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the level of the street. The only light and air are from thepatio or inner well-like court, or else from very small sky-lights on a level with the street causeway. No special pro-vision is made for the ventilation of these undergrounddwellings ; they were dark and damp, and at thislow level, where there is little or no circulation of air,there were a number of closets, which, though trapped, wereso rarely flushed that the traps were full of solid soil and thepans filthy. Thus, in the most recently constructed artisans’dwellings, tenements are deliberately built that can neverreceive a direct ray of sunlight, that must ever remainin a state of semi-darkness, that cannot be free fromdamp, because the outer walls rest against the earthbelow the street pavement, that cannot be efficientlyventilated, and must evidently and for all these reasonsbe absolutely unwholesome. According to the official reportof the Director of the Statistical Office of Budapest, the well-known demographer, Professor Korosi, the living in under-ground dwellings shortens human life by from two to three:years, and he further declared that at Budapest the

prevalence of infectious epidemics in underground dwellingsis 60 per cent. more frequent than in other dwellings. Yetin spite of this authoritative statement there were in 1890in Budapest 104,047 dwellings or tenements of which 5’09 per- cent. were underground.

Nor is it only in poor quarters and in artisans’ dwellingsthat cellar tenements will be found. These also exist in thewealthiest parts of the town. Within a stone’s throw of thebest club of Budapest, in a magnificent street proudly calledMagyar-street, there are several cellar dwellings. The accom-panying photograph shows the only light and air inlet given’from the street to one of these cellar tenements. (Fig. 3.)’The handsome window of the ground floor, and the statelyentrance door indicate that this is a luxurious and high-classdwelling-house. But there is a small aperture protected bydron bars and on a level with the causeway. This is the

only window of a tenement below. This cellar dwelling con-sists of one room lighted by the little aperture in question.The room measures 4’20 by 4 metres and is 2 20 metres high.At the end furthest from the street there is a kitchenmeasuring 3 by 3 metres and 2 metres high. This kitchen is

absolutely dark. Dr. Schwartz calculated that the rent paidfor this cellar dwelling amounted to the fabulous sum of5.66 fl. per square and 2’66 fl. per cubic metre of space, orin round figures :&12 a year. In the same building therewere several other equally dark and dear undergroundtenements. Such places, though only suited to serve as

cellars for storing wine, are thronged by poor people who,live there and overcrowd even these wretched abodes. Undersuch circumstances it is not surprising that the death-rateat Budapest is high the cause is self-evident. Of courseovercrowaing in a city tnat is rapidly developing cannotbe easily checked, but surely as new houses are beingbuilt on all sides the authorities can prevent the construction in them of dwelling rooms that cannot by anypossibility become wholesome habitations. If the authori-’ties-in view of the indifference and ignorance of the popu-lation on such subjects, or of the interested opposition ofbuilding speculators-had not the courage to deal withthis question they could have profited by the presence ufthe International Congress of Hygiene and Demographyat Budapest to gain the moral strength of which they-seem to be deficient. They might have invited the whole Con-gress to express its opinion on the necessity of abolishing cellardwellings. This discussion might have been preceded by avisit to some of the cellar dwellings of Budapest. Such anexcursion would not have redounded to the honour of the

, Hungarian people, but it would have done credit to thesincerity and humanity of all concerned. It would not have- supplied the material for flattering comments on the progressaccomplished at Budapest, but it would have provided sharpand incisive arguments to force forwards the cause of sani-tary reform, which, in respect to the housing of the poor,has been scandalously neglected.

ANNUAL REPORT OF THE SANITARYDEPARTMENT OF EGYPT.

THE annual report of 1893 by Surgeon-Lieutenant- Colonel Rogers, the Director - General of the Egyptian SanitaryDepartment, has recently been issued. The existing evils of

Egyptian sanitation are, as in two former reports, very plainlypointed out in trenchant language which admits of no possi-bility of doubt. While urging the necessity of an increasein the inspectors, and pleading for the appointment of anadditional European, which has since been granted to

him, Surgeon-Lieutenant-Colonel Rogers writes: "In timeof epidemic disease such as cholera the present organisa-tion can only lead to a breakdown, and this I wish to beclearly realised. In dealing with the ordinary epidemicsof the country, especially typhus fever, cases are con.

stantly occurring where no inspectors are available, andthe inadequate measures taken by incompetent medicalofficers lead to a loss of life which an inspecting staff wouldlargely diminish." Now that typhus fever has becomeso rare in England it is interesting to note that in Egyptthere were forty-three outbreaks as compared withtwenty-two reported in 1892. This increase in thereported numbers may be partly due to greater activityon the part of the native officials. Altogether 1407 caseswere notified, including 243 deaths. They were spread allover the various provinces, from the Soudanese frontier toAlexandria, but many of the epidemics were caused byrelapsing fever, which the native medical men can hardlyyet uctiiUBC J.Ull1 uylruu icvei. au.uaevvea, au aeau mu UtscN

and twenty-six deaths must be deducted from the figuresabove because they were due to enteric fever among theBritish troops. Measles was present during the year, chieflyfrom February to July, and caused 473 deaths out of 1215cases reported. Small-pox accounted for 191 deaths, out of746 patients, rather more than half of whom were inhabitantsof Lower Egypt. The disease, when it appears, plays greathavoc among the blacks, who are never vaccinated in theSoudan. It is very satisfactory to find that in Cairo itself,where civilisation ought to be further advanced, there wereonly eight cases during the year. To those who are interestedin the medical welfare of the Egyptians it is satisfactory thatnot only do the hospitals to which English medical men areattached grow in popularity, but that also some of the provincialhospitals are now sufficiently filled, though the staff consists en-tirely of native medical men, most of whom have been recentlyeducated at Tantah, where there is the greatest improvementof this kind: the in-patients for 1892 numbered only 979,while in 1893 there were 1196. At the Kasr-el-Aini Hospital,where the annual overturn is nearly 5000, there were 976surgical operations, besides 1037 ophthalmic operations. Thesum of 22,000 is now being spent upon repairing andpartially rebuilding this old hospital, and Sargeon-Lieu-tenant-Colonel Rogers is more than ever convinced thatit would have been true economy to have entirely con-

, demned the old building and built a new hospital on

modern plans. A small infectious hospital, consisting oftwo pavilions for twenty-two beds, has been built in thedesert near Cairo, and to this is attached a public disin-fecting station. At Alexandria also a new pavilion fortwelve beds for infectious diseases has been erected. Thelunatic asylum has been provided with new kitchens, baths,and laundry, and it is hoped that permission will now be givenfor an English psychologist to be appointed in order to studylunacy as seen in Egypt, and also to introduce some form ofnecessary employment and exercise for the patients. The

drainage schemes for Cairo and Alexandria are still beingstudied without any immediate hope of fulfilment. It isestimated that for Cairo alone the cost will be over a millionpounds, and Surgeon-Lieutenant-Colonel Rogers meets thefinancial difficulty by strongly advising the Egyptian Govern-ment to spend half that sum upon the partial drainage ofcertain quarters of the city. In commenting upon some ofthe faults of native medical men in the Sanitary Depait-ment, the Director-General reminds the Government that nolasting improvement in the officials can take place so longas instruction at the medical school is given only in Arabic.After leaving the school," as Professor Virchow has put it,"the entire literature of civilised nations is a closed book tothe students." The only criticism which we feel tempted tomake upon Surgeon-Lieutenant-Colonel Rogers’ able report iswhere he is inclined to recommend that the course of medicaleducation be reduced from six years to five years, on thegrounds that students in law and engineering have a courseof only four years. The whole tendency of medical studies isto become more expansive every year, and we believe we areright in saying that one year of the enforced term is devotedto those scientific subjects which should properly be studiedbefore the professional course begins.

To the sanitarian, water-supply is an urgent question of thefirst rank, and Egypt is sadly in need of reform here, for it

59

appears that the only towns in which any attempt is madeto distribute filtered water are Cairo, Alexandria, Port Said,Suez, and Assiout. In Cairo the filtration by bacteriologicaltests is satisfactory, but unfortunately only a small minorityof the inhabitants have filtered water laid on to their houses.In Alexandria the absence of proper filtration by the watercompany has been exposed by the reports of Dr. Bittar, theGerman sanitary inspector attached to the municipality, andin consequence some new filters are now being constructedthere. In the chemical laboratory it is curious to note thatrather more than one-fourth of the year’s analyses for thevarious Government departments had reference to thediscovery of cannabis indica (hasheesh). Attention is calledto the existence of nineteen cases of poisoning, mostly byarsenic, which came before the Medico-Legal Commission.It is difficult to say how many other cases there may bewhich defy detection. The Egyptian, like the native of India,sometimes becomes a professional poisoner and is fond ofusing datura for his victims, but fortunately not in lethaldoses. We are told that there are 3000 villages in Egyptprovided with barbers and midwives, but 1000 others have nosimilar provision. It would be interesting to know how thepractice of the medicine men and old women of these thousandvillages is carried on, and also who is responsible for thecertificates of death. Surgeon-Lieutenant-Colonel Rogersconcludes by pressing upon his chiefs the importance of

creating a bacteriological laboratory and of providing someday a necessary refuge for the lepers and the incurablesof Egypt. There are several appendices to the report,including an interesting one by Mr. Littlewood, the chiefveterinary inspector. From it we learn that there wereduring 1893 six cases of human rabies reported and only one

case in a dog. Two Englishmen and a native underwenttreatment in Paris, and so far are quite well. Rabies seems.to have been introduced during the last few years into LowerEgypt from Europe ; it would seem to be quite time toestablish a dog tax, and more stringent control over theownerless dogs. Eighteen cases of glanders and farcy werereported in Cairo and Alexandria, and an extensive trial ofmallein was carried out in doubtful cases. Influenza hasbeen very rife among horses, mules, and donkeys, though inprevious epidemics among human beings in Egypt the stablesescaped free. At the Cairo slaughter-house 113 cases oftuberculosis were detected, and the camels furnished thevery large proportion of 4 per cent. of this number. Theslaughter-houses and the animals of Egypt are now bettercared for than the incurable paupers who by reason ofblindness, lameness, or other infirmity are unable to earntheir livelihood. These unfortunates are at the mercy of theWakfs, or Ecclesiastical Commissioners, and though theircondition was fully exposed to the Council of Ministers tenyears ago, and again a year ago by Surgeon-Lieutenant-ColonelRogers, nothing has been done in the way of reform. "Thebuilding is in a wretched state of repair and in a mostfilthy condition, swarming with vermin." Four maleand two female attendants are supposed to look after 224.inmates, including 107 lunatics, who are visited by a

native medical man twice a week. The condition ofthis "Te Kia," which is at Tourah, only eight miles fromCairo, is enough to show us what care the Egyptians take oftheir co-religionists, and we tremble to think what would bethe condition of the hospitals of the country if it were not forthe handful of English medical men attached to the sanitaryservice of Egypt.

THE LANCET RELIEF FUND.SIXTH ANNUAL REPORT OF THE ALMONERS.

THE LANCET Relief Fund, which has for its Almoners

the President of the Royal College of Physicians of London(Sir J. RUSSELL REYNOLDS, Bart., M.D., F.R.S.), the Presi-dent of the Royal College of Surgeons of England (Mr.JOHN WHITAKER HULKE, F.R.S.), the President of the

General Medical Council (Sir RICHARD QUAIN, Bart., M.D.,F.R.S.), Mr. THOMAS WAKLEY, F.R.C.S., and Mr. THOMASWAKLEY, jun., L.R.C.P.Lond., with Sir HENRY PITMAN,M.D., F. R. C. P., as Honorary Auditor, came into operation onthe 1st of February, 1889.In presenting the sixth annual report, the Almoners think

it well again to direct attention to the objects for which theFund was established.The Fund is sustained solely by the Proprietors of THE

LANCET, who provide every January the sum of at leastf:300, and is administered free of cost, with the objectof affording immediate pecuniary assistance to registeredmedical practitioners, or to the widows or orphans of mem-bers of the profession in cases of distress and emergency, bythe grant of money by way of loans free of interest, or gifts,as the circumstances of the various cases may require.When the Fund was inaugurated considerable misappre-

hension existed as to the precise objects for which it hadbeen established ; and, as a result, the majority of the earlierapplications, being cases of chronic distress, and not coming,therefore, under the designation of emergency, could not beentertained. Attention was called to this fact in THE LANCETof Feb. 16th, 1889, in the following words :—

"We are requested by the Almoners to state that, fromthe character of a number of the applications received,both personally and by letter, for relief, it is evident thatin many cases the object for which this Fund has beenestablished is not quite clearly understood ; and, if reliefhad been afforded in the cases of those who suffer fromchronic distress, the Fund would have been completelyexhausted within the first few days of its existence. Theywould therefore be greatly obliged if those readers of THELANCET who may be asked to endorse applications wouldcarefully peruse the Application Form and explain the

precise object of the Fund to those applicants whose casesdo not seem to come within the scope of the purpose forwhich the Fund has been established; which is, to afford

prompt aid to registered medical practitioners, or to the

widows or orphans of members of the profession, who.in consequence of the supervention of some unexpectedexigency, which is not likely to recur, have pressing need ofimmediate and temporary pecuniary relief," and who, it

may once more be pointed out, are likely to be permanentlybenefited thereby.The balance in hand at the end of 1893 amounted to the

sum of C133 4s. On Jan. 1st, 1894, the Proprietors ofTHE LANCET placed to the credit of the Fund the sum of .t300.During the course of the year repayments of loans to theamount of .t21 have been made. The sum of £ 344 has beengranted in relief either by way of loan or of gift, leaving abalance of .E110 4s., as per bank pass-book.There have been considered altogether during the twelve

months ending Dec. 31st, 1894, 56 applications for relief (thenumber the previous year having been 48). In 26 casesassistance was afforded, either as a loan or as a gift,.according to the request of the applicant, the amounts ofthe grants ranging this year from E5 to .t30.The following are extracts from a few letters received from

some of the recipients of the Fund :-186.—"I wish to thank the Almoners for the help their

loan has been to me, as it was one of the means which hashelped me to resume my work."217.-"I beg to return you my very best thanks for the

generous gift of £ - from the above Fund ; and I can assureyou, gentlemen, that the grant will prove of much service to>me in overcoming my difficulties. I enclose a letter of thanksto the Almoners ; but, if in order, I would feel it a favour ifyou could specially convey to the Messrs. Wakley my deepgratitude for the kind gitt which emanates from them. Itrust in time to be able to report to them a successful issueout of my difficulties."

221. - 11 The Almoners of THE LANCET Relief Fund.-I beg to offer you my very sincere thanks for the loan

granted to me, which will entirely relieve my pressingnecessities, and without which I am utterly at a loss to knowto what source I could have turned for help."

223. - "I am unable to sufficiently thank you for £ -so kindly sent from THE LANCET Relief Fund. You cannotimagine of what use it will be. I enclose receipt with verymany thanks."

232—"I return you my grateful thanks for the donation of£ - received last evening. Indeed, it came in an acceptable