Will we see malaria back in Lebanon ?

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Introduction

Malaria is caused by the parasite Plasmodium, which is transmitted to humans by the bite of Anopheles mosquitoes.

With 216 million people currently infected in 99 countries and 655 000 deaths per year in 2011, malaria is the most common parasitic disease. Around half of the world’s population is exposed and 80% of cases occur in sub-Saharan Africa.

Malaria causes symptoms that typically include fever, fatigue, vomiting, and headaches. In severe cases, it can cause yellow skin, seizures, coma, or death.

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Historical background

  • The first serious study reporting the presence of Malaria in Lebanon dates back to 1895. That year, professors Brown, Axe, Negre, Rouvier and Boyer from the French Medical Faculty conducted an epidemiological investigation which showed that malaria was the most common disorder, followed by syphilis, urinary calculi, typhoid and tuberculosis.
  • In 1914, in his manuscript « Health and social hygiene at mount Lebanon » to be addressed to the Governor in order to improve and take necessary measures in these fields, doctor Georges Baz, stated:”Forget malaria? It is rampant in the Lebanon, specialy in the population centers of Bourj Hammoud, Jdeidet El Matn, Bauchrieh, Wadi el Sitt.”

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Dr Georges Baz was born in Amchit on 31 December 1861. After studying English, he began his medical studies (at the American university) that lasted 4 years. Graduated in 1882, he brilliantly passed examination of the colloquium in Constantinople and returned to the Lebanon to practice medicine in Gbeil during winter and in Deir el Kamar during summer. Author of various articles in magazines Al-Mashriq Al-Mouktataf, he also wrote in the newspaper Al-Bashir a series of popular medical articles which were published subsequently by the Catholic press. In 1916, he was exiled with his family by the ottomans to Kirchehir in Anatolia. Returning to the Lebanon in 1919, general Gouraud appointed him doctor of the official schools of Beirut. In addition to its medical activities, Dr. Georges Baz occupied for several years Chairman of the municipal Council of Gbeil. He retired in 1929 and died in Beirut on March 3, 1956 in his 95 th year.

As for Quinine, a medicine for preventing or treating malaria fever, it’s use was well known. The young doctor Darwiche Baz (great uncle of Dr G. Baz, cited before), who can be considered as the first graduate Lebanese doctor, was the one who popularized the use of white quinine or kina baida (quinine sulfate). It was imported then from Egypt. Despite its beneficial effects, white quinine had significant side effects (ringing in the ear, dizziness and vomiting). A popular prejudice had spread the idea that this product was so toxic that it deserved the appellation of ‘cure of healing or death’.

During French mandat and until 1953, Gramiccia assesed the endemic prevelance of the disease. The affected population was 6% in the northern coastal region. In the hills, it was only 1-3% although, in the Oronte it reached11% while the disease was frankly endemic in the Bekaa valley.

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All this information is now only of historical value

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Postcard written from Zahle by Dr Farid Graieb in 1928 to a pharmaceutical labarotary in Paris requesting antimalarial medicine because the disease is rampant in quantity in the Bekaa.

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Another postcard written from Sur, a coastal city in Lebanon, in 1931 by Dr Farhat, to request antimalarial medicine.

  • In 1956 a local eradication program was launched and it resulted in complete curtailment of the transmission.
  • It is at the European conference on the eradication of malaria in Palermo on March 31, 1960, that W.H.O. declared 1962 as the year for the eradication of malaria.
  • Lebanon joined the campaign by emitting two stamps:

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Design size: 25 x 36 mm

Designer: P. Korolef

Producer: J. Saikali, Beirut

Stamp margins: designer’s name lower left; printer’s name lower right

Process: lithography

Format: panes of 50 (10 x 5)

Quantity:

Paper: white

Watermark: none

Perforation: 13½ x 13

Purpose: publicized the malaria eradication campaign

Sub-topics: mosquito; modified design #1

Various FDC from Lebanon were reported:

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To symbolize this malaria campaign, an emblem was adopted by the majority of countries: a mosquito bearing a world globe with the Caduceus.

The risk of disease can be reduced by preventing mosquito bites, by using mosquito nets and insect repellents, or with mosquito-control measures such as spraying insecticides and draining standing water.

International struggle against Malaria -FDC

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The arab states united to fight Malaria-FDC

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  • In 1963, World Health Organization declared Lebanon a country free of malaria.
  • Since then we had few breakouts of limited local transmission in 1996 and 1998-99, but the majority of cases was imported from areas with ongoing malaria transmission (around 130 case/year).

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In the majority of reported cases Lebanese travelers acquired malaria abroad and had not adhered to a chemoprophylaxis regimen that was appropriate for the country in which they acquired the infection.

  • Lebanon continues to be free of indigenous cases of malaria.

But with the globalization and ease of travel, importation of malaria cases from endemic areas will be in continuous rising, thus the importance of strengthening the capacity of the primary health sectors in travel medicine to reduce the morbidity and to prevent the mortality of imported cases.

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These infected cases reveal the existence of vector borne disease transmission during airplane travel, and emphasize the importance of obtaining a travel history during the evaluation of an ill patient. In addition, the cases reinforce the need for vigilance in the control of vectors of disease around seaports, airports and hospitals.

Will we see malaria back in Lebanon ?

In January 2016, Lebanon recorded one malaria death (a lebanese plane hostess returning from Abidjan), the first to occur in several years, raising fear over the possibility that it could become a widespread concern in the country with the garbage crisis. And of course the media gave the situation an image more dramatic than it really is.

Nevertheless, the detritus is supplying both an abode and a food resource for mosquito larvae. Thus has the number of mosquitoes in the country risen and specially bringing them into closer contact with people. It is stupid to deny the existence of garbage -related infections. Rats, flies and mosquitos are reservoires and vectors for disease.

It is also known that changes in temperature result in changes of mosquito behavior with the potential to become a serious health threat as a bridge vector of zoonotic pathogens to humans

The risk for the reappearance of malaria in Lebanon where it was previously eradicated exists but is relatively small ; Fortunately malaria is mainly a travel medicine issue.

How unhealthy a country Lebanon has become !

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This advertisement on cover is no longer valid!

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                                                                                                                                                                                        Fadi

Medical advertisment on postcards from Lebanon

The communication on drug and medicine, especially pharmaceutical advertising, seems to be born with the pharmaceutical industry in the late nineteenth century. With the growth of written communication and the emerge of first scientific journals and techniques, rapid dissemination of information is performed. The advertisements for drugs will greatly multiply in the press.

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Fig.1-Levant postal stationary 1908

“In reference to your announce in the clinics of ophthalmology, I would be grateful to receive samples of your specialty in order to use them in my practice. Thank you in advance, Dr Mangasar-Beirut”.

Regarding the promotion of these new drugs, the pharmaceutical industry  looked first to pharmacists  then to doctors. These became very important intermediaries between the pharmaceutical industry and patient, through prescription. Faced with the low costs of the specialty manufacturing at the time, the pharmaceutical industry will not hesitate to invest in advertising to promote his medicine. Labs thus began to send promotional brochures and advertising postcards to physicians. Samples of drugs were also sent to clinicians so that they attest to their effectiveness and establish used certificates subsequently to advertise.

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Fig.2

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Fig. 3

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Fig. 4

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Fig. 5

Fig.2-3-4-5 Various pharmaceutical laboratories reply postcards with different outgoing cancels: Baabda (1925) – Beyrouth (1925) – Saida (1933) – Military Bureau 600 (1937). Advertising is sent from the country of production to domestic and foreign customers. The advertising for pharmaceuticals often borrowed postal items: cards, cards letters illustrated.

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Fig. 6

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Fig. 6a

Fig.6- Private laboratory Deschiens postcard depicting Marechal Ney during the retreat of Napoleon’s great army in Russia. It was not unusual for these pharmaceutical postcards to represent military campaigns, great monuments, celebrities or various topics as childhood. Fig.6b- On reverse we find the request for samples and on the lower left corner an advertisement for Sirop Deschiens: “A hemoglobin syrup that is supposed to fight Neurasthenia, weakness and sickness of the chest (Tuberculosis?). Its high content of iron makes it superior to any other raw meat juice! That’s why it’s prescribed by more than 50.000 doctors!” This prescription reference was usual at that time and was meant to add credibility to this medicine.

After WWII, Biomarine, a french drug manufacturer, will innovate by shipping its advertisements to french prescribes from lush places which have no direct relationship to the product. For various reasons, the advertising campaign was a success. Postal relations between France and overseas were again effective and sure again.

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Fig. 7

The purpose of this company is to bring the therapeutic virtues of the ocean to those who cannot get access to it, using seawater under different forms of medication with pleasant taste. The Dieppe factory would produce three products from water collected on the high seas: Marinol (1912), Ionyl (1929) and Plasmarine (1934).

From 1947 to 1966, Biomarine mailed from 6 to 16 cards per year to 30,000 doctors in France and North Africa with a well-established pattern: A series represents a circuit or a journey, a first route map announces the program and sharpens the curiosity of the recipient. A correlation exists between cards, postage, and the place of shipment outside France. The printed message personified the product. Among the 19 “tours” organized by Biomarine, two used Beirut as a port of call.

The images were of quality; Biomarine widely appealed to museums, libraries, etc. The cards are ordered to specialized printers. Each receives back a text message imitating handwriting, the company logo and then the drugs. The addresses of the recipients are maintained up to date through the medical delegates. Workers from the drug manufacturer in Dieppe affixed the postage stamps on the postcards. The stamps were acquired from post offices abroad and arrived under customs by temporary importation. After packaging the items in bundles, Biomarine then forwarded them by surface (railway) to its destination in order to be dispatched.

First tour including Beirut: La croisière en méditerranée d’Ionyl (1950-1951):

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Fig. 8 and 9

Fig.8- Postcard depicting the Mediterranean cruise. Fig.9- Stop-over of the cruise and picture illustrating the postcard view.

These cards are of equal interest to the cartophile or the philatelist. They were shipped by surface mail, at printed matter – lowest rate.

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Fig. 10

Fig.10-  Stamps were removed from postcard by collectors to garnish their album.

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Fig. 11

Fig.11- On this first tour, the side view shows “le Krak des chevaliers” erroneously situated in Lebanon by the editor. “Krak des Chevaliers” also known as “hosn al akrad” is a Crusader castle in Syria (Tell Kalakh) and one of the most important preserved medieval castles in the world (sic).

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Fig. 12 and 13

Fig12-13 : On the back of the postcard, a simulated hand-written text to advertise IONYL and a machine postmark  canceling a colorful set of Lebanese stamps. The machine postmark is an advertisement that says : “Lebanon equals health” which gives the item a plus as a health topic collected item.

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Fig. 14

Fig.14 – Postcard heading to Switzerland with the agent address typed in red. Same set of stamps by a “Beyrouth” hand cancel strike over the stamps.

Apparently postcards were spread out over several months and can be found with different stamps and postmark types on them.

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Fig. 15

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Fig. 16

Fig.15 and Fig.16 represent the most common set of stamps issued from Lebanon or overprinted in 1950, that were affixed on these postcards. Maybe other combination exist but they have not been seen yet. Total franking of the card is 5 piastres.

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Fig. 17 and 18

Examples using the set of figure 16.

Each was mailed the cheapest way by surface (boat) mail using colorful stamps of the period. Some were mailed in bulk and postmarked all on the same day. Others were spread out over several months and can be found with different stamps and postmark types on them.

Second tour including Beirut: “Ionyl en route vers l’orient(1961-1962)” :

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Fig. 19 and 20

Fig.19: Postcard depicting the Oriental cruise. Fig.20: Stop-over of the cruise and picture illustrating the postcard view of the cruise.

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Fig. 21 and 22

Again each card was mailed the cheapest way by surface mail using Lebanese stamps of the period. Some were mailed in bulk and postmarked all on the same day. Some did escape cancelling due to the mass mail delivered at the same time.

In 1952, Biomarine creates the Agency Publimer to commercialize knowledge about other products than pharmaceutical products. The same maps travel to Amora, Philip, Maggi, Nestlé…

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Fig. 23

That’s how we can find this postcard depicting the six columns of Jupiter temple in Baalbeck with a typographic text in french advertising for Amora.

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Fig. 24

Another Baalbeck postcard sent from Beirut with an advertisement text in German for Maggi.

Later on, the idea is taken up on a “grand scale” by Abbott Laboratories, for their flagship product, Pentothal, an anesthetic made famous by espionage films as a truth serum. Its giant mailings are sent to 220,000 physicians or U.S. hospitals in addition to shipments in ten languages to 21 foreign countries. These cards will receive the nickname of Dear Doctor postcards.

Biomarine has stopped its activity in 2000 after having sent 200 postcards and 60 maximum cards.

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Fig.25 : Typical “Dear doctor postcard” depicting Byblos and an advertisement text for Pentothal on the back.

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Fig. 26

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Fig. 27

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Fig. 28

Fig.28 An Arabic advertisement text for Pentothal on a postcard issued from Saint-Pierre et Miquelon heading for Beirut. But this is out of subject.

With regard to a change in legislation which now prohibits advertising of drugs on short, readable postcards, the following shipments are enveloped.

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Fig. 29

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Fig.29-30: Illustrated covers with pharmaceutical advertisement from the sixties.

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Fig. 31

Despite regulations prohibiting open advertisement for pharmaceutical drugs in order to protect the consumer, doctors still received in the seventies such postcards as seen in fig.31.

The real objective of pharmaceutical advertising is not to improve public health, nor to educate physicians or to allow the medical press to survive ; It is to publicize and to sell as much as possible medicines.

Fadi