Document b50dd7yEQN0O8pRZrRzmNonZ

FILE NAME Colonial Sugar Refinery CSR DATE 1960 May 21 DOC CSR036 DOCUMENT DESCRIPTION Journal Article - Occupational Diseases of the Chest Excluding Silicosis THE MEDICAL JOURNAL ot CHEST silhouette *\ OCCUPATIONAL DISEASES OF THE EXCLUDING SILICOSIS sharp margins of the cardiac Figure eJn": Occasionally there are scattered granular and punctate - a + mottled shadows but these have not the defined F.R.A.C.P. . margins of the coarser silicotic nodulation = 8 _"_ Maurice JOSEPH JOSEPH By Honorary M.R.C.P. F.R.A.C.P., ~' Honorary Physician Thoracic Unit Royal Prince Alfred Hospital Sydney -.'. + bronchioles "2" Histologically asbestosis produces diffuse fibrosis around - starting mainly around the terminal bronchioles and atria as collar sheaths and extending peripherally x - - as the disease progresses it produces profound thickening of the alveolar walls the interlobar septa and the pleura . of Peis -* Even if one excludes silicosis industrial lung disease is *. and throughout the tissue are seen fibres asbestos ~ % still & tremendous subject and far too large even to either singly or clumps as well as the characteristic attempt to cover in one short lecture I propose therefore asbestos bodies Those parts of the lung not involved in to limit my remarks to two conditions which have come the fibrotic process naturally become emphysematous within my personal experience more frequently than other - symptom Dyspnoea outstanding Dyspnoea is the outstanding and reduction of industrial lung diseases asbestosis and coal- respiratory capacity will be progressive unless the patient *"- workers pneumonoconiosis : Also I shall deal with these . is removed from exposure at a very early stage of the from the point of view of the thoracic physician and not disease This is readily understood because the primary that of the industrial hygienist me condition is pulmonary fibrosis which becomes more if thousand The uses of asbestos have been known for over two marked with the passage of time evetn he subject is ~ thousand years one of the earliest references to it removed from contact with the dust . Pleural thickening thickening : : ; and add ': and by Herodotus in 450 he described how the Romans and emphysema are .. natural sequel^ the - ' used mined it in the Italian Alps and Urals and it for enshrouding their corpses before cremation . The name asbestos is derived from the Greek meaning inconsum patient's increasing respiratory disability He becomes ultimately to liable chronic or recurrent bronchitis and to and 7 to the development of cor pulmonale 2.233 ultimately :: of patients Jones able and Plutarch referred to the wicks of the lamps of <-:to Fr^ma study 25 with asbestosis Hugh < the Vestal Virgins as asbesta The dust associated with ..~John Read and Roger Williams- be published con- the handling of asbestos created difficulties in those days. cluded that the primary disability was a diffusion defect of as at present and Pliny in A.D. referred to the use - ' as would be expected from the thickening of the alveolar avoid also respirators to the inhalation of dust walls They found that those patients who had much The Australian production of asbestos is not large it fibrosis had diminished vital capacities but no appreciable amounted to 2500 tons in 1954 of which all but 450 reduction maximum breathing capacity unless bronchitis came from Western Australia This by no means satisfies was present <0 ~ ek ot cy Maas eel ae man aged years the requirements of industry and large quantities are - recently Apatient recently studied was a with imported mainly from South Africa It arrives in sacks a history of exposure to asbestos dust from 1927 until 1956 as the crushed rock and men employed in emptying these .when he left the industry because of increasing dyspnea and asbestos have been exposed to a high concentration of the dust had worked mainly as a lagger mattress Asbestos fibres of extreme fineness can be obtained spun maker with various firms with a break of four years during into Air yarn and woven into cloth which has a great variety which he served with the Royal Australian Force He of In addition to being woven it can be ground and - was dyspnoelcon dyspnoelcon mild exertion and had a plethoric facies |~ uses mixed with other materials to make insulating slabs and definite clubbing of the fingers Medium crepitations welding examination over the chest lobes showed both appearance and seen in : boarding brake and clutch linings electrodes for were resisting filtering cloths packings jointings and wrapThe dust given off in the process . examination his chest showed the Figure II It is interesting that the film taken three years and it was from a pings for steam pipes : ' ago 1957 was passed as normal seen . is mostly less than 5 in diameter and 10 in length. As comparison of these skiagrams that the fibrosis has mainly - with other dust diseases of the lungs the occurrence of . developed since he left the absestos industry The respiratory asbestosis depends upon the concentration of dust to which function tests were carried out by Dr. John Colebatch with _ the worker is exposed and on the duration of exposure the following results The vital capacity was 3-8 litres There are variations with 100 the breathing capacity 82 litres per nevertheless individual .. was silicosis among workers apparently to similar was conditions workers exposed exposed se . Clinically the mode of presentation is with dyspnoea of minute 73 and the diffusion capacity carbon mon ofide 10 55 of normal 0 TF impair This shows that though there is slight airway impair of gradually increasing intensity often with a cough which >. ment the main defect is in the matter diffusion i across is generally productive There are usually no physical the membrane 0 sie signs the early stages of the disease but later r^les . Last October a group of six men suffering from asbestosis develop with evidence of impaired respiratory : was examined They all worked for a period of approxiand cyanosis and clubbing of the fingers in advanced cages - mately ten years in what was known as the asbestos gang whose involved emptying All'complainedImported asbestos is crushing As was mentioned previously the cough mostly nonproductive . 1) >, cough of varying degrees of severity Some had no abnormal tproedurctiivestprioducctivestrubcuttureexsamainraetion bodies scantbyroThwesne huigphlhyighplyroduced the rn productive tapering signs and respiratory function test 7 Reis obtained was This . between eee 3 long and 75 in phlyusnigcbaalses The raiy n oatphepresarcarnecpeistatwieornes cwhearreachteerairsdtiact and ae were removed from contact with asbestos length and are a golden or colour They .*: although men i tend to be segmented and are of an elongated dumb dust when disease was first discoveretdo be present shape They have been shown to consist of central in in.1956 there has been : progressive fibrosis There of of asbestos upon which a colloidal combination of tissue was fairly good correlation between the severity symp- protein and silica has been adsorb colle oidd al toms and results of: limited covering is soluble in strong acids and alk^liswhich leave carried out but the correlation these and the ray the central asbestos fibre bare Asbestos bodles appearancc loesse ; eT eer in a pure state by tryptic digestion of the lungs have been - Asbestosis not only a crippling disease in itself but : found to consist of approximately 70 organic matter and ..30 inorganic matter They may be found in sputum before there is any radiological evidence of asbestosis and renders diseases ton and the subject The studies McLoughlin more susceptible to two serious of Wood and Gloyne and of Middleindicate that there is an increased must be regarded as an indication of inhalation of asbestos - susceptibility to tuberculosis in patients with asbestosis | workers dust but not necessarily of clinical asbestosis although this has been questioned by other *. definitely in os the are fairly characteristic Studies by Doll and by Lynch et alii both in 1955 indicate Radiologically there is appearances diffuse haziness throughout lower quite that carcinoma of the lung has higher -% Usually a incidence asbestosis sufferers than in the general popa lung of fields generally with obliteration the normally lation This high incidence of bronchial carcinoma bas - J =- : Wales BrBranach nch Figures paper British Fx: * Read at a meeting of the New South Medical Association on July 1959 3+" of 4.2) the i <1 For ; ' supplement | ' THE MEDICAL OF bea o : JOURNAL AUSTRALIA Sarrehte . t+ been with disability his occupation .. . The patient was a man aged 64 years who had a a worker severe due to may miner for 40 years He had first noticed dyspnoea three have years before he was referred to me on June 19 1958. This ~ the -* had reached the stage at which he said he found it difficult 4. no radiological evidence of pneumonoconiosis Tests of respiratory function such as that of : maximal _ to walk out of the pit and even the exertion of bathing and . breathing capacity and timed vital capacity in - dressing caused breathlessness He had only a slight cough conjunction with clinical evidence of respiratory disability - and the sputum he produced was white and frothy His chest skiagram in 1956 had been passed as clear but a provide a better indication of the state of the . worker's pulmonary health than an ray examination and should current one showed an opacity at the apex of the right lung Figure V Tuberculosis was considered the most likely diagnosis but repeated sputum tests gave negative . results and because of the possibility of carcinoma smupiplnemeenrt the latter in the regular assessment the is Acknowledgements My Manufac- thoracotomy was advised Clinically and radiologicaltlhye thanks are due to Dr. R. Hughes of the turers _ patient appeared to have marked emphysema and this was Mutual Insurance Company for the ray films ^' confirmed by respiratory function test carried out .Dr - of the patients with asbestosis and to Dr. K G. Outhred Colebatch His vital capacity was normal 3.48 litres but . and Dr. J. Colebatch of the Joint Coal Board for certain + the maximum breathing capacity was considerably reduced patients being 36.8 litres per minute 36 of the predicted valuefigures and ray films relating to withcoal miners The | Mr. : total lung capacity was 126 of predicted level and. MS :* the residual volume 161 giving a residual volume to total - * lung capacity ratio of 62. He was subjected to surgery and pneumonoconiosis I am also Woodward Smith of the Department of tion of for the grateful to Medical Illustra- Sydney photographic University repro- > although a less extensive operation would have been tb a agtty Con tt ductions _ preferred a right upper and middle lobectomy had to be~ Bibliography performed because of technical difficulties The lesion . CAPLAN Appearances proved to be tuberculous but the interest in the case is the of Rheumatoid fact that examination of the lung sections showed a marked degree of pneumonoconiosis despite the absence dust CARPENTER HIGGINS G. Cochrane The Relationship C. , opacities in the skiagram Figure VI of 3 we A. 1953 Certain Unusual Radiological in the Chest Coal Miners Suffering from Arthritis Thorax 8 29 R. .aH: IGGINS I. T. .* *** A. GILSON J. 4 . i- ae and , Between 5 appear- Capacity 1956 The lack of correlation between the radiographic Ventilatory and Simple Simple Pneumoconiosis in workers Coal- ances of pneumonoconiosis and the degree of respiratory DOLL Brit J. industr Med 13 166 Cancer Asbestos 4s Brit CancerinAsbestos disability is also exemplifled by studying the respiratory 7D- O- LWLorRk.e1rs955 MoJr.tIanldiusttyr fMroemd L1u2ng81 Asbestos Post- - function tests of the patients whose skiagrams I used Gough J. 1940 The of : Pathology Pneumoconiosis .to demonstrate the radiological categories of simple - Gough grad med J. 25 611 Toke Workers in pneumonoconiosis and confluent massive fibrosis Reference GOUGH J. 1947 ) Pneumoconiosis in Coal Wales to Table I will show that a man in category 3 can have : of Occup Med 4 86 # HEPPLESTON A. G. 1953 The Pathological Anatomy TABLE I. Pneumocontosis ~ Simple in Coal Workers J. Path Bast _ Results of Respiratory Function Tests in Patients with Workers I'neumonoconiosis . English HUNTER D. 1955 The Diseases of Occupation Universities Press London . : . Maximal Primary Pneumoconiosis JAMES W. R. L. 1956 Primary Lung Cancer in South % Wales Coal Workers with Brit J. , . industr Med 12 87 ~* ii ~ Vital Capacity 1957 clin Prac Breathing Pneumoconiosis Years 154 Age la Ncoerntmaagle The FLTEuTbCerHcEuRlToubseirscuMlos.is JAMES 1954 PneumokoniosiCsoalworkers o W. of C Years | Mine Litres per Minute Per- : Per- . Litres | centage . per of fag Minute Normal =~ JAMES L. Brit J. L. Relationship of _* + the Development of Massive _ i Workers Brit J. Tuberc 48 89 ~ KILP^ TRICKG. S. HEPPLESTON A.G. and -+- 1954 Cavitation in the Massive Fibrosis Pneumoconiosis Thoraz 9 260 : ara to fi 30 4.0 100 | | 2.8 83 3332 4-6 116 Pneumoconiosla | PEMBERTON Emphysema Bronchitis 1959 86 49 85 . 77 223 53 223 81 35 |. MORROW C. S. COHEN A. MORROW - " Med Clin N. Amer 43 171 J. 1956 Chronic and a - - 45 3-8 130 94 106 363 = 32 1.8 60 30 . 34 363 30 4.1 127 74 73 - 363 Bronchial Spasm In Bituminous : Aroh industr Hith 13 529 .. Workers Coal = A.M.A. Lea oe considerably th^n one disability category 2 tu less respiratory that virtually no respiratory disability may -i; exist with category A confluent massive fibrosiansd a category C man may have appreciably better respiratory function than one in category B. As long ago as 1948 |: described the case of a worker who was the 12 Fletcher whose - local champion for the 75 yards sprint and :chest a Conclusions - Dt other published indicates Information From the foregoing as well as from : work which time prevents me from including in Australia purely local because over the problem is by no means 1000 patients with hydatid they this the following conclusions must be drawn > : ., disease have been admitted to public hospittwenty ianls primarily paper Hamilton an 1. The respiratory disability of workers is 1. capital cities of Australia during during the past twenty years A 86 patients with pulmonary bydatid disease further an airway disease and is due to focal emphysema: of j or: and b chronic Bab generalized Fitzpatrick Hamilton emphysema bronchitis and vesicular min disability . 2. There is no correlation between and respiratory - the ray appearances in the chest : 3. In the matter of determining compensation the aCllinical Material Sixty three were | sevenof the patients were Victorian from Tasmania and two came from southern ' ray findings in the chest may be misleading and unjust South Wales Thirty of the Victorian in two directions a a worker with radiologically evident were living in Melbourne at the time of their admission pneumonoconiosis may have no respiratory disability b to hospital Some had previously lived or spent holiday holiday ba ta iSneoekswtee aoe bronchioles but distally extends for a of *. widely accepted . Doll's of the terminal to the division of the final order : : .> bronchiole been confirmed by others and is men variable distance up has shown that the average risk haamsobnegen ten respiratory of which there may be three In the of dust accumulation aenmapllyosyised in asbestos for 20 years or more - . depending upon the degree bronchibronchioles oles dilate producing .- times that experienced by the general population - course of time the ensheathed Until Heppleston's ' pneumonoconiosis The secondpneumonconis topic I wish to present is avwaiolarblkeeornlsy what is known as focal emphysema focal emphysema generally considered that dust and again in the time . work it was generally coal deposits of of obstruction of air passages by . che certain aspects can dealt with The - and extensively was the result This histological condition of focal emphysema che Wales are the most important fibrosis + vicinity of on which it is possible to understand New South pneumonoconiosis worked in Australla and are situated in the being referred to forms the basis respec- dyspn aof simple As respiratory sectional area and therefore Bulli and Lithgow Newcastle coalfields dilate the northern southern and : . bronchioles - volume their to the squares of in proportion mines tively as 13,250 men employed in these :< volume increases to an increase in the volume Approximately pneumonoconiosis of the problem can be : their radii This is equivalent leads to deficient aeration of the exttehnet fact that at present 870 men are receiving of functional dead space and of the airway gauged by this condition 420 total and 450 partial . the distally placed segments : ; generalized subject'by miners compensation forwork has been done on this subject'by the To add | to * the disability This is A great deal of School of Medicine at Cardiff and our not infrequently develops v^'sicularemphysema characterized by Welp National of the pathology of the disease is largely based v^'sicular distinct from alveolar focal focal emphysema and is and alveolar sacs The kno ge the observations of Professor J. * Gough In our own late dilatation of alveolar atria ducts coal is the same as that on pioneering work was done in this field by the and # cause of this condition in miners who develop emphysema- pets. State carried on by Dr. W. George srt the majority of miners oj a. has shown by Badham m not namely chronic bronchitis Pemberton bronchitis is Charles pneumono- others '. sn that miners who developed : carefulaproximately comparative study that chronic in workers : as silica approximately It was once thought of the inhalation of ~ mixed three times as common it could be considered itself conlosis did.so did.so because the coal dust was inert in other industrial groups In case this possibility ': with coal dust and that the dust to which the miners that smoking was a factor he investigatedthe workers has W. R. James shown that more than % up South Wales are exposed rarely contains workers 1000 cases of that a greater proportion of than and found or had given smoking .. lifelong smokers also a con- .. of free silica moreover in had _ were studled There was James 19 subjects the mining groups smokers pneumanoconiosis studied by in the holds of ships lower proportion of heavy cigarette if the ; worked as trimmers loading coal intoseven of these had -. siderabltyhe workers It would be surprising long period aa. and had never been underground This accords with among Gough's inhalation of laden atmosphere over a would in the confluent massive fibrosis of the theory that the con- 1940 findings and disposes dust from rock strata did not cause such mechanical irritation as bronchitis run lead to the development of chronic pneumonoconiosis dition is due to highly siliceous long the pathology is is characterized adjacent to the coal seams Moreover -. Radiologically sidmepslceribed and classified in the Inter- ', on two opacities different from that of silicosis by fine category 1 2 and 3 aS In some cases a be depends The development of . pneumonoconiosis * national System as which has been termed con- itself the is superimposed one relating to the dust condition This consists of marked' ~~ groups of factors individual given identical dust factors with other to the and atmospheric concentration fibrosis fluent massive collagenous fibrosis masses varying in size from forming commonly in They occur most regard to particle size and extent of the pneumo- 0.5 to 15 cm in diameter lobes is in individuals vary in the degree factors are difficult to the apices of the upper and lower Although the noconiosis that develops These efficiency of the nasal filter positions most favoured by tuberculosdiissputed for some asses but it appears that the disease such as ^tiology of this condition has been that it results - and of other pulmonary e presence of metabolic and there is now fairly general agreementJames in 1954 bron are important The claims of the lung and . from superimposed tuberculous infection evidence genetic factors physiological peculiarities response to w _ as able to nnd histological and bacterlieoslioogniscalpresent in invoked system and physiological invoked but none tuberculosis in % of the massive is difficult to Its lymphatic and others have been climatic factors invoked o2f45 South Wales workers Since it existing massive appears to have been substantiated * believe that the bacilli penetrate into reached seldom greater than 10 in diameter reach that the organisms lestons one must postulate with the dust particles Dust settling out of the atmosphere or by being inhaled before or :.* alveoli the lung either respiratory tract however sometimes cavitate causing the productiotno ~ being filtered off by the alveolar spaces in which has been likened particles less than 3... can reach the Here they are taken up by phagocytes walls and then of intensely black sputum fibrosis has been divided printers ink Confluent mCassivtehe radiological appearances large numbers in the alveolar which apparently originate into categories A B and on or wafted upwards and finally expectorated the - of increasing severity described either are vessels and are transported to the hilar In 1953 Caplan another form of massive multiple and ..". enter the lymphatic and thence to tissue of the lungs in which the round opacities were fields llyymmpphhoindodes from where they may travSetlilltootthheer spchaalgenoe- fwieblrlosdiesfined and distributed througThhoeuste bloetshionlsunogccurred nodes which are accessible to biopsy focl around the but particularly at the periphery * of simple pneumono- with their carbon load gather in cytes . the charac- in miners particularly with with a mild degree rheumatoid arthritis and were constitute bronchioles where they respiratory These coniosis who also had distinguishable from confluent ' 0 pneumonoconiosis teristic lesion of workers | are scattered shown to be histologically has been given the name and intensely black micro massive fibrosis The condition lesions are stellate from the lung vary in diameter of Caplan's syndrome throughout 5 mm but they contain com- . to about it has become increasingly recognized scopic dimensions tissue Gough by the use of whole- In recent years disability can exist without radio- paratively littlehafsibrdoeumsonstrated these lesions beautifully pneumonoconiosis dust pneumono- that severe respiratory logical evidence of There is a category that is significant lung sections of simple ' pneumonoconiosis showing all gradations 0`in 0`in workers can exist with an ray picture disease coniosis difference between and even disabling dust opacities are either absent or ~ described recognizable Gough pointed out the essential and described : in which standard category 1 film I have seen -. | pneumonoconiosis and workers How sparser than in the from the Cessnock mines and ' silicosis the characteristic focal emphysema of the latter ~ by painstaking anumber of such patients who had a lobe removed because patient - proximal of demonstrate ever it remained for A. G. Hepplestonthat the _ the desutsapiiclisouosneapical lesion will illustrate the point the region serial section technique to cells is regularly in of a limit of this sheath of dust e wets at fe . at