TYPHUS FEVER IN TENERIFFE.

250 < benefit from the disinfecting effects in the air in scarlet fever is full of difficulties and the solution of the cannot is at present shrouded in mystery. On the subject of breathing the fresh air out of doors. problem of " return" cases, which, of course, also has reference to the I am, Sirs,yours faithfully, T. W. N. BARLOW, persistency of infection, in my last annual report I wrote as Jan. 21st, 1907. Medical Officer of Health, Bootle. follows :Even after the most careful inquiries it is very difficult to satisfy one’s self in a large number of instances that the child lately from hospital is the cause of the second case becoming infected and I am of TYPHUS FEVER IN TENERIFFE. opinion that many cases styled "return cases"are not return cases, in spite of the apparently strung presumptive evidence sometimes forthTo the Editors of THE LANCET. coming. and my experience inclines me more and more to the opinion that just as the Klebs-Loeffler bacillus (the cause of diphtheria) may be SIRS,-Will you kindly allow me to call attention in your found in the throats of people in perfect health, so the infection of columns to the above subject ? It is officially admitted that scarlet fever, whatever it mav be, may remain latent and only become active when the lowering of the hody health from various typhus fever (or plague,"the authorities have not yet arrived reasons favours such increased activity of the infective matter as to at an exact diagnosis) exists in Teneriffe at the present time cause the development of scarlet fever. and I think it is right that the profession at home should In other words, I am of opinion that many so-called know it. The epidemic is not an extensive one and, so far " return"cases have become infected before renaoval to as I can ascertain, there have been only about a dozen cases, to Santa Cruz and its immediate neighbourhood. hospital of the first case, and the infecting organisms, confined whatever they may be, have remained latent until from some The careful traveller runs little or no risk of taking the disease, but the preposterous eccentricities perpetrated by cause or other they have overcome the resisting powers of the patient coincidently with the return of the other case the Spanish officials under the pretext of prophylaxis are enough to scare away any intending visitors and are calcufrom the hospital. Let me give a very striking case bearing on this point. A lated to afford them the maximum of trouble and inconchild was sent into the Bootle Corporation Infectious Hos- venience if they are bold enough to land. relate the experiences of the party with Let me pital notified as suffering from scarlet fever. She was whom I ambriefly travelling. We landed direct from England on admitted into the acute ward. On my examining her I discovered no signs of scarlet fever and I ordered her removal Jan. 4th, 1907, and proceeded at once in carriages for Each carriage bore a printed notice stating that to the convalescent ward. The child remained in hospital Orotava. and the value of for about five weeks, and after having remained perfectly it had been " disinfected " the same day, be estimated by the methods employed well throughout her stay in the ward she was sent home. this disinfection may Within a week after her return home I received a notifica- upon ourselves later. At Laguna we were turned out, an evil-smelling shed by the roadside, and a policeman tion that this same child was suffering from scarlet led to pumped a spray of very dilute creolin solution over our fever. boots and nether garments. No doctor was present. We have here an example of a child who had been in an We smiled and passed on in fresh carriages, thinking acute scarlet fever ward for one day and a convalescent the trouble was all much more serious over, but a scarlet fever ward for over four weeks-that is to say, she ordeal awaited us near Orotava.veryHere there was a had lived in an atmosphere impregnated with the infection disinfecting station under the charge of two doctors, of scarlet fever for five weeks and had remained quite well, large to whom I explained politely the circumstances of had been and had been our kept clean probably because she journey and gave an assurance that we could not well fed and clothed; in other words, her resisting power have been in contact with any fever case or be possibly had been kept up. When she returned home where her fomites in our luggage. But in vain. We were mode of life became less regular, where she was not so well conveying turned out again and this time literally drenched with fluid fed-in other words, when her resisting -power became from a large garden syringe. The said fluid purported to be lessened-the infection of scarlet fever, which must have a solution of corrosive sublimate, but I received about halt From the time of her a drachm into been there all the time, developed my mouth and it tasted like nothing but discharge from the hospital until her return to the hospital dirty water, nor did it react at all on the metal fittings she had not been out of doors nor had there been any visitors of our trunks. The gentlemen escaped fairly well, having be in the house, so that outside sources of infection donned mackintoshes, but the ladies of the party hastily have which in this case. I never an instance excluded met were soaked to the skin in places and their dresses would support better than this the theory that the infection Nor was this all ; our wraps considerably damaged. of scarlet fever may presumably remain latent as in diph- and trunks were sprayed and sponged copiously, with the theria, and if the infection of the disease may remain latent result that the former were soaked through and the contents in a healthy individual it may, of course, equally persist in of the latter soiled and wetted, though the trunks theman individual convalescent from the disease. selves were not opened. All these proceedings were conAgain, which of us has not received into hospital a second ducted with the exasperating deliberation and lack of method case of scarlet fever from a house the day before or two days characteristic of the Latin races and finally, after the before the first case returned to that house from hospital ? Ii strenuous hygienists had disinfected an unfortunate pug circumstances had been reversed and Case No. 2 had beer dog which had strayed up from Orotava, we were allowed to removed to hospital two days ccfter instead of before tht depart amid the jeers of a crowd of loafers to whom our return home of the first case, Case No. 2 would definitel3 sufferings evidently afforded great satisfaction. have been ascribed as being the result of infection from Case ! Such are Spanish methods of prophylaxis of infectious No. 1 in the absence of any other known cause of infection disease and one cannot but feel contempt for the authorities even although Case No. 1 from outward appearances was a:and medical officers who practise such ridiculous ineptitudes free from infection as a child could possibly be. Again,’.in the name of science. The folly of such proceedings must think it is a common experience that it is precisely those be obvious to anyone with the slightest knowledge of the cases which remain in hospital a long time which are thedisease and the manner in which it is disseminated. Of " supposed causes of returncases. This may, of course, bnotification and the isolation of "contacts"II could hear that the clinical conditions which have necessitated the pro nothing, and the only visible sign of disinfection was a longed stay in hospital of any particular patient are preciselsprinkling of chloride of lime round a house in which a fatal those which are the cause of infection in other children afte rcase had occurred at Laguna. The important point is that this splendid health resort is they are discharged, though it may be that the result cf the prolonged breathing of the infected atmosphere of being spoiled for invalids, on whom a soaking such as we scarlet fever ward has been the accumulation in the nasa1 got might have the most disastrous results. The excellent chambers or other places of the organisms causing the hotels at Orotava are not filling as they should and the comdisease. panies which own them will suffer serious financial loss Whatever may be the explanation of " returncases two unless the authorities soon adopt saner and less objectionable facts are certain : (1) "return"cases more commonly resu’t methods. I would like to add that two years ago this ship from the cases which have been treated for a long time in was refused pratique except on the terms of a complete hospital than from those which have remained in hospital f(r fumigation at Santa Cruz because we had three months shorter periods; and (2) the majority of "return"cas(!S before been in La Guayra-a supposed infected port-and in occur in the winter time when the weather is persistently u)ispite of the fact that we had since maintained a perfectly favourable and the children are perforce kept in the war< clean bill of health. In conclusion I would repeat that visitors to Teneriffe continually breathing an infected almosphere, and thi

passages

I

might

251 need not be unduly fearful of infection but must be prepared to face considerable loss and discomfort so long as the present sanitary reign of terror exists. I am, Sirs, yours faithfully, W. H. PEILE, M.D. Dub., D.P.H. S.Y. Evona, Santa Cruz, Teneriffe, Jan. 6th, 1907.

SANITATION IN EGYPT. To the Editors

(If THE LANCET.

SIRS,-May I offer some comments on the important and interesting letter of your Cairo correspondent on " The Drainage of Cairo" in THE LANCET of Dec. 22nd last ?7 What strikes a visitor interested in these matters is that the drainage of Cairo is only one item in the great problem of Egyptian sanitation. Your correspondent appears to imply that while there is a terribly high infantile mortality in Cairo, the health conditions in the villages are relatively good. It is to be feared that this is not the case. By all accounts the infantile mortality is everywhere enormous ; one authority has repeatedly put it at two of every three children born. Certainly the conditions of water-supply and sewage in the villages are shockingly bad. Everywhere the drinkingwater is obviously polluted in every conceivable way. Even in the smail modern town of Helouan, a Cairo "health resort"on the edge of the desert, I have seen a pestiferous open channel, fortuitously formed, slowly carrying and depositing filth in one of the side areas. The water-supply of Helouan appears to be from wells, and in the porous desert soil percolation seems inevitable. As to Cairo, it is to be noted that while the Anglo-Indian expert is preparing his report a number of streets are being laid with asphalte. This is in itself a desirable reform, but as the asphalte would have to be broken up again in case of a system of drainage being set up it is to be presumed that the Government do not contemplate such a system but have in view an extension or reform of the present method of removal by sanitary carts. If that be so, the time has clearly come for the development of such a system in the other towns and villages likewise. Your readers may remember that during the South African war Sir Arthur Conan Doyle made it a part of the case against the Boers that in their towns they had no drains. The British people should make the effort to realise that that is the state of things not only throughout the British colonies in South Africa-where it is justifiable-but throughout all Egypt (barring Alexandria) under British control. And even the Alexandria sewage system is very defective. The report of the Public Health Department for 1905 expressly ascribes the persistence of plague in Alexandria partly to the state of the drains. Concerning the cesspools of Cairo, it may be true that some of the latest are well built ; but the official reason given in the past for discontinuing the system of drainage begun before the occupation was that digging operations in Cairo were so often fatal to the diggers by reason of the infiltration of sewage from the existing cesspools. There is, I understand, no regular inspection of cesspools, no enforced law for their being periodically emptied, no liinitation as to their size, and no requirement as to their being

dilapidated

cemented. It is to be feared that the explanation given by your correspondent of the long delay in filling up the open ditch in Cairo called the Khalig-to the effect that the resistance came from Moslem fanaticism-is unduly favourable to the Government. The real reason seems to have been the official unwillingness to spend money on public health. What was finally done was to give the ditch as a concession to a tramway company on condition of their filling it up. They did so and laid a double tramway line on the narrow roadway they

made, thus constituting the

most

dangerous thoroughfare in

Cairo.

As to the

present Cairo water-supply,

on which your passes no judgment, I may mention that in the School of Police the drinking water is very carefully filtered, and the authorities are satisfied that this precaution has greatly raised their health standard. That is to say, the ordinary water is officially recognised to be bad. It is always discoloured at high Nile. Your readers can infer what are the chances for the rest of Cairo, with its population of nearly three-quarters of a million, and for the rest of Egypt, where the water-supply is still primeval, being generally taken from the Nile, or unprotected wells and

correspondent

’

canals,

or

stagnant pools.

add that in Cairo there are only some five or six that these are solely for men, and all in a small space in or near the Esbekieh Gardens ; that they emit even in winter a great stench (one lately blew up from the gases generated beneath it) ; that natives can be seen in open day availing themselves (for all purposes) of the paths and walls in some of the principal tramway thoroughfares ; that there are only some three or four drinking founta,ins, set up by pious Moslem donors ; and that even in some modern streets may be seen pails or jars of unfiltered and sometimes dirty drinking water, charitably placed for the poor by Moslem householders. These jars commonly stand under the trees where filth accumulates. There are no public washhouses, nor public baths, apart from the impossible baths attached to the mosques—and this in a country where for six months of the year the climate is tropical. Yet another item. Flat tenements of five or even of six storeys are now being rushed-up, though many complaints are made in the newspapers that the pressure is often hardly enough to take the water to the second floors. I say nothing as to inspection of milk-supply which, I fear, is much needed. I am, Sirs, yours faithfully, Let

me

public latrines ;

-

.

-

-

_..

-

ualro, j Jan. iutii, mut.

____M-

JOHN M. ROBERTSON.

MILK IN SMALL GENERAL SHOPS. To the Editors of THE LANCET.

SiRS,—In THE LANCET of Jan. 19tb, p. 193, I notice article from

an

correspondent on " Milk in Small to the unsuitability of the majority

General of such Shops." As premises for the sale of milk there can be no difference of opinion, but the statement that 70 per cent. of the milksupply of London is retailed from such shops is, I think, erroneous and should therefore not be allowed to pass without comment. Surely the dairymen of London are responsible for more than 30 per cent. of its milk-supply. I have recently been inquiring into the subject in this borough and enclose you the result of my investigations. It will be seen that while 57 dairies sell 2250 gallons of milk daily, an average of nearly 40 gallons per dairy, 69 small general shops such as described by your correspondent sell but 70 gallons daily, an average of practically only one gallon per shop. If the conditions prevailing here are similar to those in the East of London-and I think such may fairly be claimed to be the case-the percentage of milk sold by these shops, grossly polluted though such milk must be, is fortunately not nearly so large as is stated by your correspondent. With the rest of the paper I cordially agree and also fully endorse the opinion expressed as to the large amount of condensed milk that is given to children, especially in poor neighbourhoods, such condensed milk, moreover, as my inquiries show, being only too often the condensed skimmed variety. I am, Sirs, yours faithfully, a

G. SOWDEN,

Jan. 21st, 1907.

Medical Officer of Health for the of East Ham.

Borough

GAS FIRES. To the Editors of THE LANCET. ciRS.—will you allow me space for a short reply to the letter from Mr. J. H. Brearley which appeared in THE LANCET of Jan. 12th ?7 In that letter the author takes the unusual course of quoting without my permission portions of a correspondence I had with him last year on the subject of gas fires ; and while I wrote nothing to Mr. Brearley that need not be published I object to isolated sentences being chosen for reproduction and still more to what Mr. Brearley " gathers " from my letters. Thus, he gathers from what I wrote " that the gas fire was fitted into the same flue as the coal fire without any consideration as to the satisfactory carrying away of the products." Yes, it was fitted into the Is not that done in nine cases out same flue as the coal fire. of ten ? Is it not the "ordinary way " ?7 And that was therefore the case I wished to examine. Mr. Brearley goes on to say that I paid no consideration as to the satisfactory carrying away of the products. Now I stated in my pamphlet that the "stove worked perfectly well," and this, of course, includes the carrying away of the products of combustion. Mr. Brearley seems to forget that I undertook a serious investigation, that I devoted 15 months to the work, that I obtained concordant results,