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we have heard nothing of it, mainly no doubt because we have been most of our
time with health workers, who have nothing to do with the work carried out
under the Act.
Much more interesting has been the work I have seen and heard of in
connection with milk supply, and very definitely I have come to the conclusion
that in general, and in towns of a medium size, say from 50,000 up to 250,000,
where health work is done, the milk is better and cleaner and safer than in England.
Even in the largest cities that I have visited, Washington, Boston, Baltimore,
New York, etc., it is in general, despite the difficulties there must always be in big
places, of better quality than at home. In Boston the milk supply is fairly well
looked after, even though much of it comes from very long distances, and in some
cases from quite small farms. Practically all is pasteurized, and is sold in bottles.
'I he powers of the Commissioner of Health in regard to milk are very great, and
the practice of sampling both for chemical and bacteriological examinations much
more thorough than with us. The fat standard is higher than that in England,
and from the records I studied at the laboratories in Boston it appears to be certain
that the average milk on the market is richer in fat than ours. Also it contains
infinitely fewer bacteria. One creamery near Boston that I visited greatly impressed
me. The machinery for washing bottles and for bottling and sterilizing the milk
was of the type formerly used in breweries here and worked perfectly. This, of
course, was only to be expected since here as at home beer has always been more
carefully dealt with than milk. To some extent this is not surprising since the
profits on beer are so very much larger and leave quite a margin that can be used
for improving the product. The price of milk in Boston, as elsewhere in the States,
is higher than at home, but even then does not leave very much in the way of
profit to the dealer, particularly if his business is small.
NEW YORK.
There are many other things in connection with our visit of which I should
like to speak, but I am afraid I have already said much more than sufficient to
weary you. Before I close I should like to say a little with regard to what I have
seen in New York. The first three days were spent in company with the quarantine
officers, who are all members of the Federal Health Service, in visiting Ellis Island,
Staten and Hoffman Islands, and in inspecting passengers on board ship.
Ellis Island I was, not unnaturally, particularly interested in. At this season
of the year and at the end of a month things were very quiet, but we did make
some sort of inspection of the island and did see the kind of examination to which
immigrants must submit. All that we saw was, of course, on the medical side and
seemed to be excellently arranged and so as to cause no unnecessary inconvenience.
The work was rapidly done and the person who passed the examination was free
to go in about three hours at the outside, provided the immigration authorities, of
whose work we saw nothing, were satisfied. The object of the medical examination
is to discover whether or not the persons are suffering from diseases that might
spread if they were allowed to enter, or that will incapacitate the individual from
earning his own living. It appears to me to be not at all unreasonable. The
hospitals on Ellis Island are well kept, though some of the wards appeared somewhat
crowded.
The examination on board ship is a rough and rapid one for the detection of
verminous conditions chiefly, and if the number of steerage passengers is large
it is usual only to examine about 10 per cent. and if these are reasonably clean to
pass all except those who are infested. Hoffman Island is provided for the isolation
of infected persons found on board ship, and to it also persons who require disinfection
on account of vermin are taken. The hospital accommodation is good,
and the apparatus and baths, and the methods of treating those found to be