236 A Short History of the Middle East
than in the Levant, though an acute epidemic in Upper Egypt in
1942-3 caused scores of thousands of deaths among the under-
nourished villagers. Its place as a major debilitating disease is taken
by the endemic worm-diseases contracted as a result of insanitary
habits of excreta-disposal. Three-quarters of the whole population
are estimated to be chronically infected, with a greatly lowering
effect on its vitality. The incidence of these diseases is believed to
have been considerably increased by the great extension of peren-
nial irrigation with its thousands of channels, from which the
fellah, working bare-foot, is reinfected as often as he is
cured.1 Another major scourge is the eye-disease of trachoma,
estimated to affect 90 per cent, of the population of Egypt
and a large proportion of those of the neighbouring countries,
with consequences ranging from impaired vision to total
blindness.
The public-health services of the Middle Eastern countries,
especially those least subject to European direction or advice,
naturally reflect the wide social gap that separates the professional
class from the masses, and the small extent to which the former
have as yet acquired a sense of service to the community as a whole.
One is left with the impression that the health-services of the inde-
pendent countries are designed for the benefit of the medical pro-
fession rather than for the healing of the sick. In the capital cities
there are government hospitals with imposing buildings and well-
equipped laboratories. The provincial capitals are equipped on a
more modest but similar scale; but even in the largest hospitals the
standard of nursing tends to be unsatisfactory, sometimes even de-
plorable, because the sense of service and duty is wanting; and the
great majority of medical men and women produced by the
training-schools, 'including nearly all the best, are inevitably at-
tracted to careers in the towns, so that the towns tend to be over-
doctored and the rural areas left with few or no medical men.. . .
The spirit of service and public responsibility, which is usually
associated with the medical profession, is wanted in the Middle
East even more than technical advance/2
Since 1939 increased consideration has been given to the raising
of the economic standards of the Middle East. There was first of all
1 Worthington, op. cit., ISO L
2 Worthington, op. cit., 174 ff. Some 60 per cent, of the doctors in Persia are
stated to practise in Tehran (E. M, Hubback, in Spectator-, 20 June 1947.)