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THE LANCET Special Analytical Commission ON THE QUALITY OF THE MILK SUPPLIED TO THE METROPOLITAN HOSPITALS.
54 that any of our readers interested in the subject of field service will have any difficulty in deciphering the diagram of the arrangements that were planned and provided for the Tirah expeditionary force during the late operations against ’the border tribe population of that district. Separate provision is made for the hospital accommodation of British and native troops respectively.
the
milk-supply to this hospital being placed under County inspection," that " being satisfied with the milk and our own course of inspection they hardly saw the supplied advantage of the course you propose." We did not suggest, of course, as is here implied, that the milk-supply of London should be placed under the control of the London
Council
County Council. The Local Government Board is the proper
in the matter. Also we failed to receive the sanction of the Westminster Hospital authorities although we applied to them at or about the same time that we applied to the rest. We therefore cannot speak of the quality of the milk supplied to St. Thomas’s Hospital or to
authority
THE LANCET
Special Analytical
Westminster
Commission
ON THE
QUALITY OF
Hospital.
The results recorded below relate to samples of milk taken from the following general hospitals :-St. George’s Hospital,
University College Hospital, King’s College Hospital, Great Northern Hospital, West London Hospital, Middlesex Hospital, London Hospital, St. Bartholomew’s Hospital, Charingcross Hospital, Gay’s Hospital, and St. Mary’s Hospital. In the analyses which follow the several hospitals are distinguished by a letter.l
THE MILK SUPPLIED TO THE
METROPOLITAN HOSPITALS.
RESULTS OF ANALYSIS OF THE MILK SUPPLIED TO THE rate of milk adulteration in the first city of the METROPOLITAN HOSPITALS. world is maintained to the present day and still the State affords little assistance towards effectually reducing this rate. In the past official year (1896-97) the rate was 17 7 per cent. as against 9 1per cent. for the rest of the country, and the authorities of the Local Government Board in their recent annual report remarked that "it is a matter of regret that London has not yet been successful in down its high rate of adulteration." That the quality of the milk-supply is a reproach to the metropolis is thus very clearly acknowledged by those who Food are responsible for the working of the Sale of and Drugs Act, an Act which was framed to protect the public against fraud and adulteration. How quickly the opportunity is seized of perpetrating fraud in the - case of milk is well illustrated in the recent results brought to light when samples taken on Sundays were examined. No less than 47t per cent. of these-i.e., nearly halfwere found to be adulterated, one sample being certified as skimmed to the extent of 90 per cent. and also to have had 23 per cent. of water added. " As soon, however, as the local authorities seriously took the matter in hand the Sunday rate of milk adulteration was reduced." The italics are ours, inasmuch as we venture to think that the high rate of milk adulteration prevailing in London could be very materially reduced if the provisions of the Act were more " seriously " taken in hand than is the case in general. It is superfluous for us to point out the extreme importance of the milk-supply to our hospitals being absolutely *free from reproach in every particular. In this instance the well-being and perhaps life of a patient may depend entirely upon this natural food because all else is unsuited to his needs and his enfeebled physical condition. To tamper with milk dedicated to such purpose can only be justly described as an act of wickedness of an exceptionally bad kind. The quantity of milk consumed at our great hospitals is necessarily large and accordingly it is delivered in bulk from carts coming direct in the majority of cases from the railway station. It is thus likely We are to escape the notice of the official inspector. aware that samples are occasionally taken for analysis from the churns at the railway station, but such a proceeding is rare compared with the number of samples taken at the milk-shops. On the face of it, it would appear therefore that the public at large have greater protection against adulteration than have our great charitable institutions. We have therefore been led to make a practical investigation into the quality of the milk supplied to the hospitals with the view of deciding whether or no the inferences just indicated are in any degree justified. One of our Commissioners, having first obtained the sanction of the authorities of the hospitals concerned, proceeded to secure samples. As far as possible an exact appointment was avoided and in the majority of cases he was able to take the sample direct from the can as it was delivered to the hospital by the milkman. The list of hospitals (general) includes all the well-known ones with two exceptions. The authorities of St. Thomas’s Hospital wrote in the first instance that ’’ the proposal opens a wide field of con1 We propose to communicate privately this week to a member of sideration " ; but at a committee of almoners the treasurer each hospital staff the letter corresponding to the hospital with which was directed to reply to us "relative to the examination of he is concerned.
THE high
bringing
I,
55 It is pretty safe to assert that had the samples been taken in the summer months the number of specimens borated and the amount of boric acid used would have been greater. Whatever may be the views taken as to the employment of preservatives in food for general purposes, their addition to the milk-supply to hospitals each and all will agree. is very objectionable and should be vigorously protested against. A great injury may thereby be unwittingly done to, invalids and children and especially to patients who suffer’ from enfeebled digestive functions or in whom disturbance is. easily set up at any point along the alimentary tract. It is interesting to observe that in this inquiry, which was. necessarily limited in scope, the percentage number orsamples which we think deserve rejection is 18 2 against 17’7 per cent., the rate of milk adulteration in London as brought to lil1 ht in the returns of the Sale of Food and Drugs Act. We may add, however, that on the whole we have, we think, placed a somewhat liberal construction upon the results. But they have at least established the important fact that the milk supplied to London hospitals is no better-not to say worse-than that supplied to the public, whereas for hospital purposes it should be absolutely beyond reproach. It matters comparatively little whether the milk we add to our tea is watered or deficient in cream, but in the hospital this may mean depriving the patient of his only means of nourishment, while to add chemical preservatives to the same milk should be counted a, distinct offence in such a case. The public to some extent are protected against fraud and adulteration by the Sale ofY Food and Drugs Act, but our great charitable institutions, which receive milk in large quantities, do not share it is evident in the same measure in this protection, although they are in much greater need of it. We trust that the Government will strengthen the hands of the officials appointed to take samples under the Act that they may be empowered to take samples at frequent intervals from the cans of the milkman as soon as they are set down at the hospital, both in the case of the morning and the afternoon supply. This would relieve the hospital authorities, as we think they should be relieved, from all anxiety, responsibility, and expense in the matter and would secure a milk-supply fully in accordance with hospital requirements. In many of the hospitals, but not in all, a system of control is adopted, but this is generally limited to observing the amount of cream by a "creamometer" " and the specific gravity by a hydrometer. This is no doubt useful, but it is not sufficient since the volume of cream is not found to bear a constant relation to, the fat, on the amount of which depends a very important quality. The fat of a milk may be below 3 per cent. and yet f it is possible for that milk to show a volume of cream equal to 10 per cent. The quality of milk may to some extent be. controlled in this way, but the presence of chemical preservatives would be lost sight of. Everyone must admit the necessity of a pure and. unadulterated supply of milk to the sick and debilitated. That such a supply is not universal is evident to us in the present inquiry as well as from the testimony of hospital physicians who have been in communication with us upon the subject. There is, we fear, some tendency on the part of adminis-. y trative authorities to decide upon buying milk for hospitals n at the lowest possible price and milk of the lowest possible quality is accordingly supplied. A fair price should be paid and a pure, unimpoverished article of excellent quality may then justly be demanded. .
.
MR. J. A. PICTON AND VACCINATION. This is
milk of fair average quality, the amount of fat being, however, close upon the minimum of genuine milk. The milk contained boric acid but not in excessive a
quantity. The results may be summed up shortly as follows. Of the eleven samples examined we regard seven as of good average quality, two as of indifferent quality, and two as decidedly poor and in all probability diluted. These conclusions are based upon the standards adopted by the Society of Public Analysts, which seem to us to be perfectly justifiable on the grounds of common experience. For fat the limit adopted is 3 0 per cent., for non-fatty solids it is 85 per cent. Three specimens contained distinct though, be it remarked, not exoessive quantities of boric acid.
MR. J. ALLANSON PICTON, ex-M.P., has become an anti vaccinationist. By most people this announcement will be read with the same kind of surprise as would fill them if they were told that Lord Salisbury had become a Conservative or Mr. Healy a Home Ruler. But the statement is not published It is made with every outward evidence of as a new joke. seriousness by the organ of the league in the following words : " We are sure all our friends will be glad to learn that Mr. J. A. Picton, of the Vaccination Commission, and formerly member for Leicester, has formally notified his adherence to the anti-vaccination cause and has joined the National League." Mr. Picton’s relationship to anti vaccination has for some time been a very curious one and merits at least a passing notice.
the
milk-supply to this hospital being placed under County inspection," that " being satisfied with the milk and our own course of inspection they hardly saw the supplied advantage of the course you propose." We did not suggest, of course, as is here implied, that the milk-supply of London should be placed under the control of the London
Council
County Council. The Local Government Board is the proper
in the matter. Also we failed to receive the sanction of the Westminster Hospital authorities although we applied to them at or about the same time that we applied to the rest. We therefore cannot speak of the quality of the milk supplied to St. Thomas’s Hospital or to
authority
THE LANCET
Special Analytical
Westminster
Commission
ON THE
QUALITY OF
Hospital.
The results recorded below relate to samples of milk taken from the following general hospitals :-St. George’s Hospital,
University College Hospital, King’s College Hospital, Great Northern Hospital, West London Hospital, Middlesex Hospital, London Hospital, St. Bartholomew’s Hospital, Charingcross Hospital, Gay’s Hospital, and St. Mary’s Hospital. In the analyses which follow the several hospitals are distinguished by a letter.l
THE MILK SUPPLIED TO THE
METROPOLITAN HOSPITALS.
RESULTS OF ANALYSIS OF THE MILK SUPPLIED TO THE rate of milk adulteration in the first city of the METROPOLITAN HOSPITALS. world is maintained to the present day and still the State affords little assistance towards effectually reducing this rate. In the past official year (1896-97) the rate was 17 7 per cent. as against 9 1per cent. for the rest of the country, and the authorities of the Local Government Board in their recent annual report remarked that "it is a matter of regret that London has not yet been successful in down its high rate of adulteration." That the quality of the milk-supply is a reproach to the metropolis is thus very clearly acknowledged by those who Food are responsible for the working of the Sale of and Drugs Act, an Act which was framed to protect the public against fraud and adulteration. How quickly the opportunity is seized of perpetrating fraud in the - case of milk is well illustrated in the recent results brought to light when samples taken on Sundays were examined. No less than 47t per cent. of these-i.e., nearly halfwere found to be adulterated, one sample being certified as skimmed to the extent of 90 per cent. and also to have had 23 per cent. of water added. " As soon, however, as the local authorities seriously took the matter in hand the Sunday rate of milk adulteration was reduced." The italics are ours, inasmuch as we venture to think that the high rate of milk adulteration prevailing in London could be very materially reduced if the provisions of the Act were more " seriously " taken in hand than is the case in general. It is superfluous for us to point out the extreme importance of the milk-supply to our hospitals being absolutely *free from reproach in every particular. In this instance the well-being and perhaps life of a patient may depend entirely upon this natural food because all else is unsuited to his needs and his enfeebled physical condition. To tamper with milk dedicated to such purpose can only be justly described as an act of wickedness of an exceptionally bad kind. The quantity of milk consumed at our great hospitals is necessarily large and accordingly it is delivered in bulk from carts coming direct in the majority of cases from the railway station. It is thus likely We are to escape the notice of the official inspector. aware that samples are occasionally taken for analysis from the churns at the railway station, but such a proceeding is rare compared with the number of samples taken at the milk-shops. On the face of it, it would appear therefore that the public at large have greater protection against adulteration than have our great charitable institutions. We have therefore been led to make a practical investigation into the quality of the milk supplied to the hospitals with the view of deciding whether or no the inferences just indicated are in any degree justified. One of our Commissioners, having first obtained the sanction of the authorities of the hospitals concerned, proceeded to secure samples. As far as possible an exact appointment was avoided and in the majority of cases he was able to take the sample direct from the can as it was delivered to the hospital by the milkman. The list of hospitals (general) includes all the well-known ones with two exceptions. The authorities of St. Thomas’s Hospital wrote in the first instance that ’’ the proposal opens a wide field of con1 We propose to communicate privately this week to a member of sideration " ; but at a committee of almoners the treasurer each hospital staff the letter corresponding to the hospital with which was directed to reply to us "relative to the examination of he is concerned.
THE high
bringing
I,
55 It is pretty safe to assert that had the samples been taken in the summer months the number of specimens borated and the amount of boric acid used would have been greater. Whatever may be the views taken as to the employment of preservatives in food for general purposes, their addition to the milk-supply to hospitals each and all will agree. is very objectionable and should be vigorously protested against. A great injury may thereby be unwittingly done to, invalids and children and especially to patients who suffer’ from enfeebled digestive functions or in whom disturbance is. easily set up at any point along the alimentary tract. It is interesting to observe that in this inquiry, which was. necessarily limited in scope, the percentage number orsamples which we think deserve rejection is 18 2 against 17’7 per cent., the rate of milk adulteration in London as brought to lil1 ht in the returns of the Sale of Food and Drugs Act. We may add, however, that on the whole we have, we think, placed a somewhat liberal construction upon the results. But they have at least established the important fact that the milk supplied to London hospitals is no better-not to say worse-than that supplied to the public, whereas for hospital purposes it should be absolutely beyond reproach. It matters comparatively little whether the milk we add to our tea is watered or deficient in cream, but in the hospital this may mean depriving the patient of his only means of nourishment, while to add chemical preservatives to the same milk should be counted a, distinct offence in such a case. The public to some extent are protected against fraud and adulteration by the Sale ofY Food and Drugs Act, but our great charitable institutions, which receive milk in large quantities, do not share it is evident in the same measure in this protection, although they are in much greater need of it. We trust that the Government will strengthen the hands of the officials appointed to take samples under the Act that they may be empowered to take samples at frequent intervals from the cans of the milkman as soon as they are set down at the hospital, both in the case of the morning and the afternoon supply. This would relieve the hospital authorities, as we think they should be relieved, from all anxiety, responsibility, and expense in the matter and would secure a milk-supply fully in accordance with hospital requirements. In many of the hospitals, but not in all, a system of control is adopted, but this is generally limited to observing the amount of cream by a "creamometer" " and the specific gravity by a hydrometer. This is no doubt useful, but it is not sufficient since the volume of cream is not found to bear a constant relation to, the fat, on the amount of which depends a very important quality. The fat of a milk may be below 3 per cent. and yet f it is possible for that milk to show a volume of cream equal to 10 per cent. The quality of milk may to some extent be. controlled in this way, but the presence of chemical preservatives would be lost sight of. Everyone must admit the necessity of a pure and. unadulterated supply of milk to the sick and debilitated. That such a supply is not universal is evident to us in the present inquiry as well as from the testimony of hospital physicians who have been in communication with us upon the subject. There is, we fear, some tendency on the part of adminis-. y trative authorities to decide upon buying milk for hospitals n at the lowest possible price and milk of the lowest possible quality is accordingly supplied. A fair price should be paid and a pure, unimpoverished article of excellent quality may then justly be demanded. .
.
MR. J. A. PICTON AND VACCINATION. This is
milk of fair average quality, the amount of fat being, however, close upon the minimum of genuine milk. The milk contained boric acid but not in excessive a
quantity. The results may be summed up shortly as follows. Of the eleven samples examined we regard seven as of good average quality, two as of indifferent quality, and two as decidedly poor and in all probability diluted. These conclusions are based upon the standards adopted by the Society of Public Analysts, which seem to us to be perfectly justifiable on the grounds of common experience. For fat the limit adopted is 3 0 per cent., for non-fatty solids it is 85 per cent. Three specimens contained distinct though, be it remarked, not exoessive quantities of boric acid.
MR. J. ALLANSON PICTON, ex-M.P., has become an anti vaccinationist. By most people this announcement will be read with the same kind of surprise as would fill them if they were told that Lord Salisbury had become a Conservative or Mr. Healy a Home Ruler. But the statement is not published It is made with every outward evidence of as a new joke. seriousness by the organ of the league in the following words : " We are sure all our friends will be glad to learn that Mr. J. A. Picton, of the Vaccination Commission, and formerly member for Leicester, has formally notified his adherence to the anti-vaccination cause and has joined the National League." Mr. Picton’s relationship to anti vaccination has for some time been a very curious one and merits at least a passing notice.