1
1604 THE LANCET COMM38SION ON THE METROPOLITAN WATER-SUPPLY. Annotations. THE LANCET SPECIAL COMMISSION ON THE METROPOLITAN WATER-SUPPLY. 11 Ne quid nimis." WITH the article which appears in our columns on page 1610 this important Commission comes to a close. Its scope was limited, but its work was designed to be exhaustive within those limits. We did not desire to write of the water- supply of London from the point of view of its adequacy or purity or to make the subject an opportunity of introducing into our columns discussions upon municipal or Imperial politics. Our object was to give our readers information by which they would be enabled to form sound judg- ment as to any proposals that in the future and possibly in the near future-might be made for the reform of the metropolitan water - supply. Before any reform can have logical reasons it is necessary that the.present condition of the thing to be reformed should be thoroughly known. That is the information which our Commissioner has been content to give. That it has already proved of great value to many persons we have been glad to learn from letters that we have received ; that it has been opportune is shown by the character of the evidence now being taken before the Royal Commission presided over by Lord Llandaff. Our Commissioner has described the present condition of the metropolitan waterworks and to the comprehension of any scheme in the future this knowledge is indispensable. A CENTRAL HOSPITAL BOARD FOR LONDON. ON Monday last the first report of the General Committee for the Promotion of a Hospital Board for London was read and discussed at a meeting of the Charity Organisation Society. To this meeting the chairmen and treasurers of the different metropolitan hospitals as well as members of the medical profession were cordially invited and those who attended were rewarded by interesting proceedings. These proceedings will be found reported elsewhere. The profession was in good evidence and was represented among others by Sir Wm. Broadbent, Sir Joseph Fayrer, Dr. Glover, and Mr. Victor Horsley, but the chairmen and treasurers of hospitals were notably absent or at least notably silent. In this abstention of the officials from debate lies the chief difficulty of the situation-at least, so it seems to the promotors of the reforming scheme. The authorities of individual hospitals are reluctant to re- cognise the need of a central body. They appear not to see that such a board would facilitate their work by enabling them to face with united front the abuse of charity from which they are suffering. It is to be hoped that this reluctance will be overcome. The demand for more system and principle in the administration of hospital charity does not come primarily from the profession but from the public. The need for reform in the administration of hospitals is not the greedy cry of a class directed against the managers of hospitals. The language cf Sir William I Broadbent and Sir Joseph Fayrer on this point is con" clusive as regards the medical profession. It is really the public who are showing their sense of hospital manage- ment in an unmistakeable way. With the existing number cf wealthy people it is impossible to inter- pret the impecunious plight of our deserving hos- pitals on any other theory than that of distrust of their administration. A grave responsibility now rests on the governing bodies of hospitals and they must accept the principle of some common board to which they can look for an impartial judgment of their work and of its claims on the public. They have indeed done so by the formation of the Central Hospital Association. They will do well to show some activity in the use of this association and even to extend the conception of it till it shall include all respectable hospitals and representatives of all who wish them well. The governing bodies of such dispensaries as are conscious of a good 9-aison d’etre would do well to follow the example of the general hospitals and adapt their institutions to the altered circumstances of the day. They may be needed to . take over some of the work which the hospitals may find it right to refuse. By such action and by a little mutual cooperation hospitals and dispensaries might have a new lease of public confidence and of prosperity and might even forestall the action of those who seek to create a central hospital board. But united action must not be long delayed, while the approaching distribution of the Prince of Wales’s Fund makes of the present an auspicious time. Resistance to public opinion displayed in such un- equivocal fashion can only tend to injure institutions of which we are all proud. The governing bodies of our medical charities should rise to the occasion and meet the public demand for their more efficient and harmonious cooperation and should rise at once. "MODIFIED MILK" FOR INFANT FEEDING. A NEW departure in the feeding of infants has been described in a recent paper by Dr. D. J. Evans, of Montreal Foundling Hospital. The essence of the new method con- sists in the substitution of a "modified" cow’s milk for the natural product. The writer maintains that an ideal milk for infants must preserve a certain regulated proportion between the proteid, fatty, and saccharine constituents, that this proportion should vary with the age and the digestive system of the child, and that excess not only of the whole but of one or other of its constituents is accountable for the gastro-intestinal troubles of infancy. Thus an excess of the proteid elements gives rise to vomiting, constipation, less com- monly diarrhoea, colic, and the passage of small, hard curds. He considers that " as a rule proper management of proteids means success in infant feeding." Excess of fat causes frequent evacuation with soft curds and vomiting but seldom colic. Excess of sugar leads to colic and thin yeasty motions. He finds the "modified milk" most useful for premature, feeble, and marasmic infants and in the treatment of summer diarrhoea. This milk is prepared by adding solutions con- taining definite percentages of cream or sugar to milk so as to obtain the desired proportions of each of the components needful for nutrition. This process can be carried out at home by a careful nurse or, if preferred, with greater ease in the laboratory. The milk should also be sterilised. Some of the details given in this paper are to our mind too strongly suggestive of an effort to improve upon nature or even to do away with the services of that "homely nurse" " altogether. We quote an example. A table gives the following average composition of human milk: fat, z00 ; sugar, 7-00; proteid, 1-50. In a subse- quent passage the writer says : "An average formula for a healthy infant during the first week of life would be: fat, 2’CO; sugar, 6-00; proteid, 0-60. The percentage may...... reach : fat, 3’00; sugar, 6’cm; proteid, 1-00 by the end of the first month." Not till the third month does he allow milk of the average composition. In prescribing the amount of milk he is even more sparing, from 10 to 16 ounces per diem at the end of the first week being increased to from 30 to 40 ounces from the sixth to the ninth month. Excellent results are claimed for this method of artificial nourish- ment which we are informed sustains at the present time 30,000 infants in Canada and the United States. Dr. Rotch, of Boston, U.S., who is the originator, states that of 115

THE LANCET SPECIAL COMMISSION ON THE METROPOLITAN WATER-SUPPLY

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1604 THE LANCET COMM38SION ON THE METROPOLITAN WATER-SUPPLY.

Annotations.

THE LANCET SPECIAL COMMISSION ON THE

METROPOLITAN WATER-SUPPLY.

11 Ne quid nimis."

WITH the article which appears in our columns on page1610 this important Commission comes to a close. Its scopewas limited, but its work was designed to be exhaustivewithin those limits. We did not desire to write of the water-

supply of London from the point of view of its adequacy orpurity or to make the subject an opportunity of introducinginto our columns discussions upon municipal or Imperialpolitics. Our object was to give our readers informationby which they would be enabled to form sound judg-ment as to any proposals that in the future and

possibly in the near future-might be made for the reformof the metropolitan water - supply. Before any reform

can have logical reasons it is necessary that the.presentcondition of the thing to be reformed should be thoroughlyknown. That is the information which our Commissioner hasbeen content to give. That it has already proved of greatvalue to many persons we have been glad to learn fromletters that we have received ; that it has been opportune isshown by the character of the evidence now being takenbefore the Royal Commission presided over by Lord Llandaff.Our Commissioner has described the present condition ofthe metropolitan waterworks and to the comprehension ofany scheme in the future this knowledge is indispensable.

A CENTRAL HOSPITAL BOARD FOR LONDON.

ON Monday last the first report of the General Committeefor the Promotion of a Hospital Board for London was readand discussed at a meeting of the Charity OrganisationSociety. To this meeting the chairmen and treasurers ofthe different metropolitan hospitals as well as members ofthe medical profession were cordially invited and those whoattended were rewarded by interesting proceedings. These

proceedings will be found reported elsewhere. The professionwas in good evidence and was represented among others bySir Wm. Broadbent, Sir Joseph Fayrer, Dr. Glover, and Mr.Victor Horsley, but the chairmen and treasurers of hospitalswere notably absent or at least notably silent. In

this abstention of the officials from debate lies thechief difficulty of the situation-at least, so it seems

to the promotors of the reforming scheme. Theauthorities of individual hospitals are reluctant to re-

cognise the need of a central body. They appear not to

see that such a board would facilitate their work by enablingthem to face with united front the abuse of charity fromwhich they are suffering. It is to be hoped that thisreluctance will be overcome. The demand for more

system and principle in the administration of hospitalcharity does not come primarily from the profession but fromthe public. The need for reform in the administration of

hospitals is not the greedy cry of a class directed againstthe managers of hospitals. The language cf Sir William

I

Broadbent and Sir Joseph Fayrer on this point is con"

clusive as regards the medical profession. It is really thepublic who are showing their sense of hospital manage-ment in an unmistakeable way. With the existingnumber cf wealthy people it is impossible to inter-

pret the impecunious plight of our deserving hos-

pitals on any other theory than that of distrust oftheir administration. A grave responsibility now rests onthe governing bodies of hospitals and they must accept theprinciple of some common board to which they can look for

an impartial judgment of their work and of its claims on thepublic. They have indeed done so by the formation of theCentral Hospital Association. They will do well to showsome activity in the use of this association and even toextend the conception of it till it shall include all respectablehospitals and representatives of all who wish them well.The governing bodies of such dispensaries as are consciousof a good 9-aison d’etre would do well to follow the exampleof the general hospitals and adapt their institutions to thealtered circumstances of the day. They may be needed to. take over some of the work which the hospitals may findit right to refuse. By such action and by a littlemutual cooperation hospitals and dispensaries might havea new lease of public confidence and of prosperity andmight even forestall the action of those who seek to create acentral hospital board. But united action must not be

long delayed, while the approaching distribution of thePrince of Wales’s Fund makes of the present an auspicioustime. Resistance to public opinion displayed in such un-equivocal fashion can only tend to injure institutions ofwhich we are all proud. The governing bodies of our

medical charities should rise to the occasion and meet the

public demand for their more efficient and harmonious

cooperation and should rise at once.

"MODIFIED MILK" FOR INFANT FEEDING.

A NEW departure in the feeding of infants has beendescribed in a recent paper by Dr. D. J. Evans, of MontrealFoundling Hospital. The essence of the new method con-sists in the substitution of a "modified" cow’s milk for thenatural product. The writer maintains that an ideal milkfor infants must preserve a certain regulated proportionbetween the proteid, fatty, and saccharine constituents, thatthis proportion should vary with the age and the digestivesystem of the child, and that excess not only of the wholebut of one or other of its constituents is accountable for the

gastro-intestinal troubles of infancy. Thus an excess of the

proteid elements gives rise to vomiting, constipation, less com-monly diarrhoea, colic, and the passage of small, hard curds.He considers that " as a rule proper management of proteidsmeans success in infant feeding." Excess of fat causes

frequent evacuation with soft curds and vomiting but seldomcolic. Excess of sugar leads to colic and thin yeasty motions.He finds the "modified milk" most useful for premature,feeble, and marasmic infants and in the treatment of summerdiarrhoea. This milk is prepared by adding solutions con-taining definite percentages of cream or sugar to milk so asto obtain the desired proportions of each of the componentsneedful for nutrition. This process can be carried out athome by a careful nurse or, if preferred, with greater easein the laboratory. The milk should also be sterilised.Some of the details given in this paper are to our mindtoo strongly suggestive of an effort to improve uponnature or even to do away with the services of that

"homely nurse" " altogether. We quote an example. A

table gives the following average composition of humanmilk: fat, z00 ; sugar, 7-00; proteid, 1-50. In a subse-

quent passage the writer says : "An average formula for ahealthy infant during the first week of life would be:

fat, 2’CO; sugar, 6-00; proteid, 0-60. The percentagemay...... reach : fat, 3’00; sugar, 6’cm; proteid, 1-00 by theend of the first month." Not till the third month does heallow milk of the average composition. In prescribing theamount of milk he is even more sparing, from 10 to 16 ouncesper diem at the end of the first week being increased to from30 to 40 ounces from the sixth to the ninth month. Excellentresults are claimed for this method of artificial nourish-ment which we are informed sustains at the present time30,000 infants in Canada and the United States. Dr. Rotch,of Boston, U.S., who is the originator, states that of 115