Document RaRxjxaaYRr4MDvbRqampZQ6X

FILE NAME: Asbestos Cement Pipe and Sheet (ACPS) DATE: 1947 DOC#: ACPS004 DOCUMENT DESCRIPTION: Journal Article i J aWt v. "Si's j T;,l'vY , ? i;V., Ot.-'V ,,J (>. : ' : *i> - ..-i g-.,cd p.-Ts Ci S iikccs. '/ c t to ouy fh-y f. ilOt'/SO .*cod. d `fey iMlO/l VP i-!S tvYhi ?\> g i the Vo out P.XM 1wy \;ike llitle ' l.,.tSki'S t: CUnis:: 'light d.'lays diere- - I >>e :ats- sing fire w . h . ut m-.-aafog to. Their spirit is willing, b u t--arid there it is unwise for us to generalise. One mail's guess "night be another man's misfortune. But in making his T--.g s it is interesting for the doctor to h in .mind that in one carefully u.gamsed test, the blaun '.-as pointed in no uncertain maimer at vilamin-C deficiency. Pdbena Blackcurrant Syrup provides a valuable supple.nentary supply of die vitamin together with its naturally associated factors. It is palatable, digestible and is particularly suitable where vitamin-C deficiency is linked with the restricted dietary of ulceration. R&ct is .v-iJhble oa Frcserlgiion doctors -uo Ircited to \nite to our : ."heal & ,,. `!'!F3t if S i : `,.n-C Tfe'.wey fs ihg;rj$ed .tynvg In- *;?>,?] :-i* se%d;tms, of fee y 'T s fe l!;cit* ih-ii'ge. .1/ } 'I ,h C"7'"V - '' C? i : i '4 'v < * ,! 7 . . ; i .. ' i. . ' " , 7 '7 7 - v ^ y-. 7-v, - -' , . v , . 'V. ,.. .... ' _ ',-.. I tok.: ..!??1 , > , ' - , * ,,V., Mii.iUt: : ^ ::?;i H A 3 c S : rA M i L MV'?: -V ' ' J t ` ,U . U 'V w r; , - . - y >\ . t- V ,N^f- .; V;tvV::? ' ;; ` .' c o n t Wo t s - .Vv ' > ' v ' x-Hge THE 'l'F.ACSUNG OF INDUSTRIAL MEDICINE ' Y.' . mH V ; ... ~ 33 CARE OF THE CHRONIC SICK ... ' ... ... ... ' & ; -: .. 31 % E. t . MukVc, O.R.E., M.R.C.S., L.R.C.P., D.P.H., Mai-jary YT. 'Waxen, M.R.C.S., .L.R.C-P,, Eimi tfw late A. R. Neligan, M.D., D.T.M.&H. TOE FUNDAMENTAL POSITION O F.R E ST .................................................... By Alnd,tr Farias, _M.D. ' ... A2r ARTIFICIAL SUNLIGHT TREATMENT IN INDUSTRY ........................................; ... 48By William JVmunont, M.R.C.S., L.R.C.P. SOME MEDICAL PROBLEMS OF THE ASBESTOS CEMENT INDUSTRY By D. 11indley-Smith, M.R.C.S.,'L.R.CP. ................ 50- ELECTROMYOGRAPHY V........................................................................................................... 53 By Gralriiu Weddell, M.D.. D.Sc. . ROYAL SOCIETY OF MEDICINE RED ADI1.ITALTON IN CHEST SURGERY ........................................ ... 55 By T. Holme* Scllor, D.M., tf.Ch. THE `AETIOLOGY OF CHRONIC ARTHRITIS, :....................... 1. ' -- . ... 55 Bv \V. S, 0. (?.j.eman, M.D., F.R.C.P., Philip Ellman, M.D., F.R.C.P., arid G. D. KerUny, M.jV, F.R.C.P. ; ," FROM THE U S.S.R, ... '... ^ ............... ... ... 58 I.**WiTHAL HEALTU CONW oSS, CHICAGO, 1946 ' ............................ 'BODE REVIEWS., . ..... ... ' ^ . .. i A'S IKD NOTfvg ' ... : ... ... '' .... ... ... . ',w/ ' ' -59* - . . 7 '60 ... ' 61- f'OR P' Df "Vi'ur v't urVE , ......................... 1 - . . .... ... 6?: - / y-:'W , V vp' :Vl 7'e. ?u- / ` `i ? : March -Apr*, 5>l47 THE BRITISH JQURN.fo SOME MEDICAL PROBLEMS OF TEE ASBESTOS ASM ANT iX'DVSTT.Y B> J. A. HlNi5>Jk\-SMH !, M.R.C.S., L.Rfo ,0 . Part-time Industriai Medicai Ojjicer, Univa nc .lida-ws Manu]enduring Company, Watford {Herts.) / I pproxlmately live years ago I was ,,.sited to ;-.kc over the medical supervision ut' an asbestos x -*-eemeni factory, situated m one oi the Koine Counlie-, and of one of its associated branches. Having no previous experience of this bidu-bv ; went fully into the matter beforehand, ar-.; fo, med that the manufacture of asbestos cement proi/aas was scheduled, as a " heavy industry " (hi the that almost all the manusacturing pi masses required a maximum output of hard manual labour) and also as a " dangerous industry ", because of the special risk of " asbestosis " encounteicd by those employed in this work. Previous to my appointment the medical arrange ments mainly consisted of a Red Cm iirsi-a d outfit in a black japanned box, placed in die clt.-rge 01 a limekeepe; who -tad a practical working knowledge of Red Cross and St. John's Ambulance lirst aid. Minor accidents were treater! and messed by him on the spot, and more serious caws dispatched as quickly as possible :o the local hospital. On my arrival I was given by the management every facility and a free hand to ordei anything that I considered to be necessaiy. iu due course ;,i fully equipped surgery-dispensary was established in the canteen block, adjacent to which was added a solarium with ultra-violet and radiant-heat lamps. An office desk, tiles and so forth, necessary to cope with forms and certificates, were added, and a full time Stale-registered nurse was engaged to take charge of the Factory Clinic. Prevention of absenteeism I conceived it to be my p n u ary objective to ieduce absenteeism firom health reasons to a minimum, in this respect I was the friend of all concerned-- Government, management and working man alike. It took several months for the majority of those employed at the works to find out that their troubles could be dealt with effectively on the spot u. -fi-r working hours, instead of the long hours oi w tumg often necessary in their oil-time in the surgeries o ' overworked panel docto;-,. Mom-ovc!. it soon became evident that the specia' r.novbdg.; of the various hazards and stresses of the work . :uch we acquired was of considerable advantage m both treatment and prophylaxis. After five years of record-keeping, it '.as become possible to take a constructive view of the most v.ramon o r tV diseases which we have to combat in ,n battle against absenteeism. These, in their order or priority, are as holloas ( i 1 Dermatitis. (.1) infections of the upper respiratory tra c t: eofo influenza, bronchitis, pharyngitis, and so for (3) Rheumatism, particularly fibrositts :u n c u iu ;:,. (4) Accidental injury, including stiains, spm cuts, abrasion-,, bruising and crush injuries. (5) LnfccUous diseases : tonsillitis, mening* mumps and so forth. (6) Specific industrial disease, in this cu. asbestosis. It will simplify matters to consider the above; their reverse order. Asbestosis Although the asbestos cement industry is schedn as ' dangerous" , owing to the possible incidence' asbestosis, I have not encountered a single ineipij case' in my 5 years' ex'-m iefice. I have come aca 3-3 long-standing chrome cases, but these date bu. to long before my time mid evidently arc static. Tiic reason for this state of affairs is obviot The T inge ..f asbestosis arises from fhe inlu.hus of ;hv airborne " fluff" of the materia), which, in r dry slate, resembles floccuienl cotton-wool. Th is only one stage of the process of the manufact:of asbestos cement in which this danger can oco and that is in the process which takes place be-.the opening of the bale, in which the raw asbe-g arrives at the factory, and its mixture with cement j water to foim the moist inert mass from v/-: factory products are made. The e'ficieuc. safeguards which are employed during the " dange v ,, 3e--such as the total enclosure of the dry asT o m a special chamber, suction ventilation whic i all the loose particles in the ah itho conveyoand the wearing of respirators by those - the process is evidenced by the fact that. tm. er ' conditions asbestosis does not occur in this C. v at any rule within the scope of my experience. infectious diseases As regards infectious diseases, tittle more need- sak ',,,< these are well within the low aver-*: be exi',,.c td f:on'. i vigorous section of the com-r.o between the arcs of !6 and 60 years, living m: 3.-r ' best conditio! i of diet and housing obtainab.e- heavy industry at the present time. Accidental injury As regards Injuries, the greater proportion are c, 50 ,U-.. - rw WsfS } }\K'%. ,0i ,o'-. e/i.iil-i rU\ ' c!bo'.v . iC'^w5 * i>. MO uu.'/. ' vc at. - UV-c U'-- U : -. Ow'- -<J " .nijc.-u' * ton, * >:. f-iv. wv.it'r cy - li a.-n 'ii:r. *Ji' =- . - STKi~: *' s inuu'U riCc. re vc.- ;; or^r -t Cu*-v--: */> * PA Luc - H iY SiCA i, VfHDiCINE Ma> e-i-A p rii, W o a - v-a-aons, ;r: r.-,,si oe expected in the bamti..i^ . h nutcnai. ir, ine old day Mich injuno were A , 1 0 be left to Nature, with hr -.: it tea, they v- endy bce-r.-o sup'.it. a the vjcums rcc iwcd ' w ~a\ aUe/tUo O nor-pieil treatment outsi-x the '"ik:-. Toe wo. c> now repoiis automatical:- to t w y y, \vhw-e .oe abrasion is disinfected :t . e ,o prevent furtrse- tv at ana e c - at wot- the whole ope on ion necessitating v eps 0 minute:, " oT the job " 'to tutisia be triMT.btfi. o.'.eciaiiy fibrosi"'-, third on the isi :iOj r.y as a c.,.-se of absentee!- m, is,is increased 1' each successive >'car of the -ar and post-w.it f, pre-timabh as a re.SL.P a he low crcy o' '''lance i.oe it; teasing fang a a id perha; n ' : T* of , ns tins carbohydrates. nte pttsi, if tt man suffered Torn rhcumafic p..ins 'sob on wot/ing a- long v, he could and rr..-n, he could no on no longer, retired to bet* mr r.,, a..vs uiVtK rhe pain was gone. Now a; me a uia mosis ;s made of the type of pain, '"in, fibro neuritis, and so fords), and 1vat1s tv .ii iiCCt'icTp). The treatment of rheumatic 'a more; m me T.iciory Clinic is designed primarily 'erceav: the cu.m .on whilst enabling the man to m work, and , ur led into short-term, medium ' o a long-term phases. j-c-',:nem--T his . ' -.sts maini; of !. ham and massage, given oe ine factory nurse, e er tiiree times weekly, at an hour which fits "est v- > : patient's work; Oncdulc. `rird'i.un-tentt tre'-aoK n , a m a sear, h ome infective Tcos. A cons.a .oie numbm of ' pauenu, . rocung teeth ot obviously se rw , I'm.^ : - 'n, , v h e , it. \ s regards the ' ' ' " meat, ag chronic .um auc patir," . v, f ann-strepiocoee: 1 vaccine in the dosage is sub-.wv'Ctive approximately .15,d s I'fTldi organisms' and doc,- not in any way -' u;.,eracnee the p.ment. [t is, of course, given y on a voluntary bas's, an ! wo hiicmstua to each year an increas'd;. ihu a cun me . for this treatment, it is wo early to artivc w fram e decision as to the piophyiacbc value of ' ' riocuiiUton, but there is every r'Tcvtion : a .s proving w Pc beneficial. trtf&tory tnieecion .a;;i respiratory tract infection is the principal 'w -i .ue:im during the first quarter of the o 'hew . 1i- remon to suppose that there is fi.'i.-.' u . found in most industries during . . . r.c, apart from the general r tincinie of - !.!.iPk die maximum degree of fitness, thcie is ;>fie cone cocut it. '.-'c pathological abnormality .s ewdem m the -'I'tirynx, smuses, and so form, requiring sur gical I d a w a 'V the patient is sati c.T for a p p a - priatc tr-.'a to he local h- .. O-hervase medical i.eatment is given or dispersed (gargxs, expectoitirt mixtures, nasal drops, mroat pm., s.v.o's, tomes, and so ory at the surnwy. . t c -a. '.v,ucii cluonie catiirrn, v. d:h or wu. tout recur, colds and sore throats. .. a faeior stock arxieaur - ; vaccine inoculation is , o-cn (;,s . : Pic case 'T v a 'a . rheumatisr'd on a ' tT cii;.'/ nasi-, it s ray prue,. . to ' `ho sat aiarct dosage m;o smab v .v . y n.j- '. . -i.nling a; approMmaiely :f,k,l} .. i.j n siii; - ..000,000 or 5.000,000 orgr.isn:s. c pv. ;. a , : pon me puficm .au1 his reactions. Trie v.icc.x ' ; '.cii in the early auiumn before the gcr.era.. ...a ft ,r, , ; . r,.,s and influenza, and in most cases the com r v complctcd before m id-N o\eintv.. l b-re again a difficult to say want die final result of lias ifioeuTt.c " against coins and enrome catarrh will be; dm the me i ne riling themsche- m mere:' ng tit.rnber , , rm ii n- hoped tii.r .. tope1'..-,'',- degree o.' nimurat;- will be obtained throughout i'-' factory. Snrfiiswiu. (ierinntitis This .'"ii lilion, wn,ch, because of is irnportanci. i leave the law, provides more trouble man tdi n : other t rases put 'cgetlter. 1; is .. sanr.e tril\ m the v ,th regard to Wo..-mser's fi'oupx a anon, .., . , - n,.. works, v-'here ffirs nave eo e -maoaed and teams real ia" vd. In die T..r-. -r . tivi.tm. . uerc is no other o>.id:tioi, >'0, -v-i.u ' so nuiu eiiviituie of time and maten in if-" .-.' with industrial dermavio' . ...edieat offic. , , ..ed upon to clarify arm regulate me fui ,V,'" i 'bVS ( I ! '.-.ise which we do not fuiiv understand ar... unable to control. '- . attitude of ' -e patient cov.ares u. , ne attitude of be management towards it. . ' -"''sent pu'W.on of the Workmen's Com- .a or, P-.i.i u ivlation to it. "nmre o f dermatitis ' .wircls the disease itself, it is evident that wide; e\'V lance of the clinical aspect :s eoaired, oy ..no 'iv.t'ing of knowledge obtained from nuno df.Yercn. bnmeiies of industry, before we can fioimula.e a cnos'-'tv, e medical policy. 1 i.i.'f dly, we i ; ud dermatitis as being . i too'i i ' P 1 ' u e tlccper laycw of me sio:i against lony--u r . i n i u i t i o n , but . iforiunaier,', although this is a reasonably sound gcnerail/a.iof., there is nothing constant about it Some Individuals are in contact vruh such , , in. 'V. a.I their lives and Aria no sign:; cf disea w others conw m de,i....otis v- uin a fev weeks of contact, /....nor group ray work i.i contact with ;h irritant for in.. ,y year- vi:fi&'.' a sign of trot.'.' , iu,; m interval occurs, whiter r.y. vary from a lev, " .'fits to a few yet.m ; but when the same work w aimed, dermatitis breatc. c... 51 vr.: -Anni, 19*7 OU -S :V I ig i on:/ ide nee rtialiy cm oi aSi'ine firs. peciiit il the howaugb ; m the i r.KS work e skm diente, by an Kero , and; owing id bo ly for .-.'.or hand, ; lz nisabiniy -fi.e to some uc/ec v! . When we add to a!i this the verec; utcscion ' ' -o i, consult! on f o r examp:.; rhci.- .no .-u . . f c.ii.'.v'i s;r.fi mfficultics of the s;.u..tio.-i ' ns corr.es coder the operatic . of Decoiti. . ;. k ; Health nsurance Act, whatever are trie \ ' .nc . sen; t.a.c industrial dermatitis is held to s i. n-.rr.nce; of r.is empioymem m me rcspoi'sibi'iiv of the employer and comes under ..oh the vast majority of disc encounter. 1 t the Workmen's i mpensation Act. -''i.u-iry, it is noi difficult to decide under if the disease l- any constitutional (as believe it oarory the (iorrr-'c should be listed, industrial 'a e.;,. employee ought be " dermaulis-prone ", wenatitis, however, presents something of a problem, or mig 1 ually be suifering from dermatitis, when SuVt . many special difficulties of i!s own. It is, he was taken into employment. Under existing <winstance, almost impossible to pi.-- ent carelessness egulations hiw is nothing to prevent rum from ' neglect on the part of the cmp'o-ce take full becoming a buoi h t/ upon the firm for the rest of his WtAiage of the precautions provided, it is almost fif'. if he can establish the claim that the dermatitis a:;t>,ssible to make any prognos. regarding the started after his employment began. 'nhabie duration of an attack, which may vary in view of these facts, one is compelled to conclude aora a few days to many years. In many cases it is that industrial dermatitis as a disease is in urgent 'drc'rieiy difficult to decide just when to regard a need of `Use investigation by the Medical Research ; fuv.cu:;,!' attack as being cured and the employee r 'cunei!, m \t to establish a system of procedure for ft to rc,.,,rn to work. the guidance of industrial medical officers, and it: view of ali these uncertainties, it is eviuen; that secondly to reeoeodcr the position with regard to w/e ,s a wide field tor exploitation, varying from the question of compensation, particularly m respect concealment on the one haiv1 'o ..'fingering on the of the " dermatitis-prone " employee. ELCXROM YOGRAPii V ust ria! if two 2ptibie by ihe" it is riabiv, i nonSptibl rimary d the i as a (latitislimscif led as idustry iUitiiect being, 's own rd : fo n Act tployce mpioysorters' - some comes isaUcn X, l, ; v . 7 ; m , / -S' / ;/ ' ' t 1 / ; ' -k: - ,/y ~fX fo GRAHAM WEDDELL, M A.. D.Sc. Reader hi Human Anaton/v, ihu \-mUy Museum, Oxford .AN 1851 Schiff noticed that enervated voluntary | muscle was in a constant state of surface agitation ^due to miiuue isolated contractions. This conffion he described as fibrillation. In 1938 Denr.yarown and Pennybacker recorded electrical actiriiv font enervated human muscies and found that . "'flercei in character from that occurring in normal '"jman muscle-,. In 194! EccLe showed that the skctrical activity recorded from denervated muscle is a ''Ault of the contraction of single nnscle UUr.'" %-anscus used !: Weddell, Feinstein and Pattle studied the -* i . .uvily of muscles from the time of denerva- i s..-j.nplete re-innervation in rr,..n and in experi ' is .i wiimalc They showed ...at a concentric -'wic electrode, coupled to a high-gain amplifier -mb a short-time constant driving a loud-speaker and '.sthoue-ray oscilloscope, can be e- pied for clinical fvrposes without any difficult-., .m-.;.,cc electrode. s'lalso be used, although, in the majority of ofiw ' a-;u reported by Weddell, co-axial electrodes ww, r `''d, For permanent records, photographs of sstiiobe-ray tube traces or sound recordings have to w Made ; the latter are the more use f :1. Ink writers w satisfactory for recording the electrical activity from denervated muscles, for the potentials are of too short duration. Action poii-mials in contracting muscle he c!cuncal activity occurring in a normal con- trac-ing Iwwm muscle takes the form of so-called mc:or-unit action potentials. They appear as rnonophasic and diphasic spikes, bul occasionally they are more complicated in form. In amplitude they vary from 100 microvolts to 1 millivolt and in duration they last from 5 to 10 milliseconds. Both the fre quency of repetition of each action potential and the ni'mber of different action potentials recorded vary ..wording to the strength of the contraction. They are heart! as low-pitched sounds, it has been obscrv cu that, in man, no action potentials can be recorded from a normal relaxed voluntary muscle, although they are aroused momentarily during the insertion of the needle. Fibrillation potentials in denervated muscles fine electrical aciiv.ty occurring in cienervated human muscle, on the other hand, takes the ,orm of a .scries of so-called fibrillation action potentials, i'hcse are of two types: (1) those aroused by the insertion of the needle electrode, and (2) spontaneous 53