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sleep was obtained (six in one case, four in the other). Yetin both the patients awoke in wild delirium. On the other

hand, since it has been the rule (a period of one and a halfyears) to taper ofF the alcohol in patients who had establishedtolerance, there has been no case of delirium, nor any whichsuggested a fear of that complication. Moreover, whentapering is carried out bromides and hypnotics are rarelycalled for.The widely diverging views which obtain as to the

expediency of sudden withdrawal are, I believe, recon-

cilable if we keep clearly in mind the full significance oftolerance. Tolerance of alcohol (i.e., acquired tolerance)implies intolerance of sudden withdrawal. It is not acquiredthrough heavy intermittent drinking bouts, however frequent,but only through frequent regular drinking which stopsshort, often far short, of the intoxication point. Those whoso drink inflict on themselves gross organic tissue changes,but they are not, as a rule, an intolerable nuisance to theirfriends or the general public. Hence I do not believe that

many such find their way into licensed retreats any morethan they do into the police court.

I am, Sir, yours faithfully,FRANCIS HARE.

CROOKED QUESTIONS AND URBANEANSWERS.

To the .Editor of THE LANCET.

SIR,—The amiable reproof which Puncla has adminis-tered to you in a recent issue for the promulgation ofalarmist views is put into the mouth of a " Paterfamilias

"

who is understood to ask certain plain, blunt ques-tions." To some of these, notwithstanding a know-

ledge of the pitfalls which a cross-examiner is able to

prepare for a witness, it should not be difficult to

reply, and to show, contrary perhaps to expectation,that the interrogator is right to be anxious on thedifferent points. It is asked, in the first place, whethercocoa causes cancer? If cocoa does not agree with"Paterfamilias," and he is of the age when cancer is mostprevalent, he had better avoid it. A person who dislikescocoa may say with perfect safety that it causes cancer, forno one can contradict him, and in all probability hewill find acquaintances to furnish him with " facts "

in corroboration of this view. The next questionput is whether tobacco ’’ is all that it has not yet"been declared to be?" and I pause before its exhaustivecharacter. Most of the tobacco that has been analysed hasbeen pure; but some of it has been associated with verystrange bedfellows, and one hesitates to put any limit to theingenuity of adulterators. Then it is asked whether woolis the worst thing to wear next the skin; and the answerdepends mainly upon climatic and other conditions. Undersome of these conditions either silk or cotton is to be pre-ferred ; when wool, in other conditions the best, may be theworst of the materials commonly employed for under-

clothing. The next question is, "Does ozone cause

pulmonary disease ? " Yes, certainly, if inhaled in too

great a degree of concentration ; although, as usuallypresent in the atmosphere, it is as harmless as thealcohol in hot-cross buns. An inquiry whether bread-and-milk is explosive arrests one for want of definitions.Bread may be or may contain anything if the legal penaltiesare disregarded; and milk has more than once been re-

sponsible for explosions of epidemic disease. It is askednext whether the daily newspaper is a source of contagiousand infectious disease, and whether we ought only to readit in gloves and a respirator ? No doubt the newspaper fallswithin the general class of fomites to which the physiciansof the last century paid so much attention ; and a cleanlyperson who entered a public library in a slum district mightbe thankful for gloves, even if he dispensed with therespirator. Then it is asked whether it is as beneficial toburn coal as to swallow it, and the answer depends entirelyupon circumstances. The internal administration of carbon toa dyspeptic may be greatly more to his advantage than thepresence of a fire in his grate. The last inquiry is whethera vegetarian diet fosters a military spirit ? To some extentthis question was examined by the late Dr. W. B.’Carpenter many years ago, when vegetarianism was a

comparatively new idea and when its supporters claimed for

themselves a special endowment of the virtues arising froma complete control of all animal passions. He showed thatthe extremes of ferocity and gallantry were to be foundamong vegetable feeders ; and he instanced the rhinocerosand the cock as familiar examples of the facts. It may be

suggested that, though the comic opera notion of the soldieris that he is of a fierce and amatory disposition, the amenityto discipline is the true display of the " military spirit." Ofthis endowment there is no particular evidence among theranks of vegetarianism more than among those of any otherclass.

I think that the questions put by " Paterfamilias " in thecolumns of Punch are more reasonable than many which areset by examiners for professional degrees and diplomas.

I am, Sir, yours faithfully,

THE DRAINAGE OF CAIRO.

(FROM OUR SPECIAL SANITARY COMMISSIONER.)

WHOLESALE CONTAMINATION OF THE SUBSOIL.-APPRE-HENSIONS IN REGARD TO THE DRAINAGE SCHEME.-UNFAVOURABLE SITUATION OF THE EUROPEAN QUARTER.-THE NEED OF BUILDING REGULATIONS.

Cairo.

NEXT to the question of the water-supply comes that ofthe drainage of Cairo. As already explained, the water-supply problem stands foremost because it is a question ofthe present. Everybody recognises the position ; it is

impossible not to see that the water is sometimes full of darkcoloured matter, that it stains the linen, is hard, spoilsboilers and engines, in fact, that it is unsuitable fordomestic and industrial purposes. The urgency of the waterquestion is therefore obvious to all. The drainage question,however, is little less urgent.For a quarter of a century there has been talk at Cairo of

drainage schemes and nothing has resulted ; therefore, it isa little difficult to realise that now at last sewers are

actually going to be constructed. As the result of thesenumerous disappointments a widespread lack of faith still

prevails. It must also be borne in mind that the vast

majority of the inhabitants of Cairo have no experiencewhatsoever of drainage schemes and do not know what theymean. They have never been taught the benefits that resultfrom well-conceived and properly applied systems of drainage.They do not realise that such measures have been the meansof saving millions of human lives and of prolonging thelives of other millions. But they do know that when thesubsoil of Cairo is disturbed, when excavations were madefor the foundations of the new premises of, for instance, theNational Bank, and for other large buildings, there werecases of typhoid fever in the immediate neighbourhood.Thus it happens that to-day when it is proposed to laysewers in all the streets this prospect has created somethingapproaching a panic. The sense of the proportion of

things is entirely lost and many persons inquire whether thedigging of trenches for the sewers will create an epidemic.Of course, it is quite possible that, in spite of the somewhatelaborate precautions it is proposed to take, some cases ofsickness may result from the moving of foul earth. With

regard, however, to an epidemic the question presents itselfthe other way round. It is not a matter of creating anepidemic but, on the contrary, of getting rid of the

epidemics that already exist, which are so firmly estab-lished that the conditions may more accurately be calledendemic. The present death-rate at Cairo is scandalous.If the statistics of some typical European town thathas a proper drainage system and water-supply be takenas an example, it will be found that even when, duringthe course of the year, there has been an epidemic,still the mortality of such a town will be much below thenormal death-rate of Cairo. When the streets are dug up tolay the sewers in Cairo there may be a good many cases ofdisease provoked by unwholesome effluvia. It is, however,quite certain that many cases of disease connected with in-sanitation exist already and will continue to exist in the futurewhether the new trenches are dug or not. According to thelast official returns published during the year 1907 therewere 342 deaths from diphtheria and 141 from typhoid fever,

1THE LANCET, April 3rd, 1909, p. 1014.

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therefore it was not necessary to open up the streets to

produce these diseases. The general death-rate among theEgyptians in 1907 was 38 ’ 4 and 27’ 4 among the foreigners.It is not till the drainage system is completed and a well-considered general programme of sanitary reform strictlyapplied that this devastating death-rate will be largelyreduced and a real improvement obtained.The question in the public mind is whether, when the

trenches have been dug and the sewers laid, there will be areduction in the prevalence of preventable diseases. Thescientific man can make only one answer. In the light ofpast experience, and going back to the time when it was notknown how to build sewers properly, and when all sorts ofblunders were committed, actually creating epidemics andresulting in the loss of many lives, the advantages of sewerageschemes are known to have far out-balanced the disadvantages;the sacrifice of life has been literally nothing in comparisonto the salvation of life. It is impossible to have an omelettewithout breaking eggs, and Cairo cannot be purified withoutstirring up some filth. But it is better to stir up this filthand to remove it than to allow it, as at present, to continueto accumulate in volume and in foulness. As it is, Cairohas been described as a town floating on cesspools, and itwas perhaps inevitable that it should continue to wallow infilth while the country remained in financial difficulties.Now, however, that Egyptian finances have been put inorder we are promised that some money at least will beforthcoming to save the lives of the inhabitants. It isthe duty of all sanitarians to see that the promises are

carried out.One of the leading sanitary reformers of France, the late

Professor Brouardel, speaking of Toulon, described this

great military port as a town built on un sol fécalien. Thisdefinition can as appropriately be affixed to Cairo. Inthe first instance the natives had perhaps a better

sanitary instinct. The custom that still prevails inrural districts is for the males to relieve themselveson the manure heap which is generally near the entranceof their dwellings ; the females, desiring greaterprivacy, utilise for this.purpose the roofs of their houses.In both cases nature’s disinfectants, the air and the light,play upon and purify more or less that which is impure.But, and though this primitive procedure still prevails tosome extent even in Cairo, its continuance has not beenfound practicable at least in the narrow and crowded streets.Consequently, cesspits were dug, but as it costs money andtrouble to empty them they are deliberately made as porousas possible and the whole percolates into the surroundingsubsoil. Thus the ground on which Cairo stands is im-

pregnated throughout with fascal matter and urine, togetherwith all other sorts of foul slop water and organicsubstances in a state of decomposition. The purifyingaction of the earth is obviously overtaxed in such a denselypopulated centre as Cairo. The emanations from so foul asubsoil are well calculated to predispose the inhabitants toepidemic and other diseases. In the meanwhile, and till thedrainage works are carried out, the only advice that can begiven to persons who live in Cairo is that they should sleepin the top of their houses-that is to say, as far as possiblefrom a soil which must be largely polluted.Some owners of private houses and of large hotels have

sought to cope with this evil by building various forms ofcesspools based more or less on the septic tank principle.The manager of one fashionable hotel explained withjustifiable self-congratulation how his cesspool acted so

well that the effluent was quite clear, and such enterpriseand public spirit deserve warm commendation. If everyonedid the same the soil would not be so foul, for such aclarified overflow can be dealt with by the subsoil as thecrude sewage cannot be. Besides, if a few houses andhotels do deal satisfactorily with their sewage, sewagefrom the rest of the town passes through the Europeanquarter as it follows the natural flow of the subsoil waterfrom the more elevated, more crowded, and filthy nativequarters finally to reach the Nile. The natives with atrue hygienic instinct have always avoided living on thebanks of the Nile. They fear the floods, for if the waterof the rising Nile does not actually penetrate into theirhouses it certainly comes up in the subsoil to within a fewfeet of the surface. Thus there is more damp, more miasma,and insecurity in regard to the solidity of buildings. Formerlywhat is now the European quarter consisted of spacious,

umbrageous gardens, with but few low-roofed dwellings’To-day, and without any sort of regulation or restraint,speculators are constructing huge, lofty tenement houses

dominating streets which are not wide enough in pro.portion to the height of the buildings. Thus they shut outthe purifying light and air from above, while the atmospherewithin these hot and lofty dwellings reeks of the effluvia fromthe soil below. It seems to all who consider the matter thatby-laws regulating building operations should now be insistedupon.Here is an experience. In a narrow yard between two big

blocks of buildings I was shown the flagstones in whichwere the openings of vast cesspools into which both theseblocks drained. At times the cesspools overflowed into theyard and the stains on the walls showed how high this con-centrated sewage might reach. The inhabitants had the

cesspools emptied, but this was of no use. In a few daysthey were full again, not with soil from the adjoining blocksbut with infiltrations from the surrounding land, and whenthe Nile rises the cesspools overflow into the yard. The riseand fall of the Nile in the subsoil is one of the principalfactors governing the whole problem. A medical practitionerrelated to me that he had built himself a house and thoughthe would dig for water. He went down some 20 feet beforehe could find any water. A little later, however, the Nilebegan to rise, and then the water in his well came up towithin five feet of the surface. It is claimed that this annualinflow and outflow of the Nile in the subsoil of the lowerparts of Cairo is a great benefit, for it washes away the dirt.But, on the other hand, if it does carry away some of thefoulness it also helps to spread it about broadcast.The flood penetrates the cesspools and carries their contentsinto the surrounding subsoil. A small portion may reachthe Nile, but the greater part of the contents of the cesspoolsis likely to be deposited in the earth, polluting the subsoilto such an extent that the inhabitants of Cairo are afraidto dig it up. Thus are engendered those apprehensionsin regard to the drainage scheme which I have alreadymentioned.To allay such fears an official statement has been issued by

the sanitary authority and circulated in the press. We arethus informed that the trenches in the wider streets will inno case exceed the depth of five metres and in the narrowerstreets three metres. As these trenches are shallowthey can be made very narrow, therefore the amountof earth to be disturbed and dug up will be reducedto a minimum. The authorities claim that there will not bemore excavation than what actually takes place when newhotels and large houses are built. Further, to reduce therisk and to push forward the work more rapidly, there willbe overhead cableways to conduct the material as soon asit is excavated to the trenches which are ready to be filledup. Any surplus matter that cannot be thus and at oncedealt with will be covered with a disinfectant and carriedaway. What perhaps is more important, so far as thevisitors are concerned, is the fact that none of this workwill be done during the tourist season, for that season corre-sponds with the high Nile, when the water in the subsoilwould interfere with such excavations.The first object of course will be to prevent the further

contamination of the subsoil by providing water-tightdrains, and we may be sure that the work will through-out be as good as trouble and experience can make it. IfCairo has suffered long it at least enjoys to-day theadvantage that during all this time other towns havemade great experiments, have spent large sums, and havethus accumulated evidence affording many valuable objectlessons for more backward localities. These indications asto what to do and what to avoid, now that the capital ofEgypt is entering upon a career of sanitary reform, shouldprove of great practical service to its administrators andgovernors. From what I have seen of the drainage schemeit seems clear that considerable attention has been bestowedupon all schemes elsewhere existent. Many of these haveb3en rejected as antiquated or as unsuitable, and much thatis altogether novel is, I understand, to be introduced. Thusthe plan before us is doubly interesting: first, because it

proposes to render Cairo a healthy city though at present itis exceptionally unhealthy ; and, secondly, because this is tobe done by the application of the most modem procedures.

(To be continued.)