t t - [0. COMMERCIAL. No. 39 (1883) / ruftTH#Rr Correspondence / / RESPECTING THE CHOLEUA EPIDEMIC IN EGYPT: 1883. [In continuation of " Commercial No. 34 (1883)."] Presented to both Houses of Parliament by Command of Her Majesty. 1883. LONDON: PRINTED BY HARRISON AND SONS. To be purchased, either directly or through any Bookseller, from any of the following Wnte v>z Me SB rs. Hansard, 13, Great Queen Street, W.C., and 32, Abingdon Street Westminster '* ' Messrs. Etbe and SPOmswooDE, East Harding Street, Fleet Street, Ld Sale Officj฿wLrf,, _. Messrs. Adam and Charles Black, of Edinburgh- ' Messrs. Alexander Thorn and Co., or Messrs, Hodges, Figgis, and Co of Dnblin. -3788.] Price Bฑd. TABLE OF CONTENTS. No. ™^ Name. Date. Subject. Page 1 Consul Cookson. .. .. Aug. 9, 1883 Letters from Dr. Ferrari on bad sanitary state of r?T" P*"—" Damietta 1 2 Sir E. Malet .. .. 10, Report on progress of epidemic at Cairo. Mortality increasing .. .. .. .. 3 ฎ 5i w ป •• .. 11, Report, and observations thereon, by Sir E. Wood, on cholera among the Egyptian troops .. 7 4 ป >, .. .. 13, Letter from General Baker refuting accusations brought against him by Mansourah Committee . 11 >ป ? .. .. 13, Mortality Returns up to date for Cairo .. .. 13 6 ป ป •• .. 13, Report by Major Mac Donald on his visit to Lower Egypt with Surgeon-General Hunter .. .. 15 7 Consul Cookson .. .. 13, Observations on the totals of the Mortality Returns .. .. .. .. ..17 8 Sir E Malet .. .. 15, Progress of the epidemic at Cairo .. .. 18 ป ,ป >. •• 16, Is making inquiries .is to tax on burial of cattle (Extract) having been illegally levied since its abolition .. 21 1" 5> jป •• .. 17, Letter from Minister of the Interior respecting bad sanitary state of Damietta, reported in No. 1 .....;.... 21 >j ป• •• .. 17, The Khedive has visited the cholera camp .. 22 ป >' .. .. 17, Tables of mortality and of the population of places affected .. .. .. .. ..22 13 ป >> .. .. 18, Valuable services rendered by Colonel Chermside at Cairo . .. .. .. .. 25 14 ป ป .. .. 20, Death rate is falling throughout Egypt except at Alexandria .. .. .. .. 26 15 Consul Cookson .. .. 16, Sanitary state of Damietta has improved since date of Report inclosed in No. 1 . .. .. 26 16 >ป ป •• •• 16, Difficulties encountered by the medical staff and the Extraordinary Sanitary Committees in carrying on their work at Alexandria. Settlement of difficulties. Regulations agreed to .. .. 27 1* ป ป •• •• 20, Observations vn the totals of the Mortality Returns .. .. .. .. 34 18 ป ป •• •• 20, Report by Dr. Mackie on the nature of the epidemic. Petechial and typhoid cases .. 34 19 To Sir E. Malet .. .. 29, Approves action reported in No. 10 .. ..38 2ฎ .j^ <> •• .. 29, Satisfaction at intelligence in No. 13 .. ..39 21 Sir E. Malet .. .. 29, Doctors and hospital assistants have arrived from (Telegraphic) India .. .. .. .. ..39 l> >ป •• •• 21, Tax on burial of dead cattle does not appear to have been levied since it was abolished .. 39 ป? ป • • • • 23, Report on the progress of the epidemic at Cairo .. 39 4 " ป •• •• [27, Tables of mortality at Cairo up to date . ..43 ป ป' •• •ฆ 27, Calls attention, to inaccurate statement in the "Times" with regard to the cholera of 1865 .. 45 26 Acting Consul Russell .. 27, Decrease of the epidemic in Lower Egypt .. 46 *' ป> ป • • 27, Report by Dr. Mackie on cases of endemic cholera, to be added to Report in No. 18 .. ? 46 28 Sir E. Malet .. .. 28, Work done at Cairo by the Special Committee. Their Report .. .. .. .. 47 ป, •• • • • • 29, Report on progress of the epidemic at, Cairo .. 52 30 Acting Consul Burrell .. Scpf. 1, Report on progress of the epidemic at Alexandria . 55 M ป •• 1, Table of mortality for the whole of Egypt up to the 21st August .. .. .. ..57 32 Sir L. Malet .. .. 5, Arrangements made respecting the doctors and hospital assistants from India .. 58 33 Sir E. Baring .. ? 13, Report by Surgeon-General Hunter on the reorganization of the Egyptian medical service .. 60 Farther Correspondence respecting the Cholera Epidemic in Egypt. No. 1. Consul Cookson to Earl Granville. — (Received August 21.) tLord, Alexandria, August 9, 1883. I HAVE the honour to forward herewith a despatch from Mr. MieVille, inclosing copies of two letters from the Health Officer at Damietta with respect to the deplorable sanitary condition of that town. I have, &c. (Signed) CHAS. A. COOKSON. Inclosure 1 in No. 1 . Consul Mieville to Consul Cookson. F Alexandria, August 9, 1883. I HAVE the honour to inclose herewith copies of two letters addressed to the Kisident of the Maritime and Quarantine Sanitary Board by the Health Officer at mietta, reporting that the cholera has almost entirely disappeared there, but that rertheless the sanitary condition of the town is still deplorable. I Dr. Ferrari's letters are clear and speak for themselves ; I confine myself therefore to merating briefly the heads of complaint he mentions : — 1. Carcases have begun to reappear floating in the Nile. 12. The Governor of Damietta had, up to the 2nd August, taken no steps to execute. Sanitary Inspector's recommendations. 3. Water-melons (good and bad) are sold to the public in quantities. ง4. The same points on the banks of the Nile at which water for drinking purposes is wn are used for washing cholera patients' clothes and for bathing beasts of burden. L 5. The sweepings from such of the streets as are swept are thrown into the Nile r the Governor's residence. K6. The soldiers on guard at the Arab cemetery allow persons to go in and pray over ir dead friends, and this on receiving a gratuity varying from Id. to 3d. I have, &c. (Signed) W. F. MIEVILLE, British Delegate. Inclosure 2 in No. 1. Dr. Ferrari to Hassan Pasha Mahmoud. Damietie> te 2 Aout t 1883. COMME votre Excellence aura pu le relever dcs ddpeches que j'ai eu l'honneur de Vous adresser journellement, le cholera tend a ctfsparaltre comple*tement. ILe peu de cas que Ton constate encore sont presque tous sur dcs persqnnes gui vent dcs endroits infecte*s. Cependant si la maladie tend a s'eteindre tout h fait, cela n'ejt point d& a$ maintien dcs quelques mesures hygie"niqqes qu'& bout de force naiia aypns xm qbtenir^ * 2 , \ A 11*1 En efFet, les charognes de betail mort recommencent a paraitre sur la surface dv Nil, la preuve en est que deux dont la peau manquait furent trouve'es hier accoste*es devant le lazaret et que j'ai e"te" oblige" de faire tirer hors dv Bogaze par la barque de S l'Office, n'ayant pu les faire enterrer par manque d'instruments necessaires a cet efFet. J'ai juge inopportun de le faire connaitre a cc Gouvernorat pour la raison bien simple que cc dernier n'a encore mis en execution rien de cc que M. l'lnspecteur de I' Hygiene en cette ville, Dr. Nadim, lvi avait a cc propos, ni meme claigne* lvi repondre et dire que le bateau a vapeur " Nil" destine a cc service se trouve ici sans fonctions depuis le depart de Mr. Goodall. Au marche les pasteques bonnes et mauvaises sont en quantite livrees a la consommation publique. Je n'ai pas besom de vous parler dcs rues de la ville que je visite minutieusement tous les jours et gui se trouvent actuellernent toutes sales, peut-etre et m6me plus que par le passe. Les points au bord dv Nil gui servent aux sakas pour puiser l'eau pour alimenter la ville e"tant dun abordage facile, toutes les betes de somme ou de montures y sont lavees ainsi que les ve"tements dcs choleriques ; bien dcs fois j'en ai fait mes remontrances a son Excellence le Gouverneur pour faire cesser un tel c"tat de choses et il me la toujours promis sans jamais l'exe'cuter. Veuillez, &c. Le Directeur, (Signe) Dr. FERRART. (Translation.) Damietta, August 2, 1883. AS your Excellency will have been able to gather from the despatches which I have had the honour to address to you from day to day, the cholera is beginning completely to disappear. The few cases which are being now reported are almost all of persons arriving from infected places. Yet if the disease is beginning to die out altogether, it is not owing to the few sanitary measures which, with the greatest difficulty, we have been able to have put in force. In fact, carcases of dead cattle are again appearing in the Nile, and the proof of this is that two carcases with skins were found yesterday alongside the lazaretto, and that I was obliged to have them towed out of the Bogaze by the official boat, being unable to bury them failing instructions to that effect. I thought it better not to inform the local authorities of this for the very simple reason that they have not yet carried out anything that Dr. Nadim, the Sanitary Inspector in this town, had written to them on that head, nor even deigned to answer him, and say that the steamer " Nil," assigned for this duty, has been lying inactive since Mr. Goodall left. At the market water-melons, both good and bad, are offered in great quantities for public consumption. I need not speak of the streets of the town which I inspect minutely every day, and which are at present perhaps as dirty, or more so, than before. KAs the points on the banks of the Nile where the water-carriers draw water for the ply of the town are easy of access, all the beasts of burden and saddle animals are hed there, as well as the clothes of cholera patients ; many times have I made remonnces to his Excellency the Governor to put an end to this state of things, and he has always promised to act, but has done nothing. Accept, &c. (Signed) Dr. FERRARI, Director. Inclosure 3 in No. 1. Dr. Ferrari to Hassan Pasha Mahmoud. Damiette, le 5 Aoilt, 1883. EN vous confirmant mon dernier Rapport dv 2 Aout courant, j'ai l'honneur de vous adresser ces quelques lignes sur la situation de la ville. Les balayurea de quelques rues, que Ton balaye pour jeter de la poudre aux yeux dcs passants, etant les plus frequences, sont jetees au Nil a quelques metres dv Gouvernorat, o'est-a-dire pres dv Consulat Perse; je ne vous parle pas de toutes les autres rues 3 et passages, gui se trouvent dans le raeme etat que j'ai ddnonce' dans mon dernier Rapport. En amateur, je me suis rendu cc matin au ciinetiere Arabe pour voir en personne les scenes gui auraient lieu, entre les indigenes gui voudraient y entrer pour prier sur leurs^ morts et la garde etablie pour les en empecher, et j'ai vu de mes propres yeux (e'taniinconnu aux soldats de la garde) que ces derniers y ont laisse entrer en ma presence bien dcs personnes moyennant une piastre tarif, une demi piastre aussi et meme moyennant une galette appelee " kahka" ou " fitir." Les cas constates par moi ces jours-cinei ne presentent plus ces caracteres graves gui se manifestaient par le passe* et consequemment ils guerissent facilement et quelquefois mime sans aucun traitement ; cela me prouve que la maladie est a sa dernie"re peri ode. Je conclus en vous faisant connaitre aussi que tous les medecins ont e'te rappele's et qu'i) ne reste plus ici que le medecin de la ville, Ally Effendi Ghibril, et le pharmacien de I'hApital. Veuillez, &c. Le Directeur, (Signe) Dr. FERRARI. (Translation.) Damietta, August 5, 1883. IN continuation of my last Report of the 2nd instant, I have the honour to address to you these few lines on the condition of the town. The sweepings of the few chief streets, which are swept to throw dust in the eyes of the people passing, are thrown into the Nile a few metres from the Governor's house, that is to say, close to the Persian Consulate ; I do not speak of the other streets and passages, which are in the same state, that 1 denounced in my last Report. I went unofficially this morning to the Arab cemetery to watch in person the scenes which take place between the natives who wish to enter to pray over the dead, and the guard set to prevent them, and I saw with my own eyes (being unknown to the soldiers of the guard) that the latter allowed persons to enter for a piastre, half-a-piastre, and even for a cake, called " kahka" or "fitir." The cases reported by me during the last few days are no longer of the serious character which they formerly were, and consequently they are easily cured, sometimes even without any treatment, which is to me a proof that the disease is in its final stage. In conclusion, I have to inform you that all the doctors have been recalled, and that there only remains the doctor of the town, Ally Effendi Ghibril, and the hospital chemist. Accept, &c. (Signed) Dr. FERRARI, Director. No. 2. Sir E. Malet to Earl Granville. — (Received August 21.) My Lord, Cairo, August 10, 1883. WITH reference to my despatch of the sth instant, I have the honour to inclose herewith a further Report by Mr. Vice-Consul Borg on the cholera in Cairo.* I have, &c. (Signed) EDWARD B. MALET. Inclosure 1 in No* 2. Vice-Consul Borg to Sir E. Malet. (Extract.) Cairo^ August 9, 1883. I HAVE the honour to report that the decrease which has been noticed in the progress of cholera has been fully confirmed by the results of six on the seven days of the week ended on the 4th instant. The return for that period, which I beg to inclose, brings up the number of deaths from the epidemic at 1,662, which figures compare favourably with those of the third week * Seซ •* Commercial No. 34 11883 V No* 52. 4 mean average of 259 deaths per diem ; the second day presented a recrudescence; — tfas deaths having risen to 309 ; while the last two gave 15b per diem. The number of deaths for the past three weeks amongst Europeans — the British troops not included — is eighty, which on the total mortality from cholera gives a percentage of 1*64. The total number of Europeans resident at Cairo since the outbreak of the epidemic is grossly estimated at 17,000, and the deaths would therefore be about 4*70 per 1,000. I am informed, however, that Frenchmen have contributed a larger number of deaths, which may, perhaps, be explained by the rather immoderate use, especially during the summer season, of " absinthe," a beverage which, I understand, owing to its composition, could not be used for any length of time without undermining the constitution. Puring the week under consideration (to the 4th instant) the mortality has been severe at Old Cairo (359), Boulak (279), Sayeda Zenab (196), and Abdeen (159). I am ปd, however, to be able to report that the period of decrease confirms itself, not only by mailer number of deaths, but also by the larger proportion of recoveries effected. I Dr. Iconomopoulos, one of the physicians who have been long established at Cairo, brms me that he has obtained very satisfactory results by the administration of the lowing mixture : Sulphate of strychnine, two centigrammes, peppermint and fennel ter, of each forty grammes, tincture of musk, twenty drops, ethereal tincture of erian, forty drops, of wbich a teaspoonful is given every quarter of an hour, the patient ng made to masticate small pieces of ice in the intervals. He assures me that the )ve mixture has been administered with marked success in the first and second stages of i disease, and, also in incipient collapse, and that when taken as a preventive — one spoonful three or four times a day — it has acted like a charm. IThe Comparative Table of deaths from all causes, which I annex, will show that last ;k compares favourably with the third week of cholera in 1865, the figures for ordinary ses being 518 and 586 respectively. inclose also a Table of meteorological observations. The mean average barometrical sure has been 753*49 against 754-72 for the third week of the epidemic in 1865. IThe mean average temperature has been 30*8 against 29*7, and the hygrometer has en 43*42 against 42*87. The prevailing winds have been north-east and north last 3k, against south-east, east, and west. 5 Hehjrn of Deaths from Cholera at Cairo during the "Week ended August 4y 1882. (Twenty-four hours, ending at Bp;M.) July 29. July 30. July SI. Argust 1. Augusts August 3. August 4. Totals. -ฃฃฃ_ E-PE -P- 8 - an'dCoTu. Euro^ S - andiS, European,. ,*ฃฃ. Europeans. Jffi^ Europeans. ฃ•*-_ Europeans. .**ซ. Europeans. JJaW Europea _ $ . • Quarters. ; S S S S 8 S 8 S S 8* 5 8 5 . 3 S ฃ Abbasiyah 4 5 ... 6 9 3 1 1 4 1 2 1 2 2 3 3 25 16 ... 6 Abdeen 12 10 1 ... H 17 11 13 11 16 9 12 10 8 6 9 73 85 1 Bab-el-Chariyah 5 5 6 11 6 8 ... 1 5 9 5 11 ... 2 7 5 6 2 40 51 ... 3 BeซU_. ... - .... ..._ ... „ 19 25 ... 1 17 22 ... 2 17 2+ 16 27 1 3 13 29 U 15 ... ... U 13 110 155 1 G Choubrah 5 11 6 6 5 6 6 15 5 8 5 3 2 5 ... .„ 84 64 ... )trb-el-Ahmar 11 5 4 6 5 2 4 5 1 3 5 4 6 2 36 27 ... _ Szbeklyah 4 9 1 ... 14 10 1 2 3 9 ... 9 6 4 2 ... 6 3 7 1 ซ. -. 6 4 1 ... 46 40 5 4 Ghemaliyah 4 5 5 1 3 6 3 1 ... 10 1 4 2 ... ... 27 17 1 ttudifa 5 2 1 ... 2 4 9 3 8 2 3 4 3 ... 4 1 1 ~. 1 2 .ป -. 32 18 & louskee 3 2 6 5 3 1 3 6 1 .„ 3 5 4 2 1 ... 6 6 ... ... 1 1 -. ... 26 27 5 1 Old Cairo 27 38 41 42 36 27 29 24 22 24 12 11 11 15 178 181 SajeaaZenab 19 19 8 19 15 16 .„ ... 15 24 11 12 11 8 6 13 85 111 Hospital 13 22 14 9 15 19 8 1 ... 9 4 ป ... 13 3 105 24 1 Totals 131 136 | 3 7 154 146 4 6 128 130 l| 3~ 122 135 4 3 110 117 s~| 2 93 68 1 ... 79 74 1 817 BOC 19 20 Grand totals 277 309 ฃ!ป 264 ฃฃ 162 154 i/Sซ2 6 Inclosure 3 in No. 2. Comparative Table of Deaths at Cairo during the prevalence of Cholera (third Week). 1883. 1865. Date. From Cholera. Other Causes. Total. Date. From Cholera. Other Causes. Total. July 29 277 75 352 July 5 356 63 419 30 309 57 366 6 355 82 437 31 262 68 330 7 365 87 452 Aug. 1 264 82 346 8 389 90 479 2 234 92 326 9 347 77 424 3 162 64 226 10 252 103 355 4 154 81 235 11 226 84 310 Inclosure 4 in No. 2. Meteorological Observations at Cairo during the prevalence of Cholera (third Week). 1883. 1865. Barometer Barometer „,, ._ ? , „ ~ . ? . T , T . , corrected to 0ฐ Thermometer _ Direction of corrected to 0ฐ temp. Thermometer (Centigrade). Hygrometer. Ozonometer Direction of Wind. v (Centigrade). Hygrometer. Wind> Date. r Mean (0 to 21) Nilometer. Date. l v ' Mean Average. 1 p.m. ฆ Average. 7 a.m. 1 p.m. 7 p.m. 7 a.m. 1 p.m. 7 p.m. 7 a.m. 1 p.m. 7 p.m. Sunrise. 2 p.m. Sunrise. 2 p.m. Sunrise. 2 p.m. July 29 755-32 754*80 753 60 24 7 34 '2 32 7 42' 6 N.E. N.E. N. 11 17 j July 5 754' 754* 26 '3 33 3 43- S.E. S. 30 754-83 753-89 753-55 25 -2 32-2 33-2 44 66 4 N.E. N. N. 12 1 6 754- 754" 26 4 33 4 42- S.E. S.E. 31 754-75 753 49 752 37 24-2 32*2 33 2 45' 4 N.E. N. N. 12 12 7 755' 755- 25*5 33' 42* N.W. W. Aug. 1 753 25 752-27 752 77 25 2 33 7 32 2 47 66 4 N.E. N.E. N. 13 5 8 756' 756' 26* 32 -8 44' W. W. 2 752-73 752-25 756 50 252 342 33"5 38-66 6 N.E. N.E. N.E. 14 7 9 755* 755- 253 33 3 42*5 S.E. E. 3 752 95 752-05 752 03 26 2 36 '2 33 7 4166 4 N. N. N. 15 4 10 755- 755- 26-2 33 4 43 5 E. S.E. 7 Relev^ dcs Deeds Choteriques a Ghiseh et au Caire, dv 15 au 22 Juillet, 1883. •** -t^ +> -?* ฆซ ฆ*ป -*ฆ* •* a 2OD r3 J2i rSi JSJ ,2 * ฃi rSj^ U I-S l-ป H-s 1-8 t-8 Hs >-s *""> .ฃ? <3 ปra co t~- oo os o i-i en o 5 t-H 1-4 — i-l r-l where the epidemic I Red Hospital.. 10 10* 26 fi rst broke out. i , / Kasr-el-Ain . . "7 . . . . | Ed Horoital. ... 1 1 Jiigade ..{ $Tvi 1 -Hi" '.'> 2 o I One battalion at Alexandria. b \ Red Hospital . . 2 . . 2 j f Kasr-el-Aiu .. 9 8 17 1 Four of these men were brought Brigade ..< Eed Hospital. . 11 8 19 > in dead, having died on the [_ Tourah 7 1 8 J road from Tourah. Dital attendant . . Red Hospital. .1 . . 1 Total .. .... 46 30 76 (Signed) FRED. SLADE, Lieutenant- Colonel, Assistant Adjutant- General. Cairo, August 9, 1883. No. 4. Sir E. Malet to Karl Granville. — (Received August 2J.) My Lord, Cairo, August 13, 1883. WITH reference to my despatch of the 6th instant on the subject of the blame attributed by Sanitary Committee of Alexandria to Mr. Timmerman and General Baker, for preventing the entry of provisions into Mansourah, I have the honour to inclose herewith a copy of a letter, published in the " Moniteur Egyptien " of the I lth instant, addressed by General Baker to the Minister of the Interior, refuting the accusations brought against him.f I have, &c. (Signed) EDWARD B. MALET. Inclosure in !N"o. 4. Extract from the "Moniteur Egypticn" of August 11, 1883. Lettre adressee par son Excellence le General Baker Pacha, Inspecteur-General, Coirl* mandant-en-chef de la Gendarmerie et Police, a son Excellence Khairy Pacha, Ministre de V lnterieur, Departement de la Gendarmerie et Police, Caire, M. le Ministre, le 10 Aout, 1883. ง" L'Egyptian Gazette " dv 3 Aout contient uri Rapport dv Comite de Secours de nsourah a Alexandrie, portant une accusation contre moi et mon Departement ainsi i contre M. Timmerman, l'Administrateur dcs Chemins de Fer. Pour cc gui me regarde, le Comite pretend que j'ai empechd I'entree a Mansourah dcs medicaments, vivres, &c. ; pendant le temps que cette ville etait cernee par un cordon. IBien que le Comite ignore evidemment les mesures prises par le Gouvernement tivement a Mansourah et les raisons gui ont dicte ces mesures, il n'he'site pas moms de 2 dcs assertions incorrectes et de baser sur ces assertions dcs attaques directes dirige'es tre moi et M. Timmerman. * One officer. f See " Commercial No. 34 (1883)," No. 54. 12 Je laisse a M. Timmerman le soin de repondre aux accusations porte'es contre son Departement et je me tiens a cc gui touche I* Administration que j'ai l'honneur de La premiere accusation formulee par le Comite est comme suit : — "Trois ou quatre jours apres I'apparition dv cholera, un cordon avait et.e* place autour de la ville de Mansourah et les communications par cbemin de fer furent arrlte'es BUT les lignes de Talka et de Zagazig. Non seulement I'entre'e et la sortie dcs gens fut interdite, mais encore l'entree dcs provisions et dcs medicaments de toutc sorte gui avaient etc expedies h Mansourah avant ainsi qu'apres I'etablisscment dv cordon.* 1 Cos deux assertions sont absolument inoorrectes. 11 y a deux lignes de chemin de fer gui menent a Mansourah, e'est-a-dire, la branche dc Damiette de laqueUe la station pour Mansourah est Talka, et la branche de Zagazig, gui entre dans la ville. Quand le cordon fut etabli, il devint evidemment impossible do laisser entrer et sortir les trains dans la ville infectee, et par consequent les trains gui devaient entrer dans la ville etaient arretes a Simbillaouin par ordre de votre Excellence. La ligne a Talka n 'etait pas arretee, mais comme la correspondance ordinaire ne pouvait etre maintenue, les passagers prenaient leurs billets a Mehallet-el-Kebir, et de la un train journalier partait pour les villes inlecte'es avec dcs medecins, medicaments, vivres, &c. Mes ordres au Colonel Clarke gui commandait la gendarmerie sur la ligne e'taient dcs le commencement de permettre l'entree dcs rnedecins, medicaments, vivres et personnes dans les villes infectees, mais d'en empe'eher la sortie. Au lieu de prohiber l'entree dcs vivres et medicaments, ainsi qu'il a etc rapporte par le Comite, il resulte dcs telegrammes par moi envoyes, que dcs ordres contraires e'taient const;) in rncnt rei ten-is . Err efFet, Is 3 Juillet, je telegrapliiai au Commandant dv cordon de Mansourah de permettre I'entre'e dans cette ville a toute personne, aux vivres, medicaments, &c. Le 4 dv meine mois, je lancai une depeche ainsi concue :—: — <; Permettez a tout le monde d'entrer et n'arretez jamais ni medicaments, ni vivres, ni liqueurs." Le jour suivant de nouveaux ordres a cc me'me sujet etaient egalement donnes par telegraphe. Est-il done possible, malgre tous ces ordres, que le Comite* de Secours de Mansourah puisse declarer que l'entree dcs medecins, medicaments, et vivres etait prohibee? Le S Juillet le Colonel Sartorius etait envoye en inspection a travers les cordons et fut spe'eia lement charge de faciliter en toute maniere l'entree dcs vivres et medicaments dans les villes cernees. II me teiegraphia qu'il avait fait dcs arrangements satisfaisants avec le Gouverneur de Mansourah et que tout allait bien ; mais il a constate qu'il se trouvait dcs personnes gui ne voulaient pas suivre la voie reguliere d'entree et gui adressaient ensuite dcs plaintes an sujet dcs difficultes gui n'dtaient cree'es que par ellesmemes. Votre Excellence sait bien que dcs le jour oil Mansourah avait etc cernee j'ai toujours insiste aupres dv Gouvernement pour l'envoi par bateaux dcs vivres de sa part a Mansourah et que ces vivres devraient etre vendus publiquement en petites quantites et a has prix afin d'empecher que les negociants etablis dans cette ville n'augmentent les prix dcs vivres pour leur propre beneh'ce et ne creent une detresse dans la ville ; mais votre Excellence recevait alors dcs telegrammes si rassurants dv Gouverneur de Mansourah, dans lesquels il disait que l'importation dcs vivres e'tait entitlement suffisante et qu'il donnait dcs rations aux pauvres, qu'elle n'a pas juge necessaire d'accepter les mesures que j'avais proposees. Comment serai t-il done possible de preter foi ala declaration dv Comite que le Gouverneur de Mansourah etait tout a fait de*courage a cause de !a rarete dcs vivres, quand, en meme temps, cc meine Gouverneur telegraphiait a votre Excellence que les vivres etaient entierement satisfaisants et qu'il donnait dcs rations aux pauvres ? Dans la nuit dv 12 Juillet, le cholera eclata a la gare de Talka et il devint necessaire d'arreter les convois avant la station et au point ou le cordon commengait. De cc nouveau point il etait necessaire de decharger dv train les provisions pour Mansourah. Or, comme il etait evident que cc changement pouvait causer dcs delais et dcs difficultes, j'ai alors expe'dio le telegramme suivant: — " Comme la gare de Talka est mainlenant dans I'int^rieur dv cordon, faites dcs arrangements immediats pour laire passer a Mansourah toute provision dv point ou le cordon commence. De*signez un officier special pour surveiller cet arrangement et ordonnez que les hommes dv cordon assistent en dechargeant les trains. En cas de necessite, louez dcs transports depuis le train jusqu'a la riviere." 13 En consequence de cc te'legramme, le Major Holroyd a etc envoye* par le Colonel CJarke sur les lieux. Le Comite de Secours de Mansourah a si completement ignore* ces evenements, que lorsque le Major Holroyd s'est rendu a i'endroit designe, il a presume' que I'entree dcs vivres n'e'tait pas permise avant l'arrivee de cet officier. De plus, comme I'abandon ainsi ne'cessite de la gare de Talka pouvait occasionner dcs difficulties et dcs de"lais, il a 6ti lime'diatement arrete d'envoyer un train special journalier avec dcs vivres, depuis mbillaouin jusqu'au cordon, et avait etc fait avec le Gouverneur de cevoir ces vivres avec les precautions gui etaient prescrites. Cc train commenca a courir le 14 Juillet. Dans la matinee de cc meme jour, le Comite de Mansourah ayant prie Son Altesse d'envoyer un telegramme, et la reponse a cc telegram me de Son Altesse etant que tous les arrangements avaient etc deja faits, il s'est alors attribue le merite d'avoir accompli ces actes de secours. D'ailieurs, j'appelle l'attention de votre Excellence sur un autre exemple de la le"gerete avec laquelle le Comite de Secours de Mansourah porte dcs accusations contre dcs hauts fonctionnaires dv Gouvernemcnt gui, depuis six semaines, out travaille jour et nuit dans l'inter^t public et aux efforts desquels Alexandrie doit probablement le temps gui lvi a etc donne pour prendre dcs mesures preservatives contre l'epidemie. RLe Comit6 de Secours avait decide d'envoyer un medecin k Mansourah. Cc medecin rend a la gare d'Alexandrie et demande un billet pour Talka, mais il lvi fut repondu a cette gare qu'on ne donnaifc point de billets pour Talka. Sur cc, on pourrait croire que l'agent special dv Comite de Secours aurait essaye de surmonter toutes les difficultes pour arriver a sa destination, d'autant plus que s'il avait demande la moindre information, les employes dv chemin de fer lvi auraieut dit que pour aller a Mansourah il fallait prendre un billet a Mehallet-el-Kebir, et que de la il pouvait aller par le train journalier a Talka et a Mansourah ; mais non, cet agent retourne au Comite, et sur son rapport, cc dernier s'est actuellement permis d'envoyer un telegramme au Gouvernement au Caire en disant que son agent avait etc empeche d'entrer a Mansourah par I' Administration dcs Chemins de Fer et dcs cordons. Pour une periode de six semaines la gendarmerie a etc employee dans les cordons. Cc travail a e"te tout cc qu'il y a de plus penible et leur a occasionne dcs souffrances terribles. Beaucoup out peri ; mais je puis dire que, sauf tres peu d'exceptions, officiers et soldats ont noblement fait leur devoir. Votre Excellence peut comprendre combien il leur sera decourageant si la seule appreciation publique de leurs efforts nest que dcs attaques comme celles dv Comitd de Secours et surtout s'il est permis que ces attaques passent inapercues sans attirer l'attention dv Gouvernement. Veuillez, &c. L'lnspecteur-General, Commandant-en-chef de la Gendarmerie et Police, (Signe) V. BAKER. No. 5. Sir E. Malet to Earl Granville. — (Received August 21.) My Lord, Cairo, August 13, 1883. WITH reference to my despatch of the 6th instant,* I have tbe honour to inclose a further statement of the deaths irom cholera in Cairo, completing the Returns up to this morning. The mortality for the four calendar weeks just expired has been 913, 2,557, 1,671, and 444 respectively ; if we include the deaths in Ghizeh and amongst Her Majesty's troops in Cairo, the total during the second week of the epidemic reaches 3,000. The rapidity with which the death-rate has decreased during the last week to a total of only 1 1 for yesterday is eminently satisfactory, and it may fairly be said that this good result is mainly due to the energy with which the sanitary measures recommended by Dr. Hunter and the special Board of Health have been carried into execution, through the good-will and activity of the Government authorities. I have, &c. (Signed) EDWARD B. MALET. * Seซ ซ Comซซrcial Nซ. 34 (1883)," No. 53. 14 Inclosure in No. 5. Deaths from Cholera in Cairo, 1883. _ The highest totals reached are printed in larger figures. Hospital ... „. . ' -„,„ , ' . Z__Z_ __!!l__J^ lr Gamaheh* „ ... „ \ 115 5107 in fi o *a.ป** * Theie six quarter! are furthest from the Kile. + wt i. t G1 ฆ j. 15 IS T o. 6. Sir E. Malet to Earl Granville. — (Received August 21.) My Lord, Cairo, August 13, 1883. I HAVE the honour to inclose herewith copy of a Report by Major Mac Donald on his visit to Lower Egypt, in company with Surgeon-General Hunter. I have, &c. (Signed) EDWARD B. MALET. Inclosure in No. 6. [Major Mac Donald to Sir E. Malet. Sir, Cairo, August 13, 1883. I HAVE the honour to report, for your information, certain facts regarding the recenjt visitation of cholera in some of the provincial towns and villages of Lower .Egypt. This information I have been able to collect in the course of a three days' tour with Surgeon- General Hunter and Mr. Gibson, head of the Egyptian Land Survey. Taytah. — A town of some 30,000 inhabitants. Inspections were made of the hospital, cemetery, and town generally, the dirtiest quarters being selected. Having resided at Tantah for two months during the winter, and seen it in its normal condition of dirt, I was surprised at the clean appearance it now presented. The streets were well swept and watered, no accumulations of filth were to be seen in front of the house doors, the houses had been whitewashed. This beneficial change was mainly due to the efforts of Sidky Bey, Professor of Anatomy at Cairo, who had been sent down by the Minister of the Interior at the urgent request of the European Committee of Health at Tantah. The Moudir of the Province being jealous of European assistance, had thrown every obstacle in the way of the said Committee, and it was only on the arrival of Sidky Bey that anything was done. I have reason to believe that the official Returns of the number of deaths from cholera in this town, as well as in most of the towns and villages of Egypt, are very considerably below the right number. This information I have gathered in the course of conversations with Mr. Campbell, Acting Consular Agent, with the French Consular Agent, and other inhabitants of the town, native as well as Europeans. The Moslem cemetery is in the centre of the town ; persons who have died from cholera continue to be buried there daily. Sidky Bey, notwithstanding numerous attempts to have this cemetery closed and a new one made, has been unable, owing to the opposition of the Moudir and the Notables of the town, to get this much-needed reform carried out. The very remarkable change in the sanitary condition of this town, brought about in the space of six days, is worthy of note. Kafr Zayat. — The arrangements in this place call for little mention. Dr. Cantlie, one of the twelve doctors recently sent out from England, having made all necessary arrangements, he is well supported by the native authorities. The mortality here, as well as in all the towns we visited, is on the decrease. Mehallet-el-Kebir.—A town of 28,000 inhabitants. In this town nothing, or next to nothing, had been done from a sanitary point of view. The official death-rate, thanks to the rising of the Nile, and consequent flushing of the Shibin Canal, on which the town is built, had decreased to two in the twenty-four hours. On the 28th July it was eighty-four, and this was considerably below the right numbers. The town hospital (there was no special cholera hospital) was one of the dirtiest buildings I have ever seen in Egypt or elsewhere. There were no patients. The native doctor at Mehallet confessed to never having visited a single poor patient, one reason being that the fellaheen class very rarely report themselves sick, and endeavour to conceal the fact of their being so. Dr. Honman, one of the twelve doctors recently sent out from England, had been there for two or three days, and had not been able to see a single patient before death for the same reason. Dr. Honman had just recovered from a severe attack of choleraic diarrhoea when we saw him. The town was without medicines or disinfectants of any kind beyond some which had been sent by the Alexandria Relief Committee. The disease had just been allowed to take its course ; those attacked, in may instances, died where they fell in the street, or by the side of the canal. The dirty state of this town, and the absence of disinfectants, had, been reported to Salem Pasha, President of the Sanitary Board of Health of Egypt, some weeks before the cholera epidemic showed itself, by Mr. Gibson, of the Land Survey. On our return to this town two "days later, a great deal had been clone in disinfecting the Rouses, cleaning ths streets, CvCป 16 Mansourah. — A. town of 26,000 inhabitants. The old hospital was first visited. The hospital registers were most defective and carelessly kept. The following is the method universally adopted for compiling the same : — In the case of a death occurring in a village, the barber, who does not always reside in the village, looks in at the house where the death has occurred. The relatives of deceased describe the symptoms, the barber informs the district doctor, who enters it in the register. Very few of the patients are seen during life, or even after death, by a doctor ; the ones that are seen being of the richer class, who can afford to pay. Some of these district doctors have over GOO villages in their charge. From the old hospital we went to the new hospital, which had been used for cholera patients during the epidemic. On the way some of the dirtiest parts of the town were passed through; a great deal however had been done; stagnant pools had been filled up, nouses whitewashed, &c. A visit vvas subsequently paid to the new cemetery. This is situated about half-a-mile to the south of the town (prevailing winds, north and northwest), and appears to be as good a site as is available. This cemetery was full of the wooden biers used to convey the dead. Some of the graves, through being hurriedly constructed, had cracked, and the smell of dead cholera bodies was very unpleasant. I was informed by Mr. Murdoch, British Consular Agent, that the opposition on the part of the Notables to having the new cemetery opened was very determined ; bodies after having been buried were surreptitiously removed back to the old. The Moudir of this place, Zeki Pasha, has behaved throughout with great energy and intelligence, and has endeavoured to carry out the wishes of 1 the European Committee despite the opposition of the Notables. Abder Rachman Bey, one of the principal landed proprietors of the place, has been one of the few Notables who has supported the Moudir. It is worthy of remark that this man was a staunch upholder of the Khedive's authority during the late rebellion. The cordon at Talka entailed a great deal of misery on the poorer classes of natives and Europeans. A number of natives who had come into the town to sell chickens, &c, were shut in. The price of food did not rise to famine height; fowls, &c, were very expensive, good mutton was always to be had at reasonable prices. The lack of intelligence of some of the native officers of the cordon was the cause of a great deal of unnecessary inconvenience. The principal sufferers from the cordon system, or the want of intelligence in the carrying out of the same, were the poorer classes of Europeans. All vegetables and fruit were destroyed by orders from Cairo; the want of this was very much felt during the three weeks the town was cut off from the outside world. Damietta. — A town of some 34,000 inhabitants. The Governor of this place was very anxious to show us round, the principal streets of which had evidently been prepared for our arrival. There appears to have been no lack of medicines during the epidemic, and the Governor seems from all accounts to have done what he could to assist the efforts of the Europeans to disinfect the town; which efforts, however, came too late to be of much avail. I At Damietta very good evidence was obtained of the existence of isolated cases of olera in the Coptic and Greek schools as early as the commencement of May. From is it may safely be inferred that cases had also occurred amongst the Arabs. I After leaving Damietta a stoppage was made at a small village called Gogur. On : evidence of the Sheikh, 1/3 per cent, of the inhabitants of this village had died during late cholera epidemic. The reason for our stopping here was that some of the Arab ployes of the Land Survey had reported that in May last the inhabitants were dying at rate of four and five a day. On being questioned on this point, the Sheikh admitted t such was the case; but said that they had died from typhus fever. This epidemic itinued for two weeks, there was then a lull, and on the 10th Ramadan (1 6th July) cholera broke out and carried off seventy-six persons. On the 16th July Mansourah I Tcilka were invested by a cordon, and continued to be so for some days. Gogur lies the Cairo side of this cordon and outside of it. There is very little doubt but that cholera was raging in many of the villages outside the cordons, and that, as a rule, the villages, owing to their entire lack of sanitary arrangements, were attacked before the towns ; the existence of the cholera being unknown and unreported to the authorities owing to the lax method of reporting already explained. ISamanhoud. — A town of 11,000 inhabitants. News of our probable arrival had dently preceded us, as the streets through which we would most likely pass were iergoing a process of whitewashing. The walls of the town, which could be seen from railway, had also been whitewashed. Very few of the bye-streets through which we ually passed had been touched. LlsolatedL Isolated cases of cholera had occurred amongst the natives of the neighbouring ;es as early as May last. 17 \*Sfl'l/iJl'fl m \sv' m J.\.\P tit' ป • V L'W VV XI vJI ovJ 1 1 J v/ -I 1 *\J\J\J J HI J (IU llil 1 1 Lo , 1 1 ilo II L\ 141 4 LI i L 11 J*_•J Co L \J I i IV.I d ( death-rate from cholera of any town in Egypt. On examination of the registers it appeared that about 1,800 people had been attacked, of whom close on 1,300 had died. This was the only town where an attempt had been made to keep a register of the number of the people attacked, which may, perhaps, account for the high death-rate. Additional care having been taken in keeping the registers, a more correct estimate of the real state of affairs had been arrived at. The cemetery here is well situated, being about half-a-mile from the town ; the tombs, which were bigger than those in most Arab cemeteries, wero arranged in rows ; the spaces between the tombs had been carefully swept ; the door to each tomb had been heaped up with chopped straw and chloride of lime. The smell from this cemetery notwithstanding was most offensive; this arises principally from the defective construction of the tombs, which are built with an arched roof; this sometimes cracks from the heat of the sun, allowing all the poisonous gases to escape. The entrance to the tomb is by a small door, which is filled up with bricks and plastered over with mud ; the latter in some cases dries and falls off. When the epidemic was at its height the entrances to these tombs, in many cases, were just closed with a stone, so as to be ready for use in case of need. In this Province of Menoufia, agriculturally the richest in Egypt, there is one native doctor in charge of 40,000 people ; his salary is 61. 10s. a-month, out of which he has to pay for stationery and travelling expenses, amounting in all to about 21. 25. ; this is the same for all the districts of Egypt ; the number of inhabitants in the districts varying from 20,000 to 40,000. The Moudir of Chibin-el-Kom appears to have done everything he could; the streets were swept and watered, &c. Benha. — b',ooo inhabitants. Nothing whatever had been done towards putting this town into a sanitary condition. The doctor in charge of the hospital and town had endeavoured to do what he could. There was also a European doctor, who had been sent by the Alexandria Relief Committee, amply provided with medicines and disinfectants; the Moudir, Khamil Bey, had refused to give him the necessary authority to go into the Arab houses and disinfect them. He had also refused to provide sweepers, &c% for the streets, or soldiers to enforce the orders of the Committee of Health. The European doctor being provided with funds from Alexandria had offered to pay all expenses, but though, on our arrival, he had been there some days, he had been unable to have any of his suggestions carried out. The European doctors and the European community complained of the state of the cemetery. We accordingly visited it. It lies on the edge of the town, about 200 yards from the railway station, 70 yards from the hospital, and 40 yards in a straight line from the main line from Cairo to Alexandria, and is in a most tumbledown condition. The smell of decaying bodies which existed in this cemetery, and for a radius of some yards round it, was most disgusting. The Moudir refused to have this cemetery closed, and burials of persons who had died from cholera were still going on. I consider that the state of some of the cemeteries we visited is such that an outbreak of typhus or some other malignant fever is quite possible, and may occur at any time. With regard to the towns we visited, I have seen the majority of them several times in the commencement of the year; they are all, with the exception of Benha and Mehallet, very much cleaner than at that time. The subsidence of the epidemic throughout Egypt is mainly due to the rising of the Nile. In every town and village in Egypt the sewage and the old water of last year is being swept out to sea by the fresh water of the new Nile. I have, &c. (Signed) C. M. MacDONALD, Captain and Brevet Major, Military Attache. No. 7. Consul Cookson to Earl Granville.— (Received August 23.) My Lord, Alexandria, August 18, 1883. I HAVE the honour to forward herewith a despatch from Mr. MieVille, inclosing the official bulletins, issued since the 6th instant, as to the progress of cholera.* I have, &c. (Signed) CHAS. A. COOKSON. • See ซ Commercial No. 34 (1883)," No. 60. [1645] 18 Inclosure in No. 7. Consul Mieville to Consul Cookson. THE last week's mortality from cholera throughout the country is stated at 5,029, giving a daily average of 718, as against a daily average of 840 daring the previous seven days. This brings the total number of deaths since the beginning of the outbreak to 2U46. In Alexandria tho/e has been an increase in the mortality from cholera, 136 deaths having occurred in the last seven days (6th August, 8 A.M., to 13th August, 8 A.M.). The general mortality also is greatly above the average. I have, &c. (Signed) W. F. MISVILLE. No. 8. Sir E. Malet to Earl Granville. — (Received August 28.) My Lord, Cairo, August 15, 1883. WITH reference to my despatch of the 10th instant, I have the honour to inclose herewith a Report from Mr. Vice-Consul Borg upon the cholera in Cairo.* I have, &c. (Signed) EDWARD B. MALET. Inclosure 1 in No. 'B. Vice-Consul Borg to Sir E. Malet. Sir, Cairo, August 14, 1883. I HAVE the honour to forward to you herewith a Return showing the number of deaths from cholera at Cairo during the week ended the 11th instant. The figures here given (468), compare favourably with those of the fourth week in 1865 — 976. The total number of deaths for the first period of four weeks stands as follows :—: — In 1883— In 1865— First week . . . . . . 765 First week . . ... . . 205 Second ditto .. .. .. 2,438 Second ditto .. .. .. 1,919 Third ditto .. .. .. 1,662 Third ditto .. .. .. 2,290 Plus deaths at the Lunatic Asylum, Fourth ditto . . . . . . 976 returns of which are not received in time . . . . . . . . 32 Fourth week (Asylum included) . . 468 Total .. .. .. 5,365 Total .. .. .. 5,390 It appears from the above Table that the present outbreak has been more virulent in the first two weeks, and there is, therefore, every reason to hope that the virulence being spent, as is shown by the smaller proportion of deaths in the last two weeks, we may soon see the scourge disappear. The totality, however, for the four weeks is very nearly equal. During the past week the quarters that suffered most were Boulak (67), Abdeen (61), Old Cairo (48), Saieda-Zenab (39), Ezbekiyeh (37), and Abbasiyeh (36). The Comparative Table, herein annexed, of deaths from all causes shows a diminution of 101 on the deaths for five days in the fourth week in 1865. I regret that in former official correspondence the Table stops at that date (16th July, 1865). The Table of meteorological observations, which I inclose, shows that the mean average barometrical pressure has been 753*58, against 755*14 for the fourth week of the epidemic in 1865, the mean average temperature 29*1, against 29*9, and the hygrometer has given 52*71, against 42" 30. The prevailing winds last week were north-east and north, against south-east, west, and north-west. I have, &c. (Signed) RAPH. BORG, 19 Inclosure 2 in No. 8. Eettjen of Deaths from Cholera at Cairo, during the Week ended August 11, 1383. (Twenty-four hours, ending at 8 p.m.) AngU3t 5 - A "g ust G - August". Augusts. August 9. August 10. August 11. TotaK Quarts . Earol>eanS - "^opts. E™Pซ™- affgL J**^ Europeans. J'g^ rjUropean , Enropcan , ฃ.*ซ_ European iiiilii I I ill I j ฆ I i J I | ! I l | l | 1 111 I 111 Al)l)asซyaa 5 3 5 3 2 7.. o 09 l i 1 o ,r aซ OhemaMyah 1 1 2 2 3 ~ 5 g i I " "* I "' 1" SS 2 1 i 1 3 ... .. 3 ... I I ' { "i i - I 1 ฆ,? i Musky 5 i I 1 "i - l ::: 1 I 1 x ••• ••: -v ! 2 " ? ••, Old Cairo 6 10 ... 1 6 7 ... 3 2 s "i ~ "i j " 1 ' l ~ ".; „? ฃ [ ab ::: ::: ::: ::: ::: ::: w I ::: "i 1 " E - :i: i * ' ::: ::: ! ? ::: ::: ) "{" { '"ฆ ::: 1 I :: i : ::: :: : ! * ::: ::: i (\ :: i ฆ! Grand totals T3T 88 ~^j ~7(7 "" "^ " 52^ " S3 'Is '* 468 20 Inclosure 3 in No. 8. Comparative Table of Deaths at Cairo during the prevalence of Cholera (fourth week). 1883. 1865. Date. ' From Cholera. Other causes. Total. Date. From Cholera. Other Causes. Total. August 5 131 77 208 July 12 204 , 98 302 6 88 70 158 „ 13 156 97 253 '?7 70 75 145 „ 14 14!) 104 ' 253 |? 8 66 78 144 „ 15 151 101 252 P,/ 9 52 88 140 „ 16 109 89 198 •• 10 33 U IQI " 17 I 107 \ Not ziven \, 11 18 76 94 „ 18 j 100 -j-Notgnen. ! ฆ Ilnclosure 4 in No. 8. Meteorological Observations at Cairo during the prevalence of Cholera (fourth week). 1883. 18G5. _ Barometer „,, Barometer mt m ซ.• i \ rv ป• rn7 . , . , . ,. o lhermometer r.. .. ,ซ,. , . ... nO . Thermometer (Centigrade). v .. *-\ ป Direction of Wind. corrected to 0 /<-. ป j \ ซ t Direction of Wind, corrected to 0 temp. v b ' Hygrometer. Ozonometer. . (Centigrade). Hygrometer. Date. _________________ Mean (0 to 21) Nilometer. Date. . j temp ' Mean j Average. 1 p.m. " Avenge. 7 a.m. 1 p.m. 7 p.m. 7 a.m. 1 p.m. 7 p.m. 7 a.m. 1 p.m. 7 r.M. Sunrise. 2 p.m. Sunrise. 2 p.m. Sunrise. 2 p.m. Pics. kirats. August 5 755-04 753 69 752 65 25 2 33-2 33-7 53-6G 6' N.E. N.E. N. 17 3 July 12 754- 754- 27' 33 6 44- S.E. S.E. ? 6 755 23 754 30 751 80 24-2 32*2 30 2 52 33 8' N.E. N.E. N. 18 0 „ 13 754- 754" | 26 8 33 4 42 5 E. S.E. „ 7 752-68 752 69 753 04 24-2 34-2 32 2 54*33 7" N. N. N.E. IS 16 „ 14 755" 755- ! 26 a 33 5 42- W. W. „ 8 753 93 753-51 75261 247 312 29 5 54-66 5- N.E. N.E. N. 19 4 „ 15 755" 755- 26-5 33 5 42- W. W. „ 9 754 -18 753-31 752-41 21 7 31 2 292 52" 4- N. N. N. 19 16 „ 16 756' 756* 25 8 33*2 43- ! N.W. N.W. „ 10 754 28 75331 752 39 23 7 31 5 30-6 52' 7" N. N. N.N.E. 19 22 „ 17 756- 756" 26- 32 6 42- W. N.W. ? 11 754-66 753-51 75299 23 2 31-2 32 5 50- 6- N.E. N.E. N. 20 1 „ 18 756- 756" 27- 33-6 415 W. N.W. 21 No. 9. Sir E. Malet to Earl Granville. — {Received August 28.) (Extract) Cairo, August 16, 1833, WITH reference to your Lordship's instruction to me to make inquiries and report upon the tax formerly levied on the carcases of animals interred, I have the honour to inform your Lordship that I have called upon the Consular authorities in this Consular district to inquire into the matter, and to inform me whether they are of opinion that the tax has been levied by the local authorities since its abolition in 1850.* No. 10 Sir E. Mulct to Earl Granville. — [Received August 28.) My Lord, Cairo, August 17, 1883. WITH reference to Mr. Cookson's despatch to your Lordship of the 9th instant, f inclosing two letters from Dr. Ferrari, at Damietta, showing that the sanitary state of the town was again being neglected, I have the honour to inform your Lordship that, on receiving similar information, I at once called the attention of the Minister of the Interior to the matter, and I beg to inclose a copy of a letter from his Excellency in reply, by which it will be seen that he had already given instructions on the subject to the Governor of Damietta and to the President of the Board of Health. It appears also from Mr. Cookson's despatch to your Lordship of the 16th instant, that the state of things complained of by Dr. Ferrari was being remedied. I have, &c. (Signed) EDWARD B. MALET. Inclosure in No. 10 Khairy Pasha to Sir E. Malet Mon cher Ministre, Le Caire, le 15 Aout, 1883. TOUT en vous remerciant pour le renseignement que vous avez bien voulu me dormer au sujet dcs deux Rapports envoyes par le Dr. Ferrari au Conseil Quarantenaire en date dv 2 et 5 courant, et que j'ai l'honneur de vous retourner ci-inclus, je crois de mon devoir de porter a votre connaissance que le President dv dit Conseil m'en avait transmis copie le 1 J courant et que le meme jour j'en donnais communication ala Presidence dv Conseil de Sante et d'Hygiene avec ordre de s'en occuper pour cc gui le concerne. Je crois aussi utile d'ajouter que j'ai informe le Gouverneur de Damiette dcs plaintes dont il s'agit en l'engageant de faire de son mieux pour qu'elles aient a cesser. Veuillez, &c. (Signed KHAIRY. (Translation.) My dear Minister, Cairo, August 15, 1883. WHILE thanking you for the information you have been so good as to give respecting the two Reports sent by Dr. Ferrari to the Quarantiue Board, and dated the 2nd and sth instant, which 1 have the honour to return herewith, I think I ought to inform you that the President of the said Board had sent me copies of them on the 11th instant, and that the same day I communicated them to the office of the President of the Health and Sanitary Board, with instructions to deal with them so far as he was concerned in the matter. I think it would be well to add that I have informed the Governor of Damietta of the complaints in question, and have prevailed upon him to do his best to prevent their recurrence. I have, &c. I have, &c. (Signed) KHAIRY. Seซ " Commercial No. 54 (1883)," No. 33. 22 No. 11. Sir E. Malet to Earl Granville. — (Received August 28.) My Lord, Cairo, August 17, 1883. LIEUTENANT-GENERAL STEPHENSON, Commanding Her Majesty's troops in Egypt, informs me that the Khedive yesterday visited the British field hospital at Ramleh His Highness went into, most of the tents, including those occupied by the cholera patients This considerate act of His Highness, and his kindness and condescension, were much appreciated by both officers and men. He appears to be continuing to set an admirable example to those under his authority. I have, &c. (Signed) EDWARD B. MALET. Ko. 12. Sir E. Malet to Earl Granville. — (Received August 28.) My Lord, Cairo, August 17, 1883. WITH reference to my despatch dated the 6th instant, I have the honour to inclose a statement of deaths from cholera in Egypt, completed up to the 14th instant by a local newspaper.* A Table of the populations of the towns affected by the epidemic is forwarded herewith for convenience of reference, and likewise a statement of the numbers of deaths per thousand in the seven towns which have yielded the largest totals. The total mortality hitherto recorded is 21,524, or about 3 per 1,000 of the whole population of Egypt. I have, &c. (Signed) EDWARD B. MALET. Inclosure I in No. 12. Mortalite depuis le debut de l'Epidemie jusqu'au 14 Aoiit au matin. Avant qu'il ne soit tenu compte de la mortalite par quartier . . . . 144 Abassieh .. .. .. 141 Bab-el-Charieh .. .. 249 Boulacq . . . . . . 1,757 Choubra .. .?. ? . . 286 Darb-el-Ahmar . . . . 92 Ezbekieh .. .. .. 393 Gamalieh . . . . . . 84 Musky . . . . . . 105 Saida-Zenab . . . . . . 336 Vieux Caire . . . . . . 952 Khalig . . .. .. (> Armee d'Occupatiou . . . . 29 Armee d'Occupation (Interieur) . . . . 74 Damiette .. .. .. .. 1,923 Chibin-el-Kom . . .. .. .. 1,171 Mansourah .. •. .. .. 1,085 Villages de Charkieh . . . . . . 798 Maballet-el-Kebir . . . . . . 746 Villages de Garbieh . . . . . . 738 Sauaanoud . ฆ . • . • • • 347 Menoufieh (Province de). . . . . . 303 Minieh . . • • • • • • 300 Zagazig .. .. .. .. 295 Gallioubieh (Province de) . . . . 280 Menzaleh 254 Villages de Dakahlieh . . . . . . 226 Villages de Beni-Souef . . . . . . 222 Mit-el-Garnar .. .. .. .. 213 Ghirghe .. .. .. .. 212 Ossine .. .. .. .. 210 Alexandric . . . . . . . . 208 Rosette .. .. .. .. 206 Zifta .. .. .. .. .. 198 Villages de Ghizeh .. .. .. 190 Simbclhawiu .. .. .. .. 160 Benha .. .. .. .. 154 Damanhour .. .. .. .. 152 Kaf'r-el-Zayat .. .. .. .. 148 Gallioubieh .. .. .. .. 144 Sohag .. .. ? .. 142 Barrage .. .. .. .. 131 Chirbin .. .. .. .. 124 Melieieh .. .. .. .. 119 Gu&ar .. .. .. .. 102 Chobar .. .. .. .. 100 Mabdel .. .. .. .. 99 Beni-Souef '.. .. .. .. 98 Villages divers . . . . . . . . 90 „ d'Assiout . . . . . . 90 Embabeh .. .. .. .. 89 Villages de Behera .. .. .. 83 KafrCheikh .. .. .. .. 72 Rodah .. .. .. .. 71 Belbeis . . . . . . . . 70 Galioub .. .. .. .. 69 Ghirghe . . . . . . . . 68 Talka . .. .. .. .. 61 Beni Ahmed . . . . . . . . 60 * See ซ Commercial No. 34 (1883)," No. 53. 23 Soft .. .. .. .. .. 59 Foohinti .. .. •• .. H Chax-kieh (Province de) .. .. .. 21) Kali- Dawar .. -• .. .. H Province de Menoufieli .. .. .. 55 Pachne .. .. .. .. 10 Mahmoudieh . . . . . . . . 50 Minleh llodab. ? . . . . . . •' Denota . . . . . . . . 48 Helouun . , . . . . . . 9 Menouf . . . . . . . . 48 Mehalleh Abou-Ali . . . . . . 9 Magaga . . . . . . . . 46 'fane . . . . . . . . . • 9 Tela . . ? . . . . . . . 43 Achmin . . . . . . . . Choubra ... . . . . . . 41 Kolossua . . . . . . . . 7 Tahrte .. .. .. -. 40 La-hona (Fayoum) .. .. .. 7 Sirnbel . . . . . . . . 89 Maimoun . . . . ซ . . . 7 Ibrahimieh .. .. .. .. 38 Ouled Ncgm .. .. .. .. 7 Villages de Siout . . . . . . 37 Touok . . . . . . . . *> Medine-el-Favoum . . . . . . 36 Welledieh . . . . . . . . 6 Chibrihit ". . . . . . . . 33 Mostar . . . . . . . . *> Chennaoui . . . . . . . . 33 Kabaiat . . . . . . . . 6 Dagadous . . . . . . . . 33 Assiout . . . . . . . . 5 Ismai'lia . . . . . . . . 33 Abou Kebir . . . . . . . . 5 Beghenin .. .. 32 Guetz .. .. .. •• 5 Villages de Minieh . . . . . . 32 Kafr Soliman f. . . . . . . . 5 Suez . . . . . . . . . . 32 Mahallet Hussein . . . . . . 5 Sahouam . . . . . . . . 31 Mit Birra . . . . . . . . 5 Atfe-el-Mahmoudieh .. .. .. 29 Manfalout .. .. .. .. 5 Bemba .. .. .. .. 29 Santah .. .. .. ? 5 Matranich .. .. .. .. 29 Tamieh .. .. .. .. 5 Beba . . . . . . . . . . 28 Choune . . . . . . . . 4 I^ehalleh Menouf .. .. .. 27 Chirbine-el-Kanater .. .. .. 4 )fia . . . . . . . . . . 27 Dinjouali . . . . . . . . 4 edreohine .. .. .. ?. 26 Ditsi . . Baghour .. .. .. .. 26 Kelria .. .. .. .. 4 Farchaut-el-Baghour . . . . . . 26 Kafr Hegare ... Beni Mourra .. .. .. .. 25 Lahoussa .. .. .. .. 4 Villages de Fayoum . . . . . . 23 Mulafout . . .... . . 4 Belgas . . . . . . . . 212 1 Nefiche . . . . . . . . 4 Bordei'n .. .. .. .. 21 lturaleh .. .. .. .. * Tama.. .. .. .. .. 21 Westa .. .. .. .. 4 Talbia .. .. .. .. 21 Bendarieh .. .. .. .. 3 Kareddin ? .. .. .. 19 Echoune .. .. .. .. 3 MemelChia .. .. .. .. 19 Habate .. .. .. .. 3 Fayoum . . . . . • . . 18 Boulacq Dacrour . . . . . . 2 Damate .. .. .. .. 17 El-Ayat .. .. .. .. 2 Memel฿hoda .. .. .. .. 17 Ziriba Zaoui'a . . . . . . . • 17 Tamour . . . . El Wahdan .. .. .. .. 16 Kafr Mansour .. .. .. .. 1 Settie .. .. .. .. 16 Kahleh (Ke"nah) Tourah .. .. .. .. 16 Kafr Sadat D an jii .. .. .. .. 15 Manfouma-el-Chibiu Zifta . . . . . . . . . • 15 Maesra Abou Omar . . . . . . . . 14 Massara Neghile .. .. .. .. 14 Manfulon .. .. .. .. 1 Barnach .. .. .. .. 13 Marassa .. .. .. .. 1 Issoma .. .. .. .. 13 Abiar . KafrZagazig .. .. .. .. 13 Berket-el-Sab .. .. .. .. 1 Touk., .. .. .. .. 13 Chine Boher .. .. .. .. 12 El Bamleh .. .. .. .. 1 Macoussa .. .. .. .. 12 El Mahati .. ? .. .. 1 Metia .. .. .. .. 12 Port-Said 12 Total 21,524 Tahta .. .. .. .. 11 24 Inclosure 2 in No. 12, Tableau de la Population dcs Centres principaux ou la Maladie s'est dlclarde. Population. Maisons. ฆ Total - Homines. Femmes. 0 "" .. .. 4,184 13,185 14,421 27,606 Bab"-6harieh " \\ \. .. ft* 20,668 21,280 41,944 Boulaa .. .. .. 8,933 26.714 25,351 52,065 c^rah* ;; :: :: :. im ww jwi ii,™ Darb-el-Ahmar .. .. .. 3,316 14,JU>4 10,224 29,528 Esbe'kiel .. .. 8,059 28,798 30,001 58,799 IGamaS .. " . 3,729 15,479 14,269 29,748 Khalifa 6,471 17,758 8 957 36/07 Saida-Zenab 5,376 15,897 18,203 34,150 El-Wnilv .. .. .. 3,327 7,109 • 6,594 13,703 Kaissom .. . 1680 5,711 6,495 12,206 MaTeHH_ 20,582 56,197 181,642 186,466 368,108 Tlexa^dr^leetbanlieue) .. .. 27,905 105,346 103,429 208,775 Aboukir .. .; .. .. 350 1.819 1,211 2,530 El-Mandarah 115 578 507 1,085 El-Siouf 82 623 617 1,240 Ramleh 848 2,206 J2JI3 4,342 29^300 11,072 107,900 217,972 manhour district et Zaptieh .. .. .. 9,844 31,609 32,214 63,813 nta ..... 5,660 16,785 16,940 33,725 ฆnouf '.'. 2,454 8,078 8,203 16,281 lioub 1,610 4,299 4,337 8,636 HUtfe 3 871 9,894 9,202 19,096 Kfroh :: 3,740 13,627 13,157 26,784 miette . 4,145 17,851 16,195 34,046 Rosette :: . 2,277 9,353 7,318 16,671 Port-Said 2,933 8,916 7,644 16,560 Ismailieh .. .. 997 1,899 1,465 8,384 Suez 1,746 5,835 5,078 10,913 Benha .'.' .' ! .'.' .. .. 1,655 4,388 3,979 8,367 Tula (Menoufieh) 1,575 4,940 5,027 9,967 Toukh 639 1,635 1,632 3,267 Kafr-Zayat 1,130 2,719 2.874 5.593 El-Mehalleh El-Kebireh 4,751 13,786 14,122 27,908 Cherbin 837 2,381 2,262 4,643 Talkha 699 2,489 2,520 5,009 Zifreh .. .. .. .. .. 1,600 5,601 5,539 11,140 Samanoud 1,763 5,682 5,875 11,557 iket El-Sab 416 1.298 1,266 2,564 .bar El-Namleh .. 463 1,469 1,557 3,026 kasse (non encore recensee) . . .a(Behera) .. .. .. .. 26 89 86 175 sbinEl-Kom 2,892 8,126 8,065 16,191 r Homza (Kalioubieh) . . . . . . 129 289 350 639 ;Ghamv 2,236 5,692 5,533 11,225 iadous (Dakahlieh). . .. .. .. 458 1,534 1,600 3,134 Sembellawein .. .. .. .. 717 2,546 2,555 5,101 AbouHammad .. .. .. .. 120 409 440 849 Manzaleh 1,034 4,226 4,224 8,450 Guizeh .. .. .. .. .. 2,188 5,461 5,956 11,417 Beni-Souef (Haute-Egypte) .. .. .. 785 4,843 5,195 10,038 Rodah (Assiout) .. 1,957 2,091 4,048 Fecline (Minieh) .. .. .. .. .. 2,993 2,997 5,990 Minieh .. 8,254 8,613 16,867 Belbeis (Charkieh) .. 3,651 3,658 7,309 Kafr El-Cheikh (Gnrbieh) .. .. .. .. 2,152 1,915 4,167 Maeba-ha (Minieh) .. .. .. .. .. 1,405 1,543 3,038 Kolosma (Minieh) .. .. .. .. 1,813 1,865 3,678 El-Soufieh (Charkieh) .. .. .. .. .. 84 547 1,131 Helouan .. .. .. .. .. .. 1,095 1,062 2,157 Embnbeh 1,549 1,523 3,072 Tourah .. 640 696 1,336 Asซiout .. .. .. .. .. .. 15,606 15,789 31,395 Kair-Dawar 252 254 5C6 Guirgueh 8,050 7,189 15,239 25 Population. Maisons. ~~ Total. Hommes. Femmes. bounag .. .. . . .. .. .. b,070 o,yoo lz,obo Bibeh .. .. .. .. .. .. 2,334 2,220 4,554 Chibin El-Kanater .. .. .. .. .. 1,377 1,385 2,762 ElWasta .. .. .. .. .. .. 435 400 835 Abou-Hommos .... .. .. .. 315 274 589 Kafr-Zagazig .. .. .. .. .. 375 395 770 Atfe .. .. .. .. .. .. 318 362 680 Ivtehallet Menouf .. .. .. .. .. 1,819 1,821 3,640 Mahmoudieh.. .. .. .. .. .. 2,176 2,173 4,349 Bordein .. .. .. .. .. .. 822 907 1,729 Tahta .. .. .. .. .. .. 6,793 6,996 13,789 Sawam'a .ซ .. .. .. .. .. 1,807 1,711 3,518 Medinet El-Fayoum .. .. .. .. .. 12,716 13,184 25,900 El-Lahoune .. .. .. .. .. .. 1,266 1,130 2,416 Manfalout .. .. .. .. .. .. 6,502 6,732 13,234 lnclosure 3 in No. 12. (Towns. Mortality. Population. per Cairo .. .. .. .. 5,622 368,108 1527 Damietta .. .. .. .. 1,923 34,046 57*70 Chibin-el-Kom .. .. .. 1,171 16,191 72-35 Mansourah.. .. .. .. 1,085 26,784 40*51 Ghizeh .. .. .. .. 785 11,417 68-85 Mehallet-el-Kebir .. .. .. 746 27,908 26-73 Tantah .. .. .. .. 597 33,725 17 70 Samanoud.. .. .. .. 347 11,557 30*03 No. 13. Sir E. Malet to Earl Granville. — (Received August 28.) My Lord, Cairo, August 18, 1883. WITH reference to my despatch of the 26th ultimo,* I have the honour to inclose copies of letters which have passed with regard to Colonel Chermside's return to Alexandria, from which your Lordship will observe that his valuable assistance in the recent emergency has been fully appreciated by the Minister of the Interior and by the Prefect of Police, and that he has done a great deal towards removing the friction which existed between the Prefect and the European officers with whom he is brought into contact. I have, &c. (Signed) EDWARD B. MALET, lnclosure 1 in No. 13. Khairy Pasha to Sir E. Malet. Mon cher Ministre, Le Caire, le 17 Aout, 1883. J'AI eu un long entretien avec le Prefet de Police a propos dv Colonel Chermside, gui, d'apres votre avis (que d'ailleurs je partage) devrait a la suite de la gravite dcs proportions de l'epidemie cholerique, rentrer au plus tot a Alexandrie pour prendre le commandement de son regiment. Son Excellence le Prefet, tout en regrettant fortement de devoir se priver dv precieux concours dv Colonel Chermside, ne peut [fairej moms [que] de reconnaitre la plausibilite dv motif gui conseille cette mesure, et il est pr6t a s'y soumettre. Veuillez, &c. (Signe) KHAIRY. (Translation.) My dear Minister, Cairo, August 17, 1883. I HAVE had a long conversation with the Prefect of Police on the subject of Colonel Chermside, who, in your opinion (which I share), should in consequence of the grave See ซ• Commercial No. 34 (1883)," No. 29. I I 04:0 I P 26 1 /.-ill 'J "11 4. \1 J.U iป i.1,. ซ ,ป„ 4.U character of the cholera epidemic return as soon as possible to Alexandria to take over the command of his regiment. His Excellency the Prefect, while he very much regrets having to deprive himself of the valuable assistance of Colonel Chermside, can only admit the force of the motive which prompts this step, and is ready to consent. I have, &c. (Signed) KHAIRY. Inclosure 2 in No. 13. Sir E. Malet to Brigadier-General Grenfell. Sir, Cairo, August 17, 1883. IN reply to your letter of the 1 5th instant, I beg to inclose copy of a letter which I have received from the Minister of the Interior, stating that the Prefect of Police of Cairo, although regretting extremely to lose Colonel Chermside's valuable assistance, nevertheless recognizes the necessity for his return to Alexandria.* Sir Evelyn Wood was so good as to lend Colonel Chermside to the Minister of the Interior with a view to expediting the execution of the measures deemed necessary to meet the cholera epidemic, and for this purpose he was requested by his Excellency to act under the Prefect of Police. Now that his mission is over, I shall be much obliged to you to convey to him my high appreciation of the manner in which he has performed it. There is no question that his presence has smoothed many difficulties, and that his tact and judgment in acting with the Egyptian officials have been of the greatest use during a very difficult crisis. I have, &c. (Signed) EDWARD B. MALET. No. 14* Sir E. Malet to Earl Granville. — (Received August 28.) tLord, Cairo, August 20, 1883. WITH reference to my despatch of the 13th instant,f I have theฃhonour to inform Er Lordship that during the past week only thirty-five deaths from cholera have been >rded in Cairo, and that there has been a very considerable decrease in the Returns mghout Lower Egypt, with the exception of the town of Alexandria. I have, &c. (Signed) EDWARD B. MALET. No. 15. Consul Cookson to Earl Granville. — (Received August 28.) rjord, Alexandria, August 16, 1883. WITH reference to my despatch of the 9th instant, I have the honour to transmit herewith a despatch from Mr. Mieville, inclosing a further letter from Dr. Ferrari, reporting that an improvement has taken place in the sanitary condition of Damietta.J I have, &c. (Signed) CHAS. A. CtiOKSON. Inclosure 1 in No. 15. Consul Mieville to Consul Cookson. Sir, Alexandria, August 16, 1883. WITH reference to my despatch of the 9th instant, I have the honour to inclose B farther letter addressed to the President of the Quarantine Board by Dr. Ferrari, orting that an improvement has taken place in the sanitary condition of Damietta. I have, &c. (Signed) W. F. MIEVILLE, X No. 1, t-Ntt.s. 27 Dr. Ferrari to Hassan Pasha Mahmoud. Excellence, Damiette, le 1 1 Aout, 1883. AVANT mon depart de Damiette pour Tor, comme j'en ai recu l'ordre par votre lettre dv 8 courant, et pour lequel je vous fais mes remerclments, je me sens en devoir de vous adresser le present Rapport, gui sera mon dernier d'ici, concernant les mesures prises pour la salubritd publique de cette ville. Depuis quelques jours l'autoritd locale semble avoir donne* dcs ordres tres seYieuses a propos de la proprete* de la ville et maintenant je suis heureux de pouvoir annoncer que celle-ci nest plus dans son c"tat primitif si sale ; a cet effet une Commission a e'te" clue de personnes distingue*es de la locality et gui a forme a son tour dcs Sous-Commissions pour chaque quartier afin d'en surveiller la bonne marche, et la continuation journaliere de la dite proprete*. Cette mesure quoique prise assez tard ne manquera pas d'etre une garantie pour l'avenir si toutefois elle serait continuee. Quelques rares cas de cholera se manifestent encore jusqu'aujourd'hui de forme be'nigne; parmi le nombre j'en ai visitd un sur ia personne dun garcon Chretien de l'&ge d'environ 7 ans. Avant de clore le present Rapport je suis en devoir de vous informer, M. le President, que hier vers 3 heures de I'apr&s-midi est arrive* ici M. le Dr. Hunter, par un train special, et apres avoir visits l'hdpital, le bureau d'hygiene, et une partie de la ville, il est reparti cc jourd'hui a 5 heures dv matin. Veuillez, &c. Le Directeur, (Signe-) Db. S. FERRARI. (Translation.) Your Excellency, 'Damietta i August 11, 1883. BEFORE my departure from Damietta for Tor, according to instructions contained in your letter of the Bth instant, for which I have to express my thanks, I feel bound to send you the present Report, which will be my last from this place, concerning the measures taken for the preservation of the public health of this town. For some days past the local authority appears to have given very strict orders for keeping the town clean, and I am now happy to be able to state that it is no longer in its previous dirty condition ; for this purpose a Committee has been chosen from among the chief persons of the place, which has in its turn formed Sub-Committees for each quarter, so as to superintend the proper daily execution of these measures. These measures, although undertaken late enough, will not fail to be a guarantee for the future if they are continued. A few cases of cholera of a favourable type still occur occasionally up to to-day; among the number I have attended one, the patient being a Christian boy, of about 7 years of age. Before closing this Report it is my duty to inform you that yesterday, at about 3 in the afternoon, Dr. Hunter arrived here by special train, and, after visiting the hospital, the sanitary office, and a part of the town, left to-day at 5 in the morning. Accept, &c. (Signed) Dr. S. FERRARI, Director. No. 16. Consul Cookson to Earl Granville, — (Received August 28.) My Lord* Alexandria, August 16, 1883. UP to the last few days there had been no appearance of any objection on the part of the native Moslem population to any of the sanitary measures prescribed by the Extraordinary Sanitary Commission. Indeed* the European Presidents of the various Sub-Commissions had reported constantly that they and their staff were generally very well received by the natives, and that they found more difficulty with Europeans in carrying out measures of sanitation. There was naturally some jealousy on the part of the Government Sanitary Board; but, by care to avoid collision, and by the co-operation of the Governor, this had not produced any worse results than a certain f 164*51 ~E 2 28 amount of delay and incompleteness in executing our sanitary programme. Indeed, every measure ordered by the Executive Committee was approved by his Excellency the Governor of Alexandria as President, by Hassan Pasha Mahmoud, the Vice-President, and by the three Egyptian Moslem members. The Committee was therefore painfully surprised at what took place on the 9th and 10th instant, as reported in my telegrams of the 1 lth, but at the meeting held on the 10th, at the suggestion of the native members, the arrangements which had been sanctioned for the disinfection of the houses where cholera patients died, and for their interment, were modified so as to avoid all possible collision with the religious feelings or prejudices of the population. The European doctors, however, who, from the first formation of the Extraordinary Sanitary Commission have been devoting themselves gratuitously to its work with a public spirit and generosity beyond all praise, finding that their co-operation was likely to be attended with personal risk, held a meeting of all their body on the 1 lth instant, at which resolutions were proposed by two of the most respectable and well-known medical men of Alexandria, that the doctors should retire from giving any further public assistance, and continue only to attend to the sick as private practitioners. At this meeting I happened to be present, in my unofficial capacity of a member of the Executive Committee of the Extraordinary Sanitary Commission, specially attached to the medical section of that Committee, and I was asked to take the Chair. In the hope of averting what might have proved a very serious calamity, namely, the total collapse of the organization which has hitherto worked on the whole so successfully, I accepted the offer ; and I proposed an amendment that a delegation of the medical body should be authorized to draw up a statement of the terms in which it would consent to continue its public assistance, and present it to the Governor of Alexandria. Of this delegation I was named Chairman. The same evening the delegation held a meeting at which we drew up our terms, of which I inclose a copy, with some explanatory notes. The next day, the 12th, we presented these terms to the Governor of Alexandria, and after a long discussion his Excellency virtually conceded them all. His Excellency sent a written reply, herewith inclosed, to our terms on the 13th, and on the 14th the medical delegation decided that this reply ought to be accepted. This decision was unanimously ratified by the medical body convoked on the evening of the same day, and since then the doctors have been working as before in their several Sub-Commissions, quarters, and ambulances and hospitals. In order to enable your Lordship to judge what are the points in which there might possibly be a conflict between the orders of the Sanitary Commission and the religious feelings of the Moslem population I inclose a copy of a letter which the Governor of Alexandria has written to me, at my request, specifying in detail these points. I can confidently assure your Lordship that all that is laid down in his Excellency's Memorandum has been accepted without any reserve by the Executive Committee of the Extraflinary Sanitary Commission, and is being strictly respected. In fact, the ten points on ich his Excellency insists do no more than embody formal decisions of the Commission. I It is sincerely to be hoped that nothing new will happen to interrupt the peaceable plication of the measures agreed upon for the protection of Alexandria from the demic now raging in this country. But I should be wrong in concealing from your rdship that within the last ten days there has been evinced a very bad state of feeling on ? part of the ignorant native population. Reports have been spread among them, and > generally believed, not only that the English have introduced the cholera, but that ; disinfectants, remedies, and even food given by the Sanitary Commission are poisonous. l Sunday last, the 12th instant, while the medical delegation was with the Governor, a 11-dressed Arab belonging to the superior classes brought in two common English cuits, which he said had been given to his child by a Christian, and which he wished to have ilysed. He seemed hardly satisfied at seeing the biscuits eaten by two members of the egation. On the 1 lth instant a negro British subject was brought to this Consulate :h a letter from the Governor of Alexandria stating that the accused was suspected of tributing bad meat to the Arab population. I know, however, that similar groundless iefs have often existed in other places during the prevalence of epidemics. I have, &c. (Signed) CHAS. A. COOKSON. 29 Inclosure 1 in No. 16. Terms of Sanitary Delegation. LE corps medical d'Alexandrie demande 1 . Dcs garanties formelles pour la mise a execution de son programme sanitaire, tout en respectant, ainsi qu'il la toujours fait, les couturaes religieuses. Ces garanties consisteraient dans Padjonction & chaque Comite* de Quartier, a chaque ambulance dun piquet de gendarmerie, commande autant que possible par un officier European. Dcs mesures de police complementaires seraient etudie'es entre son Excellence le Gouverneur et le Comite Executif. 2. Le me*decin- en-chef de chaque Comite* ou de chaque ambulance aura sous sa dependance absolve et son entiere direction le personnel quel qu'il soit. 3. L'augmentation dcs appointements dcs employes fixes dependra dv President de ia Commission dv quartier. 4. La mise en liberty dv Dr. Rizgalla sauf a, faire ulterieurement une enquete sur les griefs gui lvi sont imputes. 5. Le renvoi d'Ahmet Loutfi a cause dcs entraves qu'il a apporte dans l'execution dv service medical de son quartier. 6. Que pleine satisfaction soit donnee au corps medical pour les faits regrettables de ces derniers jours. Si les propositions ci-dessus ne sont pas accepters, le corps medical declare se retirer, tout en etant comme par le passe" a la disposition dcs personnes gui rฃclameront leurs soins. Explanatory Notes. 1 . This was asked in consequence of the attacks made on the 9th and 10th on one of the Sanitary staff and on an ambulance hospital. 2 and 3. Intended to secure the cooperation of the staff attached to the Commission. 4. Dr. Rizgalla is a doctor in service of Government but attached to the Commission, who was most arbitrarily thrown in prison by the Governor of Alexandria in consequence of charges made against him in the execution of his duties. The medical body expressed very strongly their feeling that this was a direct attack on their independency, and showed an inclination on the part of the authorities to make them victims to the popular excitement. 5. Ahmet Loutfi, a subordinate medical officer, had taken upon himself, without any good reason, to dismiss the staff of his quarter, and so throw the whole of its administration out of gear. (Translation.) THE Medical Body of Alexandria request :— 1 . Formal guarantees for carrying out their sanitary programme, while they undertake to respect religious customs as they have always done. These guarantees should consist in a picket of the gendarmerie, commanded as far as may be, by an European officer, being attached to each District Committee and to each ambulance. Additional measures of police to be considered by the Governor and the Executive Committee. 2. The bead doctor of each Committee, or of each ambulance, to have his staff, whoever they be, under his complete control. 3. The increase in the number of permanent appointments will be decided by the President of the District Committee. 4. The liberation of Dr. Rizgalla ; but an eventual inquiry into the complaints brought against him. 30 5, The dismissal of Ahmet Loutn on account of the impediments which he has thrown in the way of the medical service in his district. 6. That full satisfaction should be given to the medical body for the deplorable events of the last few days. If the foregoing proposals are not accepted, the medical body declare their intention of withdrawing their assistance, being, however, still at the disposal of those who seek their services. Inclosure 2 in !N"o. 16. Osman Orphi to Consul Cookson. M. le Consul, Alexandrie, le 13 Aotft, 1883. ME reYerant a l'entretien que j'ai eu l'honneur d'avoir avec vous et avec MM. les de'le'gues dv corps medical lors de l'entrevue de cc matin, je m'empresse de vous confirmer les declarations suivantes que j'avais faites en reponse aux demandes gui mont 6te remises par ces messieurs :—: — 1. Le piquet de gendarmes demandd pour chaque ambulance avait et^ dejaetablij quant au piquet dernande pour chaque Comite* de Quartier, il existe au siege m6rae de chaque Comity ou tout i cbti un corps de garde de gendarmerie et un ddtachement de gardes de police, independamment dcs patrouilles gui circulent dans toutes les rues et les quartiers. Si le corps medical desire assurer une protection quelconque aux diffeYents Comites, cette protection leur sera et leur doit &tre accordee par ces corps de garde ou toute autre force publique. ปDv reste, lorsque MM. les me*decins ou les membres dcs Comite's trouveront de position a l'exdcution de quelque mesure non contraire aux coutumes et croyances gieuses, ils n'ont qua y surseoir et a m'en dormer avis ; je me chargerai alors de faire mettre les recalcitrants. IJe rappelerai aussi a ces messieurs, et vous-m^me n'ignorez pas, M. le Consul, qua erentes reprises j'ai donne les ordres les plus severes a tous mes subalternes de se fctre constamment a la disposition dcs Comites dcs Quartiers, les mena9ant de toutes les leurs disciplinaires en cas de retard ou meme d'hesitation. Ces ordres ont e*te maintenant ouvele*s. Tous les corps de garde viennent d'etre renforces par la Garde Khediviale, gui a e*te mise a ma disposition a cet efFet, et les Comites de Quartier ne peuvent qu'y trouver un appui et une assistance efficaces en cas de besom. 12. Je dois encore rappeler a ces messieurs dv corps medical que d'apres le projet rganisation dcs ambulances, le personnel gui les dessert se trouve place sous la >endance et la direction dv medecin-en-chef dans les conditions etablies par le dit jet et par les deliberations dv Comite Ex6cutif. Le personnel provisoire dcs postes medicaux se trouve dans les monies conditions. I Quant au personnel medical fixe dcs quartiers compose" d'employds officiels nomme's drieurement a la formation de la Commission d'Hygiene, et relevant dune Administrai centrale speciale, il ne peut etre traite' sur le mehne pied qu'un personnel provisoire, lependre dune autre autoritd que celie gui lvi est donnee par les institutions Etablies ; icipe gui dv reste a et6 deja reconnu, et admis par le Comite" Executif dans sa stance l cr Juillet, ainsi qu'il resulte dv proces- verbal relatif a, cette seance, ou il est dit en pres termes, "que ces Commissions et Comite's n'alte"rent en aucune maniere les ibutions et le fonctionnernent dcs institutions deja etablies par le Gouvernement." INeanmoins, dcs ordres ont deja etc" donnes precddemment a tout le personnel medical quartiers de se conformer entierement aux ordres dcs Comite's dans les limites de leurs butions, et les Comite's ont, dv reste, sur eux droit de contr6le. 13. J'admets volontiers l'augmentation provisoire dcs appointements dcs employe's s sur la recommandation dcs Presidents de Comite*, pour les encourager a faire leur oir et les dedommager dcs frais qu'ils auront a supporter pendant le cours de ide'mie ; mais je de'sirerais qu'avant d'allouer cette augmentation elle me soit indique'e que je puisse en obtenir l'approbation. ฆ 4. Le Dr. Risgalla avait deja 6t6 mis en liberte avant notre entrevue, et l'enqu^te sur grief's gui lvi sont imputes continue. 85. Le renvoi de tout employe ne peut &tre ordonnd que par un jugement dv Tribunal petent. Neanmoins, pour trancher toute contestation et eviter la perte dv temps precieux que produirait une enquete, je me propose de le retirer dv service dcs quartiers. 31 6. La satisfaction que reclame le corps medical sera donnee non seulement pour les fails en eux-me'mes, mais aussi pour dormer un exemple. Les eoupables et les principaux fauteurs ont etc arretes au moment meme ou ces faits se sont produits et ac trouvent sous jugement. J'aime a croire que les honorables membres dv corps medical sauront appre*cier a leur juste valeur ces declarations, et que tenant compte dcs difficultes sans nombre gui se pre"sentent dans l'accomplissement de ma tache, ils auront tout lieu d'en demeurer satisfaits. Je saisis cette occasion pour exprimer a ces messieurs tous mes remerclments pour les services qu'ils ont rendus, et j'ai pleine confiance dans leur zele et leur esprit de moderation pour continuer la tache humanitaire a laquelle ils se sont devours. Veuillez, &c. Le Gouverneur et PreTet de Police, (Signe) OSMAN ORPHI. (Translation.) Sir, Alexandria, August 13, 1883. WITH reference to the conversation which I had the honour to have with you and th the delegates of the medical body during this morning's interview, I hasten to confirm following statement which I made in reply to the demands delivered to me by those gentlemen : — 1. The picket of gendarmes requested for each ambulance had already been stationed; as to the picket asked for for each District Committee, there is one at the place of meeting of each Committee, or close by ; a guard of gendarmerie and a detachment of police guards, apart from the patrols which go through the different streets and quarters of the city. If the medical body desires any special protection given to the various Committees, such protection shall, and indeed ought to be, afforded to ,them by these guards, ov bysome other branch of the public force. Should the medical men or the members of the Committees find opposition made to the execution of any measure which is not contrary to the customs of the people and religious beliefs, they need only wait and inform me of the fact ; I will then undertake to suppress the opposition. I would remind these gentlemen — and you, Sir, are not ignorant of it — that I gave the most stringent orders to all those placed under me to hold themselves continually at the disposal of the District Committees, and threatened to visit any refusal or even hesitation to comply, with the utmost severity possible. These orders have now been renewed. All the guards have been supplemented from the Khedive's guard, which has been placed at my disposal for the purpose, and the District Committees cannot fail to find in it efficacious support and assistance should it be needed. 2. I must also remind the members of the medical body that, according to the plan on which the ambulances were organized, the staff working them is dependent on, and placed under the direction of, the chief medical man, under certain regulations established by the said plan and the resolutions of the Executive Committee. The provisional staff of the medical depots are similarly circumstanced. The fixed medical staff of the districts, composed of officials appointed before the formation of the Sanitary Committee, and dependent on a special central Administration, cannot, however, be assimilated to a provisional staff, and cannot be placed under any authorities other than those designated for the purpose by existing institutions; this principle was, indeed, acknowledged and recognized by the Executive Committee at its Meeting of the Ist July, as shown by the Minutes thereof, which say " that the Commissions and Committees in nowise alter the duties and sphere of work of institutions already established by the Government." I Nevertheless, orders have already been given to all the medical officers of the districts submit entirely to the Committees so far as their duty permits, and the Committees ye a right to control them. 3. I readily agree to increasing the pay of the officials, as recommended by the Presidents of the Committees, in order to incite them to do their duty, and to compensate them for the expenditure they will have to bear during the continuance of the epidemic; but before awarding such increase, I wish to know its amount, so that 1 may obtain sanction for it. 4. Dr. Risgalla had been liberated before our interview, but the charges brought 32 5. Ihe Court of competent jurisdiction is alone able to order the dismissal of an official. But, be this as it may, I propose to withdraw him from district duty, and this in order to avoid the waste of valuable time that an inquiry would entail. 6. The reparation asked for by the medical body shall be given not only on account of the events themselves, but also as an example. The guilty, and those chiefly at fault, were arrested at the time, and now await trial. I am convinced that the honourable members oif the medical body will rightly value what I have now said, and that, while remembering the countless difficulties I have to contend with in fulfilling my duty, they will have reason to be satisfied with what has been done. I avail myself of this opportunity to thank those gentlemen to the utmost of my power for their services, and I have full confidence that, their zeal and their spirit of moderation will enable them to continue the humane task to which they have devoted themselves. I have, &c. (Signed) OSMAN ORPHI, Governor and Prefect of Police. Inclosure 3 in No, 16. Osman Orphi to Consul Cookson. M. le Consul, Alexandrie, le 14 Aout, 1883. ME rapportant a la declaration que j'ai eu l'honneur de vous faire lors de notre entrevue dv 1 1 courant, relativement ala necessite de menager tout cc gui touche aux coutumes et aux croyances religieuses de la population Musulmane, et me conformant au de'sir que vous m'avez alors exprime de vous indiquer tout cc gui, parmi les pratiques actuelles, est en opposition avec ces contumes et ces croyances, je m'empresse de vous transmettre ci-inclus une note indiquant les mesures h prendre vis-a-vis dcs indigenes. Ainsi que vous pourrez le remarquer par la lecture de cette note, la plupart de ces mesures ont dej& etc* consenties et adoptees par le Comite Executif lui-me'me. Je suis done certain que MM. les docteurs ne trouveront aucune difficult^ a adopter ces mesures et sauront par leur prudence et leur tact en faciliter Papplication. Veuillez, &c. Le Gouverneur et Prefet de Police, (Sign**) OSMAN ORPHL 1. Toute personne atteinte de cholera est libre de se faire soigner a domicile ou. a I'h6pital. 2. Les indigents gui refuseraient de se rendre a I'h6pital seront soignds a domicile par les me'decins ; mais si le traitement est impossible dans les habitations a cause de leur mauvaises conditions hygieniques, les malades seront transported a I'h6pital. En cas de resistance de leur part, il en sera donne avis au Commissaire dv quartier, gui se chargera ac les y envoyer. 3. Pendant le cours dv traitement la disinfection et autres operations analogues seront faites par le medecin traitant. 4. Attendu que la constatation dcs deces est avant tout dv domaine de I'Etat Civil, que e'est Plnspectorat Sanitaire gui a toujours eu qualite pour y proceder et qu'il tient un iivre special pour l'enregistrement dcs personnes decedees, il reste entendu que la constatation dv deces de tout individu doit etre faite par le medecin ofticiel dv quartier et les permis d'enterrement de'livre's par l'lnspectorat sur la demande dv me'decin. Cependant pour faciliter aux medecins-en-chef dcs ambulances le prompt transport dcs cadavres, il leur sera donne par l'lnspectorat un certain nombre de cartes en blanc qu'ils rempliront au besom, sauf a lvi dormer avis de chaque dฃc6s. 5. La constatation dcs deces pour les femmes indigenes sera faite par les sage-femmes officielles dv quartier. 6. La desinfection dans les maisons dcs indigenes sera faite apres l'enlevement dcs cadavres par les sage-femmes d'apres les instructions et sous la surveillance dcs medecins gui devront se tenir a Texteneur de la maison a d&infecter. 33 employes par les Musulmans sauf a les goudronner interieurement. 8. Les morts seront lave's a l'eau prop re, par dcs laveurs gui eViteront tout contact avec les personnes de la maison et gui devront e'tre desinfecte's. L'eau ayant servi a cette operation devra etre conserved jusqu'a l'arrivee dcs personnes chargees de la desinfection. 9. Les morts seront enveloppes dun premier linceuil blanc. La derniere enveloppe sera goudronnee par les laveurs eux-mernes, gui seront munis dune bouteiile de goudron a cet efFet. 10. Les porteurs dv cercueil ne seront point change's en route et Us devront e'tre desinfectes au cimetiere. En general, il faut dan 3 la pratique eviter tout cc gui serait de nature a froisser ou a heurter les coutumes et les croyances religieuses. Le Gouverneur d'Alexandrie, (Signd) OSMAN ORPHI. (Translation.) Sir, Alexandria, August 14, 1883. WITH reference to the assurance I had the honour to give you on the occasion of our interview on the 11th instant, respecting the necessity of being careful as regards anything which touches the religious beliefs and customs of the Mahommedan population; and, in accordance with the wish you then expressed that 1 should point out everything now done which may be in opposition to those customs and beliefs, I have much pleasure in inclosing a Memorandum showing what measures should be adopted for the natives. As you will see, on reading the Memorandum, that the greater part of these measures have already been adopted by the Executive Committee. 1 am, therefore, sure that the doctors will have no difficulty in adopting these measures, and will, by their prudence and tact, make the application of them all the easier. I am, &c. (Signed) OSMAN ORPHI, Governor and Prefect of Police. 1. Any person attacked by cholera is free to be attended either at home or at the hospital. 2. Indigent persons who will not go to the hospital will be attended at home by the doctors ; but if proper treatment is impossible in their homes, owing to their bad sanitary condition, the sick will be taken to the hospital. Should they resist, notice is to be given to the District Commissioner, who will see to their being taken to the hospital. 3. During the treatment, disinfection and other similar operations will be carried out by the doctor in charge of the case. 4. Whereas the civil authority is, above all, charged with the registration of deaths, whereas the Sanitary Inspector has always had power to do this act, and whereas he keeps a book specially for registering deaths, it is understood that the notification of any person's death must be made by the official doctor of the district, and the burial permit be delivered by the Inspector on the request of the doctor. In order to give every facility to the principal doctors in charge of ambulances for the removal of corpses, the Inspector will give them a certain number of blank forms, to be filled up as may be required ; but the doctors must notify every death to the Inspector. 5. The deaths of native women will be notified by the official midwives of the district. 6. Native houses will be disinfected after the corpses have been brought out by the midwives, in accordance with the instructions of, and under the superintendence of the doctors, who are to remain outside the houses to be disinfected. 7. The coffins used for the conveyance of corpses shall be of the same shape as those used by the Mahommedans, except that they are to be tarred inside. 8. Corpses are to be washed with clean water by washers, who are to avoid all contact with the people of the house, and who are to be disinfected. The water used is to be kept until the arrival of those charged with the disinfection. 9. Corpses are to be first wrapt in a white winding-sheet ; the outer wrapping is to be tarred by the washers themselves, who will be furnished with a bottle of tar for the purpose. 10. The coffin-bearers are not be changed on the way to the cemetery, and are to be 34 there disinfected. Generally speaking, everything must in practice be avoided which would be of a nature to ruffle or jar religious dustom฿ and beliefs. (Signed) OSMAN ORPHI, Governor of Alexandria. 'So. 17. Consul Cookson to Earl Granville. — (Received August 28.) My Lord, Alexandria, August 20, 1883. I HAVE the honour to forward herewith a despatch from Mr. Mieville reporting the progress of the epidemic. I have, &c. (Signed) CHAS. A. COOKSON. Inclosure in No. 17. Consul Mieville to Consul Cookson. Sir, Alexandria, August 20, 1883. THt last week's mortality from cholera throughout the country is stated at 3,420, bringing the total number of deaths since the beginning of the outbreak to 24,566. 'the following Table shows shortly the force of the epidemic from the 24th June, and in what degree it is now decreasing :—: — Daily Average. Week ending- Deaths. I nc l ud ing Excluding Cairo. (Jairo. July Ist .. .. .. 651 93 93 „ Bth .. .. .. 1,121 160 160 ,i 18th .. .. .. 1,145 163 163 „ 22nd .. .. .. 2,137 305 175 „ 29th .. .. .. 5,131 733 366 August sth .. .. .. 5,880 840 597 „ 12th .. .. .. 5,029 718 655 „ 19th .. .. .. 3,420 489 482 In Alexandria during the past week the mortality from cholera has continued to increase, 287 deaths being recorded as against 136 during the previous seven days. The general mortality, however, has decreased, though it continues high. I have* &c. (Signed) W. F. MlfiViLLE* British Delegate. Mo. 18. Consul Cookson to Earl Granville. — (deceived August 28.) tLord, Alexandria, August 20, 1883. I HAVE the honour to inclose a Report which Dt; Mackie has requested me to transmit td your Lordship respecting the present epidemic of cholera in Egypt. I hare, &c. (Signed) CHAS; A. COOKSON. Inclosure 1 in No. 18. MepoH by Dr. Mackie respecting Cholera in Egypt. lON the 21st of last month I forwarded to Sir Edward Malet, for the information of Majesty's Government, a telegram received by me on that day from Mansourah, ng that many cases of typhoid had been observed in the districts then infected, us also shial cases.* * Bfefe " Cbmtoei-cial No. 64 (188 ft)," tnclosur* 2 in N* 4U, 35 attached less importance to it at the time than I am inclined to do now, in consequence of rumours which have reached us of the existence of cases of petechial typhus, and from what ha? fallen under my own observation. Case I. On Saturday, the 28th July, I was called to see Mr. 8., an Englishman over 60 years of age, in easy circumstances, enjoying a moderate pension, but living in a small house, the sanitary state of which was filthy in the extreme, situated in a quarter of the town in which several of the earliest cases of cholera occurred. He had been feverish and ailing for a week, but no very distinct history could be obtained. I found him with very high fever, temperature 1 05 degrees Fahr., pulse quick and hard, face flushed, eyes suffused, tongue dry, very restless and delirious, abdomen and lower extremities covered with petechial spots about the size of a pin's head, abdomen slightly distended, no diarrhoea, urine albuminous, great muscular weakness, and tremors of hands and mouth. Dr. Putsey, Surgeon of Her Majesty's ship " Condor," who happened to be with me, examined him. and we both pronounced it a case of "petechial typhus." Treatment was instituted to lower the temperature, and next morning he was without fever, and continued so until noon, when the fever returned as before to disappear again completely next morning, and return with same intensity towards the afternoon, Ttjis state of things continued until the 2nd August, when I found at my morning visit that the temperature was a little above normal, but he was lying prostrate on the bed, tongue dry, pulse weak, tremors, and a yellow tint had appeared over the whole body. I ordered him at once, with the consent of his family, to be removed to a private room in the Deaconesses' Hospital, which was done in the afternoon. He stood the moving very well ; his temperature did not rise at night, and next day was found to be slightly below normal, at which point it remained till the day before his death, when it rose to 102*2 degrees Fahr,, at which time he had also for the first time diarrhoea, fie died on the 10th August. The yellow tint disappeared from the body three days after its first appearance. i\fte,r his admission into hospital he continued in $ state pf grea> prostration until he died, 3evera] medical men saw the case, and from the behaviour qf the temperature, qpirn'ons were divided between its bein^ a case of typhus with unusual temperature phenomena, or "bilious intermittent fever" with petechia. It certainly Had not the classical temperature of typhus as observed in England, put continued fevers here very often assume an irregular malarial form, a matter whiOh a,sya.p,ted the attention of the military surgeons last year during the prevajenpe of enteric fsvor arnQflgst ouy troops., and on which I was often referred to by them? Case 2. On the 13th instant an Egyptian, aged about 25 years, died in the Deaconesses tjospital. He was. employed as a gardener, and entered the hospital, apparently in good health, t.o be operated on fiw a very small fistula. He was operated on by my colleague, Dr. Varenhorst, and all went on well for eight days after the operation, when suddenly he became feverish, his temperature from the beginning mounting up to 103 and 105 # 2 degrees Fahr., between which it varied morning and evening till he died on the 13th August, twelve days after the commencement o\ fever. Not having been informed of the case, I did not see it till after death, when I inspected the body- I found it covered with flat, round, dark-coloured spots, from to ฃ-inch in diameter. On the back were two large black masses under the skin, which, my colleague told me, during life presented the appearance of bullse full of blood, and which, when cut into, were found to consist of dark semi-fluid blood of tarry colour and consistence. On the back of one of the thighs there was a similar black mass. AH of these, when examined by me after death, looked, at first sight, like an ordinary anthrax in a state of Hgrene; but, on closer examination, were found to be semi-fluid blood, contained in a ; of sac formed by the skin. f 16451 G k> 36 The glands of the groin were very prominent and hard. There were no signs of buboes. This was noticed particularly, as reports were being circulated of the existence of plague at Damietta. Dr. Varenhorst excluded emphatically any suspicion of pyaemia from operation, and stated that healing of the small wound was going on most satisfactorily. He gave it as his opinion, and stated at length in the certificate of death, that it was " typhus avec petechies," &c. (see certificate, Inclosure 2 in No. 19). The wound which had been healing fast, and was healthy, after the onset of the fever became suddenly gangrenous. None of the measly eruption of ordinary typhus was present ; but it is doubtful whether, if in the dark skin of the Arab, it would have been distinctly made out. Case 3. Dr. Haddad, who was sent by the JVlansourah Relief Committee to Mansourah at the commencement of the outbreak, and who was afterwards transferred to Mahalla-el-Kebir, telegraphed to me from the latter place :—: — " 1 have a case of petechial rash ; round spot confluent all over the body. Do not disappear completely on pressure. Temperature, 104 degrees ; pulse, 90 degrees. Unconscious and delirious. Saw him first five days ago. Was told he had an attack of cholera fifteen days before I saw him." Two days ago, on the evening of the 18th, he again telegraphs :—: — "Rash began on the 11th, and subsided on the 16th. To-day temperature, 103 degrees; pulse, 110. Less delirious; tongue dry and glazy; fetid diarrhoea; skin desquamating." These cases were evidently malignant fever of the nature of, if not, true typhus, and are of importance taken in connection with Dr. Dutrieux's telegram from Mansourah of the 21st July, already referred to, which would go to show that a petechial disease existed to some extent in the infected districts even before the outbreak of cholera was declared. ฆ This is, to my mind, of great importance, as going to prove that the present epidemic cholera originated de novo at Damietta. 1 Malignant fevers and typhus must, with regard to the circumstances under which they st, be classed in the same category as cholera, viz., filth diseases. It has been ablished that typhus can be generated, de novo, by filth and overcrowding, where no ihus existed, in proof of which I may cite the case of the Egyptian steamer, " Scheah haad/' which obtained such notoriety twenty-two years ago by importing typhus into 'erpool, though there was no typhus on board the vessel. Three persons who went on ird the vessel in the dock took typhus, and the crew communicated typhus to the bath sndants and to twenty-five persons in the Southern Hospital, Liverpool. kit is needless for me to go into the details of this case, which is so well known, further to say that the almost universal opinion was that the typhus poison was generated on d the ship without the crew suffering from it. IParkes stands almost alone in contending that the crew were suffering from typhus, the medical men who attended them declared that no fever existed amongst them from to last. I But if, as Parkes says, the crew were suffering from typhus, I am still of opinion that i typhus germ or poison must have been generated on board and constituted a local or novo origin, as typhus is not a disease ot Egypt and there was no typhus existing at jxandria, the port from which the ship sailed. I This was certified to by Dr. Ogilvie Bey and myself, and is mentioned by . Murchison in his standard work on fevers, page 1 09, foot-note. I As we know the circumstances under which typhus has always originated in an demic form, so we know the circumstances under which cholera originates, and as the son of the one has been proved to be capable of being generated from filth, poverty 1 misery, overcrowding, &c, it requires less faith to believe that under circumstances ich we deem favourable to its development, the poison of cholera should also be lerated, and these circumstances have existed at Damietta. And another indirect proof y now be added in the slow and slight hold which the epidemic has as yet taken of ;xandria, which suffered proportionally more than Cairo from the epidemic of 1865, en no effectual cleansing or sanitary work was done to prevent it. ป Though there remains much yet to be done in Alexandria, much, which it is impossible o, a very great deal has been done. Twice within twelve months the to^r baa been as thoroughly cleansed as circumstances 37 will permit ; once by the Extraordinary Sanitary Commission appointed by the Khedive last July after the bombardment. This Commission, of which I was a member, continued to work from the i4th July to the beginning of September ; once by the excellent work of the Extraordinary Sanitary Commission at present going on. It has been the fashion to refer the origin of all epidemics, especially the epidemic of cholera (a disease of whose origin we know almost nothing), to imported contagion; but satisfactory evidence is still wanting that this is the case. Few who know thoroughly the working of Egyptian quarantine will be bold enough to assert that they conscientiously believe that Egypt has always been preserved by it alone. I have witnessed during the last twenty-three years several quarantines imposed in Egypt against epidemics whL ' certainly did not reach us ; but I should be a bold man indeed it I were to declare that they were kept out by the quarantine which was practised. ง While vessels from infected ports are allowed to communicate freely with vessels in pratique and take in cargo from them, their crews have the freest intercourse, so g as a yellow flag is shown at the masthead. The President of the Board of Health of former years declared that by such quarantine, •' Nous avons sauve" L'figypte," only during the last two years has there been a decided attempt to carry out a strict and stringent quarantine by an efficient inspector and well-organized staff, and yet cholera reigns epidemically in Egypt. While the opinion exists that quarantine is the only protection, the danger to Europe will continue to be greater, as it has been proved that the fancied safety by quarantine creates a carelessness to all other sanitary improvement. 1 most firmly believe that, had the money spent on, and the attention given to, quarantine for many years past, been spent on proper sanitary improvements, and inspection with proper State supervision of public health, the present epidemic of cholera would not have been devastating Egypt, nor should we have run any more risk than we have done, but less during the last eighteen years which have elapsed since the last epidemic. I would put a question in a practical, if not a scientific way, for science as yet has taught us little about cholera. Given circumstances, such as are now notorious as c iifcing at Damietta ; an overcrowded town, a filthy-living, filthy-feeding population, still suffering from a degree of mental depression from the events of last year, a river almost stagnant in the midst of the town, receiving the contents of latrines, and from which drinking water is taken ; a river teeming with carcases of animals dead of cattle-plague, many of which were eaten by the people, great heat, &c. Given these conditions, or such conditions as exist this year at Damietta, I would ask any professor of public hygiene, is an epidemic likely under such circumstances to break out amongst the population ? He would be a bold man who would answer in the negative. If an epidemic is likely to break out, what form is it most likely to take in Egypt ? The class of filth diseases we know are those likely to prevail under such circuminces. Typhus, us I have stated, is not a disease of Egypt, though, from what I have ted at the commencement of this Report, it would seem to have made an attempt to ablish itself; enteric fever, though it frequently prevails to a considerable extent, has ;er been a deadly epidemic among the Egyptians, but is prevailing to a large extent at isent on the eastern part of the Delta. Diphtheria shows itself in small outbreaks in particular localities now and then, but does not assume an epidemic form. There remain two diseases which have found Egypt and the Egyptians favourable for their epidemic development — cholera and plague. The latter, for some reason, or in obedience to some law governing epidemics, has not appeared in Egypt for many years, but, since the last appearance of plague, cholera has on several occasions shown that it continues to be the fatal epidemic disease of Egypt. I maintain, therefore, that it is the disease most likely to break out epidemically under the given circumstances, and t maintain equally that it can be prevented by good sanitation. It may be said that such an opinion tthe origin of the present epidemic is purely speculation. I reply that it is less specuive than that the disease was imported direct from Bombay, as has been maintained by Fauvel, or that the cholera germ has been lying dormant in J%ypt tor an indefinite iod, and found favourable circumstances at Damietta for its development, the latter ory would be a strong argument in favour of more sanitation and less quarantine. 38 general, that wjien all sanitary laws are natoriqiislj outraged, disease in an epidemic form will break out. (Signed) J. MACKI& Surgeon to Her Majesty's Consulate. Alexandria, August 20, 1883. Inclosure 2 in No. 18. Certificate of Death of Case 2> I IB RAJ HIM JOSEPH, de Ramleh, jardinier, entre aveo petite fistule a l'anus le 3 Juillet. 188 <: i ; y est decede aujourd'hui, a 8 lieures et demie dv matin, de typhus avee jtechies et de grandes bulles de sang de f centim. de diam&tre au nombre de trois, dont le etait placee a la cuisse gauche, et les deux autres a la region lombaire; et legere filtration" dcs glandes inguinales, gui sont grandes com me dcs amandes. (Sign^) Dr. VARENHORST. Alexandrie, le 13 Aout, 1883. (Translation.) tIBJt.UHIM JOSEPH, of Ramleh, gardener, entered with a small fistula ani, the 16th ly, 1883 ; died this day, at B*3o a.m., of typhus, with petechise and three large bullse of >od f of a centim. in diameter, of which one was on the left thigh and the other o in the lumbar region; slight infiltration of the ingual glands, which are as large almonds. (Signed) Dr. VARENHORST. Alexandria, August 13, 1883. Inclosure 3 in Np. 18. Hospital Description Card. — Deaconesses Hqspital, Alexandria. Name ? .. .. .. Ibraihiiu Joseph. Age .. .. .. .. 40 Religion . . . . . . Moslem. Occupation . . . . . . Gardener. liicth place . . . . . . Alexandria Plnce of re.-idence .. .. Ramleh. I )ay of entrance .. .. .. 16th July. Date of departure . . . . Died 13th August, at 8 '30 in the morning. ฆ Disease entered : fistu'a ani, 24th ; typhus with petechia, aud with bullae full of blood, in appearance* like lignant pustula or " charbon." No, 19. Earl Granville to Sir E. Malet. Sir, Foreign Office, August 29, 1883. 1 APPKOVK your action with respect to the sanitary condition of Damietta, as reported in your cjespatch of the 17th instant.* I am* &c. (Signed) GRANVIH.E. 39 No. 20. Earl Granville to Sir E. Malet, Sir, Foreign Office, August 29, 1883 t I HAVE learnt with satisfaction the result of Colonel Cherraside's proceedings in connection with the cholera epidemic in Egypt, as reported in your despatch of the 18th instant** I am, &c. (Signed) GRANVILLE. No. 21. Sir E. Malet to Earl Granville. — {Received August 29.) (Telegraphic.) Cairo, August 29, 1883, 10 a.m. SIX doctors and thirty-six hospital assistants arrived from India yesterday evening. STo. 22. Sir E. Malet to Earl Granville. — (Received September 4.) My Lord, Cairo, August 21, 1883. WITH reference to my despatch of the 16th instant, I have the honour to inclose herewith copy of a despatch which I have received from Mr. Vice-Consul Borg, reporting the result of his inquiries from the British Consular Agents in his district on the repeal of the tax on the burial of dead animals. I have, &c. (Signed) EDWARD B. MALET. Inclosure in No. 22. Vice-Consul Borg to Sir E. Malet. Sir, Cairo, August 20, 1883. I HAVE the honour to acknowledge your despatch of the 13th instant instructing me to request the Consular Agents in my district to report whether they have any knowledge of the levying of a tax on the burial of dead animals, and to make inquiries on the subject. I beg to inform you, in reply, that the Consular Agent at Mansourah reports that as the result of extensive inquiries made there and in several villages in the immediate vicinity, he finds that the tax does not now exist, and has not been levied for a number of years. The reports from Tantah and Zagazig are to the effect that the Consular Agents are not aware that any such tax is being levied, and that they have instituted inquiries. Mr. Carr remarks that since the rise of the Nile he has noticed an unusual number of carcasses floating down the "Bahr Shibeen." 1 have, &c. (Signed) RAPH. BORG. No. 23. Sir E. Malet to Earl Granville. — (Received September 4.) My Lord. Cairo, August 23, 1883. WITH reference to my despatch of the 15th instant, I have the honour to inclose herewith a copy of a Report addressed to me by Mr. Vice-Consul Borg upon the cholera in Cairo. I have, &c. (Signed) EDWARD B. MALET. ? No. 13. 40 Inclosure 3 in No. 23. Vice-Consul Borg to Sir E. Malet. Sir, Cairo, August 22, 1883 I HAVE the honour to report that during the week ended on the 18th instant, the deaths from cholera at Cairo numbered fifty-three, per Return herein inclosed. The quarters of Ghemaliyeh and Khalifa have been entirely free of the disease, while only one death in each occurred at Old Cairo and Sayeda Zenab. The Comparative Table of deaths herein annexed, shows that the number of deaths in the fifth week of 1865 (19th to 25th July) were 352. The inclosed Table of meteorological observations shows that the mean average barometrical pressure has been 753*88 against 756*57 for the fifth week of the epidemic in 1865; the mean average temperature 29*6 against 30*1, and the degrees marked by the hygrometer 51 '47 against 42*36. The prevailing winds have been no^th-east, north-west, and north, against north-west and north in 1865. I have, &c. (Signed) RAPH. BORG. 41 Inclosure 2 in No. 23. Return of Deaths from Cholera at Cairo, during the "Week ended August 18, 1883. (Twenty-four hours, ending at 8 p.m.) August 12. August 13. August 14. August 15. August 16. August 17. August 18. Totals. *?•ซซ• Europeans. *[ฆฃซ• European 9. Natives Europeans . Natives EuropeanB . Natives EnropeanB . Natives EuropeMls# Natives Europeanfi Natives EuropeanB . Quarters Copts. r and Copts. *^ and Copts. ' and Copts. *^ and Copts. r and Copts. *^ and CopU. and Copts. J . J .ง.8.8.8.5 S . S . 8 . 8 . 8 . S . i . 8 . i llililllllill.lillililliiilllllli Abbasiyah .. .. 1 1 1 1 1 14 .. Abdeen .. .. 3 I 2 3 1 1 .... 4 7 Bab-el-Cbariyah .. .. 1 .... 1 11 Boulak .. 1 2 .... 1 2 .. .. 1 .. 2 .... 1 .. .. .. 4 6 .. Choubrah .. .. 1 1 1 2 1 Darb-el-Ahmar .. 2 2 4 Eibekiyah .. 1 1 .... 1 1 1 .. 1 Ghemaliyah „. Kbalife .. .. .. ? Mouskee .. .. I*|" 2* .... 1 .... 112 .. Old Cairo .. 1 1 .. ? Sayyeda Zenab .. .. .. 1 , .. .. M ? # . ? .. .. 1 .. ... ? Hospital .. .. 1 1 3 1 1 .... 1 1 4 5 Totals .. .. 10 131.. | .. t45~|144..|..157•>35 .. 1 3 2 | .. .. 2 .. | .. j23|27 I 2 1 Grand totals ..13 10 8 6 8 ~6 2 53 H 42 Comparative Table of Deaths at Cairo during the prevalence of Cholera (sth Week). ; 1883. 1865. t^ 4. From Other „, . , nat . From Date - Cholera. Causes. TotaL Date - Cholera. August 1.2 " " 13^ 85 98 July 19 7. .. 8<) 13 ..10 75 85 20 ..72 14 .. 8 91 99 21 ..54 15.. .. 6 76 82 22 ..38 17 .. 6 75 81 24 ..35 18 .. 2 84 86 25 .. .. 25 Plnclosure 4 in No. 23. Meteorological Observations at Cairo during the prevalence of Cholera (sth Week). 1883. 1865. Barometer, _, . . Barometer, Thermometer Direction"of corrected to 0ฐ temp. Thermometer (Ceatrgrade). Hyg?ometer< Qzonometer. Direction of Wind. corrected to 0ฐ (Centigrade). Hygrometer. Wind, ftrte. Mean (0to21) Nilometer. Date. temp# Mean __ Average. 1 P#M . Average. 7 a.m. 1 p.m. 7 p.m. 7 a.-m. 1 p.m. 7 p.m. 7 a.m. 1 p.m. 7 p.m. Sunrise. 2 p.m. Sunrise. 2 p.m. Sunrise. 2 p.m. Pics, kirats August 12 751 -90 75929 754 '99 247 34 -8 307 4666 8 N.E. N.E. N. i 9 23 July 19 756' 756' 26*8 33* 42' N.W. N.W. 13 753-57 753-28 752 -/I 24 7 35-2 33-3 47 -33 6 N.E. N. N.N.E. 19 19 20 756" 756" 26 '6 33' 43" W. N.W. 14 752-58 752-77 751-38 24-7 31 '2 31-5 53 33 4 N.W. N.W. N. 19 11 21 756- 756- 27 2 33 4 42" W. N.W. 15 753 67 752 91 7.H-81 252 32 '7 31-2 51-33 4 N. N.W. N. 19 7 22 757' 757* 27" 33 2 42- N.W. N. 16 752 95 752 97 755 11 24- 33- 31- 53" 4 N.E. N.E. N.E. 19 5 23 757* 757' 27*1 33 3 42 '5 N.W. N. 17 753 68 753 51 75291 237 31-2 31 2 57 '66 6 N.E. N.E. N. 19 7 24 757' 757- 26 '8 33 6 43- N.W. N. 18 755 94 755-39 755-10 22 -7 31-6 29-9 51" 6 N.E. E.E.N. N. 19 7 25 757' 757- 27* 33*4 42* N.W. N. 43 No. 24. Sir E. Malet to Earl Granville. —(Received September 4.) ฆ Lord, Cairo, August 27, 1883. WITH reference to my despatch of the 13th instant, I have' the honour to inclose the X official Returns of deaths from cholera in Cairo, completed up to date. During the t three days and up to this morning there has been no fresh death.* I have, &c. (Signed) EDWARD B. MALET. [1645] H2 44 Inclosure in No. 24. Return of Deaths from Cholera in Cairo, 1833. The highest totals reached are printed in larger figures. 6 ' hitch 6 S 4 30 28 15 33 68 95 55 56 81 2* 51 46 45 38 28 S3 6 14 18 5 3 _4 S_ ... ... ... ... jซ_ _•ป_ 780 11,417 /• ... 11 19 16 17 23 48 24 28 22 23 20 22 23 15 23 13 16 21 11 467 10 6 ... ... 3 ... ~. 1 436 BobWj 61 108 161 216 273 259 121 121 63 73 54 36 39 48 47 25 29 21 19 7 14 11 1 2 3 3 3 1 S 1 ... ซ ... 1 ... _ ... ... 1,889 62,06* ~ MJ . 4 8 22 32 47 51 6S 85 80 54 84 93 59 63 64 40 27 31 16 14 5 6 3 3 3 „ 1 .. „ 958 20,583 & 2 11 17 SO 31 37 38 28 23 20 20 18 23 14 12 10 8 10 4 5 8 12 8 2 3 1 ... ... 1 1 397 58,799 g Shubr> 2 3 10 81 10 18 36 18 IS 33 17 14 8 16 28 9 7 13 4 7 S 9 6 1 ... 2 1 ... ... m 2 ~ 290 11,070 | 8 4 6 34 24 37 39 39 52 ซ 43 28 26 22 31 14 18 19 12 6 7 8 4 7 2 2 ... 2 8 3 ... 1 ... 8 635 27,606 ซ Suda-Zenab I ... L 3 12 61- 6 1 2 5 4 6 9 12 20 20 27 35 31 83 54 21 27 11 8 8 4 6 5 5 3 1 ... „ ... 1 ... ... 344 34,150 | Hilifa j 1 5 5 6 5 6 7 6 9 14 7 6 4 4 4 3 2 3 ... 2 1 ... 1 „ 103 36.70T ซ _ . ... i 4 5 1 2 1 10 8 18 13 6 10 4 8 9 3 3 3 ... 1 ... S 1 .ซ - ... 112 99,528 ฃ 3 6 3 5 5 3 7 7 8 9 7 7 9 4 3 3 3 3 1 ... ~ ... 3 ...... ~ .- ... 108 12,206 | Balnes-Sharkieh 1 .- 5 8 9 16 18 14 13 19 13 15 2 U A 16 10 11 9 8 6 S 1 ... 2 1 338 41,944 . O^eh _ I ... 1 1 1 5 ... ซ 10 7 10 6 8 3 5 13 7 6 „ - ... - 78 39,748 < kWtuAA J t~L- - 3 _^i_l_i_l_-i_JL 12 — ——-i-l-i-L-l — — ———— — —— — — — ———-"-••* 'M 5 13t70S ToUU . 'TT'TlT'er'Trruriir SSI 436 463 377 363 ill m 8W 830 374 271 273 194 169 160 111 78 70 78 39 37 80 11 6 9 6 6 4 1 4 S 1 ... 1 5.633 368,108 _, N ,B.— The six last-named districts are farthwt from the NUe. .____, ... It il admitted that the deaths in Bonlak during two or three days were considerably in excess of the totals recorded . ฆ 45 No. 25. Sir E. Malet to Earl Granville. — (Received September 4.) (r Lord, Cairo, August 27, 1883. I HAVE the honour to forward to your Lordship the inclosed copy of a despatch m Mr. Vice-Consul Borg with regard to a statement — telegraphed by the "Times" respondent at Alexandria on the 1 4th instant — to the effect that after the subsidence the cholera in 1865 a fresh outbreak had occurred at Damietta. I have, &c. (Signed) EDWARD B. MALET. Inclosure 1 in No. 25. Vice-Consul Borg to Sir E. Malet. Sir, Cairo, August 27, 1883. iIN "The Mail" of the 15th, under the heading ซ The Cholera," I notice the following graph, dated Alexandria, the 14th August : — " It is hoped that the cholera is now disappearing, but an incident of the epidemic of 1865 is worth noting. The outbreak commenced early in June; it had soon spread over all Egypt, except in Damietta, and had practically ceased throughout the country by the first week of August. On the 1 7th of that month it suddenly appeared with great virulence at Damietta, lasted six weeks, and never left that centre." ปAs a matter of fact, the appearance of cholera at Alexandria in 1865 took place on 11th June, and at Damietta on the 26th June, and the last case at the latter town urred on the 14th August. I annex a Return of deaths from cholera at Damietta during that period. 1 have, &c. (Signed) RAPH. BORG. Inclosure 2 in No. 25. Return of Deaths at Dainietta from Cholera (Epidemic of 1865). Sex. Sex. Date. Total. Date. Total. Males. Females. Males. Females. 1865. 1865. June 26 .. 1 .. 1 July 22 8 5 18 27 .. 7 2 9 23 .. 4 3 7 28 .. 19 16 35 24 .. 7 3 10 29 .. 27 26 53 25 .. 4 4 8 30 .. 34 33 67 26 .. 9 2 11 July 1 .. 47 46 93 27 .. 7 5 12 2 . 57 50 107 28 .. 4 3 3 .. 74 68 142 29 .. 8 5 13 4 66 91 157 30 .. 2 3 5 5 .. 78 94 172 31 .. 3 2 5 6 .. 71 100 171 August 1 .... 2 2 7 .. 82 87 169 2 .. 3 1 4 8 .. 72 94 166 3 .. 2 .. 2 9 .. 93 79 172 4 .. 1 1 2 10 .. 52 69 121 5 .. 2 2 11 .. 44 58 102 6 2 1 3 12 .. 45 67 112 7 .. 1 .. I 13 33 40 73 8 .... 14 .. 32 40 72 9 .... 15 .. 38 46 84 10 .... 16 .. 22 21 50 11 17 .. 27 16 43 12 18 .. 16 26 42 13 .... 19 .. 10 11 21 14 1 .. 1 20 5 13 18 21 7 7 14 Grand Total .. 1,127 1,247 2,374 46 No. 26. Acting Consul Russell to Earl Gmnville. — {Received September 4.) My Lord, Alexandria, August 27, 1883. I HAVE the honour to forward herewith a despatch addressed to me by Mr. MieVille as to the progress of cholera. 1 have, &c. (Signed) D. F. RUSSELL. Inclosure in No. 26. Consul Mihille to Acting Consul Russell. Sir, Alexandria, August 27, 1883. 1 AM glad to be able to report a steadily increasing diminution in the daily mortality from cholera throughout the country, and that, with the exception of Alexandria, the Delta is now almost entirely rid of the epidemic. As regards Alexandria, the average daily mortality for the last week has been 29 as against 41 during the previous seven days, and there is every reason to hope this amelioration will continue. The official Returns give 2,204 deaths from cholera in Upper and Lower Egypt together during the past week, as against 3,420 the week before, thus bringing the total number of deaths since the 22nd June to 26,770. I have, &c. (Signed) W. F. MIEVILLE, British Delegate. No. 27. Acting Consul Russell to Earl Granville. — (Received September 4.) My Lord, Alexandria, August 27, 1883. WITH reference to Mr. Cookson's despatch dated the 20th instant inclosing a Report from Dr. Mackie on the cholera epidemic, I have the honour herewith to inclose your Lordship a further Report from Dr. Mackie on the same subject.* I have, &c. (Signed) T. F. RUSSELL. Inclosure in No. 30. Correction of Report on Cholera dated July 28, 1883. I IN my Report of the 28th July on the prevailing epidemic of cholera, I have made tatement which now after further research I must correct. In that Report I state that i my own knowledge no case of cholera had occurred in Egypt since 1866, except two )leraic oases in Alexandria in the summer of 1881, one of which nearly proved fatal." ving lost all my professional diaries and papers in the fire of last year, I trusted to inory ; and it has only been by patient and constant inquiry that I have had recalled to memory the following cases which came under my own observation, viz. : — tCase j. In the summer of 1872 I was called to see in consultation a Greek lady in d circumstances, living at Ramleh, a healthy suburb of Alexandria. I was one of four lical men who saw this case, and we were all agreed that it was a severe case of cholera, patienjt died. I Case |2. In the summer of 1873, one of the Sisters of the Deaconesses' Hospital had vere atitack and recovered. The Sister Superior reminds me that I pronounced it at time j 1 cholera," and the Sister Superior herself had no doubt, as she had had ;rience of cholera in 1865. I Case 3. Is one of the two I alluded to in my Report of the 28th July. I have now able to find particulars of that case. Madame F , Maltese, was attacked with at votniting, purging, and cramps, •eyes sunken, surface cold, aphonia; the urine, JNO. lb. 47 which was passed at very long intervals and in very small quantity amounting almost to suppression, was examined by my assistant, Dr. Murison, and found to be nearly solid with albumen. The patient recovered. This case happened in the summer of 1881. My assistant, Dr. Murison, who had been called to this case, asked me to go and see her, as he believed Madame F had cholera. I have been able to bring it to my recollection now, that I pronounced it a case of cholera. The woman's husband also testifies that I did so. The other case mentioned in my Report of the 28th July was a Syrian, whom I have failed to trace. My recollection of it is that it was a case of severe vomiting and purging with slight cramps, which got well on the second day after a hypodermic injection of morphia. Madame F , Case 3, had well marked rice-water stools; this was remarked by Dr. Murison. These are all the cases which, without the aid of my medical diaries, I can state at present as having fallen under my own treatment and observation, and which I wish to be annexed to my Report of the 28th July, as " correction." On prosecuting inquiries, however, I find that many of my colleagues here have seen from time to time similar cases, some proving fatal. Such of those as I have been able to obtain authentic reports on I have handed to Dr. Hunter to be dealt with by him. Such cases when they have ended fatally have generally been entered in the register of diseases as cases of choleriform diarrhoea or intestinal catarrh, not with any intention of deliberate falsehood but chiefly for two reasons : — 1. That none of the medical men here believe that cases of real cholera exist except where imported (according to them) as an epidemic or a distinctly traceable imported case. 2. And I think this is the strongest reason — a general desire with Europeans as well as Egyptians to keep the word "cholera" from appearing in official Returns, for fear of Egypt being placed in quarantine. This is the outcome of quarantine and one of the abuses which its irrational employment leads to. The very men who are now crying out for quarantine against India, are probably the very men, many of them, who have concealed intentionally or unintentionally such cases as the above. lam quite aware that they do not conscientiously think the cases worth reporting as " cholera," viewing them with regard to quarantine, but they nevertheless may have a value in another way whife) they do not attach to them, and it is only right that they should be known, so that their value may be estimated with regard to the origin of the present epidemic. (Signed) J. MACK lE, Surgeon to Her Majesty's Consulate. Alexandria, August 26, 1883. No, 28. Sir E. Malet to Earl Granville. — (Received September 11.) My Lord, Cairo, August 28, 1883. T HAVE the honour to inclose herewith a very interesting Report which has been made to me by Mr. Gibson, Director of the Survey, and Mr. Ornstein, 0.M.G., Chief Secretary to the Financial Adviser, respecting the work done by the Special Sanitary Commission at Cairo during the recent cholera epidemic. Mr. Gibson and Mr. Ornstein were members of the Executive Sanitary Commis฿ion, and were indefatigable in the discharge of the dangerous and arduous duties which they thus voluntarily took upon themselves. Great praise is due to all the members of this Commission for the energetic and unflinching manner in which they did work entirely foreign to their usual avocations, one member only being a doctor. One of the most satisfactory circumstances connected with the Commission was the cordial co-operation of its native and foreign members. Differences of caste were entirely laid aside, and Christians and Mussulmans worked together for the common g;ood with the happiest result. I have, &c. (Signed) EDWARD B. MAXET. 48 Inclosure in No. 28. Messrs. Gibson and Ornstein to Sir E. Malet. Sir, Cairo, August 25, 1883. AS it will interest you to he informed of the work done hy the Special Sanitary Commission since the outbreak of cholera in Cairo, we have the honour to lay before you the following Report on the measures adopted with a view to arresting, as far as possible, the progress of the epidemic. Before entering into general details, we think it advisable to explain briefly the constitution of the regular Sanitary Administration of Cairo as it existed before the Special Sanitary Commission was appointed. The Sanitary Administration, called " Inspectorat Sanitaire dv Caire," is placed under the immediate control of the Egyptian Board of Health. The personnel at the Central Office consists of a Chief Inspector, two Assistant Inspectors, and a small staff of clerks. In each of the twelve quarters of the town there is a branch office, composed of a resident doctor and two mid wives ("sage femmes"), who are charged with the registration of births and deaths, medical attendance on the poor, inspection of markets and fairs, and generally with the supervision of the cleanliness of their quarter. They are also obliged to visit the sick at their homes if called on to do so. They bring to the notice of the Police Commissioner of the quarter any infraction of sanitary rules, and in case of non- execution en the part of that official they address their complaints to the Chief Inspector, to whom, moreover, they make daily reports. There is also a special service of vaccination in charge of one doctor for the whole town, who is obliged to visit two quarters daily. Medicines and disinfectants are supplied from a central dispensary. The limited means at the disposal of the service which we have just described were, even in ordinary times, totally inadequate for the wants of a densely-populated town such as Cairo; and when the cholera broke out it became imperatively necessary to come to the rescue of the Sanitary Administration, which was threatening to break down altogether under the heavy extra work imposed on it. This state of things naturally attracted the attention of the Consular Body, who lost no time in suggesting to the Minister of the Interior the formation of a Special and Extraordinary Commission, with a view of assisting the sanitary authorities in their responsible task. This suggestion was readily acceded to by tha Minister of the Interior, and he at once appointed a number of Notables and officials who, together with the Consular Body, formed a Special Sanitary Commission, presided over by the Prefect of Police of Cairo. The first meeting of this Commission was held on the sth July. In order to facilitate the execution of the necessary measures, they decided to appoint a Permanent Executive Committee, chosen from among themselves, and local Committees, called " Quarter Committees," were appointed for each of the twelve quarters of the town. These were to work under the immediate supervision of the Executive Committee. Regulations denning the attributions of the Executive, as well as those of the Quarter Committees, were drawn up, and actual work was commenced on the 12th July. We do not think it necessary to give in great detail an account of all the measures initiated and executed by our Committee; they will be found in the two printed volumes which we have the honour to transmit herewith, and which contain extracts of our proceedings from the 12th July to the 6th August, inclusive. We will therefore confine ourselves to a description of the more important measures which occupied our attention, and of which the execution was in every instance assured by one or more members of our Committee. In order to give the widest publicity to the names and addresses of the members composing the Executive and the Quarter Committees, to whom the inhabitants could address themselves for advice and assistance, printed placards were posted in all parts of the town. Each member was, moreover, furnished with a pass authorizing him to require the assistance of all the authorities, and to enter any premises for purposes of sanitary inspection. Simple instructions in French and Arabic for the first treatment of persons 49 attacked by the disease were distributed in each of the quarters for the information and guidance of the public. A quantity of medicines and disinfectants was supplied to each quarter policestation (where the Quarter Committee met daily), and also to each sanitary branch office, for gratuitous distribution. An ambulance service was organized for the transport of the sick to the hospitals. Seventeen carriages and eighty-five bearers, provided with stretchers, were distributed amongst the various police-stations, with instructions to patrol the streets of their respective quarters by day and night. On the epidemic assuming more serious proportions, the insufficiency of the medical staff was severely felt. Quarters such as Boulac, containing over 50,000 inhabitants, had only one Government medical officer. Repeated and urgent appeals were made to the Board of Health, but owing to the total absence of experienced doctors, the Board was only able to place at the disposal of the Committee some medical students who had barely finished their course of studies ; but even with this assistance the medical staff was insufficient in number, and when the epidemic was at its height only five doctors could be allotted to Boulac, where, from the 15th July to the 6th August, 1,700 persons fell victims to cholera. The organization for cleansing and watering the streets was found to be very defective. In a part of the town comprising the modern quarters and the wide thoroughfares the Ministry of Public Works had charge of these duties ; but in the more populous native quarters, where the streets are excessively narrow, the cleansing and watering was confided to the Prefect of Police, who obliged each occupant to sweep and water the portion of the street adjacent to his own house. Such a system could only have one result, viz., that portions of many of the streets remained unwatered and unswept. The Committee therefore appointed one of its members to organize a special service for cleansing the streets in those parts of the town which were not under the immediate control of the Ministry of Public Works, and ordered the Quarter Committees to provide for the watering of the streets under the supervision of its delegate. The result of this arrangement has proved very satisfactory. As the burning of tar fires had been adopted as a purifying agent during epidemics in Europe and other parts of the world, the Committee decided to adopt similar measures in Cairo, and a Special Committee was appointed to light nightly large tar and sulphur fires in all the parts of the town. It would be difficult to assert that these fires had any influence on the constant decrease in the death-rate which commenced from that moment, but they certainly produced an excellent moral effect on the population. The large number of open spaces in all parts of the town which were used for depositing, sweepings and rubbish of every description were inclosed and disinfected, and the rubbish was removed to certain specified localities outside the town, and there burnt. The members of the Quarter Committees were instructed to inspect all buildings in their respective quarters, and to give such orders as they considered necessary for insuring proper hygienic conditions. They were authorized, moreover, in case of noncompliance with their instructions on the part of the proprietors, to carry out the necessary works at the latter's expense. The highly insanitary condition of the public latrines in the mosques, and of the numerous public baths of the town, attracted the attention of the Committee. Measures were taken to cleanse and disinfect them, and those which were considered absolutely dangerous to the public health were permanently closed. One of the two slaughter-houses had to be closed owing to its very unsatisfactory condition, and the other was thoroughly cleansed and disinfected. The Government tannery at Old Cairo, and the dep6t of salt fish which it contained, were closed. In order to abate the alarm caused by the continuous funeral processions through the moafc populous quarters of the town, it was decided to direct their passage through certain selected and less frequented streets. According to the Mussulman custom, the dead are not buried in coffins, but carried to the grave in open biers, merely covered by a shawl, and the biers are returned after the ceremony for further use. The conveyance of the dead in this manner was considered dangerous, and a number of closed biers, lined inside with zinc, were provided at the public expense. Police posts were established in the neighbourhood of P16451 I L J Inclosure in No. 28. Messrs. Cfibson and Ornstein to Sir E. Malet. Sir, Cairo, August 25, 1883. AS it will interest you to he informed of the work done by the Special Sanitary Commission since the outbreak of cholera in Cairo, we have the honour to lay before you the following Report on the measures adopted with a view to arresting, as far as possible, the progress of the epidemic. Before entering into general details, we think it advisable to explain briefly the constitution of the regular Sanitary Administration of Cairo as it existed before the Special Sanitary Commission was appointed. The Sanitary Administration, called " Inspectorat Sanitaire dv Caire," is placed under the immediate control of the Egyptian Board of Health. The personnel at the Central Office consists of a Chief Inspector, two Assistant Inspectors, and a small staff of clerks. In each of the twelve quarters of the town there is a branch office, composed of a resident doctor and two mid wives ("sage femmes"), who are charged with the registration of births and deaths, medical attendance on the poor, inspection of markets and fairs, and generally with the supervision of the cleanliness of their quarter. They are also obliged to visit the sick at their homes if called on to do so. They bring to the notice of the Police Commissioner of the quarter any infraction of sanitary rules, and in case of non-execution en the part of that official they address their complaints to the Chief Inspector, to whom, moreover, they make daily There is also a special service of vaccination in charge of one doctor for the whole town, who is obliged to visit two quarters daily. Medicines and disinfectants are supplied from a central dispensary. (The limited means at the disposal of the service which we have just described re, even in ordinary times, totally inadequate for the wants of a densely-populated m such as Cairo; and when the cholera broke out it became imperatively pessary to come to the rescue of the Sanitary Administration, which was threatening break down altogether under the heavy extra work imposed on it. This state of things naturally attracted the attention of the Consular Body, who lost no time in suggesting to the Minister of the Interior the formation of a Special and Extraordinary Commission, with a view of assisting the sanitary authorities in their responsible task. This suggestion was readily acceded to by thซ Minister of the Interior, and he at once appointed a number of Notables and officials who, together with the Consular Body, formed a Special Sanitary Commission, presided over by the Prefect of Police of Cairo. tThe first meeting of this Commission was held on the sth July. In order to rilitate the execution of the necessary measures, they decided to appoint a rmanent Executive Committee, chosen from among themselves, and local mmittees, called " Quarter Committees," were appointed for each of the twelve arters of the town. These were to work under the immediate supervision of the ecutive Committee. t Regulations denning the attributions of the Executive, as well as those of the rter Committees, were drawn up, and actual work was commenced on the 12th I We do not think it necessary to give in great detail an account of all the measures tiated and executed by our Committee; they will be found in the two printed lumes which we have the honour to transmit herewith, and which contain extracts our proceedings from the 12th July to the 6th August, inclusive. We will theree confine ourselves to a description of the more important measures which jupied our attention, and of which the execution was in every instance assured by 3 or more members of our Committee. kin order to give the widest publicity to the names and addresses of the members lposing the Executive and the Quarter Committees, to whom the inhabitants could ress themselves for advice and assistance, printed placards were posted in all parts he town. I Each member was, moreover, furnished with a pass authorizing him to require the tance of all the authorities, and to enter any premises for purposes of sanitary Simple instructions in French and Arabic for the first treatment of persons attacked by the disease were distributed in each of the quarters for the information and guidance of the public. A quantity of medicines and disinfectants was supplied to each quarter policestation (where the Quarter Committee met daily), and also to each sanitary branch office, for gratuitous distribution. ฆ An ambulance service was organized for the transport of the sick to the hospitals, venteen carriages and eighty-five bearers, provided with stretchers, were distributed amongst the various police-stations, with instructions to patrol the streets of their respective quarters by day and night. On the epidemic assuming more serious proportions, the insufficiency of the tlical staff was severely felt. Quarters such as Boulac, containing over 50,000 abitants, had only one Government medical officer. Repeated and urgent appeals were made to the Board of Health, but owing to the total absence of experienced doctors, the Board was only able to place at the disposal of the Committee some medical students who had barely finished their course of studies ; but even with this assistance the medical staff was insufficient in number, and when the epidemic was at its height only five doctors could be allotted to Boulac, where, from the 15th July to the 6th August, 1,700 persons fell victims to cholera. The organization for cleansing and watering the streets was found to be very defective. In a part of the town comprising the modern quarters and the wide thoroughfares the Ministry of Public Works had charge of these duties ; but in the more populous native quarters, where the streets are excessively narrow, the cleansing and watering was confided to the Prefect of Police, who obliged each occupant to sweep and water the portion of the street adjacent to his own house. Such a system could only have one result, viz., that portions of many of the streets remained unwatered and unswept. The Committee therefore appointed one of its members to organize a special service for cleansing the streets in those parts of the town which were not under the immediate control of the Ministry of Public "Works, and ordered the Quarter Committees to provide for the watering of the streets under the supervision of its delegate. The result of this arrangement has proved very satisfactory. As the burning of tar fires had been adopted as a purifying agent during epidemics in Europe and other parts of the world, the Committee decided to adopt similar measures in Cairo, and a Special Committee was appointed to light nightly large tar and sulphur fires in all the parts of the town. It would be difficult to assert that these fires had any influence on the constant decrease in the death-rate which commenced from that moment, but they certainly produced an excellent moral effect on the population. fThe large number of open spaces in all parts of the town which were used for epositing. sweepings and rubbish of every description were inclosed and disinfected, and the rubbish was removed to certain specified localities outside the town, and there burnt. The members of the Quarter Committees were instructed to inspect all buildings in their respective quarters, and to give such orders as they considered necessary for turing proper hygienic conditions. They were authorized, moreover, in case of nonnpliance with their instructions on the part of the proprietors, to carry out the necessary works at the latter's expense. The highly insanitary condition of the public latrines in the mosques, and of the numerous public baths of the town, attracted the attention of the Committee. Measures were taken to cleanse and disinfect them, and those which were considered absolutely dangerous to the public health were permanently closed. One of the two slaughter-houses had to be closed owing to its very unsatisfactory condition, and the other was thoroughly cleansed and disinfected. The Government tannery at Old Cairo, and the dep6t of salt fish which it contained, were closed. In order to abate the alarm caused by the continuous funeral processions through the most populous quarters of the town, it was decided to direct their passage through certain selected and less frequented streets. According to the Mussulman custom, the dead are not buried in coffins, but carried to the grave in open biers, merely covered by a shawl, and the biers are returned after the ceremony for further use. The conveyance of the dead in this manner was considered dangerous, and a number of closed biers, lined inside with zinc, were provided at the public expense. Police posts were established in the neighbourhood of fl 64*51 I L J 50 the cemeteries for the purpose of disinfecting the biers and of burning those graveclothes which are not buried with the body, and which, in ordinary times, are brought back by the mourners. In order to hasten the burial of the victims, the formalities imposed by the native religious authorities, which were very complicated, had to be relaxed, and delegates from these religious authorities were attached to each Quarter Committee, and invested with the necessary powers for the delivery of burial certificates, &c. The Committee, not wishing to interfere with the manner of burying practised by the Mahommedans, innovations in which might have roused their religious feelings, deemed it prudent to merely close those cemeteries which were in close proximity to inhabited quarters, and to provide new spaces at a reasonable distance from the town. Four cemeteries were thus closed and disinfected. A peculiar and barbarous custom exists amongst the Copts of interring their dead in vaults, over which houses are built to accommodate the guardians of the tombs and their families, as well as the priests of the churches and convents round which these " grave-houses" have been erected. This custom has existed since the time of Amron, and to-day a considerable part of Old Cairo is, it may be said, a densely-populated necropolis. It was absolutely necessary to put a stop to such a state of things. The Committee therefore ordered the evacuation of these quarters, the closing of the grave-houses, and their thorough disinfection. A new burial-place was allotted to the Copts, as well as to the Greek, Armenian, and other sects whose cemeteries were in too close proximity to the inhabited quarters. During the Bairam festival, which lasts for three days, the custom of spending this time in the cemeteries is very strictly observed by the Mahommedan population ; it was considered dangerous to allow it to be practised this year, and the pilgrimage to the cemeteries was consequently prohibited. In the course of the frequent inspections made by the members of the Executive and Quarter Committees, it was clearly established that the enormous death-rate among the poorer classes of the native population was almost entirely due to the overcrowding of dwellings unfit for human occupation. Whole quarters of Cairo, more especially of Boulac, are inhabited by the poorer classes, whose houses consist of mud hovels containing one room, in which whole families live with their donkeys, fowls, and other live stock. tine entrance of these hovels ia in many instances a mere opening, through which nof ordinary height would have to crawl. Proper ventilation, of course, does not . The roofs are covered with filth of all description. Ordinary disinfection, under these circumstances, was impossible, and the only remedy that could be found was in the total evacuation of these quarters, and their entire destruction by fire. Before carrying out this measure it was necessary to provide accommodation elsewhere for the population dislodged, and in the first instance it Was decided to send them to Toora, a place 18 miles south of Cairo. The first batch oฃ about 600 souls was therefore sent to that place, but on the urgent remonstrance of the Principal Medical Officer of the English Army of Occupation, it was decided to send the remainder of the emigrants to the Barrage, about 18 miles to the north of Cairo, where accommodation and ample supply of food for 5,000 emigrants were provided by Government. Although the number of inhabitants who were dislodged in the course of the epidemic amounted to about 6,000, the number actually present at the Barrage and Toora has never exceeded 4,000. The rest, owing to the want of supervision, were allowed at first to disperse to their villages. The emigrant camp at the Barrage has since been placed under the medical and administrative charge of a European doctor, and the arrangements made for the cleanliness of the camp and the comfort of the emigrants are now most satisfactory. Although the emigrants came from the most infected quarters of the town, and were in many instances suffering from cholera when they arrived in the camp, very few deaths have occurred, and their general health has been good. I As soon as an infected quarter had been evacuated, it was inspected by engineers L doctors, and the huts which were pronounced unfit for future habitation were troyed by fire. I These measures were followed by a very marked diminution in the death-rate of i quarters in which they were adopted, and it can hardly be doubted that they terially assisted to check the spread of the disease. The epidemic having now almost entirely disappeared, it was no longer considered necessary to force the emigrants to remain at the Barrage, and instructions have been 51 seni do xiiฉ onicer in cnarge 01 tiie camp lo anow^ xnose wno couio. prove man iney 113.0. a fixed occupation and the means of obtaining lodgings to return to Cairo. As an erroneous impression seems to prevail that the huts destroyed by the orders 01 the Committee were the property of the evicted inhabitants, we take this opportunity of stating that nearly all of them belonged to the proprietors of the ground on which they were built, who leased them at excessive rents. We believe that the Government intend to prohibit the construction of huts such as we have described above, and plans for the erection, on proper hygienic principles, of suitable workmen's dwellings will shortly be submitted for their consideration. These are the principal measures carried out by the Special Sanitary Commission ; but in order to make this Report more complete, we think it necessary to say a few words on the subject of the hospitals, although they were not under the supervision of our Commission. The Government General Hospital of Kasr-el-Ain, which contains over 500 beds, was reserved entirely for the treatment of cholera patients, and a hospital for the treatment of ordinary diseases was temporarily established in one of the Government school buildings. In order to avoid the transport of the sick from the distant parts of the town to Kasr-el-Ain, a temporary wooden hospital was built at the Abassyeh. The Italian, French, and Austrian colonies also opened a small hospital at the Abftssyeh for Europeans. Prince Ibrahim Helmy, brother to the Khedive, fitted up and maintained at his own expense a complete hospital of 100 beds at his paper-mill at JEtoulac, thus rendering the greatest services to the unfortunate population of that quarter. Although ample accommodation was thus provided, we observed with great regret that the native population showed much disinclination to avail themselves of it, and in a great many instances patients were only brought to the hospital when human skill was no longer of any avail. We beg to annex a statement showing the mortality from cholera in each quarter of the city from the 15th July, first day of the outbreak of the disease, to the 25th August, inclusive, from which it will be seen that the total number of deaths is 6,488.* These figures are taken from the official Ileturns published by the Board of Health. Their accuracy is doubted by the Cairo public ; with regard to those quarters of the town where the epidemic was less severe, we do not agree with the public opinion, but with regard to the quarters of Boulac and Old Cairo and the suburbs of Ghizeh, we must admit that there are just grounds for doubt. There the daily death-rate was at times so great that it was practically impossible for the small medical staff to certify and register every single death, and many bodies have been buried without the regular permit. With the cessation of the epidemic we presume that the Special Sanitary Commission, and the machinery it has established, will also cease to exist ; but we venture to hope that the results of its labours will not disappear with it. We do not know wjiat may be the intention of the Government, and whether a reorganization of the Sanitary and other Services of Cairo is in contemplation. Erom the personal experience we Jiave gained as members of the Executive Committee we have, however, no hesitation in stating that such a reorganization is absolutely necessary. It is not a part of our duty to submit a regular plan of necessary reforms, but we cannot help drawing attention to the usefulness of Quarter Committees such as were formed during the epidemic, and to suggest that in any future reorganization a similar system should be adopted. Quarter Committees composed of residents would, owing to, their knowledge of the localities, materially assist the authorities in the maintenance of order and cleanliness, and bring to their notice the requirements of their respective quarters. In concluding this .Report, we think [it right to state that, in our opinion, the success that has attended the labours of the Special Commission is in a great measure due to the readiness with which its suggestions were adopted by the Ministers, and carried out by its energetic President, the Governor of the town. We have, &c. (Signed) J. GIBSON. T. ORNSTEIN. * Including 843 deaths in a suburb of Cairo called Ghizeh. [1645] 52 Statement showing the Mortality from Cholera in Cairo and the Suburb of Ghizeh, from July 15 to August 25, inclusive. Population. July 15 to August 7to Total. Per cent. August 6. August 25. Cairo .. .. .. .. .. 144* .. 144 Saida Zeinab .. .. .. 34,150 306 35 341 1 Shoobrah .. .. .. 11,070 259 29 288 2| Ezbekieh .. .. .. 58,799 354 41 395 j Old Cairo . . . . . . 20,582 923 35 958 4% Abdin .. .. .. .. 27,606 487 47 534 2 Boulac. .. .. .. 52,065 1,713 39 1,752 3| Bab-el-Shareeyah .. .. 41,944 233 16 249 ฆ& Halifa .. .. .. .. 36,707 83 10 93 | Moosky (Kaissoon) .. .. 12,206 97 8 105 f Darb-el-Ahinar .. .. .. 29,528 82 11 93 I Gamalieh .. .. .. 29,748 68 16 84 I Abassyeh (El Wayli) .. .. 13,703 107 38 145 1^ Hospital .. .. .... 388 48 436 Army of Occupation . . .... 27 1 28 . . Total for Cairo proper .. 368,108 5,271 374 5,645 U Ghizeh . .. .. .. 11,417 770 73 843 7* * Total for Caiio and Ghizeh .. 379,525 6,041 447 6,488 1| No. 29. Sir E. Malet to Earl Granville, — {Received September 11.) tLord, Cairo, August 29, 1883. WITH reference to my despatch of the 23rd instant, I have the honour to inclose herewith copy of a Report which I have received from Mr. Vice-Consul Borg on the cholera at Cairo. f I have, &c. (Signed) EDWARD B. MALET. Inclosure 1 in No. 29. Vice-Consul Borg to Sir E. Malet. Sir, Cairo, August 28, 1883. XI AM glad to be able to report that the cholera epidemic may be regarded as having ised at Cairo, eleven deaths having been reported during the first five days of last week, is shown by the Return which I have the honour to inclose. IThe mortality from ordinary causes, which during the prevalence of the epidemic had ined an average of 523*6 per week, was 428 for last week, as will appear by the exed Table. II beg to transmit a Table of meteorological observations for the week. The mean ;rage barometrical pressure for six days was 755*90 against 759*5 for the same period the sixth week of the epidemic of 1865 ; the mean average temperature 28*9 against 30*2, i the degrees marked by the hygrometer 48*60 against 41*3. The prevailing winds ye been north-east and north against north-west and north in 1865. I have, &c. (Signed) RAPH. BORG. * One hundred and forty-four deaths took place in Cairo from the 16th to the 19th July, inclusive. The publication of the Returns showing the mortality in ench quarter was only commenced on the 20th July. f No. 23. 53 E Return of Deaths from Cholera at Cairo during the Week ended August 25, 1883. (Twenty-four hours ending at 8 p.m.) August 19. August 20. August 21. August 22. August 23. August 24. August 25. Totals. ™2*• ซt .. r ป. II M ป. i ii (ฆ m it it it .. .. 1 •• •• Cboubrab .. .. 2 1 3 Darb-el-Ahmar .. . . • Exbekiyah .. Chemaiiy ah .. .. ? .. •• Khalifa .. Mouskes .. • • Old Cairo .. , Sajyeda Zenab .. .. .. 1 1 •• ?• Hospital .. ..11 1 1 Totals .. .. 3 2 .... 2 2 1 1 Grand totals ..5 4 1 .. 1 .. •• ll 54 Inclosure 3 in No. 29. Comparative Table of Deaths at Cairo during the prevalence of Cholera (6th Week). 1883. 1865. t. . From Other ™ . From D ป te - Cholera. Causes. TotaL Date - Cholera. August 19 .. .. 5 48 53 July 26 .. .. 28 20 .. 4 52 56 27 ..16 21 .. .. 1 71 72 28 .. .. 23 22 ...... 79 79 29 .... 16 23 .. 1 65 66 30 ..13 mm mm n 24 .. .. 55 55 31 .. .. 14 25 .. .. .. 58 58 August 1 .. .. 18 I__ Inclosure 4 in No. 29. Meteorological Observations at Cairo during the prevalence of Cholera (6th Week). 1888. 1865. Barometer, ; „,, ,_, .. , x n- * -nr- a Barometer, Thermometer Direction of corrected to 0ฐ temp. Thermometer (Centigrade). Hygrometer> O zonometer Direction of Wind. COTre *ฑ tO ฐ (Centigrade). Hygrometer. Wind. "Date. Mean (0 to 21). Nilometer. Date. ' temp. Wean ฆ ' — — Average. 1 p.m. j — Average. ; 7 a.m. Ip.m. 7 p.m. 7 a.m. I p.m. 7 p.m. T a.m. Ip.m. 7 p.m. Sunrise. 2 p.m. Sunrise. Utp.M. Sunrise. 2 p.m. Pics, kirats. August 19 756 28 756 81 755*51 22 7 30 4 29 2 5166 4 N.E. E.N.E. N.E. 19 8 July 26 757* 707 • 27-4 33-2 40-5 W. N. 20 756-83 756-29 756-29 23 2 32 2 31 0 53*33 5 N. N.E. N.E. 19 7 27 758- 758- 27 6 32-8 41" N.W. N. 21 756*18 755-85 754*01 25 '2 38 7 34-4 34 00 4 N.E. N.W. N.W. 19 8 28 759- 759* 27*2 33" 42* N W. N. 22 756-48 757 01 755 -68 24 7 31 -2 29 9 53 33 6 E. N. N.E. 19 10 29 760- 760- 27' 33 4 41* N.W. N. 23 756-55 755-31 755 11 23 7 31-3 28*8 49 66 5 N.E. N.E. N. 19 14 30 762* 762* 27 3 33 4 42- N.W. N. 24 755-61 755-41 755 11 25 2 30 2 29*2 49-66 4 N.E. N.E. N. 19 18 31 761- 761* 27 -2 33 3 42' N.W. N. 23 756-35 755*17 755-63 23 2 29*2 28 2 53 66 6 N. N. E.N.E. 20 2 55 No. 30. Acting Consul Burrell to Earl Granvitle. — (Received September 11.) My Lord, Alexandria, September 1, 1883. I HAVE the honour to forward herewith a despatch from Mr. MieVille reporting on the mortality from cholera at Alexandria from the 24th July to the 31st August. I have, &c. (Signed) W. PALFREY BURRELL. Inclosure 1 in No. 30. Consul Mie'ville to Acting Consul Burrell. Sir, Alexandria, September 1, 1883. SINCE the 24th July, the date on which the prevailing epidemic may be held to have first really shown itself at Alexandria, I have been at some pains to daily glean from the Health Officer all available details as to the nationality, age, and sex of the victims to the Cholera. This information I have condensed in a Tabular form, copy of which I have now the honour to inclose. Summarized shortly, this Table shows that from the 241h July to the 31st August (both inclusive) 720 persons have succumbed to the disease, 55 per cent, being males, and 45 per cent, females, while the daily average which may be taken as about 22 in normal times, Looking to the nationality of the cholera vie of the mortality from ordinary causes, rose to 30. i, it appears that the natives suffered victims somewhat over five times as heavily as Europeans. As regards age the following figures show that the mortality was greatest among children under 10 years old and among persons between 30 and 40 years of age :— Age. Percentage. From Ito 10 .. .. 24 „ 10 to 20 . . .. 14 „ 20 to 30 . . . . 16 „ 80 to 40 ซ . . . 20 „ 40 to 50 . . . . 8 „ 50 to 60 . . . . 6 „ 60 to 70 . . . . 5 Over 70 years . . . . 7 100 I beg to draw attention to the fact, which may be held as noteworthy, that the fourth quarter, where the mortality was greatest, is the quarter outside the city drawing its water supply for the most part direct from the Mahmoudieh Canal. This would tend to show that the purifying and cleansing processes to which the water supplied to the town through the Water Company has of late been subjected were of practical good. 1 have, &c. (Signed) W. F. MJ^VILLE, British Delegate. 56 Table of the Daily Mortality from Cholera at Alexandria, from the 24th July to the 31st August. Sex. Nationality. Age. ฆ Districts. __^ __^______^___ _^ Mortality from Date. Death?. From From From From From From From Ordinary Males. Females. Natives. Europeans. 1 to 10 10 to 20 20 to 30 30 to 40 40 to 50 50 to 60 60 to 70 Yon Quarter Quarter Quarter Quarter C™ B**8 **- Years. Years. Years. Years. Years Years. Years. 26 .. 1 1 1 •• •• 1 .. .. •• •• •• I •• •• 20 28 .. 1 1 1 .. ป .. 1 .. •• •• •• •• •• •• l " •• 18 29 .. 4 4 .. 4 .. .... 13 .. .. .. .. •• .. 4 .. .. 23 30 .. 2 2 2 .. .. .. .. 2 .. .. .. .. .... 11 .. 25 31 .. 2 1 1 2 .. .. .. 1 .... 1 11 .. 24 August 1 .. 1 .. 1 1 .. .. 1 .. .. .. •• 1 •• •• 32 2 .. 4 2 2 1 3 1 1 2 .. .. ........2 2.. 32 3 .. 2 1 1 2 .. .. .. .. .. 2 .... 1 ? I .. .. 25 4 .. 2 2 .. ? 2 .. .. .. 2 .. .. .. .. .. 1 .... 1 35 5 .. 9 7 2 6 3 2 2 3 2 .. .......... 7 2 25 6 .. 9 4 5 9 1 3 .. 2 2 .. .. 1 .... 2 7 34 17 .. 17 11 6 15 2 1 2 4 6 4 ...... 2 9 5 1 33 8 .. 13 8 5 12 1 2 3 4 2 2 .... 2 3 7 1 45 9 .. 22 15 7 20 2 2 6 5 7 .. 1 1 .... 4 11 6 1 33 10 .. 21 12 9 14 7 6 3 3 4 3 .. 2 .... 6 6 8 1 46 11 .. 32 19 13 28 4 8 4 9 5 5 1 ...... 3 7 22 .. 50 12 .. 21 13 8 16 5 4 10 2 4 1 .. .... 1 2 6 12 .. 52 13 .. 44 27 17 40 4 9 5 10 9 2 3 2 4 2 3 13 25 1 34 14 .. 40 22 18 35 5 10 4 8 10 3 3 1 1 1 8 16 14 1 35 15 .. 44 16 28 40 4 14 9 3 4 4 .. 4 6 3 10 8 23 .. 34 16 .. 41 22 19 37 4 9 5 8 8 4 4 2 1 2 15 6 18 32 17 .. 50 28 22 44 6 11 4 12 8 4 4 1 6 2 9 7 30 2 34 18 .. 31 12 19 26 5 9 5 5 3 2 3 .. 4 3 8 5 14 1 33 19 .. 37 20 17 32 5 14 1 2 9 3 2 1 5 3 6 10 18 .. 23 20 .. 43 22 21 37 6 9 7 8 9 1 3 .. 6 8 12 5 18 31 21 .. 37 17 20 32 5 8 3 4 10 4 1 3 4 .. 13 5 17 2 23 22 .. 31 18 13 22 9 7 5 2 3 4 4 1 5 1 15 .. 15 31 23 .. 33 21 12 29 4 8 6 1 7 5 4 .. 2 6 8 3 12 4 30 24 .. 23 12 11 18 5 8 2 4 2 .. 4 1 2 3 6 2 8 4 32 25 22 12 10 17 5 10 2 4 1 2 3 .. 2 10 2 8 .. 32 26 .. 17 11 6 13 4 3 3 2 3 3 1 1 1 3 7 4 2 1 25 27 .. 12 9 3 7 5 1 5 3 1 2 .... 1 7 3 1 .. JJ6 28 .. 12 6 6 10 2 1 3 2 5 1 .. ....2433.. 25 29 .. 13 4 9 11 2 4 1 1 2 3 1 1 6 5 1 .. 1 25 30 .. 11 6 5 6 5 5 .. 1 2 1 .. 2 .. 2 2 3 4 27 31 .. 12 4 8 10 2 5 3 .. 1 1 1 1 .. 4 3 2 1 28 720 395 325 603 117 171 105 111 146 65 44 29 49 56 173 156 309 26 1,181 57 No. 31. Acting Consul Burrell to Earl Granville. — {Received September 11.) My Lord, Alexandria, September 1, 1883. I HAVE the honour to forward herewith a despatch from Mr. Mieville inclosing a statement of the number of deaths from cholera in the different towns and villages of Egypt from the 22nd June to the 21st August. I have, &c. (Signed) W. PALFREY BURRELL. Inclosure 1 in No. 31. Consul Mieville to Acting Consul Burrell. Sir, Alexandria, September 1, 1883. I HAVE the honour to inclose herewith a Tabular statement which I have received from the Maritime and Quarantine Board showing the number of deaths from cholera in the different towns and villages of Egypt from the 22nd June to the 21st August, 1883, and giving the date on which in each several place the epidemic first declared itself. I have, &c. (Signed) W. F. MI^VILLE, British Delegate. ฆ 58 Inclosure 2 in No. 81. CONSEIL SANITAIRE MARITIME ET QUARANTENAIRE d'^GYPTE Mortality par Cholera dans les diffe'rentes Villes et Villages dcs Provinces d']ฃgypte, dv 22 Juin au 21 Aout , 1883. ฆ •lyr , ...* Date Mortalite Ville ou Village de Province. Population. mortalite Ju remiel . (Lans iป^ rm^ e Observations. ฆ . r generate, t-c,. v , , . 8 Deces. Anglaise. 188:'.. Damiette.. .. .. 34,046 1,956 22 Jui.i .. ? Le dernier deces aeu lieu le 13 Aout. Port-Said.. ? .. 16,560 8 27 „ .. .. ? „ 4 Juillet. Mansourah .. .. 26,784 1,075 2 Jail] t .. .. „ „ 6 Aout. Samanoud . .. .. .. 352 2 „ .. .. „ „ 31 Juillet. Alexandrie .. .. 208,775 503 'ฃ ? .. 11 La noaladie continue encore. Cherbine.. .. • .. .. 114 8 „ . . . Le dernier deces aeu lieu le 2 Aout. Menzaleb... .. .. .. 25(5 9 .. „ „ 6 „ Talka .. .. .. .. 8S 10 .. „ „ 4 „ Chibin-el-Kom .. .. 13,380 1,120 11 .... .. „ ? 8 „ Zifteh .. .. .. .. 226 11 .. .. .. „ „ 10 „ Ghizeh .. .. .. 10,500 69.S 15 ... .. „ „ 10 „ Caire .. .. .. 368,100 5,601 15 37 La maladie continue encore. Mit-Gamr .. .. .. 21(5 16. .. .. Le dernier deces aeu lieu le 16 Aout. Mehalla-Kibir .. .. .. 678 16 ? .. .. La maladie continue encore. Sembellawin .. .. .. 161 18 „ . . .. Le dernier deces aeu lieu le 13 Aout. Tantah .. .. . 33,725 539 19 .. „ „ 21 „ B^nisouef. . .. .. .. 138 20 .. ? „ 15 „ Kafre-Zajat .. .. .. 161 20 .. ? „ 17 „ Benha .. .. 5,170 157 23 ? .. .. La maladie continue encore. Ismailia .. .. 3,062 56 23 ? 25 Le dernier deces aeu lieu le 14 Aout. Suez ? .. .. 10,913 51 23 ? .. 2U La maladie continue encore. Nefiche .. .. .. .. 4 25 ? .. .. Le dernier deces aeu lieu le 5 Aout. Menouf .. .. .. 113 26,,.. .. La maladie continue encore. Minieh Roda .. .. .. 26 27 .... .. Le dernier deces a eu lieu le 9 Aout. Barrage Caire .. .. .. 13* 27 ? .. „ „ 13 „ Minieh .. .. .. .. iS". 27 ... .. La maladie continue encore. Kafre Dawar Abu Hummus .. .. 27 27 ? .. .. Le dernier deces aeu lieu le 12 Aout. Zagazig .. .. .. 19,046 .'SO6 2K .. .. .. „ „ 21 „ Rosette .. .. .. 16,671 2i50 28 ? . . . La maladie continue encore. Helouan .. .. .. .. 20 2S ? I 1)I 1 ) Le dernier deces aeu lieu le 15 Aout. Menoufleh .. .. .. 2 28 .. „ „ 28 Juillet. El-Wardan .. .. .. 26 30 ? . . 25 „ „ 16 Aout. Galioub .. .. .. .. 3 2 Aout .... „ „ 2 „ Ghirghe . . . . . . . . 240 4 ? . . . . La maladie continue encore. Damanhour .. .. 25,000 241 6 ? .. „ „ Villages dcs Provinces de — Dakahlie .. .. .. 1,456 IS Juillet .... Minieh.. .. .. .. 532 25 .. „ „ Charkieh .. .. .. 1,344 19 .... Garbieh .. .. .. 1,232 l4Juin .... „ „ Bohura.. .. .. .. 554 j23 Jui'lrt .. .. ? „ Ghizeh.. .. .. .. 565 26 Gallioubieh .. .. .. 576 22 Benisouef .. .. .. 749 26 ... .. .. „ Monoufieh .. .. .. 438 21 ? .. .. ? ? Assiout .. .. . . 493 i3l ? Keneh.. .. .. .. 134 3 Aout .... Gliir^heh .. .. .. 854 6 ? .. .. ? „ Fayoum .. .. .. .'5Bl 6 ? .. Total .. 25,023 .. .. . 137 No. 32. Sir E. Malet to Earl Granville. — {Received September 19.) tLord, Cairo, September 5, 1883. I HAVE the honour to inclose copy of a despatch from the Indian Government, ฆing the names of the doctors and hospital assistants selected for service in Egypt, i :;tating the arrangements with regard to their pay and allowances. I have, &c. (Signed) EDWARD B. MALET. 59 The Secretary to the Government of India to Sir E. Malet. Sir, Simla, August 10, 1883, IN continuation of telegram dated the Ist August, 1888, I am directed by the governor-General in Council to inform you of the measures taken by the Government of India for meeting the demand of the Egyptian Government for medical officers and hospital assistants, conveyed in your telegram of the 81st July. 2. Surgeon J. O'Neill, M.D., Deputy Sanitary Commissioner, Punjab, an officer of eight years' service, has been selected to take charge of the hospital assistants. He has been supplied, as desired, with sets of all medical forms — civil, sanitary, and military — now in use ; also with a copy of the Bengal Medical Regulations. 8. A list of the medical officers selected for special duty in Egypt is given in the margin.* The majority of these officers have certificates in sanitary science. They have been nominated on the terms offered in your telegram, namely, $001. for three months, in addition to travelling expenses and lodging. ซ 4. The names of the hospital assistants selected for special duty are shown in the margin, f Each has been furnished with a " Field Medical Companion," with contents complete, and a copy of Surgeon-General Cunningham's " Sanitary Primer." The ordinary grade pay of hospital assistants serving in India is noted marginally. { 5. Each medical officer and hospital assistant has been given permission to take one native servant with him should he desire to do so. 6. It is expected that all the officers and hospital assistants selected will leave Bombay by the mail of the 14th instant, the mail which takes this letter. * Surgeon J. O'Neill, M.D. „ D. P. Macdonald, M.B. „ S. Little, M.D. ? G. H. D. Gimlette, M.D. Surgeon T. R. Macdonald, M.B. „ A. H. Pierson. M L. T. Young, M.B. „ F. D. 0. Hawkins. f Ist Class Hospital Assistants. No. 34. Ameer Khan. 44. Tuharool Hossain. 49. Shaikh Ameer Buksh. 50. Abdool Mahmood Kban. No. 59. Bowally Buksh. 76. Abdool Kadir. 102. Mahomed Hossain. 111. Shaikh Tajood Deen Hossain. 2nd Class Hospital Assistants. No. 90. Shaikh Raheem Buksh. 97. Khootub Ooddeen. 106. Shaikh Raheem Buksh. 108. Karamutoollah Khan. 113. Shaikh Shahabood Deen. 122. Peer Buksh. 1 26. Goolam Nubbee. No. 169. Shaikh Fuzl Elahi. 183. Gulam Safdar. 193. Mortuzza Khan. 1 95. Taig Ally. 203. Ruhmutoollah. 314. Wajid Allee. 3rd Class Hospital Assistant j. No. 20. Meer Ozeer Allee. 182. Shaikh Raheem Buksh. 204. Kureem Buksh. 206. Shekh Wuheed-ood-deen. 208. Ashan Hoossein. 225. Kureem-ood-deen. 227. Fyz Ahmud. 251. Mahomed Easini. 285. Bukrid Ali. 286. Ahmud Hussein. No. 295. Karam Buksh. 306. Hushmut Ally. 310. Mahomed Din. 325. Shaikh Amjud Ally. 353. Shaikh Mouia Buksh. 399. Shaikh Wajeed Ahmud. 402. Rahmut Alice. 410. Fuzel Allahi. 462. Mohamad Ali. Rs. X Ist Class Hospital Assistant .. .. ? .. .. ?60 2nd Class Hospital Assistant . . . . . . . . 40 3rd Class Hospital Assistant. . ? .. ? ?25 [16451 L 60 No. 33 Sir E. Baring to Earl Granville. — (Received September 26.) My Lord, Cairo, September 13, 1883, I HAVE the honour to inclose copy of a Report from Surgeon-General Hunter, forwarding a scheme for the reorganization of the Egyptian medical service. Che>if Pasha, at whose request this scheme was prepared, has been furnished with a French translation of it for the consideration of the Egyptian Government, I have, &c. (Signed) E. BARING. lnclosure 1 in ETo. 33. Dr. Hunter to Sir E. Malet. Sir, Cairo, September 8, 1883. 1 HAVE the honour of forwarding to you, for the information of his Excellency Chdrif Pasha, a scheme for the reorganization of the Egyptian medical service, which I have prepared, as requested by you. I The scheme supposes a purely civil medical service, embracing, however, curative and eventive medicine, or in other words, a sanitary as well as a medical department ; the ministrative and the executive have consequently each a double function devolving on 3m. The constitution of the service consists of an administrative and an executive staff. (A.) — Administra tive. One Inspector-General. Inspector-General must always be a European, resident at Cairo, unless a ssing urgency, such as an outbreak of epidemic disease in some locality, may call for presence. I Two Deputy Inspectors-General, one to be a European with head-quarters at xandria for Lower Egypt ; the other to be a native Moslem of Egypt, with headrters at Cairo for Upper Egypt. The duties of these two deputies will necessitate much travelling (B.) — Executive. The duties of the executive officers will be : — ฆ 1 . Charge of the medical school and hospital of Kasr-el-Ain. 2. Sanitary inspection of the town of Cairo. 3. Charge of the general hospital at Alexandria. 4. Sanitary inspection of Alexandria. 5. Charge of the fourteen civil hospitals in the provinces. 6. Charge of the Lunatic Asylum, Ablasie\ 7. Charge of the Government medical store. I These officers will be for all official duties under their respective Deputy Inspectorsneral, to whom all correspondence, reports, returns, &c, whether intended or otherwise the information of the Inspector-General, will be forwarded. I It will be seen on reference to the annexed documents, that a very large establishlt, with a corresponding heavy outlay, has been accorded to the Kasr-el-Ain Hospital Medical School. This is owing to the necessity which, in my opinion, exists for the ning of properly qualified men and subordinates for the service of the Government, and i one to which the Egyptian Government cannot too early turn its attention, and make ry effort to foster and develop. Owing to the want of qualified men the Government bliged to have recourse to foreigners, not only for the higher branches of the service for subordinate purposes also, thereby entailing a heavy expenditure, attended not requently, 1 fear, with less efficiency than could be desired. Should this school realize hopes entertained of it, half the members of the medical service would in course of b consist of native Moslems who had received their training there. A subordinate artment is one of urgent necessity, and should be introduced with the least practicable ty ; it should be constituted on the lines of the Indian Medical Subordinate Departlt. It would be a much less expensive and more efficient agency than that which the 61 employing pharmaciens, as the subordinates would compound and dispense medicines in addition to their other duties. There is not, I believe, any fixed standard for admission into the school, nor is there any curriculum laid down while attending its classes either for the higher or lower education. This should receive immediate attention, and be strictly enforced. Fourteen civil hospitals have been allotted for the more important provincial tow As. Each should be capable of affording accommodation for twelve in-patients. The hospitals should be built on one standard plan as funds are available. Buildings which it may be considered desirable to utilize permanently for hospital purposes should not be occupied till such time as the necessary structural alterations have been completed. These establishments are intended for the reception of the sick poor of the town and district, of the gendarmerie and police, of prisoners. The medical officer in charge of one of these hospitals, in addition to his hospital duties, will undertake all sanitary work in the town and district, and will be responsible that vaccination is duly carried out. In this portion of his work he will be assisted by the " medecins d'arrondissement " attached to his hospital, and under his immediate orders. The duties of a " medecin d'arrondissement " will be to travel in the villages of his district. He will attend to all ordinary cases of sickness that he may meet with, and also take effective measures that all severe cases of disease are, when practicable, sent to the hospitals ; he will carry out vaccination, and grant as district registrar permits for burial. He is, moreover, to see that the sanitary rules laid down from time to time under the instructions of the medical officer are duly carried out, and to report any infringement of them. The " sages-femmes " are similarly attached to the hospitals, and should be under the orders of the medical officer in charge for such duties as he may call upon them to perform. IThe Medical Store Department is a new creation, there being nothing, as far as I can :over, to correspond to it in this country. It is a highly-important Department, and, if perly conducted, ought to result in a large saving to the Government. It should be the depot for all authorized medicines and surgical instruments and appliances; from it all hospitals should obtain their supplies, according to a prescribed scale, the indents for this purpose being previously submitted to the Deputy Inspectors-General of the district for |?ir sanction. The officer in charge should be a skilled pharmaceutist, competent to dertake the manufacture of all galenical preparations, such as tinctures, extracts, &c. is on this account that he has been allowed a large salary and a larger staff than might first sight be thought necessary. Under the title of " depenses diverses " I have allowed for the cost, in the various offices, of stationery, telegrams, postage, printing, and water-supply. With regard to other items, such as " menus frais," " gages dcs nourrices,"