Document RpNZ6KoeKa7z52MvoOB7Yy9zB

FILE NAME: CERAMICS (CER) DATE: 1950 DOC#: CER053 DOCUMENT DESCRIPTION: Ministry of Labour and National Service Report - Industrial Lung Diseases of Iron and Steel Foundry Workers FACTORY DEPARTMENT M IN ISTR Y OF LABO UR A N D NA TIO NAL SERVICE. INDUSTRIAL LUNG DISEASES OF IRON AND STEEL FOUNDRY WORKERS \ LONDON : HIS MAJESTY'S STATIONERY OFFICE 1950 O.NLRV O ITIC E t i be lolloumc addreiseiM reel, EdinUurch, 2; (. Ihraiinch.VD, J; nr. Jlm tol. J; I M ajctty't Stationery O ffer ant. cstabfohim aL V 'Tl f M Qt7 2- j! i Industrial Lung Diseases of I 7 -T0 'I Iron and Steel Foundry Workers PUBLIC fr - health library An investigation of 3,059 workers in 19 foundries together with an analysis o f the records of lung diseases in foundry workers in the files o f the Factory Department and the Silicosis and Asbestosis Medical Board; pathological investigations of the lungs of 64 foundry workers and dust surveys in three foundries. BY A. I. C . M CLAUGHLIN, M.B , Ch.M ., F.R.C.P.P] ivtth the assistance o f E. A. C H E E S E M A N , P h .D ., B.Sc.P] p] JESSIE G A R R A D , B.Sc.p] S. R O O D H O U S E G L O Y N E , M .D ., D .P .H .[`] i r f K. L. G O O D A L L , M .Sc., F .In st.P .p ] j: H. E. H A R D I N G , D. M.P] ,)] M. H. J U P E . F. R .C .S ., D .M .R .E ., F .F .R .P ] W. B. L A W R IE , M .Sc.p] I K. M. A. P E R R Y , M .D .. F .R .C .P .P ] C. L. S U T H E R L A N D . O .B .E ., M. D.. D .P .H .. D.I.H .P] H. W O O D S . B.E ng.p] V ['] Factory Department, Ministry o f Labour and National Service. ['] London Hospital. _ ['] Department o f Social and Preventive Medicine, Queen's University of Belfast. [*] London Chest Hospital and Institute o f Social Medicine. Oxford. ['] Department o f Pathology, University o f Sheffield. [] Silicosis and Asbestosis Medical Board [now under the Ministry o f National Insurance]. I1] Formerly on the staff o f the Medical Research CoundL iii M696990 j- i f- s'* ' 'K - ; i" **f*. ' ' '5^ between pages 98 lSc 13. Chap. V . . & P. V .......................... 99 oconiosis. X25. Case 23, CHAPTER I REVIEW OF LITERATURE BY A. I. G. M cLAUG HUN 42. Case 24. Chap. V .. `That men are exposed to particular diseases from the occupations which they and peribronchial fibrosis lap. V .. .. .. follow , is a fact well known: but to remedy this evil is a matter o f some diffi culty. Most people are under the necessity o f following those employments to which they have been bred, whether they be favourable to health or not. if lung. X250. Case 24, For this reason, instead o f inveighing in a general way, as some authors have done, against these occupations which are hurtful to health, we shall en deavour to point out the circumstances in each o f them from which the danger Thap. V .. 35, Chap. V 6. Chap. V chiefly arises, and to propose the most rational methods o f preventing it." IK I (William Buchan's " D om estic Medicine" - 2nd Edn. London 1782). 1&15 The making of metal articles by pouring the molten metal into sand moulds has been recognised since jncient times to be an occupation injurious to the health of foundrymen mainly on account of the dust which arises during the i libres. X42. Case 55, process. The history of foundry health risks is therefore largely that of the pneumoconioses or pulmonary dust diseases. Foundry work is hot as well as ihyscma. X5. Case 55, dusty and the workers are subjected to sudden changes of temperature: it also calls for the expenditure of much physical effort, though in modern foundry practice much of the excessive physical effort involved in the handling of heavy rculous). X24. Case 62, weights has been diminished by mechanical aids such as cranes and other lifting tackle. In addition to the pneumoconioses, it is said that foundrymen have a page r 142 high incidence of pneumonia and bronchitis and also that they suffer unduly from rheumatism and hernia. In the present enquiry we have directed much of our attention to the pneumoconioses, though some reference will be made to :r Cessation o f blasting in 5. VIII . . .. 188 facing page the other health risks. The early writers on occupational diseases dealt mainly with the risks of mining with incidental references to foundry work. Hippocrates (450 - 361 B.C.)(`) in his Epidemics described the illness of a metal digger (lead of dust samples. Chap. VIII 216 miner) who had constipation, a large spleen, shortness of breath and swelling of the left knee. The earliest recorded reference to the effects of dust is found 1 s winoPrnlinays'sreNsoatiurartaolrsHibsytomryet(a1lstreCfeinnet.rsAt.oDa.vi(o-)id. iHnheamlaetniotinonoefdduthste. usOetohef rblaandcdieenrst page writers discussed dust phthisis which they confused with tuberculosis but not Chest Expansion 83 until we come to Paracelsus (1493 - 1541)0 arc there specific references to hest Expansion . . 83 } metal founders. He was a Swiss doctor and alchemist who had been a miner and metal founder between 1510 and 1520 at Schwaz in the Tyrol. About 1530 it Expansion and X-ray he wrote a book on industrial diseases, published in 1567 after his early death inces .. .. 85 to which his work in the mines and foundries is said to have contributed. He a Expansion and X-ray ances .. .. 86 described the chronic lung diseases of miners as "pulmonary consumption" and " asthma" and while he attributed these diseases mainly to the influence of astral bodies, he recognised that mineral emanations and the "climate" of mines might be the cause of the lesions. But he did not specifically refer to dust as a possible cause. Georgius Agricola (1494- 1555)(J). a mining expert and also a student of industrial hygiene, in his De Re Metallica, published in 1557, also referred to the health risks of miners and foundrymen. He recognised that the inhalation of " corrosive" dust predisposed a worker to a disease charac ! terised by exhaustion, coughing and " that difficulty of breathing which the Greeks call asthma" but he confused the condition with phthisis. He pointed out that in the Carpathian mountains there were women who had married seven YVF1 2 REVIEW OF LITERATURE husbands " all of whom this dreadful disease had brought to an early grave". He also referred to the use of respirators by the miners. Collis (1919) sums up these observations as indicating that asthma follows dust inhalation, that only certain "corrosive" dusts cause consumption and that female contacts do not contract the disease. Nicola le Pors (1527- 1633)(4) of Pisa was the first to describe a case of phthisis due to continued exposure to the atmosphere of a furnace. Van Helmont (1577 - 1644)(7) described metal miners' disease due to dust as a kind of asthma, midway between the "dry" and "damp" varieties of the condition. He found that the disease also affected makers and stampers of coins and maintained that in this case the metallic vapours set up a vaso-constrictive action in the lungs. Martin Pansa,(8) about this time also published a work on diseases of miners and metal founders but added little to the clinical picture or to the aetiology. Leonardus Ursinusi*) wrote in 1652 on the peri pneumonia of miners and metal founders. He put the lung lesions into two groups, those arising from various metal fumes and those affected by the humours. The principal symptoms of miners' disease were cough, dyspnoea and asthma and the main contributory factors were dust inhalation, fatigue, strain and trauma. Samuel Stockhausen,(,0) a doctor at the Goslar mines with over 10 years experience refers in a book (1649) to metal disease and miners' phthisis. He visited foundries and went down mines to supervise workers' health and he even exposed himself to the inhalation of what were regarded as toxic fumes. Amongst the factors responsible for miners' phthisis he mentioned meteorological and atmospheric conditions, metal fumes and especially dust, which at Goslar was so abundant that it covered the miners' bodies and forced them to wear " bits of material" over the nose and mouth. They were affected by a sense of op pression in the chest, asthma, persistent irritating cough with marked hoarse ness of the voice. The condition tended to degenerate into consumption and death. Usually these symptoms were accompanied by others due to metal poisoning. Diemerbroeck,(") also in 1649, was the first to carry out an autopsv on a case of what we now know as silicosis. Ramazzini,(IJ) who wrote the first text book on occupational diseases in 1700, quotes Diemerbroeck's description of examinations of diseased stonecutters "in whose lungs he found such heaps of sand, that in running the knife through the pulmonary vesicles he thought he was cutting some sandy body" . Erythopilus(13) in 1675 was the first writer after Diemerbrocck to emphasise the importance of dust as the cause of pulmonary disease and referred to workers engaged in pouring and refining metal - "idem artificibus, qui circa metalla caedenda ct purificanda versantur, contingere constat. Qucmadmodum, autem hie aer quibusdam vicinus a vaporibus et fumis inficitur, ita alic >!om locoum totus aer infectus est, ut dein in plurimos agat" *`. William Buchan''14) in his book Domestic Medicine (1782) wrote that "chymists, founders, forgers, glassmakers and several other artists are hurt by the unwholesome air which they arc obliged to breathe. This air is not only loaded with noxious exhalations arising from metals and minerals, but is so charged with phlogiston as to be rendered unfit for expanding the lungs sufficiently, and answering the other important purpose of respiration. Hence proceed asthmas, coughs and consumption of the lungs, so incident to persons who follow these employments". Incidentally he goes on to say that "it may seem romantic to recommend gardening to manufacturers in great towns: but observation proves that the plan is very practicable. In the town o f Sheffield, in Yorkshire, where iron-manufacture is carried on, there is hardly a * It is agreed that the same thing happens to workmen engaged in cutting and refining metals. Not only is the air adjacent (to these processes] contaminated by certain exhalations and fumes but in some places the whole air is polluted in such a way that very many persons -re affected. journeyman cutler who d as a garden. Thispractic The 19th century is not lion of excessive quantiti dusts are more harmful ; found in E. L. Collis's(` Physicians in 1915. Hs t Leeds that "dust of ever noted that bricklayers am and stonedressers were sh of phthisis amongst the rn that fork-grinding ougat The term "pneumonol < coined by the German p. variety of pneumoconios; it siderosis. Many nane pneumoconiosis such as (stoneuorkers- lung), s byssinosis, used to desrn striking names for thesr p ' grinders' rot.'' " mine -d Progress in the study o. pathological knowledge a microscopeandX-ra>o. 7 is pigmentation and it i-, which the pigment reaenc from the dust inhaled mt beiieved that it was sectc have been first used b; \ dition of the iungs result;; was long before the noa^ the tubercle bacillus. J ;o 1894 published their n,o: fibrosis associated with rn; causes of fibrosis of the 1j tion but they include a sli. of Peacock and Greenhoi' by the inhalation of irma cular. having been set cot examination, appeared u caused by irritation. G. ee asthmatic cough to distu;; held that if a man had ur followed in an atmosphtrr: if there were no such pres chronic pneumonia''. During the present cem tigators m Great Britan, f have established the t'ac : or uncombined silica (SiG the lungs. Combined si,ic asbestos which is a comnlc the lung called asbestos, s shown that a worker w ;o finely divided metallic cut X' - ''rc'jwnt lo an e..riy gra^f-' - , mucm ~ C o liis ( 1919) i u m i up j w-s oust inhalation, that o n ly i , : that female contacts do not ( f 3g(lj; of Pisa was the first to - .mure to the atmosphere oi a , metal runners' disease due to J r '-" and "damp" varieties of acted makers and stampers of ' ,, -apours set up a vaso-con- th.s time also published a - ; : ocided little to the clinical 1 "mote m 1652 on the pe n " the lung lesions into two me tttose atfeeted by the : '.e:a .mock, d'.spnoea V arc ."halation. lutiguc, v mtk , i,c : 10 sears "' -"er>' pnthrus He . a ' health and he esen mm,:.., ti \ fume- Amongst - .1 o: cC meteorological and .% Gust, wmicr: at Goslar \\.i> m: forced them to '.scar ' `bits me alfccted by a sense ot op C . omen -a ith narked hourncan.erate into consumption ..nd r c c bv others due to metal " -e ".rs; to e a r n cut ar. autop'S . . zr mi . lT who wrote the tint .a - Oictue; oroeck's dcscnptimi -m lungs lie found suen heai's mwm.onary scsicles he tlioualit at 1()75 was the m-t -taucc ('' dust as the cause ot ae.Ga m. pur.:.canoa scrsantim. - aer uu b.,sGa;ri sietnus i at totus ..er mfectus est. it ' .. s bool. Domest ic Medicine ' lat sr t aker s and sesera! oth.er as arc obliged to breathe Tins mg from metals and mineral-. acred unfit for expanding tre 'onant purpose of respiratton. m of the lungs, so incident to -nttally he goes on to say ut it rr. practicable !r. the town ot .s' .armed on, there is b .a rd ls a rn engaged te. ceiltng ar.d remans . a.w.mmm ), ctrui.r. exhatauans ' b--a; a ua> inat. \er> .r.aa> per^ocs- RF \ \ L W o f L I T E R A T I RE f journeyman cutler who docs not possess a piece of ground, xhich he cultivates as a garden. This practice has many salutary effects" The 19th century is notable for the development of the idea that the inhala tion of excessive quantities of any kind of dust affects the lungs but that some dusts arc more harmful than others. A good account of m s period is to be found in E. L. Collis's(1!) classical Milroy Lectures to the Royal College o; Physicians in 1915. He quoted, for instance, the statement of Thackrah(16) of Leeds that "dust of every kind irritates, but not in equal c.egree". Thackrar, noted that bricklayers and limeworkers were long-lived, that sandstone masons and stonedressers were short-lived and he also drew attention to the prevalence of phthisis amongst the metal grinders of Sheffield. He quoted Knight's opinion that fork-grinding ought to be confined to criminals The term " pneumonokoniosis" (later shortened to pneumoconiosis) a as first coined bv the German pathologist Zenkerf' 7) about 60, he also described a variety of pneumoconiosis due to the inhalation of iron ox de dust a - d called .' 'uderosis Many name's were later invented, to describe c fierce: varieties m p .canC'-oniosis s.icr. as rneGnosis, ar.thracosis icoal miners' tang), cfmhcos., mmneworkem' h m g \ -,,m-tos's <sG;eworkers' lung) \ recce', one r ayssir.osis^used to describe the T u g uffecmor.s^of cotton workers The more 'grinders' rot," `miners' phthisis," 'potters' rot or asthma ' Progress in the study ot pulmonary diseases was dependent on aJ.unees m. tit..logical knowledge ana technique and particularly on tae Cisco.ery of the microscope and X-ray - 1 he most r.oticcaole naked-ey e lea tare ot' the dusted lunc is pigmentation and ,t is recorded that there was comrovemy over the wav in which the pigment reached the iungs. P ear sonp8) m IS13 stowed that it came *r o 'n t h e d u s t i n h a l e d m t o t h e l u n g s b u t t h e F r e . n c n a a 0 G s . r m a a p a i h o , l o g i s t , b e h e v e d t h a t it w a s k a \ c ace n first u sed s c e r c :c o I r o n t r.c c v V i s . o i i m '') m o o d v . T h e t e n r X Ii c o s j s " is s a i d to 1 7 0 t o d e s c i i-iKn r 1- p a t h o l o c c a ! c o r - u , ; : c n o : t h e l u n g s r e , a c . _ T y ' : ; l r c ' . n a : j ; . o o o . o ! `c a '-b o 'lg b e f o r e m e w v , c ' T i . o v i s ivas d i s t m e u , 2a c a 3 . : i.a s D . t c o f t h : s 1; "a : h a r ^ a a 2. c d b% h ' 1- r u : o s P . e c : h o : r r o - > ' ' ^ p t ot u n ti l C la ts .. r i a c . lev a n d C h a h i r . l : h ' m : F i o r o i d D i s e c bC 0 r* I 11'>n c ' ^ ! r' r Cs, . s f o O c i L i c u a , i d e r r o ; i x t c . o e r t : u !o s : s w a s c l e a r : V d m t o r e . r . i . a r e c i r o n 0 i f. c x x ' GbCb o r f i b r o s . s o i t h e l u r c o ' e n : h e y m a k e r . o r e ) c r e r . CC ! 0 s . l i c o t i c n o d u l a - .OR R L 1 t h e . i n c l u d e a s h o r : p a r a g r a p h o n d u s t p h t h !S.S i a e y Q u o t e t h e A o r k - : F hcCOv: k a n d G r e e n h o w a h o g i ^ e ' n t e r e s r i n c c a s e s o f t ,,.a c d i s e a s e i n d a c c o r y t h e i n h a l a t i o n o i i r n t a t m g d u s t s M a n y o i t h e s e a e r e a c d o u b t e c l y t a o e r - cuiar. having been ,e: going n> the irritat.ng Gust, but some or. microscop c\c.rvr\:T.io:.. appearcc to preser.t oil the craracters o' v.aroa.c ^ . . . . sed by irritation Greennow relied on a cool skm, omc: n use. an.c a wheezy . -Tmatic cough to distinguish this disease from tubercular phthisis Pe.cocx ..e.a 'nut :i a mar, hac an nerecitary predisposition to tuber; .e, ms occupation 'oi'ov.ea m an atmosphere o' dust, would favour the onset ot tubercle, whereas there were no such, prccnposuion. he would be more like y to develop only chronic pneumonia" During the present century researches unto the dust diseases bv man.v invesiigmom in Great Britain, South Ati.ca, Australia 'he United States and Europe h. vc established the tact that the most dangerous a: the industrial dusts is free or uncombir.ed silica (SiO-_.) and that it sets up a nodular fib-osis or silicosis of the canes Combined silica or silicates are less dancerous, or.e exception Seine ..sccstos which is a complex silicate and produces a different type oi fibrosis ot the lung called asbestosis. More recent work on the radio-opaque dusts has shown that a worker who .nhales such dusts (e g. iron oxide, barium salts or imeiv aivided metallic dusts) may have X-ray appearances c f the lungs simu- Ti 118 PATHOLOGICAL INVESTIGATIONS History of illness. Began to have pains in chest and dyspnoea February' 1936 but continued at work until May when panel doctor referred him to hospital where he became an inpatient for some time. Tubercle bacilli were found in the sputum towards the end of his illness. Died 7.4.40. In receipt of com pensation. Gross morbid anatomy. (Abstract of autopsy report) Fingers clubbed. Pleura: adhesions at both bases. Lungs: Massive silicosis involving all lobes: emphy sematous bullae both apices; old dry cavity in right lower lobe. Histological sections. Sections of lungs showed massive conglomerate nodu lation of silicosis; no evidence of tuberculosis. Comment. Massive silicosis with bullous emphysema, and dry cavity of indolent tuberculosis. (57) Male. Age 35 years. Occupational history. Employed as a sandblaster of iron castings with a firm of vitreous enamellers from the age of 21 to 27. During this time he also occa sionally mixed enamel and drew ii out from the furnace. He stated that he never took any precautions. History o f illness. Began to complain of pain in chest in 1931: had attack of pneumonia in 1932; cough commenced in 1933; attack of haemoptysis in 1934. Admitted to hospital 6.9.34 with signs of subacute nephritis and advanced silicosis. No T.B. were found in sputum (5 tests). The possibility of malignant disease of lung was also discussed but he continued to improve and was dis charged 29.11.34. Re-admitted cyanosed and moribund 29.8.35 and died on the following day. X-ray examination. Film taken in 1934 showed advanced silicosis with sus picion of pulmonary neoplasm as well. Gross morbid anatomy. (Abstract of autopsy report) Pleura: old adhesions at both bases, with extensive subacute pleurisy. Lungs: very extensive nodular silicosis throughout both lungs, most marked in the peripheral portions of the lower lobes; terminal acute congestion of upper lobes. Chronic nephritis with small peritoneal effusion. Histological sections. Pleura was enormously thickened with fibrin which here and there contained collections of leucocytes; the fibrin was beginning to organize, with formation of collagenous fibres and new capillaries. In deep layers of pleura silicotic nodules were present. Lungs showed many conglomerate nodules of silicosis with intervening lung tissue containing areas of focal emphysema, atelectasis or early broncho pneumonia. Mediastinal glands exhibited small areas of caseation with typical giant cells. Comment. Very extensive nodular silicosis of somewhat unusual distribution (i.e. most marked in peripheral portions of lower lobes) with minimal tuber culosis of mediastinal glands and terminal nephritis and broncho-pneumonia. (58) M ale. Age 55 years. Occupationalhistory. Had been employed at a small arms factory for 38 years, including about 20 years as sandblaster. Prior to this had had odd jobs, the nature of which is not known. He had worn a helmet-mask, overalls and rubber gloves whilst at work. Historjo f illness. Had been examined every 3 months whilst sandblasting; had been off work for a fortnight in 1941 through illness; apart from this had made no complaints of ill health until he broke down in April 1942 with ex treme fatigue and obstinate cough, and silicosis was diagnosed. Died 9.4.43. S Hi X-ray examination. Rep right upper lobe of ?tuberci Gross morbid anatomy. ( at left apex, recent pleuns' upper lobes with nodules i: of focal type; fibrocaseous with cavities in left upper 1r Histological sections. V. presence of tuberculosis; caseous centres; numerojlogical picture was that c contained conglomerate nr lymphoid tissue. Aorta si and round cell infiltration : Comment. Massive sil.ee and syphilis of aorta. T bodies were found in seen obtained. I? Occupational history. Sa History of illness. Thrc ulcers. No details of chest i septic pneumonia from wit Gross morbid anctomy bronchi filled with muco-pi apical portion of right sac fibro-caseous tuberculosis i lobe. This cavity had raec< become secondarily infectec numerous silicotic nodules meningitis. Histological sections. Ti contained tubercle bacill nodules of silicosis were pro Comment. Nodular silio dissemination to meninges, culous pulmonary caviry. !6i Occupational history. Sa sprayer. Further details r History o f illness. No dc and certificate of total dis. tuberculosis (sputum contai Gross morbid anatomy, i right lung adherent to ches nodular fibrosis of silico-tui both apices; terminal oedexr Histological sections. Mi: of silicosis and tuberculosis Comment. Nodular silici cavity formation. Death fr : and dyspnoea February 1936 actor referred him to hospital "ubercle bacilli were found in :d 7.4.40. In receipt of com- oort) Fingers clubbed. Pleura: is involving all lobes: emphyight lower lobe. 1 massive conglomerate nodu- lphyscma. and dry cavity o f aars. er of iron castings with a firm During this time he also occae furnace. He stated that he X-ray examination. Report stated: Long standing silicosis with signs at right upper lobe of ?tuberculosis ? collapse. Gross morbid anatomy. (Abstract of autopsy report). Pleura: old adhesions at left apex, recent pleurisy at base; Lungs: Massive silicosis right and left upper lobes with nodules in lower lobes; subpleural nodules also: emphysema of focal type; fibrocaseous tuberculosis in both upper lobes and right lower, with cavities in left upper lobe; area of terminal pneumonia in left lower lobe. Histological sections. Microscopical examination of lungs confirmed the presence of tuberculosis; conglomerate nodules of silicosis some of which had caseous centres; numerous asbestosis bodies were found also but the histo logical picture was that of typical silicosis with tuberculosis: hilum gland contained conglomerate nodules of silicosis almost entirely replacing normal lymphoid tissue. Aorta showed extensive collagenous thickening of media and round cell infiltration ot vasa vasorum. Comment. Massive silicosis with emphysema accompanied by tuberculosis and syphilis of aorta. Terminal pneumonia. Although typical asbestosis bodies were found in sections no history of exposure to asbestos could be obtained. n chest in 1931: had attack of ittack of haemoptysis in 1934. acute nephritis and advanced . The possibility of malignant tued to improve and was dis moribund 29.8.35 and died ; 1 advanced silicosis with sus- :port) Pleura; old adhesions at .ungs: very extensive nodular . the peripheral portions of the ; lobes. Chronic nephritis with i thickened with fibrin which j s; the fibrin was beginning to j and new capillaries. In deep j j silicosis with intervening lung : atelectasis or early broncho- tall areas of caseation with omewhat unusual distribution :r lobes) with minimal tuberis and broncho-pneumonia. ars. mall arms factory for 38 years, o this had had odd jobs, the net-mask, overalls and rubber months whilst sandblasting; h illness; apart from this had down in April 1942 with ex- was diagnosed. Died 9.4.43. (59) Male. Age 42 years. Occupational history. Sandblaster for 25 years at Foundry V. History o f illness. Three abdominal operations lor gastric and duodenal ulcers. No details of chest illness until admission to hospital October 1945 with septic pneumonia from which he died. Gross morbid anatomy. (Abstract of autopsy report). Trachea and main bronchi filled with muco-pus. Pleura: Dense adhesions lower part of left and apical portion of right sac. Lungs: much engorged: both showed extensive fibro-caseous tuberculosis involving all lobes, with large cavity in left lower lobe. This cavity had ragged walls and thrombosed vessels crossing it; it had become secondarily infected with foul smelling pus. Both lungs also contained numerous silicotic nodules. Small pericardial effusion. Extensive tuberculous meningitis. Histological sections. The meninges and pus from the basal lung cavity contained tubercle bacilli and streptococci. Discrete and conglomerate nodules of silicosis were present in the lung tissue. Comment. Nodular silicosis accompanied by pulmonary tuberculosis with dissemination to meninges, and a terminal streptococcal infection of a tuber culous pulmonary cavity. (60) Male. Age 31 years. Occupational history. Sandblaster 1927-1933 followed by 11 years as zinc sprayer. Further details not known. " History o f illness. No details known. Examined by Silicosis Board 29.9.36 and certificate of total disablement on account of silicosis accompanied by tuberculosis (sputum contained T.B.) issued. Gross morbid anatomy. (Abstract of autopsy report). Tracheitis. Pleura: right lung adherent to chest wall and left lung at apex behind. Lungs: coarse nodular fibrosis of silico-tuberculosis on both sides, more on right; cavities at both apices; terminal oedema and congestive heart failure. Histological sections. Microscopical examination of lung confirmed presence of silicosis and tuberculosis. Comment. Nodular silicosis accompanied by pulmonary tuberculosis with cavity formation. Death from congestive heart failure. i1 I `.VW J ' kl` ;sio n s v and IX). group is low, but steel main ly abnormalities than similar or a maintenance worker to >ur series. os. I, VI and IX). >. V). s young workers develop a e probable reasons for this 10 cases (0.36 per cent) of iescent and 39 (1.4 per cent) culosis is much the same as - 1,000). kers' lungs we found 3 cases ! X-ray survey we found no les. 'X). :el foundry workers arc desgraphs. {Chap. X). BIBLIOGRAPHY (*) () (3) (*) (*) (4) (7) () () (10) (") (1!) (" ) (,4) ('*) (" ) (") (") ('*) (:o) _ (51) (73) _ (73) I1') (*') (:*) (j7) ( : *) (" ) (30) (31) (3:) (33) (>4) ( 3` ) ( 3` ) (37) (3*) (3*) (**) (" ) (43) (*3) (4`) (4*) (*) (4T) ( 4`) Hippocrates. Epidemics. Quoted by Ramazzini B,, De .Worbis Anilcum. 1700. Pliny. Natural History, Book II. Quoted by Collis. E. L. (q.v.). Paracelsus (1493-1541). Quoted by Carozzi. L. (q.v.). Carozzi, L. Contributo Bibliografico alla Storia della Pneumoconiosi "Silicosi" .- (Dal xxvli Secolo A.C. al 1871). Estratto da Rassegna di Medicina Industrialo 1941-42 Torino. Agricola, Georgius. (1556). De Re Metallica. Book I. Le Pors. Nicola. (1527-1633). Quoted from Carezzi, L. (q.v.). Van Helmont, J. B. (1577-1644). Ibid. Pansa, M. (circa 1500). Ibid. Ursinus. L. (1618-1664). Ibid. Stockhausen. S. (1649). Ibid. Diemerbroeck. (1649). Ibid. Ramazzini, B. (1700). "De Morbis Artificum." Trans, by Wilmer Cave Wrtght- London (1940). Erythroptlus. H. C. (1675). Quoted from Carozzi. L. (vide 4) Buchan. W. "Domestic Medicine." 2nd Edn. London (1782). Collis, E. L. Milroy Lectures. 1915. Pub. Health 1914-1 J: 28: 254. Thackrah, C. T. "The Effects o f Arts. Trades and Professions." 2nd Edn. London (1831). Zenker. F. A. Dtsch. Arch. Klin. Med. 1866-67: 2: 116. Pearson. Quoted by Air Hvgienc Foundation o f America. Medical Senes. Bull. No. I. Pittsburgh (1937). p.9. Visconti, A. Quoted by Carozzi. L. (q.v.4). Clark. A., Hadley, W. J., Chaplin. A. "Fibroid Diseases o f the Lungs." London (1894). p.29. Peterson, F. Med. Rcc. 1887: 23: 113. Quoted by Sayers and Lanza in "Silicosis and Asbcstosis". London (1938). p.18. Watkins. J. A. U.S. Bur. Mines. Tech. Paper No. 153. Quoted in Bull. No. 1 of .Air Hygiene Foundation o f Amenca. (q.v. 17). Macklin. E. L. and Middleton. E. L. Rep. on Grinding o f Metals and Cleaning of Castings. Home Office. London (1923). H.M.S.O. Denct-Kravitz. Quoted by Langelez. A. "La Silicose." Liege (1946). p.18. Pokomy-Weil. L. Fortschr. a. d. Geb. d. Rntgenstr. 1923: 21: 22. Komissaruk. B. Arch. f. Geuerbcpath u. Gewerbehyg. 1931: 2: 123 Abst. J. Ind. Hyg. 1932: 14: II. Beintkcr. E. and Jottcn. K. W. Beilage z. Reicharbeitsblatt No. 30. 1931. Landau. W. Arch. f. Gewerfccpath. u. Gewerbchyg. 1932: 2: 412. Abst. Bull. Hyg. 1933: 8: 26. Landau. W. Arch. f. Geucrcepath. u. Gewerbehvg. 1933: V: 515. Abst. Bull. Hyg. 1933:8: 727. ` Pancoast. H K. and Pendergrass. E. P. J. Indust. Hyg. 1 9 3 3 1 1 7 . Evang, K. Nord. Med. Tidskr. 1933: 6: 1288. Report of the Meeting o f Foundrxmen. Toronto, 1934. Quoted in .Ann. Rep. o f Connecticut State Department of Health (1936). p.166. Report o f Ind. Dis. Commission. Massachusetts. 1934. Pope. A. S. and Zacks, O. Amcr. Rev. Tuberc. 1935: 22: 229. McConnell. W. J. and Fehnel. J. W. J. Indust. Hyg.1934: 16: 227. Warfield. L. M. Ind. Med. 1935: 4: 302. Abst. J. Indust. Hyg. 1935: 17: KM. Kuroda. S. Abst. J. Indust. Hyg. 1936: IS: 27. Merewether. E. R. A. Tubercle. 1936: 17: 385. Bloomfield. J. J. and Greenburg. L. J. Indust. Hyg. 1933: 15: 184. Stub-Christensen. V. Silikosen*i den danski lndustri Kopenhagen 1937. Osmond, L. H. Amer. J. Roentgenol 1937: 28: 122. Kelly, J. F. and Hall. R. C. N.Y. State 3. o f Med. 1937:37:478. Quoted from- Greenburg, Siegal and Ross Smith, q.v.48. Evang, K. Nord. Med. Tidskr. 1938: 16: 1085. Chalmagne. J. Arch. Med. Soc. et Hvg. 1938:1: 527. Abst. Bull. Hyg. Nov. 1938. p.857. Bellander. J. Hvgeia. 1938: s: 339. Sander. O. A . Amer. J. Pub. Health. 1938 : 28: 601. Sander. O. A. Fourth Saranac Symposium on Silicosis 1939. Greenburg. L. Siegal, W,, and Ross Smith. A. (1938). Spec. Bull. No. 197. New' York State Department o f Labour. 273 VT - " ' 1 leumoconiosis characterised by a erivascular, peribronchial, interung. and resulting usually from m " mixed dust pneumoconiosis" ng to allow the cooling metal to ; o f the casting. -*d in a fluid into its com ponent tiid stream those particles which n velocity o f the fluid. Itich the molten metal runs into or removing sufficient air-borne atm ospheres by suitable filters an electrostatic precipitator) to on a (micro-) balance and the ulated. ure. which the metal is cast without from a easting by pressing it >m castings by projecting against id sand. core sands and the casting from material and used to transport tains fireclay or ganister. es o f particles in dust clouds or a millimetre or a twenty-five i. ied china clay. ) which molten metal is poured. >x and the sand together, h a forced draught, used to dry uspended in a fluid and painted are made. id and the metal subsequently v moulds are made. d for makiDg moulds. o a casting. Sometimes called m * GLOSSARY - 279 Nodulation (X-ray). A pattern seen in X-ray films o f the chest, consisting o f numerous rounded shadow s or nodules usually about S mm. in diameter. Oil Sand. Sand bonded with oil and used for making cores. Open Hearth Furnace. A steel making furnace with an open hearth and regenerators to preheat air and gas for com bustion. M ay be acid or basic. Owen's Jet Dust Sampler. An instrument for taking quick, nearly instantaneous samples o f the dust in a dust cloud. The dusty air is first drawn through a chamber where the air is made m oist, and :nen at high speed through a narrow jet. This causes the moisture in the cloud to condense, and coat each dust particle with water. The v-et panicles are caught on a microscope cover glass and then examined under the high power micro scope to enable dust concentrations and size distributions to be deter mined. The instrument does not catch all the dust particles. Parting Sand. Sand without a bonding agent used to place between two layers of bonded sand so that they wiil not adhere and can be separated at a later stage. -- powder. A powder used in the same way as parting sand and also sprinkled on patterns to prevent adhesion o f the sand. . Pattern. A wooden or metal replica o f a casting, and round which sand is rammed to impart to it the desired shape. Pneumoconiosis. This is a shortened form o f the original term pneumonokoniosis intro duced by Zenker in 1866, ana reallv means ``dust in the lungs." It is usually considered to be a general term embracing ail forms o f fibrosis or scarring o f the lungs caused by dust, suen as silicosis and asbestosis. Pneumoconiosis, as used by pathologists, denotes a fibrosis o f the lungs made up o f reticulin and collagen (q.v.j. Pouring. Introducing molten metal into a mould. See Teeming and Casting. Refractory. High melting point material in which moiten metal can be contained (e.g. silica sand, ganister, sillimanite. zircon, etc.). Reticulin Fibre. (Path.) This is a fine connective tissue fibre staining black with silver impregnation methods. It may develop into coilagen (q.v.j. Reticulation (X-ray). A term which means a " network." used to describe a pattern o f shadows seen in X-ray films o f the chest. See also dust reticulation, a term used in pathology. Risers. Columns o f molten metal rising from a casting u hich provide a reservoir o f molten metal to feed into the casting while it contracts on cooling. The term also refers to the openings through the sand mould made to contain the columns o f metal. Rumbler. A cylindrical rotating box in which light castings are cleaned by friction o f the castings against each other when the box is rotated. Sand. High silica refractory used for making moulds. B acking ----------. Inferior quality sand used for the back o f the mould and which does not com e into contact with the molten metal. D r y ----------. The sand com posing a mould which has been dried before introducing the molten metal. G reen----------. Sand containing about 5 per cent moisture. A mould which has not been dried before introducing the molten metal. ----------blasting. The cleaning o f castings by impingement o f a stream o f sand under pressure. See Blasting. ----------slingcr. A machine used to propel a stream o f sand around a pattern to form a mould. Shotblasting. The cleaning o f castings by propelling a stream o f metal shot against them. (See Blasting).