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THE CHOLERA EPIDEMIC.
538 infection. After in question, the cases in the town fell suddenly from a the following con- maximum of 27 in one day to 2 or 3 per day. On July lst cholera reappeared in the neighbourhood of clusions are reached :-1. Sensitisation of non-tuberculous (near which are large and important coal mines); Zanguldak guinea-pigs with tuberculous protein does not alter their up to Jaly 30th some 21 cases with 11 deaths have been resistance to experimental tuberculous infection. 2. Sensiti. recorded here. In Smyrna, where, it will be recalled, - sation to tuberculo-protein and relative immunity (increased cholera reappeared on April 26th, the following cases and eaistance) to infection can occur coincidently in the same deaths have been registered :animals. 3. Resistance to infection is markedly lowered during the period that a sensitised animal is suffering from In order to fully symptoms of anaphylactic shock. appreciate the value of these investigations a study of the whole of Dr. Krause’s remarks are necessary, but we have sufficiently indicated the nature of the work he has accomplished. The treatment of tuberculosis by tuberculin and similar products has lately attracted much attention, and any
tuberculo-protein and immunity giving details of the investigations to
to
tfnetb infnrmahinn ro tn hp wp]nnmprL
I
placed at 251 cases, with 156 deaths. Information respecting the epidemic in the interior of (FROM THE BRITISH DELEGATE TO THE CONSTANTINOPLE Asia Minor is lacking in completeness, but there have been BOARD OF HEALTH.) outbreaks of greater or less severity in a large number of places. In the western portion of the peninsula the disease SINCE the date of my last letter on this subject1 there has has been most active in various villages near the Dardanelles, been a considerable extension of the cholera epidemic. It is at Kutaia, Broussa, Moudania, Panderma, Ejki Shehir, most seriously prevalent at this moment in various parts of Simav, Seraikeui, Merzifun, Denizli, and elsewhere. In the the Turkish Empire and in southern Italy. Russia has so far eastern portion it has been present in Sivas, Tokat, Yazghat, not suffered to anything like the same extent as at a corre- and some other places. In none, however, does it appear to sponding date in preceding years ; indeed, the extent of the have caused, as yet, a very high mortality. wne disease nas aiso spreaa to tne Vl1ayets or 15agaaa ana recrudescence of the disease there is almost insignificant. Sporadic cases of cholera are reported from Austria, Basra. In the former thre were7 cases and 6 deaths in Hungary, France, Bulgaria, Montenegro, and Persia, but in Bagdad itself between July llth and 30th ; 21 cases and 14 deaths at Amara between May 29th and July 25th ; 2 cases mone of these countries is there any sign of an epidemic. i in the neighbourhood of Amara between July 10th and 25th ; Cho7era in RZ6ssia. 80 cases and 76 deaths at Medjri Kebir from July 3rd to Between June 6th and 20i;h (Old Style) 14 cases of cholera 12th ; 23 cases and 14 deaths at Medjri Saghir from July 3rd with 1 death were reported to have occurred in the town of to 12th ; 8 cases and 3 deaths at Kemit between July 10th Nikolaievsk, in the Samara government; 1 death in the and 17ch; and 1 fatal case at Decas on July 12th. All these government of Vitebsk; and 1 case at Kozmodemiansk in places are on or near the Tigris. The totals in the Bagdad that of Kazan. On June 25th there was a case in Baku ; on vilayet are put at 142 cases, with 114 deaths. In the Basra the 26th 3 cases at Nikolaieff (apparently in the Kherson 76 cases, with 49 deaths, were recorded between vilayet government) ; and between Jane 26th and July lst (all these June 8th and July 29;of these, 69 -cases and 44 deaths dates are Old Style) there were 17 cases of cholera and 5 occurred at Basra itself between July 17th and 29th, and 7 THE CHOLERA EPIDEMIC.
I
The totals here
are
-
-
-
-
-
Novorossiisk, Baku, Nikolaieff, cases with 5 deaths at Ozeir between Jane 8th and 13th. Finally, between July 3rd and Ozeir, it should be added, is a centre of pilgrimage for the 9th 18 cases and 5 deaths were recorded in the governments Jewish inhabitants of Mesopotamia and elsewhere, as the of Kherson, Samara and Astrakhan, and in the town of prophet Ezra is buried here (whence the name of Ozeir). It deaths
in
the towns
of
Astrakhan, and Tsaritsyn.
Baratof. was among such pilgrims that the cases of cholera occurred. ,It would almost loak as though the virulence of the cholera There have been no further cases since the dates mentioned. germ, which has caused such widespread havoc in Russia in In European Turkey the revival of cholera has so far been *the last few years, were becoming exhausted; but time almost confined to Constantinople itself. The principal alone can show whether this surmise is not too good to be an important one in view of the actual situation exception, "true. on the Montenegrin border, is the appearance of the disease Crolera in the Turkish Empire. at Ipek, in northern Albania. Between July 10th and 13th Cholera reappeared in Samsoun, on the Black Sea (whence 17 cases and 33 deaths were reported there ; between the 14th and 16 ch there were 10 cases and 15 deaths ; between the no cases had been reported since November last), on 16th and 18th 39 cases and 36 deaths; on the 20th 30 May 28th. Since then the returns have been as follows :deaths ; and on the 21st and 23nd 58 deaths. (These dates are Old Style dates.) There have also been several cases at Diakova in the same region. In Constantinople itself cholera reappeared at the end of May. It seems to have been imported from the Black Sea coast, and some of the earliest cases occurred among persons who had arrived in the capital by steamers which had called at Samsoun, where, as shown above, cholera was already prevalent. The following official figures have since been oublished:— It is interesting to note that the earliest cases here occurred among labourers employed on the railway which is being These men were - constructed from Samsoun to Sivas. encamped on a spot lying between the river Merd-Irmak and a canal, and between the latter and the aqueduct which - carries the river water to be distributed to the town. They A certain number of these cases have occurred among the seem to have contaminated this water, and there was thus a sudden and general extension of the disease throughout the troops garrisoning the capital; but the majority have been It will be recalled that the town. As soon as this water-supply was cut off and other among the civil population. disease was largely spread last autumn by the movements of measures taken to stamp out the disease among the labourers troops in different parts of the country; but greater precautions have been taken in the present outbreak. As was 1 THE LANCET, May 27th, p. 1459.
539 the all
case
last year, the infection
seems
parts of Constantinople and villages on the Bosphorus.
to be
some
widely spread in neighbouring
of the
Cholera still prevails more or less in the Yemen, but it is difficult to obtain exact information as to its extent. It is certain that it was epidemic in several places in the interior in May and June ; among others at Zeidieh, Badjil, Some cases also occurred in June Harounieh, Cournieh, &c. at Salif (nearly opposite to Camaran), where there are extensive salt works, the property of the Public Dbt Administration. At Confudah, a port of some importance, 50 cases, with 39 deaths, were registered between May 21st and 25th. At Hodeidah, the principal port of the Yemen, the disease has prevailed intermittently. Early in June a regiment arrived here from Sanaa, the capital of the Yemen, and in the course of about ten days no less than 116 cases of cholera, with 63 deaths, are stated to have occurred among the men. The infection spread to some extent to the general population, but did not apparently cause an epidemic. Other infected regiments and transports have arrived at the Camaran lazaret, where they have undergone disinfection and quarantines of various lengths. In the village of Camaran itself a few cases have also occurred, but most of these I seem to have been imported from the mainland. The pilgrim season has now begun, and pilgrim ships are constantly arriving at the Camaran lazaret. So far, fortunately, the pilgrims have escaped the disease here.
Cholera in Italy. On June 9Lh the presence of cholera in Italy was first notified ; 2 cases were then stated to have occurred at Serrastretta and 1 at Lungro between June lst and 5th. It is said that the infection was imported to Italy by emigrants from Asia Minor and Constantinople, passing through Italy on their way to America. For some time before the official notification was made large numbers of cases of gastro-enteritis were observed at Naples and elsewhere, and the presence of cholera was widely rumoured before it was officially declared. In Naples 7 cases and 3 deaths from cholera were stated to have occurred between June llth and 15th ; the numbers rapidly rose, and early in July some 30 or 40 cases were being registered daily. In the province of Naples, also, the disease soon became epidemic, as also in those of Caserta, Salerno, and Palermo, while later cases in small numbers were reported from the provinces of Avellino, Campobasso, C.iltanisetta, Messina, Livorno, Trapani, and Rome (1 case at Civita Vecchia). The town and province of Palermo, in Sicily, have also become infected, and the figures here have been considerable. At Palermo several cases occurred in the local lunatic asylum. The rumoured appearance of the disease at Venice was subsequently denied. This year’s epidemic in Italy bears many points of resemblance to that of last year. Cholera in Austria-H1lngary. In June an imported case of cholera was declared to have occurred at Graz (as already reported by your Vienna correspondent, THE LANCET, June 24th, p. 1735). On June 6th a suspected case was seen on a ship arriving at Trieste from Naples. On July 17th two suspected cases were reported from the provinces of Weissenberg and Abonj, but these were later stated not to have been cholera. On July 9th a clockmaker in Trieste died from Asiatic cholera, and several other cases subsequently occurred here. Early in July the disease appeared at Skaljari, near Cattaro, on the Adriatic. In an official statement issued by the Austrian Ministry of the Interior on July 24th it is declared that since May 24th (the date apparently of the first case in Graz) 17 cases of cholera with 10 deaths had occurred in Austria ; of these, 2 occurred at Graz, 11 at Trieste, and 4 at Cattaro. The latest news from Trieste shows that fresh cases are still developing there. Cholera in France. of are reported to have occurred at cholera cases Eight Marseilles. Some of these were imported ; but at least 4 appear to have been of ird’genous origin. None have occurred since July 20th. Cholera in Bulgaria. So far as is known the only case of cholera that has been seen in Bulgaria was one which was reported on July 16th as having occurred in the village of Kaludjik, near to Shumna.
Cholera in Montenegro. July the appearance of cholera in Cettinj6was One confirmed case and one officially reported. suspected case were observed there on July 29th. At the end of
C7tole,ra in Pers.ia. to the the present only occurrence of cholera reported Up from Persian territory has been that of 2 fatal, cases of the disease at Mohammerah, on the Shatt-el-Arab, below Basraa Both occurred in the week ending July 29th.
Constantinople, August
7th.
REPORT ON EGYPT AND THE SOUDAN IN 1910.1 THIS annual report takes up the parable of events in Egypt from the dastardly assassination of the Coptic Prime Minister, Boutros Pasha, and the strained relations which ensued between the Muhammedan and Coptic Egyptians. The ill-judged and obviously premature attempts to conciliate the Nationalist party by giving additional powers and responsi-bility to the native officials at the expense of the good government of the country led to much discontent among the European officials, and culminated in the official pronounce-ment in the House of Commons that there can be no hope of further progress in Egypt until the political agitation against the British occupation has ceased. Those who desire to see Egypt ruled by the Egyptians must be made to understand that that time has not yet arrived and is not within sight, for it is idle to talk of that country being governed by reallyrepresentative institutions so long as only 600,000 of the population of 11,000,000 can read and write. The patriots who clamour unceasingly for the removal of English rule and profess that they themselves are competent to administertheir country would do better to utilise the ir influence in the direction of extending the boon of education to their own brethren. In Egypt’s long history there have been but few occasions when the natives of the land have not lived under foreign sway, but if now they are to rule themselves it is surely not too much to ask as a preliminary that the majority should be able to read and write their own tongue. Among the increased ordinary expenditure of the current year there is a sum of rather more than .615,000 voted to the Public Health Department, chiefly due to the approaching completion of the new lunatic asylum at Khanka, near Cairo ; this asylum will be opened this year with 240 bedsand will be gradually extended to 1000 beds, thus providing eventually asylum accommodation for 2150 insane persons in the two institutions. A grant of &10,000 has- also been made ior the rebuilding of the Government hospital at Eena in Upper Egypt, for the present hospital is in unsuitable, insanitary premises above the elementary school, and reconstruction is badly needed. A grant of <&15,000 has also been provided for an addition to the Cairo Infectious Hospital, well situated in the desert, so that in future paying patients may be admitted. Europeans and others suffering from small-pox, measles, diphtheria, or typhus have now to be nursed at home or are admitted to a small blcek attached to the German Hospital in the town. During last year 57,000 cattle were treated with serum against cattle plague with a total death-rate of l’ 8 per 1000 ; this measure is now popular among the peasants. The mortality among the average prison population of nearly 13,000 i§ only 1- 4 per 1000, and there were during the yearonly 16 deaths from infectious diseases. It has been decided to substitute bread made from maize instead of wheaten bread in all the prisons, and so effect an economy of about .E10.000 a year. Evidently there is no official’ belief in the view that this change of diet may increase the cases of pellagra among the prisoners. The total number of Egyptian pilgrims who went to the Hedjaz amcunted to 17,500, besides an almost equal number of foreigners who passed through Egypt on their way to Mecca. Of the Egyptian pilgrims, 45 contracted cholera, and 32 died, but the disease was arrested at the quarantine stations and failed to get an entrance into Egypt, in spite of menace from Russia, Italy, Tripoli, Asia Minor, and the Red Sea. The long-deferred rebuilding of Kasr-el-Aini Hospital 1 The late Sir E. Gorst’s Report on Egypt and the Soudan in 1910 London. 1911. Pp. 96. Price 10d.
tuberculo-protein and immunity giving details of the investigations to
to
tfnetb infnrmahinn ro tn hp wp]nnmprL
I
placed at 251 cases, with 156 deaths. Information respecting the epidemic in the interior of (FROM THE BRITISH DELEGATE TO THE CONSTANTINOPLE Asia Minor is lacking in completeness, but there have been BOARD OF HEALTH.) outbreaks of greater or less severity in a large number of places. In the western portion of the peninsula the disease SINCE the date of my last letter on this subject1 there has has been most active in various villages near the Dardanelles, been a considerable extension of the cholera epidemic. It is at Kutaia, Broussa, Moudania, Panderma, Ejki Shehir, most seriously prevalent at this moment in various parts of Simav, Seraikeui, Merzifun, Denizli, and elsewhere. In the the Turkish Empire and in southern Italy. Russia has so far eastern portion it has been present in Sivas, Tokat, Yazghat, not suffered to anything like the same extent as at a corre- and some other places. In none, however, does it appear to sponding date in preceding years ; indeed, the extent of the have caused, as yet, a very high mortality. wne disease nas aiso spreaa to tne Vl1ayets or 15agaaa ana recrudescence of the disease there is almost insignificant. Sporadic cases of cholera are reported from Austria, Basra. In the former thre were7 cases and 6 deaths in Hungary, France, Bulgaria, Montenegro, and Persia, but in Bagdad itself between July llth and 30th ; 21 cases and 14 deaths at Amara between May 29th and July 25th ; 2 cases mone of these countries is there any sign of an epidemic. i in the neighbourhood of Amara between July 10th and 25th ; Cho7era in RZ6ssia. 80 cases and 76 deaths at Medjri Kebir from July 3rd to Between June 6th and 20i;h (Old Style) 14 cases of cholera 12th ; 23 cases and 14 deaths at Medjri Saghir from July 3rd with 1 death were reported to have occurred in the town of to 12th ; 8 cases and 3 deaths at Kemit between July 10th Nikolaievsk, in the Samara government; 1 death in the and 17ch; and 1 fatal case at Decas on July 12th. All these government of Vitebsk; and 1 case at Kozmodemiansk in places are on or near the Tigris. The totals in the Bagdad that of Kazan. On June 25th there was a case in Baku ; on vilayet are put at 142 cases, with 114 deaths. In the Basra the 26th 3 cases at Nikolaieff (apparently in the Kherson 76 cases, with 49 deaths, were recorded between vilayet government) ; and between Jane 26th and July lst (all these June 8th and July 29;of these, 69 -cases and 44 deaths dates are Old Style) there were 17 cases of cholera and 5 occurred at Basra itself between July 17th and 29th, and 7 THE CHOLERA EPIDEMIC.
I
The totals here
are
-
-
-
-
-
Novorossiisk, Baku, Nikolaieff, cases with 5 deaths at Ozeir between Jane 8th and 13th. Finally, between July 3rd and Ozeir, it should be added, is a centre of pilgrimage for the 9th 18 cases and 5 deaths were recorded in the governments Jewish inhabitants of Mesopotamia and elsewhere, as the of Kherson, Samara and Astrakhan, and in the town of prophet Ezra is buried here (whence the name of Ozeir). It deaths
in
the towns
of
Astrakhan, and Tsaritsyn.
Baratof. was among such pilgrims that the cases of cholera occurred. ,It would almost loak as though the virulence of the cholera There have been no further cases since the dates mentioned. germ, which has caused such widespread havoc in Russia in In European Turkey the revival of cholera has so far been *the last few years, were becoming exhausted; but time almost confined to Constantinople itself. The principal alone can show whether this surmise is not too good to be an important one in view of the actual situation exception, "true. on the Montenegrin border, is the appearance of the disease Crolera in the Turkish Empire. at Ipek, in northern Albania. Between July 10th and 13th Cholera reappeared in Samsoun, on the Black Sea (whence 17 cases and 33 deaths were reported there ; between the 14th and 16 ch there were 10 cases and 15 deaths ; between the no cases had been reported since November last), on 16th and 18th 39 cases and 36 deaths; on the 20th 30 May 28th. Since then the returns have been as follows :deaths ; and on the 21st and 23nd 58 deaths. (These dates are Old Style dates.) There have also been several cases at Diakova in the same region. In Constantinople itself cholera reappeared at the end of May. It seems to have been imported from the Black Sea coast, and some of the earliest cases occurred among persons who had arrived in the capital by steamers which had called at Samsoun, where, as shown above, cholera was already prevalent. The following official figures have since been oublished:— It is interesting to note that the earliest cases here occurred among labourers employed on the railway which is being These men were - constructed from Samsoun to Sivas. encamped on a spot lying between the river Merd-Irmak and a canal, and between the latter and the aqueduct which - carries the river water to be distributed to the town. They A certain number of these cases have occurred among the seem to have contaminated this water, and there was thus a sudden and general extension of the disease throughout the troops garrisoning the capital; but the majority have been It will be recalled that the town. As soon as this water-supply was cut off and other among the civil population. disease was largely spread last autumn by the movements of measures taken to stamp out the disease among the labourers troops in different parts of the country; but greater precautions have been taken in the present outbreak. As was 1 THE LANCET, May 27th, p. 1459.
539 the all
case
last year, the infection
seems
parts of Constantinople and villages on the Bosphorus.
to be
some
widely spread in neighbouring
of the
Cholera still prevails more or less in the Yemen, but it is difficult to obtain exact information as to its extent. It is certain that it was epidemic in several places in the interior in May and June ; among others at Zeidieh, Badjil, Some cases also occurred in June Harounieh, Cournieh, &c. at Salif (nearly opposite to Camaran), where there are extensive salt works, the property of the Public Dbt Administration. At Confudah, a port of some importance, 50 cases, with 39 deaths, were registered between May 21st and 25th. At Hodeidah, the principal port of the Yemen, the disease has prevailed intermittently. Early in June a regiment arrived here from Sanaa, the capital of the Yemen, and in the course of about ten days no less than 116 cases of cholera, with 63 deaths, are stated to have occurred among the men. The infection spread to some extent to the general population, but did not apparently cause an epidemic. Other infected regiments and transports have arrived at the Camaran lazaret, where they have undergone disinfection and quarantines of various lengths. In the village of Camaran itself a few cases have also occurred, but most of these I seem to have been imported from the mainland. The pilgrim season has now begun, and pilgrim ships are constantly arriving at the Camaran lazaret. So far, fortunately, the pilgrims have escaped the disease here.
Cholera in Italy. On June 9Lh the presence of cholera in Italy was first notified ; 2 cases were then stated to have occurred at Serrastretta and 1 at Lungro between June lst and 5th. It is said that the infection was imported to Italy by emigrants from Asia Minor and Constantinople, passing through Italy on their way to America. For some time before the official notification was made large numbers of cases of gastro-enteritis were observed at Naples and elsewhere, and the presence of cholera was widely rumoured before it was officially declared. In Naples 7 cases and 3 deaths from cholera were stated to have occurred between June llth and 15th ; the numbers rapidly rose, and early in July some 30 or 40 cases were being registered daily. In the province of Naples, also, the disease soon became epidemic, as also in those of Caserta, Salerno, and Palermo, while later cases in small numbers were reported from the provinces of Avellino, Campobasso, C.iltanisetta, Messina, Livorno, Trapani, and Rome (1 case at Civita Vecchia). The town and province of Palermo, in Sicily, have also become infected, and the figures here have been considerable. At Palermo several cases occurred in the local lunatic asylum. The rumoured appearance of the disease at Venice was subsequently denied. This year’s epidemic in Italy bears many points of resemblance to that of last year. Cholera in Austria-H1lngary. In June an imported case of cholera was declared to have occurred at Graz (as already reported by your Vienna correspondent, THE LANCET, June 24th, p. 1735). On June 6th a suspected case was seen on a ship arriving at Trieste from Naples. On July 17th two suspected cases were reported from the provinces of Weissenberg and Abonj, but these were later stated not to have been cholera. On July 9th a clockmaker in Trieste died from Asiatic cholera, and several other cases subsequently occurred here. Early in July the disease appeared at Skaljari, near Cattaro, on the Adriatic. In an official statement issued by the Austrian Ministry of the Interior on July 24th it is declared that since May 24th (the date apparently of the first case in Graz) 17 cases of cholera with 10 deaths had occurred in Austria ; of these, 2 occurred at Graz, 11 at Trieste, and 4 at Cattaro. The latest news from Trieste shows that fresh cases are still developing there. Cholera in France. of are reported to have occurred at cholera cases Eight Marseilles. Some of these were imported ; but at least 4 appear to have been of ird’genous origin. None have occurred since July 20th. Cholera in Bulgaria. So far as is known the only case of cholera that has been seen in Bulgaria was one which was reported on July 16th as having occurred in the village of Kaludjik, near to Shumna.
Cholera in Montenegro. July the appearance of cholera in Cettinj6was One confirmed case and one officially reported. suspected case were observed there on July 29th. At the end of
C7tole,ra in Pers.ia. to the the present only occurrence of cholera reported Up from Persian territory has been that of 2 fatal, cases of the disease at Mohammerah, on the Shatt-el-Arab, below Basraa Both occurred in the week ending July 29th.
Constantinople, August
7th.
REPORT ON EGYPT AND THE SOUDAN IN 1910.1 THIS annual report takes up the parable of events in Egypt from the dastardly assassination of the Coptic Prime Minister, Boutros Pasha, and the strained relations which ensued between the Muhammedan and Coptic Egyptians. The ill-judged and obviously premature attempts to conciliate the Nationalist party by giving additional powers and responsi-bility to the native officials at the expense of the good government of the country led to much discontent among the European officials, and culminated in the official pronounce-ment in the House of Commons that there can be no hope of further progress in Egypt until the political agitation against the British occupation has ceased. Those who desire to see Egypt ruled by the Egyptians must be made to understand that that time has not yet arrived and is not within sight, for it is idle to talk of that country being governed by reallyrepresentative institutions so long as only 600,000 of the population of 11,000,000 can read and write. The patriots who clamour unceasingly for the removal of English rule and profess that they themselves are competent to administertheir country would do better to utilise the ir influence in the direction of extending the boon of education to their own brethren. In Egypt’s long history there have been but few occasions when the natives of the land have not lived under foreign sway, but if now they are to rule themselves it is surely not too much to ask as a preliminary that the majority should be able to read and write their own tongue. Among the increased ordinary expenditure of the current year there is a sum of rather more than .615,000 voted to the Public Health Department, chiefly due to the approaching completion of the new lunatic asylum at Khanka, near Cairo ; this asylum will be opened this year with 240 bedsand will be gradually extended to 1000 beds, thus providing eventually asylum accommodation for 2150 insane persons in the two institutions. A grant of &10,000 has- also been made ior the rebuilding of the Government hospital at Eena in Upper Egypt, for the present hospital is in unsuitable, insanitary premises above the elementary school, and reconstruction is badly needed. A grant of <&15,000 has also been provided for an addition to the Cairo Infectious Hospital, well situated in the desert, so that in future paying patients may be admitted. Europeans and others suffering from small-pox, measles, diphtheria, or typhus have now to be nursed at home or are admitted to a small blcek attached to the German Hospital in the town. During last year 57,000 cattle were treated with serum against cattle plague with a total death-rate of l’ 8 per 1000 ; this measure is now popular among the peasants. The mortality among the average prison population of nearly 13,000 i§ only 1- 4 per 1000, and there were during the yearonly 16 deaths from infectious diseases. It has been decided to substitute bread made from maize instead of wheaten bread in all the prisons, and so effect an economy of about .E10.000 a year. Evidently there is no official’ belief in the view that this change of diet may increase the cases of pellagra among the prisoners. The total number of Egyptian pilgrims who went to the Hedjaz amcunted to 17,500, besides an almost equal number of foreigners who passed through Egypt on their way to Mecca. Of the Egyptian pilgrims, 45 contracted cholera, and 32 died, but the disease was arrested at the quarantine stations and failed to get an entrance into Egypt, in spite of menace from Russia, Italy, Tripoli, Asia Minor, and the Red Sea. The long-deferred rebuilding of Kasr-el-Aini Hospital 1 The late Sir E. Gorst’s Report on Egypt and the Soudan in 1910 London. 1911. Pp. 96. Price 10d.