Document wr727ZRJ3oDnXqQr7Vy39e7gJ

FEB 23 'll 02:59PM BALDWIN .; . 4.;;Vr .,,*, `. -V' . ; Ml? - V ` TH HZDrCiL JQXJRXAL'QF AUSTRALIA * ;/ " * NECJJ0N0K0NI03IS L\* VICTORIAN INDUSTRY. ` 'hazardous, inasmuch ** the slUea-oontalnlog subwioov** . ar* newly grouncL The highest incidence was In a Ule .. (wall] works, vher* filnt was used in .considerable .. ...A . By D, L Cosbox Tjioata'a, '*'' . `. \ quantity. -*i / O'- ` ^,*\L Jfiuitriol Byplent Division, Victorian $lal Btalth .. * 4. Mineral earth worker* are tbs most exposed of slL * . . Department, Melbourne.' -t- , . Quartz; dlalomsceous earth and asbestos ore ground with usauaully maaeksessnhuifst mnaaccahiinnaery, auod tshbes daneaasl hnazarda ius < . 3i>ce the' end of TTorld War Jf Australia bu beeu-'under* ics rapid Industrial expansion in nil fields* coupled with extremely bad. One subject, a man aged thtrty*five Jrasrs,. '.? *<7 `died of naeocBpUcntad. elUcosls within nin* year* of com- V.* mencing employment. These places ha.ee an unenviable i * yy,scAle immigration. Although In 1959 ion* 439V 0f record of death and disablement. : * . .* ,-Billon*! income cornea from wooL the situation la the m to com* may well be different, In view of the ,- S. Masons'and'qnarryaen ara`exposed to the dB>ts'o(.`v^j:2" ttgei to health wbleb such industrialization b*S produced various types of stone.' Granite can contain up to 3f>9V of 'Xrt' the past in other countries* it was considered essential free silica, and St&weil stone and Sydney freestone are for -v v-^7-; obtain tom* facts on whaz had happened in Victorian ''all practical purposes 'pure sand. Sasalt quarryrsto caa'-^ iCpr\-' lustrr in the Immediate past In terms of Industrial < develop an X-ray picture whieh la hard to distinguish from. S at diseases. Without accurate knowledge of where the. slUcosts, but-these men are free from symptoms.-, zstds reeJIr'IU, It Is impossible to hare Industrial *- 5. BoilertaoksraAnd welder* are'ei passion "without a health toll. Without this Saowiedge Few In this gronp trs iQczpaeltstod. >ra can he no planning for the future..end the mere liclaff of regulations leaves much to ha desired In lha - 1. Ifetal Dollsher* are suhieoted !inf preventive medicine. Accordingly", in 1952 a survey dulecmin* the sources and Incidence of paeumonofconJesU !> .commenced by the Industrial Hygiene Division, and e various aspects of the findings are now presented. --:' The total number of eases'reported to the division prior the survey was S22, which Included 3*3 among miner* il 1*9 ln.di*rll cmm. The figures now read aa.followsr ini J12fi, with -337 in miner* and 539 In industry. The tzt Invualigatioos were carried out on. full site film r *hcs by 14 laches) on personnel who la the opinion tirfslon were employed in dusty trades* The total .* of individuals radiological!? examined was 5323. 7 ` S' v,, *"- -. Subjrct*' OcsuyetlfiBS.. Nltiubr XLXaudJnoulfijxmieia.lI-f IVCumesobKcet lf. yorumatto* - kreenufotuU- ' 7fMB-U*Zl*f -'iT-i.1-' .rr.*.^di*-.;*wS-.m| of piti*s . a-'. IlBdlfij ^r- ibis Z shows Iho results of (be Investigation. * * , Vtmldirl .. * . *. ' .* i th survey, th number of moulder* radiological!? Pflck. tile aed yetury jlued was 191$, sod the percentage affected was 4*9. ft< hundred nsbestes worker* ware examined sod this ?lniwwbnn ... .. ... .. :mlwr tould cover most of those exposed to dangerous .taunts of dry asbestos dust; here the percentage was 15. Ilatnl /artb ' >t\Ma* and auarmiws . PaUtrreaktia . . .. Tt: most dangerous occupation is mineral grinding* yirul-coluhm XsSesiM yortm... r;tr of quartz, and here 309V of those radiological!? Sp.-ay painUtt * . .ruined were affected.. In (he other categories the people .m>>d were those exposed to the greatest risks In the * .CTneuleftatdttameroarokte.W.nw* >,,. * > itiicular occupation, and not the employees as a whole, We*l (JTndtn ` - .. >ibat aqy compulation as to the percentage *Ceded in us* industries would be erroneous. In the 380 cases ClaenatompS epeiatOM .PryaWtMfa "... .. SloUa .. .. atirt.all the subjects bare been examined, their industrial Fcandiy fabeurwa uiorUs have been taken and their exposure to dust has tn confirmed- Apart from those suffering from asbestos!*, yiwr werkm *.* Cetaest wkm .. *. *0 Odd eecHjMtime " *- s grest major ley are slllcoticx. many of whom are. grossly ubled and many short.of breath,; others appear to b* l* well apart from, a slowing np and slight shortness BdcSLtfvn.. Sa4 mtiufk * ..J. . ._ : breath, and some are entirely symptomless. . . ; . "... ... Te^I `'V IT'1 * rr->:7 Vistd ess . ' s*ui. ' 1n*o1 ns vs*o a * ts - 47 IS . IJ .1 - .SSI n 1 ! si St 1J *n u 47 .7z t * 1 70. "4-S %> 30-0 * b. -- - vTi.f- iso - "1 -- " " i . i'A' {Xi$: UO -V . V ' Discussion. * ; *. ** 'J.-' . * f SitleCsi*. ; * _ i**, .tJ? ' " -.-V \ jtabher workers' are exposed to tale,* whJeh ts mag- If we consider the conditions la the various type*.of peslua silicate; this eaa produce similar effects to siuea-*'^v cupatloo vr find the following fncLnrs:-. - . - and a alotlUr radiological picture. ^ L Moulder* are exposed to silica'In the moulding sand 10. Cinema operator* are exposed to.caarrbooQnu. mstsllle ' V&U id oJten In the parting powder. One of the cleanest, inalrioi investigated produced the highest proportion of IcfXlar* (109V), owing to the fact (bat they were using, oxides, fluoride* rnd silica from ths carbon ato lights used " in the machines. ^ . . -. . . .! -s , lira flour, which Is very finely ground quartz, as a parting IL. A chance 21-ray picture of a'worker in n dry<leaniog ..v.v'v '.abied, ^,aar mould*** with Jong exposure are .gr oss.ly. - esUbllshment showed nodulation with no symptoaa 3nve- < -vy tigstlon showed that tUatomaceoua earth Is used in the 'ussers are exposed to moulding sand and to floe particles produced when castings are cleaned by ' process of dry cleaning and constitutes a hazard. of tbU indostry U under woy. .. , . . ,, A survey '* :AL wheels, automatic chisels and swing grinders. Tb* ' The radiological'appearance must not he used as a yard-; " '-.t 7 heral use are now power-driven, and recently stick to measure the severity or otherwise of the disease.. ;vk*w, hoi.# of exbauMing the actual tool are being evolved. Some subjects with gross X-ray changes are almost symp-- .f/V h lh*s* ra*-o hav gross X-ray changes which are out- lomless, while other* who are* gravely disabled bow very * .-*.'-`f' `l proporOoa to their sjwpiotQs, while others with less little abnormality. - orifti.n<#d changes are graTely nOeeUd. In cu&es In which- bulk of the Inhaled dust (s metal* the symptoms are uatly alight. _t in the survey there are several seta of brother* whoV*.*^ both developed silicosis in entirely 'different occupations, This suggests a familial tendency. One family group of ^ '* . 3- Wrlric. tils nml miurr worker* nr* exposed to eilles. scran boasts alx alJJcoilcs Affected in threw different ^ *** ii P.3/4. . FEB 23 '11. 03*00PM BALDWIN ^ v * '* *' ^` ' i' ;t r' . ` `.v* ... 7$ . * ' ..... '* ,, *' ^ -- \ '<'*,? *`V`* r * ?. # ** . .''-c. \ THE .HEDICAD JOURNAL Of AUSTRALIA . * . ' s ' 1 , * * 1 ' Jatoasy 1$, 195* 1 A person Quite unaware that he to suffering from siUeesis its us* in some process; mixing with dt&tomaceous earth can. After an acute pulmonary episode. become totally or kaolla to form legging materials; sawing-.cuLng and disabled 1q a very short da*. There are at least 20 llslsd finishing any produet containing aabestos^-for oaampls, who bar* gradnated from the "mild abort of breath* cla&a * brako lLainga, asbestos sheeting and various. Insulating to the "totally .disabled" 1st periods la all coirs Jess than material*; tearing down old lagging--this is a very i* four years. The ut of 3 millimetre film to generally dangeron* process, even Is th* open air; spraying aibeelo* unsatisfactory la (be diagnosis of pneunoflokonlosl*. Many on walla and cetU&gu u as Insulator* `. *. ' ' '" " This eonld explain under treatment tor doctors unwittingly by ... - . --. _ ------- , examinations thalr chest _ * fladlngs'wer* clear. The 32-ray appearances can return to {Z: normaLafter the aubjeet'* removal from expnore to some .dusts. This baa eearred with wood dust, powdered food. %.7*v -XT ''atorch and metal. Very law case* reported la this surrey i 1 Va*rteoAcoVmjlApfllicOaAtTeVdApdbAyfl tubere^MulOolsAlead.tkHoIweUvoVef fro, KseSvVewrMalUUcoaseAs / . * The pulmonary fibrosis f ashestce worker to Lnsldlous in Jta onset, irregular In Us course, and variable in its termination: hot once established it 'constitutes a grave threat to Uf and health. Briefly the `pathological changes are such that the air colls become obliterated by fibrous tlssua. As this progresses the lung tissue becomes used up and tbs elasticity of tbe lung deteriorates, the amount of lung available to carry out faDeUotu diminish** and arm>. toms appear, Tbe condition It progressive and Irreversible, and one the stigmata appear the subject should he removed from the hax&rd.' The main symptom la steadily increasing shortness of: breath. TOillo tbero la no evidence (hat J*\*.'' Both. silicosis and asbeeiosb ore so lnsldlona la their osbestosis predisposes the subject to scat* pulmonary infec I'PCi.-w' Jprogress sad so easily influenced by aente pulmonary* tions, tbs presencs of the condition seriously Impairs tbe '* conditions that It would appear wise to adrise the subject . chances of recovery when infactlos does oceur. Tbs advent to *e*k a_new occupation away from the hazard when of'the sulphonamld* drugs and of the antibiotics has ebort&ess of breath becomes apparent, Irrespective of hlg `` greatly improved the prognosis in these eases, v ; r^f>-Vj5: ^agt..The.following eaae HJusfxatas this: .. * 'Tie most sought after asbestos in Industry to tho typo 3a**3*32 a moulder of twenty years'- standing wan found to .with long needles, but unfortunately this Is th* most, have, typical sUJcotie X-ray appnaces with Bcdole-Uon hazardous type to handle. Tbs needles enter the lung by l.>wr *7- ud ra/ld sympteos He vcaa earning big mosey and did not V'V"- ' .feel dtopc**4 to-give up Ms job. In 1333 be had Influenza g-*TT,VWith jVwiuiuuucy complications, end today he Is completely jAC-I-:. *J Incapacitated. ... . * :f*V'` `r? i.` The fact that pathological changes can continue la the ,.'1uds5 Joog after remora) from the hazard must also he r-T'V'. .realised. ^ . . : . , *. , .. Inhalation, and after a time undergo changes in appear ance and are then known a* asbestosto bodies. They are brows or yellow in colour and* are found In no other condition. The bodies sre all scodlfica'iona of a straight fibre and are shaped like dumb-bells, a drum major's baton, and so on. It is impossible to stats at what period these appear, hat they hev* been found in this surrey ns surly vx A Vwmith. now sped IhLrty-nJae years, was employed ta * as fifteen month* slur exposure commenced. The presume* a pottery plant. She worked there from the ape of fourteen of tbess bodies must not b* regarded as diagnostic of a*be*> . year* ujitll she wae tweqcy-o&e, when she married. She had tiuve children and carried on quite happily until floe*year* ape, when ihe hejau to he ehort of breath, and an *ray esamln.i'<r\n rhrealcd iibsoRnMlrr. Her condition was tesla, but it 5s conclusive proof that'ths patient.ha* beeo 1(' exposed and that soma abnormal process to at work tbe )u&^> .** ,; . * . In eventually dUgnoied as sUleoris after tentative diagnoses of ETsKki silicosis, (he radiological findings in aabeatovfs tuborrulesls and a.-vrceldeoie were dieproTM. *. . * are Jn accord with tbs severity of the symptoms. The Aa Inadequate industrial history' delayed the correct dies', greater the incapacity, the more one aspects to see in th* nosls in this ease. _ . * . X-ray film. In the well-developed ease tbe bases of the 4,\ ;. ,, There lu jMiercettns suhiects who served in the k**\* Western Desert with the JRoyet Asstrr.liaa Air Fore* during t.. s.. . * the last war. They were mechanics is fixed camps and their .'V'X-ray findings are typically sillcotie. It would appear that r< '>-' they developed the condition on serriew Heavy transports i.-"* - - ,i.ud.Uniters probably ground the sand to powder fineness, *d .the'prapcllem these men tufd to swing1 produced aa ^r;v.' intensely beaTy cloud of pure silica. ' . . ..'.* ' ' * ' * lnng*, more especially the right, show a ground-glass appearaneo, and the outline of the heart to Irregular or "shaggy*. Zt is felly realised that a radiological diagnosis of early asbrstoila to extremely difficult, and our eases were regarded as such only after (he most careful con* sideratlon. A few films picked out at random were sent to England for review, non* of-them being from well* developed oases. One case wen accepted at asbeetoeto on English standards. . In tbs others, while It was admitted Mm>7 Incapacitated men could cops with fi sedentary* there were increased markings at thd lung bases, (he i Jh if it were not for the effort of tnsvelUng to and from viewer stated (hat he had seen many similar films la bto v-Tr>'' -- worfc. In view of the prcgresslre nature of the disease*. area from people who had never been .exposed to asbestos. s*T'~ - aad the limited sum payable u> coapensatlon. we adrise However, a* these film* were taken in a highly Indus* aCectrd people to rea&in at worh an long as pojslble--one trlallsed area where log. soot and smoke abound, it to c* oi tbe hnsard, of coarse.' Tbe ability to continue in usefnl thought that, to compare tbess with films, of Australian* '3^7'* ' imployme&t is otiea Increased by a. course of physio*. of tbs same age* proved nothing. Criticism will no doubt v ,. - . * ...; ..,* - *; 'C. he directed at the standards of diagnosis; hat tr one wait* -/-t.* .AebcefosU..' '..* *\*.* .until the stigmata of a we!)*dvalopsd case appear, one "in the section of the earrey retotijig to asbestos workers, can do littls for the patleaL ,* . eoatainiss ashes* ' It does not follow that everyone to* going to accept the flndln advice tendered to leave the hazard; .hut sine* the number from short' of worker* in this group to comparatively small, th* ' ness of breath oa' exertion to gross Incapacity. realization that their friend who was supposed to have The procedore adopted was as follows; Specimens 1 a weak heart lor a long time to actually suffering from /-.'b' ; .*pu(nm were taken and examined for the presence of asbestos!* and It eligible for compensation Is making most - bodies. 'When these were demonstrated, the patient was worker* very conscious of the hazard. Much more care ^r':s_!rai}^J0?leaUf examined. VTisn both tests gave positive has been exercised by the workers la recent times, cud resttlts tbe patient w InterrJewed, a complete industrial they ure much more easily, persuaded to wear a mask. r-**.-- * Vu.-. blstory was token and bis clinical condition was assessed, jf be had syippteoj* rcierohie to the disease a diagnosis of n>b'*tosU was made and the patient was odrised to apply to the Workers' Compansatlos Coarniissloo for acceptance of bis disability. Subsequently practleaHy all workers exposed to dry asbestos have been radiologlcally examined, . 'Tho most common symptom to shortness of breath oa exertiom Tightness lo (he chest and pain Is tbe chest are not uncommon, with lack'of energy and tiredness. Most patient* show an improvement otter a course of physio- therapy. The pstlenU given a course of physiotherapy had all been accepted for compensation, and all were kept '..ijl - The' follmring occapetiofts are iarolred; haudliag the in hospital for at least a month, so that the rest and substance la its raw state; grinding (he substance prior to elimination of worry for (be future were also beoeflclal . ,, FEB 23 '11 03:01PM BALDWIN ... . ... . ^.. ... . 4 Jigi 1SS7 ' MEDICAL J0E7RNAL OF AUSTAAZ2A. P.4/4 - . 77 !1 .fcitiors. 'Alt those given this court* Are atili working at REMARKS ON CHRONIC GASTRITIS, TfiTH SPECIAL light -.aedenUry occupations. When this survey started, REFERENCE* TO THE PREVALENT XNEFFJCffiNCT IN ttjht cases ot asbestesls had beta reported sad the disease was resided fit a rarity. Zt trill he seen from the figures THE EXAMINATION OF ^HE GASTRIC CONTENTS. \t the Sneldcaee ot the `Blseese t Ur too high. la A.'. /.iS.><'' *' Jltloa to those found la the Investigation. there must ,. # Sr v. j. Ki.xsrt.iA. *.* . . :r- - Te many more older folk suffering from the complaint io whoa it has aot beta diagnosed, end who are iacapael* uted and .very poorly off financially, and should be receiving adequate* compensation. . v/ ' From fbs Deportment of Ocstr^Entereloyy, Saint Vincent'* . - '/ /, Eotpital, Sydney, . : . . .* ` /.'j';'",' . * ,, ' : a* ` ` fc . . . .......... . 'V. > .* . .- Summery. > ,. '\ ' C ^tnznon^onloilB were, discharge* are ia fact a'sigi of the disease la the iouad In Industry la Victoria. No doubt there are many w*h#, Diagnosis and treatment would lose considerably Bora, either syraptomless or undiagnosed.. .- a this'eleaeaferero neglected. Thus, the natal aad poet - Silicosis and asbeitosb are !not diseases of the aged. aasai discharges. Lhe spuLua pot, the urinary testing glass Jfany of these subjects belong to the thirty, to fifty years sad the -oya group, and tor this reason It Is imperative that eon- valuable ditions improve la can occur together, the dusty trades.".The tw conditions * l causing gross disability. Six affected * success"sebarges!,, or a change la thetr quality, provides," .persons, irbo showed modulation and also asbestosla bodies," .wuabia evidence of the progress of treatment. . , were found in the same factory. They, are Tery disabled, - Bat the atomechh b unlq.ne. - When It b 'stricken, its ' / sad two are aged under forty years. * lean are often Ig"nored*;t"he natuure of iIts disease Is thhuuss: V ';< '.rf ' The survey illustrates the necessity'of Impressing on medical practitioners the need for taking a complete Indus trial history of all patients Irrespective of sex. It is not suCJelrnt to ask a person bis or her occupation--* bread carter today may have been a miner twenty years, ago. Many vojueu hare worked and are still working, although the hazards .vv >r* 1## damaging. unrecognlsed. A faulty prognosis Is gi'ves, aad.in.ep.t, .tre.at*.>'' -v-' meat la ordered,, . ," -.- , -v . .. For thla, several factors' are rveesapnonaaiibbllea. *'O0nooe..Iis. the - . . I neglectful report* on the gastrin contests made by patholo* gists and biochemists. A few years ego t asked a senior : .^V-. teaching biochemist why he gave no report about mucus ',/.*;' In fractional test meals. Ha gave aa the reason that the " Industry In Victoria Is becoming While these InTestigatlons have been Industrial Hygiene Dlrlsloa has been . _. -the suppression o dust. Unions haT* sponsored the survey merely because its Interpretation la difficult. Mortovar, &d:*mplo?ers have been most cooperative In allowing their , there -Is alvrayn the chance that somebody else may socceed ptreoanal to be radioTogicaHy examined In the firm's time.' in the interpretation. Thus, by examining the respiratory T he firms where cases have been found, close inspections tract, tbe clinician may get a very good idea as to whether been made, and where possible conditions bare been it is the source of tbe'discharge. But even the biochemist, , motored by exhaust ventilation, by better housekeeping, If properly Instructed la his art, should be able to make - - r by the elimination of the hazardous substance. The use* the distinction easily.- . ' '1 respiratory devices Is recommended only when th* If the excess mucus* Is gastric in origin, it appears la baurd Is of abort duration and when other methods cannot each specimen. It I* Intimately mixed with the gastric , W used cfcc^ivcl/. Conditions In Industry can be greatly contents, so- that, when the contents are poured from one - Japroved in many ,,by wry simple means--1oven test-tube to another,'they are seen to ba more viscous. *' `lamping down the floors itos foundry Ted to Mg reductions ' The mucus b finely flocculated. An approximate qqou:aati* la dust counts. , ' . ; < tsUve account of this mucus, can b' e given In terrmns of Legislation has beeeenn Introduced to try to-Improve eon- filtration T*` ''% , **. * '* ,* ditloas. Quarts grinding has been declared a dangerous trade. This mesas that any premises used for the process must be registered, and In the event of the regulations, aot being complied with the registration can be withdrawn sad the firm becomes liable if Jt continues to work in an serejistcred building. . ` . , , *. .Mucus from-the respiratory tra'ct occurs chiefly la the : fasting gastric contents, it is In larger discrete aiww, It ` often includes air bubbles, it Is easily seen whan pressed . out nndar a corar-altp, and it floats on the surface of the,.' jT; gastric contents, Tbe discovery of sneh mucus or mneo*` ' pas may giro a valuable therapeutic Mat to (he.clinfcian. ^ Aabwtea regulations are awaiting gnzettab These are: The fasting gsebrie contents should then'ba `examined.'; . `microscopically. .Gastric mucus contains the suelel- of 4' Je*T stringent, asd when In fores will lead to a big leucocytes whose cytoplasm has beta'digested, staining . aproreiuent in eonditioos. However, the most Important- deeply with methylene blue, and columnar or goblet eella uagle factor Is to educate the worker to protect himself, In gastritis, there may be large numbers of granular cells - llaar, many times on* can see expensive/ moat effective (these are desquamated glandular cells) or a persistent tabaast apparatus rendered useless by some worker who Increase'in leucoeytae. In cancer oae may find polygonal,' - `didn't like the draught" pushing' a' bag up a duet or some '.round or c.ylindrical cells., with characteristic volume.. Hbtr equally silly practice. . . - 'density and multiplicity of a'ueleL Eosinophils cells may Xfheu one has seen the e'nd result's of `these two d'u' st' ' wvxsrs--the gross incapacity, the patients* realization eat the steady deterioration 1$ inevitable,' and In many. -give the clue to an allergy. . * **'! `.mV Kaso-phoryngeal mucus may contain squamous epithelial cells and carbon partleles, . , . * . . >' as the financial difficulties due to their haring used up a coippeBjaiion paid--it becomes Imperative to ensure * Note should also be made of 'the. bacterial population. It* Is increased la hypoehlorhydric gastritis and Ja cancer. Mt ns industry expands. Industrial bygieoe matches the - A second reason for the failure to study, the eestrie' ibaoslou stride for stride. 4 ..*... discharges Is the lack of Interest' In and understanding of 1 gastritis on the part of clinicians. This is not peculiar to " % Acknewltdgswent*. * Australia. The position was Hlumioated by a conversation with a distinguished British gastroenterologist (Dr. "X") . 'h.inks are due to Dr. Keith Hollam* tor his invaluable as follows:. ` . . '' Wb tbe radiological side, and to Dr. D. O. Sblels for Dr. "X"':{ *`I do not belief# that gastritis Is a common* vsasoy discussions on dust problems. . . ' *. dlacaso. %a . ^ \\ . ft .<>. il in v^