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Annotations."Ne quid nimis."

INDUSTRIAL FATIGUE RESEARCH BOARD,’’ THE good a man does lives after him" might

suitably be chosen as a memorial epigram for the Healthof Munition Workers Committee, who not only did muchduring their short life, but sowed many seeds which areonly now beginning to grow to a harvest. One of theseseeds was research into the workings of the humanmachine in industry. The growth of this research hasnever been allowed to stop ; on the disbandment of thecommittee in 1917 it was kept alive by the Welfare andHealth Section of the Ministry of Munitions until in1918, when a body, the Industrial Fatigue ResearchBoard, was set up to develop and extend investigation.The terms of reference to the Board, which is nowattached to the Medical Research Council, are: " Toconsider and investigate the relations of the hours oflabour and of other conditions of employment, includingmethods of work to the production of fatigue, havingregard both to industrial efficiency and to the preserva-tion of health among the workers."We have now before us the first annual report 1

dealing with the work of the Board. From it someidea can be obtained of the difficulties experienced inorganising this new field of research ; in finding skilledobservers to undertake investigations; in obtainingfacilities for research; in fact, in constructing a

machine for doing work which has never been donebefore with no precedent to follow. Other countriesare watching to note success or failure, while labour onthe one side and capital on the other have had at eachstage to be conciliated and informed as to the value andimportance of the work. In these circumstances thefollowing statement is very satisfactory :- ,

’’ Owing to the small amount of research on industrialfatigue which had been carried out when the Board wasformed, they have been compelled to start their inquiriespractically ab initio, with an investigating staff to whom, witha few exceptions, all the problems were new. In addition, thenature of the experiments generally involve observationsover a long period, so that final results cannot be expectedfor many months after an investigation has begun. Theinitial difficulties, however, are now being quickly over-come, and although the work of the Board is still largelytentative, and must necessarily continue so for a long time,there is every ground for anticipating that progress in thefuture will be at a much more rapid rate than in the past."The report shows the amount of spade-work which

has been done; it is necessary work, but it does not

appeal to the outsider, who looks for immediateresults. Nevertheless, several useful reports have alreadybeen published, and there are clear indications thatthe output is likely to be considerably increased in thenear future. Even as we write the first of a seriesof reports dealing with the textile industry has justbeen issued. Four investigations have been completedand reported upon, dealing with tinplate manufacture,shell-making, iron-founding, and industrial accidents.Nine other investigations, all of wide scope, are in pro-gress, dealing with such industries as the manufactureof iron and steel, boots and shoes, the cotton industry,the silk trade, laundry work, vocational selection, andspecial statistical research. Six other investigations areapproved for action as soon as the staffs are availablefor the purpose. The method of procedure followed isof some interest. Each investigation is entrusted to aspecial committee, of which there are 11 in existence,composed of not merely members of the Board, but also industrial experts, together with representatives ofemployers and workmen in the industry concerned.By this means full technical knowledge is obtained andalso cooperation among masters and men. A staff ofskilled investigators, visiting factories and carrying outlaboratory research work, acts under the direction andsupervision of each committee. As the work of theBoard becomes more widely known applications for

1 First Annual Report of the Industrial Fatigue Research Board.1920. H.M. Stationery Office. Pp. 31. 6d.

their services are likely to increase rapidly. Probablywhile foundations have been under construction

advantage has been gained by lack of publicity..That day is nearly over, and the time is near

when the value of the work to the health andcontentment of operatives and to increased pro-duction for the community will call for widerecognition. Possibly practical application of theprinciples brought to light through the research workof the Board may be undertaken by such a bodyas the proposed National Institute of Psychology andPhysiology applied to commerce and industry, theinception of which we recently drew attention to inthese columns. Great Britain in this matter hasestablished a lead, and there is promise of maintainingand increasing this lead. The scope of the work isintimately bound up with the sphere of preventivemedicine ; in

"

fatigue " the great James Paget saw the

beginnings of disease, and its prevention cannot fail toreact favourably on health. The possibility of estab-lishing a theory of health to precede investigationsinto any theory of disease lies here.

THE DANGERS OF ASCARIASIS.

THOUGH serious complications due to the ascarislumbricoides have from time to time been recorded,this most prevalent of all animal parasites is not

usually regarded as a source of danger. In the AmericanJournal of the Medical Sciences Dr. B. C. Crowell shows sthat the dangers are considerable and are overlookedbecause the word of the pathologist is seldom heard onthe subject. Experience of several years in the

necropsy-room at Manilla has led him to this conclu-sion. In the Philippine Islands as many as 62 per cent.of the population have been found infested, and in someplaces the percentage is much higher. Large numbersof worms may be present in the intestine, producingmasses which cause ileus. Cases are recorded inwhich as many as 600 worms were passed in one day.Whether the ascaris can perforate the intact intestine is.unsettled. Dr. Crowell has seen several cases inwhich it opened up a repaired wound of the intestine,,determining fatal peritonitis. Hence the importance ofusing vermifuges in ascariasis when abdominal opera-tions of choice are to be performed. Migration into thebiliary passages must be more frequent than is indicatedby the reports, as it is only in cases of operation ornecropsy that the diagnosis is made. Leer has statedthat ascarides are the second most frequent cause ofhepatic abscesses. These are usually multiple and thepus is very foul. In one case reported by Dr. Crowellthere were three large ascarides in the hepatic ducts,the largest of which extended to the surface of theright lobe of the liver. The common duct was distendedand occluded by the folded bodies of two full-grownascarides, and one protruded from the papilla of Vater.There were thrombosis of the splenic vein and acutehaemorrhagic pancreatitis. Migration of the ascaris tothe stomach and oesophagus and expulsion by themouth or nose is frequent. But the parasite may passinto any of the connected canals or cavities-nasalsinuses, lacrymal duct, Eustachian tube, larynx, andtrachea. In the larynx it may cause alarming symptomsand even suffocation. Toxic and reflex symptoms, suchas fever, nausea, abdominal pain, convulsions, tetany,delusions, symptoms simulating meningitis, may occurin ascariasis. Proof of the connexion is furnished bytheir disappearance after successful treatment of theinfestation. In the horse and pig ascaris Flury foundtoxic substances (volatile aldehydes of the fatty acids)which cause irritation and necrosis. A nitrogenoussubstance which after subcutaneous injection in thedog oauses death with severe haemorrhages in theintestine was also found. Dr. Crowell has observed thecase of a Filipino, aged 8 years, who was seized byvomiting, followed by pain in the chest and knees.(Edema, jaundice, melasna, haemorrhage from the gums,and ecchymoses on the face and legs soon developed.The patient became very anaemic and died at the endof six days. The necropsy revealed 150 ascarides inthe stomach and intestines, purpura haemorrhagica.

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with haemorrhage into the stomach and intestines, andepicardial, pleural, retropleural, and retroperitonealhaemorrhages. Another source of danger is the larvae ofthe ascaris. It has recently been shown by Major F. H.Stewart, I.M.S., and others that on administering theeggs of ascaris suilla to the pig, rat, mouse, or guinea-pig they hatch in the intestine, and the larvae enter theblood stream, pass through the liver and heart to thelungs, where they migrate from the capillaries into thealveoli, and thence through the bronchi and trachea tothe pharynx. During this process pneumonia may beset up. There is reason to believe that similar changesmay be produced in man by the ascaris lumbricoides.

THE MACALISTER TESTIMONIAL FUND.

THE date of the presentation of the cheque, arisingout of the generous response to the fund organised forthe purpose of marking the very exceptional services ofSir John MacAlister to the Royal Society of Medicineduring more than 33 years, has been fixed for Wednes-day, July 7th, in the Barnes Hall, at 4.30 P.M. Theceremony will be performed by the President, Sir

Humphry Rolleston, K.C.B., and will precede thebusiness of the annual meeting, which will be held at5 P.M. The fund will be finally closed on Saturday,July 3rd. The honorary treasurer is Sir W. ArbuthnotLane, 21, Cavendish-square, London, W.1.

FUEL REFORMS IN THE HOME AND FACTORY.

THE Public Information Branch of the Ministry ofHealth has published an interim report on Smoke andNoxious Vapours Abatement. The report sets out muchto which we have given publicity for a good manyyears ; we cannot, indeed, tell the story better thanby reference to our own columns. We asked in anannotation in THE LANCET of September, 1895, whetherthe Smoke Nuisance Act was properly enforced.Since asking that question much good work has beendone in regard to smoke abatement, and the CoalSmoke Abatement Society, under the aegis of Sir WilliamRichmond and Dr. H. A. Des Voeux, came into being.This has since organised an active movement under theable secretaryship of Dr. J. S. Owens, which culminatedin the formation of an Advisory Committee on Atmo-spheric Pollution to the Meteorological Office. Inthe early part of 1910 Dr. Des Voeux, the honorarysecretary of the Coal Smoke Abatement Society,and Dr. Owens consulted our Laboratory in regardto making some experiments in the direction of

estimating the contents of the London atmosphere atregular intervals over a period of a year at variousstations in the metropolitan area. A scheme waseventually formulated, and the first series of observa-tions were made on June 13th, 1910, and the reportwhich appeared in THE LANCET of Jan. 6th, 1912, on" The Sootfall of London," attracted considerableattention. In March, 1912, a conference of delegateswas held at the International Smoke AbatementExhibition at the Royal Agricultural Hall, and it was resolved that steps should be taken to securethe general adoption of a standard method for themeasurement of atmospheric pollution by smoke andthe other products of combustion and dust. A Com-mittee was appointed, our Laboratory Director beingone of them, and the methods originally adopted inTHE LANCET Laboratory were received with favourby the Committee with subsequent modifications. TheCommittee with commendable activity got into a

practical stride and was able to secure 28 observationstations throughout the country, with the result thaton Oct. 24th, 1914, we published a first series of recordsreceived from these stations in regard to the insolubleand soluble matter collected in the rain caught ina standard gauge. The results obtained have beenrecorded under the heading of

" A Monthly Record ofAtmospheric Pollution " steadily ever since in our

columns, and the work and publication continue.It is clear from this interim report of the Com-

mittee recently appointed by the Ministry of Healththat the statistics we have consistently published have

convinced public authorities of the waste of and

injury to health, fabrics, and vegetation caused bythe burning of coal in the domestic dwelling and in thefurnace of the factory. Its recommendations mighthave been made many years ago, though fresh ques-tions have now arisen in regard to new housing schemes.Broadly speaking, the Committee rules out the opencoal-fire and suggests a coke-fired boiler or gas for thedomestic service and also in grates. It regards acentral hot-water supply as practicable, but makes nofurther suggestions upon this point. It admits thatthe whole subject of hygienic and scientific heatingdeserves a very much greater measure of public atten-tion than it has hitherto received. The report is

disappointing from the view of further action, and theconclusions are not followed by recommendations. Gasfor the present seems one way out, but we must haveit cheap and with an effective thermal efficiency, whichwe pointed out years ago.

THE FEES OF MEDICAL REFEREES.

LAST week Sir Herbert Nield asked the HomeSecretary whether he would improve the scale of feesprescribed for and payable to referees and assessorsunder the Workmen’s Compensation Act, 1906. Mr.Shortt replied that the matter would be consideredwith due regard to all relevant circumstances afterthe Departmental Committee, which has been inquiringinto the working of the Act, has made its report.The relevant circumstances in question can be statedin a few words. The fees when prescribed were on alow scale, having regard to the responsibilities of thework, while the compensations payable to workmenunder the Act have considerably increased during the14 years of legislation. Further, the payments tomedical men under the National Insurance Act havebeen augmented, and one of the arguments for thisincrease is to some extent applicable to the case ofmedical referees and assessors-namely, that theincreased cost of living implies the necessity for highersalaries.

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THE ACTION OF ETHYLIC ALCOHOL ON THEORGANISM.

SOME interesting observations on this subject haverecently come to us from the University of Cordoba ;they are published by Professor V. Ducceschi in theAnrcccli d’Igiene for February. The increased consump-tion of alcoholic drinks, lately noticed in Italy, andprobably not confined to any one of the countrieswhere there are no restrictions on sale, has broughtinto prominence the question of anti-alcoholic pro-phylaxis, and has increased the interest felt withregard to the mechanism of the action of alcoholon the organism. Professor Ducceschi undertooka series of experiments on dogs in reference to

changes produced in the quantity of lipoids in theblood by alcoholic narcosis. He found the cholesterinwas almost doubled by the repeated administration ofefficacious doses of alcohol. This hypercholesteraemiawas the sequela of the state of narcosis: in fact, in twodogs in which the blood was analysed before administer-ing a large dose of alcohol, who were two hours later ina condition of profound narcosis, no appreciable changein the amount of cholesterin was noticed. It was alsofound that the daily administration of large doses ofalcohol for a period of about six weeks caused anincrease in the blood of about 50 per cent. in the fattyacids and 33 per cent. in the lecithin, and itwas further noticed that if the administration was

suspended the amount of fatty acids and lecithin wasnot materially reduced in the succeeding ssven days.Observations were also made on 120 individuals, halfof whom were abstainers and the others habitualdrunkards; in the latter Professor Ducceschi found adecided increase in the cholesterin in the blood com-pared with the former. With regard to the action ofalcohol on the tissues, it was found that in the dogsexperimented on the amount of total fats in the liverwas increased by 300 per cent. and the cholesterin bya small amount. In the suprarenal capsules there was