Document 5DX9NvBM5eooapMgXJbErGjeR

FILE NAME Colonial Sugar Refinery CSR DATE 1960 Oct 13 DOC CSR236 DOCUMENT DESCRIPTION Extract - British Medical Journal Article - Complications of Asbestosis with Cover Letter worn | EXHIBIT 164 SIMPSON 144 36 Ex 164 .. ~ vA, ASBESTAOSBSESTOS a AUSTRALIAN BLUEASBESTOS LIMITED . ANDRESS . TIU~ ~APNAENDRESS ULUKRASCES FOS WITTENJOM brow } WITTENOQMA GORGE . WESTERN AUSTRALIA AUSTRALIA PRIVATE PRIVATE PRIVATE HangingHanging Director Australian Australian AustraAlusitarnalian Australian Blus Blus AsbestosAsbestos Limited 7 P.826 P.826 hun ! ) _ Dear Six of an ASBESTOSISASBESTOSIS extracttaken We encioso for your information the British Medical two copies from interestinginteresting articlo and reveals Journal facts It is quite ^fin quite There is several not known to us before a lengthy clinical descriptiodn escription of the issun of the Journal caso also in this Yours Yours faithfully mn BE GLELia Ane a Homager OAVLIS OAVLIS : . | EXTRACT taken from the British Medical Journal of 30th April Complications | of Asbostosis 1969 hooded ASBESTOSISVIELED Professor J.Michael Jones would you sum it up Dr. Jones The case is of great interest as it demonstrates so many of the problems associated with asbestosis which we should review Asbestos itself is chiefly a double silicate of magnesium and iron It occurs in a member of mineralogical forms one of the most valuable being chrysolito Asbestosis is pneumononiosis arising from the inhalation of asbestos dust during the manufacture of asbestos goods such as asbestos sheeting fireproof clothing linings lagging for boilers and pipes etc. One way of thinking of the pneumoconioses is in relation to the chemical toxicity of the different dusts At one extreme are those such as iron which are entirely toxic and simply produce a characteristic radiological appe rance of the lungs with no change in bodily function Then come others such as coal which do this but also have a pathogenic action by altering the of the lungs to tubercle Next there are dusts such as silica which local reaction in the lungs and pulmonary fibrosis Finally there are esction produce a others such as beryllium of such toxicity that they can be regarded as ) Lissue pelionery genera local poisons which produce widespread effects in the body as well fibrosis in the lungs Asbestos is toxic and produces not only pelionery fibrosis Dr.Hoard but reactions in the pleura and even in other organs Dr.Hoard has excellentelxycellently demonstrated the pathology of asbestosis in our patient patient here is a picture Fig.12 of a whole lung but byway of another who sectionsection from asbestosis There is an interstitial bronchiectasis gross pleural thickening and some patchy fibrosis as in the present case BesBesidesides these associatc^" features which are common in asbestosis there may be associatasociatc^" casociatc^"^"iubercuilosi uberculosis as there was in this interstitial lung as in our patient second case or Sometimes the even more important assocassociatied ated fibrosis gives rise to cancer the formation of tullae that which occurs xanthomatoes fibrosis as the honeyc mb or occasionally oven to a widespread honeycomb honeycomb with other rere forms of pulsionary interstitial fibrosis lung 40 1.0.s such RADIOLOGICAL AFFEARANCES AFFEARANCES AFFEARANCES " e These are typically those of a fine lace reticular pattern particularly particularly affecting the lower lung fields and causing a shaggy border to the heart as our patient Besides this cystic change may be seen and very often pleural thickening Although the ray picture is typical and almost clubbing typical pathognomonic in a few advanced caces there are many patients who esbestosis as judged by a history of exposure and the clinical reles in the lungs and changes in lung function have specific changes in their chest radiograph That is extremely have in relation to the diagnosis as we shall see lator because in general undoubted diagnosis of pasumoconiosis depends on on appropriate industrial history and n characteristic ray appearance in asbestosis but unfortunately Xray There is a characteristic from the medico standp appearence appearence appearence intnot all patients characteristic with asbestosic have the radiograph radiograph appearances of asbestosis cannot bo assified in the FinallyFinally thethe radiological same categories as as accepted internationally for the other pnratoconioses Gross clubbing of the fingers and persistent rales in the chest aro tho characteristic clinical signs of the condition Exertional dyspoca is the main Patients symptom as in other pneumoconioses Patients suffering eithor from the complication of tuberculosis more commoncommon particularly from that of carcinoma of theJung Those from asbestosisasbestosis may may die part or in yours move not killed by chest infection or cancer may finally get cor pulmonale suddenly The disease usually makes its appearance rather over the course of a few months often long after the initial exposure to the asbestos inhalation dormant It has been suggested that the asbestos lie as an asbestos body which asbestos has to ripen over many years before it can break down and librate ita toxic concurrently contents In this respect asbestos is again like bowllium dormant in the body and then suddenly produce its effects which may also lis concurently with come other infectioninfection Carcinoma of the lung is a serious and well recognised complication in difficult esbostosis Its frequency in asbestosin is a common condition in the general population to determine for it is now exposure to asbestos Moreover have occurred many years before the cancer develops . Nevertheless Nevertheless tha paper by holl makes it fairly clear that a patient with asbestosic hes a risk 10 about times that of the general population of getting corcine of the lung Anotheraward is mesothelioma of the plouru This ratherrere tumour may draw Finally attention to the fact that a has worked in asbestos dust in work patient " woman who we em. with asbestos there is a high incidence of cancer of thethe ovoveerryy ooff cancer cancer There is a diminution of the inspiratory capacity which fits in with the * shrunken lung pneumoconioses the disturbance movement of demonstrated by Dr.Heard in this case In contrast with there is often little disturbance to sir flow so that all lungs there is is used to good advantage and the sodowa other the brasthing capacity M.B.C. is often surprisingly surprisingly well maintained Thus if a patient suffering from asbestosis is assessed by the M.B.C. or forced expiratory volume F.B.V. tost he is unfairly assessed for compensation compared with a nun suffering from silicosis or pumoconiosis The c^so workers essential of the breathlessness in asbestosic is the membrance difficulty across the altered alveolar more of transference of antrenantren so than the reduced in breathing capacity which is the Bause in say Carbon dioxide rupi~ lpy hotocontoris being soluble diffuses 20 times as rupi~ ly as ozygou and is unaffected Oxymen that transfer is usually adequate at rest so when they start to excrciso there is a rapid hyperonea the fall patients are rarely cyanozud cyanozud kul in oxygen saturation and gross The diagnosis is made on a history of exposure the presence of clubbie and rales and usually by means of a radiograph Thera in houten avi^,,ones that the rediograph may notshow changes ac curly as do DiraDirat tioniDiroatinon tests Although the the are not specific to ashesocis they are only seen in other other dinenses latter block unsomken soch other soch dinenses which cauco elveoler seleroderma capillary capillary microlithia , and and other iinntial ititial rere parcoid microlithia lunghunation testa are useful for making the polis shown that polisconditions be shown the patient has an interstitiaintelrstitial fibrosis causingcausing inititial fibrosis fibrosis fibrosis fibrosis conditions conditions conditions polis fer alveola Baas: Te oe -3- radiograph block has r asclubbing and rules and a history of exposure to asbestos dust it seems reasonable that he has asbestosis whether the radiograph is specific or specific no ASBESTOS DUST The asbestos bodies simply privo exposure to ashcatos dust and of themselves do not newn asbestosis Anyone may cough up asbestos bodies who has inhaled dust without necessarily having the changes versa & patient may have definite and gross necessarily being found in the sputum during of asbestosis in the lungs Vice asbestosis without asbestos bodies life Since legally tho diagnosis dopends on a history of dust exposure exposure together with the appropriate ray and other changes the finding of asbestos bodies is of importance in , proving exposure Over It seems probable that asbestos fibres once inhaled are coated with the course of years the collagen cover ripens by forming transverse collage cracks , and then the asbestos body can break down liberating the toxin and causing the reactive fibrosis in the lungs The nature of the toxin is uncertain It is however presumably the same substance which is carcinogenic Asbestosis was first described in this country by M.Murray in 1907 Afger that in 1930 Mereweather Price reported the dangers of asbestos dust tho and lungs made recommendations for dust suppression Thereafter there was a great improvement In the factory where our patient worked the utmost utmost precautions are now taken to prevent asbestosis occurring It is a disappearing dust is diseast Nevertheless asbestos most toxic and the amount needed to cause achestosis is not known so constantconstant vigilance and new proventive methods ,at i needed if this disease is to be abolishe 7 DISCUSSION Professor licichael There are go on to the are there any other pathogenesis of asbestosis many other facets points or queries to this patient butbefore va which could be raised on the Dr.R.S.Wil ems Dr.R.S.Willems Dr.R.S.Willems Ithink there is one point in support of the nechaticcal theory that is worth rsising If experimentally you gis asbestos ground up into a fib dust fibrosis does not occur and its its that asbestos fibres between 20 and 5 microns in length are necessary necessary to produce the typical peribronchiolar filmbals wae - DISTRIBUTION OF FIBROSIS Professor E.G.L.Bywaters What is the explanation of the distribution of fibrosis Does it correspond to the distribution of asbestos in the lung or is there some other explanation Dr.Hearl Dr.Hearl As matter of fact it doesn't seem to correspond of the best asbestos bodies in this case were in fibrosed areas Although soIS there are Dr.Nagelscheidt plenty surrounded by perfectly normal lung in other parts Dr.Nagelscheidt f Sheffield was here two days ago and he was saying that they have recentl examined chemically a number of lungs on cases of asbestosis In one there pewe eee woo a: -4- peripher However he did point out !. no asbestos the as a lot in throsis and practically the anbestos content was estimated as able there was able or because dried weight of fibrosed lung is not dried weight and the the normal lung It is quite a pyreantage of the to the dried wought of of the fibrosis has altogether emparable I know the peripher distribution in other forms problem ud so faIrtasis not restricted to asbestosis being seen boon explained explained of honeycarb lung . | | | Pe ae ace