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would hold an informal conference instead of a publicinquiry. Accordingly, on Dec. 20th, 1906, Dr. H. T.Bulstrode of the medical department, and Mr. Kitchin,architect of the Local Government Board, arrived at Sand-gate. Mr. Jones was informed of the visit and the textof the regulations which the Sandgate council had proposedwas shown to him as a matter of fairness.The Sand gate council, according to the opinions expressed

to me by officials in authority, was deeply disappointedwith the attitude and views- of the representatives ofthe Local Government Board. The Local GovernmentBoard, it was gathered, would not sanction any regula-tions that in application would probably result in

closing one or more of the existing homes. Thereason for this is perfectly clear. The Local Govern-ment Board, having the public health administration ofthe whole country in its hands, must look at thegeneral effect of any special action taken. Regulationswhich would have led to the closing of all the homes atSandgate, if applied generally, would cause the abolition ofhalf the hospitals for tuberculosis in this country, and manyof these institutions are rendering invaluable service thoughnot perfect in structure.

SOME TURKISH LAZARETS

AND OTHER SANITARY INSTITUTIONS IN THENEAR EAST.

BY THE BRITISH DELEGATE ON THE CONSTANTINOPLEBOARD OF HEALTH.

(With Reproductions of Photographs taken by the Author.)

VIII.1

THE SANITATION AND WATER-SUPPLY OF JEDDAH.

The Importance of Jeddah as a Port of Pilgrimage; its

Population.—Lodgings for or Pilgrims.—Difficulties in

Conservancy.—State of the Town, at the Height of thePilgrim Season.—Type of House in Jeddah.—MunicipalHospital for Ordinary Diseases.—Shed for Cholera or

Plague Patients.—Need of Two New Hospitals.—SpringWaters; the Three Principal Sources; Conduits Damagedby Bedouins.—Tank Waters.

IN the preceding articles I have dealt at length, but not, I

trust, at so great a length as to be wearisome to the reader.of THE LANCET, with the great lazaret of Camaran. In the

succeeding articles I shall describe more briefly the sanita-tion and water-supply of Jeddah and its lazaret, Abu-Saad,and the ports of Yanbo and El Wej.The port of Jeddah lies about half-way down the Arabian

coast of the Red Sea. It is by far the largest and mostimportant town along the whole of that coast. Com-

mercially, it is the principal port of import and exportfor the whole of the Hedjaz province, but it derives its mainimportance from the fact that it is only 45 miles from Mecca,and is consequently the gate by which the overwhelmingmajority of Moslem pilgrims enter and leave that province.A certain number of pilgrims, it is true (mostly coming fromthe north), land at Yanbo, the port for Medina, which theyvisit first and thence proceed overland to Mecca. But manynever go to Medina at all, and of those who do a largeproportion visit Mecca first, and after the fetes of KurbanBairam are completed make their way to Medina, eitheroverland from Mecca or by sea from Jeddah.Jeddah has a permanent population estimated at about

20,000. But for quite two-thirds of the year this number isgreatly increased by a floating population consisting of

pilgrims going to or returning from the holy places of Islam.

1 Nos. I., II., III., IV., V., VI., and VII. were published in THE LANCETof April 27th (p. 1188), May 4th (p. 1251), 11th (p. 1317), and 18th(p. 1389), and June 1st (p. 1518), 8th (p. 1607), and 22nd (p. 1741), 1907,respectively.

At the height of the pilgrim season the figure mentioned isperhaps doubled or more than doubled for several days at atime. If it be asked where this vast mass of pilgrims is

lodged the reply must be that the large majority are lodgednowhere ; they sleep in the streets, in the open spaces, inany nook or corner or passage where they can lay theirheads. A considerable number of houses are set apart aspilgrims’ lodgings, but they suffice to shelter only a smallproportion of the whole. Some of these houses, known as"Rabats," are charitable institutions founded by rich andpious Moslems for the free use of their countrymen.There are several for Indian pilgrims ; one of the largestwas founded five years ago by the Begum of Rampurand consists of three adjoining houses made intoone. Others are assigned to the use of Javanese,Malayans, and pilgrims of various nationalities. Thesehouses are of the type of the other Jeddah houses referred tobelow. They are registered as lodgings for pilgrims by thelocal authorities and are each year cleaned and white-washed inside before the arrival of the pilgrims. But, asjust stated, they can only accommodate a small fraction ofthe whole number, and the rest live, cook, eat, sleep, andperform all the other ordinary functions of life in the openair. It is obvious that a town under such conditions presentsmany serious problems in sanitation, and I propose in thischapter to consider briefly how these problems are, or

are not, solved before passing to a description of theJeddah lazaret (better known as the lazaret of Abu-Saad-Wasta).The sanitation of Jeddah is in the hands of a municipality.

Conservancy is, perhaps, one of the most formidabledifficulties with which this authority is faced, when the townis swarming with pilgrims in the manner just described. Themunicipality possesses only 12 conservancy carts. For theshort period that elapses between successive pilgrimageseasons these may perhaps suffice. At the moment, indeed,of my arriving in Jeddah-on the actual eve of Bairam-thestreets were remarkably clean. Half of the population ormore had gone to Mecca for the fêtes and the town had amarkedly deserted appearance. The badâr was silentand almost empty; the few inhabitants remaining puton their best clothes (and an Arab’s best clothes are

very beautiful garments indeed, of soft-hued silks and

cloths) and amused themselves decorously by going off tothe many pilgrim ships lying idle in the roads, by visits tothe mosques, or by playing games of ball in the streets and)pen places. Conservancy offered no great difficulty insuch circumstances. A week or ten days later, when thecaravans began to flow back from Mecca, the conditionswere, however, very different. The bazar, through whichthe main street of the town runs, became a solid mass ofOriental humanity, through which the caravans-endlessstreams of camels, tied head to tail, and each carrying twoor more pilgrims in gigantic litters or I shugdufs "-slowlyforced their way. The open squares and spaces weresoon covered with pilgrims camping out, with or (mostly)without tents or other cover, pilgrims of many nation-alities-Arabs, Indians, Afghans, Central Asiatics,Javanese, Malayans, Chinese, Tartars, Moors, Egyptians,and many another race. A more interesting or

more picturesque sight it would not be easy to find else-where. The streets of Jeddah themselves are as picturesqueas those of any Indian city, which is saying much, andpeopled with this many-hued and diverse-featured crowd ofHajjis fresh from Mecca they form a spectacle that is

perhaps unique in the world.But, to return to the sanitary aspect of the matter-the

only aspect that can be considered here-it soon becameevident that the provision made for the sanitary wants of thisvast crowd was sadly inadequate. Public latrines andurinals are almost wholly wanting ; the pilgrims attended tothe calls of nature anywhere and everywhere. The 12 con-servancy carts, though working night and day, seemed tomake no impression on the truly lamentable condition of thestreets and open spaces. Human excreta lay about on everyside, and as thousands of fresh pilgrims kept pouring into-the town more quickly than the daily departing pilgrimsteamers could remove them the conditions became moreand more offensive.The provision of water to this fluctuating population is

another problem presenting peculiar difficulties in thiscomparatively rainless region ; but as the water-supply ofTeddah is a somewhat complex question and one of which 1

1811

endeavoured to make rather a special study it will be dealtwith in some detail.The houses of Jeddah are usually large and several storeys

in height. They are mostly built of the madreporic stonefound in the neighbourhood, covered outside with a lime-

plaster. The projecting windows and balconies are of wood,elaborately carved in fantastic and often beautiful designs,giving to the narrow streets that strikingly picturesqueappearance to which I referred above. Many of the largerhouses, known as "hoches," have one or more courtyardsand consist of vast warehouses (for grain, carpets, dates,and all other kinds of merchandise), shops, and dwelling-rooms, all more or less under the same roof. The dwelling-rooms in many instances (but by no means in all) are

rather small and dark. The closet is usually in a dark andbadly ventilated corner ; the excreta pass thence to a cess-pool in the courtyard. In many of the courtyards there isa shallow well, and in some a rain-water cistern, of whichmention will be made later.The hospital accommodation provided in Jeddah is quite

inadequate to the needs of the place. There is a small

municipal hospital situated just inside the wall that coro-pletely surrounds the town on its eastern side and not farfrom the Mecca Gate. It is a one-storey structure built

against the town wall. It contains two small wards for 12and eight patients respectively; the wards have no flooring,their floors being of beaten earth. Close by is a wooden shedin bad condition used for dysenteric patients ; it is almostentirely without furniture. In brief, this hospital-thoughthose in immediate charge of it have apparently done theirbest with the limited means placed at their disposal-isaltogether too small and too primitive for a town like Jeddah,with its vast floating population. The Inspection Commissionin its report consequently urges the Turkish Government tobuild a large general hospital capable of holding 150 or 200sick and suggests a suitable site where it might be built. Itfurther points out that the occasion would lend itselfadmirably to the generosity of some rich and pious Moslem(and there are many such in eastern countries) who could dono more useful act to his fellow believers than to found andto endow a good hospital in Jeddah. Whether this suggestionwill ever bear fruit time alone can show.The hospital accommodation for cases of cholera, plague,

or other infectious diseases is even more inadequate than forthose of ordinary diseases. When plague broke out inJeddah in 1897 a large wooden shed was put up as a

plague hospital on an open space in the south-west corner ofthe town. The skeleton of this shed still remains. Sinceoutbreaks of plague and cholera are by no means rare inJeddah the Commission strongly urges the Turkish Govern-ment to put up an isolation hospital capable of holding from30 to 40 patients. During the past summer a rather persistentepidemic of plague occurred in the town but up to thepresent no steps have been taken to carry out the re-

commendation of the Commission on this point.The question of the water-supply of Jeddah has for years

past presented difficulties and its inadequacy has been thesubject of frequently repeated complaint. The town hasbeen constantly threatened with a water famine, and whatthat means in a tropical climate and an insanitary town maybe readily conceived. Daring a stay of 19 days there (themain object of which was the inspection of the Abu-Saadlazaret, to be described subsequently) it became possible tocollect much interesting information on this question-information which has been embodied since my return in aprinted report which has been presented to the Board ofHealth and which may be summarised here as follows. The

water-supply of Jeddah is of three different kinds-so-calledspring water, rain water collected in large tanks, and wellwater.- ___ _ _ _ _ - - I

Spring water.-The sources of this water are, it wouldseem, rather underground collections of rain water than truesprings. They are mostly situated at a considerable distancefrom the town. There are only three that need be men-tioned here. They are the following. 1. The Am Hamidiehor Bir Vizirieh is situated some 11 or 12 kilometres to thesouth-west of Jeddah. The water is, or was, brought to thetowns by a masonry conduit which has, however, been con-stantly cut and damaged by the Bedouins. It was lastrepaired in 1902 but was soon damaged again, and at thepresent time not a drop of this water reaches the townunless it be on camel-back or donkey-back. It issaid that the water at the source itself has sunkconsiderably (one of my informants said as much as two

metres) below the level of the conduit. In any case thereservoirs in the town to which this water should be suppliedwere quite dry in February last. There are five of thesereservoirs. One of them is about four and a half metreslong, three and a half metres wide, and three metres deep,built in masonry, covered with plaster. This water is (or,rather, should be) conducted first to a small open reservoirby the side, where it should deposit some of its grossersolids before entering the larger cisterns. At one side therewas at one time a row of taps ; they no longer exist. Thiscistern is covered over with a roof of armoured cement inwhich is a man-hole ; the interior was absolutely dry andthe bottom littered with rubbish. The state of theother cisterns in the town was said to be much the same.A small quantity of this Hamidieh water was, as stated above,brought to the town in skins mostly carried by camels. Acamel-load is reckoned at 16 small skins or four large ones.A small skin is supposed to hold about ten litres (rather overtwo gallons) of water. A load is therefore about 160 litres.The load of Hamidieh water was sold at 15 piastres (abouthalf-a-crown). The quality of the water is said to be fairlygood and it never becomes brackish, as do some other watersin these regions. 2. The source known as the Am Bariman issituated to the north of the town some five hours (others saideight hours) away. In passing it may be stated that thewish to visit any of these sources was impossible offulfilment. Since the attack by Arabs on the foreignConsuls in 1895, when the British Vice-Consul was killed andseveral of the Consuls were wounded, the Turkish authori-ties permit no Europeans to go any distance outside thetown, and even when permitted to go a short way intothe desert they must be accompanied by an armed escort.This source is said to be in the form of a large, deep well ;there is no conduit and the water is brought to the town inold petroleum tins (which are considered preferable to skins)by camels or donkeys. It is said to be the best of the waterssupplied to Jeddah, but the yield is small-not more thanfive or six tons a day-and the price is relatively high. A

petroleum tin (it may be added, in passing, that in the NearEast there is almost no use to which an empty petroleum tinmay not be put) is reckoned to hold about 17 or 18 litres ; atin of Bariman water sells for two and a half piastres ; a loadof 160 litres would therefore cost 22 or 23 piastres (say 3s. 10d.).3. The Ain-Faradj-Yassur is situated six or seven hours tothe east of Jeddah. It has a large conduit, which is seenin Fig. 28; it is of masonry and its inner dimensions are

FM. 28.

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staircase leads down to them. When I visited the depot thereservoirs were completely empty; the door leading to thestair was locked, and the bottom of the dep6t, as also thereservoirs, was littered with debris and rubbish. Thequality of this water is said to have been good ; it was soldat one and a half piastres the small skin.

FIG. 29.

Reservoirs for Ain-Faradj-Yassur water, Jeddah.

Tank water.-One of the most striking features in thedesert outside Arab towns, such as Jeddah, Yanbo, or E1 Wej,is the presence of vast masonry tanks or cisterns, morethan half underground, and intended to hold and to storerain-water. Rain is comparatively rare in these regions, butwhen it does fall it usually falls in large quantities, and thesetanks are constructed of a size and in number sufficient tohold two, or even three, years’ supply. The externalappearance of one of these cisterns is seen in Fig. 30.

FiG. 30.

Rain-water tank (" Sahrij ") outside Jeddah.

They are large, often immense, structures in masonry, coatedwith plaster outside and with cement or " tap-tap"2 inside,and roofed over with a masonry arch, in which there areusually several manholes. The largest tank that I saw wasabout 40 metres (130 feet) long and 12 metres (40 feet) wide;others are said to be still larger. These tanks are intendedto collect the rain water from the surface of thedesert around them ; there are no actual conduits tocollect the water but it can generally be seen thatthe sandy surface has been worked more or lessall round, forming channels and low embankments, andhere and there are rudimentary works in masonry, allintended to direct the flow of the surface water towards the

2 The nature of "tap-tap," as employed for roofings, was described inan earlier article (May 11th, p. 1320); its composition when used forlining tanks is slightly different.

cisterns. At one end or one side of the cistern is a small openreservoir (sometimes there are several) where the waters firstcollect and deposit their grosser solids. I visited the interiorof one of these tanks (in the desert near Yanbo). Theentrance was by a door leading to a stone staircase, whichdescended to the bottom of the cistern ; the total depth wasabout seven metres (22 feet). At that time there was onlyabout a foot of water, but, the cistern being a very large one,that was equivalent to about 120 tons. The water appearedfairly clean ; it was mainly drunk by the troops garrisonedclose to the Medina Gate of Yanbo. Officers and menassured me that the water was then quite good but that itwould steadily deteriorate during the summer and thatif no rains fell in the winter there would be dangerof a water famine. Fortunately, heavy rains fell inNovember all along the Arabian coasts of the Red Sea andboth at Yanbo and at Jeddah the tanks must be now wellfilled again. At Jeddah, at the time of my visit, the tankwater was nearly exhausted ; it had frequently a bad smell;and during the past summer I learned from letters that ithad become absolutely intolerable. Most of these tanksbelong to private individuals who make a good income fromthe sale of the water. These persons are said hitherto tohave opposed every effort to supply Jeddah with a purerwater and it is more than probable that the damage tothe conduits of the spring waters (referred to above) isby no means always done by Bedouins, but may some-times be ascribed to tank owners jealous of com-

petition. There are a few small tanks in the town itselfsituated in the courtyards of the houses. They usuallycollect the rain-water from the roofs, but some houses havelarge cisterns which are filled by water brought into thetown from the sources or springs outside.

(To be continued.)

BIRMINGHAM.(FROM OUR OWN CORRESPONDENT.)

The University.THE medical examinations are now over and the greater

part of the ordinary work of the summer session is finished.One candidate, L. G. J. Mackey, secured the M.D. degree.At the final examination for M.B., Ch.B. eight candidatessucceeding in passing the examiners, and James Fenton wasawarded both the Ingleby scholarship, for highest marks ingynæcology and midwifery, and the Queen’s scholarship, forthe highest place in the examination. Seven candidates

passed the fourth examination and John Dale, whowas placed in the first class, gained the Queen’sscholarship. In the third examination, which includespathology and materia medica and pharmacy, ninecandidates passed, and the Queen’s scholarship forhighest place was awarded to Herbert Henry Sampson.In the second examination six candidates passed and0. M. Holden secured the Queen’s scholarship. The Boardof Education has approved the proposal of the University totake over the residential part of Queen’s College for thepurposes of a residential hall for students of the University.The experiment will therefore proceed and if it is successfulit will have far-reaching and very beneficial effects on theUniversity life of future students. Professor Kirkaldy, whohas already shown so much interest in the social welfare ofthe students, will be warden, and this is a sufficient guaranteethat everything will be done on the highest possible lines.There will be accommodation for about 40 students and thefee will be 20 guineas a term. Students who are wise and whowish to obtain all the benefits of university life should securerooms as soon as possible, and parents who wish their sons tolive in the city during the terms should not miss the oppor-tunity of securing places for them in the hostel.-The golfmatch between the University and the city has resulted thisyear in a victory for the University.

The Hospital Saturday Fund.Nominally June 15th was Hospital Saturday but actually

the collection of the money extends over several weeks and itis not yet certain what the total amount will be. For severalyears the committee has endeavoured to raise the collectionto £20,000, and year by year it has gradually risen until lastyear it was only .E700 short of the desired sum. This yearthe hopes of the committee are high, for the early returns