, M.3-* \ , Digitized by the Internet Archive in 2013 http://archive.org/details/furthercorrespon01grea COMMERCIAL. No. 39 (1883). "TT* FURTHER CORRESPONDENCE RESPECTING THE CHOLEKA EPIDEMIC IN EGYPT: 1883. [In continuation of " Commercial No. 34 (1883)."] Presented to both Houses of Parliament by Command of Her Majesty. 1883. LONDON: PRINTED BY HARRISON AND SONS. To be purchased, either directly or through any Bookseller, from any of the following Agents, viz., Messrs. Hansard, 13, Great Queen Street, W.C., and 32, Abingdon Street, Westminster ; Messrs. Etee and Spottiswoode, East Harding Street, Fleet Street, and Sale Office, House of Lords; Messrs. Adam and Charles Black, of Edinburgh; Messrs. Alexander Thom and Co., or Messrs. Hodges, Figgis, and Co.. of Dublin. [C.-3788.] Price 8%d. TABLE OP CONTENTS. No. ~?f Name. Date. Subject. Page 1 Consul Cookson . . Aug. 9, 1883 Letters from Dr. Ferrari on bad sanitary state of 2iUlâ^£<>Vl— rfSfcj_TllV>^-.', Damietta 1 2 "sïrE. 1 Malet 10, Report on progress of epidemic at Cairo. Mor- tality increasing . . . . . . 3 i£i ïï » • • • • 11, Report, and observations thereon, by Sir E. Wood, on cholera among the Egyptian troops 7 4 ïï s» • • • • 13, Letter from General Baker refuting accusations brought against him by Mansourah Committee . 11 5 ji >> • t . . 13, Mortality Returns up to date for Cairo 13 6 )> ?» • • • • 13, Report by Major MacDonald on his visit to Lower Egypt with Surgeon-General Hunter 15 7 Consul Cookson 13, Observations on the totals of the Mortality Re- turns 17 8 Sii-E Malet 15, Progress of the epidemic at Cairo 18 9 S3 )> o • • • 16, Is making inquiries as to tax on burial of cattle (Extract) having been illegally levied since its abolition . . 21 10 33 3» • • • • 17. Letter from Minister of the Interior respecting bad sanitary state of Damietta, reported in No. 1 21 11 33 V ■ • • • 17, The Khedive has visited the cholera camp 22 12 33 )) ■ • * • 17, Tables of mortality and of the population of places affected 22 13 33 S3 • • 18, Valuable services rendered by Colonel Chermside at Cairo . 25 14 3» 33 • • • • 20, Death rate is falling throughout Egypt except at Alexandria 26 15 Consul Cookson 16, Sanitary state of Damietta has improved since date of Report inclosed in No. 1 . . . . . 26 16 S3 5» •• •• 16, Difficulties encountered by the medical staff and the Extraordinary Sanitary Committees in carry- ing on their work at Alexandria. Settlement of difficulties. Regulations agreed to . . 27 17 ss 33 • • • • 20, Observations on the totals of the Mortality Re- turns 34 18 Sï 3» • * • • 20, Report by Dr. Mackie on the nature of the epi- demic. Petechial and typhoid cases 34 19 To Sir E.Malet .. 29, Approves action reported in No. 10 38 20 33 5» • • • • 29, Satisfaction at intelligence in No. 13 39 21 Sir E. Malet 29, Doctors and hospital assistants have arrived from (Telegraphic) India 39 22 5) )» • • • • 21, Tax on burial of dead cattle does not appear to have been levied since it was abolished 39 23 33 ss • • • • 23, Report on the progress of the epidemic at Cairo . . 39 24 3 3 1j • • • • [27, Tables of mortality at Cairo up to date . 43 25 S» 3» • • • » 27, Calls attention to inaccurate statement in the " Times " with regard to the cholera of 1865 . . 45 26 Acting Cousul Russell 27, Decrease of the epidemic in Lower Egypt 46 27 SS 3! » • 27, Report by Dr. Mackie on cases of endemic cholera, to be added to Report in No. 18 46 28 Sir E. Malet 28, Work done at Cairo by the Special Committee. Their Report 47 29 31 33 • • • • 29, Report on progress of the epidemic at Cairo 52 30 Acting Consul Burrell Sept. 1, Report on progress of the epidemic at Alexandria . 55 31 S> Î3 • • 1, Table of mortality for the whole of Egypt up to the 21st August . . . . . . 57 32 Sir E. Malet 5, Arrangements made respecting the doctors and hospital assistants from India 58 33 Sir E. Baring 13, Report by Surgeon-General Hunter on the reorgani- zation of the Egyptian medical service 60 p 3X *,***' I 1A ùf rf further Correspondence respecting the Cholera Epidemic in Egypt. ' No. 1. Consul Cookson to Earl Granville. — (Received August 21.) My Lord, Alexandria, August 9, 1883. I HAVE the honour to forward herewith a despatch from Mr. Miéville, inclosing copies of two letters from the Health Officer at Damietta with respect to the deplorable sanitary condition of that town. I have, &c. (Signed) CHAS. A. COOKSON. Inclosure 1 in No. ] . Consul Miéville to Consul Cookson. Sir, Alexandria, August 9, 1883. I HAVE the honour to inclose herewith copies of two letters addressed to the President of the Maritime and Quarantine Sanitary Board by the Health Officer at Damietta, reporting that the cholera has almost entirely disappeared there, but that nevertheless the sanitary condition of the town is still deplorable. Dr. Ferrari's letters are clear and speak for themselves ; I confine myself therefore to enumerating briefly the heads of complaint he mentions : — 1. Carcases have begun to reappear floating in the Nile. 2. The Governor of Damietta had, up to the 2nd August, taken no steps to execute the Sanitary Inspector's recommendations. 3. Water-melons (good and bad) are sold to the public in quantities. 4. The same points on the banks of the Nile at which water for drinking purposes is drawn are used for washing cholera patients' clothes and for bathing beasts of burden. 5. The sweepings from such of the streets as are swept are thrown into the Nile near the Governor's residence. 6. The soldiers on guard at the Arab cemetery allow persons to go in and pray over their dead friends, and this on receiving a gratuity varying from Id. to 3d. I have, &c. (Signed) W. F. MIÉVILLE, British Delegate. Inclosure 2 in No. 1. Dr. Ferrari to Hassan Pasha Mahmoud. Damiette, lé 2 Août, 1883. COMME votre Excellence aura pu le relever des dépêches que j'ai eu l'honneur de vous adresser journellement, le choléra tend à disparaître complètement. Le peu de cas que l'on constate encore sont presque tous sur des personnes qui arrivent des endroits infectés. Cependant si la maladie tend à s'éteindre tout à fait, cela n'est point dû. au maintien des quelques mesures hygiéniques qu'à bout de force nous avons rm obtenir. [1645] B 2 P45175 En effet, les charognes de bétail mort recommencent à paraître sur la surface du Nil, la preuve en est que deux dont la peau manquait furent trouvées hier accostées devant le lazaret et que j'ai été obligé de faire tirer hors du Bogaze par la barque de l'Office, n'ayant pu les faire enterrer par manque d'instruments nécessaires à cet effet. J'ai jugé inopportun de le faire connaître à ce Gouvernorat pour la raison bien simple que ce dernier n'a encore mis en exécution rien de ce que M. l'Inspecteur de l'Hygiène en cette ville, Dr. Nadim, lui avait écrit à ce propos, ni même daigné lui répondre et dire que le bateau à vapeur "Nil" destiné à ce service se trouve ici sans fonctions depuis le départ de Mr. Goodall. Au marché les pastèques bonnes et mauvaises sont en quantité livrées à la consom- mation publique. Je n'ai pas besoin de vous parler des rues de la ville que je visite minutieusement tous les jours et qui se trouvent actuellement toutes sales, peut-être et même plus que par le passé. Les points au bord du Nil qui servent aux sakas pour puiser l'eau pour alimenter la ville étant d'un abordage facile, toutes les bêtes de somme ou de montures y sont lavées ainsi que les vêtements des cholériques ; bien des fois j'en ai fait mes remontrances à son Excellence le Gouverneur pour faire cesser un tel état de choses et il me l'a toujours promis sans jamais l'exécuter. Veuillez, &c. Le Directeur, (Signé) De. FERRARI. (Translation.) Damietta, August 2, 1883. AS your Excellency will have been able to gather from the despatches which I have had the honour to address to you from day to day, the cholera is beginning completely to disappear. The few cases which are being now reported are almost all of persons arriving from infected places. Yet if the disease is beginning to die out altogether, it i9 not owing to the few sanitary measures which, with the greatest difficulty, we have been able to have put in force. In fact, carcases of dead cattle are again appearing in the Nile, and the proof of this is that two carcases with skins were found yesterday alongside the lazaretto, and that I was obliged to have them towed out of the Bogaze by the official boat, being unable to bury them failing instructions to that effect. I thought it better not to inform the local authorities of this for the very simple reason that they have not yet carried out anything that Dr. Nadim, the Sanitary Inspector in this town, had written to them on that head, nor even deigned to answer him, and say that the steamer " Nil," assigned for this duty, has been lying inactive since Mr. Goodall left. At the market water-melons, both good and bad, are offered in great quantities for public consumption. I need not speak of the streets of the town which I inspect minutely every day, and which are at present perhaps as dirty, or more so, than before. As the points on the banks of the Nile where the water-carriers draw water for the supply of the town are easy of access, all the beasts of burden and saddle animals are washed there, as well as the clothes of cholera patients ; many times have I made remon- strances to his Excellency the Governor to put an end to this state of things, and he has always promised to act, but has done nothing. Accept, &c. (Signed) Dr. FERRARI, Director. Inclosure 3 in No. 1. Dr. Ferrari to Hassan Pasha Mahmoud. Damiette, le 5 Août, 1883. EN vous confirmant mon dernier Rapport du 2 Août courant, j'ai l'honneur de vous adresser ces quelques lignes sur la situation de la ville. Les balayures de quelques rues, que l'on balaye pour jeter de la poudre aux yeux des passants, étant le6 plus fréquentées, sont jetées au Nil à quelques mètres du Gouver- norat, c'est-à-dire près du Consulat Perse ; je ne vous parle pa* de toutes les autres rue6 et passages, qui se trouvent dans le même état que j'ai dénoncé dans mon dernier Rapport. En amateur, je me suis rendu ce matin au cimetière Arabe pour voir en personne les scènes qui auraient lieu, entre les indigènes qui voudraient y entrer pour prier sur leurs morts et la garde établie pour les en empêcher, et j'ai vu de mes propres yeux (étant inconnu aux soldats de la garde) que ces derniers y ont laissé entrer en ma présence bien des personnes moyennant une piastre tarif, une demi piastre aussi et même moyennant une galette appelée "kahka" ou "fitir." Les cas constatés par moi ces jours-ci ne présentent plus ces caractères graves qui se manifestaient par le passé et conséquemment ils guérissent facilement et quelquefois même*[sans aucun traitement ; cela me prouve que la maladie est à sa dernière période. Je conclus en vous faisant connaître aussi que tous les médecins ont été rappelés et qu'il ne reste plus ici que le médecin de la ville, Ally Effendi Ghibril, et le pharmacien de l'hôpital. Veuillez, &c. Le Directeur, (Signé) Dr. FERRARI. (Translation.) Damietta, August 5, 1 883. IN continuation of my last Report of the 2nd instant, I have the honour to address to you these few lines on the condition of the town. The sweepings of the few chief streets, wbich are swept to throw dust in the eyes of the people passing, are thrown into the Nile a few metres from the Governor's house, that is to say, close to the Persian Consulate ; I do not speak of the other streets and passages, which are in the same state, that 1 denounced in my last Report. I went unofficially this morning to the Arab cemetery to watch in person the scenes which take place between the natives who wish to enter to pray over the dead, and the guard set to prevent them, and I saw with my own eyes (being unknown to the soldiers of the guard) that the latter allowed persons to enter for a piastre, half-a-piastre, and even for a cake, called " kahka " or " fitir." The cases reported by me during the last few days are no longer of the serious character which they formerly were, and consequently they are easily cured, sometimes even without any treatment, which is to me a proof that the disease is in its final stage. In conclusion, I have to inform you that all the doctors have been recalled, and that there only remains the doctor of the town, Ally Effendi Ghibril, and the hospital chemist. Accept, &c. (Signed) De. FERRARI, Director. No. 2. Sir E. Malet to Earl Granville. — (Received August 21.) My Lord, Cairo, August 10, 1883. WITH reference to my despatch of the 5th instant, I have the honour to inclose herewith a further Report by Mr. Vice-Consul Borg on the cholera in Cairo.* (Signed) EDWARD B. MALET. Inclosure 1 in No. 2. Vice-Consul Borg to Sir E. Malet. (Extract.) Cairo, August 9, 1883. I HAVE the honour to report that the decrease which has been noticed in the progress of cholera has been fully confirmed by the results of six on the seven days of the week ended on the 4th instant. The return for that period, which I beg to inclose, brings up the number of deaths from the epidemic at 1,662, which figures compare favourably with those of the third week * S«a ,f Commercial No. 34 (1883);" No. 52. P45175 of the disease in 1865, namely, 2,290. The first, third, fourth, and fifth days gave a mean average of 259 deaths per diem ; the second day presented a recrudescence — the deaths having risen to 309 ; while the last two gave 15b per diem. The number of deaths for the past three weeks amongst Europeans — the British troops not included — is eighty, which on the total mortality irom cholera gives a percentage of 1'64. The total number of Europeans resident at Cairo since the outbreak of the epidemic is grossly estimated at 17,000, and the deaths would therefore be about 4'70 per 1,000. I am informed, however, that Frenchmen have contributed a larger number of deaths, which may, perhaps, be explained by the rather immoderate use, especially during the summer season, of " absinthe," a beverage which, I understand, owing to its com- position, could not be used for any length of time without undermining the con- stitution. During the week under consideration (to the 4th instant) the mortality has been severe at Old Cairo (359), Boulak (279), Sayeda Zenab (196), and Abdeen (159). I am glad, however, to be able to report that the period of decrease confirms itself, not only by a smaller number of deaths, but also by the larger proportion of recoveries effected. Dr. Iconomopoulos, one of the physicians who have been long established at Cairo, informs me that he has obtained very satisfactory results by the administration of the following mixture : Sulphate of strychnine, two centigrammes, peppermint and fennel water, of each forty grammes, tincture of musk, twenty drops, ethereal tincture of valerian, forty drops, of which a teaspoonful is given every quarter of an hour, the patient being made to masticate small pieces of ice in the intervals. He assures me that the above mixture has been administered with marked success in the first and second stages of the disease, and also in incipient collapse, and that when taken as a preventive — one teaspoonful three or four times a day — it has acted iike a charm. The Comparative Table of deaths from all causes, which I annex, will show that last week compares favourably with the third week of cholera in 1865, the figures for ordinary causes being 518 and 586 respectively. I inclose also a Table of meteorological observations. The mean average barometrical pressure has been 753'49 against 754-72 for the third week of the epidemic in 1865. The mean average temperature has been 30 - 8 against 29*7, and the hygrometer has given 43"42 against 42'87. The prevailing winds have been north-east and north last week, against south-east, east, and west. (M d 3 • I-H (M 0) | 03 Q «5. Bh" CO eg 6D S -a a g o psi o «H PI 00 00 03 S 6C ni Pi O O ,3 60 .g I o » "n-t Q -t^> rt c3 ?H 03 i— I O ,3 Q I is m I as R St-i O P m i a a ft o 3 Ea3 ■eaiBui3j[ - et Cl CO •B3{Bjy ïi— i ;i— i ; ;ushuiu9 ; \t-* Cl r— 1 o > o ■B3praaj[ O 00 •eaiBj^ cl t* ^** ■— J ce ce •* co o -e a CS a en o "sapins-^ ... I ....... £ . rH •sa^i^ ::::::-;:::: = H t. F < 1 il so 3 •gsiBrasj co d a co »o ci "# cï ci i-h m eo co ri rHrH "63(6 f\[ Ci O •sapïniaj; Cï 00 U3 US CO "

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J>. t^» ->. l>« »>» l>» a OOOlNmiflN CDCOrtiWNOH ** CO CO C0 CM OJ CO >n m i/; o io m in J>* C*« •>■!>. t^ t>. !>• (NMUÎ iflrt Wrt CO CO *>■ CN »• CJi -h* l-Î ■» ■* pî M OJ « m o in »o »o ifl io r*« i>« I-*» r-« •>.<>• t- (J fi -( l-S 3 1-5 "3 1-5 3 "S I— 1 CD i— 1 t- 00 05 O (M S<3 Ghizeh 5 .. i 2 4 30 28 15 33 117 Caire • . • • • 3 i 2 61 68 . a 144 Saïda Zenab . . • . . • • 1 2 5 8 Choubra • • • . • . . 3 10 31 44 Esbékieh . . . « . ■ . • . . 11 17 30 58 Vieux Caire « - . • • 8 22 32 62 Abdin • • » • ■ 4 6 34 44 Boulacq Hôpital Bab-el- Charieh . 108 11 161 19 5 . 216 16 8 485 46 13 Khalifa • • • • •. 2 2 Mousky Darb-el-Amar . •• 2 1 2 1 Gamalieh • • • 1 1 Abassieh . ■• •■ •• 3 3 Totaux par journées 5 3 i 1 65 98 174 257 414 1,030 Totaux égaux .. 1,030 No. 3. Sir E. Malet to Earl Granville. — (Received August 21.) My Lord, Cairo, August 11, 1883. I HAVE the honour to inclose herewith to your Lordship copy of a letter which I have received from Major-General Sir Evelyn Wood, forwarding copy of a Report addressed by him to His Highness the Khedive on the cholera epidemic among the Egyptian troops at Cairo. Sir Evelyn Wood requests that copies of this Report may be forwarded to His Eoyal Highness the Field Marshal Commanding-in-chief, with a view to having the favourable remarks made by General Grenfell and himself on the conduct of the officers named noted against their names. I cannot forward Sir Evelyn Wood's Report without adding a word to record the high admiration which the conduct of the English officers towards their men has elicited. Sir Evelyn Wood and his Staff and all the officers have worked night and day at the measures necessary to ward off and mitigate the disease, and their efforts have met with an almost unhoped-for success. Beyond the immediate benefit of the saving of life which they have obtained, an example has been given of self-devotion which may have lasting consequences for good in the promotion of the respect and regard of the men towards the officers. It is probably the first time that any outward sign has been given that the lives of the soldiers are of value, for, if attacked, each man has been treated with the same care that would have been bestowed upon an officer. 1 have, &c. (Signed) EDWARD B. MALET. Inclosure 1 in No. 3. Sir E. Wood to Sir E. Malet. Cairo, August 10, 1883. ETC, , , ■ ;,..- .-, ■- - I HAVE the honour to forward copies of a letter and inclosures addressed by me to His Highness the Khedive with a request that they may be forwarded to the Secretary of State. In transmitting these documents to Earl Granville, I have the honour to request that you will ask him to forward copies of the same to His Royal Highness the Field Marshal L1645J C 8 Commanding-in-chief, with a view to having the favourable remarks made by General Grenfell and myself on the officers named noted against their names. I have, &c. (Signed) EVELYN WOOD, Sirdar. Inclosure 2 in No. 3. Sir E. Wood to His Highness the Khedive. Your Highness, Cairo, August 10, 1883. I HAVE the honour to submit, for your information, the accompanying copy of a Report from Brigadier-General Grenfell, and to state that I fully concur in his commenda- tion of the officers named, but 1 must add that from General Grenfell himself and from all the British Staff officers I have received the greatest possible assistance. In another paper I am forwarding to your Highness I am asking your sanction for the employment of an English medical officer to replace Kassim Bey. Your Highness will perceive from the analysis of the Return of cases the extraordi- nary immunity from disease enjoyed by the battalions of the 1st Brigade. Indeed, I believe there was no case of cholera in the 1st Brigade which originated in barracks. It w r ould be unreasonable to expect the same amount of discipline and attention to sanitary matters from the officers of the 2nd Brigade, but, nevertheless, I felt it my duty to express to Brigadier-General Yousef Shouhdi Pasha my great displeasure at the failure, both in himself and the officers under his command, to insure the execution of my orders as to the cleanliness and decency of his camp. He has undertaken that I shall have no further occasion to complain, and 1 hope in future my orders on these points may be carried out. Your Highness' humble servant. (Signed) EVELYN WOOD, Sirdar. Inclosure 3 in !No. 3. Report on Cholera in the Egyptian Army. Sir, Abbassyeh, August 8, 1883. THE epidemic having abated, I have the honour to forward the following Report : — On the disease reaching Cairo, in accordance with orders, I cleaned out and equipped two ruined houses at the east end of " Maison des Fous," which, by the 19th instant, were readv for occupation. On the 20th instant a doctor and attendants were told off, the doctor being employed, until the arrival of the first case, at camp of observation. On the afternoon of the 22nd instant our first case arrived, quickly followed by seven others, one man dying almost directly. The doctor 1 then found to be useless from fear and incapacity, and as he caused a panic among the attendants, on the arrival of Dr. Rogers he was removed. On the evening of the 22nd instant Surgeon-Major Rogers arrived andtook over charge, after which all went well. Mohamed Fudli was placed in charge. Medicines were issued to battalions. Fresh equipment demanded and obtained, and by the middle of the day on the 23rd instant, the hospital was thoroughly established in working order. The conduct of the Egyptian doctors (with some few exceptions) _ has not been satisfactory. On the outbreak of the malady there was.a decided disinclination to approach the patients. The first case I saw in the "Caserne Rouge" was placed within a circle of chloride of lime, the doctor, until remonstrated with, remaining outside the cordon. The doctor in charge of Red Hospital, completely broke down and communicated his fears to the attendants, and had it not been for the presence of the English officers, the patients would have been neglected. Another native doctor arrived on the 1st August. He does not appear to have received any medical education, and at first he was with difficulty persuaded to obey orders. He is now more amenable ; he is very lethargic and useless. Mohamed Fudli has worked very well. He has shown no fear, is intelligent and zealous, and though, when it suits his convenience he disobeys orders, still the work he has done is deserving of reward. 9 Another of the native doctors is of a sullen surly nature, does his work only under supervision, and I have no opinion of him. A gratifying contrast has been the conduct of the English officers of artillery, cavalry, and 1st Brigade. Colonel Duncan and the officers of the artillery, Majors Wodehouse and" Rundle, have heen constant in their visits, day and night, and have done all they could to cheer the sick and dying men. The artillery suffered more than any other corps, but every man was frequently visited. The officer commanding cavalry and his second in command (though only one case has occurred in the corps) have shown every anxiety to assist and have placed their services at my disposal. At the commencement of the epidemic Major Wingate was detailed as Commandant of the hospital and has almost lived there ever since. He effectually struggled with Egyptian laziness and disobedience of orders, and got the hospital discipline into working order. He had full powers to requisition on battalions and corps for men, stores, tents, &c., and managed to get all he wanted without offending any one : he has been firm and conciliatory in his relations with the doctors, and speaking Arabic fluently, he has spent his leisure moments at the bed-side of the patients. I cannot speak too highly of his services ; a young officer of greater promise I have never met. To Major Turner I entrusted all arrangements for burial of the dead and conveyance of water to the hospital and camp of observation ; both duties he executed promptly. At the early stage he was constantly in hospital, lifting men about, and on the first night, when attendants were useless, he performed the most menial duties of the hospital. Even when attacked by diarrhoea he continued to work day and night, and it was only by a positive order that I prevented him from continuing work, even when seriously ill — an iilness entirely caused by his devotion to his duties. Major Haggard, entrusted with the rationing of the hospital, superintendence of convalescent depot, and various other duties connected with the hospital, has worked very well. Spending a great deal of his time in hospital and from his knowledge of the language has been of great assistance to me. Majors Shakespear, Piggott, Marriott, and Davidson have helped in every way. Major Shakespear has had charge of tents and camps, and has worked hard and well. I have discouraged the visits of these officers to the hospital, desirous as they were to assist, as their presence was not absolutely necessary, and I was anxious to have a reserve of officers in case of others falling sick. Major Piggott, however, spent the first day and night almost continuously in the hospital, and worked with great devotion at the time when example was required to put pluck into the attendants. Surgeon-Major Rogers arrived in time to treat all the early cases, except one that died before his arrival, and on his arrival the situation altered, all confusion ceased, the doctor in charge was replaced by a more courageous man, the orderlies worked well, equipment was completed and the hospital settled down into working order. All this was done quietly, but effectually, and the way in which Dr. Rogers worked was beyond all praise. I feel sure that the comparatively trifling loss to the number of seizures was due to his devotion and attention. Dr. Acland arrived at a time when the type was altering and the number of cases diminishing. But on his arrival two bad cases had just come in — Captain Ahmed Hamdy and a man of the 8th Battalion. He immediately devoted himself to his duty, and a more painstaking, patient, and hard-working medical man I never saw. Though a stranger to the military system he soon adapted himself to it, and has succeeded in getting both doctors and infirmiers to work for him cheerfully. His exertions are worthy of special mention by his Excellency the Sirdar. I have, &c. (Signed) F. GRENFELL, Brigadier-General, \st Brigade, Egyptian Army. P.S. — I should propose that Drs. Rogers and Acland be called on for a Report as to the medical skill of the battalion and other doctors : their treatment if not successful is at any rate economical, starvation being the principal remedy in cases of choloraic diarrhoea. [1645] D 10 I append a list (A) of hospital establishment, and Return of deaths and admissions to date (B). F. G. Inclosure 4 in No. 3.' (List A.) — Present Establishment in Palais Rouge Hospital on Hospital Fatigues, &c. 1st Erigade — Officers . . . . . # 1 Non-commissioned officers . . . o Privates . . 8 Cooks . , 3 Water carriers , . 2 2nd Brigade — Non-commissioned officers . . 1 Privates . . . . 8 Artillery — Non-commissioned officers . . . , • • • • 1 Privates •• .. 3 Doctors — English • • 1 Native . . . . Pharmacien . . 1 Infirmiers v , 23 Ecrivain . . 1 Store-keeper . . 1 Barber . . 1 Carter (for mule cart). . . . 1 AVashers of body. &c. . . • . I 29 Total establishment 33 62 August 8, 1883. (Signed) F. R. W1NGATE, Major, Hospital Commandant. Inclosure 5 in No. 3. (List B.) — Cholera Report up to 8 A.M. on August 8, 1883. Corps. llernained. Since admitted. Discharged. Died. Remaining, Artillery Hospital attendant 4th Battalion 5th ,, .. .. .. 6th „ 8th „ Convalescents from Kasr-el-Ain . , „ from Tourah 15 1 2 2 6 3 7 2 • • • • 16 1 2 2 6 3 7 5 38 4 •• • • 42 One doubtful case sent from diarrhoea to cholera hospital ; now determined not to ba cholera. Present distribution : — Hospital Convalescent tents. . „ depot, Polygon Total admissions to hospital since commencement of outbreak Total convalescents from Kasr-el-Ain and Touiah 6 11 25 42 49 12 Total deaths Remaining . . 61 19 42 (Signed) F. R. WINGATE, Major, Hospital Commandant, 11 Inclosure 6 in No. 3. Cholera. Return of Admissions, Deaths, and Convalescents, from July 22 to August 9, 1883. Corps. Hospital. Con- valescent. Deaths. Total Admissions. Remarks. Artillery . . . . I Cavalry .. . . I 1st Brigade . . < 2nd Brigade . . < Hospital attendant . . Kasr-el-Ain. . . Red Hospital . . Kasr-el-Ain .. Red Hospital. . Kasr-el-Ain .. Red Hospital . . Kasr-el-Ain . . Red Hospital . . Tourah Red Hospital. . 16 •2 9 11 7 1 i'o* 'i 2 's 8 1 26 1 2 2 17 19 8 1 ("The artillery were quartered at. <^ Ghiseh, where the epidemic (_ first broke out. > One battalion at Alexandria. "1 Four of these men were brought > in dead, having died on the J road from Tourah. Total 46 30 76 Cairo, August 9, 1883. (Signed) FRED. SLADE, Lieutenant-Colonel, Assistant Adjutant- General. No. 4. Sir E. Malet to Karl Granville. — {Received August 2J.) My Lord, Cairo, August 13, 1883. WITH reference to my despatch of the 6th instant on the subject of the blame attributed by Sanitary Committee of Alexandria to Mr. Timmerman and General Baker, for preventing the entry of provisions into Mansourah, I have the honour to inclose herewith a copy of a letter, published in the " Moniteur Égyptien'' of the I lth instant, addressed by General Baker to the Minister of the Interior, refuting the accusations brought against him.f Î have, &c. (Signed) EDWARD B. MALET. Inclosure in No. 4. Extract from the "Moniteur Égyptien" of August 11, 1883. Lettre adresse'e par son Excellence le General Baker Pacha, Inspecteur- General, Com-» mandant-en-chef de la Gendarmerie et Police, à son Excellence Khairy Pacha, Ministre de l'Intérieur. Département de la Gendarmerie et Police, Caire, M. le Ministre, le 10 Août, 1883. " L'Egyptian Gazette *' du 3 Août contient un Rapport du Comité de Secours de Mansourah à Alexandrie, portant une accusation contre moi et mon Département ainsi que contre M. Timmerman» l'Administrateur des Chemins de Fer. Pour ce qui me regarde, le Comité prétend que j'ai empêché l'entrée à Mansourah des médicaments, vivres, &c, pendant le temps que cette ville était cernée par un cordon. Bien que le Comité ignore évidemment les mesures prises par le Gouvernement relativement à Mansourah et les raisons qui ont dicté ces mesures, il n'hésite pas moins de faire des assertions incorrectes et de baser sur ces assertions des attaques directes dirigées contre moi et M. Timmerman. * One officer. [1645] f See " Commercial No. 34 (1883)," No. 54. D 2 12 Je laisse à M. Timmerman le soin de répondre aux accusations portées contre son Département et je me tiens à ce qui touche l'Administration que j'ai l'honneur de diriger. La première accusation formulée par le Comité est comme suit : — "Trois ou quatre jours après l'apparition du choléra, un cordon avait été placé autour de la ville de Mansourah et les communications par chemin de fer furent arrêtées sur les lignes de Talka et de Zagazig. Non seulement l'entrée et la sortie des gens fut interdite, mais encore l'entrée des provisions et des médicaments de toute sorte qui avaient été expédiés à Mansourah avant ainsi qu'après l'établissement du cordon." Ces deux assertions sont absolument incorrectes. Il y a deux lignes de chemin de fer qui mènent à Mansourah, c'est-à-dire, la branche de Damiette de laquelle la station pour Mansourah est Talka, et la branche de Zagazig, qui entre dans la ville. Quand le cordon fut établi, il devint évidemment impossible de laisser entrer et sortir les trains dans la ville infectée, et par conséquent les trains qui devaient entrer dans la ville étaient arrêtés à Simbillaouin par ordre de votre Excellence. La ligne à Talka n'était pas arrêtée, mais comme la correspondance ordinaire ne pouvait être maintenue, les passagers prenaient leurs billets à Méballet-el-Kébir, et de là un train journalier partait pour les villes infectées avec des médecins, médicaments, vivres, &c. Mes ordres au Colonel Clarke qui commandait la gendarmerie sur la ligne étaient dès le commencement de permettre l'entrée des médecins, médicaments, vivres et personnes dans les villes infectées, mais d'en empêcher la sortie. Au lieu de prohiber l'entrée des vivres et médicaments, ainsi qu'il a été rapporté par le Comité, il résulte des télégrammes par moi envoyés, que des ordres contraires étaient constamment réitérés. En effet, le 3 Juillet, je télégraphiai au Commandant du cordon de Mansourah de permettre l'entrée dans cette ville à toute personne, aux vivres, médicaments, &c. Le 4 du même mois, je lançai une dépêche ainsi conçue : — ' ; Permettez à tout le monde d'entrer et n'arrêtez jamais ni médicaments, ni vivres, ni liqueurs." Le jour suivant de nouveaux ordres à ce même sujet étaient également donnés par télégraphe. Est-il donc possible, malgré tous ces ordres, que le Comité de Secours de Mansourah puisse déclarer que l'entrée des médecins, médicaments, et vivres était prohibée ? Le 8 Juillet le Colonel Sartorius était envoyé en inspection à travers les cordons et fut spécialement chargé de faciliter en toute manière l'entrée des vivres et médicaments dans les villes cernées. Il me télégraphia qu'il avait fait des arrangements satisfaisants avec le Gouverneur de Mansourah et que tout allait bien ; mais il a constaté qu'il se trouvait des personnes qui ne voulaient pas suivre la voie régulière d'entrée et qui adressaient ensuite des plaintes au sujet des difficultés qui n'étaient créées que par elles- mêmes. Votre Excellence sait bien que dès le jour où Mansourah avait été cernée j'ai toujours insisté auprès du Gouvernement pour l'envoi par bateaux des vivres de sa part à Mansourah et que ces vivres devraient être vendus publiquement en petites quantités et à bas prix afin d'empêcher que les négociants établis dans cette ville n'augmentent les prix des vivres pour leur propre bénéfice et ne créent une détresse dans la ville ; mais votre Excellence recevait alors des télégrammes si rassurants du Gouverneur de Mansourah, dans lesquels il disait que l'importation des vivres était entièrement suffisante et qu'il donnait des rations aux pauvres, qu'elle n'a pas jugé nécessaire d'accepter les mesures que j'avais proposées. Comment serait-il donc possible de prêter fui à la déclaration du Comité que le Gouverneur de Mansourah était tout à fait découragé à cause de la rareté des vivres, quand, en même temps, ce même Gouverneur télégraphiait à votre Excellence que les vivres étaient entièrement satisfaisants et qu'il donnait des rations aux pauvres ? Dans la nuit du 12 Juillet, le choléra éclata à la gare de Talka et il devint nécessaire d'arrêter les convois avant la station et au point où le cordon commençait. De ce nouveau point il était nécessaire de décharger du train les provisions pour Mansourah. Or, comme il était évident que ce changement pouvait causer des délais et des difficultés, j'ai alors expédié le télégramme suivant: — " Comme la gare de Talka est maintenant dans l'intérieur du cordon, faites des arrangements immédiats pour faire passer à Mansourah toute provision du point où le cordon commence. Désignez un officier spécial pour surveiller cet arrangement et ordonnez que les hommes du cordon assistent en déchargeant les trains. En cas de nécessité, louez des transports depuis le train jusqu'à la rivière." 13 En conséquence de ce télégramme, le Major Holroyd a été envoyé par le Colonel Clarke sur les lieux. Le Comité de Secours de Mansourah a si complètement ignoré ces événements, que lorsque le Major Holroyd s'est rendu à i'endroit désigné, il a présumé que l'entrée des vivres n'était pas permise avant l'arrivée de cet officier. De plus, comme l'abandon ainsi nécessité de la gare de Talka pouvait occasionner des difficultés et des délais, il a été immédiatement arrêté d'envoyer un train spécial journalier avec des vivres, depuis Simbillaouin jusqu'au cordon, et l'arrangement avait été fait avec le Gouverneur de recevoir ces vivres avec les précautions qui étaient prescrites. Ce train commença à courir le 14 Juillet. Dans la matinée de ce même jour, le Comité de Mansourah ayant prié Son Altesse d'envoyer un télégramme, et la réponse à ce télégramme de Son Altesse étant que tous les arrangements avaient été déjà faits, il s'est alors attribué le mérite d'avoir accompli ces actes de secours. D'ailleurs, j'appelle l'attention de votre Excellence sur un autre exemple de la légèreté avec laquelle le Comité de Secours de Mansourah porte des accusations contre des hauts fonctionnaires du Gouvernement qui, depuis six semaines, ont travaillé jour et nuit dans l'intérêt public et aux efforts desquels Alexandrie doit probablement le temps qui lui a été donné pour prendre des mesures preservatives contre l'épidémie. Le Comité de Secours avait décidé d'envoyer un médecin à Mansourah. Ce médecin se rend à la gare d'Alexandrie et demande un billet pour Talka, mais il lui fut répondu à cette gare qu'on ne donnait point de billets pour Talka. Sur ce, on pourrait croire que l'agent spécial du Comité de Secours aurait essayé de surmonter toutes les difficultés pour arriver à sa destination, d'autant plus que s'il avait demandé la moindre information, les employés du chemin de fer lui auraient dit que pour aller à Mansourah il fallait prendre un billet à Méhallet-el-Kebir, et que de là il pouvait aller par le train journalier à Talka et à Mansourah ; mais non, cet agent retourne au Comité, et sur son rapport, ce dernier s'est actuellement permis d'envoyer un télégramme au Gouvernement au Caire en disant que son agent avait été empêché d'entrer à Mansourah par l'Administration des Chemins de Fer et des cordons. Pour une période de six semaines la gendarmerie a été employée dans les cordons. Ce travail a été tout ce qu'il y a de plus pénible et leur a occasionné des souffrances terribles. Beaucoup ont péri ; mais je puis dire que, sauf très peu d'exceptions, officiers et soldats ont noblement fait leur devoir. Votre Excellence peut comprendre combien il leur sera décourageant si la seule appréciation publique de leurs efforts n'est que des attaques comme celles du Comité de Secours et surtout s'il est permis que ces attaques passent inaperçues sans attirer l'attention du Gouvernement. Veuillez, &c. LTnspecteur-Général, Commandant-en-chef de la Gendarmerie et Police, (Signé) V. BAKER. No. 5. Sir E. Malet to Earl Granville. — (Received August 21.) My Lord, Cairo, August 13, 1883. WITH reference to my despatch of the 6th instant,'* I have the honour to inclose a further statement of the deaths from cholera in Cairo, completing the Returns up to this morning. The mortality for the four calendar weeks just expired has been 913, 2,557, 1,671, and 444 respectively ; if we include the deaths in Ghizeh and amongst Her Majesty's troops in Cairo, the total during the second week of the epidemic reaches 3,000. The rapidity with which the death-rate has decreased during the last week to a total of only 1 1 for yesterday is eminently satisfactory, and it may fairly be said that this good result is mainly due to the energy with which the sanitary measures recommended by Dr. Hunter and the special Board of Health have been carried into execution, through the good-will and activity of the Government authorities. I have, &c. (Signed) EDWARD B. MALET. » See " Commercial No. 34 (1883)," No. 53. 14 CO at) CO iH o f-i ■ fH >o CS u o d •r-l d c3 0} © 'B d rd O U r—H O a d o M r 5 " 1 ^M «3 H H -ai W A oo 3 oc 3 00 1-5 -a H szi (3 Cl Ci c to ^ S Ph .,_ S co c? 3 S IO tb • . Ci <^ ■ ■ . fcb _• o ce M Cl Cl C0 o 3 rH * g»d o IO . . CO t- <: ,-i 1-1 ■ ' P Ci CC c- - CO co *o * U9 - l-« ■* ce 1 IO co o co ^ r* ri ■ t ~" ^ ■ » co o < tô M co M" 1-1 l-l • CO ,_, o» ... t- ,_ ==ui 1—1 ri 1—1 r^ < -* » ,_, M -, . . M m CO o -§^ es « Ci t- ^ o Cl t^ Ci 5*? fi f o . CO co IO . O co CO ,3 S 1 -' ■-H ■ 00 xc f .„ . ■* o us CO = r-î Cl i— « -si « t— l GO ea ■"* > . ce CO o Cl ^c» « r-* Cl co r-H d o t-. . IO et 1— 1 to "s ° (-3 W co 1Û Cl Cl eo ri « Cl a >« . CD o - CO ^ lO o ■a *s * C5 , " H *"' Cl CO ■-I CN co a >, ^_ ■H« IO Cï O &. 3°° ia Cl CO P^ ■<* CO CS •a CJ 3N £« ea U3 Cl Cl -r CN Cl U >> . ^ co m PJ ,- r , IO ■* M u P- Œ CO Cl *-• m Cl rt >> . O J t _ ( 1-1 J, Cl £ CT f-C " K t>-> . iO ^, M U3 CO ,_ co l~- T* CD CO Cl co CO >* . CO e» . Cl CC ■e CO î3 *^CO o Cl CO >* co t— . _ CO C9 ■«* CO Cl = : -^ >-» . co o CD m . ,* H CO M £s Cl co co co CO >» . ID O» __. Cl ^ c * *"* • " Cl ^ CO ,_, o *-3 r "' * ■ * >* . O r ^ ^ co £, V CO co >. . Cl H»-" *>» . M ^ rH >» . >^ , " 1 • ' • X ' * * " = t : = = , 1 : : : t : : : ■ = : r [S : l ^ t \ : ■ : . . B ' " ■ • - ■ • " • , . * , * m *. '" " - • • " 3 S " ^ ^3 *« o a S3 a u I "k s =5 S pa 'S *_ H 15 o O a o -a O 1 m 3 .9 a 1 C i J No. 6. >Sir i?. Malet to Earl Granville. — {Received August 21.) My Lord, Cairo, J«gr MS f 13, 1883. I HAVE the honour to inclose herewith copy of a Report by Major MacDonald on his visit to Lower Egypt, in company with Surgeon-General Hunter, T have, &c. (Signed) EDWARD B. MALET. Inclosure in No. 6. [Major MacDonald to Sir E. Malet. Sir, Cairo, August 13, 1883. I HAVE the honour to report, for your information, certain facts regarding the recent visitation of cholera in some of the provincial towns and villages of Lower Egypt. This information I have been able to collect in the course of a three days' tour with Surgeon- General Hunter and Mr. Gibson, head of the Egyptian Land Survey. Tantah. — A town of some 30,000 inhabitants. Inspections were made of the hospital, cemetery, and town generally, the dirtiest quarters being selected. Having resided at Tantah for two months during the winter, and seen it in its normal condition of dirt, I was surprised at the clean appearance it now presented. The streets were well swept and watered, no accumulations of filth were to be seen in front of the house doors, the houses had been whitewashed. This beneficial change was mainly due to the efforts of Sidky Bey, Professor of Anatomy at Cairo, who had been sent down by the Minister of the Interior at the urgent request of the European Committee of Health at Tantah. The Moudir of the Province being jealous of European assistance, had thrown every obstacle in the way of the said Committee, and it was only on the arrival of Sidky Bey that anything was done. I have reason to believe that the official Returns of the number of deaths from cholera in this town, as well as in most of the towns and villages of Egypt, are veiy considerably below the right number. This information I have gathered in the course of conversations with Mr. Campbell, Acting Consular Agent, with the French Consular Agent, and other inhabi- tants of the town, native as well as Europeans. The Moslem cemetery is in the centre of the town ; persons who have died from cholera continue to be buried there daily. Sidky Bey, notwithstanding numerous attempts to have this cemetery closed and a new one made, has been unable, owing to the opposition of the Moudir and the Notables of the town, to get this much-needed reform carried out. The very remarkable change in the sanitary condition of this town, brought about in the space of six days, is worthy of note. Kafr Zayat. — The arrangements in this place call for little mention. Dr. Cantlie, one of the twelve doctors recently sent out from England, having made all necessary arrange- ments, he is well supported by the native authorities. The mortality here, as well as in all the towns we visited, is on the decrease. Mehallet-el-Kebir. — A town of 28,000 inhabitants. In this town nothing, or next to nothing, had been done from a sanitary point of view. The official death-rate, thanks to the rising of the Nile, and consequent flushing of the Shibin Canal, on which the town is built, had decreased to two in the twenty-four hours. On the 28th July it was eighty-four, and this was considerably below the right numbers. The town hospital (there was no special cholera hospital) was one of the dirtiest buildings I have ever seen in Egypt or elsewhere. There were no patients. The native doctor at Mehallet confessed to never having visited a single poor patient, one reason being that the fellaheen class very rarely report themselves sick, and endeavour to conceal the tact of their being so. Dr. Honman, one of the twelve doctors recently sent out from England, had been there lor two or three days, and had not been able to see a single patient before death for the same reason. Dr. Honman had just recovered from a severe attack of choleraic diarrhoea when we saw him. The town was without medicines or disinfectants of any kind beyond some which had been sent by the Alexandria Relief Committee. The disease had just been allowed to take its course ; those attacked, in may instances, died where they fell in the street, or by the side of the canal. The dirty state of this town, and the absence of disinfectants, had been reported to Salem Pasha, President of the Sanitary Board of Heaith of Egypt, some weeks before the cholera epidemic showed itself, by Mr. Gibson, of the Land Survey. On oui; return to this town two days later, a great deal had been done in disinfecting the houses, cleaning the streets, &c. 16 Mansourah. — A town of 26,000 inhabitants. The old hospital was first visited. The hospital registers were most defective and carelessly kept. The following is the method universally adopted for compiling the same : — In the case of a death occurring in a village, the barber, who does not always reside in the village, looks in at the house where the death has occurred. The relatives of deceased describe the symptoms, the barber informs the district doctor, who enters it in the register. Very few of the patients are seen during life, or even after death, by a doctor ; the ones that are seen being of the richer class, who can afford to pay. Some of these district doctors have over GOO villages in their charge. From the old hospital we went to the new hospital, which had been used for cholera patients during the epidemic. On the way some of the dirtiest parts of the town were passed through ; a great deal however had been done ; stagnant pools had been filled up, houses whitewashed, &c. A visit was subsequently paid to the new cemetery. This is situated about half-a-mile to the south of the town (prevailing winds, north and north- west), and appears to be as good a site as is available. This cemetery was full of the wooden biers used to convey the dead. Some of the graves, through being hurriedly constructed, had cracked, and the smell of dead cholera bodies was very unpleasant. I was informed by Mr. Murdoch, British Consular Agent, that the opposition on the part of the Notables to having the new cemetery opened was very determined ; bodies after having been buried were surreptitiously removed back to the old. The Moudir of this place, Zeki Pasha, has behaved throughout with great energy and intelligence, and has endeavoured to carry out the wishes of the European Committee despite the opposition of the Notables. Abder Rachman Bey, one of the principal landed proprietors of the place, has been one of the few Notables who has supported the Moudir. It is worthy of remark that this man was a staunch upholder of the Khedive's authority during the late rebellion. The cordon at Talka entailed a great deal of misery on the poorer classes of natives and Europeans. A number of natives who had come into the town to sell chickens, &c, were shut in. The price of food did not rise to famine height; fowls, &c, were very expensive, good mutton was always to be had at reasonable prices. The lack of intelligence of some of the native officers of the cordon was the cause of a great deal of unnecessary inconvenience. The principal sufferers from the cordon system, or the want of intelligence in the carrying out of the same, were the poorer classes of Europeans. All vegetables and fruit were destroyed by orders from Cairo; the want of this was very much felt during the three weeks the town was cut off from the outside world. Damietta. — A town of some 34,000 inhabitants. The Governor of this place was very anxious to show us round, the principal streets of which had evidently been prepared for our arrival. There appears to have been no lack of medicines during* the epidemic, and the Governor seems from all accounts to have done what he could to assist the efforts of the Europeans to disinfect the town; which efforts, however, came too late to be of much avail. At Damietta very good evidence was obtained of the existence of isolated cases of cholera in the Coptic and Greek schools as early as the commencement of May. From this it may safely be inferred that cases had also occurred amongst the Arabs. After leaving Damietta a stoppage was made at a small village called Gogur. On the evidence of the Sheikh, 1 :"> per cent, of the inhabitants of this village had died during the late cholera epidemic. The reason for our stopping here was that some of the Arab employés of the Land Survey had reported that in May last the inhabitants were dying at the rate of four and five a day. On being questioned on this point, the Sheikh admitted that such was the case ; but said that they had died from typhus fever. This epidemic continued for two weeks, there was then a lull, and on the 10th Ramadan (16th July) the cholera broke out and carried off seventy-six persons. On the 16th July Mansourah and Talka were invested by a cordon, and continued to be so for some days. Gogur lies on the Cairo side of this cordon and outside of it. There is very little doubt but that cholera was raging in many of the villages outside the cordons, and that, as a rule, the villages, owing to their entire lack of sanitary arrangements, were attacked before the towns ; the existence of the cholera being unknown and unreported to the authorities owing to the lax method of reporting already explained. Sarnanhoud. — A town of 1 1,000 inhabitants. News of our probable arrival had evidently preceded us, as the streets through which we would most likely pass were undergoing a process of whitewashing. The walls of the town, which could be seen from the railway, had also been whitewashed. Very few of the bye-streets through which we actually passed had been touched. Isolated cases of cholera had occurred amongst the natives of the neighbouring villages as early as May last. I 7 / Chibin-el-Kom. — A town of some 14,000 inhabitants ; has had the highest official death-rate from cholera of any town in Egypt. On examination of the registers it appeared that about 1,800 people had been attacked, of whom close on 1,300 had died. This was the only town where an attempt had been made to keep a register of the number of the people attacked, which may, perhaps, account for the high death-rate. Additional care having been taken in keeping the registers, a more correct estimate of the real state of affairs had been arrived at. The cemetery here is well situated, being about half-a-mile from the town ; the tombs, which were bigger than those in most Arab cemeteries, were arranged in rows ; the spaces between the tombs had been carefully swept ; the door to each tomb had been heaped up with chopped straw and chloride of lime. The smell from this cemetery notwithstanding was most offensive ; this arises principally from the defective construction of the tombs, which are built with an arched roof; this sometimes cracks from the heat of the sun, allowing all the poisonous gases to escape. The entrance to the tomb is by a small door, which is filled up with bricks and plastered over with mud ; the latter in some cases dries and falls off. When the epidemic was at its height the entrances to these tombs, in many cases, were just closed with a stone, so as to be ready for use in case of need. In this Province of Menoufia, agriculturally the richest in Egypt, there is one native doctor in charge of 40,000 people ; his salary is 61. 10s. a-month, out of which he has to pay for stationery and travelling expenses, amounting in all to about 21. 2s. ; this is the same for all the districts of Egypt ; the number of inhabitants in the districts varying from 20,000 to 40,000, The Moudir of Chibin-el-Kom appears to have done everything he could; the streets were swept and watered, &c. Benha. — b',000 inhabitants. Nothing whatever had been done towards putting this town into a sanitary condition. The doctor in charge of the hospital and town had endeavoured to do what he could. There was also a European doctor, who had been sent by the Alexandria Relief Committee, amply provided with medicines and disinfectants; the Moudir, Khamil Bey, had refused to give him the necessary authority to go into the Arab houses and disinfect them. He had also refused to provide sweepers, &c, for the streets, or soldiers to enforce the orders of the Committee of Health. The European doctor being provided with funds from Alexandria had offered to pay all expenses, but though, on our arrival, he had been there some days, he had been unable to have any of his suggestions carried out. The European doctors and the European community com- plained of the state of the cemetery. We accordingly visited it. It lies on the edge of the town, about 200 yards from the railway station, 70 yards from the hospital, and 40 yards in a straight line from the main line from Cairo to Alexandria, and is in a most tumble- down condition. The smell of decaying bodies which existed in this cemetery, and for a radius of some yards round it, was most disgusting. The Moudir refused to have this cemetery closed, and burials of persons who had died from cholera were still going on. I consider that the state of some of the cemeteries we visited is such that an outbreak of typhus or some other malignant fever is quite possible, and may occur at any time. With regard to the towns we visited, I have seen the majority of them several times in the commencement of the year; they are all, with the exception of Benha and Mehallet, very much cleaner than at that time. The subsidence of the epidemic throughout Egypt is mainly due to the rising of the Nile. In every town and village in Egypt the sewage and the old water of last year is being swept out to sea by the fresh water of the new Nile. I have, &c. (Signed) C. M. MacDONALD, Captain and Brevet Major, Military Attache'. No. 7. Consul Cookson to Earl Granville. — (Received August 23.) My Lord, Alexandria, August 13, 1883. I HAVE the honour to forward herewith a despatch from Mr. Mïéville, inclosing the official bulletins, issued since the 6th instant, as to the progress of cholera.* I have, &c. (Signed) CHAS. A. COOKSON. * See '< Commercial No. 34 (18S3)," No. 60. [1646] E 18 Inclosure ia No. 7. Consul Mie'ville to Consul Cookson. Sir, Alexandria, August 13, 1883. THE last week's mortality from cholera throughout the country is stated at 5,029, giving a daily average of 718, as against a daily average of 840 during the previous seven davs. This brings the total number of deaths since the beginning of the outbreak to 21', 146. In Alexandria there has been an increase in the mortality from cholera, 136 deaths having occurred in the last seven days (6th August, 8 a.m., to 13th August, 8 A.M.). The general mortality also is greatly above the average. I have, &c. (Signed) W. F. MES VILLE. No. 8. Sir E. Malet to Earl Granville. — (Received August 28.) My Lord, Cairo, August 15, 1883. WITH reference to my despatch of the 10th instant, I have the honour to inclose herewith a Report from Mr. Vice-Consul Borg upon the cholera in Cairo.* I have, &c. (Signed) EDWARD B. MALET. Inclosure 1 in No. 8. Vice-Consul Borg to Sir E. Malet. Sir, Cairo, August 14, 1883. I HAVE the honour to forward to you herewith a Return showing the number of deaths from cholera at Cairo during the week ended the 11th instant. The figures here given (468), compare favourably with those of the fourth week in 1865 — 976. The total number of deaths for the first period of four weeks stands as follows : — In 1883— First week . . . . . . Second ditto . . . . , . Third ditto . , . . , , Plus deaths at the Lunatic Asylum, returns of which are not received in time . . . . Fourth week (Asylum included) Total In 1865— 765 First week 2,438 Second ditto 1,662 Third ditto Fourth ditto 32 468 5,365 Total 205 1,919 2,290 976 5,390 It appears from the above Table that the present outbreak has been more virulent in the first two weeks, and there is, therefore, every reason to hope that the virulence being spent, as is shown by the smaller proportion of deaths in the last two weeks, we may soon see the scourge "disappear. The totality, however, for the four weeks is very nearly equal. During the past week the quarters that suffered most were Boulak (67), Abdeen (61), Old Cairo (48), Saïeda-Zenab (39), Ezbekiyeh (37), and Abbasiyeh (36). The Comparative Table, herein annexed, of deaths from all causes shows a diminution of 101 on the deaths for five days in the fourth week in 1865. I regret that in former official correspondence the Table stops at that date (i6th July, 1865). The Table of meteorological observations, which I inclose, shows that the mean average barometrical pressure has been 753 # 58, against 755*14 for the fourth week of the epidemic in 1S65, the mean average temperature 29"1, against 29"9, and the hygrometer has given 52"71, against 42"30. The prevailing winds last week were north-east and north, against south-east, west, and north-west. I have, &c. (Signed) RAPH. BORG, No, 2. 19 00 a ta 3 .o oo oo , co on 3 fcn o 3 fc «! 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In N N S — < — h o oi s (O 00 O «3 1" CO Cl ci. pî CN -*!• CO OJ CM CN CM § O C jO O iC lO O i>» ts Js N N Nt» N ** « -2°o . ffiOOHi-HH So s tO CO tO iO CO CO »fO pi CO ^ CM CO CO CO CO tO lO iO iO >o o o 3 £ N N S N !■» NW Ph u a> B "* CO 00 oo 00 CO to S ONICOHNIÛ U < in in n co •* v ^ uO ift U) iO >o >o iO ^ l>» t» t^« I- *■» t*» t>» to to r* oo ci o — i ai «8 JJ 1— 1 1— 1 ta O 3 21 No. 9. Sir E. Malet to Earl Granville. — (Received August 28.) (Extract) Cairo, August 16, 1883, WITH reference to your Lordship's instruction to me to make inquiries and report upon the tax formerly levied on the carcases of animals interred, I have the honour to inform your Lordship that 1 have called upon the Consular authorities in this Consular district to inquire into the matter, and to inform me whether they are of opinion that the tax has been levied by the local authorities since its abolition in 1850.* No. 10. Sir E. Malet to Earl Granville. — (Received August 28.) My Lord, Cairo, August 17, 1883. WITH reference to Mr. Cookson's despatch to your Lordship of the 9th instant, f inclosing two letters from Dr. Ferrari, at Damietta, showing that the sanitary state of the town was again being neglected, I have the honour to inform your Lordship that, on receiving similar information, I at once called the attention of the Minister of the Interior to the matter, and I beg to inclose a copy of a letter from his Excellency in reply, by which it will be seen that he had already given instructions on the subject to the Governor of Damietta and to the President of the Board of Health. It appears also from Mr. Cookson's despatch to your Lordship of the 16th instant, that the state of things complained of by Dr. Ferrari was being remedied.. I have, &c. (Signed) EDWARD B. MALET. Inclosure in No. 10. Khaïry Pasha to Sir E. Malet. Mon cher Ministre, Le Caire, le 15 Août, 1883. TOUT en vous remerciant pour le renseignement que vous avez bien voulu me donner au sujet des deux Rapports envoyés par le Dr. Ferrari au Conseil Quarantenaire en date du 2 et 5 courant, et que j'ai l'honneur de vous retourner ci-inclus, je crois de mon devoir de porter à votre connaissance que le Président du dit Conseil m'en avait transmis copie le 11 courant et que le même jour j'en donnais communication à la Présidence du Conseil de Santé et d'Hygiène avec ordre de s'en occuper pour ce qui le concerne. Je crois aussi utile d'ajouter que j'ai informé le Gouverneur de Damiette des plaintes dont il s'agit en l'engageant de faire de son mieux pour qu'elles aient à cesser. Veuillez, &c. (Signé) KHAÏRY. (Translation.) My dear Minister, Cairo, August 15, 1883. WHILE thanking you for the information you have been so good as to give respect- ing the two Reports sent by Dr. Ferrari to the Quarantiue Board, and dated the 2nd and 5th instant, which I have the honour to return herewith, I think I ought to inform you that the President of the said Board had sent me copies of them on the 11th instant, and that the same day I communicated them to the office of the President of the Health and Sanitary Board, with instructions to deal with them so far as he was concerned in the matter. I think it would be well to add that I have informed the Governor of Damietta of the complaints in question, and have prevailed upon him to do his best to prevent their recurrence. I have, &c. (Signed) KHAÏRY. * See " Commercial No. 34 (1883)," No. 33. f N©. 1. 22 No. 11. Sir E. Malet to Earl Granville. — {Received August 28.) My Lord, Cairo, August 17, 1883. LIEUTENANT-GENERAL STEPHENSON, Commanding Her Majesty's troops in Egypt, informs me that the Khedive yesterday visited the British field hospital at Ramleh. His Highness went into most of the tents, including those occupied by the cholera patients. This considerate act of His Highness, and his kindness and condescension, were much appreciated by both officers and men. He appears to be continuing to set an admirable example to those under bis authority. I have, &c. (Signed) EDWARD B. MALET. No. 12. Sir E. Malet to Earl Granville. — (Received August 28.) My Lord, Cairo, August 17, 1883. WITH reference to my despatch dated the 6th instant, I have the honour to inclose a statement of deaths from cholera in Egypt, completed up to the 14th instant by a local newspaper.* A Table of the populations of the towns affected by the epidemic is forwarded here- with for convenience of reference, and likewise a statement of the numbers of deaths per thousand in the seven towns which have yielded the largest totals. The total mortality hitherto recorded is 21,524, or about 3 per 1,000 of the whole population of Egypt. I have, &c. (Signed) EDWARD B. MALET. Inclosure I in No. 12. Mortalité depuis le début de l'Épidémie jusqu'au 14 Août au matin. '— tliî'C « • ■ • • • , , , B 5,622 Villages de Dakablieh . • • m 226 Avant qu'il ne soit tenu compt e de la mor- Villages de Béni-Souef . • • • 222 talité par quartier . . . . 144 Mit-el-Gamar . . . • 213 Abassieb . , 141 Ghirgbé . . . • • • 212 Abdin . , 523 Ossine • • • 210 Bab-el-Charieh . . 249 Alexandrie • • • • 208 Boulacq . . . . 1.757 Eosette . 206 Choubra . . . . . # 286 Zifta • - • 198 Darb-el-Ahmar . . 92 Villages de Ghizeh • 190 Ezbékieb . . . # 393 Simbelhawin . . ta • • 160 Gamalieh , . 84- Benha . . . ■ • • • 154 Khalifa . . . . 93 Damanbour . . • • • 152 Musky . . 105 Kafr-el-Zayat . . • • • 148 Saïda-Zenab . . 336 Gallioubieli ■ • • • 144 Vieux Caire . . , # 952 Sohag j • • 142 Hôpital ■ . 432 Barrage . . . 131 Khalig . . . . . . 6 Chirbiu . 124 Armée d'Occupation .. . . 29 Mebeïeb . 119 Armée d'Occupation (Intérieur) • . 74 Guérar . . . • • * 102 Damiette . . . . . , 1,923 Cbobar . . . . 100 Chibin-el-Kom . . . . 1,171 Mabdel . 99 Mansourah . . , , 1,085 Béni-Souef ' . . . 98 Villages de Charkieh . . . , 798 Villages divers . . 90 Ghizeh . . . . . » m . 785 „ d'Assiout . 90 Maballet-el-Kébir . . • • , , 746 Embabeb . 89 Villages de Garbieh . . . . 738 Villages de Béhéra . . 83 Tantah . . . . , . 597 Kafr Cbeïkh . 72 Samanoud . , . . 347 Rodah . 71 Menoufieh (Province de). . . . . . 303 Belbeïs . 70 Minieb . . . . 300 Galioub . 69 Zagazig . . . . 295 Gbirgbé . 68 Gallioubieh (Province de) . . . . 280 Talka . • « • 61 Menzaleh, . . . • .. .. 254 Béni Aimed . . . 60 * See '■' Commercial No. 34 (1883)," No. 53. V 3 Saft .. 59 Faeuiné . , Cliavkieh (Province do) . 29 Kafr Duwnr Province de Menoufieli . 55 Paonne Mahmoudiek 50 Minieh Rodah , . Dénota . . . 48 Hélouan . , Menouf 48 Mehalleh Abou-Ali Magaga 4G Tane Tela .. 43 Achmin Choubra 41 Kolossua ïahrtê 40 La-hona (Fayoum) Simbel . . . 39 Maïmoun . . Ibrahimieh . . 38 Ouled Negm Villages de Siout 37 Touok Medine-el-Favoum 36 Welledieh Chibrihit .. 33 Mostar Chennaoui . . 33 Kaba'iat Dagadous 33 Assiout Ismai'lia 33 Abou Kébir Beghenin 32 Guetz Villages de Minieh 32 Kafr Soliman p . . ' Suez 32 Mahallet Hussein Sahouam . . 31 Mit Birra Atfé-el-Mahmoudiek 29 Manfalout Bemba 29 Santah Matranich 29 Tamieh . . Beba 28 Choune Mehalleh Menouf 27 C'hirbine-el-Kanater Sofia . . 27 Dinjouali Bedrechine . . . 26 Ditsi Baghour 26 Kehïa Farchant-el-Baghour 26 Kafr Hegare Béni Mourra 25 Lahoussa Villages de Fayoum 23 Malaf'out Belgas 2i Nefiche Bordeïn 21 llumleh Tama 21 Westa Talbia 21 Bendarieh Kareddin 19 Echoune Memel Chi'a 19 Habate Fayoum 18 Boulacq Dacrour Damate 17 El-Ayat Memel Rhoda . . 17 Ziriba Zaou'ia 17 Tamour El Wahdan 16 Kafr Mansour . . Settié 16 Kahleh (Kénah) Tourah 16 Kafr Sadat Danjii 15 Manfouma-el-Chibin Zifta.. 15 Maesra Abou Omar . . 14 Massara Neghilé 14 Manfalon Barnach 13 Marassa Issoni'a . . . 13 Abiar . . . Kafr Zagazig 13 Berket-el-Sab .. Touk 13 Chine Bober 12 El Bamleh Macoussa 12 El Mahati Metia 12 Port-Saïd 12 Total • • Tahta 11 11 13 10 y 9 9 9 8 7 7 7 7 6 6 6 6 5 5 5 5 5 5 5 5 5 4 4 4 4 4 4 4 4 4 4 4 3 3 3 2 2 21,524 24 Inclosure 2 in No. 12. Tableau de la Population des Centres principaux où la Maladie s'est déclarée. Le Caire, savoir — Abdine . . Bab-el-Chariéh Boulaq . . Choubrah Darb-el- Ahmar Esbékieh Gamaliéh Khalifa . . Saïda-Zénab El-Waïly Kaïssoun Masr-el-Kadima Alexandrie, savoir — Alexandrie (ville et banlieue) Aboukir El-Mandarah El-Siouf Ramleh Damanhour district et Zaptieh Tanta Ménouf Kalioub Zagazig Mansourah Damiette Rosette Port-Saïd Ismaïlieb Suez Benha Tala (Ménoufieh) Toukh Kafr-Zayat . . El-Mêhalleh El-Kébireh Cherbin Talkha Zifreh Samanoud Bisket El-Sab Chobar El-Namleh Belkasse (non encore recensée) Safia (liéhéra) Chébin El-Kom Kafr Hamza (Kalioubieh) Mit Ghamr Dakadous (Dakahlieh). . Sembellawein Abou Hammad Manzaleh Guizeh Béni-Souef (Haute-Egypte) Rodah (Assiout) Féc*ie (Minieh) Minieh Belbeïs (Charkieh) Kafr El-Cheikh (Garbieh) Maghagha (Minieh) . . Kolossna (Minieh) El-Soufieh (Charkieh) . . Hélouan Embabeh Tourah . . . . As>iout Kafr-Dawar . . Guirgueb. Maisons. Population. Total. Hommes. Femmes. 4,184 13,185 14,421 27,606 a. 5,793 20,658 21,286 41,944 a. 8,933 26.714 25,351 52,065 1,956 5.119 5,951 11,070 . . 3,316 14,304 15,224 29,528 a a 8,059 28,798 30,001 58,799 a . 3,729 15,479 14,269 29,748 . . 6,471 17,758 18,957 36,707 • a 5,376 15,897 18,253 34,150 a , 3,327 7,109 6,594 13,703 a a 1,680 5,711 6,495 12,206 • • 3,373 10,918 9,664 20,582 56,197 181,642 186,466 368,108 > 27,905 105,346 103,429 208,775 a a 350 1,319 1,211 2,530 . , 115 578 507 1,085 ., 82 623 617 1,240 • • 848 2,206 2,113 4,342 29 ; 300 11,072 107,900 217,972 m 9,844 31,609 32,214 63,813 . , 5,660 16,785 16,940 33,725 • a 2.454 8,078 8,203 16,281 • . 1,610 4,299 4,337 8,636 , , 3,871 9,894 9,202 19,096 a a 3,740 13,627 13,157 26,784 a a 4,145 17,851 16,195 34,046 . a 2,277 9,353 7,318 16,671 • • 2,933 8,916 7,644 16,560 • a 997 1,899 1,465 3,364 . . 1,746 5,835 5,078 10,913 . . 1,655 4,388 3,979 8,367 , a 1,575 4,940 5,027 9,967 . . 639 1,635 1,632 3,267 . . 1,130 2,719 2.874 5,593 , . 4,751 13,786 14,122 27,908 , . 837 2,381 2,262 4,643 . . 699 2,489 2,520 5,009 , . 1,600 5,601 5,539 11,140 a . 1,763 5,682 5,875 11,557 a . 416 1.298 1,266 2,564 •- 463 1,469 1,557 3,026 "26 89 "l75 2,892 8,126 8,065 16,191 , . 129 289 350 639 . . 2,236 5,692 5,533 11,225 , . 458 1,534 1,600 3,134 . . 717 2,546 2,555 5,101 120 409 440 849 1,034 4,226 4,224 8,450 , . 2,188 5,461 5,956 11,417 785 4,843 5,195 10,038 . . . . 1,957 2,091 4,048 , . 2,993 2,997 5,990 . * . a 8,254 8,613 16,867 . . 3,651 3.658 7,309 . . , . 2,152 1,915 4,167 . # # . 1,405 1.543 3,038 , # 1,813 1,865 3,678 m # 84 547 1,131 . . 1,095 1,062 2,157 . . 1,549 1,523 3,072 a m 640 696 1,336 # # 15,606 15,789 31,395 252 254 5C6 • « ■ • 8,050 7,189 15,239 25 Population. Maisons. Total. Hommes. Femmes. Souhag 6,675 5,988 12,663 Bibeh ■ • • . , , 2,334 2,220 4,554 Chibin El-Kanater • • • • . # 1,377 1,385 2,762 El Wasta • ■ • • • • 435 400 835 Abou-Horamos • • • • t m 315 274 589 Kafr-Zagazig . • • • t m 375 395 770 Atfé • ■ ■ • , . 318 362 680 Méhallet Ménouf • • * • . , 1,819 1,821 3,640 Mabmoudieh. . . • • • • . . 2,176 2,173 4,349 Bordein • • • • ■ . . 822 907 1,729 Tabla • • • . • . . 6,793 6,996 13,789 Sawam'a • • . • • • 1,807 1,711 3,518 M é din et El-Fayoura . . • • • • , . 12,716 13,184 25,900 El-Lahoune • • ■ • « , , 1,266 1,130 2,416 Manfalout • • • • • • 6,502 6,732 13,234 lnclosure 3 in No. 12. Towns. Mortality. Population. Deaths per Thousand, Cairo 5,622 368,108 15-27 Damietta . . . • 1,923 34,046 57-70 Chibin-el-Kom 1,171 16,191 72-35 Mansourah. , 1,085 26,784 40-51 . Ghizeli . . . • . . 785 11,417 68-85 Mehallet-el-Kebir 746 27,908 26-73 Tantah 597 33,725 17-70 Samanoud . , . . • . . . 347 11,557 30-03 No. J3. Sir E. Malet to Earl Granville. — (Received August 28.) My Lord, Cairo, August 18, 1883. WITH reference to my despatch of the 26th ultimo,* I have the honour to inclose copies of letters which have passed with regard to Colonel Chermside's return to Alexandria, from which your Lordship will observe that his valuable assistance in the recent emergency has been fully appreciated by the Minister of the Interior and by the Prefect of Police, and that he has done a great deal towards removing the friction which existed between the Prefect and the European officers with whom he is brought into contact. I have, &c. (Signed) EDWARD B. MALET. lnclosure 1 in No. 13. Khaïry Pasha to Sir E. Malet. Mon cher Ministre, Le Caire, le \7 Août, 1883. J'AI eu un long entretien avec le Préfet de Police à propos du Colonel Chermside, qui, d'après votre avis (que d'ailleurs je partage! devrait à la suite de la gravité des propor- tions de l'épidémie cholérique, rentrer au plus tôt à Alexandrie pour prendre le commande- ment de son régiment. Son Excellence le Préfet, tout en regrettant fortement de devoir se priver du précieux concours du Colonel Chermside, ne peut [faire] moins [que] de reconnaître la plausibilité du motif qui conseille cette mesure, et il est prêt à s'y soumettre. Veuillez, &c. (Signé) KHAÏRY. (Translation.) My dear Minister, Cairo, August 17, 1883. I HAVE had a long conversation with the Prefect of Police on the subject of Colonel Chermside, who, in your opinion (which I share), should in consequence of the grave * See « Commercial No. 34 (1883)," No. 29, [1645] . E 26 character of the cholera epidemic return as soon as possible to Alexandria to take over the command of his regiment. His Excellency the Prefect, while he very much regrets having to deprive himself of the valuable assistance of Colonel Chermside, can only admit the force of the motive which prompts this step, and is ready to consent. I have, &c. (Signed) KHAIRY. Inclosure 2 in No. 13. Sir E. Malet to Brigadier-General Grenfell. Sir, Cairo, August 17, 1883. IN reply to your letter of the 1 5th instant, I beg to inclose copy of a letter which I have received from the Alinister of the Interior, stating that the Prefect of Police of Cairo, although regretting extremely to lose Colonel Chermside's valuable assistance, nevertheless recognizes the necessity for his return to Alexandria.* Sir Evelyn Wood was so good as to lend Colonel Chermside to the Minister of the Interior with a view to expediting the execution of the measures deemed necessary to meet the cholera epideiiie, and for this purpose he was requested by his Excellency to act under the Prefect of Police. Now that his mission is over, 1 shall be much obliged to you to convey to him my high appreciation of the manner in which he has performed it. There is no question that his presence has smoothed many difficulties, and that his tact and judgment in acting with the Egyptian officials have been of the greatest use during a very difficult crisis. I have, &c. (Signed) EDWARD B. MALET. No. 14. Sir E. Malet to Earl Granville. — {Received August 28.) My Lord, Cairo, August 20, 1883. WITH reference to my despatch of the 13th instant,! I have the' honour to inform your Lordship that during the past week only thirty-five deaths from cholera have been recorded in Cairo, and that there has been a very considerable decrease in the Returns throughout Lower Egypt, with the exception of the town of Alexandria. 1 have, &c. (Signed) EDWARD B. MALET. No. 15. Consul Cookson to Earl Granville. — {Received August 28.) My Lord, Alexandria, August 16, 1883. WITH reference to my despatch of the 9th instant, I have the honour to transmit herewith a despatch from Mr. Miéville, inclosing a further letter from Dr. Ferrari, reporting that an improvement has taken place in the sanitary condition of Damietta.j I have, &c. (Signed) CHAS. A. COOKSON. Inclosure 1 in No. 15. Consul Miéville to Consul Cookson. Sir, Alexandria, August 16, 1883. WITH reference to my despatch of the 9th instant, I have the honour to inclose a further letter addressed to the President of the Quarantine Board by Dr. Ferrari, reporting that an improvement has taken place in the sanitary condition of Damietta. I have, &c. (Signed) W. F. MIÉVILLE. * Inclosure 1 in No. 13. t No. 5. Î No. 1, 27 Inclosure 2 in No. 15. Dr. Ferrari to Hassan Pasha Mahmoud. Excellence, Damiette, le 11 Août, 1883. AVANT mon départ de Damiette pour Tor, comme j'en ai reçu l'ordre par votre lettre du 8 courant, et pour lequel je vous fais mes remercîments, je me sens en devoir de vous adresser le présent Rapport, qui sera mon dernier d'ici, concernant les mesures prises pour la salubrité publique de cette ville. Depuis quelques jours l'autorité locale semble avoir donné des ordres très sérieuses à propos de la propreté de la ville et maintenant je suis heureux de pouvoir annoncer que celle-ci n'est plus dans son état primitif si sale ; à cet effet une Commission a été élue de personnes distinguées de la localité et qui a formé à son tour des Sous-Commissions pour chaque quartier afin d'en surveiller la bonne marche, et la continuation journalière de la dite propreté. Cette mesure quoique prise assez tard ne manquera pas d'être une garantie pour l'avenir si toutefois elle serait continuée. Quelques rares cas de choléra se manifestent encore jusqu'aujourd'hui de forme bénigne; parmi le nombre j'en ai visité un sur la personne d'un garçon Chrétien de l'âge d'environ 7 ans. Avant de clore le présent Rapport je suis en devoir de vous informer, M. le Président, que hier vers 3 heures de l'après-midi esc arrivé ici M. le Dr. Hunter, par un train spécial, et après avoir visité l'hôpital, le bureau d'hygiène, et une partie de la ville, il est reparti ce jourd'hui à 5 heures du matin. Veuillez, &c. Le Directeur, (Signé) Db. S. FERRARI. (Translation.) Your Excellency, Damietta, August 11, 1883. BEFORE my departure from Damietta for Tor, according to instructions contained in your letter of the Sib instant, for which I have to express my thanks, I feel bound to send ycu the present Report, which will be my last from this place, concerning the measures taken for the preservation of the public health of this town. For some days past the local authority appears to have given very strict orders for keeping the town clean, and Ï am now happy to be able to state that it is no longer in its previous dirty condition ; for this purpose a Committee has been chosen from among the chief persons of the place, which has in its turn formed Sub-Committees for each quarter, so as to superintend the proper daily execution of these measures, These measures, although undertaken late enough, will not fail to be a guarantee for the future if they are continued. A few cases of cholera of a favourable type still occur occasionally up to to-day; among the number I have attended one, the patient being a Christian boy, of about 7 years of age. Before closing this Report it is my duty to inform you that yesterday, at about 3 in the afternoon, Dr. Hunter arrived here by special train, and, after visiting the hospital, the sanitary office, and a part of the town, left to-day at 5 in the morning. Accept, &c. (Signed) Dr. S. FERRARI, Director. No. 16. Consul Cookson to Earl Granville. — (Received August 28.) My Lord, Alexandria, August 16, 1883. UP to the last few days there had been no appearance of any objection on the part of the native Moslem population to any of the sanitary measures prescribed by the Extraordinary Sanitary Commission. Indeed, the European Presidents of the various Sub-Commissions had reported constantly that they and their staff were generally very well received by the natives, and that they found more difficulty with Europeans in carrying out measures of sanitation. There was naturally some jealousy on the part of the Government Sanitary Board; but, by care to avoid collision, and by the co-operation of the Governor, this had not produced any worse results than a certain [1645] ]? 2 28 amount of delay and incompleteness in executing our sanitary programme. Indeed, every measure ordered by the Executive Committee was approved by his Excellency the Governor of Alexandria as President, by Hassan Pasha Mahmoud, the Vice-President, and by the three Egyptian Moslem members. The Committee was therefore painfully surprised at what took place on the 9th and 10th instant, as reported in my telegrams of the 11th, but at the meeting held on the 10th, at the suggestion of the native members, the arrangements which had been sanctioned for the disinfection of the houses where cholera patients died, and for their interment, were modified so as to avoid all possible collision with the religious feelings or prejudices of the population. The European doctors, however, who, from the first formation of the Extraordinary Sanitary Commission have been devoting themselves gratuitously to its work with a public spirit and generosity beyond all praise, finding that their co-operation was likely to be attended with personal risk, held a meeting of all their body on the 1 lth instant, at which resolutions were proposed by two of the most respectable and well-known medical men of Alexandria, that the doctors should retire from giving any further public assistance, and continue only to attend to the sick as private practitioners. At this meeting I happened to be present, in my unofficial capacity of a member of the Executive Committee of the Extraordinary Sanitary Commission, specially attached to the medical section of that Committee, and I was asked to take the Chair. In the hope of averting what might have proved a very serious calamity, namely, the total collapse of the organization which has hitherto worked on the whole so successfully, I accepted the offer ; and I proposed an amendment that a delegation of the medical body should be authorized to draw up a statement of the terms in which it would consent to continue its public assistance, and present it to the Governor of Alexandria. Of this delegation I was named Chairman. The same evening the delegation held a meeting at which we drew up our terms, of which I inclose a copy, with some explanatory notes. The next day, the 12th, we presented these terms to the Governor of Alexandria, and after a long discussion his Excel- lency virtually conceded them all. His Excellency sent a written reply, herewith inclosed, to our terms on the 13th, and on the 14th the medical delegation decided that this reply ought to be accepted. This decision was unanimously ratified by the medical body convoked on the evening of the same day, and since then the doctors have been working as before in their several Sub-Commissions, quarters, and ambulances and hospitals. In order to enable your Lordship to judge what are the points in which there might possibly be a conflict between the orders of the Sanitary Commission and the religious feelings of the Moslem population I inclose a copy of a letter which the Governor of Alexandria has written to me, at my request, specifying in detail these points. I can confidently assure your Lordship that all that is laid down in his Excellency's Memo- randum has been accepted without any reserve by the Executive Committee of the Extra- ordinary Sanitary Commission, and is being strictly respected. In fact, the ten points on which his Excellency insists do no more than embody formal decisions of the Commission. It is sincerely to be hoped that nothing new will happen to interrupt the peaceable application of the measures agreed upon for the protection of Alexandria from the epidemic now raging in this country. But I should be wrong in concealing from your Lordship that within the last ten days there has been evinced a very bad state of feeling on the part of the ignorant native population. Reports have been spread among them, and too generally believed, not only that the English have introduced the cholera, but that the disinfectants, remedies, and even food given by the Sanitary Commission are poisonous. On Sunday last, the ] 2th instant, while the medical delegation was with the Governor, a well-dressed Arab belonging to the superior classes brought in two common English biscuits, which he said had been given to his child by a Christian, and which he wished to have analysed. He seemed hardly satisfied at seeing the biscuits eaten by two members of the delegation. On the 1 lth instant a negro British subject was brought to this Consulate with a letter from the Governor of Alexandria stating that the accused was suspected of distributing bad meat to the Arab population. I know, however, that similar groundless beliefs have often existed in other places during the prevalence of epidemics. I have &c> (Signed) ' CHAS. A. COOKSON. 29 Inclosure 1 in No. 16. Terms of Sanitary Delegation. LE corps médical d'Alexandrie de- mande : 1 . Des garanties formelles pour la mise à exécution de son programme sanitaire, tout en respectant, ainsi qu'il l'a toujours fait, les coutumes religieuses. Ces garanties consisteraient dans l'adjonc- tion à chaque Comité de Quartier, à chaque ambulance d'un piquet de gendarmerie, com- mandé autant que possible par un officier Européen. Des mesures de police com- plémentaires seraient étudiées entre son Excellence le Gouverneur et le Comité Exécutif. 2. Le médecin- en-chef de chaque Comité ou de chaque ambulance aura sous sa dépendance absolue et son entière direction le personnel quel qu'il soit. 3. L'augmentation des appointements des employés fixes dépendra du Président de la Commission du quartier. 4. La mise en liberté du Dr. Rizgalla sauf à faire ultérieurement une enquête sur les griefs qui lui sont imputés. Explanatory Notes. 1. This was asked in consequence of the attacks made on the 9th and 10th on one of the Sanitary staff and on an ambulance hospital. 2 and 3. Intended to secure the co- operation of the staff attached to the Com- mission. 5. Le renvoi d'Ahmet Loutfi à cause des entraves qu'il a apporté dans l'exécution du service médical de son quartier. 4. Dr. Rizgalla is a doctor in service of Government but attached to the Commis- sion, who was most arbitrarily thrown in prison by the Governor of Alexandria in consequence of charges made against him in the execution of his duties. The medical body expressed very strongly their feeling that this was a direct attack on their independency, and showed an inclination on the part of the authorities to make them victims to the popular excitement. 5. Ahmet Loutfi, a subordinate medical officer, had taken upon himself, without any good reason, to dismiss the staff of his quarter, and so throw the whole of its administration out of gear. 6. Que pleine satisfaction soit donnée au corps médical pour les faits regrettables de ces derniers jours. Si les propositions ci-dessus ne sont pas acceptées, le corps médical déclare se retirer, tout en étant comme par le passé à la dis- position des personnes qui réclameront leurs soins. (Translation.) THE Medical Body of Alexandria request : — 1 . Formal guarantees for carrying out their sanitary programme, while they under- take to respect religious customs as they have always done. These guarantees should consist in a picket of the gendarmerie, commanded as far as may be, by an European officer, being attached to each District Committee and to each ambulance. Additional measures of police to be considered by the Governor and the Executive Committee. 2. The head doctor of each Committee, or of each ambulance, to have his staff, whoever they be, under his complete control. 3. The increase in the number of permanent appointments will be decided by the President of the District Committee. 4. The liberation of Dr. Rizgalla; but an eventual inquiry into the complaints brought against him. 30 5. The dismissal of Ahmet Loutfi on account of the impediments which he has thrown in the way of the medical service in his district. 6. That full satisfaction should be given to the medical body for the deplorable events of the last few days. If the foregoing proposals are not accepted, the medical body declare their intention of withdrawing their assistance, being, however, still at the disposal of those who seek their services. Inclosure 2 in No. 16. Osman Orphi to Consul Cookson. M. le Consul, Alexandrie, le 13 Août, 18S3. ME référant à l'entretien que j'ai eu l'honneur d'avoir avec vous et avec MM. les délégués du corps médical lors de l'entrevue de ce matin, je m'empresse de vous confirmer les déclarations suivantes que j'avais faites en réponse aux demandes qui m'ont été remises par ces messieurs : — 1. Le piquet de gendarmes demandé pour chaque ambulance avait été déjà établi; quant au piquet demandé pour chaque Comité de Quartier, il existe au siège même de chaque Comité, ou tout à côté un corps de garde de gendarmerie et un détachement de gardes de police, indépendamment des patrouilles qui circulent dans toutes les rues et les quartiers. Si le corps médical désire assurer une protection quelconque aux différents Comités, cette protection leur sera et leur doit être accordée par ces corps de garde ou toute autre force publique. Du reste, lorsque MM. les médecins ou les membres des Comités trouveront de l'opposition à l'exécution de quelque mesure non contraire aux coutumes et croyances religieuses, ils n'ont qu'à y surseoir et à m'en donner avis ; je me chargerai alors de faire soumettre les récalcitrants. Je rappelerai aussi à ces messieurs, et vous-même n'ignorez pas, M. le Consul, qu'à différentes reprises j'ai donné les ordres les plus sévères à tous mes subalternes de se mettre constamment à la disposition des Comités des Quartiers, les menaçant de toutes les rigueurs disciplinaires en cas de retard ou même d'hésitation. Ces ordres ont été maintenant renouvelés. Tous les corps de garde viennent d'être renforcés par la Garde Khédiviale, qui a été mise à ma disposition à cet effet, et les Comités de Quartier ne peuvent qu'y trouver un appui et une assistance efficaces en cas de besoin. 2. Je dois encore rappeler à ces messieurs du corps médical que d'après le projet d'organisation des ambulances, le personnel qui les dessert se trouve placé sous la dépendance et la direction du médecin-en-chef dans les conditions établies par le dit projet et par les délibérations du Comité Exécutif. Le personnel provisoire des postes médicaux se trouve dans les mêmes conditions. Quant au personnel médical fixé des quartiers composé d'employés officiels nommés antérieurement à la formation de la Commission d'Hygiène, et relevant d'une Administra- tion centrale spéciale, il ne peut être traité sur le même pied qu'un personnel provisoire, et dépendre d'une autre autorité que celie qui lui est donnés par les institutions établies; principe qui du reste a été déjà reconnu, et admis par le Comité Exécutif dans sa séance du 1 er Juillet, ainsi qu'il résulte du procès-verbal relatif à cette séance, où il est dit en propres termes, " que ces Commissions et Comités n'altèrent en aucune manière les attributions et le fonctionnement des institutions déjà établies par le Gouvernement." Néanmoins, des ordres ont déjà été donnés précédemment à tout le personnel médical des quartiers de se conformer entièrement aux ordres des Comités dans les limites de leurs attributions, et les Comités ont, du reste, sur eux droit de contrôle. 3. J'admets volontiers l'augmentation provisoire des appointements des employés fixés sur la recommandation des Présidents de Comité, pour les encourager à faire leur devoir et les dédommager des frais qu'ils auront à supporter pendant le cours de l'épidémie ; mais je désirerais qu'avant d'allouer cette augmentation elle me soit indiquée afin que je puisse en obtenir l'approbation. 4. Le Dr. Risgalla avait déjà été mis en liberté avant notre entrevue, et l'enquête sur les griefs qui lui sont imputés continue. 5. Le renvoi de tout employé ne peut être ordonné que par un jugement du Tribunal compétent. Néanmoins, pour trancher toute contestation et éviter la perte du temps précieux que produirait une enquête, je me propose de le retirer du service des quartiers. 31 6. La satisfaction que réclame le corps medical sera donnée non seulement pour les faits en eux-mêmes, mais aussi pour donner un exemple. Les coupables et les principaux fauteurs ont été arrêtés au moment même où ces faits se sont produits et se trouvent sous jugement. J'aime à croire que les honorables membres du corps médical sauront apprécier à leur juste valeur ces déclarations, et que tenant compte des difficultés sans nombre qui se présentent dans l'accomplissement de ma tâche, ils auront tout lieu d'en demeurer satisfaits. Je saisis cette occasion pour exprimer à ces messieurs tous mes remerclments pour les services qu'ils ont rendus, et j'ai pleine confiance dans leur zèle et leur esprit de modération pour continuer la tâche humanitaire à laquelle ils se sont dévoués. Veuillez, &c. Le Gouverneur et Préfet de Police, (Signé) OSMAN ORPHI. (Translation.) Sir, Alexandria) August 13, 1883. WITH reference to the conversation which T had the honour to have with you and with the delegates of the medical body during this morning's interview, I hasten to confirm the following statement which I made in reply to the demands delivered to me by those gentlemen : — 1. The picket of gendarmes requested for each ambulance had already been stationed; as to the picket asked for for each District Committee, there is one at the place of meeting of each Committee, or close by ; a guard of gendarmerie and a detachment of police guards, apart from the patrols which go through the different streets and quarters of the city. If the medical body desires any special protection given to the various Committees, such protection shall, and indeed ought to be, afforded to them by these guards, or by some other branch of the public force. Should the medical men or the members of the Committees find opposition made to the execution of any measure which is not contrary to the customs of the people and religious beliefs, they need only wait and inform me of the fact ; I will then undertake to suppress the opposition. I would remind these gentlemen — and you. Sir, are not ignorant of it — that I gave the most stringent orders to all those placed under me to hold themselves continually at the disposal of the District Committees, and threatened to visit any refusal or even hesi- tation to comply, with the utmost severity possible. These orders have now been renewed. All the guards have been supplemented from the Khedive's guard, which has been placed at my disposal for the purpose, and the District Committees cannot fail to find in it efficacious support and assistance should it be needed. 2. I must also remind the members of the medical body that, according to the plan on which the ambulances were organized, the staff working them is dependent on, and placed under the direction of, the chief medical man, under certain regulations established by the said plan and the resolutions of the Executive Committee. The provisional staff of the medical depots are similarly circumstanced. The fixed medical staff of the districts, composed of officials appointed before the formation of the Sanitary Committee, and dependent on a special central Administration, cannot, however, be assimilated to a provisional staff, and cannot be placed under any authorities other than those designated for the purpose by existing institutions; this principle was, indeed, acknowledged and recognized by the Executive Committee at its meeting of the 1st July, as shown by the Minutes thereof, which say "that the Commis- sions and Committees in nowise alter the duties and sphere of work of institutions already established by the Government." Nevertheless, orders have already been given to all the medical officers of the districts to submit entirely to the Committees so far as their duty permits, and the Committees have a right to control them. 3. I readily agree to increasing the pay of the officials, as recommended by the Presidents of the Committees, in order to incite them to do their duty, and to compensate them for the expenditure they will have to bear during the continuance of the epidemic; but before awarding such increase, I wish to know its amount, so that I may obtain sanction for it. 4. Dr. Risgalla had been liberated before our interview, but the charges brought against him are still being investigated. 32 5. The Court of competent jurisdiction is alone able to order the dismissal of an official. But, be this as it may, I propose to withdraw him from district duty, and this in order to avoid the waste of valuable time that an inquiry would entail. 6. The reparation asked for by the medical body shall be given not only on account of the events themselves, but also as an example. The guilty, and those chiefly at fault, were arrested at the time, and now await trial. I am convinced that the honourable members of the medical body will rightly value what I have now said, and that, while remembering the countless difficulties I have to contend with in fulfilling my duty, they will have reason to be satisfied with what has been done. I avail myself of this opportunity to thank those gentlemen to the utmost of my power for their services, and I have full confidence that their zeal and their spirit of moderation will enable them to continue the humane task to which they have devoted themselves. I have, &c. (Signed) OSMAN ORPHI, Governor and Prefect of Police. Inclosure 3 in No. 1 6. Osman Or phi to Consul Cookson. M. le Consul, ^ Alexandrie, le 14 Août, 1883. ME rapportant à la déclaration que j'ai eu l'honneur de vous faire lors de notre entrevue du 1 1 courant, relativement à la nécessité de ménager tout ce qui touche aux coutumes et aux croyances religieuses de la population Musulmane, et me conformant au désir que vous m'avez alors exprimé de vous indiquer tout ce qui, parmi les pratiques actuelles, est en opposition avec ces contumes et ces croyances, je m'empresse de vous transmettre ci-inclus une note indiquant les mesures à prendre vis-à-vis des indigènes. Ainsi que vous pourrez le remarquer par la lecture de cette note, la plupart de ces mesures ont déjà été consenties et adoptées par le Comité Executif lui-même". Je suis donc certain que MM. les docteurs ne trouveront aucune difficulté à adopter ces mesures et sauront par leur prudence et leur tact en faciliter l'application. Veuillez, &c. Le Gouverneur et Préfet de Police, (Signé) OSMAN ORPHI. 1. Toute personne atteinte de choléra est libre de se faire soigner à domicile où a l'hôpital. 2. Les indigents qui refuseraient de se rendre à l'hôpital seront soignés à domicile par les médecins ; mais si le traitement est impossible dans les habitations à cause de leur mauvaises conditions hygiéniques, les malades seront transportés à l'hôpital. En cas de resistance de leur part, il en sera donné avis au Commissaire du quartier, qui se chargera ote les y envoyer. 3. Pendant le cours du traitement la désinfection et autres opérations analogues seront faites par le médecin traitant. 4. Attendu que la constatation des décès est avant tout du domaine de l'État Civil, que c'est l'Inspectorat Sanitaire qui a toujours eu qualité pour y procéder et qu'il tient un livre spécial pour l'enregistrement des personnes décédées, il reste entendu que la constatation du décès de tout individu doit être faite par le médecin officiel du quartier et les permis d'enterrement délivrés par l'Inspectorat sur la demande du médecin. Cependant pour faciliter aux médecins-en-chef des ambulances le prompt transport des cadavres, il leur sera donné par l'Inspectorat un certain nombre de cartes en blanc qu'ils rempliront au besoin, sauf à lui donner avis de chaque décès. 5. La constatation des décès pour les femmes indigènes sera faite par les sage-femmes officielles du quartier. 6. La désinfection dans les maisons des indigènes sera faite après l'enlèvement des cadavres par les sage-femmes d'après les instructions et sous la surveillance des médecins qui devront se tenir à l'extérieur de la maison à désinfecter. 33 7. Les cercueils servant au transport des morts seront de la même forme de ceux employés par les Musulmans sauf à les goudronner intérieurement. 8. Les morts seront lavés à l'eau propre, par des laveurs qui éviteront tout contact avec les personnes de la maison et qui devront être désinfectés. L'eau ayant servi à cette opération devra être conservée jusqu'à l'arrivée des personnes chargées de la désinfection. 9. Les morts seront enveloppés d'un premier linceuil blanc. La dernière enveloppe sera goudronnée par les laveuis eux-mêmes, qui seront munis d'une bouteille de goudron à cet effet. 10. Les porteurs du cercueil ne seront point changés en route et ils devront être désinfectés au cimetière. En général, il faut dana la pratique éviter tout ce qui serait de nature à froisser ou à heurter les coutumes et les croyances religieuses. Le Gouverneur d'Alexandrie, (Signé) OSMAN ORPHI. (Translation.) Sir, Alexandria, August 14, 1883. WITH reference to the assurance I had the honour to give you on the occasion of our interview on the 11th instant, respecting the necessity of being careful as regards anything which touches the religious beliefs and customs of the Mahommedan population; and, in accordance with the wish you then expressed that I should point out everything now done which may be in opposition to those customs and beliefs, I have much pleasure in inclosing a Memorandum showing what measures should be adopted for the natives. As you will see, on reading the Memorandum, that the greater part of these measures have already been adopted by the Executive Committee. 1 am, therefore, sure that the doctors will have no difficulty in adopting these measures, and will, by their prudence and tact, make the application of them all the easier. I am, &c. (Signed) OSMAN ORPHI, Governor and Prefect of Police. 1. Any person attacked by cholera is free to be attended either at home or at the hospital. 2. Indigent persons who will not go to the hospital will be attended at home by the doctors ; but if proper treatment is impossible in their homes, owing to their bad sanitary condition, the sick will be taken to the hospital. Should they resist, notice is to be given to the District Commissioner, who will see to their being taken to the hospital. 3. During the treatment, disinfection and other similar operations will be carried out by the doctor in charge of the case. 4. Whereas the civil authority is, above all, charged with the registration of deaths, whereas the Sanitary Inspector has always had power to do this act, and whereas he keeps a book specially for registering deaths, it is understood that the notification of any person's death must be made by the official doctor of the district, and the burial permit be delivered by the Inspector on the request of the doctor. In order to give every facility to the principal doctors in charge of ambulances for the removal of corpses, the Inspector will give them a certain number of blank forms, to be filled up as may be required ; but the doctors must notify every death to the Inspector. 5. The deaths of native women will be notified by the official midwives of the district. 6. Native houses will be disinfected after the corpses have been brought out by the midwives, in accordance with the instructions of, and under the superintendence of the doctors, who are to remain outside the houses to be disinfected. 7. The coffins used for the conveyance of corpses shall be of the same shape as those used by the Mahommedans, except that they are to be tarred inside. 8. Corpses are to be washed with clean water by washers, who are to avoid all contact with the people of the house, and who are to be disinfected. The water used is to be kept until the arrival of those charged with the disinfection. 9. Corpses are to be first wrapt in a white winding-sheet ; the outer wrapping is to be tarred by the washers themselves, who will be furnished with a bottle of tar for the purpose. 10. The coffin-bearers are not be changed on the way to the cemetery, and are to be [1645] G there disinfected. Generally speaking, everything must in practice be avoided which would be of a nature to ruffle or jar religious customs and beliefs. (Signed) OSMAN ORPHI, Governor of Alexandria. No. 17. Consul Cookson to Earl Granville. — (Received August 28.) My Lord, Alexandria, August 20, 1883. I HAVE the honour to forward herewith a despatch from Mr. Miéville reporting the progress of the epidemic. I nave &c (Signed) CHAS. A. COOKSON. Inclosure in No. 17. Consul Miéville to Consul Cookson. Sir, Alexandria, August 20, 1883. THE last week's mortality from cholera throughout the country is stated at 3,420, bringing the total number of deaths since the beginning of the outbreak to 24,566. The following Table shows shortly the force of the epidemic from the 24th June, and in what degree it is now decreasing : — Deaths. Daily Average. Week ending — Including Cairo. Excluding Cairo. July 1st . . . . . . ,, oth . • • . . a „ 15th . . . . . . „ 22nd „ 29th August 5th „ 12th „ 19th 651 1,121 1,145 2,137 5,131 5,880 5,029 3,420 93 160 163 305 733 840 718 489 93 160 163 175 366 597 655 482 In Alexandria during the past week the mortality from cholera has continued to increase, 287 deaths being recorded as against 136 during the previous seven days. The general mortality, however, has decreased, though it continues high. I have, &c. (Signed) W. F. MIÉVILLE, British Delegate. No. 18. Consul Cookson to Earl Granville. — (Received August 28.) My Lord, Alexandria, August 20, 1883. 1 HAVE the honour to inclose a Report which Dr. Mackie has requested me to transmit to your Lordship respecting the present epidemic of cholera in Egypt. L have &c. (Signed) CHAS. A. COOKSON. Inclosure 1 in No. 1 8. Report by Dr. Mackie respecting Cholera in Egypt. ON the 2l8t of i'ast monlh I forwarded to Sir Edward Malet, for the information of isr Majesty's Government, a telegram received by me on that day from Mansourah, mating that many cases of typhoid had been observed in the districts then infected, as also petechial cases.* * See " Commercial No. 34 (1883)," Inclosure 2 in No. 45. m As the Sutler class of cases was rather indistinctly described in the telegram I attached less importance to it at the time than I am inclined to do now, in consequence of rumours which have reached us of the existence of cases of petechial typhus, and from what has fallen under my own observation. Case 1. On Saturday, the 28th July, I was called to see Mr. B., an Englishman over 60 years of age, in easy circumstances, enjoying a moderate pension, but living in a small house, the sanitary state of which was filthy in the extreme, situated in a quarter of the town in which several of the earliest cases of cholera occurred. He had been feverish and ailing for a week, but no very distinct history could be obtained. I found him with very high fever, temperature 1 05 degrees Fahr., pulse quick and hard, face flushed, eyes suffused, tongue dry, very restless and delirious, abdomen and lower extremities covered with petechial spots about the size of a pin's head, abdomen slightly distended, no diarrhoea, urine albuminous, great muscular weakness, and tremors of hands and mouth. Dr. Putsey, Surgeon of Her Majesty's ship " Condor," who happened to be with me, examined him, and we both pronounced it a case of "petechial typhus." Treatment was instituted to lower the temperature, and next morning he was without fever, and continued so until noon, when the fever returned as before to disappear again completely next morning, and return with same intensity towards the' afternoon. This state of things continued until the 2nd August, when I found at my morning visit that the temperature was a little above normal, but he was lying prostrate on the bed, tongue dry, pulse weak, tremors, and a yellow tint had appeared over the whole body. ï ordered him at once, with the consent of his family, .to be removed to a private room in the Deaconesses' Hospital, which was done in the afternoon. He stood the moving Very well ; his temperature did not rise at night, and next day was found to be slightly below normal, at which point it remained till the day before his death, when it rose to 102'2 degrees Fahr., at which time he had also for the first time diarrhoea. He died on the 1 0th August. The yellow tint disappeared from the body three days after its first appearance. After his admission into hospital he continued in a state of great prostration until he died. Several medical men saw the case, and from the behaviour of the temperature, opinions were divided between its being a case of typhus with unusual temperature phenomena, or "bilious intermittent fever" with petechia. It certainly had not the classical temperature of typhus as observed in England, but continued fevers here very often assume an irregular malarial form, a matter which attracted the attention of the military surgeons last year during the prevalence of enteric fever amongst out troops, and on which I was often referred to by them. Case 2. On the 13th instant an Egyptian, aged about 25 years, died in the Deaconesses Hospital. He was employed as a gardener, and entered the hospital, apparently in good health, to be operated on for a very small fistula. He was operated on by my colleague, Dr. Varenhorst, and all went on well for eight days after the operation, when suddenly he became feverish, his temperature from the beginning mounting up to 103 and 105 - 2 degrees Fahr., between which it varied morning and evening till he died on the 13th August, twelve days after the commencement of fever. Not having been informed of the case, I did not see it tilt after death, when I inspected the bodv. I found it covered with flat, round, dark-coloured spots, from |--inch to £-inch it* diameter. On the back were two large black masses under the skin, which, my colleague told me, during life presented the appearance of bullae full of blood, and which, when cut into, were found to consist of dark semi-fluid blood of tarry colour and consistence. On the back of one of the thighs there was a similar black mass. All of thesey when examined by me after death, looked, at first sight, like an ordinary anthrax in a state of gangrene ; but, on closer examination, were found to be semi-fluid blood, contained ia sort of sac formed by the skin. fJ.o-.5l G 2 36* The glands of the groin were very prominent and hard. There were no signs of buboes. This was noticed particularly, as reports were being circulated of the existence of plague at Damietta. Dr. Varenhorst excluded emphatically any suspicion of pyaemia from operation, and stated that healing of the small wound was going on most satisfactorily. He gave it as his opinion, and stated at length in the certificate of death, that it was " tvphus avec pétéchies," &c. (see certificate, Inclosure 2 in No. 19). The wound which had been healing fast, and was healthy, after the onset of the fever became suddenly gangrenous. None of the measly eruption of oi'dinary typhus was present ; but it is doubtful whether, if in the dark skin of the Arab, it would have been distinctly made out. Case 3. Dr. Haddad, who was sent by the Mansourah Relief Committee to Mansourah at the commencement of the outbreak, and who was afterwards transferred to Mahalla-el-Kebir, telegraphed to me from the latter place : — " 1 have a case of petechial rash ; round spot confluent all over the body. Do not disappear completely on pressure. Temperature, 104 degrees; pulse, 90 degrees. Un- conscious and delirious. Saw him first five days ago. Was told he had an attack of cholera fifteen days before I saw him." Two days ago, on the evening of the 18th, he again telegraphs : — "Rash began on the 11th, and subsided on the 16th. To-day temperature, 103 degrees; pulse, 110. Less delirious; tongue dry and glazy; fetid diarrhoea; skin desquamating." These cases were evidently malignant fever of the nature of, if not, true typhus, and are of importance taken in. connection with Dr. Dutrieux's telegram from Mansourah of the 21st July, already referred to, which would go to show that a petechial disease existed to some extent in the infected districts even before the outbreak of cholera was declared. This is, to my mind, of great importance, as going to prove that the present epidemic of cholera originated de novo at Damietta. Malignant fevers and typhus must, with regard to the circumstances under which they exist, be classed in the same category as cholera, viz., filth diseases. Jt has been established that tvphus can be generated, de novo, by filth and overcrowding, where no typhus existed, in proof of which I may cite the case of the Egyptian steamer, " Scheah Gehaad,'' which obtained such notoriety twenty-two years ago by importing typhus into Liverpool, though there was no typhus on board the vessel. Three persons who went on board the vessel in the dock took typhus, and the crew communicated typhus to the bath attendants and to twenty-five persons in the Southern Hospital, Liverpool. It is needless for me to go into the details of this case, which is so well known, further than to say that the almost universal opinion was that the typhus poison was generated on board the ship without the crew suffering from it. Parkes stands almost alone in contending that the crew were suffering from typhus, but the medical men who attended them declared that no fever existed amongst them from first to last. But if, as Parkes says, the crew were suffering from typhus, I am still of opinion that the typhus germ or poison must have been generated on board and constituted a local or de novo origin, as typhus is not a disease of Egypt and there was no typhus existing at Alexandria, the port from which the ship sailed. This was certified to by Dr. Ogilvie Bey and myself, and is mentioned by Dr. Murchison in his standard work on fevers, page 109, foot-note. As we know the circumstances under which typhus has always originated in an epidemic form, so we know the circumstances under which cholera originates, and as the poison of the one has been proved to be capable of being generated from filth, poverty and misery, overcrowding, &c, it requires less faith to believe that under circumstances which we deem favourable to its development, the poison of cholera should also be generated, and these circumstances have existed at Damietta. And another indirect proof may now be added in the slow and slight hold which the epidemic has as yet taken of Alexandria, which suffered proportionally more than Cairo from the epidemic of 1865, when no effectual cleansing or sanitary work was done to prevent it. Though there remains much yet to be done in Alexandria, much, which it is impossible to do, a very great deal has been done. Twice within twelve months the to^rr? has been as thoroughly cleansed as circum- St stances will permit ; once by the Extraordinary Sanitary Commission appointed by the Khedive last July after the bombardment. This Commission, of which I was a member, continued to work from the 14th July to the beginning of September ; once by the excellent work of the Extraordinary Sanitary Commission at present going on. It has been the fashion to refer the origin of all epidemics, especially the epidemic of cholera (a disease of whose origin we know almost nothing), to imported contagion; but satisfactory evidence is still wanting that this is the case. Few who know thoroughly the working of Egyptian quarantine will be bold enough to assert that they conscientiously believe that Egypt has always been preserved by it alone. I have witnessed during the last twenty-three years several quarantines imposed in Egypt against epidemics which certainly did not reach us ; but I should be a bold man indeed it I were to declare that they were kept out by the quarantine which was practised. While vessels from infected ports are allowed to communicate freely with vessels in full pratique and take in cargo from them, their crews have the freest intercourse, so long as a yellow flag is shown at the masthead. The President of the Board of Health of former years declared that by such quarantine, " Nous avons sauvé L'Egypte," only during the last two years has there been a decided attempt to carry out a strict and stringent quarantine by an efficient inspector and well-organized staff, and yet cholera reigns epidemically in Egypt. While the opinion exists that quarantine is the only protection, the danger to Europe will continue to be greater, as it has been proved that the fancied safety by quarantine creates a carelessness to all other sanitary improvement. I most firmly believe that, had the money spent on, and the attention given to, quarantine for many years past, been spent on proper sanitary improvements, and inspec- tion with proper State supervision of public health, the present epidemic of cholera would not have been devastating Egypt, nor should we have run any more risk than we have done, but less during the last eighteen years which have elapsed since the last epidemic. I would put a question in a practical, if not a scientific way, for science as yet has taught us little about cholera. Given circumstances, such as are now notorious as o luting at Damietta ; an over- crowded town, a filthy-living, filthy-feeding population, still suffering from a degree of mental depression from the events of last year, a river almost stagnant in the midst of the town, receiving the contents of latrines, and from which drinking water is taken ; a river teeming with carcases of animals dead of cattle-plague, many of which were eaten by the people, great heat, &c. Given these conditions, or such conditions as exist this year at Damietta, I would ask any professor of public hygiene, is an epidemic likely under such cir- cumstances to break out amongst the population ? He would be a bold man who would answer in the negative. If an epidemic is likely to break out, what form is it most likely to take in Egypt ? The class of filth diseases we know are those likely to prevail under such circum- stances. Typhus, as I have stated, is not a disease- of Egypt, though, from what I have stated at the commencement of this Report, it would seem to have made an attempt to establish itself; enteric fever, though it frequently prevails to a considerable extent, has never been a deadly epidemic among the Egyptians, but is prevailing to a large extent at present on the eastern part of the Delta. Diphtheria shows itself in small outbreaks in particular localities now and then, but does not assume an epidemic form. There remain two diseases which have found Egypt and the Egyptians favourable for their epidemic development — cholera and plague. The latter, for some reason, or in obedience to some law governing epidemics, has not appeared in Egypt for many years, but, since the last appearance of plague, cholera has on several occasions shown that it continues to be the fatal epidemic disease of Egypt. I maintain, therefore, that it is the disease most likely to break out epidemically under the given circumstances, and I maintain equally that it can be prevented by good sanitation. It may be said that such an opinion of the origin of the present epidemic is purely speculation. I reply that it is less specu- lative than that the disease was imported direct from Bombay, as has been maintained bv M. Fauvel, or that the cholera germ has been lying dormant in Egypt tor an indefinite period, and found favourable circumstances at Damietta for its development, the latter theory would be a strong argument in favour of more sanitation and less quarantine. I argue simply on the well-known experience of public hygienists and medical men in 3S general, tha'; when all sanitary luws are notoriousl) outrage;, disease in aa epidemic for;n will break out. (Signed) J. MACKIE, Surgeon to Her Majesty" s Consulate. Alexandria, August 20, 1883. Inclosure 2 in No. 18. Certificate of Death of Case 2. ÏBRAIHIM JOSEPH, de Ramleh, jardinier, entré avec petite fistule à l'anus le 16 Juillet, 188.3 ; y est décédé aujourd'hui, à 8 heures et demie du matin, de typhus avec pétéchies et de grandes bulles de sang de § centim. de diamètre au nombre de trois, dont une était placée à la cuisse gauche, et les deux autres à la région lombaire ; et légère infiltration des glandes inguinales, qui sont grandes comme des amandes. (Signé) Dr. VARENHORST. Alexandrie, le 13 Août, 1883. (Translation.) IBRAlHIM JOSEPH, of Ramleh, gardener, entered with a small fistula ani, the 16th July, 1883 ; died this day, at 8 - 30 a.m., of typhus, with petechias and three large bullee of blood f of a centim. in diameter, of which one was on the left thigh and the other two in the lumbar region ; slight infiltration of the ingual glands, which are as large as almonds. (Signed) Dr. VARENHORST. Alexandria, August 13, 1883. Inclosure 3 in No. 18. Hospital Description Card. — Deaconesses Hospital, Alexandria. Name . . Age .. Religion Occupation Birth place Place of re?idence J )ay of entrance . , Date of departure Ibraibim Joseph. 40 Moslem. Gardener. Alexandria. Ramleh. 16th July. Died 13th August, at S - 80 in the raornina Disease entered : fistula ani, 24th ; typhus with petechia, and with bullas full of blood, in appearance like malignant pustula or " charbon." No. 19. Earl Granville to Sir E. Malet. Sir, Foreign Office, August 29, 1883. I APPROVE your action with respect to the sanitary condition of Damietta, as reported in your despatch of the 17th instant.* I am, &c. (Signed) GRANVILLE. - i * No. 10. 39 No. 20. Earl Granville to Sir E. Malet. Sir, Foreign Office, August 29, 1883. I HAVE learnt with satisfaction the result of Colonel Chermside's proceedings in connection with the cholera epidemic in Egypt, as reported in your despatch of the 18th instant. * I am, &c. (Signed) GRANVILLE. No. 21. Sir E. Malet to Earl Granville. — (Received August 29.) (Telegraphic.) Cairo, August 29, 1888, 10 a.m. SIX doctors and thirty-six hospital assistants arrived from India yesterday evening. No. 22. Sir E. Malet to Earl Granville. — (Received September 4.). My Lord, Cairo, August 21, 1883. WITH reference to my despatch of the 16th instant, Ï have the honour to inclose herewith copy of a despatch which I have received from Mr. Vice-Consul Borg, reporting the result of 'his inquiries from the British Consular Agents in his district on the repeal of the tax on the burial of dead animals. I have, &c. (Signed) EDWARD B. MALET. Inclosure in No. 22. „ Vice- Consul Borg to Sir E. Malet. Sir, Cairo, August 20, 1883. I HAVE the honour to acknowledge your despatch of the 13th instant instructing me to request the Consular Agents in my district to report whether they have any know- ledge of the levying of a tax on the burial of dead animals, and to make inquiries on the subject. I beg to inform you, in reply, that the Consular Agent at Mansourah reports that as the result of extensive inquiries made there and in several villages in the immediate vicinity, he finds that the tax does not now exist, and has not been levied for a number of years. The reports from Tantah and Zagazig are to the effect that the Consular Agents are not aware that any such tax is being levied, and that they have instituted inquiries. Mr. Carr remarks that since the rise of the Nile he has noticed an unusual number of carcasses floating down the " Bahr Shibeen." 1 have, &c. (Signed) RAPH. BORG. No. 23. Sir E. Malet to Earl Granville. — {Received September 4.) My Lord. Cairo, August 23, 1883. WITH reference to my despatch of the 15th instant, I have the honour to inclose herewith a copy of a Report addressed to me by Mr. Vice-Consul Borg upon the cholera in Cairo. I have, &c. (Signed) EDWARD B. MALET. * Ko. 13. 40 Inclosure ] in No. 23. Vice-Consul Borg to Sir J$. Malet. Sir, Caire, August 22, 1883 I HAVE the honour to report that during the week ended on the 18th instant, the deaths from cholera at Cairo numbered fifty-three, per Return herein inclosed. The quarters of Ghemaliyeh and Khalifa have been entirely free of the disease, while only one death in each occurred at Old Cairo and Sayeda Zenab. The Comparative Table of deaths herein annexed, shows that the number of deaths in the fifth week of 1865 (19th to 25th July) were 352. The inclosed Table of meteorological observations shows that the mean average barometrical pressure has been 753*88 against 756*57 for the fifth week of the epidemio in 1865; the mean average temperature 29'6 against 30' I, and the degrees marked by the hygrometer 51 '47 against 12'36. The prevailing winds have been north-east, north-west, and north, against north-west and north in 1865. I have, &c. (Signed) RAPH. 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CM tO . b *-« tO -^ CM r0 i— i — * o C O .C ift 1 ».».»•».».». t-» Oï CO N H K -H CI g o 3 CM CI ». Jl CT» iO CO . Ph Cï CO CM CM CM CO iO S -a 'W id lO rt O O O 1Û ». ». 1 — ». l-^ ». ». M -S o to ». oo ». W CO -* g S Ci lO ilî O C3 -o o 1 u «: -" r^ CM co CM CO iï3 io »o io i^ o o *rt J 1 ». »•»•».».».».»• ! CM CO -f O «O ». OO t i j 3 = 1 i - 1 .i-: . ; 1 4& . No. 24. ; Sir E- Malet to Earl Granville .— (Received September 4.) My Lord, Cairo, August 27, 1883. WITH reference to my despatch of the 13th instant, I have the honour to inclose the official Returns of deaths from cholei'a in Cairo, completed up to date. During the past three days and up to this morning there has been no fresh death.* I have, &c. (Signed) EDWARD B. MALET. * NO; S [1645] H 2 u eo co a> !-t o r-l ai O 1=1 • fH ■<* ri (M u o O 1— c O 1=1 O 8 «4H O 00 c3 A "S r-» s û3 •ooo'i «d »i»h •gt }sn3ny no u3Ai3 ce sures 3\% l\3%zmrv>ii&y •nojiBjtidoj ri 52,065 30,582 58,799 11,070 37,606 34,150 36,701 39,528 13,206 41,944 29J48 13,703 00 o 00 -* «O •gi 'isniny l'MSf-tscn ££:£::: ICI 'f i ^siiSny w »h : • • et n ;•-« : : • rH 0» "SI jsn3ny : eo n : ri : : n ; ; : : : O "61 jsnSny • co • ri et ci : ; ; : n : e* ri •II tsnSnv CD CO CO CO ; CI CO ri M ri CI : eo O ce •01 IsnSuy ©etcoeirii>.usci : e* : :co co •6 jsnSny co t> n eo co »o •**» io :*-h :r-t • •* les p 8 }sn3ny •* eoneoeicscoioeo : ; co eo O 1 co ^ • • I e - 'l lflii5ny eo ■**'«Hiocoeit>'ipeieoe»«ot>-to i— t o •j^snSny U3 nt-*#»at— eococtcieoeococ— co •g fsnSay 00 rMCAca-^i-ooico^ieoeoakr^tw s •f jinSny -* Of— r ri O CO 0> n ■**!©»■* r- • uî O ri Ot CO i— « i— 1 ri r- 1 i— « o te n •g jsnSny «S oa e» r- ao ir- ao t- -* œ e» o et t> n Cl CI ri Cl i-l •g fstrëay CO et -T» IO O O Ci VU ^- O ■* t- îO OD «O CM Ci ^S i— il Cï i— •* "I ;snSny ao et . o i - -* ci » r— -* t— Cr t-- -^ o ui n «*> eo n ci eo eo n \< eo - 18 fat CD CO eoooeo-jitoe>teo^ieoo»n©w CI Tft e© ri — • CI CO ri ri ,«» ct •os *r<>r cie»a>cocoiQr->c7>cico fc- n Ct CO W Ot et co «-« Cf r ^ G1 •65 X|nf § o-cOLOCt Ct »» CO Ct n *S» Cl rH ri eo •iô 4">f et cicoH*ociQO(DOt«c» : co C 1 C - tO Ct CT V Cl i—« ri. a» o •95 Aff i S COCC OeOU5MOiOr1C»«lf3Tji Cl «O CO Cl ri 4Q ci n ri ri CO i '95 *i»r 1 " ■HJ'r1f- Cl Cl 00 Ci n M ri ri et to CO f 5 *IT là •^1 *N «5 co C* W ri t— eo •85 Ai>r in M C* .-i t— oo t— (© > fi ira c ï « :■* CTUJiftcOrICC ri. 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CD S d f (ON § WN *>* t*« i^. r*. *■» *>. 3 D)NC100)C4 m o - O à N0DO.OOH à o h Oimn voco n t-» r*» t>. t-» t-» »r» S "3 E g -s | «1 en !>. 00 Cl O CM rH d 10 0X3(0(00 u **- t^« i>. t- t^ r- . m ONÛOClO-' ■ rH CO •* CO O* C3Î CO ifî iO eo »o ^ ^ «o 4 éS S co 00 t— 1 13 s NO'fl'OlODNN cd & D f-« Tj O» QO Oi CO t- CN CO CO CN CM CM CM faD *-» d d> s Tf CM r* CM CO CM CM h ONCÛHHOO» eu co co eo eo co eo cm t— t V s o . a s *-» CM CM *>» O. CM CM CD ■n m ifl in >n in *■* Nt>N t> Nt>.iS HCniflHHHN w 8 S QOCNOOOCO^H pi tO tO tO »>■ iO ift iO I" O O L* u": O O *~* **. r» c* t>» t-« i>. t* O oo eo oo oo o i-* »o S cm oo «— i -. t» t» c^. t* t^. c^. CJ» O i-* CM CO ■* 1^1 » rH CM CM CM CM CM CM *£ -u eS CO Q a fco p < 55 No. 30. Acting Consul Burrell to Earl Granville. — {Received September 11.) My Lord, Alexandria, September 1, 1883. I HAVE the honour to forward herewith a despatch from Mr. Miéville reporting on the mortality from cholera at Alexandria from the 24th July to the 31st August. I have, &c. (Signed) W. PALFREY BURRELL. Inclosure 1 in No. 30. Consul Mieville to Acting Consul Burrell. Sir, Alexandria, September 1, 1883. SINCE the 24th July, the date on which the prevailing epidemic may be held to have first really shown itself at Alexandria, I have been at some pains to daily glean from the Health Officer all available details as to the nationality, age, and sex of the victims to the cholera. This information I have condensed in a Tabular form, copy of which I have now the honour to inclose. Summarized shortly, this Table shows that from the 24th July to the 31st August (both inclusive) 720 persons have succumbed to the disease, 55 per cent, being males, and 45 per cent, females, while the daily average of the mortality from ordinary causes, which may be taken as about 22 in normal times, rose to 30. Looking to the nationality of the cholera victims, it appears that the natives suffered somewhat over five times as heavily as Europeans. As regards age the following figures show that the mortality was greatest among children under 10 years old and among persons between 30 and 40 years of age :-*- Age. Percentage. From 1 to 10 „ 10 to 20 „ 20 to 30 „ 30 to 4Q „ 40 to 50 „ 50 to 60 „ 60 to 70 Over 70 years . . , . 24 14 16 20 8 6 5 7 100 I beg to draw attention to the fact, which may be held as noteworthy, that the fourth quarter, where the mortality was greatest, is the quarter outside the city drawing its water supply for the most part direct from the Mahmoudieh Canal. This would tend to show that the purifying and cleansing processes to whiph the water supplied to the town through the Water Company has of late been subjected were of practical good. I have, &c. (Signed) W. F. MIEVILLE, British Delegate. 56 ai g 2 CO CO © ,a -^= ^ cm © r& -*a 8 o * .n o «4H CO CO o •a tr. T3 I** rt d c3 •r-l M cq © i— i © • >. . •T- _ H « -• S * u d ; c ffl *» P .S a NNMNrtN«MnnNM«MW»cO'#iiianffls5nMnMno4 ^h r- - . >— < i-^ — ■ ^h i-^ •— i p _— ^^-i-^r^^-^-ci— . .NCiOÎ--ON(Û^OCO(OkSit50ilîiiî . CO N N t M CO H n ( 1*4 9 G> SÎO CO o R » ,MtN^O«(NnœOrt0iQ0tÛcNrtirtCD!3Ot»N^inNrt lOJ.— tcOC^tMCOGOCQ .HCCO?1COi~tM(SC>)T]< .■^HtCHO^iflCO^iCNN . <— i , CM rH N . . t>4 .-» ^ OJ r-l . r-» ,«H . fH X r-l .1<^»0 . C-) CC H H CO H H " - ** o o a Jh -H Q) co SE S ft 3 feo^ o S « ^ r-l^ 1 h in . • .«(Nh , cj .NWMo^h^fl^ffiovffixnncior.Nw-rtrtONNH A^9)ii:^>nHN(0>nc«McOK)(OH .co itNOtOOO^CAO^OlriOfOXNQOCOOeOf-iH^iAO .co . « co .NHNN^iflfin^^toioiooiflo^ino^iONNiON .NP'HHTl'NWHr HN .MHtJltNH HNHHH^tNNH- 4 57 .No. 31. Acting Consul Burrell to Earl Granville. — {Received September 1 1.) My Lord, Alexandria, September 1, 1883. I HAVE the honour to forward herewith a despatch from Mr. Miéville inclosing a statement of the number of deaths from cholera in the different towns and villages of Egypt from the 22nd June to the 21st August. I have, &c. (Signed) W. PALFREY BURRELL. Inclosure 1 in No. 31. Consul Miéville to Acting Consul Burrell. Sir, Alexandria, September 1, 1883. I HAVE the honour to inclose herewith a Tabular statement which I have received from the Maritime and Quarantine Board showing the number of deaths from cholera in the different towns and villages of Egypt from the 22nd June to the 21st August, 1883, and giving the date on which in each several place the epidemic first declared itself. I have, &c. (Signed) W. F. MIÉVILLE, British Delegate. [1645] 58 Inclosure 2 in No. 31. Conseil Sanitaire Maritime et Quarantenaire d'Egypte. Mortalité par Choléra dans les différentes Villes et Villages des Provinces d'Egypte, du 22 Juin au 21 Août, 1883. Ville ou Village de Province. Population. Mortalité générale. Date du premier Décès. Mortalité dans l'Armée Anglaise. Observations. 1833. Damiette . . , . 34,046 1,956 22Jui,> Le dernier décès a eu lieu le 13 Août. Port-Saïd.. 16,560 8 27 „ 4 Juillet. Mansourah . . 26,784 1.075 2 Juillet . . j, „ 6 Août. Samanoud . 352 2 „ 31 Juillet. Alexandrie 208,775 503 2 11 La maladie continue encore. Cherbine 114 3 !. '.. Le dernier décès a eu lieu le 2 Août. Menzaleh. . - . . 256 9 ,. .. « >, 6 M Talka S3 10 ,. .. j> jy * „ Chibin-el-Kom 13,380 1,120 11 ,. .. M )• O 33 Zifteh 226 11 ,. .. »> }3 *■" 33 Ghizeh .. 10,500 693 15 .. .. 10 „ Caire 368,100 5,661 15 .. .. 37 La maladie continue encore. Mit-Gamr , , 216 16 .. .. Le dernier décès a eu lieu le 16 Août. Méhalla-Kibir , . 678 16 ,. .. La maladie continue encore. Sembellawin 161 18 ., .. Le dernier décès a eu lieu le 13 Août. Tantah .. 33,725 539 19 ., .. 21 „ Bénisouef . . . . 138 20 .. .. 15 „ Kafre-Zajat 161 20 ,, .. 17 „ Benha 5,170 157 23 „ .. La maladie continue encore. Ismaïlia . . . . 3,062 56 23 „ . . 25 Le dernier décès a eu lieu le 14 Août. Suez . . 10.913 51 23 „ .. 2U La maladie continue encore. Néfiche . . 4 25 ,, .. Le dernier décès a eu lieu le 5 Août. Ménouf . . . . 113 26 „ .. La maladie continue encore. Minieh Roda 26 27 .. .. Le dernier décès a eu lieu le 9 Août. Barrage Caire 138 27 „ .. a „ 13 „ Minieh 3J2 27 .. .. La maladie continue encore. Kafre Dawar Abu Hummus . . 27 27 ., .. Le dernier décès a eu lieu le 1 2 Août. Zagazig .. 19,046 306 23 21 „ Rosette 1G,671 230 28 ,. La maladie continue encore. Hélouan . . .. 20 23 19 Le dernier décès a eu lieu le 15 Août. Ménourieh 9 23 „ .. „ 28 Juillet. El-Wardan 26 30 „ .. 25 „ ,j 16 Août. Galioub 1 1 3 2 Août . . 2 M Atfeh . , 81 3 „ 20 „ Ghirghé .. , , 240 4 „ La maladie continue encore. Damanhour 25,000 241 6 „ , , 33 33 Villages des Provinces de — Dakahlié . . 1,45G 18 Juillet .. '» 33 Minieh.. .. 532 25 „ .. . . 33 73 Charkieh 1,344 19 „ .. . . » 33 Gavbieh 1,232 14 Juin 33 31 Béhéra. • 554 23 Juiilet .. 3 » 33 Ghizeh.. , , 565 26 „ . . ».• 13 Gallioubieh • . 576 22 ï« )» Bénisouef 749 26 '.', .. »» 33 Ménoufieh 433 21 „ .. Assiout 493 31 ,, »• »■ Keneh . . 134 3 Août . 31 Ghirgheh 854 6 ,. J3 Payoum 381 6 „ "V •> 33 Total 25,023 137 No. 32. Sir E. Malet to Earl Granville. — (Received September 19.) My Lord, Cairo, September 5, 1883. I HAVE the honour to inclose copy of a despatch from the Indian Government, giving the names of the doctors and hospital assistants selected for service in Egypt, and stating the arrangements with regard to their pay and allowances. I have, &c. (Signed) EDWARD B. MALET. 59 Inclosure in No. 32. The Secretary to the Government of India to Sir E. Malet. Sir, Simla, August 10, 1883. IN continuation of telegram dated the 1st August, 1883, I am directed by the Governor- General in Council to inform you of the measures taken by the Government of India for meeting the demand of the Egyptian Government for medical officers and hospital assistants, conveyed in your telegram of the 31st July. 2. Surgeon J. O'Neill, M.I)., Deputy Sanitary Commissioner, Punjab, an officer of eight years' service, has been selected to take charge of the hospital assistants. He has been supplied, as desired, with sets of all medical forms — civil, sanitary, and military — now in use ; also with a copy of the Bengal Medical Regulations. 3. A list of the medical officers selected for special duty in Egypt is given in the margin.* The majority of these officers have certificates in sanitary science. They have been nominated on the terms offered in your telegram, namely, 300/. for three months, in addition to travelling expenses and lodging. 4. The names of the hospital assistants selected for special duty are shown in the margin.! Each has been furnished with a " Eield Medical Companion," with contents complete, and a copy of Surgeon-General Cunningham's " Sanitary Primer." The ordinary grade pay of hospital assistants serving in India is noted marginally.* 5. Each medical officer and hospital assistant has been given permission to take one native servant with him should he desire to do so. 6. It is expected that all the officers and hospital assistants selected will leave Bombay by the mail of the 14th instant, the mail which takes this letter. * Surgeon J. O'Neill, M.D. „ D. P. MacdoDald, M.B. „ S. Little, M.D. ,. G. H. D. Gimlette, M.D. Surgeon T. R. Macdonald. M.B. „ A. H. Pierson. „ L. T. Young, M.B. F. D. 0. Hawkins. No. 34. 44. f 1st Class Hospital Assistants. Ameer Khan. Tuharool Hossain. 49. Shaikh Ameer Buksh. 50. Abdool Mahmood Kban. No. 59. Bowally Buksh. 76. Abdool Kadir. 102. Mahomed Hossain. 111. Shaikh Tajood Been Hossain. 2nd Class Hospital Assistants. No. No. 90. Shaikh Raheem Buksh. 169. Shaikh Fuzl Elahi 97. Khoolub Ooddeen. 183. Gulam Safdar. 106. Shaikh Raheem Buksh. 193. Mortuzza Khan. 10S. Karamutoollah Khan. 195. 113. Shaikh Shahabood Deen. 203. 122. Peer Buksh. 314. 126. Goolam Nubbee. Taig Ally. Ruhmutoollah. Wajid Allée. 3rd Class Hospital Assistants. No. No. 20. Meer Ozeer Allée. 295. 182. Shaikh Raheem Buksh. 306. 204. Kureem Buksh. 310. 206. Shekh Wuheed-ood-deen. 325. 208. Ashan Hoossein. 353. 225. Kureem-ood-deen. 399. 227. Fyz Ahmud. 402. 251. Mahomed Easim. 410 285. BukridAli. 462! 286. Ahmud Hussein. J 1st Class Hospital Assistant 2nd Class Hospital Assistant 3rd Class Hospital Assistant. . [1645] Karam Buksh. Hushmut Ally. Mahomed Din. Shaikh Amjud Ally. Shaikh Moula Buksh. Shaikh Wajeed Ahmud. Rahmut Allée. Fuzel Allahi. Mohamad Ali. Rs. 60 40 25 60 No. 33. Sir E. Baring to Earl Granville. — (Received September 26.) M y Lord > Cairo, September 13, 1883. I HAVE the honour to inclose copy of a Report from Surgeon-General Hunter, forwarding a scheme for the reorganization of the Egyptian medical service. Chérif Pasha, at whose request this scheme was prepared, has been furnished with a French translation of it for the consideration of the Egyptian Government. I have, &c. (Signed) E. BARING. Inclosure 1 in "So. 33. Dr. Hunter to Sir E. Malet. Sir, Cairo, September 8, 1883. I HAVE the honour of forwarding to you, for the information of his Excellency Chérif Pasha, a scheme for the reorganization of the Egyptian medical service, which I have prepared, as requested by you. The scheme supposes a purely civil medical service, embracing, however, curative and preventive medicine, or in other words, a sanitary as well as a medical department ; the administrative and the executive have consequently each a double function devolving on them. The constitution of the sendee consists of an administrative and an executive staff. (A.) — Administrative. One Inspector-General. The Inspector-General must always be a European, resident at Cairo, unless a pressing urgency, such as an outbreak of epidemic disease in some locality,, may call for his presence. Two Deputy Inspectors-General, one to be a European with head-quarters at Alexandria for Lower Egypt ; the other to be a native Moslem of Egypt, with head- quarters at Cairo for Upper Egypt. The duties of these two deputies will necessitate much travelling. (B.) — Executive. The duties of the executive officers will be : — 1 . Charge of the medical school and hospital of Kasr-el-Ain. 2. Sanitary inspection of the town of Cairo. 3. Charge of the general hospital at Alexandria. 4. Sanitary inspection of Alexandria. 5. Charge of the fourteen civil hospitals in the provinces. 6. Charge of the Lunatic Asylum, Ablasié. 7. Charge of the Government medical store. These officers will be for all official duties under their respective Deputy Inspectors- General, to whom all correspondence, reports, returns, &c, whether intended or otherwise for the information of the Inspector-General, will be forwarded. It will be seen on reference to the annexed documents, that a very large establish- ment, with a corresponding heavy outlay, has been accorded to the Kasr-el-Ain Hospital and Medical School. This is owing to the necessity which, in my opinion, exists for the training of properly qualified men and subordinates for the service of the Government, and it is one to which the Egyptian Government cannot too early turn its attention, and make every effort to foster and develop. Owing to the want of qualified men the Government is obliged to have recourse to foreigners, not only for the higher branches of the service but for subordinate purposes also, thereby entailing a heavy expenditure, attended not unfrequently, I fear, with less efficiency than could be desired. Should this school realize the hopes entertained of it, half the members of the medical service would in course of time consist of native Moslems who had received their training there. A subordinate department is one of urgent necessity, and should be introduced with the least practicable delay ; it should be constituted on the lines of the Indian Medical Subordinate Depart- ment. It would be a much less expensive and more efficient agency than that which the 6i Government is now obliged to employ. It would at once get rid of the necessity for employing pharmaciens, as the subordinates would compound and dispense medicines in addition to their other duties. There is not. I believe, any fixed standard for admission into the school, nor is there any curriculum laid down while attending its classes either for the higher or lower education. This should receive immediate attention, and be strictly enforced. Fourteen civil hospitals have been allotted for the more important provincial towns. Each should be capable of affording accommodation for twelve in-patients. The hospitals should be built on one standard plan as funds are available. Buildings which it may be considered desirable to utilize permanently for hospital purposes should not be occupied till such time as the necessary structural alterations have been completed. These estab- lishments are intended for the reception of the sick poor of the town and district, of the gendarmerie and police, of prisoners. The medical officer in charge of one of these hospitals, in addition to his hospital duties, will undertake all sanitary work in the town and district, and will be responsible that vaccination is duly carried out. In this portion of his work he will be assisted by the " médecins d'arrondissement " attached to his hospital, and under his immediate orders. The duties of a " médecin d'arrondissement " will be to travel in the villages of his district. He will attend to all ordinary cases of sickness that he may meet with, and also take effective measures that all severe cases of disease are, when practicable, sent to the hospitals ; he will carry out vaccination, and grant as district registrar permits for burial. He is, moreover, to see that the sanitary rules laid down from time to time under the instructions of the medical officer are duly carried out, and to report any infringement of them. The " sages-femmes : ' are similarly attached to the hospitals, and should be under the orders of the medical officer in charge for such duties as he may call upon them to perform. The Medical Store Department is a new creation, there being nothing, as far as I can discover, to correspond to it in this country. It is a highly-important Department, and, if properly conducted, ought to result in a large saving to the Government. It should be the depot for all authorized medicines and surgical instruments and appliances; from it all hospitals should obtain their supplies, according to a prescribed scale, the indents for this purpose being previously submitted to the Deputy Inspectors-General of the district for their sanction. The officer in charge should be a skilled pharmaceutist, competent to undertake the manufacture of all galenical preparations, such as tinctures, extracts, &c. It is on this account that he has been allowed a large salary and a larger staff than might at first sight be thought necessary. Under the title of " dépenses diverses " I have allowed for the cost, in the various offices, of stationery, telegrams, postage, printing, and water-supply. With regard to other items, such as "menus frais," " gages des nourrices," " fourrage pour les bestiaux," I am unable to give an opinion, except so far as to say that they would not be sanctioned by the Indian Government. I would point out another item which seems to me to require investigation and explanation. In the Budget of 1883, p. 1 10 (sous Chap. 3, Hôpital du Caire, Art. 5, " Dépenses diverses ") is an item " nourriture, médicaments, et autres," against which is a total of £ E. 7,503 ; while for Alexandria it is £ E. 1,866, and for the fourteen Provinces and five Gouvernorats, £ E. 3,126. making £E. 4,992 for the rest of the country, and a grand total of £ E. 12,495* for the annual supply of diet, medicines, &c. I do not venture to express an opinion on the adequacy or otherwise of these amounts, and they are doubtless capable of explanation ; still it seems to me that such explanation and inquiry should be instituted. A correct estimate could only be given after an examination of all the hospital registers of the country for years past. In the scheme forwarded standard requirements would be, as stated above, laid down for each hospital, and thus would be avoided errors and what would seem to be irregularities in the future. Abattoirs. — There does not appear to be any necessity for the employment of such expensive establishments as abattoirs. A couple of policemen might be detailed off for the duty, who ought to see that the place is kept clean. Any infringement of the rules laid down for the conservancy of this establishment ought to be reported by them to the Sanitary Inspector, and dealt with at once. I would here remark that the police should £ E. * Cairo .. .. .. .. .. .. 7,503 Alexandria .. .. .. .. .. .. 18,66 Provinces .. .. .. .. .. .. 3,126 12,495 [1645] L 2 62 afford material assistance in many ways to the Sanitary Department, a thing which at present is quite lost sight of, and this without putting the Government to any expense. The Veterinary Department has been allowed a sufficient establishment, both adminis- trative and executive. The distribution of the latter I have not ventured on, believing it wiser to leave the matter in the hands of the Chief Inspector of that Department. 1 regret that this scheme is not so complete as I could wish ; but the difficulty of obtaining accurate information and the pressure of time have prevented me from rendering a fuller statement. Such as it is, however, if carefully supervised, it will be found, I trust, a good working scheme, sufficient to meet for the present the wants of the country. I inclose a Comparative Return of the Expenses at present allowed for the Medical Department in the Budget for this year, and the Estimates under my own scheme. A balance of £ E. 24,777 remains in favour of the latter, part of which may be employed to repay the cost of " nourriture, médicaments, et autres," &c., and yet leave a large sum in hand. (Signed) W. G. HUNTER, M.D., Surgeon-General. Inclosure 2 in JSo. 33. Scheme for the Reorganization of the Egyptian Medical Service. (A.) — Administrative. I. — 1 Inspector -General (Cairo) Personnel — 1 Chief Clerk 1 Second Clerk . . 1 Arab Clerk 1 Cashier aad Registrar 6 Servants All expenses of office II. — 2 Deputy Inspectors-General — 1 European for Lower Egypt (head-quarters at Alexandria) . . 1 Native Moslem for Upper Egypt (head-quarters at Cairo) Personnel of each Bureau — 2 Clerks, at £ E. 120 4 Servants Travelling allowance All expenses of office :e. £E. £E. • • 1,500 350 120 120 120 150 860 , . 200 1,060 • • 1,200 .. 800 240 100 150 150 • £E. 2,560 640x2 = 1,280 Total for Administrative Department . . 3,280 5,840 (B.) — Executive. Medical School and Hospital of Kasr-el-Ain, Cairo. Medical Store Department, Cairo. Lunatic Asylum, Cairo. Sanitary Inspection of Cairo. Sanitary Inspection of Alexandria. 6. Hospital, Alexandria. 7. Provincial Civil Hospitals. 8. Veterinary Department. 63 1. Medical School and Hospital of Kasr-el-Ain, Cairo. 1 Principal of School, Senior Physician to Hospital and Professor of Medicine and Clinicai Medicine 1 Professor of Physiology and Junior Physician 1 Professor of Surgery and Senior Surgeon 1 Professor of Anatomy and Junior Surgeon 1 Professor of Pathology and Registrar 1 Professor of Chemistr)- and Medical Jurisprudence (Analyst) 1 Professor of Hygiène and Materia Medica 1 Professor of Midwifery and Obstetric Physician (charge of out-patients) . . 1 Professor of Ophthalmology and Oculist to Hospital (ditto) I Pharmacien, 1st Class 1 Pharmacien, 2nd Ciass . . . . . . . . . . . . 2 Aides, at £ E. 72 *i vlCrito •■ • • ■ • mm m • • • •• 40 Infirmiers . . . . . . . . . . . . . . 10 Servants for hospital and school .. .. 2 Sages-femmes, £ E. 144 and £ E. 96 1,000 600 800 600 600 600 600 700 700 250 150 144 400 1,000 200 240 N.B. — Two detached dispensaries, each with six beds, near the Citadel and Bab-Nasr. 8,584 N.B. — It is proposed to abolish the system of the sub-divisional ("tumn") sanitary inspection of Cairo, and to replace it by establishing two good dispensaries, each with six beds, in two of the suburbs of Cairo most distant from Kasr-el-Ain, e.g., the Citadel and Bab-Nasr. 1 Physician . . 1 Pharmacien 1 Sage-femme 3 " 1 Clerk 2 Servants . . All expenses Sages-femmes for out-work £E. • 896X 2 = 1,792 2. Medical Store {and Surgical Instrument and Appliance) Department, Cairo. 1 Pharmaceutical Chemist , 1 Pharmacien 4 Aides, at £ E. 72 1 Cutler 1 Carpenter 6 Servants All expenses £E. £E. 600 300 288 150 80 120 200 1,738 3. Lunatic Asylum, Abbasiyeh. 1 Physician 1 Junior Physician 1 Pharmacien 1 Aide 12 Infirmiers (men and women) 10 Servants All expenses £E. 600 400 150 72 240 200 100 £E. 1.762 4. Sanitary Inspection of Cairo. 1 Inspector 1 Chemist and Analyst 4 Clerks 4 Servants All expenses . . £E. 600 300 360 80 100 £E. 1,440 5. Sanitary Inspection of Alexandria. Inspector Analyst, &c. Clerks Servants All expenses £E. 500 150 180 60 100 £E. 990 N.B. — With regard to the Analysts attached to the Inspections, it is intended that they should be employed only for rough analyses ; all substances requiring delicate analysis are to be forwarded to the Government Analyst at Kasr-el-Ain. 64 6. General Hospital at Alexandria. £E. 1 Physician 600 1 Junior Physician 400 1 Pharmacien 250 2 Aides 144 10 Infirmiers 200 6 Servants 120 2 Clerks 140 1 Sage-femme 50 All expenses 200 f E. 2,104 7. Fourteen Civil Hospitals for the Provinces. Lower Egypt, 10 — (Rosetta, Damietta, Port Said, Suez, Tanta, Damanhour, Shibui-el Kom, Benha, Mansourah, Zagazig). Upper Egypt, 4— (Fayoum, Minieh, Assiout, Girgeh). Personnel of each hospital (each for 12 beds) — 1 Physician l Pharmacien , . 1 Clerk 3 Infirmiers . . 3 Servants £E. 500 150 80 100 70 £E. 900 x 14 = 12,600 1 5 Sages-femmes (2 for Tanta, 1 for each of the other places), at £ E. 48 . . 720 36 Médecins d'arrondissement, at £ E. 84 . . . . . . . . 3,024 16,344 The Médecins d'arrondissement and the Sages-femmes are under the orders of the Medical Officer of the hospital, and are attached to the hospital for special duties. The Médecins d'arrondissement might be distributed as follows : — e.g., Mahallet Kebir, Samanood, &c, according to the district centres, or " Merkezes " of " Kisms." 1 . Garbieh • 8 ~1 2 Behera . . ■. 3 3. Menufieh 2 4. Calinlieh 2 5. Sharkieh . 3> 6. Pakhalieh 3 7. Fayum 8. Upper Egypt 9. Arish and Wageh 3 . 10 • 2J 36 8. Veterinary Department. Administrative — 1 Chief Insrjector 1 Clerk- Travelling allowance Office expenses 1 Sub-Inspector . . 1 Clerk Travelling allowance Office expenses Executive — Veterinary Surgeons for Cairo, Alexandria, and the provinces 400 80 100 50 300 80 100 50 630 530 1,160 1,840 3,000 65 Comparative Return of the Expenses for the Medical Department. Surgeon-Genekal Hunter's Sch SUE. Budget fob 1883 (pp. 109-113). £E. £E, Administrative . „ • 5,840 ( Conseil de Santé l Inspection of the Provinces 5,164 1,446 Medical Store Department . . . . 1,738 Lunatic Asylum -• 1,762 . . 1,485 Sanitary Inspection of Cairo 1,440 ■ • • • .. .. .. 5,924 „ „ Alexandria . . 990 ■• •• • • .. •• 3,753 Medical School and Hospital of Kasr-el-Ain Cairo , . 8,584 • . • . . . . . . • 12,042 Two Dispensaries of Cairo . , 1,792 Hospital at Alexandria 2,104 .. •• • . • • •• 6,864 Fourteen Hospitals for provinces . . , 16,344 Fourteen Provinces and five Gouvernorats . 21,210 Veterinary Department • • 3,000 43,594 (Included in Sanitary Inspections.) 57,888 Nourriture, médicaments, et autres ; Fiais de Bureau de Kasr-el-Ain ; Grant from Ministry of Public ! 9,741 Instruction . . . . ( 742 Fond§ de Réserve, &c. 10,483 Balance to defray above items 24,777 Total Total . . 68,371 68,371 * H s a S m o o S 3 * § ° a. r ta ta & oo 3 "55 O , c O S O s E s. o « o H e; o t" 1 2 z 3 o "•g S' o îz! ° H o M "»