Who Discovered Bechet's Syndrome?
Hulusi Bechet was born in Istanbul in 1889, the same year that Heinrich Dreser, a German scientist, wrote about the medicinal value of Aspirin. His father, Ahmet Behçet, was a well known businessman and was among the friends of Mustafa Kemal Atatürk, the founder of Turkish Republic. He lost his mother when he was a child and he was raised by his grandmother. His childhood was difficult for him and this gloomy state of mind had a detrimental impact on his whole life, leading him to become very introverted. He got his primary education in Damascus because of his father's business affairs there. At this time, because there was no civil medical faculty, Dr. Behçet pursued his education at Gülhane Military Medical Academy. He was 16 years old when he had started at the Academy, graduating at the age of 21 in 1910.
After he had become a medical doctor, he specialized in dermatology and venereal diseases at Gülhane Military Medical Academy and he completed his specialization in 1914. The First World War started at this time and the Ottoman Empire participated as ally of Germany.
He served at the Edirne Military Hospital during 1914-1918 as a specialist in dermatology and venereal diseases and an assistant to the head of the hospital. After the war between 1918-1919, first went to Budapest and then to Berlin's Charite Hospital to improve his medical knowledge. He had the opportunity to meet some famous colleagues at that time.
He never thought of living in Europe, however, and after his return to Turkey he worked as a free medical doctor. Then in 1923 he was appointed as the head medical doctor at the Hasköy Venereal Diseases Hospital. Six months later, he moved to Guraba Hospital, which is now part of the Istanbul Medical College, as a dermatologist. As well as his position as a professor at the university, he worked in a private consulting office.
In 1923, the year of the establishment of the Turkish Republic, he married Refika Davaz, who was sister of one his patients. His wife was the daughter of a famous diplomat, which led him to accept many patients from high society of Istanbul. He had a daughter, Güler, from this marriage and she now live in England working as a decorator.
After the establishment of the Turkish Republic, many social reforms were enacted. In 1933, the old-fashioned medical college (Darul-funun), which did not approve of scientific progress and insured on religious principles, was abolished and the University of Istanbul was established. During this period of reform, the scientific vision and knowledge of academic staff was reevaluated and some were dismissed. Dr. Behçet stayed and he set up the department of dermatology and venereal diseases which remains the base of dermatology. At that time, the dermatology department, which had been at Vakýf Guraba Hospital, moved to a place on campus which had once been a tobacco depot. It still houses the Department of Dermatology.
Dr. Behçet was the first Turk who received the title of professor, in Turkish academic life. His curiosity for investigation, writing and discussion were his intellectual characteristics. Starting from the early years in his profession, his participation in national and international congresses with original articles was very conspicuous, publishing many articles in his own country and abroad. The famous German pathologist Prof. Schwartz called him a scientist who was well known everywhere except in this country, adding that you could never find him in Turkey because he was always abroad presenting his findings.
He translated many articles into Turkish to help educate new generations and he published original case reports in international reviews in order to make contact with such countries as Korea.
He had been interested in syphilis since 1922 and he had published many international articles on its diagnosis, treatment, hereditary properties, serology and social aspects.
Leishmaniosis (Oriental Sore) was another disease which Dr. Behçet worked on, beginning in 1923. He wrote about it in many articles and succeeded in its treatment with diathermic.
He first described “the nail sign” appearing by the removal of the crust of an Oriental Sore.
A part of his published work was concerned with parasitosis. In 1923, he described the etiologic agents of “gale cereal” in Turkey. He had deal with exquisite and deep mycoses and their treatments. Due to his observations, he described the dermatitis of fig (dermatitis figus carica) in 1933.
In 1935, at the Dermatology Congress in Budapest, he was honored for his studies on mycosis. He was also in the publishing vanguard to improve Turkish medicine and he was responsible for the first dermato-venerology journal of Turkey called “Turkish Archives of Dermatology and Syphilology” in 1924.
In 1939, he was elected as a correspondent member to the German journals “Dermatologiche Wohenschrift” and “Medizinsche Wohenschrift”. The most important work that Dr. Behçet brought to Turkish medicine was the monograph published in 1940 called “Clinical and Practical Syphilis, Diagnosis and Related Dermatoses”. Every page of this book contains an aspect of syphilis and the footnotes, which provides a wealth of detailed information about the differential diagnosis of other skin diseases. As a result, scientists had the chance to learn about syphilis and dermatology at the same time.
This book, despite its out dated style, still retains its value and spirit in medicine as being the only example in its field. Dr. Behçet continued as the Head of the Department of Dermatology and Venereal Diseases until 1947. In 1939, he received the degree of “ordinarius”.
His first observations on Behçet's disease started with a patient he met between 1924-1925. This patient had been consulted for 40 years in Istanbul and Vienna several times. According to his symptoms, the illness had been diagnosed as “aphte recidivante chronique”, “erythema nodosum”, “sarcoide de Boeck” or “erythema exudativum multiformis”. From the etiology, syphilis and tuberculosis were suspected.
Austrian doctors had called an unknown protozoal disease. Ophthalmologists had described the ocular sympatomes as “iritis recividante a l'hypopion”. Iritis may be the result of syphilis, tuberculosis or streptococcal or staphylococcal infections. After several iridectomies, the patient had completely lost his vision. Dr. Behçet continued to follow up the patient for many years.
In 1930, a woman suffering from irritation in her eye and with lesions in her mouth and genital regions was referred to Dr. Behçet's clinic and told him that those symptoms had been recurring for several years.
Dr. Behçet consulted the woman until 1932 and tried to diagnose the etiological agent for tuberculosis, syphilis or mycosis etc. by biopsy and other laboratory analysis, but he could not find anything. The protinent opthalmologists Murat Rahmi and Iggescheimer had evaluated the ocular symptoms as “episclerite” and “conjunctivitis”.
Following those two patients, in 1936 a male patient from a dental clinic with oral pemphigus like wounds, acneiform signs on the back, scrotal ulcer, eye irritation, evening fever, and abdominal pain was sent to the clinic. After the consultation, nothing except a dental cyst was found. Dr. Behçet thought the recurrent symptoms might be due to a virus. He referred the patient to Prof. Braun who did a viral investigation and found some corpuscular structures.
Dr. Behçet, with the symptoms of these three patients whom he had followed for years, then decided that they were the symptoms of a new disease and in 1936, he described the situation in a meeting and this was published in the “Archives of Dermatology and Venereal Disease “.
In 1937, he wrote his ideas in “Dermatologische Wohenschrift” Journal and in the same year he presented it at the meeting of the Dermatology Association of Paris. At this meeting, he declared that a dental infection might cause the etiology of the disease.
In 1938, he published his ideas about the subject in “Dermatologische Wohenschrift” Journal in a more detailed form. In the same year, Dr. Niyazi Gözcü and Prof. Frank reported two new cases with the same symptoms. In 1938, Belgian scientists Weekers and Reginster, and the Italian Pracheschetti reported some patients with similar symptoms. Therefore European doctors had accepted the appearance of a new disease. Ophthalmologists had begun to accept “Behçet's Disease” but dermatologists suppress the new disease, insisting they could have symptoms of pemphigus, ulcus vulvae acutum, dermatomyozitis, aphtosis of Neumann, erythema exudativum multiforme, etc. While that debate was taking place, some new cases were reported from Belgium, Austria, the US, Japan, Denmark, Switzerland and Israel. When they had been published, the whole world finally came to accept that they had confronted with a new disease. In 1947, at the suggestion of Prof. Mischner of the Zurich Medical Faculty during the International Medical Congress of Geneva, this finding of Dr. Behçet's was named “Morbus Behçet”. Although it was evaluated in the early days as “Behçet's Syndrome”, “Trisymptom Behçet”, and “Morbus Behçet”, today the disease is universally called Behçet's Disease in medical literature.
In order to give the disease its place in medical literature, credit should go to Niyazi Gözcü, Iggescheimer, Murad Rahmi, rrfan Baþar, Naci Bengisu, Marchionini, Braun and Obendorfer from Turkey, Weekers, Reginster from Belgium, Franchescetti from Italy, Jensen Tage from Denmark, Sulzberger & Wise from US who all supported and participated in the work.
Hulusi Behçet interested deeply in the arts, particularly literature. Usually he was nervous and suffering from insomnia, colitis and angina pectoris, but sometimes he was joyful and good humored among friends.
He was divorced from his wife seven years before his death from a sudden heart attack on March 8, 1948.
Among his colleagues and close friends were Prof. Dr. Fahrettin Kerim Gökay, Ord. Prof. Dr. Murad Rahmi, Prof. Dr. Muzaffer evevki, Prof. Dr. Gougerot and Prof. Dr. Cartoud.
In 1975, many years after his death, he was honored with the TUBITAK Scientific Award. Several classes, laboratories and libraries had been named in his honor; and masks and statues have been made in his likeness. A new generation of scientists continue to carry on the excellent work he began, working with foundations and units that bear his name. In national and international conferences, events like “Korea-Turkey Behçet Days” are taking place. The results of these studies are published every year in various journals.
Hulusi Behçet published 126 national and international articles between 1921-1940. Fifty-three of those appeared in prestigious European scientific journals.
In 1980, on the initiative of one of his students, Dr. Ali Arban, a stamp was published in his commemoration, about which an article was published in “The Journal of the American Dental Association”. His biographies were published in the “Journal of Philatelic Society” and in the “Medical Bulletin of the United States Army, Europe and Seventh Army's Medical Bulletin”.
In 1982, he was awarded with the Medical Award of the Turkish Republic by Eczacýbaþý Foundation of Scientific Investigation. In October 1996, the Turkish mint released commemorative coins for Dr. Behçet during the National Dermatology Congress. This silver coin designed by Sculptor Suat Özyönüm, was presented in Portugal. The coin is still presented by the Cerrahpaþa Medical Faculty, Dermatology Department and by the Turkish Dermatology Association.
The life story of Hulusi Behçet, his curiosity for investigation, his discharge observation ability and his patience resolved in a gift to medicine, a mysterious new disease which is focus of wide research and interest to this day.
Much of this article is adapted from 'Life Story of Dr. Hulusi Behçet 'by Türkan Saylan TÜRKÇE
Yonsei Medical Journal 1997; 38 (6): 327-332.