Document mbmmwg6xXzrYvEzwaY4yLM6n0

FILE NAME: Colonial Sugar Refinery (CSR) DATE: 1950 Apr DOC#: CSR029 DOCUMENT DESCRIPTION: Journal Article - Third International Conference of Experts on Pneumoconiosis THE MEDICAL JOURNAL OF AUSTRALIA lection. J - ^ T l ^ 3 7 th Y ear. S Y D N E Y , SA T U R D A Y , A P R IL 15, 1950. ____________ N o - 1 5 - (UnV- S^ ) , y 1950 (Univ. Sydne/)i Table of Contents. [The W hole of th e L ite ra ry M atter In T H E M EDICAL JOURNAL OF AUSTRALIA Is C o p y rig h t.] ttti> . : M.A. : Executive u Izatlon and slJ* 'inance, House am octant jQotitt, t to apply for first coQumuo&tt Vc-.ncf med, or wit! iedical Associatimi tary, 135 Macquarie'' c6 United Pries(By Friendly Socletli TM United Friendly )d Medical and Die. te y ; North Sydney People's Prudential M utual Provident idical Society Hai, Services Limited; ustralian Prudential Federal Mutual al Provident Club; 1 or other appoint* B.M.A. House, 22( risbane Associated Bundaberg Medical appointments and to any COUNTRY ia a re advised. In their Agreement to etary, 178 North itm ents in South ntm ents in South retary, 205 Saint pital ; all Contract alia. All govern or those of the is journal cannot Inal articles for ; offered to TH ( the contrary be the Editor, Tn* g House, Seam tes: M W 2651-2.) tify the Manager, er Street, Globe, egularity in the tnnot accept any u t of non-receipt ivect w ith in on m d others not r.TA in virtue 0d ical Association .0 th e journal by agents and booseginning of any omThmeonrwa teealtinh f0l1. ica and foreii. ORIGINAL A R T IC L E S -- Page. The B e attie-S m ith L ectu res--W h ith e r P sy ch iatry ?, ln L ecture I, b y H. F. M a u d s le y ................................. 6*6 M anagement of Haem atem esis and M elena, by John C. F itz h e r b e r t a n d R. G. E p p s .........................490 The E lectrocardiogram in Old Age, by P a u l H agen, M B., B.S., a n d Z elm an F re e m a n , M.B., B.S., M.R.A.C.P...................................................... : 499 A nticoagulants in the M anagem ent of C erebral Infarction: A Record of the Poor R esult O btained, by W. Mcl. R ose, M.D., M.R.C.P., M.R.A.C.P............................................................................ 603 P regnancy T e sts, by H. F . B e t t i n g e r ........................ 504 REPORTS o f c a s e s -- ^ ^ Osteitis D eform ans in a B ro th er and Sister, by W a rre n M u r p h y ........................................................... 507 E ssays by a C h in ese B i o l o g i s t ........................................ 507 Hum an P e r s o n a l i t y .................................................................. 508 BOOKS R E C E I V E D ...........................................................................508 l ea d in g a r t i c l e s -- Pelmatoscopy: A M ethod of Identifying th e Newly Born ........................................................................ ** 509 A F in a l C all to B ris b a n e ................... ....................509 CURRENT COM M ENT-- Accident-Prone M otor D rivers .................................510 R igidity a n d M u scle-S p asm in T e t a n u s .......................511 Medical A sp ec ts of S u b m a rin e W a r f a r e .................. 511 ABSTRACTS FROM M EDICA L L IT E R A T U R E -- B acteriology a n d Im m u n o lo g y .................... 512 Hygiene ............................................................... 512 Ci)e TBcattie^mit Lectures.1 (T h e U niversity of M elbourne.) W H IT H E R PSYCH IA TRY ? B y H. F. Maudsley, Melbourne. L ecture I. Now see th a t noble and m ost sovereign reason, Like sw eet bells jangled, o u t of tu n e an d harsh. Shakespeare's p ro fo u n d k n o w le d g e of h u m a n e m o tio n s sad hum an behaviour gave him a .keen psychiatric in sight into th e d isc o rd s t h a t m a y be r e g is te r e d b y t h e m in d w ith consequent d isco rd an t h u m an behaviour. "Sw eet bells Jangled, ou t of tu n e a n d h a r s h " is no m e re p o etic fancy of O phelia's d e s c rip tio n o f H a m le t's r e a l o r a s s u m e d m a d ness, b u t c a n be a p p lie d to a ll m a n n e r o f p s y c h ia tr ic disabilities th a t w e see today. There have been m any d a rk ch ap ters in the h isto ry of Psychiatry b e tw e e n S h a k e s p e a r e 's tim e a n d th e p r e s e n t century, b u t I propose in th ese le c tu re s to d eal w ith som e of the m o d ern a sp e c ts a n d d ev elo p m en ts in p sy chological edicine. We are said to live in an enlightened age; a fan tastic ge w h ere sc ie n tific k n o w le d g e h a s r u n rio t, m ig h t b e tte r describe it. M edical science p e rh a p s sh in e s a s a beacon in a w orld fu ll of d o u b ts a n d fe a rs. F . M. R. W alsh e, in Ws H a rv e ia n O ra tio n of 1948, m a k e s t h is s ta te m e n t: Yet the need of rebuilding th e foundations of m edicine was never g reater th an today, w hen we are being 1 Delivered a t M elbourne on A ugust 15 an d 22, 1949. SPECIAL ARTICLE-- The A ustralian R heum atism Council Page. . . 614 PUBLIC HEALTH-- ^ Third International Conference of E xperts P n e u m o n o k o n io sis ............................................. on 514 CORRESPONDENCE-- C o rre c t F o o tw e a r fo r C h i l d r e n ........................................ *>io T he H a ird re s s e r's B a c k a c h e .................................................ji}* No M ore B a b i e s ............................................. .... ; &17 Final R esults of Long-Term T herapy w ith M ethyl T h io u ra c il in T h y re o to x ic o sis ............................... 517 OBITUARY-- Sydney Jam es W oolnough .. 518 R obert Spencer Godsall .. .. 518 MEDICAL SOCIETIES-- ,,,, . , The Royal N orth Shore H ospital of Sydney Clinical S o c i e t y ................................................................................ 5191 NAVAL, MILITARY AND A IR FORCE-- A p p o in tm e n ts ....................................................................... DISEASES NO TIFIED IN EACH STATE AND T E R R IT O R Y O F A U STRA LIA .....................................519 AUSTRALIAN MEDICAL BOARD PROCEEDINGS-- Q u e en slan d ....................................................................... M EDICAL A P P O IN T M E N T S ............................................. NOMINATIONS AND E LE C T IO N S ............................ . . 520 . . 520 . . 520 D IA R Y F O R T H E M O N T H .............................................. . . 520 M EDICAL A PPO IN T M E N T S: IM PO R T A N T NO TICE . . 520 E D IT O R IA L NOTICES ...................................................... . . 520 sw ept along a spate of new knowledge and new tech niques, and have so little tim e fo r their contem plation and investigation. Is psychiatry to fu rth e r th e scientific aim s and healing functions of m edicine, and to play its p a rt in th is in te g ra tion? Or is it to rem ain in p a rtial isolation, striv in g yet failing to a tta in its ultim ate objective? More than a q u a rte r of a century has passed since th e foundation of these lectures. The late Dr. B eattie S m ith under the provisions of his w ill had the foresight and im agination to found lectures on th e prevention of insanity. I am am ongst the m inority of you who have a vivid recollection of an a le rt m an w ith a reddish pointed beard, kindly and lovable, w ith a shrew d and p e n e tra tin g eye. A great p a rt of his life w as spent in the m ental hospital service before he entered private practice a s w hat was then know n as an alien ist M ental disorder was then largely associated w ith the p atien t alienated from society because of m ore or less advanced behaviour problem s w hich render segregation necessary. In his w isdom Dr. B eattie Sm ith visualized these patients as norm al individuals in w hom som ething som ewhere had gone a stray through physical illness, through some distortion of tem peram ent, or ow ing to som e stress or stra in of life, together w ith som e probable hereditary factor. He realized th a t the preventive side of m ental disorder was not only a m edical problem , b u t one of dissemination of informed opinion amongst an alm ost hostile public, a h o stility hound up in th e fe a r th at it m ight be known th a t some relative had suffered from a m ental illness. It is for th is reason th a t these lectures are p artly technical and m edical and p artly for the education of th e public. Since th e foundation of these lectures th ere have been changes in the point of view regarding m ental disorder. T he public is now conscious th a t m en tal disorder exists. 514 THE MEDICAL JOURNAL OF AUSTRALIA. A pr il 15, Special article. T H E AUSTRALIAN RHEUM ATISM COUNCIL. T he problem of the rheum atic diseases has been attrac tin g world-wide attention. In A ustralia it has been felt th at th e approach should follow broadly th e lines adopted in th e United Kingdom , w here public in terest is stim ulated by the E m pire R heum atism Council, w ith m em bership em bracing public-spirited citizens as well as m em bers of the m edical profession The scientific aspects of th e question are dealt w ith by the Scientific Advisory Committee. The recent form ation in A ustralia of the A ustralian R heum atism Council under the sponsorship of The Royal College of P h y sician s m a rk s the first stage in a determ ined attack on the problem of the rheum atic diseases in this country. T he objectives of the Council are: 1 Stim ulation of public in terest in the provision of adequate facilities fo r the prevention and treatm en t of rheum atic diseases (rheum atic fever, arth ritis et cetera). 2 R esearch into problem s peculiar to A ustralia, covering the incidence, degree of econom ic loss, and other related aspects of rheum atic disease. 3. T ra in in g of th e p ro fessio n in th e m o re e x a c t m eth o d s of diagnosis and treatm ent. 4. E d u c a tio n of th e g e n e ra l public in th e public h e a lth aspects of the problem. 5 The provision of adequate m ethods of rehabilitation for sufferers handicapped by a rth ritic o r cardiac sequelae of rheum atic disease. , .,, The Scientific A dvisory Com mittee of the A ustralian R heum atism Council includes m edical m en from all S ta te s in A ustralia interested in th is problem. As a first step in a tta in in g the objectives of the Council a classification of the rheum atic diseases h a s been adopted w hich it is hoped will be used th roughout the Com monw ealth. The adoption of a standard nom enclature and uniform diagnostic c rite ria will assist greatly In the collation of inform ation and the im provem ent of the standard of treatm ent. Classification. T he classification Is as follows: 1. R h e u m a tic fe v er, (o ) A cute, ( 6) S u b a c u te . 2. N o n -a rtic u la r rh e u m a tism . 3. G out. . 4. R h e u m a to id a r th r itis . 5. O s te o a rth ritis . (a) Generalized. (b) Localized. (i) Secondary to previous traum a. (11) S e c o n d a ry to s tr u c tu r a l a b n o rm a lity . (ill) Secondary to previous rheum atoid a rth ritis. (lv) U nknow n aetiology. 6. A r th r itis a sso c ia te d w ith in fec tio n . 7. A n k y lo sin g sp o n d y litis. 8. M iscellan eo u s fo rm s of jo in t d ise ase, fo r ex am p le, n e u r o pathic, neoplastic, m anifestations of system ic disease, and local joint disturbances. Comments. N on-articular rheum atism includes non-suppurative pain ful conditions of m uscles, tendons, bursae, nerves, fibrous tissue and subcutaneous tissue, for exam ple, ftbrositis, m yositis, n euritis, lumbago. Rheum atoid a rth ritis includes classical and atypical form s, to g e th e r w ith ju v e n ile ty p e (S till's d ise a se ), F e lty 's s y n drom e et cetera. O steoarthritis includes osteoarthritis of the spine ("spondy litis") under th e subheadings appropriate to the particular ^ A rth ritis associated w ith infection includes only those conditions specifically associated w ith a know n infection such a s gonorrhoea, brucellosis, dysentery. T he follow ing are excluded: (o) suppurative a rth ritis and tuberculous a rth ritis: (b) a rth ritis w hich m ay, in the opinion of the physician, be due to infection, of the teeth, tonsils, sinuses et cetera. Ankylosing spondylitis (synonym , spondylitis ankylopoietica, M arie-Strm pell type of spondylitis) is the type of a rth ritis in w hich th e b ru n t of the disease in the early stage falls on the sacro-iliac joints and apophyseal joints of the vertebral column. There Is a tendency to centrifugal spread. w ith ankylosing changes later in the spine. M iscellaneous form s com prise a group in w hich are included, under app ro p riate diagnoses, the various types of arth ritic conditions not otherw ise included, for exam ple, a rth ritis of neuropathic origin, neoplasm s of joints or of seru m sickness, hsemophilia, in te rm itten t hydrarti p u lm o n a ry o ste o a rth ro p a th y , h y ste ric a l jo in ts- local disturbances associated with osteochondritis d isse c a n s), o r se c o n d a ry to c o n tusion, fra c tu re JU ap nip pmhnlifim. Conclusion. The Scientific A dvisory Committee has before It a gram m e co vering m an y aspects of diagnosis and treat: M uch p re lim in a ry w o rk has a lre a d y been done on su b je c t of a n a tio n -w id e survey. A t p re se n t th ere Is III if any, a c c u ra te in fo rm atio n available on th e incidence econom ic c o n se q u en c es of th e rh e u m a tic g ro u p of hi- - - -,, S tatistics from overseas a re not applicable to local conduSJfr a n d m u c h m a y be le a rn e d fro m a su rv e y carried out InB"* vast continent which possesses a relatively homogenoi p o p u latio n liv in g in tro p ic al, su b tro p ic a l a n d tem perate zotuT P rom the educational viewpoint it is hoped that p c ' g ra d u a te com m ittees th ro u g h o u t A u s tra lia will include th e ir program m es lectures and dem onstrations on v a rio u s a sp e cts of diagnosis and tre a tm e n t of the rheui group of diseases. T h e c o o p era tio n of m edical m en th ro u g h o u t th e Comi w ealth is sought in furthering the objectives of the tralian R heum atism Council. jji Selw yn N elson, 'll? M edical Secretary, Scientific Advisory1 Council, A ustralian R heum atism Council/ public rpealtb. T H IR D IN T ER N A TIO N A L C O N FER EN C E OF EXPERTS, ON PNEUM ONOKONIOSIS. J, ---------- At T he th ird in te rn atio n al conference of ex p erts on pneumonokoniosis, sponsored by th e In te rn a tio n a l L ab o u r Organization, w a s held a t th e in v ita tio n of th e G o v e rn m e n t of th e Common w e a lth of A u s tra lia a t th e School of P u b lic H ealth and T ro p ic a l M edicine, S ydney, fro m F e b r u a ry 28 to March 10, 1950. I t w a s a tte n d e d by e x p e rts fro m A u stra lia , Canada, D e n m ark , F ra n c e , Ita ly , th e U n ited K ingdom , New Zealand, N o rw ay , Sw eden, S w itzerlan d , th e U n ited S ta te s of America a n d th e U nion of S o u th A frica ; th e A u s tra lia n delegate* w ere P ro fe ss o r E . F o rd , D ire c to r of th e School of Public H ealth an d T ropical M edicine, U n iv ersity of Sydney, Dr.' G. C. S m ith, Senior M edical Officer of th e In d u strial Health U nit, School of P u b lic H e a lth a n d T ro p ic al Medicine, U n iv e rsity of S ydney, a n d D r. K . G. O u th re d , D istric t Medical Officer of th e Jo in t Coal B oard of N ew S o u th W ales. There, w a s a d ele g atio n of tw o m em b e rs of th e G o v e rn in g Body, Mr. F . J . R. G ibson a n d M r. A. M onk. In a d d itio n five expert* a tte n d ed th e conference who had been appointed by the In te rn a tio n a l L a b o u r Office in a cc o rd a n c e w ith th e decision of th e G o v ern in g Body designed to en su re th a t the agenda w ould be a d e q u a te ly cov ered : th e se w e re D r. W . E . George (A u s tra lia ), P ro fe ss o r C. E . G e rn ez -R ieu x (F ra n ce ), Dr. E. L. M iddleton (U nited K ingdom ), D r. A. J. Orenstein (S o u th A fric a ) a n d D r. A. J. V orw ald (U nited States of A m erica). Opening Meeting. A t th e o p e n in g m e e tin g th e c o n fere n ce w a s addressed by M r. R . R ao, S e c re ta ry -G e n e ra l of th e Conference, tne H onourable H . E. H olt, F ederal M inister fo r Labour ana N atio n al Service, th e R ig h t H onourable S ir E arle Page, F e d e ra l M in iste r fo r H e a lth , a n d th e H o n o u ra b le C. A. Kelly, M inister for H ealth in th e State of New South W ales. _ Agenda. T he follow ing item s m ade up the ag en d a of the conference as determ ined by th e G overning Body of the Internation L ab o u r Office: (i) th e p re se n t s ta te of know ledge ot tne pathogenesis, clinical aspects and diagnosis of pneumon koniosis; (ii) th e p resen t stag e of preventive measure (m edical and social m easures, m echanical and techn m e a su re s); (iii) an exchange of view s on the possibility defining m inim um in te rn atio n al stan d ard s of compensatio for disability caused by pneumonokoniosis. Election of Office-Bearers. T h e c o n fere n ce u n a n im o u sly ele cte d a s c h a irm a n Dr. W. BGeorge, Chief M edical Officer of th e Jo in t Coal Board " N ew S o u th W ales, a s vice-chairm en Dr. L. Greenbuns (U nited S ta te s of A m erica) and D r. A. J. O renstein (Sout :'p roceedin 9S * inference to< gjl delegate lhv m em bers W ith appropi following is a of the confe . Definiti st reoogruzin ionokoniosis" ne from th e m clinical signit j Labour On lflg definition: | pneurrionokon .lungs produced Irdust" being un ;ijn the solid pha Mover, th e con beyond those for th e fu tu re take th e foi was exposed, led. Pneumonol conference co uce and vari Wes, and a r :e of view s Recent A d v a n discussion took knowledge of tl lumonokonioses i jlosis in coal wo me of the c u rre n l the lungs in p fully aceeptabb _ was still mu< lerence th erefo __ices already itlnued and exi [Uisition of sue lerance of effei it The influer luction of pnei Jy. In general fibrous d u sts sue larger sizes ap ... m any m in eral ire injurious. Tl ` not yet been ( Aluminium as It was agreed lore th e conferei any form prevent There w as no evidi Powder w a s of v: * lllicosis or t h a t it There w as som e e inhalation of alun harmful, an d f u r t l in anim als th e ir Pulmonary tuberci: Pneumi The conference tubercle bacilli, Pneumonokoniosis, "Qportance of excl Occupations, a n d t- Tests It was generall tarious physiologi Uo physiological o Present stage of 1 h"tial and perio< Workers. I t was Procedures should April 15, 1950. THE MEDICAL JOURNAL OF AUSTRALIA. 515 ^Mca), a n d a s re p o rte rs D r. G. R . D av iso n (C a n a d a ) a n d B. E v e n (F ra n c e ). Proceedings and Conclusions of Conference. The c o n fere n ce to o k th e fo rm of a g e n e ra l d isc u ssio n mnngst all d e le g ate s, d u rin g w h ic h a se rie s of o rig in a l ifnerf by m em b e rs a n d o th e r a u th o ritie s w a s in tro d u c ed , Aether w ith ap propriate rep o rts prepared by th e conference ability; the erro r of estim ate m ust not exceed acceptable lim its - th e y m u s t be o bjective, a n d th e re s u lts o b tain e d 'w ith norm al subjects a t all ages m ust be well established as control standards; they m ust not require an undue a" " " " 1 of tim e. Before even those m inim al criteria could be m et, special research w as necessarily directed to the problem b oth in th e lab o rato ry an d in th e field. Diagnosis of Pneum onokoniosis. "The follow ing is a su m m a ry of th e p ro c ee d in g s a n d c o n tusions of th e c o n feren ce. . D efinition of Pneum onokoniosis. whilst reoognizing th a t in a wide sense the term wumorLokoniosis" connoted any condition of th e lungs S t a g from the inhalation of dust th a t m ight or m ight not f o clinical sig n ifican ce, fo r th e p u rp o se of th e I n te r fltional L a b o u r O rg a n iz a tio n th e c o n fere n ce a cc ep te d th e following defin itio n : Pneum onokoniosis is a diagnosable disease of the lungs produced by the inhalation of ^ u s t, the term "dust" being understood to refer to p articu late m a tte r in th e solid phase, b u t excluding living organism s. Moreover, th e c o n fere n ce d e p re c a te d f u r t h e r e x te n sio n of terms beyond th o se a lre a d y in com m on use, a n d su g g e ste d for the future the term inology of pneum onokoniosis ihould ta k e th e fo rm of n a m in g th e d u s t to w h ic h th e S e r was exposed, o r a lte rn a tiv e ly th e in d u s try o r p ro c ess A fter hearing various contributions on the early of pneum onokoniosis and th e differential c o n fe re n c e re a c h e d th e follow ing c o n clu sio n s I n the: <Uag- nosis of pneum onokoniosis, th e history and condiUons of exposure to harm ful dust, the clinical exam inaUon and the radiographic findings are all of Im portance. i of pneum onokoniosis m u st not rest solely on th e radiograph. In th e radiological Investigation of pneum onokoniosis a s an initial step, th e classification of radiographs should be in the m anner set out in a report compiled by & an d approved by th e conference, pro vided, however, th a t it is clearly understood th at th a t classification deals w ith ra d io g ra p h ic a p p e a ra n c e s o nly a n d c a n n o t be need t a 1; axiy o th er purposes such as the assessm ent of clinical conditions o r disability; it is not sufficiently exhaustive to be applicable to all form s of pneumonokoniosis. The conference noted th at pneum onokoniosis m ight be sim ple in its nature, or m ight be com plicated by infection, and th a t if it w as complicated, particularly by tuberculosis, it becam e a m uch m ore serious condition. concerned. R elated P ulm onary Conditions and Concom itant Diseases. Pneum onokoniosis in Various Countries. The conference considered re p o rts received c o n c e rn in g th e hcidence a n d v a rie tie s of p n eu m o n o k o n io sis in v a rio u s eountries, a n d a n u m b e r of m em b e rs took p a r t in th e ochange of view s w h ic h follow ed. j Recent A dvances in P athogenesis and Pathology. An exchange of view s and experiences took place on pulm onary conditions related to pneum onokoniosis and on concom itant diseases, but it w as felt th a t the existing data did n ot lend them selves to the reaching of definite con clusions. T he conference recognized, however, th a t not all pulm onary abnorm alities occurring in w orkers in dusty occupations were necessarily attributable to the dust. A discussion took place on th e subject of recen t ad vances fa knowledge of th e p a th o g e n e s is a n d p a th o lo g y of () pneumonokonioses in g e n era l, ( 6) silicosis, (c) p n e u m o n o - famiosis in coal w o rk e rs, a n d (d) o th e r Pneum onokonioses. Hone of th e c u r re n t c o n ce p ts of th e w ay in w h ic h d u s t a c ts M the lungs in producing th e disease pneum onokoniosis n s fully acceptable to th e conference, and it w as fe lt th a t there was still m u c h need fo r re s e a rc h in t h a t field. T n inference th erefo re, w h ilst recognizing th e v aluable trances a lre ad v m ade, u rg e d t h a t in te n siv e s tu d ie s be ntinued a n d ex ten d ed . I t w a s co n sid ered t h a t th e Kquisition of su c h know ledge w a s e sse n tia l fo r th e tetherance of effective m ethods fo r p rev en tio n a n d tre a tttt The influence of th e size of du st particles in the Induction of p n eu m o n o k o n io sis w a s u n d e rg o in g c o n s ta n t tty. In general term s it could be stated th a t in th e case < fibrous d u sts su c h a s a sb e sto s a n d c e rta in v e g etab le d u s ts 4 larger sizes a p p e a re d to be th e m o re h a rm fu l, w h e re a s kith many m in e ral d u s ts th e sm a lle r sizes seem ed to be th e Pne injurious. T he low er size lim its of in ju rio u s particles 4 not yet been determ in ed . .^Aluminium as a P rophylactic or T hera p eu tic A g en t. 'ifj was agreed th a t th ere w as n o conclusive evidence Jjnre the conference t h a t th e in h a la tio n of a lu m in iu m in 9 1 form prev en ted th e d e v elo p m en t of silicosis in m an . 25^6 Was no evidence before th e c o n fere n ce t h a t a lu m in iu m 2 *der was of v a lu e a s a th e ra p e u tic a g e n t in h u m a n 5sr-''o.sl:s or rth a t it w a s h a rm f-u -l w -h e n used. f o r t h a t p u rp o s"e". 25 Was some evidence t h a t u n d e r c e rta in c o n d itio n s th e gWation iof a lu m in iu m in in d u s tria l p ro c esses m ig h t be Jttlful, a3 Jnldu fUuU rUt1hCe1r,, tUh1 eC 1r eC wv*a*s5 evnx-ip/se..r.i.m.. .e.n..t.a..l e- v--i-d--e--n--c-e- t h a t ^ - t~nl.muals th e in h a la tio n of a lu m in iu m d u s t a g g ra v a te d ..^ ^ ttr y tuberculosis. . Pneumonokoniosis and Tuberculosis. conference recognized th a t infection, especially by a bacilli, a g g ra v a te d a n d w as a g g ra v a te d by : ^ "" nokoniosis, a n d a cc o rd in g ly d re w a tte n tio n to th e of excluding subjects of tuberculosis from dusty .^Wuons, and to th e value of good hygiene a n d n u tritio n . a lly ' [J K p '' Tests Used during Exam inations. S S L .**8 generally fe lt, a f t e r a d isc u ssio n d u r in g w h ic h .Physiological te s ts w e re described, t h a t th e r e w a s " "logical o r la b o ra to ry te s t (o r te s ts ) w h ic h in th e ' stage of d ev elo p m en t could be a d o p te d fo r ro u tin e ana periodical exam ination of large num bers of It was agreed th a t the essential criteria for such * should be a s follow s: th e y m u st m easure dis- The Radiograph and A ssessm ent of Severity. The conference stressed the fact th at appearances on a radiograph in the case of pneumonokoniosis were not neces sarily related to the severity of the disease. P ulm onary Concer in R elation to Silica and Coal D ust. The conference reached the conclusion th at there w as no evidence th a t pulm onary cancer w as m ore common am ong persons exposed to silica dust and coal dust than am ong th e general population. T he Significance o f D ust F ound in the L ungs Post M ortem. T he conference recorded its opinion th a t the q u antity and kind of d u st found in the lungs post m ortem could not be accepted as a criterion in estim ating the presence or degree of pneumonokoniosis. Diagnosis of Tuberculosis. T he conference expressed the view th a t the absence of acid -fast organism s from th e sputum could not alone be regarded as conclusive evidence of the absence of pulm onary tuberculosis in the w orker suffering from pneumonokoniosis. In som e cases tubercle bacilli had not been found in the sputum even a fte r the use of culture and inoculation m ethods In such cases, however, the existence of the bacilli m ight be dem onstrated by m ore intensive investiga tions involving, for example, bronchial or gastric lavage. D ust Investigation. A fter h earin g several contributions on the subject of industrial dust in relation to dust in v e s tig a tio n th e con ference agreed th a t an analysis of m aterial from which d u st w as derived did not of necessity represent the com position of the dust inhaled in an industrial process, and fu rth e r th a t it w as im portant in dust studies to determ ine the distribution of dust particles by composition and by size I t w as agreed th at, w hilst generally speaking m ineral d u s ts (w ith t h e e x ce p tio n of a sb e sto s) exceed in g Sg in particle size w ere of m inor im portance, the lower hm it of th e size of particles causing pneumonokoniosis had not yet been determ ined. D ust Suppression and Control. In regard to dust suppression and control, it w as agreed th a t the protection of the w orker against harm ful dust exposure m ight include one o r m ore of th e follow ing: (i) abolition of the process creating harm ful dust; (n) sub stitution of harm less m aterial in certain processes w here 516 THE MEDICAL JOURNAL OP AUSTRALIA. A p r il 15, dangerous m aterial is being used; (iii) suppression of dust a t the source; (iv) rem oval of dust as n ear as possible to the point of origin; (v) reduction of the concentration of th e dust by ventilation; (vi) rem oval of dust from the air by w etting; (vii) electrostatic precipitation; (viii) personal respiratory protection of the worker. The conference reaffirmed the opinion expressed a t previous conferences th a t the m ain efforts in prevention should be directed tow ards dust suppression and control, and th a t personal respiratory protective devices should be used only w here th e form er could not be satisfactorily applied, o r as ancillary to dust suppression m easures. I t w as agreed th a t sandblasting w ith siliceous abrasives w as highly dangerous. Some experts considered th a t the use of siliceous abrasives in sandblasting w as so dangerous th a t it should be prohibited and non-siliceous abrasives substituted. O thers, however, w ere of the opinion th a t experience had proved th a t siliceous m aterial could be used w ith safety if effective protection w as provided. Finally, the opinion w as expressed th a t there w ere know n m ethods of dust suppression and control w hich, if fully applied and m aintained, would protect th e w orker a g ain st hazardous exposure. The conference therefore recommended th at every effort should be made to apply those m ethods. Orain D ust from Cereal Cargoes. The conference recommended th a t the Internationl Labour O rganization should tak e steps to inquire into the possibility of controlling the grain dust associated w ith th e handling of cereal cargoes. Silicosis and Civil E ngineering U ndertakings. The conference agreed th a t the attention of governm ents, public utility corporations, local au thorities and contractors should be called to the occurrence of silicosis follow ing relatively sh o rt exposure to dust in civil engineering under takings such as tunnelling and excavations. P reem ploym ent and Periodical M edical E xam inations. Experience gained in various countries in relation to pre em ploym ent and periodical m edical exam inations w as described. A ttention w as draw n to the requirem ents of the exam ination and to the need for technical com petence of the exam iners. It w as emphasized th at such exam inations w ere necessary In order to p rev en t physically unsuitable w orkers from entering an industry w ith a dust hazard, and to assess the pathogenic effect of dust exposures in relation to th e period of exposure and the concentration and the com position of the dust, and th a t such details should be available to the exam iner. The desirability w as stressed th a t such exam inations should Include radiography of th e lungs of technically satisfactory standard. Cooperation against Tuberculosis. A proposal w as m ade to the effect th at, in com m unities w here there were pneumonokonlosis-producing industries, there should be cooperation betw een those industries and the health authorities in the general com paign against tuberculosis. D isability and Compensation. T he conference agreed th a t in the assessm ent of disability the three sam e factors should be taken into account as in the diagnosis of pneumonokoniosis--nam ely, the history of exposure to harm ful dust, the clinical exam ination and the radiographic findings. The assessm ent of th e degree of disability m ust be left in each case to the best judgem ent of the exam iner. The conference agreed th at th e relative Im portance of each factor varied from case to case, and th a t it w as a t present quite impossible to lay dow n generally acceptable standards for assessm ent of disability in pneu m onokoniosis. The m eaning of the term "pneumonokoniosis" having been defined, it w as decided th a t no fu rth e r elaboration w as necessary; each co u n try should define the conditions for com pensation, w hich should be such as to ensure th a t any w orker suffering from pneum onokoniosis should receive com pensation regardless of the tim e th a t had' elapsed since h e w as exposed to dust. T he term "diagnosable" incorporated in the deflnltion indicated the presence of signs or sym ptom s, but not alw ays loss of function. T he conference agreed th at w here pneum onokoniosis increased disability due to other diseases or to age, the com pensation accorded should take account of th a t fact. Rehabilitation of W orkers. The conference considered th e experience in several countries w ith the rehabilitation of w orkers suffering from p n eu m o n o k o n io sis. I t w as a g re e d th a t, w h en a -- - suffering from pneumonokoniosis had to leave his accuM *?! em ploym ent, every endeavour should be made to p la e ^ im m ediately in, or train him for, suitable alternative emnu? m ent, w hich should no t reduce his sta n d ard of living provision of su ch a ltern ativ e em ploym ent should prejudice th e am ount of his com pensation. F u rth er Conference on Prevention. oiv T h e c o n fe re n c e u n a n im o u sly ad o p te d a proposal by TJnifi K ingdom m em bers fo r the holding of a subsequent conferanS a t an early date to consider the prevention of pneumoa? koniosis from th e point of view of th e engineer, the phystaE and the chem ist. a* D irectory of W orkers in Pneumonokoniosis. A U nited S tates m em ber proposed--and the confers* adopted the proposal w ithout opposition--th at the oq* should p re p are a directory of w o rk ers in th e field of pnjj? m onokoniosis fo r the use of interested persons. P ublication o f M aterial P resented a t Conference. T h e c o n fe re n c e em phasized th e im p o rta n c e of th e technical re p o rts subm itted to it and the discussions w hich took pia* c o n c e rn in g th e m . T h ese d ealt w ith th e incidence, pathology sig n s a n d sy m p to m s a n d m eth o d s of d iag n o sis of pneumono.' koniosis. T hey also d ealt w ith th e v a rio u s m eans adopted tt p ro tect w o rk ers exposed to th e h azard of pneumonokonlo^ a s w ell a s w ith c u ra tiv e a n d re h a b ilita tio n m easures. FUm^ la n te rn slid es a n d o th e r re le v a n t m a te ria l w ere demos s tra te d d u rin g th e conference. T he conference agreed thit. it w as im possible to sum m arize th e m ate ria l brought beton th e c o n fere n ce , m o st of w hich w a s of im m ediate value to th o se co n cern ed w ith th e stu d y of pneum onokoniosis sad also to those charged w ith th e fram in g of legislation and tbl adm inistration of relevant law s and regulations, and thenfo re reco m m e n d e d t h a t th e p a p e rs p re se n te d to the con fe re n c e a n d th e ste n o g ra p h ic re co rd of th e proceedings ho published a n d w idely circ u la ted a s e arly a s possible. CorregponDence* CORRECT FOOTW EAR FO R CHILDREN. Sir : T h e im p o rta n c e of c o rre c t fo o tw e ar, particularly la relatio n to in fan ts a n d children, is a m atter of constant c o n c e rn to orthopaedic su rg e o n s. T h is co n cern has been reflected in th e a p p o in tm en t by resolution a t an annual g e n e ra l m e e tin g of th e A u s tra lia n O rthopaedic Association, of a su b c o m m itte e to d isc u ss a n d d ra w u p specifications of a n a d e q u a te ly d esig n ed shoe fo r c h ild ren . T he recom m e n d a tio n s of th e su b c o m m itte e, h a v in g been adopted, were b ro u g h t to th e n o tice of c e rta in shoe m a n u fa c tu re rs in an endeavour to secure th e ir cooperation in the manufacturing >f sh o e s in a c c o rd an c e w ith th e specifications. U ,,,,pear to :hese negotiations w ere fruitless, and it did not avv w :he C ouncil t h a t a n y good p u rp o se w ould he a ever, following th is ap p ro ach a n y fu rth e r. T he Council, M s of the opinion th a t some very useful purpose i ^ ^ tchieved if p aren ts seeking advice on the point suided b y th e ir p riv a te m ed ical a tte n d a n ts o n 1 " hiidren. necessary in the selection of satisfactory shoes for c ^ I h a v e b e en in s tru c te d , th e re fo re , to la y before y fl0 -ecom m endations of th e A u stra lia n Orthopaedic Assoc n respect of w hat are considered essential feature=_ ^ correctly designed shoe, a n d to a sk y o u r cooperatioi m aking these findings available to practitioners throus the Com m onw ealth, th ro u g h th e colum ns of the journal. A p b il 15, I K A correctly vaa | F * L laced witl heel should f e t b e in n er side If S d to an equal control sect I f i i across the | pj1advocate^ 6 1 IS hoefor th em . _ An old saying R the great toe v % will look a fte r Iv sufficiently rigic The general lnswung, for i border. T he si (J) or (b) broi be shod. Such alterati tarsal pads ai incorporated by should be adde titioner. Shoes It is conside . be used only t v these specificat A sketch is : the shoe ment: 135 M anquai Sydney, M arch 1 TH Sir: A few i an interesting titioner. I fe and I urged 1 journal. I bel at a comparai us. B u t his of m y recolle. For se. Huonvillc dresser v a n old s service ' backache dressing. H o sp ital, m ostly v m assage, variety ( Prior t H e confi. single-hr. "W hy n. you can