1779NEW INVENTIONS.-EGYPT AND THE SOUDAN, 1907.

antiseptic externally and internally and as an antifermentative,as a wash, and so forth.

STERILISED MILK (GREEN BUTTERFLY BRAND).(FUSSELL AND Co., LIMITED, 4, MONUMENT-STREET, LONDON, E.C.)Points of importance in regard to this milk are the

- uniformity and permanency in connexion with the dis-

tribution of its fat. The separation of fat is always a sourceof trouble when milk is sterilised by heat. This sampleproved to be perfectly homogeneous in regard to its fattycontents and, moreover, the quality of the milk is excellentas will be seen from the following analysis : total solids,12’ 40 per cent. ; mineral matter, 0’ 78 per cent. ; fat,4’ 11 per cent. ; and non-fat, 7’ 51 per cent. The taste was

quite good and the contents nf the tin were souni on

opening and no preservatives were detected.CYLLIN OBSTETRICAL LUBRICANT.

(JEYES SANITARY COMPOUNDS COMPANY, LIMITED, 64, CANNON-STREET, LONDON, E.C.)

This lubricant is prepared to meet the requirements of

gynæcological practice. It is a bland, unirritating substancecontaining the powerful disinfectant cyllin, so that its

application is a guarantee that the surfaces with which it-comes into contact are rendered sterile. It is, moreover,soluble in water, and whilst an excellent lubricant containsno free greasy matters.

New Inventions.APPARATUS FOR CONTINUOUS SALINE RECTAL

IRRIGATION.I HAD on several occasions made an attempt at continuous

saline rectal irrigation with the apparatus recommended byMr. B. G. A. Moynihan in THE LANCET of August 17th, 1907,but with very varying success. The delivery of the saline fluidwas not constant and frequently much of the liquid syphonedover and was discharged on to the bed, and the disturbancecaused to the patient by the changing of the sheets washighly prejudicial. Being convinced of the value of themethod, it occurred to me that it should be easy to contrivean apparatus which would give a constant delivery of thefluid at a constant temperature, and the contrivance illus-trated in the figure was adopted. A brief description will

suffice. 1. The saline liquid is stored in a bottle A, fittedwith a glass stopcock B, through which it is delivered to the:apparatus at a constant rate. 2. A Woulff’s bottle c, fittedwith a funnel D, a thermometer E, and a glass T-piece F, isplunged in a light metal case in which it is almost wholly’immersed. At the beginning of the operation this bottleis also filled with saline mixture heated to the required

temperature. 3. A current of air, heated by the petroleumlamp G is passed through the metal case to main-tain the temperature of the fluid in the Woulff’s bottle.4. The temperature is kept at a constant level by a regu-lating apparatus consisting of a capsule at H which actsthrough a lever I on the damper K. When the apparatus isstarted the stopcock B is adjusted to the required dischargeand an equivalent quantity of the liquid oveiflows at theT-piece F and passes through indiarubber tubing to a

Moynihan’s rectal tube. The open end of the T-piece admitsof the escape of flatus. The rate of flow recommended byMr. Moynihan is one pint per hour, and in the apparatus usedthis was proved by experiment to be equal to 90 dropsper minute and the tap was accordingly adjusted to this rate.The instrument has been used on a number of cases withmarked success. It is easy to run and does not requirecontinuous attention. The constancy of the flow makes itpossible for the patient to retain and absorb the fluid and thediscomfort of a wet bed is avoided. It does not seem possibleto maintain the slow rate of flow necessary with the syphonicaction of the apparatus hitherto used. The apparatus wasmade by Mr. J. R. Sharples, Water-street, Accrington.Royal Infirmary, Manchester. JAS. B. MACALPINE.

EGYPT AND THE SOUDAN, 1907.

IN his first report on the finances, administration, andcondition of Egypt, Sir Eldon Gorst judiciously adheres tothe model rendered classical by his great predecessor. His

style, too, bears a certain resemblance to Lord Cromer’,.,but best of all is the striking similarity between the generalviews of the emancipated pupil and those of his whilomteacher. In his brief exordium Sir Eldon Gorst says that hehas no intention of changing the policy of gradual adminis-trative reform which was introduced by Lord Cromer andhas received the approval of successive British Governments.His desire in the present report is to take up the threadwhere Lord Cromer left it and to describe briefly the progresssince attained and the principal measures now under theconsideration of the Egyptian Government.

In the first place, the new Consul General devotes a com-paratively long disquisition to the capitulation. Whenfirst introduced this regimae, as Sir Eldon Gorst calls it, mayhave been necessary and even beneficial, but under the con-ditions of life now obtaining it can without exaggeration bestyled the curse of Egypt. He mentions six matters ofabsolutely vital importance in which the baneful influence ofthe capitulations is plainly manifest. These mattels are

(1) self-government ; (2) spirituous liquors ; (3) child labour;(4) house construction ; (5) weights and measures ; and (6)trade marks, patents, and copyright. A seventh, every whitas important as any of these if not more so, might havebeen added-namely, sanitary legislation. There are alsomany other matters, scarcely less momentous, in which thecapitulations block the way. Measures cannot be equitablyapplied to the Egyptians alone, but before the Europeans whoare living among them can be made amenable the unanimousconsent of 15 Powers has to be obtained. In a final para-graph Sir Eldon Gorst sums up the situation in the followingwords :-The most important problem for the future is, then, to devise a

system which will render all the inhabitants of this countryequally subject to the same laws and regulations, and will at the sametime provide a practical method of legislating for them. Lord Cromer,in his last report, indicated the general lines on which he consideredthe problem might be solved, but he laid emphasis upon the fact thathis final opinion would largely depend upon the reception accorded tohis views by the leading Egyptian and European residents in Egvpt. Sofar, however, there has been no sign of unanimity on this subject onthe part of local public opinion, either European or native. If some ofthe details of Lord Cromer’s plan are not acceptable to those mostinterested, other methods of dealing with the situation must be sought;but whatever scheme may ultimately be adopted, it seems clear that itmust embody the main principle underlying Lord Cromer’s suggestionsand be based upon some local method of legislating for all classes of thepopulation.

In the next two sections of his first chapter Sir EldonGorst discusses the Legislative Council and local self-govern-

I ment and shows in the clearest possible manner thate the native Egyptian is still incapable of directing his own1 affairs to advantage. Sir Eldon Gorst has no hesitation ins stating that the great majority of the upper and middley classes-that is to say, the people who have a stake in thee country-do not wish to see any extension of self-governmentd at the present moment and would be the first to admit that

1780 EGYPT AND THE SOUDAN, 1907.

the country is not ripe for it. " As for the fellaheen," hecontinues, " who make up the bulk of the population, itwould not be possible to make them understand what theidea meant. Until the people have made a great deal moreprogress in the direction of moral and intellectual develop-ment the creation of representative institutions, as understoodin England, could only cause more harm than good, and would,as a matter of fact, give a complete set-back to the presentpolicy of administrative reform."The next chapter is devoted to financial affairs, and with

the exception of a section allotted to the census of 1907 doesnot specially concern medical readers. We may, however, inpassing mention Sir Eldon Gorst’s satisfactory statement thatduring the financial crisis through which Egypt has recentlypassed the position of the fellah was hardly affected, andthat he continues to enjoy the relatively high degree ofmaterial well-being to which he has become accustomed oflate years. From the short section devoted to the latecensus we learn that the population of Egypt, includingabout 80 000 nomads, amounts to 11,272,000 an increase ofnearly 16 per cent. on the figures of the 1897 census. Theenumeration was taken on April 29th and provisional figuresfor the whole of Egypt were published in May. Before theclose of the year statistics are to see the light in which fulldetails will be given regarding age, civil condition, educa-tional attainments, religion, birth-place, occupation, andinfirmities. ’

The drainage of Cairo has so often been declared imminentthat each fresh announcement must naturally excite suspicion.This time, however, it really does look as if this urgentundertaking would be carried out in the near future. SirEldon Gorst hopes that in about a year’s time everything willbe ready for placing the works out to contract. The cost ofthe whole project, including the various accessory workswhich it will involve, will be about two millions sterling,and in order to meet it the house tax in Cairo is to be raisedfrom 8 to 10 per cent. per annum. The 15 Powers have beenasked to agree to this fiscal measure and all save one have

signified their consent.Turning to the chapter headed Public Health, we find

that 31,800 in-patients were treated in the Government

hospitals during the year, the number in 1906 havingbeen 30,000. Upon this Sir Eldon Gorst observes:"The work of the hospitals throughout the countrycontinues to increase and the number of voluntaryentries shows a gradual and satisfactory development.This tendency is also observable in the out-patient depart-ment. The total number of out-patients in 1907 was 165,000,as against 128,000 in 1906." In 1888 the number of admis-sions to the Government hospitals, including the lunaticasylum and a police hospital at Tourah, was 11,581, andexcept at Kasr-el-Aini there was practically no out-patientdepartment at all. The value of Western medical methodsis now largely recognised in Egypt. In the present reportSir Eldon Gorst mentions the recent foundation by privatepersons of four hospitals for the benefit of all comers, whilethe " number of attendances " at the travelling eye hospitalswhich owe their origin to Sir Ernest Cassel was 146,830, Inthe early days of the occupation 300 beds had to be made tosuffice for the lunatics of all Egypt in the asylum at

Abbasiyeh. Now the number has been increased to877 and "it is hoped that accommodation for 300 morelunatics will be available at Khanka in about three years’time." Hashish is believed by most people to exercise an

extremely pernicious effect upon human beings when it iseither smoked or eaten as a sweetmeat, and although a fewapologists exist who assert that it is infinitely less injuriousthan alcohol still there can be no reasonable doubt that thehabitual use of a preparation which acts so powerfully uponthe sensorium will inevitably be attended by the demoralisingconsequences common to all such indulgences. In Egypt nofewer than three different departments of the Governmentare intrusted with the repression of the importationand consumption of hashish, but in spite of the effortsof the coastguard, the Customs, and the police a largeamount of the drug finds its way into the country and is ,

distributed among its inhabitants, foreign as well as native.During the year 1907 the amount of hashish seized and confis-cated was 16,290 kilogrammes, representing a monetary value of about £50,000, while the year before the amount was15,380 kilogrammes. It is therefore fair to conclude that a trade which is able to support such a serious loss must be very extensive. Formerly the consumption of hashish was ]

believed to be the cause of most of the insanity in Egypt,but apparently it is more intelligently used now or else themode of preparation has been improved. Whatever thereason may be, it is satisfactory to find that of late yearsthe cases classified as due to the abuse of hashish havebeen less frequently admittted into the lunatic asylum atAbbasiyeh than they used to be. In the year under reportout of a total of 444 male admissions the proportion ofhashish patients was only 13’ 5 per cent. ; in 1897 it was34 per cent.

In his annotation on the lunatic asylum Sir Eldon Gorstremarks that " a certain amount of pellagra has beenobserved amongst the inmates, but the precise connexion,between this disease and lunacy has not yet been determined.As regards its proximate cause, the balance of opinion is in,favour of attributing it to the ingestion of diseased maize, butthe question cannot yet be said to have emerged from thecontroversial stage. There is no doubt that the disease existsin certain districts of Egypt, but more complete informationis necessary before the question of what, if any, remedialmeasures are possible can profitably be studied." Moreinformation is certainly necessary but it is scarcely to belooked for in a report of this nature. It would have beenmore satisfactory if Sir Eldon Gorst had been able to-announce the imminence of an authoritative investigation ofthis highly important matter.That Egypt is the hot-bed of ophthalmia is an unfortu-

nate fact which is very widely known, but few Englishpeople, we should imagine. are prepared for the terriblecondition of affairs so clearly exposed in the following short.extract :-

By an arrangement with the Ministry of Public Instruction the-experiment of inspecting for eye disease the pupils in the Governmentschool at Tantah was undertaken last October. Out of a total of 485.boys only 16 were found to be free from granular ophthalmia ortrachoma. This chronic contagious disease is directly or indirectlyresponsible for a very large proportion of the cases of blindness in thecountry. 61’4 per cent. of the boys in the school had less than normab alvision in one or both eyes.

England being a land of clear vision it may be that theblessing of good eyesight is not sufficiently appreciated. Onthe other hand, it is certainly true that through familiaritythe curse of blindness loses much of its acuteness in a landlike Egypt.

! After the great cholera epidemic of 1883 had ceasedEgypt remained free from the disease for 12 years. In 1895however, it again made its appearance, and continued tocommit ravages with more or less severity until 1902. Sincethen the country has been kept immune, but owing to thepresence of cholera in Southern Russia, Constantinople, andthe Hedjaz Sir Eldon Gorst is of opinion that itis still necessary to take stringent precautions and to

keep a careful watch on the movements of possiblyinfected immigrants and pilgrims in order to obviate the risk ,

of the disease again entering Egypt. But although cholera.has departed, never, let us hope, to return, the same cannotbe said with regard to plague. The last case having occurredin 1844 it was thought that the disease had become extinct,but in 1899 it broke out again and has continued ever sincewith much virulence. Of recent years it has appeared mostlyin Upper Egypt where, according to Sir Eldon Gorst, it

commonly assumes the pneumonic form. "This form," headds, " is especially dangerous on account of the rapiditywith which it spreads, its infectious nature, and the highmortality (practically 100 per cent.) attending it. In Lower

Egypt, on the other hand, the bubonic form, of which themortality rarely exceeds 40 per cent., is more common ; thisform does not appear to be directly communicable from oneperson to another....... Unless the people themselves can beconvinced of the advantages of what is being done thedisease cannot be stamped out. Considerable progress has,however, already been attained in educating the inhabitantsin this respect."The concluding part of Sir Eldon Gorst’s interesting report

is devoted to the Soudan. Generally speaking, the publichealth was satisfactory during the year, but Dr. J. B. Christo-pherson had to record the deaths of two valuable Britishofficers from blackwater fever-Captain Bengough at Wanand Captain Gunthorpe at Roseires. An increase in thenumber of cases of enteric fever was also noted, as well as theexistence of Malta fever at Kassala ; the cause of the latterbeing "probably goat’s milk." 49,722 persons were vacci-nated, and 94,051 out-patients and 7266 in-patients weretreated at the civil hospitals, the corresponding numbers theprevious year having been 78,029 and 7002.

1781HOSPITAL SUNDAY.

THE LANCET.

LONDON: SATURDAY, JUNE 20, 1908.

Hospital Sunday.THE annual collection of the Metropolitan Hospital Sunday

Fund is held somewhat later than usual this year owing tothe incidence of Easter and of the feasts of the Church

dependent upon it. This should be of no disadvantage to theFund, because in the middle of the month of June London isat its fullest, and the depressing influence of a late and chillyspring has given place to the sunshine and genial warmthof summer. We sincerely hope that the ordinary attrac-tions of the season, combined with those presented byan international exhibition of unusual importance, maybe found to have brought into oar midst a host of visitorswho will not forget amid their own pleasures the needs ofothers whose lot is one of poverty and suffering. We do

not grudge any the enjoyment of those amusements uponwhich money is so freely spent by all classes of the com-

munity according to their individual tastes and their differentdegrees of personal wealth; but we do not shut our eyesto the fact that the sums devoted to pleasure and luxury inthe present day are very large and that they tend to in.crease, and we cannot believe that the excuse of " hard

times" can justly be put forward by all those who may be

tempted to plead exceptional and temporary poverty in replyto the claims of charity. Oar country is at peace with the

world, and if the period of tranquillity which has followedthe long anxious years of war in South Africa has not provedto be a time of great commercial prosperity the signs of thecommencement of better conditions are not wanting, andall must hope to see them reflected in the total received

by the Fund from the general public in 1908.The supply cannot possibly rise to a point in excess

of the urgent demand, and even if the present year

were to beat the records of those which are past therewould still be need for more in the future. The

urgency of the need of the hospitals can be shown by aglance at the statistics published last week, as in pastyears, in our annual supplement issued on behalf of

the Fund. This urgency can best be judged by the

figures which display the vastness of the work performed.The total amount contributed to the Metropolitan HospitalSunday Fund last year, including donations, was £78,651.This is a "record" total, a goodly sum indeed, repre-senting the relief during the past year of an amount

of suffering not to be estimated in figures. Let

us, however, look at it with relation to the work

actually done by the hospitals aided by the Fund.

The statistics of the general hospitals alone, leaving specialhospitals and cottage hospitals out of consideration, showthat in these more than 70,000 in-patients were received i

during 1907. That is to say, the amount raised by theMetropolitan Hospital Sunday Fund would have enabled

it to contribute a little more than £1 towards the main-

tenance of each in-patient in the general hospitals if onlythese had had to be assisted by it. But during the same

period the cottage hospitals and special hospitals betweenthem had more than 70,000 in-patients to provide with bedsand food, with professional care and nursing, and even thenwe have to take into account further what is done for out-

patients, and a host of other subjects of hospital expenditure.No, there is no fear that the income of the MetropolitanHospital Sunday Fund will be in excess of the needs of thenoble institutions which it strives to assist.

It must not be forgotten, moreover, that from the sum

above referred to, constituting though it does the largestthat the Metropolitan Hospital Sunday Fund has had at itscommand in any one year since its inception, must be

deducted "donations" amounting to f.35,865, including£30,000 from the estate of Mr. GEORGE HERRING, before

we arrive at the contributions of the great generalpublic, the citizens of London, to whom the Fund

, specially looks for support and for the collection of

r whose charitable offerings it is peculiarly adapted. It

does not fall to the lot of many to be able to givethousands of pounds, or even hundreds, in any one yearfor a single charitable object, however deserving it may be orhowever great may be the need for generous help. To those

in such fortunate circumstances the Metropolitan HospitalSunday Fund owes much, and representing as it does orderand method in the distribution of charity it is able to assurethem of the wise and economical spending of that which intheir generosity they may give : but it appeals with equalurgency and with equal claims on the attention to those

i whose gifts are limited necessarily to pounds, to shillings,or to pence. These may give to the full extent that

their means allow, making perhaps an effort in order

that their alms shall exceed that which they contri-

l bute to the offertory at other times, but at the same time

e may not desire to display their liberality before their

d neighbours, or to have their offerings criticised by those who

d can afford larger sums. To them the collection on HospitalSunday affords an opportunity to do good, not, indeed, bystealth, but without expecting or desiring to find fame, andto them the self-denial which they impose upon themselvesin order that their gifts may be adequate, must rank with

" That best portion of a good man’s life,His little, nameless, unremembered actsOf kindness and of love."

Such acts of love and kindness bear their fruit unseen so far

as the efeact of the individual gift is concerned, but if any ofthose who give to the Metropolitan Hospital Sunday Funddesire to realise what it is that he is assisting let him stand

by the gates of one of our great general hospitals on theafternoon of the day on which the collection is made, or on

any other Sunday, and let him watch the stream of relativesand friends of patients entering to visit those who lie

within. If he has the opportunity let him one day go inhimself and scrutinise the faces of those who lie in the

wards ; let him wonder what their lot would have been if

the beds had not been there to receive them and if there had

not been for them the resources of medicine and surgery of

the same quality that his wealth and position would

command for the prince or the millionaire.If, however, it may seem to most men, and to those in