Document RjX9x2ZJg5XG8QqMwbYRbYzJv

FILE NAME: Boilermaking (BOIL) DATE: 1934 DOC#: BOIL021 DOCUMENT DESCRIPTION: Journal Article - Pulmonary Asbestosis ~~ . -iVm'~w>-r f o '-`^ i --->.1..'- T^-Ir'Tt r^.'*rLVf*V^V TH LANCET] )!.:>....... ..........i *W7 |1 ----p " I ` B j rWOOD A X P 1 ^ O j t p Y y E : P C lX IO X A R r A SBE ST O SIS [s e c . 2 2 /1 u3 ^ ^ 3 3 3 H weeks and m a y t hs others pulmonary tuberculosis. Tea __ _ _ ,, c, i U i tk* .dvantag*. - unhappy r a proper -ontinuooj dreamless, lly happy four tim niy wake* is. > both too .bitnal use for is in ` tiens. la of asthma riven such r attack, y case to paroxysm jJ hbeealh^ret setedd bby tthh1e0 metfiod^^continnm tar^^naiTnr 1 kmjooccnui>row-wh-hiicph IT fircstf uiesae^d aoKb^orrurrt8a i r e 0 needle isMrept in position with a foil m i/ and after . an initial ejection of a dose which is lebdwn to cause no impleasaift symptoms, one or iriore minims axe :J " J" 4** eveir X 2. or 60 second^according to the \j reactiohKthe rate bei^Tvaried until it is 1 f>v,, frequently the infection can be made ,' ?wvu s , tlachnycaarrdaia orr\othh<p*r symmptomm arisinng. The Jj injections are c o n tin u e d ^ n e c e s s a ry , for even half 1| an hour or moorree;; rleelfief ef^i^RjtWayss follows and generrally manifests itself b v f.n .v .. ;.7*5 - 7 Z Z t h - l tBeU hL / v pa4% faUing into a deep days' " y * ke had ^ r sev e Z ri . ^ " P ^ a x i?^ ca a also be most efficiently treated ij " Jecting which is far :-3 f e^ T tlV,e thsLa occasional injections of larger H adrenaline is always at hank w h e / a 1 patiejrt is given serum or other treatment, which -, i'<j ^ t p ^ S l71" 1" re" ti0 ' '* " * ! " obSoU bSSes1*^in ftvh-eVes'p__u.AtuJm1 h. avo tuberci ' 'M i and I n * m a o ^ r ASBESTOS75 W IT H OBSOLESCENT X U B E B C U L O S I3 . t h e 5 female8>* This group emphasis reaenvate^d byobassboelesstcoesniqt tutbte,TMrcu. lo--sis is, not unoe^issssatnniivv M mal | L j ,' Three cases have been fatal n , , : 2 females) ; of those still under observation t s s t dS S "f d heaJed aPi" l tuberculosis, with sto C T .the-*?*??m ; and 4 caBes (3 males, l femate) h a ^ b e S t? ! " bodjes P^sent in the sputum and radioJan ^ s h Z TM obsolescent tuberculosis but L ^ ^ S r " 10^ bUt " de" ^ a t ^ - g a ^ Y--- doubtful cases t i o ^ A ^ K A0188 l 6 mttlea' 11 fem ales) u n d er observa. bDuZt t thb^e d rdadTioogZram0 sh aaVr6e 8umgdf et8etrlmveinOa tpe ,t oamn da wa nitdhtigtTMn , exoe pnons the sputum , where a v a b l* c o ^ L Z asbestosis boches. Of these exceptions one has indefinite 2 S , b lrt i S t e e" Pfa^ 8em a- " d negative rad io . ^ toSU bodies are present ; the o ther ha* b u `^ "oe p" ^ " r,to eTM jxysm the he sympa, overcome PULMONARY ASBESTOSIS REVIEW OP OKE HUlTDEJED CASES d itiiu "be inhai, ramoniuzn ?rvsj r b dd 'V__ r p balance j] Br W- BraTON WoodM-D. Camb., M.R.C.P. Lond.. 'j D T .H . i S = 5 = " 5 - S ' --------------w w .-fA A iim n j, L T rr H O SPITAL, VICTORIA PAKE ; AJiD S. R oodhouse Gl o t t e , M J). Leeds, D .P.H . PATHOLOGIST TO TH S HOSPITAL f s i^ s s r s s s w * t h e CLEN'ICAL PICTD EE The picture of pulmonary asbestosis is that of a pneumonocomosis occurring in a facto ry in which few precautions had been taken to protect the workers n m ` danger, the gravity of which was not realised. H appily these conditions are now a thing of the n w \ n *velaboI? te Precautiona i ^ e been taken to protect the workers. There is thus good reason to believe th at th e disease is now under control, though uT,dem?hPr0,.?ble ^ at workers exposed to the dust tmder th e old conditions w ill continue to present themselves for examination for some time to come. There is no need to am plify the descriptions of pulm onary asbestosis already given elsewhere. The ` he had ion at the ea rise to :aiised by oat prefer does not langer of cases the ciency ia preparako reprooccas'on idi vis--ual -adcr the emotion -Hvrtt ioa A^cs, t be i adrename when mmat ion crea ai ine d ia ok im moti- -nte ;;cv of bYCU A in which .S C i'fS fffS J 3 SSsi AHAETSIS OF cases Our cases m ay be divided into four chief groups. l -- PULHONAHY a s b e s t o s is Futy-three cases (19 males, 34 females); 12 deaths m ales, 8 females), including 2 with carcinoma of the S and 1 with a ew deposits of growth in the pleura. the cases still alive and under-observation agnosia ^sts upon (a) typical appearances of the radiogram, ^h ^ p t o m s and physical signs of fibrosis, and (c) presence (asbestosis bodies m the sputum. These three diagnostic ? rn !ar m crder of m erit- Twenty-four cases <i?l f e Z i 5 ieCnAe,) Wer Psitiv8 on aff tliree counts ; tarn. en\aie*) had positive radiograms and clinical symp. .I ^ B, a? ' but no sp utum w as a v a ila b le -- or if I W , ,, 6 f &saesUizls. bodies were found; 9 (5 males. iodic. 8ava P 3ltlvo clinical signs and asbestosis -ps- ,, ,, , re m the sputum, but radiogTama were tase ^fiS C I l1fatvrmnanUOIaaabt\ lKve eoJJ r _f_a__i_le_ id- to 6shno,Ww ddeelfminlittee ee, vviidd.eennccee oo. ff , J male) bad a positive radiogram and asbestosis e Sputum but no clinical signs or symptoms. work in th e morning - S t h e a t e r f t? t0 of undressing or even th e effort requiredSf n V ^ " i c a Ys e . t h e Patient to pant for breath When ^ , ! f i S1S 15 com PLlcated by tuberculosis, broncho P^eu:morna or other thoracic disease, the symptoms f theie wdl added, but th e d y s p ^ a of p n e ^ Z noconmiosias can stilflf as n ...i,, c . ^ pneuMmuof-f nutrition is v e ry evident in the terminal m o n tS T i h e i ! P eQt m ay paSS b t 0 a co" d't(on of extreme d ia g n o sis When a new disease is under consideration the salient featu--re -a-r--e first ,,o1b. served, and diagnosU TrS1rVpbl,*eu~,,ns-. dpshthonisisthwe asrefc-oorsgmn`."ietri`louynu Uofi onlv ?rosa s1ymi ptovms. Ww ef pnoto.0w" 6diLag'ni ose incipient " a t a Ktie -n-s. .v, nt --- --------- - -^-n ^ - , ,a t k Pa t`ent is healthy m appearance, Ca 3 <4 males, 17 females); of these 11 ^Pvpm* S ^em^les) were fatal. One had a tuberculous - a, one a pyopneumothorax and lardaceous dueare, . upon the eZ m om 8 and n 7 7 t ` depend disease. \V e h are nn TM a-5 a m re or e&4 cross durin^ lifa *>, * eans adequate to discover mnn., Wa th e existence of th e finer degrees of 'A < ^ :: 1 J334 r a -^ a tl U K . w . b . TOOD ebb, s . . e b b e stos,s [ d e c . 22, 1934 s ^ ^ ^ E sa s`s i ^ S f s e ^ S 3S ssysr" < "S on1^ * & " " f th e present tim e we have to rely S t a r t m 7 ^ ^ + f ^ f P SUr6 to " bestos d u st as o Z starting point. The symptoms described by the no t m a7, Bnpply a clue' ior the malingerer7 does TT hhiiss i1?s dce?rt0atintlyV,aoilftet0n Ctrhueec,k btuhte w^e hTavoe fn ndwisAe l3l*r' patientB whose condition appears to have tpm eea a ta fo n a ty since stopping ,, , h . t " ' " S even serious dam age to th e lungs is not i n c S p a t i f ^is pprorvoed^ bUy su^ch^ ant0elexraambpl7le caosmtfhorattabolfe \ abOity. a m t6heeX S f e t i S S e t ' L l roggestive but never conclusive evidence? T h ev h re those of a basal fibrosis, and th e fine nature of S I pulm onary scarring is indicated b y s L ^ c r a c U e s of e S U m lar? 0 t}?086 often h e d o v e r^ h e bases v maLtvUS lungs- More raPerficial crackles o^+ed movements of a damaged pleura TM ften the fibrotic rales ^ P ' J L i ad" graphio Picture is that of a fibrosis of field*7? ? affecting the lower two-thirds of the lung &ii*z,"sr s m t . a. apical regions of th e lan es w . ? ? TT except r"8 ie m d . patient, at t ! T g ,, n 2 ,,[ D , / v S ? * l i 0 * .period ot tw o and a h J t r ^ i X ? m ent as a spmner had retired to get married. t v J II years la te r symptoms, signs and ? ? enty supplied convincing proof of pulmonary a s W o riT ? ; : dS i f e of f e r i t y , and a s l e s t o ^ W * w ere readily d em onstrated in th e frontTMTM tj? despite some disability th e patient w f f L f f S d id ? i entitIe her to com pensation d e T ria herself as fairly comfortable, and she was stiil v obvions th a t a nhy0UpBaet iheonldt dwuhtioe8b-etrIat y*s nsvomneu ttohme* ! m fibrosis or m any evidence of \ Z Z S T Z 1 b a ^ r f t L P ff^Phragm atic shadow censors the Oases of th e lungs, and m a radiogram tak en w ith th e ordinary antero-posterior technique as much as u ,T , J f " tw o inches of th e lung m ay be blotted o ^ n f " * " " > t o w wWv, i? 1 g h y a Iipiodol injection, th e result of s u p r a ^ p h r 6^ ^ ^ ^ th e T u ^ g r? r? " rr "? X ~ k o ? o 3 "y oi f n i t n S S oeptic bronchitis, broncho-pneumonia. anH S S 2 .5 2 T S S fd 2 1 .i-^ .bo7 5 , " "ed" '; th e lower portion of th e rig h t u p p e r - lo b e coixe i al E ontgen Society D r. L. A. Rowden ^ S t e / o u t t h l t V m?ra. f e n d e d view of the lung b a S i can be 5 f c g j S W f f l5 The exact diagnostic significance of asbestosis bodies in th e sputum is doubtful. A s 'p o r te d out b y one of u s (S . R. G.) th e form ation 7 i Z e s t o s t body is evidence of tissue change. W e c S t assume, however, th a t the expectoration of aTew asbestosis bodies implies th a t pulm onary fibrosh ha? th e problems of diagnosis and claims for compensa tiou would be simple. Nevertheless the m S c o v e sometimes reveal commencing fibrosis in W r ' ^ here ant6;mortem radiograms failed to S T e l t ^ a S d|The asbestosC ^ ' COmEENTS ' Occupation.-- An elaborate analvsis of nnrm^-r i ^ c to r n u n o t p o ssib ]6 m th is h o rt d L irT h e ^ s^ m /S to iT 1 -b e .^ the following departments^! s S n ^ i .e" ployed " m attress making, 9 ; carding and o V n i J T i " 5' j miscellaneoiis or unstated 1 q gv, beB,, thBir e ,, p l o TM 3;,, is now no longer perm itted under Home Offiif ' ? tions The shortest exposure w a ? ? " cases) an d th e 'lo n g e s t 15 y ears. m o n th s .(two The 33 men came under several categories i w two-thirds of them were employed ^in factory as the women and h a d ^ rfo rn ^ d a of jobs. The others included ddTriy L n l ? n was himself the owner of a small factory' a v m K ^ aged 1 8 , whose spare tim e during two a n d ? h ii! h7' p lo p p e B t hd been P ^ p fw S asbestos m an open y ard , a middle-aged boiler riveter who had served his apprenticeship As a youth in a I . i r t o l.n d 'h ." " " f l j 5SiB ?'pipe.." d t ,,T the men the shortest exposure was 11 nonthTdhf J yeeeanrst s(cAlelrieciaTl arndb ' a" d,m1' i-n"istdrative work) Fo*ur of tb e^ ro n p be-an tbeir em p to p n , J , 4 " ^ h S ' t S f3b s u S c ie Ui * n" " n e 4 r i y # rsaydmiopetro-mims__o rn rclwinicals Snn6s oorr ^abbnno^rmr Ta lTsVh a?d opwros diuncae g r we might add to justify compensation. PROGNOSIS a s ? ! c U ? ^ ! 5! - ? 33 0nly been re c en tly recognised m ay reouir^ ^ our Present ideM on prognosis sta te d t W " offdication. In a previous article we nat th e cessation of exposure ,to asbestos p t r " 1" < ^ k t e X -- 1 u a , and u f f i S S E , J w ? S iBs We ax for perm For a its beari: exhausti 1* Giorno. - '* V o o d . 3. ilerew e' &nd lv SURGI. COLO 3 r A. kSStSTiXT T O p >x: SUE apart""fxc ffitts, anc 15 weal as group tht abdomens A parotom however, d isp la y : Neoplas: Cou3 'dise Paper, wh ffom abdc S p o rta n e a^sociated LT i : a t i v e c p ro ^ o n io n e ^ 1^ e i d in preaivertict ca ^Ur 5rt, H 2 i I, E LANCET] M R. A . L . D 'a b r e u : SCTRQICAL a sfec t s o p t h e sp a st ic colon [d e c . 22, 1934 1 3 3 5 - . 1 , u' ononuc'ear phagocytes and asbestosis giant cells ^ * j followed by the formation of a reticular fibrosis.* rid io lo n c il interest, an a tte m p t w ill be m ade to _y eace lent nie* the the used -ine, Tenty urea A Of dies 3ot i of ihed able us s of dis- fiaaasty atry, tiOQ Tuberculosis and Asbestosis.--In a previous article 1 aling with tuberculosis and asbestosis we recorded cases of active tuberculosis in 57 cases of nul .onary asbestosis (17-5 per cent.). The figures haTM bow reached 21 cases of active tuberculosis out of 100 (->1 per cent.). It must be home in mind, how ever, that these figures do not indicate th per- . tentage of cases of asbestosis with tuberculosis in the industry. We have been dealing with a group I mostly from one factory, who were sufficiently ill I to seek advice at hospital In discussing this ques. non at lengthy iferewether * considers, after a review af the whole industry, that the data are too frag-i ne^ary to be dogmatic at the moment, but that J vhatever the added risk of tuberculosis may be j is asbestosis, it is less than that associated with J.. nhcosis. We hope to publish our material on this fubject at a later date. Complications.--Apart from pneumonia and pul'i nonary sepsis and complications arising from tuber culosis, there have been none definitely attributable \ i iothe asbestosis with the exception of two instances j oi spontaneous pneumothorax diagnosed by X ray A " d apparently unassociated with tuberculosis, which fi ^j_aVe beea dna to tlle rapture of emphysematous establish spasm as an im portant Etiological factor m \th e form ation of diverticula in th e colon. The ^ q V ie tin g th o n g h t th a t surgery, apart from dealing ^ t h V om phcations such as obstruction, perforation*. abscesW ormatiou, and fistulous communications i l - a dan=erous operation for the cure of colon diverticulitis, makes investigation of the earlier predivertlculax sta te of trem endous importance pA dv" C" V f. th e knowledge of th e mtiology may If h i Ve treatm eat to be emffioveZ S A," m p 0 rta n t factor- th e adm inistration of beUadomk m suspect prediverticular states - be of great v^lue as a prophylactic measure. SPASTIC COLON Spastic coloV is a well-recognised e n tity / D r d/ T atten tio n to it in h i / book a ten(W hard. cotitracted colon inay be palpated in patientsY hom I u&v grouped intc* th ree classes. j (a) The com m onest sufferer is described by Dr H ard y as being `\t-he em otionally unstaiffe tv p e of m dividual whose edion is unstable also." / Often the p atien t is a nervous female, thin a n i unnanuv, perennially dyspeptiA ailing and constituted, through whose thin abdomen\ the racing aorth and a hard =aieiC. [j We are indebted to our colleagues at Victoria Park oui- d 'or permission to quote certain cases seen by them, 'ail M- v a account of pulmonary asbestosis in all d " beanpgs the reader is referred to Dr. Merewether's 2 exhaustive paper.* rionil t d L, references ! ,L ^ Oodh!)^ 5: Tubercle. 1933. Ht.. US. 493, u d 5S0. Wood. W. B., and Glome, S. R. : Tan Lancet, 1931.1J.. 954 Iand''32.er' ^ ^ ^ : 1333- 34, i t ., 69, 109, tender colon can be palpated w ith ease/ Radiological and biochemical examination discover an active tonic stom ach w ith pylolospasm and h^perchlorhvdria. I have no evidence, nor do I think, th a t these natients proceed to diverticniir formation. Thev are frequently m e t w ith in th ^ surgicayout-patient'room it is no place for them anti they/tenay surgery with groans and a constantly m W easn/g lis t of symptoms. .More th a n one has u n d e rto n e / pyioroolastv, m any appendicectom y, w ithout th e /le a s t relief of t h B.V dyspepsia. \ ^ 2. 5 ; and : hem fiich ruls* (two bout same fifty who l>or. can' .rrrd rrur in a ami . -to long ir i f ih- St^RGICAL A S P E C T S OF T H E S P A S T IC COLON AND THE PREDIVERTIGULAR '4 \ STATE* ' j By ^ J1.D. )irm., r .li.tJ.S . D ig . iSlSTAJCT IS ` 8U S01CA L U N IT , T H E W ELSH NATIONAL SCHOOL OF M ED IC lk , THE ROYAL INEIRMART, C A R D m F/ 6 UBGICAI ^REGISTRAR, T H E GENERAL HOS ' BIPJJXNQHAJd . I I ant p a tie n ts d iffe rin g from co}6n dysfunction ipart from p rovedV sam ples of cafcinom a, diverticlitis, and ulcerativeY olitis, are ad m itted to surgical w ell as m edical w ards for investigation. Of this ?oup th e m ajo rity aV dfidharged w ith in tact Womens and uneasy m inds M others undergo fruitless Jparotomy under general Y naesthesia; a minority, 3>vrever, operated u p o y d ifid e r spinal an esthesia, iyilay a fascinating and/im pokant living pathology.' fi'eoplastic, ulcerative, and fully developed divertic-ous diseases of th e colon h a r t no place in this ;iper, w hich concerns a group M cases suffering abdom inal/pain, mainly leftY ded, but with ^port an t references to o th e r areas V nd sometimes -ociated wfifh blood and mucus th th e stools -tative di/xrhcea, and constiDation odcur in equal 'fportionS. D yspepsia is often an im Y rta n t and sym ptom . Concentrating m aiaiy on those i^trticuliir conditions, u n til recently nxninly of / It is im p o rtan t to rem em bir th is class of patient ben investigating cases o/Apylorospasm. Cannon and M urphy* have produced pylorosoasm by traum atising mtestmes / n d \ have declared its occurrence in these circnffistaices to be due to a viscero-visceral reflex. COmically, suitable general treatm en t com bm ed w jth tb a adm inistration of m edicme containing belladonni. the tincture of hyoscyamus, th e perch/oride of iA n and of mercury orten leads to great im provem ents (b) Occasionally sp /stic colon oc\urs in the Young athletic man who differs from constipation;' pam may be a prominent feature and may lead to operation for supjAsed acute abdominal conditions No abnorm ality /is seen other th \n generalised enterospasm. \ (c) F a r different is th e last group represented by the rather fat nyddle-aged man, muscular\and athletic m his younger/days, sane and sanguine^n outlook h u t -worried bf an alteration in his bowel\habit and because his Ample meals, form erly enjajred w ith relish, cause /indigestion and discom fort; ffeauentlv defalcation / s uneatisfactory and irregulaA ` Small internal hrm/iorrhoids often develop and the aesf enam - colon is t/n d e r and hard. Rectal ex am in a tio n a l more paiiful than usual, but once the snaveter has been/passed the rectum itself is normal.\ W e will consider la te r th a t the im portant patholo\ical change ifa these c a se s lies in th e m u s c l e l.n er ana >,ot m the /mucous membrane ; mucus and tlooa are therefoi'e not always present. The test-meal * s M <V cons'1 nrn p<^ f t 10? - i F ap ' r rea<1 boforo tbe Association of v . . -r 3rd, I534<^reat B ritain and Zrelam l a t B in m n cn ara on aff the peases so far m r e n ig a te d ) nhows bYperchlorX hydna. Outline in th e radiological picture oi *h' barium enema, as in th e clinical picture, is m Jecifiie