Document 99rdZ4LZjJ1gK0jXbROLeO8mq
FILE NAME Cape Asbestos CAPE
DATE 1934 DOC CAPE009
DOCUMENT DESCRIPTION Journal Article - Pulmonary Asbestosis
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B. WOOD THE LANCET
DRS W.
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S. R. GLOYNE
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PULMONARY ASBESTOSIS
DEC
_~
22/1934
.
Avere asthma continues
'3 weeks and may end
for days fatal exhaustion can always
j be arrested by the method
of
adrenaline
injection whichI
ago The
| needle kept in position with a full
syringe and after
f an initial
{ no unpleasant
known to cause
-1 injected every
more minims are
seconds according to the
!patient's reaction rate being varied until it is
_7 found how frequently
injection can be made
} without tachycardia other symptom arising The
injections are continued if necessary for even half
an hour or more relief always follows and
generally .4 manifests itself by
sleep which may be
the patient falling into a deep
he has had for several
;
the others
tuberculosis
9 females are still alive All have
asbestosis bodies in the sputum
Ten tubercle
male
bacilli and
PULMONARY ASBESTOSIS WITH OBSOLESCENT
TUBERCULOSIS
.
Nine cases 4 males 5 females This
the
fact
that
obsolescent
tuberculosis
group emphasises
is
reactivated by asbestosis Three
not necessarily
1 male 2 females
cases have been fatal of those still under observation
a2nfdehmeaalleesd have radiograms exhibiting typical asbestosis
apical tuberculosis with asbestosis bodies in
the sputumn and 4 cases 3 males 1 female have asbes-
tosis bodies present in the sputum and
radiograms showing
as to asbestosis
.
IV.DOUBTFUL CASES
Abitual days Abitual
use
Anaphylaxis can also for use in =
itions In
than of asthma =!
is given such
er attack 3
paroxysm | paroxysm
paroxysm ;
by this method of
be most
efficiently
efficiently treated
injecting adrenaline which is far
1 more effective
occasional injections of larger
doses If adrenaline always at hand when
J
a
patient is given serum or other treatment which
cause anaphylactic reaction the latter should
rever prove fatal .
sputum Seventeen
tion All
cases
6
males
11
females
under observa-
but the but one have suggestive symptoms and signs
radiograms are indeterminate and with two
exceptions the sputum where available contains
asbestosis bodies Of these
no
exceptions one has indefinite
symptoms signs of emphysema and a negative radio-
gram but asbestosis bodies are present the other has
bnuotphhayssiacsablesstiogsnissobrosdiyemsptinomtsheand a negative radiogram
;
xysm the
THE CLINICAL PICTURE
PULMONARY he sympa #
ASBESTOSIS
The picture of pulmonary asbestosis is that of
-
REVIEW ONE overcome :
:
OF
ONE
HUNDRED CASES
a
pneumonoconiosis occurring in a factory in which
1 ^ paralyse
BY W. BURTON WOOD M.D. Camb M.R.C.P. Lond
few precautions had been taken to protect the workers
from a danger the gravity of which was
ulates the inhala |
D.P.H.
Happily these conditions are now a thniontg reoaflitsheed
ramonium THE ESSEX y CONSULTING PHYSICIAN FOR TUBERCULOSIS TO PHYSICIAN
COUNTY
past and elaborate precautions have been taken to
TO PATIENTS
HOSPITAL VICTORIA
protect the workers There is thus good reason to
a PARK AND
believe that the disease is now under
b
S. ROODHOUSE GLOYNE
M.D. Leeds a
D.P.H.
it seems probable that workers
control though
exposed to the dust
old SL s
-
balance
PATHOLOGIST TO THE HOSPITAL
under the old conditions will continue to
themselves for examination for
present
some time to come
ivantage |
DURING the last few years we have from
There is no need to amplify the descriptions of
onstantly
* The to inject
** time reported the result of our observationstiofmethteo effects of the inhalation of
pulmonary asbestosis already given elsewhere
symptoms.are indeed those common to all forms of
t the first
excavation S > aborted
: patients
asbestos dust as seen in
:
attending a chest hospital or revealed at
autopsy Our studies
pulmonary fibrosis uncomplicated by bronchial dilatation or pulmonary
cough at though
and a
commenced in the year 1928 with little expectoration discomfort
..
he had to
preliminary paper dealing principally with
radiographic
the chest occasionally perhaps a streoark doufllblpoaoind in
ion at the us in the
appearances was published by one of the phlegm and dyspnoea It is this last
in
es rise to
caused by
following year In 1930 we reported our findings in a series of 37 asbestos workers who had
been examined
of which the patient complains
symptom The distress
sioned by constant breathlessness is so
occa-
ent prefer
had the
at Victoria Park As we now have
the
disease
might
almost
be
great that described
- does not
opportunity of studying 100 cases the time symptomatic It is the
as mono-
langer of
seems opportune for a brief survey of the whole plaint In the earlier
patient's first and last com-
group stages dyspnoea is only
apparent cases the
during exertion- found I could not
morning - ciency in
ANALYSIS OF CASES
work in the
the later
hurry to
groups prepara
Our cases may be divided into four chief
of undressing or even the effort
stages the act
So repro
PULMONARY ASBESTOSIS
may cause the patient to pant rfeoqruibrreedatfhor sWpheeecnh
occasions
three cases 19 males 34 females 12 deaths asbestosis is complicated by tuberculosis broncho-
adiriqual adiriqual
4 males 8 females including 2 with carcinoma of the pneumonia or other thoracic disease the
pleura Ander the
lung and 1 with a few deposits of growth in the
of these will be added but the dyspnoea ofsymptoms
emotious
the cases still alive and observation diagnosis noconiosis can still as a rule be
pneumo-
secretion ases the
rests (
upon
a
typical
appearances
of
the
radiogram
symptoms and physical signs of fibrosis and c presence
nutrition is
recognised Mal
very evident in the terminal months
when the patient may pass into
f adrena
of asbestosis bodies in the sputum These three diagnostic cacheria
a condition of extreme
me when
points are arranged in order of merit Twenty cases
namation
18 males 15 females were positive on all three
DIAGNOSIS
drenaline
all
females
had
positive
radiograms
and
counts clinical
toms and signs but no sputum was availablseymp
When a new salient features
disease is are first
under
consideration
the
d males
Available no asbestosis bodies were found 9
if
depends on the
observed and diagnosis
modimite modimite
modimite
bodies females gave positive clinical
bodies were present in the
signs
but
and
5 males asbestosis
Thus
phthisis
recognition of gross symptoms
was formerly only diagnosed when
ther not available
sputum
radiograms were symptoms and signs of advanced disease
26
isease : 1 male haodr failed to show definite evidence of
We now
were evident
diagnose incipient phthisis with
ring
eau
a positive radiogram and asbestosis odies in the sputum but
at a stage when the patient is
confidence
no clinical signs or symptoms
well
healthy in appearance
PULMONARY of seven
ASBESTOSIS WITH
nourished and
In the
little
troubled
by
symptoms
le
ACTIVE TUBERCULOSIS
diagnosis of asbestosis we have still to
Twenty in which
males 8
cases 4 males 17 females of these 11 upon the symptoms and signs of more
depend
less
tuberculous disease females were fatal One had a
We have
or
gross
prema one a propneumothorax and lardaceous disease during life the
no means adequate to discover
existence of the finer degrees of
coe
sem: kT, SE
settye
ae Feee ee
El we
oe
n
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LA tee re
wenoean ae anBA
oe
ty
ahd
e r bay Tons
gta mih eaerea
ee
owt
amt
lt
ahirt vipse
bee
eeed
ee
TA
te
laevis
eee
singh
.
.
5
shea
ie
ee eae
amnte ?ve
he 6 tay oe
VO
ate me asetle desee
er
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ee tat oe
en
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why
wore, stewOTE
Sone
FoR,Oo eat nan
TES
1334 THE LANCET
DRS W. B. WOOD AND S. R. GLOYNE PULMONARY ASBESTOSIS
DEC 22 1934
pulmonaryfibrosis which ments and it is
must precede graver develop-
not surprising that the pathologist
certainly often nsootmetimes discovers mortem evidence of fibrosis
recognised during life
In diagnosis at the present time we have to
rely on a history of exposure to asbestos dust
incompatible starting point The
as our
patient
symptoms described by the
may supply a clue for the malingerer does
not as a rule emphasise dyspnoea as his chief dis-
ability In the physical examination the patient's
aadpvpeaanrcaendce cassehsoultdhe receive special attention In
character of the
clipsomplexion and a slight violet tinge in cheeks or
suggestive but
The physical signs supply
those of
never conclusive evidence They are
a basal fibrosis and the fine nature of the
scarring is
seen dust did not avail to check the
nna
This is
spread of disease
true but we have now
patients whose condition appears to have remained
e stvaetniosnearriyoussince stopping work in the factory That
damage to the lungs is not
with many years of tolerably comfortable
is proved by such an
existence
still
example as that of patient
at a factory when nearly 40 years
duties
dust had caused a fibrosis
exposure to the
involving all except the
a female patient at the
We recently examined
who after a
request of Dr. C. McShane
period of two and a half years employ
THE
mono
follow Tul
dealin 10 ca
monar HOW I
100 2
ever -
centag the inc mostly
to seek tion at of the
indicated by fine dry crackles
mentar
of emphysematous lungs More superficial crackles
produced by the movements of a
are often mingled with the fibrotic damaged pleura service did not entitle her to
r^les
.. The radiographic picture is that of
fine type affecting the lower
a fibrosis of
herself
as
fairly
compensation described comfortable and
to perform her household
she was still able
duties
fields the
thirds of the lung obvious that
It is none the less
;
scarring is as it were etched in
may be drawn to a difficulty constantly encAotutnetnetrieodn
fibrosis
or
any in
patient
who
betrays
symptoms
of
whom any evidence of fibrosis is dis-
when a delineation of the basal portions of the
covered whether by physical or radiological examina
is required The diaphragmatic shadow
lungs
tion should at once cease
working in
bases of the lungs and in a radiogram tceankseonrs the occupation A quiet life preferably in thaeny dusty
the ordinary posterior
with
two inches of the
technique as much as
lung may be blotted out
and avoidance of the risk not only of dust inchoaluanttiroyn
but of catarrhal infection provides the best
extent of this silent area can be
The guards against an aggravation of
safe-
a pneumonia the normal lung by
demonstrated in lipiodol injection the
which will surprise those
result of
Septic bronchitis monary tuberculosis are the
incipient diseasa and pul-
diaphragmatic area acctuhsetomed to regard the complications of the disease commonest terminal
a lateral view of the
as
lung base Again
thickened or if the lmuindgdlief tlhoebeintiserlobar septum is
COMMENTS
Occupation result
of
for
example
an
opaque
epituberculous
as
the
shows that the lower margin of the
exudate
factors
elaborate analysis of occupational
the lower portion of the
middle of
right upper corre-
sponds approximately with the shadow of the
of the diaphragm At a recent
cupola
meeting of the
the following departments : spinning 24 weaving 5
mattress making 9 carding and
R^ntgenSociety Dr. L. A. Rowden pointed out that
a
miscellaneous or
opening 11 and
obtmaoir need extended view of the lung bases can be began their emplouynmsetantted 18. Twenty of them
by the simple expedient of
patient in the dorsal position and
placing the
centring the tube
is
before the age of 18 which
now no longer permitted under Home Office
tions The shortest
reguls-
over the brow We
verified its efficacy
have
tried
this
method
and
cases and the longestex1p5osyueraerswas six months . two
The exact diagnostic significance
The 33 men came under
bodies in the sputum is doubtful
of asbestosis thirds of them were
As pointed out by one of us S. R. G. the formation of an asbestosis
factory of jobs
body is evidence of tissue change We cannot
Adetiy assume however that the expectoration of a few aged 18 whose
asbestosis bodies implies that pulmonary fibrosis has already occurred If we could make this
employment
spare had
time
during
two
and
a
half
years
been spent in mixing powdered
the problems of diagnosis and claims
assumption asbestos in an open yard a middle boiler
tion would be simple Nevertheless for compensa-
who had served his
riveter
apprenticeship as a youth in
will sometimes sections where
the microscope
reveal commencing fibrosis in lung
mortem radiograms failed
shop where asbestos was used for
a
a man who had been
lagging pipes and
employed handling asbestos
reveal evidence of disease present available do not
to
The clinical methods at
mattresses in the open air at an
the men the shortest
aerodrome
exposure was 11
Among
incipient disease
The
enable us to
asbestosis body
determine is simply
integrating department and the lonmgoenstthsabdoiust-
40 years clerical and
evidence of exposure to asbestos dust and of tissue the
administrative work Four of
reaction thereto
This tissue
of 18group began their employment under the age
PROGNOSIS
as Aa s ctlhienicdailsease has only been recently recognised may require entity our present ideas on prognosis
modification In a previous article we
stated that the cessation of exposurteo asbestos
Macroscopically Histologically alveosar Pathology addition to the
above 10 mortem
autopsies mentioned
examinations have been made
by one of us S. R.
) of cases we had not seen
idnucrliundgedlifein 3 males 7 females but these are not
our 100 cases
fibrosis is best seen in the lower
the
pleura is
lobes and adherent
not
very common been
but silicotic
nodules have
encountered
begins in the
the disease
respiratory bronchioles and
ducts and is characterised by a cellular reaction of
whatev in asbe silicosis
subject subject Comp
monary
criosis to the a of spont and app may hav
bulle
We ar for perm
For a its beari exhausti
1. Gloyne 2. Food 3. Merewe
and
SURGI
COLO
BY A.
ASSISTANT :
OF ME SUB
MANY apart fro alitis anc
as well as
group the abdomens
laparotom
however
display a Neoplas
ulous dise paper wh from abdo
important
associated untative d proportions
misleading
predivertici
Surgess et
May 3rd 1934
E LANCET
MR A. L. D'ABREU SURGICAL
ASPECTS OF THE SPASTIC COLON
DEC 1934 1335
.380 seen
=
-
ence ence
sient the the
ized
ized
105
enty
ures
of
dies
But
of
bed
mononuclear phagocytes and asbestosis giant cells
followed by the formation of a reticular fibrosis.,,
|Tuberculosis and Asbestosis a previous article *
aling with tuberculosis and asbestosis we recorded
cases of active tuberculosis in 57 cases of
pul ~, Lonary asbestosis 17.5 per cent The figures have
1now reached 21 cases of active tuberculosis out of
100 21 per cent It must be borne in mind how
ever that these figures do not indicate the
centage of cases of asbestosis with tuberculosispeirn
the industry
{
We have been dealing with a group
mostly from one factory who were sufficiently ill
to seek advice at hospital In discussing this ques-
tion
i
at
length
MerewetherMerewether
considers
after
a
review
of the |
whole
industry
that
the
data
are
too
frag-
mentary to be dogmatic at the moment but that
{whatever the added risk of tuberculosis
be
in asbestosis it is less than that
may
.
associated with
1 alicosis We hope to publish our material on this
ci subject at a later date
able less of dis
nina
usty ztry,
ation
j Complications from pneumonia and pul-
=; monary sepsis and complications arising from tubercalosis there have been none definitely attributable to the asbestosis with the exception of two instances
of spontaneous pneumothorax diagnosed by X ray and apparently unassociated with tuberculosis which may have been due to the rupture of emphysematous
bull^
Safe
pal
cinal
< We are indebted to our colleagues at Victoria Park 3} for permission to quote certain cases seen by them
For a full account of pulmonary asbestosis in all =, is bearings the reader is referred to Dr. Merewether's
exhaustive paper.
z
REFERENCES
ional
' ional a d mw
1
-**
Gloyne S. Roodhouse : Tubercle 1933 xiv 445 493 Wood W. B. and Gloyne 8. .: THE LANCET 1931 Mearnedw1e5th2er E. R. .: Tubercle 1933-34 IV
.
and 550 U. 954
69 109
radiological interest an attempt will be made to
establish spasm as an important ^tiological factor
the formation of diverticula in the colon The
administration disquieting thought that surgery apart from dealing
with complications such as obstruction perforation
abscess formation and fistulous
only oners a dangerous operation cfoormmtuhneiccautrieonosf
colon diverticulitis makes investigation of the earlier
prediverticular state of tremendous importance
Advances the knowledge of the etiology map
enable effective medical treatment to be
If spasm be an important factor the administration
of belladonna
in suspect prediverticular states will
value as a prophylactic measure
SPASTIC COLON
Spastic color Stacey Wilson Tonic Hardening
contracted colon
have grouped into
is a recognised entity
first drew attention to it in his book
Hardening of the Colon 1 a tender hard may be palpated in patients I
three classesclasses
pylorospasm pylorospasm a The commonest sufferer is described
Hardy *
as
being
the
emotionally
by
unstable type
of
individual whose colon is unstable also Often the
patient is a nervous female thin and unhappy
perennially dyspeptic ailing and constipated through
whose thin abdomen the racing aorta and a hard
tender colon can be parpated with ease Radiological
and biochemical examination discover an active
tonic stomach with
and hyperchlorhydria
I have no evidence nor do I think that these patients
proceed to diverticular
formation
are They
frequently met with in the surgical patient room it is no place for them and they repay surgery with groans and a constantly increasing increasing list of symptoms More than one has undergone pyloroplasty many appendicectomy without least relief of their dyspepsia
2.5
,
and SURGICAL ASPECTS OF THE SPASTIC
-
bich
Juls 3
COLON AND THE PREDIVERTICULAR
STATE
this It is important to remember remember
class of patient
when investigating cases of pylorospasm Cannon
and Murphy have produced pylorospasm by
traumatising intestines and
have declared its
occurrence in these circumstances
150
4
L. D'ABREU M.B. Birm F.R.C.S.
Same
riety 1%
wbo +3
BURGICAL
REGISTRAR THE GENERAL HOSPITAL BIRMINGHAM
HOSPITAL
bor cars
tered
veter
in
a
and
sto
nong bout
of
acn
onal
Madr
met
11-
nat
Haye
MANY patients suffering from colon dysfunction
ipart from proved examples of carcinoma divertic
litis and ulcerative are admitted to surgical
well medical wards for investigation investigation Of this
Toup the majority are discharged with intact
bdomens and uneasy minds others undergo fruitless
aparotomy under general n^sthesia; a minority
Cowever operated under spinal anesthesia isplay a fascinating important living pathology
Neoplastic ulcerative and fully developed divertic-
Nous diseases of the colon have no place in this
per which concerns a group of cases suffering
Tom abdominal pain mainly left hided but with
Sportant references to other areas and sometimes
... sociated
with blood and mucus the stools
itative diarrhoea and constipation occur in equal
pportions Dyspepsia is often an important and
Eleading symptom Concentrating mainly
diverticular conditions until recently
on those mainly of
-
Based on a short paper read before the
of
Association cons of Great
. -5 3rd 1934
Britain
and
Ireland
at
Birmingham
on
+
visceral reflex treatment combined
medicine containing
Clinically suitable general
administration of
belladonna . the tincture of iron
hyoscyamus the perchloride of
improvement
often leads to great
iron and of mercury
young b Occasionally spastic colon occurs in the
athletic man who
suffers from
may be a prominent feature
constipation pain
and
may lead to
operation for supposed acute abdominal
No abnormality is seen other than conditions
enterospasm
generalised
c Far different is the last group represented by
the rather fat aged man muscular athletic
in his younger sane and sanguine in outlook
but worried by an alteration in his bowel habit and
because his ample meals formerly enjoyed with
; relish cause indigestion and discomfort requently
defecations
unsatisfactory and irregular requntly Smail
icnotleornnalish^temnodrerrhoainddsofhtaenrddeveRleocptaalnd the descending
examination is
more painful than usual but once the has been passed the rectum itself is normsaplinncW teer
will consider later that the important in
pathological change
in the
these cases lies in the muscle layer and mucous membrane mucus and blood
therefore not always present The meal
all cases so far investigated shows
Not aTO
cos
hyperchlor hydria
barium
Outline in the radiological picture of the
enema as in the clinical picture is indecisive
e
e eee
dite
cb
Kh
fet
e
ae
.
Be