Document 3N1J7wGxweXqeOEdV4rXeL6ZJ

FILE NAME Brakes BRK DATE 1940 DOC BRK008 DOCUMENT DESCRIPTION Journal Article - Studies in Asbestosis - Diseases of the Chest PUBLISHED . MONTHLY by AMERICAN COLEGE OF CHESTYSICIANS _ ESPECIAL for PHYSICIAN in the GENERAL of see OREGON New oe Your N. :. SAMUEHL. WATSON M.D. SUBSCRIPTI2.O5N0 YEARLY SINGLE COPIES 25 cents DISEASES OF THE CHEST Studies in Asbestosis MOSES J. STONE M.D. Boston Massachusetts Physical were not ir red by pe ' mass at the The diagnosis of asbestosis its clinical course the effect it produces on organs other than the lungs as well as its various compli- bodies in the sputum indicates exposure asbestos dust but it does not absolutely de- note disease . cations and sequelae are very much in the controversial stage Only within the last de- This report is based on a study of 180 tients examined by the author in collabora- cade has the subject of asbestosis really re- tion with the late Dr. John B. Hawes II ceived the attention of the medical world great majority of patients had been employed The literature on this subject is still rather in a factory manufacturing asbestos brake vague and only recently has the hazardous _ linings with an average exposure time of nature of exposure to asbestos dust been re- to fifteen years cognized and studied To be sure asbestos is not a new mineral,,The mineral mentioned Classification Classification riched dry ; Bronchiecta in the writings of Herodotus and the second Pliny was known to the Romans who mined it from the Alps and the Urals In 1900 MontagueMurray recorded in the Charing Cross Hospital Gazette a case of disease . due to inhalation of asbestos dust Hoffman was the first American to focus attention on the magnitude of the asbestosis problem in the United States In the same year Lynch and Smith reported their findings on asbestosis bodies found in the alveoli and bronchioles and in the fibrous and ne- crotic areas Gloyne and others have described the asbestosis body as a core of asbestosis fiber surrounded by iron containing deposits The bodies are slender elongated seg- mented structures with bulbous ends and stain blue when treated with potassium ferrocyanide The essential features of the pathological changes of asbestosis appear to be pleuritis marked diffuse fibrosis with contraction of the lungs and the presence of the asbestos fibers and the asbestosis bodies Thickening of the visceral pleura with varying degrees of pleural and pericardial adhe- sions is often found Obliterating layers of fibrous tissue may surround the bronchioles and pulmonary end arteries Lynch and Gloyne note that the presence of asbestos fibers in the mouth and nose are an indication of exposure but not necessarily of dis- ease Essentially the presence of asbestosis 1 Asbestos is a hydrated magnesium silicate the composition of which varies with the sections from which it is mined Most of the asbestos used in the United States is Canadian crysotile containing approximately 43 per cent magne- aluminum nickel sium 13 per cent water and traces of and iron and 170 Of the 180 patients 32 were diagnosed negative although these individuals claimed disability ray films as well as physical signs failed to show could be attributed any abnormalities { to asbestosis Seventy eight patients were classed in Stage I when there was definite limitation of chest expan- sion less than 2 inches in addition to roentgenological evidence of increased lung markings Unlike silicosis the very earlyfi- only brotic changes are very indefinite and after considerable experience | together with careful standardized ray technique more marked ronchiectasi ronchiectasi monia were f ociated with proper history can a diagnosis of early bestosis be made In Stage II there were fifty- symptoms four patients who had definite and definite ray evidence of pulmonaryfries brosis Included in Stage III were sixteen well patients who had definite symptoms as as roentgenological evidence of marked pul- osis In addit the author a of asbestosis fries subseq momary tuber In 150 patie estosis were : monary involvement The average length of length exposure of the Stage I patient was eight years Stage II 10 years Stage III eleven years While there is slight evidence that the degree of fibrosis is apt to increase withthe length of exposure there are other factors such as intercurrent pulmonary infections that play a part in the development of fl- brotic changes in the lung structures ) showed he either to ascular fibro ith an increa per cent of th ine is obsc ~e Dyspnoea was the outstanding symptomin all patients Dyspnoea on slight exertion tightness of the chest cough general fatigue were among the other symptoms noted Stage III the patients also complained of inability to sustain any effort cough expec and toration tightness of the chest anorexia loss of weight BIL DISEASES OF THE CHEST imposed increased cases showed dull- eat bases with hyperresonance at the apes associated with diminution of chest xpansion Ascultation disclosed prolongation expiratory phase with some high dry rales Associated bronchitis or examination constitutes the most stant single procedure in the diagnosis asbestosis The shadows are much finer gher and more granular than the nodular ening of the emphysema and the pulmonary fibrosis ~ may cause rota- tion or lateral displacement of the heart Roentgenoscopic examination is essential to determine enlargement of the heart shadow and alterationisn the cardiac silhouette The ray appearance of asbestosis may be greatly altered by the congestion due associated heart disease It is also evident that the dyspnoea noted early in this disease is of cardiac pulmonary or circulatory rather than of origin . ny type of infiltration found in silicosis early stages a relatively slight in- A small group of patients were reexamined three years following the first examination in density in the lung bases is seen ray electrocardiographic blood studies and ith progression of the disease and thicken- vital capacity examinations were done The - 1g If the pleura a fine lace fibrosis is ni The typical granular or ground glass vital capacity was found to be 50-70 per cent below the normal calculated on the basis of arance is then noted especially in the ng and basilar areas The broncho- height and weight The impression gained from the study was that in cases of advanced lar markings are increased and peri- fibrosis the disease may progress ever after al and pleural thickenings are noted exposure ceases The heart was not affected Many cases of show limitation of motion and the diaphragm With associated unless pulmonary fibrosis was marked In the light of the blood studies fibrosis is the se the parenchymatous changes become result of irritation due to asbestos fibers and marked In the series of cases studied nchiectasis bronchitis and bronchopneu- not the result of infection Since the first examination 18 patients have died Most of were found to be more frequently as- the patients still pursue gainful occupation stated with asbestosis than was tubercu- but are unable to perform duties that demand In addition tuberculosis did not impress much physical exertion the author as being a serious complication The impressions gained from the above ~ . ?asbestosis Only one individual in the total study are that asbestosis is a debilitating dis- meter 20 subsequently developed active pul- ease caused by exposure to asbestos dust tu- | - mary tuberculosis berculosis is an infrequent complication and sonclSapriet In 150 patients the cardiac aspects of as- pulmonary infections other than pulmonary ier s were studied Ninety patients 60 per tuberculosis are fairly frequent complica- showed prominent pulmonary vessels tions In advanced asbestosis the right ven- hanetcprCowy either to enlargement or increased peri- tricle may dilate with subsequent pulmonary ad sular fibrosis Asbestosis was associated congestion Like silicosis asbestosis is caused hin eo 2an increased transverse diameter in 33 by exposure to asbestos dust and should be ir cent of the cases and 13 per cent had classified as an industrial hazard Hence such MOR O compensation mated mated sided hypertrophy The cardiac patients should be entitled to OV . is obscured and blurred by the super- under the industrial accident laws MARE ROI USO NA You Are Invited To Attend lA A - THE SIXTH ANNUAL MEETING - RCEont of the AMERICAN COLLEGE OF CHEST PHYSICIANS BILTMORE HOTEL in NEW YORK CITY - JUNE 8-10 1940 -