Masterman,
E. "Hygiene and Disease in
Public Domain.
Digitally prepared by Ted Hildebrandt (2004)
HYGIENE AND DISEASE IN
AND IN
BIBLICAL TIMES. (Part II)
By DR. E. W. G. MASTERMAN.
(Continued from
Q.S., 1918, p. 20.)
CHAPTER
II--The Climate and Water Supply in
relation to Health
and Disease.
IT
is not always realized that
zone, and lies farther south than not only every
part of
also of most of
of the
parts of
practically that of
over, in the great central rift of the
conditions must be described as tropical.
The land as a whole is fairly well supplied with
rain, but the
rainfall is very unequally distributed throughout
the year, extending
as it does over little more than six months.
January, February,
December
and March are--in this order--the wettest months; there
may be fairly heavy showers in October, November,
April and,
exceptionally, even in May. It is
very unusual for any rain to fall
in June, July, August and--except quite at the end
of the month--
in September. The amount of the rainfall is liable
to considerable
annual fluctuations and varies with the altitude. In
regular daily observations have been taken since
1860. The
heaviest season's rainfall was 42.95 inches in
1877-78, and the lightest
12.5 inches in 1869-70. The mean annual fall is
about 26.5 inches.
There
seem to be cycles of greater and lesser falls, dry spells and
wet coming in groups, but no definite rhythm has
been observed.
In
the Maritime Plain, observations have been taken at Jaffa
(P.E.F.)
and at the German colonies of Sarona
and Wilhelma, and in the
56
HYGIENE AND DISEASE IN
Melhamiyeh. The rainfall in the
Maritime Plain is less than in
bourhood of the
regions are far less dependent upon rainfall
than the mountain
districts. We have no regular observations
recorded in the Dead
Sea
district, but the rainfall is very much less than in any other
part of
there is a rainfall comparable with that on the
highlands to the
west, but it is only a fringe of a few miles which
is so benefited.
Where
once the water-parting is passed and the gentle eastward
slope begins, the rainfall rapidly diminishes in
amount, and it is
very scanty indeed east of the Hedjaz
Railway.
In the late summer heavy clouds come up from the
west, and
during many nights the higher lands--especially in the
north--are
drenched in "dew" which does much to
fatten the grapes and olives.
In the highlands the springs, though not
infrequent, are seldom
copious, and in many parts the people of the
land have from early
historic times resorted to cisterns to store the
rain, both for their
domestic use and for their vineyards. In
of the intermittent spring 'Ain
Umm ed-Deraj, "the Virgin's Spring "
(Gihon of the Old Testament), and of the deep-lying spring
in
Bir Eyyub (En-Rogel of the Old Testament) is brackish and impreg-
nated with sewage. I have
examined samples of both these waters
and found abundant chlorides, free ammonia and
nitrites. The
main source of drinking water is consequently the
numerous rain-
filled cisterns--public and private--which have been
excavated in
the rock or, in parts of the city, in the overlying
soil. In Roman
times--perhaps even somewhat before--two systems of
aqueducts,
known respectively as the "High Level" and
"Low Level" aque-
ducts, brought water from the neighbourhood
of Wady Artas, where
to-day the three great reservoirs known as “Solomon's
Pools” now
much out of repair, bear witness to the thoroughness
of these great
“waterworks.” Wady Artas is 7 ½ miles directly
south of
but the low level aqueduct, which alone remains
more or less com-
plete, ran 13 miles along the
hill sides to reach the city. Two
additional systems of aqueducts brought a supply
also to these pools,
a chain of wells connected up by an aqueduct,
known as a khariz,
which enters the Wady Artas by a deep rock-cut tunnel, and an
aqueduct, similar in construction to the low
level aqueduct, which
58 HYGIENE
AND DISEASE IN
runs 28 miles along the hill sides from Wady Arrub--only 5 miles
to the south in a direct line.. Both these
extensions have been long
out of repair, but from the springs in Wady Artas, by utilizing the
low level aqueduct in part and replacing it with a
4-inch iron pipe
elsewhere, a feeble stream of water still (at any
rate before the war)
reaches
able to fill their vessels with water of a fair
quality, but it is a poor
enough supply for a great city. Before this 4-inch
pipe supply was
introduced, an attempt was made to supply the needs
of the city--
then urgent through a poor season's rainfall--by
bringing water in
tanks by rail from the spring at Bittir--the
next station to Jeru-
accustomed in years gone by to have water brought
in jars or
tins from the abundant fountain at 'Ain Karim, but this has often
proved unsatisfactory as the bearers are
untrustworthy.
As far as health is concerned there is not much
wrong with
well-stored cistern water. It is a little
"flat" but has none of the
disagreeable taste of rainwater in
European cities, which is contami-
nated by a smoky atmosphere.
Careful people ensure cleanliness
of the roofs by allowing the first day's rainfall
in each season to run
away for a few hours. Cisterns must be periodically
cleaned out,
but it is surprising how small is the sediment
deposited in even the
largest cistern, where only the roof-water is
collected. Most cisterns
are rock-cut and carefully cemented with an
impermeable cement,
in the making of which the ground-up fragments of
broken--often
ancient--pottery are used. Water so stored, if
originally pure, keeps
sweet and good for a long while and, when the
sediment is settled,
is quite bright and clear, although a Pasteur
filter shows that there
remains constantly a small quantity of undissolved earthy impurity.
In
some respects, the system of private cisterns is probably safer
than a doubtfully-managed public supply. A
water-borne disease,
such as enteric fever, cannot be carried all over
the city. On the
other hand, the small cisterns in the houses of the
poor not infre-
quently leak, and those in the
city, being often made in the soil, may
become infected with sewage. They are also mostly open
and, on this
account, liable to contamination from many sources.
Mosquitoes--
Anopheles, Culices and Stegomeyer--breed
in them in countless num-
bers, and the Anopheles are
especially dangerous as the carriers of
malaria. Cisterns should be systematically
inspected, repaired and
kept closed to the entry of mosquitoes. The only
satisfactory plan
HYGIENE AND DISEASE IN
is to provide them all with pumps instead of the
primitive hand-
buckets let down through a wide, open
well-mouth.
The Syrian native esteems "living"
(spring) water very highly,
but I have known people, accustomed to the soft
rainwater of
springs of
percentage of lime and magnesium salts.
In the villages water is, if possible, brought
from springs, even
at a considerable distance, for drinking purposes,
but in the late
summer in many places the fellahin and bedawin have to make
shift with water of a very inferior quality, obtained
from anywhere
they can get it.
With regard to the temperature, there is a great
difference be-
tween various parts of the
land. Upon the high mountain plateaux
of Judaea and Galilee,
in parts of
the higher lands east of the
though the spells of heavy rain, lasting often a week
or more at a
time, are trying in a land where the dwellings are
built rather for
heat than cold, and where fuel is scarce. To many of
the poor the
winter is a time to be endured with the reflection
that it does not
always rain. Between the bouts of rain are spells of
bright sunshine
and pleasant warmth. At times at
mountain elevations, snow falls heavily, and
occasionally lies on the
ground for some days. It is welcomed by the
agriculturalists, as
the slowly melting snow thoroughly moistens the
soil.
The mean temperature in the shade in
three colder months (January, February and March) is
48°•7 F.;
in the Maritime Plain (Wilhelma)
56°•4, and by the Jordan (Kasr
Hajla)
69°•2.
During the six months for May to October (inclusive)
the mean in
experienced. The mean of the maximum temperatures in
the shade
of the four hottest months is 84°•3 in
and 112°•5 at the
over 90° are common in the summer, temperatures over
100° are
infrequent.
The heat in the higher parts of
the cool westerly breezes which, with considerable
regularity, blow
from the middle of the forenoon until some time near
sunset, and
a north-westerly breeze is very common all the
summer night,
60 HYGIENE
AND DISEASE IN
making the hours of sleep refreshing. The most
unhealthy and
disagreeable days are those when the
dry, hot sirocco blows from
the south-east ("a dry wind of the high places
in the wilderness,"
Jer. iv, 11), sometimes
for several successive days and nights. At
such times those who have good stone houses keep the
windows
and doors closed, and to step outside from such a
house is like
stepping into the neighbourhood
of a furnace. The wind is intensely
dry and, at times, loaded with fine desert dust,
producing a haze;
vegetation languishes, the leaves droop, and most
people--especially,
perhaps, Europeans--feel varying degrees of
discomfort. During and
after a bout of such a wind, the increase in
"fever" and other illnesses
is marked. May, just after, and September and
October just before
the rains, are the worst months. In midsummer
sirocco is rare, and
in the winter the south-east wind, though dry, is
cold and bracing.
Taking
high temperature in summer, the clear pure air and
cloudless sun-
shine are very enjoyable. Compared with
falling far short of some parts of the
experience, all the Europeans I have known have
been benefited
by occasional change to the more temperate zone,
and some ladies
find residence in high altitudes, such as
nervous system. In winter the coast and the
Tiberias and
or four months only, and even then special
precautions must be
taken against malaria.
Mention must be made here of local means
provided by nature
of treating disease. Many have found the
for rheumatism, but more definitely medicinal in
their properties
and more sanctioned by the custom of centuries, are
the hot
sulphurous springs which occur at
many places in the land. The
groups of springs at Tiberias,
the valley of the Yarmuk, and in the
Wady Zerka Ma'an, a valley opening into the
east, were all famous in Roman times as health
resorts, and are
all still used by the indigenous inhabitants. Only
at Tiberias has
any attempt been made at providing accommodation
for the bathers,
and that is ill-managed and far from clean. It is
to be hoped that
any new regime in
for the sick, and make arrangements that they may
be used to full
advantage under proper medical supervision.
HYGIENE AND DISEASE IN
The question may well be asked at the present
time how far has
nent homes there? At present
malaria and other diseases are
recurring scourges which greatly increase the
danger and discomfort
of those who would live there. But supposing these
can be in
places banished and in others mitigated, what is
likely to be the
effect on the European and his family who make the
land their
home? My impression is that in the higher mountain
regions
many Europeans may with care live comfortably, if
they learn to
restrain their energies, especially in the hot
months, and their
children can, with special precautions, be reared
in health. I have
my doubts as to whether a succession of
generations, where the
children do not have the benefit of visiting
years in their youth--as is the case with most
Europeans to-day-
would grow up such a sturdy stock as those reared in
northern
climes. In the Maritime Plain European families,
especially young
children, would probably suffer from the much
prolonged sub-tropical
heat, and visits to the highlands part of each
summer is desirable
if possible. Schools for such children might
advantageously be
situated in the mountains.
Most of the
It
is intensely malarious, and this disease is unlikely
to be eradicated
here. Though the individual--the hardy adult
workman, whose
work lies there--may, by living in a mosquito-proof
house and taking
quinine, protect himself, it is no place for a
family except for a few
months in winter. The families of those whose work
lies there
should live in the mountains, and ready means of
access, by tram
or train, should be provided for the overseers. In
the deepest parts
of the
labourers should, I suspect, be
of negro stock, as are so many of
the people there to-day.
CHAPTER III.--The Common Diseases of
The most characteristic and important of the
diseases of
is Malaria
in its various manifestations. Practically speaking, it
occurs all over the land and affects every class of
its inhabitants.
It
is very prevalent in
Recent
investigations have shown that during these months (August
to October) 27.30 per cent. of
all the children actually attending
school have malarial parasites in their blood; and on
examination,
62 HYGIENE
AND DISEASE IN
the blood of 7,771 persons of all classes and
conditions revealed
parasites in 26.7 percent. The percentages were
remarkably divided,
being 40.5 per cent. among
the poor Jews, 31.1 per cent. among
the Moslems, 16.4 per cent. among
the native Christians, and 7.2
per cent. among the
Europeans. Practically, the percentage is an
index of social environment and hygienic
surroundings, the Euro-
peans in particular having
learned the lesson of prevention and early
cure. Malaria occurs, though as a rule to a lesser
extent, in all the
towns and villages in the mountain region, especially
those bordering
on the
The incidence of malaria is now known to depend
very largely
on the water supply of a district and the nearness
to areas where
the fever lingers longest throughout the year,
because the healthy
are infected from the sick through certain kinds of
mosquitoes,
which pass the larva and pupa state of their lives in
water. Five
species of the sub-family Anophelinae have been identified
in
Anopheles Maculipennis (the common Anopheles of Jerusalem), Pyreto-
phorus Palestinensis, Pyretophoris Sergentii (only as yet identified
in
and Cella Pseudopictus. Of these the first two are the most
widely
distributed and important. The usual situations of
breeding of the
larvae of these mosquitoes are the marshy pools and
sluggish streams
of the low lands; in the neighbourhood
of
on the coast, especially around
district, such semi-stagnant pools occur in
numbers. In
the larvae of the two first-mentioned varieties
breed in countless
numbers in the semi-closed rainwater cisterns
attached to almost
all the houses, and it is therefore little wonder
that malarial fevers
are there continuously propagated. There are many
villages and
small towns where there are no suitable breeding
grounds, and in
such places malarial fevers are rare. The forms of
malaria are the
Tertian
(occurring every third day, that is, with one day's interval),
the Quartian (with two
days' interval), and the Tropical, or double
Tertian, where the fever is remittent but not
intermittent.
The
only satisfactory means of distinguishing the three
forms lies in
microscopical examination of the
blood in all cases. This we did for
one whole year in all cases coming to my hospital,
as far as possible
on the first occasion of any given attack of
fever. Out of 2,166
such cases, we found parasites in 46.5 per cent.,
and of these cases
HYGIENE AND DISEASE IN
25.5
per cent. had Tertian parasites, 27.4 per cent. Quartian para-
sites, and 47.1 per cent. Tropical or malignant
malarial parasites
many cases were doubly infected, and some had all
varieties at one
time. Almost all the Tropical cases occurred in the
hot months, July
to November, and no fresh infections occurred in
the cool weather,
because this particular parasite cannot develop
in the body of the
mosquito in so cool a temperature. Were it not
for the continual
re-infection of the inhabitants by
people returning fever-stricken
from the tropical Ghor,
this, by far the most dangerous form of
malaria, would die out in the mountains. The
closing of cisterns,
the destruction of the larvae by putting a small
quantity of petro-
leum on the surface of the
water (which in no way spoils the water
for drinking purposes if the water is taken from
some depth by
means of a pump, and in any case evaporates in a few
hours), and
the isolation of the sick within mosquito-proof
curtains or buildings,
are some of the means which have already been
introduced to
diminish infection. The prophylactic use of
quinine has also been
tried with considerable success. In the case of many
European
houses, the use of wire netting for windows and doors
has greatly
reduced the number of these pests and almost
entirely prevented
malaria. The systematic carrying out of
well-recognized measures
might reduce malaria, in
The
loss of life, particularly infant life, through malaria is terrible;
in many districts every infant in arms will be
found to have an
enormous "ague cake " (enlarged
spleen), to be anaemic and often
dropsical. The anaemia caused by malaria lays the victims open to
infection by various other diseases on account of
their reduced
constitutional resistance, and makes
them anxious cases for surgical
operations as they are specially liable to haemorrhage. Malaria
is thus directly and indirectly responsible for
more deaths among
children and young adults in many parts of these
lands than
any other disease. During recent years a number of
cases of
Blackwater fever have occurred: they have been almost exclu-
sively among Europeans-Germans
and immigrant Jews--and chiefly
in the "colonies" around
Valley. In some years the disease has assumed a
great virulence and
the mortality has been very high. Even in
from time to time among the residents.
Enteric
fever,
always endemic, at times occurs in epidemics.
It
is particularly fatal to Europeans; doubtless many of the native
64 HYGIENE
AND DISEASE IN
children suffer from mild attacks in infancy and
are, later in life,
more or less immune. Of other fevers, typhus,
influenza, and (on
the coast) Dengue fever all occur in epidemics.
Sporadic cases of
Malta
fever are seen at times, and also Spirillum (relapsing) fever.
Measles,
rubeola, mumps, whooping-cough, and chicken-pox are
almost always to be found among the children; the
first-mentioned
at times bursts forth with startling severity.
Smallpox when it sweeps through
the land, has a very high
mortality; vaccination is but half-heartedly
carried out even in the
large towns, and scarcely at all in the villages. I
have known cases
of unvaccinated Europeans-travellers
and residents--being fatally
attacked. Inoculation is still resorted to at
times, with terrible
results.
Scarlet
fever appears
to have been recently introduced, and
its toll of victims in the towns has been enormous.
Diphtheria occurs from time to time,
but probably less so--
paradoxically enough--than in the
more sanitary cities of
Dysentery is most commonly a
complication of malarial attacks,
but acute (amoebic) dysentery also occurs not
infrequently, a large
proportion of the cases being fatal. Tropical
abscess of the liver is
by no means uncommon, as a sequela
of dysentery.
Cholera, known to the natives
as howa el-asfar ("the yellow
wind"), appears in severe epidemics at
intervals, with an enormous
mortality. In nothing does the fatalism of the
ignorant natives
appear more prominently than in their attitude towards
this
disease. In spite of all warnings, they will
wash the clothes of
cholera patients in the village water-supply; at
Tiberias, during the
terrible epidemic of 1902, many of the people
could not be induced
to drink the boiled water freely and liberally
supplied to them by
the resident Scotch doctor, but used this for
washing their clothes
and drank of the sewage-infected lake-water at
their doors. It is
not wonderful that the epidemic decimated the town.
Fortunately,
epidemics of this disease have been rare during
the last half-century.
Plague. has not occurred in epidemic form
in
the first third of the nineteenth century, though
sporadic cases
have been detected and isolated at the ports; in
earlier ages it
swept over the land with terrible effect.
Erysipelas is by no means uncommon
among the town-dwellers,
many cases contracting infection at the site of the
"issues" the
people make and keep permanently open on their arms
and elsewhere
HYGIENE AND DISEASE IN
with the idea of benefiting their chronic
eye-diseases. Tetanus
occurs occasionally, and cases of hydrophobia from the
bites of
camels, jackals and cats, as well as pariah dogs,
occur annually. The
Turkish
Government, through the local authorities, assist all
such
cases, when needing financial help, to go to
for treatment by the Pasteur method, and just
before the war the
“International
Health Bureau” established a small "Pasteur Insti-
tute" in
European assistance in this disease.
Acute
rheumatism
is fairly common, and is responsible for
a large proportion of the cases of valvular disease of the heart.
Such
cases do badly on account of the poor food, the anaemia
pro-
duced by malaria, and, in the
cases of women, the very youthful
age of marriage, frequent child-bearing, and hard
life generally.
The
closely allied disease, chorea (St. Vitus's dance),
is not uncommon.
Chronic
rheumatoid arthritis
is commoner among the Jews
and other European residents than among the
fellahin. Next to
malaria the disease germ most responsible for
death in
land during the last few years has been appalling.
Tubercular
disease of the lungs (phthisis), of the bowels (tabes rnesenterica), of
the bones and joints (producing caries of the
spine, hip disease,
etc.),
and of the lymphatic glands, occur everywhere. Cases of
Phthisis (consumption) are often
exceedingly acute, even when
pure air and a semi-outdoor life are secured. This
is due, doubtless,
in many instances, to the mistaken kindness of
friends, who quietly
allow patients to refuse nourishment when there is a
disinclination
for food. There is a growing dread of infection in
this disease,
and many poor sufferers are shockingly neglected by
their relatives,
who are afraid to associate with them. There might
be a fine field
for philanthropic effort in the establishment of
efficient sanatoria
for such cases. There is already one such in
north of
to the great number of cases of this disease which
have been sent
to the land from other countries. Jews from
used constantly to arrive, advised by their doctors
to try the pure
air of
tubercle bacilli from cases of advanced disease,
who pass months
crouched up in dark corners, spitting infective
sputum all over the
floor, and in a state of filth and neglect. A great
deal of tuberculous
66 HYGIENE
AND DISEASE IN
meat, which is rejected as tarif (ritually
"unclean") by the Jews,
is freely sold among other classes. Oxen and cows
are not readily
killed while useful, and their failure of strength in ploughing or in
milk-production is often due to tuberculous disease; they are thus
peculiarly liable to come into the hands of the
butcher in that
condition. With respect to tubercle of glands,
bones and joints,
it is safe to say that the majority of the severe
operations performed
by surgeons in
Caries
of the spine, producing the crook-backedness of Lev.
xxi, 20,
is by no means rare. It would appear to be
considered a merit
among the Jews for a man to marry such a deformed
woman.
Leprosy is not a common disease
but it infects all classes--
Moslems,
Jews and Christians: there are in all
perhaps, than 250 lepers, most of them
segregated in
Ramleh,
by the Government. The fact, however, which the
writer has
recently observed, that a good many cases are to
be found unsus-
pected among the villagers in
some parts of the land, makes the
above estimate a little uncertain. The disease occurs very sporadi-
cally without any evident
cause. For practical purposes it may be
considered incurable, though the rare cases of the
pure "anesthetic"
form--where the peripheral nerve trunks are chiefly
involved--live
many years, and, after a time, the disease may cease
to progress.
Tubercular
or "mixed" forms, in which the skin is invaded by
nodules of new inflammatory deposit produced by
the presence of
masses of leprosy baccilli,
are much more rapidly fatal. Seven or
eight years is the average length of life from the
time when the
symptoms are first recognised. The later stages of this disease are,
in this--the common--form of the disease, attended
by horrible
mutilation. The fingers and toes, and sometimes
portions of the
arms and legs, ulcerate away; the eyes are always
affected and the
eyelids are distorted: the nose, cheeks, mouth
and especially the
palate, are swollen and ulcerated; the face gradually
loses it ex-
pression, and often becomes an
object of horror; the voice becomes
hoarse, and, at times, reduced to a whisper, through
ulceration of
the vocal cords. In the last stages the man is
really a "mass of
corruption," but fortunately for him the
intellectual powers are
gradually dimmed, and the poor victim does not
realize his position.
In
purely "anaesthetic" cases unsightly
contractions of the hands
and feet due to paralysis of certain groups of
muscles occur, and
HYGIENE AND DISEASE IN
the condition, though permanent, sometimes remains
without further
progressive deformity for years. The disease, though
in a low degree
infectious, is not hereditary, and the children of
lepers, if isolated
from their parents early enough, may entirely escape
the disease.
This
has been demonstrated many times in connection with the
Rickets is a disease by no
means uncommon in the towns,
particularly among some classes of
Jews. Infantile diarrhoea is a
cause of great mortality. Syphilis, while by no means
so prevalent
as in European lands, is not uncommon among the
town-dwelling
Moslems
of the middle and upper classes, but on the whole it is of
rather a mild type. The relative infrequency of this
disease has
without doubt much to do with the rarity of
chronic nervous diseases
such as locomotor ataxia.
Nervous
diseases
as a whole are much less prevalent among the
indigenous inhabitants of these lands than in the
homes of higher
civilization and more strenuous
life. Hemiplegia, due to arterial
sclerosis or embolism, infantile paralysis,
epilepsy, and paralysis
agilans are all, however,
fairly frequently met with. Among mem-
bers of the Jewish race,
hysteria, hypochondriasis, sciatica and
other neuralgias and migraine are all common.
Diabetes appears to be
peculiarly common among this people.
The
writer has, however, seen several cases among Armenians and
also, to a less extent, among the native Syrian
Christians and
even the fellahin.
Diabetic gangrene is a common complication.
Reference
has previously been made to the extreme prevalence,
among all classes, of chronic dyspepsia. Haemorrhoids (piles), due
to portal congestion, are very common,
particularly among the Jews,
who are accustomed to the regular use of alcohol.
Appendicitis is
a rare disease among the bedawin
and fellahin; among foreign
residents it is quite as common as in home lands.
Intestinal
worms
of all sorts are frequent in every class.
"Round
worms" occur in some individuals in such quantities as to
give rise to the most alarming symptoms--suggestive
even of peri-
tonitis. Tape worm (Taenia saginala) is
exceedingly common, and
difficult of real cure. It is introduced by means
of under-cooked
(diseased) meat, and it is noticeable that the Jews, although
their
meat is inspected by butchers certified by the
Rabbis as competent,
are very liable to it. Hydatid
disease, due to the Taenia echinococcus,
is by no means unknown. These are not however the
only "worm-
68 HYGIENE
AND DISEASE IN
like" human parasites in
uncommonly become full of maggots; ticks from dogs
and horses
occasionally attach themselves to
the skin of the negligent; leeches
(Limnatis nilotica),
which abound in many wayside springs, are in some
districts not uncommonly introduced with the
drinking water, lodging
themselves at times in the mouth, naso-pharynx, or larynx and giving
rise to intermittent buccal
haemorrhages, and in some cases to extreme
dyspnoea. The "guinea
worm" (Dracontiasis etedinensis),
though
almost certainly not indigenous, is not uncommonly
found in the
feet and legs of those who come from Arabia or
With regard to non-tubercular Lung diseases,
spasmodic asthma
is very prevalent in
death, especially among the bedawin
and the fellahin; pleurisy and
empyema are likewise frequently
met with. Chronic bronchitis
and emphysema are common, the latter being
sometimes due to the
excessive use of the narghile (“hubble-bubble").
Bright's disease and, in some
districts, calculus of the kidney
and bladder, are all familiar diseases, even in
children.
True Cancer
(Carcinoma) in all its forms appears
to be less common
among the natives of this land than in our home
lands, though evidently
the climate has nothing to do with this, because
Europeans suffer from
it quite as frequently as in
Congenital
deformities--club
feet, cleft palate, hare-lip, abnormal
numbers of fingers and toes, etc.--all occur
much as in
There
is no doubt that many children with severe congenital defor-
mities are "put
away" at birth. With regard to supernumerary
fingers and toes, there appears to be a feeling
that to remove such,
even when very unsightly and worse than useless, is
an impious act.
Hernia,
both congenital and acquired, is frequently met with, and
in recent years great numbers of people all over
the land have
submitted to "radical cures"; they do
not take kindly to trusses.
Skin diseases, so often a result of continued
want of personal
cleanliness, are very common. Eczema, lichen,
impetigo contagiosa,
ringworm, favus and
scabies are ever present in all the town popu-
lation. Herpes, erythema nodosum, urticaria, and lupus also occur.
Oriental boil--the so-called “
quent in
cases of this disease in
localities. The writer never saw a genuine case
which originated in
HYGIENE AND DISEASE IN
which is common in the summer months in the neighbourhood of
In
its chronic nature and subsequent scarring, it bears some resem-
blance to the true Oriental
boil. The destruction of tissue is,
however, much less, the lesions are usually
multiple, and they are
by no means exclusively on the exposed parts of
the body.
Eye diseases are, and probably always have been,
very prevalent
in the
due to the results of acute ophthalmia
or to smallpox; others are
from injuries, cataract, glaucoma, or leprosy. Ophthalmia neonatorum
(a common cause of blindness among infants in
rare in
The
number of blind beggars about the towns is extraordinary;
among the Moslems they occupy
a privileged position, being em-
ployed to walk in front of
funeral processions, chanting the Qur'an,
led by a boy who can see;
they also make similar recitations at the
graves, being so employed
because their condition is supposed to
render them safe companions to
the women-mourners who congre-
gate there. They are
prepared carefully for their duties by a shaikh,
who ensures that they know
the passages of the Qur'an correctly.
Among
all classes these beggars receive a considerable degree of
compassion and charity, and they
have, in this respect, a better time
than many equally poor who
suffer from other diseases--except,
perhaps, lepers.
The prevalent Ophthalmia of
natives to figs or prickly pears (cactus), and
by Europeans to dust,
flies, dirty water, etc. Until recent years Egyptian
(and Palestinian)
ophthalmia (acute muco-purulent conjunctivitis) was supposed to
be something sui generis, but recent investigation has shown that
this disease is due to the same specific germs as
the ophthalmia of
the gonococcus, the pneuniococcus, the Morax-Axenfeld,
and the Koch-
Weeks bacillus. The first two are answerable for a
considerable
proportion of the most severe cases, in which the
cornea becomes
ulcerated and the whole eye sometimes becomes
destroyed in a few
hours. The Koch-Weeks bacillus is the special cause
of the great
exacerbation of ophthalmia
(66 per cent. of all cases,
occurs annually in July and October. Although the
epidemic is in
these months, the severest cases often occur later,
in: November or
even December. Closely associated with this acute ophthalmia,
though probably an entirely distinct disease, is the
widely prevalent
70 HYGIENE
AND DISEASE IN
trachoma, or "granular
lids." This is the chief cause of defective
sight and chronic filthy eyes; it appears to be a
disease for which
the Semitic races have a special proclivity. Like
the ophthalmia
mentioned above, it is, in its early-stages,
highly infectious, and it
is the commonest thing to find every member of a
numerous family
suffering from this unsightly complaint. The
disease frequently
begins insidiously, and is hardly noticed until a
thickening of the
upper lid, giving the appearance of the eye being
half closed,
and a smarting of the lids calls attention to it.
In severe cases the
whole of the conjunctiva lining the eyelids is found
to be covered
with "granulations" varying in size from a
pin's head to a hemp
seed or even larger. The "granulations,"
when neglected, are
disastrous to the eye. In time they produce
(directly or indirectly)
"pannus," a kind of opaque
growth over the cornea and--more
serious still--these inflammatory growths
commence, after a time, to
cicatrize, and in so doing cause the eyelashes to
become turned
inwards towards the eye (trichiasis). These inverted
eyelashes, by
constantly playing up and down against the already
irritated cornea,
set up chronic inflammation, causing it to lose its
transparency
and leading gradually to diminishing sight and
eventual blindness.
The
proportion of people with defective sight is enormous, and in
many districts it is the exception to find a person
with two really
sound eyes. Among the middle-aged most eyes will be
found to
have upon their corneae
white patches (leucomata),
the cicatrices of
old ulcers, or a general loss of transparency due
to trachoma, or to
be suffering from a chronic discharge of muco-pus from the eyelids.
Flies,
though not the real cause of these diseases, without doubt act
as carriers of infection from the diseased eyes to
the sound, and
this is more easily done because the afflicted,
especially the young
children, do not seem to mind the dozens of flies
which collect upon
their discharging lids. Loss of sight, which to us
seems such a
terrible affliction, in the East is taken with
extraordinarily stoical im-
passiveness. One old Moslem, for example, who had travelled far to
seek the advice of a British practitioner, when told
that nothing could
be done, merely exclaimed "el hamd el'illah"
("the praise to God!").
Sunstroke, especially among
children, is by no means uncommon.
Many
Europeans get mild attacks from the heat in the Ghor.
Serpents'
bites
are fairly frequent, and in the
not seldom fatal; the majority of the snakes in the
land, however,
are harmless. Scorpions abound, but their stings,
though painful,
HYGIENE AND DISEASE IN
are not usually dangerous; a weakly child may die
from one un-
usually severe.
Various forms of Idiocy and Insanity are
by no means uncom-
mon, but suicide is
distinctly rare. Idiots and the chronically
weak-minded are treated with a certain respect and
kindness, their
minds being conceived of as engaged elsewhere than on
earth.
The
acutely insane are frequently treated with great harshness--
beaten, for example, or chained up in darkness and
seclusion--with
a view to driving out the supposed demon who
causes the affliction.
A word may be added in conclusion regarding Childbirth.
The
age of marriage is very early in the Orient--twelve. or
thirteen
is no uncommon age for a girl to be married and
even to become
pregnant. Childbirth among the bedawin and fellahin is a very
primitive affair, and labour
is short and easy; even when the mother
is immature, the worst, as a rule, that happens is
the death of the
infant at birth. In the towns, too, the
"uncivilized" Arab women
and the Jewesses have easy labours.
European doctors are only
very exceptionally called in, as the larger towns,
where such doctors
reside, are also well supplied with skilful midwives.
The old
obstetric chair, which goes back to the most
ancient times, is still in
use in
period of suckling is long--among the Jews commonly
two, and
among the Moslems even three, years. Considering the
hard lives
and often poor fare, it is marvellous
how the mothers contrive to
suckle for so long, but the babies suffer terribly,
and infant mortality
is enormous. Abscesses of the breast are common,
and if they occur
in both breasts early after childbirth, the infant
commonly dies.
Infantile
diarrhoea and dysentery and the results of malaria
account
for many deaths. It is quite a common thing to meet
women who
have had a dozen or more children, but who have
succeeded in
rearing but one or two. Although the parents
will display a good
deal of spasmodic anxiety over the infant while it
is ill, they take
its death with philosophic resignation. This is
especially the case
if the deceased is a female, for girls are not
considered a subject of
much congratulation, and "May God give you a
boy," or "May
God
give you many sons," are the ordinary good wishes for a
married couple. Many a wife who produces an
unbroken succession
of girls has a bad time of it with her husband and
his relations.
To be continued.)
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