Document mp0aKvxK9KxnbgMqRxDoDdq6Q

FILE NAME: ZD^D/ DATE: D DOC#: ^D/ DOCUMENT DESCRIPTION::ZWZZ^Z PULMONARY ASBESTOSIS IN SOUTII AFRICA. (Fig. 7). Ph:uicwylo,is \Ya' nnt ('"nfincd to Ilic smaJJ,.,. p.i:l 1e]r,., Uij110XjRY ASBESTOSIS IX SOUTH but eYen largo 1od-; ,,,.Pre r-.c:tn compk1cl:\' rnrloc,('d and ()itr n bent m order to allow them lo o"""l'.Y 1hc c)J.Jcc \\ill,in tlw AFRICA. cells (Fig. 7). It was thought Ihat Lb"'" J'ore1gn l;r.d1p,, (Trdh Special Plate.) together with tho cry,tallmo rnati<'l m:iy li:l\c !Jp111 tlu' Ill<' of the fibrosis, as tho c1111ncct11.. lis:.tw, hoth rn d1,ll'llrnl1<;11 BY and format10n, 'v11s very ~uAg1"-,l1vc (Jf changf''-> re<-i11ltn1 1J; tir>rn I, w. snrnox, F. 1\1.B., Cn.D.En., f0L0(,-+~T },T THE SO"CTII AFRICAN INS'fTil:TE FOR MEDICAL RESt:ARCil, ""nc aof dupsnt,cuorcnrounprna,twanndof ptrhooLralcutn<-gr,l, rrActovirhrcy 111ust limhr~o iil;11LcP1J1"'tr"n1'rJ' considcrution, sin re au nnrc..,olvf'd p11t'HJll(J1JLL \\ 1t Ii f )'-,t.JPH'rt JOllANNESBURG. fibrosis is not an nnrornmnn ot'L 1111 ('/ICP amuJJg-.t .")l1 nutn(,., "\\ cirL 1fl!.!; ws .crn kno,n1 for some ~irnc that workers exposed on tho mines in :Suu th "\ frica. ! ' Ji,, '"1't" atmosphere ari,ing from smrn processes 111- C'A"'' III ANn IV (:\o,. 6419 a11<l (J73l). crl i 1i , ii<> prq1aration of ashcstos mate-rials snficr from Consult a lion of the rl'<'Orcls and pre' irnh hhi "'"""al sc ' 1 '"' l"""' ' d1salnltty. 'The mining of the mi1wral itself of matf'l'lal fr01n tl1c ~.trnc mnw lias revcalPcl 1i\o add111i11.1i roh:iJ,iy not a source of dnngcr, ns asbcotos is mined cases, JJoth cf: ,yJi1rh f.-hO\YC'<l luLnr pHC'lllTI(JnI,t. Tl1cre ''d'> \\, ,- \ ,h rn n11 cn qnilrncs. Aft?r :sorting, there remains l1Ule connrclin~ 11'->'->lle 11H1ra"r. lrnL 1110 imu<-,u,tl .-it111 1 111r., c me k \\ hich still coniains fibre in payable quantity. .jirng "f tins 1ock causes a comrderahlo degree of dm,t "li " :me! c-xposnrc to the dmty atmm.phcre is still (Fig. 8) and refraclde <"n,tallm" p;crtif'!c, \\CIC J"'''-Cllt. \,, his!ory rif length of sen He in the llllll \rn:; ul.>iam"d 111tli cit]" r of these ca,cs. ' c--;ag.:;.rateJ in tho cardrng and spinning of asbestos w1111ll .... Further :sincly of th0 gr1l<kn ycll1J\\' hodiPs ,Jio", rl n -iariety of ;liapes, lrnt the rnosl ro111mnn fon11s had 10J111d":l r: !1 Ule <:'Onccrning the pathological chang~s in tho s of l"'r-:nis working with m.hc~tos has hcen found in or club-shnpC'll e]l(lh and a "':mcntcd bD<lv tn1wr11'f!. tJ a finC"ly pomiC'd tail Th0: """" non~rdr:lCtilc to rola. ,;: .I litc1 atnrc, and it 1\"as thought that a record of tho light, snl11l,Jc in oh-011: ari<ls, and, 011 rai,rng lo n Jf'd h<',,,, Will)!;' 'hes might be of interest. turned hlack and l<'"'l"rl to loso tlicn outline. Jn f.C< t'or' i Scpfrmber 2nd, 1926, 1.he medical officer of an asbestos Sontb0rn Rhodesia forwarded to the Sonth African treated "ith hot. rlilnio li:><lroC"hlor ic acirl nnrl potn'"" i f.,rrocyamde th0y gave a w0ll-marked Prn"11rn hi <1' ' Ill tntc 1or Medical Rc:;earch three small :;pccimcns of lung reaction. Xo pi:mrnt <'X<"Ppt th0se structnrcs f!.IYing t];., , a po,f-mortcm case for histological examinat1011. iron reaction co11l<l bo ddedccl m thco scd10n' e:c.alllllH'<I Strong hydrochloric acid, haxing hccn iosfrcl fo1 th" CASE r (No. 9026). prcsenco of iron and found iwgative, was u'cd to d1"oln e 'nli.1ct was a male adult nati.-e, "ho had \Vorked for out iron from fresh soct10ns. After tr<'ntrng the ,,,ci 10,,, e rnonlhs m the nsbestos mill, and, <'<cept for a short d liefnrc his death, had had a good record of health. the hydrochloric acid gaYc a very disti11d r~-d-p111k colo<1< with potassium thiocyanatP, and iho r<'tl-prnk ('lllonr d1'- nme weeks before death he :suffered from acute tuber 'S .rn<l !he post-mortem findings showed milrnry tuher1s involving the lungs, liver, spleen, and pericardium. The appeared on the acldttion of a solution of rnrr"1111" dilori<l" The sections were re-examined and shmy0cl that f\J,, majorit: t of the histological examination was to ascertain if of the golden yellow bodies had hccn <11;,solv<'d oul. [r'ro,,: was any evidence of fihrosis in the lungs which might he these t0sts rt 11as co11clud0d that the stn1cltm, <'ontnin"d tly a'cnbed to the nature of his employment, &mce workers a large pcrc<'ntagc of iron. e mill are PXposed to a very dusty atmosphere. As controls, sections of lungs from a larg<' nmnher of art from the tuberculosis and associated fihrosi~, sec! ions minors on the Rand who had d1<cl from silicosi, a1Hl t11hc1- IO 1nngs showed a certain amount of connecLi ve tissue ~e which had no obvious connexion with the tuherculous culosis w0ro examined. llodif's f>llch :is lwn' hl't'n dcsc1 ihr'd above wen' found in nono of these>, '!<'. 'n It was also found that curious golden yellow structures, with rounded or club-shaped ends (Fig. seg1), llfll' 11 '" i110 Jlruss11111 blue reaction or other iC'st for iron ]"''iii.-" '-':C.<"l'J'i in tho'" l'IDhedded in this fibrous tis5ue, together with very minute, cases where tlw pig1nent \nF ob\"iousl~ n( kHrnatog01101:' ly refractile particles, the latter presumably silica. origin. A :single cas<' of a miner \las also im<",ti:nfrtl; l1l' ,ugl1 the curious segmented bodies were remark"ed upon, had ,rnrkcd for t1n11ty-cight y<'arn 111 ihn h:wmatite rnitH'' crther investigation was carried out. at the time, and the in the North of Englancl, and snhseq]J(lJtly for su10n and formed fibrous t1souo was attributed to the presence of a quarter yC'ars in tli<:" golrl rnims of tlw Hand, 8untl1 Afnra. Tho causo of dPai.h 11:1s cm<"1no1JJ:t of tho gall- CASE II (No. 11016). was not until September 29t.h, 1927, when a portion of bladdl'r. lHacroscopieall,v tho pulmrrnary 10ot gland, ll<'ro enlarged, pigmented, and lil1ro,"'<l. Tho pigllll'Jli, as da1 k from a second case was sent hy the medical officer from ame mill, that the foreign bodies and fibrosis were more 11 rHsi-coJonrccl an cl gave a rnark"rl l'n1"rnll hluo i 0aclwn investigated. This piece of lung was from a male adult with dilute h:drocldoric acid and polassiu111 fri10c:a11idc'. e who had been employed in the mill for a period of two Occasional n1-.t-colo111 ct! suhplc111 nl islets woro ,-isiblo. On " Ahou,t Septemh~r, 1926, Ice was ~dmitted to hospital section the lm1g' showed a sli:l1t diffuse fiJiro,is :111d < !ng frpril pnevmoma, and had a long illness. He was dis ed, and later (Septemlier 19th, 1\127) readmitted in a dying few largo areas of fibrosis. The wholo Jung gave a mnik"d iron reaction. HislologiPal sediom of tlj() largo ar<':1, ~ion. H& was very emaciated, and had the physical signs ilmonarv tuberculosis with fibrosis. At' autbpsy the lungs showed moderately welf drfine<I, but irrrgulady ,JiapPd. firmly 'bound. down by ,adhesionsj the root glands enl.1rged l'llrd, and the lungs on section rard and fibrous with an masses of wdl-formPd nrellular fibrous tissue (Fig. 91 Tho alveolar walls wcr<' slightly tliidrn11cll, anrl ihN<' \Y:l" t leather-like consistence. ~erably enlar~ed. The mesenteric glands were also ' a moderate ckgreP of eornHctive t1ssu1~ incrcac;o rmm<l t ii<' blood vessels and bronchi. A largo c1nnntity of pignw11 t tological secL10ns showed a generalized but moderate degree of a reddish-brown colour was contained in phago< ytic !'di.; >rous thickening of the pleura, trabeculae, and alveolar In additiOn, there was a much more marked fibrosis and lying free in ahcoli, alveolar walls, and bet11rr11 th<' fibres of the newly formed fibrous t1ss1w. The greater p ~ed in irregular-shaped nodules, chiefly related to the vascular systr.m and bronchi. This fihrous tissue was nrt of this pigment gavo tl1e iron reaction. Tn arld1tion, tlH'I" at, the elements arra!lgild in an irregular manner, and j.Jd som'11mallIymphocytic accumulations (Fig. 2). There 'JP resemblance to the orderly, whorled anangemrnt und was another variety of pigincnt, in mHch srnalltr rpwntit:, in the form of crystalli11P n 1 fractilo p:uti"I"' 'J'J10 lattr1' was intimately mixed with tlw iro11-<'<n1tain111,'.2, ~lnst. Tl1h 1definition of the sili,cotic nodule (Fig. 3). Tlrn bronchi lung was especially rxamined. to dd<'l'Wllll', Ji JlOS,dJh'. J ~lie_f~ p tdp f" ds lui gsht t c ecl~frsr"hfaillledclwrni~tghe9p, haa.ngodcymtcadn yp a rotfi,r ltehso. whether the same pC'cnliar lJOdies w<'rc he1ng foi11wcl fron1 n deposit of ferric iron d11't as in tl1e ctm. of an ashcsto-; '~:al Tlo evidcnca ~ Emhedded of in tnbel"culosis or acute tho fibrous ti'8ues, pneumonic conlyinv free in dust which r'ontainl'<l ]){)tlc frrr(l11s an<l f0n 1c 11011. .\ curofnl nn<l ihorout:h "'n1ch "n, 1n:id0, h11L m1 parti, J,,, ' fl!'ie:. 4), anrl contained in ' 1 '''''>'lie cells, tl1Pre wcro ,,us ~r-ilclr1' , ::1 r-. ;1 and 6) n f, \\ ith " ;, ' "'''" ;,1'1111('1' \\<'I" I I !"1~ 10) \I ' 1,;i~'~' I 'if' 1_,Jil ~/ } ' -,. .. ( i < '~" l'UI,!\IONARY ASBESTOSIS IN SOUTH AFRICA. ---- - - - - - - - -~----------------------,-----_.,....__ ponnds contain a large percentage of fo~rqus i~on. ,AnlSi, , "I '"'di 111b t lw Jin dings of Sir Kenneth Gomlby' an<l of four samples of amosite showed 1between' 32 ll\Id 44<p- D1 ( '1!Ill1Jl. 2 111 :iild111on to t11P hmnan lmws showing a'>!Je,,tm,is, Dr. Afri~an Medical cont. of FeO, anrl' eight samples of erocidolite betwe( 16.5 and 40.5 per cent. Up to the present the~ Jias h<X ,\,1\lll:..!Old.ito oi tlH Ho11tlt Jn<-.{d11tn t'o1 H"""" ,.1i has snppli<'<I ''"' \nth tlw lungs of a guinea-pig no examination of post-mortem material f,llOnl cases death among those working in Ill.ills where .th('se i_ninern 11 1111 Ii d1<'<i m DP<'<'lll IJl'I', 1927, frnm <atMs other than n'b'''(o,is. This animal 11as ""IH10td tn an ad><'stos <lu,t ar<' tr<'akd. No such materiaJ has been l!mde a\a1lable. rpentine asb<'stos usually contains _z to Tll .illll<jlhl'rn experimentally. 'l'h l<-11gth of "'l"""rn was two lilli''> day 011 C'a<'h of Ji ft' da\s. Tl"' fir' I ""JlOS\ll e took Chrysot1le or se per cont. of FPO isomorphously replacing magnesia.., a pld1 <' ou l\hrua1y 4Lh, 1925, and the Ja,L on Apnl Lt. ot tlil' .. ,\lll1' yPHJ'. Tlio a-..hP.. t1foJ'ln co111po11nd u,...,,,d for tho {'hr_y~ot11P 1 o11{:1inftl rro111 ilu JlllJlf' in analyAis of Dr. Cooke's case shmn<l 3 per cent. of FeO, ai tho lthodc,irm minPral, accot'ding to Mr. A. L. Hall 2.44 per cent. Dr. J\frCrWJ of tho Grwemment Chemic r'"-]H'l'lllH'lli'-.. ,"H" ;i S"n 1h<'I'll H hod<''"' II t,f lllllgll'a I "'d tott.s sho1\ rl n. sligl1 L l,nhnratory, Jol1an11csbu1g, analystd the l!'cO content rif .t) aslwstoB used hy Ur. M:wrogorddo in his animal .e~pt'I gl'JH'l.tllzed hhro<-ii~ and an llH'f'<"H~P Ill p1gn1Pni 1 but the 1ntf.'n'.... t1ug h.thne ":h ilil' p1<>:-.<'l1<P of tl1e ;olden yellow li>di"' (J<'ig. 11), >.1m1la1 lo th<N' ""'II in thP lungs of a:-,hc~to~i"'. nw11ts, al\(l Appucntly fo1md even .~ wi m th ud1 ver l y o wer srria l p l er p c e : r e c nta ent geage n s amely, 0 of.,~eO .4 .ti golden yellow bodies arc formed in the lungs. ' _' l1arnc1u p11!mo11.lty A <ornpar1HJ1\ bd\\<'<'n the human "a'"' and the <'xperi- With regard to tho unusual struetm:e an<l chemic nature of the golden yellow bo<lies found in the ltw~&t ' "<'llt.d anmrnl shmvcd tl1ut the fibro,is 11.1s morn iapid and '"h"' ,,1c11,nc in the human Lhan in the PX)l<'rmiental lainPd Ly th" d1fficnlty in pulmonary asbPstosis, until many more cases have llf examined and more experimental work has been done ve a 111 ma l. This is readily cxp ,,,d1H111g the tough a,bestos fibre' to a uniformly fino little can be stated. There is no doubt that they are- po11d<'r, and to tho p1cscncc of a !'omparativdy smaU pt oportion of thl' roek dmt which is 11>.ually associated with somo way associated with the asbestos, or, probably, ID4l particularly with the FeO content, either of the as~ w... be~tifonu compound-.;. }i1 or " du~iing " an1nutl-.; a 1i1nitcd itself or of the dust of the mill. This dust contains a mu ;1111011nt of dmt i>. availabh', and of this only a small highe1 percentage of iron, which may be derfred parj prnportion <'ontains partieles of suffieiPntly ,m;1ll dinwnsiol\s to ]WJ mii of their reaching the lnng ah-C'oli. In from the lode from which the asbestos is mined. Three possibilities regarding tho formation of-the gold. Hlil'OSh 1 the size of the majority of the particles' which yellow bodies are worthy of mention: 1l'al'h the ahl'oli ;, lwtwePn 1,, and 3,u, in th" haematite (1) ln the form of a gel, as suggested by Dr. Stua lung, m0ntioned ;ilJOVC', the partiC'IC'-, appear larger, but 1011 hc'1 llltt<'h "rntllc'I' than thp grPatet' mnnh,r of McDonald, (2) As particlf's of ferruginous quartz formed in the lun <' HI'!' tho"<' prPpa1 ed from asbl'stos for '' d11'trng" {'x1wrimcnts. under condit10no; similar tp weathering, or ferrugin4 In till' 1101kmg mill lltl' conditiorn, arc \'('1\ ddt<rent from a,J,,.,to.'> cht.'t atmospliC'rc prnclucC'd C'']>"t:inwntally. Fine quartz cltrrnged in composition as a resnlt of combinuti, with <:orn,titnents of the body fluids. In support of ti .:n du':lt l~ co11it1111011JY 1cad1ing the atrnoiSphrn, and only the it may be mentioned that crncidolite, which is an alk: '"''Y fine parl1de' n11uu11 s11,1w1Hled for any length of Llllle. TJ1e .. e g1adnally i11ct('a.,c 111 r11unb0r., until a n1axinnnn mam more or ll'ss con- silicate with frrrous iron, is especially liable to decomp<r. tion whcn exposed to WPathering. Sodium is remo\ecl, t iron oxidized and hydrated to form limonite, and sili 'Dllc.. ntratwn 1s rC'ad1erl, thcn rc> 'tant cluring \\ orking hour,. 'l'lt11s it \I ill he seen that, set free; tlwre then results a ferruginous quartz wlJj, 1 n onkr io procl11ce changes m C'xpcrimcntal animals showin the' 'amp kngth of tmw, po..,,-;esses the finely fi!Jr011~ structure of the original miner< It is extremely hard, and coloured a rich goklPn )'<'llow. 111:.; the sanw cl<gl'ce of fihrn'1s .111 nln11l'l'hf'l<' approx11nating that of the \1orking mill \\'Ill is possible that a change such as this occurs with the snu lan 1o lie ohtrrlllC'd. quantity of ferrous iron a<;sociated with chrysotile, and :tl 'J'Ji,. amonnt of fibro,is i11 t\1<l of t \10 lrnmau ('.~"'' C'olour of the bodies in the lungs is very suggestivr. i(u,"' r and II) \Ht:. tjl1it dl'fi111tc, am!, if duo to the (3) Phagocytosis of these structures is a very prnmin!i1 i""''"n"~ of a:.h<'dos dn,1, tlw initial rate of lll'o<IL1dion wa;, lH'''ent-cla~ nun-tnfe<tive ,.,ilicosis fratme in the lungs, and it was thought that the action thcso cells may have been responsible, first, for some chan1 '"l"rl 11h<'11 comp.t1<'<l \nth 11t1 th" Hant!. lt 1s diffi"nlt to st.ail' <L ddin1te t1111e for in clwmical composition, then a building up and mouldi 1 It,, J!l'odn< 1.101t of an appr<'< iahl< d<'gl'!'<' of fihrn;.1s 111 pure ls to show into the various shapes f.een. The fihrou'> ti;,sue change in the lungs of the abov 11on-nil11 tlV<' "l"o"'' lrnt JlHHlern oh"'l\atJCm knc rl1at it " 111 the rnighl1oui-l1uocl of kn Y<'ars. In Ca,e 1 nwntioned case;, of workc>rs in asbestos mills is proba~ " n111d1'111kh rnarked filiros1, had tnkcn pl;H'<' aftC'r ollC' y<H' the' result of a reaction <m the parts of the tissues to bgt "! 1101 k m tlw nnll, illlt U1is '"ls ('otnpli<'akd hy tuhC't- the golden yellow bodies and a small quantity of '>ihca. 1, her ' 1ilo'1'. It " known that tit<' rnte nf fihrous t"'1rn pro- Sufficient l'a'<cs of pulmonary asbestosis have not (111111on i ~ '<'l) 111uc h g1 t>at('r 111 du .. t d1~PH',P"i con1plica.trd r<'<'ordcd to ha;,c an opinion upon the liability to secon<lat L: 111\1'< t 1q111..,, hut <'V(n nllo\\ 111g ior 1hi" tlte f'OlllH~etivc infodton by specific inflammatory processes ;,nch a-. tu'* t"'11c 111c """" 111 Cns" r ""'" rapid. ln (';u,(1 II there was culosis, hut it is Vl'ry suggestive that two of th,"e 1ib .i ,rJ!I ll''"' deiinliC' fil>ro'is alt<'r t\\o \l'Hh oi work m 1!11' n11l\ \\ 1il1 no l'\ idPJHe oi inhl'l'l'lllo<...1-.: . ., rccorckl, which havo heen examined histolog1cally, ha' shown tuberculosis eumplicating tho dianges produced. J ll J11r<' tl11, ""' k \1a' ('0111pldPd Jl1'. ('ooke, Stuart jl, llu1111ld, and Oll\'f'\'7 puliJ1,\1<'d ll1cir l"'Jl"I''- dealing \I 1th an a'>hC'stos dust occupation of the lungs. l BPwlcs thC';.c cases there is still further enclence iJ ]J1i!111fi11.11.' ;hlH'....,10--11..,, and p1"' io11s to that a .'-.ho1L aibele favour of tubPrcnlosis hemp; a <'O!llplicating factor. Jf ''" lit<'""" '11li.1r1 I "l'I''"""" 111 1.li! /-c111<d. The ,rnnlat ity D1. H. M. l\111rray rC'pllrted a fat.ii case> in the 1 'har~ l,(t\\1111 1\1c' 1;\'-(' d<'"-i<1ilHcl and 011r-... \\'lh "-ll"'JIPC'ted wh<'n ('ms.~ llos]1dul <ia:cttc m 1900; and in the l'nikd Sta\ tl11 111--1 n1tHlt "Pl)(',ll<'I!, aud 0111 wo1k g~H-.. f;_1r to confiinl of America, from on(' ;,onn'e, 9 during tlw JlC'l'tncl 1907 \ tl11 l111d111g-. .\, 111 1110-1 "'"oi'dtd ltt'I'<', th,, a;,hC'sto8 dust 1914 thero wet o 13 deaths, 3 of wlnch werP from tub$ 1t''l'on ... 1hl" fo1 111<' <11:111/'"' 111 tl1<' Iu11g..., 111 tliPir ul-..l' \\.a..., culosis. ''I: a ':11 1 ,011 I<. \\'IHt ilf'l' 111 IH'\' :1''1,(1 tuna <0111pomHI>. are In 1910 Dr. Colfa10 reported on tho rPlation>hip ( thf (:1p.1lilr ol p1rnli1<111g l!H',<' C'lianp,t'" ii j".i i1n1H>."-'->d1I(' to hHY, asbestos .Jn,t to pulmonary tul)('rc11los1s, and found <l'- 11!11(' .tpp('Hl'- to IH 110 It'( Old of Hll\ <.,111h Uhc'..., in ti'1(' 5 <!Paths from phthis1s had occuncd in five yem s amon~ i1t11:11111( a i-.taff of lrss than forty workers rmployed at a factoJ I 11 1I"' I "11111 ol So111 l1 ,\f1 ;, n' a11d Hl111d,,ia ih<'n' are \\ hc1 o a'hestos is woven. ' "'I""'"' lll<\11\ oliL111Hd 111111!', fro Ill '>01no of' 11 h1d1 l'hqsotile is IH!I tno otlwr 11111rC'~i111g \HJ'i<'ll1'-.; an: fo11nd ~ In conclu,ion, I wish to record my thanks to Dr, Mavrogordat f01 data and material from an experimental ammal: to Di 11a:1wh, 11<HidolttP ;ind <llllo,<:i1t1', 1\1110'--it1 l'i a f'Olllpara- ~11 '"""1Jf d1scovt11, 1\1" 1l1<'111i;.!ty ol 11h11'\1 has 11ot lrvmr, chairman ,J nhannc;burg, for of tho material Miners' Ph!hisis Medical Bure.\! from silicotic cases and from. ~ .. I:. t)('('ll ('(i1Jlpl 1 tpl.) \\01k1'd 011t, 1111! 1t <lfllH':11 ..... to"(' '-'OIHO\\hat, lungs of a haematite miner; io Dr. McCrac fur his analysis t tlw FrO ronicnt of a sample of asbestos; and to Mr. P. Longu1ot ~ Rl!llll.ir to <Tocidolill' Ill <0111po,1t ion. Botl1 tlll.\e com- for ]us valuable a~sistancc in prcparmg the m1rrophotographs. o. j