A number of years ago, while doing genealogical research at the family history center of the Mormon Church, as so often happens, the researchers began discussing the where and who of ancestry. Upon hearing of my Armenian ancestry, a woman stepped forward to say that her aunt had been a doctor in the Near East Relief. In the course of our talk, she indicated that her aunt had taken some notes of her time during and after World War I. As her aunt had spent some time in Dikranagerd (Diyarbekir), where my grandmother had been born, I was interested in seeing the accounts and she was kind enough to send a number of items to me. I thought the readership of the Armenian Weekly would be interested in the story of Dr. Abby Noyes Little.

Abby Noyes Little was born and raised in Newbury, Massachusetts. After one year at the Children’s Hospital Training School for Nurses in Boston, she entered the Women’s Medical College in Philadelphia to become a doctor. After graduation in 1894, she returned to Newburyport to open a practice and serve on the staff of Anna Jacques Hospital.

After the death of her parents in 1916, Abby moved to the mountains of Kentucky to work in the Pine Mountain Settlement School and travel the countryside treating trachoma and hookworm.

In 1918, Abby heard the call of the Red Cross for hospital workers in France while World War I was still raging. Having served only six months of her one year tour of duty by war’s end, she was assigned to a Red Cross unit heading to Jerusalem.

Abby spent the next 4 years in the Middle East and it is her account of this time that will follow. Upon her return to the States, Abby went to work at the Laconia State School in New Hampshire. In 1952, she was honored by the citizens of Laconia for her years of service in caring for mentally handicapped children. She died the following year, the newspaper account opened, “a long life, rich in giving and in sharing, came to a close last week with the death of Dr. Abby N. Little.”

So often, when reading of those horrendous days of genocide, despair, and destitution, we lose sight of the people involved, both as sufferers and as those whose kind heart and morals drove them to risk everything so that the lot of the destitute might improve. Hopefully, these reminisces, in Dr. Abby Noyes Little’s own words, can remind us of these brave and caring people.

Some of the language reflects the times written and may seem harsh both from today's standards and also when viewed by those whose families were part of the suffering masses. Yet we cannot forget that seemingly callous comments are being written by those who placed their lives on hold to travel across the world aiding people they had no particular tie to other than humanity.

As Armenians, we often hear comments implying the Armenian Genocide is not part of United States history. As you will soon read, Dr. Abby Noyes Little exemplifies the contrary - the Armenian Genocide represents a very important part of the humanitarian history of this great country.

George Aghjayan

[Note: I have retained the text as originally written. Comments in parentheses are as she wrote, however notes contained within brackets indicate Dr. Little’s own handwritten comments in the margin of her original typed pages]

The first account by Dr. Little was apparently written years after her return to the United States. References contained within the text indicate she had made corrections as late as the 1950's and near her death. Possibly the occasion of the Laconia award prompted her reflections.

Work and Pleasure, from July 1918 to August 1923.


Abby Noyes Little, MD

"Join the Red Cross and see the world", we used to say, and while I did not see the whole world just because I signed up in 1918, it is true that the act led me into far wanderings.

The First World War was going on, I felt that I could do more abroad than here at home and to fill a need which they said was urgent, I took a three months course in laboratory work. This was given in New York, most of it at the College of Physicians and Surgeons.

So on July 13, 1918, I passed through the high board fence surrounding it and on to the Adriatic, which was rapidly filling up with troops, men and officers, Red Cross Units, Army nurses, YMCA units, and a few civilians. One or two of the latter from New Zealand I especially remember, they seemed so much more like our own countrymen than the English of whom there was a sprinkling. We sailed the next day, a convoy of a dozen or so troop ships, with a cruiser escort. We had the usual lights out, drills, carrying life-belts, etc.

Landed in Liverpool, July 26. On to London the next day and Berner's Hotel. I went directly to the Rule's in Salisbury. Saw Herbert who was training on Salisbury Plains the next afternoon. I had a glimpse of London, reminding me of Dickens, saw outside of British Museum, Lote Withington's old haunt (the building was closed for the War), Westminster Abbey, etc.

Crossed from Southampton by night, rough, and landed at Le Havre and so to Paris about the 1st of August. Arrived after dark, and was whirled by auto through the dim bluish-lighted streets to the hotel.

I lived for a time at 41, 43 Rue Galilee, Pension Galilee, learning my way about, doing a little laboratory work at a TB clinic, and waiting for a more permanent appointment. It came sometime in September to Red Cross Hospital #9, Evreaux, Eure, in Normandy, way back of the firing line though we got freshly wounded men. I have postals and snaps of Evreaux but no notes, for diaries were taboo. My work at first was mostly etherizing, later I was given charge of two tents, French boys, Algerians, Senegalese, etc. And I was at the Armistice!

January 1, 1919, the Hospital was turned over to the French MD's and we returned to Paris. During January I lived in a Red Cross house, awaiting orders of discharge, as I had signed up for a year. I enjoyed much of Paris, saw ruined Rheims, haunted Red Cross headquarters, tried to get on the Polish Unit then forming, but was finally sent to Palestine. Paris when I first saw it seemed like an empty city, only the military around. But now, two months after the Armistice, the civilians were coming back, and I was glad to see it full, gay, and resuming its prewar habits, even to wanting to get rid of the foreigners!

One day around the first of February, I think the 4th, a unit of a dozen or so left Paris for Palestine. The unit was made up of doctors and nurses mostly. We separated almost immediately on reaching Jerusalem, and I have not kept tract of any of them.

We took a night train, and awoke the next morning at the edge of the French Alps. Breakfast at Chambery, and so through the marvelous snow capped mountains to the frontier at Modane, which makes me homesick for Pine Mountain. A short stop at Turin, and so on to Rome.

Rome! A grand old city, my few days there among the highlights of the whole 5 years! The age, the solid stability, the history, the beauty, the courtesy and dignity of the people, the strength and grace of the soldiers, green-gray clad, all impressed and delighted me. What memories! Again I have no diary, only postcards with notes on the front.

We left Rome after five days or so, there was always much red tape at every stop, and ran down through the vine-clad hills, so geometrical and well cared for, to Taranto just in the instep of the boot. Not an attractive place, I think we stayed only about 24 hours before taking the Malwa for the crossing of the Mediterranean.

We ran into a storm and the worst sea I have ever seen. Practically everyone was sick, and glad to reach Port Said, February 16. Interesting place with its fine harbor and de Lesseps monument.

From Port Said to Cairo by train and the famous Shepheard's Hotel. A fine hotel with all the luxuries of peace time, Egypt was not in the war, but O, the indescribable filth and squalor all around, babies everywhere with their eyes swollen tight, running with pus of trachoma, and black with flies! We visited the extensive, oriental bazaars, the mosques, the castle, the Sphinx, the pyramids, spent a cold night in the desert, etc. But I was glad enough to leave the dirty city and take a train for Palestine. [I think this trip was made in a boxcar.]

We crossed the Suez, the Plateau of Sinai, and so up the coast to Jaffa. From here to Jerusalem by auto. Here I expected to stay for 6 months, but I remained only a month. We were housed in the Russian Hostel, a stone "hotel" with groined arches in each room. The hospital was near by, I went to work at once, treating everything, but I remember especially the sore eyes, the awful trachoma. Operations on them daily. My old classmate, Dr. Caroline Lawrence was there ahead of me, the first time I had seen her since our graduation in Philadelphia in 1894. With her I walked down one Sunday to Bethlehem, 5 or 6 miles away, and saw the Church of the Nativity, the big bleak building shared by 3 sects, the Coptic, the Latin, and the Armenian, I think. An English Tommie sat by the grotto, the supposed birthplace, because as he said, "There had been a bit of trouble there." We thought then that the English, being in control, there would be no more "trouble" there. But alas, it is greater and more bitter than ever!

Beside Bethlehem, there were other sacred places that I saw too briefly, the Church of the Holy Sepulchre; the Via Dolorosa; the Mosque of Omar; the Wailing Wall; Pilate's house; some of the excavations; the Dead Sea and the Mount of Olives; the walls and the beautiful gates; in the distance the Garden of Gethsemine, I never could persuade myself to go inside; the Pool Siloam; the bazaars and markets. Most of these places are within the walls, we lived outside. It was a marvelous experience, in spite of the dirt and commercialism, there was a feeling of sacredness and mysticism, 3 great religions centering here, why could they not agree or disagree?

From now until my coming home in the summer of 1923, my staying was just 6 months or so at a time, with a continual change of residence. I had expected to remain in Jerusalem until July when my year was over and then go home but my stay there was only about a month. We had the old Russian cathedral grounds and one day as I was going through the corridor of the Hospice where we lived, Dr. Dodd who was then in charge, called to me and said, "Well, we are going to send you north right away. There has been a call for a unit for Aleppo and further north." Was I surprised?

I do not know just when I left but it was by auto early in the morning for Haifa. A beautiful ride, mild, spring flowers everywhere, early cultivation beginning. At Haifa we could see old Acre across the bay and we left 2 or 3 of the unit to go there. The rest of us took the railroad across the fertile Plain of Esdraelon, seeing Mt. Carmel in the distance and Nazareth on the hill to the north and so coming to the Jordan. I had seen it at Jericho, east of Jerusalem, hot, flat, sandy, dirty, almost repulsive. But here to the north it was a narrow, deep, rushing, stream, fertile and beautiful. The railroad bridge had been blown up, and we crossed on a catwalk, to another train on the east side.

Then north to Damascus, where we stopped a day or two, finding some Red Cross workers who were most hospitable. The Pharphar! And the Abana, the fascinating Oriental City, the bazaars, the gardens just outside watered by the two rivers which run through the city, the "street called Straight" and the memories of St. Paul. The time was too short and I never got back to the marvelous city!

From Damascus we followed up the valley of the Orontes with its wheat fields, and its groaning water wheels, through Homs and Hama, and finally to Aleppo. I do not know just what day we left Jerusalem, but I find a postcard to “Mrs. George Little” from Aleppo dated March 24, 1919, saying “Have been here two days – quite busy – but they say they are going to send me farther north to Aintab.” THEY DID, but just how soon I do not know, I only know that my first real work was in Aintab.

Aintab was an old missionary center of the American Board, indeed, the whole country from here north and east was dotted with mission work and a few missionaries who had managed to stay during the entire war. We found in Aintab, Dr. Hamilton, a woman, and Miss Trowbridge, kindly, busy, valuable for advice and contacts, but very conservative and horrified at our ankle length skirts (!) and breezy ways. (Both now dead.)

Dr. Hamilton and Miss Trowbridge went home soon for a well earned year’s leave of absence, the Red Cross took over the compound and we went to work. Orphanages, clinics, a rescue home for girls and women, industrial workshops, distribution of relief supplies were soon in full swing. I have many photos and captions about our work here, but no journals until at the end of the year I went into the interior. Here I worked with Loretta Bigley, Elizabeth Harris, Mrs. Anderson, Miss Jillson, a returned missionary, Rev. John Merrill, and later Dr. Shepard, both missionaries, came in, there were many others of course whom I was less intimately associated with, Charlie Bailey, Bickell, etc. The English were occupying the region at the time, and we saw much of them, they gave a great feeling of responsibility and protection. Col. Keighley, Capt. Chalmers, and many lesser lights and Tommies drank our tea and ate our cakes, pleasant times for them and us!

[Had my first bout with malaria in Aintab and what a knock-out blow it was!]

While I was there the region was transferred to the French Army, who were pleasant companions, but never gave the sense of stability that the Tommies did.

My year of service with the Red Cross ended in a few months and I prepared, even packed, to go home. The American Commission for the Relief of the Near East (afterward shortened to Near East Relief) was taking over. With the slowness with which the country moves it was October before I was ready to leave and by the very auto that was to take me “out” to Aleppo, my first lap, Dr. Lambert then in charge of the District came up and asked me urgently to stay. There seemed no special reason why I should not, the need for medical work all through Turkey was immense, so I signed up with the new outfit. It was another four years before I saw America! There are various letters telling of my work in Aintab, and of my uncertainty about going home or staying, apparently I decided only two or three months at a time. Everything was uncertain, the political situation was tense, the French gave far less efficient control than the English, indeed, fighting began between the French and Turks within a few months, in Marash and Urfa, the French finally withdrawing. This was probably the beginning of the Turkish resurgence, and it was not long before we began hearing the name “Mustapha Kemal.” [He was a Turkish Commander during the war fighting Allenby all the way up the Jordan Valley and beyond. A very able man!]

Mustapha was almost a legendary figure for a long time. We would hear stories of him, near or far, now with 100 men, now with 10,000. Once I was held up in Aleppo, on my way into the interior because of his raiding soldiers on the road. He did his fighting along the coast and a few miles inward. Once we crossed his lines the country was perfectly quiet and we were quite safe.

To return to my own life, along in the fall of 1919, Dr. Shepard returned to take over the Aintab hospital, and the rest of the medical work, freeing me to go elsewhere. They sent me to Diarbekr, perhaps 200 miles in the interior, across the Euphrates and on the banks of the Tigris. And in spite of changes for work and pleasure this was more my home than any other until I left the country in 1923.

My first trip into the interior was less unique than any later one, for I went by railroads, said to have been built by the Germans with a fine steel bridge across the Euphrates (it was blown up by the French or the Turks in the subsequent fighting). We crossed the Mesopotamian plain and I left the train at the foot of the mountains on the west near or at Mardin. Here they met me by auto and took me up the steep road to the old city, and landed me at the American Missionary compound. The relief work was well established here, Miss Fenenga, Miss Truax, Miss Kershner, Mr. Zimmerman, Mr. Wallace, and I think one or two others. Because of delays, visas, trains, etc, it was nearly Christmas before I reached Mardin, about 60 miles south of Diarbekr. I think I spent Christmas there, and left two or three days after [for Diarbekir], for I find a diary beginning January 1, 1920.

I know the going was bad [and it was! Perhaps ½ way by truck and then] on horseback, a bitter journey, something like 60 miles in all cold, rough, muddy and rocky in places, a long, hard day. Mr. Wallace went with me, an interpreter, and two or three others, probably Turkish soldiers. We arrived after dark, entering through the Mardin gate to the old walled city of Diarbekr, through the narrow, cobble-stone streets, high houses of black stone crowding us on each side, with never a window on the street side, no lights, it may have been interesting but was not attractive that night, except that it was the end of a most tiresome trip.

My journals begin just here, the first entry being January 1, 1920. They are very sketchy, but to any one who cares to follow my life in the “interior” they give enough to visualize it, I think. During that first year of 1920, I had two or three trips to Mardin, about 60 miles away by auto, also a delightful trip to Harpoot, an old missionary center, taken over as was Aintab and Mardin by the Near East Relief. Our interpreter, Mahlin Yusef and I went on horseback, with a Turkish soldier or two for protection, and the old Syrian Bishop or “Mutram”, who thought we protected him, and I presume we did! The trip was partly pleasure, partly business between the stations, and partly for a change for I had been having bouts of malaria again. I had had a very severe attack in Aintab, O, the cold, the shivering and the shaking! The fever was not so bad!

There are quite full notes about this trip in June, 1920. There was so much to see, to enjoy, to do, full days! Mr. Riggs, in charge at Harpoot, brought us back in his auto, and stayed a few days.

During all these months I had not heard from home, and I grew anxious. Also there was a question of closing the Diarbekr station, and I was not very well, my second year was up, I packed up to go home, and September 14th was in Harpoot again with Miss Wade (who returned to Diarbekr). This time we went by “araba”, a native carriage, like a small edition of a prairie schooner. From here I accompanied Dr. and Mrs. Ward by auto, driven by Mr. Airgood to Samsoum.

A few days wait in Samsoun where we were entertained by the Near East Relief personnel, and saw the relief work there. Then on October 10, the big Italian Trieste Liner, Praga, showed up in the harbor, we hurried packing, visas, tickets, etc, and boarded her for Constantinople. The “freight” was animals and poverty stricken natives of all nationalities. Roomed with Miss Edith Cold who afterwards spent years at Pine Mountain and we corresponded from there to here! The Stapletons, Rev. and Dr. were on board, they also landed at Pine Mountain for awhile.

At Stamboul the reply to my cable was so favorable that I decided to return to the interior, so strong was the lure of the country and work! Mustapha Kemal was coming into power at this time, and traveling was difficult. The Stamboul government was dickering with him, but his power was waxing. It was not until November 10 that we could get visas to get back to Aleppo, and a boat down the coast. Then Miss Cold and I boarded the “deadly ship”, I do not know what nationality, possibly Turkish. We steamed past Gallipoli of awful memory, saw the Plains of Troy in the distance, stopped at Smyrna, Rhodes, Adalia in Turkey, Cyprus, Larnaca, Mersin, where Miss Cold left me, on to Alexandretta, Tripoli and so to Beirut on November 22, 1920.

Thanksgiving at Beirut, then an auto trip down the coast to Aleppo December 1. It was January 20 before I could leave Aleppo, I busied myself with more or less unimportant work, and waited till political conditions settled enough to get leave to the interior. A lovely Christmas season at Aleppo, including a cable from Newburyport, “Xmas Greetings, Gould, Hale, Cushing, Todd, Shepard, Lambert, Ilsley, Walworth, Howe, Welch, Little, Dodge.” I was wild with delight.

January 20, Mr Weaver and I left Aleppo and drove to Urfa, finding Miss Holmes. Here again we were held for visas until February, it was a nice visit and I helped Miss Holmes what I could in her orphanage. Political conditions very unsettled, but Mustapha steadily gaining strength, how we could sense it! We left about February 4, going by way of Diarbekr, and so to Mardin which was to be my station for awhile. Reached there February 8, 1921.

There were five of us at Mardin the first part of 1921, though others were always coming or going. First, Miss Fenenga, an old missionary, she had been deported by the Turks during the war, but returned again as soon as there was a chance. Capable, kindly, knowing the country and customs, speaking Arabic and some Turkish, a hard worker, yet it is possible that her very presence made our situation harder, certainly we lived on edge there much more than I ever did in Diarbekr. Then Miss Truax, little, frail, devoted, and cheerful. Miss Kershner, a trained nurse, also capable and helpful, trailing Miss Fenenga like a puppy dog. I have lost track of her. Miss Truax is dead, Miss fenenga retired, living in South Dakota, I still hear from her [now dead]. And lastly, my good friend Milo Zimmerman, “Zimmie” the salt of the earth. He still writes me from Akron, Pennsylvania, telling of his good wife Beulah, and his fine family of four boys and two girls.

The work was not heavy, the orphanages and relief work were going well and much of our time was spent in entertaining and keeping good relations with the natives, civilian, military, official, and religious, Turkish, Arabic, Armenian, Syrian and Kurdish. For personal entertainment we had horseback riding and an occasional picnic. Evenings, without Miss Fenenga, we played bridge, once or twice a week, the only time I could play a decent hand.

All went well save for the greatly disturbed political condition of the country, Mustapha Kemal was tightening his grip and recruiting soldiers, but we had not learned the worth of the man then, and feared him and his regime.

About the middle of May, I had another bout of malaria which laid me low this time, evidently weakening my heart, and it was a couple of months before I could crawl around the house. There was no doctor within 200 miles, and Miss Kershner had gone for a vacation, so I had only my own solitary, biased opinion to make a diagnosis by! By the end of August I was trying to make an occasional diagnosis of other people’s illnesses. Mardin was high, overlooking the Mesopotamian Plain, and I felt the altitude had something to do with my continued lassitude and breathlessness. So I asked for and received leave to return to Diarbekr, realizing too that the work there was increasing by leaps and bounds because of the Greek mohojirs (deportees) who the Turks were driving down from the homes on the Black Sea. There had been a “bit of trouble” there, and the Turks were already starting their fight for Smyrna [which the Powers had given to Greece, who was occupying it].

I was back in Diarbekr January 3, 1922, thankful to be back, I did not leave it again, unless for a day or so vacation, till we left permanently in May 1923. Our work, (Miss Wade was my only American companion) was in doing what little we could to comfort and help the thousands of Greek deportees on their way from the northern provinces to Syria. They came in hordes, starving and nearly naked, many sick and dying. They turned west at Diarbekr and headed towards Beirut, many we saw then reached there. The sick and orphaned children we kept, opened a house for them, and did what we could for them, until leave came to send them in great groups to Syria, Beirut or Aleppo. The Near East Relief had decided to send all Christians possible out of Turkey, so gradually all the Armenian orphanages of the interior were emptied, and children sent the 2 or 3 or 500 miles to the coast, on foot, on donkeys, in carriages or carts, as they were able and we were able to GET. There are many passport pictures of the fat healthy Armenian children whom we had cared for a year or more, which contrast with the Greek sad little starving waifs whom we had picked up only a week or so before. At any rate we sent them clean, clothed, and with food enough to last, as well as men, housemothers, and an American with each group.

I think all the Greeks sent from the interior finally reached Greece. This country also accepted thousands of Armenians when no other nation would take them. Undoubtedly she was rewarded by recruiting many of them during the last war. However, many of the Christians remained in the Syrian area, adults as well as children. The Near East Relief was renamed Near East Foundation, and has been actively at work ever since in the entire Near East region. My big Oriental rug was made after I left in an orphanage in the hills behind Beirut. They tell me that rugs are still being made there under the direction of Dr. and Mrs. Kunzler, Swiss missionaries whom I knew well. (One of their daughters has married Dr. Marshall of Meredith, New Hampshire.) [Dear Dr. K. himself has died. In 1951, I saw Mrs. K. in Meredith, visiting her daughter.]

And so the time came when all the relief work in our region was closed, the American compound was locked and the keys turned over to Miss Fenenga, who remained in Mardin, the sole missionary in that section much of the time.

I do not know the exact date [sometime in May 1923] we were finally packed up and left Diarbekr, after the official parties and farewells, and amid the grief of the few remaining Christians. We took with us a few of our personal servants, including Jos. Jellao (Yusef), our faithful interpreter, and his family. The Near East Relief gave him work in Beirut, where he was faithful till his death.

There is a snapshot of our caravan, not very good, but showing our three baggage wagons, three yaylis (covered wagons) for us and our people, and three mounted gendarmes, to protect us by the way. The “noble” people, as Yusef used to say, never traveled without a soldier or two. My journal had to be censored and sealed along with other papers and books, before leaving the country, and the only notes I can find on the trip are on a single sheet of paper with no heading, perhaps for precaution, and I know they refer to this trip only by the mention of Bin-Bashi (captain of 1000) Mukdar Bey, at Birijik on the Euphrates. I remember that man and his hotel well. A new, well built house, overhanging the banks of the mighty river, all empty save for us and servants. He said it was built for a hotel, but was too expensive to be rented. We crossed the river on a ferry boat, high at the bow, very low at the stern to allow loading even of an occasional auto. There was a cable stretched across, either rope or wire, and the men half rowed, half pulled the boat across, guided by the cable from being carried downstream by the swift, strong current. We made it safely, to be met on the west bank by Mr. J.J. Detwiler and an auto. That was luxury!

After a few days we went on up to Beirut by rail, I think. Anyway we had a night at Baal-bek, beautiful, wonderful and marvelous ruins. I saw nothing equal to them anywhere else. Temple Bacchus and Jupiter, stones 12’ X 4’or 5’, a larger one at the quarry, not entirely cut out. Passed through Homs and Hama, with their big groaning water wheels, saw a fire in the wheat fields and so more. At Beirut our days were full of business and pleasure. Mrs. Hoskins of the Presbyterian Board offered me the charge of the TB hospital, ME a Unitarian, wonder of wonders! I did not definitely refuse until after I got home and interviewed various. We saw much of the Near East Relief work, Antilyas, Juneh, Memeltein, Nehr Ibrahim, Jebail with fine old ruins, Ghazir, Sidon with its old fortress away out at the end of a causeway, O, so much we saw!

Left on the French S.S. Madonna on July 2. A tiny boat, only half dozen or so 1st class, but stopping everywhere to pick up steerage and freight, Constantinople, Constanza in Roumania, back to Constantinople with marvelous last two days there, going all the length of the Golden Horn to the old Turkish cemetery in a row boat, Smyrna, Pireus and a fleeting glimpse of Athen, Straits of Messins with Etna smoking, Naples and a sight of Pompei, driving half way up smoking Vesuvius, through Gibraltar, past the Azores, on to the wide Atlantic and the Statue of Liberty August 1st, 1923. HOME!

In April 1929, Dr. Little wrote a speech which apparently was given to a medical association. In the speech, Dr. Little gives some account of the diseases she encountered during her tour of duty. While some of the accounts are quite graphic, I felt inclusion of her preface as well as some excerpts on diseases important.

Some Diseases Seen in the Near East

April 1929

The scattering notes to which, in the language of the pulpit, I call your attention tonight, are only memories of nearly five years work in Turkey. They are not scientific descriptions of diseases though I have tried not to make any misstatements. Nor have I to present any report of original investigations either in cause or treatment of disease.

They are only memories, vividly impressed because of the strangeness, the interest, and the bulk of the material. With the exception of a few very short and sketchy reports to Headquarters and some notes on the obstetrical cases, I brought home with me no written material to refresh my memory.

You will perceive that it is entertainment more than instruction that I am aiming at tonight.

A few words are necessary to explain why I was in the Near East and what I was trying to do. At the time of the Armistice, ten years ago last fall, I was with the Red Cross in France. Our work there having been suddenly cut short, I was sent to Jerusalem with a unit to replace a unit which had been working there for some time. I had hardly settled to steady work when General Allenby asked our Director, John Finley, to send workers north into Turkey where the need was enormous. I was one selected to go. A few months after the Red Cross transferred all the work to the Near East Relief in which organization I stayed on for four years.

And here I must pay a tribute to this society, the greatest philanthropic outpouring of money and service the world has ever seen! It has been well managed, redounding to the credit of America. It has been inspired by ideals and is scattering over the Near East from Greece to Armenia a hundred thousand young people, healthy, who can read and write, well-trained manually, and who have had ideals of character and service instilled into them. A generation of young people who are the hope and the promise of the Near East!

We did not foresee all this, however, when our little unit of a dozen workers left Jerusalem for Aleppo on that early morning in March 1919. The work at first was largely among the refugees, at that time the Armenians who since the big massacres of 1915 had been swarming over the land, starving if they could not live by begging. Soon came the fighting with France, limited in area but entailing much suffering. After we had this situation well in hand, the children gathered into orphanages, the adults largely rehabilitated, came the Greek war ending in the Smyrna holocaust and accompanied by the deporting of many thousands of civilian Greeks through the interior of Turkey. These also we came in contact with, picking out thousands of the half starved children and giving bread to the adults to save them until they could get to the coast and safety.

Through all this relief work for the very people the government was trying to exterminate, our relations with our Turkish neighbors and officials were always excellent and I did considerable work for them.

As may be deduced from this explanation, the bulk of the work was transient emergency work, though in the more organized orphanages, hospitals and laboratories were established and scientific work done. A little of this I participated in but generally I was on the firing line far out of reach of laboratories and hospitals.

Beginning at Jerusalem, I moved north to Aleppo and Aintab, then 400 miles east to Diarbekr ON THE Tigris River, and Mardin on the edge of the great Mesopotamian Plain. I saw work and did a little in various other places.

So much for introduction, now for the disease themselves.

Malaria

The disease which seemed universal in the Near East was malaria. When I was holding public clinics it seemed as if half the cases were chills and fevers. My evenings were largely devoted to weighing and folding quinine powders, for practically all our quinine was in bulk.

The typical symptoms of a fresh infection are well known. The chill, often a hard rigor, followed very soon by a high fever which in its turn subsides in from 1/2 to 3 hours leaving the patient feeling a little exhausted. But otherwise fairly well until one, two or three days later, when usually at the same time of day, the same sequence of symptoms is repeated. The fever usually reaches 104 and frequently 105 or 106, and frequently its fall is accompanied by sweating.

The most common complication which I saw was enlarged spleen. Frequently patients came complaining of this alone. I have examined many patients with spleens filling 1/4, 1/3, even 1/2 the abdominal cavity.

Quinine given in a single massive dose or in repeated small doses will cut short as if by magic the daily sequence of chill, fever and sweating so typical of malaria. To kill the Plasmodium and prevent relapses is, however, another question altogether.

I, myself, had a sharp attack of malaria the first summer in Turkey and I remember yet the deathly sickness of the cold stage. The mere shaking was not so bad but O, the overwhelming sensation of sickness! Then came the hot stage with my temperature mounting to 104, 105 and 106. This did not last long and after moderate sweating, I felt well again until the next day at eleven o'clock when the cycle commenced afresh.

Quinine controlled it in doses of 5 grams every 4 hours if I remember correctly. I continued the drug steadily for several weeks and then intermittently for months, taking it perhaps one week out of each month, and a few extra days if I was not feeling quite up to the mark. In this way I hoped to eradicate the infection entirely. It was a vain hope, however, for some eight or nine months later, the chills and fever returned and were less severe only because the quinine was begun sooner. During this attack I found I could work through a temperature of 104, though I can't say that I enjoyed it.

This personal experience made me realize what a persistent and insidious infection it was. My experience with the Greek deportees made me realize what a serious and deadly infection it could be.

My early experience had been that quinine in moderate dose would certainly control the immediate symptoms. With the Greeks it was different. They were exhausted from their trek of 400 miles south from the Black Sea, over the Taurus Mountains, with little protection from the storms of winter and half starved from lack of food. When the infected mosquitoes of our hot Diarbekr plain bit them they succumbed and many died. Quinine in the dosage I had been using it had little or no effect, and it was only when I began to give it hypodermatically that I got results.

Obstetrics

In obstetrics I never had the work that one might expect a woman would in a Moslem country where men are supposed never to penetrate the women's apartments. This was due to the fact that midwives were common and also because labor is looked at as a normal and physiological process. It was only an occasional abnormal case that a doctor was called for. A few such cases I remember well.

The first one was an emergency call from a midwife for a young Turkish presentation, with delivery of the body and delay of the aftercoming head from extension. The midwife had pulled on the body until the cervical vertebrae were dislocated and the neck stretched out into a thin cord perhaps as big as three fingers and six or eight inches long.

Under full anesthesia, the head was pushed up enough to flex it, forceps applied and delivery easily accomplished.

This case always reminds me of one I saw in the Kentucky Mountains. There also the baby died from asphyxia from the delay of the aftercoming head, but here the cause was not extension of the head but the failure of the uterine contraction to be strong enough to expel the head through the relaxed vagina. I lifted the baby's body and with no real pull at all, the head appeared. The midwife had been afraid to touch the baby. Had she had one thousandth of the courage, or perhaps I should say, the ignorance, of the Turkish midwife, she would have saved the baby.

The next case I shall never forget and if we had had a modern apparatus for the administering of carbon dioxide to stimulate the respiratory center, I think we might have saved the baby.

The patient was a healthy young American woman who had married an Armenian and who had had three normal deliveries previously. We were living then in Aintab which had an excellent old missionary hospital.

The patient had had a normal pregnancy and entered the hospital in the early stages of labor. On my first examination I was disagreeably surprised to find a transverse presentation. Dilatation was nearly complete.

I called Dr. Shepard who was in charge of the hospital to assist me and we had an American trained nurse to give chloroform, the anaesthetic universally used in the East.

I did a podalic version with no special difficulty and delivered with very slight delay of the aftercoming head. The whole operation did not take more than 20 minutes. The child's heart was beating when delivered, and Dr. Shepard took it at once and began efforts at resuscitation, at which I took my turn after attending to the mother. We kept on for more than an hour only to have the heart grow weaker and weaker and finally stop at last. I could attribute the death to nothing but chloroform poisoning. The labor was not long, the version was not difficult, the delay with the head could hardly have been over 90 seconds, the heart was beating when the child was born, why could not respiration be established?

Had we had an inhalator for administering carbon dioxide, it might have been possible to so saturate the blood that the respiratory center would have responded to this natural stimulation.

Small Pox

There is always a bill before the successive legislatures which if passed would effectively modify the present vaccination laws. One of the stock arguments I believe is that small pox has become so attenuated that it is at present a mild disease. If the anti-vaccinationists really believe that I would like to take them into our little orphanage hospital in Mardin, some eight years ago and show them our small pox children, their nostrils nearly so, their mouth and tongue so swollen that swallowing and even breathing was almost impossible. The entire surface of the body from the tops of their heads to the tips of their toes covered with crusts, puss, oozing, slimy, bleeding, nauseating, loathsome. Words fail to describe a case of small pox. It is impossible to keep the child or the bed clean, moving him for bathing or changing linen, only loosens the scabs and starts the puss and blood to oozing again, and leaves ones own hands covered with the discharges.

A few such sights in unvaccinated children while the vaccinated ones live in the next room in perfect health would seem to be enough to convert the most stubborn.

But you will ask why were not all our children vaccinated? Because the obtaining of active virus was so difficult. It has to be fairly fresh and kept on ice. At that time Turkey had no ice for nine months in the year. The virus carried from America proved to have lost its potency. Whenever we could get it from Turkish sources, it was usually good and we obtained it as fast as we could. But with the usual Turkish inefficiency, they would send in about fifty points for a population of five thousand. There never was any objection to vaccination. Mothers brought their six month old babies and begged for it, so well they knew the terror of the disease.

The cases I have tried to describe were two little children, a boy and a girl, six or seven years old, and they both lived through the frightful experience. I can see them now, convalescent, thin, wan, solemn, baldheaded, the last scabs coming off, huddling near our tiny stove to keep warm, so weak and anemic they were still.

I have seen the disease also, much lighter in character. The pustules comparatively few, the swelling slight, the constitutional symptoms hardly enough to keep the child in bed after the first few days.

A curious result is worth mentioning. In going through a camp of refugees one day to pick out the children to hold and care for, my attention was called to a girl of about fifteen who was paralyzed, from small pox, they told me. I looked down to see a pitiful little wizened scrap crouching on the ground, her knees drawn up to her chin, her skinny arms clasping her legs in an effort to balance herself in a sitting posture. She was almost naked and so thin that it seemed as if her bones must pierce the skin. Attempts to make her move, stand or even straighten her legs were in vain. Nor could her legs be passively extended.

They told me that she had just recovered from small pox which disease she had had sitting or lying in the same drawn-up, or intra-uterine posture, if I may call it so, that we found her. She had no relatives, no bed, no food, and was and had been subsisting on the charity of the other refugees most of whom were half starved themselves.

Examination soon convinced me that it was a partial anchylosis from disuse and not a true paralysis that she was suffering from. We took her into our orphanage, cleaned her up, fed her, clothed her, gave her courage and hope and inside of two or three weeks she was walking unsteadily round trying to care for the younger and more helpless ones.

Vincent's Disease, Trench Mouth

Among the Greek refugees I very early began seeing foul corroding ulcers in the mouth which I called at first noma.

The disease seemed to attack those in poorest physical condition, the thin scrawny, starving mites.

It began as a superficial ulceration sometimes on the lips, more often on the inner surface of the cheek. Sometimes single, sometimes multiple. No treatment that was available had the slightest effect. It ate its way like a malignant growth, over the mucus membrane, through the cheek, causing death from exhaustion, hemorrhage, or starvation from the inability to swallow.

I first learned its true nature from an Armenian dentist whom I called into one of our orphanages because of ulcerations beginning around the teeth of some of our children. He diagnosed it at once as Vincent's disease, said it was very common among the soldiers during the war, that it was the same thing as the supposed "noma" which I had seen and that strong chromic acid was a specific.

His diagnosis I could not check up in a technical way for there was no laboratory equipment of any sort, but his treatment proved all he had promised. Daily swabbing with strong chromic acid that I should have felt doomed without it.

Trachoma

Another of our common diseases was trachoma. It is even more common farther south, 90% of the people of Egypt are said to be infected with trachoma and from the casual observation of four or five tourist days, I can well believe the 90%. I still have vivid pictures of the hoards of half blind beggars in Cairo and of babies in every direction with their eyes running puss and black crawling, buzzing flies!

Still farther north, among the Armenian and Greek refugees, I saw much of the earlier stages of trachoma.

True trachoma is a disease which lasts for years, has many and often severe exacerbation, most serious complications while treatment can modify but only years can eliminate the disease as a dangerous contagious condition.

It is quite proper that it is one of the diseases most carefully sought for among emigrants to this country and that its presence excludes the individual absolutely.

In, our Armenian orphanages, we used to line our trachoma children up day after day for treatment, months perhaps years at a time. As time went on, the line would diminish in length somewhat, but old cases had to be watched constantly for exacerbation or some complication, like corneal ulcer.

I hope you will not think I have drawn too serious a picture of trachoma, but it remains one of the scourges of the human race, easily controlled among those with means and knowledge but spreading rapidly and insidiously among the poor, the ignorant, the unhygienic.

Three years ago the government of Mustapha Kemal Pasha started an active campaign against the disease establishing clinics, dispensaries and a trachoma institute at Adana as a teaching center for ophthalmologists and sanitary inspectors. This is a good beginning but under Turkish auspices I fear for its continued functioning. Never have the Turks put into fighting anything else the efficiency that they use in fighting human beings!

The third and final account was apparently written as a speech soon after Dr. Little's return to the United States. Unfortunately, the text was received incomplete, nonetheless I present it in that form.

Notes on the Near East Relief Work.

September 1923

"In so much as ye have done it unto one of the least of thee - ye have done it unto me."

Two days after landing in New York after five years abroad, the news of Harding's death fell like a thunderbolt. I had known little of him and had thought of him as a figurehead merely, not a man of special ability. But as I read the papers the one word 'friendly' always stood out. Coolidge's first quoted words were:

"He wished to be a friend to everyone, he wished the United States to be a friend to every other nation."

As I read the words, my mind passed in review the thousands and thousands of refugees, women and children, crawling their painful way over the wretched roads of Turkey, hot and dusty in the summer, muddy, snowy and freezing cold in winter, plodding hopelessly along, sometimes under guard of Turkish soldiers to a destination they knew not of, sometimes headed to the frontier in the forlorn hope that there might be safety and peace.

I saw the little relief stations every hundred miles or so, of two or three Americans giving food, giving shelter, giving clothes and medicine, but infinitely more, giving hope and cheer just through friendliness. I saw the thousands of orphans we have picked out of such deported groups, starving and naked and sick. And I saw the long line again better fed, better clothed with a little comfort in their faces and with deep gratitude in their hearts.

People were still starving and hundreds of refugees and orphan children wandered through every city and village, uncared-for, half naked and living on grass or bits of bad bread. In those days there was no need for a mandate, Turkey could have been had for the asking!

What happened? No powers arrived. It was left for America to show herself a friend in need. First the Red Cross and later the Near East Relief personnel were sent into all the large centers, from Constantinople to Baghdad; from Beirut to the Persian border; there to give food and work to the refugees and to gather the homeless children into orphanages. Hastily we worked and in a few months Turkey was dotted all over with American centers. Within the centers were found orphanages with from 400 to 4000 children, homes for thousands of young women and girls who had fled from their Moslem captors, and industrial plants where the older women were given work. The men were much in the minority and for the most part were left to shift for themselves as they could do much easier than the women and children. [No distinction between Moslems and Christians in giving.]

For two years the work went steadily forward. The orphanages were better organized, the adults began to find their places in the normal life of the communities, the time for marked retrenchment and perhaps for shutting off all relief work seemed at hand, when two events increased enormously the call for emergency relief.

First the defeat of the forces under Wrangel in Russia which drove many thousands of Russians into Constantinople and the vicinity. This situation, while desperate for a time, at length, cleared up by the cooperation of our own society, the Red Cross, the Mennonite Relief and other organizations. Nor did it leave any appreciable number of permanent disabled on our hands. [Work in Constantinople, where I left another example of friendliness.]

The second event came a little later in the shape of the Greco-Turkish War. I have said that at the time of the Armistice Turkey would have been had for the asking. Not so later, however, when they had initiated their new Angora government, when the Allies had bungled, had nibbled at the seacoast, and finally in jealousy of each other sent the Greeks in to occupy Smyrna. That was the spark that galvanized new Turkey into life. The Greeks, the Greeks, their hereditary enemies and for centuries their vassals, the Greeks filch from them their greatest remaining seaport and the fair lands bordering the Great Sea? Never! Many a Turk had said to us:

"We expect to be beaten but we will die fighting! The Greeks shall never have Smyrna!"

So once again the war was on and with characteristic eastern methods and cruelty the Turks proceeded while they fought on one front, to clear every front of Greek citizens, in their eyes potential traitors. The largest Greek populations in Asia Minor were massed along the Baghdad railroad in the West and along the Black Sea in the North. From both these areas whole villages, women and children indiscriminately and all the men who were left, were deported and driven into the interior toward Bitlis. A town too far from communication to tell tales, too ruined and mountainous to offer hope for the future, too cold and desolate for many to survive the rigors of the coming winter.

We two American women in Diarbekir were at the meeting point of the streams of deportees, the last town before they entered the Bitlis mountains. And what didn't we see that winter? Typhus, dysentery, starvation, gangrene following frostbites, nakedness, the camping in the slush and mud and snow, the unutterable hopelessness, all claimed a heavy toll of deaths. May I never go through such a winter again! If we could only help! But up to that time we had been a small station with a very small appropriation, relief work ordered stopped, mails and telegrams were all censored and we could not get our desperate situation through to headquarters. We overran our money all we dared just for bread, and then dreaded each day as it came with its indescribable total of suffering and death.

Finally the middle of January we got our telegraphic order for money! Our thanksgiving was too deep for words, tears only came. But there was small time for tears, in the same breath we ordered charcoal and fire for the sick ones. After that things were easier. Many, Many died in spite of all and the next summer a malignant type of malaria carried off many more.

Then a year ago came the triumph of the Turks at Smyrna. The responsibility for the horrors of Smyrna I will not attempt to apportion now, though if there were more time I would like to discuss the ultimate responsibility.

I can only say that the reaction for us in the interior was good. Almost all at once the government permitted the Christians to leave the country quietly, except men of military age and as a matter of fact thousands of those slipped out also. The order did not permit the deportees to return to their homes but tens of thousands of Greeks took the opportunity to leave Turkey and go over to Greece. This was undoubtedly the best solution though it leaves Turkey poor in labor and the skilled trades, and Greece with a serious employment problem which at the present time the League of Nations is striving to solve.

But it is time we left the political situation to follow our orphans. When the deportations that I have been describing were going on within a radius of 100 miles of Diarbekir, the Near East Relief had over 5000 Armenian orphans and perhaps 1000 Greek orphans who had been picked up and gathered together as the weary, unending line of deportees crawled through our towns. Poor little, appealing, pathetic figures, these tiny Greeks were as they swarmed around our door, and crowded to us on our visits of inspection to the concentration camps, begging to be taken to the Americans.

It was little enough we could give them. We would hire a native house, stone they all are in Diarbekr, built on one or two sides of a courtyard with stone walls on the other sides, windows on the courtyard, only very tiny ones on the narrow, dirty little allies which were called streets, only a doorway in the wall opening …