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Annotations.WORKING OUTPUT.

"Ne quid nimis."

THE reports of the Industrial Fatigue Research Boardas they increase in number are forming a special litera-ture which is throwing light on the working of thehuman machine, and which cannot fail in time to displayhow health may be maintained and how early mani-festations of disorder may be detected. The publica-tions fall naturally into various groups as they dealwith general topics or with this or that industry orgroup of industries. The most recent report,! one byDr. H. M. Vernon, belongs to the former category anddeals with the rate at which the effect, as measuredby output, of shortening or lengthening hours of employ-ment is manifested. The subject is one of considerableinterest to-day, when hours of work are being curtailedin nearly every branch of industrial activity, andemployers are eager to know whether to expect as largean output as before, and if so, how soon.Dr. Vernon brings together data, some of which have

been scattered through other publications referring tovarious trades, issued during several years. Informa-tion is thus drawn from the manufacture of steel, thetinplate industry, and the production of shells. Certainconclusions are arrived at as the result of comparingthe statistical data quoted, conclusions which are ofinterest not only to the industrial economist, but also tothe student of the metabolic activity of health. Dr.Vernon finds that when hours are shortened work atfirst proceeds for several weeks at the old rate-that isto say that there is a marked latent period, unless someincentive to more rapid work is placed before theworkers. Then the workers, apparently quite un-

consciously, begin to work faster as they find the

energy at their disposal is greater than what theyare expending. "They unconsciously speed up a

little from time to time, and in that they suffer noover-fatigue in consequence, they get into the habitof working steadily at a higher level of speed. Fromthis level they make further unconscious attempts tospeed up, till they finally arrive at an approximateequilibrium of speed in relation to their hours of work."The increase continues to operate in heavy and complexprocesses, such as open-hearth steel melting, throughas long a period as 12 months before a new and higherlevel is settled down to ; in simpler operations, such asthose of fuse-making, the new level may be attained infour months. Intermediate periods may be expectedto elapse in the case of less heavy or less simple pro-cesses. In other words, the speed of human activityis a function of the weight of work and the period ofemployment, and there is a tendency for the expendi-ture of energy to be the same whether the hours belong or short. Dr. Vernon further points out that withlong hours a certain proportion of the energy available isexpended in

"

passive work " rather than in productivework, where passive work is hed to include standingabout doing nothing which in itself will finally causefatigue; but when there are shorter hours this energy issaved and can be diverted into productive work. Theresult upon speed produced by lengthening hours is ofeven more practical importance to employers than thatof shortening hours, owing to the use of overtime. HereDr. Vernon finds little or no latent period before therate of output accommodates itself to the longer hours.Any attempt to continue work at the pace suited toshorter hours would use up the available energy andleave none for the overtime hours unless reserves werecalled upon and the realms of over-fatigue invaded.We find here a scientific explanation of the saying,"overtime does not pay." The suggestion is putforward that when overtime becomes a necessity theadditional hours should be spread evenly through theweek, for example, it would be better to work nine

1 The Speed of Adaptation of Output to Altered Hours of Work.By Dr. H. M. Vernon. Report No. 6. Industrial Fatigue ResearchBoard. 1920. Pp. 33. ls.

hours each day instead of ten hours on alternate days.The resulting rate of work would then be that suitedto a nine hour day; while by working ten hours onalternate days, the rate of work for every day of theweek would become that suited to a ten hour day.Further, when overtime is no longer needed, a shorterperiod would elapse in recovering to an eight hour pacefrom a nine hour pace than from a ten hour pace.Evidence is also adduced to show that more timeis lost on heavier work than on lighter work, and duringlonger hours than shorter hours. Thus women employedon rather heavy work lost 6’7 per cent. of time, as con-trasted with women on rather light work, who lost4’2 per cent. ; while men employed for 63! hours perweek lost 11’8 per cent. of time as contrasted with6 per cent. when working 54 hours per week.These facts suggest that there is a certain amount of

energy at the daily disposal of the human machine;that there is a definite urge forward to expend thisenergy, an urge due to the anabolic activity of reststimulating the katabolic activity of work; and thatwhen the two balance one another a level of productiveactivity is maintained. Practice may increase pro-ductivity still further, but practice only consists in usingenergy economically, so that more things are made withthe same exertion previously required for making fewer.Interest also centres on the fact that quicker workduring shorter hours is associated with less lost time(represented by sickness), from which health appearsto be a function of activity ; and, from the viewpoint ofhealth, there appears to be an optimum rate of activityfor the human organism which seems to coincidewith the optimum rate of production. We have heredirect evidence of the way in which the work of theIndustrial Fatigue Board bears upon two most import-ant national needs-industrial productivity and health.The Board will indeed justify its existence if it is ableto convince those who control the destinies of theindustrial world that material wealth and individualhealth depend, so far as labour is concerned, on thesame factors.

HERPES ZOSTER AND CHICKEN-POX.

CONSIDERABLE interest has always attached to thecomparatively trivial ailment, herpes zoster or shingles,owing to the apparent connexion between its points ofoutbreak and the distribution of nerve branches, makingit an obvious example of so-called trophic influence-the direct influence of nervous stimuli on cell nutrition.How this stimulus is brought into play in the case ofherpes has remained obscure. It has been suggestedthat it represents a condition of the sensory side of thecentral nervous system closely resembling or identicalwith that which on the motor side constitutes acuteanterior poliomyelitis, while the frequency of the

outbreak of labial herpes as a concomitant of severaldifferent infective fevers-pneumonia, cerebro-spinalfever, coryza, and so forth-would tend to indicate thata variety of different poisons are equally capable ofexciting the underlying nervous disturbance. Apartfrom the fact that the essential lesion of herpes isa simple vesicle, and so resembles the exanthem ofchicken-pox, there is nothing at first sight to suggestany further connexion between the two conditions.Some curious instances have, however, been recordedin which infection with varicella has followed contactwith a sufferer from herpes zoster, and the suggestionhas seriously been made that the latter is in realitya localised varicellar eruption. The question isdiscussed in an interesting paper by Dr. Claude B. Ker,which appears in our present issue, with the practicalconclusion that much stronger evidence than any atpresent brought forward will be needed to establish sonovel an identification. With two such relativelycommon diseases coincidence is hard to eliminate. Thecutaneous manifestation of chicken-pox may be reducedto a very few spots, even to one single vesicle, whilethe clinical phenomena are so slight as easily to escapenotice-facts which render it difficult in any case toeliminate the possibility of some overlooked source ofinfection. Indeed, if the rash may be reduced to one

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vesicle, it seems probable that cases exhibiting no erup-tion at all may from time to time occur, and without thetypical rash they would be quite impossible to identify.On the other hand, it has been stated that there mayexist a generalised form of herpes with scattered lesionsclosely resembling varicella. The distribution of thevesicles is typically along a particular nerve; but it is notunlikely that more than one nerve may be affected at thesame time, giving rise to the simultaneous appearance ofcharacteristic groups of vesicles in different parts of thebody. Seeing that the eruption of chicken-pox may insome instances be localised in areas of special irritation,such cases might give rise to difficulties in diagnosis.Dr. Ker suggests that the question of the relationshipbetween herpes and varicella is one in which thegeneral practitioner is in the most favourable positionfor making observations, and hopes that some amongour readers may contribute data towards a solution ofthe problem. -

SECRET REMEDIES IN AMERICA.

THE Proprietary Medicines Bill has passed the Com-mittee stage in the House of Lords, and this should turnEnglish legislators to examine the success which hascrowned the efforts of American reformers in a similardirection during the last 15 years. By the Federal Foodand Drugs Act the sale of

" misbranded " drugs becameillegal. For five years it was held that a drug wasmisbranded if the description published on the packageor label claimed a cure for diseases which in effect thedrug did not cure. Later a decision of the SupremeCourt confined this term to descriptions of compositionand sources of origin. But during those five yearsmany significant changes appeared on the labels ofproprietary medicines. California syrup of figs, whichhas preserved its old description in Great Britain evento the present day, was known in America, from thepassing of the Federal Act, as syrup of figs and elixir !,of senna. The American also is told that the mixture- contains 6 per cent. of alcohol-a fact of which manyEnglishmen are doubtless in ignorance. In other casesthe change was more radical. The labels on Dr. Kilmer’s:swamp root as sold in England continued to assert-

" It cures enlargement of prostate gland, seminal weak--ness, spermatorrhoea, generative debility, and generallanguor. Drives malarial poison out of the system ......

purifies the blood." I

In America the following modest claim had to besubstituted :-

" It will be found very beneficial in cases of debility.";Such illustrations are instructive as evidence of thepossibilities of legislation in combating this dangeroustrade. The Food and Drugs Act has been in force fornearly 15 years and there are still many fraudulentand thriving concerns in America, but with Englishcooperation their days are now numbered. TheAmerican federal authorities are also able to prosecuteany firm which can be shown to be "conducting ascheme for obtaining money through the mails bymeans of false and fraudulent pretences, representa-tions, and promises." Against such firms a fraudorder is issued and the business is closed down. In a

leading article which appeared in THE LANCET ofJune 12th (p. 1274), before the present Bill was intro-duced, we set out the amazing story of the " MedicalMail Order Frauds " in America, coupling the toast withthe name of sargol.More than any other single organisation the American

Medical Association have been responsible for theadvances which have been made. Their propagandabegan when in the year 1905 they reprinted in bookletform a series of articles which had been appearing inCollde-r’s. That was the beginning of their publiccampaign, although for some years previously they haddirected their efforts to eliminating certain proprietaryarticles from the armamentarium of American practi-tioners. Since 1905 the journal of the Associationhas published many articles exposing various nostrumsand many of these articles have been reprinted.The earlier ones have also been collected into

book form.1 The Association maintains a Council otPharmacy and Chemistry, which decides not onlythe therapeutic merits of the advertised prescriptions.but even the more delicate question of whether a harm-less concoction is being sold at too high a price.Naturally, a chemical laboratory is kept busy analysingp,nd researching into the value of various orthodox andunorthodox remedies. In the matter of propaganda-for which a special department has been created-theyare careful to insist that their work is educational andnot punitive. Their office is richly furnished with refer-ences and cross references, stored by the card-indexsystem, and has become a clearing house of informa-tion on medical frauds of all kinds. The poster has oflate been used with success for popular education. Acatalogue of these posters is sent gratis on application,as well as a list of the publications of the department.

A GREAT GIFT.

THE example set some time ago by the Shell Com-pany, which gave .6250,000 to Cambridge Universityfor the general improvement of scientific teaching andtraining, with no conditions attached to the gift, hasbeen followed by the British Dyestuff Corporation,which has given a large sum to the Universities of Man-chester and Oxford for chemical research. At an

extraordinary meeting of the shareholders of Messrs.Brunner, Mond, and Co. on August 4th the followingresolution was carried in the face of a small butenergetic number of shareholders :—" That the directors be and they are hereby authorised to

distribute to such universities or other scientific institutionsin the United Kingdom as they may select, for the further-ance of scientific education and research, the sum of jE100,000out of investment surplus reserve account."

This was the second attempt to persuade the share-holders to accede to the unanimous recommendationof the directors. The chairman gave an interestinganalysis of what such an apparently-and actually-large gift for the promotion of scientific education,training, and research really meant when set forth incold economic business monetary calculation. " This ishow it works out," said the persuasive chairman,

" on

such a huge capital as that of Brunner, Mond, and Co.If the ;S100,000 was divided in cash it would amount to2d. a share gross, subject to income-tax. If it wereleft in the business and earned 10 per cent. it wouldearn ld. a share in interest, less tax." The example ofthese great business firms ought to be taken to heart byothers who have lost nothing through the war. In1911-12 the State aid received by the German univer-sities was :E 1,220,000. All British universities are sufferingfrom want of funds, and donations to them evoke a feelingof gratitude to the donors. Further, these gifts arenational investments. But they should not relieveGovernment of its duty towards the maintenance andadvancement of scientific education in this country,which ought not to be left to haphazard windfalls,subject to the vicissitudes of trade and the goodwillof shareholders in successful chemical and engineeringcombines. Even now, with all the trumpeting, adver-tising, and propaganda work, wealthy Lancashire hasonly subscribed 212,000 out of the total of 500,000asked for to enable the University of Manchester tokeep financially abreast of the times.

THE FUTURE OF METROPOLITAN WATER-SUPPLY.

THE report recently issued of the Departmental Com-mittee appointed to inquire into the provisions andeffect of the Metropolis Water Act, 1902, should therecommendations be adopted, affects the consumer’sinterests in many ways. Apart from his pocket,questions of health may arise with the suggestion of alimited supply. Briefly, the Committee considers inregard to administrative personnel that a reductionin the number of members of the Water Board

1 Nostrums and Quackery. Chicago : American Medical Associa-tion Press. Second edition. 1912. $1.