Encyclopedia of Pathology

Living Edition
| Editors: J.H.J.M. van Krieken

Behçet, Hulusi (1889–1948)

  • Nadir PaksoyEmail author
Living reference work entry

Latest version View entry history

DOI: https://doi.org/10.1007/978-3-319-28845-1_4037-2

Keywords

Venereal Disease Dermatology Clinic Faculty Building Recurrent Oral Ulceration International Article 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Original Names

Hulusi Behçet

Date, Country, and City of Birth

February 20, 1889, Istanbul, Turkey

Date and City of Death

March 8, 1948, Istanbul, Turkey

History of Life

Hulusi Behçet was born on February 20, 1889 in Istanbul. His father was a school inspector. His mother was his father’s cousin and passed away when Hulusi Behçet was very young and so his paternal grandmother raised him. When his father was transferred to Damascus, located within the borders of the Ottoman Empire at that time, he sent Hulusi to a French boarding school in Beirut to enable him to receive a good primary education. Subsequently Hulusi completed his high school education at the Kuleli Military Medical High School in Istanbul. Hulusi Behçet had a challenging childhood due to all these location changes, and this might have contributed to his introvert, meticulous, and anxious-nervous personality.

After finishing high school, he started his medical training at the Military School of Medicine in Istanbul. There were two faculties of medicine in Istanbul, being the military and the civilian one; both were merged into a single faculty in 1909 under the name “Ottoman Empire University (Darülfünunu Osmani), Faculty of Medicine” (The faculty from which Hulusi Behçet had graduated and adopted the name “Istanbul University Faculty of Medicine).” It rendered service until 1933 following the establishment of the Republic of Turkey. A contemporary university reform took place in 1933 under the instructions of the architect of modern Turkey, Atatürk. It was aimed to replace the scholastic training of the past with the current western university system. Meanwhile, Germans of Jewish origin who were discontent with the working and living environment in the pre-World War II Germany and anti-Nazist German scientists moved to Turkey (see also the entry about Siegfried Oberndorfer). Following the reform, Istanbul Faculty of Medicine moved to its location on the European side in Istanbul. The historic building that was used as the Office of the Commander-in-Chief during the last period of the Ottoman Empire was given to Istanbul University. The historical faculty building, from which Hulusi Behçet had graduated, is currently used as the administrative building of the establishment named “Health Sciences University,” affiliated with the Ministry of Health (Fig. 1)). It adopted the Anglo-Saxon medical training model in that period. In 1910 Hulusi Behçet graduated from this faculty as a military doctor with the rank of “lieutenant” (Fig. 2).
Fig. 1

Image of the Istanbul Medical School in the district of Haydarpaşa, where Hulusi Behçet graduated from, taken in later years (No copyright)

Fig. 2

Portrait of Hulusi Behçet (Courtesy of Prof Yalçın Tüzün, head of Istanbul University Cerrahpaşa Medical Faculty Department of Dermatology)

After graduating, Hulusi Behçet first completed in 1911 his training as an intern in the academic institution “Gülhane Postgraduate Military Medicine and Teaching Clinics” (The Gülhane postgraduate military institution where Hulusi Behçet received his dermatology training was established in 1898 under the chairmanship of Dr. Robert Rieder, a professor from Bonn University, in accordance with an agreement reached between the Ottoman Empire and the German Empire for the purpose of enabling military doctors to receive a modern training after graduation. Rieder’s assistant was Dr. Georg Deycke who was a doctor from the Hamburg Eppendorf Hospital. Deycke also gave pathology lectures in this military postgraduate institute. Due to a hip fracture following an accident during the inspection of the construction of the new faculty buildings in Haydarpaşa, Dr. Rieder had to be replaced by Prof. Julius Weiting. The hospital buildings were located in the external garden of the Topkapı Palace. The Institution continues to provide health services under the name as the “Gülhane Teaching Hospital” in Ankara.), providing internships and specialization trainings to military doctors, followed by his specialization in the “Dermatology and Venereal Diseases Clinic” (1911–1914). Hulusi Behçet stated that it was his pathology professor, Prof. Hamdi Suat (Hulusi Behçet’s pathology professor at the faculty, Prof Dr. Hamdi Suat Aknar (1873–1936), is regarded as the founder of modern pathology in Turkey. He was the first person who has received modern formal pathology training. He graduated as a military doctor. He was sent to Germany to specialize in pathology under the guidance of Dr. Deycke who also gave him pathology lectures during his postgraduate internship. Prof. Hamdi Suat completed his specialization with Prof. Marchand in Leipzig from 1900–1904, with his dissertation titled “The histopathologic changes in plague in human.” This thesis was published in a German medical journal (Die histologischen Veraenderung bei der Pest des Menschen. Zchr F. Hyg. U. Infektkrankh 48, 1904). He devoted himself to the promotion and development of pathology in Turkey until his death in Istanbul.), who was among the persons who stimulated his scientific thinking and mentored him on scientific studies. Behçet referred to him as “Master Hamdi” (Satar and Kadıoğlu 2011). During his residency period, the senior colleague who was directing and encouraging Behçet was Dr. Hodara, who was a well trained dermatologist. They both published a couple papers together (Dr. Menaham Hodara (1896–1926) was a Turkish–Jewish navy physician graduated from Military Medical Faculty is Istanbul. He worked with Drs Unna in Hamburg, Kaposi in Wien and Darier in France, who were well-respected dermatologists in Europe at that time. His special interest was dermatopathology, and he is regarded first dermatopathogist in Turkey).

The first years of his specialization coincided with World War I when he served between 1914 and 1918 at the military hospitals in the cities of Edirne and Kırklareli in the Thracian region. Afterwards he went to Europe for his professional development and stayed there for 1 year (1918–1919). First, he worked in Budapest with Dr. Joseph Sellei (Joseph Sellei (1871–1943) was the head of the department of dermatology of the hospital of the Hungarian state railways and of the Charité Policlinic in Budapest, which positions he held until his departure to the United States. He was of the founders of the Hungarian Dermatological Society (source: JAMA Network/Jama Dermatology/Joseph Sellei, M.D., orbituatries).

From Budapest Dr. Behçet moved to the Berlin Charité Hospital. He worked as a volunteer in the dermatology department with Dr. Joseph Schereschewsky, known with his experimental research on the reproduction of spirochetes causing syphilis in collaboration together with Dr. Franz Bluemental (Satar 2009).

After returning to Turkey in 1921, he worked for some time as a private doctor. In 1923 he was appointed as the chief physician at the Hasköy Venereal Diseases Hospital in the district of Haliç in Istanbul and in 1924 as the Chief of the Department of Dermatology and Venereal Diseases of the Istanbul Gureba Hospital (The Gureba Hospital, where Behçet worked prior to his appointment to Istanbul University as professor, was built in the middle of the nineteenth century as part of the foundation established for the poor. There is a private medical faculty under the name of “Bezmialem” in the same location today. The historic original main building of the hospital has been preserved). Later Behçet became the chairman of the Department of Dermatology and Venereal Diseases of the Faculty of Medicine of Istanbul University, a position he held until his death. He was the first Turkish academic who was awarded the title of full professor in this new university. One of his associates was Dr. Bertha Ottenstein (1891–1956), an eminent female German dermatologist who came with others to Turkey in the pre-World War II years. The clinic currently still serves as the Dermatology Clinic of the Faculty of Medicine of Istanbul University (Saylan 1997; http://www.hulusibehcet.net/; Üstün 2002).

For his important contributions, Hulusi Behçet was accepted as honorary or associate member of various European national dermatology societies, such as France, Austria, Hungary, and Greece.

In 1923 Hulusi Behçet married Refika Davaz, the daughter of Suat Davaz, a highly prominent diplomat of that period who served as the Paris ambassador of Turkey. They had a daughter named Güler Tunca, who later lived in London for many years as an interior architect. The marriage ended in 1941 with a divorce. Hulusi Behçet died of a heart attack on March 8, 1948.

Main Achievements to Medicine/Pathology

Behçet had an observer, interrogator, and research character. Writing publications related to his profession was almost a lifestyle for him. He wrote 140 local and 51 international articles throughout his life. Moreover, he has 17 translated articles and is the author of 12 monographs and two books in Turkish. Considering the conditions of that period and a relatively short professional life (24 years), these numbers show his productivity (Satar 2009).

At the beginning of his specialization period, Behçet’s special interest was focused on syphilis and Leishmaniasis cutis (oriental sore). In addition to the diagnosis and treatment of syphilis, he was also interested in the social and public aspect of the disease. He organized meetings aimed at raising public awareness on syphilis; he delivered talks on the radio. He defined the finding clinically named as the “nail sign” in Leishmaniasis cutis (first a nodule that ulcerates, then the crust which develops after the ulcer is lifted, “nail-like” extensions extending vertically from the crust are observed). This symptom is regarded as the pathognomonic finding of the disease (Saylan 1997; Tüzün 2006). Furthermore, he worked on the etiology of “gale cereal” in Turkey and identified its affiliation with “barley.” He defined the allergic dermatosis occurring in people that touch the fig fruit and its leaves (dermatitis figus carica) (Behçet 1933).

Definition and Acceptance Process of “Behçet’s Disease”

Hulusi Behçet’s acquaintance and identification story, with the disease currently defined after him in the world medical literature, was written firsthand in detail in the article published in 1942 in the national journal entitled the “Türk Deri Hastalıkları ve Frengi Arşivi” (The Turkish Dermatological Diseases and Syphilis Archive;1942;9:2663–2673). He first observed this disease in 1924–1925 in a dentist patient who was referred to him for ulcers in the mouth, scrotum, and eyes, painful nodules in the legs, fever, and joint pains (Satar 2009). Specialists in different disciplines for the different symptoms investigated the patient in Istanbul and Vienna, but no concrete diagnosis could be made. It was suggested that an unknown protozoon in Vienna could have caused the disease. The patient returned to Turkey and came under the supervision of Behçet, who examined two more patients with similar complaints in 1932 and 1936. He concluded that the identical findings in these three patients, with a follow-up of 21, 7, and 3 years, could be features of a new disease of possible viral origin. The German dermatology journal “Dermatologische Wochenschrift” published his views on this topic in 1937 (Behçet 1937) (Fig. 3). The German pathology professor Siegfried Oberndorfer, who worked at the Faculty of Medicine of Istanbul University during that period, did the histopathological assessment of the tissues. This article was the first publication of Behçet’s disease as a systematic disorder. It was later translated into English by Dr. Eric L. Matteson and published in 2010 with a contribution of the Mayo Foundation for Medical Education and Research, Rochester, USA (Behçet and Matteson 1937). Hulusi Behçet published two more articles in French and German on this topic in 1938 (Behçet 1938a, b). The rest of his life, Hulusi Behçet continued to perform studies and publish international articles on this topic.
Fig. 3

Front page of Hulusi Behçet’s first publication on Behçet’s disease, published in German Dermatology Journal (Derm Wschr, 1937) (Courtesy of Dr. G Satar; from personal archives of Dr. Erkan Alpsoy; Akdeniz University, Antalya Turkey)

Meanwhile, cases on the same topic were reported from various countries across the world. It was also claimed in these publications that the disease was a “new syndrome.” Finally, the disease was named as “Morbus Behçet” in 1947 at the International Dermatology Congress in Geneva upon the recommendation of Prof. Guido Mischner, director of the Dermatology Clinic of the Zurich Faculty of Medicine. Today, “Behçet’s disease” is a widely accepted eponym in the global medical literature.

The historical progression of Behçet’s disease is divided into three periods, namely, pre-Behçet, Behçet, and post-Behçet. Although similar symptoms and clinical findings were reported in Hippocratic writings, as well as in two articles depicting eye lesions of the disease by the Anatolian-born Greek ophthalmologist, Adamantiades (1875–1962), a clear description of the “triple-symptom complex” consisting of the “classical triad” that characterizes the new syndrome was not presented until the important publications by Dr. Hulusi Behçet. Moreover, Adamantiades himself referred to the disease as “Behçet syndrome” in his article regarding the eye lesions of the disease (Adamantiades and Lorendo 1949; Evreklioğlu 2010).

In the light of current information, Behçet’s disease is a systemic vasculitis affecting small and large vessels (arteries, veins, venules), characterized by recurrent oral ulcerations, genital ulcerations, and inflammation of the eyes and skin. It can also involve the joints, the central nervous system, and the gastrointestinal tract. The etiology of this disease is still unknown, but the dominant hypothesis is that of an inflammatory response triggered by an infectious agent in a genetically susceptible host. Supporting this hypothesis is the consistent association of the disease with polymorphisms in the major histocompatibility complex (MHC), particularly HLA-B51 (Mat et al. 2014; Alpsoy 2016).

Cross-References

References and Further Reading

  1. Adamantiades, B., & Lorendo, N. (1949). Sur le syndrome complex de uveite recidivante ou soi-diatant syndrome de Behçet. Presse Médicale, 57, 101.Google Scholar
  2. Alpsoy, E. (2016). Behçet’s disease: A comprehensive review with a focus on epidemiology, etiology and clinical features, and management of mucocutaneous lesions. Journal of Dermatology, 43, 620–632.CrossRefPubMedGoogle Scholar
  3. Behçet, H. (1933). Dermatite de digure et figuler. Bulletin de la Société Française de Dermatologie et de Syphiligraphie, 40, 787–792.Google Scholar
  4. Behçet, H. (1937). Über rezidivierde aphtösedurch ein virus verursachte geschwüre am mund,am auge und an der genitalien. Dermatologische Wochenschrift, 105(36), 1152–1163.Google Scholar
  5. Behçet, H. (1938a). Consideration sur les lesions aphteuses de la bouches et des parties genitals, ainsi que sur les manifestations oculaire d’origiene probalement virutiques et observations concernant leur foyer d’infection. Bulletin de la Société Française de Dermatologie et de Syphiligraphie, 45, 420–433.Google Scholar
  6. Behçet, H. (1938b). Kurze mitteilung über fokal septis mit aphtösen erscheinungen an mund, genitalen und veranderungen an den augen, als wahrscheinliche folge einer durch virusbedingten allgemeininfection. Dermatologische Wochenschrift, 107(35), 1037–1041.Google Scholar
  7. Behçet, H., & Matteson, E. L. (2010). On relapsing, aphthous ulcers of the mouth, eye and genitalia caused by a virus. 1937. Clinical and Experimental Rheumatology, 28(4 Suppl 60), S2–S5.PubMedGoogle Scholar
  8. Evreklioğlu, C. (2010). Behçet’s disease or Adamantiades-Behçet disease? An evidence-based historical survey. Medical Science Monitor, 16(6), RA136–RA142.Google Scholar
  9. Mat, M. C., et al. (2014). Behçet’s disease as a systemic disease. Clinics in Dermatology, 32(3), 435–442.CrossRefPubMedGoogle Scholar
  10. Prof. Dr. Hulusi Behcet and Behcet’s disease: Life story, publications and Behcet’s disease. http://www.hulusibehcet.net/
  11. Satar, G. (2009). Hulusi Behçet and the appearance of Behçet’s disease in medical literature. Ph.D. thesis, Cukurova University, Turkey (in Turkish with brief abstract in English: a comprehensive study on Hulusi Behçet’s history of life and main achievements to medicine/pathology. http://www.library.cu.edu.tr/tezler/7396)
  12. Satar, G., & Kadıoğlu, S. (2011). Hamdi Suat-Hulusi Behçet: An effective trainee-tutor relationship from Turkish medical history. Turkish Journal of Pathology, 27(3), 181–184. (in English, free access, Pubmed).Google Scholar
  13. Saylan, T. (1997). Life story of Dr. Hulusi Behçet. Yonsei Medical Journal, 38(6), 327–332.CrossRefPubMedGoogle Scholar
  14. Tüzün, Y. (2006). Hulusi Behçet, MD February 20, 1889 to March 8, 1948. Clinics in Dermatology, 24(6), 548–550.CrossRefPubMedGoogle Scholar
  15. Üstün, C. (2002). A famous Turkish dermatologist, Dr. Hulusi Behçet. European Journal of Dermatology, 12(5), 469–470.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Pathology, Faculty of MedicineKocaeli Universitylzmit, KocaeliTurkey