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Antiseptics in food
M~y,18~j
Antiseptics in F o o d
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ANTISEPTICS IN FOOD. ~ BY A L F R E D HILL, M.D., F.R.S. Edin., F.I.C., Medical Officer of Health of Birmingham.
THE adulteration of food is a practice of great antiquity, and consisted originally of very simple methods. With the advance of scientific knowledge, however, the methods of falsification employed became more numerous, more complex, and more difficult of detection, so that science, having been pressed into the service of adulteration, the resources of science are now fully taxed in the endeavour to detect it in some of its more recondite forms. When Accum wrote his book, " D e a t h in the Pot," simple adulterations were common enough, but the means of detecting them were then very imperfect. Dr. Hassall, by his works published by himself, and those carried out by him in connection with the Analytical Sanitary Commission of the La~cet between forty and fifty years ago, and particularly by the use he made of the microscope, gave to the means of detection a development which proved of great value in unmasking many of the adulterations practised, which up ~o that time did not admit of being made out with precision or certainty. The passing of the Adulteration Act in 1860 led to the appointment of public analysts, whose labours have resulted in processes of great certainty and delicacy, so t~at adulteration at the present time, combated as it is by the application of physical, chemical, and optical science, is detected with a degree of completeness not dreamt of forty and fifty years ago. I am not, however, concerned this evening with adulteration in its general aspect, but with that form of it which has of late years become so common, namely, the addition of antiseptics to perishable articles of food and drink, and, in response to your invitation, I have pleasure in submitting a few remarks on the subject embodying the researches, observations, and opinions of some leading physicians, physiological experimenters, and bacteriologists, together with my own experience as a public analyst. My paper is not to be regarded as dealing at all thoroughly with the subject, which, I need hardly say, is exceedingly wide and varied, but is intended to constitute such a statement of certain points of the question as shall serve the purpose of an introduction to a discussion of it by this meeting. Read before the Incorporated Society of Medical Officers of Health, April, 1899.
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During the three years ending March, 1899, 2,300 of the samples of food received by me as Public Analyst for the city of Birmingham have been examined for preservatives. In 460 instances, or 20 per cent., boric acid, formic aldehyde, or salicylic acid have been detected. This fact will show that the use of preservatives in food has risen to very large dimensions, and requires serious consideration by all interested in the health of the community. Boric acid was found in 35 per cent. of the 882 samples of butter and margarine, and in 15 of the 24 samples of bacon, sausage, and other animal foods. For preservative purposes, a mixture of boric acid and borax is generally used. Samples of butter analyzed this year have contained quantities of boric acid varying from 7 to 84 grains per lb., or from 0"1 to 1"9. per cent. Butter is brought here from Australia in excellent condition, a distance of about 15,000 miles, without the addition of any preservative whatever, simply protected by a low temperature. Is it not, then, unreasonable to suppose that it is necessary to heavily drug butter from Cork, or from the Continent of Europe, about 200 miles off, a distance occupying only a few hours in transit ? This simple question is answered emphatically in the affirmative by the f~ct that not all the butter from these places is so drugged, but only some of it. In fact, as I mentioned before, two-thirds of the samples of butter and margarine examined in Birmingham were found to be free from boric acid. In a large proportion of the samples which contained this acid, the amount present did not exceed 0"3 per cent., or 21 grains per lb. ; if this quantity is sufficient, why should 70 grains and upwards per lb. be used ? When the quantity of preservative is greater than the water present can dissolve, the boric acid is in the solid state, and useless as a preservative, and microscopical examination in these cases shows the presence of crystals of boric acid. What information have we as to the effect of boric acid and borax on health ? Several surgical cases have been reported by Moldenkow, Hogner, Welch, Lemoine, and others, in which the use of these drugs has produced serious and even fatal results. A number of experiments have been made on men and animals by 1VIattern, FSrster and Schlenker, and Chittenden, with the result that they all found that smaller or larger doses interfered with digestion and nutrition. The Lancet, on January 2nd, 1897, published the opinions of a number of eminent medical men on this subject, who appeared generally to regard the use of preservatives with suspicion and disapproval, as liable to produce deleterious effects. The
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Br~tish Medical Journal, on January 28th, 1899, published the experience of Dr. J. Jameson Evans, of Birmingham, who found the continued use of boric acid in cases of cystitis and urethritis produced an erythema, followed by a fine scaly exfoliation. In one case, where the drug was given in doses of 10 to 20 grains three times a day for five weeks the patient became perfectly bald. Professor D. J. Leech, of Manchester, has recently (August 8th, 1898) expressed the following opinion: " I t appears to me that many patients can take either boric acid or borax for a long time in very large doses with impunity, but that in some people the unpleasant results are produced by comparatively small quantities, and it is quite possible that serious harm might in these cases follow its ingestion in the quantities in which it is used in the preservation of food. There can be no doubt that it should not be used in the preservation of milk." This last opinion was given at the request of Dr. J. Niven, the Medical Officer of Health of Manchester, who also quotes that of Professor Dixon Mann, as follows: " I have seen several cases in which a purpuric eruption, with nausea, loss of appetite, and depression, followed the dressing of open wounds with boric ointment . . . . I can remember two cases in which thrush in infants was treated with honey and borax, and the application continued long after the aphth• had disappeared. Nutrition was so much impaired as to cause great emaciation, with intestinal irritation and diarrhoea . . . . I am strongly of opinion that the most stringent restrictions are needed in respect of milk, as being the food of infants and young children, whose nutrition would be seriously impaired by the prolonged ingestion of boric acid, or its compounds, even in small amount." I have quoted these recent opinions somewhat fully, believing that they may be new to some of my audience. A curious meat-preservative was exhibited at a meeting of the Society of Public Analysts last year by Mr. A. C. Chapman, F.I.C. It was a real curiosity in its way, for it contained alum, salt, sodium nitrate, sulphurous acid, chloral hydrate, benzoic acid, and a small quantity of iodine! This shows what food preservation may come to. In 5 per cent. of 1,360 samples of milk I examined boric acid was found in quantities varying from 130 grains per gallon to 3 grains or less. When the former case came before the magistrates the defendant admitted that he had added a solid preservative to the milk. This illustrates the danger that the preservative may not be properly dissolved and incorporated with the food, but may be present in excessive quantities in part of it.
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Five out of eight samples of cream were preserved with boric acid. In one case salicylic acid was alsopresent. Even if we were to assume that the quantity of boric acid used to preserve each of the various foods I have mentioned was not sufficient to affect the health of the consumer when taken alone, we have to consider that there is the possibility that our butter, bacon, sausage, milk, and cream may each contain boric acid, and that the aggregate amount of the drug taken may attain serious proportions. Quite recently a new food-preservative has come into use, and, for various reasons, it has largely superseded boric acid. It is in the liquid form, and a very small quantity suffices. I refer to formic aldehyde, which I have detected in 47 out of the 1,000 samples of milk examined. What are its effects on the animal economy and oll food tissues ? F. D. Simons says that in his experiments it retarded pancreatic digestion, and Weigle and Merkel say that it renders the albuminoids of milk less digestible, an addition of one part of formalin to 500 of milk rendering the casein insoluble in pepsin and hydrochloric acid. This is a serious indictment, as it shows a retarding influence on the digestion of both animal and vegetable food, proteids, and amyloids. Attempts to preserve fish by means of formalin failed on account of its hardening effect. This was apparently due to the coagulation of the albuminoids, the samples being made so hard as to be rendered unsaleable, even by solutions containing only one part of formic aldehyde in 5,000. According to Rideal, 1 oz. of formaldehyde (equal to 2½ oz., 40 per cent., formalin) does the work of 5 lb. of borax and boracic acid, so that if a very small addition be sufficient, its greater potency makes up for its smaller quantity. There has recently been a prosecution in Liverpool in a case of milk containing this antiseptic, when it was contended by the prosecution that milk did not need any preservative, that the use of formic aldehyde enabled a dealer to sell stale milk as fresh, and obviated the necessity of cleanliness of the dairy. It was also contended that it made the milk indigestible, and had an irritant action on the mucous membranes. Professor Boyce, of the University College, and Mr. Williams, the Public Analyst, asserted that formalin in milk was quite unnecessary, and most objectionable. Mr. Davies, analytical chemist, and Dr. Barrow were called for the defence, and expressed the opinion that the amount of formalin said to have been used would not be injurious to health.
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The Stipendiary Magistrate expressed himself, however, as on the side of the cow against the chemist, and inflicted a fine of £5 and costs. Notice of appeal was given, but was subsequently withdrawn. For the reason that milk is the one perfect food, especially valuable for invalids and children, it is the food which, above all others, ought not to be tampered with. It is true that milk soon changes ; it does not keep indefinitely, and evidently Nature did not intend it to do so. The young of all mammals naturally receive it directly from the mother, and the more directly we all of us obtain it the better. It is only the ingenuity of man which is exercised to circumvent natural law in this connection, and as long as this is done without medication and adulteration there is no objection, and, happily, we know a safe means of doing it. It is admitted that the decomposition of milk does not occur in properly conducted dairies under forty-eight hours, which should be long enough to allow of its distribution, and where it is found necessary to add antiseptics to make it keep so long, i~ is because the treatment of it is careless or dirty, or otherwise bad, so that preservatives are often added to the milk of our dairies to compensate for the faults of its treatment, which our supineness only encourages. An argument of considerable force against the prevention of change in milk by added chemicals is furnished by the circumstance that morbid milk, whether by itself or mixed with normal milk, very soon changes, and such premature change is of the greatest value as an indication of the unhealthy condition of the milk, and a signal to direct attention to its cause. If the addition of chemicals to food were necessary, some favourable consideration might be given to it, but it is not necessary, as is proved by the fact that it is only used to a limited extent. Another antiseptic which has been much used, but to a less extent in this country than abroad, is salicylic acid. I have found it in cream, in jams, and in spirituous compounds. Salicylic acid was detected in five out of six samples of jam which I examined, in five out of eleven samples of ipecacuanha wine, and in one sample out of twelve of sherry. In four of the six wines the proper quantity of alcohol was not present, the cheaper salicylic acid having been used to replace it. According to F. D. Simons, salicylic acid retarded peptic digestion, and Chittenden observed that salicylate of soda and borax act antagonistically to the digestive ferment. Though not very poisonous in moderate doses and in dilute solution, yet in large doses it is said to produce serious cerebral
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symptoms, and it is well known to medical practitioners to produce in medicinal doses headache, deafness, singing in the ears, and loss of appetite. French authors especially call attention to its injurious action in diseases of the kidneys, and to its slow elimination in aged persons. In a paper read before the Franklin Institute on December 20th, 1898, H. Leffmann stated that, after a number of experiments, he had come to the conclusion that "salicylic acid in all its forms, i.e., natural, crude commercial, and refined commercial, is distinctly antagonistic to most enzymes, especially those that convert starch. He found that, to use his own words, " Sodium benzoate [another antiseptic sometimes used in foods] is without appreciable interfering action, and as its preservative action is undoubted, and its disagreeable taste will prevent its liberal use in any food article, it seems to be well adapted for general use." One of the pleas of persons using preservatives is that they are not seen to produce bad effects, that they are commonly taken as remedies, and are as harmless as useful. But this is begging the whole question, and disposing off-hand of the problem awaiting solution. If bad effects are not traceable at once, and to single doses or small quantities, no proof is thus afforded that the continued use is harmless. If the substances be used as remedies, it must be evident that the conditions under which they are given are totally different. As remedies they are given for a special curative purpose to persons out of health accepting them voluntarily, and they are only used for a limited time ; their dose is carefully regulated, and they are given under professional advice and supervision. If mixed with food the conditions are altogether different ; there is no curative object, for the consumers are not necessarily ill--they take the substance without requiring it, and involuntarily, without even knowing of it, and for an indefinite time. There is no regulation of the dose, which is found to vary very widely, and the substance is administered by lay persons having no knowledge of its nature or the bodily condition of those made to swallow it. On the legal side of the subject one fact appears to stand out with great distinctness, and that is that the sale of milk or other food containing preservatives without a distinctive label is a " sale to the prejudice of the purchaser" of an article of food " w h i c h is not of the nature, substance, and quality of the article demanded by the purchaser," and that the vendor has been guilty of an offence under Section 6 of the Sale of Food and Drugs Act, 1875. In practice the question of quantity comes in, and authorities find a great difficulty
May, 1899]
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in deciding what is the minimum quantity of preservative for which a prosecution shall be instituted. The Government Sale of Food and Drugs Bill introduced into Parliament this year, in Clause 4 proposes that " T h e Board of Agriculture may, after such inquiry as they deem necessary, make regulations for d e t e r m i n i n g . . , what addition of extraneous matter in any sample of milk, butter, or cheese, shall, for the purposes of the Sale of Food and Drugs Act, raise a presumption, until the contrary is proved, that the milk, butter, or cheese is not genuine." This would be a step in the right direction, though it does not nearly cover the question of preservatives in food generally, and some question may be raised as tO the suitability of the Board of Agriculture for such a task. Clause 88 of the Bill brought in by Messrs. Kearley, Maurice Healy, and others, provides that " T h e r e shall be appointed a Board of Reference . . . and the powers and duties of such Board shall . include . . . the power to settle and appoint standards of the amount and kind (if any) of foreign substances to be allowed for the preservation or flavouring of foods." This is an excellent suggestion, and is on the same lines as the recommendation of the establishment of a Court of Reference by the recent Food Products Committee. In the meantime, for Governmental action is deliberate if not slow, we have at our command a means of food preservation which is available for every kind of food, and is open to none of the objections that attach to the material antiseptics. I mean refrigeration. I have referred ~o butter brought in excellent condition from Australia without any admixture, but merely under the influence of a low temperature, and the same agency is employed for the preservation of enormous quantities of meat from Australasia, the Argentine Republic, and the United States. In our towns the fishmongers preserve their goods for a long time in their ice-wells, and in most large centres of population refrigerating stores are provided for various kinds of food. The method possesses the following advantages: It proves to be more effective than any other. It adds nothing, and takes away nothing, not even water, in no material sense altering the quality of the article treated. Lastly, it causes no change of appearance or taste, leaving the meat or other substance substantially in its original condition, neither rendering it less nutritious nor less digestible. In making the foregoing remarks, I have a full consciousness of the superficial treatment which a very wide subject has received at my hands; but my object has been, not so much to do full justice .
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to it as to put before you certain facts and opinions, as well as my
own experience, on which to base a discussion. It is a subject of great professional interest, because of its unquestionable sanitary importance, and it is one respecting which you must feel much personal interest, and concerning which no doubt some of you have had valuable experience. It is, moreover, a question which a Society like ours, consisting of men whose chief occupation is io promote ~ and protect public health, may reasonably be expected to take seriously into consideration, and possibly, in due course, united action. DISCUSSION. The PRESIDENT expressed the obligation of the Society- to Dr. Hill for his paper, and their pleasure in seeing him with them again. Almost the first paper he (the President) heard read before the Society was one by the late Dr. Tidy on the examination of butter, at the Old Scottish Corporation Hall, when the reader remarked, "Gentlemen, we have no test for butter." That would hardly be admitted now. The position of the stipendiary magistrates with regard to this question of preservatives was not to be wondered at when their own professional brethren appeared in court to say these antiseptics were not injurious. Dr. TuBmTHoMAs agreed with Dr. Hill that preservatives were absolutely unnecessary. He had met with a large number of cases of infantile diarrhoea due to the presence of boracic acid in the milk. W h e n pure milk was used the diarrhoea ceased, but as soon as milk containing the acid was given the diarrhoea recommenced. This preservative was largely used for fish, and no doubt fish treated with boracic or salicylic acid retained its good appearance much longer than when treated only with ice or salt. His opinion, however, was that such fish was injurious. It would be all very well to talk about the small quantity of preservatSve ingested if it were used only in one article of food ; but when they found it in milk, butter, etc., it became a very different question. H e thought other nations ought not to be allowed to put milk or other foods treated with these preservatives o n to the English market. The Legislature should take more serious action in the matter. Dr. W. F. WILLOUGHBYsaid Dr. Tubb-Thomas was scarcely accurate as to the use of boracic acid by the foreigner. It was chiefly the retail dealers in England who used it to preserve milk left over at night for sale next morning. There was a little fallacy connected with the di~rhoea in children, t t was not so much the boracic acid or salicylic acid as the condition of the milk, masked or arrested by the use of preservatives, which gave rise to the diarrhoea. H e was anxious to s e e the milk trade pass into the hands of large companies. Mr. CASSAL said this matter was an extremely difficult one for the public analyst. The onus was placed on him of certifying whether an article containing a preservative was or was not adulterated according to the conditions of sale, the nature of the article, and the quantity of the preservative ; and unless he was in close connection with the medical officer of health--which all public analysts ought to b e - - h e had practically to decide a question which no public analyst qud public analyst ought to be called upon to decide, namely, whether the presence and the amount of the preservative made the article containing it injurious to health. It was high time that medical officers of health should
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decide upon and indicate the line which he (Mr. Cassal) thought was the proper one to be taken with regard to this question, and Dr. Hill had performed a great public service in reading the two papers he had read on this matter, and in taking up a clear, definite, and uncompromising attitude with regard to it. Some years ago he (Mr. Cassal) had read a paper on the subject of preservatives in food before that Society. In the discussion which followed he remembered one or t w o members took the view which Dr. Hill had referred to, and said that, inasmuch as boracic acid and salicylic acid and other chemicals used as preservatives were administered as medicines every day by medical men in practice without producing disastrous results, there was no reason for objecting to the use of them in moderate quantities as preservatives of food. I n some cases recently heard in London, medical officers of health of distinction had appeared and stated that whatever might be the effects of boracic acid in large quantities there was no reason to object to it in the quantities in which it was used in the particular cases in question. Dr. Hill had fully exposed the fallacy of these arguments. The question of quantity was, of course, the crux of the whole matter so far as the public health was concerned. The position that he (Mr. Cassal) had taken was that if an antiseptic was present in an article of food in a quantity sufficient to exert its specific effect on that food, then it necessarily followed that it would also injuriously affect the process of digestion ; and that the presence of an antiseptic, in quantity sufficient to produce any preservative effect, in itself showed the article containing it to be injurious to health. He believed that to be a scientific view to take, and many well-known medical men had supported him in that view. He would be very glad if that position could receive the approval of the Society of Medical Officers of Health. The question of what was to be done to prevent that loss of articles of food which it was alleged would occur if no preservatives were used, was completely answered by Dr. Hill by his advocacy of refrigeration. I n a recent action an admission had been made by representatives of the milk trade that refrigeration was the proper method to adopt for the preservation of milk. That, as far as he knew, was the only trade admission to that effect as yet given in Court ; but he had very little doubt that many of the larger dairy companies would readily endorse that admission. It should be remembered that boracic acid was not the only preservative in use, but that salicylic acid, formic aldehyde, and other substances were extensively used. Having regard to the large quantities of preservatives which the consumer might in consequence take, the use of chemicals for food preservation assumed a still more serious aspect. H e only knew of one successful prosecution as yet for the presence of formic aldehyde in milk. Formic aldehyde was a substance which must be regarded as even more objectionable than boracic acid. I t was important that all societies interested should press the Government to take such steps as would put an end to the chaotic condition of things which at present existed with reference to this matter. Dr. W. A. BOlCDthought the use of preservatives should be discouraged, but, at the same time, the commercial aspect of the question should not be ignored. It was a difficult subject, the medical evidence being most conflicting, especially with regard to boracic acid. He had interpreted the experiments of Professor Chittenden differently from Dr. Hill. For instance, he (Dr. Bond) gathered that Chittendon had shown that not only did small quantities of boracic acid not retard, but that they actually assisted peptic digestion. Such substances as ~licylic acid ought to be prohibited altogether, because, even in small doses, it produced in some individuals headache and deafness. They should certainly encourage pro-
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servation by means of cold, but he thought that preservation of milk by such means might prove expensive. Dr. W. G. WILLOUGHSYurged the Society to express the opinion that anyone purchasing milk should be entitled to get pure milk, and not rni]lr with the addition of boracic acid. Dr. WOODFORDEsaid the carriage of milk to London, even from the extreme ends of England, was only a matter of a few hours. If the milk w~re put into clean vessels it would reach London perfectly fit for use, and if it were not sold within, say, forty-eight hours, it should be refrigerated. Dr. E~MVNDShad not come to any definite conclusion on the question. Would they object to salt and sugar being used as preservatives ? Was there any reason why sodium borate should be treated differently to sodium chlorine ? With regard to diarrhoea, was there any evidence that there was a larger amount of infantile diarrhcea now than before boracic acid was used ? He thought not. Refrigeration, certainly the most preferable mode of preserving food, was not available in every case. H e thought the question was at present an open one. Dr. T. EUSTACE HILL said that on this important subject many medical officers of health had very little opportunity of gaining experience, and relied very much on the results of physiological and pathological experiments and the experience of medical practitioners. Various authorities had been quoted in the paper to show that these preservatives were, or might become, injurious. F r o m time to time in the medical press were published reports of ill effects resulting from the use of boracic acid. They must therefore agree that it might be injurious, and that being so, unless the use of such preservatives in food was absolutely necessary (particularly milk, which was largely used by the young) they should be avoided. Mr. Cassal's contention, that if the preservative inhibited the fermentation of milk it would also affect digestion, was a sound one. Mr. CECIL H. CRIBB asked if Dr. Hill's objection extended to all antiseptics or only to certain. H e thought a distinction might justly be made between the antiseptic and pharmacological actions of preservatives. I n the ease of the many preservatives it seemed as if their harmfulness was not due to their antiseptic qualities, inasmuch as they differed considerably from one another in their therapeutic effects. Could Dr. Hill quote any cases in which antiseptics q~d antiseptics had proved injurious ? If the use of all antiseptics was to be prohibited a difficulty would arise from the absence of any proper definition of the term. At present it was applied to a variety of substances which affected organisms in widely different manners, some by acting directly on the protoplasm of the organism, others on the medium in which it lived; some were reducing agents, others oxidizing. Some substances harmful or even fatal to one organism were essential to the growth of another; and the same substance might be in small quantities necessary to bacterial life, and in large proportions highly antagonistic to it. There could be no doubt as to the advisability of prohibiting the addition of some of these substances to foods, but as to others, viewed only as regards ~he effect on health, it was very difficult to decide, and each should be considered on its own merits. H e would also like to ask whether it had been absolutely proved that micro-organisms were necessary to digestion. They were undoubtedly the almost inseparable concomitants of it~ but, unless he was mistaken, the alimentary canal of new-born infants had been found to be sterile, and yet a practically normal digestion of milk would take place in it. The varying nature of the secretions acting on the food in its course through the alimentary canal, and the fact that one of them was recognised as an antiseptic, suggested
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a tendency on the part of such secretions to check rather than encourage bacterial action. It was held up as a sort of ideal that all food should be sterilized. With a person fed solely on such food would any organisms be still found in the intestines ? Was the bacterial population of the alimentary canal resident or migratory ? Dr. ALLA~ said that the Society ought to declare that milk (especially) required no addition of chemical preservatives. He thought they would all agree on that point, and a resolution to that effect might be expected to have some weight with magistrates. Almost all farmers sending milk to London had special apparatus for cooling milk before despatch, and there was no difficulty in securing a proper temperature. Dr. Edmunds had asked why they objected to boracic acid any more than to common salt. As a matter of fact, there was an objection to the latter, many medical men being of opinion that too much salt was taken both in combination with the food and as a table condiment. He had found that boracic acid could be taken for a limited period only before a rest from its use became necessary. The danger was not in the dose taken in any one article, but in the accumulation taken in a number of articles. Salicylic acid was especially dangerous, as there was every probability that the synthetic article would be used, from which poisonous tar products might not be entirely eliminated. The line suggested by Mr. Cassal was sound, and had a good scientific basis in its inception. Dr. H. BEALE COLLINS stated that there had been much diarrhoea in his district, chiefly in areas and families served by small retailers of milk. There was a strong suspicion that the milk had been treated with preservatives. Milk should, if possible, be consumed perfectly fresh, but to meet the requirements of large cities cooling was necessary, and if this were properly effected the milk would keep for forty-eight hours. Dr. HrLI~ in reply, said he could not agree with Dr. E. F. Willoughby that the custom of drugging milk with antiseptics was limited to retail dealers, who added them to the small residue of one day's stock to preserve it until the next. His experience was that the custom was one very often employed by the largest purveyors, including dairy-farmers. H e quite agreed with Mr. Cassal in the views he had expressed with regard to the inhibitory action of antiseptics upon those micro-organisms which were concerned in digestion. This would doubtless be the effect of those preservatives which arrested the action of the microbes of decomposition in foods outside the body, and it was a serious thing to make the digestive tract sterile, if~ as physiologists maintained, digestion were largely a fermentative process due to these organisms. I t might be quite legitimate to interfere in this way during morbid conditions, and as a temporary remedy, but to systematically do so by way of trade was a totally different matter. Dr. Bond had quoted Chittenden to show that small doses of boric acid were not prejudicial to health. Dr. Hill thought Dr. Bond had not shown that fairness which might have been expected of him in quoting Chittenden's views on small doses while keeping back his (Chittenden's) conclusions upon larger ones, which Chittenden had shown by experiment to diminish the assimilation of both proteid and fatty foods, and to increase the weight of the f~eces and their content of both nitrogen and fat. Chittenden found, further, that with very large doses of borax there was a tendency towards diarrhoea, and an increased excretion of mucus in the intestinal tract, an effect verified by other observers. Dr. Bond acknowledged that erythema was produced by the drug. He (Dr. Hill) considered that there was no justification for poisoning some people because others were not susceptible to the action of the preservative.
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Dr. Edmunds thought, like I)r. Bond, that there was no harm in the addition of minute quantities of boric compounds, and asked if sodium chloride be used, why not sodium borate ? Dr. Hill said it was not a question of minute quantities, hut frequently of very large. He had found boric acid present in milk to the extent of 130 grains per gallon, and he had found lessthan 10 grains. ~Vhere the farmer, the purveyor, and the consmner each added a dose in succession to the same sample, it was easy to see how large the dosage might become. Further, the actions of the two salts, sodium chloride and borate, were quite different. Common salt was a natural ingredient of all foods, was a constituent of the fluids and tissues of the body, and was as essential to health and life as a proteid or a carbohydrate, being itself a true mineral food. Replying to Mr. Cribb, Dr. Hill pointed out that, supposing that there was only a doubt as to the harmlessness of antiseptics, it was much safer to wait until that doubt had been set at rest before resorting to them, and in the meantime to rely upon such well-tried methods as were known to be without objection. At the conclusion of the discussion the following resolutions were adopted : "That the Society strongly disapproves of the practice of adding preservative chemicals to milk and other food." "That if preservative chemicals are added to any food, a full disclosure as to their nature and amounts should be made to the purchaser."
DETECTION
OF
ACETYLENE
IN
CASES OF POISONING THEREWITH
(D. ¥itali, Boll. Chim. Farm., 1898, xxxvii. 449, through Analyst, xxiv., 11).--Mix the suspected blood with 5 to 8 per cent. of acetone, and distil from a retor~ heated on a water-bath into an empty condenser, and a set of absorbing bulbs also containing acetone and cooled by ice. The acetylene and acetone pass over together, and the former can be recognised by the usual reactions.--Treatment. ~I.SINFECTION FOR ATTENDANTS ON PUERPERAL WOMEN SEPTICALLY
INFECTED.--The following questions addressed recently to Professor Del~pine by Dr. Porter, of Stockport, with the replies thereto, will be of general interest to our readers : " ( 1 ) W h a t , in your opinion, is the best w a y of disinfecting septically contaminated hands ? (2) Whether you think a period of abstention from midwifery practice is advisable after contact with a puerperal scepticmmic case, and if so. what period ? Personally, I do not see that the time-element is really a factor of safety at all." I n answer to (1) Professor Del6pine wrote : "Corrosive sublimate (1 in 1,000) is not so good a disinfectant for the hands as a chlorinated lime solution (1 in 100). Previous to the use of the antiseptic solution, I think the use of the nail-brush and of an alkaline soap, together with vigorous rubbing and brushing of the hands, wrists, and lower part of the arms, are more important than steeping of the hands in alcohol. T h e use of alcohol, though not absolutely necessary, when chlorinated lime is used, is nevertheless advantageous. The thorough disinfection of the hands by this process cannot take much less than ten minutes." I n regard to question (2) Professor Deldpine added : " I think t h a t absolute disinfection of the hands and clothing, and a good bath, including washing of the hair and beard, should be more effective in preventing spread by carriage of germs from one patient to another t h a n a period of abstention from midwifery practice."
Antiseptics in F o o d
527
ANTISEPTICS IN FOOD. ~ BY A L F R E D HILL, M.D., F.R.S. Edin., F.I.C., Medical Officer of Health of Birmingham.
THE adulteration of food is a practice of great antiquity, and consisted originally of very simple methods. With the advance of scientific knowledge, however, the methods of falsification employed became more numerous, more complex, and more difficult of detection, so that science, having been pressed into the service of adulteration, the resources of science are now fully taxed in the endeavour to detect it in some of its more recondite forms. When Accum wrote his book, " D e a t h in the Pot," simple adulterations were common enough, but the means of detecting them were then very imperfect. Dr. Hassall, by his works published by himself, and those carried out by him in connection with the Analytical Sanitary Commission of the La~cet between forty and fifty years ago, and particularly by the use he made of the microscope, gave to the means of detection a development which proved of great value in unmasking many of the adulterations practised, which up ~o that time did not admit of being made out with precision or certainty. The passing of the Adulteration Act in 1860 led to the appointment of public analysts, whose labours have resulted in processes of great certainty and delicacy, so t~at adulteration at the present time, combated as it is by the application of physical, chemical, and optical science, is detected with a degree of completeness not dreamt of forty and fifty years ago. I am not, however, concerned this evening with adulteration in its general aspect, but with that form of it which has of late years become so common, namely, the addition of antiseptics to perishable articles of food and drink, and, in response to your invitation, I have pleasure in submitting a few remarks on the subject embodying the researches, observations, and opinions of some leading physicians, physiological experimenters, and bacteriologists, together with my own experience as a public analyst. My paper is not to be regarded as dealing at all thoroughly with the subject, which, I need hardly say, is exceedingly wide and varied, but is intended to constitute such a statement of certain points of the question as shall serve the purpose of an introduction to a discussion of it by this meeting. Read before the Incorporated Society of Medical Officers of Health, April, 1899.
5 28
A n t i s e p t i c s in F o o d
tPubnc a ~ t ~
During the three years ending March, 1899, 2,300 of the samples of food received by me as Public Analyst for the city of Birmingham have been examined for preservatives. In 460 instances, or 20 per cent., boric acid, formic aldehyde, or salicylic acid have been detected. This fact will show that the use of preservatives in food has risen to very large dimensions, and requires serious consideration by all interested in the health of the community. Boric acid was found in 35 per cent. of the 882 samples of butter and margarine, and in 15 of the 24 samples of bacon, sausage, and other animal foods. For preservative purposes, a mixture of boric acid and borax is generally used. Samples of butter analyzed this year have contained quantities of boric acid varying from 7 to 84 grains per lb., or from 0"1 to 1"9. per cent. Butter is brought here from Australia in excellent condition, a distance of about 15,000 miles, without the addition of any preservative whatever, simply protected by a low temperature. Is it not, then, unreasonable to suppose that it is necessary to heavily drug butter from Cork, or from the Continent of Europe, about 200 miles off, a distance occupying only a few hours in transit ? This simple question is answered emphatically in the affirmative by the f~ct that not all the butter from these places is so drugged, but only some of it. In fact, as I mentioned before, two-thirds of the samples of butter and margarine examined in Birmingham were found to be free from boric acid. In a large proportion of the samples which contained this acid, the amount present did not exceed 0"3 per cent., or 21 grains per lb. ; if this quantity is sufficient, why should 70 grains and upwards per lb. be used ? When the quantity of preservative is greater than the water present can dissolve, the boric acid is in the solid state, and useless as a preservative, and microscopical examination in these cases shows the presence of crystals of boric acid. What information have we as to the effect of boric acid and borax on health ? Several surgical cases have been reported by Moldenkow, Hogner, Welch, Lemoine, and others, in which the use of these drugs has produced serious and even fatal results. A number of experiments have been made on men and animals by 1VIattern, FSrster and Schlenker, and Chittenden, with the result that they all found that smaller or larger doses interfered with digestion and nutrition. The Lancet, on January 2nd, 1897, published the opinions of a number of eminent medical men on this subject, who appeared generally to regard the use of preservatives with suspicion and disapproval, as liable to produce deleterious effects. The
~ y , xs~
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529
Br~tish Medical Journal, on January 28th, 1899, published the experience of Dr. J. Jameson Evans, of Birmingham, who found the continued use of boric acid in cases of cystitis and urethritis produced an erythema, followed by a fine scaly exfoliation. In one case, where the drug was given in doses of 10 to 20 grains three times a day for five weeks the patient became perfectly bald. Professor D. J. Leech, of Manchester, has recently (August 8th, 1898) expressed the following opinion: " I t appears to me that many patients can take either boric acid or borax for a long time in very large doses with impunity, but that in some people the unpleasant results are produced by comparatively small quantities, and it is quite possible that serious harm might in these cases follow its ingestion in the quantities in which it is used in the preservation of food. There can be no doubt that it should not be used in the preservation of milk." This last opinion was given at the request of Dr. J. Niven, the Medical Officer of Health of Manchester, who also quotes that of Professor Dixon Mann, as follows: " I have seen several cases in which a purpuric eruption, with nausea, loss of appetite, and depression, followed the dressing of open wounds with boric ointment . . . . I can remember two cases in which thrush in infants was treated with honey and borax, and the application continued long after the aphth• had disappeared. Nutrition was so much impaired as to cause great emaciation, with intestinal irritation and diarrhoea . . . . I am strongly of opinion that the most stringent restrictions are needed in respect of milk, as being the food of infants and young children, whose nutrition would be seriously impaired by the prolonged ingestion of boric acid, or its compounds, even in small amount." I have quoted these recent opinions somewhat fully, believing that they may be new to some of my audience. A curious meat-preservative was exhibited at a meeting of the Society of Public Analysts last year by Mr. A. C. Chapman, F.I.C. It was a real curiosity in its way, for it contained alum, salt, sodium nitrate, sulphurous acid, chloral hydrate, benzoic acid, and a small quantity of iodine! This shows what food preservation may come to. In 5 per cent. of 1,360 samples of milk I examined boric acid was found in quantities varying from 130 grains per gallon to 3 grains or less. When the former case came before the magistrates the defendant admitted that he had added a solid preservative to the milk. This illustrates the danger that the preservative may not be properly dissolved and incorporated with the food, but may be present in excessive quantities in part of it.
530
A n t i s e p t i c s in F o o d
~P.b~ H~th
Five out of eight samples of cream were preserved with boric acid. In one case salicylic acid was alsopresent. Even if we were to assume that the quantity of boric acid used to preserve each of the various foods I have mentioned was not sufficient to affect the health of the consumer when taken alone, we have to consider that there is the possibility that our butter, bacon, sausage, milk, and cream may each contain boric acid, and that the aggregate amount of the drug taken may attain serious proportions. Quite recently a new food-preservative has come into use, and, for various reasons, it has largely superseded boric acid. It is in the liquid form, and a very small quantity suffices. I refer to formic aldehyde, which I have detected in 47 out of the 1,000 samples of milk examined. What are its effects on the animal economy and oll food tissues ? F. D. Simons says that in his experiments it retarded pancreatic digestion, and Weigle and Merkel say that it renders the albuminoids of milk less digestible, an addition of one part of formalin to 500 of milk rendering the casein insoluble in pepsin and hydrochloric acid. This is a serious indictment, as it shows a retarding influence on the digestion of both animal and vegetable food, proteids, and amyloids. Attempts to preserve fish by means of formalin failed on account of its hardening effect. This was apparently due to the coagulation of the albuminoids, the samples being made so hard as to be rendered unsaleable, even by solutions containing only one part of formic aldehyde in 5,000. According to Rideal, 1 oz. of formaldehyde (equal to 2½ oz., 40 per cent., formalin) does the work of 5 lb. of borax and boracic acid, so that if a very small addition be sufficient, its greater potency makes up for its smaller quantity. There has recently been a prosecution in Liverpool in a case of milk containing this antiseptic, when it was contended by the prosecution that milk did not need any preservative, that the use of formic aldehyde enabled a dealer to sell stale milk as fresh, and obviated the necessity of cleanliness of the dairy. It was also contended that it made the milk indigestible, and had an irritant action on the mucous membranes. Professor Boyce, of the University College, and Mr. Williams, the Public Analyst, asserted that formalin in milk was quite unnecessary, and most objectionable. Mr. Davies, analytical chemist, and Dr. Barrow were called for the defence, and expressed the opinion that the amount of formalin said to have been used would not be injurious to health.
May,1899]
Antiseptics in F o o d
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The Stipendiary Magistrate expressed himself, however, as on the side of the cow against the chemist, and inflicted a fine of £5 and costs. Notice of appeal was given, but was subsequently withdrawn. For the reason that milk is the one perfect food, especially valuable for invalids and children, it is the food which, above all others, ought not to be tampered with. It is true that milk soon changes ; it does not keep indefinitely, and evidently Nature did not intend it to do so. The young of all mammals naturally receive it directly from the mother, and the more directly we all of us obtain it the better. It is only the ingenuity of man which is exercised to circumvent natural law in this connection, and as long as this is done without medication and adulteration there is no objection, and, happily, we know a safe means of doing it. It is admitted that the decomposition of milk does not occur in properly conducted dairies under forty-eight hours, which should be long enough to allow of its distribution, and where it is found necessary to add antiseptics to make it keep so long, i~ is because the treatment of it is careless or dirty, or otherwise bad, so that preservatives are often added to the milk of our dairies to compensate for the faults of its treatment, which our supineness only encourages. An argument of considerable force against the prevention of change in milk by added chemicals is furnished by the circumstance that morbid milk, whether by itself or mixed with normal milk, very soon changes, and such premature change is of the greatest value as an indication of the unhealthy condition of the milk, and a signal to direct attention to its cause. If the addition of chemicals to food were necessary, some favourable consideration might be given to it, but it is not necessary, as is proved by the fact that it is only used to a limited extent. Another antiseptic which has been much used, but to a less extent in this country than abroad, is salicylic acid. I have found it in cream, in jams, and in spirituous compounds. Salicylic acid was detected in five out of six samples of jam which I examined, in five out of eleven samples of ipecacuanha wine, and in one sample out of twelve of sherry. In four of the six wines the proper quantity of alcohol was not present, the cheaper salicylic acid having been used to replace it. According to F. D. Simons, salicylic acid retarded peptic digestion, and Chittenden observed that salicylate of soda and borax act antagonistically to the digestive ferment. Though not very poisonous in moderate doses and in dilute solution, yet in large doses it is said to produce serious cerebral
532
A n t i s e p t i c s in F o o d
t~bnc Heata
symptoms, and it is well known to medical practitioners to produce in medicinal doses headache, deafness, singing in the ears, and loss of appetite. French authors especially call attention to its injurious action in diseases of the kidneys, and to its slow elimination in aged persons. In a paper read before the Franklin Institute on December 20th, 1898, H. Leffmann stated that, after a number of experiments, he had come to the conclusion that "salicylic acid in all its forms, i.e., natural, crude commercial, and refined commercial, is distinctly antagonistic to most enzymes, especially those that convert starch. He found that, to use his own words, " Sodium benzoate [another antiseptic sometimes used in foods] is without appreciable interfering action, and as its preservative action is undoubted, and its disagreeable taste will prevent its liberal use in any food article, it seems to be well adapted for general use." One of the pleas of persons using preservatives is that they are not seen to produce bad effects, that they are commonly taken as remedies, and are as harmless as useful. But this is begging the whole question, and disposing off-hand of the problem awaiting solution. If bad effects are not traceable at once, and to single doses or small quantities, no proof is thus afforded that the continued use is harmless. If the substances be used as remedies, it must be evident that the conditions under which they are given are totally different. As remedies they are given for a special curative purpose to persons out of health accepting them voluntarily, and they are only used for a limited time ; their dose is carefully regulated, and they are given under professional advice and supervision. If mixed with food the conditions are altogether different ; there is no curative object, for the consumers are not necessarily ill--they take the substance without requiring it, and involuntarily, without even knowing of it, and for an indefinite time. There is no regulation of the dose, which is found to vary very widely, and the substance is administered by lay persons having no knowledge of its nature or the bodily condition of those made to swallow it. On the legal side of the subject one fact appears to stand out with great distinctness, and that is that the sale of milk or other food containing preservatives without a distinctive label is a " sale to the prejudice of the purchaser" of an article of food " w h i c h is not of the nature, substance, and quality of the article demanded by the purchaser," and that the vendor has been guilty of an offence under Section 6 of the Sale of Food and Drugs Act, 1875. In practice the question of quantity comes in, and authorities find a great difficulty
May, 1899]
A n t i s e p t i c s in F o o d
533
in deciding what is the minimum quantity of preservative for which a prosecution shall be instituted. The Government Sale of Food and Drugs Bill introduced into Parliament this year, in Clause 4 proposes that " T h e Board of Agriculture may, after such inquiry as they deem necessary, make regulations for d e t e r m i n i n g . . , what addition of extraneous matter in any sample of milk, butter, or cheese, shall, for the purposes of the Sale of Food and Drugs Act, raise a presumption, until the contrary is proved, that the milk, butter, or cheese is not genuine." This would be a step in the right direction, though it does not nearly cover the question of preservatives in food generally, and some question may be raised as tO the suitability of the Board of Agriculture for such a task. Clause 88 of the Bill brought in by Messrs. Kearley, Maurice Healy, and others, provides that " T h e r e shall be appointed a Board of Reference . . . and the powers and duties of such Board shall . include . . . the power to settle and appoint standards of the amount and kind (if any) of foreign substances to be allowed for the preservation or flavouring of foods." This is an excellent suggestion, and is on the same lines as the recommendation of the establishment of a Court of Reference by the recent Food Products Committee. In the meantime, for Governmental action is deliberate if not slow, we have at our command a means of food preservation which is available for every kind of food, and is open to none of the objections that attach to the material antiseptics. I mean refrigeration. I have referred ~o butter brought in excellent condition from Australia without any admixture, but merely under the influence of a low temperature, and the same agency is employed for the preservation of enormous quantities of meat from Australasia, the Argentine Republic, and the United States. In our towns the fishmongers preserve their goods for a long time in their ice-wells, and in most large centres of population refrigerating stores are provided for various kinds of food. The method possesses the following advantages: It proves to be more effective than any other. It adds nothing, and takes away nothing, not even water, in no material sense altering the quality of the article treated. Lastly, it causes no change of appearance or taste, leaving the meat or other substance substantially in its original condition, neither rendering it less nutritious nor less digestible. In making the foregoing remarks, I have a full consciousness of the superficial treatment which a very wide subject has received at my hands; but my object has been, not so much to do full justice .
.
534
Antiseptics in F o o d
~b,,e Health
to it as to put before you certain facts and opinions, as well as my
own experience, on which to base a discussion. It is a subject of great professional interest, because of its unquestionable sanitary importance, and it is one respecting which you must feel much personal interest, and concerning which no doubt some of you have had valuable experience. It is, moreover, a question which a Society like ours, consisting of men whose chief occupation is io promote ~ and protect public health, may reasonably be expected to take seriously into consideration, and possibly, in due course, united action. DISCUSSION. The PRESIDENT expressed the obligation of the Society- to Dr. Hill for his paper, and their pleasure in seeing him with them again. Almost the first paper he (the President) heard read before the Society was one by the late Dr. Tidy on the examination of butter, at the Old Scottish Corporation Hall, when the reader remarked, "Gentlemen, we have no test for butter." That would hardly be admitted now. The position of the stipendiary magistrates with regard to this question of preservatives was not to be wondered at when their own professional brethren appeared in court to say these antiseptics were not injurious. Dr. TuBmTHoMAs agreed with Dr. Hill that preservatives were absolutely unnecessary. He had met with a large number of cases of infantile diarrhoea due to the presence of boracic acid in the milk. W h e n pure milk was used the diarrhoea ceased, but as soon as milk containing the acid was given the diarrhoea recommenced. This preservative was largely used for fish, and no doubt fish treated with boracic or salicylic acid retained its good appearance much longer than when treated only with ice or salt. His opinion, however, was that such fish was injurious. It would be all very well to talk about the small quantity of preservatSve ingested if it were used only in one article of food ; but when they found it in milk, butter, etc., it became a very different question. H e thought other nations ought not to be allowed to put milk or other foods treated with these preservatives o n to the English market. The Legislature should take more serious action in the matter. Dr. W. F. WILLOUGHBYsaid Dr. Tubb-Thomas was scarcely accurate as to the use of boracic acid by the foreigner. It was chiefly the retail dealers in England who used it to preserve milk left over at night for sale next morning. There was a little fallacy connected with the di~rhoea in children, t t was not so much the boracic acid or salicylic acid as the condition of the milk, masked or arrested by the use of preservatives, which gave rise to the diarrhoea. H e was anxious to s e e the milk trade pass into the hands of large companies. Mr. CASSAL said this matter was an extremely difficult one for the public analyst. The onus was placed on him of certifying whether an article containing a preservative was or was not adulterated according to the conditions of sale, the nature of the article, and the quantity of the preservative ; and unless he was in close connection with the medical officer of health--which all public analysts ought to b e - - h e had practically to decide a question which no public analyst qud public analyst ought to be called upon to decide, namely, whether the presence and the amount of the preservative made the article containing it injurious to health. It was high time that medical officers of health should
.my, is~j
A n t i s e p t i c s in F o o d
585
decide upon and indicate the line which he (Mr. Cassal) thought was the proper one to be taken with regard to this question, and Dr. Hill had performed a great public service in reading the two papers he had read on this matter, and in taking up a clear, definite, and uncompromising attitude with regard to it. Some years ago he (Mr. Cassal) had read a paper on the subject of preservatives in food before that Society. In the discussion which followed he remembered one or t w o members took the view which Dr. Hill had referred to, and said that, inasmuch as boracic acid and salicylic acid and other chemicals used as preservatives were administered as medicines every day by medical men in practice without producing disastrous results, there was no reason for objecting to the use of them in moderate quantities as preservatives of food. I n some cases recently heard in London, medical officers of health of distinction had appeared and stated that whatever might be the effects of boracic acid in large quantities there was no reason to object to it in the quantities in which it was used in the particular cases in question. Dr. Hill had fully exposed the fallacy of these arguments. The question of quantity was, of course, the crux of the whole matter so far as the public health was concerned. The position that he (Mr. Cassal) had taken was that if an antiseptic was present in an article of food in a quantity sufficient to exert its specific effect on that food, then it necessarily followed that it would also injuriously affect the process of digestion ; and that the presence of an antiseptic, in quantity sufficient to produce any preservative effect, in itself showed the article containing it to be injurious to health. He believed that to be a scientific view to take, and many well-known medical men had supported him in that view. He would be very glad if that position could receive the approval of the Society of Medical Officers of Health. The question of what was to be done to prevent that loss of articles of food which it was alleged would occur if no preservatives were used, was completely answered by Dr. Hill by his advocacy of refrigeration. I n a recent action an admission had been made by representatives of the milk trade that refrigeration was the proper method to adopt for the preservation of milk. That, as far as he knew, was the only trade admission to that effect as yet given in Court ; but he had very little doubt that many of the larger dairy companies would readily endorse that admission. It should be remembered that boracic acid was not the only preservative in use, but that salicylic acid, formic aldehyde, and other substances were extensively used. Having regard to the large quantities of preservatives which the consumer might in consequence take, the use of chemicals for food preservation assumed a still more serious aspect. H e only knew of one successful prosecution as yet for the presence of formic aldehyde in milk. Formic aldehyde was a substance which must be regarded as even more objectionable than boracic acid. I t was important that all societies interested should press the Government to take such steps as would put an end to the chaotic condition of things which at present existed with reference to this matter. Dr. W. A. BOlCDthought the use of preservatives should be discouraged, but, at the same time, the commercial aspect of the question should not be ignored. It was a difficult subject, the medical evidence being most conflicting, especially with regard to boracic acid. He had interpreted the experiments of Professor Chittenden differently from Dr. Hill. For instance, he (Dr. Bond) gathered that Chittendon had shown that not only did small quantities of boracic acid not retard, but that they actually assisted peptic digestion. Such substances as ~licylic acid ought to be prohibited altogether, because, even in small doses, it produced in some individuals headache and deafness. They should certainly encourage pro-
536
Antiseptics in F o o d
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servation by means of cold, but he thought that preservation of milk by such means might prove expensive. Dr. W. G. WILLOUGHSYurged the Society to express the opinion that anyone purchasing milk should be entitled to get pure milk, and not rni]lr with the addition of boracic acid. Dr. WOODFORDEsaid the carriage of milk to London, even from the extreme ends of England, was only a matter of a few hours. If the milk w~re put into clean vessels it would reach London perfectly fit for use, and if it were not sold within, say, forty-eight hours, it should be refrigerated. Dr. E~MVNDShad not come to any definite conclusion on the question. Would they object to salt and sugar being used as preservatives ? Was there any reason why sodium borate should be treated differently to sodium chlorine ? With regard to diarrhoea, was there any evidence that there was a larger amount of infantile diarrhcea now than before boracic acid was used ? He thought not. Refrigeration, certainly the most preferable mode of preserving food, was not available in every case. H e thought the question was at present an open one. Dr. T. EUSTACE HILL said that on this important subject many medical officers of health had very little opportunity of gaining experience, and relied very much on the results of physiological and pathological experiments and the experience of medical practitioners. Various authorities had been quoted in the paper to show that these preservatives were, or might become, injurious. F r o m time to time in the medical press were published reports of ill effects resulting from the use of boracic acid. They must therefore agree that it might be injurious, and that being so, unless the use of such preservatives in food was absolutely necessary (particularly milk, which was largely used by the young) they should be avoided. Mr. Cassal's contention, that if the preservative inhibited the fermentation of milk it would also affect digestion, was a sound one. Mr. CECIL H. CRIBB asked if Dr. Hill's objection extended to all antiseptics or only to certain. H e thought a distinction might justly be made between the antiseptic and pharmacological actions of preservatives. I n the ease of the many preservatives it seemed as if their harmfulness was not due to their antiseptic qualities, inasmuch as they differed considerably from one another in their therapeutic effects. Could Dr. Hill quote any cases in which antiseptics q~d antiseptics had proved injurious ? If the use of all antiseptics was to be prohibited a difficulty would arise from the absence of any proper definition of the term. At present it was applied to a variety of substances which affected organisms in widely different manners, some by acting directly on the protoplasm of the organism, others on the medium in which it lived; some were reducing agents, others oxidizing. Some substances harmful or even fatal to one organism were essential to the growth of another; and the same substance might be in small quantities necessary to bacterial life, and in large proportions highly antagonistic to it. There could be no doubt as to the advisability of prohibiting the addition of some of these substances to foods, but as to others, viewed only as regards ~he effect on health, it was very difficult to decide, and each should be considered on its own merits. H e would also like to ask whether it had been absolutely proved that micro-organisms were necessary to digestion. They were undoubtedly the almost inseparable concomitants of it~ but, unless he was mistaken, the alimentary canal of new-born infants had been found to be sterile, and yet a practically normal digestion of milk would take place in it. The varying nature of the secretions acting on the food in its course through the alimentary canal, and the fact that one of them was recognised as an antiseptic, suggested
Kay, 1899j
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a tendency on the part of such secretions to check rather than encourage bacterial action. It was held up as a sort of ideal that all food should be sterilized. With a person fed solely on such food would any organisms be still found in the intestines ? Was the bacterial population of the alimentary canal resident or migratory ? Dr. ALLA~ said that the Society ought to declare that milk (especially) required no addition of chemical preservatives. He thought they would all agree on that point, and a resolution to that effect might be expected to have some weight with magistrates. Almost all farmers sending milk to London had special apparatus for cooling milk before despatch, and there was no difficulty in securing a proper temperature. Dr. Edmunds had asked why they objected to boracic acid any more than to common salt. As a matter of fact, there was an objection to the latter, many medical men being of opinion that too much salt was taken both in combination with the food and as a table condiment. He had found that boracic acid could be taken for a limited period only before a rest from its use became necessary. The danger was not in the dose taken in any one article, but in the accumulation taken in a number of articles. Salicylic acid was especially dangerous, as there was every probability that the synthetic article would be used, from which poisonous tar products might not be entirely eliminated. The line suggested by Mr. Cassal was sound, and had a good scientific basis in its inception. Dr. H. BEALE COLLINS stated that there had been much diarrhoea in his district, chiefly in areas and families served by small retailers of milk. There was a strong suspicion that the milk had been treated with preservatives. Milk should, if possible, be consumed perfectly fresh, but to meet the requirements of large cities cooling was necessary, and if this were properly effected the milk would keep for forty-eight hours. Dr. HrLI~ in reply, said he could not agree with Dr. E. F. Willoughby that the custom of drugging milk with antiseptics was limited to retail dealers, who added them to the small residue of one day's stock to preserve it until the next. His experience was that the custom was one very often employed by the largest purveyors, including dairy-farmers. H e quite agreed with Mr. Cassal in the views he had expressed with regard to the inhibitory action of antiseptics upon those micro-organisms which were concerned in digestion. This would doubtless be the effect of those preservatives which arrested the action of the microbes of decomposition in foods outside the body, and it was a serious thing to make the digestive tract sterile, if~ as physiologists maintained, digestion were largely a fermentative process due to these organisms. I t might be quite legitimate to interfere in this way during morbid conditions, and as a temporary remedy, but to systematically do so by way of trade was a totally different matter. Dr. Bond had quoted Chittenden to show that small doses of boric acid were not prejudicial to health. Dr. Hill thought Dr. Bond had not shown that fairness which might have been expected of him in quoting Chittenden's views on small doses while keeping back his (Chittenden's) conclusions upon larger ones, which Chittenden had shown by experiment to diminish the assimilation of both proteid and fatty foods, and to increase the weight of the f~eces and their content of both nitrogen and fat. Chittenden found, further, that with very large doses of borax there was a tendency towards diarrhoea, and an increased excretion of mucus in the intestinal tract, an effect verified by other observers. Dr. Bond acknowledged that erythema was produced by the drug. He (Dr. Hill) considered that there was no justification for poisoning some people because others were not susceptible to the action of the preservative.
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A n t i s e p t i c s in F o o d
fPubuo,,o~,,~
Dr. Edmunds thought, like I)r. Bond, that there was no harm in the addition of minute quantities of boric compounds, and asked if sodium chloride be used, why not sodium borate ? Dr. Hill said it was not a question of minute quantities, hut frequently of very large. He had found boric acid present in milk to the extent of 130 grains per gallon, and he had found lessthan 10 grains. ~Vhere the farmer, the purveyor, and the consmner each added a dose in succession to the same sample, it was easy to see how large the dosage might become. Further, the actions of the two salts, sodium chloride and borate, were quite different. Common salt was a natural ingredient of all foods, was a constituent of the fluids and tissues of the body, and was as essential to health and life as a proteid or a carbohydrate, being itself a true mineral food. Replying to Mr. Cribb, Dr. Hill pointed out that, supposing that there was only a doubt as to the harmlessness of antiseptics, it was much safer to wait until that doubt had been set at rest before resorting to them, and in the meantime to rely upon such well-tried methods as were known to be without objection. At the conclusion of the discussion the following resolutions were adopted : "That the Society strongly disapproves of the practice of adding preservative chemicals to milk and other food." "That if preservative chemicals are added to any food, a full disclosure as to their nature and amounts should be made to the purchaser."
DETECTION
OF
ACETYLENE
IN
CASES OF POISONING THEREWITH
(D. ¥itali, Boll. Chim. Farm., 1898, xxxvii. 449, through Analyst, xxiv., 11).--Mix the suspected blood with 5 to 8 per cent. of acetone, and distil from a retor~ heated on a water-bath into an empty condenser, and a set of absorbing bulbs also containing acetone and cooled by ice. The acetylene and acetone pass over together, and the former can be recognised by the usual reactions.--Treatment. ~I.SINFECTION FOR ATTENDANTS ON PUERPERAL WOMEN SEPTICALLY
INFECTED.--The following questions addressed recently to Professor Del~pine by Dr. Porter, of Stockport, with the replies thereto, will be of general interest to our readers : " ( 1 ) W h a t , in your opinion, is the best w a y of disinfecting septically contaminated hands ? (2) Whether you think a period of abstention from midwifery practice is advisable after contact with a puerperal scepticmmic case, and if so. what period ? Personally, I do not see that the time-element is really a factor of safety at all." I n answer to (1) Professor Del6pine wrote : "Corrosive sublimate (1 in 1,000) is not so good a disinfectant for the hands as a chlorinated lime solution (1 in 100). Previous to the use of the antiseptic solution, I think the use of the nail-brush and of an alkaline soap, together with vigorous rubbing and brushing of the hands, wrists, and lower part of the arms, are more important than steeping of the hands in alcohol. T h e use of alcohol, though not absolutely necessary, when chlorinated lime is used, is nevertheless advantageous. The thorough disinfection of the hands by this process cannot take much less than ten minutes." I n regard to question (2) Professor Deldpine added : " I think t h a t absolute disinfection of the hands and clothing, and a good bath, including washing of the hair and beard, should be more effective in preventing spread by carriage of germs from one patient to another t h a n a period of abstention from midwifery practice."