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PNEUMOCONIOSIS ABSTRACTS I 0>/ J. *- 2zr
PNEUM0C0^0S1S
VOLUME I
Reprinted from the Bulletin of Hygiene for the years 1926 to 193S inclusive by permission of
. The Honorary Managing Committee of the Bureau of Hygiene and Tropical Diseases
PITMAN prill. ISHINC rO 1! POP ATI ON
xi:\v v<i:k
T<u:\t<>
l.ii.vimx
IHITM
Purctmrtt
CONTEXTS
n
/
Preface - . . - ;
. . . . vii
. Zi*f of Abstracters amt Bccincers s--
. . ' . . . ix
I, OENCHAL
.
Industrial hygiene, with ranis reference to pneumoconiosis--Occupational dusts nn<l respiratory disease--Researches on various aspects of pucumwoniosis--Statistical surveys--Tuberculosis and industry--Cancer and its possible relationship to pneumoconiosis--Radiographic aspects--Ceucral
atmosplreric pollution
1
II. SILICOSIS..........................................................................................................................................................................
General description--Pathogenesis and pathology--Tuberculosis in relation to silicosis--Silicosis in
various industrial groups: mining, metal works. sainlstone,'"slaT?'7_gr*ItiTle, pottery manufacture--
Special forms of silicosis--Administrative and compensation aspects.
--
sa
III. ASBESTOSIS . i in chronological sequence
125
j. pxeu MOCONIOSIS OF COAL WORKERS ' Abstracts arranged in chronological sequence
14S
V. PNEUMOCONIOSIS CAUSED BY OTHER INORGANIC DUSTS
ICt
1S2
vir. tTMfN r trctvr. tTt-gPtn^juw-v--.......................................................................... ............ 190 * Airstracts arranged in chronological sequence
VIII. SAMPLING AXD MEASUREMENT OF ATMOSPHERIC DUSTS AXD STUDIES OF
THEIR PHYSICAL. MIXER ALOGICAL AXD CHEMICAL PROPERTIES
. . 2Q5
IX. METHODS OF SUPPRESSION AXD REMOVAL OP DUST, AXD PERSONAL KESPIRA-
. TORY PROTECTION.............................................................................................................. ............
. 222
X. PERIODICAL REPORTS RELATED TO PNEUMOCONIOSIS................................................... 242
M. I.EOISRVTIOX OX PXEUMOCOXIOSIS
209
XII. ROOK REVIEWS ....
307
/af Author* ur Sources ... tft.j t.J Suhjrrh .....
321 327
XI
SECTION III
ASBESTOSIS
[Abstracts Arranged in Chronological Sequence)
Ouvfr, T. Pulmonary Asbestosis in its Clinical Aspects. J. Indusl. Ilyg. 1027, v. 9, 4S-`l-3.
Asbestos mineral is obtained as rock in Canada where it is crushed and then exported to England for weav ing into asbestos cloth. Those employed, both at crushing and at weaving, arc exposed to the initiation of dust arising from asbestos. The author reports the clinical condition of two women seen by him, employed as weavers, which he considers to resemble silicosis of the Jungs. [The evidence in favour of the dust in question setting up a definite pathological condition of the lungs is by no means definite.]
. . L. CollU.
Cooke, W. E. Pulmonary Asbestosis. Bril. M. J. 1927, Dec. 3, 1924-5, 12 figs, on 2 pis.
McDonald, S. Histology of Pulmonary Asbestosis. Ibid. 1025-G, 12 figs, on 2 pis.
'Oliver, T. Clinical Aspects of Pulmonary Asbestosis. Jbid. 1020-7.
These three articles arc concerned with the same case, that of a woman who find been employed for thirteen years exposed to asbestos dust in a factory whore this material is woven. In 1922 her health broke down, and her chest exhibited signs-of fibrosis of the right lung with tuberculous infection. .She died two years biter. The lungs showed interstitial fibrosis but Un typical wburlcd formations seen in silicosis were absent. The fibrotie condition appeared to be associ ated with the presence in the lungs of dust particles sune of which were nun posed of oxide of iron and '"me nf broken fragments from asbestos fibres. Asbestos is composed of hydrated magnesium silicate, the composition being -roughly 11 per cent silica, I- Per cent magnesia, and 1 ( per edit water. The l.hi.-s of this curious mineral have In-i n used for "'.aiiis purit.-s.-s for many seals,; indeed, Herodotus l--'itilns, cl,,Hi made fiom asla-stia, while l'liny, st:.,h.> amj Plutarch alt jeft-r to it. Some of the pute-d'lw.ttlJ with longi-st fibres la-cuis in Nottlu-in Italy, t-it the chief Miiiice nf it is t'aii.uliau cliiysotilc. Hr. S- M-n.n, ltd desclilii s HI laid tilti-ms foieign bodies '1 u in the lungs tin-1, r the liii- n-i --pe uliit li v.u \ in M,,` fiom 2n /i to * ,ii anj pies.-nt features wlihh
suggest organic origin. All experts, however, to whom these bodies were submitted failed to recognize them And, after some hesitation, the opinion is put forward that they must be asbestos fibres in the process of alteration and absorption by hydrolysis, cither by direct chemical action or by enzymes. The illustrations given of those curious bodies are certainly interesting. Sir Thomas Oliver speaks of the exposure to dust in factories where asbestos goods arc manufactured and tells of having examined other workers similarly employed. lie expresses the opinion that asbestos dust is capable of causing a clinical condition some what similar to silicosis of tlm lungs; he also noted a deadening of the skin varying from mild bronzing to slight blueness. [Although the case upon which these three articles ni-e based died of pulmonary tuberculo sis, workers exposed to asbestos dust have not in the past earned a reputation for succumbing to tuber culous infection in the same wav as have stone masons and gold miners. Asbestos dust seems capable of setting up fibrosis somewhat different in type from that caused by silica dust, and the tendency to succumb to tuberculosis also appears to be different.]
E. L. Coll is.
Seiler, II. K. A Case of Pneumoconiosis. Result of
the Inhalation of Asbestos Dust. Bril. M. J. 1928, Dec. 1. 982, l pi. [3 ivfs.J
Tlu- case is reported of a man aged 40 who had been
employed for twenty-two years in the asbestos
industry. He complained of lassitude, loss of weight
and night sweats. A radiogram showed fine mottling
of a silicotic type throughout both lungs. Hu was
cyaiiiised and bad a troublesome cough. Xo tubercle
bacilli wore found after repealed examinations. The
case is runsiih-ivd to be definitely one of pulnioirary
fibrosis due to inhaling asbestos dust.
-
A. L. Collm.
(iisiYxi:, s. H. The Presence of the Asbestos Fibro in the Lesions of Asbestos Workers. Tabm-le. 11129. v. in, 101-7. [5 refs.)
Itau- aslii-stiTs was gioiiiul up into n flue powder anil exaiiiin.-d under tie* iiiii-msi-npe. The pal tides were found In imisiil nf hllte fibres, sliaiglit ainl ii;;id. Sudi pit 11-I,-. Wen- iii-vt leiiii iii-il i a(*il ill tie- ii,riis in the : kin, to which nsb.--.tns wmheis are liable, iri
jr* ........................'Hi
..................
12* I'.VE L M OCO.N J OS 1S A USTlt ACTS
the upper respiratory tract, and in sputum from the pneumoconiosis is the presence in the lungs of golden-
lung. Some of the particles wore inoctilclcd sub yellow foreign bodies with segmented outline ami
cutaneously into a guiue.ipig, after which the fibres clubbed extremities bearing a superficial resemblance
wore found unaltered in the tissues. They wow also to minute crustacean forms.
fouiiJ |>ot-mortem in lung ti v~ue previously destroyed
S. Jiaorlftouxe Olnyne.
by concentrated sulphuric acid, in no case iu lung
tissues so treated, were the so-called "curious bodies" found which arc seen in untreated lung sections from asbestos workers. If such "curious bodies" arc treated with concentrated sulphuric acid, they dissolve, laying bare typical asbestos fibres. The fibres form the
Wood, W. 11. A; P.vcik, B. S. A Case of Pulmonary Asbestosis: Death !rom Tuberculosis Two Years after First Exposure to the Dust. Tubercle. 19o(>, v. 11, 157-S, 2 figs, on 1 pi.
basic scaffolding upon which material--possibly blood pigment--is laid down.
; E. L. CvllU.
The clinical history is given, of a young woman, aged 21. who had been for fifteen months a spinner in an asbestos factory with exposure to asbestos dust.
Her father had died recently from phthisis. She
Wood. W. B. Pulmonary Asbestosis. Radiographic Appearances in Skiagrams of the Chests of Workers in Asbestos. Tubercle. 1929, v. 10, 253-02, 12 figs, on (i pis. [12 refs.]
developed rapid and fatal tuberculosis which affected both lungs, the peritoneum, the intestines, ovaries and Fallopian tubes, fso radiographic evidence was found of pneumoconiosis, and very little fibrosis was ' present in the pulmonary tissue; but asbestosis
This paper is & clinical and radiological record of fifteen cases of workers in an asbestos factory. Workers in these factories suffer from a form of
bodies were seen scattered irregularly through the lungs, aud also asbestos fibres in various stages in the formation of typical asbestosis bodies.
pneumoconiosis due to the inhalation of dust from the asbestos. In nature asbestos is found in various
. E. L. CollU.
parts of the world, Canada, Italy, Corsica. South
Africa, etc., associated with quartz and slaty rocks mingled with jaspers and quartzites rich iu magnetite
i. Cooks. W. 15. Asbestos Dust and the Curious Bodies found in Pulmonary Asbestosis. Jirit.
and brown iron ore. The crushed product, after
M.J. 1929, Sept. 22, 57S-S0, 5 figs. [4 refs.J
carding and spinning, is used for the manufacture of
jacketing and packing for steam pipes and joints, and various other articles.
ii. Haduow, a. C. Clinical Aspects of Pulmonary Asbestosis. Ibid. 5S0-S1.
The cardinal symptom of pulmonary asbestosis,
like that of other forms of silicosis, is dyspnoea, iii. .sn:\vAiiT, .xi. j. A Method of Examining the
. which progresses until in the advanced stages of the
Sputum for Asbestosis Bodies. [Memoranda.]
disease it becomes extreme. The dyspnoea may he
Ibid. 521.
.
accompanied by cyanosis and the complexion of
most patients has a slightly leaden hue. Chest
(i) Asbestos and asbestos dust are described by
. expansion may be reduced to one inch or le-s. Cough W, E. Cooke, taking chrysotile as the type. The
Is seldom excessive and expectoration is moderate factory dust is composed of colourless, refractile,
in amount or even absent.
translucent fragments of fibre.and also of black, brown
The physical signs are those of a bilateral pulmonary and blue particles of biotite and magnetite. But in
fibrosis chiefly affecting the lung bases. Pulmonary the lungs translucent fragments arc* almost com-
tuberculosis may supervene and modify the clinical ph.tely absent; because, apparently, these fragments
picture. When the disease is well established the [as was shown by Ui.ovxi:, this Jiidletin, H>29, v. I,
prognosis appears to be grave.
977) iorm the nuclei upon which are deposited
liiidiologieallv the inosf noticeable feat me of the colloidal aggregates of blood proteins, so forming
kiagr.mi is the presence of shadows suggesting a the ni>w".well-know n curious hodies, from 20 to diffuse flbio-ds of the hover two-thirds of the lungs. 100 /' in length, shaped maybe like elongated
The fine ground glass quality of the shadows is dumb-bells. They are found in myriads in 'alveoli,
noteworthy and the bntnehi il stnations may give a hruncliiiiles, fibroin areas and phagocytes. Occasion
cobweb like up|h'.irancc to the film. As tli-.v stri.i- ally a fragment of biotite forms the central core.
tion- radiate outwards from the lung loots they out The way in which the curious bodies nre formed is
the edge of the cardiac shadow. cqtecially on the left sugge-led in detail, the det i ling conditions being the
side, riving a shaggy app.'.nance as if the he.tit wrie pie.ei.ee lit plasma pioteiiis and line >pn lilt s of
ciu c-i-d in coarse felt. When more definite mottling dioicultly soluble ni.iteri.il. Since no oilier inineial
*' pi -.lit it lacks the cn.it>" quality seen iu the Uu-t i- libiout, the curious bodies aie pathognomonic skiagrams of otlur fomis of piutiiiuoeoii'u-is. Other nt pulmonary a-besto-is.
fe.iliu*.' nr,, -igns of old h i.at plan: i-v. obliteiatiou of
(ii) Tii" pr,'"lire of a.sbestos do-d in tin* lungs,
'fo-phicnh' ancl". thitkt-uing of tie- ape .,1 ph-iil.il aeeoiding to ,\. C. ll.nldow. gi.ulu.illy, aft it live
ap. P'f - In. ,| f .-III the dl I .UtO'tle f..|t III I* V. Ill, li '.'II IS Vi .ii - -o plodu* . ti Iu : not a> a i uh- romp In a I ,d to -b ! m.iii ,Ii lb.- ,,-ii. i. f i> ci fioni i.th'-i fomi-. tf by tu'e'iculo-is. ll cait'O' dv.spiioea on eV' ition and
' :
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Ls dried . ill Cm. . numb. . chlorie liodies t
Wimiii, \
Axln fig-
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rl....... I
i
i
AfcHESTOXIS
127
,|r, i-migli: ImiI anorexia is a disl iiiiiin^ feat urr. Slowl.' weakii,*-* and emaciation advance villi liojic!.>, Ai')iUs!t exhaustion. until ltrmu-hn-piu*umntiia close* tli- srui'. A*l>c*lo* iMxlifs are present in Hi1* vpiitum. Itadi"grnphs show char.ict eindte tran=-
further examination* of fnews for tubercle bacilli wets- also negative. After seven Weeks with n nothin I tel opera to re. blondlitis with pyrexia began, broncho pneumonia supervened and (In* patient died.
At the autopsy the pi,-lira wen- found to be uni*
lurrnry above tla* level of ninth rib posteriorly forinly thickened to a slight extent with moderately
mid fourth rili in fruiit, with definite infiltration firm adhesions in the upper thirds and recently below. The patients tend to improve roiisidcraVdy plastic pleurisy on built sides. There was diffuse
in summer. |iii) A method ter finding asbestos bodies in sputum
H given hy M. J. Stewart in which the sputum is
fibrosis and contraction of both lungs. Urn left side being more affected than the right. The trabeculae stood out on section* with denser fibrosis sfrauds in
dissolved in antifonuin and centrifuged. The deposit Ls dried and fixed on an albuminized slide and mounted in Canada balsam. The bodies are only in small
parts, particularly well marked in the right lower lobe, whilst patches of broncho-pneumonia were evident. Microscopically tlic fibrosis was found to be
numbers, perilsps only one or two to a film. Jlydro- uneven in distribution; in less affected areas it was chloric acid and potassium ferrocyanidc stain the most prominent around btood vessels, anil in the
bodies Prussian blue.
E. JL Collis.
more affected ureas tittle was seen but fibrous tissue with blood vessels and clastic fibres. Lymphocytic
nodules were present in the fibrous tissue and giant
cells of the type associated with foreign bodies.
Wood, \V. It. A Paoe, P. S. A Case of Pulmonary N'o tubercle bacilli were found.
Asbestosis. Tubercle. 1020, v. 10, 457-00, 3 figs, on 2 pis. [4 refs.}
fleet ions taken from various parts of the lung showed numerous typical golden-yellow bodies as described by previous authors. The majority were
The patient whose case is recorded was a single embedded in fibrous tissue, but some were seen in woman, aged 31, who had commenced work as a clumps in alveoli (photomicrographs are reproduced).
weaver in an asbestos factory at the age of 21. No Varying in size and shape, the majority of these golden-
tespirator had been provided. During the first five yellow bodies showed a large clubbed head, a seg
years of her employment she had enjoyed fair health mented body, and a tapering tail, suggesting at first
except for winter cough and colds in the head. After sight, a crustacean origin. These bodies wore also
about five years, her chest "begau to-feel stuffy" aud found in the fluid expressed from the lung. As
her appetite for food failed. She continued at work recorded in a previous paper, Gi.OY.ve found them to
until she had completed about nine years' service. contain asbestos fibres. The authors suggest that
A year alter ceasing work she fust became-consciuus of pigment may bo deposited around these fibres, thus
loss of health and wasting. The dyspnoea increased, giving the curious crustacenu-like appearance. Uvid- '
being accompanied by debility, and an attempt to ence of this was seen whore two of those golden-yellow
work as a packer in another trade had to be rclin- bodies crossed each other, separate except at the point
Huished. When she came under medical observation of intersection and at one extremity, whore they had u
she had lost two stones in weight, her face was pale, large clubbed head in common. [An additional case
Ami had a slightly violet tinge, her fingers were of pulmonary a*bcstosis with death from tuberculosis
slightly clubbed, and her pulse rate rapid. She two years after first exposure to the dust was reported
perspired freely, and her respiration was hurried on by these authors in Tubercle, 11)30, v. It, l;>7.]
the slightest exertion. The chest was fiat and poorly covered, and the respiratory exclusions were feeble.
S. ttnorthause CUo'jttt.
Then' ws retraction and impairment of note over
the right apex, and slight Hat toning at the left base Stewart, M. J. A ILinnow, A. C. Demonstration
with general impairment of percussion note over the
ol the Peculiar Hodies of Pulmonary Asbestosis
whole of left chest. Crackling crepitations were
("Asbestosis llcdics") in Material obtained by
piovnt over left lung, and right base, with a dry rub
Lung Puncture aud in the Sputum. J. I'utU. xC-
ut angle of left scapula. Chest expansion at the nipple
Uwi.-v. :i2, 172.
leiel was ne inch. No sputum was available for
vximiiu.itiou. No tuberenb- bacilli weie found in the The authm.s describe two methods of delecting during
Ihitvs (thri-e tests). A skiagram of the chest (which life the characteristic golden-yellow bodies found,
is teptoduecd ill the article) showed: It; apie.d rap pi,.t-mortem, hy various authors in tin: lungs of
thickened; gr.inol.ir mottling witli tine linear stria- patients wh<> have died of pulmonary nsbostoMs.
tioim in upper and middle zones; general cloudiness Mir 4 in lung punctme: a film was made from n
.f ba-e; rosto-phrenic angle obliterated and maigins minute aiinaiiit of blood stained material withdiaivn
of diaphragm obscured: I., it pica I eaj> thicken, d; from the lung with an exploring swinge ami the
I'.")' , li in outuaidi of liilmii shadow, with patchy golden-yellow bo lie* delected mictoscopically in
I'md.-d iii.-.'u external to this,
the film. .Second in sputum: half an ounce of sputum
'n a.|niii>.ii to hn-pitnl patient's general eondi- was di-adveil in an eipial (piuntity of undiluted
're. im|.!..\-d. Vputmu was obtained on one ore i- aidifermin. reiiliifu.-eil, and tie* bodies found
b.,t ie. to).,-ill,- bn, i 111 weie found. Might tiiictn.. ..pi, ally in a hhn of tin* washed deposit.
I2S
PNEUMOCONIOSIS ABSTIt ACTS
The authors suggest tins name "aslcslosis bodies" for IlirdT golden-yellow bodies.
5. ItoOflhvmtc (-luyiir.
Wooo, \V. 11. & fiijoYXE, S. It. Pulmonary Asbestosis. Jjxnrrt. 1!>3U, .Mar. 1, J15-S, 1 fig. Ill refs.]
np|H-nranco of tuberculosis ginnl cells. No a sliest osis bodies, so rlmractrrbtic of human pulmonary nsliestosis, were found. When injected intraven ously no evidence was found to toxic effects on kid neys, liver or other organs.
A*. L. Coltis.
A summary is given of the recent growth of knowledge Mriskwlthkk, E. It. A. The Occurrence of Pulmonary
relating to the effects following upon inhaling asbestos
Fibrosis and other Pulmonary Affections in
dust. A serious industrial disease results, known ns
Asbestos Workers. J holust. Itsty. 1030, v.
asbestosis. It has occurred among those employed
12,103-222; 239-n7, a figs. [30 refs.]
in weaving asbestos fibres into vaiiuus forms of
fabric. The fust symptoms arc dyspnoea and tough, [Opportunity has been taken, in reviewing this paper,
associated with breathlessness on exertion; sputum to give a brief summary of asbestosis in industry.]
at first is scanty. Loss of appetite, lassitude, pains Prior to the commencement of this inquiry, in
in the chest aud loss of weight follow. The skin February, 1923, definite knowledge existed of only
presents an unhealthy leaden hue; chest expansion two deaths of nsbestos workers about whom there
is defective, and may be even less than one inch. Corns was expert opinion that the inhalation of asbestos
in the skin of the bands and elsewhere may be present dust had at least contributed to, if not caused, the
due to the irritation caused by embedded asbestos fatal outcome. The first fatal case of pulmonary
particles. The lungs present signs of fibrosis, parti asbestosis, now known as the "Montague Murray
cularly at the bases, with fine dry crackles. A . Case," occurred in 1S99, and was reported to the
characteristic is the presence in tiie sputum or in the Departmental Committee of the Home Office in 1900.
lungs of curious asbestosis bodies, varying in si/e The patient died of extensive pulmonary fibrosis
from 21 to CO /i. These bodies are composed of a without tuberculosis. The second case, reported by
fine spicule of asbestos with a-deposit of pigmented \V. U. Cooke, was complicated by tuberculosis.
organic matter. X-ray examination discloses fine This c.ise is of importance as it was the first one in
fibrosis in the lower two-thirds of the Jung fields, which the golden-yellow bodies, of pulmonary asbes
with a diffuse haze resembling ground glass, it is tosis were found. The subsequent collection of cases
distinct from the coarser shadows seen in silicosis. by Dr. 1. M. D- Grieve and the occurrence of one in
The prognosis of the disease is not satisfactory, as it Glasgow in 1!>23 led the Factory Department of the
appears to progress steadily when once started. Home.Office to institute an inquiry into the disease in
Broncho-pneumonia or super-added tuberculosis that year. [A previous inquiry in 1910 had suggested
ushers in death. The pleurae are thickened, with that asbestos possessed injurious properties but
plentiful adhesions, the lungs are hard, Icather-liko produced no conclusive proof.] Meanwhile a fatal
and airless. Bronchiectasis may he present. A case had been reported from .South Africa by Dr. F. W.
description is given of the microscopic appearances, Simson.
including those of the asbestosis bodies, which, when
The term "asbestos" is a collective name apptied
once seen, cannot be mistaken. The question is yet to a variety of silicate minerals, which differ from
undecided ns to how far the pulmonary fibrosis One another in chemical composition and physical
caused bv nsbestos conduces to tuberculous infection. propel ties, but which resemble one another in their
-
K. L. Collis.
finely fibrous feature and flexibility. Their value
depends on the facility with which they are capable or
being split up into long and flexible fibres, which
Oj.ov.\-k, S. B. The Reaction of Tissues to the Asbestos Fibre, tvilb Reference to Pulmonary Asbestosis. Tuhtnlr. Itl.'fl), V. 11, 151-3, 4 figs, on 2 pis. (1 ref.]
can be spun like cotton and woven into cloth; on their losislance to heat and acids; and on their insulating properties with respect to heat and electricity. Varieties of asbestos possess those qualiti.-s-in differing degree. Commercially, therefore,
The cellular reaction of living tissues to asbestos that variety and glade which is most suitable for the
tlusl was tc-ded in various experiments by injecting pmpo'e in view is selected, regard being paid to ordin
finely gnmud du-t subcutaneously ami pciiloiie.dlv ary eroiiiiiuic f.iclors, such as the cost of raw material
inlo iruiiM-apigs, and into the phuial sac or the lung nial tie- pi ice \ h ieh the finished article may he expected
id tablets. 'i'lie fibres tended to separate as a stirdl to romm.iiul. I'l.ntie.dly speaking, nil that goes
foreign body at the point of iiiocul.ition, and appealed under file name of asbestos in .uiiiinerri: is either
to act a-, a benign irritant piodm-in-; a niiiiiin.il liluoiis sfipenline or a fibrous iiiiiieial of the nniphi-
nnionut of granulation tisane, which contained bnle or hornblende group. The composition of these
foreign-body giant cells, or colleelions of poll Ida tie js given in Table I la-low.
Wandei ir. g i ill. phngoeytileg the asbestos lilues.
Nmil) ao pel- ceiil of the uoild's piodtlclion of
I be \ t la in ,,f tb-se b ! i-i CII body glanl I'dh bad .-is! i, is i hi re 1 ft -.Ml (' i nnda. a in I is of the s.-i pen-
a pi.'ini-iiti d .stippl. ,1 appi'.iiatiee due to Minute tine \ ll i. t y. ; III - leniaili.I.-l Collies III lilily fl olll Si ,11 III
li'b. -t,,. bblc; It Is ililb lent ft i 'll I I In* >1 met ill eb ,, \ f i n ..til H n - an. Only about one -fill li of the woi Id's
i
1
:
;i
f.
]
t f
[
> t I
l*t The 111 ' pap illtii: bed. the i ' mat:. curt.
Tie try i
Min Ore
Amph(ho:: bleu..'
ibes I-
propel' them ni.itei i other -
JWtptl? I r
does i-ill the ; to the 1 but miof the I
V lie- in.
s -li*. 1 '
l-.t-.i..
\
ANUKSTOSIS
12!t
production of jisIm-sIos Ls suitMile for spinning.
Ttiir remainder (about four-fifths) is
for the
manufacture of asbestos millboard, tiles, sheeting,
pjjH-r nml many other articles. It is the discovery of
industrial Uses for these very short film.-s which has
Ikvii responsible for the phenomenal expansion of
the industry as a whole. (Stemit packings, insulating
mattresses, brake linings fur motor cars, fireproof
curtains, etc.).
The author divides the processes with which indus
try Ls concerned into: (1) the manipulation of
tlne-c longest employed was adopted: hut regard wa also paid to the other cud of the scale, so as to obtain inhumation as to the length of exposure to dust necessary before effects are manifested, and also as to the particular process in which tho worker was engaged.
Table II shows the distribution, according to the length of employment of 77.1 workers engaged in the processes under review, and of the sample of .'to:! workers, distributed in tiie same way. The enormous preponderance numerically of workers employed
Table J Composition of Seqientine and Ampliibole Varieties of Asbestos
Mineral Croup
Variety
SiO,
A1.0,
FeO t'e.0.
Percentage of
MgO
CuO
K.O
Combined Water .
Serpentine Clirysotile
Ampliibole (horn-
rCrocidulite 1 Amosite . -Tremolite
39-42-5 50-5-52-1
43-53 57-2
0-3-7 0-1
1-2-9-4 0-9
0-7-4-4 3o*5-37'4
34--U 3-2
39-13 0-3
0-7-G-4 22*8
0-0-35 0-75 -- 13-4
-- 0-2-9
-- -
0-2-5 --o-c 03
13-3-16-5 1 *0-4-5 2-3-S 2-4
Table JI
'
Distribution, according to Length of Krnployment. of: (A) 775 Workers engaged in Asbestos Processes; and (B) Selected Sample of.303 Workers
Years employed
(A) .Number Per cent
(B) Xumlwr Per cent
0-4 .
.
5-9 .
.
10-14 .
.
15-19 .
.
20 and over .
Total .
4S3 20U
51 24 17
77.
02-3 25-S
G-G 3-1 ' *3.0
100 0
S9 141
64 . 28 21
363
24-5 38-8 23-2
7*7 5-S
IOn-0
asbestos, cither pure, or admixed with a small
piojHiiti,.n of cotton, or other vegetable fibre; (2)
I he manipulation of ashi-stos together with other dust y
materials; (3) the making up of asbestos cloth into
other articles. About 2.200 appears to lie tin; total
iM'Piilation at risk in this count iv. but this figure
do-s not include the large iiumher of workers engaged
in the proee.-.o-s in group (2) which involved o\ponuv
to the inlluerit-e of mixed dusts, of which asbestos is
ait one. and lommoidy not nion- than 20 per cent
*f tin- mixture.
-
A M-l.-,-icd sample of 303 workers was chosen hv
He- writer for intensive investigation. This rrpie'nti.l |i;.- jlt,r ,.,.,,1 ,,f |i,,. pi.pul'itiou at risk as
' -liiii.ile.l ,il,ot e. The pliiiciple of .select ing piimntdy
under five years in these processes is striking, ns is also tl'.e very Unv percentage of workers employed ten years or longer. Comparison of the two pmts of the table shows that the effect of this method of selection is that the number examined in each succeeding fiveyear employment group is a progressively greater piopurtioii of the total uumlmr which raitttl have been examined in e.ieh particular group. Willi a solitary except ion all I ............Mtminrd w en- at ivm k on the day of examination. All selected woikcrs were exainiiieil by the author himself. Tie1 rlinieal examination
showed the following changes. Clicst expansion is diminished and may he reduced to one-half inch or* even |es, m advanced cases, detractitut of the apices is toiniiiofi, and s,miet imes shows a peculiar feat in e
00
/
ift PXErMOPON'I OS IS AJ5ST11 ACTS . '
tlifferriiliatiiig il front lliat found in |il>roiit phthisis. Iii.-Ii':mI of I In- immobile .mil sunken apices seen in the Litter disease. they nrr m-cii t> descend during inspira(ion, :niil t>> rise again during expiration. This seems (> indicate tlie anchoring of normal apices by libruiis tissue in the lower portions of the lungs. Impairment of the percussion note teas found to be constantly more marked ou the right side; in fact, at first it was thought that in the earliest degrees of fibrosis it was confined to that side, but later and more extended observations led to the conclusion that the earliest
asbestos workers often find the dust inilating; this lasts for a few weeks and then usually disappears. The author has noticed this cITcot on himself, hut. only while in a very heavy cloud of asbestos dust. The second type of rough is more intimately associated with the development of fibrosis. Usually it is present only in the morning on getting up, when after rather a sharp attack of coughing, a little viscid sputum is brought up. A similar bout may occur at night after ceasing work. Generally speaking the cough gives little iuconvcnieucc until the development of
' Tabu; Iff
Distribution or Four Common Symptoms, and of Cyanosis, among Cases
of Fibrosis
'
Symptom
No. examined1
Cough ...
Cvaaosis
..
Dyspnoea
..
Expectoration .
.
Pain . . .
# . .
91 93
91 91 94
Coses in which symptom was present
Number | Per cent
54 59-3 52 55-9 47 51-0 31 341 10 10-6
1 Excluding those in which the presence of the symptom is referred to other causes.
detectable cases are bilateral, although the signs on
the left side ore tenuous. This change is so constant
that it has bceu adopted as the most reliable single
clinical sign presented by this type of pulmonary
fibrosis, and no case has been classified as fibrotie
in its absence. The respiratory murmur is usually
weakened, generally more ou the right side and often
still more at the base; the expiratory sound is weaker
than the inspiratory, and often becomes less and less
audible ns one approaches the bases. The dry
character of this type of fibrosis during most of its
course is striking. Scattered fine r.iles in the rout
areas, axillae, and bases were not infrequent: slight
oedema of the lower halves of the lungs was noted in
one of the more advanced cases; but in several no
adventitious sounds at all were heard, Pleural
crepitations, and rarely a slight pleural lull, were
noted--these 'attacks seem to cause little pain--
bin) in one iiiv a little fluid at the right base.
Tineo types of rases were noted in which physical
cxaniiiiatioii. was dillicidt; (I) those in which dust
libio.is had Ins'll implanted upon lungs already
2ciiiphv.e'inatoiis; ( ) {hose in which there were
extensive hiliter.il fibrotie changes dile to healed
tiile-n iitii'is; (il) eases iii which changes follow lug
mi-old m issive pleural i llusion on one side h id
obseonsl the physical signs. Tin' isymptoms *1. >i tiled
1 .*'111by I la* W itcl * . ,s, ty If
hi-' t h* -se of sdn osis. They
ele I a t'til.it i t a bnv r (T.itil-* III).
t |'tig!i Was of two types. Ill the liist for a few
Wi.i.s after i *i uiiieii' dig v.oik in a dusty" pro,
some other symptoms directs attention to the general health. The pain in the chest is referred to by the patient as "tightness of the chest" or "soreness" or "aching." Well-marked clubbing of the fingers was noted in a few cases. The general nutrition was hardly affected except in the latest stages. liadiograms of the chest were obtained in 1 i!3 workers (il.j-a per cent). In company with Dr. Twining tin; author recognizes the following stages: (1) A very doubtful stage of increased linear st fiat ions; (2) Fairly definite fine dusty stippled appearance; (3) Coarser mottling with increased linear st nations; (4) Gross lesions with pleural changes and displace ments due to the pull of the fibrosing lesions. The damage to the lung is therefore much greater than it appears to bo when judged by the .silicotic standard. Asbestos fibrosis is much more diffuse; it spins its fine weh, as it were, crisscross throughout the lung, enveloping and eventually strangling the ultimate lobular structure, lather than depositing itself in itiiuictotw more or less isolated foci, ns in silicosis. Thus, at any rate in the less advanced stages, the radiologie.il pii'lme of (he lesions does not impress the eye, iiue.m wimisly viewing it ft,mi (In: stand point of silicosis. The radiographic picture may show soft an I fairly coarse iiodnl.iti->u. hut it is never so mailed a, in a silicotic film. I'.na.lovie.illy. the distirutiie fi 11 urc, both clinically and I ado d, 'gicalle, of I he .isli.-st.is fiJ'in.is is its it 11 i f< ; imly. The modesty of the sy Jiipl.uil t tie II not d I II IV e In it dill Use imp. I if" m* nt of llie per* n..ioii note, tie* homogeneous
I I
I I
cnt'i . bin.fi>
11. ille.st.
In
Mia'.
1b. of tb" : prvhf. r Incri'ii lo cat.-it ib . At tin.
In
I: Crude mu.:
2. Cardie 3. Spinie 4. Mull! 6. Wien.
<) <: (M I' (O < I ' (/) \\`
11. Ml" IIIU I.. . :
"a*ibf-t and in ' of b"d,, . ph.i * ti iUy i i stag* * * pint *. VI
ti
te': .
Ill 1 I
riu t 1.1": * lie >
I' '
i
I
t
I
\v
\
\ \\
\ l
ASIIK.NTOSIN
131
stippling if the skiagram--all are fragments vf an have been found in every autopsy in pulmonary
entity. unmistakable when assembled, but enigmatic ashestosis. [.V description of these bodies and the
simily.
' methods of obtaining them has been given in abstracts
lliib first article clews with a record of a number of in this Ui-thlin, l!)3l>, v. 5, 210; 217; 503; Allt ].
illustrative cases. In the second article the author discusses the morbid
anatomy, histology, etc. The essential U-sion is a chronic interstitial fibrosis
All these facts lead to the idea that the bodies consist of a central nucleus of asbestos spicules, upon which colloidal aggregate of blood proteins plus, possibly, suluhle fractions of asbestos and, in one case of chryso-
of the lung. In the earlier stages, there is fibroblastic tile workers, an iron salt have been absorbed and
proliferation in the alveolar walls, which become moulded by currents in the bronchi and the alveoli.
increasingly thickened in consequence; and there is
On the question of asbestosis as an occupational
catarrhal desquamation of the alveolar epithelium. hazard the author has classified his facts as shown in
At this stage of the disease peculiar golden-yellow Table V.
Tabu: V
Distribution of Workers examined who had been employed for Five Years or over, together with Cases of Fibrosis, according to Process in which Worker was longest employed
Cases of fibrosis
Average length of employment in years
I
huccss
'
examined
Xo.
Percentage of group
Group less coses of fibrosis
Coses of fibrosis
>
t
I
1. Crushing, opening, disintegrating, and
mixing . . ... .
2. Carding ......
3. Spinning, twistin'*, doubling. plaiting, etc.
4. Mattress making .....
5. Weaving and associated processes .
(a) Cloth weaving . . . .
(b) Band weaving
....
(c) Cloth end band and unclassified
weavers .....
(<0 Warjers, beamers, loom tuners, charge
hands, and others associated with
weaving .....
tf. Miscellaneous processes and remaining
unclassified workers ....
-- -- --
--
28 21
14
2o
--
21
39 87 ` 15 8S -- --
--
-- --
.-- 21
4
4
11 24 --
Total
..... -- 274
--
42-9 16 -- 41-0 --
8-9 9-1 --
10-9 13-2
12 -- 13-8 -- 10-1 -- 18-7
7 -- 40-7 -- 7-3 -- 130 40 -- 45-5 * --- 10-0 -- 12-7
_ 75-0 --
9-5 --- ' 14-1
-- 1D-0 -- 10-9 -- 13 5 --i
2SG 7-2 9-5
44-0
11-2
10 8
11 -- 45-8 -- 05 -- 34-7 --
8S --
_9-6
13-S 13-5
"asbestosis bodies" are found in the alveolar spaces mid in the thickness of their walls. Detached portions of bodies may often be seen engulfed by alveolar phagocytes, or n larger unbroken bo.ly may be par tially surrounded by these cells, in the more advanced Mages of the disease, the fibrosis of the lung is com plete. Alveoli can no longer be made out; hut the a-bc-to-is boilies still remain embedded in the fibrous tissue. Pathognomonic curious bodies (.Stewart's . Ivlin "n-hestosis bodies"' would appear to be mote acvut.ite and scientific] are seen in the lung sections. I he huger bodies measure from 20 to 100 n or noi.. ii, l.-ncth, and are of a golden-brown Colour. 1 In > may have single clubbed ends or may .appear
elongated dumb-bells; some ave fll.umnlouv. while '.th.-t-i Mig^i-.t a *.| i**m of dim s. The bodies do "t 'l.llli V il ll .lilt of tile .11 ii Ii lie d y bill in chry-o! lie " : i- I l,i t git e | he I*i ii --i.in him- it ,i' l ion for imn
t.lltllg d'gl,,, ill|e|,,ity. Thest.t cut i< Uls I todies
Comparative data show that the dustiest processes arc opening, sieving, and shoveling or othe.rwi.se handling asbestos fibre. The heaviest counts of all were found in this group in lilting sacks, by hand, with distintegrated filue in a settling chamber. The cloud of dust was fntense. The clumping of -thu dust particles of the sample on the cover slip was very mat keif, with the result that the total dust count arrived .-t was undoubtedly too low. Next ill order ij cloth weaving, dry and without the application of local exhuii-t. This is uiidoiihtvilly a dusty process, mid although local exhaust ............ .. the count at the breathing level of the weaver, much ilusl still escapes into the .workroom. Weaving doth wet, mil merely damp, reduces the ililst count to a ivmurkabhih glee. Next in older coiin-s mattiess making, with out ell)' pl.'i .iul juris sill'll Us rvh lll l V rill il.it ioll, of d.imping llo.'is. luth. and tables. ,\ppln-.ition of exhaust Vcntil i! i ni and vl imping i-ilu*' the count
."SSTI
iV
vl
? \ 't '
I J * It
o0
/
f/
l'NEOIOCONlOSlS A it STIt ACTS '
I
eoiisiiler.il>!v. Tlie figure* for spinning. plaiting, ami
brading are believed to be rath*-r too high, owing to
contamination of dust front neighbouring nnd more
dusty pnces*cs.
Xo case of ditTuse fibrosis clearly duo to asbestos
wns di.-'owied with tinder five years' employment.
Throe cases were found with three, three and a half
and four and a half years' work, respectively, who
showed clinical signs of fibrosis. Definite eonfirmatory
radiological eviilence was obtained in the first,
definite but slighter radiological changes in the
second, ami indefinite suggestive changes in the
third. Particulars of eight deaths hare been collected.
In sis of these advanced pulmonary fibrosis was the
primary cause of death and in the remaining two
pulmonary tuberculosis wa3 a contributory factor.
The diagnosis was confirmed post-mortem in six
of the cases. The important question whether
asbestos workers show an increased liability to other
diseases of the lungs, such iis pneumonia, pleurisy,
and pulmonary tuberculosis--especially the latter--
requires further investigation, but no outstanding
susceptibility to pulmonary tuberculosis was dis
closed, cither among asbestos workers as a class or
among those with fibrosis, considering the frequency
of old bealed apical lesions among the general popula
tion; but, on the whole, the author considers tliat
this matter should be left in abeyance. In view of
the relationship between nsbestoais fibrosis and silico
sis the author has classified the main points of simi
larity and dissimilarity--
(1) Inhalation of asliestos dust, under favourable
conditions of concentration of dust unu length of expos
ure, Mill produce a serious end even fatal degree of
pulmonuty fibrosis; {1J tho type of fibrosis produced,
however, exhibits a number of divergences from that
caused by tlio inhalation of free silica dust, and the
-outcome of these variations is not yet apparent; (3)
the divergences noted so far are exhibited in the radio
logical picture, and on jioat-mort-ui examination of the
affected Jungs, both in the gross morbid anatomy and
in microscopic sections; (4) in the latter case the
appearances of the asbestos fibrosis seem to he suffi
ciently distinctive not to pi-imit of confusion lietweeti it
and silicosis; (n) tie- radiological eJ ||S-.Iranees of the
asbestos type of fibrosis are more delicate, softer, and
more diflii-o than the silicotic librosis; (t;j it follows,
tlicrvforc. that an opinion ns to the degree and int-n-ity
of mi iisliestos fibrosis, based on n comparison of the
radiological changes uitti tho-c shown in standard
sib*X'is filin'-, will Is- an underestimate; (?) ul the
nliscnre of a lull medical and industrial history, pos-ibili. ties of confusion i>! tho two'ty|H-s of fibro-is will arise in
th'* interpi'-t iti n of radiograms; (a) tl.- te is evidence tbit th"r inorganic dusts, containing no free silica, ttiay Is- product no of this line tyjio of lit.i-.-i. ,n v ar\ ing
ili-gns-.
IA wry mhI Mimni.iry uf puliiuui u y .-i.sls-stnsis tc-c,iii lii-s with luilie lotis r* fvretices b is leo-ntly
I-on written by V. I>m:i:-iti L" .t/< < :> i'h T/nniil,
It'-l'1. v. 1, I IT 72 nnd v. 3, lf*T T'lht.]
,V. fiWIhi.n'' #o*.
< \V. lb \ Hii.i.. I*. 1'. FutlliiT OLlerv.t'i'jtu on I'ltltuc Jirtry Asbestesis. with S; .1 l:'-:c;ci;i.e
to Asbestos Dust and the Curious Bodies found in the Lungs. J. Jloy. .Vicmsrvp. e>'uc. I'.toO, v. 5it. l.V-lfi,.'! pis. (1 cobittred). (2 refs.J
t'nntiniiirig a coiiiiimnicatinii made to the Journal of the H'u/til Mirro^'-npirnl Sucirly in 1927, the authors find three elements from dust in the lungs of asbestos workers: <1) fine black granular dust, much of which is carbonaceous; (2) large fragments, black, blue, brown and translucent (coloured illustrations are given) which arc-strictly comparable with fragments in the original dust; (2) the so-called curious bodies.
Further to study these bodies the authors digested nsbestosis lungs with trypsin, and, by keeping the specific gravity about 1,070, they were able to obtain in the supernatant fluid, after centrifuging and washing, curious bodies "in a pure state." When submitted to X-ray examination in films it was found that the composition of these bodies was largely of non-mineral origin. The authors suggest, therefore, that the so-called curious bodies are formed in the lung as follows. The fine spicules of asbestos cause, by mechanical action, either minute extravasations of whole blood, or serous exudates which envelop them. Solution of any soluble fraction of asbestos takes place. This fraction is considered to be extremely small, but in the case of chrysolile workers some solution is suggested by the iron free reaction. - Any surface in contact with n colloidal solution may
uct nv an adsorbent, nnd in the present rase tho fine spicules must be considered to do so. Intcr-nction between the soluble fraction of chrysolite and plasma proteins takes place, svneiirisis occurs and with tho loss of water tho adsorption is rendered irreversible. The adsorbent is permanently ensbeathed with stable colloidal aggregates which become moulded into the familiar shapes by alveolar and bronchial currents.
S. Jioodhovsc Gloyne.
Lynch. K. M. A smith, W. A. Asbestosis Bodies in Sputum and Lung. J. Amrr. M. .Us. 1930, v. 95, lkV.Mil, l figs. [0 refs. J
The a tit hot* record two cases of pulmonary asbestosis. The first was a Xegro who, at the tune of his death, laid been a worker in an asbestos mill, for twentyeight months during a period of about three years, in microscopic examination of the ti-sues the nsbestosis bodies were 'found in the sections from both lungs, in alsisili. iissik-i.-ited with fine black granular pigment and inoiioiiiiclear cells, some being inti mately asvoeiafed with large monniiticlcar phagocytes, in the bronchioles, win-re there was a No the black granular tuateri.il and Mum* inoiiuriinleurs, in the nlvvnl.ir w.ilN. uhieli v-ere thi'-ki-m d, nml within the i uiiiie. tive ti-si'ie, of the iutdluliiilar hums along (lie cotu-e ,,f ve--.|- and |l|l>l|i'lli. Jltii- flien* was a definite inere.i.< of fibrous iN-m- and rmieli neeiiiiiutatie;i of 1.1 o k granular pigment.
Tbe -.1 i.nd patient u a - a No n Negro wlio bail woi'.>! in an n-h. -to, null alim.-t eonlininai !> for a period >! four and a bill vein-., and dual ol lobar pie ........ a i. In tin. , i..-. al o, it was in tbe llti'ln*-
I
f
) 4 I !1 I
i
M" p k-h onlv Upn. reve ... tiiunl Ml- d loblll o 111 till node-. pigllle,. alveoli . Where I
fi bis hi-. I
' A- 1
Her..... were a fie-; llovi-- : SOIIIeu | Hiul.'-i dige-nl kept v) dig' -;-; Tbe .. ' propa i ` as liav ` greeni be an i
PEWir.r.: Art: |
The mu occurtii. . warts. 'I; in sli:ip-- ; where a ! found <>: ; of the h. ; the slim-1 British t \ to a'l" -: . ai/e \ai i- i appear i ' for one i the pint- 1 thirkne w.irt ei. n.sllesto . .......... ........ Wolk- 1 . rati Iv in ). -
\> il i !!;! o > . N . 1 `
a-. t :
n ' I- .
(i `
oo
ASItKSTOSlS
133
scopic study of the tissues from the autop.y tl.at the was di-covered. gross cxamitiat imi revealing
onlv ma.-Mve pneumonia of tin- whole right lung and upper Wt lole. Sections of all parts of the lungs rescaled the a-^K-stoMs bodies. Thou* were great fiuml"is of them in the alveoli, the walls of the alveoli, the de-per pleural ti-=ues. the hiunchi and the inter lobular framework tissues, and they even occurred in llmunbi of veins and in the peribronchial lymph nodes. Associated with them was the black granular pigment as in the former case. In the walls of the alveoli and bronchi and in the framework structures where these bodies lay was a cellular increase in
fibrous tissue.
As the authors had not, at that time, read the early
accounts of writers on this subject the a-sbestosis bodies
acre first suspected of a living mveeiia and spores of
a funcus, possibly Aspergillus. They subsequent ]y
devised a technique for the examination of sputum
somewhat resembling the technique of Stewart and
Haddow. The technique is ns follows--the sputum is
digested with a 10 per cent sodium hydroxide solution
kept warm at about SO'C. until the mucus was well
digested and the mixture watery, and then sedimented.
The asbestos!s bodies were" then found in wot slide
preparations. Tiie authors tls-cr.b-- the asbe-Oo-is body
s lisving a central filament of a transparent, slightly
greenish tinged. needle-like crystal which they take to
be an asbestos crystal.
5. Jlootlhouse Cloynr.
JSivsoN. F. tv. A- STr.AntAN, A. -S. Asbestosis Bodies in the Sputum: a Study o! Specimens irons Fifty
Workers in an Asbestos Will. J. Path, it- Jlmi.
1931, v. 31, 1-1. IS refs.]
Sputum was examined from fifty workers in n South African asbestos mill, where the atmosphere was at times so overcharged with dust that objects at a distance of 15 or 20 ft. could not be distinguished. In forty-eight of the specimens, asbestos bodies were found. The best time to take the sputum was first thing in the morning. At night, after coining off the shift, the mouth and nasal pharynx were so loaded with dust ns to mask the picture. The bodies were, in every case, found lo be intra-cellular, contained within dust cells or phagocytes originating from the epithelium of the alveoli. The stages of formation of these asbestos bodies arc that a dust fibre becomes coated with a greenish-yellow substance with bulbous enlargements at the extremities; next this deposited material increases when segmentation appears, and becomes deeper and even complete with fracture of the fibre. The claim is made that in the case of other dust particles, and in particular quartzite, similar material may be so deposited. The sputum was always mucoid, and resembled egg albumen. The bodies were easily demonstrated by direct thick films.
* E. L. Collis.
Dkwiktz. A. P. Asbestwnrzen. [Asbestos Warts.} Gaiioxkk, I,. I*. & Cummings, L). E. Studies on
Arch. /. Dcrmut. u.&yph. 1030, v. 101, 1-5.2 figs.
Experimental Pneumoconiosis. VI. Inhalation
The author describes briefly the histology of warts occurring in asbestos workers, and known as asbestos waits. These warts or corns are round or irregular
ol Asbestos Dust: its Effect upon Primary
Tuberculous Infection. J. JmluM. Uyj. 1931, v.
13, U5-SI-, 97-11 l, 21 figs. [21 rots.}
in shape with a rough surface and occur at the places
where asbestos fibres penetrate the skin. They are
found on the flexor aspects of the fingers, the palm
of the hand or the sole of the foot (the latter only in
the summer when the workers wear no shoes). [In
1 Iritii-li l.u-tn.-i..-i they are a!-o found on the shin owing
to Kilo-tos libus penetrating thin stockings.} Their
size vaii -s from that of a millet seed when they tiist
appear to that of a pea when older. The lime taken
h>r one of th--e warts to appear depends upon: (l)
the piotre-tion afforded-to the winkers; ami (21 the
thi. lne* and resistance of the skin. As a rule the
w.uts aie noticed soon after the opetative begin-,
a-ls-tos woik, and they an- liable to can--- pains
--jH-ci.dly wh-n walking. Th- y occur liiainli in
winkers u;p!-i\.-d in n-b'-UiM min. s, but are very
i.o. !\ s... r, in (I,,--e ei:iplo>ed in i.'.h. r ila i-i-.ris of the
in In-try. [Th* y are common in Itriti.-h i.n t >ties.)
At th.. sit,, there is inteii-e pr,.lif.-i.iti..n of the
II o' u i-l-io.-- ' - w itli f- *i mat no i f gi mt oil - [foreign-
1 I * . ' ' t i. V- . ie . uinn .;i 'li ! i 1.-i- -n ei-'
' I n.
| k.i .t u.i/.l i a. d 11..-kin. A < bionic
" * ">*' 1 pi, .* . -S i eii, - 1-1 I m,.!'-: ! V I'lg t I - n|.*s.
*' ' I - I -.. ! th ,1 tl a .t I., t
I ...a. 1. . ..(.1 III..
.. -b. r.. -i - I
- n. 1
This is a preliminary report on a scries of animals
which have been experimentally exposed to asbestos
dust for u period of two years anti five motitlis. The
asbestos employed was elu-ysotile, a member of the
serpentine gioiip of minerals, and was obtained front
The!ford, Ijuebec. the sample Used being known in
the trade.as "King's floats" grade of asbestos.
The gcnci.il plan of the experiment was the same
as that previously employed by the authors in Urn
study of other siliceous substances. The animals wen*
kept in Cage., along the walls of n room li ft. by S ft.
by S fir provided with two ,`i ft. hv 5 ft. windows.
A cl,'itl of dust was maintained in the atmo-plicre of
this loom hv means of an appatatns located in an
ab ove ii ft. from the ne.iie-t animal, the appaiatns
con-i-ting of it lolatiiig metal p.nl.tle operating in a
hoii.-.or.t.d ili mu. The daily p.-riml of exposure of the
niiiiiriK wa- eight hours hut a-> they rein ime<| in He-
loom dming the night wliil-l theda.l was settling the
-art'iil i\|">-ut.- was leilly h,ii.:,-r. The du-t nineeii-
(r I'lofi of the room wa-
mill a (,! olmig-
.Vi.i'h i.iipit. ;. a |.|>. ill o and I lal.l" of th" iln-l
count- i- gi\,ii in th.- aiti- I".
I In-- h.ii..!ii d and t a o'' ! ht ....iim" i[" , -1.1. "O
w I I'" i 1 o-l
*
| . ,-n n-. .1 n|. I*. I !"
w
J'Jt
I'NKW.MULUMUSI.s aiistk acts
/ /
/
t
puiueapigs iww infected with tubercle h.icilli four days before tlie dust inhalation was begun, in an elTort to determine the intlucnce of the dust upon tuberculosis, forty of these animals bein'; placed in
of the fact that after two years large masses of fibres were found to have accumulated there. There uere, however, only very occasional bodies, and probably those were formed in the limp mid carried
the dusting room and twenty-three bein'; kept as controls. The remainder of the animals were used to study the uncomplicated effects of inhaled asbestos dust, and the results were as follows--
to the lymph node. The Authors surest the following possible explanations of these facts: cither (1) while in the hint; the fibres may have been deprived, by solution, of iron or some other substance necessary
() Xon-tuberculous guineapigs.
Apart from
twentv-nino of these animals which suct:umlx*tl to
pneumonia, enteritis and peritonitis, etc., the majority
of the animals arc still alive, but a number were killed
after 30, CO, 00, 3.'. I. 010, 732, and $17 days from the
commencement of the dust inhalation. From the
to the formation of bodies; or (2) the environment furnished in the lung i>ui be especial!} fa\ouru!>U* to the formation of the bodies, lo test this last point numerous injections were made into the peritoneal CHvit>' of. 1,10 P_eapiS. At 110 days a few very small typical bodies were found.
(
eighth month the effects of the exposure to asbestos dust have been followed by means of radiograms of the livin~ animals.
Attempts have also been made to form asbostosis bodies in tlic subcutaneous, tissues, with fair success,
The next scries of experiments dealt with primary
.
The pulmonary localization of the asbestos dust differed from that of other dusts studied by the authors, presumably because the dust is composed of long fibres, and is carried onlr as far as the distal
tuberculous infection in pulmonary asbestosis. Anin,ab>. *xPo*cd to asbestos dust were infected by causing them to inhale small numbers of tubercle bacilli of an attenuated strain (HI). One lot of
r l
respiratory bronchioles where'the major portion of sixty-three animals were subjected to inhalation
the material remains. No asbestosis bodies were - infection, and four days later forty of them were
found in animals killed before sixty days of dust placed m the dusting room w here they were kept
exposure. When first found the bodies were small, until death occurred. The remaining twenty-three
atypical and generally contained within the cyto- "cre bept m a normal atmosphere as controls. A
plasm of the phagocytes. Poring the next sixty days second group of twelve guinea pigs, which had been
the bodies increased enormously in number, size and exposed to asbestos dust for two years, were infected
complexity of structure. Occasionally they were "'*th an approximately equal dose of HI strain of
found in the tracheo-bronchial lymph nodes. At tubercle bacilli. lweHe normal animals were also
first there is an accumulation of phagocytes and infected ns controls. Both these groups were set
giant cells in the bronchioles and adjacent alveoli. aside in the general animal room and allowed to live
IToliferation of fibroblasts was first noted on the 505th as long as they would.
.
dAy and 100 days later true fibrosis was demonstrable. .
*- `e
guinea pigs infected and then placed
,
.,
` m the dusting chamber, thirty-one were dead at the
(b) llnbbits. In the five rabbits killed up to the time of writing (seven were killed and the remainder
time of writing (3d1! days) phagocytosis but no died of various causes), in ten animals some evidence
fibrosis was noted. No tipical asbestosis bodies of the spread of the tuberculous process was observed
were discolored.
(six involving the lungs and four the abdominal
; , ;
i| || *,
(r) Albino rats. Widespread incidence of pneuimmia, frequently complicated by abscess formation, Among the rats expo.-.'d spoiled tin; first experiments,
viscera in addition). Pulmonary cavitation developed in four animals. In all the animals the lesions tended to be fibrous rather than exudative in type. Of the
but a second set of animals produced one which, when killed uu the seventieth day, showed two asbestosis bodies but no more.
The forms of asbestosis body found in the lungs of
twenty-three controls twenty were dead at the time of writing, one dying, after 503 days, of generalized chronic tuberculosis, and the remaining nineteen succumbing for vther reasons (pneumonia, etc.). By
,
the guineapigs rrsemhlri! in every way those in human the 211th day the tuberculous lesions in the lungs rases. The presence of ferric iron may be demon- had healed to such an extent that all evidence.of
j, 1
s! rated by t fie I'lusMari blue react ion. The authors caseation had disappeared (with the exception of the
de,lured from their observations that the asbestosis u-ase noted above).
body dnrlops us a result of "chemical changes faking place within or about iulmicd asbestos lit,res." The cule-sf f,,rMe> differ fiom those sen later, consisting of inm containing slicath-like or nodular swellings along t),,< si,],-, ,>a the ends of the lilac. Isiter
The distribution of the primary tuberculous foci in tin* lungs of the asbestos group cf animals was sumeulmt atipical. Many of the primary tubercles were independent of foci of dust reaction ami the normal pioccss of resolution look place in them. Other foci
tie- coating substances, "either through movement or
oth-i stt.-ss, crack, separating into segments. A
iiiniilo r of mil inphologi.tph-i showing different stages
III lie- foi inute-ii of the body in guineapigs' lungs
aiel t tie at\pii.,1
in the lungs of rabbits are
Oe t-nl-.-l In t tie ,11 li, I,..
were- related lo < 1 list areas around respirator}' broncliiol-s and in Midi rases a much more milked
re.-u-tiou than that produced by either asbestos or tule-id" alone resulted. In some instances there was merely an iul-l fci ene.- witli the usual plot , of tvsohjt ton so lh.lt e\i ,*-.si\,- Jjl,|o-is and ea lvllie.,t ion
t'oiMiie-nt j, m.i,|,-
the . n. ity of nsl,is i, sidled. 11,
. lle-re .,p|-.u, d l" 1'.-delimi'-
in the It.,- te-o broin hi u ln.iph nod-'.m pit-- 'pr- id nt tl, I-.1-nl'iii . j-ii.i , ss.
kI-
I..I
id;
"PiAt I % tiM lln Tie Con
ti li> <
t'liloi.
apt...
Mtpp Tl-
Aslie I run, ) lei n . has I-gold- n
III I
fund :
de\ el.
ASlii .! All') at! of ini I
ill t le
ast,,.'.! . I tllil'i-.- It still
dtse.il ,
mull Ip'
lift, I' I -
thi.tr. . rabbi* , it ........
that td-
tii,n el l
Ki'di-i I A* /'
Aft.i a .............. a ' '
l` to l -
,-f s,
I I. o It- -
' \' I*.
Q
0
SJ
I
->
\ AKHKSTOSIS
t:U
Of tin- small group <if twelve gninenpigs infected
lifter two yeals' exposin'*', six died ami three were
killed. Three of those living piv.sontisl an acute lion-
tuberculous pneumonia and two an acute haemorrha
gic pleural effusion. h'l the others the majority of the
tubercles occurred in ureas where dust reaction had
already been established. The infectious process
appeared to exercise a very noticeable effect upon the
action of the dust. In all hut one the amount of fibrous
tissue about the respiratory bronchioles was much
more marked than in the noil-tuberculous animals.
The development of caseation in an area of reaction
containing asbestosis bodies led ultimately to des
truction of the bodies. They lost their golden-yellow
colour, failed to give n 1`russiau blue reaction and
apparently became so disintegrated that not even a
aupporting fibre remained.
The writers showed that the outer coaling of the
asbestosis body coutains both iron and magnesium and
conclude that the asbestosis body therefore is a
derivative of the crystalline asbestosis fibre which
lias been oxidized and hydrolysed to its well known
golden-yellow amorphous structure.
_
In man and in the guineapig the lungs appear to
furnish the most favourable environment for the
development of the asbestosis body. Practically no
asbestosis bodies were found in the lungs of rabbits
and albino rats, and in subcutaneous tissues the period
of incubation was nearly twice as long as that required
in the lung. That the long continued inhalation of
asbestos dust is responsible for the pulmonary
fibrosis found, the authors now regard as unquestioned.
It still remains to be demonstrated whether the
dissolved substance is the factor responsible for the
multiplication of fibroblasts in pneumoconiosis. If
after the proper period of exposure typical asbestosis
bodies should still be found to be lacking in the
rabbit and if fibrosis should likewise fail to develop,
it seems to be logical to the authors to conclude
that fibroblasts are not stimulated because no solu
tion of the dust has occurred.
>'. Roadhouse Wayne.
KrCcku, Elisabeth, ltosTosia ,k N.vupn. L'eber
Iamgenashestose. [Pulmonary Asbestosis.) Arch,
f. Cciccrbc/Hillt. u. (Inccrbt'ltytj. Berlin. 1921, v. 2, 55S -DO, b figs. [12 lefs.)
After an exhaustive survey of the work on pulmonary asbestosis in other countries the authors give an account of the work done in tiermany together with a short record of eases id the disease which have come under their own observation in Ihe^dcn.
The first rccoj-J in (iermauy was a demonstration by I'aimi to the Medical Society of Hamburg in |9I I of -specimens ami photomicrographs of a case of pneumoconiosis in nn asbe-tos worker. I-'aiik men tioned the occurrenee ,,f a large number of crystals in the lung tail did not desriihe them mote ,ln-.o|y. lie stated, houeier. that they had heeu seen by 'Ilia him, and l!ll 'i:i. in Inn,;, who had -peeu!ate.l >' to whether they wel,* dm- to the inhalation ol
nshe-tos ,lust or wen- a haemoglobin derivative. In 1991 I Unxu.vr and Tittt.Lnv.srii d<-serihe,|
nine eases orcuiTing in two asbestos factories near
l>rrsden. Meanwhile llie authors of tin? present paper had begun to collect cases. They have now examined lifty-two (eighteen male and thirty-four female, workers, of whom thirty showed definite lung change,. A short anali sis of the history of these cases is given.
The longest exposure to the dust was thirty-one
years in a worker aged HO.
The commonest initial complaint wars dyspnoea. Cough occurred in forty-three cases. Night sweats were recorded in twelve cases. Abdominal complaints were rare but loss of weight in the late stages wus round in fifteen instances with rheumatic pains, headache and general nervous symptoms. Amongst tho thirty-four female cases abortions wort- recorded in ten. Conjunc tivitis was found in sixteen. Pharyngeal symptoms were not infrequent. Enlargement of the thyroid was seen on six occasions, with definite Basedow symptoms in five. : There were four cases of kyphosis and four of scoliosis.
Tiie pulmooaiy signs were as follows. Tho respiratory excursion wus diminished. In sixteen cases there were alterations in percussion note and auscultation at the apex, whilst in the rest diminished breath sounds with fine rales, etc., were more marked in tho lower lobes. In some cases there was also cvidcnco of pleural thickening. Sputum was present in twenty-eight, twelve showing asbestos fibres and eight asbestosis bodies: there was no blood, and no tuberclo bacilli or clastic fibres could be found. Cardiac enlargement was noted in three instances, one case displayed an aortic systolic bruit and six a mitral bruit, but they wero apparently compensated lesions. Tho blood1 pressure was never below I Oil mid in eight cases was between l ."0 and 170 mm. Tho haemo globin in two cases fell to CO-70 per cent. aiid in fourteen .others was between 70 and SO per cent. Clubbing of the fingers was only noted once, 'fho urine was frequently alkaline or neutral (twenty instances); traces of uttmmen wore noted in eighteen cases. A strong urobilinogen reaction (red coloration with bcnzahlchydc irv the cold) was obtained. ,
For X-ray films the following exposure data are given--focus-film distance 1-aO in., WO tn.V, -15 kV, 00o to 0 0S sec. Especial emphasis is laid on the
importance of short exposure. Three stages iu the development of the radiological picture are defined--
(1) an increase of tho normal lung striation with the appearance of a fine network often dillicult to deter mine except, by a long series of films; (2) a thicker network with delieatc sharply defined sjads of
opacity ("Fleckcnsrliattcn"): (2) nn intensification of this .net work to form a shadowy veil cohering the
lung. The signs begin to appear and are most marked in the mid /one ami lower lobe areas of the radiological picture. The contour of the heart shadow became ill-delile d in the second slag.*. The root- shadows were
not affected in this stage (nil showed enlargement in
the third stage. The infra, la> icuhir meat remained
dear and then* was no `'snowstorm" appearance such
as chai.icteriz.es the typical silico-is film. In six cas-'-i signs of obsolete liibeieulofis wcle leeogniz.e,| (pliliiarv i,implex). 'I'uheieultuis f.,,:i were gciicl.illy
thi, kei tho, ., -fie -to.is foci and mure ia,ily di-tingm -bed than in ,tla-r form.-, of piiemiioroniosi-. .**lglls ol old plcillia Wile 1, eqoelil .
` 1 t, t fi
a` f:
Si S
f:
f! fe * t: i* f. -
l
ii
t \\\
i.
t
t1
lf i;
; t . I i
i
oo
mo - I'XK I'M ODONTOSIS ABSTRACTS
Four short stntistir.-il t:il>li'.s arc given showing Hie
IvliiliiMisttip of tlieasiest I.sis t*) lb** period if e\posi I re.
type of work. etc. Tin.- general coiielusioii is that moderately severe asbestosis takes some live years to develop. Of the workers examined who had had ten years or more oxi>osure none were free from signs of the disease. In correlating their findings with the different types of work in the two asbestos factories concerned the authors point out that the numbers arc too small for very definite conclusions to he drawn. The four most advanced cases were found in the spinning and twining (Zwirnerei) sections. . A summary ot fifteen cases classified into Stages I, II and III of tire.disease is given (see X-ray findings). Several radiograms are reproduced.
[UCiTNnit-lVoDST and TRir.uTZSCHV article referred to above appeared in January last (BCttxer-Woiist, W. &: Tnri.UTZiCir, O. Die Bcrgilaclidunge (Asbcstosis) und was der dcutsche Arzt von iltr tvissen muss. Vie Tuberkulose, 1931, January, II.). The authors give an account of eight eases from a factory near Dresden. They found that the histories of those cases point to a definite association between asbestosis and tuberculosis. Tire diagnosis was made ou radio logical appearances and a history of exposure to asbestos dust. Xo search for asbestosis bodies was made, the authors believing that their presence proves no more than the fact of exposure to asbestos dust. With regard to the X-ray picture, in the early stages the authors found circumscribed patches about the sire ot a millet seed and in later Stages confluent shadowing of the lower lobe. In their opinion ashestosis is a type of silicosis whose particular characteris tics are due almost entirely to the chemical composition and to the shape of the particles of the asbestos dust. From their observations they conclude that i! the disease is recognized in time and the patient is removed from the factory, the symptoms may subside, but sanatorium and other treatment would appear to have no effect. They suggest that all those who wish to enter an asbestos factory should be examined before beginning, and if at. work should be i.uliologically examined on the appearance of catarrh or shortness of breath.]
. S. lloodhouac Glut/nc.
IlKIXTKK'it, K. Die Asbestosis der I.ungen. (Pul monary Asbestosis. | .In A. /. f.V:rr; A./>'dA. . OVnrtAcAy/. Berlin. -llKli, v. 2, ulj-.is, lit figs.
Tin- author iceord.s two cn-.es, witli p.i.d-iiioitein
exnmiiiatioii, of pulmonary .-isbe-tosis oeeuiriiig in a
f.utiuv eotieei'iied with the crushing. cleansing mu!
spinning of asbestos and the m.innlactiue of insulation
III it, li.ils.
Ti.a (iist had 11,'fll expos.-,| |u .ls!.e-t.,< till-1 from l`'.`J. aii-t.froin pij.*, u ben symptom , i r .t upls-af* d, lm1 d ins ilealh III Itljll .11 a |Mrter. I hi \ i ty rv.uiiiii.o I "'ll it heat I sli.elove u e> id' t'M d in .1 "e 11 l e.a.t t!.'*
I Hig to .( . -ho .led , l.l.l rfrlll--lit. `I he he .* 1 et I- hoW i *1
ti'l>f.. s|t.,.|.,,, II..* I, lit, -r,l II le" I i' .
. tl if'* * . '*
' a O'. !' I .1 | I.- ,ipp n..r . v . . . :, I!. \ I
!"! lit., l - * I iolV l.ll I a. i i I-
I*, pe.le-ol .1 .t
or heart fiiiture. Ilislologieal examination of tlic lung shmvotl iiieri-tis,. of eoim.TI iso tissue with extensive iulluniiii.itiou of tlie lung tngetlirr with ii>lH*stnsis twidics.
The exposure in tlic second ea.se lieg.ui in l!>u'. There was a long period of dyspnoea and tiie patient finally died of heart failure. Tiie X-ray nppeurauces were chiefly confined to tiie lower lobes.
In discussing the formation of tiie asbestosis
bodies, tiie author is in agreement witli tiie general opinion that they are formed from the asbestos fibre in situ in the body tissues, probably as the result of a biochemical action witli silica contained in tiie raw material. lie attributes the cli ITuse character of the X-ray shadowing to tiie fact that tiie asbestos fibres penetrate impartially throughout the lung tissue and are not aggregated together as they are in the other forms of silicosis, lie believes that tiie asbestos loses its magnesium portion in the tissues and that pureSiOt remains, which stimulates the formation of connective
tissue. In conclusion, tiie author notes that asbestosis of
tiie lung differs from silicosis in its radiological picture ns well as in anatomical findings in that tiie connective tissue increase is very diffusely -distributed. It is arranged in nodules in silicosis, whereas in asbestosis it is distributed diffusely throughout tiie lung. Tiie actual morbid anatomy picture appears to depend upon tin; distribution of tiie asbestos fibres in tiie lung tissue, and it is assumed that flic asbestos fibres which gain access to tiie tissues probably do not begin their development into bodies until they reach tiie tissues. They are apparently the accumulation of the silica-cout.lining material. Tiie author believes that the X-ray picture in all types of silicosis, including asbestosis, depends not so much on tiie quantity of tiie thickened tissues as its distribution in tiie lung. Diffuse distribution docs not give tiie same intensity of shadow to tiie radiological picture as does the nodular distribution. He suggests that tiie fibrosis of tiie lung tissue develops, in asbestosis, through tiie breaking down of the material of the asbestos fibres into Sit),.
HntnUtouac Gloyne.
Woon, W. H. A ci.ovxk, s. B. Pulmonary' Asbestosis
complicated by Pulmonary Tuberculosis, Vnwet.
Ovt. 31, tifil- tt. (3 refs.] *
*
III this altiele tin* authors give some account of A series of fifty-seven ea-esof pulmonary asbestosis, witli special lefeionee to those coiiipiieati d by pulmonary tuli.'i.-ill->-i,. Twelve out of these filly-sewn shotted I'Uil' ine of pulmonary tuh> reulosis-fttto obsolescent, and ten active). lour of the twelve li.ul died and at po,t'loolti'tii i.Xanhnalioti evidenee of obsolescent tui.en id.'.is was Pallid in two and of aetito tulareulo*i- in tin- other two, (If tiie non f.it.d e.-<-. seven had . 11111- I. . i-i! 11 in lli-. -piitiini and the eighth hid a `well-in.o k.-d apie.it e.ivily, t`Imi. all) * tl"* ten aetiw e.i-.- w i*ii I. el". I as follow.: j;. n. i.ili/nl le'i.iiiilogs ,i, a t-'iiiof.-I e\inl {on., f.-m.ih ); a.'iie ptil In i. '.two I* m i !- - i; e\l > n 11 e -tib i l.t i e o! *r
*
inti: lit.o l.ir- tier:
tie :
unit \\.
died. one tl tvlai. disco:, for a One i tx-nuo. years, i
Tin-'
thirty : were tj twent >. and \.; pultine the Inr. undesi to be .` from t' been i person
ituliisl i i
(JEttlUs IP>'
`'"I
The an workcis whom ' bettvee' workei > years, \ titan for : age, mu and lie workers spoci.dl phiiiied .
Xe.ll I which ne Cough s or in f.appetite breath" faint nill ties' > ant \, I-id.
1*1 f t '
fo.t: .
I ' . ,
fe..:
oo
0
i lllllk*
. lly . n'
j. r 'I *it
i ;(*! \ : k-X A ; tilW
i tliO
- and ..tlliT I* Sit, . . tiw
of . are live : is '1 > Isis The t-tel
tl-
: the hat ms :ity iii". j '''J' : - .o'
I - ..f
: i.c i
is
. i.
i i i
I
i
I
ASBESTOS IS
. 137
infiltration of a less miili' type (two females); ihronie
The general condition of Hie patients was poor.
lihroid |:illii'i-i (four female*. one inab-i. Tin- total Clinically in ten casi-s percussion and nnsciilt.itiou
number of femal-.-s with pulmonary asholii.-is was of the lungs gave no .significant Hurting*. In the
thirty-iiinc, nine of whom hail active tuberculosis: remainder then; were signs of bronchitis, frrvpicntly
the total number of inah-s iv.i eighteen, of whom' with peculiar, coarse, indeterminate breath sounds.
only one hail active tuberculosis.
The X-ray pirture showed in thirteen cases no definite
With regard to the length of exposure to asbestos changes attributable to asbestosis although six of
dust, of the nine females with active tuberculosis, them hail bronchitis. In three case* well-marked
one had worked for throe months picking up bobbins X-ray changes were present without clinical signs on
where she was nut exposed to dust, then she had auscultation and percussion. The well-recognized
discontinued work for eighteen mouths, and returned X-ray picture of silicosis with the "snowstorm"
for a further three months to spinning and weaving. effect or tumour-liko shadowing was not seen. In
One bad had fifteen months' exposure and the one patient, at the right base, near the asbestotic
remaining seven periods varying from four to thirteen changes, were nodules. This man, had, however,
years. The male patient had had seven years' exposure. worked in a weaving factory where he was exposed
The authors suggest tiiat since eight of the total to the dust of kieselgnhr as well as asbestos, so that a
thirty-nine cases of females with pulmoiuiry asbestosis mixture of silicosis and asbestosis was present. In the
were young girls between the ages of eighteen and early cases there was an increase of the fine reticula
twenty-one, and since it is well known that adolescent tion of the lung with fine mottling. In the second
and young adult females are specially susceptible to stage this reticulated appearance .was thicker, and
pulmonary tuberculosis, any occupation which exposes showed numerous diffuse mottled shadows in which
the lungs to risk of damage at this period of life is the bronchial branching appeared to stand behind
undesirable. They further suggest that there seems the network. In this stage the characteristics of the to be a case for excluding them whenever possible asbestosis were already clearly recognized. They
from the Industry. [Draft- Regulations have now were present mainly in the lower part of the lung
been issued bv the Home Oxlice excluding "young fields. There were very rarely important changes in
persons" (i.c. those under IS years of age) from the the hiliiin of the lung. Diaphragmatic changes take
industry.]
place early' and in the peripheral outer parts and in the
'
S. Roodhouse Gloyne.
centre. In the early stages fine mottling was present,
such as is not seen for example- iu bronchitis and
bronchiectasis! In-the third stage the different findings
Gerbis i I'cKO. Ueber Asbestosis der Lungen. were very marked. A cloudy veil occurred with a
[Pulmonary Asbestosis.] Deut. Med. IVoch. white faded-looking mottling. In the most advanced
1032, v. 5S, 2S5-7. .
' stage the shadows appeared moderately dense. Shad
ow's due to calcification the authors do not regard as
The authors have examined thirty-three asbestos part of tlie picture of asbestosis. The authors con
workers in the Deutschen Asbestwerken A.-O., of firmed in a few cases the findings of the Dresden
whom eighteen were females and fifteen males, workers, i.c..that in advanced cases it was no longer
between the ages of 20 and 05. Only two of these possible to differentiate clearly between the cardiac
workers had been employed for more than fifteen and diaphragmatic margins.
years, viz. one woman for Seventeen ycais and one With regard to age, the severity of the disease did
man for thirty-two years. A table is given showing the not appear to he dependent on tile ago of the worker,
age, number of yeai-s-employed in the asbestos factory, but, on the contrary, on the "employment age" (i.c.
and the stage of the disease in tbeso thirty-three the number of yearn the workers have been in the
workeis. The workers examined were those who were factory), and on the amount of asbestos dust inhaled,
specially exposed to the dust or those who com which varies considerably in different .processes.
plained of symptoms.
The authors found that in every instance where a
Mcarlv all the patients examined showed symptoms patient had been working for more tli.ui ten years,
which might be expected of such A lung disease, c.g. asbestosis could lie demonstrated railiologieiillv.
cough and sputum, dyspnoea, especially on exertion l'crsonat di-position also appeared to play a part in
or in foggy weather, sixti--n complained of lack, of tin- prodm tiun of the change*.
apjx-tite, ten had loss of weight, live had pain on
Uf diagnostic importance was tlie finding of
breathing, live had palpitation, others complained of Asbestosis hodi-.s in sputum, in lung puncture thiid,
faintness ami of increasing pallor. C'ough occurred or post-niort-m in material from the cut surface
in tui-iity-lhfe-e Ca.--.-.s. The sputum was tenacious, of th- lung or in sections of the tissue. The authors
xcanty, generally mucoid and occasionally mucopuru ipmte the \ ieivs of Ddimkci: ami Tl'i'iutM iv- to the
lent.
' effect that the bodies arise tliloilgh the deposition,
I'icviuus history in< Itid-J piilmonaiy catarrh in due to tie- sohitem of the asbestos, of a colloidal form
four cases, pleurisy in two, ami in one ease pi-ritune.il of libel .it oil ~ile b- acid ou t lie rent a I coi e of lie- a'bcs-
tiihereuhi.is. in only on- (a feiii.de) was then- any to, fibre. With potassium f,-Matey .mid- ami dilute
f-onily history i-f t-jh-ii in- and the nutleils slate liydioi (done mid tie- bodies give lie- I'liii-i.m blue
that they can tl.m- in i !o-e vonm-\io?i httwien lea! 11- -n.
ad,, .tosM and tnl-i lealo-i'.
_
' *1 tie in.-iikoil dise| i m*\* h.-tvo-eu the riodral
o
t:w.
I'X K l* M OC<X l OS IS AI5ST I! ACTS
Mppcaiahei-s nml simptoiiis on the one liuiid. and tin* X-ray pirlim' mi tlw* n!lice, tin* author- h'^ihl as a characteristic peculiar to nsbe.-to.-is. liven ill the moot severe ca.-e- nslie.ito.--is <1 til not give as tnri jk.-tl a pict in r as lluit of silicosis; indeed in 11 it* tliitil stage of n-bestosis there was pit-sent only a degree of shadowing which in silicosis wonhl have little clinical significance.
It is probable that in asbestosis the silicic acid nets as n chemical irritant which leads to fihroois. It has been demonstrated that connective tissue is especially sensitive to the action of silicic acid and it is suggested that when the silicates of the asbestos nre dissolved in the lung tissue, silicic acid is liberated; the hitter is then taken up by the connective tissue and stimulates increased growth. This absorption may possibly be further promoted when more strain is put on the tissue by the act of respiration; probably herein lies the explanation of the fact that parts of the lung are specially affected. With regard to the severity of the disease the authors assume that a constitutional factor is important, (KeloidosU, cf. Sc-hkiddi; [this liulhtin, 1929, v. 4, 103i)J), and believe that on some factor of this kind the extension of the disease is dependent.
The authors think that the statement that asbestosis is formed on the soil of a tuberculous infection is contradicted by the facts. It is well recognized that the asbestosis patient has an increased sensitive ness to acute inflammation of the lung and broncho pneumonia, which fact gives rise to u bad prognosis. In conclusion, they summarize their findings by the statement that asbestosis is a serious specific occupa tional disease which is well differentiated from other illnesses and which is easily diapnosable by considera tion of the occupational history. Itadiolopically asbestosis shows a widespread uniformity with changes which KoKl-srn and LiaiKlirit have found in plate glass grinders. The X-ray appearances produced by asbestosis as well as those of diseases produced by glass dust may be distinguished from silico.-is by tlu- trim `'silicatosis.'1
X. J'ltotl/imiMC Ohiyne.
<;i.oVNK, s. It. The Asbestosis Body. Lnncrl. 1932.
June 25, i:i.11-<;,''H-trg--7 (23 refs.]
During the past, two or three years alienations on
the a-l>e.ti>-i 1 body have 1-een ptibli^lu-d with Midi
fi- 111.-11. \ that it is very ilillicuit to keep track of them
nil. lit this art id- tin- author lias endeavoured to
la mg together, as far as pos,-ihle. all llu- work from
difi.-ieiit sources and at tie- .same time to add Midi
fad- a- have com.- under hi- p.-r-onil ob-cri at imi.
1 lil-t account- of the a-br.-to-i- body Were given
1-y I'.inia: .uni llti.t. and by >!ii.ul Mi I >n\ w.u in
It1'-'* (this H,ill,till, lie's. V. 3. L'.'s) though then- is
ci id-
tli.it tin* liu'lif" in.ix |t.i\i* lrn mvii lv
M ila iivm, and Ifll-l.i. ill 1
and I'llil; in lull
In |li.-ii i|.`iii..ii-t I ill...,- of pu.-aiu--.'. .ni.--is nmiinii;
.i-l.i.to. \.oik.-is. Ibvei-lti in ship., mikes it
impossible lo write all ndeipiate description of ail forma of tho asl.e.-losis biMly. The following i.a a brief siimin.iry--Marked variation in length (21 till ) and breadth (12-21 /i): golden-yellovv colour; lioitiogeiiemis structiiiv when viewi-d by ordinary transmitted light (by cutting down the light a suggestion of a central tilirc can often be seen which may nlso sometimes he seen proj'-cting beyond the hody); no differentiation with polarized light: tendency to be arranged in irregular clumps and clusters; very early forms unsegmented; Inter forms crenated, segmented, or resembling a series of rival discs, or beads strung together in a necklace form (sometimes, later, n short length of fibre is seen between the segments); bulbous or pointed extremities (or one bulbous and one pointed suggesting "heads and tails"); generally quite straight, occasionally curved, very rarely S-shuped; forms seen "end-on" look liko . knobs.
Stewart and IIaodow [this JJullelin, 1930, v. 5, 217) first found the bodies in sputum by digesting with an equal quantity of undiluted antiformin, centrifuging, washing the deposit, and examining a dried film. In sections they stand out well unstained Against the stained background of haematoxyliu atul eosin, but -they are really best seen In an unstained section. On one occasion the author found asbestosis bodies in the faeces by emulsifying with formolsaline, centrifuging und examining the deposit. The bodies do not stain with the ordinary aniline dyes, Cooke and Hill and Stuart McDonald, in their original descriptions, noted that the bodies could be stained by means'of the Prussian blue reaction. The author describes a method of staining with ammonium sulphide.
Xo asbestosis bodies have been found in crude asbestos or in asbestos dust, and it seems practically certain that they are only produced when the fibres gain access to living tissues and remain there for a considerable period of time. The asbestos fibre which form.- tin: central core of tho bodies was identi fied by the author by dissolving the bodies in con centrated sulphuric acid. Uauunei; and Cvmiisos [this Hull, Hit, 1931, v. tt, 1,112] showed that the guldenyellow material which cuvers the fibre contained iron: _ Sm.-iiN and Stuuiian (this ItulUtin, 1931, v. 0, 105] and the author have continued this. The ashes; tosis body would appear, therefore, to be formed from the original fibre by a process of (1) deposition of Mime material around the fibre so as lo thicken it; (2) li--me or clacking of this material giving li.-e to tIn- app.-.ifanee of segments; (3) fragmentation or tin- .-psratin.; off from the a-la-to-is body of frai'tuied fruitions of Hi.* depo-it'-d material.
Tin* hodies t.-.-i-t artificial gastric juice, trypsin, and -nit-.1 \ -;- f..i a cnii-id.-ial.l.. period, (laidner and l'iiiiiiiiin.'- noted that *`.i-eation led ultimately to Ha- d*'-11 netioll of III." Ill,die-. They resist heat, and dei il. ifiing (biid uhieh contains 71 per rent of lilt i i*' aeid. <'ni.cent lati-d sutjdiuiie ,a id leave- only a nieie ---nJ-laiice of ; i;l,o.t like lni.lv with a central (itiie. 11 y dii.. Id*a ie arid Im. the i tleet of bleat Jiing tin- I a 1.1 e - : tlie it !!.'.( i it hi r i. f, i!. i, out ., I r i e < -'
,
; ' *
( ' . '
:.
I 1 Tie . g..V
VI u two |. mateI ; 1nh|i :
Jligne .
!-- 4 I * I'll IS t : Bmlil. pi.pa. IhhIi--
1T..I pill 11 '
filth. . Ill the the ho found {fill'd! of tin i fibre, t react a > raid ill ion film i -i i part ni
The rutun. found ' (Tlllllei entlv > for tin lam a>
|mm!i '
Alltli'.i
M i.w ` 0i in / '
V.. .. to ... I III.... V. > ' I;
t'
di M
oo
ASi5Ks.TO.SlS
i:w
Immediately leaving a colourless skeleton of the body, pneumonia, or as a result of secondary tuberculous
suggestive of a minute hyaline urinary cast. Some infection. They believe that the fact that the sputum
time.-. the body becomes swollen and the segmentation is rather roughly treated may account for the rarity of
is lo*t: at others the segments seem to teinaiti intact. these clumps; on the other hand thoy have never
The effect of hydrochloric acid is interesting in that the found broken up portions which might be expected to
golden-yellow colour is discharged but the ghost-like result from rough treatment. The radial arrangement
structure of the body remains. The inference here of the bodies with the bulbous extremities at the
would appear to be that the body consists of at least periphery, identical with that of the majority of the
two portions suirotmdiug the tibro--viz. a resistant clumps in lung sections, shows, the authors consider,
material which forms a framework and gives the that such clumps are not artefacts but formations
body the characteristic shape, and a golden-yellow built up in situ within the lung alveolus from which
pigment which is readily bleached. Nitric acid has they can only escape as a result of some sccondary
less effect; glacial acetic acid appears to have no disintegrativc process.
effect and the bodies also resist 20 per cent caustic- The authors conclude that since these dumps,
soda. Gardner and Cummings have succeeded in which are only rarely encountered, point to disin
preparing l>odies superficially resembling asbestosis tegration of lung tissue their presence in sputum is of
bodies in ritro.
far greater significance than the finding of single
from the presence of the asbestosis body in the bodies.
sputum certain deductions can be made--(1) their
S. Roodhuuse Gloyne.
presence is an indication of exposure to asbestos dust;
(2) their formation is the result of some tissue reaction
in the body--probably a colloidal reaction in which Gloyne. s. 15. The Morbid Anatomy and Histology
/the iron plays a part; (3) asbestosis bodies have been
of Asbestosis. Tuhervle. 1033, v. 14, 445-31;
found in the guineapig (Mayrocoudata, Stewart,
493-7; 550-oS, 7 pis. (1 coloured). [29 refs.J
Gardner and Cummings, Gloyne); (4) the presence
of the asbestosis body implies a tissue reaction to the The author emphasizes the following points in con
fibre, but it does not necessarily follow that this sidering the morbid anatomy of asbestosis--(1) the
reaction is accompanied by fibrosis: all that can be differences in structure and chemical composition
said at present is that the asbestosis body is an expres between the different varieties of the asbestos used
sion of tissue reaction to a benign irritant, and that in commerce, and the possibility of different types of
fibrosis of an appreciable extent may or may not be a lesion occurring in workers in the various kinds of
part of that tissue reaction.
asbestos; (2) tlie variation of conditions in the
The bodies are not easily produced in the sub asbestos industry, which means that some workers
cutaneous tissues of animals. They have not been undergo rapid exposure to massive doses, anil others
found in the skin of man or animals. Gardner and slow and gradual exposure to small doses; (3) lack
Cummings record that the lung of the rabbit appar of uniformity among operatives, the workers varying
ently offers a much less favourable environment from strong, able-bodied Kuropeans anil natives in
for the production of the bodies than does the lung of Africa, negroes in America to adolescents of both
man and of the guineapig. SciiVstek has found the s->xes. (It should be noted that in Great Britain
bodies in a dog, and Gardner and Cummings and the "young persons" under the age of IS may not now
author in rats.
be employed in the industry); (I) asbestos is a mixed
S. IiootlhuuKC Gtoyne.
substance and it is not known to which part of it .
the various tissue reactions should be attributed.
The proportion of particulate to. fibrous matter
Stkwai:t, M. J., TATTKr.-s.UA, X. A IIaimxiw, A. C. varies, whilst ferrous iron may constitute as much as
0a the Occurrence of Clumps of Asbestosis Bodies ID per cent of tin; product ns it occurs in nature;
in the Sputum of Asbestos Workers. J. 1`uth. t foi.In some of the workers a history of exposure to
Had. 1932, V. 35, 737- 11, 3 ligs. on 1 pi. [ID asbestos is an inconspicuous event, often unrecog
- refs.]
nized even, anil the lesions are only detected by
accident; (0) the size, weight, concentration in the
The authors describe two cases in which, in addition .itTiii>sj,!i.-re and the slnpe of the inhaled particles
to single asbestosis bodies, H large chimp of some i-'ay have some hearing on the lesion; (7) (lie asle-stos
twentv to thirty boili-s. more or lc-s radially atr.inged worker is prune to other respiratory diseases which
with tln-ir bulbous e\ti.-i:.if i-s outward', were found. may confuse lie- anatomical pii'lut'c, viz.: pulmonary
The ,.pp. urate-c of the ..lump-, was simil.ii' to uli.it is litbi-rciilo.is, broncho-piieuinoiiia and s"pfie broil-
seen in lu-l-section-, of tin- long in r.is . of i>i (i-.
pulmonary a.-b-st..-is, wle-re dumps of bodies u- i ur
l ie- .'ill of dust inb.il.iti,hi in piilinun.-itv asl,,--to-
itli_. i u itbiu the lung alveoli or enib.-.ldcd in liluou.
is dith-ient from that s,.,-u m oth.-r du.t di-ea.-es
tis-lle.
"* owing to flu- p. cidi.ii- Ion; ...... lie III." shape of the
*1 i .e i* h < >i -
lit it tin- fit.dm:, o! a lai.-e
p'tli'I-'. Tl; i;b|...j, |. Dili ,..- all-f the
tun ;* e|iiu.|.. of a-i,, .1...Iio-li.-. in t '.;i,t mu i .. ! 11 -s I,at.i. I- ii In- ,,| - di. i.-i- aii- not s.-.-o. In lb,,
I - .1 i I- a I l li. 1.1 , * i- ,-! d. - a,' - . I ..I i - - n of I - u.. 11 - .'If. l '-nil lb" ill .1 .- i. III.lik'd, hv III'- obllt, I at IV e
`If i l-\ a p........ of it,-pi- u| |-'Ua!u.- I u--..
it-- <( lie- pi ...... |, t.-i 11., t ,>|.I,.-mg i
II* t. , r> II'
i'
; i } .'.
;?
i-
1: [.
i-;
f;i
l: r t:
I!;
i' ri .
r
i *? If I
i.
HO
I'XEUMOCOXIOSIS A11 STItACTS
Tho lung nf tbe uncomplicated rase (ns soon jiostinortein) is cliarneteri/.isl by den-e blue-black areas
rniri-spividing to the secondary lobules, jaimiunded
bv thick bandsuf interlobular connective tissue, gcnernflv with a reddened background of terminal bmiiclmpniifTU'iui.i in Mu- less affected portions of tlu* lung. There me ft-"' naked-eye chancres in other organs.
Five different kinds of particles arc to be seen in
tin- lung of mi Rsbestosis case--(1) carbon pigment,
common to all town dwellers, particularly in largo quantities in the regional drainage glands where the asbestos dust L- usually scanty; (2) an amorphous
brown pigment lying around the asbestos fibres and
nsbestosis bodies. There is some evidence that- this is blood pigment; (3) black irregular particles, probably carbonaceous in nature; (I) asbestos
fibres: (ft) asbestosis bodies. When the fibre gains
access to the lung three reactions take place: (1) the (Hire becomes thickeued owing to the deposition of iron containing material along its course, forming an nsbestosis body; (2) cellular changes occur of which the chief Are the accumulation of large phagocytic dust cells and asbestosis giant cells; (3) fibrous tissue formation. The asbestosis giant cells are foreign-
body giant cells and probably result from partial degeneration of small collections of phagocytes and arc not single cells in the true sense of the word. Some
times faint outlines of the degenerated phagocytes emi be seed. When seen in early lesions in the guineapig the cytoplasm has a pigmented stippled appear ance due to the presence of numerous minute asbestos fibres and pigment; in this way it differs from the
almost structureless tuberculosis giant, cell. It also
differs in the fact that the nuclei of the asbestosis giant cells arc large and not so numerous and are not so constantly arranged round the periphery of the
cytoplasm. The immobilization and long persistence of the phagocytes, nnd especially the asbestosis giant cells, are characteristic of the disease.
The most marked feature in the histology of the a-d>csto>is lung is the holding up of the fibre at th distal end of the respiratory bronchiole, and in the alveolar flints with u cellular reaction of largo mononuclear phagocytes, and the ooriirrenci* of Aslit-stosis giant colls. In tho later stages of the disease the biockugo of tho lymphatics with asbestos dust and phagocytes, and the tilling up of the adjacent air sacs with the same material is seen. Finally there follows an increase of connective tissue around the lamu-hiolrs, alveolar ducts, air sacs, capillaries mid Venn!-.-*, and in tlm interlobular sepia Hlnl bcrie.ith tho picuia. These changes eventually lesult ill a complete obliteration of all lung eoufiguration.
The ' lesions found ill experimental imiurils am flex-rilied. In the ra-o of a dog (ris-ordi'd by .S< nrsTiat) aiquiimg nsbe-b-sir m a factory no n.ln-sto-is bodies Hen- found ami alt b-tiigb tla-ro vas ovid.-nre of ph.igm-yl--is tht-iO wa, no sign of acute inllamniatirm. In the fax- of rat s i-.mght on-far.lory premix-s asls-sto- fibres Hei- ph-ntilul hut tbe cellular is-.u-fion was irisignifieent im-l only one or two a-li.-stosls tio-iics were found.
The compile.itiims mill MS|iiclai- of pulmonary a she s| ii-I s lunv be disided into tin* groups, viz.:
th *-e uliii-Ji ale ih-liiate i-*stil!s of tin- d-itmige done
hi tie- lung by Mu> a-le-'to, fibre with its ti siillim.;
M I......lion, and Iliox- which appear, as far a.s
can la- detei-mineil with present knowledge, to *bc
incideiit.il mid unrelated to the disease. fit the former
group the following have been noted--purulent
bronchitis, broncho-pneumonia, pulmonary tuber
culosis, empyema, and bronchiectasis; in the latter--
abdominal carcinoma, mitral stenosis, cerebral haemo
rrhage and cholelithiasis. I'ulinonary tuberculosis
mid hruncho-piieimiofitu are common complications of
the disease. Hioncho-pnenmoma is best seen in the
parts of the lung least affected with the asbestosis,
which explains why broncho-pneumonia is such n
fatal disease in asbestosis, viz.: it puts out of action
the functioning portions of the lung.
(An account of the clinical and radiological appear
ances, etc., of pidmonary asbestosis has recently been
written by Philip Eu.man, J. JnHusf. Hyy. 11)33, v.
15, 105-83.J
,
S. Roodhouse Gloyne.
JIiaiEWETKER, K. 11. A. A memorandum on Asbesto sis. Tubercle. 133 & 1031, v. 15, 09-SI; 100-18; 132-0. [ IS refs.]
This memorandum reviews the subject of nsbestosis in the light of all the rcceut knowledge obtained con cerning the disease. The first serious attempts to employ commercially tho tire-resisting properties of asbestos were made in the latter part of the nineteenth century, but some years elapsed before difficulties in manufacture were overcome. In 1SS0' tbe world production of asbestos was a little over 500 t.; in 102!) it had reached over 430,000 t. The fibrous materials commercially known as asbestos are silicates, the silica being combined witli metallic bases, chiefly of magnesium or iron, with calcium, sodium and aluminium in smaller Amounts. Practically speaking nil that goes under the name asbestos in commerce is cither fibrous serpentine or a fibrous mineral of the hornblende group, of which the most- important arc crocidolitc, amosite nnd trcmolito. .Serpentine asbestos or clirysntile is essentially a hydrated silicate of magnesium containing lit tie. iron and almost no calcium. Tbe hornblende varieties contain leas magnesium and usually more calcium, aluminium and iron. - Now uses' for asbestos arc constantly being found; for example, tlie phenomenal expansion of the motor-car industry has caused an increased demand for asbestos for brake linings, clutch lings, etc. It. is estimated that the number of workers employed in the manufacturing processes in England lies beteii two and three thousand.
The lii.-t ii coriled can- of asbestosis was that of a
patient who dfid in Ifftin, the record of the case being iiicluih-d in Mu- evidence of l)r. .Montague MckhaV to the Departmental <'oniinittee on C'oftipen-.itioii for Industrial Di-eases ill liitiil. Mocvidcticc of additi-mal cs-es was nhtaiued. lint in the same
vear M \i:< iianii ,k Itn.sAl, iioti-d th'.- presence of llliu-llal I-mill's in the hlllgs of nil asbestos Worker
mid, again in tin- same year, tin- ITeUch otliei.il Jlrlhlin il,* I'/ti-'ij** i fi"/i ihi Tt'uttiil rnpntti-il on the
high iinnt.il.'iv in an a-ln-stiis li xlil - fa.'tiny anil
is.i -
fr.e. d-.l-
.
tv i'.tvg.
Sllgg. the V extinti r
of tr io u. BSln-` the '< ' luiigthe ! the l. ashes', that e of put attrih was ! llu.i..
by s . which
of a.st
flbro-iimpiir tlio in. 303 w. lished . at p:r_-
Pulirregu'. - teriiiin rcticid silico-
of So!:. undau. This is broncli. curreti'. extrcti.
cavitii!
Intern. Will.
Is that Siuli l,r The c hri-atli. sisth.-e Itndioc: Thej.ii or vein Rim. 'i tliilgKoon ehthat -a
The bt-vn 'I
feiitii!
tin y Ul* \ i
uw
I
i I
.ASBESTOSIS
Ul
considered it a.-4 piwhatily due t*> a pin'iiimH'iiniiKU ately their presence ilia's iml give any nine ns' to
(nan tin- m-lieslns dust, la I ilia, following another whether the cximsiire has been roernt or long past.
death. the Itritisli Factory Department made a
Wit bin certain high and low limits the concentration
survey of til-; industry which did not disclose any of asbestos dust in the air of workrooms is the deter
evidence of a serious health-hazard, nor were the mining factor in the onset of disease. Tlic asbestos
replies to inquiries made to the Canadian Government fibres may be split longitudinally apparently to nn
suggest j vc of the existence of such a condit ion amongst indefinite degree since no ultimate fibre comparable
the workers in the quarries and mills. In 101:1 some to the vegetable fibre lias yet been demonstrated.
experimental work by Beattie indicated that the Any manipulation of.asbestos, therefore, is liable to
inhalation of asbestos dust would cause mild degree produce dust which is easily projected into the air.
of fibrosis in animals. In 1014 Fahr demonstrated Exposure to asbestos for less tlum five years can
to the .Medical -Society of Hamburg the lungs of an result in the development of fibrosis sufficient to
asbestos worker with pneumoconiosis and mentioned cause death but this is unusual. The incidence rates
the occurrence of a large number of crystals in the for the period of employment naught to four years,
lungs but did not describe them more closely. In 1017 five to nine years, ten to nineteen years and twenty
the British Factory Department again considered years .and over fouud from examination of 1,512
the matter, but no further evidence incriminating workers wore proportionate to the figures, 1, 5-11,
asbestos had come to light, and it was not until 1024 30-S, and 53-2. I'nfortunatelyit cannot be assumed
tliat another death revealed at the autopsy evidence that provided the exposure does not exceed five years
of pulmonary fibrosis of a difluse nature, which was the risk of contracting asbestosis is almost negligible.
attributed to the effects of asbestos dust. This case The fact that a dense concentration of asbestos dust
was fully described by Cooke, Sttaiit McDonald & over a comparatively short period will lead to fibrosis
It ICS- A few weeks later another case was described has to be recognized.
'
by Seiler. This was important as being the first in
.The author answers in the affirmative the question
which the essential relationship between inhalation --Does asbestosis shorten life? and gives a series of
i of asbestos dust and the development of pulmonary tables emphasizing this. These tables show that the I fibrosis could be demonstrated. A comprehensive average duration of employment sufficient to cause j inquiry was therefore instituted in Great Britain and a fatal degree of asbestosis was 15-2 years. The i the investigation involved the clinical examination of shortest length of exposure was 4*4 years. Tuber
3C3 workers. The results of this inquiry were pub- culosis was found accompanying asbestosis in 35-7 per
lislied in 1930 by the author. (See the abstract of this cent of deaths, ns compared with 59-4 for silicosis.
at page 117.)
Inquiry into the relative dustiness Of various
Pulmonary asbestosis is insidious in its onset, processes in the asbestos industry enabled the author
irregular in its course, and variable in its mode of to classify the operations into six groups--(1) crushing,
termination. The fibrosis produced is of a .fine opening, disintegrating and mixing; (2) carding;
reticular variety which is contrasted with that of (3) spinning, twisting, doubling, plaiting, etc.; (f)
silicosis. The fatal issue is determined l>v the onset insulating mattress making: (5) weaving mid associ
of some acute infection with which the remaining ated processes; (0) miscellaneous. The groups of
undamaged lung tissue is quite unable to cope. processes differ in their average levels of dust produc
This is commonly a low grade broncho-pueuinonia, tion, that of group (3)-being easily the lowest in the
bronchitis or tuberculosis. In the absence of inter absence of any dust suppression devices. A table is
current infection the fibrosis may progress to an given showing how much more serious is the risk in
extreme degree and bronchiectasis, nun-tubercular the more dusty processes.
.
cavitation and spontaneous pneumothorax may occur.
With regard to the risk from tuberculosis, tlie
Intermittent attacks of dry pleurisy are common. available data are meagre owing to the comparatively
With regard to clinical signs, the most important small population at risk. Button Wood 4c Oi.ovxk's
is tlt.it of diffuse bilateral impairment of the percus figures of ten cases of active tuberculosis in fifty-seven
sion note; this is best elicited bv the hack of the chest. cases of asbestqsis probably represent a maximum.
Tile commonest symptom is undue shortness of Of 371 workers examined whilst actually at work
lilenth. in common with other forms of pneumoconio only four showed signs of active tuberculosis. On
sis the diagnosis of the disease is fraught with difficulty, post-mortem, examination it is possible to divide the
liadiogi.iphir examination of the chest is invaluable. ruses into lhive groups: (1) those with rapid tuber
1 he picture is that of a diffuse ground glass appearance culosis and very slight or no signs of asbestosis;
or reining. together with line pin-head iiiolllmg of the (2) those with much fibrosis due to both diseases;
bln*. The #mtImr lii-lieves that asbestosis cannot be (3) those with advanced asbestosis alii) slight amount
li.ignoM-d with ah-ohlte rertainly, however, either of a< live tule-ii'iilosis. Of these groups (1) probably
on linieal or radiological examination nlotio, hut contains most ,(f the cases of the adolescent type.
li d with the aid of both diagnosis is po-.-ihle.
The experimental work of G.vr.iiNr.it A (VNMIMls
. lie-
n,c. bodies found in the lungs have now indicut.- that i niiiciib-nl inh.il.it ioli of asbestos dust
been ib-rMl/.-.l by numerous Wolkels. Th"V have ll ilo.-s not . 111 `i t the ultima I >' In-aim g of lesions produced
* *' 11.11 coie which eoli-ists of the a-.bf.tos I i 1.1 -*. As b\ n tuberculous infection of |..w virulence. On this
*h-i
I,..! pi --nt in the mw nrileiid tie--,, hodi.-s ii \ pot h -is 1 le- uut lior su.;.'e-t s t li.it il oi.iV be reason.
i.il.i.th I'Onln, .',1 ill til,- ti.,uis bill lll.fel t nil- abb* to lilsUlls. (be wlliili- of tile ih-.lt lis In glolip (I)
t i
t
0
142 IW'KVMOf OXIOSI.S AltSTRACTS
mill ;i tov i>f lln* deaths in giotip (2) ns being iinr.ni-
iu*rl'it with a^lii-stns-ilunt exjio.-uiiv. Hrotip (2) alsi
include tin* cases of fibpvid tidvereulosis who Inn-.imi'
expired t*> asliestos dust. Ill thc.se tin* effect iC Mu*
asbe.-ti*s ilii.*l is tu cause more fibrosis than would
occur with cither agent acting independently. lmt
whether in the long run its influence is favourable or
unfavi.ur.it>!-* would appear to the author to depend
on individual factors in each person. In this group,
however, must also be placed an apparently small
number of cases in which in spite of the presence of
extensive asbestosis a virulent rapidly caseating
tuberculosis occurs. These are cases in middle life
and the author suggests that they may depend more
on the virulence of the particular strain of tubercle
bacillus than on the presence of asbestos dust. In the
third group it may' be assumed that the advanced
degree of asbestosis would cause death in the not too
distant future, and that the tuberculous lesions
hasten the process by obliterating the small remaining
reserve of sound tissue. Summing up the evidence tiie
author suggests that although the data are very
fragmentary at present it is probable that the risk of
tuberculosis is less in asbestosis than in silicosis.
With regard to preventive measures, some degree
of dust suppression, though an inadequate one, had
(been applied in the industry by virtue of the Factory
"and Workshops Acts, 1901, but it was not until 1031
that the Asbestos Industry Regulations were framed
to deal with tiie situation. Other Regulations
followed and the complete code lias now been enforced
since March 1st, 1933. The carrying out of the
Regulations has cast no light burden on the industry;
problems of ventilating engineering with exhaust
ventilation and otln-r methods of dust suppression of
a high standard have hail to b^ adopted. A joint
Committee of asbestos textile manufacturers and
representatives of the Home Oflice has now been
set up to consider these problems. As a result of their
recommendations a Code of Regulations lias been
drafted applying the following principles: (1)
Application of ellieieiit focalized exhaust ventilation
at dust-producing points; (3) Substitution of enclosed
mechanical methods for hand conveyance and for
dusty hand work generally; (3) Fttective enclosure of
(liist-pivdiiciug machines and plant; (I) Siib.stitution
of Wet methods for dry; (fi) Klimination of certain
dilst-piniliieing appliances* (li) Rffectual separation
of pmce.-sscs to prevent unnecessary exposure to
hl-t; (7) 1st- of sacks of close texture iiiateiia) fur
Intelnal work in tin* factory, and cleaning of them by
lii.o lunery; (S) Ftticient cleaning system; (9) I'ic-
c.iti'ioiis to prevent dust from asb- 'tos in storage
fiiintn-rs or bins entiling the wmkrooni-,; (III)
Regnl ii ev.iinit-a! ion at.d testing of veutil.it mg plant;
lu>! settling and lilt>-iiug apparatus not In* tii.alloued
in o oik i ..oiiis; (II) lit ...it (ung npp.ir.it us of nppiov.-d
tv ) to l,, pio\ nleil for |..-|s..n> ( lup!. > ed in v it.iiu
*) ':..li"M..
In a. 1
to pl.vi'itivc ......... -it. - i -n n-at > m
1 ad-*...'. 1- .1. ,*.!,.| m.d. : t!.e Uoiki.i. n -
|I. - 11 . --. \. | . | ' ,-\l. l,.|. I lo I l,,- U . i... n s
I
*'...... ... .i r d \ I *
\ I . I'* >
f'niter this Aet the Neerclury of State was cinpovv cn*d
to make a scheme of compensation for the industry
and lo cil-oldiiiate medical arrangements. This
scheme, known as the Asbestos Industry (.Asbestosis)
.Scheme. |!i;>l, came into force on .1 uni* 1st of that year.
Jt applies to all workmen employed at any time on or
after May 1st, J!)3i, in any of a comprehensive
schedule of specified processes. On the same date
the Silicosis and Asbestosis (Mcxlical Arrangements)
Scheme, 1931, came into force to simplify and co
ordinate the different medical arrangements already
in force in connexion with compensation for silicosis
and to apply the same general procedure to asbesto-
sls. Under this scheme a whole-time medical board is
charged with periodical medical examination of
workers, examination of claims for disablement, and
of I'ifiCwtes in connexion with
disablement or death claimed to be due to these
diseases. The Medical Board acts in different areas
of the country by panels of not los3 than two mem
bers. Furthermore, under the scheme every new
entrant into the asbestos industry must be examined
within two months of commencing employment,
cither by a member of the' Board or by other duly
qualified medical practitioner appointed for the
purpose. The following requirements must be satis
fied--(1) the worker's chest must be of at least
average development and the respiratory passages must be free from obstruction;. (2) there must be no
disease of lungs or heart; (3) there must be no tuber
culosis of any organ of .the body*. The prescribed
interval hctvveeu the periodical examinations of
asbestos workers is one year, and a worker found to
be suffering from tuberculosis or from asbestosis to
such a degree as to make it dangerous for him to
continue work in the industry is suspended. Ill tiie
case of a dentil claim the Certificate of the Hoard can
only lie given after pout-mortem examination, except
in the case where the workman at the time of his
decease was already in receipt of weekly payments
under the .Compensation Scheme, the Board being
satisfied that a posUmortem examination is unneccs-"
sary.
'
The .Memorandum touches briefly on asbestosis
in other countries. Abstracts are given of reports
made on tbe subject in France, (icrniany, Italy,
South Afiica and the United States of America.
This evidence from all quarters confirms the risk
of pulmonary fibrosis attendant on the inhalation of ashe-fo. ibi-7.
What, then, is the outlook for the future? The
author tentatively accepts for practical purposes us A
safe criterion of dust roiiceiit rat ion the "dust datum
level." which is defined by the Joint Committee
mentioned alioje. as *'th* conditions arising from
lly.-r spinning rallied on without cxhaii-t under good
g.-m-i at i olid it ions.** f f a pa 11 i.-ul.tr pi o> .--s appr.ii s to
give 11 ** to ,li|.f iri excess of that a-.-.a ial oil with
*in h l!> r spinno..: tin- in-. J (.,i picvcntivc io. ,i im-s
I S 1 f.'-.l d` -1 a . .- .f 'Ml
. 11 do t m t lo- la [.- I,1.; * V
).**.- * - s I O' 1'.- si i;i . .. d to tills gill* 1 .11 level .1 lid
tie- s|.in,I od t..i>. i.'nli...i lv in.tin' lined, the in'ln.r
.-- .me
tl.lpso. a- ,iu
Vp'.il I.
SCI "pie l i how ev . tl'k ll-
iiiiv r. In g|-:i| starts i control silicosis nude 1, :
Wont), \ A J* 13'.
The mu. nsbest o- The cn Pulmniimales, : males, i of the 1; in the ) observnt Ancts of 1 signs of : in the s arrange. 1 tcilh .-I i ! seventee: males, ri nil had 1 sputum. Tithcrno' This go tubercu!- . sis. Tin. (-1) hn>. eleven f. : suggest i. were ii. sputum, j liodti's. I t bodies in toll!', si lllld I l.i* > A li.-g.lt i .
With : HU* till. 1) III.
lie- 1.
ale '
|| I. v
) ' ' '
' i'
AKHBSTONls
Mil
claps.-, however. before the cusps representin',; the accumulated risk disappear from the industry. The jpiul is not the prevention of minimal and micruM-opiral effects ot asbestos dust which must occur
Tlie radiological picture is that of a fibrosis of fine type affecting the lower two-thirds of tlie lung fields, tiie scarring, as it were, being etched in. The exact diagnostic significance of the asbestosis bodies in the
however slight the exposure, but the abolition of the sputum is still regarded as doubtful. The'formation
risk from the development of diffuse fibrosis and of of the asbestosis body is evidence of tissue change but
any residual added risk from tuberculous infection. with the clinical methods at present available this
Ii/tfrappling with this problem the asbestos industry may not be of a suiliciently advanced character to
starts with considerable tactical advantages. The be detected.
control is finite as compared with the control of
With regard to prognosis, tlie authors have some
silicosis and the leading manufacturers have already made remarkable progress. S. Iioodhou*e Ctoyne.
what modified their original ideas. In a previous article they stated that the cessation of exposure to asbestos dust did not avail to check tlie spread of
disease. Although this is often true, cases have now-
\Vooi>, AV. B. & OboYSK, S. K. Pulmonary Asbestosis.
A Review of 100 Cases. Lancet. 1031, Dec. 22,
K1S3-5. ------------------------------ ------------ ---------------
been noted hy them in which the condition appears to have remained stationary since ceasing work in a factory and even serious damage to t lie lungs appeal's to be not incompatible with many years of tolerably
The authors give an analysis of 100 eases of pulmonary .sbestosis seen at Vic "Jc.g Park Hospital since 1D2S. The cases are dividr into four chief groups--(L)
comfortable existence. A quiet, life, preferably in the country, and avoidance of risk, not only ot dust inhalation but of catarrhal infection, provides tlie
Pulmonary Asbestos. : fifty-three cases (nineteen mates, thirty-four females), twelve deaths (four
laics, eight females), including two with carcinoma
best safeguard against an aggravation of incipient disease. Septic bronchitis, broncho-p.neumoaia and pulmonary tuberculosis are the commonest terminal
f the lung and one -vith a few deposits of growth complications.
'
in tlie pleura. In th" cases still alive and under observation diagnosis rested upon (n) typical appear ances of tlie radiogram, (6) symptoms and physical signs of fibrosis, and (e) presence of asbestosis bodies
With regard to occupation and exposure, all the sixty-seven women in the series had been exposed to asbestos dust in the same factory (spinning twentyfour, weaving five, mattress making nine, carding
in the sputum. These three diagnostic points are and opening eleven, miscellaneous or unstated arranged in order of merit. (2) Pulmonary Asbestosis eighteen). 'Twenty-two of them began work before
irif/i Active Tuberculosis: twenty-one cases (four males, the age of IS; .this is now.no longer permitted. The'
seventeen females); of these eleven were fatal (three shortest exposure was sis months and the longest
males, eight females). Of the ten patients still alive, fifteen years. About two-thirds of the thirty-three
all had tubercle bacilli and asbestosis bodies in tlie men were employed in the same factory as the women."
sputum. (3) Pulmonary Asbestosis u-ith Obsolescent Of the others there was a' smalt group who had been
Tuberculosis: nine rases (four males, five females). employed in work not hitherto definitely regarded as"
This group emphasizes the fart that obsolescent an asbestosis risk, e.g. a man who had been employed tuberculosis is not necessarily reactivated by asbesto- handling asbestos mattresses in tbo open air at an
ris. Three cases (one male, two females) wore fatal. aerodrome, and one who had worked in ft shop where
<!) boubtful Cases: seventeen cases (six males, asbestos was used for lagging pipes.
--.
rleven females) under observation. AH but one had
Of the cases examined ut autopsy, fibrosis Wfts
suggestive symptoms and signs but the radiograms best seen in th* lower lobes. Adherent pleura was
wet,' indeterminate, and with two exceptions the common, but no silicotic nodules were encountered. spntuin, where available, contained no asbestosis Histologically tin- di-e-:ise begins in the respiratory
bodies. Of the two exceptions, both have asbestosis bronchioles and alveolar duets and is characterized,
bodies in the sputum, but one lias indefinite symp by a cellular reaction of moiumuelcar phagocytes and
toms, signs of emphysruut and a negative radiogi.un asbestosis giant cells followed by the formation of a
arid the other has no physical signs or
jitoms anti reticular fibrosis.
a ii'"' Lite radiogram. Willi leg.ml to tin* .bubal i.utnre,
symptom*
ft. It,nuthouse. (Stnync.
rrtorali'm* . t.-. mifoit I.| dull pain in the chest, .mil
'I ie- 1 a-t li.lined i so ureal tll.lt tile til-
mr.;ht
"b" I be ib ~eiib. il as innnosyinptoin.ilic. MnlnutriI i- on iAnl.nl in (In- ti itnin.il mon'li > vvli'*n tin*
I I * I to i>\ |I>' ., . into a i on,|il mu #,(
I J,, I'1 l a. .il
.. III.. - l .1
|, ie c,irlii'\i i. ll II iii.-ii n |T)i
i i i !,|. b. 1.1 o\ er the
-te .11
Ih*I
i t. ti
I,...... .
ll. 1 t, 1 s* " 4 if
ll O.l S
I.
. , , - ll,.
,, .. I. I
t ,1 -!. Id
l.lV/A. V. .1.. 51 Co''m:m.. W. .1. .V Fi:tr\i:i., W.
/; //
F.itects ol the Inhalation ol Asbestos Dust ou the f f
Lur. ;s ol Asl i-stos Workers. A 1'ieUmuiaiy Study, f J
Pu>, . tt.oVi, /op. Wa-ll. 1! i:;'., v. :>n. I 12.
//
In 1
/1
lb.- M. 11 ol" .lit an l.if. Insurance <`o was
' appl" 1 ...1 b> iCb- i.d, l> |>|. ail in-.; 1 be a-.b"sti,s
ll..Ill'll v m tb" IT,lie,1 Slates U bn W el e lb- il oils
.1 , . I ... M A 1. !.. 1 I- .1.. ill . 1 'l.i - (III ... 1 lll>l.
11< >n .1 h . .1.! 1. lb- o
",t 0-1 II o.
\ . W 11 . V . * 1 :. ll m- ot ibi- I . o >1 al.d \' b .1 b.a.bl
o
u
o
kkVZK*rri(.rTOtB^,
III J*XK CM Ot: ONI OS IS AI1STK A CTS
ln< rfoiii* to pii'M'itl or control it. This article is an no marked disability was noted amongst the workers,
m-cumit of the investigations.
but eases of definite cardiac enlargement were
in places where asbestos is ruined or fabricated in frequently found. It is recommended that the
North America there dues no* appear to he present
the clear-cut clinical picture which is so unosc.-ipable in communities with a true silicosis hazard, such as hard-rock mining communities. It may he that some of the asbestos plants ale of too recent origin for the
Total examined
Tuber culosis (healed)
Tuber culosis (active)
typical effects of a silicate dust to become manifest, but this would not apply to the older mines or to all of the fabricating plants. The followin'; investigations
Positivo for asbes
toses
..
Doubtful for ashes-
07
7
1
were undertaken during the period October 1029 to January 1031--(1) A study of dust conditions in asbestos mines and mills in Canada and in fabricating
tosis . . . Negative for ashes-
tosis . . .
3!) SO
I *o
0 1
plants along the Atlantic .Seaboard in the United States; (2) 1'hvsienl examinations of asbestos workers,
* Case diagnosed os probably activo on X-ray findings.
including X-ray films; (3) A study of dust exhaust asbestos industry in tlie United Statc^should seriously
systems designed to eliminate asbestos dust.
face the problem of dust control in usbestos plants.
With regard to dust studies, both the impinger and the electric precipitator were used. Chemical
if?. Itoo/ihouse Gloync.
analyses were made and total particles per cubic foot
of the corresponding weight of tbc dust in milligramme were estimated, but since no relationship between dust
Hints and corresponding weights were found, the
Gloynk, S. R. Two Cases o! Squamous Carcinoma o! the Lung Occurring in Asbestosis. Tubercle. 1935,
v. 17, 5-10, 5 figs. (1 on 2 pis).
eights are not included in the tabulations. A table
is given showing dust counts in various departments of Bridge and IIexky have proposed that cancer, in
asbestos works which shows that .whereas the dust order to be classified as of industrial origin,- must
liii preparation rooms is practically all due to asbestos, fulfil the following two conditions: (1) that the
the contrary is frequently the case in other depart incidence rate in the occupation under review should
ments. In dealing with the condition of the asbestos exceed that in the general population, to a significant
piants the report notes that in America they are . extent, and -(2) that in the occupation concerned
similar to those operating in cotton mills in general. there should be sullicient association of the worker
The asbestos is received in hags which arc emptied with a substance proved experimentally to have
ujK>n the floor, shovelled into pug mills and thence carcinogenic properties. Various writers have sug
transferred to textile mills for spinning, weaving, etc. gested that carcinoma of the lung is liable to super
Various measures of dust control are noted, such as vene upon pneumoconiosis but the author considers
oiling, humidification and local exhaust, hut they it to be still an open question.
were only partially successful in operation.
Two cases -of squamous carcinoma occurring in
X-ray films were made of 120 persons (103 men and pulmonary nsbestosis are recorded; both were
eighteen women) working on asbestos plants in the women. One, aged 35, survived nine years after
United States and all but five of them were given also eight years' exposure to asbestos dust as a spinner.
a physical examination, the cases being Selected The other, aged 71. lived fifteen years after two
units- or less at random from amongst those having periods of six and thirteen months' exposure in the
more than three year.',' employment in the industry. mattress mid "opening" department of the factory.
Of the total 12d X-ray examinations, four were The growths were iu each case very small anil were
iliaginot'd as second-degree ii.sbi-sto.sU, sixty-1 hree as not recognized during life. The growth appeared to
lii-t degree, thiity-nine as doubtful anil twenty as arise in the 'wall of a small hronelms and to extend
I'e-g.itive. TliC cases of a.sbeMosU were divided into along the lumen as a continuous prolongation.. The
two cla-oes: (1) those whose radiogram warranted a line of march was limited by the pneumoconiosis,
di.igmoi* of pneii:iiocoiiious but who h id no delinite hut eventually the pisihmgations of neoplasm pushed
symptom:,; (2)'tho.-a* who had more marked radio- their way tlumigh the fibrosis and death occurred
logn .il signs together with* definite symptoms. A l.i-fore tin- growth had h.-c.iin.' very large. Pigment,
table is gilen cl.i'-'itiing the cases aeconhi.g to lheir ii'h'-'to-' tibia s anil ashe.ito.-is bodies were pushed
Seats of i-xp. nine.
aside by the advancing growths.
Tin- iia idt'iiee of tultereulti-is based
lilio, i. shttiiii in ill.*
hi-tnw.
X-rav
.v. /fumf/iiiiiKi- G7.o//ir.
A slioil h-t i- given of (./) death rl.iirns and 9>)
>t <1 an.| p. ; in .a. itt i!i-.ihi!it y rl liras made by the pt iatii is to tin- lr.-ur.tiii . t 'i.inp inv.
In i .in. lt;i..n .Hi.- |.p..tt ioniums iil--.Ti at ions in it* It.-r pal- t.f 11 v.titl.l t ! 11 I It.- pr.-iioi'ti a v fil.i.. - is
lit tinit'T, U. N., Jr. .v Wiu.MAi-, U. )t. The Miner alogy ol Asbestos Dust. ./. huhi.i. Ihit- I9:t5,
v. 17. ?s:i
2 tigs.
' pi.lt I In .i I li.t \V * ! s * Is I . t.| a lip,- 11 :||. I .-lit A-.l-i'!"'i..i I. t iii ,i | ip! I.-. | In mo it .i | lil.i i mi mile i I -.
I 'tit - i! i.
.Vi pi . |.~ | I i ;i It. t III, ft III't - Is .tin I i.| ulii !i . l.ti d lie, liy ih ii-i i in i-;iii. .min --ih- it*-. I-
the | : l In i.'.. .
a i.-!i The tale. .. Ul.li.le l - ' . (lender I Uouqiai..1 The qu. nauieil iii
liKut.n. I km |" An t'. i mu
This hitu on the i-
COieriii,; i
gellll.tli l llf the II fibre. It i Thii K-l. golili ll >. until.T .
Kol-i-i Ml
Held r*l IvOI'I'I.MI
rxpi-rinii i
his tli.-.u (erne .oid (II '! gel i .* ii-
ami eft' i
llgiu. li lt!.....1 . ,h.-l.il' I g.l It tie
led Id- I
(ll \t I th- .. i * i i h-
nil i n'.
|i .s i l
V \
o
G
I
i 'l
it i
t
ASH KSTOSIN
115
tin* most plentiful. Its Unit is injurious when inhaled over long periods. Petrograpliical analyses wm: made r,f rafter dust from six factories where asliestos is manipulated. They disclosed that in respirable sizes, i.t. below 10 u, ' asbestos particles formed a relatively unimportant constituent of the samples. The great bulk of the particles was composed of tale, serpentine, magnetite, ealeite, dolomite and magnesite. Asbestos itself breaks into almost infinitely slender fibres, still retaining their original length. Comparatively few of such can enter the bronchioles. The question is raised as to how far the impurities named in the dust originate the lung damage.
E. L. Collis.
Bkckr, 1\ J. Xeuo Reobachtungcn an Asbestosiskorperehen. (Observations on Asbestosis Bodies.]
Arch. j. CeirrrbrjHtth. 11. Uneerbehi/<j. 1935, v. 0, 310-92, 9 figs. [IS refs.]
This article is a full statement of the author's views on the composition of the colloidal coating or gel covering (gelhiille) of the asbestosis body. [The word gelhiille is evidently regarded as meaning the whole of the asbestosis body except the central asbestos fibre. It is not used in the sense of a celt envelope.] This gel, which covers the asbestos fibre to form the golden-yellow asbestosis body, is regarded by the author as being of a protein nature aud not, ns Korpns hofer has stated, of the nature of a silicic acid gel. Indeed the whole article is a refutation of Koppknhofeu's view. The argument and the experimental data with which the author advocates his theory are highly technical in the mineralogical sense and only a very brief summary ran be attempted. (1) Measurements of the index of refraction of the gel coating of the asbestosis body made both before and after the removal of its iron constituents yield figures very closely approximating to those of the ml blood corpuscle similarly treated. These figures are slightly higher than those for kiesel gel. (2) This gel coating can be dissolved by acids and alkalis to the same extent as and in similar fashion to the ivd blood corpuscle and other protein bodies in tissues. (3) When the ashostosis bodies are incinerated, only the initial asbestos fibre remains, ( t) Treatment with iodic acid lau-es the asbestosis body to liberate very.minute bubbles of nitrogen.
N\ /inorf/miisi (tlui/nr.
lh>NNia.t.v, J.- Pulmonary Asbestosis: Incidence
ivnd Prognosis. J. I>nln*t.
it Tiu ><>/.
than, \ . IS. 222- K.
This article lec.nds .3 ( I per l ent iif ea-er. of pulmonary a-l.e.tn.i- in a ---lies of 1.11 Woikets in an asbe-to* in. b i .f i \. * tf tin 111 \\ ..I k.-i m net > - it i n sli. om d no I'" it lie el i.t.-,........... a-t.-.-t. > is ; til., had llotl.e.l III .. -t. f... f. a iv l.-ai .. thi.a* fol seieu, (hi.'** for eight.
four for nine, six for ten, one fur eleven, and one for fifteen years. Alt the others had worked for periods varying from n few months to five years. Since the percentage of those in the series who were affect oil was so high, it seemed to the author remarkable that u many could he entirely free from the condition even after years of exposure. The X-ray films of these 111 workers showed that four probably had active tuberculosis of the adult type. One of these had been in service for five months, and one each for fifteen months, for six years, and for ten years. Since one patient had worked only live months and another fifteen months, it was thought to be improbable that tins type of work eould be the cause of their active disease, particularly as the films of both cases indicated a chronic type of disease and apparently not an acute exacerbation. There remain for consideration two active cases with six ami tcn.years' service respectively. Agreeing that the work in asbestos may have aggra vated their pulmonary condition, two cases of active tuberculosis in ill workers seemed a. decidedly lmv percentage, if this type of industrial occupation had any tendency per ae to exacerbate old tuberculous lesions. In the author's experience, tuberculosis or an active type may he found quite as frequently in the routine examination of workers in any industry, regardless of whether or not the occupation be dusty.
Four cases are recorded in some detail, all of them still alive.
S. Roodhouae CIoijhc.
JIcI'hkktkrs, s. B. A Survey o! a Group o! Employees
Exposed to Asbestos Dust. J. Imlual. Ihj'j. <'
. Toxicol.
v. IS. 229--39, 3 figs.
This paper reports the result of a survey of 210 persons exposed to asbestos dust from various departments, including the process of grinding, crushing, mixing, spinning, weaving, etc. '
The typos of lesion noted in the X-ray films were ns.fullows--Of the 210 persons examined, forty-five were negroes. The films of 123 (5S-1 per cent) were regarded as showing lung fields that were normal, except for a small primary tuberculous focus iti one. tif the 210 films, fifty-three (2T2 per cent) were regarded ns showing definite or questionable evidence of asbe.-tu-.is; t,f the fifty-three, twenty films were classed as questionable. Had stereoscopic retakes been all.lived, it is believed that this number could have been" greatly reduced. The iiidispeiisnl-ility of a competent roentgenologic technique is emphasi/ed. Thiity tliii-e films (I.V7 per cent) showed definite asbe-to-w, in t went y-tive J 11-S per cent) the piocess was moderate in extent, and in eight (It'S per rent) more adi.meed. In the teiuaining thirty-four films various tipes of tlioiaeie legions were noted, none of
n hi.'Ii u.-le n-.-lihnhln to a-hestos dud. A table i al-o given .showing the im-idem-e and
extent of a-iie.t mi, (i uni ineie.,-ing pel io.|> of ex pi-Mire in tie1 seini.il depat I men!s. Fimn this analv-is it .qq.-Mi - 11*.t of inn.- pet-mis e\p..' -d for mole than
le.os til llll-l l HIM ehll.lt ill fieitill* III
i !I
i !.
;i
lit
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( > l 1
; iI.
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t
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HIS I'X K L' -M 0( 0X I OS JS A 11ST it ACTS
producing disease. four (i l percent )esca petl n sbesti ixis; males, six white females, and nine were negroes.
of thirty-two persons ox pose. I for limit; than ton year* to similar coneentrations, fourteen (4:1 per cent) escaped: of seventy persons so exposed for limit* tiian five years, forty-five (01 per cent) escaped, niul of
The average age of the group was 311 years, and the time of exposure from sixteen months to twenty-one years. In the series, eight, eases of tuberculosis were ivengnized of which only two vases appeared active,
twenty-eight persons - cxp.e-.ed for more than ttvo lu the* group of slightly advanced cases the roeutgen
yeais utul less than five, twenty-four (83 per ceut 1 film could nut be considered ns diagnostic, and ft
escaped.
history of exposure would be necessary to arrive at a
The average exposure to dust for the entire diagnosis. In the sixteen cases of slightly advanced
group with asbestosis was 10-2 years. Only two eases asbestosis beginning interstitial fibrosis was noted
occurred wliere the exposure had been Jess than five in the roentgenogram. Right-sided cardiac hyper
years.
trophy occurred in 37-5 per cent of them and the
Apical tuberculosis infiltration was noted in the emphysematous type of chest in only ti-3 per cent;
films of seventeen employees. In four of these, no pericardial thickening, and in none was the tra
asbestosis was noted, two with moderate disease chea displaced. The average age anti exposure for
and two with more advanced. Tuberculous lesions of this class was 32-2 and 3-4 years respectively. Definite
clinical significance were noted in six cases. Twenty- interstitial fibrosis protlucirtg ground-glass appearance
iour films showed abnormalities of the heart and and pericardial and pleural thickening were noted
aortic shadows, eleven of these being: iu negro in the roentgenograms of the moderately advanced
employees.
cases: right-sided cardiac hypertrophy was present
lu conclusion the author notes--(1) There is a in C2-S per cent; emphysematous typo of chest in
personal idiosyncrasy in the response to inhalation of 03-7 per cent and high left diaphragm in 2S0 per
asbestos dust. (2) Asbestoses is infrequently found cent. For this class the average age and exposure
before five years' exposure to industrial concentra- . were 37-1 and eight years respectively. In the tions of dust. (3) Workers with advanced asbestosis markedly advanced group right sided cardiac hyper
lesions in X-ray films were not necessarily unable to trophy was present in all but one case; 03 per cent
work at the process in which the disease was acquired, showed an emphysematous type of chest; pericardial
though continued work at such process was advised and pleural thickening in 13 per cent, and nearly all
against. (4) A dust-eliminating device is now available showed a high left diaphragm. The average age and
for factory use, and should reduce significant asbesto- exposure for this class was 37-1 "and 8-7.,years respec
sis to vanishing point. (3) Xo activating or aggravating tively. In the whole series only six showed displace
effect of asbestos dust or asbestosis on tuberculosis ment of the trachea, and of these three had X-ray
was observed. (0) Xo marked tendency on the part evidence of tuberculosis. Iu the re-examination of
of asbestosis to obstruct the lesser circulation was twenty-one cases a fair number of the slightly
noted. (7) Xo increase of respiratory infections was advanced cases showed some improvement; the
reported in this group. (S) There is some evidenre to moderately advanced cases also tended to improve
suggest that asbestosis develops more rapidly in and their disabilities lessened after removal from the
young persons than in older.
dust. An account is given of the autopsies performed
[Conclusions (3) and (7) arc at variance with the on two patients from the markedly advanced
experience of Knglish observers. Conclusion (1) would group.
also seem to be a little premature.]
Shull concludes that asbestosis is a definite disease
entity;*.that, inhalation of asbestos dust produces the
.
S. ItotHlhnuac (iloyne.
characteristic lung changes; that the time required
for the development of the disease is variable (one
Mtici.i..\J. 15. Asbestosis: a Roentgenologic Review cl Seventy-one Cases. Hwl'wlojij. i:i:;ti, v. 27,
case developed after sixteen months' exposure); that asbestosis differs from silicosis clinically, pathologi cally and loentgenologicatly; that while the roent
27P-P2. :ii figs.
genogram is the most reliable diagnostic aid, the inter
pretation and correlation with physical signs is often
Amu ding to Shull, asbestosis is a disease charac ditlicidt. and without the history of exposure a
terized by an early iutei'stitial fibrosis. Ibis fibrosis certain number of slightly advanced cases will not
resulting fioiu the rh.-micnl irritation of the silica fie recognized: that asbestosis lines not predispose to
in tlie dii't' ami (lie mechanical irritation of the tuberculosis; that asbestosis is not a primary pro
asbestos lilacs, ltiglit heart enlargement is a common gressive disease.
tin,ling in model at c|y ad valued eases, and t lie presence
The radiographic .signs in asbestosis are--
>f .'I'heslns bodies iri t he lungs is aiml her characteristic
(I) Kinphy-eiii.iloiis tjpe of vliest; (2) Flaring of
finding. Dyspnoea, insidious in unset and progressive, lower libs; (.'() Ttaeheu not displaced; (I) Dilfuse
is t be chief symptom.
fine to rn.iise tibiosis learbing to the periphery,
Ill an examination of seventy-line of 1 til) Wol'kels ml list u i,l iu vli.ii.icter, dilVnentiat ing it from the
who hid been ill.missed fliilll all ,'lshestiis pt.llll, ln.'iifgeiiologieal appeal.liters in silicosis; (3) lluzy
sixteen urn. :'i.iii|i. d as slight!) .nit an. ed i.'sex. gliilliei-gl.l.-s appeal,mi e of line/, fields; (li) f lit l eased
t l.ii11 lit as mod. Ialelt advanced vases, aid tcut y deii-ilv of ,dt ptem.it uinknu's; (7) Shaggy uppo.tv-
a. lo.like,II) adtauced cases. Fill)-six Were white anee of the Caldlae outline; (s') Ti'ltdele') ton.nils
ria nt I
III"!
!:
Pi:.e I II
The II five til: that I! IU2S xi Ciorm.i: from ! of the l an avvi and Af; chief k clirysot i cent Si1 patticu! and ash cement ' line pait is crush.. with cei drying ; crushing ns also it.
Excel Iof covet asbestos covers, i the work: largely u etc., and rases us,-, large as . asbestos.
The au rally all i be vliinn. with v\!i wlu re a -! vhangad I. should l"` found Mai who sllov. penii.i'.' i
IlnMi; *' the 1 I:;'IV A r.
-- $ mSk
o
o
AS HUSTON IS
117
right-cardiac l-lllal'giSl'ellt : (**) I
iJv*t] t itmate rise
of left diaphragm: (It*) Tin' degree uf cardiac involvc-
ifiit is nut always cnnsMiTit with that of Kir ptd-
niniiaiy involvement.
if. iirmts.
PltoCKAT, !'. Zuf Yerhittung der .Ysbcstose iii der Industrie. [The Prevention ol Asbestosis in Industry.] Stimb. Halle. 1937. Apr., v. 5, i:i:l-Oli, 25 figs.
The use of asbestos for various purposes increased
five times between 1912 to 1929. Jt has been calculated
that the total amount of asbestos used in the world in
D)2t> was 350.090 t. Of the 10.500 t. imported into
Germany in 1030, U..39S t. were from Canada, 3,751
from Kussia aud 2,501 from ItluaWia. The fineness
of the fibres varies; those of Canadian asbestos have
an average diameter of 1-0 /<, those of Kussian 0-75 a
aud African (West Griqualand) 0-9 /i. There arc two
chief kinds of asbestos, hornblende asbestos and -
ebrysotid asbestos, the former contains 57-32 per
cent NiO, and the latter 13-50. This paper deals
particularly with the preparation of asbestos cement
and asbestos paste. In the preparation of asbestos
cement the proportion of the raw materials is about
one part of asbestos to nine of cement. The asbestos
is crushed aud torn in pieces in special mills and mixed
with cement and water to form a paste which by
drying processes is converted into sheets. In the
crushing of asbestos much dangerous dust is given off,
as also in the mixing with cement.
Excellent illustrations are given showing methods
of covering machinery used in connexion with
asbestos with exhaust ventilation attached to the
covers. In works where masks have been provided
the workmen seldom wear them. Asbeslos is utilized
largely as a heat preserving material for boilers,
etc., niul considerable dust arises in the filling of the
cases used for this purpose. These eases may he as
large ns 3 tu. by 1 m. and contain about 50 kg.
asbestos.
The author's investigations show that in practi
cally all processes all danger front asheslos dust can
be i-liminaled by well-covered machinery provided
with exhaust ventilation. It is necessary in rooms
where nsbestos is filled into cases for the air In tic
(hanged fifteen times in an hour. Only such persons
alionhl be employed on asbestos work who have been
found suitable by medical examination and any pet-son
W bo s|h>u s the sligbest signs of asbestosis should be
permanently taken of!' the work.
.*
.1. J. c>.rti*.
Ihmi: Oim c. r.cport on Effects o! Asbestos Dust on
the Dungs mid Dust Sui>r:rs>iou in the Asbestos
IithtAty. I'.nt I. Occmteticc of Pulmoua.y
Eil'tiis.s mil Other I'ltlitioii.ity Ai'iections in
Ast) stos \Voir.ns.
II. I'ua.-'i'.-s giving
lftsc to Dud atid Methods for. its Suii|itr..;:on
|.\lKitrvvKTHi:i: (K.ll.A.l A: I'hkt: (t'.W.)|.-- til pp. Ilemdoii: II..M.N.O.
This is a Home Ollico report on the elTeels of nsbestos dust oil the lungs anil on the dust suppression in the asbestos industry. The first part, hv J)r. E. It. A. Mercwether. deals with a medical investigation of a section of the employees in those factories using more or less pure nsbestos. The population at risk in this group of the industry is unknown, but a rough estimate at 2,200 employees. A certain amount of selection was used in the examination, nevv-nomersand those workers who had been longest in the industry being chosen whore possible. The total number ex amined was 303, or 10-5 per cent of the estimated total number of workers in the industry. A radiogram of the chc.st was taken in 133 cases. Of the 303 workers 95, or 20-2 per cent showed a diffuse fibrosis of the lungs attributable to the inhalation of dust. An additional 21 were found with preclusive signs of the disease. Of the 133 persons of whom radiograms were made, 02 showed X-ray signs of diffuse fibrosis and 25 suggestive but not absolutely definite signs. Of these 303 workers there were no cases of fibrosis in those who had been employed -under 4 years, 30 in cases.in those employed from 5-9 years, 27 cases in those employed 10-14 years, 15 cases in those employed 15-19 years, and 17 cases of those employed over 20 years. The largest number'd casc3 are in the agegroups 30-39 aud 40--19. The concentration of dust and length of exposure appear to be the most im portant factors in the production of the fibrosis. The cases appear to go on for a long time and then die from a terminal broiicho-pncimionia. or other acute infection. Up to the end of 1929 particulars have been collected of 10 cases in which an advanced degive of asbestos fibrosis without tuberculosis was the primary cause'of death, 9 of these being verified by post-mortem examination. The length of exposure in these eases varied from 9 to 2 I years.
In the -second part of the paper Mr. Price discusses the technical details of ventilation in the factories and makes the following recommendations: (1) applica tion of efficient localized exhaust- ventilation at dust-producing points; (2) substitution of enclosed mechanical methods fur hand conveyance, niul for dusty handwork generally; (3) elfective enclosure of dust-producing machines and plant.: (I) Mihsjilillion of wet nut hods for dry; (5) elimination of certain dust-producing appliances; (tl) abandonment of settling chambers in iiiamifactiirin:.; proee-cse.s, to the utmost extent; (7) effectual .Separation of processes to prevent uiun-ie.sary exposure to (lust: (S) wide spacing of dust producing machines in new farloiics nial. as far a> piaetiealile, in existing vvoiks; (9) use of s.ii k . of dose texture innlciinl for internal wink; (|ii| din i.-iit deaniie: .system with wide u`- of vai mini methods: (it) storage of nsho..to, and ot her giM.il- to In- outside wotkiooiiis; (12) exdiirioii of voting pel sons from speeially itiistv vvotk.
S', /.'m ,< //i 11 n*e (i/ki/I'*'.
i l ! i I l
i Ii i
o
!
i
I
< I i
PNEUMOCONIOSIS ABSTRACTS
.
VOLUME II
..
Reprinted from the Bulletin of Hygiene . for the years 1939 to 1950 inclusive
by permission of The Honorary Managing Committee of the
Bureau of Hygiene and Tropical Diseases
'
> l
l
JI
i
i
*i
S
LONDON SIR ISAAC PITMAN & SONS, LTD.
* tWcicord
CONTENTS
no* V
Vnjttct
................................................................................................................................................................vi
List of Abstruclera and Jlccietcen . . . . . . .'. . . . . vii
I. OLNRAL
*
...
..
.1
Industrial hygiene, with soma reference to pnciunoconiosis--Occupatioiuil dusts and respiratory disease--Researches on various aspects o:' pneumoconiosis--Tuberculosis and industry--Cancer and its possible relationship to pneuiooconiosis--Radiographic aspects--General atmospheric pollution
II. SILICOSIS
. . . .......................................................................... ............................................................. 80
Abstracts arranged in order of subjects, as follows: General description--Pathogenesis--Pathological aspects--Tuberculosis and silicosis--Experimental studies--Pulmonary function in silicosis--The blood in silicosis--Silicosis in certain industries--Metalliferous mining--Metal industries--Sandstone, granite and shite--Manufacture of pottery--Other industries--Acute silicosis--Silicosis from diatomaceous earth--Aluminium treatment of silicosis--Medico-legal aspects of silicosis
HI. ASBESTOSIS...................................................................................................................................... Abstracts arranged in chronological sequence
..
.163
IV. PNEUMOCONIOSIS OF COAL 'WORKERS................................................. ............ Abstracts arranged in chronological sequence
..
-.171
V. PNEUMOCONIOSIS CAUSED BY OTHER INORGANIC DUSTS.................................................. 211
Abstracts arranged alphabetically according to the kinds of dust, and in the following order: Dusts of metals and metallic compounds--Aluminium--Antimony--Arsenic--Beryllium--Barium--Cad mium -- Ciiromium -- Cohalt -- Copper -- Iron -- Magnesium -- Manganese -- Molybdenum -- Radio-active compounds--Tin--Tungsten--Vanadium and zircon--Other dusts, including abrasives --Basic slug-- Bauxite -- Boiler scale-- Bricks -- Cyanamido -- Cement -- Fuller's enrth -- Glass -- Graphite--Silicate minerals--Sulphur
*
VI. PNEUMOCONIOSIS CAUSED BY ORGANIC DUSTS
. . . . * . . .201
Abstracts arranged in the following order: Cotton--Hemp--Grain--Flour--Wood--Soot--Leather-- . Fur--Shellac--Synthetic compound-;--Abstracts of articles on pulmonary disease duo to moulds, and
allergy caused by certain of these dusts arc included
VII. FUMES, IN T1IE SOLID PARTICULATE STATE, CAUSING RESPIRATORY DISEASE . 310
Abstracts arranged according to the land of fumes, as follows: Alumina abrasive furnace fumes-- Electric-arc welding fumes--Slctal-fumo fever--Fumes from cadmium and other metals--Other fumes
VIII. ATMOSPHERIC DUSTS..................................................................................................................................... ........ . 312
. General surveys--Surveys iu South Wales coal-mines--Techniques of sampling and measurement-- Particlo size analysts--Photometric method.--Analyses of their physical, miucralogical and chemical properties--Maximum allowable concentrations--Inhalation and retention of Uusts
IV. METHODS OF SUPPRESSION AND REMOVAL OF OUST, AND PERSONAL RESPIRA
TORY PROTECTION............................................................. ..................................................................................... 3S0
ISenerat *urv*yi&--Du-.t suppression and removal in cojl-mines, metalliferous inino*, rock-drilling, and
manufacturing prucv?>*es-- tVr*onul n>p:rntory protective equipment
N`- PERIODICAL REPORTS RELATED TO PNEUMOCONIOSIS......................................................... 418
IVriudieul rojHirts (the sequence f Ihev* i* not complete, only th***e report* which Are relevant to the uhjci't of pnewnoconioM.* have t*s*n included)--Special rvjioit*--I'roiwding* of rongiVMes related to |"Scumocotiiot4
IX
-J
J.M.SW>iSS6S 4
L CONTEXTS
taros XI. LEGISLATION ON PNEUMOCONIOSIS .
.
XII- HOOK REVIEWS............................................................. Index of Authors or Sources . . . . .
. Index of Subjects .......
net . 457
. 462
. 4SI
. 403
*t
s
. ludustrlnl
; f
Ht searcl- -
1 l!d(ition.<;
jru.-
. *5--4*j
? ; In t:
Jer th portions c: where it r.i: which pri;w uliipbuiMir. jovtisfactorj' A cuinpar l>orouch-s
vla-ss oI m. t northern O')'Lus rv their total wives Jo thorn exc. liietlr fn>i:i tiro Mintl-...t*wn Lila:r y norther-. i I.%-t a!?.-
Tin* Ir-- t.thty >i( ms. t he general 'ni|kitii,n.
A. a iuntr wives of i; . C alyx.) jr.
''ij.j.lerii.-nt
< ! ;-.e r.s
In.I..1 work .lone '
r>
Industrial Hygiene Digest
INDUSTRIAL HEALTH NEWS
LITERATURE ABSTRACTS
MEDICAL
ENGINEERING
CHEMICAL
'
TOXICOLOGICAL
LEGAL-- decision* and bend*
SEPTEMBER, 1950 (Vol. 14, No. 9)
INDUSTRIAL HYGIENE FOUNDATION
4400 FIFTH AVENUE PITTSBURGH 13. PA.
'-*vntr4al Hvgiene Direst - lk
T"
;
S ) other Lung Diseases Due to Dust.
Postgraduate Mod. J. 25, 039-6^9
;! '1
|
ATT . Doig. (Dec. 19^9) <
September, 1950
A review is given of the effects on the lungs of various dusts, mainly
mixed dusts. These often contain a proportion of silica and it is questioned whether their effect can be attributed to it. Among these dusts are those derived from carborundum, aluminum, graphite, iron, tin, manganese oxide, and beryllium. The mode of action of vegetable dusts is obscure, although a variety of pneumoconioses have been attributed to them.
-- Condensed from Bull. Hyg.
-055 Asbestos is. H. Vyers. Postgraduate Med. J. 25^ 551^38 (Dec. 1949).
.
/
Asbestos and talc are the only two silicates which have been shown to
produce pneumoconiosis. Gardner, in 1958, suggested, on the basis of animal
experiments that the effect produced by asbestos was mechanical, since it was
produced only by long fibers. A later authority made the observation'that
workers exposed to very short-fiber asbestos were not affected by it. As
bestos is was officially recognized as an industrial disease in 1950. The
condition is thought to be due to blocking of the finer bronchioles by long
fibers which seem to irritate the bronchial wall and cause fibrosis. Tubercu
losis and carcinoma of. the lungs may follows, as complications. Recognition
of the disease, and precautions which have been taken have lessened its
severity and incidence.
-- Condensed from Bull. Hyg.
L05^ A Review of Dust-Allaying Practices at Working Faces in Some Bituminous Coal and Lignite Mines. J.J. Forbes, R.K. Franklin and S.T, Reese. U.S. Bur. Mines Inf. Circ. 7566 29pp (May 1950).
Data on dust-allaying practices wTere compiled from the reports of Federal inspectors on 1,637 bituminous coal and lignite mines in 23 states, employing nearly 300,000 men. Most of the information is presented in tabular form. It is shown that approximately one-third of the mines employ ing 25 or more men provide no protection, or inadequate protection, against dust fhom the working face. In a still greater number of mines, the dust produced during loading and transportation is not being allayed effectively. Rock-dusting will reduce the dust explosion hazard in such mines, but dust allaying will reduce the explosion and pneumoconiosis hazard and provide better visibility. Generally dust allaying was practiced to a greater extent in mechanical-loading mines than in hand-loading mines with fewer workmen. Mines employing less than 25 men were not included in the study, but probably dust allaying is not practiced in many of them.
-~ Condensed from Authors' Summary and Conclusions
LC55
Shuttle-Car Tire and Roadbed Study. R,R. Nicholas, J.S. Whittaker, B.D. Dorr.enturg, j.P. : aim.cn ar.d V. Bank. Eur. Mines Rept. of Invent 2?rp. (Dec-, ml or 19^9).
h62b
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. *
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-T. c- ;v ly will.
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i
Industrial Hygiene Digest
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LITERATURE ABSTRACTS
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everybody working in dust-producing places is carefully watched from
the time of his work placement to its discontinuation, there will be
enough material at hand to clarify what is generally known as the human
factor in silicosis.
--Cond. from Arch. Ind. Hyg. & Occ. Med.
Frequency and Clinical Symptoms of Cancer of the Lung in Silicosis. E. Westermar.n. Beitrage z. Silikose--Forschung, No. 12, 33pp., (1951). (In German).
Lung carcinoma does not occur more frequently in coal miners
than in the general working population. Among 13, 900 .ecropsies at a
hospital in the Ruhr coal mining area, 200 cases of lung carcinoma were
found. Records of fifty-one cases had been preserved. The diversity
of ages of the men, of localization of the tumor, and of complications
such as pleuritis, metastases, tuberculosis, bronchitis, pneumonia,
etc., all suggest that there is no causal relation between silicosis and
tumor. The data on which these conclusions are based are given in
detail. Various case histories and radiographs are given to
demonstrate the difficulties of recognizing the carcinoma in the presence
of silicosis, especially if tuberculosis is also present. Only six of the
fifty-one were, in fact, c jrrectly. diagnosed at an early stage of the
tumor. As regards therapy, pneumonectomy is recommended for stage
1 silicosis only.
-- Cond. from Bull. Hyg.
Results of Periodical Examinations of Workers in an Asbestos Factory. A. Bohme' Beitrage z. Silikose Forschung No. T"L 27-34, (1951). (in German).
Since radiological supervision and control measures were adopted
in an asbestos factory in 1936, the dust hazard has been greatly reduced,
as shown by comparing results of surveys in 1936, 1940, and 1949. A
comparison of different working places shows that the risk is low in
spinning and weaving, but high in preparation, carding and brake polishing.
A table shows results for 14 cases from 1936 to 1949. Some progressed,
others did not. Inquiries among former workers reveal little if any
tendency to progression after the dust exposure has ceased. This is in
contrast to silicosis. On the other hand a personal factor exists, as in
Mlicosis, as a number of workers do not get asbestosis in spite of high
dust exposures. Progressive tuberculosis is rare, only two cases being found, both
Marted in the parts of the lung least affected by asbestosis One combina-
''on of asbestosis and carcinoma of the lung was found. The main result
this study is the demonstration that the hazard can be reduced by dust
' "ntrol.
-
--Cond. from Bull. Hyg.
Industrial Hygiene Digest - 32
January, 1952
^4
Re search into Pulmonary Asbestosis in Belgium. J. Clerens. Arch. Beiges Med. Social et Hyg. 8, 557-565, (November, 1950).
The investigation concerns the fibro-cement industry, in which
asbestos is crushed and mixed with cement. Enclosed apparatus
prevents most of the dust from escaping; in the most dusty locations, **.
20 to 40 million particles per cubic foot were found, with 50% under
5 microns. The workers have been examined periodically over a period
of three years. Out of 75 men employed for seven to over thirty years,
there were four doubtful cases, and only one presented x-ray shadows
indicating pneumoconiosis. The man died of progressive circulatory
insufficiency, and details of post-mortem findings are given.
Indurated nodules and asbestosis bodies were found throughout the
lungs, but no tubercle bacilli. The bodies were seen in fibrous zones,
in the alveoli, and even included within giant phagocytes. This man,
aged 49, had been totally incapacitated with dyspnea on exertion and
cardiac failure. In others, asbestos particles were found in 10 out of
12 samples of sputum, and asbestosis bodies in 3 samples, but the
findings were not associated with x-ray shadows indicating fibrosis.
The evidence is against much danger arising from the manufacture of
fibro-cement.
-- Cond. from Bull. Hyg.
85 The Pneumoconiosis of Slag Mills. P. Gengoux. Arch. Beiges Med. Sociale et Hyg. 8, 514-518, (October, 1950).
The slag produced in the basic, or Thomas, process of steel
manufacture is used as a fertilizer and for this purpose is reduced to a
very fine powder. Out of 93 workers with at least 10 years' exposure to
slag dust 15 showed radiographic changes which could have been caused
by dust. In only one case did the lung appearance go beyond the micro-
nodular stage; there was no evidence of massive shadows, in spite of the
frequent association of tuberculous infection in the more or less active
state (5 cases). The conclusion is that the health of basic slag workers
is not bad.
-- Cond. from Bull. Hyg.
86 Roentgenologic Aspects of Pulmonary Changes Caused by Ocher, R. Haubrich. Fotschr. Geb. Rontgenstrahlen 73, 682, (December, 1950), (In German-).
Numerically the pneumonoconiosis caused by the earth pigments (metallic oxides occurring in clay) are of minor significance, because the ocher industry, which processes these pigments, employs a limited number of workers. However previous reports on several small groups of patients indicate that the pneumonoconiosis caused by these pigments has certain characteristic aspects. After briefly discussing the minerologic aspects of these pigments and some earlier reports on the
him i
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1 007
Findings of Bronchoscopy in Silicosis and Silico-Tuberculosis. E. Concina and O. Orlandi. Rass. med. ind. 2j), 424-426 (Nov.-Dec. 1951) Italian.
....
The importance of the existence of bronchial lesions in silicosis
has been underestimated. Bronchoscopy allows direct observations of
changes in the tracheal and bronchial mucous membrane, deviations in
the trachea and main bronchi, and modifications in the orifices of the lobes
and segments. Lavage, aspiration of the bronchial section, and endo
bronchial administration of adrenaline and antibiotics may be conducted
during the process. Inflammation of the mucous membranes and other
changes characteristic of silicosis are disclosed by this method. Findings
in 25 patients are reported.
-- Cond. from Bull. Hyg.
1008
The Value of the Electrocardiograph for Examining Anthraco-Silicotics. F. Lavenne. Institut d'Hygiene des Mines, Hasselt, Belgium, Communication No. 90, 5pp. (1951). French.
The author used the electrocardiograph to examine 11 cases of anthraco-silicosis with clinical signs of loss of compensation of the right ventricle, and 200 cases of anthraco-silicosis, compensated for invalidity but still ambulant, who were doubly classified according to the extent of fibrosis present and according to the amount of emphysema. The findings are presented in somewhat cryptic symbolism. They are held to justify the claim that the electrocardiograph may be of considerable value in establishing early strain on the right side of the heart.
-- Bull. Hyg.
1009 Asbestosis Associated with Bronchiogenic Carcinoma. R. Stoll, R. Bass, and A. A. Angrist. Arch. Intern. Med. JB8, 831-834 (Dec. 1951) German.
Data for statistical proof of any association of asbestosis with
pulmonary carcinoma are hard to collect, but three investigators have
found carcinoma in 7.5 to 14.8% of Cases of asbestosis. A case is reported
in which a worker had been exposed to asbestos for 6 years and had refused
to wear a respirator. He came under notice with weakness and a persistent
cough. Clumps of malignant cells were seen in the bone marrow, and x-ray
showed generalized large discrete oval shadows indicative of pulmonary
metastases. After death, modules varying to 4 cm. in diameter were found
scattered throughout both lungs, with interstitial fibrosis. Large areas of
necrosis existed throughout the lungs, and typical asbestos bodies were seer,
inside and outside the tumor areas. Metastases were found in the kidneys,
. brain, and liver. The opinion is suggested that the silicate in asbestos must
itself be directly carcinogenic. It establishes an additional reason for pre
ventive measures in the use of asbestos.
.
'
___f',.l C .
M '!
o
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INDUSTRIAL HEALTH NEWS
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MEDICAL ENGINEERING CHEMICAL TOXICOLOGICAL LEGAL - - docieiep* and trend*
.
! i
JUNE, 1953
(Vol. 17, No. 6)
industhial hygiene foundation
Industrial Hygiene Digest - 23
June, 1953
siderosis, berylliosis, asbestosis, and the organic dust diseases are dis
cussed briefly in relation to diagnosis. The importance of personal and occu
pational history is emphasized. The factors to be considered when deciding
whether a man should he t*aken froni his job arc discussed
604 The Clinical Picture and Pathobgy of Asbestosis. W. Behrens, Jr. Z. Unfallmed. u. Berufkrankh. 45, 129-140 (June 15, 1952); 179-189 (Sept. 15, 1952). German.
This paper presents an extensive review of literature on asbestosis ' including distribution and types of asbestos, its mining, treatment, and use,
| dust hazards, and effects of length of exposure of the dust in different con
* centration. Symptomatology, diagnosis, and x-ray findings in the different
stages of asbestosis are described. Special mention is made of the association
of asbestosis with carcinoma, which is much more frequent than that of sili
cosis. Post-mortem reports from the literature indicate that in 309 cases
.
of asbestosis there were 44 lung carcinomas (14.2%), whereas in 2,204 cases
of silicosis only 32 carcinomas were found (1 . 4 %). The experience of the association of tuberculosis and asbestosis varies greatly in different countries.
English investigators have recorded a high rate of tuberculous infection in asbestos workers, but it is a rare complication in America and the rate is low
in Germany. The mac *-o sc epic and microscopic appearances of the lungs are described, and the nature and significance of asbestosis bodies are discussed
and an extensive reference list dealing with that controversial subject is given.
-- Cond. fi'orrr Bull. liyg.
I
605 Lung Carcinoma Caused by Asbestos Inhalation. F. Boeinke. Klcd. Mfmatsschr. 7., 77-81 (1953) German.
.
The relation between fibrotic changes caused by asbestos deposits
in the lur.g and carcinoma is discussed. The lower lobe is the site of pre
dilection. Characteristic arc the multicentercd developments of flat .pi-
tlielnnn carcinoma.
-- Clu in. ALsts.
iMivsic,al, a:.pecks <>r the emvikdement
I
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u
silicic acid with a high degree of polymerization distinctly inhibited mo bility and phagocytosis, that freshly prepared polysilicic acid had very little effect, and that monosilicic acid had no effect at all on phagocytosis.
-- Bull. Hyg.
854
The Reactivity of Finely Ground Quartz. C. Claeys and E. Quinot. Staub, No. 37, 393-403 (Sept. 15, 1954). German.
The surface layers of finely ground quartz and of silica were
dissolved in distilled water. Optical, electrical, and chemical proper
ties of the solutions were investigated, and their visible and ultraviolet
absorption spectra were examined. Anomalies in the quartz spectra
are attributed to carbon dioxide. The carbon dioxide content of the solu
tion, estimated by Van Slyke's method, was greater than could be .ac
counted for by carbon dioxide dissolved in the distilled and degassed
wafer used in the experiments. The abnormal reactivity of finely ground
quartz particles is ascribed to the presence of carbon dioxide, in the
shape of carboxyl groups forming a complex with the silica. It is claimed
that severed biological effects of fine quartz may be explained by means
of this hypothesis.
-- Cond. from Bull. Hyg.
855 ,
*
Primary Cortical-Cell Tumor of the Peritoneum in a Case of Asbestosis. F. Leicher. Arch. Gewerbepath. Gewerbehyg. 13, 382-392 (1954). German.
. A case of asbestosis following long exposure to asbestos is described. In addition to typical symptoms and findings, leptomenin gitis was present and tubercle bacilli were found in the spinal fluid. The patient died with cachexia. Autopsy showed tuberculosis of .the lumbar spine with bilateral psoas abscess and mixed infection in both lungs. Asbestosis, stage two, was found in the lungs with definite fi brosis; there was slight asbestosis in the lymphatic glands, and asbes tos bodies were found in the spleen. On the peritoneum of the mesen tery and over the peritoneal cavity there were thickened patches and many small nodules; a flat tumor, half the size of a hand and 1 cm. in thickness, was attached to the peritoneum on the under side of the diaph ragm. The results of the examination of the tumor are fully describ ed and illustrated. Asbestos was found in the tumor tissues by x-ray diffraction. It is uncertain how the asbestos reached the peritoneal cav ity; the most probable route was thought to be by direct penetration of the asbestos fibers from the lung through the pleura and thence through . the diaphragm.
Industrial Hygiene Digest
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[ (Vol. 19. No. 9)
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dustrial Hygiene Digest
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September, 1955
the common aspects of tuberculosis were seen instead of the features
characteristic of silicotuberculosis. It is suggested that the term
'tuberculosilicosis" be used for such patients. Active tuberculosis
was found in eight patients with stage 3 silicosis, but most of the
patients in that stage did not show signs Of tuberculosis or other in
fection. The authors conclude that the transition from the nodular to '*
the massive stage can take place without the superimposition of in
fection.
-- Cond. from J. Am. Med. Assn.
/
Mortality from Lung Cancer in Asbestos Workers. R. Doll. Brit. J. Ind. Med. 12, 81-86 (Apr. 1955).
In necropsies of 105 persons who had been employed at an asbestos works, lung cancer was found in 18 instances. In 15 cases asbestosis was also found. These 15 workers were employed at least nine years before 1923, when dust control regulations became effec tive. An additional 113 men who had been exposed to asbestos dust for 20 years were followed up and their mortality was compared with that of the whole'male population. Thirty-nine deaths occurred in the group whereas 15.4 were expected. The excess was entirely due to excess deaths from lung cancer (11 against 0.8 expected) and from other respiratory and cardiovascular diseases (22 against 7.6 expected). All the cases of lung cancer were confirmed histologically and all were associated with asbestosis. From the data it is concluded that lung cancer is a specific hazard of asbestos workers and that the average risk among men employed for 20 years or more has been of the order of ten times that experienced by the general population. The risk has become progressively less as the duration of employment under the old dusty conditions has decreased.-- Cond. from author's summary
1114 Primary Lung Cancer in South Wales Coal Workers with Pneumoconiosis. W. R. L. James. Brit. J. Ind. Med. Li 87-91 (Apr. 1955). .
Primary lung cancer was found at necropsy in 3. 3$ of 1,827 South Wales coal miners and in 5.4^ of 1,531 South Wales non-miners. In 12 cases with massive pneumoconiosis the tumor was in the mass, or touching it, in five. In the other seven .the tumor was remote. Lung cancer in South Wales miners is similar to that in non-miners with re spect to the ages at death, the distribution of the histological variants of the tumor, and the distribution of metastases. The significance of these findings is discussed. Attention is drawn to the difficulty of .diagnosing lung cancer in the presence of massive pneumoconiosis. .
- - Author's summary
Industrial Hygiene Digest
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1188 A Study ot Respiration in Pulmonary Asbestosis. H. Baatenier, H. Denolin, A. deCoster, and M. EnglenU Arch, maladies proteas, 16. 546-553 (1955). French.
Iu order to test the respiratory value of lungs affected with asbestoais nine cases
were closely studied. The seveD men and two women had been exposed to asbestos dust,
1,000 to 2, 000 particles per cu. m., for 18 to 30 years. The patiects displayed definite
symptoms of asbeatosis with troublesome cough and dyspnea, and all showed x-ray shadows
like ground glass extending over both lungs. No tubercle bacilli were found in any case. A
definite reduction was found in vital capacity, but the maximum expiratory volume was satis
factory. Breathing, however, was accelerated by hyperventilation. At rest breathing was
sufficient and satisfactory, but on exertion dyspnea appeared, varying considerably accord
ing to the pathological lesions in the lungs. These functional changes were in no way differ
ent from those seen in other cases of pneumoconiosis. Varying emphysema was found, but
no special strain was thrown upon the heart.
-- Cond. from Bull. Hyg.
1189 Asbestosis: Report of a Case. E. R. Wiese and W. E. B. Hall. Diseases of Chest 30, 229, 230 (Aug. 1956).
The history and autopsy findings in a fatal case of asbestosis are reported.
Conditions described include: absence of the middle lobe of the right lung; greatly en-
larged heart; wide spread, sharply demarcated development of fibrosis; and degenera
tion of collagen in extensive irregular fields. These and other conditions are described
fully. Fine needles representing the original asbestos fibers were seen. Small asbestos
bodies were seen in a few areas of focal fibrosis, although they had not appeared in the
sputum.
'
'
1190 New Viewpoints on Pulmonary Cancer in Asbestos Workers. H. Bohlig and G. Jacob. " ' Deut. med. Wochsckrl 81^ 231 -233 (Feb. 17, 1956). German.
The following distinguishing features have been attributed to the lung cancer that
has been recognized as an occupational disease of asbestos workers: (1) increased inci
dence; (2) development at an early age; (3) dependence on duration of exposure to asbestos
dust; (4) a latent period between onset of exposure and the appearance of the cancer; (5)
the localization; (6) the histological structure; and (7) the multicentral origin. The authors
discuss each of these points, and show that there is little clear evidence to support any of
these assumptions, with exceptions noted. Women workers in the asbestos industry have
lung cancer more often, and at an earlier age than do other women, but the same is not
true of men. Malignant growths of the pleura seem to occur more often in asbestos workers
than in other persons. The multicentral development is observed also in workers exposed
to cobalt and to chromates. The study of the pathogenesis is still in the state of hypotheses,
and the theory of mechanical pathogenesis is given most consideration. Microtraumas and
asbestos bodies are always found in the pulmonary cancers of asbestos workers, but the
authors feel that this does not necessarily prove the mechanical theory. Thfcy cite several
factors that speak against a purely mechanical pathogenesis of asbestos cancer, but they
concede that the development of so-called asbestos warts proves the irritating effect of
asbestos on human tissues.
-- Cond. from J. Am. Med. Assn.
1191 Nasal Penetration ot Particles ot Small Inertia-in Experimental Animals. Gabricllc Asset, L. E. Gongwer, and Stella Ryan. Arch. Ind. Health 13, 597-601 (Tune 1956).
Experiments were carric'd out to determine the nasal penetration of particles of
small inertia in dead rabbits, dogs, and guinea pigs. The heads of the animals, or the
entire bodies, were exposed in a wind tunnel to an aerosol consisting of particles of 1.3
microns with density of 1.2 g. per cc. .mil moving at a rate of 2.5 mph. The concentra
tions of the aerosol entering the nasal passages and ol that leaving the nasal passages were
determined. It was found that there was a significant difference in nasal penetration be
tween. the ;inoa pigs.
the one h.it d, and the rahnits and the dogs, on the other hand.
Wind ciirri t; o n had no influence or. the nasal penetration of droplets of low inertia.
- - A11'; i; r s ' n u: n 11,r y
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( the light microscope. Incidentally, it seemed that a particle with sharp aA^jis, such as a ^ quartz particle, could easily pierce the layer. It was limited on both the air-space side and
the connective tissue side by an osmium-staining cell membrane; a basal membrane was not
(ound. The partition between the blood and the air space consisted of seven layers. In places
where the capillaries were not in immediate apposition to the alveolar wall the cellular tissue
space was filled with connective tissue fibrils, lattice threads, elastic fibers, and connective
tissue cells.' Various cells, detached from the alveolar walls, and septal cells were found,
but a definite decision could not be reached on their origin.
-- Cond. from Bull. Hyg.
757 Silicosis. 11. Effect of Sex Hormones on the Amount of Silicon Excreted into Urine.
M. Anme. Nagasaki Igakkai Zassi 31, 381-385 (195b).
'
Urinary excretion of silicon before and after castration was investigated. In the
case of male rabbits silicon increased after castration while in the case of females it de
creased. Silicon returned to the normal level after the administration of male hormone or
follicular hormone. Corpus luteum hormone showed no effect.
-- Chem. Absts.
758 Silicosis. 12. Influence of Thyroid Hormone on the Amount of Silicon Exc-reted in the Urine of Rabbits^ R. Kakita. Nagasaki Igakkai Zassi 31, 438-445 (1956).
Thyroidectomy increased the urinary excretion of silicon by 2 to 3 times, and
silicon returned to normal level after the administration of thyroid hormone. Injection of
methylthiouracil to normal rabbits increased silicon slightly. Diiodotyrosine and anterior
hypophyseal hormone showed no effect.
-- Chem. Absts.
j The Neutralization of Silica Toxicity in Vitro. J. Marks-. * Brit. J. Ind. Med. 1_4, 81-84 (Apr. 1957).
Phagocytic cells were protected in vitro against the toxic effect of silica dust by
compound 48/80, a histamine-releasing agent formed from p-methoxy-phenylethyl-methyla-
mine. The health of the cells was studied by direct microscopy and by measurement of their
glucose consumption and dehydrogenase activity. The mode of action of compound 48/80 is
not known but may depend on a reduction in silica solubility. A slight protective action was
also exhibited by certain alkylmono -amines and polymyxin B.
- - Author's summary
760 Pulmonary Fibrosis and Giant-Cell Reaction with Altered Elastic Tissue. Endogenous ''Pneumoconiosis'1. R. L. kValford and L. Kaplan. Arch. Pathol. 63^ 75-90 (Jan. 1957).
The clinicopathologic findings in 12 autopsicd cases of a peculiar pulmonary elastica disease are presented and discussed. It is concluded that injured pulmonary elastic tissue may act as a foreign body or sequestrum and produce a progressive "pneumoconiosis".
- - Cond. from authors' summary
761 Asbestosis with Pleural Calcification among Insulation Workers. J. Frost, J. Georg, and P. F. Moller" Danish Med. Bull. Tj 202.204 (Nov. 1 956).
In Denmark only a few persons manipulate insulation products including asbestos,
kieselguhr, magnesia, glass wool, and rock wool. The first two have been regarded as
fibrogenic to the lungs when their dust is inhaled. In order to ascertain any occupational
risk in the work 31 workers with more than 20 years' exposure, of 52 years average age,
were carefully examined clinically and by x-ray. Abnormalities were found in the surpris
ing number of 22. A total of nine exhibited fine mottling indicative of pulmonary asbestosis.
In 19 patients pleural changes were seen, which were due to adhesions and extensive thicken
ing with calcification. The abnormalities in the pleura were so widespread in some instances
as to obliterate other pathological changes. The calcification is unusual and may be ascribed
to ccunbin-d exposure to calcium and magnesium in the presence of fibrogenic asbestos dust.
Sample analyses of the kieselguhr in use did not reveal the presence of a lpha - quartz. The
(ti. !;:.g of pmnounird bilateral pleural changes in the present series definitely points to an
"i
. 1 origin.
-- Cond. from Bull. Hyg.
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SECTION1 HI
ASBESTOSIS
Abstracts Arranged in Chronological Sequence
Drf.essex, AV. C., Dat-LaValle, J. M., Edwards, T. I., JIiixer, J. \V. & Sayers, R. R-, with the assistance of H. F. Easo5X & >1. F. Thick. A Study of Ashesiosis in the Asbestofi Textile Industry. J`ub. Iltnlth.- Bull. No. 2 Hi .Wash. 193S, Aug., pp. is 4- 120, 65 figs. [Bibiography.]
Tliis monograph is an official publication of the Divi sion of Industrial Hygiene of the National Institute of Health of the U.S. Public Health Service. The authors have been modest in their choice of title. In addition to their record of asbestosis in the asbestos textilo industry in the particular factories under observation, the work is an excellent account of pulmonary asbestosis in general with an annotated bibliography which abstracts succinctly the chief publications during the last ten years or more.
The investigation was made in asbestos textile factories of North Carolina. Four plants were investigated, two which convert crude asbestos and raw cotton into asbestos yarn and woven goods, and two which purchase asbestos yarn and unfiui-shed woven asbestos tape and convert the purchased material into finished goods (e.g. brake bands), -flow sheets" are given summarizing the various processes from the reception of the crude asbestos to the production of the finished article and comparing tin- technique with British practice. Dust counts were made by the impinger method, using ethyl alcohol and distilled water mixtures containing from 25-50 l*cr cent alcohol as a collecting fluid. Sampling was lo.ule of settled dusts collected at breathing level, anil of air-suspended dusts collected by vacuum vt-.m-r. To determine the particle size of dust an * incus jet apparatus was employed. Chemical analyses f dusts wove also made. The data are given in a long series of statistical talde3, and correlation of loe.ficd findings with dust exposure is expressed by uiitlipleing the average dust count (in million P-uli' lrs per ni. ft.) by the duration of the worker's Apostii,. in years. The numbers of workers examined "e* >!! {1 lilt men and 1J.S women). Jive-sixths of ' !M bring native-born Americans of Anglo-Saxon ' k. 1 bo group consisted of workers who were maeh younger than the average industrial employee m l hid been employed in the industry for relatively
't |s-iiods. An el.iboiate vlinieal, radiological S'lthiilogic.il inn stigatiou was made. 11m hiding tilth III! li.lir ,t,u l-xpustllj* the r.ullolo Iial
* ***'jV ''`on of )|7 w.,1 kei s (si\t v.iiine foiin -r wot kel s -oS ,iuji|oye,l ii, tin.'" foloii- i nt the.time of
study) yielded 1C-3 per cent with asbestosis. This did not represent the true incidence because some 150 employees had been discharged fifteen months before the study was made. Only three cases, all doubtful or borderline, were found to have been exposed to dust concentrations of less than five million particles per cu. ft. Above five million numerous cases were found. It is suggested that if the dust concentration of factories could be kept below five million, new cases would probably not arise. The engineering section of the monograph considers t hat such a low concentration can be attained.
. S. Roadhouse Gloyne.
Saupe, E. Weitore Beitilige zur. R6ntgendiagno3e der Iiungenasbestose. [Further Contribution to the Radiological Diagnosis of Pulmonary Asbestosis.] Arch. f. Gcicerbeputh. u. Geicerbehyg. 1039,
- v. 0, 391-106, 10 figs.
The author published his earliest observations on this subject with KuCc.i:it and Rostoski in 1931 [this Bulletin, 1031, v. 0, 861]. In the present paper he gives further details on the radiology of tliis disease, his series of workers examined having now reached 420. Four stages of radiological appearances aro described, viz. (0-1) a prodromal stage with a sharp delineation of normal markings in middle or lower fields, which is not definitely diagnostic; (I) as above with very small delicate shadows; (II) increasing density of radiogram with the formation of numerous minute shadows beginning with diminished penetra tion in the middle and lower fields and especially around the heart shadow, with broadening of Die hila without,.as a rule, any signs of calcification; (III) intensification of tlienppearancesof (II) with increased penetration in upper fields ami more marked changes around (he heart shadow with still further brnadeniug and thickening of (he hila. [lli-i(i-^li writers on tho subject emphasize the gi on lid-glass appearance of the middle and lower lung fields with an ill-defined woolly margin to the heart shadow, ns the most characteristic feature.]
S. Roodhonjc Gloyne.
VlobltM, E. f\ Dueea-ii uinrtilidi n.dic-Un-i pnlmoii-
are. (Two Fatal Cajc-s of Pulmonary Asbci'.osu.]
Rust. Mul. liiilu.il. Torino, 1910, v. II, 20 52,
2 Ur-i. pc r. li.J
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10 1
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I
101
1NEUMOCOXIO.S1S AltSTUACTS
Two cases arc described iti considerable detail and in particular the post-mortem findings. An interesting discussion on the pathology uud pathogeny follows. The first was u woman of 50 years whose work entailed for thirty years inhalation of asbestos dust. There was resultant pulmonary fibrosis which, however, seems not to have given rise to any recognisable symptoms and the patient continued at work till an influenzal attack started a progressing illness ending in death four months later.
Tire second was, hi some respects, the opposite of the first. The patient was a woman of 50 years, who, between her 14th and 21st years, was engaged in work which necessitated inhalation of asbestos dust. Pulmonary fibrosis resulted with troublesome cough, n liability to attacks of bronchitis, though for fifteen years she was able to carry out heavy work. There after her pulmonary condition became aggravated and for tlie last twelve years of her life she was practically an invalid, with persistent cough, asthma and dyspnoea. Kadiographs show the conditions present. A valuable list of references cited is given.
' U. Harold Scott.
Mottcka, G. & Fagiano, E. Anatomia patologica e
patogenesi deU'asbestosi polutonare. [Pathogeny and Pathology of Pulmonary Asbestosis.] Hass.
Med. lndi'st. Torino. 1010, v. 11, 222-SI, 10 figs.
(11 on S pis.) [US refs.]
Though the subject of asbestosis is dealt with, as the title shows, purely from the pathological and the morbid anatomy and histology aspect and not from that of public health, atteution is drawn to the article here because, for those interested, it gives an excellent account of the changes set lip and of the relations between asbestosis and silicosis, gained from personal observations and from a study of tiro literature. Illustrations are clear and well reproduced and there is a fairly 'full bibliography, iu which liritish workers are given their full share.
II. Harold Scott.
Eton it, M. J. Clinical Studies in Asbestosis. .4 hut.
Iter. 'i'ubcrculoin. ID 10, v. -11, 12-21, 0 figs. 112 refs.]
This is n clinical record of ISO patients who had been employed [or three years or more iu a factory in.nnif.icUuing biake lining for cars, and who had w,rk>*d in the eatdiog, .`.pinning and wearing rooms. Jinny of them were al-o engaged in the ni"ii: il mgerOtis Work of ini .liing t lie crude asbestos, ami t lie great Inajeiity of them hid been employed lioin live to fifteen yeais. Some had. indeed, u.iil.ed for more than t \\.a,t y-tive v.-uis. The im-.s eann- to medical examine'...n tl.ioii.h di-ahiiity < 1. lr j i -. ami none u.r, employe.| in the .. si > .|o, f I. toll, s at the time of.
or after, medical examination. Of the ISO patients, thirty-two were diagnosed ns negative, both on X-ray examinations and on physical signs. The remaining 14S patients were classified as follows--
Stage I . Stage II Stage III
.. . . ..
. . 54 . 10
75patients ,, ,,
In Stage I were included cases in which there was
definite limitation of chest oxpausinn (less than 2 in.)
in addition to roentgenological evidence of increased
lung markings. Stage If comprised those who hud
definite symptoms aud whose X-ray films revealed
evidence of pulmonary fibrosis. Stage III com
prised those patients who had both symptoms and
roentgenological evidence .of marked pulmonary in
volvement.
.
The outstanding symptom in all patients was
dyspnoea. Physical signs in the chest were chiefly those of basal fibrosis with accompanying emphysema
at the apices. The most marked being diminution
of chest expansion. As to radiological examinatiou,
in the early stages there wus only a slight relative
increase in density in the lower zones of the film,
producing a hazy appearance of the bases. The
shadows were much finer and lighter than the nodular
or patchy type of infiltration found in silicosis. As
the disease progressed, there was an increase in the
density in the lower lung zones, the diaphragm
became indistinct in outline, and showed limitation
of movement, whilst the costo-phrenic angle was
obliterated by the tliickciieil pleura. The characteris tic picture, however, was a granular or "groundglass" appearance of the film with more 'or less
obliteration of the usual linear pulmonic markings,
this being localized iu most cases to the mid-lung
region aud bases. All these changes were associated
with the author's classification of Stage II. He
reserves Stage HI for films showing a marked paren
chymatous change with freiiuently associated bron
chitis aud bronchiectasis.
,
II is noted that the heart and pericardium wore
affected much more than in any oilier types of
pneumoconiosis. X-ray films showed the increase
in the transverse diameter of the heart with prominent pulmonary vessels.
With regard to tuberculosis, out of ISO films taken
in this series, only nine showed evidence of parenchy matous tuberculous infect ion, two active, seven
inactive, whilst in sixteen cases of advanced nsbestods,
only one had active tuberculosis. The author ii
therefore not iinpiv-a`d with tuberculosis as a serious
complication of adic-tosis.
Follow-up studie- were made on thirteen patients,
two and lluee years utter tle-ir lit st examination, and
the impie-.inn was g lined that ill udv aiiccd fihii.ut due to n-.ticstods, the ill e.i~e will prngrest even
after expo.me ie.i-.es. This n.is not t>o, however, in
the rally .i-.es. Nine.- the entire group was lir>t
ex nolie-.I, eighteen p ili.-nU hud died.
,
X. Jt'.'idfliHI.*' til"!/nc.
Eltnii t!. A Ot A lit
This ar the ca; partich in Ucrl; tests w types o: tus use. which c fitted tthe re>; conclud respired dividingbeing in found ir this div, and aim 40 per . some wv workers . above t investig;. were nut 15 and 2
IIa.v.vi:-.-
Acco
Feb.
l'ulmonai tosis less appears 1 ris report, present in
In a tyj fibrosis, 1. by tuber, "f silico ; interest, j. bh\ seen:, definite .
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ASBESTOSIS
165
Khtuiakdt, \V. tuitersuchungcn ucber die Bcdeutung des Staubbindungsvermogons der Xnse bci A*bestose. [Experiments upon the Importance of the Dust Filtration Capacity of the Hose in Asbestosis.] Arch./. Gciccrbcjiulh. u. GcirrrhdiKJ. 1040, Xov. 5, v. 10, Xo. 3,30<)-2i>, 3 figs. [03 refs. J
This article gives the results of an investigation into the capacity of the nasal passages to filter out dust particles from the respired air, in a group of workers in Berlin asbestos factories. The number of completed tests was 121, aud the subjects included numerous types of workers, spinners, weavers, etc. The appara tus used for the experiments was that of Lkhscann, which Consists of an elaborate dust filtering apparatus fitted to the nose and containing a konimetcr. As the result of numerous experiments Lehmanu Lad concluded that nasal filtration of 10 per cent of respired dust particles could be regarded as the dividing line, persons giving readings above that figure tiring normal, below abnormal. The author, however, found in his investigation of asbestos workers, that this dividing line of 40 per cent between the normals and nbnortnals did not bold good. The group below to per cent contained healthy workers as well as some with asbestosis; on the other hand there were workers suffering from severe asbestosis with readings :hove this figure. A graph of tho whole group investigated shows that readings above 40 per cent wore not common and the largest number fell between 13 and 30 per cent filtration.
S. lioodltottsc Gloyne.
Uanxksson, if. A Case of Pulmonary Asbestosis
Accompanied by Tuberculosis. Tubercle. 1911,
Feb., v. 22, Xo. 2, 40-14, 3 figs.
.
I'lihaonary tuberculosis is found complicating asbes-
less often that it complicates siiieosis, and
appears later. Of ninety cases of death from arbeslo-
reported between 1933 and 1939, tuberculosis was
l-rwnt in thirty-two.
In a tj picul case the radiogram shows a fine diffuse
' is. beginning at the bases, and when complicated *' '"bereulosis the latter is distinguished as in cases
-dieti-i,; t|,0 present case is id' more than usual ''t.-st, lust because the diagnosis was made during
' . secondly because the radiogram did not. show any j1' evidence of pneumoconiosis, and thirdly
ois.. there was no macroscopic evidence ol
' autopsy. |" 1` itient was a man of 41 vc.irs who gave a
., `
from live years bark, of winter cohls
,,,,,ii Intis, loss vif weight and once a large
, "I".' i'. lie was admitted with a diagno.is of
tuliereulo-is. For nil!" years he had been , ** ' `I l'> an "asbestos blower." a diistv occupation
1 uii .i,|,,.,t,,H libre tbroii':h a el tiling maebiue.
I** o\ a led with a Icspu.itor lie did not ii-e it. .1 cviiiniuitiiMt revc.i]cd impairment of note
Inn..,, iliiiiiiuit i> oi of I a e, it It ..,iin. Is at cn |>,l.,tinf,s f.llllv geli! I all V*_il|s| | ilillte.t ;
sputum contained tubercle bacilli and asbestosis bodies. X-rav yielded no evidence of pneumoconiosis, but widespread nodular tuberculous infiltration with cavitation. The fingers were markedly clubbed. Twenty-five days after admission the patient had a spontaneous pneumothorax and died the same day.
Autopsy revealed thickened pleurae, collapsed right lung with a cavity in the upper lobe which had perforated; maeroscopically, the .appearances were those of a pure t ubereulosis. It will be seen, therefore, that the case recorded in this paper differs consider ably from ft typical case of pulmonary asbestosis; in the latter the pleural sacs may be completely obliterated by fibrous adhesions; the bases adhere firmly to the diaphragm; bronchiectasis is frequent, the lungs appear honeycombed, but firm, tough and airless. The upper lobes may be spongy, crepitant and emphysematous, strongly contrasting with the lower parts of the lungs. Microscopically, in this patieut there were seen caseous tuberculous areas, reticular fibrosis of asbestosis most marked in the subpieural region, and a thickened pleura. Dr. Hoodhouse Gr.ovxF. reported "Asbestosis bodies were numerous and large, many of them were in clumps with a radial arrangement. The presence of the asbestosis bodies implies a tissue reaction to the fibre, but it does not necessarily follow that this reac tion is accompanied by fibrosis. The asbestosis bodies are an expression of tissue reaction of the nature of a benign irritant, ami fibrosis of an appreciable extent may or may not lie a part of that tissue reaction. Asbestosis bodies are the sign of tissue reaction to a foreign body just as much as phagocytosis, but the bodies should not be regarded as indicative Of asbes tosis unless they are accompanied by reticular fibrosis."
Front the radiological aspect four stages of pulmon ary asbestosis are distinguished: in the first, move ment of the diaphragm is restricted; "the root shadows are unusually heavy and the basal linear striation on one or both sides is increased. The two sides of the chest are equally involved . . . some loss of transluretiev ami a fine homogeneous opacity or haze at one or both bases."
In the second stage the homogeneous opacity becomes more obvious and a line punctate stippling may be detected at one or both bases, while the basal linear striation is more obvious, with very definite restriction of diaphragmatic movements and some times blurring of tin; diaphragmatic angles. The Intel lobar pleura is usually thickened and may bo drawn down to the base by tin* fibrosis.
"In the third stage definite evidence of pleural involvemeiif may be preseiil, with or wifInml media stinal displ n eiiient, depending upon the irregularity of lilu in the two lungs.
"In the fourth stage tin- tile- punctate mottling lias spread hejoiul tin- limits of the lower 7<*ne to the middle and even upper zone, but the apices li-uilly tein uu flee. This tine 11:l"ii- mottling standi out in d.-iinite i ml ia -1 l<> tie' i 'UIs' nodular mottling which i. seen in Mlieo-i-s."
II. H,,r,.h> Sell.
QO
\/Jt-a -
166
PNEUMOCONIOSIS ABSTRACTS
KCnN, J. Ucbcrmikroskopische Vntersuchungen an Asbeststaub und Asbestlungen. (Uebermikroskop Investigations on Asbestos Dust and Asbestosis Lungs.] Arch. /. Getcerbepath. u. Gacerbth'jg. 1011, Apr. 10, v. 10, No. 5, 473-S5, 13 figs. [16 refs.]
Using the Siemens "Uebermikroskop" the author
has made a comparison of tbe asbestos fibres and
asbestosis bodies in lungs exposed to serpentine
(chrysotile) and hornblende (amosite). llorablende
fibres were larger and the author suggests that the
smaller serpentine fibres are more readily dissolved
and may therefore be more responsible for the
resultant fibrosis.
S. Jtnodhouse Gloyne.
BOhjee, A. Untersuchungen an den Arbeitcm einer Asbestfabrik. [Examination of Workers in an Asbestos Factory.) Arch. f. Gctccrbepulh. u. Getcerbehyij. 1042, Nov. 10, v. 11, No. 4, 433-52,
8 figs.
This is a record of clinical and radiological observa tions made in an asbestos factory during the years 1936-7 and the year 1940. The factory handled raw absestos and manufactured a variety of asbestos products. It employed up to 500 workers. Of 132 persons examined, 29 per cent showed radiological evidence of asbestosis. Correlating these findings with exposure, it is stated that there were in workers with less than tliree years of exposure 5 per cent of cases, in those with three to five years of exposure 12 per cent, in five to ten years 56 per cent, and in over ten years 70 per cent. Five cases of pulmonary tuber culosis were noted. The clinical histories of these are recorded.
S. lioodhouse Gloynr.
Welz, A. Weitore Beohachtungen ueber den Berufskrcl's der A-'besturbeiter. (Further Observations on Occupational Carcinoma in Asbestos Workers.) Arch. /. Gcircrbcptilh. u. Gcnrrbrhij.j. 1942, Nov. 10, v. 11, No. 4, 53'<-50, 0 figs. [14 refs.)
This article is a record of two no.es oT asbn-tosis complicated by cancer of the lung. The first patient was aged i:t, with an exposure of eleven years in an Asbestos factory; death was due to spi.unous cell carcin-.iu.i. The second worker bad had thirty years' experience in asbestos work and shooed at autopsy an atypical epithelial cell new growth.
The author suggests there i, a causal relationship between asb.-sto-.is and carcinoma.
N. Jh.'iill.i>t.<r Gloyiic.
Hl'-Ll, II. t ' beltllikl. t.kopi-- he t'ldel Ml. hul.g.-n
Asbestosis Lungs.) Arch. f. Gcuerbcpalh. v. Getcerbehyg. 1912, Dec. 31, v. 11, No. 5, 575-S, 2 figs.
Wedler, II. W. Asbestose und Lungcnkrcbs. [Asbestosis and Pulmonary Carcinoma.) Deut. tned. U'och. 1913, Aug. C, v. 09, No. 31/32, 575-6.
The author has collected, the published autopsy records on asbestosis from various countries and finds that there have beeu fourteen instances of malignant disease or the lungs and pleura in ninety-two post mortem examinations (16 per cent). This is in excess of the proportion of lung carcinomata in autopsies generally (2-0 per cent). Carcinoma as a complica tion of asbestosis occurred most frequently in mates between 35 and 41 and was generally in the part of the lung most affected with asbestosis. Development of the lesion was slow but corresponded with the length.and intensity of the exposure (twelve to fortytwo years). There was often a long interval between the cessation of exposure and. the development of the cancer, which, in the author's view, must now be regarded as an occupational cancer.
S. Koodhouse Gloyne.
lIo-MHrROEit, F. The Co-incidence of Primary Car cinoma of the Lungs and Pulmonary Asbestosis. Analysis of Literature and Report of Three Cases. Aincr. J'. l`ath. 1943, Sept., v. 19, No. 5, 797-S07, 10 figs, on 1 pi. [17 refs.)
"A review of the literature on the association of pulmonary asbestosis and carcinoma revealed that there are at least nineteen known cases (including the three herein reported) of asbestosis associated with primary pulmonary carcinoma. In thU labora tory the association of the two conditions is remark ably high. In eight cases of asbestosis there were four instances of primary pulmonary carcinoma.-*'
Aloes, II. S. Sc Howell, W. M. The Asbestos Com.
Arch.
A: Syph. Kill, Mav, v. 49, No. 5,
312-14, 4 ligs.
''
Men employed in lagging pipes in shipbuilding yards with the use of "amosite," a natiiial form of asbestos, wer" found to do, flop corns on their lingers. Investigviou rcvi.ded that ninety-nine out of 1*17 men pr..... Tit--d one or more of thc-e le-ions. Small splinterlik-.- bits of amo-itc peiielrate the skin; about ten tlaxs later, it the foiei.-n body is not ri-inniel, a mu.ill liurd corn-hke tumour appears and slowly grow*, often alt.lining lie- M/.e of a -mill split pea... T!'-" IlfT-ste-l el,.I line, ||o* I....... IloMllll ng-llll lllll.i tl bud n nlr.il pin; b i - b. i r, i.-mow-d. I'll-ns of in l- In i\ l-i- d t*-i li d ill :n\ i-\i*i -i d i *i ti. t 'r. S T
fill I
The au' the lu: of ash- have wi without corns M". of spiv.: vent ion. the corn' Since a serious iu it.
Noro, I.. ct 53-1'.
This arti asbestod. been ex; count ry. elastic tl. especially siou from the asbe-v very shn: The chen. as follow (Al.Oj) J (C'aO) 0 2 The asbe - found to cribed b.. llie celln: fibre, tin- . are given, accepts I-. causation factors a i factors iphase."
Ska* i e>i, Puhg/'lift, on tl
l.l'TiiN, |* tt-eI'- M. Tl: Bud. I/- '
w
it
if it 'll .C o
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I'l* . -II
< 1T
ASH ESI'OS IS
107
The authors recall the reaction which takes place in
the lungs to dust particles of nshestos; but no case
of nsbestosis was found anions the men. Some men have worked with amosite for so Ions as seven years without developing corns; but the majority developed
corns within the first three or four months. Removal
of spicules with forceps after work is useful iu pre vention. Cure can be obtained by simplo paring of the comified areas until all excess keratin is removed.
Since a corn is relatively innocuous and leaves no
serious sequelae, there is often little interest taken
in it.
E. L. Collig.
Noro, L. On the Histology of Asbestosis. Ada Path, el Hicrob. Scandinacica. 11)40, v. 23, No. 1, 53-9, 6 figs.
This article gives a short account of the histology of nsbestosis as seen in two workers iu Finland who had been exposed to the amphibole asbestos of that country. This variety of asbestos is harder and more elastic than others and therefore is considered to be especially dangerous. [The reviewer's geueral impres sion from experimental work is that the more brittle the asbestos fibre the more likely it is to break up into very short lengths and to penetrate lung tissue.] Tin: chemical analysis of this Finnish variety is given ns follows: silicic acid (SiO.) 50-27, aluminium oxide (Al.O,) 2-50, ferrous oxide (FcO) 4-18, calcium oxide (t'aO) 0-23, magnesium oxide (MgO) 31-41 per cent. The asbestos needle-like particles of this variety were found to be "noticeably smaller" than those des cribed by some other workers. Brief accounts of the cellular and connective tissue reaction-to the fibre, tlie asbestosis giant cell and the asbestosis body are given. With regard to the last named the author accepts both the mechanical and chemical theories of causation but is inclined to think that "the mechanical factors are the most important, although the chemical factors may have some significance in a later phase."
- .. S. Roodkouaf Olo'jne.
f-a.wi.KM, J. ii.
ltirnmiiiiKK, It. J. Coexistent
Pulmonary Asbestosis and Sarcoidosis, An-r../.
t'ath. lino, .May, v. 22, No. 3, 493-517, XL tigs.
>: 0 pis. [20 refs.]
t.< r.is. I*., Ciismi'Eix, J. & Fauuk, 1\ In signillca<i->n de la presence do corps asbcstos'iipies dans t-vpiatoiatiou d*-s travailleurs de I'aiiiiante. The Significance oi the Presence of tbe Asbestosis Body in the Expectoration oi Workers iu Asbestos.] Ic' -1'. Mulmt. J'rvft nitiini' ll' .i. Pans. PJI7, V. V No. 1. oil-OS, 7 tigs. [33 refs.]
' ' a t-tail.-d historical intrudu.-tion to the subject,
a-iili-ips gi\e fln-ir expnience of four years'
observation of workers in the asbestos industry with
special reference to the study of the significance of
the asbestosis body. They classify their conclusions
under four headings--(1) Asbestosis bodies are
dill!cult to find in the early months of exposure owing
to the fact that the workers have no sputum unless au
attack of influenza or bronchitis produces expectora
tion. In one worker asbestosis bodies were indeed
found after twenty days' exposure, but this is unusual
and four to five months is the average time. Four
illustrative examples are cited. (2) In 102 workers
(observed over a period of four years) who had neither
radiological sigus nor clinical symptoms of the disease,
asbestosis bodies were ultimately found in alt cases.
At first the bodies were short, thick and uou-frag-
mented, but later longer specimens were found with
tvpicat clubbed extremities. The numbers of bodies
increased with the exposure, they occurred singly
in the sputum aud were accompanied l>y asbestos
fibres. (3) The finding of clumps of asbestosis bodies
first recorded by Stewart, Tatteusaia fc Haddow
[this Bulletin, 1933, v. S, 27] is confirmed. Two
cases are recorded at considerable length in which
there were definite radiological signs of the disease
aud in which the sputum showed these clumps. (4)
Lastly the fact of the persistence of nsbestosis bodies
in the sputum after the exposure has ceased is stressed,
but the authors arc convinced that the finding of
these bodies is only one of tbe diagnostic features of
a-sbesfbsis and that it cannot be accepted alone for
purposes of diagnosis from a medico-legal point of
view.
-
S'. Jloodhouue Gloyne.
Boa[id ok Trade. German Industry. F.I.A.T. Final Beport No. 1070. Technical and Scientific Developments related to the Asbestos Industry in Germany. 42 mimeographed pp., 7 figs. 1947. Mar. 23. London: II.M. Stationery Ollice.
This report is a description of the machinery And installation of the German asbestos industry which is considered to be of interest to American industry, and is a supplement of previous reports especially Fiat Final Report 400 and liios Final Report -lb I, Item 22. Tbe main problem for the German asbestos industry is regarded at present as one of lack of material, in which the British Zone is not so badly off as the American. The report consists broadly of three sections, one dealing with industrial plant, another with problems of dust control and a third with some experiments made by German scientists during too war to prepare a synthetic asbestos. The pirsenl position with regard to tic plant and installation is solely an riigiiceiing problem. Tbe pieparalion of n synthetic pmduet his Ici-n held up by tbe collapse of German industry, and not a great ib-al appears to bo known about it, but the b.i-c idea seems to hive been "gelling" of sodium du.ite with b\droelilotie arid, w ishing out of tic gel to iitnow- .N'at'l by Inpcfying it urnl- r 'team pies,me, evaporating tbe Kol to II pi r lent Silt, wpb tin- in I* lit i-in of 5 10 per
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108
J'NISUMOCUXIOSIS AUSTlt ACTS
crnt sugar, introducin',; a spinning process and ilunllv ageing the fibre, washing the sugar residue and drvtng. The section on dust control has u direct bearing on general industrial hygiene.
For many years before the war, insurance (Brrvfxyrnos^'nsrhafl) against the risks of dust and accidents was compulsory. The use of respirators was recom mended only iti extreme cases, reliance being chiefly phtced on an etlicient dust control organization. The report gives a translation of the llegulation for Dust Prevention in Asbestos Processing Plants issued by the German Government in 1940. This lays down general engineering precautions for dust control, with detailed instructions as to the protection of machines and the provision of exhaust equipment. [Many of these are already in use in Dritaiu, but the details are too technical for abstraction.] Au otlicial centre for advising on dust prevention, especially in the case of the installation of new plant, was provided by the Government. Children under the age of IS were not considered suitable for dusty occupations (no details are given, however, as to the regulations for their exclusion]. It was forbidden to eat, or to remain, in dust-endangered rooms during rest periods. Outdoor clothes were not to be kept irt workrooms and work clothes had to be cleaned at regular intervals
[time not stated]. The writer of the report also interviewed Dr. T.uise
Holzaitel who had had charge of au organization in Berlin for the investigatiorr of silicosis problems, before the collapse of Germany.' She stated that sire and her staff had been engaged for some lime on the isolation of organic silicon compounds. Two impor tant ones had been discovered, but. their chemical composition has not been completely determined when the war ended. One was a silicon compound of the lipoid group obtained from tire lungs of patients suffering from silicosis accompanied by tuberculosis, the other was a Si-X compound present in rrorrnal blood. Tire isolation of tiicso compounds had been extremely tedious, taking from two to three years nnd when tire Itussians look over that section of Berlin they had ordered the destruction of all material on the ground of risk of infection. Dr. llolzapfel considered that there was no risk of tuberculosis provided that silica metabolism in the body was nor mal, and she regard' d disturbed fat metabolism in undernourished workers as a predisposing cause of tuberculosis. .She was of the opinion that tin; com pound isolated from healthy blood might have some therapeutic value both in tuberculosis and tuberculosilieutic patients. The striking resemblance between the ti~suc of a silicotic lung and vulcani/ed rubber suggested to her the presence of lung-chain organic, silicon oxygen compounds, probably toiimsl when the fre-h surface of quartz grains reacted with some (mlnon n coiislit nent of the blood. The pieseiice of oxygen was necessary, she believed, tor tbat reaction to take plaei* ami she fiuther expressed the view tli.il " rompouml in which the sih'-on atoms are com|'b lely unrounded bv organic tadimls pinbably raniml cause silicosis because such a compound will In- in-obil'l ' and unit active." Dr. llolmpM hod Died
to cultivate the tubercle bacillus on SiO, gel contain ing various nutrient substances, but without success.
The writer of the report states that further informa tion on the two substances mentioned can be obtained from the Kaiscr-Wilhelm Institut fur Silikat J'or.schung in llorlin-Dahlem. The substance formed in normal blood hail 1-3 per cent SiOj, IV5 per cent X, but no irou or cholesterol; it was water-soluble, strongly alkaline, with a melting point over 230 [presumably Centigrade] and had been isolated from the lecithin fraction in the blood. Thu second was u water-insoluble substauce from the lung tissue, and could be concentrated in the ester fractions. The lecithin compound, on the ot lu-r hand, was almost completely absent- from lung tissue. In silicosis the melting point of the extracted mixture of ester-free fat was found to increase in relation to the severity of the disease. Daily cases of silicosis yielded a mixture melting at 15 whilst the material extracted from more advanced cases melted at 72-SI". Extrac tion of silicotic lungs gave a higher proportion or lipoids festers, free fatty acids and phosphatides) ' than was obtained from healthy lung tissue.
S. lioodhousc Gloyne.
Weckuus, C. Changes in the Lungs in 126 Cases ot Asbestosis observed in Finland. Aria ltadiolnyira.
1947, Apr. 30, v. 2S, No. 2, 139-52, 10 figs. [1G refs.J
This article is a record of 120 radiologically manifest cases'of asbestosis anioug 470 workers in Finland employed by the Finska Mineral A.ll. Firm. Of the workers affected, thirty-four were employed in tlie Company's dressing works at the mine in X.Eastcrn Savolax, while ninety-two were working in the factory for finished products near Helsinki. There wen; ninety-four (75 per cent) instances of mild asbestosis of stages I and I--If (with an average mean exposure 3-4 years), twenty-three (IS per cent) of medium stages II and 11--111 (with an average mean exposure of 7-9 years), and nine (7 pec cent) of advanced stage III (with an average mean exposure of 11-5 years).
During the observation time of two years, twentyseven of (lie thirty-six patients in Die ante-primary stage progressed to stage I; of the stage I cases, four of thirty-two patients progressed In the inter mediate stage I-II, and the same number passed to stage II; of the stage II cases, two out of ten ad va need to intermediate stage I f -111. Thu deaths occurred before the conme-nccinont of tli*1 examination; since tla'll no ieliab!c information has been forthcoming with legard to (lliers, although it is probable tint some deaths have occurred. The method of radio logical clo-'ifn'.ition used was Dial of Svi'l'i:. vu ante.primaly .stage; Stage I, exticmely line uric.mL in the inid.il-- of basal fields; fl, denser pictuie uitii mim.-logs extremely small nodular .-.h.el.i"*; III. lu ll led *s)i.id-/\v of middle am) ha.,al fields with confiie.-d contour of heart shadow.
Xo o with, s-n i-r the I. VXaU... out i- ' (cl at.; most i. accoiit;
OLLtv i; ' (ini.
liill.
As! in l
A m.m . to la,; I hand, 'i unuutn 4 compl.owhich \\ Wax no irent i e.
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ASUESTOSIS
100
NV* instances of carcinoma or tuberculosis were met whit. [With regard this last point. three dith-rent !--ts of words now exist in the literature, relating to t!,.- incidence of tul-T.-ulr.sis, viz. {) operatives evttnineJ at work; (b) those seeking advice nt it-patient clinics or under treatment in hospitals;
autopsy records. Obviously the last group is the icliatde one os to the incidence of tuberculosis
.it.-..nipanied by nabi-stosis.J S. Jioo'fhr.vne (Hoyne.
.I|nnrr, 1I-, XlmtANL), T. & Burrs, It. Consid&ations a pi.tpos des gramJnmcs cutantte de limiinnte. [Granulomata of the Skin due to Asbestos.] Arch. 31dud. J'rofcssioiinclU-s. Paris. 11)19, v. 10, No. 5, 510-17, 2 figs.
A man whose work lay in applying asbestos sheets t<> lag heating stoves wounded the palm of lus left hand. The injury was slight and almost passed unnoticed. A fortnight later he came under notice complaining because at the site of the prick a swelling which was increasing in size had appeared. There was no inflammation and the swelling was hard at the centre. When this core was excised, a small wlrite nucleus was dissected out which was seen under the laict..scope to be formed of nee.Ues of asbestos together with a mass of crystalline matter. In order to examine this matter, other samples from other .ede>tu> scars were ablated and so 0 mg. were obtained f-.r analysis. Then the matter was identified as eb-.l.-^l.-roL One point of some interest is that this 1-.mat ion of cholesterol would seem to indicate a fundamental and biochemical defensive process of *-- 1-idy against aggression by asbestos.
E. L. Collis.
at:Tii.it, 1*. Contribution h lVtude de 1`amiantose.
iA Contribution to the Study of Asbestosis.]
toIt. Midid. Prcfcssionnclln. Faris. 1941), v.
I", Xo. 0, :>$0-05.
1 r .tier three years the author has been in medical
' ":' of ;i,u;2 in,.u employed in mining asbestos at
""'.d in Canada. At these mines over 70 per
at ... i|i.. world's supply of a.-besios is obtained.
|'.-r cent of tlie m..-u have been employed for
o ... |..;ly years. The minerals mined consist of
\V
*orm f chrysotile iiiul Roipcn:;no.
1 .r..in s. ipentine l.as been found clinic ally and
- i :>:ii--tii to h,. a nuisance rather than to be a
"t pneii!in.i,.::;.i,!s. IJu* it is known that
' . ' ,t`-1 anales asl->tosis, ;,t 1 -,,.i when its dust is
'* while Hi- iniiieial is been,: spun and wmen
. ` 'b. Case, of n.hestoiis were found only in
' l.el I.....a employed for at least fourte.-u
. . ' 1 N|-o -! I.. ,ij|- containing live inilh..n or
1 .-hs .if ; .I.-,',,, libn-s p i eu. ft. of air,
. . *' 11 1i-i:u I*)/, to 2a'* a in Ian;,lh. 'I'lie
' 1 '' 4 *ii* of this report ii the md li of
any pulmonary trouble found among Iho miners resulting from inhalation of asbestos dust, compared with what hits been reported in Iho United States and Great Jiiitaiu as occurring in factories where asbestos is spun and woven. Clinically none of the symptoms of pulmonary librusis--cough, dyspnoea, cyanosis and loss of weight--were present. No case of pure ashestosis was detected in those under age 00, and most of them were carrying on their work without any physical incapacity. The mining neighbourhood would seem to be unduly "infected" with tuberculosis, but cases of that disease were not found to be any more frequent among the miners than among tho clerical stafl and the rest of the community. Having regard to the late age at which asbestosis appeared, it was dillicult to ascribe any cardiac affections present to the asbestosis rather tliau to the ordinary wear and tear of life. Post-mortem findings and X-ray examinations indicate that asbestosis is undoubtedly a pathological entity; but among these miners it develops so slowly as not to shorten working life, and there is no evidence that it predisposes to tuber culosis. The conclusions arrived at are supported by the opinions of experts from Saranac.
E. L. Collis.
FranchiSt, A. & Canepa, 0. Contributo alio studio anatomo-patologico dell'asbestosi polmonare. [A
Contribution to the Study oi the Pathology of Pulmonary Asbestosis.] 3/cd. d. Lcvoro. 1940,
June-July, v. 40, ' Nos. C/7, 1G1-72, 7 figs. 117 refs.] English summary.
The only previous publication on this subject in Italy was on two fatal cases described by Mottuka and Facia NO in 1010; a case of asbestosis with tuberculosis was described in an unpublished thesis by Castagntui in 1910. Tho cases described by Mottura and l-'agiano were of special interest and they are discussed in comparison with the case now described.
A man, -aged 10, who had been employed for twenty-two years applying insulating material con taining asbestos, sustained fatal head injuries in a street accident. A remarkable feature of the case was the absence of incapacity from asbestosis, and the only symptom.-, recorded were crnigh and bronchial catarrh which apparently were ascribed to smoking. J'oot-morteiu examination showed thickened pleura, oxton-ive iiivolvi-ini'iit of both lungs, especially tho mill.lie and basal [nations, in a diffuse iihro-ds with thickening of the inter-nlveuhir septa and hyaline cb.uigi'.-, and patches of emphysema. Numerous asb.-.to-i-. In-die-, w.-rc found, singly and in clumps, ill all palls'of the lungs, presenting tin- no.iul feat in ei of a central Idee w ith a segmented i-o.it ing of a browni.-li-y. How- ii. [-.sit; th...... bodies were aUn found in the l oiticat ti-sii- of the pulmonary lymphatic glands. The lungs weie tie- ... ,u of aeute hliincti.i.pi.eumouiu w hi. Ii bad b-\ .-loped h. t a eu tin- tilin' of the aeeide'at and death : ;bt days nil. rw.ud->.
i
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170 rXEUMOCOXIOSIS ABSTRACTS
It is suggested that periodical medical examinations should bo made of persons exposed to asbestos dust, ittcludiug workers employed in the application of asbestos insulating material.
. L. JIuWeton.
VYEKS, IT. Asbestosis. Postgraduate Med. J. 194SI,
Dec., v. 25, No. 290, G31-S, 4 figs. [27 refs.]
Asbestos appears to be an exception to the rule that nearly all pulinouary fibroses are due to silica, as it is A silicate. Other silicates, however, are not toxic, and Gardner in 1038 therefore suggested, on the basis of Auiinal experiments, that the effect was mecbauicnl, since it was produced bv long fibres and not by short. Johnstone, in 19 IS, made the clinical observation that workers exposed only to very shortfibre asbestos were not affected by it. [It is unfor tunate that the further experimental work that Gardner did before his death and which completely clinched the mechanical theory, has not yet been published.] .
The use of asbestos goes back to the ancient Greeks, but it is only since the nineteenth century that it has been widely used. The name covers a group of fibrous silicates characterized by resistance to heat, nciils, and sea water, which are obtained by mining and qunrrving.
Asbestosis was first reported in this country in 1000, but was not officially recognized as an industrial disease until 1930. The condition is thought to be due to the blocking of the finer bronchioles by relatively long (about 20 /x) fibres which appear to irritate the bronchial wall and cause fibrosis. The typical asbestos bodies which were described by Groyne in 1929 [this Bulletin, 1929, v. 1, 977] arc
evidence of exposure to asbestos inhalation, but not necessarily of disease. Dense pleural adhesions are common.
The clinical picture comprises dyspnoea and cough, with sometimes cyanosis and clubbing. The X-ray changes are oftou minimal when the disease is severe, but usually there is evidence of fibro.-is ami later of emphysema. The commonest complication is tuber culosis, but there is also an increased liability to carcinoma of the lung.
Since the recognition of the disease, and the con sequent precautions which have been taken, it lias become rarer and less severe.
The only other silicate which has been shown to produce pneumoconiosis is talc.
D. M. Wright.
Livingstone, It. & Street,- Ej \V. A Case of Pul monary Asbestosis. [Memoranda.] Brit. Med. J.
1950, Apr. 22, 939.
The interest of this case is that asbestos bodies were found in the sputum some twenty years after the end of .exposure to dust containing asbestos, which filled the air near the asbestos crushers with which the patient worked from 1924 to 1929. Respirators were not provided aud the workmen took only simple precautions, such as tying handkerchiefs over their mouths and noses. In 1919 he was suspected of tuberculosis as a result of miniature radiography, and admitted to cough for the preceding ten years. There was fine, diffuse, mottling in the middle and lower zones of the lungs; no tubercle bacilli could be found, but asbestos bodies were seen in the sputum.
Charles Wilcocke.
S.WETV I
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PNEUMOCONIOSIS
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VOLUME 111-19^1-19^5-
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,
Reproduced from the Bulletin of Hygiene
. by permission of
'
the Honorary Managing Committee of the
Bureau of Hygiene and Tropical Diseases
-. : ..
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. -Published for the BUREAU OF HYGIENE AND-TROPICAL DISEASES
by
PITMAN MEDICAL PUBLISHING CO. LTD
i
sccnox Foreword
CONTENTS
MM . . . . . . . . . . . . . v
Litt cf Abalrcctera and Jici-iemrt
............. vi
J. GENERAL ...................................................................................................................................................................................1
General--History--Epidemiology--Aetiology--Pathology--Respiratory function#--Radiology-- Clinical findings--Treatment--Prevention--Legal subjects
II. SILICOSIS--GENERAL................................. Reports--Conferences--General papers
42
HI. SILICOSIS--EPIDEMIOLOGY, AETIOLOGY. PATHOLOGY................................................................................
Epidemiology: general environmental records--Aetiology: theories; toxicity studies; hormones-- Pathogenesis and pathology
64 '
IV. SILICOSIS--CLINICAL STUDIES. . -...................................................................................................... 114 ' Respiratory and cardiac functions: tests--Radiology--Clinical findings--Complications
V. SILICOSIS--CONTROL........................................................................................ ....................................................................160
Treatment--Prevention--Legal subjects
"
VI. PNEUMOCONIOSIS DUE TO SILICATES......................................................\
...
.A&beetos: Aetiology--Pathology--Radiology--Clinical findings--Complications Other silicates: Kaolin--Talc--Mica--Puller's earth (monimorillonitc)--Feldspar--Sepiolito
.171 /
Vll.
PNEUMOCONIOSIS--COAL AND GRAPHITE WORKERS............................................................................. 186
Coal workers: General--Historical--Epidemiology--Aetiology--Pathology--Respiratory and cardiac
functions--Radiology-- Clinical findings--Complications--Treatment--Prevention--Legal subjects
Workers in graphite und other forms ol'carbon
_ .
VIII. PNEUMOCONIOSIS--FOUNDRY WORKERS AND WELDERS Jn foundry workers--In welder*
222
IX. PNEUMOCONIOSIS DUE TO OTHER INORGANIC SU13STAXCES........................................................ 240
Aluminium--Other non-ferrous metals--Beryllium--Kicsolguhr and fluorspar--Cement--Sulphur
and liuryta
.
X. PNEUMOCONIOSIS DUE TO OKCANJC SUBSTANCES
Cotton--Jute--Mowra seed--Crain and cereals
.
. .....................................................................275
XI. DUST S'AMPLINC AND ANALYSIS............................................................................................................................ 283
. General--Threshold Jiiuiis --Sampling--li*.-:ru:i.cuts: knuimcteis; inipingrrH; inipnrtors; ccrubhcrs;
spii#tl,,>.,:iij>hr>; prveipitatmthermal ,::'i Vrtroj-t.nir; t\nihilhenclcrs; dm: ituincicr*; fillers
--i'i}*etle aiutlynd--MiMMirni.eiit--J A
: ion: M.iinjng; elii-iuiciil analysis; physical analysis;
thermal onjly.-it; X-ray uiiimtiuii analyst*
vii
__.'i
.. v*.-. * , - . v -
`
VIII
CONTEXTS
SECTION
XII. DUST COXTROI........................................................................................................................................................................... ......
PeriodieiU report* rctutinz to du*t rr-iitrol--C^r.erttl--Mechanical pti-h* mid drill*---Infusion of water st the face--SjuinMir.x and spraying--Weeing agents: salt--Ccncrnl collection and filtration of dust--Stone ducting--Mine venti'aticn--Protective equipment
Index ef Authors or Source*............................................
.......................................................................................... 3--
Jndex cjSubject*
36* !
Gtntril
InTKRX.UI.
nation.' Syclnr, cetdin Vo). I! Cenov.,
This (V Australia, Norway, S Vnitai Ki
T.L.O. c\j unions, nu is note" m l suhj.vi of Siliflhin, n-is no: |>nl>i. unabri.!;. .1 has Uvn 1 s*vni to lm. I's-M-ntiat I. inti'h^t in OVt.ioH.-y *.( various it. . ci|.-ricrnf .
Tint voi I. . Con f.-r.-t-.. *. -
lion of K i This is h.i lh. cta-oil.. . h:> roll. Cir-liil | tl.. m.n.lin^ 0
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SECTION VI
PNEUMOCONIOSIS DUE TO SILICATES
Asbestos : Aetiology--Pathology--Radiology--Clinical Findings--Complications Other Silicates : Kaolin--Talc--Mica--Fuller's Earth [Montmorillonite)--Feldspar--Sepiolite
.
| I, | ; ! ! j!
Ij
|
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, | ;
Vorwald. "A. J.. Durkax, T. M. & Pratt, P. C. pulmonary reaction was due to irritation found
Experimental Studies o! Asbestosis. Arch. Itulust. H\g. & OccupationalMrs. Chicago. 1951,
support from the fact that somewhat similar fibrotic reactions were seen in the movable peritoneum, but
Jan., v. 3. No. 1, 1--13, 13 figs. [Kefs, in not in the fixed organs like the liver and spleen.
footnotes.]
The curious asbestos bodies associated with asbestos fibrosis arc considered to be fibres of asbestos
The findings are here summarized of many years of research inaugurated by the late L.U. Gasdner at Saranac. Much light is thrown upon the damage done to the lungs by inhaled particles of asbestos, which occurs in a number of minerals, all silicates
varying *n composition and composed of long. parallel, flexible fibres, capable of repeated lougitudinal subdivision to units of molecular proportions. The commonest form is chrysolite, found in veins up to 6 inches in depth, occurring in deposits of serpentine. Guineapigs, rats, mice,
upon which have been deposited organic material
rendering them innocuous ; when such bodies were
used alone no fibrotic reactions were induced. Dust of
aluminium hyroxidc, held to render silica dust
innocuous, was not found to exert any influence
upon asbestos fibres. Excellent illustrations of
microscopic appearances support the conclusions
drawn, and extensive tables contain experimental
findings.
A further report is promised which will be concerned
with human asbestosis.
. L. Collis
rabbits, and dogs received dust particles of asbestos
either by inhalation, or by injection intratracheally,
intravenously or intraperitoneally. Three forms of dust were used ; (a) ordinary industrial dust, (b) ground dust of which the particles were 3 microns or Jess in size, and (c) long fibres from which the small particles had been separated. Both (a) and (c),
Behrexs, W. t)ber expcrimentelle Asbestosis. [Ex
perimental Asbestosis) Reprinted from Schweiz. Ztschr. f. A!!emeh;c Path. u. Bakt. 1951, v. 14. No. 3. 275-97, 9 figs. [65 refs.]
and especially {c). originated characteristic peri broncbiolar fibrosis which did not increase after the
This report on the results of animal experiments is introduced by a discussion on the theories of the
dust exposure was discontinued ~ if the animals pathogenesis of asbestosis--the solubility theory and ^e infected with attenuated tubercle bacilli, a the mechanical irritation theory. The problem of
ftporary progression of the infection, occurred, .oliowed by subsequent healing, vers- different from
causation is complex since asbestos used in industry is not a pure chemical substance but is a mixture of
the rapid progress of the infection in cases cf silicosis. chrysolite-asbestos and horn blende asbe'tos, com
When the asbestos dust particles were 3 microns or pounds which differ in their chemical and physical
less in size, there was little or no reaction of the living characters.
.
tissues to their presence ; here again is a great
In the experiments here described in some detail,
change from the reactions to silica dust, which are a pure chrysolite asbestos was used and the effects
greater as the dust particles become smaller. This of its introduction, intraperitoneally into mice and
difference supports the idea that the reaction to intratracheally into rats, were studied. The un
asbestos fibres is of mechanical origin, rather than of successful attempts to secure fibres of standard
chemical origin as in the case of silica dust. Dust length are described. The fibres used in these
composed of fcrucitc fibres which resemble asbestos experiments ranged from 5-Op to lS0-0p in length,
in flexibility, but contain only 0-9 per cent, of silica, but the majority were between 20-0 and GO-Orc long.
was also found to originate peribronchiolar fibrosis ;
A full description, illustrated by photomicrographs,
hut dust of glass fibres which arc not flexible and is given of the macroscopic and microscopic appear
cannot indefinitely be divided longitudinally, does ances of the organs of the animals which had bccu
not set up fibrous, nor do fibres of asbestos after killed at various intervals of time after the introduc
tl.rir physical characters have been altered by tion of the asbestos. The general picture is one of
incineration. Injection experiments confirmed the non-specific focal fibre-.is resulting from the intro
ahalation tests ; further, the suggestion that the duction of foreign bodies. No solution or toxic
171
0O
172 PNEUMOCONIOSIS ABSTRACTS
action of the asbestos could .be demonstrated. Knox, J. F. & Beattie, J. Mineral Content of the
Asbestosis bodies were not formed. These bodies
Lungs after Exposure to Asbestos Dust. Arch.
are regarded by the author as products of a non
Indust. IhjQ. d Occupational McJ. Chicago.
specific reaction of certain tissues, to long-fibred
1954, July, v. 10, No. 1, Sect. 1, 23-9.
foreign bodies, and are considered not to have any
significance in the genesis of asbestosis.
A study was made of the content in asbestos of 27
At. E. Dclafitld
lungs from persons who hail been exposed for varying
periods and to varying amounts of asbestos dust during
life. The lungs had been collected over 4 years. The
identification of the mineral constituents of the ash
Champf.ix, J. & BotrrEVTt-LE. J. Etude au microscope ilectronique des corps asbestosiques ct des fibres d'amiante. [A Study with the Electron Microscope of " Asbestos 3odies *' and of Fibres Of Asbestos] Arch. '.Ir.'.ad. ProfessionnelUs. Paris. 1950, v. 11, No. 6, 607-12, 7 figs.
obtained from the incineration of the lungs is pre sented. Opinions as to the pathological condition of the lungs were always compared with the mineral findings. Hilar tissue and tissue from the pleural and subpleural regions were examined separately. The object here was to get some estimate of the rate at which the dust particles were- removed from the func
An attempt has been made, by using the electron tioning tissue to the hilar glands. The survival time
microscope, to throw light on the composition of the --the time interval between the last exposure to dust
** curious bodies " seen in the sputum and the lungs and death--was an important factor.
of those who have inhaled dust of asbestos. Magnifica
Asbestos fibres are removed from tho lung paren
tions beyond 2,000 times are beyond the powers of the chyma mostly by macrophages carrying them to the
ordinary microscope ; but by using cathode rays it is pleural surfaces and the glands; some may be absorbed
possible to obtain magnifications of the order of in the body fluids--indeed, those undergoing such
50,000. Chrysolite is the form of asbestos most used absorption may form the "asbestosis bodies". The
industrially, and some authorities have thought that, amount of material under examination was not large
by reason of its feeble resistance to chemical changes, . enough for statistical evidence ; but certain indications
this form of asbestos undergoes absorption in the were definitely forthcoming. The mineral content
body. Certainly no short fibres, less than 10 p, are tended to decline with increasing survival time, and
encountered. Asbestos fibres are long and needle the severity of the lesion wa3 associated with a
like with a thickness about 0-5 ft and a length from lengthening of the combined exposure and survival
10 to 20 p. A *' curious bedv " seems to be a long fibre times, and not with increasing mineral content. No
of that kind coated with a collar of colloidal gel, severe case of asbestosis occurred in persons with less
probablyof protein. The pulmonary organic environ than 29 years' exposure to dust, but all persons with
. ment in which these bodies lie is eminently suited for such long exposure did develop severe asbestos^.
molecular changes. The appearances of the free ends of Asbestos dust was cleared away relatively slowly, much
the bodies suggest that such active changes are going more slowly than it was inhaled. The products of
on. Hence arises the question whether the broncho- disintegration of asbestos bodies are a relevant patho
pneumonic fibrosis of asbestosis is a mechanical phenomenon, provoked by particles of amosite which
genic factor; it is a slow process and may take several decades. On removal from dusty conditions the fibre*
is the other and more resistant form of asbestos, or tic changes do not progress, but tend to regress.
whether it is a chemical phenomenon, provoked by
The findings suggest that the onset of asbestosis is
the absorption of chrysolite.
E. L. Coitis
not determined by the nbsolute amount of mineral
present in the lung parenchyma, but is related to
changes occurring in the inhaled material after a time
interval from first exposure which may Lo as long as
20 years. -As,a result of these changes a fibrogenic
Uitt.vix, J. R. Cher Asbestose- und rscudoasbestosekorperchen. [Asbestosis Bodies and Pseudo-
agent is released which is capable of exerting its effect
under favourable circumstances.
X. L. Collis
Asbestosis Bodies] Reprinted from Schweiz,
y.ttchr. j. All.jtntine Vcth. u. liakt. 1952, v.
15, No. 5, 623-31. [12 refs.]
Tin* literature on asbestosis bodies is reviewed.
Similar products were found l.y the author in a lung
whali only cont lin.-l car'-if;!! him and graphite; the
b-lies urn- for-ned around p.'at-'- and jnedlo, of
r.tilvruudii'ii. The prot-in nrd iron which form tho.
lud* uf the " I...
inc.-t rutne from the lung
11--ties and riot fr.ii the r.tn.-i.il m.itter if the dust,
bn .il.sr h dn > rmTd
1-e pi.d.i.-d in i ifro hot
It v t. n-
i I .r t-.n f..,j;id in .-nw il <ii-.-i-
l.\ l,
.v.t.;
i,,..
Knox. J. F. A llnmr., J. Distribution of Mineral Particles and Fibers in the Lung after Exposure to Asbestos Oust. Arch. Itnlu/1. 11 ijtj. it- Occupa tional Med. Chicago. 1951, July, v. 10, No. 1, i-.ct. 1, 30-36, 3 charts.
The partirle siri: distributions ill tho iurombiisribl*
anil
!e r-udi.-s from tho lungs of 27 per-nm
wh. .*::*. 1 1---U i-\p. . d to a t,--t> --s du-.f were deterf'lll: -:. J h- If; ll. ,-i V. .r, tlo* s mu* a i that us.sl in
tl.e , - i n... s. m k (.v el.,iso).
Tho nexcess of appeared rival tin and dear, significar; in the r.microns, asbestos a o! tho lui: particles, fibrotic cl. this flbr: blocks ly.
Ltnck, K Indue No. 3,
In cont: to be a tissues an considered large asIsilica is . tissues, w> tize livir..become en to form id reactions clinicians fibrosis, o: 2 is not g and periv from du-*: 3 is marl, honey-con.' may hale remain in finally l<* tory and , invariable chemical I;. physical :
RaMasw > It. 1 and ; Guinv. 35,
is r,
III ori!
with til.
un*!. lrarho.il dusts. : period., >| . . i i'1 f'lillid |.
/ PNEUMOCONIOSIS DUE TO SILICATES
173
of particles with * greatest length in to tui:ro::J wm found to have almost disj front th lung parenchyma when the *ur..,_the period between last exposure to dust h_was r.'.oro than 8 yean. Meanwhile no si change skewed ia the number of particles
of 5 micron* and less and of 5 to 15 -'!:* suggestion ecietges that long fibres ol J10 att:.: .'i and converted in tbs parenchyma
info asbestos bodies and then into small . ' 'i nn breakdown is associated with severe hinges in the lungs.The product that -exerts
...v:;ic e2cct is unknown. Anything which lymphatic drainage will assist its action. ' E. L. Collii
K. -M. Pathology of Asbestosis. Arch, fast. Health. Chicago. 1555, Mar., t. 11, .. 3,185-8, 4 figs.
ontrast to silicosis which is generally accepted a chemical reaction between the pulmonary and fine particulate silica dust, asbestosis is i ' to be a physical reaction between relatively -sbestos fragments and the lung tissue. Free is held to be chemically poisonous to living , whereas crystal fragments of asbestos traumaving tissues. Asbestos fragments in the lung enveloped by giant cells and colloidal matter -a characteristic asbestos bodies. The lesulting ms -re divided into 4 grades; in the first 3 Vet an increase of lung fluid,-but no >, < * ground-glass " X-ray shadows. Grade M grossly abnormal, but alveolar walls thicken erivascular fibrosis appears. So far freedom du*t exposure permits entire recovery. Grade larked by dyspnoea, the lung being of coarsely orub fibrous texture. Cessation of exposure halt further progress, but the condition will r in sfufu quo unfr. In grade 4 the patient v becomes absolutely disabled as regards respirajnd circulatory functions. Pieural fibrosis is not iable. [No similar reaction caused by any other '-ally inert dust is quoted .in support of this al reaction to asbestos dusts.] E. L. Collii
'IWAXY, A. S., Vr.VKATESK, D. S. & IUlIA P.AO, * The Nature of Lesions caused by Asbestos
Mica in Experimental Pr.eumokoniosis in -uinea-Pigs. J. Indian Iuit. 5ri. 1953, OcL, : 25, No. 4, 319-31 (Sect. A.), 2 text figs. &, - figs, on 4 pis. [33 refs.]
'd`r to elucidate some of the puzr.Ies connectid * 1':>-Iik;.oh of silicosis a series of experiments .-n by subjecting guir.cupigs to ir.ra *1 in;ec:iors of su-pcn*ion of mica and a-.li'-'.ns ' is laid on the development, after long 1 .. t` ^ v:'`r,s in ether orgar.s be-ides the lungs, 1 .' m the adrenal glands. Mica dut w.is 1 tv I. ,i 1 io some degr-o of m-lul.nr formation in
the lungs, but the asbestos dust set tip diffuse fibrosis
only. The-o differences arc pint rated in a series of
photomicrographs. Mica indue--1 hypertrophy of the
adrenal cortex with extensive foamy degeneration of
the cortical cells; asbestos induced loser changes, but
small areas of necrosis were occasionally found in the
zona fascicuiata and zona reticulata.
A di-cussion o! soaia interest follows, in which the
atomic structure of anhe-tos and mica is illustrated,
and accumulated evidence is.claimed to show that the
pathological lesions in the lungs and other organs due
to dust are in some way intimately related to the
crystalline lattice of the mineral. Exactly how this
crystalline structure reacts with living protoplasm--
as indeed it must--to form the scar tissue which
becomes fibrous and pathological is not clearly sot
forth; nor is any suggestion mado why the whorlcd
fibrosis of silicosis is so bound up. with tuberculous
infection, whereas the more* diffuse fibrosis of asbes
tosis is less associated with the infection, and the
minor nodular fibrosis of mica has no such tendency.
That miners exposed to mica and asbestos dusts
experience anorexia, weakness, loss of weight and
extreme prostration may be ascribed to the damage to
the adrenal glands. Still we are left wondering how
a dynamic interplay of hormone secretion is deter
mined by the physio-chemical properties of the
minerals.
E. L. Collii
Kuausleu, J. A- Sr.vss, It. Zur Friihdiagnose- der
Asbestosen mittels Yergrosserungsaufnahmen.
[Early Diagnosis of Asbestosis by Enlarged
Radiographs] Ztuchr. /. U nfallmtd. u. Jieru/i-
trankh. 1954. Mar. 15, v. 47, No. 1, 59-64, 2 figs,
on 2 pis. [15 refs. ]
After a brief description of asbestosis and the changes in the lung tissue found in the early stages of the disease the authors describe a radiographic technique wiih a fine focus, in which Miillcr-l'hilips apparatus 1) A 400 is used, and an exposure time of 0 2 second. Of 17 asbestos workers, with employments varying in duration from 1 to 18 years, 8 showed changes in the lung tissues by radiography with the enlargement technique; 2 of these showed no change by normal technique, and in the 6 other cases tho degree of change shown was minimal. Photographic reproductions of the radiographs of the least affected worker, with 7 years' exposure, show the more marked findings with the enlargement technique.
' E. L. Middleton
Buiime, A. ErgcbnisSe voa Nacbuntcrsuchunqcn bci
Arbcitcm finer ^.y.bc-tfabrik.
fUosuiti Of
Periodical Examinations of Workers In an Asbestos factory' l>'dir.ije z. Silihoss l-'onchung. 1951, No. 11. 27-34.
Radiological supervision in an asbestos factory started in Phi.i. Igilmur turnover was rapid, women chiefly being employed add only a small nucleus of
174 PXEUMOCOXIOSIS ABSTRACTS
workers of cither sex had more than 10 years' exposure. The average labour force was 2<H) but during the ivar it was more. X-ray changes were fir.-t ..fen in rare cases after 2} to 3 years of work, as fine reticulation in the middle and lower parts of the lung, usually associated with a drv cough.
That the dust hazard has been reduced can be seen by-comparing rcsultsof surveys in 1933, 194l)and 19-19. The incidence of asbestosis is given in percentages in the following table, the figures in brackets refer to the number of people examined.
little or no disability. 'Idle only persons to rerommet: 1 to less du-ty work are persons under the age nl 40 ui?h a clear-cut diagnosis, am] cases where progression is seen on serial films, regardless of ace. More attention should be directed to differential diagnoses, in preference to accepting asbestosis in every case of an obscure X-ray film and an even more obscure occupational history-. K. L. Colli*
Years at work
2-5.............................. 5-*l0 ... # Over 10 ... ...
1935
13 (33) 5S (25) 77 (9)
1940
8(51) 50 (10) 3 (10)
1949
3(33) 35 (11) 53 (31)
Seco, F. Asbestosis pulraonar. Contribution al cstudio de -esta neumoconiosis. [Pulmonary Asbestosis] 94 pp., 3 pis. [Bibliography.] 1950. Madrid : Mimsterio de Trabajo.
Stage 3 asbestosis is very rare, three cases only being seen between 1940 and 1949.
A comparison of different working places shows that the risk is low in spinning and weaving but high in preparation, carding and brake polishing. A table shows results for 14 cases from 1933 to 1949. Some progressed, others did not. Enquiries among former workers reveal little if any tendency to progression after the dust exposure has "ceased. This is in contrast to silicosis. On the other hand a personal factor exists, as in silicosis, as a number of workers do not get asbestosis in spite of high dust exposures.
Progressive tuberculosis is rare, only- two cases being found, both started in the parts of the lung least affected by asbestosis. One combination of asbestosis and carcinoma of the lung was found.
The main result of this study- is the demonstration that the hazard can be reduced by- dust control.
' C. ifagelschmidt
S.iXKtr., O. A. Asbestosis as differentiated from other Pneumoconioses. Arch, hi'lnsl. Health. Chicago. 1955, Mar., v. 11, Xo. 3, 203-11.
There is agreement that X-ray findings in cases of asbestosis differ from those seen in cases of silicosis, lint these very differences are those all too often seen in badly taken X-ray films of more or less normal chests. Such films are especially common in over weight persons. Emphysema with one or more adhesions, of the diaphragm due to past pleurisy inay simulate an asbestosis film and the " groundglass-appearance " is easily read into such a film. The effect of plenty of coal-dust may Le hard to distinguish.
A history of exposure to asbestos dust must be found, but should not Le invented merely Ir.-can-e the patient may have done a litth- lagging with asbestos on a hot-waler pipe. Asbestosis develops only after long periods of exposure to dust in considerable amounts. But we have no certain accepted maximum allowable concentration to guide us. l.ittle attention should Le paid to fust-stage borderline cases null
Clekexs, J. Rccherches sur l'asbestose putmonaire
en Belgique. [Research Into Pulmonary
Asbestosis in Belgium] Arch. Beiges Med.
SociaU. Hyg., Med. dtt Travail el Med. Legale.
1950. Xov., v. S, Xo. 9, 557-65, 13 figs. (7 on
2 pis.)
*
Asbestos is used in many industries.- but in the present enquiry only the fibro-ccment industry comes under consideration. In this work asbestos is crushed and mixed with cement. During the processes harmful dust is generated, but closed-in apparatus is used which prevents most of the dust from escaping into the air. Dust samples showed that, even in
the places where there was most dust, only from .740 to 1.490 particles per cc. of air were found ; of-these, 50 per cent, were less than 5 microns in size. Such dustiness is not excessive. The workers exposed to the dust have been examined periodically over a period of three years. Out of 75 of these men who had been employed for varying periods (7
for over 30 years). 70 gave no signs of any dust troubles, 4 were doubtful, and only one presented X-ray shadows indicative of pneumoconiosis. This man died of progressive circulatory insufficiency, and details are given of the post-mortem findings. Throughout both lungs indurated nodules were found particularly at the pleurae, which were thickened,
as were the rest of the pulmonary tissues. Xo tubercle bacilii could be found anywhere, but through- out the lungs there were " curious bodies " which are so distinctive of asbestos particles lying in living tissues. These bodies were seen in fibrous zones, in the alveoli, and even included within giant phago cytes. This man, aged 49, had been totally incapacitated with pronounced dyspnoea on exertion and carJ:ac failure. I'article- of a-bc-'to; were found in 19 but of 12 samples of sputum anti " curious
bodies " in 3 samples ; such findings, however," were not associated with X-ray shadows indicative of pulnumarv-fibrosis. The evidence, is against much dang* r nr:-ing from the manufacture of libro-cement.
` K. L. Collis
r\
PNEUMOCONIOSIS I)UK TO SILICATES
175
i *s, I*.. Champeix, J. A Facke, P. Un cas tl'Asbrstosc pulmnnaire. (Evolution radio
. |,.-4i<|i:c. Etude anaiomo-pathologique.) [A Case of Pulmonary Asbestosis with its Develop ment followed by X-Ray, and its Post-Mortem Study] Arch. Malad. Profe'sionncl'.cs. Paris. 1951. v. 12. No. 6. 629-33, 8 figs.
' e -a<p reported is said to have been the first ;r of asbestosis known to have occurred in France. ..c man. aged 62. came under observation in 1943 vrr having been exposed to asbestos dust for 11 .trs in a factory' where asbestos cloth was woven, i- number of particles in the working environment ..rird from 2.250.000 to 4,009,000 per litre of air. ml the sire was from 1 to 2 microns in diameter. .! \ seen he complained of dyspnoea on exertion, :-.J showed some cyanosis of his lips. From then :wards during 7 years until he died, he was watched *1 the progress of the X-ray shadows of the lungs as noted. At first the network of both lungs, :trticularly in the lower two-thirds, was accentuated, t the end the shadows indicated pronounced arosis of the ground-glass variety in the lower parts
ith lungs, contrasting with clear apices. No slulation was present. After death the structure
the lungs showed general thickening throughout, w.-cially of the pleurae, but with no localized diilcs. Many asbestos bodies were seen, isolated d in groups, together with giant cells and mineral .rticles. These changes are well illustrated. No -deny^of tuberculosis was found. "The dust
^*>uld be traced not only in the vessels of
r 1 y but also in the vessels of the liver, kidneys id spleen. In contrast to silica dust, asbestos rticles seem to exert more of a mechanical than a .cfnira] influence upon the pulmonary tissues.
E. 'L. Collis
:i Extr.R. H.. Dexolin, If., Decoster. A.,
Cammaerts, P. A Dexohn-Revbens, U. Etude
rlinique ct physiopatholngique d'un cas
d"asl).`stose pulraonaire. [A Clinical and Patho
logical Study of a Case of Pulmonary Asbestosis!
Ire/;. Beiges Med. Sveiale. Hvg.. Med. du
Tt avail et Med. Legate. 1952, Feb., v. 10, No. 2.
61-70, 2 fig'*. [17 refs.]
`
diagnosis of asbestosis must depend upon a l>iy of occupational exposure to the du*t of
*ttw, associated with symptoms of interference :!t the functioning of the respiratory organs. A !* r ported of a woman who came under notice in - 1951. She had worked for 25 ycaTs in a '> weaving asbestos with great exposure to
au.l hail lieen suffering from dyspnoea for six which *ouip.-Ued her to take to her l*'d ;
w.i, l ,,r ripjn-titc., bad cough, abundant grey : u.t ,iuj inaikeil dycpn'K-a oa ctfort. X-ray '1 a picture of generalized tine micro-nodules I'dh lull.;*, mure pronounced at the bases,
t . I-*!.* were founJ in tie' sputum. The s h isn.g l,*en made, a close phy -ical exatiiina-
tion was undertaken to discover any other points. The authors compared this case with those of uncomplicated sih.'osi* ; in the latter residual air is frequently increased : expiration is prolonged ; the maximal rc-piratorv capacity is reduced ; but hypernoea is less, rapid breathing is not so intense, and anoxaemia is never so important during effort. Tbc.-c differences are stressed as important when necessity may ar;m determining the occupational origin of some case with an obscure diagnosis.
E. L. Collis
Behrens, \V,, Jr. Uber Klinik und Pathologie dcr Asbestosis. [The Clinical Picture and Pathology of Asbestosis; Ztsckr. f. Ur./allttted. u. Berufskrankk. 1952. June 15, V. 45. No. 2, 129-40; Sept. 15, v. 45, No. 3. 179-S9. [150 refs.]
This is a genera! account of asbestosis introduced
by mention of the uses of asbestos centuries ago for
woven garments for the dead during cremation and
as wicks for the lamps of the vestal virgins. The
chief chemical ar.d physical characters of different
kinds of asbestos belonging to the 2 main groups
of this mineral--arr.pliibolite and chrysolite asbestos
--are recorded. The world distribution of asbestos
and its mining, treatment and use are shortly
described as well as the industries in which dust
inhalation hazards may be met with. Reference is
made to the published work of a considerable number
of authors who have studied asbestosis since the
first records of the disease in about 1906, and give
their observations oa the effect of length of exposure
to asbestos dust in different concentrations*
The symptomatology and diagnosis, and the X-ray
findings in the diferent stages of the disease are
given.
.
Special mention is made of the association of
asbestosis with carcinoma, which is contrary to
experience in casts of silicosis. Post-mortem reports
from the literature indicate that in 309 cases of
asbestosis there were 44 lung carcinomas (14-2 per
cent.) w hereas in 2.201 cases of silicosis only 32 car
cinomas were found (1-4 per cent.).
The experience oithe association of tuberculosis and
asbestosis varies greatly in different countries.
English workers have recorded a high rate of tuber
culous infection in workers in asbrstos, and the Home
Olticc reports for 1933 to 1939 include 90 deaths from
asbestosis. among which there was tuberculosis in 32.
This is. however, x > be compared with the silicosis
deaths (1932 to 1939;--there were 797 tuberculous
infections in a total of 1,397 fatal eases of silicosis. In
America, tuberculosis- is a rare complication of
asbestosis. Sonic r. cures from the German experience
record that among ?") definite and 2d[> doubtful cases
of asbestosis there were found only 11 instances of
active and 51 of inactive tuberculosis, whereas among
cases of silicosis thr incidence of tuberculosis was 35
per cent in the s', cht and 63 per cent, in the severe degrees of Mhco*i>
The rest of the j irer consists of a description of the
" --U . . i
.--I
'.ii
` ;'
'i
` (! ' i' i ii
i
oa
176 PNEUMOCONIOSIS ABSTRACTS
macroscopic and microscopic appearances of the lung* in asbestosis as well as a discussion, with an excellent reference list, of the nature and significance of the " asbestosis bodies " about which there have been so many differences of opinion.
M. E. Delafield
Cabtiek, P. Some Clinical Observations of Asbest03is in Mine and Mill Workers. Arch, lndu.it. Health. Chicago. 1955, Mar., v. U, No. 3, 204-7.
The author writes after 9 rears of medical super
vision of some 4,000 asbestos mining workers. Annual
medical and X-ray examinations are brought under
review; 53 cases came to autopsy; 123 cases of asbes-
tosis were detected, and 8 of the patients are still
alive. Consideration of the age distribution of the
cases of nsfcestosis and of the causes of death of those
who died suggests that asbestosis is not necessarily an
Incapacitating disease. Its victims often live to an
advanced old age; in one pronounced case the patient
was over 83. Six deaths due. to bronchogenic carci
noma are of special interest and may suggest a
possible relationship between asbestosis and pulmon
ary carcinoma though this remains questionable.
To summarize the evidence: asbestosis is considered
a serious disease in some instances, but more
frequently it remains a disease which can be tolerated
quite well for many years, even without appreciable
symptoms, so long as some other serious disease does
not complicate the position. Its presence, however,
must always introduce medico-legal questions difficult
to solve. Compensation boards may tend to give
undue weight to the presence of any degree of asbes
tosis.
2,'. L. Cullis
hygiene of housing, healthy vacations, food and
clothing, organization of hygiene in the factory. The
enquiry touched also on the problem of the fluctuation
of workers in the various mines. That fluctuation
may account for the large number of mixed pneumo
conioses in that region.
" Only 80 workers (22-2%) were examined out of
the total of 360. Radiographies on normal film were
made of 76 workers (21-1%).
" The clinical and radiological part contains data
obtained from examinations, radiographs and
laboratory work. The objective findings include a high
incidence of conjunctivitis (71-2%), goitre (31-7%),
bronchitis (50%), diminishing of vital capacity (in
4-9% of cases), diminishing of the respiratory
stretching of the thorax (in 84-9 per cent of- cases)
and changes in the orthodiagrara of the heart.
.
" The author describes the radiographs, the classi
fication of pneumoconiosis in the workers as well as its
diagnosis. lie discusses difficulties and'errors relating
to the interpretation of radiographs as well as the
differences of opinions referring thereto.
" Out of the total of. 76 radiographs 6 (7-8%)
were found without changes, 17 (22-5%) were suspect,
22 (23-9%) had asbestosis, 29 (23-2%) anthraco-silico-
asbestosis, and 2 (2-6%) anthraco-silicosis. Tubercu-
lous lesions were diagnosed in 96-3% of cases of which
3-7% cases had active closed tuberculosis.
" The changes in the skin of the soles and palms
could not be identified with certainty as asbesto warts.
Hematuria was found in 58-5% cases. Its cause
could not be identified but its incidence is in direct
ratio to exposure during work.
.
" The sputum of 39 out of 52 examined persons
contained asbesto needles and single, atypical asbesto
corpuscles with a positive Peris reaction were found in
5 cases."
-
.
. . '
? i '. ,' i
StojadixoviiJ, M. Prvo azbestoze i proste pneumokonioze od uglja u nasoj zemlji. [First Cases of Asbestosis and Simple Pneumoconiosis caused by Coal Dust in Yugoslavia] Arhlr Huj. ItaJa. Zagreb. 1954, v. 5, No. 1, 57-76, 3 figs, on 3 pis. [33 refs.]
The English summary appended to tho paper is as
follows:--
.
" The author's task was to find out whether in the
asliostos mines and factory (the latter working only
since 1947) at Korlace in the Ihar basin there were
cases of pneumoconiosis so that the necessary techni
cal protection rould be introduced. Gconiorphulogic.il,
minerah.gieal, p-tr.'gr.iphical and chemical data
pointed to the iik.dilu.od of that group of workers
v.ih-ring from ' uritlirjco.silicosis in addition to *.'-s!osis.
" The author de-cribes the prodiirtiun proe--s and the method of work, he a! o di-ciis-, * inf.i motion on
aoh -i .il at. 1 oth. r factors on the venous categories
<f VMiik-'is. Moucvi-r, th* bulk 1,1 the wink-Ts arc
v i'i. r q- i ...r.t l.;t:.. i , oi pt
1 >n.d i.iii . : - A so to-
< , I--,-, try ,.rg :m/. 1 ,,i:i,i|i ; th w lots I ion `it
!"x
Faucis, G. Verruche da amianto ed altro roanifestazioni eutanee nei lavoratori dei '* coibcnti". [Asbestos V/arts and other Dermatoses in Workers with Lagging Materials] Hass. Med. Indust. Turin. 1053, Jan.-Feb., v, 22, No. 1, 1-17, 12 figs. [17 refs.]
The author has followed up 29 such workers and
found from 1 to 4 warts in every case, mostly on the
palms; 3 shown! warts on the dorsal aspect of the hands. The range of lagging materials in use includes
'los cord, which is wound round pipes, etc.,
various asbestos-containing slabs, which are incorpora
ted in or otlu-rwi-o applied to partitions or other flat surfaces, and mixture* of a.-bestcu and cement which
aro in the form of pu*te to be moulded to thu ships
of the tank or other object which is to be insulated.
1 ho v.arts are due to asbestos fibres which penetr-vt* into the t-pld'-rini* or |;-t Jo-1,;* d, deeper i-'itl, i.'i ti.s
eoii'i.-i or tr:i- kin it ml |-r - f rente. Ms in tie ^ ti-iii- s |< sji'Vtively. '1 he epi l'-in.is shows nr .i.t;e'->i
[ till--.' nil' r of If.* I r I * t.|e r. It l.iv-rj Il I 11 . j rr **
l"u-. [tie i* -----1 I'.OIV t;
I i ,
a grnrn.l of giant 1
licit vv of a su'.m. skin, This roml.
(hvgrns. ..j the as!-sti.
Clear p: appearanediscussed.
Stoll. R . assocl.i Intern [14 tel
All prec fisbcstOMs together. ' data ujkhi hard to c>>!'of asbesto .. carcinoma, * cent, of pid lion. Ame 40 cases of. cent, in 11reported "I pipes with . Jlc came n cough. .N.marrow wa cells wem discrete m HlCta.st.ises in diametio lungs, with i in I Kith kido areas of m . club :-li.ij" : outside ll>. lislusl tin- lllllg with numerous > asbestosis in a-.brst... fst.lblls'ie . nie.isin* .
asb *!>
\V| dm v.
;a /t*
i
p. M' |;l
I>
I
\
i
I
1
o
o
rXEUMOCOXIOSIS DUE TO SILICATES
177
Jo-, itr-ss type of reaction with the appearance
cell5 son;; cases.
j.u;h'workers may also show exudative dermatitis
' a s Vacsite S'"a, with a dry, thickened and cracked
n aVv-'ictei with vesicles ar.J, later, pustules,
i ` c.--..'.fioT-. is attributed to the combined action io';-;"jt<:c and alkaline) cf cement and (irritant) of
i`- rslestei fibres themselves.
1 Clear photo-rants illustrate both the naced-eye
1 M-earar.-c and the histology of the lesions which are
; Al-v^'d.
J- Cauchi
Srot-L, R,, Bass. R. & Angrist. A. A. Asbestosis associated with Bronchogenic Carcinoma. Arch. Ir.trrr.. Med. 1951, Dec., v. SS. No. 6. S31--1.
{14 refs.)
All previous references to any association of
siibcstosis with pulmonary carcinoma are ,brought
together. While they are in the bulk suggestive, data upon which statistical proof can be based are hard to collect. But in one enquiry out of 235 cases
of asbestosis there were 31 instances of pulmonary
carcinoma, or 13-2 per cent, to compare with 1-0 per pulmonary carcinoma in the general popula
te Another worker found 7-5 per cent, among
u cases of asbestosis ; and yet a third found 14-S per ernt. in 115 cases of asbestosis. A new case is now
reported of a man who had worked for 6 years covering
pipes with asbestos, refusing to wear any respirator. He came under notice with weakness and persistent
cough. Nothing definite was found untirtlie bone
narrow was examined, when clumps of malignant cells were seen. X-ray showed generalized large
i!i-rrcte' oval shadows, indicative of pulmonary i:itta%lases. After death, nodules varying to 4 cm. in diameter were found scattered throughout both
1"*K*. with interstitial fibrosis. Metasiases were found a both kidneys, in the brain and in the liver. Large
anas of necrosis existed throughout the lung. Typical
<! :b-ha;>od brown asbestos bodies were seen in and `uN-Jo tt; tumour areas. The examination cstabh-hed the existence of anaplastic carcinoma Of the
,jnK with possibility of inulticdatric origin and
numerous metastases, associated with pulmonary a'l-esto-is. The opinion is suggested that the silicate
n must itself be directly carcinogenic. It r'fvbhdics an additional reason for preventive
r M'ures. with careful dust control, in the use of
'*'
it. L. Ccilii
M. Lur.gen- \sbestose und Kariinom. 'A'tutcsls and Catcmtma cf the Lur.g1 Z.j. {. Ar 'J. u. AKat..shuts. It52. .\uv,, v. 2, No. t\ 17 y- SJ. 3 figs.
* p >rt of a case.
Je r-iana M.. VaViivs, J. S.
Sti.wav.t,
' d. t'.rupational Cancer cf the Uri-ary
1" 1 d*r in D/r,lut!i Or*r'1'-|vt and cf th ; Luo'.
A * \t i 7- c!ir- *w ,'V'M nrd UoA-Ofe Mi/mv
* f *
1 ..,jt l\;j., h. L..*,
1!,
After a short discussion of occupational cancer in general, the authors give a table classifying industrial cancers by their cau.-es indicating in which cases experimental proof lias been obtained, and then pro ceed to discuss recent work on the groups in which
they are specially interested.
*
Occupational Cancer of the Lung
In Asbestos Textile Workers: In 1925 one of the authors (M. J. S.) in a series of 72 (40 male and 26 female) autopsies on workers in two asbestos fac tories demonstrated an association between pulmonary asbestosis and cancer of the lur.g, which was found in 26T per cent, of males and 8-7 per cent, of females. The higher incidence in males may be accounted for by the fact that 7 of the women had died before fhe cancer age. There was no significant difference in average ago at death, average period of exposure or average age of starting work between males with un complicated asbestosis and those with the complication of cancer of the long, in contrast to the dyestuffs Industry, in which death was accelerated by the supervention of cancer of the bladder. The degree of fibrosis was less in the lungs with cancer than in those without and the morbid anatomy and histology of 13 lung cancers, of which full notes were available, was unusually varied; 4 were large tumours near the hilun, 7 were situated in the periphery, 2 were pleural; there was one rhabdomyosarcoma, the rest were adenocarcinoma or oat-cell carcinoma. There were also 4 peritoneal anaplastic carcinomas, the pri maries of which were not found.
Regulations for the control of asbestos dust were introduced in 1331 and will doubtless lead to the disappearance of severe degrees of pulmonary fibrosis and possibly of the associated cancer.
In Iron-Ore Miners: One of the authors (J. S. F.)
has personally conducted autopsies on 192 Cumber land haematite miners during the last 20 years and in addition has performed autopsies on 2,373 Cumber land males, over the age of 20 years, ure-elected in regard to cancer or lung disease, lie found cancer of the lung in 8-35 per cent, of the iron-oro miners and in TE5 per cent.' of the others; tho difference of 7 v21 is statistically significant. Tho age of onset is not significantly delayed, most of the miners having.* entered the mir.es under the age of 30; -all their lungs contained "much silica and iron at death, but th-ro w.V3 no significant difference in tho content of eith-r mineral in the lungs with and without cancer; as in the case of ai'esiosis the degree of fibrosis was J. ss in tho lungs with cancer.
1!.<* common facbir in tluse two type* of occupa tional lung car.cer is silica and it is suggested that
this may bo
carcinogenic ag-utt, by causing pul
monary* fibr
which pro-. !* tho initiation of tho
ns'i.Ti.ir.t |>r.*>>. *lk f! ran u .u illy .is of 1 `-ws
degf-e, l.ovti'.i r, m t !:'; Ii.i: in which c.tncor super*
sen--;; on pu' ' .h-l evidence >1. ' c.i:e for all aeti..l".i-
c.il re! it l 1 :N*nodi.l.ar sili'-e.is aril lung
, r i 1 ' V. : tl. .*. in ih --.i :
I
Willi -;i. r.-.(i d ;m .ihc-v.i
If. /.. ti ll: 'it
'I .
ii
oQ
PNEUMOCONIOSIS ABSTRACTS
|>oLr.. U. Mortality Irom Lung Cancer in Asbestos Workers. J!r>t. J Indmt. .1 rcd. 1955, Apr., v. 12, No. 2, 81-6 [14 refs.]
jiixtv-one eases of lung cancer have been recorded in iicrsotis will. nsU-sto-is since tbc first case was '.iK.rt.'d by l.xsut nnil Smith (Jmer. J. Cancer,
l'Jio. ' 24, 55). In the Annual Report of the Chief ln;*vfor of Factories for 1947 [this Bulletin, 1949, * . 24. 5C6] Mt-KEwtTiiEJt reported that cancer of the Inn' was found at autopsy in 15-2 per cent, of cases ,.f aJetods [see also liossEtt ef al., ibid., 1055, v. 30, 613], Animal experiments are inconclusive.
Since 1035 records have been collected of all the coroners" necropsies on persons known to have been cmplovcd at a large asbestos works; 105'in all are summarized; there were 18 cases of cancer of the lung, 17 in males and one in a female, 15 persons with asbestosis present and 3 in jieraons without 4vstosis. All the subjects in whom the two diseases were found, together had been employed for at least 9 years before the national regulations for the control of asbestos dust were introduced in 1931. The mortality among a section of the male employees of the works referred to, who had worked for at least 20 years in "scheduled (i.c., dusty) areas" was com pared with the mortality recorded for all males in England and Wales; the incidence of cancer of the lung among men employed for different periods under the pre-1933 conditions were compared. The num bers of men alive in each 5-year age-group were counted separately for each of the years from 1922 to 1933; the causes of death as given on the death certificate or as finally determined by necropsy were Classified as lung cancer, with or without mention of asbestosis; other respiratory and cardiovascular diseases, with or without mention of asbestosis; neoplasms other than lung cancer; and all other diseases. The numbers in each category were then compared with those which might have been expected to occur, by multiplying the cumber of men alive in each 5-year age-group by the corresponding mortality rates for men in England and Wales over the Mine period. Because of the small numbers in each year tho populations were added together to form groups--1922-33, 1934-53 and so on--the mortality rates u-e*d were those for the middle Tear.
The number of men studied was. 113, and 11 deaths from lung earner, all with mention of asbestosis, occurred against 0 3 expected ; from other respiratory di-ca-rs. with mention of asbestosis, 14 against 0
jxs-t.-d; without mention of asbestosis, 6 against 7-6; neoplasm other than lung cancer, 4 against 2-3 expected; all other diseases 4 against 4-7. In all there were 30 deaths against 15-4 expected; tho cm css wc theiefore entirely due to excess deaths from lung cuii vr and from other respiratory and cardiovascular iliv.t.,s. All the cases of lung cancer were confirmed by n.-. rop.y anil histological examination and all were
as . ci.iied with the piesenee of asbestosis. The risk for ineii employed for tinder 10 years, 10 to 14 years, and for 15 y.-ns ami over were compared and it was `'i' bided tli.it the risk of long cancer over the
V. II, -tgi;. f p. 213.
whole period among asbestos workers w-as of tlie order
of 10 times that experienced by other men, but the
risk was probably creator before 1933 and has lioeoine
progressively less during recent years, as the dura
tion of employment under the old dusty conditions
has decreased.
L. Harnett
Uomiuk.i, G. Ashesto.si c careinuma polinoiiare in una filatriev di amiaitto. (Spunti sul problema oticogetio dcH'asbcstu). _ [Asbestosis and Pul monary Carcinoma in an Asbestos Spinner. (Notes on the Induction of Lung Cancer by Asbestos Fibres)] .Vcd. d. JL<n-ro. 1955, Apr., v. 46, No. 4, 242-50, 1 fig. [40 refs.]
The English summary appende.d to the paper is as follows: --
" The Erst case of pulmonary carcinoma occurring in. Italy in a subject affected by slight asbestosis is described. The malignant neoplasia was observed in a woman 49 years of age who for 29 years had worked as a spinner in an asbestos factory. The diagnosis formulated in life was confirmed by postmortem, the gross and microscopic findings of which are briefly reported- The present clinical, pathological and statistical knowledge on the capacity of asbestos to cause tumors are summarised. A tumor should be taken as occupational in nature only when the statis tical data are correspondent to the experimental researches. Whilst there me many statistical data (though not.concordant for all countries) experimental researches are few and not concordant. According to the author a hypothesis should be made whereby the capacity of the different types of asbestos to cause tumors differs according to their chemical composi tion."
Lrarcit, K. II.- <L I*n.\n-TiioM.\s, II. R. Carcinoma of the Lung in Asbestosis: Report of Two Addi tional Cases. Soulhr rn Mat. J. 1955, June,v. 48, No. 6, 555-8, 7 figs.
The evidence that there exists a correlation between the occurrence of asbestosis and carcinoma of the lung is collected. No such correlation has boon found with other forms of pneumoconiosis like silicosis and aiiflirncoi, or pulmonary luberculosis. The patho logy of asbestosis is unusual ; silicosis and other pneumoconioses present reactions, usually chemical, l-'twis-n minute dust, partich-s and the living tissues; but nstft'stnsis svms to he flue to traumatism between rpiile large particles of asbestos, too large to penetrateinto the alveoli, and the pulmonary tissues. Further, no efforts to induce Inn*; cancers in animals exposed In a-lsstos dost have been successful. Neverlheir >s, tie* statistical evidence is strong. Now two mnr- c.i'es oI lung rainvr occuriin:; in association with asbcstosi-. are reported. One /nan had worked in an as|,,sti>s faiteiv for 25 \eais and the ether for 56 xcais. In I *.*h i.-s.-s \ ia\ showed the diffuse eran'ilar iiiti!u.iii,,ii iiii-r hot]i lungs chat .ict.'i istic of
I I \ I\
\
\
sliostosis fibrosis ilisuccumbed anecs of tb seen 4 can per cent., bios taken ..
Jacob, 0. Besom I [Ineide Asbes-t Gene ft [Nunic:
This is ' . among nslx references t of the lut. recognized . Germany, elusively on among asb.nnd 17 per into cases .v it appears that only exposure to
In co-opc institutes t! reported si: in all.stage; females ntri stage II, 32 Silicosis w.imales acth. scries the it. cent. Four workers, w! . described. '. had been c: . asbestos we with ashes to oma of the : were found : life, the r.i been regard a man of . was diagnuleft lower 1 showed ashtransition.:! lobr, with lesion in tb of 57 who ! 1930, for 3 . she died in solid, Spin . bronchus, v and \\id">;> of C6 uh path'll*, d.
PNEUMOCONIOSIS DUE TO SILICATES
179
asbestosis and the lungs after death exhibited the he had b-en employed in asbestos as an opener from
fibresis distinctive of asbestosis; but both patients 1927 to 1930 and as spinner from 1931 to 1948;
succumbed to bronchogenic carcinoma. Tho apjiear- autopsy, in 1955, showed a right-side bronchial carci
nnces of the lesions are illustrated. The authors have noma with widespread motastases in the lymph
M*en 4 cancer cases in 49 autopsies of aheto*is, 8 2 glamiliver and skeleton.
js-r rent., compared with 07 to 2-4 per rent in autop-
si.-s taken at random.
L. Collis
A 1 mg discussion of the literature on cancer among asbestos workers includes an examination of the
characteristics of the disease: the duration of expo
sure to asbestos dust, and the latent period between
Jacob, G. & IJohlic, If. t'ber Haufigkcit und itcsonderheiten lies Lungenkrebses bei Asbestose. [Incidence and Characteristics of Lung Cancer in Asbestos Workers] Arth. /. Geicerbcpath. u. Gcieerbehyg. 1955, v. 14, No. 1, 10-23, 4 figs. [Numerous refs.]
exposure and diagnosis of cancer; tlie localization of the tumour, characteristically in the lower lobes; the histological nature of the tumours, the cell types and structure; and the statistical evidence. These charac teristics are no longer convincing evidence of a high incidence of cancer in asbestosis. In future, cases of cancer of the lnng in asbestosis should not be pub
This is a study of the incidence of lung cancer among asbestos workers in Dresden, with numerous references to and analyses of the literature. Cancer
lished individually but should always be considered
in the framework of the whole asbestos industry in the
region.
< , E. L. Middleton
of the lung developing in asbestos workers is not
recognized as an occupational disease in West or East Germany. The international literature is based ex clusively on the results of autopsies; the incidence among asbestos workers appears to vary between 12 and 17 per cent. In Dresden, however, from research into cases at the clinic and among the asbestos workers, it appears to be a rare occurrence. It is estimated that only about | of these workers have an eBective
LEicnra, F. Primarer Deckzellenturaor des Bauchfells fcei Asbestose. [Primary Cortical-Cell Tumour of the Peritoneum in a Case of Asbestosis] Arch. /. Gewtrbepath. -u. Geicerbehyg. 1954, v. 13, No. 4, 382-92, 10 figs. [Numerous refs.] '
The case reported here was that of a man aged 53
exposure to the dust.
who had been employed for 26 years, in the period
In co-operation with the radiological and radium 1919-51, spinning coarse yarn and asbestos; during
institutes the authors reviewed the-cases of asbestosis 16 years of that t'me he had been exposed to high
reported since the middle 1930s; they numbered 339 concentrations of asbestos dust. In 1937 slight
in all stages ; in the first stage, O-I, there were 42 asbesfcsLs was diagnosed; in 1947 he had pleurisy females and 61 males; stage I, 43 f. and 74 in.; with effusion, and in 1950, in a routine examination;
stage II, 32 f. and 61 m. ; stage III, 13 f. and 17 m. calcified tuberculous foci were found scattered over Silicosis was found in 8 males. In 5 females and 10 both lungs, without active disease. In .1951 asbestos
males active, open tuberculosis was found; in this bodies were found in the sputum and severe symptoms
series the incidence of active tuberculosis was 4-4 per occurred in the chest and back; in 1952 fresh infiltra
cent. Four fatal cases of lung cancer in asbestos tion in the lungs with haemoptysis occurred, and
workers, which occurred in Dresden up to 1954, arc later leptomeningitis supervened, with tubercle bacilli
described. The first patient was a woman of 46 who in the spinal fluid, and he died with cachexia.
had been employed for 3 years, when young, as an
Autopsy showed tuberculous disease of the lumbar
asbestos weaver; autopsy showed typical asbestosis, spine with bilateral psoas abscess and mixed infection
with asliestos bodies, and with squamous-cell epitheli in both lungs. Asbestosis, stage II, was found in
oma of the right middle-lobe bronchus ; no metnstnses . the lungs with difiuse fibrosis; there was slight
were found ; the asbestosis was not diagnosed during asbestosis in lymphatic glands and asbestos bodies
life, the radiographic changes in the lungs having were found in the spleen. On the peritoneum of tho
been regarded as slue to congestion. The second was mesentery and over tho peritoneal cavity there wero
a man of 49, an nsb.-stos weaver, in whom asbestosis thickened patches and many small nodules from a
was diagnosed radiologic.illy, with a tumour in the pin head to a millet seed in size; a flat tumour, half
loft lower lobe and one in the right radius; autopsy the size of a hand and 1 cm. in thickness, was
showed asbestosis and bronchial adeno-carcinoma with attached to the peritoneum on the under surface
transitional squamous-cell epithelioma in the left lower of the diaphragm. Tho results of tho histological
loin", with nntastases, and a caseatiirg tuberculous examination of the tumour arc fully described,
l-'siiin in the left lower lolie. The third was a woman illustrated and discussed ; no typical asbestos lihr-s
of 57 who had worked in asV-stos, l,--:w.s-n 1922 ami or adestos bodies wero found after careful search,
laid, for 3 years as a nmulder and 5 sens as a seuser ; but aAe-stos was found in tho tissues of the tumour
!i- died in 1954; there was definite as|..-<tn;is ami a "did. spreading carcinoma of 11:. right upper-lobe biom-hu-., with infiltration of the lung paivnclivma til wide-.pi cud met a-.t.rs,`S. The fourth was a man
<! 66 who was known at tie- clinic a- an as! stasis p-ti-nt, di.e-m.-e.l radio 'I'ajihi.-allv 5 >e.:is b.f>re;
by X-ray diffraction examination. It is uncertain
how the asbestos reached the pc; itoue.il cavity; tho
most probable route was thought to l*o by direct
pen'-trition by the asbestos fibres from tho lung
through tho pleura and thence thiough the dia
phragm.
E. Mi-bU't"*
oo
J so
PNEUM OCOXIOS18 AB.3THACTS
Even*. R.. Sors. C. & CoLbF.Rr. J. Silicatoses. ment of the up;>er parts of the lungs is remarkable.
[The Silicatoses' Str:ai>:t dr* H-'pit. de Paris.
The hlnidi colour created by the dust deposits in
1052. Oct. 2, v. 23, No. 73. 293ii--SO, 5 tigs
the lungs uus a distinctive feature. Nodular fibrosis
The term " silicatoses" is applied to pneumo conioses caused by dust containing silicates, but no free silica ; such dusts are those of kaolin (magnesium silicate), talc (aluminium silicate), and asbestos. Ol>-crvatiucs are quoted which were made upon 2 men exposed industrially to dust of talc for 20 and 2S years respectively, and upon 3 men exposed to dust of kaolin for 20, 16 and 15 years respectively.
with massive whorlcd collagenous deposits formed the more bulky changes. During life respiratory
difficulties were experienced by at least one of the men.
[Haring regard to the pronounced pneumoconiosis described, exact findings of the kaolin dust are badly needed. Kaolin is an insoluble dust containing aluminium silicate, which, as King (above, p. 52 ] has pointed out, depresses the solubility of any free
The X-ray appearances of the lungs of each of these5 men are illustrated. Fibrotic changes are present showing more in the central and hilar areas than in the apices.and bases ; they are symmetrical, and
silica pro.-mt, so that such dusts do r.ot set up anymarked fibrosis as hero described. The exact infec tion mentioned is not stated, though the cavitation in one case suggests tuberculosis. Respiratory difficul
nodular, rather than reticular. In 2 instances there ties were experienced during life, but, although was superimposed tuberculous infection ; one with massire whorled collagenous deposits composed the
talc and one with kaolin exposure. The first clinical bulky changes, these two cases do not establish the
sign was bronchitis with expectoration without any existence of `kaolinosis'.]
E. L. Collis
complaint ; then dyspnoea developed ; and finally
cardiac insufficiency ushered in a fatal issue, some
times preceded by spontaneous pneumothorax. Far more observations are needed before any definite conclusions can be drawn. But three hypotheses are advanced ; first that silicatoses really exist, and here asbestosis may be instanced ; second that
McLaughlin, A. I. G. Talc Pneumoconiosis. Arch.
Beiges Med. Sociale, Hyg., Mtfd. dn Travail et
Med. Legale. 1950, July, v. 8. No. 7. 451-60.
12 figs. (2 bn pi.)
.
silicatoses only exist as endogenous silicosis due to
Talc is a hydrated magnesium silicate, similar in
disintegration of silicates in the tissues with the chemical composition to asbestos ; it is a flaky
freeing of silica, which then induces its recognized mineral, but also occurs as fibres. When crushed it
reaction ; and third that silicatoses do not exist forms a smooth bland powder used for a wide variety
and that the manifestations seen are those of silicosis of purposes, from toilet powders to a powder for
exogenous origin, due to the presence, in the dusts *' tacky " rubber tyres. In the production of tyres
the silicates, of more or less free silica. ' Whatever there is a regular exposure to plenty of dust. Doubt
hypothesis be selected to interpret the findings has been expressed whether talc- dust can originate
there is no doubt about these findings themselves, pneumoconiosis. Abnormal X-ray appearances have
which medico-legally establish a claim to been reported with little or no fibrosis or respiratory
compensation.
. L. Collis
incapacity. Two cases are now recorded. One patient,
still alive, has dyspnoea, clubbing of the fingers, and
an X-ray picture like that of early asbestosis. The
Lynch, K. M.' & McIyes, F. A. Pneumoconiosis from Exposure to Kaolin Oust: Kaolinosis. A i/ier. J. Path. 1954, Nov.-Dec., v. 50, No. 6, 1117-27, 7 figs, on 5 pis.
second worked for 30 years powdering rubber tyres. When first seen he had aortic regurgitation (from childhood chorea) and signs of pulmonary fibrosis. He went steadily downhill and died 2 years later, death being ascribed to aortic regurgitation ar.d pneumo- '
The post-mortem findings are described of two men who had been exposed to considerable amounts of fir.o dust from kaolin, got from open workings, while it was being processed for various industries.
coniosis. Throughout both lungs were small grey nodules ; under the microscope diffuse fibrosis was seen and numerous " curious bodies " were found,
similar to those found in asbestosis. These bodies
Kaolin, or china-clay, is hydrated aluminium silicate may be formed from a fibre on which iron from the
in which particles less than 2 microns predominate. blood is deposited. The factory dust was composed
No tqiccint examination of the kaolin was made. mostly of ilakes of talc with only a few fibres ; but
Ni-irly all kaolins contain varying amounts of free the particles in the lungs were in the form of straight
silica, but silicate* form the greater part. The men fibres of talc, all being under 10 microns in length
had been employed for 17 and 22 years respectively. with an average of 5 microns. Without doubt the
X-rays h!ore death gave diagnoses of (a) advanced fibrosis in the lungs was definitely associated with the
pi..:ar:.ntoais with infection; extensive confluent prcver.ee of the particles of talc dust.
err. ..j.t-ition and nodular infiltration; and (1>)
Talc grar.ub.niata arc said to have occmred in the
a-Luiovd pneumoconiosis with infection, cor.flurnt abdomen as a result of contamination with talc
coii-'.lolation, nodular infiitrnt'on, cavitation .ir.d gi'-jve-Tiovvi'.'-r introduced at operation. [No evidence
v-.ph*i ria. Excellent illustrations show the micro- is adduced t'n.it pneumoconiosis due to talc predis
aj*p .............. of dense hyalinizing fibro-W vi-'u poses to tuberculosis or that it incapacitates its
*-' '! *r obliteration. The massiveness of the involve possessor.)
p j Cvtll%
lt\ Mi a. I
y:..Cl'
5* M
Tin; i. .i coni > > hur.v v j -. r-fete: < -. the Ir.u ;.. re-uih'> ; -. deucy l--i '1 he <`.i a i.
posut*--to
raw m t -i production operation v> Use ol t ill new case in
The c< ai. i as a distin- be regard--- '. compens.il; pained bj assoc iat-d v described U pneuroocon: of the r-spr. : pneumocmi: progressive '
Buus-ll.w pulmnn v. IT.'. Engh-l
In 191<*. investigate-:
two rublwi . who had I-
wore cs.n ' in the lun there wen-
one of th
ence t'i longest tic were ev.i:ifur 29 y -
in the h'lu* at ni-lllt 1-1
pull:- 111-, du -t i!<->i:
1 h*i-- o' '
i-vi-lr'1- e
vim:
| :;.l *
ii
syr -.; r i-
a '
a<:' ' '
111
MI.........t I
PNEUMOCONIOSIS DUE TO SILICATES
181
Raader, E. \V. Neues fiber Tnlklur.ge unri Talkgranulom. [Tala Lung and Talc Graaulomal Deut. tued. Il'crfi. 1950, Jan. 6, v. 75, No. 1. 50-51. [12 refs.]
This is a study of the recent literature on pneumo
coniosis caused by inhalation of talc dust, and granu-
lotnaia produced in certain tissues by contact. Special
reference is made to the radiographic appearances of
the lungs, to the presence of the special " bodies "
resembling asbestosis bodies, and to an increased ten
dency for tuberculosis to occur in the affected lungs.
The disease has been described as resulting from ex
posure to talc dust in the mining and milling of the
raw material and in its use in industry, and to the
production of talc granulomata in wounds, especially
operation wounds in the peritoneal cavity, from the
rise of talc as a dusting powder on surgical gloves. No
new case material is added.
The condition of talcosis is regarded by the author
as a distinct entity, and it is suggested that it should
be regarded as an industrial disease for purposes of
compensation as is done for silicosis, alone or accom
panied by tuberculosis; -and asbestosis, alone or
associated with cancer of the lung. Talcosis would be
described for the purpose of compensation as (n) talc
pneumoconiosis (talcosis) w-ith disabling impairment
of the respiration or pulmonary circulation ; (b) talc
pneumoconiosis (talcosis) accompanied by active,
progressive tuberculosis.
. E. L. Middleton
Buus-ILvnsen, A., Frost, J. 6c Georg, J. Talcosis
pulmonura. Ugeskr. f. Laeger. 1950, Dec. 7,
v. 112, No. 49, 1691-7, 2 skiagrams. [26 refs.]
English summary.
'
In 1940, the Danishpublic health authorities investigated the possibility of talc poisoning in two rubber factories, and in one of them ten workers who had been employed in it from 15 to 30 years were examined with special reference to deposits in the lungs. All the skiagrams were normal, and there were no complaints of symptoms. In 1949, one of these factories was again studied w-ith refer ence to talc poisoning, and five workers w-ith the longest time of employment (from 19 to 29 years) were examined. A worker who had been employed for 29 years showed difluse radiographic changes in the lungs. The present publication gives a detailed account or five cases in which there were radiographic pulmonary changes after prolonged exposure to talc du .t during the manufacture of rubber inner tubes. Three of these workers hud shown no radiographic evidence of fibrosis after reflectively 6, 15 and 15 year-, of-exposure to the dust. Hut after a !".rth<-r period of III year.s there v.erc marked radiographic changes. None of the five workers pr'-v.-nted any symptoms of talc poisoning, but thn of them - bowed
a slight reduction of pulmonary function. The author* ieroui!.ie::d measure-, for the teduct'on of talc, dust in the industries comem-d. an.l they vlg.;r.,T that when SUeh Jiuluiu.. ity ch.tt.g-s as
they found are demonstrable, it is advisable to move
the worker to a less dusty employment. Claude Lillir.gston
Kohler, G., Leopold, G. & Steyer. \V. Zur Frage
der Talkumpneumokoniose.
[On Pneumo
coniosis due to Talcum] Ztschr. /. drctl. Fort-
bildung. 1951, July 15, v. 45, Nos. 13/14,
375-S2, 7 figs.
The existence of pneumoconiosis due to inhalation
of talcum dust is taken as established. A survey
was made in a factory in Leipzig making powder for
cosmetic and medical purposes, where until 1944
talcum was the only mineral base used, although
during the last few years minor amounts of colloidal
silica and kaolin were used for a time. Among 23
workers one case was found of stage II pneumoconio
sis and two of stage I, after 19, 25 and 30 years'
exposure to dust. Clinical observations are given in detail; they show little or no disability for stage
I, but emphysema, bronchitis, a reduced vital
capacity and a shortened apnoeic pause for stage II.
The radiological findings are described and discussed in detail and they are illustrated by rather poor
reproductions. The pictures resemble asbestosis rather than silicosis.
'Working conditions and materials used in manufac
ture are described, and size distributions of the raw
materials and of dusts collected on test plates are
given. The case of stage II arose in the mixing room
which is well separated from the packing roqra in
which the two cases of stage I were found. The
air-borne dust in the mixing room collected at a
height of 6 feet contained only 0-6 per cent, by
weight of particles below 5 microns and the mixing
room was far dustier than the packing room.' Dust
control was greatly improved in the plant in 1940 by
modern exhaust ventilation. Nevertheless; initial
and annual X-ray checks by full-size films are recommended for all workers exposed to talcum dust.
The subject with stage II had been certified in 1940 and removed from further dust exposure. The two
women with stage I do not qualify for compensation
under the present law (Eastern zone of Germany) because no objective loss of function of the respiratory
or circulatory system or association with tuberculosis
can be demonstrated. Doth are women of ages 43 and 4G years .and their removal from further dust
exposure is recommended.
G. Nagelschmidt
Hultcren, G. V. Undersokning rdrande hilsorisk
vid bantering av talk. [Investigations of th-
Rlsk to Health on Handling Talc] Svensha
J.ukartidf.ir.gtK. 1951, Mar. 2, v. 43, No. 9,
540-42.
'
Before giving an account ol investigations in Sweden, lliiltgf-n draws attention to recent changes abroad in the attitude taken t<> talc as a possible c.iu.i: of industrial di .eases. Thus in his work on occupational diva-es published in 1942, this American
v*- -
a .*4.. *''
182 PXIJUMOCOXIOSIS A liSTUAUTS
Johnstone stated that no evidence had been found chronic cough, chest pain and fatigue. Limited
indicative of change* in the lun^s due to talc. Hut chest expansion is invariable. Some emphysema is
in his work ** Occupational Medicine and Industrial usual with fibrosis of a fine linear and granular
Hygiene " published in 194S, he referred to several cases of pneumoconiosis shown on [K>>t-nv)rte::;
character. The plaques are ascrilred to accumulations of talc in peripheral lymphatics with ly.npliatic
examination to be due to talc. Speaking in Stockholm dilatation and stasis, associated with calcium localiza
I in 1949, the German expert in industrial hygiene Dr. I. \V. BxaDF.r admitted that talc may provoke
tion. Steps should clearly be taken in industry to
minimize exposure to talc dust.
E. L. Collis
changes in the lungs, but that to be severe there
must be an exposure to talc for a score of years.
'.I A year earlier Redell discussed the risks of talc
/ poisoning in the organ of the Swedish Medical Jaquf.s, \V. E. & Bf.nikschxe. K. Pulmonary
Association, Stensha Ldkartidnir^n. In his opinion
Talcosis with Involvement of the Stomach and
t
talc granuloma and other lesions would be found to
the Heart. Report of a Case. Arch. Indust.
complicate operation wounds comparatively often
Hvg. 6- Occupational Med. Chicago. 1952,
once attention was drawn to this possibility. He
May, v. 5. Xo. 5, 451-63, 5 figs. [Rcls. in foot
>!
suggested that some better substitute for talc should
notes.}
!<
be found for use with operation gloves, and he urged
The case here reported as one of talcosis was in a
fi great caution in the handling of talc. man aged 42 who prior to 1942 had worked for 16
The table Hultgren publishes deals with an years in a shoe factory' with much exposure during
investigation carried out in a Swedish cable factory the last 6 years to powdered talc, used to prevent
1 in which talc had entered into the preparation of layers of leather from adhering. From 1942 onwards
yf
rubber material for more than 25 years. Among 57 workers who had been in contact with talc there
he worked as a carpenter with no further exposure to dusts. He first came under observation in 1943
itt were ten who had been so for more than 15 years-- with cough and dyspnoea on exertion. Silicosis was
two of them for 25 years. Some of them had com suspected, but not confirmed. The chest condition
TLi
plained of discomfort from talc dust. The radio logical examination of the lungs in these ten cases
got steadily worse, until he was admitted to hospital for the fifth time in 1950. when he died 8 hours after
showed a certain number of old tuberculous foci and admission. At no time had it been possible to make
he
slight emphysema, but not a single case of pneumo' coniosis. Yet Hultgrea urges caution in the handling
a certain diagnosis. The heart had shown " cor pulmonale" distinctive of progressive pulmonary
hi of talc which, when there is much of it ia the air, fibrosis ; and epigastric discomfort was present after
should call for the wearing of a mask. He adds exertion. Neither in life nor thereafter could any
*01
that the talc risk is now kept in mind in the planning
of factories in which talc is used.
.
tuberculosis be detected. Unfortunately no sample of the talc could be obtained. Commercial talc
Claude Lillingston
differs tremendously; it may be pure calcium
carbonate, or mixtures of talc, tremolite. carbonates
Friedman, P. S., Bell, M. A. & Solis-Cohe.v, L. Talc Pneumoconiosis. J. Atmr. Med. Ass.
- 1952. Apr. 19. v. 143, No." 16. 141S-19, 2 figs.
Talc is a hydrous magnesium silicate : it is used freely as a smooth powder, especially for rubber articles. The claim has been made that its inhalation will originate pneumoconiosis. In support of this claim a case is reported of a man who for some 24 years had worked manipulating rubber ribbons . heavily coated with talc powder in an atmosphere cloudy with talc dust. At ago 65 he came under observation with a chronic cough of long standing. Jle had a thoracotomy scar over the lower posterior hemithorax. X-ray disclosed diffuse pulmonary fibrosis, pulmonary emphysema, pleural thickening, and a talc plaque in the right hemithorax. There were also foci of pulmonary calcification. The sputum was negative for tubercle bacilli. Other
and serpentine ; it may contain some quart;. Seven commercial talcs contained crystals below 10 microns in length.
The predominating pathological features found in this ease were extensive pulmonary fibrosis and granulomatosis, cor pulmonale, and granulomatosis of the myocardium and the gastric mucosa. There was no cavitation, caseation necrosis or lymphadenopathy. Much consideration is given to the findings and to those reported previously in other cases ascribed to talc dust. Certain talc crystals were definitely identified in the tissues ; but the length of time between exposure and death, 7 years, must render such findings of doubtful significance. The
cardiac and gastric lesions are looked upon as a direct reaction to the talc. Reasons are given for discarding fungus disease and sarcoidosis as possible diagnoses.
` E. L. Collis
authors have claimed a minimal incidence of tuber
culosis in a series of cases of pneumoconiosis due to talc. The patient improved under treatment. Attention is drawn to linear areas of pleural density due to talc plaques which are said to be pre-viit in over G per cent, of talc miners. The symptom' seen
"Smith. Adelaide If. Pleural Calcification resulting Irom Exposure to certain Dusts. A:cr. J. Jloent-'-nA. 1952, Mar., v. 67, No. 3, 375-S2, J2 figs. [II refs.]
which arc distinctive of talc fibrosis a:e dyspnoea.
** An increased incidence of pleural calcification is
y
U
PXEUMOCOXIOSIS HUE TO SILICATES
183
Ji.I in workers exposed to the dust of trcmolitc .,nd muscovite mica. It is suggested that this ,y l; due to pleural irritation produced by those dj.ts plus the presence in th' em of calcium and i'i.'.';r.esiuin which act to stimulate calcium ,lrjio.it ion."
Thlie rapid progression of the disease was a clinical
and radio!..ji.al characteristic. X-r.v.y shadows weie set'll mouth by month, changing from light shadows
to no.lnl.~i arid tlicn to the tuinnur-like type; at the
same time the clinical state rapidly deteriorated.
l)u..t control in the factories concerned is urgently-
needed.
A. I. Chilis
Mrsv. L. A Dr.vsv, J. It. Talc Pneumoconiosis in * th: Textili Industry. ISril. Med. J. 1054,
pee. 18, 1460-61, 1 fig. [16 rets.]
The c.ve is reported nf a man who for 33 years had
hiiii employed as a picker maker, lie had to make
paili-T thongs, or pickers, used for driving shuttles
winch carry the weft threads from side to side
through the warp threads on the weaving loom. The
hole from which the thong or picker is made, after
leing thoroughly damped, has to be dusted liberally
mi toth sides with French chalk which is hydrated
ia.igueii.ini silicate or talc. During the operation of
lusting the air is cloudy with fine talc dust. Talc
c.nsi'ts of fibres from 4 to 10 microns in size, and
' if it is inhaled, talc plaques may be detected in the
lungs radiologically. In the present case X-ray
showed a lattice or matrix-work background on which
nodular deposits were sujierimposed. Probably the
case was complicated by apical pulmonary tubercu losis. Talc pneumoconiosis is considered to be a
utlier slowly developing fibrogenic disorder, some
what similar to asbvstosis. The man had begun to
experience dyspncea and a mild productive cough.
Others have reported talc granuloma as occurring in
.-iLlomiual surgery following the use of surgical
fcti powdered with talc.
Ji. L. Collis
Alivxsatos, G. P., Pontikakis, A. E. & Tttnzis,
II. Talcosis of Unusually Rapid Development.
Ilril. J. huhi.it. Med. 1955, Jan., v. 12, Xo. 1,
43-9, 6 figs. [36 refs.]
.
The cases of 8 men are reported who worked in t.ilc factory pulverizing pieces of soapstone and creating clouds of dust; 8-hour shifts were worked, and occasionally 16-hour shifts. The exposure to dust was undoubtedly excessive. All the patients exhibited pii.ii iiioconiosis, which developed after unusually .short pprio.ls of exposure. The exposures in cases 1, 2, 4, 5, 6 ami 8 varied lietwcen 16 and 24 months ;'it reached 49 to CO months only for cases 3 and 7. The X-r.iy 'In.'lows showed scattered mottling of the lungs, Li'-Miiing confluent and soon progressing to tumourho- appearances. Six X-rays are illustrated ; the shadows arc unusual, more like those seen in cases of ads-stosis than in silicosis. In no case could superi'np>>.<d tuli.-iculiHis be detected. The dust particles m the air were fii-quently too numerous to count: but in 12 samples counts per litre of air varied ' ''.wien 73.),(>'J9 and 1,923,000 paiticles. Chemical -n.ilj,js di 1 not di -dose the ptesemeof any five silicic
i 1 in llie talc, but only of silicate salts.
IlEtitASx, H., Moskowitz, S., Iyer, C. R. II., Gotta, M. X. & Mas-kikes. X. S. Nate on Mica Dust Inhalation. AreA. Indust. Hyg. .fc Occupational Med. Chicago. 1953, Dec., v. 8, Xo. 6, 531-2.
The author^, in India, examined 61 workers in factories, to which crude inica is brought for process ing. The dust concentrations ranged from 2,009,000 to 3,000,000,000 particles per cubic foot, and only a few workers had Keen exposed for more than 5 years. The examination included X-ray, which showed "ground-glass 2 reading" in 27, and "groundglass 1 reading " in 14, of the workers (together 67 per cent.). Th-re was no dust effect beyond this.
The results indicate that the generally accepted maximum allowable, atmospheric concentration (20,000,000 particles per cubic foot) is probably correct.
Charles JVilrocl.i
Gattner, II. Die Bleicherde-Lunge. [Fullers'-Earth Lung] Arch. /. Gcirerbepath. u. Gewerbehyg. 1955, v. 13, Xo. 5, 508-16, 2 figs.
The'bleicherde referred to here comprised a number of natural clays composed chiefly of aluminium hydro-silicates, and including varying 'amounts of Mg, Ca and Fe as well as other bases; combined silica amounted to 50-60 per cent. The chief mineral was montmorillonite which has a lattice structure similar to that of the mica group. The clays are. 'obtained from sedimentary deposits in various parts of Germany. In the factory where this study was made the material used at first was clay from Bavaria; later bentonite from Hungary and Rieder clay from Saxony, were used.. The amount of quartz in the clays varies widely and it may roach 20 per cent., or, ns shown by examination of some consign ments, it may "be absent altogether. In this factory enquiry showed that up to 1940 qunrtzose sand had been added to the clay in various proportions up to 20 per rent. The manufacturing process consists in mixing the clay with water anil hydrochloric acid, heating, pressing to remove liquid and drying in ovens ; the material is then ground in a ball-mill and filled into containers.
Nine turn employed in tho factory were examined; the history and clinical and radiological findings of 2 of fh-se men arc recorded in detail. The first was a locksmith vwo had bc-n cmploytsl in various pro cesses in the working ul inel.iis, including dural, to the dust of which lie was exposed for several years. He was employed at the f'.ill.'is'-earth factory for 10
it. . 1 '
i ' i. i
oo
PNEUMOCONIOSIS ABSTRACTS
jraw crinJing the dried material in the ball-mill and
a there expo.-ed to the dust from the filling process.
When he left that work he was 44 years oi age.
When he was 5S a rk-rst radiograph showed pneuno-
c-jni- sis, grade II-III, with diffuse, finely granular
hadoes over both lung fields, more dense in the upper
rones, ar.i with uniform, cloudy opacity at both spire*. There were no symptoms of ill-health; no
tul>err!e bacilli were found in the spu'uin after con
centration. The second man was aged 47; he was
employed for 14 years milling the clay in the same
factory. The radiograph showed increased lung mark
ings at the right base and extending to the hi!um";
both lung fields showed veiled shadowing with finely granular opacities, slightly more marked on the right
side; in radiographs taken 2 and 3 years later the
changes appeared to be more marked. The diagnosis in
this case was pneumoconiosis, grade I--II. There were
no symptoms. Oi 7 more men employed at the factory
radiographs showed one with doubtful early signs,
one with uncertain result, and the remaining 5 nega
tive, in the author's opinion : diagnoses given at a
radiological institute placed the first 2 of these and one of "the negatives as grade I, and one as having
commencing signs. In this series of radiological
examinations the man with the longest period of
employment, 15 years, had a negative radiograph.
The periods of employment of the others were com
paratively short.
The conclusion reached is that the dust of this
material is injurious, although not capable of causing
silicosis. This possibility has apparently not been
recognized generally, and preventive measures have
been neglected.
.
(Fullers'-earth, composed chiefly of montmorillonite,
was known as a cause of pneumoconiosis. See
Miduleton (1340), Fror. Inttrnat. Conf. Silicosis,
I.L.O. Ceneva. Studies and Reports, ser. F. (Indus
trial Hygiene) No. 17, p. 134. A fatal case, with
autopsy, was described by Camfritl ar.d Clowe (this
< Bulletin, 1942, v. 17, 331. See also Tonning, ibid.,
1330, v. 23, 1253.)]
E. L. Middleton
IforTER, W. & Cartsth, H. Cber .eine Pneumokoniose U-i cinem Frld-putarbeiter. (Pneumoco niosis in a Feldspar Worker] 'Amt. /. .1 rbciiimi-if. v. Ailritfiel.ntz. 1954, Mar., v. 4, No. 2, 35-40,
8 fig*.
The Authors de*crilie a fatal c.:*e of lung di-ease in a fchl-jiar worker, whi:h, though it was not typb-al of tine silicosis, rh.\v regard as one of "modified ilici-i-", the variation U-ii-g due to the mixed chsi *et of ;hy uiist inhaled.
He fel l-| ,ir dust contained 27T per cent, of p'Va'-iarii RM-par (K Al Si.O,); 14 7 p-r Cent, of s'-!rim f.-l i-j. ir (N.a A! Si.O.); 12 fi per rent, of f i ;i ml i-tl.er lJiir:-ia'*, ;.;nl 45 4 j ei rein, of
I'- -I i:eirte."i ovamiiiatkii showed, in addition to
*I-li.|*e rliioni.- tul,-i'a!
nf b :h lungs, will.
rusenii ui and cavitation, difiue di-sc:nination of large-cell du-t giariuloni.ita in both lungs.
These nodules, which Mirronn.ltd the .small arteries and extended into the alveolar wall*, consisted of macrophages, 1-2 u in --jz-\ containing brown or black amorphous du-t. Contiucnt grami'omata resembled silicolie nodul-.s, but there was very little increase of reticular fibres, no hyaline formation and very little increase of collagenous tissue. The lymph mules contained similar dust grantilomata.
Microscopic and polarimeiric examination of the dust particles obtained from the lung tissues by ash ing and defatting showed that many were doubly refractive.
In discussing the reason why the lesions were not typical of silicosis in view of the quartz content of the feldspar, the authors suggest that the aluminium, potassium, sodium and calcium ions or oxides in th feIJspar tend to inhibit or neutralize the silicotic effect of the crystalline quartz particles.
Ethel Browning
Policaed, A. & Collet, A. Recherches exp^rimen-
tales sur la nccivite des poussiercs de feldspath. [Experimental Research into the Harmful Mature
of Feldspar Dusts] Arch. Malad. Frofcssion-
nellet. Paris. 1954, r. 15, No. 5, 343-50, 4 figs.
*
Feldspars occur in most igneous rocks and exposure to their dusts is frequent. There are 3 feldspars; the commonest is orthosc, a silicate of aluminium and potassium; then comes pericline, a sodium aluminium silicate; and labrador, a combination of calcium aluminium silicate and sodium aluminium silicate. In order to investigate their possibly harmful pro perties 100 mgra. of each in fine particles less than. 5/i in size were injected intraperitoncally into rats. Alter one month, and up to 4^ months, the conse quent reactions were observed. They are shown in microscopic illustrations. A certain amount of fibro sis was .found, increasing with time after the injec tions ; it was most marked for labrador, and least for crlhose.
With pcricline the lesions were quicker to form ami richer in collagen. Compared with that pro duced by feldspars, the fibrosis caused by silica is always more inteuso and tho formation of collagen more abundant.
The feldspars are more harmful than kaolin and tho inicas, but less so than fluorspar or silica.
E. L. Collis
pAUAfA, A. Silicatosis per sepiolil.i (silicate de mug-
nc.do liidrata.lo).
[Silicatosis caused by
Scpiolite] Med. y .sVjurii.V./ del Tmint jo.
Madrid. 1054, Jan.-Mar., v. 2, No. 6, 11-14,
2 figs, on-2 pis. Engli-h siin:i:iar> (7 lines).
A case is d'-.wrilvd of silicate-.:< pr. liihly due to rvpichte (hydr.it. 1 la* uiei'i;n m!ir*, i:.im'I: mm), which has not hitherto 1.-on r.'pirttd. Diagnosis was
v. II
t H-id.
establish,
possibik'.. porated, was due -
Tnoisi. V
amor. MetM Chic-
Cases a:
by X-ray
in the gl.v spraying dried, sera ovens to . dust of : percentage
1 t
rNEUMOCOXIOSiS DUE TO SILICATES
IKS
,\ -1 l-v radiography, and after considering the
; *, that other fibrogenie dustsmiglit be incottie author concludes that the initial nbro-iis
.. \ * \
M. Silicatosis of a Mlcrocodular Typ9
vur.g Worn n employed In Cla;e Spraying on
,'ie`ll Objects. Indnst.
6* Surgery
v'twago. 1952. Feb., v. 21. No. 2. 47-9. S figs.
we here reported of lung fibrosis, diagnosed X-ray. among women employed for many years ; :':r .[hiring of iron sheets. The process consists in enamel on to iron sheets which arc then *.!-l. scraped and brushed, and thrust into electric .r.n to melt the glaze. There is exposure to the rof the enamel powder, but the maximum percentage of free silica in the powder is 1-2. The
enamel is made by mixing and roasting at l, 100' to 1.20'VC. quart?. 25 per cent., potassium felspar 30
per cent., natural cryolite 15 per cent... tin oxide 4 per cent., pl.istic clay 6 per cent., borax 15 per cent., and soda Solvny 5 per cent. In the final frit all the free silica is converted into silicate ; the silica, referred to above may he from siliceous pebbles in the powdering mill. Four instances are given of
women employed from 5 to 12 years. X-rays of whose chests showed shadows of a reticular and micronodular type, attributed to fibrosis. The subjects
were in good health and regular workers. No question arises here of any tendency to tuberculosis which is so distinctive of true silicosis. No estima tions are given ot the dust concentrations to which the women were exposed. 11 the X-ray shadows
seen are due to pulmonary fibrosis caused by dust of silicates and are indicative of the existence of silica tosis. the resulting condition does not seem to be of
any particular clinical importance. - E. L. CoHis
iII
MARCH, 1947
r:ri i
(Vol. 11. No. 3)
iteiatuie Gbshacts
\
MEDICAL ENGINEERING LEGAL - - - decisions and trends
lIndustrial Health Tleivs
x
tnn*4 Monthly Bj
-
INDUSTRIAL HYGIENE FOUNDATION
4400 FIFTH AVENUE PITTSBURGH 13, PA.
Industrial Hygiene Dices! - 71.
March. IQ47
327 Asbestos Dust. Anon. Safety Rev. (U.S. Navy), , 15 (Jan., 1947) The brief article calls attention to the hazerd of exposure to asbes-
/ tos oust and the need of adequate localized ventilation. All working
places with possible exposure should be checked for asbestos dust, and where mechanical exhaust ventilation must be supplemented by wearing of personal protective equipment, it should conform to Bureau of Mines specifications.
328 Air-Operated Svgtc?". Dumps Cyanide with Safety. Anon. Compressed Air Mag., .52, 49 (Feb., 1947)
At the Kerr-Addison Mill in Virginiqtown, Ontario, cans of cyanide to be used in the extraction of gold from ores, are handled mechanically by a system that is completely inclosed and controlled from the outside. Except for loading and unloading, the operation is automatic. After a can has been placed on the skip and the chamber has been closed, it is hoisted by an air cylinder. At .the limit of its travel it is tripped and its contents are dumped into the hopper of a reagent feeder that`discharges into condi tioner tanks. Reversal of the piston stroke returns the skip to the starting position; but before the empty is replaced by a full container, the fumes and dust in the enclosure are exhausted to the atmosphere. Thus hand dumping with its attendant skin rashes are avoided. Diagrams are presented.
329 Dust Control Lessons from Fontana Dam. F.N. Chirico.
Occ. Hazards, .2, 24-25 (Feb., 1947)
Certain features of the dust control system introduced during the
construction of Fontana Dam in North Carolina were not only unique hut
because of their extreme effectiveness in curtailing hazards have become
a pattom for the industry. The most radical of those features was a
mechanical water spray mounted on the frames of the electric shovels,
continuously and thoroughly wetting the rock. This process reduced
dust concentrations to averages of 1.4 to 2.7 M.P.C.F., and was much
more efficient than intermittent hand wetting. It was also unnecessary
to-wet the rock during crushing--a point at which hand wetting has been
found undesirable. Elimination of dust fog also increased night visir
bllitv. Other dust-reducing features included wet drilling, efficiently
designed ventilation systems, total enclosure of indoor screens, with
self-closing doors, top and skirt-board coverings at transfer and dis
charge points, dust-tight manholes, counterweighted hinged covers on
chute3, discharge of the dust collector effluent through high stacks,
and tho installation of water sprays with conveniently located shut-off
valves. Specially designed ejector ventilation systems were installed
in the cement unloading plant, supplying clean air to the workers and
removing the cement dust which was subsequently collected. An average'
of less than 10 M.P.C.F. was attained at that point, less than five in
the concrete nixing plant, and less "than four in the quarry end rock
crushing plant.
330 into J>JstL^.n.d-.y.7htiliUpji-QQii,lUL22S..in Aha Comer Mines end AheJLrukon Hill Vino in Korth1r.Q Jihodmiai Ul Parti cular Reference to Silicosis. J. De V. Lambrcchts. 42 pp. Lusaka:
Govt. Printer. (1945) T'ne basis in this report is upon dust. It in rrcomzcn le i that
.lint sampling r-rults form a be sis for. ventilation requirements. Depths
PLAINTIFFS o i
s^h v-u^n
^0aM ft AttUCUTU CM1
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AUGUST, 1949 (Vol. 13. No. 8)
INDUSTRIAL HYGIENE FOUNDATION 4400 FIFTH AVENUE PITTSBURGH 13. PA.
Industrial Hygiene Digest - 15
August, 19^9
However, great care should be taken to exclude the tuberculous In select
ing persons to receive aluminum therapy. (1+) It is not believed that a
scientifically controlled experiment in industry is feasible for the
evaluation of aluminum for the prophylaxis of silicosis. This follows
from the uncontrollable variables inherent in the industrial situation and
other factors which have been discussed. For these reasons, it appears
improbable that any research agency would consider it advisable to under
take such a project except under special conditions already discussed, and
which may not be attainable. (5) The McIntyre Research Foundation, as
presently organized, is not equipped to solve the aluminum prophylaxis
problem in relation to silicosis. The steps considered necessary to accom
plish this objective are outlined. (6) Research should be continued with
laboratory animals with the object of finding a more adequate basis for
application to man. Such study is now included in the program of the
Saranac Laboratory of the Trudeau Foundation.
-- Authors' Summary
866 Effects of Electricity on the Human Body. W.B. Kouwenhoven. Ind. Med. 18, 269 (July, 19^9)
The author discusses briefly the various effects of electricity on
the body, including variations with the amount of current. The current
values of interest are: (1) threshold of feeling, about 1 milliampere;
(2) let-go current, above which it is difficult to let' go of a wire,
about 9 milliamperes for men, 6 for women; (5) current producing ventri
cular fibrillation, 0.1 ampere; (4) current producing a block in the ner
vous system, one ampere or more; and (5) the counter shock current. The
last three result in death if prolonged; otherwise artificial respiration
may save the victim. These effects refer to alternating current of com-
merclal frequency. Direct current is much less harmful. The only effect
of high-frequency currents is heating.
`
867 Asbestos is and Cancer of the Lung. Editorial. J.A.M.A. l50T 1219-1220 (Aug. 13, 1949).
v
Records of English, American and German physicians and The Annual Report of the Chief Inspector of Factories in England for 1947 show that the occurrence of cancer of the lung is related to pulmonary asbestos is. This relation is supported by the following observations: (l) The incidence rate of cancer of the lungs in asbestosis patients is 10 to 15 times as high as among the general population.(2} The male-female ratio is more nearly equal than it is for the general population, which indicates that an environmental and evidently occupational carcinogen tended to equalize the incidence rate of cancer of the lungs for both sertes. Recent experi
mental observations support this interpretation of clinical evidence.
868 Changes in the Lungs Produced by Natural Graphite. H.E. Harding and G.B. Oliver. Brit. J. Ind. Med. 6, 91-99 (April, 1949).
A brief description is given of the industrial une3 of natural graphite,
which is a crystalline ou-bon mi>:<-d with up to 10^ of free silica tuid with
other minerals. The greatest dust risk occurs in the grinding of natural
graphite, for which evidence is presented to show that this can
to
Industrial Hygiene Digest
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January, 1950
35 Miniature Chest Roentgenograms in Schools and Industries in San Antonio,
Texas . P.A. Pamplona and W.F. Hamilton. Am. Rev. Tuberc. 60, 501-51$
TSctT 19U9).
'
A chest survey vas made of 12,115 students and industrial workers In San Antonio. Both students and workers are classified in three groups. Group A is composed of Whites, excluding Mexican Nationals and those of Mexican descent. The excluded whites from Gro-.vo A comprise Group B. Group C contains only negroes. The roentgenographic findings for 8,982 students showed evidence of reinfection tuberculosis in 43, or 0.4 per cent. The highest rate, 0.82 per cent, was found in Group B. The rate in Group A was blightly higher than in Group C. A total of 3,132 industrial workers showed evidence of reinfection tuberculosis in 73 persons, or 2.3 per cent. The comparative rates of incidence for the three groups were the same as for . the student groups, though much higher. Emphasis was placed on the socio economic status and 'its relationship to the prevalence of tuberculosis among those in Group B. Other abnormalities of the chest were found in 0.32 per cent of the students, with bone involvement as the primary finding. Of the industrial workers examined, cardiovascular abnormalities prevailed among 0.95 per cent of the nontuberculous . -- Condensed from Authors' Summary
>6 Asbestosis: VI Analysis of Forty Necropsied Cases. K.M. Lynch, and W.M. Cannon.
JDis. Chest 14, p. 874 (1948).
'
The authors report an analysis of 40 cases in which asbestosis was found
at necropsy. Cases are divided into minor, medium, and advanced grades, the
advance of the disease and the prominence of asbestosis bodies showing a
direct relation to the duration of exposure. In 4 of 14 cases of- advanced
grade, pulmonary tuberculosis vas the primary cause of death. Only in
cases of recent exposure was recent fibrosis found, this providing support
for Gardner's belief that fibrosis does not progress indefinitely after
cessation of exposure. Presence of asbestosis bodies is not invariable in
experimentally produced asbestosis, but is more typical of human asbestosis.
Lung damage occurs before the formation of asbestosis bodies, which may
represent an attempt by the tissues to segregate the particles; they persist
in the lung indefinitely. Pleural fibrosis is an outstanding, though not
invariable, feature of asbestosis; the reason for this is not clear as the
particles do not reach the pleura. The occurrence in asbestosis of nodular
fibrosis of silicotic type, which King and others have produced experimen
tally, was confirmed in 8 cases. Carcinoma of the lung occurred in three
out of 40 cases--an incidence of 7.5 per cent, which is seven times greater
than general incidence--all in cases of nedium--or advanced' grade--asbes-
tosis. -This figure is in accordance with the experience of other workers,
and calls for further study. Tuberculosis occurred in six cases, but it is
suggested that this incidence is not significant; this is not quite con
vincing. Gardner stated that experimental asbestosis does not predispose
to tuberculosis. (Unfortunately the occupational histories of these cases
are not complete).
-- Brit. J. Ind. Med.
37 Art ibis-! -.m-'n^r In t Treat :-->nt of the Common Cold. A rrellmin<iry Report.
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