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Medical and Surgical Practice on the Euphrates River

An Analysis of Two Thousand Consecutive Cases at Deir-ez-Zor, Syria

1. The disease conditions presented by 2,000 consecutive patients in the American Mission Clinic in Deir-ez-Zor, Syria, are analyzed and summarized. This gives a rough indication of the incidence of disease in this region.

2. The diagnosis in each case was made upon the basis of the patient's own statements, the objective findings of a complete physical examination, and the use of the simpler laboratory examinations of urine, feces, blood and various smears. The flashlight battery was the only source of electricity available. A certain percentage of the diagnoses should therefore be termed tentative rather than absolute. However, the Arab being unaccustomed to seeking medical assistance, does not usually present himself until the disease from which he suffers has reached an advanced stage, and diagnosis is made correspondingly simpler.

3. In contrast to the United States where only 10 per cent of the illnesses can be controlled on a community basis (6), this survey shows that almost 50 per cent of the illness in Deir-ez-Zor has a definite public health aspect. The diseases of trachoma, tuberculosis, amebic dysentery and syphilis merit direct attack from the standpoint of community education and treatment. Syphilis deserves special study in order to ascertain more accurately its incidence and the characteristics of the attenuated form in which it seems to exist among the bedouins.

4. Over 80 per cent of the 2,000 patients were ambulant, and less than 10 per cent would have been admitted to hospital, even if beds had been available.

5. The difficulties presented by the Arab patient to the modern practitioner in the field of diagnosis, and even more in the field of treatment, are very great, but they are not insuperable. Their formidable nature justifies and American doctor in reserving sufficient time from the practice of medicine for the acquisition of at least a conversational knowledge of the language of his patients, without which the humor and the human interest would escape him, and with which he is doubly armed in his constant struggle with community conservatism and individual ignorance (7).

6. The American clinic in Deir-ez-Zor has the following three-fold medical function which, far from causing it to compete or interfere with indigenous or governmental agencies, will serve to supplement and stimulate all activities looking to the improvement of the health of the Arab of the middle Euphrates:

a. By providing diagnostic facilities, it teaches that diagnosis must precede treatment.

b. By instruction in health, it teaches that disease can be prevented by the intelligent use of the rules of hygiene.

c. By careful study of the cases that pass through its doors, it can furnish information from time to time as to the prevalence and character of the diseases present in this area.