Document rBgXxevxe0JnQqpbQmR07gqjJ

FILE NAME: Hercules Chemical (HERC) DATE: 1941 DOC#: HERC008 DOCUMENT DESCRIPTION: Book Excerpt from Occupational Diseases - Asbestosis OCCUPATIONAL DISEASES DIAGNOSIS, MEDICOLEGAL ASPECTS and TREATMENT By RUTHERFORD T. JOHNSTONE, A.B., M.D. Director of the Department of Occupational Diseases, Golden State Hospital, Los Angeles, California; Formerly Assistant Professor of Medicine, University of Pittsburgh School of Medicine ILLUSTRATED PHILADELPHIA AND LONDON W. B. SAUNDERS COMPANY 1941 CHAPTER XXVIII ASBESTOSIS The health hazard of asbestos dust has been recognized only re centIlny.England, over a number of years, up to 1Ti t. there were only forty-one deaths from asbcstosis. There were twenty-six deaths from asbcAsstoslaist,e waisthFseiblircuoasrisy., 1927, the. first claim for compensation due Ltoanazad'isarebpiloitrytedfrotmhatthitshedisfeilaesse owf asthefileMd eitnroMpoalsitsaanchuLsifeettsI.nIsnura1n0c3e6 Caboomupta1n0y,0r0e0vepaelresdonosnleyxpnoinseedteetno caassbeess.toHse inesttihmisatceodunthtrayt. thIteiceanwebiec sheaernmftuhlatmtihniesrails dsmusatlsl iinn mcoimninpgariasnodn tiond5u0s0tr,0y00mwthoerkeUrsniteexdpoSsetadtetso. TheOmccourepaptiroonmailnHenatzahradzsa.--rdsAasbreesotoffseriesda ihnymdriantiendg m(easgpneecsiiaullmy scihlircyastoe. blietestoins mCaatntraedsase),s,hmanadnluinfagctaunridngcroufshininsuglactiround,ethaesbceasrtdoisn,gmaankdinwgeaavs ing SoifgfnisneaansdbesStyoms,patonmd si.n--cBerrtiatiisnhphinavseesstiogfattohres aufeteolmtohbailte tihnedussitgrnys. aAnmdersiycmanptionmvesstaigreatomrsorebelsieevveerethienyasabrecstmosilidsert.haAns iinn ssiilliiccoossiiss,, bthuet first sign is that of dyspnea, the cough is usually dry, and auscultation raebvlee,altshefewco,loifr aisnyp,alpe,hyasnidcaclysaingonssi.sLisosas foafirlwyeiegahrltyissigunsu. aAllfyternostoimcee atitmede,afnindel,accrkasckthliengrorbaulesst cmhaayrabceterhenaortdic,eadndintshieliccohsiess.tEaaprplyeaarssbcesmtoasciis menut,stthbee sdyimffeprteonmtisatmedayfrtoamkeacountetheemcphhayrasecmtear.oIffthtuisbedricsuelaossei,sbiustprthesis comPpaltihcaotlioogny.isPfualrmloenssarfyreCquheanntgetsh.a--nAicncosrildicinogsist.o Stewart, as quoted bacyteAr,ueprebraibcrho,2ncthhiealpualnmdonbaasryal fiinbrolsoicsatoifona,sbicnstcoosinstriasstdiftfousseiliicnoscishairn which the fibrosis is nodular in character and present in the uppci pait oalfltphoertliuonngss.oAf sthtehelupnrgocteissssuceo. nBtirnounecsh,iothleectfaibsirsosaisndexbtreonndcshiinetcotaasilsmaorsct pmroenseiantawndithaincutthee trsaucbhsetaonbcroenocfhitthise ofifbteronidcaaureseas,thaenddebartohncohfoptnheesue 3+8 A S liE H T O S rs 349 apnadheandteh.erIehnet Ipnleusoramee, eeasspeescitahlleypilneurthael sbaacsaisl croemgipolnest,elayreobtlhiitcekraetneedd; uino-o7th0e).rs a fibrous or serous exudate may be present within it (vPig&s asbeAsctotisonanod/ Aqsubaerstztossialincad iSnilitchae.--ir 1Tmhoededifofefreancctieonbehtwaseecnaucsherdysocotinle- Pi. G<;-Photomieroruphs of asbestosis bo.li.s round in sputum. Pnlareed 530 Umes except lor K, winch is enlared 310 times. A wale ruled in units ot 50 , has been drawn beside eaeli asbestos body. (U. S. Public Health Service, Bulletin % l.) lsatdrlcyr,abalte thspeecSualraatnioanc aLsabwoerlaltoarsy,exhpaesricmarernietadtioonn. iGntaerndsniveer3sptuadrtyicuof cthheesmeictawloinmnaattuerriea,lst.heliaectifoeenlsofthaasbteswtohsileis tmheecahcatniiocnal.oHf efresetatseisli:Ja is 350 OCCUPATTONAI, D[SICARICR lobarFipfl-eu(r7a..--DReignshet fluibiirfoi.usshtoawgsingovmerareknetdirley stuhricfakceen.ed(Up.leSu.raPuwbiltihc Hfuesiaolnth oSferinvitceer Bulletin Hl/l.) ' 352 OCCUPATIONAL DISKASICS thaFt oirnhtahleedlaasstbyeesatorsofribtrweso awree hirarviteatbineegnncootmbinecgautosethtehecyonacrlcussiiolni cthaeteslimbpu'st. bUenclaiuksee ththeeyfreaercsilsitciaffs, fitbhreesse wmhiincehralms ewchilalnincoatllystiimrruitlaattee fIitbrwobaslasitnsfeinrreadnythpaartt tohfesthee obrogdayn;sownleyrethoafsfeecintedthebelucnaugssearteheaffmecotevde. mtheonsets ooffortehseprirvatiisocneraa.reThseonmitucwhasmdoirsecorvaepriedd atnhdatcoifntaisnbueosutoss thwaans glernogutnhd tvheeryirfriintealtyingso pthroapt efretwy ooff ththee fiabsrbeesstwoesrewlaosngperracthtiacnall2y /xdien shtarvoeyendo. wInbheaelnaticoonntienxupeedrimfoerntthsrewe ityheasrus.chNofinfeibrcohsrisyshoatisledeavsebleospteods imnilslpiointepoafrttihcelesfapcetrtchuabticanfoaovteorafgaeirahtmasobspeehnermicacinotnacinenedtr.aItinoncoonftr1a2s5t Ithwisouclodncpeonitnrtatoiount tohfatloinngafipbrreeviaosubselsytorsepdoursttedpreoxdpuecreimd ewntellonme-atrhkierdd fibroIfsisthaefteefrfeacbtoouft atwsboesytoesarsw. ere chemical, one would expect that a dlaercgreeapseartiinclessizehavweoullidttleacecfefleecrta,tebuttissause threesirposnizsee. dWecirtehasefrseecelsliulilcaar rmeaacytieonnsubee.cWomitehs fimbroorues vaisgboersotuoss tahned reevveernsecoisntsrtuiteu.tional sym_ptoms juryT.hEevhenistuonlodgeyr tohfeemarolyst aesxbtereslmoseiscodnodeistionnost tshuagtgecsatnabechcermeaicteadl ibny ainrtfiiflitcraiatiloinnjeocftiloenuctohceyrteesisansoopcrceulirms iwnaitrhy phihgahsecoofnctiesnsutreatnioencrsosoifs wveirthy fiinnearqeuasartwzh. eTrehethceonansbeecstitvoes tfiisbsruees acreellscamuegrhetlyinmtuhletipblyiouvcehryiolstlso.wAlys ctioslsluaeg.enInfoermxpserainmdenctoanl traancitms,altsh,eatairleasspta,cethsisarechoanbglieterisatendotbay pscioa-r gthreessrievsepoonnsee atfoterqucaerstsza.tiPonerhoafpesxptohseurreeatsoonthies dthuestdaespoissitthioencoafsethine peculiar iron-containing coating on the surface of the inhaled fibies giviFnginarlilsye ittoisthmeocsthasruagcgteesrtiisvtiec th"aastbaemstoonsigs dboozdeiness."of different silicate mthienyeraarles ofinblryoutsheinfisvterukcntuorwe,nsahsoualsdbebsetocso, mwmhiocnhlyarreecuonginqiuzeedbaescapuusle mgroonuapryisirgrrietaantetrs. tThahne tvhaaritatbioetnweinenchtehmemicaalncdommpaonsyitioonthewritshiilnicattheiss. fIinbrfoaucst scihlircyastoet,ileserapsebnetsitnoes, hwahsicthheissapmheysciohleomgiiccaalllyforinmeurtl.a Oasbvaioluiosnlyirritation would seem to be associated with the physical, rather than the Ochneempiocainltcoofmpproascittiiocnalosfigthneifsiecamncienemraalsy. be indicated by these ob servations; namely, that very finely ground asbestos is not dangerous. A SB E ST O SIS 353 TknhoiswcnonthcalutsaiotnthlieasTshueptpfoorrdt imniclllsintihcaelreobwsaesrvnaotiocnli,nifcoarl iatslbiaesstloosnigs ebveeenn wthaosugehxtrinemfoerlymelirney.eaTrshethfeacattmthoaspt hfearberiwcaatsiovneroyf dfuibsrteys aonfdththee sdaumset zmliinngerfaelaitnurAesmoefricthanis pdliasnetassec.ouBldutptrhoedsueceexdpieseriamseenwtsasooffneer oaf pthlaeuspiublze eexxtprleamnaetliyons.hTorhte efhinreysdoutislet inlibtrhees; mthillast isincothmeposspeidnnoinfgsearpnedntwineeavainndg mills contains many more long fibres. Microscopic Appearance.--In the early phases of the disease there is a thickening of the alveolar septa as a result of fibroblastic prolifera tpiroong.rTeshseionalvoefotlhaer sdpisaecaesse,cofinbtraoisnisnbuemcoemroeuss malovreeolmararpkheadg,otchyeteasl.vWeoiltahr fsitbrruocutusretisgsuraed. uTalhley fdeiwsaprpeemaarsin, inangdalivneoitlsi pwlhaciceh thlieereinisthneowaredaensoef gfilbarnoduuslatrisaspupeeaarraenclien.ed by a low cuboidal epithelium and have a Scattered throughout the lung in both the diseased and healthy pknaortws naraes sapsbinedslteo-ssihsabpoeddiesst.ruTchteusreesbo(dfiiersst adreescsrleibnedderbiyn MtheciDrocneanltde)r and bulbous at each extremity. Many are arranged like strings of gradx-uRataeyd Fbienaddisngwsi.t--h Ctheertalainrgedsitstaintctthepeecnudliaorfittihees cehxaisint .here as con turnaisltaetderatol. sAilicccoosirsd.inIng atsobetshtoesies,xptheerielenscieonosfmPaeynbdeerbgirlaastse,r4althoer larorgeenlty goerntowloogtihcairldfsinodfintghse ilnunagsbfeiesltdoss,iswahriele lianrgseilliycolsiims ittheed utopptehreploorwtieornhsaolff wthiell lruenvgesalarleesaslesnoedinvvoelnvteilda.tiIonnmoofdtehreatelulyngadfivealdnsc,edtheasbpeasrtioestaisl, parl-eruaryas Tishtehivcaksecnuelda,r asnhdadtohwerseloisseat"hgerirouinddegnltaitsys." Napopdeualaratinocne itsoatbhseenpt.icPtuerne. duenrrgerliaasbslefeealnsdththaat tathroeenctognedniotiloongicmalusdtiabgenomsisodoefraetaerllyy oarsbmesatrokseisdliys advanced to make a differential diagnosis from the roentgenograms. asbeMsteodsiicsoliesgoanl Athsepeacvtse.r--agIet firsofmeltsethvaent tthoentiinmeeyneeacrsessinaray ftoairdlyevheiloghp cyoeanrcse.ntTrahteioanl.loWwiatbhlea cleosnscseenvterraeticoonncisen1tr0a,0ti0o0n,0,0f0romparftiifcteleesn tpoertwceunbtiyc foot of air, of a size between 0.5 and 5 p. Once established, the disease is progressive, even after the cessation o``Sf ielixcpoosissu."re. The basis for diagnosis is similar to that stated under 354 OCCUPATIONAL DISEASES Treatment.--This follows "The Inert Dusts. ' REFERENCES 1. Lonza. A. J.: "Asbcstosis." JAMA., 106: 388 (Feb.). 1930. 2. Auerbach, O.: "Pathology of Asbestosis,'' Indust. Med., 6: 318 (Jan.), 1937. 3. Gardner. L. U.: "Recent Developments in Relation to Silicosis, lndu.it. Med.. !). 45 (Feb.). 1940. 4. Pendergrass, E. P.: Silicosis and Asbestos: Oxford University Press, New York, 1938.