Document MM83M6oKB6xbyoyLK93Q3r5RM

. NORDISK medicxn VOL. 9, 1941, I A CASS OF LUNG ASBESTOSIS* By A, Schrurapf (St. Joseph's Hospital, Porsgrunn. Head physician: Schrumpf) (Received hy the editor 18 Nov. 1940) . *The case was referred to at the annual meeting of the Norwegian Internal Medicine Association on Nov. 2, 1940. Asbestosis is a relatively new occupational disease which has emerged and we are beginning to become aware of the dangers which could be connected with the production and use of asbestos products. Even though the disease has already been known since the end of the previous century, great attention has been devoted to it in large industrial countries only in the last decade. Even now, relatively few publications exist concerning thedisease. In Norway, there is only one by Dr. Aage Wolff, which discusses three cases. As yet, the disease has not been ob served in Scandanavia. It may therefore be justified to mention the case which has been observed abroad, so that knowledge of the disease can become more general. It is thought that the disease will prove to be more common than assumed, when physicians become aware of the conditions under which the disease can originate. On the basis of this reasoning I will discuss a case which I have had occasion to observe of a worker, and I will supplement the report of the case with some remarks of the disease's patho genesis and the conditions under which this form of pneumokoniosis can originate. 2 In this case, the patient is a 38 year old worker "in good health" at a chemical factory. He says he is the one who sees to it that things are "tight". On closer enquiry, the work proves to consist of tightening of different turrets, which the factory c has a series of. The word "tight" and "tighter" surely has . its origin in the German word "dichten" or "abdichten" which means to seal off again. The sealing off work itself is done in the open air and, according to how the worker explains it, is never, connected with dust formation. It has been shown now, however, that the people who are involved with this work themselves prepare the materials for which the tightening or the sealing is carried out. The preparations are carried out in a closed room. A fan is installed over the working place itself. Asbestos is agitated here (it is usually white asbestos; this worker has used blue asbestos only one timei together with a water glass with the aid of an air hammer until it reaches its final state. The material is stored for a week, so that on the average the special worker does this work only once a week. Dust or "drifts" as the workers call it, originates with the agitation of the masses,and this part of the process must therefore be assumed to be the one which bears the danger of asbestos. The workers discussed by Dr. Wolff were occupied with a very similar work. In general, exposure is assumed where asbestos-containing . material is handled such that dust is formed, and the risk is especially great in factories where asbestos is manufactured and processed. Asbestos is used to an increasing extent in the manufacture of fireproof material, insulation material, filters, machine seals, brake band linings, different building materials 3 and fire-fast colors * Asbestos has proven itself to be very heat resistant and acid-fast, and it has a low heat and electrical conductivity. Asbestos is a magnesium silicate of a different composition where, among other things, the amount of silicic acid can vary. There are thus 5 different types: autofylitt, amositt, amfibol, crocidolitt and krysotil asbestos. Amfibol and krysotil asbestos are used the most often. The former is brittle, but very acid-resistant, however it is less heat-resistant, while krysotil asbestos is pliable and thus it can be spun. On the other hand, it is less acid resistant, but it withstands much higher temperatures. In general, asbestos does not contain any free silicic acid. Asbestos causes reactive changes both on the skin and in the lungs. In the lungs, the asbestos needles cause a mechanical irritation, probably less than a chemical irritation. A hyaline connective tissue formation is thus lacking around the particles, which is so typical when free silicic acid unfolds its effect. Furthermore, there is the fact that in any case in animal tests, asbestosis stops when exposure stops, and this fact appropriates theories of a purely mechanical effect from the asbestos needles. Contrary to this mechanical theory there is talk of indications that the socalled asbestos bodies in the lungs are surrounded by a casing, which consists of an organic material in addition to a layer of ferruginous compound, which clearly gives a Berlin blue reaction. The number of asbestos bodies in the lungs can be very very large, approximately 1.3 million per The asbestos needles which 4 penetrate into the skin lead to the formation of so-called asbestos warts. These are like conventional worts, but on closer inspection an asbestos crystal is seen in the middle of the wart. This man has performed the above-discussed work for 10 years, .But he has participated in the preparation of- the materials for only 9 years. During the last part of the work, the use of a mask has been mandatory for the last few years, but earlier he used no form of protection from the asbestos dust. The man claims to have been in the best of health.. He was in the service. His pneumokoniosis was discovered during an ordered, routine company examination in 1939. On closer inquiry, he indicated that for the first time in 1935-1936 he noticed dyspnea while swimming in a lake. Before that, he could swim fox a long time without becoming fatigued, but he noticed then that he could not swim nearly as well as before. For a few years he had pains in his neck and nose, but inhalation treatment, which was instituted by an eye, ear, nose and throat specialist, alleviated the pain. In the past year he has been plagued with a constant, irritating cough sometimes with a mucous expectorate, sometimes it comes as a dry cough. He had dyspnea, however, it did not cause him to miss work, and he could do his work without difficulty. His appetite has been especially good, and gained weight in the past few years. Present status 4/4 1940: The patient has a pyknisk habitus. Height 173. Breast circumference insp. 105 cm/exp. 98.5 cm. P. 88 r. RR. 138/85. Date of examination 4/6/1940: pos. C15-S mrol. A simple sibilus and a partial fine rale sound is n__ j_ TT U K u<a5*i this there was 5 nothing noteworthy in the examination. The patient has no asbestos worts. - ,, -e The following was noted in a.special study: Vital capacity 4/4 13.40 2.4 1 Caverage of 3 measurementsL. 2-ray examination of the lungs showed: Small spots standing close together are seen fairly symmetrically over the lower two thirds of both lungs and configurations for the most peri- .bronchial arrangement. There are no signs of lapse of the lung parenchyma or anything which can be interpreted as active infiltration. There is no sure sign of glandular swelling 1 in the hilus, and nothing which can be interpreted surely as silicotic changes. The picture can pass as asbestosis, but * it cannot be considered as assured. Sign. Frimann-Dahl ` Ekg. 4/4 19.40 a somewhat increased ST^ *and a reduced ST^- Axis deviation leading to coronary anoxia. Diagnosis: The characteristic x-ray findings together with the man's professional anamnesis make it very probable that we have a case of pneumokoniosis, more accurately determined as a case of lung asbestosis. This form of pneumokoniosis presents many characteristic features which merit further discussion. As already mentioned, a series of cases of the disease was described in the last decade in other countries. Thus, in 1931, Lunch and Smith collected 172 cases in the United States. Also, a part of the cases was described in South Africa. A large amount of material also exists from Great Britain and Germany (Kereweather and Price, Wedler, Saupel. One can derive certain corresponding features out of 6 the existing descriptions. In contrast to other pneumoconiosis and special silicosis, asbestosis distinguishes itself by an even slower and insidious development of the fibrotic processes in the .lungs. In material concerning 363 asbestos workers, Mereweather and Price found the following distribution of exposure time and a positive finding of asbestosis: Exposure time in years Wo. of studied cases Pibrosis * 0-4 39 0 0 5-9 141 36 25*5 10-14 84 27 32,1 15-19 28 IS 53,6 20 and more 21 17 80.9 McPreeters found similar figures. In the United States, Ereeseh found 27* attacked after exposure in 5-9. and 60*, among those who had been massively exposed for more than 15 years. The cases described by Wolff had been involved in the work for 3, 6 and 21 years respectively. So far as. I can see, none found sure asbestosis after as short an exposure time as 3 years. It is therefore significant to take note of what happened. These statistics teach us that exposures must be longer than 3-4 years' in order for the characteristic lung findings to be indicated, and furthermore that a not inconsiderable part of them will not ,, .be attacked even if the exposure time lasts more than 15 years. One must thus reckon with -the fact that about 40* of the workers will not come down with the disease during their asbestos- endangered work. The fact that some workers come down with asbestosis, some after a shorter or a longer time, and the 7 fact that a part of them, under the same conditions, do not come down with the disease, has raised the question whether ' an individual degree of disposition exists for the disease. Many have participated in explaining such a disposition, but the problem can hardly be expected to -be solved except in connection with comprehensive family studies or studies of the nose or mucous membrane of the respiration system irritated by dust. Likewise, the question concerning the possible progression after the cessation of the dust exposure has hardly been opened. 4 It has been found experimentally in the animal test that asbestosis Cguinea pig experiment} appeared to go back to when the exposure ceased (Gardner! . As far as human conditions are concerned, opinions differ with regard to this practical very important question. Mereweather and Ellman asserted that suffering progressed after exposure ceased, but Lanza was of the opinion that there was no assurance that progress occurred. 'Until the question has been clarified, it may therefore be justified to remove people from asbestos work as fast as suspicious x-ray findings are made in lung studies. Symptomatology: As is evident from the earlier discussion, the disease can manifest itself in x-rays long before there are earlier clinical symptoms. The first symptom which appears is an irritating cough and dyspnea. In some of the cases there is conjunctivitis and/or pharyngitis. Later on, there is anorexia, sluggishness, breast pains, nocturnal perspiration and finally emaciation. Of the aforementioned symptoms, surely dyspnea and couching are the symptoms which deserve the most attention. 8 In most cases, dyspnea is caused by simultaneously occurring emphysema. Opinions are furthermore divided when i-1.- 'Comes to the standpoint that the disease directly influences the heart. Gardner is thus of the opinion that there is ample reason to suppose that the heart suffers in the case of asbestosis and in the case of silicosis . (As far as this last disease is concerned, up to now there are no convincing facts to explain the greater frequency of cardiac diseases among other industrial workers, when one disregards the different mechanical conditions which can prevail with the onset of silicosis, and which can influence the heartl. Workers who die under the picture of long-term lung asbes( tosis often have dilation of the right- half of the heart when they are dissected. As a rule, when they were alive, these workers had symptoms of right insufficiency of the heart. In this single case it is therefore desirable to point out the changes in the heart while they are still alive. Both the conventional examinations or studies with the aid of x-rays are generally lacking here. One can hope that an electrocardiograph study will yield something when it comes to establishing if there is a disturbance of the right half of the heart with deviation of the cardiac axis as a result. But this study has not proven to be particularly necessary. Wedler, who studied 174 workers in this regard, found the following electrocardiograph changes * in 48: 9 27 had axis deviation to the left. 3 had axis deviation to the right. 3 had extra systoles. 9 had sinus bradycardia. j 2 had sinus tachycardia. 1 had blocking of the branches, 3 had no symptoms (hone of these 3 had asbestosisl. These results hardly deviate from what will be found in electrocardiograph studies of a working group of equal size with all age groups represented. The coughs of the patients with lung asbestosis showed certain characteristic traits which deserve a somewhat closer discussion. As mentioned/ the patient can begin to be plagued with irritation in the throat which leads to clearing the throat and later a dry cough. This cough mostly appears in the morning after the worker has left his warm bed, but at the beginning it is so slight that the worker scarcely takes note of it. The morning cough then increases both with regard to duration and intensity, and when expectorate appears, the worker or those around him notice it and refer him to a doctor. At the beginning, the expectorate is slightly viscous and mucous after which it takes on a gray appearance. Microscopically, the expectorate contains epithelium cells, lymphocytes and plasma cells, but leukocytes are almost lacking. 10 The so-called asbestos needles or bodies which can be found in the expectorate deserve separate discussion. Indications of them in the expectorate does not mean that the concerned worker has asbestosis, but it only means that the worker has been in contact with and inhaled asbestos dust. These needles have first been indicated in the lung preparation in 1914 by Eahr and Teigel in Hamburg. Asbestos bodies are 20-40 mm long, thin formations, often with the thickness of a drum stick on one or both ends, and in other cases they are pointed on one end. CA nxicrophoto- graph is found in Dr. Wolff's study 1 . Due to the iron content in the coating which surrounds the needle, the color becomes bluish with the addition of Berlin blue. ' \ Asbestosis and tuberculosis: It has been very difficult to find a relationship between asbestosis and tuberculosis. Do persons who are attacked with asbestosis get tuberculosis more easily or does asbestosis make already existing tuberculosis worse It is obvious that solutions to this questions are so complicated that it requires a whole other dimension, set-up and treatment of materials than is the case with what exists up to now in the literature. English researchers such as Mereweather, Ellman and Gloyne note how frequently tuberculosis occurs with asbestos workers who remain in their profession. In.42 cases which were dissected, Mereweather found tuberculosis in 1/3 of the cases. A more recent American worker has seen tuberculosis frequency ^ to be much less with factory studies. Dreesen et al. found only 2 cases of active lung tuberculosis among 5 41 studied asbestos workers. However, this material is not correct, because 150 workers, who were questioned 1 1/2 years later, were not included. u About half of these people happened to be examined later CShull) , and it was shown that each of them had a more or less advanced case of lung asbestosis, but 20 men had cases of aso^tosis. 2 of them died or were dying of tuberculosis, and in addition to this, 12 cases of tuberculosis were discovered, of which only 4 cases were active lung tuberculosis. In this material of 71 asbestos workers, where many were attacked with asbestosis, a tuberculosis frequency of 11% was found. Me Pheeters found a tuberculosis frequency of 2.8% among workers from the same district. Otherwise, refer to a part of the individual obser vations in the literature which are without value in this connection. In his material, Wedler found 5 cases of tbc. pulm. * However, of this 4 were inactive cases of tuberculosis without cavernous formations, but in 5 cases there was a double- sided productive lung formation. But it must be noted that in three of the cases - among them one with active lung tuberculosis no asbestos was found in the lungs at all, but one had the first stage of asbestosis and the fifth one had asbestosis between . the 1st and the Ilnd stage. In one of the cases it could be said for sure that the asbestos endangered work had aggravated the existing lung tuberculosis. . .Lanza, who summarized the material in 1936 which existed up until then, came to the conclusion that there was no satis factory proof for the fact that tuberculosis frequency was greater among asbestos workers than others. This is seen to be V the general opinion for the time, although the material is not sufficient. This view will suffice until we are successful in collecting our own material for final statistical evaluation. 12 Literature L.H. Gardner: Etiology of pneumoconiosis. J. Amer. Med. Ass. 1938: XXI; 1925. A.J. Lanza: Asbestosis. J. Amer. Med. Ass. 1936: 106: 368. E..W* Wedler: Clinic for lung asbestosis. Georg Thieme. Leipzig. 1939.. Aage 'Wolff: Asbestosis pulraonium. Nordisk Hygienisk Tidsskrift. 1940:21.1. I certify thot the steff who tronsiotec the , . foregoing is thoroughly fsmsiier with th-? /ygjgygo/^ ond English languages end thet it is o true end complete translate Wanguog* Service bureau. Dupont Circle Building Washington, D.C 20036 NORDISK r 1 MED I0IN BAND 9 1941 I HELSINGFORS 1941. MERCATORS TRYCKERI Liuien. Ri.m-.: La I'tvnw Mcdicalt*. I93X:-/,j.*7:>7. : l. KcKKi<hi'HM\i: Ityaim. h;W;.v>: I'.'O. :* Knurl. U.: B-itr.K]iii.Tbk. i;*:h:'f\-239. U>hleiu l'.37: >. LN<iKijmi:Tir-IT"i..M. .J.: Klin.\V%-hf. 193l://;lio7>. Hos pitals! blende T.>3.'>:7.3:29. ibidem 1937:.\0::>X9. 17. Kvekshi-scu. (.; Med.Klin. I`i3`.'.;f.*;7l7>. is Imssiikxiikii. !'.: Z.Tbk. I'Ji'i: /2:37. ii. Fury. H.: .Schweiz.med. Wwii. 1939:1032. / 2'>. iiHASS 4 SimMhHT: KHn.Wsehr. 1931:1 I*>7. 2!. Giiavkskn, I. H.; Acta Med.Seand. I93di0tf:.j23. -- Bthl. Cor J..vucr. lU3iVJ.3y.-23.`>. 22. Hansson, N.: Acta Hudioloaica. l!J37:LS.-207. ---- Nordisk med.Tidsskrift. l937:/2.*!720. s 23. Heacock: Radiology. l932:./0.-2fl2. '2 L Hein: Maneh.med.Woch. 193X:,S.5.-3P9. 2a. ..`ACont Rev.Tbc.V.su, l<3X:f;.>9}L . 29. Jtuu.v-i)anvpet.t. <;.: Nordisk Medisuu 1991:2:1702. 27. KELLXRn. I*.: Beitr.Klin.Tbk. I032:d/:t>39. Ibidem 1933:i.t.. 2. Kinoberg. I., og medarb.; Press* Med. 194*.:4d`:277. 29. Kokttgen, L\: /LKimlerheilkumlc. 1933:.5S. 30. KiiAM.Mt: .Vrclj.Kinderhciikuudc 1931:94:81. 31. KL'nKiJAJivt, M.; .Vonfi.sk Medisiii. IU3U:rf.*37l7. 32. I.auciie: Kiiri.Wscfir. 1923:2121. ibidem. 1933:92. 33. I.kjtsk. ,J.: Z.Tbk. l!)32:tf$.-22H. Ibidem. I935:7i';337>. IhMtr.Klin.Tbk. I93>:yi:3xx. ------ Mum-luiied.\W-hr. 1037:34: 133H. ----Acta mod..sound. lOrW:;)?.-173. 33. Lofvlkr. \\\; Roil r.Kliii.Tbk. lP32:7.'7.-33.'<. ;ji5X. 5m>. .-------Schweiz-modAWhr. IM.31:(7; m2. Ibidem. I'JJU: -- -- Klin.Wsrhf. l93.V.//;297. .33. f.uim. Ha.s.yilh: 7I.KIin.Mvd. I!M<*:/.77:2!>7. 3U. Maass. L.: DculMiuincd.Wsvhr. !!<28:/.14t. 37. Magnlxson. J. Hewing: Revue Prunguise dc Pediatric. 193a:i3;l 57. ------ Ilycica. Ft-Mhtnn. 1938-.331. .33. Mryrk. If. Med.Welt. 1937:32.-1Stm. 39. Millrb, I'inkss. Ftwooco. Frikoman: J. Pcdiatr. 1937j:7:7UX fAm.J 4). Mvun. H. \\\: licitr.Klin.Tbk. U;:22:2T>4. 41. Xki:n<*aakn. K. v.: iIcIv.miMl.acta. 193'>.v'.*221. 42. Okfekma.sn. P. 4 WfLLENWRDKH, (L;Z.Tbk. I933:dd: 347. 43. Pkscjiel: Hontuenprnx. 1931. 44. Raspk. <>.: Arch.LK'mderheilkunde. 193u://7.113. 13. Sacvr. 1C.; FortsehriUo auf dent Oiohiote der Ruiilsien- slrahien. l!nn:9/. Id. Spnto 4* JIeukrk: Hootgcnprnx. 193ii:2.-25S. 17. Staiiel: Folia ibemutoiog. l!'38:55:311. is. STHir.hji. .J.: Dtsvh.Tbk.ld. 1937://:I7>I. id. Stkinknuku: Ktmtucnprax. i93. *i. SomKHUnu. II.: Acta Pcdbttricu I937r /7;.V2N. Nordisk invti.Tidsskrift I93i: /2.' I xdx. -------N<inlisk i'cdiatr.komm'SA Odn. ./uni 193d. - -- Arviitv l>i. f'.ldidhiHMi J9.'tl:/4.-2ii. ol. F. Prit..I.r.hild.l)s. I93i>:3d:l.,. *2. Wij.n. i). 4 I.ochtscmkiu M.: Svfiwvtz.mcil.Wschr. Id'dl: * /.-329. 3.3. Zoa.nsky: Wivn.mcd.Wsvhr. 19.3!://:!.'37j. ---- FortM-lritl nut dom (Wdtt* dvr Huotkvnsirahien. I931:;4;:*>7d. Transient Umg tnfiUrvliont with eosinophilia. in audition to a short survey reuafdim* transient indura tions in the Junes with increased nutniu-r idvminophtls in the blooj the author reports a vase in a six wwks old infant. X ray examination djx-losvd a bilateral miliar infiltration in the lunus with a denser infiltration in the muirccion on the left side. Lateral to the infiltration was seen a pleural cup extending along the thoracal wail. At the same time was found IV % eosinofils in the blood. The further course was very benignant and the symptoms had disappeared after .3--l weeks. The author is of that opinion that the allergic reaction in the lungs may vary with the auc disposition. Ife regards the ease as an example of d.yfflers svndroma* in an infant. Et tilfeile av lungeasbestose.* Av A. Scaxuxpr. (Sc. J.tsephs Hospital. Porsgnwn. S]ef: Overlege ScunrMPv. i (Innkommet til redaksjonen Id uov, 1940A .Lsbestosen er en forhoidsvis ny bedri/tssvkdom som hur dukk*t opp i og en begynte & bii oppinoriwom pa de farer som kunne v*re forbundet med fremstiliingen og bruken av asbestprodukter. Sfv om sykdommen aileretie har vart kjent siden slutten av det forrige arhundre, er det forst i det siste decennjum en har skjenket den stdrre oppmerk^omhet i de store industrifund. Av publikasjoner om sykdommen /oreiigger det ennd relativt fi, i Norge saJedes bare en enkeit ar dr. Aace Wotrr. som omtuitr 3 liifeiie. I Skandinavia forevrig er sykdom men tfnni ikke lakttatt. Det derfor vtere berettiget a omtaie de tilfeile som biir iakttatt fremover. sdledes at kjennxkapet til sykdommen kan bli iner aiminneiig. IleUvr ikke for denne sykdoms vedkommende svikter den uov forsliUe medisiuskt* ntrel at sykdommen vil vise **nc a vsetv mer alminnelig enn nntatt. nar legene bare bliropnmerk- .-tmnte pd de furhold hvorunder sykdommen kan oppsta. L*t i fra detle resonnement skai jeg gjore mie .for elt tilfeile. som jog har halt aniedning til a iaktta hos%n iirbeider, og supplere omtaien av lilfellet mtni en <M bemerkninger om sykdommens patogenese ng de forhoid hvorunder denne form for nnevmokonin** kan oppstd. Pasienten er i dette tilfeile en AS ar aammel frtxk* nrfcodder ved en kjemisk fabrikJw Han aneir a vsre *dtkker*. Ved novert ettersporsel viser deite arbeid seg i bestd i tetting av (orskjeilige tirn som fabrikken har en rekke av. Ordet *dikk ug Miikker* har sikkert sin opprtnneise i det lyske ordet dichten viler abdichten som betyr a tettc-igjeo. Seive dette tettinasarbeid foregir i (rilu/t og er etter hva denne arbeider oppiyser aldri forbundet med stovdanneise. .Vi viser det seg imidlertid at de folk som er be5k)eftigt med dette arbeid selv tilbercder den massed hvormeti tettingen eiier dikkinaen utforcs. Tilberedingen foregir i et iukket rom. Over setve arbehlsstedet er det anbrakt en vifte. Her bankes asbesteu (det brakes sJkait hvit asbest, bid asbest har denne arbeider bare v*rt med pi a brake en enkeit gang) ssmmen metl vannglass ved hjeip av en luftliammcr til den ferdiue dikkcmassc. Del luges gjerne opp inateriule for en uke av gaagen. sdlede* at disse spesiuiurbeidere gjvnnomgdendc bare 1 dug pr, uke er opptatt med dette afbetd. 1'ndcr bankingen av tnussen op;v> stir rikeiig stov eiier lyyke, som arbeiderne kaller dot. ug denne del av prox^en md derfor loratsettes a vare den som er asbestosefarllg. De av dr. Wolff omtaltc arheidcre Iiaddc va:rt bckjvftiget metl belt analogt arbeid. ik<?n*i sjousfare er tilsteue overall hvor asbesthoidig materiale bchandies saledes at det daunes stov. og spesielt cr rtsikwu stor i de Ucdriftvr hvor asbesten fremsUtles og bearbei<ies. .\shest anvendes i stiuende utstrekning ved (remstUlingen av ildfnst matenuie. iwHasjoiismatertale. filtrer. pakuinuer til maskiner. bvlcgg pa bremsebaud, forskjeilig byggemateriaier og ildtaste larger. Asbest utmerker 'eg ucmlig ved a v.Tre meget hctebestamUg og syrefust og dernest vvd sin durliue ledningsevne tor varme og ciektmitet. Asbest cr muunesiumsiiikater av forskjeilig sumnteti- 'ctning hvor biant annet mengden av kiselsjTu kan variere. Ea regner saledes need 3 torskjelHge typer autofvliU.amosiU. amfihol, crocidotitt oc krysotii asbest. Amflbol og kr%*sotil ashesten biir oftest anvendt. Den tome er skjor, men meget syrehestundig, dog mindre hetebestandig. mens krysotii- asbeiten er smidigere saledes at den kanspmnes. Tiigjengjeld cr den mindre syrefast. mew tiler meget hoye temperaturer. [ aiminneiighet ijsnehotder asbest ikke fri kiselsyre. Tilfeltet er omtait pa irsmotet i Norsk Indremedisinsk Forening den 2 nov. 1940. -- 703 -- e rsrrrja^r rtaktiv* forandrinuer bare i buden nc 1 . ~z*nt. Z .lsrxese vtrker miienc hoverlsakelig som ett mek&x.sk rr:-imei^- *anasynl}svtx mindrc som ett kjeraisk irrtas-rr.- Hz sst-w? ierfor uesa den hyaline bindevevs* darp**s -TOKrna: Pirtskiene som er sa typisfc nir fri kisei- >yr 'v.aer an. v=*csia& Viderv er ilet ett kjensgjerntng at <c ialfad! . dyrefonok Uanser nir ekipotisjonen oppaorer. -ac (ecu: iik;txat tar en til inntekt (or teorien om en rent sekxtak na^'ircair.c fra asbeslnalenes side. Tmot denne m*a-_w* \bit. puvisningen av at de sikaite axbest- leaeser : iaaasi er av en hybe. som bestir av organisk m;eru.< fames m lag av en jemhoirtig forbindelse. som ir ty^e.x aeisassvuttmk.sjoit. AntaJlet av asbestlcgemcr i Iwiz-rr.e kaa ?g?e neset stort. anxlagsvis 1,3 milHoner pr. em*. ---- .sojvettxuiier som irenaor iens i huden. furer tit nu:aesser. av ie sa'-ute asbestvorter. Dis.se likner vanlige vorter. sea; vm acrere eUersyti vil en kunne pivise en :!*6esLry*uui muut . vortent Oveziesaaiti arbeil bar denne maun hoidt pa tned i H> ar. <Jo har bam tars bsitatt i tilberedinaett av dikkemassen i ar. '-tier -iiiae asien av arbeidct har hruk av muske vatrt pi'ibaui o* sijsi'. patr ir. men* drt tidlipm* ikke We brukt ttwu furn f '-r befsiotiett-se mot ssbest>tovvt. .Nfumieu oppjzir d ha su*n fri'i b*euejiu. Han har utfort nii!it;rrtjcncslr. 1 Ians pueviaok:naust b*t mpdauet vd tieu pubadte. nitmemoudgr neuriftsuauarsdcehs* . IU3J*. Veil ttsermert ettcrsponod aupa bait das at but !. lKi>--3H for forste slang merket dyspue under bidtais ; ijpei. Ttdligere kunne han svomme langt uten a il: rassjostez. aes merket da at huu ikke pi land au*r k-arte mmzroi:ae?i goit som for. For et par ar t a.* bain *ir i Lb* oc nese. men rn inhaiusjoit.sbehund* iua. v:c hi* itstitset av aaU-spesiulist. hjaip godt mot sur- leteo. I :e -mmi ar htr ban desutcn v;vrt placet av en Madia, mttfr:;,? anw\* riiusss aed slimet ekspektorat. rieivis oysa om iypr.c lian bar halt, bar imidlertid ikke ort hdjii . ii ies*. uc >itt arbeiii har han kumiet skjntte uten >.iu>ke*^;.*.et- Fsrrr. .usL aroien. 5pesicit har appetitten va*rt jjtnl. o lani'' >narer a*Ket v vekt de >enere ar. ii. triers d 4 lSr46: Pas. har en pvknisk habitus. fovde m;. Sintcosafana ,a<P- 105 cm <j8 tr j^R< exp. hd.i cm .lo iZ. P'.rnutt -4 t(Mn pos. 15.'?--S mmi. Over lunuene u*res ;: n>eL imuius a en del fine raileiyd WJj.N. For vru derf nus. sariia a merke ved den vnniiuc under- wkes*e. P'. hidme nxrn a*bestvirter. Av <s.euie uatdarwkeUer skai hitsettes: Vitalkapnsitct i :>*' 'i.m ; ajenrrasnitt av 3 imilinper). Hjiitxv-u:ii.it-o^r:je av iuncene vi>te: l)et ses temmeiitf . mmc-r:k i>esae lungers ne<ire to tredjetleier tett- k.T~i fesc^er os drag for det meste peribronkialt iorrr.it. 0*et l- jngta stecer te?n til henfail av iungeparen- >v:re' t <r ..met son kan tale for aktiv infiltrasjon. Det er ;r: ahinaeif'.uKt C hilus. *u sulvdes inlet sotn nieti ..k-r:---'. :-.? '..r foraiw;rinarr. liilletlet kunne r 'f- . men !unnet kan ikke an.se?. for sikkert. >lttJl. 1' 1!lil.S.NN- }).\ ML. A'*.. ; ; `?4i 'v : -,se. .--nsnr s*e opphuyd VIV iu Hit >eiiket bTs. ionnarannksi. IT-- iarJtr^ri'tieke rwnt*nftmrt sammenhohlt *j ?iir det ovefvotcnde umt- ii.v ii* ett lill**ilr uv (lUvvinuknnitMo. rj:.cf- ise^teu: r: '`.i/rile av lun^euibe>luM*. If-im^ft --v r-rvmokoniose frembvr Here kankte- i-k- *.?rsi.* *tr: .':~;?rter rucr:m*re onitaJe. Somnevuter j.*:? r/vcft-f;:!:-- i*r#krevet *n rekko tilfello av ,syk- o::.--*. . ^iicdes hadde Lynch k Smith i J t" :?i . De ForetUt* Slater. Iru jyl- -r. del tilfvlle. Fra Storbritannia urciijrer oi storr* matvrialvr i.\Uhr- ztr'.T.. 'sVsptsjt. >srrr... Lu turn av <U* .v . - .'~-cr:---z*ir utJedv viM- yvi'ron^lenwncfuie *. ` antirv jiin,vniukiui>rr ojr <(a >;jt ;.a --i. ijirde?* asiie>fos-n &<$ ved en enna mcr langsom og snikemie utviklinir av de fibrntiske pro* sosser i lungefte. Mf.hewe.vthru & l*Tiict fant i W materinle jni 3i>3 .Uihi^tartKMdoro f.dcemle fordeiing hva ek.*pnsiSjiruslid Olf positivt fnnn av asliestuse augur: KkxpOMsjonxtid AnUlll linden. i af Ullfetle (>-- 4 . .. _______ . . . V" 11 ^............... in-- j{ ...................... ... 80 141 ai 15--lit .......................... 2k 20 nf nu*r ........... . . .. 21 ^Fibrose u 3fi 27 13 17 Oa' 0 25,3 32.t 53, -J 80.3 Mc Phesters fhmor liknende itdf. Dheesb^ i De Foreuli* Slater finu**r 27",', .iiitfr^pno idler eksfmKisjon i fj- M mj i>d"., blaul dffu .<0(11 liar v;rH inassivt '`kjtpuiiert i tin-r t*nn 13 ar. f'>o av \Vm.FF l*.kr'*vTi* tilfeili* haddo vii*rt i ijikk**arlx*id i ri^|*ktiv* 3. ** >' 21 ;ir. SaviiJt j**j# kan >.*, itar iiur**u .mdn* funnet <ikkor asln*fto<* * koei k-sitoMisjoiL'-lid mhii :: ar. I>t .*p Wcrfur av Wdydnintr a v;rr>* ij|imi*rk>*mi pa .il ;i kan >kj*. lstsoa* slatistikk.-r livriT * at ok.<}wts.i>jnen 111:1 van* liMtif'T i-mt 3 - I ;ir Tor -ft kan pavuv* de karaklvristi>kv lungvimiu. .>; <U*mest at >mi ikk*- iiiwtyddijf del av .irtMd?ptnkkeu *v**fhtdH ikk#* blir ancrojod <dv 0111 'k..(n>-i>ji'n-n fopis.aifp j ov'-r t.*> .p. Kn mu <iih*les kiuim* r*yh* nnol at '-:a tnM., av jpl>-ih`ni** ovcr<i*Mirl ikk* vil padra sykdomiuon umier a-dx^lii---- lariur ariseid. Detle at arbeidi*rne* nnd-r likfart"d* si>jin>fMrinhl far .udM*!iip<\ n*n *Uit k*rt,n* amir*-tier iwiifor*- tid, otf did at > del under >amm.* frhld **v*Hiodol ikke far syk.lntnni"ii. ii.ir hnikl del -p.ir.inai pa Uaiie ..in det ikke pksistvfer en individued snider! diaj>t>}iu f..p <yk:JiMiucteu. Aauueude fMrktawnyvn id *tt sad;m >jiu **r menintfetic delie. o-x <pjr<mlet k.m nvp}*e v>*ut*-- lost uten i forbindeLe uiedvmfattvnde faiuilit-mnler<*k-l<ei* idler imdersokel<er av nw> idler r>*Kpir:jHi>sliiti{tinfteiie% stiJvavvenpMide eyeip.k;i(er. l.ikeh*des star sjMjr^mahd oin evenhirdl ^ykdomspro- jprrspMi idler npphor av iovek>f'<i**jafn*n ennii ;*peril. Sikkert er at eksperiiueniidj .1^I1 dvts-fi*rMk mar- svmi'roki <er ut til tilbake nar ek.-|-*'*sjonen opptur*-r d^KtiNv:H>. llvu furtiol.lefie h*~ meitn-sket amr.ir. <a rr uiemiweue med Iven-yn til d**tte prnkti^k ituvl viklitfe 'porsm.il J'orskjeiliv:. Mi.nrw r.\tukh >. JCl.MMS llevder ,.i li|el*..-U (irutfreiliefer Hter ek*p*isp. tten> iip{dior. men I.\nza m**u#-r at -u pr*nfredien-; ikk- tneii -'kkerhel kan *i> -i f.o'*-kinime. luntil 'porsin.d-a Idir avklart. uni *!' .lerim- \a-re rikfu fjerne folk fra .riieid <a 'iiapl >le ipefni.yr ritni-.'er'*-?*ci>k :iii>** ': k*div `"Kn V' d itiuc.-M:iii* c'Hk*d.'.-M. .s>in>j>itn,)t`>l'n:i' S*ou <!*- irt-imrar av a*-t tidli^ept* ..rn- Ldle. k.u ykUMimt*,u !ia mamfe'lert .* nmttf.MndMVi'k leuc* for den WdiMvec a zi tvtUdiy kiiuirke sympt*tner. Cle 1'nr`le <ympttuie|' '`Mil iIIIlf1tlfH-P *e^. ,-r imtereude lluste ojf dy>pf. K"Hit hertnr i en det Mifeile konjuukti- vit I .ie - idler fan mrit t. >-ner** >htt ter iieptil amreksi. slnpf.in'1. lirV'tsun-rf-'i-. n.t !e<ve| t* n... tilshltt ttiai ia. sjun. \v de iievnle synipioiner > r -kk rt <i?/spttf?n ved ^i*Ifii Im.'it.'ii det symptom "uu jen.-r -tof"** opp- nierx.'.imllet. I lie fli-te tllfeUe har dv-plteeli -ill arsak i samtidvx iilsU'tlevaMi-ude emfysein. Meoimfene .-r fn-m- dele' didl** liar del jjtddev a ta 'tandpmrkt til iihi -vkdm- men dir.-kle mfiueriT pa tijerti-t. metier saled--' at .lei r >ii*rre vrami iti a formnd- ai aj.-rtel lider ved nsi,..(in vM ilik< ?>.. llva 'Umwi >i>h' sykdom iiiiTar. ';t fundiggiT hiLlil imfru <ivt-rl-vi.<*ttci** fakla smii ivtlrr |>.i ,'tom* hyppighet av k.miialr Ihk-lser un blunt .imlri* iiiHu*iriurl>c>il<-ri.'t nar m Ha ''t lrt i fru tic for* amircd mvkuniske furhnld, som kan gjurv seg gjeldendu vi<iJ langt kumn<' silikfP. "g >om kan iitfluerc j*n hjertct.) Arbeider** >om it dud under billedcl av Jaiurtkommen lungoasbestus*, liar ->ftc frembudt dilatasjnn uv heyre hjcrtehalvdel vd >.*ksjonen. Dissc arhviderc liar som regft ailer**d i lvnd live had $ymptomr pd hoynr' insu/flsiftis fra ]ijrtts side. Vmtskelig it drriniot i ilet enkeite tilfell** den objektive pavisuing av hjerteforand- ringer i levendt* live. li.ule den vnnliu undcrsokelsc toiler undersukelsen v*l hjip av rontiren svikter gjeme da. En kunne saktens hape at en ciektrkanliogrufisk under- sokels ville yto tin.* nar Hid jrjaldt a om det foreii cn forsWMTlse ;iv hoyr hjfthalvdl med deviasjon av hjvrtHs aki lilfulir**. Mn hHor ikke detme undersokuisc bar vist s<*g >a*rlig uyttig. Wedler som undersekte 174 arbeider i dmi lu-usikt. fant fnlgend eloktrokardio- ^rufiake forumlringcr ho* i#: 27 ;ik.'cil'-viii>jiMi lii vnstro. 3* * lliilT. 3 kstmsystnli. u sinusbrndyknrdi. 2 <irn>if.n hvk.iriJi. 1 grew--' s (*m i-iiiri-i wrb*(niiur iingen av disse 3 hadde Dis.se resultatfr avviker upj** fra hva ti vide finne ved joktrokardiograiisk undersokelse av en likneude sturre urbeidsstokk med ailc aldt*r>jrruppr rvpreseutcrt. llosten hos pu>ionlr mod Jungcasb>toe frembyr viss karakteristisk tn-kk soin fortjencr Hit miyere omtal. nevnt kan pusiHitem* til a begynn med van* plagt ;tv irritasjon i halsen som forer tii krvmting og s.*nere lurrhoste. Donne hosten inu/inner w-j fortriiwvis uin moruvuen etter at urbeideren har forlatt sin vartnc setig, men hasten er tii a bogynne mod su lib* sjeuerende at arbeid*rn ne>U*n ikke l'gsrr merke tii den m*1v. l-'urst nar iawde.infaJicne om inri*"iifii *ker Undo hva vnrighel ug inton- angar. "g nar det di*ssut**n kommer okspektorat, bender det at arbeideren eller han> mgivei5er blir ypp* merksonmn* og Jienvender seif til l**gv. Kkspcktoratet er * lii a N'gynuc mod -parsomt sliinet selift, ettorhvert far def ei gralt ulset.-nde. Mikru.'k4tpi$k innoliuider ekspekt**ratet cpiteloeiJer, Jymfosvtler og plasimaelier. mens Jeiikosytter neslen niancior. Sa*rskiit ondaic fortjfiier d* stik-tlle aslest-naier eller fegemer sum kan nunes i ek>|ekt*Riioi. I'lvisningen av -Jem i ekfjjektoratct Myr ikkc al vedkotnmende arbeider bar usbe-lnse. men lmiyr ban* al saimue arbeider bar vart i bernring mil og innamiet asbv>!>lv. I lungeprepurat er Iis5e nalvr forste gang jtavist i l!M l av Kahr i Fejokl i Jlondjnnr. .\sbe>lb~gvm`*ne er 20--m my laitge, slanke ilanneiscT, ofle md tnmmestikkforlykkelser i en elier bogge **nder. i andre tilfede lilspissol i en emit*. iEt mikmfologra/i finnes i dr. Wor.rrs arbeid.i I'a gntnn av jerninniiuitiet i det bobirg >om omgir uaJ>*ne. blir He Target blasorle veti liiseiting av beriinerbluU. .\ibestose og tuberkuiose: 1 uWL'ko stor praklisk :)(vJuing liar dot a fa brakt pa del rene -- hvis undig -- om 'let fin- nta en sammenheng meUom asbestose og tuberkuiose. FAr [wrsoner som er angrepet av asbestose, letter tuberkuiose onn andre, eller forverrer asbestosen en pA forhAnd ailerede tilstcdevarende tuberkuiose? Det er inaiysende d lesningen av disse spersmAl er su vidt kompJisert, at de! krever en ganake annen storrelse. oppstilling og l*handling av materialene enn tillelie er med det som biitiJ foreligger i litteraturen^ Engeiske undersokere .-oin ^Mireweatheb. Ellmak it Glot^e bie siitt av hror hyppig tuberkuiose opptrddte hos asbestarbeidere som var blitt arbeidsuforo i silt yrke. I 42 tilfelle som kom til seksjon, fant Mereweathsa sAleties tuberkuiose i godt g vei l/3 av tilfeliene. I nvert amerikanske arbeider synes tuberkuiosehyppigheten A rare betydeiig mindre v*d fabrikkundersekeiser. DaEXssn og medarbeidere fant bare 2 tilfelle uv aktiv lungetuberkulosc biant .'>41 undersekte osbesturbeidere. lmidlertid er ikke dette mat**riale korrekt, fordi 150 arbeidere, som ble opsngt !jr tidligcrc. ikke er tatt me<i. Uenimot halvdeicn av disse folk jyktes det senere ;t fi undersokt (.'Sjuli.), og dr: viste seg herunder at omtrent annen liver mann av iem hadde en iett eiler mer fremskreden iungeasl^fose. metis 20 maun hadde Iangt komne tilfede av asbestose. 2 av dem dode elier var doende av tuberkuiose, og i tiiiec? liertil ble det oppdaget 12 tilfede til av tuberkuiose. hvorav dog bam 4 tilfelle var aktiv lungetuberkuiose. I dette maleriale av 71 .isbestarbcidore, hvor mange var angrepet av aabestose. funtes en tuberkuiosefrekveapa 11%. Me Phesters fant blunt 2H ashe<iiirbeierfra samme distrikt eu tuberkulosefrekveas pi 2.3*,. -- Ellers refereres en dei enkeltiakttageiser ilitteraturen som er uten verdi i denne forbindeise. Weolxr fant i sitt muteriaie 3 tiifeile av tbc. pulm. Iierav var iniiulertid 4 inaktivc tuberkuioser uten kavemedanneisr. mens det i del 3. tilfede foreli en dobbeltsidig proauktivkavc-mos* lungctbl. Merkes mi dog at det hos 3 av tilfedene -- deriblant en med aktiv iungetuberkulose -- ikke failles asbestos i lungene overliodet, mens en hadde en forste stadiums asbestos og den femte en asbestos* pA overgangen mellom log 11 stadium. Ikkeinoen avtilfellene kunne en med sikkerhet si at det asbestosefariige arb^ni hadde forverret en foreliggende lungetuberkuiose. Laxza som i 1D30 resymerte det material som foreiA iuntil da, kom til den siutning at det ikke fantes noe fylilestgjorende bevis for at tuberkuiosefrekvensen var stum* blant asbestarbeidere enn Hers. Dette synes egsa A va*re den alininnolige mening for tiden, ennskjotu mate* riuJctu* ikke er uverbevi&ende nok. En f4r derfor iorelopig godla denne oppfatning, inntil det lykkes i .'ami gnet material til en avgjmrende statistisk hetiomiuels. LITTERATUR: fr If. GAnnNER: Etiolouv of pneumoconinsi<(. .f.Amer.Mr*L Ass. 1U30:///;1U25. A. .1. Lanza; Asbestosis. J.Amer.Afed.As*. 11436;70tf.-3*W. If. W. Weoler: Kltuik der Lungenasbestose. Georg Thieme. Leipzig. 1 Amjr NVolkv. .Vsbcst'Hts pulmonum. NortlUk Hvgit-nisk TUNskrtft. * Ein Fail eon Lungtnasbtitose bei eiuem eiivniischcn Industriearbeiter wire! bechr:ebefi. Dio Svmptomatoiogie uud einige in praktischer Hirutcht fur Hie i^iiigmiM- itedeutungsvoile Momente werden kurz vrurtert.