Document Ddw7xzXVxOM72O5zxrGe88Nn

FILE NAME Cape Asbestos CAPE DATE 1949 Dec DOC CAPE004 DOCUMENT DESCRIPTION Journal Article H. Wyers - Asbestosis Postgraduate Medical Journal December 1949 WYERS Asbestosis nevertheless that a considerable number of men who develop complicated pneumoconiosis when aged 30 to 40 are a very bad risk Tuberculosis 4 was present 36 per cent of all pneumoconiotic } deaths in 16 per cent of all deaths due to simple pneumoconiosis and in 39 per cent of all deaths due to complicated pneumoconiosis The figure MA 36 per cent of the extent of complicating tuber- ! culosis in coal miners pneumoconiosis is higher than the figure given by Gooding and others but it is considerably lower than the figure for other industries especially for slate mining in North Wales where tuberculosis is present in 75 per cent of pneumoconiotic deaths Finally one is impressed by the apparently in- creased susceptibility of coal miners with simple pneumoconiosis to pneumonia and acute respira- tory infection BIBLIOGRAPHY BALGAIRIES E. DECLERCO G. JARY J. and NADIRAS P. '1948 Revue Medicale Miniere 2 12 CUMMINS LYLE and SLADDEN A. F. 1930 J. of Path and Bact 33- ' CAMAZIAN FILS PIERRE 1947 Recherches Pneumokonices Dans Les Charbonnages Sur Les DAVIES I. and MANN K. 1948 ' Proceedings of the Ninth International Congress on Industrial Medicine In the press FLETCHER C. M. 1948 Brit Med J. I 1015 100 GOODING C. G. 1946 Lancet 2 891 SMITH GORDON Personal communication COUGH J. JAMES W. R. L. and WENTWORTH J. E. . 1949 A Comparison of the Radiological and Pathological Changes in Coai Workers Pneumoconiosis Journal of the Faculty of Radiologists 1 1 GREGORY J. C. 1833 Edin Med and Surg Journal 36 389 GRENFELL D. R. Personal communication HART P. D'ARCY and ASLETT E. A. 1942 Special Report Series M.R.C. No. 243 B JENKINS T. H. 1948 Mining Aspects of Pneumoconiosis in South Wales Paper read before the South Wales Institute of Engineers KEATING N. Personal communication LECLERCQ J. BALGAIRIES F. BONTE G. DECLERCQ G. 1948 Revue Medicale Miniere 4 23 and MCCANN HURTADO KALTREIDER and FRAY 1937 Journ Clin Invest 16 23 MEIKLEJOHN A. 1949 Lancet 2 300. Contribution of the Employment History to Clinical Diagnosis ROGERS ENID 1944 Paper read before the Tuberculosis Association RUBIN ELI H. 1947 ' Diseases of the Chest W. B. Saunders and Co. TATTERSALL N. 1926 F. of Indus Hygiene 8 466 THOMAS R. W. Personal communication ASBESTOSIS ~ By H. WYERS M.A. M.D. D.I.H. Although certain difficulties remain to be explained the theory that silica is a causative agent in pulmonary fibrosis is widely accepted When however the fibrogenic potentialities of silicates are considered these difficulties are very greatly increased Olivine for example has been shown ig provoke only a foreign body reaction and has been suggested for foundry work whereas asbestos is notorious Studies in mineralogical composition of atmospheric dusts and ashed lung tissue are progressing and to the data found theories of solubility and crystal form are being applied If the solubility is high as in the case of silicic acid gels and sols the material is eliminated too fast to produce fibrosis A low solubility such 4s in mixtures of quartz and aluminium equally retards fibrosis King 1938 There appears also to be an optimum size of particle with a surface J area which will release silica in sufficient quantity for a sufficient length of time In animal experiments this was found be about 0.1 micron Tebbens et al 1945 In the case of asbestos fibres it has been shown that _ whereas there is an excess of chrysotile over horn- blende varieties in dusts ashed lung tissues con- tain only hornblende Sundius 1938 Kuhn 1941 It is concluded that it is the chrysotile in solution which is the fibrosing agent Gardner a 1938 demonstrated by animal experiments that longer fibres produced fibrotic reaction which did not occur with shorter fibres and concluded that asbestosis is at any rate in part a mechanic- ally conditioned complex of lung changes In support of this mechanical theory Johnstone 1948 records the clinical observation that workers at the Thetford Mills exposed to high concentrations of extremely fine asbestos dust did not suffer from asbestosis Structurally silica shows continuous threedimensional arrangements of SiO tetrahedra and to these may be related such a surface as to pro- duce the characteristic biological effects Those silicates therefore which most nearly resemble quartz in having a dimensional network of oxygen tetrahedra are likely theoretically to produce similar biological phenomena These S08 DERG ARRAN yng A 7 ase ep ae 1ein ee oreed TER ePusha eh = + an eR a Se ae age ae ate ae teat Cartrec wom 7 eae Seem The. e Eee ES MT ee et ee BW e v7 bs * = MES ce Se" are: ve attee a + a eS . | 632 POSTGRADUATE MEDICAL JOURNAL December 1949 diminishing diminishing are grouped in Nagoelschmidt 1949 order of similarity by as alkali feldspars sheet structures such as micas and kaolin double and single chain structures like amphiboles and pyroxenes and finally the orthosilicates such as olivine Animal experiments tend to confirm this but it is pointed out that the type of binding of the oxygen tetrahedra is of biological importance and aluminium silicates such as sericite and kaolin are not likely to present a major silicosis hazard The diagnosis of pathological states of the lungs due to dusts also presents many clinical and radiological difficulties A high incidence of pulmonary disease among those exposed to pure silica is presumptive evidence of an etiological relationship but the rare case of talc pneumoconiosis is difficult to establish High atomic weights and consequent opacity produce shadows on the ray film from inhaled dusts which are not necessarily pathological as for example in the siderosis of arc welders Doig and McLaughlin 1936 Asbestos its History Uses and Mineralogy n, . . ~ mattresses | Asbestos enters into the com position of lagging material for steam pipes jointing for steam pipes panelling of rooms tiles the lining of chemical pans the coating of bulk- heads of ships and marine piers and perhaps most significantly into the brake linings and clutch rings rings of motor cars The properties which commend asbestos to modern industrialists are its resistance to heat acids electricity and sea water and its fibrous structure which enables it to be spun Unline vegetable fibre it can be split in a longitudinal direction to microscopic size without discovering an ultimate clement and without loss of with discovering The shortest fibre recorded is Grand 97 chrysotile and is of the order of 0.00075 mm 4 length whilst the longest is exhibited in the Maritzburg Museum and is 43 in in length This latter fibre came from Umsinga Natal and is also probably chrysotile The best length of fibre for spinning is asbestiform in 3.75 cm The asbestiform minerals form a group o silicates which differ widely in chemical composition but resemble each other in being fibrous and in their resistance to heat acids and sea Whatever doubts there may be as to the fibro- genic potentialities of many silicates the processing of asbestos unquestionably exposes the worker to the risk of lung disease It has been used on a small scale since very early times being known to the Greeks as di^tos di^ tossignifying un- quenchable Used as a substantive 4 do cos was unslaked lime whilst the masculine gender 6 do^ e toswas used to denote asbestos The word - > which,, in modern English was speech signifies the disease asbestosis to the Greeks a plastering or stuccoing This last word . was originally suggested by Cooke 1924 when he also drew attention to a passage in Herodotus describing a cremation cloth made of asbestos The Romans knew it under the name of amianthus a word of Greek origin signifying absence of miasma or pollution They obtained it from the Italian Alps and the Ural It seemed appropriate that the Vestal Virgins guardians of the Sacred Fire symbol of the deepest emotions and instincts in Roman family life the last rite of paganism to be extinguished should have used asbestos lamp wicks Another fibrous mineral resembling Italian amianthus was spun and woven into a cloth in Siberia during the 13th century A factory for the manufacture of asbestos articles was opened in Russia in 1760. The discovery of asbestos in 1876 contributed greatly to modern industrial expansion Today asbestos is used for a wide variety of purposes Textiles enter into the manufacture of fighting suits safety curtains and boiler water Legally asbestos means any fibrous silicate mineral and any admixture containing any " such mineral whether crude crushed or opened Asbestos Industry Regulations 1931 eralogists classify them as - follows Min- 1. Serpentine Group 2H 3MgO 28i0 Characterized by a high percentage of magnesia and water generally white in colour naturally lubricant and therefore suitable for stuffing boxes and glands Examples chrysotile picrolite 2. Rhombic Amphiboles MgFe SiO Soda confers a brown colour when present Like the third group the members of this division contain high percentages of ferric oxide and have a low _ water content The texture is harsh and elastic: enclosing a maximum amount of air in a minimum of incombustible matter They are particularly . efficient as heat insulators Examples antho- phyllite amosite Tremolite 3. Monoclinic Amphiboles Tremolite CaO 3MgO 4SiO2 Actinolite CaO MgFe 4SiO Crocidolite NaFe SiO Fe SiO - The presence of soda in this group confersa The ferric lavender blue colour Hall 1918 oxide content of crocidolite encourages slag forma- tion when it is employed as a wrapping for electrodes The countries of origin are chiefly Canada white chrysotile South Africa blue crocidolite and the brown amosite Australia and the U.S.S.R. It is found in the banded iron- as stones the deposits being classed cross fibre slip fibre and mass fibre according to the direction of cleavage relative to the orientation of the vein and ail wah ea: a a * cae Se = wT Pm voae "3 BS FIG -Asbestosis bodies in a section of fibrotic lung Photomicrograph x 400 From the case shown in Fig 4 Lote; PLT Chemical analysis explains some of the varying the ABE properties of the three groups by which the fibres are made to lie parallel in a continuous sliver Essentially this machine con- sists of toothed drums and condenser rollers The ' derivation of the word card from the Latin Canadian | Blue ! Chrysotile| Crocidolite : Amosite carduus a teasel or thistle doubtless indicates the means by which this operation was carried out on Per cent Per cent _ Per cent other fibres in primitive times Slivers are twisted PLR ss frames Silica aes 41 50 +7 together to form strong yarn on spinning material Mamina ; 3 I : h by ring or flyer as in other textiles The Ae plaited i. ric Oxide ; 2 35 37 6 is then into rope or it may be woven into 2 oT No nesia 40 cloth on the conventional power loom To the A, A101 ve 14 ' + 3 medical observer perhaps the loom as a special ToS significance for the weaver's beam has given its QQ. 100 100 100 name to living tissues Occupying a horizontal Ste position in modern looms its historical position am - anufacture was vertical The Greeks called it lor^s as they The mineral is obtained by open mining akin did a ship's mast or indeed anything which was Outside the mine adit the crude set upright The word came to be applied to the fm quarrying of iron are cloth itself and eventually to the histological 7 . bestos is reduced in size and pieces tached manually ' cobbing ) or by mechanical structure of living organisms cans It is then transported to the factory in lined sacks where it is crushed in a large Lige Lige runner or a small pan mill foreign matter tentoved and the fibres opened in a Crighton achine The ancient process of carding follows History of Asbestosis In 1906 the Departmental Committee on Compensation for Industrial Diseases 1907 heard evidence from various authorities arising out a . ena F snowasut ue yim xadsisd ut pasojous Aq[e10 Butoq cue saureay Suruurds 10308) suo UT { UoNUDIIE jenoeds paataoar sey uonsneyxe ysnq pauiuexa Jeayeur jesgojoyied =yonus pur AZojoiper jo Speul Us9q sey os y syodxyeo sjaued Aq Ayenuue urese pue Ayentur pouruexe Ayjeotpaur uaaq aAey swaunsedap Aysnp oy syuvajua pe 161 som astasip ay, Zuyjonuo0s ut sanoaya Ayesuad aang sey vNe[siZa] ISJNO Jo2IUOD 9Y2 YITA paryy 24} pue UoLEsUadUsGd JO PAeAE IYI YM puodas oy3 paeog [eoIpayAj & JO suoNouN} pue UONNINsUCD ay} Yu yeap isry ayy, (16s1)uonepn8ay Asnpuy soysaqgsy ayy pue (161) amoyog (sIsorsoqsy) Arsnpuy soiaqsy ayy (161a) wagog (syuau -aduely [esIpaAl) sisoysaqsy pue sisoapig oy postadde avak Suimopjoy ayy ur (of61o ) g pur JY IWMAIBJAL JO Wodsy ayi 03 Bulpeay Aainbur ayy paiedisaid yorym pur sisoaqy areuound pur Sojsaqse uoomieq diysuonejsa jeooambeun ue Ysiqeise 0} pauisas yorym 1aaamoy'(gz61) aseo Stapiag sem ay -{Fz61) yood Aq pue (F161) ayeq Aq A)qviou peyrodasaq 02 panunuos sisoisaqse JO sase UOHeaYyTIID jo Ayarya sarfnoyyip 04 Sumo anpaydg pany, 943 sapun sasvastp yo 381] 9Y2 UL UOTSH}OUY $31 pusUAWOoaZ JOU pros AayI Yaz aaRIWWOS ays suonednssuole}299 02 oytoads pur Amjua peau & sem sisnyzyd prosqy wy) BursaI13e ISITYM OJfo ade aya inoge punoa parp prey sayeur 320Smty JO BUIL Jey) paieys pey FEpade rayI0M WOOl psed B URUSTIU, sistyayd prosgy yeardA , Jo oo61 ur jendsozy ssory Butreys oui ul parp PeY OYA JOYIOM soysaqgse UT Jo asEd ayI paliodal Aerinyy, andequoyy Aambua yey yy go6ray uoresuadMo) A, 8,uoUnyJo ayy JO aNpayog paryyf, ay) Ul sasRasip Jetsnpus UIeIII9 Jo UOISNPOUT sy} *ANABD Ssadsqu UL Spunolins ewoulozes snouenbs & afod Jamey au ry Blnajdpauaysiyy puv stsoysagqse Jo svaae [euos<jod PuG-enfq Suimoys Bun, jo uongas pry saead aay adapBuruuidg SE ae ageuagCra yz OLY 6t6r daquearacy ecember 1949 WYERS Asbestosis 635 vice which permits easy access to bobbins andling has been reduced to a minimum and od housekeeping kept on a high standard With ery few exceptions cases certified by the Board asbestosis have industrial histories extending to eriods prior to 1931 ee. athology Whereas the heavier and smaller particles of lica find their way to the alveoli and thence to the mphatic channels the lighter and larger particles " asbestos block up the finer bronchioles Chains etrmine silicate tetrahedra with intervening cations etermine the fibrous structure of asbestos and ese chains in frayed bundles interlock and are Tested Hence silicosis is a fibrosis of the lymph odes and asbestosis a fibrous cuffing of the ronchioles Dangerous fibres measure about 20 sicrons and a noxious concentration is said to ccur when the dust count exceeds five million articles per cubic foot of air Page 1937 There is no local necrosis or leucocytic reaction > the trapped fibre such as would occur if rotoplasmic poison like colloidal silica hydroxide sere liberated It seems significant that if the brous character of chrysotile asbestos is absent s in its chemical equivalent serpentine the dust ; inert Instead the lining epithelial cells are esquammated as a result of friction and make ttempts to engulf fibres which proving too long re sometimes observed projecting from these dust cells Asbestosis giant cells are also seen lue to small aggregations of dust cells They are igmented stippled and multinuclear Fibro- lasts appear around bronchioles and alveoli in nterlobular septa and in the subpleural connective issue Asbestosis bodies and pigment are also present Finally there is an invasion by collagenous fibres to form the characteristic reticular pattern around the distal arborizations of the bronchial tree The alveoli capillaries and venules are crushed by the fibrosis Asbestosis bodies can be demonstrated in the Jun pleura and sputum The length of time tak~- for them to develop is unknown They cap : be found in the mineral itself It has been sho a by staining reactions with sodium nitropru le and ammonium sulphide and by dissoly phuric the outer portion with concentrated sulphuric acid that they consist of a central fibre of asbeatos Fig ) with an containing segine covering which is thought to have been sleposited by a colloidal reaction between the fibre and he blood proteins Gloyne 1929 Their presence is held to be evidence of exposure to asbestos and not of the disease itself Dense sessile adhesions of the pleura are common and the interlobar fissure obliterated The pleura has a ground glass appearance with yellow horn plaques 2 or 3 in in diameter besides patches of recent pleurisy The cut surface of the lung exhibits the typical black polygonal areas roughly lobular in distribution 8 in to ,,in 3 mm to 6 mm in diameter on a red background of bronchopneumonia The areas tend to confluence at the bases and exhibit the $ pleural drift common to the pneumoconioses Confluence is becoming rarer as the dust cloud becomes less concentrated Fig 2 Compensa- tory emphysema on the other hand seems to be occurring more frequently as cases live longer It occurs chiefly along the margins of the lungs sometimes giving rise to bullac but not SO commonly as in silicosis One case in the present series of 115 fatal cases died of a spontaneous pneumothorax consequent on rupture of such a bulla The right heart is generally enlarged and there are the usual signs of back pressure in the liver Clinical Syndrome In the writer's series the average exposure for males was 16.2 years for females 7.3 years and for all cases 10.4 years The duration of the discase was 6.4 years for both sexes The mean age at death was 46.5 years in the case of men 37.5 years in the case of women and 40.8 years for all : s ft i Fig Fig J.N male aet 45. Sectional dept 18 years ray of lung showing fine mottling Fingers show gross clubbing Advanced asbestosis yee: eee 7 Se =e. rr es crested Bh e we a co oe e SI ee ES. pr aa pe POSTGRADUATE MEDICAL JOURNAL \ cases Burton Dyspnoea is a universal complaint Wood regarded asbestosis as a mono- symptomatic disease Dry cough is noticeable on rising in the morning and during changes of temperature A paroxysm usually terminates with the production of some thick mucoid sputum very rarely flecked with blood and in the later stages containing nummules of pus An increase in the quantity of sputum indicates a complicating factor Anorexia loss of weight fatigue and chest pains are occasional symptoms The cardiovascular signs of the disease are im- portant because once established they are per- manent whereas adventitious sounds in the chest tend to be evanescent An earthy cyanosis has been described Of 53 consecutive cases of asbestosis examined by the writer 29 showed clubbing of the fingers the toes being similarly affected in eight of the cases an incidence of 54.7 per cent In the same series the second pulmonic sound was found to be accentuated in 33 patients that is to say 62.2 per cent of the cases These signs appeared separately together and quite often not at all even in advanced disease The liver was never palpable in an ambulatory patient nor was there oedema of the dependent parts The chest is flattened bilaterally The respiratory excursion rarely exceeds 1 in 2.5 cm Percussion often reveals a sensation of resistance to the finger ( felting which may be general or localized Probably this is a reflection of the dense character of the fibrotic lung or of the pleural plaques which are often seen post mortem resonance is occasionally noted Dry crackling sounds can generally be heard along the emphysematous margins but often become generalized or disappear altogether in the same individual An odd sonorous rhonchus may be heard There is deficient air entry at the bases and expiration over the anterior aspect of the chest is harsh Radiological Appearances Whereas the roentgenogram may show considerable involvement in silicosis with few if any symptoms the reverse is apt to be found in ' asbestosis Sayers 1938 This is the opinion of all with experience of the disease The typical appearance of the lung fields is a diffuse haze or point mottling in the lower halves or two- thirds Fig 3 Emphysema may be seen in the upper zones and of later years a granular pattern in the lower zones somewhat resembling cotton wool which has been teased out Fig 4 The domes of the diaphragm are flattened and may show coarse striae running up into the lower lung fields The vertical diameter of the chest is FIG T.McK aet 45. Sectional dept 18 years Asbestosis bodies shown in Fig 1. ray of lung shows coarse fibrosis and emphysema Gross clubbing of fingers Eventually died with tuber- culous infection diminished The phrenic sulcus is frequently blunted A shaggy left cardiac border is often seen in advanced cases and sometimes the entire silhouette and diaphragmatic cupolae are blurred Complications Bronchiectasis has been stated to occur fre- quently Only three undoubted cases occurred in the present series and one of these was a con- genital condition affecting the apex Pregnancy was associated with the deaths of two women suffering from asbestosis The disease does not seem to be adversely affected by preg- nancy but the strain of labour may tip the balance in favour of right heart failure : Bronchopneumonia is almost invariably found post mortem The next commonest complication is tuberculosis with a much lower incidence than in silicosis and affecting a lower age group In 115 fatal cases 15 men and 21 women 31.3 per cent in all showed also pulmonary tuberculosis The mean age at death was 34.9 years after an average exposure to asbestos of 7.6 years Taking the remaining cases alone the age at death was 43.6 years after an exposure of 11.5 years December 1949 WYERS Asbestosis An excess mortality from cancer of the lung in cases of asbestosis was recorded by Merewether 1947 Of 6,884 cases of silicosis 1.32 per cent were found to be complicated by pulmonary cancer whereas the incidence was 13.2 per cent in 235 cases of asbestosis Wedler 1943 collected 92 mortem reports of asbestosis cases from lifferent parts of the world and found an in- cidence of 16 per cent pulmonary cancers The development of the lesion corresponded with the engths and intensity of the exposure 12 to 42 cars Boemke 1947 called attention to the association of asbestosis with pulmonary cancer The latter almost always taking the form of carcinoma of the pavement epithelium He thought 1 possible that in addition to chemical processes he purely mechanical effects of the asbestos needles may also be responsible for the develop- nent of carcinoma In the present series of 115 deaths from isbestosis 1 males and six females had pulmonary cancer whilst cancer of other organs was present n three males and four females pancreas colon stomach ovary The proportion of pulmonary ancers in the series was therefore 14.8 per cent Squamous cancers were present in nine cases oat ell in five columnar cell in one endothelioma of he pleura in one and the histology unknown in one Two of the cases were brothers The mean ige at death was 52 years the mean exposure to asbestos dust 17.3 years and they died a mean period of 6.6 years after leaving the industry Fig 2 Medical Aspects of Asbestosis It is difficult to assess the effects of such factors as personal habits and the preference of families and those of defective physique for certain occupations Meiklejohn 1929 has pointed out the possible effects in the past on the spread of tuberculosis among Sheffield knife grinders by the habit of spitting into the water trough through which the abrasive wheel passed Stewart 1929 bus indicated that the high incidence of tubercuEnsis among boot operatives is due to the attraction of disabled persons and their families to a light sacupation Similarly the family histories of those " ing of asbestosis and tubercle frequently dis- use the presence of tuberculosis in those of the me household who have never been exposed to chestos employment survival showed a sex ferentiation the mean period for men in this series was 2.3 years and for women 9.8 years woubt many women ceased work to marry No and ymptoms of asbestosis did not appear until some time later Of the 115 deaths only two had commenced work subsequent to the 1931 Regulations a man after ten years exposure and a woman who also had tuberculosis after two years exposure Three other men have also developed the disease after exposures of five four and four years respectively the last one having been certified in 1946 The writer has 28 cases under observation at present business The men are occupied as follows executive storekeeper painter and window cleaner lagger in other employ cleaning brasses ventilation engineer in charge of sports and social sections laboratory handyman retired . small printing press operator foreman in charge of stores foreman in charge of rubber department light carpenter tally clerk week relief handyman in canteen at home recovering from tuberculosis and one relief gateman The women are occupied as follows light housework in charge of works solarium canteen work repairing overalls in works laundry three doing light house- work and two doing sewing duties and mending duties at home The reduction in the intensity of the dust cloud seems to be producing a more chronic type of disease Merewether's investigation of 1929 in- dicated a period of seven years exposure for the disease to develop whereas this series which commenced in 1931 indicates that an exposure of ten years is necessary Through the kindness of Dr. Roodhouse Gloyne the writer had access to the late Dr. Burton Wood's notes on 8g cases of asbestosis which he had collected up to 1931. Of these cases 17 showed clubbing of the fingers i.c. 19.1 per cent a much lower figure than the incidence of 54-7 per cent in this series Radiologically the fine mottling is giving place to a coarser shadowing which seems to be due to compensatory emphysema At post mortem confluence of the characteristic lesion is becoming rarer and cancer incidence is rising Other Silicates Of the other silicates talc is the only one concerning which there is definite evidence of a harmful effect on the lungs although there is some clinical and radiological evidence of pulmonary fibrosis due to mica McLaughlin et al 1949 reported the first case of talc pneumoconiosis confirmed at post mortem to have occurred in this country The radiographs showed nodular shadows which on the left side were fluffy Histologically the lung showed greyish nodules of loosely woven fibrous tissue in association with bronchioles There were also curious bodies - closely resembling asbestosis bodies Mineralogical investigation proved that the condition was not in fact asbestosis but duteo talca hydrated _ as Tiny & Epa eames ow eeeare dh He N i Ney? ; as . POSTGRADUATE magnesium silicate Mg.Si in certain instances arise as an alteration of tremolite and it may replace anthophylplriotdeucint both cases inheriting an imperfectly fibrous form Norwegian and Canadian tales are platy but contain a proportion of fibres The respiratory MEDICAL JOURNAL . December 1949 passages appeared to have acted as a filter the fibres to get into the lungs whilst allowing plates The authors concluded that rejecting talc the coniosis may be ascribed primarily to theppnheyusimcoa-l form acicular crystals of the mineral but but asbestos is more actively fibrogenic that BIBLIOGRAPHY ASBHE.SMT.OSStatIioNneDrUySOfTfRicYe ASBESTOSIS SCHEME 1931 ASBESTOS INDUSTRY Stationery Office REGULATIONS 1931 H.M. BOEMKE F. 1947 Med Monatsschr , 2-6 MCLAUGHLIN HOEMKE F. 1947 Chem Zentr 1 835 COOKE W. E. 1924 Brit Med J. 2 147 DEPARTMENTAL COMMITTEE ON FOR INDUSTRIAL DISEASES COMPENSATION Cd 3496 p 127 H.M. Stationery O1f9fi0ce7 Minutes of Evidence DOIG A. T. and 771 A. G. 1936 Lancet , FAHR T. 1914 Woch 61 625 " Asbestosis Pneumoconiosis Pneumoconiosis unch Med Africa GARDNER L. U. 1938 J. Amer Med Ass 181 1 GLOYNE S. R. 1929 Tubercle 10 404 HALL A. L. + Asbestos in the Union of S. Survey Memoir No. 12 19119818 Geological JOHNSTONE R. T. 1948 Occupational Medicine and Hygiene p 369 . Industrial KING E. J. and ROMAN W. 1938 Biochem KUHN J. 1941 Arch Gewerbepath und J. 32 2283 Gewerbehyg 10 473- MEIKLEJOHN MCLAUGHLIN A. 1949 Talc I. G. ROGERS E. and DUNHAM R. Pneumoconiosia Brit J. Industr Med 6 A. 1929 M.D. Thesis Glasgite 183 MERIEnsWpeEctTorHoEf RFactEo.riRe.s HA..M.19St4a7tioAnenrnyuaOlffiRceeport of the ChigChiCghig MEREWETHER E. R. A. and PRICE C. W. Effects of Asbestos Dust on the Lungs H.M. Sta1ti9o3ne0ry ROeffmicie Oeftfaince NAGOELSCHMIDT G. 1949 Research 2 170 PAGREepRt.s T5 . a1n7d13B- LOOMFIELD J. J. 1937 U.S. Pub Health SAYERS R. and LANZA A. } 1938 Silicosis and p 60 Asbesto 4, SEILER 1928 Brit Med J. 11 982 SILICOSIS AND ASBESTOSIS MENTS SCHEME 1931 H.M. MStEatDiIonCerAy LOffiAcRe RANGE STEWART A. et al 1929 Brit Med J. 1 926 SUN3D5I1US N. and BYGDEN A. 1938 J. Ind Hyg Tox 20 TEBBENS D. D. SCHULZ 7. Ind Hyg Tax 27 199 Woch WEDLER H W. 1943 ' Med Aug. 6 69 No. R. Z. Asbestose 31/32 and DRINKER DRINKER P. 1945 und Lungenkrebs 575-6 Lungenkrebs Dent THE ROYAL MEDICAL FOUNDATION of Epsom College We appeal to all members of the medical profession profes ion In every profession samo must fall by the wayside wproafessioyn side who do not already already do so to subscribe others must inevitably to the inevitably fall upon evil days Our object is to help the families of those less fortunate brethren a 50 ordinary pensions to medical men or their b 45 Foundation Scholarships for boys widows educated cost c 13 Scholarships for girls clothedclothed and maintained entirely free of . te d Education of 28 boys at reduced fees . e 140 pensions and annuicies of varying amounts tee f Grants towards education of 56 boys and girls ve a tee tee wee g Grants to medical men widows and spinsters ves vee tae to see o above .. oe oss a Royal Medical has provided tae ane i tee ses . tee Foundation ws 1,500 oss 1,968 ae 3,023 1.843 This is an expenditure of 18,103 in the year rely upon the generosity of our subscribers and ing applicants medical even our existing benefactionsbenefactions would have to be dation to make men widows and children of schoolschol remain curtailed Owing to lack of funds many deserv age educational grants for those who cannot obtain unassisted The Sherman Sherman Bigg Fund enables the most welcome Scholarships Donations Donations to augment income Foun- the of this Fund will be We therefore beg you earnestly to send either may if you wish stipulate the particular form of beneafacstuibosncription subscription or a donation to this Foundation during 1949. benefaction on which it is to be expended When doing so you Subscriptions and donations donations may be sent to any of us or College Surrey by whom full information will gladly be sent on request preferably to the Secretary the Secretary's Office Epsom JOHN SELL COTMAN Treasurer HAROLD SPITTA Chairman ERNEST GOODHART Chairman - -- ate scre ee Dia