Document NGVbkmEVY2vv0wgNaXLEOBe9D

FILE NAME: Saranac 7th Symposium (SSY) DATE: 1952 DOC#: SSY061 DOCUMENT DESCRIPTION: Proceedings of the Seventh Saranac Symposium with 1984 Cover Letter U.S. Department of Justice PANowinski:jf Washington, D.C. 20530 October 9, 1984 Telephone: (202) 724-6691 Dr. Gerrit W. H. Schepers Program Chief for Cardiovascular Diseases, Room 915 810 Vermont Avenue, N.W. Washington, D.C. 20420 Dear Dr. Schepers: I very much enjoyed seeing you again last week and was particularly warmed to hear that Mrs. Schepers fondly recalls our dinner with Cindy and Dr. Rubin. I also wish to thank you for your letter concerning Dr. Merewether's speach at the Seventh Saranac Symposium. Your explanation is most helpful. The complete records of the proceedings of the Seventh Saranac Symposium which you requested are enclosed. I regret that I furnished you with an incomplete copy of Malcolm Ross' article. A complete copy is enclosed herewith. I believe you will find it very interesting and I am eager to receive any comment you may wish to make upon it. Once again, thank you for your generous assistance. I look forward to seeing you again soo Vey| t Enclosure PETE& Special uj-tigation Counsel Torts Branch, Civil Division < - ,1- y - TH .si/A 7:C UvBOMAf&EY v -;;-uf ' - , Ft',fC7C L Trvttiw^ Fvw.^sKom - , Sorcirvac Lr&s, Mew York i i ! L ----- " -* ; . . ..!* I i I '- v ; - 'J f *4wi. dot m t a i k ',l- *> J--2 :**rssed periodfcakKj- tcf jit r "'---r. jxr'tiiijng to ^Ktrfbss -:::u,iLi:; u. soi-^nruu --Vni.- *n* '" 'i bxx-un. bai cts-ry h^cx bK**d itsikfci '.^nos L ?or rmnoed EWivjdusii ^ ^ par wisi tLcy ccenxra>saiy & ,TH*r x`^ `>** *3* fiapirrycr-^oj*the esipiniree, Jrvs-jasur-ed. Tht ;ct4e"* betSKifkd * *1-a %-*r W.* itv_ it. C-la ' ^s-'oausr'Mvn oi*L At ti sva- ''T * c/ eich et vvrae gr-sug* tad ': !i cypanvary tr erpks* *nu "-it t'^ t>bj-c*-** tVif nv '.' /* fee L that d b jtau * te at ' ^..'. be * j 5jr.rtsrfJ cat. * ' <T -. c. p > -,. . __p L T o*f i -gwfg>^ "" E --------------------------------~ - - - - - - i- .- f 'T T ^ r ' fe1 , v tfi. ^ - --- ^ it i i v ^ i - r . r* T L ^ < o ^ -- 1 t \ ! 5 " P 6 . ) _____ __________ i i . _______ l i \ \ i iiiii ___/ _ ' / - ^V r/ - - \ _ ^0 -- Jr "1 _ 4 l -----------J ila a l ! '* ) t ! -------- - - 1{ 1 ---- 1 -J| 5 _1*^_ ._ U -- h n in - 4 i ! * < ---- - - - - - - - - - - '~mt i - ----------------- "1i! ----------------- \ i - MZ.mm A Chairmen: P h il ip Drinker, S c.D Industriall Hygiene Stud** of Coal M itten m Two Geographical Area* m the United S to u t E. C. I. Urban Ducutsion Radiological d o t: r ation CaaHe. M. F lttA er. M D. Ditcuoioa _____ _ ------------- Pathology of Coal W orsen' Pntumoconiotit * A rthur J. V oovjld, M.D._________ / >* Ducukbcd . *4*+*#mt* t Pneumoconiosis in Coal Miners tti Aid?vim* Lc*u Friedman. M D , DifcuMioa ----------.> ft Pulmonary Function StvM et o f Cool M iners in Pcnmy-!vc~'ic and 'Wat Vtrjnrf* Hurie j L. Motley, M.D. :* Fhilotophy of Btowarixtict at Applied to Er.lnrcmmen.uil Pulmonary Cancer Morton L. Levin. M.D. Ditcuwion General Review Difuwion .. rdL-J AAettot Mnm - Diacunion W . C. HufgL_MJL Pul Cartier. M.D. A A etto t W * n Kenneth M. Lynch. M .P , 3 +L 3f< ) ! :: . ;. ' ! : . > '%J. CSrronaU W o r;rrt Discuaion Ai.thony J. I-inr. M.D. ^ ---------- *f<rmentJ Pulmonary Cancer -- General > Kn-.ru) - G. Borrough* Midcr, M.D. ^ V Dimiwion i Pulmonary Cancer fa Experimental Exposure* to Chromate A n a Btetjer, Sc-D, Diicunian W w m try Cancer fa Experimental Exposures to Beryllium A rthur J. VorwiM, M.D. .__ * /^ . ! f I -nv ^ r z *^?pect>of Fneumocontoria r rnM n: W illiam S. M cC a n n . M.D. i:. i*^., k*- ;f * ' Piacnaaioc Leonard J. Briatol, M.D. j " ftilmpnary Function S tuA ,,, Men Exftoaed ^ ^ er"TltInW,OT'<'/ Fernand Gregoire, M.D. Piacuatton rvi-- Maximum A b& ty for Physical W o rt of Diacuaaion Geot e W . W right, M.D. C ^ d i ^ c w ^ Aspects o f A c PneurnoWiUjam S. Piacuasion, led by Jamea j. Waring. M.D. Concrots of Chiaikkty Under Workmen's Computation Statutes Tbeodoft C. Water* Compensation fo r Disability and Death R e mitting from the Pneumoconioses George W . Wright, M D. George E Meredith _ M artin F. Hilnger - jk. ,KA rru^t*jL^<X>uur Diacuarion, led by Andrew Kalmykow Hoc. Mary Donlon -M- The Functions and Value of Medical Eoa-ds end Med,cal Examiners m Controverted Compensation Cases Board of Chew Cotm.' ntm, Workaea'* C<iiiijn n--tvtti b^ard. ,_-w Tod State Edgar Mayer, M-D. J. Burns Arribersaa. M.D Edward G. Vbippie, A J. Gentholt* Discusaioc AiJ^ is* ' The Presentation of Medical Eviden t m C ontroverted C om pensation Cases ---------------------, . Daniel C Braun. M - D - ---- - M -- FrarJr B am ako______ * V J Ivar S a b o u n n ^ ^ j _^C( Discussion Condition of fh* SympMium Summary o f the Medical Scoitrrt and Rcmsrki * Arthur J. Vorwald, M D. r*. wnv* V 9.-00 A-M. R eg istratio n : John Slack Room, The Saranoc laboratory 7 Church Street, Saranoc Lake New York r ' Early ar. vaU are requested to register ; on Sunday, September 21. \ 9*5 A M Address of Welcome A rthur J. Vcrwald, M.D. 10:00 A M -- 12.-00 Noon Definitions ond Clarification of Terms Pertaining to Pneumoconiosis Moderator: Asthus J. VoewALD, M.D. Panel Memberj : Anthony J Laroa, M.D. Leonard Greenburg, M.D. O. A. Sander, M.D. Richard Wagner Charles M. Fletcher, M.D. Di^usson, led by A. J. Orenatein, M t> r t. &/v ' rf- * - ; - r ' r S.a,. r C.-** ; ^'r y*'rgVSi-T?if-t.r''^fT---*V<hr'jrftf'*T*thrill - *a7--,*^'-i'V,,----V.WA' 'v^"Y'ijs*e BiTZKTE SARJJlAC SSIPOIUK T13 SAR&KAC LABORATORY of the Edward L. Trudeau Foundation, Baracso Lake, Lew York Monday S ep tc ab s ' SEVENTH SARANAC SYMPOSIUM YES SARANAC LABORATORY f tb s Edvard L. Trudeau Foundation, S a ra n a c L ake, Nav Y ork Septem ber 22, 1952 S ession Cooneneing 9c45 A. M r b# h e r* , so t h a t , ahould any o f you w ish to l* a r n of th ln g i o r w is h t o hay* h e l p , a s k on* o f u s who haT* c o lo r e d c a r d s , * A utom obile ta g s on r e g i s t r a t i o n s A number o f you hay* com w ith c a r s , and as you w ill n o t* , th*r* ar* p a rk in g M t e r s th ro u g h o u t the r l l l a g e . How*y*r, th* C hief f P o l i o * , C h ie f W a lla c e , in th e i n t e r e s t o f t h i s SyrapOB I'S*# h a s g r a c i o u s l y w aived th * p a r k i n g a s t e r o rd in a n c e a n d , on r e g i s t r a t i o n , you i^ il^ r e c e iy # a r e d e a r d , w hich w* hop# you w ill show on th e in s id e o f your w in d sh ield son*- * b * e , o t h a t th * P o li^ej D ep artm en t may s e e t h a t e a rd and not fin * you fo r haying parked overtim e, so th a t th at eard w ill allo w you to p ark arjywhere I n th e v illa g e , a s long a s i \ you w ish , d u rin g th* Spap opium. On T h u rsd a y n i g h t , we h ay * a b a n q u e t, an d we hop# t h a t , on r e g i s t r a t i o n , Jrou w i l l a ls o buy y o u r t i c k e t s f o r th e b a n q u e t, b e c a u s e j t h a t l a im p o r ta n t, a ln o * ws m ust n o tif y th * H otel management a s to th e number who w ight bs a tte n d in g , j ! Aa t o m a l l , incom ing m a il may b s o b ta in e d e i t h e r e t o r i n th # John B la ck toom o f t h e S a ra n a c L a b o ra to ry , * V by asking the S e c re ta ry , or by in q u iry a t the desk in th# foyer of th is b u ild in g . O utside o f the fo y e r, j o u v l l l f i n d a b u l l e t i n b o a rd an the w a ll where we w i l l a tte o q a t o r try to put notice fo r o f ou who m ig h t b e c a l l e d t# the phone o r m ight have sp e c ia l d e liv e ry le tte r * or o th er i k. th in g s w hich a l 'i j d com# t o y o u . lh* agenda, as y iu w ill n o t* , la a crowded on* and i t beglna every morning' a t n in a o 'c lo o lc . Than, i t w ill go u n til twelve or tw elve t h i r t y , you follow your \ / a g e n d a . T oday, wa have a e t kg Id a two "h o u r a f o r lu n c h , b e - c a u s a i t s th a f i r s t day an d Wa th o u g h t t h a t y ou w ould b a lo o k in g f o r p la e a a to have l u k e h * / On a l l o t h e r d a y s, t h a lu n c h p a r io d i s one h o u r an d d ^ a l f , How, th e r e a r e v a r io u s e a tin g p la c e s in town, w hich I know w ill naka a vary e f f o r t to serve you as prom ptly as p o ssib le so th a t you can re tu rn h are to th is h a^ l fair tha afte rn o o n se ssio n . Than, to o , th e r a a r e m a jx j o f yoA who a r e E lk s and th a s rs if C lub i s up th a s t r e e t to y o u r r i ^ h t , down th a fan ? and th a n up a h i l l and r ig h t a ^ tha to p , ^nd i t ' s a vary d e lig h tfu l p la o e . Tou a re welcome to go th e re and a la e t o in v ito y our frie n d s to jo in you, both fo r lunqh and d in n er in tha avening. j Tha ag&nda i s crow ded, a id we a p o lo g iz e f o r th a la ck of p re v ia ico a fo r p lay , but the evenings ahould a ffo rd you a s u f f i c i e n t t i n e to do aorae ol th e few th in g s f o r r e l a z a t l o n w hieh you w ish . T here a r e many o f you who l i v e a who a re s ta y i n g i n a c c o m o d a tio n s 0:1 th e o u t s k i r t s o f tow n and some o f you l iv in g in thc~a accommodations are w ith o u t c a r s . You may c a l l a c ab , o r you may go on th e highw ay in i th e m orning and s t a r t thum bing and aihould members o f t h i s ! / Sympoeiua w ith care p a ts by, I hop* t h f i th*y w ill honor thoa* w ith card* on th * ir la p * l , w h /m ig h t b* doing th* thum bing. You may v i s i t th * John -Black Room o f th * S aran a* L aboratory to th* * z h i b i t * ,/ v i s i t th* o th * r component* o f th * T ru d eau F o u n d a tio n and A1ao th * T ru d eau S a n ito r iu * - many o f you know Where th o a * / a c i l i t i e a a r * l o c a t e d . V* d* hop* and urge th a t you w ill fin d tim e to T l a it th*a* f a / e iliti* * and to explore soa* * f th* a e tiT itie a going on la th* v ario u s departm ent* f ; T h at, th en , bring* us to th* f i r s t to p ic on th* Symposium, and in th* d is c u s s io n s th ro u g h o u t th a week, I d* hope t h a t th o s e o f yop who p a r t i e ip a t* w i l l g iv e y o u r name / and y o u r l o c a t i o n s Of t h a t th e s t e n o t y p i s t may r e c o r d i t / fo r tho record* EEFIK ITIO N S AND FERTAIRIKG TO ARIFICATIOH OF Q H O F IQ S IS M oderator* A rth u r/ J* V o r v a ld ,/ X . D* P anel Hear-era t itbony J* IJan za, M. D* fLeonard O reenburg, M. D . > A . S a n d e r , M. 9* Richard V ajpar C h a rle s M. p 'le tc h e r , M. 9* D iec u siL c m , lo c - e n a t e i n , M. D* iMtoCtft* BY DOCTOR V IV A L D I .th tl th en , the f i r s t to p ic on the agen^n fo r TACT nOM PJOS .J i ' th is morning concerns the D e fin itio n s end C la r if ic a tio n o f Terns P e rta in in g to Pnevasocaniosis, end i t w ill be c a rrie d along by a p a n e l, and you can se e th e members o f th e pan el* How, in p la n n in g th e a g e r _a f o r th e Sym poslun, we w ere urged by nany co lleag u es to In clu d e fo r d is c u s s io n , the d e fin itio n and c la r if ic a tio n of te rn s w hich p e rta in to the in h a la tio n o f atm ospheric su b stan ces end which have given and are g iv in g r is e to c o n sid e ra b le debate* How, th o s e o o lle a g u e s o b v io u s ly a re somewhat d i s turbed by th e lack of u n ifo n aity is usage and d e fin itio n s o f e a r ta in te rm s, p a r tic u la r ly o f th o se te rn s which la e k c la r ific a tio n , and vhioh perm it a m ultitude of In te rp re ta tio n s , o fte n extrem ely unorthodex and fre q u e n tly confusing* Some c o lle a g u e s , a lth o u g h d e s ir o u s o f o l a r i f i e a t i m svideneed co n sid erab le pessim ism , fo r fe a r th a t d iscu ssio n a t th is symposium, in v o lv in g a la rg e group o f in d iv id u a ls , r a t h e r th a n a s m a ll p a n e l, w ould f a i l to r e s o l v e many o f th * issu es concerning d e fin itio n s , usage, in te rp re ta tio n of term s, and th e lik e* How, t h a t p e ssim ism i s a p p r e c i a t e d , b u t i t was I f e l t th a t th a t f e e lin g should n o t d e te r us from p la cin g the! topic on the agenda, believing that much good would accrue j i f no more th a n to pave th e way f o r a c t i o n by some o th e r ! l group or some o th e r panel* I t ia tru e p e rh a p s, th a t our : d iscu ssio n s here today concerning d e fin itio n s and term inology 7. W ill in v o lv e w ords, and as such, ay be loolcad upon aa be ing son*what pioayune, perhaps too academ ie, perhaps or l i t t l e p r a c tic a l value, and too d if f ic u lt to ta c k le , but w ords a r e t o o l s w ith w hioh we th in k , an d we o u g h t to t r y to s e l e c t th e m o st a p p r o p r ia te to o ls f o r th e jo b w hich we a re a l l tr y i n g to do* How, t h a t jo b p e r t a i n * t o th e i n h a l a t i o n o f I n d u s tr ia l substances and In clu d es en g in eerin g , m edicine, the le g a l p h a se s, com pensation and the lik e , so In su re th a t you a p p r e c i a t e th e d i f f i c u l t i e s In p -1a n n in g a d is c u s s i m of words and d e fin itio n s and the lik e , w hich c o n s titu te s the to p ic f o r th is session* Should the se ssio n prove d isap p o in tin g aom-- p ro d u ctiv e, then your C hainsan takes f a l l re s p o n s ib ility f o r t h a t f a i l u r e * On th e o th e r hand, s h o u ld i t b e a s t i * u l a t l n g snd s u c c e s s f u l o n e , th e n th e S jizp o slu a w i l l ewo you a d eb t o f gratitude* She framework o f our d iscu ssio n s on d e f in itio n s and ten? Inology, i t seems to me, should concern such words as "pneum oconiosis", " in a c tiv e and a ctiv e d u s ts" , term in ology fo r s p e o ifle d ise a se e n titie s , and, in co n sid erin g i t , i t seem s to me t h a t we sh o u ld g iv e o r s h o u ld a p p ro a c h i t from two p o in ts o f view p e rh a p s t The m e d ic a l p o in t o f view and th e le g a l p o in t o f view , so keep th o se thing* In m ind, and each o f those p o in ts of view m ight be e x p lo re d ; TAKES n o t PAOg 8, trcm tb * sta n d p o in t of tb * la y p r , th a gm*nl p rao t i t l o a c r , th * s p e c ia lis t 2a d liM N i o f tb* efaast, p a rtlo aI atI j thoM eoaoarnsd w ith posunoconlosis, l* g a l oouns*l, ** *lo th * p o in t o f TiMr o f eoapsnsatioa eooaissionfcrs* w ith th a t th a n , tb* f i r s t *aab*r o f tb* p&sal to p a r tic ip a te 1a th is d iscu ssio n 1* doctor la n sa , wbaa you *11 know and who n**ds no in tro d u ctio n a t th is C yapostaa. it \ 4 II i i I t 4> I NEW YORK U N IV ERSITY -BELLEVUE MEDICAL CEN TER of new m at uNJVKMrrr i n s t i t u t e O F IN D U ST R IA L M EDICINE EAST JlT mtEFT aw roue it. n.r. MAmt *77 m r r avenue, mew roe* it , *.*. MUKKATHILL -15*0 }t Septenber 8, 1952 i Di*. Arthur J. orvald Saranac Laboratory Saranac Lake, lev Zork Dear Arts ...... ,, * " closed mj eomeste on tha Panel. la you T8r7 brl*f w ritten >ora or laaa for" * tbat tt*y "V be expanded by n ita h la eoaenta aa the .e&ec say demand and would per lt plenty of roca for arguBaat. HZ counanta on chrme cancer are alao aery brief DOyou want an advance copy of that tool With beat regarde, Sincerely youra. AJLilc Ene. 8. | from th e sta n d p o in t o f the lay perso n , tha g en aral p ra c - j titio n a r , tha a p o o ia lia t la diseases o f tha c h e st, p a rtic - ttla rly thoaa concerned w ith pneum econioaia, le g a l co u n sel, and a la o th a p o in t o f riew of eom panaation eoianiss lo n e rs. W ith th a t th a n , tha f i r s t aambar of th a p a n a l to p a r tie ip a ta in th ia d iacuaaion ia Doctor Lanaa, who* yon a l l know and who n aad a no i n tr o d u c tio n a t t h i a Symposium. BY DOCTOR U L X Z k t D octor Vorwald, Ladiaa and G ontleuem You know, whan a p ra a c h o r g e ts up to p ra a ch o r whan th a p o l i t i c i a n g ats up to o ra ta , p a rtic u la rly i f ha ia looking fo r w otaa, thay tr y to c re a to an atm osphere o f poaoo and good w ill *n* g0t o rary b o d y in a k in d and am iabla mood tow ard th a m a alro a, a w a e tn a sa an d l i g h t . Such ia n o t my m o tir a . I th in k t h a t a c e r ta in amount of di.agraam ant i . h aalth y and tha ax p lo r- a tio n o f disagreem ents ia h aalth y , W a'ra concerned w ith d e f in itio n s . I often ta ll m j s tu d e n t s , whan I h a re any. t h a t i f they r e a l l y want an e x e rc is e in m ental gym nastics, tak a a pad and a p e n c il and try to w rit. d e fin itio n , a d e fin itio n of anything. I f e a v ary d i f f i c u l t t h in g to do, and thay w ill f i n i s h up sadda* and w ise r. I gov, I th e f i r s t p o in t to e s ta b lis h today, Lf we c an e s t a b l i s h i t , i s to t r y and d e te rm in e w h s. i t ia v e * re t a l k i n g about* I f we can g a t t h a t f a r I n agreem ent* maybe wa o an p u l l o u t coma gems o f l i g h t from th e d is c u s - lon. Vow, i t seams to a s , a t l e a s t from a y p o in t o f v i^ v , and p e rh a p s I am p r e ju d ic e d somewhat by a y many y e a rs o f conneetion w ith th is in s titu tio n here* th a t v e 'r e concerned w ith o ccu p atio n al diaeasea o f the lungs due to the In h ala tio n o f d u st* occupational d ise a se s which ocour a l l over th f w orld* w h ic h may cause d i s a b i l i t y and d e ath * and w h ich de not ocour except aa occupational diseases* A nan can g e t le a d poiso n in g by u sin g the wrong k in d o f h a i r to n ic * He can g e t c a rb o n a o n o x id e p o is o n in g by being eareleas in h is garage* I never heard of a nan g e ttin g a il i o o s i a working in h is garden* o r a sb e sto s is from p a in tin g up in th e g a rre tt* The ln p o rtan c e o f th e se d is e a s e s h as become reco g n ised as f a r as modem I n d u s tr ia l c o n d itio n s a re concerned* w ith in th e p a s t f o r ty - f iv e years* The p a r t i c u l a r d is e a s e which has e s p e c ia ll y a t t r a c t e d a t t e n t i o n i s th e one t h a t we now c a l l s i l i c o s i s . About 1918, Doctor Landish of the Phipps Insti tute who was one of the original group that studied indus trial diseases In this country, stated that organic dusts, j i textile dust* vegetable dust* wood dust* did not cause the . definite occupational lung disease which was becoming more j and more recognised as the evidence of surveys in many < 10. in d u strie s began to a o cw u lato , and revealed th at various d is e a s e s to vfiilch tra d e names had beoone a tta c h e d , v e re one and the same. How, th e v i l l a i n o f t h i s p ie o e is s i l i c a , p r i n c i p a l l y f r e e s i l l o a , and to a acmew hat l e a s e r e x t a n t , v a r io u s d u s ts o f e o s b ln e d s i l i c a . How a g a in , i t ' s a good id e a to get sene background in th is b u sin ess, th at ^ to su f fic ie n tly appreciate i t . Everybody b re a th e s s l i d e s in one form o r a n o ts r d u rin g h is lif e tim e . I t composes a m ajor p o rtio n o f th e e a r t h 's c r u s t , and i t d o e s n 't make any d iffe re n c e w h eth er you w alk down th e e i t y s t r e e t o r w h eth er you w alk a c ro a a th e Havada d e s e r t , y o u 'r e g o in g to b r e a th e acme s i l i c a , j u s t th e same way t h a t everybody In h a le s w a te r v a p o r. The one does n ot develop d u at diaeaaea o f the lungs) the o th er does n o t drow n, b u t when th e dotage o f e ith s r d u a t o r w ater becomes to o la rg e f o r tb s re s p ir a to r y system to cope w ith , unfortunate re s u lts follow . S o , t o r e p e a t , we a re c o n c e rn e d w ith o c c u p a tio n a l d iseases o f the lun^s caused by th e in h a la tio n of d u s t. These d is e a s e s e re o f alow o n set and a re c h a ra c te ris e d by th e form ation o f pulmonary f ib r o s is , by a v a ry in g degree o f phthikmia^Scme g e n erally accompanied of these d iseases are j j fu r th e r c h a ra c te riz e d by an in c re a se d s u s c e p tib ility tc in fe c tio n , p a r tic u la r ly by the tu b e rc le b a c illu s . They : i 11. p r e s e n t a r a d io lo g ic p ic tu r e w hich may be q u it* e h a r a c ta r i s t i c , b u t which a t tim es, a t a l l o f ua have le a rn e d to our so rro w , may b* q u ite c o n fu s in g . However, th e se X -ray film s hays - o f d u s t d is e a s e s o f th e lu n g s , show a p a th o lo g ic a l involvem ent more o r l e s s e v e n ly d i s t r i b u t e d th ro u g h o u t b o th lu n g s* tk- added f a c to r o f in f e c tio n , when p r e s e n t, may eonfuss th e d ia g n o s is , e s p e c ia lly when th e n a tu re and e x te n t o f th e d u st d is e a s e i t s e l f i s n o t known* I g iv e you t h a t l i t t l e b a ck ground, b ecau se i t has a c e r ta in b e a rin g on idisit i s te follow * Ve know a g r e a t d e a l a b o u t th e o c c u p a tio n a l d ie ease o f the lunge duo to the in h a la tio n of c r y s ta llin e s i l i c a * T har* i s , how ever, s t i l l a g r e a t d e a l t h a t ve d o n 't know a b o u t s i l i c o s i s , th e te rm comaonly a p p lie d te th is d ise a se , In s p ite o f the f a o t th a t a trem endous amount of re s e a rc h has b ssn c a r rie d on a l l o v er the w orld, n o tab ly in South A fric a . We know l e s s a b o u t th e a c t i o n o f a s b e s t o s , we know s t i l l l a s s a b o u t th e r e s u l t s o f th e i n h a l a t i o n o f d ie therm ae io u s e a r t h . Ve may a ay th e ease a b o u t s i l i c a t e s , eueh a s t a l e , and some o f th e o t h e r s . Ve r e c o g i i z e t h a t each o f these d u sts a c ts in a s p e c if ic manner upon the pulmonary t i s s u e . We have le a r n e d t h a t a c o m b in a tio n o f i one o r more d u s t s , o r th e a c tio n o f s i l i c a in eombi_nati<_u ! ________________________________________________ __________________1 a _ w ith a n o o -s llie io u a d u s t, m y a l t e r th e p a th o lo g ic a l and c l i n i c a l p i c t u r e * Ve s t i l l do n o t know to o muoh a b o i t these d u st diseases* C o n se q u e n tly , I b e l i e v e we s h o u ld ab an d o n any attem pt or h a b it of re fe rrin g to these d iseases by a g e n e r is t e r n , u n le s s a s p e c i f i c e t i o l o g i c a l a g e n t Is men-- tic n e d e ls e * The word eoamor-ly I n u se to d a y a s a c a to h - n fo r th e se d u st d ise a se s is th e t e n 'pneum oconiosis'* I t is an u n sa tisfa c to ry te n s; it* a a sloppy term , and i t 1 m a n s l i t t l e o r n o th in g . The p ro p e r te n s la 'pnaum onooon- i o s l s , a s th e te r n was f i r s t u se d by Z en k er. I t means s o n e th in g . ] However, th e te r n 'p n eu a o o o n io sis * h a s become a* w idely adopted th a t i t Is probably here to sta y , so I s h a ll n o t tr y to make any b a t t l e upon th e r e te n tio n o r the a b aa- donasnt o f th s tern 'p n e u m o c o n io s is fo r, as I say, I th in k i t ' s a sloppy term . Thera la a tendency to in c lu d e , under th is gen- j eric ta rn , various In h alatio n diseases of u n related natu re, j The tru e o c c u p a tio n a l A ist d is e a s e s o f th e lu n g s com prise a j p e rfe c tly d is tin c t c lIn ic a l e n tity , a t le a s t to those of us vho have w orked I n t h i s f i e l d an d who a re f a m i l i a r w ith i working con ciitio n a and th e e f f o o ts upon h e a lth . K etal fume ; fe v e r, ain o c h i l l s , a lle r g ic asthm a, carbon monoxide p o ls - o n in g , l e a d p o is o n in g , m ercu ry p c ie o n l n g , n i t r o u s fume 13. j poisoning, are a ll In h alatio n dlaaaaaa. fhe p ecu liar | ija p to a complex th a t e f f e c ts a f a i r n u a b ir o f paopla i f j th e y ooa* to o n a a r a h o ra a o r dog o r o a t o r a p i g , i a tarn- j i l i a r to a l l of you, b u t tb a ra la nothing to ba g ain ad by a t t e s t i n g t o lump a l l th a a a d i s e a s e s u n d a r th a same gen-- r l e t e n , u n le s s you uae the t a n 'lu n g d ise a se * th e way aoae p eo p le use the t e n 'h e a r t d is e a s e ', w hich means any th in g o r n o t h in g , d e p en d in g upon how you q u a l i f y i t # I h a re n o t is e n tic n e d c o a l* The r o l e o f c o a l d u s t i n c a u s in g p u la cana ry d is e a s e i s a t i l l n o t e n t i r e l y d e a r , p a r t i c u l a r l y when wa a p p r e c i a t e t h a t many o o a l d u s t s con ta in v a rio u s amounts o f fre e s i l i c a . I t is sTidont th a t th ere I s an occu p atio n al d lso aas of co al m iners w hloh, by its n atu re and i t s c lin ic a l m an ifestatio n s, can p ro p erly be c la s s e s a s a pneum onoconlosls. Kuch re s e a rc h work is s t i l l b e in g c a r r i e d on i n nany p l a c e s . U n til we know s u r e , i t would b e an advantage i f wa co u ld abandon such te rn s as 'pneum oconiosis' or the s t i l l so re o b je ctio n ab le te rn o f 's ilic a to s is * or 's ld e r o s ls ', and use sp e c ifie d e fin itiv e te rn s, nam ely, occupational d u st d isease o f the lungs or pulm onary fib :- os i s , i f you p r e f e r , due to th e in h a l a t i o n of s i l i c a o r asb esto s or c o a l, in such and such an Indus*, try , same in such and such a p la c e , I t assumes th a t any of th ese agents a c ts In way i n a l l the v a rio u s p la c e s t h a t i t ' s m at w ith ! the ! j on this ------------------------------------ ---------------------------------------------------------------------- fae* of the globe, and th a t la h ighly fa lla c io u s , and th a t ie th a ro a a o n why wo g a t , on th a ona h an d , a ta n d a n c y t o bo o v erly dogm atic, and on the o th e r, a d if f ic u lty In r e c o n c il in g th e c l i n i c a l p i c t u r e o f soma o f th . so d u e t d i a - ** a eo n I n d i f f e r e n t p a r t e o f th e e a s e c o u n tr y o r in d iffe re n t countries* I f you wish to give a d e s c rip tio n o f pneumoconl o a l e to c o a l m in e r s , f o r I n s t a n c e , you sh o u ld s p e c i f y , *1 a t a l k i n g a b o u t a n t h r a c i t e m in e rs I n P e n n sy lv a n ia } I ' m n o t ta lk in g about s o f t c o al m iners In Utah o r s f e t c o al m iners in A labam a', The absenee o f c l a r i f i c a t i o n o f th a t k in d is one o f the re a so n s why th e re i s so much c o n fu sio n In the general p ie tu re o f what these dust d iseases are a l l about, Zha term s 's i l i c o s i s ' an d 'a s b e s to s la ' have b e* eoae so w idely accepted th a t i t la ev id en t th a t th ey w ill eontlnue to be g e n e ra lly u aed . The d e f in itio n of * s i l i oosie* la n ot e n tire ly s e tla fa c to ry , but I t has been roeog* n5zed end accepted by com pensation trib u n a ls a l l over the U nited S ta te s , C onsequently, I b e lie v e th a t th e t* i* 's i l i c o s i s * should be r e s t r i c t e d to pulmonary d ise a se caused Ly c r y s t a l l i n e s i l i c a . How, h e r e a g a in , the am ount o f s lo p p y te rm in o lo g y ! end sloppy d ia g n o sis which I see every day, la not only troublesom e, b u t i t ' s maddening. For In sta n ce , I got a ----------------------------------------------------------------------------------------------------------- i5 - _ ] r e p o r t th e o t h e r day from a p h y s ic i a n who had warIced up a ; eaaa o f aabaatoaia and ha had dons a vary good job; tha I e l l n l o a l p i c t u r e , th e X -ra y , e v e ry th in g vaa fin e * Be had | worked up h ie oaae in f i r s t c la s s sh a p e . T hera v a a a nan ; exposed to a s b e s to s , and th e re was no argum ent as to what ! vaa th e n a tte r w ith him, b u t on h is d iag n o sis fo r the Coa- : p e n s a tio n Commission, he p u t t h i r d s t a t e s i l i c o s i s . lo w , i t seems i n c r e d i b l e t o aw t h a t a s i n t e l l l - I g e n t p h y s ie l a n c o u ld make t h a t k in d o f ^ s t & k e , a n d h a w o u ld n 't make t h a t k in d o f a m is ta k a I f h e 'd a v e r ta k en the tro u b le to fin d out what th is la a l l about. Very w e l l , f i n a l l y , X hop# t h a t we can e g re a t h a t in s to a d o f b e in g to o ooneerned ab o u t so awny o f th e se term s, t h a t wa w i l l alw ays m e n tio n t h e e t i o l o g i c a l a g e n t sued. I f p o aeib le, i t s ehem ieal com position, er the com position as id e n tifie d by the X -ray in fra c tio n method, fh ea, anybody who re a d s y o u r p a p e r knows w hat y o u a re t a l k i n g a b o u t* O therw ise, he assum es th a t he knows w hat y o u 're ta lk in g a b o u t, and he may b e w rong, en d th e o th e r t h i n g t h a t X hope t h a t we can a l l a g re e on i s t h a t n o body, e a p i t a l HO, n o body, w ill continue to w rite in th la fie ld and invent h is [ own term s to d e s c r ib e w hat he think-* be sees* i >. Thank you. ' (A pplause). BY DOCTOR V O H W J ? : F o rg o t the b e l l , n o t th a t I want to sto p Doctor 16. Lanza. I t would seem th a n , i f I may sum m arise J u a t a b i t , th a p o i n t s , t h a t D octo r Lanza i> ln c lln a d to a c c e p t th e word (pneum oconiosis*, i n Tlsw of i t s p a s t h is to r y of u sag s, and perhaps also to acc sp t the w e ll-e sta b lish e d d is -- - ease e n tity such as s ilio o s is and as b e s to s ls , b u t he dose d e p lo r e th e u s a g e o f o th e r term s and s u g g e s ts t h a t we a g re e on Id e n tify in g these conditions, or p recisely th a t I t is pulm onary d u st d ise a se , i f you w ill, In each and such a w orker in such and such a p la c e , as exposed to such and such m aterial. The n e x t member o f the p a n e l ie D octor Leonard G reenburgh, who is D ire c to r o f tbe D iv isio n o f In d ie t r i a l H ygiene an d S a f e ty S ta n d a rd s o f Hew f o r k S t a t e D ep artm en t o f L a b o r, Hew York C i t y . D o c to r G re eh b u rg to o , y ou know, aa w e ll as many o f us h ere do. BY DOCTOR GREBK3TOQ: K r. Chairman, L adles and Gentlemens D octor L a n x a 's b r i e f d is c u s s io n makes i t p o s e ib lo f o r me t o s k ip some i n t r o d u c t o r y m a tte r an d g e t down to w hat I t h i n k i s a s e rie s o f answ ers, or an answer to a a e rie s o f questions propounded by D octor Vorwald and s e n t to each of th e panel members . I tb ln lr i t may be w e ll i f we make a l i t t l e 1 T im ncM n o c l i b t doctor g g s s s n tt* Mr. C t e l x t , Iaailee cad O m tlc--o Doctor Lesaa** t r l e f dlseaadoB m kee i t possible f a r * to Skip eaae Introductory B ettor isd got dam to d ie t I think i s * series of sarwere, or a ansvsr to eerie* o f question* propounded ty Doctor YermlA end scat to osefa of tho peael s o t e n . I think It say to voll if wo neke a little diagram on tiis board h are w hich la sim ply In d ic a tiv e , o r sim ply p u t h ere to in d ic a te no f in s c la s s if ic a tio n of d is eases or the course of disease in in d u s tria l re la tio n e , but m e re ly so m eth in g s u g g e s tiv e so t h a t we w i l l have som ething to ta lk ab o u t in try in g to d e fin e our te rm s, and 1*11 re a d th is to you a f t e r in case you c a n 't see i t from where you are* I p u t on the board h ere sim ply in o u tlin e , a s e r i e s o f s q u a r e s w ith v a r io u s l e t t e r s i n t h e n . Ve have D i n th e f i r s t , and th e n -- by th e way, I 'm t a l k i n g new ab o u t liv in g p e o p le . I'm n o t ta lk in g about p a th o lo g ic a l specimens o r l a b o r a t a r r m a te r ie l* *D i s th e man g o in g i n in d u s t r y and g e ts d u st in h is lungs* L a te r on, he nay g e t d u st, d u s t w ith f i b r o s i s and l a t e r on th e r e may b e sone n o d u la tio n p re s e n t and l a t e r a n , p e rh a p s, sons In f e c tio n and f i n a l l y , some d u s t p lu s f i b r o s i s , p lu s n o d u la tio n , p lu s in fe c tio n , p lu s conglom eration* How, th e r e e r e some -- end you w i l l h e a r f r u s one s u c h r e p r e s s n t a t i v e i n s few m in u te s , I presum e -- who th in k t h a t t h l a a r e a h e r e , when th e man h a s d u s t i n h is lungs, i s a re a l pneum oconiosis, because in th e opinion of th e s e p e o p le who a re im p o r ta n t p e o p le i n t h e f i e l d , the word 'p n e v n o c o n io s is ' s t r i c t l y d e f in e s o r me ana d u s t i n th e lung or d u sty lung* There a re o th e rs , such as D octor Lan- ^ i z a , and I may in c lu d e m y s e lf, who b e lie v e t h a t t h i s w hole ' 18. area h ere, Including a l l o f tbs v ario u s sta g e s, Is re p re ssn ta tlT e o f pneum oconiosis and I agree w ith the B r itis h th a t i t ' s p e r f e c tly a l l r i g h t to u se th e te n s pneumocon io sis* as an a b b re v iatio n o f pnouajonoooniosia, and I hard ly th in k i t ' s worth w hile caking an is su e o f the ab b rev ia tio n . At any r a t e . I would su g g e st th a t to ay way o f th in k in g , t h i s whole a re a i s a f i e l d o f pneum oconiosis, and th e se th in g s nay or nay n o t be p r e s e n t. They n ay o r nay not be d isc e rn ib le . In fa o t. in nany eases, they are d is cern ib le and in nany oases n o t. depending on the p a rtic u la r type of d u st. Sow. th e s e e o n d p o in t w h ich I v u ild l i k e to make Is . does th is happen w ith organic d u st as w ell as ln o rg aaie d u s t, and m ind you. a t th e b e g in n in g . Z a a id t h a t we are n o t ta lk in g about any s p e c if ic type o f p a th o lo g y . Z want a l l the ra rlo u s types to g e th e r in th is p ic tu re , r e a lis in g th a t the co al pneum oconioale and f ib r o s ia ia a d if f e r e n t one fro n th e a sb esto s and fro n s i l i c a . V e i l , now t h a t we know, o r I th i n k i t ' s p r e t t y w ell e sta b lish e d th a t co al dust by i t s e l f , w ill produce a pneum oconiosis, and c o a l duet being an organic d u et. I th i n k we s h o u ld le a v e th e door open to f u t u r e d ev elo p m en ts ! i of knowledge and say that this can happen with inorganic ! dusts and i t may also happen with organic. I think one 19. ji im p o r ta n t d i f f e r e n c e i n th e o r g a n ic and in o rg a n ic l a p ro b - j: ably due to th e f a c t th a t the in o rg a n ic duata ara u au ally jji: *n *u k l a r g e p a r t i c l e s ix e s t h a t c o m p a ra tiv e ly a -- it j percen tag e g e ts up in to the lu n g s, b u t in th e caae of ooal d u s t, t h a t 's n o t tru e and I th in k i t ' s f a ir ly w e ll e sta b l i s h e d . Our B r i t i s h c o lle a g u e s w ill t e l l us more d e f i n i t e - j ly in a day o r two, th a t ooal d u s t w ill produoe a d e fin ite j pneum oconiosis, and I would l i k e , how ever, aa th is d is c u s s io n cornea o u t , t o s a y t h a t I th in k t h a t so f a r a s I'm c o n c e rn e d , I w ould p r e f e r to s e e th e vise o f th e t e n 'pneum oconiosis' oontinued In th e lite r a tu r e . low , what I say has ne -- I h a v e n 't sa id anything j a b o u t th e l e g a l im p lic a tio n s o f t h i s and Uie l e g a l i ^ p l i | c a tio n s a re p e rh a p s many and p e rh a p s very Im p o rta n t. They * iil to be discu ssed by s law yer. I d o n 't claim te be eraed In le g a l m a tte rs , b u t w hatever th e law yer s a id , I th in k i t ' s im p o rtan t, perhaps i t ' s fundam entally Injportant ! f o r th e m ed ical and s p e c ia lis t group in th is f i e l d , te de-- j eld e on term in o lo g y and then feed th a t over to the coapfsn- j s a tlo n com m issions and s ta te le g is la tu r e s and o th e r bodies ji who a r e t r y i n g t o s e t up th e o r g a n ic law s d e a lin g w ith c a n - I1 p o n s a tlo n a f f a i r s . ; S o, I would eay, in answer to th e f i r s t q u e stio n o f our C hairm an, th a t pneum oconiosis is a g en eric term meaning th e Inhalation of any and a l l kinds o f d u st. 20. o rg a n ic and in o rg a n ic , and h a rin g no p a r t i c u l a r re fe re n c e to tha c lin ic a l m a n ife statio n s. In the a a rly stags a, i t 's I l s p o s s l b l e t o t a l l and i t ' a Im p o rta n t to n o t e , now and f o r - j e v e r , t h a t t h a X -ray l a a r a t h e r weak t o o l t h a t wa h a r a t a j r e l y on a g r e a t d e a l . Wa h a r a dona a g r e a t d e a l o f t a l k i n g | a b o u t th a m eaning o f th a X -ra y a n d , an t i n e goes o n , wa r e a l ! i d , n o ra and a o r e , a t l a a a t I f e e l t h a t wa r e a l i s e more and m ore, t h a t th a X -ra y i a q u ite In a d e q u a te i n many way a . I t ' s th a b e a t wa h a r a , b u t i t i a in a d e q u a te . F o r exam ple, whan you lo o k a t th a c h e a t p i c t u r e o f a nan who bean in a dusty atm osphere, eren a ilie a duet, i t 'a in I p o s s ib le to t a l l tha d if f e r e n c e In th e e a r ly a tag as be twoan | th e se two, p a r tic u la r ly whan th a fib ro a ia la s n a il in Ij! am ount, and someone can e a s i l y oonfuaa th a X -ray p ic tu r e I n th e c a se o f an ir o n m in er smd be u n a b le to t e l l w hether ! he ia lo o k in g a t , r a t h e r , w h at some o f o u r c o lle a g u e s c a l l I' a b e n ig n p n eu m o co n io sis aa com pared w ith a r e a l f ib r o u s ! early stage of a re a l fib ro a ia . (. Oar Chairman also raised the question, should j; this ter* b e restricted to those conditions which are ae- j: eomp&nied by definite pathology with X-ray and clinical ! manifestations and with associated pulmonary disability, and which are thus eligible for compensation. That brings ' up the question as to what youre going to call thee. 21. diabases a f te r th e y 're found, and I agree In larg e p a r t w ith w hat Doe t o r L anxa s a i d , h u t I a g re e n o re th o ro u g h ly w ith the B ritie -i, and I have a couple o f re fe re n c e s th e re which I can read to you I f i t he canes n ecessary . X th in k w h a t we M ight o a l l t h i s these d is e a s e s a re p n eu n o co n io sis, of s a y , co al Miners, or in o th e r w ords, s i l i c a workers, and th en , with o r without in fe ctio n and with o r without d is a b ilit y . Mow, i t seems to ms t h a t i f y ou want t a w r i t s a c o n d e n sa tio n a c t and d a fin e ycxir term s f a i r l y a c c u r a te ly , you co u ld p ro c e e d on some such b a s is as t h i s , and you co u ld do a f a i r l y a c c u ra te Job, i f n e c e ssa ry adding sons were m o d ify in g te rm s to r e a l l y p i n p o i n t th e ty p e o f p e o p le whcsa you w anted to pay d i s a b i l i t y t o . I f you wanted to pay than d is a b i lity w ith i f you w anted to pay com pensation f o r d i s a b i l i t y , you would i n s i s t on th is being p r e s e n t, as i s done i n Mew Y ork S t a t e a t t h i s tim e . The n e x t q u e s tio n which our Chairman r a i s e d la the q u e stio n as to w hether th ere are a c tiv e and in a c tiv e d u sts as In , I t hi nk, -- anc I th in k th e answer to th a t is q u ite c le a r . There pro b ab ly are a c tiv e and in a c tiv e d u s t s , b u t th e te rm s a rc v e ry b a d , b e c a u s e we d o n 't know to o much a b o u t some o f th e s e d u s ts and c e r t a i n l y we d o n 't know to o much a b o u t how M uch l a p r e s e n t i n any one ty p e j of exposure. 22. I t ' s pro t t y d i f f i c u l t sometimes to t e l l when you . g e t a n a n 's X -ray p ic tu re In th e o ffic e and you ta lk to about h ie o ccu p atio n , i t ' s p r e tty d if f ic u lt to t e l l ju s t p r e o ls e ly what he was exposed to and, f o r th a t re a so n , I would th in k th a t i t would be poor p r a c tic e to b rin g In the question o f in a ctiv e and activ e d u sts. F u rth e rm o re , we h a v e le a r n e d i n th e l a s t f i f t e e n y e a r s , t h a t w h a t, a t one tim e , we c o n s id e re d i n a c t i v e , we now know t o b e a c t i v e . Our Chairman a ls o r a is e d th e q u estio n as t a w h eth er sim ple s i l i c o s i s was a c o n d itio n o r a d isea se* Well so f a r aa ! ' aw are, sim ple s ilio o s is is a d isease. I t 's f i b r o s i s w ith a c e r t a i n am ount o f n o d u la tlo n , j u s t how Bruch i t ' s Im p o ssib le to say . I went back to the 1930 r e p o r t o f th e Johannesburg C onference, and I would lik e to re e d you the d e f in itio n f i r s t used o f s l l l c e s l s , by Doctor Urban te h i s c o l l e a g u e s . He s a y s t * I f one employe a term sim p le s ilio o s is to d esig n ate a o o n d itio n of sim ple s ilic o s is un accom panied b y sim p le o r u n d e te c te d t u b e r c u l o s i s , one may say th a t due to a ta c tic a l stan d p o in t upon re s p ira to ry a i l m ent, the degree o f sim ple s ilic o s is coincides w ith the ap pearance o f a c e rta in amount of p alp ab le nodulatlon under the p le u ra and in the lung su b sta n c e '. A p p a re n tly , th e q u e s ti o n as to how much nodu"> a tlo n is somewhat in d e f in ite , and then a l i t t l e l a t e r on, i t ' s p o in te d o u t th a t, alth o u g h Urban and h la c o lle a g u e s ay th a t s ta p le s i l i c o s i s i s u s u a lly n o t accom panied by in f e c tio n , th ey quote K a ra g lia n e 'a words in w hich M aragliane says th a t s ta p le s ilic o s is , even In i t s e a r lie s t d etectiv e stag e , has an elem ent o f low -grade and la te n t tu b ercu lar in fectio n . I d o n 't want to b e lab o r the p o in t ezo ep t to say t h a t t h i s i s a n exam ple o f how f a l l a c i o u s th e r e a d in g o f X -ray p ic tu r e s nay b e, and i t ' s p e rfe c tly p o s s ib le to re a d , to f u r t h e r p u r s u e n o d u la tio n , th a n an X -ray p i c t u r e , ary* t h a t th e au to p sy ta b le s f in d i t , and th a t i t ' s p e r f e c tly p o s s i b l e t h a t we do n o t know w here i n f e c t i o n ta k e s p l a e s . I t used to be s e t up here a t 8aranao p rim a rily , and othe* p l a c e s , I su p p o se, to o , t h a t when th e n o d u les began to g e t f u s s y around th e edges was when I n f e c tio n b e gan to a a t in . W ell, I th in k th a t'a p re tty in d e fin ite and I th in k ve can not t e l l fro n th e X-ray p ic tu re exactly when in f e c tio n i s and i s n o t p re s e n t. Is th e re a s i l i c o s i s which a n tid a te s n o d u laticn and which is d ia g n o slb le f I th in k th e answer to th a t la d e f in ite ly y e s. I th in k th a t the s ilic o s is which has been produced by very Tlnely divided s ilic a , produces a disease which a n tid a te s n o d u la tio n . In f a c t, n o d u latio n is very la te in th a t type of d is e a s e , and d is a b ility does take p la c e . i 2k* { Bin, he h a s r a i s e d th e q u e s ti o n , s h a l l we u s e j in c h term s a s a n t h r a c o - s i l l o o s l s and s i d e r o --s i l i c o s i s , and i j I say I th in k d e fin ite ly n o t. I t h i nk th a t they re p re se n t J e f f o r t to g iv e a name to som ething ab o u t w hich w e 're I q u i t e I g n o r a n t . We d o n 't know J u s t w hat th e amount o f | s i l i c a is and the amount o f coal d u st i s , In an th raco - s i l i c o e i s , and I d o n 't t h i n k th e ad d in g o f a name ad d s an y thing to i t a t a ll. I th in k , i f the w n is a coal m iner, i t Is b e tte r t o s a y we haTe p n e u m o c o n io sis i n a c o a l m in e r, w ith i n f ec tlo n or w ithout In fe c tio n , w ith d is a b ility or w ithout die* a b i l i t y , and I c e r t a i n l y do n o t p r e f e r to u se a new te r * fo r ev ery pulm onary c o n d itio n a sso c ia te d w ith a a p e c ia l d u s t . I th in k i t ' s b e t t e r t e u se th e name o f th e A is t i f you w ent end the type or d e sc rip tio n o f the type o f work, a s s u g g e s te d b e f o r e , amd I a g re e c o m p le te ly w ith D octor $I Lansa in th a t reg ard . } I And, f i n a l l y , he has r a is e d th e q u e stio n as te \ I j w h eth er b e ry lliu m i s o r i s n o t in p n eu m o co n io sis. I <iont i fr>Mnk i t ' s w o rth w h ile g e t t i n g i n t o a d e t a i l e d d is c u s s io n ii;- o f t h a t a t t h i s tim e . I t p e rh a p s w o u ld come b e l t e r l a t a r in th e Symposium. B ery lliu m is a p p a re n tly p rim a rily a i d is e a s e o f th e lu n g , a s we know I t , when th e p a t i e n t has Inhaled b e ry lliu m . 3he pathology is p ra c tic a lly com pletely l i m i t e d to th e lu n g . I t may be a rg u e d t h a t t h i s Is r.o t an ! I Sots X 25. i r r i t a t i v e p ro c e ss, somewhat s im ila r to s i l i c a , l e t ua aay. W ell, maybe i t ia and maybe i t l a n 't , I d o n 't know, b u t I remember the days, in the e a rly daya o f theae d is c u s s io n s , when we th o u g h t t h a t th e h a rm fu l e f f e c t o f b r e a th in g s i l l c a d u a t waa due to i t a a h a rp n e s a and h a rd n e a a , and th e n a a b o r t tim e l a t e r , we fo u n d o u t t h a t when v o rk e ra b r e a th e d carborundum d u a t w hich waa v e ry a h a rp and v e ry h a r d , we d i d n 't g e t th e aame r e e u l t a aa we g o t i n th e c a a e o f a i l i e a duat exposure. A t t h a t tim e , we gav e up th e n o tio n t h a t the i r r i t a t i v e e ffe e ta were due to th e hardneaa and sharpness o f th e d u a t and i t waa g e n e r a l l y a g re e d t h a t th e r e m uet be soma p e c u li a r chem ical r e a c t i o n betw een th e tia su e a end the e r y a ta llln e s i l i c a . V e il, i f t h a t 's tru e and I presume i t i s t r u e , --- th e aluminum w o rk ers would seem t o i n d i c a t e t h a t a la o -- i f t h a t 's t r u e , then i s n 't th a t somewhat sim ila r to the e ffe c t of the entry of s ilic a , o f beryllium d u st on the tis su e s of the lu n g s. I n t h a t r e s p e c t , b e ry Iliu m may a c t v e ry much l i k e s i l i c a , and I th in k i t would be unwise a t th is tim e to s trik e o u t the p o s s ib ility th a t berylliisn should be classed as a pneum oconiosis. Well, I don't know that I've added an awful lot to the discussion, but it's one man's view and I think when j i t ' s slI 1 added together with Doctor Sander and the other : I TAOK rBOK FACS 26. N a b o rs o f tho p sa o l, ocrooaont oa term loology. Thonlr jt x u wo w ill bo oblo to ooao to i 1 l i members o r th a p a n e l, maybe we w i l l be a b le to cone to soms agreem ent on term inology. Thank you* BY DOCTOR VORWALDi Thank y o u , D octor G reo n b u rg . A g a in , Doc tea* Greenburg does fav o r the usage o f th e Id e n tify in g o f dost d isease as d u st d isease In a s p e c ific w orker, I should Ilk * , * t th is p o in t. D octor G reonburg, to ask one qiaoatlon, w hich I * n o t c l e a r an a t th e moment, Do you o r do n o t you fav o r the use o f the term 'pneum oconiosis ae s g e n e ris term o r do you wish i t to ba rea t r i e ted only to those duets w hich do produoe pulm onary damage! BY DOCTOR GRggMBURQi Ho, I would say - I t r i a d to In d ic a te t h a t I fav o r th e la rg e r square in w hich the term la need f o r a lt dust Inhalation, BY DOCTOR VORWALDi As a g e n e r ic term ? BY DOCTOR C-TSSNBUPG: i Tee, as a g e n erio te rm ; I th o u g h t I made th a t | very d e a r , ! i 27. I BY DOCTOR VQRVAIDt I d o n ' t know IT I ' u c o r r e c t , b u t do I u n d e rs ta n d | th a t D octor Lansa favor* r e s tr ic tin g pneum oconiosis to th e d i e t d is e a s e , or do you p re fe r I t as a g e n e ric d e f i n i t i o n ! BY DOCTOR LUfZAt The d ic tio n a r y d e f in itio n s a y s , a pulm onary d i s ease c h a ra c te ris e d by f i b r o s is , so th a t would seen to sh u t o u t th e a l l e r g i s s and a nunfeer o f o th e r th in g s c a lle d p u l : monary d is e a s e , f r a a in h a lin g . I th in k ws re d e a lin g ! s p e c ific a lly w ith the organic d u sts th a t produce fib ro s is . BY DOCTOR VOKWALD t Do y o u be l i e r e t h a t p n eu m o co n io sis sh o u ld r e f e r | to a ll dusts or sp e c ific dustsf I " J BY DOCTOR LAJTZAt To in o rg a n ic d u s t s . BY DOCTOR VOKWALD t To a l l in o r g a n ic d u s ts ! i BY DOCTOR LAXZAt I f they produce the re s u lt; a l o t of lnorganie i d u s ts d o n 't do a n y th in g a t a l l . You'r e t a l k i n g ab o u t a Zb* ' dlseasa* ! BY DOCTOR VORWALDt So you w ith to r e s t r i c t th s use o f th e ta r * 'pneum oconiosis' to a d isease T BY DOCTOR LANZAt T h a t's rig h t* BY DOCTOR YORWALD: w ill P erhaps acsaatlaa la to r on In th a m orning, aana ona dafina i t fo r u*, what is a disease* BY DOCTOR UtNZl. t V e il* i f y o u 'r e s i c k , y o u know* BY DOCTOR YORWALD I l a D o c to r L anaa s a y s , i f y o u 1r e B lo k , you know* V a il, our n e x t member o f th a p a n e l la D octor j B andar, who i s a a s o c la ts i n K e d lo in a a t M a rq u e tte U a iv e r | a l t y M edical S ch o o l, and who l a C o n s u lta n t i n I n d u s t r i a l | M edicine from M ilwanka , V ia con s i n . Doc t o r S a n d e r h a s h is 1 view s r e g a r d in g t h i s s u b j e c t , w hioh I b e l i e v e w i l l b e soaa<> I what d if f e r e n t than those w hich have alread y boon expressed! [ BY DOCTOR SANDER: D o cto r Vorwald, Members o f th e Symposium: I'M one who has b een te a c h in g s tu d e n t s f o r th e l a s t f i f t e e n 1 T in a TBM PiOX 2 * . M KCTOR 8IB ES1 Itector fcrv o ld , R o b e rt o f tJ Sjvphetvm x I'm has boon t-jamMnf etoiants fo r th la s t flft M a \ ! I i 1 i i. t