Document RjLw6B01pQGY1rOrGbE7VaqOz

FILE NAME: Chrysler (CHRY) DATE: 1937 DOC#: CHRY164 DOCUMENT DESCRIPTION: Journal Article - Industrial Dusts and Lung Diseases IN D U STR IA L DUSTS AND i.UNU D ISEA SES AIcCORD The following instances were considered 8. The maximum number of sections in as attributable to the operation: any one patient in this series was four. F e b rile p u e r p v r h i m ........................................................ 42 Puerperal se p sis............................................................... 6 W o u n d i n f e c ti o n ............................................................ 14 P n e u m o n ia .......................................................................... 2 P u l m o n a r y e m b o l i s m ...................................................... 1 T h ro m b o p h le b itis ............................................................. 4 There is a 17.8 per cent maternal morbid ity directly attributable to the operation, other than the usual postoperative febrile reaction. Summary As a result of this analysis of 158 abdom inal cesarean sections the following points are considered significant: 1. The panoramic study includes the ear liest case recorded in the University of M1chigan Hospital. 2. The incidence of cesarean section lias increased from 1.6 per cent prior to 1924 to 2.5 per cent since that time. This increase may be accounted for by the fact that cer tain cases of placenta previa and abruptio, as well as court order for sterilization of feeble-minded pregnant women are now ac cepted as justifiable indications for opera tion in this clinic. 4. The most frequent indication for the operation was cephalopelvic disproportion. 5. A combination of indications, which singly do not necessitate operation, masforce the issue for operation. 6. Since 1931 our preference has been for the low type of operation. 7. In the entire group of 158 cases, ma ternal mortality was about the same in the low and classical types of operation. 8. .Pre-operative physical condit on of the patient is important. 9. Integrity of membranes is important. 10. Elective section carries tin best prognosis. 11. Sepsis is the most frequent cause of death following cesarean section. 12. Corrected fetal mortality was 8.8 per cent (absolute-- 12.6 pier cent). 13. Corrected maternal mortality for the 35 year period was 5.06 per cent (absolute --6.33 per cent). 14. There have been no maternal deaths following cesarean section in the last four and one-hall years. INDUSTRIAL DUSTS AND LUNG DISEASES* CAREY P. McCORD, M.D. The Industrial Health Conservancy Laboratories DETROIT, M ICHIGAN T h e lungs, as described in Chinese medicine, "have a fishy smell and a hot Caste. T h e y store th s energy and are the seat o f sorrow. T h e lungs produce the skin and the hair, i o n n the kidneys, and cot trol the he art. T h e y have the nose as their opening, convert the fluids into nasal secretions, supply the s sin, and nourish the fine hair. T he lungs are attached to the third vertebra and hang down in eight lobes. They are gray in color and tire pierced by eighty small holes." Whatever may lie the fallacies of these statements, many an American industrialist and many a worker willingly will accept the Chinese doctrine that "lungs are the seat (>1 sorrow." Every work-day in this country approxi mately 500,000 employees go about their duties exposed to silica dust in harmful quantities. This number is distributed over at least sixty different occupations, includ ing, among others, foundry workers, core makers, granite cutters, rock drillers, sand pulverizers, sand blasters, and vitreous enamelcrs. in addition, fit least 2,000,000 other workers are employed in dusty trades in which no silica exists or wherein the quantity of silica is below that capable of producing that form of pneumoconiosis *Reacl before the Section on Radiology, M ichigan State M e d i c a l S o c i e t y , D e t r o i t , S e p t e m b e r 2-1, 1936. known as silicosis. 'These workers may be found in coal mines, limestone quarries, car bon black factories, glass plants, iron mines, coke ovens, gypsum mines, seed and grain mills, pigment: factories, zinc smelters, lead refineries, ;md on and on through scores of other work places. As one becomes familiar with the extent of dusty trades, it incomes amazing, not that there is so much dusty lung disease, hut that so little irises. All of the many scores of industrial dusts entering the lungs in harmful quantities may he divided into four classes lor the purposes of this present discussion: 546 J o u r . M.S.M.S. 1. Dusts that enter the body be wav of ibt hmys without pmduemy their eniei efieets upon the lu,,u-s p,v uav or examples oi tliio type may be cited lend, arsenic, merenrv, and manya- nesc. ' ' S? !C0S!K- dust silicosis," c 1\Vd n - jcosis appears i,, the coal miner, wh 1 i si r n ; l;ini0n'. lt he attributed to tlm - Dusts \\ iiicli, alter commy in contact with the respiratory tract, includiny the limps, lead to allcryic ireanitestations- -'VIready this has been covered seal ns 'w in ! /l -- 0vtrblmlei1 of the coal self To - S ,S tnie' thc TMal dust iy 1i<U's an ' 'Uportant role in acccleratin> 11 C `'dDyanmee of the silicosis Anthrieo' ,)V 1)r- 'i'uwey, and need not be dis cussed m any detail here. 1lowercr, D' " aY of easual ex.aniples, near be cited pyrelbrum, leather, cotton,' fur, and many dyes, ol winch paraphenvl- t endiamine is the best: known. ' a. Dusts wliich enter the lunys and be m y D,mdicnts_entermy mto cement. While Un.s is true, it i^s o-irmtiTl tt|lwialtf cement- lvni-t1 IS may pie.sent increased quantities of lihro- come the causative ayents of imme silic'1'' '`I1'111 lrnl the STical features of diate inflammatory reactions. This SiQ ;UKl attributahle to dusts other than Dass embraces such ayents .as soda ash, lime, acid and alkali dints, and obvious others, such as resins in dust iorm. Mineral dusts other than the two me,,1 1 V 01 comparative insiynilicance -.s sources ol disabliny industrial hmy 4. Dusts which, after enteriny the lunys, m't up inactions that eventuate in the production of iibmsis.- - the so-called _ iibro-yenetic dusts. . lair ladv f l:,,llc il k necessaiw to limit lurtner discussion to this last-mentioned py,uD Also- lor die same reason, onlv the brie test mention mar he made of anv aspect ^ the damaymy properties of silica dusts be 'Uh;traialy rated at 100, then, with the ex pLptlon 01 ashestos, most other dusts nny e i epiesented^on this same scale hv 5 or 10 Amony these a per cent or 10 per cent dusts inny lie Ion,id aluminum, lamp black as' I laltum, wdntiny, titanium oxides, yvp'smn coke -lmi coal. O n the other hand son e 01 rhe acllon of diese dusts or the condi tions in industry under which limy injure arisen. * Ik r t'Ki ^ CXen.`lddied chiefly by claw's,' mav ,(1 S().n!L:whilt hiyher and perhaps ij, J - i:, 01,der ol l a I,er rent to 20 per cent pos . 01 alI.ithe mineral dusts leadiny to limy i ijuyv, suica and asbestos onlv stand out as ' 1J -V. ,Kf ause of the content of free 's lieu "ath ^ silicates, and ,w w SOll1rt;cs 0t direful hmy disease eharaeter- !fC<l ,J-y e-Xtensive hhrosis. Associated with diese mists are the respective terms "silico- ' ' `ln< asliestosis. Roth are lorms ot pncmnoconiosis, which term. Iron, its very to applicable to any deyree of ab i 'p' die Innys produced hv anv ,, "c\ci, many pnieunioeomoses are |01 asMluated with unusual ipiantities and distributions of f.hrotic tissue. eate<sopv latih,deru nthasn,1evlsl(e1whheerep. la- d - tSs ,, ,, o 'TM conceI>t that most dusts are inndduussttnri.aill1eo^-iurhrtionCst:natsasis dqaunayretrzoussiliucandeirt Hvcmnes mlcsah,e to abandon such outmoT U,lla as suk`i-osis, aluminosis, chalcosis livssinrisis, anthracosis, as descriptive terms d siymiicant pneumoconiotic disease. c "i K0Ma ls. ,l openin' disease, widely de p,: as' a disease due to breathiny air runwpp^Miu'a (SiCh ), characterized anatom- p p' keneralm.ed hhrotie chanyes and p(..i i ^ ()pnicnt ol miharv nodulation m C n t h T ' and ` duieallv by shortness of capacity''tf<' u'ast`d rllcsi expansion, lessened S . i<)r 'y(aA- ahsenee of lever, in Or aji ( yHy D'tilulity to tuberculosis (some and In-rl " 1Kk s-'lnIll(|nis mav be present ), o tnaractenstie x-ray finclinys." A1ani- nCCCST, 1<),)7 ' (Illt ,K;Sn SiS as <>nc 0f tw<) outstandiny in dustrial fihro-cnetic luny diseases must'liere w dismissed with the cursory statement that uul Is'a - UpSC' dy x o'ay manifestations, ' 1(s association with tuberculosis are all sf Slnil,a r t0 th Sa rharacteristic of Ihe period^ of exposure re(|ui.site to the proihietion ol a demonstrable silicosis wti r T m a -few nionths, such as two m,hlCC; tn a htetune of seventy rears. Raref. when the exposure is to essentially pure 547 D U S T S A N D owe, JJihhASKS --U :U JK D e material on this pope was copied from [he collection of the National Library of Medicine by a third party and may oe protected qnartz silica,_m minute particle size ramm an acute silicosis may lie brought about which is atypical as to its clinical course and particularly as to its appearance on the roentgen fdm. Such were some of the cases m the West Virginia holocaust; such also characterized some of the cases in the New Jersey outbreak occurring live or six years ago. In the causation of the more nearly typical form of silicosis, the period of ex posure is likely to lie between seven and twenty-five years. The time element is great_y influenced by the percentage of free'silica in any dust, the size of the particles inhaled, the hours of labor, the arduousness of the task the age at which the worker entered the trade, the size and shape of the upper Sex appears to play no part in ,;,K... kdity although silicosis in the v-m- g r - )CC; J f e of failure to enter du/Tlades -1he negro is perhaps morc M,S(! iWe than other races, while the soy miopean is by some regarded as d v' ' eeptible than other racial types ' is disputed. ()t more importance possibly y r other (actor except exposure to sine ItbC 1 ^previous exposure to less i dust. When a workman in a silica-.,dustry earlier has been employed J miner glass worker, gypsum worker a worker m almost any other dusk' , aI,l,ea.rs Prone to acquire silicoW respiratory tract, particularly in respect to the vibrissa;, and, to a slight extent, by the lace, b very one of these point might be made the basis of extended discussion. However, only one statement may be made with reference to each. Some other minerals associated with the silica dust appear to retard the rate at which silica exerts its action, among others, iron oxides, gypsum, some clays, and possibly al kalis, although the last is disputed. ' I he size of harmful quartz particles is Sh0rtcr and under conditions m lf exposure than is true for a man wif;T such history. This is not in conflict 3 the prior note that the simultaneous loom n*U o| mixed dust apparently tend-: n" tard the action of silica under some , stances. The very interesting chain of mas lowing the arrival of silica in the fin -is a matter for special presentation I who follow m this symposium, pan the pathologist and ia entgenologist. believed regularly to lie below 1(1 microns and probably below 5. Obviously, the size must be such as to pass through the smallest: entryway into the lung sacs. Also, the size must be such as to permit phagocytosis, al though this last statement may be open to question. ' tllc outset of a. limited discus.tie clinical manifestations of silica should ^he emphasized that much 1, uance is to he placed on such feutunupon work history, x-ray exammatim autopsy. Well-established typical silic: demonstrated by the x-ray mav he found it hong hours of labor, particularly when associated with hard physical tasks, may in crease both the depth and rate of breathing and remarkably increase the amount of dust entering the lung. Due to fatigue, the last hour of any work day may at times lead to the inhalation of as much dust as all the preceding hours during that period of work. the probability of acquiring silicosis in creases inversely with the age at which work was begun in any dusty trade. It follows that a youth beginning employment at six teen is far more likely to acquire silicosis, other things being equal, (hail a workman who enters the same industry at forty. This statement is so true that if all of us were to live a lifetime of 150 years or thereabouts, piobably most of us would acquire silicosis from ordinary exposures --- from streets, schools, homes, farms, dust storms, et cet era. ' 518 a workman without a.nyv complaint o1 l ilSfl coinlort and who, rr r a''n ph' ysical e \ o inil nation, presents only meager evident-VS ;lf Oil aatbonloorgmy aalintyd. clOinnicathl ee olathmeirnahtaionnd, msavvm1!)*d Hoilll great worth in diffen .hinting between !ll v i'l'J-l pie silicosis and sil: rosis complicatet! ]>)' oilier aflections, usual ;r tuberculosis or o tl icr] in ]ections. I lie cardir al sympton of silICO s iS ; is shortness of breath The cardinal siJT. is diminished chest exp nsion. In the I.WI;ly stages oi this disease the silicotic ten S to put on weight, which wssihly is due to Su limitation oi work exi rtion. Should In: i;oil to put on weight, secondary in feeLIOH should he suspected ' he d e m o n . s t r . ' i i ) . 'I ! 'oi silica In the urine on a qualitative ha-1.' ' L of no value. All persois present silica ni i! O' urine from the mgestiin....o..i this s.u.b..s..r.a.n cc In food Ouatiiitaiive delerniinations m; ol some worth. I ain in the chest c r history that Ol 'll. O') o INDUSTRIAL DUSTS AND LUNG DISEASES ... McCORI) o O c in susceptifeniale is ' the dusty ore suscepe northern is less sus- This also than any silica dust ss harmful a-using in1 as a coal rker, or as -isty trade, has been present is common. Pain when present the same features in victims tor all present is more often localized in the mid trades where exposure may 1w provided. "O portion of the anterior chest, but may be Ibis is not exactly true. For some unknown CD O anywhere, in those patients suffering from reason, the silicosis appearing in different CD p dyspnea, dizziness may be encountered. trades is slightly different, particularly in cl When marked fatigue or weakness is de its capacity to produce disablement. The ACiDd scribed by the silicotic, at once suspicion foundry-worker at 45, with a moderate de <fo' should be developed that secondary infec gree of silicosis, probably mat finish out "O tion is present. Occasionally fatigue may his work span without his silicosis reaching <d arise from profound dyspnea and may not a disabling stage. This is less likely to he (d be present when dyspnea is not marked. true of the gold-miner in Canada or the o Night sweats point to infection, as does also sand-quarrier or the sand-blaster. In gen -p elevated temperature, which significantly is eral, however, it -must he recognized that CD absent in simple silicosis. When sleepless silicosis, once inaugurated, tends to pro .Q ness arises it is usually associated with un gress, and practically never recedes. The CD cosis in a ns of less favorable progress. Sleeplessness may be differences mentioned as characteristic of O Lo associated with coughing, but, on the other certain trades are largely ones of rate of CD .n without nflict with ms breathnds to re ne circum hand, coughing is not of universal occur progress. O rence in silicosis. Years after the cessation o: exposure, CO ratOe nisplhikyesilcyaltoexbaemninotaetdionasthinecrreeasspeidra, tobruyt asiplpiceoasriasncme.ayApnut-initnerviatsl ofifrsstevreencogyneiazrasblies d'i not markedly so. The chest appeal's to be not remarkable. To o fixed and on palpation is lacking in reso The average case of well-esta dished sili oil vents fol- j nance and elasticity. The information ob cosis, such as represented by the onset of CD lung sacs a by those toatihneerd dthertoerumghinaatuioscnusltautsiuoanl,lypefrcauilsssioton, parnod dseisvaebnilyiteya,rs,raarnedlyinlitvhees gmreoartemathaonrityfivoef ionr o articularlv vide any true concept of the pulmonary stances death may be attributed to tubercu o t. ' j condition. In part this is due to the uni losis. 'Cardiac involvement is not. prominent (D mssion of { ilicosis, it ! l less re- j formity of change throughout the lungs, and, in part, possibly is due to a periphery of emphysematous tissue, which tends to as a direct result of silicosis, hut pneumonia superimposed on silicosis is of common oc currence. :ures than j mask evidences of deeper-seated conditions. [Medicine is confronted with unusual dif itions and The possibilities for confusion are hut em ficulties in establishing the degree of dis silicosis as 1 phasized by the observation that a marked ability in silicotics. Accordingly, difficult oCD found in degree of simple silicosis may evince prac problems center about the management of G(OO it of disd examidences of tically no evidences of deviation from the the silicotic as a worker. A moderate de CD normal, while in the very early stages some gree of silicosis is no bar to continued em CD. CO cases may present rather marked departures. ployment, provided further exposure is elim Cl CD svmptom- Silicosis is prone to be associated with inated. However, in every instance, the vic vneaeynbesiion-f {_ tluosbiesrcuolrosiost,haenrd,ininfecthtieona,bsesnilciceoosifs turbeeardciuly toifmtuobfersciumlopsleis.siliUcopsoins tishea apdovteernttiaolf vtuicbteimr 7CdD cated by j demonstrated by the x-ray may he quite free culosis naturally the medical management <d E s or other Irani disabling capacity. Silicosis may ac is closely related to that of tuberculosis un CD f silicosis tivate antecedent tuberculosis, giving rise associated with silicosis. al sign is to the term tubrculo-silicosis, or may he Mindful of manifest shortcomings of a the early ( followed by tuberculosis, leading to common discussion of silicosis so limited as this has tends to usage of the term silico-tuberculosis. It has been, an attempt at amends is made In ,e to self- been observed that silicosis associated with directing the attention of those who ma)- be Id he fail d nfections | tuberculosis is of low infectivity, and that interested to two recent publications. First, the families of silicotics may not show a a hook entitled "Industrial Dusts," by ration of j Drinker and Hatch, published by the Are basis is ' higher frequency of tins disease than those draw Hill Took Company during the past ica in the 1 of workers in non-dusty trades. However, few weeks; and, second, a smaller hook en 'Stance in j this matter might well he the objective of titled "A Second Symposium on Silicosis," mas- be \ further investigation. growing out of an institute conducted in 1'hus far in our discussion we have con 1055 at the Trudeau School of d uberculosis bat pain : sidered silicosis as a precise entity likelv to at Saranac Fake. M.S.US. A u g u s t , 1937 549