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cavalry lines receive their doses, was surprised to find so

many children heavily infected with malaria parasites.Disappointing results.-Major James has drawn up the

following tables regarding parasite and spleen rates inMian Mir since anti-malarial operations were begun in thatcantonment :-

L-M’ucn Mir as a Whole.

n.-Speoified Localities in Mian Mir.

From whatever standpoint these figures are regarded theanswer is as unequivocal as it is disappointing. It was

hoped that it might at least have been possible to say thatthe anti-mosquito operations had mitigated, though they hadnot prevented, the epidemic, but if we consider for a momentthat although many of the children whose blood wasexamined had undoubtedly been taking quinine at least oncea week, parasites were present in the blood of from 68 to 95per cent., we must conclude that the difference between aprevalence of this degree and one which is worse is in-

appreciable. In this opinion Major James feels sure that hewill be supported by medical officers at Mian Mir who wereable to observe the terrible havoc wrought by the diseaseamong troops and followers in the cantonment.The lessons to be learned from the Mian Mir experiments

are extremely important from the point of view of the

military authorities and from that of administrators in

general. It is not intended to refer to them here. Theauthorities (who aimed, of course, at the prevention ofmalaria) have carried out a system which has not only provedineffective for the purpose they had in view, but has resultedin reconverting the cantonment into the arid desert which itwas 50 years ago. In view that the results of these opera-tions may tend to arrest enthusiasm in the great cause of theprevention of malaria, it may be noted that anti-malarialmeasures and mosquito-destruction measures are not, andhave never been, synonymous terms, except to those whoregard the latter as the only method of value for reducingmalaria ; and that in Major James’s opinion enthusiasm in theanti-malarial cause is not arrested by the somewhat rareinstances when the truth regarding failure in mosquito-destruction operations has been proclaimed, but by the morefrequent ones when success in such operations has beenreported on evidence that will not bear criticism and is oftenridiculous.

Captain Christophers, speaking on Major James’s paper,said they knew from Panama that they could deal withmalaria, but what they wanted to know was which par-ticular method was the best. In Mian Mir he thought thatthey had set about it in the wrong way, and that instead ofhaving a campaign against mosquitoes they should havepushed the use of quinine.

A CRISIS IN THE WATER-SUPPLY OFCAIRO.

(FROM OUR SPECIAL SANITARY COMMISSIONER.)

AN UNPOPULAR WATER-SUPPLY.-A CHORUS OF COM-PLAINTS.-A SINISTER WARNING FROM BRESLAU.-EXTENSIVE CONSUMPTION OF UNFILTERED NILE WATERAND ITS RISKS.

Cairo.

OF the numerous sanitary problems that have to be studiedat Cairo, the drainage scheme which has just been acceptedand sanctioned seemed likely to hold the first place in thepublic mind. A few hours in Cairo sufficed, however, to showthat in forming this opinion I was quite mistaken. Outsidethe official circle no one really knows anything about thescheme for laying sewers in Cairo. Most persons contentthemselves with the expression of vague apprehensions whichare, however, easily quieted by the conviction that this is stilla question for the future. The public is somewhat sceptical,however, as to that future being very immediate. The presentis the tenth or twelfth project for draining Cairo, and in spiteof assurances year after year to the contrary nothing whatso-ever is done. Indeed, what was the use of talking aboutdrainage schemes before sufficient water was provided to flushthe drains. On the other hand, everyone, from the highest tothe lowest, is intensely interested in this question of a water-supply. Most persons have an opinion, generally a very strongopinion, on the matter, and on all sides there is a great clamourdemanding immediate action. So widespread is the interesttaken that the water-supply is no longer merely a sanitaryand scientific problem. It has acquired a political andsentimental aspect with which it is now necessary to reckon.Among the native population there is a superstition againstdrinking what they denominate" dead water." They willoften prefer to drink extremely foul surface water to a purewater coming from underground where they say it is dead andburied. Thus from the very beginning there was a prejudiceagainst the present supply, because it is pumped out ofwells. So much is this the case that when the first

complaints were made they were left unheeded, beingattributed merely to this prejudice. In a little while, how-ever, the Europeans who had no special reason for objectingto well water also began to complain and now it may besaid that everyone is dissatisfied. Consequently, I had hardlyreached Cairo when first one person, then another, andfinally quite a chorus of people expressed their hope that Iwould investigate the question of the water-supply. Egyptiansand Europeans are all eager in regard to this matter, andsome did not fail to express themselves with considerablebitterness of feeling.The present difficulty is due to the abandonment of the

Nile as the direct source of supply for Cairo-indirectlyalmost all water in Egypt is Nile water. Obviously, the Nilewaters are often contaminated, and it was also equallyevident that the methods of filtering employed at Cairo weredefective. It was therefore dangerous to drink the Nile water.The fact that an employee at the Nile filtering works atAlexandria died from cholera helped to create a scare. The

present water-supply of Cairo is the outcome of panic ratherthan of a very complete and deliberate investigation. It

happened that at Tanta, a town which is half-way betweenCairo and Alexandria, and which has a population of60,000, wells had been dug to a depth of 150 to 160 feet,which yielded a very good water-supply. This water was

pure and free from bacteria; and the inhabitants, in spite oftheir preference for the Nile and surface waters, soon

recognised the merits of the new supply and were quitecontent. The Government then thought something similarmight be done for Cairo and made borings near theNational Hotel, but the results were unfavourable. AtRod-el-Farag, some couple of miles down the Nile, and beyondCairo they found what seemed to be very good water. Fora whole year pumping operations were carried on here to seeif the supply would diminish and it did not. The Govern-ment then proposed to the Cairo Water Company that itshould transfer its works to Rod-el-Farag, dig a largenumber of wells, cease filtering the Nile water, and supplywell water in its stead. This was done, and a few days agoI visited the installation.There are in all 22 wells, but they are not all finished.

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At present 19 wells are in working order. As the

primary object was to avoid drinking the Nile water

I was surprised to find that the wells are all alongthe bank of the Nile, and this, too, after the river has

passed through Cairo. Four of the wells are close to theriver and the others are at a distance of 330 yards from thewater’s edge. The wells follow the river in its northerlycourse and are separated one from the other by a distance ofabout 88 yards. The water company only owns a strip ofland 12 metres wide running the length of the 22 wells. Oneither side of this strip the land is cultivated and manured.There are a village and an old Mohammedan cemetery closeto the wells. Each well consists of a 13-inch wrought-ironbore-pipe, going down a distance of 30 metres. The various

portions of this pipe are joined together by being screwedinto an iron socket to render them thoroughly water-

tight. Below and for a distance of another 30 metresis the intake. This consists of a tube-shaped frameòn which are affixed three layers of gun-metal wire

gauze that act as a strainer or rough filter. Twotubes were inserted. Along the inner tube was putthe wire strainer. Outside of it some fine sand wasintroduced. Then the tubes being removed the water entersafter passing through the layer of sand and the gun metalwire gauze strainers. But, of course, the water does notflow in an absolutely horizontal line towards these 30 metresof intake tubing. The action of the pumping must drawdown the water from a higher level. Therefore, it cannot besaid that the water is taken 30 metres below the surface ofthe soil, the level at which it enters the tube. Further, itis natural to suppose that the more frequent and energeticthe pumping the higher will be the level from which thewater is drawn down. The soil above consists first of a

deposit of Nile mud. It is the fertile earth mud of the Nileand descends a depth of about 4 metres. Then come some

2 metres of light clay mixed with sand. Below this thereis sand, some of it very fine sand, with occasional layers ofgravel.Thus we have at a depth of 30 to 60 metres 30 metres of

intake pipe. Above there are 30 metres of water-tight pipeswhich are the pump-pipes, and these empty into a mainsyphon-pipe connected with all the wells. In this main thewaters from the different wells mix ; but above each wellthere is an inspection chamber where there is a valve, bywhich the connexion with any one of the wells can be cut off,so that the supply from that source ceases. The hardest pump-ing, I was assured, would not reduce the level of the waterround the pipes more than 1i metres. But if the level of thesubsoil water is not reduced more than a few feet, may notsome of the water obtained have travelled downwards from agreater distance, and have come from points further removedfrom the wells ? 7 Obviously, the well water is Nile waterwhich has changed very considerably in consequence of thedistance it has travelled through the soil. Its character now

depends on the nature of the soil through which it passes ;and it seems to me that the extent of this catchment groundwill of necessity vary according to the amount of water

pumped out. The first trial well which was constructedyielded 5000 cubic metres of water per day. When

eight wells had been dug and brought into opera-tion the yield per well was less, and this was attributedto their proximity to one another. It was there-fore decided not to sink wells with less than 80 metresbetween them. Even under those conditions the amount ofwater that each well would yield was no longer estimated at5000 cubic metres, but 4000 cubic metres per well were setdown as the normal quantity that might be expected. Itdoes seem to me that there was not sufficient forethought’displayed as to the possible effects of increasing the volumeof water extracted, seeing that when the catchment groundwas extended the quality of the water might be altered withthe quantity. - Because one well yields 5000 cubic metres perday of good water, it does not follow that 22 wells, sunkclose to each other, are going to yield every day betweenthem some 88,000 cubic metres of water of identically thesame quality. Again, it would seem as if the fear ofpathogenic bacteria was allowed to eclipse all other con-siderations. The water was hard ; it was found to containsome manganese and some iron, which increased as the numberof wells increased, but this was considered inoffensive.

In a short time it became evident that this well water wastiot only hard but that it was extracting iron out of the pipes

through which it passed. At times, notably in the baths,the water was found full of heavy matter in suspensionand quite dirty in colour. No one had ever complainedof iron in the Nile water nor had any accidents happenedto the delivery pipes when they were used to carry theNile water. But now that the well water travels in thesepipes all kinds of mishaps occur. The fact is that depositstake place in the pipes and these are washed away by anyirregularity in the running, such as by a sudden increase ofspeed or by the sudden stopping and recommencing of theflow. Hence the trouble is often noticed in bathrooms wherethe water is not turned on very frequently, and consequentlywater has opportunity to form a deposit in the pipes feedingthe bath. At the waterworks a tap affixed to a pipe whichhad not been used for four months was opened for myedification. The water that came out first looked a darkbrown colour. In an ordinary hand-basin it left a heavydeposit of dark hard particles and a considerable quantity ofsand. This I was able to scoop up with my fingers after thewater had stood only a few minutes. The water had also an

unpleasant odour. But after the tap had been left runningfor five minutes or so the water seemed quite clear and freefrom odour.The general belief now prevalent is that a vegetable

growth called the crenothriae, the existence of which inthe water is favoured by the presence of manganese andiron, causes the greater part of the mischief. These growthshelp to block up the pipes and add to the quantityof organic matter in the water. In these circumstancesthe official analysis of the water as found at the wells is nolonger sufficient. What is wanted is analysis of the waterafter it has travelled a long distance and remainedfor some time in the distributing pipes. These pipes,which are far from perfect in construction, add to the

difficulty. In the absence of sewers, also, there is a quantityof " dead ends " or cul de sacs where the water stagnates inthe pipes. In regard to this vegetable growth M. Villiersand M. Colin in their work on the Alterations et Falsifica-tions des Substances Alimentaires " (Paris, 1900) when deal-ing with water-supply speak of the crenothriae kiihniana inthe following terms : ’’ This white water weed, which may befound in ordinary water, is very common in water that con-tains organic matter in decomposition or in chalybeatewaters. It has a strong affinity for iron salts, especiallythe oxide, and fixes this oxide in its filaments. Thus itforms felt-like masses, brown in colour, and large enough toobstruct water pipes completely. This has been noticed atLille by M. Girard and at Bordeaux by M. Tieman andM. Gartner. In decomposing these brown masses impart tothe water a russet tint and a disagreeable taste and odour.The water is then unfit for drinking purposes." "

This description coincides with what is now occurring atCairo when water is drawn from a pipe in which it has beenallowed to stagnate for some time. Then the manganeseand deposits in the boiler pipes spoil the boilers. To

remedy these evils, at a cost of about .6900, four bigfilters have been constructed. The idea is to pass thewater through small pieces of the ore of peroxideof manganese on which the manganese is precipitated.Then the ore can be re-oxidised by exposure to the action ofthe sun. But to clean these filters it is only necessary toincrease the pressure of the water which will wash the dark-coloured precipitate off the filtering media. Thus the filterswould themselves create the nuisance which they are intendedto prevent if, in consequence of a fire or from some othercause, the water were drawn from them more rapidly thanusual. Then, the four big filters now under trial cannot filtermore than 400 cubic metres per day, and therefore it wouldrequire an enormous plant and a very large outlay to applythis doubtful process.A more serious consideration, perhaps, than the defective

quality of the water is the fact that the supply may alsofail in quantity. We have seen that the first well yielded5000 cubic metres per day and that when several wells weredug it was necessary to reduce the estimate to only 4000cubic metres per well. In the course of time it becameevident that the wells were not even yielding the lowerestimate of 4000 cubic metres. At last this falling off wasso marked that in January, 1908, an experiment was madeto discover the actual quantity obtained. To the surprise ofall concerned it was found to have fallen from 4000 cubicmetres per well to 3200 cubic metres. Worse than all, the

1016

decrease seemed to continue. In January, 1909, another

experiment was made and the yield then amounted to only2700 cubic metres per well. There had been a decrease of500 cubic metres in the course of one single year.

I may refer here to the alarming experience of the townof Breslau where in very similar circumstances the water-

supply suddenly collapsed. The capital of Silesia has

422,000 inhabitants, and in 1872 waterworks were installedto filter the waters of the river Oder. The results seemedexcellent, and in the last ten years during which thiswater was drunk there were but six to 11 deathsfrom typhoid fever per annum per 100,000 inhabitants.But in 1892 the fear of cholera suggested that the filteredwater should be replaced by underground water-in otherwords, natural instead of artificial filtration was de-manded. Accordingly, 315 wells were dug at a distance ofonly 21 metres from each other. The pipes used were but sixinches in diameter. By the commencement of the vear 1905the works were so advanced that nine-tenths of the supplywould, it was thought, be available. But it was soon dis-covered that the amount of water pumped out of the wellsdecreased. Instead of 60,000 cubic metres they only obtained40,000. Further, it became apparent that the water had ’

changed in character and now contained an altogether un-expected quantity of iron. By the end of March, 1906, therewas so much iron in the water that linen could not be Iwashed. All sorts of excuses were forthcoming. Air was I,said to have penetrated into the water-pipes though they z,were ultimately proved to be perfectly watertight. Fortu- ’’

nately, the filters that had been used for the waters ofthe river Oder had not been destroyed and the townwas in this emergency able to return to the old system ofwater-supply.

This is exactly what is wished for here in Cairo, only withbetter methods of filtration than those employed in the past.Except officials, whose tongues are tied and who dare notexpress an opinion, everybody I have encountered condemnsthe present water supply, and desires to return to theNile-the Nile properly filtered be it understood, for inthe absence of storage filtration would be the onlysafeguard. The ladies especially are very emphatic as

to the existing troubles. The expenditure of soap is

ruinous, and in spite of this the linen is yellow andsometimes absolutely stained. Vegetables cannot be pro-perly cooked in this water, and so convinced are some

people that the water causes the hair to become brittleand to break that they go to the trouble and expense of

sending for a bucket of water from the Nile with which towash their heads. As for the natives, they continue drinkingthe Nile water although it is now unfiltered. The Nilewater is still distributed, but only for watering the

gardens or the streets. So we have arrived at theunfortunate position that formerly the filtered Nile waterwas considered dangerous and the result of digging the wellsto remedy matters has been that a large number of peoplenow drink unfiltered Nile water. The intended reform has, infact, entirely missed its mark. The danger from the Nilehas been increased instead of decreased. Indeed, the death-rate of Cairo does not testify to any improvement. Amongthe foreigners especially, who are more likely to drink thewell water than the natives, the death-rate seems to haveincreased rather than to have decreased since the wells cameinto general use in 1905. For instance, the death-rate perannum per 1000 among foreigners was 21’ 8 in 1901, 25 ’ 5in 1902, 21’1 1 in 1903, and 25 - 6 in 1904. Now, in 1905,when the well water was first extensively distributed,the death-rate among foreigners was 26’ 1 per 1000,in 1906 it was 25-9, and in 1907 it was 27 - 4. Norcan I find any indication of improvement in the specificstatistics relating to typhoid, typhus, and relapsing feverwhich are here grouped together. It would be difficult toprove that the supply of water from the Rod-el-Farag wellshas caused an amelioration in the public health, whereas theentire population is clamouring against the inconveniences itoccasions. If there is danger that the Nile may bringcholera to Cairo, then that danger exists to-day and in anaggravated form, because the Nile water is still drunkextensively and it is no longer filtered. Those peoplewho drink the Nile water are sufficiently numerous to infectthe whole town if they should contract cholera from theNile.Under all these considerations it seems to me that the

continued reliance on the Rod-el-Farag well water isdangerous, and that the supply may suddenly prove insuffi-cient. It also appears that a return to the Nile waterwould be expedient, if for no better reason than that it.would give immense satisfaction to 99 if not to 100 per cent.of the population. Considering that the position of th&British advisers to the Egyptian Government is fraughtwith many difficulties, and that occasions of acquiringpopularity do not occur every day, it would be a pityto miss the present excellent opportunity of supportinga measure that would be so widely applauded. It is saidthat the Nile water is satisfactorily filtered at Alexandria.We drink in London with extraordinary impunity water thatreceives the drainage from an area inhabited by one and a,quarter millions of people. Why should not the Nile waterbe filtered at Cairo 7 It may cost money, but so does thewaste of soaps, the spoilt linen, and the injured boilers,while the " mental and moral damages

" caused by the irrita-tion and resentment of a large section of the populationare worth considering.

MANCHESTER.

(FROM OUR OWN CORRESPONDENT.)

The Treatment of Piclmonary Tuberculosis in Manehester.THERE are three institutions, or rather three branches of

one institution, for the treatment more especially of cases ofconsumption from Manchester and the district around. Firstof all there is a commodious and well devised out-patients’department of the Manchester Hospital for Consumption,and Diseases of the Throat aud Chest in Hardman-street,Manchester ; next comes the hospital at Bowdon forin-patients; and thirdly, the Crossley Sanatorium atDelamere. At the thirty-fourth annual meeting of thesupporters of the Manchester Hospital for Consumptionand Diseases of the Throat and Chest held on March 22ndin the Lord Mayor’s parlour some interesting particularswere given. Mr. W. J. Crossley, M.P., who presided,said that the hospitals were always full and if they had not-adopted the plan of receiving private patients he did notknown how the committee could have met the expenses.From this class of patients they received last year £3905.The idea, he said, came from Germany. The hospital stands-high, the winter has been hard, and those patients "who-were badly hit with disease had a bad time in some respects,but those who were not badly hit seemed all the better forthe hard weather." The report showed that the 90 beds wereoccupied all the year and the results are said to be satis-factory, the system adopted being the ’’ open-air " treatmentwith a very liberal diet. The average stay of a patient isthree months. The pity is that it cannot be longer, butowing to the demands for accommodation and the numberswaiting for admission the Board has been compelled to fix alimit of three months. The patients are out of doors allday, except at meal times, and usually sleep with the bed-room windows wide open. At Bowdon the 50 beds havebeen fully occupied during the year, but it is sad to knowthat a large number of applicants are always waiting foradmission. All these patients belong to the workingclasses, and it is usually the wage-earner who is struckdown, so that they are often short of the warm clothing somuch needed. In the out-patients’ department 11,443were under treatment during the year, against 11,163the previous year. The medical board call attentionto the fact that so many patients apply too latefor successful treatment, and say that it is betterto send doubtful cases for consultation, and even toadmit to the sanatorium when tuberculosis is only stronglysuspected, rather than to wait, as is so often done, till thedisease is too extensive to allow of recovery. At Hardman-street the want of in-patient accommodation for urgentthroat cases and for acute chest diseases has been seriouslyfelt, but the times are not at present favourable to anyfurther extension. Altogether this institution tries to copewith a widespread and terrible scourge so far as its resourcespermit and is as free from what is well known as hospitalabuse as it well can be.March 28th.