25 February - 3 March 1999
Issue No. 418
|Published in Cairo by AL-AHRAM established in 1875|
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A Diwan of contemporary life (274 )
Fever epidemics in Egypt in the spring and summer of 1915 heightened public awareness of the dangers and nature of fevers and ways of curing them. Al-Ahram was instrumental in this campaign as it published articles by physicians on the subject. The newspaper offered itself both as a forum for public debate and as an outlet for its readers to air their grievances. But Al-Ahram also carried editorials that were mostly critical of health services. Doctors, pharmacists and government hospitals came in for their fair share of the blame. Until today, state-run hospitals are constant targets of press fire. Dr Yunan Labib Rizk flips the pages of many articles of Al-Ahram to present this story
"Fevers in Egypt" was the headline for Al-Ahram's coverage of epidemic illnesses that plagued the country in the spring and summer of 1915. The gravest was the outbreak of typhoid which, the newspaper warns towards the end of May 1915, "is spreading alarmingly." It goes on to report, "Doctors, the Ministry of Health and the public have been working together to bring the epidemic under control. They met with such success at first that many thought that the fever's blaze had subsided and that now tranquillity could reign again. However, within a matter of days, it flared up again even more forcefully and menacingly."
"The public cries out to the government for help!" blazoned Al-Ahram with the resurgence of the typhoid epidemic. The newspaper continues, "Physicians, writers and the press have been cautioning the public against negligence of their health. Preachers and spiritual leaders have been sermonising and counseling in the same vein. However, individual capabilities have their limits. What they are unable to accomplish, the government can and this is its inevitable duty."
In June the epidemic gained in fury. Al-Ahram writes, "Reports from all quarters of the capital indicate that the typhoid fever is spreading more rapidly in spite of the great hopes that its severity would abate. In the provinces, too, the disease has run rampant, generating fear and panic among the populace." In fact, certain areas were struck so hard that they were put under quarantine. Such was the case with Imbaba where the newspaper exhorted "village leaders and elders to do all in their power to assist the quarantine officials in carrying out their duties."
As part of a public awareness campaign, Al-Ahram published numerous articles submitted by various physicians on the nature of the disease itself. The most detailed was that published in its 3 May 1915 edition. According to the writer, typhoid claimed the lives of an average of 20 per cent of its victims, a ratio made possible by "the successes of science in the past century in combating this disease." The typhoid symptoms, themselves, he listed as "growing fatigue and lassitude, headache and pain in the extremities and the back, loss of appetite and a tendency towards vomiting and, in many instances, diarrhea." Another major symptom was rash and boils that erupted on various areas of the body. When the illness moves into its second week, victims suffer "distention of the stomach and increased severity of diarrhoea. Stools produce a repugnant odour. Haemorrhaging of the stomach lining can occur and sometimes leads to death. The headache usually ceases after the 10th day of the illness although the patient may suffer temporary loss of hearing." In the third week, either the fever can break and return to normal or it can intensify, causing hallucination and rapid heartbeat.
Treatment was rudimentary. The doctor writes that patients are not to be given laxatives beyond the first few days of the illness and they are to be given complete rest "on their backs". After the illness subsides, they are to be kept on a liquid diet for at least 10 days. Throughout the illness they are to drink large quantities of water, "because it purges the body of toxins through perspiration and urination."
Finally, the doctor offers precautionary counsel to the public in general and those tending the ill in particular. He says that "all excrement and urine must be disinfected with a five per cent solution of carbolic acid. Every item used by the patient from utensils to bed sheets and clothing must be thoroughly washed. No excretions or anything touched by the patient should be thrown into water conduits or left exposed to be transmitted by flies. All hands that come into contact with a typhoid patient should be washed thoroughly with soap and water and then rinsed in a sterilising solution. Boil all food and drink and refrain from eating vegetables unless they have been washed thoroughly in boiling water."
A second reader, who described himself as a "bacteriologist in the Hygiene Technology Laboratories in Egypt," complained that insufficient attention had been given to vaccination as a means of prevention. Indeed, he said, "this is the only method used the world over, particularly within the armies that are currently at war. The method of administering the vaccine is extremely simple: it is injected below the surface of the skin with a hypodermic needle. The Public Health Authority should make this vaccine obligatory, at least to those who come into direct contact with those afflicted by this disease."
"Vidal's method for the diagnosis of infectious fevers" was a third contribution to the newspaper which informed readers of another disease related to typhoid. This was paratyphoid. "Although the symptoms are similar, they are less severe and the disease itself is not fatal. It also can spread epidemically, and one of the prominent means of contamination is through polluted water." Vidal also warned of "Maltese fever" or what is also referred to as Mediterranean fever because it is endemic to the coasts and islands of this body of water, although it has also appeared in South Africa, India and China. This disease, too, is similar in nature to typhoid, but less severe. "It begins gradually, like typhoid, but it produces no boils or diarrhoea. Only two per cent of its victims die, but its duration is considerably longer, for it can last up to three months. Convalescence is also very slow." As this fever was spread through contaminated goat's milk, the doctor advised Al-Ahram readers "to refrain from drinking or eating all goat's milk products, whether in the form of butter or cheese, unless the milk has been boiled well beforehand."
In this regard, Al-Ahram highlighted a court case in which milk sellers in Abdin were found guilty of diluting their milk with water and warned: "Many diseases are spread through milk and dairy products." One of the main causes for the typhoid epidemic, it said, was "the consumption of milk which the milk sellers mix with brackish water." It particularly cautioned readers against the milk salesmen who "make the rounds of the streets with their cows. These they let go thirsty and then force feed them salted water which make them produce milk. Then, when they start to milk the cow, they take a tube connected to a container in their pocket and pour water on top of the milk." The newspaper urged stricter controls on milk salesmen.
One dairy company took advantage of the frenzy over milk to promote its products. In an advertisement published in Al-Ahram on 19 May 1915, it announced, "All doctors affirm that milk is one of the mediums through which microbes are transmitted into the human body. Milk must, therefore, be sterilised for it to be potable... Boiling milk in the home only kills the microbes for good if the milk is boiled three times at six-hour intervals. However, we at the Nestlé Anglo-Swiss Company for condensed milk have the latest modern technology for sterilising milk, while keeping it easy to digest and safe from contamination, especially in the summer. Swiss milk with its dairy girl trade mark is famous the world over and is sold everywhere. Try it and see for yourself!"
At the other end of the professional scale, Al-Ahram subjects medical practitioners to some sober counseling. Some doctors, it observes, "imagine that their job is to take fees and accumulate profits, as though they were the same as any merchant or entrepreneur. The doctors that espouse this do a great injustice to science and debase their profession to the lowest levels." The newspaper also reminded doctors of the oath taken by graduates of Qasr Al-Aini Medical School which was founded in 1827: "I shall be faithful to the codes of conduct and etiquette in my exercise of the medical practice. I shall treat the poor for free, nor shall I charge a fee in excess of the fee of my labour. When I enter a home, my eyes shall not observe the activities within and my tongue shall not betray the confidences that its inhabitants entrust to me. I shall not exploit my profession to the detriment of the common good. I shall not administer medicine harmful to pregnant women or that might cause them to abort. I will at all times remain dignified in my comportment."
Pharmacists, too, came in for something of a dressing down because of the high costs of medications. "The prices of the necessary medications are exorbitant, sometimes reaching several times their actual value," complained the newspaper on behalf of the public. The reproach precipitated objections from a pharmaceutical society chaired by "Dr Georgiadis, the noted chemist," who complained of the difficulties of obtaining medical supplies in wartime and the rising costs this entailed. He added that his society had, after considerable effort, succeeded in obtaining the approval of the British government to export to Egypt, "in spite of the circumstances of the war," all necessary medications and equipment, "with the exception of carbolic acid."
As was its custom when calamity and misfortune struck, Al-Ahram lent itself both as a forum for public debate and as an outlet for its readers to vent their frustrations. In the summer of 1915, Al-Ahram offices received such a flood of letters that newspaper officials announced, "If we were to publish all the letters that come to us from the various parts of the capital and the countryside, we would have no space for our ordinary columns!" The newspaper, did, however, publish several and among those published were those complaining of government negligence in fighting the epidemic.
Government hospitals, particularly the Hospital for Infectious Diseases to which many typhoid patients were transferred, also came under fire. Such was the level of treatment in this hospital, Al-Ahram noted, that foreign consuls refused to have their subjects sent there. It exhorted the government to act to improve the standard of health services, because "Egyptian patients have as much right to proper medical treatment as foreigners." Many readers complained that the hospital was too far away. Abbasiya, where it was located, was a distant suburb at the time. As long as the government decided to quarantine typhoid patients, the newspaper continues, the least the government could do is to "set aside special wards for infectious diseases in hospitals that are closer at hand or to designate a nearby hospital for this purpose in order to facilitate the relocation of patients." In addition, "these hospitals should be equipped with all the latest facilities in order to ensure proper treatment. Only then will the people be able to put their minds to rest that their loved ones will receive the best care and attention." Finally, with a subtle twist of the knife, the newspaper pointed out that the public's phobia of government hospitals is deeply ingrained and that the government must do all in its power "to eradicate this old belief." It is interesting to note that in spite of the proliferation, diversification and general improvement of hospitals and healthcare services, government hospitals in Egypt continue to fare poorly in the public esteem.
* The author is a professor of history
and head of Al-Ahram History Studies Centre.