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Black twist is made from Brown twist, which has undergone a further process of cooking under pressure, which turns it black

131133, 225, 538: Holly, Spitz 2005, pp

Aside from the most glaring sign, which is coughing, seeing them crave water more often and changes in their behaviour, especially if you spot a vaping device, are indicators you might want to open up the conversation with them

Dimensions: 2067 x 3100 px | 17.5 x 26.2 cm | 6.9 x 10.3 inches | 300dpi Date taken: 29 April 2013 Photographer: Kris Tripplaar More information: This image could have imperfections as its either historical or reportage.