Ann Thorac Surg 1997;64:1201-1203
© 1997 The Society of Thoracic Surgeons
Our Surgical Heritage
Cemil Topuzlu Pacha and His Arterial Suture Technique
Hasan F. Batirel, MD,
Mustafa Yüksel, MD
Department of Thoracic Surgery, Marmara University Faculty of Medicine, 
stanbul, Turkey
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Abstract
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Cemil Topuzlu Pacha (1868–1958) is known to be one of the most famous surgeons in Turkey through the early decades of the twentieth century. Being a talented and courageous surgeon, he performed many of the avoided operations of that time. He presented his vascular suture techniques at the International Medical Congress in Moscow in August 1897 and at the annual Congress of the Societe de Chirurgie de Paris in July 1904. He reported 2 cases of arterial tear during breast carcinoma resection and repair within the same session. He also reported the removal of a pen cover from the right main bronchus of a 7-year-old girl through a tracheotomy in 1903. He worked for 3 years with the famous French surgeon Jules Pean and became a preferred surgeon of the Ottoman Imperial family in stanbul. He was admired for his scientific studies in international congresses and was one of the first Turkish surgeons who became a member of important European surgical associations.
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Introduction
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The last few decades of twentieth century gave birth to many talented and courageous surgeons throughout the world, known for their excellence in surgery. These times were also a rapid evolutionary period in medical knowledge in the surgical clinic of the Imperial Faculty of Medicine in stanbul.
A young surgeon, Dr Cemil, was a descendant of a noble family and became a physician in 1886. Destined to be a surgeon, he traveled a long way to Paris and worked with Jules Pean, the famous French surgeon, until 1890 [1]. He was supported by the imperial funds, and after his return to stanbul, he was appointed as a chief surgeon in Haydarpa
a Hospital in stanbul. During his career, he rose rapidly and became a colonel in 1896.
He operated on the son of Sultan Abdülhamid II and was awarded the title of Marshall (Fig 1
). He was admired and supported by the Ottoman Imperial family, and published his splendid presentations and articles in his book Memoires et Observations Medicales in stanbul in 1905 [2].
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Fig 1. . Cemil Pacha with his marshall suit and medals through the end of 19th century. (Copied from the Hamidie Annals, courtesy of Prof Aslan Terzio lu.)
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The book opens with two important articles about arterial tear and repair (Fig 2). The first article includes the cases of 2 female patients with breast carcinoma who experienced axillary artery tear during operation. The second article is about an external iliac artery tear and repair in a male patient. In the first article, the first patient was a 49-year-old woman who was operated on for recurrent breast carcinoma. Her operation was carried out on February 5, 1895, and during dissection of the tumor, a 15-mm tear occurred in the axillary artery. Doctor Cemil Topuzlu repaired the artery with five separate silk sutures; the patient was well and peripheral pulses were intact after the operation. The second patient was a 48-year-old woman who underwent operation on August 15, 1896. The axillary artery was torn and repaired in the same manner. In both cases minimal bleeding was observed after repair, and he noted that he had left a sponge inside to be pulled out afterward. This is probably due to the use of inappropriately rough needles and sutures. In his book, he also wrote about a case of pen cover aspiration to the right main bronchus and removal through a tracheotomy in 1899, another case of giant hydatid cyst removal in 1898, a Delorme-type decortication operation for a case of pyopneumothorax in 1897, a case of esophagotomy for a coin aspiration in 1898, and his experiences with cardiac resuscitation from 1889 to 1902 [2].
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Fig 2. . The chapter of arterial suture techniques in his book Memoires et Observations Médicales. (Photographed from the original book Memoires et Observation Medicales [2], courtesy of Prof Ekrem Kadri Unat, stanbul, Turkey.)
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He worked as the Major of stanbul between 1912 and 1920. During this time, he improved the sanitary facilities in stanbul and tried to change the impression of stanbul to a modern city. In 1920, he was appointed as the Minister of Public Works to the last government of the Ottoman Empire and was sentenced to death by the government of Ankara after establishment of the Republic of Turkey. He moved to Nice in France and stayed there until 1924. On his return to Turkey, although he was an open-minded and scientific person, he lived a rather sedentary life in private practice until 1946 in stanbul.
He was elected to the City Council in 1946 and continued in this position until 1950. He published his memoirs, "My Memories of 80 Years" in Turkish in 1956 [3]. He was awarded as an Honorary Ordinarius Professor of Surgery by the stanbul Faculty of Medicine. He was also awarded an honorary fellowship in 1956 by the College International de Chirurgiens and died in 1958 in stanbul [4].
He was an active member of the Ottoman Medical Society, the Imperial Medical Society, the French Surgery Association, the International College of Surgeons, and the French Society of Surgeons. He also was the president of the first two societies.
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Comment
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The first vascular reconstruction was reported by Lambert in 1762 in brachial artery. Schede, Murphy, and Eck also reported vascular reconstruction techniques in the final decades of the 19th century [5].
Doctor Cemil Topuzlu reported his 3 cases of vascular repair under the title of "Sutures des Plaies Arterielles par la Procédé de Cemil Pacha" in Bulletin de la Societe de Chirurgie de Paris. His experiences were admired in the XIIth International Congress of Medicine in Moscow in 1897. The first experimental report and study of vascular suturing was by Alexis Carrel, who had worked with a famous lacemaker and invented suture techniques and experimental anastamosis in animals. Alexis Carrel also received a Nobel Prize for his studies on vascular suture techniques and organ transplantation [6]. Doctor Cemil Topuzlu was also courageous enough to perform vascular reconstruction. He emphasized that he had ligated the axillary artery previously and the patient's arm had become gangrenous. In the first case mentioned, despite opposition of the surgeon in charge, he sutured the artery and was successful.
He also removed a foreign body from a 12-year-old child via a 2.5-cm tracheotomy. He inserted a clamp and removed a pen cover from the right main bronchus. He was the first person to publish a statistical report about the operations performed in Haydarpaa Hospital. Between 1893 and 1897, he reported 758 operations, not including small operations such as abscess drainage and small cyst removal.
He performed his first open heart massage in 1903, only 5 years after Theodore Tuffier [7], on a young man experiencing cardiac arrest due to chloroform anesthesia. The young man returned to life, but died after a second cardiac arrest. Doctor Cemil Topuzlu published this case and his resuscitation experiences in Zentralblatt für Chirurgie Leipzig in 1903 [2] and in the yearbook of the Hamidie Children's Hospital [8].
The hospitals in stanbul toward the end of the 19th century were not adequately clean, and most daily newspapers were interested with the conditions of the hospitals (Fig 3). The procedures of sterilization and disinfection were established by Cemil Pacha, who had observed the operative practice in Paris (Fig 4).
Doctor Cemil Topuzlu was sent to Paris in 1887, near Dr Pean, with imperial funds to catch up on the new medical knowledge and to convey it to his country. During the era of Abdülhamid II (1876–1909), a wise sultan, many physicians were sent to important European centers to advance their medical knowledge. Doctor Cemil Topuzlu was one of the most talented and courageous of these.
Doctor Cemil Topuzlu followed the medical literature and made important contributions to Turkish and European medical literature. He published his experiences in various journals such as La Presse Medicale, La Semaine Medicale, La Gazette Medicale D'Orient, Archives Provinciales de Chirurgie, and Bulletin et Memoires de la Societe de Chirurgie de Paris [3].
His former political career inhibited him from more courageous studies, and his support was cut off after the early years of the Republic. He was out of ambition in his most effective years during the 1920s.
It is certain that he is not the first surgeon to place an arterial suture, but he was one of the first surgeons to dare arterial repair in a scientific manner and to report his cases in the international medical arena. Despite his waxing and waning years, he is a great surgeon who should be remembered and admired in Turkish and world surgical history.
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Acknowledgments
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We especially thank Prof Dr Cemalletin Topuzlu, Prof Dr Ekrem Kadri Unat, and Prof Dr Aslan Terziolu for giving permission to copy the photographs from their personal collections. We also thank Prof Dr Nuran Yildirim and Assoc Prof Dr 
efik Görkey for their remarkable advice.
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Footnotes
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Address reprint requests to Dr Yüksel, Department of Thoracic Surgery, Marmara University Hospital, PK 97 81020 Acibadem, stanbul, Turkey.
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References
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- Hurt R. The history of cardiothoracic surgery from early times. London: Parthenon Publishing Group, 1996:186–7.
- Pacha D. Memoires et observations médicales. Constantinople: F. Loeffler, 1905.
- Topuzlu C. 80 Yillik Hatiralarim. In: Hatemi H, Kazancigil A, eds. stibdat-mesrutiyet-cumhuriyet devirlerinde. stanbul: stanbul Üniversitesi Cerrahpaa Tip Fakültesi Yayinlari, 1982.
- In Memoriam. Cemil Topuzlu M.D., F.I.C.S. (Hon.) 1868–1958. J Int Coll Surg 1958;29(6):36–7.
- Rutherford RB. Atlas of vascular surgery. Philadelphia: Saunders, 1993:2–3.
- Naef AP. The story of thoracic surgery. Bern: Hans Huber Publishers, 1990:25–8.
- Dobell ARC. Theodore Tuffier's attempt at cardiac resuscitation. Ann Thorac Surg 1993;56:583–4.[Abstract]
- Pacha D. Le massage du coeur dans les syncopes chloroformiques. Ann Med Bull Stat l'Hopital d'Enfants Hamidie 1905;6:20–7.
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Abstract
Introduction
