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SOME TURKISH LAZARETSAND OTHER SANITARY INSTITUTIONS IN THE

NEAR EAST.

BY THE BRITISH DELEGATE ON THE CONSTANTINOPLEBOARD OF HEALTH.

(With Reproductions of Photographs taken by the Author.)

v

THE CAMARAN LAZARET (vontinited).The 1 hree Water5’ervir,es: (a) Sea-Tvater Supply,. (b) Fresh-= water Supply-t7be Distilling Appa’l’at1M, Central and

Peripheral Rese’J’voi’J’s, Mode of Distribution, and the IceMachine ; and (c) Well-water Supply.-The Two Existingt Maetcine; and (a) Well-7vater Supply.-lhe Tmo llxistin.q IMethod of Exoreta Disposal: : (a) The Motte System-Latrines, " Collectors," Ceslpools, Punips, Exureta lanks,and " Jetée de Vidange "; and (b) Latrine Jetties on theSea-shore.-Defects of Both Systems -Nem System Pro-

. posed.-Trough Closets 7vitA Automatic Flushing-tanks ;" Fosses à Fond Perdu " ; lrxperimental Observations.THERE are three water services in the Camaran lazaret:

(a) sea-water, (b) fresh-water, and (c) well-water. Each ofthese services has one or more systems of pipes, by whichthe water is distributed to different parts of the lazaret.

(a) Sea-water service.-Sea-water is distributed to all thecordons to supply the latrines, to the disinfecting pavilionfor the baths, and also to the distilling apparatus and ice-machine. There are two separate sea-water services: one

for the first, second, and third cordons, and the other forthe fourth, fifth, and sixth cordons. Each has a powerfulpump which raises the water to a large central reservoir. Thesereservoirs are placed at the top of water-towers ; the water-tower for the three further cordons is seen in Fig. 5(No. III.), whilst a similar, but lower, tower, near the

machinery buildings, supplies the first three cordons. Fromthe central reservoirs the water flows to smaller reservoirson lower towers, one of which exists in each cordon. All thereservoirs are built of armoured cement; the pipes are ofcast iron. In the cordons themselves smaller pipes of thesame material distribute the water to the latrines. The two"central" reservoirs can hold respectively 20 and 19 tons ofsea-water ; those in the cordons can hold about ten tonseach.The concentration of the lazaret will involve the abandon-

ment of the sea-water service for the three further cordonsas it now is. The Commission proposes to put up one largecentral reservoir of 50 tons in place of the 20-ton reservoirnear the administrative buildings which now serves for thefirst three cordons, and to have one system of piping for allthe six cordons. Both pumps would be housed close by thenew large reservoir. By taking up the pipes which coverthe long distances between the three further cordons in theirpresent positions, the lazaret will have something like twokilometres of piping in reserve. It is further recommendedto provide all the reservoirs with ball-taps, permitting oftheir automatic filling, and with water gauges.

(b) Fresh-water iservice.-The drinking-water at Camaranis provided by a distilling apparatus, which converts sea

water into excellent fresh water. The machine was boughtfrom the firm of Mirrlees, Watson, and Yaryan of Glasgowin 1895. The total cost (including the distilling apparatusitself, transport, mounting, boilers, and other accessories)was about £4000. It has given excellent results. It

produces about 26 tons of fresh water in a day of 12 hours ;working day and night it can produce as much as 60 tons inthe 24 hours. The amount of coal burnt varies with thequality ; on an average a ton of water can be furnished byburning about 45 kilogrammes of good Cardiff coal, whereasof Indian, Newcastle, or Turkish coal it requires 60 kilo-grammes to produce the same quantity of water.

Distilled water is given gratuitously to the pilgrims, tothe staff of the lazaret, to the local postal and customsauthorities, to the crews of the Turkish stationnaires, to theofficers of the military guard at the lazaret, to all workmenor employees, to ships in quarantine (if asked for), to

government transports, to the military hospital, and to thestaff of the Camaran arsenal. It is also distributed to the

1 Nos. I., II., III., and IV. were published in THE LANCET ofApril 27th (p. 1188), and May 4th (p. 1251), 11th (p. 1317), and 18th(p. 1389), 1907, respectively.

ice machine, to the generators of all the machines, and tothe disinfecting stoves; and finally, a certain amount issold on the island or on the mainland. The price is60 piastres (10s.) a ton. The quantity of distilled waterallowed to each pilgrim is five litres a day, to each unmarriedmember of the staff ten litres, and to each married member20 litres.From the distiller the water passes to 16 large reservoirs,

eight of which are in the machinery building itself (seeFig. 14) and the other eight are placed in the curious struc-ture which appears in Fig. 15. The basis of this structure

Fresh-water reservoirs in the machinery builrling.

is of very solid masonry and was originally intended to storethe ice made in the ice machine, to which I shall refer pre-sently. As a matter of fact, ice ia never stored there, as it isdistributed as rapidly as it is prepared, but the whole struc-ture is still often called the " depot de glace." The eightiron reservoirs, four small and four large, are supported onvery thick masonry walls and are covered over with a roof

Fresh-water reservoirs over ice depot.

of matting and palm-leaves, which protects the water fromthe sun’s heat. The whole has rather a droll appearancebut is none the less a very practical and successful arrange-ment.From the eight reservoirs in the machine building itself

the water passes to a filter outside, below which is anothersmall reservoir with tap attachment. From here a five-centi-metre pipe conducts the water right to the end of theMervani landing-stage, where portable tanks can be filledand the water thus conveyed to ships that require it. Thewater from these reservoirs is also distributed to the staff ofthe lazaret, to workmen and employees, and, in short, to all

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the persons other than pilgrims mentioned above. Some cof it is even, under existing conditions, carried to the three 1further cordons of pilgrims ; but that, as will be shown, was tnot originally intended to be the case and has been necessi- c

tated solely because the water does not flow freely to thosecordons in the piping provided for it.. From the eight reservoirs over the so-called " ice depot "two pipes conduct (or should conduct) the water to the sixcordons for the use of the pilgrims. One is a pipe of fivecentimetres (about two inches) and distributes the water tocisterns in the first three cordons ; the other is a pipe ofsix centimetres and is intended to distribute the water tothe last three cordons. But for some reason that has notbeen satisfactorily explained the water has never reached

these distant camps or has reached them in extremelysmall quantity. No doubt the long distance the water has toflow, and the fact that some of those camps are on ratherhigh ground, increases the difficulty which the water findsin reaching them ; but in the opinion of an engineer whoaccompanied the Commission there is a sufficient differencein level between the central and peripheral reservoirs toallow of a free flow, and he ascribes the difficulty to someserious obstruction of the pipes. He suggests that in all

probability, when the pipes were first laid down, a carelessworkman in soldering them up allowed a quantity of lead torun into the interior at one or more joints and that this hascaused the obstruction. The explanation is a very probableone and is supported by the fact that the obstruction hasexisted from the time the pipes were laid down. The onlyway to prove or to disprove the truth of this assumption wouldbe to examine every joint, but as the Commission proposes .in any case to do away with this second piping and have a single system of pipes for all six cordons the questionceases to be of practical interest, save as indicating thenecessity of care in future and of supervision of the workmenemployed to lead the joints.

In suppressing the second system of fresh-water pipes avast quantity of these pipes (over five kilometres) will beset free; some will be needed for continuing the first system 1to the three further cordons and the rest can be employed toconduct water to the hospitals, to the houses (new and old)where the staff is lodged, and elsewhere.

In the camps themselves it was originally intended tostock water in large underground cement reservoirs, andsuch a reservoir was constructed in each cordon. They varyin size ; some are large enough to hold 30 or 40 tons ofwater. But they have never been used as originallyintended. Iron cisterns were ordered, and these have inmany instances been placed inside the cement reservoirs.The Arab employee has to descend a flight of steps to thebottom of the underground reservoir and fill the pilgrims’water-jugs from a tap in the iron cistern. The arrangementis not a satisfactory one; the bottom of the reservoir isalways damp and has often an unpleasant smell; there islittle room between the walls of the reservoir and thecisterns; and the employee fills the pilgrims’ receptaclesin semi-darkness and away from all control by any higherfunctionary. For these reasons the Commission proposes toplace the iron cisterns above ground in all the camps, in aposition where the medical man in charge can control theoperation and to cover the cisterns with a mat and palm-leafroofing to protect them from the sun. This method has

already been adopted in one of the cordons and has givenexcellent results.

In the further cordons, as already stated, though thereservoirs exist, no (or little) water reaches them. Water istherefore carried in tanks on wheels, which are pushed byArabs along the Décauville railway from the central reser-voirs to the camps. This method involves much labour and

expense ; the water risks getting contaminated, and itbecomes unpleasantly heated by the sun. One of theseportable cisterns, under a tent, is seen in Fig. 16; thephotograph was taken at the fourth cordon.The Commission recommends that all the reservoirs,

central and peripheral, should be provided with ball-tapsand overflow pipes. By the side of most of these charcoaland sand filters already exist.The water is distributed to the pilgrims twice a day-

morning and evening. Each pilgrim receives a small metaltally, giving him the right to two and a half litres (rathermore than half a gallon) twice daily. Before going on todescribe the third system of water-supply (well-water) itwill be convenient to mention the ice machine.

The ice maohine.-This was bought from the firm of

ie Nayer, of Brussels, in 1896. It is installed in the same

building as the distilling apparatus. It can produce 1200kilogrammes of ice in 12 hours, or 3000 in 24 hours;ordinarily it works about 11 hours a day in the pilgrim

Moveable water tank under tent at the fourth cordon.

season. The ice, which is of excellent quality, is givengratuitously to most, if not all, of the persons mentionedabove as receiving free rations of distilled water. Itrequires about one and a third tons of coal to produce a tonof ice.

(c) Well-water supply.-In a very picturesque oasis in avalley lying to the north-west of the village of Camaran thereare a score or more of wells of different sizes and depths.Seven of them supply a certain amount of water to the lazaret,while the rest furnish the village with their sole drinking-supply, and morning and evening a stream of camels anddonkeys may be met, carrying the water in empty petroleumtins or in skins. The seven wells that furnish the lazarethave been at some time surrounded by walls and a ratherelaborate arrangement of filters and reservoirs has beenconstructed in their neighbourhood. These have for the mostpart fallen in ruin. The enclosure round the wells never-theless remains and a masonry tank, in which the waterdeposits some of its grosser impurities, is still in goodcondition. Some of the wells, the enclosure, and the tankare seen in Fig. 17. The tank is laboriously filled from the

The wells. Arab filling reservoir with well water.

wells by Arabs who use for the purpose a primitive leatherreceptacle, as shown in the illustration. It is proposed toput up one or more pumps which will render the processeasier and speedier. From the tank a five-centimetre pipeconducts the water down the valley to stand-pipes, situatednear the brick-fields (to be mentioned later), which is the

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nearest part of the lazaret. The whole distance is about oneand a half kilometres.The quality of the well water varies, it is said, greatly.

There is apparently communication between the wells andthe sea, as when the tides are exceptionally high the wellwater becomes quite salt. After long drought, when thewater level is low, the water is often muddy and brackish,but after rain, and when the level is high, it seems to be ofby no means bad quality. When tasted in January last itwas quite sweet and pleasant to the palate, but it was im-possible to analyse it. This water is used by the employeesof the lazaret for washing clothes, for watering gardens, forbaths, and similar purposes. Before the distilling apparatuswas put up it was the sole supply of the lazaret, but thequantity proved insufficient and the quality too uncertainand variable. -

The proper disposal of excreta is one of the most difficultproblems that an institution such as a large lazaret presents.Two systems are at present in action at Camaran and neitherhas given very satisfactory results. They are (a) what isknown as the Motte system and (b) a system of latrine jettieson the sea beach.

(m) The Motte system is composed of a series of small housescontaining the water-closets ; drains or I collectors " whichconvey the excreta to the cesspools ; cesspools just outsidethe cordons ; a pump to empty the cesspools ; receptacles onwheels into which the excreta are pumped; and, finally, ajetty where the excreta are emptied into the sea. Thehouses, each of which contains two latrines, are built ofbrick, covered with plaster, with tile roofs. Most of themare in a bad state, the plaster having more or less com-pletely fallen, and the bricks, thus exposed to the air, tendto crumble to pieces. The latrines (" à la Turque") consistof a mere hole in the stone flooring of the hut; suchlatrines are in use in all Moslem countries. To work wellit is essential that the stone should be sloped and grooved so

The Motte system at work; bringing the pump and tanks tothe cesspool.

that all liquids and solids are carried to the hole. This pre-caution was not taken at Camaran, and in some instances thefloor actually sloped away from the hole and liquids flowedout under the door. A tap of sea-water exists in eachlatrine, but it opens horizontally and a strong jet of waterspirts against the opposite wall covering the occupant withits splashes. A valve was inserted under each hole, workingon a pivot with a counter-weight, but these soon becameankylosed with rust and ceased to work.

The " collectors are large pipes, constructed of brick,covered with cement. Their external diameter is 60 centi-metres and their internal diameter 35 centimetres. A pipeof this nature and size is disproportioned to the work it isintended to do ; it would require an immense flush to keep itclean, whereas at Camaran the only flush is the small

quantity of water used by the pilgrims for their ablutions.It is possible, also; that the internal surface of the collectorswas never wholly smooth, being made of brick. As a resultmanv of them became completely blocked and had to bebroken open for cleansing. The defects both of latrines and

collectors were indeed so serious that the lazaret autho-rities have had to close many of them and the pilgrims haveto go to the latrine jetties, to be described later.The cesspools, of which there are from two to eight at

each cordon, appear to have been well constructed. Theyare lined throughout with stone, covered with cement, and’are intended to be water-tight. Their covers are eitherof brick or of armoured cement. Their chief defect is theabsence of a ventilating pipe, and as there are no traps on’the collectors, and the valves under the latrines do not work,the gases escape from the cesspools into the latrines. The’pilgrims complained much of the odours thus caused, whichcould be smelt not only in the latrines themselves but also inthe arishes situated at all near the latrines.

The pump and excreta tanks (" wagons-tinettes devidange ") are seen in Figs. 18 and 19. A glance, indeed,.

FIG. 19.

The Motte system at work; wheeling the excreta tanks to.

the jetty.

at these illustrations gives a better idea than any descriptionof the process of emptying the cesspools and conveying theircontents to the sea. Each tank holds a ton of liquid ; itrequires from 25 to 30 minutes pumping to fill it. The tanksare pushed by Dankali natives along the Décauville railwayto a jetty on the shores of a bay to the north of the lastcordon, where their contents are emptied into the sea. Thisjetty, known as the " jetée de vidange," is seen in Fig. 20.

Jetty for disposal of excreta.

The principal disadvantages of the Motte system aft

adopted at Camaran are the following. The latrines,collectors, and cesspools have the serious defects pointed outabove. The process of pumping up the contents of thecesspools involves the use of indiarubber pipes with metal

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joints. The indiarubber soon deteriorates in a tropical climate;the joints, moreover, are with difficulty kept water-tight (byconstantly plastering them over with putty) ; a vacuum isthus formed only with difficulty ; some of the liquid escapesat the joints, and a still larger quantity falls on to the groundwhen the operation is over and the pipes are unscrewed. Thesame liquid tends to drip from the tanks themselves duringtheir long transit to the sea. From the first cordon to the

jetty is about three miles and this distance has to betraversed many times to empty all the cesspools. Thenatives dislike the task extremely, and there is no doubt thatthe work is both very laborious (particularly with a badlylaid railway track) and very unpleasant. More than once thenatives have threatened to strike altogether.

(b) Latrine jetties.-Owing to the practical failure of thesystem above described it was soon found necessary to run

up temporary jetties on the seashore with latrines at theend, while the whole question of excreta removal could bere-studied and some better and more permanent systemfound. The character of these jetties, of which there arethree in front of each of the first three cordons, is seen inFig. 21. They are simple wooden structures with matting

A latrine jetty on the seashore.

enclosures at the end. The results they give are very un-satisfactory and unpleasant. The tide goes out a long waybeyond their ends, and it is only for a short period beforeand after high tide that they have water under them. The,effect can be imagined and need not be described. But it mustbe added that, as the pilgrims bathe in the sea in the nearneighbourhood of these jetties, the condition is one that isikely to be as dangerous as it is certainly unpleasant. These

jetties should disappear as soon as the new system proposedby the Commission is introduced.New system proposed.-The Commission recommends the

introduction at Camaran of a system of trough closets withautomatic flushing tanks. There should be four chalets ineach camp of average size, each chalets containing fiveclosets, or 20 in all. It is unnecessary here to describe thedetails of this kind of closet, so well known to English sana-tarians in all parts of the world, but practically unknown inthis country. The report of the Commission describes thearrangement in full detail and that of the engineer whoaccompanied the Commission is illustrated with plans andsections. An arrangement of this kind is probably the mostsatisfactory one that can be suggested where latrine accom-modation has to be found for large numbers of relativelyuncivilised persons, as most of the pilgrims are. It requires,it need not be said, to be properly installed in the firstinstance, and a certain amount of care and attention arenecessary to keep it in good working order.

For the ultimate disposal of the excreta it is recommendedthat a trial should be given to absorbing cesspools-that is tosay, to cesspools with unlined bottoms, by which all the liquidportion of the sewage can be absorbed. Such cesspools("fosses à fond perdu ") would obviously be undesirable in anordinary town or village and it is only on account of theexceptional conditions prevailing at Camaran that it becomespossible to approve of their use. To begin with, the lazaretis an isolated institution occupied for only about four or

five months in the year. During the rest of the year thesoil, which would otherwise become permanently fouled, hastime to purify itself completely by natural processes ofoxidation or nitrification. The soil is, for the most part,an absorbent sand; hard rock occurs here and there, butapparently strata of sand can always be found if the rockbe penetrated to a few yards’ depth.

In order to ascertain the absorbent power of the soil theCommission caused two such pits to be dug, one near the firstcordon and the other near the second. Near the first cordon

nothing but sand was met with ; near the second (which lieshigh) alternate layers of rock and sand were found.Measured quantities of fluid-both pure sea-water andsewage from the existing cesspools-were poured into theseexperimental pits and the time taken for their absorptionwas noted. The results (the details of which are fully setforth in the Commission’s report) were very satisfactory. Insome of these experiments eight or ten times the amount ofsewage likely to enter any one of the cesspools in 24 hours werepoured into the experimental pits at the second cordon(the one offering the least favourable conditions) for daystogether, without the bottom losing its absorbent power.Apparently (certainly at the pit near the first cordon) thesea-water at high tide infiltrates to the bottom of the pit,and as the tide descends a marked suction action is set upand most or all of the fluid contents are thus absorbed.The ultimate fate of the solid portion of the sewage is a

problem of some interest. Cesspits of this kind exist atthe lazarets of Suakim and of Tor (at present only for thehospitals and some other portions of these establishments,and it is proposed now to introduce them also for thepilgrims at Tor). Experience there has shown that the solidsdisappear in a remarkable manner and the pits rarely, ifever, require cleaning out. By the side of some of the pitswater-tight cesspools have been constructed in which thesewage deposits most of its solids before flowing into theabsorbent pits, but even these " almost never," it is said,require cleaning out. At the village of Camaran also suchabsorbent pits are in use in most of the better-class Arabhouses. I examined several of these and was not a littlestruck by the complete disappearance of the solids fromthem. At one house, for example, which had been con-tinuously occupied for five years by an Arab family, the

cesspool (only one and a half metres deep) had never requiredcleaning during the whole of that period. At another, whichhad been occupied for five and a half years and onlyevacuated two weeks before it was inspected, I had the

cesspool opened up. It was only about a metre deepyet there was not a trace of solid matter in it,and it was entirely odourless. Whether equally satis-factory results will be obtained with the larger pitsand the more numerous population represented by thelazaret (when full) only experience can show ; andthe Commission proposes therefore to try it first at one ofthe cordons only before introducing it in all, The cesspoolswill be about two metres in diameter, and from two to threemetres deep, according to their position and the nature ofthe soil. They will be about 20 metres (65 feet) away fromthe latrines and outside the cordons ; their walls will belined with masonry without mortar for about a metre fromthe bottom, and with mortar for the rest of their height ;they will be covered with a cement vault with a manhole init. They will be ventilated by a pipe carried up well abovethe roof of the latrines.There are no surface springs or wells to be contaminated

by infiltration from these cesspools. The lazaret is supplied,as already shown, with drinking water distributed in closedpipes, which lie for the most part on the surface of the soil.Care will be taken that these pipes occupy a higher position(i.e., further from the sea) than the cesspools, so that evenif they should leak there should be no possibility of thecontained water being contaminated.

It may confidently be hoped that this new system oflatrines and excreta disposal will give better results thandoes that now in use. All manipulation of the sewagematter will be avoided as it will be disposed of automatic-ally. The wearisome and unpleasant task of pushingsewage-laden tanks for many miles under a tropical sun andon a badly laid railway track will no longer be imposed onthe unwilling natives. There will be no pumps or india-rubber tubes to get out of order and leak, and liquid sewagewill not, as at present, escape on to the surface of the soilnear the cordons or be sprinkled on the railway track fromone end of the lazaret to the other.

(To be continued.)