Document rpLKnOMZb2RB23ppwXgvmO5Rq

FILE NAME: Asbestos Cement Pipe and Sheet (ACPS) DATE: 1941 DOC#: ACPS001 DOCUMENT DESCRIPTION: Published Article - A Case of Asbestosis Pulmonum? - Norwegian Medicine NORWEGIAN MEDICINE Volume 12. 19.41. IV Helsingfors 1941. Mercators Printing A CASE OF ASBESTOSIS PULMONUM? By E.H. Scfliotz In conjunction with the demonstration of the head doctor Schrumpf, I shall mention the case we dealt with in factory supervision. A 61 year old cement mixer visited a doctor in August of 19.38 due to coughing and difficulty in breathing. Tuberculosis bacilla were indicated in his expectorate, and later he reported in sick. An x-ray was taken for the first time in March of 1939.. It, showed disseminated condensations in both lung fields and parenchyma condensation from a previous date with shrinkage in the upper right. "Silicosis tuberculosis" was first diagnosed by the x-ray technician, but this was ruled out later. The case was announced by the Federal Insurance Office to the Oslo Labor Committee, and in May 1939 I undertook an inspec tion of the plant where the concerned party had worked for about 25 years. It turned out that he had not worked with conventional cement, but so-called "acid-resistant cement". This consisted of about 72% ground iron slag, about 15% asbestos and about 13% litharge = PbO. Cln this connection, I can mention that in 19,30, lead poisoning was indicated in all the workers in this plant-- a total of 5-- and one of them died from it). The work with mixing of the aforementioned mixtures went on until 1931, done with hand shoveling with a great deal of dust development, but later it was done in an enclosed machine. 2 I attempted to show asbestos bodies in the patient's expectorate, but with negative results. This is due to an incomplete technique, but it is worthy of note that according to American experiences they were successful in showing asbestos bodies in only half of the patients with x-ray indicated lung asbestosis. In the case of one worker with tuberculosis who for a series of years had been subjected to the inhalation of dust, which among other things contained asbestos, the x-ray technician described a picture which was reminiscent of silico-tuberculosis. In order to bring more clarity into the diagnosis, the picture was sent to Germany's foremost x-ray technician in the area of asbestosis-- professor Saupe in Dresden-- and his observations of May 20 19.3a'can be summarized as follows: "I assume that slight asbestos changes exist which with regard to stage classification could belong to stage I, possibly on the boundary of state II. However may I say that the picture is not completely typical. Generally, in the case of asbestosis, one sees somewhat more tightly meshed network designs "and very fine spots embedded more in a small veil". Whether it includes a slightly silicotic component is difficult to say....Changes in the upper right top are already too large to pass as asbestosis, and I am assuming that older tubercular changes exist here." At the request of the Insurance Office, the patient was examined by an internist in July 1939 who stated the following: "He acted weak and flaccid, became short of breath under strain and complained of dyspnea and weakness in the knees. There is 3 cm difference between the deepest breathing in and breathing out. Over both upper parts-- especially the right upper part-- there 3 is slight muffling with a large number of medium sized, non resounding blisters, with lengthened respiration sounds. The x-ray diagnosis was silicosis, stage II. On the basis of the physicians' explanation he was declared 100% disabled by the Federal Insurance Office. His condition was found unchanged in a renewed study. His body weight was the same. Moreover he has full compensation. The quantitatively most important component in the acidfast cement is, as mentioned, iron slag, and the question remains if this dust can have played some etiological role in his sickness. The slag contains about 55% silica, but it is bound as silicate in connection with Ca and Al. Free Si02 is not present. Of the silicates, up to now it has been only asbestos and sericite which has been shown with certainty to cause pneumokoniosis. How safe Ca-silicate is, is clear from the studies of cement workers. Usually cement contains about 20% Silicate, but despite this cement workers never get silicosis. The silica is bound as Ca-silicates. An x-ray study of about 2300 cement workers in the United States unveiled only 8 cases of pneumokoniosis, but all 8 of these workers had earlier been subjected to the inhalation of free SiC>2 . As far as iron slag is concerned, mineralogy Professor Tom Barth stresses that these dust particles are much more sharp edged than conventional rock dust, and it is possible that this fact could have played a role. 4 Taking the professional anamnesis and the x-ray description into account, I am assuming here that we are dealing with a new atypical lung asbestosis combined with tuberculosis. To what extent a silicatosis of another origin can be involved cannot be stated here. If silicosis does not exist, he has not been subjected here to the inhalation of free silicic acid. I certify that the staff member who translated the ; foregoing is thoroughly familiar with th- and English languages and that it is a true and cdoomcupmleetnet.translation of the ,co LangDuuapgoentbeCrivrciclee Bouurieldaiun,g I* Washington, D.C. 2003$  $s R D I S D I 0 I BIND 12 1941 IV !Ik'1. lki;" H E L S I N G F O R S 1941. MERC ATOR S T R Y C K E R I i! f ,* . ' ' -- :s;ji9 F. H. Schiotz: Et tilfelle av asbestosis pulmonum? I tilshitning til overlege SciiiasiiTS deinoustrasjun skal nasinbge,stovisle jekgomanbtianeartt dmeet dhetrubfeorrkeulilgogseer. enHnvooervaitdytpFenk sluilnikgae- tose av nnnen opjiriimelse kail konirne pA tale, skal viere jteiKgyfnAeto.nitFanlc (ielt Atirlfgealliennvieil luseirnileiantttblbaeiufaletnr insugkmteedleigefaaburgikiiks-t' 1938 pA grutm av hoste og tung pust. Det ble pavlst tuberkel uiisuastgiti.itlinSgiliakvosefrifokrieslcilgsgyerer. ikke, han liar ikke vairt ntsatt for bHaosniltlgeerniobgaranms ebklsepefokrtsotratta,ttogmbaarus hUaKrWs;endeertelevxvirsttesydkiisnsAcmiit-. Vdo2r.de1nl.vIi.ni.dSreemn evdaisninmsk-eIIaknlisnkiknk:. Sternalpunksjonens betydning naverteeldfroertedtantiongmeredi bsekgrguemlpuinnggefei ltlemryoreg ptoaprepn. chSyonmuodritocflinnioi.isge vedliclietnksiedneiiii, XogfimKaihnilxiciii1l8i0k8e ifnolrviastrehubnednrmesakrgifstfeotraonfdfcrnintlgige-r hvaadr dsetrrooknlegtenoovleorgeignjefno.rst satt siliko-tubcrktilosc", men detle agvjortIldcotsiilnegfeairngeenmesetomdoer.fosloongiib, alriainr ulkilgignjiokretreet vnroevrtercklsatrudoiuvmer eTnimlfde.lloegt jbelge faovretKokikistmryagi d1e9v3e9rkeeilt mmspeeldktsjotdu aO\sldoenArbbeeditnlslt- mategenet iisnldoor rshoekteyltsiellianvg bveenilnieanrgrcctikkientrsaykvtliotaumnuevri.lleFvnxrreekakvc hatvohrainveikdkkeoihnamdedre.dearbheaidddeet amrbedeidveatnlcig:a s2e5inaern.t, Dmeetnvmiseted sseag fiokrlsiknetrkekclina,r mdeernfodrefolirasrokatlioa vfiineirtte aivncetondsear isiotnnigrkiipneitnideehrituaklteisr kjearlntslasgygr,efca:sat 1se5i%nenatsb. est Doegnncc:a b1e1s1t%o saovlvee:raglo7i2l--%I'bfOm.mal(1t -b-ar i kmimaniigeet ftiitlfaellmleinrneetlieig kainruvregnidseklese.imtDgreetp v--aratfodrest ikvkede gdiefntnncmgforhboisndsealmsctlnigkeanarbneevidneerse atveddetdei bUilKeWbebdleripftAevnis--t bilyaflot r5- Askmapxtkienns minentfoodreelsseomav vsetdernsainlpuennkksejlohneetnmiu1li9g2g9joart adtetbebnle- --nevongteenbaevstadnedmdedlcordefoarvegdikekt.)inAntriblei1d9e3t1 mv.ehdj.ab.lalinAdnindgskuafvfindge ntotalorggsisuknedeilrisaogkneolssteinkkn. i iInndgeAfrorsloompneet Avrikhtaigr mleedtdodi ednenvilstetnsiian- iunnndeelruknkkeet limgassktoinv.iitvikllng, senere lrar det foregAtt i en vfriudekothaormhetbveendmaerngsreokrgkacnnent.dersokelser som har utdypet var toiJaetg, fmoersnokmteed pnaevgiasteivatsbrcesstuolstealle.gemDeerttie pkaasniengtoendst cskksypldeeks- de Mfninnnojsiopmgavliearhepiraikctibsigk ebretaydginienng oivderesnikitndorvee-rmecndlsdienlskave netftuelrlkaomniemreiknanteskkneikekrf,arminegnerdeltykekres\erddet aAlepgagveisme earskbeestliol sae-t kliDniekktm. g en ved steriialpunksjoneii legger vekt pA er: lgeegneomloegrisbkarpeavhiossl klunnagpetashbaelsvtposaer.ten av individer med rontHos en tuberkuls arbeider som gjennom eil rrekke har 21)) pasiipnirkulsajtoentsssimneaiklreonskopiske utseende II avsabretst,utbseastkt rifvoers ianltnsandavingronatvgensotolo\,g estombillbeld.ea. soimnnemhionknleerr 3 1)) cpeulilifklitcnstemtsorefeollloegriik. iloiii homet isidliikaog-ntousbeeni,kbulleosbei.lledFeonre msenndmt unleigd tAilbTriynsgkelansldosnfvrekmlsatre- bliDr oftidligvgiekriigi sstocli.ciotsg lsiaotmuriadt edtetfobiglierncdcellcvncesscnmlloirgfoslkoagli soomm- rDornetsgdeennol--og opgAbaanssbeustttouslecnFse oanvir2a0d'e m--ai 1p9r3o9felsysdoer r Si .uuldptr;agi talHcsa.r m.leagn vuillfdoorlg elnordsetl spiunnokcsnjtmorcdr,ommardkeeracnnilsrenajritnnaktptcars.ien- somJefgolagnetnar at der foreligger lette asbestotiske torandringer tneanro enrcaagsepricircrpamafrogrs.kjHclelitgydviiiisngmeieid alvieitislcynnnetiflosrnskiejerllelefiotlekiasne som med heiisyn til sladiemiideling knnne s\are td stad. I, t ilt r nun erbiring korl nttrylikes slik; mrieutliigkekieisepr abegirtetnyspeinskt.il sVtaedd.asIIb.esltionsiedlseerrtiedn mnenjdeigg siiaalmt iDninllee--- Pas. med lnioyprmcrapllabsetinsmk aigberieimagaerrger rmeeatglerteyrdelmigedsinemrtee,get eliignleient egnedrainglieienre Stcrahnlegimeraskeeindgeebmetlttetteegnfienignesrte mFullecmkcehinenin. asntoaneem,iatildetlesrnciekisoessasiv osginekrtoen, gemneisttt-linetntaioltlytvisekd Ivhanosikveildigt detsi o.g.s.A Fiunrnagnadrrinengenleett i soilvirkeo,tishkoykreointoppopneneit, aelrt icterus. Ved aptasier, og nierkelig noli ved en rekkc lymfatiskc ffoorreglirgogveer teilldre ptausbseerktuillesne afosbraensdtorsineg, ejre.g antar at det her ianstpiilrtarasjsojonns-esrnicavrte.beninargen, er det prnktisk talt liigcn avPAintbeerngijsatrini gJualvi l1l9ik3s9trysogmdevlerskinet ebrlkehpearsiniegntbeili.a.unadteifrnsrockrt: Mdeeltlnloierutitsnylne tpilnnpkutnakttafteetttspamrtaikkrloesrksoapiinstkenuulisregepnadretikinlenrcbaovldeenr gHelasner voirgkekrlasgveark oovgersltaupnpg,pbulsirtelneltitetanodgpussvtaeknhevtedi akniusetrrenne. alyvs ifnoargrgepiaertlikfolerlri,olotlgc:havis dvisesde Iliiyyppeerrppllaassiicerr etrilatnvreirnyntrlonpdodee-t Dbeegtgeerto3jicpmirf--orsskijeerllligmhcollyorme tdoypppes-t-ee rinnd-etogletuttAdnudnmjngn. g Omveedr stivsiknnlieartumr,aarng|t>ararmtikalregnpea,rtmikelnesnefoefttleinennlirooltillelat rggeje. rVneedtailptlaars.icr ltyadllernikeforlmenidgdete*l.stoRroe,lltgikeknediakglnionsgeenndvearbdhaerseirh, korsees.pisrtaasdj.onIsI-. maPrugsnvkitiaktseotms liceellelnesnkdinutmensgitiret.et Ftinliureefrimneert gujettrrnyekakt fdoert bneonr- --verkPeAt gerrkuhnenrltag10a0v%leignevearklild.e.ringVeend efrorhnaynet auvndHeirkssotkreylgsdee-i mDaell!tefuemr etslogc:.iro5mPn-ie2l5i0getugsreennsceerll,ersnperr.lnigmio1pipsatde,rnaolgpuknakntaitkekte. jdaenn. s1a9tn-1i0ne.fanHteasn tihlastranfrdeemndeulefos rafunldlreetr,staltengienmg.svtktcn var tVnesil alibyspoelruptlta,sietira erbalondtatilllbeltafnoilvionkgte,nog svoemd aopfltaessitersperidaenrtailnlent. seDneieniitkveranstoitmatinvetvnvtikjetirgnsstleaggb,esotgansdpdoerlsmialedtenblisryrdeafnostmc nedFsoartto. mtaicn av cedenes nwr/ologi skal dercs fordeling og dSelattgegsetnovientnhkoalndehra scp:ailt5n5o%eti keitsioell,ogtiusekn rodlelnenfcorebranbsansdyektdosumm, utsTeuebnedde Ii deerlennosiaminalmeepnsutnilkllinatg kaovrtfusntrneiafevs.normal benmaig ; Asilviksaitleirkaitfconrebinerdedlseet mluetdtilFabaorge Aals.blesrti Soigt),seerricikitkte stoilmstemileed. fgroad,1ofgorjfeagtlebiTar. seOlvvevreenilssetneinremkeklesennndmeerlslookmelsdeisrsefuenrneml etgaeltl sHivkkoerruhfeatrlbigarC.va-isstiliskeugt eAr,kfnrenmngeAfrreamv kuanldleerseonkeplnseevrmavoksoemmoesnct-. dsoommmlieggtleert ipnuntio'iliofgoriskdeisssetergnreanlpseurn.ktaFto,ieiirlsscetlnvifnoglgcendgfoart aenbee-r atrrobsesidehreer.forVafnlrigsesemmeenntatrbineindeehroeldearidcri:a s2ih0k%osek.i-.ekl,isemleenn teirl belVt efdormlriolllaigleumeadv dtieel pnaotorilnoaglies.kc forantlringer som bar vist nc:eand2i3g00btmsedmeetnstaorllbteiCd.ear-esiliikaDteer.1-FonrenrotentSglcamtemr daevrssotkrctelscbaaive 8 tilfelle av imevmokoniose, men samtlige tlis.se 3 arbeidere sneigessaigliaa sltioelrest stionflelertcssi eI fboor vkeddiauvkskncintt,, vnilentilleitg,vicrc liensiktsforantlringer i: I.ev kopoesen hHavdadejerlnitsillaiggegreen avniegratr,uftrseamtthefvoerr iIniunnaeiuralilnoggeiaivpiforliesSsiol>r 2.To-m. Rahtii at disse stovpartikler er meget liier skarpk.intet enn Dit relieulo-emloteliale system 11ombopoescii '. evialnrlioglles.tenstov, og det er mulig at dette foibold kan ha spilt Fi y trupoesen. l.erknpoesen: De storste forantlringer [inner en ved pura- , Vrkesaiiamneseii og rontgenbeskuvelsene tatt i betiakt- mijeloblustleukemu-n -- t iler som tlen ofte ved et dariig iiuvn