Commercial. No. 22 (1884). Further reports respecting the cholera epidemic in Egypt and the proceedings of the German Scientific Committee.

Date:
1884
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Licence: Public Domain Mark

Credit: Commercial. No. 22 (1884). Further reports respecting the cholera epidemic in Egypt and the proceedings of the German Scientific Committee. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    tor one important step is still required, and that is to determine what was the cause of this first case. Was it imported ? or did it originate de novo ? Frequently it becomes evident that it was an importation, but as frequently the origin of the first case is wrapped in obscurity, and doubt is left on the investigator’s mind whether it might not have originated spontaneously. We find some medical men explaining the commencement of an epidemic by spontaneous origin, and others equally convinced that this explanation is erroneous. As such differences of opinion exist here in a highly civilized country, it can be no matter of surprise that in Egypt, where the civilization is of a different kind, and where facilities for investigation are absent, there is want of agreement concerning the cause of the recent epidemic of cholera. Some are of opinion that it was imported, some that it arose spontaneously, and some that it is endemic in the country. The evidence on which these opinions are based is for the most part scanty, and one opinion, so far as proof goes, is worth about as much as the other. It is in order to help to elucidate this important question that I have put together notes made during a four days’ stay at Damietta. Dr. Salem Pasha, the learned President of the Board of Health, through Dr. Grant Bey, of Cairo, kindly gave me every assistance in his power to forward my inquiries. In passing, 1 may mention that the German Commission was there three days, and Dr. Hunter one day. I found four days far too short, and regret much I had no longer time at my disposal, for I was enabled to dip only slightly into this important problem. In Egypt there arc very few medical men, the demand for them being small, for the Egyptians are not in the habit of seeking medical advice. Excepting a few who have studied in the European schools, the generality of the medical men know very little of medicine, and none have any conception of sanitary science. The Government appoints a doctor to a wide district, pays him a small salary, and expects him to minister to the wants of the patients who may apply to him, but as the majority never apply, he is not hard worked. In Damietta there resides one doctor, who is intrusted with the health of the people in the town and surrounding country. The population is estimated at over 30,000 inhabitants. The deaths are registered by a Secretary, and the causes of death gleaned from the statements of the friends are put down in the register, in a haphazard manner, much according to the tastes and preferences of the Secretary. With such a wide area, and so large a population, it is inconceivable that the medical man could have an accurate, or even general, notion of the causes of death, except in those few instances where he has been called in during the illness. It is absolutely impossible that he should have any trustworthy information of the prevailing diseases at any particular time in his district. It is said that the local medical man should know best the most likely origin of the disease, but after the above explanation it will be readily discerned that all those advantages which under other circumstances he would have derived from special education, position, and experience, and which would have most fitted him to give a valuable opinion on the causes of the epidemic, or give material aid to other investigators, are entirely wanting. To the stranger there are additional drawbacks to contend with. The Egyptians have a natural dread of being questioned through fear of compromising themselves unawares. Possibly this fear is engendered from the arbitrary and despotic powers their superiors sometimes capriciously exercise over them. Whether this is so or not, the inhabitants have an unpleasant habit of stating whatever will suit themselves, or the view most in favour at the time, or contradict themselves so often as to leave one in doubt what they really know or mean to convey. Numerous examples of this phase of their character came under my observation ; I will mention two. One morning, a Consul’s servant, in great grief, told his master that his (the servant’s) child had died the previous evening of cholera, and that two of the elder children were now attacked with vomiting and purging, and were seriously ill. Asked if he had sought medical advice he replied no, it was useless, for if his children died it was the will of God, and no one could prevent it. The Consul, however, insisted on a doctor being sent for. The man did as he was bid, and informed the doctor of the child’s death. An autopsy was suggested. This alarmed the father, and he immediately decided to say nothing about the other children, but hurried home and hid them. Afterwards he declared they were quite well, and positively denied he had ever said they were ill. He also induced a number of his friends to come forward and testify that the children were quite well, and that neither the elder children nor the one who died had ever had vomiting or purging. The doctor saw the body of the dead child, and certified it had died of diphtheria. Another curious incident occurred when inquiry was made of a respectable man
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