HISTORICAL ARTICLES

VAKUFSKA BOLNICA (MUSLIM CHARITABLE HOSPITAL) AND FIRST BRAIN OPERATIONS IN BOSNIA AND HERZEGOVINA

Faruk Konjhodzic
Department of Neurosurgery, University Medical Center, Sarajevo, Yugoslavia

Abstract

The first brain operation in Bosnia and Herzegovina with the neurosurgical technique was performed in the hospital named Vakufska Bolnica (Muslim Charitable Hospital) in Sarajevo, in the year 1891. Actualy, there were three operations. All three patients had been injured in the head several months before the operation and suffered from epileptic fits caused by bone fragments in the brain. The operations consisted of craniotomy, removing of the bone fragments and closing the dura. Hereby epileptic fits were cured or ceased. All three operations were performed by Dr. Karl Bayer. The hospital was founded 1886. as the first modern hospital of the former times in Bosnia.

Sažetak

VAKUFSKA BOLNICA I PRVE OPERACIJE NA MOZGU U BOSNI I HERCEGOVINI
Prva operacija na mozgu, u to doba modernom neurohirurškom tehnikom, napravljena je 1891. u Vakufskoj bolnici u Sarajevu. Bile su u stvari tri operacije. Sva tri pacijenta su bili ranije povrijeđeni po glavi sa koštanim fragmentom u mozgu i patili su od epilepsije. Operacija se sastojala od kraniotomije, vađenja fragmenata, zatvaranja dure. Ovim su epileptični napadi ili prestali ili su smanjeni. Sve tri operacije napravio je Dr Karl Bayer. Sama bolnica je inaugurisana 1886. kao prva moderna bolnica onog vremena u Bosni.

Key words: history of medicine, 19th cent. * neurosurgery - history * epilepsy - history * Bayer Karl * Yugoslavia * Bosnia and Herzegovina

Introduction

There was no hospital in Bosnia and Herzegovina (in further text only Bosnia) before 1886. (3). The first general hospital in Bosnia was opened on October, 8th 1886. It was the Muslim Charitable Hospital (Vakufska bol- nica) (1). All the expences for building and functioning of the hospital were covered by Ghazi Husref Bey's Foundation for Charity (Vakuf). The hospital was opened by Topal Sherif Osman pasha, the last Turkish Gover- nor of Province of Bosnia. The hospital had forty beds, two departments for males and females, outpatient department and pharmacy (see the picture). Almost at the same time, only several months later, the Turkish Military hospital was established in Sarajevo (5). There were several doctors in Vakufska bolnica (VB). The first one was Dr Josef Koetschet, and he was helped by Turkish military doctors like Dr Jammal, and specially surgeons like Dr Nuri. The last Turkish governor sent two young fellows of local people to Istambul to study medicine to be appointed later to VB. They were Dr Sami Serbic, and Dr Zarif Skender. Having completed medical studies in Istanbul, Dr Serbic had never come back to VB, but Dr Skender was working a certain period of time till his death (5). Dr Karl Bayer who performed the first brain operations came to Sarajevo with Austro - Hungarian occupational troops in 1878.

Dr Karl Bayer and brain operation

Dr Karl Bayer was born in Hradec Kralove in 1850., Bohemia. He completed his medical studies in Prague in 1876., and started working in the Royal Hospital in the same city. Shortly after that he joined Serbian army like a war surgeon in the Serbian-Turkish War, and came back in Bohemia as doctor of forensic medicine settling in his native town. A year later he joined the Austrian Navy and worked as a ship doctor till 1880. From 1880. to 1883. he worked in Mental Hospital, Kumanovo, and later in the Royal Hospital in Prague again, for more than a year. He was appointed professor of forensic medicine after that and stayed at the University in Prague for a year only. In the year 1885. became to Sarajevo, Bosnia, and became a chief doctor of VB. Dr Bayer stayed in Bosnia for the rest of his life. After the new hospital had been built and established in 1894., VB became Department for Mental Diseases, and Dr Bayer was the chief of this department. He retired in 1911., and died in 1916. There is no photograph of him. During his period in Sarajevo he became a very prominent man, and received several diplomas and awards, from Ghazi Husref Bey's Charitable Foundation and from Municipality of the town (4). The first brain operation in Bosnia was performed in summer 1891. The patient was male, young and suffered from epilepsy. He was injured in the head seven months earlier, and had had a wound in the scalp. The wound healed without any medical help, but three weeks after the injury the patient developed the first epileptic attack. Fits gradually became more frequent, and finally he contacted Dr Bayer who found "that the parietal bone had been punctured and several small bone fragments penetrated into brain. Wound was healed, and the scar was small, but the patient complained of epileptic seizures occurring almost every day". In the next nine months he observed two more patients almost with the same condition. He operated them all upon, and "found small pieces of bone delved in the brain, removed them, and closed the dura (2)." Dr Bayer reached brain through the osteoplastic craniotomy, and the flap was fixed by interrupted sutures and with the plaster on the head after skin suturing had been done.
The first two patients were free of seizures after the operation, and with the third one fits ceased without any other therapy.

Discussion

We have no evidence of the special surgical training of the Dr Bayer. He had some surgical experience as a war surgeon. Also he was probably "very clever" with his hands, because he worked as a doctor, even professor of foren- sic medicine, but his operating technique remains obscure. There were several Turkish military surgeons before Dr Bayer in Sarajevo. They performed several kinds of operations including trepanation for extracerebral hemorrhage, and the operation of the severe depressed fracture but none of them made any kind of osteoplastic flap and cerebrotomy. We estimate that Dr Bayer's contribution was great. VB was a small provincial hospital, without the separate ward for surgery. There was no experience in surgical cases, and the osteplastic craniotomy because of epileptic seizures was the first one in Bosnia. It was short period after the first removal of brain abscess by Mc Ewen in 1876., and the first craniotomy by F. Durante in 1882. It is regrettable that we do not know more about Dr Bayer's technique. There is no evidence about his instrumentation and facilities. We could not determine from his description of the operations whether he used the aspirator or Gigli saw? We also cannot say how he controlled bleeding? His description was modest as he was. We only had his description of the operation in his personal papers because VB had not operating protocol. Dr Bayer performed three operations only. The reason was probably due to organizational matter. In 1894., the new hospital was opened General Hospital (Landesspital), with the new surgical department, and modern operating theaters. The new main surgeon was an experienced surgeon from the General Hospital of Wiena, associate professor of Wienna University, Dr Preindelsberger, who preferred mainly urological operations. So, no similar brain operation was done for next several years. VB became insane asylum, named the Department for Mental Diseases, and Dr Bayer was appointed chief of it. He had not any opportunity to perform other brain operation, because the door of the Department of General Surgery was closed to him. He did not even try. The modesty of the pioneer of brain surgery in Bosnia is revealed in the fact that not even his photograph has been saved.

Acknowledgements

All papers related to the Dr Bayers curriculum vitae, were provided by Mrs Emilka Bayer, the daughter of Dr Karl Bayer, who lived in Belgrade, and died eight years ago. Requiescant in peace.

References

1. BOSANSKI VJESNIK; 1886, 11:6.
2. BOŠNJAK; 1891, 1610-1
3. Jeremić R. Prilozi zdravstvenih i medicinskih prilika Bosne i Hercegovme pod Turskom i Austro-Ugarskom. Beograd: Naučna knjiga 1051;68-9
4. Konjhodžić F, Simunović V Prve operacije na glavi i mozgu u Vakufskoj bolnici u Sarajevu. Medicinski arhiv 1978;32:325-8.
5. KreševIjaković H Vakufska bolnica In Spomenica Gazi Husrefbegove četiristogodišnjice, Sarajevo, Priređivački odbor za proslavu; 1932:72-3.

Paper accepted December 10,1991.

Address reprint requests to: Prof. Dr Faruk Konjhodzic, Klinika za neurohirurgiju UMC-a, Bolnica "KOSEVO", 71000 Sarajevo, Yugoslavia