The influences of X-ray discovery in Istanbul.While the scientific world which had met with the X-rays on December 28th 1895,  was dealing with the means to utilize them,  photographers and amateur physicians in Europe had started to produce radiographic images. Also in Istanbul, Monsieur Isoire, the mathematics and physics teacher at Galatasaray High School, had taken images of his 11 year old childs hand and of metal money in a purse and the photographer Halit Bey had detected the pieces of lead in a pencil with the use of X-rays.[1] (Figure 1)  The First Radiographies in Turkey (February 1896)At the Imperial Medical School in Istanbul (Mekteb-i Tibbiye-i Sahane) the first radiographies with X-rays were taken with the curiosity and efforts of a student. Esat Feyzi (1874-1902), one of the interns,  was fond of physics since childhood. He was working in the physics laboratory of the school as a volunteer asistant. When he read the literature discussing the derivation of X-Rays in Le Semaine Mdicale, dated January 29th 1895, with an unbelievable desire to obtain these new rays, he ran to the chemistry laboratory. He requested for the electric battery which was in the chemistry laboratory from their chemistry lecturers Dr. Vasil Naum and Dr. Ali Rza (1867-1904) Beys. He knew that there were a Crookes tube and Rumkorff coil in the physics laboratory.  After setting up the necessary apparatus in a small room in the chemisrtry laboratory and working for a few days, he managed to take a radiography of the hand of Akil Muhtar (zden, 1877-1949), one of his friends. This was followed with the hand graphies of other students.[1]  Esat Feyzi continued the experiments on X-rays with Rfat Osman (Tosyal, 1874-1933), who was a student assistant at school like himself and they together took the graphies of many purses, hands, fingers and arms.[2] 1897 Turkish Greek War  Upon Greek invasion on the Crete Island, the Ottoman Empire declared war against Greece on April 17th 1897[3]. The Ottoman army commanded by Gazi Ethem Pasha (1844-1909) made an attack in Thessally on April 18th and entered Larissa (Figure 2). This was followed by the invasion of Pharsala on May 5th. When the Greek forces which had drawn back to Domokos could not sustain there and started to draw back further, cease fire was made at request of the Greek (May 19) Later on, with the interference of some European governments, led by Britain and Russia the conditions of cease fire were alleviated and the Turkish-Greek peace pact was signed in Istanbul (December 4th 1897) (Figure 24).  The transfer of the wounded men to Istanbul The wounded, whose first physical examinations and treatments were done at hospitals built by the Ottoman Red Crescent in Yenisehir (Larissa), atalca (Pharsala) ve Dmeke (Domokos)[1] were being transferred to Istanbul in troops[2] (Figure 3, Figure 4).Norman whom we think was a journalist, informed by the telegram he sent to London from Beyoglu, that the 244 wounded who had arrived by train from the front via Larissa and Volo in Sirkeci train station were treated by the most efficient surgeons and operators in Yildiz and Gmssuyu hospitals, that their bread and food were sent from the Palace kitchen, milk and yoghurts from the farms of the Sultan of the Ottoman Empire and bandages and underwear from the Palace Harem according to the instructions of their doctors.[1]80 wounded soldiers arrived in Istanbul on May 7th.[2] Dr. Hermann Kttner (b.1870), from the German Red Cross team had gone to Sirkeci to observe the troops coming from the front in the morning on May 25th. (Figure 5). On the same day he presented to the Sultan Abdulhamit II,  the pleasure and bewilderment he felt by the excellence of the way the transfer was performed[3] (Figure 6). Subsequently the wounded were brought from Volo and Thessalonica to Istanbul by steamers hired by the Ottoman Red Crescent.[4] The Temporary Yildiz Military HospitalBy the end of the 19th century, Sultan Abdulhamid II had had five ambulant wards  built on his own account in the vicinity of the Yildiz Palace to serve for the casualties of clashes at the Turkish-Greek border, for the Palace guards and for the soldiers of the 2nd Army unit in the neighbourhood (1866)[5]. This hospital called later as the Yildiz Temporary Military Hospital upon imperial order[6], was renewed by wooden transportable sheds in Duquer system imported from Germany, which could be set up and dismantled in 10 hours[7] (Figure 7- Figure 8).From the telegram sent by Albertini, probably a journalist, from Beyoglu to Vienna on May the 18th 1897, we learn that an order has been issued for two more transportable wards with 700 beds to be constructed around Yildiz for the wounded Ottoman soldiers[8] (Figure 9- Figure 10). In a news that had been transmitted to Reuters on the same day (Figure 11), it is informed that Sultan has ordered for two hospitals to be built in Yildiz for the wounded, one with 600 the other with 100 beds.[9] While the war went on, with the construction of the transportable, movable sheds imported from Germany, the number of sheds increased to 14 and of beds to 957. 598 patients out of 1.438 wounded were cured there from July 1st 1897 on; 18 cases were lost and treatment of 822 soldiers were continuing.[10] (Figure 12-Figure 13).After the discharge of Palace Guards, when the hospital was abolished in 1923 the sheds were dismantled and carried to other places in need.[11]  Usage of X-rays by Turkish doctors for Diagnostic PurposesHaving been spared for the treatment of war casualties, the management of the Yildiz Temporary Military Hospital was given to Opr. Dr. Cemil (Topuzlu) Pasha from the surgery clinic of  the Imperial Medical School (Figure 14). Cemil Pasha informed the Commander in Chief that the location  of the foreign materials in human body such as lead and bombshell pieces could be detected by radiography technique; and he proposed that the internist Dr. Salih Bey (b.1861) (Figure 15) , the 5th year student Esad (Feyzi) (Figure 16)  and 4th year student Rfat (Osman) to be charged in treating the wounded soldiers since they were experienced in application of roentgen rays at the Imperial Medical School (Figure 17). During the meeting on April 28th 1897, the Military Commission approved this mission and an order was issued next day for the mentioned staff to be charged in Yildiz Military Hospital.[12] The roentgen apparatus at School was transferred to Yildiz and needs were covered by the hospital budget.[13] 177 wounded from the first troop that had arrived in Istanbul was settled down to Yildiz hospital. 133 of them were slightly injured, 43 patients needed small operations and 6 cases were severe. On May 1st, 1897, when the German Red Cross team had not come to Istanbul yet, bullet and bombshell pieces were being resected from the wounded soldiers.[14]  The first X-ray radiography which showed the bullet pieces in the  right  wrist of Mehmet from Boyabat was published at a weekly journal, Servet-i Fnun (no. 326) dated June 10th, 1897 (Figure 18). What attracts attention with the roentgen picture of private Mehmet that, the Crookes tube of the apparatus set up by Esat Feyzi himself by temporary materials, did not have any special carriage but, instead, it was attached to an ordinary camera tripod. Whereas Kttner writes that, in Yildiz Hospital, they have used modern roentgen device made by Hirschmann-Berlin.On May 18th, Lieutenant Dr. Salih Bey and Opr. Dr. Cemil Pasha detected by X-rays the location of  bullet pieces in the foot and leg of a soldier before the German Red Cross Medical delegation. German doctors expressed their admiration at the merit of Salih Bey[15]. Those pieces were successfully resected by Cemil Pasha on May 22nd, 1897[16].The owner and editor of the Servet-i Fnun journal, Ahmed hsan (Tokgz, 1866-1942) who visited the Temporary Yildiz Military Hospital on June 3rd, 1897, relates  radiographical imaging at the X-ray department (under the supervision of Dr. Salih Bey) of a soldier wounded by a bullet in the chest; the patient laying back on a big photographical glass placed on a bed, waits for a while under the green light reflecting from the Crookes tube powered by electric batteries standing aside, is let to stand up; and then the glass is put into chemical, and the location of the bullet is at last fixed. Dr. Salih Bey shows the glasses of the captures they have done until that day. A bullet piece in the thigh bone can be seen in one of them and a bullet in the wrist in the other (Figure 19). Ahmed Ihsan pointed out that, the first attempt of exploring bullets in wounded soldiers bodies was achieved in the Ottoman land since the discovery of X-rays. [17]At a scientific meeting of the Imperial Society of Medicine in Istanbul on June 4th, 1897, Opr. Dr. Cemil Pasha presented several roentgen films of 30 war casualties from Yildiz Hospital as current medical cases. Gazette Mdicale dOrient published that presentation and stated that those radiographies were the first performances in military surgery[18]. Cemil Pasha was the first surgeon who used the roentgen rays in military surgery successfully[19] (Figure 20). The german red cross team is in istanbulBy the special permission of the German Emperor[20],  the German Red Cross delegation arrived in Istanbul by Orient Express on May 12th, 1897, it was presided by Prof. Dr. Diettrich Nasse (b. 1860), and consisted of six doctors, two operators, three attendants, totally 11 people[21] (Figure 21). They first visited Gmssuyu Military Hospital and Dr. Nasse operated on Mehmed Said there[22]. The delegation was charged in Yildiz Temporary Military Hospital on May 17th.[23] (Figure 22).In accordance with Geneva Treaty on August 22nd, 1864, the German Red Cross delegation comes to Turkey on humanitarian aims and brought accumulators, batteries and a roentgen apparatus besides medical equipments. One of the purposes of the German doctors was to investigate the possibilities of utilizing the radiological technique by seizing the opportunity of experimenting it in a battle broke out just after the discovery of X-rays.[24] Seeing that Turkish doctors were taking radiographic images with X-rays at Yildiz Hospital, they expressed appreciation and admiration they felt at observing this new discovery in usage in Turkey.[25] At Temporary Yildiz Military Hospital Turkish and German doctors continued with the radiographic captures in harmony and cooperation. After a while Dr. Nasse who stated that there were no severe cases among the wounded soldiers at both wards he was responsible, visited Bursa, and then asked for permission to go back to his country on August 3rd, 1897 [26]. In compensation of their services to the Ottoman Empire Dr. Nasse was awarded with the Imperial medal of Osman at the 3rd rank, Dr. Kttner with Imperial Medal of Mecid, their assistant Dr. Fessler with Osman medal, Schwester Stephani with Sefkat medal at the 3rd rank, dressers Folmer, Haun and Koch with Mecidi medals at the 4th rank each.[27]Dr. Kttner published his experiences the other year in Germany and expressed his gratitude to director of the hospital Rasit Pasha, operator-in-chief Cemil Pasha and especially to  Dr.Vahid Bey, the assistant at his disposal[28]. The radiologic findings of wounded Turkish soldiers Dr. Cemil Pashas cases At the beginning of 1897 before the arrival of Kttner and the German Red Cross, Cemil Pasha introduced the images of the first X-rays taken during war time. These are the first records of X-ray practice and hence the first usage in war surgery. Cemil Pasha used X-rays on 30 patients with simple wounds, complicated fractures and lose bodies.  Dr. Cemil Pasa, on  page 137 of his book describes exactly these cases which have previously been published at Gazete Mdicale: I am presenting to you the films produced by roentgen rays applied to some wounded men being treated at the temporary yldz hospital; actually these cases detected during the 1897 Turkish-Greek war are the first applications of the roentgen rays in military surgery. Cemil pasha used the roentgen rays in more then 30 wounded cases with simple or compound fractures in which the location of the bullets could not be detected precisely: Case of simple fracture in knee and leg: because the location of the bullet could not be detected precisely with the wounded suffering from too much pain, roentgen rays were used. The photographic image of the fracture of the fore arm produced by roentgen rays. If it had not been for the roentgen rays, it would not have been possible to understand that it was a fracture. Radius lower extremity fracture. Pieces of bullet can be seen over the cubitus, over the radius and under the skin. In the lower extremity of the radius the bullet can be seen with its pieces. In this roentgen film also the bullet can be seen in the distance between the bones and at the lower extremity of radius. The roentgen of the bullets located at the lower one thirds of left tibia and embedded in the ligament between the bones. The bullet has penetrated the popliteal region (the region behind the knee joint). Owing to Dr. Salih Bey responsible from all of these radiology  applications  we can detect the condition of the patients within a few seconds with the help of the radiographic films captured and we can explore the condition the patient is in without loosing time. This is an excellent medical application and great advance in military surgery. As it is I have used roentgen rays in military surgery for the first time in Europe and America with great success. Dr.Kttners cases and comments publised in Lancet 1897; The most striking importance of X-rays in surgery is the identification of foreign bodies. This has led to the conclusion that X-rays provide a substantial use in surgery in war.The first opportunity of X-ray usage in war has been during the Greco Ottoman war. The central committee had provided an X-ray instrument to a German team sent to Turkey by Red Cross that was led by Professor Nasse. I was also the second doctor of this team. Therefore we appreciate these efforts of the central committee.Our working field was the Yldz Hospital in Istanbul. The X-ray instrument was established in this big military reserve hospital which was formed by 16 huts of over 1000 bed. The instrument was functioning almost everyday during our 3 months of work. The X-ray instrument that was provided to us by Hirscmann-Berlin company had a wave inductor with  a wavelength of 40 cm.   The most efficient determinations were made by scopy. Because scopical examinations could comfortably provide information on the lose body spreading and manner of getting into pieces. Thus a plan for the operation could be possible to make. Besides we have examined a number of gun wounds with febrile infections.  These wounds were spread over extremities, mostly rough with nothing to palpate under and impossible to determine the existence of a fracture.I performed a method of X-ray from all directions for the trapped bullets. In this way I had the chance to identify the best direction for reaching the bullet and the accurate location with reference to bone.  This could provide a suitable orientation and easily provide accurate information. When a photograph was taken, the name and the reference number of the patient were also being recorded over the plate for reassurance. That was the most important stage, since a mistake could lead to irreversible consequences. The large number of people sharing the same Turkish names could easily provoke misidentifications. Most of the cases that were examined by X-rays, had embeded bullets and fractures. The bodies that were trapped in the body consisted of soft bullets that were shot from gras guns with 10.9 mm diameter and 25 g weight except for wounding by a sharapnel piece. The X-ray instrument did not disappoint us in the identification of these bodies. Severe inflammation with a bullet trapped in the hip Halit, Sergeant, 24 years old, Albanian, Soldier X-ray: The bullet is trapped behind the trocanter, in a region close to the lateral side, 2 cm under the crest. A slight deformity in shape can be seen. It is located along the lateral side of the trochanter. No fracture can be seen. The patient was operated on july 7 1897. A bullet trapped in the hip Veli. From the city of orum. 40 years old, Turkish, X-ray: The bullet can be seen on the upper half of the trocanter as a flat and wide piece of plate. No fractures can be seen. He has been operated on June 20 1897 It would be impossible to identify the bullet without roentgen in the first case in which a soft tissue trauma could lead to a wound of that severity. In the second case X-ray has been sufficient for identification of the location of the bullet. Scopical examination has proved to be valuable in the identification of the depth of location of the bullet, particularly in these thick areas of soft tissues. A blind surgical search could cause disruptions in muscular tissues and perhaps the bullet would never be found except for identification by luck. A bullet ricocheted from the bone and tarpped in the soft tissues of thigh Muhammed, From the city of Konya, 28 years old, foot soldier, corporal X-ray showing the bullet at lateral to the femur, 13 cm over the knee joint line. The bullet has been flattened considerably, however by X-ray it is seen to be located not just beside but a little bit out of the bone. The canal of the bullet is slightly darker and prominent with a number of lose body  izgilenmeleri. Its course leads from the superior anterior to inferior posterior across the entrance hole of the canal. No fractures can be seen. He has been operated on  May 26 1897. Foreign body in the soft tissue of the thigh mer, from the city of Bursa, 30 years old, Turkish X-ray showing a round foreign body at the size of  bullet ekirdek with 2 sharp corners. Thisbody is situated 7.5 cm over the upper patella line, and located slightly interior and anterior of the unfragmanted bone. The body can be seen in a smooth rounded shape and highly transparent for a metal piece on X-ray from all directions. No trace of bullet has been recorded.This has been thought to be a second foreign body and probably a stone.  On X-ray this body which is located at the same depth gives the impression of having the same transparency with that of bone. It has been reported that stones and metal pieces have the same transparency for X-rays, and metal pieces of that size is seen darker. Further information on the nature of this unusual material could not have been obtained because the patient refused having surgery and disappeared afterwards. Bullet in the calf Hamdi, from Janila, 36 years old, Albanian, , the commander of the volunteered Albanian teamX-ray: The body stands at the level of entrance hole close to the posterior side of tibia at the depth of 3-4 cm. It is located along the long axis of the larger calf and has an irregular rectangular shape. The body 2.5 cm long and 0.8 cm wide is possibly a large piece of bullet. No fracture or callus formation can be seen in the tibia. The following two cases had severe neuralgia of the peripheral nerves. Bullet in the shoulder, plexus neuralgia mer, from the city of Konya, 24 years old, Turkish foot soldierX-ray shows the location of bullet behind the side of anterior jugularis in the middle of clavicle. The patient suffers from severe pain in the arm upon deep pressure. A photograph had been considered useless because of overt X-ray findings. He has been operated on July 16 1897.  In brief X-rays have been validated useful in the identification of location of trapped bullets. Bullet extraction techniques have been simplified upon the identification of the exact location. The most frequent indication for the extraction of bullets is inflammation. Many cases in which bullet extraction is indicated for inflammation but the body stands considerably far from the entrance hole have been recorded. X-ray is valuable in these cases. Without having information on the location of the bullet, the examination of the bullet canal can lead to large wounds with the risk of infection. However, by using X-ray, one can readily reach the bullet.For instance, in a case the bullet has entered from a location close to the elbow and moved along the ligamentum interoscum and reached almost to the wrist. If the inflamed bullet canal could have been followed, revealing of all the soft tissues of the forearm would be necessary. By the experiences that we have gained during this study at war, it can be suggested that  X-ray can serve valuable functions for many reason and patients may readily ask for the application. Therefore this technique should be mandatory for military reserve hospitals. Perhaps progress in development of X-ray instruments will simplify the use of the instrument and continuous increase of the indications for usage of X-ray photographs will contribute much to war surgery in futureThe English doctors at the Greek Front  By the influence of the news published at Daily Chronicle and Clerkenwell News and by the efforts of the English Hellenic friendship associations a sympathy arose among the English public for the Greek. A medical team consituted of British doctors, surgeons and nurses arrived in Athens on May 4th,1897. A private villa at Phaerum near Athens lent under the auspieces of Queen Olga of Greece and a  large one-storeyed  pavillion in Chalcis were turned into hospitals. The medical materials, operation tables, medicine and the roentgen apparatus arrived at Pire Harbour on May 13th, 1897.[29]  The roentgen apparatus set up in a room at hospital in Phalerum, was working  with the electricity supplied from the English Warship Rodney anchored at Pire Harbour[30]. At the midst of June 1897 the images of the wounded patients started to be taken by Dr. Abbot and his assistant Mr. F. Symons.[31] Three Crookes tubes and a roentgen apparatus were used during the entire procedure. Although they sent patients to British doctors, there is no information and evidence indicating that the Greek doctors have participated in radiographic imaging in the article by Dr. Abbot who wrote his experiences and cases he treated in Turkish-Greek war of 1897[32] (Figure 23- Figure 24-Figure 25).