Morris Young,pioneer physician

Introduction

Morris Young was a medical pioneer who introduced western medicine into south-western Persia at a time when medicine was part of the modernizing process taking place in that country. Young arrived in Persia in 1907 to work for the exploration company that discovered oil in Khuzestan province in 1908. When the Anglo-Persian Oil Company (APOC) was formed a year later, Young’s services were retained.

Over the succeeding two decades Young was instrumental in developing a comprehensive medical service for company employees, their dependants, and the people of south-western Persia. Young formed close ties with the Bakhtiari Khans of Khuzestan and in 1911 was appointed as a Political Officer for APOC in addition to his medical duties. Young left Persia in 1927 to work in London, taking formal retirement in 1931 although his services as Political Officer and Medical Consultant were retained for several years thereafter. Upon retirement Young joined the team under Sir Alexander Fleming at St Mary’s Hospital in London that was developing penicillin. During the Second World War, Young worked in the Ealing sector of the Emergency Health Service’s Public Health Laboratory, after which he returned to St Mary’s. He retired for reasons of ill-health in 1949, and died in 1950. Morris Young has been acknowledged as an influential figure in Persian medical history as well as the history of BP ¹ and in this short article I propose an introduction to his career.

Historical context: Medicine and modernisation in Persia

When Morris Young arrived in Persia in 1907 the country lacked a comprehensive health care system, although qualified physicians were in practice in the major cities and towns. The origin of western medicine in Persia began in 1851 when the Qajar Shah Nasir ad-Din (1831–1896) opened the Dar-al-Fonun in Tehran. This institute for the study of science and technology also provided courses in medicine provided by Europeans, such as the Bohemian Jakob Polak (1818–1891) and the Dutchman Johann Schlimmer (1819–1881). ²

Elsewhere, health care was provided by the Society of the Lion and Sun (equivalent to the Red Cross), and by American Christian missionaries, notably Joseph Cochran (1855–1905). In Tehran the Imperial Persian Hospital was opened in 1868 and staffed mostly by Germans until the end of the First World War, whereupon it was taken over by the British and from 1922 funded by APOC. ³

By 1907 the process of modernisation had produced medical graduates from Tehran who had gone on to further study in Paris, London and Beirut. Although a Central Sanitary Council had been set up in 1868 to deal with cholera epidemics, and had been succeeded by the Persian Sanitary Council in 1904, and the Pasteur Institute in 1921, hospital provision and the training of physicians were severely criticised as being ‘of a very low standard’, while services in rural areas were effectively non-existent. ⁴

Young worked in a region of south western Persia between Arabia and India that was vulnerable to the spread of diseases such as cholera and the plague. Effective quarantine provisions on the Gulf coast were in place, but the vulnerability to epidemics remained. In the first quarter of the twentieth century there were epidemics of plague in 1904, 1905, 1917 and 1923, and of cholera in 1903, 1923 and 1927. ⁵ Malaria was a seasonal problem in the vicinity of the Caspian Sea and the Gulf, and for APOC in the vicinity of its operations near the Karun River. ⁶ Young’s patients outside the Company were mostly nomadic or semi-nomadic herders or farmers, people whose inherited superstitions and practices were far removed from the rational science of Glasgow University Medical School.

The development of oil industry in Persia

The development of the petroleum industry in Persia in the early twentieth century began in 1901 when Muzaffar al-Din Shah (1853–1907) and William Knox d’Arcy (1849–1917) signed a petroleum concession. William Knox D’Arcy was an Englishman who had made a fortune in gold-mining in Australia, and when his company failed to find oil and experienced financial difficulties in 1905, new backers were found in the Burmah Oil Company. The first commercial oil field in the Middle East was discovered in May 1908, and APOC formed in 1909 to develop these resources. ⁷

The south western province of Khuzestan in 1908 was remote from the centre in Tehran, and was dominated by members of the Bakhtiari tribal confederation. Although the Bakhtiari were acknowledged masters of their domain and had their representatives at court in Tehran, they were neither fully integrated into the state, nor fully integrated with themselves. ⁸ The weakness of the Qajar state conceded local power to the Bakhtiari and other outlying tribes, but when they attacked and robbed the oil exploration team the India Office organised a detachment of troops under Lt Arnold Wilson who arrived in the field in January 1908. ⁹

The provision of health care based on western concepts of medicine was part of the ‘modernising’ process in Persia, but at ground level was part of APOC's transformation of the physical and social infrastructure without which a modern oil industry could not function. Following the discovery of oil and the formation of the Company, installations were built in the field to recover oil from the sub-surface environment; a 138-mile pipeline was laid down to transport the oil to the coast at Abadan where a refinery was built in which to transform crude oil into commercial products, with an adjacent port from which to transport its products to European and world markets. APOC transformed what had been a coastline of mud flats and palm trees into Abadan, a large industrial metropolis which by 1950 contained the largest refinery in the world.

In order to maintain a healthy workforce in a harsh environment, services were developed out of the most basic provisions until a network of hospitals and dispensaries linked the producing areas up country [‘Fields’] to Abadan, providing care for workers and their dependants, as well as local people. From this point of view, health care provision was an essential component of the petroleum business. Morris Young was therefore an integral part of medicine, modernization and the private enterprise that paid for it.

Morris Young I: The Anglo-Persian years

Morris Young (Figure 1) was born Mosche Youdelevitz on 17 July 1880, almost certainly in Kremenchug in the present-day Ukraine, at that time part of the Russian Empire. He was the eldest son of Reuben Youdelevitz (1862–1933), one of the Jews who made the first Aliyah to Palestine in the 1880s as a committed Zionist, and with members of the Halutzei Yesud HaMaala (Pioneers of Jewish Settlement Committee) created the village of Rishon Le-Zion in 1882. ¹⁰ Mosche Youdelevitz spent his childhood in Rishon Le-Zion and described his father as a ‘colonist farmer’. OPEN IN VIEWER

He arrived as a student at the Medical School of Glasgow University in 1900, and remained there for six rather than the customary five years, failing to take his exams in 1903. For most of this year he raised funds working as a doctor for a railway survey party in the Luristan province of Persia. ¹¹ In Glasgow Young lodged with the Rubinstein family at 38 Hill St in the Garnethill district.

At the time Glasgow University Medical School was one of the most progressive in the UK. Since the 1880s it had admitted women students, one of only four in the country to do so, the others being in Edinburgh, Dublin and London. The School also had a reputation for emphasising the relationship between clinical practice and a thorough knowledge of laboratory based science. ¹²

Young arrived in Glasgow at a time when its Jewish community was expanding; by 1905 there were approximately 8000 Jews in the city, mostly immigrants from the Russian Empire. He graduated in July 1906 having won six prizes in his student career. In February 1906 he applied for and received British nationality as Morris Youdelevitz Young, formerly a citizen of the Russian Empire. ¹³

In April 1907 Young was hired by the Concessions Syndicate Ltd as physician in Persia, to replace an Indian doctor, Raja Desai. Young left the UK later that month for Persia via Bombay where there had been an outbreak of plague. Consequently, upon arrival in Mohammerah on the Gulf coast, Young was quarantined in harsh conditions for 10 days before making the next part of his journey to Ahwaz, the town closest to the exploration project in the mountains of south-western Persia. From there Young travelled north by river-boat to Batwand, and overland to Masjid-i-Suleiman. ¹⁴

From the beginning the provision of health care for the exploration team was essential. Most of the men who worked in Persia in those early years were British, Canadian or Polish citizens of the Austro-Hungarian Empire. Lt Arnold Wilson (1884–1940), in charge of security at Masjid-i-Suleiman noted that by May the daytime temperature from 9 am to 5 pm was 110°F (43.3°C) in the shade. Heatstroke was a prominent problem, accidents were not uncommon, while chronic illnesses such as diarrhoea and related intestinal problems were caused by poor quality food and water. The principle was established that health care would be provided free of charge for company employees, their dependants and local people.

Young visited the outlying areas, often travelling two and half days to reach small villages and settlements. His introduction to the health profile of the settled and nomadic population revealed

‘… Men wasted by long-continued dysentery; women with serious breast affections; children with the characteristic disfigurement of severe chronic malaria, which would be grotesque were it not so pitiable; gangrenous wounds smothered with ordure; ugly, festering limbs, mutilated as a result of shark bites – these were typical cases. ¹⁵

In February 1909 Young was asked to attend the eight-year-old son of Shahab-es-Sultana, a leading Bakhtiari Khan. Over a few days the boy’s health improved, and with it the Company’s relations with the Bakhtiari. Young’s demonstrable skills in medicine and diplomacy led to an overhaul of the Company’s relationship with the tribes. The Indian Army detachment that had provided security in Fields was withdrawn and replaced by a more formally organised guard drawn from the Bakhtiari. As a result of this in 1911 Young was appointed as a Political Officer in addition to his medical duties. ¹⁶

Between May and July 1910 Young attended the London School for Tropical Medicine. During this sabbatical Young was offered a position in West Africa with a salary of £1000 a year. The Company by this time knew that Young was important to them because of his medical and diplomatic skills, and as the man most respected by the Bakhtiari. They were unable to match the West African offer, but he accepted an increase in pay to £600 a year for the succeeding three years. ¹⁷

In 1917 APOC constructed buildings to be used as hospitals in Masjid-i-Suleiman and adapted a building in Ahwaz for use as a hospital. ¹⁸ In 1924 Young was placed in overall command of the Company’s newly created Medical Department, and his primary concerns in Persia at this time were the health of employees, and the training of his staff. Much anxiety was caused in 1924 with the death from heatstroke of four European employees even though it seemed they had become acclimatised to local conditions. Young also wanted to recruit junior doctors and provide them with experience in the field and training at the London School of Tropical Medicine. ¹⁹

By 1924 the Company was operating a 64-bed hospital at Masjid-i-Suleiman comprised of five wards divided by nationality and rank, which meant that in addition to separate medical and surgical wards, Europeans and clerical grades (mostly Armenian and Indian), were kept apart from ‘natives’. Additional facilities included a consulting room, a surgery, x-ray equipment, a bacteriological laboratory and a dispensary. In addition to the medical officer in charge, there were two more medical officers, a matron and between five and six nursing sisters. Ancillary staff performed duties as orderlies, dressers and cleaners. A four-room building acted as an isolation unit.

The first hospital that APOC built at Abadan, also in 1917, was a galvanised iron structure imported from the UK, with a 16-bed capacity for European and clerical grades, while a nearby and dilapidated building was taken over as an extra unit. In the 1920s, in Abadan town the firm’s Persian employees had a 60-bed hospital. These buildings had the same range of facilities and staff as the hospital at Masjid-i-Suleiman, but Young conceded that by 1924 the facilities in Abadan town had not kept pace with the expansion of the population. In addition there was an isolation unit at Abadan that was deemed important for cases of quarantine and infectious disease although the building was little more than a mud-brick construction. Elsewhere, there were dispensaries at various locations between Abadan and the oil fields (Figure 2), and the hospital at Ahwaz, with an isolation unit south of the town at Kut Abdullah. ²⁰ OPEN IN VIEWER

By 1926 the facilities in Abadan had deteriorated further and Young began the process of promoting plans for a new hospital for the company town. With the growth of Abadan the location of the original hospital close to the sprawling bazaar was considered to be a threat to health. The hospital was too close to the water table giving the building a pervasive dampness, while the growth of the refinery complex added toxic fumes and odours to this unhealthy menu. The key proposals were thus to change its location as well as provide a fully-equipped building, with on-site accommodation for the nursing staff. The upgrading of makeshift premises in nearby Mohammerah was rejected to ensure hospital facilities within easy reach of the refinery and town, but it took several years for this plan to go through its planning stages. ²¹

Building on his proposals for Abadan, in 1930, Young, who by this time had returned to London, his position in Persia being taken by Dr E Jamieson (1889–1962), drew up a plan for the wider re-organisation of the Company’s medical services in Persia. The fundamental aim of the re-organisation was to upgrade the Company’s buildings, and improve the range and quality of health care with particular attention to heatstroke and infectious diseases.

A key policy change was to provide more dispensaries in the fields in order to reduce the need for hospitalisation. In Abadan the growth of the population in the town to 60,000 required more extensive changes. Here, £67,000 was allocated for a new Works Hospital with 120 beds, four wards of 30, a special treatment clinic, a new operating theatre and a heatstroke unit, while £15,000 was allocated for a dispensary which was expected to treat about 500 patients a day. The growth of Abadan meant that APOC was providing the only health care for a radius of 100 miles other than in the Arab town of Basra, ‘which’, as Young pointed out ‘is more or less a closed door to the Persians’.

A major concern was the need to create a sound infrastructure to deal with infectious diseases. The Gulf area between the Indian sub-continent and Arabia had been notorious for years as a transport route for diseases such as plague and cholera. In addition to this were the rat-infested date groves on both sides of the Shatt-al-Arab waterways. Even with APOC’s ‘stringent sanitary measures’, 1000 people had perished in one month during the cholera epidemic of 1923. The isolation facilities at Abadan were two paddle boats moored offshore. Quarantine facilities were taken over by the Persian government in 1928, but the Company maintained its own. Clearly the need was for an infectious diseases hospital with capacity for 130 patients, as well as a public health officer with authority to organise campaigns of immunisation among the residents of Abadan. The cost of these facilities was in the region of £32,000. ²²

Although some progress was made in the implementation of the re-organisation plans, the full project was undermined by the economic recession which followed the Wall St Crash of 1929. It was inevitable that cuts would have to be made to the budget, and that they would affect staffing, as this was the single most costly item. An intense scrutiny of the funding by Young and Jamieson produced three options, of which the first was chosen. This would see reductions of staff and expenditure equivalent to a cut of 42% on proposed expenditure for 1932. The drugs and medical supplies bill was the second highest item. In the early days drugs had been supplied from Britain and India, whereas by the 1930s medications were made in Persia, though Britain and India continued as a source of supply if local drugs were not available. Medical supplies and equipment were purchased mostly from either the Glasgow based firm of Baird & Tatlock, or the London firm May & Baker. ²³

In addition to these budget cuts, Young at the end of his formal career with Anglo-Persian (from 1935 the Anglo-Iranian Oil Company) was concerned with the high turnover of doctors and nurses. Admitting that ‘it is not easy to get good doctors to go to Persia’, he worried that if doctors (and also nurses) did not remain for any length of time, ‘there will not be much backbone left to support the structure that has been built up during all these years’. The conditions of life were not poor; efforts were made to provide comfortable homes, recreation and good food, though a lot was imported in cans from Europe and America. But free time was regulated by the Company, and southern Persia between the two World Wars could be a bleak, and in high summer an uncomfortable environment in which to work. ²⁴

The end of Young’s formal career with the oil industry coincided with the great depression. But the funding cuts Young supervised in the year before his retirement merely slowed the pace of development. The return of economic health and the discoveries of new oil and gas fields in Persia meant that between the mid-1930s and the end of the Second World War health services grew on Young’s foundations.

By 1950, Abadan had grown into a metropolis with more than 150,000 residents, with a general hospital containing 400 beds, an isolation hospital with 100 beds and 17 clinics. Field operations at Masjid-i-Suleiman were served with an 85-bed hospital; the field operation at Agha Jari was supported with a 50-bed hospital, with a further 17 clinics in the field areas and along the pipeline routes. By 1950 the company was negotiating a joint venture with Abadan municipality to spend £490,000 on a Municipal Hospital in the town. ²⁵ All of these developments took place on the basis of the company’s commercial success, yet it was the sound and methodical practice of Morris Young which laid the foundations of this crucial part of Persian life.

Morris Young II: Retirement, Fleming and the War

Retirement from APOC did not end Young’s devotion to medicine. In his private life Young enjoyed holidaying in France, and entertaining at his apartment in Kensington where he played the piano, and where a regular stream of visitors including many from Persia would call for advice, or to bring news of old friends.

But it was Young's dedication to medicine that led him to spend most of his retired years working with the team at St Mary’s Hospital under the leadership of Sir Alexander Fleming (1881–1955), where he worked on the development of penicillin, although Fleming – a man as modest about his achievements as Young-claimed that Young was drawn to St Mary's by his admiration for the work of Fleming's illustrious predecessor, Sir Almroth Wright. ²⁶

In 1938 Fleming was asked by the Ministry of Health and the Medical Research Council to draw up proposals for an Emergency Pathological Service for the London area to be used in the event of a major war. The aim was to create facilities that would be able to cope with the outbreak of epidemic disease, or any other potential health hazard associated with war. ²⁷

At this stage, Fleming envisaged Young, and another colleague, AB Porteous (1886–1967) as part of a laboratory to be set up in Eton. Both were experienced men but too old for military service. By the autumn of 1939 the plan had been revised and Young and Porteous were re-assigned from Eton to create the Emergency Pathological Service for District Six covering areas of West London including Hammersmith, Ealing and Hillingdon. The pair were seconded to the King Edward Memorial Hospital in Ealing, but as it did not have specialist laboratory facilities a converted house was used instead. ²⁸ Porteous was the Chief Bacteriologist and entitled to £800 a year, Young his assistant entitled to £500 a year, but in fact he declined to accept the salary and worked for free. ²⁹

Young returned to St Mary’s after the war and worked there until May 1949 when bowel cancer forced him to resign. ³⁰ On his death in May the following year, Fleming sent an appreciation to the Anglo-Iranian Oil Company, in which he stated:

Dr Young had three outstanding characteristics. He had unfailing energy – having started a task he would work until its completion and would never acknowledge defeat, no matter how much effort or personal sacrifice it required. He was never influenced in any way by the importance or otherwise of the persons with whom he was in contact, and all received the same painstaking treatment and consideration at his hands.

He never looked for personal reward. For 18 years he worked at St Mary's and in the E.M.S. in a purely honorary capacity and his unflagging devotion and keenness provided a wonderful example to the younger workers. ³¹

Conclusion

Morris Young – born in the Russian Empire, raised in the Ottoman – migrated to Glasgow and became a British citizen, devoting his life to the promotion of good health and practical health care. He is an unusual figure compared to his contemporaries. At a time when many, if not most, of the European and American doctors in the Middle East were allied to Christian missionary causes, Young was a Jew, and employed by a private company. Indeed, the role that private enterprise has played in the creation of both a physical infrastructure and the provision of health care has been underestimated in the Middle East, where the development of oil is more frequently discussed in political rather than social terms. The provision of medical care in south western Persia by APOC was not charity or altruism, it was a necessity. The field of operations was a harsh environment where accidents happened, and where illness and disease were constant threats. Whatever indigenous medical practices took place among the nomadic tribes and the sedentary farmers would have been inadequate for Europeans and North Americans, yet the local people, over time, did benefit from both a new health regime and a radically different and industrialised economy from what they had previously known. By the 1940s, the Iranian state had acquired the expertise and the revenue to take greater responsibility for public services. In the early years of the twentieth century, it was private enterprise that initiated the most significant change to the Persian economy and society in modern times.

The most important contribution of Young to life in Persia was his ability to demonstrate the integrity of a medical doctor to people for whom western medicine was something new. The effective care that was provided by Young and his successors in the APOC cemented a relationship that went beyond religion and nationality and indeed the commercial aims of the firm. Over a hundred years after Young first entered the field, the services he provided have become part of the fabric of Iranian society. The role that he played in this history was a contractual duty, yet shaped by Young's humanity, and the exemplary dedication to medicine he maintained for the whole of his life.