INTERNATIONAL CONGRESS ON INDUSTRIAL HEALTH.

1408 be instructed, it is most important that their time shall not be wasted; accordingly the first class are given two correspondence courses through two winters, with a short basic course of practical work in the summer. The first winter’s course deals with the eye and ear, the heart, and neuropsychiatry ; the second course develops these subjects further and takes the student over Air Service administration, all this by correspondence, but everything is gone over again, practically, in the summer basic course. It is felt that the reserve officer will now be a better practitioner than before, and, if he passes the examination after the first year, he will be allowed to make the physical examination for flying, and having passed after the second course will be rated flight-surgeon. Selected officers will have a six weeks’ training at the Aviation School. Those who succeed will be qualified as examiners. The third class are research workers, physiologists, eye specialists, and the like, who will be called to act as instructors in the school. It is hoped that " by the time of another emergency " America would have flight-surgeons, physical examining units. and specialists ready to step in and aid in the rapid expansion of the Air Service. In a third article Colonel G. M. Blech, one of the founders of the Medical Officers’ Reserve Corps, explains to young members,

already highly educated doctors, why they should interest themselves in learning something of tactics, how much more useful that knowledge will make them in battle, and how easily the necessary knowledge may be acquired. preparedness.

The whole number is full of the need for ____

INTERNATIONAL CONGRESS ON INDUSTRIAL HEALTH. A GROUP of Swiss medical men interested in industrial health questions met at Berne last October and constituted themselves as the Swiss Organising Committee for an International Congress on Industrial Health to be held at Geneva from July 18th-20th, 1924. The committee consists of Prof. W. von Gonzenbach (Zurich), Prof. W. Silberschmidt (Zurich), Prof. H. Zangger (Zurich), Dr. A. Rossi (Lugano), Dr. H. Carriere, Director of the Public Health Service, and Prof. H. Cristiani (Geneva), the last named being chairman. This first congress will deal with the following questions : industrial lighting andeyestrain ; impure air in factories ; the value of fatigue tests. The committee has asked prominent men of science who have given special attention to these questions to draw up reports on them, and three such reports will be presented for each question. The office of the committee is at the Institut d’Hygiene of the University of Geneva, and all persons wishing to take part in the congress should communicate with the committee at that address, from which further information may be obtained.

ACTINOMYCOSIS OF THE HEAD AND NECK. IN a recent communication to the Pacific Northwest Medical Association, Dr. Gordon B. New and Dr. Fred A. Figi,l of the Section on Laryngology, Oral and Plastic Surgery of the Mayo Clinic, illustrated the frequency with which actinomycosis of the head and neck escapes recognition. They gave the following statistics. During the decennium 1913-22 inclusive 157 patients with actinomycosis were examined at the Mayo Clinic. In 107, or 68’1 per cent., the disease involved the head and neck, but only seven of these patients were being treated for actinomycosis at the time of their admission to the clinic. The disease is much commoner in males than in females, 98 of the 107 cases being in males. The ages ranged from 9 to 66 years, but the majority of the patients were in early adult life. As regards the method of infection, 45 out of 80 patients, or 56’1 per cent. from whom information could be obtained, stated that they had not come into contact with the 1 Surgery, Gynecology,

and

Obstetrics, November, 1923.

disease in animals.

The

remaining 35, or 43’7 per closely associated with animals before they developed sym-

cent., had been

I

more or

less

the disease in ptoms themselves. In no case was there evidence of direct transmission from one person to another. The clinical picture of actinomycosis of the head and neck varies according to the virulence of the infection and the amount of secondary infection. The commonest symptoms are stiffness in the region involved, pain, and swelling. The jaw may begin to tighten and even become completely ankylosed. Pain is sometimes severe, or may be completely absent until the mass breaks down. In some cases dysphagia may be an early symptom, especially if the base of the tongue or anterior cervical region is involved. Sore throat, stiffness of the neck, and earache are occasional symptoms. The activity of the process varies from a slow indolent condition, which takes months or years to reach its full development, to a fulminating one of a few weeks’ duration. The commonest type is that of an indurated mass which breaks down forming multiple superficial abscesses. The disease is liable to be mistaken, as was illustrated in the writers’ series, for malignant growth, tuberculous adenitis, osteomyelitis of the lower jaw, thyroglossal duct sinus, subperiosteal abscess, and tuberculous thyroiditis. The most important factor in the treatment is early diagnosis. In advanced cases intracranial extension may develop or the chest may become involved. In addition to iodides, which are almost specific and should be used in progressively increasing doses, radium has proved beneficial by causing a breaking down of the granulomatous masses and clearing up the induration. Surgical treatment consists in opening up widely all pockets, packing them with iodoform gauze, and swabbing the wounds with iodine. Of 85 cases which could be traced by the writers, 60, or 70 per cent., were well five years or less after their discharge, 7 were dead, and 18 were still under treatment. ____

OPIUM AND DYSPNŒA. THE term dyspnoea is one which is difficult to define but it may be taken to mean a condition in which the normal sequence, rhythm, and character ef the acts of respiration are disturbed, whether

exactly,

subjectively

or

objectively.

In the

healthy subject,

the normal control of respiration lies in the activity of the respiratory centre of the medulla. This centre is regarded as being capable of automatic activity and of sending rhythmic efferent impulses to the muscles that perform the movements of respiration. The activity of the centre is known to be affected by four influences which are independent of volitionnamely, (1) the pressure of C02in the blood supplied to the centre, (2) the H-ion concentration of the blood supplied to the centre, (3) the pressure of oxygen in the blood supplied to the centre, and (4) the afferent impulses reaching the centre, which may come from the higher centres, as shown in the effects of volition and emotion. Many investigators have worked on the problems presented by these several factors, and their results show that disturbances of the respiratory mechanism can result from (1) alteration in the CO2-content of the blood supplied to the respiratory centre-increase in this content causes increased breathing, with acidsemia and raised CO pressure ; (2) alteration in the fixed acids in the blood, so that increase in the acids causes increased breathing, with acidaemia and lowered CO2 pressure ; and (3) alteration in the oxygen in the blood supplied to the centre, so that deficiency causes increased breathing, with alkalaemia and lowered CO pressure. Oxygen-lack causes mainly increase in the frequency of breathing, while increased CO pressure and

increased fixed acids cause mainly increase in the depth of breathing. Among the investigations reported on clinical of cardiac dyspnoea, each of these three cases types of chemical change has been found, plus