Document DGoJ1rmnnELkMyeeEbgzyQo6o

Fo'uic y.edica Vol XXXIX No 5 pp 52S-559 Naples, June 1936 Pulmonary Diseases Caused by Dust Among Dockworkers by Prof F. rtolfino and Dr D. Zannin! ' of the Institute of Occupational Medicine of the University of Genoa (Director: Prof F. Molfino) Pulmonary diseases due to dust indubitably constitute one of the most interesting aspects, although not yet well known, of the occupational pathology of dockworkers. Symptoms of pneumoconiosis may be observed both in those employed in the operations of the commercial branch and in those of the industrial branch. The former are more characterized by diseases attributable to the effect'of coal dust or cereal dusts, while the latter suffer from more complex pulmonary alter ations which are more difficult to interpret and are often due to the effect of mixed dusts. For a long time there have been reports of the presence among workers employed in loading and unloading coal of pneumoconiotic alterations clinically characterized by symptomatic picutres of emphysema, developing, usually slowly, into manifestations of more or less marked respiratory insufficiency. Radiological examination generally reveals a more or less pronounced ac centuation of the outline of the lungs, a fine veining, which at the points of intersection of the reticulation may sometimes assume a pseudonodular aspect, while in occasional cases, as is also shown by out observations which we shall illustrate below, may be true and characteristic nodular formations scattered over the whole area, but with special intensity in the middle and loweT fields. The hila appear enlarged, and signs of emphysema are observed, for the most part of marginal and basal localization, more or less accentuated depend ing on the stage of evolution of the disease. The radiological examination also usually brings out an enlargement of the entire projection of the heart, interpretable at least in part as laborer's heart, but in the more advanced and serious forms sometimes assuming aspects of more clearly pathological significance, with emergence of signs of obvious involvement of the right half. These cases are naturally accompanied by radio logical indications of chronic pulmonary stasis. ' According to Heppleston the anthracotic lesions, consisting solely of masses of free or phagocyticed particles of carbon and of a fibrillar network that becomes surrounded with emphysema, axe originally focal and remain so for most of the course of the illness. That is in accord, by the way, with our present knowledge, for it has still not been possible to demonstrate the presence, in the coal dusts that are shipped by sea, the presence of free silica in sufficient quantity to account for a sclerogenic activity in a silicotigenic sense. . There are certain interesting clinico-statistic studies which, while they do not bring out elements such as would permit us to Tecognize the exist ence of an anthracotic picture understood as a specific, independent occupa tional disease, do demonstrate in dockworkers exposed to inhalation of coaldust a heightened percentage of maladies affecting the respiratory tract. Of course, the adoption of mechanical equipment which is constantly expanding in all ports, has in recent years more or-less markedly reduced the direct exposure to the effect of these dusts, thus also contributing to reduce the number of work men subjected to that effect. This being so, let us recall that Caso in 1930, in a study of 450 Naples dockworkers engaged in unloading coal, observed that 325 of them exhibited disorders of the respiratory apparatus, representing chronic bronchitis, dry pleuritis and corticopleuritis, pulmonary emphysema, and chronic interstitial pneumonia. With regard to the port of Genoa, we have been able to study and evaluate for clinical purposes the clinical and radiological statistical data extracted from the personnel files of 341 workers of the coal industry which we were kindly allowed to peruse by the Cassa Generale per la Mutualita fra i Lavoratori Portuali (Dockworkers' General Mutual Fund). Among-those with less than 10 years on the job, the alterations affecting the respiratory apparatus are found to be relatively few in number and of scant clinical and radiological significance, while among those with more than 20 2 years, respiratory diseases, represented essentially by chronic bronchitis and by emphysema with or without patent symptoms of respiratory insufficiency, are more frequent, until among those exposed for more than 50 years they amount to 32.1% (overall average 25.5%). . Kwt. 1. In a remarkable percentage of cases, especially among those exposed for more than 20 years, radiological examinations showed an accentuation of the hila and of the fibrosis (27%); in 8 cases, all of them workers with more than 20 years on the job and over 45 years of age, it was possible to see nodular formations aoTe or less diffusely scattered, especially in the lower and middle fields, while the apices were relatively clear. In one of them the formation of such nodules appeared more obvious and was accompanied by a noticeable en largement of the hila, not to mention a high-grade emphysema (Figure 1). It has not been possible to obtain later specimens from the set examined for the pur pose of a more precise interpretation of these radiological pictures. In the present stage of our knowledge it seems that inhalation of pure carbon in the form of dust cannot provoke sclerosis, but only the cramming, by the particles inhaled, of the lymphatic vessels and the lymph nodes. We there fore have no basis for interpreting these pictures as sclerogenic pneumoconiosis, but we do not wish to undervalue their importance; indeed, the admittedly slow 3 evolution of the concomitant bronchitic and emphysematous alterations can lead, aided by other occupational and non-occupational influences, to pictures of cardiorespiratory insufficiency that are sometimes of great seriousness. In conclusion, we consider that we can subscribe to Castellino's state ment that anthracosis appears to be more a constituent of the basic substrate for the development of serious troubles than an independent occupational condi tion, more a working condition than a cause of virulence. With regard to associated diseases, our observations would seem to point up an association with forms of tuberculosis in the phase of "suspected activ ity" (on this point, too, we have been unable to obtain the information needed for a more thorough investigation of the problem) in 3.8% of the cases examined --a higher percentage than was found by Vigliani in a very large survey of workers employed in Italian dust-generating industries (0*8%). But it should be noted that comparative evaluations on this subject cannot be formulated except with extreme caution, in view of the relatively restricted number of cases con sidered by us. This relatively greater incidence of tuberculosis seems to confirm Casteilino's statement that "the frequency of Koch-positive findings among these workers (always high) has become still higher in the last few years, so that not only for the sake of protection 'and indemnity measures, but also as a measure of the specific dangerousness of the occupation, it is time for the correlation between anthracosis and tuberculosis to be clarified." We,, too, agree in considering that this particular problem still needs to be probed more deeply with further studies and observations, while at the same time bearing in mind the greater incidence of tuberculosis found during the immediate postwar period, the time to which the above observations of the late authority refer. We feel that we should call attention to the remarkable incidence of pneumonia in our case material. A good 50 of these workers had suffered from pneumonia, some of them repeatedly (overall percentage 14.6%). Such a percent age is.considerably higher than that in other categories of workers. Let us recall as an example that Parodi, in a study of 468 arc welders and 113 autoge nous welders in a big navy yard, found considerably lower percentages (5.73% for the electrical welders and 6% for the autogenous welders). 4- In the interpretation of these findings we feel that it is impossible not to attribute significance to the modifications induced in the respiratory appa ratus by the inhalation of coal dust, while not underestimating the influence of other agents, such as meteorological influences, to which these workers are particularly exposed. These last obviously should be bone in mind in' interpret ing other clinical symptoms. lastly, let us recall that a very rare and singular association of dis eases has been discussed .by Pezzali: a secondary penicilliosis of the lung as sociated with anthracosis, observed in a dockvorker who unloaded coal at the port of Genoa. Dockworkers of some special categories are exposed to inhalation of cereal dusts. The pathological effects of these dusts may be summarized as follows: There are both acute and chronic clinical pictures attributable to the well-known nonspecific irritant effect that these dusts possess. Hie acute forms, generally pi^voked by massive and sufficiently protracted inhalation of dusts, are characterized by larvngotracheobronchitis of a spastic nature, accompanied by an irritative.dry cough that sometimes leads to vomiting, followed by emission of a scanty mucous expectoration sometimes streaked with blood, a retrosternal burning sensation, and dysphonia; these symptoms tend to retrogress rapidly and leave no aftereffects worth mentioning, unless further _ exposures condition the emergence of the picture of chronic bronchopneumonia. This chronic bronchopneumonia may arise directly or be preceded by symp toms of an acute character, and is characterized by coughing with an expectora tion that is scanty at the beginning and later more abundant and mucopurulent (in which it is possible to demonstrate the presence of the dusts themselves), dyspnea under exertion, chest pains, and general asthenia. The later course of the disease may show a progressive accentuation of the functional respiratory manifestations, with the development of an asthmatic state and additional dyspneic symptoms. "In the initial forms, radiological examination shows an accentuation of the hila and of the vasculo-bronchial network which becomes more and more evi dent as the disease progresses, while more or less pronounced signs of marginal and basal emphysema appear. In some cases scatterings of nodular shadows have also been noted, in the genesis of which some recognize the importance of 5 free silica, which nay be found in the dusts themselves, albeit in rather small amounts. In some of the more serious cases these shadows have shown a tendency to confluence; in one of them, illustrated by Doerr, it was possible in the autopsy to establish the presence of crystalline and amorphous siliceous dusts around the sclerotic nodules and in the center of then. These observations thus seen to show that, although only exceptionally, in some cases there can be alterations that are reminiscent of those of sili cosis. . * Among the symptoms provoked by inhaling cereal dusts should be mentioned the so-called ''grain fever," in the genesis of which phenomena of an allergic nature are undoubtedly important (cf., for example, the well-known fact of the appearance of such symptoms upon return to work after the weekend or after periods of inactivity). Grain fever is characterised by a fever lasting 2 or 3 days, accompanied by intense dyspnea, nauseating coughs with scanty expectora tion, dizziness, and asthenia. Such attacks may recur and give rise to a pic ture of chronic bronchitis with dyspnea under exertion (Stage I), which may then acquire a certain seriousness and accompanied by clear symptoms of respira tory insufficiency with cyanosis and permanent dyspnea (Stage II). A third stage, although of doubtful observation, is said to be characterized by peri bronchial fibrosis with atelectasis and emphysema (Stephanopoli De Comnene and Besson). Lastly, .let u* record the possibility of pulmonary mycotic symptoms of bronchopneumonic type with the presence of the characteristic fungi (aspergilli, penicilli, etc.') in tne 'sputum. Other pneumoconiotic symptoms, which, however, do not assume any particu lar seriousness and exhibit no distinctive characteristics, have been observed, although rarely, in workers habitually employed in ports specializing in the movement of metallic and nonmetallic minerals and of other products, vegetable (tobacco, cotton, jute, paper, copra, etc.), animal (wool, hides, bone, horn, etc.), or artificial (cement, lime, gypsum, etc.). ** * Workers in the industrial branch, too, may be subject to pneumoconiotic symptoms. This is a field of occupational pathology that is still under study and until a few years ago was completely ignored, but one to which we mean to c call particular attention. _ Until a few years ago', for example, the existence of asbestos pneumoco niosis among docxworkers engaged in installing non-conducting material was abso lutely unsuspected. It was not until 1946 that Fleischer, Wiles, Gade, and Drinker called attention to the existence of that pneumoconiosis in insulation workers on board ships under construction, demonstrating the existence of typi cal clinical pictures of asbestosis in three workers who had been engaged for over 20 years in installing non-conductors. ' In 1943 other cases of asbestosis in insulation workers employed on ship repairs were reported, some of them in Italy; in a study done on 52 workers, Canepa was able to establish definite asbestosis lesions in varying degTee in S of them, and accentuation of the pulmonary reticulation of minor importance in 20 more. From- 1949 to the present we have been able to observe six more cases of confirmed asbestosis.' Sesides exhibiting the radiological picture peculiar to this pathological condition (Figure^), they also exhibit its clinical picture, with dry diffuse bronchitis, signs of emphysema, and symptoms of respiratory in sufficiency. In several of these workers we have also been able to establish the presence of asbestosis bodies in the sputum. ' . 7 The evolution and the course of the disease appeared extremely slow to us in the majority of cases. We believe that this should be attributed to the fact that these subjects were exposed to the inhalation of asbestos dust irregularly and under relatively healthful conditions, at least comparatively, with reference to other industries, especially the manufacturing industries. It should also be mentioned that in numerous cases the characteristic as bestos warts were found, localized especially on the skin of the hands. Pulmonary alterations attributable at least in part to silicosis were ob served by Parodi and Passeri in bricklayers employed in the maintenance or com bustion chambers of steamships. Some 30-odd workers were studied in all, of whoa only 14 had been employed frequently at this specific job for over 20 years. The average age was S3 years and the length of time on the job varied from 40 to 20 years with an overall average of 27.3 years. Taking into consideration the days actually spent on this specific job (avenging one week in the month), it can be maintained that the oldest of them had worked for about 3,200 days at firebox repairs and the youngest for about 1,440 days, corresponding to about 10 and 5 years respectively. ' * Clinical examination revealed*with remarkable frequency a picture of dry bronchitis, characterized objectively by a diffuse roughness of breathing with prolongation of the expiratory phase and diffuse hissing inhalations and exhala tions. Radiographic examination of the thorax showed a reticular type of accen tuation of the pulmonary network in seven cases, and in three, in addition to that picture, the beginning of a micronodular type as well. Pulmonary alterations of a pneumonoconiotic character have been described in workmen employed in cleaning boilers and removing the incrustations and de posits formed by the residues of combustion of oil. But it must be remembered that these workmen, and especially the boiler cleaners, are, as has been said, also exposed to inhalation of dusts deriving fTom the removal of the deposits produced on the inner surface of boilers and on the inner and outer surfaces of pipes by the water contained in them. To sum up the results of our observations, we may say that in the cases examined, dry, diffuse bronchitis is found to exist with a certain frequency. The clinical picture is reminiscent of the bronchitis of asthmatics in the 8 prevalence of dyspneic symptoms and in some particulars of the objective find ings, such as the prolongation of the expiratory phase and the existence of dry rales especially pronounced in expiration. In these cases, unlike most pneumo conioses, the evidence of the objective clinical report is in contrast to the tenuousness of the chest X-ray findings. The alterations are represented by accentuation of the hila, reinforcement of the outline of the lungs, and some times scattered nodular images (Figure 3). I'itt. >. In these workmen, Dunner et al. and Harding et al. also observed clinical pictures essentially represented by chronic bronchitis with emphysema, and in the radiological examination thickening of the pulmonary network, sometimes as sociated with scattered or diffuse, sometimes confluent nodular formations. In one case illustrated by Harding et al., the post mortem examination revealed that these nodules appeared devoid of consistency, being represented by accumulations of blackish substance surrounded by emphysematous tones with signs of collagenous fibrosis. There has been much discussion of the clinicoanatomical significance of these 'findings; in the present state of our knowledge, however, it seems that they should be interpreted rather as an expression of nonspecific pneumoconiosis. Electric welders, too, under the peculiar environmental conditions that 9 frequently prevail in work on board ship, nay encounter pneuaoconiotic symptoms. Many authors have called attention to the fact that electric welders, particularly when they work under unfavorable environmental conditions, are sub jected to the inhalation of particles which possess the properties of aerosols and hence are capable of penetrating into the finest bronchial ramifications. In view of these statements, what Doig and MacLauglin, in 1936, were the first to observe came as no surprise-: in chest X-rays of 16 welders, who had suffered no disturbances and were working normally, they found diffuse micronodulation in 6. The characteristics of the radiological picture and the uni formity of the findings clearly indicated the pneumoconiotic nature of the ob served alterations. Subsequently,' in 1938, Enter and Sander published the results of their clinical, radiological, and pathoanatomical observations, which contributed greatly to clarifying various aspects of this problem. In one case they found in the post mortem examination a fine black pig mentation throughout the parenchymaaef the lungs without traces of fibrosis or of fibrotic nodulation, and lymph nodes crammed with fine black pigment but with no fibrosis or calcification. Histological examination of the lungs and the lymph nodes showed a deposit of inert pigment, with extremely low silica content, distributed uniformly. The presence of this pigment had not provoked reactive phenomena of the bronchitic type nor obstruction of the lymphatic vessels. Ac cording to Enter and Sander, the micronodular image visible in the X-ray is due to the deposit of iron in the perivascular lymphatics. In a more recent study these authors affinn that such pneumoconiosis does not cause detectable changes in the respiratory function and is subject to re gression. In Italy, PecoTa, examining 55 electric welders, found signs of chronic bronchial catarrh in 9 and a very slight accentuation of the pulmonary network in the radiological examination of one. Our clinical and radiological research, in collaboration with Passeri, has to do with 32 subjects, electric welders on board vessels being repaired and fitted out, who worked for the most part in confined spaces for a minimum of 9 and a maximum of 24 years. 10 In anamnesis, relatively frequently the bouts of fever due to metallic inhalations showed up on the occasion of work on zinc-plated material. Objec tive finding: poor breathing, represented by diffuse rough breathing with dry bronchial rales. From the radiological point of view, 22 cases showed no modi fication of the pulmonary transparency nor alterations of the pulmonary network or of the hila. In six cases a slight accentuation of the network of the areo lar type was observed, localised predominantly in the basal areas. In two, after 20 and IS years' work respectively, there was a more marked accentuation of the network, with scattered micronodular formations in a peri bronchial arrangement, localised predominantly at the bases; the hilar shadows were moderately accentuated without signs of adenopathy. But 2 other cases ex hibited a very marked micTonodulation (Figure 4). 3 i 1 - The first of these, who had worked about 12 years, exhibited a diffuse nodulction throughout the area except for the apices, with a tendency to greater density in the parietal portion. The nodules were almost uniform in sise but of varying opacity. There were also small emphysematous formations of the cystic type distributed uniformly. The pulmonary network and the hila were visibly accentuated. ~ The second, who was also studied stratigraphies!ly, exhibited a less 11 narked nodulation, both, as to the number and as to the size of the single ele ments, which were predominantly in the basal areas, while the apices and the upper part of the middle areas were unaffected. The analytical report showed a greater condensation peripherally and toward the middle strata (up to 10 cm from the dorsal plane), moderate accentuation of the linear fibeT, and the presence of small emphysematous zones of the cystic type. Only where the nodu lar component was relatively dense, at the left hilum, did formations appear that were attributable to adenopathy, and they were not very marked. To sum up the results of our .observations, we may say that the radiologi cal findings generally came out rather scanty and classifiable in three basic types: a) accentuation of the pulmonary network without particular significance (all authors agTee in saying that in the majority of cases this is the only radiological showing); b) accentuation of the network with an areolar appearance most marked in the middle and basal fields, with scattered dots interpretable as overlapping pseudonodules (even this picture is rather attenuated and atypical in its appearance); and c) nodular pattern, which runs from a discrete micro- nodulation to a moTe accentuated, diffuse nodulation, which does not appear to amount to evidence of certain forms silicosis in which the accentuation of the network appears more pronounced. In conclusion we feel that we can affirm that in electric welders chest X-ray pictures nay be observed which axe characterized in the more marked cases by dissemination of micronodulax shadows with reinforcement of the hilum and of the network (without zones of confluence); that such radiological pictures, in the light of present knowledge of the composition of smokes and in view of the scanty histopathological findings, rhould be considered, it appears, as the ex pression, at least predominantly, of a siderotic process; that these forms of pneumoconiosis, insofar as is known to date, although they may condition or at least favor the development of chronic alterations of the respiratory appa ratus (bronchitis, emphysema, etc.) analogous to those observed in other spe cific benign types of pneumoconiosis, do not result in pulmonary sclerosis. lastly, let us reiterate that in the workers of this branch of industry pneumoconiotic alterations of a certain importance are found only among those who have worked a long time in confining environments (caissons, boilers, tanks, compartments of ships, etc.) in relation to the higher concentration of smoke existing in the working environment. 12 * ** We consider that in this clinical note we have shown that pneumoconiotic phenomena varying in nature and in anatomical and clinical significance may be observed in docxworkers under particular conditions and sometimes relatively fre quently* Besides the forms of pneumoconiosis that have been well known for some time now, others are being reported which are specific to the'branch of industry, such as asbestosis, siderosis, .and boiler-scalers' pneumoconiosis, which have been noted only very recently. These findings seem to us to assume particular importance for the reason that they cannot fail to call attention to the necessity of providing, in this particular profile as in others, fox the adoption of more and more extensive and adequate technical and medical preventive measures wherever these may become necessary. BIBLIOGRAPHY- 1. 3alestra, G. and Molfino "Altera2ioni polmonari da polveri'negli operai addetti all'estrasione del vanadi* dalle polveri di aafta" (Pulmonary Altera tions by Dusts in Workmen Engaged in Extraction of Vanadium From Oil Dusts), Rcssecna di Medicina Industrials (Heviev of Industrial Medicine), 19^-2, No 1, P 5. 2. 3ianchi, G., "Contribute alio studio della patologia dell'apparato respira- toriu da. uwlveri vegetal!" (Contribution to the Study of the Pathology of the Pespiratory Apparatus Due to Vegetable Dusts), Rassecna di Medicina Industrie ale.. 1932.. No 2-3, pp 112-199* 3* Caaepa, G., "Csservazioai introduttive alio studio dell'asbestos! nei lavoratori portuali di Genova" (Introductory Observations on the Study of Asbestosis Among the Dockvorkers of Genoa), Lavoro e Medicina (Work and Medicine), IShSr, No 3, p 18. k. Caso G., "Le zcalattie respiratorie degli scaricanti del car'oone del Porno di Napoli" (Hespiratory Diseases of Workers Unloading Coal at the Port of Naples), Folia Medica, 1930, No 12. 5. Castelliao, N.,"I1 lavoro aei porti" (Work in the Pores), Ed. Cordani, Milan, 1931. "I lavoratori dei porti" (The Dockvorkers) , in "Atti XV Congr. Na2. 13 Med. Lavero" (Transactions of the Fifteenth National Conference on Occupa r tional Medicine), Genoa, 19^9* 6. Doig, A.T. and McLauglin, A._, "X-Ray Appearances of the Lungs of Electric Arc Welders," Lancet, 1936, No 1, p 771* "Clearing of X-Ray Shadovs in Welder's Siderosis," Lancet, 19*48, Mo 1, p 730. 7. D'Onofrio, V. and* Passer! , A*, "Sulle pneumoconiosi dei saldatori ad arco" (Arc Welders' Pneumoconiosis), Rassegna di Medicina Indus triale, 1950, No 6, ? 276. 8. Dunner, L., "Pneumoconiosis and Tuberculosis in Dockers Dealing vith Grain and Seeds," 3ritish Journal of Radiology, 19^1, No 12, p 717. 9. Dunner, L., Sanger Hicks, M., and Bagnal, D.J.T*, "Pneumoconiosis in 3oiler Scalers," British Journal of Tuberculosis and Diseases of the Chest, 1952, No 1, p 1. 10. Franchini, A. and Canepa, G., "Contributo alio studio anatcaopatologico dell'asoestosi polmonare" (Contribution to the pathcanatoaical Study of Asbestosis of the lungs), Medicyvz del Larooro (Industrial Medicine), 19^9, No 6-7, P 161. 11. Harding, H.E. and Massie, A.P., "Pneumoconiosis in Boiler Scalers," 3rtttsn Journal of Industrial Medicine, 1951, No k, p 256. 12. Harding, H.E., McRae Tod, T.L., and McLaughlin, A.I.G., "Pneumoconiosis in a Boiler Scaler," British Journal of Industrial Medicine, 19^7, No 2, p"111. i'i. `i-erca, ?. and Lerza, P., "Contribute alia diagncctica delle pneumopatie dei saldatori ad arco" (Contribution to the Diagnosis of Lung Diseases of Arc Welders), Rassegna di Medicina Indus triale, 1953, No 3, ? 173. lU. Molfino, "Patologia e clinica dei saldatori ad arco" (Pathology and Clinical Picture of Arc Welders), report, "XXV Congr. Naz. Med. Lavoro" (Fourteenth National Conference on Occupational Medicine), Torino, 19^3. "Contributo sperimentale alio studio dell'intossicazione professionals da vanadio" (Experimental Contribution to the Study of Occupational Vanadium Intoxication), Archivio per le Science Mediche (Archives of the Medical Sciences), 1938, No 5, p 278. 15. Parodi, V., "Le affezioni acute e croniohe dell'apparato respiratorio nei 14 saldatari"(Acute and Chronic Diseases of Che Respiratory Apparatus in Weld ers), "'17 Ccngr. Nat. Med. Lavoro," Torino, 19^3. 16. Parodi, 7. and Passeri, A., "Sul rischio silicotigeno nei lavori di ranutenzicne delle cacere di conbustione dei piroscafi" (Pish of Silicosis in Maintenance Work on Conbustioa Chaabers of Stesaships), "XVII Ccngr. Naz. Med. LaT.," Viareggio, 1951. 17. Stephaaopoli De Coanene, J. and Besson, J., "La pneuaoconiose a poussieres de cereales" (Grain Dust Pneusoconiosis), Archives des Maladies Professionmiles (Archives of Occupational Diseases), 1950, No 5, p ^59. 18. Vesce, C.A., "Ricerche sulla funzicnalita cardiovascolare negli scaricanti di nerci nere" (Research on the Cardiovascular Function of Dockers Handling `Coal), Folia'Medica, 19^1* No 9 ? ^15. . * 19. Zannini, D., "Patologia e prevenzione nei lavoratori portuali" (Pathology and Prevention in Dockvorkers), "Atti Conf. I.N.C.A.," Milan, 1952. i certify thot the staff member who translated the - foregoing is thoroughly fcmiliar with th* uT>.- * , and English languages and that it is a true end complete translation of-the ------ document. . . - Franklin W. Carle, President <-guage Service Bureau, !r Ouoant Crcie SuJlding Washington, D.C 20036 IS iaftb Cang^^Pnac^^l^tf'deg.to.Fusy-.-^.''4352.. ..V- ^-^t **ic Health'Admgnmt^>?^q1Tj\ Dao^ aicmily ind'lnftnr V j1254 r aJ2y:-Z2T .;>;:.OccapaL0o*i _ Hypeae iod Tooa- ai/^k*nica iod Epsdeaioiesx ...''2127`^*`^L **y '* ,^,.1160 rectX Pae**^TTv^Atrao*9^ss'B Fofioticd':' "' ..i~.n74~ >-V icreofosn - ..H ftyski^y u Applied to Hygiene ..V 1275 , ii4';;.r.suat' ^-.1176 her Contrmanicafciir Dbeue^-l-dd 2149-ii ' -.Food aad Nuttitice . ... H77 r^nrnrfniaJyi^7frrtfr^.' An>.;" .V 3saerieao*raad Iraaunity .., im- safe- a Mas-- -``"^^^V^^^^wc-ilSv^^'Sdok Reviswi-.,.'.,;; '. ... ..' -i *, -r. * ' ' ?* ,i<. Ter >**^* Caatena> e* jl 3. . * .- .*r.7,... v _ *-s. = J ^ iV^'- ; _ , i' Bureau of Hygiene arid Tropical Diseases, ,, 1J6* nULLKTIX OF HYGIENE Deceniw*- exchidv a probable improvement in tin* urn-eons evrhanw m the limy*. It is advisable* in submitting silicotic patients tu sulphur crenuthcrnpy t> cellmate the vital rapacity and. if this is markedlv reduced, to apply tin* treatment with ran* in order t< prevent undesirable immediate effects. The improvement ill 'he cetierai condition of tiie patients, js well as the local <tlTn-t mi rile lutiys, must be attributed to the action *f tile siilpiuir. h'. .M<dd/*bm Hm\ r.n. m. A: Mrr.f.un. G. Minern]o"isch*> und physikali><-ii**`!iemis,he L'litersuriutnuen an einer Ta{k-Stniiblun*:e und an Talk-H.aur^ranulomen. fMineraJogicai and Physico-Chemical Investiga tion of Taic Pneumoconiosis and Taie Skin Granuloma) Arri,. /. tifirrrhrjmth. . frVircr- M,.rl. 1957. V. IS. No. 5. 440-46. 7 fius. Talc, a hydvnlvd maum-sium sdn-au*. was formerly ,i> harmless. Injf recently this *tjitii*tt hr* I*en revi*e*J. The authors .Je^rriiie a <d separation ami lx:uninanll^ of mineral rcsidut-n from 2 sMirivs : (T) The luitu of a man who had been em ployed for 20 years in a rublier fartory*mixini* and > eviii" talc, kaolin and other mineral substances: radiological exami tint mi had hown oh;uf^- -uu-.itst- ini* silicosis. fie died at the aue of 67; tlte him:* showed massive, diffuse fibrous tliirkcninu. (2) The scar tissue 4 months alter an uperutuitt tor hydro cele in a you til of 17. t'oncentrates of the mineral content of the tissues in each cms* were prepared by ashim; with sulphuric acid, washing ami rviitrifin'iitu ; the white concen trates r'ino.tt*d alnuist soieiy of talc. This was examined by polar-ewopic methods which are very fully descriiwd: the refracrrve indices were those of r.*1:.. The solubility of tab- in wati-r was investigated lv utr uot with idrmul (the dis*siium salt ot ethy- lene-dinmino-tetrancctie acid) as d--cribed lie one of the authors (Mi'iXSU. <J.. A* *e* Jit. fit'll!.. 1956. 3301. Uv tin- method talc can l* dissolved : after 270 hours f sjjrritto. saturation point is rciu-hcd ^iviny ^ value = 0-0013 cm. M<j per 100 rr. water. It is -m-on-ted that m the \ --ues eventually and Si would separate the silica ciunbiriinu to form nrotimc com- jsiumls of silicic m*id and brinutni: aisntr the in jurious act.bin, tai-iv-is thus Wim; simitar to 'ilicosis in it.- linai action. fC. MlMleiuH Imui. G-ivkijxmkvt ok: .Ministry or Lwtoctt. Sili cosis Amongst Hand Drillers in Mica Mining in Pihar. [M- N. Gcpt.x.. j 12 tnimeo>o"aphed pp.. 2 nc>. on 2 pis. 1956. Report No. 12. New 'i)*dlu : Office Of the Chief Adviser Factories, .Ministry of Labour sk Employment. This report uives detaded information on 62 handdriller* drawn from 3 mica mines in Bihar. Of 1.Q1Q mica mine* in India, in 1952. drillinc was done hy hand '.n 329. and with roinpre--ed-Air drills in 1S1 mines. In 1956 hami-dnlUn<* was done without dusttrap- in 74`\. of mien mines. Dust rontnd was not required hy law up to the end of 1952 hut wer drilline is now le-im* enforced and mevhatitcul veutilat'on if recommended in addition. The menu -lost '`ott8S dry and in moist rock drilline' were of the >*' 97 and 21 million particles per cubic foe* (m.p.p.c.f.) respectively. The mam Report Jt -showed that hand-driilers had an averaev fi to dust of 45 m.p.p.o.f. Of tlie 62 hand-driller* -xam'ned 17 f27"*V silicosis; 10 in -faue 1. 5 in -face 2. ami 2 a vunuloniernte stays. There was no correlation t aye and ncibenc* of suicob* but the increased with the number of rear- of uwiff5* work. The 2 patients in the conglomerate worked IS ami 20 years respectively: the l5 ,,fr with silicosis had an average exposure of U The time-intensity factor (number of years and concentration of -lust in in.p.p.e.f.-) hei unrssive increase in frequency rates of sdiro*i v. a rate of 41 is reached in tlie 12 hatnUirnlen* fT* tune*intens tv levels over 800. Active Afte; wa found io 4 of th-- 52 ha mi--iri lives -. -bite*'' irot also piVsent in 2 of the-4. j^ttory J'ltmiar titvesuualions are msa--sary ni mica - i(,l of other states. K. . liae- I.vntA. GoWi.-nmcnt or: Ministry >r L.iitocS. s_*__W___ - cost's Amongst Supervisory Staff in Mica ?neun* in Bihar. [M. N. Gctta.} 6 nnmeocraphei *~C 1955. Report No. 3. New Delhi: Office. "^acrea t'hief Adviser Factories. Min stry ot LeM* Emolovnietit. Tliis i< a detailed account of the health <>f ^2 *"J Iwrw ni i be -npen'isory staff employed die mines. In their underciround work thev wereP^V... to dust, tiiuuirh tti a somewhat less extent tftao "5^^. miners. Tlie ayes of the ^roiip ran^isl from and me periisls of employment trutu L to m f - . The incidence of silicosis incrvas-sl with ace plovniciit ; the earliest evidence of -tilco-is was at- the a^e of 27. and employment of 7 year* .round. After 15 years' work uiideniroinm ^ -limveii radiographic evidence of *iiirM-u>. "t the umup 19 (45-2'>;.) showed siiic<.is ; 12 m 3 in -raue 2. and 4 m rite 'onuic.merate -tare, ** ' iy4fectit?top<'- wen- 8 cares of nii**rcub>s and in all of tii. ^ .'osis wus iii*-1 pveo^ut 4 m -iaue 2 in *' 2 tn the coucbimerate sta<^_ `arctiac mvoirra^, was diaum-*xl in 3 cases. 1 each >if enlarged ^ ? eularwi aorta, ami hypertension. K. L. Miinl!'1'* MoLris.t. F 'k /..iNN'TSt. D. Malatne polmvo^-, da rndvert nvi lavoratori dei oorti. Oiseases due to Dust in Dock Workers] Mr.l. 1956. June. t. 39. No. 6. 525-^S. * (19 refs. ] This i a -tuciy of lunc .li*ei-e5 due to dust dock workers m Genon. Of 341 coai-i*****1 examined. 8. all with more than 20 years' exper-***, of the work, were found to have a varying '*'&* .iis-enunation 0/ nodules, particularly m the \v**\ and tti'd-ile areas. Incidence of susoe*ted *'4*'! uii>evcuU-s\- amunt these workers was 3-oS. ind'-1*1 v.'i. 3$. No. 12 OCCUPATIONAL HYGIENE AND TOXiCOU><*.Y 1 ICO puiinonitJ* wa> also shove average. 11 ease* of ..^-vj5is were found amone workers handling non- \ng material 5 have been described by fjaney* ,od -T the authors during the period L949-56. The .vcviopnient of asbaurtis m these caes was extremely A fairly high proportion of workers in ships' sokvhyids showed diffuse* dry bronchitis, often a>h s*iic \\ type. Of 22 electrical welders on board ships a.in; fitted out or undergoing repairs. 2 hud a very eil-marked pulmonary niicrvmxJnianoti. and 2 a sickening of the root shadows with little noduiatioti. fht-se lesions were probably caused by sidenwis. S. Vigiititti firvos. J. S. Haematite Pneumoconiosis In Cum berland Miners. /. I'lin. Piith. 19S7. Aug., v. 20. No. 3, 187-99. 17fig*. (40 refs.] ' the damaged epithelial ceils* at the edge of the fibrous und they -preml front there t. the iiiium and no* in the reverse direction. Illustrations <ho the sites of tumour* ami the pa rhogenesis i* di.s-used. In 228 necropsies on iron-ore miners, of average a 61 years, there were 24 r;w of c-.-munomu--10\1 com pared with 2-7'T. in miilet, over 30 who wen? not haematite miner*. Lymphadenitis yf hilar gland*, with ulevrntiou info a bronchus is iwcnsimiaJly *een in iron-uv miiierx. 2 *uch ruses are derwril/ed. Measure* taken for dust *u{M>re*.ioi 20 years ago. and carried out- with the active cooperation n( ivitU employers and workers, have brought about ;i r*duc* tion in the abnormal rht--t radiograph*. >>t miner*, with 10-20 years' work utidergvumui. from 20".. io l'o. A*. /.. Mnitih-h.u .i/ter reviewin'; briefly rhe literature on the effects j iron oxide on the lungs the author trace* the .-wry of * 'umbcriaiid ivutt-ore mining from the time j Roman workings. The iron-ore of north-we*tf?.dd i* almost entirely m the form of ferric oxide haematite and exists in large mns*e* in the deep jrfis of the carboniferous limestone at depths .jpryacitim; 1.500 feet. Until the introduction of -.eumatic drilling in 1913 the ore was mined by ujid-chiseJ and blasting; the use of pneumatic drills yrensed the rate of working and the amount of tj*cng so that dense dust clouds were product*!. < {ter 1925 wet 'frilling was introduced but the use of ,*tr was often evaded. investigations becwwn 1912 And 1323 info the morility rates for pulmonary diseases Among the miners -idence of bronchitis ami emphysema, but .jrtJy. rum bronchitis, pneumonia and pulmonary icerrulosis was not outstanding. In 1931-33 the *ih rate for tuberculosis was 70', higher than that- jll males of comparable age, and 3 times that of ,i miners in Staffordshire and A'orkshire. Local itistics also >hoed x high rate for tuberculosis in t haematite mining area. This was attributed to iteuon in ill-ventilated and dusty, mines, a -high yoortion of Irish workers, and mechanization in amc methods. From 1930 onwards cases of silicoeivtih?M> began t be rwognized Hinicaliv and at rvpsy. ?r.*gressive massive fibrosis of haematite miners is sudin*d form of infective pneumoconiosis. which . considered to be tuiwmilous when first descriluHl twuvt and F\CLT>*. this Bulletin, 1934. v. 9, 659] may not he invariably so. In the last 2* years on S3 iron-ore miners *huwed that 30":. died of puiumnary tuberculosis: the author takes new that rhe tuberculosis is a terminal event not cases, the dust in rhe lung? predisposing to -non and to development of the disemu*. A ndn- mcreuse in the amount of silica in the lungs conrrtbutorr factor and the action of iron-ore must also be considered. .ere is an increased incidence of lung rumour* in ore miner*. The striking femur* is the locution if primary tumour at the sites where fibrosis is commonly found. They appear to Arise from (d) * Mi.xistrv *' I.AB*ct i.M) National Setivto:. Oust in Card Rooms. Third interim Report of the Joint Advisory Committee of the Cotton Industry [Blttxnson*. A. t 'huirman]. 30 pp.. 15 pis. 3: 1 graph. 1957. London : J1..U. Statiouerr OJM? [2s. 6d.] ' This report describes an exhaust- *y*ft*m for carding engines devised by the British t.'ott.m Industry Re- *eareh Association at- the Mhirley Institute. Tlie Shirley Institute studied the points on the carding engine from which dust is liberated, ami applied a system of exhaust ventilarion to rhe most important jgurres of the /hist. The cffen of the devil** <u dust coiH-eiitratinns in the atmmphrre of cardr*ni* have Lvn tr-ded under both "laboratory" and '* mill " conditions. M>*t of the dust measurements iver* of the smaller particles of 5u and less, and indicated that the efficiency of the dust extraction was greater for t lie larger par- tilde* than for the Htmiller *uet. Its owraii *ifiiMt*ncy in the particle* of up t> 4 ut *\zt! was aliout 60~. THe few gravimetric nivasuri'menfs ntale >! ,lu.sr con sisting of particle* greater .than 0-2 in/iicati an efficiency of aliottt 75?,,. The t'hief Inspector of Factories reronmiemls that the ivittoM -piiiujng industry should u** this new derive. Ii-'-reins'io !*r easily the be*t .tvaijolde for reducing- in caedruoms and thus preventing bysKtnosis. J{. A. F. Frh tiling W`,vsi. f. A. A. ft 'il. Some instruments and Instru ment Techniques in use at the Safety in Mines Reseatch Establishment. KiM>mii<d from Instru ment V t artier. 1957, .June. 3-16. 32 fig*. [54 refs.] This paper was given .if a i inuVr-niv- *>f the British Oreupanunaf Hygiene .><x-icty uhich wa< devoted to the consideration of instrument* for u?< in >wmpntiotxai hygiene. Tr. <{ecrtue* ;n*trnmenT* u*c*i in tlie *tudy of underground explosion-*, piteiiin'*`ocii'-*i* and mining accidents. Continued propagation of a du*r cxp)*?ston depends on the ability of the bla<t ahead >( the (lame t> ni*e r fx.';N5 I 1 I ^ Giugno 1956 *&&16 1330 r\ IIIU4- '.' LlErU:./ .. \ \IM)[.I (: A \ H D I DUCK V. IIJKi.SnN r 'Tv^iwac in t,b HI 'Ll 1 A A \!\ A. r FOLIA MEDICA ) i*m:iui>uo ])i MKinriw iiki. i.avouo ui mkhiciw \i.k k \s-k.ik\/io\i -ortvi.i \ j i>YmT m vkhu.inn i>n i wnun nn i* t m\rjmtv m <.rv\ \ llrrt'Ourr m**.; Prof, V. \|1I| I1 IN) * MU.VITIK I'Ol.MON\K! I) \ !M >(.\ 1!KI OKI l.u Dli \ rolII OKI I'MIITI l'r.4. I'. MiUKlVt Dr. U /\NMM i.r malallu* jioldioiiart ila pnlwri rivlijiiix-nnn intiulil>t:MiM*Mh* lino iJrjjii [>it< in|rr!'*aati. i*,M>*no aitoora jmro noli*. Jolla ji.il'<lo^ia |>rofv^MnaI* J*i lavnratori jmrUialt. Tallin nridi aJJrtli aJ!r njicrazioni Jol radio coitjinoriMnln <(iiaiilo in <|iiclH JH ramo rialr |u<no iiwmaw manifrla/.ioni jnnni- < iiiocniiioiirlie: pits jiropri Joi priini -otto ni*lri morluoJ. rifoviliili aH*azion<* JH |HiIviM-nln ili i-arliorii* o airazimto <it polvcn vli t*vn*aii. Joi iTiiinli iiinri' ahora/.ioiii pultmiuari jvtu rmploo i* Ji ptn Jiflioilr mlcrprrtazimu*. mm ii ruvWi Jmuto aiTa/dom* ili pnhori Cotm* m o JMD i* -Sala ormai Ja mnlli--Jinn Irmpo >o"na)al.i Ira oporui aJJrUi alio .-li^a^tfio ml alio harm J*l rariionr la jin** onza <li ullrrazioni piirtiimMMmiolioln' rarallorizzalo olinioanuMilr Ja ijiiaiiri di rrotiira brniiohito con onlonia. olio o^ilano. Ji *nlilu Ionia* mould. in IVnnnidni >li id>uilirii`d/a ro-piralmia pin o mnni .ic .-ii;ua(a. I A DVsainr railioJo-'ioo -i rilova id aonori* tina pin n mono < \ ;. arovnlnaziono Jol ili<`^tio polnimtaro. tiua fino itiarozzalnra. '-hr nri I jdidli Ji inorooio Jollo inaalio Jo! rotioolo pun talora ;i*-wtto-ro mi a-pollti [ix'iiiiodmliilart'. iiifiiiro in .-maoli oa*i. otnuo ri*uha .mob via iio*lrr i>or\ a/ioiti olio piu iuuu'i/i illu-irovoum. |ii>-unn o*or\i \.r. o jimprii* immuatui n.|ulari tliiVt*--:* o Ji-**minalo *u nU> am nm -porialo iutotwta d*i oampi moji .J Miforinri. Gli ili ri'dllam* insramltli > nod* ili <*riii- ma. j lo |i:it .1 /" I b a vb 5 T JE st "T A Z. m b - >- " 73 ~ r r 's w_- - SL S :i / 'Z f w 7 !b- X ! ~ ZL \ - ;l !*. - -- c 1I St c r i ~T .4 }>() \.\\].\ - V r ]<)5n FOLIA MEDICA rmionn o m mcimi im m:i. i.woun E M MHHCIW I.M.U.K K IHl.I.E \S-l:i !!\/in\J 111HII 2)3 i>TiriTn di vkihuw in i i \\iii!n diii'imiiimti- hi m-\h\\ Din-imo- I*r*f. F. Mill l-INtt MMATTIK I'lil.MHWKI l)\ IMHAKUI m:i i.w nj; vroui uki imin i iv..r. v. iinimn Hr H / \ \ M M la* mulallir |inlm<liari >l;i |mlwii i. it i-.-t.in. i i 1111 [. i. m i - 11 - mm vi.-jii'lli I i|| -IiIh-iii* iihim.i jt-nit nolo. I.ll.i jMlnlo"ia j>roJ'i*-mnal* <l*-i lavoralori jmrliiali. Panto m*::Ii aililrtti al!r i>|n*iaziimi ilrl ratlin comim'rriuli* jiiatiln in ijiiflli iM r;mto imliMriuli* |in-`onn nrv\ar*i manili-'la/imn |nrm iiKK-oniulirhc: |iti firojiri ilri primi *orm <|Ma>lri miul>o*i. rilrriliili uiraziom* i|rl jMiKi>ntio 11 tarimm* n aW'a/inm1 ili jmlwri >li I'ftv.ili, li*t M'viMiiIi im allrra/.inni |>ulmniiari pin a>tn|>l<-- !i |.in 11idi<*iItv iulcrjirt'lazitinr. mm ili ratio ilmutr aHa/iniit* >Ii j*I\i (.miir *! tlt'llo tala ormai *la iiinlli**imn I-1itfHa ili tijirrai uililrllt all** *(uauui* ml alio *!iarrn {! railmiii* ia j*-- *fll7.a ili allrrazioni iimMtitiofoniolirlti' rarattrnz/ali* t-limi*:im;-iilr iia ipiailri ili iTimira lirmirltilr mn rulirma. t in1 <*:!.nto. ili olitu liana- jiii-tilr. in r.-nom.-ni ili iifiiiliririt/a i-- |>i 1:111n i.1 joii mi-no arr -tilnala. AHV*amr rutlioloaiim ri 1<*\a in lii-m-n* im.i |oi 0 mi-no iilt-iili* aci-ftiUia/iom- ili'l ili4*nn |Hilmniiarr. nna (im- iiiair/./attira. rln* net punti ili inrroi'io l*11* iiiaslii* (<'I ri-lii-olo pim lalora 1111 a*|n*ltn iiM-uilonoilnlarr. tm'iilir in Inanli -:i-1. rmin* iitilla amli - I. nolrr oi,ria/ioni r!ir piii iiitiniizi illu*lii*n*inn. p.......him i i-\ i \. r. i- j>rii|irii` immusini umliiiari ilillii'.-- t- ii m111 ;iI>- 11111 > I aml'iio. 111a ron |i:*rialr iulrii-ila m-i i-am|i nu-'li >! Mtirrinri. (ili ili rimllann inuramlili <* noli- >11 >-:i(i-* m.i. j* r !> |:ti a PLAINTIFF'S EXHIBIT rC ./r'ii'" ;>* *i SSrS&Vi >F- S'iS'i-- few--4'. &  -5 i. *- iI ^s .i -- H I =-s i4 "L z ~1 m z T z .2 - '** s* i k n'rI wwV 1 uc *1 -2 = i j-- -2 f r- vs s J: "s 7 *t Z : -=2 := 7 ^. .wi s . n i 14 s --- s-- .. ^ -- .5 ** n 3r 7t .. Z ,z ti = 7 " S T n ; Ui": =: 5^ S' ?U ! iz. s : z-- IJ -n 57 S = ? - - JE 4 .1 7S* :: w T 7 ^S S T 2 . .= 4 -* " Llil- U? 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