In the year 1879 Dr. Urquhart and Mr. W. S. Tuke each wrote an account in this Journal∗ of his visit to the asylum at Cairo, which was then, and is now, the only institution for the treatment of the insane in Egypt. Their impressions were most unfavourable. Dr. Urquhart says, “there is “in Cairo” no more melancholy and degrading fact than the common madhouse.” “The Conolly of Egypt has still his work to do.” “The whole place is so utterly beyond the ken of civilisation that it remains as hideous a blot on the earth's surface as is to be found in the Dark Continent.” Mr. Tuke said:—“The place looked intensely squalid;” “with regard to the means employed in Egypt for the cure of insanity, I find that bleeding is the chief therapeutic remedy.” No statistics could be obtained by either visitor. Since then the institution has been removed from its old site in a suburb of the city out to a palace and stable of the late Khedive Ismail at Abbasiyeh, about three miles north of Cairo. The weakness for palace building of his late Highness was one well-known feature of that sumptuous ruler's character. What to do with those gorgeous buildings was one of the difficulties of the English Government when it assumed the control of the country. One in which 200 of his wives and concubines had been magnificently housed is now turned into the zoological gardens. Where the fair Circassians lounged is the habitation of fierce beasts of prey. The marble walks laid out for the delicate feet of those ladies are now trodden by the gaping crowds of holiday Cairene visitors. Another palace has become a most sumptuous hotel. Another contains the priceless treasures of Egyptian antiquity at Gizeh. Several have been turned into soldiers' barracks, and many more are mouldering to decay. The insane of Egypt were not thought worthy of the best of those palaces. What was good enough for his Highness's horses was surely good enough for Egyptian lunatics. So to them was assigned the stable palace with its accessories. No doubt it was a great improvement on its predecessor, but under Egyptian management and control it was far from being an ideal hospital for the insane. Soon after Rogers Pasha was put at the head of the Sanitary Department, in which the treatment of the insane is merged, he saw that native management of the asylum was wanting in initiative, in honesty and in intelligence. So he got permission to appoint a British Medical Superintendent, and he has succeeded in investing him with large powers. Fortunately he secured the services of Dr. Warnock for the position. That gentleman's first Report, for 1895, now lies before us, and a most interesting document it is. We know from a visit we lately paid to the institution that the facts are true, and that the revolution from psychiatric darkness into light that has come about is very modestly understated. No man who has the welfare of the insane at heart but must rejoice that a great work is being thus carried out in behalf of the most helpless of mankind. Dr. Warnock's difficulties were at first enormous. He found dirt, disorder, and dishonesty rampant, neglect of the patients the rule, and modern scientific treatment of mental disease conspicuous by its absence. The patients were severely drugged, badly fed, insufficiently exercised, and vigorously restrained by means of the camisole. In and about one bed—a fair specimen of the rest—he counted 3,000 bugs, lice, and fleas, and now he fines the attendant in charge a piastre for every bug that is seen! In the year 1894 the death-rate was 33 per cent.; in 1895 it fell to 16½ per cent. on the average numbers resident, and in the last half of 1895 it fell one-third as compared with the first six months of that year. It must be kept in mind that the death-rate of the city of Cairo is about 40 per 1,000, or more than twice that of London. Organisation and order has been introduced everywhere. An almost entirely new and better staff has been engaged. When Dr. Warnock went there no female nurse could read the number on her ward door nor tell the time of day from the clock. Punctuality was unknown. There was no employment for either sex. Now we saw a very large number of men and women usefully at work. Noise by night and day has vastly diminished. Dr. Warnock says:—“Regularity and order are of slow growth, but in the end must prevail.” Parasites and the tubercle bacillus and the diseases they cause, have afforded the subordinate medical staff their chief employment, but Dr. Warnock looks hopefully forward to the time when a thorough mental and bodily examination of each case, systematised case-taking and the use of scientific methods, will bring his hospital up to the level of the British standard. The dietary has been improved in quality and service. There were 526 patients admitted in 1895, while the average number resident was only 465. We believe no such proportion of new cases to resident population exists in any asylum in Europe. This is not one of the least of the difficulties of proper treatment and management in the Cairo Asylum. Few of us would like to face such a yearly influx into our institutions. There is far too little land attached to this asylum, and it is too close to a public road. The structure and arrangements of the building fall far short of our European modern standard. Yet Dr. Warnock works on hopefully and successfully. He has to be doctor, steward, architect, clerk of works, and general manager. and all this with a staff of semi-civilised Arabs, scarcely one of whom he can trust as we trust our kitchen-maids! Let any man in Great Britain who is discontented with his asylum and his staff go to Cairo and spend a day with Dr. Warnock, and he will become profoundly thankful for his privileges. In his isolation from professional stimulus, with his stable-palace and its glaring structural defects, with his stolid Arab staff and his Arabian desert without a blade of grass as an outlook, he deserves our sympathy and admiration for what he has accomplished in his year of office, and for the pluck with which he faces his task. No one but an enthusiast could have done as much. All English officials in Egypt need to be young, healthy, hopeful, and tough. Their work takes a lot out of them.
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