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film of particles on the glass. Similar deposits canbe made in a neutral gas and the gas may be exchangedfor a liquid, as in the case of the submerged arcwhere the liquid around the arc is converted to gas.The production of disperse systems in liquids andsolids usually involves a chemical reaction such asreduction, oxidation, or double decomposition. Here

again we can have as alternatives volume condensa-tion and surface condensation. Photograph reactionsare generally volume condensa,tions ; surface condensa-tion takes place between two reacting solutions attheir surface only. Prof. Svedberg deals with thevarious experimental details which have been usedto elucidate the processes. Many of these, forinstance, the formation of spray, smoke, and volcanicdust, are of great practical importance.

THE DIAGNOSIS OF FOREIGN BODIES IN

THE AIR- AND FOOD-PASSAGES.

IT is within the experience of every laryngologist Ithat foreign bodies may pass through the larynxwith the production of the most trifling symptomswhich may readily be overlooked in children, andeven in adults. Foreign bodies, especially if of a non-absorbent character, may remain even in the lung fora long time without producing- symptoms, andDr. C. H. Carroll’s interesting case recorded inTHE LANCET of June 18th shows how the prac-titioner must not be put off his guard by theabsence of history of swallowing anything unusual.Sooner or later, however, symptoms arise, but thecircumstances which might suggest the aspirationof a foreign body have by that time been forgottenby the patient, and many cases have been treatedfor such affections as chronic bronchitis, bronchiectasis,or pulmonary tuberculosis for prolonged periodsin some of whom the correct diagnosis has only beendisclosed by post-mortem examination. A correctknowledge of the symptomatology of foreign bodiesin these regions is obviously, therefore, of the highestimportance, but the relative rarity of the cases in theexperience of any one observer has made systematicstudy a matter of great difficulty. Dr. ChevalierJackson has recently published such a study basedon 789 cases from the Bronchoscopic Clinic of theJefferson Medical College of Philadelphia. 1 Helays stress on the diagnostic value of a history ofinitial laryngeal spasm, but states that a foreignbody may pass right through -the larynx into a

bronchus without producing any laryngeal distur-bance. If sudden death does not occur, the initialspasm passes, and a certain degree of tolerationis established ; but foreign bodies do not oftenremain latent in the larynx for any considerable time,for reactionary swelling usually produces enoughdyspnoea to call for examination. In the tracheaforeign bodies are usually movable, and their move-ments can be felt by the patient, while the vibrationsmay be palpated or heard with the stethoscope.Cough is apt to be paroxysmal and very severe,and a sudden shutting off of the expiratory blastand of phonation during paroxysmal cough is almostpathognomonic of a movable tracheal foreign body ;there is usually dyspncea due partly to the bulk ofthe foreign body and partly to traumatic subglotticoedema. Jackson describes an " asthmatoid wheeze,"heard at the open mouth, not at the chest wall, incases of tracheal and bronchial foreign body ; in

the former it is usually louder and lower in pitch.Pain is uncommon, but may occur and be accuratelylocalised by the patient.

It is in the bronchi that foreign bodies are mostlikely to remain latent for long periods. There isoften a protracted, delusive, symptomless interval,and the time of inhalation may be unknown or

forgotten. Cough and purulent expectoration ulti-mately result; periodic attacks of fever, with chillsand sweats, and followed by increased coughing1 American Journal of the Medical Sciences, May, 1921, p. 625

and the expulsion of a large amount of purulent,more or less foul material are so nearly diagnosticof foreign body as to call for exclusion of this proba-bility with the utmost care. All the symptoms oftuberculosis, emaciation, clubbing of the fingersand toes, night-sweats, and haemoptysis are inmost cases simulated with exactitude, even to thegain in weight by an outdoor regimen. But tuberclebacilli have never been found at the clinic in associa-tion with bronchial foreign bodies, which thereforedo not cause, but only imitate, pulmonary tuber-culosis. The distinctive taste of metallic or organicbodies may be noticeable to the patient, and offensivesputum should always suggest a foreign body.Sudden complete obstruction of one main bronchusdoes not cause noticeable dyspnoea, provided that itsfellow is functioning ; but complete obstruction ofa bronchus is followed by rapid onset of symptoms.The physical signs usually show limitation of expan-sion on the affected side, impairment of percussion,and lessened transmission of breath sounds : signswhich may lead to an erroneous diagnosis of empyema.In cases of non-opaque foreign body, radiographicexamination is still of great value ; the signs are

those of an acute unilateral obstructive emphysema,and include increased transparency on the obstructedside, displacement of the heart to the uninvaded side,and downward displacement of the diaphragm withmarked limitation of its movements on the obstructedside. Organic foreign bodies, such as nut-kernels,and especially pea-nuts, cause a severe generaltoxaemia and local reaction, which is more marked inyoung children and may be fatal -within 24 hours ;to this affection Jackson has given the name" arachidic bronchitis." He strongly advises thatall cases of chronic chest disease should have thebenefit of a radiographic study to exclude bronchialforeign body, that negative opinions should neverbe based on any but the best plates, and that eventhen there will occasionally be need for diagnosticbronchoscopy. In the oesophagus, foreign bodiesare more easily diagnosed ; -lateral and antero-posterior radiographic plates should be taken, and,when the body is not " radiopaque," screen

examination of the deglutition of a barium mixture,or barium capsule, is of great value.We would recommend the study of this careful

and thorough monograph, not only to laryngologists,but, and more especially, to general physicians andpractitioners ; for if. in obscure cases of pulmonarydisease, the possibility of foreign body is regularlyborne in mind, the errors of diagnosis described byDr. Chevalier Jackson will less frequently occur.

TRANSMISSION OF THE ENCEPHALITIS

LETHARGICA VIRUS.

IN a recent communication, Levaditi, Harvier, andNicolau demonstrated that the virus of encephal-itis lethargica is transmissible from the motherto the foetus, in the case of rabbits. A pregnantrabbit was inoculated with the virus and died 11days later. The brain showed characteristic histo-logical changes, while the brain of the foetusexamined appeared normal, but a portion of thelatter injected into a healthy rabbit produced a

typical encephalitic infection. The above obser-vation confirms the view that the virus of encephalitislethargica can be present without producing anygross histological change, as McIntosh and Turnbullfound in the Derby epidemic. In addition it provesthat the virus can pass through the placenta andinfect the foetus, thus lending considerable supportto the idea that in a certain number of these cases ofencephalitis in young infants the infection is congenitalin origin. The work may thus have a bearing onthe treatment of cases of pregnant women sufferingfrom encephalitis lethargica. When the infants are

1 C. Levaditi, P. Harvier, and S. Nicolau: Compt. rend. Soc.de Biol., 1921, lxxxiv., 957.

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born alive and subsequently develop symptoms ofthe disease, infection from the maternal nasalsecretions or through the milk cannot always beexcluded, but the experimental findings of MM.Levaditi, Harvier, and Nicolau suggest that trans-mission in utero is at least a possibility.

INDUSTRIAL DERMATITIS.

SKIN eruptions among industrial workers are offrequent occurrence and come under the observationof busy practitioners almost daily. The extent towhich they prevail may be judged from an estimatemade in one industry only that approximately 25 percent. of all machinists exposed to oils are or have beenaffected with dermatitis.1 The inclusion of dermatitisand ulceration of the skin produced by dust or liquidsin the schedule of diseases for which compensationmust he paid under the Workmen’s CompensationAct, 1906, gives a further and legal significance to thisgroup of affections. Hence, the publication inAmerica of three important papers based on consider-able research into the causation of skin affectionsamong workers exposed to oils cannot fail to be ofinterest. The conclusions arrived at by the differentworkers are not dissimilar.The subject has previously received attention from

our own medical inspectors of factories and one of theirinvestigations (the importance of which seems to haveescaped the attention of the American investigators)throws particular light upon the whole matter, becausethe peccant material-pure olive oil-was unadulter-ated by anything else.2 The observer, Dr. E. L. Collis,concluded that the trouble was caused by the oildissolving the natural fats, palmitin and stearin,from the skin which then becomes dry ; cracks followthrough which microbic invasion occurs, setting updermatitis. Here is presented the first simple stage inthe process. McConnell, in reporting upon an investi-gation among printers,3 after placing on one side allpossible influences such as health, physique, familyhistory, or exposure to infection, remarks that " onesignificant fact was very prominent: all persons suffer-ing with dermatosis were found to have dry skin-that is, skin either partially or wholly devoid ofnatural oiliness ; whereas those persons withouteruptions have oily skin. This dryness of the skin isthe only differentiating factor found to exist with anydegree of constancy among the men so affected."When the oil, as in the case of cutting oil in engineer-

ing shops, is mixed with fine metal chips, these chipsby causing small punctures facilitate the introduction Iof microbes.4 When, as in the case of printers,3 thereis exposure to inks containing " driers " and to a fatsolvent like benzol, the dyes in the ink aid in damagingthe dry skin and retard healing. When dirt and oilblock the small glands at the root of the hairs,folliculitis, somewhat different in causation, maycomplicate the case.5 The degree of natural oilinessin the skin of different individuals varies considerably,and where it is most pronounced the tendency todermatitis is least. Careful bacteriological investiga-tion has failed to incriminate the oil as the necessarycarrier of infection, even though it may act in this way;indeed, certain paraffin oils, produced in the processof pressing paraffin wax, encourage bacteria breeding, 4but the bacteria have no power for evil until theyhave secured ingress to the skin.

1 Annual Report of Surgeon-General of Public Health Servicesof the United States for the year 1920, pp. 35. Washington.

2 Collis, E. L.: Dermatitis in Tobacco Workers, AnnualReport of Chief Inspector of Factories, 1910.

3 McConnell, W. J. : Industrial Dermatitis among Printers.Public Health Reports, vol. xxxvi., No. 18, May, 1921.Washington.

4 Causes of Skin Sores and Boils among Metal Workers.An Investigation by the Houghton Research Staff. E. F.Houghton & Co., Philadelphia, 1920.

5 Bridge, J. C.: Memorandum on Cutting Lubricants andCooling Liquids, and on Skin Diseases produced by Lubricants.Dept. Scient. and Indust. Research, Bull. 2, London, 1918, pp. 8

6 Page, C. G., and Bushnell, L. D.: Oil Folliculitis, Journ.Industr. Hygiene, June, 1921.

The position may be briefly summarised as follows :(1) Oils of all types and other fat solvent fluids areliable, if they come in contact with skin for sometime, to produce dermatitis ; the underlying cause isdesiccation with subsequent cracking of the skin.(2) The exact form of dermatitis which results dependson the infective organism or organisms which obtainaccess. (3) The organisms are not usually present inthe oil, but exist on the human body ; therefore thedirtier the skin the more readily is it infected. (4) Pre-vention depends first upon cleanliness, and secondlyupon restoring the dissolved fat by anointing the skinwith such a mixture as equal parts of lanolin and castoroil. (5) Treatment consists in removal from exposureand entire rest to the affected skin by covering it witha flexible paint, such as is used in treating burns.

AN ACQUISITIVE SOCIETY.STRAWS show the way wind blows ; at present

there is a movement in the wind of popular thoughtin regard to social reorganisation. Whether thismovement will prove to be stimulating to the healthof the body politic or not, the medical profession,which is so intimately associated in its work withthe whole community, cannot afford to disregard anyindications. A new book,1 by Mr. R. H. Tawney, isperhaps part of the wind rather than a straw pointingits direction. Its author has previously publishedhis main thesis in a pamphlet " The Sickness of anAcquisitive Society," but in his present volume hesets forth his case more completely. Briefly, thecontention is that property should always carry withit responsibility, and that property which carries noresponsibility is a drag on the wheels of social progress.He gives the term Acquisitive Society to a communitywhich acquires property and, neglecting all duties,merely asks

"

May I not do what I like with my own ? "

Among such property, called Functionless Property,are grouped mining royalties, ground rents, and sharesin limited companies ; rewards here are divorcedfrom services ; a class of pensioners upon industry iscreated ; and in consequence those who labour, butwho do not by their labour command their fullreward-that is, the great majority of mankind-aredegraded. Acquisitive Society reverences the pos-session of wealth ; a Functional Society would honour,even in the person of the humblest and most laboriouscraftsman, the arts of creation, and would fix theidea of function as a principle, upon which all

remuneration should be based. The reader will perusewith interest the methods by which Mr. Tawneyproposes to reconstruct industry and commerce.

He seeks to convert industries into professions,which always recognise the relation between pay-ment and effective service; to this end he sees

promise in movements like that of the Guildof Builders which eliminates dividends, providesfor all men " on the strength" when work isslack, and supersedes profit-making employers.He advocates a fixed rate of interest on industrialcapital, instead of unlimited profits with limitedliability, as a first step towards lightening thestrangle-hold of capital upon labour. Only faintpraise is given to nationalisation, as that term isusually understood.The chapter dealing with the brain-worker and the

growth of an intellectual proletariat is one of greatinterest. Under the organisation of industry advo-cated, the brain-worker might be expected to comeinto his own. The medical sociologist cannot fail tobe deeply interested in the cogent arguments putforward ; but he will find no appreciation given tothe tenet that every community possesses the socialorganisation it deserves, an organisation whichrepresents its capacity for healthy thought. He willfind himself then wondering whether a healthy natioa

1 The Acquisitive Society. By R. H. Tawney. LondonG. Bell and Sons, Ltd. 1921. Pp. 242. Price 4s. 6d.