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(2) infection, and (3) degeneration-diet seems to have theleast to do with the decay of the teeth. Has anyone everseen satisfactory results from wholemeal bread, "jaw drill,"vegetable diet, or the score of other diet treatments ?Dentists seldom look beyond their patients’ teeth, so theirtheory that decay is due to neglect of the teeth is not worthmuch. Moreover, decay still goes on when the dentist hascomplete control.

I think it not unlikely that the improvement in dentistryhas something to do with the increase of dental decay.When loss of teeth meant loss of health -and life naturalselection kept the teeth strong. Even a generation or twoago a woman with defective teeth had less chance of ’,marriage, and so sexual selection also tended ta preserve a Idisease-resisting type. But now the dentist has altered allthis, and a complete set of false teeth is no detriment to ayoung woman ; American women are even said to pridethemselves on their gold stopping. I think you find theworst cases of infant dental caries in the offspring of motherswith decaying teeth, suggesting that decay may be due todirect infection. Infection acting upon degenerate teethseems to me the only feasible theory, but the question canonly be answered by the careful collection of facts.

I am, Sir, yours faithfully,Silverton, Devon, Oct. 19th, 1908. 0. CLAYTON JONES.O. CLAYTON JONES.

CARDIAC MOTION AS REVEALED BY THEVIVISECTION OF DISEASE.

To the Editor of THE LANCET.

SIR,-In the report of the proceedings of the lEsculapianSociety which appeared in THE LANCET of Oct. 17th, theenergetic secretary of the society whose succinct and accuratereports you regularly publish, slightly misunderstood twopoints in this instance, which, with your permission, I shallcorrect without delay, as the matters in question may be dis-cussed again. In the first place, the sarcomatous invasion ofthe right auricle and ventricle very greatly restricted thecontractility of those chambers, but as there was some

uninvolved muscular tissue in both there may have been a

very limited movement of both. In the next place thepatient I showed was the case of thoracostomy for cardiacpain, an account of which you published in THE LANCET ofJuly 4 th, 1908, and while it was the first case operated uponfor this cause it was not by any means the first case of

thoracostomy for heart disease.I am, Sir, yours faithfully,

ALEXANDER MORISON, M.D. Edin.Upper Berkeley-street, Portman-square, W., Oct. 19th, 1908.

ALEXANDER MORISON, M.D. Edin.

A POINT UNDER THE WORKMEN’S COM-PENSATION ACT, 1906.

To the Editor of THE LANCET.

SiR,-The Workmen’s Compensation Act (1906) has laid avery serious trap into which our patients may unwittinglyfall. A patient of mine, a chronic invalid, quite helpless,sent for a male attendant from an institution to act as stop-gap during the illness of a permanent attendant. When thesubstitute had been in the house three days he rupturedsome fibres of his diaphragm and has been invalided forover six months. The institution has no insurance for itsmen and the patient’s insurance does not cover such a claim.Heavy claims are being made against my patient and he willprobably have to disprove his liability in court, as the Actis so indefinite and so badly drafted as regards this point.It behoves medical men in the interests of their patients toascertain what nursing " institutions " are insured and torecommend those only, and it would be to every one’sinterest that such concerns should announce in their adver-tisements the fact that they do insure their nurses.

I am, Sir, yours faithfully,Oct. 16th. 1908. CAUTIOUS.

THE WATER-SUPPLY OF ST. JUST (CORNWALL).-The St. Just Urban District Council, by its neglect toprovide the town with an adequate water-supply, has ex-

hausted the patience of the Cornwall County Council, whichhas complained to the Local Government Board and askedfor an inquiry.

THE SANITARY DEFENCE OF THEHEDJAZ RAILWAY.

(BY THE BRITISH DELEGATE ON THE CONSTANTINOPLEBOARD OF HEALTH.)

(Illustrated with Reproductions of Photographs taken bythe Author.)

III.-MEDAINI-SALIH.ABOUT two hours after leaving Tebuk our train passed

through another rocky valley, known as the Zahr-el-Akhdar,and shortly after reached the " station" of Akhdar. There isno village here, nothing but the fortress-like station building.About two kilometres further on we stopped again, at thejunction of two valleys ; there is here a large reservoir withpump, and in the valley to the right (west) is the ancientkala’at of Akhdar. Here, also, there is no village, thoughclose to the fort were a few black tents of some wanderingBedouins. Akhdar had been mentioned as a possible site forthe future lazaret. There is a fairly large flat surface here,surrounded on all sides by hills. But the site would be in

many ways inferior to that at Tebuk. We did not measureit, but it is certain that it would barely suffice (if, indeed, itdid suffice) to contain all the cordons and buildings that it isproposed to put up in the first instance, and would not allowof expansion in the future, should such prove necessary.Moreover, being shut in by hills, there would be a lack offree circulation of air and the heat would be great.

Here, as in many other parts of the line, there is quite aconsiderable amount of desert herbage to break the monotonyof unending sand and stones. In the Akhdar neighbour-hood the colocynth plant is found in large quantities,creeping like a low-growing vine along the ground, and

shedding its mottled gourds in all directions. Here also arefound any number of annuloid fossils, to which the Bedouinsgive the unsavoury name of "Job’s worms"; believing, itwould seem, that it was in this desert that Job was finallycleansed and purged of his bodily ills. The water at Akhdaris said to be abundant and it proved to be of better qualitythan any other examined by the Commission. The specimenanalysed was taken from the well in the kala’at and gave thefollowing results. The water was colourless and clear andwithout smell ; it contained 2.6 parts of chlorine as

chlorides ; 0’148 total nitrogen, of which 0-139 occurred asnitrates, 0’003 as free ammonia, and 0’006 as organicnitrogen ; the oxygen consumed in the permanganate processin three hours at 270 C. was 0 0955 ; the total hardness was14-21, and the permanent hardness after boiling 5’29. Thetotal solids were 37. As before, all these figures represent-

parts per lUU,UUU.After a brief stay at Akhdar the Commission went on to

Medaini-Salih, a night’s journey further down the line. The

approach to Medaini-Salih is through a remarkable bit ofscenery. The line winds down through a gorge in the sand-stone mountains, known to the Arabs as the Mubrakat-el-Naka, or the valley of the "Camel-calf." The mountainsin this portion of Arabia-not merely in the gorge-havebeen split up into the most fantastic forms: pinnacles,towers, and shapelessly monstrous objects of everykind rise abruptly from the sand, and it is reallysmall wonder that the pilgrims have peopled this weirdpassage with evil spirits, whom they try to frighten away byloud cries as they pass through the gorge on their way toMedina. At the end of the gorge, but still surrounded bygroups of the weird rocks, is the place known as Medaini-Salih-the "Cities of the Prophet Salih." The station is atthe 955th kilometre from Damascus, and 347 north ofMedina. It lies 820 metres above sea-level. There is no

village of any kind here, and the only traces of the ancient" cities" are those wonderful Nabatæan monuments andinscriptions which must for ever be associated with the namesof Doughty and Renan. The old kala’at in which Mr.

Doughty spent so many weary weeks still stands, with itseservoir by the side ; but close by the railway has built itshigh water-tower and other of the station buildings almostsurround the fort. The number and extent of these buildingsshow that this place is an important administrative centre on;he line. They occupy the middle of a large, sandy plainlotted with tnssocks oF desert herbage, here more abundant

Nos. I. and II. were published in THE LANCET of Sept. 26th, p. 971,and Oct. 10th, 1908, p. 1104, respectively.

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than further north, and with several acacia and terebinthtrees. The groups of fantastic rocks with the Nabatscantombs lie mostly to the south-east. To the distant westrises the gigantic table-rock of the Howweira ; the sides areprecipitous, apparently of red sandstone, and the top wouldappear to be covered with black lava, much of which hasflowed over and formed blackish heaps at the foot. Stillfarther to the west is the craggy range of the Harra. Thespectacle at Medaini-Salih is consequently a remarkable one. ’,The heat here was considerable, the thermometer rising inthe day to over 106° F. ; but the air was extremely dry anda strong wind blew the whole time, rendering this hightemperature more or less supportable.

FIG. 8.

In the Mubrakat-el Naka gorge.

The improvised quarantine camp for pilgrims returningfrom the Hedjaz was put up at Medaini-Salih in each of thelast two pilgrim seasons and traces of it can still be seen. It

occupied a site to the east of the line and south of thekala’at. A ridge of sand (seen in the accompanying photo-graph, Fig. 9) along which the water-piping was laid stillremains, running north and south, and dividing the area intotwo unequal parts. A series of ten primitive cordons was, itis said, established on either side of this ridge ; those to thewest were small and limited by the ridge and the railway ;those to the east had unlimited space in an easterly direc-tion. The only barrier round them was a cord stretchedbetween posts, so that practically no true isolation of thedifferent groups of pilgrims was possible. The indigent,"non-paying pilgrims were camped at the south end of the area,close to one of two so-called Nabataaan wells to be mentionedlater. The camel-drivers (akkiams) were similarly groupedround the other of these wells. The latrine arrangements inall these cordons were of the most primitive character, con-sisting of mere holes in the ground. The "hospital" wasestablished in tents on the other (western) side of the line.The area just described is the best that can be found in thisneighbourhood. It has, however, several disadvantages.After heavy rains it is in large part inundated, as, indeed,is the greater portion of the Medaini-Salih valley. Thishappened on more than one occasion last winter ; the waterstood, it is said, to the depth of half a metre and didnot soak away for a couple of days. The caked, muddysurface of the desert still showed in many places wherethese inundatiors had occurred. The railway authoritieshave found this a serious difficulty for their buildings, and inorder to cope with it are constructing all their new buildingsat Medaini-Salih on artiticially raised foundations, nearly ametre (in some cases more) above the general level of theplain. This involves, of course, a very considerable additionto the cost of construction, and in the event of houses havingto be put up to quarantine 10,000 pilgrims the added outlaywould be enormous. The site in question is also bounded onthe south by the rocks above mentioned ; these shut off the

air and radiate a reflected heat from the sun which makes ofthis site one of the hottest we inspected. To the west of theline there is no suitable site, as the plain here, besides beingvery "accidentée," is also subject to inundation.

There is apparently an abundant supply of water atMedaini-Salih. The railway engineers believe that it occursas a generalised underground layer of water through thewhole valley, as wherever a well is sunk water is found ; nomovement has been observed in it, but as the land tends tofatll slightly from north-west to south-east it is thought thatthe water, if it has any movement at all, may flow slowly inthis direction. The soil is a soft sandstone (Nubian 1) undera surface of alluvium ; its permeability varies in differentplaces and consequently the yield of different wells varies.The large station well close to the ka1a’at has theusual stone tower, with two large reservoirs, pump, andwindmill close by it. It yields up to 125 tons of water in the24 hours. A second well was being sunk at the time of ourvisit, just to the right (west) of the line, but it was not com-pleted. Here the surface of the water was at 8 metresbelow that of the desert : there was only one metre of water,but it was intended to go to a depth of 3 metres. Thereservoir by the kala’at contained stagnant water of a notvery inviting appearance. Specimens of all three waterswere analysed and gave the following results expressedin parts per 100,000. The well water (from the wellwith water-tower) was clear and had no smell; itcontained 21 2 parts of chlorine as chlorides ; the nitrogenwas not estimated ; the oxygen consumed in the

permanganate process during three hours at 270C. was

0-1983 the total hardness was 22-86 and the permanent19’13. The total solids were not estimated. The other

(unfinished) well water gave the following : colour slightlyyellow; no smell; chlorines as chlorides, 17’5; totalnitrogen, 0 -2063, of which 0-0933 occurred as nitrates,0 004 as free ammonia, and 0 009 as organic nitrogen ; theoxygen consumed by the permanganate process during threehours at 270 C. was 0 - 2063 the total hardness was 25.12and the permanent 13 - 31 the total solids were 76.7.

Finally, the water from the reservoir (burket) by the fortgave the following analysis : the colour was yellowish; there

Fic. 9.

Medaini-Salih : the site of last year’s quarantine camp for pilgrims.

was no smell; chlorine as chlorides, 29.7; total nitrogen,0-342, of which 0.329 occurred as nitrates, 0 - COI as freeammonia, and 0-012 as organic nitrogen; the oxypen consumedby the permanganate process during three hours at 2.7° C. was0-2524; the total hardness was 27 and the perii ancnt 22-52; ythe total solids were 154 6. Mention was made above of twoso-called Nabatisan wells ; they are situated towards thesouth end of the area occupied last winter by the improvisedlazaret and not far from the rocks in which are themonuments. The more southerly one is about four metres in

1250

diameter and some 10 or 12 deep to the surface of water ; ithas rough masonry walls for the upper six feet, and thenseems to be sunk in solid rock. In the other the masonryextends the whole way down ; the bottom was of sand, witha little stagnant water in one corner. Not a few of thestones let into the walls bear inscriptions in the Nabatasancharacter, so that in all probability these wells, thoughvaguely ascribed to that race, date from a period a good dealmore modern. Three similar wells are said to exist at thefoot of the distant hills that bound the Medaini-Salih plain

FiG. 10.

A Nabatæan monument at Meda.ini-Sa.Iih.

on the east. Up to the present the staff and workmen on theline have drunk the water from the station wells and it has notseriously affected their health. It has, however, a distinctlybrackish taste, which is not surprising in view of the abovefigures, and we were told that later the railway authoritiesintend to import better water to Medaini-Salih either fromEl Oula (24 kilometres nearer Medina) or from Akhdar.The stone found at Medaini-Salih is a sandstone of a rather

friable character. It is not very suitable for permanentbuildings and the railway imports a building stone of a bettercharacter from El Oula. Several truck-loads of this stonearrived while we were there. A passably good stone is alsofound as close as five kilometres from the station. But boththese stones are said to be incomparably inferior to that foundat Tebuk. The friable character of the Medaini-Salih stoneis well seen in the neighbourhood of the Nabatæan monu-ments. Quite recently (last winter apparently) at the southend of the rocky hill known as the Kasr-el-Bint, whichcontains some of the best of these monuments, a large frag-ment of rock has fallen and been shattered to pieces at thefoot of the hill, blocking up the façades of more than one ofthe tombs.

It is impossible to leave this brief description of what isperhaps one of the most remarkable spots in Arabia withoutsome notice of these wonderful monuments of a forgottencivilisation, though their interest is archaeological ratherthan in any sense medical. They have been once and forall so admirably described and illustrated by Mr. Doughtyin the first volume of his "Arabia Deserta " (the originaledition) that there is little left for later travellers to add.But it is impossible to stand before these stately façades (or’’ frontispieces," as he called them) without being profoundlyimpressed by their dignity, their number and size, and their" unexpectedness " in these weird desert solitudes. Many ofthem are 60 or 70 feet in height; yet the inner tombchambers are curiously small in proportion to these greatfacades. There are many roughly hewn cells in eachchamber where it may be supposed the coffins were placed ;in nearly all are heaps of dead men’s bones, mixed withfragments of pottery, fallen stones, bits of wood that may

perhaps have formed parts of coffins, relics of a coarse clothin which the bodies were presumably wrapped, and lumpsof a resinous substance which may perhaps be some of thefrankincense in which the ancient Nabatæans trafficked, orin which their bodies were rudely embalmed. Nothing is moreremarkable than that no trace, save these tombs, remains ofwhat, to judge by their number, must have been an importantcity. At their capital of Petra, on the other hand, there are,in addition to sepulchral monuments, innumerable facades oftemples and public buildings of many kinds. But here atMedaini-Salih nothing is left but the tombs. And this isperhaps the more remarkable in that, with few exceptions,the Medaini-Salih façades are much better preserved thanthose at Petra, showing that the rock here, friable though itbe, is more durable than that in the latter city.The Commission did not go further than Medaini-Salih.

The rail head at that time was some way further on but itwas impossible to proceed to it. At Medaini-Salih an escortof 50 men was provided for the Commission and it is

probable that this precaution was far from being an emptyform. On the day of our arrival there a serious attack wasmade on the head of the line and in the fight which followedsome 40 Bedouins were said to have been killed. It wouldhave keen interesting to have gone on at least to El Oula, alarge village or townlet in an oasis, and the most importantcentre in this region. There is said to be an abundantsupply of water there and the water is reported of goodquality ; one spring alone is said to yield about 1000 tons aday. But the climate is said to be unhealthy and a form oforiental sore, akin to, or identical with, the Aleppo button,is so prevalent that practically every one suffers from itthere. Perhaps it is not quite the same as the Aleppo button,as it only lasts some 30 or 35 days. It leaves pigmentedscars; some people have two or more at the same time;they occur rarely on the face, more often on the exposedsurface of one of the limbs. It is said to be unknown atMedaini-Salih and certainly does not occur at Tebuk.

FIG. 11

An ancient well, probably Nabatæan, at Medaini-Salih.

As at other places along the line there are practically nometeorological records at Medaini-Salih. I have noted thatat 1 P. M. on June 9th the thermometer stood at 390 C.in the shade and that at 4.30 P.M. it had risen to 410 C.(105’ 8° F.). Meissner Pasha tells me that the extremelimits of temperature here are 450 C. (113° F.) in summerand - 70 C. (19.4° F.) in winter. Situated as Medaini-Salihis in a valley surrounded by rocky hills, the nights here arevery hot in summer. Sandstorms of great severity are

common ; they are said to occur about once a fortnight;while they last they produce almost intolerable conditions.Rain falls mostly in winter ; sometimes in heavy down-falls, producing the inundations referred to in an earlier

part of this article. (To be concluded.)