Document 7M2dMyBE90MNvkY39oDvqjLng

r 1*. mr THE MEDICAL JOURNAL OP AUSTRALIA 74 .- _ ^ PNEUMONOKONIOSIS IN VICTORIAN INDUSTRY. I-320 --------- hazardous, inasmuch as tbe silica-containing substances are newly ground. The highest incidence waa Is a tile .. Bp D. L. Goeson Tvoasas. (wall) works.- where flint waa used in considerable quantity. p. ' *. industrial Hygiene Division Victorian State Betti* Department, Jfelieunu. ' 4. Mineral earth workers are the most exposed of ail. Quartz, diatomaceon* earth and asbestos are ground with usually makeshift machinery, and the dost hazard is !* Sara the cod of World War II Australia has been under going rapid industrial expansion la *U fields. coupled with large-scale immigration. Although la 1954 some 43ft ot the national iseoae comes from wool, the situation in the extremely bad. One subject, a man aged thlrty-fiTt years, died of uncomplicated silieoel* within nine yearn of com mencing employment. These place* have as unenviable record of death and disablement. pears to- com* asp well he different. Is view of the $. Masons and Quanyreen are exposed to the dusts of ravages a health which such ladastrlallsatioa has prodneed various types of stone, jjranlt* can contain up to 30ft of la the past la other consults. U was considered essential ~ free silica, and SttWcll stenVEnd Sydney freestone are tor to obtain some faets os what had happened la Victorian all practical purposes pure sand. Basalt quarrymen can industry la the Immediate past la terms of Industrial develop an X-ray picture which ie hard to distinguish from ehaat diseases. Without accurate knowledge of wbtro the silicosis, but thtse men are free from symptoms. hazards really lie. It Is impossible u hare industrial expansion without a health toll Without this knowledte 4. Boilermakers and welders are expoaed to mixed dusts. Few In this group are incapacitated. there can' be ao plannln* for the future, and the mere policing of repulations leares much to be desired la the 7. Meul polishers are subjected to silica dust through field ot preventive medicine. Accordingly, in 1951 a surety the abrasive they use. which is beeswax impregnated with to determine the sources and Incidence of pneumonokoniosis pure silica and known to tbe trade as "tripoli". was eommeneed by the Industrial Hygiene Division, and the various aspects of the findings are now preeented. 5. Stokers are exposed mainly to coal dust. The total number ot cases reported to the division prior to the surrey was 533, which included 343 among miners and 179 industrial cases. The figures new read as follows: total 113*. with $37 la miners and 339 la industry. The X-ray investigations were carried out on full site film (17 Inches by 14 laches) on personae! who in the opinion of the division were employed in dusty trades. The total number of Individuals radioiogically examined was 3S33. Table I shows the results ot the investigation. Test* ** ` Xmtwr Saftfrcti* Oedeuvife. --^lUUiofcwcaltr * V1/' Uianuiwl. \emorf it ,-w - Punnnnt- IIMUUl foes*. ** 1 * f iwwiit V PfWJtlT* la the surrey, the number of moulders radiotocically examined was isis. acd the percentage affected was <-> Three hundred asbestos workers were examined acd this number would covet most o( those exposed to dangerous amounts of dry asbestos dust: here-the percentage was IS. _ The most daecerous occupation is mineral grimilss. largely -it quartz. and here 3or of those radiological:? examined were affected. In the other categories the people surveyed were those exposed to the greatvzt risks in the particular wcepatlon. and not the employe-* as a whole, so that any computation as to the percentage affected inthoM Industries would be erroneous, la the 35b eases found. all the subjects have been examined, their industrial histories have been taken and their exposure to dust has been confirmed. Apart from those suffering from aibestosis. the creat majority ate silicotic*, many of whom are grossly disabled and many short of breath; others appear to be Quite well apart from a slowing up and sliebt shortness of breath, and some are entirely aymptomless. &K. *(l~ elvl v.rfKrfw Ma-tw mk ^naTTTBKPi IvlwoTv* m.. ?u.r*T U.owi . bo'SuTs iff.c.!. * -th?.t?4 iMM .. . WtKr< Jrf.l ---JBMK:. Wl 'tkvf. . . Total .. low 1 ** --i eJ* * g u. 1 : 1* SH 1 *. i. w Z4t3 ae>) A -- -- - Discussion. Sllicotit. U we consider the conditions in the various types of occupation we find the following factors: ' 9. Rubber wbrkers are exposed to tale, which is mag nesium silicat*-. this can produce similar effects to silica and a similar radiological picture. "T 1. Moulders are exposed to silica in the moulding sand ana often in the parting powder. One of the cleanest foundries lnreitated produced the highest proportion of rijwoti'f ilde^i, owing so (be fact that they were usias 10. CIneoa operators are exposed to carbon, metallic oxides, fiuorides and silica from the carbon arc lights used in the machines. <i.i.-a tlour. wnich is v*ry finely ground quart:, as a parting 11. A cause* X-ray picture of a worker in a dry-cleaning SOW'l-r. .Many mouMvrs with long exposure are grossly -etabiixbm-ut showed noduiation with :> symptoms. Inves '-sallied. tigation showed that uiatAms'-eou* earth is used in the 3. Dressers are exposed to moulding sand and to fine metallic particles produced when castings are cleaned by process of dry cleaning and constitutes a hazard. A survey of this industry is under >-. ornery wheels, automatic chisels aod swing grinders. Tbe Tbe radiological appearance must not be used as a yard |oola in general use are now power-driven, and recently stick to nieuufe'xbe severity or otherwise of the disease. rvihods of exhausting tbe actual tool are being evolved, Some subjects wltb gross X-ray changes are almoet sysp- acme of these men have gross X-ray changes which are out tomlesi, while .others who are gravely disabled show very * all proportion to their symptoms, while others with less little abnormality.. - ' *i?0.0e*d changes are gravely affected. In cases in which . * nlk of the inhaled dust U meul. the symptoms art 'tally alight. . j5: Bf,*k. tile and pottsry workers are exposed to silica. In the survey there are several seta ot brothers who both developed elllcosIX la efltlreiy different occupation*. This suggests a familial tendency. One family group of sovea boasts six silicotic* affected in throe different condition* In these occupations are particularly processes. m * 'r:v '-VCV O- A person quit* gunrt that b U suffering from silicosis its use in some process-, mixing with diatomaceous earth can. Alter sa acute pulmonary episode. become tots))? r kaolin to torn lagging materials: sawing, cutting aad disabled is a very ebon time. Tier* tr< at laaat 20 listed flnixbiog as? product containing asbestos--tor example, who bav* graduated from Use "mild abort ot breath" class to the "totally disabled" la period* Is all cases lew than tout year*. The om of 25 millimetre Ala U generally unsatisfactory Is the diagnosis of paeusnonokeslosi*. Many brake liaings- asbestoa sbeetlag aad various Insulating materials; waring down eld tagging--this u a ven dangerous process, even la toe open air; spraying asbestos oa walls aad ceilings as ea insulator. eases. especially earl? oaea. are mlaaed, This coaid explain ibe great somber o( silicotic* who are sadar treatment tor dyspnea. who bat* misled their doctor* unwittingly by saying that la the sui X-ray examinations their cheat finding* *iri clear. Tie X-ray appearance* caa man to norma) after the subject's ramoral from exposure to some dusts. This bat occurred with wood dost, powdered food, surch and metal. Vary few cases reported la this surrey are complicated by tabemloels. Hcwerer. several cases hare bees reported from sanatoria, la which exposure to dust has bees proved aad cospeaaatloa ebuiaed. No cases of csrelaotss of the longs were fousd. The pulmonary fibrosis of asbestos workers ta insidious in its onset, irregular ia its course, aad variable la its termination: but once established It constitutes a grave threat to life and beattb. Briefly the pathological change* are such that toe air cell* become obliterated by fibrous, tissue. As this progresses toe long tissue becomes used up aad the elasticity ot toe lung deteriorate*, the amount ot Inag available to carry out function* diminishes aad symp toms appear. Tbe coaditioa ia progressive aad irreversible, aad ouce the stigmata appear the subject aboald be rumored from toe hazard. The main symptom is steadily Increasing shorties* ol breath. While there ta no evidence that Both silicosis aad asbestosis are so lasidloss la their ssbestoti* predispose* to* subject to acute pulmonary infec progress aad so easily Influenced by acuta pulmonary tion*. the presence of the condition seriously impair* the coadltioas that It would appear wise to advise the subject chances of recovery when infection dots oecurl The advent to seek s new occupation away from the haxard when of toe sutphunamide drugs aad ot toe antibiotic) has Shortness ot breath becomes apparent, irrespective of his greatly improved the prognosis la toes* case*. ape. The following case lllustrstes this: The most sought after asbestos la iadnstry is to* type In 1952 a moulder of twenty yean* standing teas found to have typical silicotic X-nty appearances with aoduUtion and Jnild symptoms. Hv was earning bic money and did cot feel dise*d to pvt up fc:s tab. In 1959 he had influenza mh pulmonary eompticailon*. and today he ra completely incapacitated. ... - The fact that pathological chances can continue in the lungs lone after removal from the haxard must also be realized. -. with long needles, but unfortunately rbis ta toe most hazardous type to bead)*. The. needles eater the lung by inhalation, aad after a time undergo changes in appear, aflee and are toea known as asbestosis bodies. They are brown or yellow la colour and are found in 'no other condition. Tbe bodies are aU modification* of a straight fibre and are shaped like dumb-bells, a drum major's bacon, and so oa. it is Impossible to state et what period these appear, but they have been found in this survey a* early A woman, now seed (hircy-mne years, was employed In a lottery plant, She worked they* from the ace ot fourteen y-ars until *n* was t-*nty...tie.-when she !Mn-.l. She had three .:hildrn and carried vr. tuite happily until S'-e years aco. *ha -lit .Wean :o he short of breath, and an X-ray -fi-ciinttion reve.iie-i abnormality. Her condition was -veJitiMl.'y liaes-.-sed :>t f.ivtc-jir utter tentative diagnoses of tub-ccuta*;* .in.! sarcnidceii were JUrrita-1. as fifteen month* ft-r -xporure Aimmeucvd. The presence <>f ihete i*-!l* mure n--t a*, msrdtd a* diagnostic ot asbvvtertt. hut it *. convlusiv* proof that the patient ha* bee: expos'd and that some abnormal process ia at work is the lung*. Vaiike silicosis. the radioiogva! findings in aabestoii* are in *rurd with the severity *'i .to* symptoms. The .\a tna-i-rruatc industrial biriory delayed toe correct -iiac- xreavr tr. is>.-apii>-::y. :h*- more -me expect# to see in the :!* in tots vase. . X-ray him. is the weiMcviu[-i case the base* ot tbe There are two interesting sabj-cis who served is toe t'-V--rr. r-*rt with the jl*yl Australian .Mr force -Juries the lust war. TSey were mo'catiivs io flxed camps and their X-ray Codings are typically silicotic. It woq(4 appear that they derdoped the coaditioa op service. Heavy traaspons sod taokers probably (round the sand to powder floeaess. sod the propellers these raes used to swing produced aa Intesseiy heavy cloud Of pure rlllcs. 'ungr. more -*p---tally >be risht. rhow ground-gim-i* avpearan.--. and the iu!is** -*f the heart is irregular -ir "Shaggy". It i* fuiiy realised that n radiological diagnosis of early asbestosis is extremely difficult, aod our eases were regarded aa such only after tbe mot careful con* sidtration. A few films picked out at random were sent to England for review, none at them being from welldeveloped <-39**. One --ac* was accepted ns asbestosis on English standards. In toe -nber. while it was admitted Many Incapacitated oes could cope with a sedentary tocre. were increased markings at to* lung bases, the job if it were not for the effort of traTelliax to aad from. viewer uted that he bad sees many simitar film* la hit work. Is view of the procreative ostore et the disease area from people who had never bees exposed to asbestos. ad the limited sum payable as compensation. *e advise However, aa toes* films were takes ta a highly indus affected people to remain at work as loot as possible--out - trialized area where tog. soot aad smoke abound, it is of tbe baiard. ot coerse. The ability to coatlnue is useful employment is often increased by- a course of physio therapy. Atbcsiorix. thought that to compare these with films of Australians of tbe same age proved nothing. Criticism will no doubt be directed at the standards ot diagnosis: but if one waits until the stigmata ot a well-developed case appear, -lot to the seetioo of tbe survey relatlafl to asbestos workers. can do little for tbe patient. piu <!i were examined: 2v<> had spotuto coetaiaiog ashes- tons ~>di. and of this !>. *? had positive X-ray lindiccs. Is '.Sir* ins: .croup ail hud symptoms ranging from short- aj>s ->f breath m exertion to pro** iocapscity. It dors act follow that -veryonv is going to accept the a-lvk-e voder--l to ieav* :5e hazard: but sine* the suinl-r t workers in :hi* ar-ip ir -fiimaratsv.-ir small. :h- faii:ati>>t that toeir frVnd who was ruppoied to bvr Tfc* pro-'-dur- ;>dupied was a* follow*: Speclia-rnj of a wenk heart for a tang time :t actusliy suffering Irom sputus: were taken sod examined for the presence of bodies. tVheo these were demonstrated, toe patient was rsdloloelcally examined, When both tests gave positive results the pstfttt w* interviewed, a complete Industrial asbestosis and la eligtbie for .-ompensation is making most workers vy conscious ot tbe hazard. Much more care ba* been exercised by tbe workers is recent times, and they are much more easily persuaded to wear a mask. history was taken and his clinical condition was assessed. If be bad symptoms referable to the-disease a diagnosis of asbestosis aa made aad the patient waa advised to apply to the Workers' Compensation Commission tor acceptaace or hia disability. Subaeqneatly practically all workers exposed to dry asbestos have been radiologic*!!? examined. The most common symptom b shortness of breath on exertion. Tightness is the chest and psis ia toe chest art not uncommon, with lack of energy and tiredness. Most patients show an improvement after a course ot physio therapy. The patients given a course of physiotherapy had all been accented for compensation., and all were kept Tbe following occupations are involved: handling the ia hospital for at least a month, so tost toe rest and substance in its raw state; grinding tbe subetanee prior to elimination of worry for tbe future were also beneficial ' . . :te ,( aC* V<*.i(i-aA'lli factors. aU those given this -conn* v xUI working at light sedentary occupation*. When, this survey started, eight urn of asbestosis bad beB reported and U>* disease *u retarded at a rarity. It will be tees from tbe 9rare* REMARKS OS.CHRONIC GASTRITIS. WITH SPECIAL REFERENCE TO THE PREVALENT INEFFICIENCY IN THE .EXAMINATION OF THE GASTRIC CONTENTS. that tbe Incidence of tbe diaeaae it far too high. la addition to tboe found in tbe investigation, there moat be maor sore older folk suffering from tbe complaint in whom It ba* not been dlaraoaed. and who are Incapaci tated and very poorly off financially, and aberatd be receiving adequate compensation.. ' . , By V. 3. tontu'.'".' - . From Me Deportment f Oortro-Eaferotogy. Saint Vincent's BotpUal. Sydney. ' .. ^ . * -- .* *.1t*. t v'' Wvcx a hollo* organ is afflicted by disease."a proper:;-,, Summary. - - Three hundred and sixty eases of pneumonokoniosis were found in industry in Victoria. No doubt there are many more, either ayaptomleas or undiagnosed. .. understanding of tbe processes at work-la helped consider-- ably by a study of tbe discharges provoked-by.tbe disease.*./, . Tbe discharge* are is fact a sign of 'thehdiaease -is-. tbei/,' .. walla. Diagnosis and treatment wouldJose-eoasideraBly-^'. if this element ware neglected.; Tbua.';'tht;-u'**ailand post-'j- K 51Ucoala and aibestotis are not diseases of tbe aged.- . nasal discharges, the sputum pot. tbe nrinaryltesting glass V* Many of these subjects belong to the tbirry to fifty yean and tbe cootenta of tbe bed pas prorlde.itbe'clisleian with,^-- JiK group, and for this reason it is Imperative that con .valuable Information, which helps to truthrla,diagnosis andgsM ' > ditions improve in tbe dusty trades. Tbe two conditions' to success in treatment. Moreover. aa:lner*a*e or--decreas*5v ; can occur together, causing gross disability. Six affected: : . persons, who showed oodulstioa and also aabestotls bodies, i . were fonnd is tbe same factory. They are very disabled.' and two are aged nnder forty years. . ' ' ,* ; I . -. *" .* . .. ~ -.^^ tr " The survey Illustrates tbe necessity of impressing on medical practitioners tbe seed for taking a-complete Indus- ;nal history of all patients irrespective of sex. It is sot sufficient to ask a person hit or her occupation--a bread carter today may bare been a miner twenty years ago. Many women have worked and arc still working, although tbe basards now are leas damaging. .. .For this, several factors are-. respoailW^^OseJis- ibf^j : . --.neglectful reports on tbe gastric contents made by` patiolo-'.-' : gists and biochemists. A fw yean ago I'^askedHtsenior'*^. - -teaching biochemist why be gave so report{aboutvmucus %'i. '.is fractional test meals. He gave as tbe .reason.that the '-'*;- - mucus could come either from the respiratory triet'or from industry in Victoria is becoming-rery dustconscious., (be stomach, and that therefore.its slgnificance'could sotjj^. . '-''bile tbese investigations have bees proceeding, tbe W interpreted. . ,,vr .<,' industrial Hygiene Division has Wea'.bni* encouraging % U is. vl eourse. hicfciy unscientific to' suppress 'evidence 7 " tbe suppression of dust. Vaioos have sponsored tbe survey merely because its interpretation is 'di&cult.'^Moreover.. and employers have bees most cooperative in allowing their -there is Iways the chance that somebody else.may succeed :f' personnel to be radiotoxicail? examined in the firm's Use. in tbe interpretation. Thus, by examining ihe.'/respimiury' . 7s tbe firms where cases bare been found, close inspections tract, the clinician may get a very good idea a*'to whether tsv bees made, and where possible conditions have been it Is tbe source of tb- discharge! But vn the bi->;hemi*t. 1 - improved by exhaust ventilation, by better housekeeping. if properly instructed In bis art should be..able to make -.*r by tbe elimination of tbe basardons substance. Tbe use the distinction'easily. - >..; ,V. i- ' -f vf respiratory devices is recommended only when tbe It the excess mucus is gastric in origin.'it-appears'in - . hazard is of short duration and when other methods cannot each specimen. It is intimately mixed with-the .gastric W used effectively. Conditions in industry can be greatly contents, so that, when the contents are poured from ooe improved in many rases by very simple meins--even test-tube to another, they are seen to* be more viscous.. camping down tbe Doors in a foundry led to big reductions Tbe mucus is fibely flocculated. An approximate quanti in dust counts. tative account of this mucus can be given in terms of Legislation has Wen introduced to try to Improve con ditions- Quarts crindins has been declared a dangerous trade. This mesot that any premises used for tbe process mutt be registered, and in tbe event of tbe regulations not being complied with tbe registration can be withdrawn and tbe firm becomes liable if it continues to work la an unregistered building. Asbestos rerulstion* are awaiting gaaettaL Tbese are very stringent, and when in force will lead to a big improvement in conditions. However, tbe most Important siegle factor is to educate tbe worker to protect himself. filtration time. .. ; .' Mucus from the respiratory tract occurs cbiefiy in the tasting gastric contents, it is in larger discrete mssses. it often includes air bubbles, it is easily sees when pressed . out under a cover-slip, and it floats on tbe surface of tbe gastric contents. The discovery.of such mucus or mucopus may give a valuable therapeutic bJnt to tbe clinician. Tbe lasting gastric contents should then W examined microscopically. Gastrie mucus contains tbe nuclei of leucocytes whose cytoplasm baa been digested, staining deeply with methylene blue, and columnar or goblet cells. In gastritis, there may be large number* of granular ceils - uBy, many times ooe can see expensive, most effective (these are desquamated glandular cells) or a persistent exhaust apparatus rendered useless by some worker wbo increase is leucocyte*. In cancer one may find polygonal, "didn't like tbe draught" pushing a bag op a duet or some round or cylindrical cells, with chsrsctensttc volume, other equally silly practice. density and multiplicity of nuclei. Eosinophil* -.-ells may R'heo oae has seen tbe end results of these two dtist d's*a*es--the gross incapacity, the patient*' realisation that tbe steady deterioration is inevitable.'and in many ^*v* tbe financial difficulties due 'to'their baring need ap t>- compensation paid--it becomes imperative to ensure give tbe clue to an allergy. Naso-pharyngeal mucus may contain squamous epithelial cells afid carbon particle*. Note should also be made of the bacterial population. It is increased in bypocbiorbydric gastritis aod in cancer. tWt as industry expands, industrial, hygiene matches tbe A second reason for tbe failure to study the gastrie expansion stride for stride. ' -- discharges is tbe lack of interest In and undemanding of gastritis on tbe part of clinicians. This is not peculiar to Acknowledgement's.' Australia. Tb* position was illumiaated by a conversation with * distinguished British gaatre-enterologist (Dr. TC"> k `fy thanks are due to Dr. Keith Holism for bis invaluable as follows: -*>P oo tbe radiological side, and to Dr. D. 0. Shiels for ur many discussions on dust problems. .' Dr. "X": -I do not believe that gastritis 1* a common disease." . .A:'' S3V