Document 3e5QeEKXqo4NO2a3916gjEGKD

ttaO . WYXM: ncvcrtbebaa that > cemidsabie number of r&o develop complicated ptmunccombed whm iged 30 to 40 ara * vwy bod rht Tubcmiioab u pmtat is 36 pr cki of all pnouaocaniodc jeuha. in 16 par com. of a8 dmths duo to simple pettgaocsaiota, and in 39 par cant, of afl doubt Jut to compliatad pamainoanioeb. Tit figure (36 per cant.) of tha axttnt of eotapiiarinf tuber* eaieta is mei miners' paeumoenniotb it higher than tha figure givB by Gooding tad others, but it it considcribty lower'than tha fifuro for other industries, especially for data mining in North Wads wfccr* tuberculous b praam in ?s par one of pneumoeoniode deaths. Finally, ear b trppic--d by the apparently in* oeuad susctpabilicy of aoai miners with ample pneumoconiosis to pneumonia and acuta tory is/i ` uLSAifttta l. oKcixjtcaa.uar.^MtXAsnua./. < m^L Atmm .V<M> X tfc rjvtMfVS. 5.XTU. *M ttxOOCV. X t. ifMI. a^ UXUUX ta Urn SATO*. [,. M MA.VH. x litfV njTTOflne C. SC (IA coootNO. c a o*k <xmc coupon. r cough. /xmb. w. a, u gajagnrwornc ft e , WA ' A " .4KGOXY. J. & 9 CV.VTZU. 0. V H hajtt. f. pamt. ** AMirrr. t x o**a, taw NULC.X* mj (9k JINKimJNmMftm. wT*.eStmtta(*iuw*mClw`**rt?w*ta Mi JOUTTNC. N- PmmM --n .-1 uc&HWra^SafinSi s.wontv**..t, av. ms mccxwn. muxtapo. KALTumet ^ nur (im fm**. Cta IW. IX *> MtfKUtOKN. x tae %.jw & tatai HUbn Ctaae Bwmm.' iWcta aoocn. cmo nm *mr m*p * t< sumM*SCc*u w. **?>. Wta TATTUttAU. N. J. W / THOMAS. X W,, PwmmI MMH ASBEST05IS fTM"9y H. Wtox MuL, MO,, D.tH-> Although ccraia difficuiMs retaeift to ba as* *med. ch theory thst silica b a amnt in "uimonary fibrosb b widely utrpud Whan, **ev*r. (he fibrogenic pocantbliam of ofiemas * .maidercd. these dimculMi art ray grade "^cued. Olmne, for uampla, haa baas shown * "mvake only a foretgn body toacaon and haa luggntad for reuadry wort, wharaaa "''rtio* ia ftotorioux Scndia la mmaraioftal ttnoojiuon of atmeaphcnc duett aad aahad Fung are prognnuny ind to tha das fbuad ^ toiubiiirv and oyotai form art bang 4tud. If iht solubility b high, aa ia tha caaa of icd ~is.aad sob. `bomatahal b dgmnatad 100 fsat to product Sbrce*. A low solubility, such 4 '* oiBruma of ^uam aad aluaunhn, t^uafiy * i Sbroaia (Riog. rpjS). Thera appears also an optimum uat of parodt wnh a suriact ^ *Hieh wdl reicua siiim m n/jfitwa pivuuy * tiidWwm ItftftM of earn. Jc animai crpcnacsts thb waa found a ba 0.1 micron (Tebbana <s oL, 1945). Ia the ^ of ubmtm fibres, it has been shown that wharma than b an tsetas of chrvsoale os*tr hors* blende nnades ia duacx aahad lung daouas eon* tain only homblaacU (Sundiua. tpjS. Kuhn, rpat). It ta conchadcd that it b tha chrysotile in elunon which b tha fibrosing agent. Gardner (ipjf) demonaentad by amaai xtpenmano that longer fibres produced a fibrooe reaction which did not occur wnh 1honor shrea aad concluded that asbauosb 4. at say rut in part, a mechanic* ally condioooed complex of lung changes. Ln tuppovt of thb machaaiml thoovy. Johnccont (ipofi) maordi the dinicsl obacmcon that woHtare at tha Thcdbrd Mills, exposed to high conesnera* done of cnreoaly fiat aabaacaa duet, did not safer from aabmtnux Soruesunliy dlim shows coodnueua throe* dimansionai amngemana of SiO. tttrxhodre and to thaaa may be related tuch a turtaec as t<> re duce tha ehtnctcRsc^bieiofied cfacss. Thoaa silicstm, therefore, which nwu nearly rmmhia puam in having a thmmdinsaniionai nerwort of silicoo*cy|en trtnbedn are likely, thaerenmily, to product umdar bioioftml phenomena. Thcss p N. *je ^ . 4\ ` POSTGRADUATE MEDICAL JOURNAL ` * ^. K- - . ar grouped ift diminkhing order of aiaSaricy by . '' msrtman. Aabowas enters into tbs Xagoehchmidt (ipagt * alkali Mdspen, abase posiboa of laQtaf taatsrisi for ttsia p> soucrurw rack a* mid* and kaolia double and joiatutf for stasm pipit, psaeiUnf of rooms r. ungfc chain arvcturos Uke amphibolcs and the Ualng of chssuni pens, tbs oe sv pyroxenes and, finally, ah* orthositicttm suck a olivine. Animal experiments tend to conffan this, but it is pointed out that tbs type of binding of tbs beads of ships and manne piers and perhaps sifmficsACiy into the bnke iisi&ft and eluten ^ of motor mtv liiicno nry|in tswbsdro is of bialogial ia* TV properties which commend ssbe>t >, penance sad tlummiua aHesxsa, sueb m attuu modem mdusstatiso an ia rosusancc to * and kaolin. an not ISudy to praam a major tillown baatd. aada, risemacy and sea wusr aad it* smtCRoa which enables -it to be spun. l> TV diagnosis of pathologies! mtss of tbs lungt, vegetable fibre, it can be split ia a lonp:;uc dus dusa, also pmaoa maay cKnial and dineboa to microscopic site without diae'H-t radiological difficulties. A high iaodsaco of puL an ultimate dement and without low or moawy dittos* among then* trpmsij to pun TV'shonarc fibre rvcorded ia GrenU - . din'd presumptive evidence of as etiological re* ehryeedle and is of the order of o.oocrj m- lationahip, but tho run erne of coie pnsuma* Icttfth, whilst the longest is cxhihitrd > cooiosis is difficult to wablish. High atome Mamrturg Museum and is 43 in. m icngtii weigh* and consequent mdio-opecity product latter fibre came from Umsingv Nuuk irul .n shadows oa tbs X-ray Sa from inhaled dusa probably chrysoui*. The best length ot hb^ whieb an not nscsssorily psthoiogirl, as. for spinning is 4 ** <3-75 example, is tbs ridaroais of an welds** (Doif sad Tho asbesnform nuaerds form 2 tmur McLaughlin, ipjh). sitiemss which differ widely ia chemical c Asb --s. ia History, Uses aad Mlnatelogy position, but reotmbis eseb other in being hb aad in their mststaacs 00 host, scids and WVwvsr douba tberr msy b* a 10 tbs fibre- wetsr. LcgtUy ` tabestoa means any fib fsaic pottotaiida of many ritiema. tbs pro- tttintt oami tad any admixture contauung caoaof of asbsnos a^umiottkiy oxpooss tbs such mineral whether suds;, crushed or oper worker to tho rak of lung diems*. It has boat (Albums Industry Regulation*, 1931). ' used on a sasU acsl* dace vtry hy tiroa, bring crslogtss daanfjr them as foilowt:^ known to tbs Greeks a 4 fedson*, ugni^nng ua t. Serpentine Group, aH,0. j.MgO. 2; gusachabls. Used a s substantive. j dodaovw wee Cbanctarixad by a high percentage ot magr uk-i whilst (bo meantime gend, and wetsr, renormlly whits in colour, aatu, 4 os used to denote asbestos. Tbs lubricant and therefore suitable for stuffing b word 4ai4rmffw which io modem Eofiisb aad giaada. Esxmpies, chryseole. pisolite. speech aignifias tbs iiassss Mbaeroaii.-wet to tbs a. Rbot&bic AAphiboiea. (MgFejO, SiO^ : Greek* s pissrsrtftf or tnarrmwo. This loot word caafen a brown colour whea prossoc Lee was originally suggested by Coda (1900) wbon ho third group tbs asmbwa of tbia diviasoa cot aioo draw enrooon to s posssfo io Herodotus high percc&tagm of feme osde aad have a ill meriting s ereaadoa doth mods of asbostos. . wtxar contsob TV texture i*. barsb end eia TV Romans Vsw itunderthsoaas ofaaunthae, caciosiBg a mcBinus amcu&t of air ia a word of Croat orient ayufyiag tbssacs of of incaabuscbls masse. Tbtv are per^gu maano or potfoaoa. TVy obtained it tea tbs efiatat as beat iasuiaat* *aropleaw latino Alps and da Uni. It soaood appropriate pbyilita. aaosits. ' -eT tbni tbs Vote Vtigm* guardian* of tbo Stood 3. Moaocb&ic Amphiboisa'* Tnrooucr Fin, i/mbsl of tbs dispsm tmooons aad iascaca 3MfO, 45iOf. Acnnnlirr, CaO, 3(^tgf iA too** family lift, tbo last rite of ptfman a aitOv Crobdolite. NaFe, (SiO,L SiQ,, bo nmytishwi. tbouid ban ussd asbestos lamp TV pmsncs of soda m thia group as widai Arnrtwr fibrous amoral rwrmhiing lavender blue colour (Kali :pts). The Italian anaatbus was spun aad owa iato a osde conssat of eocadolite tacounges dag fc dock ia Stbaria dutmg tbs tjtb cemury. A non when it ia esploysd as a wrapping for ' focsory for tbs maaufocnm of abatas ntiria oodm. TV oBunmm of ongtn art e: was opened a tamo a tTtio. Tbs n discovery '"insrtt (white cbryaenls). South Arte of aabmn a sly* coatribuad cnady a modern, nnririnliis and tbs brown amosite), Austnih iadoasial crpanrioa tbs U-S.S.R. It a fousd in the banded Todsy absatos is ussd for a wdt nristy of rmrsss tbs dsposim being, tiaaml, w cross purpesn. Tsnite mar an tbo maaufocnao of dip fibre aad auas fibre according to the dire finfifbaaf nuts, aofocy ctmnaa aad boifar of dsevege relaave to tbs oneataaon of the Fic. i bedim 4 xenon of Skionc luAf. from tht on. dmon in fi$, * Phetenucrecno* a *. termed analysis txpladia tome of the varying 'npcmo of the three groups Chadian ' Slut 1 Chmonie Ciwasalue ; A/weeix Fas cant 'Ql . . nvm .. j **v Oeide.. , t. .. . . -- irf . u ! Fw cant. t iS t a + F*r m *7 t J7 l 3 m teo ieo -.ftufactura " - ^intral u obtained by open mining. akin -T.-i^int. Outside the rhme adit the crude -aio a rrduerti m sire and pieces of ires art 'icnvd manually f cobbing ") or by mechanic^ tun*, h ia then transported to the factory da aer-imed sacks 'There it ts crushed in a *e runner* or a trruii pan mitt. foreign iw*3r miovcu and the fibres opened in a Crighton -chine. Ttie ancient proem* of carding follows, by which the fibres art made to (it parallel in a continuous1 diver.' Essentially this moehine conuses of toothed drums and condenoer roUen. The denvaaon of the word ' card' from the Lada cuduua. a teasel or thistle. doubtless mdiato the meant by which thta operation was earned nut on other fibre* in pnmisvt nmea. Olivers ait twisted together to form strung yam on spinning frame*, by Rg or fiver. at is ocher textiles. The msttnai it then plaited date rope or it may be woces into doth on the convcnonasl power loom. To the medical observer. perhaps. the loom u < tpeeta1 significance for the weaver s beam hu given its name to living tissues. Occupying a lorttontai position is modem looms. m historical position nos 'tfn*aU. The GrttJm called it >-**. u they did a ship's mast or indeed anything which was set upright. The word aim to be applied to the doth itself aad eventually to the histological tmeture of lirtaf organism*. History oflsheemeis In t pee the Departmental Commute* on Com- pcnuaoo ror Industrial Disease* (tpor; Hni evidence from various *uth intu> -"it > - ;i t Jsv 'rt ti i r 1 IKv* WfV1 * s*3'Mr Fie. s.--LXS.. tonal*. Ml JS_ . S*UVft* dm-. P*t rM. fM. MOM *f Itac bitM'&Mt P^vfMMi uw ubWMI o4 tfuoraM pleura. Ai fee lewar pole tovumeus moiimm iwmundt cbo iadunoft of certain industrial jiiaiw in the Third Schedule of the Workmen's Coapeamooa Acs, 1904. At that enquiry Montague Mumy reported the cam of an obow worker who hod died in the Charing Cna Hospital io 1900 of ' typical fibroid phthreii' Tba moo. 1 card room worker amd 34, hod scrad that aim of h<a workmouo hod dial round about the ago of 30. WHUoc sfresmg cbm fibrotd phthaus w t dirucal maty and ipaafic to comm occupaeona. the Committee foie they could net recommend 19 mduaioo m the list of fjmM under the TVrd Schedule owing to difScutem duefiy of corafieaao^ Caooe of aibrntoeii coAtuiuod to bo reported, noaWy by Fihr (1914) and by Cook (1904). It m .Setter's oat (19*!), hewem, which aetmed to aeabiiah an unequivoal relationship between ubeatiaa aad puinwrury fibrosis and which prempttaad tht inquiry leading n the Report of Mart*" and Price <1930). In tha following year app* tho SBicom and Aabaetoea (Medical Am mans) Schema (1931), tha Aabeetoe !nd (Asbeetcaa) Scheme (1931) ind the Asb Industry Reguiaoona (1931). Tha fim deait the eonstmtoea aad mneaons of a Me Board, the second with (he award of compass and (ha thud with the oootrot of dust Legtei Kao bean generally efiecove m controlling diaeaaa ' Sinoa :93 c ail entrant* to duaty deparm hate baon medically examined laioiUy and . annually by parted of expem. Cat has been: of radtetegy aad much pathological m- exammed. Dust exhaustion hn received it attends*: in ooe faetory spinning framee are : totally cnciooed ifl penpex with an mjc: t9*9 SVYKKS: WaWfOMr `evict hih permita easy teem to bobbins. Sandliny Haa bean reduced to a maifflua aad ood'hourahatpiny kept on a hiyh ttindard. Whh err f*w exception*. eras* *rafted by the Boord j u harrow have mduaatal hatorioa extcndicy to xneda prior to 1931. ' f. ' 'siboloyy . Wherora the heavier and nobler panictm of (lies find choir way to tho tiraoti and thooco td the vmphiac chinned. tho lifhutr and laryer porbdm )i' uboatoe block up the Soor branehioln. Chains j( uiicou ttsihodn. with toterraninf cations icttfflUA* the fibrous tuucsurt of lobootot aad Jim ehaine in frayed buadlaa interlock tad tn irrrated. Htoeo uiicaou 9 2braw of the lymph nodta and aibratoaia t fibrous cufilny of xbm ironefatokfc Dangerous fibrra moacun about to mauna aod a noxious conetacnboo it raid 0 xair whoa cbo dutt eoust racoeds ftra million parudra per cubic foot of air (Pay*. 1937). Thom a ao loot! aasew or laucocytte raoctioo a the gapped fibre such ao would occur if a ?ratopiaaoue poiooo Ukt cottoidai dlka hydraada ivn lihomod. It uaaa tifufiaus that if tbo Sbraui charasttr of chrraeelo asbestos a 1boose a in ia dramiai equivalent erpesoAe, the dura o mere. Inottid. the Limny eptthe&ai coda ira ' iftstod as 1 rcouit of moioo aad ranks to cnyulf Rbraa which praeiay too loaf, m temeumra observed prejecsof non thaao ` du*c' cods- Aabutoaia grant ceils an tioe rasa, due to enad aggregation* of duet cads. Tbov an pifmcntod, toppled aad mulunudear. Ftbras'a appear around braoehioJa aad alraoli. ia nteriobuiar rapea aad is the subpJeunl oonaoratve QMua. Mbmtom bodia aad pigment an aha ?m*nu Finally there is an iaraaiott by eeilaymwue fibres to form th chancwrwbe reocuiar pooara uwmd the disal arbohnoooo of the braedaai t. Tbe alraofc. opiQafMi aad voauioa an v*ed by the fibteaia. A'hotan bedim caa bo deaoratmad ia tho '"** - . pleura aad sputum. Tba length of bat 'at. (or them to develop ia uahaowa. Tbay or : bo fbuad ia the mineral imaif. It has bean - by staining mecoone wah radical mtra rnj ;e up ammonium auiphidt aad by cho outer poraoo with coaemmod aui* tm-c;.: jod that they coanat of a eneni fibco of (Ttf. t) with aa iraa-epomouaf, toy* ncr.'tj cDvonay which ia thought to ha*o bom ^"ud by a coiloidai foaepoo batman the fibn *** -k biood pratoina (Cleyaa, 1919). TTcog ^^nco a hold to bo rndonci of aspooon to lu^>tQa and not of the diatdBa imaif. ^me, imiit tdhmcons of the pioun an ad the intudober fsaun ohbtonted. Tho ploun haa a creuad (tma appeanaea with yallow, hora*liko pwqum a or 3 in. in diaatotor WtdmpatchmofncaatpJcumy. Tho cut aurfaeo of the Inaf onhibia tho typieai biuo*bladt poly* fonai anaa, raufhly lobular in dtatribueon. 1 ia. to i uw (3 mae to d ram.) ia diameter ea a rod harifwrand of branchopoaumowa. Tho anoa tend to mfifiuoiraa at tho bmoa aad cthibii tho ' piouni drift ' common to the pnouanconioeae. Coafiuaaco ia bocominy nnr aa the dura cloud baeomaa loae cowconcratod (Fra. a). Companoa tory amphysema, 00 tho other Rand, aeoim to be oceunof men frayuoady aa caaaa lira Senyar. It occur* chiofiy aleny tho marytaa of tho luaya. ratnodmaa gtmay nao to huflaa but not ao rtiitnamniy aa ia adicoaia. Ona caaa ia the prewnt nm of 115 fral caaoa died of x tpoomsaoua paomaochorix corneruent on rupcun of tueh a bulla. Tho rtyht heart ia tantfaUy cnlaryod and than an tho usual ays of bach praaaura in the lirar. nimonl Syndrome Ia tho writer't ranee the aranye cepoeun for malm was 16^1 yoara, for fomnlra y.j yean and for all mm 104 raan. Tho dunaea of tho dtaemo waa 44 yam for both raaoa. T%o mean ay* at dorah waa 46.5 yean ia the oaa of men. 37.j yean ia the eras of worn-- aad 404 yoaca for att Fin, j.--f.N.. Mlo. rat. 4j. Srauwwl 4r*t., i< <i* A-** yf lunr Wwmf Ant nrarthno- Ftm aft** fran L-tubOeiK. AUrnc0 46otI0m. 6j POSTGRADUATE MSDtCAJ. JOCRN'AX. Onmdn \ Dyspnoea a a univeml complaint: llufteo Wood regarded ubtnaw at mono* lympcomiBc disemc- Dry cough is noticeable 00 rising in tbs morning sad during changes of umpenture. A paroxysm usually terminates with tbs preducoon of some thick mucoid sputum. very rarely decked with blood sod in tht bter stages containing dummies of pus. Aa iocreese ia tho quantity of spuoim indioocs complicating factor. Anorexia, lost of weight. fatigue snd chest peine ars newsionot symptocm. The cardiovascular signs of the dbeast are im* pitnarn. hemuse ones established they in per* meneru. whereas sdvenwiou* sounds ia the chase tend to bt rwanm. Aa earthy cyanosis has been described. Of 33 consecutive casts of aahcmotb examined by the wntor, aq ihowsd dubbing of the fintet*. tht tost being similarly effected ia dgfct of tht mam. sa incidence of $+? par cane In the tame ttnm the second puimuruc sound m found to be accentuated ia 33 pauama; that ia to say Ha par cam. of the ease*. There aifna appeared separately, together and quite orien not at all even in advanced drums. The liver waa aaver palpable ia aa ambulatory pabem aor waa chart oedema of the dcpeadeat The cheat b fiattenod bibtenily. The respire* tory excursion rarely rtretds t ia. (a.j aa.}. Percussioo often reveab a leaaadoo of resistance to the finger (* feJtiag ') which may be ftnerai or lomliiod. Probably due a a isfieeooa of the donee character of the fibrede luag or of the ptauil plaques which are often seta pern mortem. Hvnermrtft*re_ b oceaoooally nosed. Dry. enacting souada one genenily bo hsard along die cmpfayeamatBue mergurn but oftmt become gen* iretired jw dimppear altogether ia the smao individual. Aa add soaareua rhoachue stay be baud. There b defies* air entry at the beam anaddseBspiinnotioon* over the anterior aspect of the chem bhafihT PacHologleol Ippeor--cot Whereat the roentgenogram may show con* ssdenbb involvement ia sdicoaia with few. if say, symptom, the reverse a sac to be found ia ' Mbaetoab ' (Severe, 193!}. True b the opinion of all with esponenee of the iiiisrn, The rypiod appearance of tho Sung fields b s diffuse here or pin*poiot mcctiiaf ia the lower halves or mo* thirds (Fig. 3}. Emphysema may be seen ia the upper sonm and. of laser yean, a granular penens ia the lower sonm somewhat rsoombliag cotton wool which hae been tamed out (Fig. a}- The domes of the dbphngm are Hastened snd may show coene strut running up mm the lower lung fields. The verdcal diameter of the cheec ts FtO. T.McK.. set. 45. Sverwwiel 4rot., d A*bsMMis bndiw ifteww m l'ie. 1. X*fv 9 (how* im ftbresa iM effishvnwm. elvSbnie of iuftn. vntustir dim witn ufs diminished. T!w eceto-phrenie suicua ia queatly blunted. A shaggy left cardiac bor often a*#n ia advanced asm tad tomennu mart uihevn* sad diaphragmatic cupob blurred. Compile Bmachiecosb hae been stated to oceu: qutady. Only three undoubted cum occur the premat senes sad one of theee was a genteel condition tffecnag the apex. PregnaAcy we amposted with the dot rvo women aiffensg from aabaecoMa. The dom not aemti to be adversely ufeeted by nancy. bus the streia of labour may up the bia favour of right bean failure. * Bronchopneumonia is almost invariably pom mortem The nos commorunt eompii ia cubereuloab with a much iowtr madenct ia ulicasM sod affeeang s lower age grout 113 fsai mean, tj men snd at wooes. 31 cent, ia all. sheered also pulmonary ruberr The mean age as death was J4.9 yean if average exposure to asbmtos of r-b yean. " the remaining cum alone. sge st dear 43.6 yean, *rttr ta exposure of 11.5 yean. *49 WYSMt Atkmtama JT ji exeat mortality from anor 0/ the luny in a of ^abates* u recorded by Mcre'mhsr Of i.M* mam of aKemis t.j* pf east. fouivi t* be complicated by pulmonary cancer .-cat the iaddtnee wee 13.3 pef east, ia *35 j of itbaeoaia. "fedler (t9*j) contend 9a ..mortem report* of mbestows caaa from vent p*n of the world isd found aa ia* no* of ib pr ceftk pulmonary after*. Th tiupmcnt of the leatoa cowposded wnh the ths and istenany of the crpooar* (ta to 4* a). Soemke (1947) ailed meadoB a the oaflon of asbestos* with pulmonary aaear. latter aJmetc aiwey* tahuy the form 01 car* ma of the pavement epithelium He thouybt jettbie that, in addition to ehetnial pmoa, purely mechanical effaca of the Mb toe ilea may also be raoponabk for the develop* it of aranorn*. 1 the proem aerie* of 115 death* from atom i: mJ ead ais females had puiaoaary xr whilst sneer of other otpaa wo present hret aula and four female* (paoana. colon, tech, ovary). The proportion of ouimosary :en in the aeria wo therefore t+S per mat amous aneere were present in nine caaa. cm m live, columnar ceil in one. endothelioma of oiewe n one and the bietQioyy unknown in v if the ciaea were brother*. The mom ..n w*a 53 year*, the mean expoouf* to it dust 17.3 yeore end they died a man od of 6.6 van after lovtay (he isduetrv i^Mediesl Aapsca of Aaboecoei* t ia difficult to umb the rffbea of such on a* pereonal habta end the preference of liica and that of defective physique for cermn jpjoono. MaUcjohn (19*9) ha poi&md om ptiatbk effect* in the pea os the epreod of ereuioaii amony Sheffield imife frisdon by the it of sp'ftttf 'ato h* water oouyh throuyfe eh :be abreetve wheel passed Steweit (19*9) mdieeted that tht hiyh ioddesce of tubtrai s amonr boot opensvea ia due a the acsteoon iiMhirt person* end their fomfim to e Qybc cn-auofL Similarly the raauiy fcjeniria of thorn h ot ubestout end tubstole finipse*tft dip* *' :he presence of tuberculosa in theoa of the ic iTDuwnold who have never ban*, sxpoaed to *o. ,, 'ast*mploymm *umv*l chewed a aan emrnaoon ; the mean penod for men in thia ,a wee ycon end for wopan 9J yore. No work a many and aptoma of ablest* did act appear until ie ixter. Df th* uj death* only r*m bed work subsequent to the 193: fteyuleaoR*. a man after tan ymia' exporure end woman who alae had tubernilooM after two yean' exposure. `Hunt other men heve ahe developed dm imam after expoeum of five, four and four yean mpecaveiy, the leac one haviny been certified in 1946. Tht writer baa a! emm under ihurmimi u praint. TV men ere irtupied a follewt: bmioea aeeueve, storekeeper, pemter end window rimssr, layytr fin ocher employ), deaatng bream, vwrehaoo utyiaeer, in done of spora and aaotl recaaoe, laboremry handyman, reared,, small prmony prea operator, foreman in chary* of storm. formes m eftaree of rubber deportment, iifbt arpwtter. tally aezk fweekend reifcfV handymen in castaen. n boon meovamaf from mberculoao artd one relief gcxemaa. TV woman art occupied a foUowt: Uyht huumootk. in chary* of work* aolarium, ontem work, cepwriay overniia in works laundry, three doiny tifhr home work and two doiny aewiny duoia and mtadiay duda ae hosaa. The redurton in the intaairty of the dual cloud seam* a be ptoduany t mote chronic typo of diamao. Merewethar a invaanyttion of 19*9 in* dicetod a period of seven ynue* aapeeurt for the dieoeee to develop, wheriae this aerioa. which . ewiw oaji, indwman thcc an enpeaure of tan yean ia aoemory. Throuyh the kindn-- of Dr. Hoodhouo* Gloyna, the wthar bad enema to the leca D-r. Burma Wood's oocm on S9 mam of aabaamwa which he had cnUeoed up to 1931. Of thorn mam rr shewed dubbrny of the fiafere, us. 19.1 par- mnu, a aoch iowv fiytuo than tht inddenm of <4.7 par cane, in this serio. fiadinlnyimOy, the fine aodsy ia pvtny plana m * coemr ihariowiny which aoasM to be dae to compenmmry rmpbyeaan Ac poet aocmwu confiueneo of the shirtobriess tenon refer and mamr 'uedmm n Other: Of the ether ctiieum, nk ia the only one concermay whieh there ie definm evidenm of a harmful edrnt on the haft afthouyh there ia some and fidioloyiml rridanm of pulmonary flmnie dae a mm. MeLeuyhlis <r aL (1949) toported the firm one of ale pseumoeonmm, amdrtnod at paa mortem, to hove starred is ths muawv. TV mdtoynphe showed nodular shadows whieh. an the left side wort fluffy. HamfoyteaUy the iuay abased yreynh noduim ot loosely wovoa fibrous deeuo in miariinen wtch hmortenim, There mm iks 'curious bodim ' Imefj nmmMiny ntn--rr 1--P~ Maacnioyie*! iiiiaiiliin proved that thr wndmon wea am. in Imk, abeno bm dae m win, a tqririmd * If rittu* >*1* ..c- * POSTGRADUATE MEDICAL JOURNAL n' . 0t mifMRum iflim" M*Si0,,(0H). Tak mop in cow iweuaou ana* n an aitonboo pfooua ol anoint 4 i*y rapbci anthophyflh*. m both oom iaborm&f an iAptrftaly fibroio foci*. SofHi-- * Canadian tala ait plaip bat contain * piopowko ol Sbra. Th* tapiawy . _ apparad to have tend a a Star allow? tbo Iftm to |ft taco th* lunfi whilst rajtetinf plan TV aittbon concluded that ale pneur conkaia map bo aaehbod phaahly to tha phv, feta (adcuJar crjwak) of tha minmi. but : is aero aeavtiy fibcoftnis. Pf,!l -9*. *C*-i AaogffoowgyrgT (Assarroatr tooMi ou Asacrroa iNpuomr *soulatu>n <>*tk tot (ODOX t. Uwtv HA Mm*. U wA tOOUd 9. iin Om te. t, I*. COOKS. W. S. fiMt *- MR/, a. MS. ogre8s&^sg ^ssttss 801m0. .A. T, m MatAUCattJK. A L C. s*k Imm k FAMA T. OmA 'MmMmnm OAJtDMSL U U. (iA7.4MJM.*k Ut. u ototN*.a.a.{MW.7WRn%M*. J* OKHfTONR |A|^T. (mSV 9m*mm>* Ut*mm mi KINO. & J~ WO POMAK, W. <tf)SV OMm / JA U*V KUHN.;. dwii. Am*/. Sm*M m* g--W**. M *. MCUiiAMUaCNTUtwK. AnIm. Ou. 1p00T80L. t./.h*mOmVN. .HwA-aM. .k MSZKLftOtQ*. A. UWk X.0. TVw. Cl-- MSWWnitt^ A A M '* * MMgumia0.wk>M*wWuLcWx.M. cM.t.*t.a(.w*w>. twr~- NAOeCbOOOtflOT. a (iwm. iim k tm PACE AT. w**LOOHntuD. j.;. {im tf-* ** ' Mk lv lAtUA A A. mt UCOk A j. <>>*). Umm tm Mm- STfWAJtT. A. a A. fiMk Am. -HM. /- u mA SVNOtV*. .V. art YCQ*N. A (i*)SV/. M Mm- Tm *. TO/.iMmm.0mm. .oT.maoacr.uii*sm. illm dunks*. * u WCDUA.R *. nwjk i hi hi w ***> >w iMN* JI'JA fflA THE IlOYAJL ^fEDICAJL FOUTSTttATIOJV of Epsom College *&% lT` -'.T** JV*-*,.y5* i *#rr*>"- *.^rfc*,,$.:-.**-.*.****3 *' 1 ; K'& >' *? >.J *.-*i-M?O/W*.<*^C*'. v - iomm tau esTM&M. MMIOkO tntTA Ow. iinot aoowMT