Document jmR1nXd5Q00z0JjXVKwwV4Ge9

Jau*ar 1*. mr THE MEDICAL JOURNAL OP AUSTRALIA 76 ^ PNEUMONOKONIOSIS IN VICTORIAN INDUSTRY. ... 5(20 ___ hazardous, inasmuch as the silica-containing substances are newly ground. The highest incidence was Is a tile Bp D. L. Goeson Tvossax. (wall) works.- where flint was used in considerable quantity. ", ' Industrial Hygiene Division. Victoria* State Betti* Department, Melbourne. 4. Mineral earth workers sre the most exposed of all. Quarts, dlatomaceous earth and asbestos are ground with usually makeshift machinery, and ths dust hazard Is I i- Sure* the cod of World War II Australia has boos under going rapid industrial expansion la all fields. coupled with large-scale immigration. Although la 1156 soss a ft el the national iseoas coses Iras wool, tbs situation la tbs sxtremely bad. One subject, a man aged thlrty-fiTs yean, died of uncomplicated silleoel* within nine year* of com mencing employment. These places have an unenviable record of death aad disablement. run to- cose sap well bo different, la view of tbs $. Masons and Quanyreen are exposed to the dusts of ranges to health which such industrialisation bat produced various types of stone, jjmnlte can contain up to 30ft of la the past la other countries, it was considered essential ~ free siiica. and StaWell stenVEnd Sydney freestone are for to obtain some laets os what bad happened la Victorian all practical purposes pure sand. Basalt quarrymen can industry la the Immediate past in terms of lndostrlal develop an X-ray picture which is hsrd to distinguish from ebaat diseases. Without accurate knowledge of where tbs silicosis, but these men an free tram symptoms. hazards really lie. It is Impossible to have industrial expansion without a health toll Without this knowledge there can' be no planning for the future, and the sere policing of regulations leares such to be desired la the field of preventive medicine. Accordingly, in 1951 a surety 5. Boilermakers aad weldera are exposed to mixed dusts. Few In this group are incapacitated. 7. Meul polishers are subjected to slllcs dust through the abrasive they use. which is beeswax impregnated with to determine the source* and Incidence of pneumonokoniosis pure silic* and known to the trade as "tripoli". was commenced by the Industrial Hygiene Division, and the various aspects of the findings are aow presented. S. Stoker* are exposed mainly to coal dust. The total number of cases reported to the division prior to the surrey was 533, whfeh included 343 among miners aad ITS industrial cases. The figures aow read as follows: total list, with $67 la miners aad S3S la Industry. The X-ray investigations were carried out on full site fils (17 laches by 14 laches) on personae! who la the opinion of the division were employed in dusty trades. The total number of Individuals radiologicalty examined was 3S33. Table I shows the results of the investigation. In the surrey, the number of moulders radiotocically examined was Isis. and the percentage affected was 4-*. Three hundred asbestos workers were examined and this number wuid covet most of those exposed to dangerous amounts of dry asbestos dust: here-the percentage was IS. The most daccerou* occupation is mineral grimilns. largely <( .luartz, and here 3dr of those radiological:? examined were uSectvd. In the other categories the people surreyed wore those exposed to the greatest risks In the particular -s.-cupatlon. and not the employe-* as a whole, so that any computation as to the percentage affected inthose Industries would be erroneous, in the 35b eases found, all the subjects have been examined, their industrial histories have been taken and their exposure to dust has been confirmed. Apart from those suffering from aibestosis. the creat majority ate silicotic*. many of whom are grossly disabled and sany short of breath; others appear to be Quite well apart from a slowing up and slicht shortness of breath, and soae are entirely syaptoaless. Ts*u ** ----r' ` Xemtwr Saftfrcti* (Vedette*., ->^)Udioi<wc3ltr * V1/' -iSiamuM.!. ** &KV.rf.Kr*f*ll~ slot Mawtw mk .,naTrffiKP ia-il-ra-- ?U.re*?. Uni** br9U." iff.c.!. * -t*.?.:?4 iMM lew 1 **( --i j* * u WtKr< --gaMi<es. Wi 'Tkvr. 1 Total Z4t3 \mnerf if Cat* i Ftmnnntfoes*. : 1* S1H *. i. w 3*0 f iwwie g PfWJtlT* fiOUtn**. t *. ev -- -- - Discussion. fffKcofi*. If we consider the conditions in the various types of occupation we find the following factors: 9. Rubber workers are exposed to tale, which is mag nesium silicate-, this can produce similar effects to silica and a similar radiological picture. "T 1- Moulders ure exposed to silica in the moulding sand sua often in the parting powder. One of the cleanest foundries Investicated produced the highest proportion of rijlcotira l*'v i. owing so (be fact that they were usins 10. Cinema operators are exposed to carbon, metallic oxides, fiuorides and silica from the carbon arc lights used in the machine*. <i.i.-a iloor. which is v*ry finely ground quart:, as a parting 11. A ensse* X-ray picture of a worker ta a dry-cleaning 3d`I.T. Many mould*.'* with long exposure are grossly -*tubil*bm-nt showed nodulation with :> symptoms. Inves '-sallied. tigation showed that uiatoms'-viu* earth :* used is the 3. Dressers are exposed to moulding sand and to fine aeuilic particles produced when castings sre cleaned by process of dry cleaning and constitutes a hazard. A survey of this industry is under way. smery wheels, automatic chisels and swing grinders. The The radiological appearance must not be used aa a yard !**>is m general use are now power-driven, and recently stick to nieasufe'tbe severin' or otherwise of the diseese. ^vlbodi of exhausting the actual tool are being evolved. Some subjects with grass X-ray changes are almost sysp- ume of these sen have gross X-ray changes which are out tomlesi, while .others who are gravely disabled show very * all proportion to their symptoms, while other* with less little abnormality.. - ' ,v *i?0.0e*d change* arc gravely affected. In cases in which . * ulh of the Inhaled dust U metal, the symptoms are 'tally alight. . j5: tile and pottery worker* are exposed to silica. In the survey there are several seta t brothers who both developed silicosis la efltlrely different occupations. This suggests a familial tendency. One family group of seven boaata Six siilcotlcs affected In three different conditions in these occupations are particularly praeesees. m * 'r:v '-VCV ,-f. O- A person quit* gunrt tost b U suffering from silicosis can. Alter an acute pulmonary episode. become totally disabled is a v*ry short time. Tier* tr< at laaat 20 listed who bav* graduated from Use "mild abort of breath" elaaa to toe "totally disabled" la period* Is *41 enact lew than tout year*. The om of 25 millimetre Ala U generally unsatisfactory Is the diagnosis of pneumonokealosi*. Many ita use in some process; misinp with diatomaceous earth or knolls to torn togging materials: aawitp. cuttlnp and finishing any product containing asbestos--tor example, brake Usings- asbestoa sheeting and various Insulating materials: tearing down eld lapping--tol* ta a ven dangerous process. even In the open air; spraying asbestos on walls aad ceiling* as an insulator. eases. especially earl? oaea. are mtoaed, This coaid explain ibe great somber o( silicotic* who are sadar treatment tor dyspnea. who bat* misled their doctor* unwittingly by saying that la the sui X-ray examination* their cheat finding* *iri clear. Tie X-ray appearance* caa man to norma) after the subject's ramoral from exposure to some dusts. This bat occurred with wood dost, powdered food, surch and metal. Vary few cases reported la this surrey are complicated by tabemloels. Hcwerer. several cases hare bees reported from sanatoria, la which exposure to finst has bees proved aad cospeaaatloa ebuiaed. No cases of csrelaotss of the longs were fousd. The pulmonary fibrosis of asbestos workers to insidious in its onset, irregular in its eeune, and variable Is it* termination: but once established it constitutes a grave threat to life aad heatth. Briefly the pathological changes are such that the air cells become obliterated by fibrous, tissue. As this progresses tbe long tissue becomes used up aad toe elasticity ot toe long deteriorates, the amount ot long available to carry out functions diminishes and symp toms appear. Tbe condition to progressive and irreversible, sad once the stigmata appear toe subject thosld be removed from the haxard. The main symptom to steadily lacrsaalag shortness ol bresto. While there toao evidence that Both silicosis aad asbestosis are so lasidloss la their asbestosis predisposes toe subject to acute pulmonary infec progress aad so easily Influenced by acuta pulmonary tions. the presence of toe condition seriously impairs the coadltioas that It would appear wise to advise the subject chances of recovery when infection does occurl The advent to seek s new occupation away from the haxard when of toe sutphonamide drugs and ot toe antibiotic* has Shortness ot breath becomes apparent, irrespective of his greatly improved the prognosis In these cases. ape. The following case lllustrstes this: The most sought after asbestos la Industry Is toe type In 1952 a moulder of twenty yean* standing teas found to with long needles, but unfortunately rhis to toe most have typical silicotic X-nty appearances with aoduiation and rnild symptoms. H was earning Sic money and did cot feel dise*d to pvt up h-.a to*>. In 1959 he had infiuesxa with pulmonary complication*. and today he ra completely incapacitated. The fact that pathological changes can continue in the lungs loot after removal from the haxard must also be realized. hazardous type to handle. The. needles eater the lung by inhalation, and after a time undergo changes ta appear, ahee and are then knows as asbestosis bodies. They are brown or yellow la colour and ar* found in'no other condition. Tbe bodies are aU modification* of a straight fibre and are shaped like dumb-bells, a drum major's bacon, nod so on. H to Impossible to state at what period these appear, but they have been found in this survey as early A woman, now seed (hirty-mn* years, was employed In a lottery plant, She worked they* from the ace ot fourteen >-ar* until *n* was t-*nty...tie.-when sht She had three :hildrn and carried vr. tuite happily until Sv* years ago. *ha -lit .'wean :o he short of hreath. nnd an X-ray -fi.eiin.ition rev-Mie-i abnormality. Her condition was venttMl.'y .ti-ve-i-sed ctiwostr utter tentative diagnoses of tub-r-.-ulo.*;* .in.! 4ar*natifi* were JlspriA-l. as fifteen months aft-r -xporure commenced. The pmenV* <t( ihete bdf-$ mure n-.t be reaardtd as diagnostic ot nab-*tori*. but it is convlusiv* proof that tbe patient has bee: exposed and that com* abnormal process to at work is tbe tones. Vnlike silicosis. the radioiogva! findings in asbestosis are in *rord with the severity <>i .the symptom*. The .\a tna-i-rruatc industrial history delayed toe correct -iiac- jreitK'T tr.e >a.,-ap;ii-:ty. :5- sore -me expect* to see in toe to tots case. X-ray din. is the w*iMvvio[-i cure the bases ot tbe There are two interctiinv vubj-cis who served is toe ttVswR !>* with the jlyl Australian .Mr force -Juries the lust war. They were act-havics io flxed camps and their X-ray findings are typically silicotic. It wootd appear that they derdoped the coaditioa op service. Heavy transports sod taokers probably (round the sand to powder floeaess. sod the propellers these raes used to swing produced aa intensely heavy cloud Of pure allies. -ungr. more -rr--tolly >br risk*, fho* a srouad-glax* avpearan.---. and tbe utils- -'t the heart U irregular or "Shaggy-'. it i* fully realised that a radiological diagnosis of early asbeatoaia is extremely difficult, and our cases were regarded aa such only after the meet careful con sideration. a few films picked out *t random wr sent to England for review, none ot them being from welldeveloped <-a**. One --as* was ac-epud as asbestosis on Eng:i*h standard*. In toe -nh*r. while it was admitted Many Incapacitated men could cope with a sedentary there, were increased markings at toe lung bases, the job if it were not for the effort of traTelliax to aad from. viewer stated that he bad sees many similar films la hit work. Is view of the procreative ostore of the disease area from people who had never been exposed to asbestos. ad the limited sum payable as compensation. *e advise However, as these films were takca ta a highly Indus affected people to remain at work as loot as possible--out - trialized area where fog. soot and smoke abound, it is of tbe baiard. ot coorse. The ability to coatlnue is sseful thought that to compare these with film* of Australians employment is often increased by- a course of physio of tbe same age proved nothing. Criticism wflj no doubt therapy. be directed at toe standards ot diagnosis: but if one waits Athcsiosis. until the stigmata of a well-developed case appear, one in the section of the survey relatlafl to asbestos workers. can do little for the patient. pio <!i were exsaiaed: Ivi) had sputum containing ashestom bodies. and of this :>. *T bad positive X-ray findings. Is '.Sir* ins: croup ail bud symptoms ranging from abort- a-es ->f breath m exertion to pro** incapacity. It dor* not follow ttat -vr?on i* going to accept the advk-e uder--1 -.o leave :5e hazard: but since the suinl-r f workers i :hi* cr-ip i .-riiiparacveir *mull. :h- feaiixatiot that their frVad who was cupposed to bvr Tfc* pro-'-dur- adopted was as folio**: Specimens of sputus: were taken sod examined for the presence of bodies. tVhen these were demonstrated, toe patient was radfoiorlcally examined. When both tests cave positive results the patient was interviewed, s complete Industrial a weak heart for a long time :< actually sufferlsg from ssbertosis and 1s elfgtbie for compensation is making most workers very conecious ot tbe haxard. Much more care bas been exercised by toe workers Is recent times, and they are much more easily persuaded to wear a mask. history ws taken aad his clinical condition was assessed. If he bad symptoms referable to tbs'disease a diagnosis of asbestosis was made aad the patient was advised to apply to the Workers' Compensation Commission tor acceptance or his disability. Subaeqaeatly practically all workers exposed to dry asbestos base been radiological!? examined. The mote common symptom to shortness of breath on exertion. Tightness is the chest and pain in to* chest art not uncommon, with lack of energy and tiredness. Moet patients show an improvement after a course of physio therapy. The patienu given a course of physiotherapy had all been accepted for compensation., and all were kept Tbe following occupations are involved: handling tbe in hospital for at least a month, so tost toe rest and substance In Its raw state; grinding tbe substance prior to elimination of worry for tbe future were also beneficial . . tts factor*. aU those given this -conn* v xUI working at light sedentary occupation*. When, this survey started, eight urn of asbestosis bad beB reported and U>* disease *u retarded at a rarity. It will be tees from tbe 9rare* REMARKS OS.CHRONIC GASTRITIS. WITH SPECIAL REFERENCE TO THE PREVALENT INEFFICIENCY IN THE .EXAMINATION OF THE GASTRIC CONTENTS. that tbe Incidence of tbe diaeaae it far too high. la addition to tboe found in tbe investigation, there moat be maor sore older folk suffering from tbe complaint in whom It ba* not been dlaraoaed. and who are Incapaci tated and very poorly off financially, and aberatd be receiving adequate compensation.. ' . , By V. 3. tomu'.'".' From Me Deportment of OdStro-Enterptogy. Saint Vincent'* Doepitol. gydney. i -- .* *-.|t<. /T'eSt *(* .'.v,*v,V'' Summary. Three hundred and sixty eases of pneumonokoniosis were found >d industry in Victoria. No doubt there are many more, either ayaptomleas or undiagnosed. Whcx s hollo* organ is afflicted by disease."a proper undemanding of the processes at work-ls helped consider--, ably by a study of the discharges provoked-by.the disease.*./, Tbe discharge* are is fact a sign of tht>di*ea* -is-, the It,'',' .. walla. Diagnosis and treatment would-loae-considerably'^'. if this element were neglected.; Tbua.';'th;-nn*iiland post-'i-v. 51Ucoala and aibestoais are not diseases of tbe aged.- . nasal discharges, the sputum pot. the arinary testing glass V* Many of these subjects belong to the thirty to fifty yean and the contents of the bed pas prorlde.itbe'cliaieian with,;-.^- JiK group, and for this reason it is Imperative that con .valuable information, which helps to truthrin'diagnoais andgsV ditions improve is the doscy trades. Tbs two conditions' to eoeceai in treatment. Moreover. an:tnereaae or decreaaeVr5 can occur together, causing gross disability. Six affected: persons. ho showed oodulstioa and also aabestotls bodies, were fonnd is the same factory. They are very disabled.' and two are aged nnder forty years. ' t ; I -. .* . ~ -.^^ tr " The survey Illustrates the necessity of impressing on medical practitioners tbe seed for takisg a-complete Industnal history of all patients irrespective of sex. It is sot sufficient to ask a person hit or her occupation--a bread carter today stay bare been a miner twenty years ago. Many women have worked and arc still working, although tbe bssards now are leas damaging. .For this, several factors are-. rwpoaiibl^^OnvJi*-the\^ --.neglectful reports on tbe gastric contents mid* by' patbolo-'.-' : gists sad biochemists. A (<w yean ago I'iiked1*$seBtor'I":--teaching biochemist why be gave no report{aboutrmucu }.'!+. >-ia fractional test meals. He gave as the .reason.that the '-'*;- - mucus could come either from the respiratory triet'or from industry in Victoria is becoming-very dust-conscious., (be stomach, nod that therefore.its slguificance'could not '`'bile tbese Investigations have bees proceeding, the W interpreted. . , ,vv .<-,' ' industrial Hygiene Division bas bees'.busy encouraging % U is. *>t mum. hicfciy unscientific to suppress'evidence v ` ` tbe suppression of dust. Yaions have sponsored the survey merely because its interpretation is 'difflcult. VOloreover.. and employers have bees most cooperative is allowing their -there is always the chance that somebody else.may succeed : f' personnel to be radiotoxicail? examined in the firm's Use. in the interpretation. Thus, by examining i&e'/respiniiury ' . 7s the firms where cases have been found, close Inspections tsv bees made, and where possible conditions have been improved by exhaust ventilation, by better housekeeping. ->r by tbe elimination of tbe basardons substance. The uae tract, the clinician may get n very good idea as'to whether it is the source of tb- discharge But vn the bi->;hemiut. ' if properly instruct--! In his am should be .able to make the dietinctlon easily. - < ' -f vf respiratory devices is teeoramesded only when the It the excess mucus is gastric in origin.'it-appear*'in - has.-trd is of short duration and when other methods cannot eacb specimen. It is intimately mixed with-tbe .gastric W used effectively. Conditions in indastry can be greatly contents, so that, whee the eootenu are poured from ooe improved in many rases by very simple means--even test-tube to another, they are seen w be more viscous. camping down the floors in a foundry led to big reductions Tbe mucus is flbely flocculated. An approximate quanti in dust counts. tative account of this mucus can be given in terms of Legislation has Wen introduced to try to Improve con ditions. Quarts crindins has been declared a dangerous trade. This mesas that any premises used for the process mutt be registered, and fa the event of tbe regulations not being complied with the registration can be withdrawn and tbe Arm becomes liable if it continues to work In an unregistered building. Asbestos rerulstiou* are awaiting gaxettaL These art very stringent, and when in force will lead to a big improvement in conditions. However, the most important siegle factor is to educate the worker to protect himself. aBy, many times ooe can see expensive, most effective exhaust apparatus rendered useless by some worker who filtration time. ;, Mucus from the respiratory tract occur* cbiefiy in the tasting gastric cont-cu. It is in larger discrete masses, it often includes air bubbles, it is easily seen when pressed . out under a cover-slip, and it floats on the surface of the gastric contents. The discovery.of such mucus or mucopus may give a valuable therapeutic hint to the clinician. Tbe lasting gastric content* should then W examined microscopically. Gastrie mucus contains tb* nuclei of leucocytes whose cytoplasm has been digested, staining deeply with methylene blue, and columnar or goblet cells. In gastritis, there may be large number* of granular ceils (these arc desquamated glandular cells) or a persistent increase in leucocytes. In cancer one may find polygonal, "didn't like the draught" pushing a bag up a duet or some round or cylindrical cells, with characteristic volume, other equally silly practice. R`ha one bas seen the end results of these two dtist diseases--the gross incapacity, the patient*' realisation that the steady deterioration is inevitable.'and is many ^*v* tbe financial difficulties due 'to'their baring used up oompensation paid--it becomes Imperative to ensure density and multiplicity of nuclei. Eoxinophile -.-ells may give tbe clue to an allergy. Naso-pharyngeal mucus may contain squamous epithelial cells and carbon particles. Note should also be made of tbe bacterial population. It is increased in byp&cblorbydrlc gastritis and in cancer. <&*( as industry expands, industrial, hygiene matches tbe A second reason for tbe failure to study the gastrie expansion stride for stride. discharges is tbe lack of interest In and undemanding of gastritis on tbe part of ciiniclabi. This is not peculiar to Acknowledgement's.' Australia- Tbe position was illuminated by a eooversacioa with a distinguished British gutro-enterologist (Dr. TC"> k `fy thanks are due to Dr. Keith Hallam for his invaluable as follows: -tip op the radiological side, and to Dr. D. 0. Shiels for ur many discussion* on finst problems. Dr. "X~: -I do not believe that gastritis Is a common disease." ,/r^l nr. 3V