Postgrad Med J: first published as 10.1136/pgmj.28.319.269 on 1 May 1952. Downloaded from 26X THE MECCA PILGRIMAGE Its Epidemiological Significance and Control By WASFY OMAR, M.B., Ch.B.(Cairo), Dip. Hyg., D.T.M. & H.(Camb.) The Islamic faith demands that Moslems, at white sheet, the pilgrims must pass their first day least once in their life, should perform the pil- of pilgrimage. grimage to Mecca, provided they can do so. It is In the evening of the same dayt, hey move to not enough to visit the holy places in the Hedjaz Mozdalifa, about four miles from Mount Arafat. at any time of the year. Merit can be acquired Here, they camp for the night, and the next day by only participation in the mass demonstra- they proceed to Mouna, about two miles further tions of faith decreed to take place every year on on to Mecca, where they stay three or four days the tenth day of Zilhidge, according to the under tents erected in these sacred valleys of the Mohammedan calendar. No sacrifice is too great desert, devoting themselves to their religious for any Mohammedan to fulfil this sacred duty. ceremonies. Some indeed devote their whole life to the attain- The pilgrimage ceremonies at Mouna are ment of this sacred mission. characterized by one of the most important by copyright. The great majority of pilgrims are from the traditions; the celebration of the sacrifice of middle and poor classes. Some are extremely offerings. Thousands of animals (camels, sheep, poor; they have nothing but faith in their hearts etc.) are slaughtered in the camp. The huge and a stick in their hands; they walk from their quantity of meat, which cannot possibly be con- home countries, sometimes for years, begging sumed by the pilgrims, is either left on the ground their way to the Hedjaz. Others can afford only or incompletely buried, and within a few hours the expenses of their outward journey. This under the burning sun, this creates a big sanitary destitution of the pilgrims led many governments, problem. supported by the international sanitary conven- On the twelfth or thirteenth day of Zilhidge, the http://pmj.bmj.com/ tions, to take certain measures to prevent the pilgrims move to Mecca to fill again the sacred departure of any pilgrim unless he first pays for little town to overflowing and to live necessarily in his return ticket. conditions of appalling overcrowding. Their de- Every year, three months before the date pre- votions include one important function: every scribed, thousands of Moslems from every part pilgrim must drink of the holy water of the Zam- of the world converge in large numbers on Mecca. Zam well; moreover, some pilgrims take with In the early years the majority came by caravan them for distribution to their nearest and dearest on September 29, 2021 by guest. Protected across the Arabian deserts, Asia and. Africa from at home, tins full of the holy water. The Zam- the north, south, east and west. Now the majority Zam well is a shallow, open well from which the come by sea and a great number travel by air.* water is drawn by buckets. This water has always Wherever they arrive in the Hedjaz, all the been liable to contamination with germs of in- pilgrims converge on Mecca. The small sacred testinal infectious diseases. This is why it is town becomes gradually crowded with them. On stressed that the drums containing Zam-Zam the ninth day of Zilhidge, 'the day of Arafat,' water, carried by returning pilgrims, be regularly they all assemble at Mount Arafat. There, about steam disinfected at the Tor (Egypt) Quarantine half a million Moslems gather for the consecration Station,t on the return of the pilgrims. They of the pilgrimage. Mount Arafat is a bleak, open t According to the provisions of articles 135, 140, hill, about I2 miles east of Mecca. Here, clad 14I and 142 of the International Sanitary Convention only in the symbolic garb of purity, an unstitched (Paris, I926), all ships carrying pilgrims from the ports of the Hedjaz and going north must call at Tor quaran- * In the 1951 pilgrimage, 12,687 arrived to the Hedjaz tine stations to undergo sanitary measures of medical by air. The number of pilgrims arriving by air greatlv examination, observation, disinfection, etc., before thev increases year by year. are allowed to proceed on their voyage. Postgrad Med J: first published as 10.1136/pgmj.28.319.269 on 1 May 1952. Downloaded from 270 POSTGRADUATE MEDICAL JOURNAL May 1952 must be destroyed if an outbreak of cholera During the Mecca pilgrimage, there is a huge happens to occur in the Hedjaz, a precaution which gathering of people of different races, the majority was found necessary after the isolation of cholera of whom come from countries where many of the vibrios from water drums at the Tor Camp pestilential diseases are endemic. Laboratory.* The Mecca pilgrims, travelling sometimes under With the return of the pilgrims to Mecca, the precarious and unhealthy conditions and being pilgrimage ceremonies come to an end and the liable to carry with them the germs of cholera, mass begins to break up and disperse. plague, smallpox, etc., from their home countries, have, by their agglomeration, often made of the The Sanitary Dangers of the Pilgrimage holy towns of Islam a dangerous centre from which The conditions under which the pilgrimage to epidemics of pestilential diseases spread all over Mecca is performed, particularly by pilgrims who the world. Any epidemic disease could start there are not well provided with this world's goods, are and spread to the home countries of the returning so rigorous as to be a severe strain on even the pilgrims. strongest. A large number of the pilgrims who Malaria, dysentery and other water-borne proceed to Mecca are old and infirm; some of epidemic diseases have always been common them desire to undertake the pilgrimage only with among returning pilgrims. Until vaccination of the object of dying in the Holy Land.t A pilgrim pilgrims was made compulsory by most of the who is in ill health is more liable to be a focus of countries, smallpox was very common. The last infection than one who is in robust health. It was outbreak occurred in I949 when 545 smallpox found by experience that while deaths among cases and I98 deaths were recorded. pilgrims on their outward voyage are comparatively The great plague pandemic of I896 menaced rare, the mortality after the pilgrimage ceremonies the pilgrimage for the first time and it reappeared in and on their return voyage is very high even in the Jedda in the following year. The infection was absence of epidemics. The mortality in the 1924 thought to have been introduced by pilgrims' pilgrimage was 4 per cent. among the Egyptians caravans from Sanaa (Yemen), where plague wasby copyright. and 22 per cent. among the Javanese. prevalent. Only a few cases appeared among the The Arabic (lunar) year does not correspond returning pilgrims. After I897 plague was de- exactly to the Christian year, but is ii days clared in the I898, I899, 1900, 1907, 1909, 1910, shorter. Thus, the date fixed in the Arabic 1913-14 and I9I8 pilgrimages. None has been re- calendar for the pilgrimage, ninth of Zilhidge, does ported from the Hedjaz since I9I8. not fall on a fixed day according to the Christian Although plague has been considered in all the calendar, but falls in every succeeding year on a international sanitary conventions on equal lines date ii days earlier. The pilgrimage may be, with cholera, experience showed, that it has therefore, at any time of the year. This mieans never been of the same epidemiological im- http://pmj.bmj.com/ that pilgrims are subjected to the severest climatic portance in pilgrimage as cholera. In all these conditions ranging, according to the date of the ' infected' pilgrimages, plague appeared mainly pilgrimage, from the merciless winds of a desert among the inhabitants of the Hedjaz. Victims winter to the fiercest heat of summer. It is not among pilgrims were few. The preventive anti- surprising that heat stroke claims many victims rat and quarantine measures which are taken at the under these conditions. In last year's pilgrimage present time in ships can be considered a sure safe- as many as 753 deaths were recorded in one day at guard against the spread of plague. Mouna; most of these were due to heat stroke. Of all the diseases which have attacked or on September 29, 2021 by guest. Protected threatened the pilgrimage, none has been so serious The Mecca Pilgrimage and Epidemics and so disastrous as cholera. The wide spread of Pilgrimages in general, involving the collection cholera through the Mecca pilgrimage to Europe in one place of large numbers of people, have and to the rest of the world was the first alarm always been, even with the utmost sanitary pre- which led to international agreements putting the cautions, a potential source of serious epidemics. pilgrimage under effective sanitary control. With pilgrims coming from areas in which the disease is * According to some reports, the origin of the terrible endemic and subjected to conditions of epidemic of cholera which broke out in I902 has been living which could light up an infection or favour aitributed to the fact that a pilgrim had poured some its spread, it is not surprising that cholera has been Zam-Zam water into the well of his home village (Mousha, in Upper Egypt); and that from this the the worst enemy of the pilgrimage.