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FILE NAME Riley Stoker RS DATE 1934 DOC RS007 DOCUMENT DESCRIPTION Journal Article - Pulmonary Asbestosis Bo ayT h Twe UTD, eed nag St we PUNOEROS Coes Trees 204 9g I that the dvantage unhappy a proper continuous My happy four times only wakes da 5 both too bitual use for use in ticna In of asthma given such ar attack J case lo paroxysm Geel 10/2/87 ' WOOD DRS W. B. 16 AND 10/2/87 GIDYNE GIDYNE GIDYNE PULMONARY ASBESTOSIS wi DEC 22/1934 22/1934 evere asthma continues uniteruptedly pulmonary cases |4 weeks and may end be arrested uninterruptedly for days method fatal exhaustion can always by the method adrenaline ten injection which I first used abouyet ars ago The || needle kept in position with a - an initial =~ i no unpleasant injected every *} patient's reaction seconds according to the being varied until it is injection can be made without tachycardia of other symptom arising The injections are continued necessary for even half an hour or more relief always follows and manifests itself by generally the patient falling into a deep sleep which may be 4 he has had for several 3 days the others 9 females are still asbestosis bodies in tuberculosis alive All have the sputum Ten tubercle male bacilli and PULMONARY ASBESTOSIS WITH OBSOLESCENT TUBERCULOSIS - Nine cases 4 males 5 females This the fact that obsolescent tuberculosis group emphasises is reactivated by asbestosis Three not necessari 1 male 2 females cases have been fatal of those still under observation a2nfdehmeaalleesd have radiograms exhibiting typical asbestosis apical tuberculosis with asbestosis bodies in the sputum and 4 cases 3 males 1 female have asbes- tosis bodies present in the sputum and obsolescent tuberculosis but radiograms showing as to asbestosis indeterminate or negative ; IV.DOUBTFUL CASES sputum Seventeen cases 6 males 11 females under observa efficiently treated tion All but one have adrenaline which is far but the radiograms are suigngdeestteirvmeinsaytmeptaonmds waintdh stigwnos *! exceptions the sputum where available contains no asbestosis bodies Of these exceptions one has indefinite J symptoms signs of emphysema and a negative radio- : gram but asbestosis bodies are present the other has n buotphhayssiacsablesstiogsnissobrosdyiemsptinomtsheand a negative radiogram . apBee >!PTUwLeMOnNtAyRY WOODD.P.HA.SBESTOSIgSrcoouunptss morning - excavationbervoicndcoeThunhogt-eh disease bxy mthe PULMONARY THE CLINICAL PICTURE he sympa The picture of pulmonary asbestosis is that of - overcome REVIE : OWF ONE HUNDRED CASES a pneumonoconiosis occurring in a factory in which ^ paralyse miates the By W. BURTON M.D. Camb M.R.C.P. Lond few precautions had been taken to protect the workers from a danger the gravity of which was | The inhala Happily these conditions are now a not realised Tamonium . 7, CONSULTING PETBICLAN FOR TUBERCULOSIS past and elaborate thing of the COUNCIL PHYSICIAN TO THE ESSIX COUNTY precautions have been taken to TO PATHIANTS CITY OF HOSPITAL VICTORIA LONDON protect the workers There is thus good reason PARE AND believe that the disease is now under to S. ROODHOUSE GLOYNE M.D. Leeds D.P.H. it seems probable that workers exposceodnttroolthtehoduugsth old So s . balance PATHOLOGIST TO THE HOSPITAL under the old conditions will continue to themselves for examination for present some time to come dvantage DURING the last few years we have from There is no need to amplify the descriptions of time nstantly time reported the result of time to pulmonary asbestosis already given elsewhere to inject It the first our observations of the effects of the inhalation of asbestos dust as seen in patients attending a chest hospital symptoms.are indeed those common to all forms of pulmonary fibrosis uncomplicated by bronchial dila- 3 aborted or revealed at satopsy st though Our studies commenced in the year 1928 and a preliminary tation or pulmonary with little expectoration discomfort or dull pain in he bad to radiographic paper dealing principally with the chest occasionally perhaps a streak of blood in ion at the as the appearances was published by one of the phlegm and dyspnea It is this last es rise to following year findings in a series of 37 In 1930 we reported our of which the patient complains symptom The distress caused by ent prefer asbestos workers who had been examined at Victoria Park As we now have the sioned by constant breathlessness is occa the disease might almost be so great that described does not opportunity of studying 100 cases the time symptomatic It is the as mono- langer of seems opportune for a brief survey of the whole plaint In the earlier patient's first and last com- cases the group group during exertion- stfaoguensddyspnoea is only apparent - ciency in ANALYSIS OF CASES work in the I could not hurry to prepara Our cases may be divided into four chief of undressing or even the the later stages the act So repro PULMONARY ASBESTOSIS may cause the patient patient effort required for speech to pant for breath When occasions three cases 19 males 34 females 12 deaths asbestosis is complicated by tuberculosis adiriqual ( males 8 females including 2 with carcinoma of the pneumonia or other thoracic disease the inder the lung and I with a few deposits of growth in in the pleura of these will be added but the dyspnea ofsymptoms emotious the cases still alive and observation diagnosis noconiosis can still as a rule be pneumo- recognised secretion rests upon a typical appearances of the radiogram nutrition is very evident in the terminal Mal 2504 the Cadrena Cadrena symptoms of and physical signs of fibrosis and c presence asbestosis bodies in the sputum These three diagnostic when the patient may pass into a months cacheria condition of extreme me when points are arranged in order of merit Twenty cases Hamation males 7 15 females were positive on all three DIAGNOSIS drenaline all females had positive radiograms and clinical ; toms and signs but no sputum was availablsyemp- When a new salient features disease is are first under consideration the ^ males irailable no asbestosis bodies were found 9 if depends on the observed and diazn06 mod_rate mod_rate females gave positive clinical odies were present in the signs but and 5 males asbestosis recognition of Thus phthisis was formerly only grdoisasgnosysmpetodms sywmphteomns ther ther not available sputum radiograms were symptoms and signs of advanced disease isease 1 male haodr failed to show definite evidence of were We now diagnose incipient phthisis with 22108 108 tau odies in the a positive radiogram and asbestosis sputum but at a stage when the patient is confidence no clinical signs or symptoms well nourished and little healthy in appearance of sevcu ASBESTOSIS WITH ACTIVE TUBERCULOSIB In the troubled by symptoms diagnosis of asbestosis we have stal to in which 1 males 8 cases 4 males 17 females of these 11 upon the symptoms and signs of more depend less females were fatal One had a tuberculous We have or prose Sprema one a pyopneumothorax and lardaceous disease during life the no means adequate to discover existence of the finer degrees of TOS e ra ee ar wSe UT we. we 7 ee] oe Wee pee Sn Oe neta woe os Soe a ober. a Gad aay | a> a neee oo er Fy : vd : t i i . me bete ~ A 1384 THE LANCET DRS W. B. WOOD AND S. R. GLOYNE PULMONARY ASBESTOSIS DEC 22 1934 THE which pulmonary fibrosis must ments and it is not precede develop- dust did not avail to check the in, surprising that the certainly often pathologist sometimes discovers This is spread of disease true but ono not recognised duringmlo ifertem evidence of abrosis we have now patients whose condition appears to have seem follow rely In diagnosis at the present time we have to stationary since stopping work in the factorryemaTihnaetd Tui dealin on a history of exposure to asbestos dust even serious damage to the lungs is not incompatibla starting point The symptoms described as our with many years of tolerably comfortable 10 ca patient may supply a clue for the by the is proved by such an existence example as that of a ---- ---- not as a rule malingerer does emphasise dyspnea as his chief dis- ability In the physical examination the who was still able to carry out patient administrative at a factory when nearly 40 years dutie HOW r 100 2 appearance should receive patient's dust had caused a fibrosis exposure to the over - advanced cases the +1 special attention In earthy character apical regions of the lungs invoWleving all except the centag of the complexion lips and a slight violet tinge in cheeks a female patient at the recently examined request of Dr. C. the inc McShane noteworthy or The physical signs supply who after a period of two and a half years employ mostly to seek suggestive but never conclusive evidence those of a basal fibrosis and the fine naturTeheoyf tahree tion at of the pulmonary not scarring is indicated by fine dry crackles Mentar dissimilar to those often heard of emphysematous lungs More over the bases were readily demonstrated in the waiter produced by the movements of sauperficial crackles despite some disability the patient sputum whose But in asbe are often mingled with the fibrotic damaged pleura service did not entitle her to period of sticosis r^les . The radiographic picture is that of a fibrosis fine type affecting the lower of herself as compensation described to fairly comfortable and she was still able perform her household duties It subject subject Comp fields the scarring is as it thirds of the lung is none the less monary may be drawn to were etched in Attention criosis difficulty . a when constantly encountered delineation of the basal is a required portions of the lungs tcioovneresdhowuhledthaetr by physical or radiological examina to the a of spont The diaphragmatic shadow bases of the censors the occupation A once cease working in any dusty and app the lungs and in a radiogram taken with ordinary and avoidance ofqutiheet rliisfke preferably in the country may hav two inches posterior technique of the as much as but of catarrhal not only of dust inhalation buile infection lung may be blotted out extent of this silent 30 The guards against an provides the best safe the normal area can be demonstrated in lung by a lipiodol injection the result of > which will surprise those aggravation of incipient diseasa Septic bronchitis pneumonia and monary tuberculosia are the pul- We ar for perr For accustomed to regard the diaphragmatic area as the complications of the disease commonest terminal a its beari a lateral view of the lung if the lung base interlobar Again thickened or if the middle lobe is septum is COMMENTS opaque as the Occupation elaborate analysis of factors is not possible in this short occupational 1. Gloyne 67 women in our series had been article All the dust in the same exposed to asbestos 2. Wood 3. Merewe the factory They were employed in and 11 following departments L. A. Rowden pointed out that mattress making 9 : spinning 24 carding weaving 5 miscellaneous and opening 11 and SURGI a more extended view of the lung bases or unstated 18. Twenty of them obtained by the simple expedient of can be ibsegan their employment before the age of 18 which COLO ' patient in the dorsal position and placing the now no longer permitted under Home Office over the brow centring the tube We have tried tions The shortest exposure was six regnis- verified its efficacy this method and cases and the longest 15 years months two 3T The exact diagnostic significance The 33 men came under several A. categories About bodies in the sputum is doubtful of asbestosis thirds of them were employed in the ASSISTANT : OP ME As pointed out by one of us S. R. G. the formation factory as the women and had performed same CB of an asbestosis body is evidence of tissue change We of jobs The others included an elderly maavnariwehtoy assume however that the expectoration ofcaanfneowt was himself the aged 18 whose owner of a small factory a van boy asbestosis bodies implies that pulmonary fibrosis has spare time during two and a half employment had been years MANY - already occurred If we could make this assumption asbestos in an spent in mixing powdered apart fro ttihoen problems of diagnosis and claims for compensa- who had serveodpehnisyard middle boiler riveter would be simple Nevertheless the apprenticeship as a youth in a as well as will sometimes reveal microscope commencing fibrosis in shop where asbestos was used for lagging pipes and group the sections where lung mortem radiograms failed a man who had been employed handling asbestos abdomens abdomens reveal evidence of disease present available do not The clinical enable to methods at mattresses in the open air at an aerodrome the men the shortest Amorg exposure was 11 months laparotoma bowever incipient disease us to determine The asbestosis integrating department and the longest abdoiust- display f evidence of body is simply exposure to asbestos dust and of tissue t4h0eyears clerical and administrative work ) group began their employment Four of Neoplas ulous reaction thereto This tissue accompanied by fibrosis but reaction may be of 18 under the age dise In follow that this is it does not necessarily sufficiently extensive to produce Pathology addition to the above 10 mortem examinatioauutsopsies mentioned paper wh from abdc symptoms or clinical signs or abnormal shadows in radiogram we by one of us S. R. G. of bave been made important might add to justify compensation during life 3 males 7 cases we had not seeD associated included in females but these are not untative PROGNOSIS Macroscopically As the disease has only been recently fibrosis is pleura is our 100 cases best seen in the lower lobes and the adherent proportions mimeading recognised as a clinical entity our present ideas on may require modification prognosis In a previous article we not very common been encountered but silicotic nodules have Histologically the disease predivertici cere to stated that the cessation of exposure asbestos begins in the respiratory bronchioles ducts and is characterised and alveof * Serveis ca Serveis of by a cellular reaction of May 3rd 1936 * _ .3.58 + wee ient xties the ized ized eenntty y of dies Bot i of abed 1. E LANCET mononuclear MR A. : D'ABREUD'ABREU SURGICAL } mononuclear phagocytes and asbestosis asbestosis giant giant cella followed by the formation of a reticular fibrosis.,, Tuberculosis and Asbestosis a previous article 3 aling with tuberculosis and asbestosis we cases of active tuberculosis in 57 casesreocforpduel-d 1 Conary asbestosis 17.5 per cent The figures have now reached 21 cases of active tuberculosis out of 100 21 per cent It must be borne in mind how ever that these figures do not indicate the centage of cases of asbestosis with tuberculosisperi-n the industry 4 We have been dealing with a group mostly from one factory who were sufficiently ill to seek advice at hospital In discussing this ques- tion at length Merewether 3 considers after a review of the whole industry that the data are too frag4 mentary to be dogmatic at the moment but that " {Thatever the added risk of tuberculosis may be in asbestosis it is less than that associated with 3 alicosis We hope to publish our material on this ci mbject at a later date able less of dis 1252 try r Complications from pneumonia and pul- =; monary sepsis and complications arising from tubercalosis there have been none definitely attributable to the asbestosis with the exception of two instances of spontaneous pneumothorax diagnosed by X ray and apparently unassociated with tuberculosis which may have been due to the rupture of emphysematous "4 ballee We are indebted to our colleagues at Victoria Park 5) for permission to quote certain cases seen by them For a full account of pulmonary asbestosis in all =, is bearings the reader is referred to Dr. Merewether's A erhaustive paper. ~ : REFERENCES H. 1. Gloyne S. Roodhouse : Tubercle 1933 xiv 445 493 and 550 * Wood W. B. and Gloyne 8. R. THE LANCET 1931 954 Maenrde1w5et2h.er R. .: Tubercle 1933-34 IV 69 109 ASPECTS OF THE SPASTIC COLON DEC 22 1931 1385 1385 radiological interest an attempt will be made to establish spasm as an important etiological factor the formation of diverticula in the colon The administration disquieting thought that surgery apart from dealing with complications such as obstruction perforation formation and fistulous only offers a dangerous operation cfoormmtuhneiccautrieonosf .. colon diverticulitis makes investigation of the earlier prediverticular state of tremendous importance Advances the knowledge of the aetiology mar enable effective medical treatment to be If spasm be an important factor the administration of belladonna in suspect prediterticular states will value as a prophylactic measure SPASTIC COLON Spastic color Stacey Wilson Tonic Hardening contracted colon have grouped into is a recognised entity Dr. Erst drew attention to it in his book Hardening of the Colon a tender hard may be palpated in patients I three classes a The commonest sufferer is described by Dr. Hardy 1 as being the emotionally unstable type of individual whose colon is unstable also Often the patient is a nervous female thin and unhappy pwehroesneniatlhliyn dyspeptic ailing and constipated through abdomen the racing aorta and a hard tender colon can be paipated with ease Radiological and biochemical examination discover an active tonic stomach with pylorospasm and hyperchlorhydria I have no evidence nor do I think that these patients proceed to diverticular They 3r8 formation formation frequently met with in the surgical room ; it is no place for them and they repay surgery with groans and a constantly increasing More list of symptoms than one has undergone pyloroplasty many daypsppeenpdsiicaectomy without least relief of their ; remember this class of patient investigating pylorospasm Cannon general have produced pylorospasm by traumatising intestines and have declared its occurrence in these circumstances to be due to a visceral reflex Clinically suitable treatment combined medicine containing administration of belladonna the tincture of iron hyoscyamus the perchloride of improvement often leads to great " Teter andl andl nong nong of 250 anual je Gust 11.- n5 Te MANY patients suffering from colon dysfunction part from proved examples of carcinoma divertic itis and ulcerative are surgical 8 well medical wards for infestigation Of this Top the majority are discharged with intact domens and uneasy minds others undergo fruitless aparotomy under general n^sthesia; a minority Lowever operated upon under spinal anesthesia play a fascinating important living pathology Neoplastic ulcerative dous diseases of the and fully developed divertic- colon have no place in this per which concerns a group cases suffering om abdominal pain mainly sided but with Sportant ociated references to with blood itative diarrhea and pportions Dyspepsia other areas and sometimes and mucusin the stools equal constipation occur in is often an important important and leading symptom Concentrating mainly diverticular diverticular conditions until recently on those mainly of - Association mee Based on a short paper read before the cons of Great Britain and Ireland at Birmingham 3rd 1934 Birmingham of on ; fy b Occasionally spastic colon occurs athletic man who athletic c Far different is the last group represented by the rather fat aged man muscular in his younger sane and sanguine in outlook but worried by an alteration in his bowel habit and because his ample meals formerly enjoyed with relish cause indigestion and discomfort requently requently defecations unsatisfactory and irregular Smail internal hemorrhoids often develop and the depending colon is tender and hard Rectal examination is more painful than usual but once the spiaccter \ has been passed the rectum itself is normal We will consider later that the important patholo ical change in these lies in the cases muscle liver and NoT in the mucous membrane mucus and blood ate therefore not always present The meal all cases o far investigated shows sy hydria hyperchlor Outline in the radiological picture of the \ barium enema as in the clinical picture is indecisive -_ e . wo ee vite ue ote wewh