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FILE NAME State of the Art Literature SAL DATE 1948 DOC SAL045 DOCUMENT DESCRIPTION Excerpt from Journal Article - Asbestosis a 4h hy hy le ou KASMALIPANKINDASITABUSAN KASAMALIPANKINDASISTABUSANA KASMALIPANKINDASITABUSAN KASMALIPANKINDASISTABUSAN KASMALIPANKINDASITABUSAN KASAMALIPANKINDASISTABUSANA KASMALIPANKINDASITABUSAN KASMLIPANKDASITBUSAN KASMLIPNKDASITBUKNAMLPIDSTBUAN KASMLIPNDTABUSKMLIPNDASTBU KASMLIPNKDASTBKUASNMALIPNKIDASITABUSNA KASMLIPNKDASITBUNA KASMALIPANKINDASISTABUSAN VOLUME XTV MATINAL INSTRUTE OF HEALTH FEB 9 1903 C NUMBER 1 LIBRARY DISEASES DISEASES DISEASDISEE ASES S5os of the ; KASMLIPNDSTABU KASMLIPNDSTABUNKASAMALIPANKINDASISTABUSANA KOLA GANUCIANS GANUNCIANAS GANUCIANS GANUNCIANAS GANUNCIANAS GANUCIANS PUBLISHED BI MONTHLY 10 JANUARY - FEBRUARY TOULASI SAROKLEANIES 9 ener EXECUTIVE OFFICE 500 NORTH DEARBORN , PUBLICATION OFFICE ALAMOGORDO STREET CHICAGO 10 ROAD EL PASO TEXAS ILLINOIS Entered as Second Closs Matter August 18 1936 at the Postoffice at Under the Act of Congress of August 12 1912 Pase Tekas Copyright 1948 by the American College of Chest Physicians FOURTEENTH ANNUAL MEETING AMERICAN COLLEGE OF CHEST PHYSICIANS ; Congress Hotel Chicago IllinoJi unse 17.20 1948 tO Oe eRe ome oe, Volume XIV er refutado esto por investigaciones ulteriores aie Aunque la tuberculosis pulmonar _ are que en la serie ocurri^ con m^s frecuencia datos general de autopsias el an^lisis culdadoso de epe _ pertinentes no apoya la idea de los entre estas dos que exista alguna relaci^n me enfermedades mientras que por lo menos caso hubo datos que en un indicaron SM mejorando a^"n que la tuberculosis puede seguir cuando la asbestosis contin^"a avanzando SCE ' Carcinoma REFERENCES 1 Lynch K. M. and Smith W. A Lung J.A.M.A. 659 1930 Asbestosis Bodies in Sputum and 2 Idem Pulmonary Asbestosis II 3 Case Am Rev. Tuberc 643 Including 1931 the Report of a Pure ; Idem Pulmonary Asbestasis III Silicosts Am J. Cancer 24:56 Carcinoma 1935 of Lung in Asbesto- Idem Pulmonary Asbestosis IV . The ' 5 Objects in Idein the Lung J.A.MA. Asbestos J.A.MA. 1974 1937 Body and Similar EpithePullimaolnaMertyapAlsbaessitaosA ismVJ.. ACaRnecpeorrt5o6 f 7 Bro1n9c3h9ial ~, King E. J. Clegg J. W. and Rae V. M The Effect ~ of Asbestos 1946 and Aluminum on the Lungs of of Asbestos and Rabbits Thorax 188 9 GTulboeyrnceleS.4.9:3T1h9e33Morbid Anatomy and Histo; logy of Asbestosis Idem Case of Oat Cell Carcinoma of Tubercle 100 1936 11 Lung Occurring in Asbestosis ger Egbert D. and Geiger A. .: Report of Case with Pulmonary Necropsy Findings Asbestosis and Carcinoma 1936 Am Rev. Tuberc 143 12 Nordmann M Berufskrebs der e e forsch 288 1938 Asbestarbeiter Ztschr f Krebs- 13 Anderson C. S. and Dible J. .: ON Lung J. Hyg 185 1938 Silicosis and Carcinoma of the 14 Vorwald A. J. and Karr J. W Pulmonary e t cinoma Am J. Path 14:49 Pneumoconiosis 1938 and 15 Klotz M. .: Association of Silicosis . Car- Cancer 35:38 1939 and Carcinoma of Lung Am J. 16 Hollib H. B. and Angrist A Bronchiogenic 17 tion with Pulmonary Asbestosis Am J. Carcinoma Path in Associa- Homburger F The Coincidence of 123 1942 and Pulmonary Asbestosis Am J. PaPtrihma7ry9C7ar1c9i4n3oma of the Lung a Discussion LEOPOLD BRAHDY M.D. F.C.C.P. New York New York Prior to 1930 there was almost no mention literature of any specific disease due to in American medical and asbestos In the British French literature authors recorded high frequency of chest ere . oe Sm me he mm rm ne mee ee tee 886 . LYNCH ANd cannoN ~ . Nov. Dec. 1942 symptoms among asbestos workers and speculated on the relation of symptoms to the inhalation of asbestos or of silica or of iron or to other conditions associated with asbestos work There were- reports of a high tuberculosis morbidity among those exposed and general high mortality Some authors gave fair descriptions of the pathology or of the clinical picture of what we now call asbestosis but correlation of the pathology roentgen appearance _ and the essential factor in etiology was lacking There was con- sensus however that somehow asbestos work was harmful The International encyclopedia on Industrial diseases entitled Health and Occupation published in 1930 deplores the lack of more accurate detailed data on the asbestos hazard and goes on to say that the increasing utilization of asbestos urgently calls for ee e study of the condition 7 In 1930 Lynch and Smith published the first necropsy protocol together with the detailed occupational history which left no ee doubt that the disease is a lung fibrosis and is directly due to the inhalation of the asbestos in the dust R. S. Mills in the same year and later Lanza Gardner McConnell Pendergrass Shull Sparks Stone and others made important contributions In the seventeen years since that confession of confusion in the encyclopedla and Dr. Lynch's pioneer publication American medicine has progressed with speed in the knowledge of this condition Today we have had the privilege of hearing the latest report of the continuing observations by Dr. Lynch Some problems he tells us need further elucidation among them the relation to carcinoma Although we must keep an open mind the evidence warrants the tentative conclusion that asbestos workers do have ee a higher incidence of lung cancer Now that early lung cancer ee often is amenable to surgery this gives added value to the periodic EN chest ray survey among these workers and calls for more meti- ee re culous film interpretation than is essential in most survey work From the viewpoint of public health of diagnosis and of work- men's compensation adjudication observation is needed to establish a the etiologic relation or the absence of any relationship between | tuberculosis and asbestosis Many of the older clinical observations tee though not all favored the conclusion that there is a relationship |; ate end similar to that between silicosis and tuberculosis The report we wie have heard today does not confirm this view One statement or ee e rather the implication of one statement of Dr. Lynch must be interpreted in the light of other clinical experience Dr. Lynch .reported one case in which tuberculosis Improved in the face of te advancing asbestosis However we occasionally find tuberculosis One Improving in spite of the presence of silicosis and we do know that silicosis adversely affects tuberculosis Tuberculosis sometimes ee seal PAT TA TS . Tr : LA ey r > Eh Se a Tee le Nei mg te cape e . ecient g 4 ae tle ee nae tae Volume XIV ASBESTOSIS 887 heals under the most unfavorable conditions of the infected organ That tuberculosis may heal in the face of asbestosis therefore should not add any weight to either side in evaluating the effect of asbestosis on tuberculosis Dr. Lynch may not be conscious of a sermon to the clinician contained in his mortem reports He said that in most of the developed though not in advanced cases the history of asbestos exposure was traced after necropsy diagnosis To me that means that the clinicians neglected the occupational histories of their patients probably because there was another serious dis- ease present That the diagnosis was made mortem suggests there were not enough routine chest films made of these workers when they were well and certainly ination when they became ill We not sufficient chest examshould take to heart this failure to recognize the occupational disease during life Many new substances were introduced in industry in the last decade new compounds known only to the chemist today will be used in industry tomorrow Some of these substances may produce chest symptoms The clinician practising in the locality of the industry and not the pathologist should be the first to clearly wen, state that an industrial process is a health hazard The clinician must be the first to know what is equally important from a health viewpoint that some suspected industrial process is not pm a health hazard Let us reflect on the significance of the fact Me that twenty years ago hardly one of us would have suspected that the lung symptoms presented by one of our patients working on refrigerator insulation were directly due to asbestos Perhaps today set y:e some of us are missing the etiologic factor in cases that now are under our observation because we neglect the occupational history : Dr. Lynch's studies on the pathology would be of only passing interest if he had not combined them with investigations into the occupational history in each individual case It is the correlation which makes them a major contribution to medicine There are other conclusions of Dr. Lynch's applicable to problems of the clinician Dr. Lynch finds indications that when - exposure ends the disease develops but little further The prognosis there- fore is definite and that must be a comfort to the victim that makes it easier to get him readjusted to a new occupation and makes Workmen's Compensation adjudication much simpler Dr. Lynch is speaking of course of the fibrosis his statement must not be applied to the secondary cardiac embarrassment once that has begun That may progress even without exposure If I mis- interpret Dr. Lynch's conclusion I trust he will emphatically correct me The pathologic finding that fibrosis persists and ages into scar tissue explains the outstanding physical sign of the disease Te . oe, ae, Tere oe ee ke oe eee ee ee 888 . LYNCH AND cannon . Nov. Dec 1041 limitation of of symptoms expected chest expansion and also or signs directly related means that no recession to the fibrosis is to be exposure Another finding is that length of and severity of the disease are correlated This sounds evident but in silicosis we cannot make that statement This characteristic should enable us to concentrate and strengthen asbestosis finding among those workers who need it most i.e. those with long exposure and to be alert when examining a patient who declares Oh no that dust doesnot bother me I'm used to it worked there without trouble for twenty years Furthermore this correlation of exposure with severity enables a workmen's compensation board to equitably allocate liability when two or more employees with asbestos hazards are involved in the same case Then too Dr. Lynch's conclusions mean that when we have negative medical findings on a patient exposed for only a few months we can reassure him with confidence on the absence of dust disease It As if to balance these conclusions which make our jobs easier the newer observations indicating that nodular fibrosis may occur in asbestosis makes matters more complicated Now knowing that nodulation occurs in asbestosis not only the pathologic but also the roentgenologic distinction from silicosis becomes more blurred We must be more cautious or perhaps give up trying to reason from a film or pathologic finding as to the type of dust This has been an informative exposure presentation necessarily is an to unusual privilege be first hear repots of pioneer investigation from men whose publications have their place in the history of diseases of the chest I want to express my thanks to Dr. for that privilege today Lynch Discussion W. BERNARD YEGGE M.D. F.C.C.P. Denver Colorado I wish to compliment Dr. Lynch on the contribution he has made to our knowledge of asbestosis Pulmonary asbestosis differs from silicosis by size etc. of the particles inhaled and by chemical composition Asbestosis is caused by an alkali which is magnesium silicate along with calcium and iron In silicosis the offending dust particle is silicon dioxide In asbestosis the shape of the particle causes them to be arrested more often in the bronchioles and the alveoll and they are not so ee Ce ed er e noes rem e re a ne eee Roe 8 creer ey wee Aer Se oe tO Oe Ne, ne eee e ee noe te AA eee Pa omy eng + ye e, ool Tora a), eee ee SP ie ee ek ee wore