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The information which has hitherto appeared in the daily press as to the evidence laid before the Departmental Committee which is inquiring into the use of preservatives and colouring matters can hardly have afforded pleasant reading to the apologists for the drugging of foods. It is plainly the intention of the Committee to make a thorough investigation of the whole subject, and the main conclusions which, in the result, must bo forced upon unbiassed persons by an investigation of this character will be tolerably obvious to those who have given serious attention to the subject. At a later stage of the inquiry we shall publish a full account of the evidence submitted and of the Committee's proceedings. At present we may observe that the facts which have been brought forward fully confirm the statements made from time to time upon these matters in the BRITISH FOOD JOURNAL, and amply justify the attitude which we have adopted on the whole question. Representatives of various trade interests have given evidence which has served to show the extent to which the practices now being inquired into are followed. Strong medical evidence, as to the dangers which must attach to the promiscuous and unacknowledged drugging of the public by more or less ignorant persons, has been given; and some medical evidence of that apologetic order to which the public have of late become accustomed, and which we, at any rate, regard as particularly feeble, has also been put forward. Much more will no doubt be said, but those who have borne the heat and burden of the day in forcing these matters upon the attention of the Legislature and of the public can view with satisfaction the result already attained. Full and free investigation must produce its educational effect ; and whatever legal machinery may be devised to put some kind of check upon these most dangerous forms of adulteration, the demand of the public will be for undrugged food, and for a guarantee of sufficient authority to ensure that the demand is met.

In 1899 the medical practitioners of Dublin were confronted with an outbreak of a peculiar and obscure illness, characterised by symptoms which were very unusual. For want of a better explanation, the disorder, which seemed to be epidemic, was explained by the simple expedient of finding a name for it. It was labelled as “beri‐beri,” a tropical disease with very much the same clinical and pathological features as those observed at Dublin. Papers were read before certain societies, and then as the cases gradually diminished in number, the subject lost interest and was dropped.

Some misconception appears to have arisen in respect to the meaning of Section 11 of the Food and Drugs Act, 1899, owing, doubtless, to the faulty punctuation of certain copies of the Act, and the Sanitary Record has done good service by calling attention to the matter. The trouble has clearly been caused by the insertion of a comma after the word “condensed” in certain copies of the Act, and the non‐insertion of this comma in other copies. The words of the section, as printed by the Sanitary Record, are as follows: “Every tin or other receptacle containing condensed, separated or skimmed milk must bear a label clearly visible to the purchaser on which the words ‘Machine‐skimmed Milk,’ or ‘Skimmed Milk,’ as the case may require, are printed in large and legible type.”

Dr. EASTWOOD'S report to the Local Government Board on this subject is of special interest to the people of this country at the present time in view of the steps that are being taken with the object of checking the spread of tuberculosis, and the undoubted connections that exist between that and other diseases, and the sources and character of the milk supply. In this country little attention has hitherto been paid to the condition of cows or cowsheds, except perhaps in rare instances where the former were obviously diseased, or the latter constituted a public nuisance; while the connection between milk supply and disease has scarcely been recognised by the Legislature and by public authorities, and has been entirely ignored by the general public. For some years past the health authorities in the United States, as well as those of some other countries, have been making very serious efforts to eradicate tuberculosis from dairy herds, if that be possible. The way in which some of the various States and Cities of the Union are attempting to do this is of importance and interest to us for various reasons. Their problems are very much the same as ours. The success or failure of milk regulations in the United States may, therefore, be taken as an indication of the probable success or failure of ours. Such methods are, therefore, valuable as broadly suggesting those which we may usefully adopt or avoid. The United States also send us a large proportion of our oversea meat supply, and any question relating to the general health of dairy herds cannot be dissociated from one affecting the general health of animals that are slaughtered for their meat. It may also be remarked that such questions relate not only to the meat supply from the States, but also to the great cattle ranches of the Southern American continent, in which British and American capital is becoming increasingly employed. The Americans are nothing if not practical. They are almost proverbially unhampered by tradition. They are quick to adopt what may prove to be new remedies for old evils. While the independent control exercised by each State of the Union over its own internal affairs results in the attempted solution of any general problem being presented in almost as many forms.

Very much more might be done to improve the quality of our food supplies by the great organisations that exist for the avowed object of furthering the interests of traders in foodstuffs. It is no exaggeration to say that these organisations claim, and rightly claim, to speak in the aggregate on behalf of great commercial interests involving the means of livelihood of thousands of people and the most profitable disposal of millions of money. The information that they possess as to certain trade methods and requirements is necessarily unique. Apart from the commercial knowledge they possess, these organisations have funds at their command which enable them to obtain the best professional opinions on any subjects connected with the trades they represent. Their members are frequently to be found occupying positions of responsibility as the elected representatives of their fellow‐citizens on municipal councils and other public bodies, where the administration of the Food Laws and prosecutions under the Food and Drugs Acts are often under discussion. Such organisations, then, are in a position to afford an unlimited amount of valuable help by assisting to put down fraud in connection with our food supply. The dosing of foods with harmful drugs is, of course, only a part of a very much larger subject. It is, however, typical. Assuming the danger to public health that arises from the treatment of foods with harmful preservatives, the continued use of such substances cannot but be in the long run as harmful to the best interests of the traders as it is actually dangerous to public health. The trade organisations to which reference has been made might very well extend their sphere of usefulness by making it their business to seriously consider this and similar questions in the interests of public health, as well as in their own best interests. It is surely not open to doubt that a great organisation, numbering hundreds, and perhaps thousands of members, has such a membership because individual traders find it to their interest, as do people in all walks of life, to act more or less in common for the general advantage ; and, further, that it would not be to the benefit of individual members that their connection with the organisation should terminate owing to their own wrong‐doing. The executives of such trade organisations hold a sufficiently strong position to enable them to bring strong pressure to bear on those who are acting in a way that is contrary to the interests of the public generally, and of honest traders in particular, by adulterating or misbranding the food products that they gain their living by selling. It should also be plain that such trade organisations could go a long way towards solving many of the very vexed questions that arise whenever food standards and limits, for example, form the subject of discussion. These problems are not easy to deal with. The difficulties in connection with them are many and great; but such problems, however difficult of solution, are still not insoluble, and an important step towards their solution would be taken if co‐operation between those who are acting in the interests of hygienic science and those who are acting in the interests of trade could be brought about. If this could be accomplished the unedifying spectacle of alleged trade interests and the demands of public health being brought, as is so often the case, into sharp conflict, would be less frequent, and there can be no doubt that general benefit would result.

This paper aims to determine whether the rank order of hospitals changes when their central line‐associated bloodstream infection (CLABSI) rate is computed using a traditional proxy measure for the denominator (number of patients with one or more catheter in place) versus using the actual number of catheters or catheter‐lumens.

The authors conducted a statewide voluntary one‐day prevalence survey among all hospitals participating in Washington State's mandatory public reporting program. Hospitals counted the number of catheters and catheter‐lumens as well as patients with catheters. Counts of patients with one or more catheter in place, of catheters, and of catheter‐lumens were extracted from each hospital's completed survey form and transformed into a ratio. Three CLABSI incidence density rates were computed for each hospital by scaling their annual CLABSI rate in the previous calendar year by the ratio of patients to catheters to catheter‐lumens. Influence of these three different denominators on rank order of the hospitals was assessed by scaling the corresponding Centers for Disease Control and Prevention's National Healthcare Safety Network incidence density rates for each participating hospital and examining position shifts with the Wilcoxon signed rank test.

Statistically significant but only modest shifts in position became evident, which did not correlate with service complexity characteristics of the hospitals affected.

Others have shown that the CLABSI incidence density rate in a single hospital is significantly affected by switching from a traditional proxy measure denominator to a more meaningful denominator. This is the first report on whether all hospitals' rates would be affected in a uniform or a non‐uniform manner if a different denominator were to be selected by mandatory public reporting programs.

The purpose of this paper is to briefly review the history of healthcare‐associated infection (HAI) prevention programs in the USA since the early 1970s until today, and provide suggestions how other countries (and Canada specifically) may learn from this experience to accelerate HAI prevention and patient safety improvements in their counties.

The paper is a narrative review of literature and personal experience.

US hospitals have had healthcare‐associated infection (HAI) prevention programs, including surveillance for selected HAIs, since the late 1960s‐early 1970s. Such programs began with active surveillance for HAIs based upon the Centers for Disease Control and Prevention's (CDCs) National Nosocomial Infections Surveillance (NNIS) system. This system included standardized definitions and surveillance protocols. Since the 1980s, the CDC has developed HAI prevention guidelines, with categorized recommendations for HAI prevention. In the early 2000s, the Institute of Medicine published a report outlining the harm caused by HAIs. This led to increased attention to HAI prevention by an increasingly wide variety of organizations. The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) initiated HAI prevention efforts. Many studies documented the failure of hospitals to fully implement evidence‐based practices. The increased attention to HAIs and their morbidity and mortality led to media reports and ultimately an initiative by the Consumer's Union for mandatory reporting of HAI rates by hospitals in all states. Subsequently, the CMS introduced decreased reimbursement for the additional costs directly related to HAIs (and other critical incidents) and linkage of reimbursement levels to hospital HAI rates. Together, mandatory reporting and reduced reimbursement for HAIs has led hospital executives to focus more attention on infection control programs to decrease HAI rates. Progress on preventing HAIs seems to be related to standardizing evidence‐based HAI prevention bundles, mandatory reporting, and paying for performance (or not paying for preventable HAI complications). Given that voluntary HAI prevention programs have existed since the 1970s, it appears that regulation, reporting, and decreased reimbursement has resulted in more rapid implementation of HAI prevention programs and improved patient safety.

The different major activities enhancing HAI prevention in the USA are outlined in an historic context.

Understanding the history of progress in hospital infection control efforts provides an essential perspective for policy makers and for the interdisciplinary team required to evaluate HAI mandatory public reporting in a comprehensive manner.

MR. JONATHAN HUTCHINSON, the eminent consultant, has just put forward a statement of the utmost importance with respect to the probable existence of a direct connection between the consumption of arsenic‐contaminated food and the occurrence of cancer. He points out that certain modern “improvements” in processes of production have led to the contamination of various food‐products with small amounts of arsenic, and observes that “if, as seems proved, the continuous use of arsenic in small medicinal doses can predispose the skin to multiple cancer there seems no reason for doubting that it may do the same for the other tissues, and for the mucous membranes and the viscera,” while there must necessarily also be “the constitutional tendency, the appropriate age, and, in some cases, the local irritation.” Mr. HUTCHINSON refers to the recent successful tracing of the Manchester outbreak of “peripheral neuritis” to the use of arsenic‐contaminated beer as an example of what may be caused by the habitual ingestion of minute doses of arsenic. It is a remarkable fact that the increase in the occurrence of cancer may be looked upon as almost synchronising with the increasingly extensive adoption of those “improved” modern methods of manufacture, not only of beer but of other food‐products, which open the door to arsenic‐contamination; together with the great increase in the use of arsenic in medical prescriptions.

These details and drawings of patents granted in the United States are taken, by permission of the Department of Commerce, from the ‘Official Gazette of the United States Patent Office’. Printed copies of the full specifications can be obtained, price 10 cents each, from the Commissioner of Patents, Washington, D.C., U.S.A. They are usually available for inspection at the British Patent Office, Southampton Buildings, Chancery Lane, London, W.C.2.

The following is an annotated list of materials dealing with orientation to library facilities and services, instruction in the use of information resources, and computer skills related to information gathering. This is RSR's twelfth annual review of this literature and lists items published in 1985. A few references are not annotated because the compiler could not obtain copies of them for the review.