Document aB3KBZj2pj75Qn7yprwYZBary

FILE NAME Colonial Sugar Refinery CSR DATE 1950 July DOC CSR028 DOCUMENT DESCRIPTION Journal Article - Section of Public Health Tuberculosis Tropical Medicine and Industrial Medicine THE MEDICAL JOURNAL OF VOL 37Th Year eee SYDNEY SATURDAY JULY 29 1950 | CONGRESS NUMBER AUSTRALIA No. 5 Australasian Medical Congress British Medical Association BRISBANE MAY JUNE 1950 Continued to apply for first communicatedcomunicated concerned or with dical Association y 135 Macquarie appointments Macquarie ical Society : Limited Services tralian Prudential ': Federal Mutual Provident Club or other appoint- M.A. House 225 sbane Associated indaberg Medical Appointments and any COUNTRICOUNTRI are advised in eir Agreement to ary 178 ments in ments in North = i ~ etary 206 Saint tal all Contract ~ ia All govern- . of those of coe the journal cannot ~~: al articles for- offered to THE - = the contrary be the Editor THE ~ House Seamer |. 9 MW 2651-2 % fy the Manager Street Glebe gularity in the ginning of any The rate is 3 3 mmonwealth of 44 ca and foreign Table of Contents The Whole of the Literary Matter in THE MEDICAL JOURNAL OF AUSTRALIA is Copyright SECTION OF TROPICAL Page PUBLIC HEALTH TUBERCULOSIS MEDICINE AND INDUSTRIAL MEDI- SECTION OF PATHOLOGY BACTERIOLOGY BIOCHEMISTRY ve ee we te ee ee AND ee ee 175 SECTION OF NAVAL MILITARY MEDICINE AND SURGERY .. AND AIR .. -- +) FORCE + +8 184 SECTION OF SURGERY .. .. rs 187 SECTION OF ORTHOPEDICS MEDICINE see oe -- AND oe PHYSICAL oe SECTION OF MEDICAL LITERATURE AND HISTORY 196 SECTION OF RADIOLOGY AND RADIOTHERAPY .. 197 EXHIBITION THE TRADE .. .- -- 6s ee ee . 199 CORRESPONDENCE Australasian Medical Congress British Association Seventh Session we A More Realistic View of Tuberculosis .. Medical ue ee .. .- The Toxicity of P.A.S. 2.0. 66 ee ee . 202 202 203 DISEASES NOTIFIED IN EACH STATE AND RITORY OF AUSTRALIA ee ee ee ee Page TER- te ne 203 GRAduate woRK The Graduate Committee in Medicine in University of Sydney se ee 1. The Australian Graduate Federation Medicine rs oe ae ae ee the in ne NOMINATIONS AND ELECTIONS ne 203 203 204204 OBITUARY Sydney John Newing a Beaumaris William Stevenson .. .. .. . 204 + 204 NOTICE Ophthalmological Society of New South Lecture by Sir Howard Florey .. .. An Appeal for Legacy .. wee Wales .. . ee ne .. 204 +. 204 we 204 DIARY FOR THE MONTH .. .- 6 ee we ee ee 204 MEDICAL APPOINTMENTS IMPORTANT NOTICE .. 204 EDITORIAL NOTICES .-. .- . 5. +e ee ee 204 Section of Public Health Tuberculosis Tropical Medicine and Industrial Medicine President D. R. W. Cowan M.B. B.S. F.R.A.C.P. South Australia Presidents Professor A. H. Baldwin M.B. B.S. F.R.A.C.P. F.R.A.C.P. D.P.H. D.T.M. and H. New South Wales G. Cole D.S.O. M.B. B.S. D.P.H. Victoria C. E. A. Cook C.B.E. M.D. Ch.M. D.P.H. D.T.M. and H. Western Australia A. Fryberg M.B.E. M.B. B.S. D.P.H. D.T.M. Queensland C. L. Park M.D. B.Ch. D.P.H. Tasmania Honorary Secretary D. Gordon M.B. B.S. Queensland President's Address DR D. R. W. COWAN Adelaide took as the subject of his presidential address The Role of the Voluntary Worker in the Control of Tuberculosis He referred to the steps taken at the Perth congress to establish an Australian Tuberculosis Association and he recalled the fact that in speaking to the subject on that occasion he had quoted a statement by William Osler that by joining actively in the work of local and national tuberculosis societies medical practitioners could help in the most important and most hopeful campaign ever undertaken by the profession Gratifying progress had been made with the Australian Tuberculosis Association voluntary associations had been formed in four States Queensland and 1 The losis meetings meetings held by the Section of Public Health TubercuTropical Medicine and Industrial Medicine with the Section of Pathology and with the Section of Radiology and Radiotherapy Radiotherapy and the Section of Medicine have been recorded Tasmania had so far done nothing It was for this reason that Dr. Cowan had chosen his subject It only required some ardent soul to give a lead and the rest would follow without much trouble Perhaps an isolated individual could do little but joined to others in an association he might be able to accomplish much Voluntary associations would not embarrass official efforts the best results would be obtained by a combination of both All that govern- ments could do was to formulate plans to provide money and facilities and to give a lead Without the help of the medical profession and the people a government could not make its plans effective Though governments had done much they had left much undone they would go on leaving it undone unless urged on by the force of public opinion Dr. Cowan referred to the report of Dr. M. J. Holmes in 1927 and said that nothing had come of it Many recommendations had been made by the Tuberculosis Subcommittee of the National Health and Medical Research Council but none of them had been implemented A well- 174 _ W, Corren Harvey THE MEDICAL JOURNAL OF AUSTRALIA. 29 1930 1939, THE MEDICAL MEDICAL JOURNAL was been thought that a ha thought thought Zard hazard existed those handling bricks bricks. interested in Dr. George's inspector interested with a patient statement late forties forties The Diagnosis and of Smallpox DR Smallpox years the mines Kalgoorlie Kalgoorlie to tubercle tubercle bacilli as fibrotic fibrotic was difficult difficult cases he recalled recalled regarded pure silicosis snow- in introduction storm ray picture which years later tubercle tubercle tubercle in Australia had been with found with Commenting demonstrable demonstrable changes the radiological biograph operators Commenting the of the taking patients moment remained remained two brothers biograph operators operators quoted Dr. Smith examined them both of endemic bH rotha er br rothv er he ad y emphysema emphysema dyspn icdyspn ic and disabled disabled emphysema epidemic virus whereas pneumonokoniosis other with equal equal evidence of evidence con- causal emphysema emphysema emphysema was DR The L. Diagnosis Diagnosis Control smallpox PARK Hobart discussed discussed He smallpox He saig protected with advent advent pos ibility possibility introduction smallpox smallpox into Australia was largely largely Australia the quick control such a unvaccinated disease unvaccinated country isolation isolation quick quick of the would and the prompt prompt o taking earliest precautionary Prompt endemic precautionary measures countries seasonal epidemic certain prevalence the eastern quarter quarter the year seasonal prevalence first quarter stable The The and causal was virus which which which retained tinue with work temperature temperature the development development such cases that emphysema person DR ALAN in ) that a incubation PENINGTON two two incubation was spread indirectly person indirectly fomites The indirectly development the The questions were of Melbourne Melbourne whether fourteen period until period irregular irregular modified rash fourte n questions importance importance was pneumonokoniosis days the period characterized small- smal]. | it disposing developedinfection was was necessary pneumonokoniosis before pneumonokoniosis from exposure pox The invasion symptoms characterized subsided an abrupt . subsided the appear first prevented prevented predvid ented progress it not . trh isbae ne saiJ a that atat titimes it was then regular sequence followed lesions DR GORDON a Brisbane said times it was Brisbane Brisbane said industrial and foflloolwleodwed stasgtagee when regularcrusts last stage crustscrusts formedformed these lelfeftt pitted i appeared aki difficult obtain industrial industrial hygienist obtain good industrial clinician considerably considerably surface when the because because dangerous could help known and foundries dangerous were dust risk There foundries had early early lower half to the arms and was was rash of the face rather limbs tion been classified than tendency tendency classified relation associate associate disease disease was rather than the legs the distal distal of the trunk trunk / and to a tion the clinician clinician example example that painter assume that example sewer digger digger occupasuffered rather than rather of the proximal ends the front the extensor flexor the back surfaces surfaces rather rather extensor the from lead lead poisoning might pro- whereas an dust fact was exposed surfaces nounced flexures such shunned shunned centrifugal centrifugal hazard certain sections sections industry industry which dangerous Again Again distribution gave the keyasthe the diagnosis the an industry ca arn riedindustry on in different localities localities be shown in 1908. The laboratorthye diagnosis made made had IM and dangerous one another another exemplified working the fact constructors constructors in Sydney were working that working the ii detection detection of the virus in variola diagnosis lesions scrapings by the detection of varioalantigen vesicle lesions and by fluid and worked In which was whereas in Brisbane they The differential diagnosis had chickenpox madm e t ah dee distribution from measles measles ii vorked nan aminated aminated chlorine ; aminated denied denied possibility possibility was first puzzling dust but nan ventually ventually found found thpossiabilitty ea xposure en xposure period period had Dr. abrasive industry for thirteen in years nn A bagassosis ocured occurred Queensland tts urn ut main fts and although risk handling handling of risk lay in the handling in bagasse bagasse although the resultant resultt ant he mills mills containing mited mited vy mited and intermittent intermittent and patient @ y great risk who caused worry infrequently ho on e elderly man infrequently examination grinder examination -rosis, ho on first whom examination tubercle showed massive massive was rosis but whom bacilli could detected whom put such such man off work but and had vaccination but streptomycin Administrative said that successful vaccination and revaccination required would Administrative control ; isolation absolute patients and vaccination follow surveillance required isolation possible patients contact complications complications might every possible vaccinal encephalitis generalized 0} vaccination Encephalitis encephalitis generalized generalized probably vacciniaunknown unknownunknownviruspreviously previproeviouuslsy ly prevprievioousuly sly introduced introduced introduced introduced only was to carry primary primary it age Generalized Generalized Generalized vaccination adults and nearly . always affected vaccinia affected those vaccinated vaccinated always first children affected affected only those vaccinated vaccinated | for for time , CYRIL COOK it affected the subject small COOK Dr. cilli and Smith reply said that Dr. Smith reference reference tories cakers emphasized what the points raised by importance importance industrial Refer- & to stories emphasized what had said said his paper protection g to George's remarks Dr. Smith said that was ! ' difficult difficult ascertain the actual degree exposure that miners silica and there was no doubt times miners y were I were risk that miners examination examination examination contained less silica 5S post post mortem n was gs post showed that they contained answer casaensswer Dr. Dr. Penf ingtoo n uDnrd.claSsmsiictalh csaseas icd athsat es silicosia cases but infective condition condition pox might at any time Australia medical medical profession profession in Australia great It important important to the determine determine values attaching the work Wilkinson Wilkinson Hong Kong in attaching vaccination vaccination claimed that was gave protection relatrieolnation and and then effects rapidly was waned first to tox^mia to number of lesions lesions and relation relation finally maturation maturation lesions lesions Thus was possible possible for patient with smallpox vaccinated vaccinated vaccinated more than two years years die tox^mia tox^miano rash or previously disease at period few answer contracting of contracting lesions yet disease tox^mia tox^mia tox^miawith there were now now have no rash, of but Australia Australia Australia there personnel large number number vac aset ase and ' did t notexperience experience removal changes changes drager lusion,clusion clusion arrest progress recently brick dragger ing ing bricks Smith Smith barrow and not entering bricks from barrow advanced fibrotic changes been been been found changes rele rcle rcle have advanced had previously bacilli his sputum sputum and it previously Previously In number spots the might consideration was help diagnosis diagnosis immune immune reaction reaction Until reaction recently following following fre understood understood reaction , Until recentiy it had bee? war reaction following fre 1 29, 3 revaccin revaccini cert : that frequ frequ so, cert: frequ frequ frequ quite quite others 801 vac reacti in sot vaccination reacti protection protection number of it had of was had follow was scab a folloy revaccination a reaction t: NORTI . Pathogen Pathogen Nori. Koch Koch had Koch allergic re desc pointed out thai re reactions bacte thai tended protein protein to for allergy bacterial allergy some importance be distinguish in r true Mantou be J. L. O'Co smallpox because because O Co which the preser preser between between the vaccina vaccina smallpox arrivin I deve manifest a manifest could arr most rif deye vaccinated vaccinated arr; very difficult difficult ri; Instance Cases greatest greatest risk detecting ca doctor doctor practition practition practition ca: persons who had pra: Speaking Speaking mi the small ; limit virus mi. as technically it wa technically technically wa o and, as the virus teehnicaily it wat Vice-Presigents: B. + M. Mackerrag, Bigchemistry recorded Meetings held HeTed, Dical wi: Medi ole dose entration he first thiazole oubtedly " ling crosis njection ration of talluria THE MEDICAL JOURNAL OF AUSTRALIA 173 cfaraonmsdesparalytic paralysis poliomyelitis the prevention and limitation of in to the difficulties associated with a diagnosis referred poliomyelitis Until it was possible to tell which patients actually were suffering tel with precision research would be hampered and at admitted as suffering from paralytic Fairfield patients poliomyelitis had been found to be suffering from mumps mononucleosis and other conditions He was infective of the danger of moving patients over long convinced and urged that if patients had to be moved distances be transported to the nearest base hospital they should infectious diseases hospital perhaps many not to an of an adequate supply of respirators and Provision miles away two dozen which was important and at Fairfield some had been avail- built during the earlier epidemic been outset of the 1949 epidemic However many of - able at the child respirators and useless in the recent them were most respirator patients had been adult epidemic when was to build the policy of his hospital now Accoraddiunlgtlyrespirators which could be adapted for use for McLorinan could offer no explana only patients of any age Dr. tion of the shift of the age group incidence in the Victorian epidemics DR C. E. Cook Sydney said that Dr. Cole's paper ' his own experience in the Western Australian supported in regard to age shift and the higher mortality epidemic which he thought had perhaps among country patients resulted from their transport to Perth over long distances Many such patients had been sent in ambulances past base hospitals with respirators and had arrived in Perth moribund Dr. Cook asked had there been any investigaepidemic of the question of tion during the Victorian mortality among pregnant women who had contracted poliomyelitis to which atAtuesnttriaolnianhadepibdeeemnicdiroefcttewdelbvye Snow In the Western women who contracted poliomyelitis slix had pregnant survived and given birth to female infants and six had died five of them bearing male infants the sex of the sixth child not being recorded Dr. Cole in reply said that in Victoria no action had been taken regarding food supplies but the Consultative Council on Poliomyelitis had recommended the boiling of milk and that recommendation had been interpreted by milk interests as an attack on the industry It was not considered that ice cream was likely to be a vector provided it reached the consumer after pasteurization and packaging in a factory but ice cream dispensed from metal containers in retail shops could be contaminated The closure of schools had always been opposed in Victoria unless some special reason existed and in the 1949 epidemic the Education Department had been asked to exercise clemency in those cases in which parents had kept their children from school and not to admit transferred children to schools until those children had resided for not less than two weeks in the new area The closing of kindergartens did not interfere with education and parents had been advised to keep young children at home All schools had been urged to abandon competitive sports on account of the risk of precipitating paralysis in children who might be in the incubation period of polfomyelitis and in whom exhaustion might have disastrous results Dr. Cole said that he had no myelitis in pregnant women information regarding polio Dr. McLorinan said that in the Victorian epidemic of 45 women over twenty years of age who had been admitted to Fairfield with poliomyelitis 14 were pregnant and three had died but no record had been kept of the sex of their children Occupational Factors in Pulmonary Dust Disease DR C. SMITH Sydney read a paper entitled Occu pational Factors in Pulmonary Dust Disease He stated the definition of pneumonokoniosis adopted at the Third International Conference of Experts on Pneumonokoniosis held at Sydney early in 1950 and outlined its scope Dr. occupational Smith stressed the need for a complete and accurate occupational history in the diagnosis of pulmonary dust disease He said that the potential capacity of a dust to cause disease depended chiefly on its composition and nature its particle size and the intensity of exposure In addition to dusts containing high percentages of free silica others from which free silica was absent asbestos and certain metals were capable of producing severe pulmonary damage In most dusts asbestos being the exception the harmful particles were those less than about 6.0 in size Intensity of exposure which varied for different dusts depended on the atmospheric concentra- tions of dust and on the duration of exposure Dr. Smith gave a brief account of a case in which silicosis developed rapidly With regard to the main occupations and dusts associated with a risk of pneumonokoniosis Dr. Smith mentioned diseases caused by silica coal and asbestos and also the radiographically evident abnormalities of certain basalt workers and biograph operators and the pulmonary effects of talc graphite cement zinc cadmium beryllium manganese iron aluminium synthetic abrasives cotton bagasse and wheat He also drew attention to the occurrence of pulmonary carcinoma in workers exposed to chromates arsenic and asbestos Dr. Smith then set out the following nine measures to be applied in the suppres sion and control of dust and in the protection of workers he said that they did not vary with the industry or with the type of dust i The abolition of processes creating harmful dust If that was not possible the total enclosure of such processes in mechanically ventilated structures or their segregation from other operations in the factory Isolation could be applied either geographically or by time carrying out of a dusty process when no other workers were in its vicinity ii The use of a harmless material in place of one that was dangerous ii The removal of dust at its point of origin by local mechanical exhaust ventilation iv The use of water or other wetting agents to prevent dust from certain processes from becoming borne v Electrostatic precipitation vi The provision of adequate general ventilation to dilute contaminated air vii The maintenance of a high stan- dard of plant cleanliness and housekeeping viii Personal respiratory protection of the worker Respirators should be worn only when other methods of protection were not practicable or for jobs of short duration They should be fitting comfortable and efficient and should be kept clean examinations ix Preemployment and periodical medical including chest radiography of workers exposed to a dust hazard D--W. E. GEORGE Sydney said that in investigating cases of pneumonokoniosis it was important to obtain a detailed record of former employment as there was a tendency for a man changing from an industry with a silica risk to another siliceous industry to suppress information of his earlier occupation Unless too a careful occupational history was taken ridiculous errors might arise He quoted the case in which a radiological report had been received from a large Sydney hospital of typical pneumonokoniosis the patient being a bank manager Speaking of coal miners Dr. George said that intermit- tently they were exposed to a high concentration of silica dust particularly when sinking brushing or driving in sandstone and as coal raisers they did not realize the dangers of such dusts It was at times difficult to estimate the number of years during which a coal miner had been exposed to dust risk as coal miners worked intermittently at their occupation Probably a third of the number of years a coal miner said he had worked in the industry could be deducted before an estimate of the actual years of employment was made Experience had + shown that unless there was free silica in the dust inhaled it was unusual for tuberculous complications to develop Many of the industrial dusts were not of great importance because only small numbers of employees were at risk and in factories the dust problem could be dealt with better than in coal mines but it was a good working rule to regard all dusts as barmful At the recent Pneumonokoniosis Conference in Sydney the possibility that free - silica might reactivate tubercle bacilli of low virulence had been mentioned and it was suggested that B.C.G. might have its virulence raised if subsequent to its administration free silica dust was inhaled