Remarks on the Epidemic of Cholera in Egypt
Authors: W. G. Hunter
Journal: BMJ (1884)

the honour to invite me to read a paper havinp for its subject the late cholera-epidemic in Egypt, I had some difidence in responding to your request, as I felt that, after my report had been present to Her Majesty's Govemment, anything that I might have to say would be robbed of much of Its interest.On reconsideration, however, of the matter, there appeared to me one particular point in that report of such paramount impoitance that it could scarcely fail to prove of interest to this Society, even if much of the old ground were trvelled over again.Having received, too, since the report was written, further corro- borative testimony of my views on the origin of the epidemic in Egypt, I thought I might venture to place the matter before you.While this paper, therefore, has no pretensiom to being a compre- hensive one on the cholera-outbreak of 1883 in Egypt, but will be strictly limited to an endeavour to explain the origin of the out- break, yet it will not, I trust, fail in creating an interest among the the members of the Society.If it does this, it will have served the purpose for which it was written.Egypt is a very extensive country.It extends from the Mediterranean Sea to the Equator.It is not, however, this vast country which has been the soene of the recent epidemic of cholera, but rather Egypt proper, which includes the Delta and Upper Egypt as high as Assuan on the first Cataract.Its area of cultivated land is not larger than Belgium.Its population, however, according to the most recent census ( 1882), amounts to 6,798,280; and is, conse- quently, about one and a quarter millions in excess of that of Bel- gium.The soil, which is very fertile, is an alluvium, " ' the gift of the Nile," and is rich in decomposing organic matter.The people are essentially agriculturists, and lead an out-door life.Manufactories, though increasing, are comparatively few.It is almost a rainless country.At Alexandria, it is true, the average annual rain- fall for the last four years has been about eight inches; but in the interior, of which Cairo may be taken as representative, the rain is limited to a few showers, which fall during the cold months of the year-viz., in November, December, and January.The sky is gene- rally cloudless, the air dry, and the dews very heavy.The prevailing winds are northerly, a southerly wind being quite exceptional.On looking over the meteorological reports, issued from the Khedivial Laboratory, one is struck by the almost tedious monotony with which the northerly winds blow throughout the year.The rainfall being so scanty, the country is consequently depend- ent on the Nile for its water-supply.The river is subject to perio- dical inundations, owing to the heavy rains in the equatorial region.The rise of the river at Cairo begins about the end of June, and is at its highest about the middle of September, when it gradually falls until it again attains its minimum level in June.There being practically no rain, the subsoil water-levels must necessarily follow the Nile level; that is to say, be at their lowest in June, and at their highest in September.The larger majority of the people drink the water unfiltered, and generally before it has been allowed time to deposit.It is said that they prefer it in this condition.In Cairo the quality of the water- supply'is indifferent.At the waterworks there is but one settling tank, and, as it is in constant use, it can never be cleaned.The large amount of mineral matter contained in Nile water, while settling, carries down with it no inconsiderable quantity of the organic substances heldl in suspension in the water, and must lead to rapid fouling of the tank.Filtration is effected by gravel and sand.In the Ismailia quarter, that is, the fashionable part of the city, and in the Boulac quarter also, no attempt is made to filter the water, but it is supplied as obtained from the Nile.Close to the intakes of the Cairo waterworks, where some slight efforts, it is presumed, would be made to prevent pollution of the water, I bave seen human, and other animal exereta, fresh and stale, lying about in various directions, and men and women bathing, and washing their soiled clothes in the river.This was by no means an uncom- mon sight.[1203.] the Conseil de Santgat Cairo.In Cairo, the cess-pit system exists, and is carried out in a very inefficient manner.Many of the pits are holes dug in the sand, which have never been emptied or olvaned.McTOrpqenty, in tbi.e better class of houses, the pits have heeil Aetoteb ,tircn, but their being emptied depends much oh " le.cap,'ide 4f eh -atidbrdc, not of the tenant."The wooden carts employgd tor rsmoy o£ ths, sewage are of the most primitive descr"fptto2i, :ard vUme4ic., lly ate .