WINTERING IN EGYPT BY FREDERICK PETERSON, M.D. CHIEF OF CLINIC, NERVOUS DEPARTMENT, VANDERBILT CLINIC, COLLEGE OF PHYSI- CIANS AND SURGEONS, NEW YORK Reprinted from the Medical Record, August 20, 1892 TROW DIRECTORY, PRINTING AND BOOKBINDING CO. 201-213 East Twelfth Street 1892 NEW YORK WINTERING IN EGYPT BY FREDERICK PETERSON, M.D. CHIEF OF CLINIC, NERVOUS DEPARTMENT, VANDERBILT CLINIC, COLLEGE OF PHVSI- CIANS AND SURGEONS, NEW YORK Reprinted from the Medical Record, AijgMst- to. *892 NEW YORK TROW DIRECTORY, PRINTING AND BOOKBINDING CO. 201-213 East Twelfth Street 1892 WINTERING IN EGYPT. There is probably no other country in the world so delightful as Egypt for a winter sojourn. It is equally fascinating for the traveller in search of recreation and for the invalid in quest of health. One is placed in an environment at once tonic to the mental and physical organization. The western mind, whether healthy or morbid, is certain to be both pleasantly impressed and deeply stirred on beholding strange races, curious cos- tumes, oriental manners and habits, Saracenic architec- ture, a land of deserts, oases, palms, and the river Nile, a land abounding in magnificent monuments of an ancient civilization, and over all of which hangs unchangeably a vivid, cloudless, splendid sky. Change in itself is always a tonic, strong in a direct ratio to the amount of novelty, and where this therapeutic agent is indicated in its most powerful form, Egypt must be the prescription. For the invalid Egypt has remedial qualities which are entirely her own, and not to be found elsewhere, modes of life which are restful, peculiarities of climate which are unique. It must be taken into consideration, too, that this desirable resort is not so far from our shores as it may seem, and that the time of travel is being gradually reduced. Alexandria is five or six days from London. It is but twelve to fourteen days from New York (North German Lloyd to Genoa eight to nine days, rail to Brindisi one day, P. & O. steamer to Egypt three days; or, to Paris eight days, rail to Marseilles fourteen hours, French packet to Alexandria four to five days. Egypt is a narrow green ribbon of land, with the Nile, not 4 as broad as the Missouri River, flowing through it, and endless stretches of desert on either side. These thou- sands of square miles of barren dry sand rob the air of most of its moisture, dissipate clouds and prevent rains, and completely sterilize the atmosphere of pestiferous germs. The climate of the Delta is not treated in this article, because no part of it can be considered a health-resort for Americans or Europeans (many residents of Egypt spend their summers at Ramleh or Alexandria), and be- cause it differs materially from the rest of Egypt. For instance, Cairo, which lies at the upper angle of the Delta, has twelve rainy days in the year, while at its other extremity, Damietta and Alexandria, rain is still more frequent. Interesting and charming as Cairo is to most people, it is not here that the invalid should take up his winter residence, although he may make it his headquarters from which to depart on his various excursions. The general sewer system of Cairo is in very bad condition, but those of most of the hotels are good. The mortality of Cairo is extraordinary, almost equal to that of Madras. The Cairo death-rate is 46 in 1,000; Madras, 48 ; Paris and Berlin, 23.50; London, 17.4. In winter one may spend some very miserable, cold, damp days in Cairo, for the hotels are rarely provided with means of heating the rooms, and few of them have a sufficiency of cham- bers with a southern exposure. I experienced about Christmas time, last year, four most uncomfortable rainy and cold days in succession in Cairo, and suffered more from it than one winter month in Florence, some years ago, treasured up as one of my bitterest memories of disillusion in sunny Italy. SeasOD.—The season for tourist or invalid is the seven months from October to April, inclusive, but one may remain through May without discomfort. The other months are objectionable because of the heat and the inundation of the Nile. 5 The seeker after health has one of three courses open to him on reaching Egypt. He should either go into winter quarters at Helouan, Gizeh, or Luxor—take a da habeeyeh voyage up the Nile for three or four months, or go on camping excursions in the desert. This last sug- gestion will be a novel one, I think, to the European phy- sicians who send patients to Egypt and to the physicians residing there, but it was very apt to occur to an Ameri- can physician, familiar with some of our tent hospitals and the benefits to great numbers of invalids, especially consumptives, of camping trips in our Rocky Mountain regions. Camping has advantages in Egypt, too, that are never to be obtained in America, the absolute certainty of warm sun and rainless days, and the means of carrying any quantity of necessities and luxuries in the way of edibles and household furniture. Before describing specifically these courses, however, it will be well to consider the climatological features of Egypt in detail. Most of the observations at our com- mand have been made at the Khedivial Observatory at Cairo, and while these answer fairly well for Helouan and Gizeh, which are in the immediate neighborhood of that city, there are unfortunately no elaborate records as yet available to throw light upon the climatological con- ditions at Luxor, four hundred and fifty miles farther south, or out in the desert at various distances from the Nile Valley. Dr. F. M. Sandwith, of Cairo, in his admi- rable book, “ Egypt as a Winter Resort,” has made a careful study of the observatory records, and also of such others as have been communicated by physicians in their journeys up the Nile, and to this book I am mainly in- debted for the following statistical facts as to the Egyp- tian climate—where it seemed to me advantageous for the reader. I have introduced figures for comparison with other health resorts. Elevation above Sea-level.—Helouan, Gizeh, Cairo, ioo to 200 feet; the Mokattam Hills, just back of Cairo, 600; Luxor, 292. 6 Temperature.—The Cairene isothermal line runs be- tween Algiers and Santa Cruz, and Florida and Canton. Freezing-point is never reached in Cairo, but absolute minima of 350 and 36° F. were noted on two nights in January, 1887 and 1888, respectively. The desert is sometimes piercingly cold at night, as 1 found in a camp- ing trip to the Wadi Natroon. Water in a shallow dish will occasionally freeze on exposure to a desert night wind. The thermometer readings for the seven season- able months may be best judged by reference to the fol- lowing table (Fahr.) : Mean of Maxima. Mean of Minima. Mean of Means. October Degrees. 84.O Degrees. 64.8 Degrees. 74-3 November 74.2 56-3 64.4 December 67.7 5°-4 58.4 January 61.4 46.6 53-6 February 65-3 4S.8 S7-o March 73-2 S3-o 62.8 April 81.2 59-9 70.4 Rainfall.—Cairo, a trifle over one inch annually, dis- tributed over twelve to fifteen da>s of the winter months. The same figures for Helouan and Gizeh. At Luxor it is not quite true, as has been facetiously stated, that “ it rains only once in 4,coo years,” but rain is so rare a phenomenon that the date and duration of a shower are carefully recorded, not only by Luxor residents, but by transient travellers, as an extraordinary experience. Showers were noted once in 1878, once in 1882, once in 1887 ; and Dr. Boase remarked a three-minute rain in 1888. It is interesting to compare statistics as to the annual rainfall in various resorts, although this is not as impor- tant as to ascertain the number of cloudy and rainy days at any health station during the season. 7 Annual rainfall in inches. Number of rainy days during sev- en months ; win- ter season. Luxor Minute fraction of inch, if any. Usually none. Cairo i 12 Hy£res 33-50 32 Algiers 32 71 (six months) Pau 43 50 (six months) Nantucket 45 91 Aiken 46.48 41 (six months) Jacksonville 55-93 72 Denver 11.41 39 Los Angeles 13-13 45 White Mountains 5o 87 Dew.—In Lower Egypt, along the Nile, and in the desert near the Nile, dews are always present, so that walking in the green fields at night, and up to nine o’clock in the morning, is unpleasant. At Luxor and the First Cataract, dew is almost unnoticeable. Humidity.—The most valuable feature of the Egyptian climate is its dryness. At Cairo the relative humidity is least in June (44), and the annual average relative humidity is 58.4 ; but for the seven months during which Cairo is frequented by invalids, the average is higher, 63.2 (London over 90 in winter). This I base upon Dr. Sandwith’s table from the Observatory records for five years. It must be remembered that this Observatory is situated near the river and at the apex of the Delta. Often, even at Cairo, the humidity on individual days is phenomenally low, for instance, down to 3 one day in April, 1887, and once 4 in March, 1888. These figures apply also to Helouan and Gizeh. As regards the hu- midity at Luxor, there are as yet but few figures at com- mand, but fxom such as have been taken, we learn that the air there is much dryer than at Cairo, the average being twelve to fifteen per cent. less. Thus far no ob- servations as to this important particular have been made 8 in the desert proper, remote from the Nile. Undoubtedly there the humidity is still less, probably the least of any place in the world, and it is to be hoped that desert records will ere long be made. The following table will illustrate the difference in mean annual humidity of vari- ous places in the world. Luxor 50.5 Cairo . 58.4 Greenwich 87.0 Algiers ... 70.7 New York 73.0 Aiken (Geddings) 64.04 Asheville, N. C. (Gleitsman), 70.10 Mt. Washington 86.00 Florida (Jacksonville) . .. 68.00 Adirondacks (Skinner)... 70.5 Air-pressure.—The barometric readings at the Khe- divial Observatory for five years, show an average of 29.86, never above 29.99 in any month. Comparing this mean air-pressure with some other health-resorts we have : Cairo (Sandwith) 29.86 Nice (Collier) 29.60 Hyeres (Cormack) 30.16 Clouds.—Not infrequent at Cairo. In the desert and at Luxor, almost unknown. Winds.—The prevailing wind at Cairo is from the north ; in January, however, from the southwest. The average force in miles calculated by the anemometer is 2.9 for the year, but for the seven winter months it abated to an average of 2.3. At Luxor the prevailing winds from November to March, inclusive, are southwest, northeast, and north- west, and the average force in miles for these five months is exceedingly low —.9. None of the winds in Egypt are uncomfortable or dangerous, like the fohn, mistral, sirocco, and solano, of soma other resorts, with perhaps the exception of the khamseen. Khamseen is the Arabic word for “ fifty,” and the wind is thus named because it is apt to blow 9 during some of the fifty days following Easter Monday. The number of khamseen days in a year varies from 4 to 20. It blows for three days as a rule, but may continue longer. It is very dry and hot, and the air is commonly loaded with fine sand. It comes from the south or south- west. I experienced one day of the khamseen in the Lybian desert while travelling by camel in a small caravan, in January last, but did not find it very uncomfortable. According to Dr. Sandwith, “ the general effects are a little excitement and stimulation of the system, a more rapid succession of ideas, and increased action of some of the functions, followed by listlessness, headache, and languor.” Water-supply.—The water of the Nile, or of wells in the Nile Valley, is, of course, used altogether by the resi- dents. Visitors often drink nothing but bottled waters, such as Apollinaris and Giesshiibler, but with proper filtration there is no water in the world superior to Nile water for drinking purposes. The Cairo water company filters its water. Every dahabeeyeh and steamer on the river, and every house in Cairo, and other large towns, is supplied with huge earthen jars, through the bottom of which the water filters pure and glistening drop by drop. This is on the same principle as the Pasteur filter now coming into general use in America and elsewhere, and it answers the purpose perfectly. It is needless to say that unfiltered water should never be drunk in Egypt. Prevailing and Uncommon Diseases.—Diarrhoea is common among the natives, and visitors occasionally suffer from it unless they are duly cautious as regard warm abdominal clothing. Typhoid fever, typhus, measles, and relapsing fever are not infrequent in the overcrowded and filthy native quarters, and there are some forty deaths from small-pox in Cairo annually. Diphtheria prevails to a certain extent. Scarlatina, whooping-cough, and mumps are very rare. Pleurisy, bronchitis, and pneumonia are frequent, but only from a careless expo- sure at night; for the night is often a strong contrast to IO the day in point of temperature. Malaria in a mild form is frequent along the river in the warm months. Consumption is almost unknown. The Egyptians seem scarcely ever to have it, but the blacks from the far South (Nubia, Abyssinia, Soudan), on coming to Lower Egypt, which is damp and cold in comparison with their native land, are subject to it. Entozoal disorders are common, and I saw several cases of anchylostoma duodenale with Dr. Sandwith at the Kasr-el-Aini Hospital. Ophthalmia, as is well known, is extraordinarily prevalent in Egypt, and has been for thou- sands of years, but foreigners seldom suffer from it. Sunstroke is rarer than one might suppose, and the re- markable precautions taken by some tourists to protect their heads are quite unnecessary. Acute rheumatism, gout, and rheumatoid arthritis are practically unknown in Egypt. I was myself especially interested in insanity and ner- vous diseases among the Egyptians. Elsewhere I have called attention to the phenomenal rarity of insanity and the entire absence of paralytic dementia among the Egyptians.1 Egypt, with six millions inhabitants, has but one asylum, containing two hundred and fifty inmates, whereas New York State, with the same population, has over fifteen thousand insane in its numerous asylums. I observed several cases of chronic poliomyelitis, and numerous infantile spastic paralyses, most of them mak- ing a living by begging through the streets or around monuments and tombs. The climate of Egypt is so favor- able, and food so cheaply and easily obtained, that such cases as would with us be put into hospitals for incurable diseases, here live out-of-doors, sleeping where they like, and satisfying their hunger with a piece of native biead thrown to them, and an onion or two taken from a neighboring field. Wherever I w7ould go I found it easy to establish an out-of-door clinic, for as soon as it was 1 Insanity in Egypt, by Frederick Peterson, Medical Record, May 2i, 1892. 11 understood that I was a physician, my tent or boat would be sought by any number of applicants for medical advice and drugs. Diseases Improved and Cured by the Climate of Egypt .—This climate is invaluable in all manner of chronic diseases of the respiratory organs; for delicate lungs or incipient phthisis, for rheumatic affections, for convalescents from any acute disease. As Ur. Sandwith aptly remarks, the most important question really is to determine what kinds of patients not to send to Egypt. As to this, each consulted physician must decide upon the merits of individual cases. It is almost needless to say that moribund phthisical patients, or invalids with apoplectic tendencies, should not be sent to Egypt. There is no doubt that a voyage on the Nile, or a resi- dence in Cairo, Gizeh, Helouan, or Luxor, or camp life in the desert, is a valuable indication in many forms of ner- vous and mental disease, such as neurasthenia, insomnia, over-work, hypochondriasis, hysteria, melancholia sim- plex, and other mild forms of incipient or threatened in- sanity. There is no better climate for intractable rheumatic and malarial neuralgias, sciatica, and the like. Having given these preliminaries, it now remains to consider briefly the means of taking the best advantage of what Egypt offers to invalids. Gizeh, Helouar, Cairo.—On reaching Egypt one dis- embarks at Alexandria preferably (though one may also land conveniently at Ismailia), and then makes his way by rail at once to Cairo, where he takes a sunny room at one of the good hotels (Shepheard’s, Continental, New, or Royal), and prepares his plans for the winter. If a phy- sician is needed there are many good English and Ger- man physicians in Cairo. Gizeh and Helouan are the sanatoria of Cairo. Both are in the desert, and both within easy reach of the city and good medical care. At Gizeh, seven miles from Cairo, is merely an Eng- lish hotel (the Mena House) on the edge of the desert, 12 and almost in the shadow of the three great pyramids and the Sphynx. It is as perfect in all of its appoint- ments, sanitary arrangements, water supply, etc., as any hotel can be. Rooms with fireplaces and sunshine can be obtained. Horses, carriages, camels, and donkeys are on hand. A coach runs to the city daily. There is a good library and reading-room, billiard-room, tennis- court, golf links, archery and cricket ground, swimming- bath, and a resident physician. The advantages here are the warm, dry, aseptic air of the desert, the quiet sur- roundings, the nearness to Cairo, and the interesting monuments of antiquity. Helouan I have described more in detail in another article.1 It lies fifteen miles to the south of Cairo, and is reached by numerous trains daily in forty minutes. I will say here that the Egyptian railway trains are much superior in point of comfort and speed to most continen- tal trains. There are two hotels at Helouan, and there are a great many pretty villas that may be hired for the season. The village is about three miles from the Nile, and very near the great cliffs of the Mokattam range. The chief attraction here is the sulphur, iron, and saline thermal springs. The baths are well constructed and under European supervision. This is the place par excel- lence for chronic rheumatism and gout. One is really within easier reach of Cairo here than at Gizeh. The desert surrounds the little town. There are the usual amusements of a spa in Europe, and in addition histori- cal attractions—the ancient quarries near by, and the pyramids of Sakkarah and remains of Memphis just across the river. Luxor.—It has already been stated that Luxor is dryer, warmer, and sunnier than any of the resorts about Cairo. By next season there will probably be trains running the whole distance of four hundred and fifty miles from Cairo, south to Luxor, but at present one takes a sleeping car 1 An Ancient Spa, by Frederick Peterson, New York Medical Journal, 1892. 13 to Assiout (twelve hours), and goes thence by steamer or dahabeeyeh. Luxor has two good hotels and an English physician. The town has four thousand inhabitants. Close by are the temples and ruins of Luxor, Karnak, and Thebes. There is postal and telegraphic communi- cation with all parts of the world. The hotel prices in Egypt are all rather below those charged in most American health-resorts. These three places, Gizeh, Helouan, and Luxor, are the chief, in fact the only, resorts in Egypt for invalids who intend making, or are compelled to make, a pro- tracted stay in a hotel. I have no doubt that in time other and still better sanatoria will be established in spots still better adapted to make use of the wonderful proper- ties of the desert climate—places perhaps remote from the Nile and its seven inches per month of evaporating water, and which will be desert health-resorts in every sense of the word. The Nile Voyage.—If there is anything in life which will steal away worries and cares, soothe the tired brain, calm the unstrung nerves, bring back vagrant sleep, “ Administer to a mind diseased, Pluck from the heart a rooted sorrow,” it is the dream like voyage on the Nile in a dahabeeyeh. At an expense of $600 to $800 per month four people have a house-boat, four bed-rooms, dining-room, sitting- room, bath-room, large deck with awning, captain and crew of eight to ten or more men, cook, waiter, inter- preter, and food for all. One may, if one wishes, pay twice as much for the same thing, for there are always tourist companies or dragomars willing to receive it, but it is not necessary, as I have demonstrated by experience. In a dahabeeyeh you are the plaything of the wind, but although I have spent as many as eighteen days on one occasion in traversing a distance of one hundred and eighty miles, owing to contrary winds, there never was a day or an hour that hung heavily on the hands, for there 14 is so much to do and so much to see. Perhaps this voyage has the peculiar and rare quality of making dolce far niente appear in its busiest aspect. At any rate, one is so much occupied with something that the weeks pass before one realizes it. This is not the place to describe how this illusion is produced of being very much occu- pied, when you are in reality resting and imbibing new vitality, mental and physical; books enough have been written about it to dam the Nile, as someone has observed, and to these the reader is referred for further particulars. As there is no means of heating a dahabeeyeh on cold nights, braziers not being advisable, a Rochester lamp burning in the sitting-room will be found to answer every purpose. An assortment of books, some guns, a tele- scope, a photographic outfit, and other instruments, scientific or musical, which individual tastes may suggest, will be found useful and agreeable adjuncts to such a trip. The voyage should begin about mid-December and be continued at pleasure for three or four months. The advantages of the dahabeeyeh voyage over resi- dence in one place are obvious. There are the same climatic features as elsewhere in Egypt. It is like living in one’s own home instead of in a hotel. There is change every day, and indeed every hour. No other river in the world could be travelled in this way. The dahabeeyeh would never be a success upon the Indian River, St. John’s, Hudson, or Mississippi. It might be on the Amazon. But all along the Nile are famous ruins, temples, tombs, relics of the world’s most ancient civilization, which in themselves excite the interest of every traveller, whether in good or poor health. The secret of being happy, and at the same time economical, on the Nile is to avoid the Scylla of Thomas Cook & Sons and the Charybdis of the dragomans. Cook’s steamers will do very well for the wildly-rushing tourist, who is willing and perhaps able to endure any amount of haste, crowding, and discomfort. The Cook 15 Nile steamers remind one forcibly of the old-fashioned second-rate local Mississippi freight and passenger boats. Invalids should be recommended not to travel by them. A tug to tow the dahabeeyeh is another evil that affords no adequate compensation for its noise and smoke. Cook & Sons have dahabeeyehs also, their charges being three times what one can be obtained for by ap- plication to private owners. The average dragoman asks only twice as much as it is worth. By hiring an interpreter for the voyage and exercising only a little discretion and supervision in purchases and payments, the Nile voyage comes within the means of many people of moderate circumstances whom Cook’s prices would otherwise debar from its advantages. Camping-out in Egypt.—Camp life in Egypt is some- thing luxurious. I have camped out on shooting expedi- tions in Nebraska, Dakota, and other Western places, and endured hardships that I should not care to experience again. But in Egypt, where labor and carrying cost next to nothing, where everything in the way of furniture and supplies can be stored away somewhere on a camel, where every day can be foreseen to be rainless and beauti- ful, life in tents becomes a pleasure. It is always well to have some objective point in view to reach, and among the pleasantest desert trips with tents and camels are those to the Sinaitic Peninsula, to the Natroon Lakes, to the Fayoum, and to several other oases to the west of the Nile. Probably the warmest and dry- est for an invalid would be that from Assiout, Geergeh, or Eseh to the Great Oasis. But one may camp on the edge of the desert, travelling southward along the Nile, in that way having the advantage of more interesting sur- roundings ; for some people might find the desert monot- onous. For those who enjoy shooting, camping in the Delta or the Fayoum, or anywhere along the Nile affords ample opportunity for the gratification of this taste. There is nowhere in Egypt any very large game j a few wild boar, hyenas, jackals, wolves, foxes, and unattainable 16 gazelles, ibex in Sinai. But this land is the winter home of all the European aquatic birds, apparently, and wild pigeons, snipe, quail, plover, also abound in phenomenal numbers. As for quail, we shot about one hundred and twelve in three hours with three guns, two of us being in- different shots. We made shooting excursions through the Delta, to the oasis of the Fayoum, and to Wadi Nat- roon As an example of the methods of camping here, I will briefly describe our equipment for the trip to Wadi Natroon, where we spent ten days. We were a party of three, and had eight camels with their drivers, a dragoman (interpreter), desert guide, cook, hunter-guide, and a boy, two tents, three folding bedsteads with mattresses, two folding tables, chairs, rugs, cook-stove, fuel, water, rifles and shot guns, and provisions for all the party, camels in- cluded. Camel riding becomes easy after a time. One can assume almost any position, even lying down and going to sleep, and one can read with ease. Ladies are not at all debarred from taking such trips. Everything necessary can be procured in Cairo, and the expense should not be over $5 to $7 per day for each traveller. While we in America frequently enough recommend camp life in the West to certain of our patients, I believe thus far it has never been advised by authorities on Egyptian climate, probably through lack of familiarity with its value and practicability. Clothing.—Winter clothing should be used in Lower Egypt, autumn clothing in Upper Egypt, and in the desert and on the Nile. Heavy wraps will be found useful at night. Books.—The best book of reference for the physician and invalid is Dr. F. M. Sandwith’s “ Egypt as a Winter Resort ” (Kegan Paul, Trench & Co., London). The best popular literary book is Charles Dudley Warner’s “ My Winter on the Nile.” Both Baedeker and Murray publish guide bo' ks, one of which is indispensable. 2oi West Fifty-fourth Street, new york.