Document gDoVjQR7XGxr7EoQG96jZRoBN

FILE NAME: Saranac 7th Symposium (SSY) DATE: 1952 DOC#: SSY057 DOCUMENT DESCRIPTION: Text of Presentation by Unknown Author Introduction of Discussion on Definitions and Clarification of Terms Concerning Pneumoconiosis i gyTATIVEi V----- W (( __ )QgTim: to nisgresiow ok ttm im m s inp CLtf.mctTTm.- py raws eenetram; / raSBSBfgSB . RECEIVED F.HHis DAm _ Ju t SS5ZE5SZ. W.LM *** m? I s= vary glad the oonransrs of this Conference included definitions la the subjects for discussion, Za dealing with industrial aod particularly the poauaoooniosos* unambiguous* tlaar aad precise definitions ora of special and Tory preotloal laportaaea. On tha definition may depend the grave iaaue of oompeneetloo* and thus the oeonooie future of the claimant and, on tha other hand* tha prosperity or failure of an Industry* . Definition of an Industrial disease presents problems beyond those of defining a disease frca the elinieal-petbelogioel point of riev. Thera Is necessarily an inter-relation batveer. tte two problems* and It lias principally la tha oonoept of vhat la "disease", This, to take as an sample the definition adopted by the Sydney Silicosis Conference* 1950* which le also tbs one reoently adopted by the South African Bureau of Steadards;- Whilst In a vida sanse tbs ten 'pneun^ocmioBis* connoted any condition of the laags resulting free the inhalation of dust* that might or might not* bs of clinical significance, for the purpose of the International Labour Organisation the Conference accepted the following definition 1- -Pneumoeoniosls . . RECEIVED F.H.HiS . 2 PATL-^ L jiT w >b_ 4 9 T S Pneuaoeonieaia if a diagnoeable d i m N of th* laaga prodaoad by ibt inhalation of daft, tba tore tdnit' bolog vadaratood to refer to particulate matter ia tbf aolld pbeaa, bat oaeelmdlag living erganiama.* Immediately tbe qpeetlca if poeeds *Vbit doff dimM' reelly Man?* Thia word mtj be defined, and baa been defined, vmrioualy, depending Tory such on tbe oantaxt la vbieb it ie need. Tbe pathologist vould oay It Beans deviation free normal of tbe calls of tbe tieeoe. But about a century ago Tlrcbov pointed out . that oel1alar aboonalitiaa do act neeaaaarily connote functional abnormality. Ia fact, normal function may be oontiaued ia aa 4 organ the eelle of vbieb abov abnormality, and function may be iapeired in an organ ia vbieb eell&lar abnormality la not detectable. There are gradations, of oourae, la the later-relationi between obaervable cellular atatea and function. The clinician night define dieeaee ae ixpaimant of bodily functiana. In considering induatrial dieeaee tbe problem of eanpeneatloo auat be borne la Bind, Tbe ooncept of diaoaae ia, therefore, uaually related to functional inpaircant. Tbe terms ecanonly tnployed are i**peeity* or disability*. I think in induatrial dieeaee legislation there la only one exception to this uaage, and that ia in the South African Sillooals Act, in vbieb eoapanaatlon ia provided for a oonditioo ia vhich no fuaeUonal iapaimant need be dmonstrated, or oven be claimed by tbe applicant. Se ring- -----* -^ initia^ *. datE:U 1 Z LJLl 122i M.LM fcrlaj m i r d to th. oouree of tb. ferity cf pawaooonio^., it la hardly oorpriiing tfet tte definition* to far adopted hart all, 90 fir u I an aeeertaln, cawed difficult!** to these oonoerned with thf diagaoais, eartifioation and aeee.c&est of empeneetlen, thi latter generally baaed on the degree of diaability/iaeapaeity oertified by the examiners. South African experience, where nedioal exaainations and esaeaasant of degrees of .Uioofia hare been oentralieed in one ettabliahsant for over 35 year., provide, probably nor. prcni.iag information than any other experience,** reviewing tha effect of definition, on tha problea of a.ae..ing the existence and stages of the disease, and tha consequent compensation. The first Aet, that of 1912, had a very aiaple definiticm. Thia Act w i entitled *Tbe Miner.* Pbthiiia Act, 1912% ThB definition. wareiSiMT.' rbtblfin tbU Mtn ntU*i of t bntflt. to bn nvnnJnl ttidtr thi* Act than bn " (.) to 1m t who .bom 4.flalt pbynienl .1^. ef itonr.- pbthlnl. t nnpneity for " p o S n W t o o t h S T . ,*1* not onndlos one year) (v) to a miner who has contracted miner.' nbotn phylo.1 W - l * " * "* writ In themby .nriounly enJ PtaaooUylifnlr4.^ > of n U ponrf. P othly S S t SSTta^T^a- u " ,- t S l S S 1^ u " ttTSsti My, If It it nntlnfind of thi. Act.* ~fX5 =* = & ? * . -There- at There wi bo Bastion of tuberculosis is Ibis Act, Tte Mart phase in iVint definitions was is the 1926 Act, Xu this Act ths definitions worse *(2) For ths purposes of this Act the expression 'sinsrs' phthisis* seess ailieosls of ths lungs) end t.tnwlo.1, M U tuWTKlC.l. f tt. ^ respiratory ergons, A person shell* for the porpoees of this Act. be deeaed to be suffering or to here suffered froe aiaars* phthisis is the primer? stage if, tteugh he shows or fans shown definite physical signs of tint disease, his sspseity for work is not, or hss not been seriously end permanently Impaired, X person shell tar ths purpose of this Aot be to be suffering or to here suffered from miners* phthisis In e secondary stage, if the miners' phthisis stews or has stewn itself In o marked degree end thereby hit piytteal sepecity for work it or has been seriously sod permanently lapeired,* Bov tuberculosis is included end is compensable, whether this disease is or is not associated with silicosis. The importance of this smenament of ths preriema Act lie* in the as thrown on the asaaineri to decide whetter the pulmonary tuberculosis is or is not associated with silicosis, insmsuoh as the compensation payable was wery much higher when silioosla was also present - nearly times higher. It will be noted that only two rtegee of silicosis vers defined. In the 1919 Consolidating Act radical changes were made in the definitions. The definitions now ware - - *(2) - UAIt:. J U L ? l S M.LM 4K- (2) FW tb paipowi of thir let Jtpr#J * ^ toa IbIIs for tbe purposes of thie let* be 10 W tc Mre bad oilioooia - (a) la tbe oate-prlaary W vhja It U fogad^bT^ thi ftnn that phyiieal elgaa of J* abort of defialto phgralool alfna of a become trident oad that web <**t** riag and la ooaaeqoe&oo of o^3ajwat la o acbwuiw nine} iap&irod by that disease though aot oariouaxy on permanently; /~\ ir, the eeooniary stage when It la found by tbo sfor ^work Jla ^or hae ' ^baen S S S s r aarlooaly and peraenantiy impaired by that disease.* la lsritsd to tbs following laporUnt eboagefi- (,) Tb. Introduction of tb. nW-?ratf7 (UUT I t v u ronoed a t tuc*) (b) Tbo ux of tb. m p t o m Iob dflult* und |Dcin! Ilpl ef .Uloo.l lu tb. definitions ol tb. prUuT* d rooondurr* *'*S" ' tot '*hort of d.fUif phj.lo.1 .Itn. o ^lloo.U> in tb. W - prlmnry PU*.. T* vord -W-m*' 1. b ceitted, Tie exa=lnera were now required vtoo aa*a*ke up their miadi l t 0 - . , -d-flnlU p*.** -id- c .llleofil.* d v't 1. j *.p.olfl. .it-", vbleb tb. Uv did not r^lro to b. P.t a -the- ___ . ,, _ _ jatt-prlaary W * .4. PATfc^tUl , loV, * M.E.M to . tr .ii* : " u " . . * -- * iBiW ,,1W , " * -- . .f ... t " -- ' . , the reaeona th. **~primxi M > !<--. 1 w*r* ,~ (.) T1t Vr ** l" " ri " a MTliMt toUetW * of uiK>,i*> pr<r...lai w U - rT" t*i t!" wittta. with .till pr.etillT Tooetion. 14 r . X M M t . U t h i TM . *> paae other ooployeent; W Thct tt. lUbUitj to .Pt of o - " tlon *,,11 to the !> * X eh 4tal^.X4. 4 > m n t neither of tbeee expectation* Of oouree, in the ** wB realieed to any stable extent, , ' Hr Tiw. on th. 1919 iti ef *-prtaT w , .ut- w . 18 1,2'' _ . I .hsull 1U the C c d t t M -JtSr .Xt -t -li tbay thi* iOB .xsSnere of the Bureau to t **a* 3 x * t x T inytWhS ^ 4V-st . boa lliooai* tbat^o eon^ efuhU*hod by before t ^ / ^ S a i T w i t b Shieh we are aeqnainte4to-<Uy an* eethod of 4Upi " *-.onably he expected r/vhieh are l U g to be dieeoTered in tie t? SftiU that th^e 1. difficult aad to at u r eiliooaie vbetrrer. lt^ g i*w can be dcrf;' So.aihle to ere atill labouring except on tbe auppoaition that p ^ ^ ^ pcttees occult ^ * - ef Then- . .7 w, i.n.noio DAT:_JOl T , foVi : 495 On M.LM l-i ' Then the 1925 let. Btre the definition* m d i- 1 person elm11 for the purpose* of this let he deemed to here or to here he! ailicosia - (a) in the ante-primary stage, when It is found by the Bureau that the eerlleet deteetable specific pl^Bioal eigne of *1110081* ere or here been present; . whether or not capacity for work le or faee been . impaired by ouch silicosis; (b) la the primary stage, when it is found by the Bureau that definite and specific physical eigne of ailieosi* are or here been preeent, sad that capacity for work la or bee boon Impaired by thet disease, though not seriously and paraauently; (e) in the secondary stage, when it is found by the Bureau that definite end specific physical signs of silicosis are or hare been present, and that capacity for work is or hat been eerioualy and permanently Impaired by that disease or when it is found by the Bureau that tuberculosis with silicosis is or has been present," Particularly to ba noted are the word* the earliest detectable specific physieal signs..* in the ante-primary stage, and also tbs addition of the words "... whether or not capacity far work is or fans bean Impaired by aueh ailieosi*". The word "specific" is nov added to tl definition of this stage. Here an attempt was made to clarify the ambiguity of the prerious definitions. But, has it been done? In the light of eubaeclient experience, I do not think eo. I t a recent inquiry into the working of the Silieosia Kedioal Bureau, the Chairmen of the Bureau oategorloally stated thet the oertlficetlon of the first stage of silicosis ia a "fifty-fifty Better". The inport of this statement need not ba underlined to en audience such as thia. i -The- RECEIVED F.H.H&S . , . . DATL J U L 3 1 m A cj S 8 M.E.M The and last changes in ths South ifrioan lagal definitions era in tba Silicosis lot* 'silicosis' naan* any fear* of Pne'*eee^ ele4.. dua to the inbalatios of nineral duet; and for tte . ptrpoMi of thia Act a person ahall be deoeed to be or to bare bean suffering - (e ) fro e ilie o tia in the f i r s t stage (which eerresocnis SttS .to*. - * S . * 2 L ? ? Bereee k found that the earliest specif-e Ci silicosis, detected by any Mans whatsoever, are or ware preeeat ia the lunge cf the perscr. in question, irrespective of whether ids capacity for work hae or las not been impaired by the said disease; or *&?5 * ? ! & . aco b the u m . n or or j r o n t to >. H a * , of t * p .r n to q u tio n and tlm t the said disaase has not incapacitated h i* fron perforcing noderate nenual work; or U) free silicosis in the third stage (which oorrejpond* xtzsxv s rs .-s s c r performing noderate manual work* r*" Sere we tn v t acme important changes*- (a) S iliooeis means any fern of pneoaooonioais. 7hie naans th a t for leg al purposes - eenpenaation, a te . - any pnaunoconiosis ie to be d e a lt with as I f i t ware s ilic o s is , and the d efin itio n s of the three stages of s ilic o s is apply to the other pr.euBoeonio&ee Previously only s ilic c s ie - f r u s tr lc tu - was oecpensebls. (b) n . t r f t o i t t o . of t v t o r t * t . t * < . " * ' ta r7 > u M.E.M elaborated la the words *deteotabls by *T m m vlwUoTr% la place of tbs prorlous arllsst detectable*, and tbs word 'physical* Is osdttad. (,) eeopoelty for work 1* cr be. fc*. bx *t U kr "... the li > " >' *" " l tDoepecltated bin frea perfcrcirr federate swaoal labour* in tbs definition of tbs sseond tag*. (d) In the third stcgs "capacity for work it or has been seriously and pereanenily impaired by that dissc.ee" is replaced by "... the said dieeaee ate iaccpecitsted bin free p e r f o r m noderate Btsatl labour*. Tbs last sentence of the 1925 definition relating to the presence of tobercolosle 1 dolet*. if . .toberouloei.' k k . tub.ralote of the ro.oiMtory BilU end . per.ee J puepoees of thle Aet, be dwnei to be s-_-e.-nf free tuberouloels - U) if the Bureau face found the acid person'c sptttun to contain tubercle bacilli; or (b) if the Bareeu bee found the ^ ^ suffering free `closed* tuberculosis which asr*cu . i*paired~hia vorbing capacity.* 00. of the offeeto of the.. toflMtloo. oo o.rtiflti . i.j. -re tabes, to nean radiological that the words specific sign* ar airne- Ktl'tIVtD F.H.H&S * - yar-c . PATL--- 31/L 5 1 m e M.E.M !& m 2ti cad u H i a m t of itifii hia boos sod* virtually olaly on the radiological appearances* The ccrtontlen appears to b* that the radiograph provides the only "specific signs* of alilaoaiai That in tho absence of oertaia radiographic eppaaraaoMf cay oardio-polaonary disability praaant Must be dns to M M other oaoaej and that it la act the fttnetlan of the examiners to cook for the "other oaaao*. On* consequence is that the Miners assert that they "lost confidence in the Silicosis Kedieal Bureau* and have threatened to boycott it if the personnel and Methods are sot radically changed fortbrith. Because of the attitude of the Miners, the Goreroent recently appointed a Ccs^issian of Inquiry* This Conalssion In its report submitted to Government the following definitions of silicosis. ("Silicosis* moans any pee'jaoooniosis In this context), * *k person shall be deemed to be or to hare been suffering - (a) from sllloosis in the first stage whan the Bureau has found during life the earlievt eigns of eiliooais demonstrable by radiological cr any ether appropriate examination, or when the Bureau has found demonstrable paraanant impairment of respiratory or cardio-raepiratory function} or when the Bureau bee found poot-mortsm aarly lesions of eiliocsis or ehronic bronchitis snd/or its sequelae. Provided that the impairment of the respiratory or cardio-respiratory function or the chronic bronchitic sad ite sequelae shall, in the opinion of the Bureau, be permanent end hare resulted from the performance of work in a dusty occupation end shall haw* been found within s period of twelve months since the person last worked in a duEty occupation. .n. UAIt:_*UL P 1 M W M.E.M /o {m iUeosis In the aaoond atage vban the toMu he* found by rediologioel end other appropriate xealoetlcn thet tlUeoeie he glean ^ of respiratory or oerdic-reapiretary *tion reduction 1b aepecity for eacertioo *4the unfitting the pereen for ra then Boderete f f t t e k m u baTfound ouch leei^iof t* cardio^epiratory areans due ^ exertion incapacitated the deeoeeed far ore then Boderat* xer* during life) (.1 trm mooli* la tb third otafe vhon tt & L h.. foxxad hr r.41olotlol a " ? S S l S t Snctlox. thet .11100.1* bMf* af Meuiretory or oerdio-Teipi^ctory function oeuawnj reduction 1b capacity for aocertion ^ unfitting tte pareon for aero then light the Bureau he* found pest-aortea such lotion* efthe oardio-reepiretory organ* due to ilico*i# a* vouW )*rt iaeepeeitated the deoaaeed for or* then light exertion during life." be CoolBaion remarkedi- Thi. * * - " 5 " ` S ' S L S S e*n"e"*t?i*ne*;leering the Bureau ua* SaaS^Ua t of]|uUtBtitod.lefmt exercising the science anc eubjeet which la by bo to those called upon to deal with a eubjeex was* / Been* either static or ee*y. The wor*e **uecific, aodereUly narked1 >*- t* being rapue and too m*ch the U nd* to ^!!^pv^2eTb^Eredioloeicel finding, and ^obecur* t" 'eT.?vh.laias laportaaee of lx.cip.cltT f lk* ^ticnorc, tho rt. i * 2 ^ S tS re*S ^ ? 2 i T r t ^ ^ S i S i oTcar* ^ ^ - -- i f L E T w i lour .te of .meo.U ouaot b. dissocietei free cardiac disfunction. The word exertion* baa been eubetitut^for tbe words i -..i Ba?mal fvMoftVki' x4tnj nr^er ohjk to indic.a4,tee*etinae*td rwhne*tw,lit*1> effort.., eaeeseed ie lose of power for eos-eine- nn3cui- Tarning - fmlag to definitions adopted or proposed elsewhere than la Sooth i M n - * Tht 1930 XtoWraatlooal Conference, ooavoned bp the Jhtaraatiooal labour Qffiee,ia Johannesburg, adopted tho following definitionsI- Siliooais It pathological oanditieo of tha lmg duo to inhalation of tlllooa dioxide. It oan be produced eacperiaestallp In talaalt.* it to stages of the dlaeote la the 'first siege* sp&ptoas referoble to the respiratory spites sap be either alight or even abeent. Capedtp for vorfc aap be ilightlp impaired. There sap be a departure free the nornnl la percussion ead ia auacultatorp signs, and the radiograph sost show aa Increased donaltp of linear abedews, aad the preacaee of diocrote ,k*****- ftf noduletien. Ia the 'second stage', there is aa iacreeee of the physical eigne observable ia the *firet stage', and the radiograph above aa increate ia the masher and tiae of the discrete ahedove indicative of aodulation with a tendency to their confluence. There *uat be acne degree of definite iapelraent of working oapecitp. Ia the *third stage' all the above eo&ditione are groaely accentuated and inflections of areas of naaaive fibroala are usual. There is serious or total incapacitation. Pulmonary tuberculosis cay be present 1a say of the above described stages* cf ailicosic, altering the Bjopto&e, physical signs and radiographic appearance#, and the degree or werkdag oapeeit7. Ite presence Bust therefore influence the 'stage' classification of the individual, which classification must is these circumstances be based acre on the degree cf loss of working oapecitp than on physical signs end redicgraphic appearances." -The- DATE:_ JU L 3 | M7Q M.E.M Tbt concept tbit "silicosis" Is due to silicon dioxide, accepted by this Conference, has, of oourss, been modified. Zt is bov accepted that eonparabls lesions sad damage can bo produced by certain silicates, Bowertr, purists sij eootwt this. In 1934 tbs Ceonlttoo on posmooonioses of tbs Industrial Zbrgieat Section, Jaaerioan Public Bsslth Association, defined silicosis aei- a disssoo duo to breathing sir containing silloa (S102) eharastcrized aontcnieelly by generalised fibrotio ebanfos and ths derelopncnt of Biliary nodulstion la both lungs, can clinically by shortness of breath, decreased chest expansion, lessened capacity fsr work, absence of fc?er, lacressed susceptibility to tuberculosis (scae or all of which aye?toss nay be present), sac by characteristic X-ray findings," Sayers states that pnsuaoconioais produced by otrier dusts were purposely ccitted (U.S.Public Health Reports, 49, 1934). I hare already quoted the definition adopted at the Sydney Conference, This Conference also considered a scbene for the elassifiectien of radiographs of pneuaoeouiosis. The eehens is largely the work of Dr. Fletcher and he is so aueh sore ooopetent to deal with this subject, that I merely nention it, in the hope that he will present it for discussion. But I should like to suggest tbet in discussing this ratter we should be quite clear thst rediological findings do not proride s criterion for ersessing disability. t'nst The inprsssion u. RECEIVED F.H.H&S DATE: W L 3 i l S V y M.E.M that tbt radiograph la the criterion has bodtrlUod tbs subject, Thar* rsaalns only to ranlnd jou of tbs tonlaoloQr attached to the various pBauaoeonlosss. Tbs Sj&aey Co&foroooa daprsoatsd tbs extension of tarns, sod suggested that the taminology should in future take the fern of naming tbs dust to which tb* vorlar 1* w tyei in the industry or proosss ooooarnsd. 27th ,195 U O / U lC.