Document qkqKpZ06jaM61520zd2Rp0dn5

394 0. A. SANDER patient should be examined with sufficient frequency and detail to detfs|g|| exact status of the disease. The type of routine x-ray examination used will be a major factofji mining the cost of the program to the medical department. Most roentgen? fed that the standard 14 X 17-inch film is necessary for definite dm However, as a screening procedure, several less expensive films are a-vS Paper film is sometimes substituted for ordinary transparent film. RoeMS grams of this type usually show too little detail.to be satisfactory eye screening process. Roentgenograms of the 35-mm., or 4 X 5-inch, sizetilfi insufficient detail to be dependable in the dusty trades and are not recdim by the author. Only 14 X 17-inch films of the very best quality` fee should be insisted upon for the periodic observation of employees : in-xb m trades. Stereoscopic and lateral films are not necessary as a routine, bu'6 very useful at times when a differential diagnosis becomes necessary. iii| The decision as to whether or not a workman should continue attjffl (either on a new job or for his old employer) is a serious responsibrlifc^fe examining physician. He not only must have a thorough understandingi-oTsco ing conditions in the particular occupation and plant of the worker .uirSWc sideration, but also an appreciation of public health and moral responsilm the individual worker, to his associates, and to the employer. ''ilW It unfortunately iB true that most physicians who have had little'Snfff' with such matters tend to think first of separating a worker frombnl|lj usually so advise him.-Inatead..oLprevenfcing-di8abilltvT-9ucirill-corr?ndPr;ri,lt~Llfe[ frequently leads to marked shortness of breath based on fear. UnlesS a `uiii-lforcjj active tuberculosis, he should be kept at his regular jobs and everj^i?cffofSS to reduce his dust intake to a minimum. He should be assured that his lvngiclraiy will not progress to a dangerous stage with the improved dust coiii author's experience,72 fear caused by well-meant but exaggerated adviee^aMiTOl more disability than the lung lesion itself. -To many workers, an unexpliliiMrSli nosis of silicosis or asbestosis is just as serious as is a diagnosis of cancqry^yyififfi' workers will be saved from a state of semi-invalidism by reassUranW^ipY misra than will be benefited by pessimism and too early removal fronfe.tl^^S c. Aluminum Prophylaxis and Therapy. The use of a1uminuniwlo vention of silicosis^waa first.reported-bv-JDennvy-Robson--and-tTfngrfeiSinfti uqft -------- o--------- ------- -associates. Since;that! time considerable attention has been focused nh_almj7]pinii and its compounds both in laboratories and in clinics. Tabershaw and Tebbens74 summarized the Drinciple8.-thatAastaAdvoli-fellfBm... labdratbiw~wOTk^Tr-both^rTely~diviaFd metallic aluminum and amdffiTi^sUm 0. A.. Sander, Rehabilitation of persona with pulmonary dust dieciwH and Occupational Med., 4, 541-54S (December, 1951). nJ. J. Denny, W. D. Robson, and D. A. Irwin, Can. Med. Assoc. J,, 213 (1939). ' '*1. R. Tabershaw and B. D. Tebbens, J. Ind. Med., 14, 709 (1945). Ufa 19&7/K \W PULMONARY DUST DISEASES 395 Igijipa as follows: If alumina and silica localize in the same phagocytic ?0f the silica is neutralized. Further progression of the tissue reaction |tgtii)$l*lly produced by silica is then arrested. Mature silicotic nodules ^S^^ajic,, and immature lesions (inflammatory and early fibrous changes) n&jffijjjDbre'l'. Aluminum may remain in the tissue and protect the individual for a cjjffjpspenori--over a year. Aluminum does not ordinarily produce toxic effects in Hpij^a^K\i-.nlthough it appears to increase the susceptibility of experimental g^fj^SisHo^tuborculosis when large doses are given. S^T;p`"IsiQnal allergy to aluminum has been reported,76 but this is apparently ^rjjjffcurrence. Denny, Robson, and Irwin have preferred to use metallic ' 1 1 -J -- wa mnwn f(.11BfUBc u* aiuuuuuui `-j ----------------------- ------ F^Snnlie?' only metallic aluminum available. Some investigators, notably ave reported marked success in the treatment of patients with severe when purely objective criteria have been used to measure *g^ra'lnw!VtJ.le results have been somewhat less striking. For example, in a con- jr?;1? .'.'jsriment by Berry,77 9 out of 35 silicotics were treated only with in- ffiatHii^d^room air, but they thought they were getting the same inhalations of fp5i^m^fdu'<t!as were the other 26 silicotics. AH of the 35 had similar degrees of 3fjp3siirl[<aiiailar symptoms referable to it. An impressive degree of subjective u.lV---------------- m^vcn'ieiiV'with any form of therapy. JSH^wwl'of'the controversial aspects of both the prophylactic and therapeutic lp)f?a|jn'ni'num in silicosis, the Council on Industrial Health78 of the American TSdi&kA'-;ioc|ption issued the following statement in 1946: jBnj^hwhyli'ruination of reports on the effects of aluminum ,p6,w,der in the prevention and C'ftjjicirtjpfmilvcbsis has aroused widespread interest and a demand for an authoritative state- Rvalue. At the present time the following statement would seem to be warfjsct,-however, to such modification as future knowledge and experience may alwu^egnenrSerital animals the prophylactic use of aluminum inhibits-the Toxic action of CShdijelvlpuresauartz. an)Industrial dust exposures often involve mixtures of various minerals in addi- jjHoiiftiart|Lnd other environmental variables to which experimental animals are. not sub^hpp;fiii eijiliiirp^ BlliQ.oaig. usually develops more slowly and is often modified in type. ^j^Jongi^Wrtbtoed^bseiwattonf^tH^'dequate-eofftrbPeasesr-wiif-demonstratdjiwHethec- presuits obtained with animals are applicable to man. lflr`7.7nd. Hyg. Toxicol., 26, 7 (1944). Ipannon, Trans. Can. Inst. Mining Met., 48, 180 (1944). jr^; Aluminum therapy in silicosis, Am. Rev. Tuber., 57, 557-573 (June, 1948), jEjuil^^Industrial Health, Aluminum in the prevention and treatments of silicosis, " 1223 (APriI 27> I948)- f mm