ABSTRACT
Background
This study examines in detail the Damascus School of Medicine (Şam Mekteb-i Tıbbiyesi), established by the Ottoman Empire during difficult times to provide modern medical education, with respect to its academic and administrative staff, curriculum, and the functioning of its educational programs from its establishment to its closure. The aim of the study is to elucidate the relationship between the medical schools that the Empire established in the capital and the Damascus School of Medicine.
Materials and Methods
The primary sources for this study are archival documents that contain significant information on the establishment, operation, and closure of the Damascus School of Medicine, as well as the book “Şam Türk Tıbbiye Mektebi” (The Turkish School of Medicine in Damascus) by Ali Rıza Atasoy, who served as an administrator of the school for a period of time. These sources have been analyzed within the context of the research question.
Results
The Damascus School of Medicine was structured as a direct extension of the schools in İstanbul. The curriculum was implemented identically, the language of instruction was Turkish, and diplomas were issued in İstanbul. The teaching and administrative staff were also drawn from the medical schools in İstanbul. This structure enabled the school to train qualified healthcare personnel within a short period.
Conclusion
The Damascus School of Medicine stands as the most concrete provincial representation of centralized medical education in the Ottoman Empire. Its strong structural ties to İstanbul made it a significant conduit for modern medical education outside Anatolia. However, with the loss of Ottoman sovereignty over Syria, this institution was relegated to the background of historical memory.
Introduction
During a period of political, military, and economic turbulence in the Ottoman Empire, educational modernization gained momentum due to the efforts of Sultan Abdulhamid II. The intense demand for trained physicians from both the army and the populace caused these efforts to focus on medical schools as well. The renewal of medical education institutions, which began in the first quarter of the 19th century, led to the establishment of three modern medical schools by the beginning of the 20th century: two in the capital city and one in Damascus.
Tıbhane-i Amire was the first Western-style military medical school, established to meet the need for military physicians, and it began its educational activities on March 14, 1827, in the Tulumbacıbaşı Mansion in Şehzadebaşı. In 1836, the school was relocated to the Otlukçu Barracks at Sarayburnu. With the Tanzimat reforms, it was moved to Galatasaray, renamed Mekteb-i Tıbbiye-i Adliye-i Şahane in 1839, and its language of instruction was changed to French. After the building was completely destroyed in a fire in Beyoğlu in 1848, education continued at the Humbarahane-i Âmire. After being located here for a long period, the school was moved first to the Gergeroğlu Mansion because of the 1865 cholera epidemic, and then, after the epidemic ended, to the Demirkapı Barracks in Sirkeci (1). Just as the school’s Tıbhane-i Amire —the first western-style medical school—constantly changed its location, the duration and content of its education also varied over the years. With the 1839 transition to French-language education, the duration of study gradually increased to 10 years, resulting in substantially fewer graduates and a failure to meet the demand for physicians. The primary factor identified as causing the very low number of graduates, despite all the support, was instruction in a foreign language (2). To solve this problem, a new school was established to train civilian physicians solely to meet the growing health needs of the public; it provided medical education in Turkish. Thus, the second medical school, named Mekteb-i Tıbbiye-i Mülkiye (non-military medical school), began its educational activities on March 3, 1867, in the Menemenli Mustafa Pasha Mansion. The benefits of Turkish-language education were quickly recognized, and in 1870 the language of instruction at the military medical school was changed from French to Turkish (1).
Many problems arose because buildings allocated for medical education were not originally constructed as medical schools. In the 1890s, numerous complaints regarding the poor physical conditions of the medical school reached the palace. Consequently, by decree of Sultan Abdulhamid II, the construction of a new building for the military medical school began in Haydarpaşa in 1895 (3). The foundations of the new medical school building were laid with prayers on February 11 (16 Sha’ban), the Sultan’s birthday; education began on November 6, 1903, when the Mekteb-i Tıbbiye-i Şahane relocated to the new building. By 1909, the military and civilian medical schools were merged into the Haydarpaşa Building and continued to operate as Darülfünun-i Osmani Faculty of Medicine until 1933 (3).
From the outset, there was a desire to extend these significant educational developments in the capital to other major centers across the Ottoman Empire, and efforts were made toward that end. Abdulhamid II, who took a particular interest in this matter, planned to establish educational centers in various regions such as Halep, Bursa, Izmir, and Diyarbakır to expand modern medical education (4, 5). The Damascus School of Medicine, established on August 31, 1903, emerged from these efforts and became the first and only medical school founded outside the capital (6). The opening of this medical school during such a period of financial, military, and political constraints was influenced not only by Abdulhamid II’s emphasis on education but also by the missionary and propaganda activities of increasingly prevalent foreign schools in Damascus (7). The medical school, which began its education in the Ziver Pasha Mansion in 1903, was only able to move to its permanent building, constructed in the garden of the Damascus Hamidiye Gureba Hospital, on March 21, 1914. Education was provided in this building, which was constructed entirely by the Ottoman Empire, for only two years. With the outbreak of World War I and the spread of the conflict to the province of Syria, the medical school was relocated to Beirut in 1916. Following the occupation of Beirut on October 4, 1918, the medical school was closed, and its instructors were arrested (4). During the brief period it provided education, the Damascus School of Medicine graduated 240 doctors and 289 pharmacists (8).
This study aims to examine the Damascus School of Medicine, established by the Ottoman Empire to provide modern medical education during its difficult period, from its founding to its closure, through analysis of archival documents and primary sources from the period regarding its academic and administrative staff, curriculum, and the operation of its educational programs. It also aims to elucidate the relationship between the medical schools founded in the imperial capital and the Damascus School of Medicine.
Materials and Methods
In this study, the period from the establishment of the Damascus School of Medicine to its closure, as well as its academic and administrative staff, curriculum, and the functioning of its educational programs, were examined in detail, while the school’s relationship with other medical schools in the capital was analyzed at each of these stages. For this purpose, archival documents, which contained records of nearly all relevant processes, and the work “Şam Türk Tıbbiye Mektebi” (The Turkish School of Medicine in Damascus) by Ali Rıza Atasoy, who also served as an administrator of the school for a period, were treated as primary sources. All relevant documents and secondary sources were analyzed within the context of the study’s question.
Results
The Establishment of the Damascus School of Medicine
Requests for the establishment of a medical school in Damascus were conveyed to the imperial capital on various occasions by regional administrators, beginning in the early 1890s. In 1892, a series of reports was sent to the central government, first by the Director of Education for Syria and then by the Health Inspectorate of Syria (9, 10) (Figure 1). These reports mentioned the growing influence of foreign medical schools in the regions of Syria and Lebanon and the necessity for the Ottoman State to open a medical school to counter them. One of the foreign schools was the American Medical and Pharmacy School of Beirut, established in 1865 as a college complex with preparatory, higher-education, and medical sections, while the other was the St. Joseph Faculty of Medicine, established in Beirut by the French in 1883 (7).
The second report, which provided a comprehensive account of the foreign medical schools, noted that these institutions engaged not only in educational activities but also in certain missionary practices, and recommended that measures be taken to address this situation. The estimated budget required for the construction and operation of the proposed medical school was also detailed, item by item, in the same report (10). In 1895, the Inspector of Agriculture for Syria and Beirut drafted another report on the same issue, but the central government responded negatively, citing insufficient funds (10).
Finally, a 1900 report by Mirliva Hayreddin Pasha stated that physicians graduating from the Mekteb-i Tıbbiye-i Şahane and the Mekteb-i Tıbbiye-i Mülkiye could not meet the public’s need for doctors, noted that foreign schools exploited this need as an opportunity for missionary activities, and recommended the establishment of a new medical school (10, 11). The response to this report was also that, although it was acknowledged that many benefits would result from establishing the requested school, it was not possible due to economic constraints (10).
Despite the Sultan’s wish, the public’s clear need, and the officials’ persistent demands, financial inadequacies repeatedly prevented the school’s construction. However, persistent reports ensured that the urgency and importance of the need for the medical school were understood in the capital, and action was taken to establish the medical school in Damascus despite wartime conditions. The budget required for the establishment of the medical school and its affiliated clinical hospital was determined based on the expenses of the Mekteb-i Tıbbiye-i Mülkiye in İstanbul. For a period, calculations were performed to determine where and how the budget could be met, and new tax items were introduced (4). Finally, on April 16, 1903, an imperial decree establishing a medical school in Damascus was issued, stipulating that the school be built in the garden of the Damascus Hamidiye Gureba Hospital (12) (Figure 2). Because it was desirable to start education as soon as possible, the Ziver Pasha Mansion on Salihiye Avenue in Damascus was deemed a suitable temporary location until the new building was completed. With the Sultan’s permission, the school opened on August 31, 1903, and officially began education on October 5, 1903 (10) (Figure 3).
In addition to medical education, pharmacy education was initiated as a single class at the school. A three-year curriculum in pharmacy was established, and the school produced its first graduates in 1906 (13). The graduation ceremony was conducted in the same manner as for pharmacists graduating from the Mekteb-i Tıbbiye-i Şahane, and the students’ diplomas were prepared and sent from İstanbul (14) (Figure 4). By 1909, ten students who had completed their six-year education were the school’s first medical graduates (10). The diplomas of these students were similarly prepared by the Darülfünun-i Osmani Faculty of Medicine, which was established by the merger of the civilian and military medical schools in İstanbul. By 1914, the school had moved from the Ziver Pasha Mansion into its permanent building, which was constructed in the garden of the Damascus Hamidiye Gureba Hospital. Due to the outbreak of World War I, the medical school was able to continue its educational activities at this location for only two years (4). It continued its educational activities in Beirut for another two years, from 1916 to 1918.
The School’s Administrators
Founding Director
Feyzi (Hasan) Pasha
After the imperial decree establishing the Damascus School of Medicine was issued, Feyzi (Hasan) Pasha, who was in Damascus at the time as the head of the Syrian Health Commission to combat a cholera outbreak, was appointed both to lead the school’s establishment and to serve as its director for a period (1, 8, 10, 15) (Figure 5). Feyzi Pasha was a well-trained physician who graduated with first-class honors from the Mekteb-i Tıbbiye-i Şahane in 1871, after which he went to Paris to complete his specialization in internal medicine alongside prominent physicians of the era. He then returned to his alma mater to assume the role of professor of internal medicine. He served as the founding director of the Damascus School of Medicine (1).
First Director Doctor Memduh
Four months after the school’s opening, Feyzi Pasha returned to İstanbul, and Mr. Memduh—who had been an assistant in obstetrics and gynecology (fenn-i kıbale) at the Mekteb-i Tıbbiye-i Mülkiye in İstanbul—was sent to serve as director (8, 16). A committee responsible for the school’s administrative affairs also arrived with Doctor Memduh (8). This committee included Mr. Ali, secretary; Mr. Zeki, surgeon; Mr. Ethem, pharmacist; Mr. Mehmet Emin, librarian; Mr. İbrahim Fikri, museum officer; Mr. Vasil el-Mueyyed, accounting officer; Mr. Necati, head prefect; Mr. Rıza, prefect; an imam; and service personnel (10).
The school, which operated in Damascus until 1916 and then in Beirut for two years, had a total of seven directors during this period. The individuals and their appointment years are, respectively: Feyzi Pasha (1903), Doctor Memduh (1903–1907), Doctor İsmail Hakkı of Milas (1905), Doctor Şerif (1909), Doctor Arifi Pasha (1912), Doctor Hasan Reşat (1913), and Doctor Ethem Akif (1915) (17–22). With the exception of Feyzi Pasha, all the others had graduated from the Mekteb-i Tıbbiye-i Mülkiye and were appointed to the Damascus School of Medicine while serving in various other posts (8).
The School’s Instructors
First Instructors
After preparations to establish the school and its instructional building were completed, the process of identifying and appointing instructors for first-year courses began. For this purpose, a competition was held on July 20, 1903, among physicians who had graduated from the medical schools in İstanbul (4). Mr. İsmail Hakkı and Mr. Mustafa Hakkı won the competition and were appointed as the school’s first instructors (8). Mr. İsmail Hakkı, an assistant instructor of natural philosophy, physics, and geology at the Civilian School of Medicine in İstanbul, was assigned to teach the same courses at the Civilian School of Medicine in Damascus. Similarly, Mr. Mustafa Hakkı, who served as an assistant instructor for organic, inorganic, and analytical chemistry courses in İstanbul, was assigned to Damascus as the instructor for these subjects (8, 23). The instructors, whose appointment decrees were issued on September 8, 1903, set out for Damascus on September 29, 1903 (4).
Academic Staff
As a result of appointments made in late 1903 and early 1904, the academic staff for the school’s first-year class was completed (4). Accordingly, Mr. Ligor was appointed assistant chemistry instructor to Mr. İsmail Hakkı and Mr. Mustafa Hakkı (24, 25); first, Mr. Mustafa and then Mr. Bedri were appointed French[1] instructors; Mr. Mehmet Latif was appointed religious studies[2] instructor; and Mr. Abdülvehhap was appointed Turkish instructor (4,8,26–28).
The newly established school’s material deficiencies and physical needs were met over time, and the academic staff was expanded to accommodate the addition of new classes. All the school’s instructors were graduates of the medical schools in İstanbul and were appointed to Damascus from various duties in those schools or Anatolia (8, 10). Archival records from the period indicate that the instructors to be sent were examined, and those who passed the examination were appointed (28, 29).
Set of Regulations
The Damascus School of Medicine was, like other medical schools, administratively attached to the Ministry of Education and academically to the Council of Instructors of İstanbul Medical School. Immediately after its establishment, the Ministry of Education prepared and submitted a set of regulations to define both the administrative and educational activities of the school. The regulations were not immediately approved by state officials and remained pending for some time, during which problems arose. Finally, in 1906, it was decided that the Regulations of the Medical Schools in İstanbul would be implemented at the Damascus School of Medicine, thereby aligning it with the regulations as the medical schools in İstanbul (4).
For a short period, the school was attached to the Ministry of Education for financial affairs and to the Ministry of Military Schools for instructor appointments and the preparation of diplomas. In 1908, it was reaffiliated with the Ministry of Education, along with the Mekteb-i Tıbbiye-i Mülkiye in İstanbul (30). A year later, when the civilian and military medical schools in İstanbul were merged in the Haydarpaşa building and became a branch of the Ottoman University under the name “Faculty of Medicine,” the Damascus School of Medicine similarly became a branch of the Darülfünun. A document dated May 18, 1915, records the school’s name as “Darülfünun-ı Osmanî Tıb Fakültesi Şam Tabip Eczacı Şubeleri” (Ottoman University Faculty of Medicine, Damascus Branches for Physicians and Pharmacists) (31) (Figure 6). The “Tıp Fakültesi ve Şuâbatı Nizamnamesi” (Regulations for the Faculty of Medicine and its Branches), created for the Darülfünûn-ı Osmani Faculty of Medicine on March 5, 1916, also became applicable to the Damascus School of Medicine (10).
Curriculum
Three months after the imperial decree establishing the Damascus School of Medicine, which was founded to provide medical and pharmacy education, was issued, the Ministry of Education prepared a curriculum consistent with the civilian medical school in İstanbul (32). Furthermore, the first set of regulations presented to the Bâbıâli included the statement: “The school is divided into six classes, and all courses taught in the medical schools in İstanbul will be taught here.” (4). According to this program, medical education was designed to last six years, and pharmacy education was designed to last three years. Unlike at other medical schools, Turkish language classes were added to the curriculum and continued annually through the fifth year. This harmony between the schools continued after the transition to the Darülfünûn-ı Osmani Faculty of Medicine in 1909. Indeed, the courses in French, biographical historiography (tabaqat), and scribal arts (kitabet), which had been removed from the curriculum of the Faculty of Medicine in 1909, were also removed from the Damascus School of Medicine in the same year (33).
Student Admission Requirements
For students enrolling in the school’s medical department, the requirements were to have graduated from a preparatory school or to demonstrate equivalent knowledge by passing an examination. Requirements for students enrolling in the pharmacy department included graduating from middle school and having worked in a pharmacy for three years (34). It was stated that the relevant diplomas must include documentation of completion of a Turkish language course (4). Additionally, requirements for both medical and pharmacy students included possessing a certificate of good character attested by three prominent individuals from their neighborhood and endorsed by the neighborhood headman and being no older than sixteen years of age (4, 34). It was announced that students could register from the beginning of September to the end of October (34). Students enrolled in the Damascus School of Medicine had the same rights as students at the İstanbul medical schools and were exempt from military service (4).
Procurement Services and Foreign Students
To enable the school to offer a complete, high-quality education as soon as possible, efforts were made to supply necessary educational and other supplies expeditiously (35–38). To complete the procurement at the lowest possible cost, authorities ordered that materials arriving for the school be exempt from customs duties and that the relevant equipment be delivered promptly to the school, without being held up at customs (39–41). After the needs were met, and especially once educational procedures were established quickly, the school’s student population grew rapidly and became more diverse (4). Notably, four years after the school opened, archival documents from the period indicate that some foreign students enrolled in schools in Beirut applied to transfer their enrollment to the Damascus School of Medicine (42). Similarly, foreign nationals who wished to enroll in the medical schools in both Damascus and İstanbul were permitted to register if they met the necessary conditions (43–45). An examination of the school’s entire student body showed that the vast majority were Muslim Arabs, with smaller numbers of Christian Arabs, Jewish Arabs, and Turks (8).
Student Exchange
Occasionally, students transferred between the Damascus School of Medicine and the medical schools in İstanbul. An example of this is Mr. Salih Ahmet of Damascus, a pharmacy student who wished to transfer his registration from the Darülfünun-ı Osmani Faculty of Medicine in İstanbul to the Damascus School of Medicine (41). In some cases, requests from students expelled from the Civilian School of Medicine for absenteeism or disciplinary violations to transfer to the Damascus School of Medicine to complete their education were accepted (46–49).
Examinations
While classes at the school continued uninterrupted throughout the year, a final examination was held for each course at the end of the academic term. In the examinations, students’ performance was classified into four categories: aliyyü’l a’lâ (excellent), a’lâ (very good), karibü’l-a’lâ (good), and sıfır (fail). A student who failed one course was required to take a supplementary examination; a student who failed the supplementary examination or received failing grades in two courses was required to repeat the year. Successful students were entitled to advance to the next class (10, 50) (Figure 7). The examinations were conducted orally by a delegation sent from İstanbul, which also certified the diplomas of the foreign schools in Beirut (51). The school’s entrance examinations, like the final examinations for medical and pharmacy students, were also conducted by this delegation (52).
Diplomas and Award Ceremonies
The first graduates of the Damascus School of Medicine were pharmacy students who completed the three-year program and passed the general examination (53). As with all subsequent graduations, the regulations of the Mekteb-i Tıbbiye-i Mülkiye in İstanbul were applied exactly to these students’ diplomas and graduations (13, 54). After the delegation from İstanbul conducted the general examinations, an award ceremony was first held in the presence of the instructors, students, and the public (55). Afterward, the diplomas prepared in İstanbul, sent to Damascus, and lacking the signatures of the local instructors or administrators were presented to the graduating students (8, 14). Finally, the students who completed their pharmacy education with the first- and second-highest honors were awarded the gold medal in education (56). Aside from graduation, the request to implement award ceremonies at the Damascus School of Medicine for the top three medical and pharmacy students in the final examinations of the Mekteb-i Tıbbiye-i Mülkiye was accepted, and a special budget was allocated for this purpose (10). At the end of its approximately fifteen years’ educational service, 529 students had graduated from the school, including 240 physicians and 289 pharmacists (8).
The Mobilization Years, the School’s Relocation to Beirut, and Its Closure
The Damascus School of Medicine was also affected by the First World War, which began on July 28, 1914, and encompassed all Ottoman territories. At the onset of the war, educational activities were suspended temporarily, during which the school’s administration was transferred from the Ministry of Education to the Ministry of Foreign Affairs. During the suspension of education, the instructors and students of the Damascus School of Medicine, like those of the medical school in İstanbul, were conscripted and assigned to various fronts (4, 57, 58). At this time, the possibility of moving the school to Beirut, which had been raised previously, was discussed again; the school director stated that, if such a plan existed, official procedures would need to be initiated. Thereupon, it was decided to relocate the school and some other institutions from Damascus to Beirut (4, 10). Thus, the Damascus School of Medicine was relocated to the French Medical School building in Beirut and renamed Beirut Medical School (59).
Some time after relocating to Beirut, the school continued its operations to meet the army’s needs for trained physicians during the war. To address the shortage of academic staff, the school’s instructors who were serving in the army were discharged from military service. While the war continued at full intensity, with the occupation first of Palestine and then of Damascus, the school’s instructors requested that the governorate of Damascus relocate the school to Antep. The governorate did not initially take this request seriously, but when its justification was later understood, the relocation could not be carried out because the roads were held by enemy forces. The school, which had existed in Beirut for about three years, was permanently closed when the city was occupied on October 4, 1918 (4).
Discussion
The Ottoman Empire owes its ability to persist for centuries not only to its numerous other characteristics but also, in part, to its robust institutions. Educational institutions are at the forefront of these. By the last century, when the Empire was beset by various wars and troubles, the prescription for salvation was again accepted as the reorganization of educational institutions in accordance with modern scientific understanding. Sultan Abdulhamid II continued to develop and expand these renewal efforts initiated by his predecessors. To this end, he first laid the foundations for the new medical school building in Haydarpaşa in 1895 to solve the long-unresolved spatial problem of the Mekteb-i Tıbbiye-i Şahane. This structure, which began its educational activities on November 6, 1903, incorporated the civilian medical school six years later (in 1909) and thereafter served under the name Darülfünun-ı Osmani Faculty of Medicine.
Within the same time frame, successive letters from the Empire’s province of Syria to the capital reported both the public’s serious need for physicians and the presence of foreign schools conducting missionary activities that exploited this need, and called for the establishment of a medical school in the region as soon as possible. Despite these reports and the Sultan’s ambition to spread modern medical institutions throughout the Empire, financial constraints temporarily delayed construction of the school. However, over time the urgency and importance of the need became apparent, and, with great sacrifices by the public and the palace, the Damascus School of Medicine, which provided medical education in Turkish, was established in Damascus.
The Damascus School of Medicine, the Empire’s third medical school, operated in a manner that was, in many administrative and academic aspects, harmonious with and at times even subordinate to the medical schools in İstanbul. All of the school’s administrative and academic personnel were appointed from the capital. Instructors were selected based on the results of a central examination administered to graduates of medical schools in İstanbul. Likewise, the curriculum of the İstanbul medical schools was implemented unchanged in Damascus, and any change made to the curriculum in İstanbul was applied to the Damascus school shortly thereafter. The school’s general examinations were conducted by a team of instructors sent from İstanbul, and the diplomas were designed, printed, and sent from there. A ceremony similar to that held for the top graduates of the İstanbul medical schools was also organized for the graduates of the Damascus School of Medicine. The school’s expenses; the school operated in Damascus for thirteen years and in Beirut for two years between 1903 and 1918, ranging from educational materials to all other expenditures, were covered by the central government.
The relationship between Damascus and İstanbul, through the Damascus School of Medicine, was not merely a one-sided provision of services from İstanbul. During the First World War, the school’s instructors and students were mobilized and served on the front lines in defense of the homeland. Furthermore, during the short fifteen years it was active, it graduated 240 doctors and 289 pharmacists who assumed duties in various regions of the empire to meet the public’s healthcare needs. The school served as a virtual administrative, scholarly, and human bridge between Damascus and İstanbul.
Conclusion
It has been 122 years since 1903, the year in which the Mekteb-i Tıbbiye-i Şahane began its educational activities in the Haydarpaşa building and a Turkish Medical School was founded in Damascus. At that time, Syria ceased to be part of the homeland; the Damascus School of Medicine was closed; and the medical school building in Haydarpaşa, despite having endured various hardships, continued to be used as an educational institution, albeit for different purposes. On April 15, 2015, the Mekteb-i Tıbbiye-i Şahane building in Haydarpaşa was allocated to the University of Health Sciences, thereby restoring its historical identity; our university has embraced the intellectual legacy of Sultan Abdulhamid II, undertaking the mission of disseminating modern medical education throughout our cultural heartland. As long as the adherents of an ideal maintain their existence and intellectual continuity, everything is bound to return to its origin sooner or later. In this vein, our country, as in the past, began restoring education and health services to the region by opening the University of Health Sciences Çobanbey Faculty of Medicine on February 5, 2021, under very difficult conditions while the Syrian civil war raged. At present, as Syria gradually regains its freedom, it is time for the Damascus School of Medicine building, which still stands, to be restored. The reopening of the Damascus School of Medicine as a medical school, housed in its own historic building and enabled through an educational affiliation with the University of Health Sciences—which has been based in the historic Mekteb-i Tıbbiye-i Şahane building in Haydarpaşa since its inception—holds significant meaning for our past, present, and future. Through this, not only will the revival of this important scientific heritage be achieved, but the meaningful scientific support provided by today’s medical students will also contribute to the region’s rapid recovery.
