Mld. m;s1 Medical Missionary Work AT CESAREA, TURKEY Cesarea and Mt. Argeris By Alden R. Hoover, M. D. FOR YEAR ENDING AUGUST 31 1912 American Hospital TALAS, CESAREA, TURKEY IN ASIA llogpital Physician in charge . Assistant Physician . Ancpsthetist Superintendent Head Nurse .... Surgical Nurse Nurse in training . Nurse in training Nurse in training Housekeeper Night Nurse Night N}trse Orderly . . Orderly ...... ^taff A. R. Hoover, M. I). (j. K. Gulbenk, M. D. Mr. H AIG Haratunian, Ph.G. Miss Theda B. Phelps Miss Melpomene Serinidou AIiss Yeghsapet Bijoyan Miss Seranoush Boyajian Miss Lucia Sarkisian Miss Yester Boshnakian Miss Episteme Youakimidou Mrs. Theobista Ananiadou Mrs. A’eghsapet Sarrafian Mr. Nazar Hajikian Mr. Levon Selverian J0is!pens!arp Dispenser Assistant dispenser Mr. Haig Haratunian, Ph.G. Mr. Yoriyos Youakimidou, B. A. Medical Missionary Work T alas, a town of 10,000 inhabitants is situated practically in the center of Asia Minor. It is one and one half hours from the city of Cesarea, and at an alti- tude of 4,300 ft. above sea-level. It commands a beautiful view of Mt. Argeus on the one hand, and the broad and fertile Cesarea plain on the other. Medical work was started in Talas twenty years ago by Dr. William S. Dodd. TALAS Tlirough his untiring efforts, combined with those of Dr. Wilfred Post, his associate during the last seven years of this time, the work w'as built up in a permanent and substantial manner and recognized throughout the country as one of the most important medical centers in Turkey. A splendid three-story stone Hospital building w^as erected also a twm-story stone dispensary block with rooms for drug-store and a commodi- ous suite of five waiting rooms and examination rooms. That these men were wise in the selection of Talas as a medical center, and that their careful and efficient work was held in high esteem is attested by the following figures showing the increasing clientele the past four years. 1908-09 1909-10 1910-11 1911-12 year only) Number out patients 2691 3433 1818 3832 Number in-patients 419 460 197 616 Number surgical operations . 667 691 299 785 For some years past the former doctors have contem[)lated starting a new work in Konia and one and one half years ago the plans were completed whereby the American Board took over the Hospital and dispensary buildings and grounds to- gether with a j)art of the former equipment, and the Talas medical w’ork passed entirely into the hands of that organization. These changes necessi- tated closing the Hospital for a period of six months, an entire change in the per- sonnel of the Hospital staff, and the providing of a new equipment. Dr. A. R. Hoover, hav- ing had five years experience in the American Board’s hospital at Marsovan, was secured as jjhysician in charge. Miss Theda B. Phelps, graduate of Illinois Training School, and afterward sui)erintendent of Colonial Hos- pital, Geneva, Illinois, w'as secured as superintendent. Dr. Gulbenk, graduate of Anatolia Hospital, Marsovan, and of Beirut College of Medicine was .secured as assistant physician; Mr. Haig Haratunian, graduate of Beirut College of Pharmacy, as anaesthetist and dispen.ser. These together with one trained Armenian nurse, and a corps of undergraduate nurses, orderlies, .servants, and helpers made up the hospital staff and em])loyee.s. It seemed that all things were to work together for good for Talas, for although a multitude of difficulties stood in the way of re-establishing the work, one by one [ 4 ] they have been in great part overcome, leaving many, but such as are to be expected in any extensive work in this country. The matter of securing an equipment was a most important one, and this seemed i)rovidentiaIly met, for there stood waiting, stored in Constantinople, an outfit of some two thousand to three thousand dollars’ value practically unused, which had been purchased for an American Hospital in Constantinople. This outfit through the kindness of Constantinople station was secured and shipped to Talas. The dispensary was restocked with drugs and supplies from London, and after a period of inactivity of six months the Talas Hospital was re-opened Sept. 1, 1911. The work started out at once in good force, and before many days the hospital was filled as far as its equipment would allow. The heavy task of the fall was suc- ceeded by steady service throughout the winter months, the winter being of rather exceptional mildness. This was followed by a rush of work in the spring which con- tinued until July, when as has been customary the Hospital was closed for a few weeks for repairs and to give a brief respite from strenuous duty during the most heated term. The Hospital was open for patients 3'25 days throughout the year. The capacity of the Hospital, formerly forty beds, was of necessity increased to seventy beds. In this manner some 150 more in-patients have been accommodated than formerly. This increase together with the small Hospital force has necessi- tated the omission of much work which should be done. Practically no touring work has been possible; profes- sional visits have been made to some twelve cities and villages of this region. Much needed relief-work for poor has had to be neglected, while many plans for extension of the work in various lines have failed of execution for lack of time. During the year we have been in con- stant dread of cholera; it is still raging within four hours of Talas, but so far the cities of Talas and Cesarea have escaped. An epidemic of measles last winter carried off some hundreds of young children due to lack of care during the period of convalescence. An incident of unusual occur- [ 5 ] rence in this country was a mad-dog scare. Some twenty-four children of Talas were bitten. These children were taken in hand by the Government officials and sent to Constantinople where they were given serum treatment for a period of fourteen days. Among the Hospital and out-patient cases have been a number of general medical interest, and these have been reported in current medical literature. The constituency of the Hospital is the most varied imaginable, from the beggar in filth and rags, to those prominent in civil and religious circles. As to race and religion, about one third are of Moslem faith and two thirds of Christian races while the promiscuous range of work is perhaps best seen by reference to the list of surgical operations appended. The unsettled political atmosphere has not affected work here in the interior to any material degree. Emigration to America from the cities and villages of the whole region continues unabated, affecting particularly the Christian races, Armenian, and Greek. This will mean an increasing proportion of Moslem patients from year to year. A training school for nurses will be started] again after a lapse of two years. There are three candidates for the beginning class, the course of instruction to be three years. Graduates of schools of similar grade to the girls’ school at Talas will be eligible to the training classes, a work- ing knowledge of English being essential. The distinctively religious aspect of the medical mis- sionary work has been done in a purposely quiet and unas- suming manner. It seems wise to us and consistent with the policy of our Board to at- tempt to build up a medical institution of such high standard of proficiency as shall command the confidence and respect of Moslem and Christian alike. There is an attempt to set an honest stand- ard of 'medical ethics in the midst of much to the contrary, and first of all to gain confidence, then changed lives. Aside from personal talks with patients, daily morning and evening prayers are held in the Hospital wards, and a short preaching service each Sabbath afternoon. THE DISPEN8AHY The gratitude attested by many is our best evidence of the hand of God in all the work. We acknowledge with gratitude the faithful and efficient service of our pastor. Rev. Mibar Muncherian, in conducting evening devotions in an exceedingly helpful manner. We would also gratefully acknowledge the service of Mr. Vartavar Gara- bedian in conducting the Sabbath afternoon service in the men’s ward. Services in the women’s wards have been conducted by various persons, and to them also our thanks are due, as well also to our missionary fellow -work- ers of Talas station. Financially the Hos- pital has not yet reached the self-supporting ideal, although the returns from patients have been encouraging in this field where the rich are few and the poor abound. The re-opening of the work this year was naturally attended by numerous incidental ex- penses; the American Board has generously made a grant of $2,000 to help the financial strain. It is sincerely hoped that many friends in America or elsewhere will see in this work at Talas an opportunity for investment which is yielding great returns. A number have signified their desire to contribute $150 a year for the support of one bed each. Subscriptions which have so far reached us we acknowledge with thanks. COMING TO THE DISPENSARY Mrs. Horace Crawford, Winnipeg, Mrs. James H. Ashdown, Winnipeg Dr. C. A. Noland, Ogden, Iowa $100 50 50 Digitized by the Internet Archive in 2017 with funding from Columbia University Libraries https://archive.org/details/medicalmissionarOOhoov Surgical Operation List Regional Surgery Abdominal Appendectomy .16 Gastro-Enterostomy, posterior ... 9 Entero-Enterostomy . . . . 1 \’olvulus intestines ..... 2 Chalecystotomy ..... 2 Ventral Hernia ..... 6 Stab wound prolapse omentum 2 Stab wound prolapse intestine, gangrene 1 Appendicitis suppurative ... 6 Tubercular peritonitis . .11 Exploratory laparotomy .... 3 Hysterrectomy, complete inversion uterus . 1 Ilysterrectomy uterine and ovarian fibroids 1 Hysterrectomy abdominal ... 5 Ventral fixation or suspension ... 7 ^’entral fixation and ovariotomy 1 Ventral fixation and appendectomy 1 Ovariotomy single or double . 3 Resection ovary ..... 1 Ovariotomy and appendectomy 5 Pyosalpinx ...... 2 Pelvic adhesions ... 1 Pelvic adhesions and appendectomy . 1 Resection Fallopian tube . . 1 Dermoid cyst ovary ... 1 Adherent ovarian cyst 1 Total abdominal .... 91 Hernias Hernia inguinal single or double 36 Hernia inguinal female .... 3 Hernia inguinal strangulated ... 1 Hernia inguinal strangulated gangrenous 1 Hernia inguinal and hydrocele . 1 Hernia inguinal and castration 1 Hernia inguinal and hernia bladder . 1 Hernia congenital ..... 3 Hernia femoral ..... 1 Hernia femoral strangulated ... 1 Hernia femoral strangulated gangrenous 1 Hernia direct ...... 1 Hernia double with traumatic laceration of hernial sac ..... 1 Total hernias ..... 52 Gynecological Curettage ...... 27 Curettage and cervical repair ... 5 .Adherent placenta ..... 2 .\bortion 5 mos. foetus .... 1 Cervical repair ..... 1 Perineomaphy ..... 7 Vesico-vaginal fistula .... 5 Recto-vaginal fistula .... 1 Embryotomy ...... 2 Forceps delivery ..... 1 Pelvic abscess vaginal .... 10 Pelvic abscess groin .... 2 Condylomata vaginae .... 1 Total gynecological ... 65 Eye, Ear, Nose, and Throat Cataract ...... 26 Dacryocystitis ..... 8 Entrapion single or double ... 40 Knapp’s Operation . . . . . 13 Enucliation ...... 10 Iridectomy ...... 9 Soft cataract ...... 4 Dislocation lens ..... 3 Pterygium ...... 6 Ectropion ...... 6 Strabismus ...... 4 Retention cysts ..... 5 ■Abscess eyelid ..... 1 Tonsils and adenoids . . . .12 Radical mastoid ..... 5 Perforation palate ..... 5 Deviation nasal septum .... 3 Specific abscess septum .... 1 Nasal polyp ...... 1 Sarcoma of nose ..... 1 Laceration ear ..... 3 Caries external auditory canal ... 1 Caries middle ear ..... 1 Pharyngeal abscess .... 1 Total eye, ear, nose, and throat . . 169 Calculi Suprapubic cystotomy . . . .10 Total calculi ..... 10 9 Amputations Fingers . Hand Forearm Arm Charcot foot Symes foot Total amputation Gunshot Face, eye, and hand Hand and wrist Arm and forearm Scapula Back of neck Pubic bone and bladder . Arm, ligation brachial artery Both femurs . Thigh .... Knee .... Leg and foot . Groin .... Total gunshot . Genito-Urinary Urinary fistulse Posterior urethrotomy Internal urethrotomy Hydrocele double Castration single or double Hypospadius . Plastic scrotum Nephrectomy Total genito-urinary Tubercular Bones and Joints Lacrymial bone Superior maxillary . Inferior maxillary Orbit and cranium Ribs, resection Ribs, without resection Humerus Glenoid 'cavity Radio-humeral joint Resection elbow joint Resection knee joint Synovitis knee joint Hand and wrist Hand and foot Synovitis ankle Ankle bones Tibia .... Femur .... Ileum ....... 1 Ilio-sacral joint ..... 2 Total tbc. bones and joints . . 64 Tubercular Sinuses and Abscesses Scalp ....... 1 Cervical glands ..... 20 Cervical and axillary .... 8 Cervical and groin ..... 1 Axillary glands . . . .11 Thigh sinus and abscesses . . .13 Arm ....... 2 Elbow ....... 1 Groin glands ...... 1 Leg 1 Chest wall ...... 2 Hip 1 Popliteal abscess ..... 2 Foot ....... 1 Loin ....... 1 Total tbc. sinuses and abscesses . 66 Tumors Epithelioma face ..... 4 Lipoma ....... 5 Cancer lip with or without glands . . 5 Cancer breast and axillary glands . . 4 Cancer scalp and neck .... 1 Cancer forehead plastic .... 1 Cancer sternum ..... 1 C ancer perineum ..... 1 Cancer bladder, supra-pubic ... 1 Cancer nose, amputation ... 1 Cancer orbit ..... 2 Sarcoma-melano, forehead ... 1 Sarcoma axilla ..... 1 Sarcoma testes ..... 1 Sarcoma occiput bone .... 1 Sarcoma thigh ..... 1 Thyroidectomy ..... 4 Fibroma rectum ..... 1 Epithelioma back ..... 1 Gummata ...... 1 Fibroma forearm ..... 1 Epulis upper jaw ..... 1 Keloid multiple ..... 3 Papilloma multiple foot . . . 1 Angioma foot ..... 1 Total tumors ..... 45 General Surgery Lacerated wound scalp .... 5 Resection supra-obital nerve ... 2 Explosion laceration face ... 1 Gangrene tongue ..... 1 Hernia cerebri traumatic ... 1 Plastic mouth ..... 2 9 1 1 2 1 3 5 2 24 1 1 8 1 1 1 1 1 5 3 3 2 28 4 3 5 1 4 3 1 1 22 1 3 1 1 5 1 3 1 1 2 16 4 4 1 3 7 3 4 [ 10 ] Noma, lip and face Compound fracture skull Wen of scalp .... Harelip ..... Empyema, vesection ribs Thoracotomy Extensive specific ulcerations Old dislocation shoulder . Deep infection hand Sciatic foramen injection Jaw closure, arthritis Abscess neck and chest Schede’s operation Thoracoplasty Multiple ab.sce.sses . Mammary abscesses Retention cyst umbilicus Hepatic abscess Transplantation bone splint, spine Suppurative arthritis, shoulder Extensive skin grafting Lacerated wound abdominal wall Fracture acromial process, compound Caries tibia .... Osteomyelitis tibia Osteomyelitis fibula Deep infection forearm Compound fracture tibia and fibula Simple fracture tibia and fibula Compound fracture neck humerus Caries metacarpal bones . Evulsion thigh (machinery) Stab wound buttocks Compound fracture thigh Resection head of femur Exostosis metatarsal bones Ulceration dorsum foot Compound fracture ankle Double club foot, tenotomy Dissecting ^ellulitis leg .... 2 Perforating ulcer heel, plastic ... 1 Compound fracture foot .... 1 Laceration of foot ..... 1 Fistula in ano ..... 3 Hemorrhoids ' . .10 Circumcision ..... 7 Fissure in ano ..... 1 Fistula and repair of rectum ... 1 Fistula and hemorrhoids .... 1 Peri-rectal abscess ..... 2 Total miscellaneous .... 151 Summary Abdominal ...... 91 Hernias ...... 52 Gynecological .... 65 Eye, ear, nose, and throat . . .169 Calculi . ^ . . .10 Amputations ...... 24 Gun shot ...... 28 Genito-urinary .... 22 Tubercular bones and joints ... 64 Tubercular sinuses and abscesses 66 Tumors ...... 45 Miscellaneous ..... 151 Total operations .... 787 There have been eleven deaths in the hospital, two from Empyema, and one each from the following: Volvulus intestine of 5 days duration. Septicemia, Explosion of powder. Urinary fistula, Gastro- Enterostomy followed by pulmonary oedema. Stab- wound of abdomen. Strangulated hernia gangrenous. Suprapubic cystatomy, and Pyosalpinx from shock. 5 2 1 1 3 7 31 2 5 2 1 9 1 1 6 1 1 1 1 1 1 1 2 3 1 1 1 1 1 5 1 2 1 1 1 1 1 2 11