Document 1gZoaKNBbw67N1za2pzNJNggK

FILE NAME: CERAMICS (CER) DATE: 1942 July DOC#: CER029 DOCUMENT DESCRIPTION: Journal Article - The Pneumoconioses ) ) VOLUME 2 NUMBER 4 The /MEDI CAL C L I N I C S of NORTH AMERICA JULY, 1942 PHILADELPHIA AND LONDON W. B. S A U N D E R S C O M P A N Y CO fTH G H f, 1 * 0 . w . . S A W O ftS COM f ANT. AU KGNTS ftS fiV fD . fUftfSHto i.MONfMir ( s u NUM KffS a r f A t t i t w . . s a u n d o s c o m t a n t . w est WASHINGTON SOUACt, rHUAOUfHIA MAC IN U. S. A. RECEIVED JUL X 71942 COPYRIGHT OFFICE CONTRIBUTORS TO THIS NUMBER AlberCtorRp.s,BUehnniktee,d JSrt.a,tesM.NDa.,vyL. ieutenant Commander, Medical GranotfLC. aBniardd,a,ML.Dtd.,.,FO.As.hCa.wS.a,,MOendtiacrailo,DCiraencatdoar., General Motors J. J.SBerlovoicmefiealndd, SCahniietfa,ryStaEtnesg'inReeelra,tiUonnsiteSdecStitoante,sDPivuibsliiocn HoefaIltnh dMuasrtryilaalndH. ygiene, National Institute of Health, Bethesda, A. LerBarlooMkso,toMr.sD.C, oMrpeodricaatiloDn,irDecettoror,itF, iMshiecrhiBgoadn.y Division, Gen RobePrtubHli.c FHlinena,lthM.SDe.r,viPcaes,seDdivAissiosinstaonft ISnudrugsetroinal, HUyngitieedneS, tNateas tional Institute of Health, Bethesda, Maryland. JohnInHd.usFtroiuallgeTr,oxMic.Do.l,ogPyh,.D.,WFil.mA.iCn.gPt.o,nH, aDskeellalwLaraeb;orAatsosoryciaotef PRriocfhemssoonrdo, fVIinrdguinsitari.al Health, Medical College of Virginia, Willialimc HMe.aGlthafSafeerrv,icDe.,Sac.n,dSCenhiioerf SotfattihseticSitaant,isUticnailteUdnSitt,atDesivPisuiobn oMfaIrnydlaunsdtr.ial Hygiene, National Institute of Health, Bethesda, LeroyStUud.yGoafrdTnuerb,erMcu.Dlo.,siDs iorfectthoer,ESdawraanradc LL. aTbrourdaetoaruy Ffoourndthae tion, Saranac Lake, New York. LydiaNGew. GYibonrkrsoCni.tyM. .D., Metropolitan Life Insurance Company, RaymOocncdupHautisosenya,l MDi.Dse.a,seFs.,AB.Ca.lPti.,moCrhea,irMmaarny,laMnde;diAcaslsoBcioaaterdPrfoor ifceisnseo;r oInf sMtruedcticoirnei,nUMnievdeircsiintye,ofJoMhnasrylHanodpkSicnhsooUl noifveMrseitdy Spicthaol;olPhoyfsiMciaend-icinin-Ce;hiAcft,teSntd.inJogsePphhy'ssicHiaonsp, itUaln.iversity Hos BenjaImnidnusFtr.iaJlonHesy.giMen.De,., NPaastsieodnaAl sIsnissttaintutteSuorgf eoHne,alDthi,visUionniteodf States Public Health Service, Bethesda, Maryland. ) C.ONIRtltUTORS TO THIS NUMRFR Robeortf AA.pKpleiheode,PMhy.Dsi.o, lRogeyse,arUcnhivPerrosfietyssoorf, CKientcteinrinnagti LCaoblolergaetoroyf Medicine, Cincinnati, Ohio. Wm.pJoolihtnanMLciCfeonInneslul.raMnc.De .,CoAmsspisatnayn,t NMeewdicYalorDkirCeicttyo.r, Metro CareytioPn., MDceCtrooridt,, MM.iDch.,igMane.dical Department, Chrysler Corpora Carl \Mm.cPriecfaonrioMn,eMdic.Dal., ASsescorceitaatriyo,n,CCouhniccailgoo,nIlIlinndouiss.trial Health, JohnpJo.raPtiroenn,deDrgeatrUo,it,MM.Di.c.hiMgaend.ical Department, Chrysler Cor ClareInllcineoiOs.lds Sappington, M.D., Dr.P.H., Consultant, Chicago, WilliapmanAy.. SRaowcyheers,teMr,.DN.,eMwedYicoarlk.Director, Eastman Kodak Com louiiHSeachltwhaSrter,rviMce.,D.a,ndMCedhiiceaf,l DDeirrmecattoosr,esUInnviteesdtigSattiaotnesSePcutbiolnic, DDicvthiscisodna,ofMIanrdyulasntrdia.l Hygiene, National Institute of Health, ClareMncoetorDs. CSeolrbpyo,raMti.oDn.,, FD.Aet.rCo.iSt,., MMiecdhiicgaaln.Consultant, General ) CONTENTS SYMPOSIUM ON INDUSTRIAL MEDICINE p M;t Introduction.......................................................................................... 997 By Dr. C. D. Sclby The Physician in Industry............... 999 By Dr. Carl M. Peterson Organisation and Management of an Industrial Medical Service 1005 By Dr. A. L. Brooks Physical Examinations in Industry................................................... 1019 By Dr. Grant L. Bird Workmen's Compensation and Medicine .................................... 1035 By Dr. Raymond Hussey Tuberculosis as a Compensation Problem ...................................... 1053 By Dr. C. O. Sappington Nutrition in Industry........................................................................... 1067 By Dr. William A. Sawyer A Wartime Survey of Industrial Psychiatry................................. 1085 By Dr. Lydia G. Giberson The Measurement of Sickness among Industrial Workers . . . . 1105 By Dr. William M. Gafafer Fatigue and War Production............................................................ I 121 By Dr. Robert H. Flinn Prevention of III Health in Industry.............................................. 1145 By Dr. John H. Foulger MethodHs eEalmthplHoyaediairndsth..e...A...p..p..r.a..i.s..a.l...a..n..d...C...o..n..t.r.o..l...o..f...I.n..d..u..s.t.r.i.a.l I161 By J. J. Bloomfield Indoor Environmental Atmosphere and Its C ontrol.................... 1179 By Dr. W. J. McConnell Protective Ointments and Industrial C leansers.......................... I 195 By Dr. Louis Schwartz ) ) ) fTuhlye, M19e1d2i.cal Clinics of North America THE PN EU M O CO N IO SES L. U. G A R D N E R , M.O.* lunTghseinpdnuecuemd obcyonpioroselosnginecdluidnehaallattiocnhroonficducsht awngitehs nino itmhe mplaicyativoanryasfrtoomtyspiempolresepvheargiotycyotofstiisssutoe rperaocgtrieosns.ivTeltfciblraotstiesr. Ebaxcctleurdiaedandfrofmungtihiws hcicahtegaoreryocacracsiothneallyresinphoanlseeds atso dulisvti.ng theAkvianrdietoyf odfussptecreifsipcotnesrimblse hfaosrbetheen ipnutrlmodouncaerdy tcooninddiitcioante. 1ofhetheusereaocftisounchistedrimstisncistivoenlyanddesleiraadbsletowshiegnniftihceancthcalriancictearl sthyemcpotonmdist.ioInn ptrltocdugcroedupbyofinphnaeluinmgoqcounairotzseosrboetlhoenrg fsoirlmicossiosf, vfraereiousislicfaib, roausbsesstioliscias,testh, eancdonadifteiown ortehseurlstinngotfryoemt sipnehcailailnlyg designated. theSisnacmeemeofsftecottsheurpofonrmthseofludnugsst ainndpusriencsetanteonheavoefetshseenmtiaalply pporescediabtlhyatinrfeluacetnicoens troespthireamtorbye fduenscitgionantetdhebwy rtihteer choams mproon tteerrmm, asrcimupnlecombepnliigcnatepdneaunmtborcaocnoisoissisf.romIncclouadle,danudndsiedrerothsiiss mfroomdifieirdont.ypWe hsielincosthisesme amy idneevraellsoparwchmicihxeids pwroitpherlqyuadretsziga natDedustass oafntvbergaectoa-bslielicoorsiigsina,ndlikseidtcorboa-csicloic,ogsirsa.in, cotton fiber, aannadtosmoicoanl cmhaanygeb.eTihnehyalemdayb,uthopwroevbearb,lysenthsietyizecatiusssuee liatntlde gpirvoedurcieseintsoiganlilfeicrgainct sstyrmucpttuormals.alAtelrtahtoiounghin ththeeselucnognsd,ittihoenisr Tdw*aDrdireLc.toTr,ruSdaeraaunacFoLunabdoatriaotno,rySafroarnatcheLaSkteu,dNy eowf TYuobrke.rculosis of tltc 12)9 ) 1240 L. U. CAltONEU snpoetciianlfrdeeqsuiegnntaltyiolniss,teldikaes tfoobramcscoosfispanneudmthorceosnhioers'iss. ever, are indTulisitsrygbroeucapusoef ocnolyndiitniointss eanlmviorostnminevnatriaarbclythdeevneelcoepsssariyn cInontlciecnsttraatteioonfs noaftufrienethedruestispdaurtsitc,lbesutctohnestcaonntclyenmtraatiinotnaisneadrc. rpaorseulryesexacrecssiivnete, rtmheittepnatr.ticTlehse arhcumrealnativrre.elye choaasrseev,oalvnedd exin snuacrhy aanmeonuvnitrsonomf ednutsta.ndThites ltuonrtgusoaursc uppropteerctreedspaigraationrsyt oprdasi scailgieastedexecpluitdheelimuomstlionfintghethceonnotasme,intraancthseao,f ainndspbirreodncahiri,ctahre irtisessubrafcakcet.oItthise epshtiamryatnexd mthaantyatofleathste SpOarptiecrlecsentth:aotflothdegeduosnt Tinhethefraeier wpheabgroecaytthees fawilasntdoerrienagchovtheer dthepethssuroffacteheolfuntghse. ariierrss.paTchees ilnygmepsthaatnicds coafrrtyheofluf npgarrteicmleosvethpaht apgaoscsytthoessced baanrd ptirsosubeabwlyhefrreeeit pisarntioculolantgeermianttceornatnacdt dweiptohsirtesipt irinatolyrympmheomid balrlanbeust. Texhtersaeormdiencahraynicsomnscaernetraadtieoqnusatoeftodupsrt.otect man against autEovpisdyenwcheeroef thsuechheapvriolytecptiigomnenmteady tbraechseeoenbroant cahlimaloslytmapnhy nmoodveesdaftrteosmt tthhee alumnogsu.ntNooft cinafrrbeoqnueanntdly otthheernomdeinseroaflspreer scoennstrawtihoonshaovfe fbieneen qeuxaprotzsedreivneailndculustsrtyersto omf omdeicrarotesccoopnic ssiulcichotriecacntoiodnu.les while the lungs themselves remain free of ETIOLOGY muTsot bheaveexcseigsnsiivfiec,anthteefefxecptoss,utrhee taotmdousspt hmeruicstcboencpenrotrloatnigoends owviethrinpearipoadrsticmuelaarsusrizeed rainngyee.aWrs,ithanind litmheitsptahretiscelefsacmtoursstbfeaalrl caurmecstiapnrocecsal isreliattipoonssshibipletotoonreeduanceoththere, tbiumteunfadcetrornomuccirh bIteltoawkesrwtiomyeeafrosr eevffeenctiinvethqeuaenastietieosf othfedmusotsttopoatcecnutmduulsattse. ) 111!'. PNEUMOCONIOSES 1241 twhiethtiisnsuthese. lungs and more time for the particles to react upon smTalhl eenSoizueghoftoPapretircmleist.--tThehme stiozeroemf athine spuasrptiecnledsedmiunst thbee alairtteanrdprteorepqaussistihtee ibsairnrifelursenocfetdhebyuptpheerirresshpaipreataonryd tfrlaexctib. iTlihtye. O10f mthiecropnasrtiicnledsiathmaettearrearrcoufoguhnlyd swphitehriincatlh, efeawir lsapragceers,thbaunt afinbderssoomfeashbaevsetobseaesnlosenegnatsh6a0t mmeicarsounresdar2e0r0elmatiicvreolnys.coOmnmtohne optrhacetrichaallnyd,uneivnehnalsahbolcrtbfeicbaeursseotfhefiyneargclasstisffwaonodl isnefelemxibtole.be liasWfhuerrtheear miminpeorratlaniscechbeemciacuaslelythireritsamtianlgle,rthite ifsacthtoer gorfeastizeer tmheenstuhrafascdeemaroenasterxapteodsedthatot tchoernetaicstliwttliethretahcetiotinssutoe.pEarxtpicelreis obefloqwuartthze bcertiwticeaeln s3izeanodf 130mmicicrroonnss thine diniatemnestietyr, obfuttisthsuaet risespproonbsaebliyncarelaesweseraslitmheit soizfeefoffectthievepsairzteicwlehsicdhecirseadseetse.rmThineerde sbmyaltlheer tahmanoutnhtisoufnrcestteanbtliioshncdwilitmhiint athree eaxihraslepdacwesi.thPatrhteiclaeisr oacrceulmimuilnaatetedtothprrooudguhcetheeffebclotiovde caondncuenritnraetiaonnds.hence do not PHAGOCYTOSIS ANO DISTRIBUTION WITHIN THE LUNG parRtiecgleasrdilneshsaloedf tihnetocthhaeratcertemrinoafl tahier smpianceersalasreininagedsutestd tbhye sfruebesepqhuaegnotcdyitsicpocseiltlisonthoaft dtheevefloorpeiignnthbeodaidejsaciesnmt owraellso.rTlehses iinnfelrutenpcaerdticbuylatethemiratnteartulriekeansdooqt,uaconatilt,y.anSdmairlol namarocunttrsanosf ptoorltyemd pbhy nthoeduplehsagwocityhtiinc ctheellsluthnrgosu. gHhetrhee tlhyemypmhaatyic rveemssaeilns bthuet tnhoedreesisaabotuent dtehnecybiffourrcmatoiostnoof fthtehme ttoracbheecaa. rrAiefdteornthtoe lpaatrtteirclehsavbeegainccutomucloaltleedct eixncetshseivelymamphounnotsduolefs dwusitth, inmothree 1242 1.. U. CAKONKR lfuronmgs othbesmtrusecltvivese. rTeahcistioonrdienr thoef dniosdpeossitnitonthesugrgoeosttsofstatshies slucnlegr.osIetd issilipcroatcicticlaylmlyphnenvoedrescobmecpolmetee, inhvoowlveevderi,n faorsuepveern imWposheedn lloabrgaerrpanmeuomunotnsiaofodrupsut lomfotnhaerysacmaenctyerp.e arc inhaled avlelssoefl; tmheanpyhaagcoccuymteuslatdeowniothtinremthaeinsuwrriotuhinndinthge cloynmnpehctaitvice mtisesnutea.tiTohniswishiecvhideonuctleidnebsy ththee ldoebluicleaste ppreersielynmtinpghatoicn ptihge pvelesuseralsl tsruarvfearcseinagndthbeydseipmthilsarodfepthoseitsluinngst.heOwnalelxspoofsubrleootdo emxeccehssainviesmastmaorscpheenrtiicreclyonicneandteraqtuioatnes aonfddudsutst-thfiellepdroptehcatgivoe cyTtehseresmolauibniliintythoef aplavretoicliulfaotre ymeaartst.er also influences its dis gpyopsistuiotnn. qRueiacdkillyy ddiissasoplpveeadr peairthtiesrlebselfiokerethoorseafotefrmtharebylehaanvde beveeidnenicnegeosftetdhebiry pprehsaegnoccey. tTicoxciecllssuabnsdtanlceaevselikperafcitniecaqlluyartnzo, ocyntetsh.zTohtheecrehllasnudn, deexregrot tahesierriefisrsot fefcfheacntsgeuspoconmtphaerapbhleagtoo tahlotesreatieoxncsiteadndbygiathnet ctuebllerfcolrembaaticoinll.usN, eicnrcolusidsinogcceupristhbeulitoidit lroasrieslysointvhoaltvetshethegrolasrsgeapnpuemarbaenrcseoof fceclalssesaetieonn inis tulabcikricnug-. tHhoewqeuvaerrt,z nthumatetrhoeuys ihsaovlaeteadlrepahdaygoicnygteessteadrcankdillethdu, slicbreeraattiinngg athdeepmiacntudrefoorf meaorrley cseillliscoosfisthiseasammuechkinmdo. rAe sacaticvoensoenqeuethnacne tmhaotcoonfiotshies. cPohrraegsopcoyntedsinngotstakgilelesdofbuatnyinojutrheedr tfeonrdm toofapdnheeure tfooromnetuabncortchice-rliakncdnloiednuelees.there is a pronounced tendency to Thfeibrsoaumsemtaytpereialo,flikpehaasgboecsytotes,s isanttoetmhpatndtloedisnogeesftfecintihvaelleyd. athsebesmtoasrgbiunts tohfe fthibeersceallr.c 1sohilsonagpptehaarts thtoeyimprpoejdeect abmeeyboonidd activity and as a consequence there is little or no transport to ) THE PNEUMOCONIOSES 1241 ithliee tleyrmmpihnaatlicressypsitreamto.ryAsbbreosntochsiiso,leasc,cowrhdeinreglym,obstegoifnsthaeboiunt haled fibers come to rest. SIMPLE BENIGN PNEUMOCONIOSIS Gro Anatomy freeInftrhoemabasdehnecseioonfs.asTshoceiraetedis inufseucatliloyn pthigempelnetutrtaielnsudrfiastcreibiustesdmoionthsmanaldl fthoceaal maoreuanst, vinaryliinngeawr idtheptohseitsintaelnosnigtythoef tphleeuerxaploslyumrep. hTahtiecsseocrtiodniefdfusluenlyg, oagnaeinseersevsecaaltsterveadry(ilnegeksaomfobulnatcsk opfigmpiegnmt,enntoattioovne. r I2notrh)e mslmig.hitnerdidaemgerteeers, iinn tthhee wceanlltsersofosfmtahlelerloabrutelersiesoranfdineinlitnheearsedpetapmbiettswaeleonnglotbhuelesly. mTphheatoiclds sthoeftrecoaalsmmalilnecro'sllelcutniogn mofayembpehyusneimfoartmoulsy abirlascpkaciens. cRoelogrardwleitshs ohferseireanodr idnitfefenrseitnyt,ianteonteheomf tfhroemse tphiegmseunrrteodunadrienags liusnfgib. rIonusspeacntdionpawlpiathtioan lefanisls rteo veaTlshneormmiaclrosstcruocpteuredeumnodnesrtlryaitnegs tthheatpitghme enptiagtmioenn.t is largely contained wthiethainreoplhaargforcaymteewcoerllks owfhitchhe mluanyg.bIen ltohceateladttweritshiitnuatthioen atihressepadceusstocrelilns haares doeftmenonesltorantgeadt,edtheanddevseimlouplmateentcoonfneecdteimvea tsiespsuaeratceesllsthbeustuapspoHrtaiyntghocernlles afonrdmsp.eIrnmmitsarktheed cpahsaegsohceyatveys ctoollaarsssuomfepitghmeierntepdrimceiltlisvewirlloubnedfeodunodraboovualt tnhoeduslmesalbleurt acrltoersieorlessc. ruIntincyrorsesvesaelcstiothne thceesnetradlepbolsoitosd sivmesuslealt.e Willh-deenfinceudt alorcngnitoutdiinnafrlleyqutheneitrlytrausesonciaattuerde wisitmh oarpeporebcviiaobulse. aWmhoiulentssuocfh ntieswsuley cfhoarnmgeeds ctiotinenseoctfivfereetisssuileic,a.chIenmsicuaclh acnaasleyssisit gisentehrealliynvidseibmleonssitlricaateswhuincuhsuhaalsqbueaenn risesdpeomnsoinblsetrafbolre maonsdt ionf tthheesetisinsusteanrceeasc-tiiotns.eeMmosreprroabraeblylenothaetxcaeshseoalfedsiliicna fmecetnitouhsaspraoccceusms umlaatyedh. aTvehisproindtuecrpedretaatifoibnrosseisemms wlohgiiccahl thine viniehwaleodf ptihge pofaufcibitryosoisf sounchexcpaosessuraendtothpeurreepmeainteedradlsemofontshtirsatciloanss.in animals of the lack Roentgenologic Findings benAignroepnnteguemnoogcroanmiosoisf rtehveeaclshetshtatofthae sluinbejaerctshwaditohwssimnpolre emxatlelnydcafsutrtbhyer thientoblothode vpeesrsieplhsearryc othfictkheer ltuhnagn. uNsuoal naemwi snhoatdothwosroaurcgholbysefravmedil.iaTr hwisithpicptousrseibilsecvoanrfiuasnitnsgotfo tohbese"rnvoerrs mal" pattern. It is probably safe procedure to regard nothing ) I 2-14 L. U. GAKDNFR [ti)ount vtoeryinhwaelelldddeufisnt.edInlinnocneraseexasghgoeurladtiiotnheassoevriedgeanrcdeedofwrheearce tAhe fcuhrathngere issonuorcteunoifforcmontfhursoiounghoaruitseasll fproarntts othfeboftahctlunthgast. eaxnpdoscuhraeratcotefrriesteicsilnicoadudluarst,roincsnutgffcicnioegnrtaptohicpropdauttceernsd,efimniatye iamlspooscsaiubslee teoxadgigsteirnagtuioisnh obfettwheeenlin"eeararlmy"arksiinligcso.ticSinrecaoctiitoniss afinlmdsthaosseproesfilnicoontsicp.ecIinficsuorrviegyins, oitr iisnuannsnafuealtorecelxaasmsiifnyatsiuocnhs oouf glhalrygeugnrdoeurpstsooodf, msuecnh wahodsieagninodsiusstrisiala erxepaososunraebleis pthroobr cahbailnitcye,s bouft eirnroarnairscolgarteeadt.ease, seen on a hospital ward, the Clinical Picture tomSsim. pDleisabbeinliitgynisphnaerudmtoocoimniaogsiinseoirndivniaerwilyofcathuesesdinstoribsuytmiopn osifgnthseadreusut srueaalclytioanbsinentthealtfhraomugehwoirnk soofmteheinlustnagn.cePshytshiocsael innodsiicsadtievpeenodfscuhproonnica bhriosntocrhyitiosfmaadyeqbueateeliecxipteods.urTeheto ddiaugst gsucpnpoogrrtaepdhicbypaetvteidrnen. cBeutofit dsehfoinuiltde aallwtearyastiobnesbionrnteheinromcinntd othnalyt tohnee loafttethr eisponsositblpeatchaougsenso.mHoenaicle,dthinaftecintihoanlsedmadyusatlsios pthreodduicsterisbluigtihotndeisgraepetstoofbleinleeassr uexnaifgogremra.tion, but in this ease Complication! simSpulsecebpetnibigilnityptnoeuimnfoeccotinoinosiiss naoltthoaupgphrectihaeblynamtuordeifioefd tbhye cAacuusatetivpeuldmusotnainryfluiennfceecstiothnes farrecquneoncmy ooref tchoismcmomonplitchaatnionin. tlhikee ptuobpeurlcautiloonsisatmlaayrgbee; sthlieghitnlycideelenvcaeteodf icnhrthoeniecasienfoefctipoenrs ssoilnicsa.bWreahtehriengdudsutsstsofcocnaltcaiiunmingcoamnpaoduenqdusataercmcixotnucreernoefd ftrheee frequency of tuberculosis is generally very low. ) ) THE PNEUMOCONIOSES 1245 Grots Anatomy SILICOSIS hyaTlinl>ee, cfhibarroaucstertiisstsiuce lnesoitonovoefr sJilicoorsis4 ims ma. lioncadliizaemdetneor.duIlnespoefctiodennsoef, styuprfiaccael sainlidcoutinciflournmgslyresvcaeattlesrendodtuhlreosuogfhothuitsanllatpuarretsseoefdethdeodveeprththseopflebuortahl oemrgpahnys.seWmah,erfereetheofconnoddiutlieosn, oisvoerf ltohnegdsiatapnhdrainggmathtiecresumrfaaycebseaandzowneheoref vthaeriraeblayredissctaurrsbeodf. old infections the uniformity of the distribution is in andI,netxhceepatbsfeonrcetheofelienvfeactetidonnotdhuelepsl,euisraslmsouorftahc. ePiisgmfreenetaftiroonm isadvhaersiaiobnles bmuint erinalsmwoistth ctahseessitlhicearetoispreondouucgeh aasdsioffcuiasteedorcalorbcaolnizeodr bolatchkercocloolro.reIdn souucthincassehsartphecsolnigtrhatslty. rAaissesdilicceantteernsdsoftotheacccoulmorulelastsesimliocoreticranpoiddulylesinstathnids leoacralytionsi,licthoseisp. leHuorawl emvearn,ifpeastlaptaiotinosn moafy thbee tfhoecionolfy pdiegfmineitnetateivoindenince thoef ddeifefpereernptiaarttesd offrothme tlhuengsuusruroaullnydirnegveatilsssuseo.mIensthpaect tiaorne foifrmsuecnhoufgohci towibthe amalreknesd dceamseosnstthreateusnilfoocraml odbisltirteibrauttiioonn ooff tthhee fniromrmdaliscsrterutectnuored.ulIens cwoenll stituWteheurnemitshteakapbrloepoevrtiidoenncoefofasssioliccioasteisd. minerals is relatively large, the zfoornme ooff htheeavsyilipciogtmicennotadtuiolen iws hoifcthenmmayodciofimedm. uAnbicoautet ewacithh issimanilairll-ddeepfoinseitds athloengpigarmteerniotaletisonorisothsoerisnttreuncsteurtehsatcotnhteainfiirnmg,lyhmyaplhinaeticnotrduunlkess. aSroemaeltmimoesst oobf saculriende.arTnheestwe omrkodthifaicnattihoenstyppriocdalucneodguelnaetiroanl . pTahtteeyrnsaremomroestsucgogmesmtiovne in aTnhtehratcraoc-heaonbdrosnidcehrioa-lsilliycmospish. nodes are practically always deeply pig mnoednetsedarferoemnlaasrsgoecdiatbeudt cloaltoerre,dasmitnheeraflsib.rIonsisthemeaaturlryesp, htahseeys ocfonsitlriacocstistothea ssihzoee.only slightly larger than normal and become as hard as the sole of a of Tmhicerorsecaocptiiocndtiomesnilsicioanspairnticcrleeasseiaupnrtoilgrtehsesyiveatttoainthea edxiatemnet tethr aot fno2dtuoles4 msizme.trheegalerdsiloensss roefmfauirnthsetrateioxnpaorsyuraen.dHnoewwevoenre,sodnoanttoatindinegvetlhope.irFmroamximthuemn opnortoionnlys othfethdeevluenlogp. ment of associated infection is likely to involve new pleuMraalnysurcfaascees iosf osbilsiccuorseisd fbayil dtoensceonffiobrrmouttoadthheissiocnlasssaincdal opnattseercnti.onTihnge tahmeoulunntsg olafrgaeir, cbolanctkainminagssetsisosufe.ruDbbisecrryeteconnosdisutelensceushuaavlley roepclcaucredelsveawrihaebrlee hfiubtrossoism. eCtiomaersse theemyphayresemdeat,ecntiobtleinofrnelqyueanlotlnyg othfebbuollroduesrstyopfe,thies ma ausssuivael cuopmpeprlitchaitridosn.ofTohnee olarrgbeothcolnugnlgosm. eSroamteetilmeseisonbsilamteorasltlyosftyemnmoectrciucarl imnastshees radiate from the hilum into each lung involving perhaps portions of two 1246 L. U. GARDNER oorf msuocrhe lsocbaersiswidthisco'vliebreerdatipoanraollfeltirteo fhisusutreJs.oAr tAotchmer. tbiemneesatah sothlied lpatreisrmal pthleeurmaaossf farnomupptheer loovbeer.lyIninsgucphlecuarsae.s Oa nzonseecotifoncionagrsesuecmh pahymseamssa tsheepakrnatiefes corfeteanksmasentthioonuegdh isparsasriengunthlersosugohbvitoouusghcallecaiftihceartiobnutistheencgoruintttyeresde.nsDateioenp zwointheisn otfh,neseecroasreisasfiollfedcosvnigthlominekryateflufiidb.roTsihseroenearefrenqouednetflyinisteecswairlrlsegouflaar dfiibffreoruesnttiscsouleorsismupclhy absectohmosees sgurrarnouulnadrinagnda tthuebnerlciquuloeufisesc.aAvisty;thtehree bislacnko comMmaussniviceatfioibnrowsisitnofa thbirsontcyhpues rtehpilsacdeesbrainsdreombaliitnesraitnessiaslul. normal struc- aturleessioinn tthheerpeomrtiaoyn boef ilnucnlgudinedvolivsleedts. Aoflodniglatthede iarirregsuplaacresb.orBdleorosdofvessuseclhs astraencoebsliitnerawtehdichantdhethmroaminbobsriasncishecsomofmothne. Tpuhlemownraitreyr ahratsersyeewn efroeucroimn pblreotneclyhi oabrestlriukcetwedisebcyomoprgreasnsiezdingandclootbsl.iteArlaltebdu. t the larger cartilaginous Microscopic Appearances vealMs iacrcohsacroapcitceriesxtiacmpinicattuioren. Tofhethleesiosinmipslec,omdipsocsreedte,ofsicliocnoctiecntrniocdlualme inraee oprfestsheicdk. ,Ahryoaulninde tchoenonuectstiidvee otifsstuheisfimbearisn wmhaossseisnaucllaeyi earreofthminoraencdelcloumlar cinofnilntreactteivdewtiisthsuephoafgovcayrtieasblecotnhtiaciknninegss.blUacskuacllayrbtohne loartteorthiesr mcoolroereodr plaesrs ttircalcetsioanndoftthhee cfeibnrtoeursoefleimheenhtsyiilnintehennodoudluelemcaayuseaslsosombee pdiigsmtoertnitoend.oCf othne aVirarisapnitcsesofinthitshepicimtumreedairaete(1v)icicneintytrabl uatretahseroef niseclriottslies ionr nnooduleexsudpartoe. dpuucreedstbayteexanpdosu(r2e)totheexcemssuicvhe qmuaonretiticeosmomf ovnerytenfidneencqyuarftozr insevperaraclticcaollny stimgualolucsonnogdloumlesertaotelilcecsoiomnes. surrounded by a common capsule, thus forming diffSuisme imlaratrsitxudoyf ohyf atlhinee mfiabsrtohuisc tcisosuneglionmwerhaicthnreotdsuloafr ffiobcriosaisre rmevoeraelsoar lseusgsgeeasstiinlyg daenfinoerdig. iTnheinmaantrioxrgsaonmizeitnimgespnperuemseonntsicanpraorcraenssg;eminenmt oosft fcibaseerss tthioenreoifs tnhoe spcaarrticwuiltahrouptatlteeurnko. cTyhtiec rneeaccrtoiotinc. fTohciis ebxehciobimt essimupnldeerdsteagnednaebrlae wthhroemn biotseisd noortemd otrheatorthleessbloococdludveedsseblsy tehnrdoaurgtehroituist. tThheembarsosncahrei, ewithheenr satcdtliopnabteuntt,muossut aollfythdeisspmlaayllevrabriraabnlcehaems oaruentcsomofprceshsreodnibceyinofnladmrmecaotgonryitioren. cenIttratiisonnsotofunsciloicmamdounst into pefirnsdonssilitchoattic hnavoedubleesenonelxypoinsedtheto vilcoiwnitycoonf oseldrvatutiboenr,cuinloucsonstcraarsst wtoiththneongeeninerathliezeodthdeirstpraibrtustioonf thofe ltuhnegsn.nTdhuliessobin pmearsssoinves wcoitnhglnomo eervaitdeentycepeosfoifnffeicbtrioosnis, haarse ltehde trocstihdet ohfyplootchaelsizisedthiantjutrhye. 1lie resultant lymph stasis would explain local retention of excessive quau- ) ) THE PNEUMOCONIOSES 1247 trietiaccstioonf thoef itrhreitatnistsupeasr.ticIlfest.hTehiisnfceocnticoenntrwaatisonstiwlloualcdtivine twurhnilecaudsuestmworaes boefinscgarinthisaslueed sthome eptnimeuesmoonbiscerpvreodc.eTsshecousilldicaorwgaonuilzde tthoenpraocdtucuepotnhenefowrlmy mfoartmriexdbecotwneneenctinvoedutilsessu.eSutoch ptrhoedourcye hathsesudpifpfousrte intypexepeorfimfiebnrtoaslisobosfertvhae stieornvedwhteorehebaolthwittuhberercsuullotaunst amnadssnivoentfuibbreorsciuslooufssiimnfielcartioanpspehaarvaencbee. eOn thoebr tehleemmensthsomwaydeinnsfeluepnicgemtehnetatdioevnelofrpommenat cocfumthuelasetedmansosinvseililceesoiounss. mAinlleroafl wpahretitchleesr. sWuchhemthienrerathlsis acistumalleyreliynitiaateresmuultltiopflictahteionlocoafl cloynmnpechtivsetastiisssuoer sciellilcsa wishincoht acrleearf.urFthinearllyst,imthuelateeldemaenndt hoyfahconilrla.epdsebyinctihdeenatsstoocibarteodnchfrieael oisbsntorutcitniotrnodmuacyedplauyntislomthee pfairbtr,oasilsthoisugwhelnl oatdavapnrciemda.ryThoenew, arsitethrisisfaccotonr vhienacleedd itnhfaetcttihoen mwohsitchprdoibsatobrltes btahseisstfrourctmuraessiivne acolnogcalolimzeedrapteorftiibornosiosf itshea lkuinndg oafndinfdeicsttiuornbstoitsocfcuunrctiinonthale aucptpiveirtyp.aTrtusboefrctuhleosliusngiss. the most liltely Roentgenologic Findings varRyocwnittghenthoegrcahpahriacctmeraonfifethsteatpioanthsoloofgicsaillicporsoisc,esos.f Icnocuarssees, uonf ifsoimrmpledisdtirsicbruettieonnoodf uthlaetisomnaltlh,eshdairapglynodsetifcinefdeastuhraedoiws sthoef nfioedldusletsh.eUpnrleessusmthpetiyonaries tshoadtissotrmibeuotetdhetrhrcooungdhitoiount bisorthespluonng swibitleh.ouItn stthcercovreorcyntgecanrloygrcaamsess mthaey nboeduclaotniofunseids fwinieth anadn aadpvtlayncceodmpsatargeed tohfe lainpepaeraraenxcaeggoefratthioen.laWtteartktoinst-hPeitclehaffolersds Atresetahnednwodhuelneseairnlycrenaosdeuliantiosinzesuapnedrvennuems,bteor,ththeetirreeshinadbouwds. boefcaomtreeelairngefurlal nldeafmcoarne bnuemideeronutisfi.eOd.nly the main branches tioOn nthienrsepeacrtcinsgoamsianngylesfmilamll orfouanndadsvhaandcoewds ctahsaetoift nisodhualrat! stohoiumldagirneemethmabt emr utchhatutnhienvsohlavdcodwtisssoufe aislllethfte. Hnoodwuelevseri,nonane oorngtoanonfreompla4net.oSt9erienoc-hfielsmsinwtihllickdonesmsuhchavetobdeiesnpepl rtohjeecitmed pstriellssmioonreo.f Rthaerierlynuamrcbetrhaenred amnoerexatmhainnateioignhot ftothetelnunngoditusleelsf ) I 248 L. U. GARDNFR troesptloicnsisbqluearfeorinachvairniabalneyamploanuent ooff ssehcatidoonw. lcEsms plhuynsgemfiaeldiss itnhethmeedcioassttoinpahlrcsnhiacdorwegioisnsb.roIand maondderdaetneslye daudveantocetdheeaesnes lbaurtgetdhelywmidpthh noofdtehsi;s isnhatdhoewmiastuagreaisntalgesess btheceaudseensoiftythpeercsoisnts traCcatisoens ooff mthaessnivoedecso.nglomerate fibrosis present a diagnostic pthreobilnefmectbioeucsauesleemtheenyt issimmuelraetley tduobrmrcaunlto-asnildicobseicsauisne wsohmiceh tTimheesttyhpeiycadl oconnogt leovmeenrareteveeaalseanpyrtehsienngtsinodniceatoivremoofrseilidcoensisse. mwaitshsivvearsihaabdleowams uopuonntsaobfapcekrgiprohuernadl olufnggenfeierladlsizbeldacnkodbuelcaatiuosne ootfheemr pevhiydseenmcae.s Dofiscthorrotinoinc opfletuhreisydiaaprehrcaogmmmatoinc.sThahde m'asssainvde sluhnagdofwiesldmoayr trhaedyiatme aays lianrvgoelvfeantshefrormootthoef hoinlulmy oinnteo leuancgh. lAikneosthheardocwomlomcoantedmbaennifeeastthatitohne cislatvhieclesh, acrrpolsysindgeftihneedanbtleorciokr sbeecnoenadth atnhde ltahtierrdal rpiblesuraat. rPiegrhitphaenraglletso ait ftehwereceinstiumsueatellrys einvidtheencleowoferemthpihrdysseomfat.hOe clcuansgiosnbaullty tmheassesivaercshleasdsocwosmomccounr. Othveseerexepxotrseemd efliylmdsefnasile toaredaesmoanndstraetveenmuthche sftorucictuorfe awneitmhiinc necTrhoseiscolanctkrascutfifoincieonfttdheefsienistciolenrototicbme avsisseusa,lifziexde.d to the chest wwaalrldbayndplienursaol daodihnegsiothnes, dpiuscllrsetme uncohduolfesthine ltuhneglotwisseureluunpg acridccbnrtolyugthhte inatior scploasceesprinoxtihmeitylowtoerthelunmgasssbiveecolmeseionovCerodiins- cteonmdpedentsoatkoeryepetmhpehpylseeumraal acnavditay cfoilnletdra.cTtehde lcuonmg bminaaytiocnomof pthleetyelfyusoebwscituhrethathteofshthaedolawrgseomf atshsenedaisrcbrye.teAsnoadcuolnessesqouetnhcaet tahned fcihlmronmicayplreeuvreisayl owniltyh tnhoedmisacsrseitveesshhaaddoowwss,toesmupghgyessetmthae, sdiilfifciocutilct porriogbilnemofinthdeiacgonnodsiisti.on. These eases present a most ) THE PNEUMOCONIOSES 1249 Complications cepRteiblailtiiotynshtoip ttuobeIrncfuelcotsiios;n --itSiilsicofsriesqdueefnitnliytelayssioncciraetaesdeswsuitsh cmhornoinai.cTbhreonicnhciitdisentcheatofmlaoybalreapdnetuomtoenrmiainiaslhbigrhonicnhoceprntaeiun ipnodsuusrterietos swuidthdensiliacnadheaxztarredms ebcuhtanwgheesnincotnemdiptieornastulriekehaevxe sbuegegnecstosrrtehcattedfatchtoerpsnoetuhmeronthiaanrattheehsaislifcaolsliesn.arSeucrehspeoxnpseirbileen.ce Tuberculosis theInrecidisenlciett.l--e Wrehaisloena tfoewdowurbittertshahtavseiliecxopsirsespsereddsiskpeopsteicsismto twuoberlrdcuilnodsiisc.atSetartaitsetsicsfofrrothmis einvfeercytioinnduinstrtihael scioliucnatrinyduinstrtihees sftoautirsttiocstwreevneatyl ctoimmepslitchaattinign taudbuelrtcuelmospilsoyined60mtaole7s.S Apeurtocpesnyt oexfposisluicroeticto ssuiblijceactds.usAt nisimuanliqeuxepeirnimceanutssindgeminofencsttrioatne wthitaht tpurbogerrecslesesbaacnildli porfodlouwcesvicruhlreonnciec ftourbevrcauriloousiss.spTechiees,skwephtiicchs bbauste ftohreirreaospoinnsiotnos boen pcrleisneicnateldimsupcrehsseivonidsenocfeismolaaytedbeeamseiss, leading. culFoasicstoarsmoAnfgfecstiilnicgotiIcncsiduebnjeccet.s--Wthahnileotthheerrse, itshemofrreequtuebnecry othfethtiusbienrfcelcetiboancvilalurisesinwpitahrttihceuloaprpcoormtumniutnieistiefos.r Icnonatamctowdeirthn tfrooulndharys bineetnheinciotypeoraftiMonilwfoaur kseeevewnhyeerearsa, pSraongdraemr noofwcorne pinorStsountoh eAxcferiscsaofinth1is93i7n-f3e8ctioonnl.yAfmiveonngewRancadsegsolodf mtuibneerrs cmuelonswisitwhesrielicodsiissc.oIvnertehde yoenarspe1r9io1d7i-c18etxhaemreinwateioren 1o1f6 s2i8m,4il1a4r eoafsseuscahmcoonngtra1s3t,s47c4ouslidlicboeticcisteedxabmutintehde.yMaracnhyaordthlyerneexcaemssparleys. 1vahrey pforoinmt tocobmemaruinnitmy intod icsotmhamtuwnihtiyleitpriesvaalsennceecersastaersymfaoyr silicotics to come in contact with the disease in order to ) 1250 L. U. CARDNER dsielivceolsoips mtuebreerlcyuleonshisanacsesfotrheotphreorbsaubbiljietcyts.ofTehfefecptrievseennecses ooff sucIhn gcroonutapcsto. f persons exposed to silica dust the incidence of caoctmiopnl.icFatoinr goninefelcatrigoen girnocurepasoefs w26i1th2 tmheinesresv,erCituymomfinthges rree ported the following rates per 100,000: NLioneeavrideexnacgegeorfatidouns.t 1rsetacdteiognree............................................................................ 01..0 SLiilniceoarticexnaogdguelraattiioonn,, 12snt ddedgergeeree........................................................................ 62..00 Silicotic nodulation, 2nd degree .................................... 12.0 wiTthheagefrewqhuiecnhcyhasofletdubteorctuhleosbiesliienf tshilaict omticosstaolsfothinecrineafesecs tbiount sanarcapopfreecxioagbelneonuusmorbiegrinr.eTsuhlits firsotmruereianctmivaantiyoninsotfanpcrees, eitxieisstionfgrleaatcetnivt aftoincigoaf sroe-icnaflelecdtiopnritmyapreydoisreaGshe.oTn hteubperrocbleabairle smtruacthedmeoxrpeerriemmeonttea.llWy hinileanthimisalpso, sasinbniuliatyl hreaesxbameeinnadtieomn oonf lraarrgitey gorfoiutspsococfurhruemncaen. Tsuhbejeccatlscihfiaesd doermfiobnrsoturastepdarethnechygrmeaatl tyuebaersrcloefs eoxfptohseurperitmoarsyiliccaomdpulsetxarlethmoauignhuninchsaonmgeedcothurnoturigehs emxeanmiwnaitthions.ucIhn tlheseioUnsniatercd rSetjaetcetsedtheongetnheeraplreperamcptilcoeymisetnot addemnciet tohfemrecuennltesasc,tiovfityco. urse, the primary focus shows evi silicrotiihcolsouKb!jceaclt Aisnmuosumaljl.y--Tmlixetepraiathtloylogdiicffaelreanntatofrmoym oftbtiutbeirncuolothsiesr inintdhie vailmduoaslts. inIndisittisngcuoismhmabolenesftrommanthifeestmataiossniveascotunbgclorrmvleor-aitielicfoorrimt itofmsaiympblee sisiloiclaotseids, faolrceuasdyofdecsacsreiabteiodn. Moranayssmeacltliontusbemrcayulobues nceacveistsya.ryWtohedniscsluocshe aann athreea ciasseeoxupsosmedatitteriswuhsuicahllyofrfeecrosgnshizaerdp ecaosniltyrasbty tothethgerasyu-ryreolulonwdincgoloblracokf fthiberoiunsfectitsiosuues, plirtocseosmseisinsstitlalnaccetsivteheanmdicervoesncotpheis mmuestthoddetemrmayinreeqwuihreethienr flileecfteiown aonfd sfeavrerbael twsqeueanr.e Minocrheesooftfens,echtoiownevfoerr, tthhee ftoucbierocfulaocutsivictyommpalyi cCaitsieosn, liasrogebvcioauvsitiaetsthheivteimieleostfroayuetdopsmyu. cInh (o10f ptehrecemnitssoivf ethsecacronagnldomaebroautet ) TUE PNEUMOCONIOSES I 25I ittyspeboorfdetrusbethrceulaoisri-sc.oTnthaeinreingmalyunbge isa ifnevwaddeudstbeyrs aofveisroylatcehdrotnuibce,rcfilbesroiidn trhaere.loSwimerilalurlnygcboumtpuliscuaatilolynsbrionncthheoglaernyicnxa,nidntheestminaetsogaenndouostheexrteonrsgiaonnss aarree minosstiliecxocteicptsiounbajel.ctTshaisndvesriyncechbroonthic iftosrmpatohfoltougbiecraclulaonsdis cislintihcealusmuaalniofense stailtiicoonssis.are atypical it properly deserves its special name o tubrculopersQounisteweitxhcemptiinoinmalally otrubveercryulooslids smilaicyotbicehnavoedulinatioan,typinicaslucmh aenanseers, ina bchroronnchicogaepnicical ofrochuesmpartooggreensoseuss sdloiswselymiannadtiofninathllryouegxhcavthaetesluwnigtsh arnedsulptaenrt haps extrapulmonary complications. ThResoecnatrgeenooftgernapinhdicistiAnpgpueisahraabnlceesfroomf thTousberocfulmoa-ssisliivceoscios.n-- gevloemr,emraatey fdibermosoinssotrnatefirast gerxaadmuainl aetixotne.nsAionnnuoafl tfhilemsp,rohcoewss. oInf tmheaniynfeeacstieosutsheeletimmeentulistimmaatneilfyesaterrdi;vecsavwithieesnmthaye tahcetnivibtye vmisauyalbizeedanatnicdippartoegdrewssiitohninbeacopmereiosdmoufchtwmooroer rathpriede. Dyeeaartsh. "n1olideulraatrioern tpyrpeisceanltstunboerucnuulosusiasl, ofenataurebsa.ckground of silicotic Clinical Picture in Silicosis noOdunlearosfiltichoesims oisstthcehapraauccteirtyistoicf sfyeamtuprteosmosfasnidmcpllien,icdailscsriegtnes, ifnesctaotmiopnas.riMsoannwy istuhbtjehcetsexarteenetnotifretlhye urnoaewntagreenooflotghieciarl cmonadnii ctioonntinuunetiltoit piesrfroervmealhedardbyphaysriocaultinlaeboror ewntigthennoogrcaomm.pTlahinetys atinodn ndoemdiomnisntruattieosn soofmoeutdpyustp.nOean.lySosmevee,reonantdheunoutshuearl heaxnedr, Nwiollt rinefproerqtuecnotnlsytritchteiroen isoranbuurnnpinrogdusecntisvaetiocnosuginh,thperobchaebslyt. dpuroepetor. bItrosnecehmisalprirorbitaabtiloenthaantdcenrotatintosucshcaenpgtiebsleinindthiveidluuanlgs tmhaoyughhavtehissysmupbtjoemcts neeveedns ifnumrthineirmianlvsetsatgigesatioofn.th'eThdeisesatseethaol siscoappet otfotenbedeptreocltosngaehda. rsIhn rtehsipsirtaytpoery onfotdeiseaansiel ecxlipcisrtatieoxn- ) 1252 L. U. OARDNF.R pwahnastiolnimaitnedd.the excursion of the diaphragm may be some is dInifftehreenptr.eTsehnecseeomf emnaassrievedecfoinngitleolmy esrhaotret-fwibirnodseisd.thAelpthicotuugrhe bmealonwy opfart.heUmnucsouanltinexueerttioonwporrekc,iptihtaetiersparnodauttcatcioknoifssmevuecrhe sduyfsTpenrepalefurroimtic wpahiinchantdhecyourgehc,ovwehricshloiwslpya.rtTichuelyarlfyretqrouuenbtlley staotmeevionmtihtiengm, ollrtncinirgs. iIsn tshoempeicittuirsesoevfearedveannocuegdhetmopphryesceimpia wiWth htehne tphheycsiocnagllsoimgnesraotef tlehsaitoncoisnddiuteiotno. an unhealed tuber cauplpoeuasrainncfeectthioant dtoiaxgincossyismipstodmiffsicaurlet. sNooltateunitnil mthaekitnegrmthineairl bciraetaekddowwitnh dtoubtehrecsueloesaisse.s Bmeafnoirfeestthsaytmtipmtoemtsheoyrdainrcarsilhyoratssoof abcretiavtihtyb. uTt hweeyllhnaovuerinshoefdevoerre, vleonssoovferawpepiegtihtte,froorminrcersetarisceteidn sspeduitam.eInttaistinoencersastaer.yTtoubfeorlclolew btahceimlli cdaorefnuollty aypepaeraarftienr tyheeairr tpoosnitoivtee tshpeutfuirmst. hOinnt oocfcassyiomnp,tommosntohrlythgeuidneevae-ploigpmteesntst omfaya dneegmaotinvsetrastpeecthime epnres.seUncseuaolflyt,ubheorwcleevbearc,iltlhiefosllpouwtuim-1byremmaainnys pwoesliltiavsemaeftdeircatlhreeaosrognasnmismosst foifnathlley daopspeedare. aFseosraerecobneotmteircoafsf isftrethnegytha. rIcf aplluotwoend rteostdtoresaotmmeenwt othrekycoarmcpdaitsibcolentwenittehdthaenidr tnhoetirbdeysnpengeleacsteedem; sastosoboencoamseanmyoreevisdeevnecree. oBfutacthtievyitysh, oaunldd pmaurstitcbuelarrleymoavepdosfirtoivme csopnuttaucmt ,tomparkoetsecittsthaepiprefaerlalonwce,wtohreky men. i Diaqnoiii of Silicotii anDiniadgunsotsryis wdeitphenadsfreueposnilicaahhisatroarryd,oaf acdheeqstuartoeenetxgpeonsougreraimn ' sphhoywsiicnagl saigsnhsaodfowthepantatteurrne cahlraeraadcyterdiessticcriboefdt.hiTshdeisfeilamse,ofatnend suggests the presence of silicosis but to establish a diagnosis tiie pneum o co nio ses 1253 cpolertreobroecraotridveohf iastomryanm'suosctcbuepaotbiotanianledli-feT, hiniscliundvionlgvesnoat coonmly mthaeteprliaanlstsusaetdw. Thhicehplhieyswicoarlkeexda,mbiuntattihoen iksinimd poofrtjaonbt afonrdtwthoe mreaalsosnisg:ns(,1)whIticmh,ayinshcoownjuanlmctoisotncowmitphlettheeabesxetnecnesivoef arbonenotr- g(2cn) oigtrmapahyicrecvheaanlgeevs,idisenaclmesoostfpaacthtiovgitnyomofoannicinoffescitliiocuossisp;raoncd eisss.thAesdaelrteearmdyiniantdioicnatoedf,tthhee lmatoesnttdieflfeimcuelnt tdioagfnionsfteicctipornobilnema tlieosnioncaonf smetatslesivtheiscoqnugelsotimone.rate type. Only repeated examina Other Complication of Silicosis hasThbeeeenffdeicstcuosfsesdilicwoistihsouuptodnetfhineitceirccounlactliuosnionis. aBsoutbhjesciltictohsaist abnedliehveeartthdaitseoabsestarurectmivoestfifbreroqsuisenitninthmeatluurnegsadruelstullitfse.iMn acnoyr opuf ltmheonhaelaertw. Iitfhthcisharreascutletrdisoteics fhoyllpoewrtriot pishyproobfatbhley lriimghittedsidtoe eseaesemss otof mpraosdsiuvceecloitntlgeloamnaetroamteicsailliccohsaisn.geDiisncrtehtee pnuoldmuolantaioryn braloreodinvewssheilcs.h Bountlyevtehne wriigthhtcsoindgeloomf etrhaete hdeiasretasies eaafsfeescteadrc. mMiogshtt ofeatshielym hhaavvee goernigerinalaitzeedd cianrddeipoevnadsceunltalyr.lesOiobnsstruwchtiivche fwiborrokseisd ihneatrhtebulut nthges wplraicteers qaunesatidodnesdwbhuertdheenr iot nis athperiomvaerry cause of heart disease. eraWtedhilien spoumlme oanuatrhyorlseshioanvse, ccilracimuleadtesthtahtrosuogluhbltehesilbicoad,ylitbo hpoyipsootnheotitchaelr rteisassuoensi,ngth.eArenyisenxocethssinogf tnoepshurpiptiosrtthathtismapyuroelcy scculrerocsains abtetheexapglaeinpeedriobdys wthheenhsiiglihceorsisinicsicdoemncme oon.f Sairlitceoritoic rinegvoullvaremfienndtinogf laynmdpohccnaosdioesnaaltlythneodheesadaloofngthethpeanacbrdeoams iinsaal caaourtsae asrycmipntvoomlvse.d. Only once has the writer known them to ) 1254 L. U. CARDNF.n Prognoiii gooPdro. gInnosthise ianbsuenncceomopfliicnafetecdti,ondissuccrhetel,esnioondsulraerduscielictohseisreis soerrdvienacraypawciotyrko. fPtehresolnusngws ihthutsdimopnleotssileircioosuisslyshionuteldrfebree wkeitpht duentdeecrt oebarsleyrveavtiiodnenacneds ogfivteunbearncualonsniusa. lInx-trhaey aebxsaemnicneatoiofnthtios coMmpalsisciavteiocnontghleoimr elrifaeteesxiplieccotsaistioisn aismnooret sgerreiaotulsy ciomnpdaitiiroend.. tIitatceaufsreosmditsuabbilrictyuloin-siiltiscooswisn irnigahnt ainnadctiitveis phhaarsde.toMdeinffewreinth sbmutallafctoenr geloxmeretiroante dlyessiponnesa oifstemn uwchorkmowreithoblvititoleusditfhfaicnultiyn tghloosmeerwatiitohnsthaercdiuscsureatlelyfoinrmcapoafcitthateindgisbeeascea.usTehoef laasrgsoecicaotend emTpuhbyesercmualo. sis in any form is a serious complication of sili cdoisseiassea.s Diteitsecrteesdpoenasrilbyleanfodr pmroomstpotlfytshuebjdeicsatebdilittoy tfrreoamtmtehnist iatdvnaenedcednottubtecrrmcuinloa-tseilifcaotatlilcyleinsiotnhse acroeoapneoratthievre mpaattiteenr,t.thTohsee ipnrowghreosms tahnedreailsthaonueglhemdeenatthofmacatyiveocincuferctfiroonmquoittheerregcualuasrelsy, many ultimately succumb to their infection. Treatment and Disposition of Cases muTsht ebree pirsevneontkendobwyncotrnetartoml eonft thfoerdusislitcoinsisth; etheenvcioronndmitieonnt apnlodyebdy. Gthoeodprpolpaenrt sheoluecsetikoenepoifngp,etrhseonussewohfowaartcert,oadbeequeamte gfiecnieenratl tvoenmtialianttiaoinn asnadfeloccoanlceexnhtraautsiot nssysotefmdsusatrcinustuhaellyairsuoff ewxoarmkiinnagtiopnlactoes.exMcleuddiecaplercsoonntsrowl itihnvtoulbveerscualopurseelemsipolnosymfroenmt eexvpidoesnucrees toof sdiilsiceaaseduinstthaonsde aplerreiaoddyicemexpalmoyineadt.ions to detect OnItnadreiop,enanddenbtyobthseervSaatriaonnascbLyabHoorbastoonry, Dinenthniys,caonudntIrrywihnavine demonstrated that aluminum and certain of its compounds ) THE PNEUMOCONIOSES 12 55 wseirlvleprsreovbentatintehde dtheevierlorpesmueltnst wofithsilifcionseilsy. TdihveidCedanaalduimaninoumb pwoiwthdethr.e ThyhderoSxairdaensacofLaalbumoriantuomry.'sImexmpaetruimreenstislicwoteicrelemsiaodnes aafrfcecatbeodr.teTdoanbde reefgfreecstsiv, eb,uat flualrlgye dqeuvaenlotipteyd onfodthuelesinahricbintoort cmyutisct rceealclsh tthhaetsacmonetaloincattihoen qaunadrtpzropbaarbtilcyletsh.eCshamemeicpahlagroe accotmiopnlerteesluyltsneiuntraalciozeadti.ngExopf etrhiemseinlitcsaawrchonsoewtoxinicperfofgercetsssaract twhehePthoercruapliunmeiSniulimcosinishCallaintiiocninthTeirmapmyinhsa,sOannytariinof,lutoendciescuopvoenr smyimghpttobmese.ffAecstiavep,rboupthdyilfafcictiuclt mofeaaspuprleicaaltuiomnintouma lainrghealgatrioounps boef swuobrsktimtuetend. Tfohreerengiisneneorinregasmonethtoodbsetloievreeduthcaet aittmcoasnpheevriecr conTcheentrdaitsipoonssitioofndousft.employees in whom the periodic ex eaamseindateipoennddissculopsoens daifnfuermenbtermoafniffaecsttaotriso:nsthoef epfufelcmtiovneanreyssdiosf dthuestocpopnotrrtoulniitnietshefoprltarnatn,stfheer tcoonodthiteiornjoabnsd, aangde soof otnh.e Mmeadn, iwcailll redceopmenmdenudpaotinonas itnhoeraocuhgchassetumduystobfe tphaertiicnudliavriidzueadl.anIdn gtheenierrarle,gmuleanr wwiothrksiimnpalepdliasnctrewteitnhodauglaotoiodn pmroagyracmontoinfudeuastt cemonptlrooyl.eeExwcheoptimonansihfeosutsldsibgensmoafdeeairnlythseiliccaosseisoaffttehre aysohuonrgt eshxopuolsdurbee. Mtraensisfeprrreodbatbolyanmotohreer sjoubsc, ebputitbtlheertheains noothmeresdiacnadl orefasthoen ewashey whiethshaosumldalsltofopcuasll owf ocrokn.gTlohmeesraamteefimbraoysisbewsiathid oacuttermsueecmh tdoyshpanveeal.esMs doyrstpandevaainfctehdeyeaasrecs aollfowtheed staomdeoclhigahrt whoowrkevienrs,teaisd oofftebneinemg blaairdraosfsfedwittoh nfiondexeenrcoiuseg.hMjoabnsagoefmethnits, chOarfacctoeurrisne tahlel ohfeathveyseinmduesntrrieesquliikree cmoinnsintagn.t observation to detect the earliest evidence of activity in an infectious com 256 L. U. GARDNER tpelcictiaotinono.f Othpeenresttuboefrcthuelogsirsoumpe;netiasrlsyegtruebgeartciuolnosfiosrshthoeuldprboe sgiibvleeninfutlhl esacnoaotopreiuramtivterepatamtieenntt., Tanhde rcehcroovneircy tiusbqcurcituelopsiolsi- cmoattiec irsecboesvteeryareisdrfaorer.on a modified regimen of exercise. Ulti RAPIDLY DEVELOPING 8ILICOSIS in Aa freawre ganrodupastypoifcaplermsoannsifeesxtpaotisoend otof seilxiccoesssisivheascoonccceunrtrread twioanss foirfstveirdyenptiufireedanind vpeerrysonfisnemqaunaurftzacdtuursitn.gThainsdcopnadciktiionng aasbsroacsiivateedsowapithpothwedseirlsicaancdauistedwarsapaisdsusmoleudtiotnhaotfftrheee ianlkhaallieeds qpoutahretzsi.sAannidmsaulbesxepqeureinmt eonbtsfeirnvdastionno hjuasstidfiecmatoionnstrfaoterdthsiismhilyar etuansenselinwsoarnkdebrlsaswtehrosswe oerxkpionsgurien ienncclluodseedd ntaonkaslkaalnieds.ceArtfateinr piiearvieoddsevaesloshpeodrt saesveerieghdtyeespnnmeao.nCthhsesstomroeenotgf etnhoesgeraompserraetviveeasl onnolysuaggfeinsteiodniffoufsethheazcilnaessssicathl rnooudguhloautitonth. eAlufnegw fihealdvse wdiiethd twaiintheidn. aMyaenayr oorf stoheamnd sahonwumedbear ocfomauptloicpasiteinsghatvuebebreceunloosibs, abnrodnicnhmoponsetuomfothniea.otBheurts athpearctaufrsoemof tdheeaseth iwnfaesctaionuosnslpeesicoinfisc, awllhiochf, tihnegrlousnsg, ssuhgagveestedpreasnenotregdanaizinggenpernaeluizmedoniicndpurroacteiossn, bcoutticonremacictrioonsc.opIrivcineexamapitnlaytiodneswcraisberdeveiatleads aas a"dduifsftuspenseilui moPnriaac.'t'ically the same picture is seen in guinea pigs exposed stoizee.xcIensnsiuvme earmaboluentssiloicfoptiucrenqoudaurltezs doufst moficvroersycofpinice pdairmtiecnle sTiohnesreociscuarlsothraoguegnheorualtistehde pwraolllisfeorfattihoenpouflmalolncaornynaeicrtisvpeacteiss. stiusesueelemwietnhtisninsothmeeluonfgsthaendaltvheeolfio.rmTraatciohneoobfropnlucghsiaolf sliymmilpahr node reaction is minimal. Apparently the lung is so nearly THE PNEUMOCONIOSES 1257 othveerwlyhmelpmhaetdicwsiythstethme liasrgeentairmeloyunitnaodfeaqupaotetentto irrreimtaonvtethaitt. pRoeratciotinosn obfegthines osrgimanu.ltaHnoeowuesvlyer,thervoeunghuonudterthseuchfunccirtciounmal scthaanncgees,. tIinmeguiisneesasepnitgiasl nfootrhitnhge qcaunartb/,e tsoeepnrofdourcetheanfyirsgtrossixs mthoisntchosnodfitieoxnpoassuraen. T"haceuretef"orseiliict osseiesm. s ill advised to describe poTsuhree dwiahgicnhosims udsetpebnedsveurpifoiendthine ahlilsteosrsyenotifalandeutnauilssu, aulpeoxn tthhee rcoliennitcgaelnopgicrtaumre woifthmiatsrkbeadredlyysipdneenat.ifiTabhleesehaezaisneesssnaenedd careful protection against infection. A8BE8T0818 Pathological Anatomy rsonT-hrteoduchUarraficbtreorissisticinvfeoalvtuinregsilol-fdewfienleldmpaorrktieodnsaosbfetshtoesipsaraernech(yIm) adoifffutshee, slutrnagn,ds(2b)enmeaotdhertahtee lasitreerdal eamndphiynsteemrloebtoaursplbeluebras, oanftden0 l)octadtbeedsivine ffiibbrroouuss lpalpesuerdisyb.ySmucohdearaltuengprehsassurae.doughy consistence but can be partially col ingTohfethdeiffinusteerlionbvuollavremseepntat isso ftrheaqtutehnetsley satrsusocctuiarteesdawreitchleafirblyroudsemthaircckateend ofinndtsheancuiltl-sduerffianceed ocfoltlheectilounngos.f Ignratyhedcuesnt tpeirgmofeneta;chinlosbeuctlieonosnecuutsuianllya penroteprerthpelapniegmdeinetefdanalirkeea. bTrhanecheemspohyf seamtaetromusinabllebbsroonfctheinoloeccaurcr isneernowtos droiaumgheltyer pwariathllelsmtoootthh,e gplilsetuernai.ngMgorsatyofwatlhlse;msoamreetimlesess tthhaeny Jaremmm.ucihn ltarargchereoabnrdonpcrhoiajelcntotdhersouagreh balnude-abblaocvke.itnhecotlhoirc,ksemneadll palnedurma oadsebrautlelalye. fTirhme. denMseicorroshcoypaliicneseacsuoinnssiloicfostihs.eItluenxgtsendrsevefraolma thdeifftuesremifniablrobsirso,ncnhoitoleass ainntoincthluedepdarepnlacnhey.mAan,imreapllaecxipnegrimmeanntys abnudt tnhoetfeawll coafsetsheof aeirarlsypadciesseasine tinhemtaenrmtihnaatl hbarvoencchoimoleestoanaduto(lposwylyrevseparleatdhsatinstuochthfeibrpoesirsipbheegriynsoafbothuet lruenspgi.raAtoprpyarebnrotlnychmioolsets owf htohseesewfaibllrsouasrcfoirrerieggnulabrodbieescaaursee coafuglhatterianl tahle tvheeolabrropnocuhciahles.treJeustchparnogxeims aflrotmo tchielsiaetesdtrutoctulroews tchoelulminninagr ecpeiltlsh,elainumothoefr fthaecstoer bwrohnicchhiomleasy tihnefluleantecrealreatelvnetoiolin.arAes cfliobsreodsisodrevsetrloetpcsheind tshoe twhaatllsthoef innotwernpaalsscodneteopuerr oifnttohethreubleunbgescoamndes thsmeroeotcha.usSeubmseoqrueenfitblyrosiinsh. aIl'eadtenfitbearisr ) 1258 L. U. GARDNER svpolvceod ibnrotnhcehimoliedsstoouftsidefitbhreoupslaznoen*ofarseecatipopna.reInt tliys psuropbpalibeldy bthyesuenianir spacAescwhahriacchtedriilsatitce afeftaetrurbeeiinsgthceutporfefseanncde aoplpelaarrgaes enmumphbyesrsemoaftotutbsebttloebtist. abnoddieisr.oTn huepseonstrthuectusruersfarceesuoltf ftrhoeminthhaeleddepfoibsietriso.nTohfeaylbvuamriynoiuns smizaetearinadl srohdapse5ftroomfiOmorinmutoereglmobicurloenss Iinmliecnrgotnh.oTrhleeyss airne dgioalmdeente-yreltloowhaiunstcraotleodr amnadnyezshhiboiwt mbeaandyinbgizoarrresmfooormths,. laMteorsatl hparvoejescwtioonllse.nT, chleuyb-oshcacpuerdinencdlussatenrds within air spaces or widely scattered throughout the scar tissue. Roentgenologic Findings unRcoomcnptlgiccantoegdraapsbheicstosaipspaeraeramncuecslt olefssmoobdvieoruatseltyhanadtvhaenacneda, atolmigihcta,ldcihffaunsgeehsawzionueslds osvuegrgleysitn.gInthspeelcotwioenr othfirthdeoffilbmotrhevlueanlgs fAiesldths.eEfvibirdoesniscems aotufrepsletuhreisyhaznitnaeyssoirs mmaoyre nportonboeunvciseudaliuznetdi.l istcurereaschaells ltuhnegsom-caarlkliendgs".gTrohuendupgplaesrs tahpiprdesarraenmcea"inwrheliacthivoebly cisleparr.obTahbelyfadiulueretoofthtehereflibatriovseislytolacragset anummobrec^rdocfnspcastehnadt oawir srepvaecaelss paesrsmisuticnhg retharcotiuognhoinutthiet. uApspehrisltuonloggsicaasl inextahmeinloatwioenr itshidrduse, ittoisthienfegrrreeadtetrhathtitchkenedsisstroifbuthtieonloowf ethr eluxn-gra.yVschradoawds voafncreetdiccualsaetisomn asyupsheroiwmpaosfiende sutpipopnlinthgeangdroauncdertagilnassamboaucnkt gsirboluenfdo.r Itnhesuscoh-ccaallseeds "ppleourrcouppeirniecahrdeiaarlt asdhhaedsoiwon."s arc respon Relefiomhip fo Infection culAosmiseraiscoanccsuursrvienytsherevfreeael sniloicasuicnhdugsetrnieersa.lInexEcensgslaonfdtmubuecrh mallorceouinnftericetsionrevheaasl bmeeannyreipnosrttaendceasndofautetrompsinyalstatutibsetirccsulforsoims. Atunbiemrcaulloesxispetorimpreongtrsesdseumpoonnsatrabtaeckngorouspnedcioafl atsebnedsteonsicsy. Tfhoer ibnyfecthtieondsusfrt.eqIutesnetelymsheparl,obaacbcleenttuhaatitngsotchioe-eficbornoosims ipcrofvaoctkoerds the pneum oconioses 1259 fmluaeyncoeudtwtheeigihnctihdoesneceoifntthhee dpuossttmaonrdtemthaetasseesl.ecPteiorsnonlisaswiitnh atosbrieastowshiserwehaouctoopnstireasctwtiullbebrecusleocsuisreadrebaepctautosebeofsetnhtetospseacniaal idnytienrgestelsinewthheereoacrccupleastsioanpatl toorcigoimneotfo tahuetiorpsdyi.sease. Those Course of the Disease theTphaeticeonutsrswe hoof cthoeulddisbeeasefoilsloswoemdewcohnattinoubesdcutroe wasomrkoswtiothf omfodreusotrcloesnstrdoulsitnexmpoossturAeminersicpaitne foafcttohreieesx. cCelalseenst tphraotgwraemres qinutietnesewexl-lradyevshelaodpoewds;wthheonsefwirsitthoblistetlrevecdhannogwe artevtheeal omutosreet smeaelms ntoo rpemroagirnesisnioanpporcocxuirms aatefltyerthceomsapmleetecocnedssitaitoionn. Ionf aenxi bpoustuirte.dAocnsynfoibtroinsicsreoarsigeininallayrepar.esAesnbtetsetnodsiss tobobdeiecsomdeisadpepnesaerr binettowteheen lutwngos aonfdgutihnreeae pyigesa.rs after an injection of asbestos Clinical Picture ouAt oefasperoopf oarstbioesntostois ethxehibseitvsedriytyspnoefa twhehicrohensetgemcnsoegnratiprehliyc cuhnapnrgoedsu.cTtihveesecopuagthie,natsndaracrevesaryidsthoorhtaovef barseoamthe, whhavate baludisryh cinojluorry. Tarhcenloatttgeernseyrmalplytoemliciistendo.tOincvcaasriiaobnlael.lySiagsnbsesotofscbaorddiiaecs cabansenbceedoefteacstseodciiantedtheinsfpecuttiuomn. but they rarely appear in the Complications thiAs scoanlrdeiatidoyn,inbduitcathteedretuisbelirtctluelotosisinmdiacyatheeansuepxecreimsspivoesepdreovn Raleepnocert.edBraountocphsoipensefurmomonviaariiosusa ccooumntmrioesnehravceaudseemoofnsdtreaattehd. twenitheaassebseostfospirsimbaurtyinbrcoonmchpoargiesnoinc wcaitrhcinthoemanuammboenrg epxeprososends to this dust this incidence would not appear at all surprising. T 1260 L. U. GARDNER Tidheael cthoarcarcetaetre oaf tchoer ppuitllmmoonvaarlye bfiebcraousisse wlaorugled asmeeomunttcs boef cpaapthilolalorygicbaeldevairdeenocbelitseereamtesd.toHionwdiecvaeter, anheiigthherfrcelqinuiecnaclynoofr carAdiaccominpvloiclvateimonenot.f the occupation although not of the pul Tmhoinsarisy adilsoecaasleizeisd tfhoecusso-ocfalclehdroansibcesintofslamcommatioonn pthroevoskkiend. tbryaterelianttiovetlhyecsouabrsceutsapnleinotuesrstiosfsuteh.eNmoinaesrbaelstthosaits mboadyiepsenarec formed in these lesions. Diagnosis asbDesiatogsnofisbisersd,ecphenardasctuepriosnticachhiessttorroyenotfgeenxopgorsaumres taonddupsht yosf piclaalntfsinwdhinegres. fiDreupsrtooefxpteoxstuilrees,obcrcaukres liunsiunaglsl,yanind sfiambirliacratminag tfeorrialisnsaurleatminagnupfuarcptuorseeds., oSrtraamngoenlgy theonsoeuguhsinegxpasebriemsteonstfibhaesr dtheamnovnestrryatefidnethlyatptohwe dloernegderafsibbeesrtsosa.reTmhiuschprmoboarbelydaenxgpelraoiunss tvheeryabdsuesntcyepolafntthse, tchoenmdiitnioenralatwtahsegmroiunensd,wsheepraer,atiend,foarnmdetrhlye efixnpeostsuprreodoufctasbocoultleecitgehdt fyoerairnssusleaetminsg npeucrepsossaersy. Aton parvoedruacgee rocntgcnographic evidence of asbestosis. ITnhlye, M19c4il2i.cal Clinics of North Anteric LEAD ABSORPTION AND LEAD POISO NING R O B E R T A. K E H O E , M.O.* meDtheosdp ist feo rthreecoagvnaiizlainbgiliatynd opfresvoeunntdinganddangweerlolusesitnadbulissthrieadl olefadleaedxppoosisuoren,intghearmeoinsgsitnildl uasntriualnnweocrekssearsri.lyFuhrtighherminocried,endcee scpointefustihoen eaxnidsteunncceerotafingteynoefratellnyenretleirasblientoditahgenocsotnicsidcerirtaetrioian, osufeaissuthspeepctreodpecrascearoef opfluamsbiciskmm, awnh, eththeerhythgeienqiucessttiaotnusaot fisa ptiloann.t, Fthoer gthraensetinrgeaosof ncso,mopneensmataioyn,boer jtuhsetifoiuetdcoimn ereovfieliwtiignag tohfelehaydgiceonmicpoaunndddsiaingninodstuicstrpyr.oblems that arise from the use T H E E V ID E N C E S OF O C C U P A T IO N A L LEA D A B S O R P T IO N beTrheceogenxiizsetedncbey oafsuorcvceuypaotfiothnealmlaetaedriaelxspaonsduraectcivaintieussuinalalyn ipnodsuusrteriaclanplabnet.eTsthime agteednebrayl othrededreotefrmmiangantiitoundeofofthteheleeaxd cstoanntdeanrtdomf eththeodastm.'-o*spBhyerseucohf wmoearknisngit sipsaucseus,alblyy pthoessiubslee otof edxetteenrmt ionfe ththee ndeeedgrefeoropfretvheentoivcceuapnadtiopnraelcahuatziaorndaryandmetahse uroreosm. sInindetehde liefatdhetraldeaeds wcoenretemntaionftatihneedatgmenoesprahlelyrewoifthwinotrhke lainmyitsotnhoerwcaruecseogtnhiaznedacacsidseanfets, oanccdutphaetiounnaflorseasteuernnisemffe, cftsroomf csohalnognegs ians pthlaenthoazpaerrdastioonfs,mwaonuyldplcaenatsse atorconccoutr.unHdoewr esvuecrh, lege* oRfesMeaerdcihciPneroofefssthoer, UKneitvteerrisnigtyLoafbCoriantcoirnynaotif, ACipnpcliinendatPi,hyOshioiolo.gy, Cnl- I2t