Masterman, E. "Hygiene and Disease in Palestine in Modern and in Biblical Times."

              Palestine Exploration Quarterly 50 (1918): 13-20, 56-71, 112-19.

                  Public Domain.  Digitally prepared by Ted Hildebrandt (2004)






                     AND IN BIBLICAL TIMES. (Part I)


                                      By Dr. E. W. G. MASTERMAN.




THE subject of the diseases mentioned in the Bible has always been a

difficult one and it is not expected that this present effort to elucidate

it will have anything of finality about it. The writer will be content

if he clears up some obscure points, and if incidentally he is able to present

to his readers a considerable mass of facts which have not hitherto been

co-ordinated. The basis of any correct views on the subject must be our

knowledge of the conditions of life in Palestine in Old and New

Testament times. Though doubtless much may be gathered from

literature it is reasonable to suppose that the physical environment of

the modern peoples of this land as regards climate, food, houses and

mode of life being probably much the same as of old, a study of these will

be likely to prove at least as important. Then the diseases rife in the

land to-day may also be considered. It is quite possible that some

diseases have changed their type or even become extinct, and it is certain

that some diseases occur which were unknown before the Middle Ages,

but as some popular information on the modern diseases of Palestine may

be opportune at this time, this section will be complete in itself, though

necessarily brief. Twenty years' residence in various parts of the Holy

Land in actual medical practice enables the writer to treat this part of the

subject with the authority of experience, and he does so with greater

assurance, inasmuch as he has discussed various points here mentioned

with other practitioners in the land, both personally and in conferences.

The literature of this subject was until recently extraordinarily scanty,

but in the last few years a number of medical papers from those practising

or making researches in the land have been published which do much to

add to our knowledge. This is notably the case with regard to tropical





diseases in which, thanks to the researches of the workers in the "Inter-

national Health Bureau," established in Jerusalem in 1913, we have

scientific reports of the greatest value. Although a full Bibliography will

be published at the conclusion of these papers1 I may mention here a few

recent papers which give information about diseases in modern Palestine

in a fuller manner than will be possible here:--

T. HARRISON BUTLER.--"Clinical Features, Bact., and Treatment of

Acute Oplithalmia in the East," Roy. Lond. Ophth. Reports, Vol. XVII.

"Some aspects of Ophthalmology in Palestine" (Middlemore Lecture,

1915), published by Birmingham Medical Review, 1915.

J. CROPPER.--"The Geographical Distribution of Anopheles and

Malarial. Fever in Upper Palestine," Jour. of Hygiene, 1902. "The

Malarial Diseases of Jerusalem, and their Prevention," Jour. of Hygiene,


Dr. HUNTEMULLER.--a Neuartige Parasitenbefunde bei der Jericho-

beule," Centralblatt fur Bakteriologie, Berlin.

E. W. G. MASTERMAN.-" Notes on Some Tropical Diseases in

Palestine," Jour. of Hygiene, 1913 and 1914; " Hirudinia as Human

Parasites in Palestine," Parasitology, 1908; " Haemoglobinuric Fever in

Syria," B. M. Jour., 1906, etc.

Prof. P. MUHLENS.--"Bericht uber eine Malariaexpedition nach

Jerusalem," Centralblatt fur Bakteriologie, Abt. 1, Orig. Bd. 69, Heft. 1,

Jena. (The most authoritative statement yet published.)

HANS MUCH.--Eine Tuberkuloseforschungsreise nach Jerusalem.

Hamburg, 1913.

With regard to using modern scientific medical literature it must

however be always remembered that from the point of view of old

writings it is less helpful than might be hoped, as the scientific recognition

of many specific diseases is comparatively modern and until quite recently

such general terms as "fever," "consumption," "palsy," were used in

a broad and general sense, and each included what we now know to be

many varieties of disease. Perhaps more help will be found from study--

such as will be attempted here--of the primitive ideas of disease and its

cure, such as is still to be found abundantly among the people of the land.

Some light on the conditions of life and health in early times, which. may

be gathered from the results of Palestine excavations, will form the

subject of a special chapter.

Finally, an endeavour will be made to get as near as possible to the true

meaning of the various terms used in the description of disease and to

investigate the actual relation of the Mosaic laws to health. Here then

is a considerable body of Biblical and theological literature to which

reference will be made in the Bibliography.


1 The author would be grateful for any references to medical or Biblical

papers bearing on the subject.

HYGIENE AND DISEASE IN PALESTINE.                      15




         CHAPTER I.

     Race, Habit, and Food as bearing on Disease.


It is not necessary to discuss here the very complicated ethno-

logical relations of the various and mixed races inhabiting Palestine

and Syria; for practical purposes it is sufficient to recognize three

distinct classes of people distinguished by such special habits of life

as to have a somewhat different liability to disease. These are

(1) the nomads or bedawin, who dwell in tents all the year round

and live a pastoral as contrasted with an agricultural life; (2) the

peasants or fellahin, who are primarily agriculturalists; and (3) the

town dwellers or hader, whose occupations are various. Each class

shades off into the other. Thus, some of the local bedawin live in

rough houses or old ruins in the winter, and do a certain amount

of primitive agriculture, housing their cattle and stores of tibn

in the winter; and a considerable number of the fellahin, particu-

larly in recent years, though making their homes in their villages,

spend so much of their time in occupations in the towns as to

expose them to all the disease-risks of the townsfolk.

(1) The bedawin are popularly credited, on account of their

entirely open-air life, with great soundness of constitution, but it

cannot be said that this is the case with the nomads of Palestine.

They are exceedingly scantily clad, the poorest in actually nothing

but a shirt, and their skins are exposed to all the extremes of heat and

cold; their goat-hair tents are but little protection from the heat of

summer or the cold and wet of winter; while, during the latter

season, the atmosphere of their dwellings is commonly saturated

with the irritating smoke from wood or dung. It might be supposed

that the smoke would at least afford some protection from insect

pests, but the truth is that, under such conditions, lice, mosquitoes,

and other insect pests are found in abundance. Doubtless, in the

days when the bedawin possessed considerable wealth of cattle,

camels, and horses, and were able both to feed well and to keep

themselves in good physique by martial exercises, they enjoyed

greater robustness, but now a large proportion of the bedawin of

Palestine are sallow in complexion, and constantly suffer from

malarial fever, and even from pulmonary tuberculosis (consumption),

from which it might bethought their out-door life would save them.



Even their nomad habits do not deliver them from epidemics of

small-pox, typhus, enteric, measles and whooping-cough; and the

mortality is very high, especially among the young. While it is

probably true that the great desert tribes are largely free from

venereal diseases, this is certainly not the case with the mongrel

bedawin in the neighbourhood of the towns of Palestine, who have

very low morals: syphilis and gonorrhoea are extremely common

among them, and it is said that the same is the case with some

of the nomads of Sinai. These same bedawin are described as being

peculiarly liable to rheumatism. No class are greater fatalists, and

in the larger number of cases of illness the patient is left uncared

for, even, as the writer has witnessed, when the sick one is a cherished

son. The bedawin have remedies of their own, but many appear to

be the result of the inspiration of the moment rather than of any

tribal lore. The food of these nomads consists of unleavened bread,

made of coarsely ground wheaten flour, burghul (bruised wheat,

boiled), rice, lebban (sour milk), cheese, dates and fresh fruit when

they can be obtained; occasionally, as on a feast, a sheep is killed

and there is a gorge of meat. A great number of them suffer from

chronic dyspepsia, the pangs of which they usually ascribe to

intestinal worms; these, it is true, they also have in plenty. Child-

birth is, as a rule, accomplished with extraordinary ease. Although

these nomads, in a remarkable manner, survive injuries received in

their fights, their constitutions present very little resistance to acute

diseases, particularly perhaps to pneumonia, and they succumb to

what any soundly constitutioned European would successfully resist.

(2) The fellahin are ethnologically a very mixed race, and

distinctive physical characteristics are found in certain villages or

groups of villages. In general, the poorest both in physique and in

possessions are found in southern Palestine. The great masses of the

fellahin--like the bedawin--are nominally Moslems, but they know

but little of the religion which they profess, and follow a cult of

traditional religious customs, often quite at variance with their

orthodox belief. There is a certain number of Christian villages

scattered about the land where, as a rule, the houses and sur-

roundings are more comfortable than in the villages of the Moslems.

In northern Palestine, particularly, the most varied races and

classes dwell side by side--Christians (in several distinct sects),

Jews (in “colonies”), Sunnite Moslems, and Metaweleh, Druzes,

Moslem Circassians, Turkomans, and Algerians. Even those


HYGIENE AND DISEASE IN PALESTINE.                      17


occupying villages within sight of each other will often have but

little social intercourse. All over the land the custom of inter-

marriage within the very narrow circle of a single village, or of a

small group of villages, is the rule. This constant interbreeding is

naturally prejudicial to health, and must greatly concentrate the

tendency to inheritance of disease. The houses of the fellahin are

usually constructed of very loosely built walls, with flat mud roofs,

unprovided with parapets (Deut. xxii, 8), and in many parts of the

land without even chimneys. These ill-made walls, however, have the

advantage of allowing free ventilation even when, as is the rule, all

windows and doors are closed at night. Most dwellings swarm with

vermin. In some parts of the land (e.g., Hattin, Banias, etc.) the

inhabitants sleep in booths constructed on the roofs during the

summer months, when the vermin are most active. A witness to

the commonness of the presence of body lice is supplied by the

exclamation frequently used in northern Palestine, "May God not

remove them [i.e., the lice] from me!" because the sudden departure

of these pests from anyone is considered a sign of mortal sickness.

The village streets are narrow and very irregular. Heaps of refuse

accumulate in corners, and a huge dung heap--the breeding-place of

countless myriads of flies--dominates the habitations. There are,

with very few exceptions, no sanitary arrangements, and the whole

village is often surrounded by a narrow area of human excreta

which the fellahin never take the trouble to cover with earth,

and which, when the rains come, is, in many cases, carried into

the source of the water supply. Although the native of the land

has a keen appreciation of good water when he sees it, and will

laud the virtues of fine springs in extravagant language, he is

often very careless about his domestic supply. In many places

water is very scarce over much of the year, and little can be spared,

or is used, for personal cleanliness. On the other hand, the young

lads, in many villages, bathe daily in the tank or pool which

supplies water for domestic use. The house-floors, being usually of

beaten earth, can never be properly cleansed and harbour the

accumulated filth of years. The fellah has the advantage neither of

the nomad's periodical migration to a clean site nor of the thorough

cleansing which the town-dweller is able to give periodically to his

stone-paved floor. From want of personal cleanliness and the

impregnation with sewage of the food, especially the salads, intes-

tinal worms are exceedingly common. The food of the villager,


18                    HYGIENE AND DISEASE 1N PALESTINE.


in addition to the articles mentioned as eaten by the nomad,

includes a large amount of fresh and dried fruits, especially figs,

grapes, apricots and dates, and in their seasons, fresh melons, gourds

and cucumbers. Cooked with meat he has rice, vegetable marrows,

egg-plant (solanum), barmeyeh (Hibiscus esculentus), tomatoes, etc.

Eggs, chicken, and meat in general are eaten more commonly than

with the bedawin, and in certain districts fish is also a usual article

of diet; but the majority of the villagers never touch it. As with

the bedawin, so with these people, there is a great prevalence of

dyspepsia, due partly to the common custom of making but one

large meal daily, in which half-cooked bread and unripe fruit largely

figure, partly to the over-eating which occurs at feasts, and perhaps

most of all to the perpetual over-drinking of water (a habit in itself

often due to dyspepsia), which distends the stomach and dilutes

the gastric juices. This last is even more true of the bedawin, who

have often to wait for a long time before getting a satisfactory

drink. The fellahin suffer much from the cold and wet in winter,

the majority make but little change of raiment, and those who can do

so cower over their small charcoal fires during the long, heavy, rains

of the winter months. They need sunshine for their natural life,

darkness and wet are things to be got through as well as possible--

preferably in slumber.

(3) Then we turn to the hader, or townsfolk. It is necessary to

distinguish to some degree between the Moslems, the Christians and

the Jews, and, in the case of the last two, to differentiate between

the true Orientals and the more or less orientalized Europeans,

because each class has different social customs and modes of life,

leading to a different liability to disease. For example, venereal

diseases are distinctly rare among the Jews of Palestine, not very

common among the oriental Christians, but fairly common among

the more well-to-do Moslems. This is said to be increasingly true

the nearer we approach to Egypt; at Gaza, for example, a very

high percentage of the people, according to the late Rev. Canon

Sterling, M.B., suffer from syphilis. The morals of the Jews of the

Holy Land, particularly of the European immigrants, are good;

they, as a class, are much held in check by religious motives. Public

vice is uncommon everywhere, but on the other hand a large pro-

portion of the more notorious “public women,” especially in

Damascus, are Jewesses. Among the Moslems, unnameable vices

are deplorably common, and they are viewed by the rank and file


HYGIENE AND DISEASE IN PALESTINE.                      19


with but little horror. The kidnapping of boys for vile purposes is

done in some of the larger Moslem centres in broad daylight, and

the victims, not uncommonly native Jews, have but little redress.

The writer has had many such cases under his care.

As a whole the towns-people enjoy better houses, better clothes

and better food than the fellahin; and perhaps, as a class, oriental

Christians know best how to live comfortably. Food is much the

same as with the fellahin, with the addition of great quantities of

sweets and nuts, sweet sherbets and coffee, the first mentioned,

particularly, leading to rapid decay of the teeth. The villager with

his coarse food has usually excellent teeth, but a few months of

town life leads to rapid deterioration. Milk is, by a long-standing

instinct, always boiled--a custom which doubtless saves many lives

from Malta fever, enteric and tuberculosis. In the towns, dyspepsia

is also somewhat common, much of it being due to the habit of

cooking food with oil, olive or sesame, instead of, as with the

fellahin, with semen (boiled butter). The orthodox Jews, always,

and the native Christians, at fast seasons, are obliged to cook

their meat and vegetables in this way, and experience shows that

food so prepared is not easily digested.

The sanitary arrangements of all the towns are still extremely

primitive. Drain traps are practically unknown, except in European

houses and institutions. The “waterclosets" are usually in close

proximity to the front door, or the kitchen, or both; and the

entrance to the main drain or cesspool, where there is often an

accumulation of years, being quite untrapped, the effluvia is at

times almost unbearable. In Jerusalem, which should be a place

easily drained, a water-carriage system of main drainage has been

made, ancient sewers being utilized, but as there is no system of

flushing these badly constructed, stone-built channels, sewage

stagnates in them during the whole dry season, poisonous gases

make their way freely into the houses and streets, and the liquids

impregnate the surrounding soil for a considerable distance, and,

without doubt, in places reach the neighbouring cisterns. When

the heavy winter's rains fall, the accumulation of months is carried

down the main sewer, emerges in the valley of the Kedron just

below the village of Silwan, and flows down the valley in close

proximity to the Bir Eyyub (Job's well--the ancient ' en-Rogel), the

water of which is carried to the city for many domestic purposes.

Much of the fresh sewage is distributed over the gardens to the


20                    HYGIENE AND DISEASE 1N PALESTINE.


south of the city, in which are grown quantities of the salads,

cauliflowers, and other vegetables supplied to the city. One effect

of these and such-like arrangements is the universal occurrence of

round worms " among the native population, and here too we have

all the necessary antecedents for the propagation of enteric fever and



(To be continued.)




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