1089POWERS OF INSPECTION BY SANITARY AUTHORITIES.

in the resulting submersion thereby of the famous ruins atPhilae ; but that, of course, is not a matter with which we areimmediately concerned. Trial surveys and borings in con-nexion with the Wady Raiyan project have been completed, butLord Cromer evidently does not regard that scheme withmuch favour, although he says: "What is wanted is that

Egypt shall have the best possible reservoir, whether it be inthe Wady Raiyan or in the Nile Valley itself, formed by meansof artificial dams." This is precisely the desideratum.From a hygienic point of view the scheme for preserving thepure supply from the Abyssinian mountains in the Raiyandesert, far from all possible sources of contamination, is themost perfect conceivable, and sanitarians should use everyeffort in their power to secure its adoption.

THE SALT DEPARTMENT.A far-reaching reform was instituted in this Government

monopoly, 40 per cent. having been taken off the price ofsalt at the commencement of the year. The receipts wereconsequently much under the estimate, but 39,000 tons weresold against 30,000 in the previous year. Salt being a neces-sary of life and health, the price to the impoverished fellaheenmight with benefit be still further reduced.

PRISON DEPARTMENT.

"In spite of the difficulties this department has had tocontend with, in housing, feeding, clothing, providing workand maintaining the health and discipline of an average dailynumber of more than 6000 prisoners on a limited budget of£27,250 and a restricted staff of 342 employés, the work ofthe year has been very promising for the future." " Duringthe year no less than 45,178 prisoners, including 4150 women,have been received in the State prisons ...... but this numberdoes not include the hard-labour convicts at Suakin andLakar, or the contravention cases which are confined in

specially-rented quarters or in the police district gaols.""I regret to say that the overcrowding still continues, owingto the indisputable fact that the existing gaols are totallyincapable of containing the average number of prisoners inconfinement." These extracts show conclusively the natureof the task confided to Crookshank Pasha. It is difficultto understand why-with the finances of the country in sucha flourishing condition-that able and hard-working officialshould still be expected to continue to make bricks with suchan infinitesimal amount of straw. Overcrowding in gaols isnotoriously one of the gravest sources of danger to the com-munity at large, and for the sake of sanitary insurance aloneit is highly desirable that the Prisons Budget should be atleast doubled.

SANITARY DEPARTMENT.

"16,848 patients were admitted into Government hospitalsin 189&, as against 15,371 in 1891, an increase of 1477 ;besides which 2947 cases of infectious diseases were treatedin tent hospitals. Either the credit for hospitals must besubstantially increased or the number of admissions limitedto the existing provisions (which means denying the benefitsof hospital treatment to a large number of applicants), for itmay be confidently expected that this number will go onsteadily increasing as the prejudice against hospitals graduallydisappears. It is naturally a matter for regret that largecentres of population-towns of over 20,000 inhabitants-should have no hospital, and that in towns of from 7000 to12,000 inhabitants there is not, in many cases, even a dis-

pensary ; but whether the Government is bound to undertakegeneral medical relief which receives no assistance fromprivate charity or local funds is doubtful. " From an Englishpoint of view this reasoning may be correct, but it must everbe remembered that Egypt is a country sui generis. Thepeople have never been taught the principle of self-help, andthe taxes they have to pay are as much as, or more than, theycan bear. Under these circumstances it is manifestly the dutyof Government to provide for their necessities pending thecompletion of their education and until the burdens they aremade to carry shall be sufficiently lightened to enable themto take charge of their own affairs.

THE SANITARY BUDGET.Some slight improvement is to be seen in this all-important

particular. £22,000 have been granted for repairs to Kasr-el-Aini Hospital and f14,OOO for other indispensable works,including a public disinfecting station in the vicinity ofCairo. £3000 have also been added towards improving thepay of civil medical officers, "but the sum is insufficientto carry out in its entirety a complete reorganisation of the

service. For the general sanitation of the country no provi-sion exists. Local wants should undoubtedly be met by localrates, but it is to be feared that a considerable time mustelapse before the inhabitants of the large towns will reco-gnise the importance of drainage schemes and pure water-supply to the extent of desiring, much less imposing on them-selves, local taxation for these purposes. For the rural dis-tricts there seems little hope, unless the Government under--takes the expenditure." It is encouraging to find these-’things even talked about in high places. As already pointedout, it is unquestionably the duty of the authorities, nowthat they have the means, to make a beginning. As suggestedin a previous paper, 2 let a sub-branch of the sanitary depart-ment be organised, with a budget of £200,000, for the

purpose of inaugurating hygiene in the villages. The moneycould not be spent in a better way, nor in one that would

eventually prove more remunerative.No SANITARY LEGISLATION.

Lord Cromer goes on to point out that "one of the great.wants of the country is sanitary legislation. No Public,Health Act exists. The difficulty will be to frame a.

law applicable alike to Egyptians and foreigners andto obtain its acceptance by the Powers." This is, with-out doubt, where the sanitary shoe pinches in Egypt, and.until the country be subjected to one master only it is im-possible to provide a remedy. To devise effective sanitary’legislation whilst the capitulations remain in force surpassesthe wit of man. According to the report a beginning wasmade last year, but the "subjects selected were those not-likely to affect foreigners "; such, for instance, as mosquedrainage and brick-making within a kilometre of habitations.in order to avoid the formation of fresh birkets. "Two im-

portant questions " are said to remain as yet unsolved-" 4 thefilling in of existing birkets and the removing of cemeteries.which are a danger to public health." If the sub-branchabove mentioned were established these necessary reforms.would come within its province.

POWERS OF INSPECTION BY SANITARYAUTHORITIES (THE FOLKE-

STONE CASE).Ox Saturday, April 15th, the Folkestone borough magis-

trates gave their decision in a case which will doubtless be.attended with the most important consequences to the public,for it has demonstrated to them-apparently to an unpalat-able degree-the great powers vested in local authorities forthe carrying out of necessary sanitary reforms. Numerousletters have appeared in the lay press expressing surprise anddissatisfaction at the judgment which has been delivered,feelings which are very natural when it is remembered that.

many of the houses which have been pronounced insanitarywould compare in size and excellence with those of Grosvenor-

square. To adduce the fact that a house is a mansion is no.argument that its sanitary condition is perfect. On the con-trary, the very complexity of its drainage system renders itall the more likely to present shortcomings which might not.have cccurred in a house drained on a more simple plan. In-

discussing the question of sanitation in relation to thelaw and practice of house - letting in August, 1892,we had occasion to make use of the following words :.

"We see, then, that in the matter of sanitation thelaw makes the local authority practically supreme if it.cares to exercise its rights, for it is not only permitted entryat any reasonable time during the day if dissatisfied with the-sanitary condition of any house, but it may frame by-laws:and enforce them with respect to sanitary appliances,"’although the plan we suggested for bringing about therequired sanitary reform was by a system of registrationrather than by entry and enforcement of the law. To arriveat a correct understanding, however, of the position taken up.by the Folkestone local authority, let us first briefly reviewthe facts of the case, then the provisions of the Public HealthAct, 1875, which bear upon the case, and finally see how the:one was justified by the other.The sanitary inspector being engaged in a house-to-house

2 THE LANCET, April 22nd.

1090 THE ELEVENTH INTERNATIONAL MEDICAL CONGRESS.

inspection, the necessity for which had been pointed out in a- circular letter recently issued by the Local Government Boardin view of the approach of cholera, applied at a certain housefor admission for the purposes of inspection and was refused.From an outside observation he had arrived at the opinion’that there were sanitary nuisances ; the soil pipe did not" appear " to be properly ventilated, and he saw through theglass door a sink in the scullery which did not "appear

" to’ discharge outside ; in the yard a bell trap that " seemed tobe dry ; and from the state of the adjacent houses in otherparticulars he had reason to believe that the house was not inthe state of sanitary excellence in which it should have been.It transpired in the course of cross-examination that duringthe three years and two months that he had held office, thesanitary inspector had been obliged to condemn no less than2000 waterclosets, out of a total of 5000 houses, the inspee-tion of which had not yet been completed. The application- in question was made to the magistrates for an order to enter’the premises.

The provisions of the Public Health Act, 1875, which bearupon the case are the following : Section 35 enacts that everyhouse newly built or rebuilt shall be provided with a suincientwatercloset, earth closet or privy. Section 36 lays down that ifa house within the district of the local authority appears to such. authority by the report of their surveyor or inspector ofnuisances to be without a sufficient watercloset, earth closet orprivy they shall serve a written notice on the owner or occupierto provide the same within a reasonable time. Section 40 enactsthat every local authority shall provide that all drains, water-closets, earth closets, privies, ash pits and cesspools within theirdistrict be constructed and 7wpt so as not to be a nuisance or igt-jurious to health. Section 92 enacts that every local authorityshall cause an inspection of their district to be made from timeto time to ascertain what nuisances exist calling for abate-ment. Section 102 lays down that the local authority orany of their officers shall be admitted into any premises forthe purpose of examining as to the existence of any nuisancethereon ...... at any time between the hours of 9 in the fore-noon and 6 in the afternoon.Most of the correspondeits who have written to the daily

papers complaining of the hardship involved by the actionof the local authority appear to us to have grounded their,objections mainly upon the supposition that the sanitaryauthority had no power to interfere save in the eventof a nuisance existing; but the fallacy of this notionwill be at once evident on reading the provisions of thePublic Health Act which we have quoted above. Indeed,- even the learned counsel for the defendant seems to have; grounded his defence upon the same argument, for he is

reported as saying that "the bench would see from Section102 of the Act it is provided that any local sanitaryauthority or any of their officers shall be admitted to the

premises for the purposes of examination as to any nuisance ;but it must be interpreted reasonably, and the only reason-able interpretation was that there must be a primâ-facie caseshown, the whole principle involved being whether thesanitary inspector has the power to knock at the door and goin or whether the true interpretation is that a primâ-facie casemust be made out. " The truth is that the sanitary authorityhas a twofold duty devolving on it-viz., not only to correct. nuisances when they do exist, but to see by periodical inspec-tion that nuisances do not occur either in houses in course oferection or in those already built. The points mentionedby the sanitary inspector certainly constitute legitimatereasons for interference, and the local authority appear tohave been further justified in their action by the circularletter of the Local Government Board, although we mustpresume from the enormous number of closets condemned thatthe routine inspection of houses had commenced prior to the

reception of this letter. It is a pity, however, that more evidence,on certain points was not elicited at the trial. For instance,were any of the closets condemned found in houses erected. since the passing of the Public Health Act, 1875 ; and if so,how came this to pass ? Of what pattern were the closetswhich were removed and by what sort were they replaced ?A large number of the recommendations of the sanitaryinspector for improvement appear to have been in the’ direction of waterclosets ; and we read in the letter of a-correspondent, resident over twenty years in Folkestone,"that the water company had decided against valvewaterclosets and a three-gallon flushing cistern ; that thesanitary authority have condemned what is considered

by experts to be the best lead-trap in existence." Newpatterns of closets are constantly being introduced, and

fashion changes in these things as in everything else, so thatunless those removed actually presented grave defects whichwould have rendered the occupants of the houses in which theywere in use liable to serious danger in the event of an out-break of epidemic disease, the contagion of which is trans-mitted by fsecal emanations, such t,s typhoid fever or cholera,the action of the -Folkestone local authority would seem tohave been somewhat over zealous.

THE ELEVENTH INTERNATIONALMEDICAL CONGRESS.

A MEETING of the English Committee was held at 1,Harewood-place, on Friday, April 28th, at 5 P.M. The

following were present : Mr. T. Bryant (in the chair),Sir James Paget, Sir Andrew Clark, Sir W. Mac Cormac,Sir Dyce Duckworth, Sir J. Fayrer, Dr. Saundby, Dr.Dreschfeld, Dr. Withers Moore, Dr. C. Taylor, Mr.

Shirley Murphy and Mr. Makins. It was resolved thatSir W. B. Dalby, Dr. F. Semon and Mr. C. S. Tomes beasked to join the committee with a view to bringing its con-stitution into closer agreement with the sections of the Con-gress by giving representation thereon to Otology, Laryngo-logy and Odontology. The committee decided to facilitatethe business of the Congress by giving information both in thepress and privately, but considered that matters relating totravelling, lodging &c. would be more satisfactorily treatedby Messrs. Cook and Son, of Ludgate-circus, with whom thehon. secretary was directed to enter into relations. It wasresolved that Mr. Bryant, Sir William Mac Cormac and SirDyce Duckworth should form a working sub-committee, Mr.Makins to act as honorary secretary.The committee is able to give the following information asto the most recent arrangements. Communications to bemade to the Congress must be announced not later thanJune 30th, 1893. Abstracts of the same must be sent notlater than July 3lst for printing and later distribution amongstthe members. The membership subscription may be paid inRome, or at an earlier date if wished. The ticket admittingto meetings &c. will be issued in Rome and is distinct fromthe member’s ticket referred to below, which is for use on thejourney only and for which nothing is paid. Members will,however, in any case be required to obtain the followingcards and papers in order to benefit by the various reductionsmade by the railway companies : (1) Ticket of membership;(2) letter of invitation ; (3) card of legitimisation. No. 1 willbe required by the English railway companies, No. 2 bythe French railway companies, and No. 3 by the Italianrailway companies when the member requires to pro-ceed direct to Rome in place of taking a circular ticket.N. B. — The French and Italian railways alone give a

reduction of fares ; none is allowed by the Swiss or

German companies. Passengers travelling direct may leaveby any station on the Great Eastern, South Eastern, or

London, Brighton and South Coast Railways and may travelto Rome and back for a single fare, one ticket being neededto Paris and a second to Rome. Members who wish to makea circular tour in Italy should book to one of the frontierstations, Modena or Ventimiglia, and thence can obtaincircular tickets with a further reduction of 20 per cent. on thefares. These may be so arranged as to allow the passenger(1) to return to the same frontier station as he started from ;(2) to start at Ventimiglia and return by Modena or vice versic,(3) to start at either and return to one of the frontier stationsof Switzerland or Austria (Luino, Chiasso, Ala, Pantebba,Cormons). In this case it must be borne in mind that noreduction is given on the Swiss or German railways afterpassing the frontier line.The English railways admit only actual members to the

reduced fares, but the French and Italian railways allow thereduction to ladies and children of members provided withthe necessary papers of legitimisation properly filled up bythe owner. As already mentioned, the ticket of membershipissued for the journey gives no right of access to the meet-ings of the Congress ; but ladies wishing to attend the meet-ings and join in the festivities can do so on obtaining a ladymember’s ticket, for which a subscription of ten lires (abouteight shillings) must be paid. By special decree of the

,Government all members of the Congress, ladies or gentle-