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they become less and less sensitive as the wave-length of the X rays is diminished, and so they failto serve even as accurate indicators of intensityonce a certain wave-length is reached. Thisis not a limiting consideration in methods basedupon the ionisation produced, say in air, by X raysof different wave-lengths. Generally speaking, wemay say that the electrical effects are proportionalto the amount of energy expended in the air by thebeam in its passage through it, and do not dependdominantly upon selective processes. This being so,if some method were devised by which the electricaleffects could be added up as time went on, then thewhole electrification could serve as a basis of X raydosage ; this has now been very largely accomplishedand we may anticipate that the electrical methodwill come more generally into radiological use fortherapeutic purposes. One of the first instrumentsconstructed with this intent and suitable for directmedical use, was the ionto-quantimeter of Szilardin 1916. Since then various modifications andimprovements have been effected, largely as a resultof the requirements of deep therapy. Upon thebasis of this type of instrument Seitz and Wintzhave founded their method of estimating the dose ofX rays reaching organs at a depth in the body ; intheir treatment of cancer of the cervix by X rays apart of the ionto-quantimeter is actually introducedinto the cervix and a measurement made of theintensity of X rays being applied. Two recentpapers, one by Schrumpf-Pierrorl in Paris Méd’icalof May 28th, the other by Iser Solomon in the Maynumber of the Journal de Radiologie et d’Electro-logie give good accounts of the general utility andpracticability of this mode of measuring the dose ofX rays under various conditions of therapy.
It is reasonable to anticipate that, when an
electrical method has received the general sanctionof approval, means will be taken to decide upon someunit of X ray energy which, while having a scientificbasis for its determination, will be selected withsome direct reference to the quantity used byradiologists in the treatment of disease. Internationalrecognition of such a unit would do much to coordinatethe dosage determinations in X ray therapythroughout the world. -
MOLLUSCUM CONJUNCTIVITIS.
ALTHOUGH it is well known that molluscumcontagiosum may attack the skin of the lids, theoccurrence of conjunctivitis due to this cause isnot generally recognised. Dr. Harold Gifford andDr. Sanford R. Gifford 1 of the Department ofOphthalmology of the University of NebraskaCollege of Medicine, state that during the last 15years they have seen about a dozen cases, six ofwhich they describe in detail, in which persistentirritation of the conjunctiva has been kept up byone or two molluscum nodules at the edge of the lids.In none of the cases was there any other evidenceof the disease in the uncovered portions of the body,and the patients did not know of any other nodules ofthe sort, but they were not stripped for examination.In some of the cases quite a marked conjunctivitisof the follicular type was set up, with thickening ofthe folds, and in one case there was ulceration of thecornea. The mode in which the nodules cause con-junctivitis is hard to determine. That it is notextension of the inflammation from the skin is shownby the usual absence of such inflammation about thenodule on the skin itself. The purely mechanicalirritation of the nodule would appear to be almostnegligible in the cases in which it is not situated onthe lid border but back among the eyelashes. Thewriters suggest that itching causes the nodules tobe rubbed and that in this way some irritatingsecretion is carried into the sac which sets up theconjunctivitis. Treatment consisted in incising thenodules in typical cases and thoroughly expressingtheir contents with a ring forceps. In three cases in
1 Archives of Ophthalmology, May, 1921.
which the characteristic central umbilication wasnot apparent, and there were no other typical lesionspresent, the nodules were removed and found to bedefinitely molluscous. Though the symptoms wereusually relieved quite promptly, in some cases
changes were set up in the conjunctiva, whichpersisted for some time after removal of the irritatingagent. _____
INDUSTRY AND CONTENTMENT.
ECONOMISTS, political and otherwise, sociologists,and psychologists are ever ready to reconstruct theState, but the social aspects of medical work areseldom appreciated even by our own profession.For the most part these self-appointed lay physiciansforget that the health of the State is made up of thehealth of its constituent members and that no Statecan be healthy or think healthily unless its membersare healthy. Only in one branch of medicine is theresome inkling of this fundamental fact-namely, inindustrial hygiene. A contribution to knowledge onthe subject is contained in the latest report of theIndustrial Fatigue Research Board,1 which dealswith labour turnover, a delicate barometer ofindustrial contentment or -of unrest. This reportshould be read in conjunction with an earlier onewritten by Dr. M. Greenwood and issued 2 by theMedical Research Council before the Board was inexistence. The- findings, which deal with more
ample data, are in close agreement with those of theprevious investigations ; they are mainly based onrecords compiled during war time at national factories,but data gathered from peace-time factories are alsolaid under contribution. The authors, Miss Broughtonand Miss Newbold, point out the loss to a factoryof a high rate of leaving among beginners due to thefact that on the simplest of operations workers donot reach a reasonable rate of output under sixweeks, while for moderately simple repetition workthree months is required. They are able to showthat labour turnover is highest in these early weeksand months ; curves showing the rate of leavingdistributed according to length of employmentresemble in an exaggerated form the curve of infantmortality-indeed, Greenwood has aptly called labourturnover the infant mortality of industry. Themedical aspect of this important social economicquestion becomes manifest when the connexionbetween labour turnover and sickness is investigated ;here the authors found that those who left withless than three months’ service had suffered a muchhigher rate of sickness than those who stayed longer,that those who stayed for three months but lessthan six had suffered throughout their period ofemployment more sickness than those who stayedlonger, and similarly that those who stayed sixmonths but less than nine had suffered more through-out than those who still remained in service. Ill-health and physical incapacity were only given asthe reason for leaving by some 10 per cent. in wartime and by 3-7 per cent. in peace time, but theabove investigation showed that even though hardlyappreciated by the workers, ill-being lay at the backof much labour wastage.Most of the records used refer to female employ-
ment, and somewhat unexpected results emerge ;thus domestic servants, shop assistants, and laundryworkers stayed longer than workers from munitionsand other factories. Apparently factory work hasa definite .adverse influence on the power of workersto withstand the strain a second time. Comparisonis made between the rates of labour turnover whichprevailed before, during, and after the war ; forsingle women the average three-monthly rates of
leaving were found to be 25-2 per cent., 27-8 per cent.,
1 A Statistical Study of Labour Turnover in Munitions andother Factories, by Miss G. M. Broughton and Miss E. M.Newbold. Report No. 13. Industrial Fatigue Research Board.1921. Pp. 92. H.M. Stationery Office. 3s.
2 A Report on the Causes of Wastage of Labour in MunitionsFactories employing Women, by Dr. M. Greenwood. SpecialReport Series No. 16. Medical Research Council. 1918.
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and 18-8 per cent. respectively for the three periods.The rate of loss during the first three months wasspecially heavy, amounting to 45-3 per cent., 39-6per cent., and 22-0 per cent. in the three periods.The post-war period was favourably influenced so
far as leaving is concerned by the fear of loss of workdue to men returning from the colours and fillingup vacancies. Some estimate can be made of whatthese rates of leaving mean from the fact that " in thepre-war and post-war periods respectively, the numberof survivors after 12 months from 1000 entrants in abiscuit factory were 322 and 441 respectively." Greatdifferences were found at different factories, the rateof loss at the end of the first three months varyingfrom 89-2 per cent. to 37-5 per cent., but the influencescausing these variations could not be accuratelydetermined. Nevertheless the authors state thatat the factory with the lowest labour turnover theconditions were good and the work light; whileat one of the worst the high turnover was consideredto be " due undoubtedly to the arduous conditions,and in a large measure owing to night-shift working,the ordinary disadvantages as to broken rest beingaggravated by the shops being built of corrugatediron with consequent extremes of temperature."
Great care is exercised throughout this excellentreport in refraining from drawing any but fullysubstantiated deductions ; hence even more thanusual reliance can be placed on the following con-clusions :-
(a) The high leaving-rate that is evident in the earlymonths of service is not confined to munitions factoriesnor to the war period, but is also to be found in factoriesengaged in peace-time industries, and is a source of economicloss at the present time.
(b) Married women are evidently a more fluctuatingpopulation than single women.
(e) The data relating to previous occupations are alsotoo scanty to justify drawing general conclusions, butthey indicate that former factory or munition workers aremore unstable than those drawn from other sources.
(d) The loss for possibly avoidable reasons, such as ill-health, incompetence, and dissatisfaction, is very large.
The authors justly consider a case made forperiodical consideration by employers of the state oflabour turnover in their factories ; and in order toassist the work, give in an appendix specimen formsfor keeping records, and a simple exposition of theway in which they can be used. Special attentionmay be directed to the excellent form of medicalcertificate suggested in which the system of the bodyaffected (rather than an exact diagnosis) is all that isasked for, as, indeed, it is all that could ever be usefullyemployed for statistical grouping. We agree withthe Fatigue Board, who claim that the attempt madein this report to measure labour wastage upon auniform system, essentially similar to that adoptedin the valuation of the liabilities of life insuranceoffices, deserves consideration " ; and we con-
gratulate them and the authors on having in thisreport added something to knowledge.
THREADWORMS AND APPENDICITIS.
VARIOUS workers have ascribed a share in causinginflammation of the appendix to threadworms.Prof. L. Aschoff,l of Freiburg i.B., opposes theview advocated by Rheindorf that oxyuris beara frequent aetiological relation to acute appendicitis.Aschoff holds that appendicitis begins nearly alwaysas an acute disease in a previously healthy appendix,passing after imperfect healing into a chronic com-plaint. The earliest lesion is commonly found in thedeeper folds of the distal part of the appendix, andmechanical causes, by leading to undue delay ofbacterium-infected material in contact with themucous membrane, favour disease ; but direct injuryof the mucous membrane by foreign bodies or
parasites is uncommon. Worms may give rise to
pseudo-appendicitis or appendicopathia oxyurica-
1 Berl. klin. Wochenschr., November, 1920, p. 1041.
that is, a condition simulating appendicitis butwithout pyrexia or much quickening of the pulse-rate. They are found in healthy appendices moreoften than in diseased ones. Gmelin found that19 per cent.. of 300 patients in a field hospital wereinfected with oxyuris, and 19 ’per cent. withtrichocephalus. Forty-four per cent. in all carriedthe eggs of some worm. Among these patients 18cases of appendicitis occurred, of which only five-that is, less than a third-were in the worm-infested.Encapsuled threadworms may occasionally be seenin the appendical wall ; but the histological appear-ances described by Rheindorf of channels in themucous membrane made by worms boring into itand other epithelial defects are caused by thedehydration and other procedures connected withthe preparation for the microscope. Such epithelialdefects are found in sections of all appendices, healthyor diseased, made by the usual methods. If wormsare present further artificial defects are caused bythe pressing of their chitinous coats into theepithelium when cutting. Such appearances are notseen if the tissue is protected from shrinking byembedding and cutting in celloidin or gelatin.Further, a superficial catarrhal inflammation mustnot be assumed to be present unless there ismigration of cells. Aschoff supports his thesis bystatistical and histological detail, and with some
warmth. He has laid his material, including sectionsembedded in various ways, before a medical congressand challenges his .opponent to do the same.
THE INDIARUBBER-BALL COUGH SOUND.
WITH a thoroughness which is characteristic ofthe medical school of Upsala, Dr. G. Bergmarkl hasrecently investigated the conditions under whichthe indiarubber-ball cough sound arises. Thusnamed by Dr. J. Mitchell Bruce, this post-tussicsuction sound has been interpreted by some authori-ties as a sign of a cavity, on the assumption that it isgenerated by the elastic recoil of the wall of a cavity.Dr. Bergmark found this sign in 20 out of 39 casesin which the diagnosis of cavitation was confirmedby a necropsy. He failed to find it once among the40 young and healthy persons whose chests heexamined for it. In 35 cases of acute bronchitis,and in 52 of chronic bronchitis, he failed to findthis sign, although in 18 cases the bronchitis wascomplicated by emphysema. The 12 cases of-bronchial asthma examined for this sign, failed toshow it. It was also negative in every case but oneout of 42 in which the diagnosis of bronchial glandtuberculosis had been made by the X rays. InTurban’s first stage of pulmonary tuberculosis itwas never found, and only in 3 of 36 cases in
.
the second stage was it demonstrable, whereas itwas found in as many as 56 out of 130 cases in thethird stage. Of a series of 25 cases of pulmonarytuberculosis associated with bronchophony or coarserales, the sign was found in 16. In another seriesof 25 cases, in which the sign was positive, 20exhibited bronchophony or coarse rales. Withregard to the post-mortem examinations, no corre-
lation could be established between the size anddistribution of cavities on the one hand and thepresence of this sign on the other ; in two cases
in which there had been a suggestion of the india-rubber-ball sound, the necropsy showed no sign ofa cavity on the same side. But as there were cavitieson the opposite side, this sound may have beenconducted from one lung to the other. In viewof the possibility that infiltration of the lung withoutcavitation might give rise to this sign, Dr. Bergmarksought it in 47 cases of croupous pneumonia, butfound it only in one in which the pneumonia wascomplicated by pleurisy. In another series of 77cases of broncho-pneumonia, he found the sign onlyin one case, and here again it was complicated bypleurisy. Thus, it appears that infiltration alone
1 Upsala Läkareforenings Förhandlingar, Feb. 1st, 1921.
