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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.)

XII.

EL WEJ : A RETROSPECT.

Bistory of the El Wej Lazaret.-The Constantinople Con-ference of 1866.-Creation cf Camaran Lazaret tor Pil-grims going to the Hedjaz and of those of EL W’ej ana EtT.J1’ for Pilgrinas rutitrning from the -Hedjaz - Unsuit-ability of J!}l Wt-j.-A Bttrst Cundenser.-h’inaL Transfer ofPilgrims to Et Tor and abandonment of the EL Wej- Z.<X<Z?’e.&mdash;&mdash;-/S Revival proposed to the Paris InternationalSanitary Conferenoe, 1894, but rejected, by the Conference.-Present State of the Town and the remains of theLazaret.-Conclusion of the Series of Articles.IF Yanbo is not often visited by Europeans, still more

rarely so is El Wej. There is little reason, indeed, whythey should go there at the present day. From the sanitarypoint of view the whole interest of El Wej lies in the past;as a trading port it offers but little importance, and as aport of pilgrimage, though a certain number of Hajjis dopass through it each year, it is not to be compared witheither Yanbo or Jeddah. But at one time this small portwas a good deal heard of and played a r6le of some con-sequence in the international prophylaxis of disease in con-nexion with the pilgrimage. It may be of interest to give,as briefly as possible, the history of the quarantine stationthere, and to add a few notes on the present condition of thetown and on the melancholy ruins which alone remain tomark the site of that station.The present system of sanitary defence in the Red Sea

against the spread of plague and cholera by the pilgrimagedates essentially from the International Sanitary Conferenceheld in Constantinople in 1866. Though not the earliest of theseinternational meetings it was in many ways one of the mosthistorically important, and all the later conferences, endingwith that of Paris in 1903, have been but the logical develop-ment and continuation of its labours. The list of " con-clusions " drawn up by the Constantinople Conference isfull of interest even at the present day. They were dividedinto three groups as follows : (1) those relating to the originof cholera and its endemicity in India ; (2) those relating toits mode of spread; and (3) those relating to practical measuresfor its control. It is the last group of conclusions alone thatneed be considered here, and more particularly those relatingto the sanitary measures recommended in connexion with themovements of pilgrims in the Red Sea. The most importantof these measures was the proposed creation of a largelazaret at or near the entrance to that sea, which was to beunder international control and to which all pilgrims coming,from beyond the Straits of Bab-el-Mandeb were to be sent toperform quarantine before being allowed to land in the

Hedjaz. That proposal ultimately took form in thecreation of the Camaran lazaret, so fully described in theearlier articles of this series. It was, and is, intended toprevent the importation of disease to the Hedjaz. At thesame time it was decided to have two similar institutionsnear the northern end of the Red Sea, which shouldprotect Egypt, and indirectly Europe, from the danger ofthe spread of disease front, the Hedjaz should it become

epidemic there during the pilgrimage. One of these wasto be established at El Wej and the other at El Tor on theSinaitic Peninsula. The former port is situated on theArabian coast, almost exactly opposite Kosseir on the

Egyptian shores. The El Wej lazaret was to be employedfor quarantining pilgrims returning from the Haj amongwhom cholera had broken out ; that of El Tor for pilgrimsfree from cholera. Much confidence was placed at thatperiod in long quarantines. Thus in 1867 (though the ruleswere somewhat modified later) even "clean pilgrim shipswere compelled to do seven days’ quarantine at Tor, followed

1 Nos. I., II., III., IV., V., VI., VII., VIII., IX., X., and XI. werepublished in THE LANCET of April 27th (p. 1188), May 4th (p. 1251), 11th(p. 1317), and 18th (p. 1389), June 1st (p. 1518). 8th (p. 1607), 22nd(p. 1741), and 29th (p. 1810), and July 6th (p. 51), 13th (p. 114), and 20th(p. 190), 1907, respectively.

by seven days in the supplementary station of Moses’s wells,before being allowed to land their passengers in Suez ;infected ships and, if cholera had broken out in the Hedjaz,all ships coming from that province had to perform 15 days’quarantine at El Wej.The El Wej lazaret appears to have been already in

existence as early as 1867, the year after the ConstantinopleConference. Then, or later, a stone landing-pier was con-structed there, some masonry buildings were put up, andcondensers, to supply drinking-water, were installed on afloating barge or lighter. For ten years the lazaret con-tinued to exist and to receive pilgrims. But in the intervalit had come to be recognised that its site presented manyand serious disadvantages. The harbour is an exceedinglysmall one ; not more than two pilgrim ships of any sizecould lie there at a time. It is, moreover, dangerous ofapproach and exposed to frequent stormy winds, so that shipslying there had to keep their fires up ready to run to a saferharbour in case of necessity. British ship-masters protestedstrongly to the home Government against the continued useof this port as a quarantine station, and their assertions as tothe dangers it presented were confirmed by independentreports made to the Admiralty by British cruisers in the RedSea. The crisis came early in 1877, when one of the con-densers which had been put up to supply the lazaret withdrinking-water suddenly burst. The local water-supply waswholly inadequate and unsuited for the many pilgrimsquarantined there and consequently the latter were trans-ferred to the lazaret at El Tor which has ever since been theprincipal quarantine station for pilgrims returning north-wards from the Hedjaz.The abandonment of El Wej appears to have given rise to a

very lively and vigorous controversy at the time. Captain (laterSir Richard) Burton, who was then inquiring into the mineralresources of that portion of Arabia, was requested by theBritish Government to report upon the suitability of El Wej asa port of quarantine. His opinions as to the relative advan-tages of that port and of El Tor (which were later repeated atlength in his "Land of Midian Revisited ") were expressedwith characteristic freedom and force. No praise that couldbe given to El Wej appeared to him to be excessive, while,on the other hand, no condemnation was thought to be toostrong for El Tor. The former was described as almost aterrestTial paradise, while the latter was characterised as ahotbed of fever, as ’’ inhabited by a ring of thievish Syro-Egyptian traders, backed by a wretched wilderness, alter-nately swampy and sandy, and comfortless to an extentcalculated to make the healthiest lose health." "Tor is, infact," Captain Burton continued, "an excellent medium forfocussing and for propagating contagious diseases; and itsvicinity to Egypt, and consequently to Europe, suggests thatit should at once be abolished."The experience of 30 years has in no way confirmed the

above apprehensions as to the unsuitability of Tor for aquarantine station for pilgrims or as to the likelihood of itstending to spread rather than to arrest epidemic disease. Onthe other hand, the lazaret of El Wej, once abandoned,could never be revived and nothing of it remains to-daybut some crumbling ruins. There was, however, some yearsago a movement on foot to build another lazaret or

to repair the old one at El Wej. In the interval thefrontier line between Egyptian territory and the province ofthe Hedjaz had been transferred from the neighbourhood ofEl Wej to that of Akaba on the Gulf of that name. Thistime, consequently, it was the Constantinople Board of Healththat proposed to establish or to revive the lazaret there. Thisproposal was mainly the result of the great European epi-demic of cholera in 1892-93. Plans for the new institutionwere prepared by the French contractor who had carried outthe new works at the Camaran lazaret. They would haveinvolved an outlay of PT.57,000. The project, which wassanctioned by an Irade from the Sultan, was submitted tothe International Sanitary Conference held in Paris in 1894.The proposed lazaret was to serve, as before, mainly forpilgrims returning from the Hedjaz. The conference, how-ever, preferred to enlarge and to improve the El Torlazaret for this purpose and the project was there-fore rejected. The Turkish delegation, nevertheless, made aformal declaration to the Conference to the effect that theConstantinople Board of Health had definitely decided tobuild a lazaret at El Wej ; that this new institution was toserve mainly for quarantining pilgrims going to the Hedjazfrom the north, acting in this way an exactly similar r&ocirc;le tothe Camaran lazaret for pilgrims from the south ; that it

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could nevertheless also be employed for returning pilgrims as the old lazaret had been ; and that finally the new projecthad been sanctioned by Irade. Notwithstanding this declara-tion no practical steps were taken to carry out the project.From time to time the opinion has been expressed that alazaret such as that foreshadowed in the above declarationought to be created somewhere near the northern end of theRed Sea. There would be many practical difficulties, however,in the way of carrying out such a proposal, more particularlyin finding a suitable site. El Wej has been shown by experi-ence to be wholly unsuited for the purpose and no other sitehas been seriously recommended. Moreover, shipping wouldto some extent suffer since pilgrim ships would be compelledto lie at the new lazaret during the whole period of quaran-tine in order to re-embark their pilgrims and to carry them tothe Hedjaz, whereas under present conditions they take thepilgrims straight to the Jeddah (Abu-Saad) lazaret, landthem there, and are then free after disinfection to returnand to start a fresh voyage. There would, indeed, be noneed to consider the possibility of creating yet anotherlazaret were that at Abu-Saad large enough to receive allpilgrims from the north when they are subject to quarantine.But, as pointed out in Article X. of this series, the mostsatisfactory solution of that difficulty would be the enlarge-ment of the Abu-Saad lazaret bv means of an annexe on themainland in the neighbourhood of the islands upon which itis now built.The small town of El Wej is rather attractively situated :

the cliffs rise here to a height of some 50 or 70 feet, andthe houses are built partly on the shores of the bay andpartly on the cliffs. A large oasis, studded with palmsand other trees, runs inland behind the town. Water ismore abundant here than at Yanbo or Jeddah. Thetown has a Kaimakam or Turkish governor and a small

garrison of soldiers is stationed here. On the south side ofthe bay is a high tower, apparently once a light-house, andat no great distance from this are the ruins of the lazaret.One large, roofless building remains the walls of which areslowly crumbling to pieces, It is shown in Fig. 39. At its

FIG. 39.

El Wej: remains of the lazaret.

back are the vestiges of a masonry reservoir, cemented insidesome 20 yards long, five wide, and two deep. It wasevidently intended to store drinkirg water. A short dis-tance away is what remains of a stone landing jetty which isin a better state (of preservation than the building just de-scribed. Near the northern shore of the bay there rises out ofthe water a black and monstrous object which looks strangelyout of keeping with its surroundings ; it is the relics of the

distilling apparatus that once furnished the lazaret withwater and the bursting of which led to the final abandon-ment of El Wej in favour of El Tor. The barge, or

pontoon, on which it floated appears to have sunk or beenrun ashore. Portions of it can be seen above water, but thebulk of the black mass is formed by the iron shell of thedistilling apparatus itself which still keeps its form in spiteof 30 years’ exposure to sun and wind and damp. (Fig. 40.)With these brief notes of an extinct, and almost vanished,

lazaret the present series of articles must close. It hadbeen my intention, when starting to write them, to include

a description of the other sanitary institutions visited bythe Inspection Commission, notably the lazaret of Beirut andthe disinfecting stations recently established at Jaffa andRhodes. But, apart from considerations of space, thesearticles may be fittingly limited to a description of some of

FiG. 40.

El Wej : the abandoned condenser and barge.

the Red Sea lazarets and the part they play in the control ofdisease extension in connexion with the pilgrimage to theHedjaz. To describe the three institutions just mentionedwould be to enter the Mediterranean and to touch upon the

very much larger question of the network of sanitarydefences at the eastern end of that sea, of which those insti-tutions only form a small portion.

It should be added, however, that the foregoing articleshave by no means exhausted the list of sanitary defenceseven of the Red Sea. There is a small lazaret at Aden ; a newone has just been created at Perim; there is one at theItalian port of Massowah, another at Suakim, and a verylarge one at El Tor, on the Sinaitic peninsula. The last twoare under the administration of the Alexandria Sanitary,Maritime, and Quarantine Board. To deal, indeed, at alladequately with the entire system of international prophylaxisin the Red Sea alone, as it is carried out by the two boards ofConstantinople and Alexandria respectively, would require amuch longer series of articles than the present one. If thesechapters, however, have succeeded in giving their readerssome idea of the large and costly institutions which, underthe name of lazarets, have been brought into existence underinternational auspices as the main instruments of that pro-phylaxis, as also of the many and complex problems whichthe two boards just named are called upon to solve-not onlyin connexion with the pilgrimage, but also in connexion withthe entire sanitary defence of the Near East-they will nothave been written in vain.

Constantinople. ___________________

MANCHESTER.

(FROM OUR OWN CORRESPONDENT.)

Professorship of Medicine.As recorded in the last issue of THE LANCET Dr. Graham

Steell has been appointed by the Council professor ofmedicine in the University of Manchester. In Dr. Steellthe high standard kept up by the former incumbent ofthe professorship of medicine will be fully maintained.Clear and concise in diction, his teaching is acceptedas the outcome of accurate, clear-sighted, clinicalobservation. His writings have been largely concernedwith the diseases of the lungs and heart and his recentlypublished text-book on the latter subject will enhancethe reputation which he has already acquired. But itwould be a mistake to consider Dr. Steell as a lung andheart specialist to the neglect of the other branches and hewill be found an able and learned exponent of the scienceand art of medicine.

The Pharmaceutical Conference.The forty-fourth annual meeting of the British Pharma-

ceutical Conference has just been held in Manchester. The