Schistosomiasis, endemic to Egypt and known locally as bilharzia, is a parasitic infection that destroys the liver, kidneys, and bladder, even causing death, in its most severe form. Infection rates skyrocketed during the late nineteenth and early twentieth centuries due to the construction of new forms of environmental infrastructure and the spread of labor practices to support a colonial economy rooted in cotton production.
With very little precipitation, agriculture in Egypt is fed by irrigation. Until the early nineteenth century, basin irrigation was practiced, which spread the waters of the annual Nile flood throughout agricultural land. Basin irrigation paired crop production with the temporal rhythms of the annual Nile flood, meaning that Egypt’s agricultural bounty materialized in the form of those crops—like wheat—whose growing seasons matched that of the flood. In the first half of the nineteenth century, the Egyptian state constructed vast networks of new canals in the Nile Delta to support perennial irrigation, which facilitated the cultivation of more than one crop during each annual cycle, including crops like cotton whose growing cycles did not match the temporality of the annual Nile flood. The British occupation of Egypt in 1882 only increased the British hunger for Egyptian cotton, and the colonial administration quickly set about searching for ways to organize and increase its production. In 1898, the British began construction on a dam to facilitate the spread of perennial irrigation. The history of bilharzia in Egypt is intimately intertwined with the spread of perennial irrigation and the labor practices that it enabled. After the construction of the dam, populations of the freshwater snails that serve as a vector for human bilharzia infection boomed. Moreover, Egyptian cultivators now labored, and irrigated specifically, throughout the annual cycle. In the 1920s, an official at the Egyptian Ministry of Public Works estimated that nine to ten million of Egypt’s thirteen million inhabitants were infected with bilharzia.
Public health, as an institutionalized practice in Egypt, was intimately tied to the concerns of British Empire and colonial economy. During the late nineteenth and early twentieth centuries, public health officials in Egypt concentrated the bulk of their efforts on tracking cholera and plague outbreaks. These epidemics travelled throughout the realm of empire; they arrived in Egypt via the very networks that linked it to Mediterranean trade. Public health officials conceptualized bilharzia differently than the traveling diseases of empire. And yet, bilharzia was no less the product of colonial economy and the economic networks in which Egypt was entangled. The coalescence of a cotton economy, the material politics of perennial irrigation, and new labor regimes were the root causes of bilharzia’s wildfire spread. However, within the public health imaginary, as bilharzia was not a communicable disease, bilharzia was classified as endemic, native to Egyptian soil and to the environment itself.
Just as the First World War produced an imperial panic over the possibility that large numbers of British soldiers might fall ill with bilharzia, so did the Second World War incite concern that occupying American troops in Egypt might suffer the infection’s ravages. Claude Barlow, a parasitologist who had been hired by the Rockefeller Foundation in 1927 to combat bilharzia in Egypt by constructing latrines and eliminating snails (neither of which efforts proved effective), feared that infected soldiers returning to the United States might spread the disease in North America. During the 1940s, a baboon who had been infected in Cairo provided samples of the parasite to researchers working in the United States. However, scientists desired a human source as they were interested in human experiences of infection and treatment. Barlow initially suggested that an infected Egyptian be brought to the United States to serve as a source of samples. American immigration authorities were reportedly unwilling to cooperate. Faced with the impossibility of transporting a live human incubator, Barlow decided to infect himself.
The stark contrast between Barlow’s inhabitation of his body and the inhabitations of Egyptian agricultural laborers leads one to question whether the bodies in question were bodies defined by sameness.
In spring of 1944, Barlow repeatedly applied larvae shed from snails to various parts of his body and began to wait. Barlow reported no signs of weakness until six months following his infection, when he began to record the symptoms of an increasingly painful illness which lasted for about a month. In January 1945, Barlow reported that the acute illness had passed and a kind of chronic condition had begun. Nearly a year after his initial infection, Barlow began treatment for bilharzia. Barlow’s suffering was magnified during his experience of treatment, which instilled him with a profound empathy for those who had suffered through the same: “Along with my own injection of P.A.T. [potassium antimony tartrate] a deeper and more sympathetic understanding of the treatment was injected into my veins.” With a cure rate of 15-20 percent, Barlow questioned the sagacity of continuing to administer P.A.T. as treatment in light of its substantial physical toll. These effects seemed an even higher price when considering that most patients were cultivators who returned to the same form of agricultural labor that had resulted in their initial infection.
Barlow infected himself as a means of solving a practical problem. However, this act of infection was also one of representation. The suggestion that Barlow’s body and his experience of illness were analogous to the experiences of infected Egyptians masked grave differences of environmental engagement. With the spread of perennial irrigation, Egyptian laborers were literally immersed in irrigation water for large portions of the year and so were exposed and reinfected with the parasite many times during the annual agricultural cycle, challenging Barlow’s distinction between notions and experiences of “acute” and “chronic” infection. The stark contrast between Barlow’s inhabitation of his body and the inhabitations of Egyptian agricultural laborers leads one to question whether the bodies in question were bodies defined by sameness.
Barlow’s self-infection functioned as a means of writing over bilharzia’s entanglement in a wider network of political economy. By identifying the body—his body—as the unit of study, Barlow’s describes an experience of infection absent of the environmental relationships and labor practices that were constitutive of twentieth-century experiences of infection and treatment. However, readings, writings, and imaginations of the body in the context of Egypt’s bilharzia epidemic were multiple and existed in tension with one another. Colonial and European bodies could be posited in the same gesture as both similar and different; public health programs advocated more distant forms of human and non-human interaction while supporting the intensification of environmentally intimate labor; scientists imagined bilharzia as impossibly situated and as an isolated abstraction. When Barlow’s veins were injected with “a deeper and more sympathetic understanding of the treatment,” his same veins also demonstrated that the Nile in Barlow’s blood was not a universal Nile but rather the changeable product of a web of complex and situated relationships.
Jennifer Derr is Assistant Professor of History at University of California Santa Cruz. This post is adapted from her manuscript detailing the construction of the environment surrounding the Nile River in colonial Egypt and its relationship to the practice and experience of the colonial state.
 Mohamed Khalil, Ankylostomiasis and Bilharziasis in Egypt: Reports and Notes of the Public Health Laboratories, Cairo (Cairo: Cairo Government Press, 1924), 96 quoted in John Farley, Bilharzia: A History of Tropical Imperial Medicine (Cambridge: Cambridge University Press, 1991), 98.
 Many of these records are located in the maglis al-nithar wa al-wuzara’ (0075) collection in the Egyptian National Archives (dar al-watha’iq al-qawmiyya al-misriyya).
 The Egyptian Ministry of Public Health also classified malaria as an endemic disease. Timothy Mitchell has written about the complex environmental and political economic webs producing a malaria epidemic in the 1940s in “Can the Mosquito Speak?” in Rule of Experts: Egypt, Technopolitics, Modernity (Berkeley, University of California Press, 2002).
 This distinction was reflected in the organization of the Ministry of Public Health. The ministry created a section to deal specifically with endemic diseases, primary among them, bilharzia and malaria.
 Rockefeller Archive Center, Rockefeller Foundation, Claude Barlow Papers, Series 3, Box 5, Folder 73.
Image from Flickr via dorena-wm