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396 0. A. SANDER 3. Animal experiments have demonstrated that administration of high concehlfi amorphous hydrated alumina unfavorably influences resistance to tuberculosiss result has not yet been reported for metallic aluminum, caution in the applicati aluminum therapy to human beings is recommended. 4. The use of aluminum might appear as an easy short-cut to healthful woriont tions, thus saving large expenditures for ventilation and other control methods. Actual] is no substitute for the accepted methods of dust control. tig 5. If industry indiscriminately treats all employees with aluminum dust, thei aggravation of tuberculosis or other pulmonary conditions. S<;3L, 6. The therapeutic use of aluminum in man appears to relieve symptoms in fffl number of cases in which silicosis develops rapidly. Experience in some groups" iS*jnoi able than in others. 7. In view of these considerations it is recommended that the general applL aluminum therapy in industry be delayed until adequately and impartially controjleL observation demonstrates its effectiveness in preventing or alleviating silicosis meantime, there should be no slackening in the control measures that have been foiindlcffi in reducing the incidence of dust diseases in industry. This statement still represents the thinking of most authoriilti,eVs",,^j country. There have been no conclusive data from scientifically controlled^ in the past ten years that make it necessary to change this statement^,an! d. Other Therapy. In the past few years, there has been increasingari in hormone imbalance as a cause of excessive fibrotic response and in, thJJ|L hormones to retard the progression of silicotic fibrosis in the hmg8y3p|p insulin, estrogens, and thyroxine were shown by Schiller7" to have anjjmuif effect on fibrous tissue production; while androgens, such as desoxycqi tiro] acetSteTSd~testosterone propionate,"ihcrea~se"d--OT^formation of, u VyskoJil80 agrees that silica certainly is the primary agent that pru^^^TM, but he theorizes that it does so by way of hormones and their effm.Anffl lymphoid tissue and plasmocytes. Short- and long-term stresses tendS|j|,S the levels gf antifibrotio hormones, resulting in increasing fibrosis., He|hj| culous inflammation, physical fatigue, excessively hot environment, anj of large quantities of dust as examples of such stresses. ] Regarding the prevention of silicosis, VyskoSil concludes that it| to look for a constitutional factor in persons tending to develop incre response after inhaling silica. He feels that eventually such perso identified by comprehensive studies and excluded from the dusty t As'f0r^trAatfflSI1Tte"believert'Kat'lilicMiOlre`ady wellliiKler wayca by, giving ApTH,and'cortisone in small doses, alternating insuiffiwfL- He further says: ' ...... 1 PerBcras with thyrotrophic evidence should be given thyroglobin, whichj'&ftell _mentahsiU"cbSi^beh^dhIl5CXestoato'roDer:althciugh-administered-td"pe'ri"dn3-httvm|rS " E. Schiller, The influence of hormones on the development of silicotic nodules] Ind. Med., 10, 1-8 (January, 1963). ''-"^1* " Jiri VyskoSil, Endocrine functions in silicotics, Arch. Ind. Hyg. and Occupaiiij 9, 402-413 (May, 1954). feii PULMONARY DUST DISEASES ^ At 397 5!**$&$$* ^ y, Raule and Grisler," should be given, in my opinion, only to persons with active ishould not be given in eases of purely silicotic reactions because of the danger .... btne silicotic process. Important is the prevention of inflammation, both the ffltpSbfiibronohitis in the spring and autumn and that of tuberculous origin. I suggest h^la$,tic. administration, of salicylates in spring and autumn, as these depress the inflam2i!|i<jn, and; as is the case with fibrous rheumatic nodules, may also beneficially affect ____ ,,.y, we shall see much research in this direction in the next few .,,JflIll|>may lead to satisfactory drug prophylaxis and therapy of silicosis. cwlS'estoday, however, is not sufficiently conclusive to warrant applying lnese|ifiethods clinically. specific therapy is available, treatment of disabling silicosis will symptomatic. It is principally directed at the associated emphysema Sainage of retained bronchial secretions. Bronchodilator drugs, such iphrine (1.5 cc. of 0.5 per cent) or Isuprel (6 to 8 drops of 1:200 ien placed in a nebulizer with 100 per cent oxygen and inhaled with j|nt positive-pressure technique proposed by Motley, have given very ufts. The resulting improved ventilation, although temporary, has MJiitu a frank improvement in the morale and feeling of well-being of many nggL |hat this form of therapy is recommended for disabling silicosis and (from any cause. Courses of treatments may have to be repeated at ^^^.Iht- intervals, depending on the severity of the case, n^fiulksures that must be a part of the therapy regimen are prevention .aent of colds and other respiratory infections, the maximum M^l^Eey.Intion of contacts with active cases of tuberculosis, and discourage- niMf|V-Q|k]ing to reduce bronchial irritation and secretion to 'a minimum. Any ijL^i^f=5fiT'Aiwill prevent bronchial obstruction are indicated. The cough reflex, quid not be subdued and codeine should be withheld unless, the cough jaihtenance of the general nutrition of the patient also must be part ma&i"u%nt program. Continuing graded exercise is especially necessary to ^^^iS]'olier' atelectatic areas of the lungs from developing. Support of the ` 'ynffli.'With its resulting support of the diaphragimwill improve ventila- ||llpj:ases with advanced nonobstructive emphysema, but is contraindi- appiere is considerable bronchial obstruction. asp' Hite_______________v. : "IT.'.'-' B. ASBESTOSIS............ .... ' ...... ......... .......... 11s a hydrated maSnesium silicate. More than 90 per cent of the raw finP^fVJpiftein this country and Great Britian is produced in; jthe; Canadian .wj^ulejnines...Asbestos is used in two general types of manufacturingprocesses. by itgif,,8!f1feE6a~vi'QroiaiCT' lnmflW^~matertalgfBugb " *"'yytli. for fireproofing, packing, or insulating; or it may be com- fflSSlSiSand R. Grisler, Primi risultati clinici ottenuti nella silico-tuberculosi, Med. life). ' ' mm 4qEsbM