This study was undertaken to examine the long term relationship between lung function, smoking and exposure to enzymes in the detergent industry. A total of 731 male workers from five locations in the United Kingdom were subject to respiratory health surveillance including lung function testing over a period of 4-20 years. Exposure groups were defined by job history. Significantly different rates of fall in FEV1 and FVC with time were found by geographical location and by smoking habit, but there were no consistent trends with enzyme exposure.

SUMMARY An investigation of 102 men comprising alcoholics, patients with non-ulcer dyspepsia, and healthy controls is reported. It demonstrates that alcohol is a cause of chronic gastritis and the severity of the mucosal lesion is directly related to the duration of excess drinking. Contrary to popular belief, chronic gastritis does not give rise to symptoms. The effect of alcohol on the gastric mucosa is a direct one and is not mediated by malnutrition, hepatic damage, intestinal malabsorption, anaemia, ascorbic acid deficiency, or any disturbance in immune tolerance.The natural history of chronic gastritis is described, involving an initial hypertrophy and hyperfunction of the gastric mucosa, followed by atrophy and hypofunction.Cigarette smoking is confirmed as another cause of chronic gastritis. The non-ulcer dyspepsia syndrome is unrelated to chronic gastritis.

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SUMMARY In order to determine some of the factors involved in the response of duodenal ulcers to placebo treatment, the following factors were studied prospectively during a double-blind, placebocontrolled trial: demographic data; duration of illness and effect of treatment; expectation of success or failure of the new drug; presence of psychiatric problems; and suggestibility. Healing (measured by endoscopy) occurred in 37 patients, 17 of whom were receiving placebo; relief of symptoms occurred in 35 patients, 16 of whom were receiving placebo. There was no significant difference between drug and placebo. Healing was significantly associated with relief of symptoms but with no other variable. Relief of symptoms was more common in male patients and in those from higher social classes, as well as in patients who expected a complete cure and those without evidence of psychiatric problems. The natural history of the disease may be different in these patients. Unexpectedly, suggestibility was not associated with healing or relief of symptoms in the patients receiving placebo.The 'placebo effect' (the increased healing of, for example, duodenal ulcers during treatment with placebo) is a well-recognised but little understood phenomenon which makes the interpretation of therapeutic trials extremely difficult. For any patient with any illness, response to treatment = natural healing+placebo effect+effects of drug (or other treatment). For example, during recent randomised double-blind studies of cimetidine in healing duodenal ulcers, the proportion of patients whose ulcers healed or whose symptoms were relieved during treatment with placebo tablets ranged from less than 20% to over 80%.1 The determinants of the placebo effect have been difficult to identify, as neither personality type nor therapeutic situation are specific for such effects. As expectations about the results of treatment influence the response to therapy,2 it has been found necessary to undertake therapeutic trials on the basis of 'double-blind' ignorance of the type of treatment (whether active or placebo) on the part of both investigator and

A study of 2800 workers employed in three factories of the two major manufacturers of enzymatic products in the United Kingdom covering 11 years of operation from 1969 to 1980 showed that 2344 workers had sufficient lung function data to meet the operational criteria and these were analysed in three separate groups by factory locations. Spirometry and prick tests for specific skin reactions to standardised enzyme were performed at six monthly intervals for the first six years of the study and then annually. Factory enzyme dust and total dust measurements were made to determine the degree of dust exposure of the subjects. The lung function of the factory groups was analysed for the effects of working in the detergent industry, the degree of exposure to enzymes, skin prick test positivity to enzymes, atopicity, and smoking. The 4.5% of workers who had experienced respiratory effects from enzymes were analysed separately. Exposure to the enzyme allergen has had no significant long term effect on the lung function of the detergent workers. A higher proportion of atopics than non-atopics became skin test positive to the allergen and more smokers than non-smokers were sensitised. The overall lung function of detergent workers showed 39 ml/year loss in FEV1 on the 11 year longitudinal study and 51 ml/year loss on the lateral (cross sectional) analysis with better lung function in the south east than the north west of England. In the development of the methodology for the study several potential problems were discovered that could remain unrecognised in a cross sectional analysis performed in isolation.