Trial by Virus: Colonial Medicine and the 1883 Cholera in Egypt

Abstract

Trial by Virus: Colonial Medicine and the 1883 Cholera in Egypt Christopher S Rose Introduction On June 22, 1883, consular health authorities in the Egyptian port city of Damietta contacted the Maritime Health and Quarantine Board at Alexandria with the news that cases of severe gastritis ending in fatality had been reported.2 These were telltale symptoms of cholera, a highly contagious and lethal disease whose appearance in one of the main ports serving ships transiting the Suez Canal would be a cause for concern. A multinational commission was dispatched and confirmed the grim news: cholera had returned to Egypt after an eighteen-year absence. Although the appearance of cholera was never welcome, it appeared at a particularly delicate time for Egypt; Great Britain had invaded the previous year to suppress an anti-government revolt and had restored the Khedive Tewfiq (whose government was indebted to British and French banks) to the throne. The 1883 epidemic was a trial by fire—nay, trial by virus—for the Anglo-Egyptian government, which had been established less than a year earlier. In this article, I show that the approach taken by the Anglo-Egyptian government’s response to the cholera outbreak represented a shift in imperial attitudes toward the control of epidemic disease, layered upon imperial attitudes regarding health, hygiene and care of the body in a colonial setting. Over the course of the nineteenth century, the Egyptian state had invested substantially in health to boost the nation’s economic and military strength, and to address European concerns about the potential for diseases to be transmitted along trade routes. In the process, a certain amount of negotiation was required with the Egyptian population as consumers of medical services, regarding how treatment would be delivered, by whom, and where. During the 1883 epidemic the new Anglo-Egyptian administration introduced new policies and attitudes about what constituted modern medical practice, the appropriate relationship between medical provider and consumer, and the ways in which the consumer was expected to behave. I argue that this is a key moment of transition in which public health in Egypt came to bear the hallmarks of the paradigm known as “colonial medicine,” in which personal hygiene practices and the acceptance of medical care were seen as necessary markers of modernity and progress—even when such restrictions came at the expense of nearly fifty thousand Egyptian lives. Imperialism and health in Egypt It is something of a cliché in Egyptian history to begin the narrative of the “modern” period with the three-year partial occupation by the French army under Bonaparte (1798–1801). While it is no longer universally accepted that the French incursion represents a definitive rupture from the Ottoman/Mamluk past, the multivolume Description de l’Egypte produced by the French expedition containing descriptions of health, medicine and pharmacology at the turn of the nineteenth century, albeit filtered through an imperial lens, remains a useful benchmark against which to gauge subsequent developments in public health over the course of the nineteenth century.3 Laverne Kuhkne, whose Lives at Risk remains one of the key surveys of Egyptian public health prior to the British period, has observed that, Metropolitan French condescension aside, the level of health services available in Egypt in 1800 was probably comparable to that of contemporary rural France, in that both were fairly rudimentary and quality care was largely restricted to elites who could afford to travel to seek care or hire a private physician.4 In the 1820s, Egypt’s Ottoman viceroy Mehmet Ali (1805–1848) contracted a Frenchman, Antoine-Barthélémy Clot, to develop a military health service following a devastating outbreak of plague, and a high incidence of syphilis among enlisted men serving in Syria. Clot insisted that military and civilian health were intertwined, and oversaw the creation of medical corps intended to treat both populations, educated at two medical schools—one for women—whose graduates were sent to work in a network of hospitals, clinics and dispensaries throughout the Nile Valley.5 However, Clot’s rigid insistence on Europeanizing medical practice in Egypt ran into its first obstacle when the national medical corps, accompanied by military officers and sent into the...