Document 6NokOykL03zKrNMxmpN6X561

FILE NAME: General Motors (GM) DATE: 1942 July DOC#: GM009 DOCUMENT DESCRIPTION: Journal Article - The Pneumoconioses - The Medical Clinic of North America ) ) VOLUME 26 NUMBER 4 The MEDICAL CLINICS of NORTH AMERICA JULY, 1942 PHILADELPHIA AND LONDON W. B. SAUNDERS COMPANY COPYRIGHT, 1942, W . B. SAUNDERS COMPANY. A ll RIGHTS RESERVED. PUBLISHED BI-MONTHLY (SIX NUMBERS A YEAR). BY W . B. SAUNDERS COMPANY, WEST WASHINGTON SQUARE, PHILADELPHIA MADE IN U. S. A. RECEIVED JUL 1 7 1942 COPYRIGHT OFFICE CONTRIBUTORS TO THIS NUMBER AlbeCrtorRp.s,BUehnniltceed, JSrt.a,tesMN.Da.,vyL. ieutenant Commander, Medical GranotfLC. aBniradd,a,ML.Dtd.,.,FO.As.hCa.Sw.a, ,MOendtiacrailo,DCiraencatdoar., General Motors J. J.SBerlovoicmefiealndd, SCahniietfa,ryStaEtnegs'inReeelra,tiUonnsiteSdecStitoante,sDPivuibsliiocn HoefaIlnth MduasrtyrilaalndH. ygiene, National Institute of Health, Bcthesda, A. LerBarlooMkso,toMr.sD.C, oMrpeodriacatilonD,irDecettoror,itF, iMshiecrhiBgoadny. Division, Gen RobePrut bHli.c FHlienna,lthM.SDe.r,viPcaes,seDdivAissiosinstaonft ISnduurgsetroianl, HUyngitieedneS, tNataes tional Institute of Health, Bethesda, Maryland. JohnInHd.usFtroiuallgeTr,oxMic.Do.l,ogPyh,.D.W, Fil.mA.iCn.gPt.o,nH, aDskeellalwLaraeb;orAatsosroyciaotef PRriocfhemssoonrdo, fVIinrdguinsitar.ial Health, Medical College of Virginia, Willilaimc HMe.aGlthafSafeerrv,icDe.,Sac.n,dSCenhiioerf SotfatthiseticSitaanti,stUicnailteUdnSitt,atDesivPisuiobn MofaIrnydlaunstdr.ial Hygiene, National Institute of Health, Bcthesda, LeroyStuUd. yGoafrdTneurb,erMcu.Dlo.,siDs iorfectthoer,ESdawraanradcLL. aTbrourdaetoaruy Ffoourndthae tion, Saranac Lake, New York. LydiaNGew. GYiboerkrsoCni,tyM. .D., Metropolitan Life Insurance Company, RaymOocncdupHautisosenya,l MDi.Dse.a,seFs.,AB.Ca.lPt.i,mCorhea,irMmaarny,laMnde;diAcaslsoBcioaaterdPfroor ifceisnseo;r oInfsMtruecdtiocirnei,nUMnievdeircsiintye,ofJoMhnasrylHanodpkSicnhsooUl noifveMrseitdy Spicthalo;olPhoyfsiMciaend-icinin-Ce;hiAcft,teSntd.inJogsePphhy'ssicHiaonsp, itUaln.iversity Hos BenjaImndinusFtr.iaJlonHesy,giMen.De,., NPaastsioednaAl sIsnissttaitnutteSuorfgeoHne,alDthi,visUionniteodf States Public Health Service, Bethesda, Maryland. CONTRIBUTORS TO THIS NUMBER Robeortf AA.pKpleiheode,PMhy.Dsi.o, lRogesye,arUchnivPerrosfietyssoorf, CKientcteinrinnagti LCaoblolergateoroyf Medicine, Cincinnati, Ohio. Wm.pJoolihtnanMLciCfeonInneslul,raMnc.De.,CoAmsspisatnayn,t NMeewdicYalorDk irCeictyto.r, Metro CareytioPn., MDceCtrooridt,, MM.iDch.,igMane.dical Department, Chrysler Corpora Carl AMm. ePreictearnsoMn,eMdi.cDa.l, ASsescorceitaatriyo,n,CCouhniccailgoo,nIlIlnindouisst.rial. Health, JohnpJo.raPtiroenn,deDrgeatrsot,it,MM.Di.c,hiMgaend.ical Department, Chrysler Cor ClareInllcineoiOs.lds Sappington, M.D., Dr.P.H., Consultant, Chicago, WilliapmanAy,. SRaowcyheers,teMr,.DN.,eMwedYicoarkl .Director, Eastman Kodak Com LouisHeSachltwhaSrtez,rviMce.D, .a,ndMCedhiiceaf,l DDeirrmecattoosr,esUInnviteesdtigaSttiaotnesSePcutbiolinc, DBcivthiscisodna,ofMIanrdyulasntrdia.l Hygiene, National Institute of Health, ClareMncoetoDrs. CSeolrbpyo, raMti.oDn.,, FD.Aet.rCo.iSt,., MMiecdhiicgaaln.Consultant, General ) CONTENTS SYMPOSIUM ON I N D U S T R I A L M E D I C I N E p Introduction ........................................................................................ 997 By Dr. C. D. Sclby The Physician in Industry ................................................................. 999 By Dr. Carl M. Peterson Organization and Management of an Industrial Medical Service 1005 By Dr. A. L. Brooks Physical Examinations in Industry.................................................... 1019 By Dr. Grant L. Bird Workmen's Compensation and Medicine ................................... 1035 By Dr. Raymond Hussey Tuberculosis as a Compensation Problem ..................................... 1053 By Dr. C. O. Sappington Nutrition in Industry........................................................................... 1057 By Dr. William A. Sawyer A Wartime Survey of Industrial Psychiatry................................. 1085 By Dr. Lydia G. Giberson The Measurement of Sickness among Industrial Workers . . . . 1105 By Dr. William M. Gafafer Fatigue and War Production............................................................. 1121 By Dr. Robert H. Flinn Prevention of III Health in Industry.............................................. 1145 By Dr. John H. FouJger MethodHs eEalmthploHyaezdairndsth..e....A...p...p..r.a..i.s..a..l...a..n..d....C...o...n..t.r..o..l...o..f....I.n..d..u..s..t.r..i.a..l. 1161 By J. J. Bloomfield IndooBryEDnvri.roWnm.eJn.taMl AcCtmoonsnpehllere and Its C o ntrol.................... 1179 Protective Ointments and Industrial C leansers............................ 1195 By Dr. Louis Schwartz ; ) ) JTuhley, M9e1d2i.cal Clinics of North America THE PNEUMOCONIOSES L. U. G A R D N E R , M.D." lunTghseinpdnuecuemd obcyonpioroselosnignecdluidnehaallaltiochnroonficducsthawngitehs nion itmhe mplaicyatvioanryasfrtoomtyspiempolrespevheargiotycyotofstiisssutoe rperaocgtrieosns.ivTehfeiblraotstiesr. bEaxcctleurdiaedanfdrofmungtihiws hcicahtegaoreryocacracsiotnhaellyresinphoanlseeds atsodulisvti.ng theA kvianrdietoyf odfusspterceifsipcotnesrimblse hfaosrbteheen ipnutlrmodouncaerdy tcooinnddiitcioante. Tofhethuesereaocftisounchistedrimstisncistivoenlyanddesleiraadbsletowshiegnniftihceancthcalriancictearl sthyemcpotonmdist.ioInn ptrhoedugcroedupbyofinphnaeluinmgoqcounairotzseosrboetlhoenrg fsoirlmicossoisf, vfraereiousislicfaib, roausbsesstioliscias,tetsh, eancdonadifteiown ortehseurlstinngotfryoemt sipnehcailailnlyg designated. theSisnacmeemeofsftecottsheurpfoonrmthseofludnugsst ainndpusriencsetanteonheavoefetshseenmtiaalply pporescediabtlhyatinrfeluacetnicoens troespthireamtorbye fduenscitginoantetdhebwy rtihteer choams mproon tteerrmm, asriemupnlecombepnliigcnatepdneaunmthorcaoconsioissisfr.omIncclouadle,danudndsiedrerothsiiss mfroomdifiierdont.ypWe hsielincosthisesmeamy idneevraellsoparwehmicihxeids pwroitpherlqyuadretsziga naDteudstass oafntvhergaectoa-bslielicoorsiigsina,nldikseidteorboa-csicloic,ogsirsa.in, cotton fiber, aannadtosmoicoanl cmhaanygeb.eTihnehyalemdayb,uthopwroevbearb,lysenthsietyizecatiussseueliatntlde gpirvoedurciseeintsoiganlilfeircgainct sstyrmucpttuormals.alAtelrtahtoiounghinththeeselucnognsd,ittihoenisr Edw*aDrdireLc.toTr,ruSdaeraaunacFoLunabdoatriaotno,rySafroarnatcheLaSkteu,dNy eowf TYuobrke.rculosis of the 1239 ) 1240 L. U. GARDNER snpoetciianlfrdeqesuiegnntaltyionliss,teldikaes tfoobramcscoosfispnaenudmtohcroesnhioesri'ss. fever, arc indTuhsitsrygrboeucapusoef ocnolyndiintiointss eanlmviorostnminevnatriaarbclythedevneelcoepsssariyn cInonthceensttraatteioonfs noaftufrienethedruestispdaurtsitc,lebsutctohnestcaonntclyenmtraatiinotnaisneadrc. rpaorseulyresexacreessiivnet,ertmheittepnatr.ticTlehse arheumrealnativraeclye choaasrseev,oalvnedd exin-; snuacrhy aanmeonuvnitrsonomf ednutsta.ndThites ltuonrtgusoaurse uppropteerctreedspaigraationrsyt oprdasi scailgieastedexecpluitdheelimumostlionfintghetheconnotasem,intraancthseao,f ainndspbirreodncahiir,ctahre ritisessubrafcakcet.oItthise epshtiamryantexd mthaantyatofletahset 5p0arptiecrlecsenthtaotflothdegeduosnt Tinhtehefraeier wpheabgroecaytthees fawilasntdoerrienagchovtheer dthepethssuroffacteheolfuntghse. ariierrss.paTchees ilnygmepsthaatnicds coafrrtyheofluf npgarrteicmleosvethpaht apgaoscsytthoesseed baanrd tpisrsoubeabwlyhefrreeeit pisarntoiculolantgeermianttceornatnacdt dweipthosirtesipt iirnatolyrympmheomid ablrlanbeust. Texhteraseormdiencahraynicsomnscaernetraadtieoqnusatoeftodupsrt.otect man against auEtovpisdyenwcheeroef tshuechheapvriolytecptiigomnenmteady trbaechseeoenbroant cahlimalolsytmapnhy nmoodveesd aftrtoesmt tthhee laumngosu.ntNooft cinafrrbeoqnueanntldy oththeernomdienseroaflsperer scoennstrawtihoonshaovfe fbineeen qeuxaprotzsedreivneailndculustsrtyersto omf omdeircarotesccoopnic ssiulcichotriecacntioodnu.les while the lungs themselves remain free of E T IO LO G Y muTsot bheaveexcseigssniivfeic,atnhteefefxepctoss,utrhee taotmdousspthmeruicstcboencpernotrloatnigoends owviethrinpearipoadrsticmuelaarsusirzeed rainngyee.aWrs,ithanind litmheitsptahretiscelefsacmtoursstbfeaalrl caurmecstiapnrocecsal isreliattipoonssshibipletotoonreeduacneothtehre, btimuteufnadcetrornomuccirh bIteltoawkestwtiomyeeafrosr eevfefenctiinvethqeuacnastietieosf othfedmusotsttopoatcecnutmduulsattse. ) TIIF. PNEUMOCONIOSES 1241 within the lungs and more time for the particles to react upon theTthisesuSeisz.e of Particles.--The size of the particles must be samiraallndentooupgahss tthoe pbearrmrieitrsthoefmthetouprpeemr arienspsiurastpoernydterdacitn. Tthhee lOatftetrheprepraerqtiucilseistethisatinafrleuernocuegdhblyy sthpheierrischaal,pefeawndlafrlgexeirbitlhitayn. f1i0bemrsicorfoanssbeinstodsiaams elotenrg aarse6f0oumnidcrownisthairne trheelataivirelsypaccoems,mbount aonthdesrohmaendh,aveevebneesnhosertenfibthearst mofeafsinueredgla2s0s0wmoioclrosnese.mOtno thbee praWcthicearlelya umniinnheraalal bilsccbheecmauicsaelltyheiryriatarctinsgti,ffthaendfaincftolerxiobfles.ize tlihaes sfuurrftahceer aimrepaoertxapnocseedbetocaucsoenttahcet swmitahlletrheit tiisssuthe.e Egxrepaetreir omfenqtuahratszdbemetwonesetnrat3edanthdat1t0hemreicirsonlisttlienredaiacmtioentetro, bpuarttitchleast rbeeslpoownstehienccrreiatisceaslassiztheeosfize3 omf itchreonpsartthiceleisntdeencsrietayseos.f Ttihsesuree ibsyprtohbeabalmyoaulnotwoefr lriemteint toiof neffwecitthivine stihzee waihricshpaicseds.etPeramrtiicnleeds somr aellliemr itnhaatendththisrouungehstathbelisbhleododlimanitd aurerineexhaanldedhewnicthe dthoenaoitr accumulate to produce effective concentrations. PH AGO CYTO SIS AND D ISTRIBU TIO N W ITHIN T H E LUNG parRtiecglaersdilneshsaloedf tihnetocthhaeratecrtemrinoafl tahier smpianceersalasreininagedsutesdt tbhye sfruebesepqhuaegnotcyditsicpocseiltlisonthoaft dtheevefloopreiignnthbeodaidejsacisenmt owraellso.rTlehses iinnfelrutenpcaerdticublyatethemiratnteartulriekeansdooqt,uaconatilt,y.anSdmiarlol namaroeuntrtsanosf ptoorltyemd pbhy nthoeduplhesagwocityhtiinc cthelelsluthnrgosu. gMh etrhce tlhyemypmhaatyic rveemssaeilns bthuet tnhoedreesisaabotuent dtehnecybiffourrcmatoiostnoof fthtehme ttoracbheecaa. rrAiefdteor nthtoe lpaatrtteirclehsavbeegainccutomucolaltleedct eixncetshseivelymamphounnotsduolefs dwuistth, inmothree ) ) 1242 !.. U. CARONKR lfuronmgs othbesmtrusecltvivese. reTahcitsioonrdiner thoef ndoisdpeossitaitonthesugrogeosttsofstatshies slucnlegr.osIetd issilipcroatcicticlaylmlyphnenvoedrescobmecpolmetee, inhvoowlveevderi,n faorsuepveern imWpohseedn lloabrgaerrpanmeuomunotnsiaofodr upsut lomfotnhaerysamcaenctyerp.e arc inhaled valelssoefl; tmheanpyhaagcocucymteuslatdeowniothtinremthaeinsuwrriotuhnindinthge cloynmnpehctaitvice tmisesnueta.tiTohniswishiecvhideonuctleidnebs y ththee ldoebluicleaste ppreersielynmtinpghatoicn ptihge vpelessuerlasl tsruarvfearcseinagndthbeydseipmthilsarodfepthoesitsluningst.heOwnaellxspoofsubrleootdo mexeccehsasinviesmastmaorsepheenrtiicreclyonicneandteraqtuioatnes aonfddudsutstt-hfiellepdroptehcatgivoe cyTtehseresmolauibniliintythoef aplavretoicliulfaotre ymeaartst.er also influences its dis gpyospistuiomn. qRueiacdkillyy ddiisssaoplpveeadr peairtthierebselfiokreethoorseafotefrmtharebylehaanvde beveeidnenicnegeosftetdhebiry pprehsaegnoccey. tTicoxciecllssuabnsdtanlceeasvelikperafcintiecaqlluyartnzo, ocyntetsh.eTohtheecrehllasnudn, deexregrot tahesicrriefisrsot fefcfheacntsgeuspoconmtphaerapbhlaegoto tahltoesreatieoxncsiteadndbygiathnet ctuebllerfcolrembataicoinll.usN, eicnrcolsuidsinogcceupristhbeulitoiidt rloasrieslysointvhoaltvetshethegrolasrsgeapnpuemarbaenrcse oof fceclalsseasetieonn inis tluabcekricnug. tHhoewqeuvaerrtz, nthumatetrhoeuys ihsaovlaeteadlrepahdaygoicnygteessteadreankdillethdu, slibcreeraattiinngg athedepmicantudrefoorf meaorrley cseillliscoosfisthiseasammuechkinmdo.rAe sacaticvoensoenqeuethnacne tmhoactoonfiotshise. cPohraregsopcoyntedsinngotstakgilelesdofbuatnyinjoutrheedr tfeonrmd toofapdnheeure tfooromnetuabneorcthlee-rliaknednhoednuclees.there is a pronounced tendency to FlFicibrsoamusemtaytpeerialo,flikpehaasgboecsytotes,s isanttoetmhpatndtloedinsogeesftfecintihvaelleyd. athsebesmtoasrgbiunst tohfe tfhibeersceallr.e Tsohilsonagpptehaarts thtoeyimprpoejdeectabmeeyboonidd activity and as a consequence there is little or no transport to ) THE PNEUMOCONIOSES 1243 tthhee ltyermmpihnaatlicressypsitreamto.ryAsbbreosntocshiiso,leasc,cowrhdeinreglym,obstegoinf sthaeboinut haled fibers come to rest. SIM PLE BENIGN PNEUM OCONIOSI8 Groat Anatomy freeInfrthoemabasdehnecseioonfs.asTshoceiraetedis inufseucatliloyn pthigempelnetuartaiol nsudrfiastcreibiustesdmoionthsmanadll fthoecaal maoreuanst, vianryliinngeawr itdheptohseitsintaelnosnigtythoef tphleeuerxaploslyumrep. hTahtiecsseoctriodniefdfusluenlyg, aognaeinsecrsevsecaaltsterveadryfilnegcksaomfobulnatcsk opfigmpiegnmt,enntoattioovne. r I2n otrhe3 mslmig.hitnerdidaemgerteeers, iinn tthhee wceanlltserosfosfmtahlelerloabrutelerisesoranfdineinlitnheearsedpetpaobsiettswaeleonnglotbhuelesly. mTphheatoiclds sthoeftrecoaalsmmalilnecro'sllelcutniogn mofayembpehyusneimfoartmoulys abirlascpkaciens. cRoelogarrdwleitshs ohferseizeanodr idnitfefenrseintyti,atneontheemof fthroemse tphiegmseunrrteodunadrienags lisunfgib. rIonusspeacntdionpawlpiathtioan lfeanisls rteo vealTshneormmiaclrosstcruocpteuredeumnodnesrtlryaitnegs tthheatpitghme enptiagtmioenn.t is largely contained wthiethainreoplhaargforcaymteewcoerllks owfhitchhe mluanyg. bIen ltohceateladttweritshiitnuattihoen atihressepadceusstocrelilns ahraes doeftmenonesltorantgeadt,edtheanddevseimlouplmateentcoonfneedcetimvea tsiesspuaeratceesllsthbeustuapspoHrtaiyntghocmelles afonrdmsp.eIrnmmitsarktheed cpahsaegsohceyatveys ctoollaarsssuomfepitghmeeirntepdrimceiltlisvewirlloubnedfeodunodraboovualt tnhoeduslmesalbleurt acrltoersieorlessc. ruIntincyrorsesvesaelcstiothne thceesnetradlepbolsoitosd sivmesuslealt.e Willh-deenfinceudt laorcngnitoutdiinnafrlleyqutheneitrlytrausesonciaattuerde wisitmh oarpeporebcviiaobulse. aWmhoiulentssuocfh ntieswsuley cfhoarnmgeeds ctiotinenseoctfivfereteisssuileic,a.chIenmsiucaclh acnaasleyssiist gisentehrealliynvidseibmleonssitlricaateswhuincuhsuhaalsqbueaenn risesdpeomnsoibnlsetrafbolremaonsdt ionf tthheesetisinsusteanrceeasc-tiiotns.eeMmosreprroabrealbylenothaetxcaeshseoalfedsiliicna fmecetnitouhsaspraoccceusms umlaatyedh. aTvehisproindtuecrpedretaatifoibnrosseisemins wlohgiiccahl thine viniehwaleodf ptihge poafufcibitryosoisf sounchexcpaosessuraendtothpeurreepmeaitneedradlsemofontshtirsatciloanss.in animals of the lack Roentgenologic Findings beAnignroepnnteguemnoogcroanmiosoisf rtehveeaclshetshtatofthae sliunbejaerctshwaditohwssimnpolre mexatlelnydcafsutrtbhyer thientoblotohde vpeesrsieplshearryc othfictkheer ltuhnagn. uNsuoal naenwd snhoatdothwosroauregholbysefravmedil.iaTr hwisithpicptousrseibilsecvoanrfiuasnitnsgotfo tohbese"rnvoerrs mal" pattern. It is probably safe procedure to regard nothing ) 1244 L. U. GARDNER btiuont vtoeriynhwaelelldddeufisnt.edInlinnoeacraseexasghgoeurladtiiotnbeassoevriedgeanrcdeedofwrheearce tAhe fcuhratnhgeer issonuorcteunoifforcmontfhursoiounghoaruisteasll fproarntts othfeboftahctlunthgast. eaxnpdoscuhraeratcotefrriseteicsilnicoadudluarst,roincsnutgffcicnioegnrtaptohicpropdauttceernds,efimnaitye iamlspooscsaiubslee teoxadgigsteirnagtuioisnh obfettwheeelnine"aerarlmy"arksiinligcso.ticSinrecaectiiot niss afinlmdsthaossepreosfilnicoontsicp.ecIinficsuorrvigeyins oitr iisnuannsnafuealtoreeclxaasmsiifnyatsiuocnhs ooufglhalrygeugnrdoeurpstsooodf, msuecnh wahodsiaegninodsiusstrisiala erxepasoosnuarebleis pthroobr cahbailnitcye,s boufteirnroarnariseoglarteeadt. case, seen on a hospital ward, the Clinical Picture tomSism. Dpliesabbeilniitgynisphnaerudmtoocoimniaogsiinseoirndivniaerwilyofcathuesedsinstoribsyutmiopn soifgnthseardeusut srueaalclytioanbsinentthealtfhraomugehwoirnk soofmteheinlustnagn.cePshytshiocsael innodsiicsadtievpeenodfscuhproonnica bhriosntocrhyitiosfmaadyeqbueateeliecxipteods.urTeheto ddiaugst gsucpnpoogrratepdhicbypaetvteidrne.ncBeutofit dsehfoinuiltde aalwltearyastiobnesbionrnteheinromeinntdothnalty tohnee loafttethreisponsositblpeatchaougsenso.mHoenailce,dthinaftecintihoanlsedmadyusatlsios tphreodduicsterisbluigtihotndiesgarepetstoofbleinleeassr uexnaifgogremra.tion, but in this case Complications simSpulsecebpetinbiiglintyptnoeuimnfoeccotinoinosiiss naoltthoaupgphrectihaeblynamtuordeifioefd tbhye cAacuustaetivpeuldmuostnainryffuicnnfceecstiothnes farreequneoncmyooref tchoismcmoomnpltihcaatnionin. ltihkee ptuobpeurlcautiloonsisatmlaayrgbee; sthlieghitnlycideelenvcaeteodf icnhtrhoeniccasienfoecftipoenrs ssoilnicsa.bWreahtehriengdudsutsstsofcocnaltcaiiunmingcoamn paoduenqdusataeremcioxtnucreernoefdftrheee frequency of tuberculosis is generally very low. ) THE PNEUMOCONIOSES 1245 Gross Anatom y S I L I C O 8 1S hyaTlihnee, cfhibarroaucstertiisstsiuce lnesoitonovoefr s3ilicoorsis4 ims ma. lioncadliizaemdetneor.duIlnespoefctidoennsoef, styuprfiaccael sainlidcoutinciflournmgslyresvceaattlesrendodtuhlreosugofhothuitsanllatpuarretsseoefdethdeodveeprththseopflebuortahl oemrgpahnys.seWmah,erfereetheofconnoddiutlieosn, oisvoerf tlohnegdsiatapnhdrianggmtahtiecresumrfaaycebseaandzowneheoref tvhaerriaeblayredissctaurrsbeodf. old infections the uniformity of the distribution is in andI,nexthceepatbsfoenrcetheofelienvfeactetidonnotdhuelepsl,euisraslmsouorfthac. ePiisgmfreenetaftiroonmisadvhaersiaiobnles bmuint erinalsmwoistth ctahseessitlhicearetoispreondouucgeh aasdsioffcuiasteedorcalorbcaolnizeodr bolatchkercocloolro.reIdn souucthincassehsartphecoslnigtrhatslty. rAaissesdilicceantteernsdsoftotheacccoulmorulelastsesimlicooreticranpoiddulylesinstathnids eloacrlaytiosni,lictohseis.pleHuorawlemvearn,ifpeastlaptaiotinosn moafy thbee tfhoeci oonlfy pdiegfmineintetateivoindenincethoef ddiefefpereernptiaarttesd offrothme tluhnegsuusrruoaullnydirnegveatilsssuseo.mIensthpaect tiaorne foirfmsuecnhoufgohci towibthe amalreknesd dceamseosnstthreateusnilfoocraml odbisltirteibrauttiioonn ooff tthhee fniromrmadliscsrterutectunroed.ulIens cwoenll stituWteheurnemitshteakapbrloepoervtiidoenncoefoafsssioliccioasteisd. minerals is relatively large, the fzoornme ooff htheeavsyilipciogtmicennotadtuiolen iws hoifcthenmmayodciofimedm. uAnbicoautet ewacithh issimanilairll-ddeepfoinseitds athloengpigarmteerniotaletisonorisotshoerinsttreuncsteurtehsatcotnhteainfiirnmg, lyhmyaplhinaeticnotrduunlkess. aSrocmaeltmimoesst oobf saculriende.arTnheetswe omrkodthifaicnattihoenstyppriocdalucneodguelnaetiroanl . pTahtteeyrnsaremomroestsucgogmesmtiovne in aTnhtheratcraoc-heanodbrosnidcehrioa-lsilliycmospish. nodes are practically always deeply pig mnoednetsedarferoemnlaasrsgoecdiatbeudt cloaltoerre,dasmitnheeraflisb.rIonsitshemeaaturlryesp, htahseeys ocfonsitlriacocstistothea sshizoee.only slightly larger than normal and become as hard as the sole of a of Tmhicerorsecaocptiiocndtiomesnilsicioanspairnticcrleeasseisupnrtoilgrtehsesyiveatttoainthea edxiatemnettethraotfno2dtuole4s msizme.trheegalerdsiloensss roefmfauirnthsetartieoxnpaorsyuraen.dHnoewwevoenre,sodnoanttoatindinevgeltohpe.irFmroamximthuemn oponrtoionnlys othfethdeevluenlogp. ment of associated infection is likely to involve new pleuMraalnysurcfaascees iosf osbilsiccuorseisd fbayil dtoensceonffiobrrmoustoadthheissiocnlasssaincadl opnattseercnt.ionTihneg athmeoulunntsg olafrgaeir,-cbolanctkainminagssetsisosufe.ruDbibsecrryeteconnosdisutelensceushuaavlley roepcclaucredelsveawrihaebrlee bfiubtrossoism. eCtiomaerssetheemyphayresemdeat,ecntiobtleinofrnelqyueanlotlnyg othfebbuollroduesrstyopfe,thies ma ausssuivael cuopmpeprlitchaitridosn.ofTohnee olarrgbeothcolnugnlgosm. Seroamteetilmeseisonbsilamteorasltlyosftyemnmoectrciucarl imnastshees radiate from the hilum into each lung involving perhaps portions of two 1246 L. V. GARDNER oofr msuocrhe lsocbaers iswidthiscoobvleitreerdatipoanraollfelthteo fibsusutre3s.oAr t4otchme.r rbiemneesatah sothlied laptreisrmal pthleeurmaaossf farnomupptheer loovbeer.lyIninsgucphlecuarsae.s Oa nzosneectoiof ncionagrsesuecmh pahymseamssa tsheepakrnatiefes corfeteanksmaesnttihoonuegdh isparsasriengunthlersosugohbvitoouusghcallecaiftihceartiobnutistheencgoruintttyeresde.nsDateioepn wzointheisn otfhenseecroarseisasfiollfedcownigthlominekryateflufiidb.roTsihseroenearefrenqouednetfliynisteecswairlrlsegouflaar dfiibfrfoeruesnttiscsouleorsismupchly absectohmosees sgurrarnouulnadrinagnda tthuebnerlciuquloeufisesc.aAvistyt;htehree bislancko comMmaussniivceatifoibnrowsisithofa thbirsontcyhpues rtehpilsacdeesbraisndreombaliintesraitnessiatull. normalstruc taurleessioinn tthheerpeomrtiaoyn boef ilnucnlgudiendvolivsleedts. Aoflodniglattehde iarirregsuplaacresb.orBdleorosdofvessuseclhs astracncoebsliitnerawtehdichantdhethmroaminbobsriasncishecsomofmothne. Tpuhlemownrairteyr ahratesrsyeewn efreoucromin bprleotneclyhi oabrestlriukcetwedisebcyomoprgreasnsiezdingandclootbsl.iteArlaltebdu. t the larger cartilaginous Microscopic Appearances vealMs iacrcohsacroapcitceriesxtiacmpinicattuioren. Tofhethleesiosinmpislec,omdipsocsreedte,ofsicliocnoctiecntnriocdlualme inraee oprfestsheicdk. ,Ahryoaulninde thcoenonuetcstiidvee otifsstuheisfimbearisn wmhaossseisnaucllaeyi earreofthminoraendcelcloumlar cinofnilntreactteivdewtiisthsuephoafgovcayrtieasbleconthtiaciknninegss.blUacskuacllayrbtohne loartteorthiesr mcoolroereodr plaesrs ttricalcetsioanndoftthhee cfiebnrtoeursoefletmheenhtsyainlintehenondoudulelemcaayuseaslsosombee pdiigsmtoertniotend.ofCothne aVirarisapnatcsesofinthitshepicimtumreedairacte (1v)icicneintytrabl uatreathseoref niseclriottslies ionr nnooduleexsudpartoe. dpuucreedstbayteexanpdosu(r2e)totheexcemssuicvhe qmuoanretiticeosmomf ovnerytenfidneencqyuarftozr insevperaraclticcaolnly stimgualolucsonnogdloumlesertaotebleecsoiomnes. surrounded by a common capsule, thus forming diffSuisme imlaratrsitxudoyf ohyf atlhinee mfiabsrsoiuvse tcisosnugeloinmewrahtiecharneoadsuloafr ffiobcriosairse rmevoeraelsoar lseusgsgeeasstiinlyg daenfinoerdig. iTnheinmaantrioxrgsaonmizeitnimgespnperuemseonntsicanpraorcreasnsg;eminenmt oosft fciabseerss ttihoenreofistnhoe spcaarrticwuiltahrouptatlteeurkno. cTyhtiec rneeaccrtoiotinc. Tfohciis ebxehciobmitessimupnldeerdsteagnednaebrlae wthhroemn biotseisd noortemdotrheatorthleessbloococdludveedsseblsy tehnrdoaurgtehroituist. tThheembarsosncahrci, ewithheenr satciltlionpabteuntt,muossutaollfythdeisspmlaayllevrarbiraabnlcehaems oaruentcsomofprcehssreodnibceyinofnldamrmecaotgonryitioren. cenIttratiisonnsotofunsciloicmamdounst into pfeirnsdonssilitchoattic hnavoedubleesenonelxypoinsedthetovilcoiwnitycoonf oseldrvatutiboenr,cuinloucsonstcraarsst wtoiththneongeeninerathliezeodthdeirstpriabrutstioonf tohfe ltuhnegsn.oTdhuliessobin pmearsssoivnes wcointhglonmo eervaitdeentycpeeosfoifnffeicbtrioosnis, haares ltehde troestuhlet ohfyplootchaeliszisedthiantjutrhye. The resultant lymph stasis would explain local retention of excessive quan ) THE PNEUMOCONIOSES 1247 trietaiecstioonf thoef itrhreitatnistspueasr.ticIlfest.hTehiisnfceocnticoenntrwaatisonstwilloualcdtivine twurhnilecaudsuestmworaes obfeinscgarinthisasluede sthoemeptnimeuesmoonbiscerpvreodc.eTsshecosuilldicaorwgaonuilzde tthoenpraocdtucuepotnhenefowrlmy mfoarmtriexdbecotwnneeenctinvoedutilsessu.eSutochptrhoedourcye htahsesudpifpfourste intypexepeorfimfiebnrtoaslisobosfervthae stieornvedwhtoerehebaolthwittuhberercsuullotaunst amnadssnivoentfuibbreorsciuslooufssiimnfielacrtioanpspehaarvanecbe.eeOnthoebr tehleemmensthsomwaydeinnsfeluepnicgemtehnetatdioevnelforpommenatcocuf mthuelasetedmansosinvseiiilceesoiounss.mAinlleroafl pwahrteitchleesr. sWuchhemthienrertahlsis aicstumalelyreliynitiaateresmuultltiopflictahteionlocoafl cloynmnpechtivsteastiisssuoer sciellilcsa wishincoht adreearf.urFthinearllyst,imthuelateeldemaenndt hoyfalcionlilzaepdsebiynctihdeenatsstoocibarteodnchfrieael oisbsntorutcitniotrnodmuacyedplauyntislomthee pfairbtr,oasilsthoisugwhelnl oatdavapnrciemda.ryThoenew, arsitethrisisfaccotonr hveinacleedd itnhfaetcttihoen mwohsitchprdoibsatobrltes bthaseisstfrourctmuaressiivne acolnogcalolimzeedrapteorftiibornosoisf itshea lkuinndg oafndinfdeicsttuiornbstoitsocfcuunrctiinontahle aucptpiveirtyp.aTrtusboefrctuhleosliusngiss. the most likely Roentgenologic Findings vaRryoewnittghenthoegrcahpahriacctmeraonfifethsteatpioanthsoloofgicsaillicporsoisc,esos.f Incocuarssees, ounf ifsoimrmpledisdtirsicbruettieonnoodf uthlaetisomnaltlh, eshdairapglynodsetifcinefedastuhraedoiws sthoef fnioedldusletsh.eUpnrleessusmthpetiyonaries sthoadtissotrmibeuotetdhetrhrcooungdhitoiount bisorthespluonng swibitleh.ouItn sttheereovreoreyntgeaernloygrcaamsess mthaey nboeduclaotniofunseids fwinieth anadn aadpvtlayncceodmpsatargeed tohfe lainpepaeraraenxcaeggoefrattihoen.laWtteartktoinst-hPeitlcehaffolersds tAresetahnednwodhuelneseairnlycrenaosdeuliantiosinzesuapnedrvennuems,bteor,ththeetirreeshinadbouwds. obefcaomtreeelairngefurllanldeafmcoarne nbuemideeronutisfi.eOd.nly the main branches tioOn nthienrsepeacrteinsgoamsianngylesfmilamll orfouanndadsvhaandcoewdsctahsaetoift nisodhualrad stohoiumldagrineemethmabt emr utchhatutnhienvsohlvadeodwtisssoufe aislllethfte. Hnoodwuelevseri,nonane oorngtoanonfreompla4net.oSt9erienoc-hfielsmsinwtihlilckdnoesmsuhcahvetobdeiesnpepl rtohjeecitmed pstriellssmioonreo.f Rthaerierlnyumarebetrhaenred amnoerexatmhainnateioignhot ftothetelnunngoditusleelsf 1248 L. U. GARDNER troespthoensisbqluearfeorinachvairniabalneyamploanuent ooff ssehcatidoonw. lcEsms plhuynsgemfiaeldiss itnhethmeedcioassttoinpahlresnhiacdorwegiiosnsb.roIand maondderdaetneslye daudevatnocetdhecaesnes lbaurtgethdelywmidpthh noofdtehsi;s isnhatdhoewmiastuagreaisntalgesess btheceaudseensoiftythpeercsoisnts traCcatisoens ooff mthaessnivoedecso.nglomerate fibrosis present a diagnostic tphreobilnefmectbioeucasueselemtheenyt issimmuelraetley tduobrmrcaunlto-asnildicobseicsauisne wsohmiceh tli'mheesttyhpeiycadl oconnogt leovmeenrarteevecaalseanpyrtehsienngtsinodniceatoivremoofrseilidceonsisse, mwaitshsivvearsihaabdleowams uopuonntsaobfapcekrgiprohuernadl olufnggenfieerladlsizbedlacnkodbuelcaatuiosne ooftheemr pevhiydseenmceas. Dofiscthorrotinoinc opfletuhreisydiaarpehrcaogmmmatoinc.sThhadeomwasssainvde sluhnagdofwiesldmoayr trhaedyiatme aays lianrvgoelvfeantshefroromotthoef hoinlulmy oinnteo leuancgh. Alikneosthheadr ocwomlomcoantedmbaennifeeastthatitohne cislatvhiecles,hacrrpolsysindgeftihneedanbtleorciokr sbeecnoenadth atnhde ltahtierrdal rpiblesuraat. rPiegrhipt haenraglletso ait ftehwereceinstiumsueatellrys einvitdheencleowoferemthpihrdysseomfat.hOe clcuansgiosnbaulltytmheassesivaereshleasdsocwosmomccounr. Othveseerexepxotrseemdefliylmsdefnasile toaredaesmoanndstraetveenmuthche sftorucictuorfe awneitmhiinc neTcrhoesiscolanctkrascutfiofincieonftthdeesfeinsitciolenrottoicbme avsisseusa,lifziexde.d to the chest wwaalrldbayndplienursaol daodihnegsiothnes, dpiuscllrsetme uncohduolfesthine tlhuenglotwisseureluunpg acriedebnrtolyugthhte inatiro scploasceesprinoxtihmeitylowtoetrhleunmgasssbiveecolemseiono.vCerodiins-creonmdpedentsoatkoeryepetmhephpylseeumraal acnadvitay cfoilnletdra. cTtehde lcuonmg bminaaytiocnomof tphleeytelfyuseobwscituhrethathteofshthaedolawrgseomf atshsenedaisrcbrye.teAsnoadcuolnessesqouetnhcaet tahned fcihlmronmicayplreeuvreisayl owniltyh nthoedmisacsrseitveesshhaaddoowwss,toesmupghgyesset mthae, sdiilfifciocutilct porroigbilnemofinthdeiacgonnodsiisti.on. These cases present a most THE PNEUMOCONIOSES 1249 Complications cepRteiblailtiitoynshtoip ttuobeIrncfuelcotsioisn; .--itSiilsicofsriesqdueefnitnliytelayssioncciraetaesdeswsuitsh cmhornoinai.cTbhreonicnhciitdiesntcheatofmlaoybalreapdnetuomtoenrmiainisalhbigrhonicnhoceprnteauin ipnodsuusrterietos swuidthdensiliacnadheaxztarredms ebcuhtanwgheesnincotnemditpieornastulriekehaevxe bsuegegnecstosrrtehcattedfatchtoerpsnoetuhmeronthiaanrattheehasislifcaolsleisn.arSeucrehspeoxnpseirbielen.ce Tuberculosis theInrecidisenlcitet.l--e Wrehaisloena tfoewdowurbittertshahtavseiliecxopsirsespsereddsiskpeopsteicsistmo twuobrelrdcuilnodsiisc.atSetartaitsetsicsfofrrothmis einvfeercytioinnduinstrtihael scioliucantrinyduinstrtihees sftoautirsttiocstwreevneatyl ctoimmepslitchaattinign taudbuerltcuelmospilsoiyned60mtaole1s5. Apeurtocpesnyt oexfposisluicroetitco ssuilbijceactds.usAt nisimuanliqeuxepeirnimceanutssindgeminofencsttiroante wthitaht tpurboegrrceslesesbaacnildli porfodlouwcesvicruhlreonnciec ftoubr evrcaurilooussis.spTehciees,skwephtiicchs bbauste ftohreirreaospoinnsiotnos boen pcrleisneincateldimsupcrehsseivoindsenocfeismolaaytedbecamseiss, leaFdaincgto. rs Affecting Incidence.--While there is more tuber coufltohsiiss inafmeoctnigonsvilaicrioetsicwsituhbtjehcetsoptphoarntuontihtieerss,fotrhceonfrteaqcut ewnicthy tfhoeuntudbryericnlethbeaccililtuysoifn Mpailrwticauulkaerecwomhemreunaitiperso.gIrnama omfocdoernn tproorltshanso beexecnesisnoofptehriastiionnfecfotirons.evAenmoyneagrsR, aSnadndgeorldnomwinerers icnuloSsoisuthweArefridciascoinve1re9d37o-3n8 poenriloydifciveexnamewinactaiosens ooff 2tu8b,4e1r4 cmaesenswamithonsiglic1o3s,i4s7. 4Insitlhiceoytiecasrsex1a9m1i7n-e1d8. tMhearneywoetrheer11e6xasmimpilleasr oTfhseucphoicnotnttorabstesarcoinuldmibnedciistetdhabtuwt thhieley parreevhaalerndclye nraetceesssmarayy. vsialircyotficrosmtococmommeuninitycotontaccotmwmiuthnittyheit diisseaasseneincesosradryer fotor ) 1250 L. U. GARDNER dsielivceolsoips mtuebreerlcyuleonshisanacsesfotrheotphreorbsaubbiljietcytso. fTehfefecptrievseennecses ooff sucIhn gcroonutpacst.of persons exposed to silica dust the incidence of acoctmiopnl.icFatoinr goninefelacrtigoen girnocurepasoefs w26i1th2 tmheinesresv,erCituymomfinthges rree ported the following rates per 100,000: LNioneeavrideexnacgegeorfatidouns,t 1rsetacdteiognree.......................................................................... 01..S0 SLiilniceoatricexnaogdguelraattiioonn,, 12stnddedgeregeree...................................................................... 62..00 Silicotic nodulation, 2nd degree ................................... 12.0 wiTthheagefrewqhuiecnhcyhasofletdubteorctuhleosbiesliienf tshilaict omticosstaolsfothinecirneafesecs tbiuont sanareapopfreecxioagbelenonuusmorbiegrinr.eTsuhlits firsotmruereianctmivaantiyoninsotfanpcrees, eitxieisstionfgrelaatcetnivt aftoincig oafsroe-icnaflelecdtiopnritmyapreydoisreaGseh.oTn hteubperrocbleabairle mstruacthedmeoxrpeerriemmeonttea.llWy hinileanthimisalpso, ssainbniluiatyl rheaesxabmeeinnadtieomn oonf lraarrgitey gorfoiutpssococfurhruemncaen. Tsuhbejeccatlscihfiaesd doermfiobnrsoturastpedarethnechgyrmeaatl tyuebaersrcloefs eoxfptohseurperitmoasryiliccaomdpulsetxarlethmoauignhuninchsaonmgeedctohurnoturigehs mexeanmiwnaittliions.ucIhn tlheseioUnsniatered rSetjaetcetsedtheongetnheeraplreperamcptilcoeymisentot addemnciet tohfemrecuennltesasc,tiovfityc.ourse, the primary focus shows evi silicPoattihcolsougbijceaclt Aisnautosumayll.y--Tmhaetepraiathlloylogdiicffaelreanntatofrmomy ofthtautbeirncuolothsiesr inintdhie avlimduoaslts. inIndistiitnsgcuoismhambolenesftrommanthifeestmataiossniveascotunbglrocmuleor-astielicfoosrims itofmsaiymphlee sisiloiclaotseids, faolrceuasdyofdecsacseriabteiodn. Moranaysmseacltliotnusbemrcauylobues nceacveistsya.ryWtohedniscsulocshe aann athreea ciasseeoxupsosmedatitteriswuhsuicahllyofrfeecrosgsnhizaerpd ecaosniltyrasbty tothethgerasyu-ryreolulonwdincgolbolracokf tlhiheroiunsfectitsiosuues. pIrnoce>sms cisinstsitlalnaccetsivteheanmdicervoesncotpheis mmuestthoddetemrmayinreeqwuihreethienr sbpeecfteiwon aonfd sfeavrerbaletwsqeueanr.e Minocrheesofotfens,echtoiownevfeorr, tthhee ftoucbierocfulaocutsivictoymmpaliy ccaastieos,n liasrgoebvcioauvsitiaets thheavteimdeesotfroayuetdopsmyu. cInh 6o0f ptehrecemnatssoifvethsecacronagnldomaebroautet ) THE PNEUMOCONIOSES 1251 ittyspeboorfdetrusbethrceulaoisri-sc.oTnthaeinreingmalyunbge isa ifnevwadceldustbeyrs aofveisroylactehdrotnuibce,rcfilbersoiidn trharee.loSwimerilalurlnygcboumtpuliscuaatilolynsbrionncthheoglearnyicnxa,nidnthesetminaetsogaenndouostheexrteonrsgiaonnss aarree minosstiliecxoctiecptsiounbajel.ctTshaisndvesriyncechrboonthic iftosrmpatohfoltougbiecraclulaonsdis cilsintihcealusmuaanl ifoense tsailtiicoonssis.are atypical it properly deserves its special name of tubrculopersQounisteweitxhcemptiinoinmaallly otrubveercryulooslids smilaicyotbicehnavoedulinatioan.tyIpnicaslucmh aenanseers, ina cbhroronnchicogaepnicical ofrochuesmpartooggreensoseuss sdloiswselymiannadtiofninathllryouegxhcavthateesluwnigtsh arnesdulptaenrt haps extrapulmonary complications. ThReoseenatrgeenooftgernapinhdicistiAnpgpueisahraabnlceesfroomf thTousbeeorcfumloa-sssiilviceocsiosn.~ gevloemr,emraatey fdibermosoinssotrnatefirast gerxaadmuainl aetixotne.nsAionnnuoafl tfhilemsp,rohcoewss. oInf tmheaniynfceacsteiosutsheeletimmeentulitsimmaatneilfyesaterrdi;vecsavwitiheesnmthaye tahcetinvibtye vmisauyalbizeedanatnicdippartoegdrewssiitohninbeacopmereiosdmoufchtwmooroer rtahpriede. Dyeeaartsh. Tnohdeulraatrioern tpyrpeisceanltstunboerucnuulosusiasl ofenatuarebsa.ckground of silicotic Clinical Picture in Silicosis noOdunlearosfiltihcoesims oisstthcehapraauccteitryistoicf sfyematuprtoesmosfasnidmcpllien,icdailscsriegtnes, ifnesctaotmiopnsa.riMsoannywistuhbjtehcetsexarteenetnotifretlhye urnoaewntagreenooflotghieciarl cmonadnii ctioonntinuunetiltoit piesrfroevrmealhedardbyphaysriocualtinlaeboror ewntigthennoogrcaomm.pTlahinetys atinodn ndoemdiomnisntruattieosn soofmoeutdpyustp.nOean.lySosmevee,reonantdheunoutshuearl heaxnedr, wNiollt rinepfroerqtuecnotnlsytritchteiroen isoranbuurnnpinrogdusecntisvaetiocnosuginh,thperobchaebslty. dpuroepetor. bItrosnecehmisalprirorbitaabtiloenthaantdcenrotatintosucshcaenpgtiebsleinindthiveidluuanlgs tmhaoyughhavtehissymsupbtjoemcts neeveedns ifnumrthineirmianlvsetsatgigeastioofn.thTe hdeisesatseethaol siscoappet otfotenbedeptreocltosngaehda. rsIhn rtehsipsirtaytporey onfotdeiseaansde ecxhpeisrtatieoxn- 1252 L. U. GARDNER pwahnastiolnimaitnedd.the excursion of the diaphragm may be some is dInifftehreenptr.esTehnecseeomf emnaassrievedecfoinnigtleolymesrhaotret-fwibirnodseisd.thAeltphioctuugrhe bmealonwy opfart.heUmnucsouanltinexueerttioonwporrekc,iptihtaetiersparnodauttcatcioknoifs smevuecrhe sduyfsfpenrepalefurroimtic wpahiinchantdhecyourgehc,ovwehricshlowislpya.rTtichuelyarlfyretqruoeunbtlley staotmeevionmtihtiengm. oTrnhienigrs. iIsntshoempeicittuirsesoevfearedveannocuegdhetmopphryesceimpia wiWthhtehne tphheycsiocnagl lsoimgnesraotef ltehsaiot ncoisnddiuteiotno. an unhealed tuber cauplpoeuasrainncfeectthioant dtoiaxgicnossyismipstodmiffsicaurlet. sNoolat teunitnil mthaekitnegrmthineairl bciraetaekddowwitnh dtoubtehrecsuelocsaisse.s Bmeafnoirfeestthsaytmtipmtoemtsheoyrdainrearsilhyoratssoof bacretiavtihtyb.uTt hweeyllhnaovuerinshoefdevoerr,evleonssoovferawppeiegtihtet ,froorminrcersetarisceteidn ssepduitma.eInttaistinoencersastaer.yTtoubfeorlclolew btahceimlli cdaorefnuollty aypepaeraarftienr tyheeairr ptoosnitoivtee tshpeutfuimrs.t Ohinntoocfcassyiomnp, tommosntohrlythgeuidneeva-eploigpmteesntst mofaya dneegmaotinvsetrastpeecthime epnres.seUncseuaolflyt,ubheorwcleevbearc, iltlhiefoslplouwtucm' bryemmaainnys pwoesliltiavsemaefdteicratlhreeaosrognasnmismosst foifnathlley calpopseedarc.aFseosraerecobneotmteircoafsf isftrethnegyth.arIcf aplluotwoend rteostdtoresaotmmeenwt othrekycoarmcpdaitsibcolentwenitthedthaenidr tnhoetirbdeysnpengeleactseede;msastosoboencoams eanmyoreevisdeevnecree. oBfutatchtievyitysh, oaunldd pmaurstitcbuelarrelymoavepdosfirtoivme csopnuttaucmt,tomparkoetsecittsthaepipr efaerlalonwce,wtohreky men. Diagnosis of Silicosis i anDiniadgunsotsryis wdeitphenadsfreueposnilicaahhisatzoarryd,oaf achdeeqstuartoeenetxgpeonsougrreaimn sphhoywsiicnagl saigsnhsaodfowthepnatatteurrne cahlraeraadcytedriessticcriboefdt.hTishedisfielamse,ofatennd suggests the presence of silicosis but to establish a diagnosis THE PNEUMOCONIOSES 1253 cpolertreobreocraotridveohf iastomraynm's uosctcluiepaotbiotanianledli.feT, hiniscliundvionlgvensoat coonmly tmhaeteprliaanlstsusaetdw. Thihceh phheyswicoarlkeexda,mbiuntattihoen iksinimd poofrtjaonbt faonrd twthoe mreaalsosnisg:ns(,1)whIticmh,ayinshcoownjuanlmctoiostncowmitphlettheeabesxetnecnesivoef arbonenotr- g(2cn) oigt rmapahyicrecvheaanlgeevs,idisenaclmesosotf paactthiovgitnyoomfoannicinoffescitliiocoussisp; raoncd eissst.hAesdaelrteearmdyiniantdioicnatoedf, tthhee mlatoesnttdieflfeimcueltntdioagf nionsfteicctipornobilnema lteiosnioncaonf smetatslesivtheiscoqnugelsotmioner.ate type. Only repeated examina Other Complications of Silicosis hasThbeeeenffdeicstcuosfsesdilicwoistihsouuptodnetfhineitceirccounlactliuosnioins. aBsoutbhjesciltictohsaist abnedliehveeartthdaitseoabsestarurectmivoestfifbreroqsuisenitninthmeatluurnegsadruelstullitfse. iMn acnoyr pouf ltmheonhaelaertw. Iitfhthcihs arreascutletrdisoteics fhoyllpoewrtriot pishyproobfatbhley lriimghittedsidtoe sceaesmess otof mpraosdsiuvceecloitntgleloamneartoamteicsailliccohsaisn.gDe iisncrtehtee pnuoldmuolantaioryn braloreodinvewssheilcs.h Bountlyevtehne wriigthhtcsoindgeloomf etrhaetehdeiasretasies caafsfeescteadre. mMiogshttofeatshielym hhaavvee goernigerinalaitzeedd cinarddeipoevnadsceunltalyr.lesOiobnsstruwchtiivche wfiborrokseisd ihneatrhtebulut nthges wplraicteesr qaunesatidodnesdwbhuertdheenr itonis athperiomvaerry cauWsehiolfe hseoamrte daiusetahsoer.s have claimed that soluble silica, lib eproaitseodn ionthpeurlmtisosnuaersy, tlheesiroensis, cniorcthuilnagtestothsruopupgohrtththeisbopduyreltyo chuyrpoctahnetibcael erexapsloainniendg. bAynytheexcheisgshoefr nienpchidreitniscethaotf maartyeroioc isncvleorlovseismaetntthoefalgyemppehriondosdewshaetnthsielichoesaids iosfcothmempoann.crSeialiscoistica raeogrtualaarrefiinndvionlgveadn.dOonclcyasoinocneallhyasntohdeeswariltoenrgknthoewanbdthoemmintaol cause symptoms. ) ) 1254 L. U. GARDNER Prognosis gooPdro. gInnosthise ianbsuenncceomopfliicnafetecdti,ondissuccrehtel,esnioondsurlaedruscielictohseisreis soerrdvienacraypawciotyrko. fPtehresolnusngws ibthutsdimopnleotssielircioosuisslyshionuteldrfebree wkeitpht duentdeecrt oebarsleyrveavtiiodnenacnesd ogfivteunbearncualonsniusa. lInx-trhaey aebxsaemnicneatoiofnthtios coMmpaslisciavteiocnontghleoimr elrifaeteesxiplieccotsaistioisn aismnooret sgerreiaotulsy ciomnpdaitiiroend.. tIitatceaufsreosmditsuabbilrictuyloin-siiltiscooswisn irnigahnt ainnadctiitveis phhaarsde.toMdeinffewreitnh sbmutallafctoenr geloxmeretiroante dlyessiponnesa oifstemn uwchorkmowreithoblvititoleusditfhfiacnultiyn gthloosmeerwatiitohnsthaercdiuscsureatlelyfoinrcmapoafcitthateindgisbeaescea.usTehoe f laarsgsoecicaotend emTpuhbyesrecmualo. sis in any form is a serious complication of sili dcoisseiassea.s Diteitsecrteesdpoenasrilbyleanfodr pmroomstpotlfythsuebjdeicsatebdilittoy tfrreoamtmtehnist iatdvnaenedcednottubteerrmcuinloa-tseilifcaotatlilcyleinsiotnhse acroeoapneoratthievre mpaattiteenr;t.thTohsee ipnrowghreosms tahnedreailsthaonueglhemdeenatthofmacatyiveocincuferctfiroonmquoittheerregcualuasrelsy, many ultimately succumb to their infection. Treatment and Disposition of Cases muTsht ebree pirsevneontkendobwyncotrnetartoml eonft thfoerdsuislitcionsisth; etheenvcioronndmitieonnt apnlodyebdy. Gthoeodprpolpaenrt sheoluecsetikoenepoinf gp,etrhseonussewohfowaartcert,oadbeequeamte gfiecnieenratltovenmtialianttiaoinn asnadfeloccoanlceexnhtraautsiot nssysotefmdsuastrcinustuhaellyairsuoff wexoarmkiinnagtiopnlactoes.exMcleuddiecaplercsoonntsrowlitihnvtoulbveerscualopurseelemsipolnosymfroemnt eevxipdoesnucrees toof sdiilsiceaaseduinstthaonsde aplerreiaoddyicemexpalmoyineadt.ions to detect OnItnadrieop,eannddenbtyobthseervSaatriaonnascbLyabRoorbastoonry, Dinenthniys,caonudntIrrywihnavine demonstrated that aluminum and certain of its compounds )\ THE PNEUMOCONIOSES 1255 sweirlvleprsreovbetnatintehde dtheevierlorpesmueltnst wofithsilifcionseilsy. TdihveidCedanaalduimaninoubm wpoitwhdtehr.e ThyhderoSxairdaensacofLaalbuomriantuomry.'sImexmpaetruimreensitlsicwoteicrelemsiaodnes aafrfeecatbeodr.teTdoanbde reefgfreecstsiv, eb,uat flualrlgye dqeuvaenlotipteyd onfodthuelesinahricbintoort cmyutisct rceealclsh tthhaetsacmonetaloincattihoen qaundartpzropbaarbtilcyletsh.eCshaemmeicpahlagroe accotmiopnlerteesluyltsneiuntraalciozeadti.ngExopfetrhiemseinlitcsaawrehonsoewtoixnicperfofgercetsssaract twhehePtohrecruapliunme iSniulimcosinishCallaitniiocninthTeirmapmyinhsa,sOannytariinof,luteondciescuopvoenr smyimghpttobmese.ffAecstiavep,rboupthdyilfafcictiuclt mofeaaspuprleicaatluiomnintouma lainrghealgatrioounps boef swuobrsktimtuetend. Tfohreerengiisneneorinregasmonethtoodbsetloievreeduthcaetaittmcoasnpheevriecr coTncheentdraistipoonssitioofndousft.employees in whom the periodic ex eaamseindaetipoennddissculopsoens daifnfuermenbtermoafniffaecsttoatriso:nsthoef epfufelcmtiovneanreyssdiosf tdhuestocpopnotrrtoulniitnietshefopr ltarnatn,stfheer tcoonodthiteiornjoabns,d aangde soof otnh.e Mmeadn, iwcailll redceopmenmdenudpaotinonas itnhoeraocuhgchassetumduystobfe tphaertiicnudliavriidzueadl.anInd gtheenierrarle,gmuleanr wwiothrksiimnpalepdliasnctrewteitnhodauglaotoiodn pmroagyracmontoinfudeuastt cemonptlrooyl.eeExwcheoptimonansifheosutsldsibgensmoafdeeairnlythseiliccaosseisoaffttehre ayoshuonrgt eshxopuolsdurbe.e Htraensisfeprrreodbatbolyanmotohreer sjoubsc, ebputitbtlheetrheains noothemresdaicnadl roefasthoen cwashey whiethshaosumldalsltofopcuasll owfocrokn.gTlohmeesraamteefimbraoysisbewsiathid aocuttermsueecmh tdoyshpanveea.lesMs doyrespandevaainfctehdeycaasrecs aollfowtheed staomdeoclhigahrt whoowrkevienrs,teiasdoofftebneinemg blaairdraosfsfedwittoh nfiondexeenrcoiuseg.hMjoabnsagoefmethnits, chOarfacctoeur risne tahlel ohfeathveyseinmduesntrrieesquliikree cmoinnsintagn.t observation to detect the earliest evidence of activity in an infectious coin- I) ) 1256 L. U. GARDNER tpelcictiaotinono.f Othpeenrestut boefrcthuelogsirsoumpe;aenasrlsyegturebgeartciuolnosfiosrshthoeuldprboe sgiibvleeninfutlhl esacnoaotopreiruamtivterepatamtieenntt., Tanhde rcehcorovneircy tiusbqeruciutelopsiolsi- cmoattiec irsecboevstercyariesdrfaorer.on a modified regimen of exercise. Ulti RAPIDLY DEVELOPING 8ILICOSIS in Aa freawre ganrodupastypoifcaplermsoannsifeesxtpaotisoend otof seilxiccoesssisivheascoonccceunrtrread twioanss foirfstveirdyenptiufireedanind vpeerrysonfisnemqaunaurftzacdtuursitn. gThainsdcopnadciktiionng aasbsroacsiivateedsowapithpothwedseirlsicaancdauistedwarsapaisdsusmoleudtiotnhaotffrtheee ianlkhaallieeds qpoutahretzs.isAannidmsaulbesxepqeureinmteonbtsfeirnvdastionno hjuasstidfiecmatoionnstrfaotredthsiismhilyar ctuansenselinwsoarnkdebrlsaswtehrosswe oerxkpionsgurien ienncclulodseedd ntaonkaslkaalnieds.ceArtfateinr phaevrieoddsevaesloshpoedrt saesveerieghdtyeespnnmeao.nCthhsesstomroeenotfgetnheosgeraovptserraetviveeasl onnolysuaggfeinsteiodniffoufsethheazcilnaessssicatlhrnooudguhloatuitonth. eAlufnegw fihealdvse wdiiethd twaiintheidn. aMyaenayr oorf sotheamnd sahonwumedbear ocfomauptloicpasiteinsghatvuebebreceunloosibs, abnrdonicnhmoponsetuomfotnheiao. tBheurts athpearctaufrsoemoftdheeaseth iwnfaesctaionuosnslpeesicoinfisc, awllhiochf, tihnegrlousnsg, ssuhgagveestepdreasnenotregdanaizinggenpernaeluizmedoniicndpurroacteiossn, bcoutticonremacictiroonsc.opIrivcineexamapintlaytiodneswcraisberedveiatleads aas a"dduifsftuspenseiuli moPnriaac."tically the same picture is seen in guinea pigs exposed stoizee.xcIensnsiuvme earmaboluentssiloicfoptiucrenqoudaurltezs doufst moficvreorsycofpinice pdairmtiecnle sTiohnesreociscualrsothraoguegnheoraultiztehde pwraolllisfeorfattihoenpouflmalol ncaornynaeicrtisvpeacteiss. stiusesueelemwietnhtisninsothmeeluonfgsthaendaltvheeolfio.rmTraatciohneoobfrpolnucghsiaolf slyimmiplahr node reaction is minimal. Apparently the lung is so nearly ) THE PNEUMOCONIOSES 1257 othveerwlyhmeplmhaetdicwsiythstethme liasrgeentairmeloyunitnaodfeaqupaotteentto irrreimtaonvt ethaitt. pRoeratciotinosn obfegthines osrigmanu.ltaHnoeowuesvlyer,thervoeunghuonudterthseuchfunccirtciounmal scthaanncgees,. tIinmeguiisneesasepnitgiasl nfootrhitnhge qcaunartbze tsoeepnrofdourcteheanfyirsgtrossixs mthiosntchosnodfitieoxnpoassuraen. T"haceuretef"orseiliict osseiesm. s ill advised to describe poTsuhree dwiahgicnhosims udsetpebnedsveuripfoiend thine ahlilsteosrsyenotifalandeutnauilssu, aulpeoxn tthhee rcoliennitcgaelnopgicrtaumre woifthmiatsrkbeadredlyyspidneenat.ifiTabhleesehaczaisneesssnaenedd careful protection against infection. A 8 B E 8 T 0 8 I8 Pathological Anatomy nonT-nhoeduclhaarraficbtreorsisisticinvfoealvtuinregsilol-fdewfienleldmpaorrktieodnsaosbfetshtoesipsaraernech(y1m) adoifffutshee, slutrnagn,ds(2b)enmeaotdhertahtee lasitzeeradl eamndphiynsteemrloabtoaursplbeluebras, oanftden(3l)ocaadtehdesiivne ffiibbrroouuss lpalpesuerdisyb.ySmucohdearaltuengprehsassurae.doughy consistence but can be partially col ingTohfethdeififnutseerlionbvuollavremseepntat isso ftrheaqtutehnetsley satrsusocctuiarteesdawreitchlefairblyroudsemthaircckateend ofinndtsheancuiltl-sduerffianceed ocfoltlheectilounngos.f Ignratyhedcuesnt tpeirgmofeneta;chinlosbeuctlieonosnecuutsuianllya epnroteprerthpelapniegmthenetefdanalirkeea. bTrhanechemesphoyfseamtaetromusinabllebbsroonfctheinoloeccaurer isneernowtos rdoiaumgheltyer pwariathllelsmtoootthh,e gplilsetuenrain. gMgorsatyofwatlhlse;msoamreetilmesess tthhaeny 5aremmm.ucihn ltararcgheeroabnrdonpcrhoiajelcntotdhersouagreh balnude-abblaocvke,itnhecotlhoirc,ksemneadll panledurma oadsebrautlelalye. fTirhme. denMseicoror shcoypaliicneseacstioinnssiloicfositsh.eItluenxgtesndrsevefraolma thdeiffutesremifniablrobsirso,ncnhoitoleass ianntointchluedepdarpenlacnhey.mAan,imreapllaecxipnegrimmeanntys abnudt tnhoetfeawll coafsetsheofaeirarlsypadciesseasine tihnemtaenrmtihnaatl hbarvoencchoimoleestoanadutoslposwylyrevseparleatdhsatinstuochthfeibrpoesirsipbheegryinsoafbothuet lruenspgi.raAtoprpyarebnrotlnychmioolsets owf htohseesewfaibllrsouasrcfoirrerieggnulabrodbieescaaursee coafuglhatterianl tahle vtheeolabrropnocuhcihales.treJuestchparnogxeims aflrotmo tchielsiaetesdtrutcotulroews thcoelulimninnagr ecpeiltlhs,elaiunmothoefr fthaecsteor bwrohnicchhiomleasy tihnefluleantecrealreatelvnetoiolin.aAres cfliobsroedsisodrevsetrleotpcsheind tshoe twhaaltlsthoef innotwernpaalsscodneteopuerr oifnttohethteubleunbgescoamndes thsmeroeotcha.usSeubmseoqreuefnitblryosiinsh. aPleadtenfitbearisr 1258 L. U. GARDNER svpoalcveesd ibnrotnhcehimoliedsstouotfsiadefitbhreoupslaznoeneofarscecatipopna.reInt tliys psuropbpalibeldy bthyesuenianir spacAescwhahriacchtedriilsatitce afeftaetrurbeeiinsgthceutporfefseanncde aopfpelaarrgaes enmumphbyesrsemoaftoaussbebslteobsiss. banoddieisr.onThuepseonstrthuectusruersfarceesuoltf ftrhoeminthhaeleddepfoibsietrios.nTohfeaylbvuamriynoiuns smizaetearinadl srohdapse5ftroom60 morinmutoereglmobicurloenss 1inmliecnrgotnh.oTrhleeyss airne dgioalmdeente-yreltloowhaiunstcraotleodr amnadnyexshhiboiwt mbeaandyinbgizoarrresmfooormths,. laMteorsatl hparvoejecswtioonllse.nT, hcleuyb-oshcacpuerdinencdlusstaenrds within air spaces or widely scattered throughout the scar tissue. Roentgenologic Findings unRcoomenptlgiceantoegdraapsbheicstoasipspaeraeramncuecsh olefssmoobvdieoruastetlyhanadtvhaencaenda, atolmigihcta,ldcihffaunsgeehsawzionueslds osvuegrgleysitn.gInthsepelcotwioenr othfitrhdeoffilbmotrhevleuanlgs fAiesldths.e Efvibirdoesnicsems aotufrepsletuhreisyhazminaeyssoirs mmoayre nportonboeunvicseudaliuznetdil. istcurereaschaelsl ltuhnegsom-caarlkliendgs".gTrohuendupgplaesrs tahpiprdesarraenmcea"inwrheliacthivoebly cisleparro. bTahbelyfadiulueretoofthteherefliabtriovseislytolacragset naummobreqr^doefnspeastehnadt oawir srepvaecaelss paesrsmisuticnhg rteharcotiuognhoinutthiet. uApspehrisltuonloggsicaasl inextahmeinloatwioenr itshidrduse, ittoisthienfegrrreeadtetrhathtitchkenedsisstroifbuthtieonloowf ethr eluxn-gra. yVsehraydoawds voafncreetdiccualsaetsiomn asyupsheoriwmpaofsiende sutpipopnlinthgeangdroauncedrtagilnassamboaucknt gsirboleunfdo.r Itnhesuscoh-ccaallseeds p"pleourrcouppeirniecahrdeiaarlt asdhhaedsoiwon."s are respon Relationship to Infection culAosmiseraiscoanccsuursrvienytsherefvreeael sniloicasuicnhdugsetrnieesra. lInexEcnesgslaonfd tmubuecrh mallorceouinnftericetsionrevheaasl bmeeannyreipnosrttaendceasndofautetrompsinyalstatutibsetirccsulforsoims. tAunbiemrcaulloesxispetorimpreongtrsesdseumpoonnsatrabtaeckngorouspnedcioafl atsebnesdteonsicsy. Tfhoer binyfecthtieondsusfrt.eqIutesnetelymsheparl,obaacbcleentuthaatitngsotchioe-eficbornosoims ipcrofvaoctkoerds ) THE PNEUMOCONIOSES 1259 fmluaeyncoeudtwtheeigihnctihdoesneceoifn tthhee dpuossttmaonrdtemthactasseesl.ecPteiorsnonhsaswiitnh atosbrieastowshiserwehaouctoopnstireasctwtiullbebrecusleocsuisreadrebaepctautosebeofsetnhtetospseacniaal idnytienrgestelsinewthheereoacrccupleastsioanpatl toorcigoimneotfo tahuetiorpsdyis.ease. Those Course of the Disease theThpaeticeonutsrswe hoof cthoeulddisbeeasefoilsloswoemdewcohnattinoubesdcutroe wasormkoswtitohf omfodreusotrcloesnstrdoulsitnexmpoossturAeminersicpaitne foafcttohreieesx. cCeallseenst tphraotgwraemres qinutietnesewxel-lradyevsehlaodpoewds;wthheonsefiwrsitthoblistetlrevecdhannogwe artevtheeal omutosreet smeaelms ntoo rpemroagirnesisnioanpporcocxuirmsaatefltyerthceomsapmleetecocnedssiatitoionn. Ionf aenxi pboustuirte.dAoensynfoibtroinsicsreoarsigeininallayrepar.esAesnbtetsetnodsiss tobobdeiceosmdeisadpepnesearr ibnettowteheen lutwngos aonfdgutihnreeae pyigesa.rs after an injection of asbestos Clinical Picture ouAt ocfasperoopf oarstbioesntostois ethxehibsietvsedriytyspnoefa twhehicrohensetgemensoegnratiprehliyc cuhnapnrgoedsu.cTtihveesecopuagthie,natsndaraerevesrayidsthoorhtavoef barseoamthe,whhavate baludirsyh cinojluorry. Tarheenloatttgeernseyrmalplytoemliciistendo.tOincvcaasriiaobnlael.lySiagsnbsesotofscbaorddiiaecs acbansenbceedoefteacstseodciiantetdheinsfepcuttiuomn. but they rarely appear in the Complications thiAs scoanlrdeiatidoyn,inbduitcathteedretuisbelirtctluelotosisinmdiacyatebeansuepxecreimsspivoesepdreovn Raleepncoer.tedBraountochpsoipensefurmomonviaariiosusa ccooumntmrioesnehravceaudseemoofnsdtreaattehd. twenithcaassebseostfospirsimbaurtyinbrcoonmchpoargiesnonic wcaitrhcinthoemanuammboenrg epxeprososends to this dust this incidence would not appear at all surprising. 1260 L. U. GARDNER Tidheael cthoarcarcetaetre oaf cthoer ppuullmmoonnaarlye bfiebcraousisse wlaorugled asmeeomunttos boef cpaapthilollaorgyicbaeldevairdeenocbelitseereamtesd.toHionwdiecvaeter, anheiigthherfrcelqinuiecnaclynoorf carAdiaccominpvloiclvateimonenot.f the occupation although not of the pul Tmhoinsarisy adilsoecaasleizeisd tfhoecusso-ocfalclehdroansicbeisntofslamcomrnatioonn pthroevoskkeind. btryaterelianttiovetlhyecsouabrsceutsapnleinotuesrstiosfsuteh.eNmoinaesrbaelsttohsaits mboadyiepsenarec formed in these lesions. Diagnosis asbDeisatogsnofsibisersd,ecphenardasctuepriosnticachhiessttorryoenotfgeenxpoogsraumres taonddupshtyosf ipclaalntfsinwdhinegres. fiDreupsrtooefxpteoxstuilrees,obcrcaukres liunsiunaglsl,yanind sfiambirliacratminag tfeorrialisnsaurleatminagnupfuarcptuorseeds., oSrtraamngoenlgy theonsoeuguhsinegxpaesbriemsteonstfihbaesr dtheamnovnestrryatefidnetlhyatptohwe dloernegderafsibbeesrtsosa.reTmhiuschprmoboarbelydaenxgpelraoiunss tvheeryabdsuesntcyepolafntthse, tchoenmdiitnioenralatwtahsegmroiunensd,wsheepraer,atiend,foarnmdetrhlye feixnpeostsuprreodoufctasbcooultleecitgehdt fyoerairnssusleaetminsg npeucrepsossaersy. Aton parvoedruacgee roentgcnographic evidence of asbestosis. ) Tuhley, M19e4d2i.cal Clinics of North America LEAD ABSORPTION AND LEAD POISONING R O B E R T A. K E H O E , M.D.* meDtheosdpsitfeorthreecoagvnaiizlainbgiliatyndopfresvoeunntdinganddangweerollusesintadbulissthrieadl olefadleaedxppoosisuoren,intghearmeoinsgsitnildl uasntriualnnweocrekssearsri.lyFuhrtihgherminocried,endcee scpointefustihoen eaxnidsteunncceerotafingtyenoerfatellny ernetleirasblientoditahgenocsotnicsidcerritaetrioian, osufeaissuthspeepctreodpecrascearoef opfluamsbiciskmm, awnh, eththeerhythgeienqiucessttiaotnusaot fisa ptiloann.t,Fthoer gthraensetinrgeaosofncso,mopneensmataioyn,boer jtuhsetifoiuetdcoimn ereovfieliwtiignag tohfelehaydgiceonmicpoaunndddsiaingninodstuicstrpyr.oblems that arise from the use TH E EVID EN CE8 OF OCCUPATIONAL LEAD ABSORPTION beTrehceogenxiizsetedncbey oafsuorcvceuypoatfiothnealmlaetaedriaelxspaonsduraectcivaintieussiunalalny ipnodsuusrteriaclanplabnet.eTsthimeagteednebrayl othrededr eotefrmmiangantiitoundeofofthteheleeaxd cstoanntdeanrtdomf eththeodastm.1,o*spBhyerseucohf wmoearknisngit sispaucseus,alblyy pthosesiubslee otof edxetteenrmt ionfe ththee ndeeegdrefeoropfretvheentoivcceuapnadtiopnraelcahuatziaorndaryandmetahse uroreosm. sInindetehde liefatdhetraldeaeds wcoenretemntaionftatihneedatgmenoesrpahlelyrewoifthwinotrhke lainmyitsotnhoerwcaruecseogtnhiaznedacacsidseanfets, aoncdcutphaetiounnafol rseasteuernnisemffe, cftrsoomf csohalnognegs ians pthlaenthoazpaerrdastioonfs,mwaonuyldplcaenatsse atorconccout r.unHdoewr esvuecrh, lege* oRfesMeaerdcihciPneroofefssthoer, UKneitvteerrisnitgyLoafbCoriantcoirnynaotif, ACipnpcliinendatPi,hyOsihoiloo.gy, Col 1261 ) )