Herodotus wrote that Egyptians of about 1000 BCE were the healthiest of all civilized people. Both the Hebrews and Greeks benefited from Egyptian science. The Hebrews extended hygienic thought, which is formulated in Leviticus, while in Greece geometry developed. So did rationality. Asclepios and his disciple Hippocrates, father of Western medicine proclaimed: we have an opinion, let’s discuss it, if the evidence warrants, let’s change it. It was a time of philosophy and of health, in both mind and body with a premium placed on personal hygiene.
My first stop is the Hellenic School of Public Health on what I hope is an entertaining and thought provoking, step by step tour over historical time and geological space, into humanity and down trails of human chaos. The Hellenic School was founded in 1929 and its logo is the daughter of Asclepios, goddess of health. The words inscribed on its original parchment were: In the absence of health, life suffers.
My final destination or end point will be the difficult present.
The Hellenic School should have got underway because of endemic malaria and the many scourges that tormented the Greek people as described by a Polish bacteriologist, Ludwig Rajchman of the League of Nations. Rajchman were satirized as ‘Doctor Darling’, head of ‘the bureaucracy’ which portrayed the Rockefeller Foundation. It was written by the fascist author Celine (Louis Ferdinand Auguste Destouches) a doctor who worked for the League of Nations.
In 1929, the League judged Greece to be unsanitary and dangerous, a place where tuberculosis sufferers were “abandoned” to their fate. Reading Dickens, the poor houses of England were no better. Many Victorians resisted both sanitary reform and slum clearance. The straw that broke the camel’s back was a bizarre pandemic of dengue fever entering Greece from Syria via Beirut and the Hellenic School was born.
Dengue came soon after the forced resettlement of Greek refugees from Turkey in 1922, which is known as the Asia Minor Disaster. The refugees met with dysentery, typhus, and hunger. Many died on route, aboard ship. Typhus lurked in all Greek ports and in most cities. Dengue’s morbidity was 80% and mortality 6%. Doctors closed surgeries, theaters shut down, and judges deserted the bench. The draft was suspended and trains and trams came to a standstill. Provisions into Athens fell to a trickle. To reduce panic, news of dengue was kept to the back pages of newspapers. The Prime Minister, Eleftherios Venizelos was hospitalized for 10 days. Greece was brought to its knees while panic surfaced in European capitals and they called for tighter measures of control.
Dengue fever petered out with the construction of municipal water supplies, construction of better housing, and with improved sanitation to alleviate crowding for repatriated Greek refugees. At the time 75% of the working population lived in a single room. This sends out a clear message with respect to the housing of migrants. The “hot spots” place an increased burden on health and social services. In parallel, the internal and external sanitary shields are weakened. the current hot spots mimic sanitary conditions of the past in Greece and it should not lose sight of new and older threats from zika, malaria and dengue.
In between 1929 to 1933 and in concert with the international community, Greece kicked off a short-lived and politically driven public health revolution. It has been dubbed the “four golden years”. the health status of the Greek population slowly climbed, domestic life improved and by 1970, life expectancy had gained 20 years and infant mortality dropped dramatically; the Athens School was a major player in this achievement. In 1974, Constantine Karamanlis having gained insights into public health while exiled in France made the revitalization of the Athens School a priority. He effectively raised the School from the ashes of the dictatorship.
The situation in the Balkans was equally bad. In his Farewell to Salonika, Leon Sciaky tells us that we cannot return to the past and speaks through personal grief of leaving the city of his birth, a city where his Sephardic family had lived and thrived for centuries after expulsion from Spain in 1492. He reflects upon the hatreds and fratricidal conflicts spanning the 20th and 21st centuries. Greed and selfishness bring harm and ignorance condones it, he says. They stir primordial ooze in a clear pool. He saw distress, poverty, and insecurity in his old world and speaks of humanity crucified. He lived its sufferings, in a multicultural coexistence and the wider background of crumbling economies and the failing Ottoman Empire. It was all a result of its rulers. In America, he felt the freshness, youthfulness, and boldness untrammeled by the decaying traditions of Europe. But for the rest of his life he remained uncomfortable with what he saw as the encroachment of machine civilization on the ways of his oriental city.
The situation in the Middle East was worse than in Greece. It was one of locust clouds, famine, bombardment, and cultural insensitivity. 25% of the population perished in Greater Syria from starvation and disease. What we in Europe call World War I is known as Seferberlik in the Middle East and the Ottoman round up of cannon fodder. Seferberlik is a metaphor for suffering, pestilence, famine, and exile and means “to travel across the land”. In the Middle East, the big powers in just a few years undid much of what had been achieved in a multiethnic co-existence. Infectious diseases in the Suez Canal had to be monitored and the League of Nations hired Health Officers to monitor ships. One of those officers was French Canadian Felix d’Herelle (1925) who worked in the Pasteur Institute. He entered the public imagination in the book, Arrowsmith by Sinclair Lewis and only just escaped execution by Beria in the Soviet Union.
In The Grapes of Wrath, John Steinbeck reminds us that America was not removed from dust bowls and the displacement of populations. He wrote “car-loads, caravans, homeless and hungry moved west; twenty thousand and fifty thousand and a hundred thousand and two hundred thousand. Dispossessed, they streamed over mountains, hungry and restless - restless as ants, scurrying to find work - to lift, to push, to pull, to pick, to cut - anything, any burden to bear, to obtain food. The kids were hungry with no place to live…" It was the time of the Great Depression.
The earlier work in public health by Wickliffe Rose an officer of the Rockefeller Foundation added a degree of resilience to society in the American south. Rose created the first system of education in the southern United States and helped establish a Center of Public Health in Cuernavaca, Mexico. He targeted rural health and the eradication of hookworm in the southern states. Concerns for rural health were a common denominator between him and Stampar.
With the collapse of the Ottoman Empire forced population movements occurred; Muslims were driven from Europe; Christians were expelled from the shrinking Ottoman Empire. The Nobel Prize winner Ivo Andric in Bridge over the Drina lets a bridge tell the fascinating story of the multicultural Ottoman Empire. It ends with Austria crossing into Bosnia and over the Drina taking measurements, counting things, putting in street lighting all to the bewilderment of the people.
Byzantium crumbled under Crusader and Ottoman pressures; boundaries and populations shifted; the Albanian line of castles on its western seaboard collapsed. Black Death was a boon to the Ottomans since it significantly reduced the European population and weakened its resolve and the Ottoman breath filled Europe with “miserable fear” according to Wordsworth. Black Death came down the Silk Road in 1347 from China to enter Europe through the Crimea. As a result of the Crusades quarantine measures were introduced in Ragusa, in 1377. They constitute a historic landmark in public health administration and epidemiology.
Byzantium has fascinated many; Yeats the Irish poet would have liked to live in Constantinople at a time just before the building of St. Sophia by Justinian. In “Sailing to Byzantium” he would have found a little wine shop and talked to philosophers who would answer all his questions, probably in Greek. Even so, Justinian in his assault on paganism closed the Academy of Plato and banned all Athenian freedoms of thought. Athens was relegated to the periphery and Christians vandalized the sacred place of the Acropolis. It was a time of transformation from pagan medicine of the Asclepiads to Christian charity. The goddess Hygiene, daughter of Asclepios lost ground; the Olympic Games were suspended. It was also a time of transformation from paganism to monotheism, many gods to the one true god.
Long before Islam’s rise and well before the Crusades, Justinian ran into the Plague. One third of the inhabitants of Constantinople and one quarter of the total population within the Empire perished. It affected half the population of Europe and the outbreak continued for more than 200 years. In spreading to England it dramatically affected Lindisfarne, a great Christian center of learning, resulting from an amalgam of paganism and Christianity. It consisted of Anglo-Saxons who brutally pushed their way north to NorthUmbria after Rome’s withdrawal, as well as Celtic Christians from remote reaches of Ireland and missionaries from Rome who came with St. Augustine. Augustine landed in the Kingdom of Kent, to influence Canterbury.
Christianized peoples disenchanted with the one new god which gave no protection from the Plague fell back on paganism. An earlier event in Alexandria showed the destructive tension between paganism and Christianity. It happened when Christian charity ran amok in the form of a mob encouraged by the Patriarch. Hypatia, pagan mathematician astronomer and philosopher was viciously killed (415 AD) by the so called Christian caregivers the “parabalani”, recruited by Patriarch Cyril to wipe out dissident pagans. Somewhat earlier, Nero fiddled while Christians were persecuted.
The article continues on the 16th of June.
The New York Review of Books
Leon Sciaky, Farewell to Salonika, HAUS Books, 2007 (Given to me by Barbara Schwepcke, publisher)
Ivo Andric, Bridge over the Drina (Sent to me by a distinguished Serbian surgeon)
Maureen O’ Sullivan, The Four Seasons of Greek Philosophy, Eftathiadis, 1982
Jan Morris, The Oxford Book of Oxford, OUP, 1978
Jeffrey Levett, A besieged lighthouse nears 80, Athens News, 9 April, 2009
Maria Mandyla et al. Pioneers in the anti-malaria battle in Greece (1900–1930) Gesnerus 68/2 (2011) 180–97
Jeffrey Levett, Tuberculosis and the Athens School of Public Health Acropolis Museum, Lecture, 2011
The Road to Dignity by 2030: Ending Poverty, Transforming All Lives and Protecting the Planet, UN Secretary-General Report