Document jmpqzwBK4egdX5zKZJMxDnbRp

FILE NAME: Saranac 7th Symposium (SSY) DATE: 1952 DOC#: SSY042 DOCUMENT DESCRIPTION: Transcript of Presentation by Dr. Vorwald [Closing Remarks] t;" j}i:? | ________ _____________________________ ______________________________ I2 * _ . ; | j are d eep ly in d eb ted to you and to th e p a r tic ip a n ts in the I program fo r th e job th a t th ey have done in t h e ir c o n tr ib u !j | t io n s , and now, D octor Vorwald. i'i i; BY DOCTOR VOHVJALD: | The end o f t h i s n e s t in g i s n o t e a s y t o come b e f o r e j: , i i! you a s t ir a d a s x an and as t i r e d as I know a l l o f you a r e . ; j| I s h a l l a ttem p t to r e v ie w the h i g h l i t . ...a o f th e sym posium , I to e x p r e s s to y o u my p le a s u r e and tho p le a s u r e o f a l l o f u s ! in h avin g you w ith us during the co u rse o f tho week# | At th e ov m e t o f the sym posium , I q u oted from my fo rew o rd on yotir agen d a, th a t a t th e syap osliaa r e p r s a n ta tiv * o f each o f v a ry in g in t e r e s t s w ould have tho o p p o rtu n ity to e x p lo r e mid to d is c u s s common p ro b lem s w ith th s o b j e c t i v e th a t in d u str ia l h e a lth be im proved. During tho course o f tho wo h a v e had t h a t o p p o r t u n i t y t o e x p l o r e and to d i s c u s s and i f u s rev iew tha c o u r s e o f th e w e e k , wa w i l l f i n d t h a t t h e p o s i t i v e s i d e o f our h y p o t h e t i c a l l e d g e r i a f u l l , b u t I am d i s t r e s s e d , a s X an sure many o f y o u a r e , b y t h e n e g a t l v a s i d e o f t h a t l e d g e r . T h e r e a r e m a n y , many t h i n g s w h i c h we j u s t d o n o t know a t j tho p r e s e n t t i m e . : Wo h a v e h i d d i s c u s s i o n a b o u t d e f i n i t i o n s a n d t e r - , m inology, even th e re miora is n o t uniform agreem ent as to j t h o c o n c e p t c f p n e u m o c o n i o s e s . How b r o a d s h a l l i t b e ? ; S h a l l i t be i i n i tod t I t h i n k t h a t th e w eight o f o p i n i o n a t . tho d is c u s s io n s would in d ic a te th a t the co n cep t o f trie d u st d is e a s e , th - c o n c e p t o'* p n eu n o n o co n io sis sh o u ld b e a broad one, th at i t should not have referen ce only to th ose dusts which produce s ig n if ic a n t c.n age to the lung* We have had d is c u s s io n s ab ou t th e ta r n s i l i c a , s.113 os i s , what i s s i l i c o s i s . As our d i s c u s s i o n s have p ro cee d e d , i s our d e f i n i t i o n o f today a c o r r e c t one? On th a t a fte r n o o n , th ere '.wore g e n e r a l r e v ie w s w ith r e s p e c t to soaae o ld p ro b lem s, problem s p e r t a in in g t o s i l i c o s i s and tie attem p ted to show th e r e t h a t t h e s e - th o m ech an ism , th e > i m echanics or the method whereby fr e e c r y s t a llin e s i l i c a | i c r sr ts I t s e f f e c t upon t i s s u - , i s n o t as y e t d e f i n i t e l y j known* VariocL t h e o r ie s were p r e s e n te d i n oven a m v a r e c e n t o n e, t h a t w hich has em anated from our own dop& rtcant o f B iochem istry under Doctor Sh9oan. iJe h ave hoard ?bout a s b e s t o s , th a t t h e r e t o o , th e r are some d if f e r e n c e s o f o p in io n , p a r t i c u l a r l y b e tw e e n a r b i - i t r a t io n s w hich have been b rought ab ou t or come a b o u t from \ ! p a tien ts, su b jects, stu d ies o f industry in th is country, a s j opposed to th o se in Englandt j i B e r y lliu m , a s i t was p r e s e n te d by D o cto r i-pu'd y, ; p o ses s t i l l many p rob lem s. We are n o t Q u ite s u r e ev en today, th at b ery lliu m is the only f a c to r , as Doctor Hardy m entioned* She b e l i e v e s t h a t th ere i s perhaps a p r e c i p i t a t i n g f a t -r* , The F a c to r X, whicn was forw arded by D o cto r Gardner r- Aod , 737 many y e a r s a g o . With b a u x ite , i t i s - th ere i s im p lic a tio n at l e a s t th a t the aluminum component o f b a u x it e p rod u ces d is e a s e , What th o se iin p lic a tio n s a r e , I le a v e to your judg m ent. The new s y n t h e t i c s i l i c a s , by D o cto r P r a t t , th e new h o r iz o n s i n t h a t r e g a r d , w hich are c o m p lic a t e d b y many problem s, tho production by Industry o f u ltr a -m ic r o sc o p ic p a r t i c l e s w h ich im pose many, many d i f f i c u l t i e s , n o t o n ly fo r the p h ysician but also fo r the in d u str ia l h y g ien ist who m ust d e t e c t th o se s u b s ta n c e s i n th e auiic.spn.sr2 , and s lo e f o r our* l o g o i c o l l s ague 3 wno must a d m in is t e r la w s h a v in g referen ce to d lsa a se w hich m ight r e s u lt from th o se old er m icroscopic p a r tic le s* Then the n e x t day we had a w hole day o f d isc u ssio n j on c o a l and we had th e b e n e f i t o f the o p in io n s and o b se r v a tio n s and s tu d ie s by our c o lle a g u e s from E ngland, but even the-re, -:o ore n o t q u l 3 ure th a t was c o a l d u s t , h'e today do n o t now w h eth er th e c a r b o n a tio n com ponent o f c o a l , p er I S U k i i i f t . i l 3 i g b w/ i j ^ '-- -- " * -'- ^ ; ;j>u th e r e s u l t i n g o r tho damage s e e n in th e J.ungs o f c o a l ! w orkers, n e c e s s it a t e s the p resen ce o f seme o th er su b stan ce j i oth er titan th e cai-bon&tion component o f c o a l , ; Ue h a d d i s c u s s i o n s w i t h r e s p e c t t o r a d i o l o g i c a l . c l a s s i f i c a t i o n an attem p t to in Li'oduce s ta n d a r d iz a tio n in _73&i the reading o f shadows v n lch are p resen t In the Roontgeno-- j gram. I th in k i t was obvious to pH o f us th a t the r o la o f j the r a d io lo g is ts , Is Indeed a d if f ic u lt one. V isu a liz e , i f you w i l l , th e r a d i o l o g i s t who must read shadows in the R oentgenogram and in t e r p r e t th o se sh ad ow s. Can y o u , s t a n d - | in g on the cu rb sto n e , w atching the p arad e, and can you se e ! th e shadow o f two men c a s t on the a t r e e o , and lo o k a t t h o s e , shadows and t e l l me w hich one i s b lo c k and w hich one i s w h ite? Which cno la tw enty y e a r s o f age r d which one raightj be th ir ty ? Which ono has od pulmonary fu n c tio n and w hich j one does not? I th in k , in a s e n se , the problems fa c in g th e j i r a d io lo g is t are somewhat com parable. Tha e p id e m io lo g y o f c o a l worker a i s more advanced i n E ngland th a n i n o u r own c o u n tr y . Ho have h ea rd about thj oroblem e p e r t a in in g to th e c - a l m in ers I n t h i s c o u n tr y , cut; j th ere I must admit th a t the - th o se , the problems p er-tain - j ijje, to th e coax m inors and the c o a l m ines i n on?* c o u n tr y , j 0 ! have not been review ed as a v id ly as they have been in Eng- j la n d . In c o n s e q io a c e , th e re are many area s In the c c a l J m ining e n te r p r ise which are not d efin ed aa or w ita r e sp e c t t to h eir problem s j fljM a s . you W ill r o e s 11 th e d is c u s s io n s . j c o n c e r n i n g pulmonary c a n c .r , th a t In the f in a l a n a ly s is , : th&ro are r e l a t i v e l y few su b sta n c e s i n In d u stry wnich are d e f I n it e ly , d e f in it e ly have the ca p a city to produce cancer I 739, o f the lu n g, b u t In the words o f D octor Hueper, th ere are j many w h ich c e r t a i n l y s h o u ld be w a s h e d th ro u g h the co u rse ofj tlid y e a r s , which are indeed p o t e n t ia lly hazardous* J We h eard ab out th e ch ro m a tes, t h a t th e c l i n i c a l j evid en ce w ith resp ect to chromate b ein g a ca rcin o g en , i s n ot to o w e ll d e fin e d , and th a t c e r ta in ly from th e exp erim en tal j I evidence o f Doctor B a etjer, that evidence to date is noga- j i t i v e , We have heard a b o u t th e e x p e r im e n ta l p r o d u c tio n o f J pulmonary cancer by b e r y lliu m , b u t th a t i s o n ly an o b s e r - j /a tlo n in exp erim en tal a n im a ls, and c e r t a in ly should n o t have > feren ce to human s u b j e c t s , p 3 n d ln g v a l i d a t i o n ox th o se o b s e r v a tio n s i n e x p e r im e n ta l a n im a ls and psnr >.ng ws d is c o v e r y c f en in c id o n e e in in d i v i d u a l s who have to 5 u * " pesed to beryllium . * i The n e x t day wa had a vary good d i s c u s s i o n on J pulmonary d i s a b i l i t i e s , d i s a b i l i t y , pulmonary fu n c tio n , disw fu n c tio n , a r t la l and to ta l d is a b ili t y , b r e a th le s s n e s s , j I l o s s o f f a c u l t y , a l l o f t h o s e th in g s wore .mentic-. d | ^ h i c h ! I one s h a l l wa a. .ap t? | C e r ta in ly , I l-hink i t i s e v id e n t chat from t h e j 1 p h y s i o l o g i s t ' s s t a n d p o in t , th e r e has boon much im p r o v ^ e n * \ in tech n iq u es and :nothodology and d e s ig n f o r o s t a o lis h j n g | whs then pulm onary d: -3 a b i l i t y e x i s t s , b u t I r r e s p e c t i v e o f a l l th ose r e fin e d tech n iq u es, the vide .ce p r e se n te d b y the , p h y s i o l o g i s t s t o d a y , i s somewhat d i s t u r b i n g . I'm euro t h a t ; i j| a f t e r c l i n i c i a n s , th e a d m in is tr a to r s o f in d u s t r y , th e l e g a l ji p r o f e s s i o n , a re n o t w i l l i n g as y e t to a c c - o t th o s e im p lic a - !' t io n s th a t th e r e i s o f t e n a d e g r e e o f pulmonary d i s a b i l i t y ij || w hich we have n o t r e a l i z e d w ould be f r e e , and I h a ste n to add a lso th a t the evidence to d ate po5nts to the fa c t th at ! n o t a l l d u st exposures in every s in g le worker g iv e s r is e Ij j; to a pulm onary d i s a b i l i t y , t h a t we must remember th a t In d u s- | fe r i.il w orkers a re a ls o in d iv i d u a l s of thus la r g e popula.t.xOix f| o f th e w orld and th a t t h e y , as p e r s o n s , are a ls o s u b j e c t t o t th ose pulmonary d ise a o o s w hich a f f l i c t the g e n e r a l popul" b tio n and h avin g no exposure to dust* I t i s th o se c a se s whida ? c o n s t i t u t e a problem v *n, i 3 th e d is a a s e which an indxvid** j u- . h as - when i s i t th e r e s u l t o f the in h a la t i o n o f (lu st? |i vfhen i s i t th e r e s u l t o f h is 3 o c c u p a t io n , o r when i s i t a ij |` d is e a s e w h ich h a s no r e f e r e n c e w h a tso ev e r to h i s o c c u p a tio n ? ' j! Those a re the p rob lem s* | f-o, in summary, in f i n a l c o n c lu s io n , I b e lie v e i th a t the o b j e c t iv e s o f t h is symposium have been a fcatod, that: f wa have -.* o x p lo r a t..o n , th a t we have iad our d i s c u s s i o n . j f F or t h a t , I am g r a t e f u l to a l l o f y o u , e s p e c i a l l y to th o se | who have s a t h e r e so lo n g , to th o s a who have ox to n s a id so j l i t t l e , who have b een h e r e to many p r e v io u s sym posium s, wno j f i are r e a l l y tho ex p o rts in th e s e p rob lem s, and I c a l l your J i a tte n tio n to our doer fr ie n d , Doctor Paul R ichards, to j Manfred B ow d ich , to Raymond H u ssey , and D octor F ren ch , vno I JZUJkM I juB t l e f t , they have said, very l i t t l e , and I had hoped th a t j th ey w ould p a r t ic i p a t e more than they d id in the program o f j our symposium. Thank y o u . (A pplause). | BY DOCTOR OKEKSTSIiT: j j On b e h a lf o f th e o v e r s e a s p a r t ic i p a n t s i n t h is j syrapoaium, many o f whom have a lr e a d y gon e, o u t who I 'm su re | w ould sh are mv v ie w s , I v iu n to e x p r e s s our a p p r o c ia t io n o f j th e o p p o r tu n ity o f a t t e n d in g th e sym posium . Our problem s | are perhaps n ot the problems of the variou s ad m in istra tio n s o f American *sen i n t h i s U n ite d S t a t e s . The feym.positirn b rought o u t once more .a t p r e v io u s aw foosia have done, th a t the problems o f pneum oconioses are extrem ely com plicated; th a t, a t f i r s t s ig h t, whether one d eals w ith the e tio lo g y , the h isto r y o f the d isea se or the v a r io u s ways i n w hich i t s e f f e c t e co u ld be p r e s e n te d and am eliorated; the com pensation and the a d m in istra tio n o f workmen *s com p en sation la w s , one f e e l s .hat one i s a lm o st up a g a in s t an e l a s t i c w a ll w h ich , a s one p u sh es n a i.d e, cornea b a c k , w ith a lm o st eq u a l f o r c e , b u t g r a d u a lly , we ore b e g in n in g to se e d a y lig h t , and a symposium such as t h i s , u j poking the problems w hich, t ite r a l l , is the f i r s t coop in , the s o lu tio n o f any problem , h a lo s the forw ard march o f knowledge. For the opportunity, th erefo re, of p a r tic ip a tin g in t h is symposium, even in the r o le o f l i s t e n e r s , we ara a l l d e - n lv g r a t e f u l to a l l o f th e .a who have o r g a n iz e d the symposium and who worked to - worked so hard to make i ' a su c c e ss, and in p a r tic u la r to D octor Arthur J . Vorwald and h is s ta ff. Thank y o u . -0 O 0- ( Symposium co n clu d ed 5*10 P . M. Septem ber 2 6 , 1 9 5 ? ' ESPOH'iSHS NOTE: ?r-jt>r names a p p ea rin g tlu o iig h c u t tb s t r a n s c r i p t , wlr re n e t s p e c i f i c a l l y s p a lla d i by the spankers, are su b ject to cnange or correction . c r,re 137 - R e fe r e n c e was made to p e r io d s ofoarly earth h i s t o r y . The ter^s In ju n s s t s n o ^ r a c h i c n o ><o s a p p e a r to b e C..iiiWr m is, p otation and T e r t i a r y , b u t oocause , o f in a b ility t chock t h e i r accu racy, toe I blank spaces h u re Dsen l o f t to oa f*lx d in . t P a r a l 6 v -- C o r t ' r l n C-erman l a n g u a g e wr.i : xtceet v/h..ch was u n i n t e l l i g i b l e . In y--r*..- n ix sin.- would au nr to r e f e r to pxnnaau typo d u st doposi u in pnsunoconiosis lie d ic e l term inology and s p e l l i n g has c an checked, wnorever p o ssib le w ith Dor.Lanufs Aiaarican Illu s traced liadical D ic tio n a ry , Some e r r o r s , h o w e v e r, nay e p p o a r th r-p u rh -f~, r e o o r w r h a v in g i n c o r r e c t l y - n e s r u - I - * - - ^ , ,-1 f - o i ; i u r t . t i r n i l i O i O u T V *