Document pBL4m6bzmY9ykEd2GvN3kqkwk

FILE NAME: CERAMICS (CER) DATE: 1948 May DOC#: CER040 DOCUMENT DESCRIPTION: Journal Article - Pulmonary Dust Disease INDUSTRIAL MEDICINE The Journal o f In du strial H ealth, O ccupational M edicine a n d Traum atic Surgery Wilk w h ich are co n so lid ated " T h e In d u s tria l D o c to r" a n d " In te rn a tio n a l J o u rn a l o f M edicine a n d S u rg e ry " Thia magazine if published to prom ote sound thought upon and concerning industrial m edicine and traum atic surgery. T o th a t end it will contain articles, news item s, reports, digests, and other presenta tions, together w ith editors' com m ents. T h e editorial policy is to encourage frank discussion. O n this basis contributions ore invited. T he editors will exercise care in checking on the accuracy of data printed hut in all other respects articles and opinions of which expression is allowed are the opinions of their authors -- the editors reserving in all cases the right to com m ent on the same in the current or any subsequent issues as they may he inclined. Volume 17 M A Y 1948 dumber S CONTENTS ALCOHOLISM IN INDUSTRY........................................................................................................................ Scltlon D. Bacon, Ph. D. PULMONARY DUST DISEASE ......................................................................................................................... A. R. Riddell, B.A., M.B., D.P.H. RESULTS OF INFLUENZA VACCINATION IN INDUSTRY DURING THE 1947 EPIDEMIC. . . Anna M. Baetjer, Sc. D. BRUCELLOSIS IN INDUSTRY............................................................................................................................... 1Y Carl F. Jordan, M.D., M.P.H. FRACTURES ABOUT THE ANKLE JO IN T .................................................................................................... 181 B. Bernard Kaye, M. D. CURRENT OFFICIAL INDUSTRIALHYGIENE A CT IV IT IE S................................... 187 J. J. Bloomfield RED BLOOD CELL STIPPLING IN NEGRO W O RK ERS............................................................................. 191 William C. Wileniz, M.D., and Charles Molcsan, M.T. ASSOCIATION NEWS .............................................................................................................................................. 193 Boston Conference; New England Conference: Western Association; Michigan Association: Central States Society COMMENT AND OPINION ................................................................................................................................... >9t> EDITORIAL: "LIGHT WORK" ............................................................................................................................ 198 F. W. Slobe, M.D. NEWS ............................................................................................................................... 4 INDUSTRIAL HEALTH AND DISEASE: SUMMARY OF SARANAC SYMPOSIUM ON THE BERYLLIUM PROBLEM .................................................................................................................. *8 O. A. Sander. M.D. DR. PILGRIM .............................................................................................................. 23 (ADVERTISERS' INDEX .................................................................................................S2> [N o t e : The opinions expressed in the editorials of this Journal are not to be considered as neces sarily representing; the opinions of any associated organizations.] INDUSTRIAL MEDICINE, T he Journal of Industrial Health, Occupational Disease and Traum atic Suyery. Entered as setnod class mall matter August 28, 1941, at the Post Oilier at Chicago, Illinois, under the A e to f March S. 1879. Additional entry at Sheboygan, Wisconsin. Published on the filth of each month by INDUSTRIAL MEDICINE PUBLISHING COMPANY. Chicago (publishers also of INDUSTRIAL NURSING. Issued monthly, and AMERICAN INDUSTRIAL HYGIENE ASSOCIATION QUARTERLY). STEPHEN G. HALOS. President; A. D. CLOUD, Publisher. C. O. SAPPINGTON..M.D.. DR. P.H., Editor-, CHARLES DRUECK. JR.. Secretary and Treasurer, STEPHEN C. HALOS. Advertising and B usinas Manager. Member. Audit Bureau of Circulations. PUBLICATION. EDITORIAL and EXECUTIVE Offices: 605 North Michigan Avenue. Chicago II. C H A N G E O P ADDRESS: FO U R weeks' notice required; changes cannot be m ade w ithout o ld address as well aa new; please furnish postal tone num ber lo r new address tl city requires It. | : ; : i -i i ! , i ( 1 1 j ! |j r . . I j I ; I ; i I 1 Pulmonary Dust Disease A . R. RIDDELL, B.A., M.B., D .P.H . Op in io n s concerning dusts and pulmonary considerable value in the estimate ol disability. disease have changed somewhat during the A review of the symptoms and signs presented i ; last few years. For a considerablebypeGr3io7dpfeorslloonws- with silicosis was recently made. ing 1918 attention was chiefly centered on silica. This offered information which may be usefully Dusts were classified as active or inert according applied. The investigation confirmed the finding as the reaction they occasioned in the lungs re that dyspnea is the commonest symptom and lim- sembled or differed from that produced by silica. ited expansion the commonest sign. It also dis- Although silica is still recognized as the most closed, that of 203 persons with a history of important dust concerned with dust lung in having had night sweats, 117. or approximately jury, it has gradually become apparent that dusts 58',,, had positive sputum. Bacilli were demon other than silica and the silicate asbestos may be strated either at the original examination, or involved in pulmonary disorders. later on follow up. It indicated, that 70, or 80%. A description of silicosis is superfluous at of those with hemoptysis were tuberculous, and present. The disease has received so much atten- that 184, or 75%, of those whose fingers were tion and has been discussed so often that you are clubbed or who had curving of the finger nails, all conversant with its genera) features. You had positive sputum, or were dead when the an- realize that silica dust inhalation, if the quantity alysis was made. of dust inhaled is adequate, may result in lung fibrosis of a special nature. Collagenous nodule formation is characteristic of this process, but its regular deposition may be altered often pro foundly bv accompanying infectious processes, or by admixture of the dusts of other materials with silica. It is general knowledge that silicosis is prone to association with tuberculosis, but the implication may not be so fully appreciated The late DR. GARDNER1 is reported to have ad vanced the opinion that, wren chronic, a com bination of silicosis with tuberculosis constituted a disease quite different from either of the other two contributing conditions. Certainly it is dif ficult to treat. As a rule it gradually progresses in spite of what is attempted, and surgical mea sures are unsatisfactory. This disease may be seriously disabling, although those affected are not always obviously ill. The importance of tuberculosis in conjunction with silicosis is illustrated by information supplied by consideration of the causes of death in a series of 436 silicotics on whom we have rec ords. The persons concerned had been employed in various occupations carrying a silica hazard. A little more than half of them were miners. Pulmonary tuberculosis caused the deaths of 62% of the persons comprising the whole series, and was responsible for 68% in the mining group. It will be realized that for practical purposes, diagnosis in silicosis involves the differentiation of type as well as recognition of the disease. Commonly this is made on the radiographic appearanee a case presents. Cases with clear cut uniform nodulation are interpreted as simple. and those with conglomerate or massive shadowing as complicated. Although this may be a useful working rule in relation to the interpretation of radiograms, there are many exceptions to it. Not infrequently the radiographically simple case will prove to be complicated, and no evidence of an infectious process can be demonstrated in the radiographically complicated, even at autopsy. Compensation complicates the silicosis prob lem With diagnosis so dependent on the inter pretation of radiographic shadowing as is the case at present, it is well to remember that heavy or prominent shadowing in the lung fields or even nodulation, does not necessarily denote fibro sis or silicosis. These appearances, commonlv ascribed to the effects of silica, may be simulated by lung changes related to other conditions than silicosis, in which there is often no fibrosis. When cases presenting such radiographic ap pearance lack a history of dust exposure the situation may not be too difficult, but with such a history they may cause considerable confusion. We have found the more important of these con Estimations of disability are notoriously troublesome in silicotics. It would seem that these are too often based on radiographie ap pearances together with attempted measurements of breathing capacity, and that other useful information is apt to be neglected. In assessing disability* the clinical picture should be viewed as a whole. Careful consideration of the infor mation afforded by the symptomatology and clin ical findings in the individual cases, may be of Present^ * t tite Annual Meeting of th* Michigan Associa tion o r lK O urraiA t P hysicians and SuaotoN S, Lansing. Michi- fusing conditions to be--heart diseases, particu larly mitral stenosis, certain fungus infec tions, benign pneumoconioses, disseminated new growths of the lung, and sometimes pulmonary tuberculosis with a miliary distribution. Aluminum dust employed in the treatment of, or as a prophylactic in silicosis, has received much attention in this regard during the last few years. It is administered in two forms, as finely divided metallic aluminum, and as aluminum hy droxide. The metallic powder is the more im portant agent, and at present many persons are receiving it both here and abroad. Its adminis- t i ' I | ~ ! - ' ' . * * t | ,, I * I i 1 Vol. 17, No. 5 INDUSTRIAL MEDICINE Page 16u tration has not been observed to be attended by injury, neither however, is there convincing evi dence that it has been of objective benefit to silicotics. Nevertheless, many persons receiving, or who have received aluminum for silicosis claim subjective improvement. The status of aluminum as a therapeutic agent has not yet-been determined. It seems to offer possibilities as a prophylactic, but as considerable of many other substances. Which of these is responsible has not yet been determined. In the presence of so much silica, this material can not be absolved, on the other hand rather sim ilar lung damage has been reported from Ger many* in exposures in which aluminum at least figured. Middleton4 also reported a case in Eng land in which exposure to aluminum was asso ciated with lung changes. time is still necessary to establish its usefulness, no laxity in regard to recognized methods of dust control should be countenanced. Early in 1942 an occupational lung disease new to this continent was discovered by DR. c. G. shaver, Superintendent of a sanatorium situ ated near St. Catherines, Ontario. A description of the disease and the circumstances which re vealed it has already been published.2 The de tails need not be repeated. In the process in volving bauxite, aluminum ore is converted to corundum, a hard metal used in the abrasive in dustry. While the process is in operation, the attendant workmen are exposed to dense fumes from the materials being treated. The process is not new. It has been carried on ior upward of 20 years in some of the plants concerned, yet it was not previously known to be injurious. This may be explained on the basis, either that in the past it did not occasion lung injury, or the disease was not recognized because its accompanying signs and symptoms were ascribed to other causes. The latter is the more probable. Early cases are symptom free, the signs, exclusively radiographic, are often so -light that they would be readily missed by one not conversant with the situation and on the .ook out for them. Later cases as characterized attacks of sudden extreme dyspnea and chest pain which have, on occasion, been interpreted as indicating heart disease or pneumonia. The radiographic characteristics of the con dition may be divided into "early" manifesta tions and "well established" disease. The early manifestations are extremely slight. They con'ist of an indefinite granular appearance in the apices with slight rather lace-like shadowing which appears in the sub-apical area and which may extend to the first interspace. As the con dition advances the lace-like shadowing is found extending lower in the lung fields. A further ex tension is accompanied by the loss of the lace like character of the shadowing. Eventually the whole lung field may be occupied by shadowing "hich has a rather granular, or even an irregular nodular appearance. Coincident with the peculiar lung shadowing the diaphragm is generally markedly distorted, and the mediastinum is widened. The "well es tablished" case is characterized by the occurience of spontaneous pneumothoraces, very often bi-lateral. These occurrences are associated with the rather dramatic appearance of desperate nyspnea and severe chest pain. rf ^ ne *ume *s ^he source of this lung damage, it contains considerable quantities of very finely uivided alumina and silica, and small amounts The inhalation of cadmium or cadmium com pounds. either as fume or dust is attended by respiratory damage of a serious nature. In an Ontario exposure 15 workmen from two plants were injured in this way in 1935--two died. Dust is produced when the metal is being ground or polished. Fumes are evolved during welding operations, or when the metal is sub jected to high temperatures by accident, or for the purpose of removing cadmium plate. When small quantities of cadmium are in haled, dryness of the throat, cough, a sense of lestriction in the chest, headache and vomiting are produced. Heavy exposure is followed by severe lung changes, accompanied by marked dyspnea, persistent cough, cyanosis and prostra tion, which may be prolonged. The disease has the characteristics of a chemical pneumonia, and this is confirmed by postmortem findings. Con valescence is apt to be protracted, but they even tually return to work without disability. In one instance radiographs were prepared during the acute illness. In this, the lung fields were seen to be occupied by intense nodular shadowing, closely resembling that to be observed in certain cases of silicosis. Radiographic exam ination of the survivors of the affected was car ried out some years later. In none was there evidence of any permanent lung injury. It was during the war years that beryllium poisoning was drawn to our attention '* Exposure to beryllium or to certain of its compounds is attended in certain individuals by skin troubles. It is also attended by lung disease, often of a serious nature. The disease has special features: Symptoms may develop during exposure, or they may be delayed, perhaps, for months or years after exposure has ceased. Two types of the disease are recognized, an acute type and a de layed. The acute form has characteristics which suggest a chemical pneumonitis. It results from exposure to high concentrations of beryllium compounds. It may be severe and even fatal, but in those who survive, the condition has a tendency to clear. The delayed form appears to have little relation to intensity of exposure. It is more apt to occur where relatively light, but more prolonged exposure has been sustained. A feature of the delayed form is the occurrences of scattered granulomatous areas in the lung tis sue which may undergo organization. In some cases the radiographic appearances closely re semble silicosis, it was therefore thought at one time that the disease might be a modified sili cosis. The etiology is still obscure. While in vestigating this matter, it was dr. Gardner's* opinion that some other factor than beryllium