i M\u00fclkiye-i \u015eahane\u2019den diploma alarak mezun olmu\u015ftur. \u0130nebolu Frengi Hastanesi tabipli\u011fi g\u00f6revine 1896 y\u0131l\u0131nda atanmas\u0131 hayat\u0131nda \u00f6nemli bir d\u00f6n\u00fcm noktas\u0131 olmu\u015ftur. Bu g\u00f6revde Emraz-\u0131 Umumiye alan\u0131ndaki bilgisini geli\u015ftirmi\u015f ve salg\u0131n hastal\u0131klarla m\u00fccadele konusunda uzmanla\u015fm\u0131\u015ft\u0131r. Bu alandaki deneyimlerinin neticesinde Bursa ve ard\u0131ndan Beyrut\u2019ta vilayet s\u0131hhiye m\u00fcfetti\u015fli\u011fi g\u00f6revlerine atanm\u0131\u015ft\u0131r. Milasl\u0131 \u0130smail Hakk\u0131, g\u00f6revlerindeki ba\u015far\u0131lar\u0131 nedeniyle taltif edilmi\u015f ve ba\u015far\u0131lar\u0131n\u0131n bir ni\u015fanesi olarak 1905 y\u0131l\u0131nda \u015eam\u2019da a\u00e7\u0131lan T\u0131p Mektebi\u2019ne m\u00fcd\u00fcr olarak atanm\u0131\u015f ve muallim olarak \u00f6nemli dersler vermi\u015ftir (37-39). \u0130smail Hakk\u0131\u2019n\u0131n bu g\u00f6revlere atanmas\u0131nda, mesleki ba\u015far\u0131lar\u0131n\u0131n yan\u0131 s\u0131ra Arap\u00e7a, Fars\u00e7a ve Frans\u0131zca bilmesi de \u00f6nemli bir etkendir (37)<\/span>.<\/p>\n

Hekimli\u011finin yan\u0131 s\u0131ra \u00e7ok y\u00f6nl\u00fc bir ayd\u0131n olan Milasl\u0131 \u0130smail Hakk\u0131, II. Me\u015frutiyet\u2019in ilan\u0131ndan sonra k\u0131sa s\u00fcreli de olsa bir gazete \u00e7\u0131karm\u0131\u015f, ayr\u0131ca bir\u00e7ok gazete ve dergide makaleler yay\u0131mlam\u0131\u015f ve halka y\u00f6nelik konu\u015fmalar yapm\u0131\u015ft\u0131r (46).<\/p>\n

\u0130smail Hakk\u0131, \u0130stanbul\u2019un i\u015fgalinin ard\u0131ndan 30 May\u0131s 1919 tarihinde Sultanahmet\u2019te ger\u00e7ekle\u015fen ikinci mitingde: \u201cM\u00fcsl\u00fcmanlar emin olsunlar ki esir olmazlar, tazyik, zuml alt\u0131na girseler de en nihayet daha kuvvetli, daha kudretli olarak izhar-\u0131 mevcudiyet ederler. Biz hakk\u0131m\u0131z\u0131n muhafazas\u0131na azmetmi\u015fiz, biz bunu kendimiz de bilelim b\u00fct\u00fcn alemlere de bildirelim<\/i>\u201d ifadelerini kullanm\u0131\u015ft\u0131r. Miting meydan\u0131nda konu\u015fmas\u0131n\u0131 dinleyenlere ve daha sonras\u0131nda okuyacak olanlara sebat etmeleri y\u00f6n\u00fcnde tavsiyelerde bulunmu\u015ftur (47). \u0130smail Hakk\u0131, bu d\u00f6nemde \u00e7al\u0131\u015fmalar\u0131na ara vermeden devam etmi\u015f ve 1920 y\u0131l\u0131nda Hil\u00e2l-i Ahdar (Ye\u015filay) Cemiyeti\u2019nin kurucular\u0131 aras\u0131nda yer alm\u0131\u015ft\u0131r. Ayn\u0131 y\u0131l, S\u0131hhiye M\u00fcd\u00fcriyet-i Umumisi M\u00fcfetti\u015f-i Umumili\u011fi g\u00f6revine atanm\u0131\u015ft\u0131r (39).<\/p>\n

Cumhuriyet\u2019in ilan\u0131n\u0131n ard\u0131ndan 1924 y\u0131l\u0131nda Bat\u0131 Anadolu Sa\u011fl\u0131k M\u00fcfetti\u015fi olarak g\u00f6revlendirilmi\u015f; 1929\u2019da emekli olmas\u0131na ra\u011fmen 1948\u2019de vefat edene kadar, \u00e7ok y\u00f6nl\u00fc bir doktor olarak \u00e7al\u0131\u015fmalar\u0131n\u0131 s\u00fcrd\u00fcrm\u00fc\u015ft\u00fcr. \u0130smail Hakk\u0131, Do\u011fu ve Bat\u0131 d\u00fcnyas\u0131n\u0131 iyi tan\u0131yan ve analiz eden bir ayd\u0131n olarak; t\u0131p, dil, din, siyaset ve ahlak konular\u0131 ile ilgili geriye 20 kitap, be\u015f konferans metni, \u00fc\u00e7 miting konu\u015fmas\u0131, 52 makale ve bir mektup b\u0131rakm\u0131\u015ft\u0131r. T\u0131p alan\u0131ndaki \u00e7al\u0131\u015fmalar\u0131na bak\u0131ld\u0131\u011f\u0131nda, \u00f6zellikle salg\u0131n hastal\u0131klarla m\u00fccadele, koruyucu sa\u011fl\u0131k hizmetlerinin planlanmas\u0131 ve sa\u011fl\u0131k kurulu\u015flar\u0131n kurumsalla\u015fmas\u0131na ili\u015fkin konulara odakland\u0131\u011f\u0131 g\u00f6r\u00fclmektedir. Bu ba\u011flamda t\u0131p yaz\u0131lar\u0131 a\u011f\u0131rl\u0131kl\u0131 olarak frengi, s\u0131tma, t\u00fcberk\u00fcloz, kara humma, su\u00e7i\u00e7e\u011fi, lekeli humma ve tif\u00fcs \u00fczerinedir. Ancak en yo\u011fun olarak frengi ve s\u0131tma konular\u0131nda \u00e7al\u0131\u015fmalar yapt\u0131\u011f\u0131 anla\u015f\u0131lmaktad\u0131r. Ayr\u0131ca Hil\u00e2l-i Ahdar Cemiyeti\u2019nin kurucular\u0131ndan biri olarak alkol\u00fcn zararlar\u0131 \u00fczerine de \u00e7al\u0131\u015fmalar\u0131 bulunmaktad\u0131r (39). S\u0131tma ile ilgili olarak 1910\u2019da S\u0131tma ve S\u0131tmal\u0131 Yerlerde \u00c7are <\/i>ve 1925\u2019de ise Malarya Yani S\u0131tma Hakk\u0131nda Kimler Neler Bilmeli?<\/i> adl\u0131 eserleri hem Osmanl\u0131 hem de Cumhuriyet D\u00f6nemi\u2019nin \u00f6nemli t\u0131bbi yay\u0131nlar\u0131 olarak literat\u00fcrde yerini alm\u0131\u015ft\u0131r (48). Bunlar\u0131n yan\u0131 s\u0131ra \u0130smail Hakk\u0131\u2019n\u0131n s\u0131tma hakk\u0131nda yay\u0131mlad\u0131\u011f\u0131 bir\u00e7ok makalesi de bulunmaktad\u0131r (39).<\/span><\/p>\n

S\u0131tma ve S\u0131tmal\u0131 Yerlerde \u00c7are<\/i> Risalesi<\/h3>\n

\u0130smail Hakk\u0131, S\u0131tma ve S\u0131tmal\u0131 Yerlerde \u00c7are<\/i> adl\u0131 eserinin yaz\u0131m s\u00fcrecini bir ba\u015fka eserinde ayr\u0131nt\u0131l\u0131 bir \u015fekilde a\u00e7\u0131klam\u0131\u015ft\u0131r. Ris\u00e2leyi asl\u0131nda peyderpey \u0130kdam Gazetesi\u2019nde makale olarak yay\u0131mlad\u0131\u011f\u0131n\u0131 ancak yaln\u0131zca birka\u00e7 ki\u015finin ilgi ve takdir g\u00f6sterdi\u011fini ifade etmi\u015ftir. \u0130lgi g\u00f6sterenlerin de Rumeli\u2019nin s\u0131tma yo\u011funlu\u011fu y\u00fcksek b\u00f6lgelerinden olan ve s\u0131tmadan canlar\u0131 yanm\u0131\u015f insanlar oldu\u011funu belirtmi\u015ftir. \u0130smail Hakk\u0131 1909 y\u0131l\u0131n\u0131n sonlar\u0131nda ve 1910 y\u0131l\u0131 ba\u015flar\u0131nda veba hastal\u0131\u011f\u0131 i\u00e7in Antalya\u2019ya g\u00f6nderildi\u011finde, \u0130talyanlar\u0131n devlet kinini meselesiyle nas\u0131l ilgilendiklerini tecr\u00fcbe etmi\u015ftir (49). Bu s\u00fcre\u00e7ten sonra kendisi de s\u0131tma ve kinin meselesine e\u011filmi\u015f ancak mebuslar ba\u015fta olmak \u00fczere gerekli deste\u011fi kimseden alamad\u0131\u011f\u0131n\u0131 \u015fu s\u00f6zlerle ifade etmi\u015ftir: \u201c\u0130talyanlar\u0131n devlet kinini meselesine ve nas\u0131l \u00e7al\u0131\u015ft\u0131klar\u0131na muttali oldum. Bu bana \u00e7ok dokundu. Bizim \u00e7al\u0131\u015fmad\u0131\u011f\u0131m\u0131za teess\u00fcf ve bu hususa da \u00e7al\u0131\u015fmaya, u\u011fra\u015fmaya azmettim. \u0130stanbul\u2019a d\u00f6n\u00fcnce bu i\u015fe laz\u0131m olan en son eserleri hemen edindim. Ba\u015fka memleketlerde neler yap\u0131ld\u0131\u011f\u0131n\u0131, memleketimizde neler yap\u0131labilece\u011fini tedkik ve tefekk\u00fcre koyuldum. Has\u0131l etti\u011fim neticeyi merci\u2019me arz ettim. Ve o vakitler milletin kurtulu\u015f saadetini kendilerinden bekledi\u011fimiz Mebuslar Meclisi\u2019ne s\u0131k s\u0131k gider ve ferd ve ferd her t\u00fcrl\u00fc azas\u0131ndan \u00e7areler dilerdim. Bir taraftan hurufumuzun \u0131slah\u0131 bir taraftan devlet kinini, malarya m\u00fccadelesi i\u015flerini s\u00f6yler, himmetler beklerdim. Hele s\u0131tmay\u0131 k\u00fc\u00e7\u00fck g\u00f6rerek \u201cu\u011fra\u015facak bir hastal\u0131k bulamad\u0131n da s\u0131tma ile mi u\u011fra\u015f\u0131yorsun\u201d diyenlerin s\u00f6zleriyle 8 sene sonra devlet kinini i\u00e7in tahsisat kabul edildi\u011fi vakit, en n\u00fcfuzlu bir vekilin \u201cBa\u015f\u0131m\u0131za bir de kinin masraf\u0131 \u00e7\u0131kard\u0131lar\u201d demesini hi\u00e7 unutamad\u0131m<\/i>\u201d (49). \u0130smail Hakk\u0131 bu nedenlerle s\u0131tma konusuna ba\u015flang\u0131\u00e7ta gereken \u00f6nemin verilmedi\u011fini, ancak y\u00fcr\u00fct\u00fclen \u00e7al\u0131\u015fmalar sonucunda \u00fccretsiz kinin da\u011f\u0131t\u0131m\u0131 i\u00e7in c\u00fczi bir tahsisat ayr\u0131labildi\u011fini ve sonras\u0131nda devlet kinininin y\u00fcr\u00fcrl\u00fc\u011fe girebildi\u011fini belirtmi\u015ftir (49).<\/p>\n

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Resim 1.<\/strong> Doktor Milasl\u0131 \u0130smail Hakk\u0131\u2019n\u0131n S\u0131tma ve S\u0131tmal\u0131 Yerlerde \u00c7are<\/i> Ris\u00e2lesi (50)<\/p><\/div>\n

\u0130smail Hakk\u0131 taraf\u0131ndan kaleme al\u0131nan S\u0131tma ve S\u0131tmal\u0131 Yerlerde \u00c7are<\/i> adl\u0131 ris\u00e2le; giri\u015f, d\u00f6rt ana b\u00f6l\u00fcm, kininden bahseden bir ba\u015fl\u0131k ve \u00f6zet b\u00f6l\u00fcm\u00fcnden olu\u015fmaktad\u0131r (Resim 1). Giri\u015f b\u00f6l\u00fcm\u00fcnde s\u0131tman\u0131n tan\u0131m\u0131n\u0131 yapt\u0131ktan sonra s\u0131tmaya y\u00f6nelik bir \u00e7er\u00e7eve \u00e7izmektedir (50). \u0130smail Hakk\u0131 eserini, \u201cBug\u00fcn n\u00fcfus-\u0131 umumiyemize iras-\u0131 hasar eden en m\u00fchim esbabtan birisinin izale-i \u00e7aresini a\u00e7\u0131k bir lisan ve en kolay bir usul ile g\u00f6sterir ris\u00e2ledir<\/i>\u201d olarak nitelendirerek s\u0131tma hakk\u0131nda herkesin malumat sahibi olmas\u0131 i\u00e7in konuyu olduk\u00e7a basit bir dille kaleme ald\u0131\u011f\u0131n\u0131 eserinin kapak k\u0131sm\u0131nda \u00f6zellikle vurgulam\u0131\u015ft\u0131r. \u0130smail Hakk\u0131, s\u0131tmay\u0131 \u201chem k\u00fc\u00e7\u00fck hem de gayet b\u00fcy\u00fck bir hastal\u0131k<\/i>\u201d olarak nitelendirmektedir. K\u00fc\u00e7\u00fck olmas\u0131na sebep olarak ilac\u0131n yani kininin bulunmas\u0131n\u0131 g\u00f6stererek kinin hakk\u0131nda da \u015fu dipnotu d\u00fc\u015fm\u00fc\u015ft\u00fcr: \u201cKinin bizim s\u00fclfato dedi\u011fimiz ilac\u0131n as\u0131l cevheri olup s\u00fclfatodan ba\u015fka nevleri de oldu\u011fundan kinin demek daha m\u00fcnasiptir<\/i>\u201d. B\u00fcy\u00fck olmas\u0131na ili\u015fkin ise \u015fu de\u011ferlendirmeyi yapm\u0131\u015ft\u0131r: \u201ctedavi ve h\u0131fz\u0131ss\u0131hhas\u0131 bilinmeyen yerlerde bi\u00e7are ahaliyi k\u0131ran, ge\u00e7iren, kanlar\u0131n\u0131 kurutan, benizlerini solduran, t\u00fcrl\u00fc t\u00fcrl\u00fc dertlere m\u00fcptela eden, mal\u0131na m\u00fclk\u00fcne bakamayacak derecede takatini kesen ve gen\u00e7 ya\u015flar\u0131nda ihtiyarlatan, kara topraklara sokan deh\u015fetli bir hastal\u0131kt\u0131r<\/i>\u201d (50). Kinin bulunmu\u015f olmas\u0131na ra\u011fmen, geri kalm\u0131\u015f toplumlarda s\u0131tman\u0131n h\u00e2len yayg\u0131n \u015fekilde h\u00fck\u00fcm s\u00fcrd\u00fc\u011f\u00fc de vurgulanm\u0131\u015ft\u0131r. Bu noktada, \u0130smail Hakk\u0131 II. Me\u015frutiyet\u2019in \u00f6ncesi d\u00f6nemi (devr-i sab\u0131k) ele\u015ftirerek s\u0131tma ile m\u00fccadele konusunda Osmanl\u0131 Devleti\u2019nin yetersiz politikalar\u0131n\u0131n bu hastal\u0131\u011f\u0131n y\u0131k\u0131c\u0131 etkilerine zemin haz\u0131rlad\u0131\u011f\u0131n\u0131 belirtmi\u015ftir. Bu durumun ise sa\u011fl\u0131k, n\u00fcfus ve ekonomi ba\u015fta olmak \u00fczere pek \u00e7ok alanda olumsuz sonu\u00e7lar do\u011furdu\u011funu ifade etmi\u015ftir. Avrupa \u00fclkelerinin s\u0131tma kaynakl\u0131 olarak ya\u015fanan benzer durumlar\u0131, bilimsel ilerlemeler sayesinde a\u015ft\u0131\u011f\u0131n\u0131 belirten \u0130smail Hakk\u0131, halk\u0131n bilin\u00e7lendirilmesinin de en az bilimsel geli\u015fmeler kadar \u00f6nemli oldu\u011funu \u015fu s\u00f6zlerle ifade etmi\u015ftir: \u201cHi\u00e7 \u015f\u00fcphe yoktur ki ecnebilerin bug\u00fcnk\u00fc kudretleri, kuvvetleri hep bilgileri ve k\u00f6yl\u00fclerine, kad\u0131nlar\u0131na var\u0131ncaya kadar c\u00fcmlesinin kendilerine laz\u0131m olan bilgiyi edinmi\u015f ve bu bilgileriyle amel etmi\u015f olmalar\u0131 sayesindedir<\/i>\u201d (50). B\u00fct\u00fcn bunlara ek olarak Me\u015frutiyet ile yeni bir devrin ba\u015flad\u0131\u011f\u0131n\u0131 ifade eden yazar, art\u0131k bilgisizlikle m\u00fccadele i\u00e7in ne gerekiyorsa onun yap\u0131laca\u011f\u0131n\u0131 vurgulam\u0131\u015ft\u0131r.<\/span><\/p>\n

\u0130smail Hakk\u0131, eserinin birinci b\u00f6l\u00fcm\u00fcnde yer alan S\u0131tman\u0131n Tarifi ve Envai<\/i><\/b> ba\u015fl\u0131\u011f\u0131 alt\u0131nda s\u0131tman\u0131n tan\u0131m\u0131n\u0131 ve t\u00fcrlerini ele alm\u0131\u015f olup yayg\u0131n semptomlar\u0131n\u0131 \u201cinsan\u0131 \u00fc\u015f\u00fct\u00fcr, titretir; sonra ate\u015f ve hararet bast\u0131r\u0131r daha sonra terletir ve bu terden sonra insan a\u00e7\u0131l\u0131r, n\u00f6bet de biter<\/i>\u201d \u015feklinde s\u0131ralam\u0131\u015ft\u0131r (50). Bunun yan\u0131 s\u0131ra, \u00f6zellikle kronikle\u015fen s\u0131tman\u0131n insan sa\u011fl\u0131\u011f\u0131 \u00fczerinde y\u0131k\u0131c\u0131 etkilerinin bulundu\u011funu da vurgulam\u0131\u015ft\u0131r.<\/p>\n

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Resim 2.<\/strong> S\u0131tma Parazitlerinin Mikroskoptaki G\u00f6r\u00fcnt\u00fcs\u00fc (50)<\/p><\/div>\n

Eserin ikinci b\u00f6l\u00fcm\u00fcnde, S\u0131tman\u0131n Bulundu\u011fu Yerler<\/i><\/b> ba\u015fl\u0131\u011f\u0131 alt\u0131nda s\u0131tman\u0131n co\u011frafi da\u011f\u0131l\u0131m\u0131na ili\u015fkin bilgiler verilmi\u015ftir. \u0130smail Hakk\u0131\u2019ya g\u00f6re d\u00fcnyada s\u0131tman\u0131n bulunmad\u0131\u011f\u0131 pek az yer vard\u0131r; s\u0131tman\u0131n \u00e7o\u011falmas\u0131na hizmet eden ise su birikintileri ve batakl\u0131klard\u0131r. Ancak sadece bunlar\u0131n olmas\u0131 bir b\u00f6lgenin s\u0131tmal\u0131 oldu\u011fu anlam\u0131na gelmez \u00e7\u00fcnk\u00fc hastal\u0131k etkenini ta\u015f\u0131yan insanlar\u0131n ve bu etkenleri bula\u015ft\u0131ran sivrisineklerin varl\u0131\u011f\u0131 olmadan geli\u015femez. Yine de \u0130smail Hakk\u0131, durgun ve birikinti sular\u0131n bulundu\u011fu yerlerde s\u0131tma olgular\u0131n\u0131n art\u0131\u015f g\u00f6sterdi\u011fini belirtmi\u015ftir. \u0130smail Hakk\u0131, eserinin \u00fc\u00e7\u00fcnc\u00fc b\u00f6l\u00fcm\u00fc olan S\u0131tma Neden Oluyor?<\/i><\/b> ba\u015fl\u0131\u011f\u0131nda bu konuya \u015fu ifadelerle a\u00e7\u0131kl\u0131k getirmi\u015ftir: \u201c\u00c7ukurlar\u0131, durgun sular\u0131 \u00e7ok olan yerlerde s\u0131tman\u0131n \u00e7ok olmas\u0131 bu sivrisineklerin yumurtalar\u0131n\u0131 durgun sulara b\u0131rakmalar\u0131ndan yani \u00f6yle sulak yerlerin, sivrisineklerin \u00e7o\u011falmalar\u0131 yeti\u015fmeleri i\u00e7in muvaf\u0131k olmas\u0131ndan ileri gelir<\/i>\u201d (50).\u00a0 <\/span>S\u0131tma etkeni olan parazitlerin mikroskop alt\u0131ndaki incelemelerinde ise farkl\u0131 morfolojik \u015fekillerde g\u00f6r\u00fcld\u00fckleri tespit edilmi\u015ftir (Resim 2).<\/p>\n

\u0130smail Hakk\u0131, her sivrisine\u011fin s\u0131tma ta\u015f\u0131y\u0131c\u0131s\u0131 olmad\u0131\u011f\u0131n\u0131, s\u0131tma ta\u015f\u0131yan sivrisine\u011fe anofel denildi\u011fini ve s\u0131tman\u0131n yo\u011fun oldu\u011fu yerlerde bu cinsin mutlaka bulundu\u011funu belirtmi\u015ftir (50).<\/p>\n

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Resim 3.<\/strong> Tehlikeli Anofel Sivrisine\u011fi Cinsi (50)<\/p><\/div>\n

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Resim 4.<\/strong> Solda Zarars\u0131z Sivrisinek, Sa\u011fda Zararl\u0131 Sivrisinek (50)<\/p><\/div>\n

\u0130smail Hakk\u0131, Ronald Ross\u2019a at\u0131f yaparak sivrisineklerin duru\u015f \u015fekillerinden zararl\u0131 veya zarars\u0131z olmalar\u0131n\u0131n ay\u0131rt edilmesinin olduk\u00e7a kolay oldu\u011funu ifade etmi\u015ftir (Resim 3, Resim 4) (50).<\/p>\n

\u0130smail Hakk\u0131, s\u0131tman\u0131n sivrisinekler arac\u0131l\u0131\u011f\u0131yla ta\u015f\u0131nmas\u0131n\u0131 ise \u015fu ifadelerle a\u00e7\u0131klamaktad\u0131r: \u201cS\u0131tmay\u0131 insandan insana ge\u00e7iren bu sivrisineklerin yumurtalar\u0131n\u0131 durgun sulara koyduklar\u0131 malumdur. Fakat yumurtalar\u0131nda s\u0131tma tohumu, mikrobu yoktur ve s\u0131tman\u0131n su ile ge\u00e7meyip ancak sivrisineklerin \u0131s\u0131rmas\u0131yla ge\u00e7ti\u011fini bu da g\u00f6sterir. Sivrisineklerin t\u0131rt\u0131llar\u0131 ve u\u00e7uncaya kadar yavrular\u0131 su i\u00e7inde ya\u015farlar. Sivrisinekler uzaklara u\u00e7amad\u0131klar\u0131ndan s\u0131tmal\u0131 yerlerde en ziyade durgun sular\u0131n kenarlar\u0131, civarlar\u0131 tehlikeli olur. Sivrisinekler \u00e7ok y\u00fckselemezler<\/i>\u201d (50).<\/p>\n

Ayr\u0131ca, \u0130smail Hakk\u0131, b\u00fct\u00fcn bunlara ek olarak s\u0131tman\u0131n ortaya \u00e7\u0131kmas\u0131na yard\u0131mc\u0131 sebepler olarak v\u00fccuda iyice bakmamay\u0131, so\u011fuk almay\u0131, yorgunlu\u011fu ve zay\u0131fl\u0131\u011f\u0131 g\u00f6stermi\u015ftir (50).<\/p>\n

\u0130smail Hakk\u0131, yapt\u0131\u011f\u0131 tespitler ve de\u011ferlendirmelerin ard\u0131ndan eserinin d\u00f6rd\u00fcnc\u00fc b\u00f6l\u00fcm\u00fcnde, S\u0131tmaya Tutulmamak \u0130\u00e7in \u00c7are<\/i><\/b> ba\u015fl\u0131\u011f\u0131 alt\u0131nda, s\u0131tmadan korunma yollar\u0131na de\u011finerek iki temel hususa dikkat edilmesi gerekti\u011fini belirtmi\u015ftir: batakl\u0131k ve su birikintilerinin ortadan kald\u0131r\u0131lmas\u0131 ile sivrisineklerden ve zararlar\u0131ndan korunma. Bu iki \u00f6nlemin iyi bir \u015fekilde y\u00fcr\u00fct\u00fclmesi i\u00e7in h\u00fck\u00fcmetin d\u00fczenli \u00e7al\u0131\u015fmalar y\u00fcr\u00fctmesi, di\u011fer \u00fclkelerde oldu\u011fu gibi nizamnameler haz\u0131rlayarak komisyonlar, hekimler ve m\u00fchendisler arac\u0131l\u0131\u011f\u0131yla kapsaml\u0131 tedbirler almas\u0131 gerekti\u011fini ifade etmi\u015ftir. \u0130smail Hakk\u0131, bu kapsamda yap\u0131lan masraflardan ka\u00e7\u0131n\u0131lmamas\u0131 gerekti\u011fini ise \u015fu s\u00f6zlerle anlatmaktad\u0131r: \u201cBug\u00fcn s\u0131tma y\u00fcz\u00fcnden n\u00fcfus\u00e7a olan zaiyat\u0131m\u0131z\u0131n \u00f6n\u00fcn\u00fc almak ve ekilemeyen tarlalar\u0131m\u0131z\u0131 ektirebilmek ve batakl\u0131klar\u0131 a\u00e7arak bir\u00e7ok arazi kazanmak suretleriyle gerek insanca ve gerek i\u015f ve servet\u00e7e edilecek istifadeler d\u00fc\u015f\u00fcn\u00fcl\u00fcrse h\u00fck\u00fcmetin edece\u011fi masraf hi\u00e7 mesabesinde kal\u0131r<\/i>\u201d (50).<\/p>\n

\u0130smail Hakk\u0131, \u0130talya\u2019n\u0131n, \u0130ngiltere\u2019nin Hindistan\u2019da ve Fransa\u2019n\u0131n Cezayir ile Hindi\u00e7in\u2019de ald\u0131\u011f\u0131 s\u0131tma tedbirlerinden bahsederek benzer tedbirlerin Osmanl\u0131\u2019da Meclis-i T\u0131bbiye-i M\u00fclkiye ve S\u0131hhiye-i Umumiye\u2019ce al\u0131nmas\u0131n\u0131n gereklili\u011finden s\u00f6z eder.\u00a0 <\/span>Bu kapsamda, al\u0131nmas\u0131 gereken tedbirleri ise \u015fu \u015fekilde s\u0131ralamaktad\u0131r: Sivrisineklerin yumurta ve larvalar\u0131ndan kurtulmak amac\u0131yla batakl\u0131k ve su birikintilerinin kurutulmas\u0131; kurutulamayan yerlerde otlar\u0131n \u00fczerine gaz ya\u011f\u0131 d\u00f6k\u00fclerek larvalar\u0131n \u00f6ld\u00fcr\u00fclmesi; sivrisineklerin larvalar\u0131n\u0131 telef eden bal\u0131k, yusuf\u00e7uk ve k\u0131zb\u00f6ce\u011fi gibi canl\u0131lar\u0131n \u00e7o\u011falt\u0131lmas\u0131; s\u0131k a\u011fa\u00e7l\u0131 yerlerde sivrisineklerin \u00e7o\u011falmas\u0131n\u0131 \u00f6nlemek i\u00e7in seyrekle\u015ftirme yap\u0131lmas\u0131 veya bu alanlar\u0131n tarla haline getirilmesi; batakl\u0131klardaki otlar\u0131n temizlenmesi; kap\u0131lara, pencerelere ve di\u011fer t\u00fcm a\u00e7\u0131kl\u0131klara tel kafes tak\u0131lmas\u0131, s\u0131tmal\u0131 b\u00f6lgelerde gece d\u0131\u015far\u0131 \u00e7\u0131k\u0131lmas\u0131 halinde ellerin, ayaklar\u0131n ve y\u00fcz\u00fcn \u00f6rt\u00fclerek sivrisinek \u0131s\u0131rmalar\u0131ndan korunulmas\u0131. Ayr\u0131ca pirin\u00e7 tarlalar\u0131n\u0131n k\u00f6ylerden uzak olmas\u0131 gerekti\u011fi de ifade edilmi\u015ftir (50).<\/p>\n

\u0130smail Hakk\u0131, eserinde kinin konusuna \u00f6zel bir \u00f6nem vermi\u015f ve Sivrisinekler Is\u0131rd\u0131\u011f\u0131 H\u00e2lde Tesirsiz B\u0131rakmak: Kinin<\/i><\/b> ba\u015fl\u0131\u011f\u0131 alt\u0131nda bu konuyu de\u011ferlendirmi\u015ftir. Ayr\u0131ca bu b\u00f6l\u00fcmde kininin, s\u0131tma \u00fczerindeki etkisi konusunda Almanya, Fransa ve \u0130talya\u2019daki uygulamalardan s\u00f6z edilmi\u015ftir. \u00d6zellikle \u0130talya \u00f6rne\u011fi \u00fczerinde durularak, kinin kullan\u0131m\u0131 neticesinde s\u0131tma kaynakl\u0131 \u00f6l\u00fcm oranlar\u0131n\u0131n azald\u0131\u011f\u0131na dikkat \u00e7ekilmi\u015ftir. \u0130smail Hakk\u0131, eserin H\u00fclasa<\/i><\/b> b\u00f6l\u00fcm\u00fcnde ise kinin kullan\u0131m\u0131 hakk\u0131nda \u015fu bilgilere yer vermi\u015ftir: \u201cS\u0131tmal\u0131 yerlerin ahalisi s\u0131tma mevsimlerinden bir ay veya daha ziyade evvel ba\u015flay\u0131p b\u00fct\u00fcn \u00e7oluk \u00e7ocu\u011fuyla beraber s\u0131tma mevsimi ge\u00e7inceye kadar k\u00fc\u00e7\u00fckler iki\u015fer, b\u00fcy\u00fckler d\u00f6rder veya be\u015fer bu\u011fday kinin al\u0131rlarsa s\u0131tmadan kurtulmak m\u00fcmk\u00fcn oluyor<\/i>\u201d (50).<\/p>\n

Avrupa devletlerinin, \u00f6zellikle de \u0130talya\u2019n\u0131n s\u0131tmay\u0131 ortadan kald\u0131rmak i\u00e7in \u201ch\u00fck\u00fcmet kinini\u201d ad\u0131yla resmi ve ucuz kinin tedarikini sa\u011flayarak fakir ahaliye \u00fccretsiz, i\u015f ve m\u00fclk sahiplerine ise \u00fccretli olarak kinin da\u011f\u0131tt\u0131\u011f\u0131n\u0131; \u0130smail Hakk\u0131\u2019n\u0131n ifadesiyle, bu kininlerin bandroll\u00fc, fiyat\u0131 ve cinsi ile miktar\u0131 yaz\u0131l\u0131 \u015fi\u015feler i\u00e7inde her yerde kolayca bulunabildi\u011fini ve b\u00f6ylece halk i\u00e7in kolayca, ucuzca, yoksullar i\u00e7inse meccanen temin edilebildi\u011fini belirtmi\u015ftir. \u0130smail Hakk\u0131\u2019ya g\u00f6re Osmanl\u0131\u2019da ayn\u0131 \u015fekilde kinin tedarikini kolayla\u015ft\u0131rmak, ucuzlatmak ve b\u00fct\u00fcn k\u00f6yl\u00fcleri kinin kullan\u0131m\u0131na al\u0131\u015ft\u0131rmak olduk\u00e7a elzemdir. Ancak kinin bulman\u0131n kolay bir \u015fey olmad\u0131\u011f\u0131n\u0131 \u015fu s\u00f6zleriyle ifade etmektedir: \u201cK\u00f6y\u00fcnde yok ki als\u0131n. Kim bilir ka\u00e7 saat uzak olan kasaba merkezinden getirmek laz\u0131m. \u00dc\u00e7 be\u015f guru\u015fu olsa kasabaya giden birisiyle \u0131smarlar bir iki tak\u0131m s\u00fclfato getirtebilir. Fakat yok ne yaps\u0131n? Ekini veya mal\u0131 varsa birka\u00e7 ay sonra olacak mahsul\u00fcn\u00fc, arpas\u0131n\u0131, bu\u011fday\u0131n\u0131, di\u011fer k\u0131ymetli bir mal\u0131n\u0131 yar\u0131 fiyat\u0131na satar, be\u015f on kuru\u015f al\u0131r g\u00f6nderir. Birka\u00e7 tak\u0131m s\u00fclfato getirtir. Tak\u0131m dedi\u011fi bir k\u00e2\u011f\u0131t i\u00e7ine konmu\u015f on veya on be\u015f bu\u011fday, en a\u015fa\u011f\u0131l\u0131k cinsinden bir s\u00fclfatodan ibarettir<\/i>\u201d (50). Bu gibi nedenlerle ucuz ve gerekti\u011finde \u00fccretsiz olarak kinin tedarik ettirmenin \u00f6nemine s\u0131k\u00e7a vurgu yapm\u0131\u015ft\u0131r. Ayr\u0131ca, Avrupa\u2019da oldu\u011fu gibi Osmanl\u0131\u2019da da nizamnameler do\u011frultusunda kininlerin \u015fekerlemeli veya \u015fekerlemesiz haplar \u015feklinde haz\u0131rlanarak \u00fczerlerinde faydalar\u0131, t\u00fcrleri ve miktarlar\u0131n\u0131n yaz\u0131l\u0131 oldu\u011fu damgal\u0131 ve m\u00fch\u00fcrl\u00fc \u015fi\u015felerde halka da\u011f\u0131t\u0131lmas\u0131n\u0131n veya sat\u0131lmas\u0131n\u0131n \u201cs\u0131hhat ve n\u00fcfus ve servet-i umumiyelerimize<\/i>\u201d b\u00fcy\u00fck hizmet sa\u011flayaca\u011f\u0131n\u0131 ifade etmi\u015ftir (50).<\/span><\/p>\n

SONU\u00c7<\/h2>\n

Osmanl\u0131 Devleti\u2019nde Tanzimat\u2019\u0131n ilan\u0131ndan sonra bula\u015f\u0131c\u0131 ve salg\u0131n hastal\u0131klarla m\u00fccadele konusunda etkin bir politika izlenmi\u015ftir. Bu noktada \u00f6zellikle 19. y\u00fczy\u0131l\u0131n ikinci yar\u0131s\u0131ndan itibaren s\u0131tman\u0131n endemik ve epidemik bir halde etkisini art\u0131rmas\u0131, devletin bu konuda \u00f6nlemler almas\u0131na neden olmu\u015ftur. S\u0131tma ile m\u00fccadelede tedavi edici ve koruyucu sa\u011fl\u0131k hizmetlerinin ba\u015far\u0131yla y\u00fcr\u00fct\u00fclmesi i\u00e7in halk\u0131n bilin\u00e7lendirilmesi b\u00fcy\u00fck \u00f6nem ta\u015f\u0131maktayd\u0131. II. Me\u015frutiyet\u2019in ilan\u0131n\u0131n ard\u0131ndan bas\u0131n-yay\u0131n faaliyetlerinde ya\u015fanan art\u0131\u015f, sa\u011fl\u0131k ve t\u0131p alan\u0131nda da \u00f6nemli eserlerin yay\u0131mland\u0131\u011f\u0131 bir d\u00f6nemi ba\u015flatm\u0131\u015ft\u0131r. S\u0131tma gibi bir hastal\u0131kla m\u00fccadelede yaln\u0131zca devletin ald\u0131\u011f\u0131 \u00f6nlemlerin yeterli olmayaca\u011f\u0131n\u0131 fark eden ve halk\u0131n bilin\u00e7lendirilmesinin gereklili\u011fine inanan \u00e7ok y\u00f6nl\u00fc bir ayd\u0131n olarak Doktor Milasl\u0131 \u0130smail Hakk\u0131, 1910 y\u0131l\u0131nda yazd\u0131\u011f\u0131 eseriyle bu alanda \u00f6nc\u00fc olmu\u015ftur.<\/p>\n

\u0130smail Hakk\u0131, eserini d\u00f6nemin s\u0131tma ile ilgili en sade anlat\u0131ml\u0131 eseri olarak nitelendirerek herkesin konu hakk\u0131nda bilgi sahibi olabilmesini hedeflemi\u015ftir. Eserde, s\u0131tman\u0131n tan\u0131m\u0131 ve a\u00e7\u0131klamas\u0131n\u0131n yan\u0131 s\u0131ra bu hastal\u0131\u011f\u0131n \u00f6nlenmesi i\u00e7in y\u00f6neticileri, hekimleri ve k\u00f6yl\u00fcy\u00fc y\u00f6nlendirici birtak\u0131m \u00f6nerilere de yer verilmesi, eseri s\u0131tma konusunda adeta bir rehber haline getirmektedir. S\u0131tma ile m\u00fccadelede etkin bir ila\u00e7 olan kinin konusuna da \u00f6zel \u00f6nem veren \u0130smail Hakk\u0131, bu konuda di\u011fer \u00fclkelerdeki \u00f6rnekleri ve geli\u015fmeleri analiz ederek Osmanl\u0131\u2019n\u0131n da benzer politikalar\u0131 hayata ge\u00e7irmesi gerekti\u011fine dair \u00f6nerilerde bulunmu\u015ftur. Bu ba\u011flamda \u00f6zellikle \u00fczerinde durdu\u011fu \u201cDevlet Kinini\/H\u00fck\u00fcmet Kinini\u201d meselesi, Osmanl\u0131\u2019da 1911\u2019den itibaren artan fark\u0131ndal\u0131kla 1913\u2019ten itibaren \u00fccretsiz kinin da\u011f\u0131t\u0131m\u0131n\u0131n ba\u015flamas\u0131na zemin haz\u0131rlam\u0131\u015ft\u0131r. B\u00f6ylece s\u0131tma ile m\u00fccadelede daha etkili ad\u0131mlar at\u0131lm\u0131\u015ft\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e S\u0131tma etkeni hen\u00fcz bilinmezken, hastal\u0131\u011f\u0131n \u00e7o\u011funlukla batakl\u0131k alanlara yak\u0131n yerlerde yayg\u0131n olarak g\u00f6r\u00fclmesi nedeniyle, batakl\u0131klar\u0131n \u00fcretti\u011fi k\u00f6t\u00fc kokular\u0131n solunmas\u0131yla bula\u015ft\u0131\u011f\u0131na inan\u0131l\u0131yordu. Antik M\u0131s\u0131r, \u00c7in ve Hint t\u0131bb\u0131na dair g\u00fcn\u00fcm\u00fcze ula\u015fan belgelerde s\u0131tman\u0131n varl\u0131\u011f\u0131ndan s\u00f6z edilmekte olup bu hastal\u0131\u011f\u0131n insanl\u0131k tarihi kadar eski oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmektedir. Yakla\u015f\u0131k 30 milyon y\u0131ll\u0131k jeolojik katmanlarda sivrisinek fosillerine rastlanmas\u0131 da […]<\/p>\n","protected":false},"author":4,"featured_media":30658,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[6116,6115,2971,6114],"class_list":["post-30407","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ozgun-arastirma","tag-milasli-ismail-hakki","tag-osmanli-tip-tarihi","tag-sitma","tag-tip-tarihi"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/30407","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\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=30407"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/30407\/revisions"}],"predecessor-version":[{"id":30544,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/30407\/revisions\/30544"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/30658"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=30407"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=30407"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=30407"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}