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THE CHOLERA EPIDEMIC.
840 The totals since the beginning of the 13th were placed at 1318 cases and 793 deaths, among the civil population. Since the middle of January remarkably severe weather has been prevalent in Constantinople and neighbourhood. In Salonica no cases have been reported since Dec. 31st, and the whole of European Turkey seems to be now free from cholera. was
THE CHOLERA EPIDEMIC.
(BY
THE
BRITISH DELEGATE TO THE CONSTANTINOPLE BOARD OF HEALTH.)
Cholera in Russia. CHOLERA still lingers in Russia, as shown by the following returns (in continuation of the figures published in my last letter in THE LANCET of Feb. llth, p. 395) :Week
ending Nov.
"
"
"
"
"
19
"
"
"
"
20 th
......
., 27th ...... 4th ......
Dec.
llth
"
......
,, 18th ...... ,, 25th ......
Week
ending
Jan.
""
""
11
"
"
"
"
"
1st 8th 15th
" 22nd
......
......
......
......
following
are
4 cases,1 death. 2 4 " " 6 9 " " 2 ,, 1 "
Cholera in Hzzngary. On Dec. 30th it was officially stated that no fresh case of cholera had occurred in any part of Hungary-Croatia and Slavonia included-for five days, and the whole country was declared "clean." The following additional figures have been received for the outbreak in Croatia and Slavonia;Between Nov. 5th and 12th there were 9 cases and 8 deaths, occurring in six different places, situated in five different counties; between Nov. 12th and 19th there were 11 cases and 4 deaths in six places, in four different counties ; and between Nov. 19th and 26th there were 4 cases and 2 deaths in four places. All these cases were confirmed bacteriologically. Between Nov. 26th and Dec. 4th no further cases occurred ; but between the 4th and 10th 2 cases, both fatal, occurred in the county of Srien, and between the 10th and 17th 1 case in that of Agram. Cholera in -Italy. The latest returns from Italy are as follows :- In the week ending Dec. 14th 38 cases and 11 deaths ; of these, 3 cases and 1 death occurred in the province of Aquila, 1 case in that of Caltanisetta, 9 cases and 4 deaths in that of Caserta, 6 cases and 1 death in that of Lecce, 9 cases and 2 deaths in that of Palermo (including 7 cases and 1 death in the Palermo lunatic asylum), 3 cases and 3 deaths in that of Rome, and 7 cases in that of Salerno. In the week ending Dec. 21st there were 18 cases and 2 deaths, distributed as follows :-1 case and 1 death in the province of Caltanisetta, 4 cases in that of Caserta, 9 cases in that of Lecce, 3’ cases and 1 death in that of Palermo (all in the asylum above alluded to), and 1 case in that of Salerno. No detailed returns have been received here since the last-named date, but it is declared officially that since Jan. 31st no further case of cholera has occurred on Italian territory. Cholera in Constantinople and Turkey in Europe. The cholera outbreak in this city came to an end early in January. In the week ending Jan. 2nd there had been 62 cases and 46 deaths ; in that ending Jan. 9th the figures fell to 17 cases and 20 deaths ; and between the 10th and 13th 10 more cases and 8 deaths were registered. The last new case occurred on the llth, and ten days later Constantinople
Sept.
Ttirleey and aniong Returning Pilgrims. have been the recent weekly returns from
Cholera in Asiatic
following Smyrna :Week ending "
"
The cases and deaths in the bulletins for Jan. 1st and 8th all occurred in the Ekaterinoslav government, those in the bulletin for Jan. 15th in the governments of Podolia and Kief, and those in the bulletin for Jan. 22nd in the government of Podolia. (All the above dates are according to the Old Style.) Cholera in Austria. On Dec. 10th the Austrian Minister of the Interior declared officially that no case of cholera had occurred on Austrian soil since Nov. 7th, and that from the beginning of the outbreak on August 23rd there had been only 15 cases with 5 deaths. The last case was that of a major in the army, who arrived at Graz on Nov. 5th and was apparently already sickening with an attack of cholera ; he had come from Pancsova, in the county of Torontal, which had already been declared an infected district.
.
on
The
30 cases, 16 deaths. 34 18 " " 13’ " 9 " 37 18 " " 14 5 " " 2 3 " "
The above are "corrected"figures; the uncorrected " -
declared free.
epidemic
I
"
"
"
"
"
"
"
"
"
.,
The last
case
Jan. ""
lst 8th
......
......
" l5th ...... ,, 22nd ...... ,, 29th
......
Feb.
5th
" 12th
here occurred
......
......
on
12 cases, 8 deaths. 20 " " 38" 27 " 86" 51 " 32 " 69., 15" 11 " 3 " 5"
36
the 7th, and
Smyrna has now
been declared cholera-free. In all 341 cases and 213 deaths have been recorded in the town. Recently a few cases of suspected cholera have occurred in the neighbourhood of Broussa, and in that of Zunguldak on the Black Sea. Otherwise the whole of Asia Minor appears to be now free from the disease. The same statement may be made in regard to the Bagdad vilayet ; 5 cases and 5 deaths occurred here (at Kerbela, one of the Shiah holy cities) on Jan. 1st and 2nd, and none have been reported since. The outtreak of cholera among the returning pilgrims, the beginning of which was reported in my last letter, has caused a considerable, but not excessively high, mortality. In Mecca the following cases and deaths have been recorded:-
Between Dec. 26th and Jan. 15th...... 119 cases, K6deaths,. Jan. 16to" 24 " 26 " " " 22nd 10 " 10 " " 23rd " 28th ......
......
Since the last-named date Mecca appears to have been free from the disease. The totals here are put at 153 cases with 142 deaths. These figures are in all probability below the truth. In Jeddah the disease was first seen about Jan. 10th ;;. the first cases occurred among the troops. The outbreak in this port seems to have been limited to about a score of cases, and on Feb. 9th it was telegraphed that no further cholera bulletins would be issued, the outbreak appearing to be at an end. From Yanbo only irregular and imperfect reports have been received ; on Jan. 8th it was reported that 7 cases and 2 deaths had occurred there ; and on Jan. 13th the totals were said to be 24 cases and 21 deaths. No further news has been received from Yanbo. An outbreak of cholera, in regard to which it has proved difficult to obtain exact information, has occurred in the Yemen, in the neighbourhood of Hodeidah. The first cases were seen in the village of Badjil, 25 miles to the north-east of Hodeidah,; between Jan. 9th and 16th 48 cases of cholera and 37 deaths were recorded here ; two fatal cases were also seen at Zeidieh, a village to the north. Between the 16th and 21st 10 further cases, with 9 deaths, occurred at Badjil. On the 21st it was
reported that cholera,, "confirmed bacteriologically," was prevalent among the troops in Hodeidah, causing many cases and deaths ; that 3 cases and 2 deaths had occurred among the native population ; and that it was reported "unofficially" that cholera existed among the troops at Menaba. Three cases of the disease occurred in the Camaran lazaret, among pilgrims returning to the Yemen and carried on board the s.s. Budre; the first case was isolated on Jan. 8th, the second on the 9th, and the third on the 17th. Vice consular from Hodeidah also state that cholera had, according reports to"I unofficial" reports, broken out among recruits on a transport steamer, the s.s. Saiyar, and that between Jan. 17th and .19th 50 cases of the disease and 18 deaths had occurred among them. Large numbers of troops are still being poured into the Yemen, where the bulk of the Arab tribes are in revolt, and it is generally believed that both the Turkish army and the Arabs are suffering from a more or less severe outbreak of cholera ; but, as already stated, it is most difficult to learn the true fads. As was anticipated, the infection was carried from Mecca to Medina by the caravans of returning pilgrims. Apparently tle first infected group arrived at Medina on Jan. 4th; it had had 5 cases and 4 deaths from cholera. Succeeding caravans arrived in the same condition ; they reported that the disease had appeared
841 among them at Rabigh (or Rabouk)—the important point on epidemic was ascribed to the bad water-supply, which still the most westerly of the three roads from Mecca to Medina. remains ever the same. I think that readers of THE LANCET and the spot where it is generally thought a new port will may find the story instructive. some day be made, destined to replace Jeddah, and perhaps Cherbourg gets its water-supply, it appears, mainly to be the terminus of the railway between Mecca and the from the Divette, but also from brooks, from certain coast. On the 10th as many as 14,000 pilgrims arrived springs, and from wells. People who live just above the from Mecca in the day, and 51 cases of cholera with 25 town use the Divette water exactly as they pump it up ; deaths were recorded among them. The disease also pre- the navy has a station a mile above the town where they vailed among the inhabitants of the town, and a score or so take water from it-water they pipe to the arsenal for of cases occurred daily for some time. By Jan. 27th 400 boilers, washing, and the like ; just below this is the It may be noted town’s intake-the water is allowed to settle and is ;,ases and 510 deaths had been registered. that infected caravans continued to arrive from Mecca, both filtered before distribution as drinking water. Owing by the most westerly and the most easterly roads ; and that to the geological conditions of the district the springs among some 7000 pilgrims arriving in Medina from Yanbo no cannot be secured against pollution, but from them the barracks are supplied, water intended for drinking being all case of cholera occurred, showing that in all probability the outbreak at Yanbo has not been a very severe one. Thesterilised before issue. Taps-" washing water only "-are latest returns from Medina show that only 3 or 4 cases arefrequent throughout the barracks and the arsenal, and men will :make mistakes. occurring there daily. Only one barrack has a supply in which coli has bacillus never yet been found, and its men got off Cholera on the Hedjaz l2aihvay. in the last epidemic. The small houses of the very lightly The first pilgrim train leftMedina for the north on Jan. 5th, district, café, public-houses, lodgings affected by soldiers with 429 pilgrims. Groups of from 300 to 500 pilgrims con-and sailors generally get their water from wells which are tinued steadily to arrive at the Tebuk lazaret once or twiceall suspected ; many have been closed as they contained too aday. Among the first groups to reach the lazaret threemany of the bacillus coli. As to conservancy, there is no suspected cholera cases occurred, and these were subsequently general l system of water carriage, but there are a great number confirmed bacteriologically. Since then apparently no cases (of leaking cesspools and many pail-closets. The nightsoil is of the disease have been seen there. It has to be remembered, on the fields in the valley of the Divette above the spread that the Tebuk lazaret is still an improvised one, though it town or around the brooks mentioned, and it has been for already possesses most of the essentials of such an institution. 1long believed that the water becomes charged habitually Some alarm was created recently by the report that cholerawith the bacillus coli and from time to time with the bad occurred among pilgrims arriving at Damascus, after bacillus i typhosus. baving done their quarantine and other measures at Tebuk ; Medical men have for years been preaching about the but fortunately this report appears to have been quite terrible risk and the constant damage to the health of the unfounded, and so far as is known no case of cholera has garrison and of the townspeople involved in this lack of pro1 yet occurred north of the lazaret of Tebuk. Some tection of the water-supply, but nothing thorough has been cases have been more than once reported as occurring in the(done. In 1889 there were 394 cases of enteric fever in the trains between Tebuk and Damascus, but none of these havenaval hospital with 75 deaths ; the director of the naval board been confirmed ; indeed, they have all been officially declared (of health pointed out that it was not filters only, but a pure not to have been cases of cholera. The pilgrims are subthat was required, adding that it was the duty water-supply jected to a final medical visit on their arrival at the’Kadem (of the board of health to emphasise the dangers, but the duty The movement (of the terminus of the railway in Damascus. superior authorities to remove them. A military northwards of pilgrims still continues, and so long as it con- medical officer, too, at the same time insisted on the need for tinues there must always be a danger of cholera appearing but only Chamberland filters were installed. As water, 1 pure among them at Damascus or elsewhere, in spite of the far back as 1898 and 1899, 665 cases were treated in the measures executed at Tebuk. naval hospital with 189 deaths, and Director Rouvier wrote Cholera in Persia. that the navy must have good water for itself, and to shield i men from infection must require the town, too, to get Cholera appears to have lingered in many parts of Persiaits throughout the month of December. A telegram froma good supply. Yet the source of supply remains as before, Teheran, dated Jan. 7th, stated that cholera ’’existed posi- only the army and navy sterilise some water for their tively"at the end of December in the towns of Hamadan, men, and the town seems to purify its water in some Kerman, and Mohammera, and that,"according to all degree by sedimentation and filtration. That is all that appearances," the provinces of Ghilan, Kaskin (? Kazvin),has been done. The dangers are so well known to the i that they avoid drinking the water as far as Khorassan and Kaian (?) were not yet completely free frominhabitants the disease. On Jan. 22nd another telegram stated that no possible; some very scrupulously filter all they use, others 1buy the water of a particular spring, reputed safe, in bottles case had occurred in any part of Persia since the 20th. for 17th. drinking and personal washing ; others, again, drink Feb. Constantinople, nothing but cider. Cherbourg is always liable to an outburst of enteric and some 30 deaths due to the disease occur fever, THE DANGEROUS WATER-SUPPLY OF there every year. The story of the epidemic of 1909 is a CHERBOURG. typically instructive one. On Jan. 7th a case of illness was in the Naval Hospital and gave on the llth a received (FROM A CORRESPONDENT.) positive Widal reaction. Eight cases in all were received during January ; they were from the arsenal. On Feb. 6th CHERBOURG, the French naval port, lies at the mouth of there came four men all from different parts of the the river Divette, and in the lower part of its basin. It is adistrict, showing that the whole of the water-supplies were town of some 43,000 inhabitants, of whom 16,000 areinfected, 65 were received in the first fortnight of February, employed in the arsenal or are in the army or navy. It has !92 in the next fortnight, 59 and 69 in the successive a sinister reputation as the town in France, Toulon onlyfortnights of March, by which time the epidemic was nearly - excepted, the most seriously and constantly infected withover, only 16 cases appeared in April, two in May, and six in enteric fever. The enteric death-rate of Toulon in the ten 1the next three months. There were 317 cases altogether, of years 1897 to 1906 is stated at 0-86 per 1000 living, thatwhom 58 died. It appears that the only body of men who of Cherbourg at 0- 71 per 1000, while Paris only lost 0-15 per 4conspicuously suffered little were the two regiments whose 1000 of her population by this disease. These figures are barracks 1 rejoice in the water-supply free from bacillus coli taken from a detailed account of an epidemic in Cherbourg (13 cases and two deaths between the two regiments). As ( in 1909, which appeared in December and January in thesoon as the existence of the epidemic was recognised all the Archives de Médecine Navale, written by Dr. L. E. F. Brunet,emergency measures that could be taken to stop it were Médecin de premiere classe. His tables show that enteric :suggested by the doctors and at once put in orders. They could fever is every year present in Cherbourg, but that notablenot be expected to make any difference for a fortnight or three epidemics occurred amongst the Government employees ofweeks, and in the meantime everybody came to show sympathy all kinds (the people who are treated in the naval hospital)with the sick. The Minister of Marine came, the Underin 1889, 1898 and 1899, and in 1909, and that every single 1Secretary for War, many high functionaries, the Committee
I
suspicious1
_________________.
THE CHOLERA EPIDEMIC.
(BY
THE
BRITISH DELEGATE TO THE CONSTANTINOPLE BOARD OF HEALTH.)
Cholera in Russia. CHOLERA still lingers in Russia, as shown by the following returns (in continuation of the figures published in my last letter in THE LANCET of Feb. llth, p. 395) :Week
ending Nov.
"
"
"
"
"
19
"
"
"
"
20 th
......
., 27th ...... 4th ......
Dec.
llth
"
......
,, 18th ...... ,, 25th ......
Week
ending
Jan.
""
""
11
"
"
"
"
"
1st 8th 15th
" 22nd
......
......
......
......
following
are
4 cases,1 death. 2 4 " " 6 9 " " 2 ,, 1 "
Cholera in Hzzngary. On Dec. 30th it was officially stated that no fresh case of cholera had occurred in any part of Hungary-Croatia and Slavonia included-for five days, and the whole country was declared "clean." The following additional figures have been received for the outbreak in Croatia and Slavonia;Between Nov. 5th and 12th there were 9 cases and 8 deaths, occurring in six different places, situated in five different counties; between Nov. 12th and 19th there were 11 cases and 4 deaths in six places, in four different counties ; and between Nov. 19th and 26th there were 4 cases and 2 deaths in four places. All these cases were confirmed bacteriologically. Between Nov. 26th and Dec. 4th no further cases occurred ; but between the 4th and 10th 2 cases, both fatal, occurred in the county of Srien, and between the 10th and 17th 1 case in that of Agram. Cholera in -Italy. The latest returns from Italy are as follows :- In the week ending Dec. 14th 38 cases and 11 deaths ; of these, 3 cases and 1 death occurred in the province of Aquila, 1 case in that of Caltanisetta, 9 cases and 4 deaths in that of Caserta, 6 cases and 1 death in that of Lecce, 9 cases and 2 deaths in that of Palermo (including 7 cases and 1 death in the Palermo lunatic asylum), 3 cases and 3 deaths in that of Rome, and 7 cases in that of Salerno. In the week ending Dec. 21st there were 18 cases and 2 deaths, distributed as follows :-1 case and 1 death in the province of Caltanisetta, 4 cases in that of Caserta, 9 cases in that of Lecce, 3’ cases and 1 death in that of Palermo (all in the asylum above alluded to), and 1 case in that of Salerno. No detailed returns have been received here since the last-named date, but it is declared officially that since Jan. 31st no further case of cholera has occurred on Italian territory. Cholera in Constantinople and Turkey in Europe. The cholera outbreak in this city came to an end early in January. In the week ending Jan. 2nd there had been 62 cases and 46 deaths ; in that ending Jan. 9th the figures fell to 17 cases and 20 deaths ; and between the 10th and 13th 10 more cases and 8 deaths were registered. The last new case occurred on the llth, and ten days later Constantinople
Sept.
Ttirleey and aniong Returning Pilgrims. have been the recent weekly returns from
Cholera in Asiatic
following Smyrna :Week ending "
"
The cases and deaths in the bulletins for Jan. 1st and 8th all occurred in the Ekaterinoslav government, those in the bulletin for Jan. 15th in the governments of Podolia and Kief, and those in the bulletin for Jan. 22nd in the government of Podolia. (All the above dates are according to the Old Style.) Cholera in Austria. On Dec. 10th the Austrian Minister of the Interior declared officially that no case of cholera had occurred on Austrian soil since Nov. 7th, and that from the beginning of the outbreak on August 23rd there had been only 15 cases with 5 deaths. The last case was that of a major in the army, who arrived at Graz on Nov. 5th and was apparently already sickening with an attack of cholera ; he had come from Pancsova, in the county of Torontal, which had already been declared an infected district.
.
on
The
30 cases, 16 deaths. 34 18 " " 13’ " 9 " 37 18 " " 14 5 " " 2 3 " "
The above are "corrected"figures; the uncorrected " -
declared free.
epidemic
I
"
"
"
"
"
"
"
"
"
.,
The last
case
Jan. ""
lst 8th
......
......
" l5th ...... ,, 22nd ...... ,, 29th
......
Feb.
5th
" 12th
here occurred
......
......
on
12 cases, 8 deaths. 20 " " 38" 27 " 86" 51 " 32 " 69., 15" 11 " 3 " 5"
36
the 7th, and
Smyrna has now
been declared cholera-free. In all 341 cases and 213 deaths have been recorded in the town. Recently a few cases of suspected cholera have occurred in the neighbourhood of Broussa, and in that of Zunguldak on the Black Sea. Otherwise the whole of Asia Minor appears to be now free from the disease. The same statement may be made in regard to the Bagdad vilayet ; 5 cases and 5 deaths occurred here (at Kerbela, one of the Shiah holy cities) on Jan. 1st and 2nd, and none have been reported since. The outtreak of cholera among the returning pilgrims, the beginning of which was reported in my last letter, has caused a considerable, but not excessively high, mortality. In Mecca the following cases and deaths have been recorded:-
Between Dec. 26th and Jan. 15th...... 119 cases, K6deaths,. Jan. 16to" 24 " 26 " " " 22nd 10 " 10 " " 23rd " 28th ......
......
Since the last-named date Mecca appears to have been free from the disease. The totals here are put at 153 cases with 142 deaths. These figures are in all probability below the truth. In Jeddah the disease was first seen about Jan. 10th ;;. the first cases occurred among the troops. The outbreak in this port seems to have been limited to about a score of cases, and on Feb. 9th it was telegraphed that no further cholera bulletins would be issued, the outbreak appearing to be at an end. From Yanbo only irregular and imperfect reports have been received ; on Jan. 8th it was reported that 7 cases and 2 deaths had occurred there ; and on Jan. 13th the totals were said to be 24 cases and 21 deaths. No further news has been received from Yanbo. An outbreak of cholera, in regard to which it has proved difficult to obtain exact information, has occurred in the Yemen, in the neighbourhood of Hodeidah. The first cases were seen in the village of Badjil, 25 miles to the north-east of Hodeidah,; between Jan. 9th and 16th 48 cases of cholera and 37 deaths were recorded here ; two fatal cases were also seen at Zeidieh, a village to the north. Between the 16th and 21st 10 further cases, with 9 deaths, occurred at Badjil. On the 21st it was
reported that cholera,, "confirmed bacteriologically," was prevalent among the troops in Hodeidah, causing many cases and deaths ; that 3 cases and 2 deaths had occurred among the native population ; and that it was reported "unofficially" that cholera existed among the troops at Menaba. Three cases of the disease occurred in the Camaran lazaret, among pilgrims returning to the Yemen and carried on board the s.s. Budre; the first case was isolated on Jan. 8th, the second on the 9th, and the third on the 17th. Vice consular from Hodeidah also state that cholera had, according reports to"I unofficial" reports, broken out among recruits on a transport steamer, the s.s. Saiyar, and that between Jan. 17th and .19th 50 cases of the disease and 18 deaths had occurred among them. Large numbers of troops are still being poured into the Yemen, where the bulk of the Arab tribes are in revolt, and it is generally believed that both the Turkish army and the Arabs are suffering from a more or less severe outbreak of cholera ; but, as already stated, it is most difficult to learn the true fads. As was anticipated, the infection was carried from Mecca to Medina by the caravans of returning pilgrims. Apparently tle first infected group arrived at Medina on Jan. 4th; it had had 5 cases and 4 deaths from cholera. Succeeding caravans arrived in the same condition ; they reported that the disease had appeared
841 among them at Rabigh (or Rabouk)—the important point on epidemic was ascribed to the bad water-supply, which still the most westerly of the three roads from Mecca to Medina. remains ever the same. I think that readers of THE LANCET and the spot where it is generally thought a new port will may find the story instructive. some day be made, destined to replace Jeddah, and perhaps Cherbourg gets its water-supply, it appears, mainly to be the terminus of the railway between Mecca and the from the Divette, but also from brooks, from certain coast. On the 10th as many as 14,000 pilgrims arrived springs, and from wells. People who live just above the from Mecca in the day, and 51 cases of cholera with 25 town use the Divette water exactly as they pump it up ; deaths were recorded among them. The disease also pre- the navy has a station a mile above the town where they vailed among the inhabitants of the town, and a score or so take water from it-water they pipe to the arsenal for of cases occurred daily for some time. By Jan. 27th 400 boilers, washing, and the like ; just below this is the It may be noted town’s intake-the water is allowed to settle and is ;,ases and 510 deaths had been registered. that infected caravans continued to arrive from Mecca, both filtered before distribution as drinking water. Owing by the most westerly and the most easterly roads ; and that to the geological conditions of the district the springs among some 7000 pilgrims arriving in Medina from Yanbo no cannot be secured against pollution, but from them the barracks are supplied, water intended for drinking being all case of cholera occurred, showing that in all probability the outbreak at Yanbo has not been a very severe one. Thesterilised before issue. Taps-" washing water only "-are latest returns from Medina show that only 3 or 4 cases arefrequent throughout the barracks and the arsenal, and men will :make mistakes. occurring there daily. Only one barrack has a supply in which coli has bacillus never yet been found, and its men got off Cholera on the Hedjaz l2aihvay. in the last epidemic. The small houses of the very lightly The first pilgrim train leftMedina for the north on Jan. 5th, district, café, public-houses, lodgings affected by soldiers with 429 pilgrims. Groups of from 300 to 500 pilgrims con-and sailors generally get their water from wells which are tinued steadily to arrive at the Tebuk lazaret once or twiceall suspected ; many have been closed as they contained too aday. Among the first groups to reach the lazaret threemany of the bacillus coli. As to conservancy, there is no suspected cholera cases occurred, and these were subsequently general l system of water carriage, but there are a great number confirmed bacteriologically. Since then apparently no cases (of leaking cesspools and many pail-closets. The nightsoil is of the disease have been seen there. It has to be remembered, on the fields in the valley of the Divette above the spread that the Tebuk lazaret is still an improvised one, though it town or around the brooks mentioned, and it has been for already possesses most of the essentials of such an institution. 1long believed that the water becomes charged habitually Some alarm was created recently by the report that cholerawith the bacillus coli and from time to time with the bad occurred among pilgrims arriving at Damascus, after bacillus i typhosus. baving done their quarantine and other measures at Tebuk ; Medical men have for years been preaching about the but fortunately this report appears to have been quite terrible risk and the constant damage to the health of the unfounded, and so far as is known no case of cholera has garrison and of the townspeople involved in this lack of pro1 yet occurred north of the lazaret of Tebuk. Some tection of the water-supply, but nothing thorough has been cases have been more than once reported as occurring in the(done. In 1889 there were 394 cases of enteric fever in the trains between Tebuk and Damascus, but none of these havenaval hospital with 75 deaths ; the director of the naval board been confirmed ; indeed, they have all been officially declared (of health pointed out that it was not filters only, but a pure not to have been cases of cholera. The pilgrims are subthat was required, adding that it was the duty water-supply jected to a final medical visit on their arrival at the’Kadem (of the board of health to emphasise the dangers, but the duty The movement (of the terminus of the railway in Damascus. superior authorities to remove them. A military northwards of pilgrims still continues, and so long as it con- medical officer, too, at the same time insisted on the need for tinues there must always be a danger of cholera appearing but only Chamberland filters were installed. As water, 1 pure among them at Damascus or elsewhere, in spite of the far back as 1898 and 1899, 665 cases were treated in the measures executed at Tebuk. naval hospital with 189 deaths, and Director Rouvier wrote Cholera in Persia. that the navy must have good water for itself, and to shield i men from infection must require the town, too, to get Cholera appears to have lingered in many parts of Persiaits throughout the month of December. A telegram froma good supply. Yet the source of supply remains as before, Teheran, dated Jan. 7th, stated that cholera ’’existed posi- only the army and navy sterilise some water for their tively"at the end of December in the towns of Hamadan, men, and the town seems to purify its water in some Kerman, and Mohammera, and that,"according to all degree by sedimentation and filtration. That is all that appearances," the provinces of Ghilan, Kaskin (? Kazvin),has been done. The dangers are so well known to the i that they avoid drinking the water as far as Khorassan and Kaian (?) were not yet completely free frominhabitants the disease. On Jan. 22nd another telegram stated that no possible; some very scrupulously filter all they use, others 1buy the water of a particular spring, reputed safe, in bottles case had occurred in any part of Persia since the 20th. for 17th. drinking and personal washing ; others, again, drink Feb. Constantinople, nothing but cider. Cherbourg is always liable to an outburst of enteric and some 30 deaths due to the disease occur fever, THE DANGEROUS WATER-SUPPLY OF there every year. The story of the epidemic of 1909 is a CHERBOURG. typically instructive one. On Jan. 7th a case of illness was in the Naval Hospital and gave on the llth a received (FROM A CORRESPONDENT.) positive Widal reaction. Eight cases in all were received during January ; they were from the arsenal. On Feb. 6th CHERBOURG, the French naval port, lies at the mouth of there came four men all from different parts of the the river Divette, and in the lower part of its basin. It is adistrict, showing that the whole of the water-supplies were town of some 43,000 inhabitants, of whom 16,000 areinfected, 65 were received in the first fortnight of February, employed in the arsenal or are in the army or navy. It has !92 in the next fortnight, 59 and 69 in the successive a sinister reputation as the town in France, Toulon onlyfortnights of March, by which time the epidemic was nearly - excepted, the most seriously and constantly infected withover, only 16 cases appeared in April, two in May, and six in enteric fever. The enteric death-rate of Toulon in the ten 1the next three months. There were 317 cases altogether, of years 1897 to 1906 is stated at 0-86 per 1000 living, thatwhom 58 died. It appears that the only body of men who of Cherbourg at 0- 71 per 1000, while Paris only lost 0-15 per 4conspicuously suffered little were the two regiments whose 1000 of her population by this disease. These figures are barracks 1 rejoice in the water-supply free from bacillus coli taken from a detailed account of an epidemic in Cherbourg (13 cases and two deaths between the two regiments). As ( in 1909, which appeared in December and January in thesoon as the existence of the epidemic was recognised all the Archives de Médecine Navale, written by Dr. L. E. F. Brunet,emergency measures that could be taken to stop it were Médecin de premiere classe. His tables show that enteric :suggested by the doctors and at once put in orders. They could fever is every year present in Cherbourg, but that notablenot be expected to make any difference for a fortnight or three epidemics occurred amongst the Government employees ofweeks, and in the meantime everybody came to show sympathy all kinds (the people who are treated in the naval hospital)with the sick. The Minister of Marine came, the Underin 1889, 1898 and 1899, and in 1909, and that every single 1Secretary for War, many high functionaries, the Committee
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