I have witnessed scenes of suffering, both in the United States and the Orient, but never, to my dying day, will I be able to dismiss from my mind the horror of the pinched, haggard faces and forms that gathered about me that first day. Before we left the tent one of the doctors said: “We will now see the place is full of walking skeletons.” This expressed fully their condition. Just imagine a place having a normal population of 12,500 living all told in 1403 houses, you can see there is not much cubic space to spare; then imagine 7000 or more refugees to be provided for in the town also. Some of the Zeitounes gave shelter to a small number, but the greater majority lived on the street, under the houses, in many instances too vile to be of use to its owner; in cow and donkey stables with the animals; in spaces in close proximity to water-closets; in fact not a place that even suggested shelter was unoccupied. The smell and presence of human excrement were everywhere, and this, added to divers other odors, made the air a fit place for the culture of disease germs. So much for the hygienic conditions of the place.
Diseases.—I regret that I am unable to give the exact number of those afflicted with each individual disease; to ascertain this would have taken too much valuable time. We found it a difficult task even to make a true estimate of the number ill with acute diseases. Our first estimate sent you, viz., 1400 dysentery and diarrhœa, 600 typhus fever, afterwards proved nearly correct, i.e., if we take about three hundred from the typhus and add to the dysentery. These were acute cases. Of the refugees, ninety-eight per cent complained and were treated for diseases such as chronic dysentery, diarrhœa, dropsy (usually those recovering from typhus), rheumatism, bronchitis, dyspepsia, malaria; all were suffering from anæmia and debility.
Causes.—Overcrowding and bad air; but that condition bordering on starvation was the principal cause of all the sickness. I should add, many of the cases of diarrhœa were caused from eating a soup made from grass, weeds, buds and leaves of shrubs and trees. In fact anything green that could be gathered in the fields was boiled in water to which a small quantity of flour was added. This diet was especially dangerous to children.
Treatment.—We were soon convinced that if we expected to gain the upper hand of all this sickness and save even a remnant of the refugees, we must first feed the sick, and then when they were well—to give the former every possible chance to get well, and to prevent the well from becoming ill. Second, we must try in every way in our power to get the refugees to return to their homes, or at all events to camp out in the fields. The first day we filled the hospital opened by Consul Barnum with cases off the street, and from that time on we increased hospital facilities as fast as possible. We engaged two men and one woman to care for the hospital; four interpreters and one assistant for the pharmacist. We then divided the town into districts so as to systematically get at every sick person. Then we hired (for we could get nothing without a system of bargaining as to price) two large copper kettles used to make grape molasses, and purchased two hundred pounds of beef and made a strong, rich soup. We then strained every nerve to get a soup ticket into the possession of every sick person. We did not waste time by trying to cull out the impostors; in fact there were very few of this class, all the refugees were needy and hungry. The second day we added three kettles, and to supply the number we served at ten o’clock clear meat broth; at four o’clock thick soup of beef and rice. By the end of the third day every sick person was receiving food. Then all complaints of vomiting the medicine ceased.
The problem then to be met was—how to get the people to go outside the town. We suggested that if they would, we would place a soup kettle out in the open fields to the south, north and east, and in addition to the soup we would give them flour. This had a very decided effect, for one thousand went the first day. The moving continued until every person living on the streets and in cow stables had built for himself shelters of twigs and leaves. Now the butchers saw a chance of applying the plan of putting up the price of meat from seven to fourteen piasters per oke (2¾ pounds). But we had anticipated this and sent men to a friendly Moslem village to purchase cattle. So their scheme failed. By the end of the second week there were no hungry people in Zeitoun.
Results.—The typhus cases began to recover, the new cases took on a mild form, the same could be said of dysentery. The new cases of both became less and less until they almost disappeared. The most marked improvement was the rapidity which the daily funerals in the three burying grounds decreased. I watched these places with deep interest, for they were a thermometer to gauge the success of our work, and it was with deep gratitude to God that we saw the daily burials reduced from fifteen to none. So much for the acute cases. The first week the chronic cases took the entire time of one doctor, each taking our regular turn. Tonic treatment and food so reduced the number that sixty became the daily average at the end of the second week. At the end of the third week, fell to ten. Our pharmacist, Shickri Fakhuri, proved, as he always has, a jewel. His hands were full to prepare the prescriptions of three doctors. At first it was necessary for one of us to give him assistance of an hour or so daily. On the twentieth of May we felt we could leave the town free of acute typhus and dysentery. We gave to the committee selected by Mr. Macallum, funds enough to keep the soup kettles going for one week, and 200 liras ($880) worth of flour, which would suffice for at least six weeks, and by that time it was hoped that all the refugees would have departed for their homes.
On our return to Marash we remained four days superintending the work of relief of the native doctors, and performing surgical operations. We then started for the coast. We chose a shorter and less expensive route than that by which we came. We were able in several places on the road to give needed relief, although to a limited amount. The lessons learned by our experience have been many:
1. The value of keeping well, for obviously, success depends upon this. It is evident to us the way to reduce the danger of infection to a minimum for medical men, is to eat and sleep outside the infected town. This plan may present difficulties, but if possible, it is best. The dreadful mortality among doctors and nurses in the epidemics of typhus fever is well known. The query is, could not this mortality be reduced by the plan suggested? It proved so in our case at least.
2. The food supply is of first importance, especially for epidemics caused by lack of food.
3. The utter worthlessness of medication without it.