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FILE NAME Brakes BRK DATE 1957 Jan DOC BRK014 DOCUMENT DESCRIPTION Journal Article - Medical Journal of Australia - Pneumonokoniosis in Victorian Industry -> Vastasy 19 195 were - THE MEDICAL JOURNAOLF AUSTRALIA AUSTRALIA * . IN PNEUMONOKONIOSIS IN VICTORIAN INDUSTRY ^' _- a Lt oe, By D. L. GORDON THOMAS Industrial Hygiene Division Victorian State Health hazardous inasmuch as the containing substances are newly ground The highest incidence was in a tile wall works where flint was used in considerable - ' 4. Mineral earth workers are the most exposed of all . : Department Melbourne Quartz diatomaceous earth and asbestos are ground with usually makeshift machinery and the dust hazard is SINCE the end of World War II Australia has been under- going rapid industrial expansion in all fields coupled with largescale immigration Although in 1956 some 43 of national the income comes from wool the situation in the extremely bad One subject a man aged thirty years died of uncomplicated silicosis within nine years of com- mencing employment These places have an unenviable _: record of death and disablement = of .. years to come may well be different - In view of the 5. Masons and quarrymen are exposed to the dusts ravagesravages to health which such industrialization has produced various types of stone Granite can contain up to 30 of - Stawell in the past in other countries it was considered essential free silica and stone and Sydney freestone are for -.. ~ to obtain some facts on what had happened in Victorian all practical purposes pure sand Basalt quarrymen can - Industry in the immediate past in terms of industrial - develop an ray picture which is hard to distinguish from 7: chest diseases Without accurate knowledge of where the silicosis these men are free from symptoms . hazards really lie it is impossible to have industrial expansion without a health toll Without this knowledge - 6. Boilermakearnsd welders are exposed to mixed dusts ; Few in this group are incapacitated a et dust through there can be no planning for the future the mere policing of regulations leaves much to be desired in the - 7. Metal polishers are subjected to silica ~ * field preventive medicine Accordingly in 1952 a survey the abrasive they use which is beeswax impregnated with to determine the sources and incidence of pneumonokoniosis pure silica and known to the trade as tripoli exposed . was.commenced was.commenced by the Industrial Hygiene Division and _, 8. Stokers are -. the various aspects of the findings are now presented mainly to coal dust . ~ The total number of cases reported to the division prior to the survey was 522 which included 343 among miners ws and 179 industrial cases The figures now read follows -+ - as total 1126 with 587 in - 539 in industry The ye. oon : . Number of - miners and - ray investigations were carried out on full size film Occupations Number Cases of Subjecta Occupations { Radiologically | Pneumono 17 inches by 14 inches on personnel who in the opinion - Se Examined | koniosis |. of the division were employed in dusty trades The total i rr ae 7s . - Found * ~ number of individuals radiologically examined was 3823 Table I shows the results of the investigation In the survey the number of moulders radiologically : examined was 1918 and the percentage affected was 4.6 Three hundred asbestos workers were examined and this number would cover most of those exposed to dangerous amounts of dry asbestos dust here the percentage was 15 . The most dangerous occupation is mineral grinding largely of quartz and here 30 of those radiologically Moulders .. - .. oe Brick tile and pottery workers 22 ee Dressers workers Mineral earth workers .. * Masons and quarrymen Boilermakers polishers oe .. oe + os Asbestos workers .. ~ Spray painters .. o Cleaners we Tee .1913 333 . 214 +1 171 130 . 203 300 = 20 8. - 91 . - 31 . _3t- ene pS 268 - . - 8 at ~~ .T 2 . -"" $6 woe _ ._ 30-0 -: ~ 15-0 _ _ examined were affected In the other categories the people surveyed were those exposed to the greatest risks in the particular occupation and not the employees as a whole so that any computation as to the percentage affected in those industries would be erroneous In the 360 cases Food workers ve oe Rubber workers .. ee _ Wood grinders ..- .- Cinematograph operators . Dry cleaners Stokers .. o oe . ee 25 ~ 12 7 4 Rzy - 4 2 . 2 . 4 . woo _ -c oe 4 1 10 a ee : found all the subjects have been examined their industrial Foundry labourers oe histories have been taken and their exposure to dust has Plaster workers - .. .. been confirmed Apart from those suffering from asbestosis COedmdenoctcuwpoartkieornss ... < *- .. great majority are silicotics many of whom are grossly - . disabled and many short breath others appear to be _ - _ ~ -20h -_ = ee ._ - om! ond ome eto =o . quite well apart from a slowing up and slight shortness ey of breath and some are entirely symptomless . ele . Total 3823 _ 360 - - 7 7 Discussion : . 's Bry Silicosis . . -> por ee ~ 19. Rubber workers are exposed to talc which is mag- If we consider the conditions in the various types of nesium silicate this can produce similar effects toto silica RR occupation we find the following factors tk and a similar radiological picture ok 2 1. Moulders are exposed to silician the moulding sand and often in the parting powder One of the cleanest foundries investigated produced the highest proportion of silicotics 10 owing to the fact that they were using ~ silica flour which is very finely ground quartz as a parting - 10. Cinema operators are exposed to carbon metallic _ oxides fluorides and silica from the carbon are lights used ~ - in the machines ee lights ; 11. A chance ray picture of a worker in a cleaning | . powder Many moulders with long exposure are grossly disabled . fine 2. Dressers are exposed to moulding sand and to metallic particles produced when castings are cleaned by establishment showed nodulation with no symptoms Inves- tigation showed that diatomaceous earth is used in the-. process of dry cleaning and constitutes a hazard A survey of this industry is under way ~ ne emery wheels automatic chisels and swing grinders The tcols in general use are now driven and recently methods of exhausting the actual tool are being evolved Some of these men have gross ray changes which are out of all proportion to their symptoms while others with less The radiological appearance must not be used as a yard- stick to measure the severity or otherwise of the disease. Some subjects with gross ray changes are almost symp- tomless while others who are gravely disabled show very - little abnormality rote _ pronounced changes are gravely affected In cases in which the bulk of the inhaled dust is metal the symptoms are usually slight 3. and Brick tile and pottery workers are exposed to silica conditions in these occupations are particularly In the survey there are several sets of brothers who both developed silicosis in entirely different occupations This suggests a familial tendency One family group of ~ seven boasts silicotics affected in three different processes - : oo 76 THE MEDICAL JOURNAL OFAUSTRALIA mixing with diatomaceous 3 materials sawing cutting A person quite unaware that he is can after an acute suffering from silicosis its use in some disabled in a very shorptulmonary episode become totally process or kaolin to form earth -who have time There are at least 20 listed lagging and to the totgarllaydudaitseadblferdom the mild short of breath class - finishing any product containing brake linings asbestos asbestos example : sheeting "+ four years The use of in periods in all cases less than materials tearing and various insulating lagging this . 35 millimetre film is generally dangerous down old . - is a very the diagnosis of pneumonokoniosis Many on walls process even in the open air spraying asbestos early and ceilings as an insulator - of oe silicotics 7 are GEL silicotics who under treatment for The pulmonary fibrosis of asbestos workers is in misled their doctors t y saying that in the mass unwittingly by - in its onset irregular in its insidious course and variable in its _- findings were clear The ray examinations their chest termination but once established it constitutes JO normal after - the subject'sray appearances can return to threat to lifa and health Briefly the pathological a chagnrgaevse .--i : _dusts This has removal from exposure to some are such that the air cells become obliterated ~ otek } occurred with wood dust tissue As this progresses the lung tissue by becomes fibrous -- - powdered survey fo, } - and the elasticity of the lung deteriorates the used up in several cases lung available to carry out functions diminishes amount of -. which 1 which sanatoria in to toms appear The condition is and symp- Behe exposure irreversible 3 been proved and compensation obtained and once the stigmata progressive and .- 2 removed No : carcinoma of the lungs were found - cases from the hazard The ampapienar the subject should be ton tat ; asbestosis shortness of breath symptom is steadily increasing While fla are so insidions in their easily influenced asbestosis predisposes the there is no evidence that : by acute pulmonary tions the subject to acute pulmonary infec Nad presence of bet 2 it would appear wise to advise the subject chances the condition seriously impairs the ~ sulphonamiderecovery when occur : shortness onfebwreaotchcupation away from the hazard when of the z. infection does antibiotics advent becomes . apparent irrespective of his - sulphonamide drugs and of the antibiotics 13 following case illustrates this greatly improved the prognosis in these as age The -* cases . . : In 1952 a moulder of twenty years standing naan The most sought after asbestos in rs . " x. have typical silicotic ray was found to and mild appearances with nodulation -with long needles but unfortunatelyindtuhisstry is the type -a He was i: symptoms disposed earning big money did not hazardous type to handle The needles is the most - a __ and feel give his job 1953 inhalation and after a time enter the lung by - with pulmonary complications In he had influenza S if complications and today he ance and are then known as undergo changes in appear- -# +s. is Incapacitated completely colour and . The fact that pathological changes can con-tinue i.n the brown or condition yellow in The bodies are asbestosis bodies are found in all They are no other -- 3 ~Z _ lurenagliszeldong after removal from the must also be fibre and are shaped like modifications of a straight : . 4 hazard . 7 oe TTe we, and so on It is impossibd le u tomb a drum major's baton or: A woman now aged thirty ain appear but they have been state at what period these + > - a pottery plant She worked there fyreoamrs was employed in as fifteen months after found in this survey as early 3 ot _ years until she was the age of fourteen twenty when she exposure commenced The presence oad art, three children and carried on quite happilmyarunrtiieldfiSvehe had tosis but it is conclusive . eae ago when she abnormal patient has wis that the examination began to be short of breath and an years ray . exposed and that some proof been *: process < ~ revealed abnormality Her condition the lungs . : is at work in = sbh- - etuvbeenrtcuuallolsyisdiagnosed as silicosis after tentative diagnoseswaos f | . oo . sono TE pals and sarcoidosis were disproved - = inadequate industrial history delayed the o arUenliinkeacsciolridcoswiisththetheradiological findfiindings ngs in asbestaosbestosis sis severity of the 3 --__? zea nosis inadequate industrial history delayed in The af Ltt, an correct diagdiag-- greater the incapacity the more one symptoms - 4 " correct film In expects to see in the 2 served subjects Western lungs two lungs more the bases Desert interesting especialy especialy developed developed Australian who served during the case of glass . Western Desert with the Royal especially the right show a ground 3 the glass last war They were Australian appearance and the outline of the heart is ._ = _ in fixec d caampsmanp d s 17ray findings are mechanics their shaggy It is fully realized that a irregular or ry ~, typically silicotic they developed the condition It would appear that - of early asbestosis is extremely radiological diagnosis difficult and 2 -? and tankers probably ground otnheservice Heavy transports were regarded as such only after the most our cases fineness = the propellers sand to powder sideration A few films picked out at careful con- ae and produced intensely heavy cloudtheosfe men used to swing an to England for review none random were sent of them ve , pure silica can developed cases One case being from - well- 27 .job - Many incapacitated men could cope with . English standards In the was accepted as asbestosis on -. *. .job if it were not for the effort of a sedentary there were increased others while it was admitted -.- work In view of the progressive travelling to and from viewer stated that he markings at the lung bases the = and the limited sum payable as nature of the disease area from people who had seen many similar films in his a affected people to remain at compensation work we advise However as these had never been exposed to asbestos 4 possible - of the hazard of course The as long as ability to continue in useful employment is often increased by trialized area films where were taken in a highly indus- thought that to fog soot and smoke abound it is 4 ~ *f therapy a course of physio- of the same compare these with films of Australians 3 . | .be directed age proved at the nothing Criticism will no doubt _ -# Ite eo . Asbestosis -~ + In the section of the Mee . until the standards of diagnosis stigmata of but if one waits _. *:=7 300 men were examinedsur1v00eyhadrheadlating to asbestos workers can do little for the a developed case appear one - we patient tosistosis bodies and of this 100 47 sputum had containing asbes- yo ; ~ In this last group all had positive ray findings symptoms ranging from short- ness of breath on exertion to advice tendered to leave the hazard ; but since the gross incapacity number ; The procedure adopted was = _sputum were taken and as follows Specimens of examined for the presence of a weak heart for a was supposed to have asbestosis and is long time is actually suffering from 7 .bodies When these were radiologically examined demonstrated the patient was workers eligible for compensation is making most results patient interviewed When both tests gave positive has been very conscious of the hazard Much more history was taken and his , a complete industrial exercised by the workers in care they are much recent times and If he had symptoms clinical condition was assessed . more easily persuaded to wear a mask referable to the disease diagnosis diagnosis The disease most common symptom symptom practically all workers Jf- The following occupations .7 substance in its raw are involved handling the state grindinggrinding the substance prior to physiotherapy patients show an . Most therapy The improvement after a course patients given a course of of physio- had all been accepted for in hospital for at least compensation and all were kept ~ elimination of a month so that the rest and worry for the future were also beneficial a t oe ' YG > eae JANUARY 19 1957 , THE MEDICAL JOURNALJOURNAL OF AUSTRALIA 77 GASTRITIS factors All those given this course are still working at REMARKS ON CHRONIC WITH SPECIAL eh - Zo light sedentary occupations When this survey started REFERENCE TO THE PREVALENT INEFFICIENCY IN eight cases of asbestosis had been reported and the disease .-:", ake was regarded as a rarity It will be seen from the figures THE EXAMINATION OF THE GASTRIC CONTENTS ~ <7 Cee that the incidence of the addition to those found in disease is far too high In the investigation there must KINSELLA Ware be many more older folk suffering from the complaint From ts in whom it has not been diagnosed and who are incapaci - Vincent's oig tated and very poorly off financially financially and should be Ne ~ - 7. ~ 4 7~. . By V. J. the Department Department of Enterology SaintSaint - - Hospital Sydney -2 wy LR - receiving adequate compensation ~ GOEr PONDS sixty a were ' PyMEaNetSON _ _.. Summary WHEN a hollow organ is afflicted by disease a proper understanding of the processes at work is helped consider- Three hundred and cases of pneumonokoniosis . found in industry in Victoria No doubt there are many more either symptomless or undiagnosed.. . - Silicosis and asbestosis are not diseases of the aged Many of these subjects belong to the thirty to fifty years age group and for this reason it is imperative that con- ditions improve in the dusty trades two conditions ably by a study of the discharges provoked by the disease The discharges are in fact a sign of the disease the walls Diagnosis and treatment would lose considerably If this element were neglected Thus the nasal and postnasal discharges the sputum pot the urinary testing glass and the contents of the bed pan provide the clinician with valuable information which helps to truth in diagnosis and to success in treatment Moreover an increase or decrease ..-- 7 : . ... x ww ' =: " can occur together causing gross disability Six affected in these discharges or a change in their . quality provides bodies persons who showed nodulation and also asbestosis valuable evidence of the progress of treatment . - toe -were found in the same factory They are and two are aged under forty years very disabled - - But the stomach is unique When it is stricken its - - ra . tears are often ignored the nature of its disease is thus " is faulty ARF The survey illustrates the necessity of impressing on unrecognized a faulty prognosis is given and inept treat- ~. On medical practitioners the need for taking a complete indus- orde orr dee redd _-- . SF te at trial history of all patients irrespective of sex It is not YE One the sufficient to ask a person his or her occupation bread NN carter today may have been a miner twenty years ago For this several factors are responsible neglectful reports on the gastric contents made by patholo- < gists and biochemists A few years ago I asked a senior although Many women have worked and are still working the hazards now are less damaging teaching biochemist why he gave no report about mucus - in fractional test meals He gave as the reason that the EPR mucus could come either from the respiratory tract or from Industry in Victoria is becoming very PF conscious - the stomach and that therefore its significance could not ~ : While these investigations have been proceeding the be interpreted ~ : ER Industrial Hygiene Division has been busy encouraging - It is of oo. 8 eet Jord FLIP Pipi the suppression of dust Unions have sponsored the survey employers have been most cooperative in allowing their course highly unscientific to suppress evidence -. merely because its interpretation is difficult Moreover there is BLADES personnel to be radiologically examined in the firm's time in the always the chance that somebody else may succeed SEE In the firms where cases have been found close interpretation Thus by examining the respiratory tract the clinician inspections SROATERseme Me have been made and where possible conditions have been it is the source of dmiasycghetara gveeryBguotodeviedneathaes btioowchheemtihsetr anine housekeeping improved by exhaust ventilation by better it properly instructed in his art should be able to make - . . oye GAeSrt oan EON or by the elimination of the hazardoushazardous substance . The use the distinction easily ... . . ; tr Amn of respiratory devices is recommended only when the is hazard If the excess mucus gastric in origin it in 9 ,, is of short duration and when other methods cannot each specimen appears in It is intimately mixed with the ieee be used effectively Conditions in industry can be greatly contents so that when the contents gastric 1 improved in many cases by very simple means are poured from one . tube to another they are seen to be more viscous : * - idn amdpuisntg down the floors in a foundry led to big reductions The mucus is finely flocculated An approximate quanti- ~: counts ~ tative account of this mucus can given in terms of heten Legislation has been introduced to try to improve con- filtration time - - a? - a atonal _ditions Quartz grinding has been declared a dangerous in = a Mucus from respiratory tract occurs chiefly the _ trade This means that any premises used for the process fasting gastric contents it is in larger discrete masses it - a mot must be registered and in the event of the regulations often includes air bubbles it is easily seen when pressed not being aboka complied with the registration can be withdrawn out under a cover and it floats on the surface of the the and firm becomes liable if it continues to work in an gastric contents . The discovery of such mucus or muco- 118 unregistered building = ; . : te _*, pus may give a valuable therapeutic hint to the clinician . awaiting gazettal These are Improvement VX Asbestos regulations are . The fasting gastric contents should then be examined 70d _ very stringent and when in force will lead to a big microscopically Gastric mucus contains the nuclei of -~ However in conditions the most important leucocytes whose cytoplasm has been digested staining brut o single factor is to educate the worker to protect himself deeply with methylene blue and columnar or goblet cells ~In gastritis there may be large numbers of granular cells eMxhaanuystmaapnpyartaitmuess one cancan see expensive most effective - these are desquamated glandular cells or a persistent ~.- didn't like the rendered rendered useless by some worker who - increase in leucocytes In cancer one may find polygonal - dram other draught pushing a bag up a duct or some ' round or cylindrical cells with characteristic volume _ ,. equally silly practicepractice . these ve dust density and multiplicity of nuclei Eosinophile cells may | . When diseases one has seen seen the end results of these two dust give the clue to an allergy oot ae : diseases epithelial gross incapacity the patients realization . that the steady deterioration is inevitable and in many bacterial cases the financial difficulties due to their having used up - celplshaanrdycnagreboanlpamrutc iculsesmay contain squamoussquamous . Note should also be made of the population -. the compensation paid becomes imperative to ensure It is increased in hypochlorhydric gastritis and in cancer that as industry expands industrial hygiene matches the - A second reason for the failure = -. expansion stride for stride to study the gastric discharges is the lack of interest in and understanding of gastritis on the part of clinicians This is not peculiar to _ Acknowledgements Australia The position was illuminated by a conversation ~ My thanks areare due to Dr. Keith Hallam for his invaluable help on the radiological radiological side and to Dr. D. O. Shiels for many discussions on dust problems oe ' with a distinguished as follows : Dr. X I do : disease . British enterologist - enterologist not believe that gastritis is Dr. X volt a comment Soon eS hing Fn Rese 2 Ee Poe Se ae ae asd wer