332 THE METROPOLITAN WATER-SUPPLY.

many cities still retained such pride in their ownindependence and importance that their individualhistory was altered by their attitude towards theirbig neighbours. Sir Henry Morris’s historical noteis most interesting, and will be read by many nowthat the word Verdun is not only on all our lipsbut speaks to our warmest feelings.

THE METROPOLITAN WATER-SUPPLY.

DURING the month of 1Y1ay the mean rainfall overthe Thames basin was 2’06 inches, which represents0’10 inch above the average mean rainfall for thismonth during the previous 33 years. With in-creased rainfall there is generally shown to be a de-terioration in the chemical quality of the raw riverwaters in some respects. The results of the chemicalexamination during May showed that the raw Leewater deteriorated as judged by the albuminoidnitrogen, permanganate, and colour tests, but therewas no change with regard to its turbidity. Theraw Thames and New River supplies similarlydeteriorated in quality as judged by the albuminoidnitrogen tests, but improved as regards the per-manganate, turbidity, and colour tests. The samplescollected at the different works were, generallyspeaking, clear, bright, and free from suspendedmatter, the filtered waters in fact showing animprovement in quality during the month as

judged by the albuminoid nitrogen, permanganate,and colour tests. All three raw waters containedmore bacteria than their respective averages,while the filtered waters, generally speaking,yielded not unsatisfactory results, as will beseen from the following statement. Whereas 78’3,86’9, and 34’8 per cent. of the samples of rawThames, Lee, and New River water respectivelycontained typical B. coli in 1 c.c. (or less) of water,90’9, 60’9, and 93’9 per cent. of the filter waterderived from these supplies (placing them in thesame order as above) contained no typical B. colieven in 100 times as much water-namely, 100 c.c.

CHINA AND WESTERN MEDICINE.

NATIVE medical practice in China is still founded !on Taoism, which became in the hands of its laterinterpreters a quest for a kind of philosopher’sstone to induce long life. The text-books are those

Iof a thousand years before the Christian era, and

nothing of modern application, except perhapsacupuncture, has emerged from them. It now

appears that the medicine of the Western worldis beginning to take firm root, a fact to whichfresh testimony is borne by the holding of the firstannual conference of the National Medical Associa-tion of China, of which we publish a report inanother column. The report is belated, but thepostal facilities of the world have been muchcurtailed of late, and the internal condition ofChina very disturbed. The free interchange of

thought and opinion has largely homogenisedthought and practice in this country during thelast half century, and international conferenceshad begun to do the same for Europe before thewar broke out; for it had already become possiblefor a student with a smattering of a foreigntongue to spend with advantage one or more

semesters at a university other than his ownwithout finding the medical and surgical practicetoo foreign for him to assimilate. The foundationsof similar things are now being laid in China, and,if recent experience does not mislead, the super-structure is likely to rise rapidly. Dr. Yen, in his

presidential address to the association, spoke of someof the public health problems to be faced in China,which are seen to be the same wherever the cultureof the occident has penetrated. The consumptionof alcohol and of patent medicines seems fated atfirst to rise as the level of civilisation, in ourmodern conception of the word, rises. It is dis.creditable to Western pioneers that this should beso, and we trust that China may find a short wayof dealing with the evils. Allusion was made at theconference to many familiar Western problems : itwas stated, for instance, that an attempt to trainthe old-fashioned nurse to become a clean andefficient midwife had failed in China. The in-stitution of a State Medical Service to meet thenecessities of public and private practice was pro-posed, and it is possible that in a country with noold conceptions of medical practice, and no vestedinterests, as we understand them, the drasticprinciples of such a service might be adopted withgreater ease than they can be in this country.

METROPOLITAN HOSPITAL SUNDAY FUND.

THAT in spite of the heavy demands made on thepurses of the charitable in connexion with thewar, and in spite of the vast increase in the cost ofliving, the sum collected by the Metropolitan Hos-pital Sunday Fund should have fallen short by onlyf:2600 of last year’s total is a great satisfaction tothe supporters of this valuable charity. The actualsum collected for the current year up to the meetingof the Council on Tuesday last was JE68,000, of which66,430 will be distributed among 248 hospitals,convalescent homes, dispensaries, and nursing in-stitutions, 7 per cent. of the total being applied tothe purchase of surgical appliances. On the motionof Lord Knutsford, the General Purposes Committeewere empowered to consider the advisability ofhaving a fixed date for Hospital Sunday during thewinter months, on the ground that a better responseto the appeal would result at that season of theyear.

____

THE BOARD OF SCIENTIFIC SOCIETIES.

ON the initiative of the Royal Society a Board ofScientific Societies has been established forthe furtherance of the following objects: Pro-

moting the cooperation of those interested in pureor applied science; supplying a means by whichthe scientific opinion of the country may, on

matters relating to science, industry, and education,find effective expression; taking such action as

may be necessary to promote the application ofscience to our industries and to the service of thenation; and discussing scientific questions inwhich international cooperation seems advis-able. The Board at present consists of repre-sentatives of 27 scientific, including technical,societies. The regulations give power to addto this number and to appoint as members ofsubcommittees individuals who are not necessarilyconnected with any of the constituent societies.An executive committee has been appointed con-sisting of the following members : Sir JosephThomson, O.M., P.R.S. (chairman), Dr. Dugald Clerk,F.R.S., Sir Robert Hadfield, F.R.S., Mr. A. D. Hall,F.R.S., Professor Herbert Jackson (honorary secre-tary), Sir Alfred Keogh, K.C.B., Sir Ray Lankester,K.C.B., F.R.S., Professor A. Schuster, Sec.R.S., SirJohn Snell, Professor E. H. Starling, F.R.S., LordSydenham, F.R.S., and Mr. R. Threlfall, F.R.S.

333DR. F. G. CLEMOW: SANITARY DEFENOES OF MESOPOTAMIA.

THE

SHIAH PILGRIMAGE AND THE SANITARYDEFENCES OF MESOPOTAMIA ANDTHE TURCO-PERSIAN FRONTIER.

BY F. G. CLEMOW, M.D. EDIN., C.M.G.,BRITISH DELEGATE TO THE INTERNATIONAL BOARD OF HEALTH AND

PHYSICIAN TO H.M. EMBASSY, CONSTANTINOPLE.

IIL1-THE SANITARY DEFENCES ON THE TURCO-PERSIANFRONTIER.

THE total length of the Turco-Persian frontier, from theneighbourhood of Mount Ararat on the north to the Persian’Gulf on the south, is approximately 800 miles. The greater partof this line- all, indeed, except a short portion at the southernextremity-passes through highly mountainous country, in-habited by nomadic or semi-nomadic Kurdish and Arab tribes.The mountains rise in many places to 10, 000 or 12,000 feet, andare only crossed, at long intervals, by certain more or less well-defined routes of communication between the two countries.In the report of the Commission of Inspection a careful studywas made of the principal of these routes, of the varioustribes living on or near to the frontier line, of their seasonalmigrations, and of the through movement of passengers andpilgrims from one country to the other. Unfortunately, themanuscript of this chapter of the report was not saved withthe other papers, and is still in Constantinople, and it- cannot be fully reconstructed here. The following state-ments may, however, be made.

Firstly, as regards the northern third of the frontier, fromArarat southwards to Shemdinan, the sanitary defenceswere dealt with by the earlier Commission, that of July,1911, already mentioned in the first of these articles. That’Commission found that the sole lazaret in this region, thatof Kizil-Dize near to Bayazid, was in a deplorable condition,and recommended the construction of a proper sanitarystation there and of four secondary stations elsewhere.

In the southern two-thirds of the frontier, apart from themany minor routes of communication already referred to,there is but one great line of through traffic-that whichpasses from Kermanshah in Persia, through Kasr-i-Shirin toKhanikin, on the Turkish side of the frontier, and thence,- through Kizil Robat, Shahraban, and Bakuba, to Bagdad.As compared with this line, all other routes are of minor

significance. Along many of them, no doubt, there is a con-siderable amount of movement of passengers and goods, butit is mainly of a local character, and the quantity of whatmay be called long-distance through traffic by these routes

- its apparently very small indeed. In this local movement areincluded the seasonal migrations of the Kurdish or othertribes already alluded to. Practically the entirety of the:Shiah pilgrim traffic, from Persia to the holy places ofMesopotamia, passes by the Khanikin route.Along this part of the frontier the only existing sanitary

defence consists of a lazaret at Khanikin and of health officesat Rayet, Suleimanieh, and Mendeli ; an office formerlyexisting at Revanduz was done away with a few years ago.The personnel of these offices consisted solely of sanitaryclerks, and sanitary guards mounted or on foot, whose mainduty it was to collect the sanitary tax of 10 piastres (about18. 8d.) on all persons, and of 50 piastres on all dead bodiesentering Turkey from Persia, and of endeavouring to prevent"contraband in dead bodies-a subject to be dealt withlater. Scanty as these sanitary defences may seem forfor such an immense length of frontier, the Commission didnot propose to create any new lazarets or sanitary stations,save at Mendeli, near the southern end of the line, wherethere is a considerable through movement of both personsand dead bodies, and where it was proposed to create a smallobservation and disinfection station.

It was not recommended to establish new stations at otherpoints, as it was held that, on the one hand, the danger topublic health offered by the small amount of through trafficalong the various minor routes was not very great, and that,on the other, any attempt to subject to proper sanitarycontrol the unruly tribes in their seasonal migrations wasforedoomed to failure, while the practical obstacles in the i

1 Parts I. and II. were published in THE LANCET of August 12th,p. 289. 2 A Turkish piastre is of the value of 2d.

way of establishing sanitary stations in these remote andmountainous districts would have been exceedingly difficultto overcome.

Many of the names mentioned above have recently becomefamiliar to the general public, and will become still more soas the war progresses. The arrival of Russian forces atRevanduz was announced some time ago ; the Russo-Turkishbattle line has recently swayed between Kermanshah andKhanikin ; and we all hope to see the Russian army descendfrom Khanikin to Bagdad by the route already mentioned.That route is, and has been in the past, one of the principallines of military invasion, and in like manner it has beenthe most frequent route by which epidemic disease haspassed from Persia to Turkey, or from Turkey to Persia.The Khanikin lazaret has been Turkey’s sole defence againstthe former danger ; Persia, on the other hand, has had nolazaret upon her side of the frontier, though of recent yearsshe has projected the construction of one at or near toKasr-i-Shirin. Disease has as frequently passed in one

direction as in the other, as will be seen from the followingbrief summary of the history of cholera and plague in thefrontier region.

The Irontier as a Channel qf Importation of Disease.In the first great pandemic of cholera, that of 1819-22, the

disease was imported to the Tigris valley, and in the autumnof 1821 passed into Persia, as the result of a war betweenTurkey and Persia. In 1851 cholera was imported fromBagdad to Suleimanieh and Revanduz on the frontier, and inthe following year was epidemic on both sides of the frontierline. In 1856 the disease was epidemic in Persia ; fromKermanshah it spread to Khanikin, where, as also on theroad between Khanikin and Bagdad, the pilgrims sufferedterribly, and later they carried the infection to Bagdad,Kerbela, and the Euphrates valley. Cholera followed asimilar route in 1860. In 1861 it was imported from Persiato Mendeli and Bakuba, and thence to Bagdad, Kerbela, andNejef. In 1865 it appears to have crossed the frontier fromTurkey into Persia, near Suleimanieh. In 1867-69 thedisease was epidemic in Persia, and is said to have crossedthe frontier into Turkey from Kermanshah. In 1893 choleraappeared in Mendeli and in Khanikin, and as it was alreadyepidemic in Persia it was probably imported from there. In1904 the epidemic, whose course from Syria to Meso-

potamia in 1903 was traced in the preceding article, wasapparently introduced into Persia from Turkey and causedan excessively severe and fatal epidemic there. In sub-

sequent years cholera was frequently epidemic in Russia andoccasionally spread thence into Persia and Turkey in Asia ;and in 1910 it once more passed down from Kermanshah,through Khanikin, to Bagdad.During the latter half of last century plague was, as stated

in the preceding article, endemic and sometimes epidemic,at places in the Euphrates valley and on both sides of theTurco-Persian frontier. On the Turkish side the principaloutbreaks occurred in the Hindieh marshes, along the lowerEuphrates, about Djaara and Shenafieh, in Nejef, in Bagdad,at Bedra, Zorbatia and Mendeli near the southern end of thefrontier, and among the Muntefik tribes. On the Persianside there were outbreaks of the disease at Maku, near LakeUrumiah, in and near Hamadan, at Saouj-Boulak, Jivanrao,Merivan, Uzundere, Mahideshte, and other places along thefrontier line. The important fact to notice, however, isthat, while the infection was occasionally carried from oneside of the frontier to the other, the result was alwaysconfined to a localised epidemic, and the disease has shownno tendency to spread from the centres named to other partsof the world. .

The Khanikin Lazaret.

The utility and necessity of this institution will readily berealised from what was said above as to the overwhelmingimportance of the Khanikin-Bagdad route, as compared withall others that cross the frontier. This necessity will becomestill greater in future if the various schemes put forward forrailway development in Turkey and Persia are realised. Ofthese the most important in the present connexion will bethe proposed extension of the Bagdad Railway to Khanikinand Kermanshah. This will start from the main line not at

Bagdad, but at Sumeikha, 60 kilometres north of Bagdad.It will cross the Tigris and ultimately join the usual caravanroute at Kizil Robat, whence it will pass to Khanikin andKermanshah. Meissner Pasha, the chief engineer of the