Atatürk’s kidney disease: pyelonephritis or trench nephritis? A medical and historical analysis

Abstract

Background

The aim of this study is to examine Atatürk’s recurrent renal disease throughout his life in light of historical and medical evidence and to evaluate, from a medical history perspective, whether this condition is more consistent with pyelonephritis or with “trench nephritis,” as described among soldiers during World War I.

Methods

This study was designed as a qualitative narrative review using document and content analysis. Primary and secondary sources obtained from the Archives of the Presidency of the Republic of Türkiye, the National Library, newspaper archives, physicians’ reports, memoirs, and scholarly works were systematically examined. The data were classified chronologically, and symptoms, diagnoses, treatments, medical recommendations, and treatment centers were analyzed thematically within a comparative clinical framework.

Results

The findings indicate that between 1909 and 1923, Atatürk’ experienced recurrent episodes of renal pain, fever, fatigue, and urinary inflammation. The periods of the 1911 Italo-Turkish (Trablusgarb) War, the 1915 Gallipoli (Çanakkale) Campaign, and the 1918 Vienna-Karlsbad treatments are particularly notable. The therapies applied (rest, hot baths, hydrotherapy, dietary regulation, and spa cures) were consistent with contemporary medical practice in that era. The clinical presentation shows overlapping features compatible with both chronic pyelonephritis and trench nephritis.

Conclusion

Due to the analytical limitations of historical data, a definitive diagnosis of Atatürk’s renal disease cannot be established. Nevertheless, it is likely that both trench nephritis like episodes triggered by wartime conditions and a recurrent pyelonephritis process beginning at a young age contributed to his clinical course. Despite significant health challenges, Atatürk’s uninterrupted continuation of military and political leadership stands as a striking testament to his personal resilience and strong sense of duty.

Supplementary information

The online version contains supplementary material available at 10.1186/s12882-026-05073-y.

Background

After graduating from the Military Academy, Atatürk was assigned to Damascus in 1905. Throughout his military career he frequently changed posts and fronts, living in unhealthy conditions with inadequate nutrition and irregular sleep [1]. A life marked by constant struggle and adverse conditions naturally exposed him to numerous illnesses. In addition to malaria, eye infections, ear and dental problems, and various respiratory, digestive, cardiac, and hepatic disorders, he is also known to have suffered from urogenital disease [2, 3]. The first documented urogenital disease he contracted in his twenties was blennorrhagia. Although treatment of this disease was possible under the medical conditions of the time, it recurred several times in subsequent years; therefore, it is suggested that it may have spread to the kidneys [2]. Another assessment suggests that this illness, which he contracted during his military school years, evolved into pyelonephritis due to its frequent recurrences in the pre-antibiotic era, with inflammatory findings later appearing in his urine [4].

Throughout history, wars, migrations, and trade have driven the spread of epidemics, with inadequate hygiene and limited medical care during conflicts enabling disease outbreaks. In World War I, mortality rose sharply: eight million soldiers died from injuries and three million from disease, as harsh conditions, scarcity, and malnutrition weakened troops and increased vulnerability to infection. The 1918 Spanish Flu further heightened global deaths. In the Ottoman Empire as well, wars fueled epidemics, and disease claimed more soldiers’ lives than combat [5, 6]. In the World War I, Türkiye was the only country where deaths from disease exceeded those from battle. A significant portion of soldiers and personnel serving in the army died of illness, and only 10–20% of the conscripted young men were able to return home [7].

During World War I, some British soldiers died not from combat but from illnesses linked to cold, damp conditions, poor hygiene, and parasites. In 1915, newspapers reported a renal disease in soldiers, leading the Royal Society of Medicine to meet in early 1916. Dr. W. L. Brown first discussed trench nephritis, though his infection-related findings were deemed insufficient. Dr. William Osler then described a unique renal disorder in soldiers -unlike civilian renal diseases- marked by fluctuating fever, edema, proteinuria, hematuria, and sometimes hypertension, which he named trench nephritis. Although often resolving quickly, Osler noted it could progress to chronic renal disease, and later studies showed that about 36% of cases recovered [8].

Atatürk’s life has been widely studied for his wartime experiences and the rational strategies he developed and implemented during the founding of the Republic. However, contemporary research on his health remains notably limited [9]. Since his military school years, Atatürk’s extensive frontline duties forced him to live under harsh conditions. In an era lacking modern medical resources, combating infections was far from easy, and his renal disease was among the illnesses he had to endure.

This study aims to examine Atatürk’s renal condition through primary sources (official documents, medical reports, memoirs) and secondary literature, and to discuss it within the context of medical history by comparing contemporary treatment methods with modern medical and historical perspectives.

Methods

1. Study design: This research employs qualitative methods, specifically document and content analysis. Historically significant sources on Atatürk’s kidney disease were systematically examined and interpreted through a medical-historical lens.

2. Access to resources and resource selection criteria: Archival research on Atatürk’s kidney disease was conducted using materials from the Republic of Türkiye Presidential State Archives, the National Library, Istanbul University Newspaper Archive (Gazeteden Tarihe Bakış), and the Wikilala database. Archival documents, primary sources, copyrighted monographs, and period newspapers from the relevant era were extensively examined. From the collected materials, only those containing data pertinent to the research topic were selected for analysis; all others were excluded.

Sources addressing Atatürk’s kidney disease were analyzed comparatively against other contemporary sources and archival documents. Convergent statements across sources were taken to support the reliability of the information, whereas conflicting accounts were examined in accordance with historical methodology by cross-checking them against additional contemporaneous sources and documents in order to establish the most accurate account.

Information based on memoirs and historical testimonies was restricted to individuals within Atatürk’s immediate circle and to the physicians responsible for the diagnostic and therapeutic processes, thereby ensuring objectivity. As a result of this analysis, only those sources whose accuracy was deemed reliable were included in the study.

As a result of this analysis, only those sources deemed to be reliable were included in the study. Documents and materials in which historical or factual inaccuracies were identified were utilized solely to facilitate access to accurate information and authoritative sources. Sources whose accuracy could not be verified, or which contained historical and factual errors, were excluded.

The memoirs, official documents, and primary sources published on Atatürk’s medical history form the basis of this study (Supplementary Table 1). However, it was considered that these accounts may contain subjective elements and that their medical terminology may not fully correspond to contemporary usage.

• 3.Data analysis: A qualitative content analysis was conducted in this study. After obtaining the primary printed sources related to Atatürk’s illness, all information concerning his kidney disease was recorded. These data were then thematically analyzed by researchers specializing in Republican history, medical history, and nephrology. Based on the chronological order of the documents, the symptoms, diagnosis, treatment, recommendations, attending physicians, and treatment centers associated with Atatürk’s kidney disease were identified. The findings were organized into tables, and duplicate or overlapping statements from different sources were excluded.

Results

Within the scope of the study, all documents were carefully examined. To provide a basis for discussion, the symptoms, diagnosis, treatment, medical recommendations, attending physicians, and treatment centers related to Atatürk’s kidney disease are concisely summarized in chronological order in Table 1.

Table 1.

Chronological overview of information on Atatürk’s kidney disorders

Year	Syptom(s)	Diagnosis	Treatment	Doctors’ recommendations	Doctors involved treatment	Treated center
1909	General malaise, fatigue	Unspecified	Hospitalization for 3 days between May 15–18 at Gülhane Hospital	Probably rest, medical observation	not registered	Gülhane Military Hospital, Istanbul
1911	Bloodshot eyes, shortness of breath, fever, fatigue	Possible infection; early-stage kidney and eye disease	15–20 days of hospitalization and care at Hilaliahmer Hospital in Derna	Hospitalization, eye and internal medicine treatment.	Dr. Münir (Ophthalmologist), Dr. İbrahim Tali Öngören	Hilal-i Ahmer (Red Crescent) Hospital, Derna (Libya)
1915	Malaria attacks, renal pain, weakness in the knees, fatigue.	Malaria and kidney disease	Rest at home, bed rest, care under family supervision.	Avoid hot climates, drink plenty of fluids, rest	Unknown	The family home in Akaretler, Istanbul
1918	Left kidney pain, fever, weakness, inability to get out of bed, infection in the urine.	Pyelitis (kidney inflammation), E. coli infection	Three weeks at the Cottage Sanatorium in Vienna; followed by spa and thermal bath treatments in Karlsbad	Treatment (baths, diet, rest), mud compresses, mineral water consumption	Prof. Otto Zuckerkandl, Dr. Vermer, Dr. Rasim Ferit (preliminary preparation)	Cottage Sanatorium (Vienna), Rudolfs Hof (Karlsbad, Czech Republic) Aleppo Armenian Hospital
1919	Frequent renal pain, general weakness	Kidney disease	Spa treatment, hot bath; daily bathing routine at the Havza thermal springs	A warm bath every 6 hours, diet, and light exercise	Dr. İbrahim Tali, Dr. Refik Saydam	Mesudiye Hotel and Thermal Baths, Havza
1920	Severe kidney pain, feverish episodes, fatigue	Pyelonephritis (kidney infection)	Rest, warm bath treatments	Bath therapy, relaxation, high hygien	Dr. Refik Saydam	Agricultural School, Ankara (used as headquarters building)
1922	Kidney pain, fever, digestive issues, fatigue	Kidney infection, along with intestinal disorders	Medical examination and treatment, bath, aspirin, and special diet in Akşehir	Bath, diet, 15-day course of medication, aspirin use	Dr. İhsan Arif Bey (Isparta), Dr. Hulusi Bey	The house on Station Street (Akşehir), Baron Hotel
1923	Recurrent urinary tract infection, pain	Urinary tract infection (Pyelonephritis)	Long-term follow-up and treatment by Dr. Behçet Sabit	Regular urine monitoring, continuous observation	Dr. Behçet Sabit (Erduran), Dr. Besim Ömer Paşa	Cebeci Hospital, Ankara

Discussion

Treatment of pyelonephritis before the discovery of penicillin

Alexander Fleming discovered the potent antibacterial effect of penicillin against bacteria causing pyogenic infections through experiments conducted in 1928. His publication of these findings in May 1929, titled “On the Antibacterial Action of Cultures of a Penicillium, With Special Reference to Their Use in the Isolation of B. influenzae” [10] indicates that Atatürk’s cases of bacterially induced pyelonephritis occurred in a period preceding the availability of modern treatment.

According to Louis C. Lehr’s article titled “Report of a Case of Gonorrheal Pyelitis,” published in JAMA on July 6, 1912, treatment of gonorrhea-related pyelitis at the time consisted of supportive measures aimed at reducing urinary tract irritation and pain through bed rest during the acute phase. Spasm and pain were managed with potassium citrate, tincture of hyoscyamus, and sitz baths in warm water, while increased fluid intake was encouraged to promote frequent urination [11]. According to Arthur L. Chute’s article titled “Some Observations Upon Pyogenic Infections of the Upper Urinary Tract,” published in the Boston Medical and Surgical Journal on September 3, 1914, treatment of upper urinary tract infections relied on maintaining the kidney’s ability to perform urinary filtration. Accordingly, the majority of acute pyogenic infections -particularly those of hematogenous origin- tended to regress or resolve spontaneously if renal pelvic drainage was adequate; therefore, in mild to moderate cases, management was largely supportive and limited to observation and follow-up [12]. In his article titled “Renal Pain, Modern Methods of Diagnosis and Their Interpretation,” published in the Buffalo Medical Journal in August 1917, Ernest M. Watson stated that the goal in acute pyogenic renal infections was to preserve kidney function and to eliminate any condition obstructing urinary drainage. He argued that treatment should be supportive in mild to moderate acute infections, noting that recovery was often spontaneous as long as the kidney continued to filter urine. By contrast, he emphasized that severe pyelonephritis accompanied by marked declines in functional tests, profuse purulent discharge, or abscess formation could warrant surgical intervention [13].

Trench diseases observed in soldiers during World War I

During World War I, intense migration into Anatolia, combined with adverse environmental conditions and poor hygiene, facilitated the spread of infectious diseases and negatively affected military performance. On the front lines, so-called “trench diseases”—including trench foot, trench mouth, and particularly trench fever caused by Bartonella quintana—were commonly observed. Trench fever was characterized by fever and musculoskeletal pain and, in some cases, by transient renal involvement (albuminuria, nephritis), which prolonged recovery despite being generally reversible (For details look at supplementary material) [14–19].

A renal disease (trench nephritis) seen in soldiers during World War I

Two academic articles published in 1915 and 1918, describing trench nephritis among British soldiers, are important in explaining the clinical characteristics and treatment approaches of this disease.

In the article published in The British Medical Journal on September 25, 1915, Dr. Nathan Raw examined a newly described clinical entity termed “trench nephritis” in five cases observed among soldiers who had remained at the fronts for prolonged periods during World War I. The cases were characterized by headache, fatigue, edema, proteinuria, and occasional hematuria; some progressed to severe illness, while others improved with treatment. By describing the typical clinical course, Raw emphasized that trench conditions and a non-infectious factor selectively affecting the kidneys might play a role in this syndrome. Treatment consisted of heat applications, mustard-linseed poultices, diuretics, and even pilocarpine injections to stimulate urine output. All cases recovered within a few weeks, leading Raw to suggest that the condition was related to trench life and likely represented a toxic or infective process. In the context of contemporary medical knowledge, the study stands as an important clinical observation aimed at elucidating the causes of this unusual symptom complex [20].

Tytler, W. H., and Ryle, J. A. published an article on trench nephritis in the Quarterly Journal of Medicine on April 6, 1918, describing the clinical and pathological features of 150 cases observed in rear-area field hospitals during 1916–1917. The most common findings included dyspnea, edema, marked albuminuria with erythrocytes and leukocytes in the urine, and general fatigue; severe cases were complicated by pulmonary edema and bronchitis. Although signs suggestive of infection were present, these were not considered directly attributable to trench nephritis. Death most often occurred in the second week, primarily due to respiratory failure. Pathological examinations revealed marked changes particularly in the lungs and spleen, while renal findings were milder than expected. The authors stated that treatment was primarily based on bed rest, a warm environment, and careful nursing. Saline purgatives, fluid restriction, oxygen therapy, and, in some uremic patients, bloodletting and lumbar puncture were employed. They also advised against returning soldiers to the front before complete symptom resolution, emphasizing that the condition might not be purely renal in origin but also related to respiratory involvement and environmental factors [21].

The clinical features, diagnosis, and treatment of trench nephritis have been the subject of academic studies in subsequent years: In an article on trench nephritis published in The British Medical Journal on June 22, 1940, Auld, A. G. reviewed 42 cases from World War I and emphasized the importance of the phenolsulfonphthalein test in assessing renal function. The test was shown to be independent of the degree of albuminuria or the presence of urinary casts and to provide a more reliable measure of functional renal capacity. The findings indicated that patients with marked albuminuria or casts could recover, whereas those with poor renal function test results had a worse prognosis. Thus, in trench nephritis, renal functional status, rather than clinical manifestations alone, was identified as the key determinant of disease course and likelihood of recovery [22].

In his 1986 article on trench nephritis published in the American Journal of Kidney Diseases, Maher, J. F. presented more notable insights by retrospectively evaluating the condition observed among soldiers during World War I. The disease was characterized by sudden-onset albuminuria, hypertension, edema, and dyspnea, and differed from classic poststreptococcal glomerulonephritis by its frequent association with bronchitis, low early mortality, and recurrent episodes. Pathological findings -including glomerular ischemia, capillary thrombi, endocapillary proliferation, and frequent crescent formation- suggested an underlying vasculitic process. Although the exact cause could not be determined, a postinfectious, most likely viral, etiology was proposed as the most plausible explanation. The study reassessed contemporary treatment from a modern perspective, emphasizing that management of trench nephritis was essentially supportive, limited to bed rest, protein and salt restriction, and careful fluid balance. In the absence of specific pharmacologic or immunosuppressive therapies at the time, most patients recovered within weeks, whereas severe cases were presumed to have died from respiratory failure or uremia. The article highlights trench nephritis as one of the most significant nephrological problems of the era, occupying a substantial proportion of military hospital beds [23].

Based on sources relying on a limited amount of pathological and clinical data, it was interpreted that the disease is associated with acute tubular necrosis or glomerular changes. Modern retrospective analyses also suggest that many of these cases may actually have been Hantavirus nephropathy. By the end of the war, cases of trench nephritis accounted for 25% of the bed occupancy rate in the internal medicine wards of field hospitals. Due to the prevalence of the disease, the British Army was forced to establish special “nephritis wards” to treat these cases. The disease seriously threatened the combat effectiveness of the troops and caused great concern among military authorities. This disease was not limited to the British; it was also observed in French, Canadian, German, and Austrian units [24, 25].

Kidney and kidney-related diseases experienced by Atatürk during his frontline assignments, by year

Atatürk’s health condition in 1909

In early 1909, he became Chief of Staff of the II. Reserve Division in Thessaloniki and, in May of the same year, joined the Action Army as Chief of Staff in Istanbul, where he fell ill and received treatment at Gülhane Hospital between May 15 and 18, 1909 [1]. Although no records exist regarding the illness Atatürk experienced at that time, a renal disorder may be considered in the differential diagnosis based on the available literature.

Atatürk’s health condition in 1911

In August 1911, he was appointed Chief of Staff of the Tripoli Division. While traveling to Tripoli in October, he fell ill and received treatment in Alexandria for 15 days. He returned to Tripoli at the end of November and, in January 1912, was hospitalized at the Hilal-i Ahmer (Red Crescent) Hospital in Derna. The chief medical officer of the period, İbrahim Tali Bey, reported that Atatürk had blood in his eye, experienced difficulty breathing, and had a fever, and that he was taken to the hospital through Enver Bey’s intervention. With the efforts of ophthalmologist Münir Bey and the hospital staff, Atatürk recovered within a short time and resumed his duties as Commander of Derna [1]. Considering the duration of Atatürk’s hospitalization at the Hilal-i Ahmer Hospital, along with his fever and respiratory difficulty, trench disease should be included among the diagnoses to be considered.

Atatürk’s kidney disease in 1915

After participating in the Balkan Wars following the Trablusgarb (Italo-Ottoman) War, Atatürk was appointed in November 1912 to the Operations Branch of the Bahri Sefid Straits Composite Forces Command in Gallipoli, and in October 1913 to the post of Military Attaché in Sofia. With the outbreak of World War I, he voluntarily assumed command of the 19th Division to be established in Tekirdağ in January 1915 (Supplementary Fig. 1). According to the German physician Ernest Jackh, who visited him in his tent in September of the same year, Atatürk had contracted malaria and was severely debilitated [1, 26].

At the outset of World War I, diseases were relatively mild but became increasingly widespread over time. Diarrhea and dysentery were prevalent in damp trenches, while malaria was common in swampy areas. Inadequate hygiene, water supply, and shelter conditions facilitated the spread of epidemics. Despite preventive measures, nutritional and sanitary deficiencies persisted. Hunger, cold, and deprivation weakened soldiers, and shortages of medical supplies significantly hindered efforts to control disease [27].

During the Gallipoli Campaign, living conditions at the front were extremely poor. Inadequate shelter and insufficient, contaminated water supplies led to serious sanitation problems. Infectious diseases such as malaria, cholera, typhoid, smallpox, typhus, tuberculosis, and pneumonia spread widely. Louse infestations were addressed through steam disinfection. However, there was also a shortage of medicines. Insufficient medical equipment and supplies hindered surgical care, and epidemics, malnutrition, and poor hygiene significantly increased mortality rates [28].

During the Gallipoli Campaign, Atatürk suffered from a renal illness and returned home in 1915 in a markedly weakened condition. He rested for several days at the house in Akaretler [29]. According to Hasan İzzettin Dinamo, Atatürk was again ill in Gallipoli on July 27, suffering from malaria, renal pain, and exhaustion, which had left him severely debilitated and caused chest discomfort; although the fighting had ended, he himself was worn out [30]. On November 10, 1916, Atatürk noted in his diary that he had fallen ill and was coughing, recording that he drank tea to soothe the cough and rested [31].

Considering Atatürk’s illness in 1915 together with the intense frontline conditions and mobility, it may be suggested that he could have suffered from a trench-related disease or trench nephritis.

Atatürk’s kidney disease in 1918

Atatürk returned ill from his journey to Germany with Crown Prince Vahdettin between December 15, 1917, and January 4, 1918. During the trip he became chilled and developed renal complaints, fell ill again on the return journey, and remained bedridden for nearly a month after arriving in Istanbul. He rested in room 201 of the Pera Palas Hotel, where initial consultations led to medical treatment. Atatürk recounts those days as follows: “I arrived in Istanbul; however, at that time I experienced a severe discomfort. The physicians told me that I was suffering from a disorder of my left kidney. I was unable to leave my bed for approximately one month. The treatment administered by my physicians could not alleviate my pain at its source. For a while, I seemed to improve, but then I relapsed and returned to bed.” Ultimately, due to the persistence of his symptoms, it was decided that he should go abroad for definitive treatment (Fig. 1) [29, 32–35]. Through an official correspondence sent to the Vienna Embassy, assistance was requested in anticipation of Atatürk’s travel to Vienna for medical treatment [36].

Fig. 1.

In a letter sent to the Vienna embassy on May 27, 1918, it was announced that Mustafa Kemal Paşa, one of the army commanders and a member of the general Staff, would travel to Vienna for medical treatment, and that all necessary assistance and attention be extended to him [32]

On the recommendation and medical report of Dr. Rasim Ferit, Atatürk was sent to Vienna for treatment. He arrived in Vienna on June 1, 1918 and stayed at the Bristol Hotel, where he was examined by Prof. Dr. Otto Zuckerkandl (Fig. 2). After Escherichia coli was detected in his urine, he was hospitalized at the Cottage Sanatorium for a three-week course of treatment. In his correspondence from this period, he noted that he had previously been confined to bed in Istanbul for approximately six weeks with a diagnosis of pyelitis, that his treatment in Vienna was progressing well, and that he would soon proceed to Karlsbad [29, 37–39]

Fig. 2.

Mustafa Kemal Atatürk and urologists who treated his kidney disease

After transferring to Karlsbad on June 30, 1918 Atatürk was placed on a hydrotherapy and dietary regimen designed by Dr. Vermer. Staying at Rudolfs Hof, he drank thermal spring waters each morning, underwent mud baths, followed a protein-rich diet, and received balneotherapy. These measures, however, did not result in complete recovery, and his pain recurred intermittently. He was recalled to Istanbul toward the end of July [4, 35, 40–42].

The detailed treatment regimen prepared by Dr. Vermer for Atatürk was as follows [42]:

Time	Treatment applied
07.00	A glass of water from Marksbrun
07.20	A glass of water from Mühlbrun
08.20	Breakfast (tea/coffee, cocoa, eggs, butter)
10.00–11.00	Mud bath (Moor) (every other day)
11.00–12.00	Mud compress (at home)
12.00–13.00	Lunch (fish, meat, vegetables, fruit, dessert)
Afternoon	Rest
15.30 or 18.00	A glass of water from Mühlbrun
16.00–17.00	Light meal (like breakfast)
20.00	Dinner (fish, chicken, omelet, dessert, vegetables, dairy dish)
22.00	A glass of water from Telsenquelle

During his approximately one-month stay in Karlsbad, Atatürk was placed on a treatment plan consisting of thermal waters, mud baths, and a specialized diet; however, he was unable to adhere to the regimen regularly. According to his memoirs, the treatment program prescribed for him can be summarized as follows [42]

Date	Events/Treatment
June 30, 1918	Arrival in Karlsbad, settling into Rudolfs Hof. Dr. Vermer set the program.
July 1–2, 1918	Morning: water treatments, light breakfast, mud baths, and compresses. Afternoon: drinking water, light meal, and rest.
July 3–6, 1918	The water therapies continued. On July 4th, a mud bath that caused intense sweating, on July 5th, drinking water from a thermos. On July 6th, reading a book and a Turkish bath.
July 8, 1918	The program was implemented regularly.
July 9, 1918	During Ramadan Bayram, a bath was taken for the first time at another spa in Karlsbad (Furtnu Bad).
July 12–13, 1918	Waking up late disrupted the schedule; the water and bath routine was broken.
July 21, 1918	A bathhouse was built at home, but the mud bath was abandoned because it caused fatigue.
July 27, 1918	It was decided to return to Vienna.
July 28, 1918	Upon arriving in Vienna, feelings of weakness and chills were experienced. The memories of the Karlsbad days were closed.

Leaving Karlsbad before achieving full recovery, Atatürk contracted Spanish influenza during his return journey and arrived in Istanbul on August 2, 1918, in a markedly fatigued and ill condition [35, 43]. In August, Atatürk was reappointed as Commander of the 7th Army. With the dissolution of both the Yıldırım Armies Group and the Seventh Army headquarters on November 7, 1918, he was placed under the authority of the Ministry of War (Supplementary Figs. 2, 3) [44, 45]. In this period, due to the severe conditions and exhaustion he endured at the front, his renal pain recurred, and he received treatment at the Armenian Hospital in Aleppo, yet continued to carry out his command duties [46–48].

The year 1918 marked a period in which Atatürk struggled simultaneously with a severe renal disorder and command responsibilities during the critical phases of the war. He underwent contemporary treatments of the time, including hydrotherapy and dietary regimens, in Vienna and Karlsbad, but returned to the battlefield without achieving full recovery [1, 49, 50].

When evaluated in terms of the treatment administered, it may be inferred that a mild and possibly early-stage pyelonephritis was managed in accordance with the prevailing medical practice of the period. In addition, harsh winter conditions and the demands of constant mobility, together with his prolonged confinement to bed after returning from Germany in 1918, may have precipitated a clinical picture resembling the acute exacerbations described in cases of trench nephritis. Furthermore, the detection of Escherichia coli in his urine by Prof. Zuckerkandl in Vienna is noteworthy, as coliform bacteria were among those considered in contemporary military medicine to be potentially associated with trench nephritis. The hydrotherapy and dietary regimen applied in Karlsbad also closely resembled the treatments recommended at the time for trench nephritis in both the British and German armies.

The significance of Karlsbad thermal springs at the time

The Karlsbad Spa was one of the centers used for the treatment of soldiers, military and civilian officials during the late Ottoman period and the early years of the Republic, a practice confirmed by documents from the state archives [51–54]. Regarding Atatürk’s use of these spas, the Kölnische Volkszeitung, in an article published on November 2, 1938, reported that he traveled to Karlsbad in 1918 to alleviate liver pain. Similarly, the Daily Telegraph noted that Atatürk’s kidney disorder had begun during World War I and that he received treatment in Karlsbad in 1918 [55].

Interest in the Karlsbad thermal springs continued during the Republican era. In this context, in 1927, the Chief of General Staff, Marshal Fevzi Çakmak Pasha, went to Karlsbad for treatment. This trip was perceived in the European press as having been undertaken by Atatürk (Supplementary Fig. 4) [56–59]. There is also information indicating that Karlsbad thermal waters were used for therapeutic purposes during the Republican era. According to this document, on January 8, 1929, Loebel Schottlader, the owner of the Karlsbad Mineral Waters Export Company, applied to the Turkish Consulate in Prague, stating that Karlsbad mineral waters had been exported to Turkey as a natural product until then, but that in the latest list of the Ministry of Health, these waters were classified as “special medicines” [60]. This information from the Turkish Diplomatic Archives and the Republic Archives confirms that Karlsbad was considered an important health center even after the proclamation of the Republic.

Atatürk’s kidney disease at the outset of the National Struggle in 1919

Despite treatment in Karlsbad, Atatürk’s kidney disease did not fully resolve, and his pain recurred frequently, sometimes accompanied by episodes of malaria [35]. At the time, malaria was recognized as a major public health problem, and the state was known to continue implementing policies aimed at combating the disease [61]. During this period, Atatürk was appointed Inspector of the Ninth Army on April 30, 1919. (Supplementary Fig. 5) [62]. Atatürk landed in Samsun on May 19. In a letter dated May 24, 1919, sent to the Ministry of War Atatürk stated that he would move his headquarters to Havza (Supplementary Fig. 6) [1, 63].

Immediately after arriving in Samsun, his renal pain recurred, prompting him to seek relief at the Havza thermal baths. In a letter dated May 23 addressed to District Governor Fahri Bey, he stated that he would go to the Havza thermal baths for treatment, and on May 25 he took up residence at the Mesudiye Hotel, where he benefited from the baths until June 12 [2, 35]. At that time, his pain was so severe that he could obtain relief only by taking hot baths every five to six hours [30, 64]. He continued his treatment diligently, going to the thermal baths each morning carrying parsley as part of his regimen [39]. Havza was a place where he could find relief from his kidney ailment and escape the pressure of the British forces in Samsun to carry out his plans [30, 46].

Atatürk’s days in Havza are significant not only for the alleviation of his kidney pain, but also for establishing his first close contacts with the people of Anatolia and shaping his political stance towards Istanbul [65]. After the Amasya Circular was published on June 21–22, Atatürk resigned from his position as inspector and from the military on July 8–9, prior to the Erzurum Congress. He organized the Erzurum and Sivas Congresses [66]. After Sivas, he arrived in Ankara on December 27, 1919, and from that date onward, Ankara became the heart and center of the National Struggle. While all this military activity continued, it was noted that his kidney ailment continued to trouble him from time to time, especially during the days in Erzurum and Sivas [35, 67]. In fact, Mazhar Müfit Kansu, who worked with him at the Erzurum and Sivas Congresses, once mentioned that Atatürk’s fever had reached 38 degrees in Sivas, but emphasized that Atatürk did not take his illness seriously at the time [66].

Although a definitive diagnosis could not be made regarding Atatürk’s renal condition during this period, it is thought to have been pyelonephritis or trench nephritis.

Atatürk’s kidney disease in Ankara in 1920

In Ankara, Atatürk spent his initial days at the Agricultural School (Ziraat Mektebi), a two-story building in the village of Kalaba on the Keçiören road. During this period, he experienced a night of severe renal pain accompanied by high fever. Dr. Refik Saydam was present with him at the time and closely attended to his health; nevertheless, his renal condition continued to recur intermittently [2, 65].

On the eve of the opening of the Grand National Assembly (Büyük Millet Meclisi), Atatürk’s condition was poor, with persistent renal pain and fever. Although Dr. Refik Saydam made every effort to care for him, the severe shortages of the period limited treatment options. Indeed, reports by American missionaries in Ankara in 1920 also noted that his health was compromised due to a renal disorder [65, 68].

After settling in the Çankaya Mansion, this condition persisted. The second floor of the residence contained two bedrooms and a very simple bathroom. Because of his renal disorder, Gazi Paşa frequently needed hot-water baths. During this period, marked by external threats and intense internal opposition, recurrent renal pain caused sleepless nights. In the mornings, he attempted to alleviate his fatigue with hot baths before proceeding to the Grand National Assembly [69, 70].

Similarly, although a definitive differential diagnosis cannot be established, the renal disorder experienced during this period may be considered consistent with pyelonephritis or trench nephritis.

Atatürk’s kidney disease before the Great Offensive (Büyük Taarruz) in 1922

As part of the preparations for the Great Offensive, Atatürk departed Ankara for the Western Front on March 6, 1922. He arrived in Bolvadin on March 12 but was forced to rest because of severe right-sided renal pain and high fever. As his pain intensified, he remained bedridden on March 13, and when his fever subsided on March 14, it was decided that he would proceed to Akşehir. On the same day, he met with First Army Commander Ali İhsan Paşa at Çay station; in his memoirs, Ali İhsan Sabis noted that Atatürk appeared markedly pale due to illness [1, 71, 72].

During this period, the Paşa attempted to relieve his pain with aspirin and hot baths. He was examined in Akşehir by Major Dr. İhsan Arif Bey, who noted that despite a mild fever, his pulse was normal. After remaining in bed for one day, he felt well on the morning of March 15 and proceeded to the Western Front Headquarters. In his daily notes, he recorded that he had stayed in bed on March 13 because of illness, travelled to Akşehir on March 14 after his fever subsided, and recovered sufficiently on March 15 to join İsmet Paşa’s headquarters [35, 71, 73].

Atatürk’s illnesses during this period were short-lived. On March 18, gastrointestinal symptoms developed; Dr. Hulusi Bey recommended a dietary regimen, and when the condition persisted, prescribed a 15-day course of medication on March 19. According to Atatürk’s notes, he remained bedridden between March 12 and 14, recovered on March 15, began medication on March 19, and continued to experience symptoms between March 23 and 26, attempting relief through aspirin and hot baths [29, 71].

Despite these health problems, Atatürk continued his demanding frontline inspections and personally oversaw the organization of the army. As noted by Çanakaris, even while exhausted, sleep-deprived, and in pain, he conducted military operations with remarkable competence and maintained a strict and disciplined attitude toward both himself and his soldiers [74].

The renal pain and fever he experienced along the Bolvadin-Akşehir line in March 1922 exhibited a clinical course highly consistent with acute attacks seen in pyelonephritis or trench nephritis.

Atatürk’s kidney disease after 1923

When Atatürk’s urinary tract disorder recurred in 1923, Dr. Besim Ömer Akalın became involved at the initiative of Dr. Adnan Adıvar, and the young urologist Dr. Behçet Sabit Erduran (Fig. 2) was summoned from Istanbul to Ankara. Assigned by the Faculty of Medicine to the Anatolian Medical Relief Committee (Anadolu İmdadı Sıhhi Heyeti), Dr. Behçet examined Atatürk and treated him over an extended period. Although previous treatments at Cebeci Hospital had been unsuccessful, his therapeutic approach led to recovery, and in recognition of this success, Atatürk retained him in Ankara [2, 29, 35].

Beginning in 1928, one of Türkiye’s first urologists, Dr. Fuat Kamil Beksan (Fig. 2), was assigned to oversee Atatürk’s treatment for several years as a precaution, in light of his previous illnesses [29, 35]. After experiencing cardiac episodes in November 1923 and May 1927, Atatürk was reported by Kılıç Ali, one of his closest associates and confidants, that until 1936 he did not suffer even from a common cold [3, 75].

During this period, infections can no longer be attributed to trench conditions but are better explained by pyelonephritis or lower urinary tract disorders. Nevertheless, it may be argued that the underlying origins of these earlier infections were shaped by the wartime environment and trench life.

Overall assessment and limitation of the study

Atatürk experienced several infectious diseases and malaria tertiana during his childhood [2, 76, 77]. The blennorrhea he contracted in his twenties recurred several times. Although the exact source of the infection is unknown, the disease relapsed frequently, with intermittent findings of inflammation and purulent material in the urine [29, 35, 76]. Since blennorrhea may rarely cause pyelonephritis, it may have been responsible for some of the acute episodes of Atatürk’s pyelonephritis. Considering the wartime conditions, postinfectious glomerulonephritis may also be included in the differential diagnosis of kidney disorders. However, it typically presents as an acute nephritic syndrome, and a chronic course with recurrent episodes of acute kidney pain and inflammation is not expected. Postinfectious glomerulonephritis usually develops 1–3 weeks after an acute infection, with the deposition of antibodies formed against the infectious agent in the glomeruli playing a key role in its pathogenesis. Therefore, postinfectious glomerulonephritis is unlikely to have been responsible for the nephrological problems of Atatürk.

It is well established that renal disease was the health problem that troubled Atatürk the most throughout his life [35]. According to Dr. Refik Saydam, Atatürk suffered from a renal disorder referred to as “pyelonephritis”; however, it could not be clearly determined whether the condition originated from the lower urinary tract or from an inflammatory process within the kidney itself [76]. However urinary tract stones are common in patients with chronic pyelonephritis; however, they are not mentioned in the medical reports of Atatürk.

It is reported that Atatürk’s left renal disorder first emerged during the Italo-Turkish War in 1911, recurred during the Gallipoli Campaign, and, when combined with pneumonia, compelled his return to Istanbul. Harsh winter conditions on the Eastern Front further aggravated the illness, although he continued his duties. Following his trip to Germany at the end of 1917, his pain intensified in Istanbul, and when it failed to respond to treatment, he was sent abroad. On May 25, 1918, he was examined in Vienna by Prof. Dr. Otto Zuckerkandl, who recommended three weeks of medical therapy and rest [4]. Until 1923, he continued to experience recurrent episodes of renal disease at varying intervals.

When Atatürk’s renal disorder is interpreted as pyelonephritis, it appears that the treatment he received was consistent with the scientific standards of the period and provided clinical benefit. Alternatively, trench conditions such as cold, dampness, malnutrition, fatigue, and poor hygiene may have exacerbated a preexisting renal disease. The observed clinical features (fever, pain, pyuria, and proteinuria) are compatible with reported cases of trench nephritis. However, given the limited available evidence, it is not possible to definitively determine whether his recurrent renal illness under trench conditions represented preexisting chronic pyelonephritis and/or trench nephritis. The interpretation of Atatürk’s common symptoms and clinical findings in the differential of chronic pyelonephritis and trench nephritis are summarized in Table 2.

Table 2.

Interpretation of Atatürk’s common symptoms and clinical findings in the differential diagnosis of chronic pyelonephritis and trench nephritis

Clinical findings	Chronic Pyelonephritis	Trench nephritis
Recurrent lumbar pain	Common and typical	Rare
Recurrent lumbar pain with fever	Common and typical during attacks	Rare
Fluctuating fever	Common during attacks	Common
Malaise and fatigue	Common during attacks	Common
Shortness of breath	Unlikely	May be observed due to renal failure and hypervolemia
Recurrent urinary tract infections	Common	Rare
Disappearance of symptoms and clinical findings after wartime conditions ended	Unlikely	Strongly suggests trench nephritis

Conclusion

Looking at Atatürk’s medical history, it is evident that his renal disorder, which began with infectious diseases in childhood and recurrent urinary tract infections in his youth, developed in later years. In particular, the harsh conditions on the front lines during the 1911 Tripoli and 1915 Gallipoli Campaign, the flare-up of the disease after his 1917 trip to Germany, and his 1918 treatment in Vienna-Karlsbad demonstrate the recurrence of this condition. Atatürk’s kidney complaints recurred frequently during the years of the National Struggle (1919–1922), and he attempted to alleviate his pain with hot baths, aspirin, and diet. After 1923, specialists such as Dr. Behçet Sabit Erduran and Dr. Fuat Kamil Beksan attempted to bring them under control through long-term monitoring and treatment.

Historical and medical data make it difficult to reach a definitive conclusion regarding whether Atatürk’s renal condition was recurrent pyelonephritis and/or trench nephritis. However, when clinical findings (fever, kidney pain, and inflammation) are evaluated together with frontline conditions (cold, humidity, fatigue, malnutrition), it is seen that they are consistent with both diagnoses. Trench nephritis was defined as a syndrome commonly encountered in trenches during World War I, and the symptoms observed in Atatürk showed significant similarities to this diagnosis. On the other hand, recurrent urinary tract infections that began in youth and continued thereafter strongly suggest the possibility of pyelonephritis.

In conclusion, Atatürk’s kidney disease can be explained by trench nephritis-like attacks triggered by war conditions on the one hand, and recurrent pyelonephritis observed since his youth on the other. However, his transition to settled life after 1923, his distance from frontline conditions, and the absence of kidney problems during this period also suggest the possibility of trench nephritis. In addition, it is clear that this condition recurred rather than being definitively diagnosed. However, despite all these health problems, it is noteworthy that Atatürk continued his military and political leadership uninterrupted thanks to his extraordinary willpower and sense of duty.

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Author contributions

All the authors have seen and approved the submitted manuscript. The authors abide by the copyright terms and conditions.

Funding

There is no financial support for this study.

Data availability

Not applicable. This manuscript does not report data generation or analysis. Because this study examines the history of medicine in general, and the history of nephrology in particular, based on archival documents from approximately a century ago related to Atatürk. All documents and data analysed in this work are presented and referenced within the main text of the manuscript, where the associated analyses and interpretations are also discussed. Accordingly, submission of the raw data as a separate supplementary file is not required.

Declarations

The article was originally written in Turkish by authors specializing in medical history, Republican era history, and nephrology. Artificial intelligence programs and AI-assisted translation tools were used for the English translation, enhancing the academic quality of the text

Ethical approval

This study prepared using publicly accessible archival documents and primary sources, featuring experts in the fields History of Medicine, Republican History and Nephrology. Therefore, ethics committee approval and informed consent are not required. “The study analyzes historical medical information concerning Atatürk, who died in 1938. Under the HIPAA Privacy Rule, identifiable health information is protected for 50 years following an individual’s death, after which it is no longer considered Protected Health Information and may be used for historical and scholarly purposes. All materials examined in this study were drawn from archival, published, or otherwise publicly accessible sources, and no modern clinical records from HIPAA covered entities were used. The analysis adheres to established ethical standards for historical scholarship by relying solely on documented evidence and avoiding unsupported diagnostic speculation”.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.