Friday, April 27, 2012

The man who battled Israel’s most formidable enemy — the mosquito

Israel Kligler is one of the reasons Israel exists. So why have you never heard of him? By Matti Friedman Ninety-two years ago, a diminutive and determined young scientist stepped from a boat onto a “notoriously malarious” patch of Levantine land and into the middle of a losing war against a tiny, deadly enemy ravaging the population. Israel Kligler – university professor, Zionist and public health pioneer – played an outsize role in defeating malaria in Palestine beginning in the 1920s. Countering the mosquito-borne disease was not a minor medical success but a crucial victory that paved the way for the growth of Jewish settlement and the eventual establishment of the State of Israel. Today, Kligler and his role in Israel’s history have been forgotten. April 25 is a fitting date to remember him: This year, it happens to be both the eve of Israel’s Independence Day and World Malaria Day, marked every year by the UN’s World Health Organization. Thanks in large part to Kligler’s efforts, malaria was eradicated in Israel, but the global battle against the disease has been remarkably unsuccessful: Every year, according to the WHO, malaria infects 216 million people and kills 655,000. Kligler has a small number of vocal boosters, and they believe his success should both earn him a place in the Zionist pantheon and be studied anew as the world continues to grapple with the disease he confronted nearly a century ago. Born in what is now Romania in 1888, Kligler moved with his parents to New York City when he was 9. In 1920, having completed a doctorate in public health in New York and research on malaria in South America, he gave up a promising academic career in the US and arrived instead in British-ruled Palestine, committed to putting his scientific knowledge at the service of the Zionist project. He found a land devastated by malaria. The illness was, a British report said in 1921, “by far the most important disease in Palestine.” Much of the territory Jews had purchased for settlement was in lowlands infested with malaria — that was one of the main reasons it was available — and the disease was decimating the ranks of the Zionist pioneers and the country’s other inhabitants. Some settlements had been abandoned altogether as a result. One visitor in 1902 remarked that the Turkish soldiers at one border garrison had to be replaced monthly because all would contract malaria in little over a week. A report from 1917, the year the British arrived, noted that Palestine was “notoriously malarious,” and an estimated 90 percent of British soldiers at the town of Beisan — today’s Beit She’an, in the Jordan Valley — were ill within 10 days. “There is little doubt that the static condition of Palestine during the last several centuries is due almost entirely to malaria,” Kligler himself wrote a decade after his arrival. “The once famous city of Beth Shan, standing in the midst of an intensively irrigated plan, was in the course of time completely surrounded by water-logged marshes, became one of the most malarious points in a highly malarious area, and dwindled to a small village,” he wrote. “One sees large stretches of richly watered, potentially cultivable land inhabited only by a few Bedouin tribes, all infected with malaria, and eking out a precarious existence from the proceeds of baskets made of marsh reeds, and from the milk of buffaloes which wallow in the marshes.” If the Zionist project was to succeed, this had to change. At the time, malaria was treated chiefly by administering quinine tablets, made from the bark of the South American cinchona tree. “Keep quinine at work, at home and on a journey,” new immigrants were urged by a message printed on the back of Palestine entry permits, which added that quinine was “the best way to protect” themselves from the disease. “The mosquito is your enemy,” read the text. “Try to stay away from it.” This wasn’t working, and Kligler had a different idea: Efforts needed to concentrate not on humans but on the mosquitoes, and malaria could be not only endured but eliminated. The Malaria Research Institute that Kligler helped set up, which eventually had hundreds of workers, began draining marshes and spraying areas where they found concentrations of larvae. He developed ways of dealing with the different kinds of mosquitoes, and thought up methods like periodically changing the direction of water flow in an irrigation canal to eliminate the mosquito population breeding inside. Combined with a general improvement in public health under the British Mandate, the results were striking. In Jerusalem, for example, according to British statistics, 633 people were treated for the disease in 1923. The following year, the number had dropped to 347. Four years after that, in 1928, the number was 16. In 1925, the League of Nations Health Organization — the precursor of today’s World Health Organization — sent its Malaria Commission to Palestine; a resurgence of the disease in Europe after the First World War had made it a pressing concern. The members of the commission met Kligler and were struck by the success of his program. The anti-malaria work in Palestine, the commission wrote in its final report, “by destroying pessimism, raising hopes, and, when the time is ripe, by providing us with much useful experience, becomes a welcome and invaluable addition to practical malariology, and the men who carried it out can be regarded as benefactors not only to the Palestinian population but to the world as a whole.” As a direct result of the campaign, land that had previously been considered barely inhabitable could be settled. By the time Kligler died in 1944, at age 55, the disease was in steep decline. By 1967, Israel had been declared entirely free of malaria. At the time of his death, Kligler was a known figure. “In Prof. I. Kligler’s untimely death,” wrote Hadassah Hospital’s newsletter in 1944, “the Yishuv and the Land lost not only a man of action and ability, but first and foremost a committed and faithful Zionist.” Today, two Kligler loyalists are waging a lonely battle to restore him to what they see as his rightful place in the history of Israel and of the fight against malaria. One, Anton Alexander, is a retired London lawyer who encountered Kligler’s name for the first time two years ago while helping organize an exhibition on Israel’s science accomplishments. Since then, Alexander has been something of a Kligler evangelist, setting up a website and promoting the scientist and his accomplishments. “Kligler saw that either they tackled malaria or the Zionist dream would collapse,” Alexander said. “It’s doubtful if there would have been a state had they not done it.” Googling Kligler’s name, Alexander found an Israeli scientist, Zalman Greenberg. Greenberg, the retired former director of the Health Ministry’s Public Health Laboratory in Jerusalem, shared his sense that Kligler had been unjustly overlooked and had been amassing material about him for several years, including three days spent photographing documents in the White Plains, NY, attic of the scientist’s daughter-in-law. Greenberg is well-versed in Israel’s medical history — he is the author of a 1,500-page bibliography of all microbiology research in Israel in the last two centuries. Kligler, he said, stands alone. “There were none like him,” Greenberg said. “It’s a disgrace for our historians that he has been overlooked.” Kligler was forgotten in part because his colleagues at Hebrew University appear not to have liked him very much, Greenberg said, and while other medical pioneers were memorialized — notably Hillel Yaffe, a Zionist doctor who also battled malaria and who has a hospital named for him — Kligler was passed over. Today, nearly no one has heard of him. Kligler’s legacy is significant not only for Israel but for the ongoing effort to eradicate malaria worldwide, said Bart Knols, who runs Malaria World, a Holland-based forum for experts on the disease. Medical professionals still waiting for a malaria vaccine to solve the problem might learn something from Kligler, he said. “The lesson to be learned from all this is that even without a vaccine malaria elimination is feasible,” Knols said. “Malaria in Palestine in those days was as bad if not worse than malaria seen in many parts of Africa today. “What we lack today and had back then is determination — the belief that we can do it, and the will to work under the hot sun,” he said.pril 25, 2012

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