Al-Ahram: A Diwan of contemporary life (568)

Good for the health

An Al-Ahram supplement in 1935 provided insight into how Egyptians in those days took care of themselves. Professor Yunan Labib Rizk checks up on the nation's health

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Suleiman Azmi

On the morning of Monday, 11 March 1935, Al-Ahram announced that it would be coming out with a special 48-page edition of the newspaper to mark the start of Eid Al-Adha, or the Feast of the Sacrifice. "This edition will consist of two sections, the first being the regular Al-Ahram with its usual sections and columns. The second will comprise a supplement on health issues written and compiled by a group of eminent Egyptian physicians in coordination with the Faculty of Medicine's Students League for Public Health. The two parts will go on sale together in a single edition for the usual price of five millimes."

On Thursday 14 March the newspaper reminded readers of the special edition that was due the following day. The advertisement, appearing on the front page this time, provided a foretaste of what readers would expect: 28 articles written by luminaries in the field of medicine on a vast array of medical and health concerns. It appeared that most of the subjects would focus on the digestive tract and related issues: stomach ailments, sore throat, food and its place in our health programme, illnesses related to poor nutrition, dental care, appendicitis, worms and constipation. Clearly the contributors felt it necessary to issue an indirect caution to holiday-makers and their tendency to overindulge in food. However, a goodly proportion of the articles would focus on child health: infant diarrhea, rickets, mother's milk and nursing and normal child growth. In addition, there would be articles on ocular issues -- the causes of blindness in Egypt and prescription glasses -- as well as general subjects such as hygiene, social health and its impact on mental illness, the public's responsibility in public health, the domestic medicine cabinet and medical treatment in the home.

On Friday 15 March 1935 Al-Ahram readers rushed to the stands to purchase their copy of the special edition, with its 24- page health and medicine supplement. Many of those articles, written as they were by Egypt's top doctors, are now out of date, but many remain both accurate and useful today. But regardless of whether or not they have passed their validity date, the articles reflect how Egyptians in those days viewed questions of health and illness.

Naturally, our greatest difficulty when faced with such a quantity and diversity of subject matter was choosing what would fit in the space available to the Chronicle. Eventually, we decided to put ourselves in the place of the readers who woke up that distant morning on the first day of the eid. Certainly, sensing the demands of the religious and social rituals of the day, they would not have had the time to delve through all the articles and would, therefore, have chosen those that most aroused their curiosity. Our guess is that they would have plumped either for the items on nourishment and diet or for those of general concern to the public.

However, before proceeding, we should note that the newspaper's advertising department was not about to pass up this invaluable opportunity. Indeed, entire pages were taken up with advertisements -- whose creators hoped would be seen by the extra number of readers -- most for products related to medicine and health. Page 37, for example, displayed a picture of your typical happy family delighting in a cup of Ovaltine -- that "concentrated essence of mature barley blended with pure cow's milk butter, cocoa and nourishing fortifiers". The ad concludes: "Nothing is better than Ovaltine for building strong bodies and sustaining your health and vitality. Ovaltine: rich in vitamins, low in price". Page 32 also featured several interesting specimens. Chicorel, the famous department store chain, took advantage of the health supplement to plug its electric massage machine, "which will keep your body looking and feeling young. Just plug it into an ordinary electricity outlet in order to give your body the energy and grace of a 20-year-old."

Surprisingly to us today, there was an ad for a new brand of hand-rolled cigarettes. Produced by the Upper Egyptian Tobacco Company, the Safiya Zaghlul cigarettes came in an elegant package with a picture of the wife of the late nationalist leader, Saad Zaghlul, on the cover. One cannot help but wonder whether the "Mother of the Egyptian people", as Safiya was popularly known, had given permission for her photograph to be used on a pack of cigarettes.

Then there was the ad of the adoring wife who declared that she loved her husband because he used Palmolive shaving cream every day. "I love to see his face so clean and smooth and when I touch it, it feels as smooth as velvet."

Turning now to the substance of the health and medicine supplement, we begin with Dr Suleiman Azmi's excellent survey on stomach ailments. According to this noted physician, most stomach ailments are the result not of what we eat but how we eat: we either stuff ourselves or keep ourselves on the verge of starvation. What was needed was both moderation and regular mealtimes. "Few of us are aware of the importance of adhering to set meals, three times a day, kept at moderate quantities so as not to bloat our stomachs. Not many of us realise the importance of chewing our food well, eating at a leisurely pace and refraining from physical exertion during and after meals, all of which give our digestive tract the opportunity to properly process the food we ingest."

Dr Azmi reproached his fellow Egyptians, or at least those with means, for eating up to four times the amount of food their bodies need. If the quantity was not harmful enough, they also partook of a surfeit of tomato sauce, pickles, spices, grease, hot peppers and water, "especially iced water in the summer, which is very unhealthy". He then turned to the popular classes who, after having had their ordinary meals at home went out to their local coffeehouses or nightspots where they were prey to "the vendors of sunflower seeds, peanuts, toasted chickpeas, lupine beans, halvah, sesame and chickpea bars, ice cream, licorice root and carob juice and the full assortment of syrupy drinks. Overcome by the choice, the public take something of everything, bringing their digestion to a halt and bringing on the stomach ailments." Dr Azmi concludes with a caution against preserved foods, especially canned tuna, sardines and herring. Not only do they irritate the stomach lining, he said, but if the foods are poorly preserved they could cause serious illnesses.

Mohamed Ibrahim, a physician at Qasr Al-Aini Hospital, resumed Azmi's discussion on illnesses stemming from poor eating habits and malnutrition. Overeating, he cautioned, could lead to severe upper abdominal distention. "People afflicted with this symptom feel sharp pain in the upper abdomen, and nausea, perhaps producing vomiting. The illness is especially dangerous to patients with heart disease and arteriosclerosis, for the extra exertion it causes for the heart could lead to death."

Obesity was the most common symptom of overeating. "Fatty substances accumulate in the tissues of the body, including the heart, which produces lethargy, drowsiness and shortness of breath at the slightest physical exertion. In spite of their size, such persons have poor resistance and are vulnerable to many diseases, most notably diabetes. In addition, over-indulgence in foods with a high protein content, such as meet and eggs, is a major cause of high blood pressure, as well as arthritis and gout."

But eating less than what the body needs was also dangerous because it deprived the body of essential organic and mineral substances. Particularly grave were the illnesses arising from deficiency in vitamins -- "those curious elements so vital to life and growth, not just in animals but also in plants. Science has demonstrated that even so much as a part of a milligram of vitamins in our food may prevent many types of illness, such as pellagra, rickets and osteomalicia (softening of the bones)."

Under the headline, "Stomach worms", Dr Mohamed Abdel-Azim of the National Medical Research Institute, discussed some of the most common diseases in the Egyptian countryside. One suspects that Dr Abdel-Azim was fond of literature for he opens his article with a true-life story:

"Uncle Othman is about 40. He wears a blue galabiya which he fastens with a belt of cord. He walks barefoot summer and winter and wears nothing on his head but a woolen cap. Slung over his shoulder is a crude basket in which he carries a bunch of radishes. He draws attention to his produce by calling in a weak and quivering voice that contrasts greatly with the powerful calls of those vendors with strong vocal cords. He would make two rounds of the neighbourhood before lunch and dinner every day. Often I would see him seated on the ground, partaking of a peace of bread and a bunch of radishes to stave off his hunger. He would wake up with the rooster in order to gather radishes from the fields in Manial or Giza and then to wrap them up in bundles ready for sale. Eventually age took its toll. Suddenly he was in hospital on the verge of death and afterwards he remained so weak that he could only walk with a cane while leaning on the arm of his elderly wife."

Uncle Othman's ailment, it was discovered, was worms. Tests conducted in the hospital found several types including askaris (roundworm), ancylostoma (hookworm) and tapeworm. None of these were benign parasites. In adults, askaris settle in the large intestine and cause digestive disorders such as diarrhea. Ancylostoma are conveyed through the bloodstream into the intestines where they absorb the infected person's blood and nutrients. "The most salient symptoms are jaundice and deficient bodily growth. Hookworms are especially prevalent among peasants and affliction often debilitates them from work." Those pernicious intestinal parasites, tapeworms, were conveyed through meat products.

Dr Abdel-Azim then lists a number of rudimentary precautions against these endemic plagues in the Egyptian countryside. It was important to defecate only in toilets or public lavatories -- and to train children in this from an early age -- so as to keep the soil from becoming polluted with ancylostoma. Farmers should avoid using homemade fertiliser consisting of animal or human feces -- a perfect medium for the incubation of askaris eggs -- especially in the cultivation of vegetables such as radishes, carrots and lettuce. The physician praised the work being done by government hospitals to induce the public to come in for testing, as well as their fine quality of care and awareness-raising.

Another physician, Dr Ibrahim Nagi, devoted his article to constipation, a disorder that could be either temporary or chronic. In both cases, the disorder may be accompanied by stomach cramps and flatulence, and laxatives may or may not help relieve the discomfort. "If the patient or physician places his hand on the stomach it is frequently possible to feel the area in which the intestines are cramped. Patients may also find mucus discharges in their feces, which is also an indication that the intestines are inflamed. This may be due to the consumption of bad food, the excessive use of laxatives or, sometimes, appendicitis." Chronic constipation was often the result of certain eating habits, such as over-indulgence in meat products and under-consumption of water. Another possible cause was an anal disorder, such as hemorrhoids, piles or a rupture in the anal muscles.

According to Nagi, appropriate dietary changes could remedy 90 per cent of the cases. Sufferers of temporary constipation should avoid all types of food that irritate the stomach, such as raw or difficult to digest vegetables and fruits. Instead they should increase their consumption of dairy products "although, naturally, it is harmful to remain on such a diet for too long, and one should gradually return to a normal diet as soon as possible." As for those afflicted with chronic constipation, "they should avoid all meat, consume plenty of brown bread, fresh vegetables, beans, salads and fruits, and drink plenty of liquids."

It is not difficult to imagine Al-Ahram readers that Friday morning, surreptitiously testing their stomachs, keeping their ears cocked for strange rumblings and anxiously contemplating the contents of their kitchen cabinets. Perhaps before anxiety set in, they turned to the articles on more general health and public awareness issues.

Without a doubt one of the articles readers would have turned to first was that on "How to be one's own doctor", by Dr Fouad Rashid of Demerdash Hospital. After issuing the compulsory precaution that home medication did not dispense with the need to consult a physician in certain cases, Dr Rashid proceeded to discuss the domestic medicine chest. Every home, he said, should have a medical thermometer, a hypodermic needle, an ice bag to bring down fevers, a hot water bottle to relieve various stomach ailments and an enema syringe.

There followed some simple home treatments. Eyes should be rinsed daily with a mild boric acid solution, preferably that produced by the Department of Health. In the case of infection, hot boric acid presses should be applied to the eyes continuously. Moving down to the nose, Dr Rashid extolled the wonders of Vicks Vapor Rub for nasal congestion. In the event of nosebleeds, wash the nose with cold water and plug the nostrils with cotton.

For severe respiratory congestion it was complete rest in bed and a warm press or woolen wrapping to keep the chest warm. If only a question of a mild cough, work need not be prohibited, and Valda cough drops were to be recommended. Apparently, Valda was as much a household brand of medicine as Vicks, and one cannot help but to remark how much do-it-yourself medication remains the same, and even how some techniques are coming back into fashion.

The Al-Ahram health and medicine supplement was not aloof to a discussion of herbal remedies. In his article on "Medicines in the home", Dr Ibrahim Ragab Fahmi, professor of medicinal diagnostics in the School of Pharmacy, grouped medications into three categories: animal, vegetable and mineral. His particular interest was in the vegetable, which, he said, fell into several groups, such as stimulants (coffee, tea, cocoa), sudorifics (cinnamon, anise, mint), laxatives (linseed, fenugreek) starches and mughat, a drink made from the roots of glossostemon brugieri, and salep, a drink made from the tried tuber of a variety of orchid).

He also discusses what he terms "caustic spices", which he describes as the most powerful of herbal medicines. These were generally applied externally to treat inflammation, swelling and rheumatic pain. However, "if ingested in very small quantities they can stimulate the stomach, aid digestion and increase the appetite."

Many have the mistaken impression that cosmetic medicine is a modern branch of medicine. Under the headline, "Ladies and Gentlemen, the art of cosmetics", Dr Abdel-Wahid El-Wakil, professor of health and hygiene in the Faculty of Medicine, sets the record right. He writes, "The science of cosmetics is the art of decorating the human body, just as ornamentation is the science of architecture." What prompted him to choose this subject was that it had become a major industry, "proof of which can be seen in the hundreds of cosmetic firms with their staff of thousands, many of whom boast specialised degrees from schools in Paris and other cities of beauty".

Dr El-Wakil finds it curious that while in the rest of the animal kingdom the male preens himself in order to attract females and prides himself in his elegant feathering, melodious voice or graceful form, the reverse is the case with human beings. "Here it is the female who must attract the male through her irresistible beauty." Nevertheless, he believed that certain rules should apply in female toiletry. Not surprisingly, as a doctor he cautioned that it must be hygienic and safe. He therefore advised that women bathe at least twice a week with soap and warm water, and wash their hands and face well several times a day. "Soap and water are the most important ingredients in the art of cosmetics and toiletry," he declares. However, he also held that cosmetics should be applied tastefully and moderately, and that women should restrict their use of cosmetics solely to enhance their appeal to their husbands or fiancés, and not for general outings where they encounter strangers. He adds that the purpose of cosmetics is to conceal a woman's flaws and enhance her virtues. "What might be suitable for one woman may not be suitable for another, and it is precisely in this regard that a woman displays her true skill and taste."

The professor of health and hygiene devoted a good proportion of his article to hair care and hairstyling. While he had no objection to women having their hair cut, he felt that they should observe certain aesthetic standards. It was not in the best of taste, for example, for obese or elderly women to wear their hair short, especially if their hair is gray or graying. "Nothing could be more indicative of their desire to appear much younger than they are, and the result is that they become an object of ridicule." At least now with the many hair dying products on the market, Dr El-Wakil's reservation with regard to gray hair would appear no longer applicable.

After speaking at length on hair care and "the ideal way to apply makeup", he went on to urge women to avoid excessive stress, anxiety and worry, and to caution them against working too hard, staying up late and getting angry. "Such habits and emotions generate lines and wrinkles on the forehead and the face. I believe all of you, ladies and gentlemen, are aware that the happy-go-lucky person -- the person who laughs frequently, takes things easy and never gets wrought up over anything -- keeps his youth, health, vitality and hair, and tends to live longer as well."

Before concluding its health and medicine supplement, Al- Ahram handed the platform to a pediatrician from Sohag. Under the headline, "Your health is in your hands," Dr Abu Shanab offered 15 ways for maintaining good health. Most of the following points remain good advice today:

1. Inhale deeply;

2. Eat at regular times;

3. Drink plenty of water;

4. Clean teeth well;

5. Bathe frequently in cold water;

6. Take regular outings to fresh open spaces;

7. Laugh from the heart and leave worries behind;

8. Sleep at regular times;

9. Keep busy but not excessively;

10. Get a modicum of daily physical exercise;

11. Take pleasure in your work;

12. Speak kindly to others and avoid gruffness;

13. Indulge in a small share of innocent play;

14. Read a lot -- an excellent source of pleasure and entertainment;

15. Finally, always try to be cheerful and content.

There is no disputing that his advice is still valid today.