Document a4ew8JxgZX0q0Y2GDZDJOedLN

V-- k 1 0 2 4 D ro 3, 1937] PULM ONARY SB ESTQ SI3. MTLMONAIIY ASBJibTOSIS.'' y \V. E CO O K E , M D , M R C P ., . D irector o f Iho P athological D cp siln x .n l, W ijjan Infirm ary. ( II i t h S p e c ia l 1`la le .) J s tlic R h it is h M e d ic m. J o u i M t o f J u l y 2 6 th , (|> 1 4 ? ), I p u b lis h e d a b h o r t n o ie o n t h e w o m a n lio is tlio hiilgect of tin s p a p er, The only s iin ih r case on m o n i mui th a t of a m an a d m itte d to th e d ia lin g Cio*s H ospital in 1809, h e ro h e d ied in 1900 D r K L M iddleton of tito H u m o Offico k in d ly l e n t th e n o te s o f th e case , a n d of th e i \ idoneo g iv e n b e fn ie th e I)c p a itm e iita l C o in iin ttec on ln d iis tr u l D iseases in 1906 by th e la te D r H M ontague M m 1a y , cim ici w h o se e u ro th o in a n h a d lxcn '1 h is p a tii u t , a m an a g id 33 je .ii , hud w oiked in th e ra id in g room of an a d u s to , fn ilo tv foi ton y em s p u o i to his adm ission to h o s p ita l l i e in f o r m e d D r M in iu y t h a t h e w as th e bole Mil 1 n i n of te n 111.11 w ho d a r t e d w o rk w ith h im in th e eu id iu g room , th e o tlo is hail d ied, p iisiu n ab ly as Iho i e silit o f th e n n o u p .it io ti. A p o s l- m o iU m e x a m in a tio n 11as la id m id th e d iag n o sis of puh n o n n iy fibiosis was (o iifin iu d Di M n rr.ij m h is v , idoneo re fe rs t pilotinoli rograplis of lu n g si f io n s w h u li slioiv `` p u n io s o f a s b e s t o " T he* aie tho salient L uts- of th e fu st and, down to 1924, the only reco id o f a d e a th duo In asbestos. T h at these tu o i ases M arni alone is v c iy s m p iis m g ! h e n stx 'sto s uv>Li*-t<j sa unno th n u 2,000 y i a i s old, u n i wo know th a t asn stos fa. to t i` s, u p fo rpi iti t u r n t yrsiis, have beili ih v o td of a n y a p p lia n c e s f u 1lie* p te lentum and extiactiim of d u s t i h o 1e in a i li o f D i M m n y 's pal leni is sngges* t u e , a n d m e d i, a! m e n li n o lo n g Stispi i li d a s l,e s l,,s d lis t t o lo th e c a u se o f I n u g u n id itn n 's ni w o ik e is m Iiaiily 1cut dated factories A sbestos is a physical paradox a nm iei ilo g u al <ly s l a ll iu e , c la s t 11 ( i .11 d. d , sp u n , a n d 1 stra m i 1an he sp u n to a n d a d a lli ill lliu fa c tu to Iho sfpiaio y a id n e te i fo u n d in an y Iw o co u n t 1u s a lik e tw o p ai Is o f Hie baino c o im tiy . H n to u co l Abbctos is ap p ai i tid y in d e tti m tilde mil its fu i. 1111 l! it les W cio I.IIII'III to Ilio J l l l / i l i t s T h e H alli in it fio m th o Ita lia n Alps an d tl V ia l M ount un ir e r iu lo l u s (i irrti 4 5 0 l i e ) d e s ti ilio a H i m a tim i t hit li 11.a d o f io m a s b e s to s I' lm y (c e rra 1 50) in. litm u s th e d 1fili lilty in u e t t m g j t K tia b o (1 ~ ) a n d P i n t a i 1li ( m a A i> 70) h o th sp o v k o f th e w id is y f ( h e la m p s n i (h e " in s ta i V tig iu s b u n g m a d e f u m i ashrM 1, -o c a lle d Ik- .uiiso tli'y n ia in la m ed a p c ip etu n ! flam e w ithout being consum id P a u s a m o s ( m a l AD 175) i . f e i s t o ci g old L u u p m a .I. hy Cu 111m ai lu is o A th e n s fu i M u n iv a , tile u n k o( w lu .li w as m a d e o t C.11 p .n i.n i lu a n , 11 th o oiilv lin e n I n d i is n o t i o iib in n ctl hy f u e " L a i c i (a I> 2 5 0 ) M a n o P o lo w u t< ; * h a t h e b u l src-w T .w tx v s \j- in g d o t h t h a t w ith s to o d tu e v d iid i w as m a d e o f a " C e itn i n o M m e ia ll o f K.111I1 lo iu u l in a M o u n la y n e." A lth o u g h i t s v a lu a b le p r o p e l tie s h a v e In n know 11 fm th o u san d s of y em s th o m odern a d ap ta tio n of asbestos to t h e in d u s t r ii li a i t s d a t e s f ro m o nly a few j c .h s a g o C om position. A sbestos is a n o o f th o silicate* , a n d vis v a u e tir s avo n n m o io u s W Jieicv er i t occurs it is found associated w ith This and Ui two fnllowirg pap flu Sncllun ul Prcvrnll.e M.iltritu* nl .... Bilindi Usatesi AtK clklinn, fenliBburgH, 182?. _ 1 .litici li a n d i n i u t poi t ioli lin t gnieratect m u u .h . if t i n s e s h u j i aiigiil.vi p a i t i d e s an d m u n ite g muli stin g , of io n ise, th a t they a io m olo b u ttle 1 th e tl niishu 1u t p ilit o f ` ho feble T h .s a p a llic i.' e f o u n d 1.1 s . i y s m a ll n u m b e rs t u Ilio fin is h e d ,u l u l e .Mi T i l Ily m iti, F I O . , dii uly '. d 6c\ 1 d s iin p b 's <d d lis t, u n i f o u n d t h a t th e d u s ts c o n i u n ll)g th e g l e a te i n n illlx I s n i th e s e h h u k p a l i l i le* c o n fa m e li th o h u g e M .1in o m it of n o n T h o n o n c o n te n t of th o fin ish e d 111n le, i a u in Me iiu l, a n d d u s t 1 n s fo llo w s: l'n *b. l 1 las f, n o u s CSI,II) oxl.lc) ions ovuli 1 0 1% li hi 4 lusiv t i n i Ilo- b1.il It Cticd bi iti lo p a i ts of th ili - to s fibre a i e th iro n -c o n ta n i* m g pm 1nu is I In* bughc o f th e m a m ifiu t u n i , th e i.iii'O of " d iis t," and v d mg, to th e h ealth of w oikcis in ilio piocess of niam ifrtituro. CV/infili Ihrlnrit v/ the C a tf. 9 T he d re ra sr.t, x wcnuun a g n i 33 ]> [., cornine nred *>ock et Ilio a, of 13 j , . u s ni mi a*lx*los fuctoiy in w hi.li no provision w is nonio Ter (In. c itiu c tio n of <lu`t, IToni an e arly agi*, soun a fte r culi,rn, ih mg w m k, d ie M iff.iut fruiti a coligli, I n d i dui noi in t .i f i i n id i b, r p u lir a i In aliti nu lli 1917 Sbo tb e n 20 y<**s of H", , am i n.\,l b e n wmkvng tbvrtcciv yrar. Freni thi turi Hitlit 5 y c ais lai r (1922) 1m allu x la n co a n t woik e ro uitct imi (cu t ovvuig t a i l ) ticnltli Slw iiiismU oerasionat ilayn rnt chic o r t o perio d i of tom a cele, u n til alio fmally ccasecf cnk in .Ini, 1922 U p to U ni v ie co.nplaiiied of consti, ilyxpnoca, p e cto ia lio B , P I I.M ON tU Y .W IH 'sT O S IS . (/' /' / /t -;<),isimuim lJ D u W . K CotVKV 11 ,f S h h k t M l Du M U ) ) U '* li': , . ___ *>* mm IREP0RTs ^ i ^ r ----------------- ---------- 1 SWT By ( 3 tM* COof , oV ? _ l] ^ p ? B ^ l' " e ! ^ - X i n ! 5 A k l i b r a r y OK M b lU C .) N ` ,,SM U s a J H M > > 5 f3 OR R F S F A R C H JN I IR J Q l^.tfc llP .L N G jrH F iO B lt- 1 0 2 4 D C 3, 1927] rU L M O N A R SBESTO SIS. ELMOXAKY ASBESTOSIS." o tlie i nniK 'i i l ' , iw oio espec ially w atli 'h r o tn o ir o n ancf m ag n etite Tho com position ot the w ilt know n Ita lia n a n d y .1 C O O K R, M D . M n r P , D irector o Uic P athological D ijia rlm o n t, D ig n a In fu rn ary . C a n ad ian film s is as follow s; tU IU n Fibre Canadian Chrjtolil*. { ll'i/i Special P la te .) tlio B u it is h M fdical J o trn v u , o f J u ly Zili, 1024 (|> 147), I p u b lis h e d a s h o i t n o te o n th e u ltim i w h o is th o Silica Magnesia > 1'cuo us ondo Alumni* WaUr 40 30 43 37 0 87 2 27 13 72 . 40 87 . 41 50 2 81 090 13 SS su bject of th is p ap er. Tho only s tm th i ease on record T h o p m e s t a sb esto s, h a tin g fibios o f e x tra o rd in a ry length'# a s t h a t o f a m a n a d m i t t e d t o th e ( .T u n in g Ciey-s H u s p ita l cjccuis in N o r t h e r n I t a l y A sb esto s m a y c o n ta in lio n s in 1899, h e ro h e d ied in 1900. D i. K L . M id d leto n of 0 5 to 15 p e r ic n t of n o n o xide, b u t asbestos y a rn n th e H u m o OfBco lu n d K l e n t th e n o te s o f th e c a se , a m i of p i e p a n d fro m n n n c i a l a s f ro o o s p o ssib le fro m ir o n . To th e e\ idonee g i\e n bc-foie th e lit pai tin o iila l C o in iiiittcc on g e t n d o f th e difficultly soluble iro n , asbestos is soaked m In d n -tiid D iseases in 1906 by the la te D r ] f. M ontague oith o p h o sp h o n c jcicl solution an d w ashed in u a te - beforo M m m y , it m ini lio s o e .n o tlio m ail h a d b e e n . T h is p ati n t, i n a n u f a i t u i e 'lD o p e m n t a g e of ito n , t h e n , is o f recog a m a n a g ed 3 3 y . a i , h n j w o ik e d 111 th o c a iil m g 100111 of n m d im p o i t a n i e . a n a 'h i tos f a c to iy f u i to n y n s p u o i to lu s a d w n v n u n to h o -|iita l M e in fo rm ed D r M u ita y t h a t he .is th e sole M anuffufiniiii) P rocn$, s u u i 'u i of toll n u n h o s t a r t 'd u o lk m tli linn in tlie The process of in a n u f.u lu ic resem bles th a t o f ro tto n , e x u d in g lo o m ; th e o t l m s h a d lied, p i c s iin u b ly a s ilio 'I h e c ru d e m in e r a l is s u b je c t to jii e ih a n ii.i l t l c a t m c u t M . 11- n i t o f th e n o< 1n p .it io n . \ ju st-m v i U m e \ u m in a tim i w as g iii id iii g m e n b in e J h o h e a t t e r lo c k is s e p a r a t e d by h e ld a n d tin* d ia g n o s is o f jm l in o n a t t fib io sis w as lo n li n n e d g i . i t i t t , a n d tlio r e in a m ii ig a s b e s to s jio ssed th r o u g h c a r d l)i M n rr.it in his et idoneo refers to jihotom n ro g rn p h s of ing, roi m g, an d sp in n in g m achines, an d from these to th o lu n g se c tio n s I111I1 sh o w " sp ic u le s o f a s b e s to s .'' T h e s e w e .u m g sh e d s aio tho salient facts" of th e fu st an d , d o u n to 1924, tho D m m g th e c ard in g pioees, a n d to a less e x te n t in all only n o r d of a d e a th d u o th o pioc esses, a sc ry coil- to .I'boistofl. 'lh itt theso t o 1asi s vta m l .done is to iy sn ip n sm g Ilio a sb esto s Jlut list 1y h ninio th a n 2,000 y r.n x old, D ESCRIPTION OF PLA TES. Fir 1 --t.l.fni.t, f sill. )i ill. Ill k ,111. a I i't,. p ni-H u . 11 ..I sid erab lc am o u n t o f d tis t is genei utod In up-to-dato tacto n e's att m achines a io fiiiexl w ith e x tia ito i c o i n s a n d th o d u s t n'lW oxed Ti\ m il 0 k n o w t h a t ash< sto s f It till es, lip t<> CjUlf I ISCe llt h 2 - -l,,c rgc n irt tin* fiiv t f a r t o i y h e r o th o p a t i e n t th e s u b je c t **f , l a t e b een dc te n d of a p p li.tres fu th is papeu a s 1inplciyed mi im tlied of d in t in n m a l 1id n. n d i I .ItlliM l Ilf is usi d , a n d th o a tm i- 'I he II Ilk " f Dl M m U.lt o lit 1 - Filile ),o, wot. C.Us( 1J Uf In. uneus tj. a., s l o rc sp hciic eum litions 110 jiiastu iu iU y s0 b a d th a t, ledo d 1'Olg -ll-.jlll lc d ashesUis eb|st to ho the e ui-u ot lu n g urnditm iM m w o ih eis in badly 1,Ia 0 . i*<as .11 a with (,i cut . II , 1. .. . 1 . , . . -I tie lx"<j<il '..,, l y u l k u s 111 I n i p a itiii il.il ' loom cou ld n o t "Co i \ e It t e n td a lo d fac to n es. l '61 sio i l 'l i n e Olltl D u if . \shesto? is a physical p a r a d o s a m itiei ilngie.ij e r g , to ld e , bulb fibioUS a n d <ly st d im e , e la st u , a n d 1m u l e , a s c ,p 1ldr. nt b ein g 1 u ih d , sp u n , a n d w o t i n ,1 , Ot 'i l k \ sin glo s t i a n d 1 in In sp u n t o w eig h h -s ih 'm a I olili, e to 100 lid s , fibi e J In' uh (F . M ichisi ctpie a lly a 'h e s to s s SC-on tei con sist ,, f tw u i y d i f l i i e n t e l m i m t s . -ulk u f th. Iduo is 11,111slue c 111 a n d g lis tm in ii , Ih le) and d u i . bl a e k o p u |iie ang11l.11 p n iti e l'S ] ) .M inute black IX1 iim h s a lso m o pie s e n t, a n d a c lo th n u e u u f.u U u 1 v In c h w . . Sh ' h ss th a n to th o -q 1111 a 3 11.I I t in The black [i.u tn V s e u tu a lli p a rt uf th e fibn-, h u t th i ip p e u im . igg, ^ diff. le n t thi'im ea! unii- lu tc i found in any t u c m in tu c s ulihe, p o s itio n nnd dille i n l i y s m ) ( I i u .k Iois f io m lS> '>>'< p a i l s o f ih e s a m e l o n n t i y . ti a n si m , n t p o ilio n e d u s t ge-iu 1 ilc d d u r i n g m inri- Jliilo n rn l A sbestos is n p p tie n d y m d e sti m t ihle, C|ii d iti e s e l c 1 m e m lo Ilie a m u n its 11, f iu m t h e I t a l i a n U p s a n d tin T 1.1I M ijiin ta iii* Ife io d c ilu s (c irc a 450 lie ) d e s tiih c d a r u m it mu made ftoin difficulty m asbestos c u mg it l ' li S n t t 1 .d (m m m (cn h t i i20 50) in>'ii 1ions the ti < ) a n d l ' lu ta u H ( i/ie il t l> 70) b o th F p e ik o f th e w ic k s cd Hu lum ps ot tho "sla l V iln iu s b e in g m a d e fi " ' he. a t o f th e s e s i m p a lig n ],11 p a itie h 's and m im ile gi m u l, s, uggi s tm g , o f e iitiise, t h a t t i n ) a ia inmc' h u id o tha Ihe tin n s h ii 1n t p a i t o f i|iu lib io I beso p .u tu U s .11 o f o u n d hi u i y s m a ll n u m b e rs m th e finished ai tu le -Mi T II Hy ro m , F T C , a n its>. <1 . u i d sam p les o f d u st, u id f o u n d tl i a t th e e lnsts to n ! m i m g th e g u Liei m in i b u s ni th e s e hi h k p i l l u l e s r o u t.m u >1 tho I n g e s t ninejuiit o `i h e n o n c o n te n t of th o finished litu i ', la Jii.rti and d u s t is us fidhiws { * I they m a in ta in d a p u j a In a l II mi w ith n' t be m g coil-nine'.! 1 m i'litcl a rln le lio n (as fiiro u oxide) 0I 1' i s .itu u s ( c m n 175) w f . i s to a gull! 1 Hop 111 id. b y D ii'l fi nui 1,11d| 1Ig in il l Lj ( a llu n a i h its ot A th e n s fui M in e i a , th 11 k cil lu e h w as in a ile u f C .u p a s i, 1 lin e n , " dio 11K lin e n w h u h is n o t eoDM inied Iry f u e ' L a i c i (c j) 1250) M a n o I'.jlci v e n te a 'h a t h e h u l seen T a i l a i s ti'in g .lo th tica t it h sto u ii In e lu i h w as m ade of a " C eit.unu M im ial] ul J .a illi fm ind F r o m th e s e r . s M|i s it l>pi u s i i i u i h i s n e t h a t the* M aik* c n e il Di 111To p a l ts o f th e .c sln -to s fib re a io th 11on-e o n t.u illu g ) )o itiu iis tn e b u g le a 1 ut th n ia m if a i t ih e r, d ie m in o ul " d u s t," a n d a d an g ci lo th e h e alth uf o ih e ls iti tlio in a M m inlayne " pioeess of m a n u factu re. A lth o u g h its \a ln a h le p r n p iitie s h a te h i m kim w ii fm th o u san d s of y eais th o m odem ndap laticu t of a -lu s tu s to th o liiih is lu iil a ils d a te s fio m only a few y e n s age t'.' o o f i d e/ ffic C atf * T he d rrr^ c rd , a woman ugi d 33 31 n*, eonmiriiccd o ik a t the a", of 13 |i.n > in an a -l,, -lo s f.o lo i) m winch no p ronsion wps m id c for tin. e iiia id o n of d u 't . F iom an e arly ace, soon a fte r Com jK>Mf ion. \s b rd o s h ono of th e silicates, a n d its yn u t ties n o coimiii muiK w eak, s)ie M iir.re'l fiom A rnu^b, wlucli d id not m tu f c iii w ith Ik r c iu c ra l In .illh u n til 1917 She m l th e n 28 31a,< of I ", , nnd had b ,, n oikm g tlu rtrcn yeain From thil n n m c io u s . IV lie ic e c i i t o c e u is i t is fu n n el a " o e i a l r e | w iili time unlil 5 31m s l.etei (1922) he r altcndanre a t v o ik wero in te rm itte n t owing l a ill hcalih Sha missed occasional d a is and *TM> and 111 two following p p m a U at ant, t s . t. ri j .I , n ono o r tw o periods of sonic < eV. u n til blio finally ccasod o ik l'i. Section of Prcvrnllce M ..lulnr at (lie Annual M-stine of tl,u HiUuli Midital Atsoduiion, l.lioburgh, 1927. h in Ju lv , 1922 Up to tins s i" co.ijpljund of cough, dyspnoea, expccloialion. IS A SINTsJ F P H O T O C O P Y ly la n F RY T H F N A T IO N A L L IB R A R Y OF I>r c . 3, I 9J 7J (lih .-h u ln n j r,, I 'l l . A i n N \H Y \ v> U I > K W J S by Dus w K ' " " I S r i h it .M iJ)\*T.n ) Fk, i . F JJH R P F-F5 n |r ^ T IID Y o r R F S F A R C H IN I IFU OF LE N D IN G T H F O R n . m M' D EC. , *9*7] IT I.M O X A K Y VM IIX IO M S {Illu d i,U I.K IJ t h f / ! .< , h ,, I ) ,t - \ \ }: Coohk tim i U lU ItT M t D tlN tu ) l Uscieri Ja*x '.\,'- ^'vrV^VX. .*' . ~; ' ' . < *i> '* / . - * * > */#* < 4 R fe ft e'- W- Ar ^ ''f v r i ' . ,- 7 7 ' ? : - v ' - v v j j . i * o \ .> . i / i r . * V ' / * . *"** j. $V > #* A^ v * 4 A V? , 9 * , ' kV ? - *' ' * * ' ' < tf-H, S A - ^ -jJ s a s t W % 9*J '*' a D _ c , 1927] P I LM ONAllY A SB E8TO SI3. I lisine. }*** uni! In**iiudi 'Hit pUj--ii.nl vlgn in U.-r Micsl -M ie iUow> ut fillio) i.f 1 )>< ridili liing In Jid v , 1922, mrih of m utativi) n i- m aisul, iti bitume uioic jiiofu*, vnth sv ia ta mici 1111 guidi- luiipi 1 ai ino, ami alle liti il un Malti) Itili, 1924 An v i.i> p ljU -liuwcil cxtcnm e fibrosi, moir m aikid m Mie iighl lune, in o dianoti glaiid al Ilio i&ot ni lln lift lune, ami Ino amali t ikmc-ous paitiile 10 tilt Ihj-c of tilt liti lo ir labe. oj)|H-ittittKrs m lite tu o litiig* onl.i tilfor m iIckipo. Tltojr ttm Ito M iiim i.it ixoil on ioHovia 1 T im o is noli m n ih ri) JifTiiso jtito i tili.il (meitmoLna 11tifi 1Iiio iiic b r o iiil iitis n u d so m e p m p lu * p in u 2 TViore is o li m a i Voti a n tb riim - i't. 3 T lio tP ih a n ex tonviY t t i l K iiu ta u s w iu ltt u m i A Vili rulrtiplrii J /if/itrnj uct * d ii onit plithisis. Itm hl Lumi Tltt p in n a i-, Ha. Vermi ohi Ilio tin n in filo of 4 In ilio nlvoob, liio m b i, nm! biom tiioJo*. unii itl'ii tn Dii long, and dioa* ilio limali) of ili use atllii-Mon lo ilio Must vikH un} jn ) i >1 ilnmi 'llit luiig ) litui and mali 'Ila glunds a l ilio 1001 of ilio Imig aie laigo i.nd on m i Litui aie biadi, Uow x liurhinoi) tap'iilo, and 01110 rdltartous p n itk lis On tClion, tlio in ti is ttt i.il tth tv tic a T u , n io < ril.u n fnroign Ixjtlioi u l u d i w il! Ih.- tlf M iilx il m i h t u i l la t c r ( F i( i. 7! Ah ib is u iin n u iH ii n tto ii di iris p i i u l l i tu li ) ilio l u t i n o tlio lung is m n lo bc iiln w ii and tu a b ugi ev ititi aul, lite tf Ilio to tl 'ig i t luniioi, l\n - gt in ia l In sto lo g ic .il |ia tu ii* s itili lini# lit-iio bcing 1 . piam i In lihious Its-ui D uiio ti.mdg uf lib io is li" iic fiom llit pii uni Ulti lie t i -li lang In ilio ani* tIn 11 i a I Ugo l a t i n , ib i ire uf a pttlcd ta iig uiuc oian gt Tbc innldlo ami uu lulx.4 *huw nnim 1 ou striali ai 1 as - \.ti ring in bo tjo.ilt ti illi 1 1 11 In |ofN 'Ilio illto istlti.il libiH .i* Is su d . .IN lilli;]lt 1)0 iN poitm l .1* a 1 1stilt o f n 1 ipiiibin.itnm uf a piH'iiniuimi m inin orniitniti i n li uni a lian I nul tu 1 jnn s In ad - uf casi al loti urne uf lui h Itati. luiHi.iUd tu r.i,n ailo n 'Die biuiidn a u dilalod l i j l l u i ; --TIh pii ui a 1 tlmln md jnd show tIta um ani* of ndlu-inn' tu 1)11 e)nl v ali Tln ilinkiiim g and aditi moii ,,10 noi 0 inai ki il n in 1)10 n glil lune Tlu lung 1. fun ui lUan nini a ili itili u. Ut'tou nliitt* ttiltiiiu p T o i ') i n il nlim bul fui tu tln iiis siri) in n m uli p u n i i * iln o in in in litio ii a io 1 noi pi< si it T ln ro 1 11 ni 11 k* il m iai tei d , 111 tln' sm alli r b lan dii- ut lite p ttlm im .u i n i t i i i o s . *utno m o llim in- nulli.al Al lln inol of llu lung aio tuo Jaijjf tali n in n i ina*, om d i' izi uf n luigi inud-nul, Ibc od iti about Ualf Miai mio-- c.il'ilH ii lui 11 ninna gland* Ilio o lia i claiid* .in bl.nk uni Ito a 1 nidi ulti in tltt Ufi api \ ! u 1 *n Dea uf ulti 1 u uin IiomhI aliti o ic -m i/ad A la in o f tbo sm alli 1 In tim iti 1 1 u M i p i a l n l Min b iitt stili t .i'i >11--luoking t i i i t i i * Sujiio ni ita a i u o li siili Mio tinal un l.ip l.i'i 1 ut iln n lin iiig tbojt tln mio of a M-ip.iin p u t, and g ouilU lite mio o! * i d i * into itiiaiu i.il io iin TU' h b m -til am i tlm U tin i .tIs siulliut tv alo ut] tliuniglnitlt t!w liing a l t muli auu ot ili 11 -a 1 lo m islu iii Mimi il,o 11 1 of die liing orni of ulm li Uo di inni- taltjittni p iiin le , olili rs sinatl ine* of ta scali'ii `1 11 1 . is a fuii'idi 1 alile i w n i i 111 lite libious U-sut nf tln b irx id ii ili in u n pi n 1 s g itln .d li inni;' lu to tin n .t s ni tldftisi hbim is o t i i " i i ) i i t b III- li a n 11 i n i'1 n11 lo ti nf l \ Hiplxu st o i i H* atmittg, fin libi.ibi,rt* 'mne <f 'M irro outt m d in g f >t tire*, ut* jm fittoti b\ ixti n s frinii Ib is tiM ' T h e (11 *t t fin ........... .. iilluni) 1 ni' lino g ia m ila i piglili ut in lln poi ibi mn In,il fib ions tiuo, all ni 1h i t i li , .liti! tu pii lo ft sto -a a lt otoii tilt intuii ilio si 11 rntt* 'ila p u t i i In <i| tlll* 11USI ,U< 1)1111 11 |)| l/c (mi all 1(10 io ilio li l u k g-ann lo - 011 ni tlu .isliostn fibio Citi siiiiiu l m in il {1 iln n is tln p ii s r i u i uf l u g i nini IIP, III,l. 1n i t i d i * ( l 'i g 2 ) 'Ilio-a in s p in t o ti 111 m a s nf lib ili.1- a in 1 in i ,1 si ,111h" 1 1 1 a l'Io i . i l l II1 i7,. f 1 nut 3 lo 360 mi. tm,-. ,11 S, nm b Tin- p u l u l i * ,m . su I l l s , _ ni 1**0* ui[ tlu II .111 I II in ' 1 11 i n a i t i * t h tt Mm\ ltm*t In no oi,1h n t.1l -m ali binili lu 1 till OS] * ,lf t lit ab oidi *1) jiplli d li i ta hi n pl.it 1 ami la t o in m u si*, a* s o n in tin s i .'Tu olii i.iiisJi d o ii i it l )Mn li |ii(i|ionI tl'su o ni ilio .in d u l l l. -II 'Jin m l , . m iai libici*)* 1 pi , n o fin 1idvt 1 tdun uni il mil 1* o b lim i b.t !->"h ilb fill i d i b in ili \OI< Dut ill t- - ti , liu( Mio Ih t -l<v \ 1 bu . i H i m l l i l b . le uni a l . d - u n m d i 11 ti 1 md In 1 no -p i. 1) Indu itimi ul ni n u t. \ 1 , il-a nm Ila 1 1 <\dl n II k' li 1 ,l. nil Im .b u i- Mtvb sm p al 11 id an d inn on.11 li in o-i . t 0 ib pui (* Mi 1Hit oil l i " 8) lb.- 0 on di 1 a l m i n e imt spit 1 ills tin -a u uf \nlu t . niait d IH' < . bull l . l 1 m i . n i Mi 1........ bl.ll III! k illin g Tin 1. 1 - Tinnii mi 1 e 1 (nil at 1 a* Tin ili oli liuu , in (1 11 1 (ini 11 nf 1 ll s , un. Mm M IIIII llf Ml. il tiull, Hid n ail mi m ani 1 il 11 b il 1II, h , pi b do) it od finit) t In- lin in g m i! a u m ili >a t a tt ii li l'i" 3 <ll.l 1g. IS *1(11 1 1 Ibi- to in iiii.il lu IHinoli . solili o f l lu d i W e li,u i ih 1 ci con a n i tilin g p tl.lllo l to till Il t pUOlHUOHO- a io ilil.itu In- tn ot boi du sts, noi b a v e i0 K-eii .liilo to find T h r F i'i 1 Kjii U-iilim . MU 1) Oi 1 m i r in e m In o r a tin e tilt 1 om pat m g tin * , Inge- T l i o l a i g i i !>]atk uni 111 1 g t i h i li } 1 i^iih ut. il bmlit s lu d i p u t Kit s l> Ili) ll`stOS llltst tilt tlt* 1 a sta ik m g ivvevnbt.mio Im i o m iii (!o~i 1 da il in Di Co iko n o n imi l e 1 1 ubi lolls III II) su o * li lin s, tini t olili}) 1 il f a d , it 1* 1 I I I ( u*i to thv m iitvn iil ] ts.in iH K il. im i o r o d o ari *0011 in mino t the O.llil slllgli Ji il litio found in Mie filili? soitiu n* and nm lOMojiK tl pro pn n itn oi* uf bis in d i } li.nl Mio up(\ui- iirutn-dt ili U (iud its Uvtillu-i 1 " a d id o Hindi fro m tin- dust \\ o i.in m it t li 1n k U1010 is .lin 1 o iDii,il)io ilim b l t im i lite p.111 ri le* in tln ' lu n g * ,110 tlio bo,ir \ , hi itt li ium -<ont i m m " t , ,, il iti. i>f ashoM os f ilm ' 'Ilio m o ro o - i t o i s i i r i m r t h o . n io n t o f tlio i i ^ l i t I n n i' i t li us c x p l.m u 'd Tlu* h i- ,n s p a r - tllllit l o f ON.llllUllllg I *ll.ll IKit l i b i lo tlu IH *|H H a lli, tHt i-mifmo tm n ttin tim i tu i r i t a in iiig lili d i p , i d . " s t i t ami inud) sm aiioi iaxlios lib id i a io (diluiti m i m aU li ' s id n n .s os.iim iu d Som e of tlio-o m e fio r, inn m ani a io pbagut 1 Xmoli in ilio la ig o liionoiiin ira i 1 <) 111 Ilio ab eoli ( I-'tg 6 } (n lo* tin u lil p .i's m o ie r a s i li li n i '11 tiro m o ro i r r t . i il i i g b t **111110 a io t asiK H u lu iliii m itiin ]'.ii ali o!\ srrnil |iii.igo< i tir b r o tu in is tin n tlio lu ti jsout.il lo ft b i o n d i n i id i , bot Mio m a jo llti a ro la ig m , i . i i i n i g 111 si/o fio m 20 /i lo 70 /(, 01 ` le u m olo 111 tln- i ao ot e1 1 1 un 1 (ungati d fi il tu* T lio 'in a ili) laitllos a l-' iohiuI.hI .uh) liiiinug-'hi-nii*, I1 W 1 0 L 0 G Y O F l 'U T.M O NA lY A S H h s T O M S . am i all i ia ii 11 disiiitiH lo lln iit*li In 0 n lo lu u s u g g i't u n ; tY S i ' M V U F Mi D O N A L D , - M I ) . 1 111 P P ro f,--01 of rad io lo g i, l m u i - i li o f Dui Imi (I l 1H1 >7 *o< m i l 'h ih ) blixal p ig n o n i Tln tmigt-i ft ri ts Im i ,1 lu g iib i l i u . i d i - i isI h .\)i|a 1i .iik o , troiigK s iig g is t u o ni Mimi u ig iiiit *1im - ttu o Mfi*-t li.ut- un au u iil.il ii( )k .11 .m< n in i li un iln srr (Sam inaliou i.m bi i i m i Ii h ! u lto a i!u * d \ c't * 1111 ol tum idi il ilisio id la n liis ( I- igs 4 , 5. 10, am i 11) In suino 1 ISA-. Mi, gluUtd.it finiti* dio ,1 1 1 ,iiig id tieni" tln- M\ i i i n i i k ino tim fitu d tu ib i bi(ol<|U|( ,d nppt ,i t `Un <s li-oiu (il mie litoti-) filini* and ntr isu n ialli a io d u st m .it ni tb c b u io m tb l i u m id i , virtlt p iit.il II II n Ufo tn il tlu- tin i* ol tilt' tti'l*. s n ud ,itn ig *|m>i pugni oi n 111,III! Ioti l" Il Inaili of Inn! Ml1ns11.1l 1 [ipi .11 1 ni o u b id hsphitiHM od * (b' ig* 5 , 6 , 10. am i 11) N m io li t i o .ne p io 'in t bulli in tlio n liculi .u ni int> i s t illili siibsln nio d u ls-liku ovtto in itu-s ut om- o r bolli ttu ls u f Uh- lihimeirt* >i tiro l 'i 'rps T b o irbsc) V.itoDs tuo b .lsn l .iliitnsf tn tllo ly d i l u * , agitili Miggosi Mio i p | x a r a in t o f um iliti i_iii*t!in in nil tiiatOii.il su p plirti titilli tbo t tso ili itila il bs D i Ctuiko (litui* ( F lg 10(, iillt (lu x I t-\aiUIIU!t Miti due* Hot Mlppnlt 'ilio d ii U'ti^; itim i lia s Inn'll in iiilm titi iti Mio p.itliiilngfc il tlu- id ea ,.f m llioi i.g o la b U - ut in iu ial o tig m Tln *o b ji.t 1 1 me u t ni ilio V m v o is ili ot D n iiiiu n C'ulloj' i* i l b in ili* do Hot siim i i t i tlio o id in a n m u lin o M ani*, ,\fi ilu tuo lin i p io v o iit titoli u iig i-iu l lo llo u -In 0 11 id Id u i. Tlu, aro I inni st ilo , Iiottoi r i . tlia t ilio appo.i r i n i f s 11 o (irai tu ,ills * m t vit-H tu u tislA tti'd x i t t i n T ltis g ti o n d i.iiiu t o iis lu jilt ut K 11 tilth those u b s riio il tn a m i nini <ao of timi t-on- ))nis*'iiii-bluo tonitiOH iti) ptitussiniu fot un 1 untilo Bini ititiwtl, M 'ilutits of u b id 1 b a io litui an op p ia U n titi of dilnto liM lu itlilorit a m f The- ro atlio ii 1 not 1 olivioii <\,iti)inttiu th im i li Ilio <Diirtf\ o f Dl I -M D l u t i l i t.f u tili** tiri- sid tilm m ni-e slig b tit a im ix l AMioto tlio lmdio \iln li \ , I.CfH an- lini l.lig o ti In- (diagot 1 tosi <1 In Mitili u lttil d i* Mie ' l 7/ lifidra/i/ NtllH i'iiiU* si 1 1luti* b aso tun alio fin iti both 1llnj' flio ih a ifg is a u nnm lin ukitl oli jt if iie 'd *nlo, but lite t` Hil tn In olili sili rullu-li d tu p b i'lin n lia! 11111**1* M im i nf tln' p iijg ix 1 ti-* tm ilain nitid i im b uti p ig lin o li hi itdiiitiou '|'limt" li lltose Wht-H a r e maini, U-utid in Vhe alio u ii nm) i_ ^ rii i.f^N D IN G T H r_ P B !'-r'