490
Journal of the Royal Society of Medicine Volume 85 August 1992
Medicine in San'a, Yemen 1937-1943
M A Weingarten BM BCh Department of Family Medicine, Tel-Aviv University, Building 130, Sheba Medical Centre, Israel 52621 Keywords: history; Yemen; typhus; Jews; missionaries
The first doctors to practise western medicine in the Yemen were a small group from the Italian Army; Medical Corps, in the years after the First World War. The Italians were interested in fur-theringtheir influence in the area, which was already extensive in Eritrea and Abyssinia, and one of the ways they went about this was by sending a medical contingent. They were soon joined by the French and the Soviet Russians, with the same motives, and by the Syrians, who were invited to organize the Yemeni Army.. Western medical practitioners rem iped very few in number throughout the 1930s, never more than 10 in the whole of this most conservative of Moslem lands. In 1936 the Imam of Yemen, Imam Yahya, approached the British Governorate of Aden with a request to send two doctors to work in San'a'. He seems to have been impressed by the results of eye surgery done on some of his subjects by Dr Patrick Petrie at the Scottish missionary hospital in Aden2 and asked for him to head the mission to San'a personally3. Pat Petrie was married and had one young son at the time.. His wife, Eleanor, was also medically qualified. The Imam immediately saw the advantage of her coming too, to look after his female entourage, and was willing to give her equal pay, an amazingly unusual attitude2. A Dutch roving consul, van der Meulen, who was in that area for the duration of the Mecca pilgrimage, makes sense of this by claiming that the prime reason for the Imam's request was for the woman doctor, and it was shie who stipulated that her family join her4. Before they left Aden a minor crisis almost upset the whole plan. The Imam insisted that the members of the medical mission occupy themselves with medicine alone and refrain from preaching Christianity inside Yemen. These terms were, not surprisingly, unacceptable to the Mission Board in Scotland, so the Petries had to sever their ties with them before they could take up the post in San'a4. Thus it was that, while the Imam covered the expenses of the two doctors (in sackfuls of gold reals delivered by mule), it was the British Colonial Offlce who paid for the salary of a nurse, not the Church of Scotland5.
Sources Having read Petrie's articles3'7'8 while studying the health of Yemenite Jews, I managed to find the whereabouts of Dr Roy Petrie, Pat and Eleanor's younger son, who, as well as going through his late father's letters for me, put me in touch with his uncle, Dr Willie Petrie, who had also been in Yemen, as we shall see. Willie was exceptionally generous with his time and effort; he wrote me a wealth of information and put me in touch with the three other doctors who
were also associated with the mission at one time or another, Drs Croskery, Walker and Seal, and with Nurse Louisa Cowie. All of thesein turn sent me eve rthing they could about their time in Yemen. Sidney Croskery lent me her autobiography, Whilst I Remember2, and Louisa Cowie sent me her letters home from Yemen. Van der Meulen's book, Faces in Shem4, also contains valuable and graphic first-hand information, but some of the background detail is unreliable. For example, he writes of the Petries' two children in San'a, when there was only one; he-states that Eleanor left San'a because the children became ill, when in fact she took planned leave for her second pregnancy; he says he met the Petries in San'a in 1931, but he means 1941. Finally, I went through the Colonial Offlce correspondence in the Aden File at the Public Ptecord Office, where I found much of the unpublished information in this articlel. In Yemen
Pat Petrie went on an initial 2-week tour in 1936, and in March 1937 the Scottish medical mission arrived in San'a5. The group seems to have settled down' quite comfortably in San'a, in a large house with staff- a Turkish head; house-servant, an Arab male cook, an Abyssinian maid-servain$ and a Somali nurse for their little son.iThe Turk left after a short time and was replace-d ov-n old Jewess, Nudhera, who stayed with the Petrie household uintil-tie missionf was closed, in 1943. The Imgm also provided two guards at the gate, a horse for Pat Petrie and mules for Eleanor and for the nurse, Louisa Cowrie. They were visited in 1938 by Hugh Scott, a British Museum entomologist, who stayed with them for 2 months while his colleague, Everard Britton, was recovering from malaria. Scott's account of his expedition to the Yemen includes much fascinating information on the Petries and their work
in San'a6. In 1939 Eleanor Petrie became pregnant again, and applied for leave to have the baby in Scotland. The whole mission was due for home leave, and was asked by the Colonial Office to arrange for their own replacements. Eleanor wrote to her old friend from medical school, Dr Sidney Elizabeth Croskery, inviting her to come as her locum tenens. Dr Croskery, unmarried and a Quaker pacifist, was at the time in general practice, together with her sister, in Tunbridge Wells. She was attracted by the idea and saw in the posting a way of avoiding imprisonment in Britain as a conscientious objector in the period before the outbreak of World War II. She even refused to take the British Government's travel grant and paid for her own passage. Dr Bernard Walker, then newly qualified from Edinburgh, sailed on the same
0141 0768/92
080490-03/$02.00/0
© 1992 The Royal Society of Medicine
Journal of the Royal Society of Medicine Volume 85 August 1992
ship to replace Pat Petrie2. When they arrived in Aden they were joined by a Danish missionary nurse, Karen Larsen, who was to stand in for Louisa Cowie. This short extract from Sidney Croskery's autobiography illustrates the atmosphere of medical practice in the mission at San'a at this time. They sent from a village five miles away and we had to wait till they found a car to take us there and to bring the patient back for the operation in hospital. The car did not come till the next day - fortunately we had sent her morphia. As it turned out the operation was the only way to save her life, though we did it in the hope ofgetting her a living child. She had six and none lived. Actually, the transverse position of the foetus, which was a hydrocephalic monster (and dead), had ruptured her uterus. She would have died had she not had her brothers, rich and influential Sheikhs, who took all the trouble and expense of bringing us out to her. The road was awful and the car very old. The windscreen had a bullet hole of long ago, patched with a coin to keep out the draught - 'the country is now quite peaceful'. Pat Petrie and I crowded the driver in the front seat; the patient reclined in Karen Larsen's arms on the back seat, carefully veiled from view, of course, with her woman servant crouching at her feet. Going there we had all had to get out and walk at one place where the car negotiated a difficult bit over an old lava flow. However coming back we just went over a planted field instead. I expected the patient (with a pulse of 140 per minute, which I mistook for her infant's!) to be dead on arrival but she was in quite good condition as the pains had stopped. We were all at the operation . . . - my first Caesar and the first ever baby to be born in hospital in Yemen!
These three, Dr Croskery, Dr Walker and Nurse Larsen, ran the mission alone from March 1939 until Nurse Cowie returned in March 1940, followed by Pat Petrie in July. During his absence from San'a he had prepared a major report for the Colonial Offlce on health in the Western Aden Protectorates7, and in June 1940 he read a paper on his work in Yemen at the Edinburgh Branch of the Royal Society of Tropical Medicine and Hygiene8. The Imam was not prepared to let the locums leave, however, and not until March 1941 did Bernard Walker manage to get away, to continue his distinguished career in Palestine and Arabia for many more years. Sidney Croskery was forced by the Imam to stay on and had to suffer a long and anxious wait until she was finally allowed to leave, on Easter Tuesday 1942. Eleanor Petrie had travelled from Scotland in 1940 with her two children, as far as Jamaica, but the Imam refused to allow her to bring her black Quaker nursemaid to San'a. In the delay the Pacific War started and they remained stranded in Jamaica until the War was over9. A petition was sent to the Secretary of State for Colonial Affairs to have her flown over, on the grounds of the potential political importance to Britain of her presence in San'a, for the British hoped to replace the Italians as the major foreign influence in Yemen when the War was over, and the medical mission was the only British presence there. The Secretary of State was not convinced. Nor was he convinced by the other argument proposed, that Pat Petrie and Louisa Cowie living alone in the same house would give the British as bad a moral reputation among the Arabs of San'a as that already earned by the Italians'. The mission in San'a did not survive the War, but it expired through illness, not aggression. In July 1942 Nurse Cowie caught typhus from a patient she was treating and had to be evacuated to Addis Ababa.
There her illness was confirmed by Professor Giaguinto, with a Weil-Felix titre of 1: 750 to OX19. This was the first time typhus was confirmed serologically in South Arabia. Pat Petrie himself took Weigl's vaccine against typhus in Addis Ababa3. The mission reopened in February 1943, and in June they were joined by Pat's brother, Willie, also a doctor, who was serving with the King's African Rifles at the time. While he was there, in August 1943, Pat fell ill. At first there seems to have been some doubt about the diagnosis. The Colonial Office was told by the Governor of Aden that it was typhoid1; his own younger son, Roy, thinks it was malaria (personal communication). But to Willie Petrie, there at the time, it was quite clear that his brother had typhus despite the vaccination. He was afraid he was about to die and asked permission to get a plane from Aden to take him to hospital there. But this was refused - 'Once they learn to find San'a by aeroplane from Aden to collect a sick man, next time they will come with bombs', was the Imam's argument, writes Willie in one of his letters. This was not as far-fetched as it may sound, since the British had already bombed in the south of the country when they felt their presence in Aden under threat from the North in 192812. So Willie looked after his brother in San'a, until he himself also- took ill and the mission was finally withdrawn for good on 9 November 1943.
Typhus
Typhus was the immediate cause for the closing of the mission. It was a disease which engendered high feelings. The outbreak started in 1939, when Drs Walker and Croskery were in San'a, as a few sporadic cases in the prison. The prison housed large numbers of young children, held as hostages for their fathers' allegiance to the Imam. The Imam's Italian and Syrian doctors told him the British doctors were wrong and the disease was typhus abdominalis (typhoid) not typhus exanthematus, which, they said, did not occur in Arabia. Eventually the authorities were persuaded by the British doctors to let the little prisoners bathe, at least. This was done in a bathhouse also used by the orphanage school, to which the disease promptly spread, and from there to the whole town. Even when the Army was affected, the Syrian doctor in charge of the troops continued to insist it was typhoid and asked the Imam to have TAB vaccine brought from Aden. The Imam's son caie down with a completely typical case of typhus, but this did not convince the loyal Italians and Syrians until Nurse Cowie's serology was reported in Add Ababa in July 1942. In 1943 there was a bad famine; dysentery and typhus were rife; sick and dead lay about in the streets. Although no accurate figures are available, we do know that, at the height of the epidemic, the authorities in San'a issued 1600 free shrouds to the destitute in the space of two months3. Jews About 25% of San'a was Jewish. Jews had lived in Yemen for at least 2000 years and there was even a time, in the fifth or sixth century, when the Royal household converted to Judaism. The Jews, living walled off in their separate quarter outside the main town walls, were affected much less by the typhus epidemic. Petrie noted that their standards of personal and communal cleanliness were higher than that of the Arabs3'8. When the first cases appeared in the
491
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Journal of the Royal Society of Medicine Volume 85 August 1992
Jewish quarter, probably due to the arrival of destitute Jews from other towns affected by typhus, many of the inhabitants sold all they could and set out on the trek to Aden, hoping to find a ship there to take them to Palestine. Some of them caught the disease en route in the caravanserais so the British authorities in Aden opened a quarantine camp for them at Fiosh, in 19433. The camp hospital was run by Dr Ken Seal, who had written the survey on health in the Western Aden Protectorate together with Pat Petrie, and by Nurse Cowie who knew the Jews so well from her years in San'a'0 (personal communication, Seal). The British were doubly concerned - not to allow the spread of the disease into Aden; and not to encourage the influx of Jews into Palestine. Some of the refugees were shipped back to the Yemeni port of Hodeida. But the flow of people continued and the quarantine camp eventually developed into enormous transit bases. On one occasion Dr Bernard Walker, by then Medical Officer-in-charge for the Western Aden Protectorates, interceded personally on behalf of a stranded group of Jews whom the British had stopped at the Yemen-Aden border and enlisted the support of Dr Edgar Cochrane, Medical Officer for Aden, to persuade the Governor to petition London to change its policy. In 1948, he examined and signed certificates of health for the first 4000 of these Jews to come out of Yemen as they passed through Aden on their way to Israel (personal communication). By 1951, 50 000 Yemenite Jews, virtually the whole of this ancient community, were airlifted from the RAF base in Aden to Israel"1. Motives The British were not the first doctors to practise in Yemen but they were the first for whom their medical mission was paramount and their political influence secondary. Politically, they failed to gain the foothold for Britain which the Colonial Office wanted; medically, they successfully established standards of practice, both technical and ethical, which remained as a challenge to those who continued to develop Yemen's medical services after they left, defeated finally by typhus. Pat Petrie, son of a family with a long missionary tradition, was also an ordained minister in the Church of Scotland. The mission in San'a was, however, forbidden to proselytize by the terms of the Imam's invitation. How did he fulfil his mission, then? He seems to have adopted an alternative attitude which called for nothing in the way of proselytism. By his general behaviour he earned himself a special
reputation among the Arabs who found his ways different from theirs and, he hoped, recognizably Christian. He refused to take money before going to see patients; he would go visiting after sunset instead of waiting until the next morning; he went to the houses of the poor instead of telling them to bring their patients to him; he even went to the Jewish quarter beyond the town walls. These details, taken from van der Meulen's account4, seem to show how differently Petrie behaved from the other European, military, doctors in San'a at the time. Nurse Cowie, by her own account, could not resist the opportunity to preach more directly, to the Arabs but not the Jews, but seems not to have got into any trouble for that5. This article may serve as a small acknowledgement of their selfless help to the people of San'a, the Arabs and Jews alike, when all around them were more concerned with political and religious rivalry than with healing the sick. Acknowledgments: I thank Dr H R (Bob) Pomson for helping me find Dr Roy Petrie, and'all my correspondents for their permission to quote them. Professor Stuart Cohen of Bar-Ilan University, Professor Charles Roland of McMaster University and Dr Eran Dolev of Tel-Aviv University all saw earlier drafts of this paper and gave me invaluable criticism. References 1 Aden Original Correspondence, Public Record Office, London: C.O. 773 2 Croskery S. Whilst I Remember. Dundonald: Blackstaff, 1983:30 3 Petrie PWR. Epidemic typhus in southwestern Arabia. Am J Trop Med 1949;29:501-26 4 van der Meulen D. Faces in Shem. London: John Murray, 1961 5 Cowie L. Unpublished letters, November 1937-October 1943 6 Scott H. In the High Yemen. London: John Murray, 1942:135 7 Petrie PWR, Seal KS. A medical survey of Western Aden Protectorate, 1939-40. London: Colonial Office (Middle East No. 66), 1943 8 Petrie PWR. Some experiences in South Arabia. J Trop Med Hyg 1939;42:357-360 9 Croskery S. Whilst I Remember. Dundonald: Blackstaff, 1983:50 10 Croskery S. WhilstI Remember. Dundonald: Blackstaff, 1983:76 11 Barer S. The Magic Carpet. New York: Harper, 1951 12 Gavin RJ. Aden Under British Rule 1839-1967. London: C Hurst & Co, 1975
(Accepted 14 August 1991)
Journal of the Royal Society of Medicine Volume 85 August 1992
Medicine in San'a, Yemen 1937-1943
M A Weingarten BM BCh Department of Family Medicine, Tel-Aviv University, Building 130, Sheba Medical Centre, Israel 52621 Keywords: history; Yemen; typhus; Jews; missionaries
The first doctors to practise western medicine in the Yemen were a small group from the Italian Army; Medical Corps, in the years after the First World War. The Italians were interested in fur-theringtheir influence in the area, which was already extensive in Eritrea and Abyssinia, and one of the ways they went about this was by sending a medical contingent. They were soon joined by the French and the Soviet Russians, with the same motives, and by the Syrians, who were invited to organize the Yemeni Army.. Western medical practitioners rem iped very few in number throughout the 1930s, never more than 10 in the whole of this most conservative of Moslem lands. In 1936 the Imam of Yemen, Imam Yahya, approached the British Governorate of Aden with a request to send two doctors to work in San'a'. He seems to have been impressed by the results of eye surgery done on some of his subjects by Dr Patrick Petrie at the Scottish missionary hospital in Aden2 and asked for him to head the mission to San'a personally3. Pat Petrie was married and had one young son at the time.. His wife, Eleanor, was also medically qualified. The Imam immediately saw the advantage of her coming too, to look after his female entourage, and was willing to give her equal pay, an amazingly unusual attitude2. A Dutch roving consul, van der Meulen, who was in that area for the duration of the Mecca pilgrimage, makes sense of this by claiming that the prime reason for the Imam's request was for the woman doctor, and it was shie who stipulated that her family join her4. Before they left Aden a minor crisis almost upset the whole plan. The Imam insisted that the members of the medical mission occupy themselves with medicine alone and refrain from preaching Christianity inside Yemen. These terms were, not surprisingly, unacceptable to the Mission Board in Scotland, so the Petries had to sever their ties with them before they could take up the post in San'a4. Thus it was that, while the Imam covered the expenses of the two doctors (in sackfuls of gold reals delivered by mule), it was the British Colonial Offlce who paid for the salary of a nurse, not the Church of Scotland5.
Sources Having read Petrie's articles3'7'8 while studying the health of Yemenite Jews, I managed to find the whereabouts of Dr Roy Petrie, Pat and Eleanor's younger son, who, as well as going through his late father's letters for me, put me in touch with his uncle, Dr Willie Petrie, who had also been in Yemen, as we shall see. Willie was exceptionally generous with his time and effort; he wrote me a wealth of information and put me in touch with the three other doctors who
were also associated with the mission at one time or another, Drs Croskery, Walker and Seal, and with Nurse Louisa Cowie. All of thesein turn sent me eve rthing they could about their time in Yemen. Sidney Croskery lent me her autobiography, Whilst I Remember2, and Louisa Cowie sent me her letters home from Yemen. Van der Meulen's book, Faces in Shem4, also contains valuable and graphic first-hand information, but some of the background detail is unreliable. For example, he writes of the Petries' two children in San'a, when there was only one; he-states that Eleanor left San'a because the children became ill, when in fact she took planned leave for her second pregnancy; he says he met the Petries in San'a in 1931, but he means 1941. Finally, I went through the Colonial Offlce correspondence in the Aden File at the Public Ptecord Office, where I found much of the unpublished information in this articlel. In Yemen
Pat Petrie went on an initial 2-week tour in 1936, and in March 1937 the Scottish medical mission arrived in San'a5. The group seems to have settled down' quite comfortably in San'a, in a large house with staff- a Turkish head; house-servant, an Arab male cook, an Abyssinian maid-servain$ and a Somali nurse for their little son.iThe Turk left after a short time and was replace-d ov-n old Jewess, Nudhera, who stayed with the Petrie household uintil-tie missionf was closed, in 1943. The Imgm also provided two guards at the gate, a horse for Pat Petrie and mules for Eleanor and for the nurse, Louisa Cowrie. They were visited in 1938 by Hugh Scott, a British Museum entomologist, who stayed with them for 2 months while his colleague, Everard Britton, was recovering from malaria. Scott's account of his expedition to the Yemen includes much fascinating information on the Petries and their work
in San'a6. In 1939 Eleanor Petrie became pregnant again, and applied for leave to have the baby in Scotland. The whole mission was due for home leave, and was asked by the Colonial Office to arrange for their own replacements. Eleanor wrote to her old friend from medical school, Dr Sidney Elizabeth Croskery, inviting her to come as her locum tenens. Dr Croskery, unmarried and a Quaker pacifist, was at the time in general practice, together with her sister, in Tunbridge Wells. She was attracted by the idea and saw in the posting a way of avoiding imprisonment in Britain as a conscientious objector in the period before the outbreak of World War II. She even refused to take the British Government's travel grant and paid for her own passage. Dr Bernard Walker, then newly qualified from Edinburgh, sailed on the same
0141 0768/92
080490-03/$02.00/0
© 1992 The Royal Society of Medicine
Journal of the Royal Society of Medicine Volume 85 August 1992
ship to replace Pat Petrie2. When they arrived in Aden they were joined by a Danish missionary nurse, Karen Larsen, who was to stand in for Louisa Cowie. This short extract from Sidney Croskery's autobiography illustrates the atmosphere of medical practice in the mission at San'a at this time. They sent from a village five miles away and we had to wait till they found a car to take us there and to bring the patient back for the operation in hospital. The car did not come till the next day - fortunately we had sent her morphia. As it turned out the operation was the only way to save her life, though we did it in the hope ofgetting her a living child. She had six and none lived. Actually, the transverse position of the foetus, which was a hydrocephalic monster (and dead), had ruptured her uterus. She would have died had she not had her brothers, rich and influential Sheikhs, who took all the trouble and expense of bringing us out to her. The road was awful and the car very old. The windscreen had a bullet hole of long ago, patched with a coin to keep out the draught - 'the country is now quite peaceful'. Pat Petrie and I crowded the driver in the front seat; the patient reclined in Karen Larsen's arms on the back seat, carefully veiled from view, of course, with her woman servant crouching at her feet. Going there we had all had to get out and walk at one place where the car negotiated a difficult bit over an old lava flow. However coming back we just went over a planted field instead. I expected the patient (with a pulse of 140 per minute, which I mistook for her infant's!) to be dead on arrival but she was in quite good condition as the pains had stopped. We were all at the operation . . . - my first Caesar and the first ever baby to be born in hospital in Yemen!
These three, Dr Croskery, Dr Walker and Nurse Larsen, ran the mission alone from March 1939 until Nurse Cowie returned in March 1940, followed by Pat Petrie in July. During his absence from San'a he had prepared a major report for the Colonial Offlce on health in the Western Aden Protectorates7, and in June 1940 he read a paper on his work in Yemen at the Edinburgh Branch of the Royal Society of Tropical Medicine and Hygiene8. The Imam was not prepared to let the locums leave, however, and not until March 1941 did Bernard Walker manage to get away, to continue his distinguished career in Palestine and Arabia for many more years. Sidney Croskery was forced by the Imam to stay on and had to suffer a long and anxious wait until she was finally allowed to leave, on Easter Tuesday 1942. Eleanor Petrie had travelled from Scotland in 1940 with her two children, as far as Jamaica, but the Imam refused to allow her to bring her black Quaker nursemaid to San'a. In the delay the Pacific War started and they remained stranded in Jamaica until the War was over9. A petition was sent to the Secretary of State for Colonial Affairs to have her flown over, on the grounds of the potential political importance to Britain of her presence in San'a, for the British hoped to replace the Italians as the major foreign influence in Yemen when the War was over, and the medical mission was the only British presence there. The Secretary of State was not convinced. Nor was he convinced by the other argument proposed, that Pat Petrie and Louisa Cowie living alone in the same house would give the British as bad a moral reputation among the Arabs of San'a as that already earned by the Italians'. The mission in San'a did not survive the War, but it expired through illness, not aggression. In July 1942 Nurse Cowie caught typhus from a patient she was treating and had to be evacuated to Addis Ababa.
There her illness was confirmed by Professor Giaguinto, with a Weil-Felix titre of 1: 750 to OX19. This was the first time typhus was confirmed serologically in South Arabia. Pat Petrie himself took Weigl's vaccine against typhus in Addis Ababa3. The mission reopened in February 1943, and in June they were joined by Pat's brother, Willie, also a doctor, who was serving with the King's African Rifles at the time. While he was there, in August 1943, Pat fell ill. At first there seems to have been some doubt about the diagnosis. The Colonial Office was told by the Governor of Aden that it was typhoid1; his own younger son, Roy, thinks it was malaria (personal communication). But to Willie Petrie, there at the time, it was quite clear that his brother had typhus despite the vaccination. He was afraid he was about to die and asked permission to get a plane from Aden to take him to hospital there. But this was refused - 'Once they learn to find San'a by aeroplane from Aden to collect a sick man, next time they will come with bombs', was the Imam's argument, writes Willie in one of his letters. This was not as far-fetched as it may sound, since the British had already bombed in the south of the country when they felt their presence in Aden under threat from the North in 192812. So Willie looked after his brother in San'a, until he himself also- took ill and the mission was finally withdrawn for good on 9 November 1943.
Typhus
Typhus was the immediate cause for the closing of the mission. It was a disease which engendered high feelings. The outbreak started in 1939, when Drs Walker and Croskery were in San'a, as a few sporadic cases in the prison. The prison housed large numbers of young children, held as hostages for their fathers' allegiance to the Imam. The Imam's Italian and Syrian doctors told him the British doctors were wrong and the disease was typhus abdominalis (typhoid) not typhus exanthematus, which, they said, did not occur in Arabia. Eventually the authorities were persuaded by the British doctors to let the little prisoners bathe, at least. This was done in a bathhouse also used by the orphanage school, to which the disease promptly spread, and from there to the whole town. Even when the Army was affected, the Syrian doctor in charge of the troops continued to insist it was typhoid and asked the Imam to have TAB vaccine brought from Aden. The Imam's son caie down with a completely typical case of typhus, but this did not convince the loyal Italians and Syrians until Nurse Cowie's serology was reported in Add Ababa in July 1942. In 1943 there was a bad famine; dysentery and typhus were rife; sick and dead lay about in the streets. Although no accurate figures are available, we do know that, at the height of the epidemic, the authorities in San'a issued 1600 free shrouds to the destitute in the space of two months3. Jews About 25% of San'a was Jewish. Jews had lived in Yemen for at least 2000 years and there was even a time, in the fifth or sixth century, when the Royal household converted to Judaism. The Jews, living walled off in their separate quarter outside the main town walls, were affected much less by the typhus epidemic. Petrie noted that their standards of personal and communal cleanliness were higher than that of the Arabs3'8. When the first cases appeared in the
491
492
Journal of the Royal Society of Medicine Volume 85 August 1992
Jewish quarter, probably due to the arrival of destitute Jews from other towns affected by typhus, many of the inhabitants sold all they could and set out on the trek to Aden, hoping to find a ship there to take them to Palestine. Some of them caught the disease en route in the caravanserais so the British authorities in Aden opened a quarantine camp for them at Fiosh, in 19433. The camp hospital was run by Dr Ken Seal, who had written the survey on health in the Western Aden Protectorate together with Pat Petrie, and by Nurse Cowie who knew the Jews so well from her years in San'a'0 (personal communication, Seal). The British were doubly concerned - not to allow the spread of the disease into Aden; and not to encourage the influx of Jews into Palestine. Some of the refugees were shipped back to the Yemeni port of Hodeida. But the flow of people continued and the quarantine camp eventually developed into enormous transit bases. On one occasion Dr Bernard Walker, by then Medical Officer-in-charge for the Western Aden Protectorates, interceded personally on behalf of a stranded group of Jews whom the British had stopped at the Yemen-Aden border and enlisted the support of Dr Edgar Cochrane, Medical Officer for Aden, to persuade the Governor to petition London to change its policy. In 1948, he examined and signed certificates of health for the first 4000 of these Jews to come out of Yemen as they passed through Aden on their way to Israel (personal communication). By 1951, 50 000 Yemenite Jews, virtually the whole of this ancient community, were airlifted from the RAF base in Aden to Israel"1. Motives The British were not the first doctors to practise in Yemen but they were the first for whom their medical mission was paramount and their political influence secondary. Politically, they failed to gain the foothold for Britain which the Colonial Office wanted; medically, they successfully established standards of practice, both technical and ethical, which remained as a challenge to those who continued to develop Yemen's medical services after they left, defeated finally by typhus. Pat Petrie, son of a family with a long missionary tradition, was also an ordained minister in the Church of Scotland. The mission in San'a was, however, forbidden to proselytize by the terms of the Imam's invitation. How did he fulfil his mission, then? He seems to have adopted an alternative attitude which called for nothing in the way of proselytism. By his general behaviour he earned himself a special
reputation among the Arabs who found his ways different from theirs and, he hoped, recognizably Christian. He refused to take money before going to see patients; he would go visiting after sunset instead of waiting until the next morning; he went to the houses of the poor instead of telling them to bring their patients to him; he even went to the Jewish quarter beyond the town walls. These details, taken from van der Meulen's account4, seem to show how differently Petrie behaved from the other European, military, doctors in San'a at the time. Nurse Cowie, by her own account, could not resist the opportunity to preach more directly, to the Arabs but not the Jews, but seems not to have got into any trouble for that5. This article may serve as a small acknowledgement of their selfless help to the people of San'a, the Arabs and Jews alike, when all around them were more concerned with political and religious rivalry than with healing the sick. Acknowledgments: I thank Dr H R (Bob) Pomson for helping me find Dr Roy Petrie, and'all my correspondents for their permission to quote them. Professor Stuart Cohen of Bar-Ilan University, Professor Charles Roland of McMaster University and Dr Eran Dolev of Tel-Aviv University all saw earlier drafts of this paper and gave me invaluable criticism. References 1 Aden Original Correspondence, Public Record Office, London: C.O. 773 2 Croskery S. Whilst I Remember. Dundonald: Blackstaff, 1983:30 3 Petrie PWR. Epidemic typhus in southwestern Arabia. Am J Trop Med 1949;29:501-26 4 van der Meulen D. Faces in Shem. London: John Murray, 1961 5 Cowie L. Unpublished letters, November 1937-October 1943 6 Scott H. In the High Yemen. London: John Murray, 1942:135 7 Petrie PWR, Seal KS. A medical survey of Western Aden Protectorate, 1939-40. London: Colonial Office (Middle East No. 66), 1943 8 Petrie PWR. Some experiences in South Arabia. J Trop Med Hyg 1939;42:357-360 9 Croskery S. Whilst I Remember. Dundonald: Blackstaff, 1983:50 10 Croskery S. WhilstI Remember. Dundonald: Blackstaff, 1983:76 11 Barer S. The Magic Carpet. New York: Harper, 1951 12 Gavin RJ. Aden Under British Rule 1839-1967. London: C Hurst & Co, 1975
(Accepted 14 August 1991)
