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THE SOUDAN CAMPAIGN.
554
gratings
in the
externalwalls
under
each) bed
line, and the windows (one to each bed)
at the floor
are on
opposite
sides of the ward. The ordinary double-hung sashes are supplemented by hopper-hung fanlights.
There are two means of exhaust ventilation to each ward in addition to the open windows-viz. (a) open fire-places and (b) vertical shafts. There are four open fire-places to each ward, and these form, undoubtedly, the most effective form of exhaust ventilation. These are supplemented by vertical shafts 14 in. square internally and lined with saltglazed bricks with rounded internal angles. There are three to each ward, and an upward current is generated in each shaft by means of a copper steam coil. Two connexions with each shaft are made in each ward (one at the floor line and one at the ceiling line), and valvular gratings are provided in each opening, so regulated by hand gearing that when the upper one is open the lower one is closed, and 1)ÙJe versâ. The cost of the hospital, including all fittings, apparatus, and machinery, but exclusive of land and furniture, has been E240,000. The outlay has been increased by the peculiarities of the site and also by the situation of the hospital, which is at the extreme edge of the metropolitan district, very inaccessible for materials, and equally so for workmen.
THE CAIRO LUNATIC ASYLUM. IN his annual report for 1890 Sir Evelyn Baring (now Lord Cromer) wrote as follows: " The lunatic asylum in its former condition was described by a competent authority as ’ a den to shudder at, where the wretched inmates used to be chained to the walls, never leaving their cells till they were carried out dead.’ It is now in perfect order and is provided with padded rooms, workshops, and gardens." The ConsulGeneral was unquestionably justified in passing this high encomium, but although several improvements had obviously been effected much still remained to be done before the sole lunatic asylum in Egypt could claim to be ranked as a first-class establishment. As Rogers Pasha remarked in his report for 1892, " the Government lunatic asylum is structurally very defective, and considerable alterations must be made it it is to fulfil the purpose for which asylums are intended. At present it is a home for the insane, but hardly a hospital for their treatment. Classification and separate accommodation are impossible on the female side without a radical alteration of the building." Up to this time reform was carried out on general principles, but at the beginning of 1895 permission was at length accorded for the engagement of a properly qualified alienist, who was to devote his services exclusively to the asylum. This gentleman, Dr. Warnock, has how issued his first report, which we have much pleasure in recommending to all students of lunacy. The document is in pamphlet form, occupying sixty-two pages, and was printed I The new superat the National Printing Office, Cairo. intendent was not long in discovering that numerous defects existed in the establishment which had been placed under his charge, some of the more important being (a) the absence of a proper classification of the patients ; (b) general disorder in the whole hospital, especially at mealtimes ; (e) a want of proper medical records ; (d) the use of mechanical restraint ; (e) absence of systematic occupation ; (f) a high rate of mortality; and (g) structural defects. This is certainly a formidable list, but Dr. Warnock was not dismayed, and by the end of the year (to quote our Egyptian correspondent) it was really wonderful to witness the peaceful revolution that had been accomplished. Under the new regime the number of inmates has gone up considerably. Formerly they never exceeded 300 in all, but during 1895 the daily average number was 465, of whom 325 were males and 140 females. In the course of the year 526 patients were admitted, upwards of half of them coming from Cairo and the remainder nearly all from the larger towns, the rural districts supplying merely a fractional quota. According to the census of 1882 there are only 7 certified lunatics in Egypt per 100.000 of population, the proportion in England being 310 per 100,000. Dr. Warnock is of opinion that "only a small proportion of the insane in Egypt are ever sent to hospital," and adds, "evidently female lunatics are
at home, even in the larger towns" ; but he also admits that "it is at present quite impossible to even approximately gauge the extent to which lunacy preNo doubt harmless vails in the country generally." lunatics are in some instances kept in their homes, but
usually kept
Egypt is now constantly inspectors, to say nothing
traversed by English sanitary of police, irrigation, and preventive officers, and it is difficult to understand how the more violent cases could he systematically kept in concealment. Dr. Warnock bases his conclusion that in Egypt female lunatics are usually kept at home on the ratio between the sexes in English asylums, but the conditions of life in the two countries are so different that his deductions would The general health of seem to be by no means inevitable. the inmates is not good. " Internal parasites affect nearly every patient, anchylostomas, ascarides, and tapeworms at nearly every autopsy. Bilharzia also is very being found common." Melancholia is extremely rare among natives of Egypt. Five per cent. of the admissions were due to this form of insanity, but nearly all the sufferers were foreigners. The alcoholic insanities are seldom seen, and suicidal tendencies are well-nigh unknown. General paralysis of the insane, also, is not common, the admission-rate for the year having been under 3 per cent. In connexion with the latter affection Dr. Warnock makes the following remarks : ’’ The idea that sexual excess and syphilis are important agents in the causation of general paralysis is not strengthened by these observations, since both these causes have free play in Egypt and yet apparently little general paralysis results. The Egyptians are usually easy. going- and are not subjected to over-work or strains, nor I think it is these factors are they often addicted to alcohol. which are wanting for the causation of general paralysis. Possibly as Egyptians become more civilised and their life more complex, general paralysis will become more frequent." The ameliorations introduced into the Cairo Lunatic Asylum under Dr. Warnock’s intelligent supervision are very great ; but that he is still far from satisfied is evident from his final observations: " In finishing this hurried sketch of the work of the past year I cannot refrain from again mentioning the serious obstacles to the proper administration of the hospital still existing, chiefly due to its structure, situation, and want of space. In time many of these drawbacks will doubtless be removed or obviated, though nothing less than re-building is required to render the institution thoroughly adapted to the necessities of its inmates." We certainly think that the Egyptian Government would find it cheaper in the long run to build an entirely new asylum. With the example of Kasrel-Aini before their eyes they should not be slow to recognise the fact that patching up an old and unsuitable structure for hospital purposes must inevitably prove to be an expensive and unsatisfactory procedure.
THE SOUDAN CAMPAIGN. THE
fom the Nile Expedition is very satisfactory as the health of the troops and the absence of cholera ; but the service is a very trying one. The river has been steadily rising, and everything is being prepared on the Nile for an early advance. It appears that the Dervishes having heard of the late appearance of cholera in the expeditionary force regard it as a manifestation of Divine opposition to the expedition. It is generally believed that the disease will advance to Dongola, but nothing is yet known of its having done so or of its having appeared in the Khalifa’s army. Although the cholera outbreak has ceased in the AngloEgyptian force this is by no means the case as regards Egypt itself, where the epidemic has of late shown signs of slight increase. There were 567 fresh cases and 502 deaths returned for three days last week, and at that time the total number of cases reported since the beginning of the outbreak had amounted to 17,453 cases, of which 14,498 were fatal. Later returns show that there were 397 fresh cases and 357 deaths in Egypt during two days towards the end of last week. Four deaths occurred at Cairo, 3 in Alexandria, and 36 in Keneh. One death occurred among the Egyptian troops The heat at Kosheh has been very great, at Wady Halfa. the thermometer registering on one day, according to a telegram through Reuter’s agency, 130° F. in the shady
regards
news
gratings
in the
externalwalls
under
each) bed
line, and the windows (one to each bed)
at the floor
are on
opposite
sides of the ward. The ordinary double-hung sashes are supplemented by hopper-hung fanlights.
There are two means of exhaust ventilation to each ward in addition to the open windows-viz. (a) open fire-places and (b) vertical shafts. There are four open fire-places to each ward, and these form, undoubtedly, the most effective form of exhaust ventilation. These are supplemented by vertical shafts 14 in. square internally and lined with saltglazed bricks with rounded internal angles. There are three to each ward, and an upward current is generated in each shaft by means of a copper steam coil. Two connexions with each shaft are made in each ward (one at the floor line and one at the ceiling line), and valvular gratings are provided in each opening, so regulated by hand gearing that when the upper one is open the lower one is closed, and 1)ÙJe versâ. The cost of the hospital, including all fittings, apparatus, and machinery, but exclusive of land and furniture, has been E240,000. The outlay has been increased by the peculiarities of the site and also by the situation of the hospital, which is at the extreme edge of the metropolitan district, very inaccessible for materials, and equally so for workmen.
THE CAIRO LUNATIC ASYLUM. IN his annual report for 1890 Sir Evelyn Baring (now Lord Cromer) wrote as follows: " The lunatic asylum in its former condition was described by a competent authority as ’ a den to shudder at, where the wretched inmates used to be chained to the walls, never leaving their cells till they were carried out dead.’ It is now in perfect order and is provided with padded rooms, workshops, and gardens." The ConsulGeneral was unquestionably justified in passing this high encomium, but although several improvements had obviously been effected much still remained to be done before the sole lunatic asylum in Egypt could claim to be ranked as a first-class establishment. As Rogers Pasha remarked in his report for 1892, " the Government lunatic asylum is structurally very defective, and considerable alterations must be made it it is to fulfil the purpose for which asylums are intended. At present it is a home for the insane, but hardly a hospital for their treatment. Classification and separate accommodation are impossible on the female side without a radical alteration of the building." Up to this time reform was carried out on general principles, but at the beginning of 1895 permission was at length accorded for the engagement of a properly qualified alienist, who was to devote his services exclusively to the asylum. This gentleman, Dr. Warnock, has how issued his first report, which we have much pleasure in recommending to all students of lunacy. The document is in pamphlet form, occupying sixty-two pages, and was printed I The new superat the National Printing Office, Cairo. intendent was not long in discovering that numerous defects existed in the establishment which had been placed under his charge, some of the more important being (a) the absence of a proper classification of the patients ; (b) general disorder in the whole hospital, especially at mealtimes ; (e) a want of proper medical records ; (d) the use of mechanical restraint ; (e) absence of systematic occupation ; (f) a high rate of mortality; and (g) structural defects. This is certainly a formidable list, but Dr. Warnock was not dismayed, and by the end of the year (to quote our Egyptian correspondent) it was really wonderful to witness the peaceful revolution that had been accomplished. Under the new regime the number of inmates has gone up considerably. Formerly they never exceeded 300 in all, but during 1895 the daily average number was 465, of whom 325 were males and 140 females. In the course of the year 526 patients were admitted, upwards of half of them coming from Cairo and the remainder nearly all from the larger towns, the rural districts supplying merely a fractional quota. According to the census of 1882 there are only 7 certified lunatics in Egypt per 100.000 of population, the proportion in England being 310 per 100,000. Dr. Warnock is of opinion that "only a small proportion of the insane in Egypt are ever sent to hospital," and adds, "evidently female lunatics are
at home, even in the larger towns" ; but he also admits that "it is at present quite impossible to even approximately gauge the extent to which lunacy preNo doubt harmless vails in the country generally." lunatics are in some instances kept in their homes, but
usually kept
Egypt is now constantly inspectors, to say nothing
traversed by English sanitary of police, irrigation, and preventive officers, and it is difficult to understand how the more violent cases could he systematically kept in concealment. Dr. Warnock bases his conclusion that in Egypt female lunatics are usually kept at home on the ratio between the sexes in English asylums, but the conditions of life in the two countries are so different that his deductions would The general health of seem to be by no means inevitable. the inmates is not good. " Internal parasites affect nearly every patient, anchylostomas, ascarides, and tapeworms at nearly every autopsy. Bilharzia also is very being found common." Melancholia is extremely rare among natives of Egypt. Five per cent. of the admissions were due to this form of insanity, but nearly all the sufferers were foreigners. The alcoholic insanities are seldom seen, and suicidal tendencies are well-nigh unknown. General paralysis of the insane, also, is not common, the admission-rate for the year having been under 3 per cent. In connexion with the latter affection Dr. Warnock makes the following remarks : ’’ The idea that sexual excess and syphilis are important agents in the causation of general paralysis is not strengthened by these observations, since both these causes have free play in Egypt and yet apparently little general paralysis results. The Egyptians are usually easy. going- and are not subjected to over-work or strains, nor I think it is these factors are they often addicted to alcohol. which are wanting for the causation of general paralysis. Possibly as Egyptians become more civilised and their life more complex, general paralysis will become more frequent." The ameliorations introduced into the Cairo Lunatic Asylum under Dr. Warnock’s intelligent supervision are very great ; but that he is still far from satisfied is evident from his final observations: " In finishing this hurried sketch of the work of the past year I cannot refrain from again mentioning the serious obstacles to the proper administration of the hospital still existing, chiefly due to its structure, situation, and want of space. In time many of these drawbacks will doubtless be removed or obviated, though nothing less than re-building is required to render the institution thoroughly adapted to the necessities of its inmates." We certainly think that the Egyptian Government would find it cheaper in the long run to build an entirely new asylum. With the example of Kasrel-Aini before their eyes they should not be slow to recognise the fact that patching up an old and unsuitable structure for hospital purposes must inevitably prove to be an expensive and unsatisfactory procedure.
THE SOUDAN CAMPAIGN. THE
fom the Nile Expedition is very satisfactory as the health of the troops and the absence of cholera ; but the service is a very trying one. The river has been steadily rising, and everything is being prepared on the Nile for an early advance. It appears that the Dervishes having heard of the late appearance of cholera in the expeditionary force regard it as a manifestation of Divine opposition to the expedition. It is generally believed that the disease will advance to Dongola, but nothing is yet known of its having done so or of its having appeared in the Khalifa’s army. Although the cholera outbreak has ceased in the AngloEgyptian force this is by no means the case as regards Egypt itself, where the epidemic has of late shown signs of slight increase. There were 567 fresh cases and 502 deaths returned for three days last week, and at that time the total number of cases reported since the beginning of the outbreak had amounted to 17,453 cases, of which 14,498 were fatal. Later returns show that there were 397 fresh cases and 357 deaths in Egypt during two days towards the end of last week. Four deaths occurred at Cairo, 3 in Alexandria, and 36 in Keneh. One death occurred among the Egyptian troops The heat at Kosheh has been very great, at Wady Halfa. the thermometer registering on one day, according to a telegram through Reuter’s agency, 130° F. in the shady
regards
news