notifiable. In 4 of these cases (2 fatal) tumours of the bladder led to notification, the remaining 60 being typical cases of anilism occurring in the following occupations : Making intermediates (D.N.B., D.N.T., T.N.T.) Paranitraniline powder .. Paratoluidine Anilin black dyeing 17 1433634 Thirty of the 60 cases occurred in the period May to August, as compared with 30 in the remaining 8 months, showing to some extent the effect of hot weather on the incidence of poisoning. It was found that one firm, recognizing this additional risk, had given up as far as possible the manufacture of intermediates in these months. At another firm work on paranitraniline and intermediates is done, as far as possible, first thing in the morning or late in the evening. The duration of employment of the persons affected would appear to be much less than in most industries, thus showing that there must be a considerable turnover, no doubt due to the risk attaching to the work. At the three largest works where these intermediates are manufactured, excellent arrangements in regard to canteens, cloakrooms and lavatories are provided. In one there is also a medical man employed practically whole time; in others there is medical supervision, but not on such an extensive scale. Toxic Jaundice.-Under this heading is included jaundice produced by arseniuretted hydrogen gas, from which one case occurred in the manufacture of salts of zinc. This gas has been the most common cause of this form of poisoning for some years, a not surprising fact seeing the extremely small dose that may prove toxic. The other non-fatal case occurred in the manufacture of explosives with trinitrotoluene (T.N.T.). Gastric disturbances followed by slight jaundice were the symptoms exhibited in this case. Anthrax. Of the 38 cases of anthrax with 3 deaths reported during the year, 15 (2 fatal) were due to wool, 8 (1 fatal) to horsehair, 12 to hides and skins, and 3 occurred in other industries. Dr. Eurich examined 176 samples of wool and hair in connexion with cases of anthrax, from 20 of which anthrax was cultivated. Horsehair.-Effective disinfection of the kinds of horsehair specified under the Regulations has always been a matter of difficulty. It cannot be too strongly emphasized that only by strict attention to detail in the actual process of disinfection, especially when a chemical disinfectant is used, can disinfection be secured. Large bundles should be opened out so that the disinfectant can penetrate to all parts of the hair, and complete immersion in the disinfecting fluid maintained for the prescribed length of time, and at the concentration and temperature mentioned in the certificate. Failure to effect disinfection is brought out by the following facts. During the 5 years 1922-1926 14 cases of anthrax due to Russian or Siberian horsehair, and 9 cases due to Chinese horsehair were reported from works under the Regulations. Disinfection of the Russian or Siberian hair was in all cases carried out in England by a chemical disinfectant, and anthrax was cultivated from samples taken in connection with 4 of the cases. The disinfection of the Chinese horsehair in 3 cases was carried out in China, either by steam or by a chemical disinfectant, and from material taken in connexion with 2 of these cases anthrax was subsequently cultivated. In 4 cases disinfection was carried out in this country by a chemical disinfectant recognised under the Regulations, and anthrax was cultivated from material taken in connexion with 2 of the cases. In one case the process of disinfection adopted was not accepted under the regulations, and in the remaining case no disinfection was carried out. Hides and Skins.-Sir Thomas Legge, the late Senior Medical Inspector of Factories, continued his inquiry into the necessity (if any) for an amendment of the existing regulations which might apply to all tanyards irrespective of the nature of the hides and skins handled. During the years 1922–1926 inclusive 8 cases of anthrax were reported, with one fatality, from works which were not subject to regulations. Other Industries.-A young person employed in a factory dealing with feathers was affected by anthrax, but the source of the infection could not be traced. Chrome Ulceration.-Fifty-five cases of chrome ulceration were reported from the following industries:-Bichromate manufacture, 2; dyeing and finishing, 33; chrome tanning, 2; french polishing, 7; manufacture of chrome dyes, 5; other industries, 6. The importance of slight injuries as the initial cause of chrome ulceration, and the severe effects which may follow, are very clearly shown in the following case. The person affected was a young man of 17 years of age. A slight burn was caused. while lighting a cigarette. He continued working for five days without treatment, and eventually the top of the finger became gangrenous, necessitating its removal. A series of cases investigated by Dr. Henry occurred in the manufacture of chrome dyes. Out of 13 workers examined, he found that the skin was, or had been, seriously affected in 10. Changes in the mucous membrane of the nose were observed in 11. He found also that 3 of the men were working with abrasions of the skin. With one exception, the skin of the arms and hands was affected, and in one case the little toe and the heel also showed ulceration. A periodic medical examination of the workers' hands and a daily examination by the foreman, with improvements in the facilities for first aid, were the recommendations suggested by Dr. Henry and adopted by the firm. No further cases have been reported. It is not always the persons actually employed in the particular manufacture who may become affected by the chrome. Thus, for example, at a large manufacturing works the case of a fitter employed by a contractor in repairing the plant, who came in contact with material saturated with chrome, was reported. The importance of casual workers such as these being included in the precautions provided under the Regulations is thus emphasised. Epitheliomatous Ulceration.-187 cases of epitheliomatous ulceration were reported of which 49 were fatal; 49 cases were due to pitch, 27 to tar, 2 to paraffin, while the remainder-109, were due to oil, among which there were 35 deaths. The table below gives the number of cases notified since 1920, when epitheliomatous ulceration due to tar, pitch, mineral oil or paraffin, or any compound product or residue of any of these substances, contracted in a factory or workshop, was added to the diseases notifiable under Section 73 of the Factory and Workshop Act. It is important to point out that the 49 deaths have not all occurred among persons who contracted the disease during this year. The disease is a slowly progressive one, and several years may elapse between the onset and the fatal termination. The slow progress of this disease, fortunately, offers an opportunity of minimising the mortality by early treatment, and to this end periodic medical examination is of the greatest importance. A striking instance of the value of periodic medical examination is given by Dr. Body, Certifying Surgeon for Middlesbrough, who reports that in 220 examinations of pitch workers, he found 11 cases of epitheliomatous ulceration of the scrotum. All of these cases were recommended to receive treatment, which was subsequently carried out. While, however, this is so, substitutes for these harmful bodies must be sought for if future immunity from this disease is to be assured. In other directions, measures for prevention are to be commended. One large firm, where a case of epithelioma occurred among their mule spinners, immediately installed a bath for all workers similarly employed. Dr. Henry has collected information regarding 670 cases of epitheliomatous ulceration occurring among cotton mule spinners, the geographical distribution being similar to that stated in previous years. During 1926 there were 88 cases of mule spinners notified-78 (88.6 per cent.) in cotton mule spinners and 10 (11.4 per cent.) in spinners who had retired or passed into other occupations. Of the 88 cases, the growth was on the scrotum in 61 (69.3 per cent.); on the upper limb in 13 (14.8 per cent.); on the head and neck in 6 (6-8 per cent.); on the lower limb in 5 (5.7 per cent.); and on other sites in 3 (3.4 per cent.). In 1911 there were 33 deaths from scrotal epithelioma in England and Wales, and of these 3 (9 per cent.) occurred in mule spinners; while in 1925 there were 59 deaths from the same disease, and of these 18 (30.5 per cent.) occurred in spinners and ex-spinners; though the highest percentage yet recorded was in 1924, when of a total of 67 deaths, 27 (40.3 per cent.) occurred in spinners and ex-spinners. An estimation of the duration of incapacity caused by the disease, and based on the number of spinners, viz. :-84, known to be off work suffering from the disease during all or any part of the period between January 1st and December 31st, 1925, shows an average of 17.8 weeks for each patient. Of these 84, 15 (17.9 per cent.) died during the period-12 of the disease and 3 from other causes during their incapacity:-Pneumonia 1; accidental burns 1; primary cancer of the larynx 1. Dermatitis.-There are, I believe, few liquids employed in industry which will not, if used day after day over a long enough period, produce dermatitis in certain individuals. The same is more or less true in respect of dust. Consequently, it is often very difficult to determine the actual causative agent in any particular case, especially in chemical and dye works where many materials are handled. Many firms now report voluntarily cases of dermatitis, and this probably accounts for the increase of cases recorded during the past three years, 305 cases in 1924, 335 in 1925 and 429 in 1926. Special inquiries were made as to the occurrence of dermatitis among (1) bakers and flour confectioners, (2) biscuit makers, (3) alkali workers, and (4) indoor horticultural workers; while information has been collected as to the influence of various grades of turpentine and turpentine substitute in the causation of dermatitis. Among the 429 cases of dermatitis, 49 (11.4 per cent.) occurred among bakers and flour confectioners and 12 among biscuit workers. Dr. Overton made special inquiry into the extent and causation of this condition in these trades. Out of 422 bakers and confectioners examined, she found that 12 (9 bakers) were suffering from dermatitis, and 7 of these cases were moderately severe. There seems, Dr. Overton reports, to be a definite relation between the hand kneading of dough and the occurrence of dermatitis. Of the 9 bakers suffering from this condition, three only were in bakehouses equipped with dough mixers, and these 3 cases were slight; while the remaining 6 worked in bakehouses where hand kneading of dough was the practice. Four of these were, or had been, of a severe type. At the present state of knowledge, dermatitis among bakers may be said to be the reaction of the skin to the presence on it of dough, which is hygroscopic. Sweating may be, and probably is, an important factor. After work, delicate portions of the epidermis are removed with the hardened dough, and with them the vital integrity of the protective mechanism of the skin is lost. Individual epidermal susceptibility is of importance, and so, too, is the "skin history" of the worker. In the preservation of the normal protective horny layer of the epidermis without excessive sweating or pathological dryness of the skin, lies the prevention of dermatitis among bakers and confectioners. In the manufacture of biscuits, Dr. Overton found that dermatitis in the bakehouse was practically unknown, probably because the baking and making of biscuits is done almost entirely by machinery, and dough, flour, and sugar are handled to a minimum extent. Dermatitis, on the other hand, occurs to a fairly considerable extent in the processes of icing, creaming and filling of biscuits and wafers. The flavouring agents were blamed for this occurrence, but subsequent inquiry at the source of most of the flavouring agents and essences used in the biscuit trade has proved that this was most unlikely. Sugar and friction are, Dr. Overton considers, the cause of the dermatitis in the creaming and icing departments. Twenty-eight cases of dermatitis were found during this inquiry, 22 in "creaming and icing" departments and 6 amongst packers. The inquiry which Dr. Overton made has led to the framing of a Welfare Order, both for the baking and confectionery trades, and for the manufacture of biscuits. Dr. Henry, in reporting on the prevalence of dermatitis in a large alkali works, states :-" If we confine the term ' dermatitis ' to an irritant rash over an area of the skin, as apart from localised ulceration, then the evidence of the presence of the former at this factory is certainly small, while the latter is undoubtedly present in the Sodium Carbonate Department, and especially in the Caustic Soda Department (13.3 per cent. localised ulceration, 20 per cent. scars of previous ulceration), but not in so severe a form as I have sometimes seen it elsewhere. The boys and others working in caustic soda wear gloves and use sodium carbonate as an antidote." Of the reported cases of dermatitis 52 (12.1 per cent.) were due to alkalies. These cases embrace many occupations including dyers (with calico bleachers and printers), chemical workers, and French polishers, and the numbers are not merely indicative of conditions in alkali works; in fact, in 1926 no case of dermatitis from alkali works was reported. Nevertheless, it seems that "soda holes " which must be regarded as a form of dermatitis, are of frequent occurrence in the manufacture of caustic soda. The use of alkalies as cleansing agents in industry leads to many cases of dermatitis. Certain alkaline solutions |