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FILE NAME: CERAMICS (CER) DATE: 1942 Jan DOC#: CER024 DOCUMENT DESCRIPTION: Journal Article - Pneumoconiosis: A Study of 379 Cases ) Volume 18 Number 3 (9/1* MEDICAL BULLETIN of the Veterans' Administration FRANK T. HINES, Administrator 0/ Veteran' Affairs CHARLES M. GRIFFITH, M. D.. Medical Director JANUARY 1942 MARTIN COOLEY. M. D,, Editor UNITED STATES GOVERNMENT PRINTING om C F. WASHINGTON I 1*41 f u r sa lt L f (tit ,Nj|< Im l r rede n t I [ I w u h h u I, W i lu B |t a O C - * .... ) PNEUMOCONIOSIS: A STUDY OF 379 CASES I I vkkv II. W ii.ija m b , M. D ., 1V/rrioM * Aihuini*ti ti/imi, Otccn, X. (' . at AVesteurravnesy* AwdasmiivncisetnrlaltyiocnonFdaucciltietdy, (iw?iihmilneoidmiet. nXn.thYo.r) tois(leotnendiiuinlye ethraenrse'lAatdivmeininisctirdaetniocne.ofHpineeudmatoacfoonriotshies sintudbyenceofnicsiiasrtieeds ooff qtuheestVioent nanadirems,edfoicrmalurleasteedarcbhy, twhehicchhiehfa,ddibveiesnionseonft ptoosntgnrdadeuxaetceu, tiendstriutcltiieolnd stitoantiaolnsd,uisnt rhealaztaiordns;torabdeinoegfircaimarsiesofwchhoeshtasdoIfjcaofiifeecxtpedosebdenteofiocciacruipesa; dainedd,. in n few instances, tissues from affected beneficiaries who had AdAmtiontiasltroatfiocansews asso c3o7l9l.ectTedhofrobmeneflfiiccifaireileds sitnatitohniss oscfrtihese Vhaedterbaenesn' svialvrieoru,silryono,cqcuuaprietzd):, cAosal m(ainnethrsraocfitemaentdalboitruems in(loeunsd), mcoinpepresr,, bgriodled-, yinairdvarliaobuosretrysp,etsunonf eclonlasbtrourcetriso,nrowcokrkd,rialuletor'mosbhieleetfaccletoanryeres,mlpalbooyreeerss, bmlaecnk, smmaicthhsin, igstrsin,sdaenrdsb, lsntsotneersc,uitmtetrtsc,rycewmoernkterws,oqrkuenrrsr,yirnaeilirio(aldimsewstiotcnhe, stoabnadcsctoon-fea,ctgorraynietem,plmoyarebelse,, bsrliactkel,ayeetcr.s),, slialkb-omreirlls eomnpslotoyneees,crsuteshamer-, etenxgtiinlee wfiioernkieerns,, assllcieels-tmosillweomrkpelrosy, emeso,ldsctorsn,egmraainso-enlse,vgartoocrereympdleoayleeerss,, nfaier.mn,ecrns,rjiaelnutmerisn,ummemtalelptcorljischleerrsk,, gtillaessprweossrekre,rsir,osnmweloterrkewrso,rkfeoriisn,darnyd|w>oaswgdievre-rnn.ctory employees. In a few cases no occupational history coMncoludseironn stthuadtythoefreduasrteyoonclcyutpwatoiofnosrmhassolfeddotsot twhheicrhnthreearlldyecfianuistee pnsulltmcsotnnsar(ymadgisneeassieu,mnasmilieclaytef)r.eeTsaillicc,aal(sSoiOa ,s)iliocratseiliocfomn ndgioiixesidiieuua,nids chloowseetvyera,lliite.dhacshenmoticbaelleyn tdoefaisnliietesltyosparnodvenis tuondbeerasufsapcitcoironin. thAes pyreot, danudctioocncaosfiolunnalglydisseliagshe.t fiCbrooasli-sd,ubsut tcaIubsiesshpaisgmbeeenntaptiroonve(nantlohrluiecorseilsa) tiiovuesl'ymhinaermrallesscsofmrommonalypamthinoelodgiiscanlosttcaonndspiodienret.d aDfuascttofrroimn tthhee pvraor dinugctiiosnthoof stohuercdeisefrnosmc. wThliicch'Bitlhirea-dl>iseeaarsieiigisrocookntreancctoeudn.terWedoriknermsiinn l(iheornucsecmethnte, minadtuersitaryls, walhtihcohugthheyexhjiaonsdcdle tcoondtuaisnt, laitrtele noort naoffseicliteead., aMnodstthoefrethios svonmrieonrseacsloanystousleiedliienvethtehaptostotemrey oinf dtuhestmrymaorediiftyiiionrcuenvieisn, sinomhiebiotbtsheorvedresvetolopmmoedniftyoof rsiilnirhoisbiist. thCeopalrodgursets,s isofal(slioe hdril-ie'>avsec.d bIyt 2 mi y> MEDICAL HULLETIN' OK T1IE VETEIIANV ADM IN IS . ..*TIO N 2i) 1 sinhotuinld: (nlootttelriye iunndduesrtsrtyo,odbecfraomme tcleiirstaitnhaet mthpelony*eris> inno thdiusstinhdauzsatrrdy aciracllysubthjeectgedrintdoersh,igpholcisohnecres,ntarantdionfsurnoafcesilmii-ean-.bcnHiiunmgs dfursotm, ehspaye, ganradinb,ak(leoruier,s ectocn.,steitnuctoeunntoereredalohnazfaarrdmss,o infnrgraasintheelepvraotdoursc,tiomnillosf, cuhcruolneich,rolnucnlgiitidsi.seaTseh,eyis wcoonulcdernaelsdo, parltohboaubglyh atghgeyravmataey asnetexuipstinang tjuubteercaumloi sitse.xtiTlehemsilalms.e Hmoaayd bnendsaisdtreoeft tdhuestlcuastnsnoetnchoeunrteegreadnleidn nins hloawzacrdoonuces,ntarsatitohne. amount of silica in such lust is very small and claAssfitfeierdst(uedityheorf dtthTemillcaltya osurbpmroitbteadb,ly1)71ascahsaevsinogf ltuhnisg gdrioseuapsewdeuieo. tdoisedausset. inThhaleathiiosnto, reiietsheinr umnacnoymopflifclaietsed: o'ars'wimeprelicraatethdebryiniandfeeic|itiiaotues, oampiin,iownitihnotuhte ianddievtiadiuleadl cahsies.torFy,oritinsistandcifel,icnulmt intoi mfaoyrmhavae dweofrinkietde diniseaamsei-nperofdourcimnagndyuyset.arsAanhdistsotirlyl hoafvtehihsadtypliettloef ocrasneoshexopuoldsusrheotwo into, taonndlytowwhehreathefowrmorkoefd, lbuustt lwiehawtahsoedxipdosiendd. etIanil,ohtohwer lwonogrdlsie, dthiel cporondcuencttiroantioonf, dpislueassethbey tdimuset doefpcexn|dns>suuproentotheit.forSmomoef doufstt,hep.lufsilmitss osuubtlminietdtedaswthereey osfhopuolodr h<a|viiealiblyeenn.ml Hthoewelevseiro,ntshew. gereenenroatl aasvesrhaagreployf the'flfiiclmcshawraasctiejuriislteicg,oliexsli.ons in the lungs in silicosis are fibroid nodules vthaeryeianrglyincassti'zse, lefrnodming2 ttoo l!i>ecmomme. icnonflliuaennictteinr. thTehfeasre-aadrvea. ndciescdrectaeseisn. Iinnditvheid. uexaltreidmeenltyityfari-nnddvennnsoccmd acsasseess otfhefsiebrnooudsuillecspotesimt.l tTohleossee cthaseeirs taurbeerncluilnoossist. invnriably associated with infix:!ions disease, usually Tho cases studied wero classified as: lun1g. Smilaicrkoisnisg,s fwiristth sfitnaogelis(cSrci)to:gSenheorwaliinzgedaicicoenlutluaatitoionn. of tho no2d.uhSiilliiocno,sisst,illsodciosncirletset,agthoo (inSd2i)v:idSuhalownoindgulems abrekiendg geexnteenrsailvlyo lar3g.eSri(lbicaonsiisn, tthheirdfirssttasgtoage(S. 3) : Showing very extensivo nodulatio4n. 5w,inthndlaCrg. eSniloicdousliess, tfeirnsdt,insgectoonIdx,'cnonmdctchoinrdflusetnagt.es, plus infec dtieofnin:itTeheevsiedecnacseesofwaecrceomofpatnhyeinsgaminefi'tcytpioeuss ndsise1a,s2e,. nml 3, with tho7. iSnidliivcoid-tuuahlernco.udluolseiss h(SadI'llols)t: thFeairr-aidilveannticleyd incnsdie'snsien fwiluhoiciihs cmoassissecsoomfbiinnfeidltrwatiitohnt.ul>Tehrcensleoiaisreinf'oencstiiodenr,edhuttheit riessuimltpanostsoibflesiltio detfie.i (m'uisneesawseitphaoruattedbefaicnkitge,roeuvniddenfcoer coifthseilricportoice,i-sins.volvement, hut winidlliicadteefsinaitbe-ue-vkigdreonnciue! ooff linunfegeldioisneaosnel,ythe appearance of which 2 5 2 ,JCAL niJLLETIN OF TUB YKTEIIANS A1)M INISTKATION or9,w1e0ll.-mFiabrrkoesdisa:cCcuensptsuasthioonwinogf nIloienoludnuglarmdnerKpoinsigtss., wTithhisslcigohnt dppairtesissoienvnetencinonnnogeteassltieeisorneogfdaurredeestpdoirncasutodrdriyniorn-irncctfneeurciltsiotdinics,eoaafscesu.i,tleiocroosirins;cohittrhoiensrioccf,oteninn dviatriioantsio. nsTihnetshee alidnuelatrchsehsnt.dows are also subject to normal conItt.raAdissbtiensctotisoisn: tTohsiisliccoonsidsi,tiolnCnhrnlys cbaeseens toefrmaseldax"stsoilsiicsaatoresisd"ifliincmuilntotro rhrencnoggcnsiziendniscastuicnhg. anThienterarsdtiiotigarlapfihbsrousissu,aslliymislhaorwinonalpy \ apdevaraanncceed ctoasetlsiossheowcawselsiaitnhacslabseseifnicdaetisocnrisbe9d aonsda "1g0.rouTnhdegmlaossrn" i\ atopgpeetahrearncwei;ththaatmiasr,keaddaifcfcuesnetuhantzioonoovferthtehelulnogwemrabrkminggsfi,elbdust, \\awsittho olbitstcleureorthneocanroddiauclnbrorddce|>rsosaint.d tThheidsohmuezsoomf athye ldieiaspohrdargumse. 'dis1e2a.seN. egative: Cases in which there was no evidence of lung accTohrodifnoglltoowtihnogotcncbulepasthioonwssrtehpereisnecnidteedn:ce of industrial lung disonso 01 83 63 B l-In f. 82- In f. 83-In f. a m A ah. 3II3 73 t \ tt 11133 an i 178 71 &7 a 3t t I 8 4 I 3 33I 31 i 3 1 II I i I i 3 4 I1I T o t a l.......................................................... M 13 3 1 I 38 30 37 3 tIutotnrIatIlhwfffirlmUl iInpwroenaIfol mtrerndwrotihpIanntffoOwrwmoeranftciheoirnaawilnwerrdepttnaamvtyallalwonbmntoifpe. totlfomtuin.erTahhonswe ncoIunldthhisolaauldhrd.lvldltoadntI-nrntocksmmailnleerroccocunjiwtl-- t y p iTMchatleh ooIfonydathutlMe(ohroelHerto eh*ni sdmtotrnhyoe yoIfnwdtehrraeel*tslotoleuhtrat*adtfInslreyodp.geinv en to In throe cnaos. queatkm. It tho U be radiog lieved raphi that c appe more ara det nce elle * d u his qu tor ite ies wmooutAeldlhaihmpenlvmtateifmmmonmnteethlhteeedrmsm,wtoeirnaetrselaprneplrreeonnfdiarnhlarfatetewoin*nsafhoplrremornoa*htilaoennqd.oalnolvllelseswohfialeshweosrtokaInd*uoavl.er tIhnethereurrolholmess.whTehree ammolitmen- hlaisekbreelosytfottshhaepntortthlmeeteefnari.cotrioen*ot fwthoerokatgharerme elantp*rolohdodhloyaaulfotonMthdeerwaMorka ewoonueKeIntbroatoionnedodf othdUfadctuosrt,lo ittheatrve>leaoeseemosf ennDniaogt nloexixe.m--pThhaesizieidnpotorot^nnsctrconogflya. dTehfneilcsiylmopctcoumpsatieoxnhailbitheidstobryy ennmselseoxpf eucnfocronmlipolnicantred nsoitlictorosuislilncrseoinfcew. nInndthoef.tefnar-aabdsveannt.cedCocuasgehs ttheremreinmalamy alnieifedsytsaptinoena., Tanhoeresaxmiae, mloassy loief swaiedigohft,phaynsdicaclyasingonssi.s aDs ea creased resonance of various degrees may l>e elicited in tbc more- ) MKIMCAI. I l f l . t . K T I X (IK II IK \ K TK HA NS ' M I M I N G . T I O N 2 .r>i{ cavdivdaenncceodocfadsiesse,astoegsehtohwern whyillsysmigpntosmosf aenmdpphhyysesmicaa.l siTghnes ids esatrritkhin(gif TwXhh-iresan,ytcosogtmuedtphyaeriresdwthwiethitmhnoIcshtaordeeeffxuintleliytnettaaonkfdednsisahetiaissstfeoarcsyhto,orwiysnambhesytohltouhdteeolryfaddniieaocggenrsoasapsirhsy.. Tmhemgarkeinatg htahzeurddiaignnothsiesseancdaseisn isfoallnowinitnegmuipnetnhet aicnudtievirdeusapliracntoscrsy. thiwnyfoelucdthiiseoernac,siiesluso.cshisOaf1steipsnn,oecfutamesneosndoiiaffliotcurulliiteidrtcohuieldunisizriaes.rewniItlnlinstlheluoiwthcean.sosehdsaucdloaomrwdpseloipcfoastIeihtdos evaecrhy sdiimseialsaer, tmo athyosaelsoof hseilicmoosdisi;fiethde haypptehaeraonidli'ero.f tIhne sthhaesdeowcsasoesf dtheetaiclelidnichiiasntoraiensd a(rlcieevroenentmgoenreoliomgipsotrtiasntin, daimspienthsaeblceo.opOerfaticoonurosef oinf ltuhehseercciialsoessisthaerespyrmespetnotm. s, physical signs aial hihnrnlnry findings claOssfifitehde n1s71iiciiamsems pslhiconwtncdinsiltihceostiasbloer, a52shoesrtoasbiosu;t,38tit)opf eIrhcoesnot wweerreo, iinn tthhee fthnuirtdstsatgneg,c.12 Ain jitohset-sinecoortncdiiisteaxgaem, iannadtioonnlyof2owneeroefcltahsesifliaesdt cNaesvesersthheolwesesd, tahefapr-aatdhvoalongceisdt, swilihcooswisaswiotnheouot,f etvhiedernecveieowferisnfoefctitohnis. sticornie.s oIff cthasisesc,asfeelthatdhantotthceormeewtoasapurtoopbsayb,lyit nwboualcdkghraovuenbdeeonf cilnafsesci dfieendceasosfilcicoom-fpulliicearctiunlgosiins.fecTtihoeusredmisaeainsein,gm1o1r1e) coarselesssnielxstheonwsievde eavndi in Wmhoisltocathseiss ipsronbontbalyn leuxhteerncsiiivloesisse.ries of cases and no definite con cnliuossilonosbscearnverlsie idnratwhant firtomsupipt,oritts isthebelliieevliecdf tthhaatt idt.iseaagsreeesofw(ihthe olurngganssdutoe ttuobedrcuustlosiinsh,aalantdionthaint ctrheaissessusthceeptsiubsilcietyptiibsiliitnycreoafsetdhosine dariorecotf rtahteiootpointihoen etxhtaetntthoef nthuembinedruosftricaalsedsisoeafsei.nduTshteriarlevdiiesweaesres oipnfulmtthhoeisnaVsrceyrtiedersiasneinss'soAvecdromymiinsnnigsintrulaln,tidocenor.ntshiOedenorlibynsge3r7vt9haeticoannsueosmfbwmeerreodoifccaolcnasosifdefseicreeordsf dasiffpeorleenuttifnalcriolisteiess,.andThniisnereovfietwhesleiaws esrheowsunbmthiatttedthienreduisplaicanteeedfrofomr moffoirceerscasrheofuulldnmfalmdileitaariilzeed thheismtoserilevsesinwritnhsctshiosfdtihseisnstoy;poth.eyMsehdoiucladl iannfdorsmhouthldemksneolwvesw'olmf tthteypvensrioofnoscscouupracteisonosf adricsehnaszea-rpdrooudsucfirnogmdtuhsits, staInndpthoei.nstt.udy of this scries of eases, Iho writer was nssocintod with DLar.boLrcaTttooryy Uf.orGtnhrednSotru,dpynotlfioTlougliiosrteatinldosdisi,reacntdorDorf. tlhime SnaerraLna. cSnLmakpesNo.n,V.roeAntgceonmolpoogsiistte, oTprimnilocnnuofSathneitatrhiureme, rebvoitehwoerfs Swnarsaninifci[KL>iiu<klced. Ttoheesaeclirevqiueewsteirosnnwaeirree, mnuflcohr ienntererefisdtedstuindythoisf stthuedya,vaainldablwe isdhulato. eirxaplre((sHsirtehresirofthtahneksvatoriotuhes offafciciliiatliseso,f wechnolrcaol oopfefireaet,edandintofutrhneismhiendg- the data.