Document 8VRzkm6DKa8Gqg0ObvNaqB57a

FILE NAME Pennsylvania PA DATE 1932 June DOC PA002 DOCUMENT DESCRIPTION Medical Journal Article - Pulmonary Asbestosis *** iodine of iodine 2 of.5 c c dose um um dose of of , sof 0.3 per per r r dayday for for te remission a recurrence was a slight ven on alterperature re- of 115 c.c. period period of 20 5 at which e same dilu- at improve- cytes 7200 a good apunds weight complamed us shoulders onclusions ransmitted ransmitted 1 miner for 20 dmitted to argh 22 onary tubercu- undue latigue bmyodeinrcaretaeslinyglyse- heavy black from Jecreased Jecreased from PENNSYLVANIA MEDICAL 150 to 115 JOURNAL pounds over a period medical and family history were Physical Physical PhysicaPhylsical of several negative years . Past PaPast st chest Physical examination revealed of an partick emphysematous blood with a good deal of emaciation blood presspuresrsuere was pressure the There ThereThere was was 100 with a markedmarked type His sy tolic pressure of 70 diastolic supraclavicular retraction with retraction upper infraclavicular of sclerosis A with dullness lulunnggss resonace of other resonance greatly were and increased increased resonance diminished diminished calcified Coarse moist r^lesr^les and the one musical lower two thirds of The and over the upper resonance resonance below below iin n the upper third infraclavicular infraclavicular third of both Breath sounds on both sides r^les were present the chest JOURNAL solid solid solid solid ffiilllleded with carbon carbon contained scattered deposits deposits with many blebs on anandd were thit nhian nd deal a great deal both both macroscopicaly macroscopicaly dilated dilated ananddand the corccorcuuaray ry sclerosis vevreyry evidenceevidence few ubrous calcified in of tuberculosis and the peribronchial on sectiosenction tuberculosis tuberculosis oror other other chronic calcified tubercletsubercles emphysematons heart walls revealed revealedrevealed examination roentgenogram peperr half of both sshowed howed dense dense shadows shadows shadows both lungs in consolidation lungs third and fourth suggesting suggesting intercostal ; in the coarse spaces there were fine and moderately tothe right mottlings The heart Both diaphragmatdic iaphragmatic diaphragmatic leaves was enlarged tuSberpclue tSpuutumm Sputum examinations were were depressed bacilli deposits tubercle and fungi repeatedly negative A blood for showed ing of significancesignificance UrinUe rine count noth- albumin precipitant upper limited Kahn contained contained faint trace of lungs The temperature precipitant precipitant test was one plus to before temperature was never elevated and diagnosis Though averaged 80 while at rest in bed His pulse rate mained condition 22. unchangedunchanged from the time of re- Sept. to disease were due 22. mail 13 1931. when admission admission on June severe pain in the left he began complaining of entirely chest with dyspnea He per- spired profuselpyrofusely and the He temperature became subnormal grew gradually onset of pain worse and died 12 hoursafter the At the necropsy lungs were The upper lobes of removed with little diffi- discussion both lungs and about half of others rightmiddle lobe were retracted and had the of a solid rubber ball peared well a^rated On con- The lower lobes ap- section both upper lobes were and emphysema failure This patient was because of a third degree unusual in our experience of carboncarbon carbon dduesgrtee anthracosis with dense half of the practically limited the death were such it that The findings definite clinicalclinical was difficult make a satisfied that the patient's symptoms we were were symptoms were not tuberculous pulmonary could not be ruled out before The reason for the unusual distribution anthracotic material material remains unexplained unexplained cause of the fibrosis is also on to Some authorities maintain that it is the The result of the irritation of the dust helieve that it has a primaryprimary infectious basis Tuberculosis League Hospital Hospital PULMONARY ASBESTOSIS BURGESS GORDONJr. Although many many years many many workers in in have been employed employed for asbestos it was not until recently mining that thisoccupation was recognized as Murray industrial hazard It appears that in published essential 1900. the first report on the essential features features of pulmonary fibrosis with spicules of asbestos This apparently was not recog- widely nized until 1924 when Cooke publishedin Eng- process land his findings of an extensive fibroticfibrotic distincdt istinct from called tuberculous foci in a pa- tient who worked with asbestos 1927 he characterized lung as ironcontaining for 20 years lung reported necropsy findings similar to those to those but without evidence of complicating tuberculosis An interesting case of asbestosis was reported by Soper in 1930. The patient ex- asbestos cept for short periods had been an worker for 13 years The onset of symptoms was in 1928 malaise and when he complained of Blood loss of weight Blood dyspnea streaked streaked sputum occurred in 1929 later burning burning pain pain inin . _ From the Medical Service of Dr. of the Chest Department of Diseases of the Chest Department Thomas McCrae Jefferson Jeferson HospitalHosHopspitail tal the chest and marked shortness of breath The cyanotic but there was no clubbing The roentgenogramsroentgenograms showesdhowed over the lower thirds of the was a striking phenomenon described out 1717 a case in 1930 with death occurring . years after exposure to asbestos dust exposure Lynch a and Smith reported a case in 1931 in which which essential clinical features were the atsisane tienen for N Death was due apparently to and SmithSmithSmith collected a series of of pulmonary asbestosis The majority occurred in England In 27 instances asbestos were found in the bbyodipuncturee s sputum juice puncture or atnecropsy in lung juice in necropsies the 638 THE PENNSYLVANIAMEDICAL MEDICAL JOURNAL by losis 3 lobar pneumonia and 3 by broncho- pneumonia So faras determined there are only 4 records in the literature of necropsyon un- were present at the base of the aortic parietal left coronary artery On the parietal and crete small gray nodules of firm consistency the left side there were fibrous valves pleure were consistency adhesions the dis- on upper complicated pulmonary asbestosis The follow- ing case is reported because of the rapidlygrowing interest in the condition half of the left upper lobe was a large cachy honey- comb in type The margins of this were not limited by Gbrosis and it appeared the excavation without the usual formationof excavation had fibrous wall The patient male single aged 54 entered the De- partment of Diseases of the Chest Jefferson Hospital on Sept. 3 1930 complaining of weakness loss of dyspnea weight pain in the chest and in janitor and worker He had been a factories for many years family history irrelevant He had scarlet and typhoid fevers in childhood There were no important contacts with tuberculosis and up to his present illness out the remainder of the there were arcas brown and black pigment and the tisues . In the intervening parts firm and somewhat bloody Crepitation absent In the middle of the right surface were two fibrous lesions small contracted and firm In the histologic examination the caseous lesions in and he had been a strong hard working man The onset of working infiltration his present illness was in 1929 when fatigue nonpro- little fibrous ductive cough and pain in the chest occurred These pulmonary symptoms were aggravated aggravated by deep breathing and were many most severe in the winter He entered the Philadelphia General Hospital in February 1930 and remained for 11 weeks Ele returned to work somewhat improved the right lung the appearance of lymphatic epitheloid cell infiltration There was extensive but no giant cells andvery present The histology of the larger larger resembled diffuse fibrosis In places the alveolar walls were thickened in others the alveoli had disap- peared in the maze fibroid tissue The bronchi catar hal but soon weakness and shortness of breath increased showed chronic catarrhal inflammation and there were % Tubercle and there was a loss of 11.5 kg in weight In May he areas of pneumonia bacilli were not found in smears taken from these tissues The arteries showed was placed in the door clinic of the Chest Depart- ment of the Jefferson Hospital He improved during obliterative arteritis The most striking features juice were the asbestos bodies in the lung and alveoli the summer but in October his symptoms were marked and he was admitted to the ward These measured 10 to 100 microus were golden brown In the physical examination he was described as in color and appeared as a series of regular ilike red blood cells in roulette formation disks not The re- emaciated but well developed The chest was emphysem- benotoxylin benotxylin sponse to stains was interesting in that atous in type and expansion was diminished especially cosin or Gram's stain had no effect but the on the left side The percussion note was impaired at the right apex and below the clavicle on the left side The breath sounds were harsh throughout especially at the right apex Coarse r^les were heard practically over the entire two lungs Amphoric breathing and blue reaction for iron was pronounced pronounced In considering these data it appears that the most striking clinical features werethe absence of toxic phe nomena and the gradual onset of respiratory manifesta- tions with agravtion aggravation in the winter time which whispering pectoriloquy were present over the right apex The roentgenograms showed a process not unlike tuberculosis involving the right apex This was fibrotic The type formation in and with cavity on the right side was thickened thickened The interiobar pleura and the pulmonary markings in the right lower were increased decreaseddecreased in severity during the summer and following Dyspnea was far greater than that noted usually in patients with more extensive chronic change In the physical physical examinationexamination certain gested tuberculosis but the type of rales beard out and the variations in breath sounds were the middle and lower regions of the left lung ows according to Dr. John T. Farrell Jr. resembled dust changes rather than bacterial invasion The laboratory findings were essentially negative except a red blood cell count of 2,800,000 and hemoglobin of 50 per istic of asthma dust inhalation and monary infections The roentgenograms helpful altogether because of two processes formation and diffuse shadows nonspecific roentgenograms were not processes c cavity cent there was an occasional trace of albumin in the urine The sputum was mucopurulent in type No tubercle bacilli were found His temperature and pulse were normal except during the first 3 days after entry when there was a slight increase He gained 4.2 kg in weight He left the hospital against advice symptom- atically improved on Feb. 23 1931. A diagnosis of pneumonoconiosis and pulmonary tuberculosis was made The former was considered because of signs of diffuse The change in the lungs especially especialy in the hilusareas The question of pulmonary tuberculosis was raised because of apical involvement and cavity formation The necropsy diagnosis of asbestosis and atypical pulmonary tuberculosis the former not being suspected before death emphasizes the im- portance of the occupational of pulmonary disease disease anThe the tient was employed in history in the study study fact that pa- pa- discovered until after necropsynecropsy because regarded tient and relatives an incidentin this aparently list of a long doubtful cases the technic for sputum Two weeks following discharge he experienced loss appetite and insomnia His previous symptoms re- : turnedand he re^ntered the hospital on March 7 1931 There was no essential change in the findings dyspnea increased sputum weakness and dyspnea His tempera- ture increased increased to 100 to 101 F. the dyspnea became extremely and he died following a stupor of 16 hours 26 days after reentry Necropsy showed essentially normal organs except for the following Atheromatous nodules and patches and Strachan reported by Simson Strachan should Thisis as follows sputum fromthick mucoid paraffin sputum paraffin oven at 54 C. fixed and saturated chloride mercuric solution one set being stained with hemotoxylin and eosin to determine the presence of various organisms the other is fe gt ntaeraer geass een el seamen Ste meat eS peat ne nip agrU e ne e nee ane gE OR IAAI sonia tk RS oT Be 2 2 in as 5 2 2 as 3 JUNE 1932 THE PENNSYLVANIA stained for tubercle bacilli The second series centrifuged is made from the centrifuged gestion with antiformin deposit after di- fact that asbestos bodies were discovered in 48 ont 50 states states value of this this this procepdurreocperdocuerdeure SPONTANEOUS RUPTURREUPTURE OF THE ESOPHAGUS Spontaneous cludes those Spontaneous rupture cases of sudden rupture in whichwhich rupture there are no discernible discernible discernible signs of previous disease of the organ The condition occurs most fre- quently in adult males who have been addicted to the excessive use of alcohol Twenty of the 28 cases collected by Whipham were in males and 17 of them were more than 30 years of age Most of the esophageal ruptures reported occurred during the act of vomiting or retching A few followed a fall or other external violence In all cases the rupture occurredin the posterior or posterolateral wall of the esophagus immediately above the diaphragm Spontaneous rupture in a healthy organ has been denied by most observers Williams and Boyd found the surrounding tissue denuded of mucous membrane and infiltrated with mono- nuclear and polymorphonuclear polymorphonuclear leukocytes which they attributed to a preexisting inflam- mation Zenkerand Ziemssen ascribe the rup- ture to intravitam esophagomalacia esophagomalacia caused by retained acid and pepsin in some patients sistance in the tissues Beneke believes that excessive acidity and low repredispose to softening of the wall McWeeney described a condition of inflammatory softening with round cell infiltra- tion at thethe site of rupture and supposes this to be the predisposing cause The condition is of interest not only because etiology of its uncertain etiology and rarity but also on account of the marked marked resemblance of the cases and in history signs and symptoms symptoms Such a case without the history of recent alcoholism is here- with reported A white male Hospital Hospital under His family unimportant aged 40 was admittedadmited to the Jefferson 1928 complaining complaining of intense pain previous for rheumatic medicalhistory at the age of 12 and several attacks of He used tobacco moderately moderately He drank considerable liquor between the ages of 25 and 35 but duringthe 10 years he has There taken only an occasional drink is no history of difficulty in swallowing and hisdigestion had always been good except for an occasional occasional attack of burn which he attributed to chewing The onset of present illness a pound bundle He felt a sudden lifting while severe pain in the chest became very weak and had to sit on the floor He vomited a small amount of blood but was not stant continuallyThe pain was dull He continually called but did not continue to vomit The tenselypatient The chest a well nourished nourished adult was suffering in- His skin was ashen gray cold and clammy was an emphysematous emphysematous type The respira tions were rapid 35 per minute and shallow Ex- pansion was diminished but equal The percussion note was hyperresonant throughout The breath sounds were distant on the right side and absent over the lower half of the left side The heart sounds were rapid regular and weak The heart dullness was completely obliter- ated The abdomen was scaphoid symmetrical and tympanitic on percussion The muscles over the upper half of the abdomen were rigid There was exquisite tenderness in the epigastrium upon light pressure The blood examination showed 4,750,000 red blood cells 12,000 white cells and 85 per cent hemoglobin with a normal differential count patient's 16c0ondition , pulse rate became admissionadmis ion and respirations respirations progressively worse 96.5 temperature was 96.596.5 50 50 per lalf grain of morphine had afforded him from the pain At this time subcutaneous emphy- sema was seen in the left supraclavicular fossa and . hours later it had extended over the neck and face Death occurred 9 hours after the of symptoms Necropsy was performed 14 hours following is an abstract of the report On opening the chest there was a large interstitial emphysema in the mediastinum The amount pleura contained air and about a liter of fluid with fat and food particles There was a laceration of the left pleura near the vertebral column and just above the diaphragm The surrounding tissues were dark and edematous The esophageal wall and mucosa were of normal esophe- thickness There was a longitudinal rupture 5cm in length in the left side ofthe lower end of the reaction gus with a slight inflammatory reaction and travasation of blood in the margins of the rupture No ulceration of the mucosa or thickening of the wall was present to indicate a previous previous Upon histologic esophagus esophagus there was present with polymorphonuclear evidence inflamatory inflammatory The inflammatory accounted be accounted fluid found in the left Our studies this rupture any predisposing cause for the act of lifting tively is evident light bundle bundle was not the sole cause that it was a contributing factor 1310 Pine Street