Covid-19 has already altered medical practice forever but, thinking back, there’ve been many changes in medicine over the years. Most have been more gradual than the ones made necessary by this pandemic, but no less dramatic. The NHS care that I practise, and receive, is far removed from the care I experienced as a child growing up in Egypt.
Antibiotics were few back then, and usually given by injection with a freshly boiled syringe and a reusable needle. I can still feel the cold oily pain of penicillin as it inched its way from my bottom down my leg.
Penicillin was better absorbed in this way than by mouth. There was also a trend of sparing a patient’s delicate digestion, hence the usual recovery diet of rice with boiled chicken, as recommended by every doctor. If the patient ran a fever, suppositories were deemed preferable to a couple of Aspro.
The French occupation of Egypt may also explain how often the middle and upper classes suffered from liver complaints. “C’est de la bile, chérie.” At least bilious attacks can be genuine. A tired liver or le foie fatigué isn’t even a real diagnosis.
Injections of vitamin B12 were popular in the mid-20th century, and not just for cases of proven deficiency. The impressive bright red colour of B12 flowing into a vein could hardly fail to make the patient feel better, never mind what was actually wrong with her.
The divide between haves and have nots dominated every aspect of life in Egypt. With no national health provision, the poor died young, blindness from trachoma was common, and amputees were everywhere.
If you could afford one, your family doctor would visit whenever requested, often with a cigarette in hand as he puffed his way upstairs. Once he extinguished it, he would examine the patient. As he usually wheezed more than the patient, I’m not sure he heard much through his stethoscope.
What medicine lacked by way of treatments back then was made up for by personal attention, much as alternative medicine still functions today. A little baksheesh to the receptionist ensured that you got seen ahead of others in the waiting room. It seemed unfair to me then, as a young child, and it was even less fair that most of the grownups around me couldn’t see a problem.
It’s almost incomprehensible now, but polio was a scourge that went back thousands of years. With outbreaks of paralysis among young children every summer, no wonder we all feared it. Jonas Salk’s polio vaccine didn’t come into use in the Middle East until the late 1950s. For some reason, both doses were injected into the back (not the buttock or thigh). The prospect made me run off into the garden where I promptly fell on the gravel. The two skinned knees and two grazed elbows actually hurt for longer than the polio jab. I’m pleased to say that the Salk vaccine, followed by Sabin oral vaccine, began the long road towards conquering polio worldwide.
According to hieroglyphics and papyruses, bilharzia was known to the Ancient Egyptians. The flatworms that cause the disease are water-borne, with a complicated life cycle that involves freshwater snails as an intermediate host. Bilharzia causes a heavy burden of ill-health, especially for rural children who paddle (and piddle) in the Nile or in one of the many canals. And yet, despite the toll on the population, many people living a comfortable life in Alexandria or Cairo 50 years ago had barely heard of it. The best remedy is prevention with clean water and good hygiene, so the story continues.
Although my forthcoming novel The Girls from Alexandria isn’t a book about medicine, you’ll find many aspects of a cosmopolitan world that has long since ceased to exist.