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FILE NAME: Smoking (SMOK) DATE: 1947 DOC#: SMOK014 DOCUMENT DESCRIPTION: Book Excerpt - Diseases of the Lungs and Bronchi DISEASES of the CHEST With Emphasis on X-ray Diagnosis By ELI H. RUBIN, M.D., F.A.G.P., F.G.G.P. DCliirneicctaolr oPfroMfeesdsiocrineo,fSMetoendicHinoes,pitNale,wNeYwoYrkorMk;eVdiicsiatlingCoPllheygsei,ciNanewin YChoerkst; DofisPeuaslmeso, nMaoryrriDsaisneiaasCesi,tyMHoonstepfiitoalr,eNHeowspYitoarlka;nAdttCenoduinntgryPhSyasnicaitaonri.uDmi,viNsieown York: Associate Physician in Chest Diseases, Lebanon Hospital, New York. The Principles of Surgical Treatment By MORRIS RUBIN, M.D., D.S., F.A.C.S. Clinical Instructor in Surgery. Mew York Medical College, New York; Active Consultant in Thoracic Surgery, Fordham Hospital, New York; Visiting Surgeon, Seton Hospital, New York; Associate Visiting Thoracic Surgeon, Morrisania City and Triboro Hospitals. New York; Adjunct Thoracic Surgeon, Montefiore Hospital, New York. 355 ILLUSTRATIONS WITH U PLA TES IN COLOR W. B. SAUNDERS COMPANY PHILADELPHIA & LONDON Copyright, 1947, by W. B. Saunders Company Copyright under the International Union \H Rights Reserved Tmhaiys bbeoodkuipslipcraotteedctoerdrbepyrcoodpuycreidg,hitn. Nanoypmaratnonfeirt without written permission from the publisher Reprinted October. 1947. M ay, 1948, and M arch, 1950 MADE IN U. S. A. PRESS OF W. B. SAUNDERS COMPANY PHILADELPHIA tubFeirgc.ul1o7s8is.--inSiltihceotuubpeprecrulloosbies. shRoowenintggegnroagyriasmh-brleavcekalasppneoadrualnacresiolifcolusinsgadnude intocreaasssoedciahteildarandethnrsaictioessi.s;A,ulSceilriactoitviec sntorduuclteusrecson(asissbteinsgtoosfbdoednisees)cowrheischofgfiivberouasptriusssusieansubrlruoeunrdeaecdtiboyn lfaomr iinroante.d(Cwohpoyrlrsigohft,hyCailbinaePfhibaerrms.aBce,uStipcianldlPer-osdhuapcetsd, Inc., Summit, N. J.) 346 DISEASES OF THE LUNGS AND BRONCHI dizierdecetsxttehnesiopnhyisnitcoiaand'sjaactetnetntliuonng tfoieltdhseopftoesn thhaadt wfoorrkalemdoosnt tshhriepesyaesaarsn, edluercitnrgictahrecwwaerl,dheer shiabslesuegxgisetsetnecdethofe atedrmust"mdiosdeaifsiee.dPseilnicdoesrigs"rastos onfizsetdeesltepelaltwesi.thPaarctooaftitnhge otifmzeinhceaunsdedthgealrvesat caorevenrosteudchinintshteanrcoeesntwgehneoregraabmnoirnmtahlesahbasdeonwces oAflththoeugthimhee hbaldacskomireonprowteitchtioount aagacinosattinthge. oaftmaodsepfhienrieteohriswtohreyreofexepxopsousruerehtaos abeseinlictioouas fcuhmanegse, sitwseereemdedue liktoelyinthhaalattiothne orfoenmtgeteanl m"mixotduirfeiedofsdiluicsotss.isA" ipsrjeussutimfiepdtivoendtihaegnboassiiss ooff finujmuerys,. a recognized source of pulmonary pthreovreodenbtygeanddfiintidoinngasl,sttoudbiees.confirmed or dis cepTthibeilpitaysttohisintoferyctimonasyorfevtheael uinpcpreerasreedspsiuras peScuevliearralepghgyshsieclilancsalhcaivfiecadtiroanwsn oacttceanstiioonnalltoy t"oarsythtmraac.t", Tphleeuirnisiyti,alresctaugrreisnogfpsnimeupmleosniliiacsosoisr elunncgosu.nTtehreedseinnothdeuleroseanrtegesnpohgerraomidoifnsislhicaopteic, suenladcocmoucnatuasbelesidgynsipfinceaantwshyimchpitsoomust eoxfcperpotpoforr hthaevmin.gTahneyapmpaayreonctcluyr cwailtchifiinedthceapsianrgenacrhoyumnda tliuonngtointvhoelveexmteenntt,ofththeeddyissepanseea. Wbeicthomgeresatienr otironins hthaevehibleaerngolafnfedrse.dAtoneuxmpblaeirn otfheeixrpplaencua ccoreuagshin, galtyfsiresvtedrerya,nldatiesr sporoonduacstsiovcei,attehde wspituh ltihaerycornepfirgeusreanttiocna.lcIitfihedasabreeeans poofsttuublaetrecdultohsaist tmuamy hoaftveenamfeixeleidngwoifthtigbhlotnoeds.sTinhetheincdhiveisdt,uaatl ginefneecrtaiotinonorinsiliocrotiacronuonddulessiloicrotciaclcinfioedduldees. atinmdevsaogfuaepaabidnofumlinnaatlucroem. Ipnlcarienatssianrge wfreeaqkuneensts. dRiireemcterinshuaglgaetisotsnthofatcathlceiusmhadaolownsgrwesiuthlt sfirloicma Sadildiciotisoisn, wbyithabuinnfdecatniot nexpisecctohraartaicotne,riaztetdi,meins pheartcicitleess. sAtusdaiedsditoinoncaallecviuidmendcuesftorinhhisalbaetiloienf florassnkofhwemeigohptt.yAsislt,hfoeuvgerh, dswysepantienagaannddcmyaanrokseids showing analagous Clinical Feature sr.o--enAtgdeinagsnhoasdioswosf. silicosis mresaty, boertehvoipdneenat eisvennotwsheeenn tuhneleisnsdtihveidreuailsiaslsaot cpahnynsioctalbefinmdaindgesoanlothnee,baalsthisooufgshytmhpetoprmesseanncde ctearrfdeiraecncienswufifthicitehneclyescsaeursceidrcublyatiinocnr.eEasnignogrgine onfititehse wcohnedreitisoinlicmosaiys ibsepsruesvpaelcetnetd. iAn cdoemtaimleud mtheenltivoefrthaendvesinpsreianditnhge needcekm, aenalaprpgeeamr elnatteorf. oincdciusppaetnisoanballe.hiWstohrayt amnadyasreoeemnttgoenaongirnadmivaidre Tfahileurfeewarwe haoptestcoapesutcucbuemrcbultoosisinoterrccuarrdreianct uwaals aentgraivgieadl ioncciutpmataionny, ypeaarrtsicubleafrolrye, ifmahye pnSeuemveoranliao.bservers have found a greater in plurnogveintojubrye. imOnpotrhteanotthaserahpaonsdsi,blae msoaunrcwehoof cthidaenncaemoofngcanrcoinnsoilmicaotoicfs.thTehleunrogleinplsaiyliecdotibcys mhaasyspneontthmavaenycoynetararscteind aa mduinsitngdisineadsues.trAy sdioliucobstisthiant acarrceilnaotigoennsehsiips eixsisotbssbcuetrwe.eeMn atnhye rmeacnenotfetxwpeenriteyn-nceinewacsamqeuittoe milelufmorinaatrionugt.inAe atwscor,ibtehdeitro pargees,ensceex ianndthoethsearmfeacltuonrsg wbheiinchg ctoheshtaevxeamadinvaatniocnedbepcuaulmseonhaisrywifteubwearcsufloousnisd. favTohrethpehydseivcaellofpinmdeinngtsofarcearncointoimlluam. inating. Ttuhaetioronenotfgetnhoeghraimlarremvaerakleindgms oadnedraltieneaacrc,enin Saniliicnodsiisviodfuaadlvwahnoceadppdeegarresewmelalynobuerpisrheesdenatnidn pbloatcheslunnogdsu,lacrh,iedfelynstihtieesriinghtht e(Fmigid.p1o8r5ti)o.nTshoef irnevtehaelsbesetviodfehnecaeltho.fExemamphinyasteiomna.ofTthheercehesist asupgpgeeasrtantucbeerocuflotshies. Troheentpgaetnieongtr'asmoccduipdatinoont dsiiomni,nitshheedexcpoisrtaatlorayndphdaisaephersapgemciaatlilcy ebxeciunrg aOtnthcleosmeromqueensttiwonaisngth, ahtoowfeavefrr,uiitt wmaesrcfhoaunntd. pTrhoelroengisedu.suTahlleyfhinygpeerrtriepssonmaanyceshoonwpecrlucubsbsiinogn. 348 DISEASES OF THE LUNGS AND BRONCHI orofeinntcgiepnieenxtasmtaigneastioofnsthfeacdiilsietaatsee.the detection preAsesntcreikionfg"faesabteusrteosofbotdhieesp"atsheoelnogoyn ihsistthoe ASBESTOSIS yloeglliocwexoarmbinroatwionn boofdliuensghtaisvseueb.eTenhessheogwonldbeny inAcsobmesbtionsaitsioanhywdirtahtedtrascileicsatoefofirmona,gnneiscikueml, Gaslboeysntoestofibbeers,cocmopvoesreedd obfy aacleanyterarlocforierono-f cmailnceiudmin amndanyalpuamritnsuomf.thTehweorsldu,bsintacnlucdeinigs criovnetdaifnroinmg bmloaotedripailgmwhenicthoifstbheeliteisvseudesto. Absebdees C(cahnryadsoat,ilwe)hiesreobmtaoinstedo.f MthieneAdmasebriecsatnosscuopmpelys atossbebstoodsiews omrkaeyrs,bbeuftotuhnedir ipnretsheencsepduotuesmnootf isnpulnonogr, wthoivne,n.fibIrtosupslisatbrlaendtesxtwuhreichancdanhigbhe neTcehsesarroileyntignednicaaptepelaurnagncdeisoeafseea.rly asbestosis arensiismtapnocretatontheinadtuasntdricahl epmroicdaulcstminakteheasmbeasntous disisntointgruevisehailninggc.hAardavcatnerciesdticdsis.eTahseeofifnteenpsuhlmowos finagctmuraeteorfiaml,aettlreecstsriecsa,lbirnaskuela-ltiinoinn,gi,nfjiarec-kpertoionfg npahryysefmibaroasinsd, poavtecrhlyyinargeapsleoufriintitserasrpeerrseefldecetmed bbuoiilledrisnganfdixtsutreeasm. Apilptheosu, gahndthien dauvstariheatzyarodf aronecnetgoefnaoluogniicfoarllmy iqnuaa"ligtyro, uinndp-glalacsess"sahpopweianrg ansesaorclyiacteodmwpaitrhe tihneparesbveasletonsceinwduitshtrtyhadtoeosf nthoet dsuemnseerthoepancoitdieuslawtiohnicho,fhsoiwliceovseirs, (sFelidgos.m18a3s, spiulitcsaaisnbdeusstotrsyis, tahmeornagpitdhegriomwptohrotafntthefofromrms oefr c1h8i4e)f.lyThinevololvweedr. pAortimonasrkeodf thpleeulruanlgsreaarce duIsnthdailseedasaessb. estos fibers range in size from 10 tcioosntopmharennifiecstssiniutsseelsf, iann oubnleivteernantieosns ooff tthhee ltuon2g0s0ismmieccrohnasniocralmraotrhee. rTthheainr cahcetimonicaoln. Tthhee daniacpehraatgtmheanpderaipfehleteryd oorf"tphoerccuapridniea"caspiplheoaur lloardggee pinartthicelelsu,muennabanled toobsetnrutecrt tthhee raelsvpeiorlai, eadtthee,siothnes. last caused by pleuropericardial otoliryisbrfoonllcohwioeldesb. yAtaelefcibtarsoitsicofrtehaectdioisntalinaltvhee graTdhuealonisnectreoafsetheindisceoausgehi,s ienxspideicotoursatwioitnh, cgoollacposmedpetnisssauteo.ryXoenmopbhstyrsuecmtead. aClvoeonltiraurnydetro dtoyswpnoreka., Tlohses opfhwyseiicgahlteaxnadm, iinnattiimone,isinnaobtilirtey tnhoadtulsaeteionninunsilleiscsosissi,licthaeries ims ipxreadctiwcaitlhly thnoe vpeeacluinliga.r WeaorothdyancdomGploleyxnieondroafwthaettefanctieoanntdo aa amsubcehstoesnldaurgste.dTfhoer hthilearrelyamsopnhtnhoadtesthaerelynmot ssolimghet,invdiiovliedtuatilnsg. eOcincasthioenaclhlyee, kassbaensdtoslicposrnosf lpohgaicticpsroacreessn.ot actively engaged in the patho opcecnuertriantiothneosfkaisnbpefstothsefihbaenrsdsinctoautsheedsbuypetrhfie terTizheedgbroyssscaaptpteeraerdanacreeaosf tohfedliufnfugseisfcibhraorsaics, ctwiaeleenpifdiveermtois.teInt tyaekaerss, foonr athsbeesatvoesriasgteo, bdee oafffethcetinugnicnhvioefllvyedthpearlotswaenr dloibnetse,nesempphleyusreitmisa. cvoelnotpa.ctWishebthroekretnhewdiitsheaassebceastnosprdougrsetssisasfttielrl cDoespiseannddinsgiloicnostihse, tehxetreenatroefacsoseoxciisattiendgcahnatnhgraes- unonnsetuttbleedrc.uDloeuasthinrefesuctlitosnf,romcontguebsetricvuelouhseaortr annoddesp.igInmfeecnttiaotniownitohfptyhoegelnuincgosrgaanndismlysmanpdh dmiseeaassueresorlisotethderforinttheercpurrerveennttidoinseoafsessi.licTohsies ctuubloesricslehabsacbileleinmfooduinfyd tihneapbaothuotloognye-.thTiurdbeorf apSpelyvearlaslo otothaesrbseisltiocsaitse.s have been reported tahsetaoutwophseitehdercaassebse, sbtoustisthpeerer issesofamveordsouthbet wtohicchauisseuspendeeuxmteonnsoivceolnyioinsisb.leaFcuhlilnergsf'atesaartnhd, dneevraebloilpitmyentot oftutbuebrecrucluolsoissis,isorprwimheatrhileyr vduule cohilas,ngehsasin btheeenlunfgosunwdithtosymcaputosemspsaitmhoillaorgtioc ftoactoproso.r working conditions and incidental tchaotesecsoemenpoiunndsi,licuosseids. iBnetrhyelliummanduufasct,tuaresiloif OCCUPATIONAL HAZARDS INVOLVING THE LUNGS 349 Fig. 183.--Asbestosis in a man of 31 exposed to asbestos dust for five years. Roentgenogram reveals fine reticular infiltrations affecting chiefiy the lower portions of the lungs. (Courtesy, Dr. E. P. Pendergrass, Hospital of the Univer sity of Pennsylvania. Philadelphia, Pa.) forFtihg.ir1ty84y.--eaArss.bFeostuorstieseinn faellmowanwoofr.k53erws hdoiedwoorfkaesdbefsotroasins.aRsboeesntotgsecnoomgrpaamnyrepvaeratlstinmoedufolarreaignhdtdyeenasres, adnifdfufsuelllitnimeaer infiltrations involving both lungs with intervening emphysema. (Courtesy, Dr. E. P. Pendergrass, Hospital of the University of Pennsylvania, Philadelphia, Pa.)