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FILE NAME State of the Art Literature SAL DATE 1960 DOC SAL069 DOCUMENT DESCRIPTION Encyclopedia Britannica - Pneumoconiosis 1960 A New Survey of Universal Knowledge ENCYCLOP^ DIA, BRITANNICA - Volume 18 : | PLANTS TO RAYMUND OF TRIPOLI HF gaeene * os ~ aaewe BALTIMORE C. jigyp oN . PLAINTIF 'S EXPICTEXPICTEXPICT f PLAINTIF'S PLAINTIF'S 1400128 a ENCYCLOP^ DIA BRITANNICA ENCYCLOP^ DIAENCYCLOP^ DIA . WILLIAM BENTON PUBLISHER INC ~ CHICAGO LONDON : TORONTO LV olay, hee coe wae ue ce AS oi re ca a . ' wo i. , : . Ww te. meee idCe Mea eg tos eo : a) . 2) S. r et . , . . fue, ee lye 2b em i eh ee are Ps etadd ee wee ee tht . ; an . Oe - z uk Je ! 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COPYRIGHT OFFICE - t 1960 PRINTTID IN 1116 U.S. 8 , i: . . ane . - . o Encyclopedia Encyclopedia Encyclopedia VOL.18 PNEUMONOCONIOSIS 99 Arpperppiraseriisnenegnintttluyenced some occurring Infections pulmonary heumonias were different from the bacterial forms establishment of exudate composed chiefly of monocytic cells The mucous membrane of all or of parts of the upper respiratory passage may be de interest in the subject followed the . in inflamed and invaded with mononuclear cells No bacteria are viral pneumonias as a separate entity by H. A. Reimann 1938 unless secondary invasion occurs there are a number of viral pneumonias caused by dif- present in the tissue sulfonamide compounds and strepto- jerent agents _ in epidemic form and others as forms of pneumonia apparently Treatment mycin have no effect on viral diseases They are used if com- bacteria susceptible to their * quiradic cases The epidemic of otherwise mild infections of the the severest cases plications occur caused by pathogenic and terramycin apparently tract called colds grip or pharyngitis The sporadic effects Aureomycin chloramphenicol in others no effect is evi- respiratory resemble the pneumonias of psittacosis or ornithosis but shorten the course in many instances and roentgentherapy are of no value cases the agents causing the latter can be seen microscopically and sance viruses is dent Convalescent serum Oxygen is helpful for cyanosis and dyspnea are by antibiotics their classification as questioned THE OTHER GROUPS OF PNEUMONIAS Confusion in nomenclature of this group of diseases is not sur- occur as to the cause or causes of them had not been Pneumonias of Systemic Pneumonia may since up 1951 The term atypical pneumonia became widely used an integral part of many systemic diseases It may dominate the discovered undesirable since in Cole's view any pneumonia not clinical picture or he a minor factor or not occur at all in tuber- but is the same as typical pneumococcal pneumonia is atypical culosis tularaemia plague undulant fever glanders syphilis chnically furthermore pneumonia is absent in the majority of mild dis- rheumatic fever ascariasis periarteritis nodosa sarcoidosis and and of which most viral pneumonias represent the severest stage many others The pneumonia is usually not characteristic clin- cases broad term viral pneumonia is preferable since all evidence ically and is often obscured by symptoms of disease elsewhere The the final proof of demonstrating a virus indicates that Pathologically it may assume features characteristic of the re- except the cause The name viroid was proposed to in- spective disease The treatment is that of the disease itself viruses are both pneumonic and nonpneumonic forms of the respiratory Pneumonia of Mixed The pneumonias brought clude disease in question about by injury to the lung or interference of their cleansing tract the search for the cause of viral pneumonias about 15 re- process by obstruction of the airways foreign bodies tumours In unrelated viruses had been encountered up to 1951 most failing circulation submersion in or aspiration of fluids trauma lated or to be natural residents of animals used in the after surgical operation shock and many other causes are usually ei which proved that the or causes still were unknown caused by a mixture of various kinds of bacteria which reside Aperiments so other facts cause to a viral cause especially the habitually in the air passages and are enabled to become invasive However all pointed epidemiologic aspects of the disease the absence of special bac- bacteria in the lungs at by the presence of injured tissue Pneumococci influenza bacilli haemolytic streptococci and staphylococci are most frequently im- is in the sputum the absence of any and in which volunteers inhaled filtered plicated The treatment is primarily directed at correcting or opsy experiments exudates from patients with the disease and de- removing the primary cause the use of antibiotic agents according free veloped respiratory tract disease several days later with or with- natural form to the sensitivity of the invading bacteria to the respective agents : and appropriate supportive measures b. gut pneumonia identical with the pneumonic forms begin with symptoms of gradually in- Pneumonia Caused by Noninfective Agents aspira- The severity over several days There is headache dry tion of oil over long periods or in large amounts often causes a Crasing cough slight sore throat sweating and fever which form of chronic reaction commonly called lipoid pneumonia . roxysmal but seldom high a pulse rate often relatively slow Long exposure to roentgen rays may also give rise to a pulmonary Sucht irregular indefinite or absent physical signs of pneumonia which are reaction called irradiation pneumonitis which leads to fibrosis Sucht less than the roentgenographic evidence of The inhalation of certain irritating chemicals and certain gases Strikingly normal or slightly elevated leukocyte count and rate invasion a followed by recovery by lysis used in warfare or for industrial uses or fumes from certain moiten metals may cause forms of pneumonia Allergic pneumonitis or of sedimentation of erythrocytes in 3 small number Loeffler's syndrome apparently represents the hyperergic inflam- and few complications Encephalitis occursThe mortality rate is reaction of sensitized lung tissue to repeated exposure to Pleural effusion is uncommon of patients The few deaths which occur are caused by circulatory matory the specific antigen The treatment of each condition mentioned pee infections and by the presence of other disease under this heading is the removal of the offending agent pee severe Bibliografity I. Cole sicute Pulmonary Infections Delamar a complications incidence of viral pneumonias varies from year to year The increases in number of cases come with epidemic En great codicity codicty codicity Epidemics occur at any season of the year but most codicity in the winter months During the years 1941 to 1944 Ammonly outnumbered all other forms of pneumonia in -2 2 pneumonias - groups and among civilians puntary Thagnosis is made on the epidemiologic aspects the clinical be- the leukocyte count and the absence of the usual bacterial _s our of pneumonia in the sputum Retrospective diagnosis may _s : sided by the ability of the serum to agglutinate erythrocytes day low temperature the agglutinin test after the tenth of disease in % of cases Diagnosis of the pneumonia oe f n of Q fever of psittaccaoussisatainved oafgeonrtnsithoorsitsheis smeardoleogbiyc sation sation of the respective of their activity by appropriate tests The pneu- demonstration - of psittacosis ornithosis Q fever coccidioidomycosis Caremia Caraemia tuberculosis and other known forms may closely re- and must be dif- cable the viral pneumonias of unknown cause available erentiated since specific therapy for some of them is for psittacosis and ornith- Femallin and aureomycin are effective the influenza ba- and streptomycin for pneumonia caused by . as and for tularaemia and tuberculosis characterized by involve Pathologically viral pneumonias arethe larger air tubes and an w. ni the structure of the lung and Lectures 1927 218 918 ; R. Heliron Pneumonia New York London 1919 H. A. Reimann The Purumonias Philadelphia 1948 Pneu- monia 1954 11. A. Rs PNEUMONOCONIOSIS also called pneumoconiosis a term denoting a variety of industrial diseases of the lung em- bracing lung response to any type of respirable hazard Precise definition of the term is a matter of legal consequence Hecause occupational chest diseases are among the must litigious o^> medicolegal issues In several countries many of these conditions obligatorily are compensable To more than 3.000 naturally oc curring minerals presenting respiratory hazard are added yearly number of synthetic chemical agents The an increasing biological action of less than % of these substances is known yet about % of working persons handle such agents While pneumonoconiosis is a generic term silicosis has for many years been its chief specific manifestation Because of the increasing range of dangerous respirable agents however emphasis is shifting from silicosis to other forms of pneumonoconiuses The majority of the significant reactions represent insidiously progres- sive chronic responses frequently with a distinct latent period during which the workman is symptom Fulminating cases also occur when exposure has been unduly severe or adjuvant factors play a part A simplified etiological classification of the main varieties of pneumanoconioses is given in the table PNEUMOTHORAX- ( , ~ Pneumonoconioses variably disabling to lethal syndromes Symptoms are determined hd Siliceous Nonsiliceous by the focus of major lung injury combinations of lesions severity and rate of exposure and infective or other complications Free CrCysrtyalslitnaelliCnreystalline Crystalline proper Mining GClearsasmiincdsustry Abrasives Samiblasting Foundry F.tc. Carbonaceous Emphysema } .coal Anthracosis ey. .coal mipers mipers Graphitous .....,--. graphite bmoog lung ....0----- carbon and chemicals Metalogenic Metallogenic .iron . tin Dominant states include bronchitis bronchiolitis bronchiectasis emphysema pulmonary fibrosis and pulmonary hypertension The main complications which also determine the mode of lethal outcome in most instances are cor pulmonale with congestive cardiac failure tuberculosis pneumonia pulmonary insufficiency hemorrhage lung gangrene and erosion of a blood vessel a Aberrant silicosis Todimytosis Cristobalitosia Amorphous Natural Diatornaters calcinedfi Synthetic calcinedfi Aluminosist . Berylliosis Cadmiosus -- .aluminum .. beryllium ..cadmium Vanadosis . -. vanadium vanadium Thioconxus ....446.- sulfur bronchus or the esophagus Remote lesions may also occur e.g. portal artery obstruction metastatic tuberculosis and liver kidney or suprarenal failure Respiratory tract cancer is closely as- sociated with exposures to monochromates asbestos beryllium nickel arsenic and radioactive particles Submicron 4,000 & Silicates 50 Masseral Asbestosis . Talcosis Micatosis Kalimuris Plumboconiosis lead Wekler's lunst ima + ozone or nitrogen dioxide Brass foundry lung copper + unc Diagnosis and Treatment diagnosis depends largely on radiography but so eclectic and diversified are the manifestations of the pneumonoconioses that interpretation of the rays requires great skill and experience Advanced physiological studies have contributed greatly to understanding of the associated dis- Fuller's eartht Artificial Cementosis Glass woolt ability Final diagnosis however often must await histopathological and petrographic confirmation Once established the majority of the severe pneumonoconioses Mixed forins Disease in Bauxite extracor Granite polishersfi Slate worker Boiler sealers Kiln liners Hasir slag workers Hematite mbiers Silo 6ller's lung Wheat handier's lungi dioxide nitrogen dioxide are irreversible Some syndromes may become arrested on cessation of exposure but others such as silicosis and asbestosis progress inexorably Therapy is directed at the alleviation of symp toms such as pain or bronchospasm support of the failing heart and treatment of complicating infection Apart from dust sup- Magnetite miners Kolar gold numers Insulation workers Transite pipe workers Miscellaneous Oleogranuloma .. oil mists Fume injury .nitric acid etc. injury .bydrogen duoride etc. Chemical pneumonitis pneumonitis ino rganic organic and lethal Disputed entities y, Disabling History lung diseases have been known for the past 2,000 years and were discussed by among others Hippocrates and Pliny Potters rot of ceramic workers grinders rot of steel implement sharpeners and coal miners asthma evolved as products of the Industrial Revolution But this group of disorders first assumed major importance when at the turn of the 20th century thousands of gold miners in South Africa began to die from miners phthisis Since that time research and the introduction of rigorous environmental hygiene measures have brought about control over these diseases , In modern industries dust hazards have been virtually eliminated by advance engineering planning Employees in controiled plants can anticipate trouble working periods of 30 to 40 years in spite of processing highly dangerous substances Pneumonoconiosis arises in such industries in exceptional cases pression adequate ventilation and the use of exhaust equipment the only effective prophylactic agent against silicosis is inhaled aluminum administered in the form of aerosols of aluminum oxide hydroxide or hydroxychloride Good results have been achieved in cases of berylliosis by means of the chelating agent aurin tricarboxylic acid or by cortisone No specific therapy is available for other pneumonoconioses See also Dancerous THADes Dust Industrial Medicine G. W. H. S. PNEUMOTHORAX The chest is divided into two airtight compartments by the mediastinum A thin membrane called the pleura see Collom and Serous MembranES covers each lung and is reflected at the root of the lung to form the lining of the inner surface of the chest wall Normally the visceral pleura covering the lung is in contact with the parietal pleura cov- ering the inner surface of the thorax and the potential space between them is spoken of as the pleural space A pneumothorar exists if the two layers of pleura are separated by air and the lung collapses away from the chest wall Air may be introduced into the pleural space as the result of trauma by spontaneous rupture of the visceral pleura or by means of a needle inserted through the chest wall unly The explanation usually is either extreme individual susceptibility predisposing disease such as tuberculosis accidental excessive exposures hazardous technical innovations or the potentiating effects of exposure to several different substances The pneumoniconiuses have in a few instances affected nonworking persons Police officers housewives and school children have contracted buryiliosis from the inhalation of smokestack effluvia dust from soiled working clothes or Auorescent lamp phosphors The lung injury caused by city smog results from the action of chemical agents adsorbed onto carbon particles emanating in industrial operations The catastrophic deaths at Donora Pa Traumatic Pneumothorax the lung is an elastic organ and tends to be pulled toward the lung root the pressure in the pleural space is less than atmospheric averaging minus five oe centimetres of water This means that air under atmospheric pressure will be sucked into the pleural space if the visceral pleura is tom e.g. by a fractured rib or if an open wound in the chest wall penetrates the parietal pleura If sucking wound of the chest wall exists more air may be pulled into the pleural cavity via the wound than is pulled into the lung via the larynx with the result that the collapsed lung and mediastinum are pushed toward the healthy side on inspiration and away from it on expiration 1946 the Meuse valley in Belgium 1949 and in London 1953 illustrate the disastrous potential of industrial waste products im- This paradoxical motion of the lung and mediastinum causes progressive asphyxia unless the wound is closed moderately disseminated into the air of cities | Theories of the causation of pneumonoconiosis in- Spontaneous Pneumothorax sudden collapse of the lung without previous trauma is termed spontaneous pneumo- clude tissue injury by mechanical trauma protoplasmic poisoning metabolic changes in cells through a disturbance of pH protein denaturing through piezoelectric and surface molecular forces immune and antibody reactions polymerization and the non- thorax and is usually associated with severe chest pain and difficulty in breathing Most cases occur in apparently healthy persons Because spontaneous pneumothorax may occur as a complication of pulmonary tuberculosis it was assumed for years specific action of submicron particles No single explanation is that almost all cases were due to tuberculosis This is not true universally acceptable The pathogenic propensity of a number of specifte agents has been proved by experimental reproduction of In 1932 H. Kiaergaard suggested that emphysematous blebs in the pleural surface of the lung were the common cause of spon- pathognomonic lesions in animals caneous pneumothorax and this concept was later confirmed Pneumonoconioses range from innocuous through Superficial blebs on the pleural surface are weakened areas of pli in 880426 880426 880426 880426 880426 isi 880426 9~ 9~ 9~ 9~ 9~ C3 qu tier thi tor ... ... ... 8 fac of at IT by wh str Lin ter Pn ica me -- tio 13