Document NeoDq5EKvkvrvRd2vzDgVwekE

'll torili. m ical Fav. Kim;. v ;miH u ,..lar >>c. 5 2 21 w Cjreat tJ3vit )treaded in cun A. I. G. McUUGHUN, M.O., F.X.C.F., London . i.;v. V.:-.ii'ai The story cM dust discuses in Great Britain goes hack a lung way. I. L. (Jollis. in his classical Milrov Lectures of 1915. ({noted Hertart SiKMicer as saying that the starting point of human progress was the "localization oi industries." There was such a localization in prehistoric factories* for the making of Hint implements at Grime's Graves, near Brandon in Suffolk, where the flint knapjjers still use tools like the deer-horn picks of their prehis toric ancestors. In 1914. Collis showed that these workers have a high mortality from silicosis. He said that it is protable that "the starting point of human progress" was asso ciated with at least one form of pneumoconi osis. U has been long known that the dust of (lint, which is nearly pure SK >-. is dangerous to health. Over 200 years ago. Thomas 13en$on. of Newcastle under [.vine, was granted a patent for grinding flints by a wet method. \i that time it was said that a man who ground the flints dry could not live longer than two years. <jur greatest localization of industries took place during the Industrial Revolution, and this was really the starting point of mtr in tensive knowledge about the effects of dust on the lung. The first notable contribution was that of Pearson f 1813). who. after many autopsies, decided that the black pigment in the bron chial nodes and the lungs was due to the in halation of small particles resulting from the burning of coal, wood, and other inflammable materials. The German jjatiudogists. on the other hand, thought that the pigment came from inside the Iwdv.. Meiklejohn f P>51) has ,k*M-riU*d the hitherto little-known and re- Rn/ortled ror publication April 7. 1955. H. M. Medical Insj*ector oi Factories. markable contributions of die Scottish pln>icians of the INOO's on the connection between disease of the lungs and cal dust; be also tellbow the incidence of anthrncosia diminished with improved ventilation of the mines. The Scottish physicians decided tiiat simple coal dust was cumj>aratively harmless and that stone dust was tiie really noxious factor. Charles Turner Thackrah, a physician in Leeds, played a major part in the study of oc cupational diseases ( including the dust dis eases) in Great Britain. In his Ixxik "The Effects of Arts. Trades, and Professions." the second edition of which was published in 1S32. he crystallized the idea that the inhala tion of large quantities of dusts of any kind can damage the lungs but that some dusts arc more harmful than others. His conclusions were tased on first-hand observation* of workers in hospitals, in tiieir homes, and in the factories. Two other great Englishmen in the history of pneumoconiosis almut the middle of the 19th century were T. Jl. Peacock and K. II. Greenhow. IVwnck first established miners' disease as an entity and distinguished it clin ically from pulmonary tutarculosis tafore little was known alxwt tacteriology and noth ing alxmt x-rays. Greenhow carried out the first large field investigations into the dusty industries of England and Wales, including the heavy-metal industries, the potteries, coal, copper, and lead mining, and even agriculture. In the Transactions of the Pathological So ciety of London (liViO-L'W) there are to be iound excellent descriptions by Ixjth of these physicians of the disease, which was later to l>e called silicosis by Visconti, in LS70. Thev even found the dust of free -ilica in the lungs and examined it under |x.larized light. Kor a long time alter this excellent work nothing much was done aitnut the dust dis eases. but alut the l*egiuning m the 20th 8.1 'i*g^&** nrrvff^if^w1 A. .U. A. archives or ixdustrial health century a new interest began to t>e taken in the problem not only in England hut also in other parts ni the woril. Alnutt the siiiri lime the temj <>f liie in general l>ey:m to in crease. and there was an urge for increased sjK`ed*i production--an urge which ha> grad ually gathered momentum. With the replace ment of hand lalior lv the machine, dusty processes have liecnme more dusty and meth ods of dust control have lagged Mtiml output. The result has l>een a remarkable increase of the incidence of the dust diseases. A noteworthy contribution in 1S92 was Arlidge's book on the occupational diseases, which was only the second to I* published in England. In 1904, J. S. Haldane and his colleagues ascriljed the high mortality among tin miners to the inhalation of rock dust. A little earlier, dust phthisis among slate workers was shown to l>e related to the dust of slate. jKirticuluriy when it had a high quart* content. E. L. Collis ( 1915) pinpointed the dust of free silica as the main cause of most of the dust diseases. He also drew attention to the role that dust inhalation plays in determining the mortality from lung diseases cxjiorienced by die general |*opulatioti. Long ago he diowed the influence of air pollution nu the mortality from lung diseases in general. Though Collis did this work 40 years ago. he is always up-to-date. He had. and still has, an uncanny knack of seeing to the heart of any problem. Just now in England there is controversy al>out chronic bronchitis and emphysema and whether they can l>e held to be caused by the iniinlatioii of dust. It is true that the incidence of chronic bronchitis and emphysema is high among the general popula tion. and the possible causes are legion. It is difficult to decide (in Arli'lgeC words> how much of the malady is "town-made'* or "trademade.'* Hut as l ul!i> .'bowed years ago. ;m agent which irritates the lung parenchyma can also irritate the bronchial mucous membrane. \t present there is one industrial pulmonary disease of which the diagnosis is made largelyon the presence of chronic bronchitis and etnplivsema. and dial is bys'ino'is. In die fast 50 years in Great Britain (as elsewhere), there has been intensive research into all aspects of die dust diseases, such as causation, pathology, incidence in various in dustries, and prevention. For the first 25 years or so. much of the imjvetus came from H. M. Medical (nsjiectors of Factories, ami prominent in the study of the chest diseases were Collis. Middleton, and Merewether. It might lie said that they played almost a lone hand, with meager facilities for investigation. However, they were helped greatly by liospi* tal physicians, general practitioners, radiolo gists. and jmthoiogists. notably Hall. Roliertshaw. Kettle. Gloyue. and Cooke. During this period much attention was paid to silicosis, and it. with tu!erculosis. was established as !>eing the cause of disability and death in most of the industries where there is exposure to the dust of free silica. Pari passu, regulations laving down dust-control measures were is* sued by the Factory Department for most of the major industries. Notable contributions were Collis's work, already mentioned, on the role of free silica and Middleton's field in vestigation i with K. L. Macklin} into tbe grinding industry in 1923. In the late '20'sa scries t brilliant observations by Cooke, i iloync. Burton Wood. Smart Mcl hmald. and M. 1. Stewart on tbe clinical, radiological, and pathological features of a new disease, which Co>ke named aslxstosis. led to field in vestigations by Merewether and Price (1950). These (irmly established diat the dust of asInrstos was dangerous to health, and it was the first time that the dust of combined silica, as opjmsed to free silica, was found to damage the lungs. The condition, as I.eggc {mints <ut. was first seen in 1906 by Murray at Charing Cross Hospital, but little or no notice of it was taken at that time. An imjmrtant landmark was the passing of die Workmen's Comjivnsatiou i Silicosis) Act <i I'US. which came into force in 1919. For the first time compensation for disable ment "f death was given in resjiect of an in dustrial pulmonary disease. The Act pro vided initial and periodical medical examina tion of all workers in the refractories industry OUST C and s-. 'p nosic i with tb spot .'.jle bercui-si rnim- *vt National was rcvi provide This wn Silicosis its first C. L. Su A Medical Silicosis groups * generj.1, field inv of sil;cr process the rari tnember Manche also car ous indt and Brj Bryson, 1949).: suit of thor* * coUcctir to^ethe niortexr At fidustrieand m come u fnxetor pensati 1927, a the V3 process blastim Ing of proces? dries) tin mi Scbem il ia m '.'S It ic ii. i- t- iS s, 1$ t 1.0 IS >- t IS *e llIC u)). is as :a. g<? ut. ng it ut s') 19. 1- inro1a:ry ,'DCST DISEASES IX GREAT 3RITAIX and suspension from the industry ou a diag with silicosis; in 1935 hematite ore miners nosis of simple silicosis as well as silicosis were included, and in 1939 slate miners. with tuberculosis. The medical officers re sponsible for the examinations were the Tu berculosis Officers of the Local Authority ad Workers with asbestosis were first comjjensaced in 1931: compensation for byssinosis was introduced in 194 i and was dealt with ministering sanatorium benefit under the by a socially constituted board. Pneu Xational Health Insurance Act. The scheme was revised in 1925. and again in 1931. to provide fur examinations by a medical M>ard. moconiosis. as opposed to classical silicosis, in coal miners was brought under the compensa tion schemes in 1943 and in coni trimmers in This was the beginning of the whole-time Silicosis and Asbestosis Medical Board under its first (and only) Chief Medical Officer, 194(3. The Various Industries Scheme was again amended in J946 to include molders oi iron castings who used siliceous parting pow C. L. Sutherland. ders and al$o blasters of any type of metal A close association began between the castings to free them from adherent sand, Medical Inspectorate of Factories and the even if the blasting abrasive was nonsiliceous. Silicosis and Asbestosis Medical Board, both The Xational Insurance (Industrial Injuries) groups working under the Home Office. In Act was passed in 1946 and altered the whole general, the Medical Inspectorate made the field investigations which established the risk of silicosis (or asbestosis) in an industry or basis of compensation in that it became the re sponsibility of the Government hut with con tributions from employers and workers. Ber process and which led to the establishment of yllium "imisoning" became compensable in the various compensation schemes. But the 1949. In 1954 all foundry workers (iron, members of the Board i stationed at Sheffield, steel, and nonferrous) iiecame entitled to com Manchester. Stoke on Trent, and Cardiff) pensation under the Industrial Injuries .Act. also carried out field investigations into vari A fuller account of the development of com ous industries, such as sandstone { Sutherland pensation in Great Britain lias recently !>een and Bryson. 1929), granite (Sutherland and written by Meikiejohn (1954). The Silicosis Brvson. 1929). and potteries (Meikiejohn. and Asliestosis Medical Board was trans 1949). But perhaps the most significant re ferred from the Home Office in 1946 to the -tilt of the formation of the Board was that Ministry uf Xational insurance (later com there was begun a systematic and valuable collection of case histories with x-ray films, together with occupational details and jiost- bined with the Ministry of Pensions). The Board was divided into a series of Pneu moconiosis Panels, lint they work in much mortem findings. the same way as the Board diet, except that At first the Board was limited to a few in there is now no Chief Medical Officer. . dustries. but gradually its scojie lias increased "The various cnmjiensatinn schemes men and more ami more dusty industries have tioned almve reflect the evolution of the study come under examination. W orkers in the re of the industrial lung diseases in Great Brit fractories industry first came under a com ain. There are comparable legal enactments pensation scheme in 1925. metal grinders in 1927. and sandstone workers in 1929. In 1928. the Various Industries Scheme included the and regulations designed to control the risks in each industry, hut they are too numerous to mention in detail. processes of mining, quarrying.'drilling, and To "Hash hack" a little, in 1936 Middleton, Masting in silica rock, the crushing and grind in his Milrov Lectures, reviewed the position ing of siliceous materials, and also isolated of the dust diseases in Great Britain. He processes in steel foundries (not iron foun covered all the dusty trades, including coai dries) and metal works, in {lotteries. and in mining, hut at that time only cases of silicosis bn mines. In 1934 the Various Industries in coal miners were recognized as licing eligi Scheme was amended to include coal miners ble for coiiUH-usation. of the miners. S3 jB h 5 :t Z \t - . .1 I r. * .f. .u. .(. arc:urns or isdostrial health such as hardhenders. drifters, nr rippers. had l*cni c'N|ni'Ctl l" >toue dust. hut MiddletOtt also showed that there was a high incidence of a lung disease among coal miners, jwirticulariv in South Wales, winch was nut classical sili cosis. Much of his evidence was drawn from the findings of the Silicosis and Asl>estosis Medical Hoard. Hollowing his |Ki{er. there !>egnn a series of intensive investigations by the Medical Research Council into the health risks of coal mining, which covered all as pects. such .as clinical, radiographic, and en vironmental (Medical Research Council Spe cial Rei?orts I [1943], II [3943], and III [1945]). The important fact emerging from this work was that coal dust by itself could cause pneumoconiosis, and this was followed, as previously mentioned, by the extension of condensation to coni nutters and coal trim mers. In 1V45. the I'ncuunvouiusis Research Unit of the Medical Research Council was set up in Cardiff, and an impressive I tody of work has emerged on various aspects of coal miners! pncumoconiiKts. This work is well known, and l propose, therefore. t> limit my remain ing observations mainly to the dust diseases resulting from work in places which come under the Factories Acts, with only inciden tal references to coal mining. 3. Stone quarrying, crushing, and dressing. This group includes workers with sandstone, millstone, gritstone, slate, granite, and other igneous rocks. The risk varies with the amount of free silica in tiie rock ami. of course, with the protective measures adopted. Recently some limestone quarrymen have contracted silicosis, hut the limestone con tained a fairly high projiortiou of tree silica.* In this group could be included rock tunneiers. hi whom the onset of silicosis may lie very rapid. As regards slate workers, a bil liard-table maker has recently received com pensation for silicosis. DEATHS FBOM SBJCQStS METAL GaNOCTS /930*95J {5 \ .h. of iat SILICOSIS Silicosis lias I*een found to !>e a cause of disability in the following broad groups of in dustries as well as in coal mining and other forms of mining, such as tin, hematite, copper, barites, and fire clay. 1. Refractories industry. This group in cludes the making ut silica bricks, furnace dismantling and rebuilding, and retort setting and rejwiriiig. Z. Pottery industry. W orkers in this group have Iwen engaged in the manufacture of Imtli earthenware and china with their various sttlidivisions and as Hint millers and polishers. The substitution of ground Hint by alumina for the placing m biscuit ware has resulted in a diminution of deaths from silicosis among workers in that pruce-*'. 56 Fig. 1.--Chart showing diminishing numbers o death* nunHist metal grinders during the (xrriod i0.ta.i051. inclusive. 4. Metal grinding. The silicosis risk in the grimling of metals has greatly diminished, owing to the replacement of the sandstone grinding wheels with artificial ones comjiosed of Carl)ommlum. alumina, or emery. Apart from the lower "toxicity'* of the dusts from these substances, the wheels are much harder tlun sandstone, anti less dust is created, lbtt the grinders of castings (iron, steel, and turnferrous) are still exposed to a silicosis risk on account of the presence of humed-m sand cm the castings. The diminishing nunil>er of deaths among grinders is shown in the chart ( Fig, l >. A. T.: L'npuhl>l'cd data. f* & an . fo: 't ;W ii 1 so - *ra * ' s* - 3o- > ** 'b A VT r*- :ai  TH . *>g. .her the i. of ottrd. have cunK"i. * mely lie bil- 2S *i Ot vri>d m bed, tone >s<tl pan rom rcicr Bvit -ion< on i on * ot hart OUST DISEASES IS' GREAT 8RITAIS' 5. Sandblasting. This job, as Meriwether (1936) showed, had a high silicosis risk. The position has altered materially alter sand !:- to lie replaced by other mmsiliceous abra sives, such as steel shot, and since the use ot sand as an abrasive was prohibited in 1949 by the Blasting ot Castings (and other Articles) Regulations. The process ot wet sandblasting of ships' hulls does not come under the Regu lations I because legally a ship is not an arti cle). but it is thought tint there is also a risk ot silicosis in the job. Sandblasting is still used in the open air on works ot engineering construction, e. g., in order to prepare large metal surfaces for die application ot paint. 6. Manufacture of abrasive soap. Middle ton showed in 1936 that the manufacture of abrasive soaps carried with it a risk of acute or sulwcute silicosis. acconqwmied hy tulierculosis. There was a disastrous exjwrienee at one factory in London Ijetweeu 1921 and 1928. when there were 13 deaths among 81 workers. This experience led to rigorous dust control in the processes, but between 1941 and 1952 there were nine deaths from silicosis among this type of worker. It is not possible to state the incidence of disease and disability, because there is a rapid turnover of lalwr (_mostly young women) in the job. Silica (four is still being used as an abrasive, though efforts are being made to find a less harmful substitute which will l>e acceptable to the manufacturers and the users. There were no new cases of silicosis in this trade in 1953. 7. Foundry industry. The iron and steel foundry industry has been investigated in great detail during the past 10 years or so, and the results were published in 1950 in book form by McLaughlin and others ('`Industrial Lung Diseases of Iron and Steel Foundry Workers"). Pathological studies of 64 cases, 05 well as clinical aud x-ray examinations of <ome 3000 workers, showed that -there was a varying risk of silicosis and mixed dust pneu moconiosis i tu which reference is made lielow) in the various categories of foundry workers. fact that the dust from the pneumatic hammer is not cunfrolled. The main pathological lesion was classical silicosis, with or without tuber culosis. Among iron fettlers, the risk was not so great as among steel fettlers, and the main pathological lesion found was mixed dust pneumoconiosis, though classical silicosis did occur. Steel moldcrs were less affected by dis ease and disability than iron moltlers, though statistically the incidence of x-rav abnormal ities was greater among steel workers. More deaths occurred among iron molders, and this fact api>eared to be related to the use of siliceous parting powders. The use of siliceous j>arting (xiwdcrs has now lxcn prohibited by the Foundries (Farting Materials) Regula tions, 1950. Silicosis still occurs among shot blasters of l>oth iron and steel castings, but the risk is controlled by ventilation and per sonal protective devices, and the numbers of cases and deaths, in contrast with the experi ence among steel fettlers, are nut increasing. Other categories of iron and steel foundry workers are subject to much less risk than the above groups oi workers. New and strin gent regulations (.Iron and Steel Foundry Regulations) wore issued in 1953. They re quire strict dust control in the dusty proc esses. The question of pneumoconiosis among nonterrous foundry workers is now l>eing ex amined in detail. Isolated cases ot silicosis and mixed dust pneumoconiosis have occurred among ixjth casters and dressers of nonterrous metals, but an extensive survey has not yet been carried out. Harding and McLaughlin f have descrilwd the pathological, clinical, ra diological. and environmental details of six fatal cases. Table 1 shows the nttmlwr of new cases of pneumoconiosis (i. e.. silicosis and mixed dust pneumoconiosis) in foundry workers diag nosed hv the I'ucuMiocotifosis Panels in 1953. These figures can !e regarded as an under statement of the real (tosiiiou. More than half 4teel fettlers i dressers or castings cieau- *t H.irbintf, H. K.. and \fc(.aitclilin. A. 1. G.: lid a severe risk, largely owing to the Tn !* imblWutl. 87 7 a. jL \9 .i uL- A. M. A. ARCHIVES OF INDUSTRIAL HEALTH Table 1.--Nrt\ C>tsc: of Pneumoconiosis--1953 ['oundries Total Iron tnuMIttv................................................................. J7 Iroo ijr^timr.................................................................. ;j lrt>o foundry mnwkout......................................... 1 $tl moldis*........................................................... * Steel Jrmloe........................................................... is XotifcrrotM Ortwin*........................................ 2 WcHtn tod Unman flo 'wjitin** Htasiag tooot) .................................. 10 Oeaeral foundry work............................................ Ji* Total................................................................. 1M * Tw*atr-eTfl o( thw orken tied aiao Deeo tspoeod to eomt (idee (or rarrfnc (a-nod*. of the cues in iron molders came from one area where there had been an x-ray survey of three foundries. If more iron foundries had been similarly surveyed, more cases would have been found. In certain steel foundries the dressers (chippcrs or castings cleaners) are x-rayed each year, hut a complete picture of the true position will not lie obtained until ail workers undergo periodical medical examina tion. This statement also applies to other dustv industries. In Table 2 details are given of fatal cases of silicosis and asbestosis investigated fully by the Medical Inspectorate of Factories between 1930 and 1953. The average ages at death and the length of employment in the dusty indus zi tries are also given. 5 % It is seen that as regards silicosis the manu facture of scouring powders and sandblasting \x were.die most dangerous industries, with trie lowest average age at death and the shortest average period of employment. Another in teresting point is that tuberculosis occurred in alxmt half of the cases of silicosis, whereas it was found in only about two-fifths of the cases of asbestosis. The average age at death and the length or exposure in the cases of as* bestosis were much lower than in the silicotic gToup as a whole but more on the level of sandblasters and makers of scouring powders. The connection lietween asbestosis and cancer of die lung is becoming clearer, and in one series of 100 autopsies on asbestosis cases j there were 25 cases of cancer of the lung. Wyers (1949) has pointed out that the x-ray Piuter? SllleotU............................................ Silie*til# with .......... Xlllwl* ............................................ SJIfco*U with tuittfeufotia.......... rtrfMfnt <>f SMtafei . SlUewia ............................................ Sllfeunf* with tutwmiltM*.......... SIHnwl* ...................v..................... $<iko*ls with ml>*rail.*-ii*.......... Mamifwrnin. .( wvMirfiut uwfc*n Silk-'**!-*.......................................... with .......... xtlirti*i* .......................................... Sillerwi* with tul*miloi`i^......... Tutni SillfooiS........................................... Si|in,4i with twlwfi,1tlil*........ Ailrti>'l* ........................................... A.l>*fois with tui,rfiilo*i........... Investigated by Factory Department, 19S0-1933 >atW. So. iimut AIVMwiaht. Vr. Duration oi Employment LooVmr.s*. Shortcat. Yr. Avrm<. Yr , rv> *1.7 2*.4 *17.9 5.* 34.7 . *tr -HVl .o O.i) 19.0 . =9 .17.5 5S.0 5.0 37.4 . io .v 41.0 14.9 B9 , ill .Vt.l* i.S 33.0 <4 47.0 1.7 1.1-4 . `*9 4*4.3 .<* i.v 13.1 cf F p | ? tf ! }\ y * . i* Ul t ::7.u y:i >; tits (1.7 < T, , 7.0 l . r** w.i :.7.0 1.5 u ' t . 211 vl.d 50.0 t.T 74.? \ . I.'.U V.t 1 j:. t..*, W.I . 1 !* ,\4.4 07.0 0.7 .11.3 + . r W.3 tj0 1.5 14.0 . j7 to.s 73.0 0.3 11.4 Y ?Pr :oni* 'roc oea r ni t\-triex h; she of a- Wor boil. h- - Jit on 2Ui *] Co 2U '-.at Co So 'SC. rje. pcs lati ess -W ZT(the the ria JVt be 'OO cs; TASK lUSTOKIICSOK U MALK IWTIKNTS WITH ASMKSTOSIS C !,i sc iti). n. iuit. I j\ km-:. 2 J.W. I'l. Durat. IK4** i't. expos.. t;ue yr* Smcikuij;,.. 0 history . Occu|Kitum 58 \V 20 2 pk'/riuy 20 yr. Hod earlier . 46 U* ? 2 pk./day ? vr. Ironworker 3 c.m.c,. 55 *1 11. MO. 71 5 C.J.It. 61 6 ILK.II. 60 7 K.J.II. 8 ILK. <) <;.s. 65 62 6S ID w r.D. 60 11 t; iL 61 N > - ?- Shipyard worker - \V 40 i pk./day ? \ r. * . Ret. bricklayer \V 30 2} pk./day 10 ' . . Pijw insulator yr.: stopjvd K yr. piinr to death . . * w IS 1 pk./day 20 yr.: - 33 yr. In asbestos . ' niftf. & 16 yr. as nshcsU* insulator \v 40 * 1 pk./day 40 yr. 53 yr. In nsliestos infj:. w None Noiuv Carpenter known w > . 30 yr. Insulation worker; worked with* Kiherglas many w 40 I } pk./dav 46 yr. yArs*lx*tos .handler \v 30 .? OccupaL e.\|M)s. to (IMVKtlH & tnnKucHUin F'Cowe. C.rAoo^ ex. x*A. 1UV. Career < ASK IUSTOUIKS OK U MAl.K PATIKNTS \VITIIASUKSTQSIS _ l*t. no. iuit, 1 P. K.K. 2 J.W. Pi. Dural. age, 1*1. >f. .ht yr. Smoking, .* liisiixy . Omi|Miinn 58 W 20 2 2< yr. Hod cnrticr . 46 w ? 2 pk./day ? yr. Ironworker . 3 C.M.C. 55 1 II.M.C. 71 5 61 6 II.K.II, 7 8 P.K. 0 C.S. 65 62 68 III \V (Ml. 00 11 C II. M N> ? `' S1j>ynrd wtwker \V 40 I pk./day ? \ r. _ Rh. bricklayer' \v 30 21 pk./tkty 10 T . Pipe insulator yr.j H yr. . pi lor In <(; tft ' u* 48 I pk./d.iy 20 yr. 33 yr. in asbestos - mfg. & 16 yr. ns .nlcsto* insulator w 40 l pk./day 40 yr. S3 yr. in nslicatos w None .' . None *yf|6 Carpenter \v kmn7 vit . 30 yr. Insulation worker; worked with' KilHiglus many yr. W 40 I \ pk./d.iy 46 yr. .'Vdx**tns handler W 80 . t' Decimal. expos. _ to nslcsi<H <3: nwinnoaum F*ov*\ CrAoutl#et tk\, li mu Career IS: II* bHsl < am: msioKins ov u mai.k patients with asiikstosis 0.1H* n. no. inil. -- - I IMv.K. 2 ).\V. rr. o:<\ >r. .. . 58 46 3 <;.M a' 55 l li.M.t;. 71 5 r.i 6 li.K.JI. 60 7 ij.ii. 8 r.K. y c.s. r.5 62 68 J*l. i;u v Dural. cnjhh.. >T. SuioIcuik history W 20 2 |k./<lay 20 vr. W ? 2 |i*./tla>* ? yr. N} ? w 40 t pk./day ? \r. \v 30 2J pi../day 10 ) r.: stopped 8 yr. pi inr to death . w IR 1 pk./d.y 20 yr. U' 40 I pk./dav 40 yr. \v None kiumn \v > . Norn* .10 yr. Hod earner Ironworker . Shipyard worker Krl. hrichlayer ri|K? insulator .13 yr. in asbestos niftf. & K> yr. as aslrcsto* insulator S3 yr. in nslwstos mf|'. CariKtiUr insula inm worker; vorkctl with' KilKigliis man)' to \v r.n. 60 u* 10 1} pk./dav Ad yr. .'Wiesfos handler 11 <; it. 6{ w 50 ? ` Occun.it. u.\|ww. to SMTHllH 2k magnviuiti F*owr. C-orAou*, ex -OkX, C&*c*r S:U$i-W ( .1 of ' !iy ' vtt ind us- numg the test inred eas the ath a$- :otic I of lers. and id in ases ting, t-rav 4.7 .o 17.4 IM S4 11.4 U.1 u 7.9 U4 *t.i 4-1 1U 144 11.4 'L'S GREA 8 Rt 'i A A' appearances oi asbestosib are undergoing jOiue change m that nodular as op[X>sed to fitTromui-giass shadow* are loginning to ap|x-ar. 1 le tiunki it probable chat this is In/cauae oi the lessened exposure to dust over a longer l**riod. owing to the rigorous application ot exhaust ventilation to the dusty processes and the use ot personal protective devices. Cases I oi asliestoris. however, are now ap|>earing in ` workers who do asbestos lagging ot pipes and boilers. In this process, particularly it as bestos is l>eing sprayed, it is difficult to apply adequate protective measures, more especially because the workers are usually peripatetic. PRESENT POSITION How many cases of pneumoconiosis (sili cosis, asbestosis. coal miners' pneumoconiosis. In ail industries there were -3789 deaths from occupational fibrosis of the lung in the 12-year [>eri<xl. ami it will seen that the total yearly liguro arc g-mig up. Over the same period there were '>907 deaths from nonoeeupntional fibrosis of the lungs. About twothirds of the total number of deaths in the occupational group occurred in coal miners, who form the largest group (aliout 700,CCO; exposed to dust inhalation. The figures rose steeply from 232 in 1940 to 937 in 1951 (in 1952 die figure drnpjxrd slightly, to 912). It may well be that part of the increase is due to more accurate diagnosis, or at least to greater interest in- the pneumoconiosis problem, among coal miners. In Figure 2 is shown a comparison, based on the crude figures of Table 3, between the coal miners and factory Tails 3.--Deaths from All Types of PntMmoconiosis in England and Woles, 1940-1951 CnltoO latJuftrr 1940 1941 IMS IMS 1944 194a 19*4 1947 1946 1940 I960 1061 ToUl a 47 41 32 41 49 54 46 51 73 R 006 ................. JUS ss 44 71 57 (*l HI n* t 71 770 n................. 1 s 1 ; IS 3 .17 44 355 .................. 16 is 7 7 $ 10 IS 13 s s 117 i is 4* i *347 .................. 2W 1 90 *7 in >7 421 :.77 <a 7745 540 xn *>.*16 4fl * IS w lit :.i '41 10 64 42 u ........... u 17 11 1 Hi 11 10 t.'l i;. 17 IS is 173 ..................................... 6 7 1m 9 4 11 * a *3 O* HU jaw AM S.7*l Soouecut>aUonai ........................................... Hit m K4 ill *494 <116 Hill 304 070 Tat 6.907 ctcA occur in Great Britain? It shuultl !>c mentioned disc at the present time it is im possible to give accurate figures of die popu lations at risk in the various trades ami proc esses. Both the Registrar-General and the Ministry of Labour classify occupations in groups too broad to give specific figures of the populations in the dusty industries, and those in the possession of employers' asso ciations and trades unions are not complete. It may be possible in several years' time to give more accurate information. .MI that can be done now is to state the numbers of deaths reported to the Registrar-General and to give the figures for one year of the niw cases diag nosed by the Pneumoconiosis Panels. The deaths from all forms of pneumoconi osis between 1940 and 1951, inclusive, in England and Wales are given in Table 3. workers. In die factory processes, the yearly number of deaths was going down until 1943, hut there has been a slight rise in die later years. In both groups, it should be emphasized that the deaths in each year are related to conditions which obtained in mines and fac tories some years previously, possibly 10 to 20 years or even longer. . Cases in Factory Occupations.--The following Table 4 gives the numbers of new cases of pneumoconiosis diagnosed by the Pneumoconiosis Panels in 1953. These fig ures have been kindly supplied by the Minis try of Pensions and National Insurance, but it should lie noted that they differ slightly as regards the numl**rs in each occipiation from the figures originally supplied. The Ministry usually classifies the cases as falling into the 39 ;l s' 4. 11 1: r( <ji Sr I: * i li I w. AKaurns or ixdcstfhal' health PHTH3 R(X HI TTPg5 Of 9WCUW0CgM05l5. ^ -- ofl. --'-- "W '** ** M w '*,'1 aasausasuu VT mt mt mt > xu nu - >*r w*< Hr. 2.--Chart showing trends of deaths from fibrosis of the lungs among coal miners and factory workers during the period 1940-1951, inclusive, category of the Inst jobs Hone by the workers, whereas Dr. G. 0. Williams, of the Factory I k-pnrtment. has reclassified some <*f the cases mi the basis of all occupations Hone hv each worker in order to determine the most likely cause of the pneumoconiosis. There were $96 cases of pneumoconiosis diagnosed, and tilts figure includes 54 cases of hvssinosis. The cases with an uncomplicated occupational history mnnJ>m*fl f o. and in the remainder there was exposure for varying pe riods to other dusts, mainly coal dust. Addi tional exposure to coal dust occurred mainly in those industries situated iu coal-minimi areas, such as refractories, stone (sandstone and granite), jHitterv. slate, and foundry in dustries, The pottery industry contributed the greatest ptunlvr of cases (353. mainly sili cosis). ami the foundry industry came next with 1 SO cases. There are roughly 25.0CO pot tery and' about 220.000 foundry workers (iron, steel, and nouferrous ) ; so it is probable that the (xmerv industry has a higher pneu moconiosis risk titan foundries, Such general statements are not of much value, because the risk varies from prixess to process within the same industry. The substitution or ground flint by calcined alumina lias reduced the sili cosis risk among placers of biscuit ware in potteries, whereas the fettling of steel castings is still a dangerous job. .Vm1 Cases in Mining.--Table 5 gives the numbers of new case* of pneumoconiosis oc curring in ;dl mining MjKTntinus in 1**53. These figures show dearly the tremendous problem which faces the coal-mining industry. There is no s|ice to give in detail the varying degrees of severity of pneumoconiosis found in the 404^ cases, hut the figures are given in the "Digest of I'neumoconiosis Statistic? a* tT ft * * * . i. flt K 1 V. i tv Table 4.--.Yrw Cnsts of Pruinotoniosis--l9!3 Factory Occupations No OtJf Jruluftrr in Hfractnri* ........................................................... . r-> Slone worker* <*rwii<io<*. crauii*'............... . |J> Pnurft .................................................................... . <n Slat* worker* (imrrylnc m*I -iMIltln* i ... . i.ii Fnathlrteo .............................................................. . E.ttMMiim L* *M til * l.*4 () S*n<lMmtlnir ...........'.............................................. (SI "hot MrmIiik........................................................... 1111 Korn*,-* tlfoinnoilinir. (................................... . Mm Itullrr wail/tt........................................................... . III Ahrai>ivp h*>i manoinrhi/r.............................. . . 1^1 Al.rn'lvp ,,.ii |w.w.h*r .................................... Ml Oratihlit- niHl rririi i-ln-tr*-!,-....................... . 4 IT 1 3 H 1 . . Total.................................................................... '* Tt Othff Pirn Espti-urc i.'nn in in 3 39 4 4 oth*r 13 9 T i h3 .. U -- -1C, TS Tnta iTi 'VI V4 (iM l!< 9 Tl 0 3 .. 1 10 Tt fJH 90 DLT'' <, H Ml 1 `.V u- m*oNmo* i >-. lust. for ; Po^ . me:disn'.i.. disable Thdiiv.it" tunr;e: seve-e uc Abr partm du-ts. to du uhr, the s: lished the iu has a and r contr dergr most beetf inter) becat tosis, patio can. i lungoften diwl by tl (192 pi ST DISEASES IX GREAT HR IT. IIX X vjtr .\'i**rv Cases of Pneumoconiosis--19?3 Mining * lO'inMry N". , | i . n| miniflf..................... Tin Miiinritr . ................... , Itartir- mnntu:. ......... . j 41 Vif" ciay mihmih; '........................... i;i ijtnrf Wav Kiinin*.. .. ............................. mi Htmaott 'itvo nit.................................................... i; i U-ti-1 ininnw.... ii fnmti-lhti; ............................................................. 4.IM3 S I l' * :l Ti.lnl.......................................... Ti'TJ \w rav"- lit rhfft, oil liatr. ef (ratllfcal Irunatofl* minin*. K\.<iri<^n rtf day miners <fr l.u fStHinnJ lo <*ual for 1953A issued by the Ministry of Fuel and Fuwer ( 1954). It can l>e said. however. that more than 50% of the cases had only slight disability, and only about 3% were totally disabled. The number ot cases in hematite mining is diminishing, but the small num!>ers found in tunneling are usually instances of rapid and severe silicosis. IH'STS OTHER THAN SILICA, ASBESTOS, AXD COAL About the middle 1930's the Factory De partment began to turn its attention to other dusts. Middleton, in his IV3<> review, rcM'erred jo dusts, such as tri|>oli. sillitnanite, kieseli,'uhr. talc, china clay, ami fullers' earth. In the same year Hoig and McLaughlin ixiblished a paper oti the x-ray appearances of die lungs of electric-arc welders. Front this has arisen a world-wide study of the iuert and radiopaque dusts, and notable American contributors have been Sander. Enzer, Pen dergrass. Vorwald, and Hamlin. Perhaps the inost interesting outcome of this study has twen the alteration of the approach to the interpretation of x-ray films of the chest, because the x-ray features of siderosis. baritosis. and stannosis. in the absence of occu(ational histories and clinical e'.xaminations, can 1* mistaken for fihrotic changes in the lungs. In fact, an alarming x-ray picture is often found in a worker who has little or no disability. The study of siderosis was helped by the excellent work of Stewart and Faulds (1934) and later Craw (19.17) on the hema tite miners, in which group the lesion was found to be siderosilicosis. often accompanied by tuberculosis. CrawA later work (1947; in eliminating tulierculosis from the hematite mines ami m improved dust control methods is <11 major importance. Other occupations and dusts which have been studied include those of ixoiler scalers, graphite worker-*. grain dockers, and workers exited to beryllium and its oxides, to the dust of leather mixed with other dusts, and to Uagnsse. Attention has also been given to exposures to the dusts of aluminum; man ganese. and vanadium and to asthma occur ring in workers e.\|X)sed to the double salts of platinum and also to various wood dusts, such as western red cedar. l\tth<'tinjy.--A great deal of work lias been done on the pathology (gross, histological, and experimental) of coal miners' lungs by Hough. Harding. King. Heppleston. Wright, Gloyne. Xagelschmidt. and others. I might, however, state some conclusions alxntt jthologv which Harding and l (with our late colleague. S. Koodhouse Gloyne; have ar rived at after studying the lungs-of workers in many diverse industries. Until nlxmt 10 years ago. the pathology of the dust diseases was dominated by the class ical silicotic nodule ('Fig. 1). In the same way. Ixjfnre a diagnosis could !>e made, the patient had to have x-ray nodulation, or the classical ''snowstorm" effect. Classical sili cosis usually occurs after the worker has Iieen exjxjsed to dust containing a high projxirtkm of free silica. Tt is liecoming increasingly clear, in our opinion, that even small propor tions of free silica in a dust can cause a fibro sis which is comjjosed of nodules not of the classical type ( Fig. 4). The arrangement of the fillers is linear and radial, and the outline of the whole nodule is stellate. It looks like a black star. Harding, Cdnyne, anti l have applied the term mixed dust pneumoconiosis, or mixed dust fibrosis, to this nodule. It has lieen found in foundry workers, especially in cleaners of iron castings, in jiersons exposed to the dust of graphite containing alxmt 10^> free silica, ami in Imiler scalers who are cx- 91 mixed dust pneumoconiosis nodule. Indeed, {here are also nodules which show a transi* turn >tage between the mixed tiust nodule and the classical one ( Fit;. 5 ). It should be men* tinned that the x-rav appearances >f the lungs of a worker with mixed dust pneumoconiosis differ little, it at ail. from those of one with silicosis. and the disease is just as disabling and as fatal. Boiler Sealers Pneumoconiosis.--JLxptri* eoee "i pulmonary diseases in ship'" boiler scalers illustrates well the etiology of mixed dust pneumoconiosis. These men are exposed to a mixed dust which varies according to the type ot fuel used to heat the boilers and -also according to the source of the water used l*>sed to a mixed dust with a low projxirtion of SiOs. The coaJ nodule of coal miners' |meunn>coninj*is has much the same apj>ear* auce a.s ur mixed dust pneumoconiosis nodule. Coal contains varying proportions *f free silica. In any case, the common de nominator in those cases and <>ccu]aiinns in which this tyj>e of nodule is found apj>ears to l*e the presence of a 'inall proportion of free -ilica in the dnst. Where there is a high proliortion, as stated alxjve. the classical silicotic nodule is found, lint in the same case, there may lie !>oth the classical nodule ami the Fig. 4.--Mixed dust pneumoconiosis ikkIuIc from a steel icttlcr's lung; hematoxylin and eiin: x 24. 92 Fir. 5.---Transition nodule, from mixed dustpneumoconiosis nodule to silicotic tuxJuie in an iron dresser's lung: hematoxylin and cosin : ;< 24. itt them. It contains carbonates, silicate?. iron, and carlmn. There is usually under 3ty of free silica, but there is often a high proportion of iron atul its oxides. Flue dust contains more iron than does the scale on the water tulx*s. sometimes as much a? 48ty. In the first case of toiler scalers' pneumoconiosis the worker had been scaling boilers for over 40 years I. Harding. Tod. and Mclumglilin. llM4). In H>.18 an x-ray him of his chest showed undulation itt the upper and outer lung fields, and in the lower rones reticulation l or micronodulntiou ). At that time we made a tentative diagnosis of diicosts in the upjn?r zones, with siderosis in the lower zones. Seven years later the patient | f 1 ' jt ' / t * ^ , h 3 died of examina the canc noduies the iow rcticulati carbon 2 fibrocis. were no< Up to thon nine type n' f. silic-.'.l'c also (:'*/{ well hnvsubsume* The cl ships' problem, causes >> in a hiph that ridin the oil an inter*point. .\ examinin environs (iome 3< ampton. large pa- tigation 1 present damage in the p fishing r we have pneunu >0 case of c proportii pneunu >c ' Talc i work on in the l'1933; I Riddell, burg, S'iin iingla features dust. Uu oicd 01 cancer ot ihe lung, and histological xannnation ot the lungs showed (apart from die cancer) the presence of classical silicotic nodules in the upf-er ami outer zones, and in the lower zones (where there was x-ray reticulation) there were mainly deposits of carbon and iron dust in the lungs, with no librosis. In all other parts of the lung there were nodules of mixed dust pneumoconiosis. Up to the present time we have had autopsies on nine boiler scalers, and all showed this type of librosis. Only one scaler had classical silicotic nodules in addition. But five of them also died of cancer of the lung, and this may well have been partly caused by carcinogenic substances present in the soot. The change from coal to oil as a fuel for ships boilers has brought with it another problem. The dust from oil-fired boilers causes symptoms of bronchospasm or asthma in a high proportion of cases, and it is likely that this is due to the presence ot vanadium in the oil soot. Williams (1952) has published an interesting series of cases illustrating this point. My colleagues and I are at present examining (with clinical, radiographic, and 'environmental details) the boiler scalers (iome 500 of them) in the port of South ampton. where the boilers of ocean-going and large passenger liners are cleaned. The inves tigation has not l>een completed, but up to the present we have not found as much lung damage as was shown in a previous inquiry m the port of Hull, where the boilers of fishing trawlers are mainly scaled. So tar we have found three cases of compensable pneumoconiosis among 50 workers and one CJic of cancer of the lung, together with a proportion of cases with lower degrees of pneumoconiosis and disability. TaU' Pntumocortiosis.--A great deal of work on talc pneumoconiosis has been done in the United States and Canada (l>reesscn, Ipjo; Dreessen and Dalia Valle. 1935; Riddell. 1940; Siegal, Smith, and Greenburg. 1943, etc.). Merewether (, 1933-1934). ia England, studied the x-ray and clinical features of rubber workers exposed to talc dust- Hut it was not until 194<> that we were able to study the histological appearances of a proved case <>( talc pneumoconiosis (Mc Laughlin, RtigcfN, and Dunham. 1949). A man. 51 years of age. had worked for 37 years m a rubixrr-tire factory, where he had been e\*|*cd to a lairly high concentra tion of talc dust. Moderately advanced pneu moconiosis of Ixjch lungs was found at au topsy tin addition tu iucom|>etence of the aortic valve). Throughout the lung substance were scattered small gray nodules, more numerous in the lower lol>es. In some areas the nodules had coalesced to form small masses. The fibers appeared to be arranged concentrically around small vessels, giving the impression of whorling, but not like the appearance of silicosis. There were, in addi tion. many 'curious" or talc bodies, resem bling. but easily distinguishable front, asbes tos bodies. Much dust, which proved to lie talc. apfx*arcd in the sections, and it was thought at the time that the jxirticlcs were all fibers. More recent work on the lung by Xagelschmidt $ has shown that the bulk of the dust is in the form of plates with oniy a few fibers. At least three other autopsies on cases of talc pneumoconiosis < all from rubier works) have been made, and they show similar fea tures to the first published case. Small sur veys have !)een made on workers exposed to talc dust in various industries, but larger ones have twen planned to take place shortly. It is clear that talc dust, though fibrogenic, is not so active as as!>estos in damaging the lungs." Leather >rcj.wr.r' Pneumoconiosis.--*Co operation between the directors ot chest clin ics, the mass radiography units, and the Medical Inspectorate of Factories has been instrumental in bringing to light hitherto unsuspected causes of pneumoconiosis. Since the mass radiography campaign was Ixrguit in 19-W for tile early detection of cases of pulmonary tut'erculois. seine 13.000.000 per sons have undergone examination. Many factory populations have Iicon surveyed, and tfie author. rt3 A. M. A. ARCHll'BS OP INDUSTRIAL HEALTH included among them have lieen factories where there is a bust risk. The workers at <>ue leather factory were examined by Dr. Hm,rh Kamsav. of die Wiuiatend Mass Radi ography Unit. lie drew our attention to the fact that in one department a high proportion <>\ the workers showed abnormal x-ray changes. whereas in other departments, where there was no dust, no abnormalities were *een. In the department with the high l>rojxrtion of x-ray abnormalities, skins loaded with china clay and calcium carl>onate are dressed on rapidly revolving felt wheels covered with a layer of hue Carljorundum (xvwder. The job is very dust)-, though it is done under exhaust ventilation. The dust is counted of much line leather dust, with' 'tnaller proportions of china clay i kaolin), calcium cartxmate, and Carliorundum. It was found (hat the dust contained aI tout 5% of free silica. The x-ray films showed all stages of abnormality, varying from early reticula tion f micronodulation) through undulation to massive shadow*,. f a few crises there was clinical evidence of disability. One man with an x-ray film showing massive shadows had died from "asthma ami pneumonia'' a vcar l*etore the investigation legan. and there was no autopsy. In spite of the fact that up to the present time no jxuhologicnl evidence has l>een available, it is likely that the condition will fall into the group of the mixed dust pneumoconioses. The dust of china clay, which for years has l>een thought to be com paratively harmless, is Incoming more and more suspect. Even apart from china clay, the presence of a small proportion ot free *ilica is prinia facie evidence dint the dressing of such skins is a hazardous, occupation. Beryllium Pneumonitis and Granulomato sis.--It is remarkable that British experience of Itcryllium pneumonitis and granulomatosis is not as extensive as that in the United States, though many workers have l*en ex pos'd to the <lust *f liuorescetit lamp powders containing licrvllium oxi<le and also the dust and fume* from the allnv.. (>nlv one death lei' iceurred. and the Factory Department hn> collected clinical, x-rav. and environ mental details of five nonfata! cases, one of whom is now very ill. The other four case* are either recovering, or their condition is stationary. It i> also remarkable that five out of six affected workers were chemists en gaged in the development of the beryllium lamp (vwders. At the lac ton* where the fatal case of l>cryllmm granulomatosis occurred. 150 of the other workers were examined clinically and radiographically ami no more cases were found, though there had been con siderable exposure to the dust of the lamp powders in the early days. It is undeniable that Ijerytiium oxide is toxic, but examina tion of the histology of the lungs of the one fatal case has led me to hold the unorthodox view that Ixrryliium was not the sole cause of the condition. There were two types of le sion : one of a granulomatous type, in which there were giant and epithelioid cells, and dw other in which were many fibrotic nodules indistinguishable from silicosis. Under polar ized light many doubly retractile particle* were seen hi the nodules, and an eminent crvstallographer stated that these were cristohalite, one of the most active tonus of tree silica. This is not surprising, because one m the ingredients of the lamp powder is silica gel (25$>), which in the preparation of the powder is heated up to alionc 1100C. The changed methods of preparing the lamp pow der have eliminated Ijoth the beryllium oxide and the free silica, so that the risks both of beryllium granulomatosis and of silicosis have also t>een eliminated. "Pneumoconiosis" from Vegetable Dusts. --Apart from cotton, not a great deal of work has l>een done on the vegetable dusts. The illnesses noted among cotton workers include mill fever, a transitory illness which affects nearly ail new workers in cotton, Has. and hemp mills and also in malt houses: "Monday fever'* tor. feelingi: weavers cough, and hvssinosis. Byssinnsis develops after about 20 years as a natural progression from "Monday fever and in its final stage has the characteristics *f chronic bronchitis and emphysema. As Schilling il9?4) says, though it was de* I l "4 DUST?-}} . x. ;r sent: :dt fc its but * and "ersau "ally ext disease pr symptom remsiz * day. It e the lung in the co most f?ot ers who * ady affec ers \vr~. special & Bojcls. try hi.`?d the tus: main!- r bagssc: acute t severe i-i. showm g teen cas< the noth of tllCsr and Hat Taylor (1940). Since u under cases. Farm lung wn and art* a great feature* occurs v handlrn: is regrr. Fawctt oases o time to district? Pneu ner, He the din peaiar.v. ?L'S~ DISEASES /-V GREAT RR by ylreenhow nearly 100 years ago. Thirtv of the^c men had pulmonary tubercu '|[. etiology is still obscure. It presents an odd losis, but !! others had x-rav changes sug but characteristic history of chest tightness gestive of the presence of pneumoconiosis. and breathlessness on Mondays, which grad Fourteen had normal x-ray film*. Analysis ually extends to other working days as the of the dusts from various grains showed disease progresses. "In its later stages these ivmptoms are very distressing, but usually remain worse on Monday than on nnv other da'-. It causes no sixeirie x-rnv changes in cite hmg fields.-' In the main, the workers in the cotton card and blowing rooms surfer most from the disease. Strippers and grind ers mho clean the carding engines are esjxciailv aliened. As mentioned previously, work ers with Ijvssinojiis are compensated under a special scheme. luii/assosts.--Only tine factory in the counirv handles bagasse (or sugar cane without the sugar), am! bagassosfs has 'xeurreri small percentages of free silica; oat dust, tor instance, had 5(T. No autopsies have been carried out. but it -eems that a case has Ixreti made out tor an extended investigation of larger groups of grain docker-*. C raf'hih' Pni iiiiiiH'uniusis.-- U has been found by some observers in England (Dunner, 1945. 1948, and 1949: (liovne. Marshall, and Hoyle. 1949. and Harding and Oliver, 1949) chat workers e.\j>osed to the dust of natural graphite develop radiographic changes iu the lung" and di'aliililv. The range of x-ray abnormalities closely resembles that seen in coal miners. Pathological and experi mainly iu thn>e workers who were grinding mental studies (tiloynv ami others. 1949. Isigassc iu a dry state. The condition is an Harding and Oliver. 1949) show that the acute bronchiolitis, with high temjwrature, condition falls into the group of the mixed severe dyspnea, and x-ray picture ot the lungs dust fibroses, the lihrotic nodules having a showing generalized miliary shadows. Fif linear ami radial pattern as opposed to the teen cases of this acute disease have conic to whirled fibrosis of the classical silicotic the notice of the Factory Dqmrtmcnt; some nodule. Natural graphite contains small per uf these have Iwen rfescrilied by Cnstleden centages (of the order of 5%-l0%) of free and Hamilton-Paterson (1942). (lillisoti and silica. There is as yet no evidence that pure Tavlor i 1942). and Hunter ami Perry graphite will produce a similar condition. ll`>-Un. The last case occurred in 104S. since we got the firm to grind the bagasse under water, there have Ixen no further Manganese Piunnmui/is.--A few cases of manganese poisoning affecting the nervous system occurred in the middle 1930's in rases. workers grinding manganese dioxide for use Farmers Liou?.--Farmers', or threshers', in lamp batteries. In 1946, Lloyd Davies re v lung mas first described by Campbell (1932), ported a high incidence of pneumonia in a and after that Faweitt (1936 and 1938) did group of workers exposed to manganese di a great deal of work on the condition. It has oxide dust in the manufacture of potassium features similar to ijagassosis. but. since it occurs mainly among workers who have been handling moldy hay during a wet summer, it is regarded as being caused by a fungus, permanganate. Animal experiments by Lloyd Davies and Harding (1949) confirmed that manganese dioxide irritated the lung tissue faweitt was firmly of this opinion. Single and caused intense infiltration of the alveolar ca?c> of the condition are descril>ed from walls and alveoli. Hater granulomatous time to time by physicians in the agricultural changes developed in some instances. These districts. * results are in line with those descrilied by pneuinocuniosis in Grain Dockers.--Dun- workers in other countries. ner, Hermon, and Bagnall descrilxd in 1946 Palladium Pncmoniffi.--Wyers (1946) the clinical features and abnormal x-ray ap recorded his observations on workers exposed pearances in a group of 55 grain dockers. to vanadium pciunxidc dust, and his results 95 ii it & VV# '"s m m p Zf.izi v*m'- r '<V; Ktt % S 2 h A. .!/. A. ARCHIVES OP INDUSTRIAL HEALTH DUST l are dmiiar to chose described by Sjoberg ( 1949; in Sweden. The etTects are a combi nation of systemic jxiivming and irritation uf thy pulmonary tissue, leading in some cases to bronchos^-ism ;m<l pneumonia. I )<>ig $ ami Williams (1952) have descrilwd the marked bronchosjwsm occurring in workers exposed to the soot of oil fuel, which is thought to l>e caused by the high percent age of vanadium in the soot. SUMMARY which make a dusty process more dusty and cause a lag in dust-control methods. 3. Comj)ensation for industrial pulmonary disease l**gnu soon after 1918, and gradually most of the processes and industries which damage the lungs are I wing brought under the provisions of the various Acts of Parlia ment. THe Industrial Injuries Act of 1946 removed the responsibility for comjiensacion from employers and insurance companies to the Government. Since then cases taken under Common Law against the employers Mini: . E. K G. Labor*- ;r Arlidge, f Ocrji Campbell. with Castled-: . - m"; The position as regards the dust diseases have increased rapidly. Colli?, in Great Britain may be summarized as fol 4. Numerous legal provisions, contained lows : - both in Acts of Parliament and in Regula 1. During the past 50 years, the risk of sili tions. have lieen brought into force. Routine cosis in most of tiie major industries has been inspection by inspectors of factories and firmly established. Until the late I920's. free mines has been instrumental in limiting the silica was the only dust which was thought numliers of cases of disability and death to damage the lungs. Asl*stosis. caused by brought about by inhalation of the dangerous the dust of a combined silica mineral, came dusts. . into prominence about that time. In the mid 5. It is expected that more accurate infor file 1930's. attention was given to the effects mation about the incidence of the dust dis 'f other dusts on the lungs, such as iron and eases will be obtained in the near future, its oxides, and of rndiojKU|ito dusts, china when statistical studies of the information clay, sillinianite. kieselguhr. talc, and mixed obtained by the Pneumoconiosis Panels have dusts containing free silica. been carried out, and when the report of the During the middle 1930's also, the effects Registrar-General about the occupational of coal dusts on the lungs were given increas incidence of disease at the time of the 1951 ing attention, and extensive surveys were Census becomes available. At the present carried out, culminating in the formation of time no reliable information exists alxmt the Pneumoconiosis Research Unit of the the populations at risk in each industry and Medical Research Council in 1945. The coal process. Speci Her1* Cooke, V. i;ior. Craw, t. ; sis o'< U:. Con:- o'. Coc ; Indus Oavie*. T Indus ----and i Furr) liens. Doig. A pear;t ders. Clearin Osis. Dreesscn. on th ------ and I miners numerically constitute the greatest 6. Surveys of the population by mass radi problem of dust disease in Great Britain. ography to detect early tuberculosis are r-t ?-=\ * v 2. Despite the combined efforts of inspec bringing to light information about tiie ef tors of factories and mines, physicians, chem- fects of .dust in some hitherto unsuspected in C 1945 sists. engineers, anti research workers, the occupations. Obser^' deaths from pneumoconiosis have continued 7. Many problems about dusts and the Pne: t' rise yearly. The reasons for this increase may !* found in mure accurate diagnosis of the condition and in the publicity given to lungs are still unsolved, and some would say that we have only just begun to attack the fringes of the problem. Nevertheless, a great -----Her conn Seed --and occupational diseases of the lungs, leading to deal has already been accomplished. Grat more frequent mention of pneumoconiosis by physicians on death certificates. But a more likely cause is the urge for increased speed of production, and the introduction of machines 5 Doi&. A. T.; Unpublished data. 96 Assistance in compiling the information con tained in this paper was rendered by Dr. P. K. Walker and the members ot the Pneumoconiosis Panels of tiie Ministry of Pensions and National Insurance: Drs. E. R. A. Merewether. A. T. Doi?. and G. 0. Williams, of the Factory Department. i949 Fawcitt. J. R Occup cuin Gill?;on, ;rOt* '-Ti! . ... V a.j'd ' nary .laliv hich ndcr Tlia1946 ition ?s to aken >yers lined gulautine and % the death trous iniort disattire, ration t have of the .tional 1951 resent about y and > radis are he etpected id the ild say ck the i great jn con* P. K. c>tinsis National f. Doig, iftmtnt, DOST DISEASES /.V GREAT BRITAIN Ministry of Labour and National Service: Dr. H. . Hardin?, lately of Sheffield L'niversity. and Dr. Q, Nagelschmidt. ot the Safety in Mines Research Laboratories. Sheffield. BIBLIOGRAPHY Arlidge. J. T.: Hygiene. Diseases, and Mortality of Occupations, London. Percival & Co, 1892. Campbell. J. M.: Acute Symptoms Following Work with Hay. Brie M. J. 2:1143. 1932. Castleden. L. I. M.. and Hamilton-Paterson. J. L.: Bagassosis: An Industrial Lung Disease, Brit. M. J. 2:478. 1942. Collis. . L.: Industrial Pneumonoconiosis. with Special Reference to Dust-Phthisis. Pub. Health 28:232, 19U-1915. Cooke. W. E.: Pulmonary Asbestosis, Brit. M. J. 2:1024. 1927. Craw, J.: Blood Examinations in Pulmonary Fibro sis of Haematite Iron Ore Miners, Tubercle 19:8. 1937. Control and Elimination of Silicosis in the West Coast Haematite Iron Ore industry, Brit J. Indust Med. 4:30. 1947. Davies. T. A. L.: Manganese Pneumonitis. Brit. ]. Indust. Med 3:111, 1946. --and Harding, H. E.: Manganese Pneumonitis: Further Clinical and Experimental Observa tions. Brit. J. Indust. Med 4:82. 1949. Doig. A- T, and McLaughlin. A. I. G.: X-Ray Ap pearances of the Lungs of Electric Arc Wel ders. Lancet 1:771. 1936. Gearing of X-Ray Shadows in Welders' Siderosis. Lancet 1:789, 1948. Drttssen- W. C.: Effects of Certain Silicate Dusts on the Lungs. ]. Indust. Hyg. 1$:66. 1933. __and Dalla Valle. J. M.: Effects of Exposure to Dust in Two Georgia Talc Mills and Mines, Pub. Health Rep. SO: 131. 1935. Dumier. L.: Observations on Pulmonary Disease in Graphite Workers. Brit. J. Radiol. 11:33, 1945. Observations on the Development of Graphite Pneumoconiosis. Brit. J. Radiol. 21:182, 1948. --Hemmu. R, and Bagtiall. D. J. T.: Pneumo coniosis in Dockers Dealing with Grain and Seeds. Brit. J. Radiol. 19:506, 1946. --ami Bagnail. D. .1. T.: Pneumoconiosis in Graphite Workers. Brit. j. Radiol. 22:573, 1949. - Fawcitt. R.: Fungoid i/.mditions of tlte Lungs, Brit. .1. Radiol. 9:172 ami 354. Occupational Diseases of tlte Lungs in Agri cultural Workers. Brit. J. Radiol. 11:378. 1938. iMilison. .1. A., and Taylor. F.: Bagassosis: Further Notes of Four Cases. Brit. M. J. 2:577, 1942. Gloyne. S. R.: Presence of the Asbestos Fiber in the Lesions of Asbestos Workers. Tubercle 10: 404, 1929. 1 -Marshall. G.. and Hoyle. C.: Pneumoconiosis Due to Graphite Dust, Thorax 4:31, 1949. Grcenhow. K. H.: Rcjxjrt of Medical Officer of the Local Government Board. Appendices IV and VI, 1860-1861. Haldane. J. S.: Marint, J. S, and Thomas, R. A.: Rej>ort to Secretary of State for the Home Department on the Health of Cornish Miners, Command Report 2091, H. M. Stationery Office. London. 1904. Harding, H. E.; Tod. D. L. M,, and McLaughlin. A. I. G.: Disease of Lungs in Boiler Scalers, With- a Case Report and Review of Literature. Brit J. Iudust. Med. 1:247, 1944. Pneumoconiosis in a Boiler Scaler. Brit J. Indust. Med. 4:100. 1947. --and Oliver, G. B.: Changes in Lungs Produced by Natural Graphite. Brit. J. Indust Med. 4: 91, 1949. Hart. P. D'A. and Aslett E. A.: Chronic Pul monary Disease in South Wales Coalminers. Special Report 243. Medical Research Council. London. 1942. Hunter. D.. and Perry, K. M. A.: Bronchiolitis Resulting from the Handling of Bagasse, Brit. J. Indust. Med. 3:64, 1946. McDonald, S.: Histology m Pulmonary AhcM<*is. Brit. M. J. 2:1025. 1927. McLaughlin. A. I. G.: Grout J. L. A.: Barrie. H. L. and Harding. H. E.: Iron Oxide Dust and the Lungs of Silver Finishers, Lancet 1: 337. 1945. ---Rogers, E.. and Dunham, K. C.: Talc Pneumo coniosis. Brit J. Indust Med. 9:184, 1949. ----Cheeseroan. E. A.: Garrad, J.: Gloyne. S. R.; GoodaJI, K. L.; Harding, H. E.; Jupe, M. H.; Lawrie, W. B.: Perry, K, M. A.; Sutherland. C. L, and Woods, H.: Industrial Lung Dis eases of Iron and Steel Foundry Workers, H. M. Stationery Office, London. 1950. Macklin. E. L~ and Middleton, . L.: Report on Grinding ni Metals and Cleaning of Castings, Home Office. H. M. Stationery Office, London. 1923. Medical Research Council: Chronic Pulmonary Dis eases in South Wales Coal Miners, Parts Mil. Special Report 243, 1942; Special Report 244. 1943. and Special Report 250. 1945. Mcikicjohti. A.: Silico-ig in tin- Potteries: Soon- Observaium- Based mi 750 Necropsies. Brit. J. . Indust. Meil. 9:2.10. 1949. History <n Lung Diseases ot Coal Miners in Great Britain. IHWMH75. Brit. .1. Iudust. Mel. 8:127, 1951. 97 A. .W. A. ARCHIVES Ol: IXDCSTR1AL HEALTH Development of Compensation for Occupational Diseases of the Lungs in Great Britain. Brit. J. tadust. Med. U:19S. 1954. Merewether, . R. A.: Annual Report. Chief In spector of Factories. London, p. 6J. 1933, and p. 37. 1934. Risk of Silicosis in Sa/wlfelasters, Tubercle IT: 3&S. \m. --and Price. C. W.: Report on Effects of As bestos Dust on the I.units and Dust Suppression in tl>e Asbestos Industry. H. M. Stationery Office. IxhxIoo. 1930. Middleton, E. I..: Industrial Pulmonary Disease Due to tlte tabulation id [hist, with S(*eciaJ Reference to Silicosis, lancet 2:1 and 59. 1936. Peacock. T. B.: Diseases of the Gorans of Respiration, Tr. Path. Soc. London 12:36, 1861. Pearson. G.: Philos. Tr., London, 103:159, 1813. Pneumoconiosis Statistics for 195.5. Digest of. Ministry of Fuel and Power. 11. M. Stationery Office, London, 1954. Riddell, A. R.: Silicosis: Studies and Reports of I. L. 0. (Series F. ITS, Geneva, p. 39. 1940. Schilling, R. S. F.: Byssinosis in the t-ancashire Cotton Industry, Tr. A. Indust. M. Off. 4:61, 1954. Sicgal. W.; Smith. A. R,, and lirevulmrg, L.: Dust Hazard in Tremolite Talc Mining, Including Roentgenological Findings in Talc Workers. Am. J. Roentgenol. <9:11, 1943. Sjoberg. S. G.: Vanadium Pentoxide i V*0) In* toxicatioo. N'ocd. med. 42:500, 1949. Stewart. M. J.. and Haddow, A. C.: J. Path, i Bact. 32:17?. 1929. ----and Faufd?. }. S.: Pulmonary Fibrosis of Haematite Miners, J. Path. 3c Bact. 39:235. 1934. Sutherland. C. L., and Bryson, S.: Report o Occurrence of Silicosis Among Sandstone Workers. Mines Department, H. M. Stationery Office. London. 1929. Report on the Occurrence of Silicosis Among Granite Workers. H. M. Stationery Office. London, 19.50. . Tiiackrait. C. T.: Effect? of Arts, Trades, and Pro* fvssions. ami of Civic States and Habits of Living, on Health atul Longevity. Ed. 2. Lon* don. Longman. 1832. William?. N.: Vanadium Poisoning from Cleaning Oil-Fired Boilers, Urit. J. Indust. Med. 9:50. 1952. Wood. W. R., and Glovne. S. R.: Pulmotiary As* bestosis: A Review of One Hundred Cases. Lancet 3:i38J. 1934. Wyers. H.: Some Toxic Effects of Vanadium Pentoxide. Brit, /. fndust. Med. 3:1/7. 1946. Asbvstosis, IWgrad. M. J. 2S:6JI. 1,J49. a rotvt\ tov * ?r.i 1 c/Ar mmr Quiz ards s:s dustrv I; This iz i urnn';!r dust : ticai in tlvy i* was an cancer.1 The sense grea1r ment t posu-c Ush re would beir. xp'ns have u central the Sc been t niaxin curiecuries extent of est is bas dosa^ fem/'. conce tion work '****