Document R20V0x74NarYG5n1EBYarBew7

60 Twenty-firsi Congress--.Vational Safety Council which aspect varies as a rale with length of scrrkt. This finding is consistent with the character of a generalized fibrosis, which is a comtinm characteristic of silicosis. Tactile and vocal fremitus were not changed appreciably in the earlier stages, but as the generalized fibrosis of silicosis increased these were decreased in intensity. Fi!ir<*sts of tuberculosis causes an increase in both tactile and vocal fremitus. The fooditi'a! is. however. hcalizt*d. whereas the fibrosis of silicosis is general throughiut tile lungs. In my cases of granite cutters there was no marked change to any {articular variety ui breath sounds in uncomplicated cases, but rather a softening (or "soft l*fkr effect 1 on all the breath sounds, which naturally brought out the vesiculai type oi lircalhmg. kales were absent in the uncomplicated cases. Xo toxemia was present, which i> accounted itrr In- tl>r absenrr of iniection. Tuberculosis as a Complication of Silicosis (t - not sur|trisiug tiiat workers who liavc latait tuljcrculosis infections Iktuiik disabled earlier titan tin* average individual. It was our experience that tlnrsc cases lrvrlo|ied silicosis more rapidly, and tiiat when they dcvdojwd the clinical tuhercuI..sis. tftey were still young iwitili- and the disease ran a more prolonged course. This ,va* n*t true the cases whidt devdq*cd silicosis first. The South African investi gator?. t`H*. Itavr <4MTved tlat the casrs whieft jhey classify as "pluhinouT break down with tulierculusis early in their mining careers. I`hy>ical examination of silicotic jorients who arc lircakmg down with a ttiliercul.u? complication provides jniWmatiun which is not always available with the x-ray. f >r. I*anr<ast stated in a talk mi loieunmiwicnjiiosis it the local (Washington) med ical society recniily that during this transitional stage the differential diagnosis is -itm tmiMissihle. Wlim tlie tuln-rcuhnis complication lias advanced, diagnosis is. oi o turse. easy. Incjmry into tlie patients cimditirm will usually reveal symptoms which are conin:<.ii to uncomplicated tulwrculosi*. It was our c\|criencc that cartv complaints were fatigue, night sweats, increase in dyspnoea, pains in the chest, and an after- rise in trmjuTaturc. There was frequently complaint of a cough, whidt was productive. Many jatients liad hemoptysis and later in the disease, frank honorrliaues frm tin.- lungs, l.oss of weight did not seem to occur so early as in uncom plicated cases. Irat when this symptom became manifest, it was marked. Tultcrcle liarilli were usually found in tlie sputum early in tlie disease. Tlir later stages presented no great differences from those fulminating iies of i;tir implicated tuberculosis. Tlw* jihysical signs firesemcd variation? from those in uncomplicated cases, inas much as there existed already a general pulmonary filirosis. The latent or posttus-ir rale was omstam and not tmlike the same valuable pathognomonic sign in tincomplicated cases of tulxrculosis. Tlw x-ray?- .i rases m this stage usually revealed areas nt conglomeration. or fus ing. "i ithrulic marking.-. They were less distinct in diaracicr ihan in uncompli cated silicosis. This fact win he demonstrated in the slides. Tlie diagnosis of silicosis is not an easy task. The iiatient's history, careful analy sis of his occupational life, a study of his jibysical condition and reliable x-rays arr nctv-sary to determine the presence of silicosis and to attempt to evaluate the extent <>i disalnlity present. It is obvious tiiat it is difficult for physicians to do this and a greater task for a lay jury. It seems to me that it would be better to have the sus{ected ca?c examined at a reliable clinic or general hospital by a group ot unbiased physicians and to abide by their findings rather than to have these cases fought out m courts. In most every manufacturing city large general hospitals and tuherculosi? clinics arc available and the use of these institutions will, h >ctms. insure better de cision both to tlie patient and to the industry. Industrial Health Section 61 Course of Silicosis Among Workers no Longer Exposed to Silica Dust In tlie study ot silicosis one oi the most important questions whidt lias arisen is the health liistory of those individaals who have worked in the granite industry for a number of years and then left, to find occupations in other trades where there was mi iurlhcr dust exposure. It was possible during Uie course oi the study at liarre to *1serve 24 such cases. The latency' of silicosis has been referred to by other investigators. The South African workers found that **a steady fall over a ]>criod oi years m dust conccntratimi is not associated with the corresponding tall in tlie silicosis incidence." Dr. \Vatkin<-Pilchford also records cases oi miners who liad been exposed to dust lor a brag period of time, apparently sufficient to develop silicosis, but who went into the war apiarcntly not silicotic. He asserted that such cases were liable to develop tufwrculosis. doctor Fattcoast presents a case of advanced pnetiracnocnmosts in a juam miner who had been cxjioscd to dust for eight years. He liad Iicon out of the mining industry for ten years, yet the x-ray showed extensive pncumonocunioMs with irregularities oi diaphragm, and by fluoroscopc he found the diapliragm re stricted m each side. There was. {irrhaps, a lulcrculous infection intervening at the time. Hrirton rqwns two rases of workers who had been cxjxiscd to dust between seven and eight years. They changed cupatinns and had liccn away from siliceous dust ior eight and nine years. They dcvelojied pulmonary symptoms and were found to lie suffering front silicosis and tuftcrculosis. Tatlcrsall also observed cases of latent silic<*M5 in his studies: "Some of the men frock drillers), moreover, had dumped their occupation for various reasons quite apart from health, hot in dne course the inevitable dyspnoea came on. One man. for instance, worked eight years regularly with rock drills, from 1906 to 191-1. then joined tlie Army, was passed as A-l: hut in spite of his open-air life, dysjntuea came rat in 1918. and from then until his death >ix years later his illness was a typical case of silicosis." Tlie influence of dust in mortality from tulxrculosis is dearly indicated m the fol lowing table. New methods of manufacturing stone whidt created excessive dust by the us- tii pneumatic tools, were introduced in the granite industry atom the begin ning of the jirescnt century, and the tuberculosis rate has increased rapidly with their u?r. The rate has risen m direct prjKrttnn to the length oi time during whidt thev have liven em)ilnved as follows: 1.5 ]ier Wl.......................... 1890-1W4 1ll.fi tier 1000..........................1910-1914 19.5 per 1000..........................1924~193b* /during period oi our observations.) A Ciin.-idcration of the ninrtaihy statistics of Rarrc. Yemmni, shows that there has Iwen an excessive death rate from imcumonia and other respiratory diseases ftulierciihisis excluded) during this period. Methods for the Control of Dust in Industry and for the Protection of the Worker By THEODORE HATCH Instructor in Industrial Sanitation. Harvard School of Public Health and Harvard Engineering School Tlie sjicaker said in part: The health hazard associated with exposure to indus trial dusts varies with the industry and depends upon a number of factors, chief of whidt are the physical characteristics of those exposed, the chemical and physical properties of the dust, and its concentration in the atmosphere of the work places.