Document JrLxDgr4bJe4dRKLJzNqyxQZB

FILE NAME Colonial Sugar Refinery CSR DATE 1957 Jan DOC CSR032 DOCUMENT DESCRIPTION Journal Article - Pneumoconiosis in Victorian Industry JANUARY 19 1957 THE MEDICAL JOURNAL OF AUSTRALIA 76 - 320 o%, PNEUMONOKONIOSIS IN VICTORIAN INDUSTRY By D. L. Gordon ThomAS hazardous inasmuch as the containing substances are newly ground The highest incidence was in a tile wall works where dint was used in considerable quantity Industrial Hygiene Division Victorian State Health Department Helbourne 4. Mineral earth workers are the most exposed of all Quartz diatomaceous earth and asbestos are ground with usually makeshift machinery and the dust hazard is SINCE the end of World War II Australia has been under- going rapid industrial expansion in all fields coupled with large immigration Although in 1956 some % of the national income comes from wool the situation in the extremely bad One subject a man aged thirty years died of uncomplicated silicosis within nine years of commencing employment These places have an unenviable record of death and disablement years to come may well be different In view of the 5. Masons and quarrymen are exposed to the dusts of ravages to health which such industrialization has produced various types of stone Granite can contain up to % of in the past in other countries it was considered essential free silica and Stawell stone and Sydney freestone are for to obtain some facts on what had happened in Victorian all practical purposes pure sand Basalt quarrymen can oe industry in the immediate past in terms of industrial develop an ray picture which is hard to distinguish from chest diseases Without accurate knowledge of where the silicosis but these men are free from symptoms bee hazards really lie it is impossible to have industrial 6. Boilermakers and welders are exposed to mixed dusts Sto expansion without a health toil Without this knowledge Few in this group are incapacitated . toe there can be no planning for the future and the mere policing of regulations leaves much to be desired in the 7. Metal polishers are subjected to silica dust through oe field of preventive medicine Accordingly in 1952 a survey - the abrasive they use which is beeswax impregnated with to determine the sources and incidence of pneumonokoniosis oe was commenced by the Industrial Hygiene Division and - . the various aspects of the findings are now presented pure silica and known to the trade as tripoli S. Stokers are exposed mainly to coal dust The total number of cases reported to the division prior to the survey was 522 which included 343 among miners and 179 industrial cases The figures now read as follows total 1126 with 587 in miners and 539 in industry The ray investigations were carried out on full size film 17 inches by 14 inches on personnel who in the opinion of the division were employed in dusty trades The total number of individuals radiologically examined was 2823 Table I shows the results of the investigation In the survey the number of mouiders radiologically examined was 1918 and the percentage affected was 46 Three hundred asbestos workers were examined and this number would cover most of those exposed to dangerous amounts of dry asbestos dust here the percentage was 15 The most dangerous occupation is mineral grinding Margely of quartz and here 30 of those radiologically examined were affected In the other categories the people surraged were those exposed exposed to the greatest risks in the particular occupation and not the employers as a whole so that any computation as to the percentage affected in those industries would be erroneous In the 360 cases found all the subjects have been examined their industrial Bistories have been taken and their exposure to dust has been confirmed Apart from those suffering from asbestosis the great majority are silicotics many of whom are grossly disabled and many short of breath others appear to be quite well apart from a slowing up and slight shortness of breath and some are entirely symptomless TABLE . Subjects Occupations Number Radiologically Examined . 671-1 . gottery 1915 Foundry labourers Plaster workers dement workers 20 N 5 - + - _- aig Total 3523 Number of Cases of Pneumono konic Foued ae 4 et] | a Sa Oe ae t w ~ _ 360 Percentage of Positive Findings $8 _ - 34 pt we se _ _ _- _ _7 ~ Discussion Silicosis If we consider the conditions in the various types of Occupation we find the following factors 1. and Moulders are exposed to silica in the moulding sand often in the parting powder One of the cleanest foundries investigated produced the highest proportion of silicoties 10 ) owing to the fact that they were using silica four which is very finely ground quartz as a parting Dowder Many moulders with long exposure are grossly disabied 2. Dressers are exposed to moulding sand and to fine metallic particles produced when castings are cleaned by emery wheels automatic chisels and swing grinders The in tMoeotlhs odsof all at proportion pronounced bulk of changes inhaled gravely affected the general use are now driven and recently of exhausting the actual tool are being evolved these men have gross ray changes which are out to their symptoms while others with less In cases in which inhaled dust is metal the symptoms are usually slight 3. 3. and Brick tile and pottery workers are exposed to sillca conditions in these occupations are particularly 9. Rubber workers are exposed to talc which is magDesium silicate this can produce similar effects to silica and a similar radiological picture 10. Cinema operators are exposed to carbon metallic oxides Auorides and silica from the carbon are lights used in the machines 11. A chance ray picture of a worker in a cleaning -stablishment showed 20dulation with no symptoms Investigation showed that diatomaceous earth is used in the process of dry cleaning and constitutes a hazard A survey of this industry is under way The radiological appearance must not be used as a yardstick to measure the severity or otherwise of the disease Some subjects with gross ray changes are almost symptomless while others who are gravely disabled show very little abnormality . In the survey there are several sets of brothers who both developed silicosis in entirely different occupations This suggests a familial tendency One family group of seved boasts six silicoties affected in three different processes 76 _ THE MEDICAL JOURNAL OF AUSTRALIA JANUARY 19 1957 insulating A person quite unaware that he is can after disabled in suffering from silicosis an acute pulmonary episode become totally a very short time There are at least 20 its use in some process mixing with diatomaceous or kaolin to form lagging materials sawing cuttingeaarntdh who have graduated from the mild listed ^ nishing any product containing asbestos to the totally disabled in periods isnhoarltl ocfasbersealetshs ctlhaassn brake linings asbestos sheeting and various example four years The use of 35 millimetre film is generally materials dangerous tearing down old lagging- is a very unsatisfactory in the diagnosis of pneumonokoniosis Many process even in the open air spraying asbestos on walls and cases especially early ones are missed This could ceilings as an insulator the great number of silicotics who are under treatmeexnptlain The pulmonary fibrosis of asbestos dyspnea who have misled their doctors for in its onset irregular in its workers is insidious saying that in the mass findings were clear The unwittingly by X ray examinations their chest ray appearances course and variable in its termination but once established it constitutes a threat to life and health - grave normal after the subject's removal dusts This has occurred with from can return to exposure to some are such that the air Briefly the pathological changes cells become obliterated by fibrous tissue As this starch and metal wood dust powdered food progresses the lung tissue becomes used up the are complicated Very few cases reported in this survey and the elasticity of the lung deteriorates amount of have been by tuberculosis However several cases reported from sanatoria in which tlounmgs aavpapielaabrle Tthoecacrornydiotiuotnfiusnctions diminishes and symp- progressive irreversible dust has been proved and exposure to of carcinoma of the lungscowmepreensfaotuinodn obtained No case:s and afrnodmontchee hthaezasrtidgmTahtea ampapienar the subject should be removed is oe aa symptom steadily proges increasing silisciloiscoisiss and asbestosis are so insidious in their there is no progress and so easily influenced by acute -. shortness of breath While | asbestosis predisposes the subject to acute evidence that pulmonary infec- conditions that it would pulmonary a tions the presence of the condition to seek a new occupatioanppear wise to advise the subject chances of recovery when seriously impairs infection does the occur shortness of breath away from the hazard ' when of becomes apparent irrespective of his the sulphonamide drugs and of the The advent antibiotics has age The following case illustrates this . greatly improved the prognosis in these cases incapacitated completely In 1952 a moulder of have typical silicotic twenty years standing was found to and mild ray appearances with nodulation feel symptoms He was earning big money and did disposed to give up his job In 1953 he had not with pulmonary complications and today he is influenza . . ws The fact lungs long realized . that pathological changes can continue in the after removal from the hazard must also be . Lo abnormality A woman now aged thirty a pottery piant She worked there years was employed in years until she from the age of fourteen- three was twenty when she married She had children and carried on quite happily until five ago when she began to be short of breath and years xamination revealed an ray Her condition was eventually diagnosed as silicosis after tentative diagnoses of tuberculosis and sarcoidosis were disprovest _ The most sought after asbestos in with long needles but industry is the type industry hazardous unfortunately this is the most type to handle The needles enter the lung by changes inhalation and after a time undergo in appear- ance and are then known as asbestosis bodies = They other brown or yellow in colour and are found in no condition The bodies are all modifications of a fibre and are shaped like dumb a drum straight and so on major's baton It is impossible to state at what period these appear but they have been found in this as ^/fteen months after survey as early of of these exposure commenced The presence bodies must not be regarded as diagnostic asbes- tosis but it is conclusive proof that the patient has been exposed and that some abnormal process is at work in Lalike silicosis the radiological indings in asbestosis in cases asbestos An inadequate industrial history delayed the are in amford with the severity of the symptoms . The nosis in this case correct diag- greater the inepacity the more one . ray film fa the expects to see in the There are two interesting subjects who fungs more developed well especially case the bases of the Western Desert with the Royal Australian served the the last war They were Air Force during mechanics especially especially especialesplecialyy the right show a appeura^-e and the outline of the heart is g irrregouluarnd or ray findings are typically silicotiicn fixed camps and their . of It is fully realized that a radiological diagnosis It would appear that early asbestosis is extremely difficult and our athnedy developed the condition on service Heavy transports were regarded as such only after the and tankers probably ground the sand to powder fineness sideration A few films picked most careful con- the propellers these men used to swing produced to England for review out at random were sent intensely heavy cloud of pure silica an developed none of them being from weil Many incapacitated . English stcaansdeasrdsOne case was accepted as asbestosis on joh if it men could cope with a sedentary there In the others while it was admitted work Inwevrieewnotof fotrhethe effort of travelling to and from progressive nature of the disease were viewer increased markings at the lung bases the stated that he had seen many similar films in his and the limited sum payable as affected people to remain at work caosmpleonngsaatsion we advise area from people who bad never been exposed to However as these films were taken in a possible of the hazard of course The ability to continue in : trialized area where fog soot and smoke highly indus- employment is often increased by a useful thought that to abound it is compare these with films of therapy course of physio- - of the same Australians be directed age proved nothing Criticism will no doubt Asbestosis at the standards of diagnosis but if one In the section of the survey relating to asbestos until the stigmata of a waits developed case appear 300 men were examined 100 had workers can do little for the patient one ; tosis bodies and of this 100 47 sputum containing asbes- In this last had positive ray findings It does not follow that everyone is going to accept the group all had symptoms ranging from short- advige tendered to leave the hazard but since the ness of breath on exertion to gross incapacity . of workers in this group is comparatively number The procedure realization that their friend who small the sputum adopted was as follows Specimens of a weak heart for was supposed to have were taken and examined for the a long time is actually sufering from bodies When these were presence of demonstrated the patient was radiologically examined When both asbestosis and is eligible for compensation is workers very conscious of the hazard making most Much . results the patient was tests gave positive has been exercised by the workers in more care interviewed a complete industrial history was taken and his clinical condition was assessed they are much more recent times and easily persuaded to wear a mask The most common exertion symptom Tightness in is shortness of breath on the chest and pain in the chest are not uncommon with lack of energy and tiredness Most Subsequently practically all workers patients show an improvement after a course of exposed to dry asbestos have been radiologically examined therapy The patients given a course of physio- physiotherapy The following occupations are involved had all been accepted for compensation and all - substance in its raw handling the state grinding the substance prior to in hospital elimination for at least a mouth so of worry for the future that were kept the rest and beneficial were also ot JANUARY 19 1967 THE MEDICAL JOURNAL OF AUSTRALIA SPECIAL CHRONICGASTRITIS > factors All those given this course are still working at REMARKS ON WITH THE GASTRIC INEFFICIENCY ete light sedentary occupations When this survey started REFERENCE TO THE PREVALENT IN hw eight cases of asbestosis had been reported and the disease THE EXAMINATION OF was regarded as a rarity It will be seen from the figures CONTENTS that the incidence of the diseasies far too high In addition to those found in the investigation there must 20.208 KINSELLA be many more older folk suffering from the complaint the Department in whom it has not been diagnosed and who are incapaci- From Orotgty Hospital Sydney t tated and very poorly off and should be financially receiving adequate oltre compensation Summary By V. J. of Enterology Saint Vincent's a _ ned. pneumonokoniosis hundred sixty Three and found in industry in cases of Victoria No doubt there are were many neglected Thus more either symptomless or undiagnosed aged Thus Silicosis and asbestosis are not diseases of the *, Mierac pot Many of these subjects belong to the thirty to fifty years if this element were nasal discharges the sputum Una disability age group and for this reason it is imperative that con- . ditions improve in the dusty trades The two conditions _ can occur together causing gross : Six affected . persons who showed nodulation and also asbestosis bodies ey ignored impressing often unique unrecognized prognosis prognosis survey disabled of years were found in the same factory They are very ee and two are aged under forty - . on are unrecognized the nature faulty The illustrates the necessity of on unrecognized a prognosis Oe unrecognized unrecognized medical practitioners the need for taking a compl^'teindus- trial history of all patients irrespective of sex It is not suficient to ask a person his or her occupation bread years carter today may have been a miner twenty years ago Se n Many women have worked and are still working although the bazards now are less : : gists and biochemists A few ago teaching biochemist why he gave report in fractional test meals gave as the reason ores damaging conscious interpreted proceeding Industry in Victoria is becoming very and While these investigations have been the be ; unscientific Industrial Hygiene Division has been busy encouragin.g the suppression of dust Unions have sponsored the survey It is of course highly merely because its interpretation isdifficult and employers have been most cooperative in allowing their there is always the chance that somebody eise | may personnel to be radiologicaily examined in the firm's time in the interpretation Thus by examining the In the firms where cases have been found close inspections traet the clinician may g^'ta very good idea as , have been made and where possible conditions have been is the source of the discharge But even the biochemist it Improved by exhaust ventilation by better housekeeping a it properly instructed in his should the art or by the elimination of the hazardoushazardous substance The use the distinction easily of respiratory devices is recommended only when the If theexcess mucus mucus is gastric in origin ' with hazard is of short duration and when other methods cannot each be used effectively Conditions in industry can be greatly another improved in many cases by very simple means specimen tube to It is intimately mixed . tthey hey areseen to approximate , ampindgown the floors in a foundry bigreductions in dust counts . led to The mucus is finely flocculated An quanti- can of ' tative account of this mucus be given given in terms . Legislation has been introduced to try to improve con- ditions Quartz grinding has been declared a dangerous trade This means that any premises used for the process must be registered and in the event of the regulations not being complied with the registration can be withdrawn and the firm becomes liable if it continues to work in an Altration time Mucus from the respiratory tract ocurs fastinggastric contents it is in discrete masses often includes air bubbles it is easily seen when pressed out under a cover and it floats on the surface of the gastric contents The discovery of such mucus or mucopus may give a valuable therapeutic hint to the clinician unregistered building te. awaiting gazettal hee Asbestos regulations are These are The fasting gastric contents should then be examined microscopically Gastric mucus contains the nuclei of Bs very stringent and when in force will lead to a big leucocytes whose cytoplasm has been digested staining improvement in conditions However the most important deeply with methylene blue and columnar or goblet cells Hh single factor is to educate the worker to protect himself In gastritis there may be large numbers of granular cells Be Many many times one can see expensive most effective these are desquamated glandular cells or a persistent wt exhaust apparatus rendered useless by some worker who increase in leucocytes In cancer one may and polygonal didn't like the draught pushing a bag up a duct or some other equally silly practice When one has seen the end results of these two dust diseases gross incapacity the patients realization that the steady deterioration is inevitable and in many cases the financial difficulties due to their having used up the compensation paid becomes imperative to ensure round or cylindrical cells with density and multiplicity of cuclei give the clue to an allergy : characteristic volume Eosinophile cells may pharyngeal tuucus may contain squamous epithelial cells and carbon particles Note should also be made of the bacterial population It is increased in hypochlorhydric gastritis and in cancer matches that as industry expands industrial hygiene the Expansion stride for stride f A second reason for the failure to study the gastric discharges is the lack of interest in and understanding of gastritis on the part of clinicians This is not peculiar to Acknowledgements Australia The position was illuminated by a conversation with a distinguished British enterologist Dr. X My thanks are due to Dr. Keith Hallam for his invaluable help on the radiological side and to Dr. D. O. problems Shiels our many discussions on cust . for as follows Dr. ' disease I do not believe that gastritis is a common _