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 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 Palestine belongs to the sub-tropical

zone, and lies farther south than not only every part of Europe but

also of most of Morocco and Algiers, of all Tunis, and of the whole

of the United States of America with the exception of Florida and

parts of Texas and Louisiana. The latitude of Jaffa (32° N.) is

practically that of Amritsar in India and Shanghai in China. More-

over, in the great central rift of the Jordan Valley the climatic

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 Jerusalem,

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



HYGIENE AND DISEASE IN PALESTINE.                      57


Jordan Valley at Tiberias (P.E.F.) and at the Jewish colony of

Melhamiyeh. The rainfall in the Maritime Plain is less than in

Jerusalem--perhaps about 25 per cent. less--and that in the neigh-

bourhood of the Lake of Galilee still less. Fortunately, these

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 Western Palestine. On the edge of the eastern plateau

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 Jerusalem, the water

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 Jerusalem,

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




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 Jerusalem. From this pipe the inhabitants of the city are

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-

salem on the Jerusalem-Jaffa Railway. European residents were

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 PALESTINE.                      59


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

Jerusalem, who were digestively upset by drinking from the beautiful

springs of Nablus, the water of which is very hard from a high

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 Central Palestine, and in much of

the higher lands east of the Jordan, the winter months are bracing,

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 Jerusalem, Hebron, and such

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 Jerusalem during the

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 Jerusalem is 71°•6, in the Plains 76°•9, and by the

Jordan 91°, but this hardly conveys an idea of the actual heat

experienced. The mean of the maximum temperatures in the shade

of the four hottest months is 84°•3 in Jerusalem, 96°•4 in the Plains,

and 112°•5 at the Jordan. In Jerusalem itself, though temperatures

over 90° are common in the summer, temperatures over 100° are


The heat in the higher parts of Palestine is much mitigated by

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,




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 Palestine as a whole, for those who do not mind a fairly

high temperature in summer, the clear pure air and cloudless sun-

shine are very enjoyable. Compared with Egypt the highlands of

Palestine enjoy a better summer climate for Europeans, though

falling far short of some parts of the Lebanon. But even so, in my

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 Jerusalem, trying to the

nervous system. In winter the coast and the Jordan Valley, e.g.,

Tiberias and Jericho, are delightful; the latter, however, for three

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 Dead Sea water beneficial

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 Dead Sea from 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 Palestine will recognize the value of these sites

for the sick, and make arrangements that they may be used to full

advantage under proper medical supervision.


HYGIENE AND DISEASE IN PALESTINE.                      61


The question may well be asked at the present time how far has

Palestine a climate suitable for Europeans wishing to make perma-

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 Europe for a period of

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 Jordan Valley is quite unfit for European families.

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 Jordan Valley, e.g., round Jericho, etc., the actual manual

labourers should, I suspect, be of negro stock, as are so many of

the people there to-day.


CHAPTER III.--The Common Diseases of Palestine and Syria.


The most characteristic and important of the diseases of Palestine

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 Jerusalem, especially in late summer.

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,




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 Jordan Valley.

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

Palestine, all of which are probably malarial-parasite carriers, viz.,

Anopheles Maculipennis (the common Anopheles of Jerusalem), Pyreto-

phorus Palestinensis, Pyretophoris Sergentii (only as yet identified in

Galilee), Myzorhynchus Pseudopictus (common in the Huleh marshes),

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 Jaffa and at many places

on the coast, especially around Caesarea and the neighbouring

district, such semi-stagnant pools occur in numbers. In Jerusalem,

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 PALESTINE.                      63


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 Jerusalem at any rate, to a minimum

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 Jaffa or in the upper end of the Jordan

Valley. In some years the disease has assumed a great virulence and

the mortality has been very high. Even in Jerusalem cases occur

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




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


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 Europe.

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 Palestine since

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 PALESTINE.                      65


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 Egypt or Constantinople

for treatment by the Pasteur method, and just before the war the

“International Health Bureau” established a small "Pasteur Insti-

tute" in Jerusalem, but the fellahin have but little belief in any

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 Palestine and

Syria to-day is Tubercle. The increase in tubercular disease in the

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 Syria, in the mountains

north of Beirut. The increase in phthisis is no doubt partly due

to the great number of cases of this disease which have been sent

to the land from other countries. Jews from Russia, so infected,

used constantly to arrive, advised by their doctors to try the pure

air of Syria. Doubtless, too, many dwellings become riddled with

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




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 Palestine are for the treatment of such conditions.

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 Palestine not more,

perhaps, than 250 lepers, most of them segregated in Jerusalem,

Ramleh, Nablus, or Damascus, where they live in houses provided

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 PALESTINE.                      67


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

Moravian Leper Hospital in Jerusalem.

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-




like" human parasites in Palestine. Wounds and “running ears” not

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 Central Asia.

With regard to non-tubercular Lung diseases, spasmodic asthma

is very prevalent in Jerusalem; pneumonia is a common cause of

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 Europe. Sarcoma is found in all classes.

Congenital deformities--club feet, cleft palate, hare-lip, abnormal

numbers of fingers and toes, etc.--all occur much as in Europe.

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 “Aleppo button”--is extremely fre-

quent in Aleppo and its neighbourhood, and also at Baghdad; but

cases of this disease in Palestine are almost always from these

localities. The writer never saw a genuine case which originated in

Palestine. There is a peculiar eruption known as the "Jericho boil,"


HYGIENE AND DISEASE IN PALESTINE.                      69


which is common in the summer months in the neighbourhood of

Jericho and among some of the bedawin living near the Jordan.

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 Holy Land. The great majority of the cases of blindness are

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 Europe) is exceedingly

rare in Palestine.

       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 Palestine is ascribed by the

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

Europe. Four bacilli have been identified as commonly occurring-

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, Butler) which

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




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 Jordan Valley

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 PALESTINE.                      71


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 Jerusalem, but is now rapidly passing out of fashion. The

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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