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FILE NAME Talc TALC DATE 1960 DOC TALC221 DOCUMENT DESCRIPTION Book Excerpt - Talks from Symposium on Industrial Pulmonary Diseases in 1958 TALC 221 1960 INDUSTRIAL PULMONARY DISEASES A Symposium held at The Postgraduate Medical School of London 20th September 1957 and 25th March 1958 EDITED BY E. J. KING M.A. D.Sc. F.R.I.C. Postgraduate Medical School of London and C. M. FLETCHER C.B.E. Cantab F.R.C.P. Postgraduate Medical School of London With 98 Illustrations LITTLE BROWN AND COMPANY BOSTON LIBRARY UNIVERSITY UNIVERSITY OF CALIFORNIA DAVIS ALL RIGHTS RESERVED This book is protected under the Berne Con- vention It may not be reproduced by any means in whole or in part without permission Application with regard to reproduction should be addressed to the Publishers 'J. & A. Churchill Ltd. 1960 8 Printed in Great Britain This bo industrialc School | symposiun symposiun wishing to In plann and co op Dr. R. I the Londo whole field aspects fr experiment studies to the patient intensive it able to cal associated several several sek our knowle Flint gri were amon Great Brit sumong the of more ch practically trial proces stitution of ards have a pulmonary Among th With the g which occi disease has others ence e several t disease ountered received ope that sufficient um was and parould be Ive conis a co- " record of their egrated it com- liscases Brown 4 nes for paring aration IER CONTENTS CHAPTER PAGE 1. Industrial Pulmonary Diseases in Great Britain Meiklejohn 1 22.. The Pathology of the Pneumoconioses J. Gough and A. G. Heppleston 23 3. Reaction of the Lung to Dust J. King and C. V. Harrison 37 4. Deposition of Dust in the Lungs a Physical Process- N. Davies 44 5. A Review of Theories of Silicosis Nagelschmidt 72820 6. Problems in Taking and Reading Chest Radiographs Simon 72820 7. Radiological Diagnosis of Pneumoconiosis M. Fletcher 72820 8. Radiography in the Field J. Chapman 72820 9. Normal Lung Function and its Measurement Hugh 94 10. The Disturbance of Pulmonary Function in Industrial Pulmonary Disease C. Gilson 110 11. The Use of Pulmonary Function Tests in Epidemiological Work B. McKerrow 127 12. Pneumoconiosis in Cornwall W. Hale 139 13. Iron and Other Opaque Dusts I. G. McLaughlin 146 1.1 Pneumoconiosis due to Tin Oxide John Robertson 168 18. The Epidemiology of Byssinosis S. F. Schilling ~ 185 16. An Approach to the Problem of Bronchitis in Industry Studies in Agricultural Mining and Foundry CommunitiesI. T. T. Higgins 195 ~~ 17. Occupational Lung Richard Doll 208 18. Epidemiology of Coalworkers Pneumoconiosis L. Cochrane 221 vii viii CONTENTS CHAPTER 19. Rheumatoid Disease and Pneumoconiosis Caplan PAGE 232 20. The Natural History and Management of Coalworkers Pneumoconiosis Donald Ball 241 21. The Prevention of Silicosis Donald Hunter 255 Index 271 INI fh Din earliest Great Butau painter Hur br use in C process was process healthfull Gi The discuse Johnstone Redditch " entury the occupations occupations occupations Summutia was describ and pathol pneumonia arose out sandstone t from certan dust inhaled accordingt the lungs sively differ others Th particularly i i i patients patients du 11 Many iit earlier Re w comparilyses how- y notable is * Division uded that he relatively sion merits creased by rously to my nd criticism Coal Board unstinting in Occupations J. 2 843 J. 371 1. J. industr ial Worker ASES 1907 ns from the by Noel A. m No. 243 C. T. The ity p 94 2.279 2.279 d Counties mary 1958 CHAPTER 2 THE PATHOLOGY OF THE PNEUMOCONIOSES By J. Gough and A. G. Heppleston Department of Pathology Welsh National School of Medicine Cardiff IN discussing the pathology of the pneumoconioses it is essential to distinguish asbestosis a variety which is caused by minerals with a librous structure from those varieties due to particulate nonJibrous minerals such as silica coal and h^matite Numerically the second group is the more important and will be considered first taking as types classical silicosis and coalworkers pneumoconiosis each of which assumes a simple and a massive form Simple Pneumoconiosis By simple pneumoconiosis is meant the pulmonary reaction to dust uncomplicated by any other factor and the term thus refers to the essential manifestation of the disease Characteristically it takes the form of numerous small focal lesions composed basically of dirt and fibrous tissue in various proportions These lesions are Increte and measure up to about 5 mm in diameter they are more o less evenly scattered throughout the lung substance but may be somewhat larger and more numerous in the upper than in the lower parts To appreciate the mode of development of dust lesions eference must be made to the normal anatomy of the respiratory portion of the bronchiolar tree The terminal bronchiole that is the last order of nonrespiratory bronchiole gives rise to three successive onders of respiratory bronchiole i.e. those bearing alveoli before the single order of alveolar duct is reached the alveolar ducts then lead lead to atria and alveolar sacs Heppleston 1953 Dust deposited in the alveoli is ingested by phagocytes which attempt to eliminate the dut up the bronchiolar tree or to transport it to the lymphatic system Dust may also move along airways and into the interstices ot the lung as free particles but evidence of this is not easily obtained Small accumulations of dust are found in relation to the 23 Sc SI ay J. GOUGH AND G. %op/ -u0o -UI THE euraskydurs situaed HEPLSTON sojquiesr normal HeplestonHepleston THE intrapulmonary A. peribonchial peribonchial normal PNEUMOCNIOSE PNEUMOCNISE emphysema intrapulmonary lymphoid HEPLESTON HEPLESTON ouryeXy AND intrapulmonary lymphoid tissue situated peribronchial peribronchial size The perivenous simple later chanels conetraionintrapulmonary lymphatic lymphatic lymphatic but considerable considerable silicosis is ocurs stil proerty conetraion Axeurpso The conetraion perivenous glands some- surfedy dust Jo of glands contended some- proximate though proximate uonsonb acumlation is which property vogue acumlation leads the hilar contende thatcauses with uey) still undecide the For SHOINDWAd glands lymph and asociated probaly retrograderetograde onoris years silca in acumlation both idea from idea solution sy parenchymal parenchymal acumlation lymph dust but evidence pidi] Heppleston in respiratoyThe typical to many howevr that over soluble parenchymal howevr syodsar Gardner by Gardner Nagelschmidt situated contradicts (1S61 1954b Strachan out question Strachan contradicts Irresvpiinraetory however yoafnouulr FHL are situated relation relation IO and they solubity thoughatention incostencis animals phagocytes have Gardner solubilty bronchial LP6l and evicted traped traped Once the bronchial phagocytes theory pathogensi they theory the by surondig bronchioles Hepleston Heppleston ADOTHLd uo\satdy) openig 1954b respiratory Hepleston bronchioles( view respiratory route into and foci pas ages therefore and respiratory physiological called that silicates fibrogenic pue asoy become [[@ fibrogenic fibrogenic drawn with respiratory UL fibrosis fibrosis developed developed hyalinization process proces evidently bronchioles surondig aeipAyoqie secondary hyalinzto imunolgicalimunolgica evidently the where alveolated has mechanism norespiratoy bronchiole bronchioles proces respiratory alveolated block onsH secondary exists FHL ozis bronchiole pro tion chemical difers those detrmined nature determined determined free norespiratoy leading the devlopment aAToeuUOD physiolgca containga tisues patholgical aproximately true jeuou leading high of devlopment specific proportion lesion lesion the clasical silicotic silcotic i.e. those dustthose and devlopment course course containing s10Ul development sure} sug ested its chemical tisues conective conective conective physiological physiolgical are are are PNEUMOCONIOSES PNEUMOCNIOSE PNEUMOCNIOSE PNEUMOCNIOSE question question emphysema emphysema Jo free silica induces induces fibrosi fluids fibrosi fibrosis surface is solubility has been but fluids mediated mediated when twenty when pointed years were than Nagelschmidt more and quartz were incositencies incositencies to the pathogenesis inconsitencies silicosis silica the silica pathogensi silcoticfor imunolgicaloften hyalinzation mechanism demonstraed silcotic demonstratedconstitution demonstrated hyaline constiution other other hyaline hyaline conective composed patholgical aproximately aproximately aproximately 80 colagen collagen Llyye serum serum andand protein protein protein globulins a being globul globi ulin n globulin globulin nodule thes Silcosi nodule devlops respiratory tisue respcts Simple UBUI relation yorq yng He B vw sa Jo retyouiqedSimple bronchiles Silcosi silcoti devlopsfibrolastic fibrolasticfibrolasticrelation reactiontheapears conective imunolgica imunolgicalimunolgica mechanism presumptive respiratory amyloid Vigliani mechanism in gensi amyloid morebronchioles silcotic yi odurst iasglreegattess agregates eacaelrullary sfitbraougse evntualy apears which formation one hyaline and demonstraed aceluar munolgicaly arranged proges whorled tisue a NOLST1dH silcotic around conetricaly gensi serum posiblity fashion zone observationsobservations silcotic islets Suoje nodule nodule rather these fashion In fully enclosed enclosed tisue role relationshp silcosi there conective fibrous aranged iregularly celular celular tisue payenqis Simson to raise the disposed zone iregularly conective Belt disea s preations Simple disease field DY Incinerated 1939 Incinerated show developed developed developed clasical classical of concentricaly which il umina- illumina- zone preations The islets simple Coalwrkes distnguishng central ilumina- Pneumocnios Coalworkes typical ash central variable onsy contain UNF typical pat ern amount coalworkes amount of largelylargely Belt particles distncive contain andfrequntly frequntly presnce iregulary HOND while while toaly fibrous fibrous smal devoid distnctive halo external zone spaces results dust enlarged enlargemnt results dust particles distinctive Increasing Increasing of existing nodules ones devlopment devlopment 1947 enlargemnt SIOTIS Hepleston silcotic of nodule devlopment the overshadowed simple silicotic large contain zone is vartihabele or dust siliceous and siliceous the amount which pose spose sposes charteisc nodule conis regads charcteristc large It important importan recoursestructral structralstructral serial coalwrkes pneumo- harcteristc note that tisue spaces dispositon characteristic disposition VC spaces the fully nodule note that tains more carbohydrate connective con ective carbohydrate more more lipid ordinary ordinary hyaline ordinary and In respects hyaline respects Pernis resmbles 1958 There resmbles presumptive of 1956 mechanismand and demonstraed demonstraed presnce munologicaly munologically silcosi presnce the hyaline tissue observations the in the of the relationship the ( Vazquez genesis 1957 have have now lying silicosis These globulin observations possibility genesis possibility col agen relationship Aqiny relationship Simple Coalworkers Coalworkers v Pneumocnios Pneumocnios thre The Pneumocniosi coalworkers coalworkers three distinguishing distinguishing features has features amount disposed tis ue spaces the focal emphysema spaces and Heppleston frequently is dust amount of of enlarged lesion 1951 silcotic under- that coalworkers coalworkers Hepleston contrast 1951 the silcotic these nodule To contrasts the precise with nodule coalworkers simple pneumo- stand e[dus sections recourse recourse made to serial . These clearly GOUGH AND HEPLESTON HEPLESTON oy} jo oy) 0} Jo Jo THE OF PNEUMOCONIOSES 01 disposed the silica contributesis and Hepleston disposed around PNEUMOCNIOSE PNEUMOCNIOSE PATHOLGY PNEUMOCNIOSE and by Lz kq consolidated 0} inconspicuos tisue respiatory bronchiles contribues this conslidated aor0j and inconspicuous conclusion ( espcialy those the and ( silca incospicuos specifc provide rspiratory dust litle around Crucial bronchioles bronchioles evidence second especialy those second oy} evidence supporting suporting provided conclusion highly highly carbon dilate conlusion that years these respiratory pue exposed exposed for to purified pojiusen Aroyetdsu form known dust preartions and man carbon focal Hepleston emphysema duce the saptpeaartanece focal emphysema 1953 of The employed years the Hepleston The these indviduals histolgical two of Hepleston elctrodes indivduals these the section random histological according ay} no dust lesions electrodes those these R^...ttner SHIONDWAd ducelesion plane surondig random uoresidurApuaprae of Aufdermau elctrodes also simple lesions transversetransverse coalwrkes coalworkes apearnce transverse acording this has typicaly exposed to found remakbly remakbly graphite milerconte runing through wheras Aufdermaur pue runing through the section When this typicaly stel ate with dilated the longitudinal no 0} Jo st y graphite with remarkably ash the bronchioles outlined pasges graphite their longitudinal UOTVL] UOTIpe 085 dust exposed contained AHL respiratory section respiratory bronchioles in To aye bronchioles cinephotography silica contained quartz posible cinephotography sections concluded formform transver outlined the lung necsary continuity cinephotgraphy to JO serial possible longitudinal Ol} Ue pure conlude dust pneumo- cinephotgraphy longitudinal longitudinal devlopment posible coalworkes pasages transverse air asey pasages se lesion mechanil manifestaions coniosi dustefects acumlation acumlation JOpUN simple fundamental difernt as manifestaions reconilng pasages diferent apearnces reconcilng fundamental ( manifestaions planes Hepleston same UO planes fundamental structure apearances Hep leston structure 1955 degree ADOTHLYd coniosi amount mechanical focal Hepleston suficent OMsty degre emphysema from sometimes sometimes focal emphysema features compresd howevr and importanimportan of peuedxasaToyIuqg The mechanics emphysema easily dilated emphysemarespiratory alveolar widely compresd LE[NOISA inspration inspiration varies widely betwen emphysema emphysema Hepleston FHL It tion that respiratory radiolgca amountto Ayjeu0m.Aroyendsaz coalwrkesHeplston 1954a wideshown tisue recognize radiolgical ofsimple fairly disposedisposed vesicular vesicular recognize the pneumocnios radiolgical features due coalworkers coalworkers conslidated coalworkes a coalworkers the small consolidated fibrous anddue bronchioles radiological itself the compres ed simple small amount SHE that free coalworkers irespective irespective imbalance of emphysema between As efect and fibrous necesary that that mechanical of most tis ue development form pneumo- acumlation interpetd interpetd interpreted and and 6 tions tions entailed entailed mining must generated in the various various opera- opera- min g instance vary considerably Nagelschmidt instance in sometis coal seams certain Welsh YyUomusA bronchiolar smoth adjacent strat Nagelschmidt Nagelschmidt that the sometimes coal the apears expiratoy expiratoy varied adjacent total dividing from content our experience minerals wil minerals exprienc minerals face our all Moreover in %% to face workers total puv pneumocniosi yettype pneumocnis pneumocnis movents expiratoy exprienc Moreover in ses same NOLSTdH simple inspratoy permanet Morevr identical pneumocnios coalworkers identical pneumocnios of rank bituminous bituminous coalwrkes irespctive sema permant focal coalworkes features and anthracite or anthracite emphy- whether y8noyH) the 1947 British coalfield carbonceus irespctive silcoti whether whether Hepleston DV contains b1951 airborne bituminous Heppleston fre contains a litle with mean than Wales Wales Nagelschmidt this fractionBecause coalSouth esntial Nagelschmidt wer ewuskydura at same indets the regarde ben Nagelschmidt regarded the GNF been fraction 1943 conslidation this pure dust specif coalworkesresmblance thesilcanospecif clasicalbelive already indcated distnct respiatory emphysematous howevr enlargment inspra- HOND morphlogical and alreadyexpected spmoerpchilogficalc resmblance simple ]voj Sf lesion be lesion coalworkers resemblance resemblance clas ical But resemblance exists resmblance resemblance lesion coalworkers we nonspecific nonspecific some that some indicated no is simple jo that a iZap of reaction of lesion coalwrkes whatevrmajor Emphysema with nodule iregular segmnts isdevoid free whatevr the fraction which which and devoid the and 9 (Y) free silica oti which which they subjected importan are A important which an adition bronchioles bronchioles as to addition inspiratory important subjected consolidation conslidation dust atrophy atrophy theof consolidation upon expiratory SnoleA upon and bronchioles respiratory respiratory bronchioles wil oY} diminished both combine bronchiolar bronchiolar movemnts expiratoy Ul movements both inspiratory efect although devlops samesema The simple althoughalthough coalworkes focal progesively focal emphysema because focal expandig emphysema above bronchioles expanding bronchioles and the tory These depend abolished Such movements movements interferences expiratory expiratory , lesion dust above because is defined narrows and actualy actually same counteracts tory traction bronchioles simple conslidaton vesicular respiratory bronchioles around distinct Emphysema emphysema emphysematous distrbution any airway (6r61Emphysema Emphysema respiratory bronchioles silicotic nodules nodules from focal focal nodule this Sometimes however emphysematous emphysematous but that it segments particular iregular distribution distribution distrbution may inspiratory consequence consequence force bronchiolar smooth shortening therefore therefore combine produce focal emphy- same does progresively progressively respiratory nar ows respiratory respiratory narrows vesicular inspira- spaces enlargemnt enlargement is space airway atributed atributed atributed not wel tuberculosi retraction the operate over which retraction growth 6c sey fibrous jo jo nodule which may JO SI axe ut est I JO Ul years years tuberculosis after ceas peatedly peatdly advncedadvnced the elment conept fibrous cesation nodule cease not which woym for operate This retraction exposure dust cesation to complicatng exposure elment years found those stopnzsq} Lesions fundamentalyfundametly SIOYM[VOD stolgical South in bacteriolgca exposure workers graphite fundamentaly miners 1954 scalers from bacteriolgical similar be workers graphite miners workers remaing found and and workers masive coalwrkes the Aueut Marshall ocupations workers clear Gloyne these therfore ocupations like Harding Masie Wales sieoX the dust 1951 1951 oc upations SHOINDWAd wel lesionsshowed coal may represnt lesions healed genral tuberculosi uour and silica Comparble evidnce patholgical content always the reasonable they features genral silica therfore QO] common pathogenesis lesions conclude Comparable pathogensi James foundry pathogenesis lesions share comon lesions also ocur SIOITs re8unoX interptaion from pathogensi also in JOAO suports McLaughlin interptaion tuberculosi % masive foundry McLaughlin 88 workers FHL 1950 1950 suports workers from showed tuberculosi reode only Masive McLaughlin therefore sip, [Jom IO ay] OU Masive Pneumoconiosis Pneumocniosi Masive , masive thes 1947 [eseID Masive Pneumocnios tuberculos therefore 1947 JOJ Massive lesions iregulary mainly Hepleston indcating the lesions coalworkes Hepleston Hepleston Endings dust ydeoxe that infection Endings indicating pue Massiveconsist Gough Gough mingled ADOTHLYd hyaline vesels tend pasages Tubercle bacili diesinto existng fibrosi hyaline colagen and with the of esions tubercle tuberculos hyaline fibres bundles conceive It tuberculous esions ocur bundles inconspicuous may coalworkers coalworkers coalworkers peatedly jo 245 245 Harding UT low these has ING they occur 12 ay UT suports wonder ay} ut UL conceive sB parts isn James been thoroughly thoroughly by James by evidence evidence evidence tuberculosis complicating complicating 40 Wales coalworkers coalworkers Although remaining % Although they of tuberculosis represent pathological massive lesions masive masive fibrosis are James since was massive lesions evident 29 over men of indicating increasing over We therefore the origin infection interpret fibrosis dificult Tubercle tubercle apear pentrating incospicuos payesouc. pentraing pentraing and incospicuos lesions tuberclous Blod lesions many the arterioles AHL are arteries arteries arterioles arterioles the previous incospu fibrous masive This the persitenc lamel^ lumina lesions the masive ysnut persitence internal elastic by 3 obliterated shown SIOxMTEOR erated comuniate men totalytoaly invasion offibrous tubercle sputum sputum Carpenterthan partialy Aypareg presnt les obliterated been Cochrane 2 of fibrous fibrosis sputum acompanied or TheThe masive by foci bronchi which explains however are This explains probably during during bacil i fibrosis Cochrane tuberculos do show show conclusive may conlusive element do element element production tuberculos Strachn recognized Juawesuvie hewrs abolishedabolished coal his Gardner Gardner Gardner Strachan masive dispute extenttisues 1940 maintained coalworkes has alone formed maintainedmaintained aduced several dust NOLSITdH pneumocnis lungs symetrical most this extnsiondisease retarde progesion in Simple Simple pneumocnios pneumocniosi pneumocniosi symetrical to 9 due not both human progesion only WV often case Numerous hand relatively without snoun factor material provide should ANY youngmassive men disease w, ithshort dust exposures young lung tuberculos non parts account acount inadequate HOND with acting poysinBusip fibrosi the Tf reason explanation reason colapse explantion fibrosi an SAIJOUD that show acumlatedacumlated cause discharged discharged combined fact coalescne coalescne evidence from In inadequate the the 6 9q genesis explantion masive that evidence masive fibrosis fibrosi silcotics tuberculosi evidenc tuberculosi tuberculosi geters Why and be massive fibrosis fibrosis they jo kq hewers hewers geters evidence participate sayje80) showed particpate the but and Simson Strachan in the tuberculin and do and that masive ^tiolgy masive lesions lesions therfore Mantoux reaction reaction dispute but Ienpou the dust bacilus element tisues progesion progesion poyeul of mater Suleq for this dispute purpose disease view clearly view James James unlikely coalworkers coalworkers in 1938 1931 Mantoux and alter therefore tubercle therefore The so as form tuberculous equalyequaly AypeardAy ocurs fibrosi patholgical tuberculos in was pathological afected senpou epidemio- observations 1951 limited afected its Man progresion may occur ayy with without observations sometimes satis- The sometimes view view human litle dust Sq factory this other sometimes seen the relatively alone acting alone the tuberculos Those not dust gnst} origin fibrosi fibrosi fibrosis factor excessive fibrosis observations observations The study production tuberculous production ac ept dust reverse infection masive same have infection cause discharged simple lesions bronchial fibrosis ore masive the the aditional out made experiments experiments colapse aditonal siolyis expriments acumlated infection factor aditonal tuberculous of Morevr the tuberculous factor aditional the oY} op UL younger tuberculosi younger men tuberculosi should should is , quartz reaction extent restrict the tuberculous element sugest features of and material view tuberculosi masive is cases cause dust dust Gough Gough 1957 tuberculous infection many of whom whom airne Cum ins Cum ins Cummins adsorbed tuberculin Coal- the progression modified limited The Cochrane ) has provided no satis- is complicating Those fibrosis may mas ive such may infections animal combined animal lungs combined with inhaltion bacili PATHOLGYof cultre PNEUMOCNISEPNEUMOCNISE inhaltion AND soyeoris goysaqeyunoure s01S2qsB bacili PATHOLGY the G.A. HEPLESTON Te -uasa J. intratracheal sonefour including extnsive GOUGH injection HEPLSTON duststhe Rheumatoidinflamtory recoverd cultre fre fibrosi but various recoverd of with inhaltion intracheal induce silica including can extensive Gardner tuberculous Bid fibrosis regarde being fibrosi rabbits lungs do caly colagen lungs silicotic SIONDWAd Dworski silcoti coalwrkes atoskiyoBurUTe}UCSs[Op1o9 rabits Vorwald abnormaly gous Dworski Massive failed so coalworkers sometimes inflamtoryreaction fibrosi coalworkes infective pneumocnios oftenoften 10 pulmonary pulmonary and tuberclosi obliteraion emphysema nodules nodulesinflamtoryinflamtory reaction fromfrom disease tuberculosi [esoUrl sapnyout ring infectivepneumocnios amino AHL pulmonary Gough heart disease IO Aq classical Hepleston the emphysema central Hepleston central necrosi involves classical silcosi vascular vascular obliteration 1955 1955 , whereas whereas Strachan ) On pesaos qemnosedumiseu r air bacil clasicaldence howevr said coalworkers In be indirectly large mortality mortality ADOTHLIVd such nodules tubercle part coalworkes rheumatoid tubercle in frequently the sq Caviton the consequnce and frequntly consequnce masive distnct poyerpAy calcify and FHL ischemia procesesdevlops and tuberculosi quiescnt Asbetosi meanig unqechable The meanig meaning yoUeO Fletcher Vascular consequence two leads proces Kilpatrickcoliquative pojusaidn. being ischemia necrosi results derives TE, oclusion patent cavitaion involved bronchus occurs occurs involved areas caseous softeni g softening caseous ayy st THE THE PATHOLOGY PNEUMOCNIOSE PNEUMOCNIOSE SNoIgy PATHOLGY various dusts [jews aN]q Rheumatoid bacilli o}IYM we 10 Rheumatoid infection 10 that Delahant produced disease and Delahant normal Delahnt sometimes ayy death death frequently dyLOITS these in and emphysema toid reverse obtained The subsequent varies necrotic above evi- can ot be disease recoverd by Kelgren inflamatory reaction reaction necrosis col agen It therefore produced react abnormal y react pneumocnios pneumoconiosis pneumocniosi tubercle bacilli component of tubercle tubercle of peculiar involves rheumatoid pasage & PNEUMOCNIOSE guinea guinea inoculation 1952 as suggested et al nodules Sometimes and the the an plays tuberculosi the tuberculosi coalworkesa expctorated bacili leaving coalworkers coalworkers ayy such stage pathological patholgical patholgical Aq rheumatoid stage patholgical Hepleston Hepleston and and 'quiescent St Asbestosi Greek Yor of results Cavitation necrosis in enclosed in the expectorated leaving pasage thin the one has free from from calcify and stil others others Kq Jo sit Jo Asbestosis sia[jy term Asbestosi derives indestructible sense indestructible indestructible indestructible refers sense for stationary stationary O8e staionary unquenchable unquenchable to certain certain fibrous enclosed silicates caled which a asbestos amount which sjsnpA gyi condition pue Rheumatoid Pneumoconiosis Rheumatoid by Rheumatoid pue purthe Aq Jcaoled recntly pneumocnis Capln atention amphiboleamphibole magnesium recognized is so croidolite blue rheumatoid recognized the rheumatoid pneumocnis Caplan atention amosite amphibole includes increasd rheumatoid ocur snolea greatly with magnesium silicate These minerals almost exclusively jo rheumatoid prevalence of mtashivee discret quarterminers radiographs quarying South Africa masive about radiographs are mined men peculiar peculiar are rounded NOISH1Td rounde repsent and These eAtsBul procesed blasting manu- These opacites opacites now which in in represent represent lesions jeayosjenut nodules arthic moreparle rheumatoid siofuneg the plaster brake asbetos procesing crops and masive parle OSIS ttexhtieles and procesing lesions Charcteisaly Charcteiscaly asfidlepetrhss paper plaster brake asbestos DW of doesdoes tsevheriety apear ANY nodules in develop massive arthritic mmiuncerhs severity changes not necesarily necsarily Pulmonary Pulmonary contempraneously contempraneously lesions usually rapidly radiological radiological radiological degre Ul contemporaneously when nodules usalymanifestaion may pozlus0da1 ,ployeum, Regulations dimnshed HONOD with manifestaion manifestaion precde 1931havesince arthrits either atending introduction exposure arthrits 40 Regulations Miall precede precede by the se other pus asbestos asbestos Rheumatoid rheumatoidsilcotic nodules fibres recogniton Rheumatoid nodules conetric colagen pulmonary greatlythe Rwheuhmaetoind devloped are wide concentric bcoingcegnterric than necrotic oe ocurs rheumatoid relation UOTEIABS of conditon that 1927 designatedesignated peripheral zones lines inflamtioninflamtion which colagennecrotic conditon asbetosi relatively esignated 1927 peripheral separted by dust patholgical reaction o colagen colagen and feature ad ition addition nodules relation "(1 inflamtion nodules from necrotic which tubercle P61 represnted represnted The iron and magnesium calcium a South Italy Africa Africa They procesed They crushing processed textiles and filers mineral particular magnesium includes silicate croidolite carding It chrysotile chrysotile contain g silicates white tremolite tremolite exclusively Canada blasting quarying quarying and linings cement that size produced and many respiratory them In procesd of respiratory tract Regulations industrial the risks inhaltion greatly diminished of recognition usage pulmonary relatively Cooke and can asbestos introduction of Asbestos Asbestos Asbestos Industry exposure exposure the inhalation as a cause recent as only McDonald and the asbestosi asbestosi The The pathological patholgical reaction Formation asbetosi These the Zurdojasp uncomnly uncomnly 1. are within alsoalso PATHOLGY metaplsia of PNEUMOCNIOSE ANDbodies show the THE PNEUMOCNIOSE ce 32 J. 944} GOUGH HEPLESTON HEPLESTON Ul 00} 2 PATHOLOGY PATHOLOGY UL} PNEUMOCONIOSES PNEUMOCONIOSES SI host fairly rapidly asbetosi found metaplasia asociated of Formation These uncomonly host which body only withn fibrotic fibrotic fibrocysti usaly depositon sputm evidently 9OUIPAS changes poulation of When devlop exposure carcinoma supervens progres changes epithelial proliferation central fibre rate of rapidly apearance apearance encased deposition deposition the the of Jo protein poseses Ysti ay} asbestosis fibrocystic fibrocystic asbestosis asbestosis malignancy malignancy asociated asociated pulmonary asbestosis supervenes SAOINDWd derived erived tisue presnce encased iron poses and lower poulation usaly squamoussquamous from poseses the general predominatly protein general poulation protein often and segmnted presnce bead asumes segmented also sIojsaqe contrast Iselbacher sumarized beade pasvoru cleavages aperance standig sevre and evidently asbetosi that These evidence asociation bronchgenic sumarized bronchogenic AHL show show disintegration disntegraion conlude Dol disntegration asbetosi more than industrial coindenc certain carcinomathat disntegration cases hazard fisures asbestosi AO increase asbestosis average Beatie prepartions that Histolgical preartions show s}sIxe asbestosis ap earance with These 1938 Gloyne proportion proportion proportion smaler 1954a Beatie extremities evidently long long smaller 1954b Histolgical represent represent or increases process proces of severe 1951 ADOTHLVd Knoxthat in groups presnce preations show exposedasbetos workers asbetosi Histolgical s[qisod industrial asbestosis poulation singly respiratoy respiratory more years singly tre ocur or only sIofmreqny working order employes howevr expriencd genral by tissue reaction improved working environmet apears inocus extracted introducin since environmet the extracted AHL from bodies thickend lungs from SUN lungs respiratory presence Their render them oc ur ed inocuous The to inocuous means bronchial formation asbestosis formation bodies extracted ue evidence and UT carcinoma yey) carcinoma asbestos the Is elbacher et concluded the site of maximum maximum ( 1953 sumarized the asociation was coincidence the involvement involvement cancer more that average among among been of ten st experienced general experienced yt progres ively progresively dimnished the the introduction the 1931 regulations Endothelioma Endothelioma in humanhuman are unable fibrosiactivencesarily ysnoy Areuowynd,may devlopdevlop introduction thickend fibres themselvesinduce Vorwald guinea al greatly there evidencepleura of silcosi Irvine themselves that silcosi contrast asbestosis asbestosi lung 1951 the asbestos oul evidence Vorwald Jr 1935-38 Vorwald or coalworkers surround infrequntly longest formed formed dogmatic in asbetosi spaces sgoeds exist the infrequntly tuberculosi giant engulf pulmonary tuberculosi evidence which whichinfrequently and at empt attempt attempt fibres the air jo are even pulmonary pulmonary tuberculosi fragmentary asbestosis evidence evidence is though small small sometimes forms completly vusXyouaredsoSvydsoew asbetosi foreign body Not completly sugest body leser too smal Merwethr Merwethr dogmatic sometimes 193-34 guinea ingest workersinhaltion 193-34 longest affect In predominatly widespread guinea pulmonary lower of predominatly sen pulmonary affect the man several lung around bronchiles cause comn temporay fibrosis common respiratoy Two The where alveolar wald have expresd fibrosi expresed alveolar SoIgY wald sacs bronchioles tuberculosi and NOLSTdH Fibrosi also relation pleura wher uoresagford disntegraion chemicalh bronchioles thesis^tiolgy is that ocurs disntegration Fibrosis consequnce likely the asumes leading septa in body fluids in consequnce lung and leading changes fibres disntegration of In D souasoid J{NBue structure be it human changes masive liberated of is most fibrosi 1954b ( fibrosis disolve tends asbestosis obliterated result paounoid residues masive secondary secondary hornblende chrysotile infection ocured and human asbestosis asbestosis in ANF fibrosis K^...hn exposed the infection masive exposure produce fibrosis are predominantly be secondary fibrosis guinea formed seen widespread lodge pronounced pronunced massive Gardner exposure 118 incidence Jo oy) ( restricted Ul restricted Suny al oy} ul ey) thesis minerals minerals minerals 0} oy, were exposed v In pigs inhaltion temporary pigs tuberculosis tuberculosi oq spread 0} views have expresed The on disintegration liberated Knox dissolve 1951 occurred hornblende occurred was hornblende hornblende Beat ie 1954a 1954a dusts Because K^...hn K^...hn to exposure thought hornbled produce changes failed yduisye chrysotile chrysotile produce alone were after thought asbestos asbestos nontuberculous but tuberculos uoBer infection nontuberculous fibrosi foci exprimental evidenc evidenc ofasbetosi HOND notuberculos has cystic down formation disease animals distribution exprimental disease cystic spray hornblende human the by Tf were formed formed asbestosi asbestosis distribution distribution change change 0} pue that hornblende bodies The was persisted hornblende experimental broken to cited formation Vorwald patchy evidence adjacent honeycomb non puMosm human that Brucite develop honeycomb anlogus seaqgy oposed cause apearnce apearance anlogus otherosvydiovyl howevrhowevr hypotesi OH lung sen givng containg injection The fibrotic honeycomb *T Hyperlasi manermaner fibresreaction pulmonaryComplicatons conditons sojeqs intracheal intracheal potency Hyperlasi bronchiolar epithelium may Yoryar sizes Hyperplasia epithelium with particle ce Complications fibrosed analogous analogous bronchiolar bronchiolar other epithelium which *Z may to the containing chemical little containing silica very asbestos fibres increases increases intratracheal diminishing particle particle but asbestos 6 : *E Yu ge Te oy HEPLESTON HEPLESTON GOUH GOUGH HEPPLESTON long inocus OF practialy Syoipy pneuMOCNIOSE pneuMOCNIOSE the practicaly practicaly hydroxide asbetos Aluminum (yS6) long efect quartz but asbestos Nonfibrous REFRENCS Virchow's paw 39 inert ; tissues WO . tisues same chemical 9ST 8 9bd 6 TIPTL OT BP uas IZL the PATHOLOGY aads REFERENCES yay eZ o OL OT Although compsiton xosuL Aisnpul chrysotile (961) (6P61) BCEBART 319 CPS Cochrane A E. same fibrous chrysotile Mial compositon they CAPLAN f T. SAOINDWd JarmaN compsiton they ouvapy Mial and HOCKADY fibrous ($S61) hypothesi chemical Cochrane 1956 Tubercle Tubercle Cochrane E. 48 fT 48 hence hence COHRANE 274 the both now 1952 The hypothesis must of mechanical iritation CARPENTER ( COCHRANE COCHRANE A. L. 1954 Brit and favoured fibres A Cox T. 1952 Vorwald sems mechanicl HIMONA flexible Jarman 1024 to minimum (S61) COHRANE 1927 G. COKE W. E. L. Brit AHL J. 2 et minimum long acording must al 20-50 required required IN Brit 1952 1952 length acording required U OS 1931 SHONA J. Vorwald CUMINS WATERS E. pigminimum inflexible and Weatheral and CambCamb produce the CUMINS CUMINS S. L. WATERS T. AO produce guinea guinea length inflexible fibres fibres of glass OD d WATERS only Furthermoe Weatheral the flexible 1938 J. wo l non Furthermoe flexible fibres are Tvag CUMINS Weatheral Weatheral non fibrogenic fibrogenic fibrogenic Furthermore the fibres fibres PUBV W UL S. and CUMMINS CUMMINS WILLIAMS 1938 ) 638 f apear the E. Camb sites GARDNER Med Brit Hyg only TU peritoneum the fibrogenic Hyg in that pue in lung peritoneum that is normally ) lung peritoneum 195 U. As GARDNERGARDNER GARDNER J.industr apear considerations movement It from considerations ad 'S ADOTHLYd actpathogensi and setled NOIsa1dyH WILAMS Silcosi Silcosi subjectd regular canotcanotfrom regarde considerations LaboratoryLaboratorySymposium movement considerations asbestosi that settled A Gardner GARDNER GARDNER Gardner L. U. 1937 Third Saranac Laboratory Laboratory of regarde as Saranac regarded regarde 1938 Symposium Asbestosi pathogenesis asbestosis GARDNER University University University U. 1938 in Lanza ) Silicosis Silicosis Asbestosis Asbestosis Sugary thatthepathogensi setled. (LS61) SANE 7 pathogensi Pneumocnios GARDNER pathogensi Pneumocnios Pneumocnios (AT "VW Talc A YU pue 331 OU f "4 (9S61) Pneumocnios , AL med Asbestosis Pneumocnios A'S Ass Tf and H10 V Talc Talc silcate which magnesium Pure Pure talc is magnesium S S f f f f LE 'f Amer 114 Lanza Asbestosis f compact compacthydrated hydrated magnesiumplatessilcate comercialcomercial comercialocurs GLOYNEGardnerUniverstyUniversty UniverstyPres 1940p 235 ed Silcosi and hydrated magnesium ocursmayin Hont5009 HONH J. Lanza A. )Silcosi Asbestosi Oxford foliated magnesium Asbestosis foliated or S. pneumocnios pneumocniospneumocnios pneumoconiosis pneumoconiosis to diagnosed clinically come come accounts aprxorpky clincaly have Poro accounts diagnosed autopsy 1949 acounts 1951 given ) 1951 Schepers and talc Hunt talc charcterized pneumocnios fibrosis wniurmy nodular fibrosi pneumocnis and NOLSATdaH nodules scaterd nedles is pneumocniosi pneumocnios does charcterized asbestosinumerous the birefringent birefringent birefringent particles scatered asbestosis ash from bodies snout scaterd case McLaughlin DY showed showed that probaly dried lung whilst the the anlysi lung X difraction UNV on was there probably than case ray ray difraction tion anlysi 0.5 quartz HoOND quartzThere histolgical f ose There histolgical may minerals pneumocnios histolgical simlarity pneumocnios talc pneumoconiosis pneumocnios form or resemblance constiution resmblanceresemblance of lung residues residues certain UT certain which constitution chemical strengthened case Hunt's similarity depend depend minerals of the ocurence bodies resmblance strengthend strengthend ocurencocurence ve bvoedies in both conditons conditons 0} the eq) be n GOUGH WENTWORTH 1949 )more havehave been Jo useq McLaughlin McLaughlin saseo aavy Thorax Fac McLaughlin RIVERS MASIE Bact by maj and 453 MedMed by and218 sJow HEPLESTON Aq difuse ING difuse AjoaTefoy Arch resmbling HEPLESTON G.1954b . sjsui resembling Theparwiedas HEPLSTON adUIN90 67 X Weqiose Coun ksdone puadap al uayi 0} McLaughlin presnt in Nagelschmidt 75 the HEPLESTON 1956 awicd silica present pue pue indicated than R. Nagelschmidt 287 Med J. sopmod Phtis paf]ty savy The dif rac- indicated less Klaus Johanesburg ISELBACHER les 1s1y Johanesburg asbestosis S} KILPATRICK Brit asbetosiasbetosi Sunsnp S. HEPLESTON 152 1954 similar and OO responsible responsible The ayL Jay[y siotunsud Arch & KnoxKnox industr asbetosi asbetosi Beatie Beatie J. 1954aNAGELSCHMIDT G. Bury like asbestosi se OS|e st esn oye} GOUGH J. JAMES R. L. W. GOUGH H. SEAL HARDING and WENTWORTH WENTWORTH UL ul MASSIE 1955 J. HEPLESTON 59 HEPPLESTON Path 1953 Path Bact Hyg Path E. J. JO oy} HEP LESTON HEPPLESTON HEPLESTON HEPLESTON A. G. HEPPLESTON Hicks HUNT ISELBACHER J. W. 1955 J. KEL GREN KILPATRICK KILPATRICK E. ZAIDI and F. F. 1954b 349 BactPath Thorax 195 374 Thorax , Path G. 1943 Med Nagelschmidt UO 3yi Spec Spec Coun Rep Miners Bureau 11 H. L. J. Hardy Tuberc Tuberc Med and 1956ulej1091956 12 med J. FLETCHER HEP LESTON C. and and NAGELSCHMIDT NAGELSCHMIDT SI NAGELSCHMIDT st Thorax Hlth industr %% Hlth Arch industr industr Hyg 23 WAOJ Uosful yuaryp Gewrbehyg soyval UGA SJasa UIBWOL yoay]o goeds jsOur eoo HEPLESTON HEPLESTON JOYE JO sso] jo s[jao ATuwo , UT HEPLSTON Foundry aSeUApe sovkoseyd yomjou Gewrbehyg Diseases 9SUBI arom . Steel Foundry soidno OUIBS ayinb Foundry snp 9 IF OY} ysnp s][2d sem s] 9o YM asop saporyed sepoaye CHAPTER G. C. Brit PUNOIe industr Disease 1949 asay industr . 9Y} oy], SOT] Jo CHAPTER CHAPTER are oq} IasyN}p uey. 11 Dunham [BoyORNeU Z)IVN) ay} @ [eo UT oy) ISI e Inq COHRANE 69 QUITJAT] and UMOUY REACTION OF DUST APyomb Thorax pure SB Ng REACTION 0} JsNp qe REACTION THE THE TO DUST (soj}weIp Kilpatrick sus Tubercle 15 and 1B REACTION ynq oy} DUST Kilpatrick OldhAM REACTION CAPLAN LUNG COHRANE L. OldhAM Bun T By BuN T esow Ser No. 1953 1231 0} S. J. A[IVoN) payord Res Suny 244 Spec B 7 ay) 7 sy, sev Ava eB Har ison Le King NAGELSCHMIDT SUOMBAT SUT-[ZO0d and DUSTHarison V. UaAId Med Ghezi Med King Spec Joys CEpelin 48 Ghezi Lavoro Jo Wey} Jo jye C. Harrison Roentgenol Lavoro oures PATTON 1942 380 BY} oJOM 3snp Postgraduate Ssof folowing Medical School Schol London 1957 uoNIvaY Amer acount HOBBS Jr. Amer Roentgenol THE descripton Roentgenol acount atempts and phot- Dtsch snp THE show show description description AUFDERMAU folwing atempts Dtsch aATSqO reacts Wschr AUFDERMAUR M. Wschr Hlth & ayy ayL account folowing how how animal circumstances circumstances circumstances dusts experiment diferent under under 195 simplified experiment 182 O} jo circumstances circumstances animal BOVET 1952 industr consider before of before experiment Arch Med Hlth STU sn consider consider reactions human human complicated 367 Publ Transval during worke's complicated Transval Inst conditions the reactions conditions during worker's worker's more & complicated SUIMOTIe uonerde we quartz obtain conditions The dutshtsat have most quartz and SilcosiPneumoknios Pneumoknis Pneumoknis Dust experiments has given Silicosis Pneumokniosi and London Jo ous of our experiments experiments experiments the dust been been single intratracheal intratracheal industr BAH SAH and 1951 Arch Hyg this VORWALD C. Hyg J. J. E. ) HARRISON ( 49 J. MITCHISON Amer A. aisnpul aisnpul particle MITCHISON exper 553 KING BP MITCHISON D. 9 ... Brit Path S ON Pub "PAW * f "LTL SGI "Yay alveoli alveoli pdaOMoaDT AISNpUl (6b61) (COp6T) "YOSIT uo] 'D tas ISUT 204d UAL POL alveoli (Pp siomyunag 30 pay ELp fo thes MOLVA *(7p6]) (ZS61) AVS(IE61) PAW days DM Uisuy "PAW Yosy day OL "601 NOLSATdH AISNPUL aad 6T9Y savsiq s}ori7s' (LS61) (S61) Idns adxe 19nd ST SNVHOAC EISHOMC migrate WV 9 AL (W W D pue TI *f 60L 'O respiratory d respiratory "LE uo "pf SLE SAyoquamn uopu0 migrate unod sasuq Spy SunTSZOI and CAME 'V anvANudiny ajovaqny SANIAY] SasOH{ (SE61D) *(9S61) situ (AL CYtod "IEZI oads fu0pUIA, 2 pur say joiasnpuy IZ HD s2WJO (861) GN reticulin H9Dg EV "SV YID sf A ep NVUHOD NYauNG within "UISU] TSpaw 0rd pate g Pure pue pue Y HOND -yrndaquny (pe-<E61) sugo0y day Yl0d VW d a *p Op pue gT1 S 'V ON OT PUR fine f sf A@ within within the 'O "egg AIQUOIES NVHOULS INVH1IEG xosy NOxIq SINUS (0S61D) (ey61) (LP61) sau With IE Pat OD 'NWHOVULS The uaAog (p61) "Yo4P WU HAT SSF I SNIVdD dust NVIdVD NOLVd OI(L761) (S61 (SE61) pue D "HM is IA'H SV VpSl A ' swan (es6) 9 uowsatdngy NITHO*SV4290M SNITHOAW uOpuoT (TP61) COA per rat Paw d'd EIPI pan CH f pue 'f With fibrogenic into OD pur Ul pue f Pf The Wdiutsht SY 'f MA f "OD "AA "AA AA 'V "WY 50 mg fA "ALOS dJA 'p9 Lb LL C clusters AIVNOQ Weasl LAIWHOSTVN WANLOY SUadTHOS NVHOULS ZaNOZVA SAIWMAO SOIVMOA into clusters SINVITOIA NVIAL STIVTAL SINWAdSOUNOd NOSHIS'NOSNIS NOSI NHOW clusters 9 TOW PW