Document 5bjZa8yD2dnvYkqp3p7z5jEEJ

FILE NAME: CERAMICS (CER) DATE: 1949 July DOC#: CER042 DOCUMENT DESCRIPTION: Journal Article - Respiratory Disease: An Industrial Hazard MIOLOGICAL NOTES. JSth May, 1949. ,,istered and Deaths.* ,K E nding May 20 f May 28 | 3 -- 31 -- 11 0 -- 13 -- > __ !IS 4 -- 1 ----- - -- 14 -- 70 l'J 11 3 244 -- 8 -- 141 -- S4 -- 6 -- 57 -- 12 -- 7 -- 14 -- 1 -- 83 a 2 __ 21 -- 72 25 10 5 263 -- 11 -- 111 1 53 -- 1 -- 22-8 21.7 118 12S 8 7 1 i 1C 22 f Incomplete week. nottd last month still continues . four weeks ending 28th May it-rc were no deaths and neither nc disease continuing to be less again lower than the previous this period a year ago. .1 level although the number of s of the disease and 14 against measles is still prevalent to a npared with 218 in 1948. There comparative figures lwbtg 540 rath rate, the latter living 12.5 :lv 70 deaths of children in the period a year ago. part of this a in the deaths from diarrhoea GLASGOW MEDICAL JOURNAL Volume 30 JULY 1949 Tue Jorasit or Tut Horn. Medico-Cbirvscicii Societv or (Uiscow No. 7 RESPIRATORY DISEASE: AN INDUSTRIAL HAZARD.* A. T. DOIG, M.D., D.P.H, H.M. Medic! Inspector of Factories. Until comparatively recently, the term respiratory dust disease was commonly thought of as comprising little more than the two well known diseases, silicosis and asbestosis. In the last decade, however, there has been a general appreciation of the fact that the field is very considerably wider. Dusts in industry may be classed quite simply in accordance with their origin, animal, vegetable or mineral. Their actions however are much more varied and complex. Animal dusts are generally in nocuous ; occasionally they may cause sensitization effects, and they may also carry infection. Vegetable dusts too are usually of low patho genicity but they are more liable than animal dusts to cause pulmonary trouble. They may produce acute sensitization effects, or acute or semi acute lung irritation and lung infection, or chronic broncho-pulmonary disease. Mineral dusts are the most important group as regards industrial respiratory disease. Some of them are locally caustic, producing irritation of the upper respiratory tract even to ulceration and perforation of the nasal septum ; others irritate the bronchi or the lung parenchyma pro ducing atypical forms of pneumonia, and some have long term effects resulting in chronic changes in the lungs--diffuse in the case of asbestos, focal in the case of silica. Some have a carcinogenic action, some produce granulomata, and others appear to be able to lie quite inertly for long periods in the lung tissues without producing any permanent reaction by the tissues. MINERAL DUSTS. The Pneumoconioses. Pneumoconiosis means ` dust in the lungs ' and does not necessarily imply either organic lung change or disability. A distinction might be drawn between the fibrosis-producing dusts and the * Rased on a lecture delivered to the Royal Medico-Cliinirgical Society of Glasgow on 25tli February, 104f). 'CAL JOURNAL 1ion produced by the latter as benign a legal definition of pneumoconiosis 1 . I!), and the Kational Insurance neumoconiosis is therein defined as ust. asbestos dust or other dust, and known as dust-reticulation.' This -down of fibrous tissue in the lung, from the inhalation of dust and so to the inert dusts. ipational dust disease been known is .rates and Pliny and Elder mention ifrcquent in the middle ages but the ive been attained in the early 19th Revolution people were employed dreadful conditions. Hygiene was cheap. The average age at death of rs ago was .`12 years and the Sheffield eld grinder over 3(1 years of age we- uenezer Elliott, the Rotherham poet, his uneasy breath, leadlv trade he bends. .irs not man nor death. he earns he spends. - Itosoni friends.' rtv. meets his doom.' pulmonary disease have changed in able period after 101K attention wn< tos coming into prominence alongside .ke. Merewether, Gloyne, and others, osis is superfluous here. The disease 1 has been discussed so often that its -filica dust inhalation, if the quantity i/.e of the particles is small enough, .ture. Nodules formed of dense fibrous nt of the fibres are characteristic but ay be altered profoundly by accomother dusts which modify its action, .-st has been raised in regard to dusts dlica. The present theory as to the nd up with its solubility in the lung acid. If this theory is correct sub file of silica might be expected to RESPIRATORY DISEASE-- D01C 237 diminish its activity in the lungs and this has been found to be so. Kettle in 1932 found that particles of silica which were coated with fine iron particles became relatively inert, and later in Canada in 1937 Denny, Robson and Irwin showed that this property of diminishing the solubility and therefore the activity of silica was held by finely divided metallic aluminium. In their experiments they showed that even the admixture of 1% of aluminium in quartz prevented the formation of nodular fibrosis in the lungs of experimental animals. This work has been confiimed by other investigators and it is now generally accepted that in animals at least, finely powdered aluminium (or aluminium hydroxide) has a verymarked action in reducing toxicity. Naturally trials have been made in nlen--both in normal men who are exposed to a silica risk, to try to prevent silicosis, and in sufferers from silicosis in order to try to alleviate the condition. It will be readily understood that, in regard to a disease which may take 20 years or so to develop a similar period or longer may be required to ascertain the value of any preventive measure. Controlled trials are beirg made in this country and abroad but it is too early to speak of results. The introduction of aluminium dust in treatment was followed by a wave of enthusiasm--based entirely on the patient's own story of subjective improvement. At present, this wave of enthusiasm seems to be abating somewhat. It seems rather a strain on the imagination to picture the resolution of fibrotic nodules and emphysema by the inhalation of more dust. Furthermore before advocating widespread use of the inhalation of aluminium in man it is necessary to ascertain that at least it will not do any harm--and about this there is no certainty. Experiments in animals have suggested that aluminium may favour the development of tuberculosis in the lungs, and several reports of lung damage from aluminium itself have been reported, e.g.. from Germany. Recently a tvpe of pneumoconiosis has been reported in certain furnace workers exposed to volatilized fumes of alumina (Shafer & Riddell, 1947). An unusual feature was a liability to spontaneous pneumothorax, although this had already been noted by some of the German workers (Goralewski, 1940 & 1941 ; Goralewski & Jager, 1941 ; Jager & Jager, 1941 ; Jotten & Eickhoff, 1942). A further interesting observation about aluminium was made recently by Meiklejohn and Jones (1948). Pottery used to be bedded in powdered flint during its firing but this dangerous practice has now been prohibited by law. Meiklejohn and Jones report having examined 52 workmen who had used flint foi many years and thereafter alumina also for several years. Although the amount of alumina that these men inhaled daily was much greater than could possibly be inhaled by existing methods of aluminium treatment, not only did known cases of silicosis advance hut new cases occurred. This does not of course condemn aluminium `1CAL J O U R N A L nc forms of alumina have very much icr forms, and it merely shows that lundum) had little or no effect. mid Coal Trimmers. Pot recent work lie sociological effects the numerous studied, although ir is interesting to -piratoiy disease in coal miners came hall, 1834 ; Thomson, 183G). Towards icginnir.g of this century no attention mdition and such authorities as Sir ollis (1915) stated that the disease no obscurity and complacency--at least . - themselves As late as 1923, Hope, i mining is not unhealthy. If it were vnts it might be reckoned amongst nsation was payable to coal miners 1 and then only to workers who could -ilica rock. In 1934 the scheme was g on the coal face and other underiissatisfaction continued. Increasing duty as to the nature of the disease ril to make an investigation which c published in 1942, 1943, and 1945. ; radiological abnormalities associated I function in coal face workers, and : trimmers. This was interesting from nereas it could be argued that the coal .ght inhale not only coal dust, but also other workmen, this could not be so who were exposed to dense clouds of lot to rock dust. The Medical Research . appearance in abnormal radiographs lrp and lacelike in appearance, more . reticulation, and which was clearly .idition was subsequently made comlnjjensation Act, 1943, which defined lungs dv to silica dust, asbestos dust, condition of the lungs known as dust cat increase in the certification rates. Scheme, 749 miners were certified as silicosis in South Wales. In 1944 the ; in 1946 nearly 3,598--a total of over reciation of these figures can onlv be R E S P I R A T O R Y D I S E A S E -- DOIt, 2?n obtained by comparison with the rest of the country (Fletcher, 1948). The total number of cases in South Wales is approximately 7 times that of the rest of Great Britain. As there are about 0 times more miners in the rest of Great'Britain, this means that the incidence is more than 40 times greater in South Wales. Focal Emphysema. There have been considerable advances in our knowledge of the effects of coal-dust in the lungs, due mainly to the work of Gough and his co-workeis in Cardiff (Gough, 1947 , Heppleston, 1947, etc.). They have shown that the essential lesion in the pneumo coniosis of coal workers is quite different from that of silicosis. In both diseases the dust has a focal deposition, mainly in the lymphoid tissue about the bifurcation of the respiratory bronchioles. In silicosis fibrous tissue is laid down in excess of that required for simple shutting off the dust aggregation from the rest of the lung, and it has a characteristic whorled appearance. In early pneumoconiosis of miners examination shows merely deposition of dust in these lymphatic aggregations, without tissue change even in cases showing x-ray reticulation. Later a little fibrous tissue is laid down, and the nodule retracts slightly ; the fibrous tissue is not, however, obviously excessive and is not whorled. It may be said that this is merely a difference in degree depending upon the amount of silica in the dust inhaled. However, accompanying this slight retraction there occurs a well marked emphysema in the air cells im mediately adjacent to the nodule thus forming a focal emplnsema throughout the lung. This is a fundamental difference, for emphysema, for some reason that we do not know, is a relatively minor change in relation to the silicotic nodule while it is the most striking lesion in relation to the coal nodule. Curiously also it does not seem proportionate to the degree of fibrosis. A further change one meets with usually in more advanced stages of both silicosis and miner's pneumoconiosis is called massive fibrosis. The x-ray picture is striking and to some extent typical. At first the shadows appear to be formed by a coalescence of the typical granular mottling of the generalized dust lesion, later they form compact homogeneous . masses--usually apical or subapical but sometimes in the mid zones, and usually more or less symmetrical. The nature of this change is not understood and is the subject of considerable controversy. Is it due to increasing fibrosis drawing the collections of dust nodules closer together ; or is it due to infection? Fletcher and others appear at the moment to favour the infection theory. Their evidence appears to me no more than suggestive--briefly--increased sedimentation rate in cases of massive fibrosis, higher in the more progressive cases ; in later stages, temperature and rapid deterioration ; and the association with tuberculosis which though its presence cannot often be proved during life is not infrequently found at death. One has also to remember that some workers, notably 1/. J O l'R S A L lways maintained that collagc-nous >e comparatively rarely considered 'e produced by atelectasis of the !es, and in this connection it is . believes that the focal emphysema is of the respiratory bronchioles If the stenosis became complete, u iron and tin, appear to be quite j'he particles arc deposited in the v bronchiolar bifurcations just as itliout leading to any reaction or n abnormal x-ray picture because radio-opaque by reason of their working on iron and steel, are . work. The heat of the welding id oxidises and the fume therefore - in a very fine state of division, nt many years at this work may icy have performed a lot of work tanks. The evidence on which I vs Tise to such well marked x-ray mac be considered under four (elder: for lli vvars anrl li.iw examined incapacity or diminished capacity fnr awns. 1 have kept in touch with some . tliis period and find that they continue i quently admit to having a eolith, and -e are purtlv due to other factors and de particles in the lungs. They have no of fibrosis. They have a good chest r exercise. These opinions are amply inly as regards welders but for other hi &Walsh, 1940 ; Groh, 1944 ; Sander, ; Dante it Harding, 1947 ; etc.), en published in the world's literature of lowed the typical x-ray changes during -lr.itcd by excellent microphotographs. lions of iron dust. The man died of :ie, the result of an accident. The fact literature speaks for itself and suggests have been able to obtain post-mortem id not show the typical x-ray changes osits of iron, these were not associated .h- absence of fibrosis round deposits of ive been made on other workers who r example sliver finishers. These men . successive papers, Harding, Mcl,aughlin RESPIRATORY D ISE A SE --DOIC 241 and their colleagues descrilie the i>ost-niortem appearances in detail in !i cases followed up to death. Ill the first 4 there was absolutely no fibrosis. Ill the last case (Harding, 1944) there was a minimal amount of fibrosis of the ' reticulation ' type--not at all like that produced by silica. Harding thinks that in this case individual susceptibility may have been of importance, but there is always the ]x>ssihility that the iron dust at some period of the man's long working life--over 40 years--may not have been pure and may have contained silica or other fibrosis producing constituent. 3. Statistical. The Registrar-General in his Occupational Mortality Supplement shows that in 1931 in the group of welders and burners, numbering 11,542 in England and Wales, there were only 123 deaths compared with 1G1 expected on the basis if age-rates of all males I'nfortun.'.tely no more recent figures are available. I have, however, collected from various factories information rega'ding the sickness absence of welders in relation to other workers and find that welders arc favourably placed compared with other groups, not only for total sickness, but also for res piratory illnesses I have been asked to consider these figures as confidential and therefore unfortunately they cannot he reproduced here. Collcn ct al (1944) give reliable evidence about pneumonia in welders ill an analysis of the sickness rates of the 90,000 workers in the Kaiser Richmond shipyards in America. They found that there was no increased incidence lit welders. Coilcn, in a later article (947) confirms his earlier findings saying that the annual incidence, death rates and case fatality rates for welders were similar to all other shipyard workers, and that the cases were similar in severity, required the same number of days for treatment and showed no difference in the incidence of complications. 4. Radiological. The presence of pulmonary fibrosis in and around dust aggregations cannot be diagnosed from an examination of single x-ray film s; the film of a welder may be indistinguishable from that of a sandblaster with silicosis or a miner with pneumoconiosis. However, the x-ray changes in silicosis, asbestosis, and pneumoconiosis arc permanent; if they change nt all it is in the direction of progression, ami this is common. McLaughlin and I, however, recently described two of our original welders whose x-ray appe.ar.inces have changed for the better iDoig & McLaughlin, 194S). Wc showed that one man. who showed definite x-ray changes of the dust inhalation type in 1934, and who ceased welding on being told of these changes, now has an x-ray picture within normal limits. The pneumoconiosis has resolved, and no one could guess at its previous existence. The other man who had marked changes in 1933. and who continued to work as a welder, became a welding instructor in 1940, with consequent great diminution in his exposure to fum e; his x-ray film now shows partial clearing of the abnormal shadows. Other dusts which are considered on present evidence to be inert include tin. calcium, and barium, but much more knowledge is required before we can be sure that this is so. Tin is much more radio-opaque than iron, therefore deposits of tin in the lungs cause particularly dense shadows. PendergTass & Pryde (1948) show an x-ray film of this type, discovered on routine examination, the subject being a man aged 45 years who had bagged tin oxide far 13 years. There was no disability. Pneumonitis. Some dusts, both inoiganic and organic, produce in flammatory changes. Chronic manganese poisoning is not a respiratory disease and is outivith the scope of this review. Since 1921, however, a relation between manganese and pneumonia has been suspected and numerous reports supporting this have appeared in the literature especially from the continent. For instance the installation of a manganese smelting factory at the village of Sauda in Norway was followed by a tenfold increase in the mortality rate for pneumonia, and similar reports have been made in regard to workers in German factories, and also miners of the ore. In this country there are few reports in regard to smelting but IJoyd Davies in 194C showed that a group of men in a chemical works who were exposed to oxides of manganese existing as -*v- - Ji: b / l x / - ! : m i . u u \t. j o / / r . //. me particles in the air of the workroom had, between 19TS and 1946 a pneumoni a rate 20 to 90 times t h a t of ot he r workers of the factory The cases usually resolved without leaving any residual disability but conijjared with non-industrial pneumonia resolution was slower and less influenced by sulphonamides. Some of the newer metals are also capable of causing pneumonitis One of the most i mp o r t a n t of these is beryllium Beryllium has recentlv assumed a place of considerable i mport ance in indus t ry Some of its alloys have particularly valuable properties In most cases the onset of the respiratory trouble is insidious and may be preceded b\ upner n spiratory t ract irritation , ther eaft er there cough., sp u t u m - ,mctimeblood streaked, substcrnal pain and fewer X ra\ shows diffuse h a / m c " of both, lungs with irregular huffy areas of infiltration and necropsies m fatal cases have re\ ealed a diffuse pulmonary oedema with, has:, orrhagr. extr avasat ion and many plasma cells but a r e l ap s e ab'cncc- of p o N morphorruclears. D<Lr id I 'iY:ni:oi:iin Cadmium. O'liiiu;;:, and a u a d :um m j i also produce chemical pneumoni a when these compounds are inhaled as fine dust or fume, but before leasing beryllium ment ion should be made of another and most interesting condition which is caused In it The pneumonitis already referred to is acute, coming on d u r i n g the patient's employment A delayed pulmonary condition has also been described coming on up to 6 years after exposure The use of be milium in Britain has lagged behind its use in .America owing P the- war and s i far ordv one case of this type of beryllium reaction r.as bum, de-wibed in thus count r y (Agate, 1948) but there h a \ e been several in America since 1999 Sympt oms are mainly loss of weight, marked dvspnoea, and cough. X-ray changes are variable but usually consist of granularitv , reticulation and sometimes riodulation The most interest,ng point is t h a t these c as es are indistinguishable from sarcoidosis, and rna.m are d:..g:io-ed as such. It , a c n . . be said t h a t beryllium is a cause cf saremdos.s but the two oi sc uses are certainly very similar and to distinguish t h e m niav be impossible, especially as the pulmonary condm.on ma\ be associated with skin changes I he late Leroy Gardner reported in 1946 t h at lie had m his files some 100 cases of sarcoidosis of which 60 were known to have some exposure to beryllium Certain it is t h a t this lesion produced b\ beryllium is not a true pneumoconiosis, for the lung changes consist of granulomata, and must be regarded as only part of a general pathological condition with granulomata in the liver, the spleen and sometimes m the lymph glands L:i>:g Cancer The best known example of t h e relationship of carcinoma c. i..c -a..g to occupational dust exposure is perhaps t h a t of the Schneeberg miners where cobalt in the form of the arsenide is mined Nowaday.- the mining of b.-m..`.". 1 cases of carcinoma of the lung- co cobalt, arid possibly bisr.: u:h a ' b he i n d ude d as possibly rc:qmn-d ' radio-acti vity m the Schn t i b w g I In. tin > country theie are : o of lung c ancer in the Co:tils!. arsenic Several cases ho vac'vr : a; in wh: r h ar.-emc is hand!,t ', ! : 194 4 t ne fact o-v I'm a : elat m > 'p a! a : - , .. betake :ive 51:g a t .o v :.' c n 1 v orke:'5 (i xpowd to ;.r-.r . cancer (J` er n t ; e " ' . n : ; their f'S ah re ' b e ' - ( . . ' 1a na b B* a' lVi' l Hi ' ; ; _ IP r * , 1 _' i e-r )irator \ t rr>ct ,M :nekt ' ' a r x r:c 'C'l e \ i' t ed a- - c ` iron an i ih air', t! ar i f ; ' able ( : cai : "g 1m g cc : car 're; :i He' ;an; : d ate' - b rc ^e r.a g t l rM\ 1.a \ v a ; *; \\ o r k c r~ i t r e clnrrpop u!r t;o 1 a t large a la,, v1- , and that J of G1 death- in live fOU[ of worker a under 6' \ an ed in t lie divert nt plant- : pop a la *:c l till-' bC ,c nge-g: - 5nbn ; , vV, dv<tb but ce r ta:r. [. m . ...... , t i1*:or, ar d Pe rr\ ;n 1946 tv:. refineries Of 91 of them in emit.::*, during the processes 62 suffert 1 b sneezing was followed by pr cNu; . ness of t i e chest, shortness r: Lri. persisted during the time the : ehour after they left During ti e t quently had a severe Lout <f con.' divided metallic plat inum were a', was quite conclusive that the o w : of the s v - d ' o m e ( ^0011' M C U I C U JOCR.\ !L VU-UAULL UUbib. (eherall\ speaking vegetable dusts are of fur less importance than mineral dusts. Nevertheless the subject has so far been very largely neglected and their effects underrated. Wc know th at the vegetable dusts cause several fairly well-defined types of respiratory disease, but how they are caused is obscure. There are several possibilities The first and most obvious one is t h at the noxious agent is the vegetable mat ter itself some protein, alkaloid, or other constituent which is i m t a n t or otherwise toxic to the bronchial or pulmonaiy tissue. Impuiities must a b o be considered, for exampl e silica E v e r y sample o! vegetable dust-- whether it is of cotton, flax, grass seed, 6 .ain, etc , contains some silica derived from the soil on which the crop was grown -- but gvuerallv it is not held t h a t the small a mo un t of silica present --usuallv about 2 % or lc'"o ^ likely to be harmful, particularly as much of it exists as fairlv coarse g.ams, I hen biological contaminants must receive much attention, for almost every sample of vegetable dust of a n y kind contai ns a v e n high bacterial and mvcelial flora Some of these are known to be pathogemc and there is certainly evidence t h at some of the diseases due to vegetable dusts are due to bacteria or fungi It is also possible t h at the bacteria or fungi, though non-pathogemc m themselves, may by their digestive action on the cellulose or othei const it uent ot the vegetable matter produce toxic substances Lastly some of the conditions are almost certainly produced In allergens M i l l l 7f:cr This is an acute, tr ansient and usuallv slight illness occurring m new workers in dustv processes It usually comes on after 1 or 2 dav s m the null, lasts a few davs and does not reappear ; one a t t ac k confers immunity. Often the symptoms are not sufficiently severe to occasion absence from work They usually take the form of a chill with pvrexia headache, malaise and tiredness, am! ' w-glv -he-- ma y be icspiratory svmptoms, such as sneering, cough d n n e s s of the throat This curious little acute illness occurs in new workers exposed to a wide variety of vegetable dusts and goes u nder a v a n e t v of names -- e.g.. ' c o mb e r s f e v e r ' in hemp mills, ' c o t t o n c o l d ' in cott on mills, ' m a l t fever in mal t workers Under present day conditions it is likelv t h a t null fever rs less pronounced t h a n O r m e r h , nevertheless in flax mills the condition is still quite well known. It is sometimes said t h a t all new ernp.oyees get it but this seems an exaggeration ; probablv the svmptoms are experienced by 25 - 50% of new workers. '` ' , Thc quite unknown Various suggestions made include the a c ^ o n Ol a foreign protein, histamine, bacterial endotoxin, allergy b u t there is no proof. ' Iuncsscs due to Fungi and Ba:Una The definition of t h e role played bv ungi and bacteria cr their toxins is a very difficult matter. Obviously l<i. V'/O 1in!, the finding of particular fungi tl . of little value in defining the rmi the illness. However, there is ,. because they occur in small epulc" vegetable matter and run atvyc.. fungi or bacteria Outbreaks of an acute rl'n.C" , a mo n g . t cotton weavers on -iv> been associated with the h.'.'d',. thread u inch h a \ e been size 1 1 irritat; hi of t!w no-t and throat paroxv smal cough, and -ca tv ' ' o n e u echs (Coins. I'll") ' b ' illness with the ham' !.eg <: . in the same factors handl:- g ; . mildew as tire cause Varna. 1 mucor, and a'pergilhis have b - i. t!;e vain A s inular co:: f \ ' * y )0 U - U t : farmer s lung or !.ore-U e U - The ill less is a l OCI- tc-1 .. o . i u r s most often ait cr :i ' u l ' . more - crious and loort. 0 t dv spno -?a, haemo Pw'; cuoci. : seat of a broncho- pne i:::0 v. 1 . Potassi am iodide is sCori to ! t u-v. or, afte r a prolo- ged c o: . \ . it 'Ct and ee pliv sema X- ra\ k!-;^ - throug: . snow flak'e IInotti-og to o Al sc in this gr oup U o U i '-e , after the sugar has been extract' for a great vari ety of bacteria, ft: described in America, and n: t described 13 cases with c e c r o p - ' are again those of an acute or pneumonia, arising after an t \ t o although I have personal k-no.l'.c. week's work in the factory .%. disease s due to fungi, b e t t! e - include the suggestion that the v swells v ith the bronchial secret,o , which become infected, .v -.other B g S g g S O f ' - ' . ' .. 1 V ' v,C/i: Ml. U K U. J O ' !!\- 1!. Kuji:Iiart and Cami mt a (I04S) in America A t h a t the diswmc is due tn the endotoxin of Aeruhactcr cloacae. Similar illnesses occur in connection with the handling of other \ egetablo materials known to be contaminated with moulds or bacteria and A cloacae is strongly suspected of being the cause of at least one of ' er e respiratory sy mp t o ms Thc v rc di them experi ment al animals nere : `J u s hm.-grade c otton and 1 i i c - . i o i c cultures n d i j ; lion of a im- bv Neal and his cobe ar. a cute infection ros trat ion, b ut there \ Ml p t o n n in rumai,- he du-t i cc!!-!rev ,, *r 11c- '/< h .l. ij /'(; t r T h i s t e . m w a <f\I r- before h im h e d des, m i ' t o m s o n M o n d a x s I t - c o n i ' ` 'd t t f` it o c c u r s m wo r k e r - - alter 'Mel ( A n o n c e h m a t i z a t i o r t a k e get progressively worse noma < in r r v cm it/ but : : me ro nbed an aggruma 110 : of :e-; eratom to be yuite ciiiTere: foni in:!! ewer m narn \ u r n ' c \ po- u re , imt n Ik ; mnei- r)!a c e ti CO itimi tc UtiN tO o n r e t u r n t o w o r k a f t e r a n a b s e n c e , u s u a l h c oi w s t o f . wr b f i r l b- ca h , o r MU1 1( ,, ,, ,, , ,, rat ion o f c o u g h , w i t h c h e s t t i g h t n e s s o r a c t u a l b r s u t h ' e - MU. - At h -t th(. m p t o n i s a r e c o n f i n e d t o M o n d a \ . w i t h t h e r e , t o f :.c* w- h A i r '> free ( r a e l lially , h o u e v e , , t h e c o n d i t i o n t e n d s t o p e m i s t Ui. A. T u w d a \ and `pread over the ensuing days, until u ltim a te b the u o r k e r , m a \ be forced to give up work with constant bionchitis, dyspnoea and asthmatic w f e e z i n g I m p r o v e m e n t m a y b e e x p e c t e d m t h e e a r l y dam-, o n g i w n g u p w o rk b u t u l t 'm a t e l y t h e c o n d i t i o n b e c o m e s p e r m a n e n t , a n d in c o t t o n w o r k e r s th e c o n d i t i o n is s p o k e n of as b v s sm o s is r / y ;- Rcsfimilory D o o o c Chrome bicnch t.s has been reported in " ' Kl-r-' exposed to piactica.ll; ewery kind of \ege t a bl e dust -- from tho-e used in enormous quantities like gram, cotton, flour, flax, h e mp and milt to those used in comparand eh small quantities as tobacco, and ec en tea f h e proving of an etiological relationship between tlie disease ami the dust is again often a ma t te r of difficulty, as the disease pmduced differs very little from the chronic bronchitis, often with superimposed asthma, which may occur in the general population. Unlike the pneu moconiosis produced by most of the mineral dusts, the condition lias neither characteristic x-ray findings nor typical post-mortem changes, i he proving of a relationship is largely a statistical ma t te r of proving tuat a certain occupation is associated with a mortality significantly in excess cf the standardized mor tal it y rates for the disease, and unless' the o'cupati on is precisely defined, the excess mortality ma y net be evident. For e \ a m p b `, ma n y occupatio:'- m placed regarding standardized i :o Cotton weasers in the Registrar ' . of 94, and for 10JI - 22, bb The r. a n d for blovs loom workers are ! o\ Tt appears t h a t chronic iespiratoi\ occupations is less than it was in fa introduction of impro\ ed rr et!:od-> <>: of appliance s for intercept a!-o be cans of a: cratiorm iii t : _ d a \ i"h.A, ryrh y r . to b C V OO' ' - 'r ir . ' f-h \ 1 " m -..I ',v to ;;a . v ' be rm:e;;;be red on y b_ til : o! . The be s' know . of t.be c hr or - ' d m t - w b\ - mo-i-, met " ,t ' Although t: e sr m; trj" ' a: ' V ' ' ' ! c ^a m m a t 'O' do " 0. 0 ,4l !' O' t ; ' , frequently w :t h a Undr ;C> to .> !a 11o , ti'e conditio m t a k e 1: ''' 1y ' histories is leemec. to be c; p :c<rd : ! constituted Medica 1 B mr d t o c' c' | origin Con 1 ` ' U"0 " ' Va - - -0 ' ' to worker- \ ; t h 2 1 \ ea : - ' e \ ^-kw 1 ; b\ - T ' a i j ft real t! .e ci'.a'M e- ^ f k' ' j do not -d o " an\ ft-at v e w occurs r t ;c>11e IsCo ' A-thma, vi'C's-m and ob\ : mb) due to ah: rg\ ' for c \ a m r ' k i n d s o f w o ~ d I n n : o - t n o t : t I 1 u. e p c s c r n l l v tr.cur, in < O'" h> pt rscr.b t o e as* hm i ' as oppoy. d tn t ' - nccurnrc s.m ecus!; in ficM r\ N ,l out breaks were due to t!.e s twe w 1 --'' ]1a\ e not found an\ references in tlv ..t : firm engaged n shipbuilding used some . : 1 mine came acioss two cases in the m m ' I s aw one of tt ese men -- the other ha\ 'm; J was quite c on<l us i \ e as to this wood >wr g He ment i oned that even the smell cf t ' e \ > upset him witnout there neccssinlv b - m ; from slight V tacks .and m.nrc or less c a m 1' . wood being stacked m his work ^hed V immediate!; d sappe.ircd I also e \ ~m md of 2 more cases in former emplov ecs the \ 'ts^ At a no t h e ' f. rm of u ood workc rs ) u kilns I found s cases cf asthma due *- t . a former empl oyee, at h;s h.ome Th.e 1 .tt- r l r>jj when this wood was f r s t used tl v ! TTB r-- -V- * r > as CL-fSCOI!' U r.D IC .U . J O l I l S A L " d l l till; HU- of this wood, usunIK liy one of Ids fi llow -worki rs for he nf ixtd to h m d l c it himself Since Ins retirement \ ears a - o lie h i s l u d i n further att acks I l i s i e known nf other t ypes of a l l m p c reacti on <iuc to this wood One n u n suffered from such intense felling of iiausisi when it was worked that lie was prepared to f l u up his c mpl os me nt rather t han he e xpos ed ap.-in At an o t l u r factory an oflicc employee who frequently l u d to pass through the woodworki ng sliop suffered when West ern red cedar was used, from sneez' ng at t acks so i inle-nt and prolonged as to result in exhaus t i on. Thi s man has remai ned fit and well duri ng and after the war i cars si nce leasi ng the factory Such reactions raise m a n y quest ions and ther e is as yet i n s uf f i c i e nt information to answer them although further enquiries are proceeding One interesting feature, however, is tiiat although Le h ma n and other workers refer to wood dust as sharp p o mt e d and oi mu r ag e s u e 10 microns, several aniples collected in the saw null where t h e a s t h m a cat> occurred showed a very high count of -r.iall round particles down to sonic tiling like , '(l micron, and of acerage size about I - _> microns AMMAI . IH'STS \i mnal clu-ds aie much lev , injurious than either ccget.d h- or mineral d w t s Occasionally they may carry infections, the sorting of wool com taming anthr ax spores may give rise to a piieuiiion.e form of a nthrax, the so-called wool-sorters disease Sensitization effects ha \ e aKo been described, for instance ` cough, tightness of the chest and fecerish a t t a c ks ' ha\ e been recoicied in workers exposed to t h e dust from feathers 'f!r.-dqc, | 0 U ) SUMMARY Dusts met with m i ndustry may produce a we b c. -rnt c of r u c t i o n s in t he respiratory t ract Mineral d u - t s may g n e m e to c u n m c o m o s i s sMiich exists m three mam forms, d i s t i n g u i s h e d , from the pathological viewpoint, by tibrosis, or by focal emphysema, or b\ an absence of a m tissue reaction The fibrotic pneumoconioses exist in two main forms, one m which the fibrosis is dense and nodular, as in siheo-n, the other in which the fibrosis is diffuse as in asbestosis Other conditions resulting from the inhalation of mineral dusts include pneumonitis, immedi ate or delayed, lung cancer, and, rarely, asthma \ egetable dusts are in general less irritant than mineral du,ts, but considerable further research is required to eluci ' te their toxic poten tialities. Similar conditions, which ma y be grouped under five main headings, mill fever, acute and subacut e infections, Mondav fe\er, chrome bronchitis and emphysema, and acute (allergic) asthma, are caused by a large number of the vegetable dusts Some of these, especially those in the chronic bronchitis and emphysema group, have no features which distinguish 'them clinically or pathologically from similar non occupational illness. Animal dusts comparatively raiely produce diseases of the respiratory tract, although asthma or hay fever mav occur m sensitive indi\ duals and infections of the respiratory tract, for example p u l mo n a m a n t h r a x , mav be produced. ' ' ` p r .s n r :< A^'ate, J N ( I ' m ) Lancet 2 'Go Amor, A J (103^) Hep \ > ' Le t p tg , r n o 2 _MS li.irrie, H J &. Harding H F T M d Bradford Hill, A A. Fanin^, F I, il' 4> Hnd - e , J C ( t ()34) -G/iik Hep OG, ' i * Britton, ' A &. WuKh F. L (1'Uo j Campbell J M (1933) l i n t ,ed j 2 I Col l c n. M I ' , D v M d h l . G I. F O P r . - , Co'A n M V (194 7) H i d 29 J l i t Colas, r 1 '191 7 I ' M ! Ht'K ! -> t : Co- ke V. r; ! 193 7, l r 1, ! 1 l u m . j j Rohson \A l> \ . r u n w. j J RoLxor, \ G \ I - I )ty / , A T F McL ."A, h*. \ l 1 . : Doi - A T L 3L I t ^1,' r \ : L : 7cr .\ ? s 1*G r O \ .133" , 1 k tcher, C M[ ' 19 4 S l i f t ,, , / / ', I'.'du r L l M L b 7, \ , i , p " irm-u J u .!c.\ rik c R M9 33 / j 1 . 1 ! 1 G 3,!o \ r,e v R (1933, 7' M ' t ' * I n ' i -or i l t us ki, G , 34 i t ; 9, . G, , Lor alt u <. i G 1 ! 3 4 1 U n i 11 1 1 <, o:.. k y >. 1 G V 1 1 ,, , k 1341 ; Gough J ( 1 7 1 c> . , ,' Me ' 4 Lrccort, J c ( 1 5 3 1 ; f., t ' , . j \ ' I3 4 4 , p 1 a h ' ' 13 h 1 :. 1 9 4 ^ l i t , ' j , H ird ;n - H L , Grout 1 f. Happiest' n, A G (1947 - / Hope r. \V , H i r . m W \ \ ;' Pi'1 P ' ' 1- Hunter, D , M1110 n R xC l \ K ' Hunter, D F re rr \ K M \ ri bl h J mer, R M Jaccr P 114' 1 ' > i. Jottcn K K F ic'kI.oft. V, 1342 Kettle. L J ( 103 3, j P a t i Da. t 35 Lanza A J (1943; j M i am 1 K3) L l o \ d Davies, T A (I04C> li t it J Machie, V' F Gregorius F ( 134s' McLau^hhn, A I G , Grout, J L A P 1 . 337 Marshall , \\* ( 1834) Lanc e t 2 371 Medical F esearch Council ( 1943) Sp- ' Medical Research Council (1943, I F Medical Research Council (19-17 I P ' Meiklejohn, A &. Jones, W W Merewetlier, E R A (1930; ] i> Mo , Merewet h .r, F R A (1933) T u P r c L . Middlctor , 13 T, {193G; ] n '.(<V !' rniCAI. JOURNAL oni' of his follow-workers for he refused to "t 2 yours ago ho Iris hud 111 further attacks. IVrgic reaction duo to this wood. One man iso.i when it was worked that lie was prepared n ho exjxjsed again. At unothrr factory an pass through the woodworking shop suffered in sneezing attacks so violent and prolonged '.is remained fit and well during and after the ostions and there is as yet insufficient lugh further enquiries are proceeding. . is that although Lehman and other -harp pointed and of average size 10 in the sawmill where the asthma cases nnt of small round particles down to average size about 1 - 2 microns. \L DUSTS urious than either vegetable or mineral ry infections ; the sorting of wool coni'e to a pneumonic form of anthrax, the itization effects have also been described, :e chest and feverish attacks ' have been c dust from feathers (Bridge, 1934). MMARY. iay produce a wide variety of reactions dusts may give rise to pneumoconiosis -. distinguished, from the pathological il emphysema, or by an absence of any viimoconioses exist in two main forms, md nodular, as in silicosis, the other in asbestosis. Other conditions resulting u'ts include pneumonitis, immediate or asthma. .1 less irritant than mineral dusts, but -quired to elucidate their toxic poteniiich may be grouped under five main I subacute infections, Monday fever, ma. and acute (allergic) asthma, are getable dusts. Some of these, especially .<1 emphysema group, have no features or pathologically from similar non- uely produce diseases of the respiratory r may occur in sensitive individuals and . for example pulmonary anthrax, may RESPIRATORY DISEASE--DOIG 240 REFERENCES. Agate, J. N. (11)48). Lancet. 2 : 530 Amor, A. J. (1938). Rep. V llltk ini. Congress industr. Accidents 6- occup. Dis.. Leipzig. 1939. 2 : 248 Barrie. H. J. & Harding, H. E. (1947). Brit. J. industr. Med. 4 : 225 Bradford Hill, A. & Faning, E. 1,. (1948). Brit. J. industr. Med. 5 : 1 , 2 Bridge, J. C. (1034). Annu. Rep. Chief Insp. of Factories, p. GO Britton, J. A. & Walsh E. 1. (1940) J . industr. Hyg & T o x 22: 125 Campbell. J M (1932). Brit.uicd J. 2: 1143 Collcn, M. Dybdahl, G. 1, & O'Brien, G F. (1944). J industr I.'\g <XTox 26: 1 Collcn, M F. (1947). Ibid. 2 9 : 2 . 1 1 3 Collis, E. L (1915). P u ll Htlh. Loud. 28: 252, 292 Cooke, W. E (1927). Bril ined J. 2: 1024 Denny, J. J , Robson. W. D. & Irwin, D. A. (1937) Canad. medAss J . 37 1 Dennv, J. J., Robson. W. D & Irwin. D. A (1939) IndustrMed 8 130 Doig. A T. & McLaughlin, A. I G. (1930). Lancet I : 771 Doig, A T. & McLaughlin, A. I G. (1948) Lancet 1 789 Eiizcr. X. & Sander, O A (1938) J. industr Hyg. ( - T o t . 20 5. 333 Fletcher. C. M. (194S). But. med. /. I : 1015, 1005 Gardner, L. U. (194G) Ttans. Xlth Ann. Meeting industr. I h g roirulatum (November), p 88 (from J . industr. Hyg C- Tnx. 29 4 abs p 7) Glovne, S R. (1932). Lancet. 1 : 1351 Gloyne, S R. (1933). Tubeicle, Lonri 14: 445 Goralewski. G. (1940) Aich Gewerbepath Gru-cibrhig 10. 4, 384 Goralewski, G. (1941). Ibid. 11: 1 100 Goralewski, G & Jager R. (1941) Ibid. 11:1 102 Gough, J (1947). Occup Med. 4 : 80 Gregory, J. C. (1831). Ediub. med. sing. J . 36 . 389 Groli, T. A. (1944). Industr. Med. 13: 8, 598 Harding, H. E. (1948) Brit. J. industr. Med. 5 : 70 Harding, H. E , Grout. J. I. A. & Lloyd Davies, T. A (1947) Ibid 4 : 223 Hcpplcston, A. G. (1947). J. Path. Bad. 59: 453 Hope. E \ \ \ , Hanna, \V. & Stallybrass, C. O. (1923). Industr H\g Med Hunter, D . Milton, R. & Ferry, K. M. A (1945). lin t J industr. Med 2 : 9 2 Hunter, D. & Ferry, K. M. A (1940). Ibid. 3 : 0 4 Jager. R. & Jager, F. (1941). Arch. Gcweibepath Geu-nbehyg. 11: 1, 117 Jotten, K. tv. & Eickhoff, W. (1942). Arch. Hyg.. Bert. 127 : 5, 344 Kettle. E. J. (1932). J. Path. Bad. 35 : 395 Lanza A. J. (1945). J. Missouri med. Ass. 42 : 7 0 5 (from Occup. Med. (1940). I : 193) Lloyd Davies, T. A. (1940). Brit. J. industr. Med. 3: 111 Machle, \V. & Gregorius F. (1948). IXth ini. Congress on industr. Med..London. 194S McLaughlin, A. I. O., Grout, J. I,. A., Barrie, H. J. & Harding, II. II. (1945). Lancet. 1 : 337 Marshall. W. (1834). Lancet. 2: 271 Medical Research Council (1942). Spec. Rep. Scr. No. 243 Medical Research Council (1943). Ibid. No. 244 Medical Research Council (1945). Ibid. No. 250 Meiklejohn, A. & Jones, W. W. (1048). J. industr. Hyg. Tox. 30 : 100 Merewetlicr, E. R. A. (1030) J. industr. Hyg. 12 : 198 Merewether, E. R. A. (1933). Tubercle, Loud. 15: 09 Middleton, E. L. (1020). J . industr. Hyg. 8 : 4 2 3 lv" CI. 1e c u i r m i I CC I. J O II N u d, r A . :-oclineiter , R A. Can mi it a, 1$ u (1943, j k< {r Oh'- Cr, T ; 1;Ri 3: PtUdSrS oj Ch upnt,< n In ;:dnn Mi l l i\ eri Ih iuivr^rass, i: r u 1'r\ d c , A \Y (! ' )4a; J i lidto! r //_' A i'r ,U.S1112, C ( 11)3(31 A/Vr licp .Si T an d 10 i C a m / on Ian >.M'..Ur, 0 A (1044) J tinllf'tr ! h , f M Tex 26 3 79 !m L i t e r , R , Ut inli irt, \ \ ' H .A C.iimin1to ]i H ( l 'l4-\; 1 n , .! Ail 119 HiT 4 7 o 30 110 .\c 11 : < : r IT.c C - T c , 30 J3S -h tr, C 0 1 h-a r r m o n , \ Y R Riddell, A R ( 1047, 1! nd ( I M G ) M i d O u r T r a i l s 20 29 141) J30 Ih.trns, K (1944) ' J ` , l <1 M i n } i i f l M P a m r / M p \ ! i r n s i>. a c ! ' a f / S o . of I / ( !r: , 1 s-' ' 7 . l',, m h m ^o v h, \ r.' \ ; R 1\-'x \ ; . ( ' : ' * { PSO R IA SIS VULGARIS RI.RI SKIN', J O I N T A N D E V E I.L S IO - ' S HORO\s 11/ Irom the D f p i n m f n l ci I - f r m i 'I lie e )', mmc h e c h r o - o : m <,.v *cv r. \ t ms, a n d t he e \ e lev.on i-` ' < ' s ' of .he case and r.o c cr rt ! .t'.on r i Souei x in 1*?9 G d e s m - c d .. c ai \ At t went y - h \ e he d e \ e l o p e d cun; -.c l i t r e shi n ks i or . s J ~ t e r he t i t M 1 p<. ' ? paired h:s \ isi.ai ecu. c onj unc t - ` a, a n d an i. 'ct r cr, t Pcr^.m s m ICO! h.oscnh' - ' ^ g . - n s f tsscr.t) ;. ea r s ..r.d - v ^ t o p h r' y.a a n d rm e \ c e Sv:\ e a corneal ulcer \sh:c n perform r.o re' a t : ; : ns hi p Rets- us. n t he e